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515 Cards in this Set
- Front
- Back
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extremity/limb/appendage defintion
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one of the paired terminal parts that extend off the trunk
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how are the upper and lower limbs similar
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in their patterns of parts, bones, muscles, innervations and blood supply
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for upper and lower extremities...one joint joins
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the appendicular skeleton with the axial
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what joint in the lower extremity starts it
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sacroiliac joint
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main purposes of the lower extremity
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support body weight and locomotion
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each extremity has a transition zone that consists of...
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a girdle and a ball and socket joint
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what is the transition zone of the lower extremity
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gluteal region
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parts of the gluteal region
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-rounded posterior region (buttocks)
-hip region laterally -extends from the iliac crest to the gluteal fold and the natal cleft |
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parts of the thigh
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from inguinal ligament, ischiopubic ramus and gluteal fold to the knee
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parts of the knee
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from the condyles of the femur to the head of the fibula and tibial condyle
-includes patella |
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parts of leg
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from the knee to the lateral and medial malleoli
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parts of the ankle
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a small area in the region of the lateral and medial malleoli
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parts of the foot
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the part of the lower extremity distal to the ankle
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longest bone in body
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femur
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largest sesamoid bone in the body
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patella
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patella fxn
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increases leverage of quadriceps femoris muscles
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sesamoid
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encased within a tendon, usually to increase leverage
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tibia significance
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weight bearing bone of lower extremity
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in general flexion and extension are in what plane
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sagittal
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flexion moves the body part...
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away from the anatomical position
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extension does what to body
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returns part to anatomical position
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at the hip joint, flexion occurs when the thigh...
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moves towards the fixed pelvis (raising the knee) or the pelvis moves towards the fixed thigh (bending foward while standing)
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2 general defintions of hyperextension
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1. extending a limb or part beyond normal limit (possibly causing injury) seen in "double jointed"
2. extending a limb or part posterior to the plane of anatomical position |
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adduction and abduction are in what plane
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coronal
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medial and lateral rotation are generally movement about
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a longitudinal axis
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in the thigh the longitudinal axis would be
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the femur
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in medial rotation at the hip joint what does the anterior surface of the thigh do
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turns toward the midsagittal plane (lateral =opposite)
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circumduction
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movement that outlines a cone in space, combines flexion/extension, hyperextension, add/abudction and medial and lateral rotation
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one of the few joints that can do circumduction
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hip joint
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fascia lata
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strong deep fascia that surrounds the muscles of the thigh like a stocking
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iliotibial band or tract
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lateral thickening of the fascia lata that is attached distally to Gerdy's tubercle
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what antagonists insert proximally on the ITB or ITT
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tensor fascia latae
gluteus maximus |
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intermuscular septa
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divide the thigh into 2 compartments (ant, med., post) and each septum extends from teh fascia lata to the linea aspera
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great saphenous vein...uses
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very superficial
gets varicose coronary artery bypass cutdown for venous access |
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great saphenous vein drains into
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femoral vein
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where is the great saphenous vein found...picks up what where
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anterior to medial malleolus and picks up saphenous nerve at the medial knee
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small saphenous vein drains into...where
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popliteal vein at posterior knee
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where is the small saphenous vein found
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posterior to lateral malleolus
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what nerve does small saphenous vein pick up, where
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sural nerve...distally
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origin of psoas major
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T12 - L5
vertebrae and IV discs between them |
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insertion of psoas major
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lesser trochanter
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action of psoas major
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hip flexor
stabilize hip joint |
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innervation of psoas major
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ventral rami of lumbar nerves
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iliacus origin
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iliac fossa
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ilacus insertion
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lesser trochanter
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action of iliacus
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hip flexor
stabilize hip joint |
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innervation of iliacus
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femoral n.
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tensor fasciae latae origin
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anterior part of iliac crest
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tensor fasciae latae insertion
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iliotibial tract
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action of tensor fasciae latae
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-abduction
-medial rotation -flexes thigh -steadies trunk on thigh |
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tensor fasciae latae origin
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anterior part of iliac crest
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tensor fasciae latae innervation
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superior gluteal n.
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sartorius origin
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ASIS
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sartorius insertion
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superior medial surface of tibia
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sartorius action
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flexes thigh and knee
abducts and laterally rotates thigh |
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sartorius innervation
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femoral n.
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rectus femoris origin
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AIIS and groove superior to acetabulum
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rectus femoris insertion
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tibial tuberosity (via the patellar ligament) and the base of the patella
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action of rectus femoris
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extend knee joint
flex hip joint |
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innervation of rectus femoris
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femoral n.
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vastus lateralis origin
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greater trochanter and linea aspera
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insertion of vastus lateralis
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tibial tuberosity (via the petallar ligament) and the base of the patella
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action of vastus lateralis
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extend knee joint
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innervation of vastus lateralis
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femoral n.
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vastus medialis origin
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intertrochanter and linea aspera
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vastus medialis insertion
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tibial tuberosity (via patellar ligament) and the base of the patella
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vastus medialis action
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extends kneejoint
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innervation of vastus medialis
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femoral n.
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vastus intermedius origin
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anterior and lateral surfaces of femur
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vastus intermedius insertion
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tibial tuberosity (via patellar ligament) and the base of the patella
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vastus intermedius innervation
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femoral n.
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collectively, largest muscle in body
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quadriceps femoris
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quadriceps femoris make up
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rectus femoris + 3 vastus muscles
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the 4 muscles of the quadricpes femoris form...
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quadriceps tendon and then patellar ligament/tendon
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longest muscle of the body
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sartorius
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sartorius actions
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flexes, abducts, laterally rotates hip
flexes knee |
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sartorius named so because
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it assists in crossing the leg in tailor's squatting position placing lateral malleolus on teh opposite knee
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what forms pes anserinus
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sartorius
gracilis semitendinosus |
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articularis genu(s)
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small muscle located deep to the inferior part of the vastus intermedius
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articularis genu insertion
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on the knee joint capuse
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action of articularis genu
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pulls the joint of knee capsule superiorly during knee extension that that it doesn't get caught in the joint
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femoral triangle boundaries
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superior: inguinal ligament
lateral: medial border of sartorius medial: adductor longus floor: iliopsoas and pectineus |
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superior boundary of femoral triangle
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inguinal ligament
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lateral boundary of femoral traingle
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medial border of sartorius
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medial boundary of femoral triangle
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adductor longus
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flood of femoral triangle
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iliopsoas
pectineus |
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contents of femoral triangle
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-femoral a. including profunda femoris a.
