Anatomy revision 2
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The document provides information on the anatomy revision session on the upper limb muscles and their functions. Key points covered include identifying the muscles of the upper limb and their nerve supply, orientation and movement terms, and muscles of the forearm, hand, and nerves of the upper limb. There will be pop quizzes to test understanding. The session then reviews muscles of the gluteal region, hip bone anatomy, and the hip joint.
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Anatomy revision 2
- 1. Anatomy Revision Session 2 slides are available online at Slideshare.net/muradalshehry After this session The Upper Limb
- 2. Anatomy Revision Session 1 Objectives of this session • To be able to Identify the muscles and their functions of the upper limb. • Know relations of muscles to important nerves. • There will be a few pop Quiz…. Stay focused ☺
- 3. Orientation and Movement REVISION adduction abduction flexionextension circumduction rotation
- 4. elevation depression supination pronation protraction retraction Orientation and Movement REVISION
- 5. Flexor digitorum superficialis • Medial epicondyle of humerus and coronoid process of ulna to middle phalanges (lateral) of digits 2-5 (i.e. all except thumb) • Flexion of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint • Median nerve (C7,C8,T1)
- 6. Flexor digitorum profundus • Ulna and interosseous membrane to distal phalanges digits 2-5 (palmar) • Flexion of MCP, PIP and distal interphalangeal joint (DIP) of digits 2-5 • Ring and little fingers = ulnar nerve (C8,T1) • Index and middle fingers = median nerve (C8,T1 anterior interosseous)
- 7. Flexor digitorum muscles: Superficialis Splits in two, To Permit Profundus Passing through.
- 8. Flexor pollicis longus • Radius and interosseous membrane to base of distal phalanx of thumb (palmar) • Flexion of MCP and IP of thumb, wrist • Median nerve (C8, T1 anterior interosseous)
- 9. Pronator quadratus • Distal anterior ulna to distal anterior radius • Pronation and help to stabilise distal radioulnar joint • Median nerve (C8, T1 anterior introsseous)
- 10. Anterior forearm muscles: superficial group There are five, like five digits of your hand. Place your thumb into your palm, then lay that hand palm down on your other arm. PFPF [pass/fail, pass/fail]: Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Your thumb below your 4 fingers shows the muscle which is deep to the other four: Flexor digitorum superficialis.
- 11. Median nerve • C6-T1 fibres, medial and lateral cords • Major nerve of anterior compartment of forearm, THROUGH carpal tunnel • Main nerve of thumb side of hand
- 12. Ulnar nerve and artery • C7-T1 fibres from medial cord, medial epicondyle of humerus, pisiform ABOVE carpal tunnel • Branch brachial artery, interosseous branches, little finger side, superficial palmar arch
- 13. median ulnar radial ant. interosseous anterior interosseous Median nerve passes between the heads of pronator teres
- 14. Anconeus • Lateral epicondyle of humerus to olecranon of ulna • Extension of the elbow • Radial nerve (C7-C8)
- 15. Brachioradialis • Distal humerus (supra-epicondylar ridge) to radius proximal to styloid process • Puts the forearm into the semi-prone position, flexion of elbow • Radial nerve (C5, C6, C7) (before division into deep and superficial)
- 16. Posterior compartment of the forearm • Common extensor origin = lateral epicondyle of the humerus • Extensors of the digits, wrist • Abductor of the thumb • Supinator • Radial nerve
- 17. Extensor carpi radialis longus and brevis • Extensor carpi radialis longus from distal humerus (supra- epicondylar ridge) to base of 2nd metacarpal • Wrist extension and abduction • Radial nerve (C6,C7) (pre-division) • Extensor carpi radialis brevis from lateral epicondyle of humerus to base of 3rd metacarpal • Wrist extension and abduction • Radial nerve (C7,C8) (deep = posterior interosseous) extensor carpi radialis longus extensor carpi radialis brevis
- 18. Extensor carpi ulnaris • Lateral epicondyle of humerus (small slip from ulna) to base of 5th metacarpal • Wrist extension and adduction • Radial nerve (posterior interosseous) (C7, C8)
- 19. Extensor digitorum • Lateral epicondyle of humerus to dorsal expansion of digits 2-5 (NOT thumb) • Extension of principally MCP, but also PIP and DIP extension of digits 2-5 • Radial nerve (posterior interosseous) (C7,C8)
- 20. Extensor digiti minimi • Lateral epicondyle of the humerus to dorsal expansion of 5th digit (little finger) • MCP, PIP, DIP extension of little finger • Radial nerve (posterior interosseous) (C7,C8)
- 21. Extensor indices • Posterior surface of ulna (and interosseous membrane) to dorsal expansion of digit 2 (index finger) • MCP, PIP, DIP extension of index finger • Wrist extension • Radial nerve (posterior interosseous) (C7,C8)
