lower limb Flashcards
(124 cards)
1
Q
lumbar plexus content
A
femoral (L2-L4)
obturator (L2-L4)
sciatic nerve - lumbosacral trunk (L4-L5)+sacral nerves (S1-S3)
2
Q
root of nerves of lumbar plexus from pelvis to lower limb
A
femoral - subingual space
obturator - obturator canal
sciatic nerve - greater sciatic foramen
3
Q
superficial veins at sciatic hiatus
A
superficial epigastric
superficial circumflex iliac
accessory saphenous
greater saphenous
4
Q
cutaneous nerves of the lower limb
A
lateral thigh:
lateral cutaneous T12
lateral cutaneous nerve of thigh L2-L3
anterior thigh:
femoral branch of genitofemoral L1-L2
medial thigh:
ilioinguinal L1
cutaneous branch of obturator L2-L4
all:
anterior cutaneous branch of femoral L2-L4
5
Q
boundaries of the femoral triangle
A
roof: fasciae latae cribiform fascia subcutaneous tissue skin
base:
inguinal ligament
lateral:
sartorious
medial:
adductor longus
floor:
iliopsoas
pectineus
6
Q
content of femoral triangle
A
femoral nerve, artery, vein and lymph (NAVL)
7
Q
femoral sheath composition and what it does
A
transversalis and iliopsoas fascia
adventitia of femoral vessels
8
Q
what is the space medially within the femoral sheath
A
femoral canal
contains fat and lymphatics
9
Q
muscles of the anterior compartment of the leg
A
iliacus
psoas major
pectineus
sartoriuous
quadriceps: rectus femoris vastus lateralis vastus medialis vastus intermedius
10
Q
role of muscles of anterior compartment and which muscles do extra
A
extend knee (quadriceps)
flex hip (all other)
pectineus - adducts hip and assists in medial rotation
sartorious - abducts, laterally rotates and flexes knee
rectus femoris - flexes hip
11
Q
pectineus attachment
A
superior ramus of pubis to pectineal line of femur
12
Q
sartorious attachment
A
anterior superior iliac spine to superior medial tibia
13
Q
rectus femoris attachment
A
AIIS and ilium above acetabulum to quadriceps tendon then tibial tuberosity via patellar ligament
14
Q
vastus lateralis attachment
A
greater trochanter to quadriceps tendon then tibial tuberosity via patellar ligament
15
Q
vastus medialis attachment
A
intertrochanteric line to quadriceps tendon then tibial tuberosity via patellar ligament
16
Q
vastus intermedius attachment
A
anterior and lateral shaft of femur to to quadriceps tendon then tibial tuberosity via patellar ligament
17
Q
what nerve is found deep to the inguinal ligament
A
femoral nerve
18
Q
branches of the femoral nerve
A
muscular
articular
cutaneous - saphenous is terminal
19
Q
root values for the anterior muscle compartment:
iliacus, *pectineus and sartorious
psoas major
quadriceps
A
femoral (L2-L3) *sometimes obturator
anterior rami (L1-L3)
femoral (L2-L4)
20
Q
muscles of medial compartment of the leg
A
gracilis adductor longus adductor brevis adductor magnus obturator externus
21
Q
role of muscles of the medial compartment and which muscles do extra
A
hip adductors
gracilis - flexes knee
adductor brevis - may assist flexion
obturator externus DOES NOT ADDUCT - laterally rotates thigh
22
Q
root values for medial compartment muscles:
gracilis
adductor longus, braves and *magnus
obturator externus
A
obturator (L2-L3)
obturator (L2-L4) *also sciatic (L4)
obturator (L3-L4)
23
Q
obturator nerve branches
A
anterior and posterior division
muscular branches
(anterior is cutaneous to middle)
24
Q
location of the adductor canal
A
starts at apex of femoral canal to adductor hiatus
under distal sartorious
25
boundaries of adductor canal
sartorious
vastus medialis
adductor longus
26
what passes through the adductor canal
femoral vessels (veins and arteries) and the saphenous nerve (between sartorious and gracilis)
27
arterial supply to the anterior and medial thigh
femoral artery from the external iliac (eventually becoming popliteal through the adductor hiatus)
profunda femoris is a branch
obturator artery from the internal iliac
posterior and anterior branches
28
where does profunda femoris branch off and what branches does it have
deep to adductor longus
3-4 perforating branches through adductor magnus
medial (posterior) and lateral (anterior) circumflex branches (they join anteriorly and with inferior gluteal to form cruciate anastomosis)
29
what do the posterior and anterior branches of the obturator artery supply
anterior - muscles of medial compartment
| posterior - muscles attached to ischial tuberosity
30
