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Musculoskeletal Module > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Where are the 2x most common places for compartment syndrome to occur?

A

Forearm

Leg

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2
Q

What is the structural boundaries and components of the leg?

A

Knee to ankle
2x bones: Fibula and Tibia
3x compartments: Anterior, Lateral and Posterior
3x fascia: Interosseus membrane + Anterior and Posterior Intermuscular Septae

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3
Q

What are the 3x structures which divide the leg into its 3x compartments?

A

Interosseous Membrane

Anterior + Posterior Intermuscular Septae

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4
Q

What are the structural boundaries of the anterior compartment of the leg?

A 
Bound 
Anteriorly: by Skin + Deep Fascia
Medially: by Lateral surface of Tibia
Posteriorly: by interosseous membrane
Laterally: Anterior intermuscular septum
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5
Q

What are the main features of the anterior compartment of the leg?

A 
Dorsiflexor (extensor) compartment
Bound 
Anteriorly: by Skin + Deep Fascia
Medially: by Lateral surface of Tibia
Posteriorly: by interosseous membrane
Laterally: Anterior intermuscular septum
--Due to being bound by 3x fairly rigid structures (2x bones and interosseous membrane) is Most vulnerable to compartment syndrome
Contains:
4x muscles: Tibialis Anterior, Ext. Digitorum Long. , Ext. Hallucis Long. & Peroneus Tertius
Deep Peroneal Nerve
Anterior Tibial Artery
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6
Q

Where in the leg is most vulnerable to compartment syndrome and why?

A

Anterior Compartment of the Leg

-as it is bound by 3x fairly rigid structures( 2x bones and Interosseous membrane)

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7
Q

What are the 6x contents of the Anterior Compartment of the leg?

A 
4x muscles:
Tibialis Anterior
Ext. Digitorum Long.
Ext. Hallucis Long.
Peroneus Tertius
1x Deep Peroneal Nerve
1. Anterior Tibial Artery
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8
Q

What other compartment does the anterior compartment of the leg belong to?

A

Dorsiflexor/Extensor compartment

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9
Q

What is the function of the interosseus membrane in the Leg?

A

Thick and rigid/tight and unyeilding membranous sheet
Landmark
a) Divides Anterior and Posterior compartment
b) then splits Laterally dividing Anterior and Lateral compartments (from anterior 1/2 of the leg)

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10
Q

What is the physical properties of the interosseus membrane?

A

Thick and Rigid membranous Sheet

Tight and Unyielding material

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11
Q

For what 2x reasons is the interosseus membrane in the leg a landmark?

A

a) Divides Anterior and Posterior Compartment

b) Splits Laterally and divides Anterior and Lateral Compartments (from anterior 1/2 of leg)

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12
Q

What is the relationship between the Deep Fascia and the Tibia?

A

Deep fascia is quite ADHERENT to the tibia

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13
Q

Which compartments in the Leg have the least space?

A

Lateral (smallest) and Anterior

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14
Q

What happens when there is a tibial/fibular fracture?

A

NOT Uncommon to fractur BOTH tibia and fibula when there’s moderate-severe trauma to the leg
Upon fracture/breaking = fluid, blood and material leaks out of the bone marrow
-cancellous bone is making cells and contains fluid
-alot of blood out of the middle
Increases Volume -> Increases Pressure in Anterior Compartment
-as extra fluid is forced into the compartment with nowhere to go

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15
Q

Is it common or uncommon to break both the Tibia and Fibula in one injury?

A

Common/NOT Uncommon

when there’s Moderate-severe Trauma to the leg

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16
Q

What leaks out of bone marrow when there is a Tibular/fibular fracture/break?

A

Upon break= Fluid, blood and material leaks out of bone marrow
-as cancellous bone is making cells and contains fluid
-alot of Blood out of the middle
RESULT:
increase in volume –> increase in pressure
- as extra fluid is forced into the anterior compartment with nowhere to go

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17
Q

Why is there an increase in volume when the bone marrow is broken with a tibial and/or fibular fracture?

