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Flashcards in Lower Extremities Deck (62):
1

ANTERIOR THIGH MUSCLES
- flexors of the __________; extensor of the __________
- innervated by the ___________
- consists of:
----- ____________ - strongest flexor
----- ____________ - flexes and medially rotates thigh
----- ____________ - flexes and laterally rotates thigh
----- ____________ - flexes and adducts thigh
----- quadriceps femoris: (4)

thigh
leg
femoral nerve
Iliopsoas
Tensor fascia lata
Sartorius
Pectineus
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
(origin of vastus muscles: femur)

2

Origin of sartorius and tensor fascia lata

ASIS

3

Origin of rectus femoris

AIIS

4

Common insertion of iliacus and psoas

Lesser trochanter of the femur

5

Common insertion of quadriceps femoris

Patellar tendon

6

Most powerful flexor muscle of thigh

Iliopsoas

7

MEDIAL THIGH MUSCLES
- ____________ the thigh
- innervated by _________
- consists of: (4)
- common insertion of these muscles: ____________
- insertion of the hamstring part of adductor magnus: ___________

adducts
obturator nerve

adductor longus, adductor brevis, gracilis

linea aspera of the femur
adductor tubercle of the femur

8

POSTERIOR THIGH MUSCLES
- extensors of the ____________; flexors of the ___________
- innervated by the ____________
- consists of hamstring muscles: (4)
- common origin of these muscles: ____________

thigh
leg
sciatic nerve
semitendinosus, semimembranosus, biceps femoris, adductor magnus
ischial tuberosity

9

FEMORAL TRIANGLE
Boundaries
Superior: _________
Medial: __________
Lateral: __________
Floor: (3)

Contents: (4)

Boundaries
Superior: inguinal ligament
Medial: adductor longus
Lateral: sartorius
Floor: adductor longus, pectineus, iliopsoas

Contents: (4) N-A-V from lateral to medial
- femoral nerve and its branches
- femoral artery and its branches
- femoral vein and its tributaries
- femoral sheath and its contents

10

Thigh muscle with dual innervation

Adductor magnus (sciatic and obturator nerves)

11

______________
A funnel-shaped fascial tube formed by inferior prolongation of iliopsoas and transversalis fascia of the abdomen
Contents:
- lateral: femoral artery
- intermediate: femoral vein
- medial: femoral canal

Femoral sheath

12

FEMORAL VEIN CATHETERIZATION
Skin of the thigh below the inguinal ligament is innervated by the __________, which is blocked with a local anesthetic.
Femoral pulse (artery) is palpated midway between ASIS and symphysis pubis; the femoral vein lies immediately __________ to it.
At a site two fingerbreadths below the inguinal ligament, the needle is inserted into the femoral vein.

genitofemoral nerve
medial

13

True or False.
The femoral ring is a weak area in the anterior abdominal wall that normally admits the tip of the fifth digit. A femoral hernia appears as a mass, often tender in the femoral triangle.

True

14

ADDUCTOR CANAL
- a fascia tunnel in the thigh running from the apex of the femoral triangle to the adductor hiatus in the tendon of _____________
- BOUNDARIES
-- Anterior: ___________
-- Lateral: ____________
-- Posterior and medial: _____________
- Contents: (3)

adductor magnus
-- Anterior: sartorius
-- Lateral: vastus medialis
-- Posterior and medial: adductor longus/magnus

Femoral artery/vein
Saphenous nerve (branch of the femoral nerve)
Nerve to vastus medialis (branch of the femoral nerve)

15

GLUTEAL REGION
Muscles
- Superficial group: _____________ - extensor of the thigh
- Intermediate group: (2) - both abductor and medial rotator of thigh
- Deep group: (5) - lateral rotator of thigh
Common origin of gluteal muscles: ___________
Common insertion of gluteal muscles: ___________ except
gluteus maximus (gluteal tuberosity, iliotibial tract)
quadratus femoris (quadrate tubercle)

gluteus maximus
gluteus medius and minimus
piriformis, obturator internus, superior gemellus, inferior gemellus, quadratus femoris

