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Storage Organ the placenta acts as a storage for glucose muscle relaxant benzodiazepines purchase robaxin on line amex, calcium and iron in the first few months of pregnancy knee spasms pain 500 mg robaxin. Normal Site of Implantation of Ovum Normally, placenta is attached to the upper uterine segment, which includes the fundus and the greater part of the body of the uterus. The attachment of the placenta may extend partially or completely in to the lower uterine segment, which includes the lower part of the body and the cervix of the uterus, this condition is called placenta previa. First degree: the attachment of the placenta extend in to the lower uterine segment, but does not reach the internal os. Second degree: the margin of the placenta reaches the internal os, but does not cover it. Third degree: the margin of the placenta covers the internal os, but when the os dilates during childbirth, the placenta no longer occludes it. Fourth degree: the placenta completely covers the internal os, and occludes the internal os even after it has dilated. Interstitial tubal implantation: the placenta may get implanted in the part of the fallopian tube passing through the uterine wall. Layers of Placental Barrier Up to the Third Month of Pregnancy From fetus to mother: i. The placenta acts as transport of oxygen, water, electrolytes and nutritions between the maternal to fetal blood. It also helps excretion of carbon dioxide, urea and other metabolic end product from the fetus in to the maternal blood. Transport of maternal antibodies (IgG gamma globulins) reaching the fetus through the placenta fetus gets passive immunity from the mother against infectious diseases like diphtheria, chicken pox and whooping cough. It prevents the entry of many bacteria and other harmful agents from mother to fetus. Most of the viruses like poliomyelitis, measles and rubella and some bacteria can pass across it. Most of the drugs taken by the mother pass through the placenta and can produce congenital malformations. Lesion of the cervical part of the spinal cord which interrupt the reticulospinal tracts, carrying fibers from the hypothalamus to the sympathic outflow to the first thoracic segment of the spinal cord. Appearance of blastopore: A depression medial corners of the eyes) appears in the center of the primitive node. Formation of notochordal process: It is the cranially extended part up to the prochordal plate by the multiplication of the cells of the primitive knot. Formation of notochordal canal: the blastopore extends in to the notochordal process and converts in to a canal called notochordal canal. Appearance of neuroenteric canal: the floor of the notochordal canal break forming small openings and communicate between the yolk sac and amniotic cavity. Formation of notochordal plate: the opening rapidly becomes confluent and the floor of the notochordal canal closed, flattened to notochordal plate. Formation of notochord: Finally, the cells of the notochordal plate life prorate and thickened forming in to a solid rod of cells called notochord. Posterior or inferior: On its free margin usually presents two clefts, which subdivides the cusp in to three scallops Fate 1. Free margin: Connected with the chordae tendineae, on the free margin of the post leaflet usually presents two clefts. The cusps are closed during ventricular systole by the apposition of the ventricular surfaces with the zones of the adjacent cusps. The rough zone: It is thick and provides attachments to the chordae tendineae on its ventricular surface. The basal zone: It is thick and vascular about 2 to 3 mm in extent and provides attachments of to the basal chordae on its ventricular surface. These are connecting the apical one-third part of the papillary muscles to the free margins and ventricular surface of the cusps. The chordae tendineae are help in the valve closure during ventricular systole and prevent eversion of the cusps towards the atrium. Commissural and Cleft Chordae: They are fan shaped, and attached to the commisssures and free margins of the adjacent cusps or scallops.

