Week 5, Monday
Posterior Leg ppt
Which nerve travels with the lesser Saphenous? Sural nerve or Sural communicating nerve (both answers are accepted)
From which of the following does the Fibular artery arise? The posterior tibial
Ligaments run from bone to bone. Tear in those = Sprain
Muscle and tendon tear = strain
Femoral artery travels anterior through the abductor Hiatis, turns into the popliteal
The spine ppt
Cervical vert. C3-C6 typical sometimes C7 is also included
Cervical vertebra has a heart-shaped body
C3-C6 SPs are short and bifid
C2 SP is large and bifid
Superior surfaced is concave and has lips laterally called Uncinate processes
uncinate processes articulate
Inferior surface is convex
They form the uncovertebral joints with the
Transverse processes project laterally
Between the anterior and posterior tubercle is a groove for the Spinal nerve (ventral ramus)
Costal lamella is the end off the anterior costal bar and posterior costal bar, between the tubercles
Distinct feature is the oval transversarium (occasionally absent in C7), also called the Foramen Transversarium
Vertebral arteries pas through these foramina except at C7
Atypical vertebra: C1, C2, C7
C1 (Atlas) ring-shaped bone
2 lateral masses
Groove for the Suboccipital nerve and vertebral artery
Kidney-shaped concave super articular facets for the occipital condyles
No body
No spinous process
But there is a anterior and posterior arch around the vertebral foramen
Ant and post arches, each with a tubercle
Has a transverse ligament of the Atlas that hold the Dens of the Axis in place
During whiplash, this ligament can be torn, allowing C1 to slip
Down syndrome patients often do not have this ligament or it is Lax
Fracture of C1 usually break in more than one place (like breaking a lifesaver mint
Usually called a “hanger’s fracture”
C2 (Axis)
Strongest of the cervical vertebra
2 large flat bearing surfaces, superior articular facets, upon the atlas rotates
Dens of the axis (aka odontic process) articulates with Atlas
Articulates at the facet for the atlas
Rotates allowing the shaking (no) motion of head
In embryonic development, part of the body of C1 is added to C2 instead, which forms the Dens
Atlanta-axial joint
Where the Axis and Atlas meet on the median and lateral facets
Occipital condyles: are kidney shaped
Atlanta-occipital joints: allow the nodding (yes) motion of head
Vertebral artery comes through C6 to
Sacrum:
aka are wings situated tot he lateral body of S1
Sacral promontory is anterior body of S1 - most important OB landmark
Ventral foramina are larger than dorsal foramina
Dorsal is concerned with skin
Ventral is concerned with
Wedge shaped to provide strength and stability to the pelvis via SI joint
Tilted, joint between L5-S1 is lumbosacral joint
Ventral surface is anterior, has transverse lines where the IVD were before the vertebra fused to make the sacrum.
Fusion begins around the age of 20 and is usually complete by age 35
1 Median sacral crest: SPs of superior 3-4 sacral vertebra
S5 doesn’t have SP, instead has Hiatus
2 Intermediate sacral crests: fused articular processes of all 5 sacral vertebra
2 lateral sacral crest: tips of the fused TPs of all 5 sacral vertebra
Sacral Hiatus:
results for absence of SP at S5
Opens into the inferior end of the sacral canal
Contains: Filum terminals, S5 spinal nerve, Coccygeal nerve
Anchor the spinal cord
Sacral Cornua (horns
Inferior in articular process of S5
Each side of Hiatus
Auricular surface:
Auricular part of the sacrum for the SI joint
Sacral tuberosity:
Roughened region between the Auricular surface and lateral sacral rest
Forms the nonarticular part of the SI joint to which interosseous sacroiliac ligaments attach.
