This muscle may be regarded as the lower separated part of the extensor digitorum longus antibiotic mouthwash prescription purchase sumycin 500 mg mastercard. Around the ankle antibiotic and pregnancy purchase sumycin on line, the deep fascia forms a number of thickened bands that hold underlying tendons in place antibiotic resistance otolaryngology order sumycin 250mg on line. On the lateral side there are (much less prominent) superior and inferior peroneal retinacula. The tendons passing under cover of the extensor retinacula are (from medial to lateral side in 12. The relationship of the inferior extensor retinaculum to the tendons is as follows: a. The stem is in the form of a loop through which the tendons of the extensor digitorum and peroneus tertius pass. The superior limb has two layers one passing superficial to the extensor hallucis and the tibialis anterior, and the other deep to them. The inferior limb is superficial to these tendons; it may sometimes have an additional layer deep to the tendons. As they pass under the retinacula, the extensor tendons are surrounded by synovial sheaths (12. There is a gap between the areas of origin of this muscle from the head of the fibula and from the shaft. The muscle ends in a tendon that passes along a groove behind the lateral malleolus; here it is covered by the superior peroneal retinaculum. It passes just below the peroneal trochlea, where the tendon is covered by the inferior peroneal retinaculum. Thereafter, the tendon winds round the lateral side of the cuboid bone to reach its plantar aspect (12. This aspect of the cuboid bone bears a groove for the tendon (which is converted into a canal by the long plantar ligament). The muscle helps to maintain the arches of the foot (both longitudinal and transverse). Medial cuneiform bone (lateral side) Superficial peroneal Shaft of fibula (lower 1. Steadies the leg on the nerve (L5, S1, S2) surface) ing anterior to that of foot peroneus longus) 2. Tendon gets inserted into fifth metatarsal bone (lateral side of base) Peroneus brevis (Fibularis brevis) Chapter 12 Front and Lateral Side of Leg and the Dorsum of Foot 269 12. Because of the fact that the posterior border of the fibula turns medially in its lower part, the area of origin of the peroneus brevis (on the lateral surface) extends onto the posterior aspect of the bone. At the ankle the tendon passes behind the lateral malleolus: here it lies anterior to the tendon of the peroneus longus. It then runs forwards on the lateral surface of the calcaneus; here it lies above the longus tendon, the two being separated by the peroneal trochlea. The superior peroneal retinaculum is attached above to the lateral malleolus and below to the lateral surface of the calcaneus. The inferior peroneal retinaculum is attached below to the lateral surface of the calcaneus.
The lymphatic drainage of the parenchyma antibiotics for acne in pakistan effective sumycin 500mg, and of the areola and nipple is shown in 3 infection 3 weeks after tonsillectomy cheap 250mg sumycin. Many of these vessels communicate with a dense subareolar plexus lying beneath the skin of the areola and nipple bacteria belong to what kingdom buy 250mg sumycin otc. Vessels from the plexus in the parenchyma, and from the subareolar plexus drain as follows. These vessels end mainly in the anterior group of axillary lymph nodes: a few drain into the posterior group. Lymph from the anterior and posterior groups passes to the central group, and from there to the apical group of axillary lymph nodes. Some vessels from the upper part of the parenchyma pass direct to the apical group: some of these vessels are interrupted by the infraclavicular lymph nodes (3. Several vessels drain in a medial direction into the parasternal nodes present within the thorax near the lateral margins of the sternum. Some lymph vessels reach the intercostal nodes lying within the thorax near the posterior ends of the intercostal spaces. These vessels travel backwards along the lateral cutaneous branches of the posterior intercostal arteries (3. The lymphatic drainage of the skin of the breast (excluding that of the areola and nipple) is shown in 3. Some vessels from the upper part of the skin cross the clavicle and reach the lowest nodes of the deep cervical chain: these nodes lie just above the clavicle and are, therefore, called the supraclavicular lymph nodes (3. Traditionally, radial incisions have been advised for drainage of an abscess in the breast (to avoid injury to the ducts). In the past an extensive operation involving removal of axillary lymph nodes, the pectoralis major and pectoralis minor used to be performed in an effort to remove all cancer cells. In most cases only simple removal of the breast along with removal of axillary lymph nodes is undertaken. Periodic palpation of the breast (which can be done by a woman herself) can lead to early detection of any mass. Early detection of carcinoma is also facilitated by a procedure called mammography. In carcinoma of the breast the suspensory ligaments may be invaded by cancer cells and may shorten. Knowledge of the lymphatic drainage of the breast is very important in dealing with carcinoma of the breast. The vessels to the axillary nodes pass laterally over the pectoralis major, and wind around its lateral margin to reach the nodes. Some vessels from the parenchyma may reach the nodes by piercing the pectoralis major. The lymph nodes of the anterior group are in direct contact with the axillary tail of the breast and cancer may spread to them without having to pass through the lymph vessels. Lymphatics of the skin over the breast cross the midline and carcinoma of one breast can spread to the other breast through them. Some vessels from the inferomedial part of the breast probably communicate with lymphatics within the abdominal cavity (subperitoneal plexus). Cancer of the breast has been known to spread to the peritoneum, to the liver and to pelvic organs.
