anatomy ta notes from sarah
TRANSCRIPT
ANATOMY–MUSCULOSKELETALBLOCK(muscularchartkey=NAME/ORIGIN/INSERTION/ACTION/INNERVATION)SUPERFICIALBACKANDSHOULDERREGION:
‐ Extrinsicmusclesoftheupperlimb:superficialback(5),pectoral(4)‐ Intrinsicmusclesoftheupperlimb:shoulder(6),arm(4),forearm(20),hand(19)‐ RELEVANTSKELETALCOMPONENTS:
o Vertebralcolumn–spinousprocess,transverseprocesso Clavicle(collarbone):medial&lateralsurfaces,superior&inferiorsurfaceso Scapula:acromion,coracoidprocess,glenoidcavity,neck,angles&borders,supra&
intraglenoidtubercles,suprascapularnotch,subscapularfossa,spine,supraspinousfossa,infraspinousfossa
o Humerus:head,anatomicalneck,greatertubercle,lessertubercle,intertubercularsulcus(bicipitalgroove),deltoidtuberosity
‐ SUPERFICIALBACKMUSCLES(5):Trapeziusmuscle skull,ligamentumnuchae,
spinousprocessesofT1‐T12lateral(acromial)1/3ofclavicle,acromionprocess,scapularspine
elevatescapula(upperfibers),retractscapula(middlefibers),pullmedialborderofscapula,orientingglenoidfossaupward(lowerfibers)
accessorynerve,branchesofVPRofC3andC4
Latissimusdorsi posterioriliaccrest,thoracolumbarfascia,spinousprocessesofT6‐T12(sometimes3to4ribsandinferiorangleofscapula)
floorofbicipitalgrooveofhumerus
armextension,armadduction,medialrotationofarm
thoracodorsalnerve
Levatorscapulae transverseprocessesofC1‐C4
superiorportionofmedialborderofscapula
pullscapulamedially,elevatescapula
dorsalscapularnerve,VPRofC3andC4
Rhomboidminor ligamentumnuchae,spinousprocessesofC7andT1
medialborderofscapula,justmedialtobaseofspineofscapula
pullscapulamedially,elevatescapula
dorsalscapularnerve
Rhomboidmajor spinousprocessesofT2‐T5 lowerportionofmedialborderofscapula
pullscapulamedially,elevatescapula
dorsalscapularnerve
‐ Rulesofsuperficialbackmuscles:o AllareinnervatedbydorsalscapularnerveEXCEPTtrapeziusandlatissimusdorsi
‐ SHOULDERMUSCLES(6):Deltoidmuscle
spineofscapula,acromion,lateral(acromial)1/3ofclavicle
deltoidtuberosity abductsthearmattheshoulder,flexionandmedialrotationofarm(anteriorfibers),extensionandlateralrotationofarm(posteriorfibers)
axillarynerve(C5‐C6)
Supraspinatusmuscle
supraspinousfossaofscapula
greatertubercleofhumerus,capsuleofglenohumeraljoint
initiatesabductionofthearm,stabilizesshoulderjoint
Suprascapularnerve(C5‐C6)
Infraspinatusmuscle
infraspinousfossaofscapula
greatertubercleofhumerus,capsuleofshoulderjoint
lateralrotationofarm,stabilizesshoulderjoint
Suprascapularnerve(C5‐C6)
Subscapularismuscle
subscapularfossaofscapula
lessertubercleofhumerus medialrotationofthearm,stabilizesshoulderjoint
lower(C5‐C6)andupper(C5)subscapularnerves
Teresminor middle1/3oflateralborderofscapula(dorsal)
greatertubercleofhumerus(dorsally),capsuleofshoulderjoint
rotatesthearmlaterally,stabilizestheshoulderjoint
axillarynerve(C5‐C6)
Teresmajor inferior1/3oflateralborderofscapula(dorsal)
lessertubercleofhumerus(mediallipofbicipitalgroove,ventrally)
rotatesthearmmedially lowersubscapularnerve(C5‐C6)
‐ Rulesofshouldermuscles:o Alloriginatefromthescapula(someinpart)andinsertonthehumerus
‐ STERNOCLAVICULARJOINTo Skeletalcomponents:medialclavicle,manubrium,1stcostalcartilageo Synovialplanejoint;articulardiscdividesthejointspaces
LateralCompartment:elevation(superiorsliding)ofjointbysternocleidomastoid,trapezius,levatorscapulae,rhomboids;depression(inferiorsliding)ofjointbypectoralisminor,subclavius
MedialCompartment:anteriorslidingofjointbyserratusanterior;posteriorslidingofjointbytrapezius,rhomboids
o Ligaments:sternoclavicular=surroundsarticularcavitiesofjoint;costoclavicular=connects1stribtoclavicle
‐ ACROMIOCLAVICULARJOINTo Skeletalcomponents:lateralclavicle,acromionofscapulao Wedgeshapedarticulardisco Ligaments:acriomioclavicular(superior&inferior)=surroundsthejoint;
coracoclavicular(trapezoidlaterally&conoidmedially)=connectclavicletocoracoidprocess
o Innervation:supraclavicularN,medial&lateralpectoralNN,axillaryN‐ GLENOHUMERALJOINT
o Skeletalcomponents:glenoidfossaofscapula,headofhumeruso Ballandsocketjoint;though,glenoidfossaisrathershallow,depthincreasedby
fibrocartilageringcalledglenoidlabrumo Synovialcavity:attachedtoedgesofarticularsurfaces;extensions=synovialsheathof
bicepslongheadtendonandsubscapularisbursao ANTERIORSUPPORT:
Ligaments:superior,anterior,inferiorglenohumeralligaments;transversehumeralligament(overbicipitalgroove)
Muscular:subscapulariso SUPERIORSUPPORT:
Skeletal:acromion&coracoidprocess Ligaments:coracoacromial&coracohumeral Muscular:supraspinatus,longheadofbiceps
o POSTERIORSUPPORT: Muscular:infraspinatus,teresminor
o Bursae:Subdeltoidbursa,subacromialbursa,subscapularbursa(deeptosubscapularis)DEEPBACK&VERTEBRALCOLUMN
‐ VERTEBRALCOLUMN:o 33vertebrae=>24truevertebrae=>7cervical,12thoracic,5lumbar,5sacral,4
coccygealo Function:protectspinalcord&providesasupportingstructureo Curvatures(presentingonanterioraspect)
2concavities=thoracicregionandsacralregion(primarycurvatures=presentatbirth);2convexities=cervicalregionandlumbarregion(secondarycurvatures=NOTpresentatbirth)
‐ Vertebraeo Typicalvertebra:
Anteriorbody,vertebralforamen,posteriorvertebralarch(pedicleslaterally,laminaposteriorly),7processes:1spinous,2transvers,4articular(2superior,2inferior)
Facetjointsbetweenarticularprocessesofvertebraeabove/beloweachother
• Superiorarticularprocessesarticulatewithinferiorarticularprocessesfromvertebraabove(oppositetrueforinferiorarticularprocesses)
o Intervertebraldisc Shockabsorberallowingformovement Nucleuspulposus:centerofdiscconsistsofwatery,gelatinoussubstance Annulusfibrosus:peripheryofdiscmorefibrouscartilage(thickeranteriorly
thanposteriorly)o Cervicalvertebra:
Foramentransversariumallowspassageofvertebralveinthroughthe7cervicalvertebrae,w/vertebralarterypassingthroughupper6cervicalvertebrae
Groovesintransverseprocessesforspinalnerves Uncinateprocess(inferioraspectofvertebralbody)foundinarticulation
betweenvertebralbodiesandintervertebraldiscs Spinousprocessesarebifid(exceptC1andC7) Articulatingsurfacesareflatter:superiorarticulatingsurfacesareoriented
upward;inferiorarticulatingsurfacesareorienteddownwardo Atypicalcervicalvertebrae
Atlas(C1):novertebralbodyorspinousprocess;articularsurfacesonupperaspectareforoccipitalcondyles(formovementofskullinnodding“yes”)
Axis(C2):odontoidprocessprojectssuperiorlyfromsuperioraspectofbody NointervertebraldiscbetweenC1‐C2
• CruciateligamentbetweenC1‐C2consistsoftransverseligamentofatlasandsuperior&inferiorlongitudinalbands
