Lower limb Flashcards
1
Q
Limb bud formation
A
week 4 upper
week 5 lower
2
Q
Hip bone fusion
A
starts 15-7, complete 20-25
ischiopubic ramus 9
3
Q
Intertrochanteric line and crest
A
line ant
crest post
4
Q
angle of inclination
A
135 3y
126 adult
120 old
smaller women
5
Q
Talus articulates
A
no muscular or tendinous attachments
articulates tib fib, calcaneous and navic
6
Q
Calcaneous articulates
A
talus and cuboid
7
Q
Cuboid articulates
A
calcaneous, navicular, L cuneiform, 4,5 metatarsals
lat groove for tendon peroneus longus
8
Q
Navicular articulates
A
talus, cuneiform, cuboid
attaches ligaments of arch of foot
9
Q
iliotibial tract
A
lateral thickening
shared aponeurosis TFL and glut max
attaches lateral tubercle of tibia
10
Q
Great saphenous vein course
A
ant to med maleolus, post medial condyle femur, in saphenous opening fascia lata
11
Q
small saphenous vein course
A
post lateral maleoulus
through dep fascia mid fibula
between heads gastroc
joins popliteal
12
Q
deep veins leg
A
dorsal venous arch -> ant tibial
plantars -> post tibial and fibular
all then to popliteal
13
Q
Lymph drainage leg
A
with great saphenous vein to superficial inguinal and external iliac
with small saphenous / deep to popliteal to deep inguinal
14
Q
Innervation dorsum foot
A
lateral sural
medial malleolus saphenous
rest superficial peroneal/ fibular except web 1st toe deep
15
Q
Innervation sole of foot
A
calcaneal
lat plantar - also nail bed lat 1.5
med plantar - also nail bed med 3.5
16
Q
Femoral cutaneous innervation leg
A
anterior cutaneous - ant med thigh
saphenous - med leg and foot
17
Q
Key dermatomes lower limb
A
L3 knee
L5 sole of foot
S1 lat foot and leg
S2 back of leg
S2/3 penis
S3 what you sit on
18
Q
Hip adduction/ abduction
A
add L234
ab L5S1
19
Q
Hip int/ext rot
Ankle inversion/ eversion
A
int/ inv L45
Ext / evers L5S1
20
Q
Pectineus attachment
A
superior pubic ramus to pectineal line femur
21
Q
Pectineus innervation and action
A
Femoral and obturator
hip flexion and adduction
22
Q
Psoas major attachment
A
T12-L5 and all L TPs to lesser trochanter femur
23
Q
Psoas major and minor innervation and action
A
L1,2 anterior rami
hip flexion + vertebral flexion
24
Q
Psoas minor attachment
A
T12-L1 to iliopubic eminence via iliopectineal arch and pecton pubis
25
Iliacus attachment
iliac crest and fossa to tendon psoas major and lesser trochanter
26
Iliacus innervation and action
femoral L2,3
hip flexion
27
Sartorius attachment
ASIS to superior medial tibia via pes anserinus
28
Sartorius innervation and action
Femoral L23
flexion, abduction, external rotation
29
Quadriceps femoris muscles and innervation
Femoral nerve
rectus femoris
Vastus - lateralis, intermedialis, medialis
30
Rectus femoris insertion
anterior inferior iliac spine
31
Vastus lateralis insertion
greater trochanter femur
32
Vastus intermedialis insertion
anteriior and lateral surfaces shaft femur
33
Vastus medialis insertion
intertrochanteric line
34
Medial thigh muscles not supplied by obturator
pectineus - femoral
adductor magnus hamstring portion - sciatic
35
Adductor innervation and action
obturator + sciatic for hamstring part magnus
Adduction + extension with magnus
36
Adductor insertion
inferior pubic ramus to
brevis - pectineal line and linea aspera
longus - linea aspera
magnus - supracondylar and adductor tubercle
37
Gracillis insertion
body and inf ramus pubis to sup tibia medially via pes anserinus
38
Gracillis innervation and action
obturator
adduction, flex knee, medial rot
39
Obturator externus attachment
obturator foramen and membrane to trochanteric fossa femur
40
Obturator externus innervation and action
obturator
lateral rotation thigh
stabilise head of femur
41
Pes anserinus
tendon attaching to medial superior tibia
made of sartorius, semitendinous and gracillis
42
Borders and contents femoral triangle
Borders: inguinal ligament, sartorius, adductor longus
Contents NAVL, saphenous vein joins, femoral nerve splits
lunate lymph node
43
Femoral sheath formed from
transversalis and iliopsoas fascia
44
Femoral sheath contains
femoral vein and artery and femoral canal with come lymph vessels
45
Femoral canal borders
lat - septum
post - pectineus and sup ramus
