Clinical Anatomy of the Lower Limb Flashcards
what are the bony components of the lower limb?
pelvis hip joint (ball and socket) femur knee joint tibia/fibula ankle joint foot - hindfoot - midfoot - forefoot
why are there bumps on bones?
for muscle attachment
what stabilised the hip joint?
large surface between femoral head and acetabulum
what are the compartments of the knee?
medial
lateral
patellofemoral
what is the ankle mortus?
contains the talus
composed of the lateral malleolus (fibular head), distal end of tibia and medial malleolus (tibial head)
what makes up the hindfoot?
calcaenous
talus
what makes up the midfoot?
navicular
cuneiforms
cuboid
what are the bones of the forefoot?
metatarsals
phalanges
acetabulum pedis?
spring ligament
sacral foramen?
holes in fused sacrum that allow exit of sacral nerves
what is the labrum?
rim of fibrocartilage surrounding the acetabulum which stabilises the hip joint by deepening the acetabulum and encapsulating the femoral head
what is the blood supply to the femoral head?
medial femoral circumflex artery
small amount from obturator artery
small amount from lateral femoral circumflex artery
medial and lateral come back around head
what is the upper femoral epiphysis and what happens there?
upper femoral epiphysis = small area of bone in the femoral head surrounded by cartilage and separate from the femoral neck bone
spreads out via ossification of the surrounding cartilage until it meets the femoral neck bone at around 6-9 years
where does the iliacus originate and insert?
origin = iliac crest/inner aspect of ilium insertion = lesser trochanter of femur
where does the psoas major originate and insert?
origin = transverse processes of L1-L5 insertion = lesser trochanter
give a possible problem with psoas major?
psoas abscess
common in IV drug users
what are the secondary hip flexors?
rectus femoris
sartorius
where does the rectus femoris originate and insert?
origin = AIIS insertion = tibia via patella tendon
where does the sartorius originate and insert?
origin = ASIS insertion = tibia
what else does the sartorius do?
externally rotates the hip
what is a common problem in secondary hip flexors?
avulsion fractures in children after kicking a football
what are the 5 hip adductors?
adductor brevis adductor longus adductor magnus pectineus gracilis
what is the common origin and insertion of the hip adductors?
inferior pubic rami
insertion = linea aspera, pectineal line, tibia
name 3 clinical issues with hip adductors?
adductor tendinopathy
osteitis pubis
spasticity in NM conditions
what are the 2 hip abductors?
gluteus minimus/gluteus medius
tensor fascia lata
where does the gluteus minumus/medius originate and insert?
originate = iliac wing insertion = greater trochanter of femur
clinical issue with gluteus maximus/medius?
weakness
- trendelenberg gait
where does the tensor fascia lata originate and insert?
origin = iliac crest insertion = lateral tibia via iliotibial tract
what is the main hip extensor?
gluteus maximus
where does the gluteus maximus originate and insert?
origin = posterior aspect of ilium/sacrum insertion = iliotibial tract
what are the hip extensors/knee flexors?
hamstrings:
biceps femoris
semimembranous
semitendinous
where does the biceps femoris originate and insert?
origin = long head - ischial tuberosity, short head - lineu aspera insertion = fibula head
where does the semimembranous originate and insert?
origin = ischial tuberosity insertion = posterior tibia
where does the semitendinous originate and insert?
origin = ischial tuberosity insertion = medial tibia
give a clinical issue with hamstrings
avulsion
tears
what clinical issue can occur with bursae?
trochanteric bursitis
- causes lateral hip pain
what do the collateral ligaments do?
resist varus/valgus stresses at the knee
clinical issue with collaterals?
tear
what are the cruciate ligaments and what do they do?
ACL - resists anterior movement of tibia
PCL - resists posterior movement of tibia
clinical issue with cruciates?
tears
what are the main functions of the meniscus?
load transfer/shock absorbers
increase conformity of tibia and knuckles of femoral head
stabilised knee during movement
lubricates the knee
direction of the ACL?
direction of hands in pockets
clinical issue with menisci?
tears
2 types of tear in menisci?
bucket handle - parallel along the meniscus
radial - across meniscus
what are the knee extensor muscles?
quadriceps
- rectus femoris
- vastus intermedius
- vastus medialis
- vastus lateralis
where do each of the knee extensors originate?
rectus femoris = AIIS
vastus intermedius = anterolateral proximal femur
vastus medialis = medial edge linea aspera and greater trochanter
vastus lateralis = medial edge linea aspera and lesser trochanter
insert at the patellar tendon
describe the extensor mechanism
quadriceps muscle > quadriceps tendon > patella > patella tendon > tibial tuberosity
what 4 factors may predispose to patellar instability/dysfunction?
genu valgum (Q angle)
femoral head anteversion
weak quadriceps (vastus medialis)
ligamentous laxity
what separates the compartments of the leg?
thick, fascial compartments
all muscles in a compartment have the same nerve supply
what are the anterior muscles of the leg and what nerve supplies them?
tibialis anterior extensor hallicus longus extensor digitorum longus peroneus tertius nerve = deep peroneal nerve
what are the lateral muscles of the leg and what nerve supplies them?
fibularis longus/brevis
nerve = superficial peroneal nerve
what are the deep muscles of the posterior leg?
tibialis posterior flexor hallivus longus flexor digitorum longus popliteus nerve = tibial nerve
what are the superficial posterior leg muscles and what nerve supplies them?
gastrocnemius
soleus
plantaris
nerve = medial sural cutaneous nerve
which nerve is likely to be damaged by a fibula neck fracture?
common peroneal(fibular) nerve
what are the 3 ankle plantar flexor muscles?
gastrocnemius (medial and lateral heads)
soleus
plantaris
where do the ankle plantar flexors originate and insert?
gastroc = femoral condyles
soleus = broad area on posterior tibia/fibula
plantaris = lateral femoral condyle
common insertion = calcaenous via achilles tendon
clinical issue with ankle plantar flexion?
achilles tendinopathy
what muscle dorsiflexes the ankle?
tbialis anterior
where does the tibialis anterior originate and insert?
origin = lateral surface of proximal tibia insertion = medial cuneiform and base of 1st metatarsal
what are the 2 main ankle ligaments?
deltoid ligament (medial) lateral ligement complex (lateral)
how many ligaments are in the the lateral ligament complex?
3
what is the main supporter of the medial arch?
tibialis posterior tendon calcaneonavicular ligament (spring ligament)
where does the tibialis posterior tendon originate and insert?
origin = posterior proximal tibia/fibula insertion = navicular/plantar surface of medial cuneiform
describe a common clinical issue in the medial arch
dysfunction of tibialis dysfunction
common in 6th decade
gives pain on medial aspect and causes flattening of foot
where does the plantar fascia originate and insert?
origin = tuberosity of calcaneus insertion = heads of metatarsals
clinical issue with plantar fascia?
plantar fascitis