o Thoracicvertebra: Vertebralbodyismediumsizedandheartshapedw/circularvertebralforamen Spinousprocessislongandslopingdownward Costalarticularsurfacescanbefoundonposterolateralsidesofvertebralbody
• Costalfacetsfoundontransverseprocessesforarticulationwithtubercleofmatchingrib(notransversefacetsarefoundonT11‐T12)
Superiorarticulatingsurfacesfaceposteriorly;inferiorsurfacesfaceanteriorlyo Lumbarvertebra:
Large,kidneyshapedvertebralbodywithtriangularvertebralforamen Longandslendertransverseprocesses(L3transverseprocessesbeingwidest) Superiorarticulatingsurfacesfacemedially;inferiorfacelaterally
‐ Sacrum:fusionof5sacralvertebraeo Superiorly–intervertebraldiscL5‐S1;inferiorly–coccyx;laterally–articulationsw/iliac
portionsofpelvicboneso Sacralcanalextendslengthofsacrumforthecaudaequina:anteriorandposterior
sacralforaminaexistforventralanddorsalprimaryramiofsacralnerves‐ Ligamentsofspinalcolumn:
o Anteriorlongitudinalligament–wide,strongligamentrunninglongitudinallyoverentirelengthofanteriorandlateralsurfacesofvertebralbodies
o Posteriorlongitudinalligament–w/invertebralcanal,runninglongitudinallyoverlengthofposteriorsurfaceofvertebralbodies
o Ligamentumflavum–ligamentsrunningsegmentallybetweenvertebrallaminaeo Interspinousligaments–runbetweenadjacentspinousprocesseso Supraspinousligament–runslongitudinallyoverandbetweenthespinousprocesses(in
cervicalregion,ligamentisthickerandknownasligamentumnuchae)o Noligamentsrunbetweenpediclessoastoallowspinalnervestoexit
‐ SPINALCORDo 31pairsspinalnerves:8cervical,12thoracic,5lumbar,5sacral,1coccygeal
NOTE:C1‐C7exitvertebralcolumnABOVEtheirmatchingvertebrae,C8nerveexitsBELOWC7vertebra,andallspinalnervesinferiortoC8exitBELOWtheirmatchingvertebrae
Anteriorrootletsofaspinallevelformanterior(ventral)rootofthatlevel;posteriorrootletsofalevelformposterior(dorsal)rootofthatlevel
o SpinalcordstopsaroundL1‐L2withconusmedularisandbecomesthecaudaequina Duetodifferentialgrowthofvertebralcolumnandsofttissueofspinalcord
o Transversesectionofspinalcord: Whiteandgraymatter,anteriormedianfissure,posteriormediansulcus,
dorsal,ventralhornsofgraymatter(lateralhorninT1–L2or3only)o MENINGES(3layerssurroundingspinalcord):
Duramater:(continuousw/duramatercoveringbrain)tough,protective,impermeableoutermostlayerenclosingspinalcordandcaudaequinaandendingataroundS2–uponexitingintervertebralforamen,becomescontinuousw/epineuriumsurroundingspinalnerve
Arachnoid:(continuousw/arachnoidcoveringbrain)delicate,impermeablemembranedeeptoduramater,separatedfrompiamaterbysubarachnoidspacefilledwithcerebrospinalfluid(CSF)
Piamater:vascularmembranecoveringspinalcorditself,separatedfromarachnoidbyCSF,endingataroundL1w/filumterminale
• denticulateligaments:formedfromlateralthickeningofpiamater,attachingtoduramaterbetweennerveroots
o BLOODSUPPLYTOSPINALCORD 3mainlongitudinalarteries:2posteriorspinalarteries,anteriorspinalartery Radiculararteriesenterintervertebralforaminatoanastomosew/the3above Bloodsupplyarisesdirectlyorindirectlyfromvertebralarteriesorintercostal
andlumbararteriesfromaortao Venousnetworkofvertebralcolumn
Internalandexternalvertebralvenousplexuses:valvelesssystemofveins–drainintobasivertebralveins=>intervertebralveins=>vertebral,intercostal,lumbarveins
‐ MUSCLESOFDEEPBACK(apparentlynotthatimportantforourintentsandpurposes)o Innervatedbyposteriorprimaryramiofspinalnerveso 3groups:erectorspinaemuscles,transversospinalismuscles,deepestgroupmuscleso ERECTORSPINAE:
Spinalismuscle(medially);Longissiumusmuscle(intermediate);Iliocostalismuscle(laterally)
Erectorspinaemusclesdeeptobothserratusposteriorsuperior&inferioro TRANSVERSOSPINALIS&DEEPESTGROUP:
Transversospinalismuscles:Semispinalis,mulitifidus,rotators Deepestgroupmuscles:Intertransversarii,interspinales Posturalmusclesdesignedtomaintainpostureasextensorsofthetrunk
PECTORALREGION
‐ PectoralGirdle=scapula+clavicle‐ Axilla=apyramidshapedspacebetweenthechestandarm.Itservesasapassagewayfor
vesselsandnervespassingbetweentheupperlimbandtherootofthenecksuperiortothethoracicinlet.
‐ AXILLARYREGIONMUSCLES(4)
Pectoralismajor sternum,clavicle,upper6costalcartilages
laterallipofbicipitalgroove
armadduction(clavicularfibers),medialrotationofarm,armflexion
medialandlateralpectoralnerves(branchesofbrachialplexus)
Pectoralisminor ribs3,4,5 coracoidprocess depressesshoulder medialpectoralnerveSubclaviusmuscle 1stcostalcartilage clavicle depressesclavicle,steadies
clavicleNervetosubclavius
Serratusanterior upper8‐9ribs medialborderofscapula(anterior)
protractsscapula,keepsmedialborderofscapulaopposedtothoracicwall
longthoracicnerve(branchofbrachialplexus,foundonsuperficialsurfaceofmuscle)
BRACHIALPLEXUS(seediagram)‐ Brachialplexus=anetworkofnervesformedbytheventralprimaryramiofspinalnervesC5‐T1
o ROOTS(neck):C5,C6,C7,C8,T1o TRUNKS(neck):Upper=C5andC6join;Middle=C7continues;Lower=C8andT1joino DIVISIONS(neck):AnteriorandPosterioro CORDS(axilla):Lateral=anteriordivisionsofupperandmiddletrunks;Posterior=all
posteriordivisions;Medial=anteriordivisionoflowertrunko BRANCHES(axilla):fromRoots(2);fromTrunks(2);fromCords(13)
‐ ROOTBRANCHES:o 1)DorsalScapularn:C5,innervatesrhomboidmuscleso 2)LongThoracicn:C5‐C7,innervatesserratusanterior
‐ TRUNKBRANCHES:o 1)Suprascapularn:UpperTrunk(distal),innervatessupraspinatusandinfraspinatus
muscleso 2)NervetoSubclavius:UpperTrunk(proximal),innervatessubclaviusmuscle
‐ CORDBRANCHES:o 1)Lateralpectoraln:LateralCord,innervatespectoralismajoro 2)LateralrootofMediann:LateralCord,innervatesforearmandhando 3)Musculocutaneousn:LateralCord,innervatesmusclesofanteriorcompartmentof
armandskinoflateralforearmo 4)Uppersubscapularn:PosteriorCord,innervatessubscapularmuscleo 5)Lowersubscapularn:PosteriorCord,innervatessubscapularandteresmajormuscleso 6)Thoracodorsaln:PosteriorCord,innervateslatissimusdorsimuscleo 7)Axillaryn:PosteriorCord,innervatesdeltoidandteresminormuscleso 8)Radialn:PosteriorCord,innervatesallextensormusclesofarmandforearmo 9)Medialpectoraln:MedialCord,innervatespectoralismajorandminoro 10&11)Medialcutaneousnervesofarmandforearm:MedialCord,innervateskinof
armandforearmrespectivelyo 12)MedialrootofMediann:MedialCord,innervatesforearmandhando 13)Ulnarn:MedialCord,innervatesmusclesofforearmandhand
‐ AXILLARYLYMPHATICSo Thereareusually20–30lymphnodesintheaxilla.Theydrainthesuperficialanddeep
tissuesoftheupperlimb,thelateralbreast,andthesuperficialthoraxandabdomenabovetheleveloftheumbilicus.
