MSK L8.1 Lower Limb Gluteal Region Flashcards
(28 cards)
Functions of the lower limb
Osteology and regions of the lower limb
KNOW WHATS CIRCLED IN RED
Areas of Transition
Joints of the lower limb
Movements at the hip
Organisation of the lower limb
Superficial Fascia
Loose connective tissue layer.
Contains:
Fat
Cutaneous nerves
Superficial veins
Blood vessels
Lymphatics
📌 Just remember: fat, veins, nerves = superficial
Deep Fascia
Deep fascia (e.g. fascia lata in thigh)
Dense, tough connective tissue. Deep to superficial fascia. Wraps around muscles → compartmentalises them.
📌 Important for:
Creating compartments (anterior, medial, posterior). Can cause compartment syndrome if pressure builds.
Compartments of the lower limb
Nerve supply of lower limb
🟦 Lumbar Plexus
Spinal roots: L1–L4 Location: Inside psoas major muscle Function: Supplies anterior thigh structures
🔑 Nerves to know:
Femoral nerve (L2–L4): Anterior thigh → knee extension Obturator nerve (L2–L4): Medial thigh → hip adduction Tip: Lumbar plexus = "Front & Medial Thigh Movers"
🟥 Sacral Plexus
Spinal roots: L4–S4 Location: Below lumbar plexus (more caudal) Function: Supplies posterior thigh, leg, foot
🔑 Nerves to know:
Sciatic nerve (L4–S3): Largest nerve, splits into:
Tibial nerve: Posterior leg + plantar foot
Common fibular (peroneal) nerve: Lateral + anterior leg, dorsal foot
Superior gluteal nerve (L4–S1): Gluteus medius/minimus → hip abduction
Inferior gluteal nerve (L5–S2): Gluteus maximus → hip extension
Pudendal nerve (S2–S4): Pelvic floor + genital sensation
Tip: Sacral plexus = "Back of thigh, all of leg, butt, genitals
Nerve supply of lower limb – motor innervation
🦵 Femoral nerve (L2–L4)
Anterior thigh
Hip flexors
Knee extensors (e.g. quadriceps)
🟥 Obturator nerve (L2–L4)
Medial thigh
Hip adductors
⚡ Sciatic nerve (L4–S3)
BIGGEST nerve in the body. Splits into:
▶️ Tibial nerve
Posterior thigh: Hamstrings Posterior leg: Plantarflexors Foot muscles
▶️ Common fibular (peroneal) nerve
Splits into:
Superficial fibular nerve
Lateral leg: Evertors
Deep fibular nerve
Anterior leg: Dorsiflexors + toe extensors
Blood supply of lower limb
1) When does the external iliac become femoral artery?
2) Thigh blood supply
3) What does the femoral artery pass through when it becomes the popliteal artery?
4) When is popliteal artery damage common?
5) What 2 arteries does the popliteal artery turn into?
6) What are the two foot arteries?
🔺 From Abdomen to Thigh:
Abdominal Aorta → splits into:
Common Iliac → splits into:
Internal Iliac → pelvis/glutes/perineum
External Iliac → becomes:
Femoral Artery (once it passes under inguinal ligament)
🦵 Thigh Blood Supply:
Femoral Artery
Enters femoral triangle (superficial = easy to injure)
Gives off Profunda femoris (deep femoral) artery:
Supplies thigh muscles
Gives medial & lateral circumflex femoral arteries → supply femoral neck/head
Passes through adductor hiatus → becomes:
Knee (Popliteal Region):
Popliteal Artery
In popliteal fossa behind knee
Vulnerable in distal femur fractures
Gives off genicular branches for knee joint
🦶 Leg Blood Supply:
Popliteal splits into:
🟣 Posterior Tibial Artery
Deep in posterior leg Gives off fibular (peroneal) artery Passes behind medial malleolus (in tarsal tunnel) → palpable pulse here
🔵 Anterior Tibial Artery
Passes through interosseous membrane Runs in anterior compartment with deep fibular nerve Becomes Dorsalis Pedis Artery (pulse between EHL and EDL tendons)
🦶 Foot Arteries:
Dorsalis Pedis → continues as Arcuate artery Posterior Tibial → forms Deep Plantar Arch
Lower Limb Pulse Points
📌 Pulse Points (Examinable!)
Femoral pulse – femoral triangle Popliteal pulse – popliteal fossa (harder to palpate) Posterior tibial pulse – behind medial malleolus Dorsalis pedis pulse – between EHL and EDL tendons
What are the 3 types of veins in the lower limb?
