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Home , Adductor canal, Femoral canal, Femoral sheath, Lateral plantar nerve, Medial plantar nerve, Plantar nerve

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

2019 Thunderbringers Too much to handle

• https://www.youtube.com/watch?v=glii-kaza d8 Cutaneous Innervation 5 Compartments of the

• 3 on : Medial, Central and Lateral compartments • Interosseus compartment (between metatarsals) • Dorsal compartment Foot Stuff

• How many muscles are in the feet? Foot Stuff

• 20

Bones? 26 ? 33 Foot Stuff

• What is the function of plantar muscles? – They function primarily during the support phase of stance, maintaining the arches of the foot – They also resist forces that tend to reduce the longitudinal arch as weight is received at the heel and then transferred to the ball of the foot and great Feet are like Ogres too

• Focus on the layers, but understand that they don’t “peel” back in perfect layers during dissection • There are 4 of them • Focus on the muscles but know which layer the and are in – Medial and lateral plantar arteries and nerves are all in 1st layer – and branches are in 3rd layer Layer 1

• Immediately deep to the plantar , you see flexor digitorum brevis muscle • Abductor hallucis and abductor digiti minimi muscles • Medial and lateral plantar arteries (what are these a branch of?) • Medial and lateral plantar nerves (what are these a branch of?) Layer 2

• Tendons of flexor digitorum longus • Lumbricals • Quadratus plantae • Tendon on flexor hallucis longus Layer 3

• Adductor hallucis (“7 muscle”): transverse head and oblique head • Flexor hallucis brevis • Flexor digiti minimi • Plantar arch and its branches (arteries) Layer 4

• Planter interossei Tendinous insertion of tibialis posterior • Dorsal interossei • Tendon of fibularis longus • You will also see the ligaments – Long plantar ligament – Short plantar ligament – Spring ligaments Nerves of the Plantar Foot Proper digital nn.

Common digital

Medial

A FDB D M Nerves of the Plantar Foot

Proper digital nerves

Common digital nerve

Superficial br. Of the lateral plantar n.

Deep br. of the lateral plantar n.

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

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

• FDB, abductor hallucis, flexor hallucis brevis

And first lumbrical Innervation and blood supply

• Which muscles are supplied by lateral plantar nerve and artery? Innervation and Blood supply

• Abductor digiti minimi, flexor digiti minimi, quadratus plantae, adductor hallucis, plantar and dorsal interossei The Hip Iliolumbar ligament A Anterior sacroiliac ligament L L

Iliofemoral ligament

Pubofemoral ligament The Knee

Anterior and posterior cruciate ligaments Lateral meniscus

Medial meniscus

Fibular collateral ligament

Tibial collateral ligament The Knee

ACL

Medial meniscus Lateral meniscus

PCL

Post. Meniscofemoral ligament The The Foot

Tendon of fibularis longus

Short plantar ligament (plantar calcaneocuboid lig.) Long plantar ligament Spring liament (plantar calcaneonavicular lig.)

Tendon of tibialis posterior

• I mentioned a few weeks ago as being really important • Network of nerves formed by the ventral rami of L1-4 • They receive gray rami communicantes from sympathetic trunk (which is where all sympathetics originate from – T1-L2 lateral horn cells) – Don’t worry about sympathetics now, but pack this away in your brain for next tri Branches of Lumbar Plexus Gray ramus communicans

Subcostal n. (T12) Sympathetic trunk Iliohypogastric n. (L1)

Ilioinguinal n. (L1) Genitofemoral n. (L1/L2) Lat. femoral cutaneous n. (L2/L3) Genitofemoral n. Obturator n. (L2-L4) 1. Femoral Br. 2. Genital Br.

Femoral n. (L2-L4) Cutaneous Nerves of the /Leg Genitofemoral (femoral branch) Subcostal Cut. Br. of Ilioinguinal Iliohypogastric

Lateral femoral cutaneous Lateral femoral cutaneous Obturator Posterior femoral cutaneous Anterior femoral cutaneous (Br. of the femoral n.)

