Lower Quiz #2
Terms
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- Definitin of SUPERFICIAL FASCIA
- the subcutaneous layer, immediately deep to the skin/cutaneous layer composed of loose connective tissue and adipose (fat) tissue
- Contents of superficial fascia
- superficial veins, superficial lymph nodes and lymph vessels, and cutaneous nerves
- Superficial Veins
-
-carry blood from inferior to superior
-can generally be seen through the skin
-in athletes, many bulge beneath the skin
-in general, pass superficial to the cutaneous nerves - Common Dorsal Digital Veins
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-There are 8
-collect blood from the toe
-labelled medially to laterally
-drain into the dorsal metatarsal veins - Names of Proper Dorsal Digital Veins
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-Proper Dorsal Digital Vein of the Hallux
-Proper Dorsal Digital Vein of the 5th Toe - Proper Dorsal Digital Vein of the Hallux
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-drains from the dorsomedial aspect of the hallux and 1st metatarsophalangeal joint
-becomes the medial marginal vein - Proper Dorsal Digital Vein of the 5th Toe
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-drains from the dorsolateral aspect of the 5th toe and 5th metatarsophalangeal joint
-becomes the lateral marginal vein - Name of Marginal Veins
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Medial Marginal Vein
Lateral Marginal Vein - Medial Marginal Vein
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-drains from the medial border of the forefoot and the proper dorsal digital vein of the hallux
-drains into the great saphenous vein - Lateral Marginal Vein
-
-drains from the lateral border of the forefoot and the proper dorsal digital vein of the 5th toe
-drains into the small saphenous vein - Dorsal Metatarsal Veins
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-There are 4
-one for each intermetatarsal space
-label as 1 through 4 from medial to lateral
-each receives blood from 2 adjacent common dorsal digital veins and two
perforating branches from deep layers of the foot
-drain into the dorsal venous arch - Dorsal Venous Arch
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- passes across the dorsum of the foot often at the level of the metatarsal bases
- receives blood from dorsal metatarsal veins and sometimes the proper dorsal
digital veins
- drains into the great saphenous vein, medially and the small saphenous vein,
laterally - Small Saphenous Vein
-
-begins as the union of the lateral end of the dorsal venous arch and the lateral marginal vein (or the proper dorsal digital vein of the fifth digit), then passes posterior to the lateral malleolus at the ankle region
- travels superiorly near the midline of the leg, at the posterior aspect, to the popliteal area where it passes through the deep fascia to join the popliteal vein, which is part of the deep venous system - Great Saphenous Vein
-
- begins as the union of the medial part of the dorsal venous arch and the
medial marginal vein (or the proper dorsal digital vein of the hallux), then
passes anterior to the medial malleolus at the ankle region
- travels superiorly at the medial aspect of the leg, passes posteromedially along the popliteal surface (usually about 1 hand breadth posterior to the medial edge of the patella) and continues in a superolateral direction to the groin where it passes through the saphenous opening/fossa ovalis in the
deep fascia to join the femoral vein which is part of the deep venous system - Superficial Plantar Venous Network
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- very thin intradermal and subdermal veins without valves
- drain into medial and lateral marginal veins or into dorsal digital veins through perforating branches - Inguinal Lymph Nodes
-
-located in the inguinal region, groin (where the thigh meets the hip)
- organized as 3 groups
-Superficial Inguinal Lymph Nodes
-Horizontal Group
-Vertical Group
-Deep Inguinal Lymph Nodes - Classifications of Superficial Inguinal Lymph Nodes
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Horizontal Group
Vertical Group - Horizontal Group of Superficial Inguinal Lymph Nodes
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- lie along the inguinal ligament
- drains the superficial areas of the inferior abdominal wall and a small
area of the proximal anterior thigh - Vertical Group of Superficial Inguinal Lymph Nodes
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- lie along the great saphenous vein near its termination and the fossa
ovalis
- drains from the superficial areas of the thigh, leg and foot except the
posterolateral aspect of the leg and the lateral aspect of the foot - Deep Inguinal Lymph Nodes
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- palpable only when inflamed
- lie deep to the deep fascia, along the femoral vein near its termination
- not in the subcutaneous layer
- drain the deep tissues of the lower limb (tissues deep to the deep fascia)
- efferent vessels pass to the external iliac lymph nodes in the pelvis - Popliteal Lymph Nodes
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- palpable only when inflamed
- lie along the small saphenous vein near its termination and deep to the
popliteal fascia
- drain the posterolateral aspect of the leg and the lateral aspect of the foot
- efferent vessels pass to the deep inguinal lymph nodes - Anterior Tibial Lymph Node
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- usually one or two
- lie near the proximal end of the anterior tibial artery near the interosseous membrane, deep to the muscles here
- efferent vessels pass to the deep inguinal lymph nodes - Subcutaneous Pedal Infections
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- an infection of the 5th toe will generally cause inflammation of the popliteal lymph nodes first, then inflammation of the deep inguinal lymph nodes
- an infection of the hallux will generally cause inflammation of the vertical superficial inguinal lymph nodes first, and this may pass to the deep inguinal lymph nodes, but definitely will pass to the external iliac lymph nodes - Deep Pedal Infections
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- from any area, will create inflammation of the deep inguinal lymph nodes
- from dorsum of foot, will generally create inflammation of the anterior tibial lymph node
- from planta of foot and calcaneal region, will generally create inflammation of the popliteal lymph nodes - What makes up Cutaneous Nerves?
