The document summarizes key anatomical structures of the knee, lower leg, and ankle. It describes the tibia, fibula, patella, knee joint, tibiofibular joints, ligaments, muscles, and bony landmarks. The knee joint is a complex joint formed by the femur, tibia, and patella. It contains cruciate and collateral ligaments that stabilize the joint. Muscles of the leg are divided into anterior, posterior, and lateral compartments that plantarflex, dorsiflex, invert and evert the foot. The tibia and fibula articulate proximally and distally to form the tibiofibular joints.
Knee Joint by Thirumurugan professor MScthiru murugan
Knee Joint
• The knee joint is a hinge type synovial joint, which mainly allows for flexion and extension (and a small degree of medial and lateral rotation). It is formed by articulations between the patella, femur and tibia.
Articulating Surfaces
• The knee joint consists of two articulations: tibiofemoral & patellofemoral. The joint surfaces are lined with hyaline cartilage and are enclosed within a single joint cavity.
• Tibiofemoral: medial & lateral condyles of the femur articulate with the tibial condyles. It is the weight-bearing component of the knee joint.
• Patellofemoral: anterior aspect of the distal femur articulates with the patella. It allows the tendon of the quadriceps femoris (knee extensor) to be inserted directly over the knee – increasing the efficiency of the muscle.
• As the patella is both formed and resides within the quadriceps femoris tendon, it provides a fulcrum to increase power of the knee extensor and serves as a stabilizing structure that reduces frictional forces placed on femoral condyles.
Menisci: A meniscus is a piece of cartilage found where two bones meet (joint space). Menisci (plural of meniscus) protect and cushion the joint surface and bone ends. In the knee, the crescent-shaped menisci are positioned between the ends of the upper (femur) and lower (tibia) leg bones.
• The medial and lateral menisci are fibro cartilage structures in the knee that serve two functions:
To deepen the articular surface of the tibia, thus increasing stability of the joint.
To act as shock absorbers by increasing surface area to further dissipate forces.
They are C shaped and attached at both ends to the intercondylar area of the tibia.
In addition to the intercondylar attachment, the medial meniscus is fixed to the tibial collateral ligament and the joint capsule. The lateral meniscus is smaller and does not have any extra attachments, rendering it fairly mobile.
Bursae: A bursa is synovial fluid filled sac, found between moving structures in a joint – with the aim of reducing wear and tear on those structures. There are four bursae found in the knee joint:
• Suprapatellar bursa: an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur.
• Prepatellar bursa: found between the apex of the patella and the skin.
• Infrapatellar bursa: split into deep and superficial. The deep bursa lies between the tibia and the patella ligament. The superficial lies between the patella ligament and the skin.
• Semimembranosus bursa: located Posteriorly in the knee joint, between the semimembranosus muscle & the medial head of the gastrocnemius
Ligaments: The major ligaments in the knee joint are:
• Patellar ligament – a continuation of the quadriceps femoris tendon distal to the patella. It attaches to the tibial tuberosity.
• Collateral ligaments: two strap-like ligaments. They act to stabilize the hinge motion of the knee, preventing excessive medial or lateral movement
The Ankle Joint.pptx Dr Haki Selaj Residency in Orthopedic and Traumatology i...HakiSelaj1
it is one of the joints most often attacked by injury, in this case it is distorted. for this reason, accurate evaluation and diagnosis is required. for this reason, this presentation will help young doctors for access, exam tests and radiology around the TC joint
The tibiofibular joints are a set of articulations that unite the tibia and fibula. These two bones of the leg are connected via three junctions; The superior (proximal) tibiofibular joint - between the superior ends of tibia and fibula. The inferior (distal) tibiofibular joint - between their inferior ends.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. Posterior surface contains 2 articular facets
Patellar ligament attaches the patella to the tibial
tuberosity
Patellofemoral joint – between the posterior surface
of the patella and the patellar surface of femur
Tibiofemoral (knee joint) – intermediate component
of the posterior surface of the patella.
4. Patella increases the leverage of tendon of the
quadriceps femoris muscle.
Also maintain the position of the tendon when the
knee is bent (flexed), and protects the knee joint.
5. Known as shin bone
The larger, medial, weight-bearing bone of the leg.
Articulates at its:
proximal end with the femur and fibula
distal end with the fibula and the talus
bone of the ankle.
