Lower Limb Textbook

Question 1

What is the importance of the lesser trochanter?

Answer 1

insertion point for iliopsoas muscle

Question 2

What is the name for the bony ridge between the trochanters? What attaches here?

Answer 2

anteriorly: intertrochanteric line - iliofemoral ligament attaches here, and vastus medialis

posteriorly: intertrochanteric crest. Has the quadrate tubercle where the quadratus femoris inserts

Question 3

What is the quadratic tubercle? What attaches here?

Answer 3

approximate midpoint of the intertrochanteric crest

quadratus femoris

Question 4

What is the importance of the linea aspera?

Answer 4

attachment for the adductors of the thigh
6 muscles total

Question 5

What attaches at the pectineal line?

Answer 5

pectineus

Question 6

What attaches at the gluteal tuberosity

Answer 6

gluteus maximus

Question 7

What is the importance of the adductor tubercle?

Answer 7

attachment for adductor magnus

Question 8

patella
* bone type
* attaches to the base and apex of the patella?
* what do the facets of the patella articulate with?

Answer 8

• sesamoid bone
• base: quadriceps tendon
• apex: patellar tendon/ligament (to tibial tuberosity)
• lateral facet: lateral condyle; medial facet: medial condyle

Question 9

What is the importance of the soleal line of the tibial tuberosity

Answer 9

attachment point for soleus origin

Question 10

Which bones of the lower leg are weightbearing?

Answer 10

Tibia only

Question 11

What does the proximal head of the fibula articulate with?

Answer 11

lateral condyle of the tibia

Question 12

How many bones are there per foot? What are their divisions?

Answer 12

26
Tarsals (7)
Metatarsals (5)
Phalanges (14)

Question 13

List the tarsal bones

Answer 13

talus
calcaneus
navicular
cuboid
cuneiforms (medial, intermediate, lateral)

Question 14

What foot bone bears and distributes the weight of the body to other foot bones?

Answer 14

talus

Question 15

knee joint
* joint type
* movements
* articulations

Answer 15

• hinge synovial
• flexion/extension; medial and lateral rotation
• tibiofemoral (medial and lateral condyles of femur and medial and lateral condyles of the tibia) and patellofemoral (anterior aspect of the distal femur and posterior surface of patella)

Question 16

What is the function of the menisci

Answer 16

• increase knee stability
• increase surface area to help attenuate force

Question 17

List the collateral ligaments of the knee and where they attach

Answer 17

medial collateral ligament: medial epicondyle of the femur to the medial condyle and superior medial surface of the tibia

lateral collateral ligament: lateral epicondyle of the femur to lateral surface of fibula

• NOTE: medial condyle is anatomically coupled to medial meniscus; damage to MCL usually means damage to medial meniscus

Question 18

What is the name for the intracapsular and extracapsular ligaments of the knee?

Answer 18

intracapsular: cruciate ligaments

extracapsular: collateral ligaments

Question 19

list the cruciate ligaments of the knee and where they attach

Answer 19

anterior cruciate ligament: anterior intercondylar area of the tibia and extends superiorly and obliquely to attach to the posterior part of the lateral condyle of the femur

posterior cruciate ligament: posterior intercondylar area of the tibia and passes superiorly and anteriorly to attach to the lateral surface of the medial condyle of femur

Question 20

ankle joint
* joint type
* movement permitted
* bones that contribute
* what are the borders of the ankle joint?

Answer 20

• hinge
• dorsiflexion/plantarflexion
• tibia, fibula, talus
• lateral border: articular facet of the lateral malleolus of the fibula
• medial border: medial malleolus
• superior border: inferior articular surface of the tibia and superior articular surface of the talus

Question 21

Subtalar joint
* movements permitted
* bones involved

Answer 21

• eversion/inversion
• inferior surface of talus and superior surface of calcaneus

Question 22

List the ligaments of the ankle, their attachments, and their function

Answer 22

medial/deltoid ligaments: medial malleolus of tibia to talus, calcaneus, and navicular ; prevent excessive eversion

lateral ligaments: anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament ; prevents excessive inversion

Question 23

What nerve roots make up the femoral nerve

Answer 23

L2-L4

Question 24

What 2 muscles does the femoral nerve pass between?

Answer 24

psoas major and iliacus

Question 25

What is within the femoral triangle? List it laterally to medially. What are its borders? What is its clinical relevance?

