MSK Lower Limb Flashcards
(234 cards)
1
Q
What are the superficial veins of the lower limb?
A
Great saphenous vein
Small saphenous vein
2
Q
What does the great saphenous vein empty into?
A
Femoral vein
3
Q
Where does the great saphenous ascend?
A
Anterior to the medial malleolus of the tibia
4
Q
What does the small saphenous vein empty into?
A
Popliteal vein
5
Q
Where does the small saphenous vein ascend?
A
Posterior to the lateral malleolus
6
Q
What vein are varicose veins more common in?
A
Great saphenous vein
7
Q
What is a common clinical problem of deep veins of the lower limb?
A
DVT
8
Q
What does the superficial inguinal nodes of the lower limb drain?
A
Skin of buttocks
Thigh
Anterior calf
Dorsum of foot
9
Q
What does the popliteal lymph nodes drain?
A
Skin of plantar side of foot
Posterior calf
10
Q
What do the deep inguinal lymph nodes drain?
A
Superficial inguinal nodes
Popliteal nodes
11
Q
Vessels accompanying the great saphenous vein are drained by what nodes?
A
Superficial inguinal nodes
12
Q
Vessels accompanying the small saphenous vein are drained by what nodes?
A
Popliteal lymph nodes
13
Q
What kind of joint is the hip joint?
A
Ball and socket synovial joint
14
Q
What type of cartilage is the acetabular labrum?
A
Fibrocartilage
15
Q
Function of the acetabular labrum
A
Provides an articulating surface for the head of the femur
Increases depth of the acetabulum
16
Q
What are the 3 main ligaments of the hip joint?
A
Iliofemoral
Pubofemoral
Ischiofemoral
17
Q
Function of the iliofemoral ligament
A
Prevents hyperextension of the hip
18
Q
Function of the pubofemoral ligament
A
Prevents hyperabduction of the hip
19
Q
Function of ischiofemoral ligament
A
Reinforce posterior aspect of joint capsule
20
Q
What travels out of the great sciatic foramen?
A
Sciatic nerve
Superior gluteal vessels
Pudendal nerve
Piriformis tendon
21
Q
What travels out of the lesser sciatic foramen?
A
Pudendal nerve
Internal pudendal artery
Internal pudendal vein
Obturator internus tendon
22
Q
What are the muscles that flex the hip?
A
Iliacus
Psoas major
Pectinus
23
Q
Innervation of the illiacus
A
Femoral nerve
24
Q
Innervation of the pectinus
A
Femoral nerve
25
Innervation of the psoas major
L1-L3 anterior rami
26
What is the iliopsoas muscle?
Iliacus and psoas major muscle sharing a common tendinous attachment of the femur
27
What is the chief flexor of the thigh?
Quadriceps muscle
28
What is the main extensor of the hip?
Gluteus maximus
29
Muscles that extend the hip
```
Gluteus maximus
Long head of biceps femoris
Semimembranous
Semitendinosus
Posterior part of adductor magnus
```
30
Hamstring muscles
Biceps femoris long and short heads
Semitendinosus
Semimembranous
31
Innervation of the Semitendinosus
Tibial branch of sciatic nerve
32
Innervation of the semimembraneous
Tibial branch of sciatic nerve
33
Innervation of short head of biceps femoris
Common fibular nerve
34
Innervation of long head of biceps femoris
Tibial branch of sciatic nerve
35
Actions of the hamstring muscles
Extend hip
Flexion of knee
Medial rotation of knee
36
Innervation of pectinus
Femoral nerve
37
Muscles the adduct the hip
```
Pectineus
Adductor longus
Adductor brevis
Gracilis
Obturator externus
Adductor magnus
```
38
Innervation of adductor longus
Obturator nerve
39
Innervation of adductor brevis
Obturator nerve
40
Innervation of adductor magnus
Obturator nerve
41
Innervation of gracilis
Obturator nerve
42
What is found in the adductor magnus?
Adductor hiatus
43
What passes through the adductor hiatus?
Femoral artery
| Femoral vein
44
Actions of adductor longus and brevis
Adduction of hip
Flexion of hip
Internal rotation of hip
45
Actions of gracillis
Hip adduction
| Assists in knee flexion
46
Muscles that abduct the hip
Gluteus medius
Gluteus minimus
Tensor fasciae latae (TFL)
Piriformis
47
What does an injury to the hip abductors cause?
