Anatomy - ALL Flashcards
What is the pelvis and what does it do?
-Bony ring formed by the articulation of the left and right innominate (hip) bones and the sacrum
-Takes the weight of the body and transmits it to the lower limbs
What bones make up the hip bone and where do they join?
-Pubic, ilium and ischium bones
-Join at acetabulum
What do the hip bones articulate with anteriorly and posteriorly?
-Anteriorly - each other at the pubic symphysis
-Posteriorly - sacrum at sacroiliac joints
What is this?
Describe it in life:
-Obturator foramen
-Almost completely covered over by obturator membrane and muscles attached to it
-Small gap in membrane and muscle (obturator canal) allows vessels to pass between pelvis and thigh
What do they surround?
Obturator foramen
What are these?
Iliac crests - uppermost parts of the ileum
Ischial tuberosity
What does the red articulate with?
Acetabulum of the pelvis
Describe it:
-Linea aspera
-Bony verticle ridge on the posterior aspect of shaft
-Muscle attachment
-Patella
-Lies anterior to the knee joint
What do the lateral and medial femoral condyles articulate with?
Proximal tibia at the knee joint
What movements are possible at the hip joint?
-Flexion
-Extension
-Abduction
-Adduction
-Medial (internal) and lateral (external) rotation
-Circumduction
What general groups of muscles allow what movements at the hip joint?
Anterior thigh - flexion
Medial thigh - adduction
Posterior thigh - extension
What movements are possible at the knee joint?
-Flexion
-Extension
Where does the thigh anatomically lie?
Inbetween the jip and knee
Name and describe it:
-Fascia lata
-Surrounds the thigh like a sleeve
Label and describe:
-Ileotibial band (or tract)
-Thickening of the lateral part of the fascia late
-Attaches to lateral aspect of proximal tibia and is important for stabilising the knee joint
What seperates the compartments of the thigh?
-Intermuscular septa
-Extend from fascia lata to the linea aspera
-Separate thigh into anterior, medial and posterior components
Describe the muscles of the anterior component of the thigh:
-7 muscles
As a group they:
-Primarly act as extensors of the knee but some act on hip joint
-Innervated by the femoral nerve (L2-L4)
What nerve is this and what spinal segments is it from?
-Femoral nerve
-L2-L4
What are the muscles of the anterior thigh?
-Quadriceps femoris (4 large muscles)
-Sartorius
-Iliopsoas
-Pectineus
What is common?
All muscles of the anterior thigh
What are these?
What muscles make up the quadriceps femurs?
-Rectus femoris
-Vastus lateralis
-Vastus medialis
-Vastus intermedius
What are the functions of the quadriceps femoris muscles?
-Prime extensor of the knee
-Form the bulk of the anterior thigh
Where do the quadriceps femoris muscles converge?
-Converge onto quadriceps tendon which runs over the patella
-Inerts onto the tibial tuberosity via the patella ligament
Tibial tuberosity
Describe rectus femoris:
-Lies in the midline of anterior thigh
-Attached to ASIIS proximally
-Crosses hip so contributes to flexion
Describe vastus lateralis:
-Lateral to rectus femoris
-Attaches to linea aspera on posterior aspect of the femoral shaft
Describe vastus medialis:
-Lies medial to rectus femoris
-Attaches to the linea aspera
Describe vastus intermedius:
-Lies deep to rectus femoris
-Attaches to anterior aspect of femoral shaft
What is the attachment and action of sartorius?
-Attached proximally to ASIS and inserts on medial aspect of proximal tibia
-Crosses hip and knee joints
-Flexes and laterally rotates the hip joint and can flex knee joint
-NOT prime mover - contributes
Describe iliopsoas:
-Lies proximally in anterior thigh
-Psoas major and ilacus converge via common tendon onto lesser trochanter of femur
-Prime flexor of the hip joint
ileopsoas
Describe pectineus:
-Proximal anterior thigh, medial to iliopsoas
-Attaches proximally at superior pubic ramus and distally on femur just inferior to lesser trochanter
-Flexes and adducts hip joint
Pectineus
Describe the muscles of the medial thigh:
-Contains 5 muscles
-As a group they:
-Primarily act as adductors of the hip
-Innervated by the obturator nerve (Spinal segments L2-L4)
What nerve is this and what spinal segments does it arise?
