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Medicine year 2 semester 2 > Case 24- Anatomy 3 > Flashcards

Case 24- Anatomy 3 Flashcards

1
Q

Subtalar (posterior talocalcaneal) joint

A
  • Between talus and calcaneous inferiorly
  • Posterior talar facet- convex side to side for concave talus, capsule attached at the margins
  • Medial, lateral and posterior talocalcaneal ligament
  • Interosseous talcocaneal ligament- in the tarsal canal, separates the subtalar joint and the Talocalcaneonavicular joint.
  • Inversion movement occurs when the soles are brought together, wider angle in inversion then eversion. Inversion and eversion movement occur at the subtalar joint
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2
Q

Talocalcaneonavicular (TCN) joint

A
  • Between the Talus, Calcaneous and the Navicular joint
  • Though the Subtalar and TCN are separate (different joint capsules), clinically they are one compound functional unit consisting of the subtalar and the Talocalcaneal part of the TCN because it is impossible for them to function independently. The Subtalar joint is where the majority of the inversion and eversion occurs which is around an oblique axis
  • Anterior and middle talar facets- socket for head of talus, capsule attaches to the articular margins
  • Spring ligament- between the calcaneus and the navicular bone, supports the head of the Talus and plays an important role in the transfer of weight from the Talus
  • Deltoid ligament
  • Navicular- posterior facet
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3
Q

Muscles of the leg- dorsiflexion

A
  • Anterior compartment- Extensors (4 muscles)
  • Metarsals/tarsal- Tibialis anterior, Fibularis tertius
  • Digits- Extensor hallucis longus, Extensor digitorium longus
  • The tendons of the muscle cross the ankle joint anteriorly- pass anterior to the transversely orientated axis of the ankle. Causes dorsiflexion movement
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4
Q

Muscles of the leg- Metatarsals/tarsal

A
  • Tibialis anterior attaches to the inferior surface of the medial cuneiform and metacarpal 1
  • The Fibularis tertius attaches to the Fibula and crosses the ankle joint anteriorly to attach to the dorsal surface of the 5th metacarpal
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5
Q

Muscles of the leg- Digits

A
  • The extensor hallucis longus extends the big toe, long muscle arising from the fibula. Attaches to the middle and distal phalanx of the great toe.
  • For the lateral 4 toes it’s the extensor digitorum longus. Starts from the medial condyle of the tibia and attaches to the fibula, the tendon passes inferiorly in front of the ankle joint and divides into 4 to attach to the 4 toes at the distal and medial phalanx
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6
Q

Muscles of the leg- Plantarflexion

A
  • Posterior compartment- flexors
  • Deep (4 muscles)- Popliteus, Tibialis posterior (tarsal), Flexor hallucis longus and the Flexor digitorum longus (digits)
  • Superficial (3 muscles)- Gastrocnemius, Soleus, Plantaris
  • Cross the ankle joint posteriorly, pass’s posterior to the transversely orientated axis of the ankle
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7
Q

Muscles of the leg- Gastrocnemius, Soleus

A

Gastrocnemius- there is a lateral and medial head which arises from the medial and lateral condyle of the femur. Passes the knee joint posteriorly, flexes the knee joint
Soleus- attaches to the fibia and the tibular along the Soleus line. This joins the tendon of the Gastrocnemius to form the calcanean tendon which is inserted on the Calcaneous bone of the foot

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8
Q

Muscles of the leg- Plantaris, Popliteus

A

Plantaris- has a short and long belly. May or may not be present, its vestigial. Becomes continuous or attaches to the calcaneun tendon. The Gastronscnemius, Soleus and Plantaris becomes the Calcaneon tendon
Popliteus- attaches to the superior surface of the tibia. Passes laterally, crosses the knee joint and pierces the capsule of the knee joint and attaches to the lateral condyle of the femur. Weak flexor of the knee, unlocks the knee joint which is important in flexion movement. Within the popliteal fossa of the knee joint

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9
Q

Muscles of the leg- Tibialis posterior and Flexor digitorum longus

A

Tibialis posterior- posterior to the tibia, arises from the tibia and the fibula. It passes behind the medial malleolus to insert on the tarsal bone
Flexor digitorum longus arises from the posterior aspect of the tibia medially, whereas Flexor hallucis longus arises from the fibula laterally. The tendons cross over as the flexor digitorum longus goes from the medial aspect of the leg to the lateral aspect of the foot and the Flexor hallucis longus is the opposite. Causes flexion of the toes and ankle

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10
Q

Movement of the ankle joint

A
  • Ankle is hinge joint- plantarflexion and dorsiflexion
  • But does have slight inversion/eversion movements
  • Inversion/eversion mostly occurs at the joints of foot
  • Dorsiflexion is between 20-30 degrees and involves moving the tips of the toes towards the leg and plantar flexion is to 40-50 degrees and involves extending the foot down
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11
Q

