The document provides detailed information on the anatomy and function of the posterior tibial nerve. It describes the nerve's origin, branches, innervation areas, and testing techniques. Key points include:
- The posterior tibial nerve originates from lumbar and sacral nerve roots and provides motor and sensory innervation to muscles and skin in the leg and foot.
- It gives off branches that innervate important calf and foot muscles like the gastrocnemius, soleus, flexor hallucis longus.
- The nerve can become entrapped in the tarsal tunnel, causing tarsal tunnel syndrome.
- Electromyography techniques are used to study the nerve by stimulating and recording from sites along its path
The sciatic nerve is the longest and largest nerve in the human body. It runs from the lower back through the back of the leg, and down to the toes. Any type of pain and/or neurological symptoms that are felt along the sciatic nerve is referred to as sciatica.
The sciatic nerve is the longest and largest nerve in the human body. It runs from the lower back through the back of the leg, and down to the toes. Any type of pain and/or neurological symptoms that are felt along the sciatic nerve is referred to as sciatica.
Branches/roots from L4-L5-S1 join and become superior gluteal nerve giving motor supply to abductor muscle of gluteus medius and gluteus minimus
Branches/roots from L5-S1-S2 join and form inferior gluteal nerve giving motor supply to gluteus maximus, this muscle has 2 function for extension and external rotation of the hip
The main root from L1 formed Ilioinguinal nerve, but it also form iliohypogastric nerve with contributions from the subcostal (T12) nerve
Illiohypogastric has cutaneous branch supply 2 areas : skin on the pubis and lateral of buttock, for motor supply it innervate transverse abdominis (increased intra-abdominal pressure and force diaphargm to force expiratory procces) and internal oblique muscle which primarily responsible for vertebrae collumn flexion
Applied anatomy common peroneal nerve injuryAkram Jaffar
After completion of this session, students should be able to discuss, identify, and describe:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
Branches/roots from L4-L5-S1 join and become superior gluteal nerve giving motor supply to abductor muscle of gluteus medius and gluteus minimus
Branches/roots from L5-S1-S2 join and form inferior gluteal nerve giving motor supply to gluteus maximus, this muscle has 2 function for extension and external rotation of the hip
The main root from L1 formed Ilioinguinal nerve, but it also form iliohypogastric nerve with contributions from the subcostal (T12) nerve
Illiohypogastric has cutaneous branch supply 2 areas : skin on the pubis and lateral of buttock, for motor supply it innervate transverse abdominis (increased intra-abdominal pressure and force diaphargm to force expiratory procces) and internal oblique muscle which primarily responsible for vertebrae collumn flexion
Applied anatomy common peroneal nerve injuryAkram Jaffar
After completion of this session, students should be able to discuss, identify, and describe:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
Neuropathy of the foot has more to do with mechanical trauma than secondary condition such as diabetes, alcoholism, etc.
Learn more at www.GraMedica.com.
After completion of this session, students should be able to discuss, identify, and describe:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
mpx Replay, Expedite Your Catch-Up and C3 Workflow 2 of 2thePlatform
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Enterprise workspaces - Extending SAP NetWeaver Portal capabilities SAP Portal
Enterprise workspaces empower employees to create flexible, personalized, self-service and mobile ready work environments that combine business applications and content with superior user experience and advanced social and collaborative capabilities - anywhere, anytime.
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Secure PIN Management How to Issue and Change PINs Securely over the WebSafeNet
With 25 years of security industry leadership, SafeNet provides card issuers with a solution that
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Jodi Schneider presents "15 Business Story Ideas to Jump on Now" at a free business journalism workshop, "Covering Business on Tribal Lands," hosted by the Donald W. Reynolds National Center for Business Journalists and the Native American Journalists Association.
For more information about free training for business journalists, please visit businessjournalism.org.
Nr 5 2013 innehåller nya rekommendationer om läkemedelsbehandling vid schizofreni. Varje år insjuknar mer än 1 500 personer i schizofreni i Sverige. Sjukdomen debuterar vanligen hos unga vuxna, är oftast livslång och begränsar funktionsnivån. Du kan också läsa om biverkningar av ögonfransserum och farmakovigilanslagstiftningen samt många fler spännande artiklar.
Read this article for details about the basics of pediatrics medical billing and why outsourcing this billing task can be advantageous for practitioners.
