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Lower Limb Flashcards

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1
Q

List the innominate hip bones

A
  1. Ilium
  2. Pubis
  3. Ischium
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2
Q

What cartilage unites the hip bones at the acetabulum in infants

A

Triradiate cartilage

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3
Q

List the bones of the pelvic girdle

A
  1. Ilium
  2. Pubis
  3. Ischium
  4. Sacrum
  5. Coccyx
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4
Q

What structures are attached to the ASIS

A
  • Inguinal ligament

- Sartorius

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5
Q

What structure is attached to the iliac fossa

A

Iliacus

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6
Q

List the components of the pubis

A
  1. Body
  2. Superior ramus
  3. Inferior ramus
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7
Q

What structures are attached to the inferior pubic ramus

A
  • Adductors
  • Perineal muscles
  • Perineal membrane
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8
Q

List the components of the ischium

A
  1. Superior ischial ramus
  2. Body of ischium
  3. Inferior ischial ramus
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9
Q

Where is the ischial spine situated

A

Posterior border of the body of the ischium (separates greater and lesser sciatic notch)

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10
Q

What structures attach to the ischial tuberosity and lower body of ischium

A
  • Hamstrings

- Short external rotators (except piriformis)

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11
Q

Number of vertebrae forming the sacrum

A

5

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12
Q

What comprises the anterior aspect of the sacrum

A
  • Central mass
  • Row of four anterior sacral foramina
  • Lateral mass
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13
Q

What muscles attach to the sacrum and where

A
  • Piriformis = originates from S2-4 of the anterior surface
  • Coccygeus = inserts on the lower sacrum
  • Iliacus = primarily arises from iliac fossa but also has fibres originating from the ala of the sacrum
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14
Q

What separates the greater and lesser pelvis

A

Oblique plane of the pelvic inlet = pelvic brim

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15
Q

Borders of the pelvic brim

A
  • Posterior = sacral promontory and sacral wings (ala)
  • Lateral = arcuate line of ileum, pectineal line on superior pubic ramus
  • Anterior = pubic symphysis
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16
Q

What forms the pubic arch

A

Ischiopubic rami (conjoined inferior rami of pubis and ischium) and pubic symphysis

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17
Q

Borders of the pelvic outlet

A
  • Posterior = tip of coccyx
  • Lateral = ischial tuberosities and inferior margin of sacrotuberous ligament
  • Anterior = pubic arch
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18
Q

What ligaments support the symphysis pubis

A
  • Superior pubic ligament

- Inferior pubic ligament

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19
Q

What type of joint is the pubic symphysis

A

Secondary cartilaginous joint

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20
Q

What type of joint is the Sacroiliac joint

A

Diarthrodial synovial joint

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21
Q

List the ligaments of the sacroiliac joint

A
  1. Posterior sacroiliac
  2. Ilio-lumbar
  3. Sacro-tuberous
  4. Sacrospinous
  5. Anterior sacroiliac
  6. Interosseous sacroiliac
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22
Q

Attachments of the ilio-lumbar ligaments

A

Transverse processes of L5 and iliac crests

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23
Q

Attachments of the sacro-tuberous ligaments

A

Ischial tuberosity to sacrum and coccyx

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24
Q

Attachments of sacrospinous ligament

A

Lateral sacrum and coccyx to ischial spine (divides sciatic foramen)