- 22. Extensor pollicis longus • ‘Pollicis’ = thumb • Ulna and interosseous membrane to base of distal phalanx of thumb • CMC, MCP and IP extension of thumb • Radial nerve (posterior interosseous) (C7, C8)
- 23. Extensor pollicis brevis • Radius and interosseous membrane to base of proximal phalanx of thumb • Carpometacarpal and MCP thumb joint extension • Radial nerve (posterior interosseous) (C7,C8)
- 24. Abductor pollicis longus • Radius, interosseous membrane and ulna to base of 1st metacarpal • Abducts thumb and extends it at carpometacarpal joint • Radial nerve (posterior interosseous) (C7,C8)
- 25. Supinator • Crest of ulna, lateral epicondyle of humerus, radial collateral and annular ligament of radius to lateral radius (proximal third) • Supination of forearm (rotates radius) • Radial nerve (posterior interosseous)(C7,C8)
- 26. Radial nerve passes through the lamina of supinator
- 28. The Hand
- 29. Flexor retinaculum • Roof of carpal tunnel • Medial = pisiform, hook of hamate • Lateral = tubercle of scaphoid and ridge on trapezium • Septum from trapezium – flexor carpi radialis • Attach thenar and hypothenar structures
- 30. Carpal tunnel
- 31. Carpal tunnel syndrome causes MEDIAN TRAP: Myxoedema Edema premenstrually Diabetes Idiopathic Agromegaly Neoplasm Trauma Rheumatoid arthritis Amyloidosis Pregnancy
- 32. Bones and joints carpals metacarpals proximal phalanx middle phalanx distal phalanx interphalangeal (IP) joints = synovial hinge metacarpophalangeal (MCP) joints = synovial condyloid carpometacarpal (CMC) joints = synovial saddle (thumb), plane (digits) intercarpal = synovial plane
- 34. Palmaris brevis • Palmar aponeurosis and flexor retinaculum to dermis • Grip • Ulnar nerve (superficial C8,T1)
- 35. Intrinsic muscles of the hand abductor pollicis brevis = intrinsic muscle tendon of flexor digitorum superficialis = extrinsic muscle
- 36. Intrinsic muscles – thenar eminence • Abductor pollicis brevis = scaphoid and trapezium to base proximal phalanx of thumb – CMC joint abduction – median nerve (recurrent C8,T1) • Flexor pollicis brevis = flexor retinaculum, capitate, trapezium to base proximal phalanx of thumb – CMC joint flexion – Median (recurrent) and some texts also ulnar nerve (C8,T1) • Opponens pollicis = trapezium to first metacarpal – CMC joint opposition – median nerve (recurrent C8,T1) abductor pollicis brevis flexor pollicis brevis opponens pollicis
- 37. Adductor pollicis • Transverse head from 3rd metacarpal; oblique head from capitate and 2nd/3rd metacarpals to base of proximal phalanx of thumb • Adduction of CMC joint of thumb • Flexion of MCP joint of thumb • Ulnar nerve (deep C8,T1) transverse head oblique head
- 38. Hypothenar eminence • Abductor digiti minimi = pisiform bone to base of 5th proximal phalanx and dorsal digital expansion – abduction and flexion MCP joint little finger – ulnar nerve (deep C8,T1) • Flexor digiti minimi = hamate, flexor retinaculum to base of 5th proximal phalanx – Flex MCP joint of little finger – ulnar nerve (deep C8,T1) • Opponens digiti minimi = hamate and flexor retinaculum to 5th metacarpal – weak opposition of little finger – ulnar nerve (deep C8,T1) abductor digiti minimi flexor digiti minimi opponens digiti minimi
- 39. Lumbricals • 4 small muscles from tendons of flexor digitorum profundus • 1st (index) and 2nd (middle) unipennate • 3rd (ring) and 4th (little) usually bipennate • Insert into dorsal digital expansion • MCP joint flexion and IP joint extension for digits 2-4 • 1st and 2nd = median nerve (digital C8,T1) • 3rd and 4th = ulnar nerve (deep C8,T1) 1 2 3 4 lumbrical
- 40. Lumbricals action Lumbricals action Lumbrical action is to hold a pea, that is to flex the metacarpophalangeal joint and extend the interphalangeal joints. When look at hand in this position, can see this makes an "L" shape, since L is for Lumbrical.
- 41. Palmer interossei • Between metacarpal bones • 1st from 2nd metacarpal to base of 2nd proximal phalanx and dorsal expansion • 2nd from 4th metacarpal to base of 4th proximal phalanx and dorsal expansion • 3rd from 5th metacarpal to base of 5th proximal phalanx and dorsal expansion • Adduction towards middle finger (flex MCP, extend IP) • Ulnar nerve (deep C8,T1) 12 3
- 42. Dorsal interossei • From sides of 2 adjacent metacarpals, eg, 1st dorsal interossei from 1st and 2nd metacarpals • 1st inserts into 2nd proximal phalanx and dorsal digital expansion • 2nd and 3rd inserts into the 3rd proximal phalanx and dorsal digital expansion • 4th inserts into 4th proximal phalanx and dorsal digital expansion • Abduction (MCP flexion, IP extension) • Ulnar nerve (deep C8,T1) 123 4
- 43. Interossei muscles : actions of dorsal vs. palmar in hand "PAd and DAb": The Palmar Adduct and the Dorsal Abduct. · Use your hand to dab with a pad.
