Download Plates 486-491 in Netter`s -Lower limb specialized for weight

Plates 486-491 in Netter’s
-Lower limb specialized for weight bearing, maintaining equilibrium, locomotion
-Divided into four parts:
-Pelvic girdle (hip)
-Thigh region - femur + patella
-Leg - tibia + fibula
-Foot - tarsals, metatarsals, phalanges
PELVIS
-Composite hip bone spans the sacrum and the femur
-Each hip bone consists of three individual bones that are fused in adulthood - ilium, ischium, pubis
-Separated by cartilage usually until puberty  ossification into one bone
-In adults, acetabulum is only place where the remnants of three bones can be seen
-Ilium - largest, forms superior part of hip
-Ischium - posterior/inferior part of hip
-Pubis - anterior part of hip bone, acetabulum, anterior medial hip
(Find posterior, inferior, anterior spine, greater and lesser sciatic notch, etc)
FEMUR
-At superior end has head, neck, greater and lesser trochanter
-Head in acetabulum
-Head and neck of femur are an angle of bt 115 and 140 degrees w/shaft
-When angle is reduced  Coxa Vara
-Weight of body passes through pelvic girdle onto femur, puts extreme stress on femur - easy to fracture
-When angle is increased  Coxa Valga
-Mobility is compromised - femur is too close to midline
-Normal angle allows for the greatest mobility while placing least amt of stress @ point where neck meets the shaft
-Body (shaft) of femur - curved with anterior convexity
-Distal end of the femur ends in two large condyles:
TIBIA and FIBULA
-Tibia is larger of the two - weight bearing bone - articulates w/condyles of femur superiorly, talus inferiorly
-Nutrient foramen - largest foramen on any bone in the body - posterior surface of the tibia, upper 1/3rd
-Fibula lies posteriolateral to tibia - mainly for muscle attachment
-Shaft to two bones connected by interosseous membrane (like radius and ulna)
-Distal end of tibia on medial side ends in the medial malleolus
-Distal end of fibula on lateral side ends in the lateral malleolus
TARSALS
-7 tarsal bones: talus (articulates with tibia), calcaneus, cuboid, navicular, 3 cuneiforms
-Talus: only bone that articulates with the tibia above
-Body, head, neck moving distally
-Sits on the anterior 2/3rd of the calcareous
-Articulates on lateral side w/fibula
-Articulates moving forward (anteriorly) with the navicular
-Calcaneus: largest and strongest bone in the foot
-Has on its superior medial border a shelf-like structure - sustentaculum tali - supports talus
-Lateral surface of calcaneus has oblique ridge - fibular (paroneal) trochlea
-Posterior surface has large prominence - tuberosity of calcaneus
-Has medial, lateral, anterior tubercle - ONLY the medial tubercle rests on the ground when standing
-Navicular: bt talus and cuneiforms
-Cuboid: Most lateral bone in distal row
-Cuneiforms x3: all three articulate with the navicular posteriorally and metatarsals anteriorly
-Lateral, intermediate, mediate
METATARSALS
-Number 1 to 5 medial to lateral (metacarpals are 1-5 lateral to medial)
-Each metatarsal has base proximally articulating with the navicular, body, head distally
-Head of each metatarsal articulates with a proximal phalange of the toes
-Plantar surface of first metatarsal - two sesamoid bones
-14 phalanges: two metatarsals in great toe (hallux), three in every other toe
Surface Anatomy
-Iliac crest
-Posteriorally @ level of L4 and L5
-High point of crest ends anteriorly at the anterior-superior iliac spine
-Important in locating pain(?) of appendicitis
-Pubic tubercle - anterior about 2.5 cm on either side of median plane
-Evaluating inguinal hernias
-The condyles of femur, patella are easily palpated
-Lateral and medial malleoli are easily palpated
-Greater trochanter may be palpated in some individuals
-In anatomical position - horizontal line through trochanter passes through heads of the femur, pubic tubercles
-Strength of a muscle is directly related to its cross-sectional diameter(???)
