Lower limb: Glutes, Thigh, and Knee Flashcards
(94 cards)
1
Q
What are the functions of the lower limb
A
(1) support body weight
(2) produce locomotion
(3) produce stability as foundation for standing, walking, and running
2
Q
Lower limb divisions:
from superior > inferior
A
(superior > inferior)
gluteal region > thigh > popliteal fossa > leg > ankle > foot
3
Q
Why are llimbs divided into compartments
A
to define muscles that perform group functions with their own distinct nerve and blood supply
4
Q
What bone forms the lower limb girdle that attaches the lower limbes to the vertebral column
A
os coxae
topographically and functionally the equivalent of the upper limb clavicle and scapula
5
Q
The os coxae bones (ilium, ischium, pubis) meet one another at the acetabulum via what structure?
A
triradiate cartilage
(Y-shaped)
6
Q
Os coxae articulations
A
- posteriorly to the sacrum via sacroiliac joint
- anteriorly to one another via symphysis pubis
The os coxae forms the anterolateral walls of the pelvis
7
Q
Ilium structures
A
1) iliac crest
2) anterosuperior iliac spine
3) posterosuperior iliac spine
4) iliac tubercle - notch at the middle-posterior part of iliac crest; 2 in. behind the ASIS
5) anteroinferior iliac spine
6) posteroinferior iliac spine
7) iliac fossa
8) greater sciatic notch
8
Q
Ischium structures
A
1) body
2) ramus
3) ischial spine (posterior part)
4) ischial tuberosity
The ischial spine intervenes between the greater and lesser sciatic notches - it becomes the greater and lesser sciatic foramina by the presence of the sacrospinous and sacrotuberous ligaments
9
Q
Pubis Structures
A
The pubis is divided into: body, superior ramus, & inferior ramus
1) pubic crest
2) pubic tubercle
- The pubis connects with each other at the symphysis pubis
- it connects with all 3 bones at the acetabulum
- it joins with the ischium to form the obturator foramen
10
Q
Anatomical tilt of the pelvis
A
- pelvic surface of the symphysis pubis faces upward and backward
- anterior surface of the sacrum is directed forward and downward
The front of the symphysis pubis and the anterosuperior iliac spine lie in the same vertical plane
11
Q
Important muscle attachments to os coxae 1
Memorize
A
12
Q
Important muscle attachments to os coxae 2
Memorize
A
13
Q
Femur articulations
A
- superiorly with the acetabulum to form the hip joint
- inferiorly with the tibia and patella to form the knee joint
14
Q
What is the fovea capitis
A
a small depression at the center of the head of the femur
for the attachment of the ligament of the head
Importance: part of the blood supply to the head of the femur from the obturator artery is conveyed along the ligament of the head and enters the bone at the fovea
15
Q
What is the normal angle of the femur neck with the long axis
1) in adults
2) in children
A
1) 125 degrees
2) 160 degrees
16
Q
At the femur, the greater and lesser trochanters are connected by:
(1) anteriorly
(2) posteriorly
A
(1) intertrochanteric line
(2) intertrochanteric crest
The intertrochanteric line is where the iliofemoral ligament attaches
17
Q
Posterior ridge at the shaft of the femur
A
linea aspera
18
Q
A flat, triangular area on the posterior surface of the distal shaft of the femur
A
popliteal surface
19
Q
Important structures and muscle attachments of the femur
Memorize
A
20
Q
The largest sesamoid bone
A
patella
triangular bone - apex lies inferiorly
It develops within the tendon of the quadriceps femoris muscle in front of the knee joint
21
Q
Relations of the patella
A
- inferiorly, the apex is connected to the tuberosity of the tibia by the ligamentum patellae
- posterior articulation with the condyles of the femur
- anteriorly separated with the skin by the prepatellar bursa
- upper, lateral, and medial margins give attachment to the quadriceps femoris muscle
22
Q
Largest muscle in the body
A
Gluteus maximus
also the 2nd most powerful muscle next to the maseter
23
Q
Cutaneous nerve supply of the lower limb
A
- Upper Medial: posterior rami of L1-3 and S1-3
- Upper Lateral: lateral branches of the anterior rami of the iliohypogastric (L1) and T12
- Lower Lateral: lateral cutaneous nerve of the thigh (anterior rami of L2-3)
- Lower Medial: posterior cutaneous nerve of the thigh (anterior rami of S1-3)
- Skin over the coccyx in the floor of the cleft between the buttocks: lower sacral and coccygeal nerves
24