-femoral v. with tributaries -femoral n. with saphenous n. -cutaneous n, (lat femoral) -inguinal lymph nodes and lymph vessels -femoral sheath -subsartorial canal |
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femoral sheath
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continuation of the transversalis fascia and encloses the femoral vessels and lymphatics
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what divides the femoral sheath
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septa into 3 compartments
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femoral canal
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medial compartment of femoral sheath and includes femoral hernias
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Subsartorial (Hunter's, Adductor) canal
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contains the femoral vessels and saphenous nerve
-vessels pass through adductor hiatus but the nerve DOES NOT -extends from apex of femoral triangle |
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femoral nerve spinal levels
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L2-4
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femoral nerve innervates
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all anterior compartment thigh muscles except psoas major (ventral rami of lumbar nerves) and tensor fasciae lata (superior gluteal n.)
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anterior femoral cutaneous branches go to
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large area of anterior thigh
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saphenous nerve path
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cutaneous to medial leg, enteres the adductor canal with teh femoral a. and v. but EXITS proximal to the adductor hiatus
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saphenous nerve in relation to sartorius in adductor canal
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deep
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lateral femoral cutaneous nerve pathway
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passes below inguinal ligament just medial to the ASIS
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femoral artery is a continuation of and path
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external iliac a. as it passes deep to the midpoint of the inguinal ligament and travels just lateral to femoral v.
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femoral a. and v. wrapped in femoral sheath pathway
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close to inguinal ligament
1. through adductor canal 2. adductor hiatus 3. emerge in popliteal fossa 4. become popliteal artery and vein |
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profunda femoris artery aka
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deep femoral artery
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chief artery of thigh
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deep femoral artery
-largest branch of femoral a/ |
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branches of deep femoral artery
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-lateral/medial circumflex femoral a.
-perforating arteries (4) |
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lateral/medial circumflex femoral a. branches/go to
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to the head and neck of the femur
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perforating arteries path
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to muscles for posterior thigh they wrap around femur
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descending genicular artery path
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arises in adductor canal and sends branches to anastomose around the knee
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pectineus origin
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superior ramus of pubis
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pectineus insertion
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just inferior to lesser trochanter
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pectineus action
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adducts and flexes the thigh
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pectineus innervation
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femoral n and somtimes obturator n.
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adductor longus origin
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body of pubis
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adductor longus insertion
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linea aspera
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adductor longus action
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adducts thigh
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adductor longus innervation
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obturator n.
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adductor brevis origin
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body and inferior ramus of pubis
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adductor brevis insertion
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linea aspera
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adductor brevis action
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adducts thigh
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adductor brevis innervation
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obturator n.
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adductor magnus origin
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adductor part: inferior ramus of pubis
hamstring part: ischial ramus and ischial tuberosity |
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adductor magnus insertion
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adductor part: linea aspera
hamstring part: adductor tubercle of femur |
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adductor magnus action
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adducts thigh
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adductor magnus innervation
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adductor part: obt. nerve
hamstring: tibial division of sciatic n. |
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gracilis origin
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body and inferior ramus of pubis
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gracilis insertion
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superior medial surface of tibia
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gracilis action
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adducts thigh and flexes leg
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gracilis innervation
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obturator nerve
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obturator externus origin
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margins of obturator foramen and obturator membrane
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obturator externus insertion
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trochanteric fossa
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obturator externus action
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laterally rotates thigh
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obturator externus innervation
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obturator n.
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thigh adductor group includes
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pectineus
adductor brevis. longus. magnus gracilis |
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adductor magnus parts
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hamstring
adductor |
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adductor part of adductor magnus
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more anterior
has attachments and innervation of "true" adductor |
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hamstring part of adductor magnus
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more posterior
resembles the hamstring muscles in its origin and innervation |
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adductor hiatus
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opening in the tendon of the adductor magnus near the knee
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obturator nerve spinal location
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L2-4
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obturator innervates all...but...
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all medial compartment thigh muscles except pectineus (femoral) and hamstring part of add. magnus (tibial of sciatic)
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anterior and posterior branches of obturator nerve surround...
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sandwich adductor brevis
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cutaneous branch of obt. n
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to medial thigh
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sacrotuberous ligament connection
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lateral sacrum to ischial tuberosity
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sacrospinous ligament attachment
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lateral sacrum to ischial spine
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which one is deep sacrotuberous or spinous
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spinous is deep to tuberous ligament
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significance of sacrospinous and sacrotuberous ligaments
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they close the greater and lesser sciatic notches of the pelvic bone and produce the greater sciatic forament and lesser sciatic foramen
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greater sciatic foramen
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passage for structures to enter and exit the pelvis
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piriformis
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fills the bulk of the greater sciatic foramen
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superior to piriformis
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superior gluteal vessels
superior gluteal nerve |
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inferior to piriformis
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inferior gluteal vessels
inferior gluteal nerve nerve to obturator internus nerve to quadratus femoris post. femoral cutaneous n. pudendal nerve internal pudendal vessels |
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internal pudendal vessels pathway
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wind around sacrospinous ligament and reenter the pelvis through the lesser sciatic foramen and sciatic nerve
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lesser sciatic foramen fxn
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passage for structures to enter or exit the perineum
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what fills bulk of lesser sciatic foramen
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obturator internus
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pudendal nerve and internal pudendal nerve path
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wind around sacrospinous ligament and pass through both greater and lesser sciatic foramen
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gluteal region
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rounded region of the buttocks
cluneal or natal aka |
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gluteal cleft
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between buttocks
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gluteus maximus origin
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external surface of ilium
posterior surfaceof sacrum and coccyx sacrotuberous ligament |
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gluteus maximus insertion
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iliotibial tract mostly
proximal femur |
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gluteus maximus action
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chief extensor of the thigh
-assists in laterally rotating and steadying the thigh |
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gluteus maximus innervation
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inferior gluteal n,.
