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Anatomy: Lower Limb Flashcards

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1
Q

What is gluteus maximus and which movements is it involved in?

A

The largest and most superificial of the gluteal muscles, this muscle is predominantly involved in hip extension and lateral rotation.

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2
Q

What is gluteus medius and which movements is it involved in?

A

The second of the gluteal muscles, this muscle is predominantly involved in hip abduction and also contributes to medial rotation.

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3
Q

Which muscles does the superior gluteal nerve innervate?

A

Gluteus medius

Gluteus minimus

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4
Q

Which muscles does the inferior gluteal nerve innervate?

A

Gluteus maximus

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5
Q

A patient presents with an abnormal gait after receiving an intramuscular (IM) injection in the gluteal region. The abnormal gait appears to be unilateral in nature.

Which nerve is likely to have been injured in the clinical scenario?

A

Superior gluteal nerve

This patient has sustained damage to their superior gluteal nerve which innervates gluteus medius and gluteus minimus.

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6
Q

Damage to the superior gluteal nerve causes weak hip abduction and pelvic tilt. What is the name given to the sign (when standing on one leg on the affected side) and the abnormal gait experienced?

A

The name given to the sign is the Trendelenburg sign and the name given to the gait is Trendelenburg gait. It is caused by weakness of the gluteus medius and gluteus minimus muscles and may be secondary to superior gluteal nerve damage.

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7
Q

Damage to the inferior gluteal nerve will mostly affect which movement of the hip joint?

A

Extension

Gluteus maximus is involved in extension of the hip.

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8
Q

What is the head of the femur?

A

This part of the femur articulates with the acetabulum to form the hip joint.

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9
Q

What is the greater trochanter?

A

This large protrusion of bone is a site of attachment for many muscles.

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10
Q

What is the neck of the femur?

A

This region is found just distal to the head of femur and is a common site at which fractures occur.

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11
Q

What is the lesser trochanter?

A

This smaller protrusion of bone is also a site of attachment for muscles.

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12
Q

What is the lateral femoral epicondyle?

A

A bony protrusion found on the lateral aspect of the distal femur.

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13
Q

What is the medial femoral epicondyle?

A

A bony protrusion found on the medial aspect of the distal femur.

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14
Q

What is the acetabulum?

A

This part of the pelvis articulates with the head of the femur to form the hip joint.

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15
Q

What is an intertrochanteric fracture?

A

When the fracture line runs between the greater trochanter and the lesser trochanter.

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16
Q

How many compartments does the thigh have and what are their names? Why are compartments significant?

A

The thigh has 3 muscle compartments, posterior, anterior and medial. The muscles within a compartment generally act to bring about a common function.
Each compartment has its own nerve supply.

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17
Q

What is the anterior compartment?

A

The anterior compartment contains the large quadriceps muscle group.
This compartment is responsible for knee extension and hip flexion. It is innervated by the Femoral nerve.

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18
Q

What is the medial compartment?

A

The medial compartment of the thigh contains the hip adductors. These muscles all act to adduct the hip and are innervated by the obturator nerve.

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19
Q

What is the posterior compartment?

A

The posterior compartment contains the hamstring muscles. This group brings about knee flexion and hip extension. It is innervated by the Sciatic nerve

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20
Q

Where is the greater saphenous vein?

A

It runs in the superficial fascia along the medial side of the thigh.

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21
Q

Which nerve innervates the anterior compartment?

A

The femoral nerve (L2-L4) provides motor supply to the anterior compartment and sensory supply to the skin overlying this compartment.

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22
Q

Which nerve innervates the medial compartment?

A

The obturator nerve (L2-L4) provides motor supply to the medial compartment and sensory supply to the skin overlying this compartment.

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23
Q

Which nerve innervates the posterior compartment?

A

The posterior compartment of the thigh is innervated by the Sciatic nerve (L4-S3). This provides motor supply to the posterior compartment of the thigh and the entire leg below.

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24
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

