ANATOMY - Lower limbs p2 Flashcards
1
Q
which muscle is the lumbar plexus within?
A
psoas major
2
Q
which nerves contribute to the lumbar plexus?
A
ant rami L1,2,3,4
Thoracic spinal nn T12
3
Q
branches lumbar plexus
A
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
4
Q
pathway iliohypogastric nerve
A
iliac crest –> quadratus lumbrorum then perforates transversalis abdominis
5
Q
motor inn iliohypogastric nn
A
IO
TA
6
Q
sensory inn iliohypogastric nn
A
postero-lateral gluteal skin
7
Q
pathway ilioinguinal nerve
A
same as iliohypogastric
then passes through sup inguinal ring –> genitalia
8
Q
motor inn ilioinguinal nn
A
IO + TA
9
Q
sensory inn ilioinguinal nn
A
antero-medial thigh
mons
labia majora
penis
anterior scrotum
10
Q
motor inn genitofemoral nn
A
cremasteric nn
11
Q
sensory inn genitofemoral nn
A
anterior scrotum
mons pubis
labia majora = all genital branch
upper ant thigh (femoral)
12
Q
course lateral cutaneous nerve
A
enters thigh at lateral aspect inguinal ligament
13
Q
sensory inn lateral cutaneous nerve
A
anterior and lateral thigh
14
Q
femoral nerve motor innervation
A
anterior muscles of the thigh which flex hip and extend knee
pectineus
iliacus
sartorius
quadratus femoris
15
Q
femoral nerve sensory innervation
A
anteromed thigh (ant cutaneous)
med leg + foot (saphenous)
16
Q
course femoral nerve
A
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
17
Q
motor innervation obturator nn
A
medial thigh mm
gracilis
obturator externus
adductor magnus
adductor brevis
adductor longus
18
Q
sensory innervation obturator nn
A
medial thigh
19
Q
route obturator nerve
A
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)
20
Q
where do you do an obturator nerve block?
A
inferior to PT
Lateral to tendon of adductor longus
21
Q
how wide is the sciatic nerve?
A
up to 2cm wide
22
Q
what is piriformis syndrome?
A
compression of sciatic nn by piriformis mm –> buttocks tenderness
23
Q
motor innervation sciatic nerve
A
posterior thigh muscles:
biceps femoris
semimembranous
semitendinous
hamstring adductor magnus
terminal branches inn mm leg + foot
24
Q
Anatomical course sciatic nerve
A
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
25
nerve roots tibial nerve
L4-S3
26
sensory inn tibial nn
posterolateral leg
lat foot
sole foot
27
motor inn tibial nn
posterior leg
intrinsic mm foot except EDB
28
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
29
medial plantar nn inn
plantar surface + medial 3 1/2 digits foot
30
lateral plantar nn inn
plantar + 1/12 digits (lateral) foot
31
medial calcaneal nn inn
skin over calcaneus
32
common fibular nn nerve roots
L4-S2
33
motor inn common fibular nn
short head biceps femoris which flexes knee
branches supply lateral and anterior compartment leg
34
sensory inn common fibular nn
skin lateral leg + dorsum foot
35
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
36
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
37
nn roots superficial fibular nn
L4-S1
38
motor inn superficial fibular nn
lateral compartment leg - fibularis longus + brevis
to EVERT foot
39
sensory inn superficial fibular nn
anterolat distal leg + majority of dorsum of foot
40
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
41
sensory nn roots superficial fib nn
L5,S1
42
cause of superficial fibular nn entrapment
ankle sprain
or compression by deep fascia
or fibula fracture
43
Sx superficial fibular nn entrapment
loss eversion
loss densation dorsum foot + anterolat leg
44
nn roots deep fibular nn
L4-S1
45
motor inn deep fibular nn
anterior leg mm - fibularis tertius, tibialis ant, EHL, EDL - DORSIFLEXORS
intrinsic mm foot (extend toes)
46
sensory inn deep fibular nn
webbed space betw 1+2 toe
47
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)
48
femoral triangle borders - roof
fascia lata
49
femoral triangle borders - floor
pectineus, iliopsoas, adductor longus
50
femoral triangle borders - sup
inguinal ligament
51
femoral triangle borders lat -
medial border sartorius
52
femoral triangle borders - med
medial border adducctor longus
53
contents femoral triangle
= NAVEL
Nn femoral
aa femoral
vv femoral
Empty space (femoral canal)
LN
NAVE = within the femoral sheath
54
what is the femoral canal?