gracilis attachment
body and inferior ramus of pubis to superior medial surface of tibia
31
adductor longus attachment
body of pubis to medial 1/3 linea aspera
32
adductor brevis attachment
body and inferior rams of pubis to pectineal line and proximal linea aspera
33
adductor magnus attachment
pubic ramus and ischial tuberosity to linea aspera, medial supracondylar line and adductor tubercle
34
obturator externus attachment
margin of obturator foramen and membrane to trochanteric fossa
35
long axis of shaft of femur crosses the long axis of head and neck (wider hips = narrower)
angle of inclination
36
neck angle slightly anteriorly
angle of anteversion
37
lines at inferior posterior section of femur
supracondylar lines
38
Muscles of gluteal region (8)
```
gluteus maximus
piriformis
obturator internus
gemelli
quadratus femoris
gluteus medius
gluteus minimus
tensor fasciae latae
```
39
the lateral rotators of the hip and any other action they preform
```
*gluteus maximus - extends hip
piriformis
obturator internus
gemelli
quadratus femoris
```
40
the medial rotators of the hip
gluteus medius and gluteus minimus
41
muscle has the role of support
tensor fasciae latae
42
what muscles are innervated by superior gluteal nerve (L4-S1)
gluteus medius
gluteus minimus
tensor fasciae latae
43
innervation of the gluteus maximus
inferior gluteal nerve (L5-S2)
44
innervation of the gemelli
superior - obturator internus (L5-S1)
| inferior - quadratus femoris (L5-S1)
45
gluteus maximus attachment
sacrum, sacrotuberous ligament and ilium to iliotibial tract (3/4) and gluteal tuberosity (1/4)
46
gluteus medius attachment
ilium between posterior and anterior gluteal lines to greater trochanter of femur
47
gluteus minimus attachment
ilium between anterior and inferior gluteal lines to greater trochanter of femur
48
gemelli attachments
superior - ischial spine to tendon of obturator internus (greater trochanter of fossa)
inferior - ischial tuberosity to tendon of obturator internus
49
tensor fasciae latae attachments
anterior iliac crest and ASIS to iliotibial tract
50
gluteal vessels and nerves separate to form superior and inferior around what muscle
piriformis
51
posterior cutaneous nerves of the thigh
middle clunial nerves (S1-S3)
superior clunial nerves (L1-L3)
inferior clunial nerves (S1-S3)
52
what forms the articular surfaces of the hip joint
acetabulum - fat pad in synovial membrane, transverse acetabular ligament, bridging notch, lunate surface
head of femur - articular cartilage, fovea where ligament head sits
fibrous capsule
53
ligaments of hip joint
iliofemoral
pubofemoral
ischiofemoral
54
attachment of iliofemoral ligament
AIIS to intertrochanteric line
55
attachment of pubofemoral ligament
iliopubic eminence to lower intertrochanteric line
56
attachment of ischiofemoral ligament
posterior aspect of acetabulum to greater trochanter
57
what do iliofemoral, pubofemoral and ischiofemoral ligaments limit
iliofemoral - extension, lateral rotation, adduction and abduction
pubofemoral - extension, lateral rotation and abduction
ischiofemoral - extension, medial rotation and adduction
58
blood supply to the hip joint
medial and lateral circumflex iliac arteries
| acetabular branch
59
muscles of the posterior thigh compartment (hamstrings)
semitendinous
semimebranous
biceps femoris
60
innervation of the hamstrings
tibial division of the sciatic nerve (L5-S2)
| *short head of biceps femurs - common peroneal division of the sciatic (L5-S2)
61
actions the hamstrings preform
extend hip and flex knee
* lateral rotation - biceps femoris
* medial rotation - semimembranous, semitendinous, gracilis and sartorious
62
popliteal fossa boundaries
roof - deep fascia (pierced by short saphenous and sural)
superior - tendon of biceps femoris laterally and semitendinous and semimembranous medially
inferiorly - medial and lateral heads of gastrocnemius
floor - popliteal surface of femur, knee joint capsule, popliteus muscle, oblique popliteal ligament, middle genicular vessels
63
contents of popliteal fossa
popliteal artery
popliteal vein
tibial and common peroneal divisions of the sciatic
64
what is the oblique popliteal ligament and its role
expansion of semimembranous muscle
| reinforces knee joint capsule
65
what do the 5 genicular branches of the popliteal artery supply
pierce joint to supply the cruciate ligaments
66
