Lower limbs Flashcards
What does tibial and fibular mean ?
Tibial - medial
Fibular - lateral or peroneal
During development of the lower limbs , they rotate medially
What are the impacts of this on muscle arrangement
Extensors are anterior
Flexors are posterior
Knee points forward
Dorsum of foot is anterior
Identify the parts of the hip bone and upper tibia
Identify the bones of the foot
Identify the structures of the bones of the foot
Describe the fascia of the thigh
Very strong and non-distensible
Divides lower limbs into compartments via membranes that attach to linea aspera
Thickened laterally - iliotibial tract
gluteal muscles - action, attachments, innervation
Extend, abduct and rotate hip
Attachments :
gluteus maximus - originates from posterior ilium, sacrum and coccyx. inserts into the iliotibial tract and the gluteal tuberosity of the femur.
Gluteus medius - Originates from the gluteal surface of the ilium and inserts into the lateral surface of the greater trochanter.
Gluteus minimus - Originates from gluteal surface of the ilium and converges to form a tendon, inserting to the anterior side of the greater trochanter.
Actions:
Gluteus minimus and medius have the same actions - Abducts and medially rotates the lower limb. During locomotion, it secures the pelvis, preventing pelvic drop of the opposite limb.
Gluteus maximus - hip extension/external rotation.
Innervation:
gluteus maximus - inferior gluteal nerve
Gluteus minimus and medius - superior gluteal nerve
hamstrings - functions, attachments, innervations
Semitendinosus is most medial; it originates from ischial tuberosity of the pelvis, and inserts onto the medial surface of the tibia.
semimbranosus sits in between
biceps femoris - long head originates from ischial tuberosity of pelvis, short head originates from linea aspera of femur; most lateral ; both insert into the head of the fibula
all 3 perform:
Extension of hip
Flexion of knee
semimembranosus and semitendinosus also involved in medial rotation
All innervated by sciatic nerve
Clinical relevance of ischial tuberosity
Often site of hamstring injuries
Tearing of proximal attachment of hamstring
Label the posterior compartment of thigh
Label the surface anatomy of the anterior compartment of the thigh
The anterior compartment involved in hip flexion and knee extension
Medial compartment involved in adduction of thigh
Adductor muscles of thigh
Adductor Magnus, brevis and longus
Gracilis - weak adductor; longest and thinnest of adductor muscles (be most graceful with the Gracilis)
Pectineus - highest up
Label the surface anatomy of the posterior compartment of the leg
Describe groin strain
Strain/tear of proximal attachment of adductor muscles
Describe the muscles of the posterior leg
Superficially - all plantarflex of ankle(let you go one your tippy toes) ; 3 headed triceps surae (soleus, and the 2 heads of gastrocnemius) involved in producing most of the force ,
deep veins run through here and muscle contraction aids in venous return (solely in particular is alway contracted)
Deep group - popliteus(unlocking knee), tibialis posterior(ankle invertor) , flexor digitorum longus (toe flexion), flexor hallucis longus (toe flexor)
Identify the foot evertors
Fibularis longus
Fibularis brevis
Fibularis tertius
Identify the muscles in the anterior compartment of leg
Dorsiflexors of ankle and extensors of toes: all supplied by deep fibular nerve
Tibialis anterior (in front of tibia) - dorsiflexor Extensor digitorum longus - extends the toes (except for big toe) Extensor hallucis longus - extends the big toe (hallucis = big toe)
Found on the more lateral side on the fibula
Fibularis longus - eversion and plantar flexion (superficial fibular nerve)
Fibularis tertius - evertor and dorsiflexor (not present in all people )
Fibularis brevis - evertor (superficial fibular nerve
Lumbar plexus
Consists of nerve roots L1-L4
Femoral nerve L2-4 —> most of anterior compartment of thigh (quads, sartorius, pectineus, iliacus); branches off into saphenous vein further down to provide cutaneous innervation to anteromedial knee/leg/foot
Obturator nerve L2-4 —> most of medial compartment of thigh
Sacral plexus
Encompasses L4-S4
Superior gluteal nerve L4-S1
Inferior gluteal nerve L5-S2
Sciatic nerve L4-S3
- tibial nerve posterior compartment of thigh
- common fibular nerve
- superficial ; lateral compartment of leg
- deep ; anterior compartment of leg
Descirbe the course of the sciatic nerve
Originates from lumbosacral plexus
Leaves pelvis via sciatic foramen
Passes behind the piriformis
Travels posterior to the anterior muscles of thigh
Enters posterior thigh
Terminates by bifurcating into the tibial and common fibular nerve at the apex of the popliteal fossa
Anterior thigh trauma associated with which nerve
Femoral L2-4
This affects action of muscles in the anterior thigh
Hip surgery is used to reapair damage to which nerve?
