Week 3 - Lab on Hand and Foot Flashcards
How do you identify which leg a tibia belongs to?
Has the medial malleolus on it
Which carpometacarpal joint is known as a saddle joint?
Trapezium with M1
What are the four points of attachment of the flexor retinaculum?
Hooks of hamate and pisiform
Tubercles of scaphoid and trapezium
Which side of the talus articulates with the tibia?
The medial side
What makes up the snuff box?
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
Describe the top of the talus
The top has a curved articular surface, extending on to the medial and lateral side
There is a large triangular shape on the lateral side for the fibula
Where is the head of the talus?
Anterior, is connected to the ‘body’ which has an apparent ‘neck’
What makes up the calcaneal tendon?
Gastrocnemius and soleus tendons
How many facets are on the calcaneum for the talus?
Three on the calcaneum superior surface (three on inferior surface of talus)
Which metatarsals does the cuboid articulate with?
M4 and M5
Where do you find the ulnar nerve in the distal part of the forearm?
With the ulnar artery, just lateral to the tendon of flexor capri ulnaris
Where is the median nerve in the distal part of the forearm?
It winds around the lateral stacked pairs of the flexor digitorum superficialis
Where does ECR longus attach?
2nd metacarpal
Where does ECR brevis attach?
3rd metacarpal
What retains tendons in position on the posterior side of the wrist?
The extensor retinaculum
Describe how you would identify the extensor pollicis longus at the thumb
It’s solitary, more medial than the others and winds around a bony projection
What are the two most lateral tendons going to the thumb?
Extensor pollicis brevis and abductor pollicis longus
Where do the tendons from the posterior compartment of the leg go?
Around the medial malleolus
Where does tibialis posterior attach?
It does not go all the way to the phalanges. It attaches to the Navicular
Where does the tibialis anterior attach to the foot?
Next bones AFTER the naviculum
The medial cuneiform and the base of the first metatarsal
Where does fibularis brevis attach?
5th metatarsal
Where does fibularis longus attach?
To the same bone as tibialis posterior - the naviculum. It crosses the sole to do this
What is the palmar aponeurosis?
A triangular sheet of fascia between the hypothenar and thenar groups of muscles
What is the most prominent blood vessel in the palm?
The superficial palmar arterial arch. This is seen as a continuation of the ulnar artery
Which muscle is attached to the flexor digitorum profundus tendons?
Lumbricals
Where do the two heads to the adductor pollicis longus come from?
Capitate and M3
What does adductor pollicis longus cover in the hand?
The lateral interossei
What are the differences between the dorsal and palmar interossei muscles?
Dorsal are larger and take origin from two metacarpal bones
Palmar are smaller and take origin from only one metacarpal
Which is the largest interossei muscle?
The first dorsal interosseous muuscle
What passes through the first dorsal interossei muscle to enter the palm?
The radial artery, after passing through the anatomical snuffbox
What forms the deep palmar arterial arch?
The radial artery, after passing through the first dorsal interossei muscle
Which leg muscles wrap around the lateral malleolus?
Fibularis longus
Fibularis brevis
What are the differences between hand and foot intrinsic muscles?
- Foot has no opponens muscle
- Superficial flexor of the toes is intrinsic - doesn’t come from the leg –> flexor digitorum brevis
- Deep flexor of the toes comes from the leg –> flexor digitorum longus
How many nerves enter the sole of foot?
Only the tibial nerve, where it then splits into two
What is the difference in muscles of the dorsum of the hand and dorsum of the foot?
The foot has short digital extensor muscles, the hand does not
How many abductors does the big toe have in the foot?
Big toe only has only abductor in the foot
What is the most superficial structure of the foot?
The plantar aponeurosis, extending from calcaneum to the heads of the metacarpals
Where do you find the abductor hallucis?
Big bulky muscle
Extends from the medial, posterior side of the calcaneum, to the proximal phalanx of the big toe
WHat is the most lateral superficial muscle of the foot?
