Block 3

Lab 21: Extremities II

Faculty: Structures faculty and TAs

Learning Objectives – Lower Extremities II: Gluteal Region, Posterior Thigh, Posterior
Leg
Given the information presented in this lab, students will be able to:

• Examine the structures (muscles, ligaments, vessels, nerves) of the gluteal region.
Identify
o Gluteus maximus muscle
o Gluteus medius muscle
o Gluteus minimus muscle
o Priformis muscle
o Nerve arising superiorly to the piriformis muscle (ie. superior gluteal n L4-L5, S1)
o Nerves arising inferiorly to the piriformis muscle
 “Sciatic” (Tibial and common peroneal)
 Inferior gluteal (L5, S1-2)
o Pudendal nerve (S2-4)
 Divisions of pudendal
• Inferior rectal nerve
• Transverse perineal nerve
• Dorsal nerve of clitoris/penis
• Identify the two nerves that form the “so-called” sciatic nerve;
o Tibial, L4,5, S1-3
o Common peroneal/fibular, L4-5, S1,2)
• Discuss what is meant by “Sciatic” nerve and proper use of the term.
• Examine the structures (muscles, vessels, nerves) of the posterior compartment of the
thigh and popliteal fossa. Identify
o Biceps femoris muscle (long and short heads)
o Semitendinosus muscle
o Semimembranosus muscle
o Ischiocondyler portion of adductor magnus muscle (ie, the large portion of the
muscle that wraps around from the medial compartment posteriorly; note this
posterior part is innervated by tibial nerve).
• Examine the skeleton of the leg and foot. Identify
o Femur
 Head
 Neck
 Greater and lesser trochanter
 Linea aspera
o Tibia
 Tibial tuberosity
 Medial malleolus
 o Fibula
 Lateral malleolus.
o Foot
 Tarsus (seven proximal foot bones)
• Talus
• Calcaneus (note: sustentaculum tali)
• Navicular
• Cuboid
• Medial, lateral, and intermediate cuneiform
 Metatarsals
 Proximal, intermediate, distal phalanges on all except hallux (Big toe)
 Hallux - only proximal and distal.
• Examine the structures (muscles, ligaments, vessels, nerves) of the leg and foot. From the
three leg compartments, identify
o Anterior
 Foot dorsiflexor/extensor muscles.
• Note: all the extrinsic muscles are referred to as “Extensor” (eg.
extensor digitorum longus, extensor hallucis longis are
dorsiflexors)
o Lateral (Fibular/Peroneal)
 Peroneus (fibularis) longus and brevis
o Posterior:
 Knee flexors
• Popliteus (initial “unlocker”)
• “Hamstrings”
o Biceps femoris (long head, short head)
o Semitendinosus
o Semimembranosus
• Gastrocnemius
• Plantaris
 Trace and be able to identify the tibial nerve and common peroneal nerve
from thigh into leg and then foot (*note the branching of common
peroneal into deep and superficial peroneal nerves)
• Identify extrinsic muscles of the foot (i.e., those running from the leg into the foot).
Follow from leg into the foot.
o Identify
 “Tom, Dick, Harry”
• Tibialis posterior muscle
• Flexor digitorum longus muscle
• Flexor halluces longus muscle
 Tarsal tunnel and components
• Tibial nerve, artery, vein
• Tendon of tibialis posterior muscle
• Flexor digitorum longus muscle
• Flexor halluces longus muscle
Dissector Readings

Gluteal Region, Posterior Thigh, Posterior Leg, pp 197-216

Learning Objectives – Upper Extremities II: Arm, Forearm Flexors

Given the information presented in this lab, students will be able to:

• Examine the structures (bones, muscles, tendons, ligaments, vessels, nerves) of the arm
and cubital fossa.
o Identify all bones
 Humerus
• Distal humerus and condyles
• Capitulum
 Ulna
• Promximal ulna, olecranon
 Radius
• Proximal radius
• Head & neck
• Radial tuberosity
o Brachial flexor & extensor muscle compartments
o Forearm flexor and extensor muscle compartments
o Path of nerves
 Median
 Musculocutaneous
 Ulnar
 Radial
• Examine the structures (muscles, tendons, ligaments, vessels, nerves) of the flexor region
of the forearm. Identify
o Superficial and deep forearm flexors (follow tendons)
o Palmaris longus muscle
o Palmaris brevis muscle
• Examine the palm of the hand and structures entering the hand. Identify
o Specific distal portions of radius
 Ulnar notch
 Styloid process
 Articular surface for lunate and scaphoid bones at radiocarpal joint
 Ulnar styloid
o Hand bones: 8 carpals (YES NAMES)
 Proximal row
• Lunate
• Scaphoid
 • Triquitral
• Trapezoid
 Distal row
• Pisiform
• Hamate
• Capitate
• Trapezium
• Examine and identify the carpal tunnel and structures entering the hand from the forearm
via the carpal tunnel
o Palmar location of flexor retinaculum of the wrist (transverse carpal ligament);
o Median nerve
o 9 tendons
 4 flexor digit longus
 4 flexor digit superficialis
 1 flexor pollicic longus
 Flexor carpi radialis tendon (not really in tunnel but in flexor retinaculum)
• Identify
o Ulnar (Guyon’s) canal/tunel containing ulnar nerve and artery
• Examine and identify the intrinsic muscles of the palmar region of the hand.
o Thenar
o Hypothenar
o Lumbricals
o Interroseous (4 dorsal, 3 palmar) (Interossei are ALL ulnar innervated)

Dissector Readings

Arm, forearm flexors, pp. 39-59