Exam 6 Lower Extremity 61X Flashcards
1
Q
What are some of the main branches of the Sacral Plexus?
A
Sciatic Nerve
Superior Gluteal Nerve
Inferior Gluteal Nerve
Pudendal Nerve (Supplies Perineum)
2
Q
What are some of the main branches of the Sacral Plexus?
A
Sciatic Nerve Superior Gluteal Nerve Inferior Gluteal Nerve Pudendal Nerve: -Supplies Perineum
3
Q
The Superior Gluteal Nerve of the Sacral Plexus innervates what?
A
Gluteus Minimus
Gluteus Medius
Tensor Fasciae Latae
4
Q
A Characteristic motor loss resulting in weakened abduction of thigh by the gluteus medius, disabling gluteus medius limp, and gluteal gait (compensatory list of the body to weakened gluteal side, is seen with injury to what nerve?
A
Superior Gluteal Nerve Injury
5
Q
Weight supported on both feet with no injury will have what positioning of the pelvis?
A
Pelvis is evenly supported and does not sag
6
Q
When no injury is to the superior gluteal nerve is present if weight is borne by one foot what will the muscles of the lower extremity do?
A
Muscles on the same side will hold the pelvis so it will not sag
7
Q
What will occur if the gluteus medius and gluteus minimus are inactive due to superior gluteal nerve injury when weight is borne by one foot?
A
Pelvis fall on the side of the raised limb
-Steady action is lost
8
Q
What is a positive Trendelenburg sign?
A
Hip drop on one side (raised leg) or during walking
9
Q
The Gluteus Maximus is innervated by what nerve of the sacral plexus?
A
Inferior Gluteal Nerve
10
Q
The Piriformis Muscle is innervated by what nerve of the Sacral Plexus?
A
Nerve to Piriformis
11
Q
The Sural Nerve is a sensory nerve in the calf region is made up of collateral branches of what two nerves?
A
Tibial Nerve
Common Fibular Nerve
12
Q
The Sural Nerve is a sensory nerve in the calf region is made up of collateral branches of what two nerves?
A
Tibial Nerve
Common Fibular Nerve
13
Q
The Tibial Nerve, branch of the Sciatic Nerve, furthers divides into what?
A
Medial Plantar Nerve
Lateral Plantar Nerve
14
Q
The Common Fibular Nerve (Common Peroneal), branch of the Sciatic Nerve, furthers divides into what?
A
Deep Fibular Nerve
Superficial Fibular Nerve
15
Q
The Tibial Nerve innervates what?
A
-Gastrocnemius
-Plantaris
-Soleus
-Popliteus
-Tibialis Posterior
-Flexor Digitorum Longus
-Flexor Hallucis Longus
FOOT:
-Medial Plantar
-Lateral Plantar
16
Q
What branch of the Tibial Nerve innervates the Abductor Hallucis, Flexor Digitorum Brevis, Flexor Hallucis Muscles and First Lumbrical Muscles?
A
Medial Plantar Nerve
17
Q
The Lateral Plantar Nerve, a branch of the Tibial Nerve innervates what structures?
A
- Plantar Muscles of Foot (Remaining)
- Skin over Lateral 1/3 of Plantar Surface of Foot
18
Q
The Tibialis Anterior, Extensor Hallucis Longus, Fibularis Tertius, Extensor Digitorum Longus, Extensor Digitorum Brevis muscles, and skin on adjacent sides of great and second toe are innervated by what nerve?
A
Deep Fibular (Branch of Common Fibular)
19
Q
The Tibialis Anterior, Extensor Hallucis Longus, Fibularis Tertius, Extensor Digitorum Longus, Extensor Digitorum Brevis muscles, and skin on adjacent sides of great and second toe are innervated by what nerve?
A
Deep Fibular (Branch of Common Fibular)
20
Q
Where does the Sciatic Nerve exit the pelvic cavity?
A
Greater Sciatic Foramen below the Piriformis
21
Q
What occurs in about 10% of the population in relation to the sciatic nerve?
