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(muscularchartkey=NAME/ORIGIN/INSERTION/ACTION/INNERVATION) SUPERFICIALBACKANDSHOULDERREGION: Extrinsicmusclesoftheupperlimb:superficialback(5),pectoral(4) Intrinsicmusclesoftheupperlimb:shoulder(6),arm(4),forearm(20),hand(19) RELEVANTSKELETALCOMPONENTS: o Vertebralcolumnspinousprocess,transverseprocess o Clavicle(collarbone):medial&lateralsurfaces,superior&inferiorsurfaces o Scapula:acromion,coracoidprocess,glenoidcavity,neck,angles&borders,supra& intraglenoidtubercles,suprascapularnotch,subscapularfossa,spine,supraspinous fossa,infraspinousfossa o Humerus:head,anatomicalneck,greatertubercle,lessertubercle,intertubercular sulcus(bicipitalgroove),deltoidtuberosity SUPERFICIALBACKMUSCLES(5):
Trapeziusmuscle skull,ligamentumnuchae, spinousprocessesofT1T12 lateral(acromial)1/3 ofclavicle,acromion process,scapular spine floorofbicipital grooveofhumerus elevatescapula(upperfibers), retractscapula(middlefibers), pullmedialborderofscapula, orientingglenoidfossaupward (lowerfibers) armextension,armadduction, medialrotationofarm accessorynerve, branchesofVPR ofC3andC4
Latissimusdorsi
Levatorscapulae
thoracodorsal nerve
Rhomboidminor
Rhomboidmajor
superiorportionof medialborderof scapula medialborderof scapula,justmedial tobaseofspineof scapula lowerportionof medialborderof scapula
pullscapulamedially,elevate scapula
dorsalscapular nerve
Deltoid muscle
Suprascapular nerve(C5C6) Suprascapular nerve(C5C6) lower(C5C6)and upper(C5) subscapular nerves axillarynerve(C5 C6) lowersubscapular nerve(C5C6)
Teresminor
Teresmajor
DEEPBACK&VERTEBRALCOLUMN VERTEBRALCOLUMN: o 33vertebrae=>24truevertebrae=>7cervical,12thoracic,5lumbar,5sacral,4 coccygeal o Function:protectspinalcord&providesasupportingstructure o Curvatures(presentingonanterioraspect) 2concavities=thoracicregionandsacralregion(primarycurvatures=present atbirth);2convexities=cervicalregionandlumbarregion(secondary curvatures=NOTpresentatbirth) Vertebrae o Typicalvertebra: Anteriorbody,vertebralforamen,posteriorvertebralarch(pedicleslaterally, laminaposteriorly),7processes:1spinous,2transvers,4articular(2superior, 2inferior) Facetjointsbetweenarticularprocessesofvertebraeabove/beloweachother
Rulesofshouldermuscles: o Alloriginatefromthescapula(someinpart)andinsertonthehumerus STERNOCLAVICULARJOINT st o Skeletalcomponents:medialclavicle,manubrium,1 costalcartilage o Synovialplanejoint;articulardiscdividesthejointspaces LateralCompartment:elevation(superiorsliding)ofjointby sternocleidomastoid,trapezius,levatorscapulae,rhomboids;depression (inferiorsliding)ofjointbypectoralisminor,subclavius MedialCompartment:anteriorslidingofjointbyserratusanterior;posterior slidingofjointbytrapezius,rhomboids o Ligaments:sternoclavicular=surroundsarticularcavitiesofjoint;costoclavicular= st connects1 ribtoclavicle ACROMIOCLAVICULARJOINT o Skeletalcomponents:lateralclavicle,acromionofscapula o Wedgeshapedarticulardisc o Ligaments:acriomioclavicular(superior&inferior)=surroundsthejoint; coracoclavicular(trapezoidlaterally&conoidmedially)=connectclavicletocoracoid process o Innervation:supraclavicularN,medial&lateralpectoralNN,axillaryN GLENOHUMERALJOINT o Skeletalcomponents:glenoidfossaofscapula,headofhumerus o Ballandsocketjoint;though,glenoidfossaisrathershallow,depthincreasedby fibrocartilageringcalledglenoidlabrum o Synovialcavity:attachedtoedgesofarticularsurfaces;extensions=synovialsheathof bicepslongheadtendonandsubscapularisbursa o ANTERIORSUPPORT: Ligaments:superior,anterior,inferiorglenohumeralligaments;transverse humeralligament(overbicipitalgroove) Muscular:subscapularis o SUPERIORSUPPORT: Skeletal:acromion&coracoidprocess Ligaments:coracoacromial&coracohumeral Muscular:supraspinatus,longheadofbiceps o POSTERIORSUPPORT: Muscular:infraspinatus,teresminor o Bursae:Subdeltoidbursa,subacromialbursa,subscapularbursa(deeptosubscapularis)
Superiorarticularprocessesarticulatewithinferiorarticularprocesses fromvertebraabove(oppositetrueforinferiorarticularprocesses) o Intervertebraldisc Shockabsorberallowingformovement Nucleuspulposus:centerofdiscconsistsofwatery,gelatinoussubstance Annulusfibrosus:peripheryofdiscmorefibrouscartilage(thickeranteriorly thanposteriorly) o Cervicalvertebra: Foramentransversariumallowspassageofvertebralveinthroughthe7cervical vertebrae,w/vertebralarterypassingthroughupper6cervicalvertebrae Groovesintransverseprocessesforspinalnerves Uncinateprocess(inferioraspectofvertebralbody)foundinarticulation betweenvertebralbodiesandintervertebraldiscs Spinousprocessesarebifid(exceptC1andC7) Articulatingsurfacesareflatter:superiorarticulatingsurfacesareoriented upward;inferiorarticulatingsurfacesareorienteddownward o Atypicalcervicalvertebrae Atlas(C1):novertebralbodyorspinousprocess;articularsurfacesonupper aspectareforoccipitalcondyles(formovementofskullinnoddingyes) Axis(C2):odontoidprocessprojectssuperiorlyfromsuperioraspectofbody NointervertebraldiscbetweenC1C2 CruciateligamentbetweenC1C2consistsoftransverseligamentof atlasandsuperior&inferiorlongitudinalbands o Thoracicvertebra: Vertebralbodyismediumsizedandheartshapedw/circularvertebralforamen Spinousprocessislongandslopingdownward Costalarticularsurfacescanbefoundonposterolateralsidesofvertebralbody Costalfacetsfoundontransverseprocessesforarticulationwith tubercleofmatchingrib(notransversefacetsarefoundonT11T12) Superiorarticulatingsurfacesfaceposteriorly;inferiorsurfacesfaceanteriorly o Lumbarvertebra: Large,kidneyshapedvertebralbodywithtriangularvertebralforamen Longandslendertransverseprocesses(L3transverseprocessesbeingwidest) Superiorarticulatingsurfacesfacemedially;inferiorfacelaterally