Lower Limb Anatomy Flashcards by Cian O'Halloran

Muscles responsible for flexion of the hip?

Diagram on the left is more superficial

Iliopsoas
Rectus Femoris
Tensor Fascia Lata

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Muscles responsible for extension of the hip?

Gluteus Maximus
Semitendinosus
Semimembranosus
Biceps femoris - long head

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Muscles responsible for adduction of the hip?

Adductor Brevis
Adductor Longus
Adductor Magnus

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Muscles responsible for abduction of the hip?

Gluteus Medius
Gluteus Minimus

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What are the boundaries of the femoral triangle?

Borders

Superior: Inguinal ligament

Medial: Adductor Longus

Lateral: Sartorius

Floor: Iliopsoas Pectineus Adductor Longus

The saphenous opening (saphenous O in diagram) is an oval aperture located in the fascia lata to allow the passage of the great saphenous vein.

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Borders of the Adductor Canal ?

Anterior: Adductor Lamina and Sartorius

Lateral Wall: Vastus Medialis

Posteromedial wall: Adductor Longus and Magnus

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Contents of the Adductor Canal ?

Saphenous Nerve
Femoral Artery
Femoral Vein (posterior to artery)
Nerve to vastus medialis
Lymphatics and loose connective tissue

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What are the sensory and motor deficits seen in an injury to the femoral nerve?

Wasting of quadriceps muscles
Loss of knee extension
Weak flexion of the Hip (psoas major intact)

Loss of anteromedial aspect of thigh and Medial aspect of leg and foot

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What is the origin of the lateral cutaneous nerve of the thigh?

Origin: Lumbar plexus (L2-L3).

Course: Descends along the psoas muscle, then crosses the iliacus muscle, and passes under the inguinal ligament, typically near the ASIS.

Termination: Divides into multiple branches that supply the skin of the anterolateral thigh.

Clinical Relevance:
Meralgia Paresthetica:
Compression or injury to this nerve can cause meralgia paresthetica, characterized by pain, numbness, or tingling in the outer thigh.

Surgical Considerations:
Surgeons must be aware of the nerve’s location, especially near the ASIS, to avoid iatrogenic injury during procedures like laparoscopic surgery or inguinal hernia repair.

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What are the causes of meralgia paresthetica/Skinny pants syndrome? And which nerve is affected?

Meralgia paresthetica is a condition that causes pain, numbness, or tingling in the outer thigh due to compression of **the lateral femoral cutaneous nerve. ** (L2/L3)

This nerve is a sensory nerve, so it only affects the skin on the outer thigh, not the muscles.

Nerve compression:
The most common cause is compression of the lateral femoral cutaneous nerve as it passes under the inguinal ligament, near the groin.
(1) Tight clothing:
Belts, tight pants, or other restrictive clothing can put pressure on the nerve.
(2) Obesity:
Increased abdominal fat can contribute to nerve compression.
(3) Pregnancy:
The added weight and pressure during pregnancy can also compress the nerve.
Other causes:
Diabetes, injuries, and certain surgeries can also contribute to meralgia paresthetica.

https://www.youtube.com/watch?v=btOfG2nliXw

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Which nerve provides motor and sensory innervation to the medial aspect of the thigh?

Which branch of the lumbar plexus does it arise from?

And which muscles is it responsible for innervating?

Obturator nerve

L2-L4

Adductors - adductor longus, adductor brevis, adductor magnus (adductor portion), gracilis, and sometimes pectineus.

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What are the three major causes of an obturator nerve palsy?

Urological and Gynaecological malignancies due to pelvic lymph node dissection (PLND)
(e.g Radical prostatectomy/Ovarian tumour)

Anterior Hip Disclocation

Blunt trauma or compression via haematoma

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Origin and Insertion of Gluteus Maximus?

