Anatomy- Lower Limb Flashcards
What are the 3 main long bones in the lower limb?
- Femur (proximal).
- Fibula (distal and lateral).
- Tibia (distal and medial).
What nerve innervates the muscles in the anterior compartment of the thigh?
The femoral nerve, L2-4.
What is the action of the majority of the muscles in the anterior compartment of the thigh?
Extension of the leg at the knee.
What is the origin of psoas major?
Transverse processes of T12-L5 vertebrae.
What is the origin of iliacus?
The iliac fossa and the pelvis.
Where does iliopsoas insert?
The lesser trochanter of the femur.
What is the innervation to psoas major?
Anterior rami of L1-3.
What is the innervation to iliacus?
Femoral nerve L2-4.
What is the action if iliopsoas?
Flexes the lower limb at the hip.
What muscles make up quadriceps femoris?
- Vastus medialis.
- Vastus intermedius.
- Vastus lateralis.
- Rectus femoris.
What is the lower part of quadriceps femoris related to?
The suprapatellar bursa.
What attaches the patella to the tibia?
The patella ligament.
What is the action of the vasti muscles?
Extension at the knee.
What is the action of rectus femoris?
Extension at the knee and flexion at the hip.
What is the innervation of quadriceps femoris?
Femoral nerve, L2-4.
What is the origin of sartorious?
Anterior Superior Iliac Spine
What is the action of sartorious?
Flexion, abduction and lateral rotation at the hip. Flexion at the knee.
What is the innervation to sartorious?
Femoral nerve, L2-4.
How can you test the action of quadriceps femoris?
Ask the patient to extend their legs against resistance whilst lying in a supine position.
What nerve innervates the muscles in the medial compartment of the thigh?
Obturator, L2-4.
What is the action of the majority of the muscles in the medial compartment of the thigh?
Hip adductors.
Name the 5 muscles found in the medial compartment of the thigh.
- Gracilis.
- Obturator externus.
- Adductor brevis.
- Adductor longus.
- Adductor magnus.
Where do adductor brevis, adductor longus and adductor magnus originate and insert?
Origin: pubis.
Insertion: medial femur.
What is the action of adductor brevis, adductor longus and adductor magnus.
Adduction of the thigh.
What is the innervation of adductor brevis, adductor longus and adductor magnus.
Obtruator nerve, L2-4.
What forms the superior border of the femoral triangle?
The inguinal ligament.
What muscle forms the medial border of the femoral triangle?
Adductor longus.
What muscle forms the lateral border of the femoral triangle?
Sartorious.
What are the contents of the femoral triangle?
Femoral nerve, femoral artery, femoral vein and lymph nodes. NAV lateral to medial.
What is the femoral canal and what does it contain?
A potential space medial to the femoral vein. It contains lymph nodes.
Define hernia.
The protrusion of an organ through the wall of the cavity containing it.
What is a femoral hernia?
Protrusion of bowel into the femoral canal. This manifests as a bulge in the thigh.
What is the subsartorial canal?
A passageway for vessels extending from the femoral triangle to the popliteal fossa at the back of the knee.
What is the saphenous opening
An opening in the fascia lacta pierced by the great saphenous vein.
What is the surface marking for the saphenous opening?
4cm below and lateral to the pubic tubercle.
What are the contents of the femoral sheath?
Femoral artery, veins and lymphatics.
What is the surface marking for the femoral artery?
2cm below the mid-inguinal point.
Where is the femoral artery pulsation palpable?
Below the mid-inguinal point.
Name the arteries in between the aorta and the femoral artery?
Aorta -> common iliac arteries -> external iliac arteries -> femoral artery.
Name the 2 main branches of the femoral artery.
- Profunda femoris artery.
2. Superficial femoral artery.
Which veins join to become the common femoral vein?
The superficial femoral vein and the profunda femoris vein.
Name all the major veins blood flows through from the femoral vein to the heart?
Femoral vein -> external iliac vein -> common iliac vein -> IVC -> heart.
If you do a femoral puncture to take blood from the femoral vein, do you introduce the needle lateral or medial to the femoral arterial pulsation?
Medial. NAV therefore vein is medial to artery.
What is the motor supply of the femoral nerve?
Anterior thigh compartment muscles.
Which joints does the femoral nerve supply?
The hip and knee.
