Lower Limb Muscles Flashcards
(75 cards)
1
Q
What are the Ligaments of the Gluteal Region? What do they do? What is the main function?
A
-Sacrospinous
– Sacrotuberous
They convert the greater &
– Stabilize the sacrum – Prevent its posterior rotation
at the sacroiliac joint
lesser sciatic notches into greater & lesser sciatic foramina
• Their main function is to:
2
Q
Structures passing through the greater sciatic foramen?
A
- Above the piriformis: Superior gluteal vessels & nerve
- Piriformis: an important landmark
- Below the piriformis: Inferior gluteal vessels & nerve Sciatic nerve Posterior cutaneous nerve of thigh Pudendalnerve & Internal pudendal vessels Nerve to obturator internus Nerve to quadratus femoris
3
Q
Structures passing through the lesser sciatic foramen?
A
- Entry:Pudendal nerve & Internal pudendal vessels
- Exit: Tendon of obturator internus Nerve to obturator internus
4
Q
Muscles of the Gluteal Region?
A
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Tensor fascia lata
- Piriformis
- Superior Gemellus
- Inferior Gemellus
- Obturator internus
- Quadratus femoris
5
Q
Gluteus Maximus
Origin? Insertion? Nerve supply? Action?
A
- Origin: Outer surface of ilium behind the posterior gluteal line
- insertion: Most of the muscle (3/4th) inserted into the iliotibial tract/ Deeper fibers inserted to the gluteal tuberosity
- nerve supply: Inferior gluteal nerve
- Action: hip: extension and laterally rotates / knee:extensor
- Gives simultaneous stability to the hip and knee joints
through the iliotibial tract
6
Q
chief antigravity muscle of the hip. ?
A
Gluteus maximus
7
Q
Largest muscle in the
body ?
A
Gluteus maximus
8
Q
It is used in standing up from a sitting position, running & climbing up stairs?
A
Gluteus maximus
9
Q
Gluteus Medius
Origin? Insertion? Nerve supply? Action?
A
-origin: outer surface of ilium (between the middle and
posterior gluteal lines )
-insertion: Lateral surface of greater trochanter
-nerve supply: superior gluteal nerve
-action: thigh: abduction and medial rotation
10
Q
Steady pelvis in walking?
A
Gluteus Medius
11
Q
Gluteus minimus
Origin? Insertion? Nerve supply? Action?
A
- Origin: outer surface of ilium
- insertion: Anterior surface of greater trochanter
- nerve supply: superior gluteal nerve supply
- action: thigh: Abducts & medially rotates
12
Q
The rest of the muscles?
Insertion? Nerve supply? Action?
A
• Piriformis • Superior Gemellus • Inferior Gemellus • Obturator internus • Quadratus femoris
Insertion: upper border of greater trochanter of femur (quadratus femoris= quadrate tubercle of femur)
Nerve : sacral plexus ( piriformis= 1 and 2 sacral nerves)
Action: hip :lateral rotation
13
Q
Nerves of the Gluteal Region?
A
• Sciatic • Posterior cutaneous
nerve of the thigh • Superior gluteal • Inferior gluteal • Nerve to quadratus
femoris • Pudendal nerve • Nerve to obturator
internus
14
Q
the pelvis becomes unsteady when which nerve is damaged? What is the test?
A
If the superior gluteal nerve is damaged, muscles are paralysed and the pelvis becomes unsteady. • A characteristic finding of gluteal muscle weakness is the Trendelenberg sign
15
Q
safe area for intramuscular injection? And why?
A
Outer upper quadrant of the buttock to avoid injury to the underlying sciatic nerve
/
Intramuscular injection enables a large
amount of a drug to be introduced at
once but absorbed gradually. • The injection site must be carefully
selected to avoid injury to the underlying
large vessels and nerves.
16
Q
It is a thick ‘stocking-like‘ membrane covers
the thigh
A
Fascia lata
17
Q
Fascia lata: • It is a thick ‘stocking-like‘ membrane covers
the thigh • It is thickened laterally into a longitudinal
band called?
A
iliotibial tract
18
Q
the iliotibial tract ), which
extends from? To?
