Lower Limb Flashcards
1
Q
branches of lumbar plexus
A
iliohypogastric ilioinguinal genitofemoral lateral cutaneous nerve of thigh obturator femoral
2
Q
nerve roots of iliohypogastric nerve
A
L1
3
Q
nerve roots of ilioinguinal nerve
A
L1
4
Q
nerve roots of genitofemoral nerve
A
L1,2
5
Q
nerve roots of lateral cutaneous nerve of thigh
A
L2,3
6
Q
nerve roots of obturator nerve
A
L2,3,4
7
Q
nerve roots of femoral nerve
A
L2,3,4
8
Q
nerve roots of lumbosacral trunk
A
L4,5
9
Q
branches of sacral plexus that receive contribution from lumbosacral trunk
A
sciatic nerve
superior and inferior gluteal nerves
nerve to quadrates femoris
nerve to obturator internus
10
Q
nerve roots of sciatic nerve
A
L4-S3
11
Q
nerve roots of superior gluteal nerve
A
L4-S1
12
Q
nerve roots of inferior gluteal nerve
A
L5-S2
13
Q
how to remember nerve roots of gluteal nerves
A
both contain roots from lumbosacral trunk
3 words so 3 nerve roots
inferior starts 1 lower than superior
14
Q
nerve rots of nerve to quadratus femoris
A
L4-S1
15
Q
nerve roots of nerve to obturator internus
A
L5-S2
16
Q
innervation of gemelli
A
inferior = nerve to quad femoris superior = nerve to OI
17
Q
how do sciatic and gluteal nerves and vessels leave the pelvis
A
via the greater sciatic foramen
18
Q
how do femoral nerves and vessels leave the pelvis
A
via the subinguinal space
19
Q
how do obturator nerve and vessels exit the pelvis
A
obturator canal
20
Q
what does femoral nerve supply
A
anterior thigh
21
Q
what does obturator nerve supply
A
medial thigh
22
Q
what does sciatic nerve supply
A
posterior thigh, and entire leg
23
Q
superficial veins of lower limb
A
great saphenous short saphenous accessory saphenous superficial circumflex iliac superficial epigastric
24
Q
what are the two groups of superficial inguinal lymph nodes
A
horizontal and vertical
25
which structures drain to horizontal superficial inguinal lymph nodes
```
medial = anterior abdominal wall and lower anal canal
lateral = posterior abdominal wall
```
26
which structures drain to vertical superficial inguinal lymph nodes
superficial lower limb
27
cutaneous supply of lateral cutaneous nerve of thigh
lateral thigh
28
cutaneous supply of femoral brach of genitofemoral nerve
upper anterior thigh (midline of thigh)
29
cuteness supply of obturator nerve
medial thigh (adductor compartment)
30
cutaneous supply of ilioinguinal nerve
upper medial thigh
31
supply of lateral cutaneous branch of T12
upper lateral thigh
32
supply of anterior cutaneous branches of femoral nerve
anterior thigh down to knees
33
what is the name of fascia over the thigh
fasciae latae
34
what is the name of the thickening of the lateral fasciae latae
iliotibial tract
35
where does the IT tract run to and from
iliac tubercle to anterolateral tibial tubercle
36
what is the function of the IT tract
supports femur over tibia when standing
37
what is the name of the fascia over the leg
crural fascia
38
what makes up the roof of the femoral triangle
fasciae latae
cribriform fascia
subcutaneous tissue
skin
39
what is the saphenous opening
opening in the cribriform fascia to allow great saphenous vein to grain into the femoral vein
40
where is the saphenous hiatus located
inferior to the medial aspect of the inguinal ligament
41
what are the boundaries of the femoral triangle
```
roof = fascia, SC tissue and skin
base (superior) = inguinal ligament
lateral = sartorius
medial = adductor longus
floor = Iliopsoas and pectineus
```
42
what are the contents of the femoral triangle
```
lateral to medial
femoral nerve
femoral artery
femoral vein
lymphatics
```
43
what is the femoral sheath
fascia surrounding vascular structures in the femoral triangle
44
which structures are contained in the femoral sheath
femoral artery, vein and lymphatics
| NOT femoral nerve
45
what is the femoral sheath made of
transversalis and Iliopsoas fascia and adventitia of femoral vessels
46
wha t is the femoral canal
potential space medially in the femoral sheath
47
what is contained in the femoral canal
fat and lymphatics
48
actions of anterior thigh muscles
hip flexors
| knee extensors
49
actions of medial thigh muscles
hip adductors
50
actions of posterior thigh muscles
hip extension
| knee flexion
51
what is the name of the small indentation on the head f the femur
fovea
52
what connects the greater and lesser trochanter anteriorly
intertrochanteric line
53
what connects the greater and lesser trochanter posteriorly
intertrochanteric crest
54
what is the name of the pair of ridges on the posterior surface of the shaft of femur
linea aspera
55
what is the name of the ridges as the lines aspera diverges towards the condyles
supracondylar lines
56
where is the adductor tubercle
inferior, medial femur
| superior to medial epicondyle
57
what are the hip flexors of the anterior thigh
iliacus
psoas
pectineus
sartorius
58
what are the knee extensors of the anterior thigh
quadriceps
- rectus femoris
- vastus medialis
- vastus lateralis
- vastus intermedius
59
origin and insertion of iliacus
iliac crest, fossa, ala of sacrum, anterior sacroiliac ligament
TO
psoas tendon, lesser trochanter
60
innervation of iliacus
femoral nerve L2,3
61
action of iliacus
flexes hip
62
origin and insertion of psoas major
T12-L5, IV discs, lumbar transverse processes
TO
lesser trochanter
63
innervation of psoas major
anterior rami L1-3
64
action of psoas major
flexes hip
| also has action on the trunk
65
origin and insertion of pectineus
superior ramus of pubis
TO
Pectineal line of femur
66
innervation of pectineus
```
femoral nerve (L2,3)
occasionally branches from obturator (same nerve roots)
```
67
action of pectineus
adduct and flex hip
| assists with medial rotation
68
origin and insertion of sartorius
ASIS
TO
superior part of medial surface of tibia
69
innervation of sartorius
femoral nerve (L2,3)
70
action of sartorius
flex, abduct and laterally rotate hip
flex knee
(sit cross legged)
71
what are the 4 parts of quadriceps
rectus femoris
vastus lateralis
vastus medialis
vastus intermedius
72
origin of rectus femoris
anterior inferior iliac spine and ilium above acetabulum
73
origin of vastus laterals
greater trochanter and lateral linea aspera
74
origin of vastus medialis
intertrochanteric line and medial linea aspera
75
origin of vastus intermedius
anterior and lateral shaft of femur
76
why are the lower fibres of vastus medialis horizontally orientated
to prevent lateral dislocation of patella
77
why is lateral dislocation of the patella more common
the knees are more medially positioned than the hips, so when the quads contract, they tend to pull the patella laterally
78
what is the common insertion of quads
quadriceps tendon, which envelopes the patella and continues as the patellar ligament which attaches to the tibial tuberosity
79
what type of bone is the patella
sesamoid
80
what is the action of quads
extends the knee
| rectus femoris is also a hip flexor
81
innervation of quads
femoral nerve L2,3,4
82
describe the course of the femoral nerve to the upper limb
passes deep to inguinal ligament
medial to ASIS
on tendon of Iliopsoas
83
muscular branches of femoral nerve supply...
