ANATOMYMUSCULOSKELETALBLOCK

(muscularchartkey=NAME/ORIGIN/INSERTION/ACTION/INNERVATION) SUPERFICIALBACKANDSHOULDERREGION: Extrinsicmusclesoftheupperlimb:superficialback(5),pectoral(4) Intrinsicmusclesoftheupperlimb:shoulder(6),arm(4),forearm(20),hand(19) RELEVANTSKELETALCOMPONENTS: o Vertebralcolumnspinousprocess,transverseprocess o Clavicle(collarbone):medial&lateralsurfaces,superior&inferiorsurfaces o Scapula:acromion,coracoidprocess,glenoidcavity,neck,angles&borders,supra& intraglenoidtubercles,suprascapularnotch,subscapularfossa,spine,supraspinous fossa,infraspinousfossa o Humerus:head,anatomicalneck,greatertubercle,lessertubercle,intertubercular sulcus(bicipitalgroove),deltoidtuberosity SUPERFICIALBACKMUSCLES(5):
Trapeziusmuscle skull,ligamentumnuchae, spinousprocessesofT1T12 lateral(acromial)1/3 ofclavicle,acromion process,scapular spine floorofbicipital grooveofhumerus elevatescapula(upperfibers), retractscapula(middlefibers), pullmedialborderofscapula, orientingglenoidfossaupward (lowerfibers) armextension,armadduction, medialrotationofarm accessorynerve, branchesofVPR ofC3andC4

Latissimusdorsi

Levatorscapulae

posterioriliaccrest, thoracolumbarfascia, spinousprocessesofT6T12 (sometimes3to4ribsand inferiorangleofscapula) transverseprocessesofC1 C4 ligamentumnuchae, spinousprocessesofC7and T1 spinousprocessesofT2T5

thoracodorsal nerve

Rhomboidminor

Rhomboidmajor

superiorportionof medialborderof scapula medialborderof scapula,justmedial tobaseofspineof scapula lowerportionof medialborderof scapula

pullscapulamedially,elevate scapula pullscapulamedially,elevate scapula

dorsalscapular nerve,VPRofC3 andC4 dorsalscapular nerve

pullscapulamedially,elevate scapula

dorsalscapular nerve

Deltoid muscle

Rulesofsuperficialbackmuscles: o AllareinnervatedbydorsalscapularnerveEXCEPTtrapeziusandlatissimusdorsi SHOULDERMUSCLES(6):

spineofscapula, acromion,lateral (acromial)1/3of clavicle supraspinousfossaof scapula infraspinousfossaof scapula subscapularfossaof scapula deltoidtuberosity abductsthearmattheshoulder, flexionandmedialrotationofarm (anteriorfibers),extensionand lateralrotationofarm(posterior fibers) initiatesabductionofthearm, stabilizesshoulderjoint lateralrotationofarm,stabilizes shoulderjoint medialrotationofthearm, stabilizesshoulderjoint axillarynerve(C5 C6)

Supraspinatus muscle Infraspinatus muscle Subscapularis muscle

greatertubercleof humerus,capsuleof glenohumeraljoint greatertubercleof humerus,capsuleof shoulderjoint lessertubercleofhumerus

Suprascapular nerve(C5C6) Suprascapular nerve(C5C6) lower(C5C6)and upper(C5) subscapular nerves axillarynerve(C5 C6) lowersubscapular nerve(C5C6)

Teresminor

Teresmajor

middle1/3oflateral borderofscapula (dorsal) inferior1/3oflateral borderofscapula (dorsal)

greatertubercleofhumerus (dorsally),capsuleof shoulderjoint lessertubercleofhumerus (mediallipofbicipital groove,ventrally)

rotatesthearmlaterally,stabilizes theshoulderjoint rotatesthearmmedially

DEEPBACK&VERTEBRALCOLUMN VERTEBRALCOLUMN: o 33vertebrae=>24truevertebrae=>7cervical,12thoracic,5lumbar,5sacral,4 coccygeal o Function:protectspinalcord&providesasupportingstructure o Curvatures(presentingonanterioraspect) 2concavities=thoracicregionandsacralregion(primarycurvatures=present atbirth);2convexities=cervicalregionandlumbarregion(secondary curvatures=NOTpresentatbirth) Vertebrae o Typicalvertebra: Anteriorbody,vertebralforamen,posteriorvertebralarch(pedicleslaterally, laminaposteriorly),7processes:1spinous,2transvers,4articular(2superior, 2inferior) Facetjointsbetweenarticularprocessesofvertebraeabove/beloweachother

Rulesofshouldermuscles: o Alloriginatefromthescapula(someinpart)andinsertonthehumerus STERNOCLAVICULARJOINT st o Skeletalcomponents:medialclavicle,manubrium,1 costalcartilage o Synovialplanejoint;articulardiscdividesthejointspaces LateralCompartment:elevation(superiorsliding)ofjointby sternocleidomastoid,trapezius,levatorscapulae,rhomboids;depression (inferiorsliding)ofjointbypectoralisminor,subclavius MedialCompartment:anteriorslidingofjointbyserratusanterior;posterior slidingofjointbytrapezius,rhomboids o Ligaments:sternoclavicular=surroundsarticularcavitiesofjoint;costoclavicular= st connects1 ribtoclavicle ACROMIOCLAVICULARJOINT o Skeletalcomponents:lateralclavicle,acromionofscapula o Wedgeshapedarticulardisc o Ligaments:acriomioclavicular(superior&inferior)=surroundsthejoint; coracoclavicular(trapezoidlaterally&conoidmedially)=connectclavicletocoracoid process o Innervation:supraclavicularN,medial&lateralpectoralNN,axillaryN GLENOHUMERALJOINT o Skeletalcomponents:glenoidfossaofscapula,headofhumerus o Ballandsocketjoint;though,glenoidfossaisrathershallow,depthincreasedby fibrocartilageringcalledglenoidlabrum o Synovialcavity:attachedtoedgesofarticularsurfaces;extensions=synovialsheathof bicepslongheadtendonandsubscapularisbursa o ANTERIORSUPPORT: Ligaments:superior,anterior,inferiorglenohumeralligaments;transverse humeralligament(overbicipitalgroove) Muscular:subscapularis o SUPERIORSUPPORT: Skeletal:acromion&coracoidprocess Ligaments:coracoacromial&coracohumeral Muscular:supraspinatus,longheadofbiceps o POSTERIORSUPPORT: Muscular:infraspinatus,teresminor o Bursae:Subdeltoidbursa,subacromialbursa,subscapularbursa(deeptosubscapularis)