What are the problems produced by weak quadriceps?
Difficulty walking downstairs.
In what muscle is the obturator nerve formed?
Psoas major.
Define referred pain.
Pain arising from one area but it’s felt elsewhere.
Give an example of referred pain in the leg.
Medial thigh pain can be felt due to inflammation of the ovary irritating the obturator nerve.
What is the femoral artery a continuation of?
The external iliac artery.
When does the external iliac artery become the femoral artery?
When it crosses under the inguinal ligament into the femoral triangle.
What artery does the obturator arise from?
The internal iliac artery.
Name the 3 glutei muscles.
- Gluteus maximus.
- Gluteus medius.
- Gluteus minimus.
Where does gluteus maximus insert?
The iliotibial tract and the gluteal tuberosity of the femur.
What is the action of gluteus maximus?
Extension of the thigh.
What is the innervation of gluteus maximus?
Inferior gluteal nerve.
What is the action of gluteus medialis and minimus?
Abduction of the lower limb.
What is the innervation of gluteus medialis and minimus?
Superior gluteal nerve.
When do you abduct the hip joint?
When walking.
What is the usual function of the abductors of the hip joint?
They hold the pelvis level when you take one foot off the ground.
Where do gluteal vessels and nerves emerge from?
The greater sciatic foramen.
What are the nerve roots of the sciatic nerve?
L4-S3.
What does the sciatic nerve innervate?
The muscles of the posterior thigh and the hamstring part of adductor magnus.
What does the sciatic nerve bifurcate into?
The tibial and common peroneal (common fibular) nerves.
What 3 muscles make up the hamstrings?
- Biceps femoris (lateral).
- Semimembranous (medial).
- Semitendinous.
What is the action of the muscles in the posterior compartment of the thigh?
Extension at the hip and flexion at the knee.
When do the extensors of the hip joint act?
When climbing the stairs.
What is the innervation of the muscles in the posterior compartment of the thigh?
Sciatic nerve L4-S3.
Where does the biceps femoris tendon insert?
The head of the fibula.
What muscle forms the superiomedial border of the politeal fossa?
Semimembranosus muscle.
What muscle forms the superiolateral border of the politeal fossa?
Biceps femoris.
What muscle forms the inferiormedial border of the politeal fossa?
Medial head of the gastrocnemius.
What forms the roof of the popliteal fossa?
Fascia.
What are the contents of the popliteal fossa?
- Popliteal artery.
- Popliteal vein.
- Tibial nerve.
- Common peroneal nerve.
How are the arteries, veins and nerves arranged in the popliteal fossa?
Usually NAV from lateral to medial. The nerve is always most superficial and the artery is always deepest.
How can you examine the hamstrings in the living?
Active flexion of the knee.
Name 4 muscles that insert on to the medial condyle of the tibia.
- Semitendinosus.
- Semimembranosus.
- Sartorious.
- Gracilis.
How does the popliteal artery reach the popliteal fossa?
As the femoral artery through the adductor canal.
What superficial vein drains into the popliteal vein?
The great saphenous vein.
What is the surface marking of the sciatic nerve?
Lower medial quadrant of the buttock.
What is the effect of a complete transection of the sciatic nerve?
Loss of hamstring function and of muscles below the knee.
What is the origin of the long head of the biceps, semitendinosus and semimembranosus?
The ischial tuberosity.
What is the origin of the short head of the biceps?
Linea aspera.
Where does biceps femoris tendon insert?
The head of the fibula.
Which of the hamstrings muscles lies most lateral?
The biceps femoris.
How can you identify semitendinosus
It has a very long tendon attaching to the medial condyle of the tibia.
Define myotome.
A group of muscles supplied by the same spinal nerve root.
Name 3 muscles in the anterior compartment of the leg.
- Tibialis anterior.
- Extensor digitorum longus.
- Extensor hallucis longus.
What are the actions of the muscles in the anterior compartment of the leg?
Dorsiflexion and inversion. The extensors also extend the toes.
Describe dorsiflexion.
Flexing the ankle joint so that the toes are brought closer to the shin.
What is the innervation to the muscles in the anterior compartment of the leg?
Deep peroneal nerve (L4-5).
What is the deep peroneal nerve a branch of?
The common peroneal nerve, which is a branch of the sciatic nerve.
What is the action of tibialis anterior?