anterior thigh muscles
84
articular branches of femoral nerve supply...
hip and knee joint
85
cutaneous branches of femoral nerve supply...
anteromedial thigh
86
what is the saphenous nerve
terminal cutaneous branch o femoral nerve
87
which two muscles does the saphenous nerve pass between to reach the anteromedial knee, leg and foot
sartorius and vastus muscles
88
medial compartment of thigh muscles
```
gracilis
adductor longus
adductor bevis
adductor Magnus
obturator externus
```
89
what is the order of the adductor muscles
from superficial to deep
adductor longus
adductor brevis
adductor Magnus
90
which medial thigh muscle is NOT and adductor
obturator externus
91
attachments of gracilis
bony and inferior ramus of pubis
TO
superior medial surface of tibia
92
innervation of gracilis
obturator nerve (L2,3)
93
action of gracilis
adducts hip
| flexes knee
94
attachment of adductor longus
body of pubis
TO
middle 1/3 of linea aspera
95
innervation of adductor longus
obturator nerve (L2,3,4)
96
action of adductor longus
adducts thigh
97
attachments of adductor brevis
body and inferior ramus of pubis
TO
Pectineal line and proximal linea aspera
98
innervation of adductor brevis
obturator nerve (L2,3,4)
99
action of adductor longus
adducts thigh
| may assist in flexion
100
attachments of adductor Magnus
ischiopubic ramus and ischial tuberosity
TO
linea aspera, medial supracondylar line, adductor tubercle
101
what is the adductor hiatus
gap between attachment of adductor Magnus at supracondylar line and adductor tubercle
102
innervation of adductor Magnus
adductor part = obturator nerve (L2,3,4)
| hamstring part = tibial division of sciatic nerve (L4)
103
action of adductor Magnus
adducts thigh
adductor part also flexes
hamstring part also extends
104
attachments of obturator externus
margins of obturator foramen and obturator membrane (anterior surface)
TO
trochanteric fossa
105
obturator externus run anterior/posterior to neck of femur
posterior
106
where is the trochanteric fossa
'hole' on the medial side of greater trochanter
107
innervation of obturator externus
obturator nerve (L3,4)
108
action obturator externus
laterally rotates thigh
109
nerve roots of obturator
L2-4
110
what are the first divisions of obturator nerve
anterior and posterior branches
111
what are the anterior and posterior branches of obturator nerve named in relation to
adductor brevis
112
where do muscular branches of obturator supply
medial thigh
113
what do anterior branches of obturator nerve innervate
cutaneous innervation to middle part of medial thigh
114
where does the adductor canal run
from the apex of the femoral triangle to the adductor hiatus
115
which structures make up the apex of the femoral triangle
sartorius and adductor longus
116
which muscle does the adductor canal run deep to
sartorius (distal half)
117
what are the boundaries of the adductor canal
```
roof = sartorius
floor = vastus medialis and adductor longus
```
118
what are the contents of the adductor canal
saphenous nerve
| femoral artery/vein
119
where does saphenous nerve innervate
anteromedial knee
leg
foot
120
where do the femoral vessels pass after the adductor canal
through the adductor hiatus to reach the popliteal fossa
| transitions to popliteal artery
121
the femoral artery is a continuation of which artery
external iliac
122
course of femoral artery
```
deep to inguinal ligament
femoral triangle
adductor canal
adductor hiatus
popliteal fossa
```
123
which areas does the femoral artery supply
anterior and anteromedial thigh
124
profunda femoris is a branch of which artery
femoral artery
125
which branches does profunda femoris give off deep to adductor longus
3-4 perforating branches which pierce adductor Magnus
126
after piercing adductor Magnus where do the perforating branches of profunda femoris supply
wrap around shaft to supply structures of lateral thigh
127
which branches does the profunda femoris gives off close to the femoral neck
medial and lateral circumflex femoral
128
what is the cruciate anastomosis
anastomosis between medial and lateral circumflex femoral arteries, inferior gluteal and 1st perforating branch of profunda femoris
129
what is the importance of the cruciate anastomosis
alternative route for blood to enter the lower limb if there is a blockage in external iliac
130
where does the obturator artery arise from
internal iliac artery
131
course of obturator artery
through obturator foramen to medial compartment where it splits into anterior and posterior branches
132
where do the anterior and poster divisions of the obturator artery supply
```
anterior = muscles of medial compartment
posterior = muscles attached to ischial tuberosity
```
133
what is the angle of inclination of the femur
angle between shaft and neck
134
what is the normal range of angle o inclination
120-135 degrees
135
what is the angle of ante version of femur
angle between transverse axis of femoral condyles and axis of femoral head and neck (anteromedial to posterolateral)
136
what is the angle of anteversion also known as
angle of torsion
137
what is the normal range of ante version of femoral head
15-20 degrees
138
what is the function of the angle of torsion of femoral head
affects how the muscles attach
| changes the axis of movement at the hip joint
139
where is the trochanteric fossa
medial side of greater trochanter
140
where is the gluteal tuberosity
superior aspect of linea aspera
| inferior to lesser trochanter
141
where is the Pectineal line
inferior to lesser trochanter, posterior surface of femur
