13: Leg Compartment Flashcards
A. What nerve supplies the medial anterior aspect of the leg?
B. It’s branch/ comes from where?
A. Saphenous nerve
B. From femoral nerve
A. What nerve supplies the lateral anterior aspect of the leg?
B. It’s branch/ comes from where?
A. Lateral sural cutaneous nerve
B. From common fibular nerve
What 3 nerves supply the leg posteriorly?
- Saphenous (medial, from femoral N.)
- Lateral sural cutaneous N. (Lateral, from common fibular N.)
- Medial sural cutaneous N. (from the tibial nerve (L4-S3) and descends in the posterior leg compartment between the two heads of the gastrocnemius)
What are the Superficial veins of the leg? (Mention name, where they come from, where they drain)
- Long or Great Saphenous vein: continuation of medial part of dorsal venous arch, and drains into femoral vein
- Small or Short Saphenous vein: continuation of lateral end of dorsal venous arch, and drains into popliteal vein
Deep or superficial veins have valves? (Why?Function?)
Superficial veins have valves because blood flow opposes gravity, and they don’t have muscles to compress them (in legs)
What’s the consequence of Failure of valves in the superficial vein?
accumulation of blood in superficial veins, which leads to varicose veins
Superficial lymphatics drain into …?
superficial inguinal lymph nodes
deep lymphatics drain into ..?
deep inguinal nodes.
Lymphatic vessels that follow great Saphenous vein drain into ..?
superficial inguinal lymph nodes
Lymphatics that follow small Saphenous vein drain into …?
Popliteal lymph nodes
Lymph vessels and node of lower limb (picture/visualize)
Superficial veins of the leg (picture/visualize)
What happens to lymph in inguinal group?
Deep facia of the leg is also known as?
Crural fascia
Deep facia of the leg (crural fascia) is thick at …………… part as muscles originate form deep facia. (Where?)
proximal anterior
At the ankle region deep fascia forms:
..(a)..retinaculum anteriorly,
..(b).. retinaculum laterally, and
..(c).. retinaculum posteriorly
a = extensor retinaculum
b = peroneal/fibular retinaculum
c = flexor retinaculum
Deep fascia is attached to anterior and posterior borders of tibia, where it is continuous with ….?
periosteum of the tibia.
What divides the leg into anterior, lateral and posterior compartments?
From the deep surface of the deep fascia anterior and posterior intermuscular septum enter the leg and get attached to anterior and posterior borders of fibula. These intermuscular septa along with interosseous membrane(attached to the interosseous border of tibial and fibula) divide the leg into anterior, lateral and posterior compartments with muscles having common function and innervation.
……. divides the posterior compartment muscles into superficial and deep groups
Transverse septum
What type of joint is the ankle joint? What movements happen at this joint?
- Hinge
- plantar flexion & dorsiflexion
Which compartment is dorsiflexor or extensor compartment?
Anterior compartment
Which compartment is Plantar flexors?
