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Flashcards in Lower Limb Deck (42):
1

What are the major landmarks of the bones of the pelvis?

- acetabulum (made up of all 3 hip bones)
- obturator foramen (from pubic and ischium)
- pubis: pubic symphysis, pubic tubercle and crest, superior and inferior rami
- ischium: body, spine, lesser sciatic notch, tuberosity, ramus
- ilium: greater sciatic notch, PIIS, PSIS, tubercle and crest, ASIS, AIIS

2

What are the major parts of the femur?

- fovea, femoral head and neck
- greater and less trochanters with intertrochanteric crest (posterior) and intertrochanteric line (anterior)
- gluteal tuberosity (posterior)
- linea aspera (posterior)
- medial and lateral supra-condylar lines (posterior)
- lateral and medial epicondyles
- lateral and medial condyles (posterior) and intercondylar fossa (posterior)
- patellar surface (anterior)

3

What are the major parts of the tibia? The fibula?

- tibia: medial and lateral condyles w/ articular surfaces, tibial tuberosity, medial malleolus
- fibula: head (proximal), lateral malleolus

4

What holds the tibia and fibula together?

- the proximal and distal tibiofibular joints
- the interosseus membrane

5

Name the bones of the tarsus (the ankle). Which articulate with the tibia and fibula to form the ankle joint?

- proximal (M to L): talus, calcaneus (the heel)
- navicular
- distal (M to L): medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid
- (the talus is the only tarsal bone that forms the ankle joint with the tibia and fibula)

6

What are the major ligaments of the ankle?

- the *spring ligament* (plantar calcaneonavicular ligament)

7

Where are the heads of the metatarsals located (ie, proximal or distal)?

- the heads are located distally

8

What are the major ligaments of the hip joint?

- inguinal ligament
- sacrospinous ligament and (the posteriorly overlying) sacrotuberous ligament
- ileofemoral, pubofemoral, ischiofemoral ligaments, zona orbicularis

9

Which bones make up the knee joint?

- the femur, the patella, and the tibia (NOT the fibula)

10

What are the major ligaments of the knee joint?

- medial (tibial) collateral ligament
- lateral (fibular) collateral ligament
- posterior and anterior cruciform ligaments (PCL, ACL)
- patellar ligament
- transverse ligament (not always present; anteriorly connects the medial and lateral menisci)

11

Which collateral knee ligament is anchored, leaving it more prone to injury than the other?

- the medial collateral ligament is attached to the joint capsule and therefore to the medial meniscus, making it more prone to injury due to a lack of free movement
- (lateral collateral ligament is very free)

12

What are the major ligaments of the ankle joint?

- medial collateral ligaments (deltoid ligament): posterior tibiotalar, tibiocalcaneal, tibionavicular, anterior tibiotalar
- lateral collateral ligaments: posterior talofibular, anterior talofibular, calcaneofibular
- anterior and posterior tibiofibular ligaments
- Achilles (calcaneal) tendon

13

What is the function of each gluteal muscle? What are origins and insertions of each?

- maximus: hip extension; posterior surface of ilium, sacrum, coccyx (O); gluteus tuberosity of femur, iliotibial tract (I)
- medius and minimus: hip abduction and extension; posterior iliac fossa (O); greater trochanter of femur (I)

14

What forms the iliotibial tract/band?

- the tensor fascia latae
- (not that this muscle and the ITB are considered part of the gluteal group of muscles)

15

What are the six lateral rotators of the hip? What are their respective origins and insertions?

- (from superior to inferior:)
- pririformis
- super gemellus
- obturator internus
- inferior gemellus
- quadratus femoris
- these all originate from within the pelvis and pass through the greater (piriformis) or lesser (all others) sciatic notch to attach to the trochanters/intertrochanteric crest of the posterior femur
- 6th one is the obturator externus (oirignates from the ANTERIOR side of the obturator foramen and then passes behind the femur neck to join the others

16

Which nerves supply the gluteal muscles and lateral rotators?

- the gluteal nerve
- EXCEPT for the obturator externus; it is supplied by the obturator nerve

17

Which muscles make up the anterior compartment of the thigh? What is each's origin and insertion?

- the quadriceps (these are knee extensors):
- rectus femoris: AIIS (O); quadriceps tendon/patella (I)
- vastus lateralis, vastus medialis, vastus intermedius: trochanters/intertrochanteric line (O); quadriceps tendon/patella (I)
- sartorius: ASIS (O); pes anserinus of proximal medial tibia (I)
- (these are all knee extensors; rectus femoris and sartorius are also hip flexors as they cross the hip joint as well as the knee joint )

18

The quadriceps tendon attaches to the top of the patella - what attaches to the bottom?

