First Slide Deck Flashcards by Cal Schiller

Regions of the Lower Extremity

Gluteal
Thigh (femoral)
Knee
Patellar (anterior)
Popliteal (posterior)
Leg (crural)
Anterior
Calf (sural)
Foot (pedal)

How well did you know this?

Not at all

Perfectly

Pelvic girdle is attached to the vertebral column (sacroiliac joints)

Hip bones are firmly attached at the midline

Knee has stabilizing ligaments and muscles on which it depends

Fibula does not enter into the knee joint

Bones of the foot are large and adapted for bearing weight

Flexor versus extensor surfaces

Features of the Lower Limb

How well did you know this?

Not at all

Perfectly

Features of the Lower Limb

Pelvic girdle is attached to the vertebral column (sacroiliac joints)

Hip bones are firmly attached at the midline

Knee has stabilizing ligaments and muscles on which it depends

Fibula does not enter into the knee joint

Bones of the foot are large and adapted for bearing weight

Flexor versus extensor surfaces

How well did you know this?

Not at all

Perfectly

STRENGTH VERSUS LOCOMOTION

Weight-bearing appendage needs strength

Locomotion appendage needs flexibility and range of motion

Structural compromise between stability and range of motion

How well did you know this?

Not at all

Perfectly

Weight-bearing appendage needs ___

strength

How well did you know this?

Not at all

Perfectly

Locomotion appendage needs flexibility and ____

range of motion

How well did you know this?

Not at all

Perfectly

Structural ____ between stability and range of motion

compromise

How well did you know this?

Not at all

Perfectly

Os Coxae (ilium, ischium, pubis)
Femur
Patella
Tibia
Fibula
Tarsals (7)
Metatarsals (5)
Phalanges (14)

Bones of the Lower Extremity

How well did you know this?

Not at all

Perfectly

Bones of the Lower Extremity

Os Coxae (ilium, ischium, pubis)
Femur
Patella
Tibia
Fibula
Tarsals (7)
Metatarsals (5)
Phalanges (14)

How well did you know this?

Not at all

Perfectly

Ilium
Ischium
Pubis

Hip (os coxae) component

How well did you know this?

Not at all

Perfectly

Hip (os coxae) component

Ilium
Ischium
Pubis

How well did you know this?

Not at all

Perfectly

Bones fuse in late teens / early 20s to form a single bone, the os coxae AKA ____

innominate bone

How well did you know this?

Not at all

Perfectly

Slide 8, 9 for views of the hip

check it

How well did you know this?

Not at all

Perfectly

Skin dimples mark the position of the ____

posterior superior iliac spines

How well did you know this?

Not at all

Perfectly

The dimples are typically more visible in women than in men

Skin dimples mark the position of the posterior superior iliac spines

How well did you know this?

Not at all

Perfectly

Slide three for lower limb definitions

aight

How well did you know this?

Not at all

Perfectly

Consists of complete ring composed of hip bones, pubic symphysis, and sacrum

Bony pelvis

How well did you know this?

Not at all

Perfectly

Bony Pelvis has?

complete ring composed of hip bones, pubic symphysis, and sacrum

How well did you know this?

Not at all

Perfectly

The portion of the bony pelvis superior to the pelvic brim is the ____.

false (greater) pelvis

How well did you know this?

Not at all

Perfectly

The portion of the bony pelvis inferior to the pelvic brim is the ____.

true (lesser) pelvis

How well did you know this?

Not at all

Perfectly

The___ contains the urinary bladder, portions of the large intestine, and internal organs of the reproductive system

pelvic cavity

How well did you know this?

Not at all

Perfectly

Bones of males are generally ____, and have larger surface markings than those of females of comparable age and physical stature

larger and heavier

How well did you know this?

Not at all

Perfectly

Most structural differences in the female pelvis are adaptations to requirements of ____

pregnancy and childbirth

How well did you know this?

Not at all

Perfectly

False pelvis shallow in female (left), ___ in male

deep

How well did you know this?

