Exam #5: Leg Flashcards

1
Q

What are the two bones of the leg? Which of these bones is weight-bearing?

A

1) Tibia*
2) Fibula

*Weight bearing

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2
Q

What connects the two leg bones?

A

Interosseous membrane

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3
Q

What are the four compartments of the leg?

A

1) Anterior
2) Lateral
3) Superficial Posterior
4) Deep Posterior

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4
Q

What is the major function of the muscles in the anterior compartment?

A

Dorsiflexion of the ankle & extension of the toes

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5
Q

What nerve innervates the anterior compartment?

A

Deep Peroneal Nerve

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6
Q

What artery supplies the structures of the anterior compartment?

A

Anterior tibial artery

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7
Q

What are the four muscles of the anterior compartment?

A

1) Tibialis anterior
2) Extensor digitorum longus
3) Extensor hallucis longus
4) Peroneus tertius

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8
Q

Where is the anterior compartment?

A

Anterior to the interosseous membrane, between the anterior intermuscular septum & tibia

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9
Q

What is the origin of the Tibialis Anterior?

A

Tibia & interosseous membrane

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10
Q

What is the insertion of the Tibialis Anterior?

A

Medial cuneiform and base of the 1st metatarsal

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11
Q

What is the origin of the Extensor Hallucis Longus (EHL)?

A

Fibula & interosseous membrane

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12
Q

What is the insertion of the Extensor Hallucis Longus (EHL)?

A

Base of the distal phalanx of the great toe (hallux)

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13
Q

What is the origin of the Extensor Digitorum Longus (EDL)?

A

Tibia, fibula, & interosseous membrane

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14
Q

What is the insertion of the Extensor Digitorum Longus (EDL)?

A

Middle & distal phalanges of toes 2-5 (lateral 4)

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15
Q

What is the origin of the Peroneus Tertius?

A

Fibula & interosseous membrane

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16
Q

What is the insertion of the Peroneus Tertius?

A

Base of the 5th metatarsal

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17
Q

What is the deepest muscle of the anterior compartment?

A

Extensor Hallucis Longus (EHL)

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18
Q

Where does the Anterior Tibial artery enter the anterior compartment?

A

Branches from the Popliteal artery & passes through a hole in the interosseous membrane

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19
Q

What are the branches of the Anterior Tibial artery?

A

1) Tibial recurrent
2) Anterior medial malleolar
3) Anterior lateral malleolar
4) Dorsalis pedis

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20
Q

What are shin splints? What anatomical structures are involved?

A

Shin splints are pain and edema to the distal 2/3 of the tibia caused by repetitive microtrauma to the anterior tibialis m.

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21
Q

What nerve is most commonly injured in the lower leg?

A

Common peroneal nerve

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22
Q

Why is the common peroneal nerve the most commonly injured nerve in the lower leg?

A
  • It has a superficial & lateral position

- It winds around the fibular neck, leaving it vulnerable to direct trauma

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23
Q

What is the clinical manifestation of severance of the common peroneal nerve?

A

“Footdrop”

  • Loss of innervation to BOTH the anterior & lateral compartments of the LE
  • Loss of dorsiflexion (and eversion) results in classic “footdrop”
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24
Q

What is compartment syndrome?

A

Increased pressure within a compartment compromises the circulation and function of the tissues within that space

  • Anterior compartment is most commonly effected
  • Most cases of “Acute Compartment Syndrome (ACS)” are the result of tibial fracture
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25
Q

What is the major function of the lateral compartment?

A

Eversion of the foot

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26
Q

What nerve innervates the lateral compartment?

A

Superficial peroneal nerve

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27
Q

What arteries supply the lateral compartment?

A

The lateral compartment DOES NOT have an artery coursing through it; rather, it is supplied by perforating branches from:

  • Anterior compartment’s Anterior Tibial a.
  • Posterior compartment’s Peroneal a.
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28
Q

What muscles are contained within the lateral compartment?

A

1) Peroneus Longus

2) Peroneus Brevis

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29
Q

Where is the lateral compartment?

A

Bounded by the lateral surface of the fibula & the atnerior & posterior intermuscular septa

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30
Q

What is the origin of the Peroneus Longus?

A

Lateral Fibula

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31
Q

What is the insertion of the Peroneus Longus?

A

Base of the 1st metatarsal & medial cuneiform

32
Q

What is the origin of the Peroneus Brevis?

A

Lateral Fibula

33
Q

What is the insertion of the Peroneus Brevis?

A

Tuberosity of the 5th metatarsal

34
Q

What is the smallest compartment of the LE?

A

Lateral compartment

35
Q

What are the general functions of the posterior compartment?

A

Plantarflexion & inversion

36
Q

What divides the posterior compartment into superficial & deep posterior compartments?

A

Transverse intermuscular septum

37
Q

What nerve innervates the posterior compartment? What spinal levels does this nerve originate from?

A

Tibial nerve (L4-S3)

38
Q

What artery supplies the posterior compartment?

A

Posterior tibial artery

39
Q

What are the muscles of the superficial posterior compartment?

A

1) Gastrocnemuis
2) Soleus
3) Plantaris

40
Q

What is the function of the Gastronemuis?

A

1) Flexes the leg at the knee joint
2) Plantar flexes the foot

*Note that the Gastronemius crosses both the knee and ankle joints; thus, it can act on both joints. However, it cannot act on both joints at the same time.

