Week 3 Flashcards
(495 cards)
1
Q
What is the Pelvic Girdle?
A
Circular structure that attaches the lower limb to axial skeleton.
2
Q
What makes up the Pelvic Girdle?
A
Sacrum + hip bones
3
Q
What does the lower limb consist of?
A
Thigh (femur), knee (patella), leg (tibia and fibula), ankle, and foot.
4
Q
Relative to the glenohumeral joint, is the hip joint more towards the spectrum of mobility or stability?
A
The hip joint is more towards stability, whereas the glenohumeral joint is more mobility less stability.
5
Q
What are other names for the hip bone?
A
Os coxae
Coxal bone
Pelvic bone
Pelvis
6
Q
What 3 bones make up the pelvis?
A
Ilium, Ischium, and Pubis
7
Q
T/F: Right when we are born, our ilium, ischium, and pubis have fused to become the pelvis.
A
False! The ilium, ischium, and pubis fuse between 20 and 25 years old.
8
Q
T/F: Once the ilium, ischium, and pubis bones fuse, we only collectively refer to it as the pelvis and no longer acknowledge that names.
A
False! Even when the bones fuse, we retain the separate names to regions of the coxal bones.
9
Q
Before fusion of the ilium, ischium, and pubis, what separates the bones?
A
Triradiate Cartilage (Y-Shaped)
10
Q
Where is the fusion of the ilium, ischium, and pubis (triradiate cartilage) centered on?
A
Fusion is centered on the acetabulum.
11
Q
What and where is Obturator Foramen?
A
Obturator Foramen is the hole located in the pelvis anteromedially to the acetabulum.
12
Q
Name the 3 ligaments of the pelvis.
A
Sacrotuberous ligament
Sacrospinous ligament
Posterior sacro-iliac ligament
13
Q
Where does the sacrotuberous ligament span? Is this superficial or deep?
A
Sacrum to the ischial tuberosity
Superficial ligament
14
Q
What does the sacrospinous ligament span? Is this superficial or deep?
A
Sacrum to ischial spine
Deep ligament
15
Q
What ligaments create the greater and lesser sciatic foramina?
A
Sacrotuberous and sacrospinous ligaments.
16
Q
Where does the posterior sacro-iliac ligament span? What is it continuous with?
A
Sacrum to ilium.
It is continuous with the sacrotuberous ligament inferiorly.
17
Q
What is the Obturator Membrane?
A
A sheet of connective tissue that covers the majority of the obturator foramen.
18
Q
What is the Greater Sciatic Foramen?
A
A hole/passageway for structures entering or leaving the pelvis.
19
Q
What is the Lesser Sciatic Foramen?
A
A hole/passageway for structures entering or leaving the perineum.
20
Q
Where is the Perineum region located?
A
Between the anus and urethra.
21
Q
“Door through which all lower limb arteries and nerves leave the pelvis.”
What structure is this describing?
A
Greater sciatic foramen
22
Q
Which sciatic foramina does the sciatic nerve travel through?
A
Greater sciatic foramen
23
Q
Which sciatic foramina does the pudendal nerve travel through?
A
Lesser sciatic foramen
24
Q
What vertebrae are the level of the iliac crests at?
A
Around L4-5 vertebrae
25
Why would the level of the iliac crests serve as a good landmark for an epidural or puncture?
It is around L4-5 vertebrae, which is distal to the end of the spinal cord (around L2).
26
Name the nerve, artery, and vein associated with the Gluteus Maximus.
Inferior gluteal nerve, artery, vein
27
Name the nerve, artery, and vein associated with the Tensor Fascia Lata.
Superior gluteal nerve, artery, vein
28
Name the nerve, artery, and vein associated with the Gluteus Medius.
Superior gluteal nerve, artery, vein
29
Name the nerve, artery, and vein associated with the Gluteus Minimus.
Superior gluteal nerve, artery, vein
30
What innervates Piriformis?
S1-S2 ventral nerve roots
31
What is the blood supply/drainage of Piriformis?
Inferior gluteal artery and vein
32
What innervates Superior Gemellus?
Nerve to obturator internus
33
What is the blood supply/drainage to Superior Gemellus?
Inferior gluteal artery and vein
34
What innervates Obturator Internus?
Nerve to obturator internus
35
What is the blood supply/drainage to Obturator Internus?
Inferior gluteal artery and vein
36
What innervates Inferior Gemellus?
Nerve to Quadratus Femoris
37
What is the blood supply/drainage to Inferior Gemellus?
Inferior gluteal artery and vein
38
What innervates Quadratus Femoris?
Nerve to quadratus femoris
39
What is the blood supply/drainage to Quadratus Femoris?
Inferior gluteal artery and vein
40
What is the proximal attachment of Tensor Fasciae Latae (TFL)?
ASIS and iliac crest
41
What is the distal attachment of Tensor Fasciae Latae (TFL)?
Iliotibial tract (IT), Gerdy's tubercle (anterolateral tibial tubercle)
42
What are the actions of Tensor Fasciae Latae (TFL)?
Hip flexion, abduction, and medial/internal rotation.
43
What innervates Tensor Fasciae Latae (TFL)?
Superior gluteal nerve
44
What is the proximal attachment of Gluteus Maximus?
Ilium, sacrum, sacrotuberous ligament
45
What is the distal attachment of Gluteus Maximus?
Iliotibial tract
46
What are the actions of Gluteus Maximus?
Main extensor of the thigh on trunk (does a good job of extending from a flexed position). Also assists with lateral rotation.
47
What innervates Gluteus Maximus?
Inferior gluteal nerve
48
What is the proximal attachment of Gluteus Medius?
Ala of ilium
49
What is the distal attachment of Gluteus Medius?
Greater trochanter (lateral surface)
50
What are the actions of Gluteus Medius?
Hip abduction and medial/internal rotation
51
T/F: During walking, we are not performing any hip abduction or internal/medial rotation, thus, glute medius is not important for walking.
False! Gluteus Medius is extremely important for walking. We DO perform hip abduction and medial/internal rotation with every step we take.
52
What innervates Gluteus Medius?
Superior gluteal nerve
53
What is the proximal attachment of Gluteus Minimus?
Ala of ilium
54
What is the distal attachment of Gluteus Minimus?
Greater trochater (anterolateral surface)
55
What are the actions of Gluteus Minimus?
Hip abduction and medial/internal rotation
56
What innervates Gluteus Minimus?
Superior gluteal nerve
57
What two muscles does the Superior Gluteal Nerve sit between? What also runs with this nerve between these muscles?
The Superior Gluteal Nerve sits between Gluteus Medius and Minimus.
The Superior Gluteal Artery runs with it in this area as well.
58
What is the proximal attachment of Piriformis?
Sacrum
59
What is the distal attachment of Piriformis?
Greater trochanter (apex)
60
What are the actions of Piriformis?
Lateral rotation of hip and abduction
61
What innervates Piriformis?
S1-S2 roots
62
Why is the Piriformis muscle an important landmark?
The names of nerves, arteries, and veins, in regards to "superior" or "inferior", are named based on their relation to/where they come out in relation to the Piriformis muscle.
