Week 2: Fascia & Compartments Flashcards
Describe the gross morphology of superficial fascia (hypodermis):
- A layer of loose irregular connective tissue that contains variable amounts of adipose tissue
- In the thigh it lies between the skin and deep fascia
- Attaches dermis to the underlying tissue and acts as a soft, shock absorbing layer
- Contains nerves and blood vessels
What is the name of the deep fascia of the thigh?
Fascia lata
Where does the deep fascia of the leg and thigh extend to?
Extends like a stocking from the gluteal, hip and inguinal regions through the thigh and leg into the foot
What structures is the deep fascia of the leg and thigh attached to?
Secured proximally to the pelvic girdle and distally to bones around the knee joint, tibia and to the ankle joint
Describe the role of deep fascia in aiding venous return from the lower limb:
- Deep fascia is relatively inelastic
- Muscle contraction generates pressure within fascial compartments which compresses the deep veins, pumping blood out of them
- Valves within veins ensure the flow is directed upwards
Where does the deep fascia of the thigh extend to?
The fascia lata extends from the inguinal ligament, the inferior ramus of the hip bone, the ischial tuberosity and lower borders of gluteus maximus and tensor fascia lata to the knee
What is the iliotibial band and where is it located?
- On the lateral aspect of the thigh, and can be thought of as a thickening of the fascia lata
- It is formed by fibres from the gluteus maximus and tensor fascia lata, which merge into the fascia lata and extend down the lateral thigh
What is the intermuscular septa of the thigh?
Inward extensions of the deep fascia (fascia lata), which separate the thigh into 3 compartments
What is the lateral intermuscular septum of the thigh?
The thicker and stronger septum separates the knee extensors (anterior) from the hamstrings (posterior) and anchors the iliotibial band to the femur
What is the medial intermuscular septum?
The thinner and weaker septum separates the hip adductors (medial) from the knee extensors (anterior)
Which compartment contains the neuromuscular structures of the thigh?
Medial compartment
What is the adductor canal (hiatus)?
- An opening which is located in the medial intermuscular septum and the distal portion of adductor magnus
- Provides a passage for the femoral artery and veins, which pass from the anterior compartment of the thigh into the popliteal space (posterior knee)
What is the name of the deep fascia of the leg?
Crural fascia
Where is the deep fascia of the leg located?
- Continuous with the fascia lata
- Attaches proximally to the patella, tibia condyles, and head of the fibular
- Coverage of the popliteal fossa posteriorly
- Blends with the periosteum of the fibular malleolus and is continuous with the extensor and flexor retinaculum
What are retinaculum and what is it’s function?
Thickening of the deep fascia
* Hold/stabilize tendons in place
* Smooth gliding of tendons
Describe 3 types of retinaculum in the leg/ankle:
- Extensor retinaculum (Dorsum of leg/ankle)
- Superior
- Inferior - Fibular retinaculum (Lateral/fibular side)
- Superior
- Inferior - Flexor retinaculum (Medial ankle)
What is the intermuscular septa of the leg?
Inward extensions of the crural fascia that act to compartmentalise the leg
What is the anterior intermuscular septum?
Separates the anterior compartment from the lateral compartment
What is the posterior intermuscular septum?
Separates the lateral compartment from the posterior compartment
What is the interosseus membrane?
Separates anterior compartment from the posterior compartment
- Connects between tibia and fibula
What is the deep transverse fascia?
Separates the superficial and deep muscles of the posterior calf
Why are ‘ankle-pump’ exercises advocated for post-operative patients and long haul airline passengers?
Muscle action creates pressure changes within the fascial compartment, assisting venous return by the ‘muscle-pump’ effect. This moves venous blood along the venules and veins, helping to prevent blood clotting which may occur due to venous stasis (slow moving blood in veins)
What physiological processes might occur during “compartment syndrome”, leading to pain?
- Increased volume of muscle/swelling in a fixed space
- Increased pressure
- Pain - probably due to ischaemia, deficient removal of metabolites and other substances, and possibly mechanical pain
