Anatomy - ALL Flashcards
(322 cards)
1
Q
What is the pelvis and what does it do?
A
-Bony ring formed by the articulation of the left and right innominate (hip) bones and the sacrum
-Takes the weight of the body and transmits it to the lower limbs
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Q
What bones make up the hip bone and where do they join?
A
-Pubic, ilium and ischium bones
-Join at acetabulum
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Q
What do the hip bones articulate with anteriorly and posteriorly?
A
-Anteriorly - each other at the pubic symphysis
-Posteriorly - sacrum at sacroiliac joints
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Q
What is this?
Describe it in life:
A
-Obturator foramen
-Almost completely covered over by obturator membrane and muscles attached to it
-Small gap in membrane and muscle (obturator canal) allows vessels to pass between pelvis and thigh
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Q
What do they surround?
A
Obturator foramen
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A
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What are these?
A
Iliac crests - uppermost parts of the ileum
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A
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Ischial tuberosity
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What does the red articulate with?
A
Acetabulum of the pelvis
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A
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Describe it:
A
-Linea aspera
-Bony verticle ridge on the posterior aspect of shaft
-Muscle attachment
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-Patella
-Lies anterior to the knee joint
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Q
What do the lateral and medial femoral condyles articulate with?
A
Proximal tibia at the knee joint
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Q
What movements are possible at the hip joint?
A
-Flexion
-Extension
-Abduction
-Adduction
-Medial (internal) and lateral (external) rotation
-Circumduction
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What general groups of muscles allow what movements at the hip joint?
A
Anterior thigh - flexion
Medial thigh - adduction
Posterior thigh - extension
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What movements are possible at the knee joint?
A
-Flexion
-Extension
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A
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Where does the thigh anatomically lie?
Inbetween the jip and knee
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Name and describe it:
-Fascia lata
-Surrounds the thigh like a sleeve
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Label and describe:
-Ileotibial band (or tract)
-Thickening of the lateral part of the fascia late
-Attaches to lateral aspect of proximal tibia and is important for stabilising the knee joint
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What seperates the compartments of the thigh?
-Intermuscular septa
-Extend from fascia lata to the linea aspera
-Separate thigh into anterior, medial and posterior components
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Describe the muscles of the anterior component of the thigh:
-7 muscles
As a group they:
-Primarly act as extensors of the knee but some act on hip joint
-Innervated by the femoral nerve (L2-L4)
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What nerve is this and what spinal segments is it from?
-Femoral nerve
-L2-L4
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What are the muscles of the anterior thigh?
-Quadriceps femoris (4 large muscles)
-Sartorius
-Iliopsoas
-Pectineus
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What is common?
All muscles of the anterior thigh
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What are these?
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What muscles make up the quadriceps femurs?
-Rectus femoris
-Vastus lateralis
-Vastus medialis
-Vastus intermedius
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What are the functions of the quadriceps femoris muscles?
-Prime extensor of the knee
-Form the bulk of the anterior thigh
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Where do the quadriceps femoris muscles converge?
-Converge onto quadriceps tendon which runs over the patella
-Inerts onto the tibial tuberosity via the patella ligament
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Tibial tuberosity
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Describe rectus femoris:
-Lies in the midline of anterior thigh
-Attached to ASIIS proximally
-Crosses hip so contributes to flexion
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Describe vastus lateralis:
-Lateral to rectus femoris
-Attaches to linea aspera on posterior aspect of the femoral shaft
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Describe vastus medialis:
-Lies medial to rectus femoris
-Attaches to the linea aspera
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Describe vastus intermedius:
-Lies deep to rectus femoris
-Attaches to anterior aspect of femoral shaft
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What is the attachment and action of sartorius?
-Attached proximally to ASIS and inserts on medial aspect of proximal tibia
-Crosses hip and knee joints
-Flexes and laterally rotates the hip joint and can flex knee joint
-NOT prime mover - contributes
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Describe iliopsoas:
-Lies proximally in anterior thigh
-Psoas major and ilacus converge via common tendon onto lesser trochanter of femur
-Prime flexor of the hip joint
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ileopsoas
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Describe pectineus:
-Proximal anterior thigh, medial to iliopsoas
-Attaches proximally at superior pubic ramus and distally on femur just inferior to lesser trochanter
-Flexes and adducts hip joint
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Pectineus
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Describe the muscles of the medial thigh:
-Contains 5 muscles
-As a group they:
-Primarily act as adductors of the hip
-Innervated by the obturator nerve (Spinal segments L2-L4)
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What nerve is this and what spinal segments does it arise?
