Axial Ligaments: Ligamentum Nuchae • Attachment: superior and posterior extension of the supraspinous ligament on spines of C1-C6 • Purpose: Acts as a muscle attachment for posterior neck muscles. Ligamentum Flavum • Attachment: Between anterior surface of one lamina & posterior surface of the lamina below. • Purpose: Limits and “softens” end range intervertebral flexion. Supraspinous and Interspinous Ligaments • Attachments: Between adjacent spinous processes from C7 to the sacrum. • Purpose: Limits flexion. Intertransverse Ligament • Attachment: Between adjacent transverse processes. • Purpose: Limits contralateral flexion and forward flexion. Anterior Longitudinal Ligament • Attachment: Between basilar part of the occipital bone and the entire length of the anterior surfaces of all vertebral bodies and sacrum. • Purpose: Limits extension and excessive lordosis in the cervical and lumbar regions; reinforces the anterior sides of the intervertebral discs. Posterior Longitudinal Ligament • Attachment: entire length of posterior surfaces of vertebral bodies between C2 and the sacrum. • Purpose: Limits flexion; reinforces the posterior sides of the intervertebral discs. Capsule of Apophyseal Joints • Attachment: Margin of each apophyseal joint. • Purpose: Strengthens apophyseal joints, increasingly taut at extremes of all positions. Sacrotuberous Ligament • Attachment: PSIS, lateral sacrum, and coccyx to ischial tuberosity. • Purpose: Stabilizes the SI joint. Sacrospinous Ligament • Attachment: Lateral and caudal end of the sacrum and coccyx to the ischial spine. • Purpose: Helps stabilize the SI joint. Pubic Symphysis • Superior and Inferior Pubic Ligaments • Anterior and Posterior Pubic Ligaments • Weaker out of the bunch. • Forms a connection between the two hips bones and helps stabilize the joint. Upper Extremity Ligaments: SC JOINT: Anterior Sternoclavicular Ligament • From: Anterior Sternum. • To: Anterior Clavicle. • Purpose: Reinforces the joint capsule. Posterior Sternoclavicular Ligament • From: Posterior sternum. • To: Posterior clavicle. • Purpose: Reinforces the joint capsule. Costoclavicular Ligament • From: Cartilage of the first rib. • To: Costal Tuberosity of the inferior surface of the clavicle. • Purpose: Helps stabilize the joint through all motions except during clavicular depression. Sternoclavicular Articular Disc • From: Inferiorly near the clavicular facet of sternum. • To: Sternal end of the clavicle and interclavicular ligament. • Purpose: Strengthens the articulation of the joint and functions as a shock absorber by increasing the surface area of joint contact. Interclavicular Ligament • From: Sternal end of one clavicle. • To: Sternal end of the opposite clavicle. • Purpose: It reinforces the upper part of the of the joint capsule of the sternoclavicular joint. AC JOINT: Superior and Inferior Acromioclavicular Ligament • From: Acromial end of the clavicle. • To: Acromion process. • Purpose: Reinforces the AC joint capsule. Coracoclavicular Ligament (Conoid and Trapezius) • From: Coracoid process. • To: Inferior surface of the clavicle. • Purpose: Helps to suspend the scapula from the clavicle. Coracoacromial Ligament • • • From: Medial border of the acromion. To: Lateral border of coracoid process. Purpose: Protects and supports the humerus. Acromioclavicular Articular Disc • From: Superior portion of AC joint. • To: Inferior portion of AC joint. • Purpose: Strengthens the articulation of the joint and functions as a shock absorber by increasing the surface area of joint contact. GLENOHUMERAL JOINT Coracohumeral Ligament • From: Coracoid process. • To: Greater tubercle. • Purpose: Inferior translation of the humeral head and external rotation. Transverse Humeral Ligament • From: Medial portion of bicipital groove. • To: Lateral portion of bicipital groove. • Purpose: Holds the long head of the bicep tendon in place. Superior Glenohumeral Ligament • From: Superior portion of the glenoid. • To: Anatomical neck of humerus. • Purpose: External rotation and inferior & anterior translation of the humeral head. Middle Glenohumeral Ligament • From: Middle portion of the glenoid. • To: Anterior aspect of anatomical neck. • Purpose: Anterior translation of the humeral head especially in 45-90 degrees of abduction and external rotation. Inferior