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Clinical Anatomy Course > 8. Lower Limb > Flashcards

8. Lower Limb Flashcards

1
Q

What is the pelvic girdle?

A
  • The pelvic (hip) girdle is formed from two hip bones, known as the os coxae.
  • At birth, each hipbone is composed of three separate bones which fuse together, called the ilium, ischium and pubis.
  • The pelvic girdle directly articulates with the vertebral column at the sacroiliac joints.
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2
Q

What does the pelvic girdle articulate with?

A
  • Medially -> With sacrum at sacroiliac joint
  • Laterally -> With femur at acetabulum
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3
Q

What bones make up the hip bone? What is the position of each?

A
  • Ilium -> Top
  • Ischium -> Bottom, Back
  • Pubis -> Bottom, Front
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4
Q
A
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5
Q

What are the main landmarks of the hip bone?

A

Ilium:

  • Iliac crest (palpable)
  • Anterior superior iliac spine (ASIS) (palpable)
  • Posterior superior iliac spine (PSIS) (palpable)
  • Anterior inferior iliac spine (AIIS)
  • Greater sciatic notch

Ischium:

  • Ischial spine
  • Ischial tuberosity (palpable)

Pubis:

  • Pubic tubercle (palpable)

All 3:

  • Acetabulum -> Articulates with head of femur
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6
Q

Describe the joint type and movement at the sacroilial joint.

A
  • Synovial
  • But any movement is almost entirely prevented by strong ligaments and interlocking articular cartilage.
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7
Q

What ligaments at the sacroiliac joint do you need to know about?

A
  • Intrinsic
  • Sacrotuberous
  • Sacroiliac
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8
Q

Give a summary of the ligaments at the sacroiliac joint.

A
  • Sacroiliac ligament
    • Anterior sacroiliac ligament -> From the ala of the ilium to pelvic surface of
    • Posterior sacroiliac ligament -> Similar to anterior counterpart, except on the posterior side
  • Sacrotuberous ligament -> From inferior sacrum to iliac tuberosities
  • Sacrospinous ligament -> From lateral sacrum to ischial spine
  • Intrinsic ligaments
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9
Q

Draw the position of the anterior sacroiliac ligament.

A
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10
Q

Draw the position of the posterior sacroiliac ligament, sacrospinous ligament and sacrotuberous ligament.

A
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11
Q
A
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12
Q

What bones form the acetabulum?

A

The three bones of the hip, the pubis, ilium and ischium

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13
Q

What is the acetabular labrum?

A

A ring of fibrocartilage that deepens the acetabulum socket, attaches to the transverse acetabular ligament

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14
Q

What is the femoral head lined with?

A

Hyaline cartilage, except for a section which attaches to the femoral head ligament

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15
Q

Describe the joint capsule of the hip joint.

A

Capsule passes from the rim of the acetabulum to the intertrochanteric line of the anterior femur, and reflects to the midpoint of the femoral neck posteriorly.

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16
Q

Compare the shoulder and pelvic girdles.

A

Shoulder girdle:

  • Does not directly articulate with the vertebral column
  • Shallow sockets to maximise movement
  • Adapted to offer more movement than strength

Pelvic girdle:

  • Directly articulates with the vertebral column, at the sacroiliac joints
  • Deep sockets, maximising stability but restricting mobility
  • Adapted to offer more strength than movement
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17
Q

What ligaments stabilise the hip joint?

A
  • Iliofemoral ligament
  • Pubofemoral ligament
  • Ischiofemoral ligament
  • Transverse ligament
  • Ligamentum teres

So just remember that each of the hip bone component bones has a ligament to the femur.

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18
Q

Draw the transverse acetabular ligament.

A
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19
Q

What is the ligamentum teres in the hip?

A

A ligament between the head of femur to the acetabular notch.

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20
Q

Describe the blood supply to the head of femur.

A

Medial and lateral femoral circumflex arteries create the trochanteric anastamosis around the femoral neck.

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21
Q

What are the main hip flexors?

A
  • Iliacus -> From iliac fossa to tendon of psoas
  • Psoas major -> From lumbar vertebrae and intervertebral discs to the lesser trochanter of the femur

Extra ones you don’t need to know:

  • Pectineus
  • Rectus femoris
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22
Q

What is a secondary function of the psoas major apart from hip flexion?

