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Hi, everyone. Thanks for coming. Um, we'll get started in a couple of minutes. We'll just give it another one or two minutes for a few more people to join and then we'll get started. So I think we'll make a start just because it's quite a bit to get through this evening. Um, and a few more people might join as we sort of get going. But, um, this, this evening we're going to talk about the, um, sort of an overview of upper and lower limb anatomy. So, as you pretty sure it's quite a to get through in an hour review and some of the key areas to know about mrcs and their clinical relevance and then I'll point you in direction of some other keys to go away and have a look at prior to your exam. Uh, but my name is I'm a teaching fellow in, um, um, and I am one of the committee members for the National Surgical Teacher Society. So, plan for this evening. Um, is we're gonna start with the upper limb and the dreaded brachial plexus. Um, and then we're gonna look at some of the key compartments being the cubital fossa and the carpal tunnel. Um and then we'll move on to lower limb and focus on the femoral triangle, popal fossa and the uh tarsal tunnel. So we'll make a stop. Firstly, the brachial plexus, the dread is brachial plexus. And I think there's mixed feelings about the brachial plexus. Um So generally do a little Paul, how does everyone feel about the brachial plexus? I've got some people loving the brachial plexus. That's good. Just a few averages, little crying first. Ok. So a bit of a mixed response, what I'm gonna try and do is break it down, simplify it in a way that makes it quite memorable. Um And so when you sit on your exam, you can quite easily draw it out and be confident in sort of what you're referring to when answering questions. So it looks pretty scary when it's laid out like this and there are lots of branches coming off. Um But I say we're gonna break it down. So we're gonna start with the roots and there's various mnemonics um to um try and remember roots, trunks, divisions, cards, nerves. Um One of them that I I've heard often is um which I think is quite relevant to the brachial plexus is um really tired. Don't care now for your roots, trunk, divisions, cards, nerves, um which I think is quite relevant. It's the same with the roots. So the roots of the brachial plexus um have an of um the spinal T five to T one and nice that you're thinking about dryness is essentially the top two come together and the bottom two come together and the middle one sort of stays on its own. Um So that's how the roots are progress. And we've got a few little branches that come off at this point already. So, from C five, we've got a nerve that contributes to the phrenic nerve. Um So if you think of C 345 keeps down from alive, you've got a contribution there from C five root. Also from C five, we've got the dorsal scapular nerve and that is the nerve that innervates the rhomboids. Uh It's a major minor um and scapulae, which on the picture here, you can see um the C and then the, the, that's the nerve that supplies those um coming down from uh C 45 and six, you can see sort of a long nerve dropping down and that's the long thoracic nerve uh which innervates the cirrhatus anterior. So, in terms of clinical um clinically how we assess that, uh we look for winging of the scapula. So cirrhosis anterior holds the scapula onto the um chest wall essentially. And if that um is not working or there's been a sort of trauma to that, then you get this ringing of the scapula, scapula is no longer pinned down to the, that chest wall, that's all roots. Two at the top two at the bottom one in the middle, we then move on to um the trunks. So where those two have come together at the top, we now continue in a straight line for the superior uh trunk. The middle one stays on its own stays in the middle and continues through. And the inferior, those two have come together from T one and C eight join inferior co I mean, you're thinking about all these superior middle and we're thinking about their relation in sort of anatomical position. So that's passed out um palms first and all. And we're thinking of this in relation to the, the nature of vessels that run through um the brachy plexus. So from the superior trunk, we have another branch. Um So we've got the suprascapular branch which innovates supra and infraspinatus. So part of the rotator cuff muscles, um we also have the nerve to subclavius here, which is this tiny little muscle you can see in green on the lower picture. Um And that goes from the sternum up to the mid clavicle, no other branches at that point. So nice and simple, just two small branches off at the level of the trunks. We then oh sorry about that. We then progress through to the divisions. And this is where I always think that the picture starts to look a little bit complicated. But when you think about it, it's actually not particularly complicated. So we've got a superior, middle and inferior um trunk from, from the uh so proximal side, these enter into become anterior, posterior and anterior again. So again, this is in relation to the vessel. So the middle one there is posterior to the artery and the other two like anterior to the artery. And all of these divisions must have an anterior and posterior division. So when drawing out your your plexus, your initial, so anterior that has come from that superior cord, there is progressing through to be this top anterior cord that needs a poster. So it needs to have a connection between that branch there. And the posterior division. Similarly, for