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The anterior muscle relaxant for children cheap 500mg robaxin overnight delivery, posterior and interior margins close to the articular surface gives attachments to the capsular ligament of the ankle joint muscle relaxant half-life generic 500 mg robaxin. Fracture of the shaft of the tibia is often open because whole length of the medial surface is only covered by the skin and fasciae. Fracture of the distal one-third of the shaft is prone to delayed or nonunion as the blood supply to this part is poor. In this case the knee joint remains safe because the capsular ligament of the knee joint is attached near the articular margins of the tibia. Fracture of tibia is commonly occurring at the junction of the upper two-thirds and lower one-third as this part of the shaft is more slender. Sometimes a piece of bone grafted from the shaft to repair a defect in some other bone. The malleolar fossa lies below and behind the triangular articular facet on the medial aspect of the lower end. Primary center: One primary center appears in the shaft (near the middle) at about seventh week of intrauterine life. Secondary centers: Secondary center for the upper end-appears at the birth or shortly after birth. Parts It consists of upper and lower ends and the intervening portion is called shaft or body. From the posterolateral aspect of the head presents a bony process projects upwards called styloid process. Neck Character: It is the constricted portion of the junction between the head with the shaft. It begins from the lower part of the posterior aspect of the head and ends at the medial margin of the groove on the back of the lateral malleolus. Extensor hallucis longus-from middle twofourths medial to the extensor digitorum longus. Anterior Border Character: Begins from the lower part of the anterior aspect of the head and ends below where it divides in to two limbs to form a triangular area at the lateral aspect of the lower end. Intermuscular septum between the extensor and peroneal muscles in upper three-fourths. Opposite the lower one-fourth this border divides to form a rough triangular area lies just above the medial surface of the lower end. Anterior and posterior tibiofibular ligaments- to the anterior and posterior limbs of the rough triangular area respectively. Interosseous membrane-from below the head to the apex of the rough triangular area. The lower end of the fibula projects downwards below the level of the lower end of the tibia and is known as lateral malleolus. Posterior Surface Character: It resents a vertical groove, which is bounded laterally by a sharp margin. Attachment: Superior peroneal retinaculum-at the lateral margin of the vertical groove. Inferior Border Character: It continuous with the anterior margin and presents a notch in its middle part. Primary center: One primary center for the shaft appears eighth week of the intrauterine life. Below and behind the triangular articular facet a deep nonarticular fossa called malleolar fossa. Articulation: Triangular articular facet articulates with the lateral surface of the body of the talus. Among the tarsal bones three cuneiform bones are wedge shaped and form an important part of the transverse arch of the foot. The talus forms the key bone amongst the tarsus and overrides the anterior part of calcaneus. Superiorly talus articulates with the bones of the leg and anteriorly with the navicular bone. Here calcaneus and talus form the bones of proximal row and the cuneiform bones form the bones of distal row. The navicular bone is interposed between the talus and cuneiform bones cuboid is placed laterally in front of calcaneus.

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If the intention is to maintain traction and there is no need to correct subluxation muscle relaxant yellow pill v 500 mg robaxin for sale, traction should be applied initially with weights of 2 muscle relaxant vitamins minerals buy genuine robaxin. The patient should be kept under daily radiographic control or repeated after each move or transport. Fluid replacement is a crucial point in initial therapy and the infusion of an appropriate combination of crystalloids and colloids will depend on the presence of associated lesions and urine output. One must be careful, however, to avoid overhydration, which can lead to overloading of the right heart chambers and pulmonary edema. Because there is traumatic sympathectomy, and the predominant tone of the parasympathetic autonomic nervous system, as an adjunct in the treatment of refractory hypotension, dopamine (2-5 g/kg/min) is recommended provided there are no other contraindications, mainly due to injuries to other organs. Phenylephrine should be avoided because it has a positive inotropic action and because of the possible effect of increased vagal tone, leading to intense bradycardia. Hypoxia in the injured spinal cord regions will contribute to worsen the pathophysiological cascade known to occur after trauma; therefore, it is extremely important to maintain adequate oxygenation by closely monitoring changes in blood gases, if possible with appropriate probes and registers. Clinical signs of agitation, restlessness and disorientation signal insufficient oxygen and should be observed closely. Duration of the maintenance infusion initiated within 3 hours of trauma must be maintained for 8 hours. The drug should not be administered concomitantly with methylprednisolone because its effect does not appear to show synergism of action but competitiveness instead. In the acute phase, the bladder is unable to empty by reflex (socalled areflexic bladder). Placement of a urinary catheter (Folley catheter) is useful at this stage, especially for tight control of urine output, which will serve to guide fluid restoration and prevent bladder distension due to urinary retention. Placement of an indwelling catheter, however, to keep the bladder sphincter open, predisposes in the long term to atrophy with a higher probability of urinary incontinence. Spraying water on the skin of the limbs and trunk or applying cold compresses are useful and practical measures to promote heat exchange on hot days. Whenever possible, the patient should be mobilized, even as a block, at least every 2 hours. In patients with major instabilities, guards with special air or water mattresses or supports with gel or water bags at the points of greatest pressure should be placed (ankles, heels and sacral region, elbows and shoulder blades). The recognition of areas of hyperemia or catastrophic skin changes should initiate more aggressive therapeutic measures, including massage with moisturizing oils and creams, while preventing direct contact between body areas and hard surfaces. Each o has its advantages and their combined use will allow visualization and assessment of bone structures, ligaments, the compromising stability, spinal cord, and soft tissues. The correct interpretation of cervical spine X-rays depends on adequate visualization of the cervicothoracic junction. For the radiograph to be declared as satisfactory, there is no need to see at least the upper plateau of T1. Failing that, this view should be repeat712 Surgical Treatment of Spinal Cord Injury ed with a lateral view of the caudal traction arms. If you still cannot view the cervicothoracic junction, radiographs should be obtained in the swimmer position (incidence of Fletcher). In this case, reconstruction or three-dimensional sagittal reconstruction can be useful for assessing the alignment. The first line (marginally above), the smoother, less curved than the others, the convexity above, is formed by a line joining the front edge of the vertebral body. Two similar lines tangential to the posterior edge of the body and the base of the spinous processes (and subsequent marginal spinolaminar lines).