Superior gluteal nerve L4-S1
This can affect gluteus medius and minimus
Posterior hip dislocation is associated with damage to which nerve/muscles
Sciatic nerve L4-S3
This can affect function of posterior thigh
Fracture to fibula neck can cause damage to which nerve/muscles
Common fibular nerve
This can affect function of lateral and anterior leg
Outline the arterial supply of the lower limb
Abdominal aorta —> common iliac a. —> external and internal iliac a.
External iliac —> femoral artery as soon as it passes under inguinal ligament —> Profunda femoris artery (deep artery of thigh ) ; cruciate anastamosis of the hip joint occurs here
Describe the areas where pulses of the lower limb can be idntified
Femoral hernia
Abdominal contents typically small intestine can pass through the femoral ring - a weak area in the femoral canal of the femoral sheath (size of little fingertip) and compress the femoral vein and great saphenous vein
Can result in necrosis of abdominal contents
What are the main circulatory problems of the lower limbs
Arterial insufficient
Venous insufficiency
Lymphoedema
Identify the different movements of the lower limbs
Describe the muscles of the anterior thigh compartment
Function and innervation
Pectineus - adduction/medial rotation/flexion of thigh ; femoral L2/3
Iliopsoas - primary flexor of thigh; consists of psoas major/minor and iliacus; also maintains lumbar lordosis (Posture); anterior rami of lumbar nerves L1/2 and femoral nerve partially
Sartorius - flexes hip and knee ; femoral nerve L2/3
Quadriceps fermoris - rectus fermoris, vastus intermedium’s and vastus medialis ; great extensor of knee; femoral nerve L2/3/4
Describe the popliteal fossa
Boundaries and content
Boundaries - hamstrings superiorly and gastronemius inferiorly (back of knee)
Content - common fibular nerve, tibial nerve, popliteal vein(deep to tibial nerve)/artery (deep to popliteal vein)
External iliac artery becomes the ___ ____ as soon as it passes under the inguinal ligament
Femoral artery
As soon as the femoral artery goes through thre adductor hiatus in the _____ _____ and travels posterior it is called the ____ ____
Adductor Magnus ; Popliteal artery
Label the arrangement of the tendons and neurovascular structures inside the ankle
The structure that pass behind the medial malleolus are all from the posterior compartment - they form the tarsal tunnel
Tom, Dick And Very Nervous Harry
Tibial is posterior tendon, flexor Digitorum longus tendon, posterior tibial Artery, tibial Nerve, flexor Hallucis longus tendon
Intramuscular injections of the gluteal region
Describe how you would identify the safe region
Safe region - identify the superior iliac spine on the posterior side of body, then continue a line across to the superior aspect oif the greater trochanter ; form another line by going midway across from iliac crest
What is trendelenburgs test
Ask patient to walk and view them from behind
If pelvis descends on the unsupported side, this indicates the gluteus medius and minimus are weak or paralysed due to damage to the superior gluteal nerve
Often seen in patients post hip replacement surgery
How to take popliteal pulse
What can a weak pulse indicate?
