Bones Muscles & Fascia of The lec Flashcards
Which one is longr in an anterior posterior direction? The medial or later tibia?
The medial is longer in an A-P Direction
The lateral condyle projects back further, what does this allow?
The lateral condyle projects back further, allowing the meniscus to slide back further, especially in flexion.
WHere the intercondylar eminence located?
Between the the medial and lateral condyels of the tibhia
Describe where the epiphyseal line of the tibia travels.
The line begins at the medial condyle, travels down to the tibial tuberosity then goes back up to the lateral condyle
Describe the location of the soleal line, what attaches to it? There is a smooth region above what attaches to this?
The soleal line is the attachment for the soleal msucle. It originates at the lateral tibulofibular joint and descends inferomedially covering the superior 1/3 of the tibia.
What important muscle attaches at the head of the fibula? Clue = PUMP AT GYM
Biceps femoris
What important structure does the shaft of the fibula contain, what is its purpose?
Contains the nutrient foramen, and this is a primary centre of ossification.
What does the sharp border medially adhere to on teh fibula?
The interosseus membrane
Crural Fascia the Deep Fascia of the leg, is thick and continuous with the ?
Tensor Fascia lata ( from above - laterally)
Intramuscular Septa - Deep
Periosteum of the tibia - anteirorly ( anterior tibia is subcutaenous)
Ankle retinaculae - Inferiorly –> forms retinaculum to prevent tendons from bowstringing
What are the compartments of the leg? ANd what do they achieve?
Anterior - dorsiflexion/ inversion
Lateral - Foot Eversion
Posteior - Plantar flexion + Eversion
What are the 4 retinaculae
2 x Extensor retinacule
Inferior & Superior fibular retinacle
Felxor retinaculum
Storage of elastic energy occurs in the first half of stance, and elastic recoil occurs in 2nd half o the gait, pushing the body into an areal phase. Which fuscles and fascial of the lower limb are responsible for storage of elastic potential energy?
Achilles tendon, plantar aponeurosis and Tensor Fascia lata
What the 4 anterior compartement muscles of the leg?
What nerve is supplies the anterior?
Tibialis anterior
Extensor hallicus longus
Extensor Digitorum Longus
Fibularis Tertius
Nerve: Deep fibular nerve L4,5
What does the tibialis anterior muslce do? NAme its insertion & what is a pathology associated with it?
Tibialis anterior is attached to the medial cuniform _ first metatarsal
Involved in dorsi flexion & inversion
Predominantly acts to decelerate the foot
Pathology: Reptitive use or constant stepping on hard surfaces causes microtrauma periostitis or shin splints
Where does Exetensor Hallicus Longus Attach? What is its function?
Attaches to the big toe, most distal phalanx, invovled in dorsiflexion
What does the extensor digitorum longus sit? What is involved
Attaches to the distal most pahalanx of later 4 digits. It is involed in dorsiflexion.
Fibularis tertius what is it?
it is a vestigial muscle attaching to the base of the 5th metatarsal
Organisation of the anterior compartment of the leg from medial to lateral?
Tim Has a very nasty dirty toe
Tibialia Anterior , EHL, Artery, NErve, Vein, Extensor Digitorum longus, Fibularis tertius
The muscles of the anteiror and posterior leg are protected by sunovial sheats as they pass their way aroudn the malleolus and through the retinaculum
What is compartment syndrome? What can cause compartment syndrome? What is the effect of compartment syndrome in the anterior leg? What is the clinical signs associated with this?
The deep fascia compartmentalises the muscles and prevents them from expanding. Pressure build up due to problems can thus cause compartment syndrome. Foe example muscular bleeds can cause this. THis can compress neurovascular structures causing pathology
Anterior Compartment
- Common fibilar nerve- innervating the compartment may be damaged
- Tibilais anterior cannot contract to cause dorsiflexion, this causes a foot drop.
What are two muscles of the lateral compartment and what are their insertions? What nerve are they supplied by?