Not at all

Perfectly

Pelvic brim (inlet) larger and more __ in female

oval

Acetabulum smaller and faces ____ in female, faces laterally in male

anteriorly

Obturator foramen oval in female, ___ in male

round

Pubic arch ____° angle in female, < 90° in male

> 90

Check slide 16, 17, 18 for male/female pelvis slides

DO IT

False pelvis shallow in female (left), deep in male ____ larger and more oval in female Acetabulum smaller and faces anteriorly in female, faces laterally in male _____ oval in female, round in male Pubic arch > 90° angle in female, < 90° in male

Pelvic brim (inlet) Obturator foramen

Iliac crest more/less curved in female?

less

Ilium more/less vertical in female

less

Greater sciatic notch ___ in female

wider

____ more movable and more curved anteriorly in female

Coccyx

___ shorter and wider in female

Sacrum

Pelvic outlet wider in?

female

Ischial tuberosity shorter, farther apart, and more medially projecting in female; whereas in males it's

longer, closer together, and more laterally projecting in male Slide 18

Slide 20 for some bone deets

word

an abnormality of the hip in which the angle between the top of the femur and the femoral shaft is smaller than normal.

Coxa vara

an abnormality of the hip in which the angle between the top of the femur and the femoral shaft is larger than normal.

Coxa valga

Coxa ___ = less (horizontal neck) | Coxa ___ = more (vertvaraical neck)

vara valga

The angle of ____ varies with age, sex, and development of the femur. It may also change with pathological processes that weaken the neck of the femur, such as rickets.

inclination

Slides 19-23 for coxa vara, coxa valga

He has the same definition several times... hint, hint

Leg—Osteology?

Tibia Fibula

Slide 25, 26

tibia Fibula

``` Talus Calcaneus Navicular Cuboid Cuneiforms (3) ```

Tarsals (7 bones)

7 tarsal bones?

``` Talus Calcaneus Navicular Cuboid Cuneiforms (3) ```

How many metatarsals?

How many phalanges?

Slide 28, 29 for a foot

check it

Fractures of the metatarsals can occur when a heavy object falls on the foot, or when a heavy object rolls over the foot.

Sciecne

Metatarsal fractures are also common among dancers, especially female ballet dancers, who place the full weight of their body on the tips of their toes. Additional forces result from ballet movements

Sports

Slide 31, 32

The bones of the foot are arranged in ___ that are held in position by ligaments and tendons

two arches

What are the two arches of the foot?

Longitudinal arch, which has two parts Transverse arch

distribute body weight over the soft and hard tissues of the foot provide leverage while walking yield as weight is applied because they are not rigid, and spring back when the weight is lifted, thus storing energy for the next step and helping to absorb shocks

Functions of the arches

Distribute weight Provide leverage yield weight (energy storage/absorption)

The MEDIAL part of the longitudinal arch originates at the ____, rises to the talus, and descends through the navicular, the three cuneiforms, and the heads of the three medial metatarsals

calcaneus

The MEDIAL part of the longitudinal arch originates at the calcaneus, rises to the talus, and descends through the navicular, the three cuneiforms, and the heads of the ____

three medial metatarsals

The LATERAL part of the longitudinal arch also originates at the calcaneus. It rises at the cuboid, and descends to the heads of the _____

two lateral metatarsals

The transverse arch is formed by the ___, the three cuneiforms, and the bases of the five metatarsals

cuboid

The __ of the foot normally carries about 40% of the weight, and the heel carries about 60%

ball

High-heeled shoes changes the normal distribution so that the __ of the foot may carry up to 80%. As a result, the fat pads at the ball of the foot are damaged, structural changes in bones may occur, and joint pain develops

ball

Deep to subcutaneous tissue Connects “skin” to bone

FASCIA

Forms compartments Provides tight fitting sleeve of support for upright posture

FASCIA

Fascia lata/Iliotibial band Crural fascia Retinacula

FASCIA

Deep fascia of the thigh Superior attachment: inguinal ligament Defect: saphenous hiatus

Fascia Lata

Fascia Lata superior attachment?

inguinal ligament

Lateral thickening of the fascia lata attached distally to the lateral tibial condyle Insertion of gluteus maximus and tensor fasciae latae muscles Septa dividing the three compartments arise here

Iliotibial tract

Lateral thickening of the fascia lata attached distally to the lateral tibial condyle

