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Lower Limb > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Name the 4 regions of the lower limb.

A

Gluteal region
Thigh
Leg
Foot

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2
Q

Describe the location of the centre of gravity down the lower limb.

A

Posterior to the hip, anterior to the knee and anterior to the ankle.

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3
Q

Define the pelvic girdle.

A

L and R hip bones connected at the front by the pubic symphesis and at the back by the sacrum.

Tilted at 60 degrees to give support to the pelvic organs.

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4
Q

What type of joint is the sacroiliac joint?

A

Modified synovial joint

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5
Q

What type of joint is the pubic symphesis?

A

Secondary cartilaginous joint

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6
Q

Name the three componants of the innominate bones.

A

Ilium
Ischium
Pubis

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7
Q

Name the key bony features of the hip bones. (16)

A

ASIS, AIIS, Iliac crest, iliac tuberosity, greater sciatic notch
Pubic tubercle, superior pubic ramus, inferior pubic ramus (ischiopubic ramus) , pubic symphesis, pubic crest
Ischial spine, lesser sciatic notch, ischial tuberosity, ischial ramus (ishiopubic ramus)
Acetabulum, obturator foramen.

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8
Q

Name the three neurovasculature exits from the pelvis and how they are formed.

A 
Greater sciatic foramen (posterior route to gluteal region): Sacrospinous and sacrotuberous ligs turn the greater sciatic notch into  foramen.
Obturator canal (medial route to thigh): Obturator foramen covered by membrane except small hole = obturator canal.
Under the inguinal ligament (anterior route to thigh): Inguinal lig from ASIS to pubic tubercle. For femoral vessels and nerve.
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9
Q

What is the name of the fascia of the thigh?

A

Fascia lata

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10
Q

What is the iliotibial tract?

A

Specialised thickening of the fascia lata along the lateral boarder of the thigh.

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11
Q

Name the openings of the fascia lata.

A

Saphenous opening (top of thigh) and the popliteal opening (behind knee at popliteal fascia). For the greater and lesser saphenous veins.

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12
Q

Name the fascia of the leg.

A

Crural fascia

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13
Q

Name the retinaculae of the ankle and their general function.

A

Sup and inf extensor retinaculae
Sup and inf peroneal retiaculae
Flexor retinaculum

Prevent bow stinging.

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14
Q

Describe the nerves of the lower limb.

A 
Femoral nerve (L2-4) - ant thigh
Obturator nerve (L2-4) - med thigh
Sciatic nerve (L4-S3) - tibial nerve (supplies posterior thigh and leg, forms med and lat plantar nerves to supply sole of foot) and peroneal/fibular nerve (supplies extensor and lateral compartments of leg and dorsum of foot).
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15
Q

Outline the femoral artery and its divisions.

A 
External iliac -> Femoral -> popliteal 
Profunda femoris (main branch of femoral - supplies medial and post thigh. Has 6 branches = med & lat circumflex femoral and 4 perforating arteries).
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16
Q

Describe the 4 pulse points in the lower limb.

A

Femoral pulse - mid-inguinal point
Popliteal pulse - felt in a flexed knee
Post tibial pulse - just behind and below med ankle
Dorsalis pedis pulse - dorsum of foot.

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17
Q

What are the superficial veins of the lower limb?

A

Greater and lesser saphenous veins

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18
Q

Where are the lymph nodes of the lower limb?

A

Deep: Popliteal and inguinal (including Cloquet’s node in the femoral canal)
Superficial: T shaped at saphenous opening.

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19
Q

Name the bony features of the acetabulum and head of femur.

A

Lunate surface, acetabular fossa, acetabular notch
Fovea, head, neck, shaft of femur, greater and lesser trochanter, intertrochanteric line, intertrochanteric crest (quadrate tubercle), linea aspera.

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20
Q

What are the normal angles of inclination and antervesion of the femur?

A 
Inclination = 125 degrees (decreases with age - starts at 160)
Anterversion = 12 degrees forward

coxa valga = abnormally large angle
coxa vara = abnormally low angle
Is a mechanical (virtical) axis and an anatomical axis.

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21
Q

What is Shenton’s line?

A

Continous arch from femoral neck to pubic symphesis. Dislocation or displaced fracture will disrupt line.

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22
Q

What is developmental dysplasia?

