Anterior Thigh, Leg, & Foot Flashcards by Kaelyn Garner

Anterior compartment of the thigh

Actions?
Innverated by?
Emerges? Passes?
Innervates muscles where?
What part innerves skin where?
Muscles of the anterior compartment of the thigh?

Anterior compartment of the thigh

Action:
- Flex hip joint
- Extend knee joint
Innervation:
- Femoral nerve (L2-L4)
Emerges lateral to psoas major
Passes deep to the inguinal ligament
Innervates muscles in the anterior compartment of the thigh and skin on the anterior medial thigh
Terminal branch, the saphenous nerve, innervates skin on the anterior medial aspect of the knee, leg, and foot
Muscles of the anterior compartment of the thigh:
- Quadriceps femoris
  - Rectus femoris
  - Vastus lateralis
  - Vastus medialis
  - Vastus intermedius
- Iliopsoas
- Satorius
- Pectineus

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Quadriceps femoris (of the anterior compartment of the thigh)

What are the four muscles that make up the quadriceps femoris?
Origin and action for each of the main two?
The four parts unite to form?
What is the patella and what does it do?
Where are the two places bursitis can develop?
What is the patellar reflex?

Quadriceps femoris (of the anterior compartment of the thigh)

Rectus femoris
- Orgin: anterior inferior iliac spine (AIIS)
- Action: flex hip joint and extend knee joint
Vastus
- Lateralis
- Medialis
- Intermedius (deep to rectus femoris)
  - Orgin: femur
  - Action: extend knee joint
4 parts unite distally to form the quadriceps tendon, which continues as the patellar ligament and inserts on the tibial tuberosity
Patella: large sesamoid bone, embedded in the quadriceps tendon, increases leverage of the quadriceps and increases power of knee extension
Bursitis: can develop in the prepatellar bursa (between skin and patella) or the suprapatellar bursa (deep to quadriceps tendon)
Patellar tendon reflex: tests the integrity of the femoral nerve and the L2-L4 spinal nerves. With knees flexed and relaxed, the patella ligament is tapped to elicit rapid extension of the knee joint (exploiting proprioception)

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(Of the anterior compartment of the thigh)

Iliopsoas

Composed of what two muscles?
Origin, insertion, action?

Sartorius

Origin, insertion, action?

Pectineus

Origin, insertion, action?
Innervation

(Of the anterior compartment of the thigh)

Iliopsoas

Iliopsoas = iliacus + psoas major
Origin:
- Iliac fossa (iliacus)
- Lumbar vertebrae (psoas major)
Insertion:
- Lesser trochanter of femur
Actions:
- Flex hip joint (if lower extremity is free)
- Stabilize the trunk (if lower extremity is fixed)

Sartorius

Origin:
- ASIS
Insertion:
- Medial aspect of proximal tibia
Actions:
- Flex (b/c it is posterior)
- Abduct (b/c it is lateral to hip joint)
- Laterally rotate hip joint
- Flex knee joint (sit cross legged)

Pectineus

Orgin:
- Pubis
Insertion:
- Proximal femur
Actions:
- Weakly flex hip joint
- Adduct hip joint (b/c it is medial to hip joint)
Innervation:
- Femoral nerve (similar to rest of the compartment)
- Branch of obturator nerve

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Medial compartment of the thigh

Origin, action, and innervation?
Courses along? Exits?
Innervates what?
What muscles make up the medial compartment of the thigh?

Medial compartment of the thigh

Origin: pubis
Action: adduct hip joint (medial to hip joint)
Innervation: obturator nerve (L2-L4)
Courses along lateral walls of pelvis and exits via the obturator canal
Innervates muscles of medial compartment of thigh and skin on medial thigh
Muscles that make up the medial compartment of the thigh:
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracilis
- Obturator externus

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(Of medial compartment of the thigh)

Adductor longus vs brevis?
Adductor magnus
- Adductor vs hamstring part?
- Hamstring origin, insertion, action, and innervation?
Gracilis insert and action?
Obturator externus origin, insertion, and action?

(Of medial compartment of the thigh)

Adductor longus

Longer and more superficial

Adductor brevis

Shorter and deeper

Adductor magnus

Adductor part
- Follows compartment rules for action and innervation
Hamstring part
- Origin: ischial tuberosity
- Insertion: adductor tubercle of femur
- Action: extend hip joint
- Innervation: tibial nerve of sciatic nerve

Gracilis

Insertion: medial aspect of proximal tibia
Actions:
- Weakly adduct hip joint
- Flex knee joint

Obturator externus

(remember: obturator internus is inside the pelvis and obturator externus is outside)

Origin:
- External aspect of obturator membrane
- Margin of obturator foramen
Insertion:
- Proximal femur
Actions:
- Laterally rotate hip joint
- Stabilize hip joint

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Crural fascia and compartments

What are the three fascial compartments in the leg?
The crural fascia thickens where to form what?
How are tendons protected under the retinaculum? Function of this?