terminal branches of the popliteal artery
anterior and posterior tibial arteries
67
tendons that laterally rotate the knee joint
quadriceps tendon and patellar tendon
68
type of joint at knee
modified hinge joint
69
what are the three articulations making up the knee joint
femoropatellar - patella on anterior femur
| 2x femorotibial - lateral/medial femoral condyle with lateral/medial tibial condyle
70
articular surface of the femur tibia and patella
femur - patellar surface, lateral and medial condyle, intercondylar fossa
tibia - lateral and medial condyle and intercondylar eminence
patella - (inf->sup) apex, medial and lateral facets
71
attachments of the capsule covering the knee
anteriorly fuses with quadriceps tendon
| posteriorly encloses intercondylar fossa of femur (opening posterior to lateral condyle for popliteus muscle)
72
synovial membrane attachments
alar folds attach to inner surface of fat pads on either side of the patellar ligament
infra patellar fold attaches to the femur
(cruciate ligaments are inter capsular but not it the synovial membrane)
73
bursae around the knee joint associated with synovial cavity
suprapatellar - reduces friction
gastrocnemius
semimembranous
popliteus
74
bursae around knee joint not associated with synovial cavity
subcutaneous prepatellar
deep + subcutaneous infra patellar
anserine (gracilis, sartorious + semitendinous meet)
75
extracapsular ligaments of the knee
oblique popliteal
arcuate popliteal
medial collateral (broad)
lateral collateral (cord-like)
76
role of popliteal ligaments of the knee
oblique popliteal - expansion of semimembranous tendon, reinforces posterior
arcuate popliteal - thickened fibres over popliteal muscle, strengthens posteriolateral capsule
77
attachment of medial collateral ligament of the knee
medial epicondyle of femur to medial condyle and superior surface of tibia
78
attachment of lateral collateral ligament of the knee
lateral epicondyle of femur to lateral head of fibula
79
intracapsular ligaments of the knee
anterior cruciate ligament
| posterior cruciate ligament
80
role and attachment of anterior cruciate ligament
anterior intercondylar tibia to lateral condyle of femur
| limits anterior displacement of knee
81
role and attachment of posterior cruciate ligament
posterior intercondylar tibia to medial condyle of femur
| limits posterior displacement of knee
82
describe the menisci and their role
fibrocartilage wedges
| shock absorption
83
describe medial meniscus and its attachment
C shaped
broad posteriorly
attached to tibial collateral ligament
84
describe lateral meniscus and its attachment
circular
freely movable
attached to popliteus
85
blood supply to the knee
5 genicular branches from popliteal
descending genicular branch from femoral
descending branch from lateral circumflex
recurring branches from anterior and posterior tibial arteries
all join at periarticular genicular anastomosis
86
septum surrounding the anterior compartment of the lower leg
anterior septum
87
septum separating the lateral and posterior compartments
posterior septum
88
septum that divides the posterior compartment into deep and superficial
transverse inter muscular septum
89
properties of the interosseous membrane
surface for muscle attachment and resist pull of muscles attached to fibula
fibres inferolaterally from tibia to fibula
90
what type of joint is the superior tibiofibular joint and its attachments
plane synovial
| head of fibula to facet on tibial condyle
91
does the superior tibiofibular joint allow any movement
slight movement during dorsiflexion of ankle
92
Muscles of the lateral compartment of the lower limb (2)
peroneus longus
| peroneus brevis
93
Muscles of the anterior compartment of the lower limb (4)
tibialis anterior
extensor digitorum longus
peroneus tertius
extensor hallucis longus
94
Action of the muscles of the lateral compartment of the lower leg and nerve supply
evertors of the foot
| superficial peroneal nerve (L5-S2)
95
Action of the muscles of the anterior compartment of the lower leg (including extras) and nerve supply
all extensors (dorsiflexors) of ankle joint and digits
tibialis anterior - inverts foot
peroneus longus - everts foot
deep peroneal nerve (L4-L5)
96
attachment of peroneus longus and tendon
```
lateral fibula (head and upper 1/3) to base of metatarsal and medial cuneiform
