Chapter Five: The Lower Limb Flashcards
Lumbar plexus minor branches
-ileohypogastric
-ileoinguinal
-genitofemoral
-lateral femoral cutaneous
Ileohypogastric nerve (minor)
-T12 and L1
Ileoinguinal nerve (minor)
-T12 and L1
Genitofemoral nerve
-L1 and L2
Lateral femoral cutaneous nerve
-L2 and L3
Roots of the lumbar plexus
-T12 to L5
Major nerves of the lumbar plexus
-femoral
-obturator
-lumbosacral trunk
Femoral nerve (major)
-L2, 3, 4
Obturator nerve (major)
-L2, 3, 4
Lumbosacral trunk (major)
-L4, 5
Roots of the sacral plexus
-L4 to S4
Major nerves of the sacral plexus
-superior gluteal
-inferior gluteal
-sacral sciatic
-pudendal
Superior gluteal nerve (major)
-L4, 5, S1
Inferior gluteal nerve (major)
-L5, S1 ,2
Sacral sciatic nerve (major)
-S1, 2, 3
Pudendal nerve (major)
-S2, 3, 4
Sciatic nerve
-made up of the lumbosacral trunk and sacral sciatic nerve
-made up of roots L4 to S3
Divisions of the sciatic nerve
-tibial
-common peroneal
Minor nerves of the sacral plexus
-obturator internus
-gemellus superior
-gemellus inferior
-quatratus femoris
-piriformis
Obturator internus nerve (minor)
-L4, 5, S1, 2
Gemellus superior nerve (minor)
-L4, 4, S1, 2
Gemellus inferior nerve (minor)
-L4, 4, S1
Quadratus femoris nerve (minor)
-L4, 5, S1
Piriformis nerve (minor)
-S1, 2
Bones of the hip
-ilium
-ischium
-pubis
Labelling of the hipbone
-page 106/107
The sacroiliac joints
-sacroiliac
-sacrospinous
-sacrotuberous
Sacroiliac ligament
-join the sacrum to the 2 iliac bones
Sacrospinous ligament
-run from the sacrum to the ischial tuberosity and the ischial spine
Sacrotuberous ligament
-run from the sacrum to the ischial tuberosity and the ischial spine
Proximal femur labelling
-page 109
Proximal femur head shape
-2/3 of a sphere
Muscles of the gluteal region (groups)
-the gluteal muscles (3) and the tensor fasciae latae
-the lateral rotators (6)
Gluteal muscles and the tenor fasciae latae
-gluteus maximus
-gluteus medius
-gluteus minimus
-tensor fasciae latae
Gluteus maximus
-origin: posterior ilium, sacroiliac joint and sacrotuberous ligament
-insertion: deep third inserts on gluteal tuberosity and superficial two thirds insert on insert on IT band
-innervated by inferior gluteal nerve
-powerful hip extensor, lateral rotator and adductor
Gluteus medius
-origin: middle of iliac blade
-insert: greater trochanter
-innervated by superior gluteal nerve
-medial rotation
Gluteus minimus
-origin: external surface of iliac blade
-insertion: greater trochanter
-innervated by superior gluteal nerve
-medial rotation
Tensor fasciae latae
-origin: anterior superior iliac spine
-insertion: IT band and gerdys tubercle
-innervated by the superior gluteal nerve
-acts by tensing the ITB (stabilizor and abductor)
The lateral rotators
-piriformis
-obturator internus
-gemellus superior
-gemellus inferior
-obturator externus
-quadratus femoris
Piriformis
-origin: inside of pelvis from the front of the sacrum
-insertion: greater trochanter
-innervated by S1, 2
-lateral rotator
Obturator internus
-origin: inside the the obturator membrane
-insertion: greater trochanter
-innervated by L4, 5, S1, 2
-lateral rotator
The gemelli (2) (superior and inferior)
-origin: edge of the foramen one above and one below the obturator internus
-insertion: on greater trochanter with gemelli
-superior is innervated by L4, 5, S1, 2
-inferior is innervated by L4, 5, S1
-lateral rotators
Obturator externus
-origin: outside of obturator membrane
-insertion: base of greater trochanter
-innervated by L2, 3, 4
Quadratus femoris
-origin: ischial tuberosity
-insertion: middle of the intertrochanteric crest
-innervated by L4, 5, S1
-lateral rotator
Blood supply and nerves of the gluteal region
-labelling on page 113
The hip joint
-multiaxial, ball and socket,
-acetabulum articulates with head of femur
Transverse acetablular ligament
-completes the “full circle” of the hip joint
Iliofemoral ligament
-most important ligament of the hip joint
