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204: Theme 2 > Anatomy of the Lower Limbs > Flashcards

Anatomy of the Lower Limbs Flashcards

1
Q

What is the lower limb adapted for?

A
  • locomotion
  • weight-bearing
  • endearing high stresses
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2
Q

Label this diagram

A
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3
Q

Label this diagram

  • what structure is it
A

Pelvis

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4
Q

Label this diagram

  • what structure is it?
A

Femur

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5
Q

Label this diagram

  • what structures are they?
A

Tibia, fibula, foot

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6
Q

What movements occur in the lower limbs?

A
  • Flexion/Extension
  • Abduction/Adduction
  • Lateral (external) /medial (internal) rotation
  • Pronation/supination
  • Circumduction
  • there is no opposition
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7
Q

What are the joints of the lower limb?

(4)

  • what movement do they allow
A
  • Hip joint
    • ​flexion/extension
    • abduction/adduction
    • circumduction
    • medial/lateral rotation of femur
  • Knee joint
    • flexion/extension
    • a little medial/lateral rotation
  • Ankle joint
    • ​dorsiflexion/plantarflexion
  • Joints of the foot
    • ​Inversion/eversion (pointing foot in and out)
    • Extension/ flexion
    • Supination/pronation
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8
Q

What movements are carried out by the joints of the foot?

A
  • ​Inversion/eversion
  • Extension/ flexion
  • Supination/pronation
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9
Q

What are the compartments of the Thigh?

(3)

  • what do they contain
A
  • Anterior: extensors of the leg
  • Posterior: flexors of the leg
  • Medial: adductor muscles
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10
Q

What are the three major gluteal muscles?

  • movement/ action
A
  • Gluteus maximus: Extension + lateral rotation of thigh
    • also supports the extended knee via the iliotibial tract where it inserts
  • Gluteus medius: Abduction + medial rotation of thigh
  • Gluteus minimus: Abduction + medial rotation of thigh

superficial to deep

these muscles facilitate locomotion

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11
Q

OrIn of the Gluteus Maximus

  • innervation?
  • role of the Tensor fasciae latae + OrIn
A

Origin: Illium

  • Inserts: Gluteal tuberosity, Iliotibial tract
  • Innervation: Inferior gluteal nerve
  • the Tensor fasciae latae: tenses the fascia and the iliotibial tract to help stabilise the knee joint
    • origin: anterior superior iliac spine
    • inserts: iliotibial tract
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12
Q

OrIn of the Gluteus medius and minimus

  • innervation?
A
  • Origin: Ileum
  • Insertion: Greater trochanter
  • Innervation: superior gluteal nerve
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13
Q

What are the small muscles of the gluteal region?

(main 1)

  • action/ role
A
  • Piriformis
  • Gemellus superior, Obturator internus, Gemellus inferior, Quadratus femoris
  • they are equivalent to the rotator cuff
    • stabilize the hip
    • sit posterior to the hip joint
    • provide lateral rotation of the thigh
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14
Q

OrIn of the small muscles of the gluteal region

  • Innervation?
A
  • Origin: Sacrum (piriformis) and ischium/ischiopubic ramus*
  • Insertion: Greater trochanter
  • Innervation: branches of the sacral plexus
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15
Q

What are the muscles on the anterior compartment of the thigh?

  • action?
A
  • The Quadriceps: extension of the leg
    • Rectus femoris: provides flexion of the thigh
      • origin AIIS
    • Vastus lateralis
    • Vastus medialis
    • Vastus intermedius (behind rectus femoris)
  • Sartorius: flexes the thigh, flexes the leg at the knee joint
    • ​allows you to cross your legs (tailors muscle)
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16
Q

OrIn of the Quadricep muscles

  • innervation?

what about Sartorius muscle

A
  • Origin: anterior inferior iliac spine (rectus femoris) + femur
    • Sartorius: anterior superior iliac spine
  • Insertion: Tibial tuberosity
    • Sartorius tibia
  • Innervation: femoral nerve
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17
Q

Label this diagram

  • what does it show?
A

Quadriceps

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18
Q

What are the muscles of the Postoriar thigh compartment?

