NYCC 2nd half of notes on lower extremity: thigh - foot Zumpano Spring 2010
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| gluteal tuberosity, linea aspera, medial supracondylar line | Insertion of adductor part of Adductor Magnus
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| innervation of Adductor part of Adductor Magnus | posterior branch of obturator n.
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| Obturator n. spinal levels | L234
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| Adductor portion of Adductor Magnus innervation and spinal level | Obturator n., L3,L4
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| adductor tubercle (insertion) | Hamstring part of Adductor Magnus
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| What lies between the adductor part and the hamstring part of the Adductor Magnus insertions | Adductor HIATUS! See ya!
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| Innervation of hamstring part of Adductor Magnus | tibial division of sciatic n.
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| What is the difference in origins of the obturator n. and the tibial part of the sciatic nerve? | Obturator is the most medial/last branch off the lumbar plexus (L234) while Tibial division of sciatic is most lateral/first branch of lumbosacral anterior plexus
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| Why does it make sense for the adductor portion of Adductor magnus to be innervated by Obturator n. and the hamstring portion to be innervated by Tibial division of sciatic n.? | Obturator n. is short, close in and higher up like the adductor portion and Tibial division of sciatic is long, innervating all the hamstrings (except short head biceps femoris) so makes sense for hamstring head of adductor magnus
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| Why would Obturator EXternus be considered a lateral rotator only? | It attaches on the posterior femur in the trochanteric fossa between greater and lesser trochanters, but begins in the front along the obturator foramen. It stretches exactly parallel to the floor, so when it contracts, it can only pull lateral to medial
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| innervation of Obturator EXternus | posterior division of Obturator n. (L234)
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| spinal level of Obturator EXternus | L4
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| What is the difference in insertions for Obturator EXternus and Obturator INternus? (and innervation?) | EX inserts in the trochanteric fossa. IN inserts above the fossa, on the medial side. EX innvervated by Obturator n. IN innervated by n. to Obturator INternus
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| Why doesn't Obturator EXternus aBduct the flexed thigh like Obturator INternus? | it only functions in one plane (horizontal) so short and sweet and rotate lateral!
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| The posterior branch of Obturator n. lies between what two muscles? | Adductor brevis and longus
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| what cutaneous/skin area does the obturator n. innervate? | the dogbite patch right above the medial knee
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| Inversion of the foot is any muscle with the word __________. | tibialis
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| The word "tibialis" is in every muscle that ________ the foot. | inverts
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| muscles of posterior crural compartment | Tibialis Posterior, Flexor Digitorum Longus, Flexor Hallucis Longus (Tom, Dick, Harry but arranged as Dick, Tom & Harry on the post tibia), Popliteus, Soleus, Gastrocnemius
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| what lies between the superficial and deep muscles of the posterior leg? | neurovascular plane
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| toewalk | S1
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| S1 means | toeWalk
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| Sky1toeWalker | S1 is toeWalk
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| SkyWalker (Help me, Obi One! You're my only hope.) | S1 toewalk
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| describe the cutaneous innervation/dermatomes of the posterior leg from medial to lateral: | Saphenous n. (from femoral), PFC dipping down between gastrocs, Lateral sural cutaneous upper outside, Sural n. lower outside to lateral foot, Medial calcaneal branches of Tibial to heel
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| describe the spinal levels of the posterior leg, medial to lateral | L4 (wrapping around like a ribbon over the knee then to medial ankle), S2 where gastrocs dip down, L5 on the side, S1 for SkyWalker toewalker Achilles tendon to heel and lateral foot
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| describe the anterior leg cutaneous innervation lateral to medial | Saphenous n. from dogbite obturator n. area above knee to medial heel, Lateral sural cutaneous n. upper outside, Superficial fibular n. lower outside and dorsum of foot excluding pinky toe which is Sural n.
