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LOWER LIMB > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

tibia

A

• Second longest, second strongest (bone of body)
o Slightly longer than fibula
• Males: nearly vertical
• Females: distal end more medial (compared to proximal end)
• Tibial plafond – Inferior surface
• Proximal extremity
o Greatly enlarged
o Superior surface – Tibial plateau
 Oval shaped
 Wider side to side
 medial and lateral condyles – flattened
• Articulates with femoral condyles (central portions)
• Medial and lateral menisci
o Overly peripheral portions

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2
Q

tibia cont

A

• Medial condyle
o Condyle larger
o Articular surface larger
o Medial surface – roughened
 Attachment: tibial (medial) collateral ligament of knee joint
 Non-articular intercondylar ridge (between condyles) – 3 structures:
• 1) Anterior intercondylar fossa
o 3 attachments (from anterior to posterior):
 A) anterior horn of medial meniscus
 B) anterior cruciate ligament
 C) anterior horn of lateral meniscus
• 2) Intercondylar eminence (intermediate position)
o Ridge/spine located between two intercondylar fossae
o Contains (2) tubercles: medial & lateral intercondylar tubercles
 Covered by articular cartilage
• Continuous with tibial condyles
• 3) Posterior intercondylar fossa
o 3 attachments (from anterior to posterior):
 A) posterior horn of lateral meniscus
 B) posterior horn of medial meniscus
 C) posterior cruciate ligament

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3
Q

tibial tuberosity and fibular facet

A

o Tibial tuberosity
 Triangular prominence of bone
• Apex: directed inferior
o Attachment: patellar ligament (continuation of quadratus femoris tendon)
o Palpable
o Fibular facet (**FACET closest to the face)
 Oval shaped
 Posterolateral depression on lateral tibial condyle
 Fibula and tibia articulation (proximal tibiofibular joint)

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4
Q

tibia shaft

A

• Shaft
o 3 borders: anterior, medial, and lateral
 Anterior
• Aka shin
• Subcutaneous and palpable (throughout its course)
• Extends: tibial tuberosity to medial malleolus (anterior border)
• Attachments:
o Crural fascia (deep fascia of the leg)
 Medial
• Extends: medial condyle (below) to medial malleoulus (posterior border)
• 4 attachments:
o 1) Medial collateral ligament
o 2) popliteus
o 3) soleus
o 4) flexor digitorum longus

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5
Q

tibia shaft cont

A

 Lateral
• Aka interosseous crest
• Extends: articular facet from fibula (superiorly) to divides – forms two ridges (inferiorly)
o Ridges form anterior & posterior borders of fibular notch
 Attachment: posterior (inferior) tibiofibular ligament

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6
Q

medial tibia

A

 Medial
• Smooth, convex
• Bounded by anterior & medial borders
• Superiorly – attachment of 3 muscles & common aponeurosis (superior to inferior) known as Pes anserinus (“goose’s foot”) – union of tendons
o 1) Sartorius
o 2) gracilis
o 3) Semitendinosus
Hint: these three Muscles can be remembered with the acronym “SGT” (T for semiTendinosus)
• Tibial collateral ligament
o Attachment at roughened area – superior portion, medial surface
• Inferiorly
o Medial surface is subcutaneous
o Crural fascia (deep fascia of the leg) attaches along medial surface of tibial shaft

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7
Q

lateral tibia

A 
	Lateral
•	Narrow
•	One muscle attachment:
o	Tibialis anterior
	Upper ½ to 2/3, grooved by muscle origin
•	4 tendons cover distal portion (from medial to lateral):
1) tibialis anterior 
2) extensor hallucis longus
3) extensor digitorum longus
4) peroneus tertius (not depicted)
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8
Q

posterior tibia

A

• Soleal line
o Oblique ridge extending superolateral to inferomedial
 Superior portion, posterior surface, tibial shaft
o Partial origin of soleus muscle
• Vertical line
o Extends: inferior from soleal line
o Structures Lateral to vertical line
 Tibialis posterior (partial origin)
 Nutrient foramen
• From a branch of posterior tibial artery
• Just distal to soleal line
• Points distally – away from growing end of tibia (proximal end)
• Largest of nutrient foramen
o Medial to vertical line – attachment:
 Flexor digitorum longus
Memory Hint: recall that the tibial proximal surface extends slightly medial on females, now picture the soleal line following that same course with the vertical line representing the fibula.
• Distal portion
o Smooth
o Covered by tendons:
 Flexor digitorum longus
 Tibialis posterior (deep)
 Flexor hallucis longus
Hint: Distal Tibial Hallmarks – just remember that the tibialis posterior lies deep, and the other two are opposite of what you woud think – hallucis lying laterally, digitorum more medially in attachments.

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9
Q

distal tibia

A

• Distal Extremity
o Larger than shaft, smaller than proximal extremity
o Five surfaces: anterior, posterior, lateral, medial, and inferior
 Anterior surface
• Continuous with lateral surface – tibial shaft
• Distal portion:
o Transverse groove – attachment of capsule (ankle joint)
• Smooth surface (with above exception)
 Posterior surface
• Continuous with posterior surface – tibial shaft (superiorly)
• Continuous with posterior aspect, medial malleolus (inferiorly)
• Grooves for tendons:
o Tibialis posterior (deep to FDL)
o Flexor hallucis longus

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10
Q

distal tibia cont

A 
	Lateral surface
•	Fibular notch – articular location with fibula
o	Attachment (along margins):
	Anterior tibiofibular ligament
	Posterior tibiofibular ligament
	Medial surface
•	Continuous with medial malleolus (medial surface)
	Inferior surface
•	Aka tibial plafond 
•	Quadrilateral shape
o	Wider anteriorly – than posteriorly 
o	Concave anteroposteriorly 
o	Convex side-to-side
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11
Q

medial malleolus

A 
	Pyramidal shaped
	Extends inferiorly – beyond rest of tibia
	Lateral surface (articulates w/talus)
•	Comma shaped facet
•	Superiorly 
o	Continuous with tibial plafond
	Medial surface
•	Subcutaneous (easily palpated) 
	Inferiorly surface
•	Two slight elevations: anterior and posterior colliculi (“hills”)
o	Attachments:
	Deltoid ligament (portions – also attaches interfollicular sulcus)
Note: Deltoid ligament attaches to intercollicular sulcus, anterior and posterior borders of medial malleolus.
	Posterior border
•	More pronounced than anterior border
•	Malleolar sulcus
o	Groove along posterior border
o	Location of 2 tendons:
	Tibialis posterior
	Flexor digitorum longus
o	Flexor retinaculum (attaches near malleolar sulcus)
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12
Q

tibial arterial supply

A 
o	Genicular anastomosis
	Supply proximal end
o	Malleolar anastomosis
	Supply distal end
o	Anterior Tibial artery 
	Supply periosteum (shaft)
o	Nutrient Artery
	Branch of posterior tibial artery
	Foramen of nutrient artery – largest of all long bones
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13
Q

fibula

A
  • Articulates with: tibia & talus (NOT femur)
  • Non-weight bearing bone (anatomically)
  • Function – muscle attachment
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14
Q

fibular head

A 
•	Head
o	Irregular
o	Quadrate shape (somewhat)
o	Apex (styloid process) 
	Superior projection – from posterolateral portion of head
	Two attachments: 
•	Biceps femoris tendon (insertion)
•	Lateral collateral ligament of knee joint
o	Anterior aspect Attachments:
	1) peroneus longus
	2) extensor digitorum longus
	3) anterior ligament of head of fibula
o	Posterior aspect Attachments:
	1) soleus muscle
	2) posterior ligament of head of fibula
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15
Q

fibular neck and shaft

A 
•	Neck
o	Constricted region
o	Just distal (inferior) fibular head
o	Common peroneal nerve courses around the neck
	Often site of injury
•	Shaft
o	Four surfaces: anterior, medial, posterior, and lateral
	Anterior – flat, narrow
•	Origin of 3 muscles
o	1) extensor hallucis longus
o	2) extensor digitorum longus
o	3) peroneus tertius
Note:  All but one of the anterior compartment muscles.  Recall tibialis anterior attaches superiolaterally on the tibia and interosseous membrane.  
	Medial
•	Origin (partial): tibialis posterior
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16
Q

fibular shaft cont

A

 Lateral
• Origin of 2 muscles
o 1) peroneus brevis
o 2) peroneus longus
Note: Both of the lateral compartment muscles.
 Posterior
• Superiorly
o Origin (partial): Soleus muscle
• Nutrient foramen – branch of peroneal artery
• Midway
o Origin: Flexor hallucis longus
• Inferiorly
o Interosseous ligament attachment (unites tibia to fibula)
Hint: the posteromedial border is also known as the oblique border because distally it runs obliquely to join the anteromedial border, hense the posterior surface attachment of this ligament.

