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Post Midterm Anatomy > Lower limb > Flashcards

Lower limb Flashcards

1
Q

Saphinous vein

A

superficial, medial/anterior leg/thigh except around the knee where it goes posterior, enters fossa ovalis and joins femoral vein

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2
Q

Iliotibial tract

A

stabilize knee and hip joint, acted on by gluteus maximus and tensor fascia latae

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3
Q

Anterior compartment of thigh

A
  • Flex hip, extend knee
  • Pectineus, Iliopsoas (Iliacus and psoas), Sartorius, Quadriceps Femoris
  • Innervation: Femoral and Obturator nerves
  • Blood supply: Femoral artery and branches
  • openings: subinguinal hiatus, femoral canal, femoral triangle, subsartorial canal
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4
Q

Pectineus

A
  • shared b/w ant and medial compartment
  • dual innervation mostly femoral nerve (L2-3), some obturator
  • medial circumflex femoral artery, obturator artery
  • adduct and flex thigh
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5
Q

Iliopsoas

A

Anterior compartment of thigh
Iliacus: flex thigh, stabilize hip; iliac branches of iliolumbar artery; femoral nerve (L2-3)
Psoas: lumbar branches of iliolumbar artery; ventral rami of L1-L3; flex thigh and stabilize hip

*Infections can spread down psoas into thigh

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6
Q

Sartorius

A
  • Anterior compartment of thigh
  • Abduct, laterally rotate, flex thigh
  • femoral nerve (L2-L3)
  • Femoral artery
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7
Q

Quadriceps Femoris

A

Anterior compartment of thigh, 4 muscles:

  • Rectus femoris: Lateral circumflex femoral artery, deep femoral artery; extend leg at knee, flex thigh at hip; femoral nerve
  • vastus lateralis: Extend leg at knee; lateral circumflex femoral a, deep femoral a; femoral nerve
  • vastus intermedius: lateral circumflex femoral a, deep femoral a; extend leg at knee; femoral n
  • vastus medialis: extend leg at knee; femoral a, deep femoral a; femoral n
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8
Q

Rectus femoris

A

Part of quadriceps femoris, ant compartment of thigh

Lateral circumflex femoral artery, deep femoral artery; extend leg at knee, flex thigh at hip; femoral nerve

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9
Q

Vastus lateralis

A

Part of quadriceps femoris, ant compartment of thigh

Extend leg at knee; lateral circumflex femoral a, deep femoral a; femoral nerve

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10
Q

Vastus intermedius

A

Part of quadriceps femoris, ant compartment of thigh

lateral circumflex femoral a, deep femoral a; extend leg at knee; femoral n

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11
Q

Vastus medialis

A

Part of quadriceps femoris, ant compartment of thigh

extend leg at knee; femoral a, deep femoral a; femoral n

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12
Q

Pes Anserinus

A

-Common insertion point for 3 muscles on medial proximal anterior tibia
-Sartorius (femoral n), Gracilis (obturator n), Semitendinousus (tibial n)
Acronym (via wikipedia)
SGT FOT

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13
Q

Femoral Triangle

A 
Boudries:
Superior: Inginal ligament
Medial: medial border adductor longus
Lateral: Sartorius
Roof: Fascia Lata
Floor: pectineus, iliopsoas, adductor longus

Contents (Lateral to medial): Femoral nerve, artery vein (a/v within femoral sheath) (also lymphatics altough she didn’t mention it)

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14
Q

Femoral sheath

A

-formed from transversalis and iliopsoas fascia
-3 compartments:
Lateral-femoral a
intermediate-femoral v
medial-femoral canal (base of which is femoral ring, contains deep inguinal lymph nodes)

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15
Q

Femoral ring

A

-base of femoral canal within medial compartment of femoral sheath
Borders
-Lateral: vertical septum b/w canal and femoral v
-posterior: pubic bone covered by pecineus muscle/fascia
-Medial: lacuna ligament
-Anteriorly: medial part of inguinal ligament

