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Surface anatomy of lower limb

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Surface anatomy of lower limb

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Surface anatomy of lower limb

  1. 1. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Bony features of lower limb
  2. 2. Surface features of Pelvis  Iliac Crest  Anterior Superior Iliac Crest  Tubercle of Iliac crest  Pubic Tubercle  Pubic Symphysis 12-2 5cm(L5) 2.5
  3. 3. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Adductor longus for pubic tubercle
  4. 4. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Inguinal lig Inguinal fold
  5. 5. Apex of sacrum in male Apex of coccyx in female
  6. 6. Highest point of Iliac crest L3-L4
  7. 7. Highest point of Iliac crest
  8. 8. Anterior Superior Iliac Crest , Pubic Tubercle , Pubic Symphysis ASIS,PSIS,S2,Sacroiliac joint,Lower part ofSubarachnoid space
  9. 9. PSIS (S2)
  10. 10. PSIS(Punctureof bone marrow) Natal/gluteal cleft = crack Gluteal folds = bottom of cheek pg 755 4cm 1cm ASIS
  11. 11. L4 in lumbar puncture PSIS
  12. 12. Sacral hiatus In sacral anaesthesia Second sacral foramen In extradural caudal anaesthesia Natal cleft PSIS:S2 3CM .
  13. 13.  Ischial tuberosity 5cm 5cm
  14. 14. Head of femur Mid inguinal point
  15. 15. !! Greater Trochanter Tubercle of iliac crest 5cm Midline of iliac crest Gluteal depression
  16. 16. Greater Trochanter 12cm
  17. 17. 12-19
  18. 18. Upper part of Greater trochanter
  19. 19. Lesser trochanter Midline of gluteal fold
  20. 20. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Medial condyle of femur Adductor tubercle
  21. 21. ick to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Tibial tuberosity 2.5cm 5cm Tibial tuberosity Palpation of patella Anterior border
  22. 22. Subcutaneous infrapatelar bursa
  23. 23. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  24. 24. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Flex against resistance 1cm
  25. 25. Lateral malleolus 1. 5cm
  26. 26. rsus
  27. 27. 2.5cm Peroneal tubercle Sustentaculum tali Attachment of spring lig 2cm 2.5cm Tuberosity of navicular
  28. 28. Peroneal tubercle Between Peroneus longus&brevis in inversion
  29. 29. 3cm from distal end of tibia Head of talus
  30. 30. Head of talus
  31. 31. Tubercle of 5 metatarse Ball of foot Large knob Metatarse
  32. 32. Tubercle of 5 metatarse Ball of foot First metatarse Metatarse Medial cuneiform navicular cuboid
  33. 33. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Bony Landmarks Chien s lines: Highest point of Iliac crest Anterior Superior Iliac Crest Tubercle of Iliac crest Greater trochanter
  34. 34. Chien s lines Prof. Monsees 38 Schomaker s line
  35. 35. Nelaton s line
  36. 36. Supine
  37. 37. Joint
  38. 38. Hip joint 2.5-3.5cm
  39. 39. Hip Joint Injection or Aspiration
  40. 40. Knee joint 3cm
  41. 41. ● Third level ● Fourth level ● Fifth level 2.5-3.5cm Knee joint
  42. 42. Meniscal Cartilage Located between the femur and tibia
  43. 43. Ankle joint 1cm2cm Ankle Injection
  44. 44. Tubercle of 5 metatarse First metatarse TarsoMetatarsal joint cuboid Tarsometatarsal joint First metatarse
  45. 45. Metatarsophalangeal joint 2.5 cm
  46. 46. Prof. Monsees 50 • Bones of foot do not lie flat in single plane  • Longitudinal + transverse arches of the foot • Arches are flexible; absorb and transmit forces during standing and walking
  47. 47. 51
  48. 48. 52
  49. 49. Foot Arches
  50. 50. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  51. 51. Injuries Dislocation -femoral head moves out of the acetabulum -usually it goes posterior into notch -position typically flexion, adduction, and internal rotation -
  52. 52. Genu valgum
  53. 53. long jumper’s career compound tibial facture
  54. 54. lpate Effusion – patellar tap Fluid displacement Tenderness
  55. 55.  – image carpenters knee (or parson’s knee to pray)– infrapatellar bursitis  suprapatellar bursitis ‘housemaid’s knee’
  56. 56. Click to edit Master title style Knee Injection suprapatellar bursa
  57. 57. Investigations Examine other joints (? Rheumatoid/ psoriasis + other inflammatory arthropathies) Aspiration + culture of fluid
  58. 58. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  59. 59. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Cruciate ligament
  60. 60. ACL ACL is actually smaller in cross section and weaker than the posterior cruciate – and as a result it gets damaged more often.ACL cane be torn or ruptured during hyperextension, particularly if combined with rotation
  61. 61. Phantom Foot / ACL Injury ACL being put under a very amount of strain. hips in a position which is lower than your knees
  62. 62. Anterior cruciate ligament  Anterior Drawer test (+ve if ant cruciate torn) ◦ Or Lachman test
  63. 63. Injuries- PCL is thicker in cross section and stronger than the ACL, so we don’t see it damaged so often. When off the pitch, we see PCLs being damaged by dashboards. If you’re driving along with your kneeflexed and then youre in a high velocity smash, the front end of the car is often shunted backwards, ramming the dashboard into you shin, which takes your tibia posteriorly and pops your PCL
  64. 64. Posterior cruciate ligament Posterior Drawer test (+ve if post cruciate torn)
  65. 65. Movements of the knee 135 deg of extension plus  5-10 deg of hyperextension With knee flexed >35 deg: 30 deg int rotation 45 deg ext rotation
  66. 66. Move  Hyperextension – Ehlers danlos syndrome, Charcot’s disease + polio (rare), girls esp. – high patella, chondromalacia patellae, recurrent dislocation, sometime tears ant. Cruciate, medial meniscus or medial ligament. Ballet + high-heels – retard upper tibial epiphyseal growth.
  67. 67. Menisci Feel for clicks, listen for crepitus McMurrays test – medial + lateral menisci Medial McMurray’s – leg flexed, foot EXTERNALLY rotated, hip abducted, - clicks + grating felt while leg smoothly extended Lateral McMurray’s – lef flexed, foot INTERNALLY rotated, hip abducted – as above. Meniscal injuries – meniscal tears in young adult, degenerative lesions in middle age Meniscal cysts – firm on palpation joint line, tender on deep pressure – usually lateral side.
  68. 68. Move - instability  1)Valgus stress test (+ve if medial lig torn)  2)Varus stress test ( +ve lat lig torn)