Knee needs to be flexed ti relax fascia and hamstrings
Place finger inferiorly and press down hard
Weak pulse = popliteal artery rupture after knee dislocation, Popliteal artery entrapment syndrome (PAES) from excessively large calf muscles, popliteal artery aneurysm, peripheral artery disease from CHF
Calcaneal tendon reflex
Assesses the fucntion of the tibial nerve and its innervation of the gastronomeus, soleus and triceps surae
Tap the calcaneal tendon with hammer, the foot should be initially flat; after tapping, plantarflexion should occur
Label the different parts of the hip bone
Muscles responsible for flexion of hip
Psoas major, iliacus, pectineus, rectus femoris, and sartorius
Identify the muscles responsible for hip extension
Gluteus maximums and hamstrings (semitendinosus, semimembranosus, and bicep femoris)
Identify the muscles responsible for abduction of leg
Gluteus maximus, medius and minimus
Tensor fascia lata
Identify the muscles responsible for leg adduction
Adductor Magnus, longus and brevis
Gracilis
Pectineus
Identify the muscle responsible for internal rotation of leg
tensor fasciae latae, adductors longus and brevis, pectineus and the anterior fibers of gluteus medius and minimus.
Identify the muscles responsible for external rotation of the leg
Gluteus maximus, piriformis , obturator internus, gemellus superior and inferior, quadratus femoris, and obturator
identify the deep hip muscles
Patched Good Often Go On Quilts (mnemonic for order of muscles from top to bottom)
Piriformis Gemellus superior Obturator internis Gemellus inferior Obturator exterminator Quadrator femoris
Describe the quadriceps and sartorius - actions, attachments, innervations
Sartorius - originates from Anterior superior iliac spine of the pelvic bone and inserts on the top of tibia; involved in hip flexion, external rotation, and abduction ; femoral nerve
Quadriceps - vastus lateralis/intermedius/medialis all originate from femur but rectus femoris originates from anterior iliac spine of pelvic bone ; all insert on the patellar tendon; all extend knee (rectus femoris also flexes hip) ; femoral nerve
The anterior, posterior and medial compartments of the thigh are innervated by which nerves?
Anterior = femoral Medial = Obturator Posterior = sciatic
Patellar reflex
Striking the patellar tendon just below the patella causes the quads to contract
Test L3/4
identify muscles A-F
A= vastus lateralis
B= vastus intermedius
C= rectus femoris
D= vastus lateralis
E= Sartorius
F=Adductor Magnus
Course of Obturator nerve through thigh
L2-4
Descends through psoas major and emerges medially
Then enters the medial thigh via the obturator canal
Label this CT scan through the leg
most common lower limb muscles to get strained
hamstrings, rectus femoris, gastrocnemius
Calf strains
Most commonly occurs in medial gastrocnemius
Substaintial pain and swelling in first 24 hours ; pain on resisted plantarflexion
Also called tennis leg as typical presentation is of a middle aged tennis player who suddenly extends knee
Treated with NSAIDs, ice, rest, elevation, physio
Describe the posterior compartment of the leg ; name the muscles and describe their action, innervation and attachments if necessary
Collectively all muscles of posterior leg are innervated by the tibial nerve
Superficially ; 3 plantarflexors :
Gastrocnemius - (gastro means belly -cnemius means calf)
Soleus just underneath gastrocnemius ; both join to form the calcaneous tendon
Plantaris is even deeper to gastrocnemius and soleus
Deep layer ; deriving from the tibia, fibular and interosseus membrane
Tibialis posterior runs down behind medial malleolus
Flexor digitorum longus
Flexor hallucis longus
Structures passing behind the medial malleolus
Tom Dick And Not Harry Tibialis post (tendon|) , flexor Digitorum (tendon) , tibial Artery, tibial Nerve, flexor Hallucis longus
Contents of the tarsal tunnel
Tibialis posterior
Flexor Digitorum longus
Flexor Hallucis longus
Tom, Dick and Harry
Foot muscles
Dorsal muscles :
Extensors digitorum brevis - originates in foot; extension of all toes except big toe