Both are supplied by the superficial fibular nerve (L4,5)
Fibularis longus
-Fibularis Brexis
- Inserts into the dorsum of 5th metatarsal at the fibularis peroneal tubercle
- In severe sprains - there is avulsion of this site of insertion
These muscles have a signficant propriceptive role
The superficial posterior comparment of the leg? What nerve is it supplied by? Which muscles form the the posteriore compartment? What are their roles?
Supplied by the tibial nerve S1,2
Their role is to resist force of gravity, line of gravity goes in front of the joint.. Also involved in venous returnn
Name thre three muscles of teh posteror compartment? What are their attachments? What are their fucntions?
Gastrocnemius
- HAs two heads, and is two joint muscle, inserts into the calcaenues via tendons fusing to form achilles tendon ( susceptible to strain)
- Powerful muscle used in running and locomotion
- Problems can arise such as calcaneal tedinopahty
Soleus:
Also inserts into the calcaneus, achillesl tendon, lying deep to gastrogenemus
- Mainly a postural muscle, high concentratoin of slow twich muscle fibres, prevents body from falling forward
- ALso acts as a muscle pump
Plantaris
- arising from lateral conyle of femur and inserts into the achillies, ther eis no role
What are the pathologies associated with posterior compartment
Achilles tendon:
• Gastrocnemius together with soleus form ACHILLES TENDON = prone to strain in dynamic plantar flexion (running)
• Strains = muscle tear, musculo-tendinous junction tear, tendon tear + AVULSION FRACTURE (especially children where this site is weak)
• Muscles that are coming from anterior & posterior aspect of leg = protected from synovial sheaths
• ACHILLES TENDON = does not have a synovial sheath has a PARATENDON instead
• Both paratendon + Bursa that protect the Achilles tendon are prone to inflammation from excessive running ( bursitis) ( repetitive use)
• Tendinopathy at calcaneal tendon
Deep Posterior Muscles
Clinical Signficance
FDL
- Origin: Posterior TIbia
Insertion - Plantar surface; base of the distal phalanges of the four lesser toe
- Hence it starts medial - travels to insert laterally to supply the 4 digits
FHL
- Origin: Posteior Fibula ( lateral)
Insertion: PLantar surface –> base of distal pahalnx of hallux - Location: Deep to FDL
Clinical Signficance: Shin Splints - Microtrauma of the periosteuum occurs
Tibialis Posterior
- Origin:
- Insertion: INserts into teh navicular & medial cuneiform
Popliteus
- Origin: Posteior TIbia
- Insertion: Lateral Femoral condyle
ACts to laterally rotate the femur and unlock the knee
Tarsal Tunnel = Beneath flexor retinaculum –> Organisaton from medial to lateral
TP, FDL, Posterior Tibial Artery, posterior tibial vein, tibihal nerve, FHL
Tom Dick and very naughty harry
Clinical Signficance
These muscles, especially TB, can be inovled in shin splints.
Tarsal Tunner syndrome
Tendonitis - Tendons exapnd –> compress neurovascular structures –>
Name intrinsic Foot muscles in The Dorsum?
Superficial Fibular NErve ( L4,5)
Extensor Hallicus Brevis
- Dorsiflexion of toes
Extensor Digitorum Brevis
- Dorsiflexion of toes
Action = Relatively weak dorsiflexion
Sole of Foot:
Layer 1: Stabilise the foot in locomotion
- Abductor hallucis
- Flexor Digitorum Brevis
- Abductor Digiti Minimi
Layer 2 :
- With FDL & FHL tendons
- Lumbricals (4)
- There is no extensor expansion in the foot associated with the lumbricals
- Flexor acessories (quadrantus plantae)
- Its role is to straighten the pulll of FDL, that is acting on the four digits
Layer 3
Flexor hallicus Brevis
Adductor Hallucus
Flexor Digiti Minimi
Sesamoid bone = creates tunnels fo rnerves & vessels to pass
Layer 4
Interossei = 4 dorsal & 3 plantal
Line of rotation = 2nd metatarsal
PAD = Plantar adductor
DAB = dorsal abductor
