Anterior Leg FINAL Flashcards
Hip flexors
-pectineus - obturator artery too
-iliopsoas -iliolumbar artery
-rectus femoris
-sartorius
-femoral nerve
Adductors of hip
-adductor magnus
-adductor longus
-adductor brevis
-gracilis
-obturator externus
-obturator nerve
-profunda femoris / obturator artery
-scissor gait- one limb crosses in front of other during stepping due to over active obturator nerve
Sartorius
-flexes hip
-lateral rotates leg
-abducts hip
-flexes knee
fibula
-does not articulate with femur or bear any weight
knee extendors
-rectus femoris
-vastus lateralis
-vastus medialis
-vastus intermedius
-femoral nerve and artery
femur
-inferomedially pointed- oblique -> COG
-women are more oblique
-angle of inclination largest while young and decreases with age
-male angle > female
hip bone
-ilium (largest and superior)
-ASIS and AIIS and PSIS and PIIS
-superior border of greater sciatic notch
-ischium - inferoposterior
-ischial rami
-inferior margin of greater sciatic notch
-ischial spine - lesser sciatic notch
-ischial tuberosity
-pubis- superoanterior
-pubic crest
-pubic tubercles- inguinal ligament attaches
-superior and inferior pubic rami
obturator foramen
-ischium and pubis rami bound
-obturator nerve and vessels pass through here
femur
-fovea- attachment site for ligamentum teres (head of femur)
tibia
-articulates with femur superiorly
-articulates with talus inferiorly
compartments of thigh
-anterior- femoral nerve
-medial- obturator nerve
-posterior- sciatic nerve
-septa from inner aspect of deep fascial sheath of thigh to linea aspera of femur
dermatomes of legs
-posterior- S3, S2, S1 (foot)
-anterior- L1, L2, L3, L4 (medial shin), L5 (lateral shin)
-genitals- S3, S4
femoral triangle
-superior- inguinal ligament
-medially- adductor longus
-laterally- sartorius
-femoral nerve, femoral artery, femoral vein, lymph
-sheath- transversalis and iliopsoas fascia -> NO femoral nerve
-femoral canal- deep inguinal lymph nodes (cloquet)
-femoral canal allows space for vein dilation and intraabdominal pressure causes stasis of vein
-great saphenous vein enters via saphenous ring
-deep femoral branches within the triangle
adductor canal
-intermuscular passage
-from apex of femoral triangle to adductor hiatus
-femoral artery and vein, saphenous nerve, nerve to vastus medialis
-NOT FEMORAL NERVE
-between anterior and medial compartments
-roof- sartorius
-retract sartorius to see contents of canal
common femoral artery branches
-superficial circumflex iliac artery
-superficial epigastric artery
-superficial external pudendal artery
femoral artery and branches
-external iliac -> femoral
-profunda femoris artery -> medial circumflex femoral and lateral circumflex femoral (ascending, transverse, descending)
-descending genicular artery -> superior lateral/medial genicular artery and inferior lateral/medial genicular artery
-adductor longus separates profunda from femoral artery
knee ligaments / tendons
-quadriceps tendon
-patella tendon
-anterior cruciate ligament
-posterior cruciate ligament
-lateran and medial collateral ligaments
knee cartilage
-articular cartilage on femur
-meniscus on tibia
-if you tear -> medial pain and knee will lock
iliac crest
-bone marrow typically aspirated from iliac crest
talonavicular bone fracture
-concerns for necrosis
-not a lot of blood supply to navicular bone
hip bone fractures*
-MCly femoral head, neck, trochanters
-avulsion fractures common during sudden stops -> sartorius from ASIS or rectus femoris from ISIS
-at least 2 fractures in the ring of bone formed by pubis, pubic rami and acetabulum (think of a pretzel)
femoral fractures*
-MC neck (osteoporosis females)
-intertrochanteric
-direct violent injury - spiral
-distal femur fracture - misalign knee joint
-neck fracture- median circumflex femoral can cause avascular necrosis
-hip bone/neck fracture- injured leg is shorter and externally rotated
hip dislocation*
-posterior hip dislocation- internal rotation
-anterior hip dislocation- external rotation
coxa vara and coxa valga
-decreased angle- coxa vara -> mild passive abduction of hip
-increased angle- coxa valga
-can be caused by rickets
