Musculature of Indian Elephant Part II. Musculature of the Hindlimb
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Tibialis Posterior Tendon Transfer Corrects the Foot Drop Component
456 COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Tibialis Posterior Tendon Transfer Corrects the Foot DropComponentofCavovarusFootDeformity in Charcot-Marie-Tooth Disease T. Dreher, MD, S.I. Wolf, PhD, D. Heitzmann, MSc, C. Fremd, M.C. Klotz, MD, and W. Wenz, MD Investigation performed at the Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany Background: The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. Methods: We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. Results: The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion. -
Static Stretching Time Required to Reduce Iliacus Muscle Stiffness
Sports Biomechanics ISSN: 1476-3141 (Print) 1752-6116 (Online) Journal homepage: https://www.tandfonline.com/loi/rspb20 Static stretching time required to reduce iliacus muscle stiffness Shusuke Nojiri, Masahide Yagi, Yu Mizukami & Noriaki Ichihashi To cite this article: Shusuke Nojiri, Masahide Yagi, Yu Mizukami & Noriaki Ichihashi (2019): Static stretching time required to reduce iliacus muscle stiffness, Sports Biomechanics, DOI: 10.1080/14763141.2019.1620321 To link to this article: https://doi.org/10.1080/14763141.2019.1620321 Published online: 24 Jun 2019. Submit your article to this journal Article views: 29 View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=rspb20 SPORTS BIOMECHANICS https://doi.org/10.1080/14763141.2019.1620321 Static stretching time required to reduce iliacus muscle stiffness Shusuke Nojiri , Masahide Yagi, Yu Mizukami and Noriaki Ichihashi Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan ABSTRACT ARTICLE HISTORY Static stretching (SS) is an effective intervention to reduce muscle Received 25 September 2018 stiffness and is also performed for the iliopsoas muscle. The iliop- Accepted 9 May 2019 soas muscle consists of the iliacus and psoas major muscles, KEYWORDS among which the former has a greater physiological cross- Iliacus muscle; static sectional area and hip flexion moment arm. Static stretching stretching; ultrasonic shear time required to reduce muscle stiffness can differ among muscles, wave elastography and the required time for the iliacus muscle remains unclear. The purpose of this study was to investigate the time required to reduce iliacus muscle stiffness. Twenty-six healthy men partici- pated in this study. -
Organization of the Lower Limb Audrone Biknevicius, Ph.D
www.thestudio1.co.za Organization of the Lower Limb Audrone Biknevicius, Ph.D. Dept. Biomedical Sciences, OU HCOM at Dublin Clinical Anatomy Immersion 2015 LIMB FUNCTION choco-locate.com blog.coolibar.com Mobility versus Body weight support Dexterity Locomotion Equilibrium & Stability 2 Pectoral Girdle Pelvic Girdle Mobility versus Body weight support Dexterity Locomotion Equilibrium & Stability 3 Arm – forearm – hand Thigh – leg – foot 4 CORRECTED SLIDE #5 The upper and lower limbs are innervated by: A. Posterior (dorsal) rami of spinal nn. B. Anterior (ventral) rami of spinal nn. 50% 50% Posterior (dorsal) rami of spin.. Anterior (ventral) rami of sp... 5 Week 5 RULE #1 Limbs are outgrowths of the ventral body wall Upper limb: C5-T1 trunk segments Lower limb: L2-S3 trunk segments (morphogenesis ~1-2 days later) 6 Week 7 RULE #1 (continued) Limbs are outgrowths of the ventral body wall that undergo distal growth, differentiation and rotation 7 Before rotation en.wikipedia.org • Pollex and hallux both preaxial • Anteriomedially-directed palms and soles 8 Post rotation embryology.med.unsw.edu.au Upper limb rotates 90◦ laterally: Lower limb rotates 90◦ medially: -Extensor mm. on posterior surface -Extensor mm. on anterior surface -Future elbow directed posteriorly -Future knee directed anteriorly -Supine hand in anatomical position -Foot fixed in prone position -Pollex positioned laterally -Hallux positioned medially 9 RULE #2: Innervation of lower limb mm. established in early embryogenesis – resulted in dedicated nerve-compartment relationships Spinal nerve Dorsal primary ramus Ventral primary ramus (L2-S3) Anterior (ventral) division Posterior (dorsal) division limb axis 10 Stern Essential of Gross Anatomy “Roots of BP” Brachial Plexus (=ventral rami) (right side; simplified) C5 Trunks C6 Divisions U C7 Cord M C8 Lat L Terminal T1 Branches Post Musculocutaneous n. -