Superiorarticularprocessesarticulatewithinferiorarticularprocesses fromvertebraabove(oppositetrueforinferiorarticularprocesses) o Intervertebraldisc Shockabsorberallowingformovement Nucleuspulposus:centerofdiscconsistsofwatery,gelatinoussubstance Annulusfibrosus:peripheryofdiscmorefibrouscartilage(thickeranteriorly thanposteriorly) o Cervicalvertebra: Foramentransversariumallowspassageofvertebralveinthroughthe7cervical vertebrae,w/vertebralarterypassingthroughupper6cervicalvertebrae Groovesintransverseprocessesforspinalnerves Uncinateprocess(inferioraspectofvertebralbody)foundinarticulation betweenvertebralbodiesandintervertebraldiscs Spinousprocessesarebifid(exceptC1andC7) Articulatingsurfacesareflatter:superiorarticulatingsurfacesareoriented upward;inferiorarticulatingsurfacesareorienteddownward o Atypicalcervicalvertebrae Atlas(C1):novertebralbodyorspinousprocess;articularsurfacesonupper aspectareforoccipitalcondyles(formovementofskullinnoddingyes) Axis(C2):odontoidprocessprojectssuperiorlyfromsuperioraspectofbody NointervertebraldiscbetweenC1C2 CruciateligamentbetweenC1C2consistsoftransverseligamentof atlasandsuperior&inferiorlongitudinalbands o Thoracicvertebra: Vertebralbodyismediumsizedandheartshapedw/circularvertebralforamen Spinousprocessislongandslopingdownward Costalarticularsurfacescanbefoundonposterolateralsidesofvertebralbody Costalfacetsfoundontransverseprocessesforarticulationwith tubercleofmatchingrib(notransversefacetsarefoundonT11T12) Superiorarticulatingsurfacesfaceposteriorly;inferiorsurfacesfaceanteriorly o Lumbarvertebra: Large,kidneyshapedvertebralbodywithtriangularvertebralforamen Longandslendertransverseprocesses(L3transverseprocessesbeingwidest) Superiorarticulatingsurfacesfacemedially;inferiorfacelaterally Sacrum:fusionof5sacralvertebrae o SuperiorlyintervertebraldiscL5S1;inferiorlycoccyx;laterallyarticulationsw/iliac portionsofpelvicbones o Sacralcanalextendslengthofsacrumforthecaudaequina:anteriorandposterior sacralforaminaexistforventralanddorsalprimaryramiofsacralnerves Ligamentsofspinalcolumn: o Anteriorlongitudinalligamentwide,strongligamentrunninglongitudinallyoverentire lengthofanteriorandlateralsurfacesofvertebralbodies o Posteriorlongitudinalligamentw/invertebralcanal,runninglongitudinallyoverlength ofposteriorsurfaceofvertebralbodies o Ligamentumflavumligamentsrunningsegmentallybetweenvertebrallaminae o Interspinousligamentsrunbetweenadjacentspinousprocesses o Supraspinousligamentrunslongitudinallyoverandbetweenthespinousprocesses(in cervicalregion,ligamentisthickerandknownasligamentumnuchae) o Noligamentsrunbetweenpediclessoastoallowspinalnervestoexit SPINALCORD o 31pairsspinalnerves:8cervical,12thoracic,5lumbar,5sacral,1coccygeal

NOTE:C1C7exitvertebralcolumnABOVEtheirmatchingvertebrae,C8nerve exitsBELOWC7vertebra,andallspinalnervesinferiortoC8exitBELOWtheir matchingvertebrae Anteriorrootletsofaspinallevelformanterior(ventral)rootofthatlevel; posteriorrootletsofalevelformposterior(dorsal)rootofthatlevel o SpinalcordstopsaroundL1L2withconusmedularisandbecomesthecaudaequina Duetodifferentialgrowthofvertebralcolumnandsofttissueofspinalcord o Transversesectionofspinalcord: Whiteandgraymatter,anteriormedianfissure,posteriormediansulcus, dorsal,ventralhornsofgraymatter(lateralhorninT1L2or3only) o MENINGES(3layerssurroundingspinalcord): Duramater:(continuousw/duramatercoveringbrain)tough,protective, impermeableoutermostlayerenclosingspinalcordandcaudaequinaand endingataroundS2uponexitingintervertebralforamen,becomes continuousw/epineuriumsurroundingspinalnerve Arachnoid:(continuousw/arachnoidcoveringbrain)delicate,impermeable membranedeeptoduramater,separatedfrompiamaterbysubarachnoid spacefilledwithcerebrospinalfluid(CSF) Piamater:vascularmembranecoveringspinalcorditself,separatedfrom arachnoidbyCSF,endingataroundL1w/filumterminale denticulateligaments:formedfromlateralthickeningofpiamater, attachingtoduramaterbetweennerveroots o BLOODSUPPLYTOSPINALCORD 3mainlongitudinalarteries:2posteriorspinalarteries,anteriorspinalartery Radiculararteriesenterintervertebralforaminatoanastomosew/the3above Bloodsupplyarisesdirectlyorindirectlyfromvertebralarteriesorintercostal andlumbararteriesfromaorta o Venousnetworkofvertebralcolumn Internalandexternalvertebralvenousplexuses:valvelesssystemofveins drainintobasivertebralveins=>intervertebralveins=>vertebral,intercostal, lumbarveins MUSCLESOFDEEPBACK(apparentlynotthatimportantforourintentsandpurposes) o Innervatedbyposteriorprimaryramiofspinalnerves o 3groups:erectorspinaemuscles,transversospinalismuscles,deepestgroupmuscles o ERECTORSPINAE: Spinalismuscle(medially);Longissiumusmuscle(intermediate);Iliocostalis muscle(laterally) Erectorspinaemusclesdeeptobothserratusposteriorsuperior&inferior o TRANSVERSOSPINALIS&DEEPESTGROUP: Transversospinalismuscles:Semispinalis,mulitifidus,rotators Deepestgroupmuscles:Intertransversarii,interspinales Posturalmusclesdesignedtomaintainpostureasextensorsofthetrunk

PECTORALREGION PectoralGirdle=scapula+clavicle Axilla=apyramidshapedspacebetweenthechestandarm.Itservesasapassagewayfor vesselsandnervespassingbetweentheupperlimbandtherootofthenecksuperiortothe thoracicinlet. AXILLARYREGIONMUSCLES(4)

Pectoralismajor

sternum,clavicle, upper6costal cartilages ribs3,4,5 st 1 costalcartilage upper89ribs

laterallipofbicipital groove coracoidprocess clavicle medialborderof scapula(anterior)

armadduction(clavicular fibers),medialrotationof arm,armflexion depressesshoulder depressesclavicle,steadies clavicle protractsscapula,keeps medialborderofscapula opposedtothoracicwall

medialandlateralpectoral nerves(branchesofbrachial plexus) medialpectoralnerve Nervetosubclavius longthoracicnerve(branchof brachialplexus,foundon superficialsurfaceofmuscle)

Pectoralisminor Subclaviusmuscle Serratusanterior

BRACHIALPLEXUS(seediagram) Brachialplexus=anetworkofnervesformedbytheventralprimaryramiofspinalnervesC5T1 o ROOTS(neck):C5,C6,C7,C8,T1 o TRUNKS(neck):Upper=C5andC6join;Middle=C7continues;Lower=C8andT1join o DIVISIONS(neck):AnteriorandPosterior o CORDS(axilla):Lateral=anteriordivisionsofupperandmiddletrunks;Posterior=all posteriordivisions;Medial=anteriordivisionoflowertrunk o BRANCHES(axilla):fromRoots(2);fromTrunks(2);fromCords(13) ROOTBRANCHES: o 1)DorsalScapularn:C5,innervatesrhomboidmuscles o 2)LongThoracicn:C5C7,innervatesserratusanterior TRUNKBRANCHES: o 1)Suprascapularn:UpperTrunk(distal),innervatessupraspinatusandinfraspinatus muscles o 2)NervetoSubclavius:UpperTrunk(proximal),innervatessubclaviusmuscle CORDBRANCHES: o 1)Lateralpectoraln:LateralCord,innervatespectoralismajor o 2)LateralrootofMediann:LateralCord,innervatesforearmandhand o 3)Musculocutaneousn:LateralCord,innervatesmusclesofanteriorcompartmentof armandskinoflateralforearm o 4)Uppersubscapularn:PosteriorCord,innervatessubscapularmuscle o 5)Lowersubscapularn:PosteriorCord,innervatessubscapularandteresmajormuscles o 6)Thoracodorsaln:PosteriorCord,innervateslatissimusdorsimuscle o 7)Axillaryn:PosteriorCord,innervatesdeltoidandteresminormuscles o 8)Radialn:PosteriorCord,innervatesallextensormusclesofarmandforearm o 9)Medialpectoraln:MedialCord,innervatespectoralismajorandminor o 10&11)Medialcutaneousnervesofarmandforearm:MedialCord,innervateskinof armandforearmrespectively o 12)MedialrootofMediann:MedialCord,innervatesforearmandhand o 13)Ulnarn:MedialCord,innervatesmusclesofforearmandhand AXILLARYLYMPHATICS o Thereareusually2030lymphnodesintheaxilla.Theydrainthesuperficialanddeep tissuesoftheupperlimb,thelateralbreast,andthesuperficialthoraxandabdomen abovetheleveloftheumbilicus. o 1)Pectoral(anterior)nodes:(levelI)foundalonglowerborderofpectoralisminor, drainlateralquadrantsofthebreastandsuperficialchestandabdomenabovethe umbilicus o 2)Subscapular(posterior)nodes:(levelI)foundonsubscapularismuscle,drain superficialareasofthebackdowntotheleveloftheiliaccrest o 3)Lateralnodes:(levelI)foundalongaxillaryvein,drainsmostoflymphfromtheupper limb o 4)Centralnodes:(levelII)foundinthecenteroftheaxillaryfat,collectlymphfromthe pectoral,subscapularandlateralgroupsofnodes

