Anatomy of Lower Limb and Foot
PROJECT HD | HBS2ALF Prepared by: Jasmine Kouch Course: Bachelor of Health Sciences/Master of Podiatric Practice Prepared for: Semester 1, 2014
Anatomy of Lower Limb and Foot
1. Vertebral Column
Part Spinous Process Lamina Facet joint (zygapophysial joint)
Pedicle Body Spinal canal
Transverse Process Articular Processes Intervertebral discs
Function Attachment site for muscles and ligaments Forms the vertebral arch, attachment site for ligamentum flavum Synovial joint that connects the superior articular process and the inferior articular process directly above it. Prevents excessive rotation and flexion. Forms the vertebral arch Weight transmission/bearing Contains the spinal cord Enclosed within the vertebral foramen. In the intervertebral spaces, it is protected by ligamentum flavum posteriorly and posterior longitudinal ligament anteriorly. Attachment site for muscles and ligaments Attachment for the next vertebra Fibrocartilage joint that holds vertebrae together. Allows slight movement. Main job is shock absorption.
Superior articular process and facet Inferior articular process and facet Superior and inferior vertebral notches Regions of the Vertebral Column Region Number of Vertebrae Cervical 7
Distinguishing Features Oblique Allows flexion/extension, lateral flexion C3-C7 have bifid spinous processes
Thoracic
12
Lumbar
5
Sacral
5
Body is more oval shaped Sits on the coronal plane Allows rotation No transverse foramen Singular spinous process Body is a small semi-circular shape Articulates with the ribs Demifacets for articulation with the ribs Lies on the sagittal plane Allows stability, protects tissues Allows flexion/extension, slight rotation Singular spinous process No transverse process Assists with weight transfer to the lower limbs Fused
Typical ligaments of the vertebral column Ligament General Attachment Anterior longitudinal From: Anterior tubercle of C1 To: Pelvic surface of upper sacrum
Posterior longitudinal
From: Posterior surface of body of C2 To: Posterior surface of body of S1
Supraspinous
From: Tip of C7 spinous process To: Tip of S1 spinous process
Function 3 layers: Superficial: extends over 3-4 vertebrae Intermediate: extends over 2-3 vertebrae Deep: laterally short fibers connecting adjacent vertebrae Limits extension of the vertebral column
2 layers of collagen fibers: Superficial: extends over 3-4 vertebrae Deep: pass between adjacent vertebrae Limits flexion of the vertebral column
Thicker and broader at lumbar region 3
Continuous from ligamentum nuchae Helps maintain upright position of the head
From: external occipital protuberance to the spine of C7 To: external occipital crest, posterior tubercle C1, medial aspect of cervical bifid spines
Provides attachment for cervical muscles Tendon-like structure Sustains the weight of the head
Ligamentum flavum
From: C2 To: S1 Connects the lamina to adjacent vertebrae
Preserves upright posture Especially after flexion Elastic
Interspinous
From: Spinous process To: Spinous process Connects from root to apex from each vertebrae
Narrow and elongated in the thoracic region Thicker and quadrilateral in the lumbar region Limits flexion of the spine
Ligamentum nuchae
Intertransverse
From: Transverse process
Limits lateral flexion of the spine 4
To: Transverse process Connects adjacent transverse processes
Curvatures of the vertebral column Region
Curvature
Contributing structures, time of appearance and function Cervical Anteriorly concave Toddler period (after birth) - Weight bearing of the head and neck Thoracic Anteriorly convex When the child starts standing - Supports for weight bearing - Posture - In the foetus it was anteriorly concaved Lumbar Anteriorly concave Appears after birth Sacral Anteriorly convex Appears before birth ***Primary curvatures: appear before birth – thoracic and sacral ***Secondary curvatures: appear after birth – cervical and lumbar
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Muscles of the vertebral column Muscle Sternocleidoma stoid
Origin **TWO HEADS Anterior surface of sternum & Upper surface of medial 1/3 of the clavicle
Insertion Lateral surface of mastoid process of temporal bone and adjacent part of the superior nuchal line
Trapezius
External occipital protuberance, ligamentum nuchae, medial superior nuchal line, spinous processes of C7-T12
Posterior border of lateral 1/3 of clavicle, acromion process and spine of scapula
Splenius
Capitis: ligamentum nuchae and spinous process of C7-T4
Capitis: mastoid proess and occipital bone
Cervicis: Spinous process of T3-T6
Scalenes
Cervical vertebrae C2-C7
Cervicis: posterior tubercles of transverse process C1-C3
