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Interview Preparation > Anatomy - Lower Limb > Flashcards

Anatomy - Lower Limb Flashcards

1
Q

Attachments of the hip joint capsule

A
  • Margins of the acetabulum and transverse acetabular ligament
  • Intertrochanteric line, base of GT/LT, femoral neck 1.2cm proximal to the trochanteric crest
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2
Q

What 3 ligaments reinforce the hip joint?

A

1) Iliofemoral = ASIS to each end of trochanteric line
2) Pubofemoral
3) Ischiofemoral

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3
Q

Articulations of the knee joint?

A
  • Tibiofemoral
  • Patellofemoral
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4
Q

Communications of the knee joint capsule?

A
  • Suprapatellar bursa
  • Bursa over medial head of gastroc
  • Perforated by popliteus
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5
Q

List the anterior bursa of the knee joint

A
  • Suprapatellar (between femur and quads tendon)
  • Subcutaneous prepatellar (between patella and skin)
  • Deep infrapatellar bursa (between tibia and patellar ligament)
  • Subcutaneous infrapatellar (between distal tibial tuberosity and skin)
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6
Q

Describe the attachments of the ACL?

A

Passes from the anterior tibia to the lateral intercondylar notch of the femur

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7
Q

Describe the attachments of the PCL

A

Passes from the posterior tibia to the medial intercondylar notch of the femur

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8
Q

Describe the attachments of the MCL

A

Passes from the medial femoral epicondyle to the medial tibial condyle

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9
Q

Describe the attachments of LCL

A

Passes from the lateral femoral epicondyle to the head of the fibula

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10
Q

What is the blood supply to the knee joint?

A

Genicular branches of the femoral, popliteal and anterior tibial arteries

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11
Q

Describe the function of the principle muscles acting on the knee

A
  • Extensor = quads femoris
  • Flexor = hamstrings, adductor longus, gracilis, gastroc, sartorius
  • Medial rotator = popliteus
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12
Q

List the connections between tibia and fibula

A

1) Superior tibiofibular joint
2) IO membrane
3) Inferior tibiofibular joint

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13
Q

What are the attachments of the ankles’s deltoid ligament?

A
  • Tip of medial malleolus
  • Tuberosity of navicular, spring ligament, sustentaculum tali, medial tuberosity of the talus
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14
Q

List the ligaments making up the deltoid ligament

A
  • Superficial layer = tibionavicular, tibiospring, tibiocalcaneal, superficial posterior tibiotalar ligament
  • Deep layer = anterior tibiotalar ligament, deep posterior tibiotalar ligament
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15
Q

Describe the structure of the lateral collateral ligament of the ankle?

A
  • ATFL
  • Calcaneofibular
  • PTFL
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16
Q

What are the principle muscles acting on the ankle joint?

A
  • Dorsiflexors = TA, EDL, EHL, peroneus tertius
  • Plantarflexors = Gastroc, soleus, TP, FHL, FDL
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17
Q

Describe the longitudinal arches of the foot

A
  • Medial arch = calcaneus, talus, navicular, 3 cuneiforms, medial 3 metatarsals
  • Lateral arch = calcaneus, cuboid, lateral 2 metatarsals
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18
Q

What ligaments support the longitudinal arches?

A
  • Dorsal, plantar and interosseous ligaments between small bones of the forefoot
  • Short plantar ligament
  • Long plantar ligament
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19
Q

What are the boundaries of the femoral triangle?

A
  • Superior = inguinal ligament
  • Medial = lateral border of adductor longus
  • Lateral = medial border of sartorius
  • Roof = fascia lata
  • Floor = iliacus, tendon of psoas major, pectinueus, adductor longus
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20
Q

What is the fascia lata?

A

Deep fascia of the thigh that extends down to ensheath the entire lower limb except of the the subcutaneous surface of the tibia and at the saphenous opening

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21
Q

What are the boundaries of the femoral canal?