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| describe anterior leg spinal levels lateral to medial | pinky toe S1 skyWalker toewalker, L5 on the side and toes 1-4, L4 medial tibia where you get kicked in soccer and there's no meat, S1 at medial heel again. Understand that S1 is like dipping your heels in water.
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| what is spinal level for knee? | L3, because L5 is on the side and L4 is where you got kicked in the shin before
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| L3 is for the ______, because L5 is on the ______, and L4 is where you were kicked in the _______. before | L3 is over the knee, because L5 is on the side and L4 is where you got kicked in the shin before.
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| Why does it make sense for the back of the thigh to be PFC and spinal level S2 of S1,S2,S3 choices for Posterior Femoral Cutaneous n.? | Because S2 is the only branch shared by both the common fibular and tibial divisions that comprise the PFC.
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| what vein drains the medial thigh and leg? | Great Saphenous vein
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| What nerve travels with the Great Saphenous vein on the medial thigh and leg because it does NOT run in the adductor canal? | Saphenous nerve (from Femoral)
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| What nerve is on the cutaneous dorsum of the foot? | Superficial Fibular n.
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| what nerve innervates the superficial surface of the dorsum of foot? | Superficial Fibular n.
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| What nerve innervates the lateral foot? | Sural n.
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| what branch off the Sural n. innervates the cutaneous aspect of the lateral leg? | Lateral Sural Cutaneous nerve
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| nerves of superficial aspect of leg from medial to lateral, start posterior and medial and go all the way back around to the same nerve | Saphenous n., Sural n., Lateral Sural Cutaneous n., then on dorsum most laterally is Sural n., the Superficial Fibular n., the Deep Fibular n. and again the Saphenous nerve completes the circle
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| What artery and nerve feed the anterior compartment of leg? | Deep Fibular nerve and Anterior Tibial artery
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| What artery and nerve feed the lateral compartment of the leg? | Superficial Fibular n. with fibular artery ***** fibular artery is actually located in the POSTERIOR leg
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| is there an actual artery in the lateral compartment of the leg? | no, the Fibular artery feeds it but does not live there. It lives in the posterior compartment.
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| where is the fibular artery? | posterior compartment (but responsible, also, for lateral leg)
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| what nerve innervates the anterior compartment of leg? | Deep fibular n.
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| What nerve innervates the posterior compartment of leg? | Tibial n.
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| Artery of posterior leg | posterior tibial artery
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| artery of anterior leg | anterior tibial artery
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| artery of lateral leg | fibular artery, although it is actually in the posterior leg
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| lateral condyle and lateral surface of the proximal 1/2 of tibia, interosseous memebrane and crural fascia | origin of Tibialis Anterior
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| lateral condyle and lateral surface of the proximal 1/2 of tibia | origin of tibialis anterior
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| medial and plantar surfaces of the 1st metatarsal and medial cuneiform bone | insertion of tibialis anterior
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| innervation of tibialis anterior | deep fibular n.
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| spinal level of tibialis anterior | L4 (where I got kicked in the shin before)
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| action of tibialis anterior | dorsiflexion and inversion of foot/ankle (remember: if it has "tibialis" in it, it inverts)
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| spinal level for tibialis anterior | L4 where I was kicked in the shin before
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| open space between insertion of T. anterior and Extensor Hallucis longus contains? | VAN- the Anterior Tibal artery and vein, and the Deep Fibular N.
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| basically originates on the lateral surface of the tibial crest and into the interosseous area, but written as "lateral condyle and lateral surface of proximal 1/3 of tibia" | origin of Tibialis anterior
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| "medial and plantar surfaces of the 1st metatarsal and medial cuneiform bone" | insertion of Tibialis anterior (tibialis posterior inserts on navicular)
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| medial surface of fibula and interosseous membrane and the crural fascia (book shows lower 1/3 of fibula because it crosses over to insertion) | Origin of Extensor Hallucis Longus
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| dorsal surface of the base of the distal phalanx of the great toe | insertion of E.H.Longus
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| innervation of E.H.Longus | Deep Fibular n.