Trendelenberg gait
48
What do the hip abductors contribute to?
Normal walking gait
49
What is the obturator internus tendon accompanied by?
Twin gemeli
| Quadratus femoris
50
Where do lateral/external rotators of the hip cross the joint?
On the posterior side
51
Where do medial/internal rotators of the hip cross the joint?
On the anterior side
52
Muscles that internally rotate the hip
```
Gluteus medius (anterior part)
Gluteus minimus (anterior part)
Tensor fasciae latae
```
53
Innervation of the quadriceps femoris
Femoral nerve
54
How many heads does the quadriceps femoris have?
4
55
What are the 4 heads of the quadriceps femoris?
Rectus femoris
Vastus medialis
Vastus intermedius
Vastus lateralis
56
Function of rectus femoris
Stabilises joint
| Helps iliopsoas flex hip joint
57
What do the 4 heads of the quadriceps unite to form and where?
Quadriceps tendon
| Proximal to the platella
58
What does the quadriceps tendon continue as and where?
Platellar ligament
| Distal to the platella
59
What does the platellar tendon attach to?
The tibial tuberosity
60
Actions of quadriceps muscles
Knee extensors
| Hip flexors
61
Actions of the sartorius
Flexion of hip
Abduction of hip
Lateral rotation of hip
Flexion of knee
62
Where does the sartorius cross the joint?
Crosses hip joint anteriorly
| Crosses knee joint posteriorly
63
Nerve roots of obturator nerve
L2-L4
64
How does the obturator nerve enter the medial thigh?
Via obturator canal
65
Where is the obturator canal found?
Obturator membrane in the obturator foramen
66
What does the obturator nerve innervate?
Medial compartment of thigh
| Cutaneous sensations to skin of medial thigh
67
What is the main artery of the thigh?
Femoral artery
68
What is the femoral artery a continuation of?
External iliac artery
69
What level does the femoral artery arise?
L5
70
Where does the femoral artery enter the thigh?
Midway between the anterior superior iliac spine and the pubic symphysis
71
What is a branch of the femoral artery and where does it go?
Profunda Femoris artery
| Passes posteriorly towards the hamstrings
72
What is the femoral vein a continuation of?
The popliteal vein
73
The femoral vein passes under _____ to continue as _____
The inguinal ligament
| External iliac vein
74
What drains into the femoral vein in the femoral triangle?
Profunda femoris vein
| Great saphenous vein
75
What is cannulation of the femoral vein used for?
Right cardiac angiography
76
Nerve roots of the femoral nerve
L2-L4
77
What is the largest branch of the lumbar plexus?
Femoral nerve
78
Course of the femoral nerve
passes deep to inguinal ligament
| enters femoral triangle lateral to the femoral veins
79
What does the femoral nerve supply?
Sartorius
Pectinus
Iliacus
Quadriceps muscles
80
Why is the femoral triangle exposed?
Due to quadrupedal to bipedal stance
81
Medial border of femoral triangle
Adductor longus
82
Lateral border of the femoral triangle
Sartorius
83
Superior border of the femoral triangle
Inguinal ligament
84
What forms the base of the femoral triangle?
Pectinus
Illiopsoas
Adductor longus
85
Contents of the femoral triangle
```
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
Deep inguinal lymph nodes
Assosiated lymphatic vessels
```
86
What is the femoral sheath?
A funnel shaped fascial tube which surrounds the proximal parts of the femoral vessels (NOT the nerve) and creates the femoral canal medial to them, which contains lymphatic vessels
87
3 compartments of the femoral sheath
Lateral
Intermediate
Medial
88
What does the lateral compartment of the femoral sheath contain?
Femoral artery
| Femoral branch of genitofemoral nerve
89
What does the intermediate compartment of the femoral sheath contain?
Femoral vein
90
What is the medial compartment of the femoral sheath?
Femoral canal
91
What does the femoral canal contain?
fat
loose connective tissue
efferent lymph vessels
a lymph node not embedded in lymphatic tissue (of cloquet)
92
Which gender gets femoral hernias more?
F > M
93
Pathology of femoral hernias
Femoral ring week area
| Abdominal contents push into femoral canal within the femoral sheath
94
Other names for the adductor canal
Hunters canal
| Subartorial canal
95
Where do neurovascular structures in the adductor canal come from?
