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By N. Eusebio. Southeast College of Technology.

Note the two muscles inserted into the iliotibial tract The contents of the medial compartment of the thigh The adductor (subsartorial or Hunter’s) canal (Figs 47 order floxin 400mg on line. It commences in the mid-portion of the thigh and is lateral rotator of the thigh at the hip) (see Muscle index floxin 200 mg visa, p purchase 200mg floxin otc. The contents of the adductor canal The contents of the posterior compartment of the thigh These include: the femoral artery, the femoral vein which lies deep to (Fig. They include: biceps femoris,semitendinosus,semimembranosus the lower limb with the great saphenous vein), the nerve to vastus medi- and the hamstring part of adductor magnus (see Muscle index, p. The muscles of the the intermediate cutaneous nerve of the thigh (branch of the femoral posterior compartment are supplied by the tibial component of the sci- nerve, p. The small diagrams show how the cruciate ligaments resist forward and backward displacement of the femur The knee joint (Figs 48. In the knee joint the femoral and tibial condyles attached above to the femoral epicondyle and below to the subcuta- articulate as does the patella and patellar surface of the femur. Unlike the medial collateral ligament is a large opening through which the synovial membrane is continuous it lies away from the capsule and meniscus. This bursa extends superiorly The collateral ligaments are taut in full extension and it is in this three fingerbreadths above the patella between the femur and quad- position that they are liable to injury when subjected to extreme val- riceps. Posteriorly the capsule communicates with another bursa under the Behind the knee the oblique popliteal ligament, a reflected exten- medial head of gastrocnemius and often, through it, with the bursa of sion from the semimembranosus tendon, strengthens the capsule (Fig. Anteriorly the capsule is reinforced by the ligamentum patellae mits the passage of the tendon of popliteus. The latter are reflected fibrous expansions • Extracapsular ligaments: the capsule of the knee joint is reinforced arising from vastus lateralis and medialis muscles which blend with the by ligaments. Conversely, • The anterior cruciate ligamentapasses from the front of the inter- the first stage of flexion is unlocking the joint by internal rotation of the condylar area of the tibia to the medial side of the lateral femoral medial tibial condyleaan action performed by popliteus. This ligament prevents hyperextension and resists for- The principal muscles acting on the knee are: ward movement of the tibia on the femur. The The femoral artery and vein pass through the hiatus in adductor magnus medial meniscus is C shaped and larger than the lateral meniscus. The lateral menis- the biceps tendon (superolateral) and semimembranosus reinforced cus is loosely attached to the tibia and connected to the femur by two by semitendinosus (superomedial). The classic medial meniscus injury occurs when a footballer • The roof consists of: deep fascia which is penetrated at an inconstant twists the knee during running. It is a combination of external rotation position by the small saphenous vein as it drains into the popliteal vein. Knee movements The popliteal pulse is notoriously difficult to feel because the artery Flexion and extension are the principal movements at the knee. Whenever a popliteal pulse is easily pal- rotation is possible when the knee is flexed but is lost in extension. The knee joint and popliteal fossa 111 49 The leg Rectus femoris Vastus lateralis Vastus Vastus lateralis Biceps femoris medialis Iliotibial tract Ligamentum patellae Sartorius Peroneus longus Peroneus longus Soleus Gastrocnemius and brevis Gastrocnemius and soleus Extensor digitorum Tibialis longus anterior Extensor hallucis longus Peroneus brevis Subcutaneous surface of tibia Peroneus retinaculum Superior and inferior extensor retinacula Peroneus tertius Extensor digitorum brevis Peroneus tertius Fig. Students are often confused about the description of movements • The superior extensor retinaculum: is a transverse band attached to of the foot. Extension of the foot (dorsiflexion) refers to lifting the the anterior borders of the tibia and fibula. The deep fascia of the leg The deep fascia of the leg is continuous above with the deep fascia of The peroneal compartment of the leg (Figs 49. It envelops the leg and fuses with the periosteum of the tibia This compartment consists of two musclesaperoneus longus and at the anterior and medial borders. The contents osseous membrane, divide the leg into four compartments: extensor, of the peroneal compartment include: peroneal, superficial and deep flexor. The inferior per- These are, respectively, synovial and fibrous joints between the tibia oneal retinaculum is a similar band of fascia which is continuous with and fibula at their proximal and distal ends. The The flexor muscles of the calf are considered in two groupsasuperficial fibres of the membrane run obliquely downwards from tibia to fibula. All flexor muscles of the calf receive their Its function is to bind together the bones of the leg as well as providing nerve and arterial supplies from the tibial nerve and the posterior tibial a surface for muscle attachment. The contents of the flexor compartment of the calf include: The extensor aspects of the leg and dorsum of the foot • Superficial flexor muscle group: gastrocnemius, soleus and plan- (Figs 49. Note