The lower limb

The lower limb

1. Bone Anatomy

   • Tibia and fibula
   • Foot

2. Ligaments of the knee

3. Knee joint

   • Is called patello-fumeral joint and Tibiofemoral joint
     • Articular surfaces are
       • Anterior and distal part of femur and medial & lateral facet of patella
       • Femoral condyles and tibial condyles
   • Blood supply of the knee
   • Nerve supply of the knee joint
     • -Femoral nerve -Tibial nerve -Common peroneal nerve -Obturator nerve
   • Examination of the knee joint
     • Introduce your self Explain to the patient the nature of the test Obtain Consent Confidentiality
     • Hand washing Exposure Position Appearance
     • Inspection
     • palpation
     • Movement
     • Stability and special Tests
       • -Collateral ligaments stress -patellar apprehension test -knee effusions test -Apley's test -McMurray's Test

4. Muscles

   • Anterior compartment
     • -Tibialis anterior -Extensor digitorum longus and bevis -Extensor hallucis longus and brevis
   • Lateral Compartment
     • -peroneus (fibularis) longus – peroneus (fibularis) brevis
   • Posterior Compartment
     • – Gasrocnemius – Plantaris – Soleus (intermediate) – Tibialis Posterior – Flexor Digitorum Longus – Flexor Hallucis Longus – Popliteus

5. Nerve supply of the leg

   • Deep peroneal nerve
   • Superficial peroneal nerve
   • Tibial nerve

6. Blood supply of the leg

   • Anterior tibial artery
   • Fibular artery
   • Posterior tibial artery

7. Superficial veins

   • The Small Saphenous Vein
     • 1. dorsal venous arch + dorsal vein of the little toe 2. posterior side of the leg 3. posterior to the lateral malleolus 4. Drains into the popliteal vein
   • The Great Saphenous Vein
     • 1. dorsal venous arch + dorsal vein of the great toe. 2. medial side of the leg, 3. anterior to the medial malleolus 4. posterior to medial condyle of tibia 5. drain into the femoral vein

8. Cartilage

   • Structure
     • connective tissue dense matrix of collagen fibres and elastic fibres  ground substance  perichondrium
       • Types
         • -Hyaline cartilage -Fibrocartilage -Elastic
   • Function
     • provides support, but is less rigid than bone. It also allows for some flexibility of movement, but has more stability than muscle

9. Body Mass Index

   • which is The body mass divided by the square of the body height.
     • chart

10. Osteoarthritis

    • what is it:degeneration of joint cartilage and the underlying bone, most common from middle age onward. It causes pain and stiffness, especially in the hip, knee, and thumb joints
    • Signs and Symptoms of Osteoarthritis
      • Pain Tenderness Stiffness Loss of flexibility Crepitus Bone spurs
    • Risk Factors
      • -Gender(females) -Age -Family history -Trauma -Ethnicity -Smoking and alcohol -Obesity
    • Pathogenesis
      • Articular cartilage
        • Erosion occurs
          • Fibrillation, which causes softening, splitting and fragmentation of the cartilage
            • Collagen fibres split and there is disorganisation of the proteoglycon
              • Bone surface becomes hard & polished
                • Known as eburnation
                  • Cystic cavities form in the subchondral bone
                    • Osteophytes + Venous congestion occurs
      • Ligament
        • fibrous denervation
      • Muscles
        • Undergoes atrophy
    • Management goals
      • Limit pain •Increase range of motion •Increase muscle strength
        • Pharmacotherapy
        • Non pharmacotherapy
    • Diagnosis
      • Imaging tests
        • -X-rays -MRI
      • Lab tests
        • -Blood tests- Joint fluid analysis
    • Epidemiology

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