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ACEM Primary > Musculoskeletal: Anatomy - Fascia, veins, lymphatics, efferent vessels, and cutaneous nerves of lower limb > Flashcards

Musculoskeletal: Anatomy - Fascia, veins, lymphatics, efferent vessels, and cutaneous nerves of lower limb Flashcards

1
Q

Superior boundaries of the fascia lata

A

Anterior: pubic tubercle, body of pubis, pubic arch, inguinal ligament, Scarpa fascia (deep membranous layer of inferior abdominal wall)
Posterolateral: iliac crest
Posteromedial: sacrum, coccyx, sacrotuberous ligament, ischial tuberosity/ischiopubic ramus

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2
Q

Inferior boundaries of the fascia lata

A

Continuous with exposed parts of bones around knee, and deep fascia of leg inferior to knee

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3
Q

What forms the iliotibial tract?

A

Lateral fascia lata reinforced by additional longitudinal fibres (shared aponeurosis of tensor fasciae latae and gluteus maximus)

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4
Q

What are the compartments of the thigh? How are they formed and which is the strongest of the intermuscular septa?

A

Anterior, medial and posterior compartments
Forms by fascia lata and three intermuscular septa which attach to the linea aspera of the femur
Lateral intermuscular septum is strongest

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5
Q

What is the saphenous opening? Describe its margins

A

Hiatus in fascia lata located inferolateral to pubic tubercle
Medial margin is smooth; superior, lateral and inferior form sharp cresenteric edge called the falciform margin

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6
Q

What closes the saphenous opening?

A

Cribiform fascia

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7
Q

Where is the deep fascia of the leg thickest?

A

Proximal part of anterior aspect of leg

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8
Q

Where does the deep fascia of the leg attach proximally?

A

Anterior and medial borders of tibia (continuous with periosteum)

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9
Q

Describe the compartments and septae of the leg

A

Anterior (dorsiflexor), posterior (plantarflexor) and lateral (fibular) compartments
Anterior and posterior intermuscular septa divide lateral from anterior and posterior compartments respectively
Transverse intermuscular septum separates superficial and deep plantarflexors

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10
Q

Do superficial veins have valves?

A

Yes but more numerous in deep veins

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11
Q

Two major superficial veins in lower limbs

A

Great and small saphenous veins

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12
Q

Describe the course of the great saphenous vein

A

Formed by union of dorsal vein of great toe and dorsal venous arch of foot
Ascends anterior to medial mal
Passes posterior to medial femoral condyle
Anastamoses with small saphenous vein
Traverses saphenous opening
Empties into femoral vein

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13
Q

How many valves are in the great saphenous vein? Where are they typically located?

A

10-12
Typically located inferior to perforating veins

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14
Q

6 tributaries received by great saphenous vein

A
  1. Accessory saphenous (from medial and posterior tributaries of thigh)
  2. Lateral cutaneous veins
  3. Anterior cutaneous veins
  4. Superficial circumflex iliac
  5. Superficial epigastric
  6. External pudendal
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15
Q

Describe the course of the small saphenous vein

A

Arises on lateral foot from union of dorsal vein of the little toe and dorsal venous arch
Ascends posterior to lateral mal (as continuation of lateral marginal vein)
Passes along lateral border of calcaneal tendon
Penetrates deep fascia in midline of fibula
Ascends between heads of gastrocnemius
Empties in popliteal vein in popliteal fossa

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16
Q

What are perforating veins? What features assist in their function?

A

Veins that originate from the superficial veins and penetrate the deep fascia, carrying blood to the deep veins
Contain valves that allow one-way flow (from superficial to deep) and penetrate at an oblique angle so that they are compressed during muscle contraction: contributing to venous return via the musculovenous pump

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17
Q

Describe the pattern of deep veins in the lower limb

A

Paired, frequently interconnecting veins flanking the major arteries and their branches
Contained within a vascular sheath with the artery (pulsation of artery helps to move blood in vein)

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18
Q

Three deep veins of the leg

A
  1. Anterior tibial
  2. Medial plantar -> posterior tibial
  3. Lateral planta -> fibular
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19
Q

Where do the three deep veins of the leg drain to?

A

Popliteal vein -> femoral vein -> terminal portion of femoral vein + profunda femoris -> external iliac vein

20
Q

Describe the lymphatic drainage of the lower limb

A

Superficial:
- Lymphatics accompanying great saphenous: superficial inguinal lymph nodes -> external iliac lymph nodes (some to deep inguinal nodes)
- Lymphatics accompanying small saphenous: popliteal lymph nodes

Deep:
- From leg: popliteal lymph nodes -> deep lymphatic vessels of thigh -> deep inguinal lymph nodes -> external and common iliac lymph nodes -> lumbar lymphatic trunks

21
Q

How many nerves provide cutaneous innervation to the lower limb? List them and describe the area they innervate

