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Lower Limb Anatomy > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

What type of joint is the hip

A

Multiracial synovial joint of the ball and socket variety

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2
Q

The articular surfaces of the hip joint

A
  1. Acetabulum - formed by fusion of ilium, ischium and pubis bone, covered by hyaline cartilage and forming 3/4 of the socket
  2. Acetabular notch - the missing inferior segment of the socket, traversed by the transverse ligament to complete the socket
  3. Acetabular labrum - a fibrocartilaginous rim extending the margin of the acetabulum by about 10%
  4. Femoral head
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3
Q

The hip capsule and its attachments

A

Capsule is attached circumferentially around labrum and transverse ligament: passes laterally like a sleeve, attached to neck of femur
Anteriorly: attached to intertrochanteric line
Posteriorly: it extends for only half this distance, attached halfway along the femoral neck
Synovial membrane is attached to the articular margins

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4
Q

Describe iliofemoral ligament

A

Strongest ligament: triangular, from lower half of AIIS to intertrochanteric line
Limits extension, anterior and superior to hip joint

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5
Q

Describe pubifemoral ligament

A

Attached to superior ramus and obturator crest of pubic bone, blends with the capsule
Prevents over abduction, anterior and inferior to hip joint

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6
Q

Describe ischiofemoral ligament

A

Weakest ligament: from the pesteriorinferior margin of acetabulum, spirals upwards, blends with capsule, posterior to hip joint

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7
Q

Describe ligamentum teres

A

Attached centre of head of femur to the transverse ligament

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8
Q

What is the blood supply of the hip joint

A

Branches from the circumflex femoral artery, form retinacular arteries/trochanteric anastomosis to supply head and intracapsular part of neck of femur
Branch of obtrurator artery supplies ligamentum teres, usually atrophies by age 7

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9
Q

Neve supply of the hip joint

A

Femoral nerve - to nerve to rectus femoris
Obturator nerve - anterior division
Sciatic nerve - nerve to quadratus femoris
These 3 nerves also supply the knee

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10
Q

In relation to the hip joint what is anterior

A

Flexors
1.ilipsoas, femoral artery
2. Pectineus, femoral vein
3. Femoral nerve - lateral to the artery, between iliacus and Psoas tendon

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11
Q

In relation to the hip joint what is superior

A

Abductors and medial rotators
Medial- rectus femoris
Lateral - gluteus minimus

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12
Q

In relation to the hip joint what is inferior

A

Adductors - obturator externus

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13
Q

In relation to hip joint what is posterior

A

Lateral rotators, extensors
Piriformis, obturator internus tendon, gemelli, sciatic nerve

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14
Q

In relation to the hip joint what is lateral

A

The capsule blends with the iliotibial tract

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15
Q

In relation to the hip joint what is medial

A

Acetabular fossa

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16
Q

What factors help with stability of the hip joint

A

Bony: snug fit of femoral head into acetabulum
Ligaments: particularly iliofemoral ligament
Muscular: short muscles of the gluteal region are important stabilisers - piriformis, obturator internus, gemelli, quadratus femoris and also gluteus medius and minimus

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17
Q

What is the most stable position of the hip joint

A

Extension

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18
Q

What position is the hip most unstable

A

Flexed and adducted

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19
Q

What muscles cause flexion at the hip

A

Psoas major, iliacus
Assisted by rectus femoris, sartorius, pectineus

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20
Q

What is the degree of full flexion of hip with knee flexed

A

120 degree

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21
Q

What muscles cause extension at the hip

A

Gluteus maximus, hamstrings

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22
Q

What is the degree of extension at the hip and what is it limited by

A

20 degrees, limited by tension in iliofemoral ligament

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23
Q

What causes adduction at the hip joint

A

Pectineus, adductors longus, brevis, Magnus

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24
Q

What is the degree of adduction at the hip joint and what is it limited by

A

30 degrees, limited by touching other leg or tension of gluteus med and min

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25
Q

What causes abduction at the hip joint

A

Gluteus medius and minimus
Assisted by tensor fasciae lata and sartorius

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26
Q

What limits abduction at the hip and what is the degree of abduction

A

Limited by tension in adductors and pubofemoral ligament to 60 degrees

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27
Q

In the sitting position what other muscles are abductors

A

Piriformis, gemelli, obtruator muscles

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28
Q

What causes medial rotation at the hip joint

A

Anterior fibres of gluteus medius and minimus

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29
Q

What is the degree of medial rotation at the hip and what limits it

A

40, limited by tension in the lateral rotators and ischiofemoral ligament

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30
Q

What causes lateral rotation in the hip joint

A

Piriformis, obturator internus and gemelli, quadrants femoris, obturator externus
Assisted by gluteus maximus and sartorius

