1- anatomy of lower limb Flashcards
what makes up the upper limb?
- axilla
- arm
- elbow/cubital fossa
- forearm
- wrist
- hand
what makes up the lower limb?
- inguinal region/groin
- thigh (femoral region)
- knee/popliteal fossa
- leg
- ankle
- foot
what are the 4 muscles in superficial muscle group of gluteal region?
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fascia latae
what nerve innervates gluteus maximus?
inferior gluteal nerve
what nerve innervates gluteus medias, minimus and tensor fascia latae?
superior gluteal nerve
where are the superficial muscle groups of gluteal region found?
- gluteus muscles make up the but - with gluteus maximus being the biggest and most superficial, gluteus medius the next and gluteus minimus deepest
- the tensor fascia latae stretches down side from iliotibial tract to lateral condyle of tibia
when is gluteus maximus contracting more?
when walking uphill or running - not much on flat
what does damage to superior gluteal nerve result in?
trendelenburg’s gait = if damage to nerve supplying muscles then leg will go like floppy and lowers at pelvis. to compensate for that person will lean away to make pelvis higher to clear ground when walking = characteristic waddle
*superior gluteal nerve supplies other 3 of gluteal muscles
what are the deep muscle groups (smaller) in gluteal region?
- piriformis
- obturator internus
- gemelli (2 of them, superior&inferior)
- quadratus femoris
what are foramen in pelvis?
they are notches with ligaments. they’re passageways for nerves & vessels
what ligaments are in pelvis?
- sacrotuberous ligaments running from sacrum to ischial tuberosity
- sacrospinous ligament running from sacrum to ischial spine
what foramen is passage for nerves & vessels to:
a) pelvis
b) perineum
a) greater sciatic foramen
b) lesser sciatic foramen
where is the sciatic nerve?
it emerges as most lateral structure from greater sciatic region and arrives deep to gluteus maximus (just inferior to piriformis) = it comes from L4-S3
what vertebral levels does sciatic nerve originate?
L4-S3
what nerve supplies skin over posterior thigh, popliteal fossa, lateral perineal and upper medial thigh?
posterior cutaneous nerve of thigh (S1-3)
what quadrant of gluteal region should injections be done?
upper outer quadrant used for injections since much less likely to damage structures
what does sciatic nerve supply?
doesn’t supply anything in gluteal region but passes down into posterior thigh where it then separates into 2 main branches the tibial and common fibular division (varies where specifically per person but most people in distal thigh)
what are the superior, medial, lateral, roof and floor borders of femoral triangle?
superior = inguinal ligament (ASIS to pubic tubercle)
medial = adductor longus
laterally = sartorius
floor = iliopsoas & pectineus
roof = deep fascia (fascia latae)
what are the contents and in what order of femoral canal?
- femoral nerve
- femoral artery
- femoral vein
- lymphatics
→order they pass is as NAVY
what is femoral sheath?
connective tissue that passes deep to inguinal ligament, vessels (not nerve) is contained to allow movement in hip movement
what are 3 areas of deep fascia in the thigh?
- fascia lata
- iliotibial tract
- crural fascia (leg)
what are the lower limb fascia compartments?
3 in thigh (anterior, medial, posterior)
3 in leg (anterior, posterior and lateral)
what are the flexor muscles in the anterior compartment of thigh?
- pectineus
- iliopsoas
- sartorius
(reducing angle of thigh to hip)
what are the extensors of leg muscle in anterior of thigh?
the quadriceps femoris (made of 4 muscles and extends knee out, like starting bottom of squat)
1. rectus femoris
2. vastus lateralis
3. vastus medialis
4. vastus intermedius
what nerve innervates the anterior thigh muscles?
all innervated by femoral nerve (L2,3,4) apart from psoas major innervated by L1,2,3
what are the adductor muscles of medial compartment of thigh?