142
where is the adductor tubercle
superior to medial condyle
143
lateral rotators of the hip
```
gluteus maximus
piriformis
obturator internus
gemelli
quadrates femoris
```
144
medial rotators and abductors of hip
gluteus medius
| gluteus minimus
145
what is the main action of gluteus Maximus
extension of hip
146
attachments of tensor fasciae latae
anterior iliac crest and ASIS
TO
iliotibial tract
147
action of tensor fasciae latae
tenses fascia lata and iliotibial tract
| supports femur on tibia when standing
148
innervation of tensor fasciae latae
superior gluteal nerve
| L4, L5, S1
149
in which muscular plane is superior gluteal nerve found
between gluteus minibus and medius
150
attachments of gluteus Maximus
sacrum, sacrotuberous ligament, ilium behind posterior gluteal line
TO
iliotibial tract (superficial 3/4) and gluteal tuberosity (deeper 1/4)
151
action of gluteus Maximus
extension of hip
| assists in lateral rotation
152
innervation og gluteus maximus
inferior gluteal nerve
| L5, S1, S2
153
attachments of Piriformis
anterior sacrum and sacrotuberous ligament
TO
superior border of greater trochanter
154
action of piriformis
lateral rotation of hip
155
innervation of piriformis
anterior rami S1, S2
156
attachments of obturator internus
pelvic surface of obturator membrane and surrounding bones
TO
trochanteric fossa (via tendon)
157
where does tendon of obturator internus pass to reach trochanteric fossa
lesser sciatic foramen
158
where does piriformis pass to reach trochanteric fossa
greater sciatic fossa
159
action of obturator internus
laterally rotates hip
160
innervation of obturator internus
nerve to obturator internus
| L5, S1
161
attachments of superior gemellus
ischial spine
TO
trochanter fossa
162
action of superior gemellus
laterally rotate hip
163
innervation of superior gemellus
nerve to obturator internus
| L5, S1
164
attachments of inferior gemellus
ischial tuberosity
TO
trochanteric fossa
165
action of inferior gemellus
laterally rotate hip
166
innervation of inferior gemellus
nerve to quadratus femoris
| L5, S1
167
attachments of quadrates femoris
ischial tuberosity
TO
quadrate tubercle on intertrochanteric crest of femur
168
action of quadratus femoris
laterally rotates hip
169
innervation of quadratus femoris
nerve to quadratus femoris
| L5, S1
170
attachments of obturator externus
outer surface of obturator membrane
TO
trochanter fossa
171
action of obturator externus
laterally rotates hip
172
innervation of obturator externus
obturator nerve
| L3, L4
173
lateral rotators from cranial to caudal
```
piriformis
superior gemellus
obturator externus
inferior gemellus
quadratus femoris
```
174
attachments of gluteus medius
ilium between posterior and anterior gluteal lines
TO
lateral surface of greater trochanter
175
action of gluteus medius
abducts and medially rotates hip
176
innervation of gluteus medius
superior gluteal nerve
| L4, L5, S1
177
attachments of gluteus minimus
ilium between anterior and inferior gluteal lines
TO
anterior surface of greater trochanter
178
action of gluteus minimus
abducts and medially rotates hip
179
innervation of gluteus minimus
superior gluteal nerve
| L4, L5, S1
180
roots of sciatic nerve
L4, L5, S1, S2, S3
181
branches of sciatic nerve
tibial
| common peroneal
182
describe route of superior gluteal nerve
exits pelvis above piriformis
| moves between.gluteus medius and minimus
183
what do branches of superior gluteal artery supply
superficial: gluteus maximus
deep: gluteus minimus, gluteus maximus and tensor fasciae latae
184
roots of posterior cutaneous nerve of thigh
S1, S2, S3
185
which areas does posterior cutaneous nerve of thigh supply
posterior thigh
| inferior half of buttock via inferior clunial nerves
186
what are the roots of the clunial nerves
superior: posterior rami L1, L2, L3
middle: posterior rami S1, S2, S3
inferior: anterior rami S1, S2, S3
187
where do the superior clunial nerves supply
skin of superior half of buttocks
188
where do the middle clunial nerve supply
skin on medial side of buttocks
189
what type of cartilage covers the articular surface of hip joint
hyaline cartilage
| except at fovea
190
what shape is the acetabulum
horse-shoe shaped
191
what structure connects the inferior ends of the acetabulum
transverse acetabular ligament
192
what attaches to the fovea on head of femur
ligament of head of femur
193
what is carried in the ligament of head of femur
artery to head of femur
194
where does the capsule of hip joint attach
margins of acetabulum
| whole neck of femur (intertrochanteric line and above crest)
195
which ligaments attach hip bones to femur
iliofemoral
ischiofemoral
pubofemoral
196
attachments of iliofemoral
AIIS to intertrochanteric line
197
what are the divisions of iliofemoral ligament
upper (more posterior, attaches to superior aspect of intertrochanteric line)
lower (more anterior, attaches to inferior intertrochanteric line)
198
which movements does the iliofemoral ligament limit
extension
lateral rotation
abduction (lower)
adduction (upper)
199
attachments of pubofemoral ligament
iliopubic eminence to lower part of intertrochanteric line
200
which movements does the pubofemoral ligament limit
extension
lateral rotation
abduction
201
attachments of ischiofemoral ligament
posterior acetabulum to greater trochanter
202
which movements does ischiofemoral ligament limit
medial rotation
adduction
extension
203
which movement of the hip is not limited by a ligament and why
flexion
| trunk will limit movements
204
artery to head of femur is a branch of...