A
the iliac tubercle (above) to the
lateral condyle of the tibia (below)
19
Q
Fascia lata has one ?
A
prominent aperture on the
anterior aspect of the thigh below the
inguinal ligament = the saphenous
opening
20
Q
saphenous opening of the Fascia lata. What passes?
A
The great saphenous vein passes through
saphenous opening to open into the femoral
vein • Also it transmits some small branches of the
femoral artery, and lymph vessels
21
Q
Anterior compartment of thigh? + nerve supply?
A
- Pectineus
- Iliopsoas
- Quadriceps femoris
- Sartorius
-Innervation: Femoral Nerve (psoas muscle= lumbar plexus )
22
Q
Medial compartment of thigh + nerve supply?
A
- Gracilis (anterior N)
- Adductor longus (anterior N)
- Adductor brevis (anterior and posterior N)
- Adductor magnus (pubic: posterior / ischial: sciatic N)
- Obturator externus (posterior N)
-Innervation: Obturator N.
23
Q
Posterior compartment of thigh + nerve supply?
A
Hamstrings”
- Biceps femoris ( short head = common Fibular division )
- Semitendinosus
- Semimembranosus
-Innervation: sciatic N tibial division
24
Q
Sartorius
Origin? Insertion? Nerve supply? Action?
A
Origin: Anterior superior iliac spine (ASIS)
Insertion: Upper part of the medial surface of shaft of tibia
N. Supply: Femoral nerve Action: (act on both Hip& knee joints)
• Flexes, abducts, laterally
rotates the thigh (at the
hip)
• Flexes the leg (at the knee)
25
Quadriceps femoris
Origin? Insertion? Nerve supply? Action?
-Rectus femoris Origin :
(it oiginates by 2 heads) Straight head: from anterior inferior iliac spine Reflected head: from ilium above acetabulum
-vastus lateralis: Origin : from upper end& shaft of Femur (upper part of intertrochanteric line, margin of greater trochanter, gluteal tuberosity, lateral lip of the linea aspera) • -vastus medialis Origin : from upper end& shaft of Femur (lower part of intertrochanteric line, spiral line, medial lip of the linea aspera, medial supracondylar line)
-vastus intermedius Origin : upper two-thirds of anterior and lateral surfaces of femur
- Insertion of 4 heads of Quadriceps : By a common Quadriceps tendon into patella, then via ligamentum patellae into Tibial tuberosity
- N. Supply: Femoral N.
- Action of Quadriceps femoris: Extension of the Knee joint • Rectus femoris : is the only head that act on both (Hip& knee) It Flexes the Hip& Extends the Knee
26
Iliopsoas
Origin? Insertion? Nerve supply? Action?
1. Iliacus
- Origin: iliac fossa
-Insertion: Lesser trochanter of femur
-N. Supply: Femoral nerve
-Action: Flexion of the Hip joint
Psoas Major
2. Psoas Major
- Origin: lumbar transverse processes, intervertebral discs, and adjacent bodies from T12 to L5
- Insertion: together with Iliacus in Lesser trochanter of femur
- N. Supply: Anterior rami L1,L2,L3 (Lumbar Plexus)
- Action: same as Iliacus, it Flexes the Hip joint
27
Pectineus muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Pectineal line of Pubis (Superior ramus of pubis) -Insertion: Pectineal line on posterior surface of proximal femur (from base of lesser trochanter to linea aspera) N. -Supply: Femoral nerve [L2 ,L3]
- Action: Flexion, Adduction of the thigh at Hip joint
28
a wedge-shaped depression formed
by muscles in the upper thigh
?
Femoral triangle
29
Femoral triangle
Boundaries? ( base? Medial border? Lateral margin? Apex? )
Floor?
Root?
Content?
