Sem 2 RA week 4 Flashcards

Question

superior tibiofibular joint type? articular surfaces? movement? Ligaments?

Answer 1

plane synovial joint head of fibula + facet on lateral tibial condyle slight movement during dorsiflexion of ankle anterior + posterior ligament of head of fibula

Answer 2

4 muscles = tibialis anterior, extensor digitorum longus, peroneus tertius, extensor hallicus longus Extensors of ankle joint (**dorsiflexion**) + digits tendons anterior to ankle joint

Answer 3

2 muscles = peroneus longus + peroneus brevis Evertors of the foot tendons posterior to lateral malleolus

Answer 4

Peroneus longus (most superficial) attach = from head + upper ⅔rds lateral fibula → passes posterior to lat. malleolus → base of 1st metatarsal + medial cuneiform (crosses over) Innervation = superficial peroneal nerve (L5, S1, S2) - from common peroneal nerve of sciatic Peroneus brevis attach = from inf. 2.3rds lat fibula → posterior to lat. malleolus → tuberosity on lat side of base of 5th metatarsal innervation = superficial peroneal nerve (L5, S1, S2)

Answer 5

peroneal trochlea of calcaeneus can see indentation on inferior surface of cuboid bone created by peroneus longus tendon

Answer 6

tibialis anterior extensor digitorum longus peroneus tertius extensor hallicus longus all supplied by **deep peroneal nerve** (L4, L5)

Answer 7

most superficial + medial muscle in anterior compartment from lateral condyle of tibia, superior ½ of lateral tibial surface + interosseous membrane → anterior to ankle joint → medial and inferior surfaces of medial cuneiform + base of 1st metatarsal function = dorsiflexes ankle + inverts foot

Answer 8

from lateral condyle of tibia, superior ¾ of medial surface of tibia + interosseous membrane → middle and distal phalanges of lateral 4 digits extends lateral 4 digits + dorsiflexes ankle

Answer 9

from inf. ⅓ anterior fibula + interosseous membrane → dorsum of base of 5th metatarsal function = dorsiflexes ankle + assists in eversion of the foot

Answer 10

from middle anterior surface of fibula + interoesseous membrane → dorsal aspect of distal phalynx of hallux Function = extends hallux + dorsiflexes ankle

Answer 11

superior extensor retinaculum ant. border of tibia → lower end of fibula inferior extensor retinaculum = y-shaped stem attached to calcaneus laterally upper limb attached to medial malleolus lower limb passes round medial border of foot to blend with dense fascia over abductor hallicus

Answer 12

common proximal attachment = superior surface calcaneus, inferior extensor retinaculum **extensor hallicus brevis** (black) → base of proximal phalynx of hallux **Extensor digitorum brevis** → long extensor tendons of toes 2-4 Innervation = deep peroneal nerve (L5/S1)

Answer 13

posterior ## Footnote Sciatic nerve dividing into tibial (L4-S3) + common peroneal (L4-S2) common peroneal will enter anterior and lateral parts of the leg by wrapping round neck of fibula - gives superficial (laterl compartment) + deep peroneal nerve (anterior compartment) superficial peroneal will also give off cutaenous branch (dorsum of foot + anterolateral leg) Deep peroneal nerve enters into anterior compartment, runs along interoesseous membrane supplying muscles → will continue anterior to ankle joint to supply foot muscles → ends as cutaneous nerve supplying 1st webspace

Answer 14

Branch of common peroneal between peroneus longus + neck of fibula (lateral) function = supplies muscles of lat compartment of leg, cutaneous innervation to distal anterior surface of leg + dorsum of foot

Answer 15

branch of common pernoeal between peroneus longus + neck of fibula passes through extensor digitorum longus + travels with **anterior tibial artery** supplying all anterior compartment muscles crosses ankle joint to supply ext. digitorum brevis + ext. hallicus brevis cutaneous innervation to 1st webspace

Answer 16

black arrows = branches of superficial peroneal nerve

Answer 17

popliteal artery gives anterior and posterior tibial arteries anterior tibial artery = through interosseous membrane + descends in anterior compartment Posterior tibial artery = gives fibular artery which provides perforating branches to muscles of lateral compartment (not located in lat compartment but gives perforating branches)

Answer 18

Dorsalis pedis (medial) is a continuation of anterior tibial artery branches: Lateral tarsal artery deep plantar artery (sole of foot) Arcuate artery Arcuate artery runs across metatarsals to anastamose with lateral tarsal artery Arcuate artery branches to give metatarsal + digital arteries

