Post on 15-Aug-2015
transcript
Anatomy Revision Session 2
slides are available online atSlideshare.net/muradalshehry
After this session
The Upper Limb
Anatomy Revision Session 1
Objectives of this session
• To be able to Identify the muscles and their functions of the upper limb.
• Know relations of muscles to important nerves.
• There will be a few pop Quiz…. Stay focused ☺
Orientation and Movement REVISION
adduction
abduction
flexionextension
circumduction
rotation
elevation
depression
supination
pronation
protraction
retraction
Orientation and Movement REVISION
Flexor digitorum superficialis
• Medial epicondyle of humerus and coronoid process of ulna to middle phalanges (lateral) of digits 2-5 (i.e. all except thumb)
• Flexion of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint
• Median nerve (C7,C8,T1)
Flexor digitorum profundus
• Ulna and interosseous membrane to distal phalanges digits 2-5 (palmar)
• Flexion of MCP, PIP and distal interphalangeal joint (DIP) of digits 2-5
• Ring and little fingers = ulnar nerve (C8,T1)
• Index and middle fingers = median nerve (C8,T1 anterior interosseous)
Flexor digitorum muscles:
Superficialis Splits in two, To Permit Profundus Passing through.
Flexor pollicis longus
• Radius and interosseous membrane to base of distal phalanx of thumb (palmar)
• Flexion of MCP and IP of thumb, wrist
• Median nerve (C8, T1 anterior interosseous)
Pronator quadratus
• Distal anterior ulna to distal anterior radius
• Pronation and help to stabilise distal radioulnar joint
• Median nerve (C8, T1 anterior introsseous)
Anterior forearm muscles: superficial group There are five, like five digits of your hand.Place your thumb into your palm, then lay that hand palm down on your other arm. PFPF [pass/fail, pass/fail]:Pronator teresFlexor carpi radialisPalmaris longusFlexor carpi ulnarisYour thumb below your 4 fingers shows the muscle which is deep to the otherfour: Flexor digitorum superficialis.
Median nerve
• C6-T1 fibres, medial and lateral cords
• Major nerve of anterior compartment of forearm, THROUGH carpal tunnel
• Main nerve of thumb side of hand
Ulnar nerve and artery
• C7-T1 fibres from medial cord, medial epicondyle of humerus, pisiform ABOVE carpal tunnel
• Branch brachial artery, interosseous branches, little finger side, superficial palmar arch
median
ulnar
radialant. interosseous
anterior interosseous
Median nerve passes between the heads of pronator teres
Anconeus
• Lateral epicondyle of humerus to olecranon of ulna
• Extension of the elbow
• Radial nerve (C7-C8)
Brachioradialis
• Distal humerus (supra-epicondylar ridge) to radius proximal to styloid process
• Puts the forearm into the semi-prone position, flexion of elbow
• Radial nerve (C5, C6, C7) (before division into deep and superficial)
Posterior compartment of the forearm
• Common extensor origin = lateral epicondyle of the humerus
• Extensors of the digits, wrist
• Abductor of the thumb
• Supinator
• Radial nerve
Extensor carpi radialis longus and brevis
• Extensor carpi radialis longus from distal humerus (supra-epicondylar ridge) to base of 2nd metacarpal
• Wrist extension and abduction
• Radial nerve (C6,C7) (pre-division)
• Extensor carpi radialis brevis from lateral epicondyle of humerus to base of 3rd metacarpal
• Wrist extension and abduction
• Radial nerve (C7,C8) (deep = posterior interosseous)
extensor carpi radialis longus
extensor carpi radialis brevis
Extensor carpi ulnaris
• Lateral epicondyle of humerus (small slip from ulna) to base of 5th metacarpal
• Wrist extension and adduction
• Radial nerve (posterior interosseous) (C7, C8)
Extensor digitorum
• Lateral epicondyle of humerus to dorsal expansion of digits 2-5 (NOT thumb)
• Extension of principally MCP, but also PIP and DIP extension of digits 2-5
• Radial nerve (posterior interosseous) (C7,C8)
Extensor digiti minimi
• Lateral epicondyle of the humerus to dorsal expansion of 5th digit (little finger)
• MCP, PIP, DIP extension of little finger
• Radial nerve (posterior interosseous) (C7,C8)
Extensor indices
• Posterior surface of ulna (and interosseous membrane) to dorsal expansion of digit 2 (index finger)
• MCP, PIP, DIP extension of index finger
• Wrist extension
• Radial nerve (posterior interosseous) (C7,C8)
Extensor pollicis longus• ‘Pollicis’ = thumb
• Ulna and interosseous membrane to base of distal phalanx of thumb
• CMC, MCP and IP extension of thumb
• Radial nerve (posterior interosseous) (C7, C8)
Extensor pollicis brevis
• Radius and interosseous membrane to base of proximal phalanx of thumb
• Carpometacarpal and MCP thumb joint extension
