Ebook Clinical anatomy (11th edition): Part 2
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Ebook Clinical anatomy (11th edition): Part 2
Part 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2elt and may be visible in the thin subject. The greater trochanter of the femur lies a hand's breadth below the iliac crest; it is best palpated with the hip abducted so that the overlying hip abductors (tensor fasciae latae and gluteus medius and minimus) are relaxed. In the very thin, wasted patie Ebook Clinical anatomy (11th edition): Part 2nt the greater trochanter may be seen as a prominent bulge and its overlying skin is a common site for a pressure sore to form in such a case.The ischEbook Clinical anatomy (11th edition): Part 2
ial tuberosity is covered by gluteus maximus when one stands. In the sitting position, however, the muscle slips away laterally so that weight is takePart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2 the patella forms a prominent landmark. When quadriceps femoris is relaxed, this bone is freely mobile from side to side; note that this is so when you stand erect. The condyles of the femur and tibia, the head of the fibula and the joint line of the knee are all readily palpable; less so is the ad Ebook Clinical anatomy (11th edition): Part 2ductor tubercle of the femur, best identified by running the fingers down the medial side of the thigh until they are halted by it, the first bony proEbook Clinical anatomy (11th edition): Part 2
minence so to be encountered.The tibia can be felt throughout its course along its anterior subcutaneous border from the tibial tuberosity above, whicPart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2 lateral malleolus, which extends more distally than the stumpier medial malleolus of the tibia.Immediately in front of the malleoli can be felt a block of bone which is the head of the talus.The tuberosity of the navicular stands out as a bony prominence 1 in (2.5 cm) in front of the medial malleol Ebook Clinical anatomy (11th edition): Part 2us; it is the principal point of insertion of tibialis posterior. The base of the 5th metatarsal is easily felt on the lateral side of the foot and isEbook Clinical anatomy (11th edition): Part 2
the site of insertion of peroneus brevis.If the calcaneus (os calcis) is carefully palpated, the peroneal tubercle can be felt 1 in (2.5cm) below thePart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2ngus and for flexor hallucis longus.Bursae of the lower limbA number of these bony prominences are associated with overlying bursae which may become distended and inflamed: the one over the ischial tuberosity may enlarge with too much sitting ('weaver's bottom'); that in front of the patella is affe Ebook Clinical anatomy (11th edition): Part 2cted by prolonged kneeling forwards, as in207208scrubbing floors or hewing coal ('housemaid's knee', the 'beat knee' of north-country miners, or prepaEbook Clinical anatomy (11th edition): Part 2
tellar bursitis); whereas the bursa over the ligamentuni patellae is involved by years of kneeling in a more erect position —as in praying ('clergymanPart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2 into the calcaneus and may also develop bursae over the navicular tuberosity and dorsal aspects of the phalanges.A 'bunion' is a thickened bursa on the inner aspect of the first metatarsal head, usually associated with hallux valgus deformity. Note that this is an adventitial bursa; it is not prese Ebook Clinical anatomy (11th edition): Part 2nt in normal subjects.Mensuration in the lower limbMeasurement is an important part of the clinical examination of the lower limb. Unfortunately, studEbook Clinical anatomy (11th edition): Part 2
ents find difficulty in carrying this out accurately and still greater difficulty in explaining the results they obtain, yet this is nothing more or lPart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2ue to actual loss of bone length — for example, where a femoral fracture has united with a good deal of overriding of the two fragments. Apparent shortening is due to ă fixed deformity of the limb (Fig. 148). Stand up and flex your knee and hip on one side, imagine these are both ankylosed at 90" an Ebook Clinical anatomy (11th edition): Part 2d note that, although there is no loss of tissue in this leg, it is apparently some 2 ft (60cm) shorter than its partner.Umbilicus to medial malleolusEbook Clinical anatomy (11th edition): Part 2
Fig. 148 Apparent shortening—one limb may be apparently shorter than the other because of fixed deformity; the legs in this illustration are actually Part 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2 comparing the distance from the umbilicus to the medial malleolus on each side.https://khothuvien.cori!The anatomy and surface markings of the lower limb209Fig. 149 Measuring real shortening—the patient lies with the pelvis 'square' and the legs placed symmetrically. Measurement is made from the an Ebook Clinical anatomy (11th edition): Part 2terior superior spine to the medial malleolus on each side.Anterior superior iliac spine to medial malleolusIf there is a fixed pelvic tilt or fixed jEbook Clinical anatomy (11th edition): Part 2
oint deformity in one limb, there may be this apparent difference between the lengths of the two legs. By experimenting on yourself you will find thatPart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2any disparity due to fixed deformity by putting both legs into exactly the same position; where there is no joint fixation, this means that the patient lies with his pelvis 'square', his legs abducted symmetrically and both lying flat on the couch. If, however, one hip is in 60° of fixed flexion, fo Ebook Clinical anatomy (11th edition): Part 2r example, the other hip must first be put into this identical position. The length of each limb is then measured from the anterior superior iliac spiEbook Clinical anatomy (11th edition): Part 2
ne to the medial malleolus. In order to obtain identical points on each side, slide the finger upwards along Poupart's inguinal ligament and mark the Part 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2rk on each side.To determine apparent shortening, the patient lies with his legs parallel (as they would be when he stands erect) and the distance from umbilicus to each medial malleolus is measured (Fig. 148).Now suppose we find 4in (10cm) of apparent shortening and 2 in (5cm) of real shortening of Ebook Clinical anatomy (11th edition): Part 2 the limb; we interpret this as meaning that 2in (5cm) of the shortening is due to true loss of limb length and another 2 in (5cm) is due to fixed posEbook Clinical anatomy (11th edition): Part 2
tural deformity.If the apparent shortening is fess than the real, this can only mean that the hip has ankylosed in the abducted, and hence apparently Part 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily fe Ebook Clinical anatomy (11th edition): Part 2when the hip becomes ankylosed, shortening due to actual destruction at the hip (i.e.(a) Nelaton's linePart 4The Lower LimbThe anatomy and surface markings of the lower limbBones and jointsThe tip of the anterior superior spine of the ilium is easily feGọi ngay
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