med - lacunar lig
ant - inguinal lig
46
Femoral artery course
mid ing lig
femoral triangle
adductor canal
through adductor hiatus and becomes popliteal
47
Profunda femoris course
inf to ing lig in femoral triangle from femoral
between pectineus and adductor longus
posterior to adductor longus on medial femur - gives off 3-4 perforating arteries
48
Medial circumflex femur course
from profunda med post
between pectineus and iliopsoas
gives off retinacular
main supplier head and neck femur
49
Lateral circumflex femur course
ascending, descending and transverse branches
deep to sartorius and rectus femoris
50
Obturator artery course
80% from internal iliac, 20% from inferior epigastric
through obturator foramen to medial thigh
Splits into A and P - go either side of adductor brevis
51
Relationship femoral vein to artery
distal vein is posterolateral
mid point is posterior
prox is medial
52
Contents adductor canal
Femoral vain and artery
Saphenous nerve
Nerve to vastus medialis
53
Adductor canal borders
ant and lat - vastus medialis
post - adductor longus and magnus
medial and roof - sartorius
54
Cruciate anastomosis femoral head
transverse medial circumflex
transverse lateral circumflex
ascending branch 1st perforating
descending inferior gluteal
55
Ligaments making sciatic foramen
sacrotuberous - converts notch into foramen
sacrospinous - converts foramen into sup and inf
56
Superficial gluteal muscles
TFL, glut med, min and max
all supplied by superior gluteal nerve except glut max which is supplied by inf gluteal
57
TFL insertion and action
ASIS to iliotibial tract
abduct and medially rotate
58
Gluteus medius insertion and action
between post and ant gluteal lines to lat surface greater trochanter
abducts and medially rotate
59
Gluteus minimus insertion and action
between ant and inf gluteal lines to ant surface greater trochanter
abducts and medial rotation
60
Gluteus maximus insertion and action
Ilium, sacrum, coccyx and sacrotuberous ligament to iliotibial tract
extends thigh, external rotation, standing
61
Deep gluteal muscles
lateral rotation and stability +- abduction
insert near intratrochanteric crest (post)
piriformis
obturator internus
inferior and superior gemilli
quadratus femoris
62
Piriformis insertion, action, innervation
ant sacrum, sarotuberous lig to superior border greater trochanter
lat rot, abduct
s1+2
63
Obturator internus insertion, action, innervation
obturator membrane to medial surface greater trochanter
lat rot and abduct
inferior obturator
64
sup and inf gemelli insertion, action, innervation
sup ischial sine, inf ischial tuberosity to medial greater trochanter
lat rot and abd
sup - inf obturator nerve
inf - nerve to quad femoris
65
quadratus femoris insertion, action, innervation
lateral ischial tuberosity to intratrochanteri crest
lat rot and steady femoral head
L5/S1
66
Hamstring muscles and prox attachment
semitendinous, semimembranous, long head biceps femoris
from ischial tuberosity
innervated tibial division sciatic
67
short head biceps femoris
from linea espera and lat supra condylar line femur to lat head fibula with long head
innervated fibular division sciatic
68
distal attachment semimembranous
post medial epicondyle tibia
forms oblique popliteal ligament
69
distal attachment semitendinous
sup medial tibia in pes anserinus
70
Sciatic nerve course
L4-S3
converge inf border piriformis
sciatic foramen inf to piriformis, deep to glut max
descends on adductor magnus, deeps to biceps femoris
bifurcates apex popliteal fossa
71
Sciatic nerve supplies
post muscles thigh
all muscles leg and foot
sensory leg except saphenous
all joints
72
Sup gluteal nerve
L4-S1
through greater sciatic foramen sup to piriformis
between glut med and min to TFL (supplies all of these)
73
Inf gluteal nerve
L5-S2
greater sciatic foramen inf to piriformmis
deep to inf glut max which it supplies
74
Post cut nerve thigh
S1-3
greater sciatic foramen inf to piriformis
deep to glut max
supplies post skin and popliteal fossa
75
Borders popliteal fossa
sup med semimembranous
sup lat biceps femoris
inf gastroc
76
sup to deep in popliteal fossa
nerves: tibial, common fib, post cut nerve thigh
vein
artery
(also lat to med)
77