41
Q

What is the function of the Soleus?

A

The Soleus is an anti-gravity muscle with fibers that are continuously active during standing; it does not have any action at the knee like the Gastronemuis

42
Q

What is the Triceps surae?

A

Grastronemuis and soleus together; perform 95% of the plantar flexion of the foot

*Note that the relatively large size of these muscles is a human characteristics

43
Q

What is the function of the plantaris?

A

The plantaris is an organ or proprioception that is absent in 5-10% of the population

*Note that because of its relatively minor motor role, it is harvested for grafting e.g. for reconstruction of the tendons of the hand

44
Q

What is the origin of the Gastrocnemius?

A

Lateral & medial condyles of the femur

45
Q

What is the insertion of the Gastrocnemius?

A

Calcaneus via the calcaneal tendon

46
Q

What is the origin of the Soleus?

A

Fibula & soleal line of the tibia

47
Q

What is the insertion of the Soleus?

A

Calcaneus via the calcaneal tendon

48
Q

What is the origin of the Plantaris?

A

Lateral supracondylar line of the femur

49
Q

What is the insertion of the Plantaris?

A

Calcaneus via the calcaneal tendon

50
Q

Where to all of the superficial muscles of the posterior compartment insert?

A

Calcaneus via the calcaneal tendon

51
Q

What are the muscles of the deep posterior compartment of the leg?

A

1) Popliteus
2) Flexor digitorum longus
3) Flexor hallucis longus
4) Tibialis posterior

52
Q

What is the action of the Popliteus?

A

Unlocks the knee joint by laterally rotating the femur 5 degrees

53
Q

What is the origin of the Popliteus?

A

Lateral condyle of the femur

54
Q

What is the insertion of the Popliteus?

A

Superior to the soleal line of the tibia

55
Q

What is the origin of the Flexor Digitorum Longus?

A

Tibia, inferior to the soleal line

56
Q

What is the insertion of the Flexor Digitorum Longus?

A

The base of the lateral four distal phalanges

57
Q

What is the origin of the Flexor Hallicus Longus?

A

Fibula & interosseous membrane

58
Q

What is the insertion of the Flexor Hallicus Longus?

A

The base of the distal phalanx of the great toe

59
Q

What is the origin of the Tibialis Posterior?

A

Tibia, fibula, & interosseous membrane

60
Q

What is the insertion of the Tibialis Posterior?

A

Navicular, cuneiforms, cuboid, & bases of the middle three metatarsals (2-4)

61
Q

What arteries branch off the Posterior Tibial artery? What artery is the Posterior Tibial a branch of?

A

The popliteal artery branches into the Posterior Tibial & Anterior Tibial arteries on the posterior aspect of the LE. The Posterior Tibial a. gives off the following branches:

1) Peroneal
2) Posterior medial malleolar
3) Posterior medial calcaneal
4) Medial & lateral plantar arteries (foot)

62
Q

Where is the peroneal artery in the lower extremity? Where is the posterior tibial artery?

A

The posterior tibial artery is medial; peroneal (fibular) is lateral

*In some cases the peroneal MAY be larger than the posterior tibial

63
Q

What are the branches of the Peroneal artery?

A

1) Perforating branch to the lateral compartment
2) Muscular branches
3) Communicating branch that joins the posterior tibial
4) Posterior lateral malleolar
5) Posterior lateral calcaneal

64
Q

Describe the lymphatic drainage of the leg.

A

Foot–>popliteal nodes–>inguinal nodes–>External iliac nodes

65
Q

Does the foot have lymph nodes?

A

No, just vessels

66
Q

What is the difference between small saphenous vein & Great saphenous vein?

A

Small saphenous= begins on the lateral side of the foot & ascends along the posterior-medial leg; it drains into the popliteal vein posterior to the knee

Greater saphenous= begins at the foot & ascends along the medial side of the leg; it drains into the femoral vein

67
Q

Where are there more valves, in the lower leg or in the thigh?

A

Lower leg

68
Q

What are varicose veins?

A
  • Dilated, elongated, tortuous, subcutaneous veins in the lower leg, caused by pooling of blood in the superficial veins of the lower leg
  • These veins are NOT surrounded by muscle like the deep veins & have less valves; thus, they are subject to pooling
69
Q

What causes venous return to the heart from the lower leg?

A

Muscular contraction inside the deep fascia

70
Q

What nerve supplies the skin on the medial side of the lower leg? What nerve is this nerve a branch of? What vertebral levels does this nerve arise from?

A

The saphenous nerve supplies the medial side of the lower leg; it is a branch of the femoral nerve, and arises from L3-L4

71
Q

What nerve is the medial sural cutaneous nerve a branch of?

A

Tibial nerve

72
Q

What nerve is lateral sural cutaneous nerve a branch of?

A

Common peroneal nerve

73
Q

What is the sural communicating nerve?

A

A branch of the lateral sural cutaneous nerve that joins medial sural cutaneous

74
Q

What is the sural nerve?

A

The junction of the medial sural cutaneous nerve & the communicating sural nerve

75
Q

What nerve supplies cutaneous innervation to the lateral aspect of the lower extremity?

A

Lateral sural cutaneous nerve

76
Q

What nerve supplies cutaneous innervation to the posterior (small strip) aspect of the leg, & lateral foot?

A

Medial sural cutaneous nerve