-congenital ossification defect of neck of femur
tibial and fibular fractures*
-anterior tibia fracture- compound (open) or diagonal
-fracture of tibia through nutrient canal -> nonunion of bone
-fibular fracture- associated with ankle joint dislocation (inversion) -> LATERAL MALLEOULUS AVULSION FRACTURE
-ankle ligament tear- excessive inversion causes talus to sheer off ankle ligament -> fibular fracture
-must check if mortise is in tack -> surgical repair to prevent arthritis
-must be mindful of interosseous tears
bone grafts
-fibula is common site
-function remains after
-periosteum and nutrient artery taken with it
fractures involving epiphyseal plates
-disruption of epiphyseal plate at tibial tuberosity during growth -> inflammation and pain -> Osgood-Schlatter disease
-Osgood-Schlatter- muscles and bone develop at different rates
-Salter-Harris classification- fractures in children
runners knee
-weak adductors of thigh and quadricep muscles
-weak muscles allow for sliding of knee and rubbing on the condyles
-aching deep to patella or around it
-quad imbalance
-chondromalacia patellae- softening of the cartilage
-can also result from extreme flexion or blow to knee
compartment syndromes in leg and fasciotomy
-increased pressure -> poor circulation
-burns, sustained intense muscle use, trauma -> hemorrhage, edema, inflammation
-septa and deep fascia strong
-loss of distal pulse
-ischemia
-fasciotomy
saphenous nerve injury
-accompanies great saphenous vein
-pain, tingling, numbness along medial border of foot and leg
-only sensory
varicose veins
-great saphenous vein
-dilated tortuous, rotation
-valve cusps dont close
-reverse flow
-higher risk for DVT
-tx- sclerosing solutions
-failure of perforating vein valves -> pooling in superficial veins (GSV)
deep vein thrombosis
-deep femoral vein*, popliteal, posterior, and anterior tibial
-NOT the saphenous veins (this is superifical)
-swelling, warmth, eryhhema, infection
-venous stasis (stagnation) -> thrombus forms
-pulmonary thromboembolism- travels to lung
-caused by:
-loose fascia -> dosent resist muscle expansion (no pump)
-inactivity
-tx- compression socks
femoral nerve block
-just inferior to inguinal ligament
hip pointer injury
-contusion of iliac crest MC (bruise)
-can also refer to avulsion
charlie horse
-acute cramping of individual thigh muscle
-ischemia, nocturnal leg cramps, contusion, and rupture of blood vessels (can cause hematoma)
paralysis of quadricep femoris
-cant extend leg against resistance
-pt presses on distal end of thigh during walking to prevent flexion of knee joint
-weakness of vastus medialis or lateralis from arthritis or trauma to knee joint -> patella moves and loss of knee stability
transplantation of gracilis
-weak adductor
-no loss of action
-repairs forearm or external anal sphincter
patellar tendon reflex
-leg extension
-quad contraction
-testing femoral nerve - L2-L4 spinal cord
-peripheral nerve disease if no reflex
groin pull
-strain, stretching, tearing of flexor and adductor thigh muscles
-quick starts usually
great saphenous vein
-used for bypass
-strip valves or flip it around
-doesnt get occluded as frequently
-anterior to medial malleolus and posterior to medial knee condyle
-next to saphenous nerve
femoral vein
-central venous access -> can trace up to heart (RA)
-medial to femoral pulse
-must be careful of things in the triangle
-hematoma can form and obstruct flow to leg
pulses of the leg
-femoral (in triangle)
-popliteal
-posterior tibial (medial malleolus)
-dorsalis pedis (anterior tibial artery)
sensory innervation to legs/feet
-dorsum of foot- superficial fibular
-anterior thigh- anterior cutaneous femoral
-medial shin- saphenous nerve
-lateral shin lateral sural cutaneous
-between big toe- deep fibular nerve
-posterior thigh- posterior cutaenous nerve of thigh and inferior gluteal CLUNIAL
-buttcheek- superior gluteal CLUNIAL
-medial butt- medial gluteal CLUNIAL
collateral circulation of leg
-if femoral artery is occluded at adductor canal…
-descending branch of the lateral circumflex femoral anastomoses with femoral and descending genicular branch
femoral nerve
-between iliacus and psoas major