o 1)Pectoral(anterior)nodes:(levelI)foundalonglowerborderofpectoralisminor,drainlateralquadrantsofthebreastandsuperficialchestandabdomenabovetheumbilicus
o 2)Subscapular(posterior)nodes:(levelI)foundonsubscapularismuscle,drainsuperficialareasofthebackdowntotheleveloftheiliaccrest
o 3)Lateralnodes:(levelI)foundalongaxillaryvein,drainsmostoflymphfromtheupperlimb
o 4)Centralnodes:(levelII)foundinthecenteroftheaxillaryfat,collectlymphfromthepectoral,subscapularandlateralgroupsofnodes
o 5)Apicalnodes:(levelIII)foundalongcephalicvein,collectlymphfromallthenodesmentionedaboveanddrainintotherightsubclaviantrunkandthenintotherightlymphatictrunk(right)orthethoracicduct(left)
o Infraclavicularnodes:foundinthedeltopectoraltriangle,receiveslymphfromsuperficialareasofthelateralpartoftheupperlimbalongthecourseofthecephalicveinanddrainintoapicalnodes
‐ BREASTo ArterialSupply:
Medialquadrants–internalthoracicarterybranches Lateralquadrants–lateralthoracicartery,thoracoacromialartery
o VenousDrainage: Medialquadrants–internalthoracicvein Lateralquadrants–axillaryveintributaries
o Lymphatics: Lateralquadrants–pectoralnodes‐>centralnodes‐>apicalnodes Medialquadrants–parasternalnodes
o MAMMARYGLAND: Subcutaneous,exocrineglandwith15‐20lobes Connectivetissueseptasurroundinglobes(withsuspensoryligamentsinupper
quadrants) Retromammaryspace(surgicalplane):Connectivetissueseparatingthe
mammaryglandandassociatedfattytissuefromthepectoralismajorARM
‐ RELEVANTSKELETALCOMPONENTS:o Humerus:radialgroove(posterior),medialandlateralepicondyles,medialandlateral
supracondylarridges,capitulum(lateral),trochlea(medial),radialfossa,coronoidfossa,olecranonfossa
o Radius:head,neck,radialtuberosityo Ulna:olecranonprocess,coronoidprocess,trochlearnotch,radialnotch,ulnar
tuberosity‐ Brachialfascia:deepfasciasurroundingentirearm‐ Medialandlateralintermuscularseptaemakeanteriorandposteriorcompartmentsofbrachium‐ ANTERIORCOMPARTMENTMUSCLES(3):
Bicepsbrachii longhead–supraglenoidtubercleonscapula;shorthead–coracoidprocess
posteriorportionoftheradialtuberosity,bicipitalaponeurosisinsertsintomedialsideofantebrachialfascia
strongflexionandsupinationofantebrachiumatelbow,weakflexoroftheshoulder
musculocutaneousnerve
Coracobrachialis coracoidprocessofthescapula(commontendonw/shortheadofbiceps)
anterioraspectofthemiddleshaftofthehumerus
weakflexionandadductionofthearmattheshoulder
musculocutaneousnerve
Brachialis anterioraspectofdistalhalfofhumerus(largesurfaceoforigin)
coronoidprocessofulna strongflexorofantebrachiumattheelbow
musculocutaneousnerve;smallportionlaterally–radialnerve
‐ Rulesofanteriorcompartmentmuscles:o AllareinnervatedbythemusculocutaneousnerveEXCEPTpartofbrachialis(radialn)o Allservetoflextheantebrachium(forearm)attheelbowEXCEPTcoracobrachialis
‐ POSTERIORCOMPARTMENTMUSCLES(1):Triceps longhead–infraglenoidtubercleofthe
scapula;lateralhead–posteriorhumerusproximaltoradialgroove;medialhead–posteriorhumerusdistaltoradialgroove(postero‐inferioraspectofhumerus)
upperolecranonprocessofulna
strongextensionofantebrachiumatelbow,weakextensorandadductorofthearmattheshoulder(longhead)
radialnerve(all3heads)
‐ CUBITALFOSSA:o Borders:proximal–linebetweenlateralandmedialepicondyles;lateral–
brachioradialismuscle;medial–pronatorteresmuscle;superficial(roof)–skin,fascia,bicipitalaponeurosis;deep(floor)–supinatormuscle(laterally),brachialismuscle(medially)
o Contents: Superficial:Bicepsbrachiitendon,brachialartery,mediannerve(Tendon,
Artery,Nerve=TAN) Deep:Radialnerveanditsdeepbranch,beginningofulnarandradialarteries
‐ VENOUSDRAINAGE:o Basilicvein(medially),Cephalicvein(anterio‐laterally),mediancubitalvein(anterior–
connectscephalicandbasilicatcubitalfossa)‐ ELBOWJOINT:
o Skeletalcomponents:Humerus(capitulum&trochlea),headofradius,headofulnao Articulations:Humeruscapitulumw/headofradius;humerustrochleawithtrochlear
notchofulnao Synovialcavity:synovialmembranelinesjointcapsuleandiscontinuousw/thatof
proximalradioulnarjointo Ligaments:radialcollateralligament(attachestoannularligament),ulnarcollateral
ligament(anterior,posteriorandtransversebands)annularligament(crossesfromulnaovertoposterolateralradius,createssacciformrecessofsynovial)
o Muscular:muscularsupportcomesfrombicepsbrachiiandbrachialistendonsFOREARM
‐ RELEVANTSKELETALCOMPONENTS:o DistalHumerus,radius,ulnao Carpals:scaphoid,lunate,triquetrum,pisiform,trapezium,trapezoid,capitate,hamateo Metacarpalbones:1(+2sesamoidbones),2(+1sesamoidbone),3,4,5(metacarpal)o ProximalPhalanges,MiddlePhalanges(absentin1stdigit=thumb),DistalPhalanges
‐ COMPARTMENTS:Theanteriorcompartmentisseparatedfromtheposteriorbytheradiusandulna,theinterosseousmembrane,andthelateralandmedialintermuscularseptae
‐ ANTERIORCOMPARTMENTMUSCLES(8):o SUPERFICIALANTERIORLAYER(4):
Pronatorteres superficialhead–medialsupracondylarridge/commontendononmedialepicondyle,deephead–medialborderofcoronoidprocessofulna
lateralsurfaceofradius
pronationoftheforearm–rotatestheradiusmedially
mediannerve
Flexorcarpiradialis commontendononmedialepicondyle
basesof2ndand3rdmetacarpals
flexesandabductsthehandatthewrist
mediannerve
Palmarislongus commontendononmedialepicondyle
palmaraponeurosis weakflexorofhandatwrist
mediannerve
Flexorcarpiulnaris commontendononmedialepicondyle,medialolecranonandulna
pisiformbone,baseofmetacarpal5
flexesandadductshandatwrist
ulnarnerve
o INTERMEDIATEANTERIORLAYER(1):Flexordigitorumsuperficialis
medialepicondyle,medialpartofulnartuberosityandcoronoidprocess,obliquelineonradius
4tendons–insertonMIDDLEphalangesof2,3,4,and5(digits)
Flexionofdigits2,3,4,5AtPIPjoint
mediannerve
o DEEPANTERIORLAYER(3):Flexordigitorumprofundus
proximal2/3ulnaandinterosseousmembrane
4tendons–insertonDISTALphalangesof2,3,4,and5(digits)
Flexionofdigits2,3,4,5atDIPJoint
anteriorinterosseousn/mediannlaterally;ulnarnervemedially
Flexorpollicislongus
middle½radiusandinterosseousmembrane
distalphalanxofthumb(pollux)
flexionofdistalthumb anteriorinterosseousnerve/mediannerve
Pronator distal¼ofulna anteriordistalradius pronationofforearm– anteriorinterosseous
quadratus rotatesradiusmedially nerve/mediannerve‐ NOTE:theanteriorinterosseusnerveisabranchofthemediannerve
o Rulesfortheanteriorcompartmentmusclesoftheantebrachium(forearm) AllmusclesareinnervatedbythemediannerveEXCEPTflexorcarpiulnarisand
partofflexordigitorumprofundusmedially(bothulnarn)o FDSandFDPtendonstomiddleanddistalphalangesrespectivelypassthroughsynovial
sheathsinosseofibroustunnelsofdigits Fibrousflexorsheathanteriorlyandonsides,bonesofphalangesposteriorly Annularportionsoffibroussheatharelooped(5)andcruciformportionsare
crossed(4) Visceralsynoviallayerofenclosestendon;Parietalsynoviallayerlinesinner
surfaceoffibrousflexorsheatho FLEXORSYNOVIALSHEATHS:
RadialBursa=surroundstendonofFlexorpollicislongus UlnarBursa=surrounds8tendonsofFlexordigitorumsuperficialisandFlexor
digitorumprofundus;communicateswithdigitalsynovialsheathof5thdigit DigitalSynovialSheaths=eachsurroundsFDSandFDPindigits2,3,and4
o RELATIONSHIPSINWRIST: Laterally‐>Medially=Abductorpollicislongustendon,radialartery,flexor
carpiradialistendon,mediannerve,Palmarislongustendon,Flexordigitorumsuperficialistendons,ulnarartery,ulnarnerve,Flexorcarpiulnaristendon
‐ POSTERIORCOMPARTMENTMUSCLES:o SUPERFICIALLAYERMUSCLES(7):
Brachioradialis upper2/3oflateralsupracondylarridge
baseofstyloidprocessofradius
flexionofforearmatelbowjoint,assistsinlateralrotationoftheforearmfromfullpronation,assistsinmedialrotationfromfullsupination
radialnerve(C5,6,7)
Extensorcarpiradialislongus(lateralcompartment)
lower1/3oflateralsupracondylarridge
posteriorbaseof2ndmetacarpal
extendsandabductshandatthewrist
deepbranchofradialnerve(C7,8)
Extensorcarpiradialisbrevis
commontendonatlateralepicondyle
posteriorbaseof3rdmetacarpal
extendsandabductshandatwrist
deepbranchofradialnerve(C7,8)
Extensordigitorum
commontendonatlateralepicondyle
4tendonsinsertatbaseofmiddleandbaseofdistalphalangesviaextensorexpansion(hood)ofdigits2,3,4,5
extendsmetacarpophalangealjoints,assistslumbricalsandinterosseiinextendingproximalanddistalinterphalangealjoints
deepbranchofradialnerve(C7,8)
Extensordigitiminimi
commontendonatlateralepicondyle
extensorexpansionforlittlefinger
extendsmetacarpophalangealjointoflittlefinger
deepbranchofradialnerve(C7,8)
Extensorcarpiulnaris
commontendonatlateralepicondyle
posteriorbaseof5thmetacarpal
posterioraspectoflateralepicondyle
deepbranchofradialnerve(C7,8)
Anconeus posterioraspectoflateralepicondyle
lateralsurfaceofolecranonprocessofulna
assiststricepsinextensionofforearmatelbow
radialnerve(C7,8,T1)
o EXTENSOREXPANSIONHOOD: AttachmentsofExtensordigitorumtobasesofmiddleanddistalphalanges Centralbandtobaseofmiddlephalanx,lateralbandstobaseofdistalphalanx
o DEEPLAYERMUSCLES(5):Supinator superficialhead–posteriorlateral
epicondyle(infracondylarridge),lateralligamentofelbowjoint,annularligament;deephead–supinatorcrestofulna
antero‐lateralneckandshaftofradiusbywindingaroundposteriorandlateralsufaceofneckofradius
assistsinsupinationofforearm(proximalanddistalradioulnarjoints)
deepbranchofradialnerve(C5,6)
Abductor shaftoftheulna,radiusand posteriorbaseof1st abductsandextends deepbranchof
pollicislongus interosseousmembrane metacarpal thumbatcarpometacarpaljoint
radialnerve(C7,8)
Extensorpollicisbrevis
posteriorradiusandadjacentinterosseusmembrane
posteriorbaseofproximalphalanxofthumb
extendsmetacarpophalangealjointofthumb
deepbranchofradialnerve(C7,8)
Extensorpollicislongus
posteriorulnaandadjacentinterosseusmembrane
posteriorbaseofdistalphalanxofthumb
extendsdistalphalanxofthumbatinterphalangealjoint
deepbranchofradialnerve(C7,8)
Extensorindicis
posteriorulnaandadjacentinterosseusmembrane
extensorexpansionofindexfinger
extendsmetacarphophalangealjointofindexfinger
deepbranchofradialnerve(C7,8)
‐ NOTE:deepbranchofradialnerveisthesameastheposteriorinterosseusnerve‐ Rulesoftheposteriorcompartmentmusclesofantebrachium:
o Allmusclesareinnervatedbythedeepbranchoftheradialnerve‐brachioradialisandanconeusareinnervatedbyradialnerveproper(apparentlybeforesplitting)
‐ RADIOULNARJOINTS:o Proximal:Headofradiusinradialnotchofulnao Distal:baseofulnainulnarnotchofradiuso Bothjointsaresynovialpivotjointsresponsibleforpronationandsupination
‐ WRIST(RADIOCARPALJOINT):o Skeletalcomponents:distalradiusandtriangularcartilageofulna,scaphoid,lunate,
triquetralo Synovialcavity:linedbysynovialmembraneanddoesnotcommunicatewithanyother
spaceo MajorAnteriorligamentsupport:ulnocapitate,capitohammate,longradioulnate,
scaphocapitate,trapeziotrapezoido MajorPosteriorligamentsupport:dorsalradioulnar,dorsalradiocarpal,dorsal
intercarpal,scapholunateHAND
‐ SKELETALCOMPONENTS:o Carpalbones:scaphoid,lunate,triquetrum,pisiform,trapezium,trepezoid,capitate,
hamateo Metacarpals&Phalanges:Metacarpals(5),Phalanges(14)–3ineachdigit(proximal,
middle,distal),2inthumb(proximal,distal)o Sesamoidbones:Foundonheadof1stand2ndmetacarpals
‐ Palmaraponeurosis:attachedtoflexorretinaculum,4fibrousslipsextendingtoeachfingerformingapassageforflexortendons,digitalvesselsandnerves
‐ THENAREMINENCEMUSCLES:Abductorpollicisbrevis
flexorretinaculumandcarpalbones
lateralaspectofthebaseoftheproximalphalanxofthethumb(withtheflexorpollicisbrevis)
abductsthethumbatthecarpometacarpalandmetacarpophalangealjoints
mediannerve(recurrentbranch
Flexorpollicisbrevis
lateralandanteriorsurfaceoftheflexorretinaculum
lateralaspectofthebaseoftheproximalphalanxofthethumb(withtheabductorpollicisbrevis)
flexesthethumbatthemetacarpophalangealjoint
mediannerve(recurrentbranch)
OpponensPollicis
lateralandanteriorsurfaceoftheflexorretinaculum
entirelengthofthelateralborderoftheshaftofthefirstmetacarpalbone
opposition(thumbcrossespalmtotouchlittlefinger)
mediannerve(recurrentbranch)
Adductorpollicis
obliquehead–anteriorsurfacesofthebaseof2ndand3rdmetacarpal,transversehead–anteriorsurfaceofthe3rdmetacarpal(notpartofthenareminence)
medialsideofthebaseoftheproximalphalanxofthethumb
adductsthethumbatthecarpometacarpalandmetacarpophalangealjoints
ulnarnerve(deepbranch)
‐ Rulesofthethenareminencemuscles:o AllmusclesareinnervatedbymediannerveEXCEPTadductorpollicis(ulnarn)
‐ HYPOTHENAREMINENCEMUSCLES:Abductordigitiminimi
pisiformboneofcarpals medialsideofthebaseoftheproximalphalanxofthelittlefinger
abductsthelittlefingeratthemetacarpophalangealjoint
ulnarnerve(deepbranch)
Flexordigitiminimi
medialportionoftheanteriorsurfaceoftheflexorretinaculum
medialsideofthebaseoftheproximalphalanxofthelittlefinger
flexesthelittlefingeratthemetacarpophalangealjoint
ulnarnerve(deepbranch)
Opponensdigitiminimi
medialportionoftheanteriorsurfaceoftheflexorretinaculum
entirelengthofthemedialborderofthe5thmetacarpalbone
bringslittlefingerintooppositionwiththethumb
ulnarnerve(deepbranch)
‐ Rulesofhypothenareminencemuscles:o Allmusclesareinnervatedbydeepbranchofulnarnerve
‐ INTRINSICMUSCLESOFTHEHAND:Lumbricalmuscles(4)
tendonsoftheflexordigitorumprofundus(1&2–singleheadonlateralside,3&4–doublehead,betweendigits3‐4and4‐5)
lateralsideofthecorrespondingextensorexpansion
flexthemetacarpophalangealjointsandextendtheinterphalangealjoints
1&2–digitalbranchofmediannerve,3&4–ulnarnerve(deepbranch)
Dorsalinterossei(4)
2headsfromadjacentsidesofthemetacarpalbones
proximalphalangesandextensorexpansionsoftheindex,middle,andringfingers,withthe2musclesbeingdedicatedtothemiddlefinger
abducttheindex,middleandringfingers,flexthemetacarpophalangealjointsandextendtheinterphalangealjointsofthese3fingers
ulnarnerve(deepbranch)
Palmarinterossei(3)
anteriorsurfaceoftheshaftofthe2nd,4th,and5thmetacarpalbones
