A7 - gait/lower limb 1 Flashcards
what does the head of the femur articulate with?
acetabulum to form hip joint
what is the head of the femur covered in? exception?
articular cartilage except at fovea
what does the angle of projection of the neck of the femur allow?
an increased range of movement at the hip joint
what does the intertrochanteric line become after is passes the lesser trochanter on the posterior surface?
pectinate line
what does the intertrochantic crest have on its superior half?
a rounded tubercle called the quadrate tubercle — where quadratus femoris attaches
label the superior half of the femur
where does gluteus maximus attach?
gluteal tuberosity
the linea aspera splits to form what?
lateral and medial supracondylar lines
where does the medial supracondylar line end?
adductor tubercle
what attaches to the adductor tubercle?
adductor magnus
where does the flat popliteal surface lie?
between the 2 supracondylar lines
where do the medial and lateral collateral ligaments originate?
lateral and medial epicondyles
is the lateral or medial epicondyle larger?
medial
which condyle of the femur is larger and how does this help?
lateral condyle is more prominent — helps prevent the natural lateral movement of the patella
what do the posterior, inferior and anterior surfaces of the medial and lateral condyles articulate with?
- posterior and inferior with tibia and menisci of knee
- anterior with patella
what does the intercondylar fossa contain?
2 facets for attachment of intracorpuscular knee ligaments
what attaches to the medial aspect of the lateral condyle of the femur?
anterior cruciate ligament (ACL)
what attaches to the lateral aspect of the medial condyle?
posterior cruciate ligament (PCL)
the intercondylar eminence of the tibia projects upwards on either side to form what?
the intercondylar tubercels
the condyles of the tibia forms a flat surface known as what?
the tibial plateau
what does the tibial plateau articulate with?
femoral condyles to form the key articulation of the knee joint
what do the intercondylar tubercles of the tibia articulate with?
the intercondylar fossa of the femur
label the proximal part of the tibia
what does the lateral condyle of the tibia aid in?
weight bearing
what is the site of attachment for the patella ligament?
tibial tuberosity
what is the intercondylar notch of the tibia occupied by?
2 cruciate ligaments
what is the place of the final insertion of the quadriceps tendon?
tibial tubercle
what is the soleal line on the tibia the site of origin for?
soleus muscle
what usually runs proximal to the soleal line?
a nutrient artery
what is the lateral border of the tibial known as and what does it give attachment to?
interosseous border — gives attachment to the interosseous membrane
what binds the tibia and fibula together?
interosseous membrane
what does the medial malleous articulate with?
tarsal bones to form part of ankle joint
is the soleal line on the anterior or posterior side of tibia?
posterior
describe the fibular notch?
- on tibia
- where fibula is bound to tibia
- forming the distal tibiofibular joint
what groove is on the back of the tibia?
groove for tibialis posterior tendon
what is the main function of the fibula?
muscle attachment (not weight-bearing)
what bone is in the lateral part of the lower leg?
fibula
what can be found on the posterior and lateral surface of the fibula neck?
common fibular neck
describe the proximal and distal tibiofibular joints
- have almost no movement at these joints
- proximal joint is synovial
- distal is fibrous
which malleolus is more prominent?
lateral
the head of the fibula contains a facet for articulation with what?
lateral condyle of tibia
what 3 surfaces does the shaft of the fibula have?
anterior, lateral and posterior
what is the patella embedded in?
quadriceps tendon therefore a sesamoid type of bone
what is the patella attached to superiorly and inferiorly?
superior - quadriceps tendon
inferior - patellar ligament
what do the medial and lateral facets of the patella articulate with?
- medial facet — medial condyle of femur
- lateral facet — lateral condyle of femur
describe the apex of the patella
- situated inferiorly
- connected to the tibial tuberosity by the patellar ligament
the base of the patella provides attachment for what?
quadriceps tendon
what are the 2 functions of the patella?