Leaving the femoral triangle distally and burrowing into the muscles and continues posteriorly until it reaches the adductor hiatus of the adductor magnus tendon
96
Where does the adductor canal emerge after going through the adductor hiatus of the adductor magnus tendon?
Popliteal fossa
97
At the adductor hiatus, what does the anterior femoral artery turn into?
Popliteal artery
98
Contents of the adductor canal
Femoral artery
Femoral vein
Saphenous nerve
Femoral nerve
99
Nerve roots of the lumbar plexus
T12-L4
100
What are two major nerves of the lumbar plexus?
Femoral nerve
| Obturator nerve
101
Through the greater sciatic foramen, structures enter and leave the what?
Pelvis
102
Through the lesser sciatic foramen, structures enter and leave the what?
Perineum
103
Superficial gluteal muscles
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fasciae latae
104
Innervation of gluteus maximus
Inferior gluteal nerve
105
Innervation of gluteus medius and minimus
Superior gluteal nerve
106
Innervation of tensor fasciae latae
Superior gluteal nerve
107
Where is the lumbar plexus found?
Emerges through psoas major on posterior abdominal wall
108
Action of the gluteus maximus
Extension of hip
| External rotation of hip
109
Actions of the gluteus medius and minimus
Flexion of hip
| Medial rotators of the hip
110
Actions of the tensor fasciae latae
Flexion of hip
| Medial rotator of hip
111
What are the deep gluteal muscles?
Piriformis
Obturator internus
Superior and inferior gemelli
Quadratus femoris
112
Actions of the deep gluteal muscles
Stabilise hip joint
| Lateral rotation
113
What two muscles are attached to the iliotibial tract?
Gluteus maximus
| Tensor fasciae latae
114
What is the iliotibial tract?
Long fibrous reinforcement of the TFL
115
Actions of the iliotibial tract
Extension of hip
Abduction of hip
Lateral rotation of hip
Lateral knee stabilisation
116
Where is the sacral plexus found?
Anterior to piriformis
117
Nerve roots of the sacral plexus
Union of ventral rami of spinal nerves L4-S4
118
Two main branches of the sacral plexus
Sciatic nerve
| Pudendal nerve
119
Branches of the sacral plexus
```
Nerves to piriformis (S1+S2)
Posterior femoral cutaneous branch
Nerve to quadratus femoris (L4-S1)
Nerve to obturator internus (L5-S2)
Pudendal nerve
```
120
The lumbosacral trunk is made up from the union of….
L4 and L5
121
Nerve roots of supply to piriformis
S1+S2
122
Nerve roots of supply to quadratus femoris
L4-S1
123
Nerve roots of supply to obturator internus
L5-S2
124
Nerve roots to superior gluteal nerve
L4-S1
125
What does the superior gluteal nerve supply?
Gluteus medius
Gluteus minimus
Tensor fasciae latae
126
Nerve roots of the inferior gluteal nerve
L5-S2
127
What is the largest nerve in the body?
Sciatic nerve
128
What is the sciatic nerve a continuation of?
Main part of sacral plexus
129
Terminal branches of sciatic nerve
Tibial nerves
| Common fibular nerve
130
Nerve roots of sciatic nerve
L4-S3
131
What type of joint is the knee joint?
Synovial hinge
132
What are the articular surfaces of the knee joint?
Medial and lateral condyles of the femur
Tibia
Posterior surface of the patella
133
What bone is NOT involved in the knee joint?
Fibula
134
What is noted about the right and left patella?
They are different
135
Stability of the knee joint depends on what?
Strength and action of surrounding muscles, their tendons and ligaments connecting the femur and the tibia
136
What is the most important muscle to stabilise the knee joint?
Quadriceps femoris
137
What are ligaments of the knee?
Thickenings of the joint capsule
138
What are the collateral ligaments of the knee?
Lateral collateral ligament
| Medial collateral ligament
139
What does the tendon of the popliteus do in the knee joint?
Passes deep to the lateral collateral ligament, separating it from the lateral meniscus
140
What is the relationship between the medial collateral ligament and the medial meniscus?
At its midpoint, the medial collateral ligament is firmly attached to the medial meniscus - making the meniscus vulnerable in ligament injuries
141
What does the anterior cruciate ligament prevent?