• Radial nerve (posterior interosseous) (C7,C8)
Abductor pollicis longus
• Radius, interosseous membrane and ulna to base of 1st metacarpal
• Abducts thumb and extends it at carpometacarpal joint
• Radial nerve (posterior interosseous) (C7,C8)
Supinator
• Crest of ulna, lateral epicondyle of humerus, radial collateral and annular ligament of radius to lateral radius (proximal third)
• Supination of forearm (rotates radius)
• Radial nerve (posterior interosseous)(C7,C8)
Radial nerve passes through the lamina of supinator
posterior
interosseous
anterior interosseous
deep branch of radial
common interosseous
superficial
artery
artery
artery
The Hand
Flexor retinaculum• Roof of carpal tunnel
• Medial = pisiform, hook of hamate
• Lateral = tubercle of scaphoid and ridge on trapezium
• Septum from trapezium – flexor carpi radialis
• Attach thenar and hypothenar structures
Carpal tunnel
Carpal tunnel syndrome causes MEDIAN TRAP:
MyxoedemaEdema premenstruallyDiabetesIdiopathicAgromegalyNeoplasmTraumaRheumatoid arthritisAmyloidosisPregnancy
Bones and joints
carpals
metacarpals
proximal phalanx
middle phalanx
distal phalanx
interphalangeal (IP) joints = synovial hinge
metacarpophalangeal (MCP) joints = synovial condyloid
carpometacarpal (CMC) joints = synovial saddle (thumb), plane (digits)
intercarpal = synovial plane
Palmar aponeurosis
aponeurosis
palmaris longus
Palmaris brevis
• Palmar aponeurosis and flexor retinaculum to dermis
• Grip• Ulnar nerve (superficial
C8,T1)
Intrinsic muscles of the hand
abductor pollicis brevis = intrinsic muscle
tendon of flexor digitorum superficialis = extrinsic muscle
Intrinsic muscles – thenar eminence• Abductor pollicis brevis = scaphoid
and trapezium to base proximal phalanx of thumb – CMC joint abduction – median nerve (recurrent C8,T1)
• Flexor pollicis brevis = flexor retinaculum, capitate, trapezium to base proximal phalanx of thumb – CMC joint flexion – Median (recurrent) and some texts also ulnar nerve (C8,T1)
• Opponens pollicis = trapezium to first metacarpal – CMC joint opposition – median nerve (recurrent C8,T1)
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
Adductor pollicis • Transverse head from 3rd metacarpal; oblique head from capitate and 2nd/3rd metacarpals to base of proximal phalanx of thumb
• Adduction of CMC joint of thumb
• Flexion of MCP joint of thumb
• Ulnar nerve (deep C8,T1)
transverse head
oblique head
Hypothenar eminence • Abductor digiti minimi = pisiform
bone to base of 5th proximal phalanx and dorsal digital expansion – abduction and flexion MCP joint little finger – ulnar nerve (deep C8,T1)
• Flexor digiti minimi = hamate, flexor retinaculum to base of 5th proximal phalanx – Flex MCP joint of little finger – ulnar nerve (deep C8,T1)
• Opponens digiti minimi = hamate and flexor retinaculum to 5th metacarpal – weak opposition of little finger – ulnar nerve (deep C8,T1)
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
Lumbricals• 4 small muscles from tendons of
flexor digitorum profundus
• 1st (index) and 2nd (middle) unipennate
• 3rd (ring) and 4th (little) usually bipennate
• Insert into dorsal digital expansion
• MCP joint flexion and IP joint extension for digits 2-4
• 1st and 2nd = median nerve (digital C8,T1)
• 3rd and 4th = ulnar nerve (deep C8,T1)
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34
lumbrical
Lumbricals action
Lumbricals action Lumbrical action is to hold a pea, that isto flex the metacarpophalangeal joint and extend the interphalangeal joints.When look at hand in this position, can see this makes an "L" shape, since Lis for Lumbrical.
Palmer interossei
• Between metacarpal bones
• 1st from 2nd metacarpal to base of 2nd proximal phalanx and dorsal expansion
• 2nd from 4th metacarpal to base of 4th proximal phalanx and dorsal expansion
• 3rd from 5th metacarpal to base of 5th proximal phalanx and dorsal expansion
• Adduction towards middle finger (flex MCP, extend IP)
• Ulnar nerve (deep C8,T1)
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3
Dorsal interossei • From sides of 2 adjacent metacarpals, eg, 1st dorsal interossei from 1st and 2nd metacarpals
• 1st inserts into 2nd proximal phalanx and dorsal digital expansion
• 2nd and 3rd inserts into the 3rd proximal phalanx and dorsal digital expansion
• 4th inserts into 4th proximal phalanx and dorsal digital expansion
• Abduction (MCP flexion, IP extension)
• Ulnar nerve (deep C8,T1)123
4
Interossei muscles
: actions of dorsal vs. palmar in hand "PAdand DAb":The Palmar Adduct and the Dorsal Abduct.· Use your hand to dab with a pad.
