Overview of the Lower Extremity Flashcards
1
Q
What are the Divisions of the Lower Extremity?
A
- Gluteal region
- Thigh (hip to knee)
- Popliteal fossa (posterior aspect of knee)
- Leg (knee to ankle)
- Foot (dorsal and plantar aspects)
2
Q
Describe the Bones of the lower extremity
A
- Hip bones (ilium + ischium + pubis),
- femur,
- patella,
- tibia (medial bone of leg),
- fibula (lateral bone of leg),
- 7 tarsals
- 5 metatarsals (proximal part is the base, distal part is the head),
- 14 phalanges (proximal, middle, distal; the hallux (big toe) has a proximal and distal phalanx only)
3
Q
What are the 7 tarsals?
A
- calcaneus
- talus
- navicular
- cuboid
- medial
- intermediate
- lateral cuneiforms
4
Q
What are the parts of the femur
A
- Head
- Neck
- Shaft (body) with linea aspera (on posterior surface)
- Medial and lateral femoral condyles (distal)
5
Q
What are the parts of the tibia
A
- Medial and lateral tibial condyles (proximal)
- Shaft (body)
- Medial malleolus is the distal protuberance on the medial side of the ankle
6
Q
What are the parts of the fibula
A
- Head
- Shaft (body)
- Lateral malleolus is the distal protuberance on the lateral side of the ankle
7
Q
What are the Joints and Movements of the Lower Extremity?
A
- Hip Joint –> Ball and socket synovial joint
- Knee Joint –> Hinge synovial joint
- Ankle (Talocrural) Joint –> Hinge synovial joint
- Subtalar Joint –> Synovial joint
- Metatarsophalangeal (MTP) Joints –> Synovial joints
- Interphalangeal (IP) Joints –> Hinge synovial joints
8
Q
Describe the Hip Joint connection and movement
A
- Acetabulum of the hip bone articulates with the femoral head
- Flexion reduces the angle between the thigh and trunk anteriorly
- Extension increases the angle between the thigh and trunk anteriorly
- Abduction draws the thigh away from the midline of the body
- Adduction draws the thigh towards the midline of the body
- Medial rotation femur rotates medially along its long axis
- Lateral rotation femur rotates laterally along it long axis
9
Q
Describe the knee joint connection and movement
A
- Femoral condyles articulate with the tibial condyles
- Flexion brings the leg closer to the posterior aspect of the thigh
- Extension draws the leg away from the posterior aspect of the thigh
10
Q
Describe the ankle (Talocrural) Joint connection and movement
A
- Talus articulates with distal tibia and lateral malleolus of the fibula
- Dorsiflexion brings the foot closer to the anterior aspect of the leg (directs toes superiorly)
- Plantarflexion draws the foot away from the anterior aspect of the leg (directs toes inferiorly)
11
Q
Describe the Subtalar Joint connection and movement
A
- Synovial joint between the talus and the calcaneus
- Eversion causes the sole of the foot to face laterally
- Inversion causes the sole of the foot to face medially
12
Q
Describe how the muscle/tendon units move the foot
A
Muscles will have multiple actions (e.g., dorsiflexion & inversion), depending on where their tendon passes relative to the talocrural and subtalar axes of motion.
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13
Q
- Synovial joints between the metatarsals and the proximal phalanges
- Flexion of toes (towards the ground)
- Extension of toes (away from the ground)
- Abduction (movement away from the second digit axis)
- Adduction (movement towards the second digit axis)
A
- Synovial joints between the metatarsals and the proximal phalanges
- Flexion of toes (towards the ground)
- Extension of toes (away from the ground)
- Abduction (movement away from the second digit axis)
- Adduction (movement towards the second digit axis)
14
Q
Describe the Interphalangeal (IP) Joints connection and movement
A
- Hinge synovial joints between the phalanges
- Proximal interphalangeal joints (PIPs) are located between the proximal and middle phalanges
- Distal interphalangeal joints (DIPs) are located between the middle and distal phalanges
- The hallux has a single IP joint between its proximal and distal phalanges
- Flexion of toes (towards the ground
- Extension of toes (away from the ground)
15
Q
What is the Fascia of the Lower Extremity?
A
- Superficial fascia
- Deep fascia
16
Q
Describe the Superficial fascia
A
Contains: fat, cutaneous nerves, superficial veins, lymphatic vessels and lymph nodes
17
Q
Describe the Deep fascia
A
- Dense connective tissue
- Invests the lower extremity muscles like an elastic stocking; prevents muscles from bulging during contraction; efficient mechanism to pump blood back to the heart
18
Q
What is the Deep fascia of the thigh called?