Sacrum:fusionof5sacralvertebrae o SuperiorlyintervertebraldiscL5S1;inferiorlycoccyx;laterallyarticulationsw/iliac portionsofpelvicbones o Sacralcanalextendslengthofsacrumforthecaudaequina:anteriorandposterior sacralforaminaexistforventralanddorsalprimaryramiofsacralnerves Ligamentsofspinalcolumn: o Anteriorlongitudinalligamentwide,strongligamentrunninglongitudinallyoverentire lengthofanteriorandlateralsurfacesofvertebralbodies o Posteriorlongitudinalligamentw/invertebralcanal,runninglongitudinallyoverlength ofposteriorsurfaceofvertebralbodies o Ligamentumflavumligamentsrunningsegmentallybetweenvertebrallaminae o Interspinousligamentsrunbetweenadjacentspinousprocesses o Supraspinousligamentrunslongitudinallyoverandbetweenthespinousprocesses(in cervicalregion,ligamentisthickerandknownasligamentumnuchae) o Noligamentsrunbetweenpediclessoastoallowspinalnervestoexit SPINALCORD o 31pairsspinalnerves:8cervical,12thoracic,5lumbar,5sacral,1coccygeal
NOTE:C1C7exitvertebralcolumnABOVEtheirmatchingvertebrae,C8nerve exitsBELOWC7vertebra,andallspinalnervesinferiortoC8exitBELOWtheir matchingvertebrae Anteriorrootletsofaspinallevelformanterior(ventral)rootofthatlevel; posteriorrootletsofalevelformposterior(dorsal)rootofthatlevel o SpinalcordstopsaroundL1L2withconusmedularisandbecomesthecaudaequina Duetodifferentialgrowthofvertebralcolumnandsofttissueofspinalcord o Transversesectionofspinalcord: Whiteandgraymatter,anteriormedianfissure,posteriormediansulcus, dorsal,ventralhornsofgraymatter(lateralhorninT1L2or3only) o MENINGES(3layerssurroundingspinalcord): Duramater:(continuousw/duramatercoveringbrain)tough,protective, impermeableoutermostlayerenclosingspinalcordandcaudaequinaand endingataroundS2uponexitingintervertebralforamen,becomes continuousw/epineuriumsurroundingspinalnerve Arachnoid:(continuousw/arachnoidcoveringbrain)delicate,impermeable membranedeeptoduramater,separatedfrompiamaterbysubarachnoid spacefilledwithcerebrospinalfluid(CSF) Piamater:vascularmembranecoveringspinalcorditself,separatedfrom arachnoidbyCSF,endingataroundL1w/filumterminale denticulateligaments:formedfromlateralthickeningofpiamater, attachingtoduramaterbetweennerveroots o BLOODSUPPLYTOSPINALCORD 3mainlongitudinalarteries:2posteriorspinalarteries,anteriorspinalartery Radiculararteriesenterintervertebralforaminatoanastomosew/the3above Bloodsupplyarisesdirectlyorindirectlyfromvertebralarteriesorintercostal andlumbararteriesfromaorta o Venousnetworkofvertebralcolumn Internalandexternalvertebralvenousplexuses:valvelesssystemofveins drainintobasivertebralveins=>intervertebralveins=>vertebral,intercostal, lumbarveins MUSCLESOFDEEPBACK(apparentlynotthatimportantforourintentsandpurposes) o Innervatedbyposteriorprimaryramiofspinalnerves o 3groups:erectorspinaemuscles,transversospinalismuscles,deepestgroupmuscles o ERECTORSPINAE: Spinalismuscle(medially);Longissiumusmuscle(intermediate);Iliocostalis muscle(laterally) Erectorspinaemusclesdeeptobothserratusposteriorsuperior&inferior o TRANSVERSOSPINALIS&DEEPESTGROUP: Transversospinalismuscles:Semispinalis,mulitifidus,rotators Deepestgroupmuscles:Intertransversarii,interspinales Posturalmusclesdesignedtomaintainpostureasextensorsofthetrunk
Pectoralismajor
BRACHIALPLEXUS(seediagram) Brachialplexus=anetworkofnervesformedbytheventralprimaryramiofspinalnervesC5T1 o ROOTS(neck):C5,C6,C7,C8,T1 o TRUNKS(neck):Upper=C5andC6join;Middle=C7continues;Lower=C8andT1join o DIVISIONS(neck):AnteriorandPosterior o CORDS(axilla):Lateral=anteriordivisionsofupperandmiddletrunks;Posterior=all posteriordivisions;Medial=anteriordivisionoflowertrunk o BRANCHES(axilla):fromRoots(2);fromTrunks(2);fromCords(13) ROOTBRANCHES: o 1)DorsalScapularn:C5,innervatesrhomboidmuscles o 2)LongThoracicn:C5C7,innervatesserratusanterior TRUNKBRANCHES: o 1)Suprascapularn:UpperTrunk(distal),innervatessupraspinatusandinfraspinatus muscles o 2)NervetoSubclavius:UpperTrunk(proximal),innervatessubclaviusmuscle CORDBRANCHES: o 1)Lateralpectoraln:LateralCord,innervatespectoralismajor o 2)LateralrootofMediann:LateralCord,innervatesforearmandhand o 3)Musculocutaneousn:LateralCord,innervatesmusclesofanteriorcompartmentof armandskinoflateralforearm o 4)Uppersubscapularn:PosteriorCord,innervatessubscapularmuscle o 5)Lowersubscapularn:PosteriorCord,innervatessubscapularandteresmajormuscles o 6)Thoracodorsaln:PosteriorCord,innervateslatissimusdorsimuscle o 7)Axillaryn:PosteriorCord,innervatesdeltoidandteresminormuscles o 8)Radialn:PosteriorCord,innervatesallextensormusclesofarmandforearm o 9)Medialpectoraln:MedialCord,innervatespectoralismajorandminor o 10&11)Medialcutaneousnervesofarmandforearm:MedialCord,innervateskinof armandforearmrespectively o 12)MedialrootofMediann:MedialCord,innervatesforearmandhand o 13)Ulnarn:MedialCord,innervatesmusclesofforearmandhand AXILLARYLYMPHATICS o Thereareusually2030lymphnodesintheaxilla.Theydrainthesuperficialanddeep tissuesoftheupperlimb,thelateralbreast,andthesuperficialthoraxandabdomen abovetheleveloftheumbilicus. o 1)Pectoral(anterior)nodes:(levelI)foundalonglowerborderofpectoralisminor, drainlateralquadrantsofthebreastandsuperficialchestandabdomenabovethe umbilicus o 2)Subscapular(posterior)nodes:(levelI)foundonsubscapularismuscle,drain superficialareasofthebackdowntotheleveloftheiliaccrest o 3)Lateralnodes:(levelI)foundalongaxillaryvein,drainsmostoflymphfromtheupper limb o 4)Centralnodes:(levelII)foundinthecenteroftheaxillaryfat,collectlymphfromthe pectoral,subscapularandlateralgroupsofnodes
