Anatomy Limbs 8 - Review of Lower limb nerves and Vessels

Question 1

How many C,T,L,S,C vertebrae are there

Answer 1

7C
12T
5L
5S
1C

Question 2

C1-4 innervates?

Answer 2

Neck

Question 3

C5-T1 innervates?

Answer 3

Upper limb

Question 4

T2-L1 innervates?

Answer 4

Trunk

Question 5

L2-S3 innervates?

Answer 5

Lower limb

Question 6

S2-C1 innervates?

Answer 6

Perineum

Question 7

Which nerve supplies the anterior compartment of the thigh?

Answer 7

Femoral n

It passes under the inguinal ligament

Question 8

Which nerve supplies the medial (/adductor) compartment of the thigh?

Answer 8

Obturator nerve

Passes through the obturator foramen

Question 9

Which nerve supplies the posterior thigh, posterior & anterior foot and leg?

Answer 9

Sciatic nerve (which gives off tibial and common peroneal branches)

Question 10

Why is piriformis an important muscle to remember?

Answer 10

Superior gluteal nerve passes above it and inferior gluteal nerve passes below it

Sciatic nerve and posterior cutaneous nerve of the thigh emerge inferiorly also

Question 11

When does the tibial nerve split off?

Answer 11

Just before it enters the popliteal fossa

Question 12

Where is the common peroneal nerve susceptible to damage?

Answer 12

Common peroneal nerve continues superiorly and It wraps around the head of the fibula - there

Question 13

Tibial nerve supplies?

Answer 13

Posterior part of the leg

Question 14

What does the tibial nerve divide into?

Answer 14

Medial and lateral plantar nerves

Question 15

The common peroneal artery divides to give 2 branches, what are they and what do they supply?

Answer 15

Deep peroneal nerve - anterior muscles of the leg

Superficial peroneal nerve - lateral muscles of the leg

Question 16

Where does the saphenous nerve come from and what does it do?

Answer 16

It branches off the femoral nerve and supplies part of the leg and the medial side of the foot

Question 17

Which spinal nerves form femoral nerve

Answer 17

L234 (posterior fibres)

Question 18

Aside from anterior thigh, what other muscle does femoral nerve supply?

Answer 18

Iliopsoas

Question 19

Which spinal nerves form obturator nerve?

Answer 19

L234 (anterior fibres)

Question 20

Which spinal nerves for sciatic nerve?

Answer 20

L345 S123 (ant. and post. fibres)

Question 21

Which spinal nerves form the superior gluteal nerve?

Answer 21

L45S1

Question 22

What muscles does the superior gluteal nerve supply?

Answer 22

Gluteus medius and minimus, tensor fascia lata

Question 23

Which spinal nerves supply inferior gluteal nerve?

Answer 23

L5 S12

Question 24

What muscle does the inferior gluteal nerve supply?

Answer 24

Gluteus maximus

Question 25

Which spinal motor nerve roots are involved in: flexion of the knee? extension of the knee?

Answer 25

Flexion knee = L5/S1 Extension knee = L3/L4

Question 26

Which spinal motor nerve roots are involved in: flexion of the hip? extension of the hip?

