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mr C.S. > Anatomy of the Lower Limb > Flashcards

Anatomy of the Lower Limb Flashcards

1
Q

Bones of the hip

A

Ilium

Pubis

Ischium

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2
Q

Parts of the ilium

Anterosuperiorly

Posteroinferiorly

A

Anterosuperiorly:

Blade, acts as a muscle point for insertion + visceral protection

Posteroinferiorly:

Thick, for weight distribution - medially to sacrum; laterally to femur

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3
Q

How does the ilium form the greater sciatic notch?

A

The posterior part curves inferiorly - between the sacrum and ischial spine - this forms the notch

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4
Q

What muscles attach to the outer blade of the ilium?

A

Glutei

Tensor fascia latae

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5
Q

What are the attachments of the iliac crest?

A

Anterior 2/3 - 3 layers of the anterior abdominal wall

Posterior part - erector spinae, latissimus dorsi

Laterally - inguinal ligament

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6
Q

Pubis

Shape

Parts + attachments

A

Shaped like an L

Body; superior and inferior rami

Superior rami: joins acetabulum and symphyseal articular surfaces of the pubis

Inferior rami (from the pubic tubercle to the ischium): connects adductors, perineal muscles and perineal membrane

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7
Q

Parts of the ischium

Anterior

Posterior

Inferior

A

J shaped

Body - contributes to the acetabular part

Inferiorly - ischial tuberosity - bears the weight of the sitting trunk - attaches the hamstrings and the short hip rotators (except piriformis) [also attaches to the body]

Anteriorly - ramus uniting with the pubis

Posterior - spine that separates greater sciatic notch (superior) from lesser (inferior)

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8
Q

Components of the acetabulum

A

2/5 ischium

1/5 pubis

2/5 ilium

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9
Q

Sacrum

Number of vertebrae

What makes up the sacral promontory?

What does the anterior aspect comprise of?

A

Five fused vertebrae

Anterior border of the upper part of the sacrum

Comprises of:

central mass

four sacral foramina trasmitting the sacral anterior primary rami

lateral masses of the sacrum: superior aspect called the ala

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10
Q

Posterior aspect of sacrum

A

Sacral canal - continuation of the vertebral canal

Either side are the four posterior sacral foramina

Inferiorly - canal terminates at the sacral hiatus - this transmits the fifth sacral nerve

Either side of the hiatus is the sacral cornu

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11
Q

Lateral aspect of the sacrum

A

Large facet - articulates with ilium

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12
Q

Where does the dural sheath terminate?

What is below it?

A

second piece of the sacrum

Below is the extradural space, cauda equina, filum terminale

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13
Q

Coccyx - how is it related to the sacrum?

A

3-5 fused vertebrae that fuse with the sacrum

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14
Q

Symphysis pubis

Location (plane)

Comprised of:

Surrounded by:

A

Median plane

Fibrous disc surrounded by two articulate surfaces of hyaline cartilage

Fibrous ligaments

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15
Q

Sacro-iliac joints

DIfference between the young and the old

A

Young - synovial

Old - fibrous + irregular surfaces

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16
Q

Ligaments of the sacro-iliac joints

A

Posterior sacro-iliac ligament: prevent downward and backwards displacement of sacrum to hip

Iliolumbar ligament: transverese process L5 to iliac crest

Sacrotuberous ligament: from sacral ischial tuberosity to side of sacrum + coccyx (forms lesser sciatic foramen from LS notch)

Sacrospinous ligament: from ischial spine to side of sacrum + coccyx (forms greater sciatic foramen from GS notch)

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17
Q

Relations of the sacro-iliac joints + pubic symphysis

A

SIJ - internal iliac vessels run anteriorly

SP - urethra and deep dorsal vein run inferiorly

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18
Q

What are the muscles of the gluteal region?