16

MUSCLES THAT ACT AT THE HIP JOINT
Flexion:
Extension:
Adduction:
Abduction:
Medial rotation:
Lateral rotation:

MUSCLES THAT ACT AT THE HIP JOINT
Flexion: anterior compartment of the thigh
Extension: posterior compartment of thigh and gluteus maximus
Adduction: medial compartment of the thigh
Medial rotation and abduction: Gluteus medius and minimus
Lateral rotation: Piriformis, etc

17

Muscle which flexes, abducts, and medially rotates the thigh at the hip; arises from the ASIS; innervated by the superior gluteal nerve

Tensor fascia lata

18

_____________ gait
- pelvis sags on the side of unsupported limb
- (+) ______________ sign
- results from weakened __________ of the thigh by gluteus medius due to ______________ nerve injury

Waddling
Trendelenburg
abduction
superior gluteal

19

LUMBAR PLEXUS
- formed within the ___________ muscle by the __________ rami of ___________

Some branches:
______________ - supplies the skin of the lower part of the anterior abdominal wall; from L1; emerges from the lateral border of psoas and runs in front of quadratus lumborum
______________ - passes through the __________ to supply the skin of the groin and the scrotum / labia majora ; from _____; emerges from the lateral border of psoas and runs in front of quadratus lumborum
______________ - responsible for the cremasteric reflex; from ______; emerges from the ____________ surface of the psoas; divides into the ___________ branch (cremaster muscle) and the ____________ branch (skin of the thigh)

LUMBAR PLEXUS
- formed within the psoas major muscle by the ventral rami of L1-L4

Branches:
Iliohypogastric - supplies the skin of the lower part of the anterior abdominal wall; from L1; emerges from the lateral border of psoas and runs in front of quadratus lumborum
Ilioinguinal - passes through the inguinal canal to supply the skin of the groin and the scrotum / labia majora ; from L1; emerges from the lateral border of psoas and runs in front of quadratus lumborum
Genitofemoral - responsible for the cremasteric reflex; from L1 and L2; emerges from the anterior surface of the psoas; divides into the genital branch (cremaster muscle) and the femoral branch (skin of the thigh)

20

LUMBAR PLEXUS

Some branches:
____________ - supplies the skin over the lateral surface of the thigh; from _____; emerges from the lateral border of the psoas, crosses the iliacus and enters the thigh behind the inguinal ligament
____________ - largest branch of the lumbar plexus; supplies the muscles on the anterior thigh and skin on the antero-medial aspect; from ________; emerges from the lateral border of the psoas
____________ - supplies the medial thigh muscles and skin on the medial aspect of thigh; from ________; emerges from the _________ border of the psoas

LUMBAR PLEXUS

Some branches:
Lateral femoral cutaneous - supplies the skin over the lateral surface of the thigh; from L2-L3; emerges from the lateral border of the psoas, crosses the iliacus and enters the thigh behind the inguinal ligament
Femoral - largest branch of the lumbar plexus; supplies the muscles on the anterior thigh and skin on the antero-medial aspect; from L2-L4; emerges from the lateral border of the psoas
Obturator - supplies the medial thigh muscles and skin on the medial aspect of thigh; from L2-L4; emerges from the medial border of the psoas

21

Branch of the lumbar plexus which emerges from the anterior surface of the psoas

Genitofemoral nerve

22

Branch of the lumbar plexus which emerges from the medial border of the psoas

Obturator nerve

23

Largest branch of the lumbar plexus

Femoral nerve

24

LUMBOSACRAL PLEXUS
- lies on the posterior pelvic wall in front of the ___________ muscle
- formed by the anterior rami of ___________

Some Branches:
Sciatic nerve - L4-L5, S1-S3; innervate skin of the foot and leg and posterior thigh muscles
Superior gluteal nerve - innervates ___________
Inferior gluteal nerve - innervates ___________
Pudendal nerve - S2-S4
Pelvic splanchnic nerve - S2-S4

LUMBOSACRAL PLEXUS
- lies on the posterior pelvic wall in front of the piriformis muscle
- formed by the anterior rami of L4-L5, S1-S4

