 Hello everyone, welcome to this session on joints of the lower limb. In this session we will be revising all the joints of the lower limb. So here I have listed down the major joints of the lower limb, hip joint, knee joint and ankle joint. These are the joints which are most frequently asked in examination. So we will be covering these joints under all these headings. And for remaining joints I will cover the types of the joints. Just like I covered the upper limb quick revision session in the previous video, I will be covering the lower limb session as well. So let's start with the hip joint. The hip joint is which type of joint? It is an example of a ball and socket variety of trinomial joints. And what are the articular surfaces which form the hip joint? This is the head of the femur which forms the ball component of the ball and socket. And this is the acetabulum of the hip bone which forms the socket. And in this particular articular surface is referred to as the lunate surface. It is a horse shoe shaped surface in the acetabulum which articulates with the head of the femur. Then various ligaments of the hip joint. Since hip joint is a trinomial joint, it will have a fibrous capsule covering it. So capsular ligament is the first ligament which we can remember. Then with respect to the hip bone we can remember three ligaments. From ileum to the femur there is ileopemoral ligament. Then from ischium to the femur is ischio-femoral ligament. And from pubis to the femur is pubopemoral ligament. Then other ligaments are there is a transverse acetabular ligament in this region. And there is a ligament from the head of the femur. Ligamentum teris femoris. So I will repeat all the ligaments of the hip joint. One is the fibrous capsule. Then ileopemoral ligament, ischio-femoral ligament, pubopemoral ligament, transverse acetabular ligament and ligament of the head of the femur. Then let's cover the various relations of the hip joint. For relations of the hip joint there is a simplified schematic diagram. First orient yourself towards the image. This is the region of the hip joint. This region is the anterior part and superior, posterior and inferior. So which all structures from the anterior relations of the hip joint call these structures. The straight head of the rectus femoris and tendon of the ilio-sauce. The ili-actus and sauce major muscle together are referred to as ilio-sauce. Then there is a synovial bursa just beneath the sauce major. It is also referred to as sub-sauce bursa. Then the contents of the femoral triangle, femoral vein, artery and nerve. And also small part of pectinus comes in the anterior relations. Let's see the superior relations of the hip joint. In the superior relation one there is reflected head of the rectus femoris. Straight head was in the anterior relation. Reflected head is in the superior relation. Apart from that there are three glutei muscles. Gluteus maximus, medius and minimus. And when we see the posterior relation, gluteus maximus is seen in the superior relation as well. It is seen in the posterior relation as well. And there are many structures under the cover of the gluteus maximus. Pyriformis, sciatic nerve, obturator, internus, pituit, gamma-lite, quadratus femoris and nerve to quadratus femoris. All these structures are in the posterior relation. Then let's see the inferior relation. There are two structures listed. One is obturator, externus muscle and medial circumplex, femoral artery. So these are the various relations of the hip joint. Let's cover the bursae surrounding the hip joint. Bursae surrounding the hip joint with respect to the gluteus maximus, there are four bursa. Then with gluteus, medius one bursa, gluteus minimus one bursa and the sauce major where it's one bursa. We can remember around seven bursa around the hip joint. Let's cover the bursae surrounding the gluteus maximus. One bursa is near the origin along the gluteal surface of the hip bone just below the posterior gluteal line. Then there is one bursa near the graded trochanter. Here the trochanteric bursa near the east rail tuberosity is the east girl bursa, and near the insertion of the gluteus maximus where is gluteal femoral bursa. Then insertion of gluteus medius, near the insertion of gluteus medius along the lateral aspect of the graded trochanter, that is one bursa. Then along the anterior aspect of the graded trochanter near the insertion of gluteus minimus where is one bursa. was just behind the source measure which we also saw in the anterior relations of the hip joint. So, these are the various births, let us cover the blood supply and the nerve supply of the hip joint. So, blood supply will be by the blood vessels just surrounding the hip