Obturator (L2-L4)
What are the muscles of the medial thigh?
-Adductor brevis
-Adductor longus
-Adductor magnus
-Gracilis
-Obturator externus
Describe adductor brevis and adductor longus:
-Similar points of attachment to the pubic bone and linea aspera
-Adductor brevis lies deep to longus
-Obturator nerve lies between them
Where does the obturator nerve lie in the medial thigh?
In between the adductor brevis and adductor longus
Describe the adductor magnus muscle:
-Large muscle that has an adductor part and a hamstring part
-Function differently and have different nerve supplies
Describe the adductor part of the adductor Magnus:
-Attaches to inferior pubic ramus and linea aspera
-Acts as an adductor
-Innervated by the obturator nerve
Describe the hamstring part of the adductor magnus:
-Attaches to ischial tuberosity and the adductor tubercle
What is the adductor hiatus?
-Gap formed between the distal attachments of the two parts of the adductor magnum
-Femoral artery and vein pass through this to reach the posterior thigh
Describe gracilis:
-Most medial muscle
-Attaches to the pubic bone and the medial aspect of the tibia
-Weak adductor and flexor of the hip and weak flexor of the knee
NOT a prime mover
Describe obturator externus:
-Attached to external surface of the obturator membrane and inserts on the femur near the greater trochanter
-Stabilises and laterally rotates hip joint
Describe the continuation of the external iliac artery:
-Femoral artery is continuation of external iliac
-Travels deep to inguinal ligament to enter proximal anterior thigh
-Lies relatively superficially
What is the vessel in red?
Femoral artery
Describe the pathway of the femoral artery in the thigh:
-Gives off large branch called profunda femoris (deep artery of thigh) which travels deep into thigh and supplies it
-Continues distally, traverses adductor hiatus and enters distal part of posterior thigh (popliteal fossa) to become popliteal artery
Label and describe its pathway:
-Obturator artery - branch of internal iliac artery
-Travels through obturator canal into medial component of thigh
-Anastomoses with branches from the femoral artery
Describe the veins exiting the pelvis into the thigh:
-Femoral - follows artery, lies medial to it in proximal thigh. Travels under inguinal ligament and is continuous with external iliac vein
-Obturator - follows course of artery. Travels through obturator canal and joins internal iliac vein in pelvis
What does this diagram show about the pathways of the femoral artery and vein?
Vein passes more medially in the thigh
What is this?
Femoral nerve
Describe the pathway of the femoral nerve and its innervation:
-L2-L4 spinal nerve roots
-Deep to inguinal ligament to enter proximal anterior thigh lateral to the femoral artery
-Branches innervate anterior thigh muscles
What is this and describe it:
-Saphenous nerve
-Sensory branch of the femoral nerve that innervates skin over the leg
Label and describe 2:
-Obturator nerve
-L2-L4 nerve roots
-Travels along lateral wall of pelvis and exits through the obturator canal
-Emerges onto superficial surface of adductor brevis and gives rise to branches that innervate medial compartment muscle and sking over medial thigh
What is this?
-Femoral triangle - clinically important area in the proximal anterior thigh
Boundaries:
Lateral - medial border of sartorius
Medial - lateral border of adductor longus
Superior - inguinal ligament
Apex = distally where sartorius and adductor longus meet
What forms the floor of the femoral triangle?
Iliopsoas laterally and pectineus medially
What are these?
Floor of femoral triangle
What are the contents of the femoral triangle?
-Femoral artery
-Femoral vein medial to femoral artery - receives important tributary called the great saphenous vein
-Femoral nerve lies lateral to femoral vein and artery and travels deep to inguinal ligament to enter anterior thigh
What are these and what do they form?
-Close the greater and lesser sciatic notches to form the greater and lesser sciatic foramina
What do the sciatic foramina allow?
Allow structures to pass to and from the pelvis and gluteal region
Wht does this show?
-ischial spine projects from posterior ischium
-Sacrospinous ligament attaches to it
Label and describe:
-Ischial tuberosity
-Bulky prominence of bone at posterior aspect of ischium
-We sit on this part of the pelvis
-Muscles of posterior thigh and the sacrotuberous ligament attach here
Label and describe:
-Ridge of bone between the trochanters on the posterior aspect of the femur
Label and describe:
-Lies just inferior to the trochanters on the posterior aspect of the femur
-Site of muscle attachment
What groups of muscles does the gluteal region contain?