Answer 26

Flexion hip = L2/L3 Extension hip = L4/L5

Question 27

``` Which spinal motor nerve roots are involved in: plantar flexion (flexion of ankle)? dorsiflexion (extension of ankle)? ```

Answer 27

Plantarflexion: S1/S2 Dorsiflexion: L4/L5

Question 28

From which roots doe the fibres of the posterior cutaneous nerve originate

Answer 28

S1/S2

Question 29

Give some examples of autonomous sensory zones

Answer 29

S1 - lateral calf L3 - mid thigh L4 - Lower thigh

Question 30

The dorsal lateral cutaneous nerve is a branch of??

Answer 30

The sural nerve

Question 31

Give an example of root injury of L5/S1 prolapsed disc. What are the signs

Answer 31

Motor - loss of foot eversion Sensory - loss of sensation on outer border of foot Reflex - loss of ankle jerk

Question 32

Lesion of common peroneal nerve at the fibular neck - what are the signs (common peroneal nerve = anterior and lateral part of leg)

Answer 32

Motor - foot drop Sensory - dorsal of foot at least

Question 33

Explain how circumflex femoral artery arises

Answer 33

Aorta - Common iliac - ext and int - (ext) femoral - profunda femoris - circumflex

Question 34

At the knee, how does the femoral artery split

Answer 34

Femoral artery - popliteal artery - TRIFURCATION INTO: 1. Anterior tibial artery - becomes dorsalis pedis artery 2. Posterior tibial artery 3. Peroneal artery

Question 35

After the femoral has given off the deep branch (profunda femoris), the femoral artery continues downwards via?

Answer 35

The adductor canal

Question 36

The femoral artery goes from anterior to posterior via what structure?

Answer 36

Adductor Magnus hiatus It then becomes the popliteal artery

Question 37

What are the borders of the femoral triangle

Answer 37

Superiorly - Inguinal ligament Medially - lateral border of adductor longus Laterally - medial border of sartorius

Question 38

What is present in the femoral triangle

Answer 38

Femoral Nerve, artery and vein

Question 39

What forms the popliteal fossa

Answer 39

Diamond shape Formed by borders of the semimembranosus, biceps femoris and heads of gastrocnemius

Question 40

What does the popliteal fossa contain

Answer 40

Popliteal artery and vein Tibial and common peroneal nerves (but common peroneal nerve leaves the fossa)

Question 41

What drains into the popliteal vein?

Answer 41

Small saphenous vein

Question 42

The posterior tibial artery passes behind?

Answer 42

The medial malleolus Post. tibial forms a plantar arch in the foot by giving off medial and lateral plantar arteries

Question 43

How does the superficial venous supply go?

Answer 43

Dorsal venous arch - Long saphenous & short saphenous - perforating veins - saphenofemoral junction (long saphenous)

Question 44

Short saphenous arises more from which venous network

Answer 44

Plantar venous network

Question 45

The deep veins run alongside the arteries, often as?

Answer 45

Venae comitantes (2/3 veins together)

Question 46

Where and when would you do a long saphenous vein cut down?

Answer 46

At the medial malleolus (just superior and lateral to) Done if patient is in shock Now superseded by intraosseous administration

Question 47

What are the deep veins progression

Answer 47

Anterior and posterior tibial veins - popliteal vein - profunda femoris vein -femoral vein (receives long saphenous vein) - external iliac vein

Question 48

Intermittent claudication can be caused by?

Answer 48

Arterial embolism (often associated with arterial disease)

Question 49

What is compartment syndrome

Answer 49

Ischaemia caused by trauma-induced increased pressure in confined limb compartment - Commonly occurs in anterior, lateral and posterior compartments of the leg

Question 50

What pressure is required to collapse small vessels in the leg?

Answer 50

Normal pressure = 25mmHg Pressure of 50-60mmHg can collapse small vessels and cause compartment syndrome (Pulse still present as it comes from large vessel with high BP)

Question 51

What are the 2 types of compartment syndrome and what causes them?

Answer 51

Acute compartment syndrome - trauma associated Chronic compartment syndrome - exercise induced

Question 52

How is acute compartment syndrome treated to prevent muscle death in the affected compartment?

Answer 52

Emergency fasciotomy

Question 53

What vein connects superficial veins to deep veins

Answer 53

Perforating veins

Question 54

What causes varicose veins?

Answer 54

When the valves of the perforating veins are weak - causes blood to be pushed from deep veins back to superficial veins

Question 55

What is the most important valve in terms of varicose veins?

Answer 55

Sapheno-femoral junction valve THIS IS THE MAJOR CONNECTION

Question 56

What can varicose veins cause?

Answer 56

Venous insufficiency (not enough venous return) and lipodermatosclerosis (skin thickening), venous ulcers

Question 57

Where are DVT formed?

Answer 57

Clot in the deep veins - can cause PE and death Can be prevented by contracting leg muscles

Question 58

Which 2 veins can be used for CABG?

Answer 58

Long and short saphenous veins