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Anatomy Exam 2 > Anterior Thigh & Leg and Dorsal Foot > Flashcards

Anterior Thigh & Leg and Dorsal Foot Flashcards

1
Q

What muscles are found in the Anterior Compartment of the Thigh

A
  • Quadriceps femoris
  • Iliopsoas
  • Sartorius
  • Pectineus
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2
Q

Describe the Anterior Compartment Muscle Action rule

A

-Muscles Flex hip joint and extend knee joint

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3
Q

Describe the Anterior Compartment Muscle Innervation rule

A

Femoral n. (L2-L4) –> Emerges lateral to psoas major –> Passes deep to the inguinal ligament

  • Innervates muscles in the anterior compartment of the thigh and skin on anteromedial thigh
  • Terminal branch, the saphenous nerve, innervates skin on anteromedial aspect of knee, leg, and foot
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4
Q

What are the four muscles of the Quadriceps femoris

A

1) Rectus femoris
- Origin: anterior inferior iliac spine (AIIS)
- Action: flex hip joint and extend knee joint
2) Vastus lateralis
3) Vastus medialis
4) Vastus intermedius
- Origin: femur
- Action: extend knee joint

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5
Q

The 4 parts of the Quadriceps femoris unite distally to form the __________

A

quadriceps tendon

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6
Q

The quadriceps tendon continues as _________ and inserts on the ______________

A
  • patellar ligament

- tibial tuberosity

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7
Q

Patella (large sesamoid bone) is embedded in _________

A

the quadriceps tendon

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8
Q

What is the function of the patella?

A

-Increases leverage of the quadriceps (increasing the power of knee extension)

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9
Q

What is Bursitis?

A

What can develop in the prepatellar bursa (between skin and patella) or suprapatellar bursa (deep to quadriceps tendon)

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10
Q

What does the Patellar tendon reflex test?

A
  • Integrity of the femoral nerve and the L2-L4 spinal nerves.
  • With knees flexed and relaxed, the patellar ligament is tapped to elicit rapid extension of the knee joint (the patellar reflex).
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11
Q

Describe the Iliopsoas and its exceptions to the “rules”

A
  • Origin: iliac fossa (iliacus); lumbar vertebrae (psoas major)
  • Insertion: lesser trochanter of femur
  • Actions: flex hip joint (if LE is free); flex and stabilize the trunk (if LE is fixed)
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12
Q

Describe the Sartorius and its exceptions to the “rules”

A
  • Origin: ASIS
  • Insertion: medial aspect of proximal tibia
  • Actions: flex, abduct, laterally rotate hip joint; flex knee joint (sit cross-legged)
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13
Q

Describe the Pectineus and its exceptions to the “rules”

A
  • Origin: pubis
  • Insertion: proximal femur
  • Actions: weakly flex hip joint, adduct hip joint
  • Innervation: femoral n. (similar to the rest of the compartment), but may receive a branch from obturator n.
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14
Q

What are the muscles in the Medial Compartment of the Thigh

A
  • Adductor longus
  • Adductor brevis (deep to adductor longus)
  • Adductor magnus
  • Gracilis
  • Obturator externus
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15
Q

Describe the Medial Compartment Muscle Origin rule:

A

pubis

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16
Q

Describe the Medial Compartment Muscle Action rule:

A

adduct hip joint

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17
Q

Describe the Medial Compartment Muscle Innervation rule

A

Obturator nerve (L2-L4)

  • Courses along lateral wall of pelvis and exits via obturator canal
  • Innervates muscles of medial compartment of thigh; skin on medial thigh
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18
Q

Describe the Adductor magnus and its exceptions to the “rules”

A

-Adductor part (follows compartment rules for action/innervation)

  • Hamstring part
  • Origin: ischial tuberosity
  • Insertion: adductor tubercle of femur
  • Action: extend hip joint
  • Innervation: tibial n. (of sciatic n.)
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19
Q

Describe the Gracilis and its exceptions to the “rules”

A
  • Insertion: medial aspect of proximal tibia

- Actions: weakly adduct hip joint, flex/medially rotate knee joint

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20
Q

Describe the Obturator externus and its exceptions to the “rules”

A
  • Origin: external aspect of obturator membrane, margin of obturator foramen
  • Insertion: proximal femur
  • Actions: laterally rotate and stabilize the hip joint
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21
Q

Describe the 3 fascial compartments in the leg

A

-Anterior, lateral, and posterior (superficial and deep layers)

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22
Q

What is compartment syndrome

A

Swelling within a compartment can compromise blood flow and/or innervation to tissues within that space

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23
Q

The crural fascia thickens distally to form the ____, _______ and __________

A

flexor, extensor, and fibular retinacula

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24
Q

What do the flexor, extensor, and fibular retinacula do?

