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Lower Limb Flashcards

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1
Q

Femoral triangle borders

A

Medial - medial border of adductor longus

Lateral - sartorius

Superior - inguinal ligament

Roof - fascia lata

Floor - AL, pect, posts, iliacus (M to L)

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2
Q

Origin of the hamstrings (M to L)

A

Ischial tuberosity

ST, SM, BF (long head)

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3
Q

Insertion of the short rotators (S to I)

A

Piriformis

Superior gemellus

Obturator internus

Inferior gemellus

Obturator externus

Quadratus femoris

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4
Q

Anastomoses of hip

A

Trochanteric

  • Superior gluteal A
  • Inferior gluteal A
  • Medial Cx Fem A
  • Lateral Cx Fem A

Cruciate

  • Inferior gluteal A
  • Medial Cx Fem A
  • Lateral Cx Fem A
  • Ascending 1st Perf
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5
Q

Relations of N + A to Psoas

A

Medial - ext iliac A + V

Deep / Medial - obt N

Lateral - femoral N

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6
Q

Root values of gluteal muscles

A
  1. Superior gluteal N = L4, L5, S1
  2. Inferior gluteal N = L5, S1, S2
  3. N to obturator internus = L5, S1, S2
  4. N to quadratus femoris = L4, L5, S1

1 + 4 / 2 + 3 = same

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7
Q

Closely assoc. structures to iliopsoas muscle

A

Medially @ the pelvic brim -> iliac vessels

@ insertion site -> medial femoral Cx A

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8
Q

Ligaments of the hip

A
  1. Iliofemoral (strong, anterior)
  2. Ischiofemoral (weak, posterior)
  3. Pubofemoral (small, posteroinferior)
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9
Q

Innervation of anterior thigh / hip flexors

A
  1. Psoas (L1, 2, 3)
  2. Iliacus (L2, 3, 4 - femoral N)
  3. Pectineus (L2, 3, 4 - femoral N, remember pectinous = watershed)
  4. Rectus femoris (L2, 3, 4 - femoral N)
  5. Sartorius (L2, 3, 4 - femoral N)
  6. VM, VI, VL (L2, 3, 4 - femoral N)
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10
Q

Pes anserine insertion

A

Common insertion site for (Say Grace Before Tea, Mum):

  1. Sartorius
  2. Gracilis
  3. Semitendinosus
  4. Semimembranosus
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11
Q

Surgical approach to pes anserine

A

Harvest semitendinosus / gracilis

Terminal branch of saphenous N @ risk as it runs between sartorius + gracilis

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12
Q

Additional structures within the femoral triangle (NOT NAVI)

A

Lateral cutaneous N of thigh crosses the lateral corner of the triangle

Femoral br of genitofemoral N (L1 / L2)

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13
Q

Structure related to sartorius in lower thigh

A

Saphenous N lies posterior to sartorius as it exits out of Hunters canal

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14
Q

Surgical considerations assoc. w/ vastus lateralis

A

Perforators from profound femurs runs deep to VL + need to be identified + ligated to prevent excessive bleeding

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15
Q

Obturator N supply

A

Ant division:

  1. Pectineus (watershed)
  2. Add B
  3. Add L
  4. Gracilis
  5. Sensory

Post division:

  1. Obt E
  2. Add M
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16
Q

Landmark for division of anterior / posterior Obturator N

A

Add B

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17
Q

Landmark for division of anterior / posterior Obturator N

A

Add B

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18
Q

Add Magnus rule of 2s

A

Origin

  1. Pubic
  2. Ischial

Insertion

  1. P - glut tub / linea aspera / supracondylar ridge
  2. I - adductor tubercle

N supply

  1. P - post division of Obt N
  2. I - tib portion of Sciatic N

A supply

  1. Proximal = obt A
  2. Distal = profunda femoris perforators

Function

  1. P - true adduction
  2. I - hip extension
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19
Q

Unique feature of gracilis

A

Only adductor that DOES NOT insert into the linea aspera

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20
Q

Piriformis as a landmark (structures above + below)

A

Above:
1. Superior gluteal A + N

Below:

  1. Sciatic N
  2. Inferior gluteal A + N
  3. Perf cut N
  4. Post Fem cut N
  5. N to QF
  6. N to obt Int
  7. Pudendal N
  8. Pudendal A + V
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21
Q

Structures via the lesser sciatic foramen

A
  1. Tendon of obt int
  2. N to obt int
  3. Internal pudendal A + V
  4. Pudendal N
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22
Q

Vessel @ risk with posterior hip approach

A

MCFA - deep branch crosses the tendon of obt ext (behind QF) -> travels superiorly posterior to the conjoint tendon (SG / OI / IG) to perforate into the capsule

