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Year 2 Anatomy Revision Evening: Lower Limb Recording

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Summary

This teaching session is geared towards medical professionals to help them gain a deeper understanding of the anatomy and movements of the lower limb. We will be focusing on pelvic bones, ligaments of the hips, the osteology of the knee joint, the tibia and fibula, and the ankle joint. We will discuss specific features important for recognizing which side is right vs left, along with ligaments, tendons, joint capsules and vascular necrosis. We'll cover movements of the joints, ligaments, and muscles that contribute to them, relevant sports injuries and their respective tests, and plantar flexion and dorsiflexion. All of this in order to gain a better overall understanding of the osteology of the lower limb.

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Learning objectives

Learning Objectives:

  1. Identify and describe the bones, joints, ligaments and muscles of the pelvic region and lower limb
  2. Be able to identify right and left sides of the lower limb and pelvic bone structure
  3. Recognize common physical conditions and injuries related to the lower limb and hip joint
  4. Discuss the movements and functions associated with the knee, tibia, and fibula joints
  5. Describe the movement and muscular action involved in plantar flexion and dorsiflexion of the ankle joint.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

um, so, yeah, they were on What were you? Um, can you just just make sure that you can see my screen before I start. Yeah, okay. There was a little coterie the osteology off the lower limb on, um, these are learning. I comes. So we're just gonna go over the pelvic bones, the ligaments of the hips, the anatomy of the knee joint, ligaments in the knee joint on then the movements of these joints, as well as the features off the tibia fibular on, then the ankle joint on the, um, fit bones as well. So, um, in terms of the bones off the lower, then we have the pelvis, the femur, patella, and then we have the fibula and tibias well on, I just go through them all. And majority of this is a lot of pictures understanding it was identified with within the bone themselves. So within the pelvis, there's the um ileum issue Mom Cuba's on. And the ileum is the larger bones at the superior aspect. On it has that idiot crest, which is the outline right here on them. At the front, we have the anterior superior iliac spine on the on tier inferior. It acts fine. And then back. We have our PT posterior superior iliac spines on last year in period. Explain with are greater sciatic knowledge just there and then within the issue, we have the issue of curiosity on then the Rama's within the pubic bone up front with the people crest on the people. Typical on majority of these are still eligible features. There's ligaments and muscles on, and things that I talked to them on. Then we have the osteopenia in the middle, which kind of joins all three rooms together, Um, and then, in terms of deciding whether it's the right side or the left side, um, the pubis emphasis will be at the front. So whenever you're a kid thought about, well, tell you what, Just until your most posterior on them the crest, which is thought, um, larger. But they're a two, but that'll be a superior. And then the operator for him in which is the bit here, will be facing dog mugs on the escitalopram will be facing laterally. So those are the things just to be aware of whenever you're deciding whether it's right and left, um, and then in terms of the femur, which is the longer women are like on it has the ahead a neck on. Then on. We have the creator to counter on then the last week or counter, which is, um, posterior. With the introduction terrible, I'm between them on doctor that had big amounts will attach to on, um, on the posterior. It's either is the linear aspirin, which is where muscles will attach to a swell on. Then we've got the lateral and medial condyle is well on, and I'm sure someone else going to be three where the muscles attach to use. But it's good to know these features so that you can kind of visualize as well and then, in terms of right and left again, just looking for a specific feature to decide and what's posteriormost on to yours for that on your aspirin, which is the, um, kind of the bony bet of the back of the boat that makes any sense is that the posterior aspect and then the head of the femur will be pointing in medially. So that's why you decide whether it's right and left, and then the patellar. That's the small bone at the on the kneecap. What you got all kind of feel in your own lease on, um, it's assessable because it's within the recorder's that's tendon itself. And then there's lots of leg amounts for which will attach to the patella to keep it in place. So then we can see here we've got the patella tendon, which I talked to the to build porosity on in terms of the patella itself. I'm on onto your surface. The base is off. The top of the effects of the bottom of that makes any sense on that. On the posterior surface, there's the medial faucet on the lateral faucet and and then the hip joint. So it's a ball and socket. So noble joint on. Um, there's lots of the leg amounts which keep this in place. Um, so as you can see here, we've got the other tablet, which is a balloon kind of looks circular, busted up your labrum on. That's an articular surface with the head of the femur on. Then there's the transverse opposite. Also help your ligament, which kind of bridges the notch and then creates the fall. So on, um, the head of the femur em has a ligament of the head of the femur, which is also called Ligament and terrorists. And it has an artery, and it I'm a branch of the option or artery, which is in it. I'm not, um, husband Surprised the neck to the head of fever. Sorry. Um, and then you can see on the other diagram here another just way of showing you that osteo Taban on then the they go into the head of the femur. Okay, Um, in terms of other ligaments of the hip joint AM on the anterior surface, you can see that in your family joint on. It's that kind of because they chip ligament. It's the strongest of the headlines because it blends with the anterior joint capsule. And then, um, just kind of posterior are more deep. This is the people from a ligament on, and you can see them attachments without interview contact line that I was saying what I hear and then on the posterior aspect is the issue femoral ligament. And then, um, I mentioned the trump far sauce, a tablet or one a year on that I go into the head of the femur with the artery in it and in terms of the blood supply. That's quite important, because fractures of the neck of the femur can actually cause a vascular necrosis because, um, blood supply to them cut off and then the only blood supply that the neck sorry the head of funeral actually got is through that ligament with the obturator brunch in it. And that's not sufficient enough. So over time we can get collapse of the normal head on. The first sign of this isn't only pee in, so it's quite important, clinically and then in terms of the knee, there are three joints within the knee, and it's and goes on you real comedy. So you've got the medial condyle joint lateral condyle a joint, and then the patellofemoral joint. So the California join a sign of well driving and then the tip. Your family joints are more fighting and is the medial condyle are not open daughter. There, between the respect of condyles of the femur and then the condos of the tibia, um, on, we can see that on this diagram as well. Um, use it a lot on medial meniscus. A swell on, then, um, because they are ligaments around. It is. So you've got the, um, lateral collateral on medial collateral I think we have on the next flight. Yeah, so we have, um, lateral on medial meniscus within the lateral collateral ligament in the medial collateral ligament. A swell a Zonta your accu shit ligament on the posterior cruciate ligament. Um, and this is really good diagram to country where they're attaching to use well, but the medial collateral ligament is actually more commonly injured because it's attached to the joint capsule. So I'll move more with that where the other ones were afraid the lateral ones were free. There's lots of sports injuries which uses, like, nature of, like, movements that you can do in the bombings. With that, not a professional football is will I think its rupture their ACL on, um, in terms of function reason probably done this in, like, see sac, where you have the anterior drop drop drop test, which you get the patient to, like, light, stupid flux on the examining table. And then you can mix it on their foot as their flax, the knee, and then you can just like but your hands are going to like their leg and pull the tibia on The function of ACL is to prevent the femur moving. Um, I'm sorry that to be anything, um anterior. Um And then in terms of movement of the needs, a little make a lot more sense. Interview a week over the muscles and that are around it. But it is based on where the muscle is attaching to re on what then won't joint that it will produce the action. So in terms of flexion, is the biceps families, same tendinosis on our son, Remember, nurse and switch your hamstring and then Chris es Totori is and popliteus on that extension is the quarter steps, memories, tension, faster water. And then the media rotation is kind of similar. Deflection on the lateral rotation is just biceps, family. And then, in terms of tibia and fibula, that kind of the hardest thing. Whenever I was learning with which is which so on I learned it on how I remember it might not make any sense, but to me it made sense. Was that the fibula? And whenever you feel you're telling a lot I, which begins with Al's, it means it's laterals. That's what I remember that And on then the tibia is just like more medial. And it's more, um, subcutaneous a swell eso at the top of the fibula. You have that media kandahar in the lateral condyle along with the tibial tuberosity tore the yeah, the tibia. And then in between the two of the bones, you have the interosseous membrane on then out of the fibula as well. Um, and then at the bottom, you've got the articular surfaces. So you've got the Fitbit or not off the tibia. And then on the posterior side, you just got the PSA level line and there's other and labels there. But I think they're all a little bit too complicated. Don't need to know the mall. I'm on that In terms of the ankle joint. Also called the talocrural joint, it's a noble hinge. The cocaine is isn't actually part of this, um joint. It's part of it's own joint. But, um, our secluding circuits are always, say, the tallest, which is one of the bones of the fate. The in fear part of the tibia on then both the medial natural, um, ali list, which is the you can feel that I'm on that either side of your uncle. That's kind of expected on then. In terms of the ankle joint, there's so on the medial side, there's the deltoid, which has three parts. On another little side, there's the lateral collateral, which also is three parts. You kind of see them in this diagram and the interior taller figure just here to tell AfibAlert and then the calcaneofibular on. That's that You can see the calcaneal spur in there, and that's why that's called the Calcaneofibular, where it's attaching to and and then the subtalar joint that's between the calcaneus on the T list on. It's involved in movements like eversions and inversion, which is whenever you're moving your foot inwardly and then quickly. So that's why that joints important it does that it doesn't do that alone with the other joints that help it do those movements. So that may in movement. All the ankle joint is plantar fascia endorsing flexion, and you can do that with your foot problem so you can do that whenever you're walking. So in terms of dorsiflexion, it got missed. It make more sense whenever you go over the muscles, but there's Toviaz interior, extensive calluses, longest extensive, digitorum longest and then Patanase tissues, which is the same as regular store shoes. And then plant reflection is, to be honest, posterior flexor pollicis longest and fractured it. Or, um, longest person is longest and gravis plantar's and then the muscles in the back of your leg, which is gosh mean using supplies on that in terms of bones of the feet. I don't make it complicated of the hand. So you've got the large talis of the box with the cocaine is just inferior to on the regular on the medial side, with the three committed forms just in front. So there's I think it's medial, intermediate and lateral. And then the cuboid on the lot of side within the metatarsals, 1 to 5 and then proximal and distal following. Geez, and the great toe only has to. It doesn't have a better have metal, um, for allergies. Eso then just in terms of maybe bring it all together on a quick MCQ. I just think I