State establishment "DnEpropetrovsk Medical Academy of health Ministry of Ukraine"
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- Peculiarities in Origin.
- Branches.
- Nutrient Artery
- Plantar Metatarsal Arteries
- The Popliteal Artery (A. Poplitea)
- Peculiarities in Point of Division.
- The Anastomosis Around the Knee-joint.
- The Arteria Dorsalis Pedis (Dorsalis Pedis Artery)
- Position.
- Practice class 36. The veins of the extremities. The superior and inferior venae cavae. The aim
- The plan of the practice class
The Posterior Tibial Artery (A. Tibialis Posterior) The posterior tibial artery begins at the lower border of the Popliteus, opposite the interval between the tibia and fibula; it extends obliquely downward, and, as it descends, it approaches the tibial side of the leg, lying behind the tibia, and in the lower part of its course is situated midway between the medial malleolus and the medial process of the calcaneal tuberosity. Here it divides beneath the origin of the Adductor hallucis into the medial and lateral plantar arteries. Relations.—The posterior tibial artery lies successively upon the Tibialis posterior, the Flexor digitorum longus, the tibia, and the back of the ankle-joint. It is covered by the deep transverse fascia of the leg, which separates it above from the Gastrocnemius and Soleus; at its termination it is covered by the Abductor hallucis. In the lower third of the leg, where it is more superficial, it is covered only by the integument and fascia, and runs parallel with the medial border of the tendo calcaneus. It is accompanied by two veins, and by the tibial nerve, which lies at first to the medial side of the artery, but soon crosses it posteriorly, and is in the greater part of its course on its lateral side. Behind the medial malleolus, the tendons, bloodvessels, and nerve are arranged, under cover of the laciniate ligament, in the following order from the medial to the lateral side: (1) the tendons of the Tibialis posterior and Flexor digitorum longus, lying in the same groove, behind the malleolus, the former being the more medial. Next is the posterior tibial artery, with a vein on either side of it; and lateral to the vessels is the tibial nerve; about 1.25 cm. nearer the heel is the tendon of the Flexor hallucis longus. Peculiarities in Size.—The posterior tibial is not infrequently smaller than usual, or absent, its place being supplied by a large peroneal artery, which either joins the small posterior tibial artery, or continues alone to the sole of the foot. Branches.—The branches of the posterior tibial artery are: Peroneal. Posterior Medial Malleolar. Nutrient. Communicating. Muscular. Medial Calcaneal. The peroneal artery (a. peronaea) is deeply seated on the back of the fibular side of the leg. It arises from the posterior tibial, about 2.5 cm. below the lower border of the Popliteus, passes obliquely toward the fibula, and then descends along the medial side of that bone, contained in a fibrous canal between the Tibialis posterior and the Flexor hallucis longus, or in the substance of the latter muscle. It then runs behind the tibiofibular syndesmosis and divides into lateral calcaneal branches which ramify on the lateral and posterior surfaces of the calcaneus. It is covered, in the upper part of its course, by the Soleus and deep transverse fascia of the leg; below, by the Flexor hallucis longus.
Muscular. Perforating. Nutrient. Communicating. Lateral Calcaneal. Muscular Branches.—The peroneal artery, in its course, gives off branches to the Soleus, Tibialis posterior, Flexor hallucis longus, and Peronei. The Nutrient Artery (a. nutricia fibulae) supplies the fibula, and is directed downward. The Perforating Branch (ramus perforans; anterior peroneal artery) pierces the interosseous membrane, about 5 cm. above the lateral malleolus, to reach the front of the leg, where it anastomoses with the anterior lateral malleolar; it then passes down in front of the tibiofibular syndesmosis, gives branches to the tarsus, and anastomoses with the lateral tarsal. The perforating branch is sometimes enlarged, and takes the place of the dorsalis pedis artery. The Communicating Branch (ramus communicans) is given off from the peroneal about 2.5 cm. from its lower end, and joins the communicating branch of the posterior tibial. The Lateral Calcaneal (ramus calcaneus lateralis; external calcaneal) are the terminal branches of the peroneal artery; they pass to the lateral side of the heel, and communicate with the lateral malleolar and, on the back of the heel, with the medial calcaneal arteries. The nutrient artery (a. nutricia tibiae) of the tibia arises from the posterior tibial, near its origin, and after supplying a few muscular branches enters the nutrient canal of the bone, which it traverses obliquely from above downward. This is the largest nutrient artery of bone in the body. The muscular branches of the posterior tibial are distributed to the Soleus and deep muscles along the back of the leg. The posterior medial malleolar artery (a. malleolaris posterior medialis; internal malleolar artery) is a small branch which winds around the tibial malleolus and ends in the medial malleolar net-work. The communicating branch (ramus communicans) runs transversely across the back of the tibia, about 5 cm. above its lower end, beneath the Flexor hallucis longus, and joins the communicating