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25
Attachments of the interosseous sacroiliac ligaments
Lies deep between the tuberosities of the sacrum and ileum
26
Posterior relations of the pubic symphysis
- Urethra | - Deep dorsal vein of penis
27
Orientation of the femoral head
Upward, medial and anterior
28
Where does the ligamentum teres insert
Central fovea of the femoral head
29
Angle of the femoral neck
125 degrees (less in females)
30
Length of femoral neck
5cm
31
Length of femur
45cm
32
What marks the junction between femoral neck and shaft
- Anterior = intertrochanteric line - Lateral = GT - Medial and posterior = LT - Posterior = trochanteric crest
33
Where is the linea aspera situated
Posterior middle 1/3rd of femur
34
What does the linea aspera split into superiorly
- Medial = pectineal line | - Lateral = gluteal tuberosity
35
What does the linea aspera split into inferiorly
Medial and lateral supracondylar ridges
36
How does the medial supracondylar ridge end
Adductor tubercle
37
Which of the femoral condyles is more prominent and why
Lateral - prevents lateral displacement of the patella
38
Outline the blood supply of the femoral head
1. Retinacular vessels (from medial circumflex artery from deep femoral) 2. Ligamentum teres (from obturator)
39
What causes significant bleeding on femoral shaft fractures
Perforating branches of profunda femoris
40
What can cause bleeding in supracondylar femoral fractures
Popliteal artery
41
What type of bone is the patella
Sesamoid bone
42
Which facet of the patella is larger
Lateral
43
Describe the proximal tibia
- Expanded medial and lateral condyles (medial largest) | - Intercondylar eminence
44
Cross-sectional shape of tibia
Triangular
45
Where is the soleal line situated
Upper end of posterior surface of tibia
46
What forms a groove on the posterior aspect of the medial malleolus
Tendon of tibialis posterior
47
What forms a groove on the posterior aspect of the lateral malleolus
Tendons of: - Peroneus longus - Peroneus brevis
48
What structure is at risk from damage to the neck of the fibula
Common peroneal nerve
49
List the bones forming the proximal row of tarsal bones
1. Talus 2. Navicular 3. Calcaneum
50
List the bones forming the distal row of tarsal bones
1. Cuboid (laterally) | 2. Three cuneiforms
51
Describe the shape of the upper border of the talus
Widest at the front to give greatest stability in dorsiflexion
52
What forms a groove on the posterior surface of the talus
Tendon for flexor hallucis longus
53
Describe the posterior surface of the calcaneus
- Middle = roughened for insertion of calcaneal tendon - Upper = smooth where bursa between calcaneal tendon and bone lies - Lower = covered with fibro-fatty pad of the heel
54
List the articulations of the calcaneus
1. Superior = talus | 2. Anterior = cuboid
55
List the articulations of the navicular
1. Posterior = talus | 2. Anterior = 3 cuneiforms
56
What muscle inserts into the navicular tuberosity
Tibialis posterior
57
Describe the course of the spring ligament
Susternaculum tali of the calcaneum to the tuberosityof the navicular
58
What travels in the groove on the undersurface of the cuboid
Peroneus longus tendon
59
What forms the transverse arch of the foot
- Border of anterior tarsus and posterior metatarsus | - Cuneiforms narrow inferiorly to give the shape of the arch
60
What forms the lateral component of the longitudinal arch of the foot
- Posterior calcaneum - Cuboid - Lateral 2 metatarsal bones
61
What forms the medial component of the longitudinal arch of the foot
- Posterior calcaneum - Head of talus (summit) - Navicular - 3 cuneiforms - Medial 3 metatarsal bones
62
Name of deep fascia of the thigh
Fascia lata
63
Superior connections of the Fascia lata
- Inguinal ligament/pubic arch/body of pubis/pubic tubercle - Iliac crest - Sacrum/coccyx/sacrotuberous ligament/ischial tuberosity/ischiopubic ramus
64
What is the Fascia lata continuous with superiorly