Muscles and nerve ant compartment leg
tibialis anterior
extensor hallucis longus
extensor digitorum longus + fibularis tertius (share synovial sheath)
deep fibular nerve
78
superior extensor retinaculum
sup to maleoli
79
inferior extensor retinaculum
from calcaneous
houses tendons extensor digitorum longus and fibularis tertius
y shaped
80
tibialis anterior attachments
lat condyle tib, lat surface tib, io membrane to cuneiform and base 1st mt
81
extensor hallucis longus attachments
ant surface fibula + IO membrane to dorsal distal big toe
82
Extensor digiti longus attachments
lat condyle tibia, IO membrane, mid fibula to lat 4 mid and dist phalanges
83
fibularis teritus attachments
inf 1/3 fibula + IO membrane to dorsum base 5th MT
84
Cutaneous nerve femoral triangle
Genitofemoral
85
Structures under superior extensor retinaculum med to lat
Tim has a very nasty disease paratyphoid
Tibialis ant
Extensor Hallucis longus
Artery
Vein
Nerve
Extensor Digutirum longus
Peroneustertius
86
Sacroiliac joint type
Synovial plane joint
87
Muscles inserting trochanteric fossa femur
obturator externus muscle and internus
superior gemellus and inferior gemellus
88
Fibularis longus
eversion + plantarflexion
superior fibular nerve
from head + sup 2/3 fibula to 1st metatrsal base and medial cuneiform
89
Fibularis brevis
eversion + plantarflexion
superior fibular nerve
from inf 2/3 lat fibula to dorsal surface tuberosity lat 5th MT
90
Muscles superficial posterior compartment
gastroc, soleus, plantaris
innervation tibial S1,2
arterial tibial
attach to calcaneal tendon distally
91
gastrocnemius insertion and action
lat condyle and sup to medial condyle femur
plantarflexes in knee extension
92
soleus insertion and action
pos head and surface fibula, soleal line and mid 1/3 medial tib
plantarflexes ankle independent knee position
93
Plantaris insertion and action
lateral supracondylar line femur, oblique popliteal lig
weakly assists gastroc
94
Deep muscles posterior compartment
popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
95
Popliteus attachments
lat condyle femur and lat meniscus to posterior surface tibia
96
Popliteus innervation and action
tibial L45S1
unlocks knee rotating 5 degrees on tibia
med rot tibia
97
Flexor hallucis longus attachments
inf 2/3 post fibula + IO membrane to base distal phalynx big toe
98
Flexor hallucis longus innervation and action
tibial S2,3
flexes big toe + weak plantar flexion
99
Flexor digitorum longus attachments
medial tibia inf to soleal line to base distal phalanges lat 4 digits
100
Flexir digitorum longus innervation and action
Tibial S2,3
flex lat 4 toes and plantarflexes
101
Tibialis posterior attachments
post tib fib and io membrane to navicular, cuneiform, cuboid, calcaneous 2,3,4 MT
102
Tibialis posterior innervation and action
L4,5
plantarflexion
foot inversion
103
Sural nerve
made from tibial and common peroneal
travels between heads gastroc with small saphenous
skin to lat foot and leg
104
Tibial nerve
on popliteus the tibialis posterior
bifurcates inf to flexor retinaculum
muscles post leg and knee joint
105
Common peroneal nerve
medial border biceps femoris
around neck fibula then divides
skin lat post leg and knee joint
106
Superficial peroneal nerve
between fibularis longus and neck fibula
pierces deep fascia distal 1/3 becomes SC
fib longus and brevis and skin dditsal 1/3 ant leg and dorsum foot
107
Deep peroneal nerve
between fibularis longus and neck fibula
through EDL to IO membrane
muscles and leg and dorsum foot + skin 1st web
108
Popliteal artery
ends inf border popliteus
provides genicular arteries to knee
becomes ant and post tibial
109
Anterior tibial artery
from popliteal comes through IO membranes
descends between tibialis anterior and extensor digitorum longus
becomes dorsalis pedis
110
Dorsalis pedis artery
divides into plantar and arcuate pierces first IO space via deep plantar to contribute plantar arch
111
fibular artery
branch of posterior tibial
travels in post compartment
perforating branches supply lateral compartment
112
Muscles 1st layer foot
abductor hallucis
flexor digitorum brevis
abductor digiti minimi
113
Muscles 2nd layer foot
Quadratus plantae
Lumbricals
114
