DISSECTION SCHEDULE Session I - Hip (Front) & Thigh (Superficial) Surface anatomy Self study ØØØ Inguinal region ØØØ Gluteal region ••• ØØØ Thigh Features & attachments of ØØØ Leg Hip bone and femur ØØØ Foot bones ØØØ Hip bone ••• Iliotibial tract and its functions ØØØ Femur Dissection ••• Location and drainage of superficial inguinal ØØØ Superficial fascia lymph nodes ØØØ Great saphenous vein ØØØ Superficial inguinal lymph nodes ••• Cutaneous nerves ØØØ Superficial branches of femoral artery ••• ØØØ Superficial inguinal ring Origin, course, termination & tributaries of ØØØ Spermatic cord the great saphenous vein ØØØ Inguinal ligament ØØØ Saphenous opening ØØØ Deep fascia (fascia lata) Session II - Hip (Front) & Thigh (Deep) Dissection Self study ØØØ Femoral sheath ••• Boundaries and contents of femoral ØØØ Femoral artery & branches, triangle profunda artery & its branches ØØØ Femoral vein ••• ØØØ Femoral canal Formation and contents of ØØØ Femoral triangle Femoral sheath ØØØ Femoral nerve & branches ØØØ Adductor canal ••• Femoral hernia Muscles ••• Boundaries and contents of ØØØ Sartorius adductor canal ØØØ Pectineus ØØØ Iliopsoas ••• Origin, course, termination & ØØØ Tensor fascia lata branches of femoral artery ØØØ Rectus femoris ØØØ Vastus lateralis ••• ØØØ Vastus medialis Origin, root value, course and ØØØ Vastus intermedius distribution of femoral nerve Session III - Hip & Thigh (Medial Compartment) Dissection Self study Vessels ••• Attachments, nerve supply and actions of ØØØ Medial circumflex femoral vessels Adductor longus ØØØ Obturator vessels Adductor brevis Nerve Gracilis ØØØ Anterior and posterior branches of Adductor magnus obturator nerve Pectineus Muscles Obturator externus ØØØ Adductor longus ••• Origin, root value, course and distribution ØØØ Adductor brevis of Obturator nerve Accessory obturator ØØØ Pectineus nerve ØØØ Gracilis ••• ØØØ Adductor magnus Origin, course & termination of medial ØØØ Obturator externus circumflex femoral artery Session IV - Gluteal Region Surface anatomy Self study ØØØ ØØ Gluteal fold, natal cleft ••• Cutaneous nerve supply of gluteal region ØØØ Ischial tuberosity ••• ØØØ Posterior superior iliac spine Attachments, nerve supply and actions of Dissection Gluteus maximus ØØØ Cutaneous nerves Piriformis & obturator internus Muscles Superior and inferior gemelli ØØØ Gluteus maximus, medius & minimus Quadratus femoris ØØØ Piriformis & quadratus femoris Gluteus medius ØØØ Tendon of obturator internus,externus Gluteus minimus ØØØ Superior and inferior gemelli ••• Origin, root value, course and distribution ØØØ Hamstring muscles of Nerves Sciatic nerve ØØØ Posterior cutaneous nerve of thigh Superior gluteal nerve ØØØ Sciatic nerve Inferior gluteal nerve ØØØ Nerve to quadratus femoris Pudendal nerve ØØØ Nerve to obturator internus Nerve to obturator internus ØØØ Pudendal nerve Nerve to quadratus femoris ØØØ Superior & inferior gluteal nerve ••• Origin, course, termination and branches of Vessels Superior gluteal artery ØØØ Superior & inferior gluteal vessels Inferior gluteal artery ØØØ Internal pudendal vessels ØØØ Medial circumflex femoral artery ••• Cruciate anastomosis ØØØ First perforating artery ••• Bursa Trochanteric anastomosis ØØØ Bursa under gluteus maximus Ligaments ØØØ Sacrotuberous & sacrospinous Session V - Popliteal Fossa and Back