obturator artery
205
which arteries provide the main blood supply of hip joint
medial and lateral circumflex femoral arteries
| branch of profanda femoris
206
what are the hamstrings muscles
semitendinosus
semimembranosus
biceps femoris
207
what are the characteristics of a true hamstring
attachment to ischial tuberosity
acts upon the hip and knee
innervation by tibial division of sciatic nerve
208
which posterior thigh muscle is NOT a true hamstring
short head of biceps femoris
209
attachments of semitendinosus
ischial tuberosity
TO
medial surface of superior tibia
210
which muscles are closely associated with the distal attachment of semitendinosus
sartorius and gracilis
211
innervation of semitendinosus
tibial division of sciatic nerve
| L5, S1,2
212
action of semitendinosus
flexion of knee
| extension of hip
213
attachments of semimembranosus
ischial tuberosity
TO
posterior surface of medial condyle of tibia
214
innervation of semimembranosus
tibial division of sciatic nerve
| L5, S1,2
215
attachments of biceps femoris
long head: ischial tuberosity
short head: linea aspera and lateral supracondylar line of femur
TO
head of fibula
216
innervation of biceps femoris
long head: tibial division of sciatic nerve (L5, S1,2)
| short head: common fibular division of sciatic nerve (L5, S1,2)
217
what role do the hamstrings play during the gait cycle
eccentric activity during swing phase to control speed of swinging leg
218
when is maximal rotation of the knee possible
when knee is flexed
219
which muscles cause lateral rotation of the knee
```
biceps femoris
(attached to lateral aspect of knee joint)
```
220
which muscles cause medial rotation of the knee
semimembranosus/semitendinosus
gracilis and sartorius
(medial attachment to tibia)
221
roots of sciatic nerve
L4,5, S1,2,3
222
which muscle is the sciatic nerve deep to in the posterior thigh
long head of biceps
223
which branch of the sciatic nerve is located most medially in the popliteal fossa
tibial
224
what makes up the roof of the popliteal fossa
deep fascia of leg
225
which structures pierce the roof of popliteal fossa
short saphenous vein
| sural nerve
226
describe the course of the short saphenous vein
runs up midline of calf
pierces roof of popliteal fossa
drains to popliteal vein
227
what does the rural nerve innervation
skin of posterolateral leg
228
what are the superior boundaries of the popliteal fossa
diverging tendons of hamstrings
medially: semiten/semimem
laterally: biceps fem
229
what are the inferior boundaries of the popliteal fossa
medial and lateral head of gastrocnemius
230
what makes up the floor of the popliteal fossa
popliteal surface of femur
capsule of knee joint
popliteus muscle
231
which ligament is present in the posterior surface of knee joint capsule
oblique popliteal ligament
232
what forms the oblique popliteal ligament
expansion from semimembranosus tendon
233
which vessels pierce the knee joint capsule posteriorly
middle genicular vessels
234
what do the middle genicular vessels supply
cruciate ligaments
235
what are the contents of the popliteal fossa (medial/deep to lateral/superficial)
popliteal artery
popliteal vein
terminal branches of sciatic nerve (tibial then common fibular)
236
when does the femoral artery become the popliteal artery
when it passes through the adductor hiatus
237
when does the popliteal artery end
inferior border of popliteus
238
what are the branches of the popliteal artery in the popliteal fossa
```
lateral superior genicular artery
medial superior genicular artery
middle genicular artery
lateral inferior genicular artery
medial inferior genicular artery
```
239
what are the terminal branches of the popliteal artery
anterior and posterior tibial artery
240
which external structures support the knee joint anteriorly
quadriceps tendon
patella
patellar ligament
241
which external structures support the knee joint laterally
tendon of biceps femoris
242
which external structures support the knee joint medially
sartorius
gracilis
semitendinosus
semimembranosus
243
what type of joint I the knee joint
modified hinge joint
244
why is the knee joint described as a modified hinge joint
as well as flexion/extension medial and lateral rotation are possible
245
which bones articulate at the knee joint and what are these articulations called
```
femur
patella
tibia
femoropatellar
femorotibial x2
```
246
which muscle often contains a small sesamoid bone in its proximal tendon
gastrocnemius
247
what are the femoral articular surface of the knee joint
femoral condyles
| patellar surface
248
describe the femoral condyles
medial and lateral rounded condyles
| located on anteroinferior aspect of femur
249
what separates the medial and lateral femoral condyles
intercondylar fossa/notch
250
describe the patellar surface of the femur
superior to the condyles
| greater ridge on border of lateral surface to prevent lateral displacement of patella
251
describe the articular surface of the patella
has a medial and lateral facet that articulates with the medial and lateral aspects of patellar surface of femur
lateral facet is larger
252
describe the tibial articular surface of knee joint
medial and lateral condyles
| much flatter than femoral condyles
253
what separates the tibial condyles
intercondylar eminence
254
describe the capsule attachments of the knee joint
anteriorly fuses with the quadriceps tendon superiorly and patellar ligament inferiorly
posteriorly it follows the margins of the femoral condyles and posterior margin of intercondylar fossa and along the border of the tibial condyles, gains enclosing the intercondylar eminence
255
why is there an opening in the posterolateral aspect of the knee joint capsule
to allow passage of popliteus muscle
256
describe the attachment of the synovial membrane of the knee joint to the femur
follows articular margins
257
describe the attachment of the synovial membrane of the knee joint to the tibia
follows the margins of the condyles almost completely, leaving the intercondylar eminence outside the synovial cavity
258
what are the alar folds
medial and lateral folds cover the inner surface of fat pads on either side of the patellar ligament
259
which bursae of the knee communicate with the joint cavity
suprapatellar
gastrocnemius
semimembranosus
popliteus
260
describe the suprapatellar bursa
travels superiorly deep to quadriceps tendon
| reduces friction of movement of quad tendon
261
what is articularis genu and what is its function
small muscle made from fibres of vastus intermedium
| holds suprapatellar bursa in place and prevents it falling downwards
262
where is the subcutaneous prepatellar bursa
