PPC/OMM Final Exam 1

Lecture 1 – Anatomic Terminology

 Anatomical Position: standing erect, forward gaze, arm adjacent to sides w/ palms facing
forward, lower limbs close together w/feet parallel
 Supine position – laying face upward
 Prone position – laying face downward
 Lateral Decubitus Position (right or left) – laying on side with pillows designed to relieve
pressure on different points
 Lithotomy – supine positon of the body with legs separated, flexed, and supported in raised
stirrups (childbirth)
 Trendelenburg – allows blood to flow toward brain
 Reverse Trendelenburg – allows blood to flow away from brain and to the extremities
 Anatomic Planes:
o Sagittal – parallel to median plane
 Midsagittal = median
o Frontal (coronal)
o Transverse (Axial or Horizontal)
 Location of Fascia
o Deep Fascia – found between adjacent muscles
o Superficial Fascia (hypodermis) – adipose between skin and muscles
 Valgus – outward angulation of distal segment of bone or joint (pigeon toed/knock knee)
 Varus – inward angulation (bow legged – most commonly horse rider’s)
 Windswept hands – fingers swept to 1 direction (arthritis)
 Retinaculum – thickened deep fascia around joints which hold tendons & prevent bow-stringing
 Bursae – usually collapsed sacs of serous membrane enable one structure to move freely over another 
gliding (ex: olecranon bursa)
o Synovial tendon sheath – specialized type of elongated bursa
 Other Specialized bursal sacs
o Pleural sacs
 Inner layer – visceral pleura, Outer layer – parietal pleura
o Abdominal viscera
 Inner – visceral peritoneum, Outer – parietal peritoneum
Lecture 2 —The Axial Skeleton
 The skeleton
o Axial Skeleton – Skull, Hyoid, Vertebral Column, Ribs, Sternum
o Skeleton provides: support, protection, movement, storage, blood cell form
 Bone shape
o Long- tibia
o Short- phalanges
o Flat- skull bones
o Irregular-- vertebrae
o Sesamoid—patella
 Bone structure
o Outer layer = cortical/compact bone
 Compact bone - strength for bearing weight
o Inner region = spongy bone
o Long bones designed for rigidity & attachment of muscles/ligaments – amount
of compact bone greatest near middle of shaft
o Long bones have elevations to serve as supports where large muscles attach
o Living bones have some flexibility and have a lot of rigidity—hardness/support
o Unused bones= atrophy
o Bones hypertrophy when they support increased weight for a long period—if you get really fat and you stay that way for a long
time, your bones would eventually hypertrophy
 Bone matrix: organic and inorganic
o Organic matrix = shape of bone
o Inorganic matrix = rigidity
 Osteoporosis
o Age-related degeneration of bone
o Cortical and spongy bone lost (cortical plate gets thin and spicules separated by larger than normal spaces)
o Organic and inorganic components decline
o Bone density measured
o State of bone monitored by bone scanning
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 Bone is alive
o Living bone covered by periosteum—connective tissue layer richly supplied by sensory nerve endings
o Bones receive blood through nutrient-rich arteries & drain through nutrient veins
o Articular surfaces of bones are covered w/ articular cartilage
o Cartilage = living cells surrounded by matrix; matrix never mineralizes
o Articular cartilage produces a smooth, slippery, near frictionless surface so articulating bones can move against each other

