Transcript Unit 5_lower extremityx

Bell Ringer
 Name
at least 5 bones in the body
Medical terminology
and generic terminology

Unit 5: Lower
Extremity
Hip/Pelvis
and thigh
Anatomy

Pelvis formed by 2 innominate bones
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Function:
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Sacrum and coccyx
Support the spine/trunk and transfer their weight
to the lower limbs
Attachment for trunk and thigh muscles
Protect viscera
Hip – articulation of femur and acetabulum
Femur- thigh bone
Femur
Ligaments, Joint capsule, and
synovial membrane


Glenoid labrum- fibrocartilage surrounding
the rim of the acetabulum
Ligaments
 Pubofemoral
 Iliofemoral
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(Y ligament of Bigelow)
Strongest ligament
 Ischiofemoral
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Articular capsule- encloses hip joint
 All
help reinforce the hip joint and provide
stability
Hip musculature
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Anterior
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Iliacus
Psoas muscles (major and minor)
Posterior
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Tensor fascia latae (TFL)
Gluteals (maximus, medius, minimus)
6 deep outward rotators (piriformis, gemellus
superior, gemellus inferior, obturator internus,
obturator externus, quadratus femoris)
Anterior
Posterior
Muscle
Action
Iliopsoas
Flexes the thigh and trunk on femur
Gluteus maximus
Extends and externally rotates
thigh
Gluteus minimus and medius
Abducts and medially rotates thigh
Piriformis
Rotates the thigh laterally and
assists in extending and abducting
thigh
Superior gemellus, Inferior gemellus, Rotates thigh laterally
Obturator internus, Obturator
externus, Quadratus femoris
Tensor fascia latae (TFL)
Assists in flexion, abduction, and
medial rotation of thigh
Bell Ringer
 Name
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3 muscles
Be able to identify where they are located
and what their action is
I am going to call on at least 3 people
Thigh muscular
 Anterior
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thigh
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Sartorius
Quadriceps
femoris
 Vastus lateralis
 Vastus medialis
 Vastus intermedius
Posterior thigh
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Popliteus
Hamstrings
Biceps femoris
 Semimembranosus
 Semitendinosus
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 Rectus
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Medial thigh (groin)
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Gracilis
Pectineus
Adductors (magnus,
longus, brevis)
Anterior
and
medial
Posterior
Anterior
Muscle
Action
Sartorius
Flexes the thigh and leg and
laterally rotates thigh
Quadriceps (vastus lateralis,
vastus medialis, vastus
intermedius, rectus femoris)
Extends the leg
Rectus also flexes the thigh
Posterior
Muscles
Actions
Hamstrings (semitendinosus,
semimembranosus, biceps
femoris)
Flexes the leg and extends
the thigh
Popliteus
Flexes the leg and rotates
tibia medially
Medial
Muscles
Actions
Adductors (magnus, longus,
brevis)
Adducts and laterally
rotates the thigh
Pectineus
Adducts and laterally
rotates the thigh
Gracilis
Adducts and flexes the thigh
Mini Project-Partners only
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Come up with an activity to help teach you
classmates a way to remember and learn the
hip anatomy, muscular, and actions…
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Examples:
Crossword puzzle
 Word search- but you have to have more than
just search for the words
 Puzzle
 Diagram
 Rap/Song
 Poem
 Video
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NO Kahoot – may use Quizlet
No more than 2 groups can do an activity- first
come, first served
Injuries
 Hip
contusion
 Hamstring strain
 Quad strain
 Groin strain
 Dislocated hip
 Snapping hip
 Hip pointer
 Stress fracture
Search your mind
Group activity