A

Flexion of the lumbar spine

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23
Q

What are the main hip extensors? What is the innervation?

A
  • Hamstrings
  • Gluteus maximus (at extremes) -> Posterior ilium, sacrum and coccyx to femur and iliotibial tract

Innervation: Sciatic nerve (hamstrings), Inferior gluteal nerve (gluteus maximus)

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24
Q

What are the hamstring muscles? Where do they attach?

A
  • Origin: Tuberosity of ischium
  • Insertions: Tibia (semitendinosus and semimembranosus) and fibula (biceps femoris)
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25
Q

Where does the gluteus maximus insert to assist with hip extension?

A

Into the ilio-tibial tract

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26
Q

What are the main hip abductors? What is the innervation?

A
  • Gluteus medius -> Ilium to greater trochanter of femur
  • Gluteus minimus -> Ilium to greater trochanter of femur

Innervation: Superior gluteal nerve

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27
Q

How can the hip abductors be paralysed? What is the effect of this?

A
  • Damage to the superior gluteal nerve can lead to Trendelenburg gait.
  • Weakness of gluteus medius and gluteus minimus leads to a drop of the pelvis to the side opposite that which is weight bearing.
  • To compensate, the patient often swings their body to the opposite side of the drop (i.e. the side of the lesion). Management involves physiotherapy to strengthen abductors of the hip as much as possible.
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28
Q

What are the main hip adductors? What is the innervation?

A
  • Adductor longus
  • Adductor brevis
  • Gracilis
  • Adductor magnus

(Not sure you need to know named muscles)

Innervation: Obturator nerve

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29
Q

What are the main muscles responsible for lateral rotation of the hip? What is the innervation?

A
  • Principal lateral rotator: Gluteus maximus -> Posterior ilium, sacrum and coccyx to femur and iliotibial tract
  • Stablised by:
    • Piriformis
    • Obturator internus
    • Quadratus femoris

(Not sure you need to know stabilisers’ names)

Innervation: Gluteal nerve (gluteus maximus)

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30
Q

Describe how a fractured neck of femur presents.

A
  • Following a fracture of the neck of the femur, the femoral shaft freely rotates about its own longitudinal axis.
  • The psoas major muscle causes lateral rotation of the femoral shaft, aided by gluteus maximus, which cannot be opposed by the medial rotators.
  • Patients therefore present with the injured leg in marked lateral rotation.
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31
Q

What is a subtrochanteric fracture of femur? How does it present?

A
  • A fracrure within 5cm distal to the lesser trochanter.
  • These fractures usually occur in younger patients with a high energy mechanism.
  • Presentation: Leg shortening and varus deformity of the leg, and cannot bear weight on the affected side.
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32
Q

In which direction does the femur most commonly dislocate?

A

Posteriorly

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33
Q

What is a traumatic posterior dislocation of the hio commonly associated with?

A
  • Sciatic nerve injury (important)
  • Femoral head fractures
  • Acetabular fractures
  • Sciatic nerve injuries

The affected leg will be flexed, adducted and internally rotated.

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34
Q

Describe congenital dislocation of the hip joint.

A
  • Around 1 in 1000 neonates are born with one or more hip joints liable to dislocation, due to impaired formation the upper margin of the acetabulum.
  • This may present with legs of different lengths, uneven skin folds on the thigh, limping or reduced flexibility on one side.
  • The Barlow and Ortolani manoeuvres are used to identify dysplastic hips.
  • Treatment involves bracing of the hips with a harness.
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35
Q

What is a slipped epiphysis of the femoral head?

A
  • This condition occurs in teenagers who are still growing and involves a fracture through the growth plate between the neck and head of the femur.
  • This can cause pain, instability and stiffness of the hip joint.
  • Obesity is the most significant risk factor.
  • Treatment involves external pinning or open reduction and pinning.
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36
Q

Label this.

A
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37
Q

Name all of the articulations at the knee.

A
  • 2 x Femur with the tibia
  • 1 x Femur with the patella
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38
Q

Is the fibula part of the knee joint?

A

No, it is sort of off to the side.

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39
Q

Name the surfaces that articulate between the femur and tibia.