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23
Q

Relation fo sciatic N to the short rotator muscles

A

Anterior to piriformis but posterior to obturator internus

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24
Q

Innervation of the gemelli muscles

A

Sup G - N to obt int

Inf G - N to QF

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25
Landmarks for MFCA
Space between the inferior edge of inf G + superior edge of QF (lying on OR posterior to obt ext)
26
Surgical considerations for superior gluteal N
SGN is 5cm proximal / above the tip of the GT @ risk w/ lateral (Hardinge) hip approach when splitting the glut med muscle
27
Order of structures inserting onto fibular head
From A to P 1. LCL 2. Popliteofibular lig 3. Rectus femoris
28
Common Fib N relation to fibular
Passes posterior to the tendon of biceps femoris as it inserts into the fibula Passes around the neck of the fibula
29
Gerdy's tubercle
Lateral condyle of the tibia Insertion point for the ITB
30
Attachments of the fascia lata
Proximal - inguinal ligament, ASIS, iliac crest, PSIS, ischiopubic ramus Distal - patella, inferior portion of tibial condyles, head of fibular Is continuous posteriorly w/ the popliteal fossa (where transverse fibres strengthen it) + then the deep fascia of the calf
31
Muscles enclosed by fascia lata
1. Glut max | 2. TFL
32
Femoral ring borders
A = inguinal ligament P = pectineal lig + pectineus (covering superior pubic ramus) M = lacunar ligament L = femoral vein
33
Cloquet's node
LN located in the femoral canal Drains the clitoris in F + the glans penis in M
34
Genitofemoral N course in fem sheath
Fem br (L1) of GF N Runs on the anterior surface of ext iliac A Pierces the anterior wall of the fem sheath
35
Fem A br in the fem triangle
x4 superficial: 1. Superficial Cx iliac A 2. Superficial epigastric A 3. Superficial external pudendal A 4. Deep external pudendal A x1 deep: 1. Profunda femoris
36
Cx of cannulating fem A
1. Retroperitoneal haemorrhage 2. Gut perforation 3. AV fistula
37
Superficial epigastric A
Emerges from saphenous opening Supplies the skin / subcut as it passes toward the umbilicus
38
Superficial external pudendal A
Emerges medially from saphenous opening Passes anterior to spermatic cord / round lig to supply scrotal skin / subcut
39
Deep external pudendal A
Emerges more medially from saphenous opening than the SEPA Passes posterior to spermatic cord / round big to supply scrotal skin / subcut
40
Superficial Cx Iliac A
Pierces FL lateral to saphenous opening Passes superolaterally toward ASIS where it forms anastomosis w/ other vessels
41
Course of medial Cx fem A
Passes posteriorly between psoas + pectineus into the adductor compartment Passess posteriorly between obt ext + add b into the posterior compartment Visible between inf gemellus + QF as it divides @ risk w/ posterior approach to the hip
42
Course of lat Cx fem A
Lies under sartorius Ask br @ risk w/ anterior approach to the hip (lies between sartorius + TFL)
43
Fem vein course
Enters fem triangle posterior to fem A In the fem sheath it comes to lie medial to fem A Just below the fem sheath the greater saphenous vein joins its anteromedial side through the cribriform fascia
44
Gluteal IM inj
Upper outer quadrant of the gluteal region Gluteal region = extends from the iliac crest to the gluteal fold
45
Stability of the hip joint
Result of the adaptation of the articulating surfaces of acetabulum + femoral head to each other
46
Mobility of the hip joint
Results from the femur having a neck that is much narrower than the equatorial diameter of the head
47
Haversian fat pad
Occupies the central non-articular portion of the acetabulum
48
Hip capsule attachment
Anteriorly extends to the intertroch line Posteriorly it extends for only 1/2 this distance to 1/2 along the femoral neck *Capsule is loose but extremely strong*
49
Clinical implications of iliofemoral lig
Limits extension @ the hip J Forms the fulcrum or axis around which the neck of the femur rotates in dislocation of the hip joint
50
Weakest hip lig
Ischiofemoral lig
51
Bursae of the hip
1. Under glut med / min @ GT 2. Under glut max (over isch tub, GT + upper part of VL) 3. Iliac bursa - extends upwards beneath iliacus
52
Structures that separate the fem A + V + N from the hip joint
Fem A - psoas Fem V - pectineus Fem N - iliacus
53
Structure that separates sciatic N from the hip joint
Obt internus + gemelli
54
Ant approach to hip (Smith Peterson)
