ANATOMY - Lower limbs p2 Flashcards
which muscle is the lumbar plexus within?
psoas major
which nerves contribute to the lumbar plexus?
ant rami L1,2,3,4
Thoracic spinal nn T12
branches lumbar plexus
I I Get Lit On Fridays
Iliohypogastric T12, L1
Ilioinguinal L1
Genitofemoral L1, L2
Lateral Cutaneous L2, L3
Obturator L2, L3, L4
Femoral L2, L3, L4
pathway iliohypogastric nerve
iliac crest –> quadratus lumbrorum then perforates transversalis abdominis
motor inn iliohypogastric nn
IO
TA
sensory inn iliohypogastric nn
postero-lateral gluteal skin
pathway ilioinguinal nerve
same as iliohypogastric
then passes through sup inguinal ring –> genitalia
motor inn ilioinguinal nn
IO + TA
sensory inn ilioinguinal nn
antero-medial thigh
mons
labia majora
penis
anterior scrotum
motor inn genitofemoral nn
cremasteric nn
sensory inn genitofemoral nn
anterior scrotum
mons pubis
labia majora = all genital branch
upper ant thigh (femoral)
course lateral cutaneous nerve
enters thigh at lateral aspect inguinal ligament
sensory inn lateral cutaneous nerve
anterior and lateral thigh
femoral nerve motor innervation
anterior muscles of the thigh which flex hip and extend knee
pectineus
iliacus
sartorius
quadratus femoris
femoral nerve sensory innervation
anteromed thigh (ant cutaneous)
med leg + foot (saphenous)
course femoral nerve
lumbar plexus ant rami L2,3,4
through psoas major to thigh
under inguinal ligament to femoral triangle
4cm below inguinal lig splits into ant + post branches
ant –> ant cutaneous, branch to sartoirus + branch to pectineus
post –> branch to quadratus femoris + saphenous (terminal) –> adductor canal to adductor hiatus
motor innervation obturator nn
medial thigh mm
gracilis
obturator externus
adductor magnus
adductor brevis
adductor longus
sensory innervation obturator nn
medial thigh
route obturator nerve
L2,3,4 –> through psoas major –> posterior to common iliac artery
–> lateral pelvic wall
–> obturator canal where it divides into ant and post devisions
anterior = anterior to adductor brevis (betw longus + brevis) - pierces fascia lata –> cutaneous branch obturator nn
posterior = post to adductor brevis (betw brevis + magnus)
where do you do an obturator nerve block?
inferior to PT
Lateral to tendon of adductor longus
how wide is the sciatic nerve?
up to 2cm wide
what is piriformis syndrome?
compression of sciatic nn by piriformis mm –> buttocks tenderness
motor innervation sciatic nerve
posterior thigh muscles:
biceps femoris
semimembranous
semitendinous
hamstring adductor magnus
terminal branches inn mm leg + foot
Anatomical course sciatic nerve
lumbosacral plexus –> gluteal region via GSF –> inf to piriformis mm goes inf lat and crosses post surface of gemellus, obturator internus + quadratus femoris
–> enters posterior thigh deep to long head biceps femoris –> at apex popliteal fossa branches into tibial + common fibular nn
nerve roots tibial nerve
L4-S3
sensory inn tibial nn
posterolateral leg
lat foot
sole foot
motor inn tibial nn
posterior leg
intrinsic mm foot except EDB
Anatomical course tibial nn
arises at apex popliteal fossa
through fossa down leg posterior to tibia to foot
inferior and posterior to medial malleolus through tarsal tunnel
terminates by splitting into sensory branches
medial plantar nn inn
plantar surface + medial 3 1/2 digits foot
lateral plantar nn inn
plantar + 1/12 digits (lateral) foot
medial calcaneal nn inn
skin over calcaneus
common fibular nn nerve roots
L4-S2
motor inn common fibular nn
short head biceps femoris which flexes knee
branches supply lateral and anterior compartment leg
sensory inn common fibular nn
skin lateral leg + dorsum foot
anatomical course common fibular nn
begins in popliteal fossa
–> medial border biceps femoris (inferolaterally)
–> lateral head gastrocnemius (gives off 2 cutaneous branches here)
–> wraps round neck of fibular between attachment of fibularis mm
–> terminates by splitting into superficial and deep fibular nn
what are the 2 cutaneous branches of the common fibular nn given off at the gastrocnemius
sural communicating nn (+ tibial –> sural nn - posterolat leg)
lateral sural cuteanous nn - skin upper lateral leg
nn roots superficial fibular nn
L4-S1
motor inn superficial fibular nn
lateral compartment leg - fibularis longus + brevis
to EVERT foot
sensory inn superficial fibular nn
anterolat distal leg + majority of dorsum of foot
anatomical course superficial fibular nn
begins as a branch of common fibular nn at neck of fibular
–> descends between fibular mm + lat side of EDL (here gives off motor branches to fib longus + brevis)
–> lower ⅓ leg - pierces deep crural fascia to terminate as medial dorsal nn + intermedial dorsal nn
sensory nn roots superficial fib nn
L5,S1
cause of superficial fibular nn entrapment
ankle sprain
or compression by deep fascia
or fibula fracture
Sx superficial fibular nn entrapment
loss eversion
loss densation dorsum foot + anterolat leg
nn roots deep fibular nn
L4-S1
motor inn deep fibular nn
anterior leg mm - fibularis tertius, tibialis ant, EHL, EDL - DORSIFLEXORS
intrinsic mm foot (extend toes)
sensory inn deep fibular nn
webbed space betw 1+2 toe
anatomical course deep fibular nn
begins as branch of common fibular nn at neck of fibula
–> travels medially, pierces intermuscular septum
–> to anterior compartment leg with ant tibial aa
–> descends between tibialis anterior + EDL
–> then tibialis ant + EHL (stars lateral, then anterior then medial to tibial aa)
–> travels under extensor retinaculum ankle
–> divdes into lateral branch (EDB+EHB) + medial branch (skin toe web)
femoral triangle borders - roof
fascia lata
femoral triangle borders - floor
pectineus, iliopsoas, adductor longus
femoral triangle borders - sup
inguinal ligament
femoral triangle borders lat -
medial border sartorius
femoral triangle borders - med
medial border adducctor longus
contents femoral triangle
= NAVEL
Nn femoral
aa femoral
vv femoral
Empty space (femoral canal)
LN
NAVE = within the femoral sheath
what is the femoral canal?
