musculoskeletal anatomy - lower extremity...

Musculoskeletal Anatomy

- Lower Extremity -

2015. 3. 5.

Moon Seok Park, MD

Department of Orthopaedic Surgery

Seoul National University Bundang Hospital

Why anatomy ?

• Terminology (용어)

• Definition (정의)

– Facilitate Communication

– Common sense

• 여러 가지 가정을 통하여, 인간의 혈액의 양을 계산하였더니, 20 L가 산출되었다.

바로 틀린 것을 알 수 있다.

Quadriped

Biped Locomotion

(Bi + Ped)

Upper extremity

Lower extremity

(하지)

(From J.G. Fleagle’s Primate Adaptation & Evolution, 1988)

Lower extremity

1. Pelvis(골반)

2. Thigh, Femur(대퇴골, 허벅지)

3. Shin, Tibia and fibula(하퇴골, 장딴지)

4. Foot, tarsus(발)

– Ilium 장골 腸骨,壯骨

– Ischium 좌골 坐骨

– Pubis 치골 恥骨

Pelvis (골반)

Pelvis

Bony landmark

• Origin–근육이 시작되는 곳. (근위부)

–점(point)은 아니고, 면(surface)이다.

–대부분의 model에서 점으로 가정하고 있다.

• Insertion–근육이 끝나는 곳. (원위부)

• Proximal (근위), Distal (원위)

– Anterior superior iliac spine

• ASIS – Sartorius의 Origin

– Anterior inferior iliac spine

• AIIS – Rectus Femoris의 Origin

– Iliac crest

• Gluteus Maximus

– Iliac wing

Ilium

– Posterior superior iliac spine

– Posterior inferior iliac spine

– Greater sciatic notch

Ilium

– Symphysis pubis

– Pubic ramus

Pubis

– Ischial tuberosity

•Hamstring의 Origin

– Ischial spine

Ischium

- Arcuate line

- Quadrilateral plate

–Pelvic tilt

–Pelvic obliquity

–Pelvic rotation

Pelvic motion

– Rotation

• Computer science or Math

–Orientation and rotation

(position and movement)

• Anatomy or orthopedics

– Rotation

(mainly rotation on transverse plane)

Terminology

– Plane

•Sagittal plane

•Coronal plane

•Transverse plane

Terminology

Pelvic tilt

• Rotation on sagittal plane

Posterior Pevic tilt

Anterior Pevic tilt

Pelvic tilt

Pelvic obliquity

Pelvic obliquity

Pelvic Rotation

Pelvic motion

Reference coordinate - Global coordinateRelative to Global coordinate

– Pelvis

– Femur

Hip joint (고관절)

Hip joint movement

• Flexion/Extension

– Rotation on sagittal plane

• Abduction/Adduction

• External/Internal rotation

– Rotation on transverse

plane

– More…

Hip motion

Reference coordinate – Pelvic segmentRelative to Pelvic segment

Hip flexor

Origin :

T12-L5 vertebra

Insertion :

lesser trochanter

Action :

powerful hip flexion

Psoas Major

Iliacus

Origin :

iliac fossa

Insertion :

lesser trochanter

Action :

powerful hip flexion

Hip flexion contracture

• Contracture ….

• Cause of the abnormal gait

observed in CP patients

• Paoas m. is a primary cause

비디오

• Hip flexor

tightness or

spasticity

• Anterior pelvic tilt

• Lumbar lordosis

Hip flexion contracture

Hip extensor

Origin :

ilium & dorsal sacrum

Insertion

gluteal tuberosity

iliotibial band

Action

powerful extension

hip ER

Gluteal Maximus

Origin:

ilium between ant & post

gluteal lines

Insertion:

greater trochanter

Action:

powerful abduction

hip ER

Balancing during walking

Gluteal Medius

Origin:

ilium between ant & inf

gluteal lines

Insertion:

ant greater trochanter

Action:

abduction & IR of hip

assist gluteus medius during

walking

Gluteal Minimus

Femur

• Femur

– Proximal extremity

– Shaft (Body)

– Distal extremity

Femur

Femur

Femur

Femoral Muscles

Rectus Femoris muscle

Origin :

1. AIIS

2. superior rim of

acetabulum

Insertion :

patella, tibial

tubercle

Action :

1. hip flexion

2. knee extension

Posterior Femoral Muscle

(Hamstrings)

