Notes for Human Anatomy 100.pdf

Human Anatomy 100 Topic 1.1: Terminology and Tissues Week 1: Tue 23/07/24 The Anatomical Position Proximal and Distal Superior and Inferior Arms near sides Proximal - Close to head Superior - Ab...

Human Anatomy 100 Topic 1.1: Terminology and Tissues Week 1: Tue 23/07/24 The Anatomical Position Proximal and Distal Superior and Inferior Arms near sides Proximal - Close to head Superior - Above Palms facing forward Distal - Far Inferior - Below Lateral and Medial Anterior and Posterior Deep and Superficial Lateral - Further away Anterior - front of body Deep - More interior Medial - Closer to the middle Posterior - Back of body Superficial - More exterior Transverse/Horizontal Plane Frontal/Coronal Plane Sagittal Plane Divides into superior Divides into anterior Divides into left and and inferior and posterior right Topic 1.2: Bones Bones Function of bones Bone features 206 bones Support Articular surfaces 15% body weight Storage of Minerals and Lipids Fused by early 20’s Protection Depressions Living, growing tissue Blood Cell Production Openings Collagen (protein) and Leverage calcium (mineral) Foramen opening Joints Classification: Based on structure Classification: Based on motion Bony Synarthosis - no motion Fibrous - don’t allow motion Amphiarthrosis - a little motion Cartilaginous Synovial - movable Diarthosis - most motion Topic 1.3: Joints Features of synovial joints Types of Synovial joints: Can be: Hinge (elbow) Two flat facets facing each other Saddle (carpometacarple jointt A socket with a ball planar (acromioclavicular joint) Convex and concave surface Pivot (Atlantoaxial joint) Any shape Condyloid (metacarpophalangeal joint) Allows motion Ball and socket (hip joint) Function: Prevents friction between the articulating bones of the joint cavity Structure: Two bony surfaces that are encompassed by a fibrous capsule with a synovial lining Synovial fluid: lubricates the two ends of bones. Give nutrition to hyline cartilage Synovial membrane: reabsorbs fluid and remakes fluid and has high blood supply to keep the joint alive Synovial membrane: protect the joints they surround Hyaline cartilage: helps your bones move smoothly past each other in your joints. They are white, very strong, and allows for contact and weight bareing Fibrous membrane: its function is to provide physiological lubricant, the synovial fluid Articular cavity: provide a smooth, lubricated surface for articulation and to facilitate the transmission of loads with a low frictional coefficient Bone Marrow: releases blood cells into the bloodstream when they are mature and when required Spongy bone: to house the bone marrow Compact Bone: provide strength and protection to bones Topic 1.4: Muscles Types of Muscles Cardiac Muscle Regulated by the heart’s pacemaker Involuntary Only in the heart Has its own electrical regulation Smooth Muscle In arteries, digestive and urinary tracts Involuntary Skeletal Muscle Produces skeletal movement Skeletal Muscle Function Maintains posture Pulls on bones to create shapes Can store protein and energy Keeps us warm Guards entrances and exits Skeletal Muscle Features Origin = muscle fibres on a bone (periosteum) cross a joint then form a tendon Usually proximal Insertion = attach skeletal muscles to bones Action = contraction of muscle pulls insertion towards origin Innervation = what nerve gives the muscle its message Muscle Contraction Muscles that perform the intended motions are prime movers/agonists e.g. biceps Muscles performing opposite motions are antagonists. They relax as the prime mover contracts. e.g. triceps  Concentric: muscle gets shorter as it moves the body part Eccentric: muscle allows itself to get longer Isometric: muscle stays the same lengths Iso: same Metric: length Topic 1.5: Nervous system Geographical Layout Central Nervous System (CNS) = Brain and Spinal Cord Peripheral Nervous System (PNS) = Everything else Afferent Neurones - ’sensory’ neurones send impulses to the CNS Efferent Neurones - ‘motor’ signals from the CNS to the PNS SAME Sensory Afferent = to the CNS Motor Efferent = away from CNS to be acted out in muscles, organs, glands Functional Layout Somatic Nervous System Both types of nerves Voluntary functions Muscles told what to do by motor nerve (voluntary skeletal muscle) Autonomic Nervous System Both types of nerves Involuntary E.g. high blood sugar - motor nerve tell pancreas to release insulin to allow sugar into cells Spinal Nerves CNS and PNS Communication methods: Motor or Sensory messages Autonomic or somatic Spinal nerves comes from vertebral column in between every vertebra A pair come out left and right of spinal cord, enter the body, and travel to whatever organs or muscles they are destined for Spinal nerves - come from: cervical (neck) area thoracic (chest) area lumbar (low back) area to and from sacral