Coccyx
remnant of tail in human embryos until 8th week of gestation
4 rudimentary vertebrae
First 3 consists of Bodies only
Co1 articulates with S5 - largest and broadest
Usually all vertebra are fused, but sometimes the Co1-S5 joint is flexible, usually fusing by old age
Attachment site of muscles
Not responsible for bearing weight
Rudimentary articular processes form Coccygeal cornua which articulate with the sacral cornua
Curved convex anteriorly
Helps with childbirth
Curved more anterior in males
Inferior pelvic aperture larger in females
Sacrococcygeal joint being flexible also helps with childbirth
Coccydynia is pain in the coccygeal region, usually from falls on the buttocks
Pain most notable during siting
Lumbosacral angles
Mean 41*
Min 26*
Max 57*
Spinal cord ends L1-L2. Location estimated by palpating the SP of L2
Line between the highest part of the iliac crests will pas through the tip of SP of L4 and the L4-L5 IVD
Line between PSIS is lower extent of subarachnoid space, passes through SP of S2
Sacral triangle
base is formed by a line between both PSIS
Apex is formed by the superior part of the intergluteal cleft
Coccyx palpated ~2.5cm posterosuperior to the anus
Plantar Foot ppt
Will not be on 1st lecture exam, everything else up to this point will be!!
Most distal part of the lower limb
Dorsal is top of foot
Plantar is bottom of foot
5 digits, numbered medial to lateral
first is called the Hallux, or Great Toe
Abduction is with respect to the 2nd digit on the foot, because the 2nd digit is usually fairly stationary in regards to Abduction
Foot consists of 26 bones in total:
7 tarsals, 5 metatarsals, 14 phalanges
Foot bones partitioned in 3 anatomical and functions regions:
hindfoot: talus and calcaneus
midfoot: navicular, cuboid, and cuneiforms
forefoot: metatarsals and phalanges
No hair on Plantar, but larger sweat glands, thick skin, fibrous superficial fascia, and more fat than dorsum
Know the cutaneous innervation for tests
Dorsal lateral cutaneous Nerve of foot is a termination of the Sural nerve
Common plantar digital nerves are branches of Lateral plantar and medial plantar nerves
Proper plantar digital nerves branches off common plantar digital nerves
Known and love Dermatomes for test
Deep Plantar Fascia is continuous with the fascia over the dorsum
Plantar Aponeurosis is the thickened region of the middle of the plantar foot
supports longitudinal arch
Protects the sole from injury
Holds the parts of the foot together
Arises posteriorly from Calcaneus
Divides into 5 bands that become continuous with the fibrous digital sheaths that enclose the flexor tendons of the toes
Reinforced by the superficial transverse metatarsal ligament
People with flat feet should have shoes without arch support (motion control shoe) because they will over pronate, which could cause shin splints
People with arches need shoes with arch support
People with high arches need a cushion shoes with a high arch support, otherwise foot will try to fall on plantar Aponeurosis where it attaches to Calcaneus, causing plantar fasciitis and bone spurs in calcaneus
5 compartments of foot
Intermuscular septa from the margins of the plantar aponeurosis dive deep to form 3 compartments:
medial compartment
Central compartment
Lateral compartment
4th compartment is the Interosseous Compartment, located only in the forefoot
Dorsal compartment
20 individual muscles of the foot
14 on the plantar aspect, 2 on the dorsal aspect, 4 intermediate in position
support phase of stance, maintaining the arches of the foot
Resists forces that tend to reduce the longitudinal arch as weight is received at the heel and then transferred to the ball of the foot and great toe
Don’t run a marathon on your toes
Muscles on the plantar aspect are arranged in 4 separate layers within 4 compartments
1st layer of muscles
abductor hallucis
Flexor Digitorum brevis
Abductor Digitorum minimi
Vascular plane:
Lateral plantar a. And n.
Medial plantar a. And n.