```
Boundaries:
Base of the triangle: inguinal ligament
Medial border: adductor longus
Lateral margin: Sartorius muscle
Apex: points inferiorly and is continuous with a fascial canal between adductor muscles and under Sartorius (adductor canal)
The floor of the triangle is formed:
(from medial to lateral)
Adductor longus
Pectineus
Iliopsoas
The roof of the triangle : Fascia lata & Saphenous
opening
```
Contents of Femoral triangle: (from Lateral to medial) 1-The femoral nerve 2- The femoral artery 3- The femoral vein 4- Lymphatic vessels • The femoral artery, femoral vein and the associated lymphatic vessels are surrounded by a funnel-shaped sleeve of fascia (femoral sheath) (Femoral N. outside the femoral sheath) 5- Femoral canal: it is the most medial compartment of the femoral sheath • The upward Base of femoral canal
called Femoral ring
30
Gracilis muscle
| Origin? Insertion? Nerve supply? Action?
Origin: outer surface of body of the pubis, the inferior pubic ramus, ischial ramus
Insertion: Medial surface of proximal shaft of the tibia
N. Supply: Obturator nerve (anterior division)
Action: Adduction of thigh and flexion of the knee joint
31
Adductor Longus muscle
Origin? Insertion? Nerve supply? Action?
Origin: outer surface of body of the pubis (medial to pubic tubercle) Insertion: Linea aspera on middle 1/3 of shaft of femur N. Supply: Obturator nerve [L2,L3,L4] (anterior division) Action: Adduction and rotation of the thigh
32
Adductor Brevis muscle
| Origin? Insertion? Nerve supply? Action?
- Origin: outer surface of body of the pubis and inferior pubic ramus
- Insertion: Posterior surface of proximal femur and upper 1/3 of linea aspera
- N. Supply: Obturator nerve (Anterior& posterior divisions)
- Action: Adduction of the thigh
33
Adductor Magnus muscle
| Origin? Insertion? Nerve supply? Action?
```
It is the Biggest& most powerful
adductor • It is formed of 2 parts:
1. Pubic part :
- Origin:
Inferior pubic ramps
- Insertion: posterior surface of femur
-n supply: obturator nerve ( post. Divi)
Action: addiction and rotation of thigh
```
2. Ischial part :
- origin: ischial tuberosity
- insertion: adductor tubercle
- nerve supply: sciatic nerve
- action: extension of hip joint
34
There is a large circular gap inferiorly between the
hamstring and adductor parts of the muscle is the
? And gives?
adductor hiatus • Adductor Hiatus gives passage for Femoral vessels
35
• It is the Biggest& most powerful
| adductor ?
Adductor Magnus muscle
36
intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the (sartorius muscle). ?
Adductor (Subsartorial) Canal
37
Adductor (Subsartorial) Canal
Starts? Ends?
Anteromedial wall? Posterior wall? Lateral wa;;? Contain?
-start above at the apex of the femoral triangle
- ends below at the opening in the adductor magnus.
-The anteromedial wall is formed by the sartorius muscle and fascia. ■■
-The posterior wall is formed by the adductor longus and magnus ■■
-The lateral wall is formed by the vastus medialis.
-The adductor canal contains:
1- The terminal part of the femoral artery
2- Femoral vein
3- Deep lymph vessels
4- Saphenous nerve, the nerve of vastus medialis, and terminal part of the obturator nerve.
38
Obturator Externus muscle
| Origin? Insertion? N supply? Action?
Origin: External surface of obturator membrane and adjacent bone
Insertion: Trochanteric fossa
N. Supply: Obturator nerve (posterior division)
Action: Lateral rotation of the thigh
39
branch of the
lumbar plexus which lies within Psoas Major muscle
?
Obturator Nerve
40
Obturator Nerve
| Course? Division?
It emerges from the medial border of Psoas
Major muscle • Runs on the side wall of the Pelvis to reach
the upper part of the obturator foramen
(obturator canal) • It divides into 2 divisions (anterior, poaterior) Anterior Division of Obturator N. Lies anterior to Adductor Brevis & behind Adductor longus muscles) Posterior Division of Obturator N. Lies posterior to Adductor Brevis & infront of Adductor Magnus
41
hernial sac passes down the femoral canal, it expands to form a ?
, it expands to form a swelling in
| the upper part of the thigh deep to the deep fascia
42
Femoral Hernia
Common in?