joint, so which vessels are surrounding, there is the medial circumflex femoral artery, there is lateral circumflex femoral artery, these two are branches from the profunda femoris artery which itself is a branch from the femoral artery, okay, then apart from that there is superior gluteal artery, inferior gluteal artery as well as obturator artery, okay, so there is a major blood vessels to supply the hip joint. Then nerve supply of the hip joint will be again by the nerves surrounding the hip joint, so on the anterior aspect there is femoral nerve, it supplies the hip joint through the nerve to rectus femoris, then there will be obturator nerve, okay, and on the posterior aspect there is nerve to quadratus femoris and also superior gluteal nerve, okay, and sciatic nerve is seen close to the hip joint, but it occasionally supplies the hip joint, okay. Let us cover the moments of the hip joint. As hip joint is a multi-axial sinuval joint, multiple moments are possible, flexion extension, adduction, abduction, medial rotation and lateral rotation, okay, flexion is brought about the source major and EE axis, here the cheek flexes and there are some accessory muscles as well, for example in Tokyo at least we should remember the cheek muscles which is producing that particular action, okay. Then extension is brought about by gluteus maximus, accessory muscle is answering, then abduction is by gluteus medius and minimus, here the cheek abductors, then adduction by adductor longus bravis magnus, okay, then medial rotation by anterior fibers of gluteus medius and minimus, okay, in general gluteus medius and minimus they will cause abduction, specifically the anterior fibers will cause medial rotation at the hip joint, okay, and lateral rotation is brought about by short lateral rotators, okay, which are the short lateral rotators, pyriformis, obturator externus, then obturator internus with two gamelife, quadratus femoris, okay, all these muscles are included in short lateral rotators which will rotate the hip joint laterally, okay. Let's cover the applied anatomy of the hip joint, the hip joint dislocation of the hip joint is common, amongst which congenital dislocation is more common as compared to that of the acquired dislocation, head of the femur is displaced posteriorly, okay, and birth disease is referred to as flattening of the head of the femur, okay, also referred to as pseudo-coxalgia, then coxa-bara and balga these refer to the change in the neck shaft angle, normal neck shaft angle is about 125 degrees, if there is decrease in the neck shaft angle it is referred to as coxa-bara, increase in the neck shaft angle is referred to as coxa-balga, okay, then osteoarthritis is inflammation of the hip joint, then referred pain of the hip joint it may be felt in the knee joint as well because obturator nerve which supplies the hip joint also supplies the knee joint, okay, then fracture of the neck of the femur is very common in old age and it is further of two types, intracapsular fracture and extracapsular fracture, in the intracapsular fracture there are various sub types, sub-capital, basal, cervical, the intracapsular fracture of neck of femur has got certain complications as well because of the damage to the retinocular vessels that supplies the head of the femur, complications is referred to as avascular necrosis, okay, it's common when there is intracapsular fracture of the neck of the femur, okay, this was all about the hip joint, let's move on to the knee joint, let's start with the knee joint now, knee joint is which type of joint, it is an example of a compound complex modified hinge variety of synovial joint, okay, so why compound because more than two bones are taking part in the formation of the joint and why complex because an articular disc is present in between the joint cavity, okay, then why modified hinge variety because the transverse axis in which flexion and extension takes place, it is not stable, it slightly moves during the movement, okay, that's why modified and hinge variety because movements are along a transverse axis, okay, an articular surface is formed by the inferior surface of the condyles of the femur and superior surface of the condyles of the tibia and the posterior surface of the patella, okay, pibula doesn't take part in the formation of knee joint, okay, and let's cover the various ligaments of the knee joint, on the knee joint ligaments, you can divide into cheap ligaments and secondary ligaments, cheap ligaments are fibrous capsule, also referred to as a capsular ligament, since it is a synovial joint is having this, then ligamentum patellis, here we can see this is the ligamentum patellis, the quadriceps femoris tendon primary insertion