Anatomy🫀 Flashcards
what is the type of Acromioclavicular joint?
Synovial plane.
articulating bones of Acromioclavicular joint
Acromion process of scapula with clavicle (lateral end).
what are the ligaments of Acromioclavicular joint? and what is its function?
Coracoclavicular: Transmits weight of upper limb to clavicle and then to axial skeleton.
what is the type of Sternoclavicular joint?
Synovial saddle
what are the articulating bones of Sternoclavicular joint?
Sternal end of clavicle with manubrium sterni and 1st costal cartilage.
what are the ligaments of Sternoclavicular joint?
Costoclavicular: From 1st costal cartilage to the inferior surface of medial end of clavicle.
what are the muscles that act on shoulder girdle?
what are the movements done by shoulder girdle?
Protraction, retraction, Elevation, depression. Upward and downward rotation
what are the muscles that cause protraction of shoulder girdle?
- Serratus anterior.
- Pectoralis minor.
what are the muscles that causes retraction of shoulder girdle?
- Middle trapezius.
- Rhomboids.
what are the muscles that Cause elevation of shoulder girdle?
- Upper trapezius.
- Levator scapulae.
what are the muscles that cause depression of shoulder girdle?
- Lower trapezius.
- Pectoralis minor.
muscles involved in a upward rotation of shoulder Girdle
- Upper and lower trapezius.
- Serratus anterior (lower 5 digitations).
muscles involved in downward rotation of shoulder girdle
- Levator scapulae
- Rhomboids
- Pectoralis minor.
what is the type of shoulder joint?
Synovial ball and socket.
what are the articular surfaces of shoulder joint?
✓ Head of humerus.
✓ Glenoid cavity of scapula.
what are the ligaments of shoulder joint?
- Coracohumeral.
- Glenohumeral.
- Transverse humeral
what is the function of transverse humoral ligament?
Bridges Bicepital groove between greater and lesser tuberosities and acting as a retinaculum for long head of biceps.
what is labrum glenoidale?
fibrocartilaginous rim around the glenoid cavity deepens the glenoid cavity and so assist in stabilizing the humeral head on the fossa.
what are the muscles that act on shoulder joint?
what are the movements done by shoulder joint?
Flexion, Extension, Abduction, Adduction, Medial and Lateral rotation & Circumduction
what are the muscles involved In flexion of shoulder joint?
- Pectoralis major (clavicular head).
- Deltoid (ant fibers).
- Coracobrachialis & Biceps (Assistant).
what are the muscles involved in extension of shoulder joint?
- Latissimusdorsi.
- Teres major.
- Deltoid (post fibers).
- Triceps (Assistant).
what are the muscles involved in abduction of shoulder joint?
- Supraspinatus(0-15°)
- Deltoid, Middle fiber (15-90°).
what are the muscles involved in adduction of shoulder joint?
- Pectoralis major.
- Latissimus dorsi.
- Teres major.
what are the muscles involved in medial rotation of shoulder joint?
- Pectoralis major.
- Latissimus dorsi.
- Teres major
- Subscapularis
- Deltoid (ant fibers).
what are the muscles involved in the lateral rotation of shoulder joint?
- Infraspinatus
- Teres minor.
- Deltoid (post. fibers).
Circumduction
Association of flexion, abduction, extension and adduction in succession.
what are the type of elbow joint?
Synovial hinge.
what are the articulating bones of elbow joint?
- Capitulum articulates with radial head.
- Trochlea articulates with trochlear notch of ulna.
- Fossae immediately above trochlea and capitulum admit coronoid process of ulna and radial head, respectively, during full flexion.
- The olecranon fossa admits olecranon process during full extension.
what are the ligaments of elbow joint?
1. Medial collateral ligament: Attached to medial epicondyle of humerus.
2. Lateral collateral ligament: attached to lateral epicondyle of humerus.
what are the muscles Acting on elbow joint?
- Biceps
- Brachialis
- Brachioradialis
- Triceps
- Anconeus
what are the movements done by elbow joint?
Flexion & Extension
what are the muscles involved flexion of elbow joint?
- Brachialis.
- Biceps.
- Brachioradialis (in mid-prone position).
- Superficial group of the anterior compartment of the forearm
what are the muscles involved in extension of elbow joint?
- Triceps.
- Anconeus.
- Superficial group of the posterior compartment of the forearm except brachioradialis
what is deltoid muscle?
Thick triangular muscle forming the round contour of the shoulder
what is the origin of deltoid muscle?
- Anterior border of Lateral third of the clavicle.
- Lateral border of acromion process.
- Lower lip of the crest of the spine of scapula.
insertion of deltoid muscle
Deltoid tuberosity of the humerus.
nerve supply of deltoid muscle
Axillary nerve
action of Deltoid muscles
- Anterior fibers: Flexion and medial rotation of the arm.
- Posterior fibers: Extension and lateral rotation of the arm.
- Middle fibers: Abduction of the arm from (15 – 90)
What are rotator cuff muscles?
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
Origin, insertion, nerve supply & action of rotator cuff muscles
Origin of teres major
Lower 1/3 of the lateral border of the scapula.
insertion of teres major
Medial lip of bicepital groove.
nerve supply of teres major
lower subscapular
action of teres major
Extension, adduction and medial rotation of the arm.
what are the clinical cases related to rotator cuff muscles?
1) Dislocation of the shoulder joint
2) Rupture of rotator cuff
in what direction does dislocation of shoulder joint usually occur?
anteroinferior direction
what causes dislocation of shoulder joint? and what does it damage?
- the lack of support by tendons of the rotator cuff, It may damage the axillary nerve and the posterior circumflex humeral vessels.
what causes rupture of rotator cuff?
By chronic wear and tear or an acute fall on the outstretched arm.
which tendon is most frequently affected in rupture of rotator cuff?
supraspinatus tendon.
what are the manifestations of rupture of rotator cuff?
Manifested by severe limitation of shoulder joint motion, chiefly abduction. And painful abduction of the arm or a painful shoulder.
what are the muscles of the anterior compartment of the arm?
- Biceps Brachii
- Coracobrachialis
- Brachialis
Origin of Biceps brachii
1. Long head: supraglenoid tubercle of the scapula
2. Short head: tip of the coracoid process of scapula.
insertion of biceps brachii
1) Biceps tendon: Into the radial tuberosity.
2) Bicepital aponeurosis: Blends with deep fascia of forearm.
nerve supply of biceps brachii
Musculocutaneus nerve
action of biceps brachii
- Powerful flexor of the elbow.
- Powerful supinator of the flexed elbow.
- Weak flexor of the shoulder joint.
Origin of coracobrachialis
Tip of coracoid process of scapula.
insertion of coracobrachialis
Middle of the medial border of humerus.
nerve supply of coracobrachialis
Musculocutaneus nerve.
Action of coracobrachialis
Flexion and weak adduction of the arm.
Origin of brachialis
Lower half of the front of the humerus.
insertion of brachialis
Ulnar tuberosity.
nerve supply of brachialis
- Musculocutaneus nerve
- Radial nerve
action of brachialis
Flexion of the elbow joint
what are the muscles of the posterior compartment of the arm?
Triceps Brachii
Origin of triceps brachii
1. Long head: Infraglenoid tubercle of the scapula.
2. Lateral head: Posterior surface of the humerus above spiral groove.
3. Medial head: Posterior surface of the humerus below spiral groove.
insertion of triceps brachii
Upper surface of olecranon process.
nerve supply of triceps brachii
Radial nerve
action of triceps brachii
- Powerful extension of the elbow.
- Weak extensor of the shoulder joint
what is the type of superior radioulnar joint?
Synovial, pivot
articulating bones of superior radioulnar joint
- Head of radius.
- osseofibrous ring formed by annular ligament (4/5) and radial notch of ulna (1/5).
what are the ligaments of the superior radioulnar joint?
Annular ligament: Encircles head of radius.
what is the type of middle radioulnar joint?
Syndesmosis
articulating bones of middle radioulnar joint
Shaft of radius and ulna are connected by an interosseous membrane.
what is the type of inferior radioulnar joint?
Synovial, pivot
articulating bones of inferior radioulnar joint
- Head of ulna.
- Ulnar notch of radius.
what are the muscles acting on radioulnar joint?
Supination:
1. Brachioradialis.
2. Supinator (extension).
3. Biceps (flexion).
Pronation:
1. Brachioradialis.
2. Pronator teres.
3. Pronator quadratus.
what is the type of wrist (Radiocarpal) Joint?
Synovial ellipsoid joint.
articulating bones of wrist joint
From above: Distal radius and a triangular disc of fibrocartilage covering distal ulna.