A
Nerve passes through Piriformis (Conditions which cause the muscle to shorted and contract increase nerve compression)
22
Q
What occurs in about 10% of the population in relation to the sciatic nerve?
A
Nerve passes through Piriformis (Conditions which cause the muscle to shorted and contract increase nerve compression)
23
Q
Piriformis Syndrome can have what symptoms?
A
Buttock pain
Sciatic Symptoms in leg
-Sciatic component of pain in the leg can be in dermatome of any nerves that comprise the sciatic nerve (L4,L5,S1, S2)
24
Q
What is the treatment for Piriformis Syndrome?
A
Release of contracted piriformis muscle w/combination of exercises, acupuncture, trigger point injections
-Surgery (Release from attachment to superior part of greater trochanter of femur)
25
Why is the gluteal region a common site for intramuscular injections? What has to be considered about this area?
- Muscles are thick and large (Good Absorption)
| - Area of Sciatic Nerve
26
Intramuscular injections in the gluteal region should be made in what area?
Superior to line extending from Posterior Superior Iliac Spine to Superior Border of Greater Trochanter
27
What are the three of the four muscles of the Quadriceps Femoris muscle group that can be identify as surface features?
Rectus Femoris
Vastus Lateralis
Vastus Medialis
(Vastus Intermedius is deep to the three)
28
What muscle that is not part of the Quadriceps Femoris muscle group is able to be identified as a surface feature of the thigh?
Sartorius
29
What makes up the Iliotibial Tract?
Aponeurosis of Tensor Fasciae Lata plus the Gluteus Maximus Muscles
30
What makes up the Iliotibial Tract?
Aponeurosis of Tensor Fasciae Lata plus the Gluteus Maximus Muscles
31
What are the Compartments of the Thigh?
```
Anterior Compartment
Medial Compartment (Adductor Group)
Posterior Compartment (Hamstrings)
```
32
What is found in the Posterior Compartment (Hamstrings) of the Thigh?
```
-Muscles:
Biceps Femoris
Semitendinosus
Semimembranosus
-Other:
(Gluteus Maximus, kinda)
-Sciatic nerve
```
33
What is found in the Anterior Compartment of the Thigh
```
Muscles:
-Pectineus (Transitional muscle between anterior and medial compartment
-Iliopsoas:
-Psoas Major
-Psoas Minor
-Iliacus
-Sartorius
-Quadriceps Femoris:
-Rectus Femoris
-Vastus Lateralis
-Vastus Medialis
-Vastus Intermedius
-Other:
(Femur is in this location)
```
34
What is found in the Medial Compartment (Adductor Group) of the Thigh?
```
Muscles:
-Pectineus (Transitional Muscle between Anterior and Medial Compartment)
-Adductor Longus
-Adductor Brevis
-Adductor Magnus
-Gracilis
-Obturator Externus
-Other Structures:
Deep Fascia
Femoral Artery
Femoral Vein
```
35
Which muscles of the Anterior and Medial Compartments are not part of the free appendage and so they may be categorized as "extrinsic" muscles of the thigh?
Iliopsoas: Psoas Major, Psoas Minor, Iliacus
Pectineus
Obturator Externus
36
Name the primary nerves of the Anterior, Medial, and Posterior Compartments?
Anterior: Femoral Nerve
Medial: Obturator Nerve
Posterior: Sciatic Nerve
37
What is the Origin and Insertion of the Sartorius Muscle?
Origin: Anterior Superior Iliac Spine (ASIS)
Insertion: Pes Anserine Tendon at Upper tibia
38
What is the Action and Innervation of the Sartorius Muscle?
Action:
-Flexes, Abducts, and Laterally rotates femur at hip
-Flexes leg at knee
Innervation: Femoral Nerve
39
Name some of the Characteristics of the Sartorius Muscle?
- Longest Muscle in Body
- AKA Tailor's Muscle
- Superior Portion: Lateral Border of Femoral Triangle
40
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
41
What is the Action and Innervation of the Iliopsoas Muscles?
