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and fibula, and the trochlea of the talus fits into this. The malleoli of the tibia and fibula constrain the talus forming a hinge joint providing plantarflexion

joint is to absorb the rotation of the lower extremity during the support phase of gait. When the foot is fixed on the ground, the femur and tibia rotate

information. The hip joint is a synovial joint between the femoral head and the acetabulum of the pelvis. The hip is a ball and socket joint. The ball is the spherical

dorsiflexion of the proximal phalanx in hallux rigidus. The windlass mechanism of the plantar aponeurosis provides stability to the medial aspect of the foot with

function to those of the metatarsophalangeal joints. There is a limited range of motion. Generally flexion is greater than extension. The proximal interphalangeal

information. The intertarsal joints include the three cuneonavicular joints, the intercuneiform joints, the cuboideonavicular joint, and the cuneocuboid

calcaneocuboid joint), and the articulation of the talus with the navicular (the talocalcaneonavicular joint). This pair of joints separates the midfoot from the

arm of the posterior oblique ligament. Laterally the insertions are the meniscofemoral portion of the joint capsule, the fabella when present, and the lateral

structure of the body wall or limbs. A number of structures in the lumbar spine are capable of nociception including the lumbar zygapophysial joints, intervertebral

Anatomy Lumbarisation of S1 occurs in around 2% of the population. Sacralisation of L5 occurs in around 17% of the population. In a study of 147 subjects, 24

asymmetrical, with the large joints of the lower limbs being predominantly affected in peripheral spondyloarthritis. The age of onset is typically under

within 2cm of the centre of the sacrum. When the C7 plumb line sits to the left of the sacrum there is a negative coronal balance, when it sits to the right

Myalgias in rare disease (e.g., Stiff Person Syndrome), Myalgias with lesions of the central and peripheral nervous system Medication: opioids, statins, aromatase

aneurysm of the descending thoracic aorta. Fracture DISH and ossification of the posterior longitudinal ligament Tumours Infections (bones, joints, discs

with the first rib. The clavicle is the first bone to ossify, and this occurs in the fifth week of gestation. Meanwhile, the medial physis of the clavicle

Inflammatory arthritis Osteochondral lesion medial femoral condyle (lateral aspect of medial epicondyle most common) Saphenous Nerve Entrapment Medial friction

process of the vertebra above glides along the superior articular process of the vertebra below. During whiplash, the axis of rotation is located in the moving

should be aware of but not necessarily competent in. With the patient standing: Look at the spine from the side and from behind Look at the skin and natal

A high lesion of the tibial nerve results in Loss of flexion of the toes and inversion of the foot. Loss of sensation of the sole of the foot, inferior

decussation the fibres of the dorsal column form the medial lemniscus, ascend through the brainstem, and synapse in the ventral posterior nucleus of the thalamus

impingement of the L5 nerve root between the L5 transverse process and the ala of the sacrum Degenerative scoliosis with tilting of L5 and depression of the concave

stability to the medial aspect of the foot through the windlass mechanism of the plantar aponeurosis. As the body passes over the foot in toe-off, the metatarsal

regions. The medial side of the lower leg was subserved by L4 in 88%, the side of the first dorsal digit was subserved by L5 in 82%, and the side of the fifth

midline of the trunk posteriorly, across the buttock, through the lateral side of the thigh, the lateral side of the leg, and the medial side of the dorsum

originates from the posterior femur and crosses both the knee and the ankle joints. The terminal branches of the tibial nerve provide sensation to the posterior

weakness of the shoulder and upper arm but spares the hand, or the lower plexus (C7 to T1) as a group which causes weakness of the hand but spares the shoulder

is produced by the acetabular fossa, a depression in the centre of the acetabulum. The femoral head, the convex component of the ball-and-socket configuration

associated with lower limb and hand osteoarthritis, chronic pain, and disability. The rates of obesity have been increasing in New Zealand. In the New Zealand

upper limb, the posterior or anterior chest wall, the abdominal wall, the lower limb girdle and the lower limb. The distribution of referred pain in the

v t e Muscles of the Hip and Lower Limb Iliac region Iliopsoas psoas major/psoas minor iliacus Buttocks

innervate the source of the pain. The mechanisms is convergence. Sources in the cervical spine can have pain referred to the head, upper limb, interscapular

ligament, pass from the tip of the medial malleolus to the non-articular part of the medial talar surface crossed by the tendons of the tibialis posterior

following a bout of increased physical activity. The pain is primarily in the lower limbs, however upper limb pain can occur in conjunction. The pain is typically

centration of distal and peripheral joints Timing between the function of stepping forward and support of the extremities Range of motion of the upper and

require endrange flexion of the lower cervical spine and so can be used to assess C0-C2 rotation mobility in the presence of lower cervical spine pain and

medium into the joints or by electrical stimulation of the dorsal rami. Below shows the main pain distributions from C0-1 to C7/T1, and the dorsal rami C3

below the ribs at the trigonum lumbale. Palpate to examine the postural function of the diaphragm, feeling for the ability of the diaphragm to lower and

commonly at C3/4. In the lumbar spine, the zygapophysial joints face posteriorly and laterally, and share little of the axial load. The joints resist axial rotation

is in the hand unlike what is seen with skin. The muscle segments of the proximal limb contain C5-C8, the mid limb C6-C8, and the hand C8-T1. In the limbs

distal pattern. Usually the lower limbs are affected earlier and more severely than the upper limbs, and the trunk and head are the last to be affected and