From below: Scaphoid & Lunate bones and triquetral during adduction.
what are the muscles acting on wrist joint?
what are the joints of the hand?
what is flexor retinaculum?
thick band of deep fascia crossing the front of the carpal bones converting its concave anterior surface into the carpal tunnel.
Attachment of flexor retinaculum
Medially: Pisiform and Hamate.
Laterally: Scaphoid and Trapezium.
What are the structures that pass superficial to flexor retinaculum?
- from medial to lateral
1. Ulnar nerve.
2. Ulnar artery.
3. Palmar cutaneous branch of ulnar nerve.
4. Palmaris longus tendon.
5. Palmar cutaneous branch of median nerve.
what are the structures that pass deep to flexor Retinaculum (contents of carpal tunnel)?
- Tendon of flexor carpi radialis (in a special tunnel)
- Tendon of flexor digitorum superficialis.
- Tendon of flexor digitorum profundus.
- Median nerve.
- Tendon of flexor pollicis Iongus.
- Synovial sheathes around the above mentioned tendons.
what are synovial flexor sheaths?
1. Common Synovial Flexor Sheath (Ulnar Bursa): Envelops the tendons of both the flexor digitorum superficialis and profundus muscles.
2. Synovial Sheath for Flexor Pollicis Longus (Radial Bursa): Envelops the tendon of the flexor pollicis longus muscle.
what is extensor retinaculum?
Thickened band of deep fascia 2.5 cm wide extending obliquely across the back of the junction of forearm and wrist.
what is the function of extensor retinaculum?
keeps the extensor tendons in contact with the wrist joint during their contraction.
what are the structures that pass superficial to extensor retinaculum?
- Basilic vein.
- Cephalic vein.
what are the structures that pass deep to extensor retinaculum?
The tendons of the muscles of the posterior compartment of the forearm.
what is the anatomical snuffbox?
It is a depression on the lateral side of wrist identified when the thumb is abducted and extended.
what are the boundaries of the anatomical snuffbox?
Anteriorly:
- Tendons of abductor pollicis longus & extensor pollicis brevis.
Posteriorly:
- Tendon of extensor pollicis longus.
Floor:
- styloid process of radius
- scaphoid.
- trapezium.
what are the contents of the anatomical snuffbox?
Radial artery.
what is the definition of Palmar aponeurosis?
a triangular fibrous layer overlying the tendons in the palm and is continuous with the palmaris longus tendon, the thenar and hypothenar fasciae and the flexor retinaculum.
what is the function of palmar aponeurosis?
Protects the superficial palmar arterial arch, the palmar digital nerves, and the long flexor tendons
what are the fascial spaces of the palm?
Are fascial spaces deep to the palmar aponeurosis and divided by a midpalmar (oblique) septum into thenar space and midpalmar space.
what is the Thenar Space?
the lateral space that contains the flexor pollicis longus tendon and the other flexor tendons of the index finger
what is the mid-Palmer space?
the medial space that contains the flexor tendons of the medial three digits.
what are the muscles of the hand?
innervation of hand muscles
all the muscles of the hand are supplied by deep branch of ulnar nerve except the three muscle of the thenar eminence and the 1st & 2nd lumbricals which are supplied by median nerve
what is the action of lumbricals?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position), Assisted by the interossei.
what is the action of palmar interossei?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position).
- Adduction of fingers towards the axis of middle finger (PAD).
what is the action of dorsal interossei?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position).
- Abduction of fingers away from the axis of middle finger (DAP).
what are the stages of brachial plexus?
- Roots
- Trunks
- Divisions
- Cords
roots of brachial plexus
These are the anterior primary rami of C5, 6, 7, 8, T1.
Trunks of brachial plexus
3 trunks lie in the posterior triangle of the neck, pass laterally over the 1st rib to enter the axilla.
- Upper trunk: formed by C5, 6 roots.
- Middle trunk: formed by C7 root.
- Lower trunk: formed by C8, T1 roots.
Divisions of brachial plexus
Each trunk is divided into anterior & posterior divisions.
Cords of brachial plexus
3 cords lie in the axilla & are related to 2nd part of axillary artery.
- Lateral cord: formed by the anterior divisions of the upper
& middle trunks.
- Medial cord: formed by the anterior division of lower trunk.
- Posterior cord: formed by all the posterior divisions.
what is the position of stages of brachial plexus?
Roots & trunks lie in the neck, divisions lie behind the clavicle, cords& branches lie in the axilla.
what are the branches of the brachial plexus?
- From the Roots
- From the Trunks
- From the Cords
branches from the root of brachial plexus
- Dorsal scapular nerve (C5): Nerve to rhomboid.
- Long thoracic nerve (C5, 6, 7): Nerve to serratus anterior.
branches from the trunks of brachial plexus
(only from the upper trunk (C5 & 6))
- Suprascapular nerve: passes through the suprascapular notch to supply supraspinatus & infraspinatus muscles.
- Nerve to subclavius.
branches from the lateral cord of brachial plexus (C5,6&7)
- Lateral pectoral nerve: supplies pectoralis major.
- Lateral root of median nerve.
- Musculocutaneous nerve (C5, 6, 7).
branches from the Medial cord of brachial plexus (C8&T1)
- Medial pectoral nerve: supplies pectoralis major & minor.
- Medial cutaneous nerves of the arm.
- Medial cutaneous nerves of the forearm.
- Medial root of median nerve.
- Ulnar nerve.
Branched from the posterior cord of brachial plexus (C5,6,7,8&T1)
- Upper subscapular nerve (C5 & 6): supplies subscapularis.
- Lower subscapular nerve (C5 & 6): supplies subscapularis& teres major.
- Nerve to latissimus dorsi (C6, 7 & 8): Thoraco-dorsal nerve.
- Axillary nerve (C5, 6).
- Radial nerve (C5, 6, 7, 8, T1).
what are the lesions of brachial plexus?
- lesion in the upper trunk of brachial plexus C5&6 (Erb’s Paralysis)
- lesion in in the lower trunk of brachial plexus (Klumpk’s Paralysis)
what causes lesion in the upper trunk of brachial plexus C5&6 (Erb’s Paralysis)?
head traction during birth.
what deformity results from legion in upper trunk of brachial plexus?
waiter’s tip position (policeman’s position):
- Adduction of the shoulder, extension & pronation of forearm.
what causes lesion in in the lower trunk of brachial plexus (Klumpk’s Paralysis)?
- Stretch of the upper limb during climbing.
- Difficult breech delivery.
what is the deformity that results from lesion in in the lower trunk of brachial plexus (Klumpk’s Paralysis)?
paralysis of the muscles of the hand and claw hand.
what is the origin of axillary nerve?
from the posterior cord of the brachial plexus (C5, 6).
course of axillary nerve
- Passes backward through the quadrangular space with the posterior circumflex humeral artery.
- It ends by dividing into anterior & posterior divisions.
branches of axillary nerve
- Muscular branches to deltoid & teres minor.
- Upper lateral cutaneous nerve of the arm.
what does a lesion in the axillary nerve cause?
paralysis of the deltoid muscle
what are the causes of lesions in axillary nerve?
- Dislocation of shoulder.
- Fracture of surgical neck of the humerus.
what are the results of a lesion in the axillary nerve?
Flat shoulder due to paralysis & atrophy of the deltoid muscle.
what is the origin of musculocutaneous nerve?
from the lateral cord of the brachial plexus.
course of musculocutaneous nerve
Pierces the coracobrachialis to descend between brachialis & biceps.
termination of musculocutaneous nerve
continues as lateral cutaneous nerve of the forearm.
- Medial cutenous nerves to the arm & forearm: From the medial cord
- Superior & Inferior Lateral cutenous nerve to the arm: From the axillary and radial respictively (Posterior cord)
- Lateral cutenous nerve to the forearm: From the musculocutenous nerve (lateral cord)
- Posterior cutenous to the arm & forearm: From the radial nerve (Posterior cord)
what are the branches of musculocutaneous nerve?
- Muscular: to biceps brachii, brachialis & coracobrachialis.
- Cutaneous: lateral aspect of the forearm till root of thumb.
what is the origin of radial nerve?
posterior cord of the brachial plexus (C5, 6, 7, 8, T1).
course of radial nerve
- Passes through the lower triangular space.
- Runs in the spiral groove with profunda brachii artery.
- Pierces the lateral intermuscular septum to enter the anterior compartment.
termination of radial nerve
divides into superficial & deep (posterior interosseous) branches.
what are the branches of radial nerve?
Muscular:
- Triceps.
- Anconeus.
- Brachialis.
- Brachioradialis.
- Extensor carpi radialis longus.
