Anatomy of the Lower Limb Flashcards
1
Q
Bones of the hip
A
Ilium
Pubis
Ischium
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
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
4
Q
What muscles attach to the outer blade of the ilium?
A
Glutei
Tensor fascia latae
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
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
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)
8
Q
Components of the acetabulum
A
2/5 ischium
1/5 pubis
2/5 ilium
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
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
11
Q
Lateral aspect of the sacrum
A
Large facet - articulates with ilium
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
13
Q
Coccyx - how is it related to the sacrum?
A
3-5 fused vertebrae that fuse with the sacrum
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
15
Q
Sacro-iliac joints
DIfference between the young and the old
A
Young - synovial
Old - fibrous + irregular surfaces
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)
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
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
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
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.
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)
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
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
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)
25
Gemeli (superior and inferior)
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
26
Quadratus Femoris
Origin: Outer border of ischial tuberosity
Insertion: Quadrate tubercle of upper part of trochanteric crest
Nerve: Nerve to quadratus femoris (L4, L5, S1)
27
Greater sciatic foramen boundaries
Anterior + Superior: greater sciatic notch
Posterior: sacrotuberous ligament
Inferior: sacrospinous ligament + ischial spine
28
Structures that pass through the greater sciatic foramen
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
29
Lesser sciatic foramen boundaries
Anterior: Ischial spine and sacrospinous ligament
Posterior: sacrotuberous ligament
30
Structures that pass through the lesser sciatic foramen
Tendon of obturator internus
Nerve to obturator internus
Internal pudendal vessels
Pudendal nerve
31
Sciatic nerve surface marking
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
32
Where to have IM injections of the buttock?
Upper and outer quadrant to avoid the sciatic nerve
33
Femur anatomy
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
34
Blood supply of the femoral head
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
35
Clinical points of femur
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
36
Patella facts
Anterior and posterior surface
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
37
How can the patella be affected?
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
38
Tibia anatomy
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
39
What is the groove for on the posterior of the medial malleolus?
For the tendon of tibialis posterior
40
Why is the tibia so commonly fractured?
Anteromedial border is subcut - lack of vascularity to the skin (only supported by the periosteum - means that skin lacerations heal poorly)
41
What is the groove for on the posterior surface of lateral malleolus?
Tendons of peroneus longus and peroneus brevis
42
Facts about the fibula
Common peroneal nerve winds around the neck
Fibres of interosseous membrane run downwards and medially
43
Bones of the foot
Tarsals
Metatarsals
Phalanges
44
Tarsal bones
Proximal row:
Talus, calcaneus, navicular
Distal row:
Cuboid, 3 cuneiform bones
45
Talus articulations
Superior - articulates with tibia - wider in the front than behind (dorsiflexion more movement, plantar flexion little movement)
Lateral and medial - malleoli
46
/What is the groove for on the posterior groove of the talus
Tendon of flexor hallucis longus
No muscular or tendinous attachments, but ligaments present
47
Posterior surface of calcaneous
Anterior surface of calcaenous
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
Cuboid
Articulates with anterior surfce of the calcaneous
Grooved on the surface by the tendon of peroneous longus
49
Navicular
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
Cuneiforms
Wedge shaped, help to main the arch of the foot
51
METATARSALS
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
Femoral triangle boundaries
Boundaries:
Above - inguinal ligament
Medial - medial border of adductor longus
Lateral - medial border of sartorius
53
What makes up the floor of the femoral triangle?
Iliacus
Psoas major tendon
Pectineus
Adductor longus
54
Roof of femoral triangle
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
Contents of femoral triangle
Femoral canal
Femoral nerve
Femoral artery
Femoral vein
Deep inguinal lymph nodes
56
What is femoral sheath?