Obturator (L2-L4)
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What are the muscles of the medial thigh?
-Adductor brevis
-Adductor longus
-Adductor magnus
-Gracilis
-Obturator externus
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Describe adductor brevis and adductor longus:
-Similar points of attachment to the pubic bone and linea aspera
-Adductor brevis lies deep to longus
-Obturator nerve lies between them
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Where does the obturator nerve lie in the medial thigh?
In between the adductor brevis and adductor longus
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Describe the adductor magnus muscle:
-Large muscle that has an adductor part and a hamstring part
-Function differently and have different nerve supplies
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Describe the adductor part of the adductor Magnus:
-Attaches to inferior pubic ramus and linea aspera
-Acts as an adductor
-Innervated by the obturator nerve
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Describe the hamstring part of the adductor magnus:
-Attaches to ischial tuberosity and the adductor tubercle
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What is the adductor hiatus?
-Gap formed between the distal attachments of the two parts of the adductor magnum
-Femoral artery and vein pass through this to reach the posterior thigh
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Describe gracilis:
-Most medial muscle
-Attaches to the pubic bone and the medial aspect of the tibia
-Weak adductor and flexor of the hip and weak flexor of the knee
NOT a prime mover
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Describe obturator externus:
-Attached to external surface of the obturator membrane and inserts on the femur near the greater trochanter
-Stabilises and laterally rotates hip joint
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Describe the continuation of the external iliac artery:
-Femoral artery is continuation of external iliac
-Travels deep to inguinal ligament to enter proximal anterior thigh
-Lies relatively superficially
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What is the vessel in red?
Femoral artery
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Describe the pathway of the femoral artery in the thigh:
-Gives off large branch called profunda femoris (deep artery of thigh) which travels deep into thigh and supplies it
-Continues distally, traverses adductor hiatus and enters distal part of posterior thigh (popliteal fossa) to become popliteal artery
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Label and describe its pathway:
-Obturator artery - branch of internal iliac artery
-Travels through obturator canal into medial component of thigh
-Anastomoses with branches from the femoral artery
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Describe the veins exiting the pelvis into the thigh:
-Femoral - follows artery, lies medial to it in proximal thigh. Travels under inguinal ligament and is continuous with external iliac vein
-Obturator - follows course of artery. Travels through obturator canal and joins internal iliac vein in pelvis
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What does this diagram show about the pathways of the femoral artery and vein?
Vein passes more medially in the thigh
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What is this?
Femoral nerve
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Describe the pathway of the femoral nerve and its innervation:
-L2-L4 spinal nerve roots
-Deep to inguinal ligament to enter proximal anterior thigh lateral to the femoral artery
-Branches innervate anterior thigh muscles
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What is this and describe it:
-Saphenous nerve
-Sensory branch of the femoral nerve that innervates skin over the leg
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Label and describe 2:
-Obturator nerve
-L2-L4 nerve roots
-Travels along lateral wall of pelvis and exits through the obturator canal
-Emerges onto superficial surface of adductor brevis and gives rise to branches that innervate medial compartment muscle and sking over medial thigh
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What is this?
-Femoral triangle - clinically important area in the proximal anterior thigh
Boundaries:
Lateral - medial border of sartorius
Medial - lateral border of adductor longus
Superior - inguinal ligament
Apex = distally where sartorius and adductor longus meet
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What forms the floor of the femoral triangle?
Iliopsoas laterally and pectineus medially
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What are these?
Floor of femoral triangle
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What are the contents of the femoral triangle?
-Femoral artery
-Femoral vein medial to femoral artery - receives important tributary called the great saphenous vein
-Femoral nerve lies lateral to femoral vein and artery and travels deep to inguinal ligament to enter anterior thigh
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What are these and what do they form?
-Close the greater and lesser sciatic notches to form the greater and lesser sciatic foramina
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What do the sciatic foramina allow?
Allow structures to pass to and from the pelvis and gluteal region
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Wht does this show?
-ischial spine projects from posterior ischium
-Sacrospinous ligament attaches to it
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Label and describe:
-Ischial tuberosity
-Bulky prominence of bone at posterior aspect of ischium
-We sit on this part of the pelvis
-Muscles of posterior thigh and the sacrotuberous ligament attach here
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Label and describe:
-Ridge of bone between the trochanters on the posterior aspect of the femur
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Label and describe:
-Lies just inferior to the trochanters on the posterior aspect of the femur
-Site of muscle attachment
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What groups of muscles does the gluteal region contain?