-Two groups of muscles
-Superficial and deep group
What muscles make up the superficial gluteal muscle group?
-Gluteus maximus
-Gluteus medius
-Gluteus minimus
-Tensor fascia latae
Describe gluteus maximus:
-Most superficial gluteal muscle
-Several proximal attachments:
-Most posterior parts of posterior ileal surface
-Sacrotuberous ligament
-Sacrum
-Distal:
-Most fibres insert into iliotibial tract
-Smaller proportion attach onto gluteal tuberosity
What is the action and purpose of gluteus maximus?
-Extensor of the hip and is important for standing from a sitting position
-Also acts as a lateral rotator of the hip
-Inserts into ileotibial tract so stabilises knee joint
Describe gluteus medius and gluteus minimus:
-Medius lies deep to maximus and minimus lies deep to medius
-Similar points of attachment to posterior ileum - both attach to anterior parts of posterior ilium surface
-Both insert onto greater trochanter
-Abduct and medially rotate hip
What is the importance of gluteus medius and minimus?
-Important for normal gait
-When walking, only one leg in contact with floor at once
-When standing on one leg, gluteus medius and minimus in the limb you are standing on contract and hold the pelvis ‘level’ so it doesn’t tilt to the unsupported side
-If they are weak or paralysed in one limb, pelvis tilts to contralateral side every time the contralateral leg is off the ground, resulting in a limp
Describe the attachments and action of the tensor facia latae:
-Attaches to ASIS and inserts into the ileotibial band which itself inserts onto the lateral part of the proximal tibia
-Contraction tenses the fascia lata and iliotibial band
-Stabilises knee when it is extended and also flexes hip joint but is not a prime mover
What is the innervation to the superficial gluteal muscles?
-Gluteal nerves which leave the sacral plexus in the pelvis via the greater sciatic foramen
Gluteus maximus - inferior gluteal nerve
Gluteus minimus, medius and tensor fascia latae - superior gluteal nerve
What are the deep gluteal muscles?
what are their actions?
-Small muscles that primarily stabilise and laterally rotate the hip joint
They are:
-Piriformis
-Superior and inferior gemelli
-Obturator internus
-Quadratus femoris
What do all of the deep gluteal muscles insert onto?
They all insert onto, or close to, the greater trochanter
What is significant about piriformis?
-Attaches to anterior surface of the sacrum
-Passes through greater sciatic foramen and inserts onto greater trochanter
-Nerves of the sacral plexus lie over it in the pelvis
-Sciatic nerve emerges below its inferior border in the gluteal region
What does this show about the nerves?
-Nerves of sacral plexus lie over the piriformis in the pelvis
-Sciatic nerve emerges below its inferior border
What does the sciatic nerve do in the posterior thigh?
Divides into the tibial and common peroneal (common fibular) nerves
Where do the deep gluteal muscles arise?
-Piriformis - anterior sacrum
-Obturator internus - obturator membrane
-All others ischium
What is the pathway of the obturator internus?
-Arises obturator membrane
-Tendon passes through the lesser sciatic foramen
What muscles does the posterior component of the thigh contain?
-Semimembranosus
-Semitendinosus
-Biceps femoris (long and short head)
-Hamstring part of adductor magnus
What can three of the posterior thigh muscles be grouped into?
-Semimembranosus, semitendinosus and long head of biceps femoris
-Hamstrings
-Span both the hip and knee joints
What is the attachment, actions and innervation of the hamstrings?
-Attached proximally to the ischial tuberosity
-Extend the hip, flex the knee
-innervated by the tibial nerve
What does the bottom left innervate?
Three of the hamstring muscles
Where does the short head of biceps femoris arise and what does it do?
What innervates it?
-Linea aspera
-Flexes the knee but does not move the hip joint
-Common peroneal nerve
What does it innervate in the thigh?
Short head of biceps femoris
Where do the muscles of the deep posterior aspect of the thigh insert?
-Semimembranosus and semitendinosus insert on medial aspect of the proximal tibia
-Long head of biceps femoris forms common tendon with the short head and inserts on the head of the fibula
Describe the attachments of the hamstring part of the adductor magnus and its action and innervation:
-Arises ischial tuberosity and inserts onto adductor tubercle of the femur
-Extends the hip but does not move the knee joint
-Innervated by tibial nerve
What are the muscles of the posterior thigh?