- leg extension — enhances the leverage that the quadriceps tendon can exert on the femur, increasing the efficiency of the muscle
- protection — protects the anterior aspect of the knee joint from physical trauma
A = talus
B = calcaneus
C = navicular
D = medial cuneiform
E = intermediate cuneiform
F = lateral cuneiform
G = cuboid
H = 1st metatarsal
I = 5th metatarsal
J = proximal phalanx
K = middle phalanx
L = lateral phalanx
what bone transmits weight of entire body to the foot?
talus
what is the name of the joint between the talus and calcaneus?
subtalar joint
what is the name of the joint between the talus and navicular?
talonavicular joint
what is the name of the joint between the calcaneus and cuboid?
calconeocuboid joint
what is different about the big toe?
has only 2 phalanges
what is the calcaneus marked by?
calcaneal tuberosity
what attaches to the calcaneal tuberosity?
Achilles tendon
the navicular has a tuberosity on is plantar surface for what?
the tibialis posterior tendon
what makes up the hind foot?
talus and calcaneus
what makes up the midfoot?
navicular, cuboid and cuneiforms
what makes up the forefoot?
metatarsals and phalanges
the foot is made up of numerous of small bones which are connected by ligaments. how is this arrangement beneficial?
increases flexibility, assists in shock absorption and maintains stability when standing on uneven surfaces
what are the 3 arches of the foot?
2 longitudinal (medial and lateral) and 1 transverse
what are the functions of the arches of the foo?
bear the weight of the body and absorbing the shock produced during locomotion
what bones make up the medial longitudinal arch?
made up of the calcaneus, the talus, the navicular, the 3 cuneiforms, and the 1st 3 metatarsals
what is the chief characteristic of the medial longitudinal arch?
its elasticity
is the medial or lateral longitudinal arch higher?
medial
what bones make up the lateral longitudinal arch?
the calcaneus, cuboid, and the 4th and 5th metatarsals
what are the chief characteristics of the lateral longitudinal arch?
its solidity and its slight elevation
what bones make up the transverse arch of the foot?
the metatarsal bases, the cuboid and the 2 cuneiform bones
A = medial cuneiform
B = navicular
C = talus
D = cuboid
E = intermediate cuneiform
F = calcaneus
G = lateral cuneiform
what are C and D?
C = head of talus
D = sustentaculum tali = on planteromedial aspect of calcaneus
what is the main artery of the lower limb?
femoral artery
what is the femoral artery a continuation of?
external iliac artery
when does the external iliac become the femoral artery?
when it crosses under the inguinal ligament and enters the femoral triangle
after exiting the femoral triangle, the femoral artery continues down the anterior aspect of the thigh through a tunnel called what?
adductor canal
femoral artery becomes known as what when it enters the posterior compartment of the thigh, proximal to the knee?
popliteal artery
what are the branches of the femoral artery?
- 2 small branches = superficial circumflex iliac which runs laterally and the external pudendal which runs medially
- 1 large branch = deep femoral artery
what are the branches of the deep femoral artery?
- perforating branches
- lateral femoral circumflex
- medial femoral circumflex
what are the borders of the femoral triangle?
- superior = inguinal ligament
- medial = adductor longus
- lateral = sartorius
what runs in the femoral triangle?
lateral —> medial = femoral nerve, artery, vein
what is the femoral sheath?
- contains the femoral artery and vein
- continuation of the abdominal fascia
- in femoral triangle
what is the femoral canal?
- empty space medial to the femoral vein
- lymphatics
- exercise — increased vasodilation
describe the blood supply of the head of the femur
- caudal = medial and lateral circumflex (branches of deep femoral)
- cranial. = foveal artery (branch of obturator artery)
what does the obturator artery arise from?
internal iliac in the pelvic region
the obturator artery descends via the obturator canal to enter the medial thigh, where it bifurcates into what 2 branches?
anterior branch — supplies pectineus, obturator external , adductor muscles and gracilis
posterior branch — supplies some of the deep gluteal muscles
the gluteal region is largely supplied by what?
supeior and inferior gluteal arteries
what do the superior and inferior gluteal arteries arise from and where do they enter the gluteal region?
arise from internal iliac, entering the gluteal region via the greater sciatic foramen
where do the superior and inferior gluteal arteries run in relation to the piriformis muslce?