1st and 2nd ribs
Joint Crossed Cervical intervertebral joint (anteriolaterally)
Action Unilaterally Cervical rotation to opposite side Cervical lateral flexion to same side Bilaterally Cervical flexion Assists in forced inspiration Bilaterally Rotation Retraction Elevation Depression of scapula
Nerve Supply Motor: accessory nerve Sensory: cervical plexus
Capitis: Neck Extension Lateral flexion Rotation of face
Capitis: lateral branches of dorsal rami C3-C5
Motor: accessory nerve Motor and sensory: C3, C4 spinal nerves
Cervicis: lateral branches of dorsal rami C5-C7
Cervicis: Neck Lateral flexion Rotation **The two work together for pure extension Elevation of 1st and 2nd ribs
Cervical nerves C3-C6
Diagram
Erector Spinae
Spinous process of T9T12, dorsal segment of iliac crest
Spinous process of T1T2
Transversospina les
Transverse process
Spinous process
External Oblique
Ribs 5-12, iliac crest
Pubic crest, ASIS, iliac crest, linea alba
Intervertebral joints (posteriorly)
Intervertebral joints (anteriorlaterally)
Internal Oblique
Lateral 2/3 of inguinal ligament, iliac crest
Rib cartilage 9-12, xiphoid process, linea alba, pubic crest, pectin pubis
Intervertebral joints (anteriorlaterally)
Rectus abdominis
Crest of pubis
Costal cartilage of ribs 5-7, xiphoid process of sternum
Intervertebral joints (anteriorly)
Extends the vertebral column
Posterior branch of spinal nerve
Unilaterally: Rotation of vertebral column Bilaterally: Extension of vertebral column
Dorsal rami of spinal nerves
Trunk Spine -
Ventral rami of T6-T12 Contralateral rotation Lateral flexion
With internal oblique Raises pressure in the abdominal cavity and pelvis Assists in defecation and micturition Produce forced expiration Trunk Ipsilateral rotation Spine Lateral flexion Flexion of lumbar spine
Ventral rami T6-L1
Thoraco-abdominal nerves T7-T11
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Psoas major
Transverse process L1L5, intervertebral discs from inferior T12 to superior L5, body of L1L4
Posterior aspect of lesser trochanter of the femur
Psoas minor
Bodies of T1-L5 and their intervening intervertebral discs
Pectin pubis, iliopubic eminence, lateral iliac fascia
With iliacus Flexion of hip joint Medial rotation of hip Unilaterally Lateral flexion of lumbar spine Weak flexor of lumbar spine
Lumbar plexus Ventral rami L1-L3 (occasionally L4)
Lumbar Plexus Ventral rami L1
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Anatomy of Lower Limb and Foot
1. Vertebral Column
Part Spinous Process Lamina Facet joint (zygapophysial joint)
Pedicle Body Spinal canal
Transverse Process Articular Processes Intervertebral discs
Function Attachment site for muscles and ligaments Forms the vertebral arch, attachment site for ligamentum flavum Synovial joint that connects the superior articular process and the inferior articular process directly above it. Prevents excessive rotation and flexion. Forms the vertebral arch Weight transmission/bearing Contains the spinal cord Enclosed within the vertebral foramen. In the intervertebral spaces, it is protected by ligamentum flavum posteriorly and posterior longitudinal ligament anteriorly. Attachment site for muscles and ligaments Attachment for the next vertebra Fibrocartilage joint that holds vertebrae together. Allows slight movement. Main job is shock absorption.
Superior articular process and facet Inferior articular process and facet Superior and inferior vertebral notches Regions of the Vertebral Column Region Number of Vertebrae Cervical 7
Distinguishing Features Oblique Allows flexion/extension, lateral flexion C3-C7 have bifid spinous processes
Thoracic
12
Lumbar
5
Sacral
5
Body is more oval shaped Sits on the coronal plane Allows rotation No transverse foramen Singular spinous process Body is a small semi-circular shape Articulates with the ribs Demifacets for articulation with the ribs Lies on the sagittal plane Allows stability, protects tissues Allows flexion/extension, slight rotation Singular spinous process No transverse process Assists with weight transfer to the lower limbs Fused
Typical ligaments of the vertebral column Ligament General Attachment Anterior longitudinal From: Anterior tubercle of C1 To: Pelvic surface of upper sacrum
Posterior longitudinal
From: Posterior surface of body of C2 To: Posterior surface of body of S1
Supraspinous
From: Tip of C7 spinous process To: Tip of S1 spinous process
Function 3 layers: Superficial: extends over 3-4 vertebrae Intermediate: extends over 2-3 vertebrae Deep: laterally short fibers connecting adjacent vertebrae Limits extension of the vertebral column