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Floor: It slops downwards and medially and is formed by following from lateral to medial: i muscle relaxant xanax generic 500mg robaxin with mastercard. Stria terminalis (projection fibers of the amygdaloid body) lodges in the sulcus terminalis between the caudate nucleus and thalamus iii muscle relaxant used by anesthesiologist order generic robaxin online. Anterior Horn Situation: It is situated in front of the interventricular foramen in the frontal lobe. Posterior Horn Situation: It is situated behind the splenium of the corpus callosum in the occipital lobe. Below: Calcar avis produced by the inward projection of the anterior part of the calcarine sulcus. Collateral eminence (formed by the inward projection of the intermediate part of the collateral sulcus) ii. Collateral trigone which is the flattened triangular continued part of the collateral eminence. Hippocampus which is a prominent longitudinal elevation covered by white matter called alveus ii. Choroid plexus which is the temporal extension lies in the choroid fissure between fimbria and the stria terminalis. Unilateral dilatation of lateral ventricle may happen when obstruction of foramen of Monro on one side. Blockage of the foramen of Monro by a cerebral tumor resulting distention of the lateral ventricle producing a type of hydrocephalus. Choroid plexus of the lateral ventricle at the junction of posterior and inferior horns join may become calcified with age which is seen on radiographs, should no confused with that of the pineal body. In this procedure small amount of air introduced in to the subarachnoid space by lumbar puncture with the patient in the sitting posture iii. Ventriculography: In this procedure air or radiopaque agent was injected directly in to the lateral ventricles through a burr hole in the skull. The third and lateral ventricles are distended when aqueduct of Sylvius is occluded. Communications Laterally It is communicated to the lateral ventricles by interventricular foramen or foramen of Monro. Posteroinferiorly It communicates with the 4th ventricle by the aqueduct of Sylvius. Lamina terminalis (it is thin lamina of the rostral end of the primitive neural tube which is a gray matter extends from the rostrum of the corpus callosum to the optic chiasma) ii. By the medial surface of the anterior twothirds of the thalamus (on postero-superior part) extent Anteriorly Lamina terminalis and interventricular foramen Posteriorly Aqueduct of Sylvius boundaries. Hypothalamic sulcus (it extends from interventricular foramen to the aqueduct of Sylvius) iii. Interthalamic adhesion: It connects medial surfaces of the two thalami across the cavity of the third ventricle. Stria medullares thalami: On the upper part of the medial surface of the thalamus presents a laminar band. Situation In the lateral wall of the third ventricle and in the floor of the central part of the lateral ventricle. The pulvinar separates from the medial geniculate body by the superior brachium quadrigeminum. Superior surface is separated from the medial surface by a thickening of the ependymal roof of the third ventricle known as taenia thalami iv. The lateral part of the superior surface forms the floor of the central part of the lateral ventricle v. The medial surface forms the superior part of the lateral wall of the third ventricle ii. The medial surface of the two thalami is usually connected across the third ventricle by a flat mass of gray matter called the interthalamic adhesion or connexus. Lateral surface: the lateral surface is separated from the lentiform nucleus by the posterior limb of internal capsule. The superior surface is covered by a thin layer of white matter called stratum zonale ii. The lateral surface is covered by the white matter called external medullary lamina iii.