area through small nerve from coccygeal nerve 31 pairs (left and right)of spinal nerves some mingle (Plexus) and share fibres before heading out body  named by letter and number letter = region of spine cervical = C thoracic = T lumbar = L sacral = S coccygeal = CO cervical (neck), thoracic (chest), lumbar (low back), and sacral (behind pelvis) number = number vertebrae adjacent to nerve as it leaves the spinal cord Combined spinal nerve Motor fibres - Into spine anterior and sensory nerves coming out of spinal nerve into spinal cord posteriorly Anterior ramous - like a bridge Going to all of structures in front of spinal cord Posterior ramous going to structure behind spinal cord e.g. muscles or skin of back Maxillary bone: Pneumatic bone Need to know different components of synovial joints Knee: Sesanoid bone Three types of cartilage Hyaline - usually seen in two ends of the bone Tendon: connect muscle to bone Sac - bursa - located deep in muscle tendon around Ligament: connect bone to bone, catalyse to joint catalyse, one origin to other origin Fascia Exam questions: Three different joints Superficial - located just deep to the skin, loose, soft Fibrous (immobile) - sutural Deep - lines the muscles Cartilaginous (slightly mobile) - Synovial (freely) - has synovial Adipose tissue/fatty tissue cavity Need to know 1. Know the meaning of anatomical terms, where in the body do they apply? ; a. anterior, posterior b. medial, lateral c. deep, superficial d. proximal, distal e. superior, inferior 2. Recognise the anatomical position, describe it in one sentence, put yourself into this position. 3. Be able to describe the different planes of the body; a. coronal or frontal b. sagittal c. transverse or axial or horizontal 4. Describe the three types of muscle, voluntary control? Example of where each is found a. skeletal muscle b. smooth muscle c. cardiac muscle 5. Explain the structure of a synovial joint; be able to label and describe in a dot point the function of; a. bone b. cartilage c. outer joint capsule d. inner synovial membrane lining of joint e. ligament f. synovial fluid 6. Name the different shapes that a bone can take, can you give an example of a a. long bone b. short bone c. flat bone d. irregular bone 7. Recognise and name the different parts of a bone as the architecture differs; a. compact bone b. cancellous bone c. marrow bone 8. Describe at least three features of bones, eg tubercle, fossa, crest 9. Explain what is a spinal nerve. Topic 2.1: Pelvis Bones and Joints Week 1: Tue 30/07/24 Function of Pelvis withstand weight bearing and locomotion strength and stability > mobility protect organs of reproduction, digestion, and urination link trunk and lower limbs Structure of Pelvis Os Coxae fused after puberty Ilium (ilia) Sacrum (between ilia) Pubis (more medially and anteriorly) Ischium (posteriorly and inferiorly) 3 bones make up outer more lateral part By the puberty years, the ilium, pubis, and ischium are fused meaning they are not going to grow significantly or change in relation to each other  sacrum (triangular shaped bone) made of 5 fused sacral vertebra fuse after puberty coccyx inferiorly sacrum and coccyx lie between ilium bones iliium (more superior bone) pubis (anterior) ischium (posterior and inferior) Iliac crest Anterior, superior iliac spine Iliac fossa (depression) Anterior, inferior iliac spine Boney socket making up hip joint called acetabulum Obturator foramen Joints Synovial joints: reinforced anteriorly and posteriorly Sacroiliac joints not most mobile joint extremely strong because it has thick ligaments posteriorly strong ligaments anteriorly pelvis will not dislocate at sacroiliac joints sacrum is wedge shape and does not easily fall through iliac bones it is fixed shape of bones and ligaments make sacroiliac joints stable Pubis anteriorly meeting Pubic symphysis tubercles on either side of pubic symphysis superior pubic ligaments running across joints above inferior pubic ligaments holding the joints together between two joints are fibrocartilaginous disc very little movement at pubic symphysis joint Differences in male and female pelvis male ilium bone is taller and narrower female ischial tuberosity further apart female pelvis more broad, ilia bones are wider and less tall subpubic angle smaller on male all allow for childbirth Topic 2.2: Urinary Structures Arteries and Veins of the Pelvis arteries and veins often travel together kidneys = renal blue (vena cava) returning deoxygenated blood to heart from each kidney is renal vein blood comes back from kidneys to heart from renal veins arteries come from abdominal part of aorta (large blood vessel carrying oxygenated blood to body) this part of aorta has given 2 renal arteries Ureter : takes urine from kidney down to bladder Where does bladder get blood supply? aorta bifrocates (divides into 2) in pelvis 