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16
Q

Subinginal canal

A

where Femoral n/a/v/canal pass beneath inguinal ligament

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17
Q

Branches of femoral artery

roughly superior to inferior

A
  • superficial circumflex iliac (deep circ iliac looks like its off ext iliac)
  • superficial external pudendal
  • deep external pudendal
  • Profunda femoris (deep femoral) gives lateral femoral circumflex (has ascending, transverse and descending branches), medial circumlex femoral, and perforating branches
  • muscular branches (from deep and proper)
  • descending genicular artery (articular and spahenous branches)
  • superior medial (anastamose with lat circ desc) and lateral genicular arteries (part of petallar anastamosis)
  • Name change: popliteal a (in popliteal fossa)
  • ant tibial a
  • bifurcates: posteior tibial a and fibular a
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18
Q

Cruciate anastamosis

A
  • Anastamosis between ext iliac and femoral, can provide blood to popliteal artery
  • Medial circumflex, lateral circumflex, inf gluteal, 1st perforating branch of profunda femoris

The route of blood is through the internal iliac, to the inferior gluteal artery, to a perforating branch of the deep femoral artery, to the lateral circumflex femoral artery, then to its descending branch into the superior lateral genicular artery and thus into the popliteal artery.

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19
Q

Cutaneous innervation of thigh

A
  • femoral n gives anterior cutaneous branches for ant thigh (-saphenous nerve is continuation of femoral n (gives cutaneous innervation below knee, anteriomedial on leg, medial foot))
  • Lateral femoral cutaneous n does lateral and some anterior thigh
  • posterior: posterior femoral cutaneous n (S1-S3)
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20
Q

Medial compartment of thigh

A

Muscles: Gracilis, Adductor longus, adductor brevis, addcutor magnus, obturator externus, pectineus
Innervation: obturator and tibial nerves
Openings: adductor hiatus
Blood: obturator aa

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21
Q

Obturator nerve

A

L2-4
Ant and post divisions
-Anterior: Pectineus, adductor longus, gracilis (superficial)
-Posterior: Adductor brevis, adductor magnus, obturator extuernus

small cutaneous region on distal medial thigh

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22
Q

Adductor Longus

A
  • Medial compartment of thigh
  • Medial circumflex femoral a, obturator a
  • adducts thigh
  • obturator n (anterior division)
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23
Q

Adductor Magnus

A
  • Part of medial and posterior (part of hamstrings) compartments of thigh
  • Blood: deep femoral, popliteal, obturator
  • Action: adduct and flex thigh (adductor part), extend thigh (hamstring part)
  • nerves: obturator (adductor part, L2-L4), tibial (L4, hampstring part)

forms Adductor canal and adductor hiatus

adductor minimus is part of it (I think the hamstring part)

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24
Q

Obturator externus

A
  • medial compartment of thigh
  • Laterally rotate thigh, stabilize head of femur in acetabulum
  • medial circumflex femoral a, obturator a
  • obturator n (L2-L4)
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25
Q

Obturator internus

A
  • Gluteal region
  • laterally rotate thigh, abduct flexed thigh
  • nerve to obturator internus (L5-S2)
  • internal pudendal and superior gluteal a
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26
Q

Adductor Brevis

A
  • medial compartment of thigh
  • medial circumflex femoral a, obturator a
  • adducts and flexes thigh
  • obturator n (L2-L4)
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27
Q

Gracilis

A
  • medial compartment of thigh
  • deep femoral a, medial circumflex femoral a
  • adduct thigh; felx and medially rotate leg
  • obturator nerve L2-L3
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28
Q

Adductor canal

A
  • aponeurotic tunnel in middle third of thigh, adductor magnus is floor (also ad. longus), sartorius roof, laterally bordered by vastus medialias
  • Femoral triangle to adductor hiatus
  • Contents: Femora a/v, verve to vastus medialis, saphenous nerve
  • Only femoral a/v go through adductor hiatus
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29
Q