Scarpa's fascia of the anterolateral abdominal wall (at a fingers width below the inguinal ligament)
65
What forms the iliotibial tract
Shared aponeurosis of the tensor fascia lata and gluteus maximus muscles (extends from iliac tubercle to anterolateral tubercle of tibia)
66
Where do the intermuscular septum insert in the leg
Linea aspera
67
List the muscles of the medial compartment of the thigh
- Obturator externus - Adductor magnus - Adductor brevis - Adductor longus - Pectineus - Gracilis
68
List the muscles of the anterior compartment fo the thigh
- Vastus medialis - Vastus intermedius - Vastus lateralis - Rectus femoris - Sartorius
69
List the muscles of the posterior compartment of the thigh
- Semitendinosus - Semimembranosus - Biceps femoris
70
Where is the saphenous opening
- Within the fascia lata - 4cm inferolateral to the pubic tubercle - Superior margin is formed by the falciform margin
71
Contents of the saphenous opening
- Great saphenous vein | - Superficial inguinal nodes
72
What artery and nerve supply the anterior compartment of the leg
- Deep peroneal nerve | - Anterior tibial artery
73
List the muscles of the anterior compartment of the leg
- Tibialis anterior - Extensor hallucis longus - Extensor digitorum longus - Peroneus tertius
74
What artery and nerve supply the lateral compartment of the leg
- Superficial peroneal nerve | - Peroneal artery
75
List the muscles of the lateral compartment of the leg
- Peroneus longus | - Peroneus brevis
76
What artery and nerve supply the posterior compartment of the leg
- Tibial nerve | - Posterior tibial artery
77
What separates the posterior compartment of the leg into deep and superficial plantarflexor muscles
Transverse intermuscular septum
78
List the deep plantarflexors of the posterior compartment
- Flexor hallucis longus - Flexor digitalis longus - Tibialis posterior - Popliteus
79
List the superficial plantarflexors of the posterior compartment
- Gastrocnemius - Soleus - Plantaris
80
What artery and nerve supply the anterior compartment of the thigh
- Femoral artery | - Femoral nerve
81
What artery and nerve supply the medial compartment of the thigh
- Obturator nerve | - Profunda femoris artery and obturator artery
82
What artery and nerve supply the posterior compartment of the thigh
- Sciatic nerve | - Branches of profunda femoris artery
83
Pectineus OIIA
``` O = Superior ramus of pubis I = Pectineal line of femur I = Femoral nerve (L2/3) A = adducts and flexes thigh, assists MR ```
84
Psoas Major OIIA
``` O = Sides of T12-L5 I = Lesser trochanter I = Anterior rami of lumbar nerves (L2-3) A = flexes hip ```
85
Psoas Minor OIIA
``` O = Sides of T12-L1 I = Pectineal line/Iliopectineal eminence I = Anterior rami of lumbar nerves (L1/2) A = flexes hip ```
86
Iliacus OIIA
``` O = iliac crest/iliac fossa/ala/anterior sacro-iliac ligaments I = tendon of psoas major/lesser trochanter I = Femoral nerve (L1/2) A = flexes hip ```
87
Sartorius OIIA
``` O = ASIS I = medial surface of tibia I = femoral nerve (L2/3) A = Flexes, abducts, LR hip ```
88
Insertion of all knee extensors
Quadriceps tendon
89
Innervation of all knee extensors
Femoral nerve (L2/3/4)
90
Origin of Rectus Femoris
- AIIS | - Ileum superior to acetabulum
91
Origin of Vastus Lateralis
- GT | - Lateral linea aspera
92
Origin of Vastus Medialis
- Intertrochanteric line | - Medial linea aspera
93
Origin of Vastus Intermedius
Anterior and lateral surfaces of femoral shaft
94
What muscle lies deep to Rectus femoris
Vastus intermedius
95
Which is the largest of the vastus muscles
Lateralis
96
Function of Articularis Genu
Prevents folding of the knee's synovial membrane and hence keeps it out of the patellofemoral joint
97
Adductor Longus OIIA
``` O = body of pubis I = middle 1/3rd linea aspera I = obturator nerve (anterior division) A = Adducts thigh ```
98
Adductor Brevis OIIA
``` O = body and inferior ramus of pubis I = pectineal line and proximal linea aspera I = obturator nerve (anterior division) A = adducts thigh, some flexion ```
