Week 1 (Lec 1 To Lec 7)

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BIOMECHANICS OF JOINTS AND

PT ORTHOPAEDIC IMPLANTS
PROF. SANJAY GUPTA
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DEPARTMENT OF MECHANICAL ENGINEERING, IIT KHARAGPUR
Module 01:
Lecture 01 : GENERAL INTRODUCTION TO THE COURSE
Overview of the course
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Modules and Topics T
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Biomechanics of Joints and Orthopaedic Implants
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Professor Sanjay Gupta
Department of Mechanical Engineering
Indian Institute of Technology Kharagpur
Overview
Biomechanics is an interdisciplinary subject that seeks to understand the mechanics of living system
- it is mechanics applied to biological system.
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Biomechanics helps to understand the relationship between
structure and function, predict changes due to alterations, and
propose methods of artificial interventions.
Overview
A most vigorous development of Biomechanics is associated with Orthopaedics,
because the most frequent users of the surgical theatres are patients with
musculoskeletal problems.
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Biomechanics of trauma, injury and rehabilitation is becoming

increasingly important to the modern society.
Overview and Benefits
• This course will cover the fundamental topics of Biomechanics as well as state-of-the-art
techniques of modelling and simulation.
• Fundamental research has not only included surgery, prosthesis, implantable materials and
artificial limbs, but also cellular and molecular aspects of healing.
• This course would be useful for a wide spectrum of students, researchers, engineers and faculty
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members, who wish to work and pursue research in the field of Biomechanics and related areas.
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NP / PhD students of
Course is designed for B.Tech / M.Tech
• Mechanical Engineering
• Civil Engineering
• Biomedical Engineering
• Medical students (with special interest).
Pre-requisites subjects: Engineering Mechanics, Solid Mechanics
Modules
Module 1: Introduction to Musculoskeletal System; Anatomy of Synovial
(Week 1) Joints - Structure and Function; Hip, Knee, Shoulder, Elbow, Spine.
Module 2: Basic Biomechanics of Human Joints:

(Week 2) (a) Hip, (b) Knee, (c) Shoulder, (d) Elbow (e) Spine
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Module 3: T
Gait Cycle; Biomechanics of Gait Analysis;
(Week 3)
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Measurement Techniques; 3-D Motion Analysis System.
Module 4: Joint Kinematics; Joint Forces and Moments; Estimation

(Week 4) of Musculoskeletal Forces during Movements.
Modules
Module 5: Concepts of Stresses and Strain; Bone Structure and Mechanical
(Week 5) Behaviour; Bone Adaptation; Viscoelasticity; Anisotropy.
Module 6: Biomechanics of Implants; Failure Mechanisms and Implant

(Week 6) Design Considerations; Biomechanical Modelling of Bone and
Implant; Experimental Validation.
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Module 7: T
Finite Element Analysis of Implanted Bone Structures;
(Week 7)
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Bone Remodelling – formulation, algorithm, simulation.
Module 8: Bone Fracture Healing; Tissue Differentiation and

(Week 8) Mechanoregulatory Principle; Mechanobiology
Based Simulation of Bone Ingrowth.
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BIOMECHANICS OF JOINTS AND ORTHOPAEDIC IMPLANTS
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PROF. SANJAY GUPTA
Module 01:
Lecture 02 : Musculoskeletal System
Ø Introduction to musculoskeletal system
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Ø Bone, Muscle, Ligament, Tendon, Joints
Skeletal System
Types of Bone
(a) Long Bones
(b) Short Bones
(c) Flat Bones
(d) Irregular Bones
(e) Sesamoid (Round) Bones
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There are 206 bones in the human skeleton (210 if we
count the two sesamoid bones that lie under the head
of the first metatarsal in each foot in most people).
Source: Figure adapted from https://courses.lumenlearning.com/wm-biology2/chapter/types-of-bone/

Skeletal Organization
§ Appendicular Skeleton
§ Upper limbs
§ Lower limbs
§ Pectoral (shoulder) girdle
§ Pelvic girdle
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§ Axial Skeleton T
§ Skull NP
§ Ossicles of the inner ear
§ Hyoid bone of throat
§ Thoracic cage (Rib cage)
§ Vertebral column
Source: Figure adopted from https://commons.wikimedia.org/wiki/

Anatomical Planes and Directions
Superior
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T
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Inferior
Anatomical planes of reference Anatomical directions

Anatomical Terms
Superior
Anterior and posterior: describe structures at the

front (anterior) and back (posterior) of the body;
e.g. the toes are anterior to the heel.
Superior and inferior: describe a position above

(superior) or below (inferior) another part of the
body; e.g the pelvis is inferior to the abdomen. E L
T
NP Inferior
Proximal and distal: a position that is closer (proximal) or further (distal) from the trunk
of the body; e.g. shoulder is proximal to the arm, foot is distal to the knee.
Anatomical Terms
Superior
• Medial and lateral: a position that is

closer to (medial) or further from (lateral)
the midline of the body; e.g. the thumb is
lateral to the other fingers.
• Ventral and Dorsal: describe structures
towards the front (ventral) and back
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(dorsal). T
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Inferior
• Cranial and Caudal: describe structures towards the top (cranial), and the
bottom of the body (caudal).
Anatomy of a Femur
Epiphysis
Femur – the longest and strongest bone
Fovea Metaphysis
q Epiphysis: the connectors Proximal Capitis
Neck Head
§ Connect femur with other bones to form joints
Greater
Trochanter
Shaft
q Diaphysis: the central shaft Diaphysis
§ Composed of hard cortical bone E L Lesser

Trochanter
T
§ Load transfer
NP Metaphysis
q Metaphysis: conical eminences Epiphysis
§ Composed of cancellous bone with

Distal
thin layer of cortex
§ Sites for muscle attachments
Bone Tissue
• Bone is a hard tissue - a type of specialized connective tissue.
• Bone has a complex internal and external structure.
• Bone possess the remarkable property to repair itself and adapt

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its structure according to the mechanical stimulus.
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Figure adapted from Wikipedia and https://commons.wikimedia.org/wiki/
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Cancellous and Compact Bone
Macroscopically, classification of bone tissue is based on porosity
Epiphysis
Trabecular bone
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Compact bone T Cancellous bone
Diaphysis NP
• Cortical or Compact Bone - dense solid bone with volume fraction of solid greater than 70%
• Cancellous or Spongy Bone - porous network of interconnected rods or plates with volume
fraction of solid less than 70%
Figure adapted from Wikipedia and https://commons.wikimedia.org/wiki/
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Bone Function
q Support, Movement & Protection
• supports body weight
• protects vital organs, e.g. heart, lungs, brain
• bones and muscles interact when limbs move – enables mobility of the human body
q Blood Cell Formation

• haematopoiesis
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• red marrow T
NP q Mineral Storage
• calcium
• phosphate
• magnesium
• sodium
• potassium
Muscle
There are approximately 700 different muscles in the human body, divided into three types:
• Skeletal: attached to bones and moves the skeleton, voluntary muscle
• Cardiac: muscle of the heart, involuntary muscle (e.g., in walls of blood vessels, intestine,
and other 'hollow' structures and organs)
• Smooth or visceral: muscle of the viscera

