{Lower Leg

Session 16

Deduce and apply the range of motion restrictions of the ligaments of the knee joint.

Describe the attachments, innervations, actions, and relationships of the Lower Leg musculature.

Describe the function and course of the neurovasculature structures of the Lower Leg.

Objectives

A

B

C

D

E

F

G

H

I

J

K

Step 1: In your team, label each structure in the provided cross-sections (in the powerpoint).

Step 2: Add to the labels (if not already included)-attachment sites

innervations nerve and vessel continuations (where was this nerve

in the thigh? where does it go in the foot?) muscle actions

Step 3: Discussion Questions

Step 4: Post your labels and discussion summary to the wiki.

On slide 11, what are some observations you can make that direct you to the level of the cross section? Around what level is it?

How do you know that slide 5 is higher in the body than slide 7? Than slide 6?

What do you notice about the muscles in the pes anserine at different levels of the thigh?

On slide 1, what are the bony landmarks that give away the level?

What else do you notice going through the cross sections?

Discussion Questions

Tibiofemoral Joint – Bony Variations

Genu Vara and Genu Valga

Will affect the amount of force transferred between the two femoral condyles – one side will carry more weight and be damaged faster

Hip and ankle issues may also result

An elderly patient with noticeable genu varus walks into your clinic. Which side of the knee is he more likely to have osteoarthritis in?

A. MedialB. Lateral

50%50%

In a patient with Genu Valgus, which ligament is most stretched?

A. MCLB. PCLC. LCLD. ALLE. ACL

MCL PC

LLCL

ALL

ACL

20% 20% 20%20%20%

Tibiofemoral Joint – Menisci

Both: Have an anterior and posterior horn to hold it to the Tibia Are attached to the capsule and Tibia on the external edge by the coronary ligaments Coronary ligaments are loose and allow menisci to pivot Are held together anteriorly by the transverse ligament Blood supply near external border, avascular near internal border Aneural except near the horns Function as shock absorbers!

Medial Meniscus C shape External border is attached to the MCL and capsule

Lateral Meniscus O shape External border attached to the capsule and Popliteus Muscle Posterior border is attached to the femur by the Posterior Meniscofemoral Ligament

Tibiofemoral Joint – Ligaments

LAMP

Lateral Collateral Ligament (Fibular Collateral)

Dense and strong Medial Collateral Ligament

(Tibial Collateral) Less dense, two parts, weaker

Anterior Cruciate Ligament (ACL) Anterior Tibia -> Posterior Femur

Posterior Cruciate Ligament (PCL)

Posterior Tibia -> Anterior Femur Anterior Lateral Ligament (ALL)

Lateral epicondyle -> Gerdy’s tubercle

https://www.youtube.com/watch?v=RTV5Yo3E7VQ

Which ligament(s) are you testing by pulling a patient’s tibia anteriorly relative to the femur?

A. PCLB. ACLC. LCLD. ALL

25% 25%25%25%

One essential function of the crural fascia is to create a set volume of space for the lower leg muscles, so that when they contract, they push blood back up toward the heart through the veins.

A. TrueB. False

50%50%

Your patient has weakness dorsiflexing his ankle. Which nerve may be pinched?

A. Tibial nerveB. Anterior tibial nerveC. Superficial fibular nerveD. Deep fibular nerve

25% 25%25%25%

Re-orienting

Development Back Spinal Cord, Vasculature Discs and IV Joints Gluteal region Anterior, Medial, Posterior thigh Hip Lower Leg Knee biomechanics Ankle biomechanics Foot Review vasculature Connect nerves up to nerve roots

Exams

Tag Test 15 stations 5 q/station 75 total questions 9 term lists 6 presentations MC, TF, SA,

identify, attachments, innervations, relationships, cross sections, images, cadavers

Midterm 30 MC 15 TF 5 SA Range of

questions Memorization ->

Evaluation

No Schoo

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