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17
Q

fibula

A 
o	Four borders: anterolateral, anteromedial, posterolateral, and posteromedial
	Crural fascia (deep fascia of leg) 
•	Forms TWO intermuscular septa
o	Attachments: 
	Anterlolateral border
•	Seperates extensor muscles from lateral ones
	Posterolateral border
•	Seperates lateral muscles from flexors
	Anteromedial border 
•	Aka interosseous crest 
o	interosseous membrane attaches here
	Posteromedial border
•	Aka oblique ridge
o	Courses obliquely
o	Inferiorly blends with interosseous crest
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18
Q

lateral malleolus

A

• Lateral malleolus
o Major feature of distal fibula
o Base: Continuous with shaft
o Apex: pointed distally
o Two surfaces: medial & lateral
 Lateral
• Subcutaneous (easily palapable)
 Medial
• Triangular shaped facet (articulates with talus)
o Lateral malleolar fossa located posterior to facet
 Attachments:
• posterior tibiofibular ligament (superiorly)
• posterior talofibular ligament (inferiorly)

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19
Q

lateral malleolus cont

A 
o	Two borders: anterior & posterior
	Anterior
•	Attachments: 
o	anterior tibiofibular ligament
o	anterior talofibular ligament  (roughened area)
o	calcaneofibular ligament (small inferior tubercle)
	also attaches apex of lateral malleolus
	Posterior
•	Shallow sulcus (groove)
o	Two tendons pass through 
	1) peroneus longus
	2) peroneus brevis
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20
Q

fascia of the leg

A 
•	Deep “crural”  fascia – continuous with fascia lata (of thigh) proximally
•	Attachments:
o	Patella
o	patellar ligament
o	tibial tuberosity
o	condyles of tibia
o	head of fibula
•	forms popliteal fascia posteriorly 
•	receives fibers from tendons of:
o	biceps femoris
o	sartious (“SGT”)
o	gracilis (“SGT”)
o	semitendinosus (“SGT”)
o	semimembranosus
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21
Q

fascia of leg cont

A

• Subcutaneous periosteum of tibia – continuous with deep fascia anteriorly
o Thicker proximally (thins out as progresses distally)
o Distally – forms retinacula of the ankle
o Forms part of origins for:
 tibialis anterior
 extensor digitorum longus
o deep surface gives rise:
 anterior intermuscular septa
 posterior intermuscular septa
 deep transverse fascia
Note: anterior and posterior intermuscular septa seperate peroneus longus and brevis from each other and from muscles of anterior and posterior crural compartments.

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22
Q

tibialis anterior m

A 
•	Lateral to tibia
•	Thick muscle
•	Covers anterior tibial vessels & deep peroneal nerve (as courses distally in leg) 
•	Origin:
o	Lateral condyle (tibia)
o	Upper 2/3, lateral surface (tibia)
o	Interosseous membrane
o	Deep crural fascia

• Insertion:
o Medial cuneiform (medial plantar surface)
o Base of 1st metatarsal (medial plantar surface)
• Innervation:
o Deep peroneal nerve
• Functions:
o Inversion (ankle)
o Dorsiflexion (ankle)
o Supination [adduction, inversion, plantarflexion] (intertarsal joints)

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23
Q

extensor hallucis longus m

A

• Lateral to tibialis anterior
• DISTALLY: Anterior tibial vessels and deep fibular nerve – lie between EHL and tibialis anterior
• Passes lateral to medial
o inferior to extensor retinaculum
o Superficial to neurovascular structures
• Origin:
o Middle 2/3, anterior surface (fibula)
 Medial to extensor digitorum longus origin
o Interosseous membrane (accessory origin)
• Insertion:
o Base of distal phalanx, 1st digit (crest)
o Base of 1st metatarsal (additional slip)
• Innervation:
o Deep peroneal nerve
• Functions:
o Extension (1st MTPJ)
o Dorsiflexion (ankle)
o Supination (intertarsal joint)

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24
Q

extensor hallucis capularis

A 
•	Accessory Muscle – an extension of extensor hallucis longus
•	Origin:
o	Extensor hallucis longus tendon
•	Insertion: 
o	Medial surface of capsule of 1st MPJ
•	Function:
o	Lifts capsule out of joint
	Prevents entrapment of the capsule in joint on extension
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25
Q

extensor digitorum longus m

A 
•	Lateral to extensor hallucis longus
•	Lateral extreme of   anterior crural compartment
•	Origin: 
o	Lateral condyle (tibia)
o	Head (fibula)
o	Upper 3/4, anterior surface (fibula) 
o	Interosseous membrane
o	Deep fascia
o	Anterior intermuscular septum 
	(separating muscle from peroneus longus)
•	Insertion:
o	Extensor expansions (2-5 digits)
•	Innervation:
o	Deep peroneal nerve
•	Functions:
o	Extend MTPJ (4 lateral digits)
o	Dorsiflexion (ankle)
o	Eversion (ankle)
o	Pronation [abduction & eversion] (intertarsal joints)
Hint: This muscle has more of a lateral distribution, not attaching to the hallux.  Hense the functions.
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26
Q

fibularis peroneus tertius m

A 
•	Inconstant muscle
•	Considered part of extensor digitorum longus
•	Origin:
o	Lower 1/3, anterior surface (fibula)
•	Insertion:
o	Base of 5th metatarsal
	Passes with extensor digitorum longus tendon
•	Innervation:
o	Deep peroneal nerve 
•	Function: 
o	Dorsiflexion (ankle)
o	Eversion (ankle)
o	Pronation (intertarsal joints)
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27
Q

fibularis peroneus longus

A

• Most superficial in lateral compartment
• Creates opening between attachments – fibular head & body
o Location of common peroneal nerve passing into anterior compartment
• Origin:
o Lateral condyle (tibia)
o Head (fibula)
o Upper 2/3, lateral surface (fibula)
o Crural fascia
o Both intermuscular septa
• Insertion:
o Base of 1st metatarsal (lateral, plantar side)
o Medial cuneiform (lateral, plantar side)
o Base of 2nd metatarsal (occasional accessory insertion)
• Innervation:
o Superficial peroneal nerve
• Function:
o Plantar flexion (ankle)
o Eversion (ankle), pronation

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28
Q

peroneus longus course

A

Muscle ends in a long tendon ->
passes posterior to lateral malleolus (w/tendon of peroneus brevis) ->
deep to superior peroneal retinaculum ->
across calcaneus (distal to peroneal trochlea) ->
under the infereior peroneal retinaculum ->
lateral then plantar medial side of cuboid (sesamoid bone location: os peroneum) ->
under long plantar ligament -> inserions.

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29
Q

fibularis peroneus brevis

A 
•	Found deep to peroneus longus 
•	Origin:
o	Lower 2/3, lateral surface (fibula)
o	Crural fascia 
o	Both intermuscular fascia
•	Insertion: 
o	Tuberosity of 5th metatarsal
•	Innervation:
o	Superficial peroneal nerve
•	Function: 
o	Plantar flexion (ankle)
o	Eversion (ankle)
o	Pronation (intertarsal joint)
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30
Q

fibularis peroneus brevis course

A

Tendon passes posterior to lateral malleolus ->

Anterior to tendon of peroneus longus -> Inserts.

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31
Q

gastrocnemius

A

• Most superficial muscle of the superficial group
• 2 heads
• Origin:
o Medial head
 Medial condyle (femur) – proximal & posterior part
 (posterior to adductor tubercle)
o Lateral head
 Lateral condye (femur) – depression on lateral side
Note: both origins extend to adjacent areas on the femur and
knee joint capsule.
• Insertion:
o Two heads approach midline > tendinous raphe > aponeurosis of m
o Aponeurosis tapers distally > joins soleus m> tendocalcaneus
o Tendo calcaneus inserts central part, posterior surface, calcaneus
• Innervation:
o Tibial nerve
• Functions:
o Plantar Flexion (ankle)
o Supination [adduction & inversion] (intertarsal joints)
o Flexion (knee)

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32
Q

soleus m

A

• Deep to gastrocnemius
• Common insertion & actions of gastrocnemius – together called triceps surae
• Origin:
o Head & body, posterior surface (fibula)
o Soleal line, middle 1/3 (tibia)
o Tendinous arch (between tibia & fibula)
 Popliteal vessels and tibial nerve pass through underneath
• Insertion:
o Tendo calcaneus, into calcaneus
• Innervation:
o Tibial nerve
• Functions:
o Plantar flexion (ankle)

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33
Q

plantaris m

A 
•	Tendon found between gastrocnemius & soleus
o	Runs along medial border of tendo calcaneus
•	Absent about 10% of cases
•	Origin: 
o	Lateral supracondylar line (femur)
o	Oblique popliteal ligament
•	Insertion: 
o	Medial side, posterior surface (calcaneus)
o	Tendo calcaneus (joins occasionally)
•	Innervation:
o	Tibial nerve
•	Functions: 
o	Plantar flexion (ankle)
o	Flexion (knee)
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34
Q

popliteus m

A

• Origin:
o Groove on lateral condyle (femur)
o Arcuate popliteal ligament
o Lateral meniscus
• Insertion:
o Body of tibia, proximal to soleal line (tibia)
• Innervation:
o Tibial nerve
• Functions:
o Flexion (knee)
o Rotation (knee)
 Weight bearing – rotates the thigh laterally
 Non-weight bearing – rotates the leg medially
Hint: “Popin Leg-in” (leg always ends up in/medial to thigh) and
“Un-Pops” the knee out of locked position (unlocks the knee joint)
Recall: The muscle courses with the soleal line so must pass from lateral to medial.

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35
Q

flexor hallucis longus m

A 
•	Bipennate muscle
•	Origin:
o	Distal 2/3, posterior surface (fibula)
o	Interosseous membrane
o	Posterior intermuscular septum
•	Insertion: 
o	Base of distal phalanx, 1st digit
•	Innervation:
o	Tibial nerve
•	Functions:
o	Flexion (interphalangeal joints, 1st digit) 
o	Plantarflexion (ankle)
o	Supination (intertarsal joints)
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36
Q

flexor hallucis longus course

A

Tendon passes in groove, posterior surface, distal tibia ->
Over posterior surface (talus) ->
Inferior surface (sustentaculum tali) ->
Sole of the foot, between two heads of flexor hallucis brevis ->Insertion.

