Lower Limb Part 1 Flashcards
1
Q
what is an innominate bone
A
this is the coxal bone or the hip bone. that is a flattened irregularly shaped bone
2
Q
what is the pelvis
A
2 hip bones and sacrum
3
Q
what is the coxal bone made up of
A
ilium
ischium
pubis
- these complete fusion around the age of 20-25 years old
4
Q
read chapers 3
A
pages 327-337, 350-355, 357-362
5
Q
what is the angle of inclination
A
angle between the femoral neck to the femoral shaft
6
Q
what does the angle of inclination allow
A
allows for greater mobility places the head and neck more perpendicular to the acetabulum
7
Q
what is the angle of a child, normal adult, and in older populations
A
child = 135 degrees
normal adult= 126 degrees
older population= 120 degrees
8
Q
why might the angle of inclination change
A
due to pathological process that weaken the neck of the femur
9
Q
what is the coxa vara
A
the angle of inclination is decreased
10
Q
what is the coxa valga
A
the angle of inclination is increase
11
Q
what type of fascia is seen in the thigh
A
superficial
deep
12
Q
what type of fascia is the deep fascia of the thigh
A
this invest the lower limb like ann elastic stocking
- contains the fascia lata ( iliotibial tract)
13
Q
what type of fascia is the deep fascia of the leg
A
- the crural fascia
- extensor retinacula
14
Q
what is the iliotibial tract
A
lateral thickening of deep fascai
– this is tendinous reinforcements form the TFL and gluteus maximus
15
Q
where does the iliotibial tract start and end
A
from iliac tubercle to anterolateral tubercle of tibia
16
Q
what is intermuscular septum
A
this is the fascia separating the muscles into compartments
17
Q
what are the muscle compartments of the thigh
A
anterior
medial
posterior
18
Q
what are the muscle compartments of the leg
A
anterior
lateral
posterior
19
Q
where can the saphenous opening be found
A
inferiro to inguinal ligament whcih is a hole in the fascia lata
20
Q
what is the fascia that surounds the opening of the fascia lata
A
the cribiform fascia
21
Q
what is the cribiform fascia
A
subcutaneous tissue spreads over saphenous opening and closing it
22
Q
What is the gluteal region ( buttocks)
A
transitional area between trunk and limbs
23
Q
what are some gluteal region ligaments
A
sacrotuberous
sacrospinous
24
Q
what is the sacrotuberous ligament of the gluteal region
A
goes from sacrum dorsal surface to ischial tuberosity
25
what is the sacrospinous ligament of the gluteal region
goes from margins of sacrum to ischial spine
26
what do the gluteal region ligaments create
they create the greater and lesser sciatic foramen
27
what is the greater sciatic foramen
helps with passage for strucutes in and out of the pelvis
28
what are the greater sciatic boundries
greater sciatic notch, sacrotuberous lig, and sacrospinus Lig
29
what takes up most of the greater sciatic forament space
the piriformis
30
what come out/ in above the pirifomris
superior gluteal vessel, Superior gluteal n
31
what come out/in below the piriformis
inferior gluteal vessels, internal pudendal vessels, inferior gluteal n., pudendal n , sciatic n, posteriro femoral cutaneous n., nerve to quadratus femoris, terve to obturator internus
32
what are some structures that pass from the perineum through the greater sciatic forament
internal pudendal a, nerve to obturator internus, pudendal n
33
what is the lesser sciatic foramen
passage for structures in and out of perineum
34
what are the boundries of the lesser sciatic formane
ischial tuberosity, sacrospinous lig, sacrotuberous lig
35
what is the path of nerve to obturator internus
travels through the greater sciatic forament inferior to the piriformis , but then loops back aroudn to reenter the pelivis through the lesser sciatic foramen
36
what is the path of the internal pudendal artery
it exits the pelvic cavity through the greater sciatic foramen to enter the gluteal region. it then curves aroudn the sacrospinous ligament to enter the perineum throgh the lesser sciatic foramen
37
what are the m. of the gluteal region
gluteus max, med, min
| plus the lateral rotators
38
what does the gluteal region do for the tfl
tightens the fascia lata allowing the thigh mm. to increase the power
39
what are some different ways the sciatic n wraps around the pirirforms
```
normal= it comes below the m. toghether
1= the tibial n is below the m and the common fibular n is going through the m.