the anterior um coming from the inferior um trunk, we've got a, a division that needs to go to join that posterior called uh division. Sorry. And somebody with the posterior division, it needs to have some form of anterior um section. So that joins the at the top with the with the anterior division. So it looks a little bit scary. Actually, it just needs an anterior posterior and no branch is coming off here, which is quite nice. So then move on to cards and this is where it gets a little bit complex in terms of there's lots of branches coming off here. So again, if we think of it as just that um just a continuation of those cords, so we've got the anterior cord at the top become the lateral cord. Again, thinking with this in the anatomical position, the lateral, the outermost part of the arm. Um and that has the lateral pectoral nerve which contributes to innovation of peck me peck measure is also innervated by the medial pectoral nerve which comes from the medial um cord down at the bottom here. So those two will join um and innovate the peck major muscle peck minor is only innervated by the medial pectoral nerve moving on from the lateral cord. We've got the posterior card. So again, remember this in related to the artery and we've got a couple of different branches. We've got the subscapular. Uh No, sorry. And remember earlier on, we had the subscapular and these innovates, we've got a superior and an inferior which sort of sandwich the thra Adoral branch in the middle there. So these two come off to innovate the subscapularis muscles and both of them will innovate subscapularis. Um And just the inferior one will innovate Terry's me. So thinking again about those rotator cuff muscles and the innovation for them comes there for the subscapularis and Terry's measure sandwich in the middle of those. Uh We've got the thoracodorsal nerve. So that's the nerve that supplies lettuce dorsi, that big muscle at the back. We've talked a little bit about like medial pectoral. So that's to pick major and minor. And then also that medial card, we've got the um cutaneous innervation, medial cutaneous nerve of the forearm and the arm. Um So as that suggest, it supplies the sensory skin here. So you can see on the diagram I've got here. So that's the orange segment, the medial cutaneous nerve of the arm and the sort of dark green and medial cutaneous nerve of the forearm. And that is both anterior and some posterior, but on that medial side. So it looks a little bit scary, lots of branches. But actually when you think about their supplying it, it's quite sort of easy to break that down and think about what's sort of in that area. So posterior called, for example, you've got um nerves are coming up to supply muscles that are posterior. So it's rotator cuff on the system, doi for example, and finally, we've got the terminal branches or terminal nerves um and their terminal nerves. So it's axiliary off slightly on this photo. So if we have a quick look back at the cords, you can see the axiliary is starting to come off there from the posterior. Um and that's sort of cut off slightly, but it's starting from the top. So if we think about, so this is a remember continuation of that lateral cord, we've got the musculocutaneous nerve and that moves, that goes on to supply the anterior aspect. So again, thinking an anatomical, so that's anterior side of the arm. So your muscles like Caraco brachialis, brachialis, um and the um biceps muscle, you've then got that axillary nerve coming in here um which slightly broken off, but we can, we can sort of see appreciate where it's coming from. And that's supplying deltoid muscles and sensory innervation over the same area of what called Sergeant's patch um over essentially the deltoid muscle, the median nerve. Um So that's joining from that um both the medial and lateral court. So we've got a um combination of innovation here and this is why the brachial plexus and the innervation of the arm is quite complex because is such overlap and that it's not a, you know, all your innervation to this comes from this one nerve, there's a lot of overlap um which is why your clinical signs can be quite varied. But on the whole, the median nerve supply is most of the flexors of the forearm. So both superficial and deep compartments apart from flex carpi ulnaris and the um most medial aspect of flexor dial profunda. So they have supply from the ulnar nerve. Um but the rest of the flexor muscles on the anterior side have innovation from the medium of and that also includes the thenar muscles. So at the base of the thumb and to sort of remember the um muscles that the median nerve innervates in the hand, use the lo pneumonic. So it's the most lateral to lumbar, the opponens, abductor and flexor brevis. So those are thenar muscles base of the thumb, your radial nerve coming mostly from your p cord because it supplies the posterior arm and forearm. So it supplies your triceps, um, back of the foot and the back of the fore extensor muscles or wrist extensors. Um And then finally, we've got the, um, uh, sorry, which as I said, some of the, um, media arm muscles. So flex carp narrows, medial aspect of flexor, digital and Profundus and the ulnar nerve supplies those intrinsic hand muscles that includes the hypothenar eminence at the base of the little finger. So it does all of the hand muscles except for those lof muscles that I mentioned earlier. Yeah. So hopefully, that's broken down the brachial plexus into reasonable chunks to remember the branches and the innervation of those sort of terminal nerves. It's brachy