Exam 5 Flashcards
(185 cards)
1
Q
Tibialis anterior. O, I, A, I
A
- Origin: tibia and IO membrane - Insertion: medial cuneiform and 1st metatarsal - Action: main dorsiflexor, toe extensor - Innervation: deep peroneal nerve
1
Q
Flexor hallucis longus. O, I, A, I
A
- Origin: fibular and IO membrane - Insertion: base 1st distal phalanx - Action: plantar flexion - Innervation: tibial nerve
1
Q
Nerve supply to the knee joint?
A
- Femoral, obturator, common peroneal and tibial
2
Q
3 compartments of the leg? What forms each compartment? Muscles of each compartment? Main action? Nerves and arteries?
A
1.) Anterior compartment: IO membrane, anterior intermuscular septum and tibia - Muscles: tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius - Action: extensor (dorsiflexion) compartment, extensors of toes - Nerve: deep peroneal nerve - Arteries: anterior tibial artery (off popliteal) and gives to tibial recurrent, anterior medial/lateral malleolar and dorsalis pedis (name at ankle joint and after) 2.) Lateral compartment: fibula, anterior / posterior intermuscular septa - Muscles: peroneus longus, peroneus brevis - Action: eversion - Nerve: superficial peroneal nerve - Arteries: branches of peroneal artery (from post compartment) and branches of anterior tibial (from ant compartment) 3.) Posterior compartment: transverse intermuscular septa divides this compartment into superficial and deep - Muscles: gastrocnemius + soleus = triceps surae, plantaris, popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior - Mnemonic: Tom Dick ANd Harry = Tibialis posterior, flexor Digitorum longus, A(posterior tibial Artery), N(tibial Nerve), flexor Hallucis longus = all on medial / posterior side of leg - Action: flexion (plantar flexion) and inversion of foot - Nerve: tibial nerve (L4-S3) - Artery: posterior tibial a with branches: a.) Circumflex fibular b.) Fibular (peroneal): perforating branch of peroneal, communicating artery, posterior lateral malleolar&calcaneal arteries c.) Nutrient d.) Muscular e.) Posterior medial malleolar&calcaneal f.) Communicating (joins posterior tibial and peroneal arteries) g.) Medial plantar h.) Lateral plantar
3
Q
Nerve supply to cutaneous femoral triangle/proximal anterior thigh
A
- Femoral branch of genitofemoral (L1, L2)
4
Q
65 yo female comes into your office with paralysis of her gluteal muscles. Do you suspect sciatic nerve involvement?
A
- No. Injury to sciatic nerve does not affect muscles in the gluteal region. Innervation to those muscles are prior to formation of the sciatic nerve in the sacral plexus
4
Q
Extensor hallucis longus. O, I, A, I
A
- Origin: fibula and IO membrane - Insertion: distal phalanx 1st toe - Action: dorsiflexion, toe extensor - Innervation: deep peroneal nerve
5
Q
What is the plantar aponeurosis? Function?
A
- Central thick/strong part of the deep plantar fascia from calcaneus to toes that has five slips foe each toe. Has vertical septa to divide foot into three compartments: medial, lateral and central. - Support longitudinal arches of foot and prevents injury
5
Q
Talocrural joint (ankle joint). Bones of the joint, joint type, ligaments, actions?
A
- Bones: trochlea of talus, tibia, fibula - Joint type: hinge (ginglymus) type of synovial - Ligaments: a.) Articular capsule: surrounds joint cavity, surrounded by b.) Deltoid ligament: medial side of joint with 4 bands (very strong): anterior tibiotalar, posterior tibiotalar, tibionavicular, tibiocalcaneal c.) Lateral ligament: lateral side of joint with 3 bands (weaker than deltoid): anterior talofibular, posterior talofibular, calcaneofibular - Actions: dorsiflexion (stable in this position), plantar flexion (unstable)
6
Q
Pelvic girdle vs bony pelvis
A
- Pelvic girdle = 2 hip bones - Bony pelvis = pelvic girdle + sacrum, coccyx bounded by ligaments
7
Q
On which side of the foot is the deep fascia thickest?
A
- Plantar surface
9
Q
What forms the greater sciatic foramen?
A
- Greater sciatic notch and sacrospinous / sacrotuberous ligaments
9
Q
What muscle(s) extends the lateral four toes?
A
- Extensor digitorum longus - Extensor digitorum brevis
10
Q
Posterior division sacral plexus nerves
A
- Common peroneal (L4-5, S1-2)* part of sciatic - Superior gluteal (L4-S1) - Inferior gluteal (L5-S2) - Posterior femoral cutaneous, partly (S1-S3) - Nerve to piriformis (S1, S2)
10
Q
What connects the tibia and fibula?
A
- Interosseous membrane
11
Q
Transverse arch. Bones?