- Action: Flex torso and thigh w/respect to ea other, rotate thigh laterally
- Innervation:
- Psoas: Lumbar Spinal Nerves
- Iliacus: Femoral Nerve
42
What is the Origin and Insertion of the Tensor Fasciae Latae?
- Origin: Anterior Superior Iliac Spine (ASIS) and Iliac Crest
- Insertion: Tibia Via Iliotibial Tract (ITB)
43
What is the Action and Innervation of the Tensor Fasciae Latae?
-Action: Flexes, Abducts, and Medially rotates thigh at hip joint
HELPs: Stabilize and steady the hip and knee joints by putting tension on ITB fascia
-Innervation: Superior Gluteal Nerve
44
What is the Origin and Insertion of the Rectus Femoris?
- Origin: Anterior Inferior Iliac Spine (AIIS)
| - Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar ligament
45
What is the action and innervation of the Rectus Femoris?
- Action: Extends Leg at Knee, Flexes Thigh at Hip
| - Innervation: Femoral Nerve
46
What is the Origin and Insertion of the Vastus Lateralis?
- Origin: Grater Trochanter and Linea Aspera of Fermur
| - Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar ligament
47
What is the Action and Innervation of the Vastus Lateralis?
Action: Extends Leg at Knee
Innervation: Femoral Nerve
48
What is the Origin and Insertion of the Vastus Medialis?
- Origin: Linea Aspera of Femur
| - Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar ligament
49
What is the Action and Innervation of the Vastus Medialis?
Action: Extends leg at Knee
Innervation: Femoral Nerve
50
What is the Origin and Insertion of the Vastus Intermedius?
- Origin: Superior Anterior and Lateral Surfaces of Femur
| - Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar ligament
51
What is the Action and Innervation of the Vastus Intermedius?
Action: Extends leg at knee
Innervation: Femoral Nerve
52
What are the boundaries of the Femoral Triangle, in which femoral nerves and vessels pass through this space?
- Superior (Base): Inguinal Ligament (External Oblique)
- Lateral: Sartorius
- Medial: Adductor Longus
- Floor: Iliopsoas and Pectineus
53
How are the Major vessels and nerves arranged in the superior aspect of the femoral triangle? (Lateral to Medial)
```
Femoral Nerve
Femoral Artery
Femoral Vein
Lymphatics
(NAVL)
-Femoral Sheath covers these
```
54
What area of the femoral triangle allows distension of femoral vein, is normally filled w/ extraperitoneal fat? What are the openings called in this structure?
Femoral Canal
- Femoral Ring (Proximal End)
- Saphenous Hiatus (Distal End)
55
Name the general features of the hamstring muscles?
Origin: Ischial Tuberosity
Insertion: Tibia or Fibula
Innervated: Tibial Nerve of Sciatic Nerve
56
What muscles are considered Part of the Hamstring muscles?
- Semitendinosus
- Semimembranosus
- Biceps Femoris (Long Head Only)
- Adductor Magnus (AKA vertical or posterior portion)
57
What joint and action do the Hamstring Muscles have?
Hip and Knee
- Extend thigh at hip
- Flex leg at knee
58
Why are the Hamstring muscles not able to perform both extending of hip and flexing of knee at the same time?
Requires to much shortening of the muscle
59
What is the Origin and Insertion of the Biceps Femoris Muscle?
- Origin:
- Long Head: Ischial Tuberosity
- Short Head: Linea Aspera of Femur
- Insertion: Fibular Head and Lateral Tibial Condyle
60
What is the Action and Innervation of the Biceps Femoris Muscle?
```
-Action: Entire muscle- flexes leg at knee
Long Head extends thigh at hip
-Innervation: Sciatic Nerve constituents
-Long Head: Tibial Nerve
-Short Head: Common Fibular Nerve
```
61
What is the Origin and Insertion of the Semitendinosus muscle?
Origin: Ischial Tuberosity
Insertion: Pes Anserine Tendon at Upper Tibia
62
What is the Action and Innervation of the Semitendinosus Muscle?
- Action: Flexes leg at Knee and Extends thigh at hip
| - Innervation: Tibial Nerve
63
What is the Origin and Insertion of the Semimembranosus Muscle?