 Bone markings and formations

o Capitulum – distal articular surface of the humerus (smooth, rounded eminence)
o Condyle – round prominence at the end of a bone that anchors muscle ligaments and articulates with adjacent bones
o Crest – projecting structure or ridge
o Epicondyle – protuberance above or on the condyle of a long bone
o Epiphysis – end part of a long bone
o Facet – small smooth area on a bone where 2 or more bones articulate
o Foramen – any opening that allows muscles, nerves, arteries, etc. to pass through
o Fossa – depression or hollow
o Groove – a long narrow furrow or low area in a surface
o Head
o Line – thin projection with a rough surface
o Malleolus – bony prominence on each side of the ankle
o Metaphysis- wide portion of a long bone between the epiphysis and the diaphysis
o Notch – small indentation or concave cut into a surface or edge
o Protuberance – blunt projection, eminence, or swelling
o Shaf – the diaphysis of a long bone
o Spine – a sharp, short projection
o Spinous process – protrudes where the laminae of the vertebral arch join
o Trochanter – one of the bony prominences toward the near end of the bone
o Trochlea
o Tubercle – a nodule or small eminence/projection
o Tuberosity – a large prominence on a bone which serves for attachment to muscles/ligaments
 Axial skeleton
o Skull
o Vertebrae
 7 cervical
 12 thoracic
 5 lumbar
 5 sacral
 4 coccygeal
o Ribs
o Sternum
o Hyoid
 Movements of the Axial Skeleton
o Movements of the Vertebral Column
 Flexion/extension
 Lateral flexion/lateral extension
 Rotation
 Head and neck flexion, extension, and rotation
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 Skull
o Subdivided into neurocranium (8 bones) and viscerocranium (15 bones)
 Includes flat bones and irregular bones
 Many bones joined at fibrous, interlocking sutures
o Landmarks—glabella, pterion, vertex, external occipital protuberance
o Several bones are pneumatized = interior of bone is air-space
 Air-spaces form the sinuses
o Calvaria = skull cap
 Composed of 6 bones:
 Frontal
 Occipital
 Temporal (L and R)
 Parietal (L and R)

 Vertebral column
o Vertebrae stacked to form vertebral column
o Vertebrae are more massive in inferior region of column vs vertebrae in the
superior region
o Ribs articulate posteriorly w/ thoracic vertebrae
 Anteriorly- ribs are joined to sternum via costal cartilages
o Sternum = single bone in adult
 3 different regions
 Manubrium
 Body
 Xiphoid process
 Developed as 3 individual bones
o Joint between manubrium and body forms sternal angle—easily palpable
o Sacrum = five fused sacral vertebrae
 Articulates with the os coxa (hip bone)
o Coccyx = 4 fused vertebrae
 General description of vertebrae
o Typical vertebra includes:
 Body
 Pedicle
 Lamina
 Spine
 Articular processes
 inferior and superior
 Vertebral notch—inferior and superior
o Body +pedicle +lamina +spine = vertebral foramen
o When vertebrae are stacked to form the vertebral
column, the vertebral foramina form vertebral
canal—spinal cord is in the vertebral canal
o In the vertebral column, the inferior vertebral notch
will pair with superior vertebral notch to form an
intervertebral foramen
 Passageway for nerves and vessels
o Facets – area on articular processes where bones form a joint
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 Articulations between adjacent vertebrae

o Inferior articular processes (which include facets) pair w/ superior
articular process to form zygapophysial joint
o Vertebral bodies separated from adjacent vertebral bodies by an
intervertebral disk
 General description of a rib
o Ribs categorized as:
 True (1-7) - articulate directly w/ sternum via costal cartilage
 False (8-10) - articulate indirectly w/ sternum through costal
connection to cartilage immediately above
 Floating (11-13) – do not articulate with the sternum
o All ribs articulate posteriorly w/ vertebral column
 Landmarks of ribs
o Landmarks include:
 Head – articulates with body of thoracic vertebrae
 Neck – immediately after head
 Body/shaf
 Costal tubercle – creates joint w/transverse process (facet to allow movement)
 Angle – visualize triangle with head and end of shaft
o Ribs articulate with the body (1) of a vertebra (or w/ 2 demi facets located on 2 adjacent
vertebral bodies) and with the transverse process (2)
 Ribs articulate w/ thoracic vertebrae
o A typical rib articulates w/ 2 thoracic vertebrae
o Typical thoracic vertebra includes
 Superior and inferior costal facet
 Superior and inferior costal facets = demifacets
 Superior and inferior demifacets combine and articulate w/ head of
typical ribs
 Connections between vertebrae
o Adjacent vertebrae attached by stout layers of connective tissues
o Capsule of zygapophysial joint shown
o Intervertebral disk, w/ tough outer layer = annulus fibrosis, separates adjacent
vertebral bodies
 Sacrum - Made from fusion of 5 sacral vertebrae, articulates w/skeleton of lower extremity
o Important landmarks:
 Sacral canal—extension of vertebral canal
 Superior articular process—articulates w/inferior articular process of L5
 Anterior and posterior sacral foramina—analogous to intervertebral
foramina in superior regions of vertebral column
 Median crest—analogous to spines of cervical, thoracic, lumbar
 Coccyx = 4 fused coccygeal vertebra
 Hyoid bone = only bone in the body that does not articulate w/ any other bones
o Associated w/ muscles of larynx, tongue, skull, mandible, shoulder attach to hyoid
o Involved in raising larynx during swallowing and forming a stable platform for the tong
o Tip of greater cornu can be palpated
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Lecture 3: The Upper Extremities

