Joints in the body

Transcription

Joints in the body

Joints in the body
1.2
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Contents
Articles
Ball and socket joint
1
Hinge joint
3
Condyloid joint
4
Knee
5
Elbow
19
Hip
30
Wrist
38
References
Article Sources and Contributors
43
Image Sources, Licenses and Contributors
44
Article Licenses
License
46
1
Latin = Articulatio sphaeroidea
1: Ball and socket joint; 2: Condyloid jointor the (Ellipsoid); 3: Saddle joint; 4 Hinge joint; 5: Pivot joint;
Capsule of shoulder-joint (distended). Anterior aspect.
Gray's
subject #70 287
[1]
The ball and socket joint (or spheroidal joint) is a joint in which the ball-shaped surface of one rounded bone fits
into the cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of
axes, which have one common center. It enables the bone to move in many planes (almost all directions).
An enarthrosis is a special kind of spheroidal joint in which the socket covers the sphere beyond its equator.[2]
2
Examples
Examples of this form of articulation are found in the hip, where the rounded head of the femur (ball) rests in the
cup-like acetabulum (socket) of the pelvis, and in the glenohumeral joint of the shoulder, where the rounded head of
the humerus (ball) rests in the cup-like glenoid fossa (socket) of the shoulder blade.[3] It should be noted that the
shoulder includes a Sternoclavicular articulation joint.
Additional images
Hip
Shoulder
References
[1] http:/ / education. yahoo. com/ reference/ gray/ subjects/ subject?id=70#p287
[2] Platzer, Werner (2008) Color Atlas of Human Anatomy, Volume 1, p.28 (http:/ / books. google. com/ books?id=T9bb4T422j8C& pg=PA28)
[3] And the phalanges (toes, fingers). Module - Introduction to Joints (http:/ / anatomy. med. umich. edu/ modules/ joints_module/ joints_20.
html)
This article incorporates text from a public domain edition of Gray's Anatomy.
Hinge joint
3
Hinge joint
Hinge joint
Metacarpophalangeal articulation and articulations of digit. Ulnar aspect.
Latin
articulatio gynglimus
Gray's
subject #70 285
[1]
A hinge joint (ginglymus) is a bone joint in which the articular surfaces are molded to each other in such a manner
as to permit motion only in one plane.
The direction which the distal bone takes in this motion is seldom in the same plane as that of the axis of the
proximal bone; there is usually a certain amount of deviation from the straight line during flexion.
The articular surfaces of the bones are connected by strong collateral ligaments.
The best examples of ginglymus are the interphalangeal joints and the joint between the humerus and ulna. The knee
joints and ankle joints are less typical, as they allow a slight degree of rotation or of side-to-side movement in certain
positions of the limb. The knee is the largest hinge joint in the human body.
Hinge and pivot joints can be both considered cylindrical joints.[2] An hinge joint can be considered a modified sellar
joint, with reduced movement.
Similar objects that work like hinged joints are door hinges, closet doors, dog flaps etc.
References
[2] Platzer, Werner (2008) Color Atlas of Human Anatomy, Volume 1, p.28 (http:/ / books. google. com/ books?id=T9bb4T422j8C& pg=PA28)
It altso moves back and forth
External links
• Diagram at ntu.edu.tw (http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/
JointStructionAndFunciton.htm)
• Hinge Joint information and diagram (http://www.hingejoint.net)
Condyloid joint
4
Condyloid joint
Condyloid joint
1: Ball and socket joint; 2: Condyloid joint (Ellipsoid); 3: Saddle joint; 4 Hinge joint; 5: Pivot joint;
Ligaments of wrist. Anterior view
Latin
articulatio ellipsoidea
Gray's
subject #70 285
[1]
A condyloid joint (also called condylar, ellipsoidal, or bicondylar) is an ovoid articular surface, or condyle that is
received into an elliptical cavity. This permits movement in two planes, allowing flexion, extension, adduction,
abduction, and circumduction.
Examples
Examples include:[1]
• the wrist-joint
• metacarpophalangeal joints
• metatarsophalangeal joints
These are also called ellipsoid joints. Oval shaped condyle of one bone fits into elliptical cavity of other bone. These
joints allow biaxial movements i.e foreword-backward and side to side but not rotation. Radius carpal, Metacarpophalangeal joints are examples of condyloid joint.
References
[1] Module - Introduction to Joints (http:/ / anatomy. med. umich. edu/ modules/ joints_module/ joints_18. html)
This article incorporates text from a public domain edition of Gray's Anatomy.
Knee
5
Knee
Knee
Right male knee
Latin
Articulatio genus
Gray's
subject #93 839
Nerve
Femoral, obturator, sciatic
MeSH
Knee
[1]
[2]
Dorlands/Elsevier Knee [3]
The knee joint joins the thigh with the leg and consists of two
articulations: one between the femur and tibia, and one between the
femur and patella. It is the largest joint in the human body.[4] The knee
is a mobile trocho-ginglymus (a pivotal hinge joint),[5] which permits
flexion and extension as well as a slight internal and external rotation.
Although the design of knee joint has not changed fundamentally over
millennia, it is vulnerable to both acute injury and the development of
osteoarthritis.
It is often grouped into tibiofemoral and patellofemoral components.
(The fibular collateral ligament is often considered with tibiofemoral
components.)
Real-time MRI- Knee (central)
Human anatomy
The knee is a hinge type synovial joint, which is composed of three
functional compartments: the femoropatellar articulation consists of the
patella, or "kneecap", and the patellar groove on the front of the femur
through which it slides; and the medial and lateral femorotibial
articulations linking the femur, or thigh bone, with the tibia, the main
bone of the lower leg.[6] The joint is bathed in synovial fluid which is
Articular surfaces of femur.
contained inside the synovial membrane called the joint capsule. The
posterolateral corner of the knee is an area that has recently been the subject of renewed scrutiny and research.
Knee
The knee is one of the most important joints of our body. It plays an
essential role in movement related to carrying the body weight in
horizontal (running and walking) and vertical (jumps) directions.
At birth, a baby will not have a conventional knee cap, but a growth
formed of cartilage. By the time that the child is 3-5 years of age,
ossification will have replaced the cartilage with bone. Because it is the
largest sesamoid bone in the human body, the ossification process
takes significantly longer.[7]
Articular bodies
The articular bodies of the femur are its lateral and medial condyles.
Articular surfaces of tibia.
These diverge slightly distally and posteriorly, with the lateral condyle
being wider in front than at the back while the medial condyle is of
more constant width.[8] The radius of the condyles' curvature in the sagittal plane becomes smaller toward the back.
This diminishing radius produces a series of involute midpoints (i.e. located on a spiral). The resulting series of
transverse axes permit the sliding and rolling motion in the flexing knee while ensuring the collateral ligaments are
sufficiently lax to permit the rotation associated with the curvature of the medial condyle about a vertical axis.[9]
The pair of tibial condyles are separated by the intercondylar eminence composed of a lateral and a medial
tubercle.[10]
The patella is inserted into the thin anterior wall of the joint capsule. On its posterior surface is a lateral and a medial
articular surface, both of which communicate with the patellar surface which unites the two femoral condyles on the
anterior side of the bone's distal end.[11]
Articular capsule
Lateral and posterior aspects of right knee
The articular capsule has a synovial and a fibrous membrane separated by fatty deposits. Anteriorly, the synovial
membrane is attached on the margin of the cartilage both on the femur and the tibia, but on the femur, the
suprapatellar bursa or recess extends the joint space proximally.[12] The suprapatellar bursa is prevented from being
pinched during extension by the articularis genu muscle. Behind, the synovial membrane is attached to the margins
of the two femoral condyles which produces two extensions similar to the anterior recess. Between these two
extensions, the synovial membrane passes in front of the two cruciate ligaments at the center of the joint, thus
forming a pocket direct inward.
Mainly made of hylaine cartilage
6
Knee
Bursae
Numerous bursae surround the knee joint. The largest communicative bursa is the suprapatellar bursa described
above. Four considerably smaller bursae are located on the back of the knee. Two non-communicative bursae are
located in front of the patella and below the patellar tendon, and others are sometimes present.
They are bright on MR T2WI.
Cartilage
Cartilage is a thin, elastic tissue that protects the bone and makes certain that the joint surfaces can slide easily over
each other. Cartilage ensures supple knee movement. There are two types of joint cartilage in the knees: fibrous
cartilage (the meniscus) and hyaline cartilage. Fibrous cartilage has tensile strength and can resist pressure. Hyaline
cartilage covers the surface along which the joints move. Cartilage will wear over the years. Cartilage has a very
limited capacity for self-restoration. The newly formed tissue will generally consist of a large part of fibrous
cartilage of lesser quality than the original hyaline cartilage. As a result, new cracks and tears will form in the
cartilage over time.