- the superior gluteal artery leaves the foramen above the piriformis muscle, the inferior below the muscle
the popliteal artery descends down the posterior thigh, giving rise to ______ branches that supply the knee joint
geniculate
where does the popliteal artery exit the popliteal fossa?
between the gastrocnemius and popliteal muscles
the popliteal artery terminates by dividing into what?
the anterior tibial artery and the tibioperoneal trunk
what does the tibioperoneal trunk divide into?
posterior tibial artery and the fibular (peroneal) artery
the posterior tibial artery continues inferiorly down the deep posterior leg, entering the sole of the foot via the _____, accompanying the _____
via the tarsal tunnel accompanying the tibial nerve
describe the fibular (peroneal) artery
descends posteriorly to the fibula, within the posterior compartment of the leg. gives rise to perforating branches which penetrate the intermuscular septum to supply muscles in the lateral compartment of the leg.
describe the anterior tibial artery. what does it become?
passes anteriorly between the tibia and fibula, through a gap in the interosseous membrane. it then moves inferiorly down the leg. it runs down the entire length of the leg, and into the foot, where it becomes the dorsalis pedis artery
what does the popliteal artery give off above and below the knee?
above — the superior lateral and superior medial genicular arteries
below — inferior medial and inferior lateral genicular arteries
what is the deepest structure in the popliteal fossa?
popliteal artery
where do you palpate the posterior tibial artery?
medial malleous
what is the role of the medial compartment of the thigh?
adduction
what are the 2 arteries of the foot?
dorsalis pedis and posterior tibial
what is dorsalis pedis artery a continuation of?
anterior tibial
what does dorsalis pedis artery anastomose with to form the deep plantar arch?
lateral plantar artery
wha does the dorsalis pedis artery supply?
the tarsal bones and the dorsal aspect of the metatarsals, and via the deep plantar arch also contributes to the supply of the toes
posterior tibial artery enters the sole of the foot through what?
the tarsal tunnel
what does the posterior tibial artery split into?
lateral and medial plantar arteries
what do the anterior and medial plantar arteries supply?
plantar side of the foot and contributes to the supply of the toes via the deep plantar arch
deep vs superficial veins of the lower limb
deep = under the deep fascia, accompanying major arteries
superficial = found in subcutaneous tissue. eventually drain into deep veins
what is the main venous structure in the foot and where does it drain?
dorsal venous arch - mostly drains into superficial veins. some veins from the arch penetrate deep into the leg, forming the anterior tibial vein
on the plantar aspect of the foot, medial and lateral plantar veins arise —> these combine to form the _______ and ______ veins
posterior tibial and fibular veins
the posterior tibial vein accompanies the posterior tibial artery, entering the leg posteriorly to the _______
medial malleolus
what 3 veins unite to form the popliteal vein?
anterior tibial, posterior tibial and fibular veins
the popliteal vein enters the thigh via what?
the adductor canal
he femoral vein leaves the thigh by running underneath the ________, at which point it is known as the _________
- underneath the inguinal ligament
- external iliac vein
inferior and superior gluteal veins — empty into _______
internal iliac vein
superficial veins of lateral aspect of foot join to form _______
medial aspect from _________
lateral - short saphenous vein
medial - long saphenous vein
the great saphenous vein arises from the union of what?
dorsal venous arch and the vein of the great toe
where does the great saphenous vein in relation to the medial malleolus?
anterior to medial malleolus
on what side of the leg does the great saphenous vein run?
medial aspect of leg
where does the great saphenous vein ascend in relation to the medial condyle of the femur?
posterior to it
the small saphenous vein arises from the union of what?
dorsal venous arch and vein of small toe
where does the small saphenous vein pass in relation to the lateral malleolus?
posterior to it
the small saphenous vein ascends lateral to the _____ then between the 2 heads of the ______
- lateral to the Achilles’ tendon
- 2 heads of the gastrocnemius
what does the small saphenous vein drain into?
popliteal vein
what does the great saphenous vein drain into after passing throguh the saphenous opening?
femoral vein
what branch does the femoral artery give off in the femoral triangle?
profunda femoris
what does the popliteal artery lie deep to in the popliteal fossa?
tibial nerve and popliteal vein
the popliteal artery terminates at the lower border of the popliteal fossa by dividing into what?
anterior and posterior tibial arteries
what muscle does the posterior tibial artery pass deep to to supply the posterior compartment of the leg?>
gastrocnemius
where does the posterior tibial artery pass in relation to the medial malleolus?
posterior to it
what are the roots of the femoral nerve?