Posterior Ilium
Posterior Sacrum
Superior Gluteal Line

Insertion:

IT band (75% fibres)
Gluteal tuberosity (25%)

IT band: the iliotibial tract, a thick band of fascia on the lateral thigh

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Origin and Insertion of Gluteus Medius?

Posterior Ilium (between the superior and middle gluteal lines)

Insertion:

Greater Trochanter

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Origin and Insertion of Gluteus Minimus?

Outer Surfce of Ilium (between the inferior and anterior gluteal lines)

Insertion:

Greater Trochanter

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Which nerve innervates the gluteus maximus? And what are the nerve roots?

Inferior gluteal nerve (motor only)
L5, S1, S2

The inferior gluteal nerve leaves the pelvis via the greater sciatic foramen, entering the gluteal region inferiorly to the piriformis muscle.

It is accompanied by the inferior gluteal artery and vein for much of its course.

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An injured sciatic nerve causes which functional problem?

What is a common cause of this injury?

Hip Extension

Knee Flexion

Foot drop (no dorsiflexion)

Flail foot (no dorsiflexion/plantar flexion)

Inappropropriately placed gluteal injections
Posterior Hip Dislocation

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What the sacral plexus roots of the sciatic nerve?

L3-S4

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An injured inferior gluteal nerve causes which functional deformity?

Hip extension and loss of lateral rotation (INNERVATES GLUTEUS MAXIMUS)

e.g climbing stairs or standing up from a seated position

Cause - posterior hip dislocation / surgery in this area

The sciatic nerve is more frequently affected in posterior hip dislocations

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A superior gluteal nerve injury leads to which functional deformity?

Tredelenburg sign

Weakness of gluteus medius and minimus leads to contralateral hip drop when standing on ipsilateral leg

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What nerve innervates the gluteus medius and minimus? and what are its nerve roots?

Superior gluteal nerve

L4-S1

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What are the roots of the sacral plexus?

Superior Gluteal
Inferior gluteal
Sciatic
Posterior cutaneous nerve of thigh
Pudendal

‘Some Irish Sailor Pesters Polly’. This stands for Superior Gluteal, Inferior Gluteal, Sciatic, Posterior cutaneous nerve of thigh, Pudendal

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What is Van Hochstetters triangle for gluteal injections?

Palm on greater trochanter
Thumb on ASIS

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What are the muscles of the hamstring?

Semitendinosus Semimebranosus Biceps femoris Ischial part of adductor magnus

What are the functions of the hamstrings?

Hip extension Knee flexion

What is the nerve supply to the hamstring?

Sciatic Nerve Biceps Short Head - Common Peroneal/Fibular Nerve Biceps Long Head - **T**ibial nerve (**T **for tall/long)

What is the blood supply to the Hamstring muscles?

Deep femoral artery (aka profunda femoris artery)

Blood supply to the head of the femur?

The head of the femur receives its blood supply from multiple sources, primarily the medial and lateral femoral circumflex arteries and to a lesser extent, the artery of the ligamentum teres

Causes of avascular necrosis of femoral head?

**Trauma** (Intracapsular fractures/Acetabular fractures): **Atraumatic:** 5 "s" Steroids Sickle Cell Disease SLE Spirits (alcohol) SUFE

Neck of femur fractures

Internal Fixation: If the fracture is nondisplaced or impacted, internal fixation with screws or pins may be used to stabilize the fracture. Hip Replacement: For displaced fractures, especially in older adults, hip replacement (hemiarthroplasty or total hip arthroplasty) is often recommended

What is the presentation of an ACL injury?

The ACL is slender and weaker compared to the PCL ACL is taught on extension PCL is taught on flexion

Mechanism of usual PCL injury?

What is the unhappy triad injury of the knee?

Unhappy triad aka O'Donoghues Triad - usually occurs from a valgus force but can also be due to a twisting/rotational force on a planted foot. **MAT!** Medial Meniscus Anterior Cruciate Ligament Tibial collateral ligament (AKA Medial collateral ligament)

When dissecting the popliteal fossa identify which structures are medial to lateral?

