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M1: Anatomy and Embryology Lecture BW > Block 3: Lower Limb, Gray's Text > Flashcards

Block 3: Lower Limb, Gray's Text Flashcards

1
Q

Longest bone in the body

A

femur

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2
Q

Describe the proximal end of the femur

A

head, neck, greater & lesser trochanter

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3
Q

What does the femoral head articulate with?

A

acetabulum

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4
Q

Describe the fovea

A

Non-articular pit on the medial surface of the head of the femur

For the attachment of the ligament of the head

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5
Q

Significance of the orientation of the neck of the femur in relation to the shaft

A

orientation of the neck in relation to the shaft increases the range of movement for the hip joint

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6
Q

Greater & Lesser Trochanter f(x)

A

attachment for muscles that move the hip joint

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7
Q

Trochanteric Fossa f(x)

A

attachment for the obturator externus muscle

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8
Q

Lesser trochanter attaches to

A

combined tendonds of psoas major and iliacus muscles

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9
Q

What forms the posterior margin of the greater trochanter to the lesser trochanter

A

intertrochanteric crest

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10
Q

Quadrate Tubercle f(x)

A

attachment fo the quadratus femoris muscle

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11
Q

Attachment for the gluteus maximus muscle

A

gluteal tuberosity

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12
Q

What is the clinical significance of femoral neck fractures?

A

the femoral head has a significant blood supply; fractures of the neck `can disrupt the supply and lead to necrosis of the femoral head

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13
Q

What artery enhances blood supply to the femoral head and neck?

A

Artery of the Ligamentum Teres

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14
Q

Describe an inter-trochanteric fracture

A

a break that runs b/w the greater and lesser trochanter; does not disrupt blood supply to the femoral neck, does not render femoral head ischemic

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15
Q

Describe why femoral shaft fractures are significant

A

It takes a lot of energy to fracture the femoral shaft so this injury is usually accompanied by damage to the surrounding soft tissues, which includes muscle compartments & the structures they contain

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16
Q

What type of joint is the hip joint?

A

A synovial articulation b/w head of femur and acetabulum, specifically a ball and socket joint

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17
Q

What are the articular surfaces of the hip joint?

A

spherical head of the femur and the lunate surface of the acetabulum

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18
Q

Significance of the Ligament of the Head of the Femur

A

carries a small branch of the obturator artery, which contributes to the blood supply of the head of the femur

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19
Q

What 3 ligaments stabilize the hip joint?

A

iliofemoral
pubofemoral
ischiofemoral

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20
Q

Describe how the ligaments of the hip joint work to stabilize the joint d

A

the fibers are spirally oriented so they become tight when the joint is extended; this stabilizes the joint and reduces the amount of energy needed to stand

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21
Q

What comprises the vascular to the hip joint

A

branches of the obturator artery, medial & lateral circumflex femoral arteries, superior and inferior gluteal arteries, first perforating branch of the deep artery of the thigh

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22
Q

What is the hip joint innervated by?

A

femoral, obturator, superior gluteal and nerve to quadratus femoris

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23
Q

What are the gateways to the lower limb?

A

obturator canal
greater sciatic foramen
lesser sciatic foramen
gap b/w inguinal ligament & anterosuperior margin of the pelvis

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24
Q

What runs through the obturator canal?

A

obturator nerve and vessels

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25
Q

What passes through the greater sciatic foramen above the piriformis?

A

superior gluteal nerve and vessels

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26
Q

What passes through the greater sciatic foramen below the piriformis?

A

sciatic nerve
inferior gluteal nerve & vessels
pudendal nerve, internal pudendal vessels
posterior cutaneous nerve of thigh
nerve to obturator internus & gemellus superior
nerve to quadratus femoris & gemellus inferior

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27
Q

Inguinal Ligament & Pelvic Bone Gap

A

major route of communication b/w abdomen & anteromedial aspect of thigh

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28
Q

What passes through the gap b/w the pelvic bone & inguinal ligament?

A 
psoas major 
iliacus 
pectineus muscle 
femoral artery & vein 
lymphatics of the lower limb
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29
Q

What are the nerves that enter the lower limb from the abdomen and pelvis?