A

The lateral and medial femoral condyles articulate with the lateral and medial tibial menisci of the tibial plateau (on the lateral and medial tibial condyles). There is a raised intercondylar eminence on the tibia.

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40
Q

Draw the anterior view of the knee joint.

A
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41
Q

Draw the posterior view of the knee joint.

A
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42
Q

What type of bone is the patella?

A

Sesamoid

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43
Q

What attaches to the patella?

A

Quadriceps tendon

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44
Q

What are the menisci of the tibia? Draw them.

A

C-shaped pieces of fibrocartilage that deepen the medial and lateral femorotibial articulations.

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45
Q

Summarise the extracapsular ligaments at the knee joint.

A
  • Medial collateral ligament (MCL) – a broad, flat band running between the medial femoral epicondyle and the anteromedial aspect of the tibia, directly communicating with the medial meniscus. The MCL resists valgus (laterally applied) forces to the knee
  • Lateral collateral ligament (LCL) – a thin, cord-like band passing between the lateral femoral epicondyle and the head of the fibula, which does not communicate with the lateral meniscus due to the presence of the popliteus muscle tendon. The LCL resists varus (medially applied) forces to the knee
  • Oblique popliteal (posterior) ligament – passes obliquely from the lateral femoral epicondyle to the medial condyle of the tibia. Limits the degree of rotation possible at the knee joint.
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46
Q

Describe the attachments and functions of the cruciate ligaments.

A
  • ACL
    • From lateral femoral condyle to anterior tibial plateau.
    • Resists anterior displacement of the tibia against the femur and medial rotation.
  • PCL
    • From the medial femoral condyle to posterior tibial plateau.
    • Resists posterior displacement of the tibia against the femur.

Use the mnemonic “LAMP” – Lateral condyle = Anterior cruciate, Medial condyle = Posterior cruciate.

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47
Q

What are the main bursae of the knee joint?

A
  • Suprapatellar -> Between femur and quadriceps tendon
  • Superficial infra-patellar -> Between skin and tibial tuberosity, helpful to withstand pressure when kneeling
  • Deep infra-patellar -> Between patellar ligament and anterior tibia
  • Pre-patellar -> Between skin and anterior patella, allows free movement of skin over patella during knee movements
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48
Q

Describe how knee locking and unlocking works.

A

Locking:

  • As full extension is approached, the femur rotates medially on the tibia by a few degrees. This rotation is brought about by the tightening of the ligaments around the knee.
  • In full extension, the knee is locked and this allows the joint to weight bear with little to no muscular effort.

Unlocking:

  • In order to flex the knee from this locked position, the popliteus muscle must contract to rotate the femur laterally on the tibia.
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49
Q

Describe a meniscal tear.

A
  • These injuries usually involve the medial meniscus.
  • Pain on medial rotation of the tibia on the femur indicates medial meniscus injury, whilst lateral rotation pain indicates lateral meniscus damage.
  • Most meniscal tears occur with medial collateral ligament or anterior cruciate ligament tears, in the so called “Unhappy Triad” injury.
  • The most common symptoms of meniscal tears include pain, stiffness, swelling and a sensation of “catching” or “locking” of the knee.
  • Tears may heal without intervention due to good blood supply, but may require surgical repair if healing fails.
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50
Q

Describe cruciate ligament tears.

A

ACL tear:

  • Tibia can be moved forward against the distal femur.

PCL tear:

  • Leg will sag visibly if supported horizontally at the ankle, due to posterior displacement of the tibia against the femur.
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51
Q

Describe the test for an ACL and PCL tear.

A

ACL tear - Anterior drawer test:

  • Patient lies supine with the hips flexed and knees flexed to 90 degrees.
  • The examiner sits on the toes and grasps the proximal lower leg, attempting to translate the tibia anteriorly.
  • If there is excessive anterior translation relative to the contralateral side, the test is considered positive.

PCL tear - Posterior drawer test:

  • Leg will sag visibly if supported horizontally at the ankle, due to posterior displacement of the tibia against the femur.
  • This will lead to a positive “posterior drawer” test.
52
Q

What does locking of the knee involve?

A

Slight medial rotation of the femur

53
Q

What does unlocking of the knee involve?

A

Popliteus muscle driving lateral rotation of the femur

54
Q

What are the knee flexors? What is their innervation?