have to. But just if you could think yourself which the head ligaments is the strongest thing and Mad mentioned it, I'll just give you a second to think about it. Okay? Yeah. So the answer was that your family will not bad. She have a role in the anterior part of the hip couch. So it's not dark room. You can see the red one there. Um, and then the last, um, multiple discussions of the tendon, of which muscle groups attached to the patella again, these all the muscles will make a lot more sense than every week over them. So, yes, you probably all new. It's the quarter steps, families, and you can see that the patella is just within knocked em tendon. And then the patella ligament, which then attached to the tibial tuberosity. So, yeah, that was all done. If you have any questions, I'll help. Really answer if I come. Thank you so much for that I know is really useful. And so if anyone has any questions, you can put them into the shot. Or you can on meet yourself on, then also, just I just know that we will be sending my sides you used after this. I am Jack's. Have any questions? Any way through the even. You can just put them into the judge and so there's no questions for then we'll just make a call on trade the next one. So Hannah Miller handed then is going to talk about the interior on medial compartments off the eye. Okay. Can you see that yesterday? Okay. Ideal. Um, Okay. So as you said before, I want to talk you through the anterior medical services that got the cold more so if I start coughing or whatever, just for me and I wear went from second. And so he's learning, or it comes that you can give him. I love them, are just straight off identify and which you just moved able to point that I basically so said. He described painting a little bit more detail, but we'll talk you through everything. Hopefully So initially, what are the compartments of the thigh? So there are three compartments of high on to your posterior medial. These are separated by extensions, put on fashion, which cover the legs. So I'm sure you're worried about fashion, last of which covers leg. And it's just like, you know, the parent heights. Basically, that that marriage at the top with your inguinal ligament, um, and these sort of invest em to grip muscles into the and these compartments. So I'll try. You threw away about the anterior a medial, um, aspects. And we'll go through the muscles, um, and then going to the mall. We've already tell so initially you want to identify the muscles. So if we start off in the anterior compartment, you have your sort aureus, which is nice and easy to identify. Cross in the middle and behind the middle and starting off in your under your superior iliac spine for here on. Then, in starting into your tibia bone in there and then you have and your quadriceps memories muscles. So you got your rent's families in the middle. Your vastus medialis on the medial side when you're fasting or after hours and the actual size, which quest office monetary. And then did your rectus timers muscle? You put your and Lasses intermedius muscle, and I used to get quite confused between these, and but I think it's not too much because you can see that the fibers of the rectus memory's almost like a feather or like ah least, and that they kind of come together, meet in the middle compared to your fasting intermedius, which is that that deeper And the bipolar center? Um, um, sort of more vertically and then each track but yours, origins, insertions, innovations, neck shins. And it's just a summary table for you. If you remember the old. Most of the anterior compartment are innovative by your family, and they all sort of tend to help to extend the me because they will cross the knee joint a zoo can see in the previous images. Um, but not until we have a clinical context. When you are going to examine the family nerve, you can use your rashes drivers muscles to do this. So if you are doing your Lipitor lower limb motor neurological examination, then you ask the people Teo extends their knee against resistance. Then you're asking them to contract your quadriceps time. Most extended me on budgeting that you're testing the innovation of the cord optic tremors, which is also with the family, Um, and then your next letting our come is tight. And for your iliopsoas. So you're elusiveness is composed to trade muscles. You could not, so his major showed and yellow here, and you've also goes to his minor. But people don't help it, um, on. I think there's only one of this past month in the lab. Actually has. It's also I wouldn't worry too much about it. If you focus on his nature and you're doing good. And then, um, your iliac, it's muscle, which is present in your iliac also showing, and blue here least would emerge to gather to form a common tender on dance their own to your last Rituxan fracture. These function to, um, Celexa hit because across the hip joints and most actually it's the flex it on pretty much all innervated by over and hours early on, because which is in every by family before it, um, passes under the I'm gonna ligament, and then we will talk about the family triangle. So this is just in your thigh again in the anterior compartment, you got your, um, to your superior. Let's find your ace is up here and your pubic symphysis don't hear, um, your bun Juries, all of the femoral triangle or your inguinal ligament. You're sort aureus from, um, Electoral Gondry's. That's nice. Using muscles, remember? Cut, Remember, is the one that crosses over the anterior compartment of the thigh, so should be quite easy to identify. And then you're are Doctor Little This which will try in about a minute. But he's basically for your friend Will Triangle. You could remember the boundaries with the acronym sale. Apparently. What didn't do this one until recently, but and your ass is your start Your es your a Is your doctor longest, And then I l is You're in good a ligament. You find it useful when you use it. Um, on Don't forget as well about your roof on your floor of the triangle. So your floor is your pet NIST, which is here, and you're only so I just remember the two muscles that are joining together for the common insertion on the last trocar emptor is gonna be about here. Um, and then your refuse your fashion last lesson that sort of and like, parotitis covering them off fascia on structures within the femoral triangle. Then are your family nerve? More likely. Um, here, um, your family artery for final vein, and then more. Maybe your femoral canal. And because they're good for me, all flocked was you're sort of on the morning and then you're from our shrink I'm overdoing are enclosed for them. What's called the family covering it connects tissue. Uh, it's really common to ask whether the family nerve is included within this sheet. It's no, um ah, The reason that I remember it is because the family of Branch is really quite high up on. So if it started branch notice that it appears that the more she eats and then for um oh, she wouldn't be so robust. So it doesn't That's not include. It's just the artery on the vein on the femoral canal, then contentious lymph nodes. And Onda has quite a lot of speech, so that lowers it if you family has 6 lbs and it could expand into this area, but we'll probably bit more about the family on the second and then just putting out of the clinical context when you're doing your pulse examination, um, each know where to populate the family pulse. So it's at the MIT Inguinal point. And look at this confused with your midpoint of the inguinal ligament. So you're a mid inguinal point is between the A cyst on the six MP ASUs rather than your pubic typical. And that's what the pharmacy call says on Remember that Europe, between your faces on your pubic Typical is your mid point. I think when a ligament and that's where your and keep bringing inguinal Canal is stupid. Get them confused. That's another quite common in some question eso then the barn Juries of your family canal that we just spoke about. So it's most medial, um, sort of part here. I'm just under your income of ligament on. Um, it's funded by onto your inguinal ligament. Your pets. New ligament First he really you're lucky know ligament medially and then your family being laterally. And as you can see here, it's boned, um, sort of mostly by ligaments em and they obviously don't provide most a lot stretch. So, um, and where that in mind formula. No hernias. So where a vial pushes down through the family canal? Um, under the it's usually a sort of elderly women who presents with a painful lump in the groin and on. It's important to remember that this is in for a lateral to the pubic typical. So you can see compared to the inguinal hernia, and this is a lot more superior, but guess it doesn't cross the line. A ligament that formal her nose with it was costing one. A ligament. Um, has mentioned before they family canals, boundaries by ligaments. So it's difficult to them produce the hernia, and on then that makes them really susceptible to strangulation. And so remember, incarceration is where you can't reduce the bow. And strangulation is where the vial becomes ischemic. So, um, listen, Kalis, you know associated problems like and the patient becoming septic or whatever on bowel obstruction, your ms came here. Um, but yes, be able to differentiate between thermal hernias. And he's a directory. Direct inguinal hernias. But they both come on the superficial reading stuff. Um, yes. And the one we want to you the medial compartment of the thigh. So, you know, I don't find your for long distance showing yellow here. Your doctor brevis and green. Your doctor Magnus in red on wood and mentioned this later on. But this is my sculpture doctor. He just, um where you're a doctor and canal terminates. That will say we'll talk about that later on. Then you're cured. Your experiments up just put Include just for completeness causes any stomach and then sort of a little bit deeper to that. You got your pectineus muscle, Uh, your restless, cryptic loan Lessel room. I mean your last. That's why these are all your hip doctor muscles. And they're pretty much all, um, and every two by your operated on and with a couple of exceptions. But you want to chat through this again because it's so exciting And your doctor canal, then is basically an extension of your family. So you're and so your family triangle, which we just spoke about before her up here on, um uh on it is that yes, our continuation of it. So it's found anteriorly about your sexual reassess muscle. Um, lastly, by your glasses, maybe Ellis and posterior by your doctor Longest no, doctor. Um, likeness. And again, it's just a sort of stay skits and close by fashion within it. You've got your family artery here from a vein. Your Norvasc is medialis yourself. Miss numbers, which is just about to your family, knows that will be spoke about later on. But I think, um, on day, yeah, as I say, it's a continuation of your family triangles that make sense to have your family ordering your friend moving in it If you notice that, um, when this terminates at your, um I don't know how you just and your artery in your vein will become public tail artery and being and into the back of the knee and which you'll know from again from your pulses examinations when you're looking for your help it a lottery. So just a couple of really empty case. So which of the following structures are no present in the family? She your family nurse and said before brunch itself. Nice. Nearly, Um, So you don't appear for promotion too much? Yeah. Um, next question is your middle age A militia patient presents to any with the lump in the growing On examination, the lung is present in the superior and lateral to the people. Typical. What's the diagnosis? The in this instance that being in Guanajuato hernia because the lump is superior and last one to the pubic Typical is the lump was inferior lateral to the people. Typical it be more likely to be a family hernia just because of its location. But bring little hernia, pastas, tree, the superficial inguinal really weather femoral hernia as well past, um, under the inguinal ligament through the family on Finally, you are a second year medical student on the words on the consult Last you tax. It's the from a post. Where do you want to palpate on with these one since I was a 50 50. So is it the midpoint of the inguinal ligament or the meeting? Little point, You know you're not. May Daniel those and that inguinal point surgeon that point, and between your basis, I'll inject your picks. Emphasis on these are just a couple of years that I have included. It's good. Who's YouTube channel? Um, he is one of the anatomy lecturers. Ah, well, what's what's happening? Swollen the university, I believe, and hit his loads of last me. But he was, I think, quite good. Um, again, if that meant to clinical contacts, So they're couple links if you want to wash them and it's quite interesting, that's it. If you're going to questions my emails on the first line so freaking