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25
What is the main action of the hamstrings on the knee joint?
Flexion at the knee
26
What group of muscles forms the main proportion of the medial compartment?
Hip adductors
27
What are the two predominant actions of the quadriceps muscle group?
Hip flexion | Knee extension
28
Edwin presents several months after a severe pelvic fracture. He has noticed the medial portion of his thigh is 'thinner' and he has difficulties with moving that leg medially.He has lost sensation across the skin on the medial aspect of his thigh. Which nerve do you think this patient has damaged?
Obturator nerve The Obturator nerve runs along the inside of the bony pelvis and exits through the obturator foramen. It can therefore be damaged in pelvis fractures (as can other nerves). The obturator nerve then innervates the muscles in the medial compartment of the thigh which are responsible for adduction. So the pattern of muscle atrophy and weakness indicate obturator nerve.
29
How does the inguinal ligament relate to the femoral triangle?
This structure forms the superior border of the femoral triangle. It runs between the anterior superior iliac spine (ASIS) and pubic tubercle.
30
How does the sartorious relate to the femoral triangle?
This structure forms the lateral border of the femoral triangle and is sometimes referred to as the 'tailor's muscle'. Origin: anterior superior iliac spine (ASIS) Insertion: pes anserinus on proximal medial tibia
31
How does the adductor longus relate to the femoral triangle?
This structure forms the medial border of the femoral triangle. Origin: pubic body of pubis Insertion: middle third of line aspera of femur
32
A patient presents complaining of a lump in the groin region. The lump is not erythematous (red) or hot to touch.Name a potential cause of the patients swelling:
Hernia, Tumour, Aneurysm, Haematoma, Abscess, Cyst, Lymphadenopathy There are lots of potential causes of lumps in the groin region.
33
In the femoral triangle, in which order are the three structures? (from lateral to medial)
The order of structures under the inguinal ligament from lateral to medial is nerve, artery and then vein. The femoral artery can be found at the mid-inguinal point which is the mid-point between the anterior superior iliac spine (ASIS) and the pubic symphysis.
34
What is the medial (tibial) collateral ligament (MCL)?
This runs from the medial portion of the femur to the medial portion of the tibia.
35
What is the anterior cruciate ligament (ACL)?
One of two cruciate ligaments in the knee, the anterior cruciate ligament originates in the distal femur and extends anteriorly onto the tibial plateau.
36
What is the posterior cruciate ligament?
One of two cruciate ligaments in the knee, the anterior cruciate ligament originates in the medial femoral condyle and extends posteriorly onto the posterior surface of the tibia.
37
What is the lateral (fibular) collateral ligament?
This runs from the lateral portion of the femur to the head of the fibula.
38
Which movement does the PCL prevent?
PCL: prevents posterior draw of tibia in relation to the femur (or anterior slide of the femur on tibia).
39
Which movement does the MCL prevent?
MCL: prevents excessive valgus movement.
40
Which movement does the ACL prevent?
ACL: prevents anterior draw of tibia in relation to the femur (or posterior slide of the femur on tibia).
41
Which movement does the LCL prevent?
LCL: prevents excessive varus movement.
42
Which structures are injured in the 'unhappy triad'?
The three structures injured in the 'unhappy triad' are: 1. ACL 2. MCL 3. Medial meniscus
43
The quadriceps cause which action across the knee joint?
Extension of knee
44
What is the popliteal fossa?
Posterior to the knee is a diamond-shaped depression, the popliteal fossa. In this region we find several important neurovascular structures. The borders of the popliteal fossa are indicated are made up of hamstring muscles superiorly and the gastrocnemius muscle inferiorly.
45
Which structures are located in the popliteal fossa?
``` Popliteal vein Popliteal artery Tibial nerve Common peroneal nerve Short saphenous vein Sural nerve ```
46
What is the popliteal vein?
The popliteal vein runs with the artery. It is usually found superficial to the artery as seen in this diagram.
47
What is the popliteal artery?
The femoral artery continues behind the knee as the popliteal artery. This artery is located deep within the fossa, and this pulse is therefore difficult to feel.
48
What is the tibial nerve?
Superior to the popliteal fossa the Sciatic nerve splits into the Tibial nerve and the Common peroneal nerve. The tibial nerve runs through the popliteal fossa and straight into the posterior compartment of the leg, which it innervates.
49
What is the common peroneal nerve?
Superior to the popliteal fossa the Sciatic nerve splits into the Tibial nerve and the Common peroneal nerve. The common peroneal nerve runs laterally out of the popliteal fossa. The nerve wraps around the neck of the fibula. it then branches into the superficial and deep branches which innervate the lateral and anterior compartments of the leg respectively.
50
What is the short saphenous vein?
The short saphenous vein is a superficial vein which drains into the popliteal vein.
51
What is the sural nerve?
The sural nerve is a sensory nerve which provides sensory supply to the skin of the posterior area of the leg.
52
A patient presents after sustaining a sports injury to their knee. There was a posterior force through the back of the knee whilst it was flexed. On examination the knee is noted to be swollen and tender. The tibia can be moved anteriorly with respect to the femur. Which ligament is most likely damaged?