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T
NPFunctions of muscle, responsible for:
• motion
• maintenance of posture
• heat production
Skeletal Muscles
Skeletal muscles consist of numerous subunits or bundles called fasicles (or fascicles). Fascicles are also
surrounded by connective tissue (called the perimysium) and each fascicle is composed of numerous
muscle fibers (or muscle cells).
Muscle cells, ensheathed by endomysium, consist of many
fibrils (or myofibrils), made up of long protein molecules
called myofilaments, of two types: thick & thin myofilaments.
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Skeletal muscles are usually attached to bone by
tendons. The epimysium is a dense connective
tissue (surrounds the muscle tissue) and is also
continuous with the tendons, where it becomes
thicker and collagenous.
Source: Figure adapted from https://www.pinterest.com/livecam33/biology/

Ligament
Ligament is a fibrous connective tissue, which connects one bone to another bone. It is also
known as articular ligament, fibrous ligament, or true ligament.
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Knee Joint
Hip Joint
Tendon
A tendon (or sinew) is a tough band of dense fibrous connective tissue that usually connects muscle to
bone. It is capable of withstanding tension and transmitting the mechanical forces of muscle contraction
to the skeletal system. Tendons may also attach muscles to structures such as the eyeball.
Tendons are similar to ligaments and

fasciae; all are made of collagen.
Tendons and ligaments

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viscoelastic material properties: they
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exhibit both elastic and viscous behaviour.
A ligament is a fibrous connective tissue which attaches bone to

bone, and usually serves to hold structures together and keep
them stable.
Rigid Body Model Elements
Anatomic Element Model Element
Bone Rigid links
Joints Standard Joints
Muscle + Tendon L
Actuators
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T
(responsible for moving or controlling a
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Ligament Controllers
Springs
(monitors and physically alters the operating
conditions of a given dynamical system)
Joints
Articulations: The site where two or more bones meet.
• Joints are the weakest part of the skeleton.
Classification:
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Functional: Amount of movement allowed
T
NP Immovable joints
1) Synarthrosis:
2) Amphiarthrosis: Slightly movable joint
3) Diarthrosis: Fully movable joints
Classification of Joints
Structural: based on material binding the bone
1) Fibrous joint: Bone ends united by collagenic fibers

a) Sutures
b) Syndesmosis
c) Gomphosis
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2) Cartilaginous joint: Bones are united by cartilage
a) Synchondrosis
b) Symphysis
3) Synovial joint : Bones are united within a fibrous joint capsule

Fibrous Joints
Sutures (Synarthrosis) Syndesmosis (Amphiarthrosis)
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• A suture is an immovable type of fibrous joint that is only found in the skull (cranial
suture).
• A syndesmosis is a slightly movable fibrous joint in which bones, such as the radius
and ulna, are joined together by connective tissue.
Gomphosis (Synarthrosis)
A gomphosis is a joint that anchors a tooth inside its socket. Gomphosis lines the upper and lower
jaw in each tooth socket and is also called peg and socket joint.
• Immovable joint
• Ligaments hold tooth in bony socket
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Socket
Root of the
Gomphosis tooth
Periodontal
ligament
Synchondrosis (Synarthrosis)
A synchondrosis is a type of cartilaginous joint where hyaline cartilage completely joins together
two bones. Synchondrosis are immovable joints and are thus also referred to as synarthrosis.
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Symphysis (Amphiarthrosis)
A symphysis is connected by broad flattened disks of fibrocartilage as in the articulations between
the bodies of the vertebrae or the inferior articulation of the two hip bones (pubic symphysis).
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Synovial Joint (Diarthrosis)
Synovial joints allow free movement of articulating bones within a fluid-filled
synovial cavity. Synovial joints are most common in the skeletal system.
• Most movable type of joint

• Each contains a fluid-filled joint cavity
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Synovial Joints with Articular Discs
Some synovial joints contain an articular disc:
– Occur in the temporomandibular joint
and at the knee joint
– Occur in joints where articulating bones

have somewhat different shapes
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T
NP
Temporomandibular joint
1) Bartel D.L., Davy D.T., Keaveny T. M. Orthopaedics Biomechanics: Mechanics and Design in
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Musculoskeletal Systems, 2006, Pearson Prentice Hall, Pearson Education Inc, New Jersey.
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2) Nordin M and Frankel V.H. Basic Biomechanics of the Musculoskeletal System, 3rd Edition,
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2001, Lippincott Williams & Wilkins, Baltimore, Maryland.
3) Dowson D. and Wright V. An Introduction to the Bio-mechanics of Joints and Joint
Replacement, 1981, Mechanical Engineering Publications Ltd, London.
4) Wikipedia and https://commons.wikimedia.org/wiki/
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PROF. SANJAY GUPTA
Module 01:
Lecture 03 : Synovial Joints
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E structure and function
Ø Synovial Joints – Hip, Knee, Shoulder, Elbow:
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General Structure of Synovial Joints
Synovial joints allow free movement of articulating bones within a
fluid-filled cavity, known as synovial cavity. Synovial fluid is the viscous
liquid contained inside a synovial joint that functions as a lubricant.
§ Articular cartilage
• Ends of opposing bones are covered with hyaline cartilage
• Absorbs compression E L
T
§ Joint cavity (synovial cavity) NP
• Unique to synovial joints
• Cavity is a potential space that holds a small amount of fluid
q Articular capsule – joint cavity is enclosed in a two-layered capsule

§ Fibrous capsule – dense irregular connective tissue – strengthens joint
§ Synovial membrane – loose connective tissue
• Lines joint capsule and covers internal joint surfaces
• Functions to make synovial fluid
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q Synovial fluid – a viscous fluid similar to raw egg white
• Contains glycoprotein molecules secreted by fibroblasts
The articular cartilage and the joints in general are nourished chiefly
by the synovial membrane.
q Reinforcing ligaments
– Often are thickened parts of the fibrous capsule
– Sometimes are extracapsular ligaments – located outside the capsule
– Sometimes are intracapsular ligaments – located internal to the capsule
q Richly supplied with sensory nerves

– Detect pain E L
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– Monitor how much the capsule is being stretched
q Have a rich blood supply

– Most supply the synovial membrane
– Extensive capillary beds produce basis of synovial fluid
– Branches of several major nerves and blood vessels
Synovial Joints
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Shoulder joint
Synovial Joints
Pelvic
Bone
Acetabulum
Femoral (socket)
Head
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T
NP
Femur
Knee joint Hip joint

Temporomandibular Joints
Articular § Complex Joint
Disk Fossa
§ Articular disc
§ Gliding above disc
Ligament
Condyle § Hinge below disc
Muscle
§ Movements:
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T - depression
NP - elevation
- protraction
- retraction
The TMJ is a hinge and gliding joint and is one of
the most constantly used joint in the human body
Types of Synovial Joints
• Planar Joint
• Hinge Joint
• Pivot Joint
• Saddle Joint
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•T Ball and Socket Joint
NP• Condyloid or Ellipsoid Joint
Types of Synovial Joints
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Planar Joint
§ Bone surfaces are slightly curved