Look up the injury assigned to your group.
Identify what causes the injury (MOI), some
signs and symptoms, and treatment. You
need to make a Powerpoint presentation
for your injury. Each group will present their
injury.
Evaluation of Hip injury
 History:
 Observation:
 Palpation:
 Special
tests:
Injuries
 Hip
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
contusion
MOI: impact to a relaxed thigh
Signs and symptoms:
 Pain
 Loss
of function
 Bruising
 Weakness
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Treatment
 Light
stretch, rest, and ice
Hip injuries
 Quad
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strain
MOI: sudden, violent, forceful contraction
of the hip and knee into flexion
 Overstretch
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Signs and symptoms:
 Pain
 Swelling
 Loss
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of knee flexion
Treatment: RICE, pain free ROM, rehab
Hip injuries
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Hamstring Strain
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Most common injury to thigh
MOI: change from role of knee stabilization to
hip extension
Signs and symptoms:
Bruising
 Pain
 Loss of function
 Varies some with grade of injury
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Treatment:
REST
 RICE
 NSAIDS
 rehab
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Hip injuries
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Groin strain
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MOI: running, jumping, or twisting with external
rotation
Signs and symptoms:
Pain
 Weakness
 Internal hemorrhage
 Nagging pain
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Treatment:
RICE
 NSAIDS
 REST best treatment
 rehab
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Hip injuries
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Dislocated hip
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MOI: traumatic force along the axis of the femur
Most common: posterior (to acetabulum) with
femoral shaft adducted and flexed
Signs and symptoms:
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Palpation reveals that head of femur has
moved posterior to acetabulum
May result in tearing of capsule and ligaments;
fracture; nerve damage
Treatment: immobilize and medical attention
Hip injuries
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Snapping hip
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Commonly seen in dancers, gymasts, hurdlers,
and sprinters
Due to muscle imbalance
IT band snapping over the great trochanter
 iliofemoral ligaments snapping over femoral
head
 Long head of biceps femoris over ischial
tuberosity
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Treatment:
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Decrease inflammation and pain with ice, antiinflammatories, and modalities
Hip injuries
 Hip
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pointer
Iliac crest contusion
Due to fall on the iliac crest
Handicapping injury and hard to treat
Signs and symptoms:
 Immediate
pain, spasms, and transitory
paralysis of soft structures
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Treatment:
 RICE
 Severe-
bed rest and refer to doctor for x-ray
Hip injuries
 Stress
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fracture
Most common in distance runners
Due to repetitive forces on the hip while
running
Signs and symptoms:
 Rest
 Refer
to doctor – may need xray and/or MRI
 May cross train when allowed
Knee
Anatomy
 Bones:
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Femur
Tibia
Fibula
Patella- “knee cap”
Anatomy
 Meniscus
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2 fibrocartilages:
 Medial
(C shaped)
 Lateral (O shaped)
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Functions:
 Deepen
articular facets of tibia
 Cushion any stresses
 Maintain space between femoral condyles
and tibial plateaus
Anatomy
 Ligaments