Intrinsic muscles of hand (palmar surface)
"A OF A OF A":· Thenar, lateral to medial:Abductor pollicis longusOpponens pollicisFlexor pollicis brevisAdductor pollicis.· Hypothenar, lateral to medial:Opponens digiti minimiFlexor digiti minimiAbductor digiti minimi
Synovial sheaths
• Synovial membrane plus fluid
• Around tendons at wrist, palm and into digits
Cutaneous supply
median
ulnar ulnar
radial
Cutaneous upper limb
ANT POST
Carpal bones"Stop Letting Those People Touch The Cadaver's HandProximal row, lateral-to-medial: Scaphoid Lunate Triquetrum PisiformDistal row, lateral-to-medial: Trapezium Trapezoid Capitate Hamate
Or
"Happy Cat Tom Took Pie To Little Sister":HamateCapitateTrapezoidTrapeziumPisiformTriquitalLunateScaphoid
Lower Limb
Gluteal Region and Hip Joint
Outline
• Innominate (Hip) Bone• Proximal Femur• Muscles of the gluteal region• Nerves and Vessels of the gluteal region• Hip Joint
ObturatorForamen
AuricularSurface
Iliac crest
Iliac fossa
ASIS
AIIS
PSIS
PIIS
Arcuate Line
Ischial Tuberosity
Ischial Spine
Lesser SciaticNotch
Greater SciaticNotch
Pubis
Innominate: Medial
view
Innominate: Lateral
view
Iliac crest
ASIS
AIIS
PSIS
PIIS
Ischial Tuberosity
Ischial Spine
Lesser SciaticNotch
Greater SciaticNotch
Pubis
PosteriorGluteal Line Anterior
Gluteal Line
InferiorGluteal Line
Acetabulum
Pubic Tubercle
Ischium
Greater and Lesser Sciatic Foramina
Muscles of Gluteal Region
Lateral Rotators of Hip• Gluteus Maximus
(extensor)• Piriformis• Obturator internus• Gemelli• Quadratus femoris
Medial Rotators and Abductors of Hip
• Gluteus Medius• Gluteus Minimus
Support• Tensor fascia lata
Gluteus Maximus
• Sacrum, S/T ligament and ilium behind posterior gluteal line Iliotibial tract (3/4) and gluteal tuberosity of femur (1/4)
• Extends hip; assists lateral rotation
• Inferior gluteal nerve • (L5, S1, 2)
Tensor Fascia Lata
• Ant. Iliac Crest and ASIS Iliotibial tract
• Tenses fascia lata and iliotibial tract; Supports femur on tibia during standing
• Superior Gluteal nerve• (L4, 5, S1)
GluteusMaximus
Iliotibial tract
Gluteus Medius
• Ilium between posterior and anterior gluteal lines greater trochanter (lateral surface)
• Abducts and medially rotates hip
• Superior gluteal nerve• (L4, 5, S1)
Gluteus Minimus
• Ilium between anterior and inferior gluteal lines greater trochanter (anterior surface)
• Abducts and medially rotates hip
• Superior gluteal nerve • (L4, 5, S1)
Piriformis
• Anterior Sacrum and S/T lig. Greater Trochanter (superior border)
• Passes through greater sciatic foramen
• Laterally rotates hip
• Anterior rami of L5, S1, 2
Obturator internus
• Pelvic surface of Obturator mem. and surrounding bones Trochanteric Fossa of greater trochanter
• Passes through lesser sciatic foramen
• Laterally rotates hip
• Nerve to obturator internus (L5, S1)
Gemelli
• Superior: Ischial spine• Inferior: Ischial tuberosityBlend with tendon of obturator
internus (Trochanteric fossa)
• Laterally rotate hip
• Superior: Nerve to obturator internus
• Inferior: Nerve to quadratus femoris
Quadratus femoris
• Ischial tuberosity Quadrate tubercle on intertrochanteric crest of femur
• Laterally rotates hip
• Nerve to quadratus femoris (L5, S1)
Obturator externus
• Outer surface of obturator mem. Trochanteric fossa
• Laterally rotates hip
• Obturator nerve• L3, 4
Anterior
Lateral Rotators
"Play Golf Or Go On Quacking":· From top to bottom:PiriformisGemellus superiorObturator internusGemellus inferiorObturator externusQuadratus femoris· Alternatively: "P-GO-GO-Q".
