Anatomy Limbs Notes

Limbs Foot Pathway Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 17:18:00 +0000

Pathways to the Foot

Blood Supply

Aorta  descending aorta  common iliac  external iliac  through femoral sheath  femoral artery  popliteal 

Anterior tibial artery  dorsalis pedis artery  dorsum of foot
Posterior tibial artery  plantar arteries  plantar aspect of foot

Blood Drainage

Medial foot  great saphenous vein  femoral vein  external iliac  common iliac  IVC
Lateral foot  lesser saphenous vein  popliteal  femoral  external iliac  common iliac  IVC

Nerve supply

Afferent

Somatic

Dorsum of foot skin and muscles  superficial and deep peroneal nerves  common peroneal  sciatic nerve  over piriformis muscle  through greater sciatic foramen lumbosacrial plexus L4-S3  posterior division  dorsal roots  spinal cord

Autonomic

N/A

Efferent

Somatic

Spinal cord  ventral roots of lumbar/sacral plexus  sciatic nerve 
Anterior division  tibial nerve  plantar nerves (flex toes)
Posterior division  peroneal nerve 

Superficial peroneal  dorsum of foot
Deep Peroneal nerve  dorsum of foot

Autonomic

Sympathetic

IML  ventral roots  ventral rami of lumbar/sacral plexus  white rami  Lumbar/sacral plexus of sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  lumbar sacral plexus 

Sciatic nerve posterior division  common peroneal nerve  dorsum of foot
Sciatic nerve anterior division  tibial nerve  plantar nerves  plantar of foot

Limbs Lower Leg Pathways Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 17:17:00 +0000

Pathways of the Lower Leg

Blood Supply

Aorta  Descending aorta  common iliac  external iliac  femoral sheath  femoral  popliteal

Superior and inferior geniculate branches
Anterior tibial  anterior muscles
Posterior tibial  posterior muscles and skin

Blood Drainage

Anterior tibial  popliteal  femoral
Great saphenous  femoral
Posterior vein  popliteal  femoral
Lesser saphenous  popliteal  femoral
Femoral  femoral sheath  external iliac  common iliac  IVC  RA

Nerve Supply

Afferent

Somatic

Medial skin  saphenous nerve  around medial epicondyle of femur  under sartorius muscle  femoral nerve  behind inguinal ligament lateral to psoas major an medial to lateral cutaneous nerve  lumbar plexus  L2,3,4  dorsal roots  spinal cord
Lateral skin and muscles of anterior and posterior  sciatic nerve  lumbar/sacral plexus  L4-S3  dorsal roots  spinal cord

Autonomic

N/A

Efferent

Somatic

Spinal cord  ventral roots  lumbar/sacral plexus  L4-S3 

Anterior division  tibial nerve  posterior muscles of the leg
Posterior division  common peroneal nerve  superficial and deep peroneal nerves  muscles of anterior leg

Autonomic

Sympathetic

IML  ventral root  ventral rami of LS plexus  white rami  LS plexus of sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  LS plexus 

Femoral nerve  saphenous  skin of medial leg
Sciatic nerve 

Anterior division  tibial nerve  posterior skin of leg
Posterior division  common peroneal  superficial peroneal and lateral sural  anterior muscles and lateral skin

Limbs Thigh Pathways Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:55:00 +0000

Pathways to the Thigh

Blood Supply

Aorta  descending aorta  common iliac  external iliac  femoral sheath  femoral  deep femoral  thigh muscles

Blood Drainage

Femoral vein and Great saphenous vein  femoral sheath  external iliac  common iliac  IVC

Nerve Supply

Afferent

Somatic

Upper anterior thigh  femoral branch of genitofemoral nerve  genitofemoral nerve  lateral to femoral sheath and behind the inguinal ligament  lumbar plexus  L12  dorsal roots  spinal cord
Anterior thigh  femoral nerve  L234  dorsal roots  spinal cord
Medial thigh  obturator nerve L234  dorsal root  spinal cord
Lateral thigh  lateral femoral cutaneous  L23 dorsal root  spinal cord
Posterior thigh  posterior cutaneous nerve of the thigh  S123  dorsal root  spinal cord

Autonomic

N/A

Efferent

Somatic

Lumbar spinal cord  ventral roots  LS plexus 

Sciatic nerve  posterior muscles
Obturator nerve  skin of the medial thigh and adductor muscles
Femoral nerve  muscles of the anterior thigh

Autonomic

Sympathetic

IML  ventral roots  ventral ramus of LS plexus  white rami  LS plexus of sympathetic ganglion  Ach synapse  gray rami  LS plexus  same divisions as afferent except reversed and to the vasomotor of skin and muscles of thigh

Limbs Forearm Pathways Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:54:00 +0000

Pathways to the Forearm

Blood Supply

Aorta  L subclavian or brachiocephalic to R subclavian  axillary  below teres major  brachial artery 

