Morphological plan of the lower limb

Question 1

Comparison with upper limb

Answer 1

Lower limbs closer together

Extensors are anterior

Flexors are posterior

Medial rotation in development

Brings posterior compartment anterior

Question 2

Skeleton

Answer 2

Pelvis

Femur

Fibula

Tibia

Tarsal bones x7

Metatarsals x5
Phalanges x14

Question 3

Limb movements

Answer 3

Flexion/ extension

Abduction/ adduction

Lateral/ medial rotation

Pronation/ supination

Circumduction

Question 4

Joints

Answer 4

Hip joint

Knee joint

Ankle joint

Joints of the foot

Question 5

Functional compartments

Answer 5

Gluteal

Thigh

• anterior (extensors of knee)
• posterior (flexors of knee)
• medial (adductors of thigh)

Leg

• anterior (extensors of foot_
• posterior (flexors of foot)
• lateral (everters of foot)

Foot

Question 6

Three gluteal muscles

Answer 6

Gluteus maximus (extensor and lateral rotator)

Gluteus medius (abductor and medial rotator)

Gluteus minimus (abductor and medial rotator)

Question 7

Gluteus maximus

Answer 7

Origin: ilium

Inserts: gluteal tuberosity, iliotibial tract

Supplied by inferior gluteal nerve

Question 8

Gluteus medius and minimus

Answer 8

Origin: ilium

Inserts: greater trochanter

Supplied by superior gluteal nerve

Question 9

Small muscles of the gluteal region

Answer 9

Equivalent to rotator cuff

• stabilise hip
• lateral rotation of extended thigh

Origin: sacrum (piriformis) and ischium/ ischiopubic ramus

Inserts: greater trochanter

Supplied by branches from sacral plexus

Question 10

Anterior compartment of thigh

Answer 10

Quadriceps

• extend knee
• rectus femoris- also flexion of hip

Origin: anteiror inferior iliac spine and femur

Insert: tibial tuberosity

Supplied by femoral nerve

Question 11

Parts of quadriceps

Answer 11

Rectus femoris

Vastus lateralis

Vastus medialis

Vastus intermedius

Question 12

Posterior compartment of thigh

Answer 12

Hamstrings

• flex knee
• extend hip
• medial rotation
• lateral rotation

Origin: ischial tuberosity

Inserts: tibia, fibula

Supplied by sciatic nerve

Question 13

Medial compartment of thigh

Answer 13

Pectineus
Adductor longus
Adductor brevis
Gracilis
Adductor magnus

Origin: pubis and ischium

Inserts: linea aspera

Adduction, medial rotation

Supplied by obturator nerve

Question 14

Movements of the thigh

Answer 14

Flexion

Abduction

Extension

Adduction

Question 15

Flexion of the thigh

Answer 15

Rectus femoris

Sartorius

Iliopsoas

Question 16

Extension of the thigh

Answer 16

Gluteus maximus

Hamstrings

Hamstring part of adductor magnus

Question 17

Abduction of the thigh

Answer 17

Gluteus medius

Gluteus minimus

Question 18

Adduction of the thigh

Answer 18

Adductor longus

Adductor brevis

Adductor part of adductor magnus

Pectineus

Gracilis

Question 19

Nerve supply

Answer 19

Lumbar plexus
- anterior rami L1 to L4

Sacral plexus

• anterior rami L4 to L5 (via lumbrosacral trunk)
• anterior rami S1 to S4

Femoral nerve L2 to L4

Obturator nerve L2 to L4

Sciatic nerve L4 to S3

Question 20

Femoral nerve

Answer 20

From lumbar plexus

Motor: anterior compartment of thigh

Sensory: skin over anterior thigh, knee, medial side of leg and foot

Question 21

Obturator nerve

Answer 21

From lumbar plexus

Motor: medial compartment of thigh (except pectineus and hamstring part of adductor magnus)

Sensory: skin over medial thigh

Question 22

Sciatic nerve

Answer 22

From sacral plexus

Motor: posterior compartment of thigh, and leg and foot

Sensory: skin over leg and foot (except medial side)

Question 23

Blood supply

Answer 23

External iliac artery
-> (through inguinal ligament)
Femoral artery
-> (through adductor hiatus)
Politeal artery
->
Anterior and posterior tibial arteries

Question 24

Popliteal artery

Answer 24

Divides in leg as anterior/ posterior tibial arteries

Question 25

Venous drainage

Answer 25

Deep veins follow arteries Two major superficial veins - great or long saphenous vein - small or short saphenous vein

Question 26

Varicose veins

Answer 26

Damage to valves in perforating veins leads to pooling of blood in superficial veins

Question 27

Great saphenous vein

Answer 27

Longest vein in the body Drains medial side of arch Medial side of limb Drains into femoral vein in femoral triangle

Question 28

Short saphenous vein

Answer 28

Drains lateral side of arch Pierces deep popliteal fascia Drains into popliteal vein

Question 29

Lymphatic drainage

Answer 29

Follow general pattern of superficial and deep veins Superficial inguinal nodes - drain skin and superficial fascia of lower limb Deep inguinal nodes - beside femoral vein

Question 30

Produna femoris artery

Answer 30

Branch of femoral artery Large branch to posterior thigh

Question 31

Femoral triangle

Answer 31

Lateral- medial - femoral nerve - femoral artery - femoral vein - lymphatics Femoral nerve does not sit in the femoral sheath