Cutaneous branch:
- Inferior lateral cutaneous nerve of arm.
- Posterior cutaneous nerve of arm.
- Posterior cutaneous nerve of forearm.
- Superficial branch of radial nerve:
what does the superficial branch of radial nerve supply?
- Skin of the lateral 2/3 of the dorsum of the hand.
- Skin of the dorsal surface of the lateral 3.5 fingers except their distal part.
what does a lesion of radial nerve cause?
wrist drop.
what are the branches of posterior interosseous nerve?
Muscular to
- All extensor group of the forearm except brachioradialis,
extensor carpi radialis longus & anconeus.
what is the origin of median nerve?
arises by 2 roots:
- Lateral root: from the lateral cord (C5, 6, 7).
- Medial root: from the medial cord (C8, T1).
what is the course of median nerve?
In the arm:
- Passes lateral to the upper part of the brachial artery.
- Then crosses in front of the middle part of the artery.
- Then passes medial to the artery.
In the cubital fossa:
- lies medial to the brachial artery.
In the forearm:
- Enters the forearm between 2 heads of pronator teres muscle.
- Descends between flexor digitorum superficialis & profundus.
- Passes deep to the flexor retinaculum (in carpal tunnel) to enter the palm of the hand.
what are the branches of median nerve?
what does a lesion in the medial nerve (carpal tunnel syndrome) cause?
ape hand deformity
what does median nerve supply?
Muscles
- All muscles of the front of the forearm except: Flexor carpi ulnaris & Medial 1⁄2 of flexor digitorum profundus.
- 3 muscles of thenar eminence.
- 1st lumbrical& 2nd lumbrical.
Skin
- Skin of lateral 2/3 of the palm of the hand.
- Skin of lateral 31⁄2 fingers.
what is the origin of Ulnar nerve?
from the medial cord (C8, T1).
what is the course ulnar nerve?
- Passes behind the medial epicondyle of the humerus.
- Enters the palm of the hand superficial to the flexor retinaculum, lateral to the pisiform bone.
what are the branches of ulnar nerve?
what does a lesion in the ulnar nerve cause?
partial claw hand.
what does the ulnar nerve supply?
Muscles
- Flexor carpi ulnaris & Medial 1⁄2 of flexor
- All muscles of the hand except: 3 muscles of thenar eminence, 1st lumbrical& 2nd lumbrical.
Skin
- Skin of medial 1/3 of the hand.
- Skin of medial 1.5 fingers.
what are dermatomes of the upper limb?
- It is an area of skin that is mainly supplied by a single spinal nerve.
- Each of these spinal nerves send sensations from a particular region of the skin to the brain.
what are important dermatomes of the upper limb?
Important dermatomes of the upper limb:
C4: shoulder
C6: thumb.
C8: little finger
what are the manifestations of nerve lesion?
- Sensory loss in the area of the skin supplied by this nerve.
- Paralysis of muscles supplied by this nerve.
- Deformity.
what causes Lesion in long thoracic nerve?
Occurs during breast surgery
what deformity results from injury of long thoracic nerve?
winging of scapula due to paralysis of serratus anterior muscle.
Beginning of axillary artery
Continuation of subclavian artery at outer border of 1st rib
course of axillary artery
Divided by pectoralis minor into 3 parts
what are the branches of axillary artery?
1st Part
- Superior thoracic
2nd part
- Lateral thoracic
- Acromio-thoracic: (Pierce clavi-pectoral fascia to give):
1. Acromial branch
2. Pectoral branch
3. Clavicular branch
4. Deltoid branch
3rd part
- Sub-scapular gives:
1. Circumflex scapular
2. Thoraco-dorsal - Anterior circumflex humeral artery
- Posterior circumflex humeral artery
what are the veins of the upper limb?
Superficial veins:
- Cephalic vein
- Basilic vein
Deep veins:
- Axillary vein
Origin of cephalic vein
Lateral end of dorsal venous arch + dorsal digital vein of Thumb
course of cephalic vein
- Pass superficial to extensor retinaculum
- Wind around forearm to reach its anterior surface
- Run along lateral side of Forearm then cubital fossa then arm
- Pass in delto-pectoral groove
- Pierce clavipectoral fascia
termination of cephalic vein
In axillary vein
origin of basilic vein
Medial end of dorsal venous arch + dorsal digital vein of little finger
course of basilic vein
- Pass superficial to extensor retinaculum
- Wind around forearm to reach its anterior surface
- Run along medial side of Forearm then cubital fossa then arm
termination of basilic vein
Form axillary vein at lower border of teres major
Origin of axillary vein
Continuation of basilic vein at lower border of teres major
Course of axillary vein
Pass upward, backward on medial side of axillary artery
termination of axillary vein
form subclavian vein at outer border of 1st rib
anastomosis around scapula
- Suprascapular & Deep branch of transverse cervical from Thyrocervical of 1 part of subclavian
- Posterior intercostal braches of descending thoracic aorta
- Subscapular artery of 3rd part of axillary
anastomosis around surgical Neck
- Suprascapular from Thyrocervical of 1st part of subclavian
- ACHA & PCHA: from 3rd part of axillary
- Ascending branch of profunda brachii: from brachial artery
Origin of brachial artery
Continuation of axillary artery at lower border of teres major
termination of brachial artery
Gives 2 terminal branches (ulnar & radial) at level of neck of radius
what are the branches of brachial artery?
- Terminal branches: ulnar & radial
- Superior ulnar collateral : Pass behind medial epicondyle
- Inferior ulnar collateral Divide at medial epicondyle giving anterior & posterior divisions
- Profunda brachii
Pass in lower triangular space then in spiral groove with radial nerve and Gives:
1. Ascending branch
2. Posterior descending branch: Pass behind lat. epicondyle
3. Anterior descending branch: pass anterior to lat. epicondy
Origin of ulnar artery
One of 2 terminal branches of brachial artery at level of neck of radius
what is the course of ulnar artery?
Enter the hand superficial to flexor retinaculum
termination of ulnar artery
Divides into deep & superficial branches:
- The deep branch joins radial artery → deep palmar arch.
- The superficial branch joins superficial palmar branch of radial artery → superficial palmar arch
what are the branches of ulnar artery?
In forearm:
- Anterior ulnar recurrent: return to elbow
- Posterior ulnar collateral: return to elbow
- Common interosseous: gives
1. Anterior interosseous: gives median branch
2. Posterior interosseous: gives recurrent IOA - Palmar carpal: join that for radial to form palmar carpal arch
- Dorsal carpal: join that for radial to form dorsal carpal arch
In hand:
- Deep palmar
- Superficial palmar
Median cubital vein
From cephalic to basilic vein
what is the origin of the radial artery?
One of 2 terminal branches (smaller) of brachial artery at level of neck of radius
what is the course of the radial artery?
In the forearm:
- Cross lower end of the radius
In the hand:
- Enters dorsum of hand → anatomical snuff box→ pierce
1st interosseous space → passes to the palm
what is termination of the radial artery?
Join deep branch of ulnar artery forming deep palmar arch
what are the branches of the Radial artery?
(In forearm)
- Radial recurrent: return to elbow
- Palmar carpal: join palmar carpal of ulnar to form palmar carpal arch
- Superficial palmar: join superficial Palmar of ulnar forming superficial palmar arch
(In Hand)
In the dorsum:
- Dorsal digital: to lateral side of thumb
- 1st dorsal metacarpal: to adjacent sides of thumb & index
- Dorsal carpal: join dorsal carpal of ulnar to form dorsal carpal arch
In the palm:
- Princips pollicis: supply the thumb
- Radialis indicis: to lateral side of index
anastomosis around the elbow
Front of medial epicondyle:
- Anterior division of Inferior ulnar collateral of brachial
- Anterior ulnar recurrent of ulnar
Back of medial epicondyle:
- Posterior division of Inferior ulnar collateral of brachial
- Superior ulnar collateral of brachial
- Posterior ulnar recurrent of ulnar
Front of Lateral epicondyle:
- Anterior descending of profunda brachii
- Radial recurrent of radial
Back of Lateral epicondyle:
- Posterior descending of profunda brachii
- Interosseous recurrent of posterior IOA
what are the arches of the hand?