- Origin: Ischial Tuberosity
| - Insertion: Medial Condyle of Tibia
64
What is the Action and Innervation of the Semimembranosus Muscle?
- Action: Flexes leg at knee and extends thigh at hip
| - Innervation: Tibial Nerve
65
What is the Origin and Insertion of the Adductor Brevis Muscle?
Origin: Pubis
Insertion: Linea Aspera of Femur
66
What is the Action and Innervation of the Adductor Brevis Muscle?
- Action: Adducts and Flexes the thigh
| - Innervation: Obturator Nerve
67
What is the origin and insertion of the Adductor Longus Muscle?
Origin: Pubis
Insertion: Linea Aspera of Femur
68
What is the Action and Innervation of the Adductor Longus Muscle?
- Action: Adducts and Flexes Thigh
| - Innervation: Obturator Nerve
69
What is the Origin and Insertion of the Adductor Magnus Muscle?
Origin:
-Anterior (Adductor) Head: Pubis and Ischium
-Posterior (Hanmstrings) Head: Ischial Tuberosity
Insertion:
-Anterior (Adductor): Linea Aspera of Femur
-Posterior (Hamstrings): Adductor Tubercle of Femur
70
What is the Action and innervation of the Adductor Magnus?
Action:
-Anterior (Adductor): Adducts and Flexes thigh
-Posterior (hamstrings): Adducts and Extends Thigh
Innervation:
-Anterior (Adductor): Obturator Nerve
-Posterior (Vertical or Hamstring) portion: Tibial Nerve
71
What is the Origin and Insertion of the Pectineus Muscle?
Origin: Pubis
Insertion: Pectineal Line of Femur
72
What is the Action and Innervation of the Pectineus Muscle?
- Action: Adducts Thigh and Flexes the hip
| - Innervation: Femoral Nerve; Frequently also obturator nerve
73
The Pectineus both adducts and flexes the thigh and what compartment is it apart of?
Transitional muscle between anterior and medial compartments
74
What is the origin and insertion of the Gracilis Muscle?
- Origin: Pubis
| - Insertion: Pes Anserine Tendon at Upper Tibia
75
What is the Action and Innervation of the Gracilis Muscle?
- Action: Adducts and Flexes Thigh at the hip and Flexes the leg at Knee
- Innervation: Obturator Nerve
76
What is another name for the Adductor Canal?
Subsartorial Canal
77
Where does the Adductor Canal (Subsartorial Canal) Begin and End?
- Begin: Sartorius crosses adductor longus
| - Ends: Adductor Hiatus (formed by adductor magnus)
78
Where does the Femoral Artery exit the adductor canal and what does it become?
Adductor Hiatus
| -Becomes: Popliteal Artery
79
Where does the Popliteal Vein enter the adductor canal and what does it become?
Adductor Hiatus
| -Becomes: Femoral Vein
80
What is the terminal cutaneous branch of the femoral nerve?
Saphenous Nerve
81
What marks the end of the adductor canal at the opening of the long tendon of the adductor magnus?
Adductor Hiatus
82
What is the final common tendinous insertion of the conjoined tendons of (anterior to posterior) the Sartorius, Gracilis, and Semitendinosus Muscles onto the Anteromedial Proximal Tibia?
Pes Anserine (AKA Pes Anserinus; Latin for goose's foot)
83
The conjoined Pes Anserine tendon lies superficial to the tibial insertion of what ligament of the knee?
Medial Collateral Ligament (MCL)
84
The Pes Anserine Group is sometimes called the inside hamstring muscles and are responsible for what?
Flexing the knee and stabilizing the inside of the knee
85
Cutaneous Innervation of the Anterior Thigh is provided by what?
Femoral nerve (from Lumbar Plexus)
86
Cutaneous Innervation of the Lateral Thigh is provided by what?
Lateral Cutaneous Nerve of the Thigh (AKA Lateral Femoral Cutaneous Nerve) (from Lumbar Plexus)
87
Cutaneous Innervation of the Posterior Thigh is provided by what?
