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Flashcards in Lower Extremities Deck (23):
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Function of lower extremity

Support weight to body

Stable foundation for standing, walking, running

1

Regions of lower extremity

Gluteal

Thigh

Knee

Leg

Ankle

Foot

2

Fascial compartments - THIGH

Anterior compartment

Posterior compartment

Medial compartment

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Flexors of the thigh

Extensors of the leg

Femoral nerve

Consists of: ILIOPSOAS, TENSOR FASCIA LATA, SARTORIUS, PECTINEUS, QUADRICEPS FEMORIS (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)

Anterior thigh muscles

4

Continuation of internal iliac artery

Passes through the obturator foramen close to femoral ring (where it may complicate the surgery repair of femoral hernia)

Obturator artery

5

Branches of obturator artery

Muscular branches to adductor muscles

Artery of Ligamentum Teres (artery to the head of femur)
- in children, it supplies thread of femur proximal to epiphyseal growth plate
- after the epiphyseal growth plate closes, it's role becomes insignificant

6

Continuation of external iliac artery

Enters the femoral triangle posterior to inguinal ligament & midway between ASIS & symphysis pubis
- palpation of femoral pulse, ABG, percutaneous arterial catheterization can be performed at this location

Gives off the Profunda femoris artery

Femoral artery

7

Profunda femoris artery branches into:

4 perforating arteries

Medial circumflex artery
- main blood supply to the head & neck of femur in adults

Lateral circumflex artery

8

Continuation of femoral artery at the adductor hiatus in adductor magnus muscle

Extends through popliteal fossa where popliteal pulse can be palpated against the popliteal muscle with the leg flexed

Popliteal artery

9

Branches of popliteal artery

Genicular arteries

Anterior tibial artery

Posterior tibial artery

10

Descends on anterior surface of interosseous membrane with deep peroneal nerve

Terminate as dorsalis pedis artery

Dorsalis pedis artery lies between extensor hallucis longus & extensor digitorum longus tendons midway between medial & lateral malleolus (site of palpating dorsal pedal pulse)

Anterior tibial artery

11

Behind medial malleolus with tibial nerve (site of palpating lost tibial pulse)

Posterior tibial artery

12

Branches of posterior tibial artery

Peroneal artery
- behind lateral malleolus

Medial plantar artery

Lateral plantar artery
- forms the plantar arch which connects to the dorsalis pedis artery

13

COLLATERAL CIRCULATION

Around the hip joint (cruciate anastomosis)

- inferior gluteal artery

- medial & lateral femoral circumflex arteries

- 1st perforating branch of the profundus femoris artery

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COLLATERAL CIRCULATION

Around the head of femur (trochanteric anastomosis)

- superior & inferior gluteal arteries

- medial & lateral femoral circumflex arteries

15

Usually occurs where femoral artery gives off the Profunda femoris artery

SSX: 6 Ps (pain, paralysis, paresthesia, pallor, poikilothermia, pulselessness)

Acute arterial occlusion

16

MC cause: atherosclerosis

Usually involves the femoral artery near the adductor hiatus & popliteal artery

Diabetic Px: anterior & posterior tibial artery, peroneal artery are susceptible to occlusion

SSX: intermittent claudication (profound fatigue or aching on exertion but never after sitting/standing relieved by 5-10 minutes rest); ischemic pain

Chronic arterial occlusive disease

17

⬆️ in interstitial fluid pressure (>30mmHg within an osseofascial compartment --> compromise microcirculation --> muscle & never damage

Anterior thigh compartment: involves the femoral artery artery & nerve

Anterior leg compartment: involves the anterior tibial artery & deep peroneal nerve

SSX: swollen, tense compartment, pain on passive stretching, pink color, warmth, present of pulse over the involved compartment

Compartment syndrome

18

Travels with saphenous nerve

Passes anterior to medial malleolus (site for venous puncture or catheter insertion)

Ascends along medial aspect of the leg & thigh

Empties into the femoral vein within the femoral triangle

Great saphenous vein

19

Travels with sural nerve

Passes posterior to lateral malleolus

Ascends along lateral aspect of the leg

Empties into the popliteal vein within the popliteal fossa

Lesser saphenous vein

20

Communicating venous system

Connects the deep & superficial veins with valves (allows only blood flow from superficial veins --> deep veins)

Incompetent valves --> back flow of blood into the superficial veins (superficial veins <-- deep veins) leading to varicose veins

21

Blood clot (thrombus) most commonly within the deep veins of the lower limb

May lead to pulmonary embolus

Tx:
IV heparin for 5-7 days followed by warfarin (Coumadin) for 3 months
- * Coumadin is teratogenic

Deep venous thrombosis

22

Virchow triad

Venous stasis (prolonged immobilization, CHF, obesity)

Hypercoagulation (OCP use, pregnancy)

Endothelial damage