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2010-11-16 06:58:29

Hindlimb anatomy (dog/cat)
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  1. Hindlimb components
    • Bones:
    • Sacrum, pelvis, femur, tibia & fibia, tarsal bones, metatarsal bones, phalanges
    • joints:
    • sacro-iliac, hip, stifle, tarsus/hock, metatarso-phalangeal, PIP, DIP
  2. locomotion of hindlimb
    • for propulsion (front limbs are weight bearing)
    • sacro-iliac joint fused (transfer of forces from hindlimb to vertebral column)
    • Hip-joint = pivotal point
  3. Hindlimb terminology
    • regions:
    • gluteal (around hip), thigh (hip-stifle), crus (stifle-tarsus/hock), pes (tarsus-toes)
    • directional:
    • medial/lateral
    • dorsal/palmer (past hock)
  4. Evolution of hindlimb
    • toes and stifle rotated cranially
    • tibia & fibula don't rotate- remain parallel!
    • flexor and extensor angles different to forelimb
  5. pelvis (general)
    • pelvic girdle/ossa coxae
    • flat bones:
    • margins = compact bone
    • NO medullary cavity (centre = dipole) (spongy bone and marrow)
    • wing of ilium- useful for bone marrow harvesting
    • bilaterally summetrical
    • 4 sections
  6. 4 sections of pelvis
    • Ilium
    • ischium
    • pubis
    • acetabular bone
  7. Pelvis (ilium)
    • cranial section of pelvis (boday and wing)
    • wing: vertical orientation
    • dorsal iliac spine
    • ventral iliac spine
    • gluteal surface (concave lateral surface)
    • sacropelvic surface (medial surface)
    • dog sacrum= 3 fused sacral vertebrae
  8. Pelvis (sacro-iliac joint)
    • sacrum (S1)- sacropelvic surface of ilium
    • fibrous joint- fused
    • supported by ligaments from lumbar and sacral vertebrae
    • transmits forces from hindlimb during locomotion
  9. Pelvis- pubis
    • forms cranial aspect of pelvic floor
    • iliopubic eminence (ilium meets pubis)
    • pecten (concavity at cranial aspect)
    • prepubic tendon (fills pecten) (associated w/ body wall)
  10. Pelvis- ischium
    • forms caudal aspect pelvic floor
    • table: flat reigon
    • tuber ischium/ischiatic tuberosity
    • ischiatic arch (muscle attachment for reproductive organs
    • sacrotuberous ligament (sacrum (S3)- tuber ischium)/remnant/band
    • sugery: provides anchorage for sutures during muscle repair
    • **ligament absent in cats!**
  11. Pelvis (symphysis)
    • meets midline (symmetrical)
    • pelvic symphysis:
    • located between pubis and ischium
    • cartilage joint
    • visible on radiographs
    • immobile
    • pubic tubercle
    • (does not turn to bone until much later in life if ever)
  12. Pelvis (obturator foramen)
    • boundaries formed by pubis and ischium
    • bridged by membrane and muscles
    • blood vessels and nerves pass through
    • (**obturator nerve!)