A
  • Anterior = inguinal ligament
  • Medial = lacunar ligament
  • Lateral = femoral vein
  • Posterior = pectineal ligament
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22
Q

What are the boundaries of the adductor (Hunter’s) canal?

A
  • Posterior = adductor longus and magnus
  • Anteromedial = sartorius
  • Anterolateral = vastus medialis
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23
Q

What does the adductor canal connect?

A
  • Apex of the femoral triangle
  • Adductor hiatus (opening in adductor magnus)
24
Q

List the contents of the adductor canal

A
  • SFA
  • Femoral vein
  • Saphenous nerve
  • Nerve to vastus medialis
25
Q

What are the boundaries of the popliteal fossa?

A
  • Superioromedial = semimembranosus and semitendinosus
  • Superolateral = biceps femoris
  • Inferior = medial and lateral heads of gastroc
  • Floor = popliteus, popliteal surface of femur
  • Roof = deep fascia
26
Q

List the contents of the popliteal fossa

A

Popliteal artery, popliteal vein, tibial nerve, common peroneal nerve

27
Q

Describe the course and distribution of the profunda femoris

A

Arises posterolaterally from the femoral artery 5cm distal to the inguinal ligament. Passes deep to adductor longus and gives off medial and lateral circumflex branches and 4 perforating branches.

28
Q

Describe the course and distribution of the superior gluteal artery

A

Largest branch of the internal iliac. Leaves pelvis via greater sciatic foramen superior to the piriformis. Has two branches - deep and superior

29
Q

Describe the course of the posterior tibial artery

A

Largest branch of the popliteal artery. Descends in the posterior compartment of the leg deep to soleus. Gives off the peroneal artery 4cm from its origin. Becomes superficial in the lower 1/3rd of the leg and passes behind medial malleolus between FDL and FHL tendons. Below the ankle it divides into medial and lateral plantar arteries.

30
Q

Describe the course of the peroneal artery

A

Branch of the posterior tibial artery 4cm below its origin. Descends down the posterior aspect of the fibula, sloes to its medial margin. Supplies adjacent muscles and gives off nutrient branch to the fibula.

31
Q

Describe the course of the anterior tibial artery

A

Arises at the bifurcation of the popliteal artery. Passes forwards between tibia and fibula, under the lower border of popliteus. Descends on the anterior border of the IO membrane. Becomes superficial just above the ankle between tendons of EHL and TA. Continues over the dorsum of the foot as dorsalis pedis.

32
Q

What is the distribution of veins in the lower limb?

A
  • Deep veins accompany the corresponding major arteries
  • Superficial veins are the long and short saphenous
33
Q

Describe the course of the short saphenous vein

A

Commences behind the lateral malleolus where it drains the lateral side of the dorsal venous plexus of the foot. Passes behind lateral malleolus and over the back of the calf. Perforates the deep fascia over the popliteal fossa and terminates in the popliteal vein.

34
Q

What accompanies the short saphenous vein?

A

Sural nerve (sensory branch of the tibial nerve)

35
Q

Describe the course of the long saphenous vein

A

Commences on the medial side of the doral venous arch of the foot. Ascends immediately in front of the medial malleolus (accompanied by the saphenous nerve). It ascends to the groin where it pierces the deep fascia of the saphenous opening to enter the femoral vein immediately medial to the femoral pulse.

36
Q

Describe the course of the femoral nerve

A

L2-4. Passes through the substance of psoas major to arise from its lateral border. Passes under the inguinal ligament 1cm lateral to the femoral artery. Breaks into terminal branches 5cm into descent into the thigh.

37
Q

What does the anterior branch of the obturator nerve supply?

A
  • Gracilis
  • Adductor longus
  • Adductor brevis
  • Skin over medial thigh and hip joint
38
Q

What does the posterior branch of the obturator nerve supply?