99
How can Adductor magnus be divided
- Adductor part | - Hamstring part
100
Adductor Magnus Adductor Part OIIA
``` O = Inferior ramus of pubis and ischium I = gluteal tuberosity/linea aspera/medial supracondylar line I = obturator nerve (posterior division) A = adducts and flexes thigh ```
101
Adductor Magnus Hamstring Part OIIA
``` O = Ischial tuberosity I = Adductor tuberlce of femur I = Tibial part of sciatic nerve (L4) A = extends thigh ```
102
Gracilis OIIA
``` O = body and inferior ramus of pubis I = superior part of medial tibial surface I = obturator nerve A = adducts thigh/flexes leg/MR leg ```
103
Obturator externus OIIA
``` O = margins of obturator foramen and membrane I = trochanteric fossa of femur I = obturator nerve (L3/4) A = LR thigh/steadies head of femur in acetabulum ```
104
General origin of adductors
Anterior-inferior surface of the bony pelvis (pubic bone, ischiopubic ramus, ischial tuberosity)
105
Most anterior adductor
Adductor longus
106
Largest adductor
Adductor magnus
107
Most medial adductor
Gracilis
108
Which muscles insert into Pes anserinus
1. Gracilis 2. Sartorius 3. Semitendinosus
109
Where is the adductor hiatus situated
Superior and lateral to adductor tubercle between: - Distal adductor part of adductor magnus - Tendinous distal attachment of adductor magnus
110
Contents of the adductor hiatus
- Femoral artery - Femoral vein - Saphenous nerve
111
List the deep (short) external rotators of the hip
- Piriformis - Obturator internus - Superior gemilli - Inferior gemilli - Quadratus femoris
112
What overlies the short external rotators
Inferior half of gluteus maximus
113
What is the general distal insertion of the short external rotators
On or adjacent to the intertrochanteric crest
114
Gluteus maximus OIIA
``` O = ilium/dorsal sacrum and coccyx/sacrotuberous ligament I = Iliotibial tract and gluteal tuberosity I = Inferior gluteal nerve (L5/S1) A = extends thigh and assists with LR ```
115
Gluteus medius OIIA
``` O = External surface of ileum I = lateral surface of GT I = superior gluteal nerve (L5/S1) A = abduct and MR thigh ```
116
Gluteus minimus OIIA
``` O = external surface of ileum I = lateral surface of GT I = superior gluteal nerve A = abduct and MR thigh ```
117
Tensor fascia latae OIIA
``` O = ASIS/anterior iliac crest I = iliotibial tract I = superior gluteal nerve A = tenses fascia lata ```
118
Piriformis OIIA
``` O = anterior surface of sacrum/sacrotuberous ligament I = superior border of GT I = branches of anterior rami of S1/2 A = LR thigh ```
119
Obturator internus OIIA
``` O = pelvic surface of obturator membrane I = medial surface of GT I = nerve to obturator internus (L5/S1) A = LR thigh ```
120
Superior gemelli OIIA
``` O = ischial spine I = medial surface of GT I = nerve to obturator internus A = LR thigh ```
121
Inferior gemilli OIIA
``` O = ischial tuberosity I = medial surface of GT I = nerve to quadratus femoris A = LR thigh ```
122
Quadratus femoris OIIA
``` O = lateral border of ischial tuberosity I = quadrate tubercle on internal trochanteric crest I = nerve to quadratus femoris A = LR thigh ```
123
Where does piriformis exit the pelvis
Greater sciatic foramen
124
Damage to which nerve causes a Trendelenberg gait
Superior gluteal nerve
125
Superior and inferior relations of piriformis
- Superior = superior gluteal vessels | - Inferior = inferior gluteal vessels, sciatic nerve, posterior cutaneous nerves of thigh
126
Bounds of the greater sciatic foramen
- Anterolateral = greater sciatic notch of ilium - Posteromedial = sacrotuberous ligament - Inferior = sacrospinous ligament and ischial spine - Superior = anterior sacroiliac ligament
127
Nerves of the greater sciatic foramen
- Sciatic nerve - Superior and inferior gluteal nerves - Pudendal nerve - Posterior femoral cutaneous nerve - Nerve to quadratus femoris - Nerve to obturator internus
128
Vessels of the greater sciatic foramen
