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MRCS B > Anatomy - Lower limb > Flashcards

Anatomy - Lower limb Flashcards

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1
Q

Dorsalis pedis is a continuation of…?

A

Anterior tibial artery

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2
Q

Strutures posterior to medial malleolus (7)

A

Posterior tibial artery and vein
Tibial nerve

Tendons - (Tom Dick Harry)
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus

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3
Q

Contributions to achilles tendon

A

Soleus
Gastrocnemius
Plantaris

aka muscles of superficial post compartment of lower leg

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4
Q

Nerve supply to posterior lower leg

A

Tibial

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5
Q

Foot nerve sensation:
S1/ sural
L4
Deep perineal
Superficial perineal
Sural
Saphenous

A

S1- lateral foot
Sural - lateral foot
L4 - medial mal
Deep perineal - 1st webspace
Superficial perineal - dorsum
Saphenous - medial aspect foot

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6
Q

Movements of extensor hallucis longus?

A

Big toe extension (IPJ/MTPJ)
Ankle dorsiflexion
Foot inversion

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7
Q

Structures deep to extensor hallucis longus?

A

anterior tibial artery + vein
deep peroneal

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8
Q

Knee and ankle reflex nerve roots

A

Knee - L3/4
Ankle - S1/2

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9
Q

Anterior lower leg compartment muscles

A

Extensor halucis longus
Extensor digitorum longus
Tibialis anterior
Peroneus tertius

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10
Q

Nerve supply to anterior lower leg compartment

A

Deep peroneal

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11
Q

Deep posterior lower leg muscles

A

Flexor halucis longus
Flexor digitorum longus
Tibialis posterior
Popliteus

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12
Q

Why can achilles tension rupture pts still plantar flex ankle?

A

Achilles tendon only made from superficial post compartment muscles, but can still use deep post compartment muscles

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13
Q

What action happens with simultaneous contraction of tibias anterior and posterior

A

Ankle inversion

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14
Q

At what specific joint do ankle inversion and eversion occur?

A

Subtalar joint - between talus and calcaneus

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15
Q

Muscles responsible for ankle eversion?

A

peroneus longus and brevis

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16
Q

Nerve innervation of lateral compartment of lower leg

A

Superficial peroneal nerve

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17
Q

Motor and sensory function of superficial perineal nerve

A

Motor - eversion
Sensory - dorsum of foot except 1st webspace

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18
Q

Supportive structures of the ankle joint?

A

1 - syndesmosis (between tis and fib)

2 - medial deltoid ligament (med mal -> talus)

3 - 3 lateral ligaments (lat mal -> talus/ calc)
- Ant and post talofibular
- Calcaneoufibular

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19
Q

Where does the fibula sit symmetrically if the syndesmosis is intact?

A

Incisura fibularis

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20
Q

4 ligaments making up the ankle syndesmosis

A

Anterior and posterior inferior tibiofibularligaments (2)

Interosseous ligament

Inferior transverse ligament

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21
Q

Attachments of ACL

A

Lateral wall of intercondylar notch of femur -> between tibial spines

Passes anteriorly and medially

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22
Q

Nerve most likely to be injured by lateral blow to the knee?

A

Common peroneal (As it wraps around neck of fibula before splitting posteriorly)

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23
Q

Structures at risk via anteromedial approach knee surgery?

A

Saphenous nerve
Great saphenous vein
Geniculate arteries

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24
Q

Blood supply to the knee

A

Anastomotic arterial mesh around knee joint from:
1- popliteal
2- femoral
3 - crural

Mainly from popliteal branches:
- medial + lateral superior genicular
- medial + lateral inferior genicular
-middle genicular