and only if you like it you so much that on a regret and so yeah, G and if you any questions, but that you can put it into the judge. And so then next wanna make all into the navy? Who is going to talk about the posterior compartment off the thigh? It's we need wasn't able to come tonight Socialist Pass this onto me to present just today. So at this presentation just in the posterior compartment of the thigh in the gluteal region. So I hear you're learning outcomes. Eso First of all, we'll talk about the gluteal muscles, um, slight themselves. So you have three meaning gluteal muscles, your gluteus maximus being with me and one, but also your gluteus medius, which is sort of deep but also travels up superior to the gluteus maximus on. Then the gluteus minimus wishes deep again a all three of them originate from the iliac bone on the external surface. And then we'll insert on to the Femara different points. Uh, so the media's and minimus can sort of be grouped together than, uh, both, and innovation and function. So far, interviewed by the superior gluteal nerve, which is coming off of your lumbar plaques, is, uh, sorry your sacral plexus on. Then you're in for your gluteal nerve. Enervates. Your gluteus maximus makes sense because the maximum dose originally slightly lower down here to the media's, even if you're asked to ever identify them from an image your piriformis muscle look here. It can be used as a sort of allowing mark structure. It'll a a sort of differentiate between superior gluteal nerve and artery which come above the piriformis, then the inferior gluteal nerve in order e which come in below the pair for Ms Ah. So then, actual functions of the muscles both your medias on minimus actors ob doctors on medially Repeat the femur. Where is the max most and extend your say so if you think people try to build other Maximus by squad in. So the actual SWAT movement involves sort of extension of the thing to push up the weird Uh and it also helps just the study that that is well and not really repeated it slightly. So why is this rabbit? So this is important because it can come up in all skis, an antique use and you know, all sorts of parts your medicine eso injury to the superior gluteal nerve caused the trendelenburg it. So the superior gluteal nervous, we said interview. It's your immediate and minimus muscles. And so this is something that people always get confused by damage to your right superior gluteal nerve in this instance will weaken your right at medias and minimus. But it'll be the left side of the hip which will actually drop. So you can see here a normal hip were hips, bones were me and level as you're walking compared to trendelenburg it where one side is dropping as about side is raised. And the reason for this is a few mountain. It was your plant in this leg here your medias and minimus, as we've said abduct typically the leg. But in this instance because the legs planted uh, Thea other structure they're attached to you, which is the palace on those v a margin. These favorite shortening is the contract will pull out pelvis and pulled out other side of the hip up on act against gravity, which would be trying to drop it. So if they say is paralyzed, unable to contract gravity will be on a post on this side. Then we'll drop. It was important. Be able to notice that because they can show you even things like that you use or get a patient has this condition and all skis, and you sort of have to be able to think on your feet. No, no, not the fall for the trap that if one side is dropping, then it must be this. Say the nerve is damaged. Uh, so gluteus medius minimum should contract to stabilize the pelvis. And when the opposite or contralateral limb is going off of the ground Another important thing to do with the gluteal muscles and bars. The clinical relevance is your interest luteal injections. So because there's a lot of the narrow, narrow structures running deep to these muscles, you want to be careful when and certainly needle that you don't damage area on the sciatic nerve being the me and one. And so to do that, we go for the upper and I'd er, quadrant, uh, it's more sort of either or lateral than you think. You know, most people who think gluteal region would be just the buttocks. But it goes right around to sort of this say that they you please one finger on 90 years, period. The explain, uh, move the other two. The greater trochanter your problem really right after compress R E and then inject in between your two fingers. The ah middle finger will rest. They're just only you're either crest eso You remember that with shut up on? But I'd so the upper and night or part of the ah gluteal region. Then they leave tibial tract. Uh, it's just the track that runs on the lateral side of the leg. Uh, it's basically continuation of the tantrum fascia lot of muscle. Ah, which could be sort of group, then with the media's and minimus, because it's also elevated by the superior superior gouty on there. And it's also involved in abduction and medial recreation on again, it helps to keep the pelvis level is well, so then when we go into the deep gluteal muscles So these are borderland underneath your gluteal muscles or the me and major gluteal muscles. You've got this sort of rule of muscles here, starting with your performance, which we talked about earlier. Is that sort of low on more structure? Um, they're only on you've got your two Jamaal A which essentially translate the twins. So on either side of this operator internist muscle, you have your journalists superior and inferior in there, sort of collectively known as the triceps coxae. So three had muscle. And, uh, finally, then you'll have your quadrant. This family's muscle, which has the name suggests in a sort of a rectangular. And then these put here is well, the operator external was not technically considered, uh, one of the muscles, as it's, uh, got a different interviews in. It can also be good then with these muscles as well. So a lot of the innovation, then, is actually easy to remember, because a lot of them are just nerved whatever muscle it is. So nerve. Drop Creator Internists interview. It's operator internists, nerve to Cuadrado's families and every it's Cuadrado's families. What is important to note, then the gym alli or each to played by the adjacent muscles Nerve. So Jamala Superior is intermediate. Interviewed by the nerve, the operator internists on Jim Alice in Fear, is interviewed by the nerve to Cuadrado's family, so it's just important to remember that order. Ah, so it's easy to remember the nerve supplies while then on. It's easy enough to remember then, because of you a margin. Most of these muscles run from the palace across to the greater Trochanter. And they basically work a lot of really these your lateral rotators the leg then and also help the odd duck. Because if you imagine, as these are shortening the colon, not the top part of this own the femur and that will pull it out away from midline. Why is this clinically relevant? Then so was imagined Performances. Your landmarks structure, your superior gluteal muscles are superior Gluteal nerve and artery run superior to it. You're inferior. The deal nerve and order. You run below it. Well, is that your sciatic nerve? A little on the was no. Ah to this could end up compressing the sciatic nerve on cause A syndrome called Piriformis Syndrome where you get PM and the gluteal region in the posterior aspect of the thigh, uh, especially cause spasm of the muscle on it's more common in females jupiler wider Cuadrado's families angle so b c greater angle here. Ah, causing compression eso There's persistent radiating low back pian but a peon numbness part be. See all your sciatica symptoms. So sciatica is just a syndrome Just collection of symptoms which are old always come from head on your compression to the sciatic nerve. So this is just one of the many causes say I got. I will talk about more about that later. Send her home strained muscles than your posterior compartment leg, sort of about three million ones, although with the biceps Families, as the name suggests, has two hands on the base, absolutely in the lateral aspect. Where is your same tendinosis on semimembranosus are located. Then on the more medial aspect. Ah, they're collectively known as your home string muscles, but only the long head of biceps family. Same time to notice, um, same member notice that considered home strong muscles on. There's three Me and sort of qualifiers, which can remember to help differentiate thumb from other muscles that all come from the scene, please, the SGLT Ross Day. They're all in start on the leg, bones being the tibia or the fibula on. They'll all be interviewed, then by the table nerve. The short head then isn't considered home string muscle because it's emerges lower dying from the femur on. It also was interviewed by a different nerve. The common fibular nerve, which will talk about about more leaders well, but all of them essentially do the exact same function, which is just flexion off the knee because of you. Imagine if they're crossing that me joint as it shortens, they're gonna pull in the leg. Bones unfold, um, posteriorly. So it's either and says here, just flaccid lays your biceps being on the lateral side side also laterally routine. It's the leg. Where is yours To same muscles being on the medial aspect, Um, usually repeat the leg. So this is clinically relevant for a lot of athletes who get injuries to the home strings, sprint and sports specially. So it's happened you see in bold and races were at home strings because they're sort of powerfully extend the mouth I flax in that leg, it can undergo damage. Then you could be severely peeing full. And then I have definitely moving at the end is well, afterwards, you can take a maybe six weeks to recover. Usually conservative management, uh, severe tours happened. So as you can see here, well, this actually happened. Here is that time Then here is completely ruptured on the muscle valley. You can see here is sort of flicked up and fold it up on itself. Create not lump there, and they're similar Anomaly if you're up for your biceps in your arm, which that called the Popeye deformity because it's sort of that lump there that looks like Papa with the same idea here, then another require surgical reattachment in the tendon back into the leg bones. So that's all the information is just a couple of quick and seek use here. So first up, I said, there's no actual choices here. You're just gonna have to know him off the top of your head. I don't think we've been giving choices, but you're in a clinical consultation. You suspect a patient of the policy of the superior gluteal nerve. During the get cycle, patient demonstrates a dropping of the left Alvis, which nerve is affected on what side, So the right superior gluteal. So it was already handed out. What nerve this factored. So, you know, with the trendelenburg it it's going to be one of your superior gluteal nerves. The question is, which one? Some people obviously think there's the travel. It basically everyone falls into where the left side is dropping. Then clearly the problems the left eye. But if you'll remember, it's the right side muscles that are actually contracting and pulling that other side of the pelvis up normally. So if they're paralyzed, the off the femhrt side will fall in, and we're going to often for this one. So if the GP is preparing to administer an intra, a little injection to a toddler, where should the injection ship injection be? See if they administered in the buttock? So that's a honey enough, one that's just upper and either again to avoid new shot of nerve there on some of the other neurovascular structures deep in the gluteus maximus, I mean the integrity of which muscle was assessed by the trendelenburg Get Albert test. So again it's media. So this is something you might cover about more during your mskube part of third year. But the Trendelenburg tests sort of South explanatory. You'll get the patient. First of all, you'll watch their actual walk to look for that hip drop. That's actually then you could actually get thumb it just actually starting to use a new you crashed on place one finger on each of their aunt ear superior iliac spines. So just we have bony parts of the hip and then you'll get thumb and turned. Just bring obviously band one knee and bring 1 ft up a time and you'll check to see if three your fingers or me and level if they're me and level you'll nobody in that The hips are the palaces remain in statie. Um, your gluteus medius and minimus were working. Okay, if once I drops, you'll know then that the hips parlays and that's on the opposite side. Or the muscles are paralyzing the opposite side, causing the hip the drop. Uh, then a six year old hell Walker experiences piano her leg when walking uphill and climbing stars. Which of the following muscles it's responsible for hep extension. Yeah, and that's your gluteus Maximus then. So just remember that squatting