the smallest + most medial portion of the femoral sheath
femoral canal borders - medial
lacunar ligament
femoral canal borders -lateral
femoral vv
femoral canal borders - anterior
inguinal ligament
femoral canal borders - posterior
pectineal ligament, pubic ramus (sup), pectineus mm (3Ps)
where is the femoral ring
at the opening of the superior border of the femoral canal
tibial nn roots
L4-S3
sensory inn tibial nn
posterolateral leg
lateral foot
sole of foot
motor inn tibial nn
post leg - sup + deep compartments - plantarflexion, inversion, flexion toes
intrinsic mm foot except DPB
anatomical course tibial nn
arises at the apex popliteal fossa
–> throfg popliteal fossa (gives off sura+ superficial post leg branches)
–> down leg, posterior to tibia (inn post leg mm)
–> to foot - inferior + posterior to medial malleolus via the tarsal tunnel
–> terminates by splitting into sensory branches
what are the 3 nn branches from the tibial nn that inn the sole of the foot
lateral plantar nn - plantar + 1 1/2 digits laterally
medial plantar - plantar surface + medial 3 ½ digits
medial calcaneal - skin over heel
contents femoral canal
lymphatic vessels (draining into deep inguinal LN)
deep LN - lacunar nn
empty space allowing from distention of femoral vv
loose connective tissue
where does the adductor canal extend between
apex of the femoral triangle –> adductor hiatus of the adductor magnus (betw AM + hamstring)
borders adductor canal
anteromedially - sartorius
vastus medialis - lateral
adductor longus - posterior
contents adductor canal (4)
femoral aa
femoral vv
nn to vastus medialis
saphenous nn
adductor canal compression syndrome is 2’ to
hypertrophy of the adjacent mm
which nn is blocked in an adductor canal nn block
saphenous nn
popliteal fossa - borders
superomedially - semimbranous
superolaterally - biceps femoris
inferomedially - med head gastocnemius
inferolaterally - lat head gatrocnemius + plantaris
floor - post knee joint capsule, popliteus, post femur
roof - pop fascia (continous w/ TFL) + skin
contents popliteal fossa med to lateral (4)
popliteal aa
politeal vv
tibial nn
common fibular nn
most superficial contents popliteal fossa
tibial + common fibular nn
most deep contents popiteal fossa
popliteal aa
which structure of the popliteal fossa is most liable to compression via a popliteal aneurysm
tibial nn
floor tarsal tunnel
medial tibia, talus, calcaneus
roof tarsal tunnel
flexor retinaculum
where does the flexor retinaculum of the ankle extend between
medial malleolus to medial tubercle cacaneous
how many compartments to the tarsal tunnel
4
1 = NV
other 3 = the 3 tendons
contents tarsal tunnels
Top Driving VAN Hire
Tibialis post
flexor Digitorum longus
tibial VV
tibial AA
tibial NN
flexor Hallucis longus
what is tarsal tunnel syndrome
entrapment + compression tibial nn as it pases through tarsal tunnel
Sx tarsal tunnel syndrome
changes sensation sole foot
what type of joint is the hip joint?
ball + socket joint
what is the intracapsular ligament of the hip joint?
ligament of head of femur (ligamentum teres) - acetabular fossa –> fovea femur
what structure does the ligamentum teres enclose
aa to head of femur (^obturator aa)
what are the 3 extracapsular ligaments of the hip joint
ileofemoral ligament
pubofemoral ligament
ischiofemoral ligament
ileofemoral lligament extends between
ASIS –> intertrochanteric line (Y shaped)
fct ileofemoral ligament
prevents hyperextension hip
pubofemoral ligament extends between
sup pubic rami –> intertrochanteric line
triangle space
fct pubofemoral ligament
prevents XS abduction/extension
ischiofemoral ligament extends between
body of ischium –> greater trochanter
spiral shape
fct ischiofemoral ligament
prevents hyperextension