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| spinal level of E.H.Longus | L5 (covers toes 1-4)
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| spinal level of Extensor Hallucis Longus | L5
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| extension of the interphalangeal joint of the hallux | E.H. Longus action!
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| If tibialis anterior is busy originating on the the lateral surface of the tibia, where does Extensor Digitorum Longus (Dick)originate? | lateral condyle of tibia (thanks, A.T.), FIBULA and interosseous membrane
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| distal phalanges of lateral 4 digits | insertion of extensor Digitorum longus (Dick)
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| spinal level of extensor Digitorum longus (Dick-itorum)? | L5 (on the side)
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| dorsiflexion and extension of lateral four digits | action of extensor Dick-itorum longus
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| DISTAL 1/3 of the anterior surface of fibula and interosseous membrane | origin Fibularis Tertius
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| book picture shows a tiny bit of the lateral malleolus as the origin of this muscle, but the notes say, "distal 1/3 of anterior surface of fibula" | fibularis tertius
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| dorsal surface of base of 5th metatarsal | insertion of fibularis tertius
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| innervation of fibularis tertius | deep fibular nerve
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| spinal level of fibularis tertius | L5,S1 (transition zone)
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| weak dorisflexor; eversion, eccentric contractor that tries to avoid excessive eversion of foot | fibularis tertius
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| head and proximal 3/4th of the lateral surface of the fibula | origin fibularis LONGUS
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| lateral aspect of base of the first metatarsal and medial cuneiform | insertion of fibularis longus
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| how is the insertion of tibalis anterior and fibularis longus different, since they both insert near one another? | T. anterior is medial and plantar surface of cuneiform #1 and first metatarsal, while fibularis longus is lateral surface of same bones (says medial cuneiform but means medial side of 1st cuneiform). Either way, they form a "sling"
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| spinal levels of fibularis longus | like fibularis tertius, L5, S1 and is a transition area
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| innervation of fibularis longus | superficial fibular n.
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| action of fibularis longus | eversion
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| distal 1/3 of fibula and intermuscular septum | origin of fibularis brevis
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| lateral surface of base of 5th metatarsal | insertion of fibularis brevis
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| how is the insertion of fibularis tertius and fibularis brevis different since they both insert on base of 5th metatarsal? | tertius is dorsal surface, brevis is lateral surface
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| spinal level fibularis brevis | L5, S1 transition like all anterior and lateral compartment muscles except t.anterior
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| innervation fibularis brevis | superficial fibular n.
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| action fibularis brevis | eversion
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| VAN in tarsal tunnel | Posterior Tibial artery, vein, and tibial nerve
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| sural artery is a branch of the __________ artery | tibial
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| medial and lateral condyles of the femur | origin for medial and lateral heads of gastrocnemius
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| calcaneal tuberosity via tendo calcaneus | insertion of gastrocs and soleus
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| spinal level gastroc | S1 (skywalker is S1 toewalker)
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| innervation gastroc | Tibial n.
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| plantarflexion, initiates knee flexion | gastroc action
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| posterior surface of proximal 1/3 of the fibula and medial border of the tibia and soleal line | origin soleus
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| calcaneal tuberosity via tendo calcaneus | insetion of soleus and gastroc
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| spinal level soleus | S1 toewalker
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| innervation soleus | tibial n.
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| plantarflexion; active in POSTURAL support when the leg is bearing weight | soleus (has nothing to do with the knee like gastroc because does not cross that joint)
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| this tendon is often used for surgical repair of other long tendons in the body | plantaris
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| many proprioreceptors for foot, creating a closed kinetic chain, often used to repair other long tendons in the body | plantaris
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| spinal level plantaris | L5
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| is plantaris part of tendo calcaneus? | no, inserts on medial edge of calcaneal tuberosity
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| where does plantaris come from? | lateral epicondyle of femur
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