63
What actions are muscles inferior to Piriformis generally performing?
Generally performing lateral rotation and a little bit of abduction.
64
What is the proximal attachment of Superior Gemellus?
Ischial spine
65
What is the distal attachment of Superior Gemellus?
Greater trochanter (medial surface)
66
What is the action of Superior Gemellus?
Lateral rotation of hip
67
What innervates Superior Gemellus?
Nerve to obturator internus
68
What is the proximal attachment of Obturator Internus?
Obturator membrane
69
What is the distal attachment of Obturator Internus?
Greater trochanter (medial surface)
70
What is the action of Obturator Internus?
Lateral rotation of hip
71
What innervates Obturator Internus?
Nerve to obturator internus
72
What is the proximal attachment of Inferior Gemellus?
Ischial tuberosity
73
What is the distal attachment of Inferior Gemellus?
Greater trochanter
74
What is the action of Inferior Gemellus?
Lateral rotation of hip
75
What innervates Inferior Gemellus?
Nerve to quadratus femoris
76
What is the proximal attachment of Quadratus Femoris?
Ischial tuberosity
77
What is the distal attachment of Quadratus Femoris?
Intertrochanteric crest of femur
78
What is the action of Quadratus Femoris?
Lateral rotation of hip
79
What innervates Quadratus Femoris?
Nerve to quadratus femoris
80
Name the 3 bursa of the gluteal region.
Trochanteric bursa
Gluteofemoral bursa
Ischial bursa
81
Where is the Trochanteric bursa located?
Greater trochanter
82
How does Trochanteric Bursitis occur?
Can get inflamed from friction with IT band during walking.
83
Where is the Gluteofemoral bursa located?
Femur
84
Where is the Ischial bursa located?
Ischial tuberosity
85
What activity would the Ischial bursa get inflamed with?
Cycling (sitting while moving OUCH!)
86
What are the Clunial Nerves?
Cutaneous innervation to the buttocks.
87
Where do the Superior Clunial Nerves come from?
Posterior rami L1-L3
88
Where do the Middle Clunial Nerves come from?
Posterior rami S1-S3
89
Where do the Inferior Clunial Nerves come from?
Anterior rami S2-S3 via the posterior cutaneous nerve of the thigh
90
Arterial supply to the gluteal region arises directly (or indirectly) from which arteries?
Internal iliac arteries
91
What artery does the internal iliac artery come from?
Common iliac artery
92
Name the branches of the internal iliac arteries that supply the gluteal region.
Superior gluteal artery
Inferior gluteal artery
Internal pudendal artery
93
What does the Internal Pudendal Artery run with?
Pudendal Nerve
94
Describe the location of the Superior Gluteal Artery.
Comes out above the Piriformis and runs in between Gluteus Medius and Minimus.
95
Describe the location of the Inferior Gluteal Artery.
Comes out inferior to the Piriformis.
96
Describe the location of the Internal Pudendal Artery.
Comes out inferior to the piriformis. Comes from the greater sciatic foramen and courses back through the lesser sciatic foramen
97
What arteries pass through the greater sciatic foramen?
Superior gluteal artery, inferior gluteal artery, and internal pudendal artery.
98
Describe the location of Superior Gluteal Nerve.
Runs with Superior Gluteal artery in between Gluteus Medius and Minimus.
99
Describe the location of the Inferior Gluteal Nerve.
Runs with Inferior Gluteal artery superficial to the Sciatic Nerve.
100
What does the Inferior Gluteal Nerve "go into"?
Goes into the Gluteus Maximus.
101
Describe the location of the Pudendal Nerve.
Runs with Internal Pudendal artery. It is the MOST MEDIAL structure to enter the pelvis through the greater sciatic foramen.
102
What is the most medial structure to enter the pelvis through the greater sciatic foramen?
Pudendal nerve
103
Relative to the Piriformis muscle, where is the Sciatic Nerve located?
Inferior to the piriformis
104
What nerve does almost all of the innervation of the leg and foot?
Sciatic nerve
105
A patient presents to the clinic with numbness, tingling, and radiating pain down the posterior leg and foot. What structure should we first think of?
Sciatic nerve
106
Relative to the Sciatic Nerve, where is the posterior cutaneous nerve of the thigh located?
Just medial to the sciatic nerve
107
The nerve to obturator internus runs close to the _______________ nerve.
pudendal
108
T/F: The Angle of Inclination does not pertain to any importance for walking.
False! The Angle of Inclination is super important for our ability to walk normally.
109
What is the Angle of Inclination?
It is the bending or angling of the femur that happens at the head.
110
What happens to the Angle of Inclination as we age?
Angle decreases with age
111
How is the Angle of Inclination in females different compared to males?
Angle is less in females due to wider hips from birth canal.
112
T/F: Bending of the femur is a medially-driven driver.
False! Bending of the femur = laterally-driven drive
113
What do we mean when we say the angle of inclination is a laterally-driven driver?
Short muscles that attach to the proximal femur are able to create large movements. Angle of Inclination allows for all abductions and medial & lateral rotators to be located superiorly in the gluteal region (instead of medially or laterally to the actual joint).
114
Which muscle is the Lesser Trochanter of the Femur a primary site for?
Primary site for the iliopsoas, which is a flexor of the thigh
115
Which muscle type is the Greater Trochanter of the Femur a primary site for?
Primary site of attachment for aBductors and rotators of the thigh which originate in the gluteal region.
116
Name the 5 lateral rotators (beginning under the piriformis).
Gemellus superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus femoris
117
As we walk, describe what the lateral and medial rotators are doing.
These short muscles pull the head of the femur towards the acetabulum, which stabilizes the hip joint.
118
In walking, the same muscles that help to medially rotate the hip (or advance the foot forward), also help to do what?
Also help to abduct the hip to prevent hip drop and thus allowing enough clearance of the toe during a step.
119
In walking, what do the lateral rotators of the advancing free limb do?
The lateral rotators of the advancing free limb act during the swing phase of gait to keep the foot parallel to the direction of advancement.
120
T/F: When walking, lateral rotation occurs on your planted foot.
False! When walking, medial rotation occurs on your planted foot.
121
T/F: When walking, the medial rotation occurs by the posterior placed leg that is starting its forward movement.
False! This is lateral rotation that occurs by the posterior placed leg that is starting its forward movement.
122
When walking, you start by ______________ rotating your leg, then bering it forward and ______________ rotating towards the end of the step.
laterally; medially
123
What are the 3 compartments of the thigh?
Anterior, medial, and posterior compartments.
124
What structure creates the 3 compartments of the thigh? How does this then pertain to the IT band?
Fascia lata creates the compartments.
The IT band is essentially just a thickened part of the fascia lata.
125
What muscles are found within the anterior compartment of the thigh?
Quadriceps Femoris
Pectineus
Sartorius
Iliopsoas
126
What muscles are found within the medial compartment of the thigh?
Obturator externus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
127
What is the anterior compartment of the thigh innervated by? What muscle is the exception to this?
Anterior compartment of the thigh is innervated by the femoral nerve.
The iliopsoas is the exception to this and is innervated by L1/L2 and femoral nerve.