A
- Bones: cuboid, three cuneiforms, bases of all metatarsals
12
Q
Describe venous drainage of the dorsum of the foot
A
- Dorsal venous arch receives drainage from: a.) Dorsal metatarsal veins, which receive drainage from the dorsal digital veins b.) Medial dorsal digital vein of 1st toe c.) Lateral dorsal digital vein of the 5th toe - Dorsal venous arch drains into a.) Medial marginal vein, which drains to the great saphenous vein (to femoral) b.) Lateral marginal vein, which drains to the small / short saphenous vein (to popliteal to femoral)
13
Q
What traverses the greater sciatic foramen?
A
- Mnemonic: below piriformis = PIN and PINS - Piriformis - Posterior femoral cutaneous nerve - Inferior/superior gluteal vessels and nerves - Nerve to quadratus femoris and inferior gemellus - Pudendal nerve - Internal pudendal vessels - Nerve to obturator internus and superior gemellus - Sciatic nerve
13
Q
Pectineus. O, I, A, I
A
- Origin: superior ramus of pubis - Insertion: pectineal line of femur - Action: adductor - Innervation: obturator and femoral nerves
13
Q
Landmarks of tibia
A
- Condyles - Soleal line - Intercondylar eminence - Medial malleolus - Tibial tuberosity
13
Q
Peroneus tertius. O, I, A, I
A
- Origin: fibula and IO membrane - Insertion: 5th metatarsal base - Action: dorsiflexion, toe extensor - Innervation: deep peroneal nerve
13
Q
O/I of the abductor hallucis
A
- O: Tuberosity of calcaneous - I: Base of 1st proximal phalanx
13
Q
O/I of flexor digitorum brevis
A
- O: Tuberosity of calcaneus - I: Middle phalanx of lateral 4 toes
14
Q
Nerve supply to posterior thigh
A
- Posterior femoral cutaneous nerve (S1-3)
15
What is the crural fascia?
- Continuation of deep fascia of thigh (fascia), it is deep fascia of leg
16
What type of joint is the hip joint?
- Ball and socket type synovial joint
17
Lateral longitudinal arch. Bones? Ligaments?
- Bones: calcaneus, cuboid, lateral two metatarsals - Ligament: long plantar ligament, short plantar ligament (aka calcanavicular), plantar aponeurosis
18
Obturator externus. O, I, A, I
- Origin: margins of obturator foramen, obturator membrane - Insertion: trochanteric fossa of femur - Action: adductor - Innervation: obturator nerve
18
Blood supply to the thigh
1.) Femoral artery (off ext iliac) a.) Superficial circumflex iliac b.) Superficial epigastric c.) Superficial and deep external pudendal d.) Lateral femoral circumflex e.) Medial femoral circumflex f.) Profunda femoris - Cruciate anastomosis i. 1st perforating ii. Medial femoral circumflex iii. Lateral femoral circumflex iv. Inferior gluteal 2.) Obturator artery (off int iliac)
18
What nerve supplies the cutaneous medial side of the foot as far as the 1st metatarsal?
- Saphenous nerve (branch of femoral)
19
Blood supply to medial side of great toe
- Medial plantar artery (via proper plantar digital artery)
21
True/False. The nerves of the sacral plexus supply the gluteal region, anterior/posterior thigh, entire leg and entire foot.
- False. Does not supply the anterior thigh
22
Which genicular artery penetrates through the joint capsule to supply the intercondylar structures of the knee joint?
- Middle genicular artery (from femoral artery)
23
Major superficial vein of the leg. What does it drain into?
- Great saphenous vein - Drains into femoral vein inferior to the inguinal ligament - Femoral vein drains to ext iliac vein to common iliac to IVC
24
What nerve innervates the cutaneous heel area?
- Medial calcaneal (of tibial nerve) for the majority of the heel - Lateral aspect = lateral dorsal cutaneous (from sural from common peroneal)
25
Superior gemellus. O, I, A, I
- Origin: ischial spine - Insertion: tendon of obturator internus - Action: lateral (external) rotation, extension, abduction of flexed thigh - Innervation: obturator internus nerve (L5, S1, S2)
25
What is the angle of inclination of the femur? How does it change throughout life? Change with sex?
- Angle between connection of head to acetabulum and shaft - Widest at birth = 126 degrees - Diminishes with age = 110 degrees - Angle females \< angle males: corresponds to wider hips in females
26
O/I of dorsal interossei muscles
- O: adjacent sides of 1-5 metatarsals - I: proximal phalanx of 2-4 toes
27
External hip rotator muscles
- Gotta Pee GO GO quick - Gluteus maximus, piriformis (chief rotator), gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratus femoris
28
Ischium landmarks
- Acetabulum (posterior 2/5th) - Body: IT, ischial spine, lesser sciatic notch - Ramus: joins inferior ramus of pubis to form ischiopubic ramus - Part of obturator foramen
28
Semitendinosus. O, I, A, I
- Origin: ischial tuberosity - Insertion: medial upper tibia surface - Action: hip extensor, knee flexor - Innervation: tibial nerve
29
Extensor digitorum longus. O, I, A, I
- Origin: tibia, fibula and IO membrane - Insertion: middle and distal phalanges toes 2-5 - Action: dorsiflexion, toe extensor - Innervation: deep peroneal nerve
30
Boundaries (and floor/roof) of the femoral triangle? Contents of the femoral triangle? What is the femoral sheath?