2= the tibial n is going belwo and the common fiibular is going above the m.
```
40
where do the nerves of the lower limb come from
lumbar and sacral plexus
41
what is the spinal ns of the lumbar plexus
Ventral rami of L1-L4
| and help from the subcostal n (T12)
42
what are the spinal ns of the scaral plexus
ventral rami of L4-L5
ventral rami of S1-4
( 2 main ns. are the sciatic and pudendal nn)
43
what is the lumbosacral trunk
descending part fo L4 unites with anterior ramus of L5 then joins sacral plexus
-- this is not part of lumbar plexus
44
what is the cocygeal plexus
S5 and Co which form the coccygeal nerve
45
what are the nerves of the gluteal region and posterior thigh
```
1= gluteal nerves= cutaneous nerves
- superior cluneal n.
-middle cluneal n.
-inferior cluneal n.
2=deep nerves
```
46
What is the spinal n. of the superior cluneal n.
dorsal rami of L1-L3
47
What does the the superior cluneal n. supply
superior 2/3 of the the buttock
48
what is the spinal n. of the middle cluneal n.
dorsal rami of S1-S3
49
What does the the middle cluneal n. supply
skin over sacrum and adjacent buttock
50
what is the spinal n. of the inferior cluneal n.
derived rom posterior femoral cutaneous n ( S2-S3)
51
What does the the inferior cluneal n. supply
larger, innervates inferior half of buttock
52
what are deep nerves of the gluteal/ posterior thigh regioin
all are branches of scaral plexus
all leave pelivs via greater sciatic formane
EXCEPT superior gluteal n . they emerge inferior to pirifomris m.
53
what is the spinal n. of the superior gluteal n.
L4-S1
54
what are the branches of the superior glureal n.
- superior branch
| - inferior branches
55
what does the superior branch of the superior gluteal n. supply
gluteus medisu
56
what does the inferior branch of the superior gluteal n. supply
gluteus medius
minimus
tensor fasciae latae
57
what are the spinal ns. of the inferior glutteal n
L5-S2
58
what do the branches of the inferior gluteal n innverate
glutues max
59
what are the spinal ns. of the sciatic n.
L4-S3
| largest nerve in humans
60
what does the sciatic n supply
no muscles in gluteal region
| supplies muscles in posterior compartment of thigh
61
what are the branches of the sciatic n.
tibial n.
common fibular n
( they separate about half way down the thigh)
62
what are the spinal ns of the posterior cutaneous ne of the thigh
S1-S3
63
what does the posterior cutaneous ne of the thigh supply
skin of buttock, perineum, posterior thigh, upper meidal thigh
64
what are the spinal ns of the nerve to the quadratus femoris m.
L4-S1
65
what does the nerve to the quadratus femoris m. supply
articular br. → to hip joint
| muscular br. → quadratus femoris and inferior gemellus m.
66
what are the spinal nn. of the nerve to the obturator internus
L5-S2
67
what does the nerve to the obturator internus supply
obturator internus and superior gemellus
68
what are the spinal nn. of the pudendal n.
S2-S4
69
what does the pudendal n. supply
structures in the perineum
| genitalia, sphincter urethra, anal sphincter
70
what are the arteries of the gluteal and posterior thigh region
all are branches of internal iliac artery
- superior gluteal a
- inferior gluteal a
- internal pudendal a.
71
what is the superior gluteal a path
leaves pelvis thorugh greater sciatic foramen- superiorr to teh piriformis
72
what are the branches of the superior glureal a.
superficial branch
| deep branch
73
what does the superficial branch of the superior gluteal a supply
gluteus maximus
74
what does the deep branch of the superior gluteal a supply
gluteaus medius
gluteaus minimus
TFL
75
what is the path of the inferior gluteal artery
leaves pelvis through greater sciatic formaen inferior to the pirifomris m
76
what does the infereior gluteal a supply
to gluteus max, obturator internus, quadratus fem, superior part of hamstring mm.