A
  • Adductor magnus
  • Obturator externus
  • Knee joint
  • Occasionally adductor brevis
39
Q

Roots of the sciatic nerve?

A

L4-S3

40
Q

Describe the course of the sciatic nerve

A

L4-S3. Emerges from the greater sciatic foramen inferior to piriformis and under the cover of gluteus maximus. Crosses the posterior surface of ischium, obturator internus/gemelli/quads femoris and descends on adductor magnus. Terminates by dividing into tibial and common peroneal nerves in the mid-thigh.

41
Q

List the branches of the sciatic nerve

A
  • Muscular = to biceps femoris, semimembranosus, semitendinosus, hamstring part of adductor magnus
  • Tibial nerve
  • Common peroneal nerve
42
Q

Describe the course of the tibial nerve

A

L4-S3. Larger terminal branch of the sciatic nerve. Traverses popliteal fossa superficial to the popliteal vein and artery. Descends in the posterior compartment deep to soleus and accompanied by the posterior tibial vessels

43
Q

What is the distribution of the tibial nerve?

A

Popliteal fossa branches:
- Muscular = gastroc, soleus, popliteus
- Cutaneous = sural nerve
Leg/foot branches:
- Muscular = FHL, FDL, TP, intrinsic muscles of the foot
- Cutaneous = skin of the sole of the foot (via medial and lateral plantar nerve)

44
Q

How does the tibial nerve terminate

A

Medial and lateral plantar nerves

45
Q

Describe the course of the common peroneal nerve

A

L4-S2. Smaller terminal branch of the sciatic nerve. Enters popliteal fossa lateral to the tibial nerve. Passes along the medial border of the biceps tendon before winding around the neck of the fibula, deep to peroneus longus, where it divides into deep and superficial branches.

46
Q

Describe the course of the deep peroneal nerve

A

Pierces extensor digitorum longus. Descends with the anterior tibial vessels over the anterior interosseous membrane and across the ankle joint.

47
Q

What is the distribution of the deep peroneal nerve?

A
  • Muscular = TA, EHL, EDB, peroneus tertius
  • Cutaneous = skin over 1st webspace
48
Q

Describe the course of the superficial peroneal nerve

A

L4-S1. Arises at the neck of the fibula as a terminal branch of the common peroneal nerve. Descends between the peroneal muscles and the lateral side of EDL. In the lower 1/3rd of the leg it pierces the deep fascia and terminates by dividing into the medial and intermedial dorsal cutaenous nerves.

49
Q

What is the distribution of the superficial peroneal nerve?

A
  • Muscular = peroneus brevis and longus
  • Cutaneous = anterolateral aspect of the lower leg (and dorsal surface of the foot vial medial and intermedial dorsal cutaenous nerves)
50
Q

List the structures that pass behind the medial malleolus

A
  • Tibialis posterior tendon
  • Flexor digitorum longus tendon
  • Posterior tibial artery
  • Tibial nerve
  • Flexor hallucis longus
51
Q

List the structures that pass behind the lateral malleolus

A
  • Sural nerve
  • Peroneus longus tendon
  • Peroneus brevis tendon
  • Short saphenous vein
52
Q

Lost the short external rotators of the hip (from superior to inferior)

A
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quadratus femoris
53
Q

List the contents of the anterior compartment of the leg

A
  • Muscles = TA, EHL, EDL, peroneus tertius
  • Neurovascular = anterior tibial artery, deep peroneal nerve
54
Q

List the contents of the lateral compartment of the leg

A
  • Muscular = peroneus longus and brevis
  • Neurovascular = peroneal artery, superficial peroneal nerve
55
Q

List the contents of the superficial posterior compartment of the leg

A
  • Muscular = gastroc, soleus
  • Neurovascular = sural nerve
56
Q

List the contents of the deep posterior compartment of the leg

A
  • Muscular = tibialis posterior, FHL, FDL, plantaris, popliteus
  • Neurovascular = posterior tibial artery, tibial nerve

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