Skeletal System: 2 functional parts
 Axial – head, neck, trunk
 Appendicular – upper and lower limbs, pectoral girdle, pelvic girdle
The Upper Limb
 connected to the axial skeleton by the pectoral girdle
 main characteristics:
o motility and dexterity
o ability to grasp and strike
o fine motor skills
 segments:
o Shoulder – proximal segment that overlaps part of the trunk and lower lateral neck

o Arm – first and longest segment

o Forearm – connects elbow to wrist
o Hand – distal to forearm
 main function is to form smooth, efficient motion for a task
o Sacrifices stability for mobility (as compared to lower extremity)
iClicker question:
What bony landmark is a rounded projection at the end of a bone that anchors muscle ligaments and
articulates with adjacent bones?
a) Condyle
b) Groove
c) Process
d) Sulcus
e) Tuberosity
Pectoral (Shoulder Girdle)
 A bony ring, incomplete posteriorly, formed by the scapulae and clavicles
 Completed anteriorly by articulating with the manubrium of the sternum
The Clavicle
 Forms the anterior part of the pectoral girdle
 Articulates with the manubrium medially and scapula laterally
 Is palpable along its entire length
 Fracture of the Clavicle:
o Commonly caused by a fall on outstretched hand with force transmitted via
shoulder to the clavicle
o Fracture of middle third of clavicle is the most common (especially children)
 medial fragment is displaced upward by pull of sternocleidomastoid
 lateral fragment displaced downward by weight of shoulder
o healed fracture of clavicle – even with proper, a small lump may remain
The Scapula
 forms the posterior part of the pectoral girdle
 lies on the posterolateral thoracic wall
 has medial, lateral, and superior borders
 superior and inferior angles
 Surface anatomy
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The Humerus
 The long bone of the arm
 Articulates with the scapula proximally and the radius and ulna distally
 Anatomic neck separates the humeral head and the greater and lesser tubercles
 The surgical neck is the narrow part of the shaft distal to the head and tubercles
 Fracture of the Humerus
o Fractures of the proximal humerus - very common and typically occur in older patients from falling on an outstretched hand or
directly onto the shoulder, can injure blood vessels that supply the humeral head and axillary nerve
o Fractures of the humeral shaf – can injure the radial nerve
o Fractures of the distal humerus – can injure the median nerve, supracondylar fractures
 most common elbow fracture in children
The Forearm
 The Ulna
o The stabilizing bone of the forearm
o Proximally articulates with the humerus and radius
o Does not directly articulate with carpal bones
 The Radius
o The lateral and shorter of the two forearm bones
o Proximally articulates with the humerus and ulna
o Distally articulates with the carpus
o Dorsal tubercle of the radius
 Passage of the forearm tendons and serves as a trochlea for the tendon of the long extensor of the thumb
 Don’t confuse the dorsal tubercle of radius with the styloid process of radius
 Fractures of the Forearm
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 Most common cause of a fracture to the ulna: a direct blow to or forced pronation of the forearm
 Monteggia fracture - fracture of the ulna with dislocation of the proximal radio-ulnar
o The radial head usually dislocates anteriorly, but posterior, medial, or lateral dislocation also may occur. Such dislocations
may put the posterior interosseous nerve (branch of the radial nerve) at risk.

