Leg and Popliteal Fossa
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| What are the two bones that form the skeletal strut of the leg? What unites them? | Tibia and fibula; interosseous membrane
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| What do the bones of the leg articulate with inferiorly? | Talus
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| What supports the talus? | Calcaneus
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| What is the large, posterior expansion of the calcaneus which forms the heel? | Calcaneal tuberosity
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| What form the expanded proximal end of tibia for articulation with the distal end of the femur? | Medial and lateral condyles
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| What form shallow, concave facets for articulation with the rounded ends of the femoral condyles? | Superior surfaces of the ocndyles - plateaus
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| What are located between the articular surfaces and serve as sites of attachment of the cruciate ligaments? | Medial and lateral intercondylar tubercles
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| What attaches to the tibial tuberosity? | Patellar ligament
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| What marks the attachment of the soleus muscle? | Soleal line
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| What landmark is the sharp edge of the tibia that lies immediately deep to the skin? | Anterior border
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| What is located on the posterior surface and transmits an artery that is important for arterial supply to the inner tibia? | Nutrient foramen
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| What is an extension of the tibia that articulates with the talus of the ankle? | Medial malleolus
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| The lateral side of the tibis is expanded and shows a shallow groove. What is the name for this shallow groove? What is the significance of this shallow groove? | Fibular notch; articulation with the fibula
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| What is the long thin bone on the lateral side of the leg that is a strut for muscle attachment and has little direct function in weight bearing? | Fibula
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| What forms the proximal expansion of the superior end of the fibula? | Fibular head
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| What does the fibular head articulate with? What attaches to this site? | Articulates with lateral condyle of the tibia and is the site of attachment of biceps femoris tendon
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| The shaft of the fibula is long, slender, and smooth. What is the shaft of the fibula a proximal site of attachment of? | Fibularis muscle
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| What does the expanded distal end of the fibula form? | Lateral malleolus
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| What does the lateral malleolus articulate with proximally and distally? | Proximally: Tibia at the fibular notch; distally: talus of ankle
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| Attaches between the adjacent border of the tibia and fibula? | Interosseus membrane
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| The deep (crural) fascia, bones, interosseous membrane and anterior and posterior intermuscular septa divide the leg into 3 compartments. What are the actions of the muscles within the anterior compartment? | Dorsiflex the toes and foot and invert the ankle
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| The deep (crural) fascia, bones, interosseous membrane and anterior and posterior intermuscular septa divide the leg into 3 compartments. What are the actions of the muscles within the posterior compartment? | Plantar flexion of the toes and foot
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| The deep (crural) fascia, bones, interosseous membrane and anterior and posterior intermuscular septa divide the leg into 3 compartments. What are the actions of the muscles within the lateral compartment? | Evert the ankle and assist with plantar flexion of the foot
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| What are the muscles located in the anterior compartment? | Tibialis anterior, extensor digitorum lonus, extensor hallucis longus, and fibularis tertius
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| What are the attachments of tibialis anterior? | Proximally to lateral surface of superior tibia and interosseus membrane; distally by a tendon to the base of the first cuneiform and base of 1st metatarsal of foot
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| What are the principal actions of tibialis anterior? | Dorsiflexion and inversion of foot
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| What are the attachments of extensor digitorum longus? | Superiorly to fibula nad interosseous membrane; distal is via separate tendons to middle and distal phalanges of toes 2-5
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| What are the principal actions of extensor digitorum longus? | Extension of lateral 4 toes and dorsiflexion of foot
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| What are the attachments of extensor hallucis longus? | Superiorly to fibula and interosseus membrane; distally to the base of distal phalanx of big toe
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| What are the actions of the extensor hallucis longus? | Extends big toe and also dorsiflexes the foot
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| What are the attachments of fibularis tertius? | Inferior part of the fibula and interosseous membrane; distally to base of 5th metatarsal bone
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| What are the actions of fibularis tertius? | Everts the foot but also weakly dorsiflexes the ankle
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| What holds the tendons of the anterior compartment muscles in place at the distal leg and ankle? | Superior and inferior extensor retinacula, thickenings of crural deep fascia
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| What are the two muscles that make up the lateral compartment of the leg? | Fibularis longus and fibularis brevis
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| What are the attachments of the fibularis longus? | Superior, lateral surface of the fibula; long tendon that passes posterior to the lateral malleolus, then proceeds across the deep, plantar surface of the foot to attach to medial cuneiform and base of 1st metatarsal
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| What are the actions of the fibularis longus? | Eversion of the foot and weak plantar flexion