-Two groups of muscles
-Superficial and deep group
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What muscles make up the superficial gluteal muscle group?
-Gluteus maximus
-Gluteus medius
-Gluteus minimus
-Tensor fascia latae
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Describe gluteus maximus:
-Most superficial gluteal muscle
-Several proximal attachments:
-Most posterior parts of posterior ileal surface
-Sacrotuberous ligament
-Sacrum
-Distal:
-Most fibres insert into iliotibial tract
-Smaller proportion attach onto gluteal tuberosity
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What is the action and purpose of gluteus maximus?
-Extensor of the hip and is important for standing from a sitting position
-Also acts as a lateral rotator of the hip
-Inserts into ileotibial tract so stabilises knee joint
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Describe gluteus medius and gluteus minimus:
-Medius lies deep to maximus and minimus lies deep to medius
-Similar points of attachment to posterior ileum - both attach to anterior parts of posterior ilium surface
-Both insert onto greater trochanter
-Abduct and medially rotate hip
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What is the importance of gluteus medius and minimus?
-Important for normal gait
-When walking, only one leg in contact with floor at once
-When standing on one leg, gluteus medius and minimus in the limb you are standing on contract and hold the pelvis 'level' so it doesn't tilt to the unsupported side
-If they are weak or paralysed in one limb, pelvis tilts to contralateral side every time the contralateral leg is off the ground, resulting in a limp
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Describe the attachments and action of the tensor facia latae:
-Attaches to ASIS and inserts into the ileotibial band which itself inserts onto the lateral part of the proximal tibia
-Contraction tenses the fascia lata and iliotibial band
-Stabilises knee when it is extended and also flexes hip joint but is not a prime mover
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What is the innervation to the superficial gluteal muscles?
-Gluteal nerves which leave the sacral plexus in the pelvis via the greater sciatic foramen
Gluteus maximus - inferior gluteal nerve
Gluteus minimus, medius and tensor fascia latae - superior gluteal nerve
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What are the deep gluteal muscles?
what are their actions?
-Small muscles that primarily stabilise and laterally rotate the hip joint
They are:
-Piriformis
-Superior and inferior gemelli
-Obturator internus
-Quadratus femoris
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What do all of the deep gluteal muscles insert onto?
They all insert onto, or close to, the greater trochanter
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What is significant about piriformis?
-Attaches to anterior surface of the sacrum
-Passes through greater sciatic foramen and inserts onto greater trochanter
-Nerves of the sacral plexus lie over it in the pelvis
-Sciatic nerve emerges below its inferior border in the gluteal region
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What does this show about the nerves?
-Nerves of sacral plexus lie over the piriformis in the pelvis
-Sciatic nerve emerges below its inferior border
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What does the sciatic nerve do in the posterior thigh?
Divides into the tibial and common peroneal (common fibular) nerves
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Where do the deep gluteal muscles arise?
-Piriformis - anterior sacrum
-Obturator internus - obturator membrane
-All others ischium
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What is the pathway of the obturator internus?
-Arises obturator membrane
-Tendon passes through the lesser sciatic foramen
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What muscles does the posterior component of the thigh contain?
-Semimembranosus
-Semitendinosus
-Biceps femoris (long and short head)
-Hamstring part of adductor magnus
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What can three of the posterior thigh muscles be grouped into?
-Semimembranosus, semitendinosus and long head of biceps femoris
-Hamstrings
-Span both the hip and knee joints
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What is the attachment, actions and innervation of the hamstrings?
-Attached proximally to the ischial tuberosity
-Extend the hip, flex the knee
-innervated by the tibial nerve
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What does the bottom left innervate?
Three of the hamstring muscles
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Where does the short head of biceps femoris arise and what does it do?
What innervates it?
-Linea aspera
-Flexes the knee but does not move the hip joint
-Common peroneal nerve
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What does it innervate in the thigh?
Short head of biceps femoris
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Where do the muscles of the deep posterior aspect of the thigh insert?
-Semimembranosus and semitendinosus insert on medial aspect of the proximal tibia
-Long head of biceps femoris forms common tendon with the short head and inserts on the head of the fibula
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Describe the attachments of the hamstring part of the adductor magnus and its action and innervation:
-Arises ischial tuberosity and inserts onto adductor tubercle of the femur
-Extends the hip but does not move the knee joint
-Innervated by tibial nerve
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What are the muscles of the posterior thigh?