of Thigh Self study Dissection ••• Boundaries and contents of popliteal fossa Muscles ••• ØØØ Biceps femoris (long & short head) Origin, root value, course and ØØØ Semitendinosus distribution of ØØØ Semimembranosus Sciatic nerve ØØØ Lateral and medial heads of Tibial nerve gastrocnemius Common peroneal nerve ØØØ Gracilis ••• Origin, course, termination and ØØØ Sartorius branches of ØØØ Popliteus Profunda femoris artery Popliteal artery Nerves ••• Formation , course, termination and ØØØ ØØ Posterior cutaneous nerve of thigh tributaries of popliteal vein ØØØ Sural nerve ••• Attachments, nerve supply and ØØØ Lateral cutaneous nerve of calf ØØØ Tibial nerve and its branches actions of (muscular and genicular) Biceps femoris ØØØ Common peroneal nerve Semitendinosus Semimembranosus Vessels ØØØ Popliteal artery and its branches ØØØ Popliteal vein and its tributaries ØØØ Small saphenous vein Session VI - Hip joint Dissection Self study ••• Hip joint Exposure of hip joint Type, articulation, ligaments, ØØØ Hip joint capsule relations, nerve supply, blood supply, ØØØ Ligaments - movements, applied anatomy esp. iliofemoral ligament ØØØ Bursae ØØØ Ligament of head of femur John Hunter (1728 –1793) He was a Scottish surgeon regarded as one of the most distinguished scientists and surgeons of his day. He was an excellent anatomist; his knowledge and skill as a surgeon was based on sound anatomical background. Among his numerous contributions to medical science are study of human teeth, development of a child, gun-wounds and the lymphatic system. Hunter’s canal - Adductor / Subsartorial canal Session VII - Front & Sides of Leg and Dorsum of Foot Bones Self study ØØØ Tibia ØØØ Fibula ••• Attachments and functions of retinacula ØØØ Bones of foot & intermuscular septa Dissection ••• Attachments, nerve supply, and actions of Front of leg & dorsum of foot Tibialis anterior ØØØ Dorsal venous arch Extensor hallucis longus ØØØ Great saphenous vein Extensor digitorum longus ØØØ Small saphenous vein Peroneus tertius ØØØ Superficial peroneal nerve Extensor digitorum brevis ØØØ Superior and inferior extensor Peroneus longus retinacula Peroneus brevis ØØØ Tibialis anterior ••• ØØØ Extensor hallucis longus Origin, course, termination & ØØØ Extensor digitorum longus branches of ØØØ Peroneus tertius Anterior tibial artery ØØØ Anterior tibial vessels Dorsalis pedis artery ØØØ Dorsalis pedis artery ØØØ Deep peroneal nerve ••• Origin, root value, course and distribution of Lateral side Common peroneal nerve ØØØ Superior and inferior peroneal retinacula Superficial peroneal nerve ØØØ Peroneus longus ØØØ Peroneus brevis Medial side Tendons and insertion of ØØØ Sartorius ØØØ Gracilis ØØØ Semitendinosus ØØØ Semimembranosus Friedrich Trendelenburg (1844-1924) Trendelenburg was a great practical surgeon who was keenly interested in the history of surgery. His doctoral thesis ‘De Veterum Indorum Chirurgiais’ discussed ancient Indian surgery. Trendelenburg ‘s test for varicose veins – to test the saphenofemoral incompetence. Trendelenburg ‘s sign – tilting of the pelvis to the sound side on failure of the abductor mechanism of the hip joint Session VIII - Back of Leg Dissection Self study ØØ ØØØ Sural nerve ••• ØØØ Small saphenous vein •• Superficial veins of lower limb ØØØ Flexor retinaculum ••• Lymphatics & lymph nodes of