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Flashcards in Lower Limb 1 and 2 Deck (103)
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1

Describe the venous drainage of the lower limb

Superficial and deep veins

2

What are the superficial veins of the lower limb?

Great and small saphenous vein

3

How is the great saphenous vein formed?

From the dorsal venous arches of the foot and the dorsal vein of the big toe

4

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

5

How is the small saphenous vein formed?

Dorsal venous arch of the foot and the dorsal vein of the little toe

6

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

7

Describe the deep veins of the leg

They accompany the major arteries in the limbs

8

What is the significance of venous stasis in the leg

Common cause of thrombosis

9

What are some causes of venous stasis?

Muscular inactivity or external pressure on veins

10

Describe the lymphatics of the lower limb

Two categories: deep and superficial

11

What are the groups of deep lymph nodes in the lower limb?

1. Deep inguinal
2. Popliteal

12

What is the group of superficial lymph nodes in the lower limb?

1. Superficial inguinal

13

Where do lymph vessels following the great and small saphenous veins drain into respectively?

Great saphenous - Superficial inguinal
Small saphenous - Popliteal

14

How is the acetabulum well adapted to its role?

Lined with a fibrocartilage collar called the labrum that is thicker in weight bearing areas

15

Outline the ligaments of the hip joint

Iliofemoral ligament and pubofemoral ligament

16

What is the function of the ligaments of the lower limb

Iliofemoral ligament - prevents hyperextension

Pubofemoral ligament - prevents hyperabduction

17

How is the arrangement fo the hip ligaments protective the hip while extended?

Spiral formation tightens the joint when the limb is extended

18

What compartment of the lower limb allows for flexion at the hip?

Anterior (flexor) compartment

19

Name the flexors of the hip

Iliopsoas (main flexor)
Pectineus
Sartorius
Rectus femoris

20

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

21

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

Femoral nerve

22

Outline the course and innervation of the sartorius muscle

Originates from the ASIS to the medial aspects of the superior tibia

Femoral nerve

23

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

Femoral nerve

24

List the extensor muscles of the extensor compartment of the lower limb

Gluteus maximus, hamstrings

25

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

26

What three muscles comprise the hamstrings?

From lateral to medial:

Biceps femoris
Semitendinosus
Semimembranosus

27

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

28

What muscles comprise the medial (adductor) compartment of the lower limb?

Adductor magnus
Adductor longus
Adductor brevis
Obturator externus
Graciilis

29

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

Obturator nerve

30

Outline the course and innervation of the adductor longus muscle

Originates on the pubis and attaches to the line aspera broadly

Obturator nerve

31

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

Obturator nerve

32

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

Obturator nerve

33

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

Obturator nerve

34

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

35

What are the deep gluteal muscles which abduct/medially rotate the lower limb?

Glut. med
Glut. mini
Tensor fascia lata

36

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

37

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

38

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

39

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

40

What rotator muscles lie inferiorly to the glut. maximus?

Piriformis and obturator internus

41

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

42

What two smaller muscles accompany obturator interns tendon?

Gemelli and quadrates femoris

43

What is the main muscles of the anterior thigh?

Quadriceps femoris

44

What are the four parts of the quadriceps femoris?

Rectus femoris
Vastus medialis
Vastus intermedialis
Vastus lateralis

45

What are the movements made possible by the rectus femoris?

Flexion of the hip as well as extension fo the knee

46

What are the heads of the quadriceps innervated gy?

Femoral nerve

47

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

48

Describe the sartorius muscle

A long ribbon like muscle and most superficial in the anterior thigh acting on both the hip and the knee

49

Where does the obturator nerve emerge from the pelvis?

Obturator canal in obturator foramen

50

What hiatus is a feature of the adductor magnus?

Adductor hiatus

51

What is transmitted through the adductor hiatus?

Femoral artery and vein

52

The femoral vein is a continuation of what vein?

Popliteal vein

53

In relation to the inguinal ligament how does the femoral vein pass?

Deep

54

What is the largest branch of the lumbar plexus?

Femoral nerve

55

What muscles does the femoral nerve supply?