A

Congenital displacement of the femur.

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23
Q

Describe the attachments of the hip joint capsule.

A

Acetabular labrum, transverse acetabular lig, intertrochanteric line and neck of femur.

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24
Q

Name the three hip joint capsular ligaments.

A

Iliofemoral lig: AIIS to greater and lesser trochanters (Y shaped)
Ischiofemoral lig: acetabulum to greater trochanter
Pubofemoral lig: acetabulum to lesser trochanter.

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25
Q

What limits flexion of the hip?

A

Hamstrings and trunk

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26
Q

What limits extension of the hip

A

Iliofemoral, pubofemoral ligs

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27
Q

What limits abduction of the hip?

A

Pubofemoral lig, g.trochanter

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28
Q

What limits adduction of the hip?

A

Other limb

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29
Q

What limits med rotation of the hip?

A

Ishiofemoral lig

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30
Q

What limits lat rotation of the hip?

A

Pubofemoral lig

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31
Q

What is the clinical presentation of a femoral dislocation?

A

Limb shortened and med rotated (lateral rotators are made ineffective)

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32
Q

What is the clinical presentation of a hip fracture?

A

Limb shortened and laterally rotated (med rotators (TFL and glut med/min) are made ineffective)

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33
Q

Why is a cervical fracture worse than an intertrochanteric fracture of the femoral head?

A

Cervical fracture will rupture the retinacular arteries (branches of the med and lat circumflex femoral arts) which supply the femoral head. This can lead to avascular necrosis which will cause severe joint problems.

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34
Q

What are the attachments, function and innervation of gluteus maximus?

A

Posterior gluteal line of ilium, sacrum, sacrotuberous lig to gluteal tuberosity and iliotibial tract.

Extension and lateral rotation of hip (getting up, climbing stairs)

Inf gluteal n (L5-S2)

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35
Q

What are the attachments, function and innervation of tensor fascia lata?

A

ASIS to iliotibial tract

Flexor of hip

Sup gluteal n. (L4-S1)

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36
Q

What are the attachments, function and innervation of gluteus medius?

A

lateral ilium between ant and post gluteal lines to greater trochanter.

Abductor of hip (walking)

Sup gluteal n. (L4-S1)

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37
Q

What are the attachments, function and innervation of gluteus minims?

A

Lateral ilium between ant and inf gluteal lines to greater trochanter.

Abductor of hip (walking)

Sup gluteal n (L4-S1)

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38
Q

What is Trendelenburg’s sign?

A

Waddling gait due to deficient glut med/min action. Leads to muscle wasting and flat bum. Caused by lower lumbar damage - collapsed intervertebral disk crushing spinal nerve on effected side.

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39
Q

What are the attachments, function and innervation of piriformis?

A

ant surface of sacrum to trochanteric fossa

lateral rotator, divides neurovasculature

nerve to piriformis (S1-3)

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40
Q

Name the lateral rotators of the hip.

A

Piriformis, Obturator internus, gemeli (sup & inf), quadratus femoris.

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41
Q

Sup and inf gluteal arts arise from which major artery?

A

Int iliac

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42
Q

Using serface anatomy where does the sciatic nerve emerge and descend?

A

Emerges into greater sciatic foramen halfway between the PSIS and ischial tuberosity, then descends and exits gluteal region between the ischial tuberosity and greater trochanter.

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43
Q

Where is the safe site of a gluteal injection? What are the consequences if it is gotten wrong?

A

Upper lateral quadrant.

Injection into the sciatic nerves cause pain down entire limb and can cause paralysis of limb -> drop foot.

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44
Q

What are the three muscles of the hamstrings?

A

Semimembranosus, semi tendinosus, biceps femoris

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45
Q

What are the attachments, function, innervation and blood supply of the hamstrings?

A

All three attach to the ischial tuberosity, short head of biceps from shaft of femur. Semimembranosus inserts medial tibial condyle (gives oblique popliteal lig)
Semitendinosus inserts medial tibia shaft (most superficial)
Biceps femoris inserts on head of fibula.

Extensors of hip, flexors of knee

Tibial n. (L5-S1)

Supplied by Profunda femurs art

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46
Q

Describe the origin and course of the sciatic nerve.