  • action
A
  • the Hamstrings
    • Biceps femoris
      • long and short head
    • Semimembranosus
    • Semitendinous
  • carry out
    • extension of thigh
    • flexion of the leg
    • medial (semi’s) and lateral rotation (biceps femoris)
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19
Q

OrIn of the Hamstrings

  • Innervation?
A
  • Origin: Ischial tuberosity
    • short-head of the Biceps femoris: femur
  • Insertion: Tibia
    • short-head of the Biceps femoris: fibula
  • Innervation: Sciatic nerve
    • biceps femoris runs over it
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20
Q

What are the superficial muscles of the Medial thigh compartment?

  • action?
A
  • Pectineus
  • Adductor longus
  • Gracilis
    • ​flexes the leg at the knee joint
  • action
    • adduction of thigh
    • medial rotation
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21
Q

What are the Middle and Deep muscles of the medial thigh comportment?

  • action
A

Mid

  • Adductor Brevis

Deep

  • Adductor Magnus
    • adductor part
    • hamstring part

Action

  • adduction of thigh
  • medial rotation
  • extension of thigh (hamstring part)
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22
Q

OrIn of the muscles in the Medial thigh compartment

  • innervation

(deep muscle variation)

A
  • Origin: Pubis and Ischium
    • Adductor part of the Magnus: Ischiopubic ramus
    • Hamstring part of the Magnus: Ischial tuberosity
  • Insertion: Linea aspera
    • Adductor part of the Magnus: Linea aspera
    • Hamstring part of the Magnus: Adductor tubercle
    • Gracilis: Tibia
  • Innervation: Obturator nerve
    • Pectineus: Femoral nerve
    • Hamstring part of the AM: Sciatic nerve (same nerves as the hamstrings)
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23
Q

Review the different movements of the thigh

A
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24
Q

What is the significance of the Adductor hiatus?