5)Apicalnodes:(levelIII)foundalongcephalicvein,collectlymphfromallthenodes mentionedaboveanddrainintotherightsubclaviantrunkandthenintotheright lymphatictrunk(right)orthethoracicduct(left) Infraclavicularnodes:foundinthedeltopectoraltriangle,receiveslymphfrom superficialareasofthelateralpartoftheupperlimbalongthecourseofthecephalic veinanddrainintoapicalnodes

BREAST o ArterialSupply: Medialquadrantsinternalthoracicarterybranches Lateralquadrantslateralthoracicartery,thoracoacromialartery o VenousDrainage: Medialquadrantsinternalthoracicvein Lateralquadrantsaxillaryveintributaries o Lymphatics: Lateralquadrantspectoralnodes>centralnodes>apicalnodes Medialquadrantsparasternalnodes o MAMMARYGLAND: Subcutaneous,exocrineglandwith1520lobes Connectivetissueseptasurroundinglobes(withsuspensoryligamentsinupper quadrants) Retromammaryspace(surgicalplane):Connectivetissueseparatingthe mammaryglandandassociatedfattytissuefromthepectoralismajor

ARM

RELEVANTSKELETALCOMPONENTS: o Humerus:radialgroove(posterior),medialandlateralepicondyles,medialandlateral supracondylarridges,capitulum(lateral),trochlea(medial),radialfossa,coronoidfossa, olecranonfossa o Radius:head,neck,radialtuberosity o Ulna:olecranonprocess,coronoidprocess,trochlearnotch,radialnotch,ulnar tuberosity Brachialfascia:deepfasciasurroundingentirearm Medialandlateralintermuscularseptaemakeanteriorandposteriorcompartmentsofbrachium ANTERIORCOMPARTMENTMUSCLES(3):
longheadsupraglenoid tubercleonscapula; shortheadcoracoid process coracoidprocessofthe scapula(commontendon w/shortheadofbiceps) anterioraspectofdistal halfofhumerus(large surfaceoforigin) posteriorportionofthe radialtuberosity,bicipital aponeurosisinsertsinto medialsideof antebrachialfascia anterioraspectofthe middleshaftofthe humerus coronoidprocessofulna strongflexionandsupination ofantebrachiumatelbow, weakflexoroftheshoulder musculocutaneous nerve

Bicepsbrachii

Coracobrachialis

weakflexionandadduction ofthearmattheshoulder strongflexorofantebrachium attheelbow

musculocutaneous nerve musculocutaneous nerve;smallportion laterallyradial nerve

Brachialis

Triceps

Rulesofanteriorcompartmentmuscles: o AllareinnervatedbythemusculocutaneousnerveEXCEPTpartofbrachialis(radialn) o Allservetoflextheantebrachium(forearm)attheelbowEXCEPTcoracobrachialis POSTERIORCOMPARTMENTMUSCLES(1):

longheadinfraglenoidtubercleofthe scapula;lateralheadposteriorhumerus proximaltoradialgroove;medialhead posteriorhumerusdistaltoradialgroove (posteroinferioraspectofhumerus) upperolecranon processofulna strongextensionofantebrachiumat elbow,weakextensorandadductor ofthearmattheshoulder(long head) radialnerve (all3heads)

FOREARM RELEVANTSKELETALCOMPONENTS: o DistalHumerus,radius,ulna o Carpals:scaphoid,lunate,triquetrum,pisiform,trapezium,trapezoid,capitate,hamate o Metacarpalbones:1(+2sesamoidbones),2(+1sesamoidbone),3,4,5(metacarpal) st o ProximalPhalanges,MiddlePhalanges(absentin1 digit=thumb),DistalPhalanges COMPARTMENTS:Theanteriorcompartmentisseparatedfromtheposteriorbytheradiusand ulna,theinterosseousmembrane,andthelateralandmedialintermuscularseptae ANTERIORCOMPARTMENTMUSCLES(8): o SUPERFICIALANTERIORLAYER(4):
Pronatorteres superficialheadmedial supracondylarridge/common tendononmedialepicondyle,deep headmedialborderofcoronoid processofulna commontendononmedial epicondyle commontendononmedial epicondyle commontendononmedial epicondyle,medialolecranonand ulna medialepicondyle,medialpartof ulnartuberosityandcoronoid process,obliquelineonradius lateralsurfaceof radius pronationoftheforearm rotatestheradiusmedially mediannerve

CUBITALFOSSA: o Borders:proximallinebetweenlateralandmedialepicondyles;lateral brachioradialismuscle;medialpronatorteresmuscle;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(anteriolaterally),mediancubitalvein(anterior connectscephalicandbasilicatcubitalfossa) ELBOWJOINT: o Skeletalcomponents:Humerus(capitulum&trochlea),headofradius,headofulna o Articulations:Humeruscapitulumw/headofradius;humerustrochleawithtrochlear notchofulna o Synovialcavity:synovialmembranelinesjointcapsuleandiscontinuousw/thatof proximalradioulnarjoint o Ligaments:radialcollateralligament(attachestoannularligament),ulnarcollateral ligament(anterior,posteriorandtransversebands)annularligament(crossesfromulna overtoposterolateralradius,createssacciformrecessofsynovial) o Muscular:muscularsupportcomesfrombicepsbrachiiandbrachialistendons

Flexorcarpiradialis Palmarislongus Flexorcarpiulnaris

basesof2 and3 metacarpals palmaraponeurosis pisiformbone,base ofmetacarpal5

nd

rd

flexesandabductsthe handatthewrist weakflexorofhandat wrist flexesandadductshandat wrist

mediannerve mediannerve ulnarnerve

o
Flexordigitorum superficialis

INTERMEDIATEANTERIORLAYER(1):
4tendonsinsertonMIDDLE phalangesof2,3,4,and5(digits) Flexionof digits2,3,4,5 AtPIPjoint mediannerve

o
Flexordigitorum profundus Flexorpollicis longus Pronator

DEEPANTERIORLAYER(3):
proximal2/3ulnaand interosseousmembrane middleradiusand interosseousmembrane distalofulna 4tendonsinserton DISTALphalangesof2,3, 4,and5(digits) distalphalanxofthumb (pollux) anteriordistalradius Flexionofdigits2,3,4,5 atDIPJoint flexionofdistalthumb pronationofforearm anteriorinterosseous n/mediannlaterally; ulnarnervemedially anteriorinterosseous nerve/mediannerve 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 surfaceoffibrousflexorsheath o FLEXORSYNOVIALSHEATHS: RadialBursa=surroundstendonofFlexorpollicislongus UlnarBursa=surrounds8tendonsofFlexordigitorumsuperficialisandFlexor th digitorumprofundus;communicateswithdigitalsynovialsheathof5 digit DigitalSynovialSheaths=eachsurroundsFDSandFDPindigits2,3,and4 o RELATIONSHIPSINWRIST: Laterally>Medially=Abductorpollicislongustendon,radialartery,flexor carpiradialistendon,mediannerve,Palmarislongustendon,Flexordigitorum superficialistendons,ulnarartery,ulnarnerve,Flexorcarpiulnaristendon POSTERIORCOMPARTMENTMUSCLES: o SUPERFICIALLAYERMUSCLES(7):
upper2/3oflateral supracondylarridge baseofstyloidprocessof radius flexionofforearmatelbow joint,assistsinlateralrotationof theforearmfromfullpronation, assistsinmedialrotationfrom fullsupination extendsandabductshandatthe wrist radialnerve (C5,6,7)

