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CABS > Lower Extremity > Flashcards

Lower Extremity Flashcards

1
Q

Where do the superficial veins of the LE originate and where do they empty?

A

Originate in dorsal venous arch of foot and empty into great saphenous vein (medial side of foot) and small saphenous vein (lateral side of foot)

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2
Q

What is the pathway of the greater saphenous vein?

A

Ascends anterior to medial malleolus, up medial leg, posteromedial knee, and anteromedial thigh passing through saphenous hiatus in fascia lata to empty into femoral vein

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3
Q

What does the great saphenous vein drain?

A

dorsum of foot, anterior leg, and anterior, lateral and medial thigh

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4
Q

What is the pathway of the small (lesser) saphenous vein?

A

ascends posterior to lateral malleolus, up middle of posterior leg to empty into popliteal vein

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5
Q

Both the great and small saphenous veins have connections to the deep veins of the leg via these kinds of veins. They convey blood from the superficial to the deep veins

A

Perforating veins

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6
Q

What is the role of the valves in the perforating veins?

A

They prevent back flow of blood from the deep veins into the superficial (greater and small saphenous) veins

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7
Q

How do varicose veins form?

A

Result of failure of valves of the perforating veins permitting blood from the deep veins to back flow into the superficial veins creating increased blood volume which create variscosities

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8
Q

The superficial lymph vessels accompany the superficial veins and terminate where?

A

The superficial inguinal lymph nodes

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9
Q

Where does the lymph of the superficial inguinal lymph nodes drain?

A

Into the external iliac lymph nodes and some into the deep inguinal lymph nodes

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10
Q

Where does the superficial inguinal lymph nodes drain lymph from?

A

superficial lower abdominal wall, external genitalia, perineum, buttocks and lower limb

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11
Q

The deep lymphatic vessels accompany the deep veins of the leg and drain into where?

A

The deep inguinal lymph nodes

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12
Q

Where are the deep inguinal lymph nodes (3 of them) located?

A

In the femoral canal, medial to the femoral vein

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13
Q

What nerve is a branch of the femoral nerve and accompanies the greater saphenous vein?

A

The saphenous nerve

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14
Q

What does the saphenous nerve innervate?

A

Provides cutaneous innervation on anterior and medial side of leg and medial foot

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15
Q

What nerve is formed from the tibial and common fibular nerves and accompanies small saphenous vein?

A

The sural nerve

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16
Q

What does the sural nerve innervate?

A

Provides cutaneous innervation on the posterior and lateral aspects of the leg and lateral foot

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17
Q

What nerve is a branch of the common fibular nerve?

A

Superficial fibular nerve

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18
Q

What does the superficial fibular nerve innervate?

A

Provides cutaneous innervation of inferior third of anterior leg and dorsum of foot

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19
Q

The deep fascia of the thigh is called

A

Fascia lata

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20
Q

The deep fascia of the leg is called

A

Crural fascia

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21
Q

What are the 3 specializations of the fascia in the thigh?

A
  1. iliotibial tract
  2. lateral intermuscular septum
  3. medial intermuscular septum
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22
Q

Thick band that stretches along lateral thigh from iliac crest to lateral condyle of tibia

A

Iliotibial tract (band)

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23
Q

What is the role of the lateral intermuscular septum?

A

separates the quad muscles from the hamstring muscles

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24
Q

What is the role of the medial intermuscular septum?

A

separates the quad muscles from the adductor muscles

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25
Q

What are the 3 specializations of the crural fascia?

A
  1. posterior intermuscular septum
  2. transverse intermuscular septum
  3. anterior intermuscular septum
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26
Q

What is the role of the posterior intermuscular septum?

A

separates the posterior (flexor) muscles from the lateral (fibular) muscles. Boundary between the posterior and lateral compartments of the leg

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27
Q

What is the role of the transverse intermuscular septum?

A

separates the deep posterior muscles from the superficial posterior muscles

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28
Q

What is the role of the anterior intermuscular septum?

A

separates the anterior (extensor) muscles from the lateral (fibular) muscles. Boundary between the anterior and lateral compartments

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29
Q

What are the borders of the femoral triangle?