2nd layer
Quadratus plantae
Lumbricals
Tendons of flexor hallucis longus and flexor Digitorum longus
3rd layer
Adductor hallucis
Flexor Hallucis brevis
Flexor Digiti minimi
Vascular plane:
Plantar arch and its branches
4th layer
Plantar interossei
Dorsal interossei
Tendon of fibularis longus
Know the O, I, N, Act and Art for all foot muscles
If it is a medial muscle of the foot, Innervation is the medial plantar nerve and blood supply is the medial plantar artery. Same applies for the Lateral muscles of the foot with lateral Nerves and Arteries
Lumbricals (1-4) originate in plantar foot, but travel between metatarsals to insert in the Dorsal foot
Interosseous muscles divided into2 groups
3 plantar muscles (unipennate)
4 Dorsal muscles (bipennate)
Lateral plantar nerve has Both a Superficial and deep branches
Posterior Tibial artery gets larger in the plantar foot- this will be on exams and on boards
Posterior tibial artery branches to Lateral plantar artery to Deep plantar arch and Superficial plantar arch to plantar metatarsal arteries to plantar digital arteries
Dorsal and plantar arteries have perforating branches so blood still gets around foot
Muscles with “Digitorum” in the name attach to the phalanges of the 4 lateral digits. All other muscles attach to only 1 digits. There’s an exception to this rule in the dorsum of foot
Exam review
Dermatomes: Learn the chart
Orientations of Articular facets in spines
Cervical - sup are sup and inf are inf @45 angle off horizontal in the middle
Thoracic - sup are coronal plane facing post. Inf are coronal facing ant. With an exception of T12
T12 sups are like all Thoracic and inf. Are like Lumbar
Lumbar - Sagittal facing each other, sup are facing medial, inf are facing lateral
Technically lumbar are biplanar, but for this class we will say Sagittal
Will release question topic breakdown soon
Everything will be spelled out, no abbreviations
Popliteal Fossa contents:
Muscles: SupLat. = Biceps Femoris, Supmed. = Semimembranosis, inferomed. = Medial head of Gastrocnemius and inferolat. = Lateral heads of Gastrocnemius, Posteriorly = popliteal fascia
Arteries, veins and nerves: Popliteal artery and vein, Common fibular Nerve, Tibial Nerve
Memorize anything on his slides that are in bold for O, I, N, Act, and Art., because this is the most primary
Lateral and Medial dorsal rami both innervate back muscles, just different ones
Posterior Leg ppt
Which nerve travels with the lesser Saphenous? Sural nerve or Sural communicating nerve (both answers are accepted)
From which of the following does the Fibular artery arise? The posterior tibial
Ligaments run from bone to bone. Tear in those = Sprain
Muscle and tendon tear = strain
Femoral artery travels anterior through the abductor Hiatis, turns into the popliteal
The spine ppt
Cervical vert. C3-C6 typical sometimes C7 is also included
Cervical vertebra has a heart-shaped body
C3-C6 SPs are short and bifid
C2 SP is large and bifid
Superior surfaced is concave and has lips laterally called Uncinate processes
uncinate processes articulate
Inferior surface is convex
They form the uncovertebral joints with the
Transverse processes project laterally
Between the anterior and posterior tubercle is a groove for the Spinal nerve (ventral ramus)
Costal lamella is the end off the anterior costal bar and posterior costal bar, between the tubercles
Distinct feature is the oval transversarium (occasionally absent in C7), also called the Foramen Transversarium
Vertebral arteries pas through these foramina except at C7
Atypical vertebra: C1, C2, C7
C1 (Atlas) ring-shaped bone
2 lateral masses
Groove for the Suboccipital nerve and vertebral artery
Kidney-shaped concave super articular facets for the occipital condyles
No body
No spinous process
But there is a anterior and posterior arch around the vertebral foramen
Ant and post arches, each with a tubercle
Has a transverse ligament of the Atlas that hold the Dens of the Axis in place
During whiplash, this ligament can be torn, allowing C1 to slip
Down syndrome patients often do not have this ligament or it is Lax
Fracture of C1 usually break in more than one place (like breaking a lifesaver mint
Usually called a “hanger’s fracture”
C2 (Axis)
Strongest of the cervical vertebra
2 large flat bearing surfaces, superior articular facets, upon the atlas rotates
Dens of the axis (aka odontic process) articulates with Atlas
Articulates at the facet for the atlas
Rotates allowing the shaking (no) motion of head
In embryonic development, part of the body of C1 is added to C2 instead, which forms the Dens
Atlanta-axial joint
Where the Axis and Atlas meet on the median and lateral facets
Occipital condyles: are kidney shaped
Atlanta-occipital joints: allow the nodding (yes) motion of head
Vertebral artery comes through C6 to
Sacrum:
aka are wings situated tot he lateral body of S1
Sacral promontory is anterior body of S1 - most important OB landmark
Ventral foramina are larger than dorsal foramina
Dorsal is concerned with skin
Ventral is concerned with
Wedge shaped to provide strength and stability to the pelvis via SI joint
Tilted, joint between L5-S1 is lumbosacral joint
Ventral surface is anterior, has transverse lines where the IVD were before the vertebra fused to make the sacrum.