Neck of sac?
The hernial sac passes down the femoral canal, it expands to form a swelling in
the upper part of the thigh deep to the deep fascia • The neck of the sac always lies below and lateral to the pubic tubercle • The neck of the sac is narrow and lies at the femoral ring • The femoral vein lies lateral to the hernial sac • femoral hernia is a dangerous condition and should always be treated
surgically.
43
Biceps femoris
| Origin? Insertion? Nerve supply? Action?
- Origin: Long head: arises with semitendinosus from the inferomedial area of the upper 1/2 of the ischial tuberosity. Short head: arises from the lateral lip of linea aspera. -
- Insertion: The 2 heads unite to form a single tendon which is inserted into the head of the fibula.
- Nerve supply:
The long head is innervated by the tibial division of the sciatic nerve.
The short head is innervated by the common fibular division of the sciatic nerve
- Action: At the hip joint: The long head extends and laterally rotates the hip. At the knee joint: Biceps femoris flexes and laterally rotates the knee.
44
Semitendinosus
| Origin? Insertion? Nerve supply? Action?
-Origin:
It arises with long head of biceps from the Inferomedial area of the upper 1/2 of the ischial tuberosity.
- Insertion:
It descends superficial to the semimembranosus m. and curves around the medial condyle to insert by a long cord-like tendon into the upper part of the medial surface of the tibia behind the tendons of sartorius and gracilis (S.G.S.) as apart of pes anserinus.
- Nerve supply:
It is innervated by the tibial division of the sciatic nerve.
- Actions:
• It flexes the leg at the knee joint and extends the
thigh at the hip joint.
• It also medially rotates the thigh at the hip joint and
medially rotates the leg at the knee joint (working
with semimembranosus).
45
Semimembranosus
| Origin? Insertion? Nerve supply? Action?
- Origin: from the superolateral area of the upper 1/2 of the ischial tuberosity.
- Insertion:
A groove and adjacent bone on the medial and posterior surfaces of the medial tibial condyle.
- Nerve supply:
It is innervated by the tibial division of the sciatic nerve.
- Actions:
• It flexes the leg at the knee joint and extends
the thigh at the hip joint.
• it also medially rotates the thigh at the hip joint
and medially rotates the leg at the knee joint
(working with semimembranosus).
46
Popliteal Fossa
Boundaries of the upper and lower part of the diamond are formed from?
Floor? Root? Contents?
- Boundaries of the upper part of the diamond are formed
1. Medially by the distal ends of the semitendinosus and semimembranosus
2. Laterally by the distal end of the biceps femoris muscle.
- Boundaries of the lower part of the diamond are formed 1.Medially by the medial head of the gastrocnemius muscle. 2.Laterally by the lateral head of the gastrocnemius muscle the plantaris muscle.
- The floor of the fossa is formed by the capsule of the knee joint, adjacent surfaces of the femur and tibia, and the popliteus muscle.
- The roof is formed skin, superficial fascia, and deep fascia, which is continuous above with the fascia lata the thigh and below with deep fascia of the leg. The superficial fascia contains the small saphenous vein and posterior cutaneous nerve of the thigh.
1. Tibial and common fibular nerves ( most superficial)
2. Popliteal artery ( deepest structure)
3. The popliteal vein
47
Anterior compartments of the leg? Nerve supply?
1. Tibialis anterior
2. Extensor digitorum longus
3. Extensor hallucis longus
4. Peroneus tertius
- Blood supply: anterior tibial artery
- Innervation: deep peroneal nerve. (Fibular )
48
Lateral compartment + nerve supply?
1. Peroneus longus
2. Peroneus brevis
-Innervation: superficial peroneal nerve. (Fibular)
49
Posterior compartment + nerve supply?
Superficial group:-
1. Gastrocnemius
2. Soleus
3. Plantaris
B. Deep group:-
1. Popliteus
2. Flexor digitorum longus
3. Flexor hallucis longus
4. Tibialis posterior
-Innervation: Tibial Nerve
50
Planter aponeurosis
| 1st layer names?