Osteoarthritis Disorder of the synovial joints of the cervical spine (zygapophyseal joints and atlanto-axial joints), characterised by osteophytes, joint narrowing,

from the inferior aspect of the labrum and inserts on the anatomic neck of the humerus. It is the prime anterior stabiliser of the shoulder in the 90° abducted

portion of the ligament. It doesn't cover the anulus fibrosis, but blends with the upper and lower borders of the AF just anterior to that of the posterior

Conversely, forces from the lower limbs can be transmitted up from the lower limbs into the pelvis, sacrum, and spine. The sacroiliac joint is around 1-2mm wide

soft tissues range of motion of the wrist and elbow gross alignment of the limb congruity of the elbow and wrist joints on x-ray status of nerves: radial (including

(ankle) joint and ends at the calcaneocuboid joint (Figure 1). The bones of the hindfoot are the talus (lower bone of the ankle joint) and the calcaneus

men, with 18% of women over the age of 60 and 10% of men over the age of 60 experiencing symptoms of OA. In New Zealand, the prevalence of OA is approximately

characteristic regions of pelvic avulsion (Figure 5): the ischial tuberosity, by the pull of the hamstring muscles; the inferior pubic ramus by pull of the adductor

evidence for the use of NSAIDs in the short term, with naproxen being more effective than placebo. There is no evidence to support the use of ultrasound

distribution of different parts of the body. This may include the face, mouth, scalp, trunk and upper limbs before or at the same time as the lower limbs are affected

Greater trochanter of the femur. Three points of insertion: tendinous portion of the aponeurosis inserts onto the superolateral facet, the remainder inserts

to perineum and levator ani Yoo et al.. An appraisal of the short lateral rotators of the hip joint. Clinical anatomy (New York, N.Y.) 2015. 28:800-12.

(most common) Zygapophysial joint pain Discogenic pain Interspinous ligament pain Costovertebral joint pain Costotransverse joint pain Fracture Infection Malignancy

usually from the upper cervical segments (C2-3 most commonly), and pain in the lower half of the neck is usually from the lower cervical segments (C5-6

mechanical alignment of the limbs. For unequal limb lengths, procedures to lengthen the short bone can be performed or the growth of the longer bone can be

as per the Cobb method) of the spine in the coronal plane, uncorrectable by voluntary or passive movement, and accompanied by axial rotation of the vertebrae

structure of the body wall or limbs. A number of structures in the lumbar spine are capable of nociception including the lumbar zygapophysial joints, intervertebral

fractures (fibula, posterior cortex of the tibia) Vascular abnormalities - entrapment of popliteal artery, endo-fibrosis of external iliac artery, aneurysm

Arthritis (RA, hydroxyapatite deposition, Spondyloarthritis) Acromioclavicular Joint Osteoarthritis or separation Shoulder Labral Tear Quadrilateral Space Syndrome

hip Septic arthritis of the sacroiliac joint Lyme disease Osteomyelitis of femoral head or pelvis Psoas abscess Appendicitis or abdominal/pelvic abscess

Lisfranc joint injury (fracture or dislocation) Osteoid osteoma CRPS Corns, calluses Onychocryptosis Synovitis of the MTP joints First MTP joint sprain Subungual

The following is the differential diagnosis for abdominal wall pain, i.e. suggested by a positive Carnett Sign. These are not in order of frequency as

Diagnosis Checklists Coombes et al.. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. The Journal of orthopaedic and sports physical therapy

midline of the trunk posteriorly, across the buttock, through the lateral side of the thigh, the lateral side of the leg, and the medial side of the dorsum

posterior scrotal♂ / labial♀ dorsal of the penis♂ / clitoris♀ anococcygeal Related Nerve supply of the human leg

Tunnel Syndrome Posterior Ankle Impingement Referred Pain from the lumbar spine Complications of acute ankle injuries Os tibiale externum (accessory navicular)

involving the upper limbs. Cervical MRI is normal. Winging of the scapula is either static or dynamic. Static winging is due to a fixed deformity of the shoulder

off): This is the start of single limb support for the contralateral limb. It is from elevation of limb to point of maximal knee flexion. The hip flexors

adductor and medial rotator of the thigh, as well as assisting in flexion of the knee joint. It also plays a role in stabilizing the knee during standing and

occur in the remaining stance phase. Lengthens the lever arm of the quadriceps muscle force about the centre of rotation of the knee, increasing the mechanics