 Colles' Fracture
o Results from forced dorsiflexion of the hand, such as in breaking a fall with an outstretched, pronated hand
o Complete transverse fracture within the distal 2 cm of the radius
o Distal fragment displaced dorsally, giving the classic "dinner fork deformity"
o Ulnar styloid may also be avulsed
o Most common fracture in adults older than 50 years’ old
o Seen most frequently in elderly women
o Healing is usually good as the bone has a rich blood supply
Bones of the Hand
 The wrist (carpus) is made of 8 short bones – give flexibility to wrist
o Proximal bones
 Scaphoid
 Lunate
 Triquetrum
 Pisiform
o Distal bones
 Trapezium
 Trapezoid
 Capitate
 Hamate
 The skeleton of the palm or metacarpus is btwn the carpus & phalanges
o Five long bones
 Bases articulate with the carpal bones and heads (knuckles) articulate with the proximal phalanges
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o The Phalanges
 Small, long bones that form the fingers
 Have proximal, middle and distal in each finger except the thumb
 Fracture of the Scaphoid
o Most commonly fractured carpal bone
o Due to falling on the palm when hand is abducted
o Pain on lateral side of wrist
o Might not initially see on X-ray
o Important to recognize due to the risk of avascular necrosis
o Scaphoid Fracture
 Scaphoid is the most commonly fractured bone of the carpus
 Proximal pole of the bone is supplied via the distal segment of the artery and
as a result, fracture may take several months to heal
 This increases risk of avascular necrosis and subsequent degenerative joint
disease at the wrist
 Fracture often difficult to spot on initial radiographs, which should be
repeated at 2-3 weeks in any patient presenting with severely sprained wrist

Lecture 4: Lower Extremity

The Hip Bone (Os Coxa) – 3 bones in 1
 In the adult – each hip bone is a single bone
 Embryological – it is formed by the fusion of 3 bones: Ilium (1), Ischium (2), and pubis (3)
1
 The X-ray demonstrates the acetabulum where the three bones are joined by cartilage
o The individual is an adolescent because the 3 individual bones have not fused
 Other major landmarks include:
o Wing of the ilium and iliac crest
o Anterior superior iliac spine (ASIS)
o Pubic ramus (superior and inferior)
o Ischial tuberosity and spine
o Obturator foramen
o Arcuate line 3
2
Joints of the Pelvic Girdle
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 The two hip bones are joined anteriorly at the pubic symphysis
 Posteriorly, each hip bone articulates with the sacrum to form a sacroiliac joint
 The sacroiliac joints are associated with anterior and posterior sacroiliac ligaments
Pelvic Girdle and the Transfer of Weight
 The weight of the upper body is transferred
centrally down the vertebral column
 Weight is divided and directed laterally along
the sacrum and ilia (bony arch) crossing the
sacroiliac joints
 Ilia transfer weight to femurs
 Pubic rami form “struts” (braces) that maintain
the structural integrity of the arch
 The stick diagram compares human (stick figure
on left) to a quadruped (such as a cow; stick
figure on right).
 If the quadruped lifts a foot off the ground, the
body tends to tip in the direction of the lifted
foot. In humans, due to the diagonal placement
of the femur, both feet are close to a center of
gravity, which provides stability. This makes
walking more efficient in humans than in
quadrupeds.
Femur – Major Landmarks and Hip Joint
 Major Landmarks include:
o Head
o Neck
o Trochanter, greater and lesser
o Shaft
o Condyles
o Epicondyles
 Familiarity with these landmarks enables one to readily identify
additional details during the lab session.
 In the figure, the hip joint capsule has been transected and the
femur has been rotated laterally (externally); this makes it possible to
observe:
o Acetabulum partially covered by a lunate surface
o Labrum-fibrocartilage that deepens the acetabulum
o The transverse acetabular ligament that bridges the
acetabular notch
o Acetabular fossa-filled with adipose tissue
o Fovea (small pit) where the ligament of the head of the
femur attaches