Menisci
The articular disks of the knee-joint are called menisci because they only partly divide the joint space.[13] These two
disks, the medial meniscus and the lateral meniscus, consist of connective tissue with extensive collagen fibers
containing cartilage-like cells. Strong fibers run along the menisci from one attachment to the other, while weaker
radial fibers are interlaced with the former. The menisci are flattened at the center of the knee joint, fused with the
synovial membrane laterally, and can move over the tibial surface. [14]
The menisci serve to protect the ends of the bones from rubbing on each other and to effectively deepen the tibial
sockets into which the femur attaches. They also play a role in shock absorption, and may be cracked, or torn, when
the knee is forcefully rotated and/or bent.
Ligaments
The ligaments surrounding the knee joint offer stability by limiting
movements and, together with several menisci and bursae, protect the
articular capsule.
Intracapsular
The knee is stabilized by a pair of cruciate ligaments. The anterior
cruciate ligament (ACL) stretches from the lateral condyle of femur to
the anterior intercondylar area. The ACL is critically important
because it prevents the tibia from being pushed too far anterior relative
to the femur. It is often torn during twisting or bending of the knee.
The posterior cruciate ligament (PCL) stretches from medial condyle
Anterolateral aspect of right knee.
of femur to the posterior intercondylar area. Injury to this ligament is
uncommon but can occur as a direct result of forced trauma to the ligament. This ligament prevents posterior
displacement of the tibia relative to the femur.
The transverse ligament stretches from the lateral meniscus to the medial meniscus. It passes in front of the menisci.
It
is
divided
into
7
Knee
8
several strips in 10% of cases. The two menisci are attached to each
other anteriorly by the ligament.[15] The posterior and anterior
meniscofemoral ligaments stretch from the posterior horn of the lateral
meniscus to the medial femoral condyle. They pass posteriorly behind
the posterior cruciate ligament. The posterior meniscofemoral ligament
is more commonly present (30%); both ligaments are present less
often. The meniscotibial ligaments (or "coronary") stretches from
inferior edges of the mensici to the periphery of the tibial plateaus.
Extracapsular
The patellar ligament connects the patella to the tuberosity of the tibia.
It is also occasionally called the patellar tendon because there is no
Anteromedial aspect of knee
definite separation between the quadriceps tendon (which surrounds
the patella) and the area connecting the patella to the tibia.[16] This
very strong ligament helps give the patella its mechanical leverage[17] and also functions as a cap for the condyles of
the femur. Laterally and medially to the patellar ligament the lateral and medial patellar retinacula connect fibers
from the vasti lateralis and medialis muscles to the tibia. Some fibers from the iliotibial tract radiate into the lateral
retinaculum and the medial retinaculum receives some transverse fibers arising on the medial femoral epicondyle.
The medial collateral ligament (MCL a.k.a. "tibial") stretches from the medial epicondyle of the femur to the medial
tibial condyle. It is composed of three groups of fibers, one stretching between the two bones, and two fused with the
medial meniscus. The MCL is partly covered by the pes anserinus and the tendon of the semimembranosus passes
under it. It protects the medial side of the knee from being bent open by a stress applied to the lateral side of the knee
(a valgus force). The lateral collateral ligament (LCL a.k.a. "fibular") stretches from the lateral epicondyle of the
femur to the head of fibula. It is separate from both the joint capsule and the lateral meniscus. It protects the lateral
side from an inside bending force (a varus force).
Lastly, there are two ligaments on the dorsal side of the knee. The oblique popliteal ligament is a radiation of the
tendon of the semimembranosus on the medial side, from where it is direct laterally and proximally. The arcuate
popliteal ligament originates on the apex of the head of the fibula to stretch proximally, crosses the tendon of the
popliteus muscle, and passes into the capsule.
Movements
Maximum movements[18] and muscles[19]
Extension 5-10°
Flexion 120-150°
Quadriceps (with
(In order of importance)
some assistance from
Semimembranosus
the Tensor fasciae latae) Semitendinosus
Biceps femoris
Gracilis
Sartorius
Popliteus
Gastrocnemius
Internal rotation* 10° External rotation* 30-40°
Knee
9
(In order of importance) Biceps femoris
Semimembranosus
Semitendinosus
Gracilis Sartorius
Popliteus
*(knee flexed 90°)
The knee permits flexion and extension about a virtual transverse axis, as well as a slight medial and lateral rotation
about the axis of the lower leg in the flexed position. The knee joint is called "mobile" because the femur and lateral
meniscus move[20] over the tibia during rotation, while the femur rolls and glides over both menisci during
extension-flexion.[21]
The center of the transverse axis of the extension/flexion movements is located where both collateral ligaments and
both cruciate ligaments intersect. This center moves upward and backward during flexion, while the distance
between the center and the articular surfaces of the femur changes dynamically with the decreasing curvature of the
femoral condyles. The total range of motion is dependent on several parameters such as soft-tissue restraints, active
insufficiency, and hamstring tightness.
Extended position
With the knee extended both the lateral and medial collateral ligaments, as well as the anterior part of the anterior
cruciate ligament, are taut. During extension, the femoral condyles glide into a position which causes the complete
unfolding of the tibial collateral ligament. During the last 10° of extension, an obligatory terminal rotation is
triggered in which the knee is rotated medially 5°. The final rotation is produced by a lateral rotation of the tibia in
the non-weight-bearing leg, and by a medial rotation of the femur in the weight-bearing leg. This terminal rotation is
made possible by the shape of the medial femoral condyle, assisted by contraction of the popliteus muscle and the
iliotibial tract and is caused by the stretching of the anterior cruciate ligament. Both cruciate ligaments are slightly
unwinded and both lateral ligaments become taut.
Flexed position
In the flexed position, the collateral ligaments are relaxed while the cruciate ligaments are taut. Rotation is controlled
by the twisted cruciate ligaments; the two ligaments get twisted around each other during medial rotation of the tibia
— which reduces the amount of rotation possible — while they become unwound during lateral rotation of the tibia.
Because of the oblique position of the cruciate ligaments at least a part of one of them is always tense and these
ligaments control the joint as the collateral ligaments are relaxed. Furthermore, the dorsal fibers of the tibial
collateral ligament become tensed during extreme medial rotation and the ligament also reduces the lateral rotation
to 45-60°.
Knee
10
Blood supply
The femoral artery and the popliteal artery help form the arterial
network surrounding the knee joint (articular rete). There are 6 main
branches:
• 1. Superior medial genicular artery
• 2. Superior lateral genicular artery
• 3. Inferior medial genicular artery
• 4. Inferior lateral genicular artery
• 5. Descending genicular artery
• 6. Recurrent branch of anterior tibial artery
The medial genicular arteries penetrate the knee joint.
Arteries of the knee
Disorders and injury
Knee pain is caused by trauma, misalignment, and degeneration as well as by conditions like arthritis.[22] The most
common knee disorder is generally known as patellofemoral syndrome.The majority of minor cases of knee pain can
be treated at home with rest and ice but more serious injuries do require surgical care.
One form of patellofemoral syndrome involves a tissue-related problem that creates pressure and irritation in the
knee between the patella and the trochlea (patellar compression syndrome), which causes pain. The second major
class of knee disorder involves a tear, slippage, or dislocation that impairs the structural ability of the knee to balance
the leg (patellofemoral instability syndrome). Patellofemoral instability syndrome may cause either pain, a sense of
poor balance, or both.
Age also contributes to disorders of the knee. Particularly in older people, knee pain frequently arises due to
osteoarthritis. In addition, weakening of tissues around the knee may contribute to the problem. Patellofemoral
instability may relate to hip abnormalities or to tightness of surrounding ligaments.
Cartilage lesions can be caused by:
•
•
•
•
•
•
•
•
Accidents (fractures)
Injuries
The removal of a meniscus
Anterior cruciate ligament injury
Posterior cruciate ligament injury
Posterolateral corner injury
Medial knee injuries
Considerable strain on the knee.
Any kind of work during which the knees undergo heavy stress may also be detrimental to cartilage. This is
especially the case in professions in which people frequently have to walk, lift, or squat. Other causes of pain may be
excessive on, and wear of, the knees, in combination with such things as muscle weakness and overweight.
Common complaints:
• A painful, blocked, locked or swollen knee.
• Sufferers sometimes feel as if their knees are about to give way, or may feel uncertain about their movement.
Knee
11
Overall fitness and knee injury
Physical fitness is related integrally to the development of knee problems. The same activity such as climbing stairs
may cause pain from patellofemoral compression for someone who is physically unfit, but not for someone else (or
even for that person at a different time). Obesity is another major contributor to knee pain. For instance, a
30-year-old woman who weighed 120 lb at age 18 years, before her three pregnancies, and now weighs 285 lb, had
added 660 lb of force across her patellofemoral joint with each step.
Common injuries due to physical activity
In sports that place great pressure on the knees, especially with
twisting forces, it is common to tear one or more ligaments or
cartilages. Some of the most common knee injuries are those to the
medial side: medial knee injuries.