Muscles 3rd layer foot
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
115
Muscles 4th layer foot
Plantar IO - unipenate , lat 3
Dorsal IO - bipenate 1-5
116
Muscles dorsum foot
Extensor digitorum brevis
Extensor hallucis brevis
117
Action lumbricals
flex proximal phalanx, extension med and distal phalanx
from tendon flex digi longus to medial aspects expansion lat 4 digits
118
Muscles innervated medial plantar S2,3
Abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, medial lumbrical
119
Medial plantar nerve
between abductor hallucis and flexor digitorum brevis
muscular and cutaneous branches
120
Lateral plantar nerve
between quadratus plantae and fexor digitorum brevis
superficial and deep branches
121
Hip Ligaments
Iliofemoral - strongest,
AIIS to intertrochanteric line
stops hyperextension
Pubofemoral
from pubic bone to joint capsule and iliofemoral
stops overabduction
Ischiofemoral - post acetabulum to femoral neck
weakest
prevents hyperflexion
122
Main muscles hip flexion
illopsoas and adductor magnus
123
Main muscles hip flexion and adduction
adductors, gracilis and pectineus
124
Main muscles hip abduction and med rot
glut med, min and TFL
125
Nerve supply hip
femoral, superior gluteal, obturator, nerve to quadratus femoris
126
Main stabiliser knee and patella
quadriceps knee
vastus medialis patella
127
LCL
stronger than MCL
separated from meniscus by popliteal tendon
Splits biceps femoris tendon in 2
128
MCL
attached to meniscus
posteriorly blends with capsule
129
Oblique popliteal ligament
expansion of semimembranous
from posterior medial tibial condyle
blends with knee joint capsule
130
Arcuate popliteal ligament
posterior fibular head to posterior surface knee joint
131
Intraarticular ligaments knee
ACL, PCL (medial)
coronary - peripheries
transverse - joins menisci ant
post - attaches firmly post
132
Menisci
med bigger and more damages, more C shaped, less mobiles
lat almost circular more mobile
133
Innervation knee
anterior - femoral, posterior - sciatic / tibial, lat - common fibular
134
Knee bursae communicating with joint
suprapatellar, popliteus, anserine, gastrocnemius
GAPS
135
Knee flexion degrees
120 ip extended, 140 flexed, 160 passive
hamstrings and short head biceps
136
knee medial rotation degrees
10 when flexed, 5 extended
flexed - semimembranosus and tendinous
extended popliteus
137
Knee lateral rotation degrees
30-40 when flexed
biceps femoris
138
Tibiofibular joint types
prox - plane synovial
dist - compound fibrous
only move on dorsiflexion foot
139
Lateral ligaments ankle
ant talofibular - weak, goes ant med
neck of talus
post talofibular - strong, postmed horizontal
lat tubercle talus
calcaneofibular - post inf
140
Deltoid ligament ankle
medial, strong
attaches calcaneous, navicular and talus
4 parts
tibionavicular
tibiocalcaneal
A+P tibiotalar
141
Nerve supply ankle
saphenous, tibial, sural, superficial and deep peroneal
142
Subtalar joint
talocalcaneal
plane synovial
ligaments med lat post and IO(strong)
inversion and eversion
143
transverse talar joint
calcaneocuboid (modified saddle/plane) and talonavicular part talocalcaneonavicular (ball and socket)
allows forefoot to rotate on hindfoot
144
Forefoot MTPJ joint type
condyloid synovial
145
Forefoot IPJ joint type
hinge synovial
146
Superficial to deep ligaments foot
plantar aponeurosis
long plantar
short plantar (calcaneocuboid)
calcaneonavicular (spring - continuation deltoid ligament)
147
Medial longitudinal arch foot bones
calcaneous, talus, navicular, 3 cuneiform, 1st 3 MTs
148
Lateral longitudinal arch foot bones
calcaneous, cuboid, 4+5 MT
149
Transverse arch foot bones
bases of metatarsals, cuboid, 3x cuneiform
150
Muscles attaching tibia and fibula
Extensor digitorum longus
Tibialis posterior
151
Age capitate ossifies
1
152
Age pisiform ossifies
10
153
Age upper end humerus fuses with shaft
20
154
Age lower end humerus fuses with the shaft
15
155
Age medial epicondyle elbow fuses
20
156
CRITOE
1 3 5 7 9 11
Age ossification centers appear
157
Sciatic artery is a branch of
Inferior gluteal artery
158
Bones in the midtarsal joint
Talus, calcaneus, navicular, cuboid
159
Drainage into popliteal lymphnodes
Dorsolateral foot and leg