Answer 19

red markers = anterior tibial artery dorsal venous arch (superficial) → drains to great saphenous vein medially

Answer 20

Tibia superior posterior tibia = **soleal line** (attachment for soleus muscle) above this = popliteal area (triangular - distal attachment for popliteus muscle) distally tibia has medial malleolus Fibula apex - upwards projection lateral malleolus pronounced groove on medial side of lateral malleolus = peroneus longus + brevis tendons

Answer 21

7 muscles ## Footnote 3 superficial = gastrocnemius, plantaris + soleus 4 deep = popliteus, flexor digitorum longus, flexor hallucis longus + tibialis posterior superficial muscles all insert on posterior surface of calcaneous via **tendocalcaneous** tendons of deep muscles pass behind medial malleolus to plantar surface of foot (except popliteus)

Answer 22

most superficial muscle of posterior compartment medial head = popliteal surface of femur (superior to medial condyle) lateral head = lateral aspect of lateral condyle of femur superficial muscles all insert on posterior surface of calcaneous via **tendocalcaneous** innervation = tibial nerve (S1, 2) Function = plantarflexes ankle, flexes knee

Answer 23

lateral supracondylar line of femur (proximal to lateral head of gastrocnemius) superficial muscles all insert on posterior surface of calcaneous via **tendocalcaneous** innervation = tibial nerve (S1, 2) Function = assists plantarflexion of ankle

Answer 24

from soleal line of tibia, upper ⅓ of posterior fibula + tendinous arch (yellow in pic) superficial muscles all insert on posterior surface of calcaneous via **tendocalcaneous** tibial nerve (S1, 2) Plantarflexes ankle joint

Answer 25

only muscle in deep posterior compartment that does not cross ankle joint from lateral condyle of femur (pit for popliteus) + lateral meniscus → popliteal area of tibia (above soleal line) tibial nerve (L4, L5, S1) unlocks knee joint by laterally rotating femur on fixed tibia

Answer 26

(most medial) from posterior surface of tibia → base of distal phalanx of digits 2-5 (tendons of deep muscles pass behind medial malleolus to plantar surface of foot (except popliteus) tibial nerve (L5, S1, S2) flexes lateral 4 digits, weak plantarflexor of ankle

Answer 27

from posterior surface of fibula (weird because big toe is medial but proximal attachment is lat) → base of distal phalanx of hallux (tendons of deep muscles pass behind medial malleolus to plantar surface of foot (except popliteus)) tibial nerve (L5, S1, S2) Flexes hallux + weak plantorflexor of ankle

Answer 28

found between FDL and FHL from post surface of tibia + fibula + interoesseous membrane → tuberosity of navicular, cuneiforms, cuboid, sustentaculum tali of calcaneous, base of 2nd, 3rd + 4th metatarsals (tendons of deep muscles pass behind medial malleolus to plantar surface of foot (except popliteus) tibial nerve (L4, L5) plantarflexes ankle, inverts foot

Answer 29

tibialis posterior tendon passes deep to flexor digitorum longus groove posterior to medial malleolus FHL grooves the posterior surface of distal tibia and posterior surface of talus medial to lat arrangement of tendons at ankle joint = **T**ibialis posterior, flexor **D**igitorum longus, flexor **H**allicus longus (Tom, Dick and Harry) note - arrangement of tendons does not match arrangement of muscle bellies

Answer 30

from medial malleolus → calcaneous contents = tibialis posterior, posterior tibial vessels (vein, artery nerve) + tibial nerve found between FDL and FHL tendons (tom, dick And Very Naughty harry) - artery, vein, nerve

Answer 31

**Posterior tibial artery** = terminal branch of popliteal artery between heads of gastrocnemuis + deep to soleus to run on surface of TP and FDL gives **fibular artery** as branch terminates as medial + lateral plantar arteries in foot **Fibular artery** runs medial to fibula, usually within FHL

Answer 32

tibial nerve runs close to midline, gives numerous muscular branches that supply muscles of post compartment like posterior tibial artery, tibial nerve will pass between heads of gastrocnemius + deep to soleus Will continue into sole of foot, posterior to medial malleolus → medial + lateral plantar nerves

Answer 33

Passes between heads of gastrocnemius and deeo to tendinous arch of soleus with **posterior tibial artery** found between FHL and FDL at ankle joint Branches = medial + lateral plantar nerves that supply the sole of the foot