- Palmar carpal arch (cruciate anastomosis)
- Deep palmar arch
- Superficial palmar arch
- Dorsal carpal arch
Formation of Palmar carpal arch
Formation
- Palmar carpal of ulnar a
- Palmar carpal of radial a
- Recurrent of deep palmar arch
- Descending branch of ant. IOA
Formation & Branches of deep palmar arch
Formation
- Radial artery
- Deep branch of ulnar
Branches
- 3 palmar metacarpal
- 3 perforators (join dorsal metacarpal)
- Recurrent arteries (join palmar carpal arch)
Formation & Branches of superficial palmar arch
Formation
- Superficial branch of radial
- Superficial branch of ulnar
Branches
- Palmar digital (to medial side of little finger)
- 3 common palmar digital (to adjacent sides of fingers)
Formation & Branches of dorsal carpal arch
Formation
- Dorsal carpal of ulnar a
- Dorsal carpal of radial a
- Anterior IOA
Branches
- 2nd,3rd, 4th dorsal metacarpal arteries to supply medial 3.5 fingers (dorsal surface)
what divides the muscles of the thigh?
The thigh is divided by Three intermuscular septa (Medial, lateral and posterior intermuscular septa) into three compartments.
what are the compartments of the thigh?
Anterior, Posterior & Medial
contents and nerve supply of the anterior compartment of the thigh
Contents:
1. quadriceps femoris muscle
2. Sartorius muscle
3. Articularis genu muscle
4. Iliopsoas muscle
Nerve Supply:
- Femoral nerve except psoas major
contents and nerve supply of the medial compartment of the thigh
Contents:
- The anterior layer: pectineus (laterally) and adductor longus medially.
- The middle layer: adductor brevis.
- The posterior layer: adductor magnus, Obturator externs lies deep to adductor muscles.
- The gracilis muscle: lies medial to these layers of muscle.
Nerve Supply:
- Obturator Nerve except pectinius muscle & Ischial part of adductor magnus
contents and nerve supply of the posterior compartment of the thigh
Contents:
the hamstring muscles:
1. biceps femoris
2. semitendinosus
3. semimembranosus
Nerve Supply:
- Sciatic nerve
Origin, Insertion, Nerve Supply & Action of Quadriceps femoris
Origin, Insertion, Nerve Supply & Action of sartorius
Origin:
- Anterior superior iliac spine.
Insertion:
- Upper part of the medial surface of the tibia in front of gracilis and semitendinosis (SGS).
Nerve Supply:
- femoral nerve
Action:
1. Flexion, Abduction and lateral rotation of the hip joint (tailors position).
2. Flexion and medial rotation at knee joint.
Origin, Insertion, Nerve Supply & Action of articularis genu
Origin:
- lower fourth of the anterior surface of the shaft of the femur
Insertion:
- upper part of the synovial membrane of the knee joint
Nerve Supply:
- Femoral Nerve
Action:
- Elevates the synovial membrane of the knee joint during extension of the knee to prevent it from being trapped between the tibial and femoral condyles.
Origin, Insertion, Nerve Supply & Action of iliacus
Origin:
- Iliac fossa
Insertion:
- lesser trochanter of the femur
Nerve Supply:
- femoral nerve (in the abdomen)
Action:
- Main flexor of the hip joint
Origin, Insertion, Nerve Supply & Action of Psoas major
Origin:
- Lumbar Vertebrae
Insertion:
- lesser trochanter of the femur
Nerve Supply:
- Lumber plexus (L1,2,3)
Action:
- Main flexor of the hip joint
Origin, Insertion, Nerve Supply & Action of gracilis muscle
Origin:
- The margin of pubic arch (inferior pubic ramus and ischial ramus)
Insertion:
- upper part of the medial surface of the tibia, posterior to Sartorius (SGS).
Nerve Supply:
- Anterior division of obturator nerve
Action:
1. Adduction, flexion and lateral rotation of hip joint.
2. Flexion and medial rotation of the knee joint.
Origin, Insertion, Nerve Supply & Action of pectinius muscle
Origin:
- pectineal surface of superior pubic ramus
Insertion:
- upper 2/3 of pectineal line of femur
Nerve Supply:
- femoral nerve
Action:
- adduction - flexion - lateral rotation of the hip joint.
Origin, Insertion, Nerve Supply & Action of adductor longus
Origin:
- the front of the body of the pubis just below the pubic crest
Insertion:
- linea aspera of the femur
Nerve Supply:
- Anterior division of obturator nerve
Action:
- adduction - flexion - lateral rotation of the hip joint.
Origin, Insertion, Nerve Supply & Action of adductor brevis
Origin:
- Body of pubis.
- Inferior pubic ramus.
Insertion:
- lower 1/3 of pectineal line of femur
- linea aspera of the femur
Nerve Supply:
- Anterior division of obturator nerve
Action:
- adduction - flexion - lateral rotation of the hip joint.
Origin, Insertion, Nerve Supply & Action of adductor magnus
Origin:
- Pubic part: from the pubic arch
- Ischial part: from the ischial tuberosity
Insertion:
- Pubic Part: medial edge of gluteal tuberosity, medial lip of the linea aspera, upper 1/2 of the medial supracondylar line.
- Ischial Part: Adductor tubercle.
Nerve Supply:
- Pubic part: Posterior division of obturator nerve.
- Ischeal Part: Sciatic nerve.
Action:
- Pubic Part: Adduction and lateral rotation of the hip joint.
- Ischeal Part: Extension the hip joint.
Origin, Insertion, Nerve Supply & Action of obturator externus
Origin of Gluteus maximus
- gluteal surface of the ilium behind the posterior gluteal line.
- sacrum & coccyx.
- sacrotuberous ligament.
Insertion of Gluteus maximus
superficial3/4: into the iliotibial tract.
deep 1/4: into the gluteal tuberosity of the femur.
Nerve supply of Gluteus maximus
Inferior gluteal nerve.
Action of Gluteus maximus
- Main extensor of the hip joint
- Powerful lateral rotator of the hip
- helps in extension of the knee joint
- Steadies the femur on the tibia during standing
Origin of Gluteus medius
gluteal surface of the ilium between the anterior and posterior gluteal line.
Insertion of Gluteus medius
lateral surface of the greater trochanter.
Nerve supply of Gluteus medius
Superior gluteal nerve
Action of Gluteus medius
- Abduction and medial rotation of the hip.
- Stabilize the pelvis during walking (prevent tilting of the pelvis when the opposite limb is raised off the ground).
Origin of Gluteus minimus
gluteal surface of the ilium between the anterior and inferior gluteal lines.
Insertion of Gluteus minimus
anterior surface of the greater trochanter
Nerve supply of Gluteus minimus
Superior gluteal nerve
Action of Gluteus minimus
- Abduction and medial rotation of the hip.
- Stabilize the pelvis during walking (prevent tilting of the pelvis when the opposite limb is raised off the ground).
Origin of Tensor fasciae lata
anterior part of the outer lip of iliac crest
Insertion of Tensor fasciae lata
iliotibial tract
Nerve supply of Tensor fasciae lata
Superior gluteal nerve
Action of Tensor fasciae lata
- Abduction and medial rotation of the hip.
- helps in extension of the knee joint
- Steadies the femur on the tibia during standing
Small lateral rotators of the thigh
what is the definition of iliotibial tract?
it is thickened Lateral part of deep fascia of the thigh
extension of iliotibial tract
from tubercle of iliac crest to the lateral tibial condyle.
what is the function of iliotibial tract?
- It receives insertion of two muscles (tensor fascia lata and gluteus maximus)
- Help in extension of the knee joint.
- maintains the erect posture by:
1. Steadies the pelvis on the femur.
2. Steadies the femur on the tibia.
Origin of Biceps femoris
long head: arises from the ischial tuberosity.
short head: Arises from the lateral lip of the linea aspera and lateral supracondylar line.
Insertion of Biceps femoris
Styloid process of the fibula.
Nerve supply of Biceps femoris
long head: sciatic nerve (tibial part).
short head: sciatic nerve (common peroneal part).
Action of Biceps femoris
- Flexion and lateral rotation of the knee (locking after fully extension).
- Extension of the hip joint.
Origin of Semi-tendinosus
from the ischial tuberosity
Insertion of Semi-tendinosus
upper part of the medial surface of the tibia behind the sartorius and gracilis muscles (SGS)
Nerve supply of Semi-tendinosus
sciatic nerve (tibial part).
Action of Semi-tendinosus
- Flexion and medial rotation of the knee.
- Extension of the hip joint.
Origin of Semi-membranosus
from the ischial tuberosity
Insertion of Semi-membranosus
groove on the back of the medial tibial condyle.
Nerve supply of Semi-membranosus
sciatic nerve (tibial part).
Action of Semi-membranosus
- Flexion and medial rotation of the knee.
- Extension of the hip joint.
what is the type of hip joint?
Synovial polyaxial joint of ball and socket variety.
what are the articular surfaces of hip joint?
- Lunate surface of the acetabulum with its labrum acetabulare.