movement as you're pushing the way it up, your thing's gonna be extend. And then so that's the me and thanks answer for sort of explosive movements like walking up hills. Onda, 19 year old man was playing rugby when he suddenly notice is a fear PM at the posterolateral last back to his right. They which one of the Pharm muscle groups is most likely to have been under good, so this one is your biceps family stand. So could be at PM on the pasta here. Part of the thing could be any of the three home strings there. So your same muscles or the biceps, but because it's postural lateral were assume it's base ups families because the other two muscles are on the media last back and then 82 year old bone is being treated by physiotherapy and community following a long period of immobilization to to to crash in. So in a particular difficult time, abducting has hep. What muscle group contributes most of this movement. Okay, has your gluteus medius so you're medias your minimus and then you're tense or fascia Lotta all abduct on immediately rooted the thigh then so that's everything on that presentation school home, Back to Maria. Thank you very much about our great again, if any questions you just meant. And so then next one on two knees were going to talk to us by a big, um, how they're my name's need. I'm hoping everyone can see this. Oh, I'm not sure I'm doing this right. It won't move the that working properly. Can you see the Is it going to the slides. Yeah, yeah, yeah. Okay. So Hi there. My name's knee again. So I'm going to be talking you Sorry. The muscles of the leg. So first of all, there's the learning or it comes. They're taken just from the the lecture shots that you have. So first off, I'm going to talk you through the different compartments of the leg. So here you can see that there's the anterior compartment here and blow the lateral compartment on. Then there are two post here compartment. So and the pink you can see the superficial compartment on, then the deep, Mr. Your compartment is in kind of, um, peach or whatever you want to call that. Um, So what I'm gonna do is I'm just gonna go through the muscles and respect to each of their compartments because, well, I think it makes it about these ear because they all have the same norms supply, You know, all the muscles and one compartment. So first off, we're gonna talk through the anterior compartment. And so all of the muscles here are supplied by the deep fibular nerve. And first off, we're gonna talk about two miles interior, so This is, um, the muscle here. You can see it in the image A originates from the lateral surface is off the tibia inside. Schooling to the medial Canadian form bone on the base of the first metatarsal on this muscle helped dorsiflex the foot on Bart the food on I kind of find that easier. Remember, in the all the muscles on the front of the legs are going to dorsiflexors. You're going to see later on the two tibialis muscles. Both invert the foot. So if you think of where the tibia is sitting on the leg, do you know if you contract the muscles on the outside, it calls this inversion. So next we've got extensive digitorum longest thistle isn't muscle that's lateral to to be on some tear. It originates from the lateral conduct of the femur on February, uh, and it starts insights on the four lateral toes to this muscle. Also, Dorsey flexing is as it's on the dorsal side of the foot on it cause extension off the lateral four toes. So not the big toe, just the small before smaller one said it starts on next. We've got the extensive houses, longest This is a muscle that is deep to be else into your own extensive digitorum longest. It originates from the medial surface off the fibula shaft on it starts onto the base of the distal phalanx of the big toe. Again Dorsiflex is on. It causes extension off the big toe. Only this time so it's like the last one. But it only works on the one toe. Um on these are all these muscles except for our innovative by the date fibula. Nerves without one full compartment is innervated by that will nerve on, um, away it that you're able to sort of to remember it. So they've been ours. Tarshis wasn't a learning what Come in, you know, in the learning part comes we were given, but in order to remember it, you know, in your spot tests and everything we thought there you can see the tendons of not ultimate deal. It spells that fate. So you've got f here that he for the extensive digitorum longest here. Then you've got the other e for the extensor houses longest on then tibialis interior on all for these muscles, they run underneath the extensive retinaculum in order to pass into the foot. So, no, I we're gonna be going to a lot of compartment. So, um, the's are muscles that are mostly going to either. The foot on these muscles are supplied by the superficial fibula nerve. So we've seen the deep the deep brunch on my we're not going to talk about the superficial brunch. So first off, you can see fabulous longest. They says, um, more superficial than 50 carbs. Privates, which closing next. It originates from the superior lateral surface of fibulas on the lateral tibial condyle on inserts on to the medial kinase form bone on the base of the first metatarsal. Oh, again, Um, like I said So I said before that the tibia Ellis muscles, they invert the foot, the's liberal arts muscles, they are just doing the same thing. But on the different side. So sort of like the opposite. Um, So both they are going to even the food. If you think about where the muscles are on whether I'm gonna Spencer and then if they tighten, they're gonna cause it to Evert on. They also cause plant reflection as they across the ankle joint there. And you can see that they are, um, behind the lateral malleolus there so they can move that joint as well. Um, I was, except for yep. So both fabulous muscles just IV origin. And that's, you know, I feel like is that easier? Way to remember it, then just learning them all off. You know, the two to bolus invert on the 2 15 or fever. So here we have the blood brothers again and read about this a professional fibular nerve. It is deeper and shorter than figures longest on it originates in the inferior lateral surface with figure soft. So it's a bit further dawn than the longest it inserts onto the best metatarsal on it. It hurts the foot. It also planter flex if it's a swell, but I will change that on So you can see here the the two tendons, all the muscle of the two muscles. You can see them coming down here than passing under the fibula retinaculum here on this Baseer to lot of millions on they are and certain into their respective and such, um, poison the foot. No, I we're going to look at the posterior compartment. So we as I said before it got? It's a professional on a deep staring compartment on, um, I'm going to start with looking at the superficial. So these are all innovative about the tibial nerve. So there's only, um, you know, there's no suppression deep tibial nerve, which is born tibial nerve. So the first muscle big muscle gastrocnemius it is the big kind of mostly you can feel on the back off your lower leg. Um, it's the most superficial muscle off the posterior, like on it's bicep. But also it has three heads. Um, there is a medium, the lateral head, the media one originates in the medial femoral condyle on the lateral. A rich. It's in the lateral thigh Macondo, so that's quite easier to remember on, um, a little while later, they make up some of the borders off the pop. Um, so the muscle valleys they joined together, then partway during the leg. On they form a colander. Don't common tendon. The insights on cocaine ius bone. Um, so you can see here they form that tendon there, and it's also known as your a Kelly standing or your calcaneal tendon on. They cause part reflection of the foot on deflection off the knees. They cross that joint. Um, there is You can see. They can also flex the knee eso next. Um, we are going to look at so late as muscle. So this is a muscle that's just deep to the gastro new ms um, also innovated by the tibial nerve. It originates from this. So lay a line off the tibia on the parks, more fibular. So it only acts on the ankle joint is across the knee, and it joins with the gastrocnemius muscle on insert on circle K knees as that tendon is. Well, it is only involved in pontiff lecture in this time. Um, on as I said before, the Calcaneal tendon is the Achilles tendon. I'm finally then in our superficial posterior compartment, we have plantar wrists. Um, so this is a small muscles kind of strange muscle. Um, it doesn't really look like the others, but, um, it's not always present. It's absent in 10% of people. It's got a very long tendon, and sometimes confusing isn't nerve. If you look and see where it travels down into, you concede that it'll, um, you know, join with the other muscles. All not tendon. You know, whereas a nerve would, you know, that are starting that the big nerves will continue down in the past three. That they won't, um, completely terminate into the, um into the tendon. Ah, it lies between the gastro new medicines latest muscles. So, um, it's deep gash. Numb is unsightly, superficial to slay us. It originates from the super condo line of the femur and again inserts into that tendon. It provides week flexion at the names you can see it crosses the knee joint on. It helps implant reflection of foot. So are you Conceive here? Um, they're just image that shows all those muscles together. You can see how you have to kind of cut three. The heads of the Goshen, um, used to see a plantar's answer lies muscles that they're dig to them and you can see. Uh then we're going to talk about it more. That's the popliteal fall. So But I'll come to that later, eh? So now we're talking on the deep posterior compartment. These muscles are all supplied by the same nerve. A superficial Mr Compartment, The typical nerve. So first off, we've got tibialis posterior. So this is a muscle that originates from the tibia and fibula and the intraosseous membrane and inserts on to the plantar surface off the medial tarsal bones on it. Eloise for pontiff, election and inversion of the foot. Um, again, As I said earlier, both the tibial is muscles invert for so as long as well as to be else interior. I'm two bales post. You're embarrassed the foot, except just this one over the counter fax because it comes behind, whereas to be else onto your ear. Dorsiflex. Um, it also helps to maintain the medial arch off the foot. Next, we've got flexibility. Torme longest. This is a muscle that originates from the medial surface of the tibia and inserts into the plantar services. The lateral floor. Four digits. So not the big toe, just the smaller toes. It is responsible for pontiff lecture on flexion off those lot of four toes. So it's sort of the opposite off your extensive digitorum longest. You know, it kind of does the opposite of that, but it works on the same, uh, digits. And then finally, we've got extensive houses. Longest. This is well, is kind of like the opposite off flexor houses longest. So it originates from the posterior surface of the fibula. Eight inserts under the plantar surface of the first violence on it's responsible for plantar flexion of foot, um, collection of the big toe. And so they all the the flexor on the extensor muscles, all sort of Harvey a counterpart. So they they, um I will change the extensive on that slide, And I'm also just got confusing. It is right now. Sorry about that. And so you can see here the tendon. So they all run on, um, the bak off the leg, and then they pass through this as you consume. Well, inoculum on, um, they posture in a certain order, so you can see here, uh, thought there's a new mom like cold that's called Tom Dec. I'm very nervous. Hari still sort of remember the order of it. So, from nearly, like superior or, um, medial, whatever way you want to look at it to, um, very reliable. You You have your two miles posterior, which is the 1st 10 and coming down here. Then you've got your flexor digitorum longest. Um, that is next. And then the very stands for a vessel. Um, just make sure you don't get confused and think very stones for vein. It sounds with vessels of the posterior tibial artery on the vein on, um Then next you've got nervous, which is stunts for north. So that's a tibial nerve. You can see that come down there as well. And then, lastly, you've got hurry, which is for your flex. Our house is longest of the pages for calluses. Um, you can see that coming down here. I'm passing three. So if you know you're in on exam on, you can see that. And they've labeled one of the tendons or one of the muscles. Um, you know, don't panic. Just take your time. Think about it. You couldn't tell the order off the tenants. And even if you took one, you can see where they're in certain to, um, you can see that they are uncertain. Intto the correspondent tenders or uncertain where they should be in certain, if that makes sense. Okay. On know the last muscle in the date post your