Lateral sural cutaneous Saphenous Lateral sural cutaneous (Br. of the femoral n.) Compartments of the Thigh

• Anterior Compartment • Medial Compartment ➢ Muscles that extend the knee ➢ Muscles that adduct and help joint and help flex the hip flex the hip • Femoral N. (L 2, 3, 4) • Obturator N. (L 2, 3, 4)

• Posterior Compartment ➢ Muscles that flex the knee and extend the hip • Sciatic N. (L 4 – S 3) Anterior Thigh

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

• Profunda femoris, which is a branch of Anterior Thigh

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

• Medial and lateral femoral circumflex – What does lateral femoral circumflex nourish? Anterior Thigh

• Vastus lateralis Anterior Thigh

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

• Femoral artery Anterior Thigh

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

• Travels down the anterior thigh, through the and out the in the posterior thigh to become the Anterior Thigh

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

• – What is that a branch of? Anterior Thigh

• Boundaries of

• Superior/base: • Lateral: • Medial: adductor longus • Apex • Roof: lata • Floor: iliacus, psoas major, pectineus • Contents: femoral nerve, femoral artery, and their branches – Nerve to – Profunda femoris, medial and lateral femoral circumflex arteries, muscular branches – Great saphenous vein

• Fascial tube that encloses proximal parts of femoral artery and vein, allowing them to glide past the inguinal ligament during movements of the hip • 3 compartments: – Lateral: location of femoral artery – Intermediate: location of femoral vein – Medial: forms Horizontal Section of Proximal Thigh (Inferior View)

Inguinal ligament Femoral N. Femoral A. Iliacus Femoral V. Psoas major

Pectineus

Obturator canal Femoral canal

• Forms from medial aspect of femoral sheath • Allows femoral vein to expand during increased venous return from lower extremity • Site of femoral hernias, why? – Surrounded by weak extraperitoneal fat Anterior Thigh Muscles

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

• muscle Thigh muscles

• What are the 4 quadriceps muscles? Thigh Muscles

• Vastus lateralis • Vastus intermedius • Vastus medialis • Rectus femoris Anterior Thigh Muscles

• Where is the vastus intermedius? Anterior Thigh Muscles

• Deep to rectus femoris Muscular tripod

• The sartorius combines with the gracilis and semitendinosus to insert on the superomedial tibia (proximal aspect of medial surface of tibia). This complex is called . Thigh Muscles

• What are all 4 quadriceps muscles innervated by? Thigh muscles

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

• Nerve to vastus medialis*** Anterior Thigh

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

• – What does this attach to and then what does it continue as? Anterior Thigh

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

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

• Straight head: AIIS • Reflected head: rim of acetabulum Medial Femoral Group – Thigh Master Squeeze • Adductor magnus, pectineus, obturator externus, adductor longus, adductor brevis, gracilis • All adduct the thigh except 1 – Obturator externus laterally rotates • All innervated by except 2 – Adductor magnus innervated by posterior division of obturator nerve and ) – Pectineus innervated by femoral nerve Medial Femoral Group – Thigh Master Squeeze • Which medial femoral muscles are innervated by anterior division of obturator nerve? Medial Femoral Group – Thigh Master Squeeze • Gracilis, adductor longus, adductor brevis Medial Femoral Group – Thigh Master Squeeze • Which medial femoral muscles are innervated by posterior division of the obturator nerve? Medial Femoral Group – Thigh Master Squeeze • Obturator externus • Adductor magnus – Also contributions from tibial nerve remember? Medial Femoral Group – Thigh Master Squeeze • Where is the anterior branch of the obturator nerve? Medial Femoral Group – Thigh Master Squeeze • Between adductor longus and adductor brevis Medial Femoral Group – Thigh Master Squeeze • Where is the posterior branch of the obturator nerve? Medial Femoral Group – Thigh Master Squeeze • Superficial to the obturator externus and then travels between adductor brevis and adductor magnus Cutaneous Nerves of Lower Extremity

Saphenous n Lateral sural n.

Lateral sural n.

Superficial fibular n. Cutaneous Nerves of the Foot/Ankle Anterior Leg Muscles

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

• Fibularis longus • Fibularis brevis • Both innervated by superficial fibular nerve (L5-S2) • Both nourished by (What is fibular artery a branch of?) • Action is eversion of the foot Dorsal Foot Muscles

• Extensor digitorum brevis • Extensor halllucis brevis • Both innervated by deep fibular nerve (L5-S1) • Both supplied by

Arteries

Deep Nerves of the Anterior Leg Spinal levels

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

• Femoral: L2-4 • Obturator: L2-4 • Sciatic: L4-S3 • Tibial: L4-S3 • Common fibular: L4-S2 • Superior gluteal: L4-S1 • Inferior gluteal: L5-S2 Osteology Osteology Dermatomes Nerves and Veins Superficial to the Deep Fascia

Deep Nerves of the Anterior Leg