- 45. Intrinsic muscles of hand (palmar surface) "A OF A OF A": · Thenar, lateral to medial: Abductor pollicis longus Opponens pollicis Flexor pollicis brevis Adductor pollicis. · Hypothenar, lateral to medial: Opponens digiti minimi Flexor digiti minimi Abductor digiti minimi
- 46. Synovial sheaths • Synovial membrane plus fluid • Around tendons at wrist, palm and into digits
- 49. Cutaneous upper limb ANT POST
- 50. Carpal bones "Stop Letting Those People Touch The Cadaver's Hand Proximal row, lateral-to-medial: Scaphoid Lunate Triquetrum Pisiform Distal row, lateral-to-medial: Trapezium Trapezoid Capitate Hamate Or "Happy Cat Tom Took Pie To Little Sister": Hamate Capitate Trapezoid Trapezium Pisiform Triquital Lunate Scaphoid
- 51. Lower Limb
- 52. Gluteal Region and Hip Joint
- 53. Outline • Innominate (Hip) Bone • Proximal Femur • Muscles of the gluteal region • Nerves and Vessels of the gluteal region • Hip Joint
- 54. Obturator Foramen Iliac crest Iliac fossa ASIS AIIS PSIS PIIS Arcuate Line Ischial Tuberosity Ischial Spine Lesser Sciatic Notch Greater Sciatic Notch Pubis Innominate: Medial view
- 55. Innominate: Lateral view Iliac crest ASIS AIIS PSIS PIIS Ischial Tuberosity Ischial Spine Lesser Sciatic Notch Greater Sciatic Notch Pubis Posterior Gluteal Line Anterior Gluteal Line Inferior Gluteal Line Acetabulum Pubic Tubercle Ischium
- 56. Greater and Lesser Sciatic Foramina
- 57. Muscles of Gluteal Region Lateral Rotators of Hip • Gluteus Maximus (extensor) • Piriformis • Obturator internus • Gemelli • Quadratus femoris Medial Rotators and Abductors of Hip • Gluteus Medius • Gluteus Minimus Support • Tensor fascia lata
- 58. Gluteus Maximus • Sacrum, S/T ligament and ilium behind posterior gluteal line Iliotibial tract (3/4) and gluteal tuberosity of femur (1/4) • Extends hip; assists lateral rotation • Inferior gluteal nerve • (L5, S1, 2)
- 59. Tensor Fascia Lata • Ant. Iliac Crest and ASIS Iliotibial tract • Tenses fascia lata and iliotibial tract; Supports femur on tibia during standing • Superior Gluteal nerve • (L4, 5, S1) Gluteus Maximus Iliotibialtract
- 60. Gluteus Medius • Ilium between posterior and anterior gluteal lines greater trochanter (lateral surface) • Abducts and medially rotates hip • Superior gluteal nerve • (L4, 5, S1)
- 61. Gluteus Minimus • Ilium between anterior and inferior gluteal lines greater trochanter (anterior surface) • Abducts and medially rotates hip • Superior gluteal nerve • (L4, 5, S1)
- 62. Piriformis • Anterior Sacrum and S/T lig. Greater Trochanter (superior border) • Passes through greater sciatic foramen • Laterally rotates hip • Anterior rami of L5, S1, 2
- 63. Obturator internus • Pelvic surface of Obturator mem. and surrounding bones Trochanteric Fossa of greater trochanter • Passes through lesser sciatic foramen • Laterally rotates hip • Nerve to obturator internus (L5, S1)
- 64. Gemelli • Superior: Ischial spine • Inferior: Ischial tuberosity Blend with tendon of obturator internus (Trochanteric fossa) • Laterally rotate hip • Superior: Nerve to obturator internus • Inferior: Nerve to quadratus femoris
- 66. Quadratus femoris • Ischial tuberosity Quadrate tubercle on intertrochanteric crest of femur • Laterally rotates hip • Nerve to quadratus femoris (L5, S1)
- 67. Obturator externus • Outer surface of obturator mem. Trochanteric fossa • Laterally rotates hip • Obturator nerve • L3, 4 Anterior
- 68. Lateral Rotators "Play Golf Or Go On Quacking": · From top to bottom: Piriformis Gemellus superior Obturator internus Gemellus inferior Obturator externus Quadratus femoris · Alternatively: "P-GO-GO-Q".
