Exam 6 Lower Extremity 60X Flashcards
Name the Regions of the Lower Extremity?
-Gluteal
-Thigh (Femoral)
-Knee
(Patellar: Anterior)
(Popliteal: Posterior)
-Leg (Crural)
(Anterior)
(Calf: Sural)
-Foot (Pedal)
The Pelvic girdle is attached to the vertebral column via what joint?
Sacroiliac Joints
What bones make up the Hip (os coxae)?
Ilium
Ischium
Pubis
In the late teens/early 20s the Ilium, Ischium, and Pubis bones fuse to form a single bone called?
Os Coxae (AKA Innominate Bone)
What surface marker on the posterior marks the position of the posterior superior iliac spines and are typically more visible in women?
Skin Dimples
The Pelvic Girdle/Bony Pelvis is comprised of which bones?
- Innominate Bones (2) (os coxae)
- Sacrum
- Coccyx
What is the name of the anterior joint where the Hip (Coxal) Bones unite called?
Pubis Symphysis
The hip bones unite posteriorly with the sacrum to form what joint?
Sacroiliac Joints
What does the term pelvis mean?
Basin
What consists of complete ring composed of hip bones, pubic symphysis, and sacrum?
Bony Pelvis
What portion of the Bony Pelvis is the false (greater) pelvis?
Portion of bony pelvis superior to the pelvic brim
What portion of the bony pelvis is the true (lesser) pelvis?
Portion of bony pelvis inferior to the pelvic brim
What organs are contained within the pelvic cavity?
- Urinary Bladder
- Portion of Large Intestine
- Internal Organs of reproductive System
What are the differences seen in the female Pelvis compared to a males? (as seen anteriorly)
Female:
- False Pelvis shallow
- Pelvic Brim (inlet) larger and more oval
- Acetabulum smaller and anteriorly rotated
- Obturator foramen oval
- Pubic arch >90 degrees
What are the differences seen in the female Pelvis compared to a males? (as seen laterally)
Female:
- Iliac crest less curved
- Ilium less vertical
- Greater sciatic notch wide
- Coccyx more movable and more curved anteriorly
- Sacrum shorter and wider
What are the differences seen in the female Pelvis compared to a males? (as seen inferiorly)
Female:
- Pelvic outlet wider
- Ischial tuberosity shorter, farther apart, more medially projecting
Give Term: An abnormality of the hip in which the angle between the top of the femur and the femoral shaft is smaller than normal.
Coxa Vara
Give Term: An abnormality of the hip in which the angle between the top of the femur and the femoral shaft is larger than normal?
Coxa Valga
What reasons cause the angle of inclination of the femur to vary?
- Age
- Sex
- Development of Femur
- Pathological Processes (I.e. Ricketts)
Give the names and number of bones for each that make up the foot?
Tarsals (7) -Talus -Calcaneus -Navicular -Cuboid -Cuneiforms (3) Metatarsals (5) Phalanges (14)
What are the names of the two (3 technically) arches that the bones of the foot are arranged?
-Longitudinal Arch
Medial part
Lateral part
-Transverse Arch
What are the functions of the arches?
- Weight distribution in the foot
- Leverage while walking
- Shock absorber
The medial part of the longitudinal arch originates where in the foot and is made up of which bones?
Originates: Calcaneus Rise to: Talus Descends through: -Navicular -Cuneiforms (3) -1st, 2nd, 3rd metatarsals to the head
The lateral part of the longitudinal arch originates where in the foot and is made up of what bones?
Originates: Calcaneus
Rises: Cuboid
Descends through:
4th and 5th metatarsals to the head
What forms the Transverse arch?
Cuboid
Cuneiforms (3)
1-5 Metatarsals at the base
What is the normal weight distribution between the ball of the foot and heel? (%)
Ball: 40%
Heel: 60%
What structure provides a tight fighting sleeve of support for upright posture, forms compartments, connects “skin” to bone, and is deep to subcutaneous tissue?