Contextual Authentication, also known as Risk-based Authentication, is matching the level of authentication to the expected impact of the surrounding events. Simply put, contextual authentication dynamically establishes the level of credibility of each user in real-time and uses this information to change the level of authentication required to access an application. Please see a link to live tutorial here: http://pg.portalguard.com/contextual_authentication_tutorial
The foot supports the body weight and provides leverage for walking and running.
It is unique in that it is constructed in the form of arches, which enable it to adapt its shape to uneven surfaces.
It also serves as a resilient spring to absorb shocks, such as in jumping.
skin Thick and hairless. Firmly bound down to the underlying deep fascia by numerous fibrous bands.
Shows a few flexure creases at the sites of skin movement.
Sweat glands are present in large numbers.
medial calcaneal branch of the tibial nerve
Medial plantar nerve
Lateral plantar nerve
Sural & saphenous nerve
Anomalous Innervations in (EMG/NCS) by MurtazaMurtaza Syed
Anomalous Innervation.
These are the sort of normal variants which can be found in any normal subject or can concomitantly be found or superimposed in pathological cases. Identifying these anomalies helps out interpreting and making correct diagnosis and to avoid any misinterpretation.
Late response are the most helpful findings in some of the diseases affecting the peripheral nerves, (e.g GBS, Radiculopathies, ). How to assess these responses while performing Nerve Conduction Studies, is the most technical and theoretical consideration.... Here we go with the same things in the stated slides
what is RNS and what the techniques to perform this test in the lab. Its significance in the evaluation and diagnosis of NMJ disorders like MG, LEMBS etc..
EEG variants, are always to be recognized while interpreting the EEG one must be aware of these. Major and most common EEG is variants are discussed in the stated presentation.
Syed Irshad Murtaza.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Anatomy of Tibial Nerve
• The Tibial Nerve also known as posterior tibial
nerve is the largest nerve of sciatic division.
• It is formed by the fibers of L4 and L5 of
lumber and the S1, S2 and S3 of sacral ventral
(anterior) rami.
3.
4. Sciatic nerve and hamstring muscles
• The sciatic nerve is the broadest nerve of the human
body (2.5cm at its origin). It descends along the back
of the thigh and just above the popliteal fossa it
separates into its two terminal divisions (Posterior
tibial and common fibular(peroneal) nerve).
• Before the bifurcate it supplies 3muscles (hamstring)
as semitendinosus, semimembranosus and biceps
femoris (long and short head). All hamistring muscles are
believed to have tibial nerve components except the
short head of biceps femoris which has peroneal
component.
5. Cont’d
• The tibial nerve then
descends along the
back of the thigh and
the popliteal fossa to
the distal border of the
popliteus muscle,
passing with the
popliteal artery and
vein to enter the leg.
6. • In the popliteal fossa
the nerve gives off
branches to gastroc-
nemius (S1,S2) ,
popliteus (L4,L5,S1)
and soleus (S1,S2)
mucsles.
7. • Gastrocnemius (S1,S2) is involved in standing,
walking, running and jumping. The medial head
originates at the medial epicondyle of the femur
while the lateral head originates at the lateral
epicondyle of femur.
8. Popliteus Muscle
• The popliteus (L4,L5,S1)
muscle in the leg is used to
unlock the knee by laterally
rotating the femur on the
tibia during a closed chain
movement (such as one
with the foot in contact
with the ground).
Popletius muscles
9. • The Soleus (S1,S2) is
a powerful muscle in
the back part of the
lower leg (the calf). It
runs from just below
the knee to the heel,
and is involved in
standing and walking.
10. Cutaneous innervation
• The sural nerve
(S1,S2) is formed by
the joined fibres of
tibial and common
peroneal nerve and
runs down the calf to
supply the lateral
aspect of the ankle
and foot. It ends on
the lateral side of the
5th
digit.
11.
12. Muscular supply Below soleus
• Below the soleus
muscle the tibial
nerve lies close to the
tibia bone and
supplies the tibialis
posterior (L4, L5,S1)
first.
• The muscle is mainly
responsible for the
inversion of the foot.
13. • The Flexor Digitorum Longus
(L5,S1,S2) is the next muscle
supplied by tibial nerve after
TP, which is situated on the
medial side of the leg. At its
origin it is thin & pointed, but
it gradually increases in size as
it descends. This muscle
serves to flex (curl) the lesser
toes (2nd
, 3rd,
, 4th
& 5th
toes) or
(flexion of phalanges II-V)
without plantar flexion or foot
inversion.