A
  • Hamstrings:
    • Semitendinosus -> From ischial tuberosity to tibia
    • Semimembranosus -> From ischial tuberosity to tibia
    • Biceps femoris -> From ischial tuberosity to fibula
  • Adductor magnus -> From along the medial femur to ischium

Innervation: Tibial branch of sciatic nerve (hamstrings), Obturator nerve (adducot magnus)

55
Q

Describe the arrangement of tendons around the knee.

A

The tendons reach around the lateral sides of the knee, so they are not in the way of the knee.

56
Q

What are the knee extensors? What is the innervation?

A
  • Quadriceps femoris:
    • Rectus femoris -> Anterior inferior iliac spine to tibial tuberosity
    • Vastus medialis -> Femur to tibial tuberosity
    • Vastus lateralis -> Femur to tibial tuberosity
    • Vastus intermedius -> Femur to tibial tuberosity

Innervation: Femoral nerve

57
Q

What is the patellar tendon?

A

The distal portion of the common tendon of the quadriceps femoris, which is continued from the patella to the tibial tuberosity.

58
Q

What does the tibia articulate with?

A
  • Femur (tibiofemoral / knee joint)
  • Fibula (x2) (proximal and distal tibiofibular joints)
  • Talus (ankle joint)

Note that there is also an interosseous membrane between the tibia and fibula.

59
Q

What are the main landmarks of the tibia?

A
  • Tibial plateau -> Articulates with femur
    • Intercondylar eminence -> ACL and PCL, Menisci of tibia
  • Medial and lateral tibial condyles
  • Tibial tuberosity (anterior) -> Quadriceps
  • Tibial shaft
  • Medial malleolus -> Articulates with talus
60
Q

What are the main landmarks of the fibula?

A
  • Head of fibula -> Articulates with tibia
  • Fibula shaft
  • Lateral malleolus -> Articulates with talus
61
Q

Label this.

A
62
Q

Describe the articulations at the ankle joint. Draw a diagram of the joint.

A

The medial malleolus of the tibia and the lateral malleolus of the fibula “grip” the talus (a tarsal) bone.

63
Q

What does the fibula articulate with?

A
  • Tibia (x2) (proximal and distal tibiofibular joints)
  • Talus (ankle joint)
64
Q

Describe the superior and inferior tibiofibular joints.

A
  • The superior tibio-fibular joint is located between the medial head of the fibula and the lateral condyle of the tibia, forming a plane type synovial joint.
  • The inferior tibio-fibular joint is formed between the medial aspect of the distal fibula and the lateral aspect of the distal tibia. This is a fibrous joint of the syndesmosis type, allowing a small amount of movement.
65
Q

Label this.

A
66
Q

Describe the bones in the foot.

A
  • 7 tarsals -> Talus, Calcaneus, Cuboid, Navicular, Cuneiforms (x3)
  • 5 metatarsals
  • 14 phalanges (only 2 in the hallux)

Therefore the structure is homologous to the hand.

67
Q

Name all of the tarsals.

A
  • Calcaneus (forms the mass of the heel, very large)
  • Talus (forms ankle joint)
  • Cuboid
  • Navicular
  • Cuneiforms x 3 (Medial, intermediate, lateral)
68
Q

What is the technical name for the big toe?

A

Hallux

69
Q

Do inversion and eversion of the foot happen at the ankle joint?

A

No, it is a hinge joint. Inversion and eversion happen at the joints between the tarsals.

70
Q

Describe the two collateral ligaments stabilising the ankle joint.

A
  • Lateral collateral ligament – consists of three segments, known as the anterior talofibular, posterior talofibular and calcaneofibular segments.
  • Medial collateral ligament (deltoid ligament) – passes between the medial malleolus to the talus.
71
Q

Describe ankle fracture dislocations.

A
  • Forcible eversion of the ankle may strain the deltoid ligament and cause avulsion of the medial malleolus if sufficiently strong.
  • This causes the talus to move laterally, causing a fracture of the lateral malleolus.
  • Commonly, the tibia is carried anteriorly, causing a fracture of the distal, posterior portion of the tibia on impact with the talus.
  • This “trimalleolar” fracture is associated with an extremely unstable ankle joint.
  • Treatment may include surgical reduction and plating of the bones.
72
Q

What are the ankle extensors (dorsiflexion)? What is the innervation?