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gluteus medius origin
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external surface of ilium
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gluteus medius insertion
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greater trochanter
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gluteus medius action
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abducts and medially rotates thigh
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gluteus medius innervation
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superior gluteal n.
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gluteus minimus origin
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external surface of ilium
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gluteus minimus insertion
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greater trochanter
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gluteus minimus action
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abducts and medially rotates thigh
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gluteus minimus action
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superior gluteal n.
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piriformis orign
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anterior surface of sacrum
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piriformis insertion
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greater trochanter
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piriformis action
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laterally rotates thigh
also stabilizes hip joint |
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piriformis innervation
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nerve to piriformis
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obturator internus origin
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internal surface of obturator foramen and surrounding bones
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obturator internus insertion
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greater trochanter (gemelli muscles blend with tendon of obt. internus near insertion)
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obturator internus action
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laterally rotates thigh
stabilize hip joint |
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obturator internus innervation
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nerve to obturator internus
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obt int. action
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laterally rotates thigh
stabilize hip joint |
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superior gemellus origin
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ischial spine
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inferior gemullus origin
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ischial tuberosity
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superior and inferior gemellus muscle insertions
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greater trochanter (gemelli muscles blend iwth tendon of obt, internus near its insertion)
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superior and inferior gemellus action
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laterally rotate thigh
stabilize hip joint |
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superior gemellus innervation
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.n. to obturator internus
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inferior gemellus innervation
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nerve to quadriceps femoris
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quadratus femoris origin
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ischial tuberosity
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quadratus femoris insertion
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interchochanteric crest
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quadratus femoris action
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laterally rotates thigh
stabilizes hip joint |
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innervation to quadratus femoris
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nerve to quad. femoris
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gluteus medius essential role
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during bipedal locomotion
-right one prevents the left side of the body from sagging when the left foot is raised |
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how many lateral rotatrors of thigh andl list
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6:
1. piriformis 2. obt. internus 4. obt externus 4. superior gemellus 5. inferior gemellus 6. quad. femoris |
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trochanteric bursa
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separates the gluteus maximus from the greater trochanter
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deep gluteal nerves how many and where do they branch from
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7 that branch from sacral plexus
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explain path of 7 deep gluteal nerves
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exit the pelvis via the greater sciatic foramen and all emerge INFERIOR to the piriformis muscle EXCEPT superior gluteal nerve
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cutaneous innervation of gluteal region is supplied by...
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primarily by cluneal nerves
-sup. mid, inferior |
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only deep gluteal nerve that emerges superior to piriformis m.
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superior gluteal n.
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superior gluteal n. innervates
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fascia latae
gluteus medius gluteus minimis |
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obturator internus innervation
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nerve to obturator internus
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obt int. action
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laterally rotates thigh
stabilize hip joint |
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superior gemellus origin
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ischial spine
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inferior gemullus origin
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ischial tuberosity
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superior and inferior gemellus muscle insertions
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greater trochanter (gemelli muscles blend iwth tendon of obt, internus near its insertion)
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superior and inferior gemellus action
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laterally rotate thigh
stabilize hip joint |
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superior gemellus innervation
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.n. to obturator internus
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inferior gemellus innervation
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nerve to quadriceps femoris
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quadratus femoris origin
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ischial tuberosity
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quadratus femoris insertion
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interchochanteric crest
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inferior gluteal nerve innervates
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gluteus maximus
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sciatic nerve spinal levels
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L4 and 5
S1-3 |
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largest nerve in body
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sciatic
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branches of sciatic n.
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tibial
common fibular (peroneal |
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tibial and common fibular n. [path
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stay together most of the way on same CT sheath until halfway or more down thigh and then called divisions
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tibial nerve innervates
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flexor muscles of thigh, leg and foot
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common fibular innervation
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short head of biceps femoris and extensor and abudcto rmuscles int eh leg and foot
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sciatica
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pain radiating along the course of the sciatic nerve
-most oftedn down the buttock and the posterior thigh to below the knee -compression of lumbar or sacral nerve roots by a herniated disk or when sciatic n. is irritated by piriformis m. |
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posterior femoral cutaneous nerve innervates
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largest skin area of any cutaneous nerve including the posterior thigh and parts of the buttock. perineum and proximal leg
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nerve to the quadratus femoris also innervartes
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alsuperior gemellus m.
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pudendal nerve innervation
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branches and innervates structures in perineum, including the muscles of the perineum and external genitalia(sensory)
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blood supply to gluteal region
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superior gluteal a.
inferior gluteal a. internal pudendal a. |
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semitendinosus origin
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ischial tuberosity
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semitendinosus insertion
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superior medial surface of tibia
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semitendinosus action
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flex the leg
extend the thigh |
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semitendinosus innervation
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tibial division of sciatic n
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semimembranosus origin
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ischial tuberosity
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semimembranosus insertion
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medial condyle of tibia
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semimembranosus action
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flex leg
extend the thigh |
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semimembranosus innervation
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tibial division of sciatic n.