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What is the arterial supply of the gluteal muscles?
-Superior and inferior gluteal arteries
-Branches of the internal iliac artery
-Leave the pelvis via the greater sciatic foramen to enter the gluteal region
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What is the green and red superior to it?
Superior and inferior gluteal arteries
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What is the large artery of the posterior thigh?
-There isn't one!
-Hamstring muscles are supplied by three or four perforating arteries that arise from profunda femoris
-Travel through small apertures in the adductor magnus to reach the posterior compartment
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What does the femoral artery do in the lower thigh?
-Traverses the adductor hiatus to enter the region behind the knee
-This region is the popliteal fossa and the artery now becomes the popliteal artery
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What is this?
Adductor hiatus (canal?)
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What is this region called?
Popliteal fossa
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What is the venous drainage of the gluteal muscles?
-Superior and inferior gluteal veins follow their corresponding arteries through the greater sciatic foramen into pelvis
-Drain into internal iliac vein
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What is the venous drainage of the posterior thigh?
-Popliteal vein in popliteal fossa enters anterior thigh via the adductor hiatus
-Becomes femoral vein which ascends in the anterior thigh
-Femoral receives great saphenous vein in femoral triangle before travelling under inguinal ligament to continue external iliac vein
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What does this show?
Femoral vein receiving great saphenous vein
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What innervates the gluteal muscles and their pathways?
-Superior and inferior gluteal nerves
-Leave sacral plexus in the pelvis and travel through the greater sciatic foramen to enter gluteal region
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What are the structures in green and the branches above?
Superior and inferior gluteal nerves
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Describe the sciatic nerve:
-Very large nerve composed of fibres from L4-S3
-Leaves pelvis via greater sciatic foramen and enters gluteal region inferior to piriformis muscle
-Really composed of two seperate nerves bound together - tibial and common peroneal (fibular) nerves
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What do the branches of the sciatic nerve innervate and what would lesion lead to?
Tibial:
-Muscles of the posterior thigh and posterior leg
Common peroneal (fibular):
-Muscles of anterior and lateral leg
Lesion can result in severe functional deficits
Both nerves innervate regions of skin of the lower limb
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What are these?
Boundaries of the popliteal fossa
-Not labelled on diagram is semitendinosus
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What is the popliteal fossa and what makes up its borders?
-Diamond-shaped depression behind the knee joint
Two superior borders:
-Semimembranosus and semitendinosus medially (superomedial)
-Biceps femoris laterally (supero-lateral)
Inferior border:
-Two heads of the gastrocnemius - a superficial muscle in the posterior leg
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What four important structures does the popliteal fossa contain?
-Popliteal artery
-Popliteal vein
-Tibial nerve - midline of fossa
-Common peroneal (fibular) nerve - superolateral border alongside biceps femoris tendon
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What are these?
Contents of the popliteal fossa
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What is the pathway of the peroneal nerve?
-Superolateral border of popliteal fossa
-Alongside tendon on biceps femoris
-Wraps around neck of fibula and splits into superficial and deep branch
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What do the branches of the peroneal nerve innervate?
-Superficial peroneal nerve - muscles of lateral leg
-Deep peroneal nerve - muscles of the anterior leg
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What bones are in the leg?
-Tibia and fibula
-Connected by two joints and a strong interosseous membrane
-Distal ends of both bones articulate with talus at ankle joint
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Describe the tibia:
-Thick and strong bone
-Expanded proximal end articulates with femur to form the knee joint
-Distal end is tapered and articulates with the talus and fibula
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Describe what they are:
-Tibial plateus
-Superior surfaces of the medial and lateral tibial condyles
-Articulate with the femoral condyles to form knee joint
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What is the significance of the top right?
-Attachment of the patella ligament
-Projects from upper anterior surface and is palpable
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Label and describe:
Oblique ridge of bone on the posterior surface of the tibia
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What is the significance of the second down on the right?
Medial melleolus projects medially from distal end of tibia to form part of the socket for the talus
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Describe the fibula:
-Slender bone
-Proximal end does not contribute to the knee joint
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Describe:
-Proximal part expanded to form head and is palpable
-Neck just distal and is palpable - common fibular nerve lies close to bone here
-Shaft is slender and attachment site for muscles
-Lateral malleolus projects from distal end to form part of talus socket
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How is the human foot adapted for its function?
