Lower limb anatomy Flashcards
(97 cards)
1
Q
What is the gluteal region?
A
An extension from the liliac crest above to the gluteal fold below and from the natal cleft (intergluteal cleft) medially to a line extending from ASIS to greater trochonter (GT) laterally
2
Q
What are the large muscles of the gluteal region?
A
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fasciae latae
3
Q
What are the small muscles of thegluteal region?
A
1.Piriformis
2.Obturator internus
3.Superior Gemellus
4.Inferior Gemellus
5.Quadratus femoris
6.Obturator externus
4
Q
What is the function of the small muscles of the gluteal region?
A
They stabilize the hip joint (help to maintain the head of femur in the acetabulum)
5
Q
What is the origin of the gluteus minimus?
A
Between anterior and inferior gluteal lines
6
Q
What is the insertion of the gluteus maximus?
A
Superficial 3/4 into iliotibial tract
Deep 1/4 into gluteal tuberosity
7
Q
What is the nerve supply of the gluteus maximus?
A
Inferior gluteal nerve
8
Q
What is the action of the gluteus maximus?
A
The main and strongest extensor of the hip joint (essential in standing up from the sitting position, climbing up stairs and running)
9
Q
What is the insertion of the gluteus medius?
A
Lateral surface of greater trochanter
10
Q
What is the insertion of the gluteus minimis?
A
Front of greater trochanter
11
Q
what is the nerve supply of the gluteus medius and minimus?
A
Superior gluteal nerve
12
Q
What are the actions of the gluteus medius and minimus?
A
- Main abductors of the thigh (their anterior fibers are medial rotators of the thigh)
2.They prevent tilting of the pelvis to the unsupported raised limb by contraction of muscles supported side, so they are important during walking and running
13
Q
How do you test for trendelenburg sign?
A
Ask th patient to stand on the affected side the pelvis tilts to the normal unsupported side
14
Q
What type of gait occurs in case of unilateral paralysis of the glutei?
A
Lurching gait
15
Q
What type of gait occurs in case of bilateral paralysis of the glutei?
A
Waddling gait
16
Q
What causes the paralysis of the glutei?
A
Due to injury of superior gluteal nerve or hip dislocation or fracture neck femur
17
Q
What is the origin of the inferior gluteal nerve?
A
L5, S1,2
18
Q
What muscle does the inferior gluteal nerve supply?
A
Supplies the gluteus maximus muscle from its deep surface
19
Q
which muscle is paralyzd by injury to inferior gluteal nerve?
A
Gluteus maximus muscle
20
Q
What type of motor loss occurs due to injury to inferior gluteal nerve?
A
Impairment of hip extension and lateral rotation
Difficulty in raising the body from sitting or stooping position
21
Q
What does inferior gluteal nerve cause?
A
Weak hip extension
Patient has difficulity rising from a sitting position ot climbing stairs
22
Q
What does the superior gluteal nerve injury cause?
A
Loss of abduction of limb
Impairment of gait —> Trendelenburg’s sign
Lurching gait (if one side)
Waddling gait (both sides)
23
Q
What is the course of the scaitic nerve?
A
Begins in the pelvis and terminates at the superior angle of popliteal fossa
Termination divides into:
a. Tibial nerve
b. Common peroneal nerve
24
Q
What do the sciatic motor branch supplies?
A
Hamstring muscles
All muscles of the leg and foot through its terminal branches
25
What do the sensory branches of the sciatic neve supply?
Skin of leg and foor except the areas supplied by the saphenous nerve
26
where can injectio be made safely and why?
Superior lateral quadrant as there are no nerves or vessels lateral to the sciatic nerve . Made into the gluteus medius muscle and is not covered by gluteus maximus
27
What is sciatica?
Compression of sciatic nerve. Patients have pain along the sensory distribution of the sciatic nerve
28
What is the effect of sciatic nerve injury?
Piriformis syndrome
Hypertrophy and spasm of the piriformis, compression of sciatic nerve, pain radiating along sensory distribution of sciatic nerve
29
Who is suseptable to piriformis syndrome?
Athletes that use their gluteal muscles excessively
30
What can cause sciatic nerve injury?
Stab wounds
Fractures of the pelvis
Posterior dislocation of the hip joint
Badly-placed intramuscular injection in the gluteal region
31
What is the effect of sciatic nerve injury?
The hamstring muscles are paralyzed and weak flexion of knee is possible
Because of action of sartorius (femoral nerve) and gracilis (obturator nerve)
All the muscles below the knee are paralyzed, and the weight of the foot causes it to assume the plantar-fllexed position (foot drop)
32
What is the sensory effect of sciatic nerve injury?
Sensation is lost below the knee except:
1.medial side of the leg
2.Medial border of the foot as afar as the ball of the big toe
33
Why does the sensory effect of sciatic nerve injury occur?
It is supplied by the saphenous nerve (femoral nerve)
34
How is the weight of the whole body carried?