BREAST o ArterialSupply: Medialquadrantsinternalthoracicarterybranches Lateralquadrantslateralthoracicartery,thoracoacromialartery o VenousDrainage: Medialquadrantsinternalthoracicvein Lateralquadrantsaxillaryveintributaries o Lymphatics: Lateralquadrantspectoralnodes>centralnodes>apicalnodes Medialquadrantsparasternalnodes o MAMMARYGLAND: Subcutaneous,exocrineglandwith1520lobes Connectivetissueseptasurroundinglobes(withsuspensoryligamentsinupper quadrants) Retromammaryspace(surgicalplane):Connectivetissueseparatingthe mammaryglandandassociatedfattytissuefromthepectoralismajor
ARM
RELEVANTSKELETALCOMPONENTS: o Humerus:radialgroove(posterior),medialandlateralepicondyles,medialandlateral supracondylarridges,capitulum(lateral),trochlea(medial),radialfossa,coronoidfossa, olecranonfossa o Radius:head,neck,radialtuberosity o Ulna:olecranonprocess,coronoidprocess,trochlearnotch,radialnotch,ulnar tuberosity Brachialfascia:deepfasciasurroundingentirearm Medialandlateralintermuscularseptaemakeanteriorandposteriorcompartmentsofbrachium ANTERIORCOMPARTMENTMUSCLES(3):
longheadsupraglenoid tubercleonscapula; shortheadcoracoid process coracoidprocessofthe scapula(commontendon w/shortheadofbiceps) anterioraspectofdistal halfofhumerus(large surfaceoforigin) posteriorportionofthe radialtuberosity,bicipital aponeurosisinsertsinto medialsideof antebrachialfascia anterioraspectofthe middleshaftofthe humerus coronoidprocessofulna strongflexionandsupination ofantebrachiumatelbow, weakflexoroftheshoulder musculocutaneous nerve
Bicepsbrachii
Coracobrachialis
Brachialis
Triceps
FOREARM RELEVANTSKELETALCOMPONENTS: o DistalHumerus,radius,ulna o Carpals:scaphoid,lunate,triquetrum,pisiform,trapezium,trapezoid,capitate,hamate o Metacarpalbones:1(+2sesamoidbones),2(+1sesamoidbone),3,4,5(metacarpal) st o ProximalPhalanges,MiddlePhalanges(absentin1 digit=thumb),DistalPhalanges COMPARTMENTS:Theanteriorcompartmentisseparatedfromtheposteriorbytheradiusand ulna,theinterosseousmembrane,andthelateralandmedialintermuscularseptae ANTERIORCOMPARTMENTMUSCLES(8): o SUPERFICIALANTERIORLAYER(4):
Pronatorteres superficialheadmedial supracondylarridge/common tendononmedialepicondyle,deep headmedialborderofcoronoid processofulna commontendononmedial epicondyle commontendononmedial epicondyle commontendononmedial epicondyle,medialolecranonand ulna medialepicondyle,medialpartof ulnartuberosityandcoronoid process,obliquelineonradius lateralsurfaceof radius pronationoftheforearm rotatestheradiusmedially mediannerve
CUBITALFOSSA: o Borders:proximallinebetweenlateralandmedialepicondyles;lateral brachioradialismuscle;medialpronatorteresmuscle;superficial(roof)skin,fascia, bicipitalaponeurosis;deep(floor)supinatormuscle(laterally),brachialismuscle (medially) o Contents: Superficial:Bicepsbrachiitendon,brachialartery,mediannerve(Tendon, Artery,Nerve=TAN) Deep:Radialnerveanditsdeepbranch,beginningofulnarandradialarteries VENOUSDRAINAGE: o Basilicvein(medially),Cephalicvein(anteriolaterally),mediancubitalvein(anterior connectscephalicandbasilicatcubitalfossa) ELBOWJOINT: o Skeletalcomponents:Humerus(capitulum&trochlea),headofradius,headofulna o Articulations:Humeruscapitulumw/headofradius;humerustrochleawithtrochlear notchofulna o Synovialcavity:synovialmembranelinesjointcapsuleandiscontinuousw/thatof proximalradioulnarjoint o Ligaments:radialcollateralligament(attachestoannularligament),ulnarcollateral ligament(anterior,posteriorandtransversebands)annularligament(crossesfromulna overtoposterolateralradius,createssacciformrecessofsynovial) o Muscular:muscularsupportcomesfrombicepsbrachiiandbrachialistendons
nd
rd
o
Flexordigitorum superficialis
INTERMEDIATEANTERIORLAYER(1):
4tendonsinsertonMIDDLE phalangesof2,3,4,and5(digits) Flexionof digits2,3,4,5 AtPIPjoint mediannerve
o
Flexordigitorum profundus Flexorpollicis longus Pronator
DEEPANTERIORLAYER(3):
proximal2/3ulnaand interosseousmembrane middleradiusand interosseousmembrane distalofulna 4tendonsinserton DISTALphalangesof2,3, 4,and5(digits) distalphalanxofthumb (pollux) anteriordistalradius Flexionofdigits2,3,4,5 atDIPJoint flexionofdistalthumb pronationofforearm anteriorinterosseous n/mediannlaterally; ulnarnervemedially anteriorinterosseous nerve/mediannerve anteriorinterosseous
quadratus
rotatesradiusmedially
nerve/mediannerve
NOTE:theanteriorinterosseusnerveisabranchofthemediannerve o Rulesfortheanteriorcompartmentmusclesoftheantebrachium(forearm) AllmusclesareinnervatedbythemediannerveEXCEPTflexorcarpiulnarisand partofflexordigitorumprofundusmedially(bothulnarn) o FDSandFDPtendonstomiddleanddistalphalangesrespectivelypassthroughsynovial sheathsinosseofibroustunnelsofdigits Fibrousflexorsheathanteriorlyandonsides,bonesofphalangesposteriorly Annularportionsoffibroussheatharelooped(5)andcruciformportionsare crossed(4) Visceralsynoviallayerofenclosestendon;Parietalsynoviallayerlinesinner surfaceoffibrousflexorsheath o FLEXORSYNOVIALSHEATHS: RadialBursa=surroundstendonofFlexorpollicislongus UlnarBursa=surrounds8tendonsofFlexordigitorumsuperficialisandFlexor th digitorumprofundus;communicateswithdigitalsynovialsheathof5 digit DigitalSynovialSheaths=eachsurroundsFDSandFDPindigits2,3,and4 o RELATIONSHIPSINWRIST: Laterally>Medially=Abductorpollicislongustendon,radialartery,flexor carpiradialistendon,mediannerve,Palmarislongustendon,Flexordigitorum superficialistendons,ulnarartery,ulnarnerve,Flexorcarpiulnaristendon POSTERIORCOMPARTMENTMUSCLES: o SUPERFICIALLAYERMUSCLES(7):
upper2/3oflateral supracondylarridge baseofstyloidprocessof radius flexionofforearmatelbow joint,assistsinlateralrotationof theforearmfromfullpronation, assistsinmedialrotationfrom fullsupination extendsandabductshandatthe wrist radialnerve (C5,6,7)
