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Anatomy > Anatomy of the Lower Limbs > Flashcards

Anatomy of the Lower Limbs Flashcards

1
Q

Describe, in basic terms, how the lower limb rotates in foetal development.

A

It permanently pronates at mid-thigh level.

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2
Q

What is the intertrochanteric line?

A

A line on the anterior surface of the femur connecting the greater trochanter of the femur to the lesser trochanter of the femur.
One of the commonest type of fractures of the femur, after the femoral neck.

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3
Q

Describe the fascia of the upper lower limb.

A

2 layers: a superficial layer and a deep layer termed the FASCIA LATA.
The fascia lata extends like a stocking beneath the skin. A lateral thickened area is the ilio-tibial tract.

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4
Q

Which muscular compartments are located in the upper lower thigh?

A

Gluteal compartment.

Anterior, posterior and medial compartments of the thigh.

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5
Q

Which muscles comprise the gluteal region?

A

Gluteal muscles: Gluteus maximus, gluteus medius, gluteus minimus and tensor fasciae latae.

Short external rotators of the hip: piriformis, obturator internus, inferior gemellus, superior gemellus, quadrator femoris. One of the main functions of these muscles is to stabilise the hip joint.

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6
Q

Which muscles comprise the anterior compartment of the thigh? What is their general function?

A

Pectineus, ilio-psoas, sartorius.
Quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius).
Flexion of the hip, extension of the knee.

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7
Q

What are the proximal and distal attachments of the piriformis muscle?

A

Attaches sacrum proximally to the greater trochanter of the femur.

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8
Q

Which muscles converge to form the iliopsoas?

A

The psoas major and iliacus merge to form the ilio-psoas This muscle crosses the hip joint, under the inguinal ligament to the lesser trochanter of the femur.
It is a flexor of the hip.

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9
Q

Describe the sartorius muscle.

A

Attaches proximally to the ASIS, distally to the medial shaft of the tibia (crosses the knee joint).
Flexes the knee and abducts the thigh.

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10
Q

Describe the quadriceps femoris

A

Only one of the 4 heads crosses the hip joint: the rectus femoris.
All others stay in the thigh.
At the knee, the fibres converge. The patella bone is embedded in the resulting ligament.
Continues as patellar ligament and attaches to anterior surface of tibia.

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11
Q

Which muscles comprise the medial muscle compartment of the thigh and what is the general function of this compartment?

A

Adductor longus, adductor brevis and adductor magnus.
Gracilis
Obturator externus.

These muscles adduct the hip joint.

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12
Q

Give the general attachments of muscles in the medial compartment of the thigh.

A

Generally, extend from pubic bone to the posterior surface of the shaft of the femur.
Gracilis crosses the knee to attach to the tibia.
Adductor magnus forms an adductor hiatus.

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13
Q

Which muscles comprise the posterior muscle compartment of the thigh? What is the general function of this compartment?

A

Comprised of the semimembranosus, semitendinosus and biceps femoris.
Flex the knee and extend the hip.

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14
Q

Give the general attachments of muscles in the posterior compartment of the thigh.

A

Generally attach proximally to the ischial tuberosity.
The short head of the biceps femoris, however, comes off the posterior femur surface.
Biceps femoris attaches to the head of the fibula.
Semimembranosus and semitendinosus attach to the tibia.

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15
Q

Describe the femoral triangle

A

Borders are the inguinal ligament superiorly, the adductor longus medially and the sartorius laterally.
Contains the femoral nerve, artery and vein.
Covered by fascia lata.
NAVY (y = y-fronts).

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16
Q

Describe the adductor canal.

A

Extends along the medial aspect of the thigh.
Anteriorly: vastus medialis
Posteriorly: adductor longus and adductor magnus.
Medially: sartorius.
Contains femoral artery and vein and the saphenous nerve.

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17
Q

Which foramen do structures passing form the pelvis to thigh pass through?

A

Greater sciatic foramen.

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18
Q

Describe the path of the sciatic nerve in the buttock and hence describe the location of the safe area for intramuscular injection.