Some Branches:
Sciatic nerve - L4-L5, S1-S3; innervate skin of the foot and leg and posterior thigh muscles
Superior gluteal nerve - innervates gluteus medius and minimus
Inferior gluteal nerve - innervates gluteus maximus
Pudendal nerve - S2-S4
Pelvic splanchnic nerve - S2-S4

25

_______________ nerve injury
- waddling gait (pelvis says on the side of unsupported limb)
- (+) ___________ sign
- results to weakened ___________ of the thigh by ___________

Superior gluteal
Trendelenburg
abduction
gluteus medius

26

_______________ nerve lesion
- weakness in the ability to laterally rotate and extend the thigh at the hip joint
- difficulty expanding the thigh at the hip from a flexed position, as in climbing stairs or rising from a chair
- patients thrust their torso posteriorly in attempt to counteract the weakness of the _____________

Inferior gluteal
gluteus maximus

27

Sciatic nerve
- susceptible to damage from an IM injection in the __________ quadrant of the ____________ muscle or it may be compressed as a result of a ___________ dislocation of the femur
- _____ and _____ roots are commonly compressed

lower medial
gluteus maximus
posterior
L5, S1

28

Pyriformis syndrome
- piriformis muscle irritates and places pressure on the __________ nerve causing pain in the buttocks and referring pain along the course of the nerve.

sciatic

29

A basketball player fell on his left knee resulting into swelling and pain. A fracture of the patella will result in:
A. Difficulty in extending leg at the knee
B. Difficulty in flexing leg at the knee

Difficulty in extending leg at the knee

30

__________ nerve lesions
- weakness in the ability to flex the thigh at the hip
- weakness in the ability to extend leg at the knee
- diminished patellar tendon reflexes

Femoral

31

____________ nerve
- may be lesioned during a surgical procedure of the leg to remove part of the great saphenous vein or may be lacerated as it pierces the wall of the adductor canal
- lesion causes pain and paresthesia in the skin of the medial aspect of the leg and foot
- lesion causes no motor loss

Saphenous

32

____________ nerve
- most commonly lesioned in the pelvis
- lesion causes inability to abduct the thigh at the hip and paresthesia in the skin of the medial thigh

Obturator

33

Femur neck shaft angle changes
- young: ______
- adults: ______

160 degrees
120 degrees

34

_____________ is a deformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees. It is caused by a slipped epiphysis of the femoral head. Hip _____________ is limited.
_____________ is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. Hip _____________ is limited.

Coxa valga (increased angle)
adduction

Coxa vara (decreased angle)
abduction

35

Femoral shaft fracture in the upper third
- proximal fragment: flexed by _________, abducted by __________, and laterally rotated by ___________
- distal fragment: adducted by the adductor muscles, pulled upward by hamstrings and quadriceps

Femoral shaft fracture in the upper third
- proximal fragment: flexed by iliopsoas, abducted by gluteus medius, and laterally rotated by gluteus maximus
- distal fragment: adducted by the adductor muscles, pulled upward by hamstrings and quadriceps

36

Thigh with a femoral neck FRACTURE is shortened with ___________ rotation
Femoral neck fracture common in the elderly and in women after menopause: _________
Femoral neck fracture common in the young due to direct trauma: _________

Thigh with a DISLOCATION is shortened and ___________ rotated by the gluteus medius and minimus muscles. ____________ nerve may be compressed, resulting in weakness of muscles in the posterior thigh, leg, and foot and paresthesia over the posterior and lateral parts of the leg and dorsal and plantar surfaces of the foot.

lateral
Subcapital
Trochanteric

medially
Sciatic

37

Main blood supply to the hip joint

Medial circumflex femoral artery

38

ANTERIOR LEG MUSCLES
Tibialis anterior
Peroneus tertius
Extensor digitorum brevis
Extensor digitorum longus
Extensor hallucis longus

Nerve supply: _______
Actions:
- Dorsiflexion of the foot at the ankle joint
- Extension of the toes