  13. pelvis- acetabulum
    • located at boundary of ilium, pubis and ischium
    • cup shaped
    • articulates w/ head of femur = hip joint
    • acetabular fossa: non-articular area, rough bone, attachment of ligament of head of femur/round/teres ligament (all the same)
    • lunate surface (articular surface, crescent shapes, hyaline cartilage)
    • acetabular notch (ventral deficit, filled by transverse ligament)
  14. Pelvis- centres of ossification
    • main centres:
    • illium/ischium/pubis/acetabular bone
    • (acetabular bone fuses before born, fuse together to form 2 halves, pelvic symphysis fuses last)
    • secondary centres:
    • dorsal iliac crests
    • tuber ischium
    • ischiatic arch
  15. Radiography- pelvis
    • positioning:
    • obturator foramen symmentrical= straight
    • dog:
    • wings of ilium and ischium diverge
    • cat:
    • wings of ilium and ischium are parallel (boxy)
  16. Femur (general)
    • long bone
    • straight
    • head
    • body condyles
  17. Proximal femur
    • head: almost spherical, articulates w/ acetabulum (hip joint), smooth surface
    • fovea: depression, rough bone, attachment ligament of head of femur (round/teres ligament)
    • neck: forms angle between head and body
    • greater trochanter: lateral palpable feature for locating joint
    • lesser trochanter: medial
  18. distal femur
    • caudal aspect:
    • medial condyle
    • lateral condyle (covered w/ smooth bone and carilage, articulate w/ tibia= stifle joint)
    • intercondylar fossa (rough bone, non articular, attachment of ligaments)
    • popliteal fossa (origin of gastronemius muscle)
    • cranial aspect:
    • medial trochlear ridge
    • lateral trochlear ridge
    • trochlear groove (smooth surface, hyaline cartilage, articulates w/ patella)
    • extrensor fossa (lateral aspect, tendon of origin of long digital extensor muscle)
  19. Centres of ossification of Femur
    • Head
    • greater trochanter
    • body
    • distal epihysis
    • (total number = 4)
  20. Sesamoid bones of hindlimb/femur
    • patella (x1):
    • pyramid shaped
    • sits in trochlear groove
    • smooth articular surface
    • hyaline cart.
    • proximal and distal glide
    • embedded in quadriceps muscle tendon of insertion
    • continues as patellar ligament
    • inserts onto tibial tuberosity
    • Fabellae (x2):
    • popliteal fossa
    • embedded in gastronemius muscle
    • one in each tendon of origin
    • Popliteal sesamoid (x1):
    • embedded in politeus muscle

    MAX TOTAL= 4 (dog), cats will vary
  21. Cat sesamoids in hindlimb
    • patella always present
    • medial fabella often not ossified so not visible on radiographs
    • lateral fabellae and popliteus usually present but not always
    • max total = 4
  22. Clinical considerations of distal femoral fx
    • Rush pins:
    • curved
    • cross over
    • increased traction to prevent movement of distal epiphysis
    • less damage to growth plate if still open
    • (doesn't stop growth b/c pins slip as bone grows)
  23. clinical considerations for midshaft femoral fx
    • stabilisation:
    • intramedullary (IM) pin: straight shaft
    • reverse pinning technique: b/c head offset to neck
    • method:
    • make incision at fracture site
    • pass pin proximally through proximal segment, through intertrochanteric fossa and out through incision in skin
    • remove pin and pass back down through proximan segment, reduce fx and push into distal segment
    • push to distal end of femur
  24. Hindlimb nerve supply
    • spinal nerves: L5, L6, L7, S1, S2
    • dorsal branches (dorsal structures)
    • ventral branches (lumbosacral plexus)
    • emerging peripheral nerves to hindlimb muscles:
    • gluteals, obturator, femoral, sciatic (tibial, fibular/peroneal)
  25. Hip joint (general)
    coxo-femoral joint
    • head of femur
    • acetabulum of pelvis (lunate surface)
    • acetabulum: extended by labrum, completed ventrally by transverse ligament
    • joint capsule attachments: around labrum, around neck of femur
    • typical sunovial joint except NO COLLATERAL LIGAMENTS
    • stability: ligament of head of femur, teres ligamnet/round ligament (fovea to acetabular fossa), surrounding muscle mass
  26. Palpation of hip joint
    • Pelvis:
    • dorsal iliac crest/wing of ilium, tuber ischium
    • femur:
    • greater trochanter (allows location of hip joint)
    • 3 structures for triangle
    • should be bilaterally symmetrical
    • help ID: hip dislocation, and pelvic fractures
  27. radiography of hip joint
    • dorsal border
    • ventral border
    • cranial acetabular edge/rim
    • caudal acetabular edge/rim
    • location of dorsal border relative to head of femur
  28. clinical considerations (luxation/dislocation of hip)
    • usually traumatic
    • subluxation/loose hips: hip dysplasia in young dogs
    • DJD: older animals
    • Tx options: femoral head excision, hip replacement
  29. Clinical consideration (Sx approach to the hip)
    • trochanteric osteotomy
    • remove greater trochanter (muscles remain attached)
    • perform sx
    • replace w/ pin
    • minimal muscle damage
  30. Clinical considerations (blood supply and hip)
    • vessels from periosteum
    • vessels from medulla
    • joint capsule attached round neck
    • vessels run from neck-head
    • vulnerable to damage
    • significance:
    • femoral neck fracture
    • femoral head physeal separation
    • avascular necrosis
  31. Hindlimb movement
    • extrinsic muscles:
    • Axial- appendicular skeleton
    • move limb relative to trunk
    • sacro-iliac joint immovable
    • pivitol point = hip
    • pelvis functions as part of axial skeleton
    • hindlimb extrinsic muscles originate axial skeleton and pelvis
    • Protraction: hip flexion, located cranial to hip
    • Retraction: hip extension, located caudal to hip
    • Abduction: located dorsal to hip
    • adduction: located ventral to hip
  32. Extrinsic muscles (Abductors)
    • located DORSAL to hip
    • Gluteal muscles: superficial, middle, and deep
    • Origin: sacrum and pelvis, gluteal surface
    • Insertion: greater trochanter, acts as lever

    supplied by gluteal nerve!