Iliotibial tract

Insertion of gluteus maximus and tensor fasciae latae muscles

Iliotibial tract

Septa dividing the three compartments arise here

Iliotibial tract

Deep fascia of the leg Attachment: anterior and medial borders of the tibia, where it is continuous with its periosteum

Crural Fascia

Crural intermuscular septa plus the interosseous membrane divide the leg into three compartments

Crural Fascia

Crural fascia thickens to form the ____ near the ankle

extensor retinacula

divides into right and left common iliac arteries at about the level of the fourth lumbar vertebra

Abdominal aorta

Primarily an artery of the pelvis, it supplies pelvic viscera and perineum Supplies superior portions of the lower limb via gluteal arteries and obturator artery

Internal iliac

‘Femoral’ distal to the inguinal ligament

External iliac

‘Femoral’ distal to the ?

inguinal ligament

‘Popliteal’ distal to the adductor hiatus

External iliac

‘Popliteal’ distal to the ___?

adductor hiatus

Anterior tibial artery -> ___?

Anterior tibial artery  dorsalis pedis

Posterior tibial artery -> ___?

medial and lateral plantar arteries

Slide 45-47?

BLOOD

Lower limb has superficial and deep veins

Novel concept

In the subcutaneous tissue Not accompanied by corresponding arteries Have valves (less dense in arrangement than deep vein valves)

Superficial veins

Not accompanied by corresponding arteries

Superficial veins

Deep to the deep fascia Accompany all major arteries Have valves (more dense in arrangement than superficial veins)

Deep veins

Superficial venous drainage

Great and small saphenous

Formed by union of the dorsal vein of the great toe and the dorsal venous arch Ascends anterior to medial malleolus accompanied by the saphenous nerve

Great saphenous

Passes posterior to the medial condyle of the femur Anastomoses frequently with the small saphenous vein Empties into the femoral vein

Great saphenous

Great saphenous empties into the?

femoral vein

Formed by union of the dorsal vein of the small toe and the dorsal venous arch. Ascends posterior to lateral malleolus accompanied by sural nerve Empties into the popliteal vein in the popliteal fossa

Small saphenous

Slide 50 for visual

Interconnect superficial and deep veins

Perforating veins

Contain valves that allow blood to flow only from superficial veins to deep veins

Perforating veins

Permit diameter of saphenous veins to remain fairly constant even as the veins ascend (normally, veins become larger closer to the heart since they receive more blood on their way to the heart), because blood is shunted from superficial veins to deep veins

Perforating veins

superficial veins to deep veins

Accompany deep arteries of the lower limb Generally occur as paired frequently interconnecting veins, rather than as a single structure

Deep veins

Receive blood from superficial veins via perforating veins Musculovenous pump assists in movement of blood to heart Have greater density (and more) valves than superficial veins

Deep veins

Slide 53-55....

legs

Incompetent venous valves can cause veins to become dilated and tortuous, a condition called varicose veins, or varices

Varicose Veins

Although the condition may occur in veins in most any part of the body, the great saphenous vein and its tributaries are particularly susceptible

Varicose Veins

The valves causing the problem are generally valves of the saphenous vein(s), or of the perforating veins.

Varicose Veins

Veins close to the surface, especially the ____, are highly susceptible to varicosities, whereas deeper veins are not as vulnerable due to the surrounding skeletal muscles

saphenous vein

Extrinsic muscle of lower extremity?