the smallest + most medial portion of the femoral sheath
55
femoral canal borders - medial
lacunar ligament
56
femoral canal borders -lateral
femoral vv
57
femoral canal borders - anterior
inguinal ligament
58
femoral canal borders - posterior
pectineal ligament, pubic ramus (sup), pectineus mm (3Ps)
59
where is the femoral ring
at the opening of the superior border of the femoral canal
60
tibial nn roots
L4-S3
61
sensory inn tibial nn
posterolateral leg
lateral foot
sole of foot
62
motor inn tibial nn
post leg - sup + deep compartments - plantarflexion, inversion, flexion toes
intrinsic mm foot except DPB
63
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
64
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
65
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
66
where does the adductor canal extend between
apex of the femoral triangle --> adductor hiatus of the adductor magnus (betw AM + hamstring)
67
borders adductor canal
anteromedially - sartorius
vastus medialis - lateral
adductor longus - posterior
68
contents adductor canal (4)
femoral aa
femoral vv
nn to vastus medialis
saphenous nn
69
adductor canal compression syndrome is 2' to
hypertrophy of the adjacent mm
70
which nn is blocked in an adductor canal nn block
saphenous nn
71
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
72
contents popliteal fossa med to lateral (4)
popliteal aa
politeal vv
tibial nn
common fibular nn
73
most superficial contents popliteal fossa
tibial + common fibular nn
74
most deep contents popiteal fossa
popliteal aa
75
which structure of the popliteal fossa is most liable to compression via a popliteal aneurysm
tibial nn
76
floor tarsal tunnel
medial tibia, talus, calcaneus
77
roof tarsal tunnel
flexor retinaculum
78
where does the flexor retinaculum of the ankle extend between
medial malleolus to medial tubercle cacaneous
79
how many compartments to the tarsal tunnel
4
1 = NV
other 3 = the 3 tendons
80
contents tarsal tunnels
Top Driving VAN Hire
Tibialis post
flexor Digitorum longus
tibial VV
tibial AA
tibial NN
flexor Hallucis longus
81
what is tarsal tunnel syndrome
entrapment + compression tibial nn as it pases through tarsal tunnel
82
Sx tarsal tunnel syndrome
changes sensation sole foot
83
what type of joint is the hip joint?
ball + socket joint
84
what is the intracapsular ligament of the hip joint?
ligament of head of femur (ligamentum teres) - acetabular fossa --> fovea femur
85
what structure does the ligamentum teres enclose
aa to head of femur (^obturator aa)
86
what are the 3 extracapsular ligaments of the hip joint
ileofemoral ligament
pubofemoral ligament
ischiofemoral ligament
87
ileofemoral lligament extends between
ASIS --> intertrochanteric line (Y shaped)
88
fct ileofemoral ligament
prevents hyperextension hip
89
pubofemoral ligament extends between
sup pubic rami --> intertrochanteric line
triangle space
90
fct pubofemoral ligament
prevents XS abduction/extension
91
ischiofemoral ligament extends between
body of ischium --> greater trochanter
spiral shape
92
fct ischiofemoral ligament
prevents hyperextension
93
aa supply hip joint
medial circumflex femoral aa = majority
also lat circumflex femoral aa
94
inn hip joint
sciatic nn
femoral nn
obturator nn
95
hip flexion muscles (4)
iliopsoas
rectus femoris
sartorius
pectineus
96
hip extension muscles (4)
gluteus maximums
semimembranous
semitendinous
biceps femoris
97
hip adbuction muscles (4)
gluteus medius
gluteus minimus
TFL
piriformis
98
hip adduction muscles (5)
adductor longus
adductor brevis
adductor magnus
pectineus
gracilis
99
hip lateral rotation muscles (3)
biceps femoris
gluteus maximus
piriformis
100
hip medial rotation muscles (3)
anterior fibres gluteus medius
anterior fibres gluteus minimus
TFL
101
in which direction after 90% of hip dislocations
posterior
102
PS post hip dislocation
hip is shortened + medially rotated (int)
103
what % of hip dislocations have sciatic nn injury
10-20%
104
knee joint - type of joint
hinge synovial joint
105
what are the 2 articulating surfaces with the knee joint?