baseofproximalphalangesonsideclosesttomiddlefinger,andonextensorexpansionsoftheindex,ringandlittlefingers
adducttheindex,ringandlittlefingers,flexthemetacarpophalangealjointsandextendtheinterphalangealjointsofthese3fingers
ulnarnerve(deepbranch)
‐ Rulesofintrinsicmusclesofthehand:o AllmusclesareinnervatedbythedeepbranchoftheulnarnerveEXCEPTthe1stand2nd
lumbricals(digitalbranchofmediann)‐ VENOUSDRAINAGE:
o Dorsalvenousarch:cephalicveinoriginatesonlateralaspectofdorsalvenousarch,basilicveinoriginatesonmedialaspectofdorsalvenousarch
‐ ARTERIALSUPPLY:o Superficialpalmararch:
ulnararterypassessuperficialtotheflexorretinaculum,lateraltoulnarnerveandpisiform
givesadeeppalmarbranch,curvingdeeptopalmaraponeurosis Anastomoseswithsuperficialpalmarbranchofradialartery Branches:3commonpalmardigitalarteries–eachdividesinto2properpalmar
digitalarteriestoeachdigitand1tothelittlefingero Deeppalmararch:
Anastomosisofradialarterywiththedeepbranchofulnarartery Deeptolongflexortendonsbutsuperficialtometacarpalbonesand
interosseousmuscles 3smallerpalmarmetacarpalarteriesanastomosewiththematchingarteries
fromsuperficialarch radialisindicisbranchtolateralsideofindexfinger,pincepspollicisbranchto
bothsidesofthumb‐ INTERCARPALJOINTS
o Skeletalcomponents:scaphoid,lunate,triquetral,pisiform,trapezium,trapezoid,capitate,hamate
o Synovialcapsule:synovialplanejointsbetweenindividualcarpalbones=midcarpaljointsbetweenrows
Sharedsynovialcavitycommunicationw/numerousintercarpalligamentso Carpometacarpaljoints=synovialplanejointsEXCEPTthumb(saddlejointbetween1st
metacarpalandtrapezium)‐ METACARPOPHALANGEALJOINTS
o Skeletalcomponents:metacarpals,proximalphalangeso Ligaments:palmar,dorsal,collateral,&deeptransversemetacarpophalangealligamentso Interphalangealligaments:palmar,dorsal,collateralinterphalangealligaments
SUPERFICIALANATOMYOFTHELOWERLIMB;FEMORALTRIANGLE;SUBSARTORIALCANAL:
‐ DEEPFASCIAOFTHETHIGHo Fascialata:denserandtougherthansuperficialfascia
Surroundsallmusclesofthethigh Superficialnervesandveinsareexternaltofascialata(superficial)
o Greatsaphenousvein:passestofemoralveinthroughsaphenoushiatusinfascialata Falciformmarginonlateraledgeofsaphenoushiatus Tributariesnearsaphenousopening:Superficialcircumflexiliacv,superficial
epigastricv,superficialexternalpudendalv,accessorysaphenousvv‐ ILIOTIBIALTRACT
o Thickeningoffascialataonlateralsideofthigho ExtendsfromIliumtoatubercleonthelateralsideofuppertibia(Gerdy’stubercle)
‐ DEEPFASCIAOFLEGo Cruralfascia:distalextensionoffascialata
Surroundsallmusclesofthelego Greatsaphenousvein:temporarilypassesposteriortokneebeforepassinganterior
againdowntheleg;receivesdrainagefrommedialpartofdorsalvenousarchoffooto Smallsaphenousvein:posterior,superficialveinoflegthatpiercescruralfasciatodrain
intopoplitealvein;receivesdrainagefromlateralpartofdorsalvenousarchoffooto Suralnerve:accompaniessmallsaphenousveinatthelowerparto Retinaculaofankle:Cruralfasciathickensattheankletoformthesuperiorandinferior
extensorretinacula(fordorsiflexion)andtheflexorretinaculum(medial;forplantarflexion)
‐ LYMPHATICSOFLOWERLIMBo SuperficialinguinallymphnodesaresuperficialtothefascialataandarrangedinaT
withacrossbarparalleltotheinguinalligament Lymphaticsaccompanythegreatsaphenousveintotheverticalsetofnodes Lymphaticsfromthelowerabdominalwall,externalgenitaliaandgluteal
regiondrainmainlytothehorizontalnodeso Deepinguinallymphnodesreceivefromsuperficialnodes
Deepinguinalnodes=>externaliliacnodes=>lumbar(paraaortic)nodes=>lumbarlymphtrunks
‐ CUTANEOUSNERVESo THIGH
AnteriorThigh:lumbarplexus=>lateralfemoralcutaneousn,anteriorfemoralcutaneousn
MedialThigh:lumbarplexus=>cutaneousbranchesofobturatorn PosteriorThigh:Sacralplexus=>posteriorfemoralcutaneousn
o LEG Cutaneousbranchesofsuperficialfibularn,cutaneousbranchesofdeepfibular
n,lateralsuraln,suraln
‐ FEMORALTRIANGLE:o Boundaries:Superior=inguinalligament;Lateral=medialborderofsartoriusm;Medial
=medialborderofadductorlongusm;Roof=fascialata;MuscularFloor=Iliacusm,Psoasm,Pectineasm,Adductorlongusm
o Contents:(lateraltomedial)NAVEL=femoralNerve,femoralArtery,femoralVein,Emptyspace,Lacunarligament
Arterypassesanteriortoveinatbaseoftriangle(preparationfordivethroughtheadductorhiatus)
o FemoralNerve:fromlumbarplexus;providesmotortoanteriorcompartmentofthighmuscles;sensorytoanteriorthigh(anteriorcutaneousbranches)andmedialthigh(medialcutaneousbranchesofsaphenousn,infrapatellarbranchofsaphenousn)
o FemoralArtery:extensionoftheexternaliliacartery;startsinfemoraltriangleandpassesthroughsubsartorialcanal;passesthroughtheadductorhiatusofadductormagnusandbecomespoplitealartery
deepfemoralartery(profundafemoris)branchesinferiortoheadoffemur• lateralcircumflexartery(passesbetweeniliacusandrectusfemoris)• medialcircumflexartery(passesbetweenpsoasandpectineus)• 4perforatingbranchesaroundposteriorhumerus
‐ FEMORALSHEATHo Continuationoftransversalisfasciaandiliacusfasciafrompelviso Containsfemoralartery,vein,lymphatics(NOTfemoralnerve)o 3compartments:Femoralartery(lateral),femoralvein(central),femoralcanal(medial)
‐ SUBSARTORIALCANAL:o Deeptothesartoriusmuscle,endsatadductorhiatuso Contents:femoralartery,femoralvein,nervetovastusmedialis,saphenousnerveo Relationships(anteriortoposterior):femoralartery,femoralvein,deepfemoralartery,
deepfemoralvein;ONLYfemoralarteryandfemoralveinentersubsartorialcanalGLUTEALREGION:
‐ RegionbetweenIliaccrestandglutealfoldofthebuttock‐ Skeletalcomponents:
o Sacrum,coccyx,hipbone(Ilium,ischium,pubis,withacetabulum),femuro Hipbone:
Ilium(superiorportion,articulateswithsacrum)=iliaccrest,iliactubercle,anteriorsuperioriliacspine,anteriorinferioriliacspine,posteriorsuperioriliacspine,posteriorinferioriliacspine,greatersciaticnotch
Ischium(postero‐inferiorportion)=ischialspine,lessersciaticnotch,ischialtuberosity,ramus
Pubis(antero‐inferiorportion)=obturatorforamen(coveredbyobturatormembrane),superiorramus,inferiorramus
o Femur:head,neck,greatertrochanter(lateral),lessertrochanter(posterio‐medial),intertrochantericcrest(posterior),intertrochantericline(anterior),glutealtuberosity
‐ Sacro‐Iliacjoint:Strongposterior&interosseoussacroiliacligaments,thinanteriorsacroiliacligament,sacrotuberousligament,sacrospinousligament
o Sacrotuberous(superficial)andsacrospinous(deep)ligamentsformgreatersciaticforamen(superiorly)andlessersciaticforamen(inferiorly)
‐ HIPJOINTo Synovial,multi‐axial,ballandsocketjointdesignedforsupport
Acetabulumofhipbonearticulateswithheadoffemur Acetabularlabrum:attachestomarginsofacetabulum,deepensandincreases
jointstability,continuousw/transverseligamentofacetabulum
o Ligamentsofhipjoint:roundligamentofheadoffemur,transverseligamentofacetabulum,iliofemoralligament(ant.),pubofemoralligament(ant.),ischiofemoralligament(post.)
