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MSK2 - Lower Limb Flashcards

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1
Q

What are the two superficial veins of the lower limb?

A

The great saphenous and small saphenous

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2
Q

Which superficial vein ascends anterior to the medial malleolus? and which to the posterior? Where does each vein drain?

A

Anterior - great saphenous
Posterior - small saphenous

Great drains into femoral vein
Small drains in popliteal

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3
Q

What are the significant groups of lymph nodes for the leg? Where does each area drain to?

A

Superficial inguinal
Deep inguinal
Popliteal

Vessels accompanying the great saphenous drain into the superficial inguinal
Those with the small saphenous enter the poplitael

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4
Q

Describe the dermatomal arrangement of the lower limb

A

Upper thigh - L2
Mid thigh/knee - L3

Medial calf - L4
Lateral side inferior to knee, travelling to hallux - L5

Dorso-lateral foot and sole (except around hallux) - S1

Back of thigh, postolateral calf - S2

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5
Q

What part of the acetubulum does the labrum cover?

A

Upper and lateral borders

(Transverse acetabular ligamenet below)

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6
Q

What are the three main ligaments of the hip? What is each’s function?

A

Ischiofemoral - reinforces posterior, prevents hyperextension
Iliofemoral - prevents hyperextension, strongest of the three
Pubofemoral - reinforces antero-inferiorly, prevents hyperabduction

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7
Q

Which muscle is the chief flexor of the hip?
Which is the chief extensor?

A

Flexor: Iliopsoas
Extensor: Gluteus Maximus

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8
Q

Which muscles flex and extend the hip?

A

Flexors: Rectus femoris, sartorius, pectineus

Extensors:
Gluteus maximus
Hamstrings: semimembranosus, semitendinosus, biceps femoris
Adductor magnus (posterior section)

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9
Q

Which muscles adduct and abduct the hip?

A

Adductors (medial compartment):

  • Adductors longus, brevis and magnus
  • gracilis
  • obturator externus
  • pectineus(?)

Abductors:

  • Gluteus medium and minimus
  • piriformis
  • TFL
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10
Q

Damage to which group of muscles (or their nerve supply) will result in a dropped pelvis when walking? What is this termed?

A

Trendelenburg gait - drop on OPPOSITE to affected side (no longer able to stabilise pelvis)
- damage to the abductors causes this

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11
Q

Which muscles are responsible for medial and lateral rotation of the hip?

A

Medial:

  • Anterior fibres of gluteus medius and minimus
  • TFL

Lateral:

  • Piriformis
  • Obturators
  • Gemelli
  • Quadratus femoris
  • Gluteus Maximus, and minimus(?)
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12
Q

What are the four muscles of the quadriceps? How are they innervated?

A

Rectus femoris
Vastus Lateralis
Vastus Medialis
Vastus Intermedius

Femoral nerve (L2-4)

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13
Q

Where does the patellar tendon attach?

A

A continuation of the quadriceps femoris tendon distal to the patella. It attaches to the tibial tuberosity.

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14
Q

What are the actions of sartorius?

A

Flexes
Abducts
Laterally rotates the thigh at hip

Also flexes the leg at knee

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15
Q

What are the medial thigh muscles? Which nerve innervates?

A

Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis
Obturator Externus

Obturator nerve innervates

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16
Q

What structures pass through the adductor hiatus?

A

Femoral artery/vein

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17
Q

What is the main artery of the thigh, and what is it a continuation of? Where does the name change?

A

Femoral artery, from external iliac

Changes under the inguinal ligament and enters the femoral triangle

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18
Q

The femoral artery enters the thigh midway between which 2 bony surface markings?

A

ASIS and Pubic Tubercle

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19
Q

Name the large branch of the femoral artery which passes posteriorly toward the hamstrings

A

Profunda femoris

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20
Q

The femoral vein is the continuation of which vein?

A

The popliteal

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21
Q

The femoral vein passes under the inguinal ligament to continue as which larger vein?

A

External iliac

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22
Q

Which two important veins drain into the femoral vein in the femoral triangle?

A

Profunda femoris
Great saphenous

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23
Q

Which muscles are supplied by the femoral nerve?

A

Sartorius
Pectineus
Iliacus
Quadriceps femoris

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24
Q

What are the medial and lateral borders of the femoral triangle? Which structure forms the base?

What are the three major contents of the femoral triangle?