A

G maximus

G medius

G minimis

Obturator internus

Piriformis

Quadratus femoris

Sup + Inf gemelli

Tensor fascia latae

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19
Q

Glluteus maximus

Origin

Insertion

Nerve

Action

A

Origin: iliac crest (above+behind the posterior gluteal line); sacrum + coccyx; sacrotuberous ligament

Insertion: 3/4 iliotibial tract; 1/4 into gluteal tuberosity of femur

Nerve: Inferior gluteal nerve (L5, S1, S2)

Action: Thigh extension; lateral rotator of thigh; balances pelvis on thigh; balances femur on knee on standing (via iliotibial tract)

Lower border - controls overlaps the ischial tuberosity on standing but not sitting

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20
Q

Tensor fasciae latae

A

Origin: Anterior part of iliac crest but posterior to ASIS

Insertion: iliotibial tract

Nerve: Superior gluteal nerve (L4,L5,S1)

Action: Assists gluteus maximus in tighteing the ileotibial track.

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21
Q

Gluteus medius

Insertion

Origin

Action

Nerve

A

Origin: Outer surface of ilium between anterior and posterior gluteal lines

Insertion: Lateral side of greater trochanter

Nerve: Superior gluteal (L4,L5,S1)

Action: abduction of thigh; tilting upwards opposite side of pelvis (trendelenburg)

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22
Q

Gluteus minimus

Origin

Insertion

Nerve supply

Action

A

Origin: between anterior and inferior gluteal lines

Insertion: Anterior aspect of greater trochanter

Nerve supply: superior gluteal nerve (L4,L5,S1)

Action: abduction of thigh, medial rotation of thigh, assists medius to prevent pelvic tilt

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23
Q

Piriformis

Origin

Insertion

Nerve supply

Action

A

Origin: anterior surface of sacrum

Insertion: into the upper border of greater trochanter - passes via the greater sciatic foramen

Nerve supply: Directly from 2nd and 3rd sacral nerves

Action: this + three small muscles cause lateral rotation of the thigh

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24
Q

Obturator internus

A

Origin: obturator membrane on iliac fossa

Insertion: medial surface of greater trochanter via lesser sciatic foramen

erve supply: Nerve to obturator internus (L5, S1, S2)

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25
Q

Gemeli (superior and inferior)

A

Origin: upper and lower margins of lesser sciatic notch

Insertion: tendon of obturator internus

Neve: Sup - nerve to obturator internus

Inf - nerve to quadratus femoris

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26
Q

Quadratus Femoris

A

Origin: Outer border of ischial tuberosity

Insertion: Quadrate tubercle of upper part of trochanteric crest

Nerve: Nerve to quadratus femoris (L4, L5, S1)

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27
Q

Greater sciatic foramen boundaries

A

Anterior + Superior: greater sciatic notch

Posterior: sacrotuberous ligament

Inferior: sacrospinous ligament + ischial spine

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28
Q

Structures that pass through the greater sciatic foramen

A

Piriformis

Above piriformis: superior gluteal vessels and nerve

Below piriformis: inferior gluteal vessels and nerve, internal pudendal vessels and nerve, sciatic nerve, posterior cutaneous nerve of the thigh, nerve to quadratus femoris, nerve to obturator internus

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29
Q

Lesser sciatic foramen boundaries

A

Anterior: Ischial spine and sacrospinous ligament

Posterior: sacrotuberous ligament

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30
Q

Structures that pass through the lesser sciatic foramen

A

Tendon of obturator internus

Nerve to obturator internus

Internal pudendal vessels

Pudendal nerve

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31
Q

Sciatic nerve surface marking

A

Curved line drawn starting at the midpoint between PSIS and ischial tuberosity

with the 2nd point as the midpoint between ischial tuberosity and greater trochanter

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32
Q

Where to have IM injections of the buttock?

A

Upper and outer quadrant to avoid the sciatic nerve

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33
Q

Femur anatomy

A

Head: 3/4 sphere, cartilage except in the fovea wheere there is ligamentum teres

Neck: lateral - greater trochanter, medial / posterior - lesser trochanter, posterior - trochanteric crest, anterior - intertrochanteric line

Shaft - circular but flattened posterior at each extremity; posterior - middle 1/3 has ridge (linea aspera); splits superiorly into two; splits inferiorly into two: the lateral and medial supracondylar ridge - between which is a smooth area - popliteal surface of femur

Medial supracondylar ridge ends at the adductor tubercle

medial and lateral condyle separated by deep intercondylar notches posteriorly and anterior (for the patella)

