Download - Anatomy TA Notes From Sarah

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


dorsalscapularnerve

Rhomboidmajor spinousprocessesofT2‐T5 lowerportionofmedialborderofscapula


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


Extensordigitorum


4tendonsinsertatbaseofmiddleandbaseofdistalphalangesviaextensorexpansion(hood)ofdigits2,3,4,5

extendsmetacarpophalangealjoints,assistslumbricalsandinterosseiinextendingproximalanddistalinterphalangealjoints


Extensordigitiminimi


extensorexpansionforlittlefinger

extendsmetacarpophalangealjointoflittlefinger


Extensorcarpiulnaris


posteriorbaseof5thmetacarpal

posterioraspectoflateralepicondyle


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)


Abductor shaftoftheulna,radiusand posteriorbaseof1st abductsandextends deepbranchof

pollicislongus interosseousmembrane metacarpal thumbatcarpometacarpaljoint

radialnerve(C7,8)

Extensorpollicisbrevis

posteriorradiusandadjacentinterosseusmembrane

posteriorbaseofproximalphalanxofthumb

extendsmetacarpophalangealjointofthumb


Extensorpollicislongus

posteriorulnaandadjacentinterosseusmembrane

posteriorbaseofdistalphalanxofthumb

extendsdistalphalanxofthumbatinterphalangealjoint


Extensorindicis

posteriorulnaandadjacentinterosseusmembrane

extensorexpansionofindexfinger

extendsmetacarphophalangealjointofindexfinger


‐ 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


Flexordigitiminimi

medialportionoftheanteriorsurfaceoftheflexorretinaculum

medialsideofthebaseoftheproximalphalanxofthelittlefinger

flexesthelittlefingeratthemetacarpophalangealjoint


Opponensdigitiminimi

medialportionoftheanteriorsurfaceoftheflexorretinaculum

entirelengthofthemedialborderofthe5thmetacarpalbone

bringslittlefingerintooppositionwiththethumb


‐ 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


Palmarinterossei(3)

anteriorsurfaceoftheshaftofthe2nd,4th,and5thmetacarpalbones

baseofproximalphalangesonsideclosesttomiddlefinger,andonextensorexpansionsoftheindex,ringandlittlefingers

adducttheindex,ringandlittlefingers,flexthemetacarpophalangealjointsandextendtheinterphalangealjointsofthese3fingers


‐ 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


Tensorfascialatae

Outeredgeofiliaccrest,fromanteriorsuperioriliacspinetoiliactubercle

Anterioraspectofiliotibialtract

Contributestokneeextension,assistedbygluteusmaximusviatheiliotibialtract


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


Femoralnerve

Vastusintermedius(quadriceps)

Anteriorandlateralsurfaceoffemur


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

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