A

Cancellous bone is making cells and contains fluid
alot of blood out of the middle
Increase in volume –> Increase in pressure
-as there is extra fluid is forced into the anterior compartment with no where to go

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18
Q

What are some essential facts about the tibia?

A

Large/main bone
“shin”
Medial side of leg
Weight bearing bone

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19
Q

What is the main weight bearing bone in the leg?

A

Tibia

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20
Q

What bone is the leg is the most Medial?

A

Tibia

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21
Q

What bone in the leg is most Lateral?

A

Fibula

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22
Q

What are some essential facts about the fibula?

A

Thin
Lateral side of the leg
important with muscles but not weight bearing bone
Ideal place for bone grafting - you’re able to take some/middle of bone out with only minor lasting effect

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23
Q

Where is the ideal location in the body to utilise for bone grafting?

A

Fibula

you can take some/middle of bone out with only a minor lasting effect

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24
Q

Where is the ideal location in the body to utilise for vessel grafting?

A

Great Saphenous vein

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25
Q

What are some key features about the interosseus membrane in the leg?

A 
Thick sheet of tissue
similar structure to deep fascia
b/w tibia and fibula
No stretch or give
Rigid- holds the bones tightly together 
Essentially transforms the bones into a single solid structure down the middle of the leg
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26
Q

Tibialis Anterior

A

Anterior Compartment of leg (largest)
Origin: Superior/proximal 1/2(half) of lateral tibia and interosseus membrane
Insertion: Medial Cuneiform and base of 1st MT
-crosses both the ankle joint –> therefore moves foot
Action: Dorsifelxes ankle, inverts foot at subtalar joint
Nerve Supply: Deep Peroneal/Fibular nerve
INversion capability
Tibialis anterior does the Majority of lifting/dorsiflexion of the ankle and foot
-contraction/attachment and insertion points pulled together =leg and ankle lifts up= dorsiflexion & extension

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27
Q

What is the main function of the Tibialis anterior?

A

Largest muscle in the anterior compartment
Inversion capability
Does most of the muscle bulk of the dorsiflexion/extension of the ankle/foot
-upon contraction the attachment and insertion points are pulled together = leg/foot is pulled up= dorsiflexion and extension

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28
Q

What is the largest muscle in the anterior compartment?

A

tibialis anterior

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29
Q

Which muscle conducts the largest muscle bulk of the dorsiflexion/extension/lifting of foot/ankle?

A

Tibialis anterior

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30
Q

What are the 4x main muscles of the anterior compartment of the leg?

A
  1. Tibialis Anterior
  2. Extensor Digitorum Longus
  3. Extensor Hallucis Longus
  4. Peroneus/Fibularis Longus
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31
Q

Extensor Digitorum Longus

A

Extensor= rxtends/dorsifelxes the foot
Longus = long muscle
Digitorum= moves the digits (ie fingers or toes)
Anterior Compartment of leg
Origin: Lateral condyle of the tibia, superior 3/4 of medial fibula and interosseus membrane
Insertion: Middle and distal phalanges of lateral 4 toes
Action: Extends toes, dorsiflexes ankle
Nerve Supply: Deep Peroneal/Fibular nerve
INversion capability

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32
Q

Are the muscles of the anterior compartment of the leg involved in dorsiflexion or plantarflexion/ flexion or extension?

A

dorsiflexion
extension
-ALL supplied by the deep peroneal nerve

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33
Q

Extensor Hallucis Longus

A

Anterior compartment of leg
Origin: Middle/further down anterior fibula and interosseus membrane
Insertion: Base of distal phalanx of great toe
Action:extends great toe, dorsiflexes ankle
Nerve Supply: Deep peroneal/fibular nerve
INversion capability

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34
Q

Peroneus/Fibularis Tertius

A

Origin: Inferior 1/3 anterior fibula and interosseus membrane
Insertion: Base of 5th MT (TIP of big toe)
Action: Dorsi flexes ankle, everts foot at subtalar joint
Nerve Supply: Deep peroneal/fibular nerve
INversion capability
also part of LATERAL compartment

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35
Q

What ENTIRE compartment of the leg does the deep peroneal/Fibular nerve innervate?