A

inguinal ligament (superiorly), sartorius muscle (lateral), adductor longus (medial)

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30
Q

What are the contents of the femoral triangle (lateral to medial)?

A

Femoral nerve, artery, vein, and deep inguinal lymph node

NAVL

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31
Q

As the contents of the femoral triangle pass deep to the inguinal ligament they are enclosed within what?

A

except femoral nerve, enclosed in femoral sheath that is part of the transversalis fascia of abdominal wall

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32
Q

What are the compartments of the femoral sheath?

A

lateral: contains femoral artery
middle: contains femoral vein
medial: femoral canal, contains fat and deep inguinal lymph node (node of Cloquet)

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33
Q

Opening at the superior end of the femoral canal =

A

femoral ring

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34
Q

How does a femoral hernia present?

A

swelling is inferior to inguinal ligament

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35
Q

How does an inguinal hernia present?

A

swelling is superior to inguinal ligament

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36
Q

Catheterization of femoral artery is used for?

A

coronary angiography, percutaneous coronary transluminal angioplasty, and stent placement

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37
Q

Catheterization of the femoral vein is used for?

A

Swan-Ganz catheter for measurement of central venous pressure, pulmonary artery wedge pressure, and cardiac output

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38
Q

What are the risks of catheterization of the femoral artery and vein?

A

injury to femoral artery, femoral nerve, and formation of arteriovenous fistula

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39
Q

What are the risks of a subclavian approach to catheterization?

A

pneumothorax

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40
Q

What are the risk of an internal jugular approach to catheterization?

A

thromboembolism of internal carotid artery and subsequent stroke

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41
Q

What are the boundaries of the adductor canal?

A 
vastus medialis (lateral), adductor longus (posterior), and sartorius (medial)   
Roof formed by sartorius
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42
Q

What is the purpose of the adductor canal?

A

Serves as passageway for femoral vessels and saphenous nerve in middle third of thigh

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43
Q

What is the adductor hiatus?

A

Where the adductor canal ends and is an opening in the adductor magnus muscle that permits femoral vessels to travel from anterior thigh to posterior knee (popliteal region)

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44
Q

What is the major arterial supply of the thigh?

A

femoral artery

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45
Q

What is the major branch of the femoral artery and what does it supply?

A

deep femoral artery (profunda femoris)

supplies hip joint, proximal and posterior thigh and neck of femur

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46
Q

What are the branches of the deep femoral artery and what do they supply?

A

Medial circumflex femoral artery: hip joint via ascending and descending branches
Lateral circumflex femoral artery: lateral hip, thigh and knee

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47
Q

Where does the obturator artery supply?

A

medial thigh and hip and limited supply to head of femur

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48
Q

What is the supply and location of the obturator nerve (L2, L3, L4)?

A

supplies adductor muscles (injury = inability to adduct and flex thigh)
lies between adductor longus and brevis

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49
Q

What is the supply and location of the femoral nerve (L2, L3, L4)?

A

supplies quads, sartourius, iliopsoas, and pectinous (injury = inability to extend the leg and flex the thigh)
Lies superficial to psoas major

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50
Q

What are the 2 nerves that fuse together to form the sciatic nerve?

A

tibial and common fibular (peroneal) nerves

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51
Q

Where does the tibial nerve derive from?

A

anterior branches of L4-S3

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52
Q

Where does the common fibular nerve derive from?

A

posterior branches of L4-S2

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53
Q

Where does the sciatic nerve exit?

A

in the greater sciatic foramen passing under the piriformis muscle

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54
Q

Where is the safest location for IM injections in the buttocks?

A

superior lateral quadrant (upper outer) of the buttocks

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55
Q

Where does the sciatic nerve provide motor innervation?

A

flexors of the leg (hamstrings) and hamstring portion of the adductor magnus, and all the muscles of the leg and foot

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56
Q

What is the path and innervation of the superior gluteal nerve (L4-S1)?

A

through greater sciatic foramen passing superior to piriformis muscle
innervates gluteus medius and minimus and tensor fascia lata

57
Q

What is the path and innervation of the inferior gluteal nerve (L5-S2)?

A

through greater sciatic foramen passing inferior to piriformis muscle
innervates gluteus maximus

58
Q

What is the path and innervation of the pudendal nerve (S2, S3, S4)?