Fibrous Layer of the Hip Joint Capsule

 Three ligaments are named. However, they form a continuous structure that encloses the joint.
 The three ligaments are named according to the bony attachments. These three ligaments are:
o 1. Pubofemoral
o 2. Iliofemoral
o 3. Ischiofemoral
 During extension of the femur would the iliofemoral ligament become looser or tighter; would it allow more or less movement of the
femoral head?
 Would it be more likely to dislocate this joint during extension or flexion of the thigh?
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2 1 3
1
3
Anteri Posteri
 In this hip joint, the fibrous joint capsule has been transected as indicated byor or and the head of the femur has been
the dashed red line
removed from the acetabulum. The acetabular surface is revealed Surfac Surfac
 Note the relation of the labrum and the fibrous joint capsule. e – e–
 The three components of the joint capsule are indicated by the numbers: Right Right
 The synovial membrane would line the inner surface of the fibrous joint capsule.
 The iliofemoral ligament is the “thickest ligament in the body”.
Articulations at the Knee Joint
 The knee is the largest and most superficial joint. It is a hinge type joint
that accommodates flexion and extension. Common injuries to the
knee include “hyperextension”.
 There are three articulations in the knee:
o Medial femorotibial
o Lateral femorotibial
o Femoropatellar
 “Condyles” are the smooth portions of bone that are covered by
articular cartilage. These are analogous to “facets” that were observed
on articular processes of vertebrae.
 “Epicondyles” are the large bony masses superior to the femoral
condyles.
 The patella is a sesamoid bone—the largest one in the body. It is
incorporated into the tendon of the quadriceps muscle. It articulates
with the femur at the patellar surface of femur
Ligaments of the Knee Joint
 The stability of the knee depends upon surrounding muscles and ligaments.
 There are extracapsular ligaments, two of which are:
o Tibila collateral ligament
o Fibular collateral ligament
 There are intra-articular ligaments. These are contained within the capsule
of the knee joint but they are outside of the synovial sac (not contained
within the synovial sheath). Intra-articular ligaments include:
o Anterior cruciate ligament
o Posterior cruciate ligament
 The medial and lateral menisci are “shock absorbers” made of fibrocartilage. These are located on the articular surface of the tibia. The
menisci deepen the articular surface
 The medial and lateral menisci are made of fibrocartilage and serve as “shock absorbers”.
 Note that the cruciate ligaments, though they are contained within the joint capsule, are not contained within the joint cavity.
 the articular surfaces of the tibia are observed but the medial and lateral menisci have been omitted. These structures are contained
within the joint cavity
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Tibiofibular Joints
 The tibia and fibula are connected by two joints:
o Tibiofibular joint
o Tibiofibular syndesmosis
 The tibiofibular syndesmosis is a fibrous joint. In this joint, the interosseous membrane joins the
tibia and fibula along the shafts.
 The tibiofibular joint holds the head of the fibula securely to the fibular articular facet on the
lateral condyle of the tibia.
 The inferior ends of the tibia and fibula combine to form the “ankle mortise”, part of the
“talocrural” joint (ankle joint).
Ankle Joint and Ligaments
 The inferior ends of the tibia and fibula form the ankle mortise and are held together by the
tibiofibular syndesmosis; the anterior tibiofibular ligament is part of this syndesmosis.
 The tibia and fibula articulate with the talus, a tarsal bone.