A
  • the femoral blood vessels pass through to reach the posterior part of the knee
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25
OrIn of the Iliopsoas muscles - innervation? - action?
* Origin: * **Iliacus**: Inside the ilium * **psoas major**: Lumbar vertabrae * Insertion: lesser trochanter * Innervation: L2-L4 of the lumbar plexus * Action: * flexes the thigh at the hip joint * flexes the trunk
26
Which nerves supply the Lower Limb - overview (5)
27
The Femoral Nerve - journey/branches - motor supply - sensory supply
* Motor: Anterior compartment of thigh * Sensory: Skin over the anterior thigh, knee, medial side of leg and foot * from the lumbar plexus: L2-L4 * gives rise to the Saphenous nerve
28
What is the role of the Saphenous nerve? - origin?
* branch of the Femoral nerve * provides sensory supply to the medial leg and foot
29
The Obturator Nerve - journey/branches - motor supply - sensory supply
* Motor: Medial compartment of thigh * except for the _pectineus (femoral)_ and _hamstring part of the AM (sciatic nerve)_ * Sensory: Skin over the medial thigh * from the lumbar plexus: L2-L4 * travels through the obturator foramen
30
The Sciatic Nerve - motor supply - sensory supply - journey/branches
* Motor: Posterior compartment of thigh, and leg and foot * +hamstring part of adductor magnus * Sensory: Skin over leg and foot * except the medial side, supplied by the saphenous nerve * from the lumbar plexus: L4-S3 * travels through the Greater Sciatic foramen * goes through the Popliteal fossa and branches * Tibial nerve * Common fibular/peroneal nerve * superficial/ deep fibular
31
Label this diagram - what structure is shown?
Sciatic Nerve
32
What is the bloody supply progression of the lower limb?
* External iliac artery --\> (travels under the Inguinal ligament) * Femoral artery --\> * give the profunda femoris artery branch * goes through the adductor hiatus * Popliteal artery --\> * Anteiro and posterior tibial arteries
33
The Femoral Triangle? - bounds - what is within it? - clinical relevance?
* Sartorius muscle, Inguinal ligament, adductor longus * Femoral nerve --\> artery --\> vein --\> lymphatics sit within it lateral to medial _Clinical_ * Femoral hernia (femoral canal), * access the femoral artery angioplasty, * femoral nerve block, * venepuncture
34
What forms the Popliteal fossa?
* superiorly: hamstring muscles * laterally: biceps femoris * medially: semimembranosus and tendonosis * inferiorly: gastrocnemius
35
What is the venous drainage of the lower limb? - clinical relevance
* Deep veins follow arteries * Two major superficial veins: * Great or long saphenous vein * Small or short saphenous vein * Drain dorsal venous arch of the foot * **Varicose veins** * Damage to valves in perforating veins leads to pooling of blood in superficial veins – _varicosities_ * Perforating veins connect superficial to deep veins
36
The Great saphenous Vein - journey - drainage
* from the dorsal venous arch it runs along the medial side of the leg and thigh * it pierces through the fascia lata, enters the femoral triangle to drain into the femoral vein
37
The Short saphenous Vein - journey - drainage
* from the lateral venous arch, it runs along the posterior side of the leg * it pierces through the popliteal fascia * drains into the popliteal vein
38
What is the lymphatic drainage of the lower limbs - key nodes?
* follows general pattern of superficial and deep veins * **Superficial inguinal nodes** * drain skin and superficial fascia of lower limb * **Deep inguinal nodes** * beside femoral vein
39
Where are the main dermatomes of the lower limb - L1-5, S1, S2
40
What movement does the knee allow? - where does it articulate? - what type of joint is it?
* Synovial bicondylar hinge joint * it's a fibrous joint capsule formed by network of tendons ligaments * allows Extension/ flexion of the leg * some rotation when flexed * Articulation between distal femur and proximal tibia (doesn't include the fibula) * Articulation between the femur and patella
41
What factors strengthen the knee joint? | (2)-(3)
_Bony factors_ - Bony expansions - Locking mechanism - Femoral angle _Soft tissue factors_ - Ligaments - Menisci - Muscles
42
What are the bony expansions at the knee joint? - what are their role?
* Epicondyles * Femoral condyles * Intercondylar fossa (posterior) * Tibial condyles (tibial plateau) - provides a stable base for bipedalism
43
Explain the 3 contributing factors of the Locking Mechanism in the knee - what is the purpose of the locking mechanism
the locking mechanism reduces the amount of energy required when extended * Shape of femur * during flexion the femoral surface is round (movement) * during extension the femoral surface is flat (standing) * Rotation * medial rotation of the femur on tibia during extension tightens the ligaments at the knee * Centre of Gravity * the centre of gravity is in front of the knee which maintains extension (standing)