2 common iliac veins : aorta and vena cava iliac veins (draining into inferior vena cava) and 2 iliac arteries (coming from aorta) divide again internal iliac vein and internal iliac artery (one on right and left) that supply bladder Kidney bean shaped 12cm retroperitoneal retro = behind peritoneal - large space infant of kidneys that has lining and sac and has digestive organs kidneys, aorta, vena cava lie behind abdominal blood vessels, organs, and cavity between T12-L3 (T = Thoracic Vertebra : 12 = lowest one) (L = Lumbar : 3 = 1/3 lumbar or low back vertebra) kidney on right is low than kidney on left at kidneys, filtration of blood occurs and wastes like urine are passed out (area called renal pelvis)  ureter starts at renal hilum (area of indentation where blood vessels come in and out of kidney) renal vein, renal artery - 1/4 cardiac output every minute Functions regulate blood pressure by salt:water excrete wastes reabsorb water adrenal glands produce hormones to regulate water Urinary Bladder smooth (involuntary) muscle walls : detrusor sympathetic (T12 - L2) relaxation of detrusor = urine retention parasympathetic (S2 - S4) contraction of detrusor muscle = micturition (urination) somatic (S2 - 4) external urethral sphincter (pelvic floor) (voluntary) Urethra passage of urine males : also passage for semen female urethra 4cm, anterior to vagina male urethra 15-20cm  Female bladder directly behind pubic Male bladder behind pubic symphysis symphysis Urethra passes out bladder through As bladder fills it may rise up into prostrate gland inferior to bladder into penis pelvis When parasympathetic NV Urethra runs in parallel manner, dominates it allows urination (detrusor anterior to vagina muscle contracts) ejaculation not possible Female urethra only for urination When sympathetic NV is dominant, urethra can be used for ejaculation and Women more likely to get urinary semen can pass through ductus deference infection because they have short urethra which right and left into urethra (all happens in allows bacteria to enter easily. Urethra also prostrate gland) close to openings of anus and vagina What is the blood supply to the kidneys? renal arteries from abdominal aortic deoxygenated blood returns from kidneys having been filtered through renal veins What is the hilum of the kidney? depression where structures such as the urethra, renal arteries and veins enter and exit kidney Topic 2.3: Female Reproductive System Reproductive structures ovaries fallopian tubes uterus vagina external genitalia mammary glands Ovaries lead to unties via fallopian tube Uterus connects inferiorly with cervix and vagina Uterus thick wall muscular organ between urinary bladder and rectum ligaments hold it in place adult uterus = 7.5cm long, 5cm wide upper 2/3rd body, lower 1/3rd cervix uterus lies below periteneium cavity uterus communicates laterally with ovaries and fallopian tubes ovary is endocrine because it places hormones in blood stream it is also esicrine because it secretes over which is an egg that will travel through fallopian tubes 1° reproductive organs, size of an almond form ova (gonads) and hormones (glands) Supported by ligament and inner lining tissues Fallopian tubes: narrow tunnels for ova (egg cells) to pass from ovaries to uterus. Conception normally occurs here Vagina Mid-saggital picture showing: uterus superiorly cervix inferiorly vagina uterus said to be anteverted : angles forward tawdry front body as it sits above and behind bladder Uterus and vagina have no role in urinary system on right and left side of vagina is pelvic floor muscles travelling from pubic symphysis area, pubis bone, and ilium bone back to sacrum and coccyx bone Fibromuscular tube from uterus to outside Allows sperm, but protects against other items entering NOT the passage for urine supported by the pelvic floor muscles Perineum (female) Diamond shaped Pubic symphysis Ishial Ishial tuberosities tuberosities THANKS A LOT Coccyx Posterior of diamond shape = anus Anterior part = urogenitle part (opening of vagina) Anterior to that = opening of urethera  Monspubis - fatty tissue covering pubic bone, glands there release pheromones Labia Majora - fatty and hairy, enclose and protect, sweat and sebaceous glands which produce lubricating secretions Labia minor - inside labia major, surround openings of vagina and urethra Clitoris - protrusion of erectile tissue Bartholin glands - secrete lubricant near opening Topic 2.4: Male Reproductive System Testes produce: endocrine - produces hormones that go to blood supply exocrine - produces sperm Ductus/Vas deference: transport and store mature sperm travels into pelvis over pubic bone anteriorly on both sides does not travel alone spermatic cord - contains ductus, nerves, arteries, veins, and lymphatics vasectomy = tube is cut 2 ductus deference pass over bladder superiorly