77
what is the internal pudendal a path
leaves pelvis through greater sciatic foramen and descends posteriro to the ischial spine then reenters the pelivs vis lesser sciatic foramen and enters perineum with pudendal nerve
78
what does the pudendal a supply
muscles in perineal region and external gentialia
79
what are the veins of the lower limb form the internal iliac v
gluteal veins
80
what are some superficial vv of the lower limb
- small saphenous
| - great saphenous
81
where does the small saphenous v begin
on lateral foot
82
what creates the small saphenous v
union of dorsl venous arch and dorsal vein of little toe
83
what is the path of the small saphenous v
passes posterior to lateral malleolus and ascends along the lateral side of the calcaneal tendon to popliteal fossa
84
what does the small saphenous v run with
the sural n.
85
where does the small saphenous v end
by unitin with popliteal v.
86
what creates the great saphenous v
dorsal veins of great toe joins dorsal venous arch
87
what is the great saphenous v path
ascends medially pssing anterior to medial malleolus with spahenous nerve to knee then pass 10cm posterior to medial border of patella then pass through saphenous opening enters femoral v.
88
how does the deep veins travel
they accompany the major aa.
89
what are the deep veins
anterior tibial v
fibular vein
posterior tibial v
90
where do all the deep veins drian into
popliteal v
91
what creates the posterior tibial v
plantar arch unites with the medial and lateral plantar vv
92
what are perforating veins
drain blood from superficial veins to deep veins- valves allow only this one way flow
and they perforate fascia of muscles
93
what are some cutaneous ns. of the lower limb
- subcostal n
- ilioinginal n
- genitofemoral n
- iliohypogastric n
- lateral cutaneous n. of thigh
- anterior cutaneous br of femoral n
- posterior cutaneous n of thigh
- cutaneous br. of obturator n.
94
what is the spinal n of subcostal n
T12
95
what does the subcostal n supply
skin of hip inferior to anterior iliac crest and anterior to greater trochanter
96
what is the spinal n of ilioinguinal n
L1
97
what does the ilioinguinal n supply
skin of superomedial area of thigh, over medial femoral triangle
98
what is the spinal n of iliohypogastric n
L1
99
what does the iliohypogastric n supply
superolateral quadrant of buttock
100
what are the branches of the genitofemoral n
femoral br.
| genital br
101
what is the spinal n of the femoral br.
L1-L2
102
what does the femoral br. supply
supply skin over lateral femoral triangle
103
what is the spinal n of the genital br.
L1-L2
104
what doe the genital br. supply
supply external genitalia
105
what is the spinal n of the lateral cutaneous n. of thigh
L2,L3
106
what does the lateral cutaneous n. of thigh supply
direct br. of lumbar plexus to skin on anterior and lateral aspects of thigh
107
what is the spinal n of the anterior cutaneous br. of the femoral n
L2-L4
108
what does the anterior cutaneous br. of the femoral n supply
supply skin on anterior and medial sided of thigh
109
what is the spinal n of the posterior cutaneous n. of the thigh
S1-S3
110
what does the posterior cutaneous n. of the thigh supply
branch of sacral plexus, supplies the skin on posterior aspect of the thigh and posterior to knee
111
what is the spinal n of the cutaneous br. of obturator n
L2-L4
112
what does the cutaneous br. of obturator n supply
skin of middle part of medial thigh
113
what are the popliteal fossa nerves
- tibial n
- comon fibular n
- sural n.