Anterior cruciate ligament
53
Which structures are in the anterior compartment of the leg?
Ankle dorsiflexors Anterior tibial artery Deep fibular/peroneal nerve Toe extensors
54
Which structures are in the lateral compartment of the leg?
Superficial fibular/peroneal nerve | Ankle everters
55
Which structures are in the posterior compartment of the leg?
Ankle plantarflexors Posterior tibial artery Tibial nerve Toe flexors
56
What are the 2 compartments of the posterior compartment of the leg?
Superficial and deep
57
Where do the muscles of the deep compartment of the posterior leg insert? Where do they act? Where are their tendons?
The muscles of the deep compartment insert onto the calcaneal (achillies) tendon. They all act exclusively at the ankle. The muscles in the deep compartment have tendons which run into the dorsum of the foot and act to flex the toes.
58
Which nerve innervates the deep and superficial compartments of the posterior leg?
Both the superficial and deep compartments are innervated by the tibial nerve.
59
Which muscles are in the anterior compartment of the leg and which nerve innervates them? Which blood vessels are in this compartment?
The anterior compartment of the leg contains dorsiflexors of the ankle and extensors of the toes. It is innervated by the deep peroneal nerve. Running alongside the deep peroneal nerve is the anterior tibial artery and vein.
60
Which muscles are in the lateral compartment of the leg and which nerve innervates them?
The lateral compartment contains ankle everters. It is innervated by the superficial peroneal nerve.
61
What are the 3 articulations that make up the knee?
Two articulations between the femoral condyles and tibial condyles, and the third between the femur and the patella.
62
Which nerve wraps around the proximal portion of the fibula?
The common fibular/peroneal nerve
63
Where is the lateral femoral condyle?
Located at the distal portion of the femur, articulating with the tibia, on the same side as the fibula (itself a lateral structure)
64
Where is the medial femoral condyle?
Located at the distal portion of the femur, articulating with the tibia, on the opposite side to the fibula which is a lateral structure.
65
What is the tibial plateau (and intercondylar eminence)?
The tibial plateau is the weight-bearing portion of the articulating tibia at the knee joint. The intercondylar eminence is a protrusion of the tibia which divides the articular facets.
66
What is the head of the fibular?
Represents the proximal portion of the fibular, known as the head of the fibula. It is a key anatomical landmark as the common fibular/peroneal nerve wraps around this part of the bone.
67
Damage to the common fibular/peroneal nerve would result in difficulty with which movement predominantly?
Ankle dorsiflexion Damage to the common fibular/peroneal nerve would lead to weakened anterior and lateral compartment muscles, and therefore would predominantly affect dorsiflexion.
68
What type of deficit would weakened or absent dorsiflexion result in?
Foot drop
69
A ruptured Achillies tendon would lead to weakness in which action?
Ankle plantarflexion
70
The x-ray performed in the Emergency Department confirms a fracture to the head of the fibula, and also a fracture of the proximal tibia. The patient later on describes pain and a feeling of numbness in their foot distal to the injury. On examination it is noted that the foot is pale, has weakly palpable pulses and cool to touch. What is the name of the complication that may be occurring here?
This is most likely a case of compartment syndrome, whereby the pressure within a compartment increases, decreasing the blood supply, causing ischaemia and further oedema, which creates a vicious cycle.
71
Where would you test for pulses in the leg?
Behind the medial malleolus | Lateral to the extensor digitorum longus tendon on the dorsum of the foot
72
Which muscle compartment is responsible for causing inversion of the foot?
Tibialis anterior in the anterior compartment and tibialis posterior in the posterior compartment act synergistically to cause inversion of the foot.
73
Where is the fibula in relation to the foot?
Distal portion of fibula articulates at ankle joint with the tibia and the talus. Distally, it is a key site for ligamentous attachments to help maintain joint stability and integrity.
74
What is the calcaneus?
Most posterior of the tarsals within the foot. | It is a key site of attachment for ligaments and tendons.
75
What is the calcaneofibular ligament (CFL)?
Runs between the calcaneus and fibula
76
What is the anterior talofibular ligament (ATFL)?
Runs between the talus bone and fibula along the anterior portion of the foot.
77
What is the talus?
The tarsal bone which articulates with the tibia and fibula to form the ankle joint?
78
Which lateral ankle ligament is most commonly the first to rupture?
The anterior talofibular ligament (ATFL) is often the first lateral ankle ligament to be injured.
79
Which bones may be avulsed if the ATFL ruptures?
The talus or the fibula may be avulsed when the ligament ruptures.
80
What could other differentials of a swollen ankle be?
Fracture, Break, Broken ankle, Tendon rupture, Haematoma, Bruise, Septic arthritis, Inflammatory arthritis, Gout, Haemarthrosis There are lots of differentials for a swollen ankle - taking a full patient history, clinical examination and investigations are important to differentiate between them!
81
Which ankle ligaments are considered to be stronger?
The medial (deltoid) ligaments are considered to be stronger, they form a much broader ligament across the medial aspect of the ankle.

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