and run posteriorly into bladder where they encounter a seminal vesicle seminal vesicle contributes fluid to add to sperm - semen from seminal vesicles, ductus deference takes sperm and accompanying fluid into prostrate gland both drain into one tube (urethra) sperm collected from testicle fluid collected from seminal vesicle and prostrate gland to make semen that passes out as ejaculate fluids keep it alive longer and make pH more alkaline and give nutrition to sperm to keep them alive outside male body Prostrate prostrate enlargement can be benign and not cancerous bladder sits posterior to pubic symphysis more it fills it raises slightly above pubic symphysis can interfere with urinary flow Scrotum surrounding skin of testicle supports testes smooth muscle in scrotal wall for temperature control if cold, smooth muscle will contract and move testicle closer to warmer body if hot, skin will relax and allow testicle to hand further away from body warmth sperm production excellent lymphatic and blood supply structures travel through spermatic tube before at posterior, sperm will be stored and matured and then pass through ductus deference Penis glans (head of penis)coveredspongiosum, moist mucosa foreskin = mobile skin over glans corpus cavernosum: 2 columns of tissue on sides. fill with blood = erection corpus spongiosum: column of spongy tissue along the front of the penis, to glans. keeps urethra open. urethra runs through corpus spongiosum, carries ejaculatory fluid Perineum inferior to pelvic floor between thighs diamond shaped, Women have 3 outlets, men 2 Skin, fascia, external genitalia, glands, muscle THANKS A LOT Topic 2.5: Pelvic Floor resists increase in intra-abdominal pressure. external sphincters (voluntary) support of organs anterior ramus of S4 and branches of the pudendal nerve (S2, S3 and S4) Reproductive and urinary organs above Perineal muscles and external genitalia below Levator ani group of 3 muscles puborectalus pubococcygeous iliococcygeous coccygeus The pelvic floor is made of skeletal muscles called lavator ani and coccygeous Attach anteriorly to the pubic and ilium bones Attach posteriorly to coccyx and sacrum bones In male, the urethra and anus pass through lavator ani In female, the urethra, vagina, and anus Pelvic Muscles Pelvic Floor Obturator Internus Levator Ani Obturator Externus Anterior : Pubococcygeus Piriformis Intermediate : Puborectalis Iliacus Posterior : Iliococcygeus Levator Ani Coccygeus Coccygeus Male Female Need to Know 1. Be able to identify in a picture and state in one to two dot points the function of the male a. testicle b. scrotum c. vas deferens/ductus deferens d. seminal vesicles e. prostate f. urethra 2. Be able to identify in a picture and state in one to two dot points the function of the female a. uterus, b. ovaries, c. fallopian tubes, d. vagina, e. labia minora and majora 3. Be able to identify in a picture and state in one to two dot points the function of each a. kidneys, b. ureters, c. bladder, d. urethra 4. Can you show on a skeleton where the pelvic floor muscles levator ani and coccygeus attach to the pelvic bones? This is in your final viva exam 5. List what structures pass through the pelvic floor in a male and a female. always in your first written test 6. Can you describe the difference between the pelvic floor muscles and the perineum in one/two sentences? 7. Can you point out on yourself and on a fellow student all of the pelvic surface anatomy landmarks listed in the practical book this week? Can you label the bony landmarks of the pelvis listed in the practical book this week on a pelvis model or diagram? Viva process 1. orientate and landmark first verbalise palpate entire structure 2. describe structure structure function Structure: synovial joint Shape: ball and socket Bones: proximally-acetabulum distally-head of femur Acetabulum deep fossa horseshoe shaped fibrocartillaginous lining called inferiorly and anteriorly is a small transverse ligament lip (labrum) around cartilage acetabulum album Proximal Femur Articular cartilage horseshoe shape cartilage of acetabulum head of femur and neck of femur ligament that has been cut (small ligament of head of femur that holds it to acetabulum) small blood supply passes through ligament Ligaments hip joint capsule very large joint capsule extends from rim of acetabulum to intertrochanteric line on anterior femur joint capsule extends at interochanteric crest ligaments woven into fibres outer joint capsule Anterior view Ilium bone Posterior view Ishial spine Iliofemoral ligament Pubis bone Ishial tuberosity Pubofemoral ligament Ischium bone Ischiofemoral ligament The iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament, are the 3 ligaments that make the hip joint strong. Topic 3.2: Hip Features and Ligaments Angle of inclination between neck and shaft of femur adult : 115° - 140° females < males 1. 