1. piriformis and gemelli at a normal

1.     Sagittal plane:-  The movement in the gluteal region of the hip involves flexion and extension of the muscles. During flexion the muscles involved are the Iliopsoas, rectus femoris and satorius at a normal range of 1250. In extension the muscles involved are gluteus maximus, semimembranous, semitendinosus and bicep femoris at a normal range of 10-150.


Frontal plane:- The movement in the gluteal region of the hip involves abduction and adduction of the muscles. During abduction, the muscles involved are gluteus medius, gluteus minimus and deep gluteals such as the piriformis and gemelli at a normal range of 450. In adduction the muscles involved are adductors longus, brevis and magnus, pectineus and gracillis at a normal range of 300.

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Transverse plane :- The movement in the gluteal region of the hip involves lateral rotation (external) and medial rotation (internal). During lateral rotation the muscles involved are biceps femoris, gluteus maximus and the deep gluteals such as the piriformis and gemelli  at a normal range of 450. In medial rotation the muscles involved are gluteus medius and minimus, semitendinosus and semimembranosus at a normal range of 400.



2.     The talus bone in the lower limb does not have any tendon attachment because no muscles are attached to the talus but instead many ligaments are attached promoting stability to the ankle.

The talus is joined to the calcaneus and navicular by the talocalcaneonavicular joint which is an articulation between the talus, calcaneous and navicular bone which transmits the entire weight of the body to the foot.  This is responisible for the dorsiflexion and plantar flexion of the upper ankle joint. The middle calcaneal articular surface which has an oval slightly convex shape articulates with the upper surface of the sustentaculum tali of the calcaneous which creates the subtalar joint. This provides a shock absorption and facilitates the movements of inversion and eversion. The talus also links with the tibia and fibula to form a talocrural joint which is the main joint found in the ankle. This helps to stabilise the ankle and allows dorsiflexion and plantarflexion of the foot for movement.



3.     Intrinsic muscles are located within the foot and are responsible for the fine motor actions of the foot which are responsible for stabilising the arches of the foot and control the movements of the digits. The foot is comprised of muscles of the plantar aspect which can be differentiated into four layers.

 The first layer is the most superficial to the sole and found under the plantar fascia which is the flat band of tissue ligament that connects your calcaneous to the phalanges.  There are three muscles located in the first layer such as the abductor hallucis , flexor digitorum brevis and abductor digiti minimi. The abductor hallucis originates from the medial tubercle of the calcaneus, the flexor retinaculum and the plantar aponeurosis. It attaches to the medial base of the proximal phalanx of the great toe. The flexor digitorum brevis originates from the medial tubercle of the calcaneus and the plantar aponeurosis. It attaches to the middle phalanges of the lateral four digits. The abductor digiti minimi originates from the medial and lateral tubercles of the calcaneus and the plantar aponeurosis. It attaches to the lateral base of the proximal phalanx of the 5th digit.


The second layer contains two muscles the quadratus plantae and the lumbricals also there are extrinsic muscles of the foot which pass through the second layer which is  the flexor digitorium longus.

The quandratus plantae is located superior to the flexor digitorium longus tendons which originates from the medial and lateral plantar surface of the calcaneus. It attaches to the tendons of flexor digitorium longus.

The lumbricals are four lumbricals muscles in the foot located medial to the tendons of the flexor digitorium longus. It attaches to the extensor hoods of the lateral four digits.


The third layer contains three muscles such as the flexor hallucis brevis, adductor hallucis and the flexor digiti minimi brevis.

The flexor hallucis brevis originates from the planar surfaces of the cuboid and lateral cuneiforms and from the tendons of the posterior tibialis tendon. Attaches to the base of the proximal phalanx of the great toe.

The adductor hallucis is located laterally to the flexor hallucis brevis it consists of an oblique and transverse head. The oblique head originates from the base of the 2nd, 3rd and 4th metatarsals. The transverse head originates from the plantar ligaments of the metatarsophalangeal joints. The transverse and oblique head attach to the lateral base of the proximal phalanx of the great toe.