1.) Boundaries: Mnemonic = femoral triangle is shaped like a SAIL - Sartorius - Adductor longus - Inguinal Ligament - Floor = iliopsoas and pectineus muscles - Roof = fascia lata 2.) Contents: Mnemonic = NAVeL (like navy where many SAILs are found) – lateral to medial - N: femoral Nerve - A: femoral Artery - V: femoral Vein - L: lymphatics 3.) Femoral sheath = prolongation of abdominal transversalis fascia. Has 3 compartments a.) Lateral contains: femoral artery b.) Intermediate contains: femoral vein c.) Medial contains: lymphatics = femoral canal with base of canal = femoral ring
30
Ankle sprains are usually the result of what excessive motion at the joint?
- Inversion, damaging lateral ligaments, which are weaker than the medial deltoid ligaments
31
What ligament prevents duck foot?
- Transverse metatarsal ligament connects heads of metatarsal bones
32
Describe flexion/extension of ankle joint. Describe flexion/extension of toes.
Describe flexion/extension of ankle joint. Describe flexion/extension of toes.
34
Sciatic nerve is composed of what nerves? From what spinal levels?
- Tibial (anterior division) – L4-S3 - Common peroneal (posterior division) – L4-S2
35
Peroneus brevis. O, I, A, I
- Origin: lateral fibula - Insertion: tuberosity of 5th metatarsal - Action: eversion - Innervation: superficial peroneal nerve
35
Blood supply to the hip joint?
- Obturator - Retinacular arteries from the medial and lateral circumflex femoral - Inferior and superior gluteal arteries - 1st perforating artery
36
What is the unhappy triad? Describe the mechanism of this injury?
- Injury to knee involving MCL, medial meniscus and ACL - Knee is hit on the lateral aspect
37
Piriformis. O, I, A, I
- Origin: ant surface of sacrum - Insertion: greater trochanter - Action: lateral (external) rotation of thigh - Innervation: S1, S2 (mnemonic = Piriformiss, 2 esses: S1, S2)
37
O/I of plantar interossei muscles
- O: base metatarsals 3-5 - I: base proximal phalanx of toes 3-5
38
Joints of the foot. Bones that make up the joint? What type of joint is each? Motion?
1.) Ankle, aka talocrural joint: - Bones: trochlea of talus, tibia, fibula - Joint type: hinge (ginglymus) type of synovial 2.) Subtalar joint, aka talocalcaneal joint: - Bones: talus, calcaneus - Joint type: plane type of synovial - Motion: inversion, eversion 3.) Transverse tarsal joints: Motion here = inversion and eversion a.) talocalcaneonavicular: - Bones: talus, calcaneus, navicular - Joint type: ball and socket b.) calcaneocuboid: - Bones: calcaneus, cuboid - Joint type: plane 4.) Tarsometatarsal joints: - Bones: tarsals and metatarsals - Joint type: plane type of synovial - Motion: gliding 5.) Intermetarsal joints: - Bones: between bases of metatarsals - Joint type: plane type of synovial - Motion: slight gliding between bases 6.) Metatarsal phalangeal (MP) joints: - Bones: heads of metatarsals and bases of proximal phalanges - Joint type: condyloid type of synovial - Motion: flexion, extension, abduction, adduction and rotation 7.) Interphalangeal (IP) joints – proximal (PIP) and distal (DIP): - Bones: between phalanges - Joint type: hinge type of synovial - Motion: flexion and extension
39
Septa and retinacula of the crural fascia
1. Septa – with the interosseous membrane, create 3 compartments of leg - Anterior intermuscular/crural septum - Posterior - Transverse 2. Retinacula - Superior extensor retinaculum - Inferior - Flexor
39
What nerve supplies the medial 3.5 digits on the plantar surface of the foot?
- Medial plantar nerve (of tibial nerve) is larger than lateral
39
Medial longitudinal arch. Bones? Ligaments?
- Bones: calcaneus, talus, navicular, three cuneiforms, three medial metatarsals - Ligament: calcaneonavicular ligament (aka spring ligament), plantar aponeurosis
39
Which is the more common cruciate ligament damage?
• ACL, less strong
41
What traverses the lesser sciatic foramen?
- Mnemonic: PINT - Pudendal nerve - Internal pudendal vessels - Nerve to obturator internus - Tendon of obturator internus
42
Attachment points for fascia lata
- Superiorly: inguinal ligament, hip (pubic bone, iliac crest and ischial tuberosity), sacrum, coccyx, Scarpa’s fascia and sacrotuberous ligament - Inferiorly: knee joint continuous with crural fascial - Intermuscular septa (lateral, medial and posterior) attach at linea aspera
43
What are the muscle compartments of the thigh? What are the muscles contained in each? Main action? What nerve supplies each compartment?