Glenohumeral Ligament • From: Inferior portions of the glenoid. • To: Anterior-inferior and posterior-inferior anatomical neck. • Purpose. Limits motion in 90 of ABD, external rotation, internal rotation. • Has an anterior and posterior components as well as an axillary pouch. ELBOW & FOREARM Medial (UCL) Collateral Ligament (Anterior and Posterior Components) • From: Distal medial aspect of humerus. • • To: Proximal ulna. Purpose: Prevents excessive valgus, extension, and flexion. Radial Collateral Ligament • From: Lateral epicondyle. • To: Radial head. • Purpose: Resists varus forces. Lateral Ulnar Collateral Ligament • From: Lateral epicondyle. • To: Supinator crest of ulna. • Purpose: Resists varus, flexion, and external rotation of the elbow. Annular Ligament • From: One side of the radial notch of the ulna. • To: Wraps around head of radius to the other side of the radial notch on the ulna. • Purpose: Resists distraction of the radius. Articular Capsule of elbow: • From: Crosses the elbow joint. • To: Crosses the elbow joint. • Purpose: Helps stabilize the humeroradial joint, humeroulnar joint, and proximal radio-ulnar ligament. Quadrate Ligament • From: Just below radial notch of the ulna. • To: Medial surface of the radial neck. • Purpose: Helps stabilize the joint, is stretched throughout movement, most notably in SUPINATION. Oblique Cord • From: Lateral side of the ulnar tuberosity. • To: Just distal to radial tuberosity. • Purpose: May help limit distal migration of the radius. Interosseous Membrane • From: Radius. • To: Ulna. Purpose: Helps transmit forces through the arm Palmar and Dorsal Capsular Ligaments • From: Anterior and posterior radius. • To: Anterior and posterior ulna. • Purpose: Helps hold the ulna snuggly against the ulnar notch of the radius during pronation and supination. HAND AND WRIST LIGAMENTS: Triangular Fibrocartilage Complex • From: Ulnar notch of the radius. • To: Medially within the fovea and base of the styloid process of the ulna and also the carpal bones. • Purpose: Primary stabilizer of the distal radio-ulnar joint, reinforces the ulnar side of the wrist, and helps transfer compression forces that naturally cross the hand to the forearm. Transverse Carpal Ligament (Flexor Retinaculum) • From: One side of the carpal bones. • To: Opposite side of the carpal bones transversely. • Purpose: The roof of the carpal tunnel through which the median nerve and flexor tendons pass through. • Compromise of this ligament could result in Carpal Tunnel (compression of median nerve). Fibrous Digital Sheaths • Forms tunnels/pulleys for extrinsic finger flexors and are anchored on the palmar plates. Extensor Expansions • Dorsal Expansion • *Dorsal Hood* • Dorsal Aponeurosis • Insertion point where extensor tendons go into the phalanges and help keep the tendons from dislocating to either side (pulley system). LOWER EXTREMITY LIGAMENTS: HIP: Ligament to the Head of the Femur • Attachment: Runs between transverse acetabular ligament and fovea of femoral head. • Purpose: Serves as a protective conduit for the passage of the small acetabular artery. • Has more of a purpose when the child is small compared to as an adult. May also help stabilize the fetal hip Acetabular Labrum • Attachment: Strong and flexible ring of fibrocartilage that encircles most of the outer circumference of the acetabulum. • Purpose: Provides significant stabilization to the hip by “gripping” the femoral head and by deepening the acetabular notch. Transverse Acetabular Ligament • Attachment: Closes space (acetabular notch) left by the incomplete ring of the acetabular labrum. • Purpose: Assists the acetabular labrum. Iliofemoral (Y) Ligament • From: AIIS • To: Intertrochanteric line of the femur. • Purpose: Limits extension and external rotation. • Strongest and stiffest ligament of the hip. Pubofemoral Ligament • From: Inferior rim of acetabulum and adjacent parts of the superior pubic ramus and obturator membrane. • To: Blends with the iliofemoral ligament and inserts on the intertrochanteric line. • Purpose: Resists abduction, extension, and external rotation. Ischiofemoral Ligament • From: Posterior and inferior aspects of acetabular labrum. • To: Near the apex of the greater trochanter. • Purpose: Resists extension and internal rotation. • Resists internal rotation especially