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37
Q

flexor digitorum longus m

A 
•	Origin:
o	Proximal 2/3 of body – posterior surface, medial to vertical line, below soleal line (tibia)
•	Insertion:
o	Bases, distal phalanges, digits 2-5
•	Innervation:
o	Tibial nerve
•	Functions: 
o	Flexion (distal interphalangeal joints)
o	Plantar flexion (ankle)
o	Supination (intertarsal joints)
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38
Q

flexor digitorum longus course

A 
Tendon passes posterior to medial malleolus (with tendon of tibialis posterior) ->
Passes superficially to deltoid lig. ->
Superifical to flexor hallucis longus ->
Joined by quadratus plantae ->
Divides into 4 tendons ->
Insertion.
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39
Q

tibialis posterior m

A

• Lies between flexor hallucis longus & flexor digitorum longus
• Origin:
o Posterior surface interosseous membrane
o posterior surface, lateral to vertical line, below soleal line (tibia)
o Proximal 2/3 Medail surface fibula
• Insertion:
o Tuberosity of navicular (major insertion)
o Sustantaculum tali (medial, intermediate, lateral)
o Three cuneiforms
o Cuboid
o Bases, 2-4 metatarsals
• Innervation:
o Tibial nerve
• Function:
o Supination (intertarsal joints)
o Plantar flexion (ankle)

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40
Q

tibialis posterior course

A

Tendon in groove FDL > posterior to medial malleolus>
Deep flexor retinaculum > superficial deltoid ligament >
Deep plantar calcaneonavicualr ligament (Os Tibialis sesmoid if present)>
Insertiosn

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41
Q

saphenous n

A

• Longest branch of femoral nerve
• Course:
o Enters adductor canal (with femoral artery)
o Crosses over the artery (lateral to medial)
Hint: original location NAV (lateral to medial)
o Leaves canal at adductor hiatus – passes to surface on medial side of knee
Note: Nerve does not pass through adductor hiatus***
o Becomes superficial – passes between tendons:
 Sartorius
 Gracilis
o Runs with great saphenous vein (along medial side of leg)
o Proximal 1/3 of leg, divides into 2 branches:
 1) contribution to subsartorial nerve plexus
 2) infrapatellar branch
• Provides cutaneous innervation to skin over the patella

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42
Q

tibial n

A 
•	Larger component of sciatic nerve 
•	Anterior divisions of L4-S3
•	Course:
o	Proximal thigh, lies lateral to popliteal artery & vein (“NAVL”)
o	Popliteal fossa:
	 superficial to vessels
	Crosses popliteus muscle
	Leaves popliteal fossa medial to vessels
o	Disappears between heads of gastrocnemius  
	Gives off muscular branches to:
•	Gastrocnemius 
•	Plantaris
•	Soleus
•	popliteus 
o	Continues deep to soleus muscle 
	Gives off distal muscular branches to:
•	Soleus
•	Tibialis posterior
•	Flexor digitorum longus
•	Flexor hallucis longus (branch accompanies peroneal artery)
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43
Q

tibial n cont

A

o Proximal leg, lies medial to posterior tibial artery (recall it crossed medially when entering popliteal fossa)
o Inferior border popliteus > Courses lateral side of popliteal artery
 Just distal, inferior border of popliteus
o Eventually travels medial to tendocalcaneus
o Gives off last branch:
 Medial calcaneal nerves
• Innervate the skin of heel & medial sole
o Divides at flexor retinaculum into terminal branches:
 Medial plantar nerve
 Lateral plantar nerve
Note: Discussed in the foot section.
• Three articular branches to the knee joint
o 1st – corresponds with Superior genicular arteries
o 2nd – corresponds with Middle genicular arteries
o 3rd – corresponds with Inferior medial genicular arteries
• One articular branch
o Ankle joint

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44
Q

medial sural cutaneous n

A

• Branch off of tibial nerve
• Lies superficially in groove between heads of gastrocnemius
o Accompanied by small saphenous vein
• Course:
o Pierces fascia at mid leg
o Merges with communicating ramus of lateral sural cutaneous branch of common peroneal nerve
 Together form sural nerve

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45
Q

sural n

A

• Continues distally
• Supplies cutaneous branches to the skin of posterior surface of leg
• Communicates with posterior femoral cutaneous nerve
• Passes inferior to lateral malleolus
o Continues as lateral dorsal cutaneous nerve

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46
Q

common peroneal n

A

• Smaller component of sciatic nerve
• Posterior divisions of L4-S2
• Course:
o Seperates from tibial nerve
o Gives rise to lateral sural cutaneous branch
 Distribution to posterior & lateral surface of knee
 Gives off Communicating ramus
• Joins medial sural cutaneous nerve
o Forms sural nerve
o Passes diagonally across lateral portion of popliteal fossa
 Parallel to medial border of long head, biceps femoris
o As approaches head of fibula, passes between 2 muscles:
 Long head of biceps femoris
 Lateral head of gastrocnemius

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47
Q

common peroneal n cont

A

o Circles around the neck of the fibula
o Passes deep to fibularis (peroneus) longus
o Gives off three articular branches to the knee
 1st – accompanies superior lateral genicular artery
 2nd – accompanies inferior lateral genicular artery
 3rd – accompanies anterior tibial recurrent artery
• Through tibialis anterior muscle to knee joint
o Divides into two terminal branches:
 Superficial fibular (branch) nerve

• Course:
o Arises deep to peroneus longus
o Passes inferiorly between peroneus longus & extensor digitorum longus
o Two Muscular branches:
 Peroneus longus
 Peroneus brevis
o Gives rise to two dorsal cutaneous branches supplying the foot
 Intermediate dorsal cutaneous nerve
 medial dorsal cutaneous nerve
o Distal 1/3 of leg, divides into terminal branches:
 1) Intermediate Dorsal Cutaneous Nerve
• Anterior & medial side of leg
• distally at end of ankle
 2) Medial Dorsal Cutaneous Nerve
• Branch to medial side of foot as far as the ball of the foot

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48
Q

deep peroneal n

A 
fibular (branch) nerve
•	Course:
o	Originates deep to peroneus longus
o	Passes to anterior surface of interosseous membrane
o	Provides muscular branches to anterior compartment muscles:
	Tibialis anterior
	Extensor digitorum longus
	Peroneus tertius
	Extensor hallucis longus
o	Accompanies anterior tibial artery
	From proximal 1/3 of leg
	Passes together deep to extensor retinaculum
	Provides branch to the ankle joint
o	Immediately distal to extensor retinaculum – divides into:
	Medial terminal branch
	Lateral terminal branch
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49
Q

posterior tibial v

A

o veins of posterior compartment of leg
o accompany posterior tibial artery as venae comitantes
o location: between superficial & deep muscles of posterior compartment
 drain blood from posterior muscles
o Also receive blood from superficial veins
o More consistent tributaries:
 Fibular (peroneal) venae comitantes
• Accompany the fibular artery
• Drain blood primarily from lateral leg (posterior & lateral compartments)

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50
Q

anterior tibial vein

A

• Superior continuation of venae comitantes
• Accompany dorsalis pedis artery
• Course:
o Between tibialis anterior & extensor hallucis longus muscles (w/anterior tibial artery)
o Proximal end of leg, inferior to popliteal fossa, pass through interosseous membrane
 Join posterior tibial veins
• Junction forms popliteal vein

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51
Q

femoral vein

A

• Superior continuation of popliteal vein at adductor hiatus

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52
Q

popliteal vein

A

• Tributaries correspond to branches of popliteal artery
• Also receives the small saphenous vein
• Formed by joining of anterior and posterior tibial veins
o Distal border, popliteus muscle
• Ascends into popliteal fossa
o Accompanies the artery
• Inferior end of fossa – lies medial to artery
• Upper end of fossa – lies superficial to artery
• Exits popliteal fossa through adductor hiatus

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53
Q

small lesser saphenous vein

A

• Continuation of lateral marginal vein
• Course:
o Begins along lateral aspect of foot
o Passes into leg from behind lateral malleolus
o Ascends along lateral border of tendocalcaneus
o Reaches middle, posterior leg
 Communicates with great saphenous & posterior tibial veins
o Proceeds superiorly, middle, posterior leg – enters popliteal fossa
o Empties into popliteal vein
 Between two heads of gastrocnemius
Note: may terminate in accessory saphenous or deep veins of posterior compartment of leg.
• Possesses about 7-13 valves, one of which is near its termination, accompanied by sural nerve.

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54
Q

great saphenous vein

A
  • Continuation of medial marginal vein
  • Begins at medial aspect of foot, accompanies saphenous nerve ascending up medial side of leg
  • Joins femoral vein to become external iliac vein
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55
Q

popliteal artery

A

• Femoral artery -> exits adductor hiatus into popliteal fossa -> becomes popliteal artery
• Course:
o Inferior through floor of popliteal fossa
o Crosses knee joint (in intercondylar fossa)
 Lies deep to the vein
• Both enclosed in dense connective tissue sheath (artery lies deep throughout)
o Anteirorly, artery lies against capsule of joint
o Posteirorly, artery deep to:
 Semimembranosus
 Popliteal vein
 Tibial nerve
 Gastrocnemius muscle

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56
Q

popliteal a cont

A 
o	Terminates at inferior border, popliteus muscle
	Divides into 2 terminal branches:
•	1) anterior tibial artery
•	2) posterior tibial artery
•	Branches:
o	1) Cutaneus
o	2) Muscular
o	3) Medial superior genicular
o	4) Lateral superior genicular
o	5) Medial inferior genicular
o	6) Lateral inferior genicular
o	7) Middle genicular
o	8) Posterior tibial
o	9) Anterior tibial
o	10) Sural 
•	Cutaneous Branches
o	Directly or indirectly supply superficial structures – posterior leg
	Can be located between heads of gastrocnemius muscle
	Some branches follow small saphenous vein
•	Muscular Branches
o	2 or 3 branches
	From proximal end of artery
	Supplies 2 muscles:
•	Adductor magnus
•	Hamstring muscles
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57
Q

popliteal genicular a branches

A

o Supply knee joint
o 5 genicular arteries given off (by popliteal artery)
 2 superior (medial superior genicular, lateral superior genicular)
• Arise from medial and lateral sides
• Wind around superior aspect, femoral condyles
• Reach anterior side of knee – help form collateral circulation of the knee
• Both (medial & lateral) give off:
o Superficial branch – supplies muscle
o Deep branch – supplies knee joint
 1 Middle genicular
• Small vessel
• Originates from poplieteal a. opposite knee joint
• Enters knee joint to supply:
o anterior cruciate ligament
o posterior cruciate ligaments
o Synovial membrane (interior of joint)
 2 Inferior (medial inferior genicular, lateral inferior genicular)
• Originate distal to knee joint
• Medial inferior
o Larger (than lateral)
o Passes below medial collateral ligament
o Supplies: tibia & knee joint
• Lateral inferior
o Travels laterally, superior to head of fibula
o Deep to lateral collateral ligament & tendon of biceps femoris
o Branches contribute – genicular anastomosis (anterior knee)