L2, L3,L4
what does the femoral nerve lie lateral to in the femoral triangle?
femoral artery
what are the roots of the obturator nerve?
L2, L3, L4
what does the obturator nerve pass through?
obturator canal
the sciatic nerve enters the gluteal region from under what?
the prifirmois msucle
what does the sciatic nerve divide into?
common peroneal and tibial nerves
describe the course of the common perineal (fibualr) nerve
- passes through the popliteal fossa close to the medial border of the lateral head of gastrocnemius
- it passes behind the head of the fibula
- terminates by diving into the superficial and deep peroneal (fibular) nerves
describe the course of the tibial nerve
- passes into the posterior compartment of the leg betweeen the 2 heads of gastrocnemius
- descends deep to gastrocnemius and soleus
- passes into the foot posterior to the medial malleolus
sciatic nerve roots
L4-S3
which nerves give motor innervation to the anterior, medial and posterior compartments?
anteior = femoral
medial = obturator
posterior = sciatic
where do the femoral and obturator nerves emerge in relation to psoas major?
- femoral = lateral to it
- obturator = medial to it
what nerves leave the pelvis through the greater sciatic foramen?
sciatic, superior and inferior gluteal nerves
what does the sciatic nerve supply?
- motor and sensory innervation to posterior thigh
- anterior branch —
- motor ; nerve to Sartorius
- sensory : medial and intermediate femoral cutaneous nerve of thigh - posterior branch —
- motor : nerve to pectineus, muscular branches (quads supply)
- sensory : saphenous
the obturator nerve gives motor innervation to what?
all the medial muscles of the thigh (hip adductors) (except hamstring part adductor magnus)
obturator sensory innervation?
to the skin over the proximal part of the medial thigh
injury to which nerve is rare as it lies deep within the pelvis and medial thigh?
obturator nerve
which nerve descends throguh the fibres of the psoas major muscle and emerges from its medial border near the pelvic brim to enter the lesser pelvis?
obturator nerve
what nerve is the longest branch of the lumbar plexus?
femoral nerve
where does the femoral nerve emerge?
lower border of psoas major, then descends beneath the midpoint of the inguinal ligament to enter the femoral triangle
motor and sensory functions of femoral nerve
- motor : innervates the anterior thigh muscles that flex the hip joint and extend the knee
- sensory functions : supplies cutaneous branches to the anteromedial thigh and the medial side of the leg and foot
a nerve block in which nerve can also be as peri-operative analgesia for patients with a fractured femur?
femoral
describe the dermatomes in the leg
what is the obturator artery a branch of?
internal iliac
what is the terminal branch of the femoral nerve?
saphenous nerve
what is the name of the flat surface on the proximal tibia that articulates with the femoral condyles?
tibial plateau
what do superficial peroneal and deep peroneal nerves supply?
superficial - lateral compartment
deep - anterior compartment
function of flexor retinaculum
prevents bowstring of the tendons
what does the anterior tibial artery pass beneath to then emerge as the dorsalis pedis artery?
extensor retinaculum
The medial longitudinal arch is the largest and most important. Two muscles insert into the base of the first metatarsal and the medial cuneiform and therefore help to strengthen the medial arch. what are these muscles?
peroneus longus and tibialis anterior
Which group of lymph nodes do the vessels that accompany the great saphenous vein drain into?
superfical inguinal nodes
Lymph from the superficial inguinal nodes drains directly into the external iliac nodes or into which nodes?
deep inguinal nodes
Which group of lymph nodes do the vessels that accompany the short saphenous vein drain into?
popliteal nodes
Where do efferent vessels from the popliteal nodes drain to?
deep inguinal nodes
Some superficial vessels drain directly into the _________ nodes
Lymph from the vessels that surround the deeps veins of the lower limb drain into the________ nodes or directly into the _________ nodes.
Efferent vessels from the deep inguinal nodes empty into the ___________ nodes.
Some superficial vessels drain directly into the deep inguinal nodes
Lymph from the vessels that surround the deeps veins of the lower limb drain into the popliteal nodes or directly into the deep inguinal nodes.
Efferent vessels from the deep inguinal nodes empty into the external iliac nodes.