A

Adductor longus medially
Sartorius laterally

Base is inguinal ligament

Contents:

  • femoral nerve
  • femoral artery
  • femoral vein
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25
What are the contents of each compartment of the femoral sheath?
Lateral: femoral artery Intermediate: femoral vein Medial: lymphatics (+ fat/loose connective tissue to make femoral canal)
26
Are females or males more likely to get a femoral hernia?
Females
27
What does the femoral artery become, and where?
Becomes popliteal artery at the adductor hiatus
28
What are the contents of the adductor canal?
Femoral artery Femoral vein Nerve to vastus medialis Saphenous nerve (largest cutaneous branch of femoral nerve)
29
Which nerve roots contribute to the formation of the lumbar plexus?
T12-L4
30
What are the two main branches of the lumbar plexus, and what do they innervate? What are the root values of these nerves?
Femoral nerve - anterior compartment Obturator nerve - medial compartment Both roots from L2-L4
31
Which sciatic foramen is the route for structres entering or leaving the pelvis, and which for the perineum?
Greater - pelvis Lesser - perineum
32
What muscles make up the gluteal region?
Superficial: - Gluteus Maximus - Gluteus Medius - Gluteus Minimus - TFL Deep: - Piriformis - Obturator Internus - Superior and Inferior Gemelli - Quadratus Femoris
33
Which part of the fascia lata is called the iliotibial tract? Which uscles attach to the IT tract?
From pelvis to knee TFL and Glut Maximus attached
34
What are the actions of gluteus maximus and how is it innervated?
Extension and lateral rotation Innervated by inferior gluteal nerve (L5-S2)
35
What is the action of gluteus medius, minimus and TFL? Which nerve innervates them?
They are abductors and medial rotators Superior gluteal innervation
36
What is the function of deep gluteal muscles?
Stabilise hip joint and lateral rotation
37
Where is the sacral plexus found? The union of which ventral rami form it? Which two nerves are the main branches of the sacral plexus?
Anterior to piriformis L4-S4 Sciatic and pudendal nerve
38
What roots form the lumbosacral trunk?
L4-5
39
What are the roots of the superior gluteal nerve, and which muscles does it supply?
L4-S1 Supplies - gluteus medius - gluteus minimus - TFL
40
What are the roots of the inferior gluteal nerve and what muscle does it supply?
L5-S2 Supplies gluteus maximus
41
List all the branches of the sacral plexus
Superior Gluteal Lumbosacral plexus Inferior Gluteal Posterior femoral cutaneous Direct branches - nerve to piriformis, nerve to quadratus femoris, nerve to obturator internus, nerve to levator ani and coccygeus Sciatic Pudendal (SLIP DSP)
42
Where does the sciatic nerve emerge in the gluteal region?
Inferior to Gluteus maximus
43
What are the four hamstrings? What is their action and innervation?
Long and short heads of biceps femoris Semitendinosus Semimembranosus Extend the hip and flex the knee Sciatic innervation
44
What type of joint is the knee? What are the articulating surfaces?
Synovial compound hinge Medial and lateral condyles of femur with tibia and posterior surface of patella
45
Which muscle is most important for stabilising the knee?
Quadriceps - specifically vastus medialis and lateralis
46
What separates the lateral collateral ligament from the lateral meniscus?
Tendon of popliteus
47
What does the medial collateral ligament attach to? What makes this important clinically?
Medial epicondlye of femur to medial condyle of tibia Also attached at midpoint to medial meniscus - this means tearing of medial collateral ligament often also tears the meniscus
48
What is the function of the ACL and the PCL?
ACL prevents tibia coming forward relative to femur (preventing hyperextension) PCL prevents tibia moving backward relative to femur
49
What are the knee menisci made of?
Fibrocartilage
50
What are the main functions of the knee menisci?
Deepen the articular surface of the tibia, thus increasing stability of the joint. Act as shock absorbers by increasing surface area to further dissipate forces
51
What is the 'unhappy triad' and what is the mechanism of injury?
Lateral force on knee strains the medial collateral ligament. As it is attached to the medial meniscus it is also damaged. This then loads the ACL, which may also tear. If all 3 \> unhappy triad
52
Which muscles are responsible for flexion and extension of the knee?
Flexion: - Hamstrings (biceps femoris, semitendinosus/membranosus) - Gastrocnemius - Gracilis, Sartorius, Popliteus Extension: - Quadriceps
53
What bursae surrounds the knee?
Suprapatella bursa - extension of joint cavity Prepatella bursa Infrapatella bursa (deep and subcutaneous) Semimembranosus bursa
54
What are the four muscles in the anterior compartment of the leg? What are their main actions?
Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis tertius Mainly dorsiflexors of ankle and extensors of toes