2. large angle of inclination small angle of inclination knees further apart places knees closer together weight is born differently on more weight on lateral condiles of condoles of femur at knee meaning weight femur and tibia as they meet at knees is born on outer aspect of feet more weight on medial aspect of feet Stability hip is a stable joint due to having lots of articular surface in contact acetabula is deep and encloses much of the head of femur lot of bone to bone contact making joint stable it has very thick intracapsular ligaments Blood supply Abdominal aorta Common iliac arteries External iliac artery In pelvis area, abdominal aorta divides travels into thigh from front of pelvis into 2 iliac arteries (common iliac and passes under oblique muscles of abdomen arteries) forms inguinal ligament from anterior superior iliac spine to pubic tubercles Internal iliac artery supplies structures forms part of a transition zone called inside pelvis femoral triangle where nerves, arteries, veins, or tendons pass over joint Arteries and veins change names as they move to different areas External iliac artery —> femoral artery Femoral vein —> external iliac vein Nerve femoral nerve has come from lumbar vertebrae spinal nerves have travelled and will pass into anterior thigh Motions of hip extension and flexion of hip = sagittal plane adduction and abduction of hip = frontal/coronal plane external and internal rotation of hip = frontal plane Topic 3.3: Muscles of the Hip Flexion Extension Abduction Aduction Enternal/lateral Internal/medial rotation rotation Extensors of the hip Gluteus Maximus O = sacrum bone on large band of fascia that covers sacrum and ilium and medial aspect of ilium I = gluteal tuberosity and liotibial tract A = hip extension N = Inferior glueteal * a muscle that extends the hip has to pull the femur bone backwards, behind the body. Innervation nerve that supplies the structure inferior gluteus nerve innervate gluteals gluteal nerves travels inside pelvis nerve will exit the sciatic foramen with other nerves, veins, and arteries Gluteus Medius and Minimus O = ilium bone travel distally and inferiorly to where they insert on greater trochanter on femur bone they insert in slightly anterior manner on greater trochanter if they contract or shorten, they can abduct the hip joint because they have slightly anterior action/insertion, they can internally rotate hip joint o = Ilium bone I = Greater trochanter of feur A = Abduction and internal rotation of hip N = superior gluteal nerve (L4 - S1) F = support level pelvis in one leg weight- bearing/walking Gluteus medius Gluteus minimus Tensor Fascia Latae (TFL) Tensor = tenses fascia Latae = white O = iliac crest, ASIS I = Iliotibiual tract which inserts lateral tibial condyle A = flex hip abduct N = Superior gluteal (L4 - S1) F = allows you to stand and lean, keeping hip and knee extended so less energy is used Lateral Rotator Group PGOGOQ lateral rotators lie deep to the gluteals insert onto posterior aspect of femur so they can pull it backwards and because you to laterally rotate P = Piriformis G = Gemelli (superior and inferior) O = Obturators (externus and internus) Q = Quadratus femoris Hip flexors Muscles must have to lie anterior to the hip to be able to flex it Iliacus Originates on ilium bone in iliac fossa. It travels down anterior to the pubis bone Then inserts onto lesser trochanter O = ilium bone I = lesser trochanter A = hip flextion N = femoral (L2-L3) Psoas Major originates on lumbar vertebrae it travels down the posterior wall of the abdomen it passes anterior to the pubis and inserts with iliacus O = lumbar vertebrae (T12-L5) I = lesser trochanter A = hip flextion N = lumbar plexus Topic 3.4: Muscles of the Hip and Knee Thigh contains muscles that cross hip and knee joints muscles that act on the hip muscles that act on the knee ‘quads’ - anterior compartment ‘hamstrings’ posterior compartment adductors - medial compartment Anterior compartment Nerves of the Thigh femoral nerve made of spinal roots (L2, L3, and L4) passes anteriorly under the inguinal ligament into the thigh via the femoral triangle enters the anterior compartment of the thigh Quadriceps: Rectus Femoris O = AIIS and upper acetabulum I = tibial tuberosity A = hip flexion and knee extension N = Femoral (L2-4) Quadriceps: Vasti O = femur bone I = anterior tibia A = knee extension N = Femoral (L2-4) Quadriceps: Sartorius O = ASIS I = medial tibia near tibial tuberosity A = knee flexion and hip flexion, abduction, and lateral rotation N = Femoral (L2-3) Medial compartment Nerves of the thigh obturator nerve made of spinal nerve roots (L2, L3, and L4) passes through the obturator foramen enters the medial compartment of the thigh Medial thigh: Adduct hip muscles bring the thigh together support hip position where standing