compartment is the possibility is muscle. And so this is not like the other, uh, deep posterior muscles. It's up quite high. in the leg and it's in the superior part of the post your life and originates in the post Your surface off the proximal tibia I'm in starts on to the lateral condyle off the femur on the lateral meniscus off the knee joint on it. This responsible for lateral rotation of the femur of under, probably thinking, you know, the, um you know, how is that working at the knee? No, there's no real little bit a shin and this hot this works toe on. Lock your knees. You know, if you really strengthen your your knee, um, it's sort of locks in place sometimes, you know, um so this muscle contracts on it a lot of lot of over take off the femur so that then the flexor muscles of the knee come work instead of, um, you know the need being completely locked. So whenever the knees locked, that's medial rotation off the femur. So whenever the popliteus muscles pulled and it's gonna bring it into a lot of irritation and then analyze it to start blacks and, um, because if that doesn't work, we'll be damage to the day. Eso here. I just got it in a little slide. That kind of summarizes thie. Um, the muscles that work at the ankle joint. I know. I said that some of those, um, worked at the name, but most of them are only at the ankle joint on that shows. Um, which ones Dorsey Black sponsor. Flax. On which one's environment IV art the, uh, at the ankle. So now I'm gonna going to talk about the popliteal fossa s. So this is just an area in the back off the knee. You can sort of feel it, and I'm sure you probably and in clinical skills and stuff. And it's involved in the, um the examination normal that their bought, um it's kind of important terms of its boundaries in its contents. So here we've got, um, a right leg so you can see superior lateral here is gonna be your biceps. Famous muscle or superomedial Border is you're saying the number Tosis your inferior lateral border is your lateral head of gastrocnemius muscle on your plantar us Mostly concede there on. Then you're inferomedial Order is going to be your lateral head. Afternoon on. This contains Teo artery The popliteal vein, the tibial nerve on the common for your nerve, and you can see this. So the sciatic nerve kind of comes down and it just branches just above here. Brunches end our tibial nerve on are common. Um, figure or paraneal nerve. Um, so and then it's the common February nerve that's gonna divide into our, um, superficial and deep fibular nerves that supplied on those muscles are talking about earlier and then the tibial nerve that supplies all these muscles here. But I think it's going to talk to you about more about that on. Then You can also see, um, the artery. It's not as easy to kind of depend two year. But if you're looking in like perceptions or even in other images, this isn't really like a left to right kind of situation. It's more like deep to say, professional so publicly. Artery is quite date. Then you've got your vein, and then your nerve is quite on. Both of the nerves were quite superficial on you can get damaged. So if you get a fracture, um, off the tibia and fibula, you can get, you know, internal damage. If it's like, kind of, um if the distal part of the bone projects backwards that one has brought off. So it could be pulled up by the gosh me means muscle. And it's pulled up. It can pierce the artery because it's so deep in the leg. Um, whereas the nerve and that isn't more susceptible. Teo, you know, outside damage. You know, um, like, say, injury to the popliteal fossil from the outside rather than from the inside out. Um, but yeah. So that's just something to keep in mind. Um, And then in the public golf also, you can get swelling's so you can get the single the baker cyst. I'm not sure if you heard of it, but it's literally just inflammation off. Um, the semimembranosus is Barsa. Um it's associated with also arthritis of the knees. So it just causes a big swelling in the back of the knee, and you can feel it if you're examining someone's need. Um, usually, you know, it's usually no thought, which is an issue, and it can resolve itself, but it can call symptoms, and not so people, um, sometimes want to get it drained or anything. Um, you can also get, um, there's other things that cause swelling the property of fossil, one of which is you can get like an aneurysm off the popliteal artery. Um, the best way to tell the difference if it's a cyst or understand that it's not under is, um you're gonna be able to feel it pulsating or is a cyst is just, you know, Sinus related on. Then finally, um, something that I don't know how relevant it is, just like the one in there as compartment syndrome. So, as I said before, your leg is divided into those compartments. You've got urine to your your lateral and you're to posterior compartment on day air, sort of divided up by fascia on what you can get. Sometimes it usually happens in like trauma, like traffic accidents and stuff like that. There is this bleeding or like swelling or fluid in the legs into one of the compartments on the femhrt shirt. In little Martin is a lot stronger than you think, so the fluid building up, whatever it is, it's, um, contained to the compartment on. It usually results in like, really, really extreme pain of the legs, obviously, but you can you can also get it in different regions but just in specific to what I've been talking about. It's gonna be the legs, but you can see it in the glutes, the thighs on the forum region. People usually present with, like, really extreme pain toe what you would expect with certain injuries and that, you know, they could have a whole lot worse things going on that going. But they're screaming about their lives in their legs, you know, Didn't seem that box is all internal kind of blading and fluid, Um, on. But it's really a kid. It can't happen chronically but usually in trauma. It's a kit, um, it's associated with with bone fractures and crush injuries. So it's bleeding and stuff like that. They're, um, on even. It's a suit with five pains, five pieces, so there's disproportionate pain. Parasthesia Pale high pressure paralysis is quite a late morning Victorian of you against age where they're getting, um, you know, they're losing their building and the their legs and stuff. That's what worrying on the only real treatment is an emergency fasciotomy. Um, because otherwise you're going to get a skin tear off, um, the muscle in the text reason that you're gonna get the closest on it come be diagnosed using a a ultrasound, but it's not recommended that this is done. Um, just because it's such a large and say, you know, you should know when you've got it, you know, it's gonna be in the absolute extreme pain, nothing like anything else on they could have, you know, everything that's going on in their only focus and then like eggs. Um, but yeah. No. So I thought that was about relevant just because we're talking about the different compartments and and Yeah, so thank you very much for listening. I hope this has bean helpful. And again, if there's any questions at all and just feel for you to, um, ask me at any point, okay, it Thank you so much for being really great. Um, so, yeah, she said just any questions? Just stop them into the chapter on. We'll get those for free. And so next, going to have Lorcan and he's going to talk to us about that. Hi, everyone. I'm Larkin, So I'm gonna be doing the foot today. I don't have been sitting for quite a long time, so you'll be happy to see that. Um they're actually isn't much learning objectives on the foot. So today we're going to be doing the binder ease and contents of the Tarsal tunnel. I never want to be doing the intrinsic muscles off the dorsum of the foot navy went over the extrinsic muscles. And then we'll be doing the intrinsic muscles of the planter aspect of the fit on described innovation and actions of these muscles. Eso to begin with, we have the tarsal tunnel. Um, so the borders, it acts as a positive way on the postural medial aspect of the ankle. Here, um, and it's ordered by the floor, which is a conch, a V like shift which was formed by the medial aspect of the tibia. The Taylors, under Calcaneal on is formed into a tunnel by the flax around macular and similar to the wrist, which spans a big bleed between the medial malleolus and the medial tropical of the Captain. Yes, on the flex about macular is continues with the Depression of the leg and foot on s Oh, I leave said as well, and we've got the content of the tarsal tunnel with Tom Dick and a very nervous hurry. Eso from anterior deposit of the contents are the tippy Ellis posterior tendon, the flexor digitorum longest hand in the posterior tibial artery and vein. The tibial nerve on the flexor pollicis longest done in. So the tunnel is divided into four compartments, one with the neurovascular structures and the other three containing attendance s. So I think this diagram is really good for, you know, um, one sec explaining the the monarch there and they say, Naughty. I said, nervous as much of a much. Um, So there's some clinical context here. There's tarsal tunnel syndrome, which is an entrapment of compression of the tibial nerve. As it passes through this, the tarsal tunnel on the symptoms are like ultra sensation along the century, distribution of the tibial nerve, which is the sole of the fit on. In the more severe cases, there is also weakness. I'm wasting all of the intrinsic muscles. Um, management is similar to, um yeah, the rest of well, for Ah, I forgot the name of it. But the conservative management physiotherapy, steroids and surgical is just the tarsal tunnel release of the flex around knocking. Um, carpal tunnel. I just remember that I actually have carpal tunnel syndrome. Um, so we've been out to the intrinsic muscles of the foot. We've got the dorsum of the foot. Um, we have the extensive digitorum brevis, which lies deep the tandem of the X censored digitorum longest. So it originates from the calcaneal interosseous two tibial calculate a ligament and inferior extensive Maculan on it attaches to the proximal phalanx of the great toe on the long sensor. Tendons up toast 2 to 4. And it needs the extensive digitorum longest and extending the medial four toes at the metatarsal phalangeals interval and your joints on them for the extension houses. Preface. It's medial to the extent certitude, Um, longest unlawful. To the extent Sir, Hollis is longest. It also originates from the calcaneal the interosseous to a T L0 calcaneal ligament on the inferior extensive right, Macklin. But it attaches to the beast off the proximal violence of the great toe. And it adds to the extent of calluses longest and extending the great too. On both of these muscles and the dorsum of the foot to the intrinsic muscles are innovative by the deep fibula. Nerve on you could see them here both originating from the CME area on but attaching to different areas. Um, so no for the planter aspect of the fit. There's sand intrinsic muscles in the sole of the fit, and they stabilize the arches collectively, but individually, the controlled movements off the digits, so all of them are innovative by the medial planter nerve or the lateral counter nerve, which are both Bunches of the tibial nerve on the muscles, are organized into four layers, which will be described here from superficial too deep. So for the first layer, it's most superficial to the soul, and it's immediately underneath the plantar fascia. And there's three muscles in this layer. So for the first one, we've got the abductor houses on abductor. Calluses is located on the medial side of the soul, where it contributes to a small soft tissue bulge. It originates from the medial typical of the calcaneal, the flexor out macular on the planter up a neurosis on it attaches to the medial base of the proximal phalanx of the great toe on it. Abducts and flex is the great toe. So Hollis is pretty much just means the big toe, and it comes out quite a bit. So as when you see houses, you know it means to do with the movement of the big toe. Um, and it's interviewed by the medial contra. There's the flexor digitorum breath. Brevis is located laterally to that on it since sits in the center of the soul between the counter aponeurosis and the tendons of the flexor digitorum longest. So it originates from the medial typical of the calcaneal. That's well on the plunger. After neurosis, it attaches to the middle for allergies of the lateral four digits on it acts to flex the letter of four digits at the proximal inter financial joints, and it's also interviewed by the medial nerve to esos Continue. Know what that doctor digital? Many me. It's similar to the Hondas. Well, where the digital minimum evenings, the little toe or the little finger. Um, and it's located on the lateral side of the foot, which makes sense because it's the lateral side where the toe is, um on. It originates from the medial collateral tropicals. Other calcaneal on the