Extensor hallucis brevis - orginates in foot ; extension of big toe
Dorsal interossei - abduction of metatarsals
Abductor hallucis - medial side of foot ; abducts big toe
Abductor digiti minimi - abducts little toe
PAD DAB
Plantar Adducts , Dorsal Abducts
plantar muscles - 10 in total; collectively act to stabilises arches of foot and individually to control movement of toes
Quadratus plantae
Flexor hallucis brevis (bottom of foot)
Flexor digiti minimi brevis
Lumbricals of foot
Adductor hallucis - adducts big foot
Plantar interossei - adduction of metatarsals
Innervation of anterior and posterior leg
Femoral nerve branches into sensory saphenous nerve that innervates the medial aspect of leg
Sciatic splits into the tibial and common fibular nerve just above the popliteal fossa
Tibial nerve passes through popliteal fossa of posterior leg - innervates all of the posterior deep leg muscles
Common fibular winds around the neck of fibula and emerges anteriorly ; it then splits into the superficial fibular nerve (lateral leg) and deep fibular nerve (anterior leg)
Outline the venous supply/lymphatic drainage of the lower limb
The great saphenous vein is superficial to the fascia lata and joins up with the femoral vein via the saphenous opening ; drains most of thigh
Small saphenous vein drains most of leg ; it enters perforating veins which carry the blood to deep msucles - this helps with venous return
All lymph vessels drain into the inguinal region
Femoral sheath contains the femoral artery, vein and lymphatic vessels
What are the boundaries and contents of the femoral triangle
Inguinal ligament - base
Pectinues - part of floor
Adductor longs = medial boundary
Sartorius - lateral boundary
Content - femoral nerve/artery/vein/canal with lymphatic vessels; remember the order ; great spahenous and profunda femoris veins also included here
Identify the boundaries and contents of the popliteal fossa
Biceps femoris - supero lateral boundary
Semimembranosuis and semitendinosis tendon form the supero medial boundary
Lateral and medial heads of gastrocnemius form the inferior boundaries
Contents - tibial nerve, popliteal vein just below, and popliteal artery even deep, common fibular nerves, lymphatic vessels
Describe femoral nerve block
Used to reduce pain cause by femur fractures / anterior thigh wounds or during quad tendon repair/ quad biopsy/ long saphenous vein stripping
used for patients who cannot tolerate general anaesthetic e.g elderly/CHF/COPD
Performed via ultrasound guidance and local anaesthetic
Locate femoral crease - from ASIS to pubic symphysis and move lateral then medial; palpate the femoral pulse ; needle insertion site is 1-2cm right of the femoral arterial pulse
On ultrasound view femoral nerve has popcorn or honeycomb appearance
Gracilis can be used in
Transplantation to the face to treat facial paralysis
Used as its got a very long tendon and muscle part
Possible to remove the muscle with its vein, nerve and artery still intact
Describe runners knee (chondromalacia patellae)
Causes
Symptoms
Treatment
Inflammation of enderside of patella and softening of the surrounding cartilage caused by acute injury or chronic friction
Secondary causes - tight IT band, neuromas, bursitis overuse, malalignment, core instantly, patellar maltracking
Painful movement - typically felt after prolonged sitting
Typical in young athletes or older adults
Treatment - RICE , NSAIDs, physiotherapy
Femoral artery cannulation
Uses
Describe the procedure
Used for critically ill patients - refractory shock and respiratory failure
Allows:
Continuous blood pressure/gas measurement (PO2, PCO2, pH)
Continuous cardiac function measurement
Repeated blood samples for laboratory tests
Femoral vein cannulation
Indication
Procedure
Risks
Indications:
Inability to obtain peripheral venous access elsewhere
IV infusion for patients in cardiac arrest /for concentrated or irritated drugs
Haemodialysis
Transvenous cardiac pacemaker
Procedure and relevant anatomy