is on the patella which extends as the ligamentum patellis which goes up to the CBL tuberosity, and CBL and the tabular collateral ligament, the CBL collateral ligament is on the medial side, this one, and tabular collateral ligament is this one, okay, then anterior and the posterior trussate ligaments, these are seen on the interior of the knee joint, so the schematic diagram to see the interior is the anterior part, so this ligament frequency this is the anterior trussate ligament, and this one is the posterior trussate ligament, okay, they are named according to their attachment on the tibia, then menisci, medial and lateral, this is the medial meniscus, this is the lateral meniscus, okay, just appreciate the shape of this meniscus, this medial meniscus is semicircular and the lateral meniscus is almost circular, okay, smaller as compared to that of the medial meniscus, and let's look at the secondary ligament of the knee joint, the oblique popliteal ligament, here we can see this is the oblique popliteal ligament, it's an extension from the semi-membranosus muscle, there is arcuate popliteal ligament, this one, then transverse ligament, it connects the anterior ends of the two menisci, this one is the transverse ligament, and coronary ligament, it's between the peripheral margins of the menisci and the tibia, okay, so it helps in attaching the peripheral margins of the menisci to the peripheral margins of theondyles of the tibia, okay, these are the various ligaments of the knee joint, let's cover the relations and births surrounding the knee joint, so the four headings and relations anterior, posterior lateral, posterior medial and posterior, okay, anterior relations include the pre-particular birtha and ligamentum patelli, posterior lateral relations include the biceps femoris, common fibular nerve, the word peroneal is replaced by fibular, okay, then plantaris and the lateral head of the gastronomia, okay, all these are in the posterior lateral relations, that is the posterior medial relations, posterior medial relations there is tartarious gracilis and semitendinosis, the SGS muscle, okay, then semi-membranosus and the medial head of the gastronomia, then in the posterior relations there is tibial nerve, propritial vessels and the oblique propritial ligamentum, so the other various relations of the knee joint, let's quickly cover the births surrounding the knee joint as well in this image, on the anterior aspect with relation to the patellar, we can see one birtha, the pre-particular birtha, there are few other birtha in relation to the patellar, one we can see that is the pre-particular birtha, there is subcutaneous intraparticular birtha, and there is deep intraparticular birtha and supraparticular birtha, okay, there are the four birtha in relation to the patellar, then along the posterior lateral aspect there is a birtha between the tendon of the biceps femoris and the fibular collateral ligament, so here there will be a birtha, and between fibular collateral ligament and tendon of popliteus, there is a birtha here, and between tendon of popliteus and the lateral condyle of the femur, there will be one more birtha, okay, so three birtha in the posterior lateral region, and in the posterior medial region, we can remember this semi-membranosus muscle, there is a birtha between semi-membranosus and the tbl collateral ligament, there is one birtha between semi-membranosus and the medial condyle of the tbl, okay, and this SGS muscles, we know cartorias gracilis semitendinosus, there is a birtha which separates them, that is answering birtha, okay, so answering birtha, birtha between semi-membranosus and tbl collateral ligament, birtha between semi-membranosus and the medial condyle of the tbl, then along the posterior aspect, deep to the medial head and the lateral head of the gastronomia, there is manman birtha each, okay, so there are four birtha here on the anterior aspect in relation to the patella, three birtha near the posterior lateral aspect, then three birtha in the posterior medial aspect and two birtha along the posterior aspect, okay, so there are many birtha in relation to the knee joint, let's cover the blood supply and the nerve supply of the knee joint, so blood supply to the knee joint will be by the surrounding blood vessels, on the posterior aspect of the knee joint, we know there is popliteal artery which gives genicular branches, okay, there is middle genicular artery, superior medial genicular artery, superior lateral genicular artery, inferior medial and inferior lateral genicular artery, okay, so five genicular arteries of popliteal artery they will supply, as well as there is lateral circumflex, femoral artery that also supplies knee