Flashcards in Lower Limb 1 and 2 Deck (103)
Describe the venous drainage of the lower limb
Superficial and deep veins
What are the superficial veins of the lower limb?
Great and small saphenous vein
How is the great saphenous vein formed?
From the dorsal venous arches of the foot and the dorsal vein of the big toe
What is the course of the great saphenous vein?
Ascends up the medial aspect of the leg, passing anteriorly to the medial malleolus at the ankle and posterior to the medial condyle at the knee
How is the small saphenous vein formed?
Dorsal venous arch of the foot and the dorsal vein of the little toe
What is the course of the small saphenous vein?
It moves up the posterior aspect of the leg, passing posteriorly to the lateral malleolus, along the lateral border of the calcanea tendon and moves between the two heads of the gastrocnemius and empties into the popliteal vein in the popliteal fossa
Describe the deep veins of the leg
They accompany the major arteries in the limbs
What is the significance of venous stasis in the leg
Common cause of thrombosis
What are some causes of venous stasis?
Muscular inactivity or external pressure on veins
Describe the lymphatics of the lower limb
Two categories: deep and superficial
What are the groups of deep lymph nodes in the lower limb?
1. Deep inguinal
What is the group of superficial lymph nodes in the lower limb?
1. Superficial inguinal
Where do lymph vessels following the great and small saphenous veins drain into respectively?
Great saphenous - Superficial inguinal
Small saphenous - Popliteal
How is the acetabulum well adapted to its role?
Lined with a fibrocartilage collar called the labrum that is thicker in weight bearing areas
Outline the ligaments of the hip joint
Iliofemoral ligament and pubofemoral ligament
What is the function of the ligaments of the lower limb
Iliofemoral ligament - prevents hyperextension
Pubofemoral ligament - prevents hyperabduction
How is the arrangement fo the hip ligaments protective the hip while extended?
Spiral formation tightens the joint when the limb is extended
What compartment of the lower limb allows for flexion at the hip?
Anterior (flexor) compartment
Name the flexors of the hip
Iliopsoas (main flexor)
Outline the course and innervation of the iliopsoas muscle
Formed by the iliacus and psoas muscles
Originates from the lumbar vertebrae and attach to the lesser trochanter of the femur
Innervated by the anterior rami of L1-L3, iliacus by the femoral nerve
Outline the course and innervation of the pectineus muscle
Originates from the pectineal lines of the pubis and runs inferno-posteriorly to the pectineal line of the femur
Outline the course and innervation of the sartorius muscle
Originates from the ASIS to the medial aspects of the superior tibia
Outline the course and innervation of the rectus femoris muscle
Originates from the ileum and inserts into the patella by way of the quadriceps tendon
List the extensor muscles of the extensor compartment of the lower limb
Gluteus maximus, hamstrings
Outline the course and innervation of the Glut. max muscle
Originates from the gluteal aspect of the ileum, sacrum and coccyx and inserts into the iliotibial tract
Inferior gluteal nerve
What three muscles comprise the hamstrings?
From lateral to medial:
Outline the course and innervation of the hamstring muscle
All originate from the ischial tuberosity (except for short head of the biceps femoris)
BIceps femrois - inserts into the head of the fibula
Semitentinosus - inserts into the medial surface of the tibia
Semimembranosus - inserts into the medial tibial condyle
All innervated by branches of the sciatic nerve
What muscles comprise the medial (adductor) compartment of the lower limb?
Outline the course and innervation of the adductor magnus muscle
Originates from the inferior pubic rams and ischial rami and attaches to the line aspera of the femur
Outline the course and innervation of the adductor longus muscle
Originates on the pubis and attaches to the line aspera broadly
Outline the course and innervation of the adductor brevis muscle
Originates from the body of the inferior ramps of the pubis and inserts into the posterior aspect of the line aspera
Outline the course and innervation of the obturator externus muscle
Originating from the membrane of the obturator foramen and passes behind the neck of the femur and attaches to the posterior aspect of the greater trochanter
Outline the course and innervation of the gracililis muscle
The most superficial and medial muscle in the compartment; it originates from the pubic bone and runs directly inferiorly to the medial surface of the tibia
What is there in the lower limb instead of a designated abductor/lateral compartment?