1.) Medial = adductors, innervation = obturator nerve (this nerve has two divisions, anterior and posterior, which are anterior and posterior in reference to adductor brevis) a.) Pectineus#, adductor longus, adductor brevis, adductor magnus\*, gracilis, obturator externus # also innervated femoral nerve \* hamstring part is innervated by tibial nerve, not obturator nerve 2.) Anterior = hip flexors, knee extensors, innervation = femoral nerve a.) Sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius, articularis genu, psoas major, iliacus, tensor fascial latae 3.) Posterior = hip extensors, knee flexors, innervation = tibial nerve a.) Biceps femoris~, semitendinosus, semimembranosus ~ short head innervated by common peroneal nerve, not tibial nerve
44
Innervation of the plantar surface of foot
- 5 different nerves: - Medial calcaneal (of tibial) - Lateral dorsal cutaneous - Saphenous - Medial plantar - Lateral plantar
45
Adductor brevis. O, I, A, I
- Origin: inferior ramus of pubic bone - Insertion: linea aspera - Action: adductor - Innervation: obturator nerve
45
Adductor magnus. O, I, A, I
- Two parts to this muscle: adductor and hamstring part - Origin of adductor part: ischiopubic ramus - Insertion of adductor part: linea aspera - Innervation of adductor part: obturator nerve - Origin of hamstring part: ischial tuberosity - Insertion of hamstring part: adductor tubercle - Innervation of hamstring part: tibial nerve - Action: adductor
45
O/I of flexor hallucis brevis
- O: cuboid - I: base 1st proximal phalanx
46
Tibialis posterior. O, I, A, I
- Origin: tibia, fibula and IO membrane - Insertion: navicular, cuneiforms, cuboid, bases of 2nd-4th metatarsals - Action: plantar flexion - Innervation: tibial nerve
46
What type of joint is the knee joint?
- Between tibia and femur = synovial hinge joint, better described as condyloid given its rotatory motion - Patella and femur = plane gliding synovial joint
47
Popliteus. O, I, A, I
- Origin: lateral condyle of femur - Insertion: superior to soleal line of tibia - Action: unlocks knee joint by laterally rotating femur 5 degrees - Innervation: tibial nerve
48
What are the quadriceps femoris (quads) muscles?
- Rectus femoris - Vastus lateralis, medialis and intermedius
49
What nerve supplies skin of the anterolateral leg and dorsum of the foot?
- Superficial peroneal nerve (branch off common peroneal, which is part of sciatic off of sacral plexus)
50
Which of the cruciate ligaments of the knee joint are stronger?
- PCL is shorter and stronger than the ACL
51
O/I of adductor hallucis
1.) Oblique head - O: base of metatarsal 2-4 - I: base of 1st proximal phalanx 2.) Transverse head - O: MP joint ligaments - I: base of 1st proximal phalanx
53
Nerve supply to lateral thigh
- Lateral femoral cutaneous nerve (L2, L3)
53
Rectus femoris. O, I, A, I
- Origin: AIIS - Insertion: patella - Action: hip flexor, knee extensor - Innervation: femoral nerve
54
What nerve supplies the lateral 1.5 digits on the plantar surface of the foot?
- Lateral plantar nerve (of tibial nerve)
55
What forms the arches of the foot? Function?
- Tarsal and metatarsal bones - Weight bearing, resilience, shock absorption, propelling limb in walking
56
Vastus lateralis, medialis, intermedius. O, I, A, I
- Lateralis and medialis take origin from linea aspera. Intermedius takes origin from body of femur - Insertion: patella - Action: hip flexor, knee extensor - Innervation: femoral nerve
57
Function of ischiofemoral ligament?
- Checks hyperextension, internal rotation
58
Retinaculi of the foot
- Extensor retinaculum - Flexor retinaculum
59
O/I of flexor digiti minimi brevis
- O: base of 5th metatarsal - I: 5th proximal phalanx
59
Branches of posterior tibial artery in foot
a.) Medial plantar artery b.) Lateral plantar artery: forms deep plantar arch with its plantar metatarsals and plantar digital arteries then joins with the deep plantar branch of the dorsalis pedis to complete the deep plantar arch
59
Nerves to hip joint?
- Femoral, obturator, superior/inferior gluteal, sciatic
60
What nerve supplies the skin between the 1st and 2nd toes?
- Deep peroneal nerve (from common peroneal)
61
What is a positive Trendelenburg sign? What does this indicate?
- During the stance phase, the opposite abductor muscles (gluteus medius and minimis) normally serve to prevent the pelvis from tilting down, both hips should be maintained at the same level. - Positive sign = weak abductor muscles of the hip supplied by the superior gluteal nerve or damage to the nerve - These individuals have waddling/hip steppage or swing out gait
63
What are the hamstring muscles?