Tibia and fibula like the radius and ulna are
connected by interosseous membrane
6.
7. Proximal end of tibia
Is expanded into a lateral and a medial condyle
These condyles articulate with the condyles of the
femur to form the lateral and medial tibiofemoral
joints (knee joint).
The concave condyles are separated by an upward
projection called the intercondylar eminence.
Inferior surface of the lateral condyle articulates
with the head of fibula to form proximal
tibiofibular joints.
8. Tibial tuberosity on the anterior surface is a point of
attachment for the patellar ligament.
Inferior to and continuous with the tibial tuberosity
is a sharp ridge that can be felt below the skin –
anterior border (crest) or shin
9. Distal end of tibia
Medial surface of the distal end of the tibia forms the
medial malleolus
Medial malleolus articulates with the talus of the
ankle and form the prominence on the medial
surface.
The fibular notch articulates with the distal end of
the fibula to form the distal tibiofibular joint.
Most common long bone to be fractured and with an
open or compound fracture.
10.
11.
12.
13. Is parallel and lateral to the tibia and it is
considerably smaller than tibia
Proximal end of fibula
Head of fibula which is proximal end articulates
with the inferior surface of the lateral condyle of the
tibia below the level of the knee joint to form the
proximal tibiofibular joint.
14. Distal end of fibula
Distal end is more arrowhead-shaped and has a
projection called the lateral malleolus that
articulates with the talus of the ankle.
This forms the prominence on the lateral surface of
the ankle.
15.
16.
17.
18.
19.
20. KNEE JOINT
Tibiofemoral joint
The largest & most complex joint of the body
It is a modified hinge joint that consists of three
joints within a single synovial cavity.
The knee joint joins the thigh with the leg and
consists of two articulations: one between the
femur and tibia, and one between the femur and
patella.
21. Consist of the 3 joints :
1. Laterally is a tibiofemoral joint : between
the lateral condyle of the femur, lateral
meniscus & lateral condyle of the tibia.
2. Medially is a second tibiofemoral joint :
between the medial condyle of the femur,
medial meniscus & medial condyle of the
tibia.
3. Intermediate patellofemoral joint :
between the patella & the patellar surface
of the femur.
22. Articular capsule
The articular capsule has a synovial and a fibrous
membrane separated by fatty deposits.
No complete, independent capsule unites the bones
of the knee joint.
The ligamentous sheath surrounding the joint
consists mostly of muscle tendons or their
expansions.
Some capsular fibers connecting the articulating
bones.
23. Medial & lateral patellar
retinacula
Fused tendons of insertion of the quadriceps femoris
muscle & the fascia lata that strengthen the anterior
surface of the joint.
24. Patellar ligament
Continuation of the common tendon of insertion of
quadriceps femoris muscle that extends from the
patella to the tibial tuberosity.
Strengthens the anterior surface of the joint.
The posterior surface of the ligament is separated
from the synovial membrane of the joint by an
infrapatellar fat pad.
25. Oblique popliteal
ligament
Broad, flat ligament that extends from
intercondylar fossa of the femur to the head of the
tibia & lateral condyle of the femur to the medial
condyle of the tibia.
The ligament & tendon strengthen the posterior
surface of the joint.
26. Arcuate popliteal
ligament
Extends from the lateral condyle of th femur to the
styloid process of the head of the fibula.
It strengthens the lower lateral part of the posterior
surface of the joint.
27. Tibial collateral ligament
Broad, flat ligament on the medial surface of the
joint that extends from medial condyle of the femur
to the medial condyle of the tibia.
Tendons of sartorius, gracilis & semitendinosus
muscles, all of which strengthen the medial aspect
of the joint, cross the ligament.
28. Fibular collateral
ligamentStrong, rounded ligament on the lateral surface of
the joint that extends from the lateral condyle of the
femur to the lateral side of the head of the fibula.
It strengthens the lateral aspect of the joint.
The ligament is covered by the tendon of the boceps
femoris muscle.
The tendon of the popliteal muscle is deep to the
ligament.
32. Intracapsular ligament
1. Anterior cruciate ligament (ACL)
2. Posterior cruciate ligament (PCL)
Anterior and posterior cruciate ligaments limit
anterior and posterior sliding movements.