Brachioradialis

Extensorcarpi radialislongus (lateral compartment) Extensorcarpi radialisbrevis Extensor digitorum

lower1/3oflateral supracondylarridge

posteriorbaseof2 metacarpal
rd

nd

deepbranch ofradialnerve (C7,8) deepbranch ofradialnerve (C7,8) deepbranch ofradialnerve (C7,8)

commontendonat lateralepicondyle commontendonat lateralepicondyle

posteriorbaseof3 metacarpal 4tendonsinsertatbaseof middleandbaseofdistal phalangesviaextensor expansion(hood)ofdigits2, 3,4,5 extensorexpansionforlittle finger posteriorbaseof5 metacarpal lateralsurfaceofolecranon processofulna
th

extendsandabductshandat wrist extendsmetacarpophalangeal joints,assistslumbricalsand interosseiinextendingproximal anddistalinterphalangealjoints extendsmetacarpophalangeal jointoflittlefinger posterioraspectoflateral epicondyle assiststricepsinextensionof forearmatelbow

Extensordigiti minimi Extensorcarpi ulnaris Anconeus

commontendonat lateralepicondyle commontendonat lateralepicondyle posterioraspectof lateralepicondyle

deepbranch ofradialnerve (C7,8) deepbranch ofradialnerve (C7,8) radialnerve (C7,8,T1)

o
Supinator

EXTENSOREXPANSIONHOOD: AttachmentsofExtensordigitorumtobasesofmiddleanddistalphalanges Centralbandtobaseofmiddlephalanx,lateralbandstobaseofdistalphalanx DEEPLAYERMUSCLES(5):

anterolateralneckandshaft ofradiusbywindingaround posteriorandlateralsuface ofneckofradius posteriorbaseof1
st

superficialheadposteriorlateral epicondyle(infracondylarridge), lateralligamentofelbowjoint, annularligament;deephead supinatorcrestofulna shaftoftheulna,radiusand

assistsinsupination offorearm(proximal anddistalradioulnar joints) abductsandextends

deepbranchof radialnerve(C5,6)

Abductor

deepbranchof

pollicislongus

interosseousmembrane

metacarpal

Extensor pollicisbrevis Extensor pollicislongus Extensor indicis

posteriorradiusandadjacent interosseusmembrane posteriorulnaandadjacent interosseusmembrane posteriorulnaandadjacent interosseusmembrane

posteriorbaseofproximal phalanxofthumb posteriorbaseofdistal phalanxofthumb extensorexpansionofindex finger

thumbat carpometacarpal joint extends metacarpophalange aljointofthumb extendsdistal phalanxofthumbat interphalangealjoint extends metacarphophalang ealjointofindex finger

radialnerve(C7,8)

deepbranchof radialnerve(C7,8) deepbranchof radialnerve(C7,8) deepbranchof radialnerve(C7,8)

HAND SKELETALCOMPONENTS: o Carpalbones:scaphoid,lunate,triquetrum,pisiform,trapezium,trepezoid,capitate, hamate o Metacarpals&Phalanges:Metacarpals(5),Phalanges(14)3ineachdigit(proximal, middle,distal),2inthumb(proximal,distal) st nd o Sesamoidbones:Foundonheadof1 and2 metacarpals Palmaraponeurosis:attachedtoflexorretinaculum,4fibrousslipsextendingtoeachfinger formingapassageforflexortendons,digitalvesselsandnerves THENAREMINENCEMUSCLES:
Abductor pollicisbrevis flexorretinaculumandcarpal bones lateralaspectofthebase oftheproximalphalanxof thethumb(withtheflexor pollicisbrevis) lateralaspectofthebase oftheproximalphalanxof thethumb(withthe abductorpollicisbrevis) entirelengthofthelateral borderoftheshaftofthe firstmetacarpalbone medialsideofthebaseof theproximalphalanxof thethumb abductsthethumbatthe carpometacarpaland metacarpophalangealjoints flexesthethumbatthe metacarpophalangealjoint

NOTE:deepbranchofradialnerveisthesameastheposteriorinterosseusnerve Rulesoftheposteriorcompartmentmusclesofantebrachium: o Allmusclesareinnervatedbythedeepbranchoftheradialnervebrachioradialisand anconeusareinnervatedbyradialnerveproper(apparentlybeforesplitting) RADIOULNARJOINTS: o Proximal:Headofradiusinradialnotchofulna o Distal:baseofulnainulnarnotchofradius o Bothjointsaresynovialpivotjointsresponsibleforpronationandsupination WRIST(RADIOCARPALJOINT): o Skeletalcomponents:distalradiusandtriangularcartilageofulna,scaphoid,lunate, triquetral o Synovialcavity:linedbysynovialmembraneanddoesnotcommunicatewithanyother space o MajorAnteriorligamentsupport:ulnocapitate,capitohammate,longradioulnate, scaphocapitate,trapeziotrapezoid o MajorPosteriorligamentsupport:dorsalradioulnar,dorsalradiocarpal,dorsal intercarpal,scapholunate

mediannerve (recurrent branch mediannerve (recurrent branch) mediannerve (recurrent branch) ulnarnerve (deepbranch)

Flexorpollicis brevis

lateralandanteriorsurfaceof theflexorretinaculum

Opponens Pollicis Adductor pollicis

lateralandanteriorsurfaceof theflexorretinaculum obliqueheadanteriorsurfaces nd rd ofthebaseof2 and3 metacarpal,transversehead rd anteriorsurfaceofthe3 metacarpal(notpartofthenar eminence)

opposition(thumbcrosses palmtotouchlittlefinger) adductsthethumbatthe carpometacarpaland metacarpophalangealjoints

Rulesofthethenareminencemuscles: o AllmusclesareinnervatedbymediannerveEXCEPTadductorpollicis(ulnarn) HYPOTHENAREMINENCEMUSCLES:

pisiformboneofcarpals medialsideofthebase oftheproximalphalanx ofthelittlefinger medialsideofthebase oftheproximalphalanx ofthelittlefinger entirelengthofthe th medialborderofthe5 metacarpalbone abductsthelittlefingeratthe metacarpophalangealjoint flexesthelittlefingeratthe metacarpophalangealjoint bringslittlefingerinto oppositionwiththethumb ulnarnerve (deepbranch) ulnarnerve (deepbranch) ulnarnerve (deepbranch)

Abductordigiti minimi Flexordigiti minimi Opponensdigiti minimi

medialportionoftheanterior surfaceoftheflexor retinaculum medialportionoftheanterior surfaceoftheflexor retinaculum

Rulesofhypothenareminencemuscles: o Allmusclesareinnervatedbydeepbranchofulnarnerve INTRINSICMUSCLESOFTHEHAND:

tendonsoftheflexor digitorumprofundus(1& 2singleheadonlateral side,3&4doublehead, betweendigits34and4 5) 2headsfromadjacent sidesofthemetacarpal bones lateralsideofthe correspondingextensor expansion flexthemetacarpophalangeal jointsandextendthe interphalangealjoints 1&2digital branchof mediannerve,3 &4ulnar nerve(deep branch) ulnarnerve (deepbranch)

Lumbrical muscles(4)

Dorsal interossei(4)

Palmar interossei(3)

anteriorsurfaceofthe nd th th shaftofthe2 ,4 ,and5 metacarpalbones

proximalphalangesand extensorexpansionsofthe index,middle,andring fingers,withthe2muscles beingdedicatedtothe middlefinger baseofproximalphalanges onsideclosesttomiddle finger,andonextensor expansionsoftheindex,ring andlittlefingers

abducttheindex,middleand ringfingers,flexthe metacarpophalangealjoints andextendthe interphalangealjointsof these3fingers adducttheindex,ringand littlefingers,flexthe metacarpophalangealjoints andextendthe interphalangealjointsof these3fingers

ulnarnerve (deepbranch)

Rulesofintrinsicmusclesofthehand: st nd o AllmusclesareinnervatedbythedeepbranchoftheulnarnerveEXCEPTthe1 and2 lumbricals(digitalbranchofmediann) VENOUSDRAINAGE: o Dorsalvenousarch:cephalicveinoriginatesonlateralaspectofdorsalvenousarch, basilicveinoriginatesonmedialaspectofdorsalvenousarch ARTERIALSUPPLY: o Superficialpalmararch: ulnararterypassessuperficialtotheflexorretinaculum,lateraltoulnarnerve andpisiform givesadeeppalmarbranch,curvingdeeptopalmaraponeurosis Anastomoseswithsuperficialpalmarbranchofradialartery Branches:3commonpalmardigitalarterieseachdividesinto2properpalmar digitalarteriestoeachdigitand1tothelittlefinger o Deeppalmararch: Anastomosisofradialarterywiththedeepbranchofulnarartery Deeptolongflexortendonsbutsuperficialtometacarpalbonesand interosseousmuscles 3smallerpalmarmetacarpalarteriesanastomosewiththematchingarteries fromsuperficialarch radialisindicisbranchtolateralsideofindexfinger,pincepspollicisbranchto bothsidesofthumb INTERCARPALJOINTS