- Biceps femoris (except for short head), semitendinosus, semimembranosus
64
Sural vs crural
- Crural = lower leg - Sural = calf
65
Branches of femoral nerve
1.) Sensory a.) Medial femoral cutaneous nerve b.) Intermediate femoral cutaneous nerve c.) Saphenous nerve 2.) Motor (to following muscles) a. Sartorius b. Quadriceps femoris c. Articularis genu d. Pectineus
66
Blood supply to the perineal region
- Internal pudendal (off int iliac)
67
Biceps femoris. O, I, A, I
- Muscle has two heads: long and short head - Origin of long head: ischial tuberosity - Insertion of long head: fibular head\* - Innervation of long head: tibial nerve - Origin of short head: linea aspera - Insertion of short head: fibular head\* - Innervation of short head: common peroneal nerve - Action: hip extensors, knee flexors
68
Tensor fascia latae. O, I, A, I
- Origin: ASIS - Insertion: IT band - Action: hip flexor, knee extensor - Innervation: femoral nerve
69
Gracilis. O, I, A, I
- Origin: inferior ramus of pubis - Insertion: superior medial surface of tibia - Action: adductor - Innervation: obturator nerve
70
What forms the lesser sciatic foramen?
- Lesser sciatic notch and the sacrospinous / sacrotuberous ligaments
71
What is the largest strongest and widest ligament of the hip joint?
- Iliofemoral ligament
72
Branches of the dorsalis pedis
- Lateral tarsal - Medial tarsal - Arcuate: a.) 3 x dorsal metatarsal arteries each with two dorsal digital arteries\* - First dorsal metatarsal artery: gives rise to three dorsal digital arteries\* - Deep plantar: goes to plantar side and joins with deep plantar arch (of lateral plantar artery) \* 10 dorsal digital arteries (numbered medial to lateral)
74
Superficial veins of leg
- Great saphenous (from foot) ascends along medial leg and drains into femoral vein at femoral triangle - Small saphenous (from lateral foot) ascends along posterior medial leg and drains into popliteal vein in popliteal fossa, this vein drains into femoral vein
75
What nerves form the sacral plexus?
- L4/5 (from lumbosacral trunk) and S1-S4 (via sacral foramina)
77
Branches of the tibial nerve in leg
- Medial sural cutaneous nerve
77
What is genu valgum?
- Increased Q-angle = Knock knee
79
Superficial and deep layers of gluteal muscles? What are the main actions of each group?
1.) Superficial = extensors and ABductors - Gluteus maximus, medius and minimus 2.) Deep = stabilizers of hip joint and lateral (aka external) rotation - piriformis, obturator internus, superior/inferior gemellus, quadratus femoris
81
Where is it safe to give an intragluteal injection?
- Draw line between PSIS and greater trochanter. Mark middle of posterior iliac crest - Safe to give injection superior and lateral to this region over the gluteus medius and maximus
82
What is pes planus?
- Flat foot
84
Adductor longus. O, I, A, I
- Origin: body of pubic bone - Insertion: linea aspera - Action: adductor - Innervation: obturator nerve
85
Nerve supply to cutaneous proximal medial thigh
- Genital branches of genitofemoral (L1, L2) and ilioinguinal nerves (L1)
86
Semimembranosus. O, I, A, I
- Origin: ischial tuberosity - Insertion: medial tibial condyle - Action: hip extensor, knee flexor - Innervation: tibial nerve
88
Boundaries and contents of the popliteal fossa
1.) Boundaries - Gastrocnemius (inferior) - Biceps femoris (lateral) - Semimembranosus tendon/semitendinosus (medial) 2.) Contents - Small saphenous vein termination - Popliteal vessels and branches - Tibial and common peroneal nerves - Posterior cutaneous nerve of thigh - Popliteal lymph nodes and vessels
89
What muscles are affected with injury to the inferior gluteal nerve?
- Gluteus maximus
90
Pubis landmarks
- Acetabulum (anteromedial 1/5th) - Body: symphysis pubis, pubic crest, pubic tubercle - Superior ramus (fuses in acetabulum): pectineal line (pectin pubis) - Inferior ramus: obturator crest - Part of obturator foramen
91
What is the triceps surae muscle? Action of muscle?
- Gastrocnemius and soleus muscles together - Generates 95% of plantar flexion force
92
What is the name of the surface of the acetabulum that forms the joint with the head of the femur?
- Lunate surface surrounds the acetabular fossa
93
Function of ligament capitis femoris?
- Tenses when flexed thigh is adducted
93
Infection in what knee bursa can spread to the internal knee joint?
• Suprapatellar bursa, not infrapatellar or prepatellar
94
Function of the menisci of the knee joint?
