Anatomy: posterior and lateral leg (8.2)

Where does the geniular branch form an anastomoses

around the knee joint

where does the inferior gluteal artery exit

exits greater sciatic foramen inferior to piriformis

what does the posterior tibial artery give off, and what does this supply

fibular artery, supplies posterolaterlal leg (including lateral compartment)

What are branches of the popliteal artery

geniular branches anterior tibial artery posterior tibial artery

where does the superior gluteal artery exit

greater sciatic foramen superior to piriformis

Whats the mnemonic Tom, Dick, And Very Nervous Harry

"Tom, Dick, And Very Nervous Harry" helps summarize the relative position (anterior, middle, & posterior) of the tendons of tibialis posterior (Tom), flexor digitorum longus (Dick), and flexor hallucis longus (Harry) as they travel posterior to the medial malleolus in the tarsal tunnel; the posterior tibial artery/vein and tibial nerve (and) lie between the tendons of FDL and FHL

Describe deep veins of the posterior and lateral leg

- fibular>post. tibial>popliteal - anterior tibial > popliteal - popliteal vein also receives blood from the small saphenous vein (draining superficial tissues)

Define action and innervation rule for lateral compartment of the leg

Action rule: evert foot and weakly plantarflex ankle joint Innervation rule: superficial fibular nerve

Action and innervation rules of deep posterior compartmnent of leg

Action rules: plantarflex ankle joint and flex toes Innervation rule: tibial nerve

what does the posterior tibial artery give off around the ankle while the fibular artery gives off what

Around the ankle, the posterior tibial artery gives off medial malleolar and calcaneal branches while the fibular artery gives off lateral malleolar and calcaneal branches (form anastomoses around ankle joint)

Femoral artery passes through what and becomes what

Femoral artery passes through adductor hiatus and becomes the popliteal artery

Excessive use of deep gluteal muscles can lead to what

Excessive use of the deep gluteal muscles (e.g., in athletes such as ice skaters, cyclists, rock climbers) can lead to hypertrophy or spasm of the piriformis muscle, which can compress the sciatic nerve (piriformis syndrome). In individuals with a proximal split of the sciatic nerve, the common fibular nerve can become compressed as it passes through piriformis.

What are the muscles that comprise the superficial posterior leg muscle group

Gastrocnemius Soleus Plantaris All insert on Calcaneus via calcaneal tendon, all innervated by tibial nerve, all plantar flex

What does the superficial fibular nerve innervate (muscle and skin)

L4, L5, S1 Innervates the muscles of the lateral compartment of the leg Innervates the skin of anterolateral leg and most of the dorsal foot

Define insertion, innervation, origin and actions of fibularis (peroneus) brevis

Origin: Distal 2/3 lateral fibula Insertion: Tuberosity of the fifth metatarsal Actions: evert foot; weakly plantarflex ankle joint Nerve: Superficial fibular

Define insertion, origin, nerve and actions of fibularis (peroneus) longus

Origin: Head of fibula and proximal 2/3 lateral fibula Insertion: Base of 1st metatarsal and medial cuneiform Actions: evert foot; weakly plantarflex ankle joint Nerve: Superficial fibular

List action, origin, insertion, and nerve of popliteus

Origin: Lateral femoral condyle Insertion: Proximal posterior tibia Action: - unlocks the knee from extended position (when knee is extended in standing position, popliteus rotates the femur laterally 5 degrees on the tibia, unlocking the knee so that flexion can occur) - medial rotate flexed knee - knee flexion Nerve: tibial nerve

Action, origin, insertion, and nerve of plantaris (small muscle belly with long, thin tendon)

Origin: Lateral supracondylar line of femur Insertion: Calcaneus via calcaneal tendon Action: weakly flex knee joint and plantarflex ankle joint Nerve: tibial nerve

Actions, origin, insertion, and nerve of gastrocnemius (medial and lateral head)?