A

tibial and common fibular/peroneal nerve in sciatic sheath. Common peroneal descends laterally, tibial nerve descends down the middle of the calf.

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47
Q

Describe the origin and course of the post cutaneous n. of thigh.

A

S2-3. Superficial. Supplies posterior skin down to half of leg.

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48
Q

Name the muscles of the anterior compartment.

A

Iliopsoas, sartorius, Pectineus, Quadraceps- rectus femoris, vastus medialis, vastus intermedius, vastus lateralis

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49
Q

What are the attachments, function and innervation of iliopsoas?

A

Made of iliacus and psoas muscles with common tendon. Psoas major muscle arises from intervertebral disks L1-5 and is suppled directly by L1-3. The iliac us muscle is from the iliac fossa to the lesser trochanter. Supplied by femoral nerve (L2-3). The muscle is surrounded by Psoas sheath (derived from fascia of post abdominal wall).

Flexor of thigh, or if limb fixed it flexes trunk.

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50
Q

What are the attachments, function and innervation of sartorius?

A

ASIS to medial shaft of tibia.

Tailors muscle - hip flexion & abduction, lat rotation, knee flexion.

Femoral nerve

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51
Q

What are the attachments, function and innervation of pectineus?

A

Pecten of pubis to spiral line of femur.

Adductor of hip

Femoral or obturator nerve.

52
Q

Name the 4 parts, attachments, function and innervation of the quadriceps femoris.

A 
Rectus femoris - AIIS
Vastus medialis - medial linea aspera
Vastus lateralis - lateral linea aspera
Vastus intermedius - front of femoral shaft
all insert in the tibial tuberosity.

Knee extensor

Femoral nerve

Intermedius is very powerful so along with lateralis can cause patella dislocation hence medialis is bulkier to counteract the pull. Medialis wasted first due to bed rest -> increased risk of patella dislocation upon quad contraction.

53
Q

What type of bone is the patella

A

Sesamoid bone

54
Q

Define the origin and distribution of the femoral nerve.

A

L2-4.
Supplies all ant compartment muscle, cutaneous branches to the skin (lat femoral cutaneous L2-3), articular branches to knee and hip joints.
Can get referred pain from knee to hip.

55
Q

Name the muscles in the medial/adductor compartment of the thigh. State their innervation and blood supply.

A

Gracilis, adductor longus, adductor brevis, adductor magnus (adductor and hamstring portion), obturator externus, pectineus.

Obturator nerve. (hamstring part of adductor magnus innervated by tibial nerve)
Profunda femoris artery.

56
Q

What is the name of the hole between the adductor and hamstring parts of adductor mangus and what passes through it?

A

Adductor hiatus. Femoral vessels pass through to reach the popliteal fossa.

57
Q

Which root values make up the obturator nerve?

A

L2-4

Potential for referred pain from knee to hip with this nerve as well as femoral.

58
Q

What is the femoral triangle?

A

Space between ant and med muscular compartments. Contains the femoral neurovascular bundle.
Laterally: sartorius
Medially: adductor longus
Superiorly: inguinal lig
Floor: iliopsoas, pectineus, adductor longus.

59
Q

What is the subsartorial canal?

A

Canal that transmits the femoral vessels and saphenous nerve.

60
Q

What is contained in the femoral sheath?

A

Femoral artery, vein and lymphatics (lat to med)

61
Q

What is a femoral hernia?

A

protrusion of the abdominal cavity out of the saphenous opening.
Always lateral and inf to pubic tubercle.
More common in females due to wider femoral canal (wider hips).

62
Q

Define the boundaries of the popliteal fossa.

A

Medially: Hamstrings (semimembrinosus/tendinosus) above and gastrocnemius below
Laterally: biceps femoris above and gastrocnemius below.
Roof: popliteal fascia and skin
Floor: femur, oblique popliteal log, capsule of knee joint, popliteal muscle.

63
Q

What are the contents of the popliteal fossa?

A

Popliteal artery, popliteal vein, tibial & common peroneal/fibular nerves, cut n. of thigh, genicular branch of obturator nerve, lymph, fat.

64
Q

List the various reasons for lumps in the popliteal fossa.

A

Baker’s cyst - synovial fluid escapes joint capsule and forms a new sac outside joint
Venous thrombus
Enlarged lymph node (hard mass)
Popliteal aneurysm (pulsatile swelling)

65
Q

Name the 7 ligaments that provide stability for the knee joint.