joint, then there are recurrent branches from the vessels of the leg, okay, which are the vessels of the leg, the anterior tbl artery, the posterior tbl artery, right, so recurrent branches from that will supply, from the posterior tbl artery there is a specific branch called a circumflex tabular artery which gives the recurrent branch and nerve supply of the knee joint will be by the surrounding nerve, there will be femoral nerve, obturator nerve, the tbl nerve and common tabular nerve, okay, these are the major nerves which are surrounding the knee joint, so that will supply it, let's cover the moments of the knee joint, moments of flexion, extension as well as in semi flex position two other moments are possible, medial rotation and lateral rotation, so flexion is brought about briefly by the hamstring muscles, so semi-membranosis, semi-candidosis and biceps femoris, extension is brought about by quadriceps femoris, okay, there are some accessory muscles as well and in medial rotation again the muscles of flexion are featuring here, the semi-candidosis, semi-membranosis as well as there is one muscle, populate here, okay and lateral rotation is by biceps femoris muscles, okay, when we learn about the moments of the knee joint there is one specific moment which needs to be learned in details that is locking and unlocking of the knee joint, so here we can see the locking and unlocking of the knee joint, so we should know what is locking and unlocking and which muscle produces locking and unlocking, okay, locking of the knee joint is referred to as medial rotation of the femur on the tibia during terminal stages of extension, okay, why the knee gets locked because the quadriceps femoris muscle it can get relaxed and the person can stand for a prolonged period without much muscular equipment, okay, then unlocking is lateral rotation of femur of the tibia during initial stages of the flexion, okay, this is brought about by quadriceps femoris and unlocking is brought about by popliteus muscle, okay, log knee is rigid and unlock knee can be further flexed in log knee all ligaments get taught and in unlock knee the ligaments are relaxed, okay, this topic is very important, so most commonly asked as a short note in examination, now let's cover the applied anatomy with relation to the knee joint, so knee joint is one of the most common joint to be affected by osteoarthritis, then cruciate ligament injury in which the anterior cruciate ligament injury is more common as compared to that of the posterior cruciate ligament, then in menstrual tears also medial meniscus is more prone to injury as compared to lateral meniscus, then housemate's knee is inflammation of the trepatellar bursa, then clergyman's knee is inflammation of the subcutaneous intrapatellar bursa, okay, then bacer cystic swelling of the bursa deep to the semi-membranosus muscle, okay, then arthroscopy of the knee joint is now frequently performed to visualize the interior of the knee joint and as well as certain therapeutic corrections can be done through the scope which is passed inside the joint, there's something called as unhappy triad of the knee joint in which three structures are involved, one is the medial collateral ligament, an anterior cruciate ligament and medial meniscus, okay, so if these three structures together are involved they are referred to as unhappy triad of the knee joint, okay. Let's start with the ankle joint now, ankle joint is which type of joint, it is an example of a hinge variety of synovial joint because moment is along a transverse axis, okay, articular surfaces, the proximal articular surface is formed by tibia as well as tabula, the tibia of tabula are more type, formed by the inferior surface of the tibia as well as the medial surface of the tabula, then the superior surface of the talus, okay, so all these are the articular surfaces, then ligaments of the ankle joint, since it is a synovial joint the first ligament which we can remember is the fibrous capsule or the capsular ligament, the other ligaments are the medial collateral ligament and the lateral collateral ligament, medial ligament is also referred to as deltoid ligament which has got further parts, the medial ligament when we study we have to remember the tibia, the medial ligament starts with tibia and when we study the lateral ligament we have to remember the fibula and the lateral ligament ends in fibula, okay, so how we can see here from the tibia it is starting the tibiotailer anterior tibiotailer and posterior tibiotailer this one is anterior tibiotailer, this one is posterior tibiotailer, then from tibia to the calcaneus is tibio-calcanean this one and this is tibionavicular, okay, so these are the various medial