 The ankle is supported by medial and lateral ligaments
 The lateral ligament of the ankle is the most commonly injured ligament in the body. It attaches
the fibula to the talus and the calcaneus.
 The medial ligament of the ankle is the deltoid ligament. This ligament attaches the tibia to the
talus, navicular and calcaneus
Foot – Anatomical and Functional Subdivisions
 The foot includes:
o Tarsal bones
o Metatarsal bones
o Phalanges
 Functional divisions of the foot are defined by a line between the talus and calcaneus posteriorly
and the navicular and cuboid anteriorly.
 The talus and calcaneus are the hindfoot. The remaining tarsal bones and the
metatarsals are the midfoot. The phalanges makeup the forefoot.
 Movements of inversion & eversion occur around subtalar & transverse tarsal joints.
 Transverse tarsal joint: see picture to right (dashed line)
Foot – Plantar Arches
 Longitudinal Arch
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 PPC/OMM Final Exam 13
Lecture 5: Joints
Bones and Joints
 3 Classes of Joints:
o Synovial – most common; provide for free motion between the joined bones
o Fibrous – bones are joined by fibrous tissue
o Cartilaginous – bone is united by hyaline cartilage or fibrocartilage
 The shoulder joint accommodates:
o Flexion-extension
o Abduction-adduction
o Circumduction
o Protraction-retraction
 Different joints accommodate different motions
Fibrous Joints
 Fibrous joints include sutural joints of the skull. These bones are held together by a
sheet of fibrous tissue. Movement is limited.
 The interosseous membrane between the radius and ulna forms a special fibrous joint
called a syndesmosis
 Syndesmosis: bones are relatively far apart and united by a ligament
o A syndesmosis is partially movable
Sutural Joints and Fontanelles
 In the newborn calvaria (skullcap), the bones do not make contact
 The bones are connected by fibrous tissue called fontanelles.
 Fontanelles are commonly referred to as a “soft spot”.
 Eventually, the cranial bones meet and join along the sutures, which are fibrous joints
 * sutural bone = wormian bone
Cartilaginous Joints
 The articulating structures of a cartilaginous joint are united by hyaline cartilage.
 Two types of cartilaginous joints:
o Primary – usually temporary; associated with the development of long bones. The X-ray illustrates the ankle joint of an
adolescent. Two epiphysial plates (primary cartilaginous joints) are indicated.
o Secondary – symphyses; strong, slightly movable and united by fibrocartilage. Examples include intervertebral discs, which
include fibrocartilage, joining adjacent vertebrae
 Primary Cartilaginous Joint
o As long bones grow, an epiphysial plate consisting of
hyaline cartilage, separates the diaphysis from the
epiphysis
o The epiphysial plate is a primary cartilaginous joint
Six Types of Synovial Joints (see above page for picture)
 Plane – permits gliding/sliding
 Hinge – flexion/extension
 Saddle – (carpo-metacarpal joint is most common example)
 Condyloid – knuckle joints
 Ball and Socket – movement occurs in multiple axes and
planes
 Pivot – uniaxial
Anatomy of a Synovial Joint
 Synovial joints are characteristic of movable joints such as the
gleno-humeral (shoulder), hip and ankle.
 Synovial joints display common features:
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o Articular cartilage
o Synovial cavity
o Synovial membrane
o Joint capsule
o Ligaments (intrinsic or extrinsic)
 The synovial membrane produces synovial fluid (joint oil).
 Degenerative joint disease: with age, the articular surfaces, and even the
underlying bone, may erode. This often results in pain associated with movement
 Identify:
o Articular cartilage
o Synovial membrane
o Labrum
o Capsule