- Head of the femur.
what are the ligaments of hip joint?
Capsular ligaments:
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
Non capsular ligaments:
- ligament of head of the femur
- transverse acetabular ligament
- Labrum acetabulare
what is the site and shape of iliofemoral ligament?
- Lies on the front of the joint.
- inverted Y- shaped
attachment of iliofemoral ligament
Apex: is attached to the anterior inferior iliac spine.
Base: is attached to the intertrochanteric line of the femur.
what are the functions of iliofemoral ligament?
- It is one of the strongest ligaments in the body
- It resists the hyperextension of the hip joint.
- It resists the tendency of body to fall backwards during the erect posture.
what is the site and shape pubofemoral ligament?
- Lies on the inferomedial part of the fibrous capsule
- Triangular in shape
attachment of pubofemoral ligament
Apex: is attached to the iliopectineal eminence.
Base: blends with the anterior and inferior parts of the capsule.
what are the functions of pubofemoral ligament?
It checks the hip abduction.
what is the site and shape of ischiofemoral ligament?
- Lies on the posterior part of the capsule.
- Spiral in shape
attachment of ischiofemoral ligament
Above: The posterior and superior parts of the capsule.
Below: ischium below acetabulum.
what are the functions of ischiofemoral ligament?
It checks the medial rotation.
attachment of ligament of head of the femur
Apex: is attached to the fovea of the head of the femur.
Base: is attached to the transverse acetabular ligament and edges of the acetabular notch.
functions of ligament of head of the femur
- The ligament is too weak to play any mechanical part in the hip joint, but it becomes tense when the thigh is flexed and adducted.
- It may help to spread synovial fluid on the head of the femur.
- Sometimes, it transmits a small blood vessel to the head of the femur.
attachment of transverse acetabular ligament
Attachment: to the margin of the acetabular notch.
what are the functions of transverse acetabular ligament?
converts the notch into the acetabular foramen through which vessels and nerves enter the joint.
what is the definition of Labrum acetabulare?
it is a ring of Fibrocartilage.
attachment of Labrum acetabulare
to the margin of the acetabulum.
what are the characters of Labrum acetabulare?
Lies completely intracapsular.
what is the function of Labrum acetabulare?
deepens the acetabulum to hold the head of femur.
what are the movements done by hip joint?
Flexion, Extension, Adduction, Abduction, Medial Rotation, Lateral Rotation & Circumduction
which muscles cause flexion of hip joint?
Mainly By:
- iliopsoas muscle
Assisted By:
- Adductors
- rectus femoris
- Sartorius
Limited By:
- Opposition with Ant. Abd Wall
which muscles cause extension of hip joint?
Mainly By:
- gluteus maximus
Assisted By:
- hamstring muscles
Limited By:
- iliofemoral ligament
which muscles cause Adduction of hip joint?
Mainly By:
- adductor longus, brevis and magnus muscles
Assisted By:
- pectineus and gracilis
Limited By:
- lateral portion of the iliofemoral ligament
- upper part of fibrous capsule
which muscles cause abduction of hip joint?
Mainly By:
- gluteus medius and minimus
Assisted By:
- tensor fasciae lata
Limited By:
- pubofemoral ligament
which muscles cause lateral rotation of hip joint?
Mainly By:
- The 6 small lateral rotators
Assisted By:
- Sartorius muscle.
- Adductors muscles.
- Gluteus maximus
Limited By:
- pubofemoral ligament.
which muscles cause medial rotation of hip joint?
Mainly By:
- gluteus medius and minimus
Assisted By:
- tensor fasciae lata
Limited By:
- ischiofemoral ligament
what is the most stable joint of the body?
hip joint
what causes stability of hip joint?
Shape of the bone:
- The depth of the acetabulum which accommodates the head of the femur.
- The length and obliquity of the neck of the femur: allows the lower limb to move easily clear of the pelvis.
Ligaments:
- The labrum acetabulare: which deepens the acetabulum and slightly narrows its margin.
- Fibrous capsule: strong and tense.
- Strong ligaments outside the capsule: especially the iliofemoral.
Muscles:
- strong muscles: and their intimate relation with the joint capsule.
The atmospheric pressure:
- resists separation of the head of the femur from the acetabulum.
what divides the leg into compartments?
The leg is subdivided into three compartments by means of the anterior and the posterior intermuscular septa and the interosseous membrane between the interosseous borders of the tibia and fibula
what are the compartments of the leg?
Anterior compartment: contains the extensor group of muscles.
Lateral compartment: contains the peroneal group of muscles.
Posterior compartment: contains the flexor group of muscles.
what are the contents of the anterior compartment Of the leg?
- Tibialis anterior muscle.
- Extensor digitorum longus muscle.
- Extensor hallucis longus muscle.
- Peroneus tertius muscle.
- Anterior tibial vessels.
- Anterior tibial (deep peroneal) nerve.
what are the contents of the lateral compartment of the leg?
- Peroneus longus muscle.
- Peroneus brevis muscle.
- Superficial peroneal nerve (Musculocutaneous nerve).
Origin, Insertion, Nerve Supply & Action of Tibialis anterior
Origin:
- The upper half of the lateral surface of the tibia.
Insertion:
- Medial cuneiform bone.
- 1st metatarsal bone
Nerve Supply:
- Deep peroneal nerve
- Recurrent genicular nerve
Action:
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
Origin, Insertion, Nerve Supply & Action of Extensor digitorum longus
Origin:
- The upper 3/4 of the anterior surface of the fibula.
Insertion:
- Middle and distal phalanges of the lateral 4 toes through the extensor expansions.
Nerve Supply:
- Deep peroneal nerve
Action:
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
- extension of all joints of the lateral four toes
Origin, Insertion, Nerve Supply & Action of Extensor Hallucis longus
Origin:
- The middle 2/4 of the anterior surface of the fibula.
Insertion:
- distal phalanx of big toe
Nerve Supply:
- deep peroneal nerve
Action:
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
- extension of all joints of the big toe
Origin, Insertion, Nerve Supply & Action of Peroneus tertius
Origin:
- The lower 1/4 of the anterior surface of the fibula
Insertion:
- 5th metatarsal bone.
Nerve Supply:
- Deep peroneal nerve
Action:
- Dorsiflexion of the ankle joint
- Eversion of the foot at the subtalar joints
Origin, Insertion, Nerve Supply & Action of Peroneus longus
Origin:
- The lateral surface of the head of the fibula.
- The upper 2/3 of the lateral surface of the shaft of the fibula.
Insertion:
- Medial cuneiform bone.
- 1st metatarsal bone
Nerve Supply:
- superficial peroneal nerve
Action:
- Eversion of the foot at the subtalar joints
- Planter flexion of the ankle joint.
- Maintains the transverse arch of the foot
Origin, Insertion, Nerve Supply & Action of Peroneus brevis
Origin:
- The lower 2/3 of the lateral surface of the shaft of the fibula
Insertion:
- 5th metatarsal bone.
Nerve Supply:
- superficial peroneal nerve
Action:
- Eversion of the foot at the subtalar joins
- Planter flexion of the ankle joint.
- Maintains the transverse arch of the foot
what are the parts of the posterior compartment of the leg?
It is divided into three layers of muscle by two layers of fasciae:
The superficial layer: consists of the powerful plantar flexors of the ankle; gastrocnemius, soleus with plantaris muscle.
The middle layer: consists of the long flexors of the toes, flexor hallucis longus and flexor digitorum longus muscle.
The deep layer: is formed by tibialis posterior muscle. It lies on the interosseous membrane between the tibia and fibula.
Origin, Insertion, Nerve Supply & Action of Gastrocnemius
Origin:
- Lateral head: lateral surface of the lateral femoral condyle above the lateral epicondyle.
- Medial head: popliteal surface of femur above the medial condyle.
Insertion:
- The tendons of the 3 muscles join each other to form tendocalcaneus
- The tendocalcaneus is inserted into the middle 1/3 of the posterior surface of the calcaneus.
Nerve Supply:
- Tibial nerve
Action:
1. The main and powerful plantar flexor of the ankle joint.
2. Provide the propelling force in walking.
3. They are important elements in the muscle pump, returning venous blood from the lower limbs toward the heart.
4. Gastrocnemius muscle assists in flexion of the knee joint.
Origin, Insertion, Nerve Supply & Action of soleus
Origin:
- The posterior surface of the upper part of fibula.
- The soleal line and middle 1/3 of the medial border of tibia.
- The tendinous arch between the tibia and fibula.
Insertion:
- The tendons of the 3 muscles join each other to form tendocalcaneus
- The tendocalcaneus is inserted into the middle 1/3 of the posterior surface of the calcaneus.