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| What are the attachments of the fibularis brevis? | Inferior, lateral surface of fibula; tendon passes posterior to lateral malleolus, deep (anterior) to tendon of fibularis longus and attaches to tuberosity of the base of the 5th metatarsal
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| What is the action of fibularis longus? | Eversion of the foot and weak plantar flexion
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| What holds the fibularis longus and brevis in position? | Fibular retinacula and other connective tissue tunnels that attach between the inferior end of fibula and calcaneus
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| What divides the muscles of the posterior compartment into a superficial group and a deep group? | Transverse intermuscular septum
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| Where do the vessels and nerves of the posterior compartment lie with respect to the transverse intermuscular septum? | Lie deep to the transverse intermuscular septum
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| The muscles of the posterior compartment of the leg are divided by a transverse intermuscular septum into a superficial group and a deep group. What two muscles make up the superficial group? | Gastrocnemius and soleus
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| Where do the muscles of the superficial group of the posterior compartment of the leg attach? | Distally through a common tendon (calcaneal/Achilles tendon) to the tuberosity of the calcaneus
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| What are the proximal attachments of the two-headed gastrocnemius? | Medial head attaches to medial epicondyle of femur, and the lateral head attaches to the lateral epicondyle of the femur
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| What are the distal attachemnts of the soleus muscle? | Attaches to the posterior surface of the tibia (along soleal line) and to head and proximal shaft of the fibula
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| Where is the soleus muscle located? | Deep to gastrocnemius
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| What are the actions of gastrocnemius and soleus muscles? | Strong plantar flexors of foot; gastrocnemius can also assist with knee flexion because it cross the knee joint
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| What are the attachments of plantaris? | Attaches superiorly to posterior aspect of lateral epicondyle of the femur immediately superior to attachment of lateral head of gastrocnemius; long tendon passes between gastrocnemius and soleus to merge with medial side of calcaneal tendon
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| Where are the deep group of muscles principally acting? | On toes and ankle
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| What are the attachments of flexor digitorum longus? | Arises from medial, posterior surface of tibia and long tendon passes posterior to medial malleolus and divides into separate tendons that attach to bases of distal phalanges of lateral 4 toes
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| What is the action of flexor digitorum longus? | Flexion of toes and plantar flexion of foot
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| What are the attachments of flexor hallucis longus? | Superiorly to the fibula and interosseus membrane and long tendon passes posterior to medial malleolus to attach to the base of the distal phalanx of big toe
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| Where do the flexor digitorum longus and the flexor hallucis longus cross? | Ankle
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| What is the action of the flexor hallucis longus? | Strong flexor of big toe and assists with plantar flexion of the foot
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| What are the attachments of the tibialis posterior? | Posterior surface of tibia and fibula and interosseous membrane and tendon attaches broadly to the medial ankle bones and metatarsal bones
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| What is the action of the tibialis posterior? | Plantar flexes the foot and assists with foot inversion
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| What are the attachments of the popliteus? | Inferiorly to medial surface of tibia above soleal line and tapers to a small tendon that attaches superiorly to lateral surface of the lateral femoral epicondyle and to the lateral meniscus inside knee joint
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| What does contraction of the popliteus do in the standing position? | "Unlocks" the knee by slightly rotating the femur laterally on a planted tibia, thus allowing flexion of knee
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| What innervates the leg muscles? | Branches of the sciatic nerve
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| What does the sciatic nerve divide into? Where does this division occur? | Common fibular nerve and tibial nerve in or proximal to the popliteal fossa
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| Describe the course of the common fibular nerve. | Passes laterally, winds around the neck of the fibula and divides into two nerves
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| What are the two nerves that the common fibular nerve divides into? | Superficial fibular nerve and the deep fibular nerve
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| Describe the course and innervation of the superficial nerve. | Passes into lateral compartment to innervate fibularis longus and brevis; distal continuation emerges from crural fascia to provide cutaneous sensation over lateral, inferior leg
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| Describe the course and innervation of the deep fibular nerve. | Enters anterior compartment and innervates anterior compartment muscles; continues distally within anterior compartment and emerges at ankle to provide cutaneous sensation to dorsal surface of foot
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| Describe the course and innervation of the tibial nerve. | Passes through popliteal fossa where it innervates plantaris and popliteus; passes deep to tendinous arch of soleus and innervates all muscles of the posterior compartment of leg; continues distally to provide motor innervation to foot muscles
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| What nerve is formed by components of the common fibular and tibial nerves and supplies sensation to the posterior surface of the leg? | Sural nerve
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| What nerve supplies cutaneous sensation to the medial side of the leg? This nerve is a branch of the femoral nerve? | Saphenous nerve