A

Passes through the greater sciatic foramen, inferiorly and medially in the buttock.
Enters the gluteal region inferiorly to the piriformis muscles, but can pierce the muscle or enter superiorly.
Divides near the knee into the tibial and common peroneal nerves.
The safe area is hence the upper lateral quadrant of buttock. Usually gluteus medius muscle.

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19
Q

Describe the hip joint.

A

Ball and socket joint between head of femur and acetabulum of the pelvis. The acetabulum is not complete and is completed by the transverse acetabular ligament.
Acetabular labrum deepens the socket.

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20
Q

Which ligaments support the hip joint?

A

The iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament and the ligament of the head of the femur.
The 3 main capsular ligaments attach spirally and as such winding draws the connected structures together.

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21
Q

Give the arterial supply of the gluteal region.

A

Internal iliac artery produces an artery to the head of the femur (acetabular branch of obturator artery).
External iliac artery gives off profundal femoris, which in turn gives off circumflex arteries.

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22
Q

Describe the origin of the popliteal artery.

A

The femoral artery passes from the anterior compartment to the posterior compartment through the adductor hiatus to become the popliteal artery.
Same happens for the femoral vein.

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23
Q

What is the main tributary of the femoral vein?

A

The long saphenous vein, which joins the femoral vein at the sapheno-femoral junction.

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24
Q

Which nerves supply each of the muscular thigh compartments?

A

Femoral nerve supplies the anterior compartment of the thigh.
Obturator nerve supplies the medial compartment.
Sciatic nerve supplies the remaining compartments.

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25
Q

Give the motor and segmental supply of the upper lower limb.

A 
Motor:
Hip flexors = L2, 3 ; extensors = L4,5
Knee flexors: L3,4  ; extensors = L5, S1
Sensory
Front of thigh = T12, L1,2,3
Back of thigh = S1,2,3
Buttock = S2,3,4
"L3 to the knee; L4 to the floor"
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26
Q

Describe how to test the gluteus maximus muscle

A

Subject lies prone with knee flexed. Ask the subject to extend the thigh at the hip joint while applying resistance to the distal end of the thigh. Palpate the rounded contour of the buttock.

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27
Q

Describe how to test the gluteus medius and minimus muscles.

A

Subject lies on side with the lower limb fully extended. Ask the subject to abduct the limb at the hip joint while applying resistance to the distal end of the thigh. Palpate the contraction of the gluteus medius just inferior to iliac crest.

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28
Q

Describe how to test the tensor fascia lata muscle.

A

Subject lies on side with the lower limb fully extended. Roll the subject slightly towards supine. Ask the subject to abduct the limb at the hip joint while applying resistance to the distal end of the thigh. Palpate the contraction of the tensor fascia lata.

29
Q

Describe how to test the hamstrings (biceps femoris, semitendinosus, semimembranosus).

A

Subject lies prone with knee flexed to 30 degrees. Apply an opposing force just above the posterior side of the ankle as the subject attempts to flex the knee further.
The hamstring tendons will be seen around the popliteal region and the muscle contraction is palpable on the posterior side of the mid-thigh.

30
Q

Describe how to test the quadriceps muscle.

A

Subject sits on couch with knees bent to 90 degrees over the edge. The examiner applies pressure at the distal part of the leg while the subject attempts to extend it. The contracting quadriceps can be palpated on the anterior thigh.

31
Q

Describe the course of the sciatic nerve in the buttock and thigh.

A

It leaves the greater sciatic notch and enters the gluteal region at the midpoint between the PSIS and the ischial tuberosity.
Forms a downward curve to pass into the thigh around the midpoint between the greater trochanter and the ischial tuberosity, before reaching the popliteal fossa.

32
Q

What is the Trendelenburg test for?

A

Tests the integrity of abductors of the hip joint. A positive test is when the pelvis of a raised leg drops downward.

33
Q

What may cause a discrepancy in apparent (functional) leg length?

A

Pelvic tilt/rotation, hip joint or sacroiliac abnormalities.

34
Q

Name the 7 tarsal bones.

A

Calcaneus, talus, navicular, cuboid, cuneiforms 1-3 (from medial to lateral).