Winzenberg 2015 . Costochondritis Lower rib pain syndromes (slipping rib syndrome) Pain from thoracic spine costovertebral joints interspinous ligaments and paravertebral

history, multiple joint involvement. The knee is the most common peripheral site of cancer. The most common peripheral site of cancer is the distal femur,

Discogenic pain, Facet joint pain, Hip disease, Spinal stenosis, Flail coccyx (coccydynia), S1 foraminal stenosis Sacroiliac Joint Pain Differential Diagnosis

spine Referred Lumbar Spine or Sacroiliac Joint pain Hip joint causes Hip joint osteoarthritis Other hip joint causes Extra-articular hip causes Gluteus

Coccygeal disorders: fracture or dislocation, sacrococcygeal joint hyper or hypomobility, coccygeal joint hypermobility, bone spicule Referred spinal pain Pelvic

article is a stub. The gluteus maximus muscle is the largest and most superficial of the three gluteal muscles. During the normal gait, the hamstrings provide

components. The pyramidal and extrapyramidal levels of the motor system converge on the "final common pathways" which are the lower motor neurons of the brain

Ganglion Cyst Fracture Malunion Hardware Complications Distal Radioulnar Joint Instability Carpal Translocation Madelung Deformity Differential Diagnosis

Gluteal Tendinopathy Somatic Referred Pain from the Lumbar Spine or Sacroiliac Joints Calcific Tendinopathy of the abductor tendons Hip Osteoarthritis Meralgia

syndrome of the thigh Endometriosis Diabetic radiculopathy or plexopathy Acute retroperitoneal haematoma or abscess Iliacus Pyomyositis Tumours of the femoral

a source of pain and disability. Knee and hip osteoarthritis may develop in the longer limb. Examine from behind looking at the levels of the PSIS, inferior

Coccydynia Upper Limbs Sternoclavicular Joint Pain Shoulder Pain and Instability Elbow Pain Wrist Pain and Instability Neuropathic Arm Pain Lower Limbs Hip Pain

lever arm distance of the muscle enabling greater flexion torque at the first MTPJ by moving the tendon away from the centre of the joint Extrinsic extensors

osteoarthrosis Somatic Referred Pain from the Lumbar Spine or Sacroiliac Joints Calcific Tendinopathy of the abductor tendons Meralgia paresthetica Snapping

within the psoas muscle. It contains the canterior rami of the T12 to L4 nerve roots. Only the femoral nerve can be reliably tested by EMG. The lateral

SDyndrome Joint Hypermobility in Myopathies - Voermans 2009.pdf - 462 KB (f) Tofts et al.. The differential diagnosis of children with joint hypermobility:

apophysitis/avulsion fracture Posterior thigh compartment syndrome Myositis ossificans of the hamstring muscle Pelvic bone tumours Iliac artery endofibrosis Apophysitis

Posttraumatic vertigo Hyperventilation Malingering Multisensory disequilibrium of the elderly Unknown Differential Diagnosis Checklists

Rheumatic fever Systemic lupus erythematosus Viral arthritis Lyme disease Joint Aspiration Differential Diagnosis Checklists

Insertion As part of the pes anserine tendon, onto the medial superior tibia Action flexes knee joint, medially rotates knee joint (when the knee is flexed

v t e Muscles of the Hip and Lower Limb Iliac region Iliopsoas psoas major/psoas minor iliacus Buttocks

Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis Osteoarthritis of the radiocarpal joint Ganglia Radial sensory nerve entrapment in the forearm Crystal-induced

tuberosity As part of the pes anserine tendon, onto the medial superior tibia flexes knee joint, medially rotates knee joint (when the knee is flexed beyond

Soft tissue injuries Occult cervical spine fracture or instability Tumours of the neck, hypopharynx, or lung apex. Sialadenitis Odontogenic pain Temporomandibular

Cubital Tunnel Syndrome (Ulnar neuropathy at the elbow) Guyon's Canal Syndrome Radial Nerve Radial Neuropathy at the Spiral Groove (Saturday Night Palsy) Posterior

v t e Muscles of the Hip and Lower Limb Iliac region Iliopsoas psoas major/psoas minor iliacus Buttocks

v t e Muscles of the Hip and Lower Limb Iliac region Iliopsoas psoas major/psoas minor iliacus Buttocks Thigh / compartments

surfaces of two adjacent vertebrae as a result of a change of the position of the fluid in the nucleus There are no formal population studies on the incidence

increase in the production of proteoglycans and collagen. The proteoglycan content leads to separation of the collagen and disorganisation of the matrix. The