Fascia
What are the names of three of the fascia found within the lower extremity?
- Fascia lata/Iliotibial band
- Crural fascia
- Retinacula
What is the name of the deep fascia of the thigh that has superior attachment to the inguinal ligament and inferior to medial part of inguinal ligament opening for passage of saphenous vein to enter femoral vein? What is the name of the opening?
Fascia Lata
Opening: Saphenous Hiatus
The lateral thickening of the fascia lata attaches distally to the lateral tibial condyle and consists of the insertion of the gluteus maximus and tensory fasciae latae muscles, what is this called?
Iliotibial Tract
What arise within the Iliotibial tract?
Septa dividing the three compartments
What is the deep fascia of the leg called?
Crural Fascia
What is the attachment of the Crural Fascia?
Anterior and Medial Borders of Tibia
Continuous with periosteum
The Crural intermuscular septa and interosseous membrane divide the leg into how many compartments?
3
What does the thickening of the Crural fascia near the ankle form?
Extensor Retinacula
The Abdominal Aorta divides into what arteries and at what level does this occur?
R and L Common Iliac
At: 4th Lumbar Vertebra
What is the name of the primary artery of the pelvis, supplying the pelvic viscera and perineum?
Internal Iliac artery
The Internal Iliac artery supplies the superior portions of the lower limb via what?
Gluteal arteries and Obturator artery
The External Iliac becomes what artery distal to the inguinal ligament?
Femoral Artery
The Femoral Artery becomes what artery distal to the adductor hiatus?
Popliteal Artery
The Popliteal Artery will divide into what arteries?
Anterior Tibial Artery
Posterior Tibial Artery
The Anterior and Posterior Tibial arteries will become what arteries?
-Anterior Tibial Artery Dorsalis Pedis -Posterior Tibial Artery Medial Plantar Artery Lateral Plantar Artery
What superficial venous vein is formed by the union of the dorsal vein of the great toe and dorsal venous arch?
Great Saphenous Vein
Where does the Great Saphenous Vein run?
- Ascends anterior to medial malleolus
- Passes posterior to medial condyle of femur
What accompanies the Great Saphenous Vein ?
Saphenous Nerve
The Great Saphenous Vein frequently forms anastomoses with what vessel and empties into what vein?
Anastomoses:
-Small Saphenous Vein
Empties:
-Femoral Vein
What vessel is formed by the union of the Dorsal Vein of the Small Toe and the Dorsal Venous Arch?
Small Saphenous Vein
The Small Saphenous Vein travels where?
-Ascends posterior to lateral malleolus
What accompanies the Small Saphenous vein and what does it empty into?
Accompanies:
Sural Nerve
Empties:
-Popliteal Vein in the Popliteal Fossa
What purpose do Perforating veins serve?
- Interconnect superficial and deep veins
- Contain valves that allow blood to flow from superficial to deep veins
- Permits Saphenous vein to remain constant size
Describe the Characteristics of Deep Veins?
- Accompany deep arteries of lower limb
- Paired frequently interconnecting veins (rather than single structure)
- Receive blood from superficial veins via perforating veins
- Musculovenous pump assists movement of blood to heart
- Greater density and more valves than superficial veins
What forms from incompetent venous valves which cause veins to become dilated and tortuous?
Varicose Veins
What vein is particularly susceptible to forming Varicosities and which valves are typically involved?
- Great Saphenous Vein and its Tributaries
- Valves of Saphenous vein(s) or perforating veins
Why are deeper veins not as vulnerable to forming varicosities? (Veins close to the surface highly susceptible)
Surrounding Skeletal Muscles help support
What is the name of the Extrinsic Muscle of the Lower Extremity?
Psoas Major
What is the name of the Intrinsic muscles of the Lower Extremity?
- Iliac Region (Iliacus)
- Gluteal Region
- Thigh Compartments (3)
- Leg Compartments (3)
- Dorsum of foot
- Sole of foot
What muscles of the posterior abdominal wall make up the Iliopsoas?