A 
Tibial & fibular collateral
Ant & post cruciate
Meniscofemoral
Oblique Popliteal
Arcuate
66
Q

What is the blood supply to the knee?

A

Genicular arteries

67
Q

Describe the patella-femoral joint.

A

Between the posterior surface of the patella and the femoral condyles.
The lateral articular surface is larger to prevent lateral dislocation.

68
Q

What is a sunrise view?

A

Downwards view of the patella-femoral joint on an x-ray.

69
Q

What is the apprehension test?

A

Pts with a tendancy to have their patella dislocated will be very anxious about you going near it.

70
Q

Define the tibio-femoral joint.

A

Tibial condyles articulating with the femoral condyles.

71
Q

What is the close-packed position of the knee joint?

A

Full extension of the joint there is medial rotation due to the medial femoral condyle being larger than the lateral one. There is tightening of the ligaments and limited movement so is solid and ‘locked’.

72
Q

What are the attachments, function and innervation of popliteus?

A

Back of tibia to lat femoral condyle.

Unlocks the extended knee (lateral rotation).

Tibial nerve.

73
Q

How do you test collateral ligament integrity?

A

Med/tibial & lat/fibular collateral ligaments are on either side of the joint. Tibial collateral lig attaches to the meniscus so less freedom of movement.
Straighten limb to tighten ligs, abduct leg whilst holding knee firm tests med lig, adduct leg whilst holding knee firm tests lat lig.

74
Q

Describe the attachments of the cruciate ligaments.

A

Ant cruciate lig: ant intercondylar ridge of tibia to medial surface of lateral condyle of femur.

Post cruciate lig: post intercondylar ridge of tibia to lateral surface of the medial condyle of the femur. (meniscofemoral accompanies it)

They are intra-capsular but extra-synovial allowing access to blood supply. Cause haematoma if ruptured.

75
Q

Other than ligaments, what supports the knee joint?

A

Patellar retinaculae, pes anserinus, biceps femoris tendon, popliteus, iliotibial band.

76
Q

What is genu varum?

A

Bow legs - strain lat collateral lig and can tear meniscus.

77
Q

What is genu valgus?

A

Knock knees - strain med collateral lig.

78
Q

How do you test for cruciate lig injury?

A

Ant drawer sign for ant cruciate lig, post drawer sign for post cruciate lig.
Knee bent 80 degrees, pull tibia forwards - ant displacement = ant cruciate lig damage, push tibia back, posterior displacement = post cruciate lig damage.

Lachmans test: Pt lies down, legs bent 20-30 degrees. Pull tibia forwards and back - absence of firm end point indicates cruiciate lig damage.

79
Q

Describe the menisci.

A

Wedge shaped articular fibrocartilagenous pads on tibial condyles. Attached by coronary lig. Thicker at periphery. Joined by transverse genicular lig. Medial meniscus = C shaped, Lateral meniscus = O shaped.

They deepen the tibial condyles, shock absorbers, facilitate lubrication of joint (sponge like)

80
Q

Which menisci is more likely to be torn?

A

Medial as its attached to the med collateral lig - Bucket handle tear.

81
Q

What is the ‘unhappy triad’?

A

Ant cruciate lig, medial collateral lig, medial meniscus. Often injured in valgus force and medial twisting.

82
Q

Describe the bursae of the knee.

A

Suprapatellar bursa - lies deep in quads
Prepatellar bursa - between patellar and skin
Superficial Infrapatellar bursa - between skin and patellar tendon
Deep infrapatellar bursa - between patellar tendon and proximal tibia

83
Q

Describe the boundaries of the leg compartments.

A

Anterior compartment: crural fascia (ant), tibia (med), interosseous membrane and fibula (post), lateral intermuscular septum (lat)
Deep fibular nerve.

Lateral compartment: lat intermuscular septum, fibular, post intermuscular septum
Superficial fibular nerve

Post compartment: tibia, interosseous membrane, fibula. Deep and superficial parts separated by deep transverse intermuscular septum. NV bundle just inside deep compartment.
Tibial nerve

All supplied by branches of popliteal artery (ant & post tibial arts)

84
Q

What nerve supplies the medial side of the leg?