Answer 34

lateral sural from common peroneal medial sural from tibial nerve landmarks dorsum of foot L4 = big toe L5 = middle 3 digits S1 = pinky toe S2 = heel

Answer 35

syndesmosis anterior + posterior tibiofibular ligament and interosseous tibiofibular ligament interosseous ligament continuous with interosseous membrane slight movement to accommodate wedging og trochlea of talus during dorsiflexion

Answer 36

don't think we have to learn this

Answer 37

hinge joint

Answer 38

capsule attaches around articular margins - anteriorly extends onto neck of talus weak anteriorly + posteriorly supported laterally + medially by strong **collateral ligaments**

Answer 39

from lateral malleolus of fibula anterior talofibular → neck of talus posterior talofibular → latral tubercle of talus calcaneofibular → lateral surface of calcaneous

Answer 40

also called deltoid ligament 3 attaches to shelf of talus (sustentaculum tali)

Answer 41

anteriorly = tendons from ant. compartment anterior tibial artery + veins + deep peroneal nerve medially = tendons of posterior compartment, posterior tibial artery + veins (most laterally is FHL) - remember FHL creates groove on talus laterally = peroneus longus + brevis, also can see short saphenous vein + sural nerve can also see vein next to medial malleolus = great saphenous vein

Answer 42

Photograph A shows the external surface of the knee joint. The joint is surrounded by connective tissue and a synovial capsule that has a fibrous outer layer. Extensions of the tendons of vastus medialis and lateralis support the capsule of the knee joint. Photograph B shows the lateral side of the knee and the tendon of biceps femoris. Photograph C shows the medial side of the knee and tendons of muscles from the anterior, medial and posterior compartments of the thigh attaching to the tibia. An expansion of semimembranosus forms the oblique popliteal ligament that supports the posterior surface of the capsule of the knee joint.

Answer 43

Once the tendons of the medial side of the knee are reflected, the medial (tibial) collateral ligament can be seen (photograph A). It forms a thin sheet to support the medial side of the knee and also connects to the medial meniscus. Photograph B shows the lateral side of the knee which is supported by the cord-like lateral (fibular) collateral ligament. Both ligaments are taut when the knee is fully extended.

Answer 44

Photograph A shows the inner surface of the knee joint. The quadriceps tendon has been sectioned and the patella reflected distally to expose the posterior surface of the patella and the femoral condyles. A healthy knee should have smooth joint surfaces. If the cartilage is damaged then pitting or grooving of the surface may be observed. A small quantity of sticky fluid will be released form the joint – this is the remains of the synovial fluid that lubricated the knee. Photograph B shows the smooth synovial lining of the capsule and a small connective tissue structure that may initially be mistaken for the anterior cruciate ligament – the alar fold. This fold is the fringed edge of the synovial membrane.

Answer 45

The cruciate ligaments are best observed when the knee is flexed. Photograph A shows the anterior cruciate ligament (ACL). It attaches to the anterior intercondylar area of the tibia and passes posterolaterallyto attach to the posteromedial aspect of the lateral femoral condyle. The ACL acts to limit the forward gliding movement of the tibia on the femur. Photograph B shows the posterior cruciate ligament (PCL). It attaches to the posterior intercondylar area of the tibia and ascends anteromedially to attach to the lateral surface of the medial femoral condyle. The PCL acts to limit the backward gliding movement of the tibia on the femur.

Answer 46

The medial and lateral menisci are cartilaginous structures that increase the congruency of the knee joint surfaces. The medial meniscus attaches to the anterior and posterior intercondylar areas of the tibia, the fibrous capsule and the medial collateral ligament. The lateral meniscus attaches to the tibial intercondylar eminence, the posterior intercondylar area of the tibia, the tendon of popliteus and the posterior meniscofemoral ligament.

Answer 47

Photograph A shows the anterior and lateral compartments of the leg. The anterior compartment contains muscle that extend (dorsiflex) the ankle and the digits. Tibialis anterior also inverts the foot. The anterior compartment is supplied by the deep peroneal nerve – this is also called the deep fibular nerve. Either name is acceptable, they both refer to the shape of the lateral bone of the leg – the fibula. The lateral compartment contains evertors of the foot, these muscles are innervated by the superficial peroneal (fibular) nerve. Photograph B shows the great saphenous vein – this runs along the medial surface of the thigh and knee to cross anterior to the medial malleolus. This is not truly in the anterior compartment but may be damaged when skin is removed from the tibia as part of an investigation of the anterior or posterior compartments. The saphenous branch of the femoral nerve runs alongside the great saphenous vein.