Q
Lymph drainage of the gluteal region
A
Superficial inguinal nodes - lateral group
25
What is the composition of the iliotibial tract (iliotibial band)
Thickening of the fascia lata (deep fascia of the thigh) on the lateral surface of the thigh
## Footnote
Attahced above to the iliac tubercle (of the iliac crest) and below to the lateral condyle of the tibia
26
Forms a sheath for the tensor fasciae latae muscle and receives the greater part of the insertion of the gluteus maximus
Iliotibial tract
27
Function of the sacrotuberous and sacrospinous ligaments
To stabilize the sacrum and prevent its rotation at the sacroiliac joint
28
Connects the back of the sacrum to the ischial tuberosity
sacrotuberous ligament
29
Connects the back of the sacrum to the spine of the ischium
sacrospinous ligament
30
Lymph nodes of the lower limb
31
The greater sciatic foramen provides an exit from the pelvis into the gluteal region
What structures exit the greater sciatic foramen:
1) piriformis muscle
2) sciatic nerve
3) posterior cutaneous nerve of the thigh
4) gluteal nerves (superior & inferior)
5) gluteal vessels (superior & inferior)
6) nerves to the obturator internus
7) nerves to the quadratus femoris
8) pudendal nerve
9) internal pudendal vessels
## Footnote
"vessels" - artery & vein
32
The lesser sciatic foramina provides and entrance to the perineum from the gluteal region
What structures pass through the lesser sciatic notch?
1) tendon of the obturator internus muscle
2) nerve to the obturator internus
3) pudendal nerve
4) internal pudendal vessels
33
What muscle assists the gluteus maximus in maintaining the knee in extended positon?
Tensor fasciae latae
34
What muscle separates the superior gluteal nerves and vessels from the inferior gluteal nerves and vessels?
Piriformis muscle
35
Gluteal Region Muscles
| Memorize
36
Sciatic Nerve composition
*consists of the tibial and common fibular (peroneal) nerves bounded together by fascia*
L4-5 and S1-3
## Footnote
The sciatic nerve gives no branches in the gluteal region
37
Gluteal Region Nerves
| Memorize
* sciatic nerve
* posterior cutaneous nerve of the thigh
* superior gluteal nerve
* inferior gluteal nerve
* nerve to the quadratus femoris
* pudendal nerve
* nerve to the obturator internus
38
Supplies the skin in the popliteal fossa
Posterior Cutaneous Nerve of the Thigh
Branches:
(1) gluteal branches - skin over the lower medial quadrant of the buttock
(2) perineal branch - skin of the back of the scrotum or labium majus
(3) cutaneous branches - to the back of the thigh and the upper part of the leg
39
The superior gluteal nerve supplies the
* gluteus medius
* gluteus minimus
* tensor fasciae latae
40
What muscle does the inferior gluteal nerve supply
Gluteus maximus muscle
41
What muscle/s does the nerve to the quadratus femoris supply?
* quadratus femoris
* inferior gemellus
42
What structures crosses the ischial spine with the internal pudendal artery and renters the pelvis through the lesser sciatic foramen
* pudendal nerve
* nerve to obturator internus
43
What structures does the pudendal nerve supply?
structures in the perineum
44
What structures does the nerve to the obturator internus supply?
the obturator internus muscle on its pelvic surface
45
What are the primary vessels supplying the gluteal region?
* superior gluteal artery
* inferior gluteal artery
## Footnote
Blood supply to the gluteal region is composed of the: (1) superior gluteal artery, (2) inferior gluteal artery, (3) Trochanteric anastamosis, (4) Cruciate anastamosis
46
It divides into branches that distribute throughout the gluteal region but its primary flow is in the fascial space between the gluteus medius and minimus muscles
Superior gluteal artery
## Footnote
Enters the gluteal region through the upper part of the greater sciatic foramen above the piriformis
47
Its major supply is to the glutes maximus muscle
Inferior gluteal artery
## Footnote
Enters the gluteal region through the lower part of the greater sciatic foramen, below the piriformis
48
Provides the main blood supply to the head of the femur ()
What are its branches?
Trochanteric Anastamosis
Branches:
1) superior gluteal artery
2) inferior gluteal artery
3) medial femoral circumflex artery
4) lateral femoral circumflex artery
49
What provides a collateral connection between the internal iliac and femoral arteries?
