Anatomy Flashcards
Source of fibers of tibial nerve?
Ventral divisions of L4-S3 ventral rami
Where is the location of sciatic nerve bifurcation?
Middle to distal third of thigh, deep to the hamstring muscles
Tibial nerve position, relative to the popliteal vessels in popliteal fossa?
Lateral to medial: NVA
Nerve (Tibial), Vein, Artery
Tibial nerve is lateral and posterior (more superficial) to the popliteal vessels. Popliteal vein is intermediate in position. Popliteal artery is most medial, adjacent to femur, tibia, and knee joint capsule.
Popliteal fossa boundaries?
Diamond shaped.
Upper half:
- medial: semimembranosus-semitendinosus
- lateral: biceps femoris (long and short heads)
Lower half:
- medial and lateral head of gastrocnemius
Floor: popliteus muscle (lower half of popliteal fossa)
Tibial nerve branches in popliteal fossa?
Motor branches:
- medial and lateral head of gastrocnemius
- soleus
- plantaris
- popliteus
- tibialis posterior (sometimes branches to this muscle arise after the nerve dives between the soleus and the posterior compartment muscle)
Sensory branch:
- Medial sural cutaneous nerve
What structure is that?
Left popliteal fossa
Tibial nerve
What is the muscle pointed with the probe (retracted)?
Left thigh - Posterior view
Gluteus maximus
What structure is pointed by the probe?
Left thigh - Posterior view
Posterior femoral cutaneous nerve
These muscles shared common origin at the ischial tuberosity. Named the muscles!
Left thigh - Posterior view
- Long head of biceps femoris
- Semitendinosus
- Semimembranosus
What muscle is that? What is the origin and insertion of that muscle?
Left thigh - Posterior view
Semitendinosus
Origo: ischial tuberosity
insertion: medial condyle of tibia
What structure is shown by the probe?
Left thigh - Posterior view
Tendon of semitendinosus muscle
What muscle is shown by the probe? What is the origo and insertion of that muscle?
Left thigh - Posterior view
Semimembranosus
Origo: ischial tuberosity
Insertion: medial condyle of tibia
Name the muscle retracted and the muscle pointed with the probe!
Left thigh - Posterior view
Muscle retracted: semitendinosus
Muscle pointed by the probe: semimembranosus
Name the muscle indicated by the probe!
Left thigh - Posterior view
Adductor magnus
Name the muscle indicated by the probe! What is the origin and insertion of that muscle?
Left thigh - Posterior view
Long head of biceps femoris
Origin: ischial tuberosity
insertion: head of fibula
What is the cord structure (in this picture, medial to the retractor) that lies beneath the muscle (retracted)?
Left thigh - Posterior view
Sciatic nerve
What is the structure indicated by the probe?
Left thigh - Posterior view
Long head of biceps femoris
What muscle is indicated by the probe?
Left thigh - Posterior view
semitendinosus
What muscle is indicated by the probe?
Left thigh - Posterior view
semimembranosus
Name the muscles retracted in the pictures! What is the origo and insertion of those mucles?
Left popliteal fossa
medial and lateral head of gasctrocnemius
origo: medial and lateral condyle of femur
insertion: calcaneus (through a common tendon with soleus and plantaris muscle - Tendo Achilles)
What is the structure indicated by the probe?
Left popliteal fossa
common peroneal nerve (L4-S2)
What is the structure indicated by the probe? This structure enters the popliteal fossa through where?
Left popliteal fossa
Popliteal vessels, still covered by its vascular sheath.
Popliteal vessels is a distal continuation of the femoral vessels, and enters the popliteal fossa through adductor hiatus
What is the structure indicated by the probe?
Left popliteal fossa
popliteal vein
What is the structure indicated by the probe?
Left popliteal fossa
popliteal artery
Name the structure shown by the probe! What is the origin of that structure?
Right thigh, antero-medial view
distal-proximal
lateral femoral cutaneous nerve (LFCN) - a branch from the lumbar plexus
originates from the posterior division of L2-3 ventral rami, before joining the posterior division of L4 ventral rami, to for the femoral nerve
Name the structure shown by the probe!
Right thigh, antero-medial view
distal-proximal
a cutaneous branch from the anterior division of obturator nerve
Obturator nerve originates from the anterior division of L2-4 ventral rami. Bifurcates into anterior and posterior division prior to exiting the pelvis through obturator canal
covers sensation from upper medial thigh
Name the structure shown by the probe!
Right thigh, antero-medial view
distal-proximal
Intermediate femoral cutaneous nerve - a cutaneous branch from femoral nerve
Femoral nerve is the largest nerve formed by the lumbar plexus. Femoral nerve originates from the posterior division of L2-4 ventral rami.
Covers sensation from anterior thigh
Name the structure shown by the probe!