A

terminal branches of the lumbosacral plexus

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30
Q

Lumbar Plexus contents

A

anterior rami of L1-L3, part of L4

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31
Q

Lumbosacral Trunk

A

anterior rami of L4-L5

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32
Q

Sacral Plexus

A

anterior rami of S1 to S3 and part of S4

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33
Q

What are the major nerves that originate from the lumbosacral plexus and leave the abdomen and pelvis to enter the lower limb?

A 
femoral nerve 
obturator nerve 
sciatic nerve 
superior gluteal nerve 
inferior glutealnerve
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34
Q

Femoral Nerve formed by

A

anterior rami of L2-L4

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35
Q

How does the femoral nerve leave the abdomen

A

passes through the gap b/w the inguinal ligament & superior margin of the pelvis to enter the femoral triangle

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36
Q

Femoral Nerve f(x) (3)

A
  1. innervates muscles in anterior compartment of thigh
  2. in abdomen, gives rise to branches that innervate iliacus and pectineus
  3. innervates skin over anterior aspect of thigh, anteromedial side of knee, medial side of leg, medial side of foot
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37
Q

Obturator Nerve formed by

A

anterior rami of L2 to L4

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38
Q

Obturator Nerve f(x) (3)

A
  1. innervates muscles in medial compartment of the thigh (except part of the adductor magnus muscle and the pectineus muscle)
  2. obturator internus
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39
Q

Largest nerve in the body

A

sciatic nerve

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40
Q

Sciatic nerve formed by

A

L4 to S3

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41
Q

What are the 2 branches of the sciatic nerve?

A

common fibular nerve

tibial nerve

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42
Q

Posterior vs Anterior divisions of sciatic nerve

A

Posterior divisions of L4 to S3 are carried in the common fibular part

Anterior divisions of L4 to S3 are carried in the tibial part

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43
Q

Sciatic nerve innervates

A
  1. all muscles in posterior compartment of thigh
  2. part of adductor magnus originating from ischium
  3. muscles in leg and foot
  4. skin on lateral side of leg and sole of foot
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44
Q

Superior gluteal nerve formed by

A

anterior rami of L4 to S1

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45
Q

Superior gluteal nerve innervates

A

gluteus medius & minimus

tensor fasciae latae muscle

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46
Q

Inferior gluteal nerve formed by

A

contributions from L5 to S2

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47
Q

Inferior gluteal nerve innervates

A

gluteus maximus muscle

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48
Q

Ilioinguinal Nerve formed by

A

L1

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49
Q

Ilioinguinal Nerve f(x)

A

innervate skin on medial side of upper thigh & adjacent parts of perineum

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50
Q

Genitofemoral nerve formed by

A

L1, L2

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51
Q

genitofemoral nerve f(x)

A

innervate skin over upper central part of anterior thigh

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52
Q

Lateral Cutaneous nerve of thigh formed by

A

L2, L3

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53
Q

Lateral Cutaneous nerve of thigh f(x)

A

innervates skin on lateral side of thigh

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54
Q

Nerve to the Quadratus Femoris

formed by
f(x)

A

formed by: L4 to S1

innervates: gemellus inferior and quadratus femoris muscles

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55
Q

Nerve to the Obturator Internus
formed by
f(x)

A

formed by: L5 to S2

supplies: gemellus superior muscle, perineal surface of obturator internus muscle

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56
Q

Posterior cutaneous nerve of thigh
formed by
function

A

formed by: S1 to S3
f(x): innervates a band of skin over the posterior aspect of the thigh
skin over gluteal fold, upper medial part of thigh

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57
Q

Perforating Cutaneous Nerve
formed by
function

A

formed by: S2 and S3

innervation: sensory innervation for skin over medial aspect of gluteal fold

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58
Q

Major artery supplying the lower limb

A

femoral artery

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59
Q

Femoral artery is a continuation of

A

external iliac artery in the abdomen

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60
Q

When does the external iliac artery become the femoral artery?