A

18

  1. Superior clunial nerves: superior and central buttocks
  2. Medial clunial nerves: medial buttocks and intergluteal cleft
  3. Inferior clunial nerves: inferior buttocks (overlying gluteal fold)
  4. Lateral cutaneous branch of subcostal: hip region inferior to anterior iliac crest, anterior to greater trochanter
  5. Lateral cutaneous branch of iliohypogastric: superolateral buttocks
  6. Femoral branch of ilio-inguinal: medial femoral triangle
  7. Genitofemoral*: femoral branch supplies lateral femoral triangle, genital branch supplies anterior scrotum or labia major
  8. Lateral cutaneous nerve of thigh: anterolateral thigh
  9. Anterior cutaneous branches of femoral nerve: anteromedial thigh
  10. Cutaneous branch of obturator nerve: middle part of medial thigh
  11. Posterior cutaneous nerve of thigh: posterior thigh and popliteal fossa
  12. Saphenous nerve: medial leg and foot
  13. Superficial fibular nerve: anterolateral leg and dorsum of foot (excluding web space between 1st and 2nd toes)
  14. Deep fibular nerve: web space between 1st and 2nd toes
  15. Sural nerve: posterolateral leg and lateral margin of foot
  16. Medial plantar nerve: medial sole, and plantar aspect, sides and nail beds of medial 3.5 toes
  17. Lateral plantar nerve: lateral sole, and plantar aspect, sides and nail beds of lateral 1.5 toes
  18. Calcaneal nerves: skin of heel

*for purposes of recalls this supplies the skin over the femoral triangle

22
Q

Describe the lower limb dermatomes

A
23
Q

What four tributaries join the great saphenous vein at the saphenous opening?

A

Four veins corresponding to four cutaneous branches of femoral artery:
1. Superficial circumflex iliac
2. Superficial epigastric
3. Superficial external pudendal
4. Deep external pudendal

24
Q

Five branches of the common fibular nerve. Where and how does it terminate?

A
  1. Sural communicating nerve
  2. Lateral sural cutaneous nerve
  3. Superior genicular nerve
  4. Inferior genicular nerve
  5. Recurrent genicular nerve

Ends by dividing into deep and superficial fibular nerves in substance of peroneus longus

25
Q

Lateral rotation of hip myotome. What is this the same as?

A

L5, S1
Same as hip abduction, knee flexion, subtalar eversion, and toe extension

26
Q

Medial rotation of hip myotome. What is this the same as?

A

L4, L5
Same as hip extension, subtalar inversion, and ankle dorsiflexion

27
Q

Hip adduction myotome

A

L2, L3, L4

28
Q

Hip abduction myotome. What is this the same as?

A

L5, S1
Same as lateral rotation of hip, knee flexion, subtalar eversion, and toe extension

29
Q

Hip flexion myotome

A

L2, L3

30
Q

Hip extension myotome. What is this the same as?

A

L4, L5
Same as medial rotation of hip and subtalar inversion

31
Q

Subtalar inversion myotome. What is this the same as?

A

L4, L5
Same as medial rotation and extension of hip, and ankle dorsiflexion

32
Q

Subtalar eversion myotome. What is this the same as?

A

L5, S1
Same as lateral rotation and abduction of hip, knee flexion, and toe extension

33
Q

Toe extension myotome. What is this the same as?

A

L5, S1
Same as lateral rotation and abduction of hip, knee flexion, and subtalar eversion

34
Q

Lower limb movements with an L5, S1 myotome

A

Hip: lateral rotation, abduction
Knee flexion
Subtalar eversion
Toe extension

35
Q

Knee flexion myotome. What is this the same as?

A

L5, S1
Same as lateral rotation and abduction of hip, subtalar eversion, and toe extension

36
Q

Knee extension myotome

A

L3, L4

37
Q

Toe flexion myotome

A

S2, S3

38
Q

Ankle plantarflexion myotome

A

S1, S2

39
Q

Ankle dorsiflexion myotome. What is this the same as?

A

L4, L5
Same as medial rotation and extension of hip, and subtalar inversion

40
Q

Lower limb movements with an L4, L5 myotome

A

Hip: medial rotation, extension
Subtalar inversion
Ankle dorsiflexion

41
Q

Spinal cord segments mediating quadriceps reflex

A

L3, L4 (knee extension)

42
Q

Spinal cord segments mediating calacaneal reflex

A

S1, S2 (ankle plantarflexion)

43
Q

6 P’s of compartment syndrome

A

Pain (out of proportion)
Pallor
Poikilothermia (cold limb)
Pulselessness
Paraesthesia
Paralysis

44
Q

3 reasons great saphenous vein is often used for grafting

A
  1. Readily accessible
  2. Sufficient length can be harvested (good distance between tributaries and perforating veins)
  3. Walls contain a higher percentage of muscular and elastic fibres than other superficial veins
45
Q

Site of skin incision in saphenous cutdown

A

Anterior to medial malleolus

46
Q

What other structure is at risk during a saphenous cutdown and how can this present clinically?

A

Saphenous nerve
If cut the patient may complain of numbness to medial border of foot

47
Q

Site of injection for femoral nerve block

A

2cm inferior to inguinal ligament
Finger’s breadth lateral to femoral artery

ACEM Primary (71 decks)

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