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Among the last are the mismatch between the patient and the ventilator muscle relaxant medication prescription cheap robaxin 500mg fast delivery, improper patient position back spasms 36 weeks pregnant cheap robaxin 500mg, hypoxia, hypercapnia, fever, seizures, arterial hypo-or hypertension and hyponatremia. Maintaining normovolemia and the proper choice of replacement solutions play a vital role in the management of the neurotrauma patient. In patients with a bone decompression greatet than 5 cm and with an open duramater, it is recommended to lower the treatment threshold to 15 mmHg [4]. Also, this threshold should be also reduced in patients with focal lesions in one or both temporal lobes. In the 2007 update, this term and the whole algorithsm of treatment has disappeared. As a result of the collaboration between the Brain Trauma Foundation and a group of methodology experts, the methodology on the latest release has changed significantly compared to the first two editions. However, the lack of a clear proposal as to when and how to apply the various measures has generated some confusion. At the time of writing this chapter, the Brain Trauma Foundation has appointed an expert committee to update the algorithm proposed in the first version of the guidelines that should be upgraded in 2013. These second-level measures should be introduced early after the threshold of 20 mmHg has been passed and under a stepwise treatment protocol. Our recommendation is to apply these measures following a set of pre-established rules agreed between neurosurgeons and intensivists. Once the decission has taken, these measures should be implemented quickly applied in a complementary and not exclusive way. The association of barbiturates and hypothermia has been reported, as has the association of hypothermia and decompressive craniectomy. It is important to empasize that the use of these rescue measures makes sense only if the patient is considered neurologically viable. The first barbiturates introduced in to clinical practice were barbital in 1903 and phenobarbital in 1912 [18]. Since then, numerous derivatives has been introduced in the therapeutic armamentarium as sedatives, hypnotics, anticonvulsants or anesthetics. The most important ones from a neurological point of view are phenobarbital, pentobarbital and thiopental. At high doses, these drugs diffuse across all cell membranes and concentrate preferentially in certain tissues depending on their blood supply and the lipid solubility of the molecule, its affinity for plasma proteins and its degree of ionization [19]. However, there are pharmacokinetic differences depending on the type of barbiturate and its lipid solubility [20]. Moreover, individual factors such as body weight, fat compartment volume, muscle mass and other variables modify their pharmacokinetic characteristics. In the beginning, this therapy created, as often happens with new treatments, excessive optimism owing to its potential neuroprotective effect. Over time, the use of these drugs has raised significant controversy and has also shown that their use requires considerable pathophysiological knowledge for their precise and individualized application [25]. In the 1995 Guidelines version, barbiturates were covered in a single paragraph [11]. In the last update of 2007, barbiturates are included in a larger section called "Anesthetics, analgesics and sedatives" [26]. Hemodynamic stability is essential before and during the administration of barbiturates". In addition, high doses of propofol (>5 mg/kg/h) can cause serious side effects and the so-called "propofol infusion syndrome" [26]. In reviewing the evidence on the use of barbiturates there are only three controlled studies. Among others, 11 patients who did not respond to conven555 Intensive Care in Neurology and Neurosurgery tional therapy were allowed to cross over. When the "intention to treat" methodology was applied to the analysis of the results, the effect of barbiturates on mortality was lost [26]. In addition, there was no evidence that barbiturates improve either mortality or functional outcome and in one out of four patients treated with pentobarbital hypotension was a clinically relevant adverse effect. The most commonly used barbiturates have been pentobarbital in the United States and thiopental in Europe. However, because of its design, this study does not allow draw any definitive conclusions.