Allograft Reconstruction of Irreparable Peroneal Tendon Tears
DOJ 10.5005/jp-journals-10017-1022 ORIGINAL RESEARCH Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report William R Mook MD, James A Nunley MD ABSTRACT appreciated.1,2 The symptoms of peroneal tendon disorders Background: Peroneal tendon injuries represent a significant are also often vague and misdiagnosed on initial 2-4 but underappreciated source of lateral ankle pain. Partial presentation. Peroneal tendon dysfunction can be thickness tears of the peroneus brevis amenable to direct repair attributed to tendonitis, chronic tenosynovitis, subluxation, techniques are common. Irreparable tears are uncommon and fraying, longitudinal fissuring, partial tears and complete require more complex surgical decision-making. Intercalary 5-9 segment allograft reconstruction has been previously described tears. These abnormalities can be observed with as a treatment option; however, there are no reports of the concomitant chronic ankle instability, cavovarus foot outcomes of this technique in the literature. We present our deformities, low-lying peroneus brevis muscle bellies, results utilizing this technique. superior peroneal retinacular insufficiency, fibular bone Materials and methods: A retrospective chart review was spurs, and following severe ankle sprains.6,10-12 conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of Several classification systems have been described to injury, concomitant operative procedures, pertinent radiographic characterize peroneal tendon tears in order to improve the findings, pre- and postoperative physical examination, decision-making in operative management.4,13 Acute partial intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, thickness tears can often be tubularized or repaired lower extremity functional scores (LEFS), and complications primarily. -
Unusual Accessory Peroneal Muscles, Peroneus Quartus
DOI 10.1515/abm-2019-0011 — Asian Biomed (Res Rev News) 2018; 12(3 Anat issue Pt 1):125–130 Open access Brief communication (original) Unusual accessory peroneal muscles, peroneus quartus, peroneus digiti quinti, and their association with peroneus brevis tendon tear Pimpimol Dangintawat1, Jirun Apinun2, Thanasil Huanmanop1, Sithiporn Agthong1, Prim Akkarawanit1, Vilai Chentanez1,* Abstract Background: Anatomic variation and supernumerary contents in the superior peroneal tunnel, and the prominence of the retrotrochlear eminence and peroneal tubercle are related to peroneal tendon disorders. Objectives: To investigate the prevalence, origin, and insertion of accessory peroneal muscles, the prominence of the retrotrochlear eminence and peroneal tubercle, and their association with peroneal tendon tears. Methods: We examined 109 formalin-embalmed legs of cadavers from Thai donors. Accessory peroneal muscles and peroneal tendon tears were noted. Associations with peroneal tendon tears were evaluated using a χ2 test. Results: We found 48 accessory peroneal muscles comprising 13 peroneus quartus (PQ), 33 peroneus digiti quinti (PDQ), and 2 unusual muscles. All PDQ originated from the PB tendon and inserted on various parts of the 5th toe. The PQ originated mostly from the PB muscle belly and less from the tendinous part with various insertions on the retrotrochlear eminence, peroneal tubercle, cuboid, and dorsolateral surface of the 5th metatarsal base. Two unusual accessory muscles were identified, 1 coexisting with the PQ. A PB tendon tear was found in 13% of specimens. We found no association between the peroneal tendon tears and the accessory peroneal muscles, or prominence of the retrotrochlear eminence or peroneal tubercle. Conclusions: The prevalence of PQ, PDQ, and unusual accessory peroneal muscles was concordant with previous findings. -
Muscles of the Hip and Lower Limb Review Questions 1