ligaments, lateral ligaments are starts from talus and goes up to the fibula, so anterior talopabular, posterior talopabular and calcaneopabular, okay, now let's cover the relations of the ankle joint, so here we can see anterior relations as well as posterior relations, for anterior relations we can easily remember by a mnemonic, tall, Himalayas are never dry places, okay, so if you remember the mnemonic we can try to correlate with the structure surrounding that region, on the anterior aspect the muscle is tbl is anterior and hence for extensor halosus longer, a for anterior tbl artery and for the nerve on the anterior aspect there is deep fibular nerve, then b for the extensor digitorum longer and b for the peronius tertius, okay, it's the correct name now is fibularis tertius, okay and similarly the posterior relations can be remembered by a mnemonic, talented doctors are never hungry, okay, on the posterior aspect the t will stand for the tbl is posterior muscle and these stands for the flexor digitorum longest muscle, the artery is posterior tbl artery, nerve is posterior tbl nerve and hence stands for the flexor halosus longest muscle, okay, so relations median to lateral made easy by these two mnemonic and blood supply and nerve supply with respect to the ankle joint, so blood vessels will be by the surrounding vessels, so we know there is anterior tbl artery, posterior tbl artery, so that this supply the ankle joint, then nerve supply will be by the surrounding nerves, on the anterior aspect there is deep fibular nerve, on the posterior aspect there is tbl nerve, okay, in the blood supply also there will be some contribution from the fibular artery, okay, then let's cover the movement of the ankle joint, since it is a hinge joint two movements are possible dorsiflexion and plantar flexion and the muscles producing these movements dorsiflexion will be brought about by muscles of the anterior compartment of the leg, the anterior is the chief dorsiflexor and the remaining muscles will be referred to as accessory muscles, similarly in plantar flexion the cheek muscle will be soleus and gastronomia, okay, rest of the muscles will be considered as accessory muscles, let's cover the applied anatomy with respect to the ankle joint, so ankle sprains are common in which the ligaments are injured, in which the anterior talofabular ligament is the most commonly injured ligament, okay, then dislocation of the ankle joint may occur, port fracture is referred to as fracture dislocation, there will be fracture in this area as well as dislocation of the joint, fracture usually occurs of the malleolus, the medial malleolus, lateral malleolus, as well as there is a third malleolus which is described in the ankle joint that is the posterior margin of the TBR that is referred to as the third malleolus, okay, so if all three are involved it is referred to as trimalleolar port fracture, then optimum position of the ankle whenever the plaster cast has to be applied in this region, the cast is applied in such a way that the ankle is in slight plantar flexion, okay, so let's summarize what we have covered in this particular session and also I'll cover the types of the other joints of the lower limb, okay, so for hip joint, knee joint and ankle joint we covered in detail, so all our sinoval type and the subtype for hip joint is ball and socket, for knee is modified hinge and for ankle is the hinge joint, okay, then tibiofibular joints, here we can see the tibiofibular joint, superior, middle and inferior, the superior tibiofibular is the plane variety of synovial joint whereas other two are fibrous type of joint, okay, so this is a thin death muscle and sub-tailor joint is the plane variety of synovial joint, in sub-tailor joint there are actually two components, posterior talo-calcaneal joint and anterior talo-calcaneal joint, the posterior talo-calcaneal joint is specifically referred to as sub-tailor joint, okay, and anterior talo-calcaneal joint it is the component of this joint, that is the talo-calcaneal nabicular joint and this joint is referred to as ball and socket variety of synovial joint, okay, then calcaneal cuboid joint, here we can see this is the calcaneal cuboid joint, it is a saddle variety of synovial joint and also metatarsal joint it is a plane variety of synovial joint, inter-metatarsal joints are also plane variety, then joints between the metatarsal and the phalanges these are ellipsoid variety of synovial joint and inter-phalangeal joint are hinge variety of synovial joint, okay, so we have covered all the joints of the lower limb, so for PDF handout you all can what set me at this number and please do watch other sessions of this youtube channel, okay, thank you