Deep peroneal

39

LATERAL LEG MUSCLES
Peroneus/fibularis longus and brevis

Nerve supply: _________
Actions: Evertion and weak plantarflexion

Superficial peroneal nerve

40

POSTERIOR LEG MUSCLES
Superficial group: Gastrocnemius, plantaris, soleus
Deep group: Popliteus, flexor digitorum longus, flexor hallucis longus, tibialis posterior

Nerve supply: __________
Action: plantarflexion, flexion of toes

Gastrocnemius and soleus - collectively known as __________
Common insertion: ____________

Tibial nerve
Triceps surae
Achilles' tendon

41

Structures of the O' Donoghue Unhappy Triad (The Terrible Triad)

Anterior cruciate ligament
Medial/tibial collateral ligament
Medial meniscus

42

Muscle which unlocks the knee

Popliteus

42

________________
Boundaries
- Laterally: Biceps femoris above, lateral head of gastrocnemius below
- Medially: Semimembranosus and semtendinosus above, medial head of gastrocnemius below

Contents:
Popliteal vessels
Small saphenous vein
Common peroneal nerve
Tibial nerve
Posterior cutaneous nerve
Genicular branch of obturator nerve
Lymph nodes

POPLITEAL FOSSA

43

Components of triceps surae: _______
Common insertion of the component muscles: _______
Spinal root which mediates the Achilles' tendon: _______
Spinal root which mediates the patellar tendon: ______

Gastrocnemius, soleus
Achilles' tendon (calcaneal tendon)
S1
L4

45

ARTERIAL PALPATION

Dorsalis pedis artery
- laterally: tendons of the extensor digitorum longus
- medially: tendons of the extensor hallucis longus
- landmark: between malleoli or on ________________

Femoral artery
- behind the inguinal ligament midway between _________ and _________

Popliteal artery
- _____________ fully relaxed by passively flexing the knee joint

Posterior tibial artery
- behind ________ malleolus and beneath flexor retinaculum
- lies between tendon of FDL and FDH or midway between malleolus and heel

ARTERIAL PALPATION

Dorsalis pedis artery
- laterally: tendons of the extensor digitorum longus
- medially: tendons of the extensor hallucis longus
- landmark: between malleoli or on first intermetatarsal space

Femoral artery
- behind the inguinal ligament midway between ASIS and symphysis pubis

Popliteal artery
- popliteal space fully relaxed by passively flexing the knee joint

Posterior tibial artery
- behind medial malleolus and beneath flexor retinaculum
- lies between tendon of FDL and FDH or midway between malleolus and heel

46

Continuation of the external iliac artery:
___________ -> ____________ -> _____________ -> palmar arch

femoral artery -> popliteal artery -> anterior and posterior tibial arteries -> plantar arch

47

Great saphenous vein
- in front of the __________ malleolus
- drains into the ___________
- anterior to it is the __________ nerve
Small saphenous vein
- behind __________ malleolus
- drains into the ___________
- accompanied by the __________ nerve (branch of the tibial nerve)

medial
femoral vein
saphenous

lateral
popliteal vein
sural

48

Nerve for foot dorsiflexion: _____________
Nerve for plantarflexion: ______________
Nerve for eversion: ______________

deep peroneal nerve
tibial nerve
superficial peroneal nerve

49

____________________ Nerve
- most frequently injured nerve in the lower limb (from compression at _______ of fibula, hip fracture, dislocation of femur)
- "___________" - which results from a loss of dorsiflexion at the ankle and loss of eversion
- ___________ gait - raise the affected leg high off the ground and the foot slaps the ground when walking
- pain and paresthesia in the lateral leg and ___________ of the foot

Common peroneal/fibular
neck
foot drop
steppage
dorsum

50

______________ Nerve
- may be compressed in the anterior compartment of the leg
- may have foot drop and paresthesia in skin of the webbed space between _______ and _______

Deep peroneal/fibular
great toe, second toe

51

________________ Nerve
- may be injured as the nerve emerges from the lateral compartment
- pain and paresthesia in the dorsal aspect of the foot
- weakness in __________ of foot