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biceps femoris long head origin
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ischial tuberosity
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biceps femoris short head origin
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linea aspera
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biceps femoris insertion
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head of fibula and lateral condyle of tibia
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biceps femoris action
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flex leg
extend thigh except short head |
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biceps femoris long head innervation
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tibial division of sciatic nerve
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biceps femoris short head innervation
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common fibular division of sciatic n
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hamstrings
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posterior thigh muscles collectively
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posterior thigh muscles
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semitendinosus
semimembranosus biceps femoris |
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oddball of posterior thigh
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short head biceps femoris
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blood supply to posterior thigh
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perforating arteries from the profunda femorl artery
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popliteal fossa
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area behind the knee
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superolateral boundary of popliteal fossa
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biceps femoris
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superomedial boundary of popliteal fossa
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semimembranosus and semitendinosus
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inferolateral boundary of popliteal fossa
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lateral head of gastrocnemius
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Inferomedial boundary of popliteal fossa
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medial head of gastrocnemius
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root of popliteal fossa boundary
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skin and fascia
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floor boundary of popliteal fascia
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popliteal surface of the femur
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popliteal fossa contents
|
fat
popliteal a. popliteal v. small saphenous vein tibial and common fibular nerves end branch of posterior femoral cutaneous n and articular branch of obturator n popliteal lymph nodes and vessels |
|
|
second longest bone of leg
|
tibia
|
|
|
what makes up the proximal end of the tibia
|
medial condyle
lateral condyle gerdy's tubercle intercondylar eminence with intercondylar tubercles tibial tuberosity |
|
|
distal end of tibia
|
medial malleolus
|
|
|
fibula fxn of leg
|
non weight bearing
|
|
|
fibula proximal end
|
apex
head neck |
|
|
fibula distal end
|
laterall malleolus
malleolar fossa (for attachment of the posterior talofibular ligament) |
|
|
how many tarsal bones? name
|
seven:
1.talus 2. calcaneus w/ sustentaculum tali 3. navicular 4. cuboid 5. medial (1st) cuneiform 6. intermediate (2nd) cuneiform 7. lateral (3rd) cuneiform |
|
|
whats the only tarsal bone to articulate with leg bones
|
talus
|
|
|
metatarsal bones, how many
|
5, one for each toe
|
|
|
how many phalanges? describe
|
14
-1st big toe (hallux) has a proximal and distal phalanx -each of the other toes (2-5) have proximal, middle and distal phalanx |
|
|
what protects the tendons of the flexor hallucis longus
|
medial and lateral sesamoid bones within the tendons of flexor hallucis brevis on the plantar surface of the head of the first metatarsal bone
|
|
|
where does the flexor hallucis longus run
|
between the sesamoid bones (medial and lateral)
|
|
|
proximal tibiofibular joint
|
plane joint between head of fibula and lateral condyle of tibia
|
|
|
distal tibiofibular joint
|
strong fibrous joint between the inferior ends of the fibula and tibia that stabilizes the ankle joint
|
|
|
ankle (talocrural) joint
|
hinge joint between the inferior tibia and fibular superior part of the talus that permits dorsiflexion and plantar flexion
|
|
|
most frequently injured joint in body
|
ankle (talocrural) joint
|
|
|
subtalar and transverse tarsal joints
|
intertarsal joints that permit inversion (turning inward) and eversion (turning outward) oft he foot
|
|
|
tarsometatarsal and intermetatarsal joints
|
plane joints
|
|
|
metatarsophalangeal (MTPs) joint
|
condyloid joints
|
|
|
interphalangeal joints
|
hinge joints
-each toe has a proximal interphalangeal (PIP) joint and a distal interphalangeal (DIP) joint EXCEPT the big toe which has a single IP joint |
|
|
dorsiflexion at ankle
|
bending the foot upward at the ankle joint
|
|
|
plantar flexion at ankle
|
bending the foot downward at the ankle joint
|
|
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inversion
|
turning sole of foot inward
|
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eversion
|
turning sole of foot outward
|
|
|
inversion and eversion involves
|
simultaneous movements at subtalar and transverse tarsal joints
|
|
|
crural fascia
|
continuation of the fascia lata in the thigh
|
|
|
intermuscular septa in leg
|
divide leg into 3 compartments (ant, lat,post) and posterior is further divided into superficial and deep layers
|
|
|
retinaculae fxn
|
hold long tendons close to leg
|
|
|
name retinaculae of leg
|
1. superior and inferior extensor retinacula
2. flexor retinaculum 3. superior and inferior fibular (peroneal) retinacula |
|
|
muscles of the anterior leg
|
tibialis anterior
extensor hallucis longus extensor digitorum longus fibularis tertius |
|
|
origin of tibialis anterior
|
anterior surface of tibia
|
|
|
tibialis anterior insertion
|
medial cuneiform
base of 1st metatarsal |
|
|
action of tibialis anterior
|
dorsiflexes and inverts foot
|
|
|
innervation of tibialis anterior
|
deep fibular n
|
|
|
extensor hallucis longus origin
|
fibula and interosseous membrane
|
|
|
extensor hallucis longus insertion
|
base of the distal phalanx of big toe
|
|
|
extensor hallucis longus action
|
extends big toe at IP (and MTP) and dorsiflexes foot
|
|
|
extensor hallucis longus innervation
|
deep fibular n.
|
|
|
extensor digitorum longus origin
|
tibia, fibula, and interosseous membrane
|
|
|
extensor digitorum longus insertion
|
middle and distal phalanges of toes 2-5
|
|
|
action of extensor digitorum longus
|
extends toes 2-5 at DIP (and PIP,MTP)
-dorsiflexes and everts foot |
|
|
innervation of extensor digitorum longus
|
deep fibular n.
|
|
|
fibularis tertius origin
|
fibula and interosseous membrane
|
|
|
fibularis tertius insertion
|
base of 5th metatarsal
|
|
|
fibularis tertius action
|
assists ext. digitorum longus in dorsiflexion and eversion of the foot
|
|
|
innervation of fibularis tertius
|
deep fibular n.
|
|
|
common action of all muscles of the anterior compartment of leg
|
dorsiflexion of foot
|
|
|
shin splints
|
pain from swollen muscles in anterior compartment of leg
|
|
|
muscles of lateral leg
|
fibularis longus
fibularis brevis |
|
|
fibularis longus origin
|
fibula
|
|
|
fibularis longus insertion
|
medial cuneiform and base of 1st metatarsal and wraps under foot
|
|
|
fibularis longus action
|
everts foot and assits with plantarflexion
|
|
|
fibularis longus innervation
|
superficial fibular n./
|
|
|
fibularis brevis origin
|
fibula
|
|
|
fibularis brevis insertion
|
tuberosity on 5th metatarsal
|
|
|
action of fibularis brevis
|
everts foot and assists with plantarflexion
|
|
|
innervation of fibularis brevis
|
superficial fibular n.
|
|
|
explain unusual path of the tendon of the fibularis longus
|
crosses from the lateral side of the foot to the medial side of the sole.