What is the arterial supply of the gluteal muscles?
-Superior and inferior gluteal arteries
-Branches of the internal iliac artery
-Leave the pelvis via the greater sciatic foramen to enter the gluteal region
What is the green and red superior to it?
Superior and inferior gluteal arteries
What is the large artery of the posterior thigh?
-There isn’t one!
-Hamstring muscles are supplied by three or four perforating arteries that arise from profunda femoris
-Travel through small apertures in the adductor magnus to reach the posterior compartment
What does the femoral artery do in the lower thigh?
-Traverses the adductor hiatus to enter the region behind the knee
-This region is the popliteal fossa and the artery now becomes the popliteal artery
What is this?
Adductor hiatus (canal?)
What is this region called?
Popliteal fossa
What is the venous drainage of the gluteal muscles?
-Superior and inferior gluteal veins follow their corresponding arteries through the greater sciatic foramen into pelvis
-Drain into internal iliac vein
What is the venous drainage of the posterior thigh?
-Popliteal vein in popliteal fossa enters anterior thigh via the adductor hiatus
-Becomes femoral vein which ascends in the anterior thigh
-Femoral receives great saphenous vein in femoral triangle before travelling under inguinal ligament to continue external iliac vein
What does this show?
Femoral vein receiving great saphenous vein
What innervates the gluteal muscles and their pathways?
-Superior and inferior gluteal nerves
-Leave sacral plexus in the pelvis and travel through the greater sciatic foramen to enter gluteal region
What are the structures in green and the branches above?
Superior and inferior gluteal nerves
Describe the sciatic nerve:
-Very large nerve composed of fibres from L4-S3
-Leaves pelvis via greater sciatic foramen and enters gluteal region inferior to piriformis muscle
-Really composed of two seperate nerves bound together - tibial and common peroneal (fibular) nerves
What do the branches of the sciatic nerve innervate and what would lesion lead to?
Tibial:
-Muscles of the posterior thigh and posterior leg
Common peroneal (fibular):
-Muscles of anterior and lateral leg
Lesion can result in severe functional deficits
Both nerves innervate regions of skin of the lower limb
What are these?
Boundaries of the popliteal fossa
-Not labelled on diagram is semitendinosus
What is the popliteal fossa and what makes up its borders?
-Diamond-shaped depression behind the knee joint
Two superior borders:
-Semimembranosus and semitendinosus medially (superomedial)
-Biceps femoris laterally (supero-lateral)
Inferior border:
-Two heads of the gastrocnemius - a superficial muscle in the posterior leg
What four important structures does the popliteal fossa contain?
-Popliteal artery
-Popliteal vein
-Tibial nerve - midline of fossa
-Common peroneal (fibular) nerve - superolateral border alongside biceps femoris tendon
What are these?
Contents of the popliteal fossa
What is the pathway of the peroneal nerve?
-Superolateral border of popliteal fossa
-Alongside tendon on biceps femoris
-Wraps around neck of fibula and splits into superficial and deep branch
What do the branches of the peroneal nerve innervate?
-Superficial peroneal nerve - muscles of lateral leg
-Deep peroneal nerve - muscles of the anterior leg
What bones are in the leg?
-Tibia and fibula
-Connected by two joints and a strong interosseous membrane
-Distal ends of both bones articulate with talus at ankle joint
Describe the tibia:
-Thick and strong bone
-Expanded proximal end articulates with femur to form the knee joint
-Distal end is tapered and articulates with the talus and fibula
Describe what they are:
-Tibial plateus
-Superior surfaces of the medial and lateral tibial condyles
-Articulate with the femoral condyles to form knee joint
What is the significance of the top right?
-Attachment of the patella ligament
-Projects from upper anterior surface and is palpable
Label and describe:
Oblique ridge of bone on the posterior surface of the tibia
What is the significance of the second down on the right?
Medial melleolus projects medially from distal end of tibia to form part of the socket for the talus
Describe the fibula:
-Slender bone
-Proximal end does not contribute to the knee joint
Describe:
-Proximal part expanded to form head and is palpable
-Neck just distal and is palpable - common fibular nerve lies close to bone here
-Shaft is slender and attachment site for muscles
-Lateral malleolus projects from distal end to form part of talus socket
How is the human foot adapted for its function?
