1. Review of the lower limb Flashcards
What is the hip joint composed of?
The femoral head and the acetabulum
What is the relative stability of the hip joint?
This is a very very stable joint
What is the difference between the surgical neck and the anatomical neck?
Anatomical neck - region located just inferior to the anatomical head
Surgical neck - the area of the bone that breaks most often
Where are the anatomical and the surgical necks of the femur located?
The anatomical and surgical necks of the femur are both the same
Where on the femur do muscles attach?
Greater and lesser trochanter
What is shenton’s line?
Continuous arch drawn underneath the superior pubic ramus and the inferomedial border of the neck of the femur
What dislocation generally occurs at the hip and why is this more common?
Posterior dislocation due to the very strong ilio-femoral ligament which is anterior to the hip joint
This is one of the strongest ligaments of the body
What are the three major ligaments of the hip joint?
Ilio-femoral ligament - main one to be aware of:
Anterior to the hip joint
Y-shaped ligament
Pubo-femoral ligament
Ischo-femoral ligament
What is the ligamentum teres of the hip?
This is a ligament within the hop joint itself - within the acetabulum (to the head of the femur)
This ligaments helps to keep the femoral head in the socket
Which muscles attach to the greater trochanter of the femur?
Tendons of the: Gluteus medius Gluteus minimus Piriformis Obturator internus Gemelli
Which muscles attach to the lesser trochanter of the femur?
Tendons of the:
Iliacus
Psoas major
How do the ligaments of the hip work to ensure stability and allow movement of the hip joint?
When the leg moves anteriorly and is flexed, these ligaments are relaxed and slack
When the leg moves backwards, the ligaments twist and turn and this moves the femoral head further into the acetabulum
What is the blood supply to the lower limb?
External iliac artery from the common iliac artery (also have the internal iliac artery)
Continues on as the femoral artery to the popliteal artery
Splits to the anterior and posterior tibial arteries
(Very good explanation in the anatomy colouring book)
What is the blood supply to the hip joint?
Deep artery of the thigh branches early from the femoral artery (aka. profunda femoris artery)
Medial circumflex artery branch from the femoral
Lateral circumflex artery branch from the femoral
Artery to the head of the femur
The majority of the blood supply to the hip joint is from the circumflex arteries
What is the issue with artery to the head of the femur?
This is not very important in adults - does not provide enough blood supply to the head of the femur by itself
What is the clinical significance of a fracture to the neck of the femur?
A fracture to the neck of the femur can result in avascular necrosis to the head of the femur
This is because the fracture can disrupt the blood supply from the profunda femori and the circumflex arteries and the artery to the head of the femur does not supply enough blood to compensate for this
Which ligaments result in the formation of the greater and lesser foramina?
The sacrospinous ligament - superior
The sacrotuberous ligament - inferior
What passes through the greater scaitic foramen?
7 nerves: Sciatic Nerve: Superior Gluteal Nerve: Inferior Gluteal Nerve: Pudendal Nerve: Posterior Femoral Cutaneous Nerve Nerve to Quadratus Femoris Nerve to Obturator Internus
3 Vessel Sets:
Superior Gluteal Artery & Vein
Inferior Gluteal Artery & vein
Internal Pudendal Artery & vein
1 Muscle:
Piriformis
Where in the bum would you apply an intramuscular injection to the gluteus maximus muscle and why?
In the upper outer quadrant of the gluteal quadrants
Apply here to ensure you avoid the sciatic nerve (also to avoid the inferior and superior gluteal nerves but not as major)
What is the function of the gluteus maximus?
Extension of the hip
Lateral rotation of the hip
What is the function of the gluteus minimus and medius?
Abduction of the hip
What is the innervation of the gluteus maximus?
Inferior gluteal nerve
What is the innervation of the gluteus minimus and medius?
Superior gluteal nerve
Where does the gluteus maximus insert into?
3/4 inserts into the iliotibial tract
1/4 inserts into the gluteal tuberosity of the femur
What is the function of the piriformis muscle and what is the nerve root for this?
Aids the gluteus maximus with lateral rotation of the hip - also done by other lateral rotator muscles
Nerve root for this group of muscles: L5, S1, S2
What is the trendelenburg test?
To test for damage to the hip abductors i.e. the superior gluteal nerve going to the gluteus minimus and maximus
If there is damage then the hip will drop on the unaffected side
What are the different compartments of the thigh?
Anterior compartment
Medial compartment
Posterior compartment
What muscles are contained in the anterior compartment of the thigh, what is their function and what is the nerve supply?
Quads - hip flexion and knee extension
Also iliopsoas (psoas major and iliacus) and sartorius
Femoral nerve - L2, 3, 4
What muscles are contained in the medial compartment of the thigh and what is the nerve supply?
Adductors (adductor magnus, longus, brevis) (biggest to smallest) and gracilis - hip adduction
Obturator nerve - L2, L3, L4
What muscles are contained in the posterior compartment of the thigh and what is the nerve supply?
Hamstrings - hip extension and knee flexion
Sciatic nerve (tibial division) - L5, S1, S2
What are the nerves coming off of the lumbar plexus?