Pectineus, iliacus, sartorius, quadratus femoris

56

What is the femoral triangle?

Equivalent of the axilla in the lower limb

57

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

58

What are the contents of the femoral triangle?

Hint: NAVEL

Nerve, Artery, Vein, Empty space, Lymph canal

Vein and artery are in their own fascial sheath called the femoral sheath

59

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

60

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)

61

What structure does the lumbar plexus emerge from?

Psoas major on the posterior abdominal wall

62

What are the two major nerve of the lumbar plexus?

Obturator nerve and femoral nerve

63

What are the segmental root values for the lumbar plexus?

L-L5, and also T12

64

What are the segmental root values for the obturator n.s?

L2-L4 innervating the medial (adductor) compartment )

65

What are the segmental root values for the femoral nerve?

L2-L4 innervating the anteiror comaprtment of the thigh

66

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

67

What two important ligaments attach to the ischium?

Sacrospinous ligament and Sacrotuberous ligament

68

Outline the course of the sacropsinous ligament?

Runs from ischial spine to the sacrum

69

What foramen is defined by the sacrospinous ligament?

Greater sciatic foramen

70

Outline the course of the sacrotuberous ligament?

Runs from the sacrum to the ischial tuberosity

71

What foramen is defined by the sacrotuberous ligament?

Lesser sciatic formamen

72

The muscles of the gluteal region can be divided into what two groups?

Superficial abductors and extenders

Deep lateral rotators

73

What are the superficial abductors and extenders of the gluteal region?

Group of large muscles including glut. maximus, medium, minimum and tensor fascia lata

74

What are the deep lateral rotators of the gluteal region?

Smaller muscles that laterally rotate the femur, Quadratus femoris, piriformis, gemelli, obturator internus

75

What is the name given to the deep fascia of the thigh?

Fascia lata

76

Whatstructure do the longitudinal fibrs of the fascia alta form?

Iliotibial tract

77

What is the function fo the iliotibial tract?

Serves as the attachment for the gluteus maximus and tensor fascia lata

78

What is teh sacral plexus?

Formed from the union of the ventral rami of spinal nerves L4 and L5 as well as S1-S4

79

What are the main branches of the sacral plexus?

Sciatic nerve and pudendal nerve

80

What are the segmental root values for the gluteal nerves?

Superior - L4-S1

Inferior - L5-S2

81

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

82

What structure does the sciatic nerve pierce as it appears from the gluteal region?

Pririformis

83

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

84

What are the movements available at the knee?

Flexion and extension (as well as some small passive rotation)

85

What are the articular surfaces of the knee?

1. Medial and alteral condyles of the femur
2. Tibia
3. Posterior surface of the patella

86

What bone of the leg is not involved in the knee joint?

Fibula

87

What muscle is particularly involved in knee stabilisation?

Vastus medialis

88

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

89

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

90

What structure run deep to the LCL?

Tendons of the popliteal muscle - separatingit from the lateral meniscus

91

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

92

What is the function of the ACL?

Prevent anterior dislocation of the tibia onto the femur

93

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

94

What is the function of the PCL?

Prevents posterior dislocation of the tibia onto the femur

95

What is the function fo the menisci in the knee?

provide a cushion to the articular surfaces of both the femur and the tibia

96

What muscles illicit flexion of the knee?

Hamstrings, gracilis, sartorius, popliteus

97

What muscles illicit extension of the knee?

Quadriceps

98

What are the bursae around the knee?

Suprapatellar, prepatellar, infrapatellar, semimembranous

99

Describe the suprapatellar bursa

An extension fo the joint capsule between the femur and the quadratus femoris

100

Describe the infrapatellar bursa

Located between the patellar bone and the skin

101

Describe the infrapatellar bursa

Split into deep and superficial

Deep - between the tibia and patellar ligament
Superficial - between the patella ligament and the skin

102

Describe the semimembranous bursa

Located posteirorly to the knee bertween the semimembranousus muscle and the medial head of the gastrocnemius

103

Inflammation fo the semimembranous bursa causes what pathology?

Baker's cyst