place patient in supine or slightly declined and externally rotate and abduct leg ; Locate the femoral triangle, and feel femoral pulse - femoral vein medial to pulse and at the midpoint of inguinal ligament 2-4cm below
risks:
infection, thrombosis, haematoma, nerve damage, bladder perforation
Paralysis of quadriceps
What happens as a result
Causes
Can lead to severe disability as knee will be unstable and cannot be fully extended our locked in extension = giving way of knee joint ; it is an essential muscle involved in many daily activities such as climbing stairs or getting up from a chair
Can occur as a complication of anticoagulant therapy - due to a compressive haematoma of the psoas in the pelvis ; can also occur after hip or pelvic surgery
Injury to common fibular nerve
Caused typically by tibia fracture
Dorsiflexion is gone
Eversion may be affected
Peripheral nerve disease
What is it
Causes
Typical symptoms
Treatment
Causes - uncontrolled diabetes, shingles, side effects of drugs, trauma, excessive alcohol use, tumours, autoimmune diseases e.g lupus
Typical symptoms:
numbness and tingling in the feet or hands
burning, stabbing or shooting pain in affected areas
loss of balance and co-ordination
muscle weakness, especially in the feet
If autonomic nerves are affected, signs and symptoms might include:
Heat intolerance
Excessive sweating or not being able to sweat
Bowel, bladder or digestive problems
Drops in blood pressure, causing dizziness or lightheadedness
Treatment - NSAIDs, anti-seizure, antidepressants
Varicose veins
Swollen and elaborated veins in leg and feet
Other symptoms :
aching, heavy and uncomfortable legs
swollen feet and ankles
burning or throbbing in your legs
muscle cramp in your legs, particularly at night
dry, itchy and thin skin over the affected vein
Can be blue/dark purple and bulging
Predisposes you to DVT
Weak femoral pulse indicates
Coarction of aorta
Nervous roots for femoral nerve
L2-L4
Features of synovial joints
2 bones separated by a joint cavity (synovial fluid inside)
Joint capsule surrounds the cavity - consists of fibrous capsule and synovial membrane
The ends of the bones are covered by articular cartilage
Richly innervated
Each has an anastomosis
Describe the structure and function of the hip joint
Strong and stable joint
Ball and socket type of synovial joint
Enables a wide range of movements flexion/extension/abduction/adduction/inward and outward rotation
Innervated by femoral nerve
Identify the ligaments of the hip joint and briefly describe the fucntion of each
Iliofemoral ligament prevents hyper extension - very strong
Pubofemoral ligament prevents excessive abduction
Ischiofemoral ligament limits internal rotations - weak
Together, these 3 ligaments stabilise the hip joint
Label the vascular supply of the femur
Muscles attaching to hip joint
Hamstrings - ischial tuberosity
Gluteal muscles
Iliopsoas
Pectineus
Sartorius
Rectus femoris
Adductor muscles ‘Gracilis
Describe the main features for knee joint
Hinge synovial joint
Actions - primarily flexion and extension ; limited rotation
when fully extended the knee is locked - allows weight bearing
Muscles attaching to the knee joint
Hamstrings
Quadriceps
Which direction does hip dislocation typically occur
Posteriorly
Describe the function of the anterior/posterior cruciate ligaments
Anterior cruciate ligament (ACL) - limits posterior rolling of femur on tibia/prevents hyperextension; the weaker ligament
Posterior cruciate ligament (PCL) - limits anterior rolling of femor on tibia /prevents hyperflexion
Describe the role of the tibial (medial) and fibular (lateral) collateral ligament
Together they keep the tibia and femur in the correct positions, preventing them from sliding over each other laterally
Describe how to test the collateral ligaments
Take leg in the hands with knee straight.
Gently abduct the knee – to test fibular collateral
Gently adduct the knee – to test tibial collateral
There should be very little movement
Describe how to test the cruciate ligaments
Patient lies with knee flex at 90 degrees.
Sit on the foot of the leg to be tested.