- Deepen the articular surfaces
95
Hip abductor and internal rotator muscles
- Gluteus medius, gluteus minimus, tensor fascia lata
97
Embryology of limbs
- Week 5: lower limb buds appear at L2-S2 trunk segments - Great toes on superior aspect of bud, soles directed medially - Week 7: lower limbs rotate medially about 90 degrees – explains dermatome “barber-pole” pattern
99
Branches of the common peroneal nerves
- Lateral sural cutaneous nerve, branch off this = sural communicating nerve, which joins with medial sural cutaneous nerve (from tibial) - Superficial peroneal nerve - Deep peroneal nerve
101
Gluteus minimus. O, I, A, I, V
- Origin: ilium (bw ant and inf gluteal lines) - Insertion: greater trochanter - Action: abduction and medial rotation, stops sagging hip on unsupported side - Innervation: sup gluteal (L4-S1) - Vasculature: sup gluteal artery (from int iliac)
102
Quadratus femoris. O, I, A, I
- Origin: ischial tuberosity - Insertion: intertrochanteric line - Action: lateral (external) rotation of thigh - Innervation: nerve to quadratus femoris (L4-S1)
103
Function of pubofemoral ligament?
- Checks hyperextension, external rotation and abduction
105
Blood supply to the tensor fasciae latae
- Superior gluteal (off int iliac)
106
What muscle(s) extends the 1st toe?
- Extensor hallucis longus - Extensor hallucis brevis
108
Hip adductor muscles
- Fill in GAAAP muscles - Gracilis, adductors (longus, magnus, brevis), pectineus
109
What is the inferior extensor retinaculum? Name and describe the three parts?
- Thickening of deep fascia composed of a.) Stem (aka Frondiform ligament, lateral side) b.) Superomedial limb (to anterior surface of medial malleolus) c.) Inferomedial limb (blends in with plantar fascia)
110
What vessels supplies blood to the dorsum of the foot? What does it arise from?
- Dorsalis pedis (from anterior tibial artery, from popliteal, from femoral)
112
Superficial branches of the proximal femoral artery in the superficial fascia
1.) Superficial epigastric artery 2.) Superficial circumflex iliac artery 3.) External pudendal artery
113
To what bone are the menisci of the knee joint attached?
- Tibial condyles
114
What nerve supplies the cutaneous lateral side of the foot to the 5th toe?
- Lateral dorsal cutaneous nerve (continuation of sural nerve from common peroneal)
115
What nerve supplies the cutaneous middle part of the dorsum of the foot?
- Superficial peroneal nerve branches = medial / intermediate dorsal cutaneous nerves
116
O/I of quadratus plantae
- O: calcaneus - I: tendon of flexor digitorum longus
117
Nerve supply to popliteal region
- Posterior femoral cutaneous nerve (S1-3)
118
Clinical examinations to test for ACL and PCL tears?
- ACL tear: anterior drawer test - PCL tear: posterior drawer test
119
Function of iliofemoral ligament?
- Checks hyperextension and external rotation, helps maintain erect posture
121
Function of tibial (medial) collateral ligament? Fibular (lateral) collateral ligament?
- Become tight during extension and stabilize the knee joint
123
Gastrocnemius. O, I, A, I
- Origin: lateral and medial condyles of femur - Insertion: calcaneus - Action: flexes leg at knee, plantar flexes foot - Innervation: tibial nerve
124
Ligament of the knee joint? Location of each?
- Articular capsule: attached to margins of articular surfaces, incomplete where replaced by tendons - Quadriceps tendon: encloses patella - Patellar ligament: patella to tuberosity of tibia - Tibial (medial) collateral ligament: medial epicondyle of femure to medial surface of tibial, attached to medial meniscus - Fibular (lateral) collateral ligament: lateral epicondyle of femure to head of fibula, no attached to lateral meniscus - Oblique popliteal ligament: it is an expansion of tendon of semimembranosus muscle, fibers from medial condyle of tibia to lateral condyle of femur - Arcuate popliteal ligament: intercondylar area of tibia to fibular head - Coronary ligament: fibers surrounding capsule attached to menisci - Intra-articular ligaments: transverse, ant/post meniscofemoral, cruciate ligaments (ACL, PCL)
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Hip extensor muscles
- Gluteus maximus - Hamstrings: BITE ME (BIceps femoris, SemiTEndinosus, SemiMEmbranosus)
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Arches of foot – what bones does each consist of?
- Medial longitudinal arch: calcaneus, talus, navicular, three cuneiforms and three medial metatarsals - Lateral longitudinal arch: calcaneus, cuboid, two lateral metatarsals - Transverse arch: cuboid, three cuneiforms, bases of all metatarsals
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Name of nerve that exit the pelvis above the piriformis muscle. Below?
- Above = superior gluteal through greater sciatic foramen - Below = all other branches of sacral plexus
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What type of fracture leads to necrosis of the head of the femure?
- Subcapital (area of neck immediately adjacent to head) fracture as it breaks vessels to the head - Basal fracture (area at base of neck) usually doesn’t lead to necrosis of head
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Name accidents that can cause ACL and PCL tears?