  33. Extrinsic muscles (adductors)
    • located ventral to hip joint
    • origin: ventral surface pelvis
    • insertion: medial aspect limb
    • "GAPE" muscles=
    • Gracilis: Insertion tibia and calcaneous(tarsus) (via common calcanean tendon)
    • Adductor
    • Pectineus: insertion on femur
    • External obturator: (very small)

    Supplied by Obturator nerve!
  34. Extrinsic muscles (limb protractors/hip flexors- Iliopsoas muscle/Tensor fascia latae))
    • Iliopsoas muscle
    • Origin: lumbar vertebrae and ilium
    • insertion: lesser trochanter (femur)
    • supplied by femoral nerve!
    • Tensor fascia latae
    • 2 heads
    • origin: ilium
    • insertion: fascia latae
  35. Extrinsic muscles (limb protractors/hip flexors- sartorius and Quads)
    • Sartorius
    • 2 heads
    • origin: ilium
    • insertion(s): femur and tibial tuberosity (via patellar ligament)
    • (**only 1 head in cats)
    • Quadriceps muscle- rectus femoris
    • 4 heads
    • origin: ilium
    • insertion: tibial tuberosity (via patellar ligament)

    • supplied by femoral nerve!!
  36. Extrinsic muscles (limb retractors/hip extensors)
    • Biceps femoris
    • origin: tuber ishium
    • insertion: fascia latae and calcaneus (tarsus) (via common calcanean tendon)
    • supplied by sciatic nerve!
    • Semitendinosus
    • Origin: ishium
    • Insertion: tibia and calcaneus (tarsus) (via common calcanean tendon)
    • Semimembranosus
    • Origin: ischium
    • insertion: femur and tibia
    • Supplied by sciatic nerve
  37. Femoral triangle
    • Boundaries: caudal- pectineus (& adductor), cranial- sartorius
    • Femoral VAN
    • Palpable pulses
  38. Tibia and Fibula (general)
    • Crus/crural region
    • long bones: paired, Parallel
    • Tibia: weight bearing
    • Fibula: much reduced but present, lateral aspect
    • Proximal and distal fibrous joints
    • interosseous space= 1/2 length
    • no rotation
  39. Tibia (proximal end)
    • triangle in short axis
    • tibial plateau/plate:
    • medial condyle
    • lateral condyle
    • smooth bone surface
    • articulate w/ medial and lateral condyles of femur
    • Intercondylar ridge: non-articular rough bone surface for ligament attachment
    • tibial crest
    • tibial tuberosity: insertion of patellar ligament
  40. Tibia (distal end)
    • oval in short axis
    • choclea: concave articular surface, articulates w/ hock/tarsus
    • medial malleolus: medial prologation(tibia), attachment of medial collateral ligament of hock
    • lateral malleolus: lateral prolongation (fibula), attachment of lateral collateral ligament of hock
  41. Palpation of tibia/fibula
    • tibial crest
    • medial malleolus (tibia)
    • lateral malleolus (fibula)
  42. centres of ossification of tibia and fibula
    • tibia: proximal end, tibial tuberosity, body, distal end (total = 4)
    • fibula: total = 3
  43. clinical consideration fx repair of tibia/fibula
    • intramedullary pin: straight bone
    • bone plate and screws: medial aspect b/c no muscle so good exposure
    • fibula- not important
  44. Sifle joint components:
    • Femur-tibia
    • femur-patella
    • A/femoro-tibial components:
    • lateral & medial: femoral condyles, tibial condyles (don't articulate well w/ eachother)
    • Non-articular: intercondylar fossa, intercondylar eminence
    • meniscus
  45. Stifle joint (meniscus/menisci)
    • lateral and medial
    • c-shaped cartilages
    • wedge shaped
    • thicker abaxial border
    • attached to tibial condyles
    • functions:
    • stabilze joint
    • cushioning
    • proprioception (contain nerve endings, painful if damaged)