at 10-20 degrees of abduction. KNEE JOINT Transverse Ligament: Connects the two menisci Medial Meniscus • Oval shaped. • Attaches to MCL and adjacent capsule. • Primary Function: Resist compressive forces across the joint!!! • Stabilizes the joint during motion. • Helps lubricate the knee joint with synovial fluid. • Red Zone: lateral 1/3 where there is a good blood supply. • • Pink Zone: Small region of transition. White Zone: Medial 2/3s and receives its nourishment from synovial fluid. • Milking the joint! Lateral Meniscus • Circular shape • Attaches to the lateral capsule. • Primary Function: Resist compressive forces across the joint!!! • Stabilizes the joint during motion. • Helps lubricate the knee joint with synovial fluid. • Red Zone: lateral 1/3 where there is a good blood supply. • Pink Zone: Small region of transition. • White Zone: Medial 2/3s and receives its nourishment from synovial fluid. • Milking the joint! Medial Collateral Ligament (MCL) • Stronger than the LCL but normally experiences higher forces than LCL. • Resists the following: • Valgus forces • Knee extension • Extremes of axial rotation (esp. external rotation). Lateral Collateral Ligament (LCL) • Weaker than MCL but usually does not experience the same forces as the MCL. • Resist the following: • Varus forces • Knee Extension • Extremes of axial rotation. Anterior Cruciate Ligament (ACL) • From: Medial side of the lateral femoral condyle. • To: Anterior intercondylar area of tibial plateau. • Resists the following: • Extension • Excessive anterior translation of the tibia-on-femur. • Excessive posterior translation of the femur-on-tibia. • Extremes of varus and valgus • Extremes of axial rotation. Posterior Cruciate Ligament • From: Lateral side of the medial femoral condyle. • To: Posterior intercondylar area of the tibial plateau. • Resists the following: • Flexion • • • Excessive posterior translation of the tibia-on-femur. • Excessive anterior translation of the femur-on-tibia. Extremes of varus and valgus Extremes of axial rotation Distal Tibiofibular Joint Interosseous Membrane • Provides stability between tibia and fibula. Interosseous Ligament • Strongest stabilizer of the joint. Anterior and Posterior Distal Tibiofibular Ligaments • Stabilize the joint. ANKLE Lateral Collateral Ligaments • Anterior Talofibular Ligament • Resists excessive inversion and horizontal plan adduction. • Most frequently injured out of the three (Most ankle sprains). • Calcaneofibular Ligament • Resists inversion (esp. when fully dorsiflexed) of the talocrural and subtalar joint. • Posterior Talofibular Ligament • Stabilizes the talus in the mortise and limits excessive abduction of the talus (esp. when fully dorsiflexed). Subtalar ligaments: Calcaneofibular Ligament • Limits excessive inversion. Tibiocalcaneal Ligament (Part of the Deltoid Ligament) • Limits excessive eversion. Interosseous (Talocalcaneal) Ligament • Limits the extremes of all movements, especially inversion. Cervical Ligaments Limits the extreme all all movement, especially extension Talonavicular ligaments; Spring (Plantar Calcaneonavicular) Ligament • Helps maintain foot arch because it is very strong and resists elongation. Dorsal Talonavicular Ligament • Dorsally reinforces the capsule. Bifurcated Ligament • Laterally reinforces the capsule. Tibionavicular Ligament (Part of the Deltoid Ligament) • Medially reinforces the capsule. Tibiospring Ligament (Part of the Deltoid Ligament) Medially reinforces the capsule. Calcaneocuboid Ligaments Dorsal Calcaneocuboid Ligament • Dorsal-laterally reinforces the capsule. Bifurcated Ligament • Dorsally reinforces the capsule. Short Plantar (Plantar Calcaneocuboid) Ligament • Reinforces the plantar side of the capsule. Long Plantar Ligament • Reinforces the plantar side of the capsule. Metatarsal Phalangeal Joint Collateral Ligaments • Helps stabilize the joint. • Plantar Plate • Acts a tunnel/pulley for flexor tendons. • Transverse Metatarsal Ligaments • Helps maintain the first ray in a similar plane as the other rays, thereby adapting the foot for propulsion and weight bearing rather than manipulation. • Fibrous Capsule • Encloses the MTP joint. • Dorsal Digital Expansion • Tunnel for extensor tendons to go through to reach the phalanxes. • Similar to extensor mechanism in the hand.