that all of these muscles The extensor group consists of four muscles in the leg (see below) and are inserted into the middle third of the posterior surface of the cal- extensor digitorum brevis in the foot. A small bursa (the The contents of the extensor compartment of the leg are as follows: retrocalcaneal bursa) occupies the space between the upper third of the • Muscles: tibialis anterior, extensor hallucis longus, extensor digito- posterior surface of the calcaneus and the Achilles tendon. Within rum longus and peroneus tertius (unimportant in function) (see Muscle soleus, and to a lesser extent gastrocnemius, there is an extensive index, p. Midtarsal (calcaneocuboid) ligament Talus talocalcaneal Sustentaculum tali Tibialis ligament posterior Facet for medial malleolus Calcaneofibular Head of talus Flexor ligament Navicular digitorum Peroneus brevis Tuberosity of navicular longus Peroneus longus Medial cuneiform Flexor 1 2 hallucis longus First metatarsal 3 Fig. Posterior The major joints are shown tibiofibular Anterior tibiofibular ligament ligament Posterior Talus talofibular Navicular Tendo Deltoid ligament calcaneus ligament Position Medial of bursa cuneiform First metatarsal Bifurcate ligament Cuboid Cervical ligament Long plantar ligament Calcaneofibular ligament Fig. The articular surfaces are covered with cartilage and synovial the tendocalcaneus by a bursa (retrocalcaneal bursa) (Fig. The capsule is Medial and lateral tubercles are present on the inferior surface to which reinforced on either side by strong collateral ligaments but is lax anter- the plantar aponeurosis is attached. The peroneal tubercle, a small projection on the lateral sur- deep component which is a vertical band passing from the medial face of the calcaneus, separates the tendons of peroneus longus and malleolus to the talus.

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Arteries of the Thoracic Region Vessel Description Visceral A group of arterial branches of the thoracic aorta generic 200 mg floxin mastercard; supplies blood to the viscera (i order floxin 400mg with visa. This vessel remains to the left of the vertebral column and is embedded in adipose tissue behind the peritoneal cavity trusted 400mg floxin. It formally ends at approximately the level of vertebra L4, where it bifurcates to form the common iliac arteries. A single celiac trunk (artery) emerges and divides into the left gastric artery to supply blood to the stomach and esophagus, the splenic artery to supply blood to the spleen, and the common hepatic artery, which in turn gives rise to the hepatic artery proper to supply blood to the liver, the right gastric artery to supply blood to the stomach, the cystic artery to supply blood to the gall bladder, and several branches, one to supply blood to the duodenum and another to supply blood to the pancreas. The inferior mesenteric artery supplies blood to the distal segment of the large intestine, including the rectum. In addition to these single branches, the abdominal aorta gives rise to several significant paired arteries along the way. These include the inferior phrenic arteries, the adrenal arteries, the renal arteries, the gonadal arteries, and the lumbar arteries. Each inferior phrenic artery is a counterpart of a superior phrenic artery and supplies blood to the inferior surface of the diaphragm. The adrenal artery supplies blood to the adrenal (suprarenal) glands and arises near the superior mesenteric artery. The right renal artery is longer than the left since the aorta lies to the left of the vertebral column and the vessel must travel a greater distance to reach its target. Each gonadal artery supplies blood to the gonads, or reproductive organs, and is also described as either an ovarian artery or a testicular artery (internal spermatic), depending upon the sex of the individual. An ovarian artery supplies blood to an ovary, uterine (Fallopian) tube, and the uterus, and is located within the suspensory ligament of the uterus. It is considerably shorter than a testicular artery, which ultimately travels outside the body cavity to the testes, forming one component of the spermatic cord. The ovarian artery continues to the uterus where it forms an anastomosis with the uterine artery that supplies blood to the uterus. Both the uterine arteries and vaginal arteries, which distribute blood to the vagina, are branches of the internal iliac artery. The four paired lumbar arteries are the counterparts of the intercostal arteries and supply blood to the lumbar region, the abdominal wall, and the spinal cord. The aorta divides at approximately the level of vertebra L4 into a left and a right common iliac artery but continues as a small vessel, the median sacral artery, into the sacrum. They split into external and internal iliac arteries approximately at the level of the lumbar- sacral articulation. Each internal iliac artery sends branches to the urinary bladder, the walls of the pelvis, the external genitalia, and the medial portion of the femoral region. Vessels of the Abdominal Aorta Vessel Description Also called the celiac artery; a major branch of the abdominal aorta; gives rise to the left gastric artery, the splenic artery, and the common hepatic artery that forms the hepatic Celiac trunk artery to the liver, the right gastric artery to the stomach, and the cystic artery to the gall bladder Left gastric Branch of the celiac trunk; supplies blood to the stomach artery Splenic artery Branch of the celiac trunk; supplies blood to the spleen Common Branch of