Anatomy Wisdom

Question 0

What structures course from the leg to the foot along the posterior aspect of the medial malleolus?

Answer 0

From anterior to posterior:

1. Tibialis posterior tendon
2. Flexor digitorum longus tendon
3. Posterior tibial artery
4. Posterior tibial nerve
5. Flexor hallucis longus tendon

These are digit flexors, weak plantarflexors, and inverter muscles.

Question 1

What structures run from the leg to the foot along the dorsal aspect of the foot?

Answer 1

From lateral to medial

0. Fibularis (peroneus) tertius tendon (everter)
1. Lateral branch of deep fibular nerve
2. Extensor digitorum longus tendons
3. Medial branch of deep fibular (peroneal) nerve
4. Anterior tibial artery
5. Extensor hallucis longus tendon
6. Tibialis anterior tendon (inverter)

All of the dorsiflexor and extensor muscles are on this side.

Question 2

What structures course from the leg to the foot along the posterior aspect of the lateral malleolus?

Answer 2

From anterior to posterior:

1. Fibularis brevis tendon
2. Fibularis longus tendon

These muscles evert the foot and weakly plantarflex.

Question 3

Cutaneous innervation of the foot:

medial malleolus and medial aspect of foot

Answer 3

Saphenous nerve

Question 4

Cutaneous innervation of the foot:

Deep peroneal nerve

Answer 4

Skin between toes 1 and 2

Question 5

Cutaneous innervation of the foot:

Superficial peroneal nerve

Answer 5

Dorsum of foot except for between digits 1 and 2, lateral malleolus.

Question 6

Cutaneous innervation of the foot:

Medial plantar aspect of foot including plantar aspects of digits 1,2,3

Answer 6

Medial plantar nerve (branch of tibial nerve)

Question 7

Cutaneous innervation of the foot:

Lateral plantar nerve (branch of tibial nerve)

Answer 7

Sensation for skin on lateral plantar aspect of foot, including plantar aspect of digit 1. Excludes heel and lateral aspect of foot itself.

Question 8

Cutaneous innervation of foot:

Plantar aspect of heel/calcaneous

Answer 8

Medial calcaneal branches of tibial nerve (S1,S2)

Question 9

Cutaneous innervation of the foot:

Sural nerve

Answer 9

Lateral malleolus, lateral aspect of foot, and lateral-most aspect of the plantar surface of the foot.

Question 10

To examine the cutaneous innervation of the foot, where should you touch?

Answer 10

1. Between toes 1 & 2 (deep fibular nerve, L4-5)
2. Medial malleolus (saphenous nerve, L3-4)
3. Dorsal foot (superficial fibular nerve, L4-S1)
4. Lateral aspect of foot (sural nerve, S1-2)
5. Plantar aspect of foot (tibial nerve, S1-2) - can assess medial plantar, lateral plantar, and calcaneal branches individually

Question 11

Motor neurological examination of the distal lower extremity

Answer 11

Superficial peroneal nerve: ask the patient to ever the foot
Deep peroneal nerve: ask the pagient to dorsiflex the foot (L4) and extend the toes (L5)
Tibial nerve: ask the patient to plantar flex the foot (S1)

Question 12

Name the 8 tissue layers of the abdominal wall, from superficial to deep:

Answer 12

1) Skin (epidermis + dermis)
2) Camper’s Fascia (Superficial Fascia) –>Superifical Fatty Layer
3) Scarpa’s Fascia (Superficial Fascia) –>Deep Fatty Layer
4) Deep Fascia
5) Muscular Layer (EO, IO, & TA)
6) Transversalis Fascia –>Deepest layer of ant. & post. abdominal wall
7) Extraperitoneal Fat
8) Parietal Peritoneum

Question 13

What is the internal inguinal ring?

Answer 13

An opening in the TRANSVARSALIS fascia lateral to the inferior epigastric vessels.

Question 14

What is the external inguinal ring?

Answer 14

An opening in the EXTERNAL OBLIQUE aponeurosis.

Note that this layer is more superficial/external than the transversalis fascia, thus making this the external inguinal ring.

Question 15

The inguinal canal is the communication between the internal and external inguinal rings. Which structures define the superior wall of the inguinal canal?

Answer 15

The fibers of the internal oblique and transversus abdominis muscles, which form a structure termed the CONJOINT TENDON.

Question 16

The inguinal canal is the communication between the internal and external inguinal rings. Which structures define the anterior wall of the inguinal canal?

Answer 16

The external oblique (EO) aponeurosis, which is the same layer that the external inguinal ring is an opening of.

Question 17

The inguinal canal is the communication between the internal and external inguinal rings. Which structures define the inferior wall of the inguinal canal?

Answer 17

The inguinal ligament! And it’s reflection.

Question 18

What is another name for the inguinal ligament?

Answer 18

Poupart’s ligament.

Question 19

The inguinal canal is the communication between the internal and external inguinal rings. Which structures define the posterior wall (floor) of the inguinal canal?

Answer 19

The transversalis fascia.

This is the wall that Heseelbach’s triangle is located in.

Question 20

What is Hesselbach’s triangle and which structures form its boundaries?

Answer 20

Hesselbach’s triangle is the site of direct inguinal hernias.

It is bounded:

• Laterally = inferior epigastric artery
• Inferiorly = inguinal ligament
• Superomedially = lateral border of the rectus sheath

Question 21

The woman’s inguinal canal is pretty simple/empty. What is the one structure that it contains?

Answer 21

He round ligament of the uterus!

Question 22

Men’s inguinal canals are a bit more crowded with SPERMATIC CORD structures. The spermatic cord passes into the internal ring, courses through the entirety of the inguinal canal, and passes throughh the external ring into the scrotum. Which structures are found within the aforementioned spermatic cord?

Answer 22

The structures within the spermatic cord, which is invested by the cremasteric fascia:

1. Arteries: testicular + cremasteric
2. Veins: pampiniform plexus
3. Vas deferens (aka ductus deferens)
4. Processus vaginalis
5. Nerves: ilioinguinal and genital branches of the genitorfemoral nerves (NOTE: these course within the inguinal canal but are external to the cremasteric fascia)

Question 23

Where do the cremasteric and testicular veins run?

Answer 23

They DON’T. While the scrotal structures are supplied by the testicular and cremasteric arteries, venous drainage is supplied by the PAMPINIFORM PLEXUS.