A

Exits pelvic cavity passing through greater sciatic foramen and then loops through lesser sciatic foramen entering perineum via pudendal canal
Motor innervation to muscles of perineum (external anal and urethral sphincters)
Primary sensory nerve to external genitalia

59
Q

What is the path and involvement of the pelvic splanchic nerves (S2-S4)?

A

travels to inferior hypogastric plexus

autonomic regulation of bladder and bowel function and sexual response

60
Q

What results in injury to sciatic nerve?

A

weak/absent extension of thigh, and/or flexion of the leg. Also have loss of innervation to leg and foot so have foot drop

61
Q

What is the action of the hamstrings?

A

extend the thigh and flex the leg

62
Q

What is the origin and insertion of the hamstring muscles/

A

origin: ischial tuberosity
insertion: tibia (semitendinosus and semimembranosus)
fibula (biceps femoris)

63
Q

What nerve innervates the short head of the biceps femoris?

A

Common fibular nerve

64
Q

What nerve innervates the adductor magnus muscle?

A

tibial nerve

65
Q

What are the actions of the gluteus medius and minimus muscles?

A

hip abductors and stabilizers of the pelvis when we walk

66
Q

What nerve innervates the gluteus medius and minimus?

A

superior gluteal nerve (positive Trendelenburg)

67
Q

What is a positive Trendelenburg?

A

pelvis drops on opposite side of the nerve injury (superior gluteal nerve)

68
Q

What is the action of the gluteus maximus muscle?

A

extends the thigh

69
Q

What will result if injury to the obturator nerve?

A

weak or absent thigh adduction and medial rotation

70
Q

What are the actions of the tensor fascia lata muscle?

A

flexes the thigh and fixes the femur of the tibia with standing

71
Q

What nerve innervates the tenor fascia lata?

A

superior gluteal nerve

72
Q

What is the action and innervation of the iliopsoas muscle?

A

chief hip flexor

innervated by L1 and L2 nerve roots and femoral nerve (L2, L3)

73
Q

What is the action, innervation, and insertion of the piriformis muscle?

A

lateral hip rotator
innervated by S1 and S2
insertion: greater trochanter of femur

74
Q

In general, where do all the hip lateral rotators and hip abductors insert?

A

greater trochanter

75
Q

Blood supply to the hip joint is largely via the ____

A

medial and lateral circumflex femoral arteries (branches of profunda femoris artery)

76
Q

Medial circumflex femoral artery supplies most of the blood via its ______

A

retinacular branches

77
Q

Fracture of the ______ may disrupt blood supply from the retinacular arteries resulting in _______ of the femoral head

A

femoral neck; avascular necrosis

78
Q

What artery provides small source of blood to head of femur?

A

Small branch of obtruator artery (artery to head of femur)

79
Q

What are the 3 ligaments of the hip joint and what are their actions?

A

Iliofemoral ligament: prevents hyperextension
Pubofemoral ligament: prevents overabduction
Ischiofemoral ligament: prevents hyperextension

80
Q

What are the primary stabilizers of the knee?

A

ACL, PCL, MCL, LCL, medial and lateral menisci, medial and lateral retinacula, and joint capsule

81
Q

These ligaments stabilize the knee in valgus and varus stress

A

MCL and LCL, respectively

82
Q

What are the secondary stabilizers of the knee?

A

IT band (tensor fascia lata), quads, hams, and popliteus muscles

83
Q

What is the action of the popliteus muscle?

A

locks the knee in full extension and unlocks the knee to initiate flexion

84
Q

What are the 3 articulations of the knee joint?

A

2 tibiofemoral and 1 patellofemoral

85
Q

What are the 5 extra capsular ligaments?

A
  1. Patellar ligament: distal quads to tibial tuberosity
  2. Fibular (lateral) collateral ligament: cordlike, connects lateral epicondyle of femur to head of fibula
  3. Tibial (medial) collateral ligament: flat band, attached to medial meniscus, connects medial epicondyle of femur to superior medial surface of tibia
  4. Oblique popliteal ligament: expansion of semimembranosus tendon
  5. Arcuate popliteal ligament: strengthens posterior fibrous capsule of joint
86
Q

What are the 2 intra-articular ligaments of the knee (but external to synovial cavity)?

