Question

Case scenario

Mr. C, 50 years old, is an amateur soccer player who regularly plays with his friends over weekend. He has chronic anterior right hip pain and weakness over his groin region for 5 years. One day, when he was playing soccer, he was injured by another player who crushed on him from lateral side of his left leg. Then, he fell down on the grassland after twisting his left knee and ankle due to the crush. He started to feel pain and weakness over his left leg from knee to ankle. He could not move his left leg to stand up. When he fell down, he fell on the leg of that player which caused pain, swelling, numbness and weakness over the posterior side of his own left leg. Then, he was send to the emergency room of a nearby hospital. The doctor of the emergency room of the hospital assessed his legs and arranged X-ray check for him. Your supervisor asked you to identify all key anatomical structures in the initial assessment that are related to his hip, knee and ankle discomfort according to the above information. You need to provide clear rationale to support your answers when you report to your supervisor.

Please answer according to the following guidance:

1. What bone(s), bony landmark(s) and joint(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

2. What muscle(s) and soft tissue(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons. The relevant origin and insertion should be included.

3. What nerve (nerves) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

4. What artery (arteries) and vein (veins) are involved in his problems mentioned above? Please list out accordingly and support with corresponding reasons.

5. What lower limb functional movements that can be affected according to his leg conditions? Why?

Answer 1

1. What bone(s), bony landmark(s) and joint(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

Hip bones are the connecter for  the axial skeleton to the lower limbs which form pelvic girdle. Hip bone contains three bones called  the ilium, pubis and ischium and together they form a cup-shaped socket known as the acetabulum which articulates with the head of the femur.

Ankle joint is the synovial joint and functionally hinge joint found in the lower limb comrise tibia, fibula and talus.

Thigh region connects the hip bone and the lower limb and comprise  the hip joint and knee joint. There are totally 30 bones in the lower limb that includes  femur, patella, tibia, fibula, tarsal bones, metatarsal bones, and phalanges. Knee joint is a ball and socket joint enclosed in kneecap called patella. It articulates with femur, fibula and tibia. Tibia is located on the medial side of the leg and it is the weight-bearing bone. Whereas, fibula is the thin bone of lateral leg. Any injury or trauma to this bone affect the lower limb and ability to walk.

2. What muscle(s) and soft tissue(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons. The relevant origin and insertion should be included.

Muscles of the hip are iliopsoas, rectus fermoris together called as anterior muscles and posterior muscles are hamstrings and luteus maximus those help to move hip backward and forward. The leteral muscles which aid in abduction are gluteus minimus, gluteus medius and tensor fascia latae. Hip is lined with various soft tssues like tendons and bursae to aid the movement with ease. Knee joint is also connected with quadriceps muscles composed of astus lateralis, vastus intermedius, vastus medialis, and rectus femoris and hamstring muscles. It forms the anterior thigh. Various ligaments like Anterior Cruciate Ligament ACL and PCL , tendons and soft tissues are needed to maintain flexibility, stability, and strength. Sprains are the painful injury which occurs due to overstretching of ligaments beyond its normal range . Ankle sprains arise due to sudden twisting, turning or rolling movements. The major ligaments of ankle are: anterior tibiofibular ligament, lateral collateral ligaments and the deltoid ligaments. The muscles of ankle are : gastrocnemius, soleus, peroneus longus, peroneus brevis, tibialis posterior, flexor hallucis longus and the flexor digitorum longus.

Injury to lateral leg cause muscle ligament torn which affect the range of motion, Anterior compartment syndrome also arise as a consequence of injury during which the pressure gets elevated account for the pathophysiology.

3. What nerve (nerves) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

Nerves of lowe limbs are sciatic, common fibular and tibial nerve. Sciatic nerve run through the hips, buttocks and down the leg and end just after the knee. Tibial nerve run along the tibia bone.The femoral nerve is located in the pelvis and runs through the front leg. It performs hip movement and straightening of leg. Thigh region connects the hipand the lower limb. Any injury or trauma to these area is sensed by these nerve endinds and damage to these nerve affect the motor nerves of lower limb and ability to walk.

4.What artery (arteries) and vein (veins) are involved in his problems mentioned above? Please list out accordingly and support with corresponding reasons.

Superficial circumflex iliac, peronial, anterior tibial, posterior tibial, dorsalis pedis are major arteries and veins of lower limb. Femoral artery is the largesta rtey of the lower limb which branches off to popliteal artery to supply blood to the knee and terminates at the anterior and posterior tibial arteries. Swelling and numbness is due to the inflammation due to the injury.

5. What lower limb functional movements that can be affected according to his leg conditions? Why?

Sprains is the most common injury of lower leg often occur in lateral ligaments of the ankle.The functional movements of this are incude abduction, adduction, flextion and extensions might be affected in this condition.