Zapater Lower Limb

Front 1

DERMATOMES. At middle of inguinal ligament and a ittle into the upper thigh

Back 1

L1

Front 2

Lateral aspect of the thigh

Back 2

L2

Front 3

The great toe

Back 3

L4

Front 4

The middle three digits (digits 2 -4 )

Back 4

L5

Front 5

Little toe

Back 5

S1

Front 6

Medial part of posterior thigh and calf

Back 6

S2

Front 7

Tap patellar tendon to test

Back 7

L2-L4

Front 8

Tap Achilles tendon to test

Back 8

S1

Front 9

Does the great saphenous vein pass ANTERIOR or POSTERIOR to medial malleous?

Back 9

The great saphenous vein passes ANTERIOR the medial malleous. This kinda makes sense: the great saphenous vein is huge and it basically passes in everything superficial. It runs is course in the superficial fascia for the entire length of the leg & it's just in front of everything

Front 10

Does the great saphenous vein pierce the investing fascia?

Back 10

No. As we discussed the great saphenous vein runs in the superficial area, the entire length of the leg.

Front 11

The great saphenous vein joins the

Back 11

Superficial epigastric vein.

Again, the great saphenous vein follows its "superficial" ways....It even only associated with superficial veins!

Front 12

The great saphenous vein becomes tributary to the

Back 12

femoral vein

Front 13

Arising from the dorsal venous arch on the dorsum of the foo, the small saphenous vein run its course on the __________ fascia. At the level of the popliteal fossa, It then pierces the investing fascia.

Back 13

Arising from the dorsal venous arch on the dorsum of the foo, the small saphenous vein run its course on the SUPERFICIAL fascia.

But It can't take the heat like the GREAT saphenous vein for long, so at the level of the popliteal fossa, the small then pierces the investing fascia & finds refuge there.

WIMP.

Front 14

Once the small saphenous vein pierces the investing fascia, it becomes tributary to the _________________ vein.

Back 14

Once the SMALL saphenous vein pierces the investing fascia, it becomes tributary to the POPLITEAL vein.

Front 15

Shown here is the Popliteal Vein.

These ______________ & _____________ veins come together near the popliteal fossa and form the origin of the popliteal vein in the popliteal fossa.

Back 15

These ______________ & _____________ veins come together near the popliteal fossa and form the origin of the popliteal vein in the popliteal fosssa.

Front 16

The veins transform as usual--> Finish this

Anterior & Posterior Tibial Veins--> Popliteal Vein --> Femoral Vein ---> Above inguinal ligament-> ____________ Vein

Back 16

Anterior & Posterior Tibial Veins--> Popliteal Vein (in popliteal fossa) --> Femoral Vein ---> Above inguinal ligament-> EXTERNAL Iliac Vein

Front 17

Let's keep going! Deep veins (popliteal vein, femoral vein, anterior + posterior tibial veins) take the blood from lower limb & return it to heart.

External Iliac Vein ---> ____________ Vein ----> Inferior Vena Cava ---> ____________ Atrium

Back 17

External Iliac Vein---> Common Illiac Vein ----> Inferior Vena Cava ---> Right Atrium

Front 18

Great Saphenous Vein passes ANTERIOR or POSTERIOR to medial malleolus?

Back 18

Great Saphenous Vein pass ANTERIOR to MIDDLE malleolus.

Like we said, Great Saphenous vein gotta be in front of everything. Yes, PLEASE note the Great Saphenous never NEVER pierces the Investing layer.

Front 19

Small saphenous vein passes ________________ to ____________ malleolus

Back 19

SMALL saphenous vein passes POSTERIOR to LATERAL malleolus

Front 20

Deep Vein Thrombosis is common in which deep veins?

Back 20

Common in POPLITEAL and femoral veins (rmbr, popliteal vein is tributary to femoral vein)

Front 21

Ok now this order:

Popliteal Nodes ---> _________________ Nodes ---> _______________ Nodes

(Hint: Follows the same course as small saphenous vein)

Back 21

Popliteal Nodes ---> Deep Inguinal Nodes ---> External Iliac Nodes

Front 22

Alright, back to the popliteal nodes: drain what area

Back 22

Cutaneous & Subcutaneous portions of the LATERAL foot

Front 23

Superficial Inguinal Nodes, which lies along the inguinal ligament) drain which areas:

Back 23

Basically any area, for a BIKINI wax

The superficial thigh region
The anterolateral abdominal wall (below the umblicus)
The gluteal region
The genital area (except glans)

Front 24

Which is the ONLYYYYYYY muscle that is completely surrounded by investing layer of fascia in the lower limb ( & prob in upper limb too)

(FOR ALL the other muscles in this superficial & investing layer of fascia is EXTERNAL to the muscles. )

Back 24

The tensor fascia lata muscle

On the cadaver, it's going to be only other thing, externally, that attaches to the gluteus maximus.

The smaller tensor fasciae latae, like the gluteus maximus muscle, also attaches to the iliotibial tract.

Front 25

Note how the ligaments are arranged & make up the formation of the foramen

For instance, foramen above sacrospinous ligament is called ______________

The foramen b/w the sacrospinous & sacrotuberous ligament is called ______________

Back 25

formation of the foramens

For instance, foramen above sacrospinous ligament is called GREATER sciatic foramen

The foramen b/w the sacrospinous & sacrotuberous ligament is called LESSER sciactic foramen

Note how the sacrotuberouss ligament dips downwards, while the sacrospinous ligament tries to keep the foramen looking like a real circle and just essentially shoots right across to the ischial spine from the body.