Scoring Review questions /10 Name __________________________ coloring /40 Date ____________ Total /50 Pd. ______ Muscles of the Hip and Lower Limb Review questions 1. What is the longest muscle of the body? ______________________________________________________________ Where is it located? _________________________________________________________________________________ 2. How did the quadriceps femoris get its name? ________________________________________________________ 3. What are the two main functions of the anterior hip and thigh muscles? a. ___________________________________________ b. ____________________________________________ 4. What are the two main functions of the posterior hip and thigh muscles? a. ____________________________________________ b. ____________________________________________ 5. What is the function of the medial thigh muscles? _____________________________________________________ 6. Straining what muscles is termed a “pulled groin”? ___________________________________________________ 7. What is the sole extensor of the knee? _______________________________________________________________ 8. On what surface of the leg are the muscles located that plantarflex the foot? ___________________________ Dorsiflex? __________________________________________________________________________________________ 9. What is the only dorsal foot muscle? _________________________________________________________________ What does it do? ___________________________________________________________________________________ 10. How -
Illuminating the Iliacus
THE GENTLE LIFESTYLE developingcore strength practicaltips for a happylife i Ff f- i JO-IL--rra-,*= i f,I"RtshingHow to avoid injury o Vnel T \.'E. I LOrnwi A littlecove of paradise l[luminatingthe o IACUSBy Liz Koch Some muscles just seem to grab our attention and dominate our awareness while stretching: anterior superior ,1" quads, hamstrings and abdominals are all too iliacspine I ,_\l - ____=_ | familiar. But ask anyone where their iliacus anterior ---\- muscle is and the response most often will be inferior iliacspine one of uncertainty. And yet the iliacus directly influences range of motion within the hip sockets rectus femoris and maintains pelvic integrity so essential to tendon flexibility and strength. gluteusminimus Liningthe internalpelvic girdle the iliacusopens like a muscle, fan, creatinga healthybowl-like structure for all and attachment site on greater abdominalorgans and viscera.lt is the well-functioning trochanter iliacusthat maintainsfull-centered sockets for the femur ball and helpsstabilise the sacraliliac joints by counter- balancingthe largeand powerfulgluteus maximus muscles(buttock muscles). site ol attachment of fibrocartilagenous posterior The lliacusis a abdominalwall muscle pubic symphysis originatingfrom the superiorpart of the iliacfossa (the insideof your hip).lt is innervatedby the femoralnerve in ischiumand inferior the abdomen(at lumbar2 and 3) and its' fibrespass ischial tuberosity pubic inferiorlyand mediallybeneath the inguinalligament. ramus Sharinga tendon at the lessertrocanter of the femur (i.e. pubofemoral ligament the innerleg), with the psoas muscle,the iliacusis part of the core ilio-psoasmuscle group. Togetherthe psoasand iliacusform a full stablepelvic bowl and centeredhip jointsfor maximumrotation and Recentlytwo women who attendedan llio-psoasretreat freedomof leg movement.Health or diseasein one will returnedhome and immediatelyconceived. -
Prezentacja Programu Powerpoint
Department of Human Anatomy. Medical University of Białystok Beata Klim Gluteal region It lies posterior to the pelvis between the level of the iliac crests and the inferior borders of the gluteus maximus muscles. The intergluteal (natal) cleft separates the buttocks from each other. The gluteal sulcus demarcates the inferior boundary of the buttock and the superior boundary of the thigh. Gluteal region The gluteal muscles (maximus, medius and minimus) form the bulk of the buttock. Pelvic girdle- muscles The anterior compartment: Psoas major Psoas minor Iliacus They are called - Iliopsoas Iliopsoas Proximal attachments: Psoas major- sides of T12-L5 vertebrae & discs between them; transverse processes of all