The weight of the whole body is carried by the vertebral column from the 5th lumbar vertebrae to the sacrum: from sacrum 50% of the body weight is transmitted to each sacro-iliac joint
35
How is body weight carried in a sitting position?
Carried from the 2 sacro-iliac joints to the 2 ischial tuberosities of the hip bones
36
How is the body weight carried in standing position?
50% of the body weight is transmitted from each sacro-iliac joint to the corresponding hip joint
From the head of the femur to the neck and through its shaft it is transmitted to the 2 condyles (the lateral condyle receives most of the weight as the femur lies oblique)
37
what are the 4 muscles found in the anterior compartment of the thigh?
Tensor fasciae latae
Sartorius
Iliacus
Psoas major
and quadriceps femoris with 4 heads
38
What is the action of tensor fascia lata?
Extension of knee through iliotibial tract
Act as splint for knee
Helps to stabilize pelvis on thigh
39
What is the origin and insertion of the sartorius ?
Origin: ASIS
Insertion: Upper part of medial surface of tibia
40
What is the action of the sartorius?
Cross leg position/ the tailor position
1. Flexion, abduction and lateral roation of the thigh
2.Flexion of the knee joint
41
What is the insertion of the psoas major and iliacus?
Common tendor inserted into the lesser trochantor
42
What is the nerve suppy of the psoas major?
From the lumbar plexus
43
What is the nerve supply of the iliacus ?
Femoral nerve
44
What is the action of the psoas major and iliacus?
1.If acting from aove --> flex the thigh on the trunk
2.If acting from below --> flex the trunk on the thigh
45
What is the insertion of quaadriceps?
By a common quadriceps tendon into base of patella then through ligamentum patellae into tibial tuberosity
46
What is the origin of quadriceps femoris?
Reflected head groove above acetabulum
straight head AIIS
47
What are the heads of the quadriceps femoris?
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedius
48
What is the function of the quadriceps femoris ?
Extend the leg at the knee joint
Flex the thigh
49
What are the roots of quadriceps knee jerk or patellar reflex?
L2,3,4
50
What is the main nerve supply of the anterior compartment of the thigh?
Femoral nerve
51
What is the origin of the femoral nerve?
Ventral rami of lumbar 2,3,4
52
What is the course of the femoral nerve?
Enters at the midpoint of inguinal ligament
Ends by dividing into anterior and posterior divisions
53
What are the branches of the femoral nerve and what do they innervates?
Muscular:
ILiacus
Pectineus
sartorius muscle
quadriceps femoris
Cutaneous:
Medial and intermediate cutaneous ns.
saphenous nerve
54
What is the origin of the femoral artery?
Continuation of external iliac artery
55
What is the termination of the femoral artery?
Pass through adductor opening- popliteal artery
56
What is the surface anatomy of the femoral artery?
The upper 2/3 of a line extending from the mid-inguinal point to the adductor tubercle in the abducted, semiflexed and laterally rotated thigh
57
What are the branches of the femoral artery found in the femoral triangle?
1.3 superficial arteries:
Superficial epigastric artery
Superficial external pudendal
Superficial circumflex iliac artery
2.Deep external pudendal
3.Profunda femoris artery
4.Descending genicular artery
58
What are the femoral artery branches in the adductor canal?
Descending genicular -- knee joint
59
What is the origin of the femoral vein?
Continuation of politeal vein at opening in adductor magnus
60
What is the end of femoral vein?
Becomes external iliac vein
61
What is the course of the femoral vein?
It ascends through adductor canal--> femoral triangle from apex to base ----> leaving it behind inguinal ligament
62
What are varicose veins?
Dilated tortous veinds due to stagnation and pooling of blood as a result of incompetence of the values leading to increased pressure inside the veins
63
What is the femoral triangle and what is its boundries?
Femoral triangle : a triangular depression in front of upper 1/3 of thigh just below ingguinal ligament
Boundries:
base = Inguinal ligament
Laterally= Medial border of sartorius
Medially = medial border of adductor longus
64
What is the apex of the femoral triangle?
Meeting of medial & lateral borders & is continuos below with adductor canal
65
What is the roof of the femoral triangle?
Skin
Superficial fascia:
superficial inguinal LNs
Upper part of GSV
Cutaneous nerves
Superficial branches of femoral artery
Deep fascia:
Saphenous opening
66
What is the floor of the femoral triangle?
Lateral to medial:
Iliacus
psoas major
Pectineus
Adductor longus
67
What are the contents of the femoral triangle?
1.Femoral artery and its branches
2.Femoral vein and its tributaries
3.Femoral sheath which surrounds the upper 4cm of the femoral vessels
4.Femoral nerve with its branches
5.Femoral branch og the genitofemoral nerve
6.lateral cutaneous nerve of the thigh crosses lateral angle of the triangle
7.Deep inguinal lymph nodes`
68
What is the femoral sheath?
It is the funnel shaped fascial sleeve which encloses the upper 4cm of the femoral vessels.