114
what happens to the sciatic n in the superior popliteal fossa
the sciatic n
115
what does the tibial n supply
in fossa br. to soleus, gastroc, plantaris , popliteus
116
what is the branch of the tibial n
medial sural cutaenous n
117
where does the common fibular n divide
around the neck of the fibula
118
what are the branches of the common fibular n
superficial fibular n
deep fibular n
lateral sural cutaneous n
119
what forms the sural n
medial sural n ( of tibial n ) and the lateral sural cutaenous n (from common fibular n )
120
why are the thigh mm. put into their groups
by there location, action, nerve supply and are separated by intermuscular septa
121
where can the pectineus m found
in 2 different layers
- - lateral part ( lateral femorall n )
- -meidal part ( branch from obturator n )
122
what does the sartorius cover up
the femoral artery
123
what is the controversy m of the thigh
the vastus medialsi is the VMO
124
what is so different about the vmo
it is reported to have a more oblique orientation creating a better pull on patella medially
BUT many anatomists beleve they are parallel
125
what are the articualr m of the knee
they arise from the vastus intermedius fiber
O: ant. surface fo femur above patell
I: synovial capsule of knee and wall of suprapatellar bursa
A: pulls synovial capsule superiorlyduring extension of knee so it willnot get cuaght in knee joint
126
what are the medial and lateral patellar retinacula
portions of quadriceps tendon inserted onto upper tibia and contribute to knee joint capsule
127
what is the patella
large triangular sesamoid bone in the tendon of the quadriceps
128
what attaches patella ligament attach too
the tibial tuberosity
129
what does the patella ligaments articulate with
the patellar groove of the femur
130
what does the patella ligament do
increases leverage for muscles of lower limbs
131
what is the continuation of the patellar ligament
of the tendon of quadricpes
132
read slides
64
133
what divides the obturator n
the adductor brevis
| then it becomes the anterior and posterior
134
what does the anterior obturator n supply
adductor longus, gracillis, adductor brevis
135
what does the posterior obturator n supply
obturator externus, adductor magnus, adductor brevis, articular to knee
136
what is the adductor hiatus
opening in the aponeruotic attachment leads inot popliteal fossa
137
what is the adductor minimus
upper fibers of adductor magnusm
| -- sometimes the upper fivers are separate
138
what forms the Pes Anserinus
the gracilis , sartorius, and semitendious
139
what doe the SGT FOS
gracilis , sartorius, and semitendious
| femoral n, obturatorn, sciatic n.
140
what is the femoral triangle and adductor canal
triangular subfascial sace in superomedial 1/3 of the thigh
141
where can the femoral triangle and adductor canal be found
inferior to the inguinal ligament when thigh is actively flexed at hip joint
142
what are the main contians of the femoral triangle and adductor canal
femoral vessels and branches of femoral nerve
143
what are the boundaries of the femoral triangle and adductor canal
```
superior= inguinal ligaments form base
medially= lateral border of adductor longus
laterally= medial border of sartoris ( femoral pulse )
```
144
what are the spinal n of femoral n
L2-L4 ( largest branch of lumbar plexus )
145
what does the femoral n divid into
muscular and cutaneous brnaches
146
what does the femoral n supply
the anterior thigh m, knee and hip joints and to skin o n anteromedial side of lower limb
147
what does anterior division of the femorla n supply
cutaneous and muscular to pectineus and sartoris
148
what does the posterior division of the femoral n supply
muscular to quadriceps and articualr to knee
149
what is the saphenous n
cutaneous branch of femoral n.
150
where does the saphenous n go
descend through femoral triangle and passes through the adducto canal BUT not through the adductor hiatus
151
what does the saphenous n become
superficial between the gracilis and sartorisu
152
what does the saphenous n supply
the skin and fascia on meidal side of the leg and foot
153
where does the femoral a come from
continuation of external iliac artery
154
what are the branches of the femoral a
```
superifical epigastric a
superficial circumflex iliac a
superficial external pudendal a
deep external pudendal a
deep femoral a -- deep artery of the thigh
descending genicualr a
popliteal a
```
155
where does the descending genicualr a. arise
just before it passes through the adductor hiatus
156
what are the branches of the descending genicular a
- saphenous branch
| - musculor articular br.