Nerve Supply:
- Tibial Nerve
Action:
1. The main and powerful plantar flexor of the ankle joint.
2. Provide the propelling force in walking.
3. They are important elements in the muscle pump, returning venous blood from the lower limbs toward the heart.
Origin, Insertion, Nerve Supply & Action of Plantaris
Origin:
- Popliteal surface of the femur above lateral condyle of femur.
Insertion:
- Medial to achillis tendon?
Nerve Supply:
- Tibial Nerve
Action:
1. Plantar flexion of the ankle joint.
2. Assists in knee flexion
Origin, Insertion, Neve Supply & Action of Tibialis posterior
Origin:
1. Posterior surface of the tibia.
2. Posterior surface of the interosseous membrane.
3. Posterior surface of the fibula.
Insertion:
- Navicular bone (main insertion).
- All the tarsal bones except the talus.
- Middle three (second, third and fourth) metatarsal bones.
Nerve Supply:
- Tibial nerve
Action:
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
Origin, Insertion, Neve Supply & Action of Flexor digitorum longus
Origin:
- Posterior surface of the tibia
Insertion:
- Terminal phalanx of the lateral four toes.
Nerve Supply:
- Tibial Nerve
Action:
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
- Flexion of all joints of the lateral four toes.
Origin, Insertion, Neve Supply & Action of flexor hallucis longus
Origin:
- posterior surface of the fibula
Insertion:
- terminal phalanx of the big toe.
Nerve Supply:
- Tibial nerve
Action:
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
- Flexion of all joints of the big toe.
Origin, Insertion, Neve Supply & Action of Popliteus
Origin:
- Groove on the lateral surface of the lateral femoral condyle just below the lateral epicondyle.
Insertion:
- Upper part of the posterior surface of tibia above soleal line.
- Into the strong fascia which covering the muscle.
Nerve Supply:
- Tibial Nerve
Action:
- Flexes the knee
- Rotates the leg medially at the beginning of flexion of the fully extended leg (unlocks the knee joint).
Origin, Insertion, Neve Supply & Action of Extensor digitorum brevis muscle (Muscle of the dorsum of the foot)
Origin:
- From the calcaneus and the inferior extensor retinaculum
Insertion:
- it forms four tendons:
❖ The most medial: the extensor hallucis brevis is inserted into the proximal phalanx of the big toe.
❖The remaining three tendons join the long extensor tendons of the second to fourth toes to form extensor expansion.
Nerve Supply:
- lateral branch of deep peroneal nerve.
Action:
- Extension of the medial four toes
what are the muscles of the sole of the foot?
innervation of the muscles of the sole of the foot
All the muscles of the sole are supplied by the lateral plantar nerve except:
1. Abductor halluces
2. Flexor digitorum brevis
3. First lumbrical
4. Flexor halluces brevis
Are supplied by medial plantar
what is the action of lumbricals in the foot?
Flexion of the metatarsophalangeal joints and Extension of the interphalangeal joints of the lateral four toes.
what is the action of planter interossei side of the foot?
adduction of the lateral three toes towards the middle line of the second toe (PAD) + flexion of the metatarsophalangeal joints and extension the interphalangeal joints of the lateral three toes.
what is the action of dorsal interossei of the foot?
abduction of 2nd, 3rd & 4th toes away from the middle line of the second toe (DAP) + flexion of the metatarsophalangeal joints and extension the interphalangeal joints of the lateral three toes.
what is the type of Knee joint?
Synovial, biaxial condylar (or modified hinge) (it allows some rotatory movements beside flexion and extension).
what are the articular surfaces of knee joint?
Articular surface of the femur: An inverted V-shaped articular surface of femoral condyles.
Articular surface of the patella: Large lateral and small medial facets.
Articular surfaces of the tibia: The upper articular surface of the two condyles of the tibia.
articular capsule of knee joint
the capsule is deficient anteriorly and replaced by quadriceps tendon, patella and ligamentum patella.
what are the ligaments of the knee joint?
Extra-capsular:
- Ligamentum patellae
- Fibular collateral (lateral ligament)
- Tibial collateral (medial ligament)
- Posterior oblique ligament
Intra-capsular:
- Menisci (Semilunar cartilages)
- Cruciate ligaments
- Transverse ligament
attachment of Ligamentum patellae
Above: to the apex of the patella.
Below: to the tibial tuberosity.
characters of Ligamentum patellae
continuation of the quadriceps tendon below the patella.
attachment of Fibular collateral (lateral ligament)
Above: lateral epicondyle.
Below: to the head of the fibula. it pierces the tendon of insertion of biceps femoris.
characters of Fibular collateral (lateral ligament)
It is separated from lateral meniscus by the fibrous capsule and the tendon of popliteus.
attachment of Tibial collateral (medial ligament)
Above: medial epicondyle.
Below: The upper part of the medial surface of the tibia behind (S.G.S.).
characters of Tibial collateral (medial ligament)
It is firmly attached to the medial meniscus.
attachment of Posterior oblique ligament
- From the medial condyle of the tibia to the lateral condyle of the femur.
characters of Posterior oblique ligament
- It is an expansion of the tendon of semimembranosus.
what are Menisci?
two C-shaped plates of fibrocartilage on upper surface of tibial condyles
compare between lateral meniscus and medial meniscus according to:
- Shape
- Relation to capsule
- Fixation
- Liability to damage
- Function
what are cruciate ligaments?
two strong fibrous bands, which connect the tibia with the femur forming an X-shaped figure.
compare between anterior cruciate ligament and posterior cruciate ligament in terms of:-
- Tibial attachment
- Femoral attachment
- Direction
- Function
what does the transverse ligament of the knee joined connect?
Connects the anterior horns of both menisci together.
what are the muscles responsible for flexion of the knee joint?
mainly by: biceps femoris, semitendinosus muscles.
Assisted by: sartorius, gracilis and popliteus muscles.
what are the muscles responsible for extension of Knee joint?
mainly by: quadriceps femoris muscle.
Assisted by: tensor fascia lata muscle.
what are the muscles responsible for medial rotation (unlocking) of the knee joint?
mainly by: popliteus muscle.
Assisted by: semitendinosus, semimembranosus, sartorius and gracilis muscles.
what are the muscles Responsible for lateral rotation (locking) of the knee joint?
only done by the biceps femoris muscle
what is the type of Ankle joint?
Synovial uniaxial, of the hinge variety.
what are the articular surfaces of ankle joint?
Below: talus (superior surface - medial surface - lateral surface)
Above: tibia (inferior surface of the lower end and medial malleolus) – fibula (lateral malleolus)
what are the ligaments of the ankle joint?
- The medial (deltoid) ligament
- The lateral ligament
what is the shape of The medial (deltoid) ligament of the ankle?
it is triangular in shape.
attachment of The medial (deltoid) ligament of the ankle
Above (apex): distal border of the medial malleolus.
Below (base): is attached to the following structures
from before backwards:
i. The neck of the talus.
ii. The navicular bone.
iii. The medial edge of the spring ligament.
iv. The sustentaculum tali.
v. The medial side of the body of the talus.
What is the site of The lateral ligament Of the ankle?
on the lateral aspect of the ankle joint.
what is the shape of The lateral ligament Of the ankle?
Is formed of three bands:
1. The anterior talofibular ligament
2. The posterior talofibular ligament
3. The calcaneofibular ligament
What causes dorsiflexion at the ankle joint?
a. Tibialis anterior muscle.
b. Extensor hallucis longus muscle.
c. Extensor digitorum longus muscle.
d. Peroneus tertius muscle.
what causes plantar flexion at the ankle joint?
a. Gastrocnemius muscle (main).
b. Soleus muscle (main).
c. Plantaris.
d. Tibialis posterior muscle.
e. Flexor digitorum longus muscle.
f. Flexor hallucis longus muscle.
g. Peroneus longus.
h. Peroneus brevis.
what is the type of Talocalcanean joint?
Synovial plane.
what are the articular surfaces of the Talocalcanean joint?
a. The lower surface of the body of the talus.
b. The upper surface of the middle of the calcaneus.
what is the type of Talo-calcaneo-navicular joint?
synovial ball and socket.
what are the articular surfaces of Talo-calcaneo-navicular joint?
a. The ball: the head of the talus.
b. The socket: is formed by:
✓ The navicular bone.
✓ The calcaneus.
✓ The spring ligament (plantar calcaneonavicular ligament).