Answer 48

Photograph A shows another superficial structure – the superficial peroneal nerve. This nerve supplies motor innervation to the lateral compartment of the leg but sensory innervation to the skin of part of the anterior compartment and also the skin on the dorsum of the foot. Care must be taken not to damage this nerve when skin is removed from the anterior compartment. Photograph B shows tibialis anterior. Tibialis anterior runs along the lateral surface of the shaft of the tibia. It crosses the anterior surface of the ankle joint and inserts into the medial cuneiform bone and the base of the 1^stmetatarsal. It acts to dorsiflex the ankle and invert the foot.

Answer 49

Photograph A shows the muscle that lies lateral to tibialis anterior – extensor digitorum longus. It attaches to the medial side of the fibula and the interosseous membrane. It crosses the anterior surface of the ankle joint and inserts into the dorsal digital expansion of digits 2 to 5. It acts to extend all of the joints of those toes. Photograph B shows extensor hallucis longus, it also attaches to the medial side of the fibula and the interosseous membrane. It crosses the anterior surface of the ankle joint and inserts into the base of the distal phalanx of the 1^stdigit (the big toe or hallux). It acts to extend the joints of the 1^stdigit. The fact that these muscles are called ‘longus’ alerts you to the fact there are smaller ‘brevis’ equivalent muscles elsewhere in the lower limb. In this case they are on the dorsum of the foot. You may also have noted that ‘hallucis’ refers to a structure that passes to/moves the big toe.

Answer 50

Photograph A shows a common variation between individuals. Some individuals possess a peroneus tertius muscle (also called fibularis tertius) either unilaterally or bilaterally. This small muscle passes from the tendon of extensor digitorum longus and forms a small tendon that crosses the anterior surface of the ankle joint to insert into the base of the 5^thmetatarsal. If present, it assists in eversion of the foot. The other muscles that evert the foot are found in the lateral compartment – there are two of them which is why this muscle is called peroneus tertius. Photograph B shows the tendons crossing the anterior surface of the ankle. 1 is tibialis anterior, 2 is extensor hallucis longus, 3 is extensor digitorum longus and 4 is peroneus tertius.

Answer 51

Photograph A shows a deep dissection of the anterior compartment. The anterior tibial artery is a branch of the popliteal artery. It pierces the interosseous membrane to reach the anterior compartment of the leg. It supplies the anterior compartment and becomes dorsalis pedis to supply the dorsum of the foot. Photograph B shows the deep peroneal nerve that runs alongside the anterior tibial artery. It originates from the common peroneal nerve near the neck of the fibula and supplies the muscles of the anterior compartment of the leg and the dorsum of the foot. It supplies cutaneous innervation to the skin of the cleft between the hallux and the second digit.

Answer 52

Photograph A shows the lateral compartment of the leg. The most superficial muscle is peroneus longus (also called fibularis longus).It attaches to the fibula and sends a tendon around the posterior surface of the lateral malleolus of the ankle. Peroneus longus inserts into the 1^stmetatarsal and medial cuneiform. Photograph B shows peroneus brevis (also called fibularis brevis) which also attaches to the fibula and forms a tendon that passes posterior to the lateral malleolus. It inserts into the base of the 5^thmetatarsal. Both muscles evert the foot. Photograph C shows the tendons proximal to the ankle joint. Note that the tendon of peroneus longus will come to lie behind the tendon of peroneus brevis as it passes posterior to the lateral malleolus. The sural nerve and short saphenous vein also lie posterior to the lateral malleolus.

Answer 53

The posterior compartment of the leg contains muscles that flex (plantarflex) the ankle and the digits. Gastrocnemius flexes the knee in addition to the ankle and tibilalisposterior can invert the foot. The muscles of the posterior compartment are innervated by the tibial nerve. The short saphenous vein and the sural nerve lie in the superficial fascia covering the posterior compartment of the leg (photograph A). The short saphenous vein arises from the lateral side of the dorsal venous arch of the foot and passes posterior to the lateral malleolus of the ankle; it then ascends the posterior compartment to drain into the popliteal vein. The sural nerve may be a branch of the tibial or common peroneal nerves or both nerves. It supplies cutaneous innervation to the skin on the posterior compartment and around the lateral side of the foot. The most superficial muscle in the posterior compartment is gastrocnemius (photograph B). You have already seen the medial and lateral heads forming the medial and lateral boundaries of the popliteal fossa. The two heads unite to form a tendon that passes to the calcaneus. Gastrocnemius acts to flex the knee and plantarflex the ankle.