14. Flexor Hallucis LongusFlexor Hallucis Longus..
The Flexor Hallucis Longuslexor Hallucis Longus
(L5,S1,S2)(L5,S1,S2) is situated on the
fibular side of the leg. It
arises from the inferior two-
thirds of the posterior
surface of the body of the
fibula, with the exception of
2.5 cm.
Flexion of the great toe
without co’activation of
other muscles, activates the
flexor hallucis longus.
15. Passing through tarsal tunnel
• The nerve passes into the foot below the
medial malleolus.
• Here it is bound down by the flexor
retinaculum in company with the posterior
tibial artery. Before entering the tarsal tunnel
the nerve splits into 3 different paths. One
nerve (calcaneal) continues to the heel, the
other two nerve (medial and lateral plantar)
continue on the bottom of the foot.
18. Medial Plantar Nerve
• The medial platar nerve gives off cutaneous
and muscular branches.
• Cutaneous branches supply to skin of the sole,
foot, including the the digital branches of the
hallux, the 2nd
,3rd
and half of the 4th
toe.
• The Muscular branches in foot are mainly as,
• Abductor hallucis (S1, S2)
• Flexor digitorum brevis (S1, S2)
• Flexor hallucis brevis (S1, S2) and
• First lumbrical (S1, S2)
19. Origination & Functions
– Abductor hallucis (S1, S2)
Originates at the medial process of
the calcaneus & serves in
abduction of great (big) toe.
Flexor digitorum brevis (S1, S2)
Originates at the medial process
of calcaneus & serves in flexion
of four lesser toes.
Flexor hallucis brevis (S1, S2)
Originates at the plantar surface and
the tendon of the tibialis posterior.
It serves in flexion of the great toe.
20. Lateral Plantar Nerve
• The lateral plantar nerve
supplies the skin of the 5th
toe
and lateral half of the 4th
digit.
• The muscular branches supply
most deep muscles of the foot
including,
• Flexor Digitorum accessorius (S1,S2)
• Abductor Digiti minimi (Quinti) (S1, S2)
• Flexor Digiti Minimi Brevis (S1, S2)
• 2nd
and 4th
lumbricals (S1, S2) &
• Adductor hallucis (S1, S2)
21. ENTRAPMENT OF TIBIAL NERVE
• Entrapment involves pressure on the nerve where
it passes through a narrow structure (tarsal tunnel),
the compression is known as tarsal tunnel
syndrome (TTS).
• Clinically the following symptoms may be seen
• Sensation changes on the bottom of the foot (sole)
• Numbness, tingling, or other abnormal sensations.
• Burning sensation
• Pain
• Weakness of the knee or foot, difficulty in walking.
22.
23. Recording techniques for Motor NCS
• Tibial Nerve is recorded from the abductor
hallucis muscle.
• It is stimulated from the ankle and knee.
• The normative values are
• Distal Latency: ≤ 5.8msec
• Conduction velocity: ≥ 41msec
• CMAP amplitudes: ≥ 4mV
• F-wave latency: ≤ 5msec.
24. RECORDING TECHNIQUES FOR MEDIAL AND LATERAL
PLANTAR (Mixed Nerves)
Recording site. Medial ankle
G1 is placed on tibial nerve above & posterior to the medial
malleolus.
G2 is placed 3-4 cm proximally.
G3 is placed between active recording & stimulating electrodes
Stimulation sites.
Medial sole (medial planter nerve)
Lateral sole (lateral plantar nerve).
Distance14cm from the recording electrode.
Measure 10cm from the recording site in to the sole of the foot.
Then additional 4cm on a line drawn parallel to the web space
between the 1st
& 2nd
toes for medial plantar, while additional
4cm on a line drawn parallel to the web space between the 4th
&
5th
toes for lateral plantar nerve.
25. NCS technique for Plantar nerves
Medial plantar mixed
nerve study
Lateral planter mixed
nerve study.
26. Recording technique for sural sensory NCS
• Recording Site: Posterior Ankle
• G1 placed posterior to the lateral malleolus.
• G2 placed 3-4 cm distally
• G3 place between G1 & stimulating electrodes
• Stimulation Site: Posterior-lateral calf
• Distance: 14Cm
• Normative Data: Peak latency: ≤4.4msec
• SNAP amplitude: ≥ 6uv
• Conduction velocity: ≥35-40uV
27. Thanks for the patience.
• Never underestimate others, nor allow others
underestimating you, because one might do it better than
you, and at the same time you may do it better than others.
BY. IM