  46. Stifle joint (meniscal ligaments)
    • minisco-tibial ligament:
    • mensicus- intercondylar eminence (tibia)
    • hold menisci onto tibia
    • Transverse ligament:
    • between cranial aspects of menisci
    • stabilise menisci
    • Menisco-femoral ligament:
    • lateral meniscus-intercondylar fossa (femur)
    • hold femur onto menisci
    • (movement occurs between femur and menisci
  47. Stifle joint (joint support)
    • hold bones together
    • resist rotation
    • limit movement to flexion and extension
    • Collateral ligaments:
    • medial condyle femur- tibia
    • lateral condyle femur - fibul and tibia
    • (tendon of origin of long digital extensor muscle)
    • interal to joint capsule
    • attach to abaxial aspects of menisci (NO GAPS!)
  48. Stifle joint (cruciate ligaments)
    • named for attachment to tibia
    • cranial cruciate ligament: intercondylar eminence, medial aspect lateral condyle
    • caudal cruciate ligament: intercondylar eminence, intercondylar fossa
    • function: maintain femur on mensici, resist rotation
    • Cranial cruciate rupture: joint instability, "cranial draw" sign (tibia moves cranial relative to femur)
  49. Stifle joint (femoro-patellar components)
    • patella
    • trochlear groove (femur)
    • patellar ligament: insertion of quadricepts (& sartorius) on tibial tuberosity
    • stifle movement: patella pulled proximally (produces extension), patella pulled distally (allows flextion)
    • patella held in trochlear groove
    • proximal and distal glide
    • no lateral movement
    • support: medial and lateral trochlear ridges, lateral & medial femoro-patellar ligaments (patela-fabellae), fascia/retinaclulum
  50. Clinical consideration: patellar luxation
    patella no in the trochlear groove- usally medially
  51. Stifle joint support
    • femoro-tibial components
    • Femoro-patellar components
  52. Stifle joint (synovial joint)
    • 3 compartments:
    • femoro-patellar
    • medial femoro-tibial (incorporate fabella)
    • lateral femoro-tibia (incorporate fabella, incorporates tendon or origin long digital extensor)
    • **in dogs- compartments communicate**
  53. Radiography (stifle joint)
    • retropatellar fat pad (joint effusion)
    • cat: pointed patella, medial fabella often not mineralized, lateral fabella and politeal sesamoid usually visible
  54. Palpation of stifle joint
    • patella (proximal)
    • patellar ligament
    • tibial crest
    • joint space
  55. Stifle joint muscles (extensors)
    • insert onto tibial tuberosity via patella then patellar ligament
    • sartorius:
    • 2 heads
    • origin- ilium
    • insertion- tibial tuberosity
    • (also hip flexion)
    • quadriceps muscle:
    • rectus femoris: origin- ilium (also hip flexor)
    • vastus lateralis: O- lateral femur
    • vastus medialis: O- medial femur
    • vastus intermedius: O- cranial femur
    • All Insertion- tibial tuberosity (via patellar ligament)
    • Supplied by FEMORAL NERVE
  56. Stifle joint muscles (stifle flexors)
    • caudal to stifle joint
    • Biceps femoris:
    • O-ishium
    • I-fascia latae and calcaneus (via common calcanean tendon)
    • Semitendiosus:
    • O- ishium
    • I-tibia and calcaneus (via common calcanean tendon)
    • Supplied by the Sciatic nerve
    • Semimembranosus:
    • O- ischium
    • I- femur and tibia
    • supplied by SCIATIC NERVE
    • Gastrocnemius
    • O-femur (2 tendons of origin- fabellae)
    • I-Calcaneus (via common calcanean tendon)
    • supplied by the tibial nerve (branch of sciatic)
  57. Tarsus (general)
    • Composed of tarsal bones (short bones)