128
What is the medial compartment of the thigh innervated by? What muscle is the exception to this?
Medial compartment of the thigh is innervated by the Obturator Nerve.
Pectineus muscle is the exception to this and is innervated by both the Obturator and Femoral Nerve.
129
What muscles are found within the Posterior Compartment of the Thigh?
Semimembranosus
Semitendinosus
Long head biceps femoris
Short head biceps femoris
130
What innervates the posterior compartment of the thigh?
Sciatic Nerve
131
What is the proximal attachment of the long head of Biceps Femoris?
Ischial tuberosity
132
What is the distal attachment of the Biceps Femoris (both heads)?
Head of fibula
133
What is the proximal attachment of the short head of Biceps Femoris?
Shaft of femur
134
What are the actions of the long head of Biceps Femoris?
Extends hip, flexes and rotates knee
135
What are the actions of the short head of Biceps Femoris?
Flex and rotate knee
136
What innervates the long head of Biceps Femoris?
Sciatic nerve and tibial division
137
What innervates the short head of Biceps Femoris?
Sciatic nerve and fibular division
138
What nerve do the tibial and fibular divisions come from?
Sciatic nerve splits into the tibial division and fibular division.
139
What is the proximal attachment of Semitendinosus?
Ischial tuberosity
140
What is the distal attachment of Semitendinosus?
Pes anserinus (at medial side of knee)
141
What are the actions of Semitendinosus?
Extends hip, flexes and rotates knee
142
What innervates Semitendinosus?
Sciatic nerve, tibial division
143
What is the proximal attachment of Semimembranosus?
Ischial tuberosity
144
What is the distal attachment of Semimembranosus?
Medial condyle of tibia (posterior surface)
145
What are the actions of Semimembranosus?
Hip extension, flexes and rotates knee
146
What innervates Semimembranosus?
Sciatic nerve tibial division
147
3 out of 4 posterior thigh muscles have a proximal attachment to ischial tuberosity.
3 out of 4 posterior thigh muscles are innervated by the tibial division of the sciatic nerve.
What is the 1 exception to both of these?
The exception to both is the short head of biceps femoris (this is why it is sometimes considered a separate muscle).
148
What nerve roots does the lateral cutaneous nerve of the thigh come from?
L2-3
149
What nerve root does the posterior cutaneous nerve of the thigh come from?
S2
150
What is the difference between a dermatome versus cutaneous nerve innervation?
Dermatome is a way of mapping out what nerve roots are supposed to innervate which parts of the skin.
Cutaneous nerves are SPECIFIC nerves that are real and we can see in front of us.
151
Where does the Sciatic Nerve split into the Tibial and Fibular division?
Typically splits at the level of the adductor hiatus.
We say typically because there is generally variation in where the split occurs.
152
Generally speaking, what is the Sural nerve? Where does it start being visualized?
Provides cutaneous innervation to the lower leg.
Sural nerve starts distally in the posterior thigh.
153
What nerves make up the innervation of the posterior thigh?
Sciatic nerve (tibial and fibular division)
Posterior cutaneous nerve of the thigh
Sural nerve
154
What is the MAJOR nerve of the posterior thigh and leg?
Sciatic nerve
155
What nerve roots does the Tibial division of the Sciatic nerve come from?
L4-S3
156
What areas does the tibial division of the sciatic nerve innervate?
Posterior thigh muscles (except short head of biceps femoris)
Posterior leg
Sole
157
What areas does the fibular division of the sciatic nerve innervate?
Posterior thigh (ONLY short head of biceps femoris)
Anterior and lateral leg
Dorsum of foot
158
What does the Femoral Artery become? Where does this happen at?
The Femoral Artery becomes the Popliteal Artery once it passes through the Adductor Hiatus.
159
What does the Profunda Femoris Artery give off? What does this wrap around?
The Profunda Femoris Artery gives off perforating arteries that wrap around the femur.
160
Generally speaking, what is bursitis?
Inflammation of a bursa sac.
161
What activities are the most common causes of trochanteric bursitis?
Stair climbing and elevated treadmill walking.
This is due to these activities requiring more flexion and extension of the gluteus maximus.
162
If a patient has pain along the IT tract, what bursitis could we assume is present?
Trochanteric bursitis
163
What is the most common cause of Ischial bursitis?
Cycling
"sitting movements"
164
What is Piriformis Syndrome?
This is a variation of the Sciatic Nerve in which the Sciatic Nerve pierces the Piriformis muscle. Thus, when the Piriformis muscle contracts, it squeezes the Sciatic Nerve.
165
Generally, what percentage of people have Piriformis Syndrome?
12% of people
166
A decreased angle of inclination would be "_________-_________."
knock-kneed
167
An increased angle of inclination would be "________-____________."
bow-legged
168
What nerve would the Trendelenburg Sign be testing for?
Testing for Superior Gluteal Nerve injury
169
With a positive Trendelenburg Sign, what muscles are not working adequately?
Gluteus medius and minimus
170
Describe what a Trendelenburg Sign looks like when walking both on the injured side and on the uninjured side.
With a step on the injured hip, the hip rises on the injured side. The opposite (uninjured) hip lowers with foot in air.
With a step on the uninjured hip, both the right and left hip stay level.
171
With a Trendelenburg Sign, which leg is the one doing the weird walking: healthy or unhealthy leg?
The healthy leg is the one doing the weird walking.
172
With Trendelenburg Sign, patients lean to _____________ side to have _________________ foot clear the ground during circumduction.
ipsilateral; contralateral
173
With Trendelenburg Sign, as the pelvis drops on the unsupported side, the healthy limb becomes "________ ___________."
too long
174
What does the drop of the pelvis on the unsupported side in a Trendelenburg Sign result in?
Leaning away from the unsupported side (waddling/gluteal gait)
Lifting the foot higher as it is brought forward (steppage gait)
Swining the foot outward/laterally (swing-out gait)
175
What type of people would we find the Trendelenburg Sign in?
Found in people with weak or paralyzed abductor muscles of the hip, namely gluteus medius and minimus.
Could also be an avulsion fracture of the greater trochanter.
176
Why is the gluteus medius important when walking?
It is very important during the STANCE phase of the gait cycle to maintain both hips at the same level.
177
What percentage of the gait cycle is accounted for by one-leg stance?
About 60%
178
With the Trendelenburg Sign, what hip raises?
The injured hip raises
179
What are two quadrants on the gluteal region we can perform intragluteal injections?
Superolateral quadrant
Anterolateral quadrant
180
Where is the Superlateral quadrant of the gluteal region?
Above a line from the PSIS to the greater trochanter
181
Where is the Anterolateral quadrant of the gluteal region?
Spread fingers and index finger goes on ASIS; inject in between middle and index fingers.
182
Hamstring injuries are _________ as common as quad strains.
twice
183
Why are hamstring injuries twice as common as quad strains?
The more joints a muscle crosses, the easier the muscle is to injure.
184
The more joints a muscle crosses, the ______________ the muscle is to injure.
easier
185
What type of activities usually result in a hamstring injury?
Kicking, jumping, and running hard, especially without warming up.