§
what are the movements at subtalar (talo-calcaneo-navicular & talocalcanean) Joints?
eversion and inversion
what causes eversion at subtalar joints?
a) Peroneus longus
b) peroneus brevis
c) peroneus tertius.
what causes inversion at the subtalar joints?
a) Tibialis anterior and posterior.
b) Extensor and flexor hallucis longus.
c) Extensor and flexor digitorum longus.
what does arches of the foot mean?
The skeleton of the foot is built in the form of an arch.
what is the function of the arches of the foot?
a. Supporting the body weight.
b. Transmission of the body weight to the ground.
c. Important in the process of walking.
d. Protection of soft tissue of the sole of the foot.
what are the types of the Arches of the foot?
a. Longitudinal arch:medial and lateral
b. Transverse arch.
what are the bones that form medial longitudinal arch?
i. The key-stone: talus.
ii. The posterior pillar:calcaneus.
iii. The anterior pillar: navicular, three cuneiform and the medial three metatarsal bones.
what are the characters of medial longitudinal arch?
has a greater height
what is the function of medial longitudinal arch?
Important in the process of walking and running
what are the bones forming the Lateral longitudinal arch?
i. The calcaneus.
ii. Thecuboid.
iii. The 4th and 5th metatarsal bones.
what are the characters of the Lateral longitudinal arch?
nearly flat.
what is the function of the Lateral longitudinal arch?
important in support the body weight
what are the bones forming the Transverse arch?
- cuboid and the three cuneiform.
- The bases of the 5 metatarsal bones.
what are the characters of the Transverse arch?
Its medial end is high while its lateral end reaches the ground.
what is the function of the Transverse arch?
Protection of soft tissue of the sole of foot from the effect of pressure during standing or walking
what are the factors of maintaining the arches of the foot?
Shape of the bones
Long tendons of the foot:
1. Tendon of peroneus longus: maintains both the longitudinal and transverse arch.
2. Tendon of tibialis posterior, flexor hallucis longus and flexor digitorum longus: maintains the longitudinal
arch of the foot.
3. Tendon of tibialis anterior: pull the medial cuneiform upwards and hence it helps the medial longitudinal arch.
4. Short muscles of the foot: their contraction binds the bones of the foot together.
Ligaments of the joints of the foot:
plantar ligaments: They include:
1. Long plantar ligament.
2. Short plantar ligament.
3. Plantar calcaneonavicular ligament (spring ligament).
4. Deltoid ligament.
Planter aponeurosis: is the thickened central part of the deep fascia.
Superficial fascia: distribution of fat in the sole of the foot helps to preserve shape of the arches.
what is the definition of flat foot?
loss of the arches of the foot.
what are the causes of Flat foot?
Congenital:
- Weakness of the muscles of the sole
- Abnormal form of articulated bones.
Acquired:
- Rapid increase in the body weight
- Weakness or paralysis of the muscles of the sole
- Wearing improper arched shoes.
Nerves Of The lower limb
The Origin of Femoral nerve
ventral primary rami of (L 2, 3, 4) (dorsal division).
what is the course of Femoral nerve?
It enters the femoral triangle by passing behind the inguinal
ligament, outside the femoral sheath.
termination of Femoral nerve
it ends 1 inch below the inguinal ligament by dividing into muscular & cutaneous branches.
what are the the branches of Femoral nerve?
Muscular
1. Iliacus.
2. Quadriceps.
3. Sartorius.
4. Articularis genu.
5. Pectineus.
Cutenous
1. Medial cutaneous nerve of the thigh.
2. Intermediate cutaneous nerve of the thigh.
3. Saphenous nerve, It supplies the skin of:
- Medial side of the knee.
- Medial side of the leg.
- Medial side of the foot till the big toe.
Articular
- Hip & knee joints.
what is the origin of obturator nerve?
ventral primary rami of (L 2, 3, 4) (ventral division).
course of obturator nerve
In the obturator canal it divides into: anterior & posterior branches:
- Anterior division pass in front of the adductor brevis.
- Posterior division pass behind the adductor brevis.
what are the branches of obturator nerve?
what are the nerves of the gluteal region?
- superior gluteal nerve
- Inferior gluteal nerve
- Pudendal nerve
- Nerve to obturator internus
- Posterior cutaneous nerve of the thigh
- Nerve to quadratus femoris
what does superior gluteal nerve supply?
a. Gluteus medius.
b. Gluteus minimus
c. Tensor fasciae lata.
what do lesions in the superior gluteal nerve cause?
- Unilateral lesion: lead to (Lurching gait).
- Bilateral lesion: lead to (waddling gait).
what does of the inferior gluteal nerve supply?
gluteus maximus.
what is the course of the pudendal nerve?
- It leaves the pelvis through the greater sciatic foreman below the piriformis.
- Then, it enters the lesser sciatic foramen to the perineum.
what does the nerve to obturator internus supply?
Obturator internus & superior gemellus.
what are the branches of the posterior cutaneous nerve of the thigh?
Cutaneous branches to:
- Skin of the back of the thigh & roof of popliteal fossa.
- Skin of the upper half of the calf.
what does nerves to quadratus femoris supply?
quadratus femoris & inferior gemellus.
Origin of Sciatic nerve
from the sacral plexus (L. 4, 5, S. 1, 2, 3).
course of Sciatic nerve
- It leaves the pelvis through the greater sciatic foramen below the piriformis.
- Leaves gluteal region midway between the greater trochanter & ischial tuberosity.
- It enters the back of the thigh.
termination of Sciatic nerve
- At the middle of the back of the thigh it divides into:
1. Tibial (medial popliteal) nerve.
2. Common peroneal (Lateral popliteal) nerve.
branches of Sciatic nerve
Muscular:
- By tibial part
1. Ischial part of adductor magnus.
2. Semimembranosus.
3. Semitendinosus.
4. Biceps femoris (long head) - By Common Peroneal Part
5. Biceps femoris (short head)
Articular:
- Hip & knee joints.
Terminal:
1. Tibial (medial popliteal) nerve.
2. Common peroneal (Lateral popliteal) nerve.
what is sciatica?
neuritis of sciatic nerve characterized by pain at the back of thigh.
what does a lesion in sciatic nerve Cause?
leads to paralysis of all muscle below the knee & loss of sensation on the leg & the foot except area supplied by saphenous nerve.
how to avoid sciatic nerve injury?
To avoid sciatic nerve injury, an intramuscular injection in the gluteal region is given in the upper outer quadrant.
Origin of Tibial nerve
one of the 2 terminal branches of the sciatic nerve.
Termination of tibial nerve
Enters the back of the leg between the 2 heads of gastrocnemius.
branches of Tibial nerve
Muscular
1. Gastrocnemius muscle.
2. Plantaris muscle.
3. Popliteus muscle.
4. Soleus muscle.
Cutenous:
- Sural nerve
Articular:
- Superior medial genicular nerve
- Inferior medial genicular nerve
- Middle genicular nerve.
Origen of common peroneal nerve
One of the 2 terminal branches of the sciatic nerve.
termination of common peroneal nerve
Terminates at the lateral side of the neck of the fibula by dividing into:
1. Superficial peroneal nerve.
2. Deep peroneal nerve.
branches of common peroneal nerve
Cutaneous:
- Sural communicating nerve: join the sural nerve.
- Lateral cutaneous nerve of the calf.
Articular:
- Superior lateral genicular nerve.
- Inferior lateral genicular nerve.
- Recurrent genicular nerve.
what is the cause of common peroneal nerve injury?
fracture of the neck of the fibula
what is the effect of a lesion in common peroneal nerve?
foot drop.
Distribution of sural nerve
It supplies the skin of the following parts:
- Lower parts of the lateral surface of the leg.
- Lateral side of the foot.
- Lateral side of the little toe.
Origin of tibial nerve of the leg
Continuation of the tibial nerve at the lower border of the popliteus muscle.
termination of tibial nerve of the leg
- Midway between medial malleolus & calcaneus deep to flexor retinaculum it divides into:
Medial & lateral plantar nerves.
what are the branches of tibial nerve of the leg?
Origin of Deep peroneal nerve
One of the 2 terminal branches of common peroneal nerve on the lateral side of the neck of the fibula.
termination of Deep peroneal nerve
Divides into medial & lateral divisions at the ankle joint.
what are the branches of Deep peroneal nerve?
Muscular
1. Tibialis anterior.
2. Extensor hallucis longus.
3. Extensor digitorum longus.
4. Peroneus tertius.
5. Extensor digitorum brevis.
Articular
- to ankle joint & joints of the foot.
Cutaneous
- Skin of the sides of the big & 2nd toes.
Origin of Superficial peroneal nerve
One of the two terminal branches of the common peroneal nerve at the lateral side of the neck of the fibula.
termination of Superficial peroneal nerve
In the distal third of the leg: it pierces the deep fascia & divides into medial and lateral branches.
what are the branches of Superficial peroneal nerve?