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58
Q

sural arteries

A 
o	At knee joint - originates from popliteal artery
o	Supply:
	Gastrocnemius
	Soleus
	Plantaris muscles
Note: superficial compartment muscles
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59
Q

knee/genicular anastamosis

A

o Knee, largest joint in the body – needs anastomosis for blood supply
o Around anterior side of joint (around patella)
o Involved vessels include:
 1) Descending genicular
•
 2) Medial & Lateral superior genicular
•
 3) Medial & Lateral inferior genicular
•
 4) descending branch of lateral femoral circumflex
•
 5) circumflex fibular
•
 6) Anterior & Posterior tibial recurrent
•
Hint: Remember 3 genicular arteries, 1 femoral, 1 fibular, 2 tibial.
o Superificial branches of network supply – soft tissues around joint
o Deep branches of network supply – knee joint
o Sudden Popliteal Occlusion:
 Anastomosing branches – often not sufficient
o Gradual Popliteal Occlusion:
 Anastomosing branches increase in size – sufficient supply to knee

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60
Q

anterior tibial a

A

o Artery of anterior crural compartment
o Smaller of two terminal branches of popliteal artery
o Origin: inferior border of popliteus muscle
o Ends: anke joint, midway between medial and lateral malleoli
 becomes dorsalis pedis artery
o Course:
 Anteriorly – between 2 heads of tibialis posterior muscle
• Through interosseous membrane -> to anterior leg
 Descends – anterior surface, interosseous membrane (inferomedial direction)
 Accompanied by venae comitantes (either side of artery)

61
Q

anterior tibial a cont

A 
o	Branches:
	1) Posterior tibial recurrent
•	1st branch (usually) of Anterior tibial a.
•	Small, inconstant branch
•	Origin: before – anterior tibial enters anterior crural compartment
•	Joins genicular anastomosis
	2) Anterior tibial recurrent
•	Origin: close to entrance into anterior crural compartment 
•	Supplies anterior knee
•	Joins genicular anastomosis 
	3) circumflex fibular
•	Small
•	Ramifies around neck of fibula
•	Supplies:
o	Soleus muscle
o	Fibularis (peroneus) longus muscle
Note: some texts have this artery issuing from posterior tibial artery, occasionally anterior tibial artery.  Laboratory experience, shows usual origin off anterior tibial artery (40% of cases) followed by posterior tibial artery (32% of cases).
62
Q

anterior tibial a cont cont

A

 4) Anterior medial malleolar
• Origin: anterior tibial a. – 5 cm proximal to ankle joint
• Course:
o Interomedially, across proximal extensor retinaculum
o Deep to extensor hallucis longus & tibialis anterior
o Ramifies around medial malleolus
 Anastomoses with posterior tibial & medial plantar arteries
 5) Anterior lateral malleolar
• Origin: lateral side, anterior tibial artery (close to origin of medial malleolar branch)
• Course: deep to tendons:
o Extensor digitorum longus
o Fibularis (peroneus) tertius
• Supplies lateral side of ankle joint
 6) Muscular Arteries
• Supplies muscles of anterior & lateral compartments of leg
• Some branches travel deep – anastomose with posterior tibial

63
Q

posterior tibial a

A 
o	Larger of two terminal branches of popliteal artery
o	Origin: inferior border, popliteus muscle
o	Course: 
	 Deep throughout descent
•	Posterior suface, tibialis posterior muscle
•	with tibial nerve
•	with venae comitantes
	Deep to origin of soleus muscle – inferomedial direction
	Ankle
•	 Posterior to medial malleoulus
o	Separated from malleoulus by tendons:
	Tibialis posterior
	Flexor digitorum longus
•	Inferior to medial malleoulus
o	Between tendons
	Flexor digitourm longus
	Flexor hallucis longus
64
Q

posterior tibial a cont

A 
o	Branches of posterior tibial artery:
	1) Muscular
•	Distribution to:
o	Flexor hallucis longus
o	Peroneus longus
o	Peroneus brevis
o	Tibialis posterior
o	Soleus
	2) Fibular (peroneal) artery
•	Largest branch of posterior tibial
•	Deep, fibular side, posterior leg
•	Origin: posterior tibial a. 2cm distal to inferior border of popliteus m.  
•	Course: inferiorly along medial side of fibula
•	Supplies:
o	Nutrient branch to fibula
o	Muscular branches:
	Posterior leg compartment
	Lateral leg compartment
o	Communicating branch 
	Joins communicating branch of posterior tibial artery
•	Posterior lateral malleolar branches
o	Small branches
o	Course towards lateral malleolus
o	Help form lateral malleolar network
•	Terminal Branches (posterior to tibiofibular articulation):
65
Q

posterior tibial a cont cont

A

o Lateral calcaneal branches
 Lateral side of heel
 Anastomose with other heel branches

	3) Nutrient artery to tibia 
•	One of first branches
•	Largest nutrient artery of bone in the body
o	Nutrient foramen 
	Immediately distal – soleal line (posterior proximal part of the tibia)
•	Origin: just inferior to bifurcation of popliteal artery
	4) Posterior medial malleolar
•	Small vessel
•	Course: towards medial malleolus
•	Contributes to malleolar network
	5) Communicating 
•	Course: deep to flexor hallucis longus
•	Joins communicating branch of peroneal artery
	6) Medial calcaneal
	7) Medial Plantar
	8) Lateral Plantar
	9) Circumflex fibular 
•	Branch of anteiror tibial (usually)
66
Q

leg lymphatics

A

• Numerous vessels and nodes
• Closely parallel veins of the leg
o Two systems of lymphatics (coincide with two systems of veins), superficial & deep
• Lymph Nodes
o Anterior tibial lymph node & popliteal lymph node
 Where lymphatics of leg drain into

67
Q

anterior tibial node

A

• Anterior Tibial Node
o Inconsistent
 (when present) – Located within anterior compartment of leg
• Near interosseous membrane
• Inferior to the hiatus
o Where anterior tibial vessels pass through interosseous membrane
• Receives lymph vessels coursing with anterior tibial artery and vein
• Efferent vessels (from anterior tibial lymph node)
o Pass to popliteal group of lymph nodes
• If absent- anterior lymp vessels drain into popliteal

68
Q

lymphatic vessels

A 
o	Course with blood vessels
o	Lymphatic vessels begin as blind CAP 
	Vessels course towards nodes = afferent
	Vessels leave lymp nodes = efferent 
o	Superficial lymphatic vessels 
	Course with superficial fascia
	Parallel cutaneous veins only
	Medial lymphatic vessels 
•	Course with great saphenous vein
•	Drain medial side of foot
•	End in lower group of superficial inguinal nodes
	Lateral lymphatic vessels
•	Course with small saphenous vein
•	Drain lateral side of foot
•	End in superficial popliteal lymph node (most)
o	Some cross to medial side with great saphenous
o	Deep lymphatic vessels
	Course with both arteries and veins
•	1) anterior tibial
•	2) posterior tibial
•	3) peroneal
69
Q

knee joint

A 
•	Largest joint in body
•	Compound joint: 2 joints 
o	Condyles of tibia/femur – Condylar joints 
	10-12 degrees from midline
	Exaggeration > genu valgum 
o	Patella & femur – Saddle/Sellar joint 
•	One synovial membrane 
•	One cavity 
•	Movement- Condyloid Joint
o	Hinge
o	Gliding
o	Rotation
o	Mechanically weak- gains strength from tendons 
•	Articular surfaces
o	Lined with articular cartilage 
o	Tibia- flat articular surface
o	Femoral- rounded 
•	Nerve supply:
o	articular branches femoral
o	obturator
o	common peroneal
o	 tibial
70
Q

knee joint cont

A

• Blood supply-
o genicular anastomosis from descending genicular branch of femoral
o genicular popliteal
o recurrent branches of anterior tibial
o descending branch lateral femoral circumflex A
o circumflex fibular A

• Ligaments of articularting bones
1. Articular capsule
o Anterior- incomplete
 Replaced by medial/lateral retinacula of quadriceps tendon
o attached margins of articulating surface
o Lateral: tendon popliteus m perices
o Inner: synovial membrane
2. Quadriceps tendon
3. Patellar ligament
o Continuation quadriceps tendon
o Attaches tibial tuberosity
o Strong flat band anterior/inferior part of joint
o 8 cm long
o infrapatellar fat pad- Inferior surface separates synovial membrane
o Infrapatellar bursa- protects ligament from tibia

