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Ankle and Foot Region

1. Lumley JSP. (2002) Surface Anatomy: the Anatomical Basis of Clinical Examination. New York: Churchill Livingstone. pp.55-63
2. Neumann DA (2002).  Elbow and Forearm Complex.  In Neumann DA: Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. Philadelphia: Mosby.  Chapter 14, pp. 477-171
3. Smith L.K., Weiss E.L., Don Lehmkuhl L., 1995. Brunnstrom's Clinical Kinesiology, 5^th ed. FA Davis. Chapter 5, pp. 157-179

About Ankle and Foot Region

Functions

Articulations

	ankle region talocrural joint： ankle joint superior and inferior tibiofibular joints
		foot region： all structures distal to the tibia and fibula subtalar joint midtarsal joint 5 rays 5 metatarsophalangeal joints 4 proximal interphalangeal (PIP) joints 4 distal interphalangeal (DIP) joints interphalangeal joint of big toe

Bones

ankle region： distal tibia / distal fibula rearfoot： talus / calcaneus midfoot： navicular / cuboid / 3 cuneforms forefoot：5 metatarsals / 5 proximal phalanges / 4 middle phalanges / 5 distal phlanges

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Ankle Region

Arthrology

Humeroulnar joint

concave on convex joint proximal component： hourglass-shaped trochlea (trochlea=pulley) distal component： saddle-shaped trochlear notch / olecranon and coronoid processes joint type： 1 degree-of-freedom hinged joint (slight saddle shape only) (Note： total DOF of the whole elbow complex = 2) movements： elbow flexion elbow extension

Articulations within the elbow and forearm region

Humeroradial joint

concave on convex joint proximal component： spherical (ball-shaped) capitulum / radial fossa distal component： cup-shaped radial head joint type： 1 degree-of-freedom ball-and-socket joint

movements： elbow flexion with anterior glide of the radial head on the capitulum of the humerus elbow extension with posterior glide of the radial head on the capitulum of the humerus

Articulations within the elbow and forearm region

Palpable bony landmarks

lateral epicondyles medial epiconduyle axis of rotation of the elbow joint： the line passing through the centers of the trochlea and the capitulum of the humerus shaft of the humerus

1. With the forearm supported and the palm facing anteriorly, the lateral epicondyle is the enlarged bony prominence located at the lateral aspect of the distal humerus while the medial epicondyle is  located at the medial aspect of the distal humerus.  Note that the lateral epicondyle extends more distally than the medial one.
   
   
2. Have the index of your right hand pointing the tip of the lateral epicondyle and that of your left hand pointing the tip of the medial one, the line connecting both indices is close to the axis of rotation of the elbow joint. Note the obliquity of this axis.
   
   

bones within the elbow and forearm region

olecranon process shaft of the ulna carrying (cubital) angle： the valgus angle between the shaft of the humerus and the forearm

1. Bend the subject's elbow to 90º of flexion. The tip of the elbow is the olecranon process.
   
   
2. Have the subject's elbow extended and forearm supinated.  Find and mark the longitudinal axes (midlines) on the anterior aspect of the humerus and the ulna carefully, inspect the carrying angle and measure it using the universal goniometer.
   
   

1. Have the subject's elbow extended.  The palpating finger moves distally and you can find a groove where is the joint line of the humeroradial joint.  The part just below this groove is the head of the radius.  Rotate the forearm slowly.  Carefully feel the round shape of the rim of the radial head.  Then, try to find it when the elbow is flexed.
   

Palpable ligaments or other collagenous tissues

Palpable muscles and tendons

	biceps brachii origin： long head： supraglenoid tubercle of the scapula short head： coracoid process of the scapula insertion： radial tuberosity of the radius actions： elbow flexion with forearm supinated； forearm supination； shoulder flexion
	innervation： musculocutaneous nerve (C5-C6)
	brachiallis origin： middle area of the shaft of the  humerus insertion： coronoid process of the ulna actions： elbow flexion innervation： musculocutaneous nerve (C5-C6)
	brachiradialis origin： a ridge on the humerus above the lateral epicondyle insertion： styloid process of the radius actions： elbow flexion innervation： radial nerve (C5-C6)

1. Have the subject's elbow flexed and forearm supinated.  The tendon of the biceps brachii is identified in the antecubital fossa. Make a fist and see the contraction of the biceps brachii.
   
   
2. Grasp the tendon of the biceps brachii and then move your fingers up to the lower 1/4 end of the humerus.  Have the forearm rest on the lap and pronated in order to relax the biceps.  Have the subject bend the elbow isometrically with as little effort as possible.  You can feel the contraction of the brachialis.
   
   
3. Have the subject bend the elbow to 90º of elbow flexion and the forearm in the midposition of pronation and supination.  Give resistance to elbow flexion, and the you can see the whole contour of the brachioradialis on the forearm.  Feel the full course of this muscle.
   
   

1. Have the subject elevate the arm to 150º of shoulder abduction and bend the elbow to 90º of flexion.  The triceps brachii can be identified in the posterior aspect of the humerus when the resistance is given to extension of the elbow.
   
   
2. Have the subject bend the elbow to 90º of flexion.  The anconeus is palpated between the lateral epicondyle of the humerus and the olecranon process of the ulna when the resistance is given to flexion of the eblow.
   
   

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Rearfoot Region

Arthrology

subtalar joint

convex on concave joint proximal component： concave radial notch of the ulna distal component： convex rim of the head of the radius joint type： 1 degree-of-freedom pivot joint or trochoid joint movements： forearm pronation with posterior glide of the radial head forearm supination with anterior glide of the radial head

Articulations within the elbow and forearm region

distal radioulnar joint

convex on concave joint proximal component： convex  head of the ulna distal component： concave ulnar notch of the radius joint type： 1 degree-of-freedom pivot joint movements： forearm pronation with anterior glide of the radial head forearm supination with posterior glide of the radial head

Articulations within the elbow and forearm region

Bony landmarks

1. Have the subject's elbow extended and forearm supinated.  The rim of the radial head is easily identified at the lateral aspect of the proximal radius.
   
   
2. The head of the ulna is found at the wrist area on the medial (ulnar) side.  Have the forearm turn pronation and supination slowly, you can see that the ulnar head becomes more prominent in the forearm pronated position than in the supinated position.  If the ulnar head is extremely prominent, then check the arthrokinematic movements of the distal radioulnar joint.
   
   
3. The line connecting the above two heads is the axis of rotation for forearm rotation.
   

Palpable muscles and tendons

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