-Carries weight of the body and is adapted for bipedal gait
-Small joints of the foot allow it to deform and absorb shock when waking over uneven ground
Describe how the foot makes contact with the floor:
-Part of the sole of the foot does not make contact with the ground when we stand
-Raised by the vertical and transverse arches of the foot
-These are formed by the arrangement of the bones of the foot
-Allow shock absorption
-Arches are supported by ligaments and tendons in the foot
What do the tarsal bones compose of?
-Talus
-Calcaneus (heel bone)
-Navicular
-Cuboid
-Three cuneiforms (medial, intermediate and lateral)
What are they and what do they compose?
Hindfoot
What are they and what do they compose?
Midfoot
What are they and what do they make up?
Forefoot
Describe the naming of bones in the forefoot:
-Metatarsals numbered 1-5 from medial to lateral (big to little toe)
-Bones of digits are phalanges (phalanx) and there are three in toes 2-5 and two in the first digit (big toe)
-Named proximal, middle and distal phalanges
Big toe only has two phalanges so there is one interphalangeal joint of the big toe
What can the movements of the foot be compared to?
-Similar to those of the hand
-Range of movement is less extensive
-Human hand is extremely dextrous but the human foot is adapted for weight-bearing and bipedal gait rather than fine, skilled movement
What movements of the foot are possible?
-Dorsiflexion (extension) at ankle - toes point upwards
-Plantarflexion at ankle - toes point down to floor
-Inversion at subtalar joint - sole of foot medially
-Eversion - lateral border and sole of the foot laterally
What is this?
-Subtalar joint
-Formed by articulation of the talus with the calcaneum and navicular
What movements are possible by the toes?
-Flexion
-Extension
-Abduction (moving toes apart)
-Adduction (bringing toes together)
What plantarflexion is incredibly important?
-Plantarflexion at the MTP joints
-Especially the MTP joint of the big toe as it is very important for pushing the foot off the ground and forward propulsion during walking and running
Describe the leg:
-Lies between the knee and ankle joint
-Deep fascia surrounds the leg like a sleeve
-Intermuscular septa extend from the deep fascia and separate the leg into anterior, lateral and posterior compartments
Describe the muscles of the anterior compartment of the leg:
(Attachment, action, innervation)
-3 muscles
-Arise from tibia, fibula and interosseous membrane
-Primarliy act as dorsiflexors (extensors) of foot and ankle and extensors of toes
-Innervated by deep peroneal nerve
What muscles are these and what innervates them?
-Muscles of the anterior component of the leg
-Innervated by the deep peroneal nerve
What is this and what does it innervate?
Muscles of the anterior component of the leg
What are the muscles of the anterior leg?
-Tibialis anterior
-Extensor hallucis longus (EHL)
-Extensor digitorum longus (EDL)
Describe pathway of tibialis anterior and its action:
-Crosses anterior aspect of the ankle and inserts onto the medial cuneiform
-Dorsiflexes and inverts foot
Describe pathway and action of extensor hallicus longus:
-Tendon crosses the anterior aspect of the ankle and inserts onto distal phalanx of big toe
-Extends big toe
-Also dorsiflexes foot at the ankle
Describe the pathway and action of the extensor digitorum longus:
-Gives rise to four tendons
-Cross the anterior aspect of the ankle and insert onto the distal phalanges of 2-5
-Extends them
-Also dorsiflexes the foot at the ankle joint
What are these and what do they do?
-Extensor retinacula
-overlie the extensor tendons at the ankle joint
Describe the muscles of the lateral component of the leg:
-2 muscles
-Attach to the fibula
-Evert the foot at subtalar joint
-Innervated by the superficial peroneal nerve
What is the lower left and what does it innervate?
Muscles of the lateral component of the leg
Also called superficial peroneal nerve
What are the muscles of the lateral component of the leg?
-Peroneus longus
-Peroneus brevis
-Sometimes called fibularis
Describe the muscles of the lateral component of the leg:
-Peroneus longus - more superficial, inserts onto the plantar surface of the medial cuneiform bone
-Peroneus brevis - deeper muscle, inserts onto the base of the 5th metatarsal
What do tendons of the peroneus longus and brevis pass near to?
Pass posterior to the lateral malleolus to their insertions in the foot
What does this show?