186
Which of the hamstring muscles would a hamstring injury be more common in?
Biceps femoris (two joint muscles)
187
What is the Femoral Triangle?
A region at the proximal anterior thigh where main blood vessels and a nerve pass between the pelvis and lower limb.
188
What are the borders of the Femoral Triangle (medial, lateral, superior, floor, roof)?
Medial: Lateral margin of adductor longus
Lateral: Median margin of sartorious
Superior: Inguinal ligament
Floor: Iliopsoas and Pectineus
Roof: Fascia Lata
189
What are the contents of the Femoral Triangle? Name them from lateral to medial.
Which are contained within the femoral sheath?
From lateral to medial:
Femoral Nerve
Femoral Artery
Femoral Vein
Lymphatics
NAVL
Artery, vein, and lymphatics are contained within the femoral sheath.
190
What structures are found within the femoral sheath?
Femoral artery, femoral vein, and lymphatics
191
What is the femoral sheath a continuation of?
Continuation of the transversalis fascia (the fascia surrounding the abdomen muscles).
192
Why is the femoral sheath important for the structures within it?
It allows the femoral artery, femoral vein, and lymphatics to be protected and glide under the inguinal ligament without getting stuck.
193
What is the opening of the femoral canal called?
Femoral ring
194
Name the 3 compartments of the femoral sheath and what each contains.
Lateral compartment: Femoral Artery
Middle compartment: Femoral vein
Medial compartment: Femoral canal (mainly lymphatics and fat).
195
What is the superficial fascia of the thigh continuous with?
Continuous with the superficial fascia of antero-lateral abdominal wall and the gluteal region.
196
Deep to the skin and superficial fascia, what does the fascia of the thigh consist of?
Loose connective tissue
Fat (varying amounts)
Cutaneous nerves
Superficial veins
Lymphatics
197
What is the deep fascia of the thigh called?
Fascia Lata
198
What is the Fascia Lata?
Dense connective tissue encircling the thigh.
199
Deep fascia have investing septa. What is this and what does it do?
Investing septa is where the deep fascia dives deep to connect to the bone.
This divides the leg into compartments.
200
What is the fascia lata continuous with superiorly and inferiorly?
Continuous with inguinal ligament superiorly.
Continuous with crural fascia inferiorly.
201
What is the Iliotibial Tract?
Strong, thickened lateral portion of fascia lata.
202
What are the proximal attachments of the IT band?
Gluteus maximus and TFL
203
What is the distal attachment of the IT band?
Lateral (Gerdy's) tubercle of tibia.
204
What is the Saphenous Hiatus and what does it allow?
A hole in the fascia lata that allows the great saphenous vein to enter the deep compartment of the leg and drain into the femoral vein.
205
What is the longest vein in the body?
Great saphenous vein
206
What does the Great Saphenous Vein do?
Ultimately drains cutaneous venous blood from much of the leg back to the femoral vein.
207
The Great Saphenous Vein is commonly used for coronary artery bypass. Why is this?
The vein is comprised of more muscular tissue, making it a great artificial artery. When we take the vein and use it to become an artery, we just flip it around so the valves stop working in the case of an artery.
208
What forms the great saphenous vein in the foot?
Formed by the union of the dorsal vein of the great toe and the dorsal venous arch of the foot.
209
If you place your hand on the medial border of the patella, what would be found on your posterolateral hand inside the body?
Great saphenous vein
210
T/F: The great saphenous vein is located laterally in the foot. The small saphenous vein is located medially in the foot.
False! The Great Saphenous Vein is located medially, and the Small Saphenous Vein is located laterally in the foot.
211
What is the Small Saphenous Vein formed from in the foot?
From the union of the dorsal vein of the little toe with the dorsal venous arch.
212
What does the Small Saphenous Vein empty into? Where does this occur?
Empties into the popliteal vein in the popliteal fossa.
213
What do deep veins accompany?
Deep veins accompany all major arteries.
214
Generally (idiotically speaking), what do deep veins of the lower limb do?
Drain blood from the thigh muscles
215
Where do deep veins of the lower limb terminate? What do they join?
Deep veins of the lower limb terminate in the deep vein of the thigh and then join the Femoral vein.
216
What do Perforating Veins do? How does this happen?
Perforating veins connect superficial and deep veins by continuously shunting blood from superficial to deep veins.
This happens because perforating veins have valves allowing ONLY flow from superficial to deep veins.
217
What type of fascia do perforating veins pass through?
Deep fascia
218
What structure compresses deep veins?
Deep veins are compressed by deep fascia, which acts as compression stockings.
219
Why would compression of the deep veins via deep fascia be important?
Compression of the deep veins prevents flow of blood from deep to superficial and enables muscular contractions to propel blood towards the heart.
220
What divides the muscle compartments of the thigh?
Intermuscular septa
221
What type of muscles are found in the anterior compartment of the thigh?
Muscles that flex at hip and extend at knee.
222
What are the anterior compartment thigh muscles innervated by?
Innervated primarily by the femoral nerve.
223
What type of muscles are found in the medial compartment of the thigh?
Muscles that adduct the thigh at the hip.
224
What are the medial compartment thigh muscles innervated by?
Innervated mainly by the obturator nerve.
225
What type of muscles are found in the posterior compartment of the thigh?
Muscles that extend at hip and flex the knee.
226
What are the posterior compartment thigh muscles innervated by?
Innervated by the sciatic nerve.
227
The majority of the anterior compartment thigh muscles are innervated by the femoral nerve. What is the 1 EXCEPTION to this?
Pectineus muscle
228
Name the muscles of the anterior thigh compartment.
Quadriceps femoris
Sartorius
Pectineus
Iliopsoas
229
Quadriceps Femoris has __ muscle bellies and __ common tendon.
4; 1
230
Name the 4 muscle bellies of the Quadriceps Femoris.
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Vastus Intermedius
231
Where does the Quadriceps Femoris attach distally?
Attaches at the tibial tuberosity via the patellar ligament/tendon.
232
What is the proximal attachment of Rectus Femoris?
AIIS
233
What is the proximal attachment of Vastus Lateralis?
Femur (greater trochanter)
234
What is the proximal attachment of Vastus Medialis?
Femur (intertrochanteric line)
235
What is the proximal attachment of Vastus Intermedius?
Femur (shaft)
236
T/F: The Vastus Intermedius is superficial to the Rectus Femoris.
False! The Rectus Femoris is superficial to the Vastus Intermedius.
237
What is the function of Quadriceps Femoris?
Knee extension
238
What innervates Quadriceps Femoris?
Femoral nerve (L2-L4 helps kick the door).
239
One muscle of the Quadriceps Femoris has an additional function apart from knee extension. Which is it and what is the function?
Rectus Femoris also performs hip flexion. This is because it crosses the hip joint, whereas, the other 3 muscles do not.
240
Why is the patella considered a sesamoid bone?
It is a bone that has grown within a tendon (quadriceps tendon).
241
Where is the Articularis Genu muscle located?
Deep to inferior part of Vastus Intermedius (and derivative of it).
242
What is the proximal attachment of Articularis Genu?
Femur
243
What is the distal attachment of Articularis Genu?
