Ebook Clinical anatomy (4/E): Part 2
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Ebook Clinical anatomy (4/E): Part 2
Part 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2n Wiley & Sons Ltd. Published 2019 by John Wiley & Sons Ltd.Companion website: www.ellisclinicalanatomy.co.uk/14editionSurface anatomy and surface markings of the lower limbAnatomically the upper and lower limbs are comparable to each other as regards the arrangement of the bones, joints, main muscl Ebook Clinical anatomy (4/E): Part 2e groups, vessels and nerves. However, compared with the complex movements of the upper limb, designed to place the hand in a multiplicity of positionEbook Clinical anatomy (4/E): Part 2
s, together with the intricate and multiple functions of the hand, fingers and thumb, the functions of the lower limb are simple indeed - first, to acPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2aspects of the important clinical anatomy of the lower limb can be examined, reviewed and revised on yourself, your colleagues or your patients.Bones and jointsThe tip of the anterior superior spine of the ilium is easily fell and may bo visible in the thin subject. The greater trochanter of the fem Ebook Clinical anatomy (4/E): Part 2ur lies a hand's breadth below the iliac crest; it is best palpated with the hip passively abducted so that the overlying hip abductors (tensor fasciaEbook Clinical anatomy (4/E): Part 2
e latae and gluteus medius and minimus) are relaxed. In the very thin patient, the greater trochanter may be seen as a prominent bulge and its overlyiPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2ng position, however, the muscle slips away laterally so that weight is taken directly on the bone. To palpate this bony point, therefore, feel for it uncovered by gluteus maximus in the flexed position of the hip.At the knee, the patella forms a prominent landmark. When quadriceps femoris is relaxe Ebook Clinical anatomy (4/E): Part 2d, this bone is freely mobile from side to side; note that this is so when you stand erect. 1 he condyles of the femur and tibia, the head of the fibuEbook Clinical anatomy (4/E): Part 2
la and the joint line of the knee are all readily palpable; loss so is the adductor tubercle of the femur, best identified by running the fingers downPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2th of its anterior subcutaneous border from the tibial tuberosity above, which marks the insertion of the quadriceps tendon, to the medial malleolus at the ankle, rhe subcutaneous surface of the tibia, which can be fell immediately medial to its subcutaneous border, is crossed by' two structures the Ebook Clinical anatomy (4/E): Part 2 long saphenous vein, which is readily visible immediately in front of the medial malleolus of the tibia, and the adjacent saphenous nerve, rhe head oEbook Clinical anatomy (4/E): Part 2
f the fibula, as noted previously, is easily palpable; note that it lies below and towards the posterior part of the lateral tibial condyle. Distal toPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2 for its terminal 7cm (3in) above the lateral malleolus. The latter extends more distally than the stumpier medial malleolus of the tibia.217218 The lower limbImmediately in front of the malleoli can be felt a block of bone which is the head of the talus. Feel it move up and down in dorsiflexion and Ebook Clinical anatomy (4/E): Part 2 plantarflexion of the ankle.The tuberosity of the navicular stands out as a bony prominence 2.5 cm (1 in) in front of the medial malleolus; it is theEbook Clinical anatomy (4/E): Part 2
principal point of insertion of tibialis posterior. The base of the 5th metatarsal is easily felt on the lateral side of the foot and is the site of Part 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2eral malleolus and the sustentaculum tali 2.5cm (Im) below the medial malleolus; these represent pulleys, respectively, for peroneus longus and for flexor hallucis longus.Bursae of the lower limbA number of the bony prominences described in the previous section are associated with overlying bursae, Ebook Clinical anatomy (4/E): Part 2which may become distended and inflamed: the one over the ischial tuberosity may enlarge with loo much sitting ('weaver’s bottom’); that in front of tEbook Clinical anatomy (4/E): Part 2
he patella is affected byprolonged kneeling forwards, as in scrubbing floors or hewing coal ('housemaid's knee’, the 'beat knee' of north-country minePart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2'clergyman's knee' or infrapatellar bursitis). Young women who wear fashionable but light shoos are prone lo bursitis over the insertion of the Achilles tendon (calcaneal tendon or tendo calcaneus) into the calcaneus and may also develop bursae over the navicular tuberosity and dorsal aspects of the Ebook Clinical anatomy (4/E): Part 2 phalanges.A ‘bunion' is a thickened bursa on the inner aspect of the first metatarsal head, usually associated with hallux valgus deformity. Note thaEbook Clinical anatomy (4/E): Part 2
t the bursae that may develop (and become inflamed) over the calcaneus, navicular, the phalanges and the head of the first meta tarsal are called advePart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2nfrapatellar bursae, which are normal anatomical structures and which may become distended with fluid as a result of repeated trauma.Mensuration in the lower limbMeasurement is an important part of the clinical examination of the lower limb. Unfortunately, students find difficulty in carrying this o Ebook Clinical anatomy (4/E): Part 2ut accurately and still greater difficulty' in explaining and interpreting the results they’ obtain, yet this is nothing more or less than a simple exEbook Clinical anatomy (4/E): Part 2
ercise in applied anatomy.First note the differences between real and apparent shortening of the lower limbs. Real shortening is due to actual loss ofPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2ed deformity of the limb (Fig. 147). Stand up and flex your knee and hip on one side, imagineSurface anatomy and surface markings of the lower limb 219Fig. 147 Apparent shortening - one limb may be apparently shorter than the other because of fixed deformity; the legs in this illustration are actual Ebook Clinical anatomy (4/E): Part 2ly equal in length but the right is apparently considerably shorter because of a gross flexion contracture at the hip. Apparent shortening is measuredEbook Clinical anatomy (4/E): Part 2
by comparing the distance from lite umbilicus to the medial malleolus on each side.Umbilicus to medial malleolusthese are both ankylosed al 9Ơ' and nPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2t or fixed joint deformity in one limb, there may be this apparent difference between the lengths of the two limbs. By experimenting on yourself you will find lhal adduction apparently shortens the limb, whereas it is apparently lengthened in abduction.To measure the real length of the limbs (Fig. 1 Ebook Clinical anatomy (4/E): Part 248), overcome any disparity due to fixed deformity by putting both limbs into exactly the same position; where there is no joint fixation, this meansEbook Clinical anatomy (4/E): Part 2
that the patient lies with his pelvis 'square', his limbs abducted symmetrically and both limbs lying flat on the couch. If, however, one hip is in 60Part 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2rior superior iliac spine lo the medial malleolus. In order to obtain identical points on each side, slide the finger upwards along Poupart's inguinal ligament and mark the bony point first encountered by the finger. Similarly, slide the finger upwards from just distal to the malleolus to determine Ebook Clinical anatomy (4/E): Part 2the apex of this landmark on each side.To determine apparent shortening, the patient lies with his logs parallel (as they would be when he stands erecEbook Clinical anatomy (4/E): Part 2
t) and the distance from umbilicus to each medial malleolus is measured (Fig. 147).Now suppose we find 10cm (4in) of apparent shortening and 5cm (2 inPart 4The Lower LimbClinical Anatomy: Applied Anatomy for Students and junior Doctors, Fourteenth Edition. Harold Ellis and Vishy Mahadevan.02019 John Ebook Clinical anatomy (4/E): Part 2(2 in) is due to fixed postural deformity.220 Tho lower limbAnterior superior iliac spine to medial malleolusGọi ngay
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