First layer:
1. Abductor hallucis
2. Abductor digiti minimi
3. Flexor digitorum brevis
51
Planter aponeurosis
| Second layer names?
Second layer:
1. Quadratus plantae
2. Lumbricals
3. Flexor hallucis longus
4. Flexor digitorum longus
52
Planter aponeurosis :
| 3rd layer>
1. Flexor hallucis brevis
2. Flexor digiti minimi brevis
3. Adductor
53
Planter aponeurosis :
| 4th layer?
Fourth layer:
3 planter interossei
4 dorsal interosseie
54
Around the ankle, the deep fascia thickens to form retinacula that keep the long tendons around the ankle joint in position ?
Retinacula
Superior Extensor Retinaculum Inferior Extensor Retinaculum
Y-shaped
55
Anterior Compartment of leg action?
dorsiflex the
ankle and extend the
toes.
56
```
Tibialis anterior (TA)
Origin? Insertion? Nerve? Action?
```
```
- Origin -lateral condyle of
tibia, upper tibia,
-• Insertion - cuneiform, base
of 1st metatarsal
-• Nerve - deep fibular
(peroneal) (L4-5)
-• Action - ankle dorsiflexion,
forefoot inversion
```
57
Extensor Digitorum Longus (EDL) ?
| Origin? Insertion? Nerve? Action?
```
• Origin - lateral condyle of
tibia, ant surface of fibula,
interosseous
membrane[IM]
• Insertion – Dorsum-base
of middle phalanx, distal
phalanx
• Nerve - deep fibular
(peroneal) (L5-S1)
• Action - extension of toes,
dorsiflexion of ankle
```
58
Extensor Hallucis Longus (EHL)
| Origin? Insertion? Nerve? Action?
```
• Origin - middle ½ of ant
fibula + IM
• Insertion - distal phalanx of
the great toe
• Nerve - deep fibular
(peroneal) (L5-S1)
• Action - extend the great
toe, dorsiflex ankle
```
59
Peroneus Tertius
| Origin? Insertion? Nerve? Action?
• Origin - distal 1/3 ant fibula,
IM • Insertion - 5th metatarsal
Nerve - deep fibular (peroneal) (L5-S1)
• Action – forefoot eversion, Weak dorsiflexion
60
are located on the front of the shin bone and involve the tibialis anterior muscle. The tibialis anterior lifts your foot.
?
Anterior shin splints
61
If your anterior shin pain increases when lifting your toes up while keeping heels on the ground ?
suffer from anterior shin splints.
62
Lateral compartment of leg
| Action ?
Everters of the
foot (turns foot
outward)
63
Peroneus Longus
| Origin? Insertion? Nerve? Action?
```
Origin – upper and lateral
surface of fibula
Its tendon courses behind
lateral malleolus, and lies in
the groove in the cuboid
bone before going to its
place of insertion • Insertion - medial cuneiform
,
1st metatarsal [on i inferior
surface] • Nerve - superficial fibular
(peroneal) (L5-S1) • Action - forefoot eversion,
ankle plantar flexion
```
64
Peroneus brevis
| Origin? Insertion? Nerve? Action?
```
Origin - lower lateral fibula
Courses behind lateral
malleolus
Insertion base of 5th metatarsal
• Nerve - superficial fibular
(peroneal) (L5-S1) • Action – • foot eversion, • ankle plantar flexion
```
65
Middle Foot pain which muscle?
peroneus longus
66
pain, swelling and heat with a visual or feeling of popping or snapping of the tendon by the outside at the ankle. Pain isolated to the lateral aspect of the heel can be difficult to diagnose, particularly in the growing child. Patients can complain of their ankle feeling unstable, or just severely painful on activity How is the condition diagnosed? X-Rays can sometimes show a flake of bone from the ankle bone if the tendon has dislocated or calcium build up around the tendon - peroneal tubercle.
PERONEAL TENDON PROBLEMS
67
Gastrocnemius
| Origin? Insertion? Special feature ?