lumbar vertebrae Psoas minor- sides of T12-L1 & intervertebral disc Iliacus- iliac crest, iliac fossa, ala of sacrum & anterior sacroiliac ligaments Iliopsoas Distal attachments: Psoas major- lesser trochanter of femur Psoas minor- pectineal line, iliopectineal eminence via iliopectineal arch Iliacus- tendon of psoas major, lesser trochanter, and femur distal to it Iliopsoas Innervation: Psoas major- ventral rami of lumbar nerves L1, L2, L3 Psoas minor- ventral rami of lumbar nerves L1, L2 Iliacus- femoral nerve L2, L3 Iliopsoas Main action: It is the chief flexor of the thigh, and when the thigh is fixed, it flexes the trunk on the hip. It is also a postural muscle that is active during standing by preventing hyperextension of the hip joint. The gluteal muscles The gluteal muscles consist of: Three large glutei (maximus, medius & minimus), which are mainly extensors and abductors of the thigh. A deeper group of smaller muscles (piriformis, obturator internus, obturator externus, gemelli and quadratus femoris), which are covered by the inferior part of the gluteus maximus. -
Iliacus Tender Points in Young Adults: a Pilot Study BRIEF REPORT
BRIEF REPORT Iliacus Tender Points in Young Adults: A Pilot Study Ying Liu, PhD Joy L. Palmer, DO Context: Recent studies have assessed iliacus tender point Results: Twenty-five women and 24 men aged 22 to 30 prevalence in outpatient clinics. However, studies on the years (mean, 24.39 years) were analyzed. Twenty-four prevalence of iliacus tender points in the young adult participants (49%) had low back pain, 46 (94%) had an ili - population and the correlation of its prevalence with acus tender point, and 25 (51%) had a positive Thomas test daily activities are lacking. result. There was no statistically significant difference between men and women with regard to low back pain, Objectives: (1) To determine the prevalence of low back tender point presence, or a positive Thomas test result pain, iliacus tender points, and positive results of Thomas (P=.26, .99, and .78, respectively). Participants who tests (ie, hypertonic iliopsoas muscles) in young adult reported sitting for 8 or more hours in a 24-hour period participants. (2) To evaluate daily activities including or who reported running or biking more than 3 times prolonged sitting, exercise, and running or biking as pre - per week were more likely to have an iliacus tender point dictive factors for low back pain, iliacus tender points, and (P=.001 and .028, respectively). positive Thomas test results. (3) To examine the relation - ship between iliacus tender points and positive Thomas Conclusion: The prevalence of iliacus tender points was test results. high in the study population. Prolonged sitting and run - ning or biking was associated with an increased risk of Methods: Healthy students aged 18 to 30 years at Edward developing low back pain or an iliacus tender point. -
Distally Pedicled Peroneus Brevis Muscle Flap: a Versatile Lower Leg and Foot Flap Ng Y H, Chong K W, Tan G M, Rao M
Original Article Singapore Med J 2010; 51(4) : 339 Distally pedicled peroneus brevis muscle flap: a versatile lower leg and foot flap Ng Y H, Chong K W, Tan G M, Rao M ABSTRACT Introduction: The purpose of this study was to evaluate the outcome of our early experience with the distally pedicled peroneus brevis flap in the management of soft tissue defects of the lower leg, ankle and foot. Methods: This was a non-randomised, retrospec- tive study involving five patients who were treated with the peroneus brevis muscle flap for soft tissue defects over the lower leg. Fig. 1 Photograph shows the defect over the Achilles tendon. Results: In all five patients, the flaps were viable and successful in providing satisfactory soft tissue coverage for the defects. In one diabetic patient, distal flap necrosis was observed, which was Department of treated successfully with a local rotational skin Orthopaedic flap. Surgery, Singapore General Hospital, Outram Road, Conclusion: The distally pedicled peroneus brevis Singapore 169608 muscle flap is an economical, reliable and rela- Ng YH, MBBS, tively easy procedure for treating defects of the MRCS Medical Officer distal third of the leg, ankle and foot. Chong KW, MBBS, MRCS, FRCS Keywords: flap, lower limb reconstruction, Consultant Fig. 2 Photograph shows the peroneus brevis muscle (arrow) peroneus brevis Department of being identified. Orthopaedic Singapore Med J 2010; 51(4): 339-342 Surgery, Alexandra Hospital, 378 Alexandra INTRODUCTION Road, Singapore 159964 Skin and soft tissue coverage for defects in the distal third Tan GM, MBBS, of the leg, ankle and foot has always posed a challenge, MRCS, FRCS Associate Consultant as this area is more susceptible to skin and soft tissue loss. -