44
Explain the Femoral angle and it's clinical significance?
* femur is abducted and brings the knee joint under the pelvis * there is an anatomical axis and mechanical axis that are at angles * the difference between the two is 15 degree slightly greater in women * they meet at the knee joint - this important for weight-bearing
45
Explain what Varus deformity (Genu varum) is
* Deformity in the angle between the femur and tibia * **medial displacement** of the tibia * it's common in children under 2 when learning to walk and in rickets * it pushes knees apart - bow legged * decrease in the Q angle --\> increases stress at knee joint * eventually results in joint degeneration
46
Explain what Valgus deformity (Genu valgum) is
* Deformity in the angle between the femur and tibia * **lateral displacement** of the tibia * it's common in children age 2-4 (congenital) and in rickets and arthritis * it brings knees together knock-kneed * increase in the Q angle --\> increases stress at knee joint * eventually results in joint degeneration
47
What are the two groups of ligaments in the knee? - what is their role?
* Extracapsular * Medial collateral * Lateral collateral * Intracapsular * Anterior cruciate * Posterior cruciate - provide stability
48
Describe the Lateral (fibular) collateral ligament - structure - role - clinical significance
* It's an extracapsular ligament * from the lateral epicondyle to the fibular head * it's a strong round cord that prevents medial displacement of tibia * a tear of the LCL can lead to varus deformity
49
Describe the Medial (tibial) collateral ligament - structure - role - clinical significance
* It's an extracapsular ligament that reinforces the joint capsule * attaches from the medial epicondyle to the tibia * direct attachment to the medial miniscus * it's a broad flat band that prevents lateral displacement of tibia * a tear of the MCL can lead to valgus deformity
50
Label this diagram - what is it showing?
Intracapsular ligaments of the knee
51
What is the function of the cruciate ligament**_s_**
* Anterior cruciate * Prevents _anterior_ displacement of tibia on femur * Posterior cruciate * Prevents _posterior_ displacement of tibia on femur - maintains the femur against tibia; there is always one ligament tensing
52
Describe the anatomy of the cruciate ligaments? - how does the flexed knee effect its positions
* Posterior cruciate ligament * passes upward, forward and medially * Anterior cruciate ligament * passes upwards, backwards and laterally _With a flexed knee_ * Medial rotation of leg – tightens ligaments (limits rotation) (10deg) * Lateral rotation of leg – unwinds ligaments (~60deg)
53
What is the clinical significance of the Anterior cruciate ligament? - tests?
* Weaker - can become injured * Common sports injury (e.g. football) * Caused by sudden twisting of knee * **Lachman test** (variation of Drawer test): * Patient in supine position with knee bent 20-30degrees of flexion * Move tibia anteriorly and posteriorly while maintaining position of femur * _Laxity during this manoeuvre indicates anterior cruciate ligament injury_
54
What is the clinical significance of the Posterior cruciate ligament? - role?
* Stronger - Rarely injured * Principle stabilizer when knee flexed * especially when walking down hill
55
What are the menisci of the knee joint? - what is their role?
* Crescent-shaped plates of fibrocartilage * Deepen the articulating surfaces/stability * Shock absorbers * Provides smooth viscous film for joint
56
What are the attachments of knee Menisci?
* Horns of menisci attached to intercondylar area of tibia * Mobile (Accommodates rolling of femoral condyles) * _Medial meniscus less mobile than lateral meniscus_ * this is because it's attached directly to medial collateral ligament
57
What is the Unhappy Triad - cause - structures affected
* Twisting on a flexed knee and blow to lateral side * Contact sports (e.g. rugby tackle) * Rupture: * Anterior cruciate ligament * Medial collateral ligament * Medial meniscus (attached to MCL) - there is poor blood supply to the intracapsular structures --\> slow repair
58
What muscles act on the knee joint? - how?
* the knee joint is reinforced by tendons from surrounding muscles and the iliotibial tract * Illiotibial tract * reinforces the joint capsule * stabilizes the extended knee * gluteus maximus, tensor fascia lata insert into this band and contract to stabilize the joint
59
What extensor muscle(s) stabilize the knee? - action
* Quadriceps * rectus femoris * Vastus lateralis * Vastus intermdius * Vastus medialis * oblique fibres of vastus medialis prevents lateral tracking of the patella
60
Label this diagram - what does it show?
The Patella and the Extensor mechanism structures
