Lecture 25:Posterior Leg compartment and popliteal fossa Flashcards

1
Q

margins of popliteal fossa

A

The superior margins are
* Biceps Femoris (laterally) and
Semimembranosus and Semitendinosus
(medially)
* The inferior borders
* Medial and lateral heads of Gastrocnemius

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2
Q

contens of popliteal fossa

A
  • Popliteal artery and vein
  • Tibial and Common Peroneal nerves
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3
Q

structures in the popliteal fossa from deep to superficial( starting from the knee joint)

A
  • From deep to superficial:
  • Knee joint capsule
  • Popliteus (not examinable)
  • Popliteal artery (most medial)
  • Popliteal vein
  • Tibial nerve (from sciatic N)
  • The artery is the deepest structure in the
    fossa (closest to the knee joint/ tibia and
    femur).
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4
Q

what structure is likely to be affected 1st in knee dislocation?

A

popliteal a

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5
Q

sural nerve

A
  • Tibial nerve has superficial branch that exits the popliteal fossa and travels down posterior aspect of leg on gastrocnemeus and becomes = sural nerve (also gets a branch from common peroneal nerve)

sural nerve is derived from 2 branches of common peroneal and tibial nerve

Small saphenous vein runs with sural nerve

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6
Q

great saphenous vein runs with…

A

saphenous nerve

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7
Q

leg compartments

A

Three compartments
Anterior, lateral and posterior
Two sub-compartments in posterior leg:
Superficial
Deep

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8
Q

Posterior Compartment
Muscles- Superficial

A

-gastrocnemius
-soleus
-plantaris

3 muscles, all innervated by tibial nerve

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9
Q

Gastrocnemius: O, I, Action, Nerve

A

O: 2 heads: medial and lateral femoral condyles.
I: calcaneus via Achilles tendon/calcaneal tendon
Action: Plantarflex ankle, flexes knee
Essential for Jumping and walking
Nerve: Tibial

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10
Q

Soleus: O, I, Action, Nerve

A

O: superior 1/3 post fibula also tibia
I: calcaneus via Achilles tendon/calcaneal tendon
Action: Plantarflex ankle. Walking
Nerve: Tibial

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11
Q

Plantaris: O, I, Action, Nerve

A

O: Superior to lateral head gastrocnemius on femur
I: medial side of tendon achilles( seperate from achilles tendon)
Action: Plantarflex ankle
Nerve: Tibial

Good as a tendon for tendon grafts
(70)% have one

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12
Q

Tibialis posterior: O, I, Action, Nerve

A

O: post tibia & fibula and interosseous membrane
I: Complex insertion into Navicula, medial cuneform + all bones of
mid and hind foot
Action: Plantarflexes ankle
Inverts foot
medial to axis of foot
Reinforces arches of foot
Nerve: tibial n

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13
Q

Flexor digitorum longus: O, I, Action, Nerve

A

O: middle half of tibia
I: distal phalanges of lateral 4 toes
Action: Flexes toes, plantarflexes ankle,
Reinforces the arches of the foot
Nerve: tibial

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14
Q

Flexor hallucis longus: O, I, Action, Nerve

A

O: inferior 2/3 of fibula and interosseous membrane
I:distal phalanx great toe
Action: Flexes great toe, plantarflexes ankle,
Reinforces the arches of the foot
Nerve: tibial

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15
Q

Popliteus: O, I, Action, Nerve

A

O: posterior tibia
I: lateral condyle femur, lateral meniscus
Action: Medially rotates tibia
Nerve: tibial

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16
Q

Triceps surae

A

gastrocnemius + soleus

17
Q

posterior compartment muscles- deep

A

-tibialis posterior
-flexor digitorum longus
-flexor hallucis longus
-popliteus

18
Q
A
19
Q

arteries of the posterior leg compartments

A
  • The Posterior Tibial artery travels through the deep posterior compartment,
  • Accompanied by the tibial nerve and veins
  • Runs posterior to the medial malleolus.
  • Posterior tibial Artery divides into its two terminal branches, the Medial and Lateral Plantar arteries to the sole of the foot.
  • Travels with vein and sits between superficial and deep compartments
20
Q

bleeding from posterior tibial artery or politeal fossa: what do we also need to consider?

A

possible damage to the nerves
as arteries and nerves travel together in the posterior leg

21
Q

tarsal tunnel structures

A

T. Tibialis posterior
D Flexor digitorum longus
A Posterior tibial artery
V Vein
N. Tibial nerve

H. Flexor Hallucis longus
Tom Dick And Very Naughty Harry
Harry is naughty as tendon crossed
everyone in foot

22
Q

clinical presentation of achilles tendon rupture

A

The clinical presentation is the inability to push off (due to loss of plantarflexion)

23
Q

most commonly ruptured tendon

A

The Achilles tendon is the most commonly injured tendon in the body
* Injuries can occur at the musculotendinous junction, within the tendon itself, or where it attaches to the calcaneus

  • “Like kicked in back if leg”
  • Audible snap
24
Q

fabella

A
  • The fabella (little bean) is a sesamoid bone located in the tendon of the lateral head of
    gastrocnemius in some people.
  • It is often mistakenly interpreted as a fracture or loose body on a lateral xray
25
Q

venous thrombosis

A
  • Formation of blood clot in leg veins.
  • Usually deep veins
    -> can travel to the lungs
  • Occurs when:
  • Slow blood flow
  • Increased coagulability
  • Damage to epithelium
  • Eg surgery, childbirth, trauma, OC
    pill,
  • 1/3 patients >40 yrs having major
    surgery or MI develop venous
    thrombosis
26
Q

femoral nerve:
motor & cutaneous innervation

A
  • Originate from L2, L3, L4
  • Enter thigh under inguinal
    ligament splits into multiple
    muscular branches to anterior
    thigh muscles
  • Also innervates skin on
    anterior aspect of thigh
    via
    anterior cutaneous nerve of
    thigh
  • And **medial leg and foot via
    saphenous nerve **(runs with
    saphenous vein)
  • Supplies hip joint (in part)
27
Q

obturator nerve:
motor & cutaneous innervation

A
  • Originate from L2, L3, L4
  • Enter thigh under through
    the obturator foramen
  • Supplies muscular branches
    to medial compartment
    thigh muscles
  • Also innervates small area of
    skin on medial thigh via
    cutaneous branch
28
Q

sciatic nerve(tibial nerve):
motor & cutaneous innervation

A
  • L4-S4 LS plexus
  • Sciatic nerve has 2 branches:
  • Tibial nerve
  • Common Peroneal nerve
  • The Tibial nerve supplies all the muscles of the posterior compartments (thigh and leg) before passing posterior to the medial malleolus.
  • In the sole of the foot Medial and Lateral Plantar nerves (Cutaneous to sole of foot and motor)
  • A branch of the Tibial nerve and Common Peroneal nerve form the Sural nerve.
  • The Sural nerve supplies the skin to the lateral and posterior sides of the inferior leg and heel.
29
Q

sciatic nerve( common peroneal nerve):
motor & cutaneous innervation

A
  • The Common Peroneal Nerve divides into:
  • Deep Peroneal nerve
  • Superficial Peroneal nerve
  • The Deep Peroneal nerve supplies anterior compartment, the muscles of the dorsum of the foot, and then becomes cutaneous to the first webspace
  • The Superficial Peroneal nerve enters the lateral compartment and supplies both the muscles.
  • This nerve then continues as a cutaneous nerve, supplying the skin of the anterior leg and most of the dorsum of the foot.