§ Side to side movement only
§ Rotation prevented by ligaments
§ Examples:
- intercarpal to intertarsal joints E L
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- sternoclavicular joint
- vertebrocostal joints
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Hinge Joint
§ Convex surface of bone fits in concave surface of 2nd bone

§ Unilateral like a door hinge
§ Examples:
- knee, elbow, ankle, interphalangeal joints
§ Movements produced:
- flexion
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- extension T
- hyperextension NP
Pivot Joint
§ Rounded surface of bone articulates with the ring formed by the 2nd bone and ligament
§ Monoaxial since it only allows rotation around the longitudinal axis
§ Examples:
- proximal radioulnar joint
- supination
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- pronation T
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Condyloid Joint
§ Spherically shaped bone fits into oval depression
§ Biaxial: flex/extend or adduct/abduct is possible
§ Examples:
- Wrist and metacarpophelangeal joints
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Saddle Joint
§ One bone saddle-shaped, other bone fits like a person riding on the saddle
§ Biaxial
- circumduction allows the tip of the thumb to travel in a circle
- opposition allows thumb to touch tip of other fingers
§ Examples:
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- Trapezium of carpus and metacarple of thumb
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Ball-and-socket Joint
• Ball fitting into a cup-like depression

• Multiaxial
- flexion/extension
- abduction/adduction
- rotation
• Examples: E L
T
- shoulder joint
- hip joint NP
Factors Influencing Joint Stability
q Shape of the articular surfaces

Shallow poor fitting articular surfaces hinder stability, whereas well
fitting articular surfaces (i.e. hip joint) improve stability
q Ligaments
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Ligaments unite bones and prevent excessive, undesirable motion
q Muscle Tendon
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Muscle tendons are the most important stabilizing factor
Movements of the Synovial Joints
The synovial joints offer a large range of movements
§ Flexion – Extension
§ Horizontal Flexion and Extension
§ Abduction – Adduction
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§ Internal Rotation – External Rotation
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Special movements of hands and feet
• Palmar flexion and Dorsal flexion refer to movement of the flexion (palmarflexion) or extension
(dorsiflexion) of the hand at the wrist.
• Pronation and Supination refer to rotation of the forearm or foot so that in the anatomical position
the palm or sole is facing anteriorly (supination) or posteriorly (pronation) rotation of the forearm.
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Dorsal flexion
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Palmar flexion
Special movements of hands and feet
• Dorsiflexion and Plantarflexion refers to flexion (dorsiflexion) or extension of the foot at the ankle.
• Eversion and Inversion refer to movements that tilt the sole of the foot away from (eversion) or
towards (inversion) the midline of the body.
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Joint Disorders
§ Pain and restricted movement and resulting in reduction in productivity and quality of life for
people with damage to their major joints (hip, knee, shoulder, elbow)
Femoral neck
• Osteoarthritis 75% of joint replacements fracture
• Fracture 12%
• Rheumatoid arthritis 4%
• Others 9%
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T Intertrochanteric
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Decreased
joint space fracture
Exposed bone
Worn
cartilage
Arthritic hip joint Arthritic knee
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Arthroscopy and Arthroplasty
Knee
Joint q Arthroscopy- examination of joint
- minimally invasive surgery with instruments
- removal of torn knee cartilage or meniscus
- small incisions only
q Arthroplasty- replacement of joints (e.g. hip, knee)

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- total hip replaces acetablum and femoral head
- uses implants T
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- partial replacement (hemi-arthroplasty)
Total Hip Arthroplasty
Hip Resurfacing
“Synergy” total hip replacement

(Smith and Nephew)
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PROF. SANJAY GUPTA
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Module 01:
Lecture 04 : THE HIP JOINT
Ø Hip Joint: Structure and function E L
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Common problems of the hip joint NP
The Hip Joint
The hip joint forms the primary connection between the bones of the lower limb and the upper limb.
It is a synovial (diarthrodial) joint and the articulation forms a ball-and-socket joint.
The hip joint consists of: Ball-and-socket joint
• Femoral head (ball)

• Acetabulum (socket)
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Femoral Head
Source: www.wikipedia.org
Articulating Surfaces of the Hip Joint
Femoral Head Acetabulum
• Spans around two-third of a sphere • Horse-shoe shaped articular surface,
covered by hyaline cartilage
• Covered by hyaline cartilage, except
at fovea of the femur (fovea capitis). • Deep notch with narrow mouth
Ilium
Head of Femur Acetabulum

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T
NP Acetabulum
Pubis
Ischium
Functions of the Hip Joint
The hip joint is a major load bearing joint
Primary functions of the hip joint are:
§ to support to the body weight in both static (e.g. standing, sitting)

and dynamic (e.g. walking, running) postures.
§ to facilitate transfer of forces and moments (load transfer) from the

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upper part of the body (trunk) to the lower extremities.
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§ N P
to enable a large range of movement and maintain stability during
these movements.
§ to retain balance and to maintain the pelvic inclination (tilt) angle
Comparison between a neutral and

Source: www.wikipedia.org anterior pelvic tilt – effect on height
Hip Deformities: Varus and Valgus
§ Femoral neck-shaft angle
The angle between longitudinal axes of femoral neck and shaft, is called the caput-collum-diaphyseal
angle or CCD angle, normally measures approx 150° in newborn and 126° in adults (coxa norma).
Coxa vara is a deformity, where the neck-shaft

angle is reduced to less than 120 degrees. This
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results in shortening of leg and development
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Tof a limp (asymmetric abnormality of the gait).
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Coxa valga is a deformity, where the
neck-shaft angle is increased, usually
greater than 135°.
Hip Deformities: Anteversion and Retroversion
§ Femoral Neck Anteversion:
Angle between an imaginary transverse line oriented
along medial-lateral direction through the knee joint
15 - 20° and an imaginary transverse line oriented through
the center of the femoral head and neck.
Femoral Neck Anteversion: Normal angle 15 - 20°
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NP ˂ 10°
˃ 20°
Increased Femoral Neck Anteversion: angle ˃ 20° Femoral Neck Retroversion: angle ˂ 10°
Muscles of the Hip Joint
Muscles of the hip joint consist of four main groups:
• Adductor: Adductor brevis, Adductor longus,

Adductor magnus, Pectineus, Gracilis
• Iliopsoas: Iliacus and Psoas major
•
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Gluteal: Gluteus maximus, Gluteus medius,
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gluteus minimus, Tensor Fasciae Latae
• NP
Lateral rotator: Obturators externus and internus,
Posterior View
Piriformis, Gemelli superior and inferior, Quadratus femoris
• Other muscles: Hamstring, Rectus femoris, Sartorius
Anterior View
Movements and Muscles of the Hip Joint
The movements in the hip joint along with the range of motions and the muscles are:
Flexion (140°) and Extension (20°) around the transverse axis (left-right) in sagittal plane
Flexor muscles: Extensor muscles:

iliopsoas (psoas major) gluteus maximus
tensor fasciae latae
adductor longus E L gluteus medius & minimus
adductor magnus
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NP
adductor brevis long head of biceps femoris
pectineus semimembranosus
gracilis semitendinosus
piriformis
FLEXION EXTENSION
Source: Mihcin et al. (2021)