A

Saphenous nerve - branch of femoral.

85
Q

Describe the arterial supply to the leg.

A

Femoral -> popliteal -> ant & post tibial

Posterior tibial gives off fibular which supplies lateral compartment.

86
Q

What are varicose veins?

A

Engorged superficial veins due to dysfunctional valves in the perforating veins.

87
Q

What type of joints are the superior and inferior tibiofibular joint?

A 
Superior = synovial
Inferior = syndesmosis (fibrous) supported by very strong ligaments - ant & post tibia-fibular lig and interosseous ligaments.
88
Q

Name the bones of the foot. Bony features (6)?

A

Talus, calcanius, navicular, cuboid, cuneiforms (med, intermediate, lat), metatarsals (5), phalanges (14)

head of talus, trochlea of talus, sustentaculum tali, navicular tuberosity, groove of cuboid, styloid of 5th metatarsal.

89
Q

What are the attachments, function and innervation of tibialis anterior?

A

lat tibia to medial side of foot.

Dorsi flexion and invertion

Deep fibular nerve

90
Q

What are the attachments, function and innervation of extensor hallucis longus?

A

interosseous membrane and fibula to distal phalanx of big toe.

Dorsiflexion and big toe extension

Deep fibular nerve

91
Q

What are the attachments, function and innervation of extensor digitorum longus?

A

interosseous membrane and fibula to distal phalanx of toes.

Dorsiflexion and extension of digits

Deep fibular nerve

92
Q

What are the attachments, function and innervation of fibularis longus?

A

Upper lateral fibula, behind lat malleolus, under tarsal bones (causing cuboid groove) to medial side.

Plantar flexion and eversion
Maintain arches of foot

Superficial fibular nerve

93
Q

What are the attachments, function and innervation of fibularis brevis?

A

lower lat fibula, behind lat malleolus to styloid process of 5th metatarsal.

Plantar flexion and eversion.
Maintain arches of foot

Superficial fibular nerve

94
Q

What are the root values of the common fibular/peroneal nerve?

A

L4-S2

95
Q

Outline the common fibular nerve distribution.

A

Division of the sciatic nerve. Divides into superficial and deep fibular nerves at neck of fibula. Superficial supplies lateral compartment muscles and cutaneous to dorsum of foot. Deep fibular supplies anterior compartment and dorsal foot muscles.

96
Q

What are the attachments, function and innervation of gastrocnemius?

A

Medial and lateral head attach to femur down to achilles tendon on calcaneus

Plantar flexion, knee flexion

Tibial nerve

97
Q

What are the attachments, function and innervation of soleus?

A

tibia to achilles tendon

Plantar flexion, postural muscle.

Tibial nerve

98
Q

What are the attachments, function and innervation of plantar is? (often absent)

A

Lat femur condyle to achilles tendon

Functionally unimportant

Tibial nerve

99
Q

What are the attachments, function and innervation of flexor digitorum longus?

A

tibia to distal phalanx of digits

Plantar flexion

Tibial nerve

100
Q

What are the attachments, function and innervation of flexor hallucis longus?

A

fibula to distal phalanx of big toe

Plantar flexion

Tibial nerve

101
Q

What are the attachments, function and innervation of tibialis posterior?

A

Interosseous membrane to medial sole of foot (navicular tuberosity)

Plantar flexion, stabilisation, elevation (medial longitudinal arch of foot), inversion.

Tibial nerve

102
Q

What is tarsal tunnel syndrome?

A

Inflammation of tendons causing compression on tibial nerve.

103
Q

What is the arrangement of the neurovascular bundle in the tarsal tunnel?

A 
Tom, Dick AND Harry:
Tibialis posterior
flexor Digitorum longus
Artery
Nerve
Doublet of veins
flexor Hallucis longus
104
Q

Name the three lateral ligaments of the ankle and their attachments. Which of these is not at risk following a forced inversion?

A

Calcaneofibular, ant & posterior talofibular (attachments as per name)

Posterior talofibular lig is not at risk.

105
Q

What is the medial ligament of the ankle and its attachment? What would happen in eversion?

A

Deltoid lig, Attaches to sustentaculum tali, talus, navicular tuberosity and med malleolus.

V. stong so severe eversion could cause tibial fracture

106
Q

What is a sprain?