Brachioradialis
lower1/3oflateral supracondylarridge
posteriorbaseof2 metacarpal
rd
nd
posteriorbaseof3 metacarpal 4tendonsinsertatbaseof middleandbaseofdistal phalangesviaextensor expansion(hood)ofdigits2, 3,4,5 extensorexpansionforlittle finger posteriorbaseof5 metacarpal lateralsurfaceofolecranon processofulna
th
extendsandabductshandat wrist extendsmetacarpophalangeal joints,assistslumbricalsand interosseiinextendingproximal anddistalinterphalangealjoints extendsmetacarpophalangeal jointoflittlefinger posterioraspectoflateral epicondyle assiststricepsinextensionof forearmatelbow
o
Supinator
deepbranchof radialnerve(C5,6)
Abductor
deepbranchof
pollicislongus
interosseousmembrane
metacarpal
thumbat carpometacarpal joint extends metacarpophalange aljointofthumb extendsdistal phalanxofthumbat interphalangealjoint extends metacarphophalang ealjointofindex finger
radialnerve(C7,8)
HAND SKELETALCOMPONENTS: o Carpalbones:scaphoid,lunate,triquetrum,pisiform,trapezium,trepezoid,capitate, hamate o Metacarpals&Phalanges:Metacarpals(5),Phalanges(14)3ineachdigit(proximal, middle,distal),2inthumb(proximal,distal) st nd o Sesamoidbones:Foundonheadof1 and2 metacarpals Palmaraponeurosis:attachedtoflexorretinaculum,4fibrousslipsextendingtoeachfinger formingapassageforflexortendons,digitalvesselsandnerves THENAREMINENCEMUSCLES:
Abductor pollicisbrevis flexorretinaculumandcarpal bones lateralaspectofthebase oftheproximalphalanxof thethumb(withtheflexor pollicisbrevis) lateralaspectofthebase oftheproximalphalanxof thethumb(withthe abductorpollicisbrevis) entirelengthofthelateral borderoftheshaftofthe firstmetacarpalbone medialsideofthebaseof theproximalphalanxof thethumb abductsthethumbatthe carpometacarpaland metacarpophalangealjoints flexesthethumbatthe metacarpophalangealjoint
NOTE:deepbranchofradialnerveisthesameastheposteriorinterosseusnerve Rulesoftheposteriorcompartmentmusclesofantebrachium: o Allmusclesareinnervatedbythedeepbranchoftheradialnervebrachioradialisand anconeusareinnervatedbyradialnerveproper(apparentlybeforesplitting) RADIOULNARJOINTS: o Proximal:Headofradiusinradialnotchofulna o Distal:baseofulnainulnarnotchofradius o Bothjointsaresynovialpivotjointsresponsibleforpronationandsupination WRIST(RADIOCARPALJOINT): o Skeletalcomponents:distalradiusandtriangularcartilageofulna,scaphoid,lunate, triquetral o Synovialcavity:linedbysynovialmembraneanddoesnotcommunicatewithanyother space o MajorAnteriorligamentsupport:ulnocapitate,capitohammate,longradioulnate, scaphocapitate,trapeziotrapezoid o MajorPosteriorligamentsupport:dorsalradioulnar,dorsalradiocarpal,dorsal intercarpal,scapholunate
mediannerve (recurrent branch mediannerve (recurrent branch) mediannerve (recurrent branch) ulnarnerve (deepbranch)
Flexorpollicis brevis
lateralandanteriorsurfaceof theflexorretinaculum
Lumbrical muscles(4)
Dorsal interossei(4)
Palmar interossei(3)
proximalphalangesand extensorexpansionsofthe index,middle,andring fingers,withthe2muscles beingdedicatedtothe middlefinger baseofproximalphalanges onsideclosesttomiddle finger,andonextensor expansionsoftheindex,ring andlittlefingers
abducttheindex,middleand ringfingers,flexthe metacarpophalangealjoints andextendthe interphalangealjointsof these3fingers adducttheindex,ringand littlefingers,flexthe metacarpophalangealjoints andextendthe interphalangealjointsof these3fingers
ulnarnerve (deepbranch)
Rulesofintrinsicmusclesofthehand: st nd o AllmusclesareinnervatedbythedeepbranchoftheulnarnerveEXCEPTthe1 and2 lumbricals(digitalbranchofmediann) VENOUSDRAINAGE: o Dorsalvenousarch:cephalicveinoriginatesonlateralaspectofdorsalvenousarch, basilicveinoriginatesonmedialaspectofdorsalvenousarch ARTERIALSUPPLY: o Superficialpalmararch: ulnararterypassessuperficialtotheflexorretinaculum,lateraltoulnarnerve andpisiform givesadeeppalmarbranch,curvingdeeptopalmaraponeurosis Anastomoseswithsuperficialpalmarbranchofradialartery Branches:3commonpalmardigitalarterieseachdividesinto2properpalmar digitalarteriestoeachdigitand1tothelittlefinger o Deeppalmararch: Anastomosisofradialarterywiththedeepbranchofulnarartery Deeptolongflexortendonsbutsuperficialtometacarpalbonesand interosseousmuscles 3smallerpalmarmetacarpalarteriesanastomosewiththematchingarteries fromsuperficialarch radialisindicisbranchtolateralsideofindexfinger,pincepspollicisbranchto bothsidesofthumb INTERCARPALJOINTS
SUPERFICIALANATOMYOFTHELOWERLIMB;FEMORALTRIANGLE;SUBSARTORIALCANAL: DEEPFASCIAOFTHETHIGH o Fascialata:denserandtougherthansuperficialfascia Surroundsallmusclesofthethigh Superficialnervesandveinsareexternaltofascialata(superficial) o Greatsaphenousvein:passestofemoralveinthroughsaphenoushiatusinfascialata Falciformmarginonlateraledgeofsaphenoushiatus Tributariesnearsaphenousopening:Superficialcircumflexiliacv,superficial epigastricv,superficialexternalpudendalv,accessorysaphenousvv ILIOTIBIALTRACT o Thickeningoffascialataonlateralsideofthigh o ExtendsfromIliumtoatubercleonthelateralsideofuppertibia(Gerdystubercle) DEEPFASCIAOFLEG o Cruralfascia:distalextensionoffascialata Surroundsallmusclesoftheleg o Greatsaphenousvein:temporarilypassesposteriortokneebeforepassinganterior againdowntheleg;receivesdrainagefrommedialpartofdorsalvenousarchoffoot o Smallsaphenousvein:posterior,superficialveinoflegthatpiercescruralfasciatodrain intopoplitealvein;receivesdrainagefromlateralpartofdorsalvenousarchoffoot o Suralnerve:accompaniessmallsaphenousveinatthelowerpart o Retinaculaofankle:Cruralfasciathickensattheankletoformthesuperiorandinferior extensorretinacula(fordorsiflexion)andtheflexorretinaculum(medial;forplantar flexion) LYMPHATICSOFLOWERLIMB o SuperficialinguinallymphnodesaresuperficialtothefascialataandarrangedinaT withacrossbarparalleltotheinguinalligament Lymphaticsaccompanythegreatsaphenousveintotheverticalsetofnodes Lymphaticsfromthelowerabdominalwall,externalgenitaliaandgluteal regiondrainmainlytothehorizontalnodes o Deepinguinallymphnodesreceivefromsuperficialnodes Deepinguinalnodes=>externaliliacnodes=>lumbar(paraaortic)nodes=> lumbarlymphtrunks CUTANEOUSNERVES o THIGH AnteriorThigh:lumbarplexus=>lateralfemoralcutaneousn,anteriorfemoral cutaneousn MedialThigh:lumbarplexus=>cutaneousbranchesofobturatorn PosteriorThigh:Sacralplexus=>posteriorfemoralcutaneousn o LEG Cutaneousbranchesofsuperficialfibularn,cutaneousbranchesofdeepfibular n,lateralsuraln,suraln