- 69. Sciatic nerve • L4, 5, S1, 2, 3 • Tibial always leaves below piriformis • Common Peroneal may leave below, above or through piriformis
- 70. Gluteal vessels and nerves • Superior gluteal artery and nerve • Inferior gluteal artery and nerve • Piriformis
- 71. Posterior cutaneous nerve of thigh • Lies on posterior aspect of sciatic nerve • (S1, 2, 3) • Inferior Clunial nerves to skin of inferior half of buttock
- 72. Cutaneous Nerves – Gluteal and Posterior Thigh Superior Clunial (posterior rami L1,2,3) Middle Clunial (posterior rami S1,2,3) Posterior Cuntaneous n. of Thigh with Inferior Clunial branches
- 73. Hip Joint • Articular surfaces • Capsule attachments • Ligaments • Relations of the Joint
- 76. Iliofemoral ligament • AIIS → Intertrochanteric line • Upper and lower bands Limits: • Extension • Lateral rotation • Adduction (upper) • Abduction (lower)
- 77. Pubofemoral ligament • Iliopubic eminence → Lower part of intertrochanteric line Limits: • Extension • Lateral rotation • Abduction
- 78. Ischiofemoral ligament • Posterior aspect of acetabulum → Greater trochanter Limits: • Extension • Medial rotation • Adduction
- 79. Blood Supply to the Hip Joint
- 80. Anterior and Medial Thigh
- 81. Outline • Compartments of the Thigh • Features of the femur • Muscles of Anterior Compartment • Muscles of Medial Compartment • Adductor Canal • Nerves • Arteries
- 82. Compartments of Thigh Flex Hip; Extend Knee Anterior Compartment Subcutaneous tissue Fascia Lata Medial Compartment Posterior Compartment Great Saphenous vein Intermuscular Septum Iliotibial tract Extend Hip; Flex Knee Adduct Hip
- 83. Proximal femur (anterior) Head Greater trochanter Intertrochanteric line Lesser trochanter Shaft Fovea Neck
- 84. Proximal femur (posterior) Greater trochanter Trochanteric Fossa Intertrochanteric crest Lesser trochanter Pectineal line Gluteal tuberosity
- 85. Anterior Thigh Hip Flexors • Iliacus • Psoas major • Pectineus • Sartorius Knee Extensors • Quadriceps • Rectus femoris • Vastus medialis • Vastus lateralis • Vastus intermedius
- 86. Hip Flexors – Iliopsoas • Iliacus • Iliac crest, fossa, ala of sacrum, ant. sacroiliac lig. → Psoas tendon, lesser trochanter • Femoral nerve (L2, 3) • Flex hip • Psoas major • T12-L5, IV discs, lumbar transverse processes → Lesser trochanter • Anterior rami L1-3 • Flex hip
- 87. Hip Flexors – Pectineus • Pectineus • Superior ramus of pubis → Pectineal line of femur • Femoral nerve (L2, 3) [occassionally br. from obturator] • Adduct and flex hip; assist with medial rotation
- 88. Hip Flexors – Sartorious • Sartorious • ASIS → Superior part of medial surface Tibia • Femoral nerve (L2, 3) • Flex, abduct, laterally rotate hip; flex knee
- 89. Knee Extensors – Quadriceps • Rectus femoris • AIIS, ilium above acetabulum • Vastus lateralis • Gr. Trochanter & Lat. Linea Aspera • Vastus medialis • Intertrochanteric line & Med. Linea Aspera • Vastus intermedius • Ant. and Lat. Shaft of femur • → Quadriceps tendon then tibial tuberosity via Patellar lig. • Extend knee (rectus fem. also flexes hip) • Femoral nerve (L2,3,4) Rectus Femoris Vastus Lateralis Vastus Medialis Vastus Intermedius
- 90. Anterior Thigh Rectus Femoris Vastus Lateralis Vastus Medialis Sartorious Iliopsoas Pectineus
- 91. Femoral nerve • Passes deep to inguinal ligament, medial to ASIS, on tendon of iliopsoas m. • Muscular branches: anterior thigh • Articular branches: hip and knee • Cutaneous branches: anteromedial thigh • Saphenous nerve is terminal cutaneous br. – anteromedial knee, leg and foot Iliacus Rectus femoris Vasti muscles Pectineus
- 92. Medial Thigh Hip Adductors • Gracilis • Adductor Longus • Adductor Brevis • Adductor Magnus • Obturator Externus
- 93. Hip Adductors – Gracilis • Gracilis • Body and Inf. ramus of Pubis →Superior Medial surface Tibia • Obturator (L2, 3) • Adducts hip; flexes knee
- 94. Hip Adductors – Adductor Longus • Adductor Longus • Body pubis → Middle ⅓ Linea aspera • Obturator (L2,3,4) • Adducts thigh
- 95. Hip Adductors – Adductor Brevis • Adductor Brevis • Body and Inf. ramus of Pubis →Pectineal Line and proximal Linea aspera • Obturator (L2,3,4) • Adducts thigh (may assist flexion)