SUPERFICIALANATOMYOFTHELOWERLIMB;FEMORALTRIANGLE;SUBSARTORIALCANAL: DEEPFASCIAOFTHETHIGH o Fascialata:denserandtougherthansuperficialfascia Surroundsallmusclesofthethigh Superficialnervesandveinsareexternaltofascialata(superficial) o Greatsaphenousvein:passestofemoralveinthroughsaphenoushiatusinfascialata Falciformmarginonlateraledgeofsaphenoushiatus Tributariesnearsaphenousopening:Superficialcircumflexiliacv,superficial epigastricv,superficialexternalpudendalv,accessorysaphenousvv ILIOTIBIALTRACT o Thickeningoffascialataonlateralsideofthigh o ExtendsfromIliumtoatubercleonthelateralsideofuppertibia(Gerdystubercle) DEEPFASCIAOFLEG o Cruralfascia:distalextensionoffascialata Surroundsallmusclesoftheleg o Greatsaphenousvein:temporarilypassesposteriortokneebeforepassinganterior againdowntheleg;receivesdrainagefrommedialpartofdorsalvenousarchoffoot o Smallsaphenousvein:posterior,superficialveinoflegthatpiercescruralfasciatodrain intopoplitealvein;receivesdrainagefromlateralpartofdorsalvenousarchoffoot o Suralnerve:accompaniessmallsaphenousveinatthelowerpart o Retinaculaofankle:Cruralfasciathickensattheankletoformthesuperiorandinferior extensorretinacula(fordorsiflexion)andtheflexorretinaculum(medial;forplantar flexion) LYMPHATICSOFLOWERLIMB o SuperficialinguinallymphnodesaresuperficialtothefascialataandarrangedinaT withacrossbarparalleltotheinguinalligament Lymphaticsaccompanythegreatsaphenousveintotheverticalsetofnodes Lymphaticsfromthelowerabdominalwall,externalgenitaliaandgluteal regiondrainmainlytothehorizontalnodes o Deepinguinallymphnodesreceivefromsuperficialnodes Deepinguinalnodes=>externaliliacnodes=>lumbar(paraaortic)nodes=> lumbarlymphtrunks CUTANEOUSNERVES o THIGH AnteriorThigh:lumbarplexus=>lateralfemoralcutaneousn,anteriorfemoral cutaneousn MedialThigh:lumbarplexus=>cutaneousbranchesofobturatorn PosteriorThigh:Sacralplexus=>posteriorfemoralcutaneousn o LEG Cutaneousbranchesofsuperficialfibularn,cutaneousbranchesofdeepfibular n,lateralsuraln,suraln

Skeletalcomponents:scaphoid,lunate,triquetral,pisiform,trapezium,trapezoid, capitate,hamate o Synovialcapsule:synovialplanejointsbetweenindividualcarpalbones=midcarpal jointsbetweenrows Sharedsynovialcavitycommunicationw/numerousintercarpalligaments st o Carpometacarpaljoints=synovialplanejointsEXCEPTthumb(saddlejointbetween1 metacarpalandtrapezium) METACARPOPHALANGEALJOINTS o Skeletalcomponents:metacarpals,proximalphalanges o Ligaments:palmar,dorsal,collateral,&deeptransversemetacarpophalangealligaments o Interphalangealligaments:palmar,dorsal,collateralinterphalangealligaments o

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(preparationfordivethrough theadductorhiatus) o FemoralNerve:fromlumbarplexus;providesmotortoanteriorcompartmentofthigh muscles;sensorytoanteriorthigh(anteriorcutaneousbranches)andmedialthigh (medialcutaneousbranchesofsaphenousn,infrapatellarbranchofsaphenousn) o FemoralArtery:extensionoftheexternaliliacartery;startsinfemoraltriangleand passesthroughsubsartorialcanal;passesthroughtheadductorhiatusofadductor magnusandbecomespoplitealartery deepfemoralartery(profundafemoris)branchesinferiortoheadoffemur lateralcircumflexartery(passesbetweeniliacusandrectusfemoris) medialcircumflexartery(passesbetweenpsoasandpectineus) 4perforatingbranchesaroundposteriorhumerus FEMORALSHEATH o Continuationoftransversalisfasciaandiliacusfasciafrompelvis o Containsfemoralartery,vein,lymphatics(NOTfemoralnerve) o 3compartments:Femoralartery(lateral),femoralvein(central),femoralcanal(medial) SUBSARTORIALCANAL: o Deeptothesartoriusmuscle,endsatadductorhiatus o Contents:femoralartery,femoralvein,nervetovastusmedialis,saphenousnerve o Relationships(anteriortoposterior):femoralartery,femoralvein,deepfemoralartery, deepfemoralvein;ONLYfemoralarteryandfemoralveinentersubsartorialcanal

GLUTEALREGION: RegionbetweenIliaccrestandglutealfoldofthebuttock Skeletalcomponents: o Sacrum,coccyx,hipbone(Ilium,ischium,pubis,withacetabulum),femur o Hipbone: Ilium(superiorportion,articulateswithsacrum)=iliaccrest,iliactubercle, anteriorsuperioriliacspine,anteriorinferioriliacspine,posteriorsuperioriliac spine,posteriorinferioriliacspine,greatersciaticnotch Ischium(posteroinferiorportion)=ischialspine,lessersciaticnotch,ischial tuberosity,ramus Pubis(anteroinferiorportion)=obturatorforamen(coveredbyobturator membrane),superiorramus,inferiorramus o Femur:head,neck,greatertrochanter(lateral),lessertrochanter(posteriomedial), intertrochantericcrest(posterior),intertrochantericline(anterior),glutealtuberosity SacroIliacjoint:Strongposterior&interosseoussacroiliacligaments,thinanteriorsacroiliac ligament,sacrotuberousligament,sacrospinousligament o Sacrotuberous(superficial)andsacrospinous(deep)ligamentsformgreatersciatic foramen(superiorly)andlessersciaticforamen(inferiorly) HIPJOINT o Synovial,multiaxial,ballandsocketjointdesignedforsupport Acetabulumofhipbonearticulateswithheadoffemur Acetabularlabrum:attachestomarginsofacetabulum,deepensandincreases jointstability,continuousw/transverseligamentofacetabulum

Ligamentsofhipjoint:roundligamentofheadoffemur,transverseligamentof acetabulum,iliofemoralligament(ant.),pubofemoralligament(ant.),ischiofemoral ligament(post.) o Bursae:subtendonosisiliacbursa(deeptopsoasmajor),ischioglutalbursa(inferiorto ischialtuberosity),deeptrochantericbursa(betweengreatertrochanterandgluteus max),superficialtrochantericbursa(betweengreatertrochanterandsubcutaneous tissue o Nervesupply:femoralnerve(L2,3,4),obturatornerve(L2,3,4),accessoryobturator nerve(L3,4),sciaticnerve(L4,5;S1,2,3),nervetoquadratusfemoris(L4,5;S1) o Bloodsupply:obturatorartery,medial&lateralcircumflexfemoralarteries(with retinaculararteriesbranchingoff),superior&inferiorglutealarteries GREATERSCIATICFORAMEN o Contents Superiortopiriformis:superiorglutealnerve,superiorglutealvessels Inferiortopiroformis:sciaticnerve,inferiorglutealnerve,inferiorgluteal vessels,nervetoobturatorinternus,nervetoquadratusfemoris,posterior femoralcutaneousnerve,internalpudendalvessels,pudendalnerve LESSERSCIATICFORAMEN o Contents Onlystructureexiting=obturatorinternusmuscle Entering(afterexitinggreatersciaticforamen)=Pudendalnerve,Internal pudendalvessels,Nervetoobturatorinternus;PINstructures MUSCLESOFTHEGLUTEALREGION(CHART) o
Outersurfaceofilium, posteriorsurfaceofsacrum andcoccyx,and sacrotuberousligament Outersurfaceofilium, betweenposterior& anteriorgluteallines Outersurfaceofilium, betweenanteriorand inferiorgluteallines Outeredgeofiliaccrest, fromanteriorsuperioriliac spinetoiliactubercle Anterolateralborderof sacrum,passesthrough greatersciaticforamen Spineofischium Iliotibialtractandgluteal tuberosityoffemur Extendsandlaterallyrotateship joint,extendstrunkathip, contributestoextensionofknee Powerfulabductorofthethighat thehipjoint,medialrotationof thigh,preventsdownwardtiltof pelviscontralaterally Abductorofthighathip,medial rotationofthigh,prevents downwardtiltofpelvis contralaterally Contributestokneeextension, assistedbygluteusmaximusvia theiliotibialtract Lateralrotatorofthighathip Inferiorgluteal nerve