35
Q

What is the function of the 2 sesamoid bones found in the flexor hallicus brevis tendon?

A

The bones prevent crushing of the tendon when you stand on your tip-toes.

36
Q

Which muscles comprise the anterior compartment of the leg, and what is their general function?

A

Tibialis anterior, extensor digitorum longus, extensor hallicus longus.
All arise from lateral condyle of tibia.
They are ankle dorsiflexors and extends the digits.

37
Q

What is the vascular supply and innervation of the anterior compartment of the leg?

A

Innervation: deep peroneal nerve.

Vascular supply: anterior tibial artery.

38
Q

Which muscles comprise the lateral compartment of the leg, and what is their general function?

A

Peroneus longus, peroneus brevis.
The tendons pass posteriorly to lateral malleolus.
Evert the foot, can contribute to dorsiflexion.

39
Q

What is the vascular supply and innervation of the lateral compartment of the leg?

A

Innervation: superficial peroneal nerve

Vascular supply: peroneal artery.

40
Q

Which muscles comprise the posterior compartment of the leg, and what is their general function?

A

Superficial: gastrocnemius, soleus and plantaris.
Deep: popliteus, flexor digitorum longus, flexor hallucis longus, tibialis posterior.
Ankle plantarflexors.

41
Q

What is the vascular supply and innervation of the posterior compartment of the leg?

A

Innervation: tibial nerve

Vascular supply: posterior tibial artery.

42
Q

Describe the triceps surae.

A

Gastrocnemius (2 heads) and soleus (1 head) together form the triceps surae whose distal tendon is the calcaneus tendon (Achille’s tendon).
Gastrocnemius arises from femur; soleus from tibia and fibula.

43
Q

Describe the popliteus muscle.

A

A deep posterior muscle of the leg. Arises from lateral femoral epicondyle to the upper posterior shaft of the tibia.
Unlocks the knee joint.

44
Q

Which structure do the flexor digitorum longus, flexor hallicus longus and tibialis posterior pass posterior to?

A

The medial malleolus.

45
Q

What are the 2 dorsal muscles of the foot?

A

Extensor digitorum brevis, extensor hallicus brevis.

46
Q

Describe the intrinsic muscles of the sole of the foot.

A

Divided into 4 layers, supplied by tibial nerve.
The intrinsic muscles of the foot function generally as shock absorbers, adjusting the foot to uneven surfaces.
They can be trained to carry out fine movements.

47
Q

Describe the quadratus plantae.

A

An intrinsic foot muscle in the second layer of the sole, which pulls on the tendons of the flexor digitorum longus muscle to modify the angle of the obliquely running tendons to prevent the toes being adducted.

48
Q

Describe the boundaries of the popliteal fossa.

A

A diamond-shaped space posterior to the knee joint.
Medial boundaries are the semimembranosus superiorly and the medial head of the gastrocnemius inferiorly.
Lateral boundaries are the biceps femoris superiorly, and the lateral head of the gastrocnemius inferiorly.

49
Q

What are the contents of the popliteal fossa?

A

Popliteal artery and vein
Tibial nerve and common peroneal nerve (from the division of the sciatic nerve).
Short saphenous vein.
Popliteal lymph nodes.

50
Q

Describe the knee joint.

A

A hinge-type synovial joint with some gliding, rolling and rotation. Stabilised by anterior and posterior cruciate ligaments and medial and lateral collateral ligaments.
The condyles form 2 articulations: medial and lateral femorotibial articulations.

51
Q

Briefly describe the tibiofibular joints.

A

Proximal joint: a plane synovial joint, with the capsular ligaments limiting movement.
Distal joint: fibrous joint.
Slight movement in dorsiflexion/ plantarflexion of the foot, but not much movement overall.

52
Q

Which bones are involved in the ankle joint?

A

Fibula, tibia and talus.

The fibula is not weight bearing.

53
Q

Which ligaments are involved in sprained ankles?

A

The broader and tougher tibiocalcaneal ligament is less often damaged (deltoid ligament, medial).
The 3 lateral ligaments are commonly damaged by overinversion. (Anterior and posterior talofibular ligaments and calcaneofibular ligament).