A

when it passes under the inguinal ligament to enter the femoral triangle

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61
Q

Describe the anastamotic network in the upper thigh and gluteal region

A

branches of femoral, inferior gluteal, superior gluteal and obturator artery in addition to branches from internal pudendal artery

provides collateral circulation when one vessel is interrupted

62
Q

Deep veins of the lower limb

A

follow the arteries (femoral, superior gluteal, inferior gluteal, obturator)

63
Q

Relationship b/w deep and superficial veins of the lower limb

A

the superficial veins are in the subcutaneous tissue & drain into the deep veins

64
Q

What are the main 2 superficial veins of the lower limb>

A

great saphenous vein

small saphenous vein

65
Q

Normal venous blood flow depends on

A

valves

66
Q

What happens when venous valves become incompetent?

A

they place pressure on the distal valves, which may also become incompetent and this leads to dilated tortuous superficial veins (varicose veins) in the great and small saphenous venous systems

67
Q

what are the typical sites for valvular incompetence?

A

junction b/w great saphenous vein and femoral vein
perforating veins in midthigh
junction b.w small saphenous vein & popliteal vein

68
Q

What is the “classic triad” that precludes DVT?

A

venous stasis
injury to vessel wall
hypercoagulable states

69
Q

Explain the significance of a dislodged DVT

A

DVT in the calf veins can propagate to the femoral veins, then break off and pass through the heart to enter pulmonary circulation, resulting in:

  1. occlusion of the pulmonary artery
  2. cardiopulmonary arrest, leading to
  3. death
70
Q

Where do most lymphatics of the lower limb drain to?

A

superficial and deep inguinal nodes

71
Q

Superficial Inguinal Nodes receive lymph from

A

gluteal region
lower abdominal wall
perineum
superficial regions or lower limb

72
Q

Superficial inguinal nodes drain into

A

external iliac nodes

73
Q

Deep inguinal nodes receive lymph from

A

deep lymphatics, glans penis (or glans clitoris)

74
Q

Deep inguinal nodes connect with _______, and drain into ______

A

superficial inguinal nodes; external iliac nodes

75
Q

Popliteal nodes receive lymph from

A

superficial vessels accompanying the great saphenous vein & from deep areas of the leg and foot

76
Q

Popliteal nodes drain into

A

deep and superficial inguinal nodes

77
Q

Fascia Lata

A

“stocking like membrane that covers the lower limb & lies beneath the superficial fascia

78
Q

Fascia Lata is continuous with

A

deep fascia of the leg

79
Q

Describe the superior region of the Fascia Lata

A

splits anteriorly to enclose the tensor fasciae lata muscle & posteriorly to enclose gluteus maximus muscle

80
Q

Iliotibial Tract

A

lateral, longitudinal thickening of the fascia lata

81
Q

Function of tensor fasciae latae and gluteus maximus muscle (together)

A

hold the leg in extension once other muscles have extended the leg at the knee joint

82
Q

saphenous opening

A

opening in the fascia lata that allows the great saphenous vein to pass from superficial fascia through the deep fascia to connect w/ femoral vein

83
Q

Major structures in the femoral triangle

A

femoral nerve
femoral artery
femoral vein
lymphatic vessels

84
Q

Femoral Sheath

A

funnel shaped sleeve of fascia within the femoral triangle surrounding the femoral vein, artery, & associated lymphatics

does not include the femoral nerve (lateral to the sheath)

85
Q

Significance of the opening of the femoral canal

A

it’s a potentially weak spot in the lower abdomen & is a site for femoral hernias

86
Q

What provides vascular access to the lower limb?

A

femoral artery and vein

“femoral approach

87
Q

What are the deep group of muscles for the gluteal region?

A 
pififormis 
obturator internus 
gemellus superior 
gemellus inferior 
quadratus femoris
88
Q

What are the superficial group of muscles for the gluteal region?

A

gluteus minimus
gluteus medius
gluteus maximus

89
Q

Piriformis muscle f(x)

A

rotates and abducts the femur at the hip joint

90
Q

Piriformis innervation

A

in the pelvis: nerve to the piriformis

91
Q

How is the piriformis a landmark?

