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MSK > 7 - Anterior and Lateral Leg > Flashcards

7 - Anterior and Lateral Leg Flashcards

1
Q

What forms the anterior, lateral and posterior compartments of the leg?

A

Tibia, fibula, interosseous membrane, anterior and posterior intermuscular septa

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2
Q

What is the common action of the anterior compartment?

A

Dorsiflexion/extension

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3
Q

What bounds the anterior compartment?

A

Anteriorly: skin and deep fascia
Medially: LATERAL tibia
Posteriorly: interosseous membrane
Laterally: anterior intermuscular septa

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4
Q

Why is this compartment more vulnerable to compartment syndrome?

A
  • it is bound on 3 sides by fairly rigid structures (tibia, fibula and interosseous membrane (tough and fibrous like fascia)
  • unlike in the thigh there isn;t a lot of empty space and is tight
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5
Q

What are the muscles, nerve supply and blood supply to the anterior compartment of the leg?

A
  • Tibialis Anterior
  • Extensor Digitorium Longus (more anterior to hallucis)
  • Extensor Hallucis Longus
  • Peroneus Tertius

> Deep Peroneal Nerve
Anterior Tibial Artery

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6
Q

Where does the hip joint have the greatest range of movement?

A

The hip joint has the greatest range of movement in flexion and abduction, as the joint capsule is the most loose on the anterior and lateral aspects.

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7
Q

What connects the fibula and tibia?

A

Interosseous Membrane

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8
Q

What muscle lies between the femoral artery and profunda femoris?

A

Adductor Longus

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9
Q

Where do the muscles of the anterior compartment act?

A
  • On the foot at the ankle joint proper to dorsiflex

- Some act on the subtalar to invert/evert

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10
Q

Where do the anterior tibial artery and deep peroneal nerve run?

A

Along the interosseous membrane, deep to Extensor Hallucis Longus and Tibialis Anterior

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11
Q

Tibialis Anterior?

A

O: Superior half of lateral tibia
I: Medial cuneiform and base of the 1st metatarsal

> Inversion and dorsiflexion

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12
Q

Nerve supply to the anterior compartment?

A

Deep Peroneal

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13
Q

Extensor Digitorum Longus

A

O: Lateral condyle of tibia, superior medial tibia and interosseous membrane (deep to tib ant)
I: Middle and distal phalanges of lateral 4 toes

> Extend toes and dorsiflex ankle

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14
Q

Extensor Hallucis Longus

A

O: Middle anterior fibula and interosseous membrane (deep to EDL)
I: Base of the distal phalanx of the great toe

> Extend great toe and dorsiflexes ankle

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15
Q

Peroneus Tertius

A

O: INFERIOR anterior fibula and interosseous membrane
I: Base of the 5th metatarsal

> Eversion and dorsiflexion

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16
Q

How is dorsiflexion balanced when walking?

A

Tibialis anterior inverts foot (medial cuneiform and 1st MT)

Peroneus Tertius everts foot (5th MT)

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17
Q

What are the muscles in the lateral compartment of the leg, what is the nerve supply and vascular supply?

A

Peroneus Longus
Peroneus Brevis
> Superficial Peroneal Nerve
> Peroneal Artery

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18
Q

Peroneus Longus

A

O: Superior lateral fibula
I: Base of the 1st MT and medial cuneiform

> goes posterior to the lateral malleolus, UNDER the foot and inserts to 1st MT and medial cuneiform
STRONG eversion, weak plantarflexion

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19
Q

Peroneus Brevis

A

O: Inferior lateral fibula (deep to peroneus brevis)
I: Base of the 5th MT

> also goes around the lateral malleolus
Eversion and weak plantarflexion

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20
Q

What muscles insert at the 5th MT?

A

Peroneus Tertius and Peroneus Brevis

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21
Q

What muscles insert at the base of the 1st MT and medial cuneiform?

A

Tibialis Anterior and Peroneus Longus

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22
Q

What is the retinaculum and what is its purpose?

A
  • is thick bands of fascia

- the retinaculum holds down the tendons tight at the ankle joint and prevents bowstringing to maintain the line of pull

23
Q

What are the retinaculum at the ankle?

A

Superior and inferior EXTENSOR Retinaculum (anteriorly)

Superior and inferior peroneal retinaculum (laterally)

24
Q

Describe the superior extensor retinaculum

A
  • band of deep fascia from the tibia to the fibula, superior to the malleoli
  • binds down tendons of the ant comp to prevent bowstringing during dorsifexion
25
Q

Describe the inferior extensor retinaculum

A
  • Y shaped band of thickened deep fascia
  • laterally attached from the calcaneous to the medial malleolus and the plantar aponeurosis
  • at lateral insertion to the calcaneous the fibres link up to the inferior peroneal retinaculum
26
Q

Superior and inferior peroneal retinaculum

A

Superior: Lateral malleolus > calcaneous
Inferior: Calcaneous > Inferior extensor retinaculum

27
Q

Describe the path of the Sciatic Nerve

A

Sciatic Nerve (L4-S3)
> Splits in 2 at the back of the thigh to become the Common Peroneal Nerve and the Tibial Nerve
> Tibial N continues posterior while Common Peroneal splits in popliteal fossa goes lateral (superficial)/anterior (deep)
> Branch off of Tibial N and Common Peroneal form Sural Nerve which is cutaneous (S1)

28
Q

What spinal nerves contribute to the Lumbosacral Plexus?

A

L2-S2/3

29
Q

Nerves of the Sciatic Nerve?

