clinical anatomy of the lower limb 1 : Flashcards
1
Q
What type of joint is the hip joint
A
ball and socket
2
Q
what type of joint is the knee joint
A
-hinge joint
-tibia and fibula linked by
interosseous
membrane
3
Q
what type of joint is the ankle joint
A
-hinge joint
• tibia, fibula and tarsal bone
4
Q
Gait cycle
A
heel strike to heel strike
5
Q
Gait cycle - phases
A
-Stance: 60%
• Swing: 40%
6
Q
what covers the head of the femur
A
articular cartilage
7
Q
acetabulum
A
-partially covered with cartilage
– deepened by fibrocartilage
8
Q
what are the 3 main ligaments of the joint capsule :
A
-Ilio -femoral ligament
– pubo-femoral ligament
– ischio-femoral ligament
– ligament of the head of femur
9
Q
what are the lateral rotators of the gluteal region :
A
-piriformis • gemellus superior • obturator internus • gemellus inferior • quadratus femoris
10
Q
what are the extensors of the gluteal region :
A
-gluteus maximus
11
Q
what are the abductors and medial rotators of the gluteal region :
A
-gluteus medius
• gluteus minimus
12
Q
Motor and sensory innervation of the gluteal region :
A
branches of sacral plexus
13
Q
openings of the gluteal region :
A
greater and lesser sciatic foramen
14
Q
Blood supply of the gluteal region :
A
branches of internal iliac
15
Q
Tensor fasciae
lata function ;
A
• abducts thigh/ hip joint • stabilizes the knee in extension
16
Q
Gluteus medius function
A
abducts and medially rotates the thigh/hip joint
17
Q
Gluteus minimus fufnction
A
• abducts and medially rotates the thigh/hip joint
18
Q
Gluteus maximus
A
• extends the flexed thigh/hip joint • lateral stabilizer of the hip and knee • abducts and assists in lateral rotation of thigh/ hip joint
19
Q
gluteal maximus innervaton
A
inferior gluteal nerve
20
Q
tensor fasciae ,gluteus med and min innervation
A
superior gluteal
nerve
21
Q
what happens during the normal gait
A
Contraction of the gluteus medius and minimus on the stance leg this prevents tipping to the unsupported side
22
Q
positive Trendelenburg sign
A
- The superior gluteal nerved is injured
- waddling gait
23
Q
Piriformis
A
nerve to piriformis (S1 & S2) • lateral rotator of the
thigh/hip joint &
abducts flexed
thigh/hip joint
24
Q
Gemellus inferior
A
nerve to quadratus femoris • lateral rotator of the thigh/hip joint & abducts flexed thigh/hip joint
25
Quadratus femoris
nerve to quadratus femoris • lateral rotator of the
| thigh/hip joint
26
Obturator internus
nerve to obturator internus • lateral rotator of the
thigh/hip joint &
abducts flexed
thigh/hip joint
27
Gemellus superior
```
nerve to obturator
internus • lateral rotator
of the
thigh/hip joint
& abducts
flexed
thigh/hip joint
```
28
blood supply to the hip joint, upper
| thigh and gluteal region ?
```
anastomosis of femoral, inferior
gluteal, superior gluteal, and
obturator arteries, together with
branches from the internal pudendal
and femoral arteries
```
29
Trochanteric anastomosis:
```
branches of medial and
lateral circumflex arteries
• inferior gluteal artery
• branch of the superior
gluteal
```
30
Cruciate anastomosis:
```
• branches medial and
lateral circumflex femoral
arteries
• branch of 1st perforating
branch of profunda
femoris artery
• branch of inferior gluteal
artery
```
31
Blood supply to the head of the femur :
-Medial and lateral circumflex
femoral arteries
-Acetabular branch of obturator
artery
32
Intra-capsular – fracture of the femoral
| neck eg subcapital
– damages the retinacular arteries
– compromises blood supply to the
head of femur
– risk of avascular necrosis
33
Extra-capsular – intertrochanteric
| fracture
does not affect blood supply to
| the joint
34
Both intra and extracapsular fractures result
| in .....
external rotation of the leg with some
| shortening.
