Comparing the Upper & Lower Limbs

Lower Limb • Femoral Triangle • Gluteal Region • The Thigh • The Leg • Foot • Pre-axial - medial

Upper Limb • Axilla • Deltoid Region • The Arm • The Forearm • Hand • Pre-axial - lateral

The Thigh • Named Regions

– Femoral Triangle (cf the axilla) – Subsartorial Canal – Popliteal Fossa (cf the Cubital fossa)

• Muscle groups & their Nerves – Adductors (of the hip) - Obturator Nerve – Abductors - Gluteal Nerves – Extensors (of the knee, some also flex

the hip) - Femoral Nerve – Flexors (of the knee, most also extend

the hip) / Hamstrings - Sciatic Nerve

Arteries, Veins & Lymphatics

Like Bathroom Plumbing • Arteries - Deliver - High pressure - Thick wall - Narrow pipe • Veins - Retrieve - Low pressure - Thin wall - Wide pipe • Lymphatics - Scavenge

Anterior Superior Iliac Spine Pubic

Tubercle

Inguinal Ligament

The Femoral Triangle

Inguinal Ligament

The Femoral Triangle

Adductor Longus

Sartorius

The Floor

Pectineus

Ilio-Psoas

Adductor Longus

N

L

A V

The Contents

Long saphenous vein

Saphenous opening

Bones & Joints

•Bone as a Tissue •Ossification

Composition of Bone

• Bone cells • Extracellular Components

Types of Bone

• Cortical/dense/compact Bone – Shafts of long bones – Contains yellow (fatty marrow) in

adults • Cancellous/spongy/trabecular

– Flat bones – Ends of long bones – Contains red (haemopoietic) marrow

Extracellular Components of Bone

• Fibres – Type 1 collagen

• Matrix – Minerals

• Nerves & vessels

Organisation of Bone

• Woven (Immature bone) – random

• Mature (Lamellar bone) – Concentric cylindrical plates

(Lamellae) – Haversian Canals - nerves and vessels

Ossification of a Typical Long Bone

Cartilagenous Outline

Primary centre of ossification embryo Week 9

Ossification of a Typical Long Bone

Ossification of a Typical Long Bone

Secondary Centre of Ossification - After birth

Ossification of a Typical Long Bone

Epithyseal Growth Plate - new bone on shaft side

Ossification of a Typical Long Bone

Another secondary centre of ossification

Union! The 2ndary centre that appears last, unites 1st

Main Growth centre remains

Ossification of a Typical Long Bone

Ossification of a Typical Long Bone

Joints Either

A discontinuity in bones or

A place where bones meet

Types of Joints •Fibrous

–No Movement –Located

•Distal tibiofibular joint •Between bone of the skull

•Cartilagenous –Primary - where cartilage meets bone- Strong but no movement

•Ribs & their costal cartilages •Epiphyses in growing bones

–Secondary

Types of Joints •Cartilagenous

–Secondary - bones joined by fibrocartilage. Limited movement –Midline

•Symphysis pubis •Intervertebral discs

•Synovial “Egg white joints” May allow free movement

Synovial Joints 6 essential features

•Bone ends covered by hyaline cartilage •A joint cavity filled with synovial fluid •Joint surrounded by a fibrous capsule •Capsule lined by synovial membrane •Capsule reinforced by ligaments •Potentially free movement

Synovial Joints 6 essential features

Bone ends covered by hyaline cartilage •Hyaline cartilage

–Gristle –More flexible than bone –Avascular –Chondrocytes in ground substance of mucopolysaccharides & collagen

•Fibrocartilage –more like tendon etc, with some chondrocytes

Synovial Joints 6 essential features

A joint cavity filled with synovial fluid •Sticky lubricating fluid

–Normally sparse 0.5 ml per knee joint –More produced with damage to joints

Synovial Joints 6 essential features

•Joint surrounded by a fibrous capsule –Originally attached to epiphyses, but it does migrate –Varies in thickness

Synovial Joints 6 essential features

Capsule lined by synovial membrane •Membrane regarded as connective tissue, not epithelium •Cells produce extracellular substance - synovial fluid •Not joined by junctional complexes etc

Synovial Joints 6 essential features

Capsule reinforced by ligaments •Ligaments - bone to bone •Tendons - muscle to bone •Aponeuroses - flat tendon •Fascia - wrapping •Retinaculum - holds tendons in place

All basically the same stuff

Synovial Joints 6 essential features

Potentially free movement •Depends on shape of bone ends •Competing

–Mobility –Stability –Congruous bone shapes –Tight strong ligaments –Adjustable (“live”) ligaments

Plane X-ray