A

L4 - S3

30
Q

What spinal levels do each of the nerves from the sciatic nerve contain?

A

Same as the sciatic nerve - L4-S2

> Tibial, CPN, SPN, DPN

31
Q

Dermatome of the sural nerve?

A

S1

32
Q

Muscles innervated by DPN?

A

TA
EDL
EHL
PT

33
Q

Muscles innervated by SPN?

A

PL

PB

34
Q

Where does the deep peroneal nerve become cutaneous?

A

!st webspace

after supplying muscles in the dorsum of the foot

35
Q

Where does the superficial peroneal nerve become cutaneous?

A

Anterior/lateral leg and most of the dorsum of the foot

36
Q

Where does the CPN run?

A
  • Wraps around head of the fibula and becomes very superficial (prone to damage)
  • SPN stays superficial in lateral compartment and becomes very superficial 2/3 way down fibula and then splits and runs across the dorsum of the foot (very adherent to skin)
37
Q

Describe the cutaneous supply to the foot

A

Lateral = SURAL nerve
Most of dorsum = superficial peroneal nerve
1st webspace = deep peroneal nerve
Medial = Saphenous Nerve (medial malleolus no sensation? May be femoral n damage)

38
Q

Spinal nerve contributions to the Superior and Inferior Gluteal Nerves?

A 
Superior = L4 - S1
Inferior = L5 - S2
39
Q

Describe the arrangement of structures at the ankle from medial to lateral

A 
The Hospitals Are Very Nasty Diseased Places
     Tibialis anterior
ext Hallucis longus
      Anterior tibial artery
anterior tibial Vein
deep peroneal Nerve
ext Digitorum longus 
Peroneus tertius
40
Q

Describe the cutaneous supply of the lower limb

A

Femoral: anterior medial thigh
Obturator: medial thigh
Saphenous: Anterior medial leg and foot
Deep Peroneal: 1st webspace
Superficial Peroneal: dorsum foot and lateral anterior leg
Sural: Very lateral foot and lateral/posterior leg
Lateral cutaneous of the leg and thigh and posterior cutaneous

41
Q

How does the tibial nerve terminate?

A

Medial and lateral plantar nerves

42
Q

Where do the medial and lateral plantar nerves arise from?

A

Terminal Tibial nerve

43
Q

Where does the popliteal artery trifurcate?

A

As it exits the popliteal fossa into the anterior tibial artery, posterior tibial artery and peroneal artery

44
Q

Describe the pathway of the anterior tibial artery

A
  • needs to get from the posterior to anterior
  • passes anteriorly through a hole in the interosseous membrane and sits on membrane
  • at the ankle joint it passes down the middle between EHL and deep peroneal nerve + EDL and becomes dorsalis pedis after passing under EHL
  • dorsalis pedis gives off the Deep Plantar Artery, Lateral Tarsal Artery and Arcuate Artery
45
Q

What branches does dorsalis pedis give off?

A
  • Deep Plantar Artery
  • Lateral Tarsal Artery
  • Arcuate Artery
46
Q

Where does the posterior tibial artery run?

A
  • Deep to soleus
  • in posterior compartment and runs with tibial nerve and posterior tibial vein
  • eventually runs posterior to the medial malleolus
  • at this point divides into the medial and lateral plantar arteries (supply sole of the foot)
47
Q

Where does the peroneal artery run?

A

Runs laterally towards the fibula but still within the DEEP posterior compartment
Supplies both the lateral and posterior compartment

48
Q

Why is the Dorsalis Pedis Artery so important?

A
  • runs in line with the 2nd toe
  • inobtrusive way to take pulse
  • not invasive
  • a good pulse here means there is a good supply to other body parts as extremities are supplied
  • is 1st to disappear in vascular diseases and low BP
49
Q

What nerve is likely to be injured in Foot Drop?

A
  • in foot drop the passive position of the foot is plantarflexed and inverted
  • the anterior/dorsiflexion compartment is affected
  • common peroneal or deep peroneal nerves are injured
  • results in high steppage gait and slapping gait as can’t pick up foot
50
Q

Describe compartment syndrome in the lower leg

A
  • is limb threatening and potentially life threatening
  • most common in leg/forearm following trauma
  • occurs when the pressure in a compartment exceeds arterial so there is no arterial supply to the compartment putting muscles and eventually nerves at risk of ischemia and necrosis
  • when a bone breaks and IF the skin and fascia are still in tact this fills and increases pressure in the compartment
  • there is no space for the pressure to dissipate to
51
Q

What is the order of things affected in compartment syndrome?

A
  1. Veins - compress and so venous return decreases (not much of a problem but means more fluid building up)
  2. Arteries - everything supplied dies and everything DOWNSTREAM
  3. in 4-6 hours the muscle is dead and will not work again
  4. eventually nerves
52
Q

How do you treat compartment syndrome?

A
  • if there is compartment syndrome in any single compartment then ALL the compartments will be opened
  • antero-lateral fascia incision
  • postero-medially in fascia (avoid vessels - great saph etc)
  • often see scars down each side of leg
  • open from knee down to ankle for 2 weeks until pressure drops
  • use a skin graph to close. Can take months to years to go down
53
Q

What are the 5 clinical findings of compartment syndrome?

A 
Pain - DEVELOPS (1st sign. Very painful)
Pallor - pale as loss of blood supply
Pulselessness - vessels compressed
Paresthesia - numb (nerves later)
Paralysis - nerve stops functioning

MSK (29 decks)

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