Fascia of the Lower Limb
-Divided into superficial and deep layer
-Superficial: lies just deep to the skin - contains fat, nerves, lymphatic vessels, lymph nodes, two important veins: great
saphenous (longest vein in body), small saphenous vein
-At the knee - superficial fascia loses its fat and blends with the deep fascia
-Deep fascia: layer of dense connective tissue bt the superficial fascia and the muscles in the thigh region
-Surrounds the leg like an elastic stocking around the muscles
-Called the fascia lata in the thigh
-Very strong laterally - runs from iliac tubercle to tibia
-Called the iliotibial tract - receives the tendon from the tensa fascia lata and tendon from gluteus
maximus muscle
-Distally, iliotibial tract is attached to the lateral condyle of the tibia
-Below the knee where two layers merge, called the crural fascia
-Thigh muscles are separated into three groups (anterior, medial, posterior) by three fascial intramuscular septum
-Arise from fascia lata - attach to the linea aspera of the femur
-Lateral Septum is much stronger than the other two
-Crural fascia is continuous with the fascia lata - attached to the tibia - thick proximally and anteriorly, weak distally EXCEPT
at the inferior and superior extensor retinaculum (around the ankle)
-Leg is divided into compartments by the crural fascia:
-Anterior (extensor) compartment
-Lateral (fibular, paroneal) compartment
-Posterior (flexor) compartment - further divided into superficial and deep region
-Movements around the ankle - dorsiflexion, plantar flexion
NERVES
-Branches of the lumbar sacral plexus
-Veins - major: great & small saphenous veins
-Veins from the dorsum (dorsum surface of the arch) converge medially to form great saphenous, laterally to form
small sapnenous
-*Great saphenous vein (longest vein in body) runs from the foot to the groin - enters femoral vein near the femoral
triangle through the saphenous openings*
-Small saphenous vein ends in the popliteal fossa  popliteal vein
-Most lymph vessels parallel the saphenous veins
-End in superficial inguinal lymph nodes
-Lymph vessels associated with small saphenous veins end in popliteal lymph nodes
THIGH MUSCLES
-Divided into anterior, medial, posterior compartments
-Coxa vs. Coxal bone (pelvic girdle)
-Anterior compartment muscles:
-Iliopsoas - begins as two separate muscles (psoas and iliacus)
-Arise in abdomen, distally attach to lesser trochanter
-Span the hip joint anteriorly
-Hip flexors
-Tensa Fascia Lata - strap-like muscle between the fascia lata and anterior superior iliac spine
-Runs down to lateral condyle of the tibia
-Abducts at the hip, also plays small role in hip flexion
-Sartorius - important as a landmark!
-Longest muscle in the body
-Most superficial muscle in the anterior compartment
-Spans two joints (hip and knee)
-Parallels much of the femoral artery
-Starts at anterior superior iliac spine, runs across superficial surface of thigh to attach distally to superior
medial surface of the tibia
-Flexes at the hip, laterally rotates at hip, flexes at the knee
-Functions as a hip abductor
-Quadriceps Femoris - has four parts
-All extensors of the leg at the knee joint
-All have common insertion (distal attachment) on tibial tuberosity through quadriceps tendon - along the
quadriceps tendon distally is the patellar ligament
-Rectus Femoris - spans two joints- also has hip action
-Runs from anterior inferior iliac spine (pelvic girdle) to the base of the patella to tibial tuberosity
-Is also a hip flexor (only one that spans two joints)
-Vastus Lateralis - Originates on the greater trochanter
-Vastus Medialis - Originates on the intertrochanteric line (bt the greater and lesser trochanter)
-Vastus Intermedius - Originates on body of the femur
-Tendons of all three vasti merge distally on the tendon of the rectus femoris for form quadriceps tendon attaches to tibial tuberosity
-Chondromalacia of the patella (Runner’s Knee) - Presents with soreness and achey feeling deep to the patella
-Usually due to erosion of the underside of the patella - due to imbalance in the tension placed on the quadriceps
tendon
-When patella is fractured - dramatic decrease of efficiency of muscles attaching at knee joint
-Patella acts like a fulcrum in a lever system
-Without patella, quadriceps must exert 30% more force to perform same action