Psoas major

``` Iliac region (iliacus) Gluteal region Thigh compartments (3) Leg compartments (3) Dorsum of the foot Sole of the foot ```

Intrinsic muscles of lower extremity

Muscles of the Posterior Abdominal Wall?

‘Iliopsoas’ - Psoas major (and minor) - Iliacus

‘Iliopsoas’?

- Psoas major (and minor) | - Iliacus

Origin: transverse processes of lumbar vertebrae Insertion: lesser trochanter of femur

Psoas major (and minor)

Psoas major (and minor) origin and insertion?

Origin: transverse processes of lumbar vertebrae Insertion: lesser trochanter of femur

Action: flexion of hip, flexion of vertebral column Innervation: lumbar spinal nerves

Psoas major (and minor)

Psoas major (and minor) action and innervation?

Action: flexion of hip, flexion of vertebral column Innervation: lumbar spinal nerves

Origin: iliac fossa, sacrum Insertion: lesser trochanter of femur

Iliacus

Iliacus origin and insertion?

Origin: iliac fossa, sacrum Insertion: lesser trochanter of femur

Action: flexion of hip Innervation: femoral nerve

iliacus

Iliacus action and innervation?

Action: flexion of hip Innervation: femoral nerve

Slide 60

Muscles

The hip joint is a multiaxial ball-and-socket type of ___joint that provides both stability and a wide range of movement

synovial

bony structure: femoral head is ball, and the cup-like acetabulum is the socket ligaments musculature

Stabilizing factors of the hip joint

Hip movements on slide 63, 64

rad

the central part of the acetabulum, it is the non-articular part and occupied by a synovial fatpad

Acetabular fossa

the true articular surface. It is lined with hyaline cartilage

Lunate surface

the inferior part of acetabulum. It is bridged by the transverse ligament

Acetabular notch

fibrocartilage lip that increases the depth of the acetabulum, and grasps the femoral head beyond its equator

Acetabular labrum

Slide 66 for hip view

stuff

follows the bony rim of the cup-shaped acetabulum

acetabular labrum

acetabular labrum composed of?

fibrocartilage

deepens the acetabular fossa, and helps stabilize the head of the femur in the acetabulum

acetabular labrum

The acetabular surface is smooth and lined by ____

articular cartilage

The head of the femur is also covered by articular cartilage on its surface, except?

where the ligament of the head of the capsule attaches

AKA ligament of head of the femur

Ligamentum capitis femoris

This ligament extends from the acetabular notch to the fovea of the head of the femur

Ligamentum capitis femoris

It is weak, and is of little importance in strengthening the hip joint

Ligamentum capitis femoris

It usually contains a small artery to the head of the femur (obturator artery)

Ligamentum capitis femoris

The ____ is both strong and loose, permitting free movement of the hip joint

fibrous articular capsule

Attachments of the articular capsule?

Proximal attachment is the edge of acetabulum and transverse acetabular ligament Distal attachments are to the intertrochanteric line and femoral neck

Ligaments of the articular capsule are parts of the capsule that are thicker than others. What are the four?

Iliofemoral Pubofemoral Ischiofemoral Ligament of the femoral head

prevents hyperextension one of the strongest ligaments in the body Y-shaped AKA Ligament of Bigelow

Iliofemoral ligament

(prevents overabduction)

Pubofemoral ligament

prevents hyperextension

Ischiofemoral ligament

The ____ loses the greater sciatic foramen.

sacrospinous ligament c

The ____ attaches the PSIS, PIIS, sacrum and cocyx to the ischial tuberosity. The lesser sciatic notch is converted to the lesser sciatic foramen by the sacrospinous ligament and the sacrotuberous ligaments.

sacrotuberous ligament slide 71

Slide 71-71 for

ligaments of the pelvis

The hip joint is most stable when it is ___ and/or bearing weight.

fully extended

___ dislocation of the hip joint is reasonably common. Because the hip joint is strong and stable, acquired dislocation is uncommon, however a head-on automobile collision may dislocate the hip.

Congenital

The ____ separates the buttocks (gluteal prominences)

intergluteal (natal) cleft

The ____ is formed by the inferior border of the gluteus maximus, and marks the lower limit of the buttock and the upper limit of the thigh

gluteal sulcus

``` Act on the hip joint: Abduct and adduct the femur Rotate the femur External rotation – toes lateral Internal rotation – toes medial Flex and extend the femur ```

GLUTEAL MUSCLES

Superficial Muscles of the Gluteal region?

Gluteus maximus, medius, and minimus

Superior (medius and minimus) and inferior gluteal (maximus) nerves Extension (maximus -> rising from a seated position) & abduction (medius-minimus)