Medial / Deep Popliteal artery Popliteal Vein Tibial and common fibular/peroneal nerve Lateral / Superficial The artery also lies deepest when dissecting / whereas the nerves lie most superficial

The surface markings of the sciatic nerve (left gluteal region). Join the midpoint between the ischial tuberosity and posterior superior iliac spine to the midpoint between the ischial tuberosity and the greater trochanter by a curved line; continue this line vertically down the leg — it represents the course of the sciatic nerve.

Anterior Aspects of Right Femur

Posterior Aspects of Right Femur

Floor of Popliteal fossa

Knee joint capsule resting against posterior surface of tibia

Lumbar Plexus

Sacral Plexus

Right Leg

Cross-sectional representation of the compartments of the right leg. EDL, extensor digitorum longus; FDL, flexor digitorum longus; FHL, flexor hallucis longus; LG, lateral head of gastrocnemius; MG, medial head of gastrocnemius; PB, peroneus brevis; PL, peroneus longus; S, soleus; TA, tibialis anterior; TP, tibialis posterior.

Borders of Bakers Cysts (Muscles)

What muscles/tendons make up the Pes Anserinus? Who gets pes anserine bursitis?

Sartorius Gracilis Semitendinosus The pes anserinus refers to the conjoined tendons of the **sartorius, gracilis, and semitendinosus ** muscles where they insert onto the medial (inner) side of the tibia below the knee joint. This area is also where the pes anserine bursa is located, and inflammation of this bursa is known as **pes anserine bursitis** Runners/Hill walkers

Which nerve roots correspond?

What are the branches of the sciatic nerve to the lower leg?

Tibial Nerve Common Peroneal/Fibular Nerve Medial Sural Cutaneous Nerve Superficial Fibular Nerve

The superficial peroneal nerve supplies which compartment of the lower leg and provides which muscle action?

Lateral compartment Eversion

The deep peroneal nerve supplies which compartment of the leg and which muscle action?

Anterior compartment Dorsiflexion of the foot Extension of the toes

The superficial and deep peroneal nerves supply which skin area of the lower leg?

Deep peroneal - between the big toe and 1st phalynx Superficial peroneal - most of the dorsum of the lower limb (except the nails and lateral foot Sural nerve - branch of tibial)

Which functional deficit might you expect from a common peroneal nerve injury? (e.g proximal fibular fracture)

Foot Drop

Which muscles are in the anterior compartment of the lower leg? (Dorsiflexion)

Tibialis anterior Extensor Digitorum Longus Fibularis tertius Extensor Hallucis Longus

Which muscles are in the superficial posterior compartment of the leg? (Plantar flexors)

Gastrocnemius Plantaris Soleus

Which muscles are in the deep posterior compartment of the leg? (Plantar flexors)

Tibialis Posterior Flexor Hallucis Longus Popliteus Flexor Digitorum Longus

Which muscles are in the lateral compartment of the lower leg?

Fibularis Longus Fibularis Brevis

What is the nerve supply to the anterior compartment of the lower leg?

Deep peroneal nerve Dorsiflexion

What is the nerve supply to the Lateral compartment of the lower leg?

Superficial peroneal/fibular nerve

What is the nerve supply to the posterior compartment of the lower leg?

Tibial Nerve Plantar flexion

What is the blood supply to the anterior compartment of the lower leg?

Anterior Tibial Artery

What is the blood supply to the posterior compartment of the lower leg?

Posterior Tibial Artery

What is the blood supply to the Lateral compartment of the lower leg?

Fibular Artery

What is the attachment site of the peroneus/fibularis longus?

1st Metatarsal and Medial Cuneiform

What is the attachment site of the peroneus/fibularis brevis?

5th Metatarsal base

What is the attachment site of the Tibialis posterior in foot inversion?

Navicular Tuberosity and all three cuneiforms

What is the attachment site of the Tibialis anterior in foot inversion?