Skeletalcomponents:scaphoid,lunate,triquetral,pisiform,trapezium,trapezoid, capitate,hamate o Synovialcapsule:synovialplanejointsbetweenindividualcarpalbones=midcarpal jointsbetweenrows Sharedsynovialcavitycommunicationw/numerousintercarpalligaments st o Carpometacarpaljoints=synovialplanejointsEXCEPTthumb(saddlejointbetween1 metacarpalandtrapezium) METACARPOPHALANGEALJOINTS o Skeletalcomponents:metacarpals,proximalphalanges o Ligaments:palmar,dorsal,collateral,&deeptransversemetacarpophalangealligaments o Interphalangealligaments:palmar,dorsal,collateralinterphalangealligaments o
FEMORALTRIANGLE: o Boundaries:Superior=inguinalligament;Lateral=medialborderofsartoriusm;Medial =medialborderofadductorlongusm;Roof=fascialata;MuscularFloor=Iliacusm, Psoasm,Pectineasm,Adductorlongusm o Contents:(lateraltomedial)NAVEL=femoralNerve,femoralArtery,femoralVein, Emptyspace,Lacunarligament Arterypassesanteriortoveinatbaseoftriangle(preparationfordivethrough theadductorhiatus) o FemoralNerve:fromlumbarplexus;providesmotortoanteriorcompartmentofthigh muscles;sensorytoanteriorthigh(anteriorcutaneousbranches)andmedialthigh (medialcutaneousbranchesofsaphenousn,infrapatellarbranchofsaphenousn) o FemoralArtery:extensionoftheexternaliliacartery;startsinfemoraltriangleand passesthroughsubsartorialcanal;passesthroughtheadductorhiatusofadductor magnusandbecomespoplitealartery deepfemoralartery(profundafemoris)branchesinferiortoheadoffemur lateralcircumflexartery(passesbetweeniliacusandrectusfemoris) medialcircumflexartery(passesbetweenpsoasandpectineus) 4perforatingbranchesaroundposteriorhumerus FEMORALSHEATH o Continuationoftransversalisfasciaandiliacusfasciafrompelvis o Containsfemoralartery,vein,lymphatics(NOTfemoralnerve) o 3compartments:Femoralartery(lateral),femoralvein(central),femoralcanal(medial) SUBSARTORIALCANAL: o Deeptothesartoriusmuscle,endsatadductorhiatus o Contents:femoralartery,femoralvein,nervetovastusmedialis,saphenousnerve o Relationships(anteriortoposterior):femoralartery,femoralvein,deepfemoralartery, deepfemoralvein;ONLYfemoralarteryandfemoralveinentersubsartorialcanal
GLUTEALREGION: RegionbetweenIliaccrestandglutealfoldofthebuttock Skeletalcomponents: o Sacrum,coccyx,hipbone(Ilium,ischium,pubis,withacetabulum),femur o Hipbone: Ilium(superiorportion,articulateswithsacrum)=iliaccrest,iliactubercle, anteriorsuperioriliacspine,anteriorinferioriliacspine,posteriorsuperioriliac spine,posteriorinferioriliacspine,greatersciaticnotch Ischium(posteroinferiorportion)=ischialspine,lessersciaticnotch,ischial tuberosity,ramus Pubis(anteroinferiorportion)=obturatorforamen(coveredbyobturator membrane),superiorramus,inferiorramus o Femur:head,neck,greatertrochanter(lateral),lessertrochanter(posteriomedial), intertrochantericcrest(posterior),intertrochantericline(anterior),glutealtuberosity SacroIliacjoint:Strongposterior&interosseoussacroiliacligaments,thinanteriorsacroiliac ligament,sacrotuberousligament,sacrospinousligament o Sacrotuberous(superficial)andsacrospinous(deep)ligamentsformgreatersciatic foramen(superiorly)andlessersciaticforamen(inferiorly) HIPJOINT o Synovial,multiaxial,ballandsocketjointdesignedforsupport Acetabulumofhipbonearticulateswithheadoffemur Acetabularlabrum:attachestomarginsofacetabulum,deepensandincreases jointstability,continuousw/transverseligamentofacetabulum
Ligamentsofhipjoint:roundligamentofheadoffemur,transverseligamentof acetabulum,iliofemoralligament(ant.),pubofemoralligament(ant.),ischiofemoral ligament(post.) o Bursae:subtendonosisiliacbursa(deeptopsoasmajor),ischioglutalbursa(inferiorto ischialtuberosity),deeptrochantericbursa(betweengreatertrochanterandgluteus max),superficialtrochantericbursa(betweengreatertrochanterandsubcutaneous tissue o Nervesupply:femoralnerve(L2,3,4),obturatornerve(L2,3,4),accessoryobturator nerve(L3,4),sciaticnerve(L4,5;S1,2,3),nervetoquadratusfemoris(L4,5;S1) o Bloodsupply:obturatorartery,medial&lateralcircumflexfemoralarteries(with retinaculararteriesbranchingoff),superior&inferiorglutealarteries GREATERSCIATICFORAMEN o Contents Superiortopiriformis:superiorglutealnerve,superiorglutealvessels Inferiortopiroformis:sciaticnerve,inferiorglutealnerve,inferiorgluteal vessels,nervetoobturatorinternus,nervetoquadratusfemoris,posterior femoralcutaneousnerve,internalpudendalvessels,pudendalnerve LESSERSCIATICFORAMEN o Contents Onlystructureexiting=obturatorinternusmuscle Entering(afterexitinggreatersciaticforamen)=Pudendalnerve,Internal pudendalvessels,Nervetoobturatorinternus;PINstructures MUSCLESOFTHEGLUTEALREGION(CHART) o