61
What is the Patella? - role?
* Triangular-shaped sesamoid shaped * Protects quadriceps tendon from stresses during locomotion * Smooth oval facet on posterior surface which articulates with the femur * the Patellar retinaculum are aponeurotic expansions of the vastus laterlis and medialis * they help to stabilise the patella during locomotion
62
What are the three main Extensor Mechanism Injury points?
* Rupture of quadriceps tendon or patellar ligament * Fracture of the patella * due to fall or blow to the knee * _results in loss of active extension_ * Dislocation of patella common * Due to sudden twisting/jumping or ligamentous laxity
63
What are the Flexor muscle(s) that act on the knee joint?
* Hamstrings and gastrocnemius flex leg * hamstring medially and laterally rotates the leg when the knee is flexed * Hamstrings muscles: form the borders of the popliteal fossa * Biceps femoris * Semimembranosus * gives off an oblique tendon which reinforces the joint capsule posteriorly * Semitendinosus
64
How is an extended leg unlocked?
* Popliteus unlocks knee joint * laterally rotates femur on tibia when the foot is on the ground * travels through the lateral collateral ligament before inserting the lateral epicondyles
65
What is the Synovial membrane? - structure/anatomy - role
* From margins of articular surfaces of femur to tibia * Attached to patella * Extends superiorly behind quadriceps tendon * Cuffs anterior surface of cruciate ligaments
66
What is a Bursae? - role? - name 3
* synovial fluid-filled sac lined by synovial membrane * provides protection and reduces friction * Suprapatellar bursa * extension of the synovial membrane (not a true bursa) * Prepatellar bursa * Infrapatellar bursa - there are many bursae associated with the knee they occur at tendon insertions
67
What is Bursitis? - examples (2)
* Inflammation of bursae * Due to repetitive movements or direct pressure * **Prepatellar bursitis (‘housemaid’s knee’)** * Seen in carpet fitters * leaning forward on the knees brings the prepatellar bursa in contact with the floor * **Infrapatellar bursitis (‘clergyman’s knee’)** * Seen in roofers * After prolonged periods of prayer clergymen sat back on their heels bringing infrapatellar bursa in contact with floor
68
# popliteal cyst What is a Baker's Cyst? - presentation - treatment
* Abnormal fluid-filled sacs in the popliteal fossa * Due to herniation of bursa * Common in patients with chronic inflammatory joint disease (e.g. arthritis) * Presents as swelling in the popliteal fossa - very painful * Can affect joint movement * treated by * aspirin and cortisone injection * or aspiration of the fluid
69
What is the Vascular supply of the knee?
* The femoral artery and the popliteal artery give off branches that form an anastomosis around the knee know as **genicular branches** * limited blood supply to the intracapsular structures * poor repair following injury
70
What are the three main functions of the foot?
* Stability/standing (support body weight) * Locomotion/propulsion (acts as lever) * Shock absorption
71
Label this diagram
72
Label this diagram
73
What are the movements of the foot? | (7)
* Dorsiflexion/extension * Plantarflexion/flexion * Eversion/ Inversion * Abduction/adduction of toes * Supination/ Pronation
74
What are the joints of the foot? - what movements do they allow?
* Ankle joint: Dorsiflexion/ plantarflexion * Intertarsal joints: Invert/evert, Supinate/pronate * Metatarsophalangeal joints: Extension/flexion, Limited abduction/adduction * Interphalangeal joints: extension/flexion
75
What structures make up the Ankle joint? - movement/ type of joint? - clinical
* Articulation between the talus and tibia/fibula * trochlea, medial malleolus, lateral malleolus (respectively) * Synovial hinge joint * Allows dorsiflexion/plantarflexion * Stabilized by collateral ligaments * Lateral ligament – lateral malleolus to talus (red) /calcaneus (blue) * Medial/deltoid ligament – medial malleolus to talus/calcaneus/navicular (green) ## Footnote *Clinical: Injury to lateral ligament due to _excessive inversion of foot_ (usually anterior talofibular ligament)*
76
What structures make up the subtalar joint? - movement
* Between talus and calcaneus * Allows inversion/eversion during locomotion
77
What structures make up the Transverse tarsal joint? - movement - clinical significance
* Between Talus/Navicular and the Cuboid/Calcaneus bone * compound joint * Allows inversion/eversion and pronation supination * important for standing on uneven ground
78
What are the functions of the arches of the foot?
* Shock absorbers during locomotion * Act as springboards (propulsion) * Distribution of weight (to calcaneus + ball of foot)
79
What makes up the longitudinal arches? - name both - clinical significance?