- 96. Hip Adductors – Adductor Magnus • Adductor Magnus • Ischiopubic ramus and Ischial tuberosity →Linea aspera, Med. Supracondylar line, Adductor tubercle • Obturator (L2,3,4); Hamstring part – tibial part Sciatic n. (L4) • Adducts thigh; Adductor part flexes and hamstring part extends thigh
- 97. Hip Adductors – Obturator Externus • Obturator Externus • Margins obturator foramen and Obturator membrane →Trochanteric fossa • Obturator (L3,4) • Laterally rotates thigh
- 99. Obturator Nerve Obturator externus Adductor Brevis Adductor Longus Adductor Magnus Gracilis • Anterior divisions L2-4 • Runs along lateral wall of pelvis to the obturator canal • Anterior and Posterior branches • Muscular branches to medial thigh • Anterior branch – cutaneous to middle part of medial thigh Obturator Externus Adductor Brevis Posterior Branch Anterior Branch Posterior Branch Anterior Branch
- 100. Adductor Canal • Apex of Femoral Triangle Adductor Hiatus (in adductor magnus) • Underlies the distal half of sartorius m. • Femoral vessels travel in canal and pass through Hiatus to reach Popliteal fossa • Saphenous nerve runs in canal then passes between sartorius and gracilis to supply skin of anteromedial knee, leg and foot Femoral a. and v. entering adductor canal Saphenous n. Sartorius forming roof of adductor canal
- 101. Arterial Supply Femoral artery – Continuation of Ext. Iliac a. • Femoral triangle → Adductor canal → Adductor hiatus to become Popliteal a. • Supplies anterior and anteromedial thigh Profunda femoris → br. of Femoral • Runs posterior to Adductor Longus → 3/4 perforating br.s through Add. Magnus to supply mm in med., post. and lat. part of ant. Compartment • Also gives Medial and Lateral Circumflex femoral br.s Obturator artery (from Int. Iliac a.) • Through obturator foramen to medial compartment → ant. and post. br.s • Anterior branch: muscles of medial compartment • Posterior branch: muscles attached to ischial tuberosity
- 102. Femoral Profunda Femoris External Iliac Commom Iliac Lateral Circumflex Femoral Femoral Profunda FemorisMedial Circumflex Femoral Perforating Branches Popliteal Obturator Adductor Magnus Adductor Hiatus Openings for Perforating br.s Anterior Posterior Cruciate Anastomosis
- 103. Posterior thigh and popliteal fossa
- 104. Outline • Muscles of posterior thigh • Sciatic nerve • Popliteal fossa • Roof • Boundaries • Contents • Floor • Popliteal artery and branches 104
- 105. Posterior Thigh • Hamstrings • Semitendinousus • Semimembranosus • Biceps Femoris • Extend hip, Flex knee
- 106. Semitendinosus • Semitendinosus • Ischial tuberosity Medial surface of superior tibia • Tibial division of Sciatic • L5,S1,S2
- 107. Semimembranosus • Semimembranosus • Ischial tuberosity Posterior surface of Medial Condyle of tibia • Tibial division of Sciatic • L5,S1,S2
- 108. Biceps Femoris • Biceps femoris • Long head: Ischial tuberosity • Short head: Linea aspera and Lat. Supracondylar line of femur Head of Fibula • Long head = Tibial division of Sciatic (L5,S1,S2) • Short head = Common peroneal division of Sciatic (L5,S1,S2)
- 109. Rotation of Knee • Knee Flexed: • Lateral rotation by: • Biceps Femoris • Medial rotation by: • Semimembranosus • Semitendinosus • Gracilis • Sartorius
- 110. Sciatic Nerve • L4-S3 • Deep to long head of biceps femoris • Tibial and Common Peroneal (fibular) Divisions Tibial nerve Common Peroneal nerve Right
- 111. Popliteal Fossa – Roof • Deep fascia • Pierced by: • Sural nerve • Short saphenous vein Sural nerve Short Saphenous Vein
- 112. Popliteal Fossa – Boundaries • Superiorly: Diverging tendons of Hamstrings • Biceps femoris laterally • Semimembranosus and Semitendinosus medially • Inferiorly: Medial and Lateral heads of Gastrocnemius
- 113. Popliteal Fossa – Contents • Popliteal artery • Popliteal vein • Terminal branches of Sciatic • Tibial nerve • Common peroneal nerve Medial & Deep Lateral & Superficial Popliteal artery Popliteal vein Tibial nerve Common Peroneal nerve
- 115. • medial to lateral arrangment "Serve And Volley Next Ball": Semimembranosus/ Semitendonosus Artery Vein Nerve Biceps femoris · Lateral and medial heads of Gastrocnemius are inferior borders.