A
  • Tibialis anterior -> Tibia to medial cuneiform and 1st metatarsal
  • Extensor hallucis longus -> Fibula to hallux distal phalanx
  • Extensor digitorum longus -> Tibia and fibula to phalanges

Innervation: Deep fibular (peroneal) nerve

73
Q

What are the ankle flexors (plantarflexion)? What is the innervation?

A
  • Gastrocnemius -> Femur to Achilles tendon (calcaneus)
  • Soleus -> Tibia and fibula to Achilles tendon (calcaneus)
  • Flexor hallucis longus -> Fibula to distal phalanx of great toe
  • Flexor digitorum longus -> Tibia to distal phalanges of toes

Innervation: Tibial nerve

74
Q

Which of the leg muscles is also involved in the venous pump?

A

Soleus

75
Q

Describe Achilles tendon rupture.

A
  • Rupture of the tendon can occur whilst performing explosive acceleration, such as jumping and pushing off with the foot, such as in running or diving.
  • Classically, a loud snap is heard and a sharp pain is felt at the back of the ankle.
  • The pain usually settles quickly, but the injury causes flat-footedness and an inability to walk on tiptoes.
  • The tendon may heal naturally in a brace/plaster cast, or may be surgically repaired.
76
Q

Describe anterior tibial compartment compression syndrome.

A

Compartment syndrome occurs when the tissue pressure within a given compartment exceeds the perfusion pressure of the arterial supply resulting in ischemia to the muscles and nerves of the compartment. The etiology is varied; however, most commonly it is related to acute trauma or overuse syndrome.

77
Q

What is a retinaculum?

A

Any of several fibrous bands of fascia that pass over or under tendons (as at or near the ankle or wrist) and help to keep them in place.

78
Q

What is the subtalar joint and what movements are possible?

A
  • A synovial joint between the talus and calcaneus
  • It is capable of inversion and eversion.
79
Q

What muscle enables inversion of the subtalar joint? What is the innervation?

A
  • Tibialis posterior (deep posterior compartment of the leg) (spec says tibialis anterior)
  • Innervation: Tibial nerve
80
Q

What muscle enables eversion of the subtalar joint? What is the innervation?

A
  • Peroneus longus and peroneus brevis
  • Innervation: Fibular nerve
81
Q

What is hallux valgus?

A

Bunion (swollen 1st metatarsophalangeal join):

  • A deformity of the foot caused by ill-fitting footwear and degenerative joint disease, resulting in lateral deviation of the great toe.
  • Often, the surrounding tissues swell and the resulting pressure against the shoe cause a subcutaneous bursa to form, which, when inflamed, is called a bunion.
  • Surgery may be required to reshape the metatarsal if grossly deformed.
82
Q

Draw the different arches of the foot.

A
  • Medial longitudinal arch
  • Lateral longitudinal arch
  • Transverse arch
83
Q

What are the longitudinal arches of the foot formed by?

A
  • The tarsal and metatarsal bones
  • Supported by the plantar ligaments, spring ligaments, small muscles of the sole and muscles/tendons of the legs.
84
Q

What is the function of the arches of the foot?

A
  • The arches enable the distribution of weight from the talus anteriorly to the metatarsals and posteriorly to the calcaneus.
  • The arches also act as shock absorbers.
85
Q

What is the plantar aponeurosis and what is the function?

A
  • The plantar aponeurosis (fascia) is a dense, fibrous sheet attached to the calcaneus which divides into five portions that attach to the sides of the proximal phalanges.
  • The planar fascia contributes to the support of the arch of the foot.
86
Q

What is the spring ligament and what is the function?

A
  • Ligament between the calcaneus and navicular.
  • It prevents the medial arch from collapsing from the weight of the body.
87
Q

What are the long and short plantar ligaments and what is the function?

A
  • Ligament between the calcaneus and cuboid bone.
  • Function to stabilise the tarsal bones and support the lateral longitudinal arch of the foot.
88
Q

Describe flat feet and fallen arches.