Ulnar  posterior arm, medial wrist and hand
Radial  anterior arm, lateral wrist  over styloid process to anatomical snuff box between extensor palmaris longus and brevis  hand

Blood Drainage

Cephalic from lateral wrist
Basilic from medial wrist
Cephalic and basilic merge with intermediate antebrachial  axillary  subclavian  brachiocephalic  SVC

Nerve Supply

Afferent

Somatic

Musculocutaneous nerve from lateral skin and anterior muscles  lateral cord  superior and middle trunks  C4-C7  dorsal roots  spinal cord
Medial cutaneous of the forearm  lateral cord  superior and middle trunks  C4 – C7  dorsal roots  spinal cord
Radial nerve from the posterior muscles and skin  Posterior cord  superior, middle, and inferior trunks  C4- T1  dorsal roots  spinal cord
Ulnar nerve to flexors  medial cord  inferior trunk  C8-T1  dorsal roots  spinal cord
Median nerve to flexors 

Medial cord  inferior trunk
Lateral cord  superior and medial trunks
Trunks  C4-T1  dorsal roots  spinal cord

Autonomic

N/A

Efferent

Somatic

Spinal cord  C4-T1  ventral roots  brachial plexus 

Superior and middle trunks  lateral cord 

Musculocutaneous nerve  medial skin and muscles of forearm
Median nerve  flexors of the forearm

Superior, Middle, and Inferior Trunks  posterior cord 

Radial nerve  extensors of the posterior fore arm

Inferior trunk  medial cord 

Median nerve  flexors of the forearm
Ulnar nerve  flexors in the forearm

Autonomic

Sympathetic

IML  ventral roots  ventral rami of cervical spinal nerves  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  cervical spinal nerves  brachial plexus 

Musculocutaneous to lateral skin and anterior muscles (lateral cord)
Medial cutaneous of the forearm (medial cord)
Radial nerve to posterior skin and extensors (posterior cod)
Ulnar nerve to flexors (medial cord)
Median nerve to flexors (medial cord or lateral cord)
All of the above  dorsal roots  spinal cord

Limbs Arm Pathways Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:53:00 +0000

Pathways of the Arm

Blood Supply

Aorta  aortic arch  L subclavian or brachiocephalic to R subclavian  axillary  brachial

Ulnar collaterals
Deep brachial

Middle collateral
Radial collateral

Blood Drainage

Basilic or cephalic  axillary  subclavian  brachiocephalic  SVC  RA

Nerve Supply

Afferent

Somatic

Posterior and lateral arm via the radial nerve  posterior cord  superior, middle, and inferior trunks  C4-T1  dorsal roots  spinal cord
Anterior arm via medial cutaneous of the fore arm  medial cord  inferior trunk  C8-T1
Medial arm via medial cutaneous of arm  medial cord  inferior trunk  C8-T1

Autonomic

N/A

Efferent

Somatic

Spinal cord C4-T1  ventral roots  brachial plexus 

Superior and middle trunks  lateral cord  musculocutaneous  muscles of anterior arm

Autonomic

Sympathetic

IML of spinal cord  ventral roots  ventral rami of cervical plexus  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  ventral rami of brachial plexus 

Superior and middle trunks  lateral cord

Musculocutaneous  anterior muscles

Superior, middle and inferior trunks  posterior cord  radial nerve  posterior and lateral muscles, skin
Inferior trunk  medial cord

Medial cutaneous of forearm  anterior skin
Medial cutaneous of arm  medial skin

Limbs Posterior Shoulder Pathways Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:52:00 +0000

Pathways to Posterior Shoulder

Blood Supply

Aorta  aortic arch  L subclavian or brachiocephalic to R subclavian 

Dorsal scapular  medial scapula
Thyrocervical trunk  suprascapular  supra and infraspinatus fossa
Axillary third part 

Posterior circumflex humoral  upper arm
Subscapular  circumflex scapular  infraspinatus fossa

Blood Drainage

Posterior circumflex humoral  basilic  axillary  subclavian  brachiocephalic  SVC

Nerve Supply

Afferent

Somatic

Supra and infraspinatus fossa  suprascapular nerve  superior trunk  C5-6  dorsal roots  spinal cord
Deltoid muscle  axillary nerve posterior cord  superior, middle, and inferior trunks  C4-T1  dorsal roots  spinal cord

Autonomic

N/A

Efferent

Somatic

Same as afferent except reverse order

Autonomic

Sympathetic

IML  ventral root 

Ventral rami of cervical spinal nerves  cervical sympathetic ganglion  gray rami  brachial plexus 

Axillary nerve
Suprascapular nerve (superior trunk)

Ventral rami of cervical spinal  cervical sympathetic ganglion  gray rami  dorsal rami  dermatomes C6-T1

Limbs Anterior Shoulder Pathway Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:51:00 +0000

