Clinical Anatomy of the Lower Limb

Question 1

what are the bony components of the lower limb?

Answer 1

pelvis
hip joint (ball and socket)
femur
knee joint
tibia/fibula
ankle joint
foot 
- hindfoot
- midfoot
- forefoot

Question 2

why are there bumps on bones?

Answer 2

for muscle attachment

Question 3

what stabilised the hip joint?

Answer 3

large surface between femoral head and acetabulum

Question 4

what are the compartments of the knee?

Answer 4

medial
lateral
patellofemoral

Question 5

what is the ankle mortus?

Answer 5

contains the talus

composed of the lateral malleolus (fibular head), distal end of tibia and medial malleolus (tibial head)

Question 6

what makes up the hindfoot?

Answer 6

calcaenous

talus

Question 7

what makes up the midfoot?

Answer 7

navicular
cuneiforms
cuboid

Question 8

what are the bones of the forefoot?

Answer 8

metatarsals

phalanges

Question 9

acetabulum pedis?

Answer 9

spring ligament

Question 10

sacral foramen?

Answer 10

holes in fused sacrum that allow exit of sacral nerves

Question 11

what is the labrum?

Answer 11

rim of fibrocartilage surrounding the acetabulum which stabilises the hip joint by deepening the acetabulum and encapsulating the femoral head

Question 12

what is the blood supply to the femoral head?

Answer 12

medial femoral circumflex artery
small amount from obturator artery
small amount from lateral femoral circumflex artery
medial and lateral come back around head

Question 13

what is the upper femoral epiphysis and what happens there?

Answer 13

upper femoral epiphysis = small area of bone in the femoral head surrounded by cartilage and separate from the femoral neck bone
spreads out via ossification of the surrounding cartilage until it meets the femoral neck bone at around 6-9 years

Question 14

where does the iliacus originate and insert?

Answer 14

origin = iliac crest/inner aspect of ilium
insertion = lesser trochanter of femur

Question 15

where does the psoas major originate and insert?

Answer 15

origin = transverse processes of L1-L5
insertion = lesser trochanter

Question 16

give a possible problem with psoas major?

Answer 16

psoas abscess

common in IV drug users

Question 17

what are the secondary hip flexors?

Answer 17

rectus femoris

sartorius

Question 18

where does the rectus femoris originate and insert?

Answer 18

origin = AIIS
insertion = tibia via patella tendon

Question 19

where does the sartorius originate and insert?

Answer 19

origin = ASIS
insertion = tibia

Question 20

what else does the sartorius do?

Answer 20

externally rotates the hip

Question 21

what is a common problem in secondary hip flexors?

Answer 21

avulsion fractures in children after kicking a football

Question 22

what are the 5 hip adductors?

Answer 22

adductor brevis
adductor longus
adductor magnus
pectineus
gracilis

Question 23

what is the common origin and insertion of the hip adductors?

Answer 23

inferior pubic rami

insertion = linea aspera, pectineal line, tibia

Question 24

name 3 clinical issues with hip adductors?

Answer 24

adductor tendinopathy
osteitis pubis
spasticity in NM conditions

Question 25

what are the 2 hip abductors?

Answer 25

gluteus minimus/gluteus medius | tensor fascia lata

Question 26

where does the gluteus minumus/medius originate and insert?

Answer 26

``` originate = iliac wing insertion = greater trochanter of femur ```

Question 27

clinical issue with gluteus maximus/medius?

Answer 27

weakness | - trendelenberg gait

Question 28

where does the tensor fascia lata originate and insert?

Answer 28

``` origin = iliac crest insertion = lateral tibia via iliotibial tract ```

Question 29

what is the main hip extensor?

Answer 29

gluteus maximus

Question 30

where does the gluteus maximus originate and insert?

Answer 30

``` origin = posterior aspect of ilium/sacrum insertion = iliotibial tract ```

Question 31

what are the hip extensors/knee flexors?

Answer 31

hamstrings: biceps femoris semimembranous semitendinous

Question 32

where does the biceps femoris originate and insert?

Answer 32

``` origin = long head - ischial tuberosity, short head - lineu aspera insertion = fibula head ```

Question 33

where does the semimembranous originate and insert?

Answer 33

``` origin = ischial tuberosity insertion = posterior tibia ```

Question 34

where does the semitendinous originate and insert?

Answer 34

``` origin = ischial tuberosity insertion = medial tibia ```

Question 35

give a clinical issue with hamstrings

Answer 35

avulsion | tears

Question 36

what clinical issue can occur with bursae?