Gluteus maximus, medius, and minimus

``` Piriformis Obturator internus Obturator externus Superior gemellus Inferior gemellus Quadratus femoris ```

‘Short’ lateral rotators (deep) of gluteal region

Origin: iliac crest and sacrum Insertion: gluteal tuberosity

Gluteus Maximus

Action: extends thigh at hip joint, laterally rotates thigh Innervation: inferior gluteal nerve

Gluteus Maximus

Gluteus Maximus OIAI?

Origin: iliac crest and sacrum Insertion: gluteal tuberosity Action: extends thigh at hip joint, laterally rotates thigh Innervation: inferior gluteal nerve

Origin: ilium Insertion: greater trochanter of femur

Gluteus Medius

Action: entire muscle abducts thigh at hip, anterior fibers flex and medially rotate thigh, posterior fibers extend and laterally rotate thigh Innervation: superior gluteal nerve

Gluteus Medius

Gluteus Medius OIAI?

Origin: ilium Insertion: greater trochanter of femur Action: entire muscle abducts thigh at hip, anterior fibers flex and medially rotate thigh, posterior fibers extend and laterally rotate thigh Innervation: superior gluteal nerve

Origin: ilium Insertion: greater trochanter of femur

Gluteus Minimus

Action: entire muscle abducts thigh at hip, anterior fibers flex and medially rotate thigh, posterior fibers extend and laterally rotate thigh Innervation: superior gluteal nerve

Gluteus Minimus

Gluteus Minimus OIAI?

Origin: sacrum Insertion: greater trochanter of femur

Piriformis

Action: laterally rotates and abducts thigh at the hip joint Innervation: piriformis nerve

Piriformis

Piriformis OIAI?

Origin: sacrum Insertion: greater trochanter of femur Action: laterally rotates and abducts thigh at the hip joint Innervation: piriformis nerve

Origin: ischial spine Insertion: greater trochanter of the femur

Superior Gemellus

Action: rotates the thigh laterally; also helps abduct the thigh Innervation: nerve to the obturator internus and superior gemellus

Superior Gemellus

Superior Gemellus OIAI?

Origin: ischial spine Insertion: greater trochanter of the femur Action: rotates the thigh laterally; also helps abduct the thigh Innervation: nerve to the obturator internus and superior gemellus

Origin: ischial tuberosity Insertion: greater trochanter of the femur

Inferior Gemellus

Action: rotates the thigh laterally; also helps abduct the thigh Innervation: nerve to the quadratus femoris and inferior gemellus

Inferior Gemellus

Origin: ischial tuberosity Insertion: intertrochanteric crest of femur

Quadratus Femoris

Action: rotates the hip laterally (stabilizes hip joint) Innervation: nerve to the quadratus femoris and inferior gemellus

Quadratus Femoris

Origin: inner (posterior) surface of membrane covering obturator foramen Insertion: greater trochanter of femur

Obturator Internus

Action: rotates the thigh laterally; also helps abduct the thigh Innervation: nerve to the obturator internus and superior gemellus

Obturator Internus

Origin: outer (anterior) surface of membrane covering obturator foramen Insertion: trochanteric fossa of femur

Obturator Externus

Action: rotates the thigh laterally; also helps abduct thigh Innervation: obturator nerve

Obturator Externus

Slide 88-90 for muscles of hip and thigh

rad

deep artery of the thigh = deep peroneal artery

Deep femoral artery

Supplies portions of anterior compartment of thigh _____ branch supplies head and neck of femur (Deep femoral artery)

Medial circumflex femoral

______ branch in turn has branches: ascending branch that supplies part of gluteal region, a transverse branch that supplies part of the femur, and a descending branch that descends to knee and joins genicular anastomoses (deep femoral artery)

Lateral circumflex femoral

Supplies head of femur branch of obturator artery within the ligament of head of femur Supplies muscles of medial compartment of thigh (adductors of thigh and gracilis)

Obturator artery, a branch of the internal iliac

supplies piriformis, all 3 gluteal muscles, and tensor fasciae latae

Superior gluteal artery

supplies piriformis, quadratus femoris, and gluteus maximus

Inferior gluteal artery

Slide 93 for gluteal arteries

aight

Muscles of the anterolateral abdominal wall Skin of inferior abdomen and buttock (portion of lumbar plexus)

Iliohypogastric portion of lumbar plexus

Muscles of the anterolateral abdominal wall Skin of superior medial aspect of thigh (portion of lumbar plexus)

Ilioinguinal

Cremaster muscle Skin over middle anterior surface of thigh, scrotum in male, labia majora in female

Genitofemoral

The ___ muscle is a muscle that is developed to its fullest extent only in males

cremaster

Its function is to raise and lower the ___ in order to regulate the temperature of the testis and promote spermatogenesis.

scrotum

Skin over lateral, anterior, and posterior aspects of thigh | lumbar plexus

Lateral cutaneous nerve of thigh

Flexor muscles of thigh Extensor muscles of leg Skin over anterior and medial aspect of thigh, and medial side of leg and foot

femoral plexus

Adductor muscles of leg Skin over medial aspect of thigh (portion of lumbar plexus)

Obturator

OBTURATOR nerve supplies the ___group (in general)

adductor

Adductor group of muscles in the medial (adductor) compartment of the thigh: adductor magnus, adductor longus, adductor brevis, and what two other muscles?

pectineus, gracilis

