1. { Lower Leg Session 16

2.  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

3. A

4. B

5. C

6. D

7. E

8. F

9. G

10. H

11. I

12. J

13. K

14. 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.

15.   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

16. 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

17. 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. Medial B. Lateral

18. In a patient with Genu Valgus, which ligament is most stretched? A. MCL B. PCL C. LCL D. ALL E. ACL

19. Tibiofemo ral 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

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

21. Which ligament(s) are you testing by pulling a patient’s tibia anteriorly relative to the femur? A. PCL B. ACL C. LCL D. ALL

22. 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. True B. False

23. Your patient has weakness dorsiflexing his ankle. Which nerve may be pinched? A. Tibial nerve B. Anterior tibial nerve C. Superficial fibular nerve D. Deep fibular nerve

24. 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

25. 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 School