Synovial membrane of knee joint
244
What is the action of Articularis Genu?
Elevates the upper portion of the synovial membrane during knee extension to prevent folds of the membrane from being compressed between femur and patella within the joint.
245
What is the longest muscle in the body?
Sartorius
246
How many joints does Sartorius cross?
Crosses 2 joints
247
What is the most superficial muscle in the anterior thigh?
Sartorius
248
What is the proximal attachment of the Sartorius muscle?
ASIS
249
What is the distal attachment of the Sartorius muscle?
Medial tibial tuberosity via pes anserinus
250
What are the actions of Sartorius?
**Think of crossing one leg over the other while sitting**
Flexes, abducts, and laterally rotates the hip. Flexes knee.
251
What innervates Sartorius?
Femoral nerve (L2-3)
252
What muscle does the Adductor Canal lie deep to?
Lies deep to the Sartorius muscle
253
What is the Adductor Canal and what does it do?
This is an intermuscular passage deep to the sartorius muscle that transmits the femoral vessels toward the knee that ends at adductor hiatus.
254
What are the contents of the Adductor Canal?
Femoral Artery
Femoral Vein
Saphenous Nerve
Nerve to Vastus Medialis
255
Where does the Adductor Canal end? What happens here?
Ends at Adductor Hiatus.
Here, the femoral artery and vein pass into the popliteal fossa.
256
What is unique about the Pectineus muscle?
It is composed of 2 layers that are innervated by 2 nerves.
257
What is the proximal attachment of Pectineus?
Superior ramus of pubis
258
What is the distal attachment of Pectineus?
Pectineal line of femur, just below lesser trochanter
259
What are the actions of Pectineus?
Adduction and flexion of thigh at the hip and assists in medial rotation of the thigh.
260
What innervates Pectineus?
Femoral nerve (L2-4) & Obturator nerve (L2-4)
261
Which muscle is considered a transitional muscle between anterior and medial compartments? Why?
Because of the dual nerve supply and its actions, Pectineus is considered a transitional/boundary muscle between anterior and medial compartments.
262
Iliopsoas is made up of _____________ & ____________ ____________.
Iliacus; Psoas Major
263
What percentage of people have Psoas Minor muscle?
Only about 60-65% of people have a Psoas Minor muscle.
264
What is the proximal attachment of the Iliopsoas?
To vertebral column (T12-L5 is psoas part) and pelvis (is iliacus part).
265
What is the distal attachment of the Iliopsoas?
Lesser trochanter
266
What are the actions of the Iliopsoas?
Strong flexor of thigh and external rotation unilaterally. Bilateral contractions results in flexion of the trunk.
267
What innervates Iliopsoas?
Anterior rami of lumbar nerve (L1-3) for psoas part
Femoral nerve (L2-3)
268
Within the femoral triangle, what border do the Iliopsoas and Pectinus muscles form?
Forms floor of femoral triangle.
269
Where do the medial compartment thigh muscles span?
Extend from antero-inferior pelvis to linea aspera.
270
All thigh muscles of the medial compartment are innervated by the Obturator Nerve EXCEPT for 1. Which muscle is it?
Adductor Magnus is the exception and has 2 innervations.
271
Medial compartment thigh muscles are primarily adductors of the thigh at the hip. However, what can most secondarily do?
Most can secondarily flex and/or rotate the thigh
272
Name the muscles of the medial thigh compartment.
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
273
What are the parallel triangular muscles in the medial thigh compartment?
Adductor longus (most anterior) and brevis (deep to longus & pectineus)
274
What is the proximal attachment of Adductor Longus & Brevis?
Pubis
275
What is the distal attachment of Adductor Longus & Brevis?
Linea aspera
276
What is the action of Adductor Longus & Brevis?
Adduction of thigh
277
What innervates Adductor Longus & Brevis?
Obturator Nerve (L2-4)
278
What is the largest, most powerful adductor?
Adductor Magnus
279
What is the most posterior adductor muscle? What does this muscle indicate transition-wise?
Adductor Magnus
This muscle is the transition to the posterior compartment.
280
There are two parts to the adductor magnus muscle: the _____________ part & the __________________ part.
adductor; hamstring
281
What are the proximal attachments of Adductor Magnus?
Adductor part: Anteroinferior bony pelvis
Hamstring part: Ischial tuberosity
282
What are the distal attachments of Adductor Magnus?
Adductor part: Attaches distally along linea aspera
Hamstring part: Attaches distally just superior to medial femoral epicondyle
283
What are the actions of Adductor Magnus?
Adductor part: Adduction and flexion of thigh
Hamstring part: Adduction and extension of thigh
284
What innervates Adductor Magnus?
Adductor part: Obturator Nerve
Hamstring part: Tibial division of Sciatic Nerve
285
T/F: The adductor part of Adductor Magnus is more medial compared to the hamstring part.
False! The adductor part is located more lateral compared to the hamstring part of Adductor Hiatus.
286
What is the most medial adductor compartment muscle?
Gracilis
287
What is the proximal attachment of Gracilis?
Pubis
288
What is the distal attachment of Gracilis?
Medial surface of tibia (distal tendon is part of pes anserinus)
289
What are the actions of Gracilis?
Adducts hip joint and flexes knee joint
290
What innervates Gracilis?
Obturator Nerve (L2-3)
291
Which muscle from the adductor compartment is often used for muscle/tendon grafts?
Gracilis
292
What is the proximal attachment of Obturator Externus?
Margins of obturator foramen and obturator membrane
293
What is the distal attachment of Obturator Externus?
Trochanteric fossa of femur
294
What is the action of Obturator Externus?
Lateral rotation of thigh
295
What innervates Obturator Externus?
Obturator nerve (L2-3)
296
What is the Pes Anserinus?
A common tendon formed by 3 muscles: Sartorious, Gracilis, and Semitendinosus. It attaches just medial to the tibial tuberosity.
297
Where does Pes Anserinus attach?
Just medial to the tibial tuberosity
298
What is special about the muscles involved in the formation of Pes Anserinus?
All 3 muscles come from different compartments and have a different innervation.
299
Name the muscles that form Pes Anserinus and their innervations.
SGT FOT (sergeant foot)
Sartorious- Femoral Nerve
Gracilis- Obturator Nerve
Semitendinosus- Sciatic Nerve
300
What does the Femoral Nerve innervate?
Muscles of the anterior thigh (except 1/2 Pectineus and Psoas Major)
301
What does the Obturator Nerve innervate?
Muscles of the medial thigh (1/2 adductor magnus)
302
Which two muscles in the medial compartment of the thigh have dual innervations? Name the innervations.
Pectineus- Femoral & Obturator Nerve
Adductor Magnus- Obturator & Sciatic Nerve
303
Name the arteries that make up the supply to the thigh.
Femoral artery
Deep femoral (profunda femoris) artery
Obturator artery
304
The Femoral Artery is a continuation of what artery?
It is a continuation of the external iliac artery.
305
Where does the external iliac artery become the femoral artery?
Name changes at the inguinal ligament.
306
What is the primary artery of the lower limb?