Outersurfaceofilium, posteriorsurfaceofsacrum andcoccyx,and sacrotuberousligament Outersurfaceofilium, betweenposterior& anteriorgluteallines Outersurfaceofilium, betweenanteriorand inferiorgluteallines Outeredgeofiliaccrest, fromanteriorsuperioriliac spinetoiliactubercle Anterolateralborderof sacrum,passesthrough greatersciaticforamen Spineofischium Iliotibialtractandgluteal tuberosityoffemur Extendsandlaterallyrotateship joint,extendstrunkathip, contributestoextensionofknee Powerfulabductorofthethighat thehipjoint,medialrotationof thigh,preventsdownwardtiltof pelviscontralaterally Abductorofthighathip,medial rotationofthigh,prevents downwardtiltofpelvis contralaterally Contributestokneeextension, assistedbygluteusmaximusvia theiliotibialtract Lateralrotatorofthighathip Inferiorgluteal nerve
Gluteusmaximus
Gluteusmedius
Uppersurfaceofgreater trochanter
Superior glutealnerve
Gluteusminimus
Anterioranduppersurface ofgreatertrochanter
Superior glutealnerve
Anterioraspectofiliotibial tract Uppermedialaspectof greatertrochanter w/tendonofobturator internustomedialaspect ofuppertrochanter Medialaspectofupper trochanterwithboth gemelli w/tendonofobturator internusinmedialaspect ofuppertrochanter Quadratetubercle,on intertrocantericcrestof femur
Superior glutealnerve Anteriorrami ofS1andS2 spinalnerves Nerveofthe obturator internus Nerveofthe obturator internus Nerveofthe quadratus femoris Nerveofthe quadratus femoris
Lateralrotatorofthighathip
Lateralrotatorofthighathip
Lateralrotatorofthighathip
Quadratus femoris
Lateralrotatorofthighathip
Superiorglutealn=L4,5;S1=>gluteusmedius,minimus,tensorfacialatae Sciaticn=L4,5;S1,2,3(gigantic) Inferiorglutealn=L5;S1,2=>gluteusmaximus Nervetoobturatorinternus=L5;S1=>superiorgemellus,obturatorinternus Nervetoquadratusfemoris=L5;S1=>inferiorgemellus,quadratusfemoris Posteriorfemoralcutaneousn=S1,2,3 Pudendaln=S2,3,4 o Cutaneousnervesofglutealregion: Uppermedial:Superiorclunealnerves(dorsalramiL13),middleclunealnerves (dorsalramiofS13) Upperlateral:Lateralcutaneousbranchofiliohypogastric(ventralramusofL1), ventralramusofT12 Lowerlateral:Lateralcutaneousnervesofthethigh(ventralramiofL23) Lowermedial:posteriorcutaneousnervesofthethigh(inferiorclunealnerves =ventralramiofS13) GLUTEALREGIONARTERIES o Commoniliacartery=>externalandinternaliliacarteries Internaliliacartery=>anteriorandposteriordivisions Posteriordivision=>superiorglutealartery Anteriordivision=>inferiorglutealartery,internalpudendalartery o Cruciateanastomosis Inferiorglutealartery,lateralcircumflexfemoralartery,medialcircumflex femoralartery,firstperforatingartery
THIGHANDPOPLITEALFOSSA MUSCLESOFANTERIORCOMPARTMENT
Sartorius Iliacus Psoas(major& minor) Pectineus Rectusfemoris (quadriceps) Anteriorsuperioriliacspine Iliacfossa Transverseprocesses& lateralbodiesofT12L5 vertebrae Superiorramusofpubis Straightheadanterior inferioriliacspine;reflected headiliumabove acetabulum Baseofgreatertrochanter, intertrochantericlineand lineaaspera Intertrochantericlineand lineaaspera Anteriorandlateralsurface offemur (lowerfibersofvastus intermedius) Uppermedialsurfaceoftibia Lessertrochanter(common tendonwithpsoas) Lessertrochanter(common tendonwiththeiliacus) Belowlessertrochanterat thelineaaspera Commonquadricepstendon onsuperiorandlateral aspectsofthepatella Commonquadricepstendon Flexesandweaklyabducts, laterallyrotatesthethigh Flexesthethighand stabilizesthehipjoint Flexesthethighand stabilizesthehipjoint Flexesandadductsthe thighatthehip Flexthethigh,extendthe leg Femoralnerve Femoralnerve Ventralramiof L1L3 Femoralnerve Femoralnerve
Flexthethigh,extendthe leg Flexthethigh,extendthe leg Flexthethigh,extendthe leg Pullsynovialmembrane superiorlytoprevent compressionbetween femurandpatella
Femoralnerve
Commonquadricepstendon Commonquadricepstendon
Femoralnerve Femoralnerve
Femoralnerve
Anteriordivision:medialcutaneousnerveofthigh,intermediatecutaneousnerveof thigh,sartoriusbranch,pectineusbranch o Posteriordivision:saphenousnerve,quadricepsbranch FEMORALARTERY o =>profundafemoris:offofprofundafemorisarethelateralcircumflexfemoralartery, medialcircumflexfemoralartery,4perforatingbranches o =>descendinggenicular o =>poplitealartery(uponpassingthroughadductorhiatus) =>5geniculararteriesofkneearterialanastomosis =>anteriorandposteriortibialarteries o Venoustributariestothefemoralveincorrespondtothearterialbranches MUSCLESOFMEDIALCOMPARTMENT o
Frontofthepubicbone Inferiorpubicramus Middle1/3oflineaaspera Upperpartoflineaaspera aboveinsertionofadductor longus adductorposteriorsurfaceof shaftoffemor,lineaaspera andmedialcondyle;hamstring tendontoadductortubercle Upperpartofmedialsurface oftibia Passesbelow,thenbehindhip jointtomedialsurfaceof greatertrochanter Adductsandlaterally rotatesthethigh Adductsandassistsin lateralrotationofthigh Adductsandweakly extendsthethigh Obturatornerve Obturatornerve
Adductorlongus Adductorbrevis
Adductor magnus
Inferiorramus
Gracilis
Ischiopubicramus
Obturator externus
Obturatornerve
Medialcompartmentrules: o AllmusclesareinnervatedbytheobturatornerveEXCEPToftheadductormagnus o AllmusclesservetoadductthethighatthehipEXCEPTobturatorexternus OBTURATORNERVE o Entersmedialthighviaobturatorcanal o Anteriordivision:deeptopectineus,anteriortoadductorbrevis Supplies:gracilis,adductorbrevis,adductorlongus,skintomedialthigh o Posteriordivision:betweenadductorbrevisandadductormagnus Supplies:obturatorexternus,adductormagnus(nothamstring),adductor brevis,skintomedialknee MEDIALCOMPARTMENTBLOODSUPPLY o theprofundafemorisarteryprovidesmusclebranchestotheadductors MUSCLESOFTHEPOSTERIORCOMPARTMENT
Longheadischial tuberosity;shorthead lineaasperaandlateral supracondylarridge Ischialtuberosity Headsuniteabovekneeand commontendoninsertsinto headoffibula Extendsthethigh(long head),flexesandlaterally rotatesthelegattheknee Sciaticnerve (tibialnerve; Shorthead= common fibularnerve) Sciaticnerve (tibialnerve) Sciaticnerve (tibialnerve)