    • proximal row: talus & calcaneus
    • Middle row: Central & IV
    • distal row: I, II, III, & IV
    • IV TB bridges middle and distal rows
    • (dog and pig have all bones present)
  58. Tarsus (Calcaneus and Talus)
    • Calcaneus:
    • lateral and plantar location
    • calcanean tuberosity/ tuber calcis (projects proximally)
    • sustentaculum: projects medially, passage for DDFT
    • Talus:
    • Dorsal & medial location
    • trochlea: articular surface, 2 ridges and central groove
  59. Tarsus (tarso-crural joint)
    • Tarsus- crus
    • Talus- tibia and fibula
    • calcaneus- not articular
    • proximal intertarsal joint: Talus and calcaneus, central & IV
    • Distal intertarsal joint: central I, II, III
    • Tarso-metatarsal joint: distal row and metatarsal bones
    • (intratarsal joints)
  60. Tarsus movement
    • Large range of flexion:
    • most movement at tarso-crural joint
    • little movement at other joints
    • Trochlea not vertical:
    • allows slight rotation at hock, limb protracted/hock flexed- hindlimbs lateral to forelimbs
  61. Palpation of tarsus and centres of ossification
    • Calcanean tuberosity
    • medial malleolus
    • lateral malleolus
    • Centres of ossification: all single centre except calcaneus = 2
  62. Tarsus (synovial joints)
    • typical features of synovial joint
    • capsule: extensive, extends (proximally between tibia and fibula, distally between metatarsal bones)
    • poor communications between compartments
  63. Tarsus (joint support)
    • collateral ligaments: long- lateral (fibula- 5th MT), medial (tibia-2nd MT), medial and lateral malleolus. Short- bridge bone- bone
    • Plantar ligaments: calcaneus-metatarsal bones, counteracts pull on calcanean tuberosity by common calcanean tendon
    • Fibrocartilagenour reinforcement of joint capsule: friction free surface for passage of tendons, passive maintenance of joint
    • Retinaculum:
  64. Pes
    • same as manus
    • no stopper/carpal pad
    • Dew claw: variable in dog, less common than for leg, absent in cats
  65. Hock Flexor muscles
    • Standing position = extension
    • hock flexion: muscles run cranial/dorsal to limb
    • peroneal/fibular nerve (branch of sciatic)
    • Cranial tibial muscle:
    • O- lateral tibea
    • I-metatarsal bones
    • Peroneus longus/long fibular muscle
    • (group of 3)
    • O- lateral tibia & fibula
    • I- plantar aspect tarsus
    • Peroneus brevis/short fibular muscle
    • O-tibia & fibula
    • I- 5th metatarsal bone
    • (peroneus tertius/third fibular- not present in dog and cat)
  66. Hock flexor AND digital extensor muscles
    • Long digital extensor
    • O- extensor fossa (femur)
    • tendon of origin: incorporated into stifle joint capsule, provides lateral collateral support to stifle
    • I- all digits (4 branches), distal phalanx-extensor process
    • (lateral digital extensor muscle)
    • O- lateral aspect tibia
    • I- fuses w/ lateral branches of long digital extensor
  67. Hock Extensor Muscles
    • **common calcanean tendon (achilles tendon)
    • inserts calcanean tuberosity of calcaneus: acts as LEVER for distal limb
    • 3 components:
    • Calcanean tendon: Biceps femoris, semitendinosis, gracilis
    • Gastrocnemius
    • superficial digital flexor
  68. Hock Extensor AND digital flexor muscles
    • Superficial digital flexor muscle
    • O- Lateral ppliteal fossa femur (assoc. w/ gastrocnemius)
    • I- Calcaneus (common calcanean tendon) AND branches to ALL digits (middle phalanx)
    • supplied by the tibial nerve! (branch of sciatic)
  69. Digital Flexor muscles