Lateral condyle larger - acts as a buttress to prevent lateral displacement of the patella

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34
Q

Blood supply of the femoral head

A

Vessels from the hip capsule - reflected onto neck in longitudinal bands (retinacula) = retinacular vessels (main source)

Vessels from the diaphysis

Artery of ligamentum teres - negligible in adult

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35
Q

Clinical points of femur

A

Femoral neck fractures = completely disrupt diaphysis flow

Intracapsular fractures = disrupt retinacular flow, more likely to cause avascular necrosis = more dangerous

Leg externally rotated as axis is not between hip and knee; its along shaft - causing iliopsoas acting as an external rotator

Femoral shaft fractures = damage perforating branches of profunda femoris artery; proximal bit iliopsoas + gluteus medius causing abduction; distal bit adductor muscles causing medial displacement

Popliteal artery - runs in popliteal surface of femur; supracondylar fractures of femur = gastrocnemius contracts - pulling distal end posteriorly; proximal end can perforate the popliteal artery

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36
Q

Patella facts

Anterior and posterior surface

A

Largest sesamoid bone in the body - within the quadriceps exapnsion - after the apex of the patella becomes the ligamentum patellae

Anterior surface rough, posterior surface smooth (surrounded by hyaline cartilage)

Large lateral facet of a patella - allows the facet to lay on the side it belongs to

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37
Q

How can the patella be affected?

A

Dislocation - rarely laterally - as large lateral condyle + fibres of vastus medialis which are bascially horizontal

Shatter - several pieces, but no avulsion as the quadriceps tendon remains intact

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38
Q

Tibia anatomy

A

Shaft with expanded upper and lower ends

Proximal end - articulates with femur - has the medial and lateral condyle; in between is the intercondylar area (where the cruciate ligaments attach) with the intercondylar eminence + lateral and medial horns of the menisci

Shaft anatomy - triangular, posterior border with the soleal line - origin of soleus,

Interosseous membrane - lateral side

Lower end of tibia expands from triangular shaft into a quadrilateral mass - medially - forms the medial malleolus and projects downwards

Inferior surface is smooth = articulates with the ankle joint

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39
Q

What is the groove for on the posterior of the medial malleolus?

A

For the tendon of tibialis posterior

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40
Q

Why is the tibia so commonly fractured?

A

Anteromedial border is subcut - lack of vascularity to the skin (only supported by the periosteum - means that skin lacerations heal poorly)

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41
Q

What is the groove for on the posterior surface of lateral malleolus?

A

Tendons of peroneus longus and peroneus brevis

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42
Q

Facts about the fibula

A

Common peroneal nerve winds around the neck

Fibres of interosseous membrane run downwards and medially

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43
Q

Bones of the foot

A

Tarsals

Metatarsals

Phalanges

44
Q

Tarsal bones

A

Proximal row:

Talus, calcaneus, navicular

Distal row:

Cuboid, 3 cuneiform bones

45
Q

Talus articulations

A

Superior - articulates with tibia - wider in the front than behind (dorsiflexion more movement, plantar flexion little movement)

Lateral and medial - malleoli

46
Q

/What is the groove for on the posterior groove of the talus

A

Tendon of flexor hallucis longus

No muscular or tendinous attachments, but ligaments present

47
Q

Posterior surface of calcaneous

Anterior surface of calcaenous

A

Middle: roughened for insertion of tendo calcaneous

Upper: smooth area, site of bursa between tendo calcaneous and bone

Lower: fibro-fatty pad, acts as a heel

Undersurface contains two condyles - the medial and lateral - of which the medial is larger - main support of the foot

Anterior surface = facet for articulation of the cuboid

48
Q

Cuboid

A

Articulates with anterior surfce of the calcaneous

Grooved on the surface by the tendon of peroneous longus

49
Q

Navicular

A

Articulates with the head of the talus behind and the three cuneiforms behind

Tuberosity present for attachment of tibialis posterior; also spring ligament from sustentacular tali to tuberoisty of naviicular

50
Q

Cuneiforms

A

Wedge shaped, help to main the arch of the foot

51
Q

METATARSALS

A

One is thickest and strongest, two depressions on the underside - lined with cartilage - because two sesamoid bones lie there on the tendon of flexor hallucis longus

2nd more likely break

5th MT - tuberosity on it for attachment of peroneus longus

In standing position - metatarsals are on the ground

52
Q

Femoral triangle boundaries

A

Boundaries:

Above - inguinal ligament

Medial - medial border of adductor longus

Lateral - medial border of sartorius

53
Q

What makes up the floor of the femoral triangle?

