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Anatomy 203 OSCE Landmark About Ligaments Muscles To palpate Greater Trochanter • proximal lateral bony projection on the femur- largest and strongest bone • larger projection- at the junction of the shaft and neck • site of muscle attachment • connected to lesser trochanter by the intertrochanteric crest posteriorly and intertrochanteric line anteriorly • ITB, TFL • gluteus medius, gluteaus minus • piriformis • superior gemelli • obt internus • prone: palate gluteals and deep 6 Lesser Trochanter • bony projection a the proximal medial femur- (posteromedial) • smaller trochanter • site of muscle attachment • iliacus • psoas major • supine- hip into flexion Linea Aspera • raised line on posterior femur • has a medial and lateral lip • starts about gluteal tuberosity and ends at med/lateral supracondylar lines • vastus medials (medial lip) • vastus iateralus (lateral) • vastus intermedius (lateral) • bicep femoris (short head) • adductor longus • adductor brevis • adductor magnus (anterior head) • prone: hamstrings and quads • resist leg flexionhamstrings Lateral Femoral Condyle • distal femur, site of muscle attachment • superior supracondylar lines • articulates w lateral meniscus • lateral collateral ligament (w bursa) • interior ACL and PCL • medial articulates w patella, bursae, retinacular fibers • gastroc • popliteus • plantaris • prone: plantar flexgastroc • palpate lateral condyle Head of the Fibula • proximal end of fibula w tibia • does not articulate with the femur • not a weight bearing bone • anterior/posterior/ interosseous ligament • bicep femoris • fibularis longus • soleus * supine: head of fibula * resist plantar flex/ eversion - fib long * prone: plant flex w knee bent for soleus * or knee flex for bicep femoris Tibial Tuberosity • bony projection on anterior proximal tibia • superior is tibial plato • site of osgoode scholtters • site which patellar ligaments attach • patellar ligament • rectus femoris • vastus intermedius • vastus lateralis • vastus medialis • patellar tendon & retinacular fibers • resist leg ext to palate the quads Interosseus Membrane • membrane spanning the length of the tibia and fibula (in btw) • holes for nerve and blood supply • several muscles attach and pass superficial to it • tibialis anterior • extensor digitorum longus • fibularis tertius • extensor hallucis longus • tibialis posterior • flexor hallucis longus • supine: proximal to distal end of tib/fib • palate the anterior compartment Pes Anserine Tendon • goose foot • attachment side for 3 muscles • attaches to antero-medial proximal tibia • distal medial to patella • proximal medial to tibial tuberosity • lateral is patellar ligament • superficial to MCL • sartorius • gracilis • bursae • semitendinosus • supine: resist knee flexion (into table) Landmark About Ligaments Muscles To palpate Navicular • tarsal bone located on medial aspect of the foot • articulates with all 3 cuneiform • talus posteriorly & cuboid laterally • forms talo-calcaneo-navicular joint (aka anterior subtalar joint) • allows for inversion/eversion, pronation/supination • talo-navicular • spring ligament • bifurcate • plantar/dorsal/ interosseous ligament • tibialis posterior • supine: find navicular & tuberosity • prone: resist plantar flexion/inversion to tip post to pop up Calcaneus • short bone inferior to the talus • heel bone, largest tarsal bone • creates the subtalar joint w the talus • inversion/eversion at this joint • has shelf like projection that supports part of the talus- sustentaculum tali • calcaneal tuberosity touches the floor • medial: deltoid • lateral: ATFL, PTFL, CFL • lateral/medial/ interosseus/posterior talo-calcaneal lig • spring ligament • bifurcate calcaneonavicular lig • gastroc & soleus (achilles tendon) • plantaris • quadratus plantea • tibialis posterior • extensor digitorum brevis • extensor hallucis brevis • abductor hallucis • abductor digiti minimi pedis • flexor digitorum brevis • prone- activate: gastroc/soleus Cuboid • articulates w calcaneus, navicular and lateral cuneiform, 4/5th MT • plantar/dorsal/ interosseous ligs • flexor hallucis brevis • tibialis posterior Medial Cuneiform • most medial of 3 cuneiform bones • articulates w 1st MT & navicular • articulates with intermediate cuneiform, navicular, 1st MT • tibialis anterior • fibularis longus • tibialis posterior • supine: find navicular then cuneiform- can resist tib ant 1st MT • most lateral metatarsal- big toe • articulates w medial cuneiform/ proximal phalanx of big toe • base is free- has sesmoid bonesimpeded in the tendon • tibialis anterior • fibularis longus • dorsal interossei • supine: find navicular/ come anterior • resist dorsi/inversion for tib ant 5th MT • most lateral metatarsal bone- pinkie toe • long bone • articulates w the cuboid posteriorly & 5th phalanx • fibularis tertius • fibularis brevis • flexor digiti minimi pedis • dorsal interossei • plantar interossei • supine: come off of the 5th MT drops down • resist dorsiflexion/ eversion for fib brev/ fib tertius to pop up • plantar, dorsal, interosseous MTP ligs