Fusion begins around the age of 20 and is usually complete by age 35
1 Median sacral crest: SPs of superior 3-4 sacral vertebra
S5 doesn’t have SP, instead has Hiatus
2 Intermediate sacral crests: fused articular processes of all 5 sacral vertebra
2 lateral sacral crest: tips of the fused TPs of all 5 sacral vertebra
Sacral Hiatus:
results for absence of SP at S5
Opens into the inferior end of the sacral canal
Contains: Filum terminals, S5 spinal nerve, Coccygeal nerve
Anchor the spinal cord
Sacral Cornua (horns
Inferior in articular process of S5
Each side of Hiatus
Auricular surface:
Auricular part of the sacrum for the SI joint
Sacral tuberosity:
Roughened region between the Auricular surface and lateral sacral rest
Forms the nonarticular part of the SI joint to which interosseous sacroiliac ligaments attach.
Coccyx
remnant of tail in human embryos until 8th week of gestation
4 rudimentary vertebrae
First 3 consists of Bodies only
Co1 articulates with S5 - largest and broadest
Usually all vertebra are fused, but sometimes the Co1-S5 joint is flexible, usually fusing by old age
Attachment site of muscles
Not responsible for bearing weight
Rudimentary articular processes form Coccygeal cornua which articulate with the sacral cornua
Curved convex anteriorly
Helps with childbirth
Curved more anterior in males
Inferior pelvic aperture larger in females
Sacrococcygeal joint being flexible also helps with childbirth
Coccydynia is pain in the coccygeal region, usually from falls on the buttocks
Pain most notable during siting
Lumbosacral angles
Mean 41*
Min 26*
Max 57*
Spinal cord ends L1-L2. Location estimated by palpating the SP of L2
Line between the highest part of the iliac crests will pas through the tip of SP of L4 and the L4-L5 IVD
Line between PSIS is lower extent of subarachnoid space, passes through SP of S2
Sacral triangle
base is formed by a line between both PSIS
Apex is formed by the superior part of the intergluteal cleft
Coccyx palpated ~2.5cm posterosuperior to the anus
Plantar Foot ppt
Will not be on 1st lecture exam, everything else up to this point will be!!