-inverted V shape
-runs from AIIS to intertrochanteric line
-prevents hyperextension
Pubofemoral ligament
-less important ligament of the hip joint
-on back side
-protect medial and lateral aspects of the joint
Ischiofemoral ligaments
-less important ligaments of the hip joint
-protect medial and lateral aspects of the joint
Ligaments of the hip joint labelling
-page 115
The shaft and distal femur labelling
-page 116
The proximal tibia and fibula labelling
-page 117
Compartments of the thigh
-anterior compartment (extensors)
-medial compartment (adductors)
-posterior compartment (flexors)
The anterior compartment of the thigh
-sartorius
-quadriceps femoris (vastus medialis, vastus lateralis, vastus intermedius , and rectus femoris)
Sartorius
-origin: anterior superior iliac spine
-insertion: anterior tibia (included in gooses foot)
-innervated by femoral nerve
-flexes the hip and knee
Rectus femoris (quadricep group)
-origin: anterior inferior iliac spine
-insertion: superior border of patella
-innervated by femoral nerve
-flexes hip and extends knee
Vastus medialis (quadricep group)
-origin: femur on linea aspera
-insertion: patella
-innervated by femoral nerve
-extend the knee
Vastus lateralis (quadricep group)
-origin: femur on linea aspera
-insertion: patella
-innervated by femoral nerve
-extend the knee
Vastus intermedius (quadricep group)
-origin: shaft of the femur
-insertion: behind the rectus femoris onto superior border of patella
-innnervated by femoral nerve
-extend the knee
Iliopsoas
-psoas origin: transverse process of lumbar vertebrae
-iliacus origin: blade of the ilium
-insertion: lesser trochanter
-innervated by several branches from the lumbar plexus
-flex and laterally rotate the hip
The femoral triangle
-made up of inguinal ligament (base), sartorius (lateral wall) and adductor longus (medial wall)
The femoral sheath and canal
-piece of abdominal cavity that runs through the thigh
-in the condom there is the artery, vein and lymphatics
-outside the condom is the nerve
Profunda femoris artery
-splits into tiny nerves to supply thigh
Adductor hiatus
-splits from the side of the knee to go through a hole in the bone and to the back of the knee
Femoral nerve
-like a cheesestring
Obturator nerve
-goes to medial compartment
Medial compartment of the thigh
-anterior layer (gracilis, adductor longus and pectineus)
-posterior layer (adductor brevis, adductor magnus)
Gracilis (anterior layer)
-origin: pubis
-insertion: upper tibia with sartorius
-innervated by obturator nerve
-adduction, flexion, medial rotation
Pectineus (anterior layer)
-origin: pubis
-insertion: uppermost linea aspera
-innervated by both the femoral and obturator nerves
-weak flexor and adductor
Adductor longus (anterior layer)
-origin: pubis
-middle of linea aspera
-innervated by obturator nerve
-adductor
Adductor brevis (posterior layer)
-origin: pubis
-insertion: behind pectineus
-innervated by obturator nerve
-adductor
Adductor magnus (posterior layer)
-origin: pubis
-insertion: adductor tubercle
-innervated by tibial division of sciatic nerve and obturator
-adductor
Blood and nerve supply to the adductor compartment
-obturator artery
-obturator nerve
Posterior compartment of the thigh
-hamstrings (biceps femoris, semitendinosus, semimebranosus)
Biceps femoris(hamstring compartment)
-long head origin: ischial tuberosity
-short head origin: linea aspera
-insertion: head of fibula
-innervated by the common peroneal division of the sciatic nerve
-extends hip and flexes knee
Semitendinosus
-origin: proximal muscular belly
-insertion: below medial tibial condyle (gooses foot)
-innervated by tibial division of sciatic nerve
-extends the hip and flexes the knee
Semimembranosus
-origin: flat aponeurotic origin
-insertion: behind medial condyle of the tibia
-innervated by tibial division of sciatic nerve
-extends the hip and flexes the knee
Blood supply to posterior compartment of the thigh
