ANATOMY - VIVA Flashcards
(21 cards)
ASIS
Palpate medially from the iliac crest until you find a sharp drop
The ASIS started off the femoral triangle as the inguinal ligament is attached to it. It also attaches to many abdominal muscles and the sartorius muscle.
The anterior inferior iliac spine can’t be palpated as it’s under muscle.
Iliac crest
To palate the anterior portion, run fingers medially from side until you find the highest point
The iliac crest runs posteriorly right to the midline
If you keep palpating past the highest point you will find a sharp drop, this is the ASIS
Pubic symphysis
Travel medially from the ASIS OR start at umbilicus and palpate downwards, the pubic symphysis is the only bone that you will find.
The pubic symphysis is the other point of attachment for the inguinal ligament, which also attaches to the ASIS. This ligament makes up the superior border of the femoral triangle.
Femoral triangle
Borders and why important
Superior border = inguinal ligament (attaches to ASIS and pubic symphysis)
Other borders are sartorius and adductor longus
Important as there are no muscles protecting the front of it
Structures are the femoral artery, vein and nerve
Posterior superior Iliac spine
Posteriorly, follow the iliac crests all the way back until you find a sharp dip and bumps preceding it
These are the posterior superior iliac spines
Some people you don’t need to palpate to find these as they have dimples which indicate their position, these are called the dimples of venus
Sacroiliac joints are deep to these spines
Ischial tuberosity
Lie patient prone and let them relax their back. Palpate in the fold of the buttock, up to the ischial tuberosity. Sometimes have to palpate while client is sitting down to see if they are weight bearing evenly on these.
These are important as they are what we weight bear on when sitting down. The area around these can also become tender as there may be tears in any of the three hamstring muscles that attach to this. Also are at the site close to which the sciatic nerve passes
Greater trochanter
Lie patient supine. Palpate from the ASIS to the lateral aspect of the leg, moving inferiorly and pushing gently into the body to feel for the bony prominence. Can feel the superior and posterior aspects of the greater trochanter.
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Gastrocnemius
The gastrocnemius is the most superficial muscle of the posterior aspect of the lower leg. It also acts as a plantar flexor of the ankle. With soleus, gastrocnemius inserts onto the posterior aspect of the calcaneus bone via the Achilles’ tendon.
Ask client to stand on toes,this further defines the medial and lateral bellies of the gastrocnemius.
Soleus
Alike gastrocnemius, soleus is also an ankle plantar flexor. You can see soleus emerging from underneath the bellies of the gastrocnemius. Can only see and palpate the lower portion of soleus as the rest is deep to gastrocnemius.
Soleus inserts onto the posterior part of the calcaneus bone via The Achilles/calcaneal tendon.
More defined when patient stands on their toes.
Achilles’ tendon
This tendon is often mistaken for a bone and the gastrocnemius and soleus insert onto the calcaneus bone through this tendon.
By plantar flexing the foot, the tendon becomes more visible and easier to palpate.
Calcaneus
Palpate posteriorly from the lateral malleolus of the ankle and you will find the posterior aspect of the calcaneus.
It isn’t possible to palpate all of the calcaneus due to its positioning in the foot. This bone is the insertion point for both the gastrocnemius and soleus muscles.
Lateral malleolus
Starting laterally on the leg, you can see that the fibula has come down and become the lateral malleolus.
Posterior to this is the calcaneus bone, and distal to this is the cuboid bone and the base of the 5th metatarsal.
Base of 5th metatarsal
To find this, move distally along the foot from the lateral malleolus. There is a fleshy dip in the foot and the cuboid bone is in this area. Further distally you will come to a large bump, and this is the base of the fifth metatarsal.
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Medial malleolus
You can palpate for the medial malleolus above the medial longitudinal arch of the foot. This malleolus is part of the tibia bone. Approximately two finger width anterior to the medial malleolus there you can feel a bump, this is the tubercle of the navicular bone.
Navicular bone
Approximately two finger widths from the medial malleolus you will feel a bump, this is The tubercle of the navicular bone.
Anterior to this are the metatarsal bones. These bones are quite easy to feel, both from the plantar and dorsal aspects of the foot. Further distally from these bones and the navicular tubercle are the metatarsophalangeal joints. The first of these is the most prominent and also the most prone to develop osteoarthritis and rheumatoid arthritis.
Dorsalis pedis pulse
The dorsal is pedis pulse comes down from the anterior tibial artery and arches towards the lateral aspect of the foot. When it arches it gives off a lot of tibbitaries (?) towards the toes and the plantar aspect of the foot.
To find the pulse, palpate between the tendons of extensor hallucis longus and extensor digitorum longus. Extend the toes to see the extensor hallucis longus tendon and palpate laterally to it to find the pulse. This pulse doesn’t project onto the metatarsal bones.
Extensor hallucis longus
Extend big tow and able to see its tendon.
This tendon can be used as a reference point to find the Dorsalis pedis pulse, which lies laterally to it.
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Extensor digitorum longus
Extend the toes and can see its tendons going to the lateral four toes.
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Tibialis anterior
Dorsiflex and invert foot and can see the tendon of Tibialis anterior.
Can’t palpate where this muscle inserts under the foot as it is covered in layers of muscle, but can easily see from the anterior aspect.
Info
Fibularis tertius
Dorsiflex ankle and invert foot and can see fibularis tertius tendon from the lateral aspect of the foot.
This tendon moves from the anterior compartment of the leg and inserts on the bone of the fifth metatarsal. Info
Fibularis longus and brevis
Both originate on the fibula bone and work to evert the ankle. They are the two most strong ankle evertors. If the patient everts their ankle you can clearly see fibularis brevis as it heads distally, behind the lateral malleolus and inserts on the base of the fifth metatarsal. Fibularis longus also travels behind the lateral malleolus before inserting deep under the foot, however it is behind and slightly deep to fibularis brevis and hence you can’t always see it.
