17 Tibia

Orientation and general presentation (Figs 17.1 & 17.2)

The proximal epiphysis of the tibia shows the tibial plateau (1). The plateau has two well-marked edges: one lateral (TLR) and one medial (TMR). Two tubercles are visible on the plateau, the lateral (2) and medial (3) intercondylar tubercles. Anteriorly, a sharp tibial crest (green line) is readily visible. The center of the tibial tuberosity (TTC) is observable at the proximal end of the tibial crest. Both lateral (TTL) and medial (TTM) edges of this tubercle are usually well visible. From TTL, a crest, the oblique line (red line), runs proximally towards the tibial plateau. The Gerdy’s tubercle (TGT) is along this crest. The distal epiphysis carries the medial malleolus (TAM).

Figure 17.1 Tibia (3D model).

Isolated bone: A anterior view; B anterosuperior view.

Figure 17.2 Tibia (anatomic specimen).

General view: A anterior view; B posterior view. C The tibial plateau: proximal view. D Proximal epiphysis: anterior view. E The medial malleolus: medial view.

Tibia – tibial Tuberosity (TTC, TTM, TTL)[R,L] ISB

Landmark TTC, TTM, TTL

Prominent oval tuberosity located at the superior extremity of the anterior tibial aspect (see Figs 17.1 & 17.2). The patellar tendon inserts on this tuberosity. Three points are palpated on this tuberosity.

Subject lying: The subject is lying supine, knee extended, with the palpator at the subject’s knee.

Subject standing: The palpator kneels, facing the extended, or slightly flexed, knee of the subject, who is asked to put his or her bodyweight on the limb that is not being palpated.

Gently pinch the patellar ligament between the thumb and middle finger. Follow the ligament distally (blue arrows) to its insertion on the tibial tuberosity.

The thumb and middle finger are located on each side of the tuberosity on its medial (TTM) and lateral (TTL) edges respectively.

Then place the forefinger between the thumb and the middle finger; this is TTC.

Observe the upper extremity of the tibia from an anterior view. Locate a bony oval bump on the anterior and proximal aspect of the tibia – the tibial tuberosity.

TTL and TTM are located at the center of the lateral and medial edges of the tuberosity respectively.

Then find TTC at the intersection of a horizontal line (in blue) running through both TTL and TTM, and a vertical line (in green) running along the tibial crest.

Tibia – Medial Ridge of tibial plateau (TMR)[R,L] ISB

Landmark TMR

Point situated on the medial edge of the tibial plateau. This is the most distant point of the tibial plateau from the medial intercondylar tubercle (see Figs 17.1 & 17.2).

Subject lying: The subject is lying supine, knee flexed (about 90°), with the palpator at the subject’s knee.

Subject standing: The palpator kneels, facing the flexed knee of the subject, who is asked to put his or her bodyweight on the limb that is not being palpated.

Locate the patellar ligament and follow it up to the joint space (thumb and forefinger on the medial and lateral sides respectively).

The two fingers then glide backwards (blue arrows) along the tibial plateau, reaching for the greatest distance between both fingers.

Once the greatest distance has been found, press the thumb on the surface of the tibial plateau to find TMR.

Manual palpation tip

• If possible, locate TMR and TLR (see p. 146) simultaneously.

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