tendon passes superior to peroneal trochlea of calcaneus and forms groove on cuboid
```
97
attachment of peroneus brevis and tendon
```
lateral fibula (lower 2/3) to tuberosity on base 5th metatarsal (lateral)
tendon passes inferiorly to peroneal trochlea of calcaneus and inserts on 5th metatarsal
```
98
attachment of tibialis anterior
lateral condyle of tibia, lateral tibia (superior 1/2) and interosseous membrane to medial cuneiform (medial and inferior) and base of 1st metatarsal
99
attachment of extensor digitorum longus
lateral condyle of tibia, medial fibula (superior 3/4) and interosseous membrane to middle and distal phalanges of of lateral 4 digits
100
attachment of preoneus tertius
anterior fibula (inferior 1/3) and interosseous membrane to dorsal of base of 5th metatarsal
101
attachment of hallucis longus
anterior fibula (middle) and interosseous membrane to base of distal phalanx of hallux
102
what is the thickening of fascia surrounding the ankle
extensor retinacula:
| superior and inferior
103
attachments of the superior extensor retinaculum
anterior border of tibia to lower fibula
104
attachments of the inferior retinaculum
Y shape
stem of Y - calcaneus
upper limb - medial malleolus
lower limb - pass medial border to blend with dense fascia of abductor hallucis
105
cutaneous supply to:
knee
lateral leg
medial and anterior leg
anterior cutaneous branch of femoral
lateral sural cutaneous
saphenous nerve
106
superficial muscles of the posterior compartment of the lower leg
gastrocnemius
plantaris
soleus
107
deep muscles of the posterior compartment of the lower leg
popliteus
flexor digitorum longus
flexor hallucis longus
tibialis posterior
108
Role of the muscles of the posterior compartment of the lower leg (including extras)
plantarflexion
popliteus - unlocks knee (by lateral rotation of femur on tibia)
tibialis posterior - inverts foot
109
innervation of the superficial muscles of the posterior compartment of the leg
tibial nerve (S1-S2)
110
innervation of the deep muscles of the posterior compartment of the leg
popliteus - tibial nerve (L4-S1)
flexor digitorium longus and flexor hallucis longus - tibial nerve (L5-S2)
tibialis posterior - tibial nerve (L4-L5)
111
Order of tendons of the deep muscles and associated vessels (medial to lateral) and location
tibialis posterior - flexor digitorium longus - posterior tibial artery - posterior tibial vein - tibial nerve - flexor hallucis longus
Tom Dick And Very Naughty Harry
Located in the flexor retinaculum
112
attachment of flexor retinaculum
medial malleolus to calcaneous
113
where do all the superficial muscles of the posterior compartment insert
tendocalcaneous (to posterior surface of calcaneus)
114
origin of the heads of the gastrocnemius
medial head - popliteal surface of femur (superior to medial condyle)
lateral head - lateral condyle of femur
115
origin of plantaris
lateral supracondylar line of femur (proximal to lateral head of gastrocnemius)
116
origin of soleus
soleal line of tibia and posterior fibula tendinous arch (upper 1/3)
117
attachments of the popliteus
lateral condyle of femur and lateral meniscus to above soleal line of tibia
118
attachments of flexor digitorum longus and tendon
posterior tibia to distal phalanx 2-4
| groove on posterior medial malleolus
119
attachments of flexor hallucis longus and tendon
posterior fibula to distal phalanx of hallux
| grooves posterior surface of the lower end of tibia and posterior surface of talus
120
attachments of tibialis posterior and tendon
posterior tibia, posterior fibula and interosseous membrane to tuberosity of navicular, cuneiforms, cuboid, calcaneus and base of 2-4 metatarsals
deep to flexor digitorum longus - groove on posterior to medial malleolus
121
passage of the tibial nerve and its terminal branches
heads of the gastrocnemius and deep to tendinous arch of soleus with posterior tibial artery
medial and lateral plantar nerves
122
```
cutaneous supply to posterior leg:
back of knee
medial
posterior
lateral
```
posterior cutaneous nerve of thigh
saphenous nerve
medial sural nerve
lateral sural nerve
123
what type of joint is the inferior tibiofibular joint
syndesmosis - no movement
| *slight movement to accommodate wedging of trochlea of talus during dorsiflexion
124
ligaments supporting the inferior tibiofibular joint
anterior and posterior ligaments that are continuous with the interosseous membrane