-inserts on the same bones as the tibialis anterior but has antagonist actions |
|
|
avulsion fracture
|
at tuberosity of 5th metatarsal from violent inversion of ankle
|
|
|
muscles of the posterior leg
|
gastrocnemius
soleus plantaris |
|
|
gastrocnemius medial head origin
|
popliteal surface of femur just superior to medial condyle
|
|
|
gastrocnemius lateral head origin
|
lateral condyle of femur
|
|
|
gastrocnemius insertion
|
posterior surface of calcaneus via tendon calcaneus
|
|
|
action of gastrocnemius
|
flexes leg and knee
plantarflexes foot |
|
|
innervation of gastrocnemius
|
tibial n.
|
|
|
soleus origin
|
tibia and fibula
|
|
|
soleus insertion
|
posterior surface of calcaneus via tendon calcaneus
|
|
|
soleus action
|
plantar flexes foot
|
|
|
soleus innervation
|
tibial n.
|
|
|
plantaris origin
|
just superior to lateral head of gastrocnemius
|
|
|
plantaris insertion
|
posterior surface of calcaneus via tendon calcaneus
|
|
|
plantaris action
|
weakly assists gastrocnemius
|
|
|
plantaris innervation
|
tibial n
|
|
|
triceps surae
|
2 heads of gastrocnemius + soleus
|
|
|
what is gastrocnemius important for and soleus
|
rapid movements in running and jumping
-soleus contracts more slowly (slow twitch, slow fatigueing muscle fibers) and is more important for posture (standing) and endurance -both are powerful plantarflexors |
|
|
fabella
|
bone in lateral gastroc
|
|
|
significance of plantaris
|
often abset and functionally insignificant but its tendon can be ruptured and cause severe pain
|
|
|
popliteus origin
|
just inferior to lateral head of gastrocnemius
|
|
|
popliteus insertion
|
posterior surface of tibia
|
|
|
popliteus action
|
unlocks knee
|
|
|
popliteus innervation
|
tibial n.
|
|
|
flexor hallucis longus origin
|
fibula
|
|
|
flexor hallucis longus insertion
|
base of the distal phalanx of big toe
|
|
|
flexor hallucis longus action
|
flexes big toe at IP and MTP and plantarflexes foot
|
|
|
flexor hallucis longus innervation
|
tibial n
|
|
|
flexor digitorum longus origin
|
tibia
|
|
|
flexor digitorum longus insertion
|
base of the distal phalanges of toes 2-5
|
|
|
flexor digitorum longus action
|
flexes toes 2-5 at DIP, PIP, MTP and plantarflexes foot
|
|
|
flexor digitorum longus innervation
|
tibial n
|
|
|
tibialis posterior origin
|
tibia and fibula
|
|
|
tibialis posterior insertion
|
navicular
cuneiforms cuboid bases of 2-4 metatarsals |
|
|
tibialis posterior action
|
plantar flexes and inverts foot
|
|
|
tibialis posterior innervation
|
tibial n
|
|
|
how does popliteus unlock fully extended knee
|
by rotating the femur laterally on the fixed tibia (while walking) or rotating the tibia medially on the fixed femur (sitting)
|
|
|
significance of flexor hallicus longus
|
powerful push-off muscle during walk, running and jumping
-it's tendon wraps under the sustentaculum tali and passes between the medial and lateral sesamoid bones of the big toe |
|
|
describe tendons of 3 deep layer muscles in posterior leg...order
|
pass posterior to the medial malleolus. order is tom dick and ANd Harry:
1. Tibialis posterior 2. flexor Digitorum longus 3. posterior tibial Artery 4. tibial Nerve 5. flexor Hallicus longus |
|
|
tibial nerve innervates...general
|
all muscles of the posterior compartment of the leg
-flexor muscles in thigh, leg and foot |
|
|
pathway of tibial nerve...what it travels with...branches
|
travels deep to the soleus with the posterior tibial artery, passes behind the medial malleolus and divides in the foot to form the medial and lateral plantar nerves
|
|
|
sural nerve
|
cutaneous nerve formed by the union of the medial sural cutaneous n. and a communicating branch of the lateral sural cut. n.
|
|
|
outside muscles what does tibial n help innervate
|
skin of lateral posterior leg and foot and sole of foot
|
|
|
common fibular nerve pathway and branches
|
winds superficially around the neck of the fibula before dividing into the superficial and deep fibular nerve
|
|
|
what is the most commonly injured nerve in LE and why
|
common fibular n.
-superficial position, severing it causes paralysis of the dorsiflexors (foot drop) and paralysis of the everters of the foot |
|
|
common fibular n helps innervate what outside of muscles
|
skin of the lateral posterior leg
-lateral sural cut. n. |
|
|
deep fibular nerve is where
|
anterior compartment of the leg
|
|
|
deep fibular nerve travels with
|
anterior tibial artery
|
|
|
deep fibular nerve innervates
|
skin between first and second toe
|
|
|
damage to what nerves causes foot drop
|
common fibular
deep fibular |
|
|
superficial fibular nerve innervates what area
|
lateral compartment of leg and skin on parts of the leg and dorsum of the foot
|
|
|
posterior tibial artery path
|
travels with tibial n. and divides into the medial and lateral plantar arteries in the sole of the foot
|
|
|
fibular artery is a branch of
|
posterior tibial a.
|
|
|
anterior tibial a. travels with...branches
|
deep fibular n. and becomes the dorsalis pedis artery on the dorsum of the foot
|
|
|
dorsal interossei
|
muscle between metatarsals
-abductors |
|
|
collective the major functions of the fot
|
supporting the arches of the foot in walking and running
-assisting the long toe flexors |
|
|
first layer of the foot muscles
|
abductor hallucis
flexor digitorum brevis abductor digiti minimi |
|
|
abductor hallicus innervation
|
medial plantar n.