Anterior dislocation of the tibia onto the femur
142
What does the posterior cruciate ligament prevent?
Posterior dislocation of the tibia onto the femur
143
What are the menisci of the knee?
C shaped plates of fibrocartilage on the articular surface of the tibia
144
What kind of cartilage is on the knee menisci?
Fibrocartilage
145
What are the two menisci of the knee?
Lateral
| Medial
146
Which of the two menisci is bigger?
Medial menisci
147
Function of menisci of the knee
Deepen the surface
| Play a role in shock absorption
148
What does the medial meniscus firmly adhere to?
Deep surface of the tibial and medial collateral ligament
149
Pathology of the "unhappy triad"
Impacts from knee generally come from lateral direction
Puts load on MCL, which is attached to medial meniscus
This tears the medial meniscus
This puts a load on the ACL, which then tears
Therefore 3 injuries
150
What are involved in the unhappy triad?
Medial collateral ligament
Medial meniscus
Anterior cruciate ligament
151
What flexes the knee?
Hamstrings
Gracilis
Sartorius
Popliteus
152
What extends the knee?
Quadriceps femoris
153
What is housemaid's knee?
Prepatellar bursitits
154
What is prepatellar bursitis caused by?
Friction between skin and patella
155
What knee bursa articulates with joint cavity?
Suprapatellar bursae
156
Where can bone marrow be taken from?
Sternum
| Iliac crest
157
What is the tibialis anterior innervated by?
Deep fibular nerve
158
What is the extensor digitorum longus innervated by?
Deep fibular nerve
159
What is the fibularis tertius innervated by?
Deep fibular nerve
160
What is the extensor hallicus longus innervated by?
Deep fibular nerve
161
Action of anterior compartment of leg
Dorsiflex ankle
| Inversion
162
Action of fibularis teritus
Dorsiflexion
| Eversion
163
What artery supplies the anterior leg?
Anterior tibial artery
164
What does the common fibular nerve split into?
Deep fibular nerve
| Superficial fibular nerve
165
What are the two divisions of the sciatic nerve?
Common fibular nerve
| Tibial nerve
166
Where does the tibial artery run?
Midway between malleoli
167
What innervates fibularis longus?
Superficial fibular nerve
168
What innervates fibularis brevis?
Superficial fibular nerve
169
Which of the fibularis longus and fibularis brevis is more superior?
Fibularis longus
170
Action of fibularis longus and brevis
Eversion
| WEAKLY plantar flex foot
171
What causes injury to common fibular nerve?
Habitual or prolonged kneeling / squatting / leg crossing
172
What muscles are affected in injury to the common fibular nerve?
Dorsiflexion muscles
173
What is the presentation of injury to the common fibular nerve?
Foot drop
174
What is the dorsalis pedis pulse found lateral to?
Tendon of the extensor hallicus longus
175
What type of joint is the ankle joint?
Synovial hinge
176
What is the malleolar mortise formed from?
Transverse part of the posterior tibial ligament and lower end of the tibia and fibia
177
What does the malleolar mortise socket articulate with?
Pulley shaped trochlea of the talus bone
178
Articular surfaces of the ankle
Distal end of tibia and fibia
Superior part of talus bone
Malleoli grip tallus tightly during movements
179
When is the malleolar grip strongest?
During dorsiflexion
180
When is the ankle joint unstable?
Plantar flexion
181
Ligaments of the ankle joint
```
Medial/deltoid ligament (4x)
Lateral ligament (3x)
```
182
What does the medial/deltoid ligament resit?
Over eversion of foot
183
What does the lateral ligament resist?
Over inversion of foot
184
3 distinct ligaments of the lateral ligament of the ankle
Anterior talo fibular
Posterior talo fibular
Calcaneofibular
185
What are ankle sprains due to?
Torn fibres of ankle ligament
186
What causes the most common ankle sprain?
Inversion of subtalar joint
187
What is footballers ankle?
Repeated strain on the anterior capsule
188
What muscles dorsiflex the ankle?
Tibialis anterior
Extensor hallicus longus
Extensor digitorum longus
Fibularis tertius
189
What muscles plantarflex the ankle?
```
Tibialis posterior
Gastrocnemius
Soleus
Plantaris
Fibularis longus and brevis (weakly)
Flexor hallicus longus
Flexor digitorum longus
```
190
What kind of joint is the proximal tibio-fibular joint?