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31
Q

What separates the adductor compartment from the anterior compartment of the thigh

A

The medial intermuscular septum

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32
Q

Origin, insertion and nerve supply of adductor longus

A

Origin- body of pubis, in angle between pubic crest and symphysis
Insertion- aponeurotic flat tendon into middle 1/3 of linea aspera of femur
Nerve supply - anterior division of obturator nerve l2-l4 mostly l3

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33
Q

Origin, insertion, nerve supply and relations of adductor brevis

A

Origin - body and inferior ramus of pubis, deep to Pectineus and adductor longus
Insertion- upper part of linea aspera, immediately behind Pectineus and adductor longus
Nerve supply: anterior division of obturator nerve l2-4 mostly l3
Relations: anterior division of obturator nerve passes on its anterior surface, posterior division passes down behind

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34
Q

Origin, insertion, nerve supply and relation of adductor Magnus

A

Hamstring origin: ischial tuberosity
Adductor origin: ischiopubic ramus
Hamstring insertion: adductor tubercle of femur
Adductor insertion: along medial supracondylar line, linea aspera and gluteal tuberosity
Hamstring part nerve supply: tibial part of sciatic nerve l4
Adductor part nerve supply: posterior division of obturator nerve l2-4
Relations: formed by fusion of adductor and hamstring muscles, medial branch of circumflex femoral artery passes between the two muscles

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35
Q

Origin, insertion, nerve supply and relations to Gracilis

A

Origin: edge of inferior ramus of pubis and the adjoining ishcial ramus
Insertion: superior part of the medial surface of the shaft of the tibia, just behind sartorius
Nerve supply: anterior division of obturator nerve l2-3
Most superficial muscle of medial thigh

36
Q

Origin, insertion, nerve supply of obturator externus

A

Origin - whole of obturator membrane and anterior bony margin of obturator foramen
Insertion - medial surface of greater trochanter in the trochanteric fossa
Nerve supply - posterior division of obturator nerve l3-4

37
Q

Origin of gluteus maximus

A

Ilium behind posterior gluteal line
Lumbar fascia
Dorsal sacrum coccyx
Sacrotuberous ligament

38
Q

Insertion of gluteus maximus

A

Iliotibial tract to the lateral condyle of the tibia - 3/4 of the muscle
Gluteal tuberosity of the femur remaining 1/3

39
Q

Blood supply of gluteal maximus

A

Superior and inferior gluteal artery

40
Q

Nerve supply of gluteus maximus

A

Inferior gluteal nerve l5-s2

41
Q

Action of gluteal maximus

A

Lateral rotation and extension
Supports extended knee through iliotibial tract

42
Q

Origin and insertion of gluteus medius

A

Origin - surface of ilium, between middle and posterior gluteal lines
Insertion - converges to flat tendon which is attached to lateral surface e of greater trochanter

43
Q

Origin of gluteus minimus

A

Gluteal surface of ilium between middle and inferior lines

44
Q

Insertion of gluteus minimus

A

Anterior surface of greater trochanter

45
Q

Nerve supply of gluteal medius and minimus

A

Superior gluteal nerve l4-s1

46
Q

Action of gluteus minimus

A

Abducts hip joint
Rotates thigh medically
Constantly in play during walking

47
Q

Origin, insertion and nerve supply of tensor fascia lata

A

Asis and anterior iliac crest
Iliotibial tract - lateral condyle of tibia
Superior gluteal nerve l4-s1

48
Q

Origin of Piriformis

A

Anterior sacrum, sacrotuberous ligament

49
Q

Insertion of Piriformis

A

Rounded tendon inserted into medial surface of upper border of greater trochanter

50
Q

What does Piriformis pass through

A

Greater sciatic foramen

51
Q

Nerve supply of Piriformis

A

Anterior rami s1 and s2

52
Q

Action of Piriformis

A

Lateral rotation

53
Q

Origin of obturator internus

A

Internal surface of lateral wall of pelvis

54
Q

What is the route of obturator internus

A

Make a right angled bend around the lesser sciatic notch (ischium) - enters the gluteal region

55
Q

Insertion of obturator internus

A

Medial surface of greater trochanter above trochanteric fossa

56
Q

Nerve supply of obturator internus

A

Its own nerve l5-s2

57
Q

Action of obturator internus

A

Lateral rotation

58
Q

Origin and nerve supply of superior gemellus

A

Arises from ischial spine
Supplied by nerve to obturator internus

59
Q

Origin and nerve supply of inferior gemellus

A

Arises from ischial tuberosity at margin of lesser sciatic notch
Supplied by nerve to quadratus femoris