-penetrating branches of the profunda femoris artery
Nerve supply to posterior compartment of the thigh
-sciatic nerve
-enters popliteal fossa and splits into the tibial and common peroneal nerves
The popliteal fossa
-diamond shape space behind and superior to the knee joint
-branches into the tibial and common peroneal branches
The knee joint
-modified hinge joint
-flexion and extension
-and at full extension medial and lateral rotation
Knee labelling
-page 129
Lateral meniscus
-more circular and is attached only at the two ends
-moves in an anterior/posterior fashion during extension
Medial meniscus
-more of an ellipse shape and attached to the tibia throughout its length
-since it cannot move it is more likely to be damaged
Ligaments of the knee
-medial collateral ligament: bipartite, deep part is fan shaped and derived from the fibrous capsule
-lateral collateral ligament: thick cord passing from the lateral epicondyle to the head of the fibula
Cruciate ligaments of the knee
-anterior cruciate: ACL, runs up from medial tibial condyle and back to the inside of the lateral femoral condyle (prevents posterior disloaction of femur and anterior disloaction of tibia)
-posterior cruciate: PCL, runs forward, upward and medially from the back of the intercondylar eminence to inside of the medial femoral condyle (opposite)
Ligament labelling
-page 130 and 131
Blood and nerve supply to the knee
-popliteal artery gives of geniculate arteries (superior, middle and inferior)
-bifurcates to form anterior and posterior tibial arteries
The leg labelling (tibia and fibula)
-page 132
Tarsal bones
-talus
-calcaneus
-cuboid
-navicular
-cuneiforms (3)
Cuboid articulations
-metatarsals 4 & 5
Cuneiforms articulations
-metatarsals 1, 2 & 3
Metatarsals
-big toe (hallux) bears half of weight load for each foot
Phalanges
-toes
Sustenaculum tali
-on the medial surface of the calcaneus
-supports the talus
Anterior compartment of the leg
-tibialis anterior
-extensor hallucis longus
-extensor digitorum longus
-extensor digitorum brevis
Tibialis anterior (anterior leg)
-origin: upper 2 thirds of tibia and interosseous membrane
-insertion: first cuniform and base of first metatarsal
-innervated by deep peroneal nerve
-extends (dorsi flexes)
Extensor hallucis longus (anterior leg)
-origin: middle half of outside of fibula
-insertion: base of distal phalanx (big toe)
-innervated by deep peroneal nerve
-extends (dorsi flexes)
Extensor digitorum longus (anterior leg)
-origin: fibula and interosseous membrane
-insertion: 4 tendons on each toe into extensor expansions
-innervated by deep peroneal nerve
-extends (dorsi flexes)
Peroneus teritius
-seperate tendon from extensor digitorum longus that seperates from main bulk of muscle to insert on the base of the fifth metacarpal
-everts the foot
Extensor digitorum brevis (anterior leg)
-origin: upper calcaneus near cuboid
-insertion: proximal phalanx of big toe and extensor expansions of the rest
-innervated by deep peroneal nerve
-extends (dorsi flexes)
The lateral compartment of the leg
-peroneus longus
-peroneus brevis
Peroneus longus (lateral leg)
-origin: head and upper 2 thirds of fibula
-insertion: runs under sole of foot to insert on medial side at base of the first metatarsal and first cuneiform
-innervated by superficial peroneal nerve
-plantar flexes and everts
Peroneus brevis (lateral leg)
-origin: distal 2 thirds of fibula
-insertion: base of fifth metatarsal
-innervated by the superficial peroneal nerve
-plantar flexes and everts
Posterior compartment of the leg (superficial)
-gastrocnemius
-soleus
-plantaris
Gastrocnesmius (posterior superficial leg)
-origin: two bellies from femoral condyles
-insertion: achilles tendon inserting into calcaneus
-innervated by tibial nerve
-flexes
Soleus (posterior superficial leg)
-origin: head of fibula and soleal line
-insertion: into achilles tendon
-innervated by tibial nerve
-ankle flexor