Sciatic nerve
• L4, 5, S1, 2, 3• Tibial always leaves below
piriformis • Common Peroneal may leave
below, above or through piriformis
Gluteal vessels and nerves
• Superior gluteal artery and nerve
• Inferior gluteal artery and nerve
• Piriformis
Posterior cutaneous nerve of thigh
• Lies on posterior aspect of sciatic nerve
• (S1, 2, 3)• Inferior Clunial nerves to skin of
inferior half of buttock
Cutaneous Nerves – Gluteal and Posterior Thigh
Superior Clunial(posterior rami L1,2,3)
Middle Clunial(posterior rami S1,2,3)
Posterior Cuntaneous n. of Thigh with Inferior Clunial branches
Hip Joint
• Articular surfaces• Capsule attachments• Ligaments• Relations of the Joint
Articular Surfaces
Capsule attachments
Iliofemoral ligament
• AIIS → Intertrochanteric line• Upper and lower bandsLimits:• Extension• Lateral rotation• Adduction (upper)• Abduction (lower)
Pubofemoral ligament
• Iliopubic eminence → Lower part of intertrochanteric line
Limits:• Extension• Lateral rotation• Abduction
Ischiofemoral ligament
• Posterior aspect of acetabulum → Greater trochanter
Limits:• Extension• Medial rotation• Adduction
Blood Supply to the Hip Joint
Anterior and Medial Thigh
Outline• Compartments of the Thigh• Features of the femur• Muscles of Anterior Compartment• Muscles of Medial Compartment• Adductor Canal• Nerves• Arteries
Compartments of Thigh
Flex Hip; Extend Knee
Anterior CompartmentSubcutaneous tissue
Fascia Lata
Medial Compartment
Posterior Compartment
Great Saphenous vein
Intermuscular Septum
Iliotibial tract
Extend Hip; Flex Knee
Adduct Hip
Proximal femur (anterior)Head
Greater trochanter
Intertrochanteric line
Lesser trochanter
Shaft
Fovea
Neck
Proximal femur (posterior)
Greater trochanter
Trochanteric Fossa
Intertrochanteric crest
Lesser trochanter
Pectineal line
Gluteal tuberosity
Anterior Thigh
Hip Flexors• Iliacus• Psoas major• Pectineus• Sartorius
Knee Extensors• Quadriceps
• Rectus femoris• Vastus medialis• Vastus lateralis• Vastus intermedius
Hip Flexors – Iliopsoas
• Iliacus• Iliac crest, fossa, ala of sacrum, ant. sacroiliac
lig. → Psoas tendon, lesser trochanter• Femoral nerve (L2, 3)• Flex hip
• Psoas major• T12-L5, IV discs, lumbar transverse processes
→ Lesser trochanter• Anterior rami L1-3• Flex hip
Hip Flexors – Pectineus
• Pectineus• Superior ramus of pubis →
Pectineal line of femur• Femoral nerve (L2, 3) [occassionally br.
from obturator]• Adduct and flex hip; assist with medial
rotation
Hip Flexors – Sartorious
• Sartorious• ASIS →
Superior part of medial surface Tibia
• Femoral nerve (L2, 3)
• Flex, abduct, laterally rotate hip; flex knee
Knee Extensors – Quadriceps• Rectus femoris
• AIIS, ilium above acetabulum• Vastus lateralis
• Gr. Trochanter & Lat. Linea Aspera• Vastus medialis
• Intertrochanteric line & Med. Linea Aspera• Vastus intermedius
• Ant. and Lat. Shaft of femur
• → Quadriceps tendon then tibial tuberosity via Patellar lig.
• Extend knee (rectus fem. also flexes hip)• Femoral nerve (L2,3,4)
RectusFemoris
VastusLateralis
VastusMedialis
VastusIntermedius
Anterior Thigh
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Sartorious
Iliopsoas
Pectineus
Femoral nerve
• Passes deep to inguinal ligament, medial to ASIS, on tendon of iliopsoas m.
• Muscular branches: anterior thigh• Articular branches: hip and knee• Cutaneous branches: anteromedial thigh
• Saphenous nerve is terminal cutaneous br. – anteromedial knee, leg and foot
Iliacus
Rectusfemoris
Vastimuscles
Pectineus
Medial Thigh
Hip Adductors• Gracilis• Adductor Longus• Adductor Brevis• Adductor Magnus• Obturator Externus
Hip Adductors – Gracilis
• Gracilis• Body and Inf. ramus of Pubis →Superior
Medial surface Tibia
• Obturator (L2, 3)
• Adducts hip; flexes knee
Hip Adductors – Adductor Longus
• Adductor Longus• Body pubis → Middle ⅓ Linea aspera
• Obturator (L2,3,4)
• Adducts thigh
Hip Adductors – Adductor Brevis
• Adductor Brevis• Body and Inf. ramus of Pubis →Pectineal Line
and proximal Linea aspera
• Obturator (L2,3,4)
• Adducts thigh (may assist flexion)
Hip Adductors – Adductor Magnus
• Adductor Magnus
• Ischiopubic ramus and Ischial tuberosity →Linea aspera, Med. Supracondylar line, Adductor tubercle
• Obturator (L2,3,4); Hamstring part – tibial part Sciatic n. (L4)
• Adducts thigh; Adductor part flexes and hamstring part extends thigh
Hip Adductors – Obturator Externus• Obturator Externus
• Margins obturator foramen and Obturator membrane →Trochanteric fossa
• Obturator (L3,4)
• Laterally rotates thigh
Medial Thigh
AdductorLongus
Gracilis
AdductorBrevis
AdductorMagnus
ObturatorExternus
AdductorMagnus
Obturator Nerve
Obturator externus
Adductor Brevis
Adductor Longus
Adductor Magnus
Gracilis
• Anterior divisions L2-4• Runs along lateral wall of pelvis to the
obturator canal• Anterior and Posterior branches• Muscular branches to medial thigh• Anterior branch – cutaneous to middle part of
medial thigh ObturatorExternus
AdductorBrevis
PosteriorBranch
AnteriorBranch
PosteriorBranch
AnteriorBranch
Adductor Canal
• Apex of Femoral Triangle Adductor Hiatus (in adductor magnus)
• Underlies the distal half of sartorius m.