Anterior wall is formed by fascia trasveralis
Posterior wall is formed by fascia iliaca
69
What is the function of femoral sheath?
Allows easy, smooth gliding of the femoral vessels during flexion and extension of the thigh
70
What are the compartment of the femoral sheath?
Femoral artery + femoral branch of genitofemoral nerve
Femoral vein
Femoral canal
71
What is the femoral canal?
The medial compartment of the femoral sheath
(Wider in females due to wider pelvis and smaller femoral vessels)
Contains afferent lymph vessels from the deep inguinal lymph node to the eternal iliac lymph node+ the lymph node of cloquet which drains the glans penis
72
What is the function of the femoral canal?
A potential space which allows distention of the femoral vein which occurs with the increased venous return during muscular exercise
73
What is femoral hernia?
The protrusion of the abdominal contents through the femoral ring and canal down to the upper part of the thigh. (More common in females)
74
What can cause severe hemorrhage in the thigh?
During surgical reduction of femoral hernia, division of lacunar ligament is sometimes required. Injury of an abnormal obturator artery which crosses the lacunar ligament may occur resulting in severe haemorrhage
75
What is the nerve supply of the anterior compartment?
Femoral nerve
76
What is the nerve supply of the medial compartment of the thigh?
Obturator nerve
77
What is the posterior compartment of the thigh?
Sciatic nerve
78
What is the origin and insertion of the extensors of the knee?
Origin: From the leum
Insertion: Tibia and femur (iliopsoas)
79
What is the nerve supply of the anterior group ?
Femoral nerve
80
What is the action of the anterior group of thigh?
Extension of the knee
Flexion of the hip
81
What are the names of muscles of the anterior group of the thigh?
Iliopsoas
Sartorius
Quadriceps
Tensor fascia lata
82
What is the origin and insertion of the posterior (flexors of the knee) compartment?
Origin :from ischial tuberosity
Insertion: tibia (2 semi) and fibula (biceps femoris)
83
What is the nerve supply of the posterior group of muscles?
Sciatic nerve
84
What is the action of the posterior group of the thigh?
Extension of the hip
Flexion of the knee
85
What are the name of muscles of the posterior group?
Biceps femoris
Semitendinous
semimembransous
86
What is the origin and insertion of the medial group? (adductors of the hip)
Origin: from the body of the pubis
Insertion: Femur (linea aspra) and tibia (gracilis)
87
What is the nerve supply of the medial group ?
Obturator nerve
88
What is the action of the medial group?
Adduction
Medial rotation
89
What ae the name of muscles of the medial group?
Add. longus
Add. magnus
Add. brevis
Gracilis
Pectineus
90
What are the layers of the adductors?
1.Pectineus and adductor longus
2.Adductor brevis
3.Adductor magnus
91
what is the origin, insertion and action of the pectineus?
Origin: From the pectineal line of the superior pubic ramus
Insertion: In pectineal line of the back of femur (below lesser trochanter)
Action: Flexion adduction of hip joint
92
What is the origin, insertion, nerve supply and action of gracilis?
Origin: arises from the lower part of the body of pubis and the pubic arch
Insertion: into the upper part of the medial surface of the shaft of tibia (SGS)
Nerve supply: Obturator nerve, anterior division
Action:
Adduction of thigh
Flexion and medial rotation of the leg
Steady the pelvis on the femur
93
What is the origin, insertion, nerve supply and action of the adductor brevis?
Origin: From the front of the body of the pubis and inferior pubic ramus
Insertion: the upper part of linea aspera
Nerve supply: Obturator nerve (L2,3,4)
Action: Adduction of the thigh
94
What is the origin, insertion , nerve supply and action of the adductor longus?
Origin: By a rounded tendon from the body of the pubis below the pubic tubercle
Insertion: in the middle 2/4 of linea aspera of femur
Nerve suply: obturator nerve (anterior division)
Action: Adduction of the thigh
95
What is the origin, insertion, nerve supply and action of the adductor magnus?
Origin:
1.Ischial (hamstring) part: from ischial tuberosity
2.Pubic (adductor) part: from the outer surface of the pubic arcg
Insertion:
Pubic part:
The fibers spread to be inserted into the medial margin of gluteal tuberosity, the medial lip of linea aspera and the medial supracondylar line
Ischial part:
The adductor tubercle and the adjoining part of the medial supracondylar line of the femur
Nerve supply:
Pubic (adductor part) : obturator nerve
ichial (hamstring part): sciatic nerve
Action :
Pubic part: adduction
ischial pat: extension of the hipjoint
96
what is the origin, insertion and action of iliacus & psoas major?
Iliopsoas muscle
Origin:
Psoas muscle: T12 & all Lumbar transverse process and disc in between
Iliacus: iliac fossa and inner lip of iliac crest and adjoining part of sacrum
Insertion: lesser trochanter of femur
Action: flexion of hip
97
What is the level of patellar reflex?
L3-4