Anterior cruciate ligament injury
ACL is the most commonly injured ligament of the knee. The injury is
common during sports. Twisting of the knee is a common cause of
over-stretching or tearing the ACL. When the ACL is injured one may
hear a popping sound and the leg may suddenly give out. Besides
swelling and pain, walking may be painful and the knee will feel
unstable. Minor tears of the anterior cruciate ligament may heal over
time, but a torn ACL requires surgery. After surgery, recovery is
prolonged and low impact exercises are recommended to strengthen
the joint.[23]
Torn meniscus injury
Model demonstrating parts of an artificial knee
The menisci act as shock absorbers and separate the two ends of bone
in the knee joint. There are two menisci in the knee, the medial (inner) and the lateral (outer). When there is torn
cartilage, it means that the meniscus has been injured. Meniscus tears occur during sports often when the knee is
twisted. Menisci injury may be innocuous and one may be able to walk after a tear, but soon swelling and pain set in.
Sometimes the knee will lock while bending. Pain often occurs when one squats. Small meniscus tears are treated
conservatively but most large tears require surgery.[24]
Knee
12
Fractures
Knee fractures are rare but do occur, especially as a result of motor
vehicle accidents. There is usually immediate pain; swelling and one
may not be able to stand on the leg. The muscles go into spasm and
even the slightest movements are painful. X-rays can easily confirm
the injury and surgery depends on the degree of displacement and type
of fracture.
Ruptured tendon
Tendons usually attach muscle to bone. In the knee the quadriceps and
patellar tendon can sometimes tear. The injuries to these tendons occur
when there is forceful contraction of the knee. If the tendon is
completely torn, bending or extending the leg is impossible. A
completely torn tendon requires surgery but a partially torn tendon can
be treated with leg immobilization followed by physical therapy.
Overuse
Radiography to examine eventual fractures after a
Overuse injuries of the knee include tendonitis, bursitis, muscle strains
knee injury.
and iliotibial band syndrome. These injuries often develop slowly over
weeks or months. Activities that induce pain usually delay healing. Rest, ice and compression do help in most cases.
Once the swelling has diminished, heat packs can increase blood supply and promote healing. Most overuse injuries
subside with time but can flare up if the activities are quickly resumed.[25] To prevent overuse injuries, warm up
prior to exercise, limit high impact activities and keep your weight under control.
Surgical interventions
Before the advent of arthroscopy and arthroscopic surgery, patients having surgery for a torn ACL required at least
nine months of rehabilitation, having initially spent several weeks in a full-length plaster cast. With current
techniques, such patients may be walking without crutches in two weeks, and playing some sports in a few months.
In addition to developing new surgical procedures, ongoing research is looking into underlying problems which may
increase the likelihood of an athlete suffering a severe knee injury. These findings may lead to effective preventive
measures, especially in female athletes, who have been shown to be especially vulnerable to ACL tears from
relatively minor trauma.
Articular cartilage repair treatment :
•
•
•
•
•
•
Arthroscopic debriment of the knee (arthroscopic lavage).
Mosaïc-plasty.
Microfracture (Ice-picking).
Autologous Chondrocyte Implantation.
Osteochondral Autograft and Allografts.
PLC Reconstruction
Knee
13
Animal anatomy
In humans the knee refers to the joints between the femur, tibia and patella. In quadrupeds, particularly horses and
ungulates the laymans term "knee" is commonly used to refer to the carpus. The joints between the femur, tibia and
patella are known as the stifle in quadrupeds. In insects and other animals the term knee is used widely to refer to
any ginglymus joint.
Additional images
Knee MR Knee
14
Knee MR Knee X-ray Knee
15
Knee X-ray (Front) Cruciate ligaments Knee
16
Left knee-joint from behind, showing
interior ligaments. Capsule of right knee-joint (distended).
Lateral aspect. Knee
17
Anterior and lateral view of knee. Anterior view of knee. Notes
[2] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?mode=& term=Knee
[3] http:/ / www. mercksource. com/ pp/ us/ cns/ cns_hl_dorlands_split. jsp?pg=/ ppdocs/ us/ common/ dorlands/ dorland/ five/ 000056558. htm
[4] Kulowski (1932), p 618
[5] See trochoid and ginglymus.
[6] Burgener (2002), p 390
[7] http:/ / science. howstuffworks. com/ life/ human-biology/ babies-kneecaps1. htm
[8] Platzer (2004), p 206
[9] Platzer (2004), pp 194-195
[10] Platzer (2004), p 202
[11] Platzer (2004), p 192
[12] Platzer (2004), p 210
[13] Platzer (2004), p 26
[14] Platzer (2004), p 208
[15] Diab (1999), p 200
[16] MedicineNet.com, Definition of Patellar tendon
[17] Moore (2006), p 194
[18] Thieme Atlas of Anatomy (2006), pp 398-399
[19] Platzer (2004), p 252
[20] Thieme Atlas of Anatomy (2006), p 399
[21] Platzer (2004), pp 212-213
[22] " Back of Knee Pain Causes (http:/ / healthlifeandstuff. com/ 2009/ 07/ back-of-knee-pain-causes/ )
[23] Knee pain and injuries (http:/ / sportsmedicine. about. com/ od/ kneepainandinjuries/ Knee_Pain_and_Injuries. htm) About sports online
portal. 2010-01-26
Knee
[24] Tandeter, Howard B. "Acute Knee Injuries: Use of Decision Rules for Selective Radiograph Ordering" (http:/ / www. aafp. org/ afp/
991201ap/ 2599. html) 2010-01-26.
[25] Knee injuries and disorders (http:/ / www. nlm. nih. gov/ medlineplus/ kneeinjuriesanddisorders. html) MedLine Plus. 2010-01-26
References
• Burgener, Francis A.; Meyers, Steven P.; Tan, Raymond K. (2002). Differential Diagnosis in Magnetic
Resonance Imaging (http://books.google.com/?id=brsH_IqPzzoC&pg=PA390). Thieme.
ISBN 1-58890-085-1.
• Diab, Mohammad (1999). Lexicon of Orthopaedic Etymology (http://books.google.com/?id=fstFQVnw8-wC&
pg=PA200). Taylor & Francis. ISBN 90-5702-597-3.
• Kulowski, Jacob (1932). Flexion Contracture of the Knee: The Mechanics of the Muscular Contracture and the
Turnbuckle Cast Method of Treatment (http://www.ejbjs.org/cgi/reprint/14/3/618.pdf) (14 < pages =
618–630). Journal of Bone and Joint Surgery.
• Moore, Keith L.; Dalley, Arthur F.: Agur, A. M. R. (2006). Clinically Oriented Anatomy (http://books.google.
com/?id=SxuA3T7JbQkC&pg=PA594). Lippincott Williams & Wilkins. ISBN 0-7817-3639-0.
• Platzer, Werner (2004). Color Atlas of Human Anatomy, Vol. 1: Locomotor System (5th ed.). Thieme.
pp. 206–213. ISBN 3-13-533305-1.
• "Definition of patellar tendon" (http://www.medterms.com/script/main/art.asp?articlekey=34200).
MedicineNet.com. Retrieved 2008-12-11.
• Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. 2006. ISBN 1-58890-419-9.
External links
Animation of bones and ligament in the knee (https:/ / www. youtube. com/ watch?v=z65EVkqRHxg&
list=PL5T9rQSYLetcHWZ1WapLRNdn2neDCqrLT&index=8)
MRI anatomy of a normal knee (http://www.claripacs.com/case/CL0370)
18
Elbow
19
Elbow
Elbow
Latin
articulatio cubiti
Gray's
subject #84 321
MeSH
Elbow+joint
[1]
[2]
In primates, including humans, the elbow joint is the synovial hinge joint between the humerus in the upper arm and
the radius and ulna in the forearm which allows the hand to be moved towards and away from the body. The superior
radioulnar joint shares joint capsule with the elbow joint but plays no functional role at the elbow. The elbow region
includes prominent landmarks such as the olecranon (the bony prominence at the very tip of the elbow), the elbow
pit, and the lateral and medial epicondyles.
Terminology
The now obsolete length unit ell relates closely to the elbow. This becomes especially visible when considering the
Germanic origins of both words, Elle (ell, defined as the length of a male forearm from elbow to fingertips) and
Ellbogen (elbow). It is unknown when or why the second "l" was dropped from English usage of the word.[citation
needed]
Human anatomy
Joint
The elbow-joint comprises three different portions enveloped by a common joint capsule.
Joint
From
To
Description
Humeroulnar joint
trochlear notch of trochlea of
the ulna
humerus
Is a simple hinge-joint, and allows of movements of flexion and extension only.
Humeroradial joint
head of the radius capitulum of the
humerus
Is a ball-and-socket joint.
Superior radioulnar head of the radius radial notch of the In any position of flexion or extension, the radius, carrying the hand with it, can be
joint
ulna
rotated in it. This movement includes pronation and supination.
In humans, the main task of the elbow is to properly place the hand in space by shortening and lengthening the upper
limb. While the superior radioulnar joint shares joint capsule with the elbow joint, it plays no functional role at the
elbow.