71
Q

knee joint ligaments

A
  1. Lateral collateral
    o Strong round fibrous
    o Lateral epicondle femur above groove poplieus m
    o Head of fibula (lateral side)
    o Covered tendon biceps femoris m – splits attach fibular head either side of LCL
    o NOT attached to capsule or lateral meniscus
    o Tendon of popliteus deep
    o Separated from lateral meniscus by articular capsule & tendon popliteus
  2. Anterolateral ligament
    o Proximal attach- lateral femoral condyle anterior to proximal attached of LCL w/ connecting fibers between the two ligaments
    o Oblique course
    o Distal attach- anterolateral aspect tibia btwn Gerdy’s tubercle & apex of fibula
    o Attach lateral meniscus
    o Fxn: check internal rotation btwn 30-90 knee flexion
72
Q

knee joint ligaments

A
  1. Medial collateral
    o Broad flat band 10 cm long
    o Proximal- medial epicondyle femur below adductor tubercle
    o Distal- medial surface tibia 2-3 cm long
    o SGT cross it superiorly
    o Attach medial meniscus
    o Capsule below ligament
  2. Oblique popliteal
    o Strengthen knee joint posteriorly
    o Expansion semimebranosus m
    o Obliquely from medial condly tibia to lateral condyle of femur
    o Floor popliteal fossa
    o Perforated by medial genicular on way to knee joint
  3. Arcuate popliteal
    o Thickened capsular fibers over politeus tendon
    o Course medially from lateral condyle tibia and head fibula to posterior intercondylar area of the tibia
73
Q

anterior and posterior cruciates

A
  1. Anterior cruciate
    o Anterior intercondylar are tibia
    o Travels superolateral
    o Posterior meidal surface of lateral femoral condyle
    o Fxn: prevent hyperextnsion of knee – prevent femur posterior sliding on tibia
  2. Posterior cruciate
    o Stronger & shorter
    o Posterior intercondylar tibia
    o Travels obliquely upward crossing ACL
    o Attach medial condyle (lateral surface)
    o Fxn: prent hyperfelxion of knee – prevent femur forward sliding on tibial plateau
74
Q

menisci

A

o Semilunar fibrocartilage discs deepn cavity of tibial condyles
o Otuer border thicker than central area
o Central area in contact with femoral condyles
o Covers 2/3 condyle of tibia
o Peripheral attachment: fibrous capsule (Coronary Ligament)- holds menisci to tibial condyles

75
Q

medial meniscus

A

o Semicircular
o Attached to tibia anterior to ACL at anterior intercondylar area
o Posterior attach posterior intercondylar area

76
Q

lateral meniscus

A
  1. Lateral meniscus
    o Together curve= almost circular
    o Tendon popliteus separates it from LCL
    o Extends form anterior itnerconydlar area to posterior intercondylar area
    o Anterior/Posterior meniscofemoral ligaments –
    o Posterior side- 70% cases fibers extend to medial condyl of femur
  2. Transverse Ligament
    o Unites two meniscis anteriorly
77
Q

superior tibiofibular joint

A
  1. Fibular facet of lateral tibial condyle
  2. Articular facet medial aspect head of fibula
    • Facets circular shaped
    • Size/direction variable
    • Fibrous capsule thickend by ligamengs:
  3. Anterior superior tibiofibular ligament
  4. Posterior superior tibiofibular ligament
    • PLANE synovial JOINT
78
Q

distal tibiofibular joint

A

• SYNDESMOSIS, fibrous joint
1. Triangular surface of distal fibula (in the inferior interossesous border)
2. Distal end of tibia
Ligaments:
1. Interosseous tibiofibular ligament
o distal continuation of interosseous membrane
2. Anterior inferior tibiofibular ligament
o Triangular shape
o Directed inferolateral
3. Posterior inferior tibiofibular ligament
o Quadrangular shape
o Directed inferolateral
o Superificial
o Deep portion- contains fibrocartilage = inferior transverse ligament
o Forms socket talus
o Lateral malleolar fossa to margin of medial malleolus

79
Q

hip to ankle

A 
•	Long Bones
o	Femur (thigh bone), Tibia & Fibula (leg bones)
o	All composed of 3 portions:
	Proximal (upper) extremity
	Shaft
	Distal (lower) extremity
80
Q

patella

A

o Sesamoid bone

o Forms within tendon of quadriceps femoris muscle

81
Q

femur

A

o 1) head
 Ball-shaped
 Articulates with hip bone (at acetabulum)
 2/3rds spherical – covered by hyaline cartilage
• Exception at the pit (fovea) – attachment of ligament of the head of femur
 Entirely lies in articular capsule of hip joint
o 2) neck
 Joins head and shaft of bone
• Joins shaft at femoral angle of inclination
o Angle greatest at time of birth
o Sex & body size determine angle
o Adult males – 125 degrees
o Adult females – 105 degrees
 Wider bony pelvis
• Projects anteriorly from shaft - 12 to 14 degrees angle (angle of declination)

82
Q

femur cont

A 
	Hourglass shape – thinnest at middle
	Two surfaces:  anterior & posterior
•	Anterior surface
o	Entirely in joint capsule of hip joint
o	Convex, superior to inferior
o	Concave side to side 
o	Many small vascular foramina
o	Intertrochanteric line
	Between greater and lesser trochanters
	Continuous inferiorly with spiral line

• Posterior Surface
o More curved (than anterior)
o Upper ½ to 2/3rds lies within joint capsule
o Lower portion
 Grooved by tendon of obturator externus
o Fewer but larger vascular foramina (vs. anterior surface)
o Joins shaft of femur – at intertrochanteric crest
 Ridge of bone between greater and lesser trochanters

83
Q

femur cont cont

A

 Two borders: superior & inferior
• Superior border
o Short, thick
o Courses horizontally – ends at greater trochanter
• Inferior border
o Long, thin
o Courses vertically – ends at lesser trochanter

84
Q

greater trochanter

A

 Large, irregular, quadrilateral-shaped prominence
 Location: lateral end of superior border of neck
 Projection: lateral & posterior
 Two (2) surfaces: Lateral & medial
• Lateral Surface
o Larger
o Palpable
o quadrilateral shape
o Oblique bony ridge
 insertion of Gluteus medius
 divides lateral surface into 2 triangular areas
• Tochanteric bursae overlie each area
• Upper triangular area – bursae for gluteus medius
• Lower triangular area – bursae for gluteus maximus

85
Q

greater trochanter cont

A

• Medial Surface
o Trochanteric fossa (major feature)
 Depression for insertion of obturator externus
o Obturator internus tendon inserts anterior to trochanteric fossa
 Superior and Inferior gemelli muscles terminate/insert into tendon of obturator internus
 Four (4) borders: superior, inferior, anterior, posterior
• Superior border
o Piriformis insertion
• Anterior border
o Gluteus minimus insertion
• Inferior border
o Vastus lateralis (partial origin)
• Posterior border
o ONLY border or surface with NO muscular attachment
o Free rounded edge inferiorly
 Blends with intertrochanteric crest

86
Q

lesser trochanter

A 
o	4) lesser trochanter
	Location: medial, near junction of femoral neck & shaft
	Directed posteromedially
	Attachment:  iliopsoas 
•	Major flexor at the hip
•	Only attachment
•	Psoas major – inserts at apex 
•	Iliacus – inserts at base & between spiral & pectineal lines
87
Q

intertrochanteric line

A 
	Anterior
	Between greater and lesser trochanters
	At junction of neck and shaft
	3 Attachments:
•	1) iliofemoral ligament (part of fibrous capsule of hip)
•	2) vastus lateralis (partial origin)
•	3) vastus medialis (partial origin)
88
Q

intertrochanteric crest

A

Intertrochanteric crest
 Posterior
 Between greater & lesser trochanters
 Hip joint capsule – not attached to this crest
 Quadrate tubercle
• Mid intertrochanteric location
• Site of insertion of quadratus femoris muscle
• Note: at times a (quadrate) line is present instead of a tubercle.
• Extends vertically – 5cm
• Superior extent located along intertrochanteric crest

89
Q

femur shaft

A

o 3 borders: medial, lateral, and posterior
 Medial and lateral – rough, poorly defined
 Posterior border
• Linea aspera (major feature)
o Latin “rough line”
o Crest, posterior border, middle 1/3 of femur
o 2 lips: medial and lateral, rough intermediate area
• Superiorly linea aspera joined by 3 lines/ridges: spiral line, pectineal line, lateral line

90
Q

femur shaft cont

A

o Spiral line (superior line/ridge)
 Joins linea aspera
 Medial line
 proximally – continuous with intertrochanteric line
Hint: “Spirals medially up”
 distally – continuous with linea aspera
o Pectineal line
 Intermediate line
 Proximally – ends at lesser trochanter
 Distally – continuous with medial lip (linea aspera)
 Insertion of pectineus muscle
o Lateral line
 Extends from greater trochanter to lateral lip (linea aspera)
 Extends almost vertically
 Gluteal tuberosity located here
• Partial insertion of gluteus maximus (also inserts on iliotibial band)

91
Q

posterior femur

A

• 1) Vastus medialis
o Medial lip, linea aspera (partial origin)
• 2) Iliacus
o Superiorly insert
o between adductor mangus & vastus medialis
• 3) Pectineus
o Superiorly insert
o between adductor mangus & vastus medialis
• 4) Adductor brevis
o Linea aspera insertion (superior to adductor longus)
o between adductor mangus & vastus medialis
• 5) Adductor longus
o Linea aspera insertion (inferior to adductor brevis)
o between adductor mangus & vastus medialis

92
Q

posterior femur cont

A

• 6) Adductor magnus
o Linea aspera (extensive insertion)
o Gluteal tuberosity (superior – partial insertion)
o Lateral line (partial insertion)
o Lateral lip, linea aspera (partial insertion)
o Medial lip, linea aspera (lower fiber insertion)
o Medial supracondylar line (lower fiber insertion)
o Adductor tubercle (lower fiber insertion)
• 7) Gluteus maximus
o Gluteal tuberosity (superior – partial insertion)
• 8) Biceps femoris, short head
o Inferior to attachment of gluteus maximus
• 9) Vastus Lateralis
o Lateral lip, linea aspera (partial origin)
o Greater trochanter (small origin)