* Lateral longitudinal arch (less defined) * Medial longitudinal arch * Supported by * long tendons, * intrinsic plantar muscles, * intrinsic ligaments and * plantar aponeurosis * *Fallen medial longitudinal arch can lead to **pes planus (flat feet)*** * *Due to degeneration of ligaments or injury to tibialis posterior; also seen in children*
80
What makes up the transverse arches? - name both
* Supported by long tendons * fibularis longus * from lateral side of the cuboid over the uniform bones to the medial side * tibialis posterior
81
What is the Plantar aponeurosis? - clinical significance
* Thickening of deep fascia that originates from the Calceneus * Protects underlying structures * Supports longitudinal arch * Plantar fasciitis (inflammation due to overuse; common in runners)
82
What are the muscle compartments of the leg - nerve supply? - movement?
* Anterior * Extend/invert foot * Deep fibular nerve * Posterior * Flex/invert foot * Tibial nerve * form the tendo calcaneus * Lateral * Evert foot * Superficial fibular nerve
83
Label this diagram - where are these structures - movement? - what supplies this area?
* the anterior compartment of the leg * dorsiflex and invert the foot * supplied by Deep fibular nerve
84
Label this diagram
85
What are the anterior compartment muscles and their tendon insertions on the foot?
* Extensor digitorum longus * Middle + distal phalanges * Tibialis anterior * Medial cuneiform + 1st metatarsal * Extensor hallucis longus * Distal phalanx of great toe
86
Label this diagram - where are these structures - movement? - what supplies this area?
* the _Superficial layer_ of posterior compartment of the leg * plantarflex foot and leg * supplied by Tibial nerve * all the muscles insert into the calcaneal tuberosity and fuse to form the tendon calcaneus
87
Label this diagram - where are these structures - movement? - what supplies this area?
* the _Deep layer_ of the posterior compartment of the leg * plantarflex and invert the foot * supplied by Tibial nerve
88
What are the posterior compartment muscles and their tendon insertions on the foot?
* Flexor digitorum longus * Distal phalanges * Tibialis posterior * Medial cuneiform + navicular * Flexor hallucis longus * Distal phalanx of great toe
89
Label this diagram
90
Label this diagram - where are these structures - movement? - what supplies this area?
* the Lateral compartment of the leg * everts the foot * supplied by superficial fifibular nerve
91
Label this diagram
92
What are the Lateral compartment muscles and their tendon insertions on the foot?
* Fibularis longus * Medial cuneiform + 1st Metatarsal * Fibularis brevis * base of the 5th metatarsal
93
Review the long tendons of the foot - what other structures are important
94
Review the intrinsic muscles of the foot (only for familiarity)
95
Label this diagram - what area is it supplying?
* posterior compartment of the leg * the Popliteal artery splits as it passes through the soleus muscle * anterior and posterior branch
96
# tom dick and harry What forms the Tarsal Tunnel? - what is the contents of the tarsal tunnel
* on the medial side of the foot, formed by the flexor retinaculum _Contents_ (anterior to posterior) * Tibialis posterior * Flexor digitorum longus * _Posterior tibial artery/ vein_ * pulse * Tibial nerve * Flexor hallicus longus
97
Label this diagram
98
Label this diagram - where is this structure found? - clinical significance?
* Anterior compartment * the Anterior tibial artery passes through the extensor retinaculum and becomes the dorsalis pedis * Pulse can be taken look for the extensor hallucis tendon to find it
99
Label this diagram - what does this structure supply? (motor sensory) - clinical significance?
* Motor: Posterior compartment of leg + plantar Intrinsic muscles * Sensory: Plantar surface of foot * *Tarsal tunnel syndrome (compression of tibial nerve)* * *burning sensation on the foot made worse when they are standing*
100
Label this diagram - what does this structure supply? (motor/sensory) - clinical significance?
* _Deep_ * Motor: Anterior compartment of leg + dorsal intrinsic muscles * Sensory: Skin between toes 1 and 2 * _Superficial_ * Motor: Lateral compartment of leg * Sensory: Skin on dorsum of foot + anterior leg * *Trauma to common fibular nerve (foot drop)* * *​blow to the lateral side of the leg* * *loss of dorsiflexion muscles of the foot*
101
What is the nerve supply to the leg?
* supplied by the terminal branches of the **Sciatic nerve** * **​Tibial -** posterior * **Common fibular** * **​Deep fibular-** anterior compartment * **Superficial fibular -** lateral compartment
102
Label this diagram - what does it show - what about the sole of foot?
* cutaneous of the leg * Medial/Lateral plantar tibial nerves supply the sole of foot

204: Theme 2 (7 decks)

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