With the elbow extended, the long axis of the humerus and that of the ulna coincide. At the same time, the articular
surfaces on both bones are located in front of those axes and deviate from them at an angle of 45°. Additionally, the
forearm muscles that originate at the elbow are grouped at the sides of the joint in order not to interfere with its
movement. The wide angle of flexion at the elbow made possible by this arrangement — almost 180° — allows the
Elbow
20
bones to be brought almost in parallel to each other.
Left elbow extended and flexed
When the extended elbow is viewed from behind, the medial and lateral epicondyles and the olecranon — the three
major landmarks of the elbow — lie on a horizontal line called the Hueter line. In the flexed elbow, on the other
hand, they form an equilateral triangle, known as the Hueter triangle, when viewed from behind and lie on the arm's
frontal plane when viewed from the side. The shape of this triangle is altered by dislocations and fractures so that the
olecranon reaches above the Hueter line in extension and behind the frontal plane in flexion.
The trochlea of the humerus runs obliquely across the distal end of the humerus. The groove running across the
trochlea is, in most people, vertical on the anterior side but spirals off on the posterior side. This results in the
forearm being aligned to the upper arm during flexion, but forming an angle to the upper arm during extension — an
angle known as the carrying angle. (See also Sexual dimorphism below.) Thus, the orientation of the transverse axis
of the elbow joint varies during extension and flexion so that it is always perpendicular to the main axis of the
forearm.
Elbow
Ligaments
Left elbow-joint
Left: anterior and ulnar collateral ligaments
Right: posterior and radial collateral ligaments
The ligaments on either side of the elbow are triangular bands which blend with the joint capsule. They are
positioned so that they always lie across the transverse joint axis and are, therefore, always relatively tense and
impose strict limitations on abduction, adduction, and axial rotation at the elbow.
The ulnar collateral ligament has its apex on the medial epicondyle. Its anterior band stretches from the anterior side
of the medial epicondyle to the medial edge of the coronoid process, while the posterior band stretches from
posterior side of the medial epicondyle to the medial side of the olecranon. These two bands are separated by a
thinner intermediate part and their distal attachments are united by a transverse band below which the synovial
membrane protrudes during joint movements. The anterior band is closely associated with the tendon of the
superficial flexor muscles of the forearm, even being the origin of flexor digitorum superficialis. The ulnar nerve
crosses the intermediate part as it enters the forearm.
The radial collateral ligament is attached to the lateral epicondyle below the common extensor tendon. Less distinct
than the ulnar collateral ligament, this ligament blends with the annular ligament of the radius and its margins are
attached near the radial notch of the ulna.
21
Elbow
Joint capsule
Capsule of elbow-joint (distended). Anterior and posterior aspects.
The elbow joint and the superior radioulnar joint are enclosed by a single fibrous capsule. The capsule is
strengthened by ligaments at the sides but relatively weak in front and behind.
On the anterior side the capsule consists mainly of longitudinal fibres. However, some bundles among these fibers
run obliquely, thicken and strengthen the capsule, and are referred to as the capsular ligament. Deep fibres of
brachialis insert anteriorly into the capsule and act to pull it and the underlying membrane during flexion in order to
prevent them from being pinched.
On the posterior side the capsule is thin and mainly composed of transverse fibres. A few of these fibres stretch
across the olecranon fossa without attaching to it and form a transverse band with a free upper border. On the ulnar
side, the capsule reaches down to the posterior part of the annular ligament. The posterior capsule is attached to the
triceps tendon which prevents the capsule from being pinched during extension.
22
Elbow
Synovial membrane
The synovial membrane of the elbow joint is very extensive. On the humerus, it extends up from the articular
margins and covers the coronoid and radial fossae anteriorly and the olecranon fossa posteriorly. Distally, it is
prolonged down to the neck of the radius and the superior radioulnar joint. It is supported by the quadrate ligament
below the annular ligament where it also forms a fold which gives the head of the radius freedom of movement.
Several synovial folds project into the recesses of the joint. These folds or plicae are remnants of normal embryonic
development and can be categorized as either anterior (anterior humeral recess) or posterior (olecranon recess). A
crescent-shaped fold is commonly present between the head of the radius and the capitulum of the humerus.
On the humerus there are extrasynovial fat pads adjacent to the three articular fossae. These pads fill the radial and
coronoid fossa anteriorly during extension, and the olecranon fossa posteriorly during flexion. They are displaced
when the fossae are occupied by the bony projections of the ulna and radius.
Muscles
Flexion
There are three main flexor muscles at the elbow:
• Brachialis acts exclusively as an elbow flexor and is one of the few muscles in the human body with a single
function. It originates low on the anterior side of the humerus and is inserted into the tuberosity of the ulna.
• Brachioradialis acts essentially as an elbow flexor but also supinates during extreme pronation and pronates
during extreme supination. It originates at the lateral supracondylar ridge distally on the humerus and is inserted
distally on the radius at the styloid process.
• Biceps brachii is the main elbow flexor but, as a biarticular muscle, also plays important secondary roles as a
stabiliser at the shoulder and as a supinator. It originates on the scapula with two tendons: That of the long head
on the supraglenoid tubercle just above the shoulder joint and that of the short head on the coracoid process at the
top of the scapula. Its main insertion is at the radial tuberosity on the radius.
Brachialis is the main muscle used when the elbow is flexed slowly. During rapid and forceful flexion all three
muscles are brought into action assisted by the superficial forearm flexors originating at the medial side of the elbow.
The efficiency of the flexor muscles increases dramatically as the elbow is brought into midflexion (flexed 90°) —
biceps reaches its angle of maximum efficiency at 80–90° and brachialis at 100–110°.
Active flexion is limited to 145° by the contact between the anterior muscles of the upper arm and forearm, more so
because they are hardened by contraction during flexion. Passive flexion (forearm is pushed against the upper arm
with flexors relaxed) is limited to 160° by the bony projections on the radius and ulna as they reach to shallow
depressions on the humerus; i.e. the head of radius being pressed against the radial fossa and the coronoid process
being pressed against the coronoid fossa. Passive flexion is further limited by tension in the posterior capsular
ligament and in triceps brachii.
Extension
Elbow extension is simply bringing the forearm back to anatomical position. This action is performed by triceps
brachii with a negligible assistance from anconeus. Triceps originates with two heads posteriorly on the humerus and
with its long head on the scapula just below the shoulder joint. It is inserted posteriorly on the olecranon.
Triceps is maximally efficient with the elbow flexed 20–30°. As the angle of flexion increases, the position of the
olecranon approaches the main axis of the humerus which decreases muscle efficiency. In full flexion, however, the
triceps tendon is "rolled up" on the olecranon as on a pulley which compensates for the loss of efficiency. Because
triceps' long head is biarticular (acts on two joints), its efficiency is also dependent on the position of the shoulder.
Extension is limited by the olecranon reaching the olecranon fossa, tension in the anterior ligament, and resistance in
flexor muscles. Forced extension results in a rupture in one of the limiting structures: olecranon fracture, torn capsule
23
Elbow
24
and ligaments, and, though the muscles are normally left unaffected, a bruised brachial artery.
Blood and nerve supply
The anastomosis and deep veins around the elbow-joint
The arteries supplying the joint are derived from an extensive circulatory anastomosis between the brachial artery
and its terminal branches. The superior and inferior ulnar collateral branches of the brachial artery and the radial and
middle collateral branches of the profunda brachii artery descend from above to reconnect on the joint capsule,
where they also connect with the anterior and posterior ulnar recurrent branches of the ulnar artery; the radial
recurrent branch of the radial artery; and the interosseous recurrent branch of the common interosseous artery.
The blood is brought back by vessels from the radial, ulnar, and brachial veins. There are two sets of lymphatic
nodes at the elbow, normally located above the medial epicondyle — the deep and superficial cubital nodes (also
called epitrochlear nodes). The lymphatic drainage at the elbow is through the deep nodes at the bifurcation of the
brachial artery, the superficial nodes drain the forearm and the ulnar side of the hand. The efferent lymph vessels
from the elbow proceed to the lateral group of axillary lymph nodes.
The elbow is innervated anteriorly by branches from the musculocutaneous, median, and radial nerve, and
posteriorly from the ulnar nerve and the branch of the radial nerve to anconeus.
Sexual dimorphism
Carrying angle
When the arm is extended, with the palm facing forward or up, the
bones of the humerus and forearm are not perfectly aligned. The
deviation from a straight line occurs in the direction of the thumb, and
is referred to as the "carrying angle" (visible in the right half of the
picture, right).
The carrying angle permits the arm to be swung without contacting the
hips. Women on average have smaller shoulders and wider hips than
men, which may necessitate a more acute carrying angle (i.e., less
angle than that in male when measured from outside). There is,
Normal radiograph; right picture of the
straightened arm shows the carrying angle of the
elbow
Elbow
however, extensive overlap in the carrying angle between individual men and women, and a sex-bias has not been
consistently observed in scientific studies.[3] This could however be attributed to the very small sample sizes in those
cited earlier studies. A more recent study based on a sample size of 333 individuals from both sexes concluded that
carrying angle is a suitable secondary sexual characteristic.