planter up a neurosis. It attach this to the lateral base of the proximal times, the fifth digit and abducts and flex is the fifth digit, or the wheat of it was, I call it it is interviewed by the lateral plan for nerves, where the second layer it contains three muscles were on the tens of the flexor digitorum longest and the flexor pollicis longest, which are extrinsic. Muscles that need describe passed through this layers well. So for the two muscles we got, the contract is planting and it's looking. It disappeared to the flexor digitorum longest tendons on it. It's separated from the first layer of muscles by the lateral counter. Vessels unnerve. So it originates from the medial medial collateral plunger surface of the calcaneus on a touches to the tendons of the factor digitorum longest. It, it says, assists the flexor digitorum longest in flexing the lateral four digits on is interviewed by the lot of applying for nerve. And then we've got the lumber. Gal's name is the hand as well, therefore lumbrical in the foot. They are each located medial to the respective tendon of the flexor digitorum longest eso they originally from the tendons of the flexibility run longest. As I said on the attack, to the extent your hoods of the lateral four digits similar to the hand, Um, and it's acts to flax The matter. Tarsal financial joints were extending that interval and your joints so innovation is similar to the hand as well. The most medial Lyrica was interviewed by the medial planter nerve but the remaining for your interview to buy the lateral counter nerve. And here's just a second layer and diagram. Forms of those are the tendons of the tendon of the flexor houses, longest on the tendons of the flexor digitorum longest. There's the lumber girls there, and there's a drug plan today, so we've been on to the third layer. It contains three muscles. Eso. The first one we have is the flexor pollicis privates, and it's located on the medial side of the foot. You know, the big toe some extensive medial sense, for it originates from two places on the sole of the foot. So it originates for the plantar services of the cuboid on lateral junior forms from the tendon of the posterior Tibialis tendon, and it touches to the proximal falling off the grid tones, and it acts to flex the proximal phalanx degree to at the matter. Metatarsophalangeal Joint and it's interviewed by the medial time for nerve, which makes sense cause some medial side. Then we've got the abductor. Hollis is it's located laterally to the flexor houses. Brevis on consists of a leak on transverse head, so the big originates from the basis of the 2nd, 3rd and 4th metatarsals. The transverse I had originates from the planter ligaments of the metatarsal phalangeals joints on both heads attached to the lateral base of the proximal phalanx of the great toe. And the doctor houses a ducts, the great toe and assistant for me, the transversus arch of the foot. It's innovative by the deep brunch of the lateral planter nerve and then, you know we've got the flag to did it in digitally minimum brothers. Um, it's located on the lateral side of the foot with the festivity it underneath the metatarsal of the little toe, remember, resembles the interosseous in structure. It originates from the base of the fifth metatarsal, and it touches to the base of the proximal following the fifth digit and acts to flex the possible dunks of the fifth digit. It's interviewed by the strip official branch of the lateral punter nerve and you can see here, just the the oblique head here on the transfer said of Doctor. House is on. Then there's bi Flex. Your house is practice for the board layer. It consists of dorsal on plunger all see a. It's annoying that it doesn't have four muscles in the layer with the Sacramento in layers, but well, so the planter injure. Honestly, I are you need Pettitte on the dorsal are interested by pen it, Um, So what That means, basically, is that by pen is connected. Teo attend on people's going separate directions, like kind of said about the restless families where it's shaped like a leaf or a feather. Um, so for the contrast dye, there are three punch also, and interosseous, which are located between the metatarsals on each, arise from a single metatarsal. Um, so this has to medial side pathologies of digits 3 to 5. Um, they act to adducted it's 35 flex them at the total financial joints on our innovative by the lateral planter nerve. So interosseous I therefore of them, which located between the metatarsals on so the original from sites of parcels. 125. The first muscle attaches to medial side of the proximal phalanx of the second digit, the 2nd 4th interossei I attached to the lateral sides of the proximal phalanges of digits 2 to 4, and they actually abducted. It's 2 to 4 a flex the metatarsal phalangeals joints, and they are also interviewed by the lateral counter nerve. So here's just empty your LC I There's the plunger ones. You can see that they're unique planet and morphology. And then there's the two tenants of the Prolia's longest and tibial supposed to your talents. And then those are the dorsal interosseous. I guess I have some clinical context. You could get medial planter nerve entrapment s so it can become compressed, and it can cause symptoms such as a aching numbness paresthesia on the medial side of the fit. This is different, too, Like tarsal tunnel syndrome, where the entire tibial nerve is compressed. You got a majority of the soul. If there's according to severe case, you are, you get wasting the intrinsic muscles of the whole fit. Um, so, yeah, I got a few questions here. Pretty, uh, the first one is, uh, what nerve is compressed in the Tarsal tunnel? syndrome. I literally just said it. They're sorry. Um, don't give you a second. So it's the tibial nerve on that. Our next question is, and what layer of the planter aspect of the foot that the medial a lot of planter arteries travels? It could be a second to think. So it is later, too. Thank you very much for listening is I know he's been sitting quite a long time. But if you have any questions, you can use my email at the very start. Or you can probably find me at any social media and DME there. Uh, very much. Thank you. Norton. Break it. Mm. So, yeah, he said any questions? Just something that way. Them. So the next going to have Craig and he's going to talk about the ask that you're off the corner. All right. Can you see that? Yeah. All right. And my internet is but Robert shelf conks out at any time. Just I know somebody tax me or something. Just sitting down, waiting. So here's and so I'm creating when talk about about the vascular supply of the lower limb. Ah, just to talk a bit about the learning that comes, and especially for this talk where it says, identify, especially for the veins, just need to be able to identify it. And then, for the art racial need to be able to describe it a bit more details through the origin course and relations often so for the venous tree and into the lower them as a whole little drink the external iliac thin and which foot itself will drain the inferior vena kid. If I common iliac in the ministry and is consists of superficial and deep friends, and the deep financial share the names with the heart rate, is that the wrong with and very often as well the nerves they robbed with Israel? They can kind of run in three and a story and bit of physiology they share. A fiber sheath with the arteries on the fiber sheath is obviously it come constrict with in it. So the pulsations of the artery will result in the vein issue turn of venous venous blood to the heart, and just in the same way you've got your muscular pump is another one of the ways that happens. So for the gastric name, yes, muscle when it contracts and it'll help return blood to the heart as well. On the superficial veins, we have the small soften ist on the great soften this fence again. You just need to be able to identify these. But I was in ah vascular clinic and third year on, but one of the surgeons asked me to to describe the course, all of them that naturally had no idea. And we'll just talk about about doctors, while so the great softness, fin and or it's always noticed, a long softness fin. It's the anterior medial one. So it starts antirougeurs the medial malleolus and descends along the medial aspect of the entire leg and this eye, and then it drains into the softness opening of the fascia. Lab it into the femoral vein, then the small softness is it. It's pretty much exactly the opposite. It's postaer lateral, So it's from the posterior part of the lateral malleolus on the dreams into the popliteal vein and via the Popliteal fossa. Just a very clinical information. Varicose veins are calls use probably seen it before in old folks, so they're caused by incompetent valves and the perforating Vince, the perforating vans or the veins that traveled between the superficial on the community communicating vents and and then this will cause. The feeling of the valves were called blood. The pill that Mr Professional beans. Usually it's a symptomatic, but the presentation usually be heavy legs or signs of chronic venous insufficiency to think sort of skin changes and ulceration. Patients also tend to not like the way they appear to make people quite self conscious risk factors. As I say it's usually the older people will tend to get these just because the valves to clap and people being overweight can cause it to another. One bit of scene is pissed. Who would do here in professions where the be standing up for a long time. So, like this se security guard or somebody in manual labor and the blood will pull her in their legs along much time and usually options to treat it would be, and you're conservative management, so just wait loss and stockings and what not and then your surgical options are and oh, thermal ablation, which you can see on an extra next lied sclerotherapy, which I can't remember from 30. But I think it's just like the injection to foment. It's very cool on then. Stripping is just from moving. And surgically, Uh, this is one of the skin changes off chronic venous insufficiency. So little pool in the superficial veins and cause hemosiderin deposition. I got a stress load on board last year. What vessels were looking up, and the more you first you see it, you'll see it everywhere. So, yeah, it's just him. That position, because the blood's been pulling quite close to the skin and not on the right is ah ah, understandable ablation. No, your deep things which are very much white, similar to the arterial supply. And so the yes of the popliteal is continuous with the family in particular. Property 11 is made up of those three legs Vince, which quit. But again, uh, the sleep is the arteries and which will become the family in the family and becomes the external iliac mean on the public. Television is for by the union off the anterior posterior tibial, vins and larvae, and it's in the popliteal false the next. The popliteal artery on the femoral vein is in that family triangle that were talking about earlier, and so it just like the arteries goes from the a doctor hiatus that gap in the A doctor Magnus muscle. It's sort of on the medial aspect of the knee, and then, ah, yes, And then it travels in the a doctor canal. And it will also receive the Deep Family or the deep femoral vein and then the Great South machine and just a bit more clinical context. Deep in from both cysts, these were the one of the causes of a swollen leg, and so it's just thrown by the form in the dates in Judah, usually usually it's quite common and surgical ward. So based on street Kevin prophylaxis against this. And don't ask me what it is cause can't remember and then so we have patients. Usually the usual picture is somebody that say pregnant or on hormone therapy. So the pill, the rich or tea and or patients usually the classic one exams. Somebody's just returned from a long haul flight gets paid painful left like ah, and it's very important because he's thrown bike and amble eyes and convicts come a pulmonary embolus, just to talk a bit about the arterial supply. As I said, you'll need to know this. That more detail, um, and the respect more to learn. But this diagram mean you've seen the left quite a good summary. And you can draw that side and try and keep your pain until you get it right. I would. So the femoral artery, this's would be the main supply of the leg is a whole. It's a continuation of the external iliac artery in fear to the inguinal ligament. That's a sign of saying that halfway between the basis and the pubic typical. That's your landmark for your pulse. And and, as I said it forms of femoral sheath with the vein and not the nerve, because it was so many branches it would weaken deceased. And then you can remember the name on it for a A and from medial to lateral, you can see here just in the family triangle itself, so being ordering nerve, and then it will travel in the A Doctor canal deep to the start aureus. You can see there is your