|
|
|
abductor halius action
|
abducts and flexes big toe at MTP
|
|
|
flexor digitorum brevis action
|
flexes 2nd-5th to at PIP and MTP squared
|
|
|
flexor digitorum brevis innervation
|
medial plantar n
|
|
|
abductor digiti minimi action
|
abducts and flexes 5th toe at MTP
|
|
|
abductor digiti minimi innervation
|
lateral plantar n.
|
|
|
muscles of the first layer are located...
|
just deep to the plantar aponeurosis (or plantar fascia) a thick layer of CT that helps support the longitudinal arch of the foot
|
|
|
plantar fasciitis
|
painful condition caused by inflammation of the insertion of the plantar fascia on the calcaneal tuberosity
|
|
|
second layer of foot muscles
|
quadratus plantae
lumbricals (4) |
|
|
PIP
|
proximal interphalangel joint
|
|
|
MTP
|
metatarsophalangeal joit
|
|
|
quadratus plantae
|
flexor accsorius
-it assists the flexor digitorum longus by bringing the pull of its tendons more directly in line with the long axes of the toes |
|
|
quadratus plantae action
|
assist flexor of digitorum longus
|
|
|
quadratus plantae innervation
|
lateral plantar n,.
|
|
|
lumbricals action
|
flex 2-5th toe at MTP and extend them at PIP/DIP via extensor expansion
|
|
|
lumbricals innervation
|
1st-medial plantar n
2-4: lateral plantar n |
|
|
2 tendons located in 2nd layer of foot
|
flexor hallicus longus tendon
flexor digitorum longus tendon |
|
|
tendon of flexor hallicus longus
|
wraps under sustentaculum tali and passes between 2 sesamoid bones on its way to the distal phalanx of the big toe
|
|
|
tendon of flexor digitorum longus
|
crosses obliquely from medial malleolus to toes 2-5 and lies superficial to the tendon of flexor hallicus longer
|
|
|
third layer of foot muscles
|
flexor hallicus brevis
adductor hallucis flexor digiti minimi |
|
|
flexor hallicus brevis action
|
flexes big toe at MTP
|
|
|
innervation of flexor hallicus brevis
|
medial plantar n
|
|
|
action of adductor hallicus in foot
|
adducts big toe
|
|
|
innervation of adductor hallicus in foot
|
lateral plantar n
|
|
|
action of flexor digiti minimi
|
flexes 5th toe at MTP
|
|
|
innervation of flexor digiti minimi
|
lateral plantar n
|
|
|
flexor hallicus brevis has...
|
2 heads each tendon contains a sesamoid bone at the head of the first metatarsal
|
|
|
adductor hallicus has..
|
2 heads
oblique and transverse |
|
|
4th layer of foot muscles
|
plantar interossei (3)
dorsal interossei (4) |
|
|
plantar interossei action
|
adduct and flex 3-5 toes at MTP
|
|
|
innervation of plantar interossei
|
lateral plantar n
|
|
|
dorsal interossei action
|
abduct and flex 2-4 toes at MTP
|
|
|
dorsal interossei innervation
|
lateral plantar n
|
|
|
2 long tendons located in 4th layer of foot muscles
|
tendon of tibialis posterior
tendon of fibularis longus |
|
|
path of tendon of tibialis posterior
|
passes behind the medial malleolus
-a broad tendon to the navicular, cuboid, cuneiforms, and bases of metatarsals 2-4 |
|
|
path of tendon of fibularis longus
|
passes behind the lateral malleolus and through a groove in the cuboid bone then crosses the sole of the foot to the first metatarsal and medial cuneiform
|
|
|
muscles of the dorsum of the foot
|
extensor digitorum brevis
extensor hallucis brevis |
|
|
extensor digitorum brevis action
|
assists the extensor digitorum longus
|
|
|
innervation of extensor digitorum brevis
|
deep fibular n
|
|
|
extensor hallucis brevis actions
|
assists the extensor hallucis longus
|
|
|
innervation of extensor hallucis brevis
|
deep fibular n
|
|
|
nerves of the foot
|
medial plantar
lateral plantar deep fibular superficial fibular sural |
|
|
medial plantar n is a terminal branch of
|
tibial n
|
|
|
medial plantar n innervates
|
4 muscles of the sole of the foot:
abductor hallucis flexor digitorum brevis flexor hallucis brevis 1st lumbrical |
|
|
medial plantar n cutaneous innervation...