Gluteusmaximus

Gluteusmedius

Uppersurfaceofgreater trochanter

Superior glutealnerve

Gluteusminimus

Anterioranduppersurface ofgreatertrochanter

Superior glutealnerve

Tensorfascia latae Piriformis

Anterioraspectofiliotibial tract Uppermedialaspectof greatertrochanter w/tendonofobturator internustomedialaspect ofuppertrochanter Medialaspectofupper trochanterwithboth gemelli w/tendonofobturator internusinmedialaspect ofuppertrochanter Quadratetubercle,on intertrocantericcrestof femur

Superior glutealnerve Anteriorrami ofS1andS2 spinalnerves Nerveofthe obturator internus Nerveofthe obturator internus Nerveofthe quadratus femoris Nerveofthe quadratus femoris

Superior gemellus Obturator internus Inferiorgemellus

Lateralrotatorofthighathip

Pelvicsurfaceofobturator membraneandsurrounding bonysurfaces Uppermarginofischial tuberosity Lateralborderoftheischial tuberosity

Lateralrotatorofthighathip

Lateralrotatorofthighathip

Quadratus femoris

Lateralrotatorofthighathip

Rulesoftheglutealreagionmuscles: o AllthegluteusmusclesareinnervatedbythesuperiorglutealnerveEXCEPTgluteus maximus(inferiorglutealnerve) NERVESINTHEPELVIS o Sacralplexus(L45;S14)

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(dorsalramiL13),middleclunealnerves (dorsalramiofS13) Upperlateral:Lateralcutaneousbranchofiliohypogastric(ventralramusofL1), ventralramusofT12 Lowerlateral:Lateralcutaneousnervesofthethigh(ventralramiofL23) Lowermedial:posteriorcutaneousnervesofthethigh(inferiorclunealnerves =ventralramiofS13) GLUTEALREGIONARTERIES o Commoniliacartery=>externalandinternaliliacarteries Internaliliacartery=>anteriorandposteriordivisions Posteriordivision=>superiorglutealartery Anteriordivision=>inferiorglutealartery,internalpudendalartery o Cruciateanastomosis Inferiorglutealartery,lateralcircumflexfemoralartery,medialcircumflex femoralartery,firstperforatingartery

THIGHANDPOPLITEALFOSSA MUSCLESOFANTERIORCOMPARTMENT
Sartorius Iliacus Psoas(major& minor) Pectineus Rectusfemoris (quadriceps) Anteriorsuperioriliacspine Iliacfossa Transverseprocesses& lateralbodiesofT12L5 vertebrae Superiorramusofpubis Straightheadanterior inferioriliacspine;reflected headiliumabove acetabulum Baseofgreatertrochanter, intertrochantericlineand lineaaspera Intertrochantericlineand lineaaspera Anteriorandlateralsurface offemur (lowerfibersofvastus intermedius) Uppermedialsurfaceoftibia Lessertrochanter(common tendonwithpsoas) Lessertrochanter(common tendonwiththeiliacus) Belowlessertrochanterat thelineaaspera Commonquadricepstendon onsuperiorandlateral aspectsofthepatella Commonquadricepstendon Flexesandweaklyabducts, laterallyrotatesthethigh Flexesthethighand stabilizesthehipjoint Flexesthethighand stabilizesthehipjoint Flexesandadductsthe thighatthehip Flexthethigh,extendthe leg Femoralnerve Femoralnerve Ventralramiof L1L3 Femoralnerve Femoralnerve

Vastuslateralis (quadriceps) Vastusmedialis (quadriceps) Vastus intermedius (quadriceps) (articularis genus)

Flexthethigh,extendthe leg Flexthethigh,extendthe leg Flexthethigh,extendthe leg Pullsynovialmembrane superiorlytoprevent compressionbetween femurandpatella

Femoralnerve

Commonquadricepstendon Commonquadricepstendon

Femoralnerve Femoralnerve

Commonquadricepstendon, synovialmembraneofthe knee

Femoralnerve

Anteriorcompartmentrules: o AllmusclesareinnervatedbythefemoralnerveEXCEPTthepsoas(L1L3ventralrami) o Allmusclesservetoflexthethighatthehip FEMORALNERVE o Branchesintoanteriorandposteriorbranchesuponenteringthethigh

Anteriordivision:medialcutaneousnerveofthigh,intermediatecutaneousnerveof thigh,sartoriusbranch,pectineusbranch o Posteriordivision:saphenousnerve,quadricepsbranch FEMORALARTERY o =>profundafemoris:offofprofundafemorisarethelateralcircumflexfemoralartery, medialcircumflexfemoralartery,4perforatingbranches o =>descendinggenicular o =>poplitealartery(uponpassingthroughadductorhiatus) =>5geniculararteriesofkneearterialanastomosis =>anteriorandposteriortibialarteries o Venoustributariestothefemoralveincorrespondtothearterialbranches MUSCLESOFMEDIALCOMPARTMENT o
Frontofthepubicbone Inferiorpubicramus Middle1/3oflineaaspera Upperpartoflineaaspera aboveinsertionofadductor longus adductorposteriorsurfaceof shaftoffemor,lineaaspera andmedialcondyle;hamstring tendontoadductortubercle Upperpartofmedialsurface oftibia Passesbelow,thenbehindhip jointtomedialsurfaceof greatertrochanter Adductsandlaterally rotatesthethigh Adductsandassistsin lateralrotationofthigh Adductsandweakly extendsthethigh Obturatornerve Obturatornerve

Adductorlongus Adductorbrevis

Adductor magnus

Inferiorramus

Obturatornerve, partiallysciatic nerve Obturatornerve

Gracilis

Ischiopubicramus

Obturator externus

Outersurfaceof obturatormembrane andischiopubicrami

Adductsthigh,flexesand mediallyrotatesthelegat theknee Laterallyrotatesthethigh

Obturatornerve

Medialcompartmentrules: o AllmusclesareinnervatedbytheobturatornerveEXCEPToftheadductormagnus o AllmusclesservetoadductthethighatthehipEXCEPTobturatorexternus OBTURATORNERVE o Entersmedialthighviaobturatorcanal o Anteriordivision:deeptopectineus,anteriortoadductorbrevis Supplies:gracilis,adductorbrevis,adductorlongus,skintomedialthigh o Posteriordivision:betweenadductorbrevisandadductormagnus Supplies:obturatorexternus,adductormagnus(nothamstring),adductor brevis,skintomedialknee MEDIALCOMPARTMENTBLOODSUPPLY o theprofundafemorisarteryprovidesmusclebranchestotheadductors MUSCLESOFTHEPOSTERIORCOMPARTMENT
Longheadischial tuberosity;shorthead lineaasperaandlateral supracondylarridge Ischialtuberosity Headsuniteabovekneeand commontendoninsertsinto headoffibula Extendsthethigh(long head),flexesandlaterally rotatesthelegattheknee Sciaticnerve (tibialnerve; Shorthead= common fibularnerve) Sciaticnerve (tibialnerve) Sciaticnerve (tibialnerve)

