TBL 17 - Anatomy.docx

TBL 17: Hip & Knee Joints, Anterior & Medial Thigh, and Anterior & Lateral Leg Dr. DeFouw Before the TBL session, you are expected to correlate the Learning Topics with the designated figures in Essential Clinical Anatomy (ECA) . Ignore all items in the figures and text not related to the Learning Topics and answer the Questions for Application of Knowledge. Identify the bold- print structures on the disarticulated bones provided during the TBL session. Learning Topics for the Hip and Knee Joints Use Figures 3.2 (A), p. 197 (ECA) to recall fusion of the ilium, pubis, and ischium forms the hip bone and observe the acetabulum of the hip bone articulates with the head of the femur (unlabeled) to form the synovial ball and socket hip joint. Use Figure 5.1, p. 310 to envision upper body weight is transmitted centrally through the vertebral column and bilaterally to the sacrum, which is stabilized by union of the pubic rami at the pubic symphysis. Surmise the ilia transfer the weight to the femurs at the hip joints thus upper body weight is transmitted to the heads and necks of the femurs when standing. Also observe the femurs are obliquely positioned in the thighs and the knees are placed directly inferior to the trunk thereby returning the center of gravity to the vertical plane of the supporting legs and feet.

Use Figure 5.4 (A-C), p. 315 to determine femoral obliquity results from the angle of inclination. Note the angle becomes more acute with aging; thus, increased strain on the neck of the femur makes its fracture more common in the elderly. Use Figure 1.4(A), p. 6 to compare flexion and extension of the thigh and of the leg. Use Figure 5.45 (A and B), p. 371 to perceive the iliofemoral, pubofemoral, and ischiofemoral ligaments pass in a spiral fashion from the bones of the hip to the femur to reinforce the joint capsule. Associate relative weakness of the ischiofemoral ligament with hip dislocations most commonly in a posterior direction.

Also envision extension of the femur winds the ligaments more tightly, which increases joint stability but restricts extension slightly beyond vertical. Deduce flexion of the femur unwinds the ligaments, which increases joint mobility and allows flexion to ≥ 90 ⁰ beyond vertical. Question for Application of Knowledge ________________________ 1. From Fractures of Hip Bone, p. 311: What is a hip fracture, and how is the term commonly misapplied? __________________________________________________________________________ Use Figure 5.2 (E), p. 313 to observe the articular surfaces of the femoral and tibial condyles at the knee, a hinge type synovial joint. Use Figure 5.51 (C), p. 378 to discern the lateral and medial menisci are incomplete rings of connective tissue that partially cover the articular surfaces of the tibial condyles.

Use Figure 5.50, p. 377 to observe the cord-like fibular (lateral) collateral ligament (LCL) attaches the lateral epicondyle of the femur to the head of the fibula , and the strong, flat tibial (medial) collateral ligament (MCL) attaches the medial epicondyle of the femur to the superomedial tibia. Envision the anterior and posterior cruciate ligaments (ACL and PCL) obliquely cross each other in the center of the knee joint. Use Figure 5.51 (A and B), p. 378 to note the stronger PCL attaches the posterior tibia to the anterior aspect of the femoral medial condyle; thus, the PCL prevents anterior displacement of the femur on the tibia and hyperflexion of the leg. Also observe the weaker ACL attaches the anterior tibia to the posterior aspect of the lateral femoral condyle; thus the ACL prevents posterior displacement of the femur on the tibia and hyperextension of the leg. Question for Application of Knowledge ________________________ 2. From Knee Joint Injuries, p. 383: What are the anterior and posterior drawer signs? _____________________________________________________________________________

Learning Topics for Muscles of the Anterior and Medial Thigh Use Figure 5.2, p. 312-313 to recall the ASIS, and recognize the greater trochanter , lesser trochanter , and linea aspera of the femur . Observe the tibial tuberosity on the tibia. Use Figure 2.61 (A), p. 184 to observe the psoas major in the abdomen joins the iliacus in the greater pelvis to form the iliopsoas that attaches to the lesser trochanter of the femur distally. Discern the iliopsoas is the main flexor of the thigh.

Use Figure 5.12 (B), p. 331 to surmise the sartorius, which attaches to the ASIS proximally and the superomedial tibia distally, synergizes with the stronger iliopsoas to flex the thigh and with stronger hamstring muscles of the posterior thigh (to be studied later) to flex the leg. Use Figure 5.12 (B, C, E and F), p. 331 to observe the vastus lateralis, vastus intermedius, and vastus medialis of the quadriceps femoris attach proximally to the lateral, anterior, and medial surfaces of the femur. Note the rectus femoris attaches proximally below the ASIS.

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