A
  • Flat feet can either be flexible (normal in appearance when not weight bearing) or rigid (flat even when not bearing weight).
  • Flexible flatfeet result from degenerated intrinsic ligaments ad is common in childhood, but typically resolves as the ligaments mature.
  • Rigid flatfeet that date back to childhood are likely to result from bone deformity.
  • Acquired flatfeet (so called fallen arches) are likely to be due to tibialis posterior dysfunction (through trauma, denervation or degeneration), which functions as an active support of the arches.
89
Q

What is clubfoot?

A
  • Clubfoot refers to a foot that is twisted out of position.
  • The most common form involves fixed ankle inversion, plantarflexion and forefoot adduction.
  • Uncorrected, the sole cannot be placed flat on the floor and the weight of the body is exerted on the lateral surface of the foot.
  • The pathology is caused by tightness of the muscles, tendons and ligaments on the medial and posterior aspects of the foot and ankle.
90
Q

Describe the arterial supply to the lower limb.

A
  • External iliac
  • Superficial femoral -> With deep femoral (profunda femoris) as a branch
  • Popliteal
    • Anterior tibial -> Continues as dorsalis pedis
    • Posterior tibial -> With peroneal (fibular) artery as a branch and continues as plantar arch
91
Q

What does the external iliac artery become and where?

A

It becomes the superficial femoral artery at the inguinal ligament.

92
Q

Where does the femoral artery pass through and what is the order of structures there?

A
  • Femoral triangle
  • A commonly used mnemonic to remember the relative positions of the neurovascular structures within the femoral triangle is NAVEL (lateral to medial): N = femoral nerve A = femoral artery V = femoral vein E = empty space (femoral canal) L = lymphatics

The femoral artery also then passes through the adductor (Hunter’s) canal to reach the popliteal fossa.

93
Q

What vessels supply the neck of femur?

A

Profunda femoris produces the medial and lateral circumflex femoral arteries to supply the head and neck of the femur.

94
Q

What can occur after fracture of the neck of femur?

A

Avascular necrosis

95
Q

Where does the profunda femoris supply?

A

Anterior and posterior compartments of the leg

96
Q

Describe the branches and areas supplied by the anterior and posterior tibial arteries.

A
  • Anterior tibial artery supplies the anterior compartment of the calf. It then becomes the dorsalis pedis artery along the dorsal side of the foot.
  • Posterior tibial artery produces the peroneal (fibular) artery proximally, which goes on to supply blood to the lateral compartment of the leg. The posterior tibial artery supplies the posterior compartment of the calf and branches into the medial and lateral plantar arteries.
97
Q

Compare the plantar arches of the foot with the arches in the hand.

A

There is only one in the foot, but two in the hand.

98
Q

What is the importance of the mid-inguinal point?

A
  • The position of the femoral artery at the mid-inguinal point is useful as a landmark for arterial catheterisation, which is used clinically as a point of entry for peripheral and coronary angioplasties.
  • If a pulse can be detected at this point, it suggests the patient has a systolic blood pressure of above 50mmHg.
99
Q

What gives rise to the gluteal arteries?

A

The superior and inferior gluteal arteries arise from the internal iliac artery.

100
Q

What are the pulse points in the lower limb?

A
  • Femoral pulse: Located at the mid-inguinal point (midway between ASIS and pubic symphysis)
  • Popliteal pulse: Located deep in the popliteal fossa, requiring deep palpation to feel.
  • Posterior tibial pulse: Located posterior and inferior to the medial malleolus.
  • Dorsalis pedis pulse: Located on the dorsum of the foot, lateral to the extensor hallucis longus tendon.
101
Q

How can compartment syndrome arise?

A

Bleeding within a tight fascia after a fracture.

102
Q

Describe the venous drainage of the lower limb.

A

Superficial veins:

  • Great saphenous vein
    • Drains blood from the dorsal arch of the foot, running along the medial side of the leg.
    • Passes anterior to the medial malleolus but posterior to the medial condyle at the knee.
    • Drains into the femoral vein just inferior to the inguinal ligament.
  • Small saphenous vein
    • Drains blood from the dorsal arch of the foot and from the dorsal vein of the little toe.
    • Runs along the posterior side of the leg, passing posterior to the lateral malleolus and along the calcaneal tendon, passing between the two heads of gastrocnemius.
    • Empties into the popliteal vein at the popliteal fossa.

