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Y2 LCRS Anatomy of Limbs > review of nerves and vessels of lower limb > Flashcards

review of nerves and vessels of lower limb Flashcards

1
Q

what do spinal nerves C1-4 innervate

A

neck

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2
Q

what do spinal nerves C5-T1 innervate

A

upper limb

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3
Q

what to spinal nerves T2-L1 innervate

A

trunk

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4
Q

what do spinal nerves L2-S3 innervate

A

lower limb

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5
Q

what do spinal nerves S2-C1 innervate

A

perineum

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6
Q

2 types of innervation

A

segmental (dermatomes), peripheral (nerves to muscles, cutaneous nerves)

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7
Q

where do peripheral nerves to limbs emerge from

A

nerve plexuses

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8
Q

define nerve plexus

A

formed when peripheral spinal nerve roots merge and split to produce a network of nerves from which new multi-segmental peripheral nerves emerge

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9
Q

what plexus do nerves to lower limb emerge from

A

lumbo-sacral plexus

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10
Q

what nerve supplies anterior compartment of thigh

A

femoral nerve (goes underneath inguinal ligament to femoral triangle); is a posterior division but supplies anteriorly (permanent pronation during development)

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11
Q

what nerve supplies medial (adductor) compartment of thigh

A

obturator nerve (through obturator foramen in abdominal pelvis by pubic bone)

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12
Q

what nerve supplies posterior compartment of thigh, leg, ankle and foot

A

sciatic nerve (or terminal branches tibial and common peroneal)

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13
Q

general organisation of lumbo-sacral plexus

A

L2-S3; many terminal branches have supply from different spinal roots; roots -> trunks -> divisions -> cords -> terminal nerves

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14
Q

before femoral nerve reaches anterior thigh, what does it give branches to

A

iliacus (hip flexor)

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15
Q

what is a major landmark of the buttock in relation to nerves and vessels of gluteal region

A

piriformis (superior gluteal above, inferior gluteal below)

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16
Q

what does the superior gluteal nerve supply

A

gluteus medius, gluteus minimus

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17
Q

what does the inferior gluteal nerve supply

A

gluteus maximus

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18
Q

what 2 other nerves emerge inferior to piriformis

A

sciatic nerve, posterior cutaneous nerve of thigh

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19
Q

where does the sciatic nerve divide to give tibial and common peroneal nerves

A

just above knee (inconsistent)

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20
Q

tibial nerve pathway

A

remains posterior and descends towards medial malleolus of ankle

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21
Q

common peroneal nerve pathway

A

emerges from popliteal fossa and goes around laterally by the neck of the fibula, before dividing to give deep and superficial branches

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22
Q

deep peroneal nerve pathway

A

remains anteriorly to supply anterior leg muscles

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23
Q

superficial peroneal nerve pathway

A

supplies lateral compartment of leg

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24
Q

what branch of the femoral nerve reaches the leg

A

saphenous nerve (cutaneous nerve of medial leg and foot)

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25
Q

what forms the sural nerve

A

branches of tibial and common peroneal (sural communicating branch from common peroneal)

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26
Q

what does the sural nerve supply

A

cutaneous nerve of lateral leg compartment and foot (sometimes removed for nerve reconstruction)

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27
Q

what does the tibial nerve divide into at the foot (supply all foot muscles between them)

A

lateral and medial plantar nerves

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28
Q

nerve and spinal nerve roots supplying iliopsoas and anterior thigh

A

femoral nerve (L2,3,4, posterior fibres), except iliopsoas which includes L1

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29
Q

nerve and spinal nerve roots supplying medial (adductor) compartment of thigh

A

obturator nerve (L2,3,4, anterior fibres)

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30
Q

nerve and spinal roots supplying posterior thigh, leg and foot

A

sciatic nerve (L3,4,5, S1,2,3, anterior and posterior fibres)

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31
Q

nerve and spinal roots supplying gluteus medius and minimus, and tensor fascia lata

A

superior gluteal nerve (L4,5, S1)

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32
Q

nerve and spinal roots supplying gluteus maximus

A

inferior gluteal nerve (L5, S1,2)

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33
Q

segmental motor supply: spinal nerves which contain motor nerve cell bodies for upper limb

A

C5-T1 (plexus)

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34
Q

segmental motor supply: spinal nerves which contain motor nerve cell bodies for lower limb

A

L2-S3 (plexus)