Medial and lateral collateral ligaments prevent
rotation of extended knee
33. Anterior cruciate ligament (ACL)
Extend posteriorly & laterally from a point anterior
to the intercondylar area of the tibia to the posterior
part of the medial surface of the lateral condyle of
the femur.
Limits hyperextension of the knee & prevent the
anterior sliding of the tibia on the femur.
Stretched or torn in about 70% of all serious knee
injuries.
34. Posterior cruciate ligament (PCL)
Extends anteriorly & medially from a depression on
the posterior intercondylar area of tibia and lateral
meniscus to the anterior part of the lateral surface of
the medial condyle of the femur.
Prevents the posterior sliding of the tibia when the
knee is flexed.
This is very important when walking down stairs or
steep incline.
38. Articular disc (menisci)
1. Medial meniscus
2. Lateral meniscus
The menisci are discs of fibrocartilage attached to
tibial plateaus. They are thicker along the periphery.
Medial and lateral meniscus absorb shock and
shape joint
43. Bursae
fluid sacs filled with synovial fluid that surround the
joint cavity.
3 type:
1. Prepatellar bursa: between patella and skin
2. Infrapatellar bursa: between the upper part of the
tibia and the patellar ligament
3. Suprapatellar bursa: between the anterior surface of
the lower part of the femur and the deep surface of
the quadriceps femoris
46. Proximal Tibiofibular Joint
Articulation surface:
between head of fibula and
inferior surface lateral
condyle of tibia
Type: planar joint
Slightly movement
Anterior and posterior
ligaments of head of fibula.
47. Distal tibiofibular Joint
Articulation surface: The fibular notch
articulates with the distal end of the fibula to form
the distal tibiofibular joint.
Syndesmosis – connecting materials is a
interosseous membrane.
50. MUSCLES OF THE LEG
Muscles that move the foot and toes are located in
the leg.
Muscles in the leg divided by the deep fascia into 3
compartment :
a) Anterior compartment
b) Posterior compartment
c) Lateral compartment
51. ANTERIOR
COMPARTMENT
Consists of muscles the dorsiflexors of the foot.
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fubularis (peroneus) tertius
52. Tibialis anterior
Long, thick muscle againts the
lateral surface of the tibia
Origin : lateral condyle & body of
tibia and interosseous membrane.
Insertion : 1st
metatarsal and 1st
cuneiform
Action : dorsiflexes foot at ankle
joint and inverts foot at intertarsal
joint.
Innervation : deep fibular
(peroneal) nerve.
53. Extensor hallucis longus
Is a thin muscle between & partly
deep to the tibialis anterior
Origin : anterior surface of fibula
and interosseous membrane.
Insertion : distal phalanx of great
toe.
Action : dorsiflexes foot at ankle
joint and extends proximal phalanx
of great toe at metatarsophalangeal
joint.
Innervation : deep fibular
(peroneal) nerve.
54. Extensor digitorum longus
Origin : lateral condyle of tibia,
anterior surface of fibula and
interosseous membrane.
Insertion : middle & distal phalanges
of toes 2 – 5
Action : dorsiflexes foot at ankle joint
and extends distal and middle
phalanges of each toe at
interphalangeal joints and proximal
phalanx of each toe at
metatarsophalangeal joint.
Innervation : deep fibular (peroneal)
nerve.
55. Fibularis (peroneus) tertius
Origin : distal 3rd
of fibula
and interosseous membrane
Insertion : base of fifth
metatarsal.
Action : dorsiflexes foot at
ankle joint and everts foot at
intertarsal joints.
Innervation : deep fibular
(peroneal) nerve.
56.
57. LATERAL COMPARTMENT (FIBULAR)
Contains two muscles that plantar flex and evert the
foot :
a) fibularis (peroneus) longus
b) fibularis (peroneus) brevis
Both plantar flex and evert the foot.
Provides lift and forward thrust.
58. Fibularis (peroneus) longus
Origin : head and body of
fibula and lateral condyle of
tibia.
Insertion : 1st
metatarsal and 1st
cuneiform
Action : plantar flexes foot at
the ankle joint and everts foot
at intertarsal joints.
Innervation : superficial
fibular (peroneal) nerve.
59. Fibularis (peroneus) brevis
Origin : body of fibula
Insertion : base of fifth
metatarsal
Action : plantar flexes foot at the
ankle joint and everts foot at
intertarsal joints.