The flexor digiti minimi brevis muscle is located on the lateral side of the foot under the metatarsal of the little toe. It originates from the base of the fifth metatarsal, this attaches to the base of the proximal phalanx of the fifth digit.


The fourth layer which comprises of the plantar and dorsal interossei of the plantar muscle layer.

The plantar interossei whereby there are three of them located between the metartarsal. It originates from the medial side of the metatarsals three to five, attached to the medial sides of the phalanges of didgits three to five.

The dorsal interossei on the plantar muscle of the foot are four in number which originates from the sides of the metatarsals one to five. The first muscle attaches to the medial side of the proximal phalanx of the second didgit. The second to fourth interossei attach to the lateral sides of the proximal phalanxes of digits two to four.




4.     A triphasic sound on the dopppler in normal arteries is when there is a rapid systolic anterograde flux, short retrograde flux in early diastole and slow anterograde flux in late diastole. A triphasic sound produces three clear sounds at each pulse beat, this indicates a very healthy artery with no impedance to blood flow and good elastic arterial walls. A Doppler ultrasound is a handheld device called a transducer that is passed lightly over the skin above a blood vessel. The Doppler sends and receives sound waves that are amplified through a microphone. The sound waves bounce off solid objects including blood cells. The movement of blood cells cause a change in the pitch of the reflected sound waves ( Doppler effect). In the cardiovascular system the blood flows in peripheral arteries , the pattern of flow in a resting state is to accelerate quickly and then stop. The blood flows backwards briefly as the pressure wave travels faster than the blood back from the smaller arterioles near the end of the pathway blood follows. The reflected pressure wave stops and even briefly reverses the flow of blood in the artery three components are heard ( triphasic pattern).



5.     Blood vessels are organs as they are made of different tissues, different types of blood vessels artery, arteriole, capillary, venules and veins. The arteries take blood away from the heart and veins take blood towards the heart, it is comprised of three layers ;tunica intima, tunica media and tunica adventita. The outer connective tissue (tunica adventitia which is the strong outer layer, arteries have more muscles tissue to withstand high blood pressure. The middle layer (tunica media) is comprised mostly of  smooth muscle cells which allow contraction and dilation. Arteries have more elastic tissue for elastic stretch and recoil to maintain blood pressure. The internal layer comprised of a basement membrane , small connective tissue of endothelium tissue.

Veins return blood to the heart which have a larger lumen relative to arteries to give resisiteance to blood flow. They have the same three layers as arteries although they have valves to prevent backflow. Tunica intima and media are thinner which allows the muscle to squeeze them to help move the blood along. The tunica intima in the veins have smooth epithelial cells also help reduce friction.




6.     The vital role of the cardiovascular system in maintaining homeostatis depnds on the continuous and controlled movement of blood through the capillaries that permeate every tissue and reach every cell in the body. It is in the capillaries that blood performs its ultimate transport function. Nutrients and other essential materials pass from capillary blood into fluids surrounding the cells as waste products are removed. There are specialised control mechanisms that help to regulate and integrate the divers functions and component parts of the cardiovascular system in order to supply blood to specific body areas according to need. These mechanisms ensure a constant internal environment surrounding each body cell regardless of differeing demands for nutrients or production of waste products.





The skin has a compound called 7- dehydrocholesterol which is converted to an active vitamin D3 which functions as provitamin-D3 .This enables humans to manufacture vitamin D3  from the sun which is then passed into the liver and converted into calcidiol, this is then absorbed into the kidney which activates calcitriol which is responsible for the formation of active vitamin D which produces calcium channels. The calcium channel is inserted on the nephron (kidneys) , intestines and the liver.

At high levels of calcium Ca2+  in the blood ,calcitonin which is a hormone produced and released from the thyroid gland. The excess calcium is moved into the bone and deposited to be stored and also the calcium is also absorbed into the kidneys which is excreted as urine. The calcium channels on the surface of the epithelium are blocked to reduce the absorption of Ca2+ into the bloodstream.