Pull the leg forward from the tibia – this test the anterior cruciate
Push the leg back – this tests the posterior cruciate
It is called the ‘Drawer Test’
There should be little movement
Role of menisci
Important in shock absorption
Medial meniscus less mobile than the lateral meniscus
Unlocking of knee
Popliteus contracts to laterally rotate the femur on the tibia
Locking the knee
In full extension the knee is locked due to medial rotation of femur on the tibia
This allows many muscle to relax
Label the arteries supplying the knee
Bakers cysts
Maybe from bursa, can also be sacs formed from synovial membrane
causes : osteoarthritis, inflammation post sports injury, gout , RA
Likely to interfere with knee movement
Describe the main features of the ankle joint
Stronger & more stable during dorsiflexion
Relatively unstable during plantarflexion
Hinge type synovial joint
Tibia/fibula forms a mortise(cavity) into which body of talus fits
Identify the ankle evertors
Fibularis longus and brevis (lateral)
Fibularis Terisus also aids (anterior)
Identify the arteries of the leg and ankle .
Identify the invertors of the foot
Tibialis anterior/posterior
Identify the medial ligament of the ankle joint
Deltoid ligaments - 4 in total
Strong set of ligaments - more stability medially than laterally
Mostly commonly injured ankle ligament
Anterior talofibular ligament
Describe the pott fracture
Due to foot being forcibly everted
Medial ligaments strong – can fracture medial malleolus
Talus moves in a lateral direction – fracturing lateral malleolus or fibula
Identify the 7 tarsal bones
Talus
Calcaneus
Navicular
Cuboid
3 cuneiforms (medial, intermediate, lateral)
Describe the transverse tarsal joint
Comping joint - consists of 2 joints
Usual site for surgical amputation (e.g. due to diabetes)
Hilton law - what is it ?
The nerve suppling the muscles that cross over and act on a joint, also innervate that joint.
identify the deep gluteal muscles
function of popliteus
forms the floor of the popliteal fossa ; involved in medial and lateral rotation of knee; unlocks knee via laterally rotating the femur on the tibia
identify the muscles/tendons of the posterior leg on this diagram
Identify the deep muscles of the posterior leg
injury to inferior gluteal nerve
loss of hip extension = gluteus maximus lurch - trunk leans backwards on heel strike https://www.youtube.com/watch?v=bTQ5ID7Tpa4
sciatic nerve roots
L4/5; S1/S2/S3
injury to sciatic nerve; clinical presentation and causes
foot drop ; weakness of knee flexion, difficulty with inversion/plantar flexion; weak or absent calcaneal reflex ; causes - hip dislocation/acetabulum fracture
damage to tibial nerve ; clinical features and causes
causes - post knee dislocation, hypertrophy of soleus leading to entrapment; fractures of tibia/fibula; tarsal tunnel syndrome(pain and paresthesia of sole of foot) ; typical symptoms are weakness and pain in the foot/toes/ankle
Idenitify the muscles and spinal segmental values responsible for flexion/adduction/medial rotation of hip
L2/3
flexion - Iliopsoas, Sartorius, tensor fascia latae, pectineus, adductors longus/brevis/magnus(anterior part), Gracilis
adduction - pectineus, adductors, obturator extensor, Gracilis
medial rotation - gluteus medius/minimus (anterior parts), tensor fascia latae
Identify the muscles and spinal segmental values responsible for extension/abduction/lateral rotation of hip
L4/5
extension = gluteus maximus/hamstrings/posterior part of adductor magnus
abduction = gluteus medius/minimus & tensor fascia latae
lateral rotation = Obturator externus/internus, piriformis, gemelli, quadratus femoris, gluteus maximus
Identify the muscles and spinal segmental values responsible for knee extension
primarily quads, weakly tensor fascia latae
L3/4
Identify the muscles and spinal segmental values responsible for knee flexion
L5/S1
primarily hamstrings and secondarily the Gracilis/sartorius/gastrocnemius/popliteus
Identify the muscles and spinal segmental values responsible for ankle dorsiflexion and plantarflexion
Dorsiflexion = L4/5 Tibialis anterior, extensor Hallucis longus, extensor digitorum longus
Plantarflexion = S1/2 triceps surae (gastrocnemius + soleus), plantaris , flexor hallucis longus, flexor Digitorum longus, tibialis posterior, Fibularis longus/brevis
Identify the muscles responsible and spinal segmental values responsible for foot inversion/eversion
Inversion= L4 Tibialis anterior and posterior
Eversion = L5/S1 Fibularis longus/brevis/tertius
What is the adductor canal ?