Popliteal artery bifurcates in the popliteal fossa into the anterior and posterior tibial arteries
Describe the pathway of the anterior tibial artery:
-Pierces the interosseous membrane to enter the anterior compartemnt of the leg - which it supplies
-Cross anterior aspect of ankle joint and enters dorsum of foot
-Here it is called the dorsalis pedis artery and is palpable in the foot lateral to the tendon of extensor hallucis longus
Describe what the bottom artery does:
Gives rise to branchs that travel between the metatarsals and anastamose with arteries in the plantar aspect of the foot
What supplies blood to the lateral component of the leg?
-Supplied by the fibular artery which is a branch of the posterior tibial artery
What major superficial veins in the leg drain the foot?
great and small saphenous veins
Describe the path of the great saphenous vein:
-Travels anterior to the medial malleolus and courses all the way up the medial aspect of the lower limb
-Terminates at the femoral vein in the femoral triangle
Describe the pathway of the small saphenous vein:
-Travels posterior to the lateral malleolus and courses up the posterior aspect of the leg
-Terminates at the popliteal vein in the popliteal fossa
Describe the nerve innervation to the anterior and lateral compartments of the leg:
-Common peroneal nerve wraps around the neck of the fibula and divides into two branches - superficial and deep peroneal nerves
Superficial - muscles of the lateral leg
Deep - muscles of the anterior leg
Both branches innervate regions of the skin of the leg
How is the dorsum of the foot similar to the hand?
Superficial veins and extensor tendons are usually visible under the skin
Describe the small muscle in the dorsum of the foot:
-Extensor digitorum brevis
-Lies laterally and gives rise to four slender tendons that insert onto toes 2-5
-innervated by deep peroneal nerve
Describe the muscles of the posterior compartment of the leg:
-Superficial and deep group of muscles
-Primarily act as plantarflexors of the foot at the ankle joint and flexors of the toes
-Innervated by the tibial nerve
What does the bottom innervate?
Muscles of the posterior compartment of the leg
What are these muscles?
Muscles of the posterior compartment of the leg
What are the 3 posterior superficial muscles of the leg?
-Gastrocnemius
-Soleus
-Plantaris
Where do the tendons of all three superficial posterior leg muscles insert?
Insert onto the calcaneus via the calcaneal (achilles) tendon
Describe the gastrocnemius:
-Most superficial muscle
-Attaches via two heads to distal femur
-Can flex the knee in addition to plantarflexing the ankle
Describe the soleus:
-Large, flat muscle that lies deep to the gastrocnemius
-Attached to the soleal line
-Contraction compresses the deep veins of the leg and is important for venous return
What are the deep muscles of the posterior compartment of the leg?
-Popliteus
-Tibialis posterior
-Flexor hallucis longus (FHL)
-Flexor digitorum longus (FDL)
What is common amongst these muscles?
Tendons of these three muscles all travel posterior to the medial malleolus and insert into the plantar surface of the bones of the foot
Describe popliteus:
-Lies in the popliteal fossa
-Attached to tibia and the femur
-Allows for a small degree of rotation of the knee
-When the knee is flexed from full extension, popliteus slightly rotates the knee before flexion begins
Describe tibialis posterior:
-Plantarflexes and inverts the foot
-Tendon attaches to multiple bones in the foot
Describe flexor hallucis longus (FHL):
-Flexes big toe via its insertion into the distal phalanx
-Plantarflexes the foot
Describe the flexor digitorum longus (FDL):
-Gives rise to four tendons that insert into the distal phalanges of toes 2-5
-Primary action is flexion of the toes, but it also plantarflexes the foot
What does the plantar aspect of the foot contain?
Contains numerous intrinsic muscles much like the palm of the hand
Describe the intinsic muscles of the sole of the foot:
-Arranged in four layers which mirror those of the palm
-include abductors of the big and little toes, flexors of the toes, adductor of the big toe, lumbricals and interossei
What innervates the intrinsic muscles of the sole of the foot?
Medial and lateral plantar nerves which are the terminal branches of the tibial nerves
What do these innervate?
Innervate the intrinsic muscles of the sole of the foot
What is important about the muscles of the sole of the foot?
They act as a group to support the foot
What is this?
-Plantar aponeurosis
-Lies superficial to intrinsic muscles of sole of foot
-protective
Plantar aponeurosis
Plantar aponeurosis
Describe the pathway of the posterior tibial artery?