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35
Q

segmental motor supply: muscle function of anterior divisions

A

flexor

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36
Q

segmental motor supply: muscle function of posterior divisions

A

extensor

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37
Q

segmental motor supply: 4 principles of segmental supplies

A

muscles supplied by 2 adjacent spinal segments, same action on joint = same nerve supply, opposing muscles 1-2 segments above/below, more distal in limb = more caudal (inferior) in spine

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38
Q

segmental motor supply: spinal roots for hip flexion

A

L2,3

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39
Q

segmental motor supply: spinal roots for hip extension

A

L4,5

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40
Q

segmental motor supply: spinal roots for knee extension

A

L3,4

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41
Q

segmental motor supply: spinal roots for knee flexion

A

L5, S1

42
Q

segmental motor supply: spinal roots for dorsiflexion (extension)

A

L4,5

43
Q

segmental motor supply: spinal roots for plantarflexion (flexion)

A

S1,2

44
Q

segmental motor supply: spinal root for foot inversion

A

L4

45
Q

segmental motor supply: spinal roots for foot eversion

A

L5, S1

46
Q

segmental motor supply: spinal roots for large toe extension

A

L5, S1

47
Q

segmental motor supply: spinal roots for large toe flexion

A

S1,2

48
Q

segmental nerve supply: define dermatome

A

sensation of field of body surface supplied by single spinal nerve

49
Q

segmental nerve supply: dermatome supply to knee

A

anteriorly L2 to L3, posteriorly S1, S2, S3, S4, L1, L2, L3, L4, L5

50
Q

segmental nerve supply: dermatome supply to foot (floor)

A

L4 to S2

51
Q

what roots do fibres from posterior cutaneous nerve of thigh supply

A

S1, S2 (not all S1 and S2 fibres, but some)

52
Q

segmental nerve supply: autonomous sensory zones

A

no overlap, so if abnormal sensation then indicative of spinal root damage

53
Q

segmental nerve supply: L3 autonomous sensory zones

A

anterior and medial thigh

54
Q

segmental nerve supply: L4 autonomous sensory zones

A

anterior thigh and knee

55
Q

segmental nerve supply: S1 autonomous sensory zone

A

posterior lateral calf

56
Q

segmental nerve supply: deep peroneal nerve autonomous sensory zone

A

cleft between large and second toe

57
Q

cutaneous innervation of foot: dorsal nerves

A

saphenous (branch of femoral nerve), superficial and deep peroneal nerves, dorsal lateral cutaneous nerve of foot (termination of sural nerve), dorsal digital nerve (from deep fibular nerve)

58
Q

cutaneous innervation of foot: plantar nerves

A

common plantar difical nerves, lateral plantar nerve, medial plantar nerve, proper plantar digital nerves, medial calcaneal branch

59
Q

4 assessments of nerve function

A

motor, sensory, reflex, autonomic

60
Q

example of assessment of nerve function: prolapsed intervertebral disc at L5/S1

A

motor - loss of eversion, sensory - loss of sensation of outer border of foot, reflex - loss of ankle jerk (S1), autonomic - minimal

61
Q

example of assessment of nerve function: lesion of common peroneal nerve at fibular neck

A

motor - foot drop (lateral and anterior muscles of leg, losing ability to dorsiflex - high stepping/wide gait to avoid catching toes as they walk), sensory - loss of dorsum of foot at least, reflex - none, autonomic - minimal

62
Q

arterial supply of lower limb

A

aorta -> common iliac -> external / internal iliac -> external passes under inguinal ligament to become femoral -> femoral -> [profunda femoris (deep) -> circumflex femoral (around hip)] -> anterior to posterior through hiatus of adductor magnus (potential occlusion) to become popliteal -> popliteal -> trifurcates after popliteal fossa: anterior tibial (-> dorsalis pedis), posterior tibial (-> plantar), peroneal

63
Q

branch of internal iliac artery into thigh

A

obturator artery (passes through obturator foramen into thigh)

64
Q

arteries where can feel pulse (ensure adequate perfusion)

A

femoral artery (cannulation), popliteal artery, posterior tibial artery, dorsalis pedis

65
Q

femoral triangle boundaries

A

superior: inguinal ligament; medial: lateral edge of adductor longus; lateral: medial edge of sartorius

66
Q

contents of femoral triangle (NAVY)

A

femoral nerve, artery, vein (also lymph nodes)

67
Q

popliteal fossa boundaries

A

fascia, femur, medial and lateral heads of gastrocnemius, semimembranosus, biceps femoris

68
Q

popliteal fossa contents

A

popliteal artery deeper than popliteal vein, tibial and common peroneal nerves, termination of small saphenous vein (into popliteal vein), lymph nodes