``` Sciatic nerve Superior gluteal nerve Inferior gluteal nerve Pudendal nerve: supplies the perineum (branches of?) ```

Sacral plexus

Gluteus minimus, gluteus medius, and tensor fasciae latae muscles

Superior gluteal

A characteristic motor loss resulting in weakened abduction of the thigh by the gluteus medius A disabling gluteus medius limp A gluteal gait, which is a compensatory list of the body to the weakened gluteal side

Superior Gluteal Nerve Injury

When the ____ are inactive due to superior gluteal nerve injury, their supporting and steadying action is lost. The pelvis falls on the side of the raised limb.

gluteus medius and gluteus minimus Slide 104-106 When weight is on both feet, the pelvis is evenly supported, and does not sag.When the weight is borne by one foot, the muscles on the same side normally hold the pelvis so it will not sag

Gluteus maximus muscle

Inferior gluteal plexus

Nerve to piriformis goes to ...

piriformis

Tibial Common fibular (common peroneal)

Sciatic Good sciatic visual on slide 110

Gastrocnemius, plantaris, soleus, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus and medial/lateral plantar` nerve of foot all receive innervation from?

Tibial nerve, from the sciatic

Abductor hallucis, flexor digitorum brevis, flexor hallucis muscles (and first lumbrical) Skin over medial two-thirds of plantar surface of foot innervated by?

Medial planter nerve (from tibial)

Remaining plantar muscles of foot | Skin over lateral one-third of plantar surface of foot innervated by?

Lateral plantar (from tibial)

Superficial fibular | Deep fibular receive from?

Common fibular... via scaitic

Fibularis longus, fibularis brevis muscles | Skin over distal third of anterior aspect of leg, and dorsum of foot innervared by?

Superficial fibular | from common fibular

Tibialis anterior, extensor hallucis longus, fibularis tertius, extensor digitorum longus, extensor digitorum brevis muscles Skin on adjacent sides of great and second toes innervated by?

deep fibular (from common fibular)

The sciatic nerve exits the pelvic cavity through the greater sciatic foramen below the ___

piriformis slide 115

causes compression and irritation of the sciatic nerve in the buttock, and is a cause of buttock pain and sciatica outside the spine.

Piriformis Syndrome

In about 10% of the population, the sciatic nerve passes through ___ instead of under it as normal. Conditions which cause the muscle to become short and contracted increase the nerve compression. Not all cases are due to the nerve passing through the muscle.

piriformis

buttock pain is common as well as sciatic symptoms in the leg. In some people the whole sciatic nerve passes through the muscle at one place, and in others the sciatic nerve is in two parts, with each part passing through at a different level.

Piriformis syndrome symptoms

(piriformis syndrome)The sciatic component of the pain in the leg can be in the dermatome of any of the nerves that comprise the sciatic nerve i.e.?

L4, L5, S1, and S2.

Piriformis treatment?

releasing the contracted piriformis muscle with the combination of exercises, acupuncture, and trigger point injections may be useful. Surgery may occasionally be necessary wherein the tendon is released from its attachment to the superior part of the greater trochanter of the femur.

The gluteal region is a common site for ___ because the muscles are thick and large, providing for good absorption

intramuscular injections

The concept that injections should be given in the “cheek” of the buttock is dangerous because the ___ lies deep to this area

sciatic nerve

Injections into the buttock should always be made superior to a line extending from the posterior superior iliac spine to the superior border of the ___

greater trochanter

First Slide Deck Flashcards

(215 cards)