on one leg adductor magnus can extend hip pectineus can flex the hip O = ilium, pubis, ischium bones I= A = hip adduction N = obturator nerve except pectineus Posterior compartment Nerves of the thigh Sciatic nerve spinal nerve roots (L4, L5, S1, S2, S3) passes through sciatic foramen enters posterior compartment of thigh Posterior thigh: Knee flexors ‘Hamstrings’ Biceps femoris Semimembranosus Semitendinosus Biceps femoris O = long head - ischial tuberosity, short head - linea aspera I = head of fibula A =hip extension and knee flexsion N = long head tibial nerve (sciatic) Semitendinosus and Semiembranosus O = ischial tuberosity I = medial condyle of tibia A = hip extension and knee flexsion N = sciatic (tibial portion) Need to know 1. Be able to describe the hip joint a. What type of joint is it? b. Describe it’s shape c. What ligaments support it? d. Name the bones that make up the joint 2. What are the motions of the hip? What muscles make these motions? Hip motion Muscles responsible Innervation This means, what nerve controls these muscles? Learn nerve innervation IF you can remember the muscle actions only hip flexion hip extension hip adduction hip abduction external or all you need to remember is that you don’t need to lateral the 6 lateral rotators are situated recall their individual rotation of the deep to the gluteals innervation hip internal or medial rotation of the hip 3. What is the angle of inclination? Explain in one dot point 4. What is the femoral triangle? what is a transition zone? What passes through it? 5. What are the large arteries and veins in the area? Be able to label the a. abdominal aorta, b. the right and left common iliac arteries and veins, c. the internal iliac arteries and veins, d. the external iliac arteries and veins, e. the femoral artery and vein 6. What nerves innervate the compartments of the thigh? a. anterior compartment b. posterior compartment c. medial compartment Topic 4.1: Bones of the Knee Week 4: Tue 13/08/24 Knee Joint synovial occurs at femur bone proximally and tibia bone distally patella is embedded in the tendon transfers weight down the femur to the tibia allows forces from ground to be transferred up e.g., jumping allows lower limb to lengthen and shorten most stable in extension (more tight) Anterior view Right knee Fibula (lateral Distally tibia Patella Proximally is distal bone) (medial bone) anteriorly part of femur Lateral and medial Lateral and medial Medial and lateral Adductor tubercle condyles of femur condyles of tibia epicodyles of femur Tibial tuberosity Proximal tibiofibular joint Head of fibula Intercondylar eminence  Epicondyles appear on all hinge joints collateral ligaments attach to epicondyles adductor magnus and medial compartment muscles insert in parts on adductor tubercle all quadriceps insert on tibial tuberosity and pull on patella to bring knee into extension Knee joint capsule synovial involves distal part of femur anteriorly patella bone distally tibia bone thin folds away for easy storage in knee flextion Menisci Function 2 very smooth fibrocartilaginous C- distribute loads shaped pads conform to articular surfaces as joint moves deeper on inside of joint deepen articular surface of tibia on parifere they are higher increase lateral stability make tibial platau more cup shaped decrease friction rather than flat to receive condyles of femur Proximal view of left tibial platau Anterior Lateral Meniscus Both Medial meniscus smaller Attach to tibia and attached at not attached to each other anteriorly where margins to joint capsule and joint capsule there is a transverse ligament tibial collateral ligament attach to Wider and larger intercondylar eminence Patella tendon patella embedded in quadriceps tendon from patella to tibial tuberosity patella retinaculae support the knee anteriorly tendon by which all 4 quadriceps insert onto the tibial tuberosity proximal tibiofibular joint is not part of the knee joint rectus femoris vastus lateralis vastus medialis Patella Retinaculae sheets hold patella centred over femur reinforce the joint medially and laterally on anterior side Topic 4.2: Ligaments of the Knee Knee: Fibular collateral ligament (lateral): hinge joint cord like has 2 epicondyles on distal femur independent of lateral meniscus of knee most tight when knee is in full extension Hinge joints: Tibial collateral ligament (medial): always have collateral ligaments broad and flat ankles runs between medial epicondyle of femur elbows attaches to medial condyle of tibia fingers also attaches to medial meniscus of knee allow flextion and extension most tight when knee is in full extension Within capsule, outside synovial membrane Anterior cruciate ligament: Posterior cruciate ligament: O = anterior tibia O = posterior tibia Both: intracapsular ligaments attach from intercondyler eminence of tibia to intercondyler