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Summary of Anatomy Lecture 20: Important Slides/Concepts **Note that for anatomy I will focus more on disorders, problems with nerves, etc. than the actual anatomy. For OIA look at some of the other reviews on vcomcc.com. Also, Dr. Paulman is a little harder to guess at than others, so this is my best estimate of what will be the most important! Slide 7 (LIKELY A TEST QUESTION) Lumbar Plexus (L1-L5) Iliohypogastric / ilioinguinal (L1) Genitofemoral (L1,2) -medial thigh and genitals Lateral femoral cutaneous (L2,3) -lateral thigh Obturator (L2-4) -medial compartment of thigh (adductors) Femoral (L2-L4) -anterior compartment of thigh (quads) (flexors of hip, extensors of leg) Lumbosacral trunk (L4,5) -join the lumbar nerves to the sacral nerves -superior and inferior gluteal arise from here Slide 8 -Obturator Nerve Injury -Problems with adduction and altered gait Slide 9 -Femoral Nerve Injury -Cannot extend the leg or flex the hip Slide 10 -Piriformis muscle is the landmark between the superior gluteal nerve and inferior gluteal nerve Slide 11 -Pudendal Nerve Injury -arises from the sacral plexus and goes through greater sciatic foramen and re-enters through lesser sciatic foramen -if lesioned numbness in perineum and loss of sexual function (often seen in males who bike) Slide 12 -Posterior Femoral Cutaneous Nerve -innervates the largest patch of sensory material on the body (posterior thigh) -if lesioned lose sensation in that area Slide 13 -Sciatic Nerve Injury (L4-S3) -NO MOTOR INNERVATION IN THE GLUTEAL AREA!! Only sensory -All motor & sensory innervation to posterior thigh, leg and foot - Splits into tibial and common fibular -function in the lower leg is lost if this is damaged Slide 15 -The thigh has three compartments (anterior, posterior, medial) -The leg has three compartments (anterior, posterior, lateral) **much more likely to develop compartment syndrome in the leg Slide 18 **This diagram is simplified. The aorta splits into TWO common iliac arteries, and then everything basically has a right and left. This is just clearing away the confusion. AORTA COMMON ILIAC ARTERY EXTERNAL ILIAC ARTERY FEMORAL A. DEEP FEMORAL A. INTERNAL ILIAC ARTERY PUDENDAL A. S./I. GLUTEAL A. OBTURATOR A. POPLITEAL A. PROFUNDA FEMORIS A. PERFORATING A. Slide 20 (LIKELY A TEST QUESTION) -Veins have tributaries, arteries have branches! -Veins do not branch, they come together! -Veins will originate distally and bring blood TO the heart -In an operation don’t put veins from the lower extremities in backwards because they have one-way valves! Slide 22 (LIKELY A TEST QUESTION) -Know your dermatomes