Muscular
1. Peroneus longus.
2. Peroneus brevis.
Cutaneous
- Front & lateral side of the lower part of the leg.
- Intermediate area of dorsum of foot.
- Dorsum of medial 3& 1⁄2 toes.
what is the origin of Medial plantar nerve?
One of the 2 terminal branches of the tibial nerve.
what are the branches of Medial plantar nerve?
what is the origin of lateral plantar nerve?
One of the 2 terminal branches of the tibial nerve.
what Are the branches of lateral plantar nerve?
Origin
- all muscles of the sole except 4
Cutaneous
- Lateral 1/3 of skin of sole of foot.
- Lateral 1&1/2 toes
Articular
- to joints of the foot.
cutaneous nerve supply of the dorsum of the foot
Most of the dorsal surface of the foot is supplied by superficial peroneal nerve except:
- The medial side of the foot: by saphenous nerve.
- The lateral side of the foot & lateral side of the little
toe: by sural nerve. - Side between the big& 2nd toes: by deep peroneal nerve.
- Terminal phalanges of medial 31⁄2 toes: by medial
planter nerve. - Terminal phalanges of the lateral 11⁄2 toes: by lateral
planter nerve.
cutaneous nerve supply of the sole of the foot
- Calcanean branch of the tibial nerve supply the skin of the heel.
- Medial planter nerve: supply:
a. Medial2/3 of the skin of the sole.
b. Medial 3&1⁄2 toes. - Lateral planter nerve: supply:
a. Lateral 1/3 of skin of sole of foot.
b. Lateral 1&1⁄2 toes.
Origin of Femoral Artery
Direct continuation of the external iliac artery at the mid-inguinal point.
Termination of Femoral Artery
continues as popliteal artery at the adductor hiatus.
Branches of Femoral Artery
Superficial:
1. Superficial external pudendal
2. Superficial Epigastric
3. Superficial Circumflex iliac
Deep:
1. Deep External pudenda
2. Descending genicular
3. Profunda Femoris Artery (Deep Femoral Artery)
Origin of Profunda Femoris Artery (Deep Femoral Artery)
Largest branch of femoral artery, 1.5 inches below inguinal ligament
branches of Profunda Femoris Artery (Deep Femoral Artery)
A. Lateral circumflex femoral artery
B. Medial circumflex femoral artery
C. upper 3 perforator arteries
termination of Profunda Femoris Artery (Deep Femoral Artery)
Pierces adductor magnus as 4th perforator artery.
Origin of Popliteal Artery
Begins at the opening in the adductor magnus as the continuation of the femoral artery.
Termination of Popliteal Artery
At the distal border of the popliteus by dividing into anterior and posterior tibial arteries.
Branches of Popliteal Artery
Genicular (5 branches to knee joint)
1. Superior medial genicular.
2. Inferior medial genicular.
3. Superior lateral genicular.
4. Inferior lateral genicular.
5. Middle genicular.
Terminal branches:
1. Anterior tibial artery.
2. Posterior tibial artery.
Origin of Anterior Tibial Artery
One of the two terminal branches of the popliteal artery at the distal border of the popliteus muscle.
Termination of Anterior Tibial Artery
It ends in front of the ankle joint midway between the two malleoli and continuous as Dorsalis Pedis artery.
Origin of Dorsalis Pedis Artery
The continuation of the anterior tibial artery on the front of the ankle joint at a point midway between the medial and lateral malleoli.
Termination of Dorsalis Pedis Artery
At proximal end of 1st inter-metatarsal space, it pierces 1st dorsal inter-osseous muscle forming deep planter artery that anastomose with medial end of planter arch
Branches of Dorsalis Pedis Artery
1- Medial tarsal: arise just distal to ankle joint
2- Lateral tarsal: arise just distal to ankle joint
3- 1st dorsal metatarsal: supply dorsum of medial 1.5 toes
4- Arcuate: supply dorsum of lateral 3.5 toes
5- 1st planter metatarsal: arises from dorsalis pedis in sole to
supply the planter surface of 1st inter-digital cleft
Origin of Posterior Tibial Artery
One of the two terminal branches of the popliteal artery at the distal border of the popliteus muscle.
Termination of Posterior Tibial Artery
passes deep to flexor retinaculum to divide into medial & lateral planter arteries.
Branches of Posterior Tibial Artery
- Circumflex Fibular artery: share in anastomosis around knee joint.
- Peroneal artery
- Communicating branch: joins communicating branch of peroneal.
- Medial malleolar: passes on the medial malleolus
- Medial calcenian: share in anastomosis around ankle
-
Terminal branches:
1. The medial plantar artery.
2. The lateral plantar artery.
Origin of Peroneal artery
one inch below lower border of popliteus.
Termination of Peroneal artery
behind inf tibio-fibular joint by giving lateral calcanean branches
Branches of Peroneal artery
- Communicating: joins communicating branch of posterior tibial a
- Perforating: pierces lower part of inter-osseous membrane
- Lateral malleolar: passes on the lateral malleolus
- Lateral calcanian: continuation of a at lateral side of calcaneus
Termination of Medial plantar artery
anastomose with 1st planter metatarsal
wjat does the Medial plantar artery supply?
medial side of big toe
what are the parts of the lateral plantar artery?
1st part: pass forward & laterally on base of 5th metatarsal bone
2nd part: pass medially to form planter arch that gives:
▪ perforating branches: anastomose with dorsal metatarsal arteries
▪ 2,3,4 planter metatarsal & planter digital to supply planter surface of lateral 3.5 toes
Anastomoses around knee joint
Anastomoses around ankle joint
Branches of Anterior Tibial artery
- Posterior tibial recurrent artery: Arises while artery in back of leg.
- Anterior tibial recurrent artery: Arises as artery reaches anterior compartment.
- Anterior medial malleolar artery: Runs anterior to medial malleolus
- Anterior lateral malleolar artery: Runs anterior to lateral malleolus.
what is the site of Dorsal Venous arch?
- dorsum of foot opposite head of metatarsal bones
Input of Dorsal Venous arch
- dorsal metatarsal veins formed by union of dorsal digital veins
Output of Dorsal Venous arch
- share in formation of great & short saphenous veins
beginning of Short (Small) Saphenous vein
- (lateral end) of dorsal venous arch + dorsal digital vein of lat. side of little toe
course of Short (Small) Saphenous vein
- Passes below lat malleolus.
- Ascends on back of lat malleolus
- then in midline on gastrocnemius
end of Short (Small) Saphenous vein
- pierces deep fascia at lower border of popliteal fossa to end at popliteal v.
what are the tributaries of Short (Small) Saphenous vein?
- lateral side of foot & back of leg
Beginning of Great (Long) saphenous vein
dorsal venous arch (medial end) + dorsal digital v. of med side of big toe
end of Great (Long) saphenous vein
- It passes on med side of dorsum of foot.
- Ascends in front of med malleolus to reach med border of tibia.
- Passes along posteromed. side of knee.
- Passes upwards in superf. fascia of thigh
what are the tributaries of Great (Long) saphenous vein?
- Communicating veins with deep veins.
- Superficial circumflex iliac v.
- Superficial epigastric v.
- Superficial external pudendal v.
Beginning of popliteal vein
At distal border of popliteus by union of venae commitants of ant & post tibial a
what is the course of popliteal vein?
- In lower part of fossa: Popliteal v is med to popliteal a
- In middle of fossa: Popliteal v crosses superf. to a
- In upper part of fossa: Popliteal v lies lat to popliteal a.
end of popliteal vein
Continue as femoral v at opening of adductor magnus.
tributaries of popliteal vein
- superior medial genicular
- inferior medial genicular
- superior lateral genicular
- middle genicular
- Short saphenous v
beginning of Femoral vein
At opening of adductor magnus as continuation of popliteal v
what is the course of Femoral vein?
✓ In lower part of subsartorial canal: Femoral v is posterolat. to femoral a.
✓ At apex of femoral ∆: Femoral v is post to femoral a.
✓ At base of femoral ∆ Femoral v is med to femoral a
what is the end of Femoral vein?
Continue as ex iliac v behind inguinal ligament
what are the tributaries of Femoral vein?
- Deep ex pudendal v.
- Profunda femoris v.
- MCF vein.
- LCF vein.
- Great saphenous
Valves of great saphenous vein
- divide it into segment to reduce venous pressure on venous wall during erect posture.
- Incompetence of valves causes venous dilatation (varicose veins)
end of great (Long) Saphenous vein
- pierces cribriform fascia at saphenous opening to end at femoral v.