Abductor digiti minimi
Posterior Calcaneus to proximal phalanx of the little toe
Describe how attachment to the calcaneus changes as the muscle gets deeper in the foot
The more superficial a muscle, the more posterior it’s attachment
Describe the flexor digitorum brevis
Equivalent of flexor digitorum superficialis in the upper limb
Extends from calcaneus, four tendons reach the middle phalanges and split into two as they approach their insertions
What are three superficial muscles of the foot?
Abductor digiti minimi
Abductor hallucis
Flexor digitorum brevis
What are the four intermediate depth muscles in the foot?
Flexor digitorum longus
Flexor accessorius
Flexor hallucis longus
Lumbricals
Describe flexor digitorum longus
Equivalent to profundus in the hand
Enters foot as single tendon, flattens into sheet, then divides into four
Comes from tibia (anatomically ‘wrong’ bone)
Describe flexor accessorius
Necessary to compensate for the oblique pull of the FDL
Runs from calcaneum to the FDL tendon
Also known as quadratus plantae
Where does the tendon of flexor hallucis longus originate and attach?
Originates from the fibula (the ‘wrong bone’)
Which two tendons cross each other soon after they enter the foot?
Flexor hallucis longus and flexor digitorum longus
Which muscles are the lumbricals attached to?
The lumbricals arise from the FDL tendons
What are the important structures of the deep plane of the foot? (6)
Long plantar ligament Short plantar ligament Plantar calcaneonavicular ligament/spring ligament Flexor hallucis brevis Adductor hallucis Interosseous muscles
Where do you find the long plantar ligament? How else could you identify it?
Extending from the calcaneus to the lateral metacarpals
It’s a thick band and covers the tendon of fibularis longus
Some of the ligament fibres attach to the cuboid bone to make a tunnel for the tendon of fibularis longus
Where is the short plantar ligament?
On a deeper plane to the long plantar ligament, and extend from the calcaneus to the cuboid bone
Where do you find the spring ligament?
On the medial side, from the sustentaculum tali, to the proximal border of the navicular bone
What makes the spring ligament quite thick?
It’s upper surface usually has some fibrocartilage
Describe the location and distinct features of the flexor hallucis brevis muscle?
Has a single proximal attachment via a single tendinous attachment from under the cuboid bone
Distal attachment is split into two heads, attached to the proximal phalanx of the big toe.
It’s tendons have sesamoid bones within them
Where is the adductor hallucis? How many parts does it have?
Adductor hallucis is lateral to flexor hallucis brevis
Has a transverse and oblique head, like adductor pollicis in the hand
Where is the reference line in the foot?
Through the second toe
Where does the tendon of fibularis tertius end?
On the 5th metatarsal
What are the two intrinsic muscles in the dorsum of the foot?
Extensor hallucis brevis
Extensor digitorum brevis
How are finer movements of the toes controlled?
By extensor expansions
What forms the tarsal sinus?
The groove between the posterior and middle facets of the calcaneum and the similar groove on the talus
What occupies the tarsal sinus?
The strong interosseous talocalcaneal ligament
What supplements the talonavicular joint?
A facet on the talus which rests on the spring ligament
What makes up the talocalcaneonavicular joint?
The two anterior joints of the subtalar complex, and the talonavicular joint together
What is the subtalar joint complex?
A joint complex made up of three articulating surfaces between the talus and the calcaneum
Which three long muscles come from the posterior compartment of the leg into the foot?
Tom Dick & Harry
Flexor Tibialis
Flexor Digitorum longus
Flexor Hallucis longus
At which joint does inversion and eversion of the foot occur?
Subtalar joint with rotation of the head of the talus
What is the transverse tarsal joint made up of?
The talonavicular (ball and socket) and the calcaneocuboid joint
What does the distal surface of the navicular bone articulate with>
All three cuneiform bones –> cuneonavicular joints
Describe the tarsometatarsal joints
- Cuboid articulates with two metatarsals
- Cuneiform bone articulate with one metatarsal
- Bases of metatarsals articulate with each other
What type of joints are the metatarsophalangeal joints?
Condyloid joints
What is the difference between the medial and lateral ligaments of the foot?
The medial ligaments are thicker and stronger than the lateral as they have to stop eversion
What is the deltoid ligament in the foot?
Composed of anterior tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament and the tibionavicular ligament