Subcostal Iliohypogastric Ilioinguinal Genitofemoral Lateral cutaneous nerve of the thigh Obturator Femoral
What are the motor nerves of the lumbar plexus?
Obturator
Femoral
What are the nerve roots of the lumbar plexus?
L1-L4
Where is the inguinal ligament located?
At the border of the external oblique muscle
What is found just inferior to the inguinal ligament?
The femoral NAVL - passes through here to move into the anterior compartment
What are the common attachments of the hamstring muscles?
Hamstrings origin at the ischial tuberosity
Distal attachment on the tibia
What are the different hamstring muscles and how can you tell these apart from each other?
Semitendinosus
Semimembrnosus
Biceps femoris (long head)
Semembranosus is more medially located with a larger membranous part superiorly
Semitendinosus - more laterally located with a longer tendon
Biceps femoris has a long head and a short head
What is the ‘pes anserinus’?
This is the insertion of the sartorius, gracilis and the semitendinosus - located medially just inferiolaterally to the patella
What are the borders of the femoral triangle?
What is the clinical significance of the femoral triangle?
Inguinal ligament - superior
Sartorius - lateral
Adductor longus - medial
Hernias are common through here in women
What passes through the femoral triangle?
NAVL Femoral nerve Femoral artery Femoral vein Deep inguinal nodes and lymphatics
What are the three bones that compose the knee joint?
Femur
Tibia
Patella
What are the three articulations of the knee joint?
Patella and femur
Lateral femoral and tibial condyles - meniscus
Medial femoral and tibial condyles - meniscus
What does the stability of the knee depend on?
Surrounding muscles and tendons
Ligaments joining the femur and the tibia
What are the menisci of the knee and what is their function?
Lateral and medial menisci to increase the strength of the knee joint
Increase strength and important for shock absorption
What is the difference between the medial and the lateral menisci?
Medial is C-shaped
Broad posteriorly
Anterior attached to the ACL
Lateral is nearly circular
Smaller and more freely movable
Attached to the PCL
What are the collateral ligaments of the knee and what is their function?
These are lateral and medial ligaments of the knee that act to stabilise the hinge-like movement of the joint
Fibular/lateral collateral ligament
Tibial/medial collateral ligament
What is the posterior cruciate ligament and what is it’s function?
Internal ligament of the knee at the posterior aspect
Stops the tibia from moving back on the femur
Helps to stabilise the knee, especially in flexion
Prevents the tibia from twisting outwards in external rotation
What is the anterior cruciate ligament and what is it’s function?
Internal ligament of the knee at the anterior aspect
Stops the tibia from moving forward on the femur
Stabilises the knee in extension and prevents hyperextension and excessive internal rotation
Which is the stronger cruciate ligament of the knee?
The posterior cruciate ligament
What is the unhappy triad?
Three common knee injuries:
Anterior cruciate ligament (ACL)
Medial collateral ligament (MCL)
Medial meniscus
What are the clinical tests to assess the cruciate ligaments?
The anterior and the posterior draw tests
What are the two nerves resulting from the sciatic nerve and where does this occur?
Sciatic nerve splits to the common peroneal nerve and the tibial nerve just above the popliteal fossa
What is the sural nerve?
This is a small nerve forming from the joining of the peroneal nerve and the tibial nerve
What structures pass through the popliteal fossa?
Popliteal artery (deep) and vein
Sciatic nerve - bifurcates at the superior angle of the popliteal fossa to the tibial and the common fibular/common peroneal nerve
Tibial nerve continues through popliteal fossa
Small saphenous vein terminates here
What are the borders of the popliteal fossa?
Medial: semi-membranosus and gastrocnemus
Lateral: Biceps femoris and plantaris
Roof: deep/popliteal fascia, superficial fascia, skin
Floor: Popliteal surface of femur, capsule of knee joint, strong fascia of popliteus muscle
Which muscle is located anterior to the popliteal fossa?
Popliteus muscle
What are the different compartment of the leg?
Anterior compartment
Posterior compartment
Lateral compartment
What is the function of the anterior compartment of the leg and what is the nerve and blood supply?
Dorsiflexion and extension of digits
Deep peroneal nerve
Anterior tibial artery
What is the function of the posterior compartment of the leg and what is the nerve and blood supply?
Plantarflexion and flexion of digits
Tibial nerve
Posterior tibial artery
What is the function of the lateral compartment of the leg and what is the nerve and blood supply?
Eversion
Superficial peroneal nerve
Fibular artery
What are the two branches of the sciatic nerve?
Tibial nerve (posterior comp) Common fibular/common peroneal nerve (anterior and lateral compartments of leg)
What are the three bones involved in the ankle joint?
Tibia
Fibula
Talus
What bone forms the heel of the foot?
Calcaneus
What are the ligaments of the ankle?
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament (lateral)
Deltoid ligament (medial)
What is the blood supply to the neck and the head of the femur?
The medial circumflex artery
Avascular necrosis to the femoral head can occur when which artery is damaged?
The medial circumflex artery
