ANATOMY - Lower limbs Flashcards
What are the 3 parts of the hip bone?
Ilium - superior
Ischium (posterolateral)
Pubis (anteromedial)
Average angle of inclination of NOF to acetabulum
126’
What attaches to the base of the patella superiorly?
Quadriceps tendon
What attaches to the base of the patella inferiorly?
Patellar ligament
What type of bone is the patella?
Sesamoid
Cause of fracture of patella
Direct trauma
Sudden contraction quadriceps muscle
Cause of dislocation of patella
High impact twisting knee injuries (sports)
How much blood can be lost by a femur fracture?
1.5L
What is the name of the part in the head of the femur that is not covered in articular?
Fovea
What attaches to the fovea?
Ligamentum teres
What shape are femur fractures typically?
Spiral
What muscle attaches to the gluteal tuberosity of the femur?
Gluteus maximus
What part of the femur articulates with the patella facets
Medial and lateral condyles
What part of the tibia do the collateral ligaments atach to
tibial condyles
what part of the tibia do the menisci attach to?
intercondylar fossa
what part of the tibia do the ACL + PCL attach to
intercondylar fossa
What important structure is the neck of the fibula associated with?
common fibular nn (after this bifurcates)
fibula vs tibia - which is the weight bearing bone
tibia
where in the tibia do fractures most commonly occur?
shaft
how are tibial shaft fractures classified?
Schatzker classification
which tendon passes through the posterior groove of the tibia?
Tibialis posterior
where do stress fractures of the foot most commonly occur?
2-3 MT necks
which 3 muscle tendons attach at the medial cuneiform
fibularis longus
tibialis anterior
tibialis posterior
name all the bones of the foot
phalanges x14
5 x MT
medial, intermediate, lateral cuneiform
navicular
cuboid
calcaneus
talus
where does the fibularis tendon insert on the foot
inferior surface cuboid in a groove
3 articulations of the talus
ankle joint (superior)
anterior - talonavicular
inferior - subtalar (w/ calcaneus)
Which foot bone is AVN risk the highest? Why?
Talus
No muscles attach here
cause - calcaneus fracture
fall from height
which foot bone forms the heel?
calcaneus
2 articulations calcaenus
subtalar
calcaneocuboid
What are the 4 gluteal extensors
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia lata
what are the 5 deep lateral rotators glutes
quadriceps femoris
piriformis
gemeeli - superior + inferior
obturator internus
which extensor of the glutes is the most superficial
gluteus maximus
arterial supply gluteal muscles
superior + inferior gluteal arteries
What are the gluteal arteries a branch of
internal iliac artery
origin/insertion gluteus maximus
Ilium, sacrum + coccyx –> IT band + gluteal tuberosity femur
action gluteus maximus
extends + lat rotates thigh
Inn gluteus maximus
Inferior gluteal nn
origin/insertion gluteus medius
ilium –> greater trochanter
action gluteus medius
abduct + medial rotate thigh
inn gluteus medius
superior gluteal nerve
origin/insertion gluteus minimus
ilium –> greater trochanter
action gluteus minimus
abduct + medial rotation thigh
inn gluteus minimus
superior gluteal nerve
which sign is related to the superior gluteal nerve
Trendelenburg sign (usually prevents contralateral pelvic tilt)
which is the most superior of the deep lateral rotators of the glutes
piriformis
origin/insertion piriformis
anterior sacrum –> greater trochanter
action piriformis
lateral rotation + abduction thigh
innervation piriformis
nn to piriformis
origin/insertion obturation internus
ischium + pubis –> greater trochanter
action obturation internus
lateral rotation + abduction thigh
innervation obturator inturnus
nerve to obturator internus
origin/insertion superior gemelli
ischial spine –> greater trochanter
action superior gemellus
lateral rotation + abduction thigh
innervation superior gemellus
nn to obturator internus
origin/insertion inferior gemelli
ischial tuberosity –> greater trochanter
action inferior gemellus
lateral rotation + abduction thigh
innervation inferior gemellus
nn to quadratus femoris
origin/insertion quadratus femoris
ischial tuberosity –> quadrate tubercle on IT crest
action quadratus femoris
lateral rotation
innervation quadratus femoris
nn to quadratus femoris
action of anterior thigh muscles
extend the leg at the knee joint
some also flex thigh
innervation of anterior thigh muscles
femoral nerve L2-4
What are the anterior thigh muscles (8)
Iliacus + psoas major –> iliopsoas
sartorius
pectineus
vastus lateralis, vastus intermedialis, vastus medialis, rectus femoris
origin/insertion - iliopsoas
iliac crest + lumbar vertebra –> lesser trochanter
action iliopsoas
flexes thigh
innervation iliacus + psoas major
Iliacus - femoral nn
Psoas major - anterior rami L1-3
which is the longest muscle in the body?
sartorius
origin/insertion sartorius
ASIS –> superior medial tibia
action sartorius
flex
abduct
laterally rotate thigh
innervation sartorius
femoral nerve
which anterior thigh muscle forms the base of the femoral triangle?