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-are nerves that exit the deep fascia and travel in the superficial fascia to supply the skin, sensory and autonomic sympathetic fibers
- all are from ventral rami except where noted
- know the levels - List of Cutaneous nerves on the anterior side.
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-Subcostal Nerve, T-12
-Femoral Branch of the Genitofemoral Nerve, L-1 & L-2
-Ilioinguinal Nerve, L-1
-Lateral Femoral Cutaneous Nerve, L-2 & L-3
-Intermediate Femoral Cutaneous Nerve, L-2 & L-3
-Medial Femoral Cutaneous Nerve, L-2 & L-3
-Obturator Nerve, L-2, L-3 & L-4
-Lateral Cutaneous Nerve of the Calf, L-5, S-1 & S-2
-Saphenous Nerve, L-3 & L-4
-Superficial Fibular Nerve / Superficial Peroneal Nerve, L-4, L-5 & S-1
-Deep Fibular Nerve / Deep Peroneal Nerve, L-5, S-1 & S-2
-Medial Calcaneal Nerve, S-1 & S-2
-Sural Nerve, S-1 & S-2 - Subcostal Nerve
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T-12
- exits the deep fascia anterior to the iliac tubercle (lateral aspect of the hip)
- supplies a small area at the anterolateral aspect of the thigh just inferior to
the groin
- cutaneous supply only in lower extremity - Femoral Branch of the Genitofemoral Nerve
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L-1 & L-2
- passes deep to the inguinal ligament and exits the deep fascia near the
fossa ovalis
- supplies a small area at the anterior thigh just inferior to the groin and
medial to subcostal nerve distribution - Ilioinguinal Nerve
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L-1
- exits the deep fascia through the superficial inguinal ring (with the
spermatic cord or round ligament of uterus)
- supplies a small area at the medial aspect of the thigh just inferior to
the groin - Lateral Femoral Cutaneous Nerve
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L-2 & L-3
- also called the lateral cutaneous nerve of the thigh
- exits the deep fascia near the anterior aspect of the iliac crest
- supplies the anterolateral aspect of the thigh (from the subcostal nerve
distribution to the knee) - Intermediate Femoral Cutaneous Nerve
-
L-2 & L-3
- also called the intermediate cutaneous nerve of the thigh
- sometimes replaced by the femoral branch of the genitofemoral nerve or
branches of the lateral femoral cutaneous nerve
- exits the deep fascia through the sartorius muscle lateral to the fossa ovalis
- supplies the anterior aspect of the thigh (from the ilioinguinal and
genitofemoral nerve distributions to the knee) - Medial Femoral Cutaneous Nerve
-
L-2 & L-3
- also called medial cutaneous nerve of the thigh
- exits the deep fascia inferolateral to the fossa ovalis
- supplies the anteromedial aspect of the thigh (from the ilioinguinal nerve
distribution to the knee) - Obturator Nerve
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L-2, L-3 & L-4
- exits the deep fascia at the medial aspect of the thigh near the junction of
the proximal and middle thirds
- supplies the central part of the medial aspect of the thigh (from the
ilioinguinal nerve distribution to the inferior 1/3) - Lateral Cutaneous Nerve of the Calf
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L-5, S-1 & S-2
- also called the lateral sural nerve
- exits the deep fascia at the posterolateral edge of the knee region
- supplies the lateral 1/2 of the leg from the knee to the inferior 1/3 leg - Saphenous Nerve
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L-3 & L-4
- supplies a small area of the medial longitudinal arch of the foot, plantarly - Superficial Fibular Nerve / Superficial Peroneal Nerve
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L-4, L-5 & S-1
- courses inferomedially and divides just proximal to the ankle - Deep Fibular Nerve / Deep Peroneal Nerve
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L-5, S-1 & S-2
- exits the deep fascia at the 1st webspace
- supplies the 1st web space and the adjacent sides of the 1st and 2nd toes - Medial Calcaneal Nerve
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S-1 & S-2
- small branches which supply the medial ½ of the calcaneal region - Sural Nerve
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S-1 & S-2
- supplies a small area of the lateral longitudinal arch of the foot, plantarly - List of Cutaneous Nerves of the Posterior View
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- Iliohypogastric Nerve, L-1
- Superior Cluneal Nerves, dorsal rami of L-1, L-2 & L-3