-Supplies posterior compartment of leg and sole of foot
-Fibular artery comes off it to lateral component
-PTA passes posterior to medial malleolus along with tendons of tibialis posterior, FHL and FDl to enter plantar aspect of foot
-In the foot, it bifurcates into medial and lateral plantar arteries which supply the sole of the foot
What are these and what do they do?
-Branches of dorsalis pedis artery which enters the sole of the foot from the dorsum
-Anastamose with branches of the plantar arteries
-Deep plantar arch is an important vessel formed by lateral plantar artery and a branch of dorsalis pedis
What does this show?
-Deep plantar arch
-Important vessel formed by the lateral plantar and a branch of the dorsalis pedis
What do these show?
Metatarsal and digital arteries supply forefoot and toes
What accompany the arteries in the posterior leg and plantar of foot?
-Posterior tibial, anterior and fibular arteries are accompanies by deep veins
-They unite to form the popliteal vein
What are these?
Veins draining the posterior component of the leg
What veins drain most of the blood of the foot?
-Superficial veins drain most of the blood from the foot
-Can usually be seen over the dorsum of the foot
-Dorsal venous network drains medially into the great saphenous vein and laterally to the small saphenous vein
What do the saphenous veins drain into?
-Small saphenous enters the popliteal vein in the popliteal fossa
-Great saphenous meets the femoral vein in the femoral triangle
What does this innervate?
Innervates all the muscles in the posterior compartment of the leg and plantar surface of the foot
Describe the pathway of the tibial nerve:
-Posterior to medial malleolus along with tendons of tibialis posterior, FHL and FDL
-Enters sole of foot and divides into two branches - medial and lateral plantar nerves which course along medial and lateral aspects of the sole of the foot along corresponding arteries
What do the medial and lateral plantar nerves innervate?
All intrinsic muscles in the plantar aspect of the foot
What are these and what do they innervate?
Digital nerves enter the toes
What innervate the skin of the foot?
-Both the tibial nerve and peroneal (fibular) nerve innervate the skin of the foot:
-Tibial nerve innervates most of the skin on the plantar foot surface
-Common peroneal (fibular) nerve and its branches innervate skin over the anterolateral leg and dorsum of foot
What can sensation of the skin be assessed by examining?
-Territories of the peripheral nerves
-Dermatomes
What do these show?
Territories of the skin supplied by the peripheral nerves of the lower limb
What areas of skin do the femoral and obturator nerves supply?
Femoral: Anterior thigh and anteromedial leg (via saphenous nerve)
Obturator: Medial thigh
What des the common peroneal nerve and its branches innervate in terms of skin?
Common peroneal : Anterolateral leg and dorsum of the foot
Superficial peroneal: lower anterolateral leg, most of the dorsum of the foot
Deep peroneal: 1st interdigital cleft
What area of skin does the tibial nerve innervate?
Sole of the foot
How are the dermatomes of the lower limb arranged generally?
Anteriorly - roughly oblique strips running inferiorly from the lateral aspect of the lower limb to the medial
Posterior - more vertically
Describe the dermatomes L1-L3:
L1: Region over inguinal ligament
L2: Upper half of the anterior thigh
L3: Lower anterior thigh and the medial aspect of the knee
Describe the dermatome L4:
-Anterior surface of lower limb
-Lateral aspect of lower thigh, knee and upper leg
-Expands inferiorly over the anterior knee, anteromedial leg
-Dorsum of medial aspect of foot and skin over dorsum and plantar surface of big toe
Describe the dermatome L5:
-Anterior surface of lower limb
-Laterally covers lower 2/3 of of leg excluding lateral ankle
-Extends obliquely, inferiorly and medially to cover the dorsum of the middle foot and dorsum of toes 2-4
-Corresponding skin on sole of foot
-Posteriorly innervates vertical skin laterally from buttock in upper leg
Describe the dermatome S1:
-Posteriorly vertical strip vertically in middle of thigh extending over lateral part of posterior leg, ankle and dorsum and sole of foot and dorsum and plantar aspect of little toe
Describe the dermatome S2:
-Posteriorly innervates vertical strip over medial thigh and leg
-Extends onto the medial aspect of the sole of foot excluding the plantar surface of the big toe (L4)
Which region of skin would you test the sensation of to test L1-L3?