54
Q

Describe the gait cycle.

A

Divided into stance phase (60%) and swing phase (40%).
Double support for only 20% of cycle.
Heel strike, loading response, midstance, terminal stance (heel off), preswing (toe off), initial and mid-swing, terminal swing.

55
Q

Which nerve roots contribute to the lumbosacral plexus?

A

L2-S3

56
Q

Describe the roots of the femoral nerve, obturator nerve and sciatic nerve.

A

Femoral nerve passes underneath inguinal ligament to supply the anterior compartment of the thigh. Receives posterior roots.

Obturator nerve goes through the obturator foramen and supplies the medial compartment of the thigh. Receives anterior roots.

Sciatic nerve supplies the remaining compartments. Has both anterior and posterior contributions.

57
Q

Which structure defines whether a nerve or vessel is inferior or superior gluteal?

A

Piriformis muscle.

58
Q

Describe the split of the sciatic nerve.

A

Usually in the popliteal fossa, the sciatic nerve splits into the tibial and common peroneal nerves.
The tibial nerve continues down the posterior of the leg, dividing into the medial and lateral plantar nerves.
The sural nerve is formed from contributions from both the tibial and common peroneal nerves after they have divided.
The common peroneal nerve crosses laterally around the head of the fibula and splits to give the deep peroneal nerve (anterior compartment of leg) and superficial peroneal nerve (lateral compartment).

59
Q

What is the only nerve of the femoral nerve that enters the leg?

A

The saphenous nerve - supplies cutaneous innervation to medial leg and foot.

60
Q

Give key concepts about segmental supply.

A

Muscles are usually supplied by 2 adjacent segments.
If a muscles has the same action on a joint, it has the same nerve supply.
Opposing muscles are 1-2 segments above or below.
More distal in limb = more caudal in spine.
PERIPHERAL NERVES HAVE FIBRES FROM MORE THAN ONE SPINAL ROOT.
NOT ALL THE FIBRES FROM A SPINAL ROOT GO VIA A SINGLE PERIPHERAL NERVE.

61
Q

Describe the arterial supply of the lower limb.

A

External iliac artery –> femoral (which gives off circumflex femoral arteries and profundal femoris artery) –> popliteal artery - “trifurcates” into anterior tibial (becomes dorsalis pedis), posterior tibial and peroneal arteries.

62
Q

Which bones does the femoral pulse rebound off of?

A

The pubic ramus.

63
Q

Relate how the two saphenous veins course passed the malleoli.

A

Long saphenous vein courses anterior to the medial malleolus.
Short saphenous vein courses posterior to the lateral malleolus.
Both arise from the dorsal venous arch of the foot.

64
Q

Describe venae comitantes and their function.

A

Deep veins often run alongside arteries as venae comitantes. Multiple veins form a network of smaller veins with arteries which they accompany. Connections between the venae comitantes.
Allow heat exchange
Artery pulse promotes venous flow.

65
Q

What is a cut-down of the long saphenous vein?

A

A cut 2cm lateral and proximal to the medial malleolus to access the long saphenous vein and give someone in shock fluids as part of ATLS.
It has been superseded by intraosseous administration of fluid.

66
Q

Describe compartment syndrome.

A

The neuromuscular compartments of the limbs are enclosed in fibrous sheaths which confine them.
Normal pressure = 25mmHg. Increased pressure in the compartment (50-60mmHg) is sufficient to collapse small vessels. Since this is less than BP, pulses are still present, despite limb ischaemia.
Acute causes = trauma
Chronic = exercise-induced.

67
Q

How is acute compartment syndrome treated?

A

Emergency fasciotomy - required to prevent death of muscles in the affected compartment.

68
Q

What is associated with perforating vein valve incompetency?

A 
Varicose veins (blood flow deep to superficial).
Venous insufficiency, lipodermatosclerosis (skin thickening), venous ulcers.
69
Q

How do elastic surgical socks help replace the calf pump?

A

Compress the superficial veins, promoting more vigorous deep venous return.

Anatomy (8 decks)

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