Most distal part of the lower limb
Dorsal is top of foot
Plantar is bottom of foot
5 digits, numbered medial to lateral
first is called the Hallux, or Great Toe
Abduction is with respect to the 2nd digit on the foot, because the 2nd digit is usually fairly stationary in regards to Abduction
Foot consists of 26 bones in total:
7 tarsals, 5 metatarsals, 14 phalanges
Foot bones partitioned in 3 anatomical and functions regions:
hindfoot: talus and calcaneus
midfoot: navicular, cuboid, and cuneiforms
forefoot: metatarsals and phalanges
No hair on Plantar, but larger sweat glands, thick skin, fibrous superficial fascia, and more fat than dorsum
Know the cutaneous innervation for tests
Dorsal lateral cutaneous Nerve of foot is a termination of the Sural nerve
Common plantar digital nerves are branches of Lateral plantar and medial plantar nerves
Proper plantar digital nerves branches off common plantar digital nerves
Known and love Dermatomes for test
Deep Plantar Fascia is continuous with the fascia over the dorsum
Plantar Aponeurosis is the thickened region of the middle of the plantar foot
supports longitudinal arch
Protects the sole from injury
Holds the parts of the foot together
Arises posteriorly from Calcaneus
Divides into 5 bands that become continuous with the fibrous digital sheaths that enclose the flexor tendons of the toes
Reinforced by the superficial transverse metatarsal ligament
People with flat feet should have shoes without arch support (motion control shoe) because they will over pronate, which could cause shin splints
People with arches need shoes with arch support
People with high arches need a cushion shoes with a high arch support, otherwise foot will try to fall on plantar Aponeurosis where it attaches to Calcaneus, causing plantar fasciitis and bone spurs in calcaneus
5 compartments of foot
Intermuscular septa from the margins of the plantar aponeurosis dive deep to form 3 compartments:
medial compartment
Central compartment
Lateral compartment
4th compartment is the Interosseous Compartment, located only in the forefoot
Dorsal compartment
20 individual muscles of the foot
14 on the plantar aspect, 2 on the dorsal aspect, 4 intermediate in position
support phase of stance, maintaining the arches of the foot
Resists forces that tend to reduce the longitudinal arch as weight is received at the heel and then transferred to the ball of the foot and great toe
Don’t run a marathon on your toes
Muscles on the plantar aspect are arranged in 4 separate layers within 4 compartments
1st layer of muscles
abductor hallucis
Flexor Digitorum brevis
Abductor Digitorum minimi
Vascular plane:
Lateral plantar a. And n.
Medial plantar a. And n.
2nd layer
Quadratus plantae
Lumbricals
Tendons of flexor hallucis longus and flexor Digitorum longus
3rd layer
Adductor hallucis
Flexor Hallucis brevis
Flexor Digiti minimi
Vascular plane:
Plantar arch and its branches
4th layer
Plantar interossei
Dorsal interossei
Tendon of fibularis longus
Know the O, I, N, Act and Art for all foot muscles
If it is a medial muscle of the foot, Innervation is the medial plantar nerve and blood supply is the medial plantar artery. Same applies for the Lateral muscles of the foot with lateral Nerves and Arteries
Lumbricals (1-4) originate in plantar foot, but travel between metatarsals to insert in the Dorsal foot
Interosseous muscles divided into2 groups
3 plantar muscles (unipennate)
4 Dorsal muscles (bipennate)
Lateral plantar nerve has Both a Superficial and deep branches
Posterior Tibial artery gets larger in the plantar foot- this will be on exams and on boards
Posterior tibial artery branches to Lateral plantar artery to Deep plantar arch and Superficial plantar arch to plantar metatarsal arteries to plantar digital arteries
Dorsal and plantar arteries have perforating branches so blood still gets around foot
Muscles with “Digitorum” in the name attach to the phalanges of the 4 lateral digits. All other muscles attach to only 1 digits. There’s an exception to this rule in the dorsum of foot
Exam review
Dermatomes: Learn the chart
Orientations of Articular facets in spines
Cervical - sup are sup and inf are inf @45 angle off horizontal in the middle
Thoracic - sup are coronal plane facing post. Inf are coronal facing ant. With an exception of T12
T12 sups are like all Thoracic and inf. Are like Lumbar
Lumbar - Sagittal facing each other, sup are facing medial, inf are facing lateral
Technically lumbar are biplanar, but for this class we will say Sagittal
Will release question topic breakdown soon
Everything will be spelled out, no abbreviations
Popliteal Fossa contents:
Muscles: SupLat. = Biceps Femoris, Supmed. = Semimembranosis, inferomed. = Medial head of Gastrocnemius and inferolat. = Lateral heads of Gastrocnemius, Posteriorly = popliteal fascia
Arteries, veins and nerves: Popliteal artery and vein, Common fibular Nerve, Tibial Nerve
Memorize anything on his slides that are in bold for O, I, N, Act, and Art., because this is the most primary
Lateral and Medial dorsal rami both innervate back muscles, just different ones