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Its anterior surface articulates with the disk like upper surface of the radius in full flexion of the elbow muscle relaxant 551 cheap robaxin 500 mg free shipping. Its medial margin is prominent and projects downwards about 6 cm below the lateral margin 752 Human Anatomy for Students 4 spasms from sciatica purchase generic robaxin on-line. Carrying angle-when the arm hangs by the side of the body with extended elbow and forearm supinated the long axis of humerus and long axis of the forearm makes an angle laterally measures about 164 degree. Near the medial border of the shaft immediately above the medial epicondyle forms a prominent margin called medial supracondylar ridge or line. Attachments Muscles Origin: Common origin of the superficial group of flexor muscles of forearm-from anterior part of the medial epicondyle. Ligament: Anterior and posterior bands of ulnar collateral ligament-at the tip of the medial epicondyle. Relation: Ulnar nerve (lodges in the sulcus nervi ulnaris present on the posterior surface of the epicondyle). It is less prominent projection on the lateral part of the lower end of humerus 2. Near the lateral border of the shaft immediately above the lateral epicondyle forms a prominent margin called lateral supracondylar ridge or line. Common origin of the superficial group of extensor muscles of forearm-from the impression present on its anterolateral aspect 2. Olecranon fossa: It is deep depression on the lower part of the posterior surface of the humerus lodges the olecranon process of ulna in full extended elbow. Radial fossa: It is situated just above the capitulum on the anterior surface of the lower end of the humerus it lodges the head of the radius in full flexion of elbow. Coronoid fossa: Situated above the trochlea medial to the radial fossa it lodges the coronoid process of ulna in full flexion of elbow. Ossification Humerus ossified from one primary center and seven secondary centers of which three for the upper end and four for the lower end. The medial epicondyle fuses with the shaft by a separate epiphysial line about epiphysis, which fuses with the shaft about eighteenth year. Fracture of humerus may occur by muscular action or by direct or indirect violence 2. Commonly fracture occurs at the surgical neck, middle one-third of the shaft or supracondylar region 3. Fracture of the middle one-third (radial groove) of the shaft may injure the radial nerve 5. Fracture of the middle one-third may cause delayed or non-union due to poor blood supply 7. Upper surface of the head is disk like concave and articulates with the capitulum of the humerus. Attachment Ligament: Annular ligament-it encircles margins of the head except medially where it forms the superior or proximal radioulnar joint. Attachments Muscle Insertion: Tendon of biceps brachii-on posterior rough part of the radial tuberosity. The border begins from the anterolateral part of the radial tuberosity, at first descends obliquely downwards and laterally then vertically downwards up to lower end 3. Attachments Muscle Origin: Flexor digitorum superficialis-from the oblique part of the anterior border with adjoining surface. Side Determination the styloid process on which side belongs will determined the side of the bone. It overhangs all sides except medially where it articulates with the radial notch of the ulna Osteology 755 Other: Extensor retinaculum (lateral end)-at the lower sharp part of the border. It begins from the posteroinferior part of the radial tuberosity, then descends obliquely downwards and laterally then descends vertically to end in the dorsal tubercle of the lower end. It begins from the posteroinferior part of the radial tuberosity then vertically downwards, bifurcates below to enclose a triangular area (called medial surface) above the ulnar notch of radius.

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The first positive deflection muscle relaxant with least side effects cheap 500mg robaxin with visa, P1 (percussion wave) spasms in abdomen generic robaxin 500mg with visa, corresponds to the arterial pulse wave and represents the arrival of blood to the intracranial cavity. The second wave, P2 (volume wave), is considered a reflex of intracranial elastance. Normally, the amplitude of P1 is higher than that of P2; however, in situations of greater elastance or decreased compliance, P2 increases in relation to P1. The magnitude of this change is a measure of intracranial compliance, constituting the so-called compliance auto-test. When we have a space occupying lesion, the arterial pulse constitutes a real volume load. From cerebral pulse wave analysis we can infer in what sector of the compliance curve we are. A high amplitude (10 or 15 mmHg) pulse wave indicates a volume load in the ascending slope of the compliance curve. According to its description they were ominous, with duration between 5 and 20 minutes, with an amplitude >50 mmHg, reaching values of 100 mmHg. B Lundberg waves last between 2 and 5 minutes, with an amplitude >20 mmHg, reaching 50 mmHg. Their clinical meaning is less accurate than A waves, but are warning signs that show a decrease in intracranial compliance. Type C waves, (Hering Traube), are of short duration, with low amplitude (<20 mmHg) and show arterial curves; their clinical meaning is unknown. The phenomenon of periodic waves is essentially a physiological event, as has been demonstrated by transfontanel recording in normal neonates. It is generally of vasogenic origin, emerging from the normal vasomotricity of normal circulation and that of the brain circulation in particular. Detailed study of the chronobiology that initiates a wave of this type is essential for determining its mechanisms. With simultaneous multimodal monitoring and multichannel recording it is possible to determine whether it corresponds to cerebral autoregulating events that normally originate the wave or to a phenomenon of autoregulation loss. Its magnitude is higher in patients with cerebral atrophy and increased subarachnoid space. The venous vessels are collapsible structures that displace a considerable volume, decrease their volume, and transfer their pressure to the dural sinus. When these two systems are overwhelmed, however, the ensuing structural changes lead to a major alteration in intracranial physiology: the arteries produce ischemia and the parenchyma is displaced. It is this distortion or displacement that determines hernia with occlusion of the compartments. So we move from an initial exponential curve to its most vertical phase of cerebral tamponing. Each of these situations can be clearly identified with a transcranial Doppler study. Displacement occurs earlier than the herniation syndrome, as magnetic resonance imaging studies have shown. Early displacements were found to have a close correlation with neurologic deterioration and deepening coma. The main consequences of displacement are brainstem angulation and distortion, which ultimately define the severity. Also, displacement can cause ischemia by direct vascular compression in diverse topographies, as occurs in transtentorium hernia or in occipital infarction, by compromising the posterior cerebral artery. Deviation or displacement of the cerebral parenchyma is produced by intracranial pressure gradients. The existence of gradients between the supratentorium and the infratentorium and between the posterior cranial fossa and the subarachnoid spinal space have been observed and confirmed in both experimental models and by clinical assays. There are also gradients inside the supratentorium compartment, between both hemispheres (interhemispheric gradients) and inside each hemisphere (transhemispheric gradients).