- ACL: skiing - PCL: car accident
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Sartorius. O, I, A, I
- Origin: ASIS - Insertion: superior medial surface of tibia - Action: hip flexor, knee extensor - Innervation: femoral nerve
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Soleus. O, I, A, I
- Origin: fibula, soleal line of tibia - Insertion: calcaneus - Action: plantar flexion, continuously active while standing (anti-gravity muscle) - Innervation: tibial nerve
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Through what veins is blood from the gluteal region drained?
- Superior and inferior gluteal and internal pudendal into internal iliac vein
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Innervation of the plantar foot muscles
- Medial plantar nerve innervates: mnemonic = LAFF = 1st Lumbrical, Abductor hallucis, Flexor digitorum brevis, Flexor hallucis brevis - Lateral plantar nerve innervates all other plantar foot muscles
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Describe location of the intra-articular ligaments of the knee.
1.) Transverse ligament: connect menisci anteriorly 2.) Ant/posterior meniscofemoral ligament: obliquely from lateral menisci to medial femoral condyle 3.) Cruciate ligaments a. ACL: anterior interchondral fossa to lateral condyle of femur b. PCL: posterior interchondral fossa to medial condyle of femur
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O/I of abductor digiti minimi
- O: tuberosity of calcaneus - I: base of 5th proximal phalanx
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What muscles are affected with injury to the superior gluteal nerve?
- Gluteus medius and minimus
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Ilium landmarks
- Ala - Body - Iliac fossa - Acetabulum (superior 2/5th) - Iliac crest - ASIS/AIIS - PSIS/PIIS - Greater sciatic notch - Auricular surface - Gluteal lines (post/ant/inferior)
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What is the acetabular notch?
- inferomedial aspect of the acetabulum
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What vertebra does iliac crest correspond to?
- L4
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Inferior gemellus. O, I, A, I
- Origin: ischial tuberosity - Insertion: tendon of obturator internus - Action: lateral (external) rotation, extension, abduction of flexed thigh - Innervation: nerve to quadratus femoris (L4-S1)
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Gluteus medius. O, I, A, I, V
- Origin: ilium (bw ant and post gluteal line) - Insertion: greater trochanter - Action: Abduction and medial rotation of thigh, stops sagging hip on unsupported side - Innervation: superior gluteal (L4-S1) - Vasculature: sup gluteal artery (from int iliac)
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Nerve supply to cutaneous medial thigh
- Medial cutaneous branch of femoral (L2-4)
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What are the ligaments of the hip joint? Location of each?
- Articular capsule: surrounds joint and blends with other ligaments - Iliofemoral (iliotrochanteric) ligament: anterior of joint, attached to AIIS and intertrochanteric line - Pubofemoral (pubocapsular) ligament: superior ramus of pubis and obturator crest and blends with iliofemoral ligament - Ischiofemoral (ischiocapsular) ligament: body of ischium below and behind acetabulu and attach to femoral neck below greater trochanter - Ligament capitis femoris: fovea capitis to transverse ligament - Acetabular labrum: fibrocartilaginous rim attached to margin of acetabulum - Transverse acetabular ligament: acetabular labrum continuation across acetabular notch
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What ligament of the knee joint attaches the menisci to the capsule?
- Coronary ligament
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Anterior division sacral plexus nerves
- Tibial nerve (L4-5, S1-3)\* part of sciatic - Nerve to obturator internus (L5-S2) - Nerve to quadratus femoris (L4-S1) - Pudendal nerve (S2-4) - Nerve to levator ani
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O/I of lumbrical muscles
- O: tendon of flexor digitorum longus - I: flexor sheath of lateral 4 toes
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What is the fascia lata? What is the iliotibial band/tract?
- Fascia lata is the deep fascia of the thigh. It prevents bulging of the muscles and provides septa to divide the thigh into anterior/posterior and medial compartments - Lateral thickening of this fascia = IT band/tract
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Plantaris. O, I, A, I
- Origin: lateral supracondylar line of femur - Insertion: calcaneus - Action: flexes leg at knee, plantar flexion, organ of proprioception - Innervation: tibial nerve
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What forms the sural nerve?
- Junction of medial sural and communicating sural cutaneous nerve
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Peroneus longus. O, I, A, I
- Origin: lateral fibula - Insertion: base 1st metatarsal and medial cuneiform - Action: eversion - Innervation: superficial peroneal nerve
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What is a bunion?
• Head of 1st metarsal protrudes out medially and rubs against shoe, pushes toe laterally to almost on top of the 2nd toe
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What is the adductor canal? Boundaries? Contents?
- Aka subsartorial aka Hunter’s canal Boundaries: a.) Sartorius b.) Vastus medialis c.) Adductor longus and magnus Contents: - Femoral artery and vein - Saphenous nerve - Nerve to vastus medialis
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Flexor digitorum longus. O, I, A, I
- Origin: tibia inferior to soleal line - Insertion: bases of distal phalanges toes 2-5 - Action: plantar flexion - Innervation: tibial nerve
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Housemaid's knee causes a bursitis as a result of inflammation to what knee bursa?