-Carries weight of the body and is adapted for bipedal gait
-Small joints of the foot allow it to deform and absorb shock when waking over uneven ground
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Describe how the foot makes contact with the floor:
-Part of the sole of the foot does not make contact with the ground when we stand
-Raised by the vertical and transverse arches of the foot
-These are formed by the arrangement of the bones of the foot
-Allow shock absorption
-Arches are supported by ligaments and tendons in the foot
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What do the tarsal bones compose of?
-Talus
-Calcaneus (heel bone)
-Navicular
-Cuboid
-Three cuneiforms (medial, intermediate and lateral)
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What are they and what do they compose?
Hindfoot
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What are they and what do they compose?
Midfoot
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What are they and what do they make up?
Forefoot
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Describe the naming of bones in the forefoot:
-Metatarsals numbered 1-5 from medial to lateral (big to little toe)
-Bones of digits are phalanges (phalanx) and there are three in toes 2-5 and two in the first digit (big toe)
-Named proximal, middle and distal phalanges
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Big toe only has two phalanges so there is one interphalangeal joint of the big toe
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What can the movements of the foot be compared to?
-Similar to those of the hand
-Range of movement is less extensive
-Human hand is extremely dextrous but the human foot is adapted for weight-bearing and bipedal gait rather than fine, skilled movement
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What movements of the foot are possible?
-Dorsiflexion (extension) at ankle - toes point upwards
-Plantarflexion at ankle - toes point down to floor
-Inversion at subtalar joint - sole of foot medially
-Eversion - lateral border and sole of the foot laterally
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What is this?
-Subtalar joint
-Formed by articulation of the talus with the calcaneum and navicular
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What movements are possible by the toes?
-Flexion
-Extension
-Abduction (moving toes apart)
-Adduction (bringing toes together)
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What plantarflexion is incredibly important?
-Plantarflexion at the MTP joints
-Especially the MTP joint of the big toe as it is very important for pushing the foot off the ground and forward propulsion during walking and running
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Describe the leg:
-Lies between the knee and ankle joint
-Deep fascia surrounds the leg like a sleeve
-Intermuscular septa extend from the deep fascia and separate the leg into anterior, lateral and posterior compartments
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Describe the muscles of the anterior compartment of the leg:
(Attachment, action, innervation)
-3 muscles
-Arise from tibia, fibula and interosseous membrane
-Primarliy act as dorsiflexors (extensors) of foot and ankle and extensors of toes
-Innervated by deep peroneal nerve
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What muscles are these and what innervates them?
-Muscles of the anterior component of the leg
-Innervated by the deep peroneal nerve
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What is this and what does it innervate?
Muscles of the anterior component of the leg
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What are the muscles of the anterior leg?
-Tibialis anterior
-Extensor hallucis longus (EHL)
-Extensor digitorum longus (EDL)
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Describe pathway of tibialis anterior and its action:
-Crosses anterior aspect of the ankle and inserts onto the medial cuneiform
-Dorsiflexes and inverts foot
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Describe pathway and action of extensor hallicus longus:
-Tendon crosses the anterior aspect of the ankle and inserts onto distal phalanx of big toe
-Extends big toe
-Also dorsiflexes foot at the ankle
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Describe the pathway and action of the extensor digitorum longus:
-Gives rise to four tendons
-Cross the anterior aspect of the ankle and insert onto the distal phalanges of 2-5
-Extends them
-Also dorsiflexes the foot at the ankle joint
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What are these and what do they do?
-Extensor retinacula
-overlie the extensor tendons at the ankle joint
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Describe the muscles of the lateral component of the leg:
-2 muscles
-Attach to the fibula
-Evert the foot at subtalar joint
-Innervated by the superficial peroneal nerve
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What is the lower left and what does it innervate?
Muscles of the lateral component of the leg
Also called superficial peroneal nerve
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What are the muscles of the lateral component of the leg?
-Peroneus longus
-Peroneus brevis
-Sometimes called fibularis
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Describe the muscles of the lateral component of the leg:
-Peroneus longus - more superficial, inserts onto the plantar surface of the medial cuneiform bone
-Peroneus brevis - deeper muscle, inserts onto the base of the 5th metatarsal
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What do tendons of the peroneus longus and brevis pass near to?
Pass posterior to the lateral malleolus to their insertions in the foot
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What does this show?