- the patellar ligament!
- AKA the patellar tendon
- (this attaches to the tibial tubercle)

19

Which nerves supply the muscles of the anterior compartment of the thigh?

- (these are the hip and knee flexors)
- the femoral nerve

20

Which structures make up the borders of the femoral triangle? Which structures lie within the triangle?

- base: inguinal ligament
- medial border: adductor longus
- lateral border: sartorius
- within: N.A.V.E.L. (femoral nerve, artery, vein, empty space/canal, lacunar ligament)
- *note that the femoral nerve lies OUTSIDE the femoral sheath, while the others lie within it*

21

Which muscles make up the medial compartment of the thigh? What is each's origin and insertion?

- (these are hip adductors)
- (note that they all insert onto the POSTERIOR aspect of the femur, except for pectineus and one part of magnus, but make up the medial muscle bulk of the thigh)
- adductor longus: pubis (O); shaft of femur (I)
- adductor brevis: ischium (O); proximal shaft of femur (I)
- adductor magnus: pubis/ischium (O); along linea aspera of femur and also the ischial tuberosity (I)
- gracilis: pubis (O); pes anserinus of proximal medial tibia (I)
- pectineus: pubis (O); proximal shaft of femur
- (pectineus and adductor longus are just superior to adductors brevis and magnus)
- *note that the adductor magnus has an adductor and a hamstring part*

22

Which nerves supply the medial compartment of the thigh muscles?

- (these are the hip adductors)
- the obturator nerve
- EXCEPT for the pectineus (femoral nerve) AND the hamstring part of the adductor magnus (tibial nerve)

23

What are the fibrous arches of the adductor magnus? What about the adductor hiatus?

- the fibrous arches are found between the muscle and the femur allow the perforating branches of the deep femoral artery to pass through the muscle
- the adductor hiatus (between the adductor and hamstring parts of the muscle) allows the superficial femoral artery to pass through (this is actually where it becomes the popliteal artery)

24

Which muscles make up the posterior compartment of the thigh? What is each's origin and insertion?

- (these are the knee flexors)
- semimembranosus: ischium (O); medial condyle of tibia
- semitendinosus: ischium (O); pes anserinus, below the medial condyle, of proximal medial tibia (I)
- biceps femoris (long head): ischium (O); lateral condyle of tibia and head of fibula (I)
- biceps femoris (short head): line aspera of femur (O); lateral condyle of tibia and head of fibula (I)
- these are the hamstrings (so they also help with hip extension), EXCEPT for the short head of the biceps femoris because it only crosses the knee joint (not the hip joint)

25

What is the pes anserinus? Where is it found?

- the pes anserinus is found on the proximal medial tibia (just below the medial condyle)
- it contains the attachment of (from L to M, anterior view): sartorius (anterior), semitendinosus (posterior), and gracilis (medial)
- *note that each is from a different compartment of the thigh*

26

Which nerves supply the muscles of the posterior compartment of the thigh?

- the sciatic nerve (actually a bundle of 2 nerves)
- the tibial nerve component supplies the hamstrings (and the hamstring part of adductor magnus), EXCEPT for the short head of the biceps femoris (supplied by the peroneal/fibular nerve component)

27

In the leg, what separates the anterior muscle group from the deep posterior muscle group?

- the interosseus membrane between the tibia and fibula!
- (other compartments are separated from eachother via intermuscular septa; this is the same as in the thigh)

28

Which muscles make up the anterior compartment of the leg? What is each's origin and insertion?

- (these are the foot dorsiflexors and toe extensors)
- tibialis anterior: tibia, fibula, interosseus membrane (O); medial cuneiform and 1st metatarsal (I)
- extensor digitorum longus: fibula and interosseus membrane (O); dorsal aspect of distal phalanges of lateral 4 toes (I)
- extensor hallucis longus: fibula and interosseus membrane (O); dorsal aspect of distal phalanx of 1st toe/hallux (I)
- peroneus/fibularis tertius is also sometimes present (joins with the lower part of extensor digitorum longus)

29

What causes foot inversion? What about eversion?

- inversion: contraction of the tibialis anterior and tibialis posterior mucles
- eversion: muscles of lateral compartment; also by the peroneus/fibularis tertius if present

30

What nerves supply the muscles of the anterior compartment of the foot?

- the deep fibular nerve

31

What allows the anterior muscles of the leg to dorsiflex the foot? What about the posterior muscles to plantarflex the foot?