Bicepsfemoris
Semimembranosus
Semitendinosis
Ischialtuberosity
LEGANDANKLE Skeletalcomponents: o Baseoffemur,tibia,fibula o Boneofthefeet:Talus,calcaneus,navicular,cuboid,3cuneiforms,5metatarsals,14 phalanges o Tibia:medialweightbearingboneoftheleg,proximallarticulatesw/condylesofthe femurandtheheadofthefibula,distallyarticulatesw/talusandthebaseofthefibula, containsmedialmalleolus o Fibula:lateralbonethatdoesnottransmitbodyweight,headandneckproximally, lateralmalleolusdistally,articulatesmediallywiththetalus COMPARTMENTS
Tibialnerve:suppliessemimembranosus,semitendonosis,longheadofbiceps, hamstringpartofadductormagnus o Commonfibularnerve:suppliesshortheadofbiceps POPLITEALFOSSA o Superficialcontents:smallsaphenousvein,suralcutaneousnerve(tibialbranch), communicatingbranchandlateralsuralcutaneousnerve(commonfibularbranches), popliteallymphnodes o Deepcontents:poplitealartery&genicularbranchesofanastomosisaroundknee, poplitealvein,tibialnerve,commonfibularnerve,fat&lymphnodes KNEEJOINT o Lateralknee:Iliotibialtract,headoffibula,bicepsfemoristendon,commonfibular nerve o Medialknee:Pesanserinus:footofthegoose=tendonsofsartorius,gracilis, semitendinosus o Synovialcondylarjointbetweenmedialandlateralfemoralandtibialcondyles;also glidingjointbetweenpatellaandpatellarsurfaceoffemur Medialcondylararticulationislargerandovalshaped Lateralcondylararticulationissmallerandcircularshaped o Menisci: Semilunarfibrocartilaginouspads;peripheralborderisthickerandattachedto thecapsule;innerborderisthinner,creatingafreeedge Servetocompensateforincongruitybetweenfemurandtibia(createasortof cuppingforjointstability o Ligamentsofknee:obliquepoplitealligament,arcuatepoplitealligament,lateral (fibular)collateralligament(notattachedtolateralmeniscus),medial(tibial)collateral ligament(attachedtomedialmeniscus) AnteriorCruciateLigament(ACL):fromposterolateralcondyleoffemurto anteriorintercondylarareaoftibia PosteriorCruciateLigament(PCL):fromanteromedialcondyleoffemurto posteriorintercondylarareaoftibia o Bursaeoftheknee: Anterior:suprapatellar(synovial)bursa(w/articularisgenusfibersofvastus intermedius);prepatellarbursa=betweenskinandpatella(subcutaneous), subcutaneousinfrapatellarbursa=distaltopatella;deepinfrapatellarbursa= deeptoligamentumpatella Posterior:bursaefounddeeptogastrocnemiusheads,bicepsfemoristendon, lateralcollateralligament,popliteusmuscle,semimembranosustendon o Bloodsupplyofkneejoint:anastomosisinvolvingdescendingbranchoflateralfemoral circumflexartery,genicularbranchesofpoplitealartery,descendinggenicularartery (fromfemoralartery),recurrentbrancesfromanteriortibialartery o Nervesupplytokneejoint:femoralnerve(L2,3,4),obturatornerve(L2,3,4),tibialnerve o
Tibialisanterior
Fibularistertius
Deepfibular nerve
Rulesoftheanteriorcompartmentmuscles: o Allmusclesoftheanteriorcompartmentareinnervatedbythedeepfibularnerve o Allmusclesoftheanteriorcompartmentcontributetodorsiflexion o Allmusclesoftheanteriorcompartmentpassunderboththesuperiorandinferior extensorretinacula Anteriorcompartmentbloodsupply: o Anteriortibialartery(branchofpopliteal),deeptotibialisanterior o Foundbetweentwomalleolionthedoralankleandcontinuesasdorsalispedison dorsumoffoot Branchesareanteriortibialrecurrentartery,anteriormedialmalleolarartery, anteriorlateralmalleolarartery DEEPFIBULARNERVE o Branchofcommonfibularnerve o Enterstheanteriorcompartmentbypiercingtheanteriorintermuscularseptum LATERALCOMPARTMENTMUSCLES:
Upper2/3oflateral surfaceoffibula Lower1/3oflateral surfaceoffibula Inferiorsurfaceofthe medialcuneiform& st baseof1 metatarsal Baseofthe5 metatarsal
th
Rulesofthelateralcompartmentmuscles: o Allmusclesoflateralcompartmentareinnervatedbysuperficialfibularnerve o Allmusclesoflateralcompartmentaresuppliedbybranchesofthefibularartery o Allmusclesofthelateralcompartmentpassthroughfibularretinaculuminferiorto lateralmalleolus SUPERFICIALFIBULARNERVE o Branchofcommonfibularnerve o Emergesbetweenfibularislongusandbrevisandbecomescutaneousinlower anterolateralaspectofleg o Dividesintomedialandintermediatedorsalcutaneousnerves POSTERIORCOMPARTMENTMUSCLES: o Dividedbydeeptransverseintermuscularseptumintosuperficialanddeep o SUPERFICIALMUSCLES:
Lateralaspectoflateralcondyle offemur,medialheadfrom poplitealsurfaceoffemurabove medialcondyle 2headsfusetogether withtendocalcaneusto insertoncalcaneum Flexesthefoot(plantarflexion) attheankle,contributesto flexionattheknee Tibialnerve
Gastrocnemius
Plantaris Soleus
Weakflexoroffootatankle (plantarflexion) w/gastrocnemius,powerful flexoroffootatankle(plantar flexion) Medialrotatorofthetibiaonthe femur,servestounlockthe knee Flexesdistalphalanxofbigtoe, flexesthefootatankle,supports mediallongitudinalarches Flexesthefootattheankle, supportsbothmedialandlateral longitudinalarches Flexesthefootattheankle, invertsthefoot,supportsmedial longitudinalarch
Tibialnerve Tibialnerve
o
Popliteus
DEEPMUSCLES:
Lateralsurfaceofthelateral condyleoffemur,w/ attachmentonlateralmeniscus Middlehalfofposteriorsurface offibula Middlehalfofposteriorsurface oftibia Middleposteriorsurfacesof shaftoftibiaandfibula& interosseusmembrane Upperposterior surfaceofthetibia Baseofthedistal phalanxofbigtoe Baseofdistal nd th phalangesof2 to5 digits Tuberosityof navicularand neighboringbones Tibialnerve
Tibialnerve
Tibialnerve
Tibialnerve