Origin: Posterior femoral condyles Insertion: Calcaneus via calcaneal tendon Action: flex knee joint and plantarflex ankle joint Nerve: tibial nerve

Action, origin, insertion, and nerve of soleus

Origin: Posterior tibia and Fibular head Insertion: Calcaneus via calcaneal tendon Action: plantarflex ankle joint Nerve: tibial nerve

List insertion, origin, innervation and actions of tibialis posterior

Origin: Posterior tibia and fibula and interosseous membrane Insertion: All tarsal bones and base of 2 - 4th metatarsals Actions: plantarflex ankle joint; invert foot Nerve: tibial nerve

List insertion, origin, innervation and actions of FHL

Origin: posterior fibula Insertion: distal phalanx of hallux Actions: flex hallux (MTP & IP joints); weakly plantarflex ankle joint, invert foot Nerve: tibial nerve

List insertion, origin, nerve and actions of FDL

Origin: posterior tibial Insertion: Distal phalanx digits 2-5 Action: flex digits 2-5 (MTP, PIP & DIP joints); weak plantarflex ankle joint, invert foot Nerve: tibial nerve

what gap does the anterior tibial artery pass through

Passes through gap in superior part of the interosseous membrane

whats the posterior thigh vasculature

Perforating branches from the deep artery of the thigh (primary source) and obturator artery Deep vein of the thigh

List the muscles in the deep group of the posterior compartment of the leg

Popliteus Flexor digitorum longus (FDL) Flexor hallucis longus (FHL) Tibialis posterior

posterior tibial artery travels where

Posterior tibial artery travels posterior to medial malleolus in the tarsal tunnel, between tendons of FDL and FHL ("Tom, Dick, And Harry"), deep to flexor retinaculum (can palpate the posterior tibial pulse here)

what does the anterior tibial artery supply

Supplies anterolateral leg and dorsal foot

What holds in place the Tendons of flexor digitorum longus, flexor hallucis longus, and tibialis posterior, and where are they held in place

Tendons of flexor digitorum longus, flexor hallucis longus, and tibialis posterior are held in place in the tarsal tunnel by the flexor retinaculum, which forms the roof of the tarsal tunnel

If the common fibular nerve is injured where it wraps around the proximal fibula, how will the patient present

The patient will present with foot drop, which is caused by a loss of dorsiflexion and toe extension. The foot may also be inverted, as eversion is also affected. Note: one invertor will be affected (tibialis anterior is innervated by the deep fibular nerve) but some invertors will still be intact (tibialis posterior, flexor digitorum longus, and flexor hallucis longus are innervated by the tibial nerve).

whats the exception with the plantaris

absent in 5-10% of people

describe suprior and inferior gluteal veins

accompany arteries and are tributaries of internal iliac vein

What is the insertion of the superficial group of the posterior compartment of the leg

calcaneal tuberosity via calcaneal (achilles) tendon

What does the superficial fibular nerve branch off of

common fibular nerve

Where do tibial and common fibular nerves usually separate where? How can this vary?

in distal thigh (proximal to popliteal fossa). However, this can vary (e.g., in ~12% of people, the two nerves separate as they leave the pelvis, with the common fibular nerve passing through piriformis)

Gluteal arteries arise from what artery

internal iliac artery

Tibial nerve is a branch off of what? What is the sural nerve made up of?

medial branch of the sciatic nerve Sural nerve: tibial + common fibular L5, S1, S2

In posterior leg, tibial nerve innervates what

muscles of the posterior compartment of the leg and the skin on posterolateral aspect of leg and lateral foot (via a cutaneous branch, the sural nerve, which also receives a contribution from the common fibular nerve)

what does hte posterior tibial artery supply

posterior leg

where does tibial nerve travel between

superficial and deep muscle groups of the posterior compartment of the leg and eventually passes into the plantar foot

What arteries supply the gluteal region

superior gluteal artery inferior gluteal artery

Calcaneal tendon relfex tests what

tests tibial nerve and the S1-S2 spinal segments via plantar flexion

If the common fibular nerve is injured where it wraps around the proximal fibula, what muscles will be affected

the muscles in the anterior and lateral compartments of the leg and the dorsal foot will be affected.

what does the posterior tibial artery travel with

tibial nerve, between superficial and deep muscle groups