Between sartorius + TFL (identifying LCFA) Detaching TFL, RF + ant glut med + iliacus
55
Ant/Lat approach to hip (Watson Jones)
Between TFL + glut med (identifying LCFA) Exposes the capsule under the ant fibres of glut med / min
56
Post approach to hip (Moore)
Splitting middle of glut max in line of its fibres Divide piriformis, obt int + gemelli @ femoral attachments Sciatic nerve is protected by reflecting obt int / gemelli medially
57
Inj into hip
Anterior - 5cm below ASIS, directed upwards / backwards / medially Lateral - in front of GT + parallel w/ fem neck
58
Borders of pop fossa
Superomedial - ST / SM Superolateral - BF Inferomedial - med gastroc Inferolateral - lat gastroc
59
Floor + roof of pop fossa
Roof = fascia lata w/ strengthening transverse fibres Floor (sup to inf) 1. Femur 2. Knee capsule 3. Popliteus fascia
60
Contents of pop fossa
Deep to Sup 1. Popliteal A 2. Popliteal V 3. Popliteal LNs 4. Sciatic N OR tibial / common fibular
61
Course of fem V relative to fem A
Lateral @ add hiatus Posterior in fem triangle Medial in femoral sheath
62
Borders of add canal
M - add longus superiorly, add magnus inferiorly L - vastus med Roof - sartorius fascia w/ sub sartorial plexus
63
Contents of add canal
1. Fem A 2. Fem V 3. Saphenous N 4. N to vast m
64
Relation of fem NV bundle
@ all times the fem A lies between fem V + saphenous N
65
Course of pop A relative to N
Medial + deep to sciatic N @ add hiatus Lateral to tib N as it enters the solar arch
66
Relation of pop NV bundle
@ all times the pop V lies between pop A + tibial N
67
LCL vs MCL
LCL: - Round, cord-like lig - NOT attached to lateral meniscus - Taut w/ ext + 'screw home' movement MCL: - Broad, flat, strong lig - Attached to medial meniscus - Limits ext + 'screw home' movement
68
Oblique pop lig
Thick rounded band, strong ++ Formed from lat expansion from insertion of SM -> slopes to popliteal surface of femur (obliquely) Limits ext + rotation during screw home movement
69
Screw home mechanism
IR of tibia 15 degrees relative to femur Occurs from 20 degrees flex to O degrees ext MCL / LCL / OPL - tightens + prevent further IR ACL - tightens + prevent further ext Slightly hyperextended position ER must occur to "unlock" knee before flex can occur (ER movement - BF, SM ST)
70
Function of the menisci
1. Shock absorbers 2. Spread synovial fluid 3. Obscure role in rotation @ the knee 4. Slightly deepens the articular surface - ?stability
71
Anatomy of meniscal tears
MM torn much more commonly (x2) because of its attachment to MCL + therefore is less mobile LM is attached to popliteus + meniscofemoral lig so can be pulled out of the way when there is a rotational force @ the knee
72
Meniscofemoral lig
Arises from the posterior horn of LM + attaches to the lateral aspect of medial femoral condyle Splits into ant / post divisions around the PCL
73
Order of structures @ ext retinaculum
Timothy Has A Very Nasty Diseased Foot 1. TA 2. EHL 3. Dorsal pedis A 4. Deep fibular N 5. Dorsal pedis V 6. EDL 7. FT
74
Order of structures @ flex retinaculum
Tom Dick And Very Naughty Harry 1. TP 2. FDL 3. Posterior tibial A 4. Posterior tibial V 5. Posterior tibial N 6. FHL
75
Baker's cyst
One way valve defect in the posterior capsule of the hip Forms due to fluid accumulation in out-pouching between the tendon of SM + the medial head of gastroc
76
ACL / PCL blood supply
Middle genicular A
77
Medial + lateral meniscus blood supply
75% of the meniscus is avascular =.white zone 25% is vascular = red zone Med / Lat inferior genicular A w/ small contribution from middle genicular A to posterior horn
78
Deltoid lig
Medial collateral lig of the ankle - x2 layers Main stabiliser w/ stance phase of gait 1. Deep - narrow extending from tib mal -> medial side of the talus (rectangular) 2. Superficial - triangular shaped, continuous across several attachments
79
Individual components of the deltoid lig
1. Posterior tibiotalar lig 2. Tibiocalcaneal lig (sustentaculum tali) 3. Tibionavicular lig 4. Anterior tibiotala lig
80
Lateral collateral lig of the ankle
1. ATFL (weakest) - flat 2. Calcaneofibular - rounded, cord-like 3. PTFL (Strongest)
81
NV plane of the plantar aspect of the foot
Between 1st - 2nd muscular layers
82
Muscular layers of the foot
1. Superficial - FDB, AbH, AbDM NV plane 2. Intermediate superficial - FHL, FDL (lumbricals on tendons of FDL), QP 3. Intermediate deep - FHB, AdH, FDM 4. Deep - IO muscles + deep tendons of FL + TP

Lower Limb (2 decks)

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