Front 26

Which ligament is this: sacrospinous or sacrotuberous ligament?

Back 26

The sacrotuberus is the ligament dipping down from the coccyx (see answer in previous slide) so it's gotta be the sacrotuberous ligament. You don't really have to feel it ...but it'll probably feel bony f you're in lab.

Front 27

piriformis s labeled. I find it easiest to look for sciatic nerve & then look for the uppermost "slim" muscle above which the sciatic nerve juts out.

What vein, nerve, arteries are above the piriformis muscle & pass through the greater sciatic foramen

Back 27

Superior Gluteal VAN.

The superior gluteal artery, the largest branch of the INTERNAL ILIAC artery.

This is all internal n the 'iliac' region-so that makes sense.

Front 28

Right gluteal region.

What nerve this pointing to?

Which nerve accompanies it?

Back 28

You know it's pudendal nerve b/c

-it's the most medial thing coming out b/w the piriformis & superior gemellus
-Basically you're looking for a structure that the most medial item from sciatic nerve.

Then follow structure down in lab to confirm that the pudendal nerve is passing down to the sacrotuberous ligament--Pudendal Nerve.

Pudendal Nerve & Nerve to Oburator Internus

Front 29

Which muscle attaches to proximal tuberosity of this highlighted region.

Back 29

1. Linea Aspera On Femur
2. Tuberosity Proximal to Linea Aspera = Gluteus Tuberosity
3. Gluteal Tuberosty - Gluteus maximus

Front 30

Insertion point of _________________ & ________________

Back 30

Star= Lesser trochanter/ Lesser trochanter is most inferior from head of femur


Insertion point of Iliopsoas muscle.

In the cadaver, the iliopsoas muscle is immediately medial to sartorius muscle.

Front 31

Fill in w/ extra or intra

The artery of head of femur + ligament carrying it (ligament of the femoral head are ________CAPSULAR & ___________ SYNOVIAL

Back 31

The artery of head of femur + ligament carryng it (ligament of the femoral head are INTRACAPSULAR & EXTRASYNOVIAL

‘extra-synovial’, means that it is not actually surrounded by synovial fluid, and hence it has a better blood supply.

Artery of head of femur= branch of medial circumflex artery in Grant's dissector

Front 32

Doesn't that fracture of the femoral neck look darn painful ?! Yeah, this kind of fracture -- an intracapsular fracture--threatens the entire blood supply to the head of the femur (remember, how the branch of the medial circumflex artery)

Back 32

Fracture everywhere else on the femur are JUST NOT that serious

Front 33

Does medially rotating the femur stabilize or destabilize the femoral ligaments?

Back 33

DESTABILIzes. When femor is medially rotated, the insertion points of ligaments are brought closer to the origin--shortens --> destabilizes ligament.

Front 34

Does flexing the the femur stabilize or destabilize the femoral ligaments?

Back 34

Destabilize the ligaments

Front 35

Dislocation of hip joint:

Most of the time, the head of femur displaces ANTERIORLY or POSTERIORLY?

Back 35

POSTERIORLY

Front 36

Back to Upper Limb:

Most of the time, the clavicle tends to dislocate how?

Back 36

Generally, clavicle tends to dislocate anterior - superiorly.

Front 37

Groovy Amina is baaaaaack!

Only 4 things that are INTRAcapsular intrasynovial are:
What are they?

everything else: intracapsular EXTRA synovial

Back 37

Glenoid labrum, acetabulum labrum, and the medial and lateral meniscis

Front 38

Inferior Gluteal Nerve innervates

Superior Gluteal Nerve innervates

Back 38

Inferior Gluteal Nerve innervates Gluteus Maximus. Helps you get of your butt.

Superior Gluteal Nerve innervates Gluteus Medius & Minmus. These muscle prevents pelvic drop & allow you to walk normally

Front 39

Focus on the muscle a below the piriformis for a minute.

All of these muscle serve to ____________ (medially or laterally) rotate the femur. Will this movement stabilize or destablize the femoral ligaments?

The superior 2 muscles -- the gemellus superior & obturator internus--are innervated by _______________

The inferior 2 muscles-inferior gemellus & quadratis femoris-- are innervated by __________________________.

Back 39

All of these muscle serve to laterally rotate the femur. Destablize the femoral ligaments! (Look above)

The superior 2 muscles -- the gemellus superior & obturator internus--are innervated by Nerve to the Obturator Internus (which will run lateral to pudendal nerve)

The inferior 2 muscles are innervated by nerve to the quadratus femoris.

Front 40

Deep to the adductor brevis muscle, identify the obturator externus muscle. (Well it's shown by probe)

Does the obturator externus swing POSTERIOR or ANTERIOR to the hip joint capsule?

Back 40

Note that this is the posterior view, so tendon is visible, but muscle dissapears from view.

Also, go back to the last slide if you didn't realize that you would need to reflect the quadratis femors muscle to actually find the obturator externus.

Front 41

Sciatic nerve divides into wthat 2 nerves?

Back 41

COMMON TIBIAL & FIBULAR NERVE
This makes sense it just divides into the region it innervates.

Sticky 'i' keyboard so might me missing i's from now on

Front 42

JUST medially to the SCIATIC nerve you'll find the

Back 42

posterior cutaneours nerve of the thigh

Front 43

Where should you give a gluteal injection

Back 43

UPPER lateral quadrant