Movement Lecture 4 - Neurovasculature of the lower limb

Question 1

Which artery is the continuation of the external iliac artery in the thigh, and what is the anatomical boundary where this change occurs?

Answer 1

External iliac artery becomes the femoral below the inguinal ligament

Question 2

What is the blood supply for the anterior compartment of the thigh?

Answer 2

Femoral artery

Question 3

Where does the profunda femoris artery branch from and what is its alternative name?

Answer 3

Femoral artery

AKA The deep artery of the thigh

Question 4

How many perforating arteries are given off by the profunda femoris artery and what do they supply?

Answer 4

Four

Posterior compartment of the thigh

Question 5

Which muscle do the superior and inferior gluteal arteries pass either side of to enter the gluteal region?

Answer 5

Piriformis

Question 6

Where do the gluteal arteries branch from?

Answer 6

Internal iliac artery

Question 7

Which artery branches from the internal iliac and supplies the medial compartment of the thigh?

Answer 7

Obturator artery

Question 8

Branches from which two arteries anastamose around the femur so blood can bypass an occlusion?

Answer 8

Internal iliac and profunda femoris

Question 9

How many genicular branches are given off by the popliteal artery and what are their names?

Answer 9

Five
Lateral and medial superior
Middle
Lateral and medial inferior

Question 10

What structures are formed by the genicular branches of the popliteal artery and what is their function?

Answer 10

Genicular anastamoses

Allow blood supply to the leg to be maintained when the knee is flexed

Question 11

What are the two terminal branches of the tibial artery, and which one perforates the interosseus membrane?

Answer 11

Anterior tibial artery (perforates interosseus membrane)

Posterior tibial artery

Question 12

Which artery supplies the lateral compartment of the leg and where does it branch from?

Answer 12

Fibular artery branches from the posterior tibial

Question 13

What are the terminal branches of the anterior tibial artery and which one runs more medially on the dorsum of the foot?

Answer 13

Dorsalis pedis and lateral tarsal

Dorsalis pedis is medial

Question 14

What is the artery formed by the anastamosis of the terminal branches of the anterior tibial artery?

Answer 14

Arcuate artery

Question 15

Which artery does the deep plantar artery of the foot branch from?

Answer 15

Dorsalis pedis

Question 16

What are the terminal branches of the posterior tibial artery?

Answer 16

Medial and lateral plantar arteries

Question 17

Which terminal branch of the posterior tibial artery anastamoses with the deep plantar artery, and what is this anastamosis called?

Answer 17

Lateral plantar artery

Deep plantar arch

Question 18

The femoral pulse point can be found just inferior to a point half way between which two structures?

Answer 18

Anterior superior iliac spine

Pubic tubercle

Question 19

What is the deepest structure in the popliteal fossa?

Answer 19

Popliteal artery

Question 20

How should the knee be positioned to best feel a popliteal pulse?

Answer 20

Flexed

Question 21

Which anatomical features can the posterior tibial pulse be found halfway between?

Answer 21

Medial malleolus and heel

Question 22

Which tendon is the dorsalis pedis pulse found just lateral to?

Answer 22

Extensor hallucis longus tendon

Question 23

Name two clinical procedures that the femoral artery is used for

Answer 23

Arterial blood gases in cases of poor perfusion
Minimally invasive surgery - used as point of entry for catheter, then advance up the arterial tree to reach the target organ

Question 24

What are the six “P” symptoms of acute ischaemia in the lower limb?

Answer 24

Pain
Perishingly cold
Pallor
Paralysis
Paraesthesia
Pulseless

Question 25

What is paraesthesia?

Answer 25

Pins and needles

Question 26

Name three potential complications of chronic ischaemia

Answer 26

Tissue loss Ulceration Gangrene

Question 27

Which side of the foot has a venous arch and what does this drain into?

Answer 27

Dorsal venous arch drains into the great saphenous vein

Question 28

Does the great saphenous vein lie anterior or posterior to the medial malleolus?

Answer 28

Anterior

Question 29

Which general regions of the leg do the great and short saphenous veins drain?

Answer 29

Great - medial and anterior | Short - lateral and posterior

Question 30

What do the palmar veins of the foot drain into?

