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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