By Diana Lacraru

Senior physiotherapist at St Lukes

Hospital

19/11/2014

Articulatia
Ligamente

Musculatura
Inervare

19/11/2014

Musculara
Articulara

Ligamentara
Integritate

nervoasa

19/11/2014

Spate/

pelvis

Sold

Glezna
Piciorul

19/11/2014

19/11/2014

19/11/2014

Linia

superficiala spate (posterioara)

Linia superficiala fata (anterioara)
Linia laterala
Linia in spirala
Liniile functionale
Linia profunda -fata

19/11/2014

Bony station

Myofascial tracts

Frontal lobe, supraorbital

ridge
13
12
Occipital ridge

Galea aponevrotica/ epicranial fascia

11
10

Sacrum

Sacrolumbar fascia/erector spinae

9
8

Ischial tuberosity

6
Condyles of femur

Hamstrings

5
4

Calcaneus

Sacrotuberous ligament

Gastrocnemius/Achilles tendon

2
Plantar surface of toe
pnalanges

19/11/2014

Plantar fascia and short toe flexors

Bony Station

Myofascial tracts
15

Mastoid process

Scalp fascia

14
13

Sternal manubium

Sternocleido mastoid muscle

12

11
5th rib

Sternalis/Sternocondral fascia

10
9

Pubic tubercle

Anterior inferior iliac spine

7
6

Patella

Rectus abdominis

Rectus femoris

5
4

Tibial tuberosity

Subpatellar tendon

3
2

Dorsal surface of toe phalanges

19/11/2014

Short and long toe extensors, Tibialis

anterior, Anterior crural compart.

Bony Station

Myofascial tracts

Occipital ridge/Mastoid process

19
17,18
1st and 2nd ribs

Splenius capitis/ Sternocleido mastoid

16
14,15

Ribs

External and Internal Intercostalis

13
12,11

Iliac crest, ASIS, PSIS

Lateral abdominal obliques

9,10

Lateral tibial condyle

Gluteus maximus

Tensor Fascia Latae

Iliotibial Tract/ Abd muscle

5
4

Fibular head

Anteriore ligament of the head of fibula

3
2

Peroneal muscle, lateral crural

compartiment

1st and 5th metatarsal bases

19/11/2014

10

Bony stations

Myofascial tracts

Occipital ridge/mastoid process,

atlas/axis

1
2 Splenius capitis and cervicis

Lover cervical/upper thoracic spinal

processes
Medial border of scapula
Lateral ribs

Iliac crest/ ASIS

Lateral tibial condyle
1st

metatarsal base

Fibular head
Ischial tuberosity
Sacrum
Occipital ridge
19/11/2014

4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23

Rhomboids major and minor

Seratus anterior
External oblique
Abdominal aponeurosis, linea alba
Internal obliques
Tensor fascia latae, Iliotibial tract
Tibialis anterior

Peroneus longus
Biceps femoris
Sacrotuberous ligament
Sacrolumbar fascia, Erector spinae

11

Bony stations
BACK FUNCTIONAL LINE
Shaft of Humerus

Sacrum
Shaft of femur

Patella
Tuberosity of tibia
Bony stations
FRONT FUNCTIONAL LINE
Shaft of humerus
5th rib and 6th rib cartilage
Pubis tubercle and symphysis
Linea aspera of femur
19/11/2014

Myofascial tracts
1
2
3
4
5
6
7
8
9
10
11

Latissimus dorsi
Lumbosacral fascia
Sacral fascia
Gluteus maximus
Vastus lateralis
Subpatellar tendon

Myofascial tracts
1
2 Lover edge of pectoral major
3
4 Lateral sheath of rectus abdominis
5
6 Adductor longus
7
12

Bony stations
LOWEST COMMON

Myofascial tracts

Plantar tarsal bones, plantar surface of toes

Superior/posterior tibia, fibula

1
2
3

Medial femoral epicondyle

4
5

Tibialis posterior, long toe flexors

Fascia of popliteus, knee capsule

LOWER POSTERIOR
Medial femoral epicondyle

5
Posterior intermuscular septum, add magnus and minimus

Ischial ramus

6
7
8
9

Pelvic floor fossa, levator ani, obturator internus fascia

Coccyx

10
11

Lumbar vertebral bodies

Anterior sacral fascia, Anterior longitudinal ligament

LOWER ANTERIOR

Medial femoral epicondyle

Linea aspra of femur

12
13
14

Anterior intermuscular septum, Add brevis and longus

Lesser trochanter of femur

15
11

Psoas, Iliacus, Pectineus, Femoral triangle

Lumbar vertebral bodies and transvers processes

UPPER POSTERIOR
Lumbar vertebral bodies

11

Basilar portion of occiput

16
17

Anterior longitudinal ligament, Longud colli and capitis

UPPER MIDLINE
Lumbar vertebral bodies

11
18
19
20

Basilar portion of occiput, cervical transverse processes

Posterior diaphragm, Cura of diaphragm, central tendon

Pericardium, mediastinum, parietal pleura
Fascia prevertebralis, pharyngeal raphe, scalene muscles, medial scalene
fascia