lower limb ØØØ ØØ Medial & lateral heads of ••• Attachments, nerve supply and actions of gastrocnemius Gastrocnemius, soleus & plantaris ØØØ Plantaris Tibialis posterior ØØØ Soleus Flexor digitorum longus ØØØ Tendocalcaneus Flexor hallucis longus ØØØ Popliteus Popliteus ØØØ Flexor digitorum longus ••• ØØØ Flexor hallucis longus Flexor retinaculum – attachments and ØØØ Tibialis posterior relations ØØØ Tibial nerve ••• Origin, course, termination and branches of ØØØ Posterior tibial vessels posterior tibial & peroneal artery ØØØ Peroneal artery ••• Origin, root value, course and distribution of tibial nerve ••• Anastomosis around knee joint & ankle joint Session IX - Sole of Foot Dissection : ØØØ Plantar aponeurosis ØØØ Deep branch of lateral plantar nerve ØØØ Fibrous flexor sheaths ØØØ Plantar arch ØØØ Abductor hallucis ØØØ Plantar and dorsal interossei ØØØ Flexor digitorum brevis ØØØ Sesamoid bones ØØØ Abductor digiti minimi ØØØ Tendon of peroneus longus ØØØ Tendon of tibialis posterior ØØØ Medial and lateral plantar nerves & vessels Self study ••• ØØØ Flexor hallucis longus tendon Arches of foot ØØØ Flexor digitorum longus tendon Types ØØØ Flexor accessorius Factors maintaining the arches ØØØ Lumbricals Functions Abnormalities ØØØ Flexor hallucis brevis ••• Functional importance of the intrinsic ØØØ Adductor hallucis muscles of the sole of the foot in ØØØ Flexor digiti minimi brevis maintenance of arches of foot (Attachments of individual muscles need not be known) Session X - Knee joint Dissection Self study ØØØ Articular capsule ••• Knee joint ØØØ Collateral ligaments Type ØØØ Ligamentum patellae, Articulation oblique popliteal ligament Ligaments ØØØ Medial and lateral menisci Relations ØØØ Infrapatellar synovial fold Interior and pad of fat Blood supply ØØØ Anterior and posterior cruciate Nerve supply ligaments Movements ØØØ Bursae around knee ••• Locking and unlocking of knee joint ØØØ Tendon of popliteus ••• To draw and label interior of knee joint and arcuate ligament Session XI - Ankle joint and Joints of foot Dissection Self study ••• Ankle joint ØØØ Capsule & ligaments of ankle joint Type, articulation, ligaments, blood supply, ØØØ Plantar calcaneonavicular ligament nerve supply & movements ØØØ Long plantar ligament ••• Subtalar and transverse tarsal joints ••• Inversion and eversion movements DEMONSTRATIONS TOPICS ANNEXED TO SESSION GOALS 1 Hip bone ••• Great saphenous vein 2 Inguinal lymph nodes; femoral triangle & ••• Femoral hernia adductor canal ••• Lumbar plexus 3 Femur; adductor muscles; obturator nerve ••• Cutaneous nerves of gluteal region 4 Gluteal region - gluteal muscles & sciatic ••• Trochanteric and cruciate anastomoses nerve ••• Lymphatic drainage of lower limb 5 Hamstring muscles; popliteal fossa ••• Intermuscular septa & retinacula of leg 6 Hip joint ••• 7 Tibia, fibula, patella Anastomosis around knee & ankle ••• 8 Muscles, vessels & nerves of the leg Intrinsic muscles of sole 9 Arches of foot; applied anatomy of foot ••• Locking of knee joint 10 Knee joint, interior of knee ••• Intertarsal joints 11 Ankle joint; inversion / eversion of the foot Topics for Clinical Integration (covered in Applied Anatomy lecture) ••• Nerve injuries and nerve conduction ••• Varicose veins ••• Fracture neck of femur and dislocation of head of femur ••• Surgical approaches.