External or Lateral (30° with hip extended, 50° with hip flexed) rotation and
Internal or Medial (50°) rotation around a vertical axis (along the thigh) in transverse plane
Lateral rotator muscles: Medial rotator muscles:

gluteus maximus gluteus medius & minimus
quadratus femoris tensor fasciae latae
obturator internus adductor magnus
gluteus medius & minimus pectineus
iliopsoas (psoas major) E L
obturator externus T
adductor magnus
adductor longus
NP
adductor brevis
adductor minimus
piriformis
sartorius EXTERNAL ROTATION INTERNAL ROTATION

Abduction (50° with hip extended, 80° with hip flexed) and
Adduction (30° with hip extended, 20° with hip flexed) around a sagittal axis (anterior-posterior)
Abductor muscles: Adductor muscles:

gluteus medius adductor magnus
tensor fasciae latae adductor minimus
gluteus maximus adductor longus
gluteus minimus
E L adductor brevis
piriformis T gluteus maximus
obturator internus
NP quadratus femoris
obturator externus
semitendinosus
gracilis
pectineus
ABDUCTION ADDUCTION
Ligaments of the Hip Joint
Hip joint is reinforced by four ligaments: three extracapsular and one intracapsular
Extracapsular ligaments are:

• Iliofemoral ligament
• Pubofemoral ligament
• Ischiofemoral ligament
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T
NP
Intracapsular ligament: Ligamentum Teres
(ligament of head of femur)
Source: Schleifenbaum et al. (2016) and Wikipedia

Iliofemoral Ligament
• Ligament of Bigelow* – Y shaped ligament
• Strongest ligament of body: resist the trunk from falling
backwards in standing posture.
• The upper (oblique) and lower (vertical) fibers form thick,
strong bands, while the middle fibers are thin and weak.
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*American Surgeon Henry Jacob Bigelow described the structure and

function of the Iliofemoral ligament hip joint in great detail.
Pubofemoral Ligament
• Supports the joint inferomedially
• Triangular shaped.
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Anterior view
Ischiofemoral Ligament
• The ischiofemoral ligament (ischiocapsular or ischiocapsular band) consists
of a triangular band of strong fibers on the posterior side.
• Ligament tends to restrict internal rotation of the hip,

regardless of whether the hip is flexed, extended, or
in neutral position.
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NP
Posterior view
Acetabular Labrum
The acetabular labrum (or cotyloid ligament) is a ring of cartilage that surrounds the acetabulum
• Fibrocartilaginous rim on the periphery of acetabulum
• Provides an articulating surface for the acetabulum,
allowing the femoral head to articulate with the pelvis
• Narrows the mouth of acetabulum - helps in holding

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the head of femur in position
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•
NP portion is vulnerable during labrum tears
Anterior
• Transverse acetabular ligament (transverse ligament) is a portion of the

acetabular labrum; however the ligament has no cartilage cells among its fibers.
Factors affecting Hip stability
q Shape of the acetabulum: Due to the depth of the acetabulum, it can encompass almost 60 – 70%
of the spherical femoral head. The depth provides a larger articular surface, further improving
the stability of the joint.
q The iliofemoral, pubofemoral and ischiofemoral ligaments are very strong, and along with the
thickened joint capsule, provide a large degree of stability.
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q The structure of acetabular labrum provides the stability to the joint. It maintains a negative
pressure (acting as "vacuum seal") and enhances hip joint stability.
Common Problems of the Hip Joint
Intracapsular Fracture
• It may be subcapital (near the head), cervical (in the middle) or basicervical (near trochanters).
• Such a damage is maximum in subcapital and least in basicervical fractures.
• These fractures are common in old age, between 60 and 80 years.
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Subcapital Transcervical Basicervical

Extracapsular Fracture
• Intertrochanteric (between the trochanters)
Trochanteric fractures
• Peritrochanteric (along the trochanters)
• Subtrochanteric (below the trochanters)

• These fractures occur in young adult subjects owing to severe traumatic injuries.
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Intertrochanteric Peritrochanteric Subtrochanteric

Arthritis: Osteoarthritis
Bone degenerative disease, Osteoarthritis is the most common
form of arthritis in the hip joint.
• In osteoarthritis, the cartilage gradually wears away
• Results in bone-to-bone contact, producing bone spurs,
causes pain and stiffness, restricts movements.
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Osteoarthritis
Rheumatoid Arthritis
In rheumatoid arthritis, inflammation (swelling) of the synovial

membrane that covers the synovial joint, results in pain and stiffness.
Rheumatoid
Synovitis • Rheumatoid arthritis, an autoimmune disorder, occurs when the
Cartilage lining immune system mistakenly attacks the own body's tissues.
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• The immune system damages normal tissue (such as cartilage
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and ligaments) and softens the bone.
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Rheumatoid arthritis
1) Beverland D. (2010). The transverse acetabular ligament: optimizing version. Orthopedics, 33(9), 631.
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2) Mihcin S, Ciklacandir S, Kocak M, Tosun A. (2021) Wearable Motion Capture System Evaluation for
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Biomechanical Studies for Hip Joints. ASME. Journal of Biomechanical Engineering, 143(4): 044504.
3) NPTensile properties of the hip joint ligaments are largely
Schleifenbaum S, Prietzel T, Hädrich C, Möbius R. (2016)
variable and age-dependent - An in-vitro analysis in an age range of 14-93 years. Journal of Biomechanics,
49(14): 3437-3443.
5) American Academy of Orthopaedic Surgeons https://orthoinfo.aaos.org/en/
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Module 01:
Lecture 05 : THE KNEE JOINT
Knee Joint: Structure and function
E L
Common problems of the knee joint P
T
N
Anatomy of Knee joint
The knee joint is a major load bearing joint in the lower extremity, which forms the connection between the
thigh and the leg. It is the largest joint as well as a synovial (diarthrodial) joint. Knee is a modified hinge joint.
Femur Patella
The knee joint consists of the following joints:
§ Tibiofemoral joint - femur and tibia: between the medial and lateral
L
condyles of the femur and the corresponding tibial condyles
E
T
NP
§ Patellofemoral joint - femur and patella: between the patella and
the patellar surface of the femur
Tibia
Fibula
Source: Wikipedia
Articulating Surfaces of the Knee Joint
Tibiofemoral Patellofemoral
• Lateral and medial articulation • Intermediate articulation
• Articulations between tibial condyles and their cartilaginous • Articulation between the patella and the femur
menisci and the corresponding femoral condyles
Tibial collateral
Femoral meniscus
L
condyles
E
Tibiofemoral P
T Posterior view
Joint N
Patellofemoral
Joint
Medial
Knee X-ray Lateral meniscus
meniscus
Fibula
Functions of the Knee Joint
The knee is a weight bearing joint
Primary functions of the knee joint are:
§ to support to the heavy loads, body weight in both static (e.g. standing,
sitting) and dynamic (e.g. walking, running) postures.
L
§ to facilitate load transfer, forces and moments, from the upper part of the
E
body to the ankle and foot. T
§ to facilitate human locomotion
NP
§ to enable a range of movement and maintain stability during these
movements.
The Patella (Knee Cap)
§ The patella is a ‘sesamoid’ (round) floating bone.
Functions
§ Protection of the knee joint
§ Provide mechanical advantage:
L
• It aids in knee extension by producing anterior
E
T
displacement of quadriceps tendon, hence increasing
NP
the moment arm of quadricep muscle force.
• It allows a wider distribution of compressive
stress on femur, by increasing the area of
contact between patellar tendon and femur.
Menisci
The articular disks of the knee-joint are called menisci. The medial and lateral menisci are C-shaped
fibrocartilage disks, attached at both ends of the intercondylar area of the tibia.
Functions of the Menisci:

• Deepens the articular surface of the tibia, thus increasing
stability of the joint
•
E L
Improves congruence of the joint
• T
Distributes load bearing forces
• NP
Decreases friction between tibia and femur
• Acts as shock absorber
Anterior View
Source: Adapted from https://orthoinfo.aaos.org/en/diseases--conditions/discoid-meniscus/
Knee Deformities: Varus and Valgus
Varus deformity (genu varum) causes the knees to bend outward, giving a bow-legged appearance; this
configuration puts additional pressure on the inner (medial) compartment of the knee joint.
The opposite deformity is valgus (genu valgum).
Varus Valgus
Mechanical axis
Axis of femoral
of femur
shaft
E L
T
NP
Projection of
mechanical axis
of femur
Axis of tibial
shaft d
d
d = angle of deformity
Normal Varus Valgus
Muscles of the Knee Joint
Muscles of the knee joint consist of two main groups:
§ Quadriceps: vastus medialis, vastus intermedius,

vastus lateralis, rectus femoris
§ Hamstring: semimembranosus, semitendinosus,

biceps femoris
E L
T
Other muscles: NP
Gluteal (gluteus maximus, gluteus medius, gluteus
minimus), Popliteus and Calf (soleus and gastrocnemius)
Quadriceps Hamstring
Anterior View Posterior View
Source: Adapted from https://orthoinfo.aaos.org/en/diseases--conditions/muscle-strains-in-the-thigh

Movements and Muscles of the Knee Joint
The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external
rotation.
Flexor muscles: range of motion 120 – 150° Extensor muscles: range of motion 5 – 10°
Semimembranosus Quadriceps
Semitendinosus Sartorius
Biceps femoris
Rectus femoris E L
Iliopsoas T
Gracilis
Sartorius Flexion NP
Popliteus Extension
Gastrocnemius
Movements and Muscles of the Knee Joint
The knee permits only slight internal and external rotation
External rotator muscles: maximum 30° (for knee flexed at 90°)

Biceps femoris
External Rotation
E L
T
Internal rotator muscles: maximum 10° (for knee flexed at 90°)
P
Internal Rotation N
Semimembranosus
Semitendinosus
Gracilis
Sartorius
Popliteus
Ligaments of the Knee Joint
The major ligaments in the knee joint are:
• Medial collateral ligament

• Lateral collateral ligament
• Anterior cruciate ligament
L
E cruciate ligament
• Posterior
T
NP
• Patellar tendon (ligament)
Medial and Lateral Collateral Ligaments
§ Collateral ligaments - two strap-like ligaments. They act to
stabilize the hinge motion of the knee, preventing
excessive medial or lateral movement.
§ Medial collateral ligament

• Thick, wide and flat ligament; proximally
E L
attaches to the medial epicondyle of the femur,
T
NP
distally to the medial condyle of the tibia.
§ Lateral collateral ligament

• Thinner, rounder ligament; attaches proximally to
the lateral femoral epicondyle, distally attaches to a
depression on the lateral surface of fibular head.
Patellar Tendon (Ligament)
§ Patellar ligament
• Continuation of the quadriceps tendon, distal to the
patella.
• Attaches to the tibial tuberosity.
E L
T
NP
Anterior and Posterior Cruciate Ligaments
§ Cruciate Ligaments – these two ligaments connect the
femur and the tibia. In doing so, they cross each other,
hence the term ‘cruciate’.
§ Anterior cruciate ligament:

• Attaches at the anterior intercondylar region of the
tibia where it blends with the medial meniscus.
•
L
AscendsEposteriorly to attach to the femur in the
P T
intercondylar fossa.
N
• Prevents anterior dislocation of the tibia with
respect to the femur.
Posterior Cruciate Ligament
§ Posterior cruciate ligament
• Attaches at the posterior intercondylar region of

the tibia and ascends anteriorly to attach at the
anteromedial femoral condyle.
•
E L
Prevents posterior dislocation of the tibia with
respect to the femur.
T
NP
Factors affecting Knee stability
q Tissue structure: Stability is provided by the Joint capsule, the menisci and the ligaments.
q The ligaments of the knee provide the primary stability. Collectively the ligaments help to
maintain optimal knee stability.
q The ligaments and menisci provide static stabilityE

L
and together with the muscles and
T
tendons provide dynamic stability.
NP
Common Problems of the Knee Joint
Cruciate ligament tear
• Anterior cruciate ligament is the most commonly injured ligament of
the knee.
• Posterior cruciate ligament tears make up less than 20% of injuries
to knee ligaments.
E L
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NP
Common Problems of the Knee Joint
§ Patellar tendinitis
• Patellar tendinitis is an inflammation of the patellar ligament
Longitudinal tear
due to overuse and stress on the patellofemoral joint.
Location of pain in
patellar tendinitis
§ Meniscus tears E L
T
Stitches •
NP the most common knee injuries.
Meniscus tears are among
• Meniscus can tear with forceful twisting or rotation of the knee.
• Athletes, particularly those who play contact sports, are at
high risk of meniscus tears.
Source: Wikipedia
Knee Arthritis
The most common types of knee arthritis are osteoarthritis and rheumatoid arthritis.
Bone degenerative disease, Osteoarthritis is common in the knee joint.
• In osteoarthritis, the cartilage gradually wears away.
• Results in bone-to-bone contact, producing bone spurs, causes
pain and stiffness, restricts movements.
E L
T
NP
Osteoarthritis
Rheumatoid Arthritis
In rheumatoid arthritis, inflammation (swelling) of the synovial membrane

that covers the synovial joint, results in knee pain and stiffness.
• Rheumatoid arthritis, an autoimmune disorder, occurs when the

immune system mistakenly attacks the own body's tissues.
•
E L
The immune system damages normal tissue (such as cartilage and
T
ligaments) and softens the bone.
NP
Rheumatoid arthritis
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PROF. SANJAY GUPTA
Module 01:
Lecture 06 : THE SHOULDER AND ELBOW JOINTS
E L
Ø Shoulder Joint: Structure and functions
PT
Ø Elbow Joint: Structure and N
functions
The Shoulder Joint
The shoulder joint is an example of a very complex
musculoskeletal structure, consisting of a chain of bones
connecting the upper extremity to the trunk.
Clavicle
Scapula
E L
T Humerus
NP Thoracic cage
(Rib cage)
Front view
Source: Blausen.com staff (2014). Medical gallery of Blausen Medical 2014 WikiJournal of Medicine 1 (2).
https://commons.wikimedia.org/w/index.php?curid=27796970
The Shoulder Joint: a ball-and-socket joint
E L
T
NP
The Shoulder Girdle 3
4
The bony structures of the shoulder girdle 5
6
1. Humerus 3. Clavicle 5. Greater Tuberosity 2
2. Scapula 4. Coracoid Process 6. Lesser Tuberosity