- Superior gluteal artery and vein - Inferior gluteal artery and vein - Internal pudendal artery and vein
129
Contents of the lesser sciatic foramen
- Tendon of obturator internus - Pudendal nerve - Internal pudendal artery and vein - Nerve to obturator internus
130
What structures pass through both greater and lesser foramen
- Pudendal nerve - Internal pudendal artery - Nerve to obturator internus
131
Semitendinosus OIIA
``` O = ischial tuberosity I = pes anserinus I = tibial division of sciatic nerve (L5-S2) A = extends thigh/flexes leg/MR when knee flexed ```
132
Semimembranosus OIIA
``` O = ischial tuberosity I = posterior part of medial condyle of tibia I = tibial division of sciatic nerve (L5-S2) A = extends thigh/flexes leg/MR when knee flexed ```
133
Biceps femoris long head OIIA
``` O = ischial tuberosity I = lateral side of head of fibula I = tibial division of sciatic nerve A = flexes leg/LR when knee flexed/extends thigh ```
134
Biceps femoris short head OIIA
``` O = linea aspera I = lateral side of head of fibula I = common fibular division of sciatic nerve A = flexes leg/LR when knee flexed/extends thigh ```
135
Tibialis anterior OIIA
``` O = lateral condyle of tibia and IO membrane I = medial cuneiform and base of 1st metatarsal I = deep peroneal nerve (L4/5) A = dorsiflexion/inversion ```
136
Extensor digitorum longus OIIA
``` O = lateral condyle to tibia and IO membrane I = middle and distal phalanges of lateral 4 digits I = deep peroneal nerve (L4/5) A = extends lateral 4 digits/dorsiflexion ```
137
Extensor hallucis longus OIIA
``` O = anterior fibula and IO membrane I = dorsal aspect of base of distal phalanx of hallux I = deep peroneal nerve (L4/5) A = extends great toe/dorsiflexion ```
138
Peroneus tertius OIIA
``` O = inferior 1/3rd anterior fibula and IO membrane I = dorsum of base of 5th metatarsal I = deep peroneal nerve (L4/5) A = dorsiflexion/eversion ```
139
Peroneus longus OIIA
``` O = head of lateral fibula I = base of 1st metatarsal and medial cuneiform I = superficial peroneal nerve (L5-S2) A = eversion/weak plantarflexion ```
140
Peroneus brevis OIIA
``` O = inferior 2/3rd of lateral fibula I = lateral tuberosity of base of 5th metatarsal I = superficial peroneal nerve A = eversion/weak plantarflexion ```
141
Common insertion of posterior compartment superficial plantarflexors
Posterior surface of calcaneus via calcaneal tendon
142
Origin of gastrocnemius
- Lateral head = lateral aspect of lateral femoral condyle | Medial head = popliteal surface of femur, superior to medial condyle
143
Origin of soleus
Posterior aspect of head of fibula/soleal line/middle 1/3rd of medial border of tibia
144
Origin of plantaris
Inferior end of lateral supracondular line of femur/oblique popliteal ligament
145
Popliteus OIIA
``` O = lateral femoral condyle and lateral mensicus I = posterior surface of tibia I = tibial nerve (L4-S1) A = weakly flexes knee/unlocks knee ```
146
Flexor hallucis longus OIIA
``` O = inferior 2/3rd of posterior fibula and IO membrane I = base of distal phalnx of great toe I = tibial nerve (S2/3) A = flexes great toe/plantarflexion/support medial longitudinal arch ```
147
Flexor digitorum longus OIIA
``` O = posterior surface of tibia by broad tendon to fibula I = base of distal phalanges of lateral 4 digits I = tibial nerve (S2/3) A = flexes lateral 4 digits/plantarflexion/supports longitudinal arches ```
148
Tibialis posterior OIIA
``` O = IO membrane/posterior surface of tibia/posterior fibula I = Navicular tuberosity/cuneiforms/cuboid/calcaneus/base of 2-4th metatarsals I = Tibial nerve (L4/5) A = plantarflexion/inversion ```
149
List the muscles attached to the linea aspera
- Vastus lateralis - Vastus medius - Adductor magnus - Adductor longus - Adductor brevis - Short head of biceps
150
What structures pass posterior to the medial malleolus
- Tibialis posterior tendon - Flexor digitorum longus tendon - Posterior tibial artery - Tibial nerve - Flexor hallucis longus tendon