Crural fascia and compartments

Three fascial compartments in the leg:
- Anterior
- Lateral
- Posterior
  - Superficial
  - Deep
The crural fascia thickens distally to form:
- Flexor retinacula
- Extensor retinacula
- Fibular retinacula
As tendons pass under a retinaculum, they are protected by synovial tendon sheaths, which facilitate sliding by reducing friction and can become inflamed causing pain

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Anterior compartment of the leg

Action and innervation?
Sciatic nerve divides into?
Common fibular nerve winds around?
Common fibular nerve divides into?
Deep fibular nerve innervates what?
What are the muscles?

Anterior compartment of the leg

Action:
- Dorsiflex ankle joint
- Extend toes
Innervation:
- Deep fibular nerve (L4-S1)
  - Sciatic nerve divides into:
    - Tibial nerve
    - Common fibular (peroneal) nerves
  - Common fibular nerve winds around the neck of the fibula
  - Common fibular nerve divides into superficial fibular and deep fibular
    - Deep fibular (peroneal) nerve
      - Innervates the muscles of the anterior compartment of the leg and dorsal foot
      - Innervates the skin of the dorsal foot between the hallux and second digit
Muscles:
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
- Fibularis (peroneus) teritus

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(Of the anterior compartment of the leg)

Tibialis anterior

Insertion and action?
What are shin splints?

Extensor hallucis longus

Insertion and action?

Extensor digitorum longus

Insertion and action?
What forms on dorsal surface of the phalanges?

(Of the anterior compartment of the leg)

Tibialis anterior

Insertion:
- Medial cuneiform
- Base of first metatarsal
Action:
- Dorsiflex ankle joint
- Invert foot
Shin splints: anterior tibialis strain, results from repeated microtrauma or overexertion, or small tears in the periosteum (tissue enclosing bone), inflammation can cause compartment syndrome

Extensor hallucis longus

Insertion:
- Distal phalanx of the hallux
Action:
- Extend hallux (MTP and IP joints)
- Weakly dorisflex ankle joint

Extensor digitorum longus

Insertion:
- Distal phalanges of digits 2-5
Action:
- Extend digits 2-5 (MTP, PIP, and DIP joints)
- Dorsiflex ankle joint
Note: the extensor digitorum longus and extensor hallucis longus tendons form extensor expansions on the dorsal surface of the phalanges

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(Of the anterior compartment of the leg)

Fibularis (peroneus) tertius

Insertion and action?
Possible abnormalities of this?

Common fibular nerve

Why is this the most frequently injured lower extremity nerve?
What will injury to it affect?
What is foot drop? Steppage gait? Foot slap?

(Of the anterior compartment of the leg)

Fibularis (peroneus) tertius

Insertion:
- Base of fifth metatarsal
Action:
- Dorsiflex ankle joint
- Evert foot
May be absent in 8% of population or fused with extensor digitorum longus

Common fibular nerve

Most frequently injured lower extremity nerve as it is vulnerable to injury where it winds around the neck of the fibula
Injury to the common fibular nerve will affect:
- Anterior compartment of the leg
- Dorsal foot (dorsiflexors and toe extensors; one invertor)
- Lateral compartment of the leg (evertors and weak plantarflexors)
Loss of dorsiflextion and toe extension results in “foot drop” where toes of the affected side will not clear the ground during the swing phase of gait
Patients may compensate with exaggerated hip and knee flexion, “steppage gait,” to provide adequate clearance for the affected foot during the swing phase of gait
Patients may also show “foot slap” where the entire foot makes contact with the ground at the end of swing phase, rather than just the heel

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Dorsal foot

What are the two muscles and where are they located?
Insertion and extension of both?

Dorsal foot

There are two muscles on the dorsal aspect of the foot
Located deep to the extensor digitorum longus tendons and superficial to the dorsal interossei
Innervation: deep fibular nerve (L5-S1)
Extensor digitorum brevis
- Insertion: extensor expansions of digits 2-4
- Action: extend digits 2-4 (MTP, PIP, and DIP joints)
Extensor hallucis brevis
- Insertion: extensor expansion of the hallux
- Action: extend hallux (MTP and IP joints)

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Obturator artery

Branch of? Except in 20% of population?
Passes through? Enters?
Supplies?

Femoral artery

Primary source?
Continuation of? Changes names at?
Directly supplies?
Femoral pulse can be felt?
Passes through what to become the popliteal artery?

Deep artery of the thigh

Largest branch of?
Perforating branches supply?