60
Q

Origin of quadratus femoris

A

Ischial tuberosity

61
Q

Insertion of quadratus femoris

A

Quadratus tubercle of femur

62
Q

Nerve supply of quadratus femoris

A

Its own nerve l4-s1

63
Q

Actions of Piriformis, obturator internus, gemelli, quadratus femoris

A

Act together to adjust and stabilise the hip joint
Lateral rotators of extended thigh
Abductors of flexed thigh

64
Q

Origin of semimenbranosus

A

Lateral parry of ischial tuberosity

65
Q

Insertion of semimembranosus

A

Back of the medial condyle of tibia
From there 3 expansions
1. Passes forward along medial surface of condyle, deep to tibial collateral ligament of knee
2. Passes obliquely upwards to lateral femoral condyle as oblique popliteal ligament
3. One forms strong fascia overlying popliteus - reaches soleal line of tibia

66
Q

Origin of Semitendinosus

A

Medial part of ischial tuberosity

67
Q

Insertion of semitendinosus

A

Upper part of subcutaneous surface of tibia, behind gracilis

68
Q

Origin of biceps femoris

A

Long head - from ischial tuberosity
Short head - whole length of linea aspera and upper part of lateral supracondylar line of femur

69
Q

Describe the tendon of biceps femoris

A

Folded or split around fibular collateral ligament of the knee joint

70
Q

Insertion of biceps femoris

A

Head of fibula

71
Q

Blood supply of hamstrings

A

Profunda femoris artery

72
Q

Hamstring nerve supply

A

Tibial component of sciatic nerve l5-s2
Except short head of biceps - supplied by common perineal

73
Q

Actions of hamstrings

A

Flex knee joint
Extend the hip
With knee semi flexed biceps femoris is lateral rotator, semimembranosus and semitendinosus are medial rotators

74
Q

Hamstring order of insertion to medial upper tibia anterior to posterior pneumonic

A

Say grace before tea mum
Sartorius
Gracilis
Before semiTendinosus
semiMembranosus

75
Q

Where does the obturator nerve divide

A

Obturator notch

76
Q

What does the anterior division of obturator nerve supply and what is its route

A

Supplies adductor longus and brevis and Gracilis
Passes above obturator externus, ends in sub sartorial plexus and supplies skin to medial side of thigh

77
Q

What does posterior division of obturator nerve supply and what is its route

A

Supplies obtruator externus, adductor Magnus
Gives off branch to popliteal fossa which supplies capsule of knee joint, passes with middle genicular artery

78
Q

Origin of sciatic nerve

A

Sacral plexus l4-s3

79
Q

Course of sciatic nerve

A

Enters gluteal region via greater sciatic foramen inferior to Piriformis, in contact with the ischium, descends deep to femoris
Bifurcates into tibial and common fibular nerves at apex of popliteal fossa

80
Q

Distribution of sciatic nerve

A

Posterior compartment of thigh
Gemelli, hamstrings
Branch - nerve to obturator internus

81
Q

Boundaries of obturator foramen

A

Pubis and ischium

82
Q

What goes through obtruator foramen

A

It is completely closed by obturator membrane, except for a small passageway - obturator canal
Obturator nerve and vessels pass

83
Q

What ligaments seperate the sciatic foramina

A

Sacrotuberous ligament - extending between the sacrum and the ischial tuberosity
Sacrospinois ligament - extending between the sacrum and the ischial spine

84
Q

Boundaries of greater sciatic foramen

A

Superior and anterior - greater sciatic notch
Posterior - sacrotuberous ligament
Inferior - scarospinous ligament

85
Q

Structures that pass through greater sciatic foramen

A

Superior gluteal vessels and nerve
Piriformis
Inferior gluteal vessels and nerve
Sciatic nerve
Perforating cutaneous nerve
Posterior femoral cutaneous nerve
Nerve to quadratus femoris
Nerve to obturator internus
Pudendal nerve
Internal pudendal vessels

86
Q

Boundaries of lesser sciatic foramen

A

Lesser sciatic notch
Superior - sacrospinous ligament
Posterior - sacrotuberous ligament

87
Q

Structures that pass through lesser sciatic foramen

A

Tendon of obturator internus
Nerve to obturator internus
Internal pudendal vessels
Pudendal nerve

Lower Limb Anatomy (4 decks)

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