plexus, something that absolutely love in. Yes. Um They're quite complex because you need clinical signs from it. You can get, you know, questions of he is a patient that's with this um neuro, what um nerve is this? What trunk, uh trunks roots, et cetera. Does this come from? So one worth learning in quite a bit of detail really, I would suggest um and hopefully that's broken it down a little bit for you and makes it a little less scary. Um mhm So the key movements, I mean, I've just included here in terms of the arm, forearm. Um and I've, what I've done is broken that down into what muscles um generally um cause those movements and then we can think about in linking that to our breaking plexus and those terminal nerves I just mentioned. So you can see why, for example, for elbow flexion, um biceps brachialis supplied by that musculous nerve. If you've got a deficit in the musculocutaneous nerve, you can appreciate that. Therefore, elbow flexion would be um impaired. For example, same with extensions. If your radial nerve is, is not functioning, then your triceps won't be working. You can't extend that album and see, see where we're going in here, pro and super et cetera. Um Often there are multiple muscles are causing these. Um So you, as I mentioned, you can have sort of overlap and you man um within movement, differing innovation um depending on the injury, the deficit that you've got. Um So I've highlighted involved there some of the key muscles. Um and then there's some that contribute but aren't necessarily the biggest contribution. And why is this relevant? Why do we need to know about the brachial plexus? So, as I said, we you quite easily in an exam um because you can get these signs or these um M and sensory signs. So for example, if you had an upper trunk injury, um so that's generally C five and C six, but depending on the extent of the injury that can go down to C seven. So we need to take into account all of the branches and terminal nerves that come from C five, C six, C seven and you can go on your C five, c six is what we call herbs palsy. And you get this waiter's tip um classical description of the um the, so this is where you get um the, you get a pronated arm because what, what you're losing here if you think about the bra plexus musculocutaneous which inverts those upper arm muscles anteriorly and your biceps is a really important in. So if we've now lost function of the biceps brachii, you're resulting in a, a sort of permanent pro pronated um position, the arms media rotated again, that musculocutaneous nerve, the Caraco brachialis, which is really important in keeping um rotated. So you've lost that, you know, the arm media rotated, your elbow is extended because you have got basically unopposed extension because your nerves mostly intact. Um but you're unable to flex from that. Um musculocutaneous depending on the extent of the um injury you may or may not have wrist flexion. So wrist flexion is due to um you've got essentially unopposed flexors. So if your injury um sort of pushes down onto that um C seven as well, and you can have some radial nerve involvement involvement. You end up with the loss of the extensors and the wrist flexors have much more, um much more important or more bulk with them than the extensor. So, a a radial injury will really be exaggerated by that was flexion depending on the extent it usually, um we definitely, they get the pro and the medial rotators, elbow may or may not get reflection. So that's our policy and you can get that from sort of birth injuries. So, um, so you've got a large baby. Um it's essentially that pushing down from the top, so that shoulder and head. So, so that stretch there and so you can get that as a but commonly you hear about these things in the trauma similarly with lower trunk injuries. Um So your C eight T one down at the bottom there um can be, I promise to thinking about things like a breech delivery where your arms are gonna be stretched up and you can get this. So if you think about how a lower trunk looking back at uh full brachial plexus, this is particularly the um and again, a small contribution to the um me. Um But mostly so if we look at the amount of how it might present it is, so the intrinsic the hand also has innovation from the forearm muscles, both extensors and flexors, our flexors that are going to are going to our um proximal pharyngeal joints and distal flexion of those joints because we now have to extend them because we've lost those intrinsic hand muscles. Um the from the forearm in a proximal uh so they're causing extension at those metacarpal joints. So, extended metacarpophalangeal joints, we've got flexed pharyngeal joints and we get this claw hand because we've got lost both intrinsic muscles and that's your, your. So it can be from um I say birth injuries, you can get it. Um typically sort of Saturday night palsy where someone's rested their arm over a chair and fall asleep and it's compressed from the bottom up essentially. So that, that's why the bra is really important because we can start pinpointing. Um based on what fun the, the has. Mhm. She moving on to the next compartment. I said there's a bit of a whistle stop to her. Um But there's plenty of time for questions. I'll break in between the lower limb, but the brachial plexus is one of our biggest um areas to talk about. So the cubital fossa, this is a really key area. So this separates the arm and forearm and why we're gonna talk about is it because it's vulnerable in injuries? Um It has really defined borders and it's relevant for procedures, for example, uh fistula