Lecture Notes - Superficial Lower Limb

Superficial Structures of the Upper Limb

• Osteology
  • Humerus
    • Medial & lateral epicondyles
  • Ulna
    • styloid process
  • Radius
    • styloid process
  • Carpals - wrist bones
  • Metacarpals - hand
• Investing Fascia
  • Brachial fascia - forms arm compartments
  • Antebrachial fascia - forms forearm compartments
  • Cubital fascia/fossa - anterior elbow region
• Superficial Veins
  • Cephalic - dorsal arch, lateral side, deltopectoral groove, into axillary vein
  • Basilic - dorsal arch, medial side, pierces fascia in mid arm, joins brachial veins to form axillary vein
  • Median cubital - cephalic to basilic in cubital fossa, 70%
• Cutaneous Nerves
  • Lateral antebrachial cutaneous - w/ cephalic v.
  • Medial antebrachial cutaneous - w/ basilic v.
  • Posterior antebrachial cutaneous
  • Dorsal cutaneous branch of ulnar - dorsal surface of medial 1.5 digits & hand
  • Superficial branch of radial - dorsal surface of lateral 3.5 digits & hand

Superficial Structures of the Lower Limb

• Osteology
  • Ilium
    • Iliac tubercle - attachment of iliotibial tract
    • Post. sup. iliac spine - dimple at S2
  • Femur - largest long bone
    • Medial & lateral epicondyles
  • Tibia
    • Medial malleolus - medial ankle
  • Fibula
    • Lateral malleolus - lateral ankle
• Investing Fascia
  • Fascia lata - envelopes thigh
    • Iliotibial tract - lateral thickening, attached to lat. tibial condyle
    • Saphenous opening - for greater saphenous v. & other vs.
  • Crural fascia - leg fascia
  • Popliteal fascia - behind knee
  • Dorsal & plantar fascia of foot
• Superficial Veins
  • Dorsal venous arch of foot
  • Greater saphenous vein - ant. to med. malleolus, post. to med. epicondyle
    • Superficial epigastric vein
    • Saphenous vein cutdown
  • Lesser saphenous vein - post. to lateral malleolus; drains to popliteal v.
  • Perforating veins - to deep veins
  • Varicose veins
• Cutaneous Nerves
  • Lateral femoral cutaneous - from lumbar plexus (L2-3)
    • Meralgia paresthetica - nerve compression
  • Anterior femoral cutaneous brs. of femoral n.
  • Posterior femoral cutaneous - from sacral plexus (S1-3); deep to fascia lata; inferior cluneal brs.; perineal br.
  • Femoral branch of genitofemoral nerve - upper anteromedial thigh
  • Cutaneous br. of obturator n. - medial thigh inferiorly
  • Saphenous - longest cutaneous nerve; from femoral
  • Sural cutaneous - medial & lateral - from tibial & common fibular
  • Sural - formed mid-calf by union of brs. of med. & lat. sural
    • Sural nerve graft - piece taken to repair nerve injured elsewhere
  • Superficial fibular (peroneal) - anterior ankle & dorsum of foot
  • Deep fibular (peroneal) - between 1st & 2nd toes
• Superficial inguinal lymph nodes

Posterior shoulder

• Osteology
  • Humerus
    • Head & neck (anatomical & surgical)
    • Greater & lesser tubercles; intertubercular groove
    • Deltoid tuberosity
• Muscles
  • Deltoid - powerful abductor, but many other actions
  • Rotator cuff
    • Supraspinatus - initiates abduction
    • Infraspinatus - lateral rotation
    • Teres minor - lateral rotation
    • Subscapularis (seen later) - medial rotation
  • Teres major - medial rotation, extension, adduction
  • Long head of triceps brachii
• Neurovasculature
  • Suprascapular n., a. & v. - Navy under, Army over transverse scapular lig.
  • Axillary n. & post. circumflex humeral a. & v. - in quadrangular space
  • Circumflex scapular a. & v. - in triangular space
  • Scapular anastomosis - collateral circulation around joint