|
to medial 3.5 toes and medial sole
|
|
|
lateral plantar n is a terminal branch of
|
tibial nerve
|
|
|
lateral plantar nerve innervates
|
the remaining muscle in sole of foot after medial:
abductor digiti minimi quadratus plantade 2-4th lumbricals interosseous muscles adductor hallucis flexor digiti minimi |
|
|
cutaneous innervation of lateral plantar n
|
to lateral 1.5 toes and lateral sole
|
|
|
deep fibular nerve is the nerve of
|
anterior compartment of leg
|
|
|
deep fibular nerve innervates
|
intrinsic muscles on the dorsum of the foot
-skin between first and second toe |
|
|
superficial fibular nerve is the nerve of
|
lateral compartment of the leg
|
|
|
superficial fibular nerve innervates
|
skin on the dorsum of the foot and parts of the leg
|
|
|
sural nerve is formed from
|
branches of the tibial nerve and the common fibular nerve
|
|
|
sural nerve innervates
|
skin on the lateral foot and parts of the leg
|
|
|
sural nerve passes
|
posterior to lateral malleolus
|
|
|
blood supply to foot by
|
dorsalis pedis
medial plantar a lateral plantar a great saphenous vein |
|
|
dorsalis pedis is a direct continuation of
|
anterior tibial artery
|
|
|
dorsalis pedis gives rise to
|
an arcuate artery on the dorsum of the foot and the deep plantar artery that dives down between teh first and second toes and becomes the plantar arch
|
|
|
pulse of dorsalis pedis
|
can be palpated just lateral to tendon of extensor hallucis longus in foot
|
|
|
medial plantar a in relation to lateral
|
smaller
|
|
|
lateral plantar a branches
|
becomes the plantar arch and gives off plantar metatarsal arteries that further divide into plantar digital arteries
|
|
|
great saphenous vein is a continuation of
|
the dorsal venous arch of foot
|
|
|
great saphenous vein passes
|
anterior to the medial malleolus
|
|
|
arches of the foot
|
longitudinal (medial & lateral) arches
transverse arches |
|
|
arches of foot fxn
|
act as shock absorbers during locomotion
|
|
|
most important structures for maintaining arches
|
plantar ligaments:
short plantar long plantar plantar calcaneonavicular plantar aponeurosis |
|
|
during locomotion which muscles of the foot support the arches
|
peroneus longus
tibialis posterior |
|
|
joint
|
an articulation that connects 2 or more bones
|
|
|
explain stability and mobility trade off
|
stable joints tend to be less mobile and highly mobile joints tend to be less stable
|
|
|
primary fxn of anatomically simple joints
|
stability
|
|
|
primary fxn of more complex joints
|
mobility
|
|
|
factors that affect the biomechanical properties of a joint
|
shape of the articular surfaces
arrangement of assoc ligaments and other CT structurs and muscles that cross the joint |
|
|
fibrous joint (synarthrosis
|
bones linked by fibrous CT
-no joint activity and little or no movement |
|
|
sutures
|
extremely tight, immobile (in adults) articulations that only occur in the skull
|
|
|
syndesmosis
|
bones are united by a sheet of fibrous tissue such as the interosseous membrane between the tibia and fibula or the ligamentum flavum
|
|
|
gomphosis
|
joint between a tooth and its socket (alveolus)
|
|
|
cartilaginous joint
|
bones linked by cartilage
-no joint cavity and limited movement |
|
|
primary cartilaginous joint (synchondrosis)
|
contain hyaline cartilage; the most common; though temporary, is the growth plate between the shaft and end of a long bone that is replaced by bone when growth is complete
|
|
|
example of a permanent synchondrosis
|
sternocostal joint between first rib and sternum
|
|
|
seconary cartilagenous (symphysis) joint and ex
|
contain fibrocartilage discs of plates and all lie int eh midline
-intervertebral discs -pubic symphysis manubriosternal joint |
|
|
synovial joint (diarthrosis)
|
adjactent bony surfaces are not directly connected by CT, allowing free movement between the bones
-most common and functionally and clinically most important |
|
|
basic features of synovial joints
|
articular cartilage
joint cavity joint capsule sensory innervation |
|
|
articular cartilage
|
usually hyaline, on the articular ends of the bones
|
|
|
joint cavity
|
space containing a thin layer of lubricating synovial fluid that separates the articular cartilage
|
|
|
joint capsule
|
surrounds and protects the joint
-consists of a: fibrous capsule that reinforces the joint along with ligaments -inner synovial membrane that lines the interior of the joint (except articular cartilage)and secretes synovial fluid |
|
|
sensory innervation of synovial joint
|
supplied by nerves that innervate the muscles acting on the joint
|
|
|
articular discs
|
slab of fibrocartilage in the joint space that may absorb shock or improve the fit of the articular surfaces (ex: medial and lateral meniscus in knee joint)
|
|
|
labrum
|
fibrocartilage ring that deepends the articular surface of one of the bones (ex: acetabular labrum in the hip joint)
|
|
|
bursa
|
closed CT sac filled with synovial fluid, reduce friction in areas that are subject to friction
ex: knee |
|
|
blood vessels supplying a joint...
|
may form anastomoses that provide alternate pathways for blood flow as the joint assumes different positions
ex: collateral circulation |
|
|
plane joint with ex
|
joints with relatively flat surfaces that permit only gliding or sliding movements
ex: sacroiliac joint |
|
|
hinge joint with example
|
ginglymus
-uniaxial joints that permit only flexion and extension and are reinforced by collateral ligaments ex: ankle joint |
|
|
pivot joint with ex
|
trochoid
-uniaxial joints that permit only rotation., a rounded process of one bone rotates within a ring or concave notch ex: radioulnar joints atlantoaxial joint |
|
|
condyloid joint
|
ellipsoid/knuckle-like
-biaxial (movement around 2 axis that lie roughly at right angles) -joints in which the ellipsoid convave surface of one bone articulates with the convex surface of another bone (egg in spoon) -permits extension/flexion, abduction/adduction, circumduction |
|
|
ex of condyloid joint
|
MCP joints and wrist joint
|
|
|
SADDLE JOINT
|
sellar
-biaxial joints with saddle-shaped articulating surfaces that permit the same movements as a condyloid joint ex: CMC joint of thumb |
|
|
ball and socket joint
|
spheroidal
-highly mobile multiaxial -ex: hip joint or glenohumeral joint |
|
|
sacroiliac joint
|
strong weight bearing irregular plane synovial joint with very little mobility
-motions are limited to slight gliding and anterior/posterior rotation of the sacrum between the ilia |
|
|
sacroiliac ligaments bind...
|
ilium to sacrum
|
|
|
strongest ligaments in body
|
sacroiliac ligaments
|
|
|
divisions of sacroiliac ligaments
|
interosseous
posterior anterior |
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what happens to sacroiliac ligaments during pregnancy and old age
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become softer during preg late stages to permit expansion of birth canal
-old become partially ossified |
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other ligaments besides sacroiliac assoc with SI joint
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iliolumbar ligament
sacrotuberous ligament sacrospoinous ligament |
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iliolumbar ligament
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L5 transverse process to iliac crest
-stabilize L5 on the sacrum |
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sacrotuberous ligament connection
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lateral sacrum to ischial tuberosity
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sacrospinous ligament connections
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lateral sacrum to ischial spine
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pubic symphysis explain joint etc
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pelvic joint with fibrocartilage disck joining pubic bones
-along with sacroiliac ligaments becomes softer during preg |
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hip joint type and where
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ball and socket
between head of femur and acetabulum |
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depth of the acetabulum is increased by
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fibrocartilagenous acetabular labrum
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the rim of the acetabulum is incomplete inferiorly, forming...