비디오

semimembranosus semitendinosus biceps femoris

BTM

medial lateral

Origin:

ischial tuberosity

Insertion:

proximal medial tibia

Action:

hip extension

knee flexion & IR

Hamstrings - semitendonisus

Origin:

ischial tuberosity

Insertion:

posterior med tibial condyle

Action:

hip extension

knee flexion & IR

Hamstrings - semimembranosus

Origin:

ischial tuberosity

Insertion:

head of fibula

Action:

hip extension

knee flexion & ER

Hamstrings – biceps femoris

(long head)

Origin:

linea aspera,

supracondylar line

Insertion:

fibula, lateral tibia

Action:

knee flexion & ER

Hamstrings – biceps femoris

(short head)

pectineus

adductor brevis

adductor longus

adductor magnus

Hip Adductors

anterior view

Hip Adductors

posterior view

gracilis

Lower leg

Patella

Tibia

Tibia

Tibia

Tibia

Knee motion

Reference coordinate – Thigh segmentRelative to Thigh segment

Lower leg Muscles

The Anterior and Lat

Compartment

(Extensor and Fibularis Groups)

Anterior Tibialis

Origin :

1. Upper 2/3 of lat. Surface of

tibia

2. Crural interosseous

membrane

3. Highest part of Superficial

crural fascia

Insertion :

1. Medial and plantar surface

of medial cuneiform

2. Medial base of metatarsal

Action : Ankle dorsiflexion

Inversion

Fibularis longus

Origin :

1. Head of fibula

2. Proximal 2/3 of lateral

surface of fibula

Insertion :

1. Plantar side of medial

cuneiform

2. Base of first metatarsal

Action : Ankle plantar flexion

Eversion

The Posterior Compartment

Triceps surae

Origin :

Lateral and medial

femoral condyle

Insertion :

Calcaneus

( via Achilles

tendon)

Action :

Knee flexion, ankle

plantar flexion

Gastrocnemius

Origin :

1. Posterior fibula

head

2. Soleal line of tibia

Insertion :

Calcaneus( via

Achilles tendon)

Action :

ankle plantar flexion

Soleus

Equinus 비디오

Equinus

Posterior Tibialis

Origin :

Crural interosseous

membrane and adjacent

borders of tibia and fibula

Insertion :

1. Tuberosity of navicular

2. Cuneiforms, cuboid

3. base of second~ fourth

metatarsals

Action : Ankle plantar flexion

Inversion

varus 비디오

Varus

Flexor Hallucis longus

Origin :

Distal 2/3 of posterior

surface of fibula

Insertion :

Base of distal phalanx

of big toe

Action : Big toe flexion

Plantar flexion

Inversion

Flexor Digitorum longus

Origin :

Middle third of posterior

surface of tibia

Insertion :

Base of second through

fifth distal phalanges

Action : Plantar flexion

Inversion

Foot & Ankle

Ankle

• Stable hinge joint

• Medial/lateral dislocation prevented by

malleoli

• Square shape of talus

- adds stability of ankle

• Most stable during dorsiflexion,

least stable in plantar flexion

Ankle Motions

• Plantar Flexion

• Dorsiflexion

• Inversion

• Eversion

• Pronation

• Supination

Ankle Articulations

Talar Joint

(Talocrural joint)

• Tibia & fibula with

talus

• Dome of talus

articulates with

mortise formed by

tibia & fibula

• Motions: dorsiflexion

& plantar flexion

Subtalar Joint

• Articulation of talus

with calcaneus

• Motions: inversion &

eversion

• Tarsus

– 7 tarsal bones

• Metatarsus

– 5 metatarsal bones

• Phalanges

– 14 phalanges

Bones of foot

Bones of foot

• Talus

– Body, neck, head

• Calcaneus (largest, strongest)

• Navicular

• Cuboid

• Cuneiform

- Medial, internediate, lateral

Bones of foot

Bones of foot

• Metatarsus

– Base, body, head

• Phalanges (Prox, Middle, Dist)

– 1st

: 2 phalanges

– 2-5th

: phalanges

Bones of foot

Bones of foot

Bones of foot

PesValgus

PesVarus

Bones of foot

Bones of foot

Movement of Ankle joint

Ankle motion

Reference coordinate – Shin segmentRelative to Shin segment

Foot progression angleReference coordinate – Global coordinate

Subtalar motion

• Pronation

–DF, abduction, eversion

• Supination

–PF, adduction, inversion

Movement of Foot joint

Movement of Toes

Muscle &

Tendon of

Foot & Ankle

Muscle &

Tendon of

Foot & Ankle

Muscle &

Tendon of

Foot & Ankle

Thank you for your

attention