At low levels of calcium in the bloodstream the parathyroid gland produces the parathyroid hormone which is then passed into the bloodstream, this stimulates the stored Ca2+ from the bones  to release into the blood. The kidney is stimulated to synthesise vitamin D which then promote the Ca2+ channels on the intestines to absorb Ca2+ into the bloodstream.


6.     The pancreas is comprised of two systems such as the endocrine and exocrine system. The largest section which is the exocrine pancreas secretes digestive enzymes for the metabolism of proteins, lipids and carbohydrates. The smaller section of the pancreas known as the endocrine secretes hormones that regulate the blood glucose levels.

When there is a rise in blood glucose levels the beta cells release insulin which stimulates uptake of glucose into peripheral tissues. Blood glucose levels drops back to normal values. Insulin converts glucose into glycogen which is stored in the liver.

A drop in blood glucose stimulates alpha cells which release glucagon hormone into the blood which stimulates the production of glucose in the liver and releases glucose into the blood. The blood glucose levels increase back to normal levels.



9.   The nervous system control the endocrine system via the hypothalamus and autonomic nervous system. The hypothalamus ( endocrine tissue) is responsible for the production of anti-diuretic hormone, oxytocin and the production of regulatory hormones. The important endocrine glands are the pituatry glands which are loacated below the hyprothalmus. There are two lobes of the pituatyry gland;anterior lobe and posterior lobe. The posterior lobes secretes oxytocin and anti diuretic horomes that was produced by the hypothalamus , the hypothalamus produces the hormones and sends to the posterior lobe which secrets iinto the blood. The anterior lobe secrets many hormones  such as ACTH, TSH, GH, PRL, FSH and LH . These hormones are regulated by the hypothalamus that regulate the anterior lobe. The neuroendocrine system is composed of the hypothalamus and pituary gland and is under the influence of neurotransmitters and neuropeptides that regulate hypothalamic releasing and hypothalamic release inhibiting hormones secreted into the blood vvessles that connect the hypothalamus and pituary gland.


10. The patient complaining about having pin and needle sensations is most likely to be experiencing sciatica paraesthesia of the sciatic nerves. This is located in the Lumbosacral joint in the base of the spine which is comprised of L5-S1 vertebral segment. The sciatic nerve runs from L4- S3 segment which is also called L5 nerve root can lead to leg pain if it irritated or compressed.



11.   To examine if a patient has a upper motor neurone lesion will start by examining the muscle tone of both limbs , check if they are asymmetrical. If the patient has a upper motor neuron legion the muscles will be rigid known as hypertonia (increased muscle tone). 

The patella test, also known as the knee jerk will be performed where a patella hammer is used to tap the patella tendon. The patient with an upper motor neurone lesion will display an exaggerated deep tendon reflex with a possible clonus.

Another test will be the Achilles reflex, similar to the patella reflex only that this time the achelles tendon is tapped with the hammer. A similar response to the patella reflex should be displayed with an exaggerated/ brisk plantar flexed movement, this is considered as hyperactive.

Finally the last test will be the Babinski reflex whereby the sharp end of the patella hammer is used to scrape the end along the lateral side of foot ending at the big toe. A positive result for upper motor neuron lesion is shown when the toes splay along with the hallux toe dorsiflexing.



12. The process of peripheral nerve repair which can be induced after the nerves have been injured the first stage is called chromatolysis which takes place after 24- 48 hours after injury. At this stage the Nissl substance and axon is damaged which breaks the axon into pieces near to the site of injury. The second stage of nerve repair is the Wallerian degeneration which is stimutlated between 3- 5 days after  injury whereby the axons and myelin sheath seperate distal to the site of injury excluding the neurolemma which remains intact. There is an increase of macrophages which invade towards the site of the axon (damage). The final stage is Regeneration which is starts within the first week to several months depending on how severe and deep the nerve damage. At this stage protein and RNA synthesis is activated which allows the schwann cells to increase through mitosis forming a regeneration tube. The gaps are then reinforced with collagen fibres.







Section 2