1
E L
T
Joints consisting the shoulder joint:
P
N
a. GlenoHumeral (GH) joint
b. AcromioClavicular (AC) joint
c. SternoClavicular (SC) joint
d. ScapuloThoracic Gliding Plane (STGP)
The Scapula: Structure
E L
T
NP
Supraspinous Fossa Spine Infraspinous Fossa
Glenohumeral Joint
Source: Figure adapted from https://www.earthslab.com/anatomy/shoulder-joint-glenohumeral-joint/
Shoulder Movements Horizontal
Flexion
Normal movements of the shoulder are: Neutral plane
of scapula
Abduction Adduction
§ Abduction and Adduction
§ Flexion and Extension

Abduction Adduction § Horizontal Flexion and Extension Horizontal
Extension
E L
§ Internal and External Rotation Horizontal Flexion and Extension
T
Flexion Extension
NP
Internal External
rotation rotation
Flexion Extension Internal and External Rotation
Shoulder Muscles: Attachment Sites
Clavicle
Clavicle
Scapula
Scapula
Humerus
E L
Origin
PT
N
Insertion Humerus
Anterior View Posterior View
Source: Figures adapted from https://theartofmed.wordpress.com/2015/06/01/scapula/

Rotator Cuff
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm
(humerus) to the shoulder blade (scapula), that enables rotation in the joint.
E L
T
NP
The bursa is a fluid-filled sac that

Anterior View provides cushion to the joint. Posterior View
Source: Figures adapted from Wikipedia and https://commons.wikimedia.org/wiki/

Rotator Cuff Muscles Supraspinatus
Muscles include:
• Teres minor
• Infraspinatus
• Supraspinatus Infraspinatus
Infraspina
Teres Minor
tus
• Subscapularis Subscapularis
Posterior view
Anterior view
E L Anterior view
Posterior view
T
§ NP that attaches to the humerus.
Each muscle inserts at the scapula, and has a tendon
§ These muscles enable joint rotation and provide rotational stability to the shoulder.
§ Tears in the tendons of these muscles are called rotator cuff tears.
Supraspinatus is the most-commonly-affected muscle.
10
Shoulder Joint Ligaments
§ Coraco-acromial
§ Coraco-humeral
§ Glenohumeral (joint capsule)
§ Coraco-clavicular – Conoid ligament

E L
T
NP
– Trapezoid ligament
Function:
• Provide stability to the joint
• Glenohumeral ligament helps to hold the
shoulder in place and prevents dislocation.
Source: Wikimedia Commons
Common Shoulder Problems
The shoulder joint offers the largest range of motions in the body, but is an unstable joint owing to the
range of movements.
This instability increases potential risk of joint injury, often leading to a
degenerative process, eventually causing pain and reduced mobility; may
also lead to impingement of soft tissue or bony structures, resulting in pain.
Most shoulder problems fall into four major categories:

§ Tendon inflammation
L
E(bursitis or tendinitis) or tendon tear
T
§ Instability NP
§ Arthritis
§ Fracture (broken bone)
Other much less common causes of shoulder pain are
tumors, infection, and nerve-related problems.
Source: Figure adapted from https://orthoinfo.aaos.org/en/diseases--conditions/
Splitting and tearing of tendons: resulting from acute injury or
degenerative changes in tendons due to age, overuse or a sudden injury.
Rotator cuff and biceps tendon injuries are most common injuries.
Impingement: occurs when the acromion pressurizes the underlying soft Inferior
tissues during abduction. As the arm is lifted, the acromion impinges on Subluxation
causing pain and restricted movement. E L

the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, Dislocation
T
NP
Shoulder instability: occurs when the humeral head is forced out of the
shoulder socket (glenoid cavity). This can happen due to a sudden injury
or from overuse. If the ligaments, tendons, and muscles around the joint
become loose or torn, dislocations can occur.
Repeated subluxations or dislocations may lead to arthritis.
Arthritis: Shoulder pain and stiffness can occur owing to degenerative joint diseases
in synovial joints, like Osteoarthritis and Rheumatoid Arthritis. The glenohumeral
and acromio-clavicular joints are affected, resulting in restricted movement.
Osteoarthritis
Fracture: might occur in the clavicle (collarbone), humerus (upper arm bone), and
scapula (shoulder blade).
E L
T
NPof the glenohumeral joint. It is characterized
Frozen Shoulder: is a condition that restricts motions
by stiffness and pain in the joint, which becomes stuck and its movement is limited.
Source: Wikipedia and https://commons.wikimedia.org/wiki/

The Elbow Joint
E L
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The Elbow Joint: Structure and Joints
Joints:
§ Humero-ulnar joint
§ Radio-humeral
§ Radio-ulnar Joint
E L
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NP
Anterior view Posterior view

The Elbow Joint
E L
T
NP
Lateral view Medial view

Elbow Joint Movements
Normal range: flexion Normal range: extension
0° to 150° 150° to 0°
§ Flexion and Extension
§ Pronation and Supination
Flexion Extension
E L
T
NP
Normal range:
Normal range:
75° - 90°
75° - 90°
Supination Neutral Pronation

Source: Figures adapted from https://www.lecturio.com/concepts/elbow-joint/
Structure and Articulation
Humero-Ulnar Articulation:
• Hinge Joint
• Movements: Flexion and Extension
• Trochlea (humerus) and Trochlear notch (Ulna)
• High degree of congruency
~ 40° Space for flexor muscles

Humeral axis
E L
T
Humerus
NP Range of
Trochlear axis
Olecranon movement
Fossa ~ 150°
Olecranon Ulna
Process
Structure and Articulation
Radio-Humeral Articulation
Axis of radial
movement Annular § Spherical capitulum (humerus) and concave end-face of radial head
ligament
§ Allows rotation of the radius at any angle of elbow flexion
§ Lack of congruency
Oblique
cord Ulna § Movements: Pronation and Supination
E L
Interosseous T
Radius
membrane
NP
Radius
Pronation
Supination
Source: Figures adapted from Dowson and Wright (1981)
and Wikipedia commons
Elbow Joint: Movements and Muscles
E L
T
NP
Main extensor muscles: Triceps brachii Main flexor muscles: Brachialis, Biceps Brachii,
Source: Figures adapted from Dowson and Wright (1981) Brachioradialis
Elbow Joint: Movements and Muscles
E L
T
Ulna
NP
Main supination muscles:
Supinator, Biceps Brachii
Main pronation muscles: Pronator
Quadratus, Pronator Teres Source: Figures adapted from Dowson and Wright (1981)
Ligaments of the Elbow Joint
Stability of the elbow joint is provided by the ligaments:

§ Ulnar Collateral Ligament
- stretches from the anterior side of the medial
epicondyle of humerus to the medial edge of
coronoid process of the ulna.
Ulnar Collateral Ligament § Radial Collateral Ligament
E L
- stretches from theT
lateral epicondyle of
NP
humerus to the annular ligament deep to
the common extensor tendon.
§ Annular Ligament
- a strong band of fibers that encircles the head of
the radius, and retains it in contact with the radial
notch of the ulna.
Annular Ligament Source: Wikipedia and https://commons.wikimedia.org/wiki/
Problems of the Elbow Joint
Arthritis: Rheumatoid arthritis is most common at the radio-ulnar joint. It results in pain, stiffness,
and deformities.
Tennis Elbow
Tennis elbow: also known as lateral epicondylitis, is a condition in
which the outer part of the elbow becomes painful and tender.
The pain may also extend into the back of the forearm and grip
strength may be weak.
E L
P T
N
Golfer's elbow: is a similar condition that affects
the inside of the elbow; causes pain where the
tendons of the forearm muscles attach to the
bony bump on the inside of your elbow. The
pain might spread into your forearm and wrist.
Source: Wikipedia and https://commons.wikimedia.org/wiki/

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4) https://www.lecturio.com/concepts/elbow-joint/
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Module 01:
Lecture 07 : THE SPINE
The Spine: structure and function E L
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NP and function
Vertebrae and Intervertebral Disc: structure
Cervical, Thoracic, Lumbar Sections of Spine: structure and function
Disc Degenerative Disease
The Spine
The spine or the backbone is the central support structure of the human Brainstem
body. Spine connects different parts of the musculoskeletal system.
Spinal cord
Vertebra
§ The spinal column consists of:

- vertebrae Nerves Disc
- intervertebral discs
E L Vertebra
- spinal cord T
NP
Spinal cord Cauda
equina
(bundle of
nerves)
§ The spinal cord is the main pathway for information connecting the
brain and peripheral nervous system.
Functions of the Spine
Primary functions of the spine are to:
§ Provide protection to the spinal cord, nerve roots and

several internal organs of the body.
§ Provide structural support and balance to maintain an

upright posture.
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§ Enable sufficient physiologic mobility and flexibility
Structure of the Vertebral Column
The human spine consists of 33 vertebrae, each one stacked over the other.
• Cervical vertebrae (seven, C1 – C7)

• Thoracic vertebrae (twelve, T1 – T12)
• Lumbar vertebrae (five, L1 – L5)
L
• Sacrum vertebrae (five fused bones)
E
T
• Coccyx (three to four fused coccygeal segments)
NP
A healthy spine has three natural curves that resemble an
S-shape in the sagittal plane. These curves absorb shocks
on the body and protect the spine from injury.
Source: Wikipedia
Sacrum and Coccyx
§ The sacrum, is a large, flat triangular shaped bone
located between the pelvic bones and positioned
below the last lumbar vertebra (L5). Connection with
S1
the iliac bone forms the sacroiliac joint (either sides).
S2
S3 § The pelvic girdle comprises of the sacrum along with

the coccyx and the two sacroiliac joints.
S4
S5
E L
T
NP commonly known as the tailbone, is the
Co1
Co2
Co3
§ The coccyx,
final segment of the vertebral column.
Co4
§ It comprises of fused coccygeal vertebrae below the sacrum, attached

by a fibrocartilaginous joint (the sacrococcygeal symphysis), which
permits limited movement between the sacrum and the coccyx.
Relationship between Structure and Function of the Spine
The structure of the spine withstand the combined load of the head, shoulder
and thorax. The upper body weight is transferred to the lower extremity
through the sacrum and the pelvis.
§ Resistance to axial loads on the spine are offered by:

- the S-shaped (in sagittal plane) curved structure
- increase in size, massE
L
and load carrying capacity of each vertebrae
T
NP
from C1 to sacrum
§ Elasticity of the spine is accomplished by:

- the curved shape of the structure
- multiple motion segments (Functional Spinal Units)
Functional Spinal Unit
The Functional Spinal Unit (FSU), or the motion segment, is
the smallest segment of the spine that exhibits biomechanical
characteristics similar to those of the entire spine.
The FSU consists of:

• two adjacent vertebrae
E L
• T
intervertebral disc
• NP
two facet joints with ligaments (without muscles)
Spinal Cord
Source: Fatima et al. (2020)

Facet joint
• Facet joints are a set of synovial joints

that limits the amount of motion of the
vertebrae in six degrees of freedom and
act to transmit loads to the disc.
E L
T
• Facets are stabilizing structures and carry
almost one-third of the total compressive
NP
load borne by the spine segment. Facet
Source: Kushchayev et al. (2018)

Vertebra
A vertebra consists of the following bony structures:
Posterior
§ vertebral body (anterior part)
§ vertebral arch (posterior part), consists of
• four articulating facets (two superior and two inferior)

L
E and lamina
two pedicles
Pedicle • T
• NPtransverse process
two
• one spinous process
Anterior

Vertebrae
Articulating facets
The vertebral body is a roughly cylindrical

mass of cancellous bone contained within
Cortical bone
a thin shell of cortical bone.
Cancellous bone
Vertebral end-plates L
EIts superior and inferior surfaces (slightly
T
NP concave) are the vertebral end-plates.
Intervertebral disc

Intervertebral Disc
§ The intervertebral disc (IVD) is an fibrocartilage
that lies between two adjacent vertebrae in the
vertebral column. Each disc forms a
fibrocartilaginous joint (a symphysis), allows only a
slight movement of the vertebrae, acts like a
ligament to hold the vertebrae together, functions
as a shock absorbing spacer for the spine.
E L
§ The intervertebral disc consists of two T
distinct parts: NP
• annulus fibrosus Source: Fatima et al. (2020)
• nucleus pulposus
§ The intervertebral disc displays viscoelastic (elastic + viscous) material properties;
exhibits creep and stress relaxation mechanical behaviour.
Intervertebral Disc
§ The annulus fibrosus consists of several

concentric layers of fibrocartilage, with annular
fibres embedded in the ground matrix.
§ The nucleus pulposus contains loose fibres

Annulus fibres
suspended in a gel with the consistency of a jelly
(gelatinous). It has high water content and it
E L
resists axial load. T
NP
§ The strong composite of annulus fibrosus ground
matrix and annular fibres encloses the nucleus
pulposus that helps to distribute the pressure
evenly across the disc.