Synovial plane
191
What kind of joint is the distal tibio-fibular joint?
Fibrous joint (syndesmosis)
192
Upper medial border of popliteal fossa
Semimembraneous
193
Upper lateral border of popliteal fossa
Biceps femoris muscle
194
Inferior border of popliteal fossa
Lateral and medial heads of gastrocnemius muscle
195
Contents of popliteal fossa
```
Fat
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve
Popliteal lymph nodes and lymphatic vessels
```
196
What is the order of contents in the popliteal fossa?
Medial -> lateral
| Popliteal artery, Popliteal vein, tibial nerve, common fibular nerve (down biceps femoris)
197
What is the popliteal artery a continuation of and where?
Femoral artery as it emerges from the adductor hiatus
198
Weak or loss of popliteal pulse indicates what?
Femoral artery obstruction
199
Innervation of posterior leg
Tibial nerve
200
How many heads does the gastrocnemius have?
2
201
Actions of gastrocnemius
Plantarflexion
| Flexion of knee
202
What is the gastrocnemius essential for?
Walking gait
203
Action of plantaris
Plantar flexion
204
Nerve roots of tibial nerve
L4-S3
205
What is the arterial supply to the posterior compartment of the leg?
Posterior tibial artery
206
Where is the posterior tibial artery palpated?
Between the posterior surface of the medial malleolus and medial border of the calcaneal tendon
207
Order of deep posterior leg muscles coming posterior to the medial malleolus to enter the sole of the foot
```
Anterior to posterior
TOM DICK AND VERY NERVOUS HARRY
Tibialis posterior
Flexor digitorum longus
Posterior tibial artery
Tibial vein
Tibial nerve
Flexor hallicus longus
```
208
Function of the foot
Supports body weight
| Plays an important role in locomotion
209
Bones of the foot
Tarsals
metatarsals
Phalanges
210
What type of joint is the transverse talar joint?
Synovial plane
211
What is the subtalar joint?
Talo-calcaneal joint
212
What type of joint is the subtalar joint?
Synovial plane
213
What type of joint is between the talus and navicular bones?
Ball and socket joint
214
Movements at the subtalar joint
Inversion
| Eversion
215
What are essential for movement for walking on uneven ground or balancing on one leg?
Articulated ball and socket joint between talus and navicular bones allowing pivot
Joints between talus and calcaneous allowing side to side movements
Some movement at the transverse talar joint
216
Innervation of flexor digitorum brevis
Medial plantar nerve
217
Innervation of abductor digiti minimi
Lateral plantar nerve
218
Innervation of adductor hallicus
Medial plantar nerve
219
Innervation of quadratus plantae
Lateral plantar nerve
220
Innervation of the foot lumbricals
Most medial = median plantar nerve
| Most lateral 3 = lateral plantar nerve
221
Two terminal branches of the tibial nerve
Medial plantar nerve
| Lateral plantar nerve
222
Branches of the posterior tibial artery
Medial plantar artery
| Lateral plantar artery
223
Function of arches of the feet
Distribute body weight
| Act as shock absorbers
224
What is the influence of body weight on the feet?
Acts vertically
On the talus
Forces apart navicular and calcaneus bones
225
What is the force of body weight of the feet resisted by?
Muscle tendons that cross the joints
| Plantar calcaneonavicular ligament / spring ligament
226
Function of calcaneonavicular ligament / spring ligament
Resist force of weight on the bones
Maintain medial longitudinal arch
Contributes to subtalar joints
227
3 arches of the feet
Medial longitudinal arch
Lateral longitudinal arch
Anterior transverse arch
228
What passive factors help to maintain the integrity of the arches?
Shape of united bones
Plantar aponeurosis
Long plantar ligament
Short plantar ligament
229
What dynamic factors help to maintain the integrity of the arches?
Intrinsic muscles of the foot
Long flexor tendons
Tendon of tibialis anterior and fibularis longus
230
Who is flat feet common in?
Older people
231
What are acquired flat feet (fallen arches) likely due to?
Dysfunction of dynamic or passive factors
232
Where can you find the sciatic nerve (surface anatomy)?
Midway between the greater trochanter and ischial tuberosity
233
Where is a safe IM injection site?
Upper lateral quadrant
234
Where can the common fibular nerve be damaged?
Neck of the fibula