Gluteal region

A
  • Lateral rotators: piriformis, superior gemellius, obturator internus, inferior gemellius, quadratus femoris
  • Extensor: Gluteus maximus
  • Abductors: gluteal medius, gluteus minimus, tensor fascia lata
  • Innervaion: sacral plexus
  • openings: adductor hiatus
  • blood: branches of internal iliac

*Lateral rotators: P GO GO Q (piriformis, sup gem, ob in, inf gem, ob ex, quad fem)

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30
Q

Gluteus Maximus

A
  • gluteal region
  • superior and inf gluteal aa, first perforating branch of deep femoral a
  • extend thigh, assists lateral rotation, stabilize knee
  • inf gluteal n (L5-S2)

most fibers insert on iliotibial tract (assists tensor fascia lata)

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31
Q

Gluteus minimus

A

-gluteal region
-deep branch of sup gluteal a
-abducts thigh, medially rotate thigh (assist minimus stabilize pelvis)
-sup gluteal n (L4-S1)
(deep to gluteus medius)

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32
Q

Gluteus medius

A
  • gluteal region
  • deep branch of sup gluteal a
  • abduct thigh, medially rotate thigh, keep pelvis level during ambulation (when ipsiliateral hip is wieght bearing)
  • sup gluteal n (L4-S1)

*target for IM injections (safe zone=upper lateral quadrant of buttocks->slightly flexed hip palm on trocanter pointer on ASIS, b/w 1st and 2nd finger)

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33
Q

Tensor Fascia Lata

A
  • gluteal region
  • superior gluteal arteries, lateral circumflex femoral a
  • pull on fascia lata in iliotibial tract (stabilize trunk on thigh, knee); abduct, medially rotate, flex thigh
  • superior gluteal n (L4-L5)
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34
Q

Inferior gemellus

A
  • gluteal region
  • laterally rotate thigh
  • nerve to quadratus femoris (L4-S1)
  • inf gluteal a
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35
Q

Quadratus Femoris

A
  • gluteal region
  • medial circumflex femoral a
  • laterally rotate thigh
  • nerve to quadratus femoris (L4-S1)
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36
Q

Superior gemellus

A
  • gluteal region
  • laterally rotate thigh
  • nerve to obturator internus
  • inf gluteal a
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37
Q

Piriformis

A
  • gluteal region/pelvis*
  • superior and inf gluteal aa, internal pudendal a
  • laterally rotate thigh, abduct flexed thigh
  • Nerve to piriformis (ventral rami S1-S2 netters)
  • landmark:
  • superior edge–>sup gluteal vessels
  • inferior–>inferior glugeal a/v, internal pudendal a/v, sciatic nerve, nerve to oburator internus, pudendal n, post fem cutaneous n
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38
Q

Trendelenburg Sign

A

injury to sup gluteal n, contralateral hip drops during gait

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38
Q

Posterior Thigh

A
  • Muscles: Semtendinosos, semimembranous, biceps femoris (part of adductor magnus)–>Hamstrings (but only long head of biceps femoris)
  • innervation: sciatic nerve (common fimbular and tibial), posterior femoral cutaneous n
  • Openings: adductor hiatus
  • Blood: perforating branches of deep femoral a
  • flex leg, extend thigh
39
Q

Semitendinosus

A
  • posterior thigh/hamstrings
  • perforating br of deep femoral, superior muscular branches of popliteal artery
  • flex leg, extend thigh
  • tibial division of sciatic n (S5-L2)

(medial side of thigh, ends in thin tendon)

40
Q

Semimembranous

A
  • posterior thigh/hamstrings
  • flex leg, extend thigh
  • perforating br of deep femoral a, superior muscular branches of popliteal artery
  • tibial division of sciatic n (S5-L2)

(medial side of thigh, meatier than tendinosus)

41
Q

Biceps Femoris

A
  • posteior divison/hamstrings (long head)
  • flex and laterally rotate leg, extend thigh (short head mainly flexion)
  • perforating br of deep femoral a, superior muscular branches of popliteal artery
  • long head: timbial division of sciatic n (L5-S2)
  • short head: common fibular division of sciatic n (L5-S2)
42
Q