A
  1. ACL: connects anterior intercondylar area of tibia with lateral condyle of femur
  2. PCL: connects posterior intercondylar area of tibia with medial condyle of femur
87
Q

What is the purpose of the 2 menisci?

A

fibrocartilagenous crescents that act as shock absorbers and improve fit between tibial and femoral condyles

88
Q

How much of the menisci is avascular and how much is vascular?

A

avascular (white zone injury) = central 2/3

vascular (red zone injury) = outer 1/3

89
Q

What is injured in the “terrible triad” or “unhappy triad” and what is the MOI?

A

ACL, MCL, and medial meniscus. Blunt force to lateral side of knee while knee is flexed and leg twisting with a plated foot.

90
Q

What does the knee rapidly swell after a ruptured ACL?

A

due to simultaneous rupture of tibial intracondylar artery, located on anterior surface of ACL

91
Q

What is the preferred allograft for ACL reconstruction?

A

Achilles tendon

92
Q

What is the preferred autograft for ACL reconstruction?

A

middle third of patellar tendon

quadrupled semiteninsus-gracilis tendon = fewer risks for patellar fx and post-operative anterior knee pain

93
Q

How is the PCL commonly injured?

A

landing on tibial tuberosity with knee flexed (basketball, head-on collisions)

94
Q

How is the medial meniscus commonly injured?

A

twisting injuries

95
Q

How many bursae are around the knee joint?

A

12 (3 superficial, 4 directly with synovial joint cavity)

96
Q

What are the 3 superficial bursa?

A 
Prepatellar
2 infrapatellar (subcutaneous and deep)
97
Q

What are the 4 bursa that communicate directly with the synovial joint cavity?

A
  1. suprapatellar: largest, infxns can spread
  2. anserine
  3. popliteus
  4. gastrocnemius
98
Q

What are the terms for pre patellar bursitis and infra patellar bursitis?

A 
prepatellar = "housemaid's knee"
infrapatellar = "clergyman's knee"
99
Q

What are the knee extensor muscles?

A

Quads: rectus femoris, vastus lateralis, medialis, intermedius

100
Q

What is the “5th quad muscle” and what is its action?

A

Articularis genu: articular muscle of the knee and is derivative of and deep to vastus intermedius. Pulls supra patellar bursa superiorly during knee extension to prevent pinching between the patella and femur.

101
Q

This tendon enclosed the patella and continues as the patellar ligament to insert into tibial tuberosity

A

Quadriceps tendon

102
Q

What is the purpose of the patella?

A

provides additional leverage for the quad muscles

103
Q

What are the knee flexors and also extenders of the thigh?

A

Hamstrings: biceps femoris (lateral attaching to fibula), semimembranosus, semitendinosus (medial attachment to tibia)

104
Q

What nerve innervates the hamstrings?

A

tibial division of sciatic nerve

105
Q

What is a hamstring strain?

A

tear of tendon at proximal attachment at ischial tuberosity (quick start sports)

106
Q

What 3 muscles inset at the pes anserinus (goose foot) on medial surface of tibia?

A

sartorius, gracilis, and semitendinosus

**flex leg at the knee

107
Q

Where is the pes anserine bursa lie?

A

deep to the tendons between the tendons and tibial bone

108
Q

What is the action of the plantaris muscle?

A

weakly assist gastroc in plantar flexion of the ankle and knee. Organ of proprioception for gastroc and source of tendon grafts during hand surgery

109
Q

What is the action of the popliteus muscle?

A

weak flexor of the knee. Rotates femur 5 degrees laterally on tibia to unlock knee from extension

110
Q

What are the superior boundaries of the popliteal fossa?

A

Formed by hamstring muscles: medially by semitendinosus and semimembranosus, laterally by biceps femoris

111
Q

What are the inferior boundaries of the popliteal fossa?

A

Formed by 2 heads of the gastroc

112
Q

What are the contents of the popliteal fossa?

A

small saphenous vein, popliteal arteries and veins and tibial and common fibular (peroneal) nerves

113
Q

What is the deepest structure of the popliteal fossa?