Ankle joint- inversion and eversion

A
  • Inversion/eversion begins at transverse tarsal joint (=TCN + calcaneocuboid)
  • Rotation transfers to subtalar joint- when ligaments are tight
  • Most inversion/eversion occurs at subtalar joint
  • Eversion (external rotation)- 20-30 degrees
  • Inversion (internal rotation)- 50-60 degrees
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12
Q

Movement of the foot

A
  • Inversion= Tibialis anterior, Tibialis posterior which are attached to the tarsal bones along the medial aspect. The gastrocnemius-soleus complex via the calcaneal tendon. The extrinsic flexors of the toe
  • Eversion- Fibularis longus, Fibularis brevis and Fibularis tertius. The extrinsic muscles that extend the toes
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13
Q

What affects dorsiflexion of the foot

A

Dorsiflexion (or extension) of the foot at the ankle joint will be affected if the common fibular (peroneal) nerve or its deep fibular (peroneal) branch is injured as it supplies the extensor muscles in the anterior (extensor) compartment of the leg. Foot drop is the most obvious sign.

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14
Q

What affects Plantarflexion of the foot (nerve)

A

Plantar flexion of the foot at the ankle joint will be affected if the tibial nerve is injured as it supplies the flexor muscles in the posterior (flexor) compartment of the leg

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15
Q

Structures of the ankle

A
  • The prominence on the medial side of the tibia called the medial malleolus
  • The distal part of the fibia is the lateral malleolus
  • The body of the Talus forms the ankle joint
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16
Q

X-ray= lateral view of the ankle

A

On a lateral view of the ankle joint the Fibula is superimposed by the Tibia. The body of the talus articulates with the distal part of the tibia.

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17
Q

What to do in ankle dislocation

A

You should try and reduce it as soon as possible before you go for x-ray

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18
Q

Tibia and fibula

A

The tibia is medially positioned and is larger than the fibula, thus making it the weight bearing bone.
The fibula is more laterally positioned and does not take part in the knee joint. It also only forms the most lateral part of the ankle joint. Proximally it forms a small synovial joint (superior tibio-fibular joint) with the inferior surface of the head of the tibia. It also acts as a strut and as an extra area for muscle attachments.

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19
Q

What links the tibia and the Fibia

A

The two bones are linked along their lengths by an interosseous membrane and by the fibrous inferior tibiofibular joint. This allows little to no movement between the two bones.

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20
Q

The leg

A
  • The leg is the area between the knee and ankle joint.
  • It contains the two bones, the tibia and the fibula which are connected to the thigh by the knee joint and to the foot by the ankle joint.
  • The muscles are divided into three compartments: anterior, lateral (fibular) and posterior.
  • They are innervated by the branches of the sciatic nerve, the common fibular nerve and the tibial nerve.
  • The main blood supply is anterior and posterior tibial artery, and the fibular artery.
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21
Q

Anterior compartment of the leg

A
  • Are the dorsiflexors of the ankle
  • Tibialis anterior (inverts foot at the subtalar joint)
  • Extensor digitorum longus (extends lateral 4 digits)
  • Extensor Hallucis longus (extends great toe)
  • Fibularis tertius (everts foot)
  • Nerve- deep fibular nerve
  • Artery- anterior tibial artery
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22
Q

Lateral compartment of the leg

A
  • Are the plantarflexors of the ankle and they evert the foot
  • Fibularis longus
  • Fibularis brevis
  • Nerve- superficial fibular nerve which originates from the common fibular nerve as one of the two terminal branches (the other branch is the deep fibular nerve)
  • Artery- perforating branches of the anterior tibial and fibular artery
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23
Q

Posterior compartment of the leg

A

Are the plantarflexors of the ankle. Has both a superficial and deep posterior compartment

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24
Q

Superficial posterior compartment of the leg

A

Gastrocnemius, Plantaris, Soleus

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25
Q

Deep posterior compartment of the leg

A
  • Popliteus (unlocks knee)
  • Tibialis posterior (inverts foot)
  • Flexor digitorum longus
  • Flexor hallucis longus
  • Tibial nerve- innervates the posterior compartment
  • Posterior tibial artery- artery of the posterior compartment, it originates from the popliteal artery
26
Q

The tarsal tunnel

A

The tarsal tunnel is a fibre-osseous space at the posteromedial aspect of the ankle.
It allows the passage of tendons, nerves and vessels between the posterior aspect of the leg and foot.
The floor of the tarsal tunnel is formed by the medial aspect of the tibia, talus and calcaneus.