Answer 36

trochanteric bursitis | - causes lateral hip pain

Question 37

what do the collateral ligaments do?

Answer 37

resist varus/valgus stresses at the knee

Question 38

clinical issue with collaterals?

Answer 38

tear

Question 39

what are the cruciate ligaments and what do they do?

Answer 39

ACL - resists anterior movement of tibia | PCL - resists posterior movement of tibia

Question 40

clinical issue with cruciates?

Answer 40

tears

Question 41

what are the main functions of the meniscus?

Answer 41

load transfer/shock absorbers increase conformity of tibia and knuckles of femoral head stabilised knee during movement lubricates the knee

Question 42

direction of the ACL?

Answer 42

direction of hands in pockets

Question 43

clinical issue with menisci?

Answer 43

tears

Question 44

2 types of tear in menisci?

Answer 44

bucket handle - parallel along the meniscus | radial - across meniscus

Question 45

what are the knee extensor muscles?

Answer 45

quadriceps - rectus femoris - vastus intermedius - vastus medialis - vastus lateralis

Question 46

where do each of the knee extensors originate?

Answer 46

rectus femoris = AIIS vastus intermedius = anterolateral proximal femur vastus medialis = medial edge linea aspera and greater trochanter vastus lateralis = medial edge linea aspera and lesser trochanter insert at the patellar tendon

Question 47

describe the extensor mechanism

Answer 47

quadriceps muscle > quadriceps tendon > patella > patella tendon > tibial tuberosity

Question 48

what 4 factors may predispose to patellar instability/dysfunction?

Answer 48

genu valgum (Q angle) femoral head anteversion weak quadriceps (vastus medialis) ligamentous laxity

Question 49

what separates the compartments of the leg?

Answer 49

thick, fascial compartments | all muscles in a compartment have the same nerve supply

Question 50

what are the anterior muscles of the leg and what nerve supplies them?

Answer 50

``` tibialis anterior extensor hallicus longus extensor digitorum longus peroneus tertius nerve = deep peroneal nerve ```

Question 51

what are the lateral muscles of the leg and what nerve supplies them?

Answer 51

fibularis longus/brevis | nerve = superficial peroneal nerve

Question 52

what are the deep muscles of the posterior leg?

Answer 52

``` tibialis posterior flexor hallivus longus flexor digitorum longus popliteus nerve = tibial nerve ```

Question 53

what are the superficial posterior leg muscles and what nerve supplies them?

Answer 53

gastrocnemius soleus plantaris nerve = medial sural cutaneous nerve

Question 54

which nerve is likely to be damaged by a fibula neck fracture?

Answer 54

common peroneal(fibular) nerve

Question 55

what are the 3 ankle plantar flexor muscles?

Answer 55

gastrocnemius (medial and lateral heads) soleus plantaris

Question 56

where do the ankle plantar flexors originate and insert?

Answer 56

gastroc = femoral condyles soleus = broad area on posterior tibia/fibula plantaris = lateral femoral condyle common insertion = calcaenous via achilles tendon

Question 57

clinical issue with ankle plantar flexion?

Answer 57

achilles tendinopathy

Question 58

what muscle dorsiflexes the ankle?

Answer 58

tbialis anterior

Question 59

where does the tibialis anterior originate and insert?

Answer 59

``` origin = lateral surface of proximal tibia insertion = medial cuneiform and base of 1st metatarsal ```

Question 60

what are the 2 main ankle ligaments?

Answer 60

``` deltoid ligament (medial) lateral ligement complex (lateral) ```

Question 61

how many ligaments are in the the lateral ligament complex?

Answer 61

3

Question 62

what is the main supporter of the medial arch?

Answer 62

``` tibialis posterior tendon calcaneonavicular ligament (spring ligament) ```

Question 63

where does the tibialis posterior tendon originate and insert?

Answer 63

``` origin = posterior proximal tibia/fibula insertion = navicular/plantar surface of medial cuneiform ```

Question 64

describe a common clinical issue in the medial arch

Answer 64

dysfunction of tibialis dysfunction common in 6th decade gives pain on medial aspect and causes flattening of foot

Question 65

where does the plantar fascia originate and insert?

Answer 65

``` origin = tuberosity of calcaneus insertion = heads of metatarsals ```

Question 66

clinical issue with plantar fascia?

Answer 66

plantar fascitis