Lower Extremity lecture PDF

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summary of information regarding the lower extremity...

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JOMARI V. DESTREZA

UB BSPT INTERN ‘21-’22

Normal neck shaft angle: 125° Strongest ligament of hip: Iliofemoral lig Tailor muscle: Sartorius mm Commonly strained: Hams Primary abductor: Gmed Nerve of gmax: Inferior gluteal nn (L5-S2) Dashboard: PCL Q-angle: 15-18 or 13-18 * Inverter par excellence: tibialis posterior Main support of the ML = spring ligament/plantar calcaneo navicular ligament LOWER EXTREMITY ANATOMY AND PHYSIOLOGY I. HIP & PELVIS - Pelvis is composed of 4 bones (sacrum, coccyx, 2 innominate bones[os coxae/hip bones]) - 7 joints in the pelvic girdle - 1 Lumbosacral joint - 1 Sacrococcygeal joint - 1 Symphysis pubis - 2 sacroiliac joints - Sacroiliitis = inflammation of the SI joint; common in AS - Special Tests: Gaenslen's test & Patrick’s test - 2 Acetabulofemoral joints - Innominate Bones - Ilium - largest; located anterosuperiorly - 4 Spines (ASIS, AIIS, PSIS, PIIS) - ASIS & PSIS = the only palpable spines - ASIS - Inguinal (Poupart) lig. - originates from the ASIS - Sartorius = originates from the ASIS - Tailor’s muscle - Longest muscle in the body - AIIS - Origin of the straight head of the rectus femoris - Commonly affected in avulsion fractures - PSIS - Schober’s Test - Standing flexion test - Same level as S2 - Ischium - located posteroinferiorly - Sit bone (ischial tuberosity) - common origin of all hamstrings - Hamstrings = responsible for avulsion fracture of the ischial tuberosity

JOMARI V. DESTREZA

UB BSPT INTERN ‘21-’22 -

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Ischiogluteal bursa = commonly affected in Weaver’s/Tailor’s/Old Man’s Bottom (ischiogluteal bursitis) Pubis - smallest; located anteroinferiorly - Common origin of the adductors - Adductor longus - Adductor magnus - Adductor gracilis - Adductor brevis - Pectineus - Parts of the Pubis - Superior pubic ramus = origin of the pectineus - Body of pubis = connects the two rami - Inferior pubic ramus = common origin of adductor magnus, gracilis and brevis Hip Joint (Acetabulofemoral Joint) - Articulation between the femoral head and the acetabulum - Type: triaxial ball and socket - Open pack position: 30° Flexion, 30° Abduction, slight ER - Closed pack position: EXABIR - Capsular pattern: FABIR (IR>F>AB) - Acetabulum = vinegar’s cup; oriented laterally, inferiorly, and anteriorly (LIA) - Ilium = 40% - Ischium = 40% - Pubis = 20% - Acetabular labrum (Condyloid ligament) - Femur = biggest, longest, and strongest bone in the body contributing to 25% of a person’s height - Femoral head = oriented superiorly, anteriorly, and medially (SAM) - Blood supply of femoral head - Children - obturator artery - Adults - medial and lateral femoral circumflex artery Neck Shaft Angle (Angle of Inclination) - Children - 150° - Adults - 125° - Coxa valga - >125° (increased NSA resulting to longer leg, creating a leg length discrepancy) - True leg length discrepancy - Less stable; more prone to superior dislocation - Coxa vara - F; boys 10-14 y/o - Bilateral affectation - US is contraindicated - Tibial crest - Tibial plafond - distal weight bearing portion of the tibia - Medial malleolus - Fibula - lateral; splint bone - Parts of the Fibula - Head - Common peroneal nerve - commonly compressed nerve in the LE as it winds around the head of the fibula (cross leg palsy) - Other causes include: - Patellar tendon bearing (PTB) calf - Fibular head fracture - ER positioned leg - Prolonged icing - Gait deviation: foot slap (steppage gait) - Compensation: increased hip and knee flexion during swing - Neck - Shaft - Lateral malleolus ANKLE & KNEE...