Deep veins - RUN ALONG ARTERIES

  • Posterior tibial and fibial vein -> these arise from the lateral and medial plantar veins.
  • Popliteal vein
  • Anterior tibial vein
  • Femoral vein
  • Profunda femoris
  • External iliac vein

Communicating veins drain via the superficial into the deep veins.

103
Q

Does venous blood flow from superficial to deep or vice versa?

A

Superficial to deep

104
Q

What is the idea of muscle pumps?

A

The muscles of the anterior and posterior compartment of the leg aid deep venous return by forcing the blood superiorly on contraction.

105
Q

Describe varicose veins.

A
  • Varicose veins may occur if the valves within the venous system fail to close effectively, leading to retrograde flow from deep to superficial veins. This back-flow of blood causes distension of the veins, which become tortuous and visible on the surface of the skin. Varicosity formation is more common within superficial veins, as these are exposed to higher intraluminal pressures on standing, due to the effect of gravity.
  • Symptoms that may be experienced include pain or aching, swelling and skin thickening over the varicosities. Leg elevation and exercise should be encouraged. The varicose veins may also be surgically removed.
106
Q

Describe lymphatic drainage in the lower limb.

A
  • Lymphatic drainage of the lower limb follows the general pattern of the upper limb.
  • The superficial lymphatics, which drain the skin and subcutaneous tissues, follow the superficial veins, whilst the deep lymphatics, draining the structures deep to the deep fascia, run with the neurovascular bundles.
  • Superficial lymph nodes are located just inferior to the inguinal ligament, whilst a group of deep inguinal nodes are found surrounding the femoral artery.
107
Q

What do the superficial inguinal lymph nodes of the lower limb drain?

A

Anal canal, vagina, external genitalia

108
Q

What do the deep inguinal lymph nodes of the lower limb drain?

A

Uterus, cervix and prostate

109
Q

What nerve plesus supplies the lower limb?

A

Lumbosacral plexus

110
Q

What nerve roots is the lumbosacral plexus made from?

A

The lumbosacral plexus is formed from the anterior rami of spinal nerves L1-S4.

111
Q

What nerve roots made up the lumbar plexus?

A

L2-L4

112
Q

What nerve roots made up the sacral plexus?

A

L4-S2

113
Q

What do the anterior and posterior divisions of lumbosacral plexus nerves supply?

A
  • Anterior = Flexors
  • Posterior = Extensors
114
Q

What are the main terminal branches of the lumbosacral plexus?

A

Femoral, obturator, gluteal, sciatic nerves

115
Q

What nerves supply the gluteal compartment?

A

Superior and inferior gluteal nerves

116
Q

What nerves supply the adductor compartment?

A
  • Obturator nerve
  • This is also sensory to the medial thigh
117
Q

What nerves supply the flexor compartments of the lower limb?

A
  • Sciatic nerve supplies the thigh flexor compartment
  • Tibial nerve (branch of the sciatic nerve) supplies the leg flexor compartment
  • Also has sensory input from plantar surface of foot
118
Q

What nerves supply the extensor compartments of the lower limb?

A
  • Femoral nerve to knee extensors
  • Saphenous nerve (branch of femoral nerve) gives sensory to anterior thigh and medial leg and foot
  • Common peroneal (fibular) nerve (branch of sciatic nerve) supplies:
    • Anterior compartment (ankle and toe extensors) -> Deep peroneal nerve
    • Lateral compartment (ankle evertors) -> Superficial peroneal
  • Common peroneal also gives sensory supply to dorsum of foot
119
Q

For the femoral and obturator nerves, draw a diagram to show which muscles they innervate.

A
120
Q

For the sciatic nerve, draw a diagram to show which muscles it innervates.

A
121
Q

For the tibial nerve, draw a diagram to show which muscles it innervates. [EXTRA?]

A
122
Q

For the fibular (a.k.a. peroneal) nerves, draw a diagram to show which muscles they innervate.

A
123
Q

Draw the sensory territories of the lower limb.

A
124
Q

Draw the dermatomes of the lower limb.

A
125
Q

Name all of the nerve roots controlling the different lower limb movements.

A
126
Q
A

Clinical Anatomy Course (21 decks)

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