Right thigh, antero-medial view
distal-proximal
Medial femoral cutaneous nerve - A cutaneous branch from femoral nerve
Femoral nerve is the largest nerve formed by the lumbar plexus. Femoral nerve originates from the posterior division of L2-4 ventral rami
Covers sensation from distal medial thigh and some proximal medial thigh (mostly covered by obturator nerve)
Name the structure shown by the probe!
Right leg - anteromedial view
Saphenous nerve - A cutaneous branch from femoral nerve.
Femoral nerve is the largest nerve formed by the lumbar plexus. Femoral nerve originates from the posterior division of L2-4 ventral rami.
Saphenous nerve pierces the fascia lata at the knee or immediately below the knee level. it innervates the medial knee, medial leg, medial ankle, and arch of foot
Name the structure shown!
Right ankle - posterolateral view
Lesser saphenous vein
Name the structure shown!
Right leg - Posterolateral view
Sural Nerve
in 80% received contributions from both tibial and peroneal nerve. in 20% only from tibial nerve. supply sensation for dorsolateral foot, lateral heel and ankle, and lower lateral leg
The most common nerve harvested for nerve graft donor
Name the structure shown!
the medial terminal branch of deep peroneal nerve (Cutaneous branch)
supply sensation for the first web space on the dorsum of foot
Name the structure shown!
the medial terminal branch of deep peroneal nerve (Cutaneous branch)
supply sensation for the first web space on the dorsum of foot
Name the structure shown!
right leg - posterolateral view
Sural Nerve
in 80% received contributions from both tibial and peroneal nerve. in 20% only from one of these nerves, usually from tibial nerve. Supply sensation for dorsolateral foot, lateral heel and ankle, and lower lateral leg
The most common nerve harvested for nerve graft donor
Note that the nerve travels with the lesser saphenous vein, and proximally we can see the medial (from tibial nerve) and lateral (from peroneal nerve) sural cutaneous branch merge to form this nerve.
the lesser saphenous vein should be preserved during sural nerve graft harvest
Name the structure shown!
Right leg - posterolateral view
Medial sural cutaneous nerve
a branch from tibial nerve.
Note that the nerve travels with saphenous nerve. Initially the nerve travels beneath the crural fascia in between the two heads of gastrocnemius. About midway down the calf, the nerve pierces the deep crural fascia to enter the subcutaneous tissue. Note the lateral sural cutaneous nerve on the lateral aspect of the calf, parallel to this nerve. both nerve will merge distally to form the sural nerve proper
Name the structure shown!
Right leg - posterolateral view
lateral sural cutaneous nerve - a branch of common peroneal nerve
the branch arise in the popliteal fossa, pierces the deep crural fascia in the proximal leg, to enter the subcutaneous space, travels distally to merge with the medial sural cutaneous nerve and form the sural nerve proper
Name the structure shown! Name its origin and insertion!
(The more superficial muscle retracted)
Left thigh - posterior view
Short head of biceps femoris
Origin: femoral shaft
Insertion: head of fibula
Name the structure shown by the probe!
(the muscle group with the common origin at ischial tuberosity retracted)
Left thigh - posterior view
Sciatic nerve
Received its fibers from ventral rami of L4-S3 nerve roots. Actually two separate nerves - tibial and common peroneal nerve - enveloped by a common epineurium. the tibial division is medial and larger, the peroneal division is lateral and smaller.
What is the name of the structure shown at the medial knee level in the picture?
left knee - posterior view
tendon of gracilis muscle
origin - an aponeurosis arising from the anterior margin of lower half of symphisis pubis and the upper half of the pubic arch
insertion - below the medial condyle of tibia
when viewed from lateral - collectively with the sartorius and semitendinosus - form a three pronged structure called the pes anserinus superficialis or goose-foot.
thigh adductor
What is the name of the structure shown at the medial knee level in the picture?
left knee - posterior view
The Sartorius muscle – the longest muscle in the human body. Its upper portion forms the lateral border of the femoral triangle.
origin - anterior superior iliac spine
Running obliquely across the upper and anterior part of the thigh in an inferomedial direction. It descends as far as the medial side of the knee, passing behind the medial condyle of the femur to end in a tendon.
This tendon curves anteriorly to join the tendons of the gracilis and semitendinous muscles which together form the pes anserinus, finally inserting into the proximal part of the tibia on the medial surface of its body.
Assists in flexing, abduction and lateral rotation of hip, and flexion of knee. Looking at the bottom of one’s foot, as if checking to see if one had stepped in gum, demonstrates all four actions of sartorius.