The angle is greater in the dominant limb than the non-dominant limb of both sexes, suggesting that natural forces
acting on the elbow modify the carrying angle. Developmental, aging and possibly racial influences add further to
the variability of this parameter.
Injuries and diseases
Left: Lateral X ray of a dislocated right elbow
Right: AP X ray of a dislocated right elbow
The types of disease most commonly seen at the elbow are due to injury.
Tendonitis
Two of the most common injuries at the elbow are overuse injuries: tennis elbow and golfer's elbow. Golfer's elbow
involves the tendon of the common flexor origin which originates at the medial epicondyle of the humerus (the
"inside" of the elbow). Tennis elbow is the equivalent injury, but at the common extensor origin (the lateral
epicondyle of the humerus).
Fractures
There are three bones at the elbow joint, and any combination of these bones may be involved in a fracture of the
elbow. Patients who are able to fully extend their arm at the elbow are unlikely to have a fracture (98% certainty)
and an X-ray is not required as long as an olecranon fracture is ruled out. Acute fractures may not be easily visible
on X-ray.[citation needed]
25
Elbow
Dislocation
Elbow dislocations constitute 10% to 25% of all injuries to the elbow. The elbow is one of the most commonly
dislocated joints in the body, with an average annual incidence of acute dislocation of 6 per 100,000 persons. Among
injuries to the upper extremity, dislocation of the elbow is second only to a dislocated shoulder. A full dislocation of
the elbow will require expert medical attention to re-align, and recovery can take approximately 8–14 weeks. A
small amount of people (10% or less) report near full recovery and minimal permanent restriction, but a permanent
restriction of 5–15% movement is common.[citation needed]
Infection
Infection of the elbow joint (septic arthritis) is uncommon. It may occur spontaneously, but may also occur in
relation to surgery or infection elsewhere in the body (for example, endocarditis).[citation needed]
Arthritis
Elbow arthritis is usually seen in individuals with rheumatoid arthritis or after fractures that involve the joint itself.
When the damage to the joint is severe, fascial arthroplasty or elbow joint replacement may be considered.
Evolutionary variation
Though the elbow is similarly adapted for stability through a wide range of pronation-supination and
flexion-extension in all extant hominoids, there are some minor differences. In arboreal hominoids such as
orangutans, the large forearm muscles originating on the epicondyles of the humerus generate significant transverse
forces on the elbow joint. The structure to resist these forces is a pronounced keel on the trochlear notch on the ulna,
which is more flattened in, for example, humans and gorillas. In extant knuckle-walkers, on the other hand, the
elbow has to deal with large vertical loads passing through extended forearms and the joint is therefore more
expanded to provide larger articular surfaces perpendicular to those forces.
Derived traits in catarrhini (apes and Old World monkeys) elbows include the loss of the entepicondylar foramen (a
hole in the distal humerus), a non-translatory (rotation-only) humeroulnar joint, and a more robust ulna with a
shortened trochlear notch.
The proximal radioulnar joint is similarly derived in higher primates in the location and shape of the radial notch on
the ulna; the primitive form being represented by New World monkeys, such as the howler monkey, and by fossil
catarrhines, such as Aegyptopithecus. In these taxa, the oval head of the radius lies in front of the ulnar shaft so that
the former overlaps the latter by half its width. With this forearm configuration, the ulna supports the radius and
maximum stability is achieved when the forearm is fully pronated.
26
Elbow
27
Additional images
The Supinator. Posterior
view. Back of right upper extremity. Close-up radiograph, right
elbow-joint Elbow
28
Pathological fusion of three bones
at elbow. Notes
[2] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?mode=& term=Elbow+ joint
[3] ; ;
References
Appelboam, A; Reuben, A D; Benger, J R; Beech, F; Dutson, J; Haig, S; Higginson, I; Klein, J A; Le Roux, S;
Saranga, S S M; Taylor, R; Vickery, J; Powell, R J; Lloyd, G (2008). "Elbow extension test to rule out elbow
fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and
children". BMJ 337: a2428. doi: 10.1136/bmj.a2428 (http:/ / dx. doi. org/ 10. 1136/ bmj. a2428). PMC 2600962 (http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC2600962). PMID 19066257 (http:/ / www.
ncbi.nlm.nih.gov/pubmed/19066257).
Awaya, Hitomi; Schweitzer, Mark E.; Feng, Sunah A.; Kamishima, Tamotsu; Marone, Phillip J.; Farooki,
Shella; Trudell, Debra J.; Haghighi, Parviz; Resnick, Donald L. (December 2001). "Elbow Synovial Fold
Syndrome: MR Imaging Findings" (http:/ / www. ajronline. org/ content/ 177/ 6/ 1377. long). American
Journal of Roentgenology 177 (6): 1377–81. doi: 10.2214/ajr.177.6.1771377 (http:/ / dx. doi. org/ 10. 2214/
ajr. 177. 6. 1771377). PMID 11717088 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 11717088). Retrieved
June 2012.
Blakeney, W G (January 2010). "Elbow Dislocation" (http:/ / www. orthop. washington. edu/
elbowreplacement). Life in the Fast Lane.
Drapeau, MS (July 2008). "Articular morphology of the proximal ulna in extant and fossil hominoids and
hominins". J Hum Evol. 55 (1): 86–102. doi: 10.1016/j.jhevol.2008.01.005 (http:/ / dx. doi. org/ 10. 1016/ j.
jhevol.2008.01.005). PMID 18472143 (http://www.ncbi.nlm.nih.gov/pubmed/18472143).
Kapandji, Ibrahim Adalbert (1982). The Physiology of the Joints: Volume One Upper Limb (5th ed.). New
York: Churchill Livingstone.
Matsen, Frederick A. (2012). "Total elbow joint replacement for rheumatoid arthritis: A Patient’s Guide"
(http:/ / www. orthop. washington. edu/ sites/ default/ files/ Portals/ 21/ www/ Patient Care/ Our Services/
Shoulder &Elbow/Articles/PDFs/Total elbow joint replacement for elbow arthritis.pdf). UW Medicine.
Palastanga, Nigel; Soames, Roger (2012). Anatomy and Human Movement: Structure and Function (6th ed.).
Elsevier. ISBN 9780702040535.
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Paraskevas, G; Papadopoulos, A; Papaziogas, B; Spanidou, S; Argiriadou, H; Gigis, J (2004). "Study of the
carrying angle of the human elbow joint in full extension: a morphometric analysis". Surgical and Radiologic
Anatomy 26 (1): 19–23. doi: 10.1007/s00276-003-0185-z (http:/ / dx. doi. org/ 10. 1007/ s00276-003-0185-z).
PMID 14648036 (http://www.ncbi.nlm.nih.gov/pubmed/14648036).
Richmond, Brian G; Fleagle, John G; Kappelman, John; Swisher, Carl C (1998). "First Hominoid From the
Miocene of Ethiopia and the Evolution of the Catarrhine Elbow" (http:/ / home. gwu. edu/ ~brich/
publications/ 1998-Richmond etal. pdf). Am J Phys Anthropol. 105 (3): 257–77. doi:
10.1002/(SICI)1096-8644(199803)105:3<257::AID-AJPA1>3.0.CO;2-P (http:/ / dx. doi. org/ 10. 1002/
(SICI)1096-8644(199803)105:3<257::AID-AJPA1>3. 0. CO;2-P). PMID 9545073 (http:/ / www. ncbi. nlm.
nih.gov/pubmed/9545073).
Ross, Lawrence M.; Lamperti, Edward D., eds. (2006). Thieme Atlas of Anatomy: General Anatomy and
Musculoskeletal System (http:/ / books. google. com/ books?id=NK9TgTaGt6UC& pg=PA240). Thieme.
p. 240. ISBN 3131420812.
Ruparelia, S; Patel, S; Zalawadia, A; Shah, S (2010). "Study Of Carrying Angle And Its Correlation With
Various Parameters" (http://ns2.scopemed.com/?mno=3291). NJIRM 1 (3). ISSN 0975-9840 (http://www.
worldcat.org/issn/0975-9840).
Steel, F; Tomlinson, J (1958). "The 'carrying angle' in man". Journal of Anatomy 92 (2): 315–7. PMC 1249704 (http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC1249704). PMID 13525245 (http:/ / www.
ncbi.nlm.nih.gov/pubmed/13525245).
Tukenmez, M; Demirel, H; Perçin, S; Tezeren, G (2004). "Measurement of the carrying angle of the elbow in
2,000 children at ages six and fourteen years". Acta Orthopaedica et Traumatologica Turcica 38 (4): 274–6.
PMID 15618770 (http://www.ncbi.nlm.nih.gov/pubmed/15618770).