93
Q

inferior posterior femur

A

• Lateral lip & medial lip (of linea aspera)
o Diverge as lateral & medial supracondylar lines (ridges)
 Lateral supracondylar ridge
• More distinct
• Extends towards lateral epicondyle
 Medial supracondylar ridge
• Ends at adductor tubercle
• Smooth, just proximal to adductor hiatus
o location femoral vessels pass to popliteal fossa
 Form a triangular area – popliteal surface of the femur

94
Q

anterior femur

A 
•	Smooth, convex
•	Lies between medial and lateral borders
•	Attachments:
o	Vastus intermedius
	Upper 2/3rd  
o	Articularis genu muscle 
	Distal attachment
	Femur may be roughened, several small slips for origin
95
Q

medial and lateral femoral condyles

A

o Major features of distal extremity
o Lateral condyle – more pronounced, broader
o Medial condyle – longer (starts at adductor tubercle)
o Articulations (both medial and lateral condyles)
 Posterior surface of patella
 Respective condyle of tibia
 Large, rounded condyles, knob-like
• Project further posterior than anterior
o Lateral and medial sulci menisci
 Groove (sulcus) on each condyle
 Separate patellar and tibial surfaces of femoral condyles
 Lateral sulcus menisci
• Completely separates patellar surface (lateral femoral condyle) from tibial surface
 Medial sulcus menisci
• Deficient laterally (where tibial & patellar surfaces are continuous)

96
Q

posterior inferior femur

A

o Intercondylar notch (intercondylar fossa) – separates femoral condyles posteriorly
 Intercondylar line – serves as posterior boundary of the notch
• forms base of popliteal surface of femur
 Attachments:
• Anterior cruciate ligament
o Medial surface of lateral condyle
o Posterior attachment on femur
• Posterior cruciate ligament
o Lateral surface of medial condyle
o Anterior attachment on femur
• Meniscofemoral ligament(s)

97
Q

epicondyles

A 
o	Medial and Lateral epicondyles
	Lie above respective condyles
	Medial epicondyle
•	Larger, palpable
•	Just below adductor tubercle
o	palpable
o	Attachment:
	adductor magnus tendon
•	Attachment:
o	Tibial (medial) collateral ligament (of knee joint)
o	medial head of gastrocnemius muscle (just posterior to adductor tubercle)
98
Q

lateral epicondyle

A

• Palpable
• Attachment: Fibular (lateral) collateral ligament (knee joint)
• Two grooves – Lower portion of epicondyle (for popliteus tendon which shifts with knee movement)
o Oblique groove – flexed knee
o Vertical (anterior) groove – extended knee

99
Q

femoral arterial supply

A

o Extensive (largest bone of the body)
o Proximal extremity feeders:
 1) obturator
• Branch of obturator
o Courses within ligament of head of femur
o Supplies femoral head
o Important in infants, children, teens during ossification of femur
o Unimportant in adults (medial femoral circumflex is the main supply in adults)
 2) medial femoral circumflex- (branch profunda femoris)
• Major supply to femoral head in adults
• Enters at neck of femur
 3) lateral femoral circumflex – enters at neck
 4) inferior gluteal – enters at neck
 5) first perforating – enters at neck

100
Q

femoral shaft feeders

A

 Nutrient artery – branch of second perforating artery
• Nutrient canal: posterior, upper end of linea aspera
o Directed obliquely upward
 Away from growing end of bone during development
Note: for all long bones, nutrient canal is directed obliquely away from the growing end of the bone.
o Distal extremity feeders:
 1) superior lateral genicular artery
 2) superior medial genicular artery
 3) descending genicular artery
 4) descending branch of lateral femoral circumflex artery

101
Q

patella

A

Sesamoid bone – forms in quadratus femorus tendon
o Largest sesamoid in the body
• Articulates with the femur (part of knee joint)
• Triangular shaped
o Apex – inferiorly directed
• Three borders: (4 muscular attachments)
o Superior (base; thickest)
 Rectus femoris
 Vastus intermedius
 Vastus lateralis (lateral superior portion)
o Medial
 Vastus medialis
o Lateral
 Vastus lateralis

102
Q

patella surfaces

A 
•	Two surfaces:
o	Anterior
	Convex
	Longitudinal stria
•	Attachment: quadratus tendon
	Small nutrient foramina
o	Posterior
	Articulates with the femur (part of knee joint)
	Upper 4/5th 
•	Smooth, oval shaped
•	Vertical ridge
o	Articulates with intercondylar groove of femur
o	Separates two patellar facets
103
Q

patella cont

A

• (2) patellar facets
o Covered by hyaline cartilage
o Articulate with femur as part of knee joint
o Larger lateral facet (also deeper, more concave)
 Lower 1/5th
• Roughened, attachment: patellar ligament
• Nutrient foramen
• Arterial Supply
o Branches of genicular arteries (supplying quadriceps tendon)
• Petallar Ossification
o Variable number of centers – appear from 3-6 years; additional in later childhood
o Ossification complete around time of puberty

104
Q

subcutaneous fascia

A 
o	Covers entire thigh
o	Continuous w/subcutaneous fascia of entire anterior abdominal wall, gluteal region, leg
o	Divided into Two Layers:
	Superificial (fatty)
	Deep (membranous)
•	Attachments:
o	fascia lata
	Distal to inguinal ligament
	Along upper medial area of the thigh
o	Saphenous opening (fossa ovalis)
	Fills opening with fascia cribrosa
	Superifical vessels & nerves, inguinal lymph nodes, great saphenous vein found between layers
	Large bursa found in subcutaneous fascia over the patella
105
Q

fascia lata

A 
o	External layer of investing fascia of thigh
o	Thick laterally
o	Thin medially
	Attachment:
•	Ischial tuberosity
•	Ischiopubic ramus
•	External perineal fascia
106
Q

fascia lata cont

A 
o	Continuous with:
	Proximally:
•	 thoracolumbar 
•	external abdominal fasciae 
	Distally:
o	investing fascia of leg 
o	Anterior part
	Attachment: 
•	Pubic tubercle
•	Anterior superior iliac spine
•	Inguinal ligament
o	Over femoral vessels
	Thickened opening (saphenous opening (fossa ovalis))
•	Passage of great saphenous vein
•	Falciform margin – free lateral margin of opening
•	Lateral part – very thick & buttressed by tendons:
o	Gluteus maximus
o	Tensor fasciae latae
•	Superior attachment:
o	Crest of ilium
o	Dorsal sacrum
107
Q

fascia lata cont cont

A

o Iliotibial band
 Thickened tendon – within fascia lata on lateral thigh
 Tensor fasciae latae muscle
• found between 2 layers of fascia lata laterally
o Posteriorly
 Formed by fusion of two layers of gluteal fascia
 Lateral & medial intermuscular septa
• Connect under surface of fascia lata with linea aspera
• Divide thigh into 3 myofacial compartments

108
Q

sartorius

A

• Longest muscle in the body
Hint: “Sartorius is natorius for being the longest”
• Descends lateral to medial across the thigh
• Forms roof of adductor (subsartorial) canal & lateral border of femoral triangle
• Origin:
o Anterior superior iliac spine + inferior notch (below the spine)
• Insertion:
o Pes anserinus (proximal part of medial surface of body of the tibia)
 In common with gracilis & semitendinosis (Hint: “SGT”superior to inferior)
• Course:
o Obliquely (lateral to medial) across upper thigh -> then descends nearly vertically to its insertion
• Nerve Supply:
o Femoral nerve (anterior compartment nerve)
• Functions:
o Flexion of hip
o Abduction of hip
o Lateral rotation of hip
o Flexion of knee
o Medial rotation of leg (from flexed position)

109
Q

quadriceps femoris

A

• Consists of four thigh muscles
• Each muscle with unique origin
• Each muscle converges at a common insertion (tibial tuberosity via patellar ligament)
Note: Relationship between quadriceps tendon and patella. If the petalla is considered a sesamoid bone in quadriceps tendon, then proper tendon insertion is the “patellar ligament” (continues to tibial tuberosity). If the patella is not considered a sesamoid bone then the muscle can be thought to insert into the patella. Regardless the definition of insertion, the primary function is extension of the knee and hence the ultimate insertion of the group of muscles is the tibial tuberosity.
• Nerve Supply:
o Femoral nerve
• Functions:
o Extension of the knee
o Note: rectus femoris also assists in flexion of the hip due to origin & insertion

110
Q

rectus femoris

A

o Two tendons
 Straight (anterior) tendon – anterior inferior iliac spine
 Reflected (posterior) tendon – groove above acetabulum
o Tendons merge & form broad aponeurosis on ventral surface of muscle
o Fibers of muscle arise from the aponeurosis

•	Insertion:
o	Base (superior border) of patella  - through thick aponeurotic tendon to patellar ligament to tibial tuberosity
111
Q

vastus lateralis

A 
•	Origin: 
o	Lateral lip linea aspera
o	Lateral lip gluteal tuberosity 
o	Anterior & inferior borders of greater trochanter
o	Proximal intertrochanteric line
•	Insertion:
o	Lateral border of patella
o	Tendon of quadriceps femoris (patellar ligament to tibial tuberosity)
112
Q

vastus medialis

A 
•	Origin:
o	Distal intertrochanteric line
o	Medial intermuscular septum 
o	Tendons of adductor longus & magnus
o	Proximal medial supracondylar line
o	Medial lip of linea aspera
•	Insertion:
o	Medial border of patella
o	Tendon of quadriceps femoris 
(patellar ligament to tibial tuberosity)
113
Q

vastus intermedius

A

• Origin:
o Proximal 2/3, anterior surface of femur
o Proximal 2/3, lateral surface of femur
• Insertion:
o Quadriceps tendon (patellar ligament to tibial tuberosity)