Femoral artery
307
Where does the Femoral Artery travel? What does it travel with?
Travels with Saphenous nerve through adductor canal and then through adductor hiatus to popliteal fossa.
308
What compartments does the femoral artery directly supply?
Directly supplies anterior and medial compartments of the thigh.
309
T/F: The deep femoral (profunda femoris) artery branches from femoral artery.
True!
310
Where does the deep femoral (profunda femoris) artery branch from the femoral artery at?
Branches from femoral artery in the femoral triangle.
311
What does the deep femoral (profunda femoris) artery give off? Where do these go?
Gives off several perforating arteries that wrap around the shaft of the femur.
312
What compartments does the deep femoral (profunda femoris) artery supply?
Supplies posterior and parts of medial and anterior compartments of the thigh.
313
Where does the Obturator artery come from?
It is a small branch from the internal iliac artery (inside the pelvis) and comes from the obturator foramen.
314
What parallels the obturator artery?
Obturator nerve
315
What compartment does the Obturator artery supply?
Assists with blood supply to medial compartment of the thigh.
316
What arteries provide the arterial supply to the femoral head?
Circumflex femoral arteries
Acetabular branch of obturator artery
317
Where do the circumflex femoral arteries encircle?
Encircle proximal femur and anastomose with each other.
318
What do the circumflex femoral arteries split into?
Lateral and medial branches, which anastomose with each other
319
Where would we find the lateral branch of the circumflex femoral arteries?
Anterior to the femur. These are bigger. It also has 3 branches with the descending branch supplying much of the lateral aspect of the thigh.
320
Where would we find the medial branch of the circumflex femoral arteries?
Posterior to the femur. These are smaller.
321
What does the medial branch of the circumflex femoral arteries supply?
Acts as the MAJOR supply to femoral head and neck of the femur (retinacular artery)
322
What does the Acetabular branch of obturator artery supply?
Assists with supply to femoral head, however, it is insufficient to SOLELY supply the femoral head if we lose all other arteries.
323
How does the acetabular branch of obturator artery enter the femur?
Enters the femur via the fovea (divot in femur where artery runs into).
324
A patient presents to the ER with pain in their proximal thigh. X-rays reveal a femoral neck fracture. What structures should we check are intact surrounding this area?
Circumflex femoral arteries and acetabular branch of obturator artery.
325
"Main path by which vessels and nerves pass between the thigh and the leg"
What structure is this describing?
Popliteal Fossa
326
What are the boundaries of the Popliteal Fossa?
Superiorly: Biceps femoris, semimembranosus, and semitendinosus.
Inferiorly: Lateral and medial heads of gastrocnemius
Roof: Skin and popliteal fascia
Floor: Popliteal surface of femur, posterior capsule of knee joint and the popliteus fascia covering popliteus muscle
327
What is the popliteal fascia continuous with superiorly and inferiorly?
Continuous with the fascia lata superiorly and crural fascia inferiorly.
328
What makes up the superior boundary of the popliteal fossa?
Biceps femoris, semimembranosus, and semitendinosus.
329
What makes up the inferior boundary of the popliteal fossa?
Lateral and medial heads of gastrocnemius
330
What makes up the roof of the popliteal fossa?
Skin and popliteal fascia
331
What makes up the floor of the popliteal fossa?
Popliteal surface of femur, posterior capsule of knee joint and the popliteus fascia covering popliteus muscle
332
Name the contents of the popliteal fossa (8)
Termination of small saphenous vein
Popliteal Artery
Popliteal Vein
Tibial nerve
Common fibular nerve
Posterior cutaneous nerve of thigh
Popliteal lymph nodes
Fat
333
What is the deepest structure contained within the popliteal fossa?
Deepest is Popliteal artery
334
What are the most superficial structures contained within the popliteal fossa?
Tibial and common fibular nerves
335
What structure does the common fibular nerve follow distally?
Follows biceps femoris tendon at the lateral side of the popliteal fossa.
336
What does the Posterior Cutaneous Nerve of the thigh supply?
Supplies the skin over the popliteal fossa.
337
What supplies the knee joint capsule?
Five genicular (going around the knee) branches of popliteal artery supply the joint capsule.
338
During full knee flexion, what provides collateral circulation around the knee?
The five genicular branches of the popliteal artery participate in the formation of the genicular anastomosis around the knee, which provides collateral circulation to the leg during full knee flexion.
339
What is a Femoral Hernia?
Protrusion of abdominal viscera through femoral ring into the femoral canal.
340
How could a Femoral Hernia worsen?
Abdominal viscera could protrude through the saphenous opening.
341
T/F: Femoral hernias are more common in males.
False! Femoral hernias are more common in females due to wider pelvis.
342
T/F: The distal femoral artery is superficial.
False! The proximal femoral artery is superficial.
343
How can we palpate the proximal femoral artery?
Can palpate the pulse by placing your little finger on the ASIS and your thumb on the pubic tubercle (press firmly).
344
What is Iliotibial Band Syndrome (ITBS)?
Continuous rubbing of the IT band against the femur as it runs alongside the knee joint, which can lead to inflammation.
345
What athletes would we find IT Band Syndrome in?
Common and painful injury to the knee, often in runners, hikers, cyclists.
346
Name 3 causes of IT Band Syndrome.
Stretching the ITB against the femur.
Lack of strength and flexibility in the muscles attached to the ITB.
Incorrect or worn shoes.
347
Describe the patellar tendon reflex (deep tendon reflex).
Patient has feet dangling off a table --> tap the patellar tendon (quadriceps femoris tendon).
348
What is the patellar tendon reflex testing?
Testing the integrity of the femoral nerve (L2-4).
349
What is often torn when the femoral head is fractured or the hip joint is dislocated?
The retinacular arteries (arteries surrounding the head and neck of femur)
350
Tearing of the retinacular arteries can cause what?
Osteonecrosis (bone death) of the femoral head (the artery of the ligament of the head of femur is usually insignificant).
351
What is a Popliteal Artery Aneurysm?
Dilation of the Popliteal artery greater than 50% of the normal diameter.
352
What does a Popliteal Artery Aneurysm result in? Why?
Compression of the tibial nerve (most often).
This is because the popliteal fascia is tough and does not stretch. Thus, if the popliteal artery is getting bigger, the fascia isn't stretching, the nerve gets compressed.
353
What are the consequences of a Popliteal Artery Aneurysm resulting in tibial nerve compression?
Weakened or absent plantar flexion
Paraesthesia of the foot and posterolateral leg
354
What two bones make up the leg?
Tibia and Fibula
355
What is the strongest bone in the body? What is the second strongest bone?
First is femur
Second is tibia
356
T/F: In the leg, the fibula serves as the weight-bearing bone.
False! The tibia serves as the weight-bearing bone. The fibula actually does NOT weight-bear.
357
If the fibula does not bear weight, what is the purpose?
It is used for muscle attachment.
358
What are the 3 tibiofibular joints?
Proximal tibiofibular synovial
Interosseous membrane
Distal tibiofibular syndesmosis
359
What is the Proximal Tibiofibular Synovial joint and what is its purpose?
It is the proximal articulation between the tibia and fibula. It limits the motion between tibia and fibula.