Deep gluteal muscles function as abductors due to their attachment to the greater trochanter of the femur
What are the deep gluteal muscles which abduct/medially rotate the lower limb?
Tensor fascia lata
Outline the course and innervation of the Glut. medius muscle
Originates from the gluteal surface of the ileum and inserts to the lateral surface of the greater trochanter of the femur
Superior gluteal nerve
Outline the course and innervation of the Glut. minimus muscle
Originates from the ileum and converges into a tendon which inserts into the anterior part of the greater trochanter of the femur
Superior gluteal nerve
Outline the course and innervation of the tensor fascia lata muscle
Originating from the iliac crest, attaching to the ASIS and finally inserting into the iliotibial tract
Superior gluteal nerve
Why are the lower limb abductors essential for normal gait?
When a limb is lifted, that side of the pelvis becomes unsupported and it is the contralateral abductors that prevent this
What rotator muscles lie inferiorly to the glut. maximus?
Piriformis and obturator internus
Where do piriformis and obturator internus arise from?
From the inner pelvis via the greater and lesser sciatic foramen to attached to the greater trochanter of the femur
What two smaller muscles accompany obturator interns tendon?
Gemelli and quadrates femoris
What is the main muscles of the anterior thigh?
What are the four parts of the quadriceps femoris?
What are the movements made possible by the rectus femoris?
Flexion of the hip as well as extension fo the knee
What are the heads of the quadriceps innervated gy?
Outline the course of the quadriceps?
Four parts unite to form a single tendon proximal to the patella which then continues as the patellar ligament distal to the patella and inserts at the tibial tuberosity
Describe the sartorius muscle
A long ribbon like muscle and most superficial in the anterior thigh acting on both the hip and the knee
Where does the obturator nerve emerge from the pelvis?
Obturator canal in obturator foramen
What hiatus is a feature of the adductor magnus?
What is transmitted through the adductor hiatus?
Femoral artery and vein
The femoral vein is a continuation of what vein?
In relation to the inguinal ligament how does the femoral vein pass?
What is the largest branch of the lumbar plexus?
What muscles does the femoral nerve supply?
Pectineus, iliacus, sartorius, quadratus femoris
What is the femoral triangle?
Equivalent of the axilla in the lower limb
What are the borders of the femoral triangle?
Superior - formed by the inguinal ligament
Medial - formed by the medial border of the adductor longus
Lateral - formed by the medial border of the sartorius
Floor - pectineus, iliopsoas, adductor longus muscle
Roof - tensor fascia lata
What are the contents of the femoral triangle?
Nerve, Artery, Vein, Empty space, Lymph canal
Vein and artery are in their own fascial sheath called the femoral sheath
What is the adductor canal?
As the femoral neurovascular structures leave the apex of the femoral triangle they move deep creating the adductor canal and emerges into the popliteal canal
The contents of the adductor canal is slightly different to the femoral triangle, what are they?
Femoral artery and vein, nerve to the vests medialis, saphenous nerve (largest cutaneous branch of the femoral nerve)
What structure does the lumbar plexus emerge from?
Psoas major on the posterior abdominal wall
What are the two major nerve of the lumbar plexus?
Obturator nerve and femoral nerve
What are the segmental root values for the lumbar plexus?
L-L5, and also T12
What are the segmental root values for the obturator n.s?
L2-L4 innervating the medial (adductor) compartment )
What are the segmental root values for the femoral nerve?
L2-L4 innervating the anteiror comaprtment of the thigh
Wha tis the pelvic girdle?