Pathways to Anterior Shoulder

Blood Supply

Aorta  aortic Arch  L subclavian or brachiocephalic to R subclavian 

Axillary first part

Superior thoracic
Axillary second part

Thoracoacromial

Deltoid
Pectoral
Acromial
Clavicular

Lateral thoracic
Axillary third part

Subscapular  thoracodorsal
Anterior circumflex humoral
Brachial after teres major

Blood Drainage

Cephalic vein or basilic vein  axillary  subclavian  brachiocephalic  SVC

Nerve Supply

Afferent

Somatic

Reversal of efferent somatic except through dorsal root

Autonomic

N/A

Efferent

Somatic

Spinal cord  ventral roots  brachial plexus

Pectoral nerve  pectoralis muscle
Axillary nerve  deltoid muscle

Autonomic

Sympathetic

IML  ventral roots  ventral rami of brachial plexus  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fibers  gray rami 

Cervical plexus  supraclavicular nerve  skin of upper shoulder
Brachial plexus 

Pectoral nerves
Axillary nerve

Limbs Cutaneous Innervation of the Lower Limb Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:50:00 +0000

Cutaneous Innervation of the Lower Limb

Thigh

Anterior

Upper

Genitofemoral (L12)  femoral branch  behind inguinal ligament  through femoral ring

Lower

Femoral nerve (L234)  lateral to psoas muscle behind inguinal ligament  anterior cutaneous branches

Limbs Lumbosacral Plexus Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:49:00 +0000

Describe the Lumbar and Sacral Plexus

Lumbar Plexus

T12 – L5
T12

Subcostal nerve

Lateral and anterior cutaneous branches

Iliohypogastric

Lateral and anterior cutaneous branches

Ilioinguinal

Spermatic cord and anterior scrotum

Genitofemoral L12

Genital branch to genitals via inguinal canal
Femoral branch to upper anterior thigh via femoral sheath

Lateral femoral cutaneous L23

Obturator nerve (Anterior division) L234

Adductor longus
Adductor brevis
Adductor magnus
Obturator internus

Femoral Nerve L234

Sartorius
Gracious
Quad muscles
Patella and medial cutaneous skin

Lumbosacral trunk L45

Sacral Plexus

Sciatic nerve

Posterior division L45S12

Superior gluteal nerve over pyriformis

Gluteal minimus
Gluteal medius

Inferior gluteal nerve under pyriformis

Gluteal maximus

Common peroneal nerve

Short head biceps femoris
Knee joint
Peroneus longus
Extensor digitorum longus
Tibialis anterior
Peroneus brevis
Extensor hallicis longus
Dorsum and lateral foot

Anterior division L45S123

Tibial nerve

Gastrocnemius
Flexor digitorum longus
Tibialis posterior
Flexor hallicis
Anterior and lateral plantar foot

Posterior Femoral Cutaneous S123
Pudendal S234

Limbs Muscles of Lower Extremity Notes

noreply@blogger.com (Anonymous) — Thu, 07 Mar 2013 16:48:00 +0000

Describe the Muscles that Move the Thigh, Leg, and Foot

Thigh

Iliacus

Iliac fossa  lesser trochanter of the femur
Flexes hip

Psoas

T12-L4  lesser trochanter of the femur
Flexes hip

Sartorius

Anterior superior iliac spine  pes anserine
Flexes and laterally rotates

Rectus Femoris

Ilium  patella  tibia
Flexes

Gracilis

Inferior pubic ramus  pes anserine
Adducts

Adductor longus

Medial pubis  linea alba
Adducts

Adductor brevis

Medial pubis  linea alba
Adducts

Adductor magnus

Inferior pubic ramus  linea alba
Adducts and extends

Biceps femoris long head

Ischial tuberosity  head of fibula
Extends thigh

Semitendinosus

Ischial tuberosity  pes anserine
Extends

Semimembranosus

Ischial tuberosity  pes anserine
Extends Thigh

Leg

Rectus Femoris

Ilium  patella
Extend

Vastus Lateralis

Femur  patella
Extends

Vastus medialis

Femur  patella
Extends

Vastus intermedialus

Femur  patella
Extends

Biceps femoris long head

Ischial tuberosity  head of the fibula
Flex and laterally rotate

Semitendinosus

Ischial tuberosity  medial tibia
Flexes and medially rotates

Semimembranosus

Ischial tuberosity  medial tibia
Flexes and medially rotates

Foot

Tibialis Anterior

Anterior tibia  inferior medial cuneiform
Extends

Extensor digitorum

Interosseous membrane  2-5 phalanges
Extends

Extensor hallicis

Fibular and interosseous membrane  First phalange
Extends

Peroneus longus and brevis

Lateral fibula  fifth metatarsal
Plantar flexion

Gastrocnemius

Medial head (medial condyle) lateral head (lateral condyle)  calcaneal tuberosity
Plantar flexion

Soleus

Posterior superior tibia and fibula  calcaneal tuberosity
Plantar flexion

Flexor digitorum

Posterior fibula  phalanges 2-5
Flex

Flexor hallicis

Posterior fibula  first phalange
Flex big toe