What are its branches?
Cruciate Anastamosis
Branches:
1) inferior gluteal artery
2) medial femoral circumflex artery
3) lateral femoral circumflex artery
4) first perforating artery
5) branch of the profunda artery
50
The proximal segment of the lower limb (from hip to the knee)
Thigh
51
What is the location of the saphenous opening - gap in the deep fascia
* in the front of the thigh just below the inguinal ligament
* 1.5 in below and lateral to the pubic tubercle
## Footnote
It is filles with loose connective tissue called the cribiform fascia
52
What is transmitted in the saphenous opening?
1) great saphenous vein
2) small branches of the femoral artery
3) lymph vessels
53
Lower lateral border of the saphenous opening
falciform margin
| lies anterior to the femoral vessels
54
Cutaneous nerves of the thigh
1) lateral cutaneous nerve of the thigh (L2-3): skin of the lower lateral quadrant of the buttock
2) femoral branch of the genitofemoral nerve (L1-2): cremaster mucle (genitobranch)
3) ilioinguinal nerve (L1): skin of the root of the penis and adjacent scrotum
4) medial cutaneous nerve of the thigh (Branch of the femoral nerve, L2-4): medial aspect of the thigh; joins the patellar plexus
5) intermediate cutaneous nerve of the thigh (Branch of the femoral nerve): anterior aspect of the thigh; joins the patellar plexus
6) anterior division of the obturator nerve: skin on the medial aspect of the thigh
7) patellar plexus: front of the knee
8) posterior cutaneous nerve of the thigh (S1-3): posterior thigh and upper part of the leg
55
The patellar plexus is formed by the terminal branches of ()
1) lateral, intermediate, and medial cutaneous nerve of the thigh
2) infrapatellar branch of the saphenous nerve
56
What forms the superficial veins of the leg?
great & small saphenous veins and their tributaries
57
What vessels drain the medial side of the leg
| from the dorsal venous arch of the foot upwards medially
Great saphenous vein
## Footnote
Joins the femoral vein at the saphenous opening
58
What accompanies the saphenous nerve in the superficial fascia over the medial side of the leg
great saphenous vein
59
Connect the great saphenous vein with the deep veins along the medial side of the calf
perforating veins
60
Name the 3 tributaries received by the great sphenous vein
1) superficial circumflex iliac vein
2) superficial epigastric vein
3) superficial external pudendal vein
## Footnote
additional vein known as the accessory vein
61
Superficial Inguinal Lymph Nodes
## Footnote
Lie at the superficial fascia below the inguinal ligament
Horizontal group:
1) medial members - receive vessels from the ant. abdominal wall below the level of the umbilicus which includes the urethra, external genitalia, and lower half of the anal canal
2) lateral membres - receive vessels from the back below the level of the iliac crests
Vertical group - receive lymph vessels from the back of the thigh
62
Deep inguinal lymph node
Receive lymph from?
## Footnote
Located beneath the deep fascia and lie along the medial side of the femoral vein
1) from the superficial inguinal nodes
2) from the deep structures of the lower limb
63
The thigh is divided into how many compartments?
