A&P - MSK Anatomy PDF

Welcome to A&P – MSK Anatomy Nursing (HTHSCI 1H06) Dr. Danielle Brewer-Deluce, PhD Health Sciences & iBioMed Asst. Professor (HTHSCI 2F03) Dept of Pathology & Molecular Medicine Engineering (HTHSCI 2L03)...

Welcome to A&P – MSK Anatomy Nursing (HTHSCI 1H06) Dr. Danielle Brewer-Deluce, PhD Health Sciences & iBioMed Asst. Professor (HTHSCI 2F03) Dept of Pathology & Molecular Medicine Engineering (HTHSCI 2L03) Education Program in Anatomy Midwifery (HTHSCI 1D06 [email protected]  FOOT DROP Hip Dislocation Discuss why this would be the case! Foot Drop Characterized by an inability to dorsiflex and reduced eversion Foot hangs, plantar flexed and slightly inverted when raised off of the ground Posterior dislocation in High steps are required for hip flexion walking and the foot “clops” on the ground femur sciatic nerve Shank, Ankle, Foot A quick recap Label the image! Body of Sternum External Intercostals Internal Intercostals Quadratus Lumborum Rectus Abdominus Internal Obliques Inguinal Ligament Ileum Acetabulum Pubis Os coxae Ischium Knee Joint Summary 5 Ligaments: MCL, LCL, PCL, ACL, Patellar 4 Bones: Femur, Tibia, Fibula, Patella 3 Joints: Femoropatellar, Femorotibial, Superior Tibiofibular 2 Actions: Flexion/Extension + Rotation 1 intraarticular structure type: Menisci Considerations for stability/mobility which joint is highlighted? Posterior Anterior which ligament is highlighted? Posterior Anterior Learning Outcomes By the end of this lesson you will be able to… Identify bones and key bony landmarks of shank, ankle and foot Identify muscles residing in the shank along with the joints they cross their primary actions and innervation Compare/contrast analogous regions/muscles/joints with upper limb counterparts reflecting on actions, size, mobility and stability Shank (leg) Thigh Nerves Femoral Obturator Sciatic (tibial branch) Fibular nerve  Fibular N Tibial N Deep Branch Superficial Branch Shank Nerves lateral malleolus  Muscles Crossing the Knee Anterior Compartment: Medial Compartment: Rectus Femoris Gracilis Vastus Lateralis Vastus Intermedius Vastus Medialis Shank: Sartorius Gastrocnemeii Plantaris Posterior Compartment: Other: Biceps Femoris Popliteus Semi-Membranosus Semi-Tendinosus  Tibia + Fibula Supination /pronation do NOT happen in the shank anterior view posterior view Ankle Movements Shank Compartments anterior Crural fascia Anterior (dorsiflexors) Deep Fibular N Lateral (everters) Superficial Fibular N Deep Posterior (plantar flexors) Tibial N Superficial Posterior (plantar flexors) posterior Tibial N R  Anterior (dorsiflexors) Deep Fibular N anterior Lateral (everters) Superficial Fibular N Deep Posterior (plantar flexors) Tibial N Superficial Posterior posterior (plantar flexors) Tibial N Anterior Compartment Deep Fibular N Ankle Dorsiflexion Lateral Compartment Superficial Fibular N Ankle Eversion Support plantar arches Base of the 5th metatarsal Superficial Posterior * Compartment * ‡ Tibial N * Plantar Flexion *knee flexion ‡ unlock knee Triceps Surae = Gastrocs + Soleus Deep Posterior * Compartment ‡ Tibial N Post. ‡ Plantar Flexion FDL Tib A Post. Tib N *Inversion TP ‡ Digit Flexion FHL Gateway to the Foot “Tom, Dick, and not Harry”  Muscle Summary Anterior Deep Posterior Tibialis Anterior Tibialis Posterior Extensor Digitorum Flexor Digitorum Longus Longus Flexor Hallucis Longus Extensor Hallucis Longus FL Superficial Posterior Lateral Gastrocs Fibularis Longus Soleus FB Fibularis Brevis Plantaris Popliteus Calcaneal Tendon Shank Muscles Acting on the Foot Flexors Extensors Tibialis Tibialis Anterior Tibialis Posterior Digitorum Flexor Digitorum Longus Extensor Digitorum Longus Hallucis Flexor Hallucis Longus Extensor Hallucis Longus Lat + Med Gastrocnemii FL Calcaneal Plantaris --- Soleus FB Fibularis Brevis Fibularis --- Fibularis Longus Calcaneal Tendon  Attachment Summary Extensor Hallucis Extensor Digitorum Flexor Digitorum Longus Longus Longus Flexor Hallucis Longus Fibularis Fibularis Brevis Longus Tibialis Anterior Tibialis Posterior Tibialis Digitorum Hallicus Fibularis Calcaneal Calcaneal  FOOT DROP Hip Dislocation Foot Drop Characterized by an inability to dorsiflex and reduced eversion Foot hangs, plantar flexed and slightly inverted when raised off of the ground Why? High steps are required for - Compromised fibular N walking and the foot “clops” on - Muscles of anterior/lateral the ground compartments can’t dorsiflex foot - Flexors are unopposed To Summarize… When considering function, think about how joints are crossed! Muscles of the shank are innervated by: Anterior: Deep Fibular N Lateral: Superficial Fibular N Posterior: Tibial N Retinacula are thick fibrous bands which hold tendons in place when the cross the ankle (or wrist!)  