1st metatarsal and medial cuneiform

Which position is the ankle joint vulnerable to injury and why? Which ligament is most likely to be affected?

Plantar flexion and inversion This is because the ligaments on the outer side of the ankle (lateral ligaments) are stretched and stressed in this position, making them more susceptible to sprains. **A**lways **T**ears **F**irst -** A**nterior **T**alor**F**ibular Ligament Particularly the **anterior talofibular ligament (ATFL)** but also calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) are the primary lateral ankle ligaments.

Which ligaments are affected in Sinus Tarsi Syndrome? Between which bones?

Cervical ligament and Interossei ligament Talus and Calcaneus

What is a Lisfranc Injury?

A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the **medial cuneiform and base of the second metatarsal.** Diagnosis is confirmed by radiographs which may show widening of the interval between the 1st and 2nd ray. Treatment is generally operative with either ORIF or arthrodesis. Injury of the plantar ligament between the medial cuneiform and the second and third metatarsals along with the Lisfranc ligament is necessary to give transverse instability DLL - Dorsal Lisfranc Ligament PLL - Plantar Lisfranc Ligament

Functions of the Tibial Nerve?

Plantar Flexion Inversion Toe Flexion (1) Tibial nerve injury can occur at the popliteal fossa of the knee resulting in deficits in plantar flexion and inversion of the foot, as well as intrinsic foot muscle weakness and paresthesia at the sole of the foot. (2) **Tibial nerve injury can occur at the tarsal tunnel, where plantar flexion and inversion is maintained, but there are deficits to the intrinsic muscles of the foot and paresthesia at the sole of the foot.**

From anterior to posterior what are the contents of the Tarsal Tunnel?

"Tom Dick And Very Nervous Harry" Anterior to posterior: **T**ibialis posterior flexor **D**igitorum longus tibial **A**rtery tibial **V**ein tibial **N**erve flexor **H**allucis longus The roof of the tarsal tunnel is formed by a flexor retinaculum extending from the medial malleolus to the medial tubercle of the calcaneus. The floor - Medial surfaces of the talus calcaneus and tibia. The tunnel is divided into four fibrous compartments – one containing the neurovascular structures and the other three containing the muscle tendons.

What is the sensory distribution of the tibial nerve?

The sural nerve receives branches from BOTH the common fibular and tibial nerves.

Which test can be used to determine achilles tendon injury?

Simmonds-Thompson

What is Morton's Neuroma? What is Mulders Sign?

Neural irritation and fibrosis of the nerve most commonly between the 3rd and 4th metatarsals Mulders sign - Painful click when the metatarsal heads are manipulated Metatarsal squeeze test and Mulders Sign https://www.youtube.com/watch?v=yJ7LUCCmFAU

Which nerves give sensory innervation to the medial thigh and leg?

Thigh: Obturator (cutaneous branch) Leg: Saphenous branch (femoral nerve) The saphenous veins, specifically the great saphenous vein (GSV) and small saphenous vein (SSV), are clinically significant due to their role in venous drainage of the lower limbs and their common use in bypass surgeries. The GSV, the longest vein in the body, is frequently used as a conduit in coronary artery bypass and peripheral arterial bypass operations. Saphenous vein incompetence can lead to varicose veins, and understanding their anatomy and variations is crucial for effective surgical interventions.

Lymphatic Drainage of the lower limb

The popliteal artery continues into which segment?

The tibioperoneal trunk and then later the posterior tibial artery and common peroneal artery.

What is the function of the gluteus maximus?

Hip extension and external rotation Note the gluteus maximus is the most superficial

What is the attachment sites of the anterior cruciate ligament?

Lateral femoral condyle to intercondylar eminence of the tibia Remember lateral to medial

What is the attachment site of the psoas major muscle?