3 compartments:
1) anterior fascial compartment
2) medial fascial compartment
3) posterior fascial compartment
64
# Thigh
Anterior Fascial Compartment Contents
| Muscles, Blood Supply, Nerve Supply
Muscles: sartorius, iliopsoas, pectineus, ans quadriceps femoris
Blood Supply: Femoral Artery
Nerve Supply: Femoral Nerve
65
Muscels of the Thigh - Anterior Fascial Compartment
| Memorize
66
The Iliopsoas muscle is formed by
iliacus and psoas major muscles of the abdomen that merge together at the thigh
67
The quadratus femoris muscle is formed by
1) rectus femoris
2) vastus intermedius
3) vastus lateralis
4) vastus medialis
| **powerful extensor of the knee joint**
## Footnote
It inserts into the patella and attaches to the tibial tuberosity vila the ligamentum patellae (patellar ligament)
68
The retinacula which join the capsule of the knee for strengthening, is composed of
fibers of the vastus lateralis and vastus medialis
69
The only component of the quadriceps that crosses the hip joint - flexes the hip in addition to extending the knee
rectus femoris
70
Triangular depression situated in the upper part of the medial aspect of the thigh - below the inguinal ligament
Femoral Triangle
71
Boundaries of the femoral triangle
* superiorly: inguinal ligament
* laterally: sartorius muscle
* medially: adductor longus muscle
* floor: gutter shaped and formed from the lateral to medial by the iliopsoas, pectineus, and adductor longus
* roof: skin and fasciae of the thigh
72
Major contents of the femoral triangle:
1) femoral nerve and its terminal branches
2) femoral sheath
3) femoral artery and its branches
4) femoral vein and its tributaries
5) deep inguinal lymp nodes
73
An intermuscular cleft situated on the medial aspect of the middle third of the thigh deep to the sartorius muscle
Adductor (Subsartorial) Canal
## Footnote
begins above at the apex of the femoral triangle and ends below at the opening in the adductor magnus (adductor hiatus)
74
Enumerate the walls of the adductor (subsartorial) canal
* anteromedial wall: sartorius muscle and fascia
* posterior wall: adductor longus and magnus
* lateral wall: vastus medialis
75
Adductor canal contents:
1) terminal part of the femorl artery
2) femoral vein
3) deep lymph vessels
4) saphenous nerve
5) nerve to the vastus medialis
6) terminal part of the obturator nerve
76
The three compartments of the femoral sheath
1) lateral - contains the femoral artery
2) intermediate - contains the femoral vein
3) medial - contains the lymph vessels
## Footnote
Fascial sheath is a downward protusion of the fascial lining in the abdominal walls into the thigh
- Anterior is continuous with the transversalis fascia
- Posterior wall is continous with the fascia iliaca
77
Femoral canal
Termed for the small medial compartment of the lymph vessels in the femoral sheath
## Footnote
The opening is termed the femoral ring and the femoral septum plugs the opening
78
Potentially weak area in the abdominal wall
the femoral canal
79
Potentially weak area in the abdominal wall
the femoral canal
## Footnote
The only part where the femoral sheath does not adhere to the wall of the vessel it contains
80
A protrusion of peritoneum forced down the femoral canal and pushes the femoral septum
Femoral hernia
81
Relations of the femoral ring:
* anteriorly: inguinal ligament
* posteriorly: superior ramus of the pubis
* medially: lacunar ligament
* laterally: femoral vein
82
Blood supply and drainage of the anterior compartment of the thigh
femoral artery and femoral vein
83
The femoral artery becomes the popliteal artery at what level?
through the opening of the adductor magnus muscle (adductor hiatus) at the popliteal space
84
What structure is medial to the the femoral artery (1) and lateral to the femoral artery (2)
(1) femoral vein
(2) femoral nerve
85
Branches of the femoral artery
1) superficial circumflex iliac artery
2) superficial epigastric artery
3) superficial external pudendal artery
4) deep external pudendal artery
5) profunda femoris artery > medial and lateral femoral circumflex arteries, 4 perforating arteries
6) descending genicular artery
86
Supplies the skin of the scrotum
superficial & deep external pudendal artery
87
The descending genicular artery supplies what structure?
knee joint
88
(True/False)
The femoral nerve does not enter the thigh within the femoral sheath
True
89
Branches of the Femoral Nerve (L2 - 4)
| Memorize
90
# Thigh
Medial Fascial Compartment
| Muscles, Blood supply, Nerve supply
Muscles: gracilis, adductor longus, adductor brevis, adductor magnus, and obturator externus
Blood supply: profunda femoris artery and obturator artery
Nerve Supply: obturator nerve
91
Muscles of the Medial Compartment of the Thigh
| Memorize
92
# Thigh
Posterior Fascial Compartment Contents
| Muscles, Blood SUpply, Nerve Supply
Muscles: Biceps femoris, semitendinosus, semimembranosus, small part of the adductor magnus
Blood Supply: branches of the profunda femoris
Nerve Supply: sciatic nerve
93
Muscles of the Posterior Thigh Compartment
| Memorize
94
The popliteal fossa is a diamond-shaped intermuscular space at the back of the knee
What are its boundaries?
* Laterally-superior: biceps femoris
* laterally-inferior: head of the gastrocnemius & plantaris
* Medially-superior: semimembranous and semitendinous
* Medially-inferior: medial head of the gastrocnemius
* Anterior wall (floor): femur, capsule fo the knee joint, and the popliteus muscle
* Roof: skin, superficial fascia, deep fascia