fossa of femur when knee is in full extension, they wrap around each other, making each other very tight, and make the knee very stable and tight when extended prevent tibia and femur from moving on top of each other and from sliding backward and forward Popliteal fossa: popliteal artery runs through femoral artery enters anterior thigh through femoral triangle travels medially into anterior thigh passes through adductor muscle and becomes posterior and becomes popliteal artery once vein and artery pass through the adductor muscle in medial thigh, they will be called femoral artery and vein Contents popliteal artery popliteal vein sciatic nerve common fibual nerve tibial nerve Borders Proximal-medial border: semitendinosus and semimembranosus proximal-lateral border: biceps femoris distal border medially and laterally: gartricnemeus  insertion point of patella tendon is tibial tuberosity proximal tibiofibular joint is not part of knee joint right knee, flexed, patella missing, anterior view Topic 4.3: Bones and Anterior Compartment of the Leg Proximal Tibiofibular Joint: synovial, plane joint only 10% weight from femur goes through fibula movement = gliding when ankle moves Distal Tibiofibular Joint: Interosseus membrne: divides the leg into anterior and posterior portion Nerve and blood vessel supply of the lower leg tibia bone medially fibula bone laterally and slightly posteriorly interosseus membrane shows anterior and posterior compartment intermuscular septum Nerve innervation Sciatic nerve Common fibula nerve Deep fibula nerve Common fibular nerve Tibial Superficial fibula nerve Tibial nerve deep in compartment Anterior compartment of the leg O= I= A = dorsiflex ankle and extend toes N = deep fibula nerve Tibialis Anterior (tom) O = tibia and interosseous membrane I = medial cunieform and 1st metatarsal A = dorsiflex ankle and invert toes N = deep fibula nerve muscle fibre become tendon cross dorsom of ankle and head in medial direction held down onto dorsom of foot by extensor retinaculum extensor retinaculum holds tendons close to bone do they do not bowstring out tibialis anterior runs deep under foot  Extensor Digitorum Longus (don) O = lateral tibia, superficial-medial fibula, and interosseus membrane I = toes 2-5 A = dorsiflex ankle and extend toes 2-5 N = deep fibula nerve muscles come down as 1 tendon divide into 4 passes under extensor retinaculum into dorsum of toes  Extensor Hallucis Longus (harry) O = fibula and interosseus membrane I = base, distal phalanx hallux A = dorsiflex ankle and extend hallux N = deep fibula nerve hallucis refers to big toe becomes tendon passes under extensor retinaculum into dorsum of big toe  Fibularis Tertius O = fibula and interosseus membrane I = 5th metatarsal A = dorsiflex ankle and evert foot N = deep fibula nerve becomes tendon passes dorsum of ankle lies on dorsum of 5th metatarsal Peroneal/fibular nerve damage sometimes called ‘slap gait’ high-stepped gait nerve injury leprosy multiple sclerosis syphilis Topic 4.4: Lateral and Posterior Muscles Lateral compartment-evertors Fibularis longus O = upper fibula I = 5th metatarsal and medial cuneiform A = foot eversion N = superficial fibula nerve Fibularis brevis O = inferior lateral fibula I = base of 5th metatarsal A = foot eversion N = superficial fibula nerve Posterior compartment Superficial Vessel: posterior tibial artery and veins 1. gastrocnemius Nerve: tibial nerve 2. soleus Action = planter flexion and flexion 3. plantaris Deep 1. popleteus 2. flexor hallucis longus 3. flexor digitorum longus 4. tibialis posterior Gastrocnemius Soleus O = lateral and medial condyle femur O = Tibia, fibula I = calcaneus via calcaneal tendon I = calcaneus via calcaneal tendon A = ankle planter flexion, knee extension A = ankle planter flexion, N = Tibial N = Tibial  come through Tibialis Posterior interosseous membrane, tibis, and O = interosseus membrane, tibia, fibula fibula I = navicular, cuneiforms, cuboid, metatarsals its tendon has passed A = ankle planter flexion, invert foot, arch support behind medial malleolus of tibia N = Tibial passed into some tarsal bones shortening = planter flexion moving medially towards insertion = inversion Flexor Hallucis Longus Flexor Digitorum Longus O = interosseus membrane, tibia, fibula O = posterior tibia I = hallux I = lateral 4 toes A = flex hallux and arch support A = plantarflexion and arch support N = Tibial N = Tibial passes through posterior compartment deep passes medially behind medial malleolus of ankle approaches the toes from plantar direction puts spring in your step Tibial nerve motor: posterior compartment of leg sensory: (include plantar nerves) posterior leg + plantar foot Common Fibular Nerve motor: biceps femoris (short head) Deep fibular - anterior compartment superficial fibular - lateral compartment sensory: anterior leg, dorsal + lateral foot Need to know 1. Be able to describe the knee joint a. what type of joint is it? b. describe it’s shape c. what ligaments support it? Be able to label them d. name the bones that make up the joint e. what are the menisci? Describe them in two dot points, and state their functions in two dot points 2. What are the motions of the knee and ankle? What muscles make these motions? some muscles have action across more than one joint, for example the toe extensors act on joints of the toe - but also cross over the ankle joint and dorsiflex it. Knee motion Muscles responsible Innervation This means, what nerve controls these muscles? Learn these IF you can remember the muscle actions only Flexion Extension Ankle dorsiflexors Foot invertors Foot evertors Ankle plantarflexors Toe flexors Toe extensors 3. What is the popliteal fossa? what is a transition zone? What passes through it? 4. what is the knee locking mechanism? a. Why does it occur b. When does it lock? c. How does it unlock? Topic 5.1: Bones and Structures of the Ankle and Foot Week 5: Tue 20/08/24 Foot ankle functions: stability: push off ground - rigid lever mobility: absorption or rotation - shock absorption foot becomes soft point of folcrum takes on shape of ground gastrocnemius and soleus pulling upwards absorbs shock from ground long lever that foot makes for them to pull from  interphalangeal joint distal phalanges medial phalanges proximal phalanges phalanx metatarsalphalangeal joints metatarsals tarsometatarsal joint medial cuneiform lateral cuneiform intermediate Tarsal bones: cuneiform calcaneus talus navicular cuboid cuneiforms Ankle joint (talocrural joint) Posterior view of right ankle calcaneus Talocrural joint: talus synovial joint distal end of tibia strong ligaments distal end of fibula large area of bony contact medial malleolus plantarflection lateral malleolus dorsiflextion talus sits inside malleoli movement allowed by malleoli and shape of joint is dorsiflextion and plantarflextion Lateral aspect of ankle joint lateral collateral ligaments Topic 5.2: Joints of the Ankle and Foot Plantar flexion Dorsi flexion TALOCRURAL JOINT Eversion Inversion Arches of the foot: Longitudinal little weight on medial arch of the foot Arches of the foot: superficial support Plantar Aponeurosis/Fascia dense layer of deep fascia; plantar aponeurosis. its deep fascia covers medial & lateral muscles helps maintain longitudinal arch medially and laterally extends from calcaneus up past the metatarsal, past the metatarsophalangeal joints, and into plantar aspect of the toes protective of the nerves and muscles, arteries and veins that lie deep to them runs longitudinally Arches of the foot: deep support Tibialis posterior ‘spring ligament’ Tibialis anterior calcaneonavicular Flexor Flexor digitorum hallucis longus longus Long and short plantar ligaments Arches of the foot: bone shape cuniforms (wedge shaped) and cuboid bones do not fall through when there are forces from above because the wedge shape is wider at the top, narrower at the bottom the bony shape as well as ligaments and muscles support the arches of the foot Tarsal tunnel transition zone between the medial malleolus and calcaneus flexor retinaculum makes up fibroosseus tunnel all structures of the tarsal tunnel come from the posterior compartment of the leg Tom, Dick, And Very Nervous Harry pass through tarsal tunnel Plantar muscles Lateral plantar nerve Medial plantar nerve Lateral plantar artery Medial plantar artery Lateral plantar vein Medial plantar vein Topic 5.3: Intrinsic Muscles of the Foot Foot: Intrinsic Muscles 20 muscles, 18 plantar, 2 dorsal Groups acting on toes Abductors of little toe and big toe Flexors Lumbricals (communicate between extensor and flexor tendons in toe) Interossei (abduct & adduct 4 toes) Extensors Aductor Digiti Minimi A: Abduct the 5th toe Flexor Digitorum Brevis N: Lateral plantar A: Flex lateral toes 2-5 N: Medial plantar Lumbricals A:Flex metatarsophalangeal Abductor Halucis extend interphalangeal & sensory A: Abduct and flex hallux N:Medial and lateral plantar N: Medial plantar Quadratus plantae A:aligns flexor digitorum longus N:lateral plantar  Flexor Halluxis Brevis A:flex metatarsophalangeal Adductor Halluxis joint hallux A: may provide N:Medial plantar transverse arch support, adduct hallux Flexor Digiti Minimi N: deep lateral plantar A:Flex metatarsophalange N:Lateral plantar Plantar - 4th layer Dorsal Intrinsic Muscles:- Plantar Interossei Dorsal Interossei A: Adduction A:aBduct toes N: Lateral plantar Nerve N:Lateral Plantar Nerve  Extensor halluxis brevis A:extend metatarsophalangeal hallux N: Deep fibular Extensor digitorum brevis A:extend toes 2-4 N: Deep fibular plantar muscles flex and dorsal muscles extend the toes extend the toes innervated by the deep fibular nerve innervated by the medial and lateral plantar nerves