pectineus
origin/insertion pectineus
pectineal line pelvis –> inf to lesser trochanter
action pectineus
adduction, flexion thigh
innervation pectineus
femoral nn
which muscle group are the main extensors of the knee
quadriceps femoris
4 muscles making up quadriceps femoris
vastus lateralis
vastus intermedialis
vastus medialis
rectus femoris
vastus lateralis origin/insertion
greater trochanter + linea aspera –> quadriceps tendon
innervation vastus lateralis
femoral nn
vastus intermedialis origin/insertion
femoral shaft –> quadriceps tendon
innervation vastus intermedialis
femoral nerve
vastus medialis origin/insertion
intertrochanteric line + linea aspera –> quadriceps tendon
innervation vastus medialis
femoral nerve
origin/insertion rectus femoris
ASIS + ilium –> quadriceps tendon
action rectus femoris
flexes thigh
extends knee
innervation rectus femoris
femoral nerve
action of the medial compartment of the thigh
hip abductors
arterial supply of medial compartment thigh
obturator artery
nerve supply (in general) of medial compartment of the thigh
obturator nerve
which compartment of the thigh has been injured when a patient complains of groin pain?
medial compartment
what are the 2 components of the adductor magnus
adductor
hamstring
origin/attachment adductor magnus
ADDUCTOR - inf pubic rami + rami ischium –> linea asoera
HAMSTRING - ischial tuberosity –> adductor tubercle + supracondylar line
action - adductor portion adductor magnus
adducts + flexes thigh
innervation adduction portion adductor magnus
obturator nn L2=4
action - hamstring portion adductor magnus
adducts + extends thigh
innervation hamstring portion adductor magnus
tibial part sciatic nn L4-S3
origin/insertion adductor brevis
inferior pubic rami + pubis –> linea aspera
action adductor brevis
adducts thigh
innervation adductor brevis
obturator nerve
origin/insertion adductor longus
pubis –> linea aspera
action adductor longus
adducts thigh
innervation adductor longus
obturator nerve
origin/insertion obturator externus
membrane obturator foramen –> posterior greater trochanter
action obturator externus
adducts + lateral rotation thigh
innervation obturator externus
obturator nerve
origin/insertion gracilis
inferior rami –> medial tibial shaft
action gracilis
adducts thigh, flexes knee
innervation gracilis
obturator nerve
role of posterior compartment thigh (hamstrings)
extend hip
flex knee
innervation of posterior compartment thigh
sciatic nn L4-S3
most lateral muscle in posterior thigh
biceps femoris
long head biceps femoris - origin/insertion
ischial tuberosity –> tendon insertion head fibula
innervation long head biceps femoris
tibial part sciatic nn
short head biceps femoris - origin/insertion
linea aspera –> tendon insertion head fibula
innervation short head biceps femoris
common fibular portion sciatic nn
action biceps femoris
extends thigh
flexes knee
laterally rotates hip + knee
out of semitendinous + semimembranous, which is more superficial
semitendinous
origin/insertion semitendinous
ischial tuberosity –> medial tibia
innervation semitendinous
tibial portion sciatic nn
action semitendinous + membranous
flex knee joint + med rotate
extend thigh
origin/insertion semimembranous
ischial tuberosity –> medial tibial condyle
innervation semimembranous
tibial portion sciatic nn
role of anterior leg muscles
dorsiflex + invert the ankle joint
innervation of anterior leg muscles
deep fibular nn
arterial supply anterior leg muscles
anterior tibial aa
which anterior leg muscle is the strongest dorsiflexor
tibialis anterior
how to test tibialis anterior is workin
asking patient to stand on heels
origin/insertion tibialis anterior
lateral tibia to medial cuneiform + base 1st MT
action tibialis anterior
dorsiflex + invert foot
innervation tibialis anterior
deep fibular nn
origin/insertion EDL (extensor digitorum longus)
lateral condyle tibia + med fibula –> tendon –> divides into 4 and goes to each do
action EDL
extends 4 toes
dorsiflex foot
innervation EDL
deep fibular nn (common peroneal nn)
origin/insertion EHL (extensor hallucis longus)
medial fibular shaft –> distal phalynx hallux
action EHL
dorsiflex foot
extend hallux
innervation EHL
deep fibular nn
Which anterior leg muscle is not present in all individuals?
fibularis teritus
origin/insertion fibularis teritus
medial surface fibula –> MT V
action fibularis teritus
everts + dorsiflexes foot
cause of foot drop
damage to deep fibular nn –> permanent plantar flexion
Name the muscles of the lateral leg (2)
fibularis longus
fibularis brevis
innervation of lateral leg muscles
superficial fibular nn L4-S1
origin/insertion fibularis longus
sup + lat fibula + lat fibial condyle –> tendon –> medial cuneiform base MT I
action fibularis longus
evert and plantarflex foot
innervation fibularis longus
superficial fibular nn L4-S1
origin/insertion fibularis brevis
inferolat fibular shaft –> tendon –> tubercle MT V
action fibularis brevis
everts foot
innervation fibularis brevis
superficial fibular nn l4-S1
where does common fibular/peroneal nn bifurcate into superficial + deep fibular n
neck of fibula
How many muscles in the posterior compartment of the leg?