Answer 25

femoral nerve, artery, vein Superior (base of triangle): Inguinal ligament. Lateral: Medial border of the sartorius muscle. Medial: Medial border of the adductor longus. Target for anesthetic

Question 26

How many muscles does the femoral nerve innervate? list them

Answer 26

7 Quadriceps (rectus femoris, vastus intermedius, vastus lateralis, vastus medialis), pectineus, sartorius, ilacus Weak: hip flexion, hip adduction, external rotation of hip, internal rotation of leg, flexion of leg Abolished: knee extension

Question 27

The sensory branch of the femoral nerve that continues distally in the leg is called? What specific location does it carry sensory information from?

Answer 27

saphenous nerve Medial leg and foot

Question 28

describe the continuation of the femoral triangle - what is this called? What travels through here?

Answer 28

adductor canal saphenous nerve, femoral artery, and femoral vein

Question 29

What is the adductor hiatus?

Answer 29

opening in the tendon of adductor magnus; passageway anterior to posterior transmits femoral artery and vein and saphenous nerve

Question 30

How many muscles does the obturator nerve innervate? List them

Answer 30

5 adductor longus adductor brevis gracilus adductor portion of adductor magnus obturator externus

Question 31

Where does the sciatic nerve exit the pelvis?

Answer 31

greater sciatic foramen

Question 32

Describe the passage of the sciatic nerve after it exits via the greater sciatic foramen

Answer 32

travels posterior-inferior to piriformis crosses posterior surface of other deep gluteal muscles (superior gemellus, obturator internus, inferior gemellus, quadratus femoris) enters posterior thigh passing deep to long head of biceps femoris

Question 33

When does the sciatic nerve separate into the common peroneal/fibular nerve and the tibial nerve

Answer 33

popliteal fossa

Question 34

How many muscles does the tibial nerve innervate? List them

Answer 34

6 flexor hallucis longus soleus gastrocnemius plantaris tibialis posterior flexor digitorum longus

Question 35

list the branches of the common peroneal/fibular nerve and what they each supply

Answer 35

superficial: lateral compartment of leg; fibularis longus and brevis deep: anterior compartment of leg; tibialis anterior, extensor hallucis longus, extensor digitorum longus

Question 36

What does the external iliac artery continue as? And where is the transition point? What does that artery eventually continue as? Where is that transition point

Answer 36

femoral artery at inguinal ligament popliteal artery at popliteal fossa terminates at the inferior border of popliteus where it divides into anterior tibial artery and tibioperoneal trunk tibioperoneal trunk bifurcates into posterior tibial artery and fibular artery anterior tibial artery: supplies anterior compartment of leg and top of foot posterior tibial artery: posterior compartment and bottom of foot fibular artery: lateral compartment of leg (review this)

Question 37

Genicular anastomosis

Answer 37

branching network of arteries arising from the popliteal artery surrounds the knee to maintain its blood supply even in full flexion at the leg at the knee

Question 38

Describe the venous circulation of the leg

Answer 38

digital veins --> dorsal venous arch --> fibular, posterior tibial, anterior tibial or small saphenous --> popliteal vein --> femoral vein --> external iliac vein --> common iliac vein --> inferior vena cava also the deep vein of the thigh (profunda femoris vein) --> common iliac also dorsal venous arch --> great saphenous --> common iliac --> inferior vena cava plantar venous arch --> medial and lateral plantar --> posterior tibial --> femoral external iliac

Question 39

What divides the compartments in the lower leg

Answer 39

intermuscular septa and interossoeus membrane

Question 40

What forms the pes anserius? Where is it?

Answer 40

Superior to inferior: sartorius, gracilis, and semitendinosus tendon medial surface of tibia

Question 41

What anterior leg muscle is absent in 5-17% of the population?

Answer 41

Fibularis (peroneus) tertius

Question 42

What is the name for both the gastrocnemius and soleus combined?

Answer 42

Triceps surae

Question 43

What leg muscle crosses both the knee and the ankle joint?

Answer 43

gastrocnemius

Question 44

What fascial structure separates the deep and superficial posterior compartment

Answer 44

transverse intermuscular septum

Question 45

In what movement is tibialis posterior and tibialis anterior synergistic?

Answer 45

inversion