Arteries + Veins + nerves of LL (pathways+imp. locations) Flashcards

1
Q

Branches of the lumbosacral plexus

A

Lumbar plexus:
- formed by the anterior rami of L1-L3 and part of L4
- located within the psoas major musc.

Lumbosacral Trunk:
- Formed by the remainder of the anterior rami of the L4 + anterior rami of L5

Sacral Plexus:
- The lumbosacral trunk enters the pelvis to join the anterior rami of S1-3 and part of S4 to form the sacral pexus
- Located on the posterolateral aspect of the wall of the pelvis

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2
Q

Branches of the Lumbar plexus in the LL

A

–Femoral nerve
– Obturator nerve
– Illoinguinal nerve
– Genitofemoral nerve
– Lateral cutaneous nerve of thigh
– Motor branches (to illiopsoas)

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3
Q

Femoral nerve - pathway + branches + innervation

L2-L4

A
  • Originates from L2-L4 of lumbar plexus
  • Emerges from lateral part of psoas major
  • Passes behind the inguinal ligament in the groove between psoas major and illiacus
  • Enters the fem triangle

—-» Here it is split into its posterior and anterior divisions by the lateral circumflex femoral artery - give rise to sensory and motor branches of the fem n.

Motor branches supply:
- All anterior compartment muscles except for illiopsoas musc.
- Pectineus in the medial compartment

Sensory branches:
- Medial fem cutaneous n. (anteromedial aspect of thigh)
- Intermediate fem. cutaneous n. (anteromedial aspect of thigh)
- Saphenous nerve (anteromedial aspect of leg)
sensory innervation to:
- the knee and hip joints
- skin on the anteromedial aspect of the LL to the medial aspect of the foot

The SAPHENOUS N. :
- main sensory branch of the fem. n.
- Enters the add. canal but doesnt leave thru the add. hiatus in the posterior thigh instead travels MEDIALLY
- Instead emerges btwn SARTORIUS and GRACILIS
- To run SUPERFICIALLY down the medial aspect of the leg
- Here it accompanies the GREAT SAPH. V.
- Also gives off infrapatellar and medial crural cutaneous branches

INNERVATION: anterior and medial aspect of the leg and medial side of the foot

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4
Q

Saphenous nerve pathway + innervation + Damage to it?

A

PATHWAY:
- Largest sensory branch of Fem n.
- Fem. n. gives off this branch in the add. canal - runs with fem vessels (V. + A.)
- Doesnt leave thru add hiatus
- Instead pierces sartorius and gracilis to run superficially and down the medial side of the leg.
- Here it accompanies the GREAT SAPH. V.
- Gives off infrapatellar and medial crural branches in the medial leg

INNERVATION:
- Skin on anterior and medial leg
- Skin on medial side of foot

DAMAGE:
when varicose veins are stripped

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5
Q

What accompanies the Great saph Vein?

A

The saphenous nerve

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6
Q

Obturator Nerve - Pathway+innervation+associated injuries/diseases/pain

L2-L4

A

PATHWAY:
– Originates from L2-L4 of lumbar plexus
- Emerges from MEDIAL border of psoas major
- Travels thru obturator canal in upper part of the obturator foramen
- Pierces the obturator externus muscle
- After this it splits into its posterior and anterior branches
—> Anterior branch - anterior to ADDUCTOR BREVIS
—-> Posterior branch - post. to add. brevis

INNERVATION:
—-> Motor:
- All medial compartemnt musc. of thigh except pectineus (fem n.) and hamstring part of add. magnus (sciatic n.)
- Obturator externus (small musc. of hip but also included in medial compartment of thigh)

—–> Sensory:
- Hip and knee joints (*referred pain)
- Innervates the skin on upper part of the medial thigh (** referred pain)

REFERRED PAIN:
* Since obt. n. innervates hip and knee joints
– pain from hip disease can be felt as knee pain - patient presents with knee pain symptoms

** Obt. n. innervates medial part of upper thigh
– Pain from PELVIC INFLAMMATION felt here

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7
Q

Which muscle are the anterior and posterior branches of the obturator n. ant. and post. in relation to?

A

Adductor brevis muscle

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8
Q

Ilioinguinal nerve - L1

A
  • Pierces the transverse abdominis
  • SUPPLIES:
    – penis + scrotum
    – medial side of upper thigh
    – strip of skin above inguinal ligament
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9
Q

Genitofemoral nerve - L1 + L2

A
  • descends on anterior psoas major
    SUPPLIES:
    – Its femoral branch supplies skin on anterior central part of thigh
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10
Q

Lateral cutaneous nerve of thigh/Lateral fem. cutaneous nerve – Pathway+innervation+injuries

L2-L3

A

PATHWAY:
- originates from L2-L3
- Travels superior to and laterally on iliacus muscle
- Passes under lateral part of inguinal ligament
- Travels down lateral side of the thigh

SUPPLIES:
- Skin on lateral aspect of the thigh

INJURY:
Meralgia Paresthetica:
– Tingling, numbness and burning pain on outer thigh
– Due to compression of nerve
– tight clothing, pregnancy, obesity –> common causes

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11
Q

Motor branches of lumbar plexus

A

Supply iliacus and psoas major

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12
Q

Two main arteries supplying anterior and medial thigh?