A

Anterior compartment of the leg

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36
Q

What nerve innervates every muscle int he anterior compartment of the leg?

A

Deep Peroneal/Fibular nerve

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37
Q

Which 3x muscles in the anterior compartment of the leg have an INversion capability?

A
  1. Tibilas anterior (especially)
  2. Extensor Digitorum Longus
  3. Extensor Hallucis Longus
    - comes down MEDIAL side
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38
Q

Which 1x muscle in the anterior compartment of the leg has an Eversion capability?

A
  1. Peroneus/Fibularus Longus

- comes down LATERAL side

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39
Q

What side do the eversion muscles in the anterior compartment of the leg come down?

A

Lateral side

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40
Q

What side do the inversion muscles in the anterior compartment of the leg come down?

A

Medial Side

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41
Q

What is the point of having opposing inversion and eversion muscles in the same anterior compartment of the leg?

A

the 3x INversion medial muscles of the leg BALANCE the compartment’s other 1x Eversion lateral muscles WITHIN THE SAME COMPARTMENT

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42
Q

How does the tibialis anterior muscle of the anterior compartment of the leg move the foot?

A

It crosses the ankle joint –> therefore is able to move the foot

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43
Q

What is the broken down meaning of the Extensor Digitorum Longus muscle?

A

“Extensor”= extends/dorsi flexes the foot/ankle
=> anterior compartment of the leg is involved in extension/dorsiflexion
“longus”= long muscle
“Digitorum”= move the digits (i.e. fingers or toes) ==> therefore attaches to the lateral 4 phalanges (i.e. digits/toes)
-essentially great toe is different/its own entity

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44
Q

How do you know which muscle attaches to the toes (majority)?

A

Extensor Digitorum Longus (its tendons)
“Extensor”= extends/dorsi flexes the foot/ankle
=> anterior compartment of the leg is involved in extension/dorsiflexion
“longus”= long muscle
“Digitorum”= move the digits (i.e. fingers or toes) ==> therefore attaches to the lateral 4 phalanges (i.e. digits/toes)
-essentially great toe is different/its own entity

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45
Q

What physically attaches to the 4x lateral digits of the foot and great toe?

A

TENDONS of extensor digitorum LONGus (4x lateral digits) and extensor hallucis LONGus (great toe)

  • tendons are very long
  • the actual Muscle Belly is located in the LEg
  • therefore the tendons comes all the way down to the toe
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46
Q

Where is the actual insertion attachment of the Extensor Hallucis Longus Tendon of the Anterior compartment of the leg?

A

TIP of big toe/base of distal phalanx of great toe
Can LIFT/EXTEND your big toe INDEPENDANTLY of your other 4x toes as it has its OWN muscle to itself
“hallucis”= big toe

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47
Q

What does “Hallucis” mean?

A

Big toe
extnesor hallucis longus inserts onto TIP of big toe/base of distal phalanx of great toe
Can LIFT/EXTEND your big toe INDEPENDANTLY of your other 4x toes as it has its OWN muscle to itself

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48
Q

What muscle in the anterior compartment of the leg belongs to more than one compartment? and what is the name of the other compartment?

A

Peroneaus/Fibularus tertius

Anterior and LATERAL compartment of the leg

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49
Q

What compartment of the leg does Fibularis/Peroneus Teritius belong to?