151
Bounds of the femoral triangle
- Above = inguinal ligament - Medial = medial border of adductor longus - Lateral = lateral border of sartorius - Floor = iliopsoas/pectineus - Roof = skin/superficial fascia/superficial inguinal lymph/great saphenous vein/fascia lata
152
List the compartments of the retro-inguinal space
1. Muscular (lateral) | 2. Vascular
153
Contents of the muscular compartment of the retro-inguinal space
- Psoas muscle | - Femoral nerve
154
Contents of the vascular compartment of the retro-inguinal space
- Femoral artery - Femoral vein - Deep inguinal lymph nodes (All surrounded by femoral sheath)
155
Contents of the femoral triangle from lateral to medial
- Femoral nerve - Femoral artery - Femoral vein and its proximal tributaries (e.g. great saphenous) - Deep inguinal lymph nodes
156
Length of femoral sheath
3-4cm
157
Origin of the femoral sheath
Inferior prolongation of transversalis and iliopsoas fascia
158
List the 3 compartments and their contents of the femoral sheath
1. Lateral = femoral artery 2. Intermediate = femoral vein 3. Medial = femoral canal
159
Course of adductor (Hunter's canal)
Apex of femoral triangle to popliteal fossa
160
Anatomical relations of the adductor canal
- Posterior = adductor longus and magnus - Anteromedial = sartorius (forms roof of canal) - Anterolateral = vastus medialis
161
Contents of the adductor canal
- Femoral artery - Femoral vein (behind the artery) - Saphenous nerve
162
Bounds of the popliteal fossa
- Superomedial = semimembranosus - Superolateral = biceps femoris tendon - Inferolateral = lateral head of gastrocnemius - Inferomedial = medial head of gastrocnemius
163
Floor of the popliteal fossa
Popliteal surface of femur, posterior ligament of knee, poplitues
164
What is the most superficial structure in the popliteal fossa
Tibial nerve (bisects the fossa)
165
What is the deepest structure of in the popliteal fossa
Popliteal artery
166
List the contents of the popliteal fossa
- Popliteal artery and vein - Small saphenous vein - Common peroneal nerve - Tibial nerve - Posterior cutaneous nerve of thigh - Genicular branch of obturator nerve - Lymph nodes
167
Structures posterior to lateral malleolus and deep to superficial peroneal retinaculum
- Peroneus longus tendon | - Peroneus brevis tendon
168
Structures posterior to lateral malleolus and superficial to superficial peroneal retinaculum
- Sural nerve | - Short saphenous vein
169
Origin of superior and inferior gluteal arteries
Internal iliac
170
Distribution of superior gluteal artery
- Superficial branch = gluteus maximus and skin over its proximal attachment. - Deep branch = gluteus medius, gluteus minimus, TFL
171
Distribution of inferior gluteal artery
- Gluteus maximus - Obturator internus - Quadratus femoris - Superior hamstrings
172
Origin of the internal pudendal artery
Internal iliac artery
173
Describe the course of the internal pudendal artery
- Lies anterior to inferior gluteal artery - Parallels the course of the pudendal nerve - Enters thigh via greater sciatic foramen inferior to piriformis - Immediately leaves gluteal region by crossing sacrospinous ligament and passing through lesser sciatic foramen
174
Describe the course of the femoral artery
1. Continuation of external iliac inferior to inguinal ligament 2. Bisects femoral triangle 3. Courses through adductor canal 4. Becomes popliteal artery as it traverses adductor hiatus
175
Origin of Profunda femoris artery
Femoral artery, 1-5cm inferior to inguinal ligament
176
Course of Profunda femoris artery
1. Passes deep between pectineus and adductor longus | 2. Descends on posterior to adductor longus on medial side
177
How many perforating arteries arise from Profunda femoris to supply the posterior and posteromedial thigh
3
178
Origin of medial and lateral circumflex femoral arteries
Profunda femoris or femoral artery
179
Surface marker for femoral artery
Mid-inguinal point
180
Course of the obturator artery