114
Q

articularis genu

A 
•	Small muscle located deep to vastus intermedius
•	Origin:
o	Anterior surface, distal femur
•	Insertion:
o	Synovial membrane of knee joint
•	Nerve Supply:
o	Femoral nerve
•	Function:
o	Draw synovium proximally
115
Q

gracilis

A

• Thin muscle located superficially on medial thigh
• Origin:
o Pubic symphysis – inferior ½
o Pubic body
o Pubic arch (inferior pubic ramus) – superior ½
• Insertion:
o Pes anserinus (Proximal part, medial surface – tibia)
Note: In common with Sartorius and semitendinosus(SGT)
• Nerve Supply:
o Anterior division of obturator nerve
• Functions:
o Flexion at knee
o Adduction of hip
o Medial rotation of hip

116
Q

pectineus

A

• Origin:
o Pectin pubis
o Bone anterior to pectin pubis
 Between pubic tubercle & iliopectineal eminence
• Insertion:
o Petineal line (between lesser trochanter & linea aspera)
• Nerve Supply:
o Femoral nerve
o Accessory obturator (if present, supplies a branch)
o Note: obturator nerve may also provide a branch
• Functions:
o Flexion at hip
o Adduction at hip
o Medial rotation at hip

117
Q

adductor longus

A 
•	Most anterior adductor muscle
•	Origin:
o	Pubic body (anterior) 
•	Insertion:
o	Medial lip (linea aspera)
	Between attachments of vastus medialis & adductor magnus
•	Functions:
o	Flexion at hip
o	Adduction at hip
•	Nerve Supply: 
o	Anterior branch of obturator nerve
118
Q

adductor brevis

A 
•	Just posterior to adductor longus
•	Divisions of obturator (anterior & posterior) divide to surround the muscle
•	Origin:
o	Pubic body
o	Inferior pubic ramus
	Between gracilis & obturator externus 
•	Insertion:
o	Linea aspera (proximal part)
•	Nerve Supply:
o	Obturator nerve (anterior division usually)
•	Functions:
o	Flexion at hip
o	Adduction at hip
119
Q

adductor magnus

A 
•	Largest of adductors
•	Deep to adductor brevis
•	Upper fibers – nearly horizontal 
•	Lower fibers – nearly vertical
•	5 openings in the muscle (typically) 
o	(4) for the passage of perforating branches of deep femoral artery
o	Adductor hiatus (hiatus tendineus) – Most distal, largest opening
	Passage of femoral vessels to popliteal fossa
•	Origin:
o	Inferior pubic ramus
o	Ramus of ischium
o	Ischial tuberosity (triangular region)
•	Insertion:
o	Gluteal tuberosity (line)
o	Linea aspera
o	Medial supracondylar line
o	Adductor tubercle of femur
•	Nerve Supply:
o	Posterior division, obturator nerve
o	Tibial portion, sciatic nerve
•	Functions:
o	Flexion of hip
o	Adduction of hip
o	Extension of hip
o	Note: all possible because of different orientation of fibers.  Additional controversial function of possible rotation of hip.
120
Q

hamstring

A

• 3 components:
o Biceps femoris – found laterally, 2 heads (posterior compartment)
o Semitendinosus – found medially (posterior compartment)
o Semimembranosus – found medially (posterior compartment)

121
Q

biceps femoris

A 
•	Origin: 
o	Long head – 
	posterior part of ischial tuberosity
•	Below oblique line
	Common tendon with semitendinosus & sacrotuberous ligament

o Short head –
 lateral lip (linea aspera)
• Between adductor magnus & vastus lateralis muscles
 Lateral supracondylar line (femur)
 Lateral intermuscular septum
• Insertion:
o Long head – pass obliquely/laterally across sciatic nerve
 Aponeurosis (overlies the muscle)
• Narrows into tendon – inserts into:
o lateral side of styloid process (head of fibula)
o head of fibula
o lateral condyle of tibia
• tendon surrounds fibular collateral ligament
• common fibular nerve follows it’s medial border
o Short head – overlying aponeurosis
• Nerve Supply:
o Long head – tibial portion of sciatic nerve
o Short head – common fibular portion of sciatic nerve
• Functions:
o Both heads – Flexion of knee
o Both heads – Rotation, laterally (from flexed position)
o Long head:
 Extension at hip
 Rotation, laterally at hip

122
Q

semitendinosus

A

• Origin:
o Posterior ischial tuberosity (with long head of biceps femoris)
 Below oblique line
 With substantial aponeurosis – connecting two muscles (about 8cm from origin)
• Insertion:
o Long tendon (begins mid-thigh)
 Lies medial border of popliteal fossa
 Curves around medial condyle of tibia
 Over tibial collateral ligament (usually intervening bursa)
o Pes anserinua (Inserts into proimal part, medial surface of tibia)
• Nerve Supply:
o Tibial portion of sciatic nerve
• Functions:
o Flexion of knee
o Medial rotation of knee (from full flexion)
o Extension at hip

123
Q

semimembranosus

A

• Origin:
o Oblique line of ischial tuberosity – Upper/outer portion
 Above semitendinosus & biceps femoris
o Aponeurotic expansion (tendon of origin)
• Insertion:
o Medial condyle (tibia) – Groove, medial surface
o Lateral condyle (femur) – posterior surface
o Fascia – covering popliteal muscle
o Fibers proceed superolaterally – forms oblique popliteal ligament
• Nerve Supply:
o Tibial portion of sciatic nerve
• Functions:
o Flexion of knee
o Medial rotation of knee (from full flexion)
o Extension at hip

124
Q

genitofemoral n

A 
•	Femoral branch (L1, 2)
o	Lateral to genital branch
o	Passes deep to inguinal ligament (
	with eternal iliac/femoral artery
•	lateral compartment of femoral sheath
o	supplies skin on proximal, anterior surface of thigh
o	Lays on top of Psoas Major
125
Q

lateral femoral cutaneous

A

• (L2, 3)
• First appearance – middle, lateral border, psoas major
• Passes:
o over iliacus – toward anterior superior iliac spine
o under inguinal ligament
o over Sartorius muscle
• divides:
o Anterior branch
 Supplies skin over lateral & anterior thigh
o Posterior branch
 Supplies skin of lateral thigh (greater trochanter to mid-thigh)

126
Q

obturator n

A 
•	(L2, 3, 4)
•	Emerges into medial compartment of thigh – through obturator canal
o	Divides into two branches:
	Anterior (superficial) branch
•	Anterior to adductor brevis
•	Communicates with accessory obturator (when present)
•	Passes over obturator externus
o	Deep to pectineus & adductor longus
o	Superficial to adductor brevis
•	Articular branch to hip joint
•	Musclular branches to:
o	Adductor longus
o	Gracilis
o	Adductor brevis (sometimes)
o	Pectineus – motor (rarely)
•	cutaneous branches (when present) – skin on medial thigh, just above knee
	Posterior (deep) branch
•	Posterior to adductor brevis
•	Anterior to adductor magnus
•	Articular branch to knee joint
•	Muscular branches:
o	Obturator externus- goes through it 
o	Adductor magnus
o	Adductor brevis (sometimes)
127
Q

accessory obturator n

A 
•	(L3, 4)
•	Present 10% of cases
•	Passes deep to pectineus
o	Sends muscular branch to pectineus
•	Articular branch to hip joint (potential)
128
Q

femoral n

A 
•	(L2, 3, 4)
•	Passes under inguinal ligament (lateral to femoral artery)
•	Lies OUTSIDE femoral sheath
•	Immediately entering thigh divides:
o	Cutaneous branches
	Anterior femoral cutaneous branch
•	Medial femoral cutaneous branch
o	Skin of medial thigh, distally to leg
•	Intermediate femoral cutaneous branch
o	Skin of anterior thigh
o	Muscular branches
	All muscles of anterior compartment
•	Sartorius 
•	Quadratus femoris (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius)
•	Articularis genu
	Pectineus (sometimes)
129
Q

saphenous n

A

• Longest branch of femoral nerve
• Enters adductor canal (with femoral artery)
o Crosses lateral to medial in canal – over artery
o Leaves canal – passes to medial side of knee
 Does NOT pass through adductor hiatus
• Superficial – passes between tendons of Sartorius & gracilis muscles
• Runs with great saphenous vein (medial side of leg)
• Proximal 1/3 of leg, divides:
o 1) subsartorial nerve plexus contribution
o 2) infrapatellar branch (cutaneous innervation to skin over patella)
• Distal 1/3 of leg, divides (terminal branches):
o 1) skin supply:
 anterior & medial side of leg
 Ends at the ankle
o 2) medial side of foot
 As far as ball of the foot

130
Q

subsartorial nerve plexus

A 
•	Inferior margin adductor longus
•	Deep to Sartorius muscle
•	Formed by communications:
o	Anterior branch of obturator
o	Saphenous 
o	Medial femoral cutaneous nerves
131
Q

sciatic nerve

A 
•	Largest branch of sacral plexus
•	Largest nerve in the body
•	(L4-S3)
o	Anterior divisions (L4-S3)
o	Posterior divisions (L4-S2)
•	Supplies:
o	Posterior compartment muscles (thigh)
o	ALL muscles of leg and foot
o	Skin of foot
o	Skin of leg (most)
o	ALL joints of lower extremity
•	Anatomically one nerve
•	Physiologically two nerves (wrapped together in single connective tissue sheath)
Note: both nerves have separate origins from sacral plexus. Fibers do not mix while traveling together
o	Splits as passes into distal 1/3, posterior thigh (as emerges from beneath long head, biceps femoris)
132
Q

tibial n

A

 Anterior divisions (L4-S3)