A

Anterior

Lateral

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50
Q

Peroneus/Fibularis Longus

A

Origin: Superior 2/3 of lateral fibula
Insertion: Base of 1st MT and medial cuneiform
Action: Everts foot, weak plantarflexor
Nerve: Superificial Peroneal/Fibular nerve

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51
Q

Peroneus/Fibularis Brevis

A

Origin: Inferior 2/3 of lateral fibula
Insertion: Base of 5th MT
Action: Everts foot, weak plantarflexor
Nerve: Superficial Peroneal/Fibular Nerve

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52
Q

What ENTIRE compartment of the leg does the Superficial Peroneal Nerve innvervate?

A

Lateral compartment of the Leg

  • Peroneus/Fibularis Longus
  • Peroneus/Fibularis Brevis
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53
Q

What is the general action of the Lateral compartment of the leg?

A

Attaches Laterally to the Fibula(lateral bone)

POINTS toe = Plantar flexion/Eversion

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54
Q

What compartment of the leg is involved with pointing the toe/Eversion/Plantar flexion?

A

Lateral compartment of the leg

Attached laterally to the fibular (lateral bone)

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55
Q

What are some general features of Peroneus/Fibularis Longus?

A

slightly Stronger Everter (lateral border)
P. Longus. Tendon = Behind distal Fibula, across Bottom of foot & inserts Medially (close to where tibilias anterior inserts)

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56
Q

What muscle of the leg attaches medially close to the insertion of tibialis anterior?

A

Peroneus/Fibularis Longus

-Lateral compartment

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57
Q

Which muscle in the lateral compartment is a slightly stronger Everter?

A

Peroneus/Fibularis Longus

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58
Q

What are some general features of Peroneus/Fibularis Brevis?

A

attaches to lower part of lateral fibula
inserts onto the base of pinky toe/5th MT
Tendons are around the Posterior aspect of the leg

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59
Q

What are the muscles of the Lateral compartment of the leg?

A
  1. Peroneus/Fibularis Longus
  2. Peroneus/Fibularis Brevis
  3. also a little bit of peroneus/fibularis tertius- also part of Anterior compartment
60
Q

What are some general features and function of the Retinaculum of the foot?

A

very similar to deep Fascia
holds down tendons to remain tight onto the bone
Avoids bow stringing (dorsiflexion=shorter distance b/w bones=tendons stick up)
Tendons anterior and lateral compartments of the leg

61
Q

Through what action is the retinaculum useful?

A

Dorsiflexion - as there is a shorter distance between the bones- therefore w/o it the tendons would stick up/bowstring
If Retinaculum Damaged; Stick up. Snap. Rub against distal fibula - could fray and potentially rupture

62
Q

What would happen if the retinaculum was injured?

A

Bowstringing during dorsiflexion(when there is a shorter distance b/w the bones)
Stick up
Snap
Rub against distal fibula
-tendons could fray and potentially rupture

63
Q

Including all of the retinaculum which compartments of the legs’ tendons are held down?

A
  1. Anterior compartment of the leg (superficial EXTENSOR-as is extensor compartment/muscles)
  2. Lateral compartment of the leg (inferior peroneal)
64
Q

What are the main features of the superior extensor retinaculum?

A

Tibia –> Fibula , superior to malleoli
Binds down tendons of all 4x muscles of the anterior compartment
-preventing bowstringing during dorsiflexion

65
Q

What are the main features of the inferior extensor retinaculum?

A

Y shaped band
Lateral attachment = Upper surface of calcaneus
Medial attachment = 1. Proximally to Medial Malleolus & 2. Plantar aponsurosis

66
Q

What is the name of the Y shaped band of deep fascia in the foot?

A

Inferior Extensor Retinaculum

67
Q

What are the main features of the superior peroneal retinaculum?

A

Attached above to Lateral Malleolus

Below to lateral surface of calcaneus

68
Q

What are the main features of the inferior peroneal retinaculum?

A

Front fibres: continuous with fibres of Cruciate crural ligament
Behind= attached to lateral surface of calcaneus
some fibres attached to peroneal trochlea, forming a septum between the tendons of the peroneal longus and brevis

69
Q

What are the front fibres of the Inferior Peroneal retinaculum of the foot continuous with?