Dorsiflexion and inversion of the foot.
Describe inversion of the foot.
Turning the ankle so that the plantar surface of the foot faces medially.
What is the action of extensor digitorum longus?
Dorsiflexion of the foot and extension of the toes.
What is the action of extensor hallucis longus?
Dorsiflexion of the foot and extension of the toes.
Where does extensor hallucis longus insert?
The great toe.
What is the blood supply to the muscles in the anterior compartment of the leg?
Anterior tibial artery
What is the origin of extensor digitorum longus
Lateral condyle of the tibia and medial fibula.
What can cause foot drop?
Damage to the common peroneal nerve and so paralysis of the dorsiflexors.
What is foot drop?
When the foot is permanently plantarflexed as the action of these muscles in unopposed due to paralysis of the dorsiflexors.
Name 2 muscles in the lateral compartment of the leg.
Peroneal brevis and longu
What are the actions of the muscles in the lateral compartment of the thigh?
Eversion and plantarflexion.
What do the tendons of peroneal brevis and longus pass posteriorly to in the foot?
The lateral malleolus.
What is the innervation to the muscles in the lateral compartment of the thigh?
Superficial peroneal nerve
Name 2 superficial muscles in the posterior compartment of the leg
Soleus and gastrocnemius.
How many heads does gastrocnemius have?
2 - medial and lateral. They form the inferior borders of the popliteal fossa.
What is the origin of gastrocnemius?
- Medial head: medial condyle of the femur.
- Lateral head: lateral condyle of the femur.
What is the insertion of gastrocnemius?
It combines with soleus to form the calcaneal tendon which inserts onto the calcaneus.
What are the 2 actions of gastrocnemius?
Plantarflexion at the ankle and flexion at the knee.
What other muscle combines to form the calcaneal tendon with gastrocnemius?
Soleus.
What is the action of soleus?
Plantarflexion.
What is the innervation to the posterior compartment of the leg?
Tibial nerve.
In what compartment of thelower limb are the hamstrings located?
The posterior thigh.
Name 4 deep muscles in the posterior compartment of the leg.
- Popliteus.
- Flexor digitorum longus.
- Flexor hallucis longus.
- Tibialis posterior.
How many tarsal bones are there?
7.
Which nerve winds around the neck of the fibula?
The common peroneal nerve.
Complete transection of the common peroneal nerve can cause what clinical sign?
Foot drop.
The muscles that form the calcaneus tendon are all supplied by which nerve?
Tibial nerve.
Does the long saphenous vein cross anterior or posterior to the medial malleolus?
Anterior.
What veins drain the superficial leg?
Short and long saphenous veins. The short saphenous vein drains the posterior leg.
How do the superficial and deep veins of the leg communicate?
Via perforators which pass through the deep fascia
What area of the leg receives skin sensation from the superficial peroneal nerve?
Anterolateral inferior 1/3 of the leg.
What area of the foot receives skin sensation from the deep peroneal nerve?
Dorsum of the first web space.
What area of the leg receives skin sensation from the saphenous nerve?
Medial leg.
What area of the leg receives skin sensation from the posterior cutaneous nerve of the thigh?
Popliteal fossa.
What area of the foot receives skin sensation from the tibial nerve?
Medial sole of foot.
Describe compartment syndrome.
Bleeding, oedema or infection increase the pressure in a compartment. The increased pressure means blood flow will cease which results in ischemia.
How can you test tibialis anterior?
Dorsiflexion at the ankle.
How can you test extensor digitorum longus?
Extension of the toes.
How can you test extensor hallucis longus?
Extension of the great toe.
Which muscle compartment is supplied by the deep peroneal nerve?
Anterior leg.
Does the deep peroneal nerve innervate skin? If so, where?
Innervates the first dorsal web space.
What is the anterior tibial artery a branch of?
The popliteal artery. (Popliteal artery is a branch of the femoral artery)
Which artery is the dorsal pedis artery a branch of?
The anterior tibial artery.
When might the pulsation of the dorsal pedis artery be absent?
If the anterior tibial artery is blocked.
What are the actions of the peroneii muscles?
Eversion of the foot
What muscles make up the peroneii muscles?
- Peroneal longus.
- Peroneal brevis.
What nerve innervates the peroneii muscles?
Superficial peroneal nerve.
