The Hay is in the Barn

Transcription

1 Anatomy 1 Practical 1 Review Made by Forrest Allen (nerd) Edited by TJ Williamson (not nerd) The Hay is in the Barn 2019 Thunderbringers

2 Too much to handle d8

3 Cutaneous Innervation

4 5 Compartments of the Foot 3 on sole: Medial, Central and Lateral compartments Interosseus compartment (between metatarsals) Dorsal compartment

5 Foot Stuff How many muscles are in the feet?

6 Foot Stuff 20 Bones? 26 Joints? 33

7 Foot Stuff What is the function of plantar muscles? They function primarily during the support phase of stance, maintaining the arches of the foot They also resist forces that tend to reduce the longitudinal arch as weight is received at the heel and then transferred to the ball of the foot and great toe

8 Feet are like Ogres too Focus on the layers, but understand that they don t peel back in perfect layers during dissection There are 4 of them Focus on the muscles but know which layer the arteries and nerves are in Medial and lateral plantar arteries and nerves are all in 1 st layer Plantar arch and branches are in 3 rd layer

9 Layer 1 Immediately deep to the plantar aponeurosis, you see flexor digitorum brevis muscle Abductor hallucis and abductor digiti minimi muscles Medial and lateral plantar arteries (what are these a branch of?) Medial and lateral plantar nerves (what are these a branch of?)

10 Layer 2 Tendons of flexor digitorum longus Lumbricals Quadratus plantae Tendon on flexor hallucis longus

11 Layer 3 Adductor hallucis ( 7 muscle ): transverse head and oblique head Flexor hallucis brevis Flexor digiti minimi Plantar arch and its branches (arteries)

12 Layer 4 Planter interossei Tendinous insertion of tibialis posterior Dorsal interossei Tendon of fibularis longus You will also see the ligaments Long plantar ligament Short plantar ligament Spring ligaments

13 Proper digital nn. Nerves of the Plantar Foot Common digital nerve Medial plantar nerve A D M FDB Lateral plantar nerve

14 Nerves of the Plantar Foot Proper digital nerves Common digital nerve Superficial br. Of the lateral plantar n. Medial plantar nerve Deep br. of the lateral plantar n. Lateral plantar nerve

15 Arteries of the Foot

16 Muscle Origin Insertion Innervation Blood supply Action Flexor digitorum brevis Abductor hallucis Abductor digiti minimi Quadratus plantae Lumbricals Flexor hallucis brevis Flexor digiti minimi Adductor hallucis oblique head Adductor hallucis transverse head Plantar interossei Dorsal interossei medial tubercle of calcaneal tuberosity medial tubercle of calcaneal tuberosity and flexor retinaculum medial and latearl tubercles of calcaneal tuberosity and plantar aponeurosis plantar surface of calcaneus and long plantar ligament tendons of flexor digitorum longus plantar surface of the cuboid, latearl cuneiform, tendon of tibialis posterior base of 5th MT and tendon of tibialis posterior bases of MT's 2-4 plantar MTP ligaments of 3rd-5th digits bases and medial surfaces of 3rd-5th MT's each by 2 heads from the sides of the shafts of adjacent MT's middle phalanx of lateral 4 toes via 4 separate tendons medial side of base of the proximal phalanx of the 1st digit lateral side of base of proximal phalanx of 5th digit tendon of flexor digitorum longus dorsal digital expansion over lateral 4 digits both sides of the base of the proximal phalanx of 1st digit lateral side of the base of the proximal phalanx of the 5th digit lateral side of the base of the proximal phalanx of the 5th digit base of the proximal phalanx of the 1st digit via common tendon with oblique head bases of the proximal phalanges of 3rd-5th digits bases of the proximal phalanges and digitial expansions of 2nd-4th digits medial plantar nerve (S2-3) medial plantar nerve (S2-3) lateral plantar nerve (S2-3) lateral plantar nerve (S2-3) 1st = medial plantar nerve; 2nd-4th = lateral plantar nerve (S2-3) medial plantar nerve (S2-3 superficial branch of the lateral plantar nerve (S2-3) deep branch of lateral plantar nerve (S2-3) deep branch of lateral plantar nerve (S2-3) lateral plantar nerve (S2-3) lateral plantar nerves (S2-3) medial plantar artery medial plantar artery lateral plantar artery lateral plantar artery flexes lateral 4 toes abducts and flexes 1st digit, maintains medial longitudinal arch Abduct and flex 5th digit flexion of lateral 4 digits medial and flexes MTP's and extends IP's lateral plantar of lateral 4 digits arteries medial plantar artery lateral plantar artery lateral plantar artery lateral plantar artery lateral plantar artery lateral plantar artery flexes MTP joint of 1st digit flexes MTP joint of 5th digit Adduction of 1st digit Adduction of 1st digit ADDuct 3rd-5th digits and flex MTP joints of 3rd-5th digits ABducts 2nd-4th digits and flexes MTP joints of 2nd-4th digits