A

Obturator Artery - branch of internal iliac A.
Femoral artery - Branch of external iliac A.

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13
Q

Largest branch of the femoral artery?

A

Profunda femoris (Deep branch of fem A.)

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14
Q

Branches of the profunda femoris? which ones and where they anastomose?

A

branches:
- Lateral circumflex femoral - supplies head and neck of femur, anterior part of gluteal region + femur +knee jt.
- Medial circumflex femoral - Head and neck of femur
- Perforating branches - Perforate add. magnus and supply posterior compartment of thigh

ANASTOMOSIS:
- medial and lateral circ. fem. A. anastomose encircle the uppermost part of the shaft of the femur and anastomose

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15
Q

Main blood supply to hip joint by?

A

Branches of profunda fem:
- Lateral circumflex femoral
- Medial circumflex femoral

Acetabular branch of obturator A.

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16
Q

Anastomosis arnd hip joint - which arteries are involved?

A
  • Inferior gluteal artery
  • Medial and lat circum. fem. arteries
  • 1st perforating branch of profunda fem.
17
Q

How is the Fem A. clinically important?

A
  • Pressure over the Fem. A can be applied to control heammorhage from the LL
  • Radiologists use catheterisation of Fem A to gain access to arterial circulation
  • Cardiologists also use catheterisation of the Fem. A. to reach the coronary arteries to perform coronary angiography
  • One of the most common site for peripheral arterial disease – artery narrowed resulting in decreased blood supply to the LL.
18
Q

Obturator Artery - Pathway, branches, supply

A
  • Branch of internal iliac A.
  • Exits pelvis and enters medial compartment of the thigh through the obturator canal in the upper part of the obturator foramen
  • Accompanies the obturator nerve
  • As it passes thru obturator canal it gives off branches

BRANCHES:
- Posterior and anterior branches – encircle the obturator membrane margin

  • Acetabular branch – enters hip joint by passing thru the acetabular notch and the ligament of the head of the femur to supply the head of the femur
19
Q

Venous drainage of LL - write a note on it

A

Has superficial, deep and perforating veins similar to in the UL

Superficial veins:

  • The lateral part of the dorsal venous arch in the foot drains into the small saphenous vein and the medial part of the arch drains into the great saphenous vein.
  • Great Saph V. –>
    > Medial part of dorsal venous arch drains into great saph.
    > Travels anterior to medial malleolus and travels up the medial side of the LL
    > Drains into the Fem. V. (deep vein) after passing thru the saphenous opening
    » Saphenous opening lies inferior to the medial end of the inguinal ligament
  • Small Saph. V. –>
    > Travels up the posterior side of the leg
    > Drains into the popliteal Vein behind the knee

Deep veins:
- Accompany the arteries of the LL

Perforating Veins:
- Communicating veins between the deep and superficial veins
- Valves in these veins only allow flow from superficial to deep veins

20
Q

Where does the saphenous opening lie?

A

Inferior to the medial end of the inguinal ligament

21
Q

What issue/disease may be associated with the deep veins of the LL

A

Deep Vein thrombosis – blood clot formed in calf veins for example may travel up the Fem V. and eventually enter the Pulm. Artery and block circulation
** increased chance of occurring after surgery

22
Q

Which vein in the LL is frequently used for venous access

A

Fem. Vein in the fem triangle - easy access
Used in shocked patients w/ v low pressures

23
Q

What makes the Sacral plexus in the lower limb?

A

Lumbosacral trunk ( part of anterior rami of L4 and whole L5) joined with S1 - S3 and a little of S4 forms the sacral plexus

24
Q

Branches of sacral plexus in LL?

A
  • Sciatic nerve
  • Gluteal nerves (inferior+superior)
  • Motor branches
  • Posterior cutaneous nerve of thigh
  • Pudendal nerve
25
Q

Sciatic nerve

A
  • Enters gluteal region inferior to piriformis thru the sciatic foramen
  • Travels downwards on posterior surface of the short muscles of the hip
  • Enters posterior compartment of thigh and lies deep to hamstrings
  • At the superior border of Pop. Fossa it divides into the common fibular/peroneal nerve and the tibial nerve

SUPPLIES:
- All posterior thigh muscles
- Hamstring part of adductor magnus (rest supplied by fem n.)
- branches of it supply all muscles in leg and foot (tibial + common peroneal)

26
Q

Gluteal nerves

A

Inferior and superior
- Supply Glut max, min and medius as well as tensor fascia latae

27
Q

Which is the only nerve to enter the gluteal region superior to piriformis?

A

superior gluteal nerve

28
Q

Motor branches of sacral plexus

A

Supply all small muscles of hip in gluteal region (not obturator externus)

29
Q

Posterior cutaneous nerve of thigh

A

Enters post. thigh thru greater sciatic foramen
Inferior to piriformis
Accompanies the sciatic nerve
- Innervates skin over posterior aspect of the thigh, the pop. fossa and upper part of the back of the leg