• Femoral vessels travel in canal and pass through Hiatus to reach Popliteal fossa
• Saphenous nerve runs in canal then passes between sartorius and gracilis to supply skin of anteromedial knee, leg and foot
Femoral a. and v. entering adductor canal
Saphenous n.
Sartorius forming roof of adductor canal
Arterial Supply
Femoral artery – Continuation of Ext. Iliac a.• Femoral triangle → Adductor canal → Adductor hiatus to become Popliteal
a.• Supplies anterior and anteromedial thigh
Profunda femoris → br. of Femoral• Runs posterior to Adductor Longus → 3/4 perforating br.s through Add.
Magnus to supply mm in med., post. and lat. part of ant. Compartment• Also gives Medial and Lateral Circumflex femoral br.s
Obturator artery (from Int. Iliac a.) • Through obturator foramen to medial compartment → ant. and post. br.s• Anterior branch: muscles of medial compartment• Posterior branch: muscles attached to ischial tuberosity
Femoral
ProfundaFemoris
ExternalIliac
CommomIliac
Lateral CircumflexFemoral
Femoral
ProfundaFemorisMedial Circumflex
Femoral
PerforatingBranches
Popliteal
Obturator
AdductorMagnus
AdductorHiatus
Openings forPerforating br.s
Anterior Posterior
CruciateAnastomosis
Posterior thigh and popliteal fossa
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Outline
• Muscles of posterior thigh• Sciatic nerve• Popliteal fossa
• Roof• Boundaries• Contents• Floor
• Popliteal artery and branches
Posterior Thigh
• Hamstrings• Semitendinousus• Semimembranosus• Biceps Femoris
• Extend hip, Flex knee
Semitendinosus
• Semitendinosus• Ischial tuberosity Medial
surface of superior tibia
• Tibial division of Sciatic• L5,S1,S2
Semimembranosus
• Semimembranosus• Ischial tuberosity
Posterior surface of Medial Condyle of tibia
• Tibial division of Sciatic• L5,S1,S2
Biceps Femoris
• Biceps femoris• Long head: Ischial tuberosity• Short head: Linea aspera and
Lat. Supracondylar line of femur Head of Fibula
• Long head = Tibial division of Sciatic (L5,S1,S2)
• Short head = Common peroneal division of Sciatic (L5,S1,S2)
Rotation of Knee
• Knee Flexed:• Lateral rotation by:
• Biceps Femoris• Medial rotation by:
• Semimembranosus• Semitendinosus• Gracilis• Sartorius
Sciatic Nerve
• L4-S3
• Deep to long head of biceps femoris
• Tibial and Common Peroneal (fibular) Divisions
Tibialnerve
Common Peroneal
nerve
Right
Popliteal Fossa – Roof
• Deep fascia
• Pierced by:• Sural nerve • Short saphenous vein
Sural nerve
Short SaphenousVein
Popliteal Fossa – Boundaries
• Superiorly: Diverging tendons of Hamstrings• Biceps femoris laterally• Semimembranosus and Semitendinosus
medially
• Inferiorly: Medial and Lateral heads of Gastrocnemius
Popliteal Fossa – Contents
• Popliteal artery
• Popliteal vein
• Terminal branches of Sciatic• Tibial nerve• Common peroneal nerve
Medial& Deep
Lateral &Superficial
Popliteal artery
Popliteal vein
Tibial nerve
Common Peroneal nerve
• medial to lateral arrangment "Serve And Volley Next Ball":Semimembranosus/ SemitendonosusArteryVeinNerveBiceps femoris· Lateral and medial heads of Gastrocnemius are inferior borders.
Popliteus
Joint capsule
Femur
Popliteal Fossa – Floor
• Popliteal surface of femur
• Capsule of Knee Jt.
• Popliteus muscle
Popliteal Fossa – Floor
• Oblique popliteal ligament• Expansion of Semimembranosus• Reinforces knee joint capsule
• Middle Genicular vessels • Pierce joint capsule to supply cruciate
ligaments
Popliteal Artery
• Continuation of femoral• Adductor hiatus →Inferior
border of Popliteus• 5 genicular branches• Terminal branches:
• Anterior Tibial artery• Posterior Tibial artery
Medial SuperiorGenicular artery
Lateral SuperiorGenicular artery
Medial InferiorGenicular artery
Lateral InferiorGenicular artery
Anterior and Lateral Leg
Dorsum of Foot
Outline
• Compartments of the leg• Interosseous membrane and superior tibiofibular joint• Muscles of Lateral Compartment• Muscles of Anterior Compartment• Extensor Retinacula• Dorsum of Foot• Peroneal nerves• Arteries of the Leg and Dorsum of Foot
Compartments of the Leg
Interosseous membrane
• Provides a surface for muscle attachment
• Fibres pass inferolaterally from Tibia to Fibula
• Helps resist the downward pull of muscles attached to the fibula
Superior tibiofibular joint
Anterior and Lateral Compartments
Anterior Compartment:4 MusclesExtensors of ankle jt. and digitsTendons anterior to ankle jt.