35
acquired coxa vara
decrease in angle
| between neck and shaft
36
Subcutaneous tissue lies beneath the skin.
| Contains:
* loose connective tissue
* fat
* cutaneous nerves
* superficial veins
* lymphatic vessels and lymph nodes
37
fascia lata
thickened deep fascia in thigh and gluteal
region, attached along a line that defines the upper
margin of the lower limb and is continuous with the
fascia of the leg inferiorly
38
iliotibial tract
-longitudinal band along the lateral
margin of the limb from the anterolateral tubercle of
the iliac crest to the lateral condyle of the tibia
39
fascia cruris
– fascia in the leg
40
Thigh Compartments- Anterior compartment
• Femoral nerve
• Flexors of thigh
• Extensors of the
knee
41
Thigh Compartments-Posterior compartment
Sciatic nerve
• Extend the thigh
• Flex the knee
42
Thigh Compartments-Medial compartment
```
• Obturator nerve
• Adductors of thigh
• Except hamstring part
of adductor magnus
• Part of pectineus
```
43
lower limb -Posterior compartment muscles
semitendinosus
• semimembranosus
• biceps femoris (dual innervation
44
lower limb -Posterior compartment sensory innervation :
posterior femoral cutaneous nerve(S1-S3)
45
lower limb -Posterior compartment openings :
adductor hiatus
46
lower limb -Posterior compartment blood supply :
perforating branches of deep femoral artery
47
semimembranosus
```
origin: ischial tuberosity
• sciatic nerve (tibial part)
• function:
• flexes the leg/knee
joint
• extends the
thigh/hip joint
```
48
biceps femoris
```
origin: long head (LH): ischial
tuberosity
• origin: short head (SH): femur
• sciatic nerve: LH (tibial part),
SH (common fibular part)
• function:
• LH - flexes the leg/knee
joint. extends the thigh/ hip
joint
• SH - flexes the leg/knee
join
```
49
Sciatic nerve
```
• Combination of two nerves
-common fibular
-tibia
-exits the pelvis
below the piriformis
• Separates proximal to the
popliteal fossa
```
50
Anterior compartment-MUSCLES
-iliopsoas
• sartorius
• quadriceps femoris
51
Lower limb-Anterior compartment-OPENINGS(CANAL)
Femoral canal, subsartorial (adductor/Hunter’s) canal
52
Lower limb -Anterior compartment-BLOOD SUPPLY
Femoral artery and its branches
53
rectus
| femoris
```
quadriceps femoris tendon,
patella ligament
• femoral nerve
• flexes the thigh/ hip joint,
extends the leg/knee joint
```
54
vastus intermedius
vastus lateralis
vastus medialis
```
quadriceps femoris
tendon, patella
ligament
• femoral nerve
• extends the leg/knee
joint
```
55
ilio-psoas
anterior rami L1-3/ femoral
nerve
• flexes the thigh/hip joint
56
sartorius
* femoral nerve
* flexes the thigh/hip joint
* flexes the leg/knee joint
57
lower limb-Medial compartment:MUSCLES
* pectineus (dual innervation)
* gracilis
* adductors
* obturator externus
58
lower limb-Medial compartment:MOTOR & SENSORY INNERVATION:
obturator and tibial nerves
59
lower limb-Medial compartment:BLOOD SUPPLY
obturator artery
60
adductor
| longus
obturator nerve
• adducts and medially
rotates the thigh/hip
joint
61
adductor brevis
• obturator nerve
• adducts and medially
/hip join
62
adductor
| magnus
```
• adductor part:
• obturator nerve
• hamstring part:
• sciatic (tibial) nerve
• adducts and medially /hip
joint
```
63
pectineus
• femoral and obturator nerve
• adducts and flexes thigh/hip
joint
g
64
gracilis
• obturator nerve
• adducts thigh and flexes leg/
knee joint
65
obturator
| externus
• obturator nerve
• lateral rotation of
the thigh/hip joint
66
lateral circumflex femoral artery:
passes deep to sartorius and rectus femoris
• ascending branch
• descending branch
• transverse branch
67
• medial circumflex femoral artery
* one branch ascends to the trochanteric fossa
| * one passes laterally to participate in the cruciate anastomosis
68
• perforating arteries
• penetrate adductor magnus and supply posterior compartment
• ascending and descending branches that interconnect forming
a longitudinal channel
69
Femoral Sheath
inferior extension of the
transversalis fascia and the
iliopsoas fascia from the abdomen.
70
femoral canal
contains
| lymph nodes.
71
▪ Femoral ring
```
pening of
this canal superiorly is
potentially a weak point in
the lower abdomen and is
the site for femoral
hernias
```
72
Femoral triangle Borders:
```
• superior: inguinal ligament (forms the
base)
• medial: medial border of the adductor
longus
• lateral: medial border of the sartorius
• roof: fascia lata
• floor: pectineus, iliopsoas and the
adductor longus
```
73
Adductor canal
fascial tunnel in the middle third of
| the thigh