- Middle Cluneal Nerves, dorsal rami of S-1, S-2 & S-3
- Posterior Femoral Cutaneous Nerve, S-1, S-2 & S-3, (inferior cluneal nerves)
- Perforating Cutaneous Nerve, S-2 & S-3
- Obturator Nerve, L-2, L-3 & L-4
- Medial Femoral Cutaneous Nerve, L-2 & L-3
- Lateral Femoral Cutaneous Nerve, L-2 & L-3
- Saphenous Nerve, L-3 & L-4
- Lateral Cutaneous Nerve of the Calf, L-5, S-1 & S-2
- Sural Nerve, S-1 & S-2, (lateral cacaneal nerves are a branch)
- Superficial Fibular Nerve/Superficial Peroneal Nerve
- Medial Plantar Nerve, L-4 & L-5
- Lateral Plantar Nerve, S-1 & S-2
- Medial Calcaneal Nerve, S-1 & S-2
- Lateral Calcaneal Nerves, S-1 & S-2
- - Iliohypogastric Nerve
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L-1
- exits the deep fascia near the lateral aspect of the iliac crest
- supplies the superoposterolateral area of the gluteal skin, small area - Superior Cluneal Nerves
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dorsal rami of L-1, L-2 & L-3
- also called the superior cutaneous nerves of the gluteal region
- exit the deep fascia at the posterior aspect of the iliac crest
- supply skin of superolateral aspect gluteal region - Middle Cluneal Nerves
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dorsal rami of S-1, S-2 & S-3
- also called the middle cutaneous nerves of the gluteal region
- exit the deep fascia over the sacrum
- supply skin of the medial aspect gluteal region - Posterior Femoral Cutaneous Nerve
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S-1, S-2 & S-3
- main branch passes inferiorly along the anterior aspect of the fascia lata
- small branches from the main branch exit the deep fascia all along the
posterior aspect of the thigh, popliteal and calf regions
- supplies the inferior gluteal region, the posterior aspect of the thigh, the
popliteal fossa and the superior central aspect of the calf - inferior cluneal nerves
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-branch of posterior femoral femoral cutaneous nerve
-supply the inferior area of the gluteal region
- exit the deep fascia at the gluteal fold - Perforating Cutaneous Nerve
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S-2 & S-3
- branch from the sacral plexus
- exits deep fascia at the inferomedial aspect of the gluteal region
- supplies the inferomedial gluteal area skin - lateral cacaneal nerves
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- branches of the sural nerve
- arises in the superficial fascia between the calf and the ankle
- supplies the lateral ½ of heel; laterally, plantarly and posteriorly - Medial Plantar Nerve
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L-4 & L-5
- small branches exit the deep fascia along the medial 2/3 of the plantar
midfoot and forefoot
- supplies the plantar medial aspect of the foot from just distal to the heel to
the medial 3½ toes - Lateral Plantar Nerve
-
S-1 & S-2
-passes along the plantar midfoot deep to the deep fascia, sends cutaneous
branches to the skin and divides
-has three branches - List of cutaneous nerves of the dorsum of the foot
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- Superficial Fibular Nerve / Superficial Peroneal Nerve, L-4, L-5 &S-1
- Lateral Dorsal Cutaneous Nerve, S-1 & S-2
- Deep Fibular Nerve / Deep Peroneal Nerve, L-5, S-1 & S-2
- Saphenous Nerve, L-3 & L-4
- plus branches of all of these nerves - Medial Dorsal Cutaneous Nerve
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- the medial division of the superficial fibular nerve
- passes anterior to the ankle near the center and is palpable here
- supplies the medial part of the dorsal midfoot, then divides
- aids in supply to 1st webspace - Proper Dorsal Digital Nerve 1
- innervates the dorsomedial aspect of the hallux
- 1st Common Dorsal Digital Nerve
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- the lateral branch, passes in the 2nd intermetatarsal space dorsally and
divides to supply the adjacent sides of the 2nd and 3rd toes as Proper
Dorsal Digital Nerves 4 and 5, respectively - 2nd Common Digital Plantar Nerve
-
- passes in the area of the 2nd intermetatarsal space, plantarly
- exits the deep fascia at the level of the metatarsal necks
- supplies this area and adjacent sides of the 2nd and 3rd toes as the
Proper Digital Plantar Nerves 4 and 5, respectively - 3rd Common Digital Plantar Nerve
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- passes in the area of the 3rd intermetatarsal space, plantarly