Sciatic nerve injury

A
  • spasm of hypertrophy of piripormis, lumbar disc herniation
  • lumbar disc herniation (nerve is L4-S3)
  • fucking up IM injection
43
Q

Sciatic nerve injury

A
  • spasm of hypertrophy of piripormis, lumbar disc herniation

- lumbar disc herniation (nerve is L4-S3)

44
Q

Ligaments of Hip joint

A

-Ischiofemoral: ischium to femur head
-Iliofemoral: ilium to femur head
-Pubofemoral
(-Intertrocanteric line)

Hip joint also has bursas

45
Q

Arterial supply of hip joint

A
  • Crutiate anastamosis: Medial circumflex, lateral circumflex, inf gluteal, 1st perforating branch of profunda femoris (major)
  • Acetabular br of obturator a (often obliterated esp with age)

intercapuslar fx–>avascular necrosis

46
Q

Arterial supply of hip joint

A
  • Crutiate anastamosis: Medial circumflex, lateral circumflex, inf gluteal, 1st perforating branch of profunda femoris (major)
  • Acetabular br of obturator a (often obliterated esp with age)

intercapuslar fx–>avascular necrosis

47
Q

Sign of femur fracture

A

shortening and lateral rotation of leg

48
Q

Popliteal fossa

A

Boudries:

  • Superolateral-biceps femoris
  • Superomedial-semimembranosus and semitendinosus
  • inferolateral-lateral head of gastrcnemius and plantaris
  • inferomedial-medial head of gastrocnemius

Contents: Tibial n (common fibular commonly branches off at superior angle of fossa), popliteal a (continuation of femoral, bifurcates to ant and post tibial in this region more distally), popliteal v (small saphinous drains in here)

49
Q

Knee joint

A
  • femur, tibia, and patella (fibia is lateral, articulates with tibia)
  • tibial (medial) collateral ligament (attaches to medial meniscus, continuous with joint capsule)
  • lateral meniscus has no attachment to femoral collateral lig, attached to tendon of popliteus
  • anterior cruciate lig (inter condylar area to lateral condyle of femur, prevents ant/post displacement, more horizontal)
  • Post cruciate lig (to medial condyle of femur, more vertical, restricts post displacement)

meniscii–>fibrocartilaginous, increase congruency b/w tibiofemoral condyles

Unhappy triad-medial meniscus, tibial colateral, ACL

50
Q

Unhappy triad

A

medial meniscus, tibial colateral, ACL

51
Q

Knee joint arterial supply

A

descending branch of lateral femoral circumflex, descending genicular, sup lat geni, sup med genic, inf lat genic, inf med genic, anterior tibial recurrent

52
Q

Fate of femoral a

A

turns into popliteal, branches into ant and post tibial, post tibial continues down medially, fibular a branches off post tib and continues laterally

53
Q

Anterior compartment of the leg

A
  • muslces: tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius
  • dorsiflexion
  • deep fibular n
  • anterior tibial a
54
Q

Anterior compartment of the leg

A
  • muslces: tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertiius
  • dorsiflexion
  • deep fibular n
  • anterior tibial a
55
Q

Extensor digitorum longus

A
  • Ant compartment of leg
  • ant tibial a
  • extend 2nd-5th toes, dorsiflex ankle, eversion
  • deep fibular n (L5-S1)
56
Q

Extensor digitorum longus

A
  • Ant compartment of leg
  • ant tibial a
  • extend 2nd-5th toes, dorsiflex ankle
  • deep fibular n (L5-S1)
57
Q

Fibularis Tertius

A
  • Ant compartment of leg
  • ant tibial a
  • extend 5th toe, dorsiflex ankle, eversion
  • deep fibular n (?)