Quick Question! Which of the following muscles everts the foot? Can you demonstrate this action? A. Tibialis Anterior B. Fibularis Longus C. Lateral Gastrocnemii D. Flexor Hallucis Longus  Quick Question! Damage to the tibial nerve at the level of piriformis would result in difficulty with which of the following actions? Check all that apply: ❑ hip extension ❑ hip adduction ❑ knee unlocking ❑ knee extension ❑ ankle dorsiflexion ❑ ankle inversion  Superficial Anterior Posterior Deep Posterior Lateral Bonus Practice Extensor Digitorum Longus Extensor Digitorum Longus Extensor Hallicus Longus Flexor Hallicus Longus Tibialis Posterior Fibularis Longus Tibialis Anterior Fibularis Brevis Gastrocnemii Plantaris Soleus NERVES: ❑ Tibial N ❑ Fibular N Dorsiflexion Plantarflexion Inversion Eversion Toe Flexion Toe Extension Big Toe Flexion Big Toe Extension Ankle + Foot  I II III IV V Tarsal Bones Phalanges (distal, middle, proximal) Metatarsals lateral view Cuneiforms (medial, intermediate, lateral) Navicular Cuboid medial view Talus Calcaneus  Surface Anatomy anterior view posterior view  Distal Tibiofibular Joint Joints of the Ankle Talocrural Joint Subtalar Joint  Interosseous Membrane Distal Tibiofibular Joint Articulation between tibia and fibula Tight Tibiofibular Syndesmosis Anterior + Posterior Tibiofibular Ligaments Fibula Tibia Anterior Posterior Tibiofibular Tibiofibular Ankle Mortise Distal Tibiofibular Joint High Ankle Sprain @ Distal Tibiofibular Jt Tearing of anterior/posterior tib-fib lig May occur alongside fibular fracture Pain upon dorsiflexion Due to talus spreading the ankle mortise Typically caused by lateral rotation of foot Crural Joint *talus is wider anteriorly Articulation between Ankle Mortise (tibia + fibula) and Talus Permits dorsi- and plantar flexion  Crural Joint - Ligaments Attach fibula + tibia to calcaneus to calcaneus Deltoid Posterior talofibular Anterior talofibular ligament Calcaneofibular  Ankle Inversion Sprain Anterior talofibular ligament Posterior talofibular ligament calcaneofibular ligament medial talus lateral Lateral view Posterior view Subtalar Joint Articulation between the Talus + Calcaneus + Navicular Anterior = talonavicular complex Posterior = talocalcaneal jt Permits: inversion/eversion Subtalar Joint - Ligaments Attach talus to calcaneus on all sides Medial (med, lat, ant, post, between) Talocalcaneal lig Post. Talocalcaneal Ant. Talocalcaneal Lateral Talocalcaneal lig (cervical lig)  Anterior Posterior B A Which of the following is the Talus? E C D Lower Limb Radiology Tutorial – https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466  Anterior Posterior What are these 2 joints called? Which one permits plantar/dorsiflexion? Lower Limb Radiology Tutorial – https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466 Weight distribution iii ii i iv v The foot consists of two metatarsals arches: longitudinal & transverse. transverse arch calcaneus 50% Helps distribute 50% talus weight evenly front to back & side-to-side. calcaneus longitudinal arch Arches + Support Longitudinal + Transverse Supported by 3 structures: Tibialis (peroneus) posterior Fibularis longus Calcaneonavicular lig High vs Low Arches Pes Cavus – “high arches” Pes Planus – “flat feet” Neurologic disease (hereditary motor Common in children – arches develop and sensory neuropathy), Muscular typically by ages 5-6 imbalance, trauma Risk factors: obesity, congenital, repetitive high impact sport, lig laxity To Summarize… 3 primary joints exist at the ankle, each allowing for a different motion Distal tibiofibular: limited movement (syndesmosis) Crural: dorsi/plantar flexion Sub-Talar: ankle inversion/eversion 10 ligaments hold these 3 joints together Anterior/posterior tibiofibular Anterior/posterior talofibular, calcaneofibular & deltoid Interosseous talocalcaneal, medial/lateral/anterior/posterior talocalcaneal Nearly all muscles of the shank cross the ankle, and thus act upon it! There are intrinsic foot muscles, but we aren’t going to talk about them 2 arches (longitudinal + transverse) distribute weight across the foot Thank You & Best Wishes! Dr. Danielle Brewer-Deluce, PhD [email protected] acknowledgements Drs. Helli, Ball, & Scott Drs. Rebalka, Cates, Bayer & Wainman Athena Li Lab TAs & Staff Beth Labonte You!