A

hold tendons in place as they course into the foot

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25
Q

As tendons pass under a retinaculum, they are protected by _______________

A

Synovial tendon sheaths

26
Q

What do the synovial tendon sheaths do?

A

-Facilitate sliding by reducing friction; can become infected/inflamed, causing pain

27
Q

What are the muscles in the Anterior Compartment of the Leg

A
  • Tibialis anterior
  • Extensor hallucis longus
  • Extensor digitorum longus
  • Fibularis (peroneus) tertius
28
Q

What is the Action rule in the Anterior Compartment of the Leg

A

-Dorsiflex ankle joint and extend toes

29
Q

What is the Innervation rule in the Anterior Compartment of the Leg

A

-Deep fibular nerve (L4-S1)

-Sciatic nerve divides into tibial and common fibular (peroneal) nerves
-Common fibular nerve winds around the neck of the fibula
-Common fibular nerve divides into superficial fibular and deep fibular nerves
• Deep fibular (peroneal) nerve = Innervates the muscles of the anterior compartment of the leg and the dorsal foot AND Innervates the skin of the dorsal foot between the hallux and second digit

30
Q

Describe Tibialis anterior and its exceptions to the “rules”

A
  • Insertion: medial cuneiform & base of first metatarsal
  • Action: dorsiflex ankle joint and invert foot
  • Note: Shin splints (anterior tibialis strain) result from repeated microtrauma/overexertion of the tibialis anterior muscle, and small tears in the periosteum overlying the tibia; inflammation can cause compartment syndrome
31
Q

Describe Extensor hallucis longus and its exceptions to the “rules”

A
  • Insertion: distal phalanx of the hallux

- Action: extend hallux (MTP & IP joints); weakly dorsiflex ankle joint

32
Q

Describe Extensor digitorum longus and its exceptions to the “rules”

A
  • Insertion: distal phalanges of digits 2-5
  • Action: extend digits 2-5 (MTP, PIP, & DIP joints); dorsiflex ankle joint
  • Note: the extensor digitorum longus and extensor hallucis longus tendons form extensor expansions on the dorsal surface of the phalanges
33
Q

Describe Fibularis (peroneus) tertius and its exceptions to the “rules”

A
  • May be absent (~8%) or fused with extensor digitorum longus
  • Insertion: base of fifth metatarsal
  • Action: dorsiflex ankle joint; evert foot
34
Q

The lower extremity nerve that is most often injured is the __________

A
  • common fibular nerve

- it is vulnerable to injury where it winds around the neck of the fibula

35
Q

injury to the common fibular nerve will affect the __________ and _________ and ________

A
  • anterior compartment of the leg
  • dorsal foot (dorsiflexors and toe extensors; one invertor)
  • Lateral compartment of the leg (evertors and weak plantarflexors
36
Q

the loss of dorsiflexion and toe extension will be especially noticeable as the patient will have _______

A

“foot drop.”

37
Q

To compensate for a “foot drop” the patient will exhibit a _______ OR a _______

A

1) “steppage gait” –> patient exhibits exaggerated hip and knee flexion to provide adequate clearance for the foot, which cannot be dorsiflexed, during the swing phase of gait.
2) “foot slap” –> entire foot makes contact with the ground at the end of swing phase, rather than just the heel.

38
Q

What are the two muscles of the Dorsal Foot?

A

1) Extensor digitorum brevis
- Insertion: extensor expansions of digits 2-4
- Action: extend digits 2-4 (MTP, PIP, & DIP joints)

2) Extensor hallucis brevis
- Insertion: extensor expansion of the hallux
- Action: extend hallux (MTP & IP joints)

39
Q

What innervates the dorsal foot?

A

Deep fibular nerve (L5-S1 only)

40
Q

What are the Arteries of the Thigh, Anterior Leg and Dorsal Foot?