- 116. Popliteus Joint capsule Femur Popliteal Fossa – Floor • Popliteal surface of femur • Capsule of Knee Jt. • Popliteus muscle
- 117. Popliteal Fossa – Floor • Oblique popliteal ligament • Expansion of Semimembranosus • Reinforces knee joint capsule • Middle Genicular vessels • Pierce joint capsule to supply cruciate ligaments
- 118. Popliteal Artery • Continuation of femoral • Adductor hiatus →Inferior border of Popliteus • 5 genicular branches • Terminal branches: • Anterior Tibial artery • Posterior Tibial artery Medial Superior Genicular artery Lateral Superior Genicular artery Medial Inferior Genicular artery Lateral Inferior Genicular artery
- 119. Anterior and Lateral Leg Dorsum of Foot
- 120. Outline • Compartments of the leg • Interosseous membrane and superior tibiofibular joint • Muscles of Lateral Compartment • Muscles of Anterior Compartment • Extensor Retinacula • Dorsum of Foot • Peroneal nerves • Arteries of the Leg and Dorsum of Foot
- 121. Compartments of the Leg
- 122. Interosseous membrane • Provides a surface for muscle attachment • Fibres pass inferolaterally from Tibia to Fibula • Helps resist the downward pull of muscles attached to the fibula
- 124. Anterior and Lateral Compartments Anterior Compartment: 4 Muscles Extensors of ankle jt. and digits Tendons anterior to ankle jt. Lateral Compartment 2 Muscles Evertors of the foot Tendons posterior to lateral malleolus
- 125. Lateral Compartment Peroneus Longus: Head and upper ⅔ of lat. Fibula base of 1st Metatarsal and Medial Cuneiform Superficial Peroneal Nerve (L5,S1,S2)
- 126. Lateral Compartment Peroneus Brevis: Inf. ⅔ of lat. Fibula Tuberosity on Lat. side of Base of 5th Metatarsal Superficial Peroneal Nerve (L5,S1,S2)
- 127. Lateral Compartment Peroneus Longus Tendon Peroneus Brevis Tendon Peroneal Trochlea of Calcaneus Cuboid 5th Metatarsal Calcaneus Talus
- 128. Anterior compartment • Tibialis anterior • Extensor digitorum longus • Extensor hallucis longus • Peroneus tertius • All supplied by Deep Peroneal Nerve • L4, L5
- 129. Tibialis Anterior Lat. condyle of Tibia, Sup. ½ of Lat. Tibial surface, Interosseous mem. → Med. and Inf. surfaces of Medial Cuneiform and base of 1st metatarsal Dorsiflexes ankle; Inverts foot R R
- 130. Extensor Digitorum Longus Lat. Condyle Tibia, Sup. ¾ of med surface Fibula, Interosseous membrane Middle and distal Phalanges of Lateral 4 digits Extends lateral 4 digits; Dorsiflexes ankle R
- 131. Inf. ⅓ anterior Fibula and Interosseous membrane Dorsum of base of 5th Metatarsal Dorsiflexes ankle; Assists in eversion of foot Peroneus Tertius R
- 132. Extensor Hallucis Longus Middle ant. surface Fibula, Interosseous membrane Dorsal aspect of distal Phalanx of Hallux Extends Hallux; Dorsiflexes ankle
- 133. Extensor Retinacula Superior Extensor Retinaculum Ant. Border of Tibia Lower end of Fibula Inferior Extensor Retinaculum (Y-shaped) Stem attached to Calcaneus laterally Upper Limb attached to Medial Malleolus Lower Limb passes round medial border of foot to blend with dense fascia over abductor hallucis
- 134. Anterior muscles of leg "The Hospitals Are Not Dirty Places": T: Tibialis anterior H: extensor Hallucis longus A: anterior tibial Artery N: deep fibular Nerve D: extensor Digitorum longus P: Peronius tertius [aka fibularis tertius]
- 135. Dorsum of Foot
- 136. Muscles of Dorsum of Foot Superior surface of Calcaneus, Inferior Extensor Retinaculum Extensor Hallucis Brevis Base of Proximal Phalanx of Hallux Extensor Digitorum Brevis Long extensor tendons of toes 2-4 Deep Peroneal nerve L5/S1
- 137. Superficial peroneal nerve • Branch of common peroneal between peroneus longus and neck of fibula • Lateral compartment of leg supplying muscles and continuing as cutaneous nerve • Cutaneous innervation to distal anterior surface of leg and most of dorsum of foot
- 138. Deep Peroneal Nerve • Branch of common peroneal between peroneus longus and neck of fibula • Passes through extensor digitorum longus and travels with anterior tibial a. supplying all anterior compartment mm. • Crosses the ankle jt. to supply ext. digitorum brevis and ext. hallucis brevis • Cutaneous innervation to skin between digits 1 and 2
- 139. Cutaneous Innervation Anterior Cutaneous branches of Femoral Saphenous nerve (from Femoral)Lateral Sural Cutaneous nerve Superficial Peroneal nerve Deep Peroneal nerve Lateral Dorsal Cutaneous nerve of foot (Termination of Sural n.)
- 140. Arteries of the Leg • Popliteal a. gives anterior and posterior tibial aa. • Anterior tibial a. – through interosseous membrane and descends on this • Posterior tibial a. – gives the fibular a. that provides perforating br.s to lateral compartment Anterior Tibial a. Posterior Tibial a. Fibular a.
- 141. • Dorsalis Pedis artery is a continuaton of Anterior Tibial a. • Gives Deep Plantar artery to sole of the foot • Gives Arcuate artery which runs across metatarsals to anastomose with Lateral Tarsal a. • Metatarsal and digital aa. Arteries of Dorsum of Foot Anterior Tibial a. Dorsalis Pedis a. Deep Plantar a. Arcuate a. Lateral Tarsal a.
- 142. Posterior Leg and Ankle Joint
- 143. Outline • Posterior aspect of the bones of the leg • Superficial and deep muscles of the posterior compartment • Flexor retinaculum • Posterior arteries • Tibial nerve • Inferior Tibiofibular joint • Ankle joint
- 144. Posterior Aspect of Leg Bones Popliteal area Soleal line Apex Head Neck Medial Malleolus Lateral Malleolus Tibia Fibula Fibula Groove for Peroneus longus and brevis tendons The FibuLA is LAteral.