Name the muscle shown! Name the origin and insertion! Innervation?
right leg - posterior view
Medial head of gastrocnemius
origin: medial condyle of femur
insertion: common tendon (with soleus and plantaris), tendo Achilles - to the posterior surface of calcaneus
Tibial nerve (S1-S2)
Name the muscle shown! Name the origin and insertion! Innervation?
right leg - posterior view
lateral head of gastrocnemius
origin: lateral condyle of femur
insertion: common tendon (with soleus and plantaris), tendo Achilles - to the posterior surface of calcaneus
Tibial nerve (S1-S2)
Name the structure shown!
Right leg - posterior view
Tendo Achilles
Common tendon for gastrocnemius, soleus, and plantaris
insert to the posterior surface of calcaneus
Name the muscle shown by the probe! Name its origin and insertion, and innervation!
Right proximal leg - Posterior view
Popliteus muscle
origin: lateral surface of lateral condyle of femur
insertion: posterior surface of tibia, just above the soleal (popliteal) line
Action: flexion and medially rotates the leg at knee
Tibial nerve - clinically not important to test
Name the muscle shown! Origin-insertion-innervation!
Right proximal leg - posterior view
Plantaris muscle
Origin: inferior part of the lateral supracondylar line of the femur at a position slightly superior to the origin of the lateral head of gastrocnemius.
Passing inferomedially posterior to the knee joint, it becomes tendinous while passing distally to insert into the tendo calcaneus, or occasionally separately inserting into the medial side of the calcaneus.
Innervation: Tibial nerve - clinically not important to test
Name the structure shown!
Right leg - posterior view
Plantaris muscle tendon
Origin: inferior part of the lateral supracondylar line of the femur at a position slightly superior to the origin of the lateral head of gastrocnemius.
Passing inferomedially posterior to the knee joint, it becomes tendinous while passing distally to insert into the tendo calcaneus, or occasionally separately inserting into the medial side of the calcaneus.
Innervation: Tibial nerve - clinically not important to test
Name the muscle shown! Origin-insertion-innervation!
Right proximal leg - posterior view
Soleus muscle
Origin: fibula, medial border of tibia (soleal line)
Insertion: tendo calcaneus
Nerve: tibial nerve, specifically, nerve roots S1–S2
Actions plantarflexion
Antagonist tibialis anterior
Name the structure shown!
Right leg - posterior view
Popliteal artery
Note that at the lower border of popliteus, the popliteal artery bifurcates into anterior and posterior tibial artery. The posterior tibial artery continue its course distally with the tibial nerve, while the anterior tibial artery is seen to dive through an opening in the interosseus membrane to enter the anterior compartment.
Name the structure shown!
Right leg - posterior view
Anterior tibial artery
Note that at the lower border of popliteus, the popliteal artery bifurcates into anterior and posterior tibial artery. The posterior tibial artery continue its course distally with the tibial nerve, while the anterior tibial artery is seen to dive through an opening in the interosseus membrane to enter the anterior compartment.
Name the structure shown!
Right leg - posterior view
Posterior tibial artery
Note that at the lower border of popliteus, the popliteal artery bifurcates into anterior and posterior tibial artery. The posterior tibial artery continue its course distally with the tibial nerve, while the anterior tibial artery is seen to dive through an opening in the interosseus membrane to enter the anterior compartment.
Name the structure shown!
Right leg - posterior view
The posterior tibial artery
Passes distally on the medial side of the posterior compartment
Near its origin, the posterior tibial artery gives rise to the peroneal artery. It courses on the lateral side of the posterior compartment of the leg between the tibialis posterior muscle and flexor hallucis longus muscle. Although the peroneal artery travels in the posterior compartment, it supplies the muscles of the lateral compartment, the peroneus longus and brevis muscles. To supply these muscles, branches of the peroneal artery pierce the fascia, which separates the lateral and posterior compartments of the leg.
Name the structure shown!
Right leg - posterior view
Tibial nerve (L4-S3)
Note that proximal to the probe, there’s a take-off of a muscle branch to soleus
Name the muscle shown by the probe!
Origin-insertion-Innervation
Right leg - posteromedialview
Tibialis posterior
Origin tibia, fibula
Insertion navicular, medial cuneiform
Artery posterior tibial artery
Nerve tibial nerve
Actions inversion of the foot, plantar flexion of the foot at the ankle
Antagonist Tibialis anterior muscle
The tibialis posterior muscle originates on the inner posterior borders of the tibia and fibula. It is also attached to the interosseous membrane, which attaches to the tibia and fibula.
The tendon of tibialis posterior muscle descends posterior to the medial malleolus and terminates by dividing into plantar, main, and recurrent components. The plantar portion inserts into the bases of the second, third and fourth metatarsals, the second and third cuneiforms and the cuboid. The main portion inserts into the tuberosity of the navicular and the plantar surface of the first cuneiform. The recurrent portion inserts into the sustentaculum tali of the calcaneus.
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