ruptured tympanic membrane

**All cases are fictitious. No real patient encounters. Any resemblance to real persons, living or dead, is purely coincidental.**
 
Case*: hmm, I don't see the Tympanic membrane. Did I not push my otoscope far in enough?

Solution:

NORMAL TYMPANIC MEMBRANE:
Know what a normal tympanic membrane look like:
- pinkish gray (Wonder me! usually sees normal tympanic membrane more gray thank pinkish)
- small blood vessels along the malleus is normal too

 

Note: malleus, pars flaccida, pars tensa, & cone of light

 

 

Malleus = Hammer

Ruptured tympanic membrane:

Helpful resource: http://www.ghorayeb.com/Malleus.html

ankle anatomy

Ankle anatomy:
Lateral ankle ligaments: anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament
Medial ankle ligament: deltoid ligament
Tibiofibular ligaments/syndesmosis: anterior tibiofibular ligament, posterior tibiofibular ligament, interosseous membrane
Posterior lower leg muscles: gastrocnemius, soleus, plantaris


Images:
Ankle bone: tibia, fibula, talus (sandwiched btw tibia & calcaneus), calcaneus (heel)

Lateral ligaments:

Medial ligament:

Tibiofibular syndesmosis:

 1 Anterior talofibular ligament; 2 anterior tibiofibular ligament;

3 anterior tibiofibular ligament

Lower leg muscles:

Video:

Sources:
Pictorial essay of ankle anatomy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855022/

superficial posterior compartment of leg

all insert @ the calcaneus thru achilles tendon: gastrocnemius, soles, plantaris

tibiofibular joint/syndesmosis

deltoid ligament

Prevents eversion
Ligament of the medial ankle.

Calcaneofibular ligament

One of the lateral ankle ligaments
Prevents inversion in neutral position

Location: "The calcaneo-fibular ligament is a ligament connecting the apex of the lateral malleolus to the posterolateral aspect of the calcaneus." (1) 

Significance: "Tenderness, swelling, and ecchymosis in the area inferior and posterior to the lateral malleolus is evidence of a calcaneo fibular ligament sprain." (1) 

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Sources:
(1) http://www.orthopaedicsone.com/display/Main/Calcaneo+fibular+ligament+Surface+Anatomy

Posterior talofibular ligament

One of the ligaments of the lateral ankle
Strongest lateral ligament
Rarely injured

anterior talofibular ligament

One of the ligaments of the lateral ankle - most frequently injured w/ inversion injury.

Location: "The talofibular ligament is located between the anterior margin of the lateral malleolus (distal fibula) and the neck of the talus" (1)

Significance: "The talofibular ligament is the most common ankle ligament injured. It is often sprained during an acute ankle inversion. Inspect and palpate the ligament for tenderness, ecchymosis, and swelling to confirm a tear." (1) 

Anterior talo-fibular ligament

Talus head

Source:
(1) http://www.orthopaedicsone.com/display/Main/Anterior+talofibular+ligament+Surface+Anatomy