Bicepsfemoris

Semimembranosus

Semitendinosis

Ischialtuberosity

Posteriorportionofmedial condyleoftibia,oblique poplitealligament Medialsurfaceoftheshaftof thetibia,posteriortoinsertion ofsartoriusandgracilis

Extendsthigh,flexesand mediallyrotatesthelegat theknee Extendsthigh,flexesand mediallyrotatesthelegat theknee

Posteriorcompartmentrules: o Allmusclesareinnervatedbysciaticnerve o Allbloodsupplycomesfrom4perforatingbranchesoffofprofundafemorisartery SCIATICNERVE o Runsdeeptolongheadofbicepsfemoris,superficialtoadductormagnus o Dividesmidthighintotibialnerveandcommonfibularnerve

LEGANDANKLE Skeletalcomponents: o Baseoffemur,tibia,fibula o Boneofthefeet:Talus,calcaneus,navicular,cuboid,3cuneiforms,5metatarsals,14 phalanges o Tibia:medialweightbearingboneoftheleg,proximallarticulatesw/condylesofthe femurandtheheadofthefibula,distallyarticulatesw/talusandthebaseofthefibula, containsmedialmalleolus o Fibula:lateralbonethatdoesnottransmitbodyweight,headandneckproximally, lateralmalleolusdistally,articulatesmediallywiththetalus COMPARTMENTS

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 KNEEJOINT o Lateralknee:Iliotibialtract,headoffibula,bicepsfemoristendon,commonfibular nerve o Medialknee:Pesanserinus:footofthegoose=tendonsofsartorius,gracilis, semitendinosus o Synovialcondylarjointbetweenmedialandlateralfemoralandtibialcondyles;also glidingjointbetweenpatellaandpatellarsurfaceoffemur Medialcondylararticulationislargerandovalshaped Lateralcondylararticulationissmallerandcircularshaped o Menisci: Semilunarfibrocartilaginouspads;peripheralborderisthickerandattachedto thecapsule;innerborderisthinner,creatingafreeedge Servetocompensateforincongruitybetweenfemurandtibia(createasortof cuppingforjointstability o Ligamentsofknee:obliquepoplitealligament,arcuatepoplitealligament,lateral (fibular)collateralligament(notattachedtolateralmeniscus),medial(tibial)collateral ligament(attachedtomedialmeniscus) AnteriorCruciateLigament(ACL):fromposterolateralcondyleoffemurto anteriorintercondylarareaoftibia PosteriorCruciateLigament(PCL):fromanteromedialcondyleoffemurto posteriorintercondylarareaoftibia o Bursaeoftheknee: Anterior:suprapatellar(synovial)bursa(w/articularisgenusfibersofvastus intermedius);prepatellarbursa=betweenskinandpatella(subcutaneous), subcutaneousinfrapatellarbursa=distaltopatella;deepinfrapatellarbursa= deeptoligamentumpatella Posterior:bursaefounddeeptogastrocnemiusheads,bicepsfemoristendon, lateralcollateralligament,popliteusmuscle,semimembranosustendon o Bloodsupplyofkneejoint:anastomosisinvolvingdescendingbranchoflateralfemoral circumflexartery,genicularbranchesofpoplitealartery,descendinggenicularartery (fromfemoralartery),recurrentbrancesfromanteriortibialartery o Nervesupplytokneejoint:femoralnerve(L2,3,4),obturatornerve(L2,3,4),tibialnerve o

Anteriorandposteriorintermuscularseptaedividelegintoanterior,lateraland posteriorcompartments;deeptransverseseptumdividestheposteriorcompartment intodeepandsuperficial ANTERIORCOMPARTMENTMUSCLES: o

Upperhalfoflateral surfaceofthetibia& interosseusmembrane Medialcuneiformandbaseof thefirstmetatarsalbone Extendsthefootatthe ankle(dorsiflexion), inversionofthefoot, supportoflongitudinal arch Extendsthetoes, contributestoextensionof footatankle Extendsthebigtoe, contributestoextensionof thefootatankle,inversion ofthefoot Extendsthefootatthe ankle,assistsineversionof thefoot Deepfibular nerve

Tibialisanterior

Extensor digitorum longus Extensor hallucislongus

Upperanteriorpartofthe fibulaandinterosseus membrane Middlehalfoftheanterior surfaceofthefibulaand interosseusmembrane Lowerthirdoftheanterior surfaceofthefibula

Baseofthemiddlephalanx nd anddistalphalanxofthe2 to th 5 digits Baseofthedistalphalanxof thegreattoe

Deepfibular nerve Deepfibular nerve

Fibularistertius

Dorsalaspectofthebaseof th the5 metatarsalbone

Deepfibular nerve

Fibularis longus Fibularis brevis

Rulesoftheanteriorcompartmentmuscles: o Allmusclesoftheanteriorcompartmentareinnervatedbythedeepfibularnerve o Allmusclesoftheanteriorcompartmentcontributetodorsiflexion o Allmusclesoftheanteriorcompartmentpassunderboththesuperiorandinferior extensorretinacula Anteriorcompartmentbloodsupply: o Anteriortibialartery(branchofpopliteal),deeptotibialisanterior o Foundbetweentwomalleolionthedoralankleandcontinuesasdorsalispedison dorsumoffoot Branchesareanteriortibialrecurrentartery,anteriormedialmalleolarartery, anteriorlateralmalleolarartery DEEPFIBULARNERVE o Branchofcommonfibularnerve o Enterstheanteriorcompartmentbypiercingtheanteriorintermuscularseptum LATERALCOMPARTMENTMUSCLES:
Upper2/3oflateral surfaceoffibula Lower1/3oflateral surfaceoffibula Inferiorsurfaceofthe medialcuneiform& st baseof1 metatarsal Baseofthe5 metatarsal
th

Flexesfootatankle(plantarflexion)and evertsthefoot,supportslateral longitudinalandtransversearchs Flexesthefoot(plantarflexion)andeverts thefoot

Superficialfibular nerve Superficialfibular nerve

Rulesofthelateralcompartmentmuscles: o Allmusclesoflateralcompartmentareinnervatedbysuperficialfibularnerve o Allmusclesoflateralcompartmentaresuppliedbybranchesofthefibularartery o Allmusclesofthelateralcompartmentpassthroughfibularretinaculuminferiorto lateralmalleolus SUPERFICIALFIBULARNERVE o Branchofcommonfibularnerve o Emergesbetweenfibularislongusandbrevisandbecomescutaneousinlower anterolateralaspectofleg o Dividesintomedialandintermediatedorsalcutaneousnerves POSTERIORCOMPARTMENTMUSCLES: o Dividedbydeeptransverseintermuscularseptumintosuperficialanddeep o SUPERFICIALMUSCLES:
Lateralaspectoflateralcondyle offemur,medialheadfrom poplitealsurfaceoffemurabove medialcondyle 2headsfusetogether withtendocalcaneusto insertoncalcaneum Flexesthefoot(plantarflexion) attheankle,contributesto flexionattheknee Tibialnerve

Gastrocnemius

Plantaris Soleus

Lateralsupracondylarridgeof femur Soleallineoftibia,upperof thefibula

Medialsidew/tendo calcaneus Anteriorpartoftendo calcaneus

Weakflexoroffootatankle (plantarflexion) w/gastrocnemius,powerful flexoroffootatankle(plantar flexion) Medialrotatorofthetibiaonthe femur,servestounlockthe knee Flexesdistalphalanxofbigtoe, flexesthefootatankle,supports mediallongitudinalarches Flexesthefootattheankle, supportsbothmedialandlateral longitudinalarches Flexesthefootattheankle, invertsthefoot,supportsmedial longitudinalarch

Tibialnerve Tibialnerve

o
Popliteus

DEEPMUSCLES:
Lateralsurfaceofthelateral condyleoffemur,w/ attachmentonlateralmeniscus Middlehalfofposteriorsurface offibula Middlehalfofposteriorsurface oftibia Middleposteriorsurfacesof shaftoftibiaandfibula& interosseusmembrane Upperposterior surfaceofthetibia Baseofthedistal phalanxofbigtoe Baseofdistal nd th phalangesof2 to5 digits Tuberosityof navicularand neighboringbones Tibialnerve