a narrow intermuscular passageway for the femoral artery and vein, the saphenous nerve into the popliteal fossa
bound by vastus medialis, adductors longus/Magnus and sartosius
what is the iliotibial tract?
what are its 3 main functions ?
also called IT band is a longitudinal thickening of fascia lata
found from iliac tubercule to the lateral tibial condyle
functions:
Identify the labels
Identify the three parts of the hip bone (shown in orange, green and purple)
Orange = ilium
green = ischium
purple = pubis
Tarsal tunnel syndrome
Entrapment of tibial nerve due to excessive pressure
Symptoms an be felt anywhere along the tibial nerve, most commonly felt in sole of foot or inside ankle. This can feel like:
- sharp, shooting pains
- pins and needles
- an electric shock
- a burning sensation
causes - flat feet, varicose veins, benign bony growths in tarsal tunnel, trauma, diabetes, arthritis, tumours
Location of extensors hallucis longus and Tibialis anterior tendons in relation to medial and lateral maleoli ?
They lie in between
Which tendons pass Posteriorly to the lateral malleolus?
Fibularis longus and brevis
which muscles does the obturator nerve innervate?
All adductors except for hamstring part of adductor magnus
Gracilis
Obturator externus
Label the major veins of the leg
spinal segmental values of obturator and femoral nerves
Obturator - L2,3,4 anteriorly
femoral - L2,3,4 Posteriorly
Label the missing nerves
Dorsalis pedis pulse
how is it taken
what does its absence indicate?
The dorsalis pedis artery pulse can be palpated lateral to the extensor hallucis longus tendon
It’s absence can indicate peripheral vascular disease, hypovolemia, or CHF
Label the features of the knee
what are the functions of the sacrotuberous and sacrospinous ligaments
assist in pelvic stability by preventing rotation of the ilium past the sacrum. this stops the pelvis from excessively twisting, preventing lower back pain and sacroiliac joint strain
Identify the key phases of the gait cycle
Stance phase (60%) - foot on ground
- heel strike (initial contact)
- loading response (foot flat)
- mid stance
- terminal stance
- pre swing
swing phase (40%) - foot off ground
- mid swing
- terminal swing
Eccentric vs concentric contractions
Eccentric - lengthening of muscle
concentric - shortening of muscle
Muscles preventing excessive rotation during gait
Tensor fascia lata
gluteus medius
iliopsoas
Hip muscle action during heel contact and loading response
Eccentric load on ankle dorsiflexors, knee extensors and hip abductors
contractions of hip abdoctors (tensor fascia lata, gluteus minimus, gluteus medius)
Knee locking is performed by
quadriceps
Foot movements during walking
First contact is at the heel, the foot then “rolls” on its lateral side onto the forefoot before it is pushed off the ground via the big toe.