• Prepatellar bursa typically, sometimes infrapatellar bursa
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Iliopsoas (psoas major, iliacus). O, I, A, I
- Psoas major takes origin from lumbar vertebrae, iliacus takes origin from iliac crest and fossa - Insertion: lesser trochanter of the femur - Action: hip flexor, knee extensor - Innervation: femoral nerve
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Obturator internus. O, I, A, I
- Origin: obturator membrane and surrounding bone - Insertion: greater trochanter - Action: lateral (external) rotation, extension, abduction of flexed thigh - Innervation: obturator internus nerve (L5, S1, S2)
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Bony landmarks of femur
- Head - Greater and lesser trochanters - Intertrochanteric line anteriorly/posteriorly - Linea aspera - Medial/lateral epicondyles - Medial/lateral condyles - Intercondylar fossa - Popliteal surface
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Blood supply to the knee joint?
- Genicular arteries from the femoral artery anastomose
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Plantar foot muscle layers (most superficial to deep)
1st: ab, flexor, ab 3rd: flexor, ad, flexor 2nd: 2 tendons (both longus), 2 muscles 4th: 2 tendons (both have “P”), 2 muscles (DABS and PADS) 1.) First layer (3 muscles) - Abductor hallucis - Flexor digitorum brevis - Abductor digiti minimi (or quinti) 2.) Second layer (2 muscles, 2 tendons) - Flexor digitorum longus tendon - Flexor hallucis longus tendon - Quadratus plantae - Lumbrical muscles (x4) 3.) Third layer (3 muscles) - Flexor digiti minimi brevis - Adductor hallucis (oblique and tranverse heads) - Flexor hallucis brevis 4.) Fourth layer (2 muscles, 2 tendons) - Peroneus longus tendon - Tibialis posterior tendon - Plantar interossei muscles (x 3) - Dorsal interossei muscles (x 4)
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Gluteus maximus. O, I, A, I, V
- Origin: sacrotuberous ligament, ilium (posterior to posterior gluteal line), sacrum and coccyx - Insertion: gluteal tuberosity and IT band - Action: extend and lateral rotation thigh, sitting to standing, running - Innervation: inferior gluteal (L5-S2) - Vasculature: sup/inf gluteal arteries (from int iliac)
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If patient comes to office c/o coldness to their feet, it could be that the vasculature has been compromised. Describe alternative circulation that should normally compensate?
- If patient comes to office c/o coldness to feet, could be dorsalis pedis issue. Check DP pulse, make pt extend great toe and feel lateral to the tendon of extensor hallucis longus. If absent, the perforating branch of peroneal will take over blood supply. - If perforating branch of peroneal is absent, DP can deviate laterally to supply lateral aspect. - If DP absent and perforating branch of peroneal absent, plantar surface blood supplies dorsum, plantar artery well developed and supply metatarsal arteries.
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Function of cruciate ligaments of knee joint?
- ACL: stops hyperextension of the knee - PCL: stops hyperflexion of the knee
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Injury to the common peroneal (fibular) nerve causes what paralysis?
- Paralysis to anterior and lateral compartment muscles - Anterior is supplied by deep peroneal (fibular) nerve - Lateral is supplied by superficial peroneal (fibular) nerve
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Nerves that innervate the cutaneous gluteal region. From which rami does each originate?
- Superior cluneal (dorsal rami) - Medial cluneal (dorsal rami) - Inferior cluneal (ventral rami)
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Branches of tibial nerve at foot
a.) Medial calcaneal b.) Medial plantar nerve c.) Lateral plantar nerve
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What is a Baker’s cyst?
- Where synovial fluid escapes from the knee joint into the popliteal fossa
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Blood supply to plantar muscles of foot
- Medial and lateral plantar arteries (from posterior tibial from popliteal from femoral)
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What nerve supplies skin on the medial side of the leg?
- Saphenous nerve (L3, 4), branch off femoral
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Articularis genu. O, I, A, I
- Origin: anterior part of femur - Insertion: synovial membrane of knee - Action: hip flexor, knee extensor - Innervation: femoral nerve
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Knee flexor muscles
- Hamstrings: BITE ME - BIceps femoris, SemiTEndinosus, SemiMEmbranosus
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Landmarks of fibula
- Head - Neck - Lateral malleolus
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Draw and name bones of the foot
1. Tarsals - Mnemonic: Tiger Cubs Need MILC(K) - Medial to lateral in rows: Talus, calcaneus, navicular, medial/intermediate/lateral cuneiforms 2. Metatarsals 3. Phalanges a. Proximal phalanges b. Middle phalanges: 1st toe (hallux) is without c. Distal phalanges
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Hip flexor muscles
- RIP muscles, think dead animal with legs flexed - Rectus femoris, iliacus, psoas major
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What nerve supplies the medial side of foot (including arch) of the foot?
- Saphenous nerve (from femoral)
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What is genu varum?
- Decreased Q-angle = Bow leg
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What is a Potts fracture?
- Foot is forcefully everted, result is fracture of medial and lateral malleoli (or more proximal fibula)