17

UPPER ANTERIOR

Lumbar vertebral bodies

11
Posterior diaphragm, Cura of diaphragm, central tendon
Anterior diaphragm

Posterior surface of subcostal, cartilages, xiphoid process

18
21
22
23
24

Fascia endothoracica, transverses thoracis

Posterior manubrium

25
26

Infrahyoid muscle, fascia pretrachialis

Hyoid bone

27
28

Suprahyoid muscle

Mandible

19/11/2014

13

19/11/2014

14

19/11/2014

15

Journal of Anatomy
Volume 223, Issue 4, pages 321328, October 2013
Anatomy of the anterolateral ligament of the knee
Steven Claes1,*,
Evie Vereecke2,
Michael Maes1,
Jan Victor3,
Peter Verdonk4,
Johan Bellemans1
Article first published online: 1 AUG 2013
DOI: 10.1111/joa.12087
19/11/2014

16

Abstract
In 1879, the French surgeon Segond described the existence of a pearly, resistant,
fibrous band at the anterolateral aspect of the human knee, attached to the
eponymous Segond fracture. To date, the enigma surrounding this anatomical structure
is reflected in confusing names such as (mid-third) lateral capsular ligament, capsuloosseous layer of the iliotibial band or anterolateral ligament, and no clear anatomical
description has yet been provided. In this study, the presence and characteristics of
Segond's pearly band, hereafter termed anterolateral ligament (ALL), was investigated
in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its
course and its relationship with nearby anatomical structures were studied both
qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was
found as a well-defined ligamentous structure, clearly distinguishable from the
anterolateral joint capsule. The origin of the ALL was situated at the prominence of
the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral
ligament, although connecting fibers between the two structures were observed.
The ALL showed an oblique course to the anterolateral aspect of the proximal
tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior
lateral geniculate artery and vein. Its insertion on the anterolateral tibia was
grossly located midway between Gerdy's tubercle and the tip of the fibular head,
definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct
ligamentous structure at the anterolateral aspect of the human knee with consistent
origin and insertion site features. By providing a detailed anatomical characterization of
the ALL, this study clarifies the long-standing enigma surrounding the existence of a
ligamentous structure connecting the femur with the anterolateral tibia. Given its structure
and anatomic location, the ALL is hypothesized to control internal tibial rotation and
thus to affect the pivot shift phenomenon, although further studies are needed to
17
19/11/2014
investigate its biomechanical function.

19/11/2014

18

Anterior:

extensorii genunchiului
Posteror: flexorii genunchiului
Lateral: Abd membrului inferior
Medial: Add membrului inferior

19/11/2014

19

19/11/2014

21

19/11/2014

22

Musculara

Articulara
Proprioceptiei

19/11/2014

23

Traumatica

(cazatura, lovire,
rasucire etc.)
- 24-48 ore dupa leziune RICE
Leziune de crestere
Leziuni degenerative (RA, OA)
Leziuni determinate de folosirea
repetata in pozitii inadecvate
Probleme datorita altor
articulatii/parti ale corpului
19/11/2014

24

19/11/2014

25

19/11/2014

26

19/11/2014

27

Rectus Femoris
Trigger Point Diagram

Vastus Med Trigger Point Diagram

19/11/2014

28

Adductor Longus, Brevis

Trigger Point Diagram
Gastrocnemius Trigger Point Diagram

19/11/2014

29

Hamstring Trigger Point Diagram

Popliteus Trigger Point Diagram

19/11/2014

30

Soleus Trigger Point Diagram

Plantaris Trigger Point Diagram

19/11/2014

31

Gracilis Trigger Point Diagram

Adductor Magnus Trigger Point

Diagram

19/11/2014

32

Vastus Lasterallis Trigger Point Diagram

19/11/2014

33

Vestus Intermedius Trigger Point

Diagram

Tensor Fasciae Latae Trigger Point

Diagram

19/11/2014

34

 Examinarea

in pozitie erecta
Examinarea in pozitie sezand sau culcat
Examinarea mersului (inainte si inapoi)
Examinatea stabilitatii ligamentare si
meniscale
Examinarea temperaturii, culorii,
dimenisunii-unflat sau nu
Examinarea musculara si articulara
Examinarea zonelor adiacente
EXAMINARE BILATERALA
19/11/2014

35

19/11/2014

36

19/11/2014

37

 Musculara
Ligamentara
Articulara
Proprioceptiei
Senzatiei

19/11/2014

38

Medial hamstring
semimembranos
/semitendinos

Biceps femoris

19/11/2014

39

Quadriceps testing

Sartorius testing

19/11/2014

40

19/11/2014

41

19/11/2014

42

 Lant

kinetic deschis
Lant kinetic inchis
Excentric/concentric
Greutati
Banda elastica
Gym ball
Etc.

19/11/2014

43

19/11/2014

44

19/11/2014

45

19/11/2014

46

Anamneza
Examinarea

genunchiului cat si a
altor articulatii si tesuturi
corespunzatoare
Testarea
Recuperarea
19/11/2014

47

19/11/2014

48

19/11/2014

49

www.Google.com;
Kendall et al, Muscle testing and Function with Posture
and Pain, 5th edition, 2005 , Lippincott Williams & Wilkins;
Magee. D. J., Orthopaedic Physical assessment, 5th
edition, 2008, Saunders, Elsevier;
Myers. T. W., Anatomy Trains- Myofascial meridians for
Manual and Movement Therapists, 2nd edition, Churchill
Livingstone, ISBN 978-0-443-10283-7;
Travell. J. G., Myofascial Pain and Dysfunction- The
trigger point manual, The Lower Extremities, Vol 2,
Lippincott Williams & Wilkins, 1993, ISBN 0-683-08367-8;

19/11/2014

50