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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 Foot • 3 on sole: 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 Joints? 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 toe 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 arteries and nerves are in – Medial and lateral plantar arteries and nerves are all in 1st layer – Plantar arch and branches are in 3rd layer Layer 1 • Immediately deep to the plantar aponeurosis, 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 nerve Medial plantar nerve A FDB D Lateral plantar nerve M Nerves of the Plantar Foot Proper digital nerves Common digital nerve Superficial br. Of the lateral plantar n. Medial plantar nerve 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 toes medial plantar medial plantar flexes lateral 4 toes brevis tuberosity via 4 separate tendons nerve (S2-3) artery 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 joint 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 Ankle The Foot Tendon of fibularis longus Short plantar ligament (plantar calcaneocuboid lig.) Long plantar ligament Spring liament (plantar calcaneonavicular lig.) Tendon of tibialis posterior Lumbar Plexus • 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 Thigh/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 femoral artery 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 adductor canal and out the adductor hiatus in the posterior thigh to become the popliteal artery Anterior Thigh • What does the great saphenous vein run with? Anterior Thigh • Saphenous nerve – What is that a branch of? Anterior Thigh • Femoral nerve Boundaries of Femoral Triangle • Superior/base: inguinal ligament • Lateral: sartorius muscle • Medial: adductor longus • Apex • Roof: Fascia lata • Floor: iliacus, psoas major, pectineus • Contents: femoral nerve, femoral artery, femoral vein and their branches – Nerve to vastus medialis – Profunda femoris, medial and lateral femoral circumflex arteries, muscular branches – Great saphenous vein Femoral sheath • 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 femoral canal Horizontal Section of Proximal Thigh (Inferior View) Inguinal ligament Femoral N. Femoral A. Iliacus Femoral V. Lymph node 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 • Iliopsoas 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 pes anserinus. Thigh Muscles • What are all
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    Department of Human Anatomy. Medical University of Białystok Beata Klim Gluteal region It lies posterior to the pelvis between the level of the iliac crests and the inferior borders of the gluteus maximus muscles. The intergluteal (natal) cleft separates the buttocks from each other. The gluteal sulcus demarcates the inferior boundary of the buttock and the superior boundary of the thigh. Gluteal region The gluteal muscles (maximus, medius and minimus) form the bulk of the buttock. Pelvic girdle- muscles The anterior compartment: Psoas major Psoas minor Iliacus They are called - Iliopsoas Iliopsoas Proximal attachments: Psoas major- sides of T12-L5 vertebrae & discs between them; transverse processes of all lumbar vertebrae Psoas minor- sides of T12-L1 & intervertebral disc Iliacus- iliac crest, iliac fossa, ala of sacrum & anterior sacroiliac ligaments Iliopsoas Distal attachments: Psoas major- lesser trochanter of femur Psoas minor- pectineal line, iliopectineal eminence via iliopectineal arch Iliacus- tendon of psoas major, lesser trochanter, and femur distal to it Iliopsoas Innervation: Psoas major- ventral rami of lumbar nerves L1, L2, L3 Psoas minor- ventral rami of lumbar nerves L1, L2 Iliacus- femoral nerve L2, L3 Iliopsoas Main action: It is the chief flexor of the thigh, and when the thigh is fixed, it flexes the trunk on the hip. It is also a postural muscle that is active during standing by preventing hyperextension of the hip joint. The gluteal muscles The gluteal muscles consist of: Three large glutei (maximus, medius & minimus), which are mainly extensors and abductors of the thigh. A deeper group of smaller muscles (piriformis, obturator internus, obturator externus, gemelli and quadratus femoris), which are covered by the inferior part of the gluteus maximus.
  • Foot and Ankle Disorders Capturing Motion with Ultrasound

    Foot and Ankle Disorders Capturing Motion with Ultrasound

    VISIT THE AANEM MARKETPLACE AT WWW.AANEM.ORG FOR NEW PRODUCTS AMERICAN ASSOCIATION OF NEUROMUSCULAR & ELECTRODIAGNOSTIC MEDICINE Foot and Ankle Disorders Capturing Moti on With Ultrasound: Blood, Muscle, Needle, and Nerve Photo by Michael D. Stubblefi eld, MD Foot and Ankle Nerve Disorders Tracy A. Park, MD David R. Del Toro, MD Atul T. Patel, MD, MHSA Jeffrey A. Mann, MD AANEM 58th Annual Meeting San Francisco, California Copyright © September 2011 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson’s Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 Foot and Ankle Nerve Disorders Table of Contents Course Objectives & Course Committee 4 Faculty 5 Tarsal Tunnel Syndromes 7 Tracy A. Park, MD First Branch Lateral Plantar Neuropathy: “Baxter’s Neuropathy” 17 David R. Del Toro, MD Foot Pain Related to Peroneal (Fibular) Nerve Entrapments (Deep and Superficial) and Digital Neuromas 25 Atul T.