7
role of posterior compartment leg
plantar flex + invert foot
Innervation of posterior compartment leg
tibial nn (terminal sciatic nn)
how is the posterior compartment of the leg divided
superficial and deep compartment by band fascia
which mm are in the superficial posterior leg compartment (3)
plantaris
soleus
gastrocnemius
what % of people dont have plantaris mm
10%
origin/insertion plantaris mm
lat supracondylar line femur –> calcaneal (achilles) tendon
action plantaris mm
plantar flex ankle
flex knee
innervation plantaris mm
tibial nn
origin/insertion soleus
soleal line tibia + prox fibula –> calcaneal tendon
action soleus
plantar flex foot/ankle
innervation soleus
tibial nn
which is the most superficial muscle in the posterior leg
gastrocneumius
how many heads gastrocnemius
2 (med + lateral)
origin/insertion gastrocnemius
femoral condyles –> calcaneal tendon
action gastrocnemius
plantarflexes ankle
flexes knee
innervation gastrocnemius
tibial nn
achilles tendon reflex
S1-2
What are the names of the 2 bursa associated with the calcaneal/achilles tendon?
subcutenaous calcaneal bursa
deep bursa calcaneal tendon
what action causes calcaneal tendon rupture
forceful plantarflexion
what are the 4 deep muscles of the posterior leg?
tibialis posterior
popliteus
flexor hallucis longus (FHL)
flexor digitoris longus (FDL)
which muscle makes up the base of the popliteal fossa?
popliteus
origin/insertion popliteus
lateral condyle femur + post horn meniscus –> tibia
action popliteus
unlocks knee so flexion can occur by lateral rotation of femur
innervation of popliteus
tibial nn
which posterior leg muscle is the deepest?
tibialis posterior
origin/insertion tibialis posterior
interosseous membrane = post tib/fib –> plantar surface med Tarsal bones
actions tibialis posterior
plantarflex + invert foot
maintain medial arch
innervation tibialis posterior
tibial nn
FDL (flexor digitoris longus) origin/insertion
medial tibia –> plantar 4 digits
action FDL
flexes 4 lateral toes
innervation FDL
tibial nn
FHL (flexor hallucis longus) origin/insertion
posterior fibula –> plantar big phalynx
action FHL
flex hallux
innervation FHL
tibial nn
What are the 2 intrinsic muscles on the dorsal foot?
extensor digitorum brevis
extensor hallucis brevis
Origin/Insertion Extensor Digitorum Brevis
calcaneus, interosseous, talocalcaneal ligament + inferior extensor retinaculum –> prox phalynx 1 + long extensor tendons toes 2-4
Action EDB
aids EDL in extending medial 4 toes
Innervation EDB
deep fibular nerve
Origin/Insertion Extensor hallucis brevis
calcaneus, interosseous, talocalcaneal ligament + inferior extensor retinaculum –> prox phalynx 1
Action EHB
Aids EHL in extending phalynx 1
Innervation EHB
deep fibular nerve
How many intrinsic muscles in the plantar foot?
10 (in 4 layers)
Muscles in layer 1 plantar foot
ABductor hallucis
Flexor Digitorum brevis
Adductor Digiti minimi
Abductor Hallucis action
abducts + flexes great toe
innervation Abductor Hallucis
Medial plantar nerve
Action flexor digitorum brevis
flexes lateral 4 digits at proximal IPJ
Innervation flexor digotorum brevis
medial plantar nn
action abductor digiti minimi
abduct flexes digit 5
innervation abductor digiti minimi
lateral plantar nn
How many muscles in the 2nd foot layer?
tendon of FDL
Quadratus plantae
4 x lumbricals
= 6
quadratus plantae action
assists FDL in flexing lateral 4 digits
innervation quadratus plantae
lateral plantar nn
how many lumbricals in 2nd layer foot
4
2nd layer foot lumbricals action
flexes at MPJ + extends at IPJ
innervation 2nd layer foot lumbricals
most medial = medial plantar nn
rest are lateral plantar nn
how many muscles in 3rd layer of foot?
3
Flexor hallucis brevis
flexor digiti minimi brevis
adductor hallucis
action flexor hallucis brevis
flexes prox phalynx of hallux
innervation flexor hallucis brevis
medial plantar nn
action adductor hallucis
adducts great toe
innervation adductor hallucis
deep branch lateral plantar nn
action flexor digiti minimi brevis
flex 5th proximal phalynx
innervation flexor digiti minimi brevis
superficial branch lateral plantar nn
how many plantar interossei in the foot?
3
action plantar interossei foot
adduct digits 3-5
flex MTPJ
innervation plantar interossei foot
lateral plantar nn
how many dorsal interossei in the foot?
4
action dorsal interossei foot
abduct digits 2-4
flex MTPJ
inn dorsal interossei foot
lateral plantar nn