Rulesoftheposteriorcompartmentmuscles: o Allofthemusclesoftheposteriorcomparmentareinnervatedbythetibialnerve o Allofthemusclesoftheposteriorcompartmentcontributetoplantarflexionofthefoot o Allofthesuperficialmusclesinsertonthecalcaneusviathetendocalcaneus o Allofthedeepmusclespassthroughtheflexorretinaculuminferiortothemedial malleolus Bloodsupplytoposteriorcompartment: o Posteriortibialartery=>terminalbranchofthepoplitealartery o Passesmediallyintheposteriorcompartment,deeptogastrocnemius,soleusanddeep transverseseptum;canbepalpatedbetweenmedialmalleolusandtendocalcaneus o Dividesintomedialandlateralplantararteriesinthefoot TIBIALNERVE o Descendswithposteriortibialvessels,deeptogastrocnemiusandsoleus o Dividesdistallyintomedialandlateralplantarnerves ANKLE o Trueanklejoint:uniaxialsynovialjointbetweentalusandlowerendoftibia&fibula o SuperiorandinferiorEXTENSORRETINACULA=thickeningofcruralfasciaanteriorly Containtendonsoftibialisanterior,extensorhallucislongus,extensor digitorumlongus,fibularistertius,anteriortibialartery,deepfibularnerve o FLEXORRETINACULUM=thickeningofcruralfasciainferiortomedialmalleolus Containstendonsoftibialisposterior,flexordigitorumlongus,flexorhallucis longus,posteriortibialartery,tibialnerve o FIBULARRETINACULUM=thickeningofcruralfasciainferiortolateralmalleolus Containstendonsoffibularislongusandfibularisbrevis Suralnerveandsmallsaphenousveinpasssuperficialtofibularretinaculum o Ligamentsoftheankle: Medial(deltoid)ligament:tibiocalcaneal,tibionavicular,anteriortibiotalar, posteriortibiotalar Lateralligament:anteriortalofibular,posteriortalofibular,calcaneofibular
FOOT
o Laterallongitudinalarch:calcaneustometatarsalheads(laterally) o Mediallongitudinalarch:calcaneustometatarsalheads(medially) o Transversearch:alongbaseofmetatarsals Intertarsaljointsofthefoot: o Transversetarsaljoint:calcaneus/cuboidandtaluscalcaneus/navicular Jointatwhichinversionandeversionoccur Talocalcaneonavicularjointligaments:talonavicularligament,bifurcate ligament,plantarcalcaneonavicularligament(springligament) Calcaneocuboidjointligaments:bifurcateligament,plantarcalcaneocuboid ligament(shortplantarligament) o Subtalarjoint:talus/calcaneus Jointatwhichglidingoccursforlimitedrotationofthefoot Plantaraponeurosis: o Thickeneddeepplantarfascia,attachedatcalcanealtuberositywithdigitalbandsthat extendintotoes;attachtobonesligamentsanddermis o Transversemetatarsalligamentsbetweenheadsofmetatarsalbones o Supportslongitudinalarches INTRINSICMUSCLESOFFOOT:
Superolateralsurfaceof calcaneus 4tendonstoproximal phalanxofgreattoe, extensorhoodsof3 medialtoes Medialsideofbaseof proximalphalanxofgreat toe Plantarsurfaceofmiddle phalangesoflateral4toes Lateralsideofbaseof proximalphalanxoflittle toe Lateralsideofflexor digitorumlongustendon Medialsideofextensor hoodsof4lateraltoes Aidsinextensionof4toeson medialsideoffoot Branchofdeep fibularnerve
Calcanealtuberosity
Abductsandflexesgreattoe atmetatarsophalangealjoint Flexeslateraltoesatproximal interphalangealjoints Abductslittletoeat metatarsophalangealjoint Assistsflexordigitorum longusinflexionoflateral toes Flexeslateraltoesat metatarsophalangealjoints, extendstoesat interphalangealjoints Flexesgreattoeat metatarsophalangealjoint Adductsgreattoeat metatarsophalangealjoint
Medialplantar nerve Medialplantar nerve Lateralplantar nerve Lateralplantar nerve Medialmedial plantarnerve; lateral3lateral plantarnerve Medialplantar nerve Lateralplantar nerve
Calcanealtuberosity Calcanealtuberosity
Fromlateral&medial calcaneus 1 frommedialsideof nd FDLtendonto2 toe; nd rd th 2 ,3 ,4 ,from betweenotherFDL tendons Cuboidandlateral cuneiform,tibialis posteriortendon Transverseheads ligamentsatMTPjoints oflateral3toes;oblique headbaseof metatarsals2,3,4,from fibularislongustendon Baseofmetatarsal5and fibularislongustendon Sidesofadjacent metatarsals
st
Plantarinterossei
Medialsidesof metatarsals3,4,5
Extensorhoodsoftoes 3,4,5
ARTERIALSUPPLYTOFOOT o Plantarside:
Medialplantarartery:betweenabductorhallucisandflexordigitorumbrevis, alongmedialsideofsoletomedialsideofgreattoe Lateralplantarartery:deeptoabductorhallucis,betweenflexordigitorum brevisandquadratusplantae Archesmediallyatbaseofmetatarsal5andformsdeepplantararch Joinsterminalbranchofdorsalispedisbetweenmetatarsals1and2 Deepplantararch: Digitalbranchtosmalltoe;4plantarmetatarsalarteriesw/digital branches;3perforatingarteriesanastamosewithdorsalarteries o Dorsalside: Dorsalispedis:continuationofanteriortibialartery(namechangeatankle) Betweentendonsofextensorhallucislongusandextensordigitorum longus Arcuatebranchatbasesofmetatarsals st o Dorsalmetatarsalarteries,dorsaldigitalarteries,1 dorsal metatarsalartery st Passestoplantarsidebetween2headsof1 dorsalinterosseustojoin deepplantararch VENOUSDRAINAGEOFFOOT o Deepveinsaccompanyarteries Plantarmetatarsalveins=>deepplantarveinsatarterialarch=>lateralplantar vein=>posteriortibialvein o Dorsalvenousarchdrainssuperficialveins Originofgreatsaphenousveinanteriortomedialmalleolus Originofsmallsaphenousveinposteriortolateralmalleolus NERVESUPPLYTOFOOT o Fromtibialnerve:Medialplantarnerve,Lateralplantarnerve Medialplantarnerve:anterior2/3ofsole,medial3toes Motortoabducturhallucis,flexordigitorumbrevis,flexorhallucis st brevis,1 lumbrical Lateralplantarnerve:lateralanterior2/3ofsole,lateral1toes Motortoabductordigitiminimi,flexordigitiminimibrevis,quadratus plantae,lateral3lumbricals,dorsalandplantarinterossei o Dorsalnervesupply Superficialfibularnervenomotorsupplyinthefoot SensorytomajorityofdorsumoffootandtoesEXCEPT: o Medialankle&justinferior,lateralsideoffootandlittletoe, nd webspacebetweengreattoeand2 toe Deepfibularnerve nd Sensorytowebspacebetweengreattoeand2 toe Motortoextensordigitorumbrevis,lateral2dorsalinterossei