Answer 30

Short saphenous vein

Question 31

Name three things that aid venous return in the lower limb

Answer 31

Valves Muscle contraction Deep fascia acts as "compression stocking"

Question 32

What are the main deep veins of the leg?

Answer 32

Anterior and posterior tibial | Fibular

Question 33

What is special about the deep veins of the leg, compared to those of the thigh?

Answer 33

They are venae comitantes

Question 34

What do the deep veins of the leg join to form, and where does this drain?

Answer 34

Popliteal vein, drains into the femoral vein

Question 35

What can happen to the saphenous veins as a result of a proximal venous obstruction?

Answer 35

Varicose veins - increased pressure means they become dilated and incompetent

Question 36

What complications can result from the breakdown of varicose veins?

Answer 36

Bleeding | Ulceration

Question 37

Which veins in the lower limb can be used for emergency IV access in the event of trauma?

Answer 37

Great saphenous vein | Femoral vein

Question 38

What is the mortality rate for untreated DVT and what complication is this due to?

Answer 38

1-2% mortality rate from pulmonary embolism

Question 39

What are some risk factors for DVT?

Answer 39

``` Pregnancy Immobility Sepsis IV drug use in femoral vein Recent surgery Malignancy ```

Question 40

What are the nerve roots of the lumbar and sacral plexuses?

Answer 40

Lumber plexus = L1 - L4 | Sacral plexus = L4 - S5

Question 41

What is the name of the structure that is formed by parts of both the lumbar and sacral plexuses, and what are its spinal nerve roots?

Answer 41

Lumbosacral trunk | L4, L5

Question 42

What is the nerve supply to the anterior thigh, and what are its spinal nerve roots?

Answer 42

Femoral nerve | L2, L3, L4

Question 43

What is the nerve supply to the medial thigh, and what are its spinal nerve roots?

Answer 43

Obturator nerve | L2, L3, L4

Question 44

What is the nerve supply to the posterior thigh, and what are its spinal nerve roots?

Answer 44

Tibial nerve | L4 - S3

Question 45

What is the exception to the tibial nerve innervating the posterior compartment of the thigh - which muscle, nerve and spinal nerve roots?

Answer 45

Short head of biceps femoris Common fibular nerve L4 - S2

Question 46

Does the femoral nerve pass anterior or posterior to the inguinal ligament?

Answer 46

Posterior

Question 47

What is the terminal branch of the femoral nerve and what does it supply?

Answer 47

Saphenous nerve Medial skin of the thigh (via adductor hiatus)

Question 48

Where does the sciatic nerve bifurcate?

Answer 48

Distal thigh

Question 49

What are the terminal branches of the obturator nerve?

Answer 49

Anterior and posterior branches

Question 50

Which muscles separate the two terminal branches of the obturator nerve?

Answer 50

Obturator externus | Adductor brevis

Question 51

Which quadrant of the gluteal region should intramuscular injections be given into to avoid iatrogenic sciatic nerve injury?

Answer 51

Superolateral

Question 52

What are the terminal branches of the common fibular nerve and what do they supply?

Answer 52

Deep fibular nerve supplies anterior leg | Superficial fibular nerve supples lateral leg

Question 53

Where is the fibular nerve most vulnerable to injury and what would be the symptoms of this?

Answer 53

Where it wraps around the neck of the fibula | Foot drop, affected gait and loss of sensation on the dorsum of the foot

Question 54

What does the tibial nerve innervate before bifurcating?

Answer 54

Posterior compartment of the leg

Question 55

Where does the tibial nerve bifurcate, and what are its terminal branches?

Answer 55

Deep to the flexor retinaculum | Medial and lateral plantar nerves

Question 56

Which nerve innervates the dorsal intrinsic foot muscles?

Answer 56

Deep fibular nerve

Question 57

Divide the plantar intrinsic foot muscles into those innervated by the medial plantar nerve and those innervated by the lateral plantar nerve

Answer 57

Medial plantar nerve: abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and first lumbrical Lateral plantar nerve: all others

Question 58

Which toes receive innervation on their plantar skin from the medial plantar nerve, and which from the lateral plantar nerve?

Answer 58

Medial plantar innervates medial 3 1/2 | Lateral plantar innervates lateral 1 1/2