the celiac trunk that forms the hepatic artery, the right gastric artery, and the cystic hepatic artery artery Hepatic artery Branch of the common hepatic artery; supplies systemic blood to the liver proper Right gastric Branch of the common hepatic artery; supplies blood to the stomach artery Cystic artery Branch of the common hepatic artery; supplies blood to the gall bladder Superior Branch of the abdominal aorta; supplies blood to the small intestine (duodenum, jejunum, mesenteric and ileum), the pancreas, and a majority of the large intestine artery Table 20. Although it does branch and supply blood to the region near the head of the humerus (via the humeral circumflex arteries), the majority of the vessel continues into the upper arm, or brachium, and becomes the brachial artery (Figure 20. The brachial artery supplies blood to much of the brachial region and divides at the elbow into several smaller branches, including the deep brachial arteries, which provide blood to the posterior surface of the arm, and the ulnar collateral arteries, which supply blood to the region of the elbow. As the brachial artery approaches the coronoid fossa, it bifurcates into the radial and ulnar arteries, which continue into the forearm, or antebrachium. The radial artery and ulnar artery parallel their namesake bones, giving off smaller branches until they reach the wrist, or carpal region. At this level, they fuse to form the superficial and deep palmar arches that supply blood to the hand, as well as the digital arteries that supply blood to the digits. Arteries Serving the Upper Limbs Vessel Description Continuation of the subclavian artery as it penetrates the body wall and enters the axillary region; supplies blood to the region near the head of the humerus (humeral circumflex Axillary artery arteries); the majority of the vessel continues into the brachium and becomes the brachial artery Continuation of the axillary artery in the brachium; supplies blood to much of the brachial region; gives off several smaller branches that provide blood to the posterior surface of the Brachial artery arm in the region of the elbow; bifurcates into the radial and ulnar arteries at the coronoid fossa Formed at the bifurcation of the brachial artery; parallels the radius; gives off smaller Radial artery branches until it reaches the carpal region where it fuses with the ulnar artery to form the superficial and deep palmar arches; supplies blood to the lower arm and carpal region Formed at the bifurcation of the brachial artery; parallels the ulna; gives off smaller branches Ulnar artery until it reaches the carpal region where it fuses with the radial artery to form the superficial and deep palmar arches; supplies blood to the lower arm and carpal region Table 20. It gives off several smaller branches as well as the lateral deep femoral artery that in turn gives rise to a lateral circumflex artery. These arteries supply blood to the deep muscles of the thigh as well as ventral and lateral regions of the integument. The femoral artery also gives rise to the genicular artery, which provides blood to the region of the knee. As the femoral artery passes posterior to the knee near the popliteal fossa, it is called the popliteal artery. The anterior tibial artery is located between the tibia and fibula, and supplies blood to the muscles and integument of the anterior tibial region. Upon reaching the tarsal region, it becomes the dorsalis pedis artery, which branches repeatedly and provides blood to the tarsal and dorsal regions of the foot. The posterior tibial artery provides blood to the muscles and integument on the posterior surface of the tibial region. It bifurcates and becomes the medial plantar artery and lateral plantar artery, providing blood to the plantar surfaces. There is an anastomosis with the dorsalis pedis artery, and the medial and lateral plantar arteries form two arches called the dorsal arch (also called the arcuate arch) and the plantar arch, which provide blood to the remainder of the foot and toes. Arteries Serving the Lower Limbs Vessel Description Continuation of the external iliac artery after it passes through the body cavity; divides into Femoral artery several smaller branches, the lateral deep femoral artery, and the genicular artery; becomes the popliteal artery as it passes posterior to the knee Deep femoral Branch of the femoral artery; gives rise to the lateral circumflex arteries artery Lateral Branch of the deep femoral artery; supplies blood to the deep muscles of the thigh and the circumflex ventral and lateral regions of the integument artery Genicular artery Branch of the femoral artery; supplies blood to the region of the knee Table 20. Since the blood has already passed through the systemic capillaries, it will be relatively low in oxygen concentration. In many cases, there will be veins draining organs and regions of the body with the same name as the arteries that supplied these regions and the two often parallel one another. However, there is a great deal more variability in the venous circulation than normally occurs in the arteries. For the sake of brevity and clarity, this text will discuss only the most commonly encountered patterns. The superficial veins do not normally have direct arterial counterparts, but in addition to returning blood, they also make contributions to the maintenance of body temperature. When the ambient temperature is warm, more blood is diverted to the superficial veins where heat can be more easily dissipated to the environment.