Lesser trochanter

What are the nerve roots of the common reflexes? Achilles reflex Patellar Reflex Biceps and brachioradialis reflex Triceps reflex Cremasteric Anal Wink

One, Two - **buckle my shoe:** Relates to the ankle jerk reflex (S1-2). Three, Four - **kick the door**: Relates to the knee jerk reflex (L3-4). Five, Six - **pick up sticks:** Relates to the biceps and brachioradialis reflexes (C5-6). Seven, Eight - **lay them straight:** Relates to the triceps reflex (C7-8) L1/2 - testicles move - cremasteric S3/4 - winks galore -

What are the relations of the femoral artery/vein and saphenous nerve in the adductor canal?

The adductor canal, also known as Hunter's canal or the subsartorial canal. In the adductor canal, the femoral artery, femoral vein, and saphenous nerve travel together, but their relative positions change as they move through the canal. **The femoral artery is typically located in the anterior and central part of the canal, while the femoral vein lies posterior to the artery** (and lies laterally more ditally and in popliteal fossa) The saphenous nerve, a branch of the femoral nerve, initially lies lateral to the artery, then becomes anterior and finally medial as it travels through the cana

Linea Aspera Attachments

A simple mnemonic to remember the muscles attaching to the linea aspera is "**PABLAM**": P: ectineus A: dductor Brevis B: iceps Femoris (short head) L: ongus A: dductor Magnus M: edialis (Vastus Medialis)

What are the borders of the adductor canal?

Remember you are looking up from the foot like a CT scan Lateral: Vastus medialis Medial: Sartorius Posterior: Adductor Longus and Magnus

Muscles of the medial compartment of the thigh and their innervation

Obturator Nerve: Adductor Brevis Adductor Longus Adductor Magnus (also tibial nerve) Gracilis Pectineus All supplied by the obturator nerve except the Pectineus which is primarily supplied by the femoral nerve

Which ligament is most likely to be injured in an Ankle Eversion injury?

Deltoid Also supports the medial longitudinal arch

Which muscle can be used as a graft for hamstring repair?

Semintendinosus along with Gracilis High load to failure of 4000 newtons

The nerve supply to the long and short head of the biceps femoris muscle?

Long head - Tibial division of sciatic nerve Short head - Common fibular/peroneal division of sciatic nerve

What is the sensory innervation of the foot?

Name the quadriceps muscles and their attachment site?

Rectus femoris Vastus Lateralis Vastus Medialis Vastus Intermedius Attach to the tibial tuberosity via the patellar tendon

Which ligament injury results in a flat foot deformity? Which tendon injury results in a flat foot deforminty?

Calcaneonavicular Ligament (Spring ligament) Tibialis posterior tendon (most common cause of flat foot)

The medial and lateral circumflex arteries are direct branches of which vessel?

Profunda Femoris artery (deep femoral artery)

What are the borders of the femoral triangle?

Superior : Inguinal Ligament Lateral: Sartorius Medial: Adductor Longus

The small and great saphenous veins relation to the malleoli?

The great saphenous veins runs anterior to the medial malleolus The small saphenous vein runs posterior to the lateral malleolus

Attachments to the greater trochanter?

Piriformis Gluteus Medius Gluteus Minimus Obturator Internus and Externus (obtint in diagram) Vastus Lateralis and Gemelli (inferior and superior)

Which nerve supplies the medial aspect of the lower leg and foot?

Saphenous nerve (femoral nerve)

Which artery forms the trochanteric anastamoses with the lateral and medial circumflex arteries of the femoral head?

Superior Gluteal artery (Branch of internal iliac)

What is another name for a synovial joint?

Diarthrosis / Diarthrodal joint

Contents of the femoral sheath?

Femoral Artery Femoral Vein Femoral Canal Does not contain the Femoral nerve or lacunar ligament

What are the four main bursae of the knee? (there are actually 12 in total - 4 anterior 4 posteriorly and 2 laterally and 2 medially)

Suprapatellar Prepatella (housemaids knee) Infrapatella Semimembranosus bursa

Lower Limb Anatomy Flashcards

(122 cards)