27
Q

The roof of the tarsal tunnel

A

It is formed by the flexor retinaculum- a strap-like layer of connective tissue that is continuous with the deep fascia of the leg (crural fascia) above and the deep fascia (plantar aponeurosis) of the foot below. It spans between the medial malleolus and the medial tubercle of the calcaneus.

28
Q

Contents of the tarsal tunnel

A 
- Tibialis posterior tendon
• Flexor digitorum longus tendon 
• Posterior tibial artery and vein 
• Tibial nerve 
• Flexor hallucis longus tendon 
It is divided into fibrous compartments.
29
Q

What causes swelling over the lateral aspect of the ankle with an inversion sprain

A

Injury to the Calcaneofibular ligament

30
Q

Function of the arches of the foot

A

Shock absorption, Distribution of weight throughout the foot. Weight is transmitted via the Tibula through the Talus onto the Calcaneous which is the heel bone. Weight is then transferred to the head of the Metacarpals and then onto the toes. The non-weight bearing portions are supported by the three arches of the foot

31
Q

Arches of the foot

A

1) Medial longitudinal arch
2) Lateral longitudinal arch
3) Transverse arch

32
Q

Medial longitudinal arch

A
  • Bones- Calcaneous, talus, navicular, the 3 cuneiforms and the medial 3 metatarsals. The talar head is the keystone. The bones don’t play a significant role in maintaining the stability of this arch
  • Pillars- tuberosity of the calcaneus posteriorly. The heads of the three metatarsal bones anteriorly (MT 1-3)
33
Q

Ligaments of the medial longitudinal arch

A
  • Plantar aponeurosis and Spring ligament (Calcaneonavicular). The Spring ligament sits deep to the Plantar aponeurosis
  • They act as bowstrings under the arch
  • The ligaments are important but are unable to maintain the arch entirely on their own
34
Q

Medial longitudinal arch- muscles

A
  • The muscles are essential for maintaining the arches
  • The most important structure in maintaining the arch are the tendons- Flexor hallucis longus, Flexor digitorum longus
  • Tibialis anterior and the Tibialis posterior- action can invert the foot and help to raise the medial border of the foot
  • Intrinsic muscles of the foot- Abductor hallucis and the Medial portion of the flexor digitorum brevis
35
Q

Lateral longitudinal arch- bones and ligaments

A
  • Bones= Calcaneus, cuboid and lateral 2 metatarsal bones. The lateral arch is much flatter than the corresponding medial longitudinal arch
  • Ligaments= Plantar aponeurosis, Long and short plantar ligaments. The Short plantar ligament is also called the Calcaneocuboid ligament and is deeper then the long plantar ligament, both are deep to the Plantar Aponeurosis. These act as bowstring under the arch. The ligaments have a more significant role then in the medial longitudinal arch
36
Q

Lateral longitudinal arch- muscles

A
  • Muscles= the tendon of the fibularis longus is the most important structure in the preserving the lateral longitudinal arch. Lateral tendons of the flexor digitorum longus also supports the arch
  • Intrinsic muscles of the foot= Abductor digiti minimi and the lateral portion of the flexor digitorum brevis
37
Q

The transverse arch

A
  • Formed from the base of the Metatarsals bone as well the cuboid and the 3 cuneiform bones
  • Ligaments- Deep transverse metatarsal ligament, Plantar metatarsal ligament, Plantar tarsometatarsal ligaments
  • Tendon- Fibularis longus. Most important structure in reserving the transverse arch
38
Q

Pes planus

A
  • Refers to a flat foot along the medial longitudinal arch
  • The underlying cause may be physiological or pathological, you have it till the second or third year of life
  • Pathological pes planus occurs due to problems with the tarsal bones (i.e. tarsal coalition), the long tendons or the ligament. It often presents with stiffness and pain
  • It is managed by using an arched insole in shoes
39
Q

Pes cavus

A
  • Refers to an excessively high medial longitudinal arch
  • It is typically caused by a neurological disorder for example, Charcot-Marie-Tooth disease or poliomyelitis
  • Can be caused by an overactive fibularis longus, also managed by using inserts in shoes
40
Q

Organisation of the muscles in the back

A
  • Superficial- muscles related to the movement of the upper limbs
  • Intermediate- muscles attached to the ribs
  • Deep- muscles related to the movement of the vertebral column and head. These are intrinsic muscles which develop in the back
  • The intermediate and superficial muscles are extrinsic muscles which originate embryologically from other locations than the back
41
Q

Superficial back muscles (extrinsic group)

A
  • Attach the appendicular skeleton (clavicle, scapula and humerus) to the axial skeleton (skull, ribs and vertebral column)
  • Includes= Trapezius, Latissiumus dorsi, Rhomboid major and minor, Levator scapulae
42
Q