- 145. Muscles of the Posterior Compartment • 7 muscles • 3 superficial; 4 deep • Superficial muscles all insert on posterior surface of calcaneous via Tendocalcaneous • Tendons of deep muscles pass behind medial malleolus to plantar surface of foot
- 146. Superficial Muscles - Gastrocnemius Medial Head: Popliteal surface of femur sup. to medial condyle Lateral Head: Lateral aspect of lateral condyle of femur Tibial nerve (S1, 2) Plantarflexes ankle; Flexes knee Right
- 147. Superficial Muscles - Plantaris Lateral supracondylar line of femur (proximal to lateral head of gastrocnemius) Tibial nerve (S1, 2) Assists Plantarflexion of ankle Right
- 148. Superficial Muscles - Soleus Soleal line of Tibia Upper ⅓ posterior Fibula Tendinous arch between bony attachments Tibial nerve (S1, 2) Plantarflexes ankle joint Right
- 149. Deep Muscles - Popliteus Pit for popliteus (lateral condyle of femur) and Lateral meniscus →Popliteal area of tibia (above soleal line) Tibial n. (L4, 5, S1) Unlocks knee joint by laterally rotating femur on fixed tibia Right
- 150. Deep Muscles – Flexor Digitorum Longus Posterior Surface of Tibia →Base of distal Phalanx of digits 2-4 Tibial nerve (L5, S1, 2) Flexes lateral 4 digits Weak plantarflexor of ankle Right
- 151. Deep Muscles – Flexor Hallucis Longus Posterior Surface of Fibula →Base of distal Phalanx of Hallux Tibial nerve (L5, S1, 2) Flexes Hallux Weak plantarflexor of ankle Right
- 152. Deep Muscles – Tibialis Posterior Posterior Surface of Tibia and Fibula, Interosseous membrane →Tuberosity of Navicular, Cuneiforms, Cuboid, Sustentaculum tali of Calcaneus, base of 2nd, 3rd, and 4th Metatarsals Tibial nerve (L4, 5) Plantar flexes ankle Inverts foot Right
- 153. Inversion vs. Eversion Muscles in leg Second letter rule for inversion/eversion: · Eversion muscles: pErineus longus pErineus brevis pErineus terius · Inversion muscles: tIbialis anterior tIbialis posterior
- 154. Plantarflexion vs. Dorsiflexion Plantar flexion occurs when you squish a Plant with your foot. Dorsiflexion Look at your toe nails
- 155. Tendons of Deep Muscles Tibialis Posterior tendon passes deep to Flexor Digitorum Longus Groove posterior to the medial malleolus Flexor Hallucis Longus grooves the posterior surface of the lower end of the tibia, the posterior surface of the talus Medial to lateral arrangement of tendons at ankle joint: Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus (Tom, Dick and Harry) TP FDL FHL
- 156. Flexor Retinaculum Medial Malleolus→ Calcaneous Posterior tibial vessels and tibial nerve found between FDL and FHL tendons Right
- 157. Tarsal tunnel: contents "Tiny Dogs Are Not Hunters“ Or : From superior to inferior: T: Tibialis posterior F: flexor Digitorum longus A: posterior tibial Artery N: tibial Nerve H: flexor Hallucis longus
- 158. Arteries of Posterior Leg Posterior Tibial Artery: terminal branch of popliteal artery Between heads of gastrocnemius and deep to soleus to run on surface of TP and FDL Gives Fibular artery as a branch Terminates as Medial and Lateral Plantar arteries in the foot Fibular artery: runs medial to fibula, usually within FHL Tibial a. Fibular a.
- 159. Cutaneous Innervation Posterior Cutaneous nerve of Thigh Lateral Sural Cutaneous nerve Medial Sural Cutaneous nerve (Sural Nerve) Saphenous nerve (from Femoral)
- 160. Tibial nerve • Passes between the heads of gastrocnemius and deep to tendinous arch of soleus, with Post. Tibial a. • Lies between flexor hallucis longus and flexor digitorum longus at the ankle jt. • Gives terminal branches that supply the sole of the foot: Medial and Lateral Plantar nn
- 162. Ankle joint Distal ends of Tibia and Fibula form: Malleolar Mortise Trochlea of Talus
- 163. Ankle joint
- 164. Range of movement
- 165. Capsule and Ligaments Attaches around articular margins Anteriorly extends onto neck of talus Weak anteriorly and posteriorly Supported laterally and medially by strong Collateral Ligaments Anterior and posterior views with weak parts of capsule removed
- 166. Lateral Collateral Ligaments Anterior Talofibular → neck of talus Posterior Talofibular → lateral tubercle of talus Calcaneofibular → lateral surface of calcaneous
- 167. Lateral Collateral Ligaments Calcaneofibular Ant. talofibular Posterior talofibular Post. talofibular Right Right