1. Passes through obturator foramen 2. Enters medial compartment of thigh 3. Divides into anterior and posterior branches which pass on either side of adductor brevis
181
Distribution of the obturator artery
- Anterior branch = obturator externus, pectineus, adductors, gracilis - Posterior branch = muscles attached to ischial tuberosity
182
Describe the course of the popliteal artery
1. Continuation of femoral artery at adductor hiatus 2. Passes through popliteal fossa 3. Ends at lower border of popliteus 4. Divides into anterior and posterior tibial arteries
183
Describe the course of the anterior tibial artery
1. Arises from popliteal artery 2. Passes between tib and fib into anterior compartment 3. Descends on IO membrane between TA and EDL 4. Continue as dorsalis pedis
184
Describe the course of the posterior tibial artery
1. Arises from popliteal artery 2. Passes through posterior compartment of leg 3. Terminates distal to flexor retinaculum 4. Splits into medial and lateral plantar arteries
185
Describe the course of the great (long) saphenous vein
1. Commences on medial side of dorsal venous arch 2. Ascends immediately in front of medial malleolus 3. Accompanied by saphenous nerve 4. Ascends obliquely up medial aspect of thigh 5. Drains into femoral vein at saphenous opening
186
Surface marker for sapheno-femoral junction
4cm inferolateral to pubic tubercle
187
Describe the course of the small (short) saphenous vein
1. Commences on lateral side of dorsal venous arch 2. Passes behind lateral malleolus 3. Perforates deep fascia over popliteal fossa to enter popliteal vein
188
What structure accompanies the short saphenous vein
Sural nerve
189
What constitutes the sacral plexus
Anterior rami of L4-S4
190
List the branches of the sacral plexus
1. Sciatic 2. Superior gluteal 3. Nerve to quadratus femoris 4. Inferior gluteal 5. Nerve to obturator internus 6. Nerve to piriformis 7. Posterior cutaneous nerve of the thigh 8. Perforating cutaneous 9. Pudendal 10. Pelvic splanchnic 11. Nerves to levator ani and coccygeus
191
Origin of sciatic nerve
L4-S3
192
Describe the course of the pudendal nerve
1. Originates from S2-4 2. Leaves pelvis via greater sciatic foramen with pudendal artery 3. Hooks around ischial spine and sacrospinous ligament to enter perineum via lesser sciatic foramen
193
List the branches of the sciatic nerve
1. Muscular 2. Tibial 3. Common peroneal
194
Distribution of sciatic nerve
- Muscular branch = biceps femoris, semimembranosus, semitendinosus, hamstring part of adductor magnus - Cutaneous = posterior thigh (via cutaneous branches), gluteal region, entire lower leg except medial aspect
195
Origin of the lumbar plexus
L1-4
196
Where is the lumbar plexus formed
On the substance of psoas major
197
List the branches of the lumbar plexus
- Femoral nerve - Obturator nerve - Ilioinguinal nerve - Iliohypogastric - Lateral cutaneous nerve of the thigh - Genitofemoral nerve
198
List the branches of the femoral nerve
- Quadriceps - Sartorius - Pectineus - Medial cutaneous nerve of thigh - Intermediate cutaneous nerve of thigh - Saphenous nerve - Articular branches to hip and knee
199
Where is the lumbosacral trunk situated
Anterior to piriformis and under common iliac
200
Course and distribution of saphenous nerve
- Branch of femoral - Descends with femoral vessels through femoral triangle and adductor canal - Skin on medial side of ankle and foot
201
Course and distribution of sural nerve
- Branch of tibial and common peroneal - Descends between heads of gastroc, then with small saphenous vein, passes inferior to lateral malleolus - Skin on posterior and lateral aspect of leg and foot
202
Course and distribution of tibial nerve
- Branch of sciatic - Forms at apex of pop fossa, lies on popliteus, descends with posterior tibial vessels and crosses artery 2.5cm from its origin to run on medial side of it, terminates under flexor retinaculum - Posterior muscles of leg and knee joint
203
