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