o Bursae:subtendonosisiliacbursa(deeptopsoasmajor),ischioglutalbursa(inferiortoischialtuberosity),deeptrochantericbursa(betweengreatertrochanterandgluteusmax),superficialtrochantericbursa(betweengreatertrochanterandsubcutaneoustissue
o Nervesupply:femoralnerve(L2,3,4),obturatornerve(L2,3,4),accessoryobturatornerve(L3,4),sciaticnerve(L4,5;S1,2,3),nervetoquadratusfemoris(L4,5;S1)
o Bloodsupply:obturatorartery,medial&lateralcircumflexfemoralarteries(withretinaculararteriesbranchingoff),superior&inferiorglutealarteries
‐ GREATERSCIATICFORAMENo Contents
Superiortopiriformis:superiorglutealnerve,superiorglutealvessels Inferiortopiroformis:sciaticnerve,inferiorglutealnerve,inferiorgluteal
vessels,nervetoobturatorinternus,nervetoquadratusfemoris,posteriorfemoralcutaneousnerve,internalpudendalvessels,pudendalnerve
‐ LESSERSCIATICFORAMENo Contents
Onlystructureexiting=obturatorinternusmuscle Entering(afterexitinggreatersciaticforamen)=Pudendalnerve,Internal
pudendalvessels,Nervetoobturatorinternus;PINstructures‐ MUSCLESOFTHEGLUTEALREGION(CHART)
Gluteusmaximus Outersurfaceofilium,posteriorsurfaceofsacrumandcoccyx,andsacrotuberousligament
Iliotibialtractandglutealtuberosityoffemur
Extendsandlaterallyrotateshipjoint,extendstrunkathip,contributestoextensionofknee
Inferiorglutealnerve
Gluteusmedius Outersurfaceofilium,betweenposterior&anteriorgluteallines
Uppersurfaceofgreatertrochanter
Powerfulabductorofthethighatthehipjoint,medialrotationofthigh,preventsdownwardtiltofpelviscontralaterally
Superiorglutealnerve
Gluteusminimus Outersurfaceofilium,betweenanteriorandinferiorgluteallines
Anterioranduppersurfaceofgreatertrochanter
Abductorofthighathip,medialrotationofthigh,preventsdownwardtiltofpelviscontralaterally
Superiorglutealnerve
Tensorfascialatae
Outeredgeofiliaccrest,fromanteriorsuperioriliacspinetoiliactubercle
Anterioraspectofiliotibialtract
Contributestokneeextension,assistedbygluteusmaximusviatheiliotibialtract
Superiorglutealnerve
Piriformis Anterolateralborderofsacrum,passesthroughgreatersciaticforamen
Uppermedialaspectofgreatertrochanter
Lateralrotatorofthighathip AnteriorramiofS1andS2spinalnerves
Superiorgemellus
Spineofischium w/tendonofobturatorinternustomedialaspectofuppertrochanter
Lateralrotatorofthighathip Nerveoftheobturatorinternus
Obturatorinternus
Pelvicsurfaceofobturatormembraneandsurroundingbonysurfaces
Medialaspectofuppertrochanterwithbothgemelli
Lateralrotatorofthighathip Nerveoftheobturatorinternus
Inferiorgemellus Uppermarginofischialtuberosity
w/tendonofobturatorinternusinmedialaspectofuppertrochanter
Lateralrotatorofthighathip Nerveofthequadratusfemoris
Quadratusfemoris
Lateralborderoftheischialtuberosity
Quadratetubercle,onintertrocantericcrestoffemur
Lateralrotatorofthighathip Nerveofthequadratusfemoris
‐ Rulesoftheglutealreagionmuscles:o AllthegluteusmusclesareinnervatedbythesuperiorglutealnerveEXCEPTgluteus
maximus(inferiorglutealnerve)‐ NERVESINTHEPELVIS
o Sacralplexus(L4‐5;S1‐4)
Superiorglutealn=L4,5;S1=>gluteusmedius,minimus,tensorfacialatae Sciaticn=L4,5;S1,2,3(gigantic) Inferiorglutealn=L5;S1,2=>gluteusmaximus Nervetoobturatorinternus=L5;S1=>superiorgemellus,obturatorinternus Nervetoquadratusfemoris=L5;S1=>inferiorgemellus,quadratusfemoris Posteriorfemoralcutaneousn=S1,2,3 Pudendaln=S2,3,4
o Cutaneousnervesofglutealregion: Uppermedial:Superiorclunealnerves(dorsalramiL1‐3),middleclunealnerves
(dorsalramiofS1‐3) Upperlateral:Lateralcutaneousbranchofiliohypogastric(ventralramusofL1),
ventralramusofT12 Lowerlateral:Lateralcutaneousnervesofthethigh(ventralramiofL2‐3) Lowermedial:posteriorcutaneousnervesofthethigh(inferiorclunealnerves
=ventralramiofS1‐3)‐ GLUTEALREGIONARTERIES
o Commoniliacartery=>externalandinternaliliacarteries Internaliliacartery=>anteriorandposteriordivisions
• Posteriordivision=>superiorglutealartery• Anteriordivision=>inferiorglutealartery,internalpudendalartery
o Cruciateanastomosis Inferiorglutealartery,lateralcircumflexfemoralartery,medialcircumflex
femoralartery,firstperforatingarteryTHIGHANDPOPLITEALFOSSA
‐ MUSCLESOFANTERIORCOMPARTMENTSartorius Anteriorsuperioriliacspine Uppermedialsurfaceoftibia Flexesandweaklyabducts,
laterallyrotatesthethighFemoralnerve
Iliacus Iliacfossa Lessertrochanter(commontendonwithpsoas)
Flexesthethighandstabilizesthehipjoint
Femoralnerve
Psoas(major&minor)
Transverseprocesses&lateralbodiesofT12‐L5vertebrae
Lessertrochanter(commontendonwiththeiliacus)
Flexesthethighandstabilizesthehipjoint
VentralramiofL1‐L3
Pectineus Superiorramusofpubis Belowlessertrochanteratthelineaaspera
Flexesandadductsthethighatthehip
Femoralnerve
Rectusfemoris(quadriceps)
Straighthead–anteriorinferioriliacspine;reflectedhead–iliumaboveacetabulum
Commonquadricepstendononsuperiorandlateralaspectsofthepatella
Flexthethigh,extendtheleg
Femoralnerve
Vastuslateralis(quadriceps)
Baseofgreatertrochanter,intertrochantericlineandlineaaspera
Commonquadricepstendon Flexthethigh,extendtheleg
Femoralnerve
Vastusmedialis(quadriceps)
Intertrochantericlineandlineaaspera
Commonquadricepstendon Flexthethigh,extendtheleg
Femoralnerve
Vastusintermedius(quadriceps)
Anteriorandlateralsurfaceoffemur
Commonquadricepstendon Flexthethigh,extendtheleg
Femoralnerve
(articularisgenus)
(lowerfibersofvastusintermedius)
Commonquadricepstendon,synovialmembraneoftheknee
Pullsynovialmembranesuperiorlytopreventcompressionbetweenfemurandpatella
Femoralnerve
‐ Anteriorcompartmentrules:o AllmusclesareinnervatedbythefemoralnerveEXCEPTthepsoas(L1‐L3ventralrami)o Allmusclesservetoflexthethighatthehip
‐ FEMORALNERVEo Branchesintoanteriorandposteriorbranchesuponenteringthethigh
o Anteriordivision:medialcutaneousnerveofthigh,intermediatecutaneousnerveofthigh,sartoriusbranch,pectineusbranch
o Posteriordivision:saphenousnerve,quadricepsbranch‐ FEMORALARTERY
o =>profundafemoris:offofprofundafemorisarethelateralcircumflexfemoralartery,medialcircumflexfemoralartery,4perforatingbranches
o =>descendinggenicularo =>poplitealartery(uponpassingthroughadductorhiatus)
=>5geniculararteriesofkneearterialanastomosis =>anteriorandposteriortibialarteries
o Venoustributariestothefemoralveincorrespondtothearterialbranches‐ MUSCLESOFMEDIALCOMPARTMENT
Adductorlongus Frontofthepubicbone Middle1/3oflineaaspera Adductsandlaterallyrotatesthethigh
Obturatornerve
Adductorbrevis Inferiorpubicramus Upperpartoflineaasperaaboveinsertionofadductorlongus
Adductsandassistsinlateralrotationofthigh
Obturatornerve
Adductormagnus
Inferiorramus adductor–posteriorsurfaceofshaftoffemor,lineaasperaandmedialcondyle;hamstring–tendontoadductortubercle
Adductsandweaklyextendsthethigh
Obturatornerve,partiallysciaticnerve
Gracilis Ischiopubicramus Upperpartofmedialsurfaceoftibia
Adductsthigh,flexesandmediallyrotatesthelegattheknee
Obturatornerve
Obturatorexternus
Outersurfaceofobturatormembraneandischiopubicrami
Passesbelow,thenbehindhipjointtomedialsurfaceofgreatertrochanter
Laterallyrotatesthethigh Obturatornerve
‐ Medialcompartmentrules:o AllmusclesareinnervatedbytheobturatornerveEXCEPT½oftheadductormagnuso AllmusclesservetoadductthethighatthehipEXCEPTobturatorexternus
‐ OBTURATORNERVEo Entersmedialthighviaobturatorcanalo Anteriordivision:deeptopectineus,anteriortoadductorbrevis