*considered part of extensor digitorum longus, not present in all individuals

58
Q

Extensor Hallucis longus

A
  • Ant compartment of leg
  • ant tibial a
  • extend great toe, dorsiflex ankle
  • deep fibular n (L5-S1)
59
Q

Deep fibular nerve

A
  • Branch of common fibular n, spinal levels L5-S1?
  • formerly known as musculocutaneous n (of leg?)
  • innervates muscles of anterior leg (tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius) and skin of dorsum of foot over 1st web space
60
Q

Fibularis Longus

A
  • Lateral compartment of leg
  • fibular a, ant tibial a
  • evert foot, weak plantar flexion
  • superficial fibular n (L5-S2)

*held to foot by fibular retinacula

61
Q

Fibularis brevis

A
  • Lateral compartment of leg
  • fibular a
  • evert foot, weak plantar flexion
  • superficial fibular n (L5-S2)

*held to foot by fibular retinacula

62
Q

Fibularis brevis

A
  • Lateral compartment of leg
  • fibular a
  • evert foot, weak plantar flexion
  • superficial fibular n (L5-S2)
63
Q

Posterior Deep leg

A
  • muscles: flexor hallucis longus, tibialis posterior (inversion too), Flexor digitorum longus, poplitus
  • toe flexion mainly, plantar flexion
  • nerve: tibial nn
  • blood: post tibial a
64
Q

Posterior superficial leg

A
  • muscles: gastrcnemius, plantaris, soleus
  • plantar flexion
  • nerve: tibial nn
  • blood: post tibial a
65
Q

Soleus

A
  • posterior superficial leg (deep to gastrocnemius though)
  • posterior tibia a, fibular a, popliteal a
  • plantarflex ankle, stabilize leg over foot
  • tibial n (S1-S2)

*soleus+gastrocnemius=triceps surae

66
Q

Gastrocnemius

A
  • posterior superficial leg
  • popliteal a
  • plantarflex ankle, assists in knee flexion
  • tibial nerve (S1-S2)

*soleus+gastrocnemius=triceps surae

67
Q

Plantaris

A
  • posterior superficial leg
  • popliteal a
  • weakly assists gastrocnemius (platarflexion, knee flexion)
  • tibial n (L5-S1)

*tiny thing like palmaris longs–>1st year’s nerve

68
Q

Plantaris

A

-posterior superficial leg

-

69
Q

Flexor Digitorum Longus

A
  • posterior deep leg
  • post tibial a
  • flexes lateral 4 toes (2-5), plantarflexion
  • tibial n (L5-S1)
70
Q

Tibialis posterior

A
  • posterior deep leg
  • fibular a
  • plantarflex foot, inverts foot, supports arch
  • Tibial n (L4-L5)
71
Q

Tibialis posterior

A
  • posterior deep leg
  • fibular a
  • plantarflex foot, inverts foot
  • Tibial n (L4-L5)
72
Q

Tarsal tunnel

A

Tibialis posterior Tom
Flexor digitorum longus Dick
posterior tibial aa very
tibial nn nervous
Flexor hallicis longus Harry

Deep leg muscles

73
Q

Cutaneous innervation lower limb

A
  • Anterior and medial leg and medial edge of foot-Sapenous n (branch of femoral)
  • anterolateral-lateral surral cutaneous n (branch of common fibular)
  • medial posterior and medial edge of foot-medial surral n (from tibial, although both surral nerves join low enough)
  • dorsum except first web space-superficial fibular n
  • 1st web space of dorsum-deep fibular n
  • medial plantar surface-medial plantar n (branch of tibial)
  • lateral plantar surface-lateral plantar n (branch of tibial n)
  • heel-tibial n
74
Q

Bones of foot

A

talus-articulates with tibia/fibia
calcaneus-heel bone
navicular-b/w talus and cuneiform bones (the bump in the middle of your foot)
cuboid-sorta like the navicular fused with most lateral cuneiform
tarsals
phalnges

75
Q

Deltoid ligament

A

Medial ligament

Ant tibiotalar
Post tibiotalar
tibiocalcaneal
tibionavicular

(calcaneonavicular ligament is like a spring)