A

Iliacus

Psoas major tendon

Pectineus

Adductor longus

54
Q

Roof of femoral triangle

A

Skin

Superficial fascia

Superficial inguinal lymph nodes

Great saphenous vein

Deep fascia of thigh (fascia lata)

Cribiform fascia (part of fascia lata)

(pierced by great saphenous vein and lymphatics at saphenous opening)

55
Q

Contents of femoral triangle

A

Femoral canal

Femoral nerve

Femoral artery

Femoral vein

Deep inguinal lymph nodes

56
Q

What is femoral sheath?

A

Prolongation transversalis fascia anteriorly and fascia over ilacus posteriorly

Contains the femoral canal medially, femoral vein middle and femoral artery laterally

57
Q

Femoral ring boundaries

A

Anterior: inguinal ligament

Posterior: pectineal ligament

Medial: lacunar ligament

Lateral: femoral vein

58
Q

Inguinal nodes divisions

A

Superficial:

horizontal - below and parallel to inguinal ligament

vertical - around the terminatino of the great saphenous vein

Deep:

medial to femoral vein and in femoral canal (Cloquet’s node)

59
Q

Which sites drain into the inguinal nodes?

A

lower trunk and back below umbilicus

abdominal wall from level of umbilitcus\buttock

lower limb

perineum, scrotal skin and penis

vulva and lower third of vagina

lower half of anal canal

fundus of the uterus

60
Q

Adductor canal boundaries

A

from apex of femoral triangle to popliteal fossa

Posteriorly - adductor lonhus and adductor magnus

Anteromedially - sartorius which forms the roof

Anterolaterally - vastus medialis

61
Q

Contents of the adductor canal

A

Femoral artery

Femoral vein (behind the artery)

Saphenous nerve

62
Q

Boundaries of the popliteal fossa

A

Diamond shaped

Above and medial - semitendinosus; semimembranosus

Above and lateral - biceps femoris

Below and lateral - lateral head of gastrocnemius

Below and medial - medial head of gastrocnemius

Roof: skin, superficial fascial, deep fascia (pierced by short saphenous vein)

Floor: posterior surface of femur, posterior aspect of knee joint popliteus muscle covering the upper surface of the tibia

63
Q

Contents of the popliteal fossa

A

Popliteal artery (deepest)

Popliteal vein

Sciatic nerve - which becomes the common peroneal nerve (laterally which gives off sural communicating nerve) and tibial nerve (gives of sural nerve)

Lymph nodes - draining the lateral aspect of the foot and heel

Fat

Bursa

Also plantaris muscle located beneath the lateral head of gastrocnemius

64
Q

Femoral artery route

A

From extenerla iliac after the inguinal ligament

apex of femoral canal

through hunter;s canal

out the hiatus in adductor magnus where it becomes the popliteal artery

65
Q

Anterior relations of the femoral artery

A

Skin, superficial fascia, deep fascia, femoral branch of GF nerve, sartorius, saphenous nerve

66
Q

Posterior relations of the femoral artery

Medial and lateral

A

psoas tendon, profunda vessels, pectineus, adductor longus, femoral vein (at adductor canal and apex of femoral triangle), tendon of adductor magnus

medially - femoral vein (in femoral triangle); laterally - femoral nerve, sartorius, vastus medialis

67
Q

Branches of femoral artery

A

Superficial epigastric artery

superficial circumflex iliac artery

superficial external pudendal artery

deep external pudendal artery

profunda femoris

68
Q

Profunda femoris

A

Posterolaterally - 5 cm from the inguinal ligament

Passes distally in femoral triangle - lying on iliacus, psoas, pectineus, adductor brevis, adductor magnus

Adductor longus is superficial - separated from femoral artery by this; femoral vein and profunda veins

69
Q

Where does the profunda femoris terminate?