Van Roy, P; Baeyens, JP; Fauvart, D; Lanssiers, R; Clarijs, JP (2005). "Arthro-kinematics of the elbow: study
of the carrying angle". Ergonomics 48 (11–14): 1645–56. doi: 10.1080/00140130500101361 (http:/ / dx. doi.
org/ 10. 1080/ 00140130500101361). PMID 16338730 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/
16338730).
Yilmaz, E; Karakurt, L; Belhan, O; Bulut, M; Serin, E; Avci, M (2005). "Variation of carrying angle with age,
sex, and special reference to side". Orthopedics 28 (11): 1360–3. PMID 16295195 (http:/ / www. ncbi. nlm.
nih.gov/pubmed/16295195).
Zampagni, M; Casino, D; Zaffagnini, S; Visani, AA; Marcacci, M (2008). "Estimating the elbow carrying
angle with an electrogoniometer: acquisition of data and reliability of measurements". Orthopedics 31 (4):
370. doi: 10.3928/01477447-20080401-39 (http:/ / dx. doi. org/ 10. 3928/ 01477447-20080401-39). PMID 19292279 (http://www.ncbi.nlm.nih.gov/pubmed/19292279).
Hip
30
Hip
For other uses of the term, see hip (disambiguation).
Hip (anatomy)
Bones of the hip
Latin
coxa
Gray's
subject #92 333
MeSH
Hip
[1]
[2]
In vertebrate anatomy, hip (or "coxa"[3] in medical terminology) refer to either an anatomical region or a joint.
The hip region is located lateral to the gluteal region (i. e. the buttock), inferior to the iliac crest, and overlying the
greater trochanter of the femur, or "thigh bone".[4] In adults, three of the bones of the pelvis have fused into the hip
bone which forms part of the hip region.
The hip joint, scientifically referred to as the acetabulofemoral joint (art. coxae), is the joint between the femur
and acetabulum of the pelvis and its primary function is to support the weight of the body in both static (e. g.
standing) and dynamic (e. g. walking or running) postures. The hip joints are the most important part in retaining
balance. The pelvic inclination angle, which is the single most important element of human body posture, is adjusted
at the hips.
Anatomy
Region
The five or so tubercles and the lower lateral borders of the sacrum, and the ischial tuberosity ("sitting bone").[5]
• Proximally the femur is largely covered by muscles and, as a consequence, the greater trochanter is often the only
palpable bony structure. Distally on the femur some more palpable bony structures are the condyles.[6]
Articulation
Hip
31
The hip joint is a synovial joint formed by the articulation of the
rounded head of the femur and the cup-like acetabulum of the pelvis. It
forms the primary connection between the bones of the lower limb and
the axial skeleton of the trunk and pelvis. Both joint surfaces are
covered with a strong but lubricated layer called articular hyaline
cartilage. The cuplike acetabulum forms at the union of three pelvic
bones — the ilium, pubis, and ischium.[7] The Y-shaped growth plate
that separates them, the triradiate cartilage, is fused definitively at ages
14–16.[8] It is a special type of spheroidal or ball and socket joint
where the roughly spherical femoral head is largely contained within
the acetabulum and has an average radius of curvature of 2.5 cm.[9]
Radiograph of a healthy human hip joint
The acetabulum grasps almost half the femoral ball, a grip augmented
by a ring-shaped fibrocartilaginous lip, the acetabular labrum, which extends the joint beyond the equator. The head
of the femur is attached to the shaft by a thin neck region that is often prone to fracture in the elderly, which is
mainly due to the degenerative effects of osteoporosis.
Transverse and sagittal angles of acetabular inlet plane.
The acetabulum is oriented inferiorly, laterally and anteriorly, while the femoral neck is directed superiorly,
medially, and anteriorly.
Articular angles
• The transverse angle of the acetabular inlet (also called Sharp's angle and is generally the angle referred to by
acetabular angle without further specification)[10] can be determined by measuring the angle between a line
passing from the superior to the inferior acetabular rim and the horizontal plane; an angle which normally
measures 51° at birth and 40° in adults, and which affects the acetabular lateral coverage of the femoral head and
several other parameters.
• The sagittal angle of the acetabular inlet is an angle between a line passing from the anterior to the posterior
acetabular rim and the sagittal plane. It measures 7° at birth and increases to 17° in adults.[]
• Wiberg's centre-edge angle (CE angle) is an angle between a vertical line and a line from the centre of the
femoral head to the most lateral part of the acetabulum,[11] as seen on an anteroposterior radiograph.
• The vertical-centre-anterior margin angle (VCA) is an angle formed from a vertical line (V) and a line from the
centre of the femoral head (C) and the anterior (A) edge of the dense shadow of the subchondral bone slightly
posterior to the anterior edge of the acetabulum, with the radiograph being taken from the false angle, that is, a
lateral view rotated 25 degrees towards becoming frontal.
Hip
32
• The articular cartilage angle (AC angle, also called Hilgenreiner angle) is an angle formed parallel to the weight
bearing dome, that is, the acetabular sourcil, and the horizontal plane, or a line connecting the corner of the
triangular cartilage and the lateral acetabular rim.[12]
Femoral neck angle
The angle between the longitudinal axes of the femoral neck and shaft, called the caput-collum-diaphyseal angle or
CCD angle, normally measures approximately 150° in newborn and 126° in adults (coxa
norma).[13]Wikipedia:Disputed statement
An abnormally small angle is known as coxa vara and an abnormally large angle as coxa valga. Because changes in
shape of the femur naturally affects the knee, coxa valga is often combined with genu varum (bow-leggedness),
while coxa vara leads to genu valgum (knock-knees).
Changes in CCD angle is the result of changes in the
stress patterns applied to the hip joint. Such changes,
caused for example by a dislocation, changes the
trabecular patterns inside the bones. Two continuous
trabecular systems emerging on auricular surface of the
sacroiliac joint meander and criss-cross each other
down through the hip bone, the femoral head, neck, and
shaft.
• In the hip bone, one system arises on the upper part
of auricular surface to converge onto the posterior
Changes in trabecular patterns due to altered CCD angle. Coxa valga
surface of the greater sciatic notch, from where its
leads to more compression trabeculae, coxa vara to more tension
trabeculae are reflected to the inferior part of the
trabeculae.
acetabulum. The other system emerges on the lower
part of the auricular surface, converges at the level of the superior gluteal line, and is reflected laterally onto the
upper part of the acetabulum.
• In the femur, the first system lines up with a system arising from the lateral part of the femoral shaft to stretch to
the inferior portion of the femoral neck and head. The other system lines up with a system in the femur stretching
from the medial part of the femoral shaft to the superior part of the femoral head.[14]
On the lateral side of the hip joint the fascia lata is strengthened to form the iliotibial tract which functions as a
tension band and reduces the bending loads on the proximal part of the femur.
Capsule
Main article: Capsule of hip joint
The capsule attaches to the hip bone outside the acetabular lip which thus projects into the capsular space. On the
femoral side, the distance between the head's cartilaginous rim and the capsular attachment at the base of the neck is
constant, which leaves a wider extracapsular part of the neck at the back than at the front.[15]
The strong but loose fibrous capsule of the hip joint permits the hip joint to have the second largest range of
movement (second only to the shoulder) and yet support the weight of the body, arms and head.
The capsule has two sets of fibers: longitudinal and circular.
• The circular fibers form a collar around the femoral neck called the zona orbicularis.
• The longitudinal retinacular fibers travel along the neck and carry blood vessels.
Hip
33
Ligaments
Extracapsular ligaments. Anterior (left) and posterior (right) aspects of right hip.
Intracapsular ligament. Left hip joint from within pelvis with acetabular floor removed (left); right hip joint with
capsule removed, anterior aspect (right).
The hip joint is reinforced by four ligaments, of which four are extracapsular and one intracapsular.
The extracapsular ligaments are the iliofemoral, ischiofemoral, and pubofemoral ligaments attached to the bones of
the pelvis (the ilium, ischium, and pubis respectively). All three strengthen the capsule and prevent an excessive
range of movement in the joint. Of these, the Y-shaped and twisted iliofemoral ligament is the strongest ligament in
the human body. In the upright position, it prevents the trunk from falling backward without the need for muscular
activity. In the sitting position, it becomes relaxed, thus permitting the pelvis to tilt backward into its sitting position.