- exits the deep fascia at the level of the metatarsal necks
- supplies this area and adjacent sides of the 3rd and 4th toes as the
Proper Digital Plantar Nerves 6 and 7, respectively - Communicating Branch of Lateral Plantar Nerve
- - a medial branch which joins the 3rd common digital plantar nerve
- 4th Common Digital Plantar Nerve
-
-passes in the area of the 4th intermetatarsal space, plantarly
- exits the deep fascia at the level of the metatarsal necks
- supplies this area and adjacent sides of the 4th and 5th toes as the
Proper Digital Plantar Nerves 8 and 9, respectively - Proper Digital Plantar Nerve 10
-
- passes along the lateral forefoot, plantarly, exiting the deep fascia near
the distal 5th metatarsal shaft
- supplies this area of the forefoot and the plantar lateral aspect of the
5th toe - Lateral Calcaneal Nerves
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S-1 & S-2
- small branches of the sural nerve which supply the lateral 1/3 to 1/2 of the calcaneal region - Definition of Deep Fascia
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- dense connective tissue layer that surrounds muscles and attaches to many bony prominences and structures
- deep fascia is continuous from one region to the next - Definition of Retinaculum
-
-thickening of the deep fascia that holds soft tissue structures
in place (ex. tendons) - Fascia Lata
-
deep fascia of the thigh
has two parts
- iliotibial band / iliotibial tract
- cribriform fascia - Iliotibial (IT) Band / Iliotibial Tract
-
- thickening of the fascia lata at lateral aspect of the thigh
- provides partial origin or insertion site for several muscles
- often visible at lateral edge of extended knee; especially in athletes - Cribriform Fascia
- - very thin area of the fascia lata over the fossa ovalis / saphenous opening near the groin
- Fascia Cruris
-
- deep fascia of the leg region
- aids in forming several retinacula near ankle - Popliteal Fascia
- - deep fascia of the popliteal region
- Fascia Dorsalis Pedis
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- deep fascia of the superior aspect of the foot
- aids in forming several retinacula near ankle - Plantar Fascia
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- deep fascia of the inferior aspect (sole) of the foot, a complex structure
- several layers, some fibers attach to skin at all points along the plantar foot
- aids in forming the retinacula near the ankle - Flexor Retinaculum / Laciniate Ligament
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- thickening of fascia cruris, fascia dorsalis pedis and plantar fascia
- attaches to the distal posterior aspect of the medial malleolus and to the medial aspect of the calcaneus
- holds flexor tendons of the foot and creates a pulley to improve the muscle
function
- all tendons pass through the retinaculum and have separate tendon sheaths here - List of Deep Fascia
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- Fascia Lata
- Iliotibial (IT) Band / Iliotibial Tract
- Cribriform Fascia
- Fascia Cruris
- Popliteal Fascia
- Fascia Dorsalis Pedis
- Plantar Fascia - List of Retinacula
-
- Flexor Retinaculum / Laciniate Ligament
- Superior Extensor Retinaculum / Transverse Crural Ligament
- Inferior Extensor Retinaculum / Cruciate Crural Ligament
- Fibular Retinaculum / Peroneal Retinaculum / External Annular Ligament
- Superior Fibular Retinaculum / Superior Peroneal Retinaculum
- Inferior Fibular Retinaculum / Inferior Peroneal Retinaculum - Superior Extensor Retinaculum
- Transverse Crural Ligament
- Characteristics of Superior Extensor Retinaculum / Transverse Crural Ligament
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- thickening of fascia cruris
- attaches to the distal tibial shaft and to the distal fibular shaft, anteriorly
- fibers are continuous with the flexor and superior fibular retinacula
- holds extensor tendons of the foot and maintains their positions near the tibia
- only one tendon sheath at this level; for the tibialis anterior muscle
- all tendons pass deep to the retinaculum - Inferior Extensor Retinaculum
- Cruciate Crural Ligament
- Characteristics of Inferior Extensor Retinaculum / Cruciate Crural Ligament
-
- Y-shaped band with the stem laterally
- thickening of fasciae cruris and dorsalis pedis
- attaches to the distal anterior medial malleolus and the medial plantar medial cuneiform, then to the lateral talus (neck) and the superior aspect of the calcaneus (in the sinus tarsi); described with 3 roots and 7 sinus tarsi