Innervation : superficial fibular
(peroneal) nerve.
60.
61. POSTERIOR
COMPARTMENT
Consists of muscles in superficial and deep groups :
Superficial group of plantar flexors :
1. Gastrocnemius
2. Soleus
3. Plantaris
Deep group of plantar flexors :
1. tibialis posterior
2. flexor digitorum longus
3. flexor hallucis longus
4. popliteus (unlocks the knee joint for knee flexion)
63. Gastrocnemius- Origin : lateral & medial
condyles of femur and capsule of
knee
- Insertion : calcaneus by way of
calcaneal (Archilles) tendon
- Action : Plantar flexes foot at
ankle joint & flexes leg at knee
joint
- Innervation : tibial nerve
64. Soleus
- Origin : head of fibula &
medial border of tibia
- Insertion : calcaneus by way
of calcaneal (Archilles) tendon
- Action : Plantar flexes foot at
ankle joint
- Innervation : tibial nerve
65. Plantaris- Origin : femur superior to lateral
condyle.
- Insertion : calcaneus by way of
calcaneal (Archilles) tendon
- Action : Plantar flexes foot at
ankle joint & flexes leg at knee
joint
- Innervation : tibial nerve
66.
67.
68. Deep group of plantar flexors :
1. tibialis posterior
2. flexor digitorum longus
3. flexor hallucis longus
4. popliteus
69. Popliteus- Origin : lateral condyle of
femur
- Insertion : proximal tibia
- Action : flexes leg at knee
joint & medially rotates
tibia to unlock the
extended knee.
- Innervation : tibial nerve
70. Tibialis posterior
- Origin : tibia, fibula &
interosseous membrane.
- Insertion : second, third &
fourth metatarsals,
navicular, all three
cuneiforms and cuboid.
- Action : plantar flexes foot
at ankle joint & inverts foot
at intertarsal joints.
- Innervation : tibial nerve
71. Flexor digitorum longus
- Origin : posterior surface of tibia
- Insertion : distal phalanges of toes 2
- 5
- Action : plantar flexes foot at ankle
joint, flexes distal & middle phalanges
of each toe at interphalangeal joint &
proximal phalanx of each toe at
metatarsophalangeal joint.
- Innervation : tibial nerve
72. Flexor hallucis longus
- Origin : inferior two-thirds of
fibula
- Insertion : distal phalanx of great
toe
- Action : plantar flexes foot at
ankle joint, flexes distal phalanx of
great toe at interphalangeal joint &
proximal phalanx of each toe
metatarsophalangeal joint.
- Innervation : tibial nerve
73.
74.
75.
76.
77.
78. Diamond shaped space on the posterior aspect of the
knee
The popliteal fossa is a space or shallow depression
located at the back of the knee-joint
The bones of the popliteal fossa are the femur and
the tibia.
It is referred to as a "knee pit."
79. The boundaries of the fossa are :
superior and medial:
the semitendinosus muscle (semimembranosus is
medial to the semitendinosus.)
superior and lateral:
the biceps femoris muscle
inferior and medial:
the medial head of the gastrocnemius muscle
inferior and lateral:
the lateral head of the gastrocnemius muscle
80. The roof is formed by (from superficial to deep) :
1. Skin.
2. Superficial fascia which contains short
saphenous
vein, three cutaneous nerves i.e, terminal branch of
posterior cutaneous nerve of thigh, posterior
division of medial cutaneous nerve,
and peroneal or sural communicating
nerve.
3. Deep fascia or popliteal fascia.
81. The floor is formed by :
1. The popliteal surface of femur
2. Capsule of knee joint and the oblique
Popliteal ligament
3. Strong fascia covering the Popliteal
muscle
82. Contents of popliteal fossa :
popliteal artery, which is a continuation of the
femoral artery
popliteal vein
tibial nerve
common peroneal nerve
Six or seven popliteal lymph nodes are
embedded in the fat
The roof contains a portion of the small
saphenous vein and posterior cutaneous nerve of
the thigh.
86. Clinical significance
Injuries to the popliteal fossa are relatively
uncommon. The surrounding muscles can
sometimes experience small tears which cause
pain and inflammation in the joint. The
development of inflammation /cyst in the
popliteal fossa can put pressure on the nerves and
blood supply, causing problems in the lower leg.