Anterior Cruciate Ligament (ACL)
 Prevents
the femur from moving posteriorly
during WB
 Limits anterior translation of tibia in non-WB
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Posterior Cruciate Ligament (PCL)
 Resists
internal rotation of the tibia
 Prevents hyperextension of knee
 Limits posterior translation of tibia in non-WB
Anatomy
 Ligaments

cont’d
Medial collateral ligament (MCL)
 Prevents
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valgus force
Lateral collateral ligament (LCL)
 Prevents
varus force
Muscles
Knee flexion
Knee
extension
External
Rotation
Internal Rotation
Hamstrings
Gracilis
Sartorius
Gastrocnemius
Popliteus
Soleus
Quadriceps
Biceps
femoris
Popliteus
Semitendinosus
Semimembranosus
Sartorius
Gracilis
posterior
anterior
Knee injuries
 MCL
sprain
 ACL sprain
 Meniscal injuries
 Patellofemoral pain syndrome
 Patellar tendinitis
 IT band syndrome
Search your mind
Group activity
Look up the injury assigned to your group.
Identify what causes the injury (MOI), some
signs and symptoms, and treatment. Each
group will present their injury.
Knee Injuries
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MCL Sprain
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MOI: direct blow from the lateral side in a medial
direction (valgus force) or from lateral tibial
rotation
Signs and symptoms:
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Instability of the knee joint
Pain in medial aspect
Swelling (depending on severity)
ROM changes
Treatment:
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RICE
Crutches or splint
Gradual rehab
Refer to doctor depending on severity
Knee injuries
 ACL
sprain
Knee injuries
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Menisical injuries
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MOI: weight bearing combined with a rotary
force while the knee is extended or flexed
Signs and symptoms:
Swelling
 Joint line pain
 Loss of motion
 Locking, catching, or giving away of joint
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Treatment:
Conservative rehab
 Refer to doctor  may need surgical
intervention
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Knee injuries
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Patellofemoral pain syndrome
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lateral deviation of the patella as it tracks in the
femoral groove
Tight hamstrings or gastroc
 Tight lateral retinaculum
 Tight IT band
 Patella alta
 Vastus medialis weakness
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Signs and symptoms: dull ache in center of
knee, patellar pain and crepitus, swelling
Treatment: stretching and strengthening
program
Knee injuries
 Patellar
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tendinitis
AKA jumpers knee
MOI: jumping, kicking, running (repetitively)
Signs and symptoms:
 Pain
and tenderness at the inferior angle of
patella
 Pain may progress depending on severity
(after activity, during activity)
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Treatment: ice, modalities, ice, rehab
Knee injuries
 IT
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band syndrome
AKA runner’s or cyclist’s knee
MOI: length leg discrepancy, genu varum,
pronated feet, muscular tightness
Signs and symptoms: pain along the lateral
leg and knee
Treatment:
 Correction
foot alignments
 Ice massage
 Proper warm up and stretching
Lower
leg/ankle
Anatomy
 Tibia

Weight bearing bone of lower leg
 Fibula
 Talus
 Calcaneus
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Heel bone
Articulations
 Inferior
tibiofibular joint
 Talocrural joint (ankle joint)
 Subtalar joint
Ligaments
 Lateral
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ligaments
Anterior talofibular
Posterior talofibular
Calcaneofibular
 Medial
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Deltoid
Muscles (4 compartments)
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Anterior
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Tibialis anterior
Extensor hallucis
longus
Extensor digitorum
longus
Peroneal (fibularis)
tertius
Lateral
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Peroneal (fibularis)
longus
Peroneal (fibularis)
brevis
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Superficial posterior
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Gastroc
Soleus
Plantaris
Deep posterior
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Popliteus
Flexor hallucis longus
Flexor digitorum
longus
Tibialis posterior
Puppet Muscle Madness
Everyone will need their string and draw a
muscle from the hat. We will tie the string to
one of your toes and “puppet” the
movement to grasp an understanding of
muscle actions.
Anterior
Muscle
Action
Tibialis anterior
Dorisflex and inverts foot
Extensor hallicus longus
Dorsiflex and inverts foot;
extends great toe
Extensor digitorum longus
Dorsiflex and everts foot;
extends the toes
Peroneus (fibularis) teritus
Dorsiflex and everts foot
Lateral
Muscles
Actions
Peroneus (fibularis) longus
Plantar flexes and everts
foot
Peroneus (fibularis) brevis
Plantar flexes and everts the
foot
Superficial posterior
Muscles
Actions
Gastrocnemius
Flexes the leg and
plantarflexes the foot
Soleus
Plantarflexes the foot
Plantaris
Flexes the leg; plantarflexes
the foot
Deep posterior
Muscles
Actions
Popliteus
Flexes and rotates the leg
medially
Flexor hallicus longus
Plantar flexes and inverts the
foot; flexes great toe
Flexor digitorum longus
Plantarflexes and inverts the
foot; flexes the toes
Tibialis posterior
Plantarflexes and inverts the
foot
Ankle injuries
 Lateral
ankle sprain
 Medial ankle sprain
 Syndesmotic (high) ankle sprain
 Achilles tendinitis
 Medial tibial stress syndrome
 Compartment syndrome
Search your mind
Group activity
Look up the injury assigned to your group.
Identify what causes the injury (MOI), some
signs and symptoms, and treatment. Each
group will present their injury.
Ankle injuries