55
What are the significant branches of the common fibular nerve? Which muscles do the main and branches innervate?
Common fibular: - short head of biceps femoris Superficial: - fibularis longus and brevis (lateral compartment) Deep: - tibialis anterior - extensor digitorum longus - extensor hallucis longus (the anterior compartment)
56
What are the two divisions of the sciatic nerve?
Tibial and common fibular
57
Which terminal branch of the popliteal artery supplies the anterior leg?
The anterior tibial artery
58
Which artery runs midway between the malleoli?
Dorsalis pedis
59
What muscles are in the lateral compartment of the leg? What is their action and how are the innervated?
Fibularis longus and brevis Eveters and weak plantarflexors Superficial fibular nerve
60
Injury to what nerve may cause footdrop? Why might this happen? What muscles are affected?
Common fibular nerve Winds round fibular neck - vulnerable Affects anterior and lateral compartments
61
What type of joint is the ankle? What are the articular surfaces?
Synovial hinge Distal tibia and fibula articulate with superior part of talus
62
During what movements is the ankle most and least stable?
Strongest during dorsiflexion Weakest during plantarflexion
63
Which ankle ligament is the weakest? Which is called the 'deltoid ligament'?
The lateral ligament is weaker Medial is the 'deltoid' ligament
64
What is the structure and function of the ankle ligaments?
Medial: four ligaments - from the malleolus, attaching to the talus, calcaneus and navicular bones - resist over-eversion Lateral: three ligaments - Anterior talofibular - Posterior talofibular - Calcaneofibular - together resist over-inversion
65
Which muscles are responsible for plantar and dorsi flexion of the ankle?
Plantarflexors - Posterior Compartment: - gastrocnemius - soleus - posterior tibialis - plantaris (minorly) - fibularis longus/brevis (minorly) Dorsiflexors - Anterior Compartment: - tibialis anterior - extensor hallucis longus - extensor digitorum longus - fibularis tertius
66
What type of joint are the superior/proximal tibiofibular and inferior/distal tibiofibular joints?
Superior - Synovial plane Inferior - Fibrous
67
What are the borders of the popliteal fossa?
Upper medial - semimembranosus Upper lateral - biceps femoris Lower - lateral and medial heads of gastrocnemius
68
What are the contents of the popliteal fossa?
Popliteal artery/vein and branches Tibial and common fibular nerve Fat Termination of small saphenous vein Posterior cutaneous nerve of thigh Popliteal lymph nodes/vessels
69
What muscles make up the posterior leg? What are the innervations?
Superficial: - Gastrocnemius - Plantaris - Soleus Deep: - Popliteus Tibialis Posterior - FDL - FHL All tibial nerve
70
What is the function of the plantaris muscle?
Knee flexion Ankle plantarflexion Role in proprioception?
71
The achilles/calcaneal tendon is the tendon of which muscles?
Gastrocnemius Plantaris Soleus
72
Which nerve innervates all the muscles of the posterior compartment of the leg? Which branch of the popliteal artery supplies these muscles?
Tibial nerve Posterior tibial artery
73
Which four muscles make up the deep posterior compartment? What path do they take to the foot, and what is their action?
Popliteus FDL FHL Tibialis posterior Pass medially to enter posterior to the medial malleolus Flex toes and plantarflex ankle
74
What is the role of popliteus?
Laterally rotates the femur on the tibia – ‘unlocking’ the knee joint so that flexion can occur.
75
Which nerve and vessel accompany the deep posterior muscle tendons posterior to the medial malleolus?
Tibial nerve and posterior tibial artery
76
What are the bones of the foot?
Talus Calcaneus Naviular Cuboid 4x Cuneiforms 5x metatarsals
77
What joints allows inversion and eversion of the foot? What type of joints are they?
The subtalar joints - talonavicular - ball and socket - talocalcaneal - synovial plane
78
What are the plantar muscles of the foot, by layer? What are the innervations?
First: - Abductor hallucis - Medial plantar nerve - Flexor Digitorum Brevis - Medial plantar nerve - Abductor Digiti Minimi - Lateral plantar nerve Second: - Quadratus Plantae - Lateral plantar nerve - Lumbricals - 1x medial nerve, 3x lateral nerve Third: - Flexor Hallucis Brevis - Medial plantar nerve - Adductor Hallucis - Lateral plantar nerve - Flexor Digiti Minimi Brevis - Lateral plantar nerve Fourth: - Plantar and Dorsal Interossei - Lateral plantar nerve
79
What passive and dynamic factors maintain the arches of the feet?
Passive: - shape of bones - plantar calcaneonavicular ligament - long plantar ligament - short plantar ligament Dynamic factors: - intrinsic muscles - long flexor tendons - tendon of tibialis anterior and fibularis longus

Anatomy (11 decks)

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