Origin: It arises by 2 tendinous heads from the femur. 1. Medial head: from a rough area above the medial femoral condyle. 2. Lateral head: distinct facet from the lateral surface of the lateral femoral condyle Insertion: At the middle of the leg, the 2 heads end in a common tendon which fuses with that of soleus to form the calcaneal tendon (Achilles tendon). > Special Features : The lateral head may contain a sesamoid bone called fabella.
68
Soleus
| Origin? Insertion? Special feature ?
Origin:
It has a horse shoe origin as follows:
1.From the posterior surface of the head, neck, and upper part of the shaft of the fibula.
2. From the soleal line and adjacent part of the medial border of the
tibia.
3. From a tendinous arch which extends between the above two
origins.
Insertion:
Its tendon fuses with that of gastrocnemius to form calcaneal
tendon (Achilles tendon).
Calcaneal tendon is the strongest tendon in the body, is about 15
cm long. It is inserted in the middle 1/3 of the back of calcaneus.
It is separated from the upper part of calcaneus by a bursa.
> Special Features:
The muscle contains a rich plexus of veins which is connected to the great saphenous vein by a series of perforating veins.
69
PlantariS
| Origin? Insertion? Special feature ?
Origin: It arises from the lower part of the lateral supracondylar line of the femur. Insertion: It descends close to the medial side of the lateral head of gastrocnemius, then deep to it. It fuses with the medial side of the calcaneal tendon near its attachment to the calcaneus. Nerve Supply of the superficial calf muscle : All by tibial N. Actions :
70
Definition : It is a thickened band of deep fascia on the medial side of the ankle. ?
Flexor Retinaculum
71
Flexor Retinaculum
Attachments ? Relation deep to it?
Attachments : • Anteriorly to the posterior border of the medial malleolus. • Posteriorly: calcaneus. Relations deep to the retinaculum: the following structures pass from back of the leg to the sole. Tibialis posterior, flexor digitorum longus, posterior tibial vessels, tibial nerve, and flexor hallucis longus (Tom Does Very Nice Hats}.
72
Popliteus
| Action? And n supply?
N. Supply: Tibial N.
Actions :
It unlocks the extended knee at the initiation of
flexion (laterally rotates femur on fixed tibia).
73
Flexor Digitorum Longus
| Origin? Insertion? Specials feature ? N supply? Action?
Origin: From the medial part of the posterior surface of the tibia below the origin of soleus from the soleal line.
Insertion: Its tendon passes deep to the flexor retinaculum and enters the sole of the foot and divides into 4 tendons which are inserted into the terminal phalanges of the lateral 4 toes.
Special Features :
l. lt crosses superficial to the tibialis posterior muscle to become the 2nd muscle deep to flexor retinaculum.
2. In the sole, it crosses inferior to the tendon of the flexor hallucis longus muscle.
N. Supply: Tibial N.
Action It flexes the metatarsophalyngeal and the interphalangeal joints of the lateral 4 toes.
It assists in plantar flexion at the ankle.
74
Flexor Hallucis Longus
| Origin? Insertion? Special feature ? N supply? Action?
Origin: arises from the lower two-thirds of the posterior surface of the fibula and adjacent interosseous membrane. Insertion: Its tendon passes deep to the flexor retinaculum and enters the sole of the foot to be inserted into the terminal phalanx of the big toe. Special Features: I. Its tendon grooves the back of talus and the inferior surface of the sustentaculum tali of the calcaneus. 2. Its tendon runs in the 2nd layer of the sole N. Supply : Tibial N.
Action: I. It flexes the metatarsophalyngeal and the interphalangeal joints of the big toe. 2. It assists in plantar flexion at the ankle joint.
75
Tibialis Posterior
Origin? Insertion? Special feature ? N supply? Action?
Origin: From the posterior surface of the interosseous membrane and adjacent parts of tibia and fibula. It lies between and is overlapped by the flexor digitorum longus and the flexor hallucis longus muscles Insertion: Its tendon grooves back of the medial malleolus of the tibia, passes deep to flexor retinaculum, and runs in the sole to be inserted mainly into the tuberosity of the navicular bone and adjacent part of the medial cunieform. Nerve Supply: Tibial N. Action: • It produces planter flexion of the foot at ankle. • It inverts the foot.