Bony ring consisting of the sacrum, right andleft iliac bones and joined anteriorly by the pubic symphysis and posteriorly by the sacroiliac joints
What two important ligaments attach to the ischium?
Sacrospinous ligament and Sacrotuberous ligament
Outline the course of the sacropsinous ligament?
Runs from ischial spine to the sacrum
What foramen is defined by the sacrospinous ligament?
Greater sciatic foramen
Outline the course of the sacrotuberous ligament?
Runs from the sacrum to the ischial tuberosity
What foramen is defined by the sacrotuberous ligament?
Lesser sciatic formamen
The muscles of the gluteal region can be divided into what two groups?
Superficial abductors and extenders
Deep lateral rotators
What are the superficial abductors and extenders of the gluteal region?
Group of large muscles including glut. maximus, medium, minimum and tensor fascia lata
What are the deep lateral rotators of the gluteal region?
Smaller muscles that laterally rotate the femur, Quadratus femoris, piriformis, gemelli, obturator internus
What is the name given to the deep fascia of the thigh?
Whatstructure do the longitudinal fibrs of the fascia alta form?
What is the function fo the iliotibial tract?
Serves as the attachment for the gluteus maximus and tensor fascia lata
What is teh sacral plexus?
Formed from the union of the ventral rami of spinal nerves L4 and L5 as well as S1-S4
What are the main branches of the sacral plexus?
Sciatic nerve and pudendal nerve
What are the segmental root values for the gluteal nerves?
Superior - L4-S1
Inferior - L5-S2
What are the branches of the sacral plexus?
Sciatic nerve, pudendal nerve, piriformis nerve, posterior femoral cutaneous nerve, quadratus femoris, obturator nerve, levator ani nerve, coccygeus nerve
What structure does the sciatic nerve pierce as it appears from the gluteal region?
What is the function fo the sciatic nerve?
Innervates the posterior compartment of the thigh and its terminal branches innervate the foot and lower leg
What are the movements available at the knee?
Flexion and extension (as well as some small passive rotation)
What are the articular surfaces of the knee?
1. Medial and alteral condyles of the femur
3. Posterior surface of the patella
What bone of the leg is not involved in the knee joint?
What muscle is particularly involved in knee stabilisation?
Describe the lateral (fibular) collateral ligament of the knee
Extends from the lateral condyle of the femur to the lateral epicondyle of the head of the fibula
Describe the medial (tibial) collateral ligament of the knee
Extends from the medial epichondyle of the femur to the medial meniscus of the upper part of the medial surface of the tibia
What structure run deep to the LCL?
Tendons of the popliteal muscle - separatingit from the lateral meniscus
Describe the anterior cruciate ligament of the knee
attaches to the anterior interchondylar region fo the tibial and blends with the medial meniscus
Ascends posteriorly to attach to the femur in the interchondylar fossa
What is the function of the ACL?
Prevent anterior dislocation of the tibia onto the femur
Describe the posterior cruciate ligament of the knee
Attaches to her posterior interchondyla region of the tibia and ascends anteriorly to attach the anteromedial femoral condyle
What is the function of the PCL?
Prevents posterior dislocation of the tibia onto the femur
What is the function fo the menisci in the knee?
provide a cushion to the articular surfaces of both the femur and the tibia
What muscles illicit flexion of the knee?
Hamstrings, gracilis, sartorius, popliteus
What muscles illicit extension of the knee?
What are the bursae around the knee?
Suprapatellar, prepatellar, infrapatellar, semimembranous
Describe the suprapatellar bursa
An extension fo the joint capsule between the femur and the quadratus femoris
Describe the infrapatellar bursa
Located between the patellar bone and the skin
Describe the infrapatellar bursa
Split into deep and superficial
Deep - between the tibia and patellar ligament
Superficial - between the patella ligament and the skin
Describe the semimembranous bursa
Located posteirorly to the knee bertween the semimembranousus muscle and the medial head of the gastrocnemius