musculoskeletal anatomy - lower extremity...
TRANSCRIPT
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