133
Q

common peroneal n

A

 Posterior divisions (L4-S2)… Two words, stops at S2

134
Q

femoral artery 1

A

 1) superficial epigastric
• Small vessel
• First branch of femoral
• Originates 1 cm inferior to inguinal ligament
• Course:
o Passes through femoral sheath
o Proceeds superiorly, anterior to inguinal ligament
o Superficial epigastric vein (medial to artery)
o Terminates: anastomosing with superficial epigastric & inferior epigastric artery
• Supplies – anterior abdominal wall (below umbilicus)
o Skin
o Superficial fascia
 2) superficial circumflex iliac
• Smallest branch
• Originates: anterlolateral aspect of femoral a. – slightly below superficial epigastric
• Course:
o Travels laterally – parallels inguinal ligmanet
 To iliac crest
• Anastomoses with:
o Deep circumflex iliac
o Superior gluteal
o Lateral femoral circumflex

135
Q

femoral artery 2

A 
	3) superficial external pudendal
•	Originates: medial side of femoral
o	Across from origin of superficial circumflex iliac
•	Course: 
o	Trevels medially 
	Crosses spermatic cord
	Supplies perineal structures
	Supplies lower abdominal wall
	Anastomoses with branches of internal pudendal artery

 4) Deep external pudendal (see “Pelvis and Gluteal Region”)

136
Q

femoral a 3

A

 5) Muscular branches
• Branches originate directly from the femoral:
o Vastus medialis
o Sartorius
o Adductor muscles
 6) Profundus femoris (deep femoral)
• Largest branch
• 2-5 cm distal to inguinal ligament
• Origination: lateral aspect – femoral artery
• Course:
o Travels inferiorly – spirals posterior to femoral artery – then along medial side
o Lower 1/3 of thigh
 Posterior to adductor longus
o Terminates – small branch, entering adductor magnus muscle
 Known as fourth perforating artery

137
Q

profundus femoris 1

A

• Branches:
o Lateral femoral circumflex
 Origin: lateral side of profundus femoris
Note: 20% of time originates from stem of femoral artery
 Course: laterally – deep to rectus femoris & sartorius muscles
 (3) branches:
• 1) Ascending branch
o Travels superolaterally deep to fascia lata
o Lateral side of upper thigh
o Anastomoses – branches of superior gluteal & deep circumflex iliac arteris
• 2) Transverse branch
o Smallest branch
o Travels laterally around femur inferior to greater trochanter
o Pierces vastus lateralis
o Posterior aspect of thigh
o Posterior aspect of thigh - Participates in cruciate anastomosis, with:
 Femoral circumflex
 Inferior gluteal
 First perforating artery
Hint: together with Transverse branch, first letter spell “FFIT” circumflex
• 3) Descending branch
o Courses inferlorly – below rectus femoris
o Supplies vastus lateralis muscle
o Reaches knee joint
 Anastomoses with - lateral genicular branch of popliteal a.

138
Q

profundus femoris 2

A

o Medial femoral circumflex
 Origin: medial aspect of profundus femoris
 25% of cases – originates directly from femoral artery
 Medially disappears between pectineus & psoas major muscles
 Winds around medial aspect of femur
 Supplies:
• Adductor muscles
• Gracilis
• Obturator externus
 Contributes to cruciate anastmoses along with:
• Inferior gluteal
• Transverse branch of lateral femoral circumflex
• 1st perforating artery
 Acetabular branch
• Arises posterior to acetabular notch
• Enters acetabulum w/ acetabular branch of obturator artery
• Supplies:
o fat in acetabular fossa
o head of femur (traveling in the round ligament)

139
Q

profundus femoris 3

A 
o	Perforating (4)
	(3) originate from profunda femoris
	(1) is terminating branch of profunda femoris
	Perforate through adductor magnus to reach posterior thigh
	First Perforating
•	Superior to adductor brevis
	Second Perforating
•	Anterior to adductor brevis
•	Gives off nutrient artery to femur
	Third Perforating
•	Distal to adductor brevis
	Anastomose with each other
	Supply:
•	Adductor magnus (which they pierce through)
•	Posterior thigh muscles
o	Muscular branches
	Many terminate in adductor muscles
	Others supply posterior thigh
140
Q

popliteal a

A

o Femoral changes name to popliteal –
 once it exits adductor hiatus
• entering popliteal fossa
o courses (inferiorly) floor of popliteal fossa
o crosses knee joing –
 lies in intercondylar fossa
• deep to vein – throughout its course in the fossa
o both vessels enclosed in a dense connective tissue sheath
• anteriorly – lies against capsule of the joint
• Posteriorly – deep to:
o semimembranosus muscle
o popliteal vein
o tibial nerve
o gastrocnemius muscle

141
Q

popliteal a cont

A

o Branches in the thigh:
 Muscular (2 or 3 at proximal end)
• Supply:
o Adductor magnus (lower ends)
o Hamstring muscles
 Medial superior genicular
 Lateral superior geniuclar
 Sural (medial & latera)
• Originate from popliteal artery (at knee joint)
• Distributed to:
o Gastrocnemius (triceps surae)
o Soleus (triceps surae)
o Plantaris
o Branches to knee joint
 Genicular arteries
• (5) total given off by poplite al artery
o (2) superior genicular arteries
 Medial & lateral sides of popliteal artery
 Wind around superior aspect of femoral condyles
• Reach anterior side of knee
• Help form collateral circulation of knee
 Both give off two branches:
• Superficial branch
o Supplies muscles
• Deep branch
o Supplies knee joint
o (1) middle genicular artery
 Small vessel
 Originates from popliteal artery – opposite the knee joint
 Enters knee to supply ligaments & synovial membrane (interior of joint)
o (2) inferior genicular arteries (medial & lateral)
 Originate: popliteal – distal to knee joint
 “see leg portion of outline”

142
Q

popliteal cont cont

A

o Popliteal – terminates at inferior border of popliteus muscle
 divides into two terminal branches:
• anterior tibial artery
• posterior tibial artery

143
Q

superficial veins 1

A

o Great Saphenous Vein
 Level of knee joint
• Courses posteriorly – passes behind medial condyles of tibia & femur
• Enters medial distal end of thigh
 Course:
• Superiorly, gradually reaching anterior midline of thigh (3 cm inferior to inguinal ligament)
• Passes through saphenous hiatus
• Enters femoral sheath
• Opens into femoral vein
Review: behind medial condyles -> saphenous hiatus -> femoral sheath
-> femoral vein
 Superficial group inguinal lymph nodes – surround proximal end

144
Q

superficial veins 2

A

 Cribriform fascia (continuation of superficial fascia)
• Covers saphenous opening
o Borders (superior, lateral, & inferior) form a sharp edge = Falcform margin
o Superficial epigastric & superficial external pudendal arteries
 Contents of saphenous opening
 Emerge through opening
 Supply superficial structures
 Corresponding veins – drain into great saphenous (before it enters saphenous opening)
o Great saphenous receives following before entering canal:
 Accessory saphenous vein
• Formed by superifical venis along medial and posterior aspect of thigh uniting
• Drains into great saphenous
 Superficial external pudendal vein
 Superifical circumflex iliac vein
 Superficial epigastric vein

145
Q

deep veins

A

o Popliteal vein
 Distal border of popliteus muscle – anterior & posterior tibial veins join to form popliteal vein
 Ascends into popliteal fossa
• Accompanies the artery
o Inferior fossa – vein lies medial
o Superior fossa – vein lies superficial to artery
• Exits popliteal fossa – by passing through adductor hiatus
 Tributaries correspond to branches of popliteal artery
 Receives from small sapnenous vein

146
Q

varicose veins

A

Discussion on Varicose Veins: superificial veins of the lower limb are involved in becoming vicose. Affected veins become dialated & tortous (producing pain & possible ulcer formation) due to overextension from accumulation of blood. Not massaged by muscle like the deeper veins. Blood usually shunted to deep veins – through small connecting veins (perforating veins). Valve arrangement only lets blood go from superficial to deep veins. When varicose, some can allow blood to pass from deep to superficial veins – through incompetent valves

147
Q

femoral vein

A

 Largest vein of thigh
 Superior continuation of popliteal vein (at adductor hiatus)
 Ascends into adductor canal
• Lies posterolateral to femoral artery
• Proximal end
o Enters apex of femoral triangle
 Ascends from posterior side of artery to medial side
 Inferior to inguinal ligament
• Occupies intermediate compartment of femoral sheath
 Crosses inguinal ligament
• Becomes external iliac vein
 Usually 4-5 valvaes in femoral vein
• One usually located inferio r to entrance of deep femoral vein
 One of largest tributaries = deep femoral vein (profunda femoris)
• Formed by Junction of the 3 or 4 perforating veins
 Also drains into interior gluteal vein (anastomotic channel between femoral and internal iliac veins)
 3 cm inferior to inguinal ligament – receives largest tributary, great saphenous vein
 Medial & lateral femoral circumflex veins – drain into either femoral or deep femoral vein

148
Q

popliteal nodes 1

A

• 6 or 7 located in the popliteal fossa
• Subdivided into three groups related to popliteal blood supply (popliteal vein (posterior) vs. popliteal artery (anterior))
o 1) one node lies anterior (deep) to popliteal artery
 Receives lymph from inside knee joint
o 2) one node lies posterior (superficial) to popliteal vein
 Receives lympathics that course with small (short) saphenous vein)
o 3) 4 or 5 nodes lie within fat (lateral and medial sides of popliteal vessels)
 Receive lymphatic vessels coursing with:
• anterior tibial blood vessels
• posterior tibial
• peroneal blood vessels
• Efferent lymphatic vessels
o Follow femoral vein -> femoral triangle -> deep inguinal lymph nodes
o Few vessels: course with great saphenous vein -> lower group superficial inguinal nodes
• Major & largest group of lymph nodes
• Receive lymphatic vessels from:
o Lower anterior abdominal wall
o Perineum
o Lower limb
• 2 major groups:
o 1) superifical
 Within superficial fascia
o 2) deep
 Lie deep to deep fascia (fascia lata)
 Within femorl sheath

LOWER LIMB (4 decks)

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