Lateral Compartment2 MusclesEvertors of the footTendons posterior to lateral malleolus
Lateral Compartment
Peroneus Longus:Head and upper ⅔ of lat. Fibula
® base of 1st Metatarsal and Medial Cuneiform
Superficial Peroneal Nerve (L5,S1,S2)
Lateral Compartment
Peroneus Brevis:Inf. ⅔ of lat. Fibula
® Tuberosity on Lat. side of Base of 5th Metatarsal
Superficial Peroneal Nerve (L5,S1,S2)
Lateral Compartment
Peroneus Longus TendonPeroneus Brevis Tendon
Peroneal Trochlea of Calcaneus
Cuboid
5th Metatarsal
Calcaneus
Talus
Anterior compartment• Tibialis anterior• Extensor digitorum longus• Extensor hallucis longus• Peroneus tertius
• All supplied by Deep Peroneal Nerve
• L4, L5
Tibialis Anterior
Lat. condyle of Tibia, Sup. ½ of Lat. Tibial surface, Interosseous mem.
→ Med. and Inf. surfaces of Medial Cuneiform and base of 1st metatarsal
Dorsiflexes ankle; Inverts foot
R
R
Extensor Digitorum Longus
Lat. Condyle Tibia, Sup. ¾ of med surface Fibula, Interosseous membrane
®Middle and distal Phalanges of Lateral 4 digits
Extends lateral 4 digits; Dorsiflexes ankle
R
Inf. ⅓ anterior Fibula and Interosseous membrane
®Dorsum of base of 5th Metatarsal
Dorsiflexes ankle; Assists in eversion of foot
Peroneus Tertius
R
Extensor Hallucis Longus
Middle ant. surface Fibula, Interosseous membrane
®Dorsal aspect of distal Phalanx of Hallux
Extends Hallux; Dorsiflexes ankle
Extensor Retinacula
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 hallucis
Anterior muscles of leg
"The Hospitals Are Not Dirty Places":
T: Tibialis anteriorH: extensor Hallucis longusA: anterior tibial ArteryN: deep fibular NerveD: extensor Digitorum longusP: Peronius tertius [aka fibularis tertius]
Dorsum of Foot
Muscles of Dorsum of Foot
Superior surface of Calcaneus, Inferior Extensor Retinaculum
Extensor Hallucis BrevisBase of Proximal Phalanx of Hallux
Extensor Digitorum Brevis Long extensor tendons of toes 2-4
Deep Peroneal nerveL5/S1
Superficial peroneal nerve
• Branch of common peroneal between peroneus longus and neck of fibula
• Lateral compartment of leg supplying muscles and continuing as cutaneous nerve
• Cutaneous innervation to distal anterior surface of leg and most of dorsum of foot
Deep Peroneal Nerve• Branch of common peroneal
between peroneus longus and neck of fibula
• Passes through extensor digitorum longus and travels with anterior tibial a. supplying all anterior compartment mm.
• Crosses the ankle jt. to supply ext. digitorum brevis and ext. hallucis brevis
• Cutaneous innervation to skin between digits 1 and 2
Cutaneous InnervationAnterior Cutaneous
branches of Femoral
Saphenous nerve(from Femoral)Lateral Sural
Cutaneous nerve
Superficial Peroneal nerve
Deep Peroneal nerve
Lateral Dorsal Cutaneous nerve of foot
(Termination of Sural n.)
Arteries of the Leg
• Popliteal a. gives anterior and posterior tibial aa.
• Anterior tibial a. – through interosseous membrane and descends on this
• Posterior tibial a. – gives the fibular a. that provides perforating br.s to lateral compartment
AnteriorTibial a.
PosteriorTibial a.
Fibular a.
• Dorsalis Pedis artery is a continuaton of Anterior Tibial a.
• Gives Deep Plantar artery to sole of the foot
• Gives Arcuate artery which runs across metatarsals to anastomose with Lateral Tarsal a.
• Metatarsal and digital aa.
Arteries of Dorsum of FootAnterior Tibial a.
Dorsalis Pedis a.
Deep Plantar a.
Arcuate a.
Lateral Tarsal a.
Posterior Leg and Ankle Joint
Outline
• Posterior aspect of the bones of the leg• Superficial and deep muscles of the posterior compartment• Flexor retinaculum• Posterior arteries • Tibial nerve• Inferior Tibiofibular joint• Ankle joint
Posterior Aspect of Leg Bones
Popliteal area
Soleal line
Apex
Head
Neck
Medial Malleolus Lateral Malleolus
Tibia Fibula
Fibula
Groove for Peroneus longus and brevis tendons
The FibuLA is LAteral.