- dorsiflexion: the extensor retinacula (there is a superior and inferior retinaculum)
- plantarflexion: the flexor retinaculum

32

Which muscles make up the lateral compartment of the leg? What is each's origin and insertion?

- (these are the foot everters)
- peroneus/fibularis longus: proximal fibula (O); base of the 1st metatarsal on the PLANTAR surface (I) (it runs underneath the foot)
- peroneus/fibularis brevis: middle of fibula (O); base of 5th metatarsal (I)

33

Which nerves supply the muscles of the lateral compartment of the leg?

- the superficial fibular nerve

34

Which muscles make up the superficial posterior compartment of the leg? What is each's origin and insertion?

- (these are the foot plantarflexors and toe flexors)
- gastrocnemius (medial head): medial femoral condyle (O); calcaneus (I)
- gastrocnemius (lateral head): lateral femoral condyle (O); calcaneus (I)
- soleus: proximal tibia and fibula (O); calcaneus (I)
- *note that these three muscles attach to the calcaneus to form the Achilles' tendon (hence "triceps surae")*
- plantaris: this is a vestigial muscle; just above lateral condyle of femur (O); calcaneus (may also help form the Achilles' tendon in some)

35

Which muscles make up the deep posterior compartment of the leg? What is each's origin and insertion?

- (these are the foot plantarflexors and toe flexors; EXCEPT for the popliteus, which deals with rotation)
- popliteus: upper tibia (O); lateral femoral condyle)
- tibialis posterior: tibia, fibula, interosseus membrane (O); plantar aspect of navicular (I)
- flexor digitorum longus: tibia (O); plantar aspect of distal phalanges of lateral 4 toes (I)
- flexor hallucis longus: fibula (O); plantar aspect of distal phalanx of hallux (I)

36

Explain the "criss-cross" of the flexor digitorum/hallucis longus muscles and compare this to the extensor equivalents of these muscles.

- the flexor digitorum longus lies medial to the flexor hallucis longus; thus they are the "wrong way round" and their tendons must cross in order to reach the lateral 4 toes and the medial 1st/hallux, respectively
- the extensor digitorum longus is lateral to the extensor hallucis longus, so they are the "right way round" and their tendons do not have to cross

37

Which nerves supply the muscles of the superficial and deep posterior compartments of the leg?

- the tibial nerve

38

Which muscles make up the borders of the popliteal fossa? What lies within this fossa?

- (note that the fossa is diamond shaped)
- lower borders: the two heads of gastrocnemius
- upper borders: hamstrings (semitendinosus and semimembranosus medially, biceps femoris laterally)
- contains (from superficial to deep): tibial nerve, popliteal vein, popliteal artery, common fibular nerve)

39

Briefly explain the blood supply of the thigh and leg.

- femoral artery divides into the deep and superficial branches (the deep femoral give off the perforating branches that pass through the fibrous arches of adductor magnus)
- the superficial femoral passes through the adductor hiatus to enter the posterior aspect of the knee as the popliteal artery
- popliteal artery gives off the anterior tibial artery (pass to the anterior aspect of the leg at the top of the interosseus membrane), before the remaining tibioperoneal trunk divides into the posterior tibial artery (medial) and fibular artery (lateral)

40

Briefly explain the blood supply of the foot.

- the anterior tibial artery gives off the arcuate artery near the base of the metatarsals and then extends to the dorsal hallux as the dorsalis pedis
- the posterior tibial artery divides into the lateral plantar artery (supplies the plantar 4 lateral toes via the plantar arch) and medial plantar arteries (supplies the plantar hallux)

41

Briefly explain the venous drainage of the lower limb.

- greater and lesser sciatic veins emerge from the venous arches in the foot
- lesser sciatic vein runs posterior and drains into the femoral vein above the knee
- greater sciatic vein runs anterior and drains into the femoral vein just before it forms the external iliac vein
- (the greater sciatic vein runs medial to the femoral vein)

42

Explain the nerve supply to the lower limb.

- (these arise from the lumbosacral plexus (L1-S4)
- femoral nerve supplies anterior thigh, becoming the saphenous nerve to supply the anterior leg
- obturator nerve emerges from the obturator foramen to supply the medial thigh
- the sciatic nerve emerges from the greater sciatic notch (below the piriformis) to supply the posterior thigh before branching into the tibial and common peroneal/fibular nerves (tibial nerve supplies posterior leg and branches into the plantar nerves in the foot; common fibular supplies lateral thigh)
- common fibular splits into the superficial and deep fibular nerves (superficial supplies the lateral thigh; deep supplies the anterior thigh)