Supplies:gracilis,adductorbrevis,adductorlongus,skintomedialthigho Posteriordivision:betweenadductorbrevisandadductormagnus
Supplies:obturatorexternus,adductormagnus(nothamstring),adductorbrevis,skintomedialknee
‐ MEDIALCOMPARTMENTBLOODSUPPLYo theprofundafemorisarteryprovidesmusclebranchestotheadductors
‐ MUSCLESOFTHEPOSTERIORCOMPARTMENTBicepsfemoris Longhead–ischial
tuberosity;shorthead–lineaasperaandlateralsupracondylarridge
Headsuniteabovekneeandcommontendoninsertsintoheadoffibula
Extendsthethigh(longhead),flexesandlaterallyrotatesthelegattheknee
Sciaticnerve(tibialnerve;Shorthead=commonfibularnerve)
Semimembranosus Ischialtuberosity Posteriorportionofmedialcondyleoftibia,obliquepoplitealligament
Extendsthigh,flexesandmediallyrotatesthelegattheknee
Sciaticnerve(tibialnerve)
Semitendinosis Ischialtuberosity Medialsurfaceoftheshaftofthetibia,posteriortoinsertionofsartoriusandgracilis
Extendsthigh,flexesandmediallyrotatesthelegattheknee
Sciaticnerve(tibialnerve)
‐ Posteriorcompartmentrules:o Allmusclesareinnervatedbysciaticnerveo Allbloodsupplycomesfrom4perforatingbranchesoffofprofundafemorisartery
‐ SCIATICNERVEo Runsdeeptolongheadofbicepsfemoris,superficialtoadductormagnuso Dividesmidthighintotibialnerveandcommonfibularnerve
o Tibialnerve:suppliessemimembranosus,semitendonosis,longheadofbiceps,hamstringpartofadductormagnus
o Commonfibularnerve:suppliesshortheadofbiceps‐ POPLITEALFOSSA
o Superficialcontents:smallsaphenousvein,suralcutaneousnerve(tibialbranch),communicatingbranchandlateralsuralcutaneousnerve(commonfibularbranches),popliteallymphnodes
o Deepcontents:poplitealartery&genicularbranchesofanastomosisaroundknee,poplitealvein,tibialnerve,commonfibularnerve,fat&lymphnodes
‐ KNEEJOINTo Lateralknee:Iliotibialtract,headoffibula,bicepsfemoristendon,commonfibular
nerveo Medialknee:Pesanserinus:“footofthegoose”=tendonsofsartorius,gracilis,
semitendinosuso Synovialcondylarjointbetweenmedialandlateralfemoralandtibialcondyles;also
glidingjointbetweenpatellaandpatellarsurfaceoffemur Medialcondylararticulationislargerandovalshaped Lateralcondylararticulationissmallerandcircularshaped
o Menisci: Semilunarfibrocartilaginouspads;peripheralborderisthickerandattachedto
thecapsule;innerborderisthinner,creatingafreeedge Servetocompensateforincongruitybetweenfemurandtibia(createasortof
cuppingforjointstabilityo Ligamentsofknee:obliquepoplitealligament,arcuatepoplitealligament,lateral
(fibular)collateralligament(notattachedtolateralmeniscus),medial(tibial)collateralligament(attachedtomedialmeniscus)
AnteriorCruciateLigament(ACL):fromposterolateralcondyleoffemurtoanteriorintercondylarareaoftibia
PosteriorCruciateLigament(PCL):fromanteromedialcondyleoffemurtoposteriorintercondylarareaoftibia
o Bursaeoftheknee: Anterior:suprapatellar(synovial)bursa(w/articularisgenusfibersofvastus
intermedius);prepatellarbursa=betweenskinandpatella(subcutaneous),subcutaneousinfrapatellarbursa=distaltopatella;deepinfrapatellarbursa=deeptoligamentumpatella
Posterior:bursaefounddeepto–gastrocnemiusheads,bicepsfemoristendon,lateralcollateralligament,popliteusmuscle,semimembranosustendon
o Bloodsupplyofkneejoint:anastomosisinvolvingdescendingbranchoflateralfemoralcircumflexartery,genicularbranchesofpoplitealartery,descendinggenicularartery(fromfemoralartery),recurrentbrancesfromanteriortibialartery
o Nervesupplytokneejoint:femoralnerve(L2,3,4),obturatornerve(L2,3,4),tibialnerveLEGANDANKLE
‐ Skeletalcomponents:o Baseoffemur,tibia,fibulao Boneofthefeet:Talus,calcaneus,navicular,cuboid,3cuneiforms,5metatarsals,14
phalangeso Tibia:medialweightbearingboneoftheleg,proximallarticulatesw/condylesofthe
femurandtheheadofthefibula,distallyarticulatesw/talusandthebaseofthefibula,containsmedialmalleolus
o Fibula:lateralbonethatdoesnottransmitbodyweight,headandneckproximally,lateralmalleolusdistally,articulatesmediallywiththetalus
‐ COMPARTMENTS
o Anteriorandposteriorintermuscularseptaedividelegintoanterior,lateralandposteriorcompartments;deeptransverseseptumdividestheposteriorcompartmentintodeepandsuperficial
‐ ANTERIORCOMPARTMENTMUSCLES:Tibialisanterior Upperhalfoflateral
surfaceofthetibia&interosseusmembrane
Medialcuneiformandbaseofthefirstmetatarsalbone
Extendsthefootattheankle(dorsiflexion),inversionofthefoot,supportoflongitudinalarch
Deepfibularnerve
Extensordigitorumlongus
Upperanteriorpartofthefibulaandinterosseusmembrane
Baseofthemiddlephalanxanddistalphalanxofthe2ndto5thdigits
Extendsthetoes,contributestoextensionoffootatankle
Deepfibularnerve
Extensorhallucislongus
Middlehalfoftheanteriorsurfaceofthefibulaandinterosseusmembrane
Baseofthedistalphalanxofthegreattoe
Extendsthebigtoe,contributestoextensionofthefootatankle,inversionofthefoot
Deepfibularnerve
Fibularistertius Lowerthirdoftheanteriorsurfaceofthefibula
Dorsalaspectofthebaseofthe5thmetatarsalbone
Extendsthefootattheankle,assistsineversionofthefoot
Deepfibularnerve
‐ Rulesoftheanteriorcompartmentmuscles:o Allmusclesoftheanteriorcompartmentareinnervatedbythedeepfibularnerveo Allmusclesoftheanteriorcompartmentcontributetodorsiflexiono Allmusclesoftheanteriorcompartmentpassunderboththesuperiorandinferior
extensorretinacula‐ Anteriorcompartmentbloodsupply:
o Anteriortibialartery(branchofpopliteal),deeptotibialisanterioro Foundbetweentwomalleolionthedoralankleandcontinuesasdorsalispedison
dorsumoffoot Branchesareanteriortibialrecurrentartery,anteriormedialmalleolarartery,
anteriorlateralmalleolarartery‐ DEEPFIBULARNERVE
o Branchofcommonfibularnerveo Enterstheanteriorcompartmentbypiercingtheanteriorintermuscularseptum
‐ LATERALCOMPARTMENTMUSCLES:Fibularislongus
Upper2/3oflateralsurfaceoffibula
Inferiorsurfaceofthemedialcuneiform&baseof1stmetatarsal
Flexesfootatankle(plantarflexion)andevertsthefoot,supportslaterallongitudinalandtransversearchs
Superficialfibularnerve
Fibularisbrevis
Lower1/3oflateralsurfaceoffibula
Baseofthe5thmetatarsal
Flexesthefoot(plantarflexion)andevertsthefoot
Superficialfibularnerve
‐ Rulesofthelateralcompartmentmuscles:o Allmusclesoflateralcompartmentareinnervatedbysuperficialfibularnerveo Allmusclesoflateralcompartmentaresuppliedbybranchesofthefibulararteryo Allmusclesofthelateralcompartmentpassthroughfibularretinaculuminferiorto
lateralmalleolus‐ SUPERFICIALFIBULARNERVE
o Branchofcommonfibularnerveo Emergesbetweenfibularislongusandbrevisandbecomescutaneousinlower
anterolateralaspectoflego Dividesintomedialandintermediatedorsalcutaneousnerves
‐ POSTERIORCOMPARTMENTMUSCLES:o Dividedbydeeptransverseintermuscularseptumintosuperficialanddeepo SUPERFICIALMUSCLES:
Gastrocnemius Lateralaspectoflateralcondyleoffemur,medialheadfrompoplitealsurfaceoffemurabovemedialcondyle
2headsfusetogetherwithtendocalcaneustoinsertoncalcaneum
Flexesthefoot(plantarflexion)attheankle,contributestoflexionattheknee
Tibialnerve
Plantaris Lateralsupracondylarridgeoffemur
Medialsidew/tendocalcaneus
Weakflexoroffootatankle(plantarflexion)
Tibialnerve
Soleus Soleallineoftibia,upper¼ofthefibula
Anteriorpartoftendocalcaneus
w/gastrocnemius,powerfulflexoroffootatankle(plantarflexion)
Tibialnerve
o DEEPMUSCLES:Popliteus Lateralsurfaceofthelateral
condyleoffemur,w/attachmentonlateralmeniscus
Upperposteriorsurfaceofthetibia
Medialrotatorofthetibiaonthefemur,servesto“unlock”theknee