Ligaments of the Spine
Anterior longitudinal
ligament (ALL)
Posterior longitudinal
• Ligaments are strong fibrous bands of ligament (PLL)
tissues that hold the vertebrae together
and provide stability to the spine within Ligamentum
Flavum (LF)
its physiologic range of motion.
Inter transverse
E
ligament (ITL)
L
• Excessive movements, such as hyper- T Supra spinous ligament (SSL)
extension or hyper-flexion
restricted by the ligaments.
are
NP Inter spinous ligament (ISL)
Capsular
ligament (CL)
• There are seven types of ligaments.

Movements of the Spine
Movements of the spine are: Lateral

bending
Rotation
§ Flexion and extension (in sagittal plane)
Flexion
§ Lateral bending – left and right (in coronal plane)
§ Rotation – left and right (in transverse plane)
E L
T
NP
Extension

Cervical Spine: Structure and Function
The cervical spine is the most superior portion of the
vertebral column that provides mobility and stability to
the head while connecting it to the relatively immobile
thoracic spine. Cervical vertebra
(C3-C7)
The range of motion (RoM) of cervical spine (approx): Occiput
• Flexion: 80° to 90° E L

T
• Extension: 70°
NP
• Lateral bending: 20° – 45°
• Rotation: 90° both ways
Source: Wikipedia
Atlanto-Occipital joint: Cervical Spine
The atlas is the first cervical vertebra (C1) and

Atlanto-occipital joint
Dens articulates with the occiput of the head and the
second cervical vertebra axis (C2).
The movement of nodding the head takes place

E L
predominantly through flexion and extension at
T
NP
Atlas (C1) the atlanto-occipital joint.
Axis (C2)
Thoracic Spine: Structure and Function
The main function of the thoracic spine is to

hold the rib cage and protect the heart
and lungs.
There are 12 thoracic vertebrae in humans,

and these bones increase in size and mass
from T1 to T12. The increase in size and
E L
mass ensures more support to the weight of T
NP
Thoracic FSU
the body.
The range of motion (RoM) of thoracic spine

is very limited due to joint articulations.
Source: Wikipedia
Lumbar Spine: Structure and Function
§ The main function is to bear the weight of upper part of body and
transfer the forces and bending moments to the sacrum.
§ The vertebrae are much larger in size to withstand heavy loads

during daily activities.
§ The lumbar spine is more mobile than the thoracic spine and also
to injury in the spine. E L

carries more weight, making it the most likely region susceptible Lumbar FSU
T
NP
The range of motion (RoM) of the lumbar spine are:
• Combined flexion/extension: 40° to 90°
• Lateral bending: 20° to 45°
• Rotation: 5° to 15°
Source: Wikipedia
Disc Degenerative Disease (DDD) of the Spine
• Symptoms: back or neck pain and stiffness,

common in cervical or lumbar region.
• Degeneration means a specific injurious change in the

composition, structure and function of the spine.
L
• Leads to disc dehydration, reduction in disc
E
T
height, disruption of outer annulus lamellae,
NP
appearance of cracks and fissures.
Reduced disk height Osteoarthritis
With more severe disc dehydration and reduction of disc height, more load is carried by
the facet joints, compared to healthy spine, eventually leading to facet joint osteoarthritis.

Stages of Disc Degenerative Diseases (DDD)
I II III
• Homogeneous disc structure • Inhomogeneous disc structure • Inhomogeneous disc structure

• Normal disc height • Normal disc height • Normal disc height
E L
T
NP
IV V
• Inhomogeneous disc structure • Inhomogeneous disc structure

• Reduced disc height • Disc height collapsed
Source: Palepu et al. (2012)

Treatment
Conservative
• Physiotherapy
• Medicine
Surgery L
E Fusion Non-fusion
• Fusion P T
N
- Surgical procedure that involves fusion of two adjacent
vertebra using interbody cage and pedicle screws
• Non-fusion
- Surgical procedure that involves replacing of IVD with an
artificial intervertebral disc
1) Fatima, S.G., Ruben, L.L., Marina, C.B., Ruben E.G. (2020), Improvement in determining the risk of
damage to the human lumbar functional spinal unit considering age, height, weight and sex using a
L
combination of FEM and RSM. Biomechanics and Modeling in Mechanobiology. 19: 351-387.
E
T
2)
NP M.C., Brooks M.L., Teytelboym O.M. (2018),
Kushchayev, S.V., Glushko, T, Jarraya, M, Schuleri, K.H., Preul
ABCs of the degenerative spine. Insights into Imaging. 9: 253-274.
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BIOMECHANICS OF JOINTS AND

Biomechanics of trauma, injury and rehabilitation is becoming

Module 2: Basic Biomechanics of Human Joints:

Module 4: Joint Kinematics; Joint Forces and Moments; Estimation

Module 6: Biomechanics of Implants; Failure Mechanisms and Implant

Module 8: Bone Fracture Healing; Tissue Differentiation and

Source: Figure adapted from https://courses.lumenlearning.com/wm-biology2/chapter/types-of-bone/

Source: Figure adopted from https://commons.wikimedia.org/wiki/

Anatomical planes of reference Anatomical directions

Anterior and posterior: describe structures at the

Superior and inferior: describe a position above

• Medial and lateral: a position that is

§ Composed of hard cortical bone E L Lesser

q Metaphysis: conical eminences Epiphysis

§ Composed of cancellous bone with

• Bone is a hard tissue - a type of specialized connective tissue.

• Bone has a complex internal and external structure.

• Bone possess the remarkable property to repair itself and adapt

Figure adapted from Wikipedia and https://commons.wikimedia.org/wiki/

Figure adapted from Wikipedia and https://commons.wikimedia.org/wiki/

q Blood Cell Formation

• Skeletal: attached to bones and moves the skeleton, voluntary muscle

• Smooth or visceral: muscle of the viscera

Source: Figure adapted from https://www.pinterest.com/livecam33/biology/

Tendons are similar to ligaments and

Tendons and ligaments

A ligament is a fibrous connective tissue which attaches bone to

Bone Rigid links

Joints Standard Joints

• Joints are the weakest part of the skeleton.

1) Fibrous joint: Bone ends united by collagenic fibers

3) Synovial joint : Bones are united within a fibrous joint capsule

• Most movable type of joint

– Occur in joints where articulating bones

q Articular capsule – joint cavity is enclosed in a two-layered capsule

q Richly supplied with sensory nerves

q Have a rich blood supply

Knee joint Hip joint

§ Bone surfaces are slightly curved

§ Convex surface of bone fits in concave surface of 2nd bone

§ Monoaxial since it only allows rotation around the longitudinal axis

• Ball fitting into a cup-like depression

q Shape of the articular surfaces

Arthritic hip joint Arthritic knee

q Arthroplasty- replacement of joints (e.g. hip, knee)

Total Hip Arthroplasty

“Synergy” total hip replacement

The hip joint consists of: Ball-and-socket joint

• Femoral head (ball)

Head of Femur Acetabulum

§ to support to the body weight in both static (e.g. standing, sitting)

§ to facilitate transfer of forces and moments (load transfer) from the

§ to retain balance and to maintain the pelvic inclination (tilt) angle

Comparison between a neutral and

Coxa vara is a deformity, where the neck-shaft

• Adductor: Adductor brevis, Adductor longus,