short aureus. There on. It will become the popliteal artery of the doctor hiatus that they're got. You can see it in the A. Doctor Mark. There's some important branches, the family order. It should hopefully bring it all together for you and profunda family wrist, is it? It's quite similar to the arm, really? And so it's the deep family artery. And this will come from the posterior lateral part of the family artery and itself, and then some of the muscles. Then these two arteries that supply the neck of the femur. That's your medial and lateral start complex. Family order ease. Uh huh. Plied the neck of the femur. They're saying this these are these could be damaged in the back of the favor whenever it gets fractured, which would result in a vascular necrosis. The federal head on there, a few different types of, uh, like a femur. Fractures remember we learned about. But the one that affect this isn't enter capture a fracture. So whenever this happens, especially in older people, the apple need replaced. It's not good enough just to be able to fix it on. This is a good diagram. Sure, not on a form anastomosis with you. Remember the name of the ordinary. It's the arteries and ligament of the head of the femur. So this runs in the the leg went to the head of Famer from the old trade. Order it. I know The Popliteal artery is a continuation of the family family, ordinary it from the doctor hiatus Every it gives branches that around the knee, and we'll supply that knee joint itself. On these periarticular anastomosis is called means that knee joint could still be supplied and whenever the knees, since the reflection. Ah, on the popliteal artery, it travels deep in the posterior aspect that very day. But remember, you're trying to take the pulse. You really got a squeeze quite hard to be able to feel it on. Anteriorly is related to the popliteal surface of Famers or rubs against it, and they haven't told my goal on market. The lower border is gastric name. Houston politest away from the muscle neighbors, but it'll become the anterior tibial artery, and then usually it'll become this table fibula. Trouble, which I wouldn't really worry about, just knew what they become with the anterior tibial artery. And it's the smaller of the terminal branches, the popliteal or raisins. They're begins to the inferior or the popliteus muscle. Um, here it there for supplies that until your compartment, and it runs between tibialis anterior on extension digitorum longest. Unless it's on the anterior side, it will form the Dorsalis pedis artery, which is ah, sort of on the dorsum of the top sides. That's it. Take dorsal. Order is therefore it's the same idea is to talk. Ah, and then the posterior tibial artery is Actually, it's one of your pulse is if you can remember it's the largest turn a brunch and popliteal artery. It actually usually comes from the tibial fibula trunk, and it's a it's supplies the posterior compartment. Uh, and yes, so it runs post here to the media of Molly. A list in the Tarsal tunnel we're talking about. But you're Tom Dick and very nervous hurry, which is very important underneath the flexor at Macule and and they'll divide into medial and lateral punter arteries in these little supply. That's it, then the figure ordinary it would probably wouldn't be, is. I wouldn't call it important is the other two, but it supplies the lateral compartment. Ah, but it actually runs posterially so it descends towards the fibula like it's behind the fibular in the posterior compartment, and that supplies the lateral compartment fire these perforating brunches on again. It comes from the tibial fibula trunk, the artist supply that, I would say, is quite complicated. But if you could just remember this these three arteries eso the dorsalis paid us, which is should remember quite easily because that's the pulse. And it's for him from that until you're dead laundry and it runs lateral. To the extent your house is longest 10 in the first introduction group, you feel quite easily on yourself. It contributes to the deep counter, aren't you? Can see maybe in this image here, this deep under ordinary sort of comes and in forms this art here and and then your medial and lateral planter arteries. So the dorsal dorsal pedis totals paid us, obviously, is the door full side, and then the plantar raises the planter side of soul. On this deep Landreaux works. Let's say both forms while and we'll supply the digital arteries towards the tubes and the the lateral plantar or is much larger than the medial one is well, and I just run it all off the It's quite easy to remember, because you probably don't notice and before yourselves uh, the four pulse is with the family posts, but you don't feel quite a CT on yourself. It's very important. Financially, it's unfair to the medical point. So unfair to them. Common rule says halfway between the assistant to be triple it is quite keeping digital. Then the Popliteal pulse, which is deep in the public. He'll fall, so it would be quite hard to feel. And then the Dorsalis pedis pulse, which is lateral to the tendon, said then the posterior tibial pulse, which is post here to the medial malleolus. These were quite important. Say again, in road traffic, if you can feels the pulses easily on one side. But they're absent, say, from the knee down on the other. You know, you could've been a problem there. Uh, and that's me. I don't have any empty cues because I forgot. But But if you have any questions, please pass it on. Thank you. So much dot so really to get and so we're gonna move on to the final talk with evening, which is our and he's gonna talk with nerves, the alternate them, and that also just wanted to mention that we will be sending it. I link for a feedback form and I'll be sending it to you and email underneath a Laden. Then we'll be able to send you a chance. Traffic it's on. We'll also be able to send you the sides through that and then also just wanted to mention that way. Are currently looking for applications to join the stroke clinic next year. AM So when I send in a link, enter the checked for the rules. Another night for somebody in your application to join the clinic. And we would love to see some people joining up next year you can work with, You know, I have here a learn that you're on it, Mr. Here. Ah, the different types of nerves. There's only really three me and one's in the lower limit. The sciatic family not trade or nerves with the sciatic doing most of heavy lifting in the leg. Uh, before we talk about them just to briefly reach up at the lumbar and sacral plaques is because this is where most of the nerves of the lower lumbar region it eso they're actually located in the optimum at the lumbar flax. This is made up of favorites for mail one day. All fours. I'm teary. Um, I pushed area may just do the back, and you can remember the me and peripheral nerves coming off it with. I get leftovers on Friday. So that is your ilioinguinal a led hypogastric nerves and your genital Fowler or narrow. Ah. Which arm or involved with the abdomen. And, uh, Arnie, um, with these two, or more importantly, these three. So I am more important. You've got your lateral femoral cutaneous nerve, which is the name suggests, will be the latter. Last back to say and then you're up to read and family nerves, which we'll talk about that war in a second. These numbers here represent what am I are sorry. What? Ah, lumbar nerves contribute to each of the nerves. 23 and four give you the up trader on the family. And that's probably most important. One to remember if the lakes of empty Hughes ah, so secret plaques is than slightly. They were dying. A Z said lumbar flashes comes off L1 daily for the sequel classes. Picks up right off being derived from l 4-3 again from the anterior. Am I and you remember the me and peripheral nerves going from it with the acronym sips three pees. So this is somewhere you have. What nerves come out of it? We've already talked in the last presentation about the superior and inferior gluteal nerves. And also those little nerves going off the individual muscles and nerves. Quadratic families on operator internists Come off of the secret plaques is Well, then what about the posterior? 13 is never the thigh, which is the the Imagine just does the posterior aspect of the thigh in the buttock region. The potential nerve as not the day of the lower limit. Very innovative only structure in the perineum. Finally, we have the sciatic nerve which is doing a lot of the have a left and then the lower them, especially doing all of the muscles of the leg itself. So easy. Um, remember, then it could be a bit confused if you look back here. No one from what nerves each peripheral nerve is derived from. But there's a quick way which I have linked in the notes here. There's a YouTube video is really handy for remember and essentially it right. I just steps your s I p ps. Then each nerve here is essentially it made up of flavors from three of the lumbar nerve. So you'd rate beginning 451 And then it just goes in order of favor 1 to 123234 work. So, for instance, in fear gluteal nerve is made up of favors from L5 s, one s two or the down little bit up from as to ask three and ask for only exception then, is the sciatic nerve, which is me. It up of favors from L4 and on makes sense because it's the largest nerve in the body. So obviously it'll need a lot more favors tribute to it. So again, as I said, these were the ones that are most relevant for the lower limb. But I don't know. You can sort of forget about it so unlikely to come up for yours, but is a quick way of learning all of the sort of favors contribute into the nerves. And it's an easy thing to ask you an empty Hughes. Well, just giving each of these is an option. And, for instance, what fibers and make up the inferior gluteal nerve. So the family in there then, or the nerve more involved in kick in kick in our ah, I've already met. We've already mentioned it's a large brown to sit lumbar plaques is designed sounds in the posterolateral last back to the palace here, doesn't interviewed out, hang in the pelvis, travels underneath inguinal ligament along with your family or three, and be in in the order of nerve artery V in. And then you remember the border with the acronym near the so Nerve artery V and then way from so just basically the same. Diovan gives Innervation toe all the muscles of the anterior compartment, so we quarter stop. Stop first your sartorius so it was involved mainly in your knee extension on the thigh. Flaxen also gives articular branches that happened me and then give several cutaneous branches to the medial amount ear aspect of the thigh. But then that gives off only one branch, then past the knee. It's terminal branch. The South of us know if it gets its own knee. Um, sort of focusing on it a little bit more has said it's continuous. Only the family doesn't give any motor function past the knee, so it'll interviewed again like the femoral nerve. Did the ultra medial aspect of the thigh the softness nerve? Does the intro medial aspect of the leg uh, it raises in the femoral triangle. The Honda talked about it earlier on Descends through that a doctor canal, um, before becoming more superficial and interviewed in the skin here, and it runs alongside the gray itself. It's nerve the create was talking about, so it makes sense if it's on the medial aspect again, there's just the we summary of the interview shin, given by the family nerve in its branches. Sort of just always think antrum medial. I'll trade or nerve energy a doctor muscles so easy type muscles. You'll be using a horse riding essentially squeezed the other two. Keep yourself off right straight from favoring female to male forwards, we mentioned seems the family nerve on exits by the operator for almond Hanson E um, so that little opening in the pelvis benefits all the medial muscles. Apart from part of the hum string, part of a doctor Magnus, it also gives a tiny bit of a cutaneous innovation just to the medial aspect of the thigh at a two point of remind you. So one of the most like the things that can come up with an antique use our clinical questions for uses, nerve palsy he's and once he actually know the anonymous you the policies themselves or easy enough because the science the for instance, in this. If you know the motor and sensory functions off any nerve, then a palsy will just result in a lack of that. So, for instance, a person unable to adopt their leg and losing sensation and no hurry on the medial side, er say you'll know The only nerve that could contribute to Booklet was the Obturator nerve on again, just to remind you and most of the medial thigh is again by the family honor of itself, but that just that weeks action is the operator sciatic nerves and think it's nerve in the body, actually basically two nerves to gather the tibial and common fibula nerves on. The only reason they're kind of his movement because they're in the same sort of connective tissue sheath at the come together from