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25
Nerve supply to anterior compartment of thigh
Femoral nerve (L2-4)
26
Difference between semimembranosus + semitendinosus
Both originate from ischial tuberosity SM - more medial SM - membrane insertion ST - tendon insertion
27
Popliteal fossa contents (sup - deep)
Common peroneal nerve Tibial nerve Popliteal vein Popliteal artery Lymph nodes
28
Boundaries of popliteal fossa
Sup med - semimembranosus/ tendinosus Sup lat - biceps femoris tendon Inf med/ lat - med +lat heads of gastrocnemius Floor - knee joint, popliteus Roof - Skin/ fascia
29
What area is drained by popliteal lymph nodes?
Drainage of short saphenous vein
30
Ddx of posterior knee swellings
Baker's cyst Sebaceous cyst Popliteal artery aneurysm Lymphadenopathy Varicose vein DVT Bone deformity
31
Nerve supply to hamstrings/ posterior leg compartment
Sciatic nerve (L5-S2)
32
What is the pes anserinus?
Common conjoined tendon of sartorius, gracilis and semitendinosus Inserting into anteromedial proximal tibia
33
Define iliotibial band and attachments
Longitudinal thickening of fascia lata Dynamic knee stabiliser From iliac tubercle to lateral tibial condyle
34
What is the terrible triad knee injury?
ACL/ MCL/ medial meniscus Usually from lateral blow
35
NOF# classification
Garden's classification: 1: undisplaced incomplete 2: undisplaced complete 3: incompletely displaces 4: completely displaced (no contact between fragments) 3+4 at higher risk of AVN
36
NOF# management
1+2 (undisplaced) or extra capsular - DHS 3+4 (displaced) - Hemi / THR Subtrochanteric - IM nail
37
3 ligaments of the hip joint
Iliofemoral (Strongest - resists hyperextension) Pubofemoral Ischiofemoral
38
Describe bloods supply to head of femur
Medial and lateral circumflex arteries anastomose, arising from profound femoris. Travels in retrograde direction. Branches to femoral head are reticular arteries Also supply from artery of ligaments theres (from obturator artery) but this is negligible in adults
39
Muscle attachments to lesser trochanter of femur
Psoas major Iliacus
40
Psoas major origin + action
Deep part: L1-4 TPs Superficial: T12-L4 + vertebral discs Action: hip flexion + ext rotation
41
Attachments of iliotibial tract
Iliac crest (anterolat iliac tubercle) + lateral condyle of tibia
42
Muscles inserting onto iliotibial tract
gluteus maximus tensor fascia lata responsible for stabilisation of knee in extension/ partial flexion
43
Attachments of gluteus maximus
Iliotibial tract Gluteal tuberosity of femur
44
Nerve supply of glute max
Inferior gluteal nerve (L5-S2)
45
Action of glute max/ med/ min
Max: hip extension and external rotation Med: hip abduction Med + min: prevent hip drop during gait
46
Nerve supply to tensor fascia lata
superior gluteal nerve
47
Attachments of gluteus medius/ minimus
Greater trochanter of femur
48
Nerve supply to glue med/ mid
Superior gluteal nerve
49
Damage to what structure can cause +ve trendelenberg sign
Superior gluteal nerve supplying glute med/min. Passes 5cm above greater trochanter, so can be damaged during hip surgery
50
Surface markings of sciatic nerve
Curved line from: 1/2 way between PSIS + ischial tuberosity, to 1/2 way between ischial tuberosity and greater trochanter
51
What structures exit the greater sciatic foramen above piriformis?
Superior gluteal vessels + nerve
52
Variations of sciatic nerve exiting pelvis
Majority - below piriformis in greater sciatic foramen -Through piriformis -Divide high and pass over and under piriformis
53
Name the arches of the foot
2 longitudinal - medial and lateral Transverse
54
Components forming the medial longitudinal arch of the foot
Bones: calcaneus, talus, 3 cuneiforms, 3 metatarsals Ligaments: IO and spring ligaments Muscles: Flexor hallucis longus, tibialis ant + post, digitorum longus + brevis
55
Components forming the lateral longitudinal arch of the foot
Bones: calcaneus, cuboid, lat 3 metatarsals Ligaments: long and short plantar lig Muscles: peroneus longus, flexor digitorum longus +brevis
56
Components forming the transverse arch of the foot
Bones: all 5 metatarsals Ligaments: IO Muscles: peroneus longus
57
Muscle layers of the foot Sup - deep
Plantar fascia 1: Abductor hallucis Abductor digiti minimi Flexor digitorum brevis 2: Quadratus plantae Lumbricals Tendons of FDL + FHL 3: FHB Adductor hallucis FDM 4: plantar and dorsal interossei Tendons of tibias posterior and peroneus longus
58
What arteries form the plantar arch of the foot?
Lateral plantar branch (of post tibial) Deep plantar branch (dorsals pedis < ant tibial)
59
Movements occurring at subtalar joint
Inversion and eversion of foot
60
Sensory supply of deep peroneal nerve
1st web space
61
Motor function of L5
Extensor hallucis longus
62
What attaches to the linea aspera of the femur?
Adductor muscles - magnus/ brevis/ longus Pectineus Short head of biceps femoris Vastus medialis +lateralis Lat+ med interuscular septa