- 168. Medial Collateral Ligament (Deltoid) Fans out from Medial malleolus and has 4 parts: 1) Anterior Tibiotalar 2) Tibionavicular 3) Tibiocalcaneal 4) Posterior Tibiotalar 1 2 3 4 3 4
- 169. Plantar Surface of Foot
- 170. Outline • Bones of the foot • Deep fascia • The four layers of the foot • Plantar arteries • Plantar nerves • Cutaneous nerves of the foot
- 171. Foot – Dorsal View Phalanges Metatarsals Tarsals Navicular Talus Calcaneus Cuneiforms (medial, intermediate, lateral)
- 172. Foot – Ventral View Phalanges Metatarsals Tarsals Navicular Sustentaculum Tali Cuboid Tubercle of Calcaneus Cuneiforms Sesamoid bones within Flexor Hallucis Brevis tendon Head of Talus
- 173. The Tarsal Bones “The Circus Needs More Interesting Little Clowns”. • T: Talus • C: Calcaneus • N: Navicular • M: Medial cuneiform • I: Intermediate cuneiform • L: Lateral cuneiform • C: Cuboid Sustentaculum Tali Cuboid Tubercle of Calcaneus Cuneiforms Head of Talus
- 174. Deep Fascia & Plantar Aponeurosis Deep Fascia: Thick central portion Weaker medially and laterally Plantar Aponeurosis: Superficial Ligament formed by central portion of deep fascia Proximal attachment to Calcaneus Divides into 5 bands distally – continuous with fibrous digital sheaths Vertical intermuscular septae: Medial, Central and Lateral compartments
- 175. Compartments of the Foot Lateral Compartment Muscles of the little toe: Abductor Digiti Minimi Flexor Digiti Minimi Brevis Medial Compartment Muscles of the great toe: Abductor Hallucis Flexor Hallucis Brevis Central Compartment Flexor Digitorum Brevis Muscles associated with tendon of FDL (lumbricals and quadratus plantae) Adductor Hallucis Interossei Plantar and Dorsal interossei Muscles of Dorsum of Foot Extensor Digitorum Brevis Extensor Hallucis Brevis
- 176. Foot – Layer 1 Abductor Hallucis (1) Med. Tubercle of Calcaneus; Flex. Retinaculum → Med. Base proximal Phalynx Flexor Digitorum Brevis (2) Medial Tubercle of Calcaneus → Middle Phalanges of lateral 4 toes Abductor Digiti Minimi (3) Tubercle of Calcaneus → Lat. Base proximal Phalynx 1 2 1 2 3 3
- 177. Foot – Layer 2 Long flexor tendons to the toes: FDL and FHL Lumbricals * Tendons of FDL → Med. side of dorsal tendon expansion Quadratus Plantae (QP) Med. and Lat. surfaces of Calcaneus → Lateral side of FDL tendon * * * * QPQP FDL FDL * * **
- 178. Layers 1 & 2
- 179. Foot – Layer 3 Flexor Hallucis Brevis Cuboid and Lat. Cuneiform → Both sides base Proximal Phalanx Adductor Hallucis Transverse head: Plantar ligament of MTPJoints Oblique head: Base metatarsals 2&4 → Lat. side base Proximal Phalanx Flexor Digiti Minimi Brevis* Base 5th Metatarsal → Base Proximal Phalanx FHB FHB Ad H Ad H Ad H * *
- 180. Foot – Layer 4 Interossei 3x Plantar Interossei Bases and Med. side of Metatarsals 3-5 (unipennate) → Med. side of proximal phalanx of 3rd -5th digit PAD – Plantar ADduct 4x Dorsal Interossei Adjacent sides of Metatarsals 1-5 (bipennate) → 1st on med. side proximal phalanx of 2nd digit →2nd-4th on lat. side proximal phalanx of 2nd -4th digits DAB – Dorsal ABduct
- 183. Layer 4 Tendons: Peroneus Longus * Tibialis Posterior (TP) Long Plantar * * * * TP TP TP TP
- 184. Layers 3&4
- 185. Plantar Nerves Terminal branches of Tibial nerve deep to flexor retinaculum Enter foot deep to Abductor Hallucis Medial Plantar Nerve: Between Abductor Hallucis and FDB Lateral Plantar Nerve: Between Layers 1&2 Deep and Superficial branches Deep branch btwn Layers 3&4 Tibial nerve Sural nerve
- 186. Medial Plantar Nerve: Abductor Hallucis Flexor digitorum brevis 1st Lumbrical Flexor hallucis brevis Lateral Plantar Nerve: All other muscles S2, 3 Innervation of Muscles of Foot Medial Plantar n. Lateral Plantar n.
- 187. Cutaneous Innervation of the Foot Superficial Peroneal Deep Peroneal Saphenous Saphenous Dorsal Lateral Cutaneous of Foot Dorsal Lateral Cutaneous of Foot Medial Plantar Lateral Plantar Calcaneal Branches
- 188. Plantar Arteries Terminal branches of Posterior Tibial artery deep to flexor retinaculum Enter foot deep to Abductor Hallucis Medial Plantar artery: Muscles of hallux and overlying skin Occassionally: Superficial Plantar Arch Lateral Plantar artery: Initially btwn Layers 1 and 2 Deep Plantar Arch btwn Layers 3 and 4 Deep Plantar a. from Dorsalis Pedis Plantar Metatarsal and Digital aa. Medial Plantar a. Lateral Plantar a. Superficial Plantar Arch Deep Plantar Arch