Lateral ankle sprain
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Ligaments involved: CF, ATF, PTF
MOI: Inversion
Signs and symptoms:
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Painful pop on lateral side of ankle
Bruising
Instability
Swelling
Weakness
Treatment:
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RICE/crutches if unable to walk
Rehab
Ankle injuries
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Medial ankle sprain
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Ligaments involved: deltoid
MOI: eversion
Signs and symptoms:
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Painful pop on medial side of ankle
Bruising
Instability
Swelling
Weakness
Treatment:
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RICE/crutches if unable to walk
Rehab
Ankle injuries
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Sydesmotic Sprain (high)
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MOI: forced dorsiflexion
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Signs and symptoms:
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Typically happen in conjunction with lateral or medial
ankle sprain
Severe pain
Loss of function
Pain with passive ER and dorsiflexion
Treatment:
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Take longer to heal
Immobilization
RICE
rehab
Ankle injuries
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Achilles tendinitis
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Inflammation of the Achilles tendon
MOI: repetitive weight-bearing activities; duration
and intensity of activity is increased too quickly
with insufficient recovery time; overuse injury
Signs and symptoms:
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Generalized pain and stiffness in Achilles
Uphill running and hill workouts
Crepitus in tendon
Treatment:
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Proper shoe ware
Decrease activity and proper training
Modalities
Massage
Ankle injuries
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Medial tibial stress syndrome (MTSS)
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Shin splints
MOI: repetitive microtrauma due to running and
jumping activities
Weakness of leg muscles
 Shoes
 Training errors (on hard surfaces)
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Signs and symptoms: pain in medial leg
Treatment: stretching, strengthening program,
change in shoes and training, ice, modalities
Ankle injuries
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Compartment syndrome
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MOI: increased pressure within one of the
compartments of the lower leg and causes
compression in the muscles and neurovascular
structures
Signs and symptoms:
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Deep aching pain
Tightness and swelling
Pain with passive stretching
Reduced circulation and sensory changes
Treatment:
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Ice and elevation, stretching
Refer to doctor
Foot
Anatomy

Toes (phalanges)
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First toe- hallux
Metatarsals – 5 bones between the
phalanges and tarsal bones
Tarsal bones
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Calcaneus (heel bone)
Talus
Cuboid
Navicular
Cuneiforms – first, second, and third
Arches of the foot
 Metatarsal
arch
 Transverse arch
 Medial longitudinal arch
 Lateral longitudinal arch
Plantar fascia- band of fibrous tissue along
the bottom of the foot
Articulations
 Interphalangeal
(IP) joint
 Metatarsophalangeal (MTP) joint
 Intermetatarsal joint
 Tarsometatarsal Joint (Lizfranc)
 Subtalar joint
 Midtarsal joint
Muscles and movements

Dorsiflexion
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Tibialis anterior
Extensor digitorum longus
Extensor hallicus longus
Peroneus teritus
Plantarflexion
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Gastrocnemius
Soleus
Plantaris
Peroneus longus and brevis
Tibialis posterior
FHL
FDL
Muscles and movements

Inversion, adduction, and supination

“Tom, Dick, and Harry”
Tibialis posterior
 Flexor digitorum longus
 Flexor hallicus longus
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Eversion, abduction, and pronation
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Peroneus longus
Peroneus brevis
Peroneus tertius
EDL
So how does walking work?
Gait cycle
Let’s walk it out…
 Looking



for…
Pronation
Supination
Toe out/in
Foot deformities/injuries
 Pes
planus – flat foot
 Pes cavus – high arch
 Plantar fascitis
 Jones fracture – fx at base of 5th
metatarsal
 Turf toe (great toe hyperextension)
Lower extremity PROJECT TIME
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
Small groups
Pick a body part
Make a project to demonstrate your
knowledge about the body part…
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
Make a model
Make a music video
Make a diagram or picture
If you have another idea, you may ask and I
can approve it
NO PowerPoints OR papers
HAVE FUN WITH IT!!!
REVIEW with plicker
 We
will review all body parts and make
sure everyone is knowledgeable about
the whole lower extremity.
 For test…you may pick two body parts
and you will be tested on those.