    • Deep digital flexor muscle (2 heads)
    • O- tibia
    • Lateral (flexor hallicus longus): runs over sustentaculum of calcaneus, fibrocartilage reinforcement of joint capsule, held by retinaculum, protected by tendon sheath
    • Medial (flexor digitorum longus): runs over medial aspect of tarsus
    • merge then divide into 4 branches
    • I- ALL digits (distal phalanx)
    • supplied by the tibial nerve (branch of sciatic)
  70. Hindlimb nerve supply (review)
    • Spinal nerves: L5, L6, L7, S1, S2
    • dorsal branches- dorsal structures
    • ventral branches- lumbosacral plexus
    • emerging peripheral nerves to hindlimb muscles: (4 major)
    • Gluteals, obturator, femoral, sciatic (tibial, fibular/peroneal)
  71. Gluteal nerve
    • runs over dorsal surface body of ILIUM
    • supplies gluteal muscles only (hindlimb abductors)
  72. Obturator Nerve
    • passes through obturator foramen
    • short route to medial thigh
    • Adductors:
    • Gracilis
    • adductor
    • pectineus
    • external obtruator (very very small)
  73. Femoral Nerve
    • MIXED- motor and sensory
    • motor: cranial thigh muscles- hip flexors/limb protractors, stifle extensors (iliopsoas, sartorius, quadriceps (all heads))
    • Patellar reflex: quadriceps, extension of stifle
    • Damage: cannot extend stifle, cannot bear weight (no compensation), loss of patellar reflex
    • SENSORY:
    • saphenous branch (femoral triangle)
    • medial aspect of limb
  74. Sciatic (ischiatic) nerve
    • MIXED- motor and sensory
    • runs over dorsal surface body of ilium
    • passes caudal to hip (don't mistake for sacrotuberous ligament)
    • runs deep to biceps femoris
    • MOTOR:
    • caudal thigh muscles (hip extensors/limb retractors, stifle flexors (biceps femoris, semitendionosus, semimembranosus)
  75. Tibial Nerve
    • Branch of sciatic
    • MOTOR: caudal crural muscles, hock extensors, digital flexors (gastrocnemius, superficial digital flexor, deep digital flexor)
    • SENSORTY: caudal/plantar aspect limb
  76. Fibular/peroneal nerve
    • Branch of sciatic
    • MOTOR: cranial crural muscles, hock flexors, digital extensors (cranial tibial, peroneus group, long digital extensor, lateral digital extensor)
    • SENSORY: cranial/dorsal aspect limb, lateral thigh
  77. Sciatic Nerve DAMAGE
    • hip trauma/Sx
    • femoral fx
    • Lose supply to: hip extensors/stifle flexors
    • hock extensorys/digital flexors
    • hock flexors/digital extensors
    • lose sensation to all but medial aspect
    • CAN STILL:
    • abduct (gluteals)
    • adduct (obturator)
    • protract/flex hip (femoral)
    • extend stifle
  78. Blood supply to hind limb
    • (follow flexor surfaces)
    • external iliac: leaves aorta and becomes:
    • Femoral artery (gives off saphenous A- superficial supply to paw) becomes:
    • Popliteal Artery: becomes:
    • cranial tibial artery: provides deep supply to paw
    • SUPERFICIAL: common digital arteries (dorsal and plantar)
    • DEEP: metatarsal arteries (dorsal and plantar)
    • FUSE: Proper digital arteries (dorsal and plantar)
    • Deep supply most importat

    • Femoral Triangle:
    • pulse- femoral artery
    • intravascular catheters- femoral vein
    • femoral nerve- saphenous branch
  79. Venous drainage in hindlimb
    • Deep and superficial supply
    • superficial: lateral saphenous vein access to systemic circulation
    • Medial saphenous vein more prominent in cats
  80. Lymphatic drainage
    • popliteal (caudal to stifle)
    • enlarged in response to infection
    • can use to differentiate between localised/generalised Dz
    • important meat inspection