A

popliteal artery: continuation of femoral artery after it passes through adductor hiatus)

114
Q

The popliteal artery bifurcates into?

A

anterior and posterior tibial arteries

115
Q

This vein is superficial to the popliteal artery and receives the small saphenous vein. It becomes the femoral vein after passing through the adductor hiatus.

A

Popliteal vein

116
Q

What is the most superficial structure in the popliteal fossa?

A

tibial nerve

117
Q

Where does the sciatic nerve usually end and what does it divide into?

A

Ends at superior angle of popliteal fossa and separates into tibial and common fibular nerves

118
Q

Where does the tibial nerve innervate?

A

posterior compartment of leg and plantar aspect of foot

119
Q

Why is the common fibular nerve susceptible to injury?

A

Because it winds around head and neck of fibula in superficial position

120
Q

What results with impingement/injury to common fibular nerve?

A

Foot drop and steppage gait (weakening of muscles in anterior and lateral compartments of leg)

121
Q

What are the divisions of the common fibular nerve?

A

superficial fibular branch (lateral compartment of leg)

deep fibular branch (anterior compartment of leg)

122
Q

What muscles and their actions in the anterior compartment of the leg?

A

tib anterior, extensor hallucis longus, extensor digitorum longus, and fibularis tertius
They dorsiflex and invert the foot at the ankle

123
Q

What artery supplies blood to the anterior compartment of the leg?

A

Anterior tibial artery

124
Q

What is the mnemonic for the structures in the anterior compartment of the leg from medial to lateral?

A

Tom, Harry, Dick AND Fred
tib anterior, extensor Hallucis longus, extensor Digitorum longus, anterior tibial Artery, deep fibular Nerve, and Fibularis tertius

125
Q

What is compressed in anterior compartment syndrome?

A

deep fibular nerve (loss of sensation between 2nd and great toes) and anterior tibial artery
Paralysis of muscles results in foot drop

126
Q

What muscles comprise the lateral compartment of the leg and what are their actions?

A

fibularis (peroneus) longus, fibularis (peroneus) brevis (brevis is deep to longus)
Actions: evert the foot and assist in plantar flexion

127
Q

What is the arteriol supply and nerve innervation of the lateral compartment of the leg?

A 
Fibular artery (branch of posterior tibial artery)
Superficial fibular nerve
128
Q

What separates the superficial and deep posterior compartments of the leg?

A

transverse intermuscular septum

129
Q

What muscles are in the superficial posterior compartment of the leg and what are their actions?

A

gastroc, plantaris, and soleus (insert into calcaneus via calceneal (Achilles) tendon)
plantar flex the foot

130
Q

What is the blood supply to the gastroc and soleus muscles?

A

posterior tibial artery

131
Q

What are the muscles and their actions of the deep posterior compartment of the leg?

A

Popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior

132
Q

At midcalf, what is the position of the muscles of the deep posterior compartment of the leg?

A

Tib posterior is in the middle
Flexor digitorum longus is medial
Flexor hallucis longus is lateral

133
Q

What artery supplies the flexor hallucis longus, flexor digitorum longus, and tib posterior muscles?

A

Posterior tibial artery

134
Q

What is the order of the muscles, artery, and nerve of the deep posterior compartment of the leg at the medial malleolus?

A

Tom, Dick, ANd Harry (from anterior to posterior)

135
Q

What are the actions of each of the muscles in the deep posterior compartment of the leg?

A

tib posterior: foot inversion
flexor hallucis longus: flex distal phalanx of great toe
flexor digitorum longus: flex distal phalanx of lateral 4 toes
**all also contribute to plantar flexion of foot

136
Q

The popliteal artery bifurcates into _____?

A

anterior and posterior tibial arteries

137
Q

What does the anterior tibial artery supply and what is its route?

A

supplies anterior compartment of leg

becomes dorsalis pedis artery as enters dorsum of foot

138
Q

What does the posterior tibial artery supply and what is its route?

A

supplies posterior compartments of leg
gives off branch, fibular artery that supplies lateral compartment of leg
Travels behind medial malleolus into sole of foot

CABS (3 decks)

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