Popliteal artery bifurcates in the popliteal fossa into the anterior and posterior tibial arteries
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Describe the pathway of the anterior tibial artery:
-Pierces the interosseous membrane to enter the anterior compartemnt of the leg - which it supplies
-Cross anterior aspect of ankle joint and enters dorsum of foot
-Here it is called the dorsalis pedis artery and is palpable in the foot lateral to the tendon of extensor hallucis longus
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Describe what the bottom artery does:
Gives rise to branchs that travel between the metatarsals and anastamose with arteries in the plantar aspect of the foot
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What supplies blood to the lateral component of the leg?
-Supplied by the fibular artery which is a branch of the posterior tibial artery
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What major superficial veins in the leg drain the foot?
great and small saphenous veins
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Describe the path of the great saphenous vein:
-Travels anterior to the medial malleolus and courses all the way up the medial aspect of the lower limb
-Terminates at the femoral vein in the femoral triangle
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Describe the pathway of the small saphenous vein:
-Travels posterior to the lateral malleolus and courses up the posterior aspect of the leg
-Terminates at the popliteal vein in the popliteal fossa
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Describe the nerve innervation to the anterior and lateral compartments of the leg:
-Common peroneal nerve wraps around the neck of the fibula and divides into two branches - superficial and deep peroneal nerves
Superficial - muscles of the lateral leg
Deep - muscles of the anterior leg
Both branches innervate regions of the skin of the leg
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How is the dorsum of the foot similar to the hand?
Superficial veins and extensor tendons are usually visible under the skin
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Describe the small muscle in the dorsum of the foot:
-Extensor digitorum brevis
-Lies laterally and gives rise to four slender tendons that insert onto toes 2-5
-innervated by deep peroneal nerve
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Describe the muscles of the posterior compartment of the leg:
-Superficial and deep group of muscles
-Primarily act as plantarflexors of the foot at the ankle joint and flexors of the toes
-Innervated by the tibial nerve
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What does the bottom innervate?
Muscles of the posterior compartment of the leg
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What are these muscles?
Muscles of the posterior compartment of the leg
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What are the 3 posterior superficial muscles of the leg?
-Gastrocnemius
-Soleus
-Plantaris
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Where do the tendons of all three superficial posterior leg muscles insert?
Insert onto the calcaneus via the calcaneal (achilles) tendon
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Describe the gastrocnemius:
-Most superficial muscle
-Attaches via two heads to distal femur
-Can flex the knee in addition to plantarflexing the ankle
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Describe the soleus:
-Large, flat muscle that lies deep to the gastrocnemius
-Attached to the soleal line
-Contraction compresses the deep veins of the leg and is important for venous return
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What are the deep muscles of the posterior compartment of the leg?
-Popliteus
-Tibialis posterior
-Flexor hallucis longus (FHL)
-Flexor digitorum longus (FDL)
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What is common amongst these muscles?
Tendons of these three muscles all travel posterior to the medial malleolus and insert into the plantar surface of the bones of the foot
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Describe popliteus:
-Lies in the popliteal fossa
-Attached to tibia and the femur
-Allows for a small degree of rotation of the knee
-When the knee is flexed from full extension, popliteus slightly rotates the knee before flexion begins
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Describe tibialis posterior:
-Plantarflexes and inverts the foot
-Tendon attaches to multiple bones in the foot
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Describe flexor hallucis longus (FHL):
-Flexes big toe via its insertion into the distal phalanx
-Plantarflexes the foot
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Describe the flexor digitorum longus (FDL):
-Gives rise to four tendons that insert into the distal phalanges of toes 2-5
-Primary action is flexion of the toes, but it also plantarflexes the foot
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What does the plantar aspect of the foot contain?
Contains numerous intrinsic muscles much like the palm of the hand
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Describe the intinsic muscles of the sole of the foot:
-Arranged in four layers which mirror those of the palm
-include abductors of the big and little toes, flexors of the toes, adductor of the big toe, lumbricals and interossei
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What innervates the intrinsic muscles of the sole of the foot?
Medial and lateral plantar nerves which are the terminal branches of the tibial nerves
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What do these innervate?
Innervate the intrinsic muscles of the sole of the foot
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What is important about the muscles of the sole of the foot?
They act as a group to support the foot
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What is this?
-Plantar aponeurosis
-Lies superficial to intrinsic muscles of sole of foot
-protective
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Plantar aponeurosis
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Plantar aponeurosis
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Describe the pathway of the posterior tibial artery?