formation, I oops sl to movement. So it has some protections um within, within the compartment. If we think about the um borders of essentially when you do your anatomy revision for MRC S, you need to break down everything into what are the borders. What's the contents? Why is it relevant? So the borders of the cubital fossa, we've got laterally, we've got brachial rais. Um ra well, I remember it is breaking ra because radial, the radius is lateral, that's how I know lateral pro teres, upper border is essentially an iag line between the medial and lateral epicondyles of the uh humerus, lower border is where two muscles cross. So what's in the uh cubital fossa? I think you might. So you have in your head, what from medial to lateral or lateral to medial. However, you want to think about it, you need to know what are these coming? Um II used to think media is lateral with a median nerve because median medial, then following that real vessel. So um artery deep to vein and if you um palpate you're on a break pulse, you can feel it's medial to um your biceps tendon. And so, you know, that's um biceps tendon there, it's show in green um and your ra is in the most lateral position. So it may or may not be described as in the fossa because you have to sort of tract brachial radialis to be there and that branches out into its superficial and deep um nerves to supply um the the different compartments of the forearm. Sure. And why is it relevant again? So everything is why, why do we need to know this? Um So typically it's from uh injuries it's hard to know about. So the classical one that's talked about is supracondylar fractures. So you can see that in the um left hand here, you can appreciate, for example, that um humerus has um proximate well broken and the proximal aspect is well, uh a cubital fossa. So, thinking about things that are at risk there, we've got vessels at risk. We've got key nerves at risk clinic important. Um in terms of mentioned about fistula formation. So this is a really common area. You can have arterial venous fistulas at the wrist. Commonly, they're at the um elbow in that um cut fossa and they can be um brachial colic or they can be brachial basilic cephalic most lateral. Um because if you put your arm out and up to your head, that's, that's nearest to your head, cephalic. Um And that's just a, a diagram to show the uh venous superficial venous system there, which is the want to use to be being so catholic being lateral and basilic being van in the carpal tunnel um is the anterior portion of the wrist. So this is the entrance to the palm and it is covered by a flexor retinaculum. So, essentially, we have connective tissue that goes from the hook of the hamate bone and p form to scaphoid and trapezium as you can see on this here. Um And this is really important because it's quite common, it's a really common pneumonia. Um And there's a number of different causes that may be reversible causes and it can be really bothersome for some people. So clinically relevant in that sense. So, what's in the carpal tunnel? So you've got the flexor retinaculum at the top there and purple and then you've got nine tendons and the median nerve. See, you've got four tendons from flex dialis showing green there. You've got the four tendons coming from and you've also got one which is in, in its own sheath uh from flexor poly longus or to flexor as long um nerve lies just medial to that flexor poly longus tendon. So you can see that in yellow there and I think you can appreciate quite well on this picture. Um that that compartment is quite small. So if there's anything that is going to reduce the um area within that, it can cause compression of that median nerve. So for example, um if you've got any inflammatory arthritis that can cause flare up and and cause carpal tunnel syndrome. If you're peripherally edema, it's really common into pregnancy. Um people tunnel syndrome. Um but that's usually the the causes overuse injury, but you can also get a thickened which again reduces area and causes compression of that nerve. And what does that look like? So we've got tingling pins and needles pin, it can cause weakness and in a sort of prolonged serious case, it's thinner, muscle wasting. Um the tingling pins and needles is really classical. So because that media knowing the most sort of lateral three fingers, people will describe that distribution and they will have sparing of those tumors. So 1st, 2nd, 3rd is typically what they will describe and what we do about that, we'll briefly touch on more an anatomy session, but briefly touch on that you can split splint the hand in extension. Overnight people get quite a bit of relief from that you can use steroid injections, um or final case decompression. So sort of a a procedure to reduce the pressure from that retinaculum. Uh So we talk to her of the upper limb up of questions for you. So let me work out it. Start these, there we go. So which of these nerves supplies the majority of the flex compartment of the forearm? Correct responses. So, yeah, the majority have gone for the median nerve. Absolutely. So the ulnar nerve does supply some of the flexor compartment. So it supplies flex and the media of the um flexor digital and profundus. But the majority of the um innervation is from the median nerve. Absolutely. Well, the next one. Um so if a baby is born in and presents with a clawed hand, where's the trauma likely to have occurred? C five, C 56, C eight, C eight T one. Excellent. So majority have gone FC eight T one. Absolutely. So key having the claw hand reach position. So it indicates that