What are the branches of profunda femoris?

A

Lower 1/3 of thigh by perforating branches of adductor magnus

Lateral circumflex, medial circumflex, four perforating branches

70
Q

Popliteal artery

Route, branches, relations

A

From hiatus in adductor magnus to the popliteal fossa to the lower border of popliteus where it splits into anterior and posterior tibial artery

Branches - geniculate to the knee, anterior / posterior tibial, muscular

Relations - superficially - popliteal vein, sural nerve; overlapped above by semimebranosus in upper part, gastrocnemius and plantaris in lower part

71
Q

Posterior tibial artery

Route, branches, relations

A

Route - from lower border of popliteus to the lower margin of flexor retinaculum where it divides into medial and lateral plantar arteries

Relations - upper two thirds covered by gastrocnemius and soleus; lower 1/3 is superficial - between medial side of tibia and medial border of tendo calcaneus; lies on tibialis posterior, felox digitorum longus, tibia, back of ankle joint

Accompanied by venae commitantes and tibial nerve - which is initally medial but then crosses over to become lateral

72
Q

Branches of posterior tibial artery

A

Peroneal artery - 2.5cm below popliteus, runs on the posterior aspect of fibula - supplies the muscle + perforating branch which pierces the interosseous membrane and anastomoses with arteries on the dorsum of the foot

medial plantar; lateral plantar

73
Q

Anterior tibial artery

A

From lower border of popliteus to the front of the ankle joint where it becomes dorsalis pedis

Relations: lies deep on interosseous membrane; becomes superficial just above ankle joint in between extensor hallucis longus (which then crosses it superficially) and tibialis anterior

On dorsum of foot lies in between tendons extensor hallucis longus and extensor digitorum longus

Branches - small branches anastomosing with knee and ankle; dorsalis pedis - initially on front in first interosseous space - then plunges deeply to anastomose with the lateral plantary artery to form the plantar arch

74
Q

Clinical points of arteries of the leg

A

Femoral artery - mid inguinal point - for femoral stab; venous sample is 1cm medial

Femoral artery easily injured in butchers, stabbings, bullfights - as superficial in the femoral triangle

Popliteal artery aneurysm can cause DVT (compressing the femoral vein) or pain/numbness (compressing the tibial;common peroneal nerve)

75
Q

Superficial vs deep veins of the leg

A

Deep accompany the arteries

Superficial are the long and short saphenous vein

76
Q

Route of the great saphenous vein

Tributaries

Improtant nerve close by

A

Commences at the medial side of the dorsal venous arch

Ascends in front of the medial malleolus and up the leg

Behind the medial border of the patella

Ascends obliquely up the medial aspect of thigh - pierces deep fascia anteriorly (2.5cm inferolaterally to the pubic tubercle) to join the femoral vein

Tributaries: superficial epigastric vein, superficial circumflex iliac vein, superficial external pudendal vein, lateral accessory vein which jonis that main vein at the mid thigh

saphenous nerve; xan cause loss of sensation on medial side of foot, no motor symptoms

77
Q

Short saphenous vein

A

Lateral side of the dorsal venous arch

behind the lateral malleolus

back of the leg to enter the popliteal vein in the popliteal fossa

Accompanied by the sural nerve

Communicates with the deep veins of the foot and the great saphenous vein

78
Q

why are the tributaries important when conducting varicose vein surgery?

A

Must be fully tied off or there will be recurrence of varicose veins

79
Q

Compartments of the thigh and what causes them

A

Fascia lata surrounds the muscles; sends septa between the compartments

Anterior compartment: vastus lateralis, vastus intermedius, vastus medialis, rectus femoris, sartorius

Medial compartment: adductor longus, adductor magnus, adductor brevis, obturator externus, gracilis, pectineus

Posterior compartment: semitendinosus, semimembranosus, biceps femoris

80
Q

Compartments of the leg and how they are formed

A

Deep fascia of leg separates each compartment by septa

Anterior comparnment: tibialis anterior, extensor hallucis longus, extensor dihitorum longus, peronis tertius; all supplied by deep peroneal nerve and anterior tibial artery,