-Supplies posterior compartment of leg and sole of foot
-Fibular artery comes off it to lateral component
-PTA passes posterior to medial malleolus along with tendons of tibialis posterior, FHL and FDl to enter plantar aspect of foot
-In the foot, it bifurcates into medial and lateral plantar arteries which supply the sole of the foot
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What are these and what do they do?
-Branches of dorsalis pedis artery which enters the sole of the foot from the dorsum
-Anastamose with branches of the plantar arteries
-Deep plantar arch is an important vessel formed by lateral plantar artery and a branch of dorsalis pedis
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What does this show?
-Deep plantar arch
-Important vessel formed by the lateral plantar and a branch of the dorsalis pedis
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What do these show?
Metatarsal and digital arteries supply forefoot and toes
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What accompany the arteries in the posterior leg and plantar of foot?
-Posterior tibial, anterior and fibular arteries are accompanies by deep veins
-They unite to form the popliteal vein
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What are these?
Veins draining the posterior component of the leg
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What veins drain most of the blood of the foot?
-Superficial veins drain most of the blood from the foot
-Can usually be seen over the dorsum of the foot
-Dorsal venous network drains medially into the great saphenous vein and laterally to the small saphenous vein
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What do the saphenous veins drain into?
-Small saphenous enters the popliteal vein in the popliteal fossa
-Great saphenous meets the femoral vein in the femoral triangle
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What does this innervate?
Innervates all the muscles in the posterior compartment of the leg and plantar surface of the foot
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Describe the pathway of the tibial nerve:
-Posterior to medial malleolus along with tendons of tibialis posterior, FHL and FDL
-Enters sole of foot and divides into two branches - medial and lateral plantar nerves which course along medial and lateral aspects of the sole of the foot along corresponding arteries
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What do the medial and lateral plantar nerves innervate?
All intrinsic muscles in the plantar aspect of the foot
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What are these and what do they innervate?
Digital nerves enter the toes
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What innervate the skin of the foot?
-Both the tibial nerve and peroneal (fibular) nerve innervate the skin of the foot:
-Tibial nerve innervates most of the skin on the plantar foot surface
-Common peroneal (fibular) nerve and its branches innervate skin over the anterolateral leg and dorsum of foot
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What can sensation of the skin be assessed by examining?
-Territories of the peripheral nerves
-Dermatomes
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What do these show?
Territories of the skin supplied by the peripheral nerves of the lower limb
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What areas of skin do the femoral and obturator nerves supply?
Femoral: Anterior thigh and anteromedial leg (via saphenous nerve)
Obturator: Medial thigh
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What des the common peroneal nerve and its branches innervate in terms of skin?
Common peroneal : Anterolateral leg and dorsum of the foot
Superficial peroneal: lower anterolateral leg, most of the dorsum of the foot
Deep peroneal: 1st interdigital cleft
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What area of skin does the tibial nerve innervate?
Sole of the foot
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How are the dermatomes of the lower limb arranged generally?
Anteriorly - roughly oblique strips running inferiorly from the lateral aspect of the lower limb to the medial
Posterior - more vertically
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Describe the dermatomes L1-L3:
L1: Region over inguinal ligament
L2: Upper half of the anterior thigh
L3: Lower anterior thigh and the medial aspect of the knee
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Describe the dermatome L4:
-Anterior surface of lower limb
-Lateral aspect of lower thigh, knee and upper leg
-Expands inferiorly over the anterior knee, anteromedial leg
-Dorsum of medial aspect of foot and skin over dorsum and plantar surface of big toe
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Describe the dermatome L5:
-Anterior surface of lower limb
-Laterally covers lower 2/3 of of leg excluding lateral ankle
-Extends obliquely, inferiorly and medially to cover the dorsum of the middle foot and dorsum of toes 2-4
-Corresponding skin on sole of foot
-Posteriorly innervates vertical skin laterally from buttock in upper leg
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Describe the dermatome S1:
-Posteriorly vertical strip vertically in middle of thigh extending over lateral part of posterior leg, ankle and dorsum and sole of foot and dorsum and plantar aspect of little toe
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Describe the dermatome S2:
-Posteriorly innervates vertical strip over medial thigh and leg
-Extends onto the medial aspect of the sole of foot excluding the plantar surface of the big toe (L4)
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Which region of skin would you test the sensation of to test L1-L3?