  69. 69. Knee Arthroscopy Small incisions Camera placed into the joint Small instruments trim and smooth cartilages Operate using a video monitor
  70. 70. Surgical Treatment
  71. 71. Result
  72. 72. Treatment
  73. 73. Ligament Injuries
  74. 74. Tibial Instability
  75. 75. ACL Surgery
  76. 76. ACL Surgery
  77. 77. Patellar Pain
  78. 78. Surgical Treatment
  79. 79. Patellar Tendinitis Inflammation of a tendon Poor blood supply, slow to repair
  80. 80. Knee Arthritis Wear of the gliding articular cartilage (OA) Roughens increasing gliding friction Pain, inflammation, swelling Pain with weather change, load bearing Improves with rest, anti- inflammatory medicines, low impact exercise
  81. 81. Knee Replacement Remove worn cartilage surface Replace with metal, plastic bearing surface Larger incision Longer hospital stay Higher risks 10-15 year longevity
  82. 82. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Inversion strain Ant&post talofibular lig
  83. 83. Muscle
  84. 84. Muscles of Hip Flexion Psoas Major Iliacus Sartorius Pectineus Rectus femoris Tensor fascia latae © Trail Guide to the Body by Books of Discovery
  85. 85. Muscles of Extension Semimembranosus Semitendinosus Biceps femoris Gluteus maximus © Trail Guide to the Body by Books of Discovery
  86. 86. Muscles of Adduction Adductor Brevis Adductor Magnus Adductor Longus Gracilis Pectineus © Trail Guide to the Body by Books of Discovery
  87. 87. Muscles of Abduction Sartorius Gluteus medius Gluteus minimus Piriformis Tensor fascia latae © Trail Guide to the Body by Books of Discovery
  88. 88. Lateral Rotation Sartorius Gluteus Maximus Piriformis © Trail Guide to the Body by Books of Discovery
  89. 89. Medial Rotation Gluteus minimus © Trail Guide to the Body by Books of Discovery
  90. 90. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  91. 91. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  92. 92. Sarterius
  93. 93. Tensor fascia lata and iliotibial tract
  94. 94. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Iliotibial tract
  95. 95. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth levelTensor fascia lata 5cm anteriorto greater trochanter
  96. 96. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Flex hip joint in rectus femoris
  97. 97. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Iliotibial tract Lateral depression Medial depression
  98. 98. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  99. 99. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Pectineus,adductor brevis
  100. 100. Femoral Triangle ◦ Sartorius (lateral) ◦ Adductor longus (medial) ◦ Inguinal ligament (superior) ◦ Femoral a + v, lymph nodes pg 746 pg 752
  101. 101. ◦ Quadriceps femoris muscle 12-110
  102. 102. Adductor canal
  103. 103. PRONE POSITION
  104. 104. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  105. 105. ◦ Contents ◦ Popliteal a + v 115
  106. 106. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Gluteal depression
  107. 107. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  108. 108. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  109. 109. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  110. 110. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
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  113. 113. Leg movements by compartment (in leg all nn are branches of sciatic)
  114. 114. 126
  115. 115. ◦ Gastrocnemius muscle ◦ soleus muscle 12-127
  116. 116. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  117. 117. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  118. 118. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  119. 119. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  120. 120. edit Master text styles ond level ● Third level ● Fourth level ● Fifth level
  121. 121. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  122. 122. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
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  124. 124. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  125. 125. Lateral malleolus Calcaneus Flexor ,peroneal,extensor reticulum
  126. 126. Nerve of lower limb
  127. 127. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  128. 128. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  129. 129. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 2.5cm
  130. 130. Patellar reflex
  131. 131. Femoral Nerve Block
  132. 132. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  133. 133. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 10cm
  134. 134. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 2.5cm
  135. 135. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  136. 136. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  137. 137. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  138. 138. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level Tibial tuberosity . Angel
  139. 139. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 1cm
  140. 140. Apex
  141. 141. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level . 5cm Superficial peroneal n Deep peroneal n
  142. 142. 2.5cm
  143. 143. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  144. 144. Dermatomes of Lowe Limb
  145. 145. Superficial vein and artery
  146. 146. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level . 2cm
  147. 147. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  148. 148. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth levelAdductor tubercle 3.5cm Profunda femoris a
  149. 149. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  150. 150. Apex 2.5cm
  151. 151. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level . Tibial tuberosity
  152. 152. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level . neck .
  153. 153. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  154. 154. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 1cm
  155. 155. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  156. 156. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  157. 157.  Dorsal venous arch 12-183
  158. 158. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level
  159. 159. Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level 4cm Adductor turercle
  160. 160. Varice in Pregnancy Varicose
  161. 161. Thanks

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