The iliofemoral ligament prevents excessive adduction and internal rotation of the hip. The ischiofemoral ligament
prevents medial (internal) rotation while the pubofemoral ligament restricts abduction and internal rotation of the hip
joint. The zona orbicularis, which lies like a collar around the most narrow part of the femoral neck, is covered by
the other ligaments which partly radiate into it. The zona orbicularis acts like a buttonhole on the femoral head and
assists in maintaining the contact in the joint. All three ligaments become taut when the joint is extended - this
stabilises the joint, and reduces the energy demand of muscles when standing [16]
The intracapsular ligament, the ligamentum teres, is attached to a depression in the acetabulum (the acetabular
notch) and a depression on the femoral head (the fovea of the head). It is only stretched when the hip is dislocated,
and may then prevent further displacement. It is not that important as a ligament but can often be vitally important as
a conduit of a small artery to the head of the femur, that is, the foveal artery.[17] This artery is not present in everyone
but can become the only blood supply to the bone in the head of the femur when the neck of the femur is fractured or
disrupted by injury in childhood.[18]
Hip
34
Blood supply
The hip joint is supplied with blood from the medial circumflex femoral and lateral circumflex femoral arteries,
which are both usually branches of the deep artery of the thigh (profunda femoris), but there are numerous variations
and one or both may also arise directly from the femoral artery. There is also a small contribution from the foveal
artery, a small vessel in the ligament of the head of the femur which is a branch of the posterior division of the
obturator artery, which becomes important to avoid avascular necrosis of the head of the femur when the blood
supply from the medial and lateral circumflex arteries are disrupted (e. g. through fracture of the neck of the femur
along their course).
The hip has two anatomically important anastomoses, the cruciate and the trochanteric anastomoses, the latter of
which provides most of the blood to the head of the femur. These anastomoses exist between the femoral artery or
profunda femoris and the gluteal vessels.[19]
Muscles and movements
The hip muscles act on three mutually perpendicular main axes, all of which pass through the center of the femoral
head, resulting in three degrees of freedom and three pair of principal directions: Flexion and extension around a
transverse axis (left-right); lateral rotation and medial rotation around a longitudinal axis (along the thigh); and
abduction and adduction around a sagittal axis (forward-backward); [20] and a combination of these movements (i. e.
circumduction, a compound movement in which the leg describes the surface of an irregular cone). It should be
noted that some of the hip muscles also act on either the vertebral joints or the knee joint, that with their extensive
areas of origin and/or insertion, different part of individual muscles participate in very different movements, and that
the range of movement varies with the position of the hip joint. [21] Additionally, the inferior and superior gemelli
may be termed triceps coxae together with the obturator internus, and their function simply is to assist the latter
muscle.[22]
The movements of the hip joint is thus performed by a series of muscles which are here presented in order of
importance with the range of motion from the neutral zero-degree position indicated:
• Lateral or external rotation (30° with the hip extended, 50° with the hip flexed): gluteus maximus; quadratus
femoris; obturator internus; dorsal fibers of gluteus medius and minimus; iliopsoas (including psoas major from
the vertebral column); obturator externus; adductor magnus, longus, brevis, and minimus; piriformis; and
sartorius. The iliofemoral ligament inhibits lateral rotation and extension, this is why the hip can rotate laterally to
a greater degree when it is flexed.
• Medial or internal rotation (40°): anterior fibers of gluteus medius and minimus; tensor fascia latae; the part of
adductor magnus inserted into the adductor tubercle; and, with the leg abducted also the pectineus.
• Extension or retroversion (20°): gluteus maximus (if put out of action, active standing from a sitting position is
not possible, but standing and walking on a flat surface is); dorsal fibers of gluteus medius and minimus; adductor
magnus; and piriformis. Additionally, the following thigh muscles extend the hip: semimembranosus,
semitendinosus, and long head of biceps femoris. Maximal extension is inhibited by the iliofemoral ligament.
• Flexion or anteversion (140°): the hip flexors: iliopsoas (with psoas major from vertebral column); tensor fascia
latae, pectineus, adductor longus, adductor brevis, and gracilis. Thigh muscles acting as hip flexors: rectus
femoris and sartorius. Maximal flexion is inhibited by the thigh coming in contact with the chest.
• Abduction (50° with hip extended, 80° with hip flexed): gluteus medius; tensor fascia latae; gluteus maximus
with its attachment at the fascia lata; gluteus minimus; piriformis; and obturator internus. Maximal abduction is
inhibited by the neck of the femur coming into contact with the lateral pelvis. When the hips are flexed, this
delays the impingement until a greater angle.
• Adduction (30° with hip extended, 20° with hip flexed): adductor magnus with adductor minimus; adductor
longus, adductor brevis, gluteus maximus with its attachment at the gluteal tuberosity; gracilis (extends to the
tibia); pectineus, quadratus femoris; and obturator externus. Of the thigh muscles, semitendinosus is especially
Hip
35
involved in hip adduction. Maximal adduction is impeded by the thighs coming into contact with one another.
This can be avoided by abducting the opposite leg, or having the legs alternately flexed/extended at the hip so
they travel in different planes and do not intersect.
Sexual dimorphism and cultural significance
In humans, unlike other animals, the hip bones are substantially
different in the two sexes. The hips of human females widen during
puberty. The femora are also more widely spaced in females, so as to
widen the opening in the hip bone and thus facilitate childbirth.
Finally, the ilium and its muscle attachment are shaped so as to situate
the buttocks away from the birth canal, where contraction of the
buttocks could otherwise damage the baby.
The female hips have long been associated with both fertility and
general expression of sexuality. Since broad hips facilitate child birth
and also serve as an anatomical cue of sexual maturity, they have been
seen as an attractive trait for women for thousands of years. Many of
the classical poses women take when sculpted, painted or
photographed, such as the Grande Odalisque, serve to emphasize the
prominence of their hips. Similarly, women's fashion through the ages
has often drawn attention to the girth of the wearer's hips.
Dancers often stand with hands on hips.
Additional Images
Hip joint. Lateral view.
Hip joint. Lateral view.
Muscles of Thigh. Anterior views.
Hip
36
Notes
[2] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?mode=& term=Hip
[3] Latin coxa was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77)
[4] MediLexicon
[5] Field (2001), p 80
[7] Faller (2004), pp 174-175
[10] Figure 2 (http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC2739474/ figure/ F0002/ ) in:
[11] Page 131 (http:/ / books. google. com/ books?id=rxS9EjeGhrMC& pg=PA131) in:
[12] Figure 2 (http:/ / www. biomedcentral. com/ 1471-2431/ 5/ 17/ figure/ F2) in:
[14] Palastanga (2006), p 353
[15] Because the neck is wider in front than at the back.
[16] teachmeanatomy.net (http:/ / teachmeanatomy. net/ lower-limb/ the-hip-joint/ ). teachmeanatomy.net. Retrieved on 2013-07-12.
[17] Hip Fracture in Emergency Medicine (http:/ / emedicine. medscape. com/ article/ 825363-overview#aw2aab6b2b4) at Medscape. Author:
Moira Davenport. Updated: Apr 2, 2012
[18] Thieme Atlas of Anatomy (2006), pp 383, 440
[19] Clemente (2006), p 227
[21] Platzer (2004), pp 244-246
[22] Platzer (2004), p 238
References
• Clemente, Carmine D. (2006). Clemente's Anatomy Dissector (http://books.google.com/
books?id=oEMvo2exmJgC&pg=RA2-PA227). Lippincott Williams & Wilkins. ISBN 0-7817-6339-8.
• Diab, Mohammad (1999). Lexicon of Orthopaedic Etymology (http://books.google.com/
books?id=fstFQVnw8-wC&pg=PA200#PPA77,M1). Taylor & Francis. ISBN 90-5702-597-3.
• Faller, Adolf; Schuenke, Michael; Schuenke, Gabriele (2004). The Human Body: An Introduction to Structure
and Function. Thieme. ISBN 3-13-129271-7.
• Field, Derek (2001). Anatomy: palpation and surface markings (3rd ed.). Elsevier Health Sciences.
ISBN 0-7506-4618-7.
• "Hip Region" (http://www.medilexicon.com/medicaldictionary.php?t=77165). MediLexicon.
• Palastanga, Nigel; Field, Derek; Soames, Roger (2006). Anatomy and human movement: structure and function
(http://books.google.com/books?id=rRtPExr9Hz8C&pg=PA353) (5th ed.). Elsevier Health Sciences.
ISBN 0-7506-8814-9.
ISBN 3-13-533305-1.
• Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. 2006. ISBN 1-58890-419-9.
Hip
37
External links
• Hip Preservation Awareness, information and support for hip impingement, hip dysplasia, and related issues in
young adults (12-adult) (http://hippreservation.org/)
• Hip anatomy video (http://www.hipsknees.info/flash/HTML-HIPS/demo.html)
• High-performance hips (http://machinedesign.com/ContentItem/60950/Highperformancehips.aspx)
Wrist
38
Wrist
wrist joint
A human hand with wrist labeled at left.
Latin
articulatio radiocarpea
Gray's
subject #86 327
MeSH
Wrist+joint
[1]
[2]
In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones
forming the proximal skeletal segment of the hand;[3][4] (2) the wrist joint or radiocarpal joint, the joint between
the radius and the carpus; and (3) the anatomical region surrounding the carpus including the distal parts of the bones
of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between
these bones, thus referred to as wrist joints.[5][6] This region also includes the carpal tunnel, the anatomical snuff box,
the flexor retinaculum, and the extensor retinaculum.
As a consequence of these various definitions, fractures to the carpal bones are referred to as carpal fractures, while
fractures such as distal radius fracture are considered fractures to the wrist.