L1 - region over inguinal ligament
L2 - upper anterior thigh
L3 - medial aspect of knee
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Which region of skin would you test the sensation of to test L4, L5 and S1?
L4 - anteromedial leg
L5 - anterolateral leg
S1 - 5th digit / lateral foot
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What kind of joint is the hip?
Synovial ball and socket joint formed by the articulation between the acetabulum of the innominate bone and femoral head
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What is transmitted to the hip joints?
Weight of the body is transmitted through the lumbar vertebrae and the sacroiliac joints to the hip joints
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Is the hip joint stable and why?
Yes as the acetabulum is deep and there is a good fit between it and the femoral head
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What is this and what does it do?
Deepens the acetabulum
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What is this and what does it do?
Attaches to the femoral head and the acetabulum
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What structures reinforce the hip joint capsule?
Strong ligaments
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Label and describe:
-Arteries of hip joint mainly arise from profunda femoris
-Give rise to retinacular arteries that run along neck of femur to supply the femoral head
-Can be torn during fractures of the femoral head
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What are they?
The three ligaments that stabilise the hip joint
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What three ligaments stabilise the hip joint?
What do they do?
-Iliofemoral
-Pubofemoral
-Ischiofemoral
-As the hip is extended, these ligaments become taut and hold the femoral head more tightly - hip is therefore most stable in extension
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What kind of joint is the knee joint?
Synovial hinge joint formed by the articulation between the femoral condyles and the tibial condyles
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Describe the fit of the knee joint:
-Tibial plateaus are flat and do not provide a good fit for the femoral condyles
-Femur and tibia achieve their best fit with each other when the knee is extended, hence the knee is most stable in extension
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What things stabilise the knee joint?
-Muscles, tendons, cartilage and ligaments of the knee joint provide stability
-Ileotibial tract attaches to the lateral aspect of the tibia and stabilises the knee
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Label and describe these structures:
-Menisci are C-shaped cartilages that lie on the tibial plateaus
-Wedge-shaped with their thickest part lying peripherally and the thinnest part lying centrally
-They deepen the tibial condyles for articulation with the femoral condyles
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What important ligaments are at the knee joint?
-Two important pairs
-Collateral ligaments and the cruciate ligaments
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What are these and what do they do?
-Medial (tibial) and lateral (fibular) collateral ligaments support the knee and resist sideways movements of the tibia on the femur
-Loose when the knee is flexed but taut on extension
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Describe the attachments of the collateral ligaments:
-Medial connects the femur to the tibia and the lateral connects the femur to the fibula
-Medial (tibial) is attached to the medial meniscus
-Lateral (fibular) is NOT attached to the lateral meniscus and has clinical implications
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What do the cruciate ligaments connect and when are they lax?
-Anterior and posterior cruciate ligaments connect the tibia to the femur and are named according to attachment to tibia
-Lax when the knee is flexed but taught when the knee is extended
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Describe the attachment and action of the anterior cruciate ligament:
-Attached to the anterior part of the intercondylar area of the tibia
-Attaches to medial aspect of the lateral condyle of the femur
-Prevents the tibia moving anteriorly relative to the femur
-Being able to pull the tibia forwards indicated ACl injury
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Describe the attachment and action of the posterior cruciate ligament:
-Attached to posterior part of the intercondylar area of the tibia
-Attaches to the lateral aspect of the medial condyle of the femur
-Prevents tibia moving posterior in relation to the femur
-Crucial for stability of the knee when walking downhill or downstairs
-Being able to push the tibia posteriorly signifies PCL injury
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What kind of joint is the ankle joint?
The ankle is a synovial hinge joint formed by the articulation between the distal tibia, distal fibula and the talus
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What key ligaments support the lateral ankle joint?
-Three key ligaments support the lateral ankle joint
-Anterior talofibular
-Posterior talofibular
-Calcaneofibular
-All attach to the lateral malleolus
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What key ligaments support the medial ankle joint?
-Attach to medial malleolus
-Referred to as the medial ligament of the ankle or the delotid ligament because of the overall shape of the ligaments as a group
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Describe the subtalar joint:
-Formed by the articulation of the talus with the calcaneum and navicular
-At this joint that inversion and eversion of the foot takes place
-Important in allowing us to walk on uneven ground
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Describe the movements of the subtalar joints:
-Inversion brings the sole of the foot medially
-Eversion raises the lateral border of the foot and brings the sole of the foot laterally
-Forced inversion and eversion sprain the ligaments of the ankle