between the skin and lower part of the patella
263
where is the subcutaneous infra patellar bursa
between the skin and patellar ligament
264
where is the deep infra patellar bursa
between patellar ligament and upper tibia
265
what is the anserine bursa
bursa on the medial aspect the knee joint separating the tendons of gracilis, Sartorius and semitendinosus from the medial collateral ligament
266
describe the popliteus bursa
surrounds the popliteus tendon as it reaches beyond the opening on the joint capsule
267
what are the extracapsular ligament associated with the knee joint
oblique popliteal
arcuate popliteal
medial and lateral collateral
268
describe the oblique popliteal ligament
expansion on the semimembranosus tendon on the posterior surface of the capsule
269
describe the arcuate popliteal ligament
thickening of the capsule over the opening for popliteus
| strengthens posterolateral capsule
270
how do the medial and lateral collateral ligaments of the knee differ in appearance
the MCL is a strong, flat thickening of the capsule
| the LCL is cord-like and narrow
271
attachments of the MCL of knee
medial epicondyle of femur
TO
medial condyle and superior medial surface of tibia (close/deep to attachments of sartorius/gracilis/semitendinosus)
272
the medial collateral ligament attaches to which other structure of the knee joint
deep fibres attach to the medial meniscus
273
attachments of the LCL of knee
lateral epicondyle of femur
TO
lateral head of fibula
274
which structures are associated with the LCL of the knee
popliteus tendon runs deep
| biceps femoris tendon splits around it
275
which collateral ligament is most likely to be injured
medial collateral ligament
| from force directed on lateral side of knee
276
damage to the MCL is often associated with damage to which other structure
medial meniscus
277
which ligaments are found within the capsule of the knee joint
cruciates
| intracapsular but extrasynovial
278
attachments of ACL
anterior intercondylar area of tibia
TO
medial side of lateral condyle of femur
279
which movements does the ACL limit
prevents backward translation of femur on tibia, hyperextension and medial rotation on planted foot
280
what are the two bands of the ACL and how does their function differ
anteromedial band limits flexion
| posterior lateral band limits extension
281
attachments of the PCL
posterior intercondylar area of tibia
TO
lateral side of medial condyle of femur
282
which movements does the PCL limit
prevents forward movement of femur on tibia
283
what are the divisions of the PCL and how do their actions differ
anterolateral band limits flexion
| posteromedial band limits extension
284
what is the most important function of the PCL
supporting body weight over a bent knee eg when climb stairs
stops the body weight from pushing the femur over the anterior edge of tibial plateau
285
how do the cruciate ligaments work together to limit medial rotation
they wind around each other
286
what are the menisci made of
fibrocartilage
287
what is the function of the menisci
deepen tibial articular surface and increase congruency
| shock absorption
288
describe the medial meniscus
C-shaped
firmly attached to tibia
firm attachment from medial collateral ligament
289
describe the lateral meniscus
circular
not tightly attached to tibia (freely moveable)
attachment to popliteus
290
why does the lateral meniscus have an attachment to popliteus
contraction of popliteus pulls the lateral meniscus into a better position to accommodate the femur when the knee is flexed
291
which ligaments are associated with the menisci
transverse ligament of knee stretches between anterior aspects of menisci
posterior meniscofemoral ligament arises from lateral meniscus and blends with pCL
292
which meniscus is more injury prone and why
medial
firmly attached to tibia
attached to MCL so are often injured together
293
branches of which arteries supply the knee
femoral
| popliteal
294
what is the name of the complex anastomosis supplying the knee
periarticular genicular anastomosis
295
what are the branches of the periarticular genicular anastomosis
5 genicular branches from popliteal a.
descending genicular artery from femoral a.
descending branch from lateral circumflex femoral a.
recurrent branches from anterior and posterior tibial a.
296
why does the knee have such an extensive blood supply
because when the knee is fully flexed the popliteal artery is compressed meaning that collateral blood supply is needed to supply the leg/foot
297
what are the compartments of the leg
anterior
lateral
posterior
298
the anterior septum divides which two compartments
anterior and lateral
299
the interosseous membrane divides which two compartments
anterior and posterior
300
the posterior septum divides with two compartments
posterior and lateral
301
which direction do fibres of the interosseous membrane pass
inferolaterally
| from the tibia, downwards and outwards to the fibula
302
what are the functions of the interosseous membrane of the leg
provides a surface for muscle attachment
| helps resist the downward pull of muscles attached to the fibula
303
what is the purpose of the space in the superior part of the interosseous membrane
passage of anterior interosseous vessels and deep peroneal nerve
304
what type of joint is the superior tibiofibular joint
plane synovial joint
305
articular surface of the superior tibiofibular joint
head of fibula and facet on lateral tibial condyle
306
which ligaments support the superior tibiofibular joint
anterior and posterior ligaments of head of fibula
307
movements at the superior tibiofibular joint
very little movement
| fibula pushes slightly upwards during dorsiflexion of ankle
308
how many muscles are in the anterior compartment of the leg
4
309
what is the main function of the anterior compartment of the leg
extensors of ankle joint and digits
310
innervation of anterior compartment
deep peroneal nerve (L4,5)
311
attachments of tibialis anterior
lateral condyle of tibia, superior 1/2 of lateral tibial surface and interosseous membrane
TO
medial and inferior surface of medial cuneiform and base of 1st MT
crosses dorsal surface of foot
312
action of tibialis anterior
dorsiflexion of ankle
| inversion
313
innervation of tibialis anterior
deep peroneal nerve (L4,5)
314
attachments of extensor digitorum longus
lateral condyle of tibia, superior 3/4 of medial surface of fibula, interosseous membrane
TO
middle and distal phalanges of lateral 4 digits
315
action of extensor digitorum longus
extends lateral 4 digits
| dorsiflexion of ankle
316
innervation of extensor digitorum longus