Prolongation transversalis fascia anteriorly and fascia over ilacus posteriorly
Contains the femoral canal medially, femoral vein middle and femoral artery laterally
57
Femoral ring boundaries
Anterior: inguinal ligament
Posterior: pectineal ligament
Medial: lacunar ligament
Lateral: femoral vein
58
Inguinal nodes divisions
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
Which sites drain into the inguinal nodes?
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
Adductor canal boundaries
from apex of femoral triangle to popliteal fossa
Posteriorly - adductor lonhus and adductor magnus
Anteromedially - sartorius which forms the roof
Anterolaterally - vastus medialis
61
Contents of the adductor canal
Femoral artery
Femoral vein (behind the artery)
Saphenous nerve
62
Boundaries of the popliteal fossa
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
Contents of the popliteal fossa
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
Femoral artery route
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
Anterior relations of the femoral artery
Skin, superficial fascia, deep fascia, femoral branch of GF nerve, sartorius, saphenous nerve
66
Posterior relations of the femoral artery
Medial and lateral
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
Branches of femoral artery
Superficial epigastric artery
superficial circumflex iliac artery
superficial external pudendal artery
deep external pudendal artery
profunda femoris
68
Profunda femoris
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
Where does the profunda femoris terminate?
What are the branches of profunda femoris?
Lower 1/3 of thigh by perforating branches of adductor magnus
Lateral circumflex, medial circumflex, four perforating branches
70
Popliteal artery
Route, branches, relations
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
Posterior tibial artery
Route, branches, relations
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
Branches of posterior tibial artery
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
Anterior tibial artery
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
Clinical points of arteries of the leg
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
Superficial vs deep veins of the leg
Deep accompany the arteries
Superficial are the long and short saphenous vein
76
Route of the great saphenous vein
Tributaries
Improtant nerve close by
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
Short saphenous vein
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
why are the tributaries important when conducting varicose vein surgery?
Must be fully tied off or there will be recurrence of varicose veins
79
Compartments of the thigh and what causes them
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
Compartments of the leg and how they are formed
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
Nerves of the lower limb
Branches
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
Femoral nerve - route and branches
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
Obturator nerve route
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
Branches of the obturator nerve
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
Ilioinguinal nerve
Enters inguinal canal
Supplies skin of groin and anterior scrotum
Can be damaged during hernia repair
86
Lateral cutaneous nerve of thigh
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
Genitofemoral nerve
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
Sacral plexus
Formed from anterior primary rami L4-5; S1-4
Form in front of piriformis where they are joined by the lumbosacral trunk
89
Branches of sacral plexus
Muscular: piriformis, obturator internus, quadratus femoris, gemelli
Superior gluteal, inferior gluteal, pudendal, sciatic, tibial, common peroneal
90
Superior gluteal nerve
Root, route, supply
Root - L4,5,S1
Route - passes out greater sciatic foramen above piriformis
Supplies - gluteus medius, minimus and tensor fascia lata
91
Inferior gluteal nerve
Root, route, supply
Root - L4,5,S1
Route - exits below piriformis
Supply - gluteus maximus
92
Pudendal nerve
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
Sciatic nerve route
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
Branches of the sciatic nerve supply?
L4-S3
Muscular: biceps femoris, semimebranosus, semitendinosus and part of the adductor magnus (also supplied by obturator nerve)
+ tibial nerve
+ common peroneal nerve
95
TIbial nerve
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
branches of the tibial nerve
in the popliteal fossa
in the leg
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
Route of common peroneal nerve
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
Deep peroneal nerve
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
Superficial peroneal nerve
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
Dermatomes of the leg
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
Tendon reflexes in the lower leg
Knee: L3,L4 via femoral; quadriceps
Ankle: S1 via sciatic; gastrocnemius
102
Clinical points of hip and knee
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
Nerve injuries: sciatic nerve
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
Tibial nerve injury
Not usually isolated; commonly penetrating injury
No active plantar flexion
Loss of sensation over the sole of the foot
105
Common peroneal nerve injury
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