- Psoas Major and Minor
- Iliacus
What is the Origin and Insertion of the Psoas Major and Minor Muscle?
- Origin: Transverse Processes of Lumbar Vertebrae
- Insertion: Lesser Trochanter of Femur
What is the Action and Innervation of the Psoas Major and Minor?
Action: -Flexion of hip -Flexion of Vertebral Column Innervation: Lumbar Spinal Nerves
What is the Origin and Insertion of the Iliacus?
Origin: Iliac Fossa, Sacrum
Insertion: Lesser Trochanter of Femur
What is the Action and Innervation of the Iliacus?
Action: Flexion of Hip
Innervation: Femoral Nerve
What is the Origin and insertion of the Iliopsoas muscles?
Origin: -Psoas Major: Transverse Processes and Bodies of Lumbar Vertebrae -Iliacus: Iliac Fossa of Ilium Insertion: -Lesser Trochanter of Femur
What is the Action of the Iliopsoas?
- Flex torso and thigh w/respect to ea. other
- Rotate thigh Laterally
What is the Innervation of the muscles of the Iliopsoas?
Psoas (Major and Minor):
-Lumbar Spinal Nerves
Iliacus: Femoral Nerve
What joint is a multi-axial ball-and-socket type of synovial joint that provides both stability and wide range of movement of the Lower Extremity?
Hip Joint
What are the Stabilizing Factors of the Hip Joint?
-Bony Structure: Femoral Head–> Ball
Acetabulum (cup-like)–> Socket
-Ligaments
-Musculature
What is the True Articular Surface of the hip? What is it lined with?
- Lunate Surface
- Lined w/ Hyaline Cartilage
What is the name of the inferior part of the acetabulum and what is it bridged by?
- Acetabular Notch
- Bridged by Transverse Ligament
What increases the depth of the acetabular Fossa, helps stabilize the head of the Femur in the acetabulum and what does it grasp?
- Acetabular Labrum (Fibrocartilage Lip)
- Grasps Femoral Head Beyond Equator
What structure of the hip follows the bony rim of the cup-shaped acetabulum and what is it composed of?
-Acetabular Labrum composed of Fibrocartilage
Describe the Acetabular Surface and what lines it?
-Smooth lined by Articular Cartilage
What covers the head of the femur and where is it lacking?
-Articular Cartilage except where ligament of the head of the capsule attaches
What is the name of the ligament that extends from the acetabular notch to the fovea of the head of the femur?
-Ligamentum Capitis Femoris (AKA Ligament of Head of the Femur)
How important is the Ligamentum Capitis Femoris (Ligament of Head of the Femur) in strengthening the hip joint?
Little importance and is weak
What artery is usually contained w/Ligamentum Capitis Femoris to the Head of the Femur?
Obturator Artery
What structure of the hip is both strong and loose and permits free movement of the hip joint?
Fibrous Articular Capsule
What are the Attachment points of the articular capsule?
- Proximal Attachment: Edge of Acetabulum and Transverse Acetabular Ligament
- Distal Attachment: Intertrochanteric Line and Femoral Neck
Name the Ligaments which are part of the capsule that are thicker than other parts?
- Iliofemoral Ligament
- Pubofemoral Ligament
- Ischiofemoral Ligament
- Ligamentum Capitis Femoris (Ligament of the Femoral Head)
What does the Iliofemoral Ligament prevent and give the Characteristics?
Prevents Hyperextension
- One of Strongest Ligaments in the body
- Y-Shaped
- AKA: Ligament of Bigelow
What does the Pubofemoral Ligament Prevent?
Over abduction
What does the Ischiofemoral Ligament Prevent?
Hyperextension
What Ligament closes the greater sciatic foramen?
Sacrospinous Ligament
What Ligament attaches the Posterior Superior Iliac Spine (PSIS), Posterior Inferior Iliac Spine (PIIS), Sacrum and Coccyx to the Ischial Tuberosity?
