Review of the Lower Limb Anatomy

Question 1

What are the hip ligaments?

Answer 1

• pubo-femoral ligament
• ischio-femoral ligament (posterior)
• ligamentum teres (femoral head to acetabulum)
• ilio-femoral ligament

Question 2

What is Shenton’s line?

Answer 2

• inferior border of superior pubic ramus along inferomedial border of neck of femur
• if not smooth = indicates femoral neck fracture

Question 3

What is special about the ilio-femoral ligament?

Answer 3

• largest and strongest

- anteriorly so posterior is weaker = hip tends to dislocate posteriorly

Question 4

What are the fibres of the ligaments?

Answer 4

• straight = most movable in flexion

- twisted = most stable in extension

Question 5

How does the femoral artery supply the hip?

Answer 5

• profunda femoris
• to femoral head, neck, trochanters
• medial to femur
• gives off lateral and medial circumflex arteries

Question 6

How does the obturator artery supply the hip?

Answer 6

• artery to the head of the femur

- important in development but loses function in adults

Question 7

How can femoral fracture result in avascular necrosis?

Answer 7

• if fracture is high enough can cut off circumflex arteries

Question 8

Where should the gluteal intramuscular injection be placed?

Answer 8

• in upper outer quadrant

- due to vast number of structures in gluteal region

Question 9

What are the ligaments of the gluteal region?

Answer 9

• sacrospinous

- sacrotuberous

Question 10

What passes through the greater sciatic foramen?

Answer 10

• sciatic nerve
• piriformis
• pudendal nerve
• superior and inferior gluteal neurovascular bundle

Question 11

What passes through the lesser sciatic foramen?

Answer 11

• pudendal nerve

- tendon of obturator internus

Question 12

What are the 3 gluteal muscles?

Answer 12

• gluteal maximus
• gluteal medius
• gluteal minimus

Question 13

What is the action of the gluteal muscles?

Answer 13

• gluteus maximus = hip extension, hip lateral rotator/abduction
• gluteus medius = abduction hip/leg stabilising pelvis
• gluteus minimus = abduction of hip/leg stabilising pelvis

Question 14

What is the innervation of the gluteal muscles?

Answer 14

• gluteal maximus = inferior gluteal nerve
• gluteal medius = superior gluteal nerve
• gluteal minimus = superior gluteal nerve

Question 15

Where does the gluteus maximus insert on?

Answer 15

• onto gluteal tuberosity of the femur

Question 16

What are the lateral rotators apart from the gluteal muscles?

Answer 16

• piriformis

- nerve supply is L5-S2

Question 17

What is the Trendelenburg test?

Answer 17

• tests superior gluteal nerve

- stand on 1 leg and opposite side droops as affected

Question 18

What is the function of the anterior compartment?

Answer 18

• hip flexion

- knee extension

Question 19

What innervates the anterior compartment?

Answer 19

• femoral nerve

Question 20

What are the muscles of the anterior compartment?

Answer 20

• iliopsoas
• rectus femoris
• sartorius
• pectineus

Question 21

What are the attachments of the muscles of the anterior compartment?

Answer 21

• iliopsoas (spine to lesser trochanter)
• rectus femoris (from AIIS)
• sartorius (ASIS to tibia)
• pectineus (pubis to femur)

Question 22

What is the function of the medial compartment?

Answer 22

• hip adduction

Question 23

What is the innervation of the medial compartment?

Answer 23

• obturator nerve

apart from hamstring portion of adductor magnus

Question 24

Where do the muscles of the medial compartment attach?

Answer 24

• to the pelvis distally to linea asperea

Question 25

What are the muscles of the medial compartment?

Answer 25

- adductor magnus - adductor longus - adductor brevis - gracilis

Question 26

What is the function of the posterior compartment?

Answer 26

- hip extension | - knee flexion

Question 27

What is the innervation of the posterior compartment?

Answer 27

- tibia division of the sciatic nerve

Question 28

Where do the hamstrings originate?

