applied anatomy all

Pelvic girdle

bony ring formed by the sacrum and hip bones which are connected anteriorly at pubic symphysis

Movements of pelvic girdle

lateral/anterior/posterior pelvic rotation/tilt

Functions pelvic girdle

weight bearing, weight transference and protection

Pelvic bone landmarks

Pelvis Joints

hip joint-femoral acetabular joint, symphysis is not a joint and is stiff

Pelvic Ligaments

Sacrotuberous ligament

sacrum to ischial tuberosity

Sacrospinous ligament

sacrum to ischial spine

Iliolumbar ligament

L4 & 5 to iliac crest

Ingunial ligament

ASIS to pubic tubericle

posterior sacro iliac ligaments

from PSIS and iliac crest, to sacrum

Anterior sacro iliac ligament

lateral crest of sacrum to PSIS and posterior iliac crest

Pelvis protections

reproductive organs/ viscera, ateries and nerves, urinary system, excretory system

Perineal membrane/body

holds in place and prevents downward drift/prolapse

Pelvic fascia

supported by endopelvic fascia

Endopelvic fascia

supports and anchors pelvic floor muscles and pelvic viscera. Contains fatty tissue to protect organs. Attaches to pelvic wall via arcus tendinous laterally. Tearing and stretching of it can result in loss of organ support and prolapse causing incontinence

muscles of endopelvic fascia

Perineal body

connective tissue between vagina and testicles and the anus. Lies deep to skin important anchor point. Acts as point attachment for muscle fibres from pelvic floor and perineum

Incontinence

ability to control excretion

Pelvic diaphragm

levator ani and coccygeus

Levator ani

puborectalis, pubococcygeus, illiococcygeus. First line of defence against prolapse. Acts as a sling to increase the angle of anal canal

Coccygeus

coccyx to ishium. Acts to draw coccyx anteriorly following defaecation and parturition

Levator ani

sling lifting anteriorly and superiorly.

Puborectalis

most medial part of levator ani. Thick narrow. Draws distal rectum anteriorly and superiorly. Related to anal sphincter complex

Pubococcygeus

intermediate part of levator ani. Wide but thin. Elevates and laterally compresses closing the urogenital hiatus bringing the vagina urethra and rectum toward the pubic bone and elevates pelvic organs. Serves important role in competence of urethral and rectal sphincators doing increased abdominal pressure

Illliococcygeus

posterolateral part of levator ani, it resists depression of pelvic floor

Pelvic floor muscle functions

support abdominal structures, assist with sexual function, assist with continence and work in conjunction with abdominal muscles

Pudendal nerve

from posterior to sacrospinous ligament, enters lesser sciatic foraman, medial to sichial ramus and pubic ramus. Motor supply- superficial pelvic floor muscles. Sensory supply- skin external genitalia

Iliac region

muscles converge

Psoas minor

T12 L1 to iliopubic eminence

Psoas major

proximal- transverse process of lumbar vetrebrae sides of bodies of vetrebrae t12-l5 and IV discs. Distal- lesser trochanter of femur

Psoas major action and NS

hip/trunk flexion.

Iliacus attachments

proximal superior 2/3 of illiac fossa, ala of sacrum and sacroiliac ligaments. Distal- lesser trochanter of femur

Illiacus action and NS

hip flexion and stabilise hip. Femoral nerve

Femoral nerve formed

within psoas major, emerging low on its lateral border and passes between psoas major and iliacus in gutter. Underneath inguinal ligament with the femoral artery and vein to enter the femoral triangle in anterior thigh

Pectineus

adducts and flex hip. Femoral nerve (and obturator) supply

Sartorius

proximal- ASIS. Distal- anterior aspect of medial condyle of tibia. Synergist for hip flexion abduction lateral rotation and knee flexion. Supplied by femoral nerve

Quadriceps

vastus lateralis, rectus femoris, vastus medialis, vastus intermedius. Knee extensors supplied by femoral nerve

Rectus femoris

proximal- Asis, distal- quadriceps tendon, patella, patellar tendon, tibial tuberosity. Hip flexion and knee extension.

Vastus medialis

proximal- intertrochanteric line and medial lip of linea aspera of femur. Distal- quad tendon, patella, patellar tendon, tibial tuberosity

Vastus lateralis

proximal

Vastus intermedius.

Proximal- anterior and lateral surfaces of shaft of femur. Distal- quad tendon, patella, patellar tendon, tibial tuberosity

Femoral navel

nerve, artery, vein, empty space, lymphatic vessels

Muscular branches supplied by femoral nerve

iliacus, pectineus, satorius, rectus femoris, vastus lateralis/medialis/intermedius, articularis genu

Sensory femoral nerve branches

anterior femoral cutaneous and saphenous nerve. Also supplies hip and knee joint

Saphenous nerve

no motor function, sensory. Travels behind satorius in adductor canal, crosses to medial side of knee deep to satorius, becomes superficial between sartorius and gracilis and supplies skin medial side of leg below the knee

Ilioposas muscle group

psoas minor, major and iliacus. Proximal- sides of lumbar vertebrae and superior iliac fossa. Distal- lesser trochanter and pectineal arch

Obturator innervates

adductor longus/brevis/magnus, gracilis and obturator externus

Heart made up of

right atrium right ventricle. Left atrium left ventricle. Valve between. Arteries move away, veins move in.

