21Surface Anatomy - Anterior, Extended PatellaIndentedHollowAppears hollow on either side of patellaThere is a slight indentation above the patellaA small amount of fluid will make these hollow-appearing areas disappear. Larger effusions are most conspicuous as a fullness proximal to the patella.
24Lateral and Medial Patellar Facets Palpation – Anterior*Patella:Lateral and Medial Patellar FacetsSuperiorAndInferiorPatellar Facets*Assess for tenderness, edema, warmth**Palpate the insertion of the patellar tendon on tibial tubercle in adolescents (location of pain in Osgood-Schlatter syndrome in adolescents)Medial FatPatLateral Fat PadPatellar Tendon**
26Palpation - Medial Medial Collateral Ligament (MCL)* Pes anserine bursa**Medial jointline*Assess for tenderness along entire course of ligament from origin on medial femoral condyle to insertion on proximal tibia.**Pes anserine bursa is about 3 finger widths inferior to the medial joint line and contains the insertion site for the sartorius, gracilis, and semitendinosis muscles
29Injury to the common peroneal nerve The common fibular nerve may be severed during fracture of the fibula neck.Results in paralysis of all muscles in the anterior and lateral compartments of the leg.The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop.Foot-drop: the foot drops and the toes drag of the floor when walking.
31PNS Throughout Life Dermatome – an area of skin Innervated by cutaneous branches of a single spinal nerveEmbryonic muscles migrate to new locationsSome skin dermatomes become displacedMuscles and skin always retain their original nerve supply
33Innervation of the Skin: Dermatomes Upper limb – skin is supplied by nerves of the brachial plexusLower limb:Lumbar nerves – anterior surfaceSacral nerves – posterior surface
34Elsie (L.3 ) is trying to rescue her clumsy man Slim (SI) from a septic tank (SciaTIC nerve), using a rope and a balloon. He has some GLUe (nerves to GLUteus muscles) on his leg. She is pregnant· is FEMale (FEMoral nerve) and has an OBstetric condition (OBturator nerve).
37lumbar disc herniation Disc Level Root Comp. Weakness Reflex Involvement Sensory Loss Pain Distribution L3-L4 L4quadriceps, tibialis anteriorknee jerkmedial knee and shinanterior thigh L4-L5 L5extension of big toeno significantbig toeback of thigh, lateral calfL5-S1 S1gastrocnemius (ankle plantar flexion) Achilleslateral foot and heelback of thigh and calf
38Lower limb dermatomes L1 Dermatome: over trochanter and groin L2 Dermatome: front of thigh to kneeL3 Dermatome: upper buttock, anterior thigh and knee, medial lower legL4 Dermatome: lateral Buttock, lateral thigh, medial leg, dorsum of foot, big toeL5 Dermatome: Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toesS1 Dermatome: Buttock, thigh, and posterior legS2 Dermatome: Buttock, thigh, and posterior legS3 Dermatome: Groin, medial thigh to kneeS4 Dermatome: Perineum, genitals, lower sacrum