it's likely um a lung injury. So a loss of the intrinsic hand muscles. Yeah, absolutely. That that is exactly what it is. Um Let me get my next. Mhm mhm So a little bit more tricky. Um But how do we accurately test the function of the median nerve? So, I mentioned that they overlap um with the innervation of muscles. Um and the sort of branches where the branches come off. Um So how do we isolate that median nerve and check that function? So I'll give you a ok, assignments. Absolutely correct, isolating the median nerve. So the thenar muscles are only supplied by the median nerve. You're absolutely right. The majority in the wrist flexion is mostly the median nerve, but actually, you also have some ulnar innervation there. So to isolate the median nerve sign, um testing the strength of that lets the median nerve and those muscles welcome, move on to the lower limb. Um Just conscious of time. Oh, sorry. First of eight things to know for you. Yes, obviously, this is a doctor, sensory innervation and any issues with that rotator cuff muscles and injuries and the a uh some other key areas to focus you. Um As I said, we're going to focus on the femoral triangle, cocktail phosphate and the tarsal tunnel, all triangle important. So it has a lot of vital structures go down to the lower limb. Um It's an access point procedure. So, vascular and um cardiology and also it really relevant for hernias and femoral hernias. So I'll have a look at the femoral triangle. So again, think any compartment, any key area for your anatomy, what are the borders and what's the contents? So you can see the triangle quite nicely here. Um So uh lateral border means muscle as it passes from lateral to medial, the medial border means the longus and the superior border being and the inguinal ligand. Um thinking about the sort of all the clinical relevance of this, you've got to think what, what have we got to get through. So if you were doing a femoral endarterectomy, what have we got to get to, to get to that triangle? So, thinking about superficially, you've got obviously skin spine. Um And you've also got this fatter, which is a deep fascia tenuous with a tens fasciata muscle. Um and that over the femoral triangle. So that's one of the key structures you need to go through and you can see really nicely here how the um great ps at fascia do enter at the femoral vein. She's within the triangle. What's in it? Nice, simple drawing. Um So you can see the contents here. And if we think of it from lateral to medial again, always have in mind what lies medial or lateral to what other structures. So start most laterally. We've got the femoral nerve next to that. We've got the femoral artery next to that. We've got the femoral vein and just um medial so that we've got the femoral canal, which is a within the triangle, within the femoral sheath, but it's actually quite important in itself. So we'll have a lot as well. Um Here is quite nice, illustrate anatomically correct, like a previous picture of a femoral triangle. So you can really nicely see uh the femoral vessels here. Um And you can see a lot of the branches. Obviously, this goes slightly further down. You can see that lateral border of sartorius. You can see the common femoral artery, common femoral nerve, um and the common femoral vein o superficially that superficial femoral artery and the profunda behind. So I thought that was quite a nice illustration of what this looks like in real because as we know, then I see, um I know I don't have revision. So the femoral, so this is quite, really important with it. Um I don't know why my pictures of have gone off the um top image again. Nice illustration of you can see that femoral vein in a blue. So that's how we relate it to see in that femoral triangle. The canal is made that and it's a in. So this is what and this is where hernias come, but it's an open space, fat and lymph nodes. Um and it's there too, it can align from the limbs. So it can allow that vein as soon as you occupy the can have problems when we have things like hernias because it's neck and it's really likely to strangulate any hernia. And that's why they're, they're quite, you know, emergencies. You see them come in through the emergency list all the time. Um But is showing how uh po and bowel can quite easily drop through there and get stuck because that neck is so narrow. And in terms of the um canal, I've got um the borders here. You've got laterally, you've got the femoral vein ect and you've got um the ligament there as the medial border um ring pos structure. So, knowing the femoral triangle, knowing the femoral canal um and being able to sort of clinically, uh I've got a quick question for you. So which of these is the correct order for these femoral structures that's going from medial to. So, yeah, we've got a majority um going for from medial to lateral. We've got femoral canal, femoral vein, femoral artery, femoral nerve. Absolutely. It out to how I describe it as see how it can draw you slightly when it's, it's phrased as the opposite. Um So just have that clear in your head when you go and do your exam, you can tell these key things. Um where I've always been sort of told to remember is nervy going from lateral to medial. So nerve artery bur and then yy, um and that's how you know that's medial. Um So you can write out all these key things as soon as you go into an exam. So as soon question comes up and you've already, you, you've got it right in front of you. You can just have a look at that. So maybe to popliteal fossa just in the, in um the key area. Um Again, because we can get um