- adductor longus
- adductor brevis (short)
- adductor magnus (great/large)
- gracilis
- obturator externus
what nerve supplies adductor muscles of medial compartment of thigh?
all supplied by obturator nerve (L2,3,4) except hamstring part of adductor magnus innervated by tibial nerve of sciatic nerve
what are the extensors&flexors of leg in posterior compartment of thigh? (3)
- semitendinosus
- semimembranosus
- biceps femoris
what are the muscles of posterior thigh compartment innervated by?
tibial division of sciatic nerve (L5, S1-2)
why is short head of biceps femoris not regarded as true hamstring muscles?
a few reasons: doesn’t have same attachment point of ischial tuberosity, it therefore doesn’t have same action as other muscles and is innervated by common fibular division of sciatic nerve
what are the dorsiflexors of ankle & extensors of toes in anterior compartment of leg?
- tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- fibularis tertius
what nerves innervate muscles in anterior compartment of leg?
all supplied by deep fibular nerve (L4,5)
what are muscles in lateral compartment of leg and what is their function?
function = to evert foot & weakly plantar flex ankle
- fibularis longus
- fibularis brevis
what nerve innervates lateral compartment of leg?
innervated by superficial fibular nerve (L5, S1-2)
what muscles are in superficial group of posterior compartment of leg? and function?
superficial group = plantar flexors of ankle
- gastrocnemius
- soleus
- plantaris (absent in 5-10% people and variable in shape, can be harvested for hand tendon surgery)
what muscles are in deep group of posterior compartment of leg? and function?
deep group = flexors of toes & plantarflexors of ankle
- popliteus
- flexus hallucis longus
- flexor digitorum longus
- tibialis posterior
what nerve innervates muscles in posterior compartment of leg?
innervated by tibial nerve (S1-2) for both superficial & deep group
what type of joint is hip joint?
- ball & socket = head of femur is ball and acetabulum (part of iliac spine) is socket
- synovial joint means has external fibrous layer and internal synovial membrane layer
what are hip joint ligaments?
= they’re ligaments formed by thick part of fibrous layer of joint capsule, attach to trocanter lines
- iliofemoral (anteriorly) strongest
- pubofemoral (anteriorly, inferiorly)
- ischiofemoral (posteriorly) weakest
*also ligament teres which is at head of femur & acetabulum (quite weak)
what is hip joint blood supply?
- supplied by medial & lateral circumflex femoral arteries, usually come from deep femoral artery (profunda femoris)
*these circumflex arteries then give off retinacular arteries that go through joint capsule to supply head &neck of femur. head &neck of femur also supplied by obturator artery
what type of joint is knee joint? what articulations does it have?
= is a hinge joint which occurs with 3 articulations
→2 articulations between femur & tibia = femorotibial and 1 between femoral and patellar
what stabilises knee joint?
muscles around it especially quadriceps muscles & tendons, also strengthened by ligaments that attach femur to tibia
what are knee extracapsular ligaments?
- lateral collateral
- medial collateral
- patellar ligament (1st 2 are more important)
what are knee intra-articular ligaments? (to help prevent joint sliding against femur)
- anterior cruciate (ACL)
- posterior cruciate (PCL)
what slides where if ACL ruptured?
tibia slide anteriorly under fixed femur = called anterior drawer sign
what slides where if PCL ruptured?
tibia slide posteriorly under fixed femur = posterior drawer sign
what is purpose of menisci and where are they?
menisci act as shock absorbers, they are crescent shaped wafers of fibrocartilage between fibula & tibia
what is popliteal fossa, what is it made up of?
it’s bit behind knee (back of knee)
- mostly fat filled compartment, also terminal small saphenous vein, popliteal vessels & tibial and common fibular nerves
what are boundaries of popliteal fossa?
- superolaterally – biceps femoris
- superomedially – semimembranosus
- inferiorly – gastrocnemius
- roof – popliteal fascia
what is calcaneal tendon?
also known as achilles tendon = thickest & strongest in body
- formed by tendons of gastrocnemius and soleus together. attaches to calcaneal tuberosity
what nerve roots does ankle jerk reflex test?
tests S1,2 nerve roots
what is route of superficial lymphatics?
- follow saphenous veins
- drain to superficial inguinal lymph nodes
- then external iliac lymph nodes
what is route of deep lymphatics?
- follow deep veins
- (popliteal lymph nodes)
- deep inguinal lymph nodes
- external iliac lymph nodes