Muscle Herniation of the Extremity
Imaging Series Muscle Herniation of the Extremity Scott E. Yochim, MD, Jean Jose, DO, and Paul D. Clifford, MD uscle hernias of the upper and lower extremi- ties, also known as myofascial herniations, refer to focal protrusions of muscle fibers through Macquired or, less commonly, congenital fascial defects. These defects are usually caused by athletic activ- ity, occupational injury, trauma, or fascial weakness due to perforating nerves and vessels, chronic compartment syn- drome, and prior fasciotomy (Figures 1, 2).1,2 The tibialis anterior is the most commonly affected muscle, but hernias involve other muscles in the upper and lower limbs, includ- ing the extensor digitorum longus, peroneus longus, pero- neus brevis, gastrocnemius,3 and the forearm flexors.4 Patients usually present with a palpable soft-tissue mass that becomes more firm and prominent with contraction Figure 1. Longitudinal (A) and transverse (B) ultrasound of the affected muscle. These herniations are usually pain- images obtained at rest over the palpable abnormality in the right leg shows bright, echogenic fascia (small arrows) with less and the primary clinical concern is for an underlying a well-defined fascial defect (area between calipers). A focal benign or malignant neoplasm. However, in some cases, muscle herniation is noted at the site of the fascial defect muscle hernias may become painful after prolonged stand- (arrowheads). Longitudinal gray scale (C) and color Doppler ing or during exercise, likely owing to focal muscle entrap- (D) provocative images through the same area obtained with ment and resultant ischemia. the patient standing demonstrate accentuation of the muscle herniation (arrowheads) through the fascial defect (calipers) Both ultrasound (US) and magnetic resonance imaging with muscle contraction. -
Tibialis Anterior Tendon Rupture: a Case Report
CHAPTER 32 Tibialis Anterior Tendon Rupture: A Case Report James Uh, DPM Cameron Barr, MD INTRODUCTION weave technique. This patient had a predisposing factor that may have contributed to her rupture, which was the use of Closed rupture of the tibialis anterior tendon is a rare injury. local corticosteroids. However, she had no history of acute Bruning fi rst described it in 1905 and there have been fewer trauma to the area of her tibialis anterior tendon or any than 120 cases reported in literature since (1). The rupture other systemic factors that could have been attributed to can be a result of a direct, closed trauma without ankle her tibialis anterior tendon rupture. motion. However, it is more commonly associated with forced ankle plantarfl exion against resistance (1). It has also been CASE REPORT established that a normal tendon rarely ruptures. Conditions that increase the likelihood of rupture are systemic lupus A 70-year-old female presented to our clinic with complaint erythematosus, hyperparathyroidism, and psoriasis (2). Other of vague pain and weakness of 1 month duration that was factors may contribute to tibialis anterior tendon ruptures localized to the anterior aspect of her right ankle. She denied including metabolic disorders such as diabetes mellitus, gout, any history of trauma to the area. However, she did recall rheumatoid arthritis, or after local injections or chronic use that while walking normally that she felt a discomfort that of corticosteroids (1). The typical patient is a male older than was present to the anterior aspect of her ankle that presented the age of 45 years with a complaint of slapping of the foot as a popping type of sensation.