A

fibres of the Cruciate Crural Ligament

-in front

70
Q

What is the relationship between the Inferior Peroneal Retinaculum and the Muscles of the Lateral compartment of the leg?

A

Some of the fibres of the inferior peroneal retinaculum are fixed to the peroneal trochlea, forming a septum between the tendons of peroneal Longus and Brevis

71
Q

Which 2x muscles is the septum, produced be the INferior PERoneal Retinaculum, between?

A

Peroneal/Fibularis Longus

Peroneal/Fibularis Brevis

72
Q

What are the 2x muscles located on the top of your foot?

A

Extensor Digitorum Longus
Extensor Hallucis Longus
(both from Anterior compartment)
-both start on the calcaneous/heel bone out laterally
Most of the Muscle bulk is located in the Superior and Lateral aspect of the top of the foot

73
Q

Where is the majority of the muscle bulk of the foot located?

A

Superior and Lateral aspect of the foot

74
Q

What is the location of the Anterior Tibial Artery/Dorsalis Pedis Artery?

A

Name change as crosses ankle joint –> Dorsalis Pedis Artery
Underneath Extensor Hallicus Longus
Pops out in line with the 2nd MT
Great place to find a PULSE in the TOP of the foot (convenience and social acceptable)
also- if people have circulation problems, often the first place you will have trouble finding a pulse at the top of the foot

75
Q

What is the name change that Anterior tibial Artery experiences?

A

to Dorsalis Pedis Artery
as it crosses the ankle joint
comes out in line with the 2nd MT
Good place to take a pulse in the foot (convenience and social acceptable)
Also if circulation problems are occurring, the First place you will have trouble finding a pulse will be at the top of the foot
–> therefore if the DPA is the first place the pulse will dimmer, if the Pulse is good at the DPA/ATA then that person will have great bloody supply

76
Q

What is the name of the Artery which is an ideal target to take a pulse in the foot?

A

ATA/Dorsalis Pedis Artery
Top of foot
-artery comes out in line with 2nd MT
Would be first place to have trouble finding a pulse if someone had circulation problems
–> therefore if someone has a good pulse then they have a good bloody supple/no circulation problems

77
Q

Where is the location of the name change for ATA Anterior Tibial Artery –> to DPA Dorsalis Pedis Artery?

A

as the ATA crosses the Ankle Joint (and then goes under Extensor Hallicis Longus)

Crosses midway between the Malleoli, between the tendons of EDL and EHL

-now supplies the dorsum/back of the foot

78
Q

Where is the Femoral Artery Located?

A

Medial to the Knee
Then runs posteriorly, behind the femur, to the back of the knee in order to enter the Popliteal Fossa (name change to –> Popliteal Artery)

79
Q

What is the name change that the Femoral Artery undergoes?

A

Politeal Artery

-after it runs around posteriorly, to the back of the knee, to enter the popliteal fossa

80
Q

What are the three Arteries that the Popliteal Artery Trifurcates into as it Exits the popliteal Fossa?

A

Trifurcation into:

  1. Anterior Tibial Artery
  2. Posterior Tibial Artery
  3. Peroneal Artery
81
Q

Where does the Anterior Tibial Artery have to run through in order to supply the Anterior Compartment?

A

Gap in the interosseus membrane

82
Q

Where is the blood supply of Dorsalis Pedis Artery sent to?

A

Dorsum of the foot

-Back of the foot

83
Q

What are the three arteries that the Dorsalis Pedis Artery Trifurcates into?

A
  1. Deep Plantar Artery (between 1st and 2nd MT) - forming Deep Plantar Arch
  2. Lateral Tarsal artery
  3. Arcuate Artery
84
Q

Where is the location of the Deep Plantar Artery?