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| What spinal nerves are most important for cutaneous and motor function in the leg? | L3-S2
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| What dermatomes serve the medial leg? | L3 and L4
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| What dermatome serves the lateral leg? | L5
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| From what spinal nerves does the posterior leg receive cutaneous innervation from? | S1 and S2
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| What nerves provide dorsiflexion? | L4 and L5
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| What nerves provide plantar flexion? | S1 and S2
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| What nerves provide inversion? | L4 and L5 nerve fibers
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| What nerve provide eversion? | L5 and S1
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| Describe the course of the popliteal artery at the inferior end of the popliteal fossa. | Passes through the tendinous arch of the soleus muscle and divides into anterior and posterior tibial arteries
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| Describe the course of the anterior tibial artery. What does it supply on its course? | Passes through small opening in the superior end of the interosseous membrane; passes distally in anterior compartment supplying the contents of anterior compartment; turns into dorsalis pedis artery and supplies dorsum of foot
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| Describe the course of the posterior tibial artery. What does it supply on its course? | Passes distally deep to the transverse intermuscular septum; supplies posterior compartment, the tibia through a nutrient artery, and distally becomes principal supply to foot
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| Where does the fibular artery originate? | Near the origin of the posterior tibial artery
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| Describe the course of the fibular artery. What does it supply? | Passes inferiorly along posterior surface of fibula supplying deep compartment and lateral compartment muscles and blood to the fibula; terminates by providing blood to ankle and foot
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| How do deep veins receive blood from superficial veins? | Through perforating veins
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| How is blood moved centrally from deep veins? | By compressive forces when the leg muscles contract within the tightly fitting crural fascia as well as by arterial compressions
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| What do the deep lymph channels of the leg follow? Where do they end up? | Venous drainage to popliteal nodes
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| Describe the course by which the superficial lymph drains. | Follows small saphenous vein to popliteal nodes and then along channels and nodes close to femoral vein or along channels near the great saphenous vein and to superficial inguinal lymph nodes
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| What is the arrangement of structures from anterior to posterior in the area posterior to the medial malleolus? | (Hint: Tom, Dick, ANd Harry); Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, tibial nerve, and flexor hallucis longus tendon
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| What overlies the structures located in the area posterior to the medial malleolus? | CT flexor retinaculum
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| What is the arrangement of structures on the anterior surface of the ankle from medial to lateral? | (Hint: Tom Helps A Nurse Downtown); Tibialis anterior tendon, extensor hallucis longus tendon, anterior tibial artery, deep fibular nerve, and extensor digitorum longus tendons
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| What is the diamond-shaped space posterior to the knee? | Popliteal fossa
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| What are the superior boundaries to the popliteal fossa (laterally and medially)? | Biceps femoris laterally and semimembranosus medially
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| What are the inferior boundaries to the popliteal fossa? | Medial and lateral heads of the gastrocnemius
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| What forms the floor of the popliteal fossa? | Capsule of the knee joint, popliteus muscle, and distal femur
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| What is the roof of the popliteal fossa? | Fascia and skin
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| What appears most superficially at the upper apex of the popliteal fossa? | Sciatic nerve - usually branches into tibial and common fibular nerves within fossa
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| The popliteal vein passes superiorly through the adductor hiatus and continues as the femoral vein; What usually joins the popliteal vein in the fossa? | Small saphenous vein
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| What lies deep to the vein in the popliteal fossa? | Popliteal artery
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| Where does the popliteal artery divide into its terminal branches? | Inferior to the fossa
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| What are the branches of the popliteal artery near the popliteal fossa? | Five genicular arteries
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| What is the small muscle that arises from lateral end of femur, just superior to lateral head of gastrocnemius and crosses the fossa medially partly under cover of gastrocnemius, and its tendon merges with the calcaneal tendon? | Plantaris muscle
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| What is the small muscle that lies deep to the fossa? It attaches to posterior tibia just inferior to medial condyle and passes obliquely through the knee joint capsule to attach to the lateral condyle of femur. | Popliteus muscle
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| What is the function of poplieus? | "Unlocks" the knee when going from standing with the knee extended to knee flexion
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| What is dorsiflexion? | Moving foot superiorly
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| What is plantar flexion? | Movement of foot inferiorly
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| What is inversion of ankle? | Movement of plantar surface to face medially
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| What is eversion? | Movement of plantar surface to face laterally
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