A

Sudden over stretching of the ligament, may cause ligament to tear or rupture.

107
Q

At which joints do inversion and eversion take place?

A

Sub-talar joints, talocalcaneonavicular joint, calcaneoucuoid joint.

108
Q

What makes up the medial longitudinal arch of the foot?

A

Calcaneus,talus, navicular, cuneiforms, first three metatarsals.

109
Q

What makes up the lateral lonitudinal arch?

A

Calcaneus, cuboid, 4th & 5th metatarsals.

Cuboid is keystone.

110
Q

What makes up the transverse arch of the foot?

A

Cuneiforms, cuboid, 5 metatarsal bases.

111
Q

What is the plantar aponeurosis?

A

Broad flat tendon/thickening of deep fascia on sole of foot. Supports med longitudinal arch. Inflammation is plantar fasciitis.

112
Q

What is the attachment and function of the spring ligament?

A

Plantar calcaneonavicular lig maintains arches - no elastic function.

113
Q

What are the arch support ligaments of the foot?

A

Dorsal: Bifurcate lig (calcaneous to navicular and cuboid)
Plantar: Spring lig (calcaneus to navicular), long and short plantar ligs.

114
Q

Which muscle tendons support the three arches?

A

Lateral long arch: peroneal tendons
Med long arch: tibialis post, flexor hallucis longus.
Transverse arch: peroneus longus.

115
Q

What is the nervous supply to the foot?

A

Sole: tibial nerve - med (3.5 toes) & lat (1.5 toes) plantar nerves
Dorsum: superficial fibular nerve, 1st web space is deep fibular nerve.
Lateral: sural nerve
Medial: Saphenous nerve

116
Q

What is the blood supply to the foot?

A

Ant tibial -> dorsalis pedis (palpable) -> dosal arterial arch -> digital branches

Post tibial -> (gives off fibular) med & lat plantar arts -> digital branches (med) and plantar art arch (lat)

117
Q

What are the lower limb myotomes?

A 
Hip: flexion - L2-3
       extension - L4-5
Knee: extension - L3-4
         flexion - L5-S1
Ankle: extension - L4-5
          flexion - S1-2
Foot: inversion - L4-5
        eversion - L5-S1
        intrinsic - S2-3
118
Q

What are the main branches of the lumbar plexus relevant to the lower limb?

A

Formed inside psoas maj.
Femoral nerve (L2-4)
Obturator nerve (L2-4)
Lat cut n of thigh (L2-3)

119
Q

What is the origin, course and distribution of the femoral nerve?

A

L2-4. In psoas maj out at midpoint of inguinal lig. Outside femoral sheath.
Supplies ant thigh muscles (iliacus, pectineus, sartorius,vastus med, int, lat, rectus femoris).
Cutaneous branches = med & lat femoral cutaneous (ant and lower med skin), saphenous nerve (L3-4) (inside leg and foot)

120
Q

What is the origin, course and distribution of the obturator nerve?

A

L2-4.
Supplies medial thigh muscles (obturator externus, adductor longus, adductor brevis, adductor magnus, gracilis, pectineus)
Cutaneous supply to lower med thigh.
Supplies hip & knee joint therefore referred pain.

121
Q

What is meralgia paraesthetica?

A

Compression syndrome of the lat femoral cut nerve.

122
Q

What is the origin of lat femoral cut n?

A

L2-3

123
Q

What is the origin, course and distribution of the gluteal nerves?

A

Superior gluteal: L4-S1, passes above piriformis. Supplies glut med & min, tensor fascia lata, hip joint.

Inf gluteal: L5-S2. Passes below piriformis and supplies glut max.

124
Q

What is the origin, course and distribution of the sciatic nerve.

A

L4-S3.
Made of common fibular and tibial nerves in sciatic sheath.
Common fibular: L4-S2. Supplies anterolateral leg and dorsum of foot (including short head of biceps femoris). Gives off sural cut nerve, then divides into superficial and deep fibular nerves.

Tibial: L4-S3. Supplies hamstrings, posterior muscle and skin of leg and sole of foot. Gives med and lat plantar nerves.

Supplies knee not hip joint.

125
Q

What is sciatica?

A

Nerve pain due to sciatic nerve damage. Test by dorsiflexing foot and flexing hip.

Lower Limb (1 decks)

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