deep peroneal nerve (L4,5)
317
attachments of peroneus tertius
inferior /3 anterior fibula and interosseous membrane
TO
dorsal of 5th MT
318
action of peroneus tertius
dorsiflexion of ankle
assists in eversion
small muscle - minimal contribution
319
innervation of peroneus tertius
deep peroneal nerve
| L4,5
320
attachments of extensor hallucis longus
middle anterior surface of fibula, interosseous membrane
TO
dorsal aspect of distal phalanx of hallux
321
action of extensor hallucis longus
extends hallux
| dorsiflexes ankle
322
how many parts of the extensor retinaculum are there on the dorsal of the foot
2
| superior and inferior
323
attachments of superior extensor retinaculum
anterior border of tibia
TO
lower end end of fibula
324
attachments of inferior extensor retinaculum
Y-shaped
stem: calcaneus (laterally)
upper limb: medial malleolus
lower limb: passes round medial border of foot to blend with dense fascia over abductor hallucis
325
how many muscles in the lateral compartment of leg
2
326
what is the function of the lateral compartment of leg
eversion of foot
| can assist in plantar flexion as pass posterior to ankle joint
327
innervation of lateral compartment
superficial peroneal nerve
328
attachments of peroneus longus
head of fibula and upper 2/3 of lateral fibula
TO
base of 1st MT and medial cuneiform
329
action of peroneus longus
eversion of foot
330
describe the course of the tendon of peroneus longus on the planter surface of foot
crosses from lateral side of foot to medial side to reach 1st MT/medial cuneiform
crosses cuboid bone creating a deep groove on its surface
331
innervation of peroneus longus
superficial peroneal nerve
| L5, S1,2
332
attachments of peroneus brevis
inferior 2/3 of lateral fibula
TO
tuberosity on lateral side of base of 5th MT
333
innervation of peroneus brevis
superficial peroneal nerve
| L5, S1,2
334
which bony features are associated with the muscles of the lateral compartment of leg
(4)
groove at distal end of fibula on posterior medial aspect to allow passage of tendons
peroneal trochlea of calcaneus separates the two tendons (brevis is superior)
tuberosity on 5th MT for brevis
groove on inferior surface of cuboid for longus
335
what is the common origin of muscles of the dorsum of foot
superior surface of calcaneus and inferior extensor retinaculum (lateral side)
336
what are the muscles of the dorsum of the foot
extensor hallucis brevis and extensor digitorum brevis
337
insertion of extensor hallucinations brevis
base of proximal phalanx of hallux
338
insertion of extensor digitorum brevis
long extensor tendons of toes 2-4
339
innervation of dorsal foot tendons
deep peroneal nerve
| L5, S1
340
branches of common peroneal nerve
superficial and deep peroneal nerve
341
where does the common peroneal nerve divide into its branches
after it wraps around the neck of fibula
342
what does the superficial peroneal nerve innervate
lateral compartment then continues on as cutaneous innervation
343
which areas does the superficial peroneal nerve supply cutaneous innervation
distal anterior surface of leg and most of dorsal of foot
344
describe course of deep peroneal nerve
passes through EDL and travels with anterior tibial artery on anterior surface of interosseous membrane
crosses ankle joint to supply muscles of dorsum of foot
345
what does deep peroneal nerve supply
anterior compartment of leg
dorsum of foot
cutaneous innervation to 1st web space
346
which nerves provide cutaneous innervation in the leg
saphenous: anterior/medial leg
sural: lateral leg, lateral border of foot
superficial peroneal: most of dorsum/lower anterolateral leg
deep peroneal: 1st web space
347
describe course of anterior tibial artery
passes through interosseous membrane and descends along with deep peroneal nerve
crosses anterior to ankle joint to become dorsals pedis
348
where does fibular artery arise from
posterior tibial artery
349
where does fibular artery supply
lateral compartment
350
branches of dorsals pedis
lateral tarsal artery
deep plantar artery
arcuate artery
351
how does deep plantar artery reach planter surface of foot
dives down between 1st and 2nd MTs
352
which arteries are connected by the arcuate artery
lateral tarsal and dorsalis pedis
353
which venous structure gives rise to great saphenous vein
dorsal venous arch
354
what are the bones of the foot
```
talus
calcaneus
navicular
cuboid
cuneiforms
```
355
which bones make up the hind foot
calcaneus
| talus
356
which bones make up the mid foot
navicular
cuboid
cuneiforms (medial, intermediate, lateral)
357
what bones make up the fore foot
metatarsals
| phalanges
358
what is the thick, central portion of the deep fascia of the plantar surface of the foot
plantar aponeurosis
359
where is the deep fascia of the plantar surface o the foot thickest
centrally (plantar aponeuorsis)
| weaker medially and laterally
360
what are the attachments of the plantar aponeurosis
tubercle of calcaneus
TO
fibrous digital sheaths
splits into 5 bands to attach to each digit
361
what is the function of the vertical inter muscular septa arising from the plantar aponeurosis
splits muscles into medial, central and lateral compartments
362
which muscles are found in the lateral compartment of the foot
muscles of the little toe
abductor digiti minimi
flexor digiti minimi brevis
363
which muscles are found in the medial compartment of the foot
muscles of the great toe
abductor hallucis
flexor hallucis brevis
364
which muscles are founding the central compartment of the foot
flexor digitorum brevis
quadratus plantae
lumbricals
adductor hallucis
365
where is the first layer of plantar foot muscles found
between plantar aponeurosis and long flexor tendons
366
muscles of first layer of plantar foot muscles
abductor hallucis
flexor digitorum brevis
abductor digiti minimi
367
attachments of abductor hallucis
medial tubercle of calcaneus and flexor retinaculum
TO
medial base of proximal phalanx
368
attachments of flexor digitorum brevis
medial tubercle of calcaneus
TO
middle phalanges of lateral 4 digits
369
attachments of abductor digiti minimi
medial and lateral tubercle of calcaneus
TO
lateral base of proximal phalanx of little toe
370
how so the tendons of flexor digitorum brevis attach to the middle phalanges
tendon splits into two to attach to either side of the middle phalanx to allow the leg tendon to pass through and reach the distal phalanx
371
which muscles are found in layer 2 of the foot and what do they have in common
lumbricals and quadratus plantae
| attach to the flexor digitorum longus tendons
372
attachments of the lumbricals
medial side of tendons of FDL
TO
