Anatomical Spaces of Clinical Importance of the Lower Limb Flashcards
1
Q
What are the important clinical spaces in the lower limb
A
- Femoral triangle
- Popliteal fossa
- Medial aspect of the knee
- Ankle joint
- Dorsal surface of the foot
2
Q
What is the inguinal ligament also know as and what is its significance
A
- Poupart’s ligament
- Forms the anatomical boundary between the abdomen and the thigh
3
Q
Where does the inguinal ligament start and end
A
- From ASIS to pubic tubercle
4
Q
What is the inguinal canal
A
- An intermuscular slit that lies above the medial half of the inguinal ligament
5
Q
Where does the inguinal canal start and end
A
- Starts at the deep inguinal ring
- Ends at the superficial inguinal ring
6
Q
What structures does the inguinal canal transmit
A
- Spermatic cord in the male
- Round ligament in the female
- Genital branch of genitofemoral nerve
7
Q
What forms the floor of the inguinal canal and what is this reinforced by
A
- Floor is the in-rolled lower edge of the inguinal ligament.
- Reinforced medially by the lacunar ligament.
- Reinforced laterally by transversalis fascia.
8
Q
What are the superficial and deep inguinal ring
A
- Superficial inguinal ring is a triangular opening in the aponeuroses of the external oblique which forms the end of the inguinal canal.
- Deep inguinal ring is the beginning of the inguinal canal but also where the tranversalis fascia begins to be turned inside out.
9
Q
What are the femoral triangle and the adductor canal also known as
A
- Femoral triangle - Scarpa’s triangle
- Adductor canal - Hunter’s canal
10
Q
What clinical procedures can be carried out due to the femoral triangle
A
- Detection of femoral pulse
- Cannulation of femoral artery for surgical procedures
11
Q
What are the boundaries of the femoral triangle
A
- Superior boundary - Inguinal ligament
- Lateral boundary - medial border of sartorius
- Medial boundary - medial boundary of adductor longus
- Floor - Iliacus, psoas major, pectineus, adductor longus.
- Roof - Superficial fascia and deep fascia of the thigh
12
Q
What is the saphenous opening
A
- Hiatus in deep fascia of the thigh which allows the great saphenous vein to drain into the femoral vein.
13
Q
How does the descending aorta become the femoral artery
A
- Descending aorta becomes common iliac
- Common iliac artery bifurcates into external iliac and internal iliac at pelvic inlet.
- External iliac becomes the femoral artery below the inguinal ligament
14
Q
Where does the femoral artery start and end and where does it run
A
- Starts at the level of the inguinal ligament and ends in the adductor canal.
- Runs midway between ASIS and pubic symphysis
15
Q
What is the shape and location of the popliteal fossa, and what covers the fossa
A
- Diamond-shaped
- Back of the knee
- Deep popliteal fascia
16
Q
What can be felt at the popliteal fossa
A
- Arterial pulse of the leg, and knee must flex to relax the fascia as the artery is deep
17
Q
What are the contents of the popliteal fossa
A
- Nerves
- Popliteal artery (branches to give geniculate branches)
- Popliteal vein (lesser saphenous vein ends in popliteal vein)
- Popliteal lymph nodes
18
Q
What covers the popliteal vessels
A
- Areolar connective tissue
19
Q
What nerves are contained within the popliteal fossa
A
- Tibial nerve
- Common peroneal nerve
- Posterior femoral cutaneous nerve
20
Q
What are the boundaries of the popliteal fossa
A
- Superomedially - Semimembranosus muscle
- Superolaterally - Biceps femoris muscle
- Inferomedially - Medial head of the gastrocnemius
- Inferolaterally - Lateral head of the gastrocnemius
21
Q
Where does the anterior tibial artery start
A
- At the bifurcation of the popliteal artery
22
Q
What does the anterior tibial artery rest upon
A
- Upper two-thirds - interosseus membrane
- Lower third - the front of the tibia and anterior ligament of the ankle joint
23
Q
What vessel does the tibial artery give rise to beyond the extensor reticulum
A
- Dorsalis pedis artery
24
Q
What is the pathway of the dorsal pedis artery
A
- Ankle-joint, tibial side of the dorsum of the dorsum of the foot, first intertarsal space
25
What are the 2 branches of the dorsal pedis artery
- The first dorsal metatarsal artery
- Deep plantar artery
26
Describe the path of the posterior tibial artery
- Descends deep to the soleus and becomes superficial in the lower 1/3 of the leg.
- Passes behind the medial malleolus between the tendons of FDL and FHL
- Divides into medial and lateral plantar arteries below the ankle.
27
Where does the posterior tibial artery become superficial
- Lower third of the leg
28
What is the longest vein in the body and where does it start and end
- Greater saphenous vein
- Starts in medial marginal vein in the foot
- Ends in femoral vein in the upper thigh (3cm below inguinal ligament)
29
When does the great saphenous vein begin to ascend in the foot and where does it ascend in the leg
- Infront of the medial malleolus
- Medial side of the leg (in relation to the saphenous nerve)
30
What does the great saphenous vein drain
- The medial part of the venous plexus of the foor
31
How many valves does the great saphenous nerve have and where are most of these valves located
- 10 to 20 valves
- More valves are located in the leg compared to the thigh
32
What is one clinical use of the great saphenous vein
- Administration of fluids into the veinous system
33
Where does the small (short) saphenous vein start drain and where does it drain into
- Drains the lateral side of the venous plexus of the foot
- Drains into popliteal vein between heads of gastrocnemius
34
Describe the pathway of the small (short) saphenous vein
- Starts as continuation of the lateral marginal vein of the foot
- Ascends along lateral margin of Achilles tendon and crosses obliquely to the middle of the posterior leg
- Then ascends until it perforates the deep fascia to enter the popliteal fossa
35
What are varicose veins and what do they present as
- Valves in perforating veins become incomplete, and blood flows back from deep to superficial veins. This increases intra-luminal pressure which superficial veins cannot withstand.
- Veins become dilates and tortuous, veins appear to protrude.
36
What are the boundaries of the gluteal region
- Superiorly - iliac crest
- Inferiorly - Gluteal fold
37
What is the gluteal region characterised by
- Prominent posterior convexity - buttocks
- A sharply defined gluteal fold
38
What 3 factors cause the large posterior convex bulge in the gluteal region
- A thick layer of fat
- Lower part of a muscle
- Transverse crease of the skin
39
What is the clinical importance of the gluteal region
- Muscles used in walking (gait analysis is important for neurological diagnosis)
- Straight leg raise test (stressing sciatic nerve which runs in gluteal region)
- Major site for intermuscular drug administration.
40
What are the 4 regions of the gluteal region
- Upper inner
- Upper outer
- Lower inner
- Lower outer
41
How is he gluteal region split into 4 regions
- Draw an imaginary horizontal line between greater trochanter and ischial tuberosity.
- Then another vertical imaginary line at the midpoint of the horizontal line
42
In which of the gluteal quadrants can a safe intramuscular injection be administered
- Upper outer quadrant
43
What muscles does the upper outer gluteal quadrant contain
- Gluteus medius
- Gluteus minimus