Muscles of the Posterior Compartment
• 7 muscles• 3 superficial; 4 deep
• Superficial muscles all insert on posterior surface of calcaneous via Tendocalcaneous
• Tendons of deep muscles pass behind medial malleolus to plantar surface of foot
Superficial Muscles - Gastrocnemius
Medial Head:Popliteal surface of femur sup. to medial condyle
Lateral Head:Lateral aspect of lateral condyle of femur
Tibial nerve (S1, 2)
Plantarflexes ankle; Flexes knee
Medial
Lateral
Medial
Lateral
Right
Superficial Muscles - Plantaris
Lateral supracondylar line of femur (proximal to lateral head of gastrocnemius)
Tibial nerve (S1, 2)
Assists Plantarflexion of ankle
Right
Superficial Muscles - Soleus
Soleal line of TibiaUpper ⅓ posterior Fibula Tendinous arch between bony attachments
Tibial nerve (S1, 2)
Plantarflexes ankle joint
Right
Deep Muscles - Popliteus
Pit for popliteus (lateral condyle of femur) and Lateral meniscus
→Popliteal area of tibia (above soleal line)
Tibial n. (L4, 5, S1)
Unlocks knee joint by laterally rotating femur on fixed tibia
Right
Deep Muscles – Flexor Digitorum Longus
Posterior Surface of Tibia
→Base of distal Phalanx of digits 2-4
Tibial nerve (L5, S1, 2)
Flexes lateral 4 digitsWeak plantarflexor of ankle
Right
Deep Muscles – Flexor Hallucis Longus
Posterior Surface of Fibula
→Base of distal Phalanx of Hallux
Tibial nerve (L5, S1, 2)
Flexes HalluxWeak plantarflexor of ankle
Right
Deep Muscles – Tibialis Posterior
Posterior Surface of Tibia and Fibula, Interosseous membrane
→Tuberosity of Navicular, Cuneiforms, Cuboid, Sustentaculum tali of Calcaneus, base of 2nd, 3rd, and 4th Metatarsals
Tibial nerve (L4, 5)
Plantar flexes ankleInverts foot
Right
Inversion vs. Eversion Muscles in leg
Second letter rule for inversion/eversion:
· Eversion muscles:pErineus longuspErineus brevispErineus terius
· Inversion muscles:tIbialis anteriortIbialis posterior
Plantarflexion vs. Dorsiflexion
Plantar flexionoccurs when you squish a Plant with your foot.
Dorsiflexion
Look at your toe nails
Tendons of Deep Muscles
Tibialis Posterior tendon passes deep to Flexor Digitorum Longus Groove posterior to the medial malleolus
Flexor Hallucis Longus grooves the posterior surface of the lower end of the tibia, the posterior surface of the talus
Medial to lateral arrangement of tendons at ankle joint: Tibialis Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus (Tom, Dick and Harry)
TPFDL
FHL
Flexor Retinaculum
Medial Malleolus→ Calcaneous
Posterior tibial vessels and tibial nerve found between FDL and FHL tendons
Right
Tarsal tunnel: contents
"Tiny Dogs Are Not Hunters“ Or :From superior to inferior:T: Tibialis posteriorF: flexor Digitorum longusA: posterior tibial ArteryN: tibial NerveH: flexor Hallucis longus
Arteries of Posterior Leg
Posterior Tibial Artery: terminal branch of popliteal arteryBetween heads of gastrocnemius and deep to soleus to run on surface of TP and FDL
Gives Fibular artery as a branchTerminates as Medial and Lateral Plantar arteries in the foot
Fibular artery: runs medial to fibula, usually within FHL
Tibial a.
Fibular a.
Cutaneous InnervationPosterior Cutaneous
nerve of Thigh
Lateral Sural Cutaneous nerve
Medial Sural Cutaneous nerve
(Sural Nerve)
Saphenous nerve(from Femoral)
Tibial nerve• Passes between the heads of
gastrocnemius and deep to tendinous arch of soleus, with Post. Tibial a.
• Lies between flexor hallucis longus and flexor digitorum longus at the ankle jt.