branch of the peroneal. The medial calcaneal (rami calcanei mediales; internal calcaneal) are several large arteries which arise from the posterior tibial just before its division; they pierce the laciniate ligament and are distributed to the fat and integument behind the tendo calcaneus and about the heel, and to the muscles on the tibial side of the sole, anastomosing with the peroneal and medial malleolar and, on the back of the heel, with the lateral calcaneal arteries. The medial plantar artery (a. plantaris medialis; internal plantar artery), much smaller than the lateral, passes forward along the medial side of the foot. It is at first situated above the Abductor hallucis, and then between it and the Flexor digitorum brevis, both of which it supplies. At the base of the first metatarsal bone, where it is much diminished in size, it passes along the medial border of the first toe, anastomosing with the first dorsal metatarsal artery. Small superficial digital branches accompany the digital branches of the medial plantar nerve and join the plantar metatarsal arteries of the first three spaces. The lateral plantar artery (a. plantaris lateralis; external plantar artery), much larger than the medial, passes obliquely lateralward and forward to the base of the fifth metatarsal bone. It then turns medialward to the interval between the bases of the first and second metatarsal bones, where it unites with the deep plantar branch of the dorsalis pedis artery, thus completing the plantar arch. As this artery passes lateralward, it is first placed between the calcaneus and Abductor hallucis, and then between the Flexor digitorum brevis and Quadratus plantae as it runs forward to the base of the little toe it lies more superficially between the Flexor digitorum brevis and Abductor digiti quinti, covered by the plantar aponeurosis and integument. The remaining portion of the vessel is deeply situated; it extends from the base of the fifth metatarsal bone to the proximal part of the first interosseous space, and forms the plantar arch; it is convex forward, lies below the bases of the second, third, and fourth metatarsal bones and the corresponding Interossei, and upon the oblique part of the Adductor hallucis. Branches.—The plantar arch, besides distributing numerous branches to the muscles, integument, and fasciae in the sole, gives off the following branches: Perforating. Plantar Metatarsal. The Perforating Branches (rami perforantes) are three in number; they ascend through the proximal parts of the second, third, and fourth interosseous spaces, between the heads of the Interossei dorsales, and anastomose with the dorsal metatarsal arteries. The Plantar Metatarsal Arteries (aa. metatarseae plantares; digital branches) are four in number, and run forward between the metatarsal bones and in contact with the Interossei. Each divides into a pair of plantar digital arteries which supply the adjacent sides of the toes. Near their points of division each sends upward an anterior perforating branch to join the corresponding dorsal metatarsal artery. The first plantar metatarsal artery (arteria princeps hallucis) springs from the junction between the lateral plantar and deep plantar arteries and sends a digital branch to the medial side of the first toe. The digital branch for the lateral side of the fifth toe arise from the lateral plantar artery near the base of the fifth metatarsal bone.
The popliteal artery is the continuation of the femoral, and courses through the popliteal fossa. It extends from the opening in the Adductor magnus, at the junction of the middle and lower thirds of the thigh, downward and lateralward to the intercondyloid fossa of the femur, and then vertically downward to the lower border of the Popliteus, where it divides into anterior and posterior tibial arteries. Relations.—In front of the artery from above downward are the popliteal surface of the femur (which is separated from the vessel by some fat), the back of the knee-joint, and the fascia covering the Popliteus. Behind, it is overlapped by the Semimembranosus above, and is covered by the Gastrocnemius and Plantaris below. In the middle part of its course the artery is separated from the integument and fasciae by a quantity of fat, and is crossed from the lateral to the medial side by the tibial nerve and the popliteal vein, the vein being between the nerve and the artery and closely adherent to the latter. On its lateral side, above, are the Biceps femoris, the tibial nerve, the popliteal vein, and the lateral condyle of the femur; below, the Plantaris and the lateral head of the Gastrocnemius. On its medial side, above, are the Semimembranosus and the medial condyle of the femur; below, the tibial nerve, the popliteal vein, and the medial head of the Gastrocnemius. The relations of the popliteal lymph glands to the artery are described above. Peculiarities in Point of Division.—Occasionally the popliteal artery divides into its terminal branches opposite the knee-joint. The anterior tibial under these circumstances usually passes in front of the Popliteus. Unusual Branches.—The artery sometimes divides into the anterior tibial and peroneal, the posterior tibial being wanting, or very small. Occasionally it divides into three branches, the anterior and posterior tibial, and peroneal. Branches.—The branches of the popliteal artery are: Muscular