A

between the 1st and 2nd MT

-form the Deep Plantar Arch

85
Q

What does the Deep Plantar artery form after it has branched for the Dorsalis Pedis Artery?

A

Deep Plantar Arch

86
Q

What forms the deep Plantar Arch?

A

Deep Plantar Artery

87
Q

Where does the bifurcation between the Posterior Tibial Artery and Peroneal aRtery occur?

A

Deep to the tendinous arch of Soleus

88
Q

What occurs deep to the tendinous arch of Soleus?

A

Posterior Tibial artery and Peroneal Artery bifurcate

89
Q

What accompanies the Posterior Tibial Artery and what is it’s location?

A

Accompanied by Tibial Nerve and Tibial Vein

Posterior to the Medial Melleolus

90
Q

What accompanies the Tibial Nerve and Tibial veins?

A

Posterior Tibial Artery

91
Q

What are the two terminal branches of the Posterior Tibial Artery?

A
  1. Medial Plantar Artery
  2. Lateral Plantar Artery
    - supply the Sole of the foot
92
Q

Where in the body does the Medial and Lateral Plantar Arteries Supply?

A

Sole of the foot

93
Q

What supplies the sole of the foot with blood?

A

Medial and Lateral Plantar Arteries

the terminal branches of the Posterior Tibial Artery

94
Q

What is the location of the Peroneal Artery?

A

runs laterally towards the fibula

still in the Deep Posterior compartment

95
Q

What are the 2x branches of the Peroneal Artery?

A
  1. branches of into the Posterior and Lateral Compartments

2. Nutrient artery of the Fibula

96
Q

Where does the Nutrient Artery of the Fibula originate from?

A

Branch of the Peroneal Artery

97
Q

Out of the Anterior Tibial artery, Posterior Tibial Artery and Peroneal Artery, which ones are the more important?

A

Anterior Tibial Artery

Posterior Tibial Artery

98
Q

From which Artery in the leg would you be expected to locate and take a pulse from?

A

Anterior tibial aRtery

Posterior Tibial Artery

99
Q

What nerve travels with the Anterior Tibial Artery?

A

Deep Peroneal NERVE

100
Q

What are some key features of the Sciatic Nerve?

A

Originates from the Lumbosacral Plexus (formed in Pelvic Region)
L4-S3
drives Most of you Leg
Branches into Tibial and Common Peroneal (Fibular) Nerve

101
Q

What compartment does the Tibial Nerve innervate?

A

Posterior Compartment

102
Q

What are some key features of Common Peroneal (Fibular) Nerve innervate?

A 
Exits popliteal Fossa Laterally
winds around the neck of the Fibula
Branches into:
1. Deep Peroneal(fibular) nerve
2. Superficial Peroneal Nerve
103
Q

What are some key features about the Deep Peroneal Nerve?

A

Branches off from the Common Peroneal (Fibular) Nerve
Innervates the Anterior compartment
Runs with the Anterior Tibial Artery
-crosses the ankle to supply the dorsum of the foot
Then becomes cutaneous innervation of the 1st Web space

104
Q

What composes the Cutaneous Innervation of the first Web space?

A

Deep peroneal (fibular) nerve

105
Q

What are some key features about the Superficial Peroneal Nerve?

A

Branches off from the Common Peroneal Nerve
Innervates the Lateral compartment
Initially does the Motor control/muscle innervation of lateral compartment muscles
Then becomes a Cutaneous Nerve supplying:
1. Skin of Anterior Leg
2. Most of the Skin of the dorsum of the Foot

106
Q

What does the Superficial peroneal nerve change to Innervating after innervating the muscles of the Lateral Compartment?

A

Cutaneous Nerve supply

  1. Skin of Anterior Leg
  2. Most of the Dorsum of the foot
107
Q

What supplies the cutaneous innervation to the skin on the Anterior Leg and Majority of the skin on the dorsum of the foot?

A

Superficial Peroneal NErve

108
Q

What are some features about the Sural Nerve?