Plantaris (posterior superficial leg)
-origin: lateral femoral condyle
-insertion: achilles tendon
-innervated by tibial nerve
-doesnt do anything
Posterior compartment of the leg (deep)
-popliteus
-tibialis posterior
-flexor hallucis longus
-flexor digitorum longus
Popliteus (posterior deep leg)
-origin: behind proximal tibia
-insertion: lateral femoral condyle
-innervated by tibial nerve
-unlocks the knee by lateral rotation
Tibialis posterior (posterior deep leg)
-origin: back of interosseous membrane
-insertion: navicular and cuneiforms
-innervated by tibial nerve
-plantar flexion and eversion
Flexor hallucis longus (posterior deep leg)
-origin: lower 2 thirds of fibula
-insertion: base of distal phalanx after running under talus
-innervated by tibial nerve
-flexes
Flexor digitorum longus
-origin: lower tibia
-insertion: runs around medial malleolus and into distal phalanges of the 4 toes
-innervated by tibial nerve
-flexes
Order of the posterior deep flexors from medial to lateral
-tom: tibialis posterior
-dick: flexor digitorum longus
-and: artery, vein, nerve
-harry: flexor hallucis longus
Dorsalis pedis artery
-how the anterior tibial artery enters the foot
Tibiofibular joints
-proximal
-middle
-distal
Proximal tibiofibular joint
-between head of fibula and articular facet under the lateral tibial condyle
Middle tibiofibular joint
-interosseous membrane
Distal tibiofibular joint
-very strong fibrous joint
-two bones are united above ankle by the interosseous tibiofibular ligament
Ankle joint
-hinge joint
-flexion and extension
-inversion and eversion (only at midtalar joint)
Ligaments of the ankle
-posterior talofibular ligament
-anterior talofibular ligament
-calcaneofibular ligament
Ligaments of the knee labelling
-page 145
Axis of the foot
-2nd toe
Plantar aponeurosis
-stronger than the palmar aponeurosis
Layers of the muscles of the foot
-superficial muscles
-long flexor tendons and associated muscles
-deep intrinsic muscles
-deep tendons and the interossei
Layer 1: Superficial muscles of the foot
-abductor hallucis
-flexor digitorum brevis
-abductor digiti minimi
Abductor hallucis (layer 1)
-origin: medial side of foot
-insertion: 1st proximal phalanx
-innervated by medial plantar nerve
-abducts
Flexor digitorum brevis (layer 1)
-origin: calcaneus, navicular, cuboid
-insertion: biforcate on middle phalanges of 4 toes
-innervated by medial plantar nerve
-flexes
Abductor digiti minimi (layer 1)
-origin: lateral side of foot
-insertion: 5th proximal phalanx
-innervated by lateral plantar nerve
-abducts
Layer 2: Long flexor tendons and associated muscles
-long tendons to flexor digitorum longus and flexor hallucis longus
-quadratus planae
-the lumbricals
Flexor hallucis longus tendon (layer 2)
-insertion: hallux
Flexor digitorum longus tendon (layer 2)
-insertion: 4 small tendons that run into lateral 4 toes
Quadratus plantae (layer 2)
-origin: each side of calcaneus
-insertion: flexor digitorum longus tendon
-innervated by lateral plantar nerve
-flex the toes
The lumbricals (layer 2)
-flexor digoitorum longus to extensor expansiosn of medial side of lateral 4 toes
-medial muscle is innervated by medial plantar nerve and lateral 3 muscles are innervated by lateral plantar nerve
Layer 3: Deep intrinsic muscles
-flexor hallucis brevis
-adductor hallusis
-flexor digiti minimi brevis
Flexor hallucis brevis (layer 3)
-origin: 2 bellies on bottom of 1st and 2nd cuneiform
-insertion: two tendons to bottom of proximal phalanx
-innervated by medial plantar nerve
-help to create medial longitudinal arch of the foot
Adductor hallucis (layer 3)
-oblique origin: base of metatarsals 2, 3, 4
-transverse origin: metatarsal-phalangeal joint
-insertion: lateral sesamoid bone
-innervated by lateral plantar nerve
Flexor digiti minimi brevis (layer 3)
-origin: base of fifth metatarsal
-insertion: base of proximal phalanx
-innervated by lateral plantar nerve
Layer 4: The interossei and the peroneus longus tendon