The Hip Joint

 The acetabulum is the region that articulates with the ball of the femur.
 The lunate surface articulates with the head of the femur and is covered by cartilage.
 An acetabular labrum is attached to the rim of the acetabulum. It deepens the socket.
o It is constructed of fibrocartilage, which is more durable than hyaline cartilage.
 More than half of the femoral head fits into the acetabulum
 The fibrous capsule of the hip joint is attached proximally to the rim of the acetabulum and
distally to parts of the femur (e.g., intertrochanteric line, neck)
 The hip capsule includes three named ligaments:
o Iliofemoral
o Pubofemoral
o Ischiofemoral (covers the posterior aspect of the hip joint)
 Hip Extension:
o the ligaments become increasingly oblique
o this twisting pulls the femoral head more tightly into the acetabulum
 Hip Flexion:
o the ligaments are nearer to parallel
o do not exert as much force on the femur as they do with extension
 The hip has much more mobility in the flexed compared to the extended position.
 The iliofemoral ligament is said to be the strongest ligament in the body. It
specifically limits extension of the hip to not more than 20 degrees beyond the
vertical, thereby preventing hyperextension.
Bursae Associated with Joints
 Bursa - a small sac lined by a synovial membrane
o Fluid secreted by the membrane accumulates within the sac and serves as
a slippery lubricant
 These synovial sacs are associated with many joints, including the hip
o “cushion” the movement of soft tissue across bone
 subcutaneous prepatellar bursa - cushion is located between the
skin and patella
o It serves as a cushion to protect the skin from being
crushed by the patella especially during kneeling.
 suprapatellar bursa - an extension of the synovial membrane that
lines the joint cavity
o Like the subcutaneous prepatellar bursa, the suprapatellar
bursa is a closed sac lined by a synovial membrane.
 Inflammation, especially from overuse, may result in “bursitis”. This is
inflammation of the bursal sac.
Blood Supply to Joints
 knee, shoulder, elbow, and hip exhibit a high degree of mobility have
an arterial supply characterized by an anastomosis.
 An anastomosis: a natural communication between two blood
vessels.
o The anastomosis ensures that no matter what position the
joint is in, an adequate arterial supply will be delivered
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 In the knee, “genicular” (relating to the knee) branches arise from arteries at the level of the knee as well as from levels above and below
the knee. Thus, there are superior, middle, and inferior genicular arteries. All these vessels supply the knee joint.
o Similar anastomoses are associated with the shoulder, elbow and hip.
 In the elbow joint, there are arteries that extend beyond the joint before turning back to supply the joint. These are referred to as
“recurrent” branches, e.g., radial recurrent artery.
Blood Supply to the Hip Joint
 The head and neck of the femur are supplied with blood by way of the medial and lateral circumflex femoral arteries
o The medial circumflex femoral provides the largest amount of blood.
 Avascular necrosis – disruption of the blood supply to a joint will cause bone to die. Avascular necrosis may be precipitated by steroid use.
The femoral head (below) was removed during hip replacement surgery.
o A flap of cartilage is the result of underlying avascular necrosis

Innervation of Joints – Hilton’s Law

 Hilton’s Law: nerves supplying the muscles extending directly across and acting on a given joint also innervate the joint.
 In addition:
o “Articular nerves transmit sensory impulses from the joint that contribute to the sense of proprioception.”
Hip Joint – Fractures and Dislocations
 “Hip” fractures, which is the name commonly applied by laymen to femoral neck fractures, are common in elderly females
o This is due to age-related thinning of bone.
 If the fracture is “intracapsular” surgery will be required to reduce the fracture.
 Femoral neck fractures are rare in people less than 40 years of age
o can result from high impact accidents such as motor vehicle crashes with the lower extremity braced against the floor of the
car, a sudden stop transfers force to the hip, where either a fracture or dislocation may result
o Dislocations are characterized by the femoral head moving posteriorly
Joint Replacement
 Cartilage is vulnerable to damage and may cause pain and immobility to a degree that hip replacement is considered.
 With age, bones may form growths or “osteophytes”. These may erode articular cartilage.
 Hip and knee joints are commonly replaced in older individuals.
 In total hip replacement, an artificial surface takes the place of both the acetabulum and the femoral head and neck. Both the acetabulum
and femoral head and neck are held in place by cement
Ulnar Collareral Ligament Reconstruction
 During the throwing motion, the pitchers arm puts enormous strain on the ulnar (medial) collateral ligament of the elbow
o This can lead to stretching, tearing or complete rupturing of the ligament.
 Surgery to repair an injured medial collateral ligament is known as “Tommy John” surgery.
o A long length of autologous tendon is transplanted to the site; the tendon is passed through holes drilled into the medial
epicondyle of the humerus and the coronoid process of the ulna
Damage to the Fibrous Joint Capsule of the Shoulder
 PPC/OMM Final Exam 16
 Pitching a baseball strains not only the elbow but also the shoulder (glenohumeral joint)
 Excessive extension & lateral rotation of the shoulder joint can cause tears in fibrous joint capsule
o rupture of the joint capsule = rotator cuff injury
 The synovial membrane is also ruptured
 Damage to fibrous joint capsule may be combined w/complete dislocation of the head of humerus
 This ball & socket joint is not as deep as the hip joint - less exertion is required to cause dislocation