Sacrotuberous Ligament
What is the lesser sciatic notch converted to and what converts it to this?
-Lesser Sciatic Foramen
BY:
-Sacrospinous Ligament
-Sacrotuberous Ligament
When is the Hip Joint most stable?
Fully Extended
and/or
Bearing Weight
Acquired dislocation is uncommon of the strong, stable hip joint, however for what reasons may the hip dislocate?
- Head-on Automobile Collision
- Congenital Dislocation
The Intergluteal (natal) Cleft separates what?
Gluteal Prominences (Buttocks)
The Gluteal Sulcus is formed by what? What does this mark (indicate)?
-Inferior Border of Gluteus Maximus
Indicates:
-Lower limit of buttock
-Upper limit of thigh
The Gluteal Muscles act on the hip joint and are responsible for what movements?
Abduct Femur Adduct Femur Rotate Femur: -External Rotation -Internal Rotation Flex and Extend Femur
What muscles make up the Superficial and Deep muscles of the Gluteal region?
Superficial: -Gluteus Maximus -Gluteus Medius -Gluteus Minimus Deep: (Short Lateral Rotators) -Piriformis -Gemelli Muscles -Quadratus Femoris -Obturator Internus -Obturator Externus
What is the Origin and Insertion of the Gluteus Maximus?
- Origin: Iliac Crest and Sacrum
- Insertion: Gluteal Tuberosity (lateral part of linea aspera under greater trochanter of femur) and Iliotibial Band
What is the action and Innervation of the Gluteus Maximus?
- Action: Extends Thigh at hip joint (Rising from seated position) and Laterally Rotates Thigh
- Innervation: Inferior Gluteal Nerve
What is the Origin and Insertion of the Gluteus Medius?
Origin: Ilium
Insertion: Greater Trochanter of Femur
What is the Action and Innervation of the Gluteus Medius?
Action:
-Entire muscle: Abducts thigh at hip
-Anterior Fibers: Flex and Medially Rotate Thigh
-Posterior Fibers: Extend and Laterally Rotate Thigh
Innervation: Superior Gluteal Nerve
What is the Origin and Insertion for the Gluteus Minimus?
Origin: Ilium
Insertion: Greater Trochanter of Femur
What is the action and innervation of the Gluteus Minimus?
Action:
-Entire muscle: Abducts thigh at hip
-Anterior Fibers: Flex and Medially Rotate thigh
-Posterior Fibers: Extend and Laterally Rotate Thigh
Innervation: Superior Gluteal Nerve
What is the Origin and Insertion of the Piriformis?
Origin: Sacrum
Insertion: Greater Trochanter of Femur
What is the action and innervation of the Piriformis?
- Action: Laterally Rotates and Abducts thigh at hip joint
- Innervation: Piriformis Nerve (AKA Nerve to Piriformis)
What is the Origin and Insertion of the Superior Gemellus?
Origin: Ischial Spine
Insertion: Greater Trochanter of Femur
What is the Action and Innervation of the Superior Gemellus?
- Action: Rotates thigh laterally; Helps abduct thigh
- Innervation: Nerve to Obturator Internus and Superior Gemellus
What is the Origin and Insertion of the Inferior Gemellus?
Origin: Ischial Tuberosity
Insertion: Greater Trochanter of Femur
What is the action and innervation of the Inferior Gemellus?
- Action: Rotates thigh laterally; Helps abduct thigh
- Innervation: Nerve to Quadratus Femoris and Inferior Gemellus
What is the Origin and Insertion of the Quadratus Femoris?
Origin: Ischial Tuberosity
Insertion: Intertrochanteric Crest of Femur
What is the Action and Innervation of the Quadratus Femoris?
Action: Rotates Hip Laterally (Stabilizes Hip)
Innervation: Nerve to Quadratus Femoris and Inferior Gemellus
What is the Origin and Insertion of the Obturator Internus?
