Anatomy Lower Limb Flashcards
borders of femoral triangle
inguinal ligament, adductor longus, sartorius muscle
femoral triangle components
lateral to medial:
femoral nerve, artery and vein with femoral canal (empty space with lymph nodes and vessels)
femoral sheath components
femoral artery, femoral vein, femoral canal (allows vein to distend into the empty space in cases of increased venous return)
femoral artery pulse location
mid-inguinal point, midpoint between ASIS and pubic symphysis
femoral hernia site
bowels protrude through femoral canal
presents as lump inferolateral to the pubic tubercle
more common in women due to wider pelvis
popliteal fossa contents
all vessels and nerves passing from thigh to calf pass through fossa
medial to lateral: popliteal artery, popliteal vein, tibial nerve, common peroneal/fibular nerve
tarsal tunnel syndrome
tibial nerve compression, altered sensation at sole of foot
tibial nerve and other structures pass inferiorly to the medial malleolus
swelling in popliteal fossa DDx
1- baker’s cyst
2- popliteal artery aneurysm
baker’s cyst
inflammation of semimembranous bursa (medial border of popliteal fossa)
tarsals
proximal: talus, calcaneus
intermediate: navicular
distal: 3 cuneiforms, cuboid
ankle joint bones
talus, tibia, fibula
excessive dorsiflexion of the foot injury/fracture
neck of talus fracture, at high risk of avascular necrosis
Achilles tendon attaches to
calcaneal tuberosity
lies inferior to talus and creates heel of foot
3 methods for metatarsal fracture
1- direct blow to the foot
2- stress fracture (neck of 2nd and 3rd metatarsals, base of 5th)
3- excessive inversion (base of 5th), fibularis brevis muscle can avulse (‘tear off’) the base
cause of avulsion fracture of greater trochanter of femur
forceful contraction of gluteus medius
cause of avulsion fracture of lesser trochanter of femur
forceful contraction of iliopsoas
strongest ligament of hip joint
iliofemoral ligament attached to intertrochanteric line
neck of femur fracture presentation
shortened leg and externally rotated
proximal femur fractures classification
1- intracapsular: occurs within hip joint capsule. high risk of avascular necrosis of femoral head due to injury to medial femoral circumflex artery (neck fracture)
2- extracapsular: blood supply intact (trochanteric or subtrochanteric fracture)
femoral shaft fracture features
shortened leg
commonly spiral fracture
risk of femoral nerve and artery injury
patella type of bone
sesamoid because it is situated between 2 tendons
patella attachments
base of patella (superior aspect) attached to quadriceps tendon
apex of patella (inferior aspect) attached to patellar ligament, connected to tibial tuberosity
patella articulates with which bone
femur
on patella’s posterior surface, its medial facet articulates with medial condyle of femur
lateral facet with lateral condyle
intraosseous access in emergency cases locations
1- anteromedial surface, 2-3cm below tibial tuberosity
2- proximal to medial malleolus
anterior cruciate ligament attachments
spans between the tibial intercondylar eminence and the lateral condyle of the femur
posterior cruciate ligament attachments
spans between the tibial intercondylar eminence and the medial condyle of the femur
over-inversion of ankle injuries
1- fracture at base of 5th metatarsal
2- spiral fracture of medial malleolus (tibia), can be associated with lateral malleolus (fibula) - associated more with eversion
fibula articulations
proximally and distally with tibia
ankle joint with talus
common fibular nerve relation with fibula
nerve found on posterior and lateral surface of fibular neck
ovoid hiatus
opening in the fascia latta to allow passage of great saphenous vein and lymphatic vessels
femoral hernia can protrude through it (risk of strangulation and incarceration)
fascia lata and transplantation
popular choice due to high concentration of connective tissue fibers and vascularity
muscles of gluteal region - superficial and deep
and blood supply
superficial: (abductor, extenders, medial rotation) gluteus maximus, gluteus medius, gluteus minimus, tensor fascia lata
deep: (lateral rotation) quadratus femoris, pirifomis, gemellus superior, gemellus inferior, obturator internus
superior and inferior gluteal arteries (from internal iliac artery)
ALL attach to greater trochanter
innervation of superficial gluteal muscles
superior gluteal nerve
EXCEPT gluteus maximus innervated by inferior gluteal nerve
superior gluteal nerve damage
Trendelenburg sign
paralysis of gluteus medius and minimus, pelvis no longer stabilized during motion and falls to the side of the raised leg
damaged nerve is on the opposite side of the raised leg
innervation of deep gluteal muscles
all are innervated by a nerve specific to each muscle
EXCEPT gemellus superior: nerve to obturator internus
gemellus inferior: nerve to quadratus femoris
landmark of gluteal region
piriformis - divides region into superior and inferior (superior gluteal nerve and artery emerges into gluteal region superior to piriformis)
also sciatic nerve enters region directly inferior to piriformis
muscles of anterior compartment of thigh and
innervation
pectineus, sartorius, quadriceps femoris, iliopsoas (psoas major + iliacus)
femoral nerve EXCEPT psoas major by anterior rami of L1-3
quadriceps femoris muscles
vastus lateralis, vastus intermedius, vastus medialis, rectus femoris
thigh anterior compartment muscles function
iliopsoas: Hip flexion quadriceps femoris: knee extension pectineus: flexion and adduction of hip sartorius: at hip flexion, abduction, lateral rotation at knee, flexion
femoral nerve damage
can’t extend knee
thigh medial compartment of muscles
innervation, blood supply
function
gracilis, obturator externus, adductor brevis, adductor longus and adductor magnus
obturator nerve, obturator artery
hip adduction
groin strain
strain of adductor muscles from explosive movements or stretching
treatment: RICE protocol - rest, ice, compression, elevation
thigh posterior compartment of muscles
function
“hamstrings”
biceps femoris, semitendinosus and semimembranosus
hip extension, knee flexion
NB: adductor magnus in medial thigh has hamstring part with similar function
posterior thigh muscles innervation
biceps femoris: long head by tibial part of sciatic nerve, short head by common fibular part of sciatic nerve
semitendinous and semimembranous: tibial part of sciatic nerve
sciatic nerve spinal cords
L4 - S3
femoral nerve spinal cords
L2 - L4
muscles in the anterior compartment of the leg
tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius
anterior leg muscles function
dorsiflex and invert the foot at the ankle joint
digitorum longus and extensor hallucis longus also extend the toes
anterior leg muscles innervation and blood supply
deep fibular nerve, anterior tibial artery
common fibular/peroneal nerve spinal cords
L4 - S1
common peroneal nerve injury
causes foot drop due to injury of deep fibular nerve and paralysis of anterior leg muscles
eversion flick when walking to flick the foot
lateral leg muscles compartment
fibularis longus and brevis
lateral leg muscles function
eversion of foot (sole outwards)
lateral leg muscles innervation
superficial fibular (peroneal) nerve
lateral leg muscles and lateral malleolus relation
tendons of muscles attach posteriorly to lateral malleolus
tendons of anterior muscles attach medially
where does common peroneal structure pass and bifurcate
it passes through a small gap between parts of fibularis longus muscle (between head and neck of fibula)
it bifurcates after passing this gap
Posterior leg muscles
Function
Innervation
Gastrocnemius, plantaris, soleus, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus
Plantarflexion, flexion of toes, inversion
Tibial nerve
Injury to medial collateral ligament leads to
medial meniscus tear (they are attached to each other)