Tibialnerve
Flexorhallucislongus
Middlehalfofposteriorsurfaceoffibula
Baseofthedistalphalanxofbigtoe
Flexesdistalphalanxofbigtoe,flexesthefootatankle,supportsmediallongitudinalarches
Tibialnerve
Flexordigitorumlongus
Middlehalfofposteriorsurfaceoftibia
Baseofdistalphalangesof2ndto5thdigits
Flexesthefootattheankle,supportsbothmedialandlaterallongitudinalarches
Tibialnerve
Tibialisposterior
Middleposteriorsurfacesofshaftoftibiaandfibula&interosseusmembrane
Tuberosityofnavicularandneighboringbones
Flexesthefootattheankle,invertsthefoot,supportsmediallongitudinalarch
Tibialnerve
‐ Rulesoftheposteriorcompartmentmuscles:o Allofthemusclesoftheposteriorcomparmentareinnervatedbythetibialnerveo Allofthemusclesoftheposteriorcompartmentcontributetoplantarflexionofthefooto Allofthesuperficialmusclesinsertonthecalcaneusviathetendocalcaneuso Allofthedeepmusclespassthroughtheflexorretinaculuminferiortothemedial
malleolus‐ Bloodsupplytoposteriorcompartment:
o Posteriortibialartery=>terminalbranchofthepoplitealarteryo Passesmediallyintheposteriorcompartment,deeptogastrocnemius,soleusanddeep
transverseseptum;canbepalpatedbetweenmedialmalleolusandtendocalcaneuso Dividesintomedialandlateralplantararteriesinthefoot
‐ TIBIALNERVEo Descendswithposteriortibialvessels,deeptogastrocnemiusandsoleuso Dividesdistallyintomedialandlateralplantarnerves
‐ ANKLEo Trueanklejoint:uniaxialsynovialjointbetweentalusandlowerendoftibia&fibulao SuperiorandinferiorEXTENSORRETINACULA=thickeningofcruralfasciaanteriorly
Containtendonsoftibialisanterior,extensorhallucislongus,extensordigitorumlongus,fibularistertius,anteriortibialartery,deepfibularnerve
o FLEXORRETINACULUM=thickeningofcruralfasciainferiortomedialmalleolus Containstendonsoftibialisposterior,flexordigitorumlongus,flexorhallucis
longus,posteriortibialartery,tibialnerveo FIBULARRETINACULUM=thickeningofcruralfasciainferiortolateralmalleolus
Containstendonsoffibularislongusandfibularisbrevis Suralnerveandsmallsaphenousveinpasssuperficialtofibularretinaculum
o Ligamentsoftheankle: Medial(deltoid)ligament:tibiocalcaneal,tibionavicular,anteriortibiotalar,
posteriortibiotalar Lateralligament:anteriortalofibular,posteriortalofibular,calcaneofibular
FOOT
‐ Skeletalcomponents:o Attachedtoankleattibiotalarjoint:tibia,fibula,taluso Bonesofthefoot:
7Tarsals:talus,calcaneus,navicular,medial/intermediat/lateralcuneiforms,cuboid;5metatarsals;14phalanges
‐ Archesofthefoot:
o Laterallongitudinalarch:calcaneustometatarsalheads(laterally)o Mediallongitudinalarch:calcaneustometatarsalheads(medially)o Transversearch:alongbaseofmetatarsals
‐ Intertarsaljointsofthefoot:o Transversetarsaljoint:calcaneus/cuboidandtalus‐calcaneus/navicular
Jointatwhichinversionandeversionoccur Talocalcaneonavicularjointligaments:talonavicularligament,bifurcate
ligament,plantarcalcaneonavicularligament(springligament) Calcaneocuboidjointligaments:bifurcateligament,plantarcalcaneocuboid
ligament(shortplantarligament)o Subtalarjoint:talus/calcaneus
Jointatwhichglidingoccursforlimitedrotationofthefoot‐ Plantaraponeurosis:
o Thickeneddeepplantarfascia,attachedatcalcanealtuberositywithdigitalbandsthatextendintotoes;attachtobonesligamentsanddermis
o Transversemetatarsalligamentsbetweenheadsofmetatarsalboneso Supportslongitudinalarches
‐ INTRINSICMUSCLESOFFOOT:Extensordigitorumbrevis(note:onlymuscleondorsum)
Superolateralsurfaceofcalcaneus
4tendonstoproximalphalanxofgreattoe,extensorhoodsof3medialtoes
Aidsinextensionof4toesonmedialsideoffoot
Branchofdeepfibularnerve
Adductorhallucis Calcanealtuberosity Medialsideofbaseofproximalphalanxofgreattoe
Abductsandflexesgreattoeatmetatarsophalangealjoint
Medialplantarnerve
Flexordigitorumbrevis
Calcanealtuberosity Plantarsurfaceofmiddlephalangesoflateral4toes
Flexeslateraltoesatproximalinterphalangealjoints
Medialplantarnerve
Abductordigitiminimi
Calcanealtuberosity Lateralsideofbaseofproximalphalanxoflittletoe
Abductslittletoeatmetatarsophalangealjoint
Lateralplantarnerve
Quadratusplantae
Fromlateral&medialcalcaneus
Lateralsideofflexordigitorumlongustendon
Assistsflexordigitorumlongusinflexionoflateraltoes
Lateralplantarnerve
Lumbricals(4) 1st–frommedialsideofFDLtendonto2ndtoe;2nd,3rd,4th,frombetweenotherFDLtendons
Medialsideofextensorhoodsof4lateraltoes
Flexeslateraltoesatmetatarsophalangealjoints,extendstoesatinterphalangealjoints
Medial–medialplantarnerve;lateral3–lateralplantarnerve
Flexorhallucisbrevis
Cuboidandlateralcuneiform,tibialisposteriortendon
Bothsidesofproximalphalanxofgreattoe(bifurcationofmuscle)
Flexesgreattoeatmetatarsophalangealjoint
Medialplantarnerve
Adductorhallucis Transverseheads–ligamentsatMTPjointsoflateral3toes;obliquehead–baseofmetatarsals2,3,4,fromfibularislongustendon
Lateralsideofbaseofproximalphalanxofgreattoe
Adductsgreattoeatmetatarsophalangealjoint
Lateralplantarnerve
Flexordigitiminimibrevis
Baseofmetatarsal5andfibularislongustendon
Lateralsideofbaseofproximalphalanxoflittletoe
Flexeslittletoeatmetatarsophalangealjoint
Lateralplantarnerve
Dorsalinterossei Sidesofadjacentmetatarsals
Extensorhoodsoftoes2,3,4
Abducttoesatmetatarsophalangealjoints;resistextensionatMTP,flexionatIPjoints
Lateralplantarnerve,1stalsofromdeepplantarnerve
Plantarinterossei Medialsidesofmetatarsals3,4,5
Extensorhoodsoftoes3,4,5
Adductstoes3,4,5atMTPjoints;resistsextensionatMTP,flexionatIPjoints
Lateralplantarnerve
‐ ARTERIALSUPPLYTOFOOTo Plantarside:
Medialplantarartery:betweenabductorhallucisandflexordigitorumbrevis,alongmedialsideofsoletomedialsideofgreattoe
Lateralplantarartery:deeptoabductorhallucis,betweenflexordigitorumbrevisandquadratusplantae
• Archesmediallyatbaseofmetatarsal5andformsdeepplantararch• Joinsterminalbranchofdorsalispedisbetweenmetatarsals1and2
Deepplantararch:• Digitalbranchtosmalltoe;4plantarmetatarsalarteriesw/digital
branches;3perforatingarteriesanastamosewithdorsalarterieso Dorsalside:
Dorsalispedis:continuationofanteriortibialartery(namechangeatankle)• Betweentendonsofextensorhallucislongusandextensordigitorum
longus• Arcuatebranchatbasesofmetatarsals
o Dorsalmetatarsalarteries,dorsaldigitalarteries,1stdorsalmetatarsalartery
• Passestoplantarsidebetween2headsof1stdorsalinterosseustojoindeepplantararch
‐ VENOUSDRAINAGEOFFOOTo Deepveinsaccompanyarteries
Plantarmetatarsalveins=>deepplantarveinsatarterialarch=>lateralplantarvein=>posteriortibialvein
o Dorsalvenousarchdrainssuperficialveins Originofgreatsaphenousveinanteriortomedialmalleolus Originofsmallsaphenousveinposteriortolateralmalleolus
‐ NERVESUPPLYTOFOOTo Fromtibialnerve:Medialplantarnerve,Lateralplantarnerve
Medialplantarnerve:anterior2/3ofsole,medial3½toes• Motortoabducturhallucis,flexordigitorumbrevis,flexorhallucis
brevis,1stlumbrical Lateralplantarnerve:lateralanterior2/3ofsole,lateral1½toes
• Motortoabductordigitiminimi,flexordigitiminimibrevis,quadratusplantae,lateral3lumbricals,dorsalandplantarinterossei
o Dorsalnervesupply Superficialfibularnerve–nomotorsupplyinthefoot
• SensorytomajorityofdorsumoffootandtoesEXCEPT:o Medialankle&justinferior,lateralsideoffootandlittletoe,
webspacebetweengreattoeand2ndtoe Deepfibularnerve
• Sensorytowebspacebetweengreattoeand2ndtoe• Motortoextensordigitorumbrevis,lateral2dorsalinterossei