- Origin: Posterior (Inner) Surface of membrane covering obturator foramen
- Insertion: Greater Trochanter of Femur
What is the Action and Innervation of the Obturator Internus?
- Action: Rotates Thigh Laterally; Helps Abducts Thigh
- Innervation: Nerve to Obturator Internus and Superior Gemellus
What is the Origin and Insertion of the Obturator Externus?
- Origin: Anterior (Outer) Surface of membrane covering Obturator Foramen
- Insertion: Trochanteric Fossa of Femur
What is the Action and Innervation of the Obturator Externus?
- Action: Rotates Thigh Laterally; Helps Abduct Thigh
- Innervation: Obturator Nerve
What Muscles Laterally Rotate The hip?
Piriformis Obturator Internus Obturator Externus Superior Gemellus Inferior Gemellus Quadratus Femoris
What are the arteries that supply the Gluteal Region?
- Deep Femoral Artery (Deep Artery of Thigh, Deep Peroneal Artery)
- Obturator Artery (Branch of Internal Iliac)
- Superior and Inferior Gluteal Arteries
What Arteries supply the Gluteal Region?
Deep Femoral Artery:
-Medial Circumflex Femoral Branch:
-Lateral Circumflex Femoral Branch:
-Ascending Branch
-Transverse Branch
-Descending Branch
Obturator Artery
Internal Iliac Artery:
-Superior Gluteal Artery
-Inferior Gluteal ArteryWhat does the Deep Femoral Artery (Deep Artery of Thigh, Deep Peroneal Artery) Supply?
-Anterior Compartment of Thigh (Portions)
Which branch of the femoral artery supplies the head and neck of the femur?
Medial Circumflex Femoral Branch
The Lateral Circumflex Femoral Branch further divides into what branches?
- Ascending Branch
- Transverse Branch
- Descending Branch
What branch of the Lateral Circumflex supplies part of the gluteal region?
Ascending Branch
The Transverse branch of the Lateral Circumflex femoral branch artery supplies what structure?
Part of Femur
The Descending Branch of the Circumflex Femoral Branch artery supplies what area and joins what?
Descends to the Knee
Joins Genicular Anastomoses
What branch of the internal iliac supplies muscles of the medial compartment of the thigh (adductors of thigh and gracilis)?
Obturator
What branch of the obturator artery supplies the head of the femur? What does this artery lie within?
Acetabular Artery within Ligament of head of Femur (Ligamentum capitis Femoris)
What branch of the Internal Iliac Artery supplies the Piriformis, Gluteus Maximus, Gluteus Medius, Gluteus Minimus, and Tensor Fasciae Latae?
Superior Gluteal Artery
The Inferior Gluteal Artery, a branch of the internal iliac artery, supplies what?
Piriformis
Quadratus Femoris
Gluteus Maximus
What nerve of the Lumbar Plexus provides motor innervation to the anterolateral and abdominal wall muscles and sensory innervation to the skin of the inferior abdomen and buttock?
Iliohypogastric Nerve
The Ilioinguinal Nerve of the Lumbar Plexus innervates what?
- Motor: Muscles of anterolateral abdominal wall
- Sensory: Skin of Superior Medial Aspect of Thigh
What nerve innervates the Cremaster muscle and skin over the middle anterior surface of the thigh, scrotum, and labia majora?
Genitofemoral Nerve of the Lumbar Plexus
What nerve of the Lumbar Plexus innervates the Skin over the lateral, Anterior, and Posterior aspects of the Thigh?
Lateral Cutaneous Nerve of the Thigh
The Femoral Nerve of the Lumbar Plexus innervates what structures?
- Flexor Muscles of Thigh
- Extensor Muscles of Leg
- Skin over Anterior and Medial aspect of Thigh, and medial side of leg and foot
The Obturator Nerve of the Lumbar Plexus innervates what structures?
Adductor muscles of Leg
- Adductor Magnus
- Adductor Longus
- Adductor Brevis
- Pectineus
- Gracili
- Skin over Medial Aspect of Thigh