157
what does the superifical epigastric a supply
pubis and inferior umbilical region
158
what does the superficial circumflex iliac a supply
inguinal region and adjacent anterior thigh
159
what does the superficial external pudendal a supply
upper medial thigh, pubic region
160
what does the deep external pudendal a supply
pectineus m., adductor longus m, external genitalia
161
what does the deep femoral a -- deep artery of the thigh supply
hip joint, proximal and posterior thigh
162
what does the descending genicualr a supply
skin and superficial structures of the medial aspect of the knee and upper leg
163
what are the branches of the deep femoral a.
medial circumflex femoral a
lateral circumflex femoral a
perforating branches
164
what does medial circumflex femoral a supply
head and neck of femur
165
what is a branch of the medial circumflex femoral a
posterior retinacular artery
| this is often torn in the femoral neck is fractured
166
what does the lateral circumflex femoral a supply
the mm. on lateral side of thigh
167
what happens to the transverse branch of the lateral circumflex femoral a
winds around femur
168
what happens to the descending branch of the lateral circumflex femoral a
joins genicular anastomoses
169
what does the obturator a do
assist deep femoral artery supply adductor m of the thigh
170
where does the obturator a travel through
through the obturator foramen entering the thigh
171
what does the obturator a divide into
anterior and posterior branches
172
what does the posterior division of the obturator a supply
adductor m, knee capsule, small branch to head of femur
173
what does the anterior division of the obturator a supply
adductor brevis, skin of_________________?
174
where does the obturator n arise from
either internal iliac artery or from inferior epigastric artery
175
where does the femoral v enter from
thigh medial to femoral artery
176
what does the femoral v pass over
the pectineus
177
where does the femoral v end
posterior to inguinal ligaments where ti becomes external iliac vein
178
what happens to the femoral vein in the femoral triangle
it receives the deep femoral v., great saphenous v and other tributaries
179
what is the femoral sheath
oval, funnel shaped fascial tube
180
what does the femoral sheath contain
prosimal femoral vessels BUT NOT the femoral nerve
181
what are the 3 compartments of the femoral sheath
lateral
intermediate
medial
182
what is in the lateral compartment of the femoral sheath
femoral a
183
what is in the intermediate compartment of the femoral sheath
femoral v
184
what is in the medial compartment of the femoral sheath
a space = femoral canal
185
what is the adductor canal
narrow fascial tunnel in thigh
| --intermuscular passage for femoral vessel to popliteal fossa
186
what can be found in the adductor canal
saphenous n. and femoral a
187
what happens with the saphenous n
the nerve pierces deep fascia and passes down the medial side of the leg with the great saphenous v.
188
what leaves the adductor canal
the femoral artery and v leave the canal through the adductor hiatus
189
what is the popliteal fossa
a diamond shaped region posterior to knee
| -- between semiten and biceps femoris tendon
190
what are the boundries of the popliteal fossa
superiorlatrally: by beceps femoris
superomedially: semimembranous and semitendinous
inferolaterally: latera head of gastrocnemius
inferomedially: medial head of gastrocnemius
191
what are the contents of the popliteal fossa
```
popliteal vessels ( artery , veins and lymph)
tibial nerves
common fibular nerves
small saphenous veins
4 to 6 popliteal lymph nodes
```
192
what is the popliteal a the continuation of
femoral artery
193
where does the popliteal a start
at adductor hiatus
194
where does the popliteal a end
at inferior border of popliteus by dividing into anterior and posterior tibial aa.
195
what are the branches of the popliteal a
- genicular br.
| - muscualr br.
196
what are the branches of the genicular a of the popliteal a
- superior lateral
- superior medial
- middle
- inferior lateral
- inferior medial
= these form the genicular anastomoese aroudn the knee
197
what does the muscular branches of the popliteal a supply
hamstrings, gastroc, soleus, plantaris
--- the sural arteries form the poplitieal artery to muscles in posterior leg that anastomeose with posterior tibial, middle and lateral inferior genicular arteries
198
where does the popliteal v begin
at distal border of popliteus m.
199
what is the popliteal v a continuation of
posterior tibial v.
200
what does the popliteal v become
femoral v as it enters adductor hiatus then becomes external iliac v above inguinal ligament
