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Clinical Anatomy Dr. Aunum Iqbal Demonstrator Sialkot Medical College
25

Clinical anatomy of leg

Apr 13, 2017

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Page 1: Clinical anatomy of leg

Clinical Anatomy

Dr. Aunum IqbalDemonstrator

Sialkot Medical College

Page 2: Clinical anatomy of leg

Tibial Fractures

Page 3: Clinical anatomy of leg

Types:1.Compound/Open fractures

2.Transverse march/stress fractures

3.Diagonal fractures

Page 4: Clinical anatomy of leg

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

Page 5: Clinical anatomy of leg

Transverse march/stress fracturesCommonest site is lower 1/3rd of shaft of Tibia

Cause: long hikes without training

Page 6: Clinical anatomy of leg

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

Page 7: Clinical anatomy of leg

Important bursae

and Bursitis

Page 8: Clinical anatomy of leg

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

Page 9: Clinical anatomy of leg

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.

Page 10: Clinical anatomy of leg

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

Page 11: Clinical anatomy of leg

Calcaneal Tendinitis

and Ruptured Achilles tendon

Page 12: Clinical anatomy of leg

• 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

Page 13: Clinical anatomy of leg

Calcaneal tendon reflex / Ankle reflex

Page 14: Clinical anatomy of leg

• 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

Page 15: Clinical anatomy of leg

Fabella and

Fabellar syndrom

e

Page 16: Clinical anatomy of leg

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

Page 17: Clinical anatomy of leg

Musculocutaneous/ venous

pump

Page 18: Clinical anatomy of leg

• 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

Page 19: Clinical anatomy of leg

Compartment

Syndrome

Page 20: Clinical anatomy of leg

• 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

Page 21: Clinical anatomy of leg

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

Page 22: Clinical anatomy of leg

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

Page 23: Clinical anatomy of leg

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

Page 24: Clinical anatomy of leg
Page 25: Clinical anatomy of leg

Thank you!