Posterior compartment: gastrocnemius, soleus, plantaris, popliteus, fleor hallucis longus, flexor digitorum longus,; supplied by the tibial nerve and the posterior tibial artery

Lateral compartment: peroneal longus, peroneal brevis; superficial peroneal nerve, peroneal artery

81
Q

Nerves of the lower limb

Branches

A

Anterior primary rami of L1-4; contribution from T12

Formed in the substance of psoas major; all exit on the lateral border of psoas major, except obturator (medial border) and genitofemoral nerve (anterior aspect)

Femoral, obturator, ilioinguinal, lateral cutaneous nerve of the thigh, genitofemoral

82
Q

Femoral nerve - route and branches

A

Root value L2-4

Passes through substance of psoas major, emerges on lateral border

Travels beneath the inguinal ligament on iliopsoas lateral to the artery

Breaks up into branches 5 cm below inguinal ligament

Branches: motor - quadriceps, pectineus, sartorius; cutaneous - medial cutaneous nerve of the thigh, intermediate cutaneous nerve of the thigh, saphenous nerve; articular branches to hip and knee

83
Q

Obturator nerve route

A

From L2-4

Medial border of psoas; downwards and forwards deep to the internal iliac vessels to reach the obturator foramen

Enters thigh through this accompanied by obturator vessels

84
Q

Branches of the obturator nerve

A

Anterior - in front of adductor brevis and behind adductor longus and pectineus;

supplies gracilis, adductor longus and brevis

supplies sensation medial thigh and hip

Posterior - behind adductor brevis and pierces obturator externus

supplies adductor magnus, obturator externus, knee joint, (+sometime adductor brevis)

85
Q

Ilioinguinal nerve

A

Enters inguinal canal

Supplies skin of groin and anterior scrotum

Can be damaged during hernia repair

86
Q

Lateral cutaneous nerve of thigh

A

Direct from the lumbar plexus, beneath inguinal ligament

Can sometimes pierce the ligament or get trapped by it

Can get burning sensation on the lateral aspect of the thigh - meralgia paraethetica

87
Q

Genitofemoral nerve

A

From L1-2 and emerges on the anterior surface of psoas major

travels inferiorly and deep to the ureters

Divides into 2 branches

Genital - males - enters deep inguinal ring and emerges at superficial - to supply skin on scrotum; females - supplies labia majora

Femoral - travels beneath the inguinal ligament within the femoral sheath to supply the skin just below the ligament

88
Q

Sacral plexus

A

Formed from anterior primary rami L4-5; S1-4

Form in front of piriformis where they are joined by the lumbosacral trunk

89
Q

Branches of sacral plexus

A

Muscular: piriformis, obturator internus, quadratus femoris, gemelli

Superior gluteal, inferior gluteal, pudendal, sciatic, tibial, common peroneal

90
Q

Superior gluteal nerve

Root, route, supply

A

Root - L4,5,S1

Route - passes out greater sciatic foramen above piriformis

Supplies - gluteus medius, minimus and tensor fascia lata

91
Q

Inferior gluteal nerve

Root, route, supply

A

Root - L4,5,S1

Route - exits below piriformis

Supply - gluteus maximus

92
Q

Pudendal nerve

A

Root - S2,3,4

Route - exits through greater sciatic foramen between piriformis and coccygeus; medial to sciatic nerve

Winds over sacrospinous ligament, medial to inferior pudendal artery

re-enters via lesser sciatic foramen

continues through pudendal canal in obturator fascia on the lateral wall of the ischiorectal fossa where it divides into three branches - inferior rectal (haemorrhoidal), perineal, dorsal nerve of penis

93
Q

Sciatic nerve route

A

Nerve emerges from the greater sciatic foramen below piriformis

Covered by gluteus maximus

Crosses posterior surface of ischium

descends on adductor magnus lying deep to the hamstrings

crossed by the long head of the biceps

Divides into the tibial nerve and common peroneal nerve

94
Q

Branches of the sciatic nerve supply?