attachments
- continuous with the inferior fibular retinaculum
- all tendons have tendon sheaths at this level and pass through this retinaculum
- frondiform ligament - the stem of the inferior extensor retinaculum, attaches in the sinus tarsi - frondiform ligament
- the stem of the inferior extensor retinaculum, attaches in the sinus tarsi
- Fibular Retinaculum
- Peroneal Retinaculum / External Annular Ligament
- Fibular Retinaculum / Peroneal Retinaculum / External Annular Ligament
-
- really 2 separate retinacula
- thickening of fasciae cruris and dorsalis pedis
1. Superior Fibular Retinaculum / Superior Peroneal Retinaculum
2. Inferior Fibular Retinaculum / Inferior Peroneal Retinaculum - Intermuscular Septae
-
- extensions of deep fascia that attach to bone and separate muscles or groups of muscles
- muscles often take partial origin from or partially insert onto septae
- in the leg, these septae aid in venous return (venous pump); there is little elasticity of the septae and muscular action creates compression on the deep veins which forces fluids superiorly (the valves normally prevent inferior flow), the empty deep veins refill from the superficial veins and so on - Nail Plate
-
- body of the nail (main part), normally .5 - .75 mm thick in an adult
- is a hardening of the epidermis
- cells have no nuclei, therefore are transparent, so can see the capillary bed
- function: protect the distal end of the digit / toe - Matrix
-
- "root" of the nail
- specialized cells within the roof and floor of the proximal nail fold
- attached to the base of the distal phalanx
- extends ~= 5 mm proximal to visible nail edge
- function: produce nail plate - Eponychium / Proximal Nail Fold
-
- the skin fold at the proximal edge of the nail plate
- overlies the matrix - Cuticle
-
- small ridge of transparent skin dorsal to the proximal edge of the nail plate which is continuous with the eponychium
- creates a seal around the nail
- function: prevent infection by sealing the area adjacent to the nail plate - Nail Bed
-
- skin directly beneath and attached to the nail plate, contains some nail-
forming cells; the cells that are attached to the nail plate migrate distally and are shed at the free edge of the nail
- from matrix and lunula to the hyponychium
- function: anchor the nail plate and allow its distal growth
- sensory innervation to the nail bed is variable and may be entirely from the
proper digital plantar nerves or from the plantar and dorsal proper digital
nerves; therefore, you must take care when anesthetizing (blocking) digits for
for nail procedures
- it is safest to anesthetize both sets of nerves - Lunula
-
- the small pale half-moon-shaped area near the eponychium; whitish because
the cells retain nuclei and the capillaries beneath this portion of the nail plate are not visible
- function: produce nail - Free Edge of the Nail Plate
-
- distal edge of nail plate that overhangs the toe
- function: protect the distal tuft of the digit from blunt trauma (being smashed) - Hyponychium
- - the thickened skin adjacent to the free edge of the nail plate
- Distal Nail Groove
-
- the shallow transverse groove between the hyponychium and the skin of the
distal tuft of the toe - Lateral Nail Folds
-
Ungualabia
- the convex skin fold at the sides of the nail plate
- after a successful permanent nail procedure the lateral nail folds will about the remaining nail plate - Lateral Nail Grooves
- - the concave junction of the lateral nail fold with the nail bed
- Beau's Line
-
transverse ridge
- caused during illnesses because of the large amount of protein synthesis that needs to take place to form a nail. - Cause of transverse ridge
- illness (Beau's Line)
- Cause of Longitudinal ridges
- mechanical damage to the matrix cells
- Cause of little white spots on the nail
- cells still have nucei due to minor disturbance in growth.
- Growth of Nails
-
- nails grow primarily from the matrix and the proximal nail bed (level of the
lunula) and are pushed distally; the cells of the nail bed migrate with the nail plate
- nails grow faster in younger people and faster in the summer
- finger nails grow faster than toe nails
- finger nail takes approximately 6 months for replacement
- toe nail takes approximately 9 months for replacement - Definition of a dermatome
- the sensory innervation of an area of skin which is supplied by a single spinal nerve's dorsal root