A

it divides the greater sciatic foramen into 2 regions: one above and one below the piriformis

92
Q

Obturator Internus
f(x)
innervation

A

f(x): laterally rotates & abducts the femur @ the hip joint
innervation: nerve to the obturator internus

93
Q

Gemellus Superior Innervation

A

nerve to the obturator internus

94
Q

Gemellus Inferior Innervation

A

nerve to the quadratus femoris

95
Q

Gemellus Muscles f(x)

A

laterally rotate & abduct the femur at the hip joint

96
Q

Quadratus Femoris

f(x)
innervation

A

f(x): laterallt rotate the femur at the hip joint

innervation: nerve to the quadratus femoris

97
Q

Gluteus Medius & Minimis f(x)

A
  1. abduct the lower limb @ the hip joint

2. securing the position of the pelvis on the stance limb

98
Q

Trendelenburg’s Sign

what is it?
occurs in?
typically found in?
what’s usually associated w/ a positive sign?

A

what: when a patient stands on one limb, the pelvis severely drops over the swing limb
occurs in: people with weak or paralyzed abductor muscles (gluteus minimus and medius)
found in: patients w/ damage to superior gluteal nerve
positive sign associated w/: gait issues

99
Q

Gluteus Maximus Muscle
f(x)
innervation

A

f(x): extend the flexed thigh at the hip joint; stabilizes the knee and hip joints
inneration: inferior gluteal nerve

100
Q

Tensor Fasciae Latae f(x)

A

stabilizes the knee in extension

(w/ gluteus maximus): stabilizes the hip joint by holding the head of the femur in the acetabulum

101
Q

What is the only nerve that exits the greater sciatic foramen passing above the piriformis?

A

superior gluteal nerve

102
Q

Nerve to Quadratus Femoris f(x)

A

supplies a small branch to gemellus inferior

103
Q

Nerve to Obturator Internus Innervates

A

small branch to gemellus superior; innervates obturator internus muscle

104
Q

Posterior Cutaneous Nerve to Thigh innervates

A

skin on the posterior of leg and thigh

105
Q

Inferior gluteal nerve innervates

A

gluteus maximus

106
Q

Perforating cutaneous nerve innervates

A

skin over the medial aspect of the gluteus maximus

107
Q

Intramuscular Injections
typical site
safest place, why?

A

site: gluteal region
safest place: upper outer quadrant of either gluteal region to avoid hitting any part of the sciatic nerve or other nerves/vessels in the gluteal region

108
Q

What are the compartments of the thigh

A

anterior
medial
posterior

109
Q

Posterior compartment of thigh is innervated by

A

sciatic nerve

110
Q

Anterior compartment of thigh is innervated by

A

femoral nere

111
Q

Medial compartment of thigh is innervated by

A

(mostly) obturator nerve

the sciatic nerve innervates some of the adductor magnus and the pectineus is innervated by the femoral nerve

112
Q

Patalla

bone type
formed within

A

sesamoid bone (formed w/i tendon of quadriceps femoris)

113
Q

Describe how patellar shape helps its attachments

A

apex: pointed inferiorly for attachment to patellar ligament
base: broad, thick for attachment of quadriceps femoris
posterior surface: articulates w/ femur

114
Q

Skeletal support for the thigh is provided by

A

the femur

115
Q

Tibial tuberosity

A

palpable, inverted triangle on the anterior aspect of the tibia
site of attachment for the patellar ligaments

116
Q

Anterior compartment of the thigh contains what muscles?

A

sartorious

4 large quadriceps femoris muscle (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)

117
Q

Medial compartment of the thigh contains what muscles?

A 
gracilis 
pectineus 
adductor longus 
adductor brevis 
adductor magnus
obturator externus
118
Q

Posterior compartment of the thigh contains what muscles?

A

3 large muscles termed the “hamstrings”

biceps femoris
semitendinosus
semimembranosus

119
Q

Compartment Syndrome

what is it?
significance?

A

what: occurs when there’s swelling w/i a fascial enclosed muscle compartment in the limbs
significance: pressure w/i compartment elevates, blood flow and tissue perfusion is compromised, can lead to neuromuscular damage

120
Q

Why are the iliacus and psoas muscles grouped in the lower extremity?

A

they both insert by a common tendon onto the lesser trochanter of the femur

121
Q

What makes up the quadriceps femoris muscle?