Etymology
The English word "wrist" is etymologically derived from the ancient German word wristiz from which are derived
modern German rist ("instep", "wrist") and modern Swedish vrist ("instep", "ankle"). The base writh- and its variants
are associated with Old English words "wreath", "wrest", and "writhe". The wr- sound of this base seems originally
to have been symbolic of the action of twisting.
Anatomy
Posterior and anterior aspects of right human wrist
Wrist
39
Ligaments of wrist. Posterior and anterior views
Articulations
The radiocarpal, intercarpal, midcarpal, carpometacarpal, and intermetacarpal joints often intercommunicate through
a common synovial cavity. [7]
Extrinsic hand
The distal radioulnar joint is a pivot joint located
between the bones of the forearm, the radius and ulna.
Formed by the head of ulna and the ulnar notch of
radius, this joint is separated from the radiocarpal joint
by an articular disk lying between the radius and the
styloid process of ulna. The capsule of the joint is lax
and extends from the inferior sacciform recess to the
ulnar shaft. Together with the proximal radioulnar
joint, the distal radioulnar joint permits pronation and
supination. [8]
Micro-radiography of 8 weeks human embryo hand
The radiocarpal joint or wrist joint is an ellipsoid joint formed by the radius and the articular disc proximally and the
proximal row of carpal bones distally. The carpal bones on the ulnar side only make intermittent contact with the
proximal side — the triquetrum only makes contact during ulnar abduction. The capsule, lax and un-branched, is thin
on the dorsal side and can contain synovial folds. The capsule is continuous with the midcarpal joint and
strengthened by numerous ligaments, including the palmar and dorsal radiocarpal ligaments, and the ulnar and radial
collateral ligaments. [9]
The parts forming the radiocarpal joint are the lower end of the radius and under surface of the articular disk above;
and the scaphoid, lunate, and triquetral bones below. The articular surface of the radius and the under surface of the
articular disk form together a transversely elliptical concave surface, the receiving cavity. The superior articular
surfaces of the scaphoid, lunate, and triquetrum form a smooth convex surface, the condyle, which is received into
the concavity.
Carpal bones of the hand:
Proximal:
A=Scaphoid, B=Lunate, C=Triquetrum, D=Pisiform
Distal:
E=Trapezium, F=Trapezoid, G=Capitate, H=Hamate
Wrist
In the hand proper a total of 13 bones form part of the wrist: eight carpal bones—scaphoid, lunate, triquetral,
pisiform, trapezium, trapezoid, capitate, and hamate— and five metacarpal bones—the first, second, third, fourth,
and fifth metacarpal bones.[10]
The midcarpal joint is the S-shaped joint space separating the proximal and distal rows of carpal bones. The
intercarpal joints, between the bones of each row, are strengthened by the radiate carpal and pisohamate ligaments
and the palmar, interosseous, and dorsal intercarpal ligaments. Some degree of mobility is possible between the
bones of the proximal row while the bones of the distal row are connected to each other and to the metacarpal bones
—at the carpometacarpal joints— by strong ligaments —the pisometacarpal and palmar and dorsal carpometacarpal
ligament— that makes a functional entity of these bones. Additionally, the joints between the bases of the metacarpal
bones —the intermetacarpal articulations— are strengthened by dorsal, interosseous, and palmar intermetacarpal
ligaments.
Movements and muscles
The extrinsic hand muscles are located in the forearm where their bellies form the proximal fleshy roundness. When
contracted, most of the tendons of these muscles are prevented from standing up like taut bowstrings around the
wrist by passing under the flexor retinaculum on the palmar side and the extensor retinaculum on the dorsal side. On
the palmar side the carpal bones form the carpal tunnel through which some of the flexor tendons pass in tendon
sheaths that enable them to slide back and forth through the narrow passageway (see carpal tunnel syndrome). [11]
Starting from the mid-position of the hand, the movements permitted in the wrist proper are (muscles in order of
importance):[12][13]
• Marginal movements: radial deviation (abduction, movement towards the thumb) and ulnar deviation (adduction,
movement towards the little finger). These movements take place about a dorsopalmar axis (back to front) at the
radiocarpal and midcarpal joints passing through the capitate bone.
• Radial abduction: extensor carpi radialis longus, abductor pollicis longus, extensor pollicis longus, flexor carpi
radialis, flexor pollicis longus
• Ulnar adduction: extensor carpi ulnaris, flexor carpi ulnaris, extensor digitorum, extensor digiti minimi
• Movements in the plane of the hand: flexion (palmar flexion, tilting towards the palm) and extension
(dorsiflexion, tilting towards the back of the hand). These movements take place through a transverse axis passing
through the capitate bone. Palmar flexion is the most powerful of these movements because the flexors, especially
the finger flexors, are considerably stronger than the extensors.
• Extension: extensor digitorum, extensor carpi radialis longus, extensor carpi radialis brevis, extensor indicis,
extensor pollicis longus, extensor digiti minimi, extensor carpi ulnaris
• Palmar flexion: flexor digitorum superficialis, flexor digitorum profundus, flexor carpi ulnaris, flexor pollicis
longus, flexor carpi radialis, abductor pollicis longus
• Intermediate or combined movements
However, movements at the wrist can not be properly described without including movements in the distal
radioulnar joint in which the rotary actions of supination and pronation occur and this joint is therefore normally
regarded as part of the wrist. [14]
40
Wrist
41
Additional Images
Wrist joint. Deep dissection.
Posterior view.
Wrist joint. Deep dissection.
Posterior view.
Wrist joint. Deep
dissection.Anterior, palmar,
view.
Wrist joint. Deep
dissection.Anterior, palmar,
view.
Notes
[1]
[2]
[3]
[4]
http:/ / education. yahoo. com/ reference/ gray/ subjects/ subject?id=86#p327
http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?mode=& term=Wrist+ joint
Behnke 2006, p. 76. "The wrist contains eight bones, roughly aligned in two rows, known as the carpal bones."
Moore 2006, p. 485. "The wrist (carpus), the proximal segment of the hand, is a complex of eight carpal bones. The carpus articulates
proximally with the forearm at the wrist joint and distally with the five metacarpals. The joints formed by the carpus include the wrist
(radiocarpal joint), intercarpal, carpometacarpal and intermetacarpal joints. Augmenting movement at the wrist joint, the rows of carpals glide
on each other [...] "
[5] Behnke 2006, p. 77. "With the large number of bones composing the wrist (ulna, radius, eight carpas, and five metacarpals), it makes sense
that there are many, many joints that make up the structure known as the wrist."
[6] Baratz 1999, p. 391. "The wrist joint is composed of not only the radiocarpal and distal radioulnar joints but also the intercarpal articulations."
[7] Isenberg 2004, p. 87
[8] Platzer 2004, p. 122
[9] Platzer 2004, p. 130
[10] Platzer 2004, pp. 126–129
[11] Saladin, 2003, pp. 361, 365
[12] Platzer 2004, p. 132
[13] Platzer 2004, p. 172
[14] Kingston 2000, pp. 126–127
References
• Baratz, Mark; Watson, Anthony D.; Imbriglia, Joseph E. (1999). Orthopaedic surgery: the essentials (http://
books.google.com/books?id=TbxYM_Ts-3YC&pg=PA391). Thieme. ISBN 0-86577-779-9.
• Behnke, Robert S. (2006). Kinetic anatomy (http://books.google.com/books?id=dbVv5OhJimcC&pg=PA78).
Human Kinetics. ISBN 0-7360-5909-1.
• Isenberg, David Alan; Maddison, Peter; Woo, Patricia (2004). Oxford textbook of rheumatology (http://books.
google.com/books?id=m7GOyN5wYVAC&pg=PA87). Oxford University Press. ISBN 0-19-850948-0.
• Kingston, Bernard (2000). Understanding joints: a practical guide to their structure and function (http://books.
google.com/books?id=6DH97qvthj4C). Nelson Thornes. ISBN 0-7487-5399-0.
• Moore, Keith L.; Agur, A. M. R. (2006). Essential clinical anatomy (http://books.google.com/
books?id=Xz8F00Su2SwC&pg=RA1-PA485). Lippincott Williams & Wilkins. ISBN 0-7817-6274-X.
ISBN 3-13-533305-1.
• Saladin, Kenneth S. (2003). Anatomy & Physiology: The Unity of Form and Function. McGraw-Hill. Unknown
parameter |ed= ignored (help)
Wrist
External links
• Wrist ligaments at upenn.edu (http://www.uphs.upenn.edu/ortho/oj/1999/html/PICS/p27f2.gif)
• wrist (http://www.emedicinehealth.com/script/main/srchcont_dict.asp?src=wrist) at eMedicine Dictionary
• wrist+joint (http://www.emedicinehealth.com/script/main/srchcont_dict.asp?src=wrist+joint) at eMedicine
Dictionary
• Hand kinesiology at UK bone/wrist.html (http://classes.kumc.edu/sah/resources/handkines/bone/wrist.html)
42
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Joints in the body

Transcription

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