Superior Lateral Superior Genicular. Sural. Middle Genicular. Cutaneous. Medial Inferior Genicular. Medial Superior Genicular Lateral Inferior Genicular. The superior muscular branches, two or three in number, arise from the upper part of the artery, and are distributed to the lower parts of the Adductor magnus and hamstring muscles, anastomosing with the terminal part of the profunda femoris. The sural arteries (aa. surales; inferior muscular arteries) are two large branches, which are distributed to the Gastrocnemius, Soleus, and Plantaris. They arise from the popliteal artery opposite the knee-joint. The cutaneous branches arise either from the popliteal artery or from some of its branches; they descend between the two heads of the Gastrocnemius, and, piercing the deep fascia, are distributed to the skin of the back of the leg. One branch usually accompanies the small saphenous vein. The superior genicular arteries (aa. genu superiores; superior articular arteries), two in number, arise one on either side of the popliteal, and wind around the femur immediately above its condyles to the front of the knee-joint. The medial superior genicular runs in front of the Semimembranosus and Semitendinosus, above the medial head of the Gastrocnemius, and passes beneath the tendon of the Adductor magnus. It divides into two branches, one of which supplies the Vastus medialis, anastomosing with the highest genicular and medial inferior genicular arteries; the other ramifies close to the surface of the femur, supplying it and the knee-joint, and anastomosing with the lateral superior genicular artery. The medial superior genicular artery is frequently of small size, a condition, which is associated with an increase in the size of the highest genicular. The lateral superior genicular passes above the lateral condyle of the femur, beneath the tendon of the Biceps femoris, and divides into a superficial and a deep branch; the superficial branch supplies the Vastus lateralis, and anastomoses with the descending branch of the lateral femoral circumflex and the lateral inferior genicular arteries; the deep branch supplies the lower part of the femur and knee-joint, and forms an anastomotic arch across the front of the bone with the highest genicular and the medial inferior genicular arteries. The middle genicular artery (a. genu media; azygos articular artery) is a small branch, arising opposite the back of the knee-joint. It pierces the oblique popliteal ligament, and supplies the ligaments and synovial membrane in the interior of the articulation. The inferior genicular arteries (aa. genu inferiores; inferior articular arteries), two in number, arise from the popliteal beneath the Gastrocnemius. The medial inferior genicular first descends along the upper margin of the Popliteus, to which it gives branches; it then passes below the medial condyle of the tibia, beneath the tibial collateral ligament, at the anterior border of which it ascends to the front and medial side of the joint, to supply the upper end of the tibia and the articulation of the knee, anastomosing with the lateral inferior and medial superior genicular arteries. The lateral inferior genicular runs lateralward above the head of the fibula to the front of the knee-joint, passing in its course beneath the lateral head of the Gastrocnemius, the fibular collateral ligament, and the tendon of the Biceps femoris. It ends by dividing into branches, which anastomose with the medial inferior and lateral superior genicular arteries, and with the anterior recurrent tibial artery. The Anastomosis Around the Knee-joint.—Around and above the patella, and on the contiguous ends of the femur and tibia, is an intricate net-work of vessels forming a superficial and a deep plexus. The superficial plexus is situated between the fascia and skin around about the patella, and forms three well-defined arches: one, above the upper border of the patella, in the loose connective tissue over the Quadriceps femoris; the other two, below the level of the patella, are situated in the fat behind the ligamentum patellae. The deep plexus, which forms a close net-work of vessels, lies on the lower end of the femur and upper end of the tibia around their articular surfaces, and sends numerous offsets into the interior of the joint. The arteries which form this plexus are the two medial and the two lateral genicular branches of the popliteal, the highest genicular, the descending branch of the lateral femoral circumflex, and the anterior recurrent tibial The Arteria Dorsalis Pedis (Dorsalis Pedis Artery) The arteria dorsalis pedis, the continuation of the anterior tibial, passes forward from the ankle-joint along the tibial side of the dorsum of the foot to the proximal part of the first intermetatarsal space, where it divides into two branches, the first dorsal metatarsal and the deep plantar. Relations.—This vessel, in its course forward, rests upon the front of the articular capsule of the ankle-joint, the talus, navicular, and second cuneiform bones, and the ligaments connecting them, being covered by the integument, fascia and cruciate ligament, and crossed near its termination by the first tendon of the Extensor digitorum brevis. On its tibial side is the tendon of the Extensor hallucis longus; on its fibular side, the first tendon of the Extensor digitorum longus, and the termination of the deep peroneal nerve. It is accompanied by two veins. Peculiarities in Size.