360
What is the Interosseous Membrane joint of the Tibiofibular region? Why would there be an opening in this?
This is a fibrous sheet between the tibia and fibula that connects the bones.
Opening at the proximal end allows for arteries to pass through.
361
What is the Distal Tibiofibular Syndesmosis joint? What is its purpose?
It is the distal articulation of the tibia and fibula connected by ligaments.
It limits movement during extreme dorsiflexion.
362
What forms the ankle?
Distal Tibiofibular joint + Talus bone
363
Relative to the Talus, what does the distal tibiofibular joint provide?
Provides a slightly flexible socket for the talus.
364
What is the Crural Fascia?
Continuation of fascia lata from thigh down into the leg region.
365
What connects the crural fascia to the tibia and fibula?
Connected by intermuscular fascia.
366
Intermuscular septa ____________ the leg into _____________.
divides; compartments
367
How do the compartments in the thigh differ from the leg region?
Leg region has anterior, posterior, and lateral compartments
Thigh region has anterior, posterior, and medial compartments.
368
Great saphenous vein pierces ___________ _______ at the ______________ hiatus.
fascia lata; saphenous
369
What compartment of the thigh and leg would we find the great saphenous vein in?
Great saphenous vein travels along the medial thigh and leg.
370
What compartment of the leg would we find the small saphenous vein in? What does it travel with?
Travels along posterior leg superficial to crural fascia.
Also travels with sural nerve.
371
Small saphenous vein pierces _________ _________ at __________ to drain into the ____________ vein.
crural fascia; gastroc; popliteal
372
What 6 nerves make up the cutaneous innervation of the leg?
Saphenous nerve
Lateral sural nerve
Medial sural nerve
Superficial fibular nerve
Deep fibular nerve
Sural nerve
373
Where does the Saphenous nerve come from?
Femoral nerve
374
Where does the lateral sural nerve come from?
Common fibular nerve
375
Where does the medial sural nerve come from?
Tibial nerve
376
What does the common fibular nerve branch into?
Superficial fibular nerve and deep fibular nerve
377
Where does the sural nerve come from?
Medial and lateral sural nerve.
378
What innervates the anterior compartment of the leg?
Deep fibular nerve
379
What innervates the posterior compartment of the leg?
Tibial nerve
380
What innervates the lateral compartment of the leg?
Superficial fibular nerve
381
What is another word for fibular?
Peroneal
382
Where is the extensor retinaculum located?
Anterior
383
Where is the flexor retinaculum located?
Posterior
384
Where is the fibular retinaculum located?
Lateral
385
What is the extensor retinaculum divided into?
Superior extensor retinaculum and inferior extensor retinaculum
386
What forms the tarsal tunnel?
Flexor retinaculum
387
What is the fibular retinaculum divided into?
Divided into superior fibular retinacula and inferior fibular retinacula
388
What innervates the posterior compartment of the leg?
Tibial nerve
389
What is the blood supply to the posterior compartment of the leg?
Posterior tibial artery
390
What muscles are found in the superficial posterior compartment of the leg?
What do these all have in common for distal attachment?
Gastrocnemius
Plantaris
Soleus
All share a distal attachment of the Achilles tendon.
391
What muscles are found in the deep posterior compartment of the leg?
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Popliteus
392
What is the proximal attachment for Gastrocnemius (two heads)?
Femoral condyles (both heads attach here on each side)
393
What is the distal attachment for Gastrocnemius?
Calcaneal tendon
394
What are the actions of Gastrocnemius?
Plantar flexion and knee flexion (very very secondary muscle)
395
What innervates Gastrocnemius?
Tibial nerve
396
What is the proximal attachment for Plantaris?
Lateral supracondylar line on femur
397
What is the distal attachment for Plantaris?
Calcaneal tendon
398
What is the action of Plantaris?
Plantar flexion
399
What innervates Plantaris?
Tibial nerve
400
If the Plantaris technically crosses two joints, why does it only produce plantar flexion?
It is such a small muscle that it doesn't actually act on the knee joint.
401
What is the proximal attachment for Soleus?
Proximal fibula and tibial soleal line
402
What is the distal attachment for Soleus?
Calcaneal tendon
403
What is the action of Soleus?
Plantar flexion
404
What innervates Soleus?
Tibial nerve
405
What is the most powerful (thickest & strongest) tendon in the body?
Calcaneal (Achilles) tendon
406
How is friction of the calcaneal tendon reduced? What causes friction of the calcaneal tendon?
Bursa are used to reduce friction.
Plantar flexion causes friction of the calcaneal tendon, which we do a lot. Thus, bursa are needed to prevent that friction.
407
What are the two bursae of the calcaneal tendon region? Where is each bursa located?
Subcutaneous bursa (between skin and tendon)
Retrocalcaneal bursa (between tendon and calcaneus)
408
What is the proximal attachment of Tibialis Posterior?
Tibia/fibula/interosseous membrane
409
What is the distal attachment of Tibialis Posterior?
Inferior surface of foot
410
What innervates Tibialis Posterior?
Tibial nerve
411
What are the actions of Tibialis Posterior?
Plantar flexion and inversion
412
What is the proximal attachment of Flexor Hallucis Longus?
Tibia/fibula/interosseous membrane
413
What is the distal attachment of Flexor Hallucis Longus?
Base of distal phalanges of big toe
414
What innervates Flexor Hallucis Longus?
Tibial nerve
415
What are the actions of Flexor Hallucis Longus?
Plantar flexion and flexes big toe
416
What is the proximal attachment of Flexor Digitorum Longus?
Tibia/fibula/interosseous membrane
417
What is the distal attachment of Flexor Digitorum Longus?
Base of distal phalanges 2-5
418
What innervates Flexor Digitorum Longus?
Tibial nerve
419
What are the actions of Flexor Digitorum Longus?
Plantar flexion and flexion of digits 2-5
420
What is the proximal attachment of Popliteus?
Lateral condyle of femur
421
What is the distal attachment of Popliteus?
Posterior tibia
422
What innervates Popliteus?
Tibial nerve
423
What is the action of Popliteus?
Lateral rotation of femur on fixed tibia. This helps to unlock the knee so that it can flex and extend.
424
From anterior to posterior, what travels under the flexor retinaculum?
Tom, Dick, And Very Nervous Harry
Anterior to Posterior:
Tibialis posterior
Digitorum longus (flexor)
Artery (posterior tibial)
Vein (posterior tibial)
Nerve (tibial)
Hallucis longus (flexor)
425
What muscles are found in the anterior compartment of the leg?
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
426
What innervates the anterior compartment of the leg?
Deep fibular nerve
427
What is the blood supply to the anterior compartment of the leg?
Anterior tibial artery
428
What is the proximal attachment of Tibialis Anterior?
Lateral tibial shaft
429
What is the distal attachment of Tibialis Anterior?
Base of 1st metatarsal, medial cuneiform
430
What innervates Tibialis Anterior?
Deep fibular nerve
431
What are the actions of Tibialis Anterior?
Dorsiflexion and inversion
432
What is the proximal attachment of Extensor Hallucis Longus?