Course and distribution of common peroneal nerve
- Branch of sciatic - Forms at apex of pop fossa, follows medial border of biceps femoris, passes over posterior aspect of fibula head and winds around neck - Supplies lateral posterior aspect of leg via lateral cutaneous nerve and knee via articular branch
204
Course and distribution of superficial peroneal nerve
- Branch of common peroneal - Arises between peroneus longus and neck of fibula, descends in lateral compartment, pierces deep fascia in distal 1/3rd to become subcutaneous - Peroneus longus and brevis, skin on distal 1/3rd of anterior surface of leg and dorsum of foot
205
Course and distribution of deep peroneal nerve
- Branch of common peroneal - Arises between peroneus longus and head of fibula, passes through EDL and on IO membrane, crosses distal end of tibia to enter dorsum of foot - Anterior muscles of leg, dorsum of foot, skin of 1st and 2nd webspace, articular branches to joints it crosses
206
When is the head of the femur and acetabulum most congruent
- Hip flexed 90 - Abducted 5 - LR 10
207
Attachments of the hip capsule
- Proximal = acetabulum, transverse acetabular notch, transverse ligament - Distal = intertrochanteric line, base of GT/LT, posterior to femoral neck
208
List the 3 intrinsic ligaments of the hip joint
1. Iliofemoral (anterior and superior 2. Pubofemoral (anterior and inferior) 3. Ischiofemoral (posterior)
209
Course of the iliofemoral ligament
Anterior inferior iliac spine to trochanteric line (inverted Y-shape)
210
Outline the blood supply to the hip joint
- Medial and lateral circumflex femoral arteries (branches of profunda femoris) - Artery of head of femur (branch of obturator artery)
211
What structure is at risk during posterior hip dislocation
Sciatic nerve
212
Outline the lateral approach to the hip
1. Split fibres of TFL, gluteus medius and minimus | 2. Divide transverse branch of lateral circumflex femoral artery
213
Outline the anterior approach to the hip
1. Between gluteus medius and minimis lateraly and sartorius medially 2. Reflected head of rectus femoris is divided to expose anterior aspect of joint
214
Outline the posterior approach to the hip joint
1. Through angled incision commencing and posterior superior iliac spine and passing across GT 2. Gluteus maximus is split along the line of its fibres 3. Gluteus medius and minimis are detached from their insertion at GT
215
List the joint compartments of the knee
1. Tibiofemoral | 2. Patellofemoral
216
Outline the attachments of the knee joint capsule
- Superior = femur - Posterior = fibrous layer encloses condyles and intercondylar fossa - Inferior = margins of tibial plateau (except where popliteus tendon crosses bone) - Anterior = blends with tendons of vastus medialis and lateralis
217
Describe the course of the medial collateral ligament and its attachments
- Passes from medial epicondyle of femur to tibia | - Posterior fibres are attached to medial meniscus
218
Describe the course of the lateral collateral ligament
- Passes from lateral epicondyle of femur to head of fibula | - It is free from the capsule
219
Describe the course and function of the anterior cruciate ligament
- From the front of the intercondylar area of the tibia up to the intercondylar notch of femur - Resists forward displacement of the tibia on femur - Taught in hyperextension
220
What crosses the lateral meniscus
Popliteus tendon
221
Ligamentous support of the medial longitudinal arch of the foot
- Spring ligament | - Interosseous ligaments (including deltoid ligament)
222
What separates the PCL from the popliteal vessels
Oblique popliteal ligament
223
What muscle supports the transverse arch of the foot
Peroneus longus
224
Which ligaments support the lateral longitudinal arch of the foot
- Short plantar ligament | - Long plantar ligament
225
How many muscle layers make up the sole of the foot
4

Musculoskeletal (5 decks)

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