Answer 28

ischial tuberosity distally attach on tibia therefore act to flex the knee joint

Question 29

What are the muscles of the posterior compartment?

Answer 29

- semitendinosus - semimembranosus - biceps femoris (long head)

Question 30

What is the pes anserinus?

Answer 30

- insertion of sartorius, gracilis, semitendinosus

Question 31

What are the boundaries of the femoral triangle?

Answer 31

- inguinal ligament - sartorius - adductor longus

Question 32

What does the femoral triangle contain?

Answer 32

NAVEL

Question 33

What passes through the adductor hiatus?

Answer 33

- femoral artery | - then becomes popliteal artery

Question 34

What is the largest joint in the body?

Answer 34

- knee

Question 35

What are the 3 articulations of the knee joint?

Answer 35

- lateral femoral and tibial condyles with corresponding meniscus - medial formal and tibial condyles with corresponding meniscus - patella and femur

Question 36

What does the stability of the knee depend on?

Answer 36

- strength and action of surrounding muscles and tendons | - ligaments connecting femur and tibia

Question 37

What are the collateral ligaments of the knee?

Answer 37

- fibular (lateral) = not attached to joint capsule | - tibial (medial) = thickening of joint capsule

Question 38

What is the function of the posterior cruciate ligament?

Answer 38

- stops tibia moving backward on femur - helps stabilise knee in flexion - prevents tibia externally rotating - stronger than ACL - prevents femur sliding anteriorly on tibia - rupture = posterior drawer sign

Question 39

What is the function of the ACL?

Answer 39

- stops tibia moving forward on femur - helps stabilise knee in extension - prevents hyperextension and excessive internal rotation - prevents femur sliding posterior on tibia - rupture = anterior drawer sign

Question 40

What are the features of the medial meniscus of the knee?

Answer 40

- C shaped - broader posteriorly than anteriorly - anteriorly attached to ACL - firmly adhered to tibial collateral ligament

Question 41

What are the features of the lateral meniscus of the knee?

Answer 41

- nearly circular - smaller and more freely movable than medial - attached to PCL

Question 42

What does the popliteal fossa contain?

Answer 42

- popliteal artery (media) - popliteal vein - tibial nerve (lateral) into common peroneal nerve and sural nerve

Question 43

What are the 3 compartments of the leg?

Answer 43

- anterior compartment - posterior compartment - lateral compartment

Question 44

What is the function of the leg anterior compartment, nerve supply and blood supply?

Answer 44

- dorsiflexion and extension of digits - deep peroneal nerve - anterior tibial artery

Question 45

What is the function of the leg posterior compartment, nerve supply and blood supply?

Answer 45

- plantarflexion and flexion of digits - tibial nerve - posterior tibial artery

Question 46

What is the function of the leg lateral compartment, nerve supply and blood supply?

Answer 46

- eversion - superficial peroneal nerve - fibular artery

Question 47

What is the popliteal artery divisions?

Answer 47

- anterior tibial - dorsalis pedis - deep peroneal perforating branches - posterior tibial - medial and lateral plantar

Question 48

What does the sciatic nerve divide into?

Answer 48

- tibial nerve | - common peroneal

Question 49

What compartments does the tibial nerve supply?

Answer 49

- superficial posterior compartment (calf muscles, ankle plantar flexors) - deep posterior compartment (plantar flexors of the foot)

Question 50

What does the common peroneal nerve supply?

Answer 50

- superficial peroneal nerve (lateral compartment, eversion) | - deep peroneal nerve (anterior compartment, dorsiflexion)

Question 51

What type of joint is the ankle joint?

Answer 51

- hinge joint

Question 52

What makes up the ankle joint?

Answer 52

- tibia, fibula, talus bones

Question 53

What is the ankle reinforced by laterally?

Answer 53

- anterior talofibular ligament - posterior talofibular ligament - calcaneofibular ligament

Question 54

What is the ankle reinforced by medially?

Answer 54

- deltoid ligament