medial side of dorsal tendon expansion
373
action of lumbricals
flex MTPJ
| extend IPJs
374
attachments of quadratus plantae
medial and lateral surfaces of calcaneus
TO
lateral side of FDL tendon
375
what is quadratus plantae also known as
flexor accessorius
376
what is the action of quadratus plantae
prevents contraction of FDL from pulling toes medially as it crosses over the plantar surface of the foot
contracts and pulls the lateral side of the tendon to straighten it out
377
where is layer 2 found in the foot
deep to long flexor tendons
378
which muscles are found in layer 3 of the foot
flexor hallucis brevis
adductor hallucis
flexor digiti minimi brevis
379
attachments of flexor hallucis brevis
cuboid and lateral cuneiform
TO
both sides of base of proximal phalanx of hallux
380
how is the tendon of flexor hallucis brevis adapted to aid in the function of flexor hallucis longus
contains sesamoid bones in its split tendon at the level of the 1st metatarsal head
creates a tunnel for FHL tendon to pass through, even when body weight is applied to the 1st MT during gait
381
attachments of adductor hallucis
transverse head: plantar ligament of MTP joint
oblique head: base MT 2-4
TO
lateral side of base of proximal phalanx of hallux
382
attachments of flexor digiti minimi brevis
base of 5th MT
TO
base of proximal phalanx of 5th digit
383
which muscles are found in the 4th layer of the foot
interossei
384
how many plantar interossei are there
3
385
which toe is the axial digit of the foot (which toe does adduction/abduction occur around)
2nd toe
386
attachments of the plantar interossei
medial side of metatarsals 3-5
TO
medial side of proximal phalanx of digits 3-5
387
why are there not plantar interossei for digits 1-2
plantar interossei ADduct the toes
as 2nd digit is the axial digit it cannot be adducted, only abducted
1st digit has as separate muscle (adductor hallucis) to adduct it
388
how many dorsal interossei are there
4 dorsal interossei
389
attachments of dorsal interossei
bipennate attachments to adjacent sides of metatarsals 1-5
1st dorsal interosseous: medial side of proximal phalanx of 2nd digit
2nd-4th dorsal interossei: lateral side of proximal phalanx of 2nd-4th digits
390
why does the 2nd digit have a dorsal interossei attaching to both sides
as it is the axial digit, it cannot be adducted, so has an abductor attached to both sides
391
why do the 1st and 5th digits (big and little toes) not have a dorsal interossei attached to them
they have named abductors (abductor hallucis and abductor digiti minimi)
392
which tendons are visible in the 4th layer of the foot
```
peroneus longus (attaching to base of 1st MT and medial cuneiform)
tibialis posterior (plantar surfaces of medial tarsal bones)
```
393
which nerves supply the muscles of the foot
medial and lateral plantar nerves
| terminal branches of tibial nerve
394
how do the terminal branches of the tibial nerve enter the foot
pass deep to flexor retinaculum
| enter foot deep to abductor hallucis
395
where is the medial plantar nerve found
between abductor hallucis and flexor digitorum brevis
396
where is the lateral plantar nerve found
between layers 1 and 2
397
what are the branches of the lateral plantar nerve
deep and superficial
| deep branch runs between layers 3 and 4
398
which muscles are innervated by medial plantar nerve
abductor hallucis
flexor digitorum brevis
1st lumbrical
flexor hallucis brevis
399
which muscles are innervated by lateral plantar nerve
```
abductor digiti minimi
quadratus plantae 2nd-4th lumbricals
adductor hallucis
flexor digiti minimi brevis
interossei
```
400
which muscles are innervated by the deep branch of lateral plantar
adductor hallucis
401
which muscles are innervated by superficial plantar nerve
flexor digiti minimi brevis
402
what is the cutaneous innervation of the plantar surface of foot
medial plantar: skin over medial 3 1/2 toes
lateral plantar: skin over lateral 1 1/2 toes
calcanea branches: skin over heel
403
branches of which artery supply the plantar surface of the foot
posterior tibial artery
404
what are the branches of the posterior tibial artery in the foot
medial and lateral plantar artery
405
what is supplied by the medial plantar artery
muscles of hallux and overlying skin
406
which branch occasionally arises from the medial plantar artery
superficial plantar arch
| creates a loop over 1st MT
407
the lateral plantar artery gives off which branches in the more distal foot
deep plantar arch
| runs across lateral 4 MTs
408
how is the arterial supply of the plantar surface of foot connected to the dorsum of the foot
deep plantar arch (branch of lateral plantar artery)
| connects to deep plantar branch of dorsalis pedis
409
what's the function of the arches of the foot
distribute weight
shock absorbers
spring boards
410
which structures support the transverse arch
tendon of tibialis posterior
tendon of peroneus longus
adductor hallucis muscle
deep transverse metatarsal ligament
411
which tendons support the tarsal part of the transverse arch
tendon of tibialis posterior
| tendon of peroneus longus
412
which muscle supports the metatarsal transverse arch
adductor hallucis
413
which bones make up the lateral longitudinal arch
calcaneus
cuboid
metatarsals 4 and 5
414
is the medial or lateral longitudinal arch more pronounced
medial is more arched
| lateral arch rests on ground when standing
415
which bones make up the medial longitudinal arch
```
calcaneus
talus
navicular
3 cuneiforms
metatarsals 1-3
```
416
what two types of support help to maintain the longitudinal arches
dynamic (muscles)
| passive (ligaments)
417
structures that provide dynamic support of the longitudinal arch
intrinsic muscles of the foot
flexor hallucis longus
flexor digitorum longus
418
structures that provide passive support of the longitudinal arch
```
plantar calcaneonavicular (spring) ligament
short plantar ligament (calcaneocuboid)
long plantar ligament
plantar aponeurosis
```
419
how is weight distributed through the foot
weight is distributed equally between calcaneus and heads of metatarsals
420
which joints make up the mid tarsal joint
talonavicular and calcaneocuboid joints
421
which bones make up the subtalar joint
slightly concave posterior calcanea surface
| convex posterior articular facet of calcaneus
422
which ligaments support the subtalar joint
medial, lateral, interosseous and posterior talocalcaneal ligaments
423
which is the strongest ligament of the subtalar joint
interosseous ligament
424
what is the classification of the different parts of the mid tarsal joint
talocalcaneal part of talocalcaneonaviclar joint = plane synovial