L1 - region over inguinal ligament
L2 - upper anterior thigh
L3 - medial aspect of knee
Which region of skin would you test the sensation of to test L4, L5 and S1?
L4 - anteromedial leg
L5 - anterolateral leg
S1 - 5th digit / lateral foot
What kind of joint is the hip?
Synovial ball and socket joint formed by the articulation between the acetabulum of the innominate bone and femoral head
What is transmitted to the hip joints?
Weight of the body is transmitted through the lumbar vertebrae and the sacroiliac joints to the hip joints
Is the hip joint stable and why?
Yes as the acetabulum is deep and there is a good fit between it and the femoral head
What is this and what does it do?
Deepens the acetabulum
What is this and what does it do?
Attaches to the femoral head and the acetabulum
What structures reinforce the hip joint capsule?
Strong ligaments
Label and describe:
-Arteries of hip joint mainly arise from profunda femoris
-Give rise to retinacular arteries that run along neck of femur to supply the femoral head
-Can be torn during fractures of the femoral head
What are they?
The three ligaments that stabilise the hip joint
What three ligaments stabilise the hip joint?
What do they do?
-Iliofemoral
-Pubofemoral
-Ischiofemoral
-As the hip is extended, these ligaments become taut and hold the femoral head more tightly - hip is therefore most stable in extension
What kind of joint is the knee joint?
Synovial hinge joint formed by the articulation between the femoral condyles and the tibial condyles
Describe the fit of the knee joint:
-Tibial plateaus are flat and do not provide a good fit for the femoral condyles
-Femur and tibia achieve their best fit with each other when the knee is extended, hence the knee is most stable in extension
What things stabilise the knee joint?
-Muscles, tendons, cartilage and ligaments of the knee joint provide stability
-Ileotibial tract attaches to the lateral aspect of the tibia and stabilises the knee
Label and describe these structures:
-Menisci are C-shaped cartilages that lie on the tibial plateaus
-Wedge-shaped with their thickest part lying peripherally and the thinnest part lying centrally
-They deepen the tibial condyles for articulation with the femoral condyles
What important ligaments are at the knee joint?
-Two important pairs
-Collateral ligaments and the cruciate ligaments
What are these and what do they do?
-Medial (tibial) and lateral (fibular) collateral ligaments support the knee and resist sideways movements of the tibia on the femur
-Loose when the knee is flexed but taut on extension
Describe the attachments of the collateral ligaments:
-Medial connects the femur to the tibia and the lateral connects the femur to the fibula
-Medial (tibial) is attached to the medial meniscus
-Lateral (fibular) is NOT attached to the lateral meniscus and has clinical implications
What do the cruciate ligaments connect and when are they lax?
-Anterior and posterior cruciate ligaments connect the tibia to the femur and are named according to attachment to tibia
-Lax when the knee is flexed but taught when the knee is extended
Describe the attachment and action of the anterior cruciate ligament:
-Attached to the anterior part of the intercondylar area of the tibia
-Attaches to medial aspect of the lateral condyle of the femur
-Prevents the tibia moving anteriorly relative to the femur
-Being able to pull the tibia forwards indicated ACl injury
Describe the attachment and action of the posterior cruciate ligament:
-Attached to posterior part of the intercondylar area of the tibia
-Attaches to the lateral aspect of the medial condyle of the femur
-Prevents tibia moving posterior in relation to the femur
-Crucial for stability of the knee when walking downhill or downstairs
-Being able to push the tibia posteriorly signifies PCL injury
What kind of joint is the ankle joint?
The ankle is a synovial hinge joint formed by the articulation between the distal tibia, distal fibula and the talus
What key ligaments support the lateral ankle joint?
-Three key ligaments support the lateral ankle joint
-Anterior talofibular
-Posterior talofibular
-Calcaneofibular
-All attach to the lateral malleolus
What key ligaments support the medial ankle joint?
-Attach to medial malleolus
-Referred to as the medial ligament of the ankle or the delotid ligament because of the overall shape of the ligaments as a group
Describe the subtalar joint:
-Formed by the articulation of the talus with the calcaneum and navicular
-At this joint that inversion and eversion of the foot takes place
-Important in allowing us to walk on uneven ground
Describe the movements of the subtalar joints:
-Inversion brings the sole of the foot medially
-Eversion raises the lateral border of the foot and brings the sole of the foot laterally
-Forced inversion and eversion sprain the ligaments of the ankle