A
  • Obturator artery
  • Femoral artery
  • Deep artery of the thigh
  • Lateral and medial circumflex femoral arteries
  • Anterior tibial artery
  • Dorsalis pedis artery
41
Q

Describe the Obturator artery

A
  • Typically a branch of the internal iliac artery; however, in approximately 20% of the population, it arises from the inferior epigastric artery (aberrant obturator artery)
  • Passes through obturator canal to enter medial compartment of the thigh
  • Supplies medial and posterior compartments of thigh
42
Q

Describe the Femoral artery

A
  • Primary source of blood to lower extremity
  • Continuation of external iliac artery (change names at inguinal ligament)
  • Directly supplies anterior and medial compartments of thigh (supplies other regions via its named branches, see below)
  • Femoral pulse can be felt just inferior to the midpoint of the inguinal ligament, with patient in supine position. Compression at this location will stop blood flow through the femoral artery.
  • Distally, the femoral artery passes through the adductor hiatus (gap in adductor magnus) to reach the popliteal fossa on the posterior aspect of the knee, where it becomes the popliteal artery
43
Q

Describe the Deep artery of the thigh

A
  • Largest branch of femoral artery
  • Primarily supplies posterior compartment of thigh (perforating branches also supply the medial compartment and the lateral aspect of the anterior compartment)
44
Q

Describe the Lateral and medial circumflex femoral arteries

A
  • Typically branches of the deep artery of the thigh (can be branches of the femoral artery)
  • Lateral circumflex femoral artery supplies lateral aspect of thigh
  • Medial circumflex femoral artery supplies most of the blood to the femoral head and neck
45
Q

Describe the Anterior tibial artery

A
  • Branch of the popliteal artery
  • Passes through gap in superior border of interosseous membrane, descends along the membrane with the deep fibular nerve
  • Supplies anterolateral leg
  • Terminates at the ankle, where it becomes the dorsalis pedis artery
46
Q

Describe the Dorsalis pedis artery

A

-The major source of blood to the toes (it does anastomose with the deep plantar arch)
-Major branches:
• Arcuate artery
• Dorsal metatarsal arteries
• Dorsal digital arteries
-The dorsalis pedis pulse can be palpated on the dorsal aspect of the foot, just lateral to the tendon of extensor hallucis longus

47
Q

What are the Veins of the Thigh, Anterior Leg and Dorsal Foot?

A
  • Dorsal venous arch
  • Perforating veins
  • Deep veins
  • Femoral Vein
48
Q

Describe the dorsal venous arch

A
  • Superficial drainage of the dorsal foot
  • Anastomoses with the plantar venous arch in the sole of the foot
  • Drains into great saphenous vein medially, and small saphenous vein laterally
49
Q

Describe the Perforating veins

A

Connect the superficial to the deep veins

50
Q

Describe the Deep veins

A

Accompany the arteries and share their names (however, there is no dorsalis pedis vein)

51
Q

Describe the Femoral Vein

A

Receives blood from popliteal vein, deep vein of the thigh, and great saphenous vein and drains into the external iliac vein

52
Q

What are the borders of the Femoral Triangle?

A
  • Inguinal ligament (superior)
  • Adductor longus (medial)
  • Sartorius (lateral)
53
Q

What are the Contents of the Femoral Triangle?

A
  • “NAVEL” (lateral to medial: Nerve, Artery, Vein, Empty space, Lymph)
  • Femoral nerve (and its branches)
  • Femoral sheath
54
Q

Describe the Femoral sheath

A
  • Fascial tube enclosing the femoral vessels and femoral canal
  • Does not enclose the femoral nerve
55
Q

What are the 3 compartments of the Femoral sheath? What do they contain?

A

1) Lateral contains the femoral artery
2) Intermediate contains the femoral vein
3) Medial contains the femoral canal

56
Q

What does the femoral canal contain?

A
  • Loose connective tissue, fat, lymphatic vessels and deep inguinal lymph nodes
  • Primary function of the femoral canal is to allow expansion of femoral vein when venous return from the lower limb is increased (e.g., during strenuous activity)
57
Q

What is the femoral ring?

A
  • The proximal opening of the femoral canal

- The femoral ring is an area of weakness where femoral hernias can occur

58
Q

Normally, the femoral ring is closed by ___________, and this fatty tissue is overlain by ___________

A

extraperitoneal fatty tissue

parietal peritoneum

59
Q

What causes a femoral hernia?

A

-Abdominal viscera can protrude through the femoral ring into the femoral canal

60
Q

Where does a femoral hernia lie?

A

-In the femoral triangle, medial to the femoral vein and inferior to the inguinal ligament

Not to be confused with indirect or direct inguinal hernias, which emerge superior to the inguinal ligament

61
Q

A femoral hernia may emerge through the ___________ into the _________________

A
  • saphenous opening

- subcutaneous tissue of the thigh

62
Q

Femoral hernias occur more frequently in _______

A

females

Anatomy Exam 2 (10 decks)

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