the afford as three fiber's just under the piriformis muscle that you can see here we were talking about it are your knees. Lecture runs deep to the gluteus maximus, so you'll remember up, and I will have to inject to make sure you don't pierce it by accident on drones midway between the greater trochanter and the femur on the issue tuberosity in the pelvis It's plays all your posterior thigh muscles to your home string and then its branches to go on display all of the leg and foot muscles and almost all of the skin as well in the legs. Or actually, once you reach possibly in the sciatic nerve and its branches are all that's really going on, except for really a softness nerve given up, the media last back and you can see here. Just how long it is well runs the whole way from the hep. A right down into the tips of the toes is essentially just the note here. The actual sciatic nerve itself only really does the posterior thigh muscles, because once it hits the knee, then it'll be divide. And, as you can see in this image into its terminal branches, which we'll talk about in a second. Ah, so I clinically at the most important thing to do is sciatic nerves over these obviously sciatica, which can sometimes be a bit confusing. It's actually more of a syndrome where collection of symptoms will number of other diseases essentially just peeing in the buttock. Uh, I'm doing this. I sort of that area of continuous interview shin given by the sciatic nerve. If you ever see an antique, you sort of electric or shooting p n a lot of pins and needles, numbness or motor weakness in those home strings you'll know then it's more than likely sciatica, which could also be all saying is it? Most likely cause is, which is usually a herniated disc. So just that nucleus pulposus push the night and compressing the nerves is releasing, leaving the spinal cord. But you know, if we get things like spondylolisthesis, which is just the vertebra, essentially slate night of play a slightly and compressing the nerve or spinal stenosis, which is the name suggests the vertebral canal, so sort of narrow slightly. One thing the note is usually unilateral pee, in which it's not the most serious condition. It can be treated conservatively and usually, but if you ever see it went from a bailout. It'll sound ago. That's a red flag symptom for called acquaintance syndrome. So just be aware that bilateral would be very worried about it. That's an emergency and could be something. That's something that I could ask about car acquaint and M C. Choose as well Piriformis syndrome need already mentioned of out in another slight. It's a certainly just, ah cause the sciatica as well at one thing. To set apart. If you're possibly giving a stamp talking about someone with psychotic symptoms. But it's asking you what the possible cause could be something that can differentiate piriformis syndrome from others. Is that the peons exacerbated by internal rotation or that movement of the muscle? Uh, and again typically treated just with conservative measures. Or, if you feel not surgery with performance release, so they're natural branches of the common are the sciatic nerve or your tibial uncommon fibular nerves. So they're both four h Indian and not popliteal full. So that was school. Start there. It can be difficult to tell them apart they could. They were to take away all the labels here, just ask you what's what would be hard to differentiate the muscles and nerves, but it's so easy to remember the tibial nerve will base act, this diamond this popliteal fall so so essentially go from the superior angle, with sciatic nerve splits straight down through to the inferior angle, whereas the common fibula or common paraneal nerve. It could be a cold, either or troubles alongside that biceps. Families muscle, which is the lateral at upper lateral border. And then, once it exits in fear, fear your angle. It's troubles with the posterior tibial artery and not staying your nerve of the post to your compartments of your calf muscles like your gastro is going and getting your soleus so positive that then you wouldn't be able to dorsiflex. Sorry, plantarflex the foot, then, Ah, it also gives off Branch the medial side, sir. Little cutaneous nerve, which joins with the branch of the common fibular nerve. The cereal communicating brunch on that forms your Cyril nerve, which is just a routine ius branch that will talk about about more in detail later. And it'll also give off right before entering the foot. Um, medial calcaneal branch just to the heel on lower side of the hill on once it reaches the foot, then it will split into your medial and lateral plant or nerves. Okay, And that's just some where you see all of its functions before it hits the foot there and splits. Coming. Regular nerve then follows the base at family. It's located on the fibula side, obviously, Hanson am so the lateral last back of the leg kids with your shoe periodical follows biceps finalists. Then once it hits the head fibula ahead and it wanes around the fibular neck and splits itself and into two different nerves. The superficial and deep fibular nerves. So the common fibula nerve, then I'm sorry. No, that's just the number somewhere. Then off, uh, for another somewhere image of the nerve wind around the neck and then split in. And there's different branches. The defibrillation nerve is their nerve of the anterior compartment. So with those all the dorsiflexors, uh, travels along side the anterior temporal artery, which is just the artery in the anterior compartment land, exit the compartment into the foot to play the two intrinsic foot muscles on the back of the foot. So your accent Sorry. Digitorum gravis Extensors. Hollis is bravas. And then after that, we'll just travel slightly further on interviewed just this small area skin. Just the two essentially touch, um, services of the 1st and 2nd toe or the edges and services. Uh, drop then. So this is sort of clinically relevant for a palsy of this nerve than, obviously it's a dork laxer. So if again, just think the office that you're unable to dorsiflex eso in the normal gait or walk Psycho dorsiflexion is important because it helps you lift the toes in front of the foot and essentially stop it from dragon are hitting the ground. If that nerves parlays, the foot's going to hit the pointed down and hit the ground as you're walking. That's Mommy's foot drop. It could be a number of causes for it. Most common are overused anterior compartment muscles. So, like any muscles over use, these muscles can paper trophy on, do compress the nerve or take shoes. And this is a known risk. Ebert syndrome, where they are tight boots around the interior leg, can press the nerve because it runs quite superficially, and I can give you again possible parasthesia as well about. We point between the first two toes, and you can also get a stop and get because normally in the get as you're a place in the foot back dine, you're sort of slowly relaxed in that door, so flash in tow, get a smooth sort of sat down in the foot. If the nerves parlays that you don't get that, you just get the foot. Drop in straight by going with the grind. No control, the other only. Is this true professional fibular nerve. As you said, it's in the lateral compartment. Does your to fabulous longest and gravis the voters of the foot does. The skin on the distal anterior surface is highlighted in green here and then just the skin of the majority of the dorsum of the foot, the depo. More to do with muscular intervention with kind of a super genius innervation. While the superficial fibular is more so to do with cutaneous innovation, I'm just has a couple of muscles that interview, it's that's just the way summary of the compartments of the leg. What nerve on what artery is involved in each and how many muscles are in each. It's actually quite handy to learn because It's quite neatly organized, finding that intervention of the foot itself. So we've already covered the door. Some of the foot. It's mostly the fibula nerves on the plantar aspect. Then we have the loose to plant our nerves. We talked about earlier, which are continuations. The tibial nerve is it splits off. It'll supply. They'll supply all muscles of the sole of the foot to lose. Four layers that Lorcan was talking about know provide sensation that into the entirety of the sole of the foot as well, Then so continuous intervention in the entire lower than we've already talked about the thigh. It's moving your family up, treat her and say I like the different degrees. The leg itself is only really made up of three nerves. Given a continuous innovation, your superficial February's, we said, does the anterior aspect as well as the dorsum of the foot with any of the other two and stuffiness nerve, which we talked about. It's just that branch of the family nerve does the medial aspect, then the cereal nerve. We also talked about it. It's coming off the branches of the common fibula and tibial nerves on the consorted. Think of these twos partners and that they both do either side of the leg Cyril and the nails. Who else for lateral is well and does a lot of last fact? Your soft mist does the medial, and they also each run with one of yourself. And it's being so Southwestern our rooms with agree, it's office fee in cereal nerve runs with the smallest office being. And then there's just that little medial calcaneal branch was shows the heel on that comes off the tibial nerve as well. Gamblers your anterior aspect superficial instead. But I'm defibrillation nerves on. But then your plantar nerves will do the soldiers we talked about earlier, and there's just another image at you can see here. The media planter, nervous, actually does the obviously. The medial aspect of the soul does this far as the 1st 3.5 digits. Lot of plantar nerve, but those your other and 1.5 digits looks familiar. That's because very similar set up to the on. So if your total being equivalent or your Grand Toby and equivalent of the thumb 1st 3.5 digits were done by the median nerve and Hans. Well, that's equal into the medial prompter nerve. When you're older, Nerve does the other 1.5 the Jets, and that's your equivalent of the lateral counter nerve. So that's, uh, sort of just tourist reacts accuse then on. Then we can let you go. So, first of all the damage to which nerve consult in difficulty extending the knee. Does the Hyundai enough want to start with that? Your family nerves. So again, those the anterior compartment each of these responsible for extending your need again like we were talking earlier about your squats, the gluteal muscles and your quadriceps muscles or both involved. So as the gluteal muscles are extending the high, your and quadriceps muscles are extending the the knee straight. Not like I lift that weird and damage to the tibial nerve and the popliteal fall so may result in. So in this case, it's an ability to start on one toe, so Evers in will be your IV order muscles as your lateral compartment. That's your superficial tibial nerve reduced sensation. The dorsum of the foot again, that's your 2 February are mostly the superficial, but drop. We talked about it is. Are your the fibula nerve again? Could dorsiflex is on, then? The popular nerve is also lost. Sensation between tools want to Whereas the tibial nerve does your calf muscles your posterior compartment which plantarflex not plantar flax movement allies you to start on your toes. Last one, that the sciatic nerve was damaged by an intramuscular injection when the buttock as needed, was talking about earlier bit patient would have reduced sensation in What are you So this one is the so this one's sort of task, in your knowledge that the sciatic nerve will have actually become your tibia common fibula a nerve because you'd associate toes woman to if you're deep, which is a branch of the common fibula, which is itself a branch of the sciatic nerve. So if there's damage up here in the gluteal region, as we say it or the buttock, then essentially everything downstream from that will be damaged for weakened, if not completely parlays. Where is under a medial side legs your family older nerve given innervation on here, thigh against family medials of mix of your family nerve and I'm not little bit by the operator. Then all the both can't be right either. So but deeper needle part is coming. Don't stream from sciatica. Nerve. So that's, uh, so thank you. That's my email. If you have any questions at all on other, not Then I'll let you go it. Thank you so much for that. Aren't that great? Mm. So, yeah. Sarin said, that's all. Sport is even finished and just remind you about they feedback for much will be sudden. I drew you by email. On Also, If you want to take a look at the committee rules for next year on base, it better not occasion. No, they're not. That's it. Thank you so much to rollover presenters for him taking the payment of the evening to come and talk to us on also to everyone for joining us. So thank you. Don't have a nice Easter break.