talonavicular part of talocalcaneonavicular joint = ball and socket
calcaneocuboid joint = plane synovial
425
which ligaments support the mid tarsal joint
```
bifurcate ligament
dorsal calcaneocuboid ligament
long plantar ligament
short plantar ligament
spring ligament
```
426
attachments of bifurcate ligament of mid tarsal joint
calcaneus
TO
navicular and cuboid
427
attachments of dorsal calcaneocuboid ligament
calcaneus
TO
cuboid
428
attachments of long plantar ligament
calcaneus (posteriorly)
TO
cuboid (deep fibres)
metatarsals (superficial fibres)
429
which tendon passes under the superficial fibres of the long plantar ligament
peroneus longus
430
attachments of short plantar ligament
calcaneus
TO
cuboid
431
attachments of the spring ligament
AKA plantar calcaneonavicular ligament
calcaneus
TO
navicular
432
functions of the spring ligament
supports the longitudinal arch, mid tarsal joint, head of talus
433
what is lisfranc's joint
tarsometatarsal joints
| between cuboid and cuneiforms and bases of metatarsals
434
which ligaments support the tarsometatarsal joints
plantar, dorsal and interosseous tarsometatarsal ligaments
435
what type of joints are the MTPJs
synovial condyloid
436
what type of joints are the IPJs
synovial hinge
437
which joints are involved in inverse/eversion of the foot
mid tarsal and subtalar joints
438
describe how the mid tarsal and subtalar joints are involved in inversion/eversion of the foot
muscles of inversion/eversion attach to forefoot and mid foot
causes mid foot to rotate on hind foot
ligaments tighten and transfer force to calcaneus
causes calcaneus to rotate under talus
439
where is the soleal line
runs from lateral to medial on posterior surface of tibia
440
how many muscles are in the posterior compartment
7
3 superficial
4 deep
441
common insertion of superficial muscles of posterior leg
posterior surface of calcaneus via the tendocalcaneus
| NOT ACHILLES TENDON
442
attachments of gastrocnemius
medial head: popliteal surface of femur superior to medial condyle
lateral head: lateral aspect of lateral femoral condyle
TO
tendocalcaneus
443
innervation of gastrocnemius
tibial nerve
| S1, S2
444
action of gastrocnemius
plantarflexes ankle
| flexes knee
445
attachments of plantaris
lateral supracondylar line of femur
TO
tend-Calcaneus
446
innervation of plantaris
tibial nerve
| S1 S2
447
action of plantaris
assists in plantar flexion (not a lot)
448
attachments of soleus
soleal line of tibia, upper 1/3 posterior fibula, tendinous arch between bony attachments
TO
tendocalcaneus
449
innervation of soleus
tibial nerve
| S1 S2
450
action of soleus
plantar flexion
451
what are the deep posterior leg muscles
popliteus
flexor hallucis longus
flexor digitorum longus
tibialis posterior
452
attachments of popliteus
lateral condyle of femur and lateral meniscus
TO
popliteal area of tibia above soleal line
453
innervation of popliteus
tibial nerve L4 L5 S1
454
action of popliteus
unlocks knee by laterally rotating femur on fixed tibia
455
what is the importance of lateral rotation of femur on fixed tibia when locking/unlocking knee joint
to get to full extension, the leg must be laterally rotate slightly to loosed the ligaments sufficiently to allow full extension
after achieving full extension the ligaments tighten around the joint to maintain the position without much muscle effort (PASSIVE)
to unlock the knee, popliteus contracts to laterally rotate the femur, which causes the ligaments to loosen enough to flex the knee (ACTIVE)
456
attachments of flexor digitorum longus
posterior surface of tibia
TO
distal phalanges of digits 2-5
457
innervation of FDL
tibial nerve
| L5, S1, S2
458
action of FDL
flexion of digits 2-5
| weak plantar flexion
459
attachments of FHL
posterior surface of fibula
TO
distal phalanx of hallux
460
innervation of FHL
tibial nerve
| L5, S1, S2
461
action of FHL
flexes hallux
| weak plantar flexion
462
attachments of tibialis posterior
posterior surface of tibia and fibula and interosseous membrane
TO
tuberosity of navicular, cuneiforms, cuboid, calcaneus, and bases of Mts 2-4
463
innervation of tibialis posterior
L4, L5
464
action of tibialis posteiror
plantarflexion
| inversion
465
what is the order of the origins of deep posterior leg muscles
```
medial to lateral
flexor digitorum longus (posterior tibia)
tibialis posterior (tibia, IO membrane, Fibula)
flexor hallucis longus (fibula)
```
466
what is the order of the tendons of the deep posterior leg muscles at the medial malleolus
medial to lateral
tibialis posterior
flexor digitorum longus
flexor hallucis longus
467
attachments of the flexor retinaculum
medial malleolus to calcaneus
468
where are the posterior tibial vessels and tibial nerve found at the level fo the flexor retinaculum
between the tendons of FDL and FHL
| tom dick and very naughty harry
469
describe the course of the posterior tibial artery
terminal branch of popliteal artery
| passes between heads of gastrocnemius and deep to soleus to run on surface of TP and FDL
470
the fibular artery is a branch of which artery
posterior tibial
471
fibular artery runs within which muscle
flexor hallucis longus
472
branches of the fibular artery
perforating branches to lateral compartment
473
terminal branches of posterior tibial artery
meidal and lateral plantar arteries
474
describe course of tibial Neve
runs between heads of gastrocnemius, deep to soleus and along surface of TP and FDL
475
terminal branches of tibial nerve
medial and lateral plantar nerves
476
describe cutaneous innervation of the leg
posterior cutaneous nerve of thigh: popliteal fossa (posterior thigh)
sural nerve: posterolateral leg
saphenous nerve: posterior medial leg
477
what type of joint is the inferior toibofibular joint
syndesmosis (fibrous joint)
478
ligaments of the inferior tibiofibular joint
anterior and posterior tibiofibular ligaments
| interosseous tibiofibular ligament that is continuous with the IO membrane
479
degree of movement possible at ankle joint
20-30 degree dorsiflexion
| 30-50 degrees plantar flexion
480
is plantar or dorsiflexion more stable
dorsiflexion as the wider anterior part of the talus is held between the malleoli CF plantarflexion when the narrower posterior part is held between them
481
which ligaments stabilise the ankle joint
medial collateral ligament (aka deltoid)
| lateral collateral ligament
482
what are the parts of the medial collateral ligament
anterior tibiotalar ligament
tibionavicular ligament
tibiocalcaneal ligament
posterior tibiotalar ligament
483
what are the parts of the lateral collateral ligament
anterior Talofibular
calcaneofibular
posterior Talofibular