A
Fascia lata
19
Q
What is the Deep fascia of the leg called?
A
Crural fascia
20
Q
Describe the attachment of the Fascia lata
A
-Firmly attached to pubis, inguinal ligament, iliac crest, sacrum, coccyx, and ischial tuberosity
21
Q
Oval shaped window in the fascia lata is the _______
A
-Saphenous opening: it is located just inferior to the inguinal ligament –> the great saphenous vein and associated lymphatic vessels pass through this opening
22
Q
Lateral thickening of fascia lata is the ___________
A
Iliotibial tract (or band)
23
Q
What septa arise from the fascia lata?
A
- 3 intermuscular septa arise from the fascia lata and attach to the linea aspera of the femur
- These septa divide the thigh into 3 compartments: anterior, posterior, and medial
24
Q
What septa arise from the Crural fascia?
A
- Continuous with fascia lata
- 2 intermuscular septa arise from the crural fascia and attach to the fibula
- These septa (along with the interosseous membrane between the tibia and fibula) divide the leg into 3 compartments: anterior, posterior, and lateral
- Another septum separates the posterior compartment into superficial and deep layers
- Near the ankle joint, the deep fascia forms extensor, flexor, and fibular retinacula; these bands keep tendons in place around the ankle joint
25
What are the Veins of the Lower Extremity?
- Superficial and deep veins in the lower extremity
- Perforating veins
-These veins all have valves, but the valves are more numerous in the deep veins
26
What are the superficial veins?
- Great saphenous vein
| - Small saphenous vein
27
Describe the location of the Great saphenous vein?
- Arises from dorsal aspect of the foot
- Passes anterior to the medial malleolus
- Ascends along the medial aspect of the leg and thigh
- Enters the saphenous opening in the fascia lata
- Drains into the femoral vein
- Receives numerous tributaries as it ascends, and anastomoses with the small saphenous vein
28
Describe the saphenous cut down procedure
- The great saphenous vein can be accessed anterior to the medial malleolus to administer medications, fluids, etc.
- The procedure is effective even in infants, obese and dehydrated patients (with collapsed veins).
29
What is the Great saphenous vein used for surgically? Why is THAT vein used?
-Can be used in coronary bypass surgery
- (a) the vein is superficial and easily accessible;
- (b) the wall of the great saphenous vein contains a high percentage of muscular and elastic fibers; and
- (c) the vein is long, with long distances between tributaries (easy to harvest usable lengths)
30
Describe the Small saphenous vein
- Arises from lateral side of foot
- Passes posterior to the lateral malleolus of the ankle
- Enters popliteal fossa and drains into popliteal vein
31
Describe the Perforating veins
- Connect the superficial and deep veins
| - Contain valves that allow blood to flow only from sf deep veins
32
Describe the Musculovenous pump
- When muscles contract, blood in the deep veins is propelled to the femoral and then external iliac veins (musculovenous pump)
- Valves in deep veins prevent reflux of blood inferiorly
- Valves in the perforating veins prevent reflux of blood from the deep to superficial veins
33
When do Varicose veins occur?
- When valves in the perforating veins become incompetent, allowing large amounts of blood to reflux from the deep to the superficial veins.
- The superficial veins become distended as they receive this large volume of blood.
34
Describe Lymphatics of the Lower Extremity (Gluteal Region)
- Lymph from superficial tissues of the gluteal region --> superficial inguinal lymph nodes --> external iliac lymph nodes
- Lymph from deep tissues of the gluteal region --> superior and inferior gluteal lymph nodes --> internal iliac lymph nodes
35
Describe SUPERFICIAL Lymphatics of the Lower Extremity (Thigh, Leg, and Foot)
- Superficial lymphatic vessels accompanying the great saphenous vein drain into the superficial inguinal lymph nodes
- Superficial lymphatic vessels accompanying the small saphenous vein drain into the popliteal lymph nodes --> deep inguinal lymph nodes
- Both superficial and deep inguinal lymph nodes drain into the external iliac nodes
36
Describe DEEP Lymphatics of the Lower Extremity (Thigh, Leg, and Foot)
- Deep lymphatic vessels accompany the deep veins (e.g., popliteal, femoral) and drain into deep inguinal lymph nodes located medial to the femoral vein
- Both superficial and deep inguinal lymph nodes drain into the external iliac nodes
37
What are the Dermatomes of the Lower Extremity?
-You are responsible for knowing the dermatome map shown in C and D; however, there is a great deal of overlap between adjacent spinal nerve territories. In addition, please note that other maps (e.g., E, F) may be used by some clinicians.
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