17 Innervation and blood supply Which muscles are supplied by medial plantar nerve and artery?

18 Innervation and blood supply FDB, abductor hallucis, flexor hallucis brevis And first lumbrical

19 Innervation and blood supply Which muscles are supplied by lateral plantar nerve and artery?

20 Innervation and Blood supply Abductor digiti minimi, flexor digiti minimi, quadratus plantae, adductor hallucis, plantar and dorsal interossei

21 Iliolumbar ligament Anterior sacroiliac ligament The Hip A L L Iliofemoral ligament Pubofemoral ligament

22 The Knee Lateral meniscus Anterior and posterior cruciate ligaments Medial meniscus Fibular collateral ligament Tibial collateral ligament

23 The Knee ACL Medial meniscus Lateral meniscus PCL Post. Meniscofemoral ligament

24 The Ankle

25 The Foot Tendon of fibularis longus Long plantar ligament Short plantar ligament (plantar calcaneocuboid lig.) Spring liament (plantar calcaneonavicular lig.) Tendon of tibialis posterior

26 Lumbar Plexus I mentioned a few weeks ago as being really important Network of nerves formed by the ventral rami of L1-4 They receive gray rami communicantes from sympathetic trunk (which is where all sympathetics originate from T1-L2 lateral horn cells) Don t worry about sympathetics now, but pack this away in your brain for next tri

27 Branches of Lumbar Plexus Gray ramus communicans Subcostal n. (T12) Iliohypogastric n. (L1) Sympathetic trunk Ilioinguinal n. (L1) Genitofemoral n. (L1/L2) Lat. femoral cutaneous n. (L2/L3) Obturator n. (L2-L4) Genitofemoral n. 1. Femoral Br. 2. Genital Br. Femoral n. (L2-L4)

28 Cutaneous Nerves of the Thigh/Leg Subcostal Lateral femoral cutaneous Anterior femoral cutaneous (Br. of the femoral n.) Genitofemoral (femoral branch) Ilioinguinal Obturator Cut. Br. of Iliohypogastric Lateral femoral cutaneous Posterior femoral cutaneous Lateral sural cutaneous Saphenous (Br. of the femoral n.) Lateral sural cutaneous

29 Compartments of the Thigh Anterior Compartment Muscles that extend the knee joint and help flex the hip Femoral N. (L 2, 3, 4) Medial Compartment Muscles that adduct and help flex the hip Obturator N. (L 2, 3, 4) Posterior Compartment Muscles that flex the knee and extend the hip Sciatic N. (L 4 S 3)

30 Anterior Thigh What is the chief artery of the thigh? What is it a branch of?

31 Anterior Thigh Profunda femoris, which is a branch of femoral artery

32 Anterior Thigh What does profunda femoris give off in the anterior thigh?

33 Anterior Thigh Medial and lateral femoral circumflex What does lateral femoral circumflex nourish?

34 Vastus lateralis Anterior Thigh

35 Anterior Thigh What are the rest of the quadriceps nourished by?

36 Femoral artery Anterior Thigh

37 Anterior Thigh Where does femoral artery travel? What does it become after that?

38 Anterior Thigh Travels down the anterior thigh, through the adductor canal and out the adductor hiatus in the posterior thigh to become the popliteal artery

39 Anterior Thigh What does the great saphenous vein run with?

40 Anterior Thigh Saphenous nerve What is that a branch of?

41 Femoral nerve Anterior Thigh

42 Boundaries of Femoral Triangle Superior/base: inguinal ligament Lateral: sartorius muscle Medial: adductor longus Apex Roof: Fascia lata Floor: iliacus, psoas major, pectineus Contents: femoral nerve, femoral artery, femoral vein and their branches Nerve to vastus medialis Profunda femoris, medial and lateral femoral circumflex arteries, muscular branches Great saphenous vein

43 Femoral sheath Fascial tube that encloses proximal parts of femoral artery and vein, allowing them to glide past the inguinal ligament during movements of the hip 3 compartments: Lateral: location of femoral artery Intermediate: location of femoral vein Medial: forms femoral canal