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Superficial stratum: It is attached to the skin by the skin ligaments (retinacula cutis) b muscle relaxant with least side effects purchase robaxin 500 mg free shipping. Deep stratum: In each toe it divides in to two parts and blends with the fibrous sheath of the flexor tendons and with the deep transverse metatarsal ligaments muscle relaxant pharmacology buy robaxin 500 mg visa. It is continuous medially with the central part of the plantar aponeurosis and laterally with the fascia of the dorsum of the foot iv. Septa From the junctions of central part with the medial and lateral parts of the plantar aponeurosis the medial and lateral intermuscular septa passes deeply and divides the sole in to three compartments. It occurs due to straining and inflammation of the plantar aponeurosis caused by the long standing, walking or inappropriate footwear producing repeated minor trauma ii. It causes pain in the plantar surface of the heel and on the medial aspect of the foot iii. Often the pain is felt more severe after sitting and when beginning to walk in the morning. It is induced by the repeated attack of plantar fascitis producing ossification in the calcaneal attachment of the plantar aponeurosis which is confirmed by radiological appearance ii. Medial side of the base of the proximal phalanx of the great toe (hallux) 348 Human Anatomy for Students Insertion It divides in to four tendons. Insertion With the flexor digiti minimi brevis at the lateral side of base of proximal phalanx of little toe. In its course it is first lies between the calcaneus and abductor hallucis, then between the flexor digitorum brevis and flexor accessorius. In the distal part it is under cover of plantar aponeurosis, superficial fascia and skin and Short Notes on Inferior Extremity 349 lies between the flexor digitorum brevis and the abductor digiti minimi up to the base of the fifth metatarsal bone. It ends at the base of the fifth metatarsal bone and unites with the arteria dorsalis pedis to complete the plantar arterial arch. Then the artery runs in distal part between the abductor hallucis and flexor digitorum brevis. It passes along the medial border of the great (first) toe where it anastomoses with a branch of the first plantar metatarsal artery. Extent It extends from the base of the fifth metatarsal bone to the proximal part of the first intermetatarsal space with convexity distally. The deep branch of the lateral plantar nerve lies in the concavity of the plantar arch. Dorsally related to the base of the second to fourth metatarsal bones with corresponding interossei. Three superficial digital branches to join the first to third metatarsal arteries (branches of plantar arterial arch). Structures Passing Through the Compartments All the above structures lie in one compartment except tibialis anterior, which lies in a separate compartment, having its own synovial sheath. Situation Below the superior extensor retinaculum and in front of the ankle joint and posterior part of the dorsum of the foot. Function the tendons and other structures passing deep to the superior extensor retinaculum by which the tendons are held in position. It prevents the displacement of the extensor tendons towards medial side of foot iii. Posteriorly Lateral surface of the calcaneus and superficial transverse facial septum of the leg. The tendons of the extensor digitorum longus and the peroneus tertius have common synovial sheath ii. Tendons of the tibialis anterior and the extensor hallucis longus have individual separate synovial sheaths. Functions of Retinaculum It fixes the peroneus longus and brevis tendons in place.