Superficial peroneal/fibular
eversion

52

_____________ nerve lesion
- cannot stand on tiptoes
- paresthesia on skin of posterior leg, sole, and lateral foot
- In patients with the nerve lesion in the gluteal region (hip fracture, dislocation of femur), weakness may be evident in the ability to _______ at the knee and _______ at the ankle

Tibial nerve
flex
plantarflex

57

KNEE JOINT
- stabilized laterally by biceps and gastrocnemius tendons, iliotibial tract, and fibular collateral ligaments
- stabilized medially by sartorius, gracilis, semitendinosus, semimembranosus, gastrocnemius, and tibial collateral ligament
Intracapsular (cruciate) ligaments:
- _________ - attaches to the anterior aspect of the tibia and posteriorly and externally to attach to the lateral condyle of the femur
- _________ - attaches to the posterior aspect of the tibia and courses anteriorly and internally to attach to the medial condyle of the femur
Extracapsular ligaments:
- lateral/fibular collateral ligament
- medial/tibial collateral ligament
- patellar ligament (ligamentum patellae)
- oblique popliteal ligament

anterior cruciate ligament ("APEX" ligament)
posterior cruciate ligament ("PAIN" ligament)

58

Muscles for foot inversion (2)

Tibialis anterior and posterior

59

Most important group of muscles contributing to the strength of the knee joint

Quadriceps femoris

60

________________
- collapse of the lateral compartment of the knee and rupture of the medial collateral ligament

________________
- collapse of the medial compartment of the knee and rupture of the lateral collateral ligament

Genu valgum (knock knee)
Genu varum (bow leg)

61

ANKLE JOINT
- diarthrodial/synovial hinge joint
- bones: (3)
- medial / deltoid ligaments: (4)
- lateral ligaments: (3)

Acute Sprain on the Lateral Ankle
- excessive ____________ of the foot with _______________ of the ankle
- anterior ____________ and _____________ ligaments are partially torn

Acute Sprain on the Medial Ankle
- excessive ___________ of the foot
- medial or deltoid ligament torn

tibia, fibula, talus

tibionavicular, tibiocalcaneal, anterior tibiotalar, posterior tibiotalar

calcaneofibular, anterior talofibular, posterior talofibular

Acute Sprain on the Lateral Ankle
- excessive inversion of the foot with plantarflexion of the ankle
- anterior talofibular amd calcaneofibular ligaments are partially torn

Acute Sprain on the Medial Ankle
- excessive eversion of foot
- medial or deltoid ligament torn

62

________________
- foot is dorsiflexed at the ankle joint, everted at the midtarsal joints
________________
- foot plantarflexed at the ankle joint and inverted at the midtarsal joints
________________
- medial longitudinal arch is depressed or collapsed; foot is displaced laterally and everted
________________
- medial longitudinal arch is unduly high

Talipes calcaneovalgus
Talipes equinovarus

Pes planus (flat foot)
Pes cavus (claw foot)

63

At the ER, a 40 year old woman complains of weakness in lateral rotation of the thigh. This is likely due to paralysis of what muscle?
A. Pectineus
B. Gracilis
C. Gluteus medius
D. Obturator internus
E. Tensior fascia lata

D.

SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE: Pectineus - assists with medial rotation of the thigh; Gracilis - adducts the thigh, flexes leg and helps rotate it medially; Gluteus medius & minimus - abductor and medial rotator of the thigh; Tensor fascia lata - abducts, medially rotates and flexes thigh. Source: Topnotch Medical Board Prep Anatomy Handout Part 1 p. 11-12

64

"Muscle of the loin"

Psoas major

65

Large triangular muscle lateral to the psoas major

Iliacus

66

The lumbar plexus is formed within the ____________ muscle by the ventral rami of ________. Branches of the plexus emerge from the lateral and medial borders and from the ___________ surface of the ____________.

The lumbar plexus is formed within the psoas major muscle by the ventral rami of L1-L4. Branches of the plexus emerge from the lateral and medial borders and from the anterior surface of the psoas major.