How can you test the peroneii muscles?
Eversion against resistance.
Which nerve injury will lead to paralysis of the peroneii muscles?
Superificial peroneal nerve or common peroneal nerve.
What muscles are paralysed by damage to the common peroneal nerve?
- Peroneal longus and brevis (lateral compartment).
2. Tibialis anterior, extensor longus digitorum and extensor longus hallucis (anterior compartment).
Describe the gait of a patient who has had complete teansection of the common peroneal nerve.
- Foot drop.
- High steps to avoid stubbing toes.
Which leg bone has more muscle attached to it?
Fibula.
Why is the blood supply to the shaft of the tibia relatively poor?
The tibia has few muscles attached it. Attached muscles are responsible for supplying the majority of blood to a bone.
Why do fractures of the tibia take a long time to heal?
Poor blood supply.
How do you test the gastrocnemius?
Ask the patient to stand on their tip toes.
What is the fibular artery a branch of?
The posterior tibial artery.
Describe the ankle jerk reflex.
Tapping the achilles/calcaneal tendon acutely stretches the gastrocnemius. This results in a reflex contraction of the muscle.
Which segments of the spinal cord are you testing when you elicit the ankle jerk reflex?
S1,2.
Which segments of the spinal cord are you testing when you elicit the knee jerk reflex?
L2,3,4.
Which muscle compartment is supplied by the tibial nerve?
Posterior leg.
What are the structures in the tarsal tunnel deep to the retinaculum?
Tibial nerve.
What type of joint is the hip joint?
Ball and socket, synovial.
What is the main function of the hip joint?
To bear weight - its range of movements is therefore limited.
What bones articulate in the hip joint?
The femoral head articulates with the acetabulum of the pelvis.
What is the intrascapular ligament of the hip joint?
The ligament of the head of the femur.
Name the 3 extrascapular ligaments of the hip joint.
- Iliofemoral.
- Ischiofemoral.
- Pubofemoral.
Which extrascapular ligament of the hip joint is located most posteriorly?
Ischiofemoral.
Give 2 features of the acetabulum which add stability to the hip joint.
- It is deep and encompasses nearly all of the head of the femur.
- It is surrounded by the acetabular labrum which increases its depth and provides a larger articular surface.
What is the name of the fibrocartilage collar that surrounds the acetabulum?
The acetabular labrum.
Give 2 functions of the acetabular labrum.
- Increases the depth of the acetabulum.
2. Provides a larger articulating surface.
The circumflex femoral arteries supply the hip joint. What are they a branch of?
The profunda femoris artery.
What nerves innervate the hip joint?
Sciatic, obturator and femoral.
Any nerve supplying a muscles which moves a joint also innervates the joint
What type of joint is the knee joint?
Hinge, synovial.
What are the 2 articulations of the knee joint?
- Tibiofemoral.
2. Patellofemoral.
What is the function of the tibiofemoral articulation?
It is the weight bearing joint.
What is the function of the patellofemoral articulation?
It aloows the quadriceps femoris tendon to be onserted over the knee.
Give 3 functions of the medial and lateral menisci.
- Shock absorbers.
- Permit some rotation.
- Deepen the articulating surfaces and so increase stability.
What are the medial and lateral menisci both attached to?
The intercondylar area of the tibia.
What is the medial meniscus attached to?
- Intercondylar area of the tibia.
- Tibial (medial) collateral ligament.
- Joint capsule
What is the lateral meniscus attached to?
The intercondylar area of the tibia.
Which meniscus is more prone to injury?
Medial meniscus - its extra attachments to the medial collateral ligament and joint capsule mean it is less mobile and so more prone to damage.
What is the patellar ligament a continuation of?
The quadriceps femoris tendon distal to the patella.
What is the function of the collateral ligaments?
To stabilise the hinge motion of the knee.
Name the 2 collateral ligaments of the knee.
- Tibial (medial) - more prone to injury.
2. Fibular (lateral) - thinner and rounder.
What bones do the cruciate ligaments attach to?
The femur and the tibia.
Where does the anterior cruciate ligament attach?
The anterior intercondylar region of the tibia and the posterior femur.
Where does the posterior cruciate ligament attach?
The posterior intercondylar region of the tibia and the anterior femur.
What is the function of the cruciate ligaments?