Posterior compartment
Evertors of the foot are found at ……. compartment
Lateral
Anterior compartment
A. Muscles?
B. Innervation?
C. Action?
A. Tibialis anterior, Extensor digitorum longus, fibularis tertius, and Extensor hallucis longus.
B. deep fibular nerve
C. Dorsiflexor or Extensor compartment
Lateral compartment
A. Muscles?
B. Innervation?
C. Action?
A. Fibularis longus, Fibularis brevis
B. superficial fibular nerve
C. Evertors of the foot
Posterior compartment
A. Muscles?
B. Innervation?
C. Action?
A. Superficial muscles(Three: Gastrocnemius, Soleus, Plantaris)
Deep muscles (Four: Popliteus, Flexor digitorum longus, Flexor hallucis longus, Tibialis posterior)
B. branches from tibial nerve
C. Plantar flexors
Inversion and eversion occur at the …… joint
Subtalar
Tibialis anterior
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Lateral condyle & superior half of lateral surface of TIBIA
B. Medial & inferior surfaces of medial cuneiform & base of 1st metatarsal
C. Deep fibular N. (L4,5)
D. Anterior compartment
E. Dorsiflexes ankle and inverts foot
Extensor digitorum longus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Lateral condyle of tibia & superior three quarters of FIBULA
B. Middle and distal phalanges of lateral 4 digits
C. Deep fibular N. (L4,5)
D. Anterior compartment
E. Extends lateral four digits and dorsiflexes ankle
Extensor hallucis longus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Middle part of anterior surface of FIBULA & interosseous membrane
B. Dorsal aspect of base of distal phalanx of great toe
C. Deep fibular N (L4,5)
D. Anterior compartment
E. Extends great toe & dorsiflex ankle
fibularis tertius
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Inferior third of anterior surface of FIBULA and interosseous membrane
B. Dorsum of 5th metatarsal
C. Deep fibular N (L4,5)
D. Anterior compartment
E. Dorsiflexes ankle & aids in foot eversion
Fibularis longus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Head & superior two thirds of lateral surface of FIBULA
B. Base of 1st metatarsal & medial cuneiform
C. Superficial fibular N (L5,S1,S2)
D. Lateral compartment
E. Everts foot & weakly plantarflexes ankle
Fibularis brevis
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Inferior two thirds of lateral surface of FIBULA
B. Dorsal surface of tuberosity on the lateral side of base of 5th metatarsal
C. Superficial fibular N
D. Lateral compartment
E. Everts foot & weakly plantarflexes ankle
Gastrocnemius
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Lateral head from lateral condyle of femur, medial head from popliteal surface of femur
B. Calcaneal tendon
C. Tibial N. (S1,S2)
D. Poster compartment
E. Plantarflexes ankle when knee is extended + raises heel at walking + flexes leg at knee joint
Soleus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Fibula, soleal line of tibia, tendinous arch
B. Calcaneal tendon
C. Tibial nerve
D. Posterior compartment
E. Plantarflexes ankle independent of knee + steadies leg on foot
plantaris
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Inferior end of lateral supracondylar line of FEMUR , oblique popliteal ligament
B. Calcaneal tendon
C. Tibial nerve
D. Posterior compartment
E. Weakly assist gastrocnemius in plantarflexing ankle
Popliteus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Lateral condyle of FEMUR & lateral meniscus
B. Posterior surface of tibia
C. Tibial nerve
D. Posterior compartment
E. Weakly flexes knee & unlocks it by rotating femur 5 degree on fixed tibia, medially rotates tibia of unplanted limb
Flexor hallucis longus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Fibula
B. Base of distal phalanx of big toe
C. Tibial nerve
D. Posterior compartment
E. Flexes big toe, weakly plantarflexes, support medial longitudinal arch
Flexor digitorum longus
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Tibia
B. Bases of distal phalanges of lateral 4 digits
C. Tibial N.
D. Posterior compartment
E. Flexes lateral four digits, plantarflexes, support longitudinal arches
Tibialis posterior
A. Origin
B. Insertion
C. Innervation
D. Compartment
E. Action
A. Posterior surface of tibia & fibula
B. Almost all tarsal bones
C. Tibial nerve
D. Posterior nerve
E. Plantarflexes ankle, inverts foot
Retinaculums (extensor, superior extensor, inferior extensor)
• Extensor retinaculum: Prevents tendons from bowstringing anteriorly during dorsiflexion of the ankle joint & it keeps tendons in place.
• Superior extensor retinaculum: From tibia to fibula just proximal to malleoli.
• Inferior extensor retinaculum: Y-shaped, laterally attached to calcaneus, medially to tibia and medial cuneiform bone.
Tendons of what muscles form dorsal extensor expansion?