2 layers of collagen fibers: Superficial: extends over 3-4 vertebrae Deep: pass between adjacent vertebrae Limits flexion of the vertebral column
Thicker and broader at lumbar region 3
Continuous from ligamentum nuchae Helps maintain upright position of the head
From: external occipital protuberance to the spine of C7 To: external occipital crest, posterior tubercle C1, medial aspect of cervical bifid spines
Provides attachment for cervical muscles Tendon-like structure Sustains the weight of the head
Ligamentum flavum
From: C2 To: S1 Connects the lamina to adjacent vertebrae
Preserves upright posture Especially after flexion Elastic
Interspinous
From: Spinous process To: Spinous process Connects from root to apex from each vertebrae
Narrow and elongated in the thoracic region Thicker and quadrilateral in the lumbar region Limits flexion of the spine
Ligamentum nuchae
Intertransverse
From: Transverse process
Limits lateral flexion of the spine 4
To: Transverse process Connects adjacent transverse processes
Curvatures of the vertebral column Region
Curvature
Contributing structures, time of appearance and function Cervical Anteriorly concave Toddler period (after birth) - Weight bearing of the head and neck Thoracic Anteriorly convex When the child starts standing - Supports for weight bearing - Posture - In the foetus it was anteriorly concaved Lumbar Anteriorly concave Appears after birth Sacral Anteriorly convex Appears before birth ***Primary curvatures: appear before birth – thoracic and sacral ***Secondary curvatures: appear after birth – cervical and lumbar
5
Muscles of the vertebral column Muscle Sternocleidoma stoid
Origin **TWO HEADS Anterior surface of sternum & Upper surface of medial 1/3 of the clavicle
Insertion Lateral surface of mastoid process of temporal bone and adjacent part of the superior nuchal line
Trapezius
External occipital protuberance, ligamentum nuchae, medial superior nuchal line, spinous processes of C7-T12
Posterior border of lateral 1/3 of clavicle, acromion process and spine of scapula
Splenius
Capitis: ligamentum nuchae and spinous process of C7-T4
Capitis: mastoid proess and occipital bone
Cervicis: Spinous process of T3-T6
Scalenes
Cervical vertebrae C2-C7
Cervicis: posterior tubercles of transverse process C1-C3
1st and 2nd ribs
Joint Crossed Cervical intervertebral joint (anteriolaterally)
Action Unilaterally Cervical rotation to opposite side Cervical lateral flexion to same side Bilaterally Cervical flexion Assists in forced inspiration Bilaterally Rotation Retraction Elevation Depression of scapula
Nerve Supply Motor: accessory nerve Sensory: cervical plexus
Capitis: Neck Extension Lateral flexion Rotation of face
Capitis: lateral branches of dorsal rami C3-C5
Motor: accessory nerve Motor and sensory: C3, C4 spinal nerves
Cervicis: lateral branches of dorsal rami C5-C7
Cervicis: Neck Lateral flexion Rotation **The two work together for pure extension Elevation of 1st and 2nd ribs
Cervical nerves C3-C6
Diagram
Erector Spinae
Spinous process of T9T12, dorsal segment of iliac crest
Spinous process of T1T2
Transversospina les
Transverse process
Spinous process
External Oblique
Ribs 5-12, iliac crest
Pubic crest, ASIS, iliac crest, linea alba
Intervertebral joints (posteriorly)
Intervertebral joints (anteriorlaterally)
Internal Oblique
Lateral 2/3 of inguinal ligament, iliac crest
Rib cartilage 9-12, xiphoid process, linea alba, pubic crest, pectin pubis
Intervertebral joints (anteriorlaterally)
Rectus abdominis
Crest of pubis
Costal cartilage of ribs 5-7, xiphoid process of sternum
Intervertebral joints (anteriorly)
Extends the vertebral column
Posterior branch of spinal nerve
Unilaterally: Rotation of vertebral column Bilaterally: Extension of vertebral column
Dorsal rami of spinal nerves
Trunk Spine -
Ventral rami of T6-T12 Contralateral rotation Lateral flexion
With internal oblique Raises pressure in the abdominal cavity and pelvis Assists in defecation and micturition Produce forced expiration Trunk Ipsilateral rotation Spine Lateral flexion Flexion of lumbar spine
Ventral rami T6-L1
Thoraco-abdominal nerves T7-T11
7
Psoas major
Transverse process L1L5, intervertebral discs from inferior T12 to superior L5, body of L1L4
Posterior aspect of lesser trochanter of the femur
Psoas minor
Bodies of T1-L5 and their intervening intervertebral discs
Pectin pubis, iliopubic eminence, lateral iliac fascia
With iliacus Flexion of hip joint Medial rotation of hip Unilaterally Lateral flexion of lumbar spine Weak flexor of lumbar spine
Lumbar plexus Ventral rami L1-L3 (occasionally L4)
Lumbar Plexus Ventral rami L1
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