44 Horizontal Section of Proximal Thigh (Inferior View) Inguinal ligament Iliacus Psoas major Femoral N. Femoral A. Femoral V. Lymph node Pectineus Obturator canal

45 Femoral canal Forms from medial aspect of femoral sheath Allows femoral vein to expand during increased venous return from lower extremity Site of femoral hernias, why? Surrounded by weak extraperitoneal fat

46 Anterior Thigh Muscles What is the only muscle to insert on the lesser trochanter of the femur?

47 Anterior Thigh Muscles Iliopsoas muscle

48 Thigh muscles What are the 4 quadriceps muscles?

49 Vastus lateralis Vastus intermedius Vastus medialis Rectus femoris Thigh Muscles

50 Anterior Thigh Muscles Where is the vastus intermedius?

51 Anterior Thigh Muscles Deep to rectus femoris

52 Muscular tripod The sartorius combines with the gracilis and semitendinosus to insert on the superomedial tibia (proximal aspect of medial surface of tibia). This complex is called pes anserinus.

53 Thigh Muscles What are all 4 quadriceps muscles innervated by?

54 Thigh muscles Femoral nerve (L2-4) Which specific branch of femoral nerve innervates the vastus medialis?

55 Thigh muscles Nerve to vastus medialis***

56 Anterior Thigh All 4 muscles of the quadriceps unite to form what?

57 Anterior Thigh Quadriceps tendon What does this attach to and then what does it continue as?

58 Anterior Thigh Quadriceps tendon attaches to the patella and then continues as the patellar ligament to insert on the tibial tuberosity

59 Anterior Thigh Where does the straight head of the rectus femoris originate? Where does the reflected head of the rectus femoris originate?

60 Anterior Thigh Straight head: AIIS Reflected head: rim of acetabulum

61 Medial Femoral Group Thigh Master Squeeze Adductor magnus, pectineus, obturator externus, adductor longus, adductor brevis, gracilis All adduct the thigh except 1 Obturator externus laterally rotates All innervated by obturator nerve except 2 Adductor magnus innervated by posterior division of obturator nerve and tibial nerve) Pectineus innervated by femoral nerve

62 Medial Femoral Group Thigh Master Squeeze Which medial femoral muscles are innervated by anterior division of obturator nerve?

63 Medial Femoral Group Thigh Master Squeeze Gracilis, adductor longus, adductor brevis

64 Medial Femoral Group Thigh Master Squeeze Which medial femoral muscles are innervated by posterior division of the obturator nerve?

65 Medial Femoral Group Thigh Master Squeeze Obturator externus Adductor magnus Also contributions from tibial nerve remember?

66 Medial Femoral Group Thigh Master Squeeze Where is the anterior branch of the obturator nerve?

67 Medial Femoral Group Thigh Master Squeeze Between adductor longus and adductor brevis

68 Medial Femoral Group Thigh Master Squeeze Where is the posterior branch of the obturator nerve?

69 Medial Femoral Group Thigh Master Squeeze Superficial to the obturator externus and then travels between adductor brevis and adductor magnus

70 Cutaneous Nerves of Lower Extremity Lateral sural n. Saphenous n Lateral sural n. Superficial fibular n.

71 Cutaneous Nerves of the Foot/Ankle

72 Anterior Leg Muscles Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis tertius All innervated by deep fibular nerve (L4-5) All nourished by anterior tibial artery Main action is to dorsiflex foot Tibialis anterior also inverts EHL extends IP joint of hallux, contributing to DF Fibularis tertius also everts foot

73 Tendons of Anterior Compartment Muscles

74 Lateral Leg Muslces Fibularis longus Fibularis brevis Both innervated by superficial fibular nerve (L5-S2) Both nourished by fibular artery (What is fibular artery a branch of?) Action is eversion of the foot

75 Dorsal Foot Muscles Extensor digitorum brevis Extensor halllucis brevis Both innervated by deep fibular nerve (L5-S1) Both supplied by dorsalis pedis artery

76

77 Arteries

78

79 Deep Nerves of the Anterior Leg

80 Spinal levels What are the spinal levels of femoral nerve? Obturator nerve? Sciatic nerve? Tibial nerve? Common fibular nerve? Superior gluteal nerve? Inferior gluteal nerve?

81 Spinal levels Femoral: L2-4 Obturator: L2-4 Sciatic: L4-S3 Tibial: L4-S3 Common fibular: L4-S2 Superior gluteal: L4-S1 Inferior gluteal: L5-S2

82 Osteology

83 Osteology

84 Dermatomes

85 Nerves and Veins Superficial to the Deep Fascia

86

87 Deep Nerves of the Anterior Leg