Lower ExtremityTHIGH MUSCULATURE, KNEE AND ANKLE OSTEOLOGY

Objectives

Describe the gross anatomy for each system (circulatory, muscular, nervous, and skeletal) in the lower extremity.

Integrate the systems to discuss the lower extremity stability and mobility functions.

Analyze common injuries in the lower extremities.

For each muscle, describe how the attachment sites result in an action around a joint.

For each muscle, identify the innervation (peripheral nerve and nerve roots).

There are 4 genicular arteries that supply the hip joint

A. True

B. False

True

False

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Gluteus medius is an internal rotator when the hip is flexed

A. TrueB. False

True

False

50%50%

Your patient has trendelenburg gait when body weight is shifted to the R Leg. Which muscle is probably weakest?

A. R Gluteus MediusB. L Gluteus MediusC. R Gluteus MinimusD. L Gluteus Minimus

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Soft spots

Femoral Triangle Borders:

Problems?

Adductor Canal Borders:

Adductors

Large moment arm for adduction

Small moment arm for internal hip rotation

Obturator nerve

Clinical Relevance

Groin injury or “pulled groin”

Gracilis muscle transplant

Your patient has damage to the obturator nerve. Which muscle would be unaffected?A. Adductor longusB. Adductor brevisC. PectineusD. Hamstring portion of

adductor magnusE. Adductor portion of

adductor magnusAdducto

r longu

s

Adductor b

revis

Pectineu

s

Hamstring p

ortion of a

dductor .

..

Adductor p

ortion of a

dductor m

...

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https://www.youtube.com/watch?v=RTV5Yo3E7VQ

Bursae & Bursitis

Prepatellar

Infrapatellar Superficial

Deep

Suprapatellar

Pes anserine

MCL

Iliotibial

What’s wrong with this picture?

A. Nothing

B. The ligaments shown are wrong

C. The patella is out of place

D. The knee doesn’t bend that way

E. There is a ligament missing

A. B. C. D. E.

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Knee rotation and the locked position

Locked position: Full extension & 10 degrees

external rotation

All ligaments taught, maximal joint contact

Clinical Relevance

Genu varum & genu valgum

Patellofemoral syndrome

Patellar dislocation

Bursitis & popliteal cysts

Knee replacement

O’Donoghue Triad

Your patient suffered a lateral blow to the knee with the foot planted while playing soccer. Which of the following is least likely to have suffered damage?

A. ACLB. PCLC. MCLD. Medial meniscusE. Lateral meniscus

ACLPCL

MCL

Medial m

eniscus

Later

al menisc

us

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While rollerblading, your patient ran into a short wall. Which of the following is most likely damaged?

A. ACLB. PCLC. MCLD. Medial meniscusE. Lateral meniscus

ACLPCL

MCL

Medial menisc

us

Later

al menisc

us

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Quadriceps

Rectus Femoris

Vastus Lateralis

Vastus Medialis

Vastus intermedius

Clinical Relevance

Contusions

Avulsion fractures

Hematomas

Charley horse

Hamstrings

Biceps Femoris Long head

Short head (not a hamstring)

Semitendinosus

Semimembranosus

What is the muscle highlighted on the left?

A. Biceps femoris long head

B. Biceps femoris short head

C. SemitendinosusD. Semimembranosu

s

Biceps f

emoris lo

ng hea

d

Biceps f

emoris sh

ort head

Semite

ndinosus

Semim

embran

osus

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What is the muscle highlighted on the right?

A. Biceps femoris long head

B. Biceps femoris short head

C. SemitendinosusD. Semimembranosu

s

Biceps f

emoris lo

ng hea

d

Biceps f

emoris sh

ort head

Semite

ndinosus

Semim

embran

osus

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Popliteal fossa

Task:

Borders: Superomedial

Superolateral

Inferomedial

Inferolateral

Floor

Roof

Identify each of the numbers

Break

Ankle joint

Hinge joint with 3 articular surfaces: Medial surface of fibula -> talus

Inferior tibia -> trochlea of talus

Lateral surface of medial malleolus -> talus

Ligaments – ankle joint

Deltoid ligament 4 parts

Fibular collateral ligaments 3

Tibiofibular ligaments

Clinical relevance

Eversion and inversion sprains and fractures