Answer 54

Photograph A shows the medial head of gastrocnemius reflected to reveal soleus muscle. Soleus attaches to the tibia and the fibula, it joins with the tendon of gastrocnemius to form the tendocalcaneustendon that attaches to the calcaneus. Soleus acts to plantarflex the ankle and forms an arch above the popliteal vessels and tibial nerve (white dotted line). Photograph B shows plantaris muscle. The small head of this muscle attaches to the lateral supracondylar line of the femur and it forms a long tendon that inserts into the calcaneus. It is a very small muscle but is said to assist in the flexion of the knee and the ankle. This muscle is not present in every individual, and when present may be unilateral or bilateral.

Answer 55

Photograph A shows a deeper dissection of the posterior compartment. Flexor digitorum longus lies on the medial side of the posterior compartment. It attaches to the tibia and forms a tendon that passes posterior to the medial malleolus, it inserts into the distal phalanx of the lateral 4 digits (digits 2-5). It flexes all of the joints of digits 2-5 and as it crosses the posterior surface of the ankle will also assist in plantarflexion. Photograph B shows flexor hallucis longus which lies on the lateral side of the posterior compartment. It attaches to the fibula, interosseous membrane and the fascia over tibialis posterior. It passes its tendon posterior to the medial malleolus and it inserts into the base of the distal phalanx of the hallux. It flexes all of the joints of the big toe and assists in plantar flexion.

Answer 56

Photograph A shows tibialis posterior. It attaches to the tibia, fibula and interosseous membrane. The tendon of tibialis posterior passes posterior to the medial malleolus to insert into navicular, medial and intermediate cuneiforms and the bases of the 2^ndto 4^thmetatarsal bones. It acts to plantarflex the ankle and invert the foot. Photograph B shows the Tom, Dick and Harry arrangement of tendons at the medial malleolus. The most medial tendon (closest to the medial malleolus) is Tom (tibialis posterior), then Dick (flexor digitorum longus) then Harry (flexor hallucis longus). In this photograph the tibial nerve and posterior tibial artery have been reflected but usually lie between the tendons of flexor digitorum longus and flexor hallucis longus.

Answer 57

Photograph A shows the posterior tibial artery. It arises from the popliteal artery and supplies the muscles of the posterior compartment before passing behind the medial malleolus. It then branches to form the medial and lateral plantar arteries to supply the foot. In the posterior compartment of the leg it forms a peroneal (fibular) artery. Photograph B shows the tibial nerve that descends the posterior compartment with the posterior tibial artery. It supplies the muscles of the posterior compartment then passes with the artery posterior to the medial malleolus to form medial and lateral plantar nerves to supply muscles in the plantar surface of the foot.

Answer 58

Photograph A shows the dorsal venous arch that lies in the superficial fascia on the dorsum of the foot. It drains the superficial tissues of the foot and communicates with the great saphenous vein medially and the short saphenous vein laterally. Photograph B shows branches of the superficial peroneal nerve. This nerve supplies sensory innervation to most of the dorsum of the foot. Photograph C shows the deep peroneal nerve on the dorsum of the foot. It supplies sensory innervation to the cleft between the hallux and the 2^ndtoe. The rest of the cutaneous innervation of the foot is supplied by the saphenous nerve (medially), the sural nerve (laterally) and the medial and lateral plantar nerves (on the plantar surface).

Answer 59

Unlike the dorsum of the hand, the dorsum of the foot contains intrinsic muscles - short extensors of the digits. Photograph A shows extensor hallucis brevis. This muscle passes from the calcaneus to the proximal phalanx of the big toe and acts to extend the hallux. Photograph B shows extensor digitorum brevis. This muscle passes from the calcaneus to form 3 or 4 small tendons which join the extensor expansion of the lateral digits. Digits 2-4 if there are 3 tendons or digits 2-5 if there are 4 tendons formed. Extensor digitorum brevis acts to extend the lateral digits. Both of the short extensor muscles are supplied with motor innervation by the deep peroneal nerve. Photograph C shows the final part of the anterior tibial artery. It crosses the anterior surface of the ankle joint to become the dorsalis pedis artery on the dorsum of the foot. Dorsalis pedis usually lies on the surface of the metatarsals between the tendons of extensor hallucis longus and the tendon of extensor digitorum longus that passes to the 2^ndtoe. Dorsalis pedis supplies the dorsum of the foot and anastomoses with the medial and lateral plantar arteries.