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an acetabular noth that is bridged by the transverse acetabular ligament
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3 thickenings of the fibrous hip joint capsule and what do they do
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iliofemoral ligament
pubofemoral ligament ischiofemoral ligament *strengthen hip joint |
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in full extension of the hip the 3 ligaments...
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during standing, all 3 and the joint capsule become taut and normally prevent hyperextension
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strongest of 3 hip joint ligaments
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iliofemoral ligament or Y ligament of Bigelow
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ligament of head of femur path...primary fxn and significance
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runs from acetabular notch to the fovea of the femur
-primarily a conduit for a small artery to the head of the femur and does NOT strengthen the hip joint |
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knee type of joint and its 3 articulations
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hinge:
-femur/patella -medial condyles of femur/tibia -lateral condyles of femur/tibia and enclosed by joint capsule |
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primary actions of knee
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extension and flexion but it permits some rotation
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at full extension the femur is
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rotated medially on the fixed tibia (screw home mechanism)
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in full extension the knee is stabilized by
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primarily by ligaments
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in flexion the knee joint is stabilized by
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muscles and tendons including quadriceps femoris, semimembranosus, tendons of pes anserinus, tendon of biceps femoris, popliteus, iliotibial tract
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patellar ligament
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continuation of the quadriceps tendon inferior to the patella
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medial (tibial) collateral ligament (MCL)
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strong flat thickening of the knee fibrous joint capsule that extends from medial epicondyle of the femur to the medial condyle of the tibia
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MCL is firmly attached to
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the medial meniscus
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blow to the lateral side of the knee can cause...
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simultaneous damage to medial collateral ligament, medial meniscus, and anterior cruciate ligament
UNHAPPY TRIAD |
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lateral (fibular) collateral ligament (LCL)
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skinny rounded ligament extending from the lateral epicondyle of the femur to the head of the fibula
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lateral collateral ligament is not attached to...why
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the lateral meniscus
-popliteal tendon passes between LCL and lateral meniscus |
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which ligametn is rarely injured
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LCL
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anterior cruciate ligament (ACL)
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anterior part of intercondylar area of tibia to lateral femoral condyle
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weaker of 2 cruciate ligaments
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ACL
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ACL resists...
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posterior movement of femur on the fixed tibia and knee hyperextension
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anterior drawer sign
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tibia can be pulled anteriorly indicating a torn ACL
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ACL during knee flexion and extension
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flexion: slack
extension: taut |
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posterior cruciate ligament (PCL)
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posterior part of intercondylar area of tibia to medial femoral condyle
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PCL resists
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anterior movement of the femur on the fixed tibia (ex when walking downhill or downstairs)
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posterior drawer sign
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tibia can be pushed posteriorly
-indicating a torn PCL |
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PCL is what during knee flexion and extension
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flexion: taut
extension: slack |
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both PCL and ACL lie within
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fibrous joint capsule but outside the synovial cavity (synovial capsule is reflected anteriorly aroun dthe cruciate ligaments)
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menisci
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C-shaped fibrocartilage articular disks on the tibia that absorb shock and improve the fit of the femur and tibia during knee movements
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medial meniscus
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attached to medial collateral ligament
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lateral meniscus
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smaller and nearly a complete circle
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bursae around knee
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subcutaneous prepatellar bursa
subcutaneous infrapatellar bursa -common sites of infection from abrasion or inflammation from repetitive motion (bursitis) |
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proximal tibiofibular joint
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plane joint between head of fibular and lateral condyle of tibia
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distal tibiofibular joint
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strong syndesmosis between the inferior ends of the fibular and tibia that stabilizes the ankle joint
-reinforced by anterior and posterior tibiofibular ligaments |
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talocrural (ankle) joint type etc
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hinge joint between the tibia/fibula and talus that permits dorsiflexion and plantar flexion
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specifically, the pulley shaped articular surface (trochlea) of the talus with ankle joint fits...
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into a deep box-like socket (mortise) formed by the medial malleolus and inferior articular surface of the tibia and the lateral malleolus of the fibula
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articular surfaces are what type of fit in ankle
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better than in any other joint
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most commonly injured joint in body
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talocrural ankle joint
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medial/deltoid ligament resists
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eversion
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4 parts of medial/deltoid ligament
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1. tibionavicular
2. anterior tibiotalar 3. posterior tibiotalar 4. tibiocalcaneal |
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significance of medial ligament
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very strong and rarely torn
-forced eversion can cause the deltoid ligament to avulse (tear off) the medial malleolus |
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lateral ligaments of ankle resist
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inversion
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3 ligaments of lateral ligaments of ankle
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1. anterior talofibular
2. posterior talofibular 3. calcaneofibular |
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most commonly injured lateral ligaments of ankle
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anterior talofibular
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subtalar joint
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talocalcaneal or posterior talocalcaneal
-articulation of the body of the talus with the posterior articular surface of calcaneus |
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subtalar joint permits
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inversion and eversion of the heel
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transverse tarsal joint (midtarsal)
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compound joint (talocalcaneonavicular joint + calcaneocuboid joint) that permit inversion and eversion of the forefoot
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talocalcaneonavicular joint
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head of talus articulates with calcaneus and navicular (2 talocalcaneal articulations and 1 talonavicular articulation)
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calcaneocuboid joint
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part of ankle joint
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tarsometatarsal and intermetatarsal joints
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plane synovial joints
-metatarsal bones bound tightly together by ligaments at their bases and heads |
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metatarsophalangeal joint is what type
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metatarsophalangeal joints are condyloid joints
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interphalangeal joints are what type
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hinge
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articular surface of proximal bone with interphalangeal joints and metatarsophalangeal and distal
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convex, surface of distal bone is concave
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all metatarsophalangeal and interphalangeal joints are reinforced by
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collateral ligaments
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