Posterior Cutaneous Nerve of the Thigh (From the Sacral Plexus)
88
Cutaneous Innervation of the Medial Thigh is provided by what?
Obturator Nerve (From Lumbar Plexus)
89
What nerve is subject to damage when the Anterior Superior Iliac Spine (ASIS) is severely traumatized?
Lateral Cutaneous Nerve of the Thigh (Lateral Femoral Cutaneous Nerve)
90
What Nerve Provides Cutaneous innervation to the inferior buttock, posterior thigh, popliteal fossa, and lateral perineum?
Posterior Femoral Cutaneous Nerve
91
Which dermatome crosses the knee and medial malleolus and provides a good anterior landmark?
L4
92
Which dermatome extends from the lateral head of the gastrocnemius to the lateral (little toe) foot and serves as a good posterior landmark?
S1
93
Which dermatome extend from medial head of gastrocnemius to the medial aspect of the heel and medial arch?
S2
94
What is the name of the diamond-shaped depression of the posterior aspect of the knee?
Popliteal fossa
- Roof: Popliteal Fascia
- Floor: Popliteal Surface of Femur
95
The popliteal fossa is bounded by what superiorly and what inferiorly?
Superiorly:
-Hamstrings
Inferiorly:
-Two heads of gastrocnemius and plantaris
96
Where do all the important vessels and nerves from the thigh to the leg pass through?
Popliteal Fossa
97
What are the names of the tendons that are visible at the popliteal area?
- Tendon of Semitendinosus Muscle (Medial)
| - Tendon of Biceps Femoris (lateral)
98
The Small Saphenous vein empties into what at the popliteal fossa?
Popliteal Vein
99
What is the largest joint in the human body?
Knee
100
What type of joint is the Knee joint?
Weight-bearing hinge-type synovial joint
| Comprised of Ligaments, Cartilage, Bone, and Bursae
101
What makes the Knee Joint relatively weak mechanically?
- Incongruence of Articular Surfaces
| - Absence of some degree of enclosure of one articulating bone by the other
102
How many articulations are found in the Knee Joint and what are they?
3
- Lateral and Medial Articulations (Femoral and Tibial Condyles)
- Patellofemoral Joint (Patella and Femur)
103
What Bone is not involved in the Knee Joint?
Fibula
104
The Combination of Patella and Patellar Ligament (Anterior aspect), Articular margins of the condyle and intercondylar fossa of the femur, and condyle of the tibia (forming superior, posterior, and inferior aspects), form what?
Fibrous Capsule of the Knee Joint
105
What lines the internal aspect of the fibrous capsule?
Synovial Membrane
106
What are the attachment points of the Synovial Membrane of the fibrous capsule of the knee joint?
- Periphery of patella
- Edge of Menisci
- Reflects onto Cruciate Ligaments
107
What are the Extracapsular Ligaments that strengthen the knee?
- Patellar Ligament
- Fibular Collateral Ligament (Lateral Collateral Ligament)
- Tibial Collateral Ligament (Medial Collateral Ligament)
- Oblique Popliteal Ligament
- Arcuate Popliteal Ligament
108
Which extracapsular ligaments provide stability to the lateral and medial aspect of the knee?
-Lateral Aspect:
Lateral Collateral Ligament (Fibular Collateral Ligament)
-Medial Aspect:
Medial Collateral Ligament (Tibial Collateral Ligament)
109
Which extracapsular ligament is more commonly damaged and is weaker than the Lateral Collateral Ligament (Fibular Collateral Ligament)?
Tibial Collateral Ligament (Medial Collateral Ligament)
110
What deepens the articular surface on the tibia and acts as a shock absorber and fills in gaps during joint movement?
Menisci (Fibrocartilaginous Disc)
| -Medial and Lateral Meniscus
111
The Menisci attach to what peripherally and are within what?
Synovial Capsule
112
Which Menisci attaches to the tibial collateral ligament and is more likely to be injured?
Medial Meniscus
113
The lateral meniscus is not attached to what?
Fibular Collateral