tibiofemoral (condyles femur to condyles tibia)
patello femoral - ant femur w/ patella
106
what structure is the patella within
quadriceps tendon
107
aa supply knee joint
genicular anastomoses
108
what comprises of the genicular anastomoses
genicular branches femoral/popliteal aa
109
what law does the nn supply to the knee joint follow
Hiltons law
110
what is Hiltons law
mm which supply muscle that cross joint supply joint
in case of knee: tibial, femoral, common fibular nn
111
where do the lateral mensici attach to?
intercondylar atrea
112
where do the medial menisci attach to
intercondylar area
also fixed to tibial collateral ligament + joint capsule
113
what are the 4 bursae of the knee
semimembranous bursa
suprapatellar bursa
pre-patellar bursa
infrapatellar bursa
114
where is the semimembranous bursa
between semimbranous mm + gastrocnemius head
115
where is the suprapatellar bursa
betw quadriceps femoris + femur
116
where is the prepatellar bursa
betw apex patella + skin
117
where is the infrapatellar bursa
sup - betwn patella ligament + skin
deep - betw tibia + patella ligament
118
which bursa is inflamed in Housemaid's knee?
prepatellar ligament
119
which bursa is inflamed in Clergyman's knee?
infrapatellar ligament
120
what is the patellar ligament and where does it attach?
= a continuation of the qudriceps tendon
attaches to the tibial tuberocity
121
fct of the collateral ligaments of the knee
stabilise hinge motion of the knee
122
which collateral ligament is wider and flatter
MCL
123
where does the MCL span betweem
medial epicondyle femur --> medial condyle tibia
124
if the MCL tears, which structure of the knee has also likely torn?
medial meniscus
125
which collateral ligament is thinner and rounder
LCL
126
where does the LCL span between
lateral epicondyle femur --> lateral fibular head
127
what do the cruciate ligaments connect
femur + tibia
128
where does the ACL extend between
anterior intercondylar fossa of the tibia (blending w/ med meniscus) --> intercondylar fossa femur
129
role of ACL
prevents anterior dislocation tibia
130
where does the PCL extend between?
posterior interocondylar fossa of the tibia --> anteromed femoral condyle
131
role of PCL
prevents posterior dislocation tibia
132
which cruciate ligament is more likely to rupture in a dashboard injury?
PCL
133
extension of knee muscle
quadriceps femoris
134
flexion of knee muscles (4)
hamstrings
gracilis
sartorius
pectineus
135
lat rotation of knee muscle
biceps femoris
136
med rotation of knee muscles (5)
semimbrananous
semiteindinous
gracilis
sartorius
pectineus
137
which movements of the knee can only occur when it is flexed?