Obturator artery

Typically a branch of the internal iliac artery, however in 20% of the population it arises from the inferior epigastric artery (aberrant obturator artery)
Passes through obturator canal to enter medial compartment of the thigh
Supplies medial and posterior compartments of the thigh

Femoral artery

Primary source of blood to the lower extremtiy
Continuation of the external iliac artery (changes names at the inguinal ligament)
Directly supplies anterior and medial compartments of the thigh (supplies other regions via its branched names)
Femoral pulse can be felt just inferior to the midpoint of the inguinal ligament, with patient in supine position - compression at this location will stop blood flow through the femoral artery
Distally, the femoral artery passes through the adductor hiatus (gap in adductor magnus) to reach the popliteal fossa on the posterior aspect of the knee, where it becomes the popliteal artery
- Femoral artery –> adductor hiatus –> popliteal artery

Deep artery of the thigh

Largest branch of the femoral artery
Perforating branches supply the posterior compartment of the thigh, medial compartment of the thigh, and the lateral aspect of the anterior compartment of the thigh

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Lateral and medial circumflex femoral arteries

Typically are branches of? But can also be branches of?
What do each supply?

Anterior tibial artery

Branch of?
Passes through what and descends along what?
Supplies?
Becomes what at the ankle?

Dorsalis pedis artery

Major source of blood to?
Anastomoses with?
What are the major branches?
Where can the dorsalis pedis pulse be felt?

Lateral and medial circumflex femoral arteries

Typically are branches of the deep artery of the thigh
Can also be branches of the femoral artery though
Lateral circumflex femoral artery supplies the lateral aspect of the thigh
Medial circumflex femoral artery supplies most of the blood to the femoral head and neck

Anterior tibial artery

Branch of the popliteal artery
Passes through gap in superior border of the interosseous membrane and descends along the membrane with the deep fibular nerve
Supplies the anterior lateral leg
Terminates at the ankle, where it becomes the dorsalis pedis artery
- Anterior tibial artery –> dorsalis pedis artery

Dorsalis pedis artery

The major source of blood to the toes
Anastomoses with the deep plantar arch
Major branches:
- Arcuate artery
- Dorsal metatarsal arteries
- Dorsal digital arteries
The dorsalis pedis pulse can be palpated ont he dorsal aspect of the foot, just lateral to the tendon of extensor hallucis longus

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Veins

Dorsal venous arch
- Drains what?
- Anastomoses with?
- Drains into what medially and laterally?
Perforating veins: connect?
Deep veins: accompany?
Femoral vein
- Receives blood from?
- Drains into?

Veins

Dorsal venous arch
- Superficial drainage of the dorsal foot
- Anastomoses with the plantar venous arch in the sole of the foot
- Drains into the great saphenous vein medially and the small saphenous vein laterally
Perforating veins: connect the superficial to the deep veins
Deep veins: accompany the arteries and share their names (however the is NO dorsalis pedis vein)
Femoral vein
- Receives blood from:
  - Popliteal vein
  - Deep vein of the thigh
  - Great saphenous vein
- Drains into the external iliac vein
- Popliteal vein –> femoral vein

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Femoral triangle

What are the borders?
What are the contents?
Three compartments of the femoral sheath?
Femoral canal contents?
Function if femoral canal?

Femoral triangle

Borders:
- Inguinal ligament (superior)
- Adductor longus (medial)
- Sartorius (lateral)
Contents:
- NAVEL: nerve, artery, vein, empty space, lymph
- Femoral nerve and its branches
- Femoral sheath
  - Fascial tube enclosing the femoral vessels and femoral canal
  - Does NOT enclose the femoral nerve
  - Divided into three compartments:
    - Lateral contains femoral artery
    - Intermediate contains femoral vein
    - Medial contains femoral canal
      - Femoral canal contains loose connective tissue, fat, lymphatic vessels, and deep inguinal lymph nodes
      - Primary function of the femoral canal is to allow expansion of femoral vein when venous return from lower limb is increased (e.g. during strenuous activity)

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Femoral hernia

Location and significance of femoral ring?
What is the ring normally closed by?
How is a femoral hernia formed?
Femoral hernia lies where? Medial to? Inferior to?
May emerge where?
More frequent in males or females?
How do they differ from direct/indirect hernias?

Femoral hernia

The proximal opening of the femoral canal is called the femoral ring
The femoral ring is an area of weakness where femoral hernias can occur
Normally, the ring is closed by extraperitoneal fatty tissue and this fatty tissue is overlain by parietal peritoneum
Abdominal viscera can protrude through the femoral ring into the femoral canal, forming a femoral hernia
A femoral hernia lies in the femoral triangle, medial to the femoral vein, and inferior to the inguinal ligament
A femoral hernia may emerge through the saphenous opening into the subcutaneous tissue of the thigh
Femoral hernias occur more frequently in females
NOT to be confused with direct/indirect hernias, which emerge superior to the inguinal ligament

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Anterior Thigh, Leg, & Foot Flashcards

(15 cards)