A

L4-S3

Muscular: biceps femoris, semimebranosus, semitendinosus and part of the adductor magnus (also supplied by obturator nerve)

+ tibial nerve

+ common peroneal nerve

95
Q

TIbial nerve

A

Larger branch of sciatic nerve

traverses popliteal fossa superficial to vein and artery

crosses vessels lateral to medial

descends deep to soleus

accompanied by posterior tibial vessels

passses behind malleolus

divides into medial and lateral plantar nerves

96
Q

branches of the tibial nerve

in the popliteal fossa

in the leg

A

in the popliteal fossa:

muscular to gastrocnemius, soleus, popliteus; cutaneous - sural nerve (accompanies small saphenous vein); articular - knee joint

in the leg and foot:

muscular: flexor hallucis longus, flexor digitorum longus, tibialis posterior, intrinsic muscles of the foot
cutaneous: sole of the foot, lateral plantar - lateral aspect and one and half toes; medial plantar - medial aspect and medial three and half

97
Q

Route of common peroneal nerve

A

Enters popliteal fossa lateral side of popliteal fossa lateral to tibial nerve

passes along medial border of biceps tendon

winds around the neck of the fibula, deep to peroneus longus where it then splits into superfiical and deep

98
Q

Deep peroneal nerve

A

Pierces the extensor digitorum longus

Descends (accompanied by anterior tibial vessels) over the anterior interosseous membrane and across the ankle joint.

Branches: muscular: tibialis anterior, extensor hallucis

longus, extensor digitorum longus, extensor

digitorum brevis, peroneus tertius

cutaneous: to the skin of the web space

between first and second toes.

99
Q

Superficial peroneal nerve

A

muscular - peroneus longus, peroneus brevis

cutaneous -distal two thirds of the lateral aspect of the foot, dorsum of the foot except the first web space

100
Q

Dermatomes of the leg

A

Anterior (L to M): subcostal, femoral branch of GF, ilioinguinal; lateral cutaneous nerve of thigh, medial and intermediate cutaneous nerve of thigh, obturator nerve;
lateral cutanenous nerve of calf, saphenous nerve;
superficial pernoeal nerve;
sural nerve

Posterior (L to M): subcostal, iliohypogastric, dorsal rami L1,2,3;
dorsal rami S1,2,3
lateral cutaneous nerve of thigh, posterior cutaneous, obturator nerve;
medial cutaenous;
lateral cutaneous nerve of calf, saphenous;
sural;
tibial;
lateral and medial plantar nerve

101
Q

Tendon reflexes in the lower leg

A

Knee: L3,L4 via femoral; quadriceps

Ankle: S1 via sciatic; gastrocnemius

102
Q

Clinical points of hip and knee

A

Same nerves - so pain from hip can get referred to the knee

Obturator hernia (?intestinal obstruction) can press on obturator nerve - causing pain in cutaneous distribution of nerve (medial aspect of the thigh)

Pudendal nerve - bilateral block via palpation of ischial spine - reduces anal reflex, relaxes pelvic floor muscles and reduces sensation to vulva and lower 1/3 vagina

Posterior dislocation of hip - sciatic nerve injury = foot drop

Artery alongside sciatic nerve = arteria comitans nervi ischiadici; bleeding common in above knee amputations - must be ligated carefully otherwise risks damage to sciatic nerve

Common peroneal nerve around neck of fibula - car bumper, below knee cast and lloyd-dvis position all can damage it here

103
Q

Nerve injuries: sciatic nerve

A

Paralysis of hamstrings and muscles of leg and foot = no movement below knee joint (foot drop happens)

No sensation below the knee, except in areas supplied by the saphenous nerve - medial maleollus and in medial portion of leg to great toe

104
Q

Tibial nerve injury

A

Not usually isolated; commonly penetrating injury

No active plantar flexion

Loss of sensation over the sole of the foot

105
Q

Common peroneal nerve injury

A

In car bumper accidents, below knee casts, lloyd-davis position

Deep peroneal nerve damage - no dorsiflexion

Superficial peroneal nerve damage - no eversion

Loss of sensation on lateral aspect of leg and dorsum of foot (except medial - saphenous and lateral - sural)

106
Q
A

mr C.S. (4 decks)

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