They stabilise the knee in the anterior and posterior direction. Prevent dislocation.
Which ligament of the knee is extrascapular?
Lateral collateral.
What parts of the knee are intrascapular?
Menisci, ACL and PCL.
If a force is applied to the lateral aspect of a fixed knee which collateral ligament would be damaged?
This would stretch the medial aspect of the knee resulting in damage to the medial collateral ligaments.
What type of joint is the ankle joint?
Hinge, synovial.
What movements are permitted at the ankle joint?
Dorsiflexion and plantarflexion.
Which muscles of the leg are responsible for dorsiflexion?
Tibialis anterior, extensor hallucis longus and extensor digitorum longus (anterior compartment).
Which muscles of the leg are responsible for plantarflexion?
Gastrocnemius and soleus (posterior compartment).
What 3 bones make up the ankle joint?
Tibia, fibula and talus.
What binds the tibia and fibular?
Tibiofibular ligaments.
What do the tibia and fibula form that the talus articulates with?
A mortise.
What is the name of the ligament originating from the medial malleolus of the foot?
The deltoid ligament.
What 3 ligaments are found on the lateral side of the ankle joint?
- Anterior talofibular.
- Posterior talofibular.
- Calcaneofibular.
What type of joint is the superior tibiofibular joint?
Synovial.
What type of joint is the inferior tibiofibular joint?
Fibrous.
What movements occur at the subtalar joint?
Inversion and eversion.
What 3 bones articulate in the subtalar joint?
- Talus.
- Calcaneus.
- Navicular bone.
What ligament does the talus articulate with in the subtalar joint?
Spring ligament.
What joint shares the same synovial cavity as the subtalar joint?
Midtarsal joint.
What muscles are the predominant invertors?
Tibialis anterior and posterior.
What muscles are the predominant evertors
Peroneus longus and brevis.
What muscles support the pelvis when standing on one leg?
Gluteus medius and minimus.
In posterior dislocations of the hip which nerve is liable to injury?
Sciatic.
What accompanies the ligament of the head of the femur in children?
Blood vessels supplying the femoral head epiphyses.
What is the usual cause of avascular necrosis of the head of the femur in adults?
Fractured neck of the femur.
A child with a hip joint disease has pain in the knee joint. What is this due to?
The sciatic nerve supplies the hip and the knee and so this is likely to be referred pain.
What is the action of popliteus?
Twists the tibia on the femur to unlock the knee.
What are the functions of the quadriceps?
Extension at the knee and flexion at the hip.
How might the ACL be injured?
Hyperextension, common in sports injuries.
What are bakers cyst and housemaids knee?
Clinical presentations of patella bursae inflammation.
What is the function of the patella?
Transfers force from the quadriceps over the knee to the tibia.
What are the attachments of the patella?
Quadriceps femoris tendon superiorly and patellar ligament inferiorly.
nversion and eversion take place mainly at which joint?
Subtalar.
What 2 bones does the talus articulate with?
Navicular and calcaneus.
Name 3 things that support the medial longitudinal arch of the foot.
- The plantar aponeurosis.
- The spring ligament.
- The flexor hallucis longus.
Which muscle fibres stabilise the patella?
The vasti muscles of the quadriceps.
What is the nerve supply of the stomach?
Parasympathetic nerve supply comes from the posterior and anterior vagal trunks, derived from the vagus nerve. Sympathetic from the celiac plexus.
What is the blood supply to the anterior compartment of the leg?
Anterior tibial artery.
What is the blood supply to the posterior compartment of the leg?
Posterior tibial artery.
What is the blood supply to the lateral compartment of the leg?
Peroneal artery.
What is the innervation to the anterior compartment of the leg?
Deep peroneal nerve.
What is the innervation to the posterior compartment of the leg?
Tibial nerve.
What is the innervation to the lateral compartment of the leg?
Superficial peroneal nerve.
Which muscles extend the knee?
Quadriceps femoris - anterior thigh.
Which muscles flex the knee?
Hamstrings - posterior thigh.
If you damage the lateral collateral ligament of the knee would there be any blood?
No, the lateral collateral ligament is extrcapsular.
What muscle is the medial arcuate ligament related to?
Psoas major.
What structure is the median arcuate ligament related to?
The aorta.
What muscle is the lateral arcuate ligament related to?
Quadratus lumborum.
