5 LE Vessels + Nerves Flashcards
arterial supply of foo comes from the following:
(1) anterior tibial artery [dorsum]
(2) posterior tibial artery [plantar]
anterior tibial artery
branch off popliteal artery (behind superior tibia)
- passes through IOM
- continues as dorsalis pedis
- PALPABLE
dorsalis pedis
lateral to exterior hallicus longus tendon @ navicular bone
dorsalis pedis divides into:
(1) deep plantar artery
(2) arcuate artery [dorsal metatarsal arteries][dorsal digital arteries]
posterior tibial artery
branch off popliteal artery
- spans tibia to medial malleolus
- PALPABLE
posterior tibial artery divides into:
(1) medial plantar artery
(2) lateral plantar artery
**meet to form deep plantar arch
deep plantar arch divides into:
(1) plantar metatarsal arteries
(2) plantar digital arteries
peripheral artery (vascular) disease
poor circulation in peripheral arteries
- caused by atherosclerosis + otro damage to vessels
- common in males > 60 years
- pulse can be felt above but not below acclusion/blockage
peripheral
not coroneous, brain or aorta
venous drainage
pattern of veins more variable + anastomose more frequently
superficial veins
location: subcutaneous, in superficial fascia
(ie) great/small saphenous veins + tributaries
deep veins
located within muscular compartments
(ie) tibial, fibular, popliteal + femoral veins/tributaries
perforating veins
connect superficial + deep veins
- valves ensure one-way flow from superficial to deep
venous pump
contraction of muscles of expansion of arteries w/ each heart beat drives venous blood toward heart
- blood = sucked from superficial to deep veins when muscles relax
- valves ensure one-way flow
varicose veins
gnarled, enlarged veins, most commonly appearing in the legs and feet
- common in great saphenous vein
coronary bypass
great saphenous vein used b/c:
(1) readily accessible (superficial)
(2) length btwn tributaries + perforating veins = enough to harvest useable amounts
(3) higher % muscle + elastic fibers than other veins (FCN most similar to artery)
deep vein thrombrosis (DVT)
“deep vein clot”
formation of blood clot in deep vein
- characterized by warmth, swelling, redness + pain in area
Virchow’s Traid
factors that contribute to thrombosis
(1) tunica interna [endothelium] injury
(2) increase coagulability of blookd [prone to blood clots]
(3) venous stasis [bad blood flow]
venous stasis is caused by (4):
bad blood flow
(1) prolong sitting, lying down
(2) tight cast or bandage
(3) muscular inactivity
(4) loose fascia
thromboembolism
large clot that breaks free + travels through blood stream
- may cause pulmonary embolism [blocked artery] y death
lumbosacral plexus is made up of
lumbar plexus
sacral plexus
lumbar plexus
ventral rami of spinal nerves L1-L4
sacral plexus
ventral rami of spinal nerves L4-S4
major nerves of lumbar plexus
femoral nerve
obturator nerve
femoral nerve
innervates anterior thigh muscles + iliopsoas
obturator nerve
innervates adductor muscles
major nerves of sacral plexus
superior gluteal nerve
inferior gluteal nerve
sciatic nerve
pudendal nerve
superior gluteal nerve
innervates gluteus medius + gluteus minimus
inferior gluteal nerve
innervates gluteus maximus
sciatic nerve
-> tibial nerve -> medial y lateral planter nerves -> common fibular (peroneal) nerve -> superficial fibular y deep fibular nerves
sural (cutaneous) nerve
originates from femoral nerve
- foot nerve
saphenous (cutaneous) nerve
originates from tibial nerve y common fibular nerve merging together
- foot nerve
foot drop
patient will present complaining of excessive tripping (catching toes on ground on forward swing in walking)
- may drag toes or have “waddling gait,” “swing-out gait,” or “slap-steppage gait”
- foot position: plantar flexion + inverted -> dragging foot
usually also sensory loss down anterior y lateral sides of leg + dorsum of foot/toes [including medial side of great toe] - damage to common fibular nerve
common fibular nerve
winds around fibular neck to enter fibularis longus
- travels laterally along biceps tendon
- most vulnerable to injury around neck of fibula
- damage = common cause of foot drop
paralyzed muscles in foot drop:
(1) anterior compartment extensors
(2) lateral compartment evertors
**action of opposing muscles (inverters/flexors) causes foot position
femoral triangle
located in superior anterior thigh, inferior to inguinal ligament
femoral triangle boundaries
superior: inguinal ligament
medial: adductor longus
lateral: sartorius
contents of the femoral nerve
lateral to medial:
femoral Nerve
Artery
Vein
Lymphatics
NAVEL
femoral sheath
about 3-4cm fascial tube passing deep to inguinal ligament
- continuation of transversalis y iliopsoas fascia
FCN of femoral sheath
allow femoral vessels to glide during hip movement
femoral sheath compartments (3)
(1) lateral: femoral artery
(2) intermediate: femoral vein
(3) medial: femoral canal [contains lymphatics] - allows femoral vein to expand
femoral ring
opening to femoral sheath compartments
femoral herniation
protrusion of abdominal viscera femoral ring into femoral canal
- palpable knot in groin area @ location of femoral pulse
- results in strangulation of viscera y femoral artery
**more common in females due to wider pelvis
gunshot y stab wounds in femoral triangle
no muscle covering therefore quicker death
- it’s like stabbing the aorta
adductor canal
fascial tunnel (intermuscluar passage) deep to middle 1/3 of Sartorius
- passage for femoral vessels enroute to popliteal fossa
- spans from apex of femoral triangle to adductor hiatus
adductor canal boundaries
(1) medial: sartorius
(2) lateral: vastus medialis
(3) posterior: adductor longus
adductor canal contents
femoral artery/vein
saphenous vein
popliteal fossa
located in posterior knee
- diamond-shaped
popliteal fossa boundaries
(1) superolateral: biceps femoris
(2) superomedial: semimembranosus y semitendionosus
(3) inferior: gastrocnemius
nerves of popliteal fossa
**sciatic nerve splits near apex
(1) common fibular (peroneal) nerve
(2) tibial nerve
(3) sural nerve
vessels of popliteal fossa
popliteal artery
popliteal vein
popliteal artery
deepest VAN (next to joint capsule)
popliteal nerve
formed @ distal border when anterior/posterior tibial veins merge
- small saphenous vein joins mid-fossa
popliteal (Baker’s) cysts
swelling of bursa or accumulation of synovial fluid in popliteal fossa
- causes pain
- impedes movement
- treatement: aspirate/drain + rest