63
Compartments of lower leg contents
Anterior: 4 muscles - Tibialis anterior, EHL, EDL, Peroneus tertius Deep peroneal nerve Ant tibial artery + vein Lateral: 2 muscles: peroneus longus + brevis Superficial peroneal nerve Sup posterior: 3 muscles: gastrocnemius, soles, planters Medial sural cutaneous nerve Deep posterior: 4 muscles: Tibialis posterior, FHL, FDL, popliteus Tibial nerve Posterior tibial artery + vein
64
Name the structures that divide the lower leg compartments
Ant + post - IO membrane Ant + lat - anterior fascial septum Lat + post - posterior fascial septum Sup & deep post - deep transverse fascial septum
65
How to performa fasciotomy
Ant + lateral: Longitudinal anterolateral incision - 2cm ant to fibula, - from ankle, to level of tibial tuberosity Post: posterior incision - medial to posteromedial border of tibia - level of tibial tuberosity to 5cm above med mal Debride any necrotic tissue
66
Muscles attaching to medial cuneiform
Tibialis anterior + posterior Peroneus longus
67
What nerve supplies sensation to the medial lower leg?
Saphenous nerve
68
Nerve supply to dorsum of foot
Superficial peroneal nerve (apart from 1st webspace)
69
Describe the course of the anterior tibial artery
Appears most lateral on angiogram From popliteal a. -> on IO membrane in ant compartment Crosses ankle 1/2 way between lat and med malleoli to become dorsals pedis
70
Describe the course of the posterior tibial artery
Appears most medial on angio From tibioperoneal trunk from popliteal In post compartment -> behind med mal
71
Describe the course of the peroneal/fibular artery
Middle (between ant and post tibial) on angio From tibioperoneal trunk from popliteal In posterior compartment between posterior tibial + FHL muscle Supplies lateral compartment via lateral branches
72
Course of great saphenous vein
Originates at dorsal vein of foot joining dorsal venous arch of foot. Ant to med mal, up medial leg to knee Crosses posterior to medial epicondyle of femur Up medial thigh Enters saphenous opening in fascia lata and joins femoral vein in fem triangle (At saphenofemoral junction)
73
What does the small saphenous vein drain, and where does it drain to
Lateral part of doral venous arch Drains into popliteal vein
74
What structure does the small saphenous vein run with
sural nerve (lateral lower leg)
75
What muscles make up the anterior thigh compartment and their functions?
Iliopsoas (iliacus + psoas major) - hip flexion Quads (vastus medialis/ lateralis/ intermedius and rectus femoris) - hip and knee flexion Sartorius - hip and knee flexion, lateral rotation, hip abduction Pectineus - hip adduction and flexion
76
Attachments of sartorial and pectineus muscles
Sartorius: ASIS -> medial tibia Pectineus: pubis -> pectineal line of femur
77
Posterior thigh compartment muscles + attachments/ function
1)Biceps femoris 2)Semimembranosus 3) Semitendinosus Attachments: All = ischial tuberosity (short head BF = linea aspera) BF = lateral tibia SM/ST = medial tibia Function: BF = lat rotation SM/ST = med rotation all = hip ext + knee flexion
78
Medial thigh compartment muscles + attachments + functions
Adductor magnus/ longus/ brevis: Pubis/ inf pubic rami -> linea aspera Obturator externus: Obturator fossa -> GT Gracillis: Inf pubic rami -> medial tibia FUNCTION: All = adduction OE = external rotation G = knee flexion
79
Nerve and vascular supply to posterior thigh compartment
Nerve = sciatic -> tibial nerve *short head of biceps femoris = common peroneal nerve Artery = inferior gluteal (from int iliac) + branches of deep femoral
80
Presentation/ cause of ischial tuberosity avulsion fracture
Attachment of all hamstring muscles. Caused by rapid hamstring contraction Presents: posterior thigh pain +/- sciatic nerve sx
81
Borders of the femoral triangle
Inguinal ligament - sup Sartorius - inf/lat Adductor longus - med Floor - iliopsoas, pectineus, adductor longus Roof - Fascia lata, superficial fascia
82
Contents of femoral triangle (lat- med)
Nerve Fem artery Fem vein (+ great saphenous vein at saphenofemoral junction) empty space Fem canal with lymphatics (deep and sup inguinal nodes) Extras: Lat cutaneous nerve of thigh Femoral branch of genitofemoral n
83
What is the adductor canal
Aka Hunter's canal Runs from apex of femoral triangle to popliteal fossa (adductor hiatus)
84
Borders of adductor canal
Lateral - vastus medialis Post - adductor longus/ magnus Roof - Sartorius
85
Surface marking of adductor hiatus
2/3 along line from ASIS > adductor tubercle of femur
86
Surface marking of femoral artery pulse
Mid inguinal line (ASIS > pubic symphysis)
87
What 2 compartments are the femoral triangle split into
Lacuna vasorum - deep inguinal nodes, artery, vein, femoral branch of genitofem Lacuna musculorum - iliopsoas, femoral nerve + lat cutaneous nerve

MRCS B (10 decks)

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