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The semimembranosus is inserted into the posterior and medial aspects of the medial condyle virus x 2010 cheap sumycin 250 mg line. The popliteus is inserted into the posterior surface of the shaft antibiotic for cellulitis discount sumycin 250mg amex, on the triangular area above the soleal line antibiotic resistance and public health order 250 mg sumycin with mastercard. The tibialis anterior arises from the upper two-thirds of the lateral surface of the shaft. The soleus arises from the soleal line, and from the middle one-third of the medial border of the shaft. The tibialis posterior arises from the upper two-thirds of the lateral part of the posterior surface of the shaft, below the soleal line. The flexor digitorum longus arises from the medial part of the posterior surface of the shaft below the soleal line. The capsular ligament of the knee joint is attached to the condyles of the tibia a little below the margins of the articular sufaces. In the region of the tuberosity, the attachment of the capsule is replaced by that of the ligamentum patellae. The intercondylar area, on the superior aspect of the upper end of the tibia, has the following attachments (in anteroposterior sequence)(See 9. The anterior aspect of the lower end of the tibia (which is continuous with the lateral surface of the shaft) is crossed by the tendons of the following muscles (from medial to lateral side). The anterior tibial vessels and the deep peroneal nerve cross the anterior aspect of the lower end of the bone lying between the tendons of the extensor hallucis longus and the extensor digitorum longus. The posterior aspect of the lower end of the tibia is crossed by tendons of the following muscles (from medial to lateral side). The tendon of the flexor digitorum longus crosses that of the tibialis posterior near the lower end of the bone. The posterior tibial vessels and nerve cross the posterior aspect of the lower end of the bone lying between the tendons of the flexor digitorum longus and the flexor hallucis longus. A secondary centre for the lower end appears during the first year, and fuses with the shaft between the 15th and 17th years. The upper articular surfaces of the tibia may be poorly formed resulting in congenital dislocation of the knee. In contrast, the lower end is flattened from side-to-side and forms the lateral malleolus. The medial side of the malleolus bears a triangular articular surface (for the talus) (9. Just behind this articular surface the malleolus shows a deep malleolar fossa and this fact enables the anterior and posterior aspects of the bone to be distinguished from one another. The side to which a fibula belongs can be determined with the help of the information given above. Its posterior and lateral part shows an upward projection called the styloid process. In front of, and medial to , the styloid process the head shows a circular facet for articulation with the tibia (to form the superior tibiofibular joint). The medial surface of the malleolus bears a triangular facet, the apex of the triangle being directed downwards. This facet articulates with the lateral surface of the talus and forms part of the ankle joint. Behind the facet, the medial surface of the malleolus shows a deep malleolar fossa. It may be noted that the lateral malleolus projects to a lower level than the medial malleolus (of the tibia) 194 Part 2 Lower Extremity the surfaces and borders of the shaft show considerable variation from bone to bone and may be difficult to identify.
The pronator teres (humeral head) arises from the anteromedial surface antibiotics for baby acne order 250 mg sumycin, near the lower end of the medial supracondylar ridge antibiotics hives generic sumycin 250 mg fast delivery. The brachioradialis arises from the upper two-thirds of the lateral supracondylar ridge antibiotic 10 buy sumycin 500mg line. The extensor carpi radialis longus arises from the lower one-third of the lateral supracondylar ridge. The superficial flexor muscles of the forearm arise from the anterior aspect of the medial epicondyle. The common extensor originforthesuperficialextensormusclesoftheforearmislocatedontheanterioraspect of the lateral condyle. The lateral head of the triceps arises from the oblique ridge on the upper part of the posterior surface, just above the radial groove. The medial head of the muscle arises from the posterior surface below the radial groove. The upper end of the area of origin extends onto the anterior aspect of the shaft. On the medial side, the line of attachment dips down by about a centimetre to include a small area of the shaft within the joint cavity. The line of attachment of the capsule is interrupted at the intertubercular sulcus to provide an aperture through which the tendon of the long head of the biceps leaves the joint cavity. The capsular ligament of the elbow joint is attached to the lower end of the bone. Anteriorly the line of attachment reaches the upper limits of the radial fossa and the coronoid fossa. The medial and lateral epicondyles give attachment to the ulnar and radial collateral ligaments respectively. The intertubercular sulcus lodges the tendon of the long head of the biceps brachii. The radial nerve and the profunda brachii vessels lie in the radial groove between the attachments of the lateral and medial heads of the triceps. These three parts fuse with each other in the sixth year to form a single epiphysis for the upper end that fuseswiththeshaftaround18to20yearsofage. These fuse to form a single epiphysis which fuses with the shaft around 15 years of age. CliniCal Correlation Fractures of the Humerus the sites of fracture of the humerus are shown in 2. The humerus is related to several nerves and these may be damaged because of fracture. Fracture through the middle of the shaft can damage the radial nerve (which lies in the radial groove). In supracondylar fracture the median nerve can be injured, and there is danger of damage to the brachial artery as well. The humerus has a poor blood supply at the junction of its upper and middle-thirds. Fractures at this site may, therefore, heal poorly resulting in delayed union or in non-union. The lateral and medial sides of the bone can be distinguished by examining the shaft which is convex laterally and has a sharp medial (or interosseous) border. Theanteriorandposterioraspectsofthebonemaybeidentifiedbylookingatthelowerend:itissmoothanteriorly, but the posterior aspect is marked by a number of ridges and grooves. The side to which a given radius belongs can be determined from the information given above.