A

vastus medialis
vastus intermedius
vastus lateralis
rectus femoris muscle

122
Q

Quadriceps femoris muscle innervation

A

femoral nerve

123
Q

Explain tapping with a hammer on the patellar ligament

A

it tests reflex activity mainly at spinal cord levels L3 and L4 b/c the quadriceps femoris is innervated by the femoral nerve

124
Q

Patellar Ligament

A

essentially a continuation of the quadriceps femoris tendon below the patella

125
Q

Adductor Hiatus

A

allows the femoral artery and veins to pass b/w the adductor canal and the popliteal fossa

126
Q

Muscle injuries in the lower limb

how do they happen?
where do they usually happen?

A

how: direct trauma or overuse syndrome
where: hamstring muscles

127
Q

What arteries enter the thigh?

A

femoral artery
obturator artery
inferior gluteal artery

128
Q

Femoral Artery Paplable: Where?

A

in the femoral triangle, inferior to the inguinal ligament midway b/w ASIS & pubic symphysis

129
Q

What 4 branches arise from the femoral artery in the femoral triangle?

A

superficial epigastric
superficial circumflex iliac artery
superficial external pudendal artery
deep external pudendal artery

130
Q

Largest branch of the femoral artery in the thigh?

A

deep artery of the thigh

131
Q

What are the branches of the deep artery of the thigh?

A

lateral circumflex
medial circumflex
3 perforating branches

132
Q

What are the branches of the deep artery of the thigh?

A

ascending branch
descending branch
transverse branch

133
Q

Obturator Artery Branches

A

anterior branch

posterior branch

134
Q

Peripheral Vascular Disease
what is it?
cause?

A

what: reduced blood flow to the legs
cause: stenoses and/or occlusions in the lower aorta and iliac, femoral, tibial, and fibular vessels

135
Q

Chronic Leg Ischemia

A

vessels have undergone atheromatous change, and there is luminal narrowing

136
Q

Critical Limb Ischemia

what is it?
leads to ?

A

what: severe ischemia that leads to threatened viability of the limb
leads to: gangrene, ulceration, severe rest pain in the foot

137
Q

Most common symptoms or chronic leg ischemia

A

intermittent claudication (pain in the calf muscles or buttocks that increases with walking)

138
Q

Largest superficial vein of the thigh

A

great saphenous vein

139
Q

Femoral Nerve Branches

A

anterior cutaneous branches
motor nerves
1 long, cutaneous nerve (saphenous nerve)

140
Q

Tibial Nerve

innervate

A

innervates:
muscles in posterior compartment of leg
intrinsic muscles in sole of the food
skin on posterolateral side of the lower half of the leg & lateral side of foot, ankle, little toe

141
Q

Mensici

A

fibrocartilaginous C shaped cartilages in the knee joint (one medial, one lateral)

142
Q

What separates the synovial membrane from the patellar ligament?

A

infrapatellar fat pad

143
Q

What are the ligaments associated w/ the knee joint?

A

patellar ligament
tibial (medial) and fibular (lateral) ligaments
anterior & posterior cruciate ligaments

144
Q

Collateral Ligaments f(x)

A

stabilize the hinge like motion of the knee

145
Q

Significance of anterior & posterior cruciate ligaments

A

anterior: prevents anterior displacement of the tibia
posterior: restricts posterior displacement

146
Q

Describe the locking mechanism

A

when standing, the knee joint is locked into position reducing the amount of muscle work needed to maintain the standing position

147
Q

What are the components of the locking mechanism?

A
  1. change in the shape & size of the femoral surfaces that articulate with the tibia
  2. medial rotation of the femur on the tibia during extension
148
Q

Describe the vascular supply to the knee joint

A

descending and genicular branches from the femoral, popliteal, and lateral circumflex arteries in the thigh & circumflex fibular artery & recurring branches from anterior tibial artery in the leg

149
Q

What types of issues are common at the knee joint? Examples?

A

type: soft tissue injuries
ex: anterior & posterior cruciate ligaments, meniscal tears, trauma to collateral ligaments

150
Q

What happens in osteoarthritis?

A

degenerative joint disease where there is reduction of joint space, small bony outgrowths, and bony cyst formation

M1: Anatomy and Embryology Lecture BW (37 decks)

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