Leg Stuff Flashcards
Crural Fascia Where, what parts, attachments
Deep fascia of the leg
Continuous with the fascia lata
- Crural fascia
- Extensor retinaculum
Crural Fascia: parts and compartments
Thick septa anterior, lateral, posterior
Anterior septum
Posterior septum
transverse sptum
interosseous
Crural fascia problems
compartmental syndromes: hemorage, edema, inflammation
Intracompartmental pressure: ischemia, permanent injury
Incising fascia fasciotomy
CECS/ACS
CECS: over use, expansion of blood flow against fascia
ACE: surgical emergency following trauma
Thigh Muscles
- Anterior compartment: Femoral nerve, Extensors
- Medial compartments: adduction, obturator nerve
- Posterior compartment: Flexors, sciatic nerve
Anterior Compartment Muscles
Tibialis Anterior
- Long thick
- Proximal: tibial condyle
- Distal: medial 1st cuneiform
- Function: dorsiflexion/inversion
Strongest dorsiflexor
ACM Extensor Digitorum Longus
- Prox: lateral tibial condyle/Anterior fibular surface/Interosseous membrane
- Distal: it’s four tendons form an “extensor expansion” over dorsum of later four phalanges
Functions: extension of digits/dorsiflexion
ACM Muscle: Fibularis Tertius
- Fuses with digitorum longus proximally
- Tendon does NOT attach to a digit
Proximal: fibular surface
Distal: 5th metatarsal
Function: dorsiflexion, eversion
ACM Muscle: Extensor Hallucis Longus
- tibialis anterior
Proximal: fibular surface/interosseous membrane
Distal: Distal phalanx of hallux
Functions: extends hallux
Anterior Compartment: Deep fibular Nerve
Anterior Compartment: Anterior Tibial Artery
One of the two main branches of the fibular nerve
-innervates anterior compartment muscles, ankle joint, metacarpal phalangeal joins, dorsal intrinsic foot muscles
Anterior tibial artery:
Arises from popliteal
tibial tuberosity demarcates approx. pt of division between anterior and posterior tibial arteries
becomes dorsalis pedis artery
What does the tibial tuberosity demarcate?
The division between the anterior/posterior tibial artery
Lateral Compartment contains
- Fibularis brevis
- superficial fibular nerve
- fibularis longus
Where is the lateral compartment of the leg?
The lateral surface of the fibula
Muscles of the lateral compartment:
Fibularis longus: prox = fibula, distal = 1st metatarsal + medial cuneiform
Functions: eversion and plantar flexion
Fibularis Brevis Muscle: prox = tibia, distal = 5th metatarsal tuberosity
5th Metatarsal Fracture
3 fracture zones
- Avulsion fracture, effects inversion
- Jones fracture, non-inversion
- Stress fracture
5th Metatarsal Fracture: Avulsion fracture
Effects inversion
occurs at tuberosity of 5th metatarsal
5th Metatarsal Fracture: Jones fracture
Non-inversion
acute diaphsyeal fracture
5th Metatarsal Fracture: Stress Fracture
Diaphyseal stress fracture
Superficial Fibular Nerve
- One of the two terminal branches of the common fibular nerve
- begins between finularis longus and fibula
3, nearly entire dorsal surface of foot
- most of the dorsal aspect of digits
Common Fibular Nerve
Winds around fibular head
Damage to common fibular nerve
most commonly injured
paralysis of anterior/lateral crural muscles
Loss of dorsiflexion and eversion.
“foot drop”
“foot drop”
damage to common fibular nerve
prevents dorsiflexion and eversion
a high stepping gait a wadding fair or a swing gait
common fibular nerve damage
Lateral compartment arterial supply
the one compartment without a distinct arterial branch accommodating the compartment nerve
Fibular artery
fibular artery
largest branch of posterior tibial artery
Anterior compartment “compacted”
Muscles, prox attach/ distal attach
Innervation
Vascularization
Function
Muscles : Tibialis Anterior, Extensor Digitorim Longus, Extensor Hallucis Longus, Fibularis Tertius
Innervation: Deep fibular never
Vascularization: Anterior Tibial artery
Prox attach: Tibialis/Digitorum condyle, Hallucis/Tertius Fibula
Distal attach: all different
Functions: dorsiflexion and eversion
Superficial Fibular Nerve vs Deep Fibular Nerve
the two branches of the common fibular nerve
Superficial: supplies anterfoinferior leg,nearly entire dorsal surface of foot, most dosal aspect of digits, between fibularis longus/fibula,
Deep fibular ner: supplies anterior compartment muscles, between fibularis longus/fibula, runs inferomedially between tibialist anterior/extensor hallucis longus ends medial/lateral terminal branches of foot
Shin Splints
Medial tibial stress syndrome
indues small tears to periosteum over tibia
due to repetitive microtrauma to tibialis anterior
Calcaneus: articulates with what? special parts?
Cuboid and the talus sustentaculum tali (support of talus and groove for flexor hallucis longus)
Fibular trochlea: ridge on lateral surface (lateral pulley)
Navicular: articulates with what? specail parts?
Talus head, 3 cunieforms, cuboid
navicular tuberosity
tibialist posterior attachment
Cuboid: articulates with what? special parts?
most lateral bone in distal row of tarsus
calcaneus, 4th/5th metatarsals, navicular and lateral cuneiform
groove fibularis longus
Posterior compartment: superficial and deep
flexors/calf compartment
Superficial: gastrocnemius, soleus, plantaris
Deep: popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
TIBIAL NERVE AND POSTERIOR TIBIAL VESSELS ARE DEEP TO TRANSVERSE CRURAL CRURAL SEPTUM
Gastrocnemius
MOST SUPERFICIAL POSTERIOR COMPARTMENT MUSCLE
two-headed
1) medial head inserts on medial condyle of tibia and distally via achilles tendon
2) lateral head inserts on lateral condyle of tibia and distally via achilles tendon
PLANTAR FLEXION and knee join flexion
Sesamoid bone of gastrocnemius
“fabella”
lateral head may have sesamoid bone close to proximal attachment
fracture can result in total knee replacement
Soleus
Broad, flat multipennate muscle, deep to gastrocnemius
soleal line of tibia
inserts via tendo calcaneus (achilles tendon)
“Triceps Surae”
tripartite muscle consisting of gastrocnemius and soleus muscle
plantarflexion
Plantaris
Can be absent
short belly, long tendon
attachments: lateral supracondylar line and calcaneal tendon
weak plantarflexion and lef flexion
Plantaris damage
Long tendon used in reconstructive surgery of hand tendons
possibility of rupture during violent ankle movements
commonly injured in ballet dancers, basketball players, sprinters
Deep Posterior Crural Compartment (4)
- Popliteus
- Flexor hallucis longus (FHL)
- flexor digitorum longus (FDL)
- tibialis posterior (TP)
Popliteus
Thin, flat triangular muscle
attachments, lateral femoral condyle & meniscus
unlocks extended leg by rotating femur on tibia
Popliteal fossa
Superior medial and superior lateral genicular arteries
- above gastrocnemiuses
Inferior medial genicular artery
-deep to medial head of gastrocnemius
Inferior lateral genicular artery
-deep to plantaris and superficial to popliteus
anterior compartment of leg
1) dorsiflexion
2) extension