Pronation and supination of foot
Pronation = eversion/dorsiflexion/abduction = foot rounded
supinated = inverison/plantarflexion/adduction = foot flattened
unhappy triad knee injury (also called blown knee)
refers to injury to ACL/medial meniscus/medial collateral ligament; occurs when lateral blow is made to a fixed knee; often found in contact sports such as rugby/football
symptoms - severe pain inside knee, excessive swelling minutes after injury difficulty putting weight on knee
treatment - MCL heals on its own ACL may need a graft ; meniscectomy - repair or transplant; physiotherapy for many months after
Arches of foot
Descirbe the 3 arches
Describe their function
Two longitudinal - one medial and one lateral
medial longitudinal arch - more rounded ; doesnt touch the ground when standing
lateral longitudinal arch - flatter; touches the ground when standing
and one transverse arch - also touches ground w
their function is to absorb shock produced during locomotion and provide flexibility , facilitating walking and running
Describe pes planus (flat feet)
symptoms
treatment
Common condition where longitudinal arches have been lost
symptoms present at 2-3 years
in children present as painful foot/ankle
in adults feet may ached after prolonged use
treatment - arch supporting inserts
Hallux valgus
What is it
symptoms
Treatment
Progressive foot deformity in which the metatarsophalangeal joint becomes laterally deviated —> abduction of first metatarsal and adduction of phalanges
leads to bunion on medial side - inflammation of soft tissue and bony prominence
in later stages gait becomes impaired (lateral and posterior weight shift , late heel rise, reduced single limb balance)
more common in individuals with flat feet
Identify the ligaments of the foot supporting the arches
Hallux valgus
Progressive foot deformity in which the metatarsophalangeal joint becomes laterally deviated —> abduction of first metatarsal and adduction of phalanges
leads to bunion on medial side - inflammation of soft tissue and bony prominence
in later stages gait becomes impaired (lateral and posterior weight shift , late heel rise, reduced single limb balance)
more common in individuals with flat feet
Foot amputations
Carried out due to diabetic neuropathy /severe infection/severe ulcers/gangrene due to peripheral arterial disease/trauma
amputation carried out below cuneiforms
Identify the foot joints
advantages and disadvantages of knee replacement surgery
Advantages - freedom from pain/improved mobility and hence quality of life
disadvantages - knee will never feel as natural; difficult to kneel, numbness near scar, joints can wear out and loosen with time, pain may not be fully resolved (surgery can fail)
identify which muscles are concentric and eccentric and the angles of movement of the hip, knee and foot during the stance phases
Initial contact
- hip flexion : 20 degrees
- knee flexion : 0 degrees
- ankle dorsiflexion : 0 degrees
loading response
- hip flexion : 20 degrees
- knee flexion : 20 degrees
- ankle plantarflexion 5 degrees
- concentric muscles: gluteus maximus and hamstrings
- eccentric muscles: anterior leg muscles
midstance
- hip flexion : 0 degrees
- knee flexion : 5 degrees
- ankle dorsiflexion : 5 degrees
- concentric muscles : gluteus maximus and quadriceps
- eccentric muscles : triceps surae
terminal stance
- hip extension : 20 degrees
- knee extension : 0 degrees
- ankle dorsiflexion : 10 degrees
- eccentric muscles : triceps surae
Pre-swing
- hip extension: 10 degrees
- knee flexion : 40 degrees
- ankle plantar flexion : 15 degrees
- concentric muscles : triceps surae
- eccentric muscles : iliopsoas and adductors (quads assist)
identify muscles action and the angles of movement of the hip, knee and foot during the swing phase
Initial swing
- hip flexion : 15 degrees
- knee flexion : 60 degrees
- ankle plantarflexion : 5 degrees
- concentric muscles : iliopsoas/adductors/hamstrings/anterior leg muscles
mid swing
- hip flexion : 25 degrees
- knee flexion : 25 degrees
- ankle dorsiflexion : 0 degrees
- concentric muscles : iliopsoas/adductors/hamstrings/anterior leg muscles
terminal swing
- hip flexion : 20 degrees
- knee flexion : 0 degrees
- ankle dorsiflexion : 0 degrees
- concentric muscles : quadriceps
- eccentric muscles : hamstrings
- isometric muscles : anterior leg muscles
Identify the nerves *
- lateral femoral cutaneous
- Obturator nerve
- femoral nerve
- idk
- superior gluteal nerve
- inferior gluteal nerve
- common fibular nerve
- tibial nerve
- posterior cutaneous thigh nerve