Medial fibula and interosseous membrane
433
What is the distal attachment of Extensor Hallucis Longus?
Distal phalanges of hallucis
434
What innervates Extensor Hallucis Longus?
Deep fibular nerve
435
What are the actions of Extensor Hallucis Longus?
Dorsiflexion and extension of hallucis
436
What is the proximal attachment of Extensor Digitorum Longus?
Proximal tibia/fibula/interosseous membrane
437
What is the distal attachment of Extensor Digitorum Longus?
Distal phalanges 2-5
438
What innervates Extensor Digitorum Longus?
Deep fibular nerve
439
What are the actions of Extensor Digitorum Longus?
Dorsiflexion and extension of digits 2-5
440
What is the proximal attachment of Fibularis Tertius?
Middle fibula/interosseous membrane
441
What is the distal attachment of Fibularis Tertius?
Base of 5th metatarsal
442
What innervates Fibularis Tertius?
Deep fibular nerve
443
What are the actions of Fibularis Tertius?
Dorsiflexion and eversion
444
What muscles are found in the lateral compartment of the leg?
Fibularis longus
Fibularis brevis
445
What innervates the lateral compartment of the leg?
Superficial fibular nerve
446
What is the blood supply to the lateral compartment of the leg?
Fibular artery
447
What is the proximal attachment of Fibularis Longus?
Head/shaft of fibula
448
What is the distal attachment of Fibularis Longus?
Base of 5th metatarsal and medial cuneiform
449
What are the actions of Fibularis Longus?
Eversion and WEAK plantar flexion (there are so many other muscles that do this better)
450
What innervates Fibularis Longus?
Superficial fibular nerve
451
What is the proximal attachment of Fibularis Brevis?
Inferior shaft of fibula
452
What is the distal attachment of Fibularis Brevis?
Base of 5th metatarsal
453
What innervates Fibularis Brevis?
Superficial fibular nerve
454
What are the actions of Fibularis Brevis?
Eversion and WEAK plantar flexion (there are already so many other muscles doing this)
455
The majority of muscles in the anterior compartment of the leg are performing dorsiflexion and foot inversion. What is the exception to this?
Fibularis tertius performs eversion instead of inversion.
456
All compartments of the lower leg are supplied by which artery?
Popliteal artery
457
What does the popliteal artery branch into? Where does this occur?
The popliteal artery branches into the posterior and anterior tibial arteries below the popliteal fossa.
458
Once the anterior tibial artery branches off of the popliteal artery, where does it go and with what?
Anterior tibial artery passes through the interosseous membrane with superficial fibular nerve to get to the anterior side of the leg.
459
Once the posterior tibial artery branches off of the popliteal artery, where does it go and with what?
Posterior tibial artery stays in the posterior leg and runs with the tibial nerve.
460
What artery runs under fibularis brevis?
Fibular artery
461
The fibular artery is a branch off of what artery?
Posterior tibial artery
462
Ligation of what artery in the leg would limit blood flow drastically to the leg? Why?
Popliteal artery. This is because all compartments of the lower leg are supplied by it.
463
Where does the tibial nerve come from?
It is a branch off of the sciatic nerve at the adductor hiatus.
464
What nerve innervates the posterior compartment of the leg and plantar surface of the foot?
**Think further than the sciatic nerve**
Tibial nerve
465
What does the tibial nerve run with?
Posterior tibial artery
466
What nerve does the tibial nerve give off?
Gives off the medial sural nerve (cutaneous branch).
467
What does the tibial nerve split into? Where does this occur?
Tibial nerve splits into the medial and lateral plantar nerves.
This occurs at the medial malleolus.
468
Where does the common fibular nerve come from? When does it start?
Sciatic nerve
Starts at the neck of the fibula
469
What nerve does the common fibular nerve give off?
Gives off lateral sural nerve (cutaneous branch)
470
What does the common fibular nerve branch into?
Superficial and deep fibular nerves.
471
What sensory innervation does the deep fibular nerve provide?
**REMEMBER THIS**
Sensory to skin between digits 1-2 (small triangle area)
472
What motor innervation does the deep fibular nerve provide?
Motor to anterior compartment of the leg and 2 muscles in the dorsum of the foot.
473
What does the deep fibular nerve run with?
Runs with the anterior tibial artery
474
What sensory innervation does the superficial fibular nerve provide?
Sensory to the dorsum of the foot.
475
What motor innervation does the superficial fibular nerve provide?
Motor to lateral compartment of the leg.
476
Name the 3 fascia covering the entirety of the lower limb.
Fascia lata
Popliteal fascia
Crural fascia
477
What is Compartment Syndrome? How is the fascia of the limb involved?
The lower limb is a closed compartment. Thus, if the pressure rises too high, the fascia does not stretch, and arteries can get occluded.
Thus, compartment syndrome is occlusion of the arteries due to pressure increasing and the fascia being inelastic.
478
What are the causes of Compartment Syndrome?
Severe/deep bruising (like from a traumatic injury), muscle tearing, etc.
479
What are the symptoms of Compartment Syndrome?
Pain, loss of pallor, parasthesia, pulselessness, weakness
480
What is the treatment for Compartment Syndrome?
Fasciotomy
481
What type of athletes would you tend to observe calcaneal tendinitis and/or bursitis in?
Common in runners, especially on hills and uneven surfaces
482
How does rupture of the calcaneal tendon occur? What action would we lose?
Repeated stress can lead to tearing of the calcaneal tendon.
This would result in loss of plantar flexion.
483
Describe the blood supply to the calcaneal tendon.
The calcaneal tendon is highly avascular, meaning that the blood supply to this region is poor. Because of this, it is a very slow healing structure.
484
What is the Calcaneal Tendon Reflex testing?
Tests S1-2 nerve roots and tibial nerve integrity.
485
What movement does the calcaneal tendon reflex result in?
Results in plantar flexion of the ankle
486
Why would damage to the proximal tibial nerve be uncommon?
Damage is uncommon due to the proximal tibial nerve being located so deeply within popliteal fossa.
487
What are the symptoms of proximal tibial nerve injury?
Loss of plantar flexion
Loss of toe flexion
Loss of sensation to sole of foot
Weak foot inversion
488
What nerve could a fracture of the proximal tibia injure?
Tibial nerve
489
What is anterior shin splints the result of?
Irritation/pain in the tibialis anterior and/or tibia.
490
What is another name for shin splints?
Medial tibial stress syndrome (MTSS)
491
What is the cause of shin splints?
Repetitive use of muscles leading to small tears in the tibial periosteum (surrounds the bone and has tiny little nerves that get irritated).
492
What type of people do we commonly see shin splints in?
Usually affects runners and athletes engaged in running sports.
493
What is the cause of foot drop?
Damage to the common fibular nerve
494
What does damage to the common fibular nerve result in?
**Think differently than just foot drop**
Results in loss of anterior and lateral leg compartment (because the superficial and deep fibular nerves come off of the common fibular nerve).
Also lose cutaneous innervation on dorsum of foot.
495
If a patient presents with foot drop and an x-ray reveals a fracture, what structure may be fractured?
Fibular neck fracture