lateral and medial rotation
138
what is the 'unhappy triad'
ACL, med meniscus + MCL tears
139
cause of the unhappy triad
rugby tackle
lateral force to extended knee
140
what is the proximal tibiofibular joint
between head of fibular and lateral condyle tibia
141
what type of joint is the proximal tibiofibular joint
plane synovial joint
142
what are the articular sufraces of the proximal tibiofibular joint lined with
hyaline cartilage, within joitn capsule
143
which external factors support the proximal tibiofibular joint (3)
ant/psot tibiofibular ligaments
LCL
biceps femoris
144
aa supply proximal tibiofibular joint
inf genicular aa
145
nn supply proximal tibiofibular joint
common fibular nn
146
cause of proximal tibiofibular joint dislocation
fall onto adducted and flexed knee
147
what is the distal tibiofibular joint
articulation between fibular notch of the distal tibia + fibula
148
which type of joint is the distal tibiofibular joint
fibrous joint (hence no joint capsule)
149
what external factors support the distal tibiofibular joint
IO membrane
ant + inf tibiofibular ligaments
inf transverse tibiofibular ligaments
150
aa supply distal tibiofibular joint
branches tibial aa + fibular aa
151
nn supply distal tibiofibular joint
deep peroneal + tibial nn
152
what type of joint is the ankle joint
synovial hinge joint
153
what 3 bones make up the ankle joint
tibia
fibular
talus
154
what forms the mortise of the ankle joint
tibia + fibula bound by the tibiofibular ligaments
155
why is plantarflexion less stable than dorsiflexion in the ankle joint
dorsiflexion - broad anterior part of the talus is held in the mortise = more stable
plantarflexion - narrow posterior part of the talus held in the mortise = less stable
156
how many ligaments is the medial/deltoid ligament on the medial malleolus
4 ligaments (to talus, calcaneus + navicular bones)
157
role of the medial/deltoid ligament of the ankle
resist over evertsion of the foot
158
how many ligaments is the lateral ligament on the lateral malleolus
3 (ant talofibular, post talofibular, calcaneofibular)
159
role of the lateral ligament of the ankle
resists over inversion of the foot
160
medial vs lateral ligament of the ankle - which is more likely to be damaged in an ankle sprain
lateral ligament
161
of the lateral ligament - which ligament is most likely to be damaged in an ankle sprain
anterior talofibular ligament
162
aa supply ankle joint
malleolar branches anterior tibial, posterior tibial + fibular aa
163
inn ankle joint
tibial, sup + deep fibular nn
164
eponymous term for bi/trimalleolar fractures
Pott's fractures
165
mechanism of injury Pott's fracture
forced eversion
--> pulls medial ligaments --> avulsion fracture med malleolus
talus moves laterally --> lat malleolus fracture
tibia forced anteriorly --> distal post tibial fracture
166
what is the subtalar joint
between talus and calcaneus
167
what type of joint is the subtalar joint
plane synovial joint
168
what are the 2 articulating surfaces of the subtalar joint
post talar articular surface
post calcaneal articular facet
169
what 3 ligaments support the jont capsule of the subtalar joint
post talocalcaneal ligament
med talocalcaneal ligament
lat talocalcaneal ligament
170
which extra ligament gives the majority of the stability to the subtalar joint
interosseous talocalcaneal ligament (within sinus tarsi)
171
aa supply subtalar joint
post tibial + fibular aa
172
nn supply to subtalar joint
plantar = med/lat plantar nn
dorsal = deep fibular nn
173
which aa supplies the NOF + head of femur
med circumflex aa
174
medial circumflex aa is a branch of
femoral aa
175
lateral circumflex aa is a branch of
femoral aa
176
route of lateral circumflex aa
wraps around anterolateral femur to supply lat thigh mm
177
what is the femoral aa a continuation of
external iliac aa
178
route of femoral aa
begins from ext iliac aa after inguinal ligament
travels anteriorly in the adductor canal, when leaves adductor hiatus, enters posterior compartment of leg as popliteal aa
179
where does the profunda femoris begin
femoral triangle
180
what are the 3 main branches of the profunda femoris
perforating branches
lateral femoral circumflex
medial femoral circumflex
181
where does the obturator aa originate from
internal iliac aa
182
where does the popliteal aa terminate
lower border of popliteus
183
what does the popliteal aa terminate as
anterior tibial and tibioperoneal aa
184
where does the anterior tibial aa run between
anteriorly, between the tibia and fibula
185
what does the anterior tibial aa become
dorsalis pedis aa
186
what does the tibioperoneal aa become
posterior tibial aa
fibular aa
187
fibular aa supplies
lateral leg via branches
188
posterior tibial aa supplies
deep posterior leg muscles
189
what does the posterior tibial aa branch into
lat + med plantar aa
190
what aa does the dorsalis pedis anastomose with to become the deep plantar arch
lateral plantar aa
191
what are the 2 groups of veins in the leg
deep vv (which accompany major aa)
superficial vv (in the sct tissue)
192
what does the deep vv of the thigh (profunda femoris) drain
thigh mm
193
where does the deep vv of the thigh drain into
femoral vv
194
where does the femoral vv drain into
external iliac vv
195
the plantar foot area is drained by which veins?