• Gives terminal branches that supply the sole of the foot: Medial and Lateral Plantar nn
Inferior tibiofibular joint
Ankle joint
Distal ends of Tibia and Fibula form: Malleolar Mortise
Trochlea of Talus
Ankle joint
Range of movement
Capsule and Ligaments
Attaches around articular marginsAnteriorly extends onto neck of talus
Weak anteriorly and posteriorly
Supported laterally and medially by strong Collateral Ligaments
Anterior and posterior views with weak parts of capsule removed
Lateral Collateral Ligaments
Anterior Talofibular → neck of talusPosterior Talofibular → lateral tubercle of talusCalcaneofibular → lateral surface of calcaneous
Lateral Collateral Ligaments
CalcaneofibularAnt. talofibular
Posterior talofibular Post. talofibular
Right
Right
Medial Collateral Ligament (Deltoid)
Fans out from Medial malleolus and has 4 parts:
1) Anterior Tibiotalar2) Tibionavicular3) Tibiocalcaneal4) Posterior Tibiotalar
12
3
4
3 4
Plantar Surface of Foot
Outline
• Bones of the foot• Deep fascia• The four layers of the foot• Plantar arteries• Plantar nerves• Cutaneous nerves of the foot
Foot – Dorsal View
Phalanges
Metatarsals
Tarsals
Navicular
TalusCuboid
Calcaneus
Cuneiforms(medial, intermediate, lateral)
Foot – Ventral View
Phalanges
Metatarsals
Tarsals
Navicular
SustentaculumTali
Cuboid
Calcaneus
Tubercle ofCalcaneus
Cuneiforms
Sesamoid bones within Flexor Hallucis Brevis tendon
Head of Talus
The Tarsal Bones
“The Circus Needs More Interesting Little Clowns”.• T: Talus• C: Calcaneus• N: Navicular• M: Medial cuneiform• I: Intermediate cuneiform• L: Lateral cuneiform• C: Cuboid Sustentaculum
Tali
Cuboid
Calcaneus
Tubercle ofCalcaneus
Cuneiforms
Head of Talus
Deep Fascia & Plantar Aponeurosis
Deep Fascia:Thick central portionWeaker medially and laterally
Plantar Aponeurosis:Superficial Ligament formed by central portion of deep fascia
Proximal attachment to CalcaneusDivides into 5 bands distally – continuous with fibrous digital sheaths
Vertical intermuscular septae: Medial, Central and Lateral compartments
Compartments of the Foot
Lateral CompartmentMuscles of the little toe:Abductor Digiti MinimiFlexor Digiti Minimi Brevis
Medial CompartmentMuscles of the great toe:Abductor HallucisFlexor Hallucis Brevis
Central CompartmentFlexor Digitorum BrevisMuscles associated with tendon of FDL (lumbricals and quadratus plantae)Adductor Hallucis
InterosseiPlantar and Dorsal interossei
Muscles of Dorsum of FootExtensor Digitorum BrevisExtensor Hallucis Brevis
Foot – Layer 1
Abductor Hallucis (1)
Med. Tubercle of Calcaneus; Flex. Retinaculum
→ Med. Base proximal Phalynx
Flexor Digitorum Brevis (2)
Medial Tubercle of Calcaneus
→ Middle Phalanges of lateral 4 toes
Abductor Digiti Minimi (3)
Tubercle of Calcaneus
→ Lat. Base proximal Phalynx
1
2
1
2
3
3
Foot – Layer 2
Long flexor tendons to the toes:
FDL and FHL
Lumbricals *
Tendons of FDL
→ Med. side of dorsal tendon expansion
Quadratus Plantae (QP)
Med. and Lat. surfaces of Calcaneus
→ Lateral side of FDL tendon
* * **
QPQP
FDLFDL
FHL
FHL
* * **
Layers 1 & 2
Foot – Layer 3Flexor Hallucis Brevis
Cuboid and Lat. Cuneiform
→ Both sides base Proximal Phalanx
Adductor Hallucis
Transverse head: Plantar ligament of MTPJoints
Oblique head: Base metatarsals 2&4
→ Lat. side base Proximal Phalanx
Flexor Digiti Minimi Brevis*
Base 5th Metatarsal
→ Base Proximal Phalanx
FHB
FHB FHB
Ad H
Ad H
Ad H
Ad H
**
Foot – Layer 4
Interossei3x Plantar Interossei
Bases and Med. side of Metatarsals 3-5 (unipennate)
→ Med. side of proximal phalanx of 3rd -5th digit
PAD – Plantar ADduct
4x Dorsal Interossei
Adjacent sides of Metatarsals 1-5 (bipennate)
→ 1st on med. side proximal phalanx of 2nd digit
→2nd-4th on lat. side proximal phalanx of 2nd -4th digits
DAB – Dorsal ABduct
Plantar interossei
12
3
Dorsal Interossei
1
12
2
3
3
4
4
Layer 4
Tendons:
Peroneus Longus *
Tibialis Posterior (TP)
LongPlantar
Long
Plantar
*
**
*
TP
TP
TPTP
Layers 3&4
Plantar Nerves
Terminal branches of Tibial nerve deep to flexor retinaculum
Enter foot deep to Abductor Hallucis
Medial Plantar Nerve: Between Abductor Hallucis and FDB
Lateral Plantar Nerve: Between Layers 1&2Deep and Superficial branches
Deep branch btwn Layers 3&4 Tibialnerve
Suralnerve
Medial Plantar Nerve:Abductor HallucisFlexor digitorum brevis1st Lumbrical Flexor hallucis brevis
Lateral Plantar Nerve:
All other muscles
S2, 3
Innervation of Muscles of Foot
MedialPlantar n.
LateralPlantar n.
Cutaneous Innervation of the Foot
SuperficialPeroneal
DeepPeroneal
Saphenous
Saphenous
Dorsal LateralCutaneous of Foot
Dorsal LateralCutaneous of Foot
MedialPlantar
LateralPlantar
CalcanealBranches
Plantar Arteries
Terminal branches of Posterior Tibial artery deep to flexor retinaculum
Enter foot deep to Abductor Hallucis
Medial Plantar artery: Muscles of hallux and overlying skinOccassionally: Superficial Plantar Arch
Lateral Plantar artery: Initially btwn Layers 1 and 2
Deep Plantar Arch btwn Layers 3 and 4Deep Plantar a. from Dorsalis Pedis
Plantar Metatarsal and Digital aa.
MedialPlantar a.
LateralPlantar a.
SuperficialPlantar Arch
DeepPlantar Arch