Order of tubes

large lumen arteries, smaller arteries, arterioles, capillaries venules, veins

Right side of heart

recieves poorly oxygenated blood and pumps into lumps. From superior and inferior vena cava

Left side of heart

recieves well oxygenated blood and pumps into aorta to be distributed. More muscle

Blood supply pathway

aorta, common iliac artery, external iliac artery (under inguinal ligament), becomes femoral artery (inferiorly to femur, medially and eventually posteriorly), passes through adductor magnus hiatus, becomes popliteal artery, then becomes anterior tibial artery and posterior tibial artery at soleal line

Anterior tibial artery

passes through hole in interosseus membrane, becomes dorsal pedis artery between extensor hallucis longus and extensor digitorum longus

Posterior tibial artery

palpate behind medial malleolus. Between flexor digitorum longus and flexor hallucis longus

Deoxygenated blood route

lateral and medial plantar veins, dorsal venous arch, anterior and posterior tibial veins, popliteal vein, femoral vein, external iliac vein, common iliac vein, inferior vena cava

Deep vein thrombosis

blood clot. Common in lower calf. High cholestrol, prolongued sitting, high BP, pregnancy are risks. Clot could move to heart and lungs or brain

Agonist

has the best capacity to work around the axis. Largest bulk/ best mechanical advantage due to attachments in relation to joint axis/ leverage

Synergist

assist by adding force or reducing uneccessary movement

Stabilisers

stabilises another part of the body while the other move

Widespread exercise induced pain

Exercise induced vague pain could mean that not enough oxygen and blood is reaching the muscles. As the patient indicates very clearly that going up stairs is much worse than down stairs, this is a clear indication that the oxygen demand of climbing stairs is not being met by the blood supply. And the poor blood supply is not systemic - as they dont get dizzy - it only seems to affect that left leg. Therefore, narrowing of an artery

Hindfoot

talus and calcaneus

Midfoot

navicular cuboid and cuneiforms

Forefoot

metatarsals and phalanges

Transverse tarsal joint

calcaneocubiod joint and talonavicular joint. Inversion and eversion of distal parts of foot

Bifurcate ligament

calcaneus to cuboid and navicular. Resists inversion

Lisfranc/tarsometatarsal joints

between tarsals and metatarsals. Accessory movement, glides and slides. Eversion inversion. Sagittal plane axis

Proximal interphalangeal joint

joints between phalanges (none on hallux.) flex extend. Coronal axis through head of proximal phalanx

Metatarsophalangeal joint

between metatarsals and proximal phalanx. Flex and extend. Coronal axis through head of metatarsal

Movements of toes

flex extend, abduct adduct

Plantar ligament functions

maintain longitudinal arches of foot. Absorb load

Plantar fascia/aponeurosis

comes from calcaneus, five different bands to forefoot, attaching to base of proximal phalanges

Intrinsic foot muscles- dorsal

extensor digitorum brevis (doesn’t go to fifth) and extensor hallucis brevis. Supplied by deep fib nerve. Arrise for calcaneus and run into extensor expansion (fibrous extension over prox phalanges. Extend and stabilise)

Intrinsic foot muscles- plantar

layer one- abductor hallucis (medial plantar nerve), flexor digitorum brevis (m), abductor digiti minimi (lat plantar nerve). Layer two- quadratus plantae (L), lumbricals 1-4 (M1, L3). Layer 3- flexor hallucis brevis (M), adductor hallucis (L), flexor digiti minimi (L). Layer four- dorsal interossei and plantar interossei (L)

Abductor digiti minimi

abduct fifth digit

Flexor digitorum brevis

only goes to the middle phalange. Splits for FDl at distal attachment.

Quadratus plantae

from calcaneous to digitorum longus tendon. Orientates line of pull in flexion

Lumbricals

to extensor expansion. Flex metatarsalphalangeal joints by extending interphalangeal joints

Plantar interossei

adduct and help flex MTPJ and extend IPJ. 3

Dorsal interossei

abduct and help flex MTPJ and extend IPJ. 4\

Claw toe

intrinsic muscle malfunction

Medial Longitudinal arch

calcaneum talus navicular, 3 cuneiforms and medial metatarsals

Lateral longitudinal arch

calcaneum, cuboid, lat 2 metatarsals

Arches purpose

distribute weight, shock absorb, springs for walk and jump

Superficial fibular nerve

L4 to S2. supplies lat compartments of leg (fib long and fib brev). Cutaneous dorsal supply

Late

Deep fibular nerve

supplies muscles- tib ant, extensor digitorum longus, extensor hallucis longus, fib tertius, extensor digitorum brev and extensor hallucis brev. Cutaneous branch at 3- dorsal branch at webbing

Medial and lateral plantar nerve

from tibial nerve deep to flexor retinaculum. L4-L5. cutaneous distribution

Complete cutaneous nerves

Foot sensory role

many sense receptors as its responsible for balance weight distribution, uneven ground, surface texture, temperature

Foot adaptive role

accessory movements in tarsals and metatarsals mould to uneven ground and toes use lumbrical action.

Tibiofibular joints

proximal tibiofibular joint (synovial), distal/inferior tibiofibular joint (syndesmosis, fibrous)

Tibiofibular ligaments

anterior and posterior, interosseous membrane

Foot bones