medial and lateral plantar vv
196
where do the medial and lateral plantar vv drain into
post tibial vv
197
where does the posterior tibial vv enter the leg and what does it drain into
posteriorly at the medial malleolus
--> popliteal vv
198
where do the dorsal vv arch drain into>
anterior tibial vv
199
what aer the 2 major superficial vv of the lower limb
great saphenous vv
small saphenous vv
200
what vv form the great saphenoud vv
dorsal vv arch + dorsal vv great toe
201
pathway of great saphenous vv
travels up medial leg, anterior to medial malleolus + posterior to medial condyle knee
terminates into femoral vv inferior to inguinal ligament
202
what forms the small saphenous vv
dorsal vv arch + dorsal vv little toe
203
pathway of small saphenous vv
travels on posterior leg, posterior to lateral malleolus along the lateral border of the achilles tendon
between the 2 heads of the gastrocnemius --> popliteal vv
204
what are the 2 superficial lymphatic vessels associated with the lower limb
medial vessels and lateral vessels
205
which vv are the medial lymphatic vessels associated with
greater saphenous vv
206
where do the medial lymphatic vessels drain into
sub-inguinal LN
207
which vv are the lateral lymphatic vessels associated with
small saphenous vv
208
where do the lateral lymphatic vessels drain into
popliteal LN
209
what are the 3 main deep lymphatic vessels + where do they drain into
post-tibial
ant tibial
peroneal
==> popliteal LN
210
where are the inguinal LN
upper aspect of the femoral triangle
211
how are the inguinal LN split into 2 groups
by their relation to the termination of the great saphenous vv
212
superficial inguinal LN drain
penis
scrotum
perineum
buttock
abdo wall
(direct line under the inguinal ligament)
213
superficial subinguinal LN drain
lower leg
214
where are the deep inguinal LN
median aspect of the femoral vv
215
how many popliteal LN are there
5-7
216
where are the popliteal LN and where do they drain into
imbedded in the fat of the popliteal fossa
drain into deep inguinal LN
217
how many arches in the foot (+ what are they)
2 x longitudinal - medial and lateral
1 x ant transverse
218
out of medial and lateral longitduinal arch - which is high
medial arch
219
which bones form the medial arch of the foot (4)
calcaneus
talus
navicular
3xMT
220
mm support meidal longitudinal arch foot (6)
TA
TP
fibularis longus
FDL
FHL
intrinsic foot mm
221
which ligaments support the medial foot arch (2)
plantar ligaments
medial igament ankle joint
222
which bones make up the lateral foot arch (3)
calcaneus
cuboud
4-5 MRT
223
which mm support the lateral foot arch (3)
FL
FDL
intrinsic foot mm
224
which ligament supports the lateral foot arch
plantar ligaments
225
which bones make up the transverse foot arch
MT bases
cuboid
3 x cuneiform
226
which mm and ligaments make up transverse foot arch (2 + 2)
plantar ligaments
deep transverse MT ligaments
227
what is pes cavus
high arches, espec medial
228
causes pes cavus (3)
idiopathic
clubfoot
2' to NM danage
229
what is pes planus and which arch is lost
flat foot
longitudinal arch lost
230
what age does pes planus tend to develop
from 2-3 y/
231
causes pes planus (2)
idiopathic
tight tendons/damage
232
what are the 3 parts of the stance phase of walking
1) Heel strike - foot hits ground heel first
2) support - rest of foot hits ground, mm work to cope with force
3)toe off - foot prepares to leave group, heel first, toes last