EHL + EDL
Tendons of anterior compartment muscles on the dorsum of the foot (slide)
Superior and inferior retinaculum holds ……… & ….. muscles in position
Fibularis longus & brevis
Flexor retinaculum (location & tendon of what muscle passing)
- Medial side (from medial malleolus to calcaneum)
- tibialis posterior
Recap: name the nerve in each compartment:
- anterior=
- lateral =
- posterior =
- anterior compartment = deep fibular nerve
- lateral compartment = superficial fibular nerve
- posterior compartment = tibial nerve
Deep fibular nerve is:
1- Branch of ……. nerve
2- accompanies the ……. artery
1- common fibular nerve
2- anterior tibial artery.
Deep fibular nerve supply anterior compartment leg muscles
1- what are they?
2- what does it supply at dorsum of the foot?
1- tibialis anterior, extensor digitorum
longus and extensor hallucis longus muscles
2- extensor digitorum brevis and extensor hallucis brevis, and skin between 1st and 2nd digits
Superficial fibular nerve:
1- Branch of ……. nerve
2- Runs between ……. muscles
1- common fibular nerve
2- fibularis longus and brevis
Superficial fibular nerve supplies fibularis longus and brevis and then continues as …1…. to supply the skin on ..2.. aspect of the leg and dorsum of the foot.
1- cutaneous nerve
2- lateral aspect
Tibial nerve is
1- Branch of … nerve
2- Runs vertically with … artery
1- sciatic nerve
2- popliteal artery at popliteal fossa
Tibial nerve Leaves the popliteal fossa by passing deep to …?
tendinous arch of soleus muscle.
What nerve at the ankle region lies between Flexor hallucis longus and flexor digitorum longus.
Tibial nerve
Tibial nerve divides into ………. nerves and gives articular branches that supply knee joint.
medial and lateral plantar nerves
Nerve that supplies the skin of posterior and lateral aspect of lower leg region.
Sural nerve
Sural nerve is formed by ..?
Sural nerve- A cutaneous neve formed by medial sural cutaneous nerve & sural communicating nerve from common fibular nerve
Injury to this nerve leads to foot drop
Deep fibular nerve (Inability to dorsiflexion)
Posterior tibial artery: large and terminal branch of ..?
Popliteal artery
Posterior tibial artery supplies … ?
Supplies posterior compartment and foot.
Branches of Posterior tibial artery?
Anterior tibial artery, nutrient artery to the tibia
Fibular artery: only supplies leg region
1- largest branch of … artery?
2- branches/
1- tibial artery
2- Nutrient artery to fibula + Perforating branch (enters to anterior compartment), malleolar and calcaneal branches.
…….. divides into medial & lateral plantar arteries in the ankle region
Posterior tibial artery
Arteries of posterior compartment (slide)
Anterior tibial artery: Smaller terminal branch of popliteal artery.
1- begins at:
2- accompanied by:
3- continues as … artery at foot dorsum
1- distal border of popliteus
2- deep branch of fibular nerve
3- dorsalis pedis artery
Arteries of anterior compartment (slide)
Infections within anterior and posterior compartments spread …1…, whereas in lateral compartment spread ..2…
1- distally
2- proximally to popliteal fossa presumably through fibular nerve
Causes of tibial nerve injury
Uncommon due to its deep location
Causes: Deep laceration in popliteal fossa, posterior dislocation of knee joint
Most often injured nerve in lower limb as it winds subcutaneously around the fibular neck
Common fibular nerve
Injury to common fibular nerve leads to ..?
paralysis of dorsiflexors and evertors of ankle leading to foot drop (Cannot dorsiflex the foot)
Causes and complications of Tibialis anterior Strain (Shin Splints) ?
Edema and pain in the distal two thirds of tibia due to repetitive microtrauma of tibialis anterior muscle, which cause tear in periosteum covering the bone (because the muscles are directly attached to the periosteum)
Reflex that test of the integrity of S1 and S2 nerve roots.
Calcaneal tendon reflex (On tapping calcaneal tendon, normally leads to plantar flexion)
Reflex test the integrity of femoral nerve L2-L4 Spinal segments.
Patellar tendon reflex (normally leads to extension of leg region)
Radiological anatomy of the leg compartments (slide)
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