—The dorsal artery of the foot may be larger than usual, to compensate for a deficient plantar artery; or its terminal branches to the toes may be absent, the toes then being supplied by the medial plantar; or its place may be taken altogether by a large perforating branch of the peroneal artery. Position.—This artery frequently curves lateralward, lying lateral to the line between the middle of the ankle and the back part of the first interosseous space. Branches.—The branches of the arteria dorsalis pedis are: Lateral Tarsal. Arcuate. Medial Tarsal. First Dorsal Metatarsal. Deep Plantar. The lateral tarsal artery (a. tarsea lateralis; tarsal artery) arises from the dorsalis pedis, as that vessel crosses the navicular bone; it passes in an arched direction lateralward, lying upon the tarsal bones, and covered by the Extensor digitorum brevis; it supplies this muscle and the articulations of the tarsus, and anastomoses with branches of the arcuate, anterior lateral malleolar and lateral plantar arteries, and with the perforating branch of the peroneal artery. The medial tarsal arteries (aa. tarseae mediales) are two or three small branches which ramify on the medial border of the foot and join the medial malleolar net-work. The arcuate artery (a. arcuata; metatarsal artery) arises a little anterior to the lateral tarsal artery; it passes lateralward, over the bases of the metatarsal bones, beneath the tendons of the Extensor digitorum brevis, its direction being influenced by its point of origin; and its anastomoses with the lateral tarsal and lateral plantar arteries. This vessel gives off the second, third, and fourth dorsal metatarsal arteries, which run forward upon the corresponding Interossei dorsales; in the clefts between the toes, each divides into two dorsal digital branches for the adjoining toes. At the proximal parts of the interosseous spaces these vessels receive the posterior perforating branches from the plantar arch, and at the distal parts of the spaces they are joined by the anterior perforating branches, from the plantar metatarsal arteries. The fourth dorsal metatarsal artery gives off a branch which supplies the lateral side of the fifth toe. The first dorsal metatarsal artery (a. dorsalis hallucis) runs forward on the first Interosseous dorsalis, and at the cleft between the first and second toes divides into two branches, one of which passes beneath the tendon of the Extensor hallucis longus, and is distributed to the medial border of the great toe; the other bifurcates to supply the adjoining sides of the great and second toes. The deep plantar artery (ramus plantaris profundus; communicating artery) descends into the sole of the foot, between the two heads of the first Interosseous dorsalis, and unites with the termination of the lateral plantar artery, to complete the plantar arch. It sends a branch along the medial side of the great toe, and is continued forward along the first interosseous space as the first plantar metatarsal artery, which bifurcates for the supply of the adjacent sides of the great and second toes.
Students are supposed to identify the following anatomical structures on the samples:
Practice class 36. The veins of the extremities. The superior and inferior venae cavae. The aim: to learn the topography of the veins of the extremities, the superior and inferior venae cavae. Professional orientation: knowledge of this topic is necessary for doctors of all the specialities, especially therapeutisis, traumatologists, surgeons. The plan of the practice class:
The superior vena cava (v. cava superior) drains the blood from the upper half of the body. It measures about 7 cm. in length, and is formed by the junction of the two innominate veins. It begins immediately below the cartilage of the right first rib close to the sternum, and, descending vertically behind the first and second intercostal spaces, ends in the upper part of the right atrium opposite the upper border of the third right costal cartilage: the lower half of the vessel is within the pericardium. In its course it describes a slight curve, the convexity of which is to the right side.
The veins of the upper extremity are divided into two sets, superficial and deep; the two sets anastomose frequently with each other. The superficial veins are placed immediately beneath the integument between the two layers of superficial fascia. The deep veins accompany the arteries, and constitute the venae comitantes of those vessels. Both sets are provided with valves, which are more numerous in the deep than in the superficial veins. The superficial veins of the upper extremity are the digital, metacarpal, cephalic, basilic, median. Directory: 206 -> ENG -> Other -> Library 206 -> Space Junk: Why Gravity is More Plausible Than You Might Think 206 -> Former eurocamp participants in nba 2010-11 206 -> Cgms-41 nasa-wp-06 11 June 2013 206 -> Ap english Language and Composition Instructor 206 -> How big was the abc computer? How many vacuum tubes were in the abc? 206 -> Parent Handbook Table of Contents Introduction What is Giftedness? 206 -> 2014 Jacob K. Javits Gifted and Talented Students Education Project Abstracts pr/Award # S206A140017 Grantee: University of Connecticut Contact: Catherine A. Little Phone: 860-486-2754 Download 2.33 Mb. Share with your friends:
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