- Deep veins
Travel with deep arteries
(Femoral vein, popliteal vein, anterior/posterior tibial veins) - Superficial (drain into deep veins via perforating veins, examples include 1) great (long) saphaneous vein, medial side lfo leg, small (short) saphenous vein postolateral side of leg
- Perforating veins - Connect superficial - CONTAIN VALVES TO PREVENT BACKFLOW
Great (long) Saphenous Vein - Main Use
Coronary artery bypasss graft CABG
- Easy access
- Long straight vein
“Anterior to ankle, Posterior to knee, Fuses with femoral vein” → A-P-F
EXAMPLE OF SUPERFICIAL VEIN
Varicose Veins
❌ What goes wrong in varicose veins?
Valves stop working properly (we say they become "incompetent"). Blood falls backwards (backflow). Blood pools in the superficial veins (close to the skin). These veins get stretched out and twisted = that’s what you see in varicose veins.
📍 Which vein is the most affected?
Great saphenous vein (runs up the inside of the leg)
DVT - Deep Vein Thromboisis
What is it?
Causes
Complications
Risk Factors
Symptoms
Management
- Blood clot in a deep vein, usually in leg. This blocks blood flow
- PE - pulmonary embolism. Clot breaks off, goes to lungs, can be fatal
- Risk Factors: Immobility (long flights, hospital bedrest), clotting disorders, OCP (pill = estrogen = clot risk), travel, cancer, post surgery
- Pain, swelling, tenderness, redness, “Painful swollen red leg”
- Blood thinners
🔑 One-liner for the exam:
"DVT = deep vein clot causing red, swollen, painful leg. Risk of PE. Treat with anticoagulants."
Lymphatics of lower limb
Key points to remember:
Lymph follows veins (esp. the great saphenous vein) Superficial → Deep → Inguinal nodes Deep inguinal = medial to femoral vein Popliteal nodes drain into deep inguinal
🩺 Clinical relevance:
Swollen inguinal nodes? Think: 🔸 Infection, 🔸 Malignancy (like cancer), 🔸 Autoimmune disease
Gait Cycle
🔑 Gait Cycle = 2 Phases:
Stance phase – 60% 🦶 Foot is on the ground ➡ From heel strike to toe-off Swing phase – 40% 🕴 Foot is off the ground ➡ From toe-off to heel strike
🧩 The 4 Key Steps (In order):
Heel strike – heel hits the ground Support – body weight is on that leg Toe-off – toes push off the ground Swing – leg swings forward through the air
🧠 Quick Tip:
Most time = stance phase Swing = when leg moves forward in air They cycle one after the other – think of walking like a pendulum: one foot pushes off, the other hits ground.
Bony Pelvis Anatomy
GREATER SCIATIC FORAMEN role
provides an exit from the pelvis into the gluteal region
HIP FLEXOR MUSCLES ANATOMY
PSOAS ABSCESS
Hip Flexors = Iliopsoas (Psoas major + Iliacus)
Nerve roots: L1–L3 Main job: Flex the hip (lift your thigh)
🦴 Attachments:
Psoas major → lumbar vertebrae 🦴 Iliacus → inner iliac surface (pelvis) Both → join & insert on lesser trochanter of femur
💥 Clinical Pearl: Psoas abscess
Usually from TB Tracks down to groin area Can mimic a femoral hernia Causes groin pain due to inflammation of the tendon
Gluteal Region
Muscles of the gluteal region
1) Function
2) Superficial group
3) Deep group
TRENDELENBURG GAIT
These muscles move the hip joint and stabilise the pelvis during walking.
Abduction + Extension
Glutues Maximus - Hip Extender
Gluteus Medius and Minimus - HIP ABDUCTORS
Tensor Fascia Lata - abduction
HELP TOTATE HIP OUTWARDS
Piriformis
Obturator internus Gemellus superior & inferior Quadratus femoris
Clinical tip to remember:
Gluteus medius/minimus weakness → Pelvis drops on opposite side when walking → Trendelenburg gait Gluteus maximus = big muscle for power (stairs, standing)
Gluteal muscles: superficial abductors and extenders
Which nerve innervate gluetaus maximius?
Which nerve innervates gluteaus medius and minimus?
Ischial bursitis
Inferior glueal nerve L5-S2
Superior Gluteal Nerve L4-S1
ISCHIAL BURSITIS:
Ischial bursitis = pain when sitting, caused by inflammation over ischial tuberosity.
Key function of lesser gluteal muscles (Gluteus medius and minimus)
🔑 Exam Gold:
Medius/Minimus = Pelvic stabilisers + medial rotation
Maximus = Power + lateral rotation
Know the nerves:
Superior gluteal = med & min
Inferior gluteal = max
Lesser glutei help
stabilize hip in
walking
Why is the pisiformis an important landmark?
🔑 Key Muscle: Piriformis
Main landmark in this area
Divides the greater sciatic foramen into:
Suprapiriform space (above piriformis)
Infrapiriform space (below piriformis)
Sciatic nerve exits below piriformis (infrapiriform)
“Max does the heavy lifting, but piriformis marks the map.”