-plantar interossei
-dorsal interossei
-peroneus longus tendon
Plantar interossei (layer 4)
-origin: medial sides of metatarsal 3, 4, 5
-insertion: medial side of own extensor expansions
-innervated by lateral plantar nerve
-adduct
Dorsal interossei (layer 4)
-origin: between the metatarsals
-insertion: medial side of 2nd toe, and lateral sides of toes 2, 3, 4 into extensor expansions
-innervated by lateral plantar nerve
-abduct
Peroneus longus tendon (layer 4)
-origin: lateral side of the foot
-insertion: base of first metatarsal and cuneiform
Joints of the foot
-subtalar
-talocalcaneo navicular (TCN)
calcaneocuboid
-composite
-tarsal metatarsal
-metatarsal-phalangeal and interphalangeal
Subtalar joint
-talus rests on center of calcaneus
-secured by talocalcaneal ligament
Talocalcaneo navicular joint
-head and neck of talus rest on the sustenaculum tali and articulate with the calcaneus and navicular
-spring ligament
Calcaneocuboid (CC) joint
-lower than TCN joint
-articulation of the calcaneus and cuboid bone
-short plantar ligament
support medial and lateral arches
Composite joint
-continous joint space that unites the rest of the tarsals and the second and third metatarsals
Tarsal metatarsal joints
-cuniforms articulate with metatarsals one, two and three (some are part of composite joint)
Metatarsophalangeal and interphalangeal joints
-like hand but the MP joints can be hyperextended when toes push off while walking
Arches of the foot
-medial longitudinal arch
-lateral longitudinal arch
Medial longitudinal arch
-heel (calcaneus) to the 2 sesamoid bones under metatarsal 1
-formed by calcaneus, talus, navicular, metatarsals 1, 2, 3, and sesamoid bones on metatarsals
-supported by short plantar ligament, long plantar ligament, and spring ligament
Lateral longitudinal arch
-much lower than medial one
-runs from calcaneus to the cuboid to metatarsals 4&5
Ligaments of the foot/arches
-short plantar ligament
-long plantar ligament
-calcaneonavicular (spring) ligament
Superficial veins of the lower limb
-starts at dorsal venous arch from toes
-laterally the small saphenous vein passes behind lateral malleolus and joins popliteal vein
-medially the great saphenous vein goes over the medial malleolus and enters the femoral vein
Which vein passes behind the lateral malleolus
-small saphenous vein
Which vein passes over medial malleolus
-great saphenous vein
Plantar flexion
-point toes
-extension
Dorsal flexion
-toward body
-flexion
Blood supply of gluteal region
-superior gluteal nerve and artery enter though obturator foramen and go above piriformis
-inferior gluteal nerve and artery go under piriformis
Blood branches that arise in the femoral triangle
-femoral artery turns into medial and lateral femoral circumflex arteries and profunda femoris
-then enters the adductor hiatus and turns into politeal artery
Medial circumflex artery
-upper back of thigh and hip joint
Lateral circumflex artery
-quads and hip joint
Profunda femoris artery
-sends branches to posterior compartment
Blood supply after popliteal fossa
-politeal artery enters and turns into the superior, middle and inferior geniculate arteries
-at bottom of politeal fossa turns into anterior and posterior tibial arteries
Blood supply to plantar foot
-posterior tibial artery splits into medial and lateral plantar arteries
-which then split into plantar digital arteries (each side of toe)
Blood supply to dorsal foot
-anterior tibial artery splits into lateral tarsal and dorsalis pedis artery
-which then splits into dorsal digital arteries (each side of toe)
Nerve supply (sciatic)
-sciatic enters under piriformis and enters popliteal fossa to split into common peroneal and tibial
-common peroneal turns into superficial and deep peroneal branches
-tibial nerve tuns into lateral and plantar nerves
Nerve supply (femoral)
-goes through femoral triangle and then splits into many branches (like a cheese string)