Flexorhallucis longus Flexor digitorum longus Tibialis posterior

Tibialnerve

Tibialnerve

Tibialnerve

Rulesoftheposteriorcompartmentmuscles: o Allofthemusclesoftheposteriorcomparmentareinnervatedbythetibialnerve o Allofthemusclesoftheposteriorcompartmentcontributetoplantarflexionofthefoot o Allofthesuperficialmusclesinsertonthecalcaneusviathetendocalcaneus o Allofthedeepmusclespassthroughtheflexorretinaculuminferiortothemedial malleolus Bloodsupplytoposteriorcompartment: o Posteriortibialartery=>terminalbranchofthepoplitealartery o Passesmediallyintheposteriorcompartment,deeptogastrocnemius,soleusanddeep transverseseptum;canbepalpatedbetweenmedialmalleolusandtendocalcaneus o Dividesintomedialandlateralplantararteriesinthefoot TIBIALNERVE o Descendswithposteriortibialvessels,deeptogastrocnemiusandsoleus o Dividesdistallyintomedialandlateralplantarnerves ANKLE o Trueanklejoint:uniaxialsynovialjointbetweentalusandlowerendoftibia&fibula o SuperiorandinferiorEXTENSORRETINACULA=thickeningofcruralfasciaanteriorly Containtendonsoftibialisanterior,extensorhallucislongus,extensor digitorumlongus,fibularistertius,anteriortibialartery,deepfibularnerve o FLEXORRETINACULUM=thickeningofcruralfasciainferiortomedialmalleolus Containstendonsoftibialisposterior,flexordigitorumlongus,flexorhallucis longus,posteriortibialartery,tibialnerve o FIBULARRETINACULUM=thickeningofcruralfasciainferiortolateralmalleolus Containstendonsoffibularislongusandfibularisbrevis Suralnerveandsmallsaphenousveinpasssuperficialtofibularretinaculum o Ligamentsoftheankle: Medial(deltoid)ligament:tibiocalcaneal,tibionavicular,anteriortibiotalar, posteriortibiotalar Lateralligament:anteriortalofibular,posteriortalofibular,calcaneofibular

FOOT

Skeletalcomponents: o Attachedtoankleattibiotalarjoint:tibia,fibula,talus o 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/cuboidandtaluscalcaneus/navicular Jointatwhichinversionandeversionoccur Talocalcaneonavicularjointligaments:talonavicularligament,bifurcate ligament,plantarcalcaneonavicularligament(springligament) Calcaneocuboidjointligaments:bifurcateligament,plantarcalcaneocuboid ligament(shortplantarligament) o Subtalarjoint:talus/calcaneus Jointatwhichglidingoccursforlimitedrotationofthefoot Plantaraponeurosis: o Thickeneddeepplantarfascia,attachedatcalcanealtuberositywithdigitalbandsthat extendintotoes;attachtobonesligamentsanddermis o Transversemetatarsalligamentsbetweenheadsofmetatarsalbones o Supportslongitudinalarches INTRINSICMUSCLESOFFOOT:
Superolateralsurfaceof calcaneus 4tendonstoproximal phalanxofgreattoe, extensorhoodsof3 medialtoes Medialsideofbaseof proximalphalanxofgreat toe Plantarsurfaceofmiddle phalangesoflateral4toes Lateralsideofbaseof proximalphalanxoflittle toe Lateralsideofflexor digitorumlongustendon Medialsideofextensor hoodsof4lateraltoes Aidsinextensionof4toeson medialsideoffoot Branchofdeep fibularnerve

Extensor digitorumbrevis (note:onlymuscle ondorsum) Adductorhallucis

Calcanealtuberosity

Abductsandflexesgreattoe atmetatarsophalangealjoint Flexeslateraltoesatproximal interphalangealjoints Abductslittletoeat metatarsophalangealjoint Assistsflexordigitorum longusinflexionoflateral toes Flexeslateraltoesat metatarsophalangealjoints, extendstoesat interphalangealjoints Flexesgreattoeat metatarsophalangealjoint Adductsgreattoeat metatarsophalangealjoint

Medialplantar nerve Medialplantar nerve Lateralplantar nerve Lateralplantar nerve Medialmedial plantarnerve; lateral3lateral plantarnerve Medialplantar nerve Lateralplantar nerve

Flexordigitorum brevis Abductordigiti minimi Quadratus plantae Lumbricals(4)

Calcanealtuberosity Calcanealtuberosity

Fromlateral&medial calcaneus 1 frommedialsideof nd FDLtendonto2 toe; nd rd th 2 ,3 ,4 ,from betweenotherFDL tendons Cuboidandlateral cuneiform,tibialis posteriortendon Transverseheads ligamentsatMTPjoints oflateral3toes;oblique headbaseof metatarsals2,3,4,from fibularislongustendon Baseofmetatarsal5and fibularislongustendon Sidesofadjacent metatarsals
st

Flexorhallucis brevis Adductorhallucis

Bothsidesofproximal phalanxofgreattoe (bifurcationofmuscle) Lateralsideofbaseof proximalphalanxofgreat toe

Flexordigiti minimibrevis Dorsalinterossei

Lateralsideofbaseof proximalphalanxoflittle toe Extensorhoodsoftoes 2,3,4

Flexeslittletoeat metatarsophalangealjoint Abducttoesat metatarsophalangealjoints; resistextensionatMTP, flexionatIPjoints Adductstoes3,4,5atMTP joints;resistsextensionat MTP,flexionatIPjoints

Lateralplantar nerve Lateralplantar st nerve,1 also fromdeep plantarnerve Lateralplantar nerve

Plantarinterossei

Medialsidesof metatarsals3,4,5

Extensorhoodsoftoes 3,4,5

ARTERIALSUPPLYTOFOOT o Plantarside:

Medialplantarartery:betweenabductorhallucisandflexordigitorumbrevis, alongmedialsideofsoletomedialsideofgreattoe Lateralplantarartery:deeptoabductorhallucis,betweenflexordigitorum brevisandquadratusplantae Archesmediallyatbaseofmetatarsal5andformsdeepplantararch Joinsterminalbranchofdorsalispedisbetweenmetatarsals1and2 Deepplantararch: Digitalbranchtosmalltoe;4plantarmetatarsalarteriesw/digital branches;3perforatingarteriesanastamosewithdorsalarteries o Dorsalside: Dorsalispedis:continuationofanteriortibialartery(namechangeatankle) Betweentendonsofextensorhallucislongusandextensordigitorum longus Arcuatebranchatbasesofmetatarsals st o Dorsalmetatarsalarteries,dorsaldigitalarteries,1 dorsal metatarsalartery st Passestoplantarsidebetween2headsof1 dorsalinterosseustojoin deepplantararch VENOUSDRAINAGEOFFOOT o Deepveinsaccompanyarteries Plantarmetatarsalveins=>deepplantarveinsatarterialarch=>lateralplantar vein=>posteriortibialvein o Dorsalvenousarchdrainssuperficialveins Originofgreatsaphenousveinanteriortomedialmalleolus Originofsmallsaphenousveinposteriortolateralmalleolus NERVESUPPLYTOFOOT o Fromtibialnerve:Medialplantarnerve,Lateralplantarnerve Medialplantarnerve:anterior2/3ofsole,medial3toes Motortoabducturhallucis,flexordigitorumbrevis,flexorhallucis st brevis,1 lumbrical Lateralplantarnerve:lateralanterior2/3ofsole,lateral1toes Motortoabductordigitiminimi,flexordigitiminimibrevis,quadratus plantae,lateral3lumbricals,dorsalandplantarinterossei o Dorsalnervesupply Superficialfibularnervenomotorsupplyinthefoot SensorytomajorityofdorsumoffootandtoesEXCEPT: o Medialankle&justinferior,lateralsideoffootandlittletoe, nd webspacebetweengreattoeand2 toe Deepfibularnerve nd Sensorytowebspacebetweengreattoeand2 toe Motortoextensordigitorumbrevis,lateral2dorsalinterossei