69
Q

trifurcation of popliteal artery

A

anterior tibial first just after popliteal fossa, before carying on and dividing into peroneal and posterior tibial

70
Q

arteries of ankle

A

anterior tibial (deep between bones, crossing ankle to become dorsalis pedis - pulse), posterior tibial (passes around lateral malleolus - take pulse)

71
Q

feeling femoral artery in groin

A

between ASIS and pubic tubercle (press femoral artery against pubic ramus)

72
Q

feeling dorsalis pedis artery

A

press against tarsals / metatarsals; between extensor hallicus lonus and tibialis anterior tendon

73
Q

feeling posterior tibial artery

A

press against malleolus; between medial malleolus and calcaneal tendon

74
Q

superficial venous drainage

A

dorsal venous arch -> long (emerges in front of and superior to medial malleolus, travelling up medial leg and thigh) / short (behind lateral malleolus and up posterior leg to pierce popliteal fossa fascia) saphenous veins -> perforating veins (drain from superficial to deep) -> short saphenous drains into popliteal vein at popliteal fossa, long saphenous drains into femoral vein at sapheno-femoral junction

75
Q

deep venous drainage: what do they run alongside

A

run alongside arteries (often as venae comitantes)

76
Q

deep venous drainage: what helps move blood

A

muscle pump in calf

77
Q

deep venous drainage

A

anterior and posterior tibial veins -> popliteal vein (receives SSV) [and profunda femoris vein] -> femoral vein (arises at adductor canal; receives LSV) -> external iliac vein

78
Q

what are venae comitantes

A

mutiple veins forming a network of smaller veins with arteries which they accomany, with connections between them

79
Q

what do venae comitantes allow, and what promotes venous flow

A

allow heat exchange, with artery pulse promoting venous flow

80
Q

what is a saphenous cut down

A

cut skin just above medial malleolus and find long saphenous vein, to inject fluids if hypotensive (shocked patient, advanced trauma life support)

81
Q

what has superseded saphenous cut down

A

intraosseous administration of fluid (inserted into bone e.g. anterior tibia marrow space, with fluid infused into circulation)

82
Q

consequence of sudden occlusion (arterial embolism)

A

acute ischaemia, intermittent claudication (muscle pain during activity in calf)

83
Q

what is compartment syndrome

A

as neuromuscular compartments of limbs are enclosed in fibrous sheaths (e.g. fascia lata in thigh), they can be subjected to ischaemia by trauma-induced increased pressure

84
Q

common compartments affected by compartment syndrome

A

anterior, posterior and lateral compartments of leg

85
Q

can a pulse be felt in compartment syndrome

A

yes, as only need 50-60mmHg to collapse vessels (normally 25), despite ischaemia

86
Q

what is trauma associated compartment syndrome

A

acute

87
Q

what is exercise-induced compartment syndrome

A

chronic

88
Q

acute compartment syndrome treatment

A

emergency fasciotomy to remove fascia and open compartment to relieve pressure

89
Q

function of perforating veins

A

connect superficial and deep veins, allowing drainage from superficial to deep (as have valves)

90
Q

what happens if valves in perforating veins are compromised (genetic, lifestyle etc.)

A

blood pushed from deep to superficial veins (varicose veins), leading to venous insufficiency

91
Q

function of perforating veins

A

connect superficial and deep veins, allowing drainage from superficial to deep (as have valves)

92
Q

what can varicose veins lead to

A

lipodermatosclerosis (skin thickening) and venous ulcers

93
Q

what is the most important valve affected by varicose veins

A

sapheno-femoral junction valve

94
Q

risk factor of DVT, and why

A

inactivity, as calf pump not working to pump against gravity (normally, contraction of muscles squeeze thin-walled veins and push blood up veins)

95
Q

what are DVTs related to

A

pulmonary embolism (dislodge and goes to pulmonary circulation)

96
Q

2 consequences of DVT

A

post-phlebitic syndrome, superficial thrombophlebitis

97
Q

what helps prevent DVTs, and how

A

elastic surgical socks which compress superficial veins, promoting more vigorous deep venous return

98
Q

2 consequences of DVT

A

post-phlebitic syndrome, superficial thrombophlebitis

99
Q

what helps prevent DVTs, and how

A

elastic surgical socks which compress superficial veins, promoting more vigorous deep venous return

100
Q

what are venous grafts used for

A

CABG (bypass between arteries), with valves in correct way to ensure flow in one direction

Y2 LCRS Anatomy of Limbs (25 decks)

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