clinical anatomy of leg
TRANSCRIPT
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Clinical Anatomy
Dr. Aunum IqbalDemonstrator
Sialkot Medical College
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Tibial Fractures
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Types:1.Compound/Open fractures
2.Transverse march/stress fractures
3.Diagonal fractures
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Compound/open fracturesCommonest site: junction of upper 2/3rds and lower 1/3rd of shaft of Tibia
Cause: Direct trauma to leg
Poor blood supply in this area leads to non-union of fractured ends
This area is subcutaneous, thus fracture is of open/ compound type, i.e where skin is damaged as well
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Transverse march/stress fracturesCommonest site is lower 1/3rd of shaft of Tibia
Cause: long hikes without training
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Diagonal fracturesCommonest site: Junction of upper 2/3rds and lower 1/3rd of shaft of Tibia
Cause: Torsion (twisting) of leg during skiing
Associated fracture of Fibula
Shortening of limb due to overriding of fractured ends
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Important bursae
and Bursitis
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Bursae around knee joint
1. Deep suprapatellar bursa (b/w Femur and Quadriceps tendon; communicates with synovial membrane of knee joint)
2. Subcutaneous prepatellar bursa (b/w Patella and skin)
3. Deep infrapatellar bursa (b/w Tibia and ligamentum patellae)
4. Subcutaneous infrapatellar bursa (b/w lower half of Tibial tuberosity and skin)
5. Popliteal bursa (b/w tendon of Popliteus and capsule of knee joint; communicates with synovial membrane of knee joint)
6. Semimembranosus bursa (beneath the Semimembranosus tendon)
7. Pes anserinus/subsartorial bursa (beneath the Sartorius, Gracilis and Semitendinosus tendons)
Quadriceps femoris tendon
Ligamentum patellae
Patella
67
Pes anserinus
Popliteus
Semimembranosus
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Pes anserinusa.k.a. Goose foot
Conjoined tendons of 3 muscles that insert onto the medial surface of upper part of shaft of Tibia: Sartorius, Gracilis and Semitendinosus
The name, "goose foot", arises from the 3 pronged manner in which the conjoined tendon inserts onto the tibia.
Behind this common insertion, Pes anserinus bursa is present.
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1. Subcutaneous calcaneal bursa (b/w skin and Calcaneum)
2. Retrocalcaneal bursa (b/w Achilles tendon and Calcaneum) – Inflammation is called Calcaneal Bursitis
3. Subcutaneous bursa of medial malleolus of Tibia
Bursae around ankle
joint
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Calcaneal Tendinitis
and Ruptured Achilles tendon
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• Inflammation of Achilles tendon
• Cause: Running injuries lead to tearing of Collagen fibers in the tendon
• Symptoms: Pain during walking
• If untreated, it may lead to rupture of Achilles tendon
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Calcaneal tendon reflex / Ankle reflex
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• Achilles tendon is struck with a hammer, just above Calcaneum, while the foot is dorsiflexed
• Normal result: Plantar flexion at ankle joint – showing intact spinal nerves
• Spinal nerves tested: S1 and S2
• If S1 or S2 spinal nerves are damaged, this reflex would be absent i.e. no plantar flexion
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Fabella and
Fabellar syndrom
e
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Fabella: (little bean-Latin)
A small sesamoid bone found in the tendon of lateral head of the Gastrocnemius muscle behind the lateral condyle of the femur
Present in 3-5% of people
Fabellar Syndrome:
Tenderness over the posterior aspect of the lateral Femoral condyle due to repetitive friction of Fabella over it
Fabella
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Musculocutaneous/ venous
pump
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• a.k.a second heart/ peripheral heart
• Contraction and relaxation of deep muscles of posterior compartment of leg, causes pumping of blood
• Blood from superficial veins goes towards deep veins and then towards the heart
• This direction of blood flow is due to the presence of one-way valves in the veins
• This mechanism increases venous return to the heart: hence prevents pooling of blood in the peripheries
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Compartment
Syndrome
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• Posterior compartment of leg has two groups of muscles; superficial and deep.
• Deep group of muscles lie in a tightly packed space; the deep compartment
• Nerves and vessels of posterior compartment of leg pass through the deep compartment
• When swelling occurs, it causes compression of these nerves and vessels, leading to Compartment Syndrome
• It leads to: • Necrosis (death) of muscles – due to damaged arterial supply
• Paralysis of muscles – due to compression of nerves
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Handy points
• Triceps surae/Calf: Medial and lateral bellies of Gastrocnemius and Soleus
• Muscles of posterior compartment mainly produce plantar flexion at ankle joint
• Damage to Tibial nerve will cause loss of plantar flexion
• Plantar flexion is stronger than dorsiflexion
• Muscles involved in standing on tiptoes: Triceps surae (93% force)
• Nerve involved in standing on tiptoes: Tibial nerve
• Damage to Tibial nerve: Patient can not stand on tiptoes
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Handy points
Tibia - Shin bonePatella - Knee cap
Calcaneum - Heel bone
Plantaris - Freshman's nerveTriceps surae/Calf: Medial and lateral bellies of Gastrocnemius and SoleusPes anserinus: Common insertion of
Sartorius, Gracilis and Semitendinosus on Tibia
Anti-gravity muscle in posterior leg: Soleus
Popliteus – unlocking of knee joint by 5 degree lateral rotation of Femur on Tibia
Achilles tendon – largest tendon in bodyPatella – largest sesamoid bone in body
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DIFFERENCE BETWEEN ACTIONS OF GASTROCNEMIUS AND SOLEUS:• Gastrocnemius: Plantar flexion at
ankle joint and flexion at knee joint
Soleus: Plantar flexion at ankle joint only
• Muscle for walking and running: Soleus
Muscle for long jump: Gastrocnemius
• Gastrocnemius can plantar flex with the extended knee. When knee is flexed, Soleus causes plantar flexion
• Soleus: anti gravity muscle; helps in standing
• Line of gravity passes anterior to Tibia in leg
• Therefore gravity tends to pull the body forward over the feet
• It is prevented by contraction of Soleus
• During standing on both the legs, Soleus is continuously active
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Thank you!