Intermediate back muscles (extrinsic)

A
  • Serratus posterior superior- deep to the rhomboid muscles. From the ligamentum nuchae and spinous processes of the cervical and thoracic vertebra to ribs 2-5
  • Serratus posterior inferior- deep to the latissimus dorsi. From the spinous processes of the thoracic and lumbar vertebra to ribs 9-12
  • Actions- helps elevate and depress during respiration
  • Innervation- intercostal nerves
43
Q

Deep back muscle (intrinsic muscles)

A
  • Extend from the pelvis to the skull
  • Innervation: Posterior rami of spinal nerves
  • Action: movement of the vertebral column and control of posture
44
Q

Examples of deep back muscles

A
  • Spinotransversales: Splenius capitis and cervicis- extensors and rotators of the head and neck
  • Erector spinae and transversospinalis- extensors and rotators of the vertebral column
  • Interspinales and intertransversarii- segmental muscles
45
Q

Deep group of muscles (intrinsic muscles)- Spinotransversales

A
  • Both muscles run from the spinous process and ligamentum nuchae
  • Splenius capitis- attaches to the occipital bone and the mastoid process
  • Splenius cervicis- attaches to the transverse process of the cervical vertebrae
  • Together they draw the head back, extending the neck, individually rotates head to one side
46
Q

Deep group (intrinsic muscles)- erector spinae

A
  • 3 muscles which lie between the spinous processes and angles of the rib
  • Arises from the common tendon which attaches to the- Sacrum, Spinous processes of the lumbar and lower thoracic vertebrae and the Iliac crest
  • All three muscles can be subdivided by their superior attachments (lumborum, thoracic, cervicis and capitis)
  • They are the largest group of intrinsic muscles
  • Covered in the thoracic and lumbar regions by thoracolumbar fascia and serratus posterior inferior, rhomboid, splenius muscles.
47
Q

Erector spinae group- Iliocostalis

A
  • Outer and most lateral of the erector spinae
  • Arises from the common tendon
  • Multiple insertions on the angles of the ribs and the cervical transverse processes
48
Q

Erector spinae group- Longissimus

A
  • Between the iliocostalis and spinalis
  • Largest of the erector spinae
  • Extends from the common tendon
  • Attaches to- the lower ribs, thoracic and cervical transverse processes and the mastoid process of the skull
49
Q

Erector spinae group- spinalis

A
  • Smallest of the erector spinae
  • Interconnects the spinous processes of adjacent vertebrae
  • Constant in the thoracic region but absent in the cervical
50
Q

Erector spinae overall action

A
  • Extensors of the vertebral column and head
  • Bilaterally- straightens the back returning it to an upright position from flexed
  • Controls flexion of the vertebral column
  • Unilaterally- bends the vertebral column laterally and turns the head
51
Q

Deep group (intrinsic muscles)- Transversospinales

A
  • Deep to the erector spinae group
  • Runs from the transverse processes to the spinous processes
  • Three major subgroups- Semispinalis, Multifidus, Rotatores
52
Q

Transversospinales- Semispinales

A
  • Most superficial transversospinales
  • Divided by its superior attachments into thoracic, cervicis and capitis
  • Begins at the thoracic region, ends attaching to the occipital skull. Goes from the transverse processes to the spinous processes
53
Q

Transversospinales- Multifidus

A
  • Best developed in the lumbar area
  • Arises from sacrum, iliac spine and tendinous origin of erector spinae, and transverse processes
  • Attaches to spinous processes
  • Present throughout spine but most developed in lumbar region.
54
Q

Transversospinales- Rotatores

A
  • Deepest of the transversospinales
  • Present throughout the whole vertebral column
  • Best developed in the thoracic region
  • Pass from transverse process to spinous processes crossing 2 or more adjacent vertebrae
55
Q

Actions of Transversospinales

A
  • Bilateral contraction- Extends the vertebral column
  • Unilateral contraction- Pulls spinous processes towards the transverse processes causing the trunk to turn or rotate
  • Semispinalis capitis- bilateral contraction pulls the head posteriorly. Unilateral contraction pulls the head posteriorly and turns
56
Q

Muscles and innervation of Spinotransversales

A

Splenius capitis- innervated by the posterior rami of the middle cervical nerves
Splenius cervicis- innervated by the posterior rami of the lower cervical nerves

57
Q

Innervation of the Erector spinae

A

Posterior rami of the spinal nerves

58
Q

Innervation of the Transversospinales

A

Posterior rami of the spinal nerves

59
Q

Fracture

A

Partial or complete interruption in the continuity of the bone

60
Q

Dislocation/subluxation

A

Partial or complete disruption in the continuity of a joint

Medicine year 2 semester 2 (47 decks)

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