we can get a lot of swellings here which we'll talk a little bit about. It can be key access uh for some. So we need to know the bo and clinical relevance. So, if you think about the borders, um so it's so that a structure. So the the posterior thigh and the um lower has borders from the um so upper borders, we've got biceps and semimembranosus. And the way I've always remember that medial um is the most medial side. And then at the lower border, you had the lateral and medial heads of gastris. Um they sense of the property of um very similar to thinking about all your other key areas. What what order does this go? So you can see nicely on, on this diagram here, we've got artery popliteal vein, we've got angio common fibular nerve which has come off slightly superior. On the medial aspect of that biceps femoris muscle, most deep structure here is your, which is really important I do you know popliteal surgery. So, aneurysm surgery, for example, structure and this is essentially why it's relevant. So top left picture here, right picture they, they look pretty similar, don't they, but very different in their pathology. So your picture um with uh on the back of the knee is Baker's cyst and it's presented with a swelling, the popliteal fossa um exactly like the one side which is actually a really, really big and pathology difference in um sort of significance and in who you're gonna refer it to. And uh so you can see why that's relevant in terms of clinical and why this compartment is so important. Finally, um I think we're just about on track for time. We've got the tarsal tunnel. So we talked about the carpal tunnel earlier and this is essentially the um same principle. So you've got a structure overlying the top of a number of other structures that run through it. If you have any increase in volume, increase in pressure, then you're gonna get symptoms from, from that. So, in the same way that things like having arthritis, arthritis, um pregnancy, edema, et cetera increases that pressure. Um you get compression of the nerve that runs through that. So borders, I don't know if we've got this. It's that flex retinaculum that runs from the me down to the medial aspect of the calcaneus. So it's all um in positioning and the contents a bit. So you can see the um Fone MAOIs to medial um Calcaneous and we've got quite a few structures running through. Um Well, I've been taught to remember um the, the saying er every Harry but every Tom dick and a very naughty Harry are adding that artery and vein and nerve. So if we look at the um and that also also goes from sort of um top to bottom. I had a Tom does very nice hats. Yeah. Good one. Mhm. Um Anywhere that you can think to remember these because there's so many structures to remember. Um if it works for you, great share other people and it might stick for them as well. So, we've got tibials posterior tendon first. That's uh number one on this diagram. Um We've that our long um structures are all onto the plantar air, they're gonna cause um flexion. So that's why I've got flex. Mm mm mm. We've got the tibial artery art and then we've got tibial nerve and it's generally the symptoms here similar to the, get that pin, you get pins and needles feeling because that's sort of very s um compression, you mail. So reduced blood can result in muscle wasting, et cetera. But the sort of reduced of muscles there because the, the vessels uh split off into its median later plans. Um less sort of clinically evident than if someone which is really quite obvious. Um And then you've got your flexor final. Um um So um yeah, all of the foot because I said they were under under surface of the foot. So you can get weakness, you can get intrinsic uh muscle wasting, but that's quite a slow process as well. That sensation you can click and very similar management to carpal tunnel syndrome. So, physiotherapy bridal um for reducing, obviously, it all depends on what the cause is because if it's edematous, then you, you're gonna try and reduce the edema um, injections again and surgically last resort, tell us, um, if we're not on anything else, so it's causing significant symptoms. So that was our whistle stop to of the lower limb. Um, I think other things that are gonna be really useful. I don't want to bombard you with it. Um, since we've already done the brachial plexus, but the lumbar, um, thinking s or the nerves really important and thinking about the muscles of the gluteal region because we've sort of touched on um areas that are supplied by um the structures coming from the femoral triangle. Um but those posterior structures um we need to think about in terms of gluteal region. Um and the things that love to ask about uh familiar with it and the blood supply um and what is it where it to cause movements? So, no, that it's a retrograde blood supply nor that it comes to circumflex vessels. So, um because they love the fractures and that is about it. Um Does anyone have any questions quite early? Which I'm surprised about because I thought there was a lot to cover there. Oh, yeah. So if everyone could feed, fill out the feedback form, that would be very much. Um And please think of some questions, questions. Um I will um and yeah, come in, find everyone two more sessions in the MLC S series. Um So that's next Tuesday. And next, please come along to those and they are recorded so you can catch up. But if you could come along then you can interact and get the most out of the session and that, that would be great. So hopefully we'll see you there, watch the chat for another minute or so for any questions, uh Please feel.