A

composed of 1x branch from Tibial Artery and Common Peroneal (Fibular Artery)
Innervates the Posterior Compartment
runs Superficially down the back of the leg (hence innervates Posterior Compartment)
Cutaneous Nerve
Good for a nerve biopsy - incision on Lateral Border of Foot

109
Q

What does a branch from both the Tibial Nerve and the Common Peroneal Nerve form?

A

Sural Nerve

-cutaneous nerve

110
Q

Is the Sural Nerve a Cutaneous or Motor Nerve?

A

Cutaneous

-runs superficially along the back of the leg

111
Q

Which nerve in the leg is a good nerve for a nerve biopsy?

A

Sural nerve

-make an incision on the Lateral border of the foot

112
Q

Where is a good location to make an incision if your are wanting to conduct a nerve biopsy form the Sural nerve?

A

Lateral border of the foot -

Sural nerve is a good nerve to use for a nerve biopsy

113
Q

Are the Medial and Lateral Plantar nerves Cutaneous or Motor control nerves?

A

Cutaneous

114
Q

Eversion

A

Lateral border of foot is lifted UP

115
Q

Inversion

A

soles of feet are moving Towards Midline

-common injury of the ankle

116
Q

What are the names for the ankle movements from side to side?

A

eversion and inversion

117
Q

Dorsiflexion

A

raising of toes

Extension of ankle

118
Q

Plantarflexion

A

planting toes into ground
-e.g. accelerating or ballet
(Flexion of the ankle)

119
Q

Is dorsiflexion resulting in Extension or flexion of the ankle joint?

A

Extension

120
Q

Is plantar flexion resulting in Extension or Flexion of the ankle joint?

A

Flexion

121
Q

What is Acceleration and Ballet a good example of?

A

Plantar Flexion

122
Q

What are the 4x types of ankle movement?

A
  1. Plantarflexion
  2. Dorsiflexion
  3. Inversion
  4. Eversion
123
Q

What movement of the ankle most often leads to ankle injury?

A

Inversion

-twist ankle is when the ankle is forced from side to side

124
Q

What are the 6x Cutaneous Nerves of the Leg?

A
  1. Superficial Peroneal Nerve
  2. Deep Peroneal Nerve
  3. Sural Nerve
  4. Medial Plantar Nerve
  5. Lateral Plantar Nerve
  6. Saphenous Nerve
125
Q

What is the Tibial Nerve’s two cutaneous branched named?

A
  1. Medial Plantar Nerve

2. Lateral Plantar NErve

126
Q

What is the Femoral Nerve’s cutaneous branch’s names?

A

Saphenous Nerve

127
Q

What are the 3x cutaneous nerves which innervate the feet?

A
  1. Superficial Peroneal Nerve
  2. Deep Peroneal Nerve
  3. Saphenous Nerve
128
Q

What are some essential features of the saphenous nerve?

A

cutaneous nerve
runs along corner of medial side of ankle and foot -(medial malleolus)
travels through adductor canal
supplies the Medial side of the foot cutaneously

129
Q

What are some essential features of the superficial peroneal nerve?

A

big nerve
branches out and covers most of the foot
Lateral Compartment
supplies Lateral compartment of leg and Top of foot

130
Q

What are some essential features of the deep peroneal nerve?

A

Anterior compartment
Deep and Tight to interosseus membrane
Supplies First Web space of foot

131
Q

What is the arterial and Nervous supply to the 1st web space of the foot?

A

Deep Plantar Artery (from Dorsalis Pedis Artery)

Deep Peroneal Nerve

132
Q

Extensor Digitorum Brevis

A

Origin: Calcaneus and Inferior Extensor Retinaculum
Insertion: Middle and distal phalanges of lateral 4 toes (with EDL)
Action: Extends toes at MTPJs and IPJs
Nerve Supply: Deep Peroneal

133
Q

Extensor Hallucis Brevis

A

Origin: Calcaneus and Inferior Extensor Retinaculum
Insertion: Base of Proximal phalanx of great toe
Action: Extends great toe at MTPJ
Nerve Supply: Deep Peroneal

134
Q

Where are the Dorsal foot muscles located?

A

Top of the foot

135
Q

Where do both the Dorsal foot muscles (extensor hallucis brevis and extensor digitorum brevis) start/originate from?

A

both Lateral
and both start on the Calcaneous/Heel bone
–> therefore most of the muscle bulk is located on the Superior and lateral aspect of the top of the foot

136
Q

Where is the main muscle bulk on the top of the foot?

A

Lateral and Superiorly

-as both EHB and EDB start/originate laterally on the Calcaneous/heel bone

137
Q

What is the function of the dorsal foot muscles/EHB & EDB?

A

both of the brevis muscles essentially just HELP OUT the longer/longus versions from the anterior compartment

138
Q

What happens with the tendons of extensor hallucis brevis and extensor digitorum brevis?

A

Tendons run together into the foot

-just HELP OUT the longer versions of these muscle

139
Q

What tendon does the ATA/Dorsalis Pedis artery run underneath?

A

tendon of Extensor Hallucis Longus

Hallox = great toe. and Dorsalis pedis is going to go supply the big toe

140
Q

What are the essential features of a foot drop clinical application?

A

Common peroneal or Deep Peroneal nerve injury
Passively: Planter flexed and Inverted
Results in= High stepping/slapping gait. becuase the Dorsiflexors are not functioning

141
Q

What nerves are injured in a Foot Drop injury?

A

Common Peroneal Nerve

or Deep Peroneal Nerve

142
Q

What is the passive position of a Foot Drop injury?

A

Plantar flexed

and Inverted

143
Q

What happens when you have a foot drop injury?

A

High Stepping
or Slapping gait
-because your Dorsiflexors arent functioning

144
Q

What do you either have a high stepping or slapping gait with a foot drop injury?

A

your Dorsiflexors are not working

145
Q

What are the essential features of a compartment syndrome?

A

Limb threatening and/or life threatening
Increase in pressure within compartment
(Anterior compartment doesnt have much room for extra blood or fluid)
Therefore muscles will start to die quickly.
A) Vessels compressed
1. Veins compressed, as thin walled and not much resistance against compression. Means no outflow of blood out of compartment.
Pressure continues to build up.
2. arteries compressed. Big trouble. means No blood coming into compartment =1. Muscles Die. 2. No blood going to foot. (as ATA changes into Dorsalis Pedis Artery)
-this can lead to people losing limbs due to compartment syndrome, because if you dont treat soon enough, can lead to irreversible damage.
B)Muscles breakdown. results in toxin release. Can knock of kidneys. can lead to potentially life threatening condition
5x Symptoms:
1. Pain (First experienced)
2. Pallor
3. Pulselessness
4. Parasthesia
5. Paralysis
Parasthesia and Paralysis are Late symptoms, shouldnt see them for a while, and if these symptoms do arise you know you are really in trouble

146
Q

What are the 5x P symptoms of compartment syndrome?

A
  1. Pain (first visual symptom. Massive, rapid, sudden increase in pain, uncontrollable by medication) -f broken bone, sometimes cast for before surgery may need to be released- not just the fascia is the problem
  2. Pallor: pale. no blood supply , therefore no pink skin, –> toes and feet are a dusty grey
  3. Pulselessness: artery is compressed
  4. Parasthesia: nerves get compressed –> foot and leg get numbe. LAte symptom = big trouble if visible
  5. Paralysis: muscles stopped working (no vein, arterial or nervous supply.) Late symptom = big problem
147
Q

How can Compartment Syndrome be a life threatening injury?

A

Muscle breakdown (due to loss of venous and arterial supply - both to leg and foot)
= toxin release
=knock of your kidneys
=potentially life threatening

Musculoskeletal Module (27 decks)

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