76
Q

Lateral ligament

A

post talofibular lig, ant talofibular lig, cacneofibular lig

77
Q

Layer 1 of plantar foot

A

Abductor digiti minimi, flexor digitorum brevis, abductor hallucis

78
Q

Layer 2 of plantar foot

A

-4 lumbricals, quadratus plantae, tendons of FDL and FHL
-lateral and medial plantar aa & nn
(medial does first lumbrical and FHB, lateral does the rest)

79
Q

Layer 3 of plantar foot

A

flexor digiti minimi, adductor hallucis (transvers and oblique heads), flexor hallucis brevis (medial and lateral heads)

80
Q

Layer 4 of foot

A 
Dorsal interossei (4 abductor, Dab)
Plantar interossei (3 adductors Pad)

lateral and deep lantar arteris form deep arch, contribution from dorsalis pedis a

81
Q

Dorsal foot

A
  • tendons of anterior compartment muscles, extensor retinaculum
  • dorsalis pedis a
  • deep fibular n (and superficial br of it)
  • extensor digitorum brevis
82
Q

Abductor hallucis

A
  • 1st layer
  • blood-medial plantar a, medial malleolar network (ant and post tibial aa)
  • abduct and flex great toe
  • medial plantar n (S2-3)
83
Q

Abductor digiti minimi

A
  • 1st layer
  • lateral plantar a, plantar metatarsal and plantar digital arteris to 5th toe
  • abduct and flex 5th toe
  • lateral plantar n (S2-3)
84
Q

Flexor digiti minimi brevis

A
  • 3rd layer
  • lateral plantar a; plantar dgital a to 5th toe
  • flex proximal phalanx
  • superficial br, lateral plantar n (S2-3)
85
Q

Flexor hallucis brevis

A
  • 3rd layer
  • medial plantar a; 1st plantar metatarsal a
  • flex proximal phlanx
  • medial plnatar n (S1-2)
86
Q

Quadratus plantae

A
  • 2nd layer
  • medial and lateral plantar aa
  • corrects oblique pull of fdl tendon; assists in flexion
  • lataral plantar n (S1-S3)
87
Q

Adductor hallucis

A
  • 3rd layer
  • medial and lateral plantar aa and plantar arch, plantar metatarsal aa
  • adduct great toe, maintain transverse arch
  • deep branch of lateral plantar n (S2-S3)
88
Q

Flexor hallucis brevis

A
  • 3rd layer
  • medial plantar a; 1st plantar metatarsal a
  • flex proximal phalanx
  • medial plantar n (S1-S2)
89
Q

Inguinal lymph nodes

A
  • Superficial horizontal (along inguinal lig): body wall inf to umbilicus, buttock, ext genitalia, lower part of anal canal, vagina and lower part uterus
  • superficial vertical (along gr saphenous v): superficial thigh, leg and foot (except lateral side of foot and posterior aspect of leg, popiteal nodes to deep, small saphenous v) (Grey’s review says no part of foot to inguinal lymph nodes, but prompt is consistent with subtler explanation)
  • deep (in inguinal canal): deep areas of thigh, leg and foot; glands penis/clitoris, distal spongy urethra, superficial nodes
90
Q

Petallar reflex

A

afferent branch is at L4, efferent I thing is L2-L3–>femoral nerve

91
Q

Achilles reflex

A

wikipedia: mediated by S1, checks S1-S2 nerve roots (mostly S1)–>absent in L5-S1 heriniation

92
Q

Deep fibular n spinal levels

A
  • L4, L5, S1
  • L5=cutaneous innervation at dorsum of foot 1st web space
  • L4=foot inversion by tibialis anterior

tib ant, EDL, EHL

93
Q

Superficial fibular n spinal levels

A

L5-S2–>fibularis longus and brevis–>eversion

94
Q

Flexor digitorum brevis

A
  • layer 1
  • medial an dlateral plantar arteries and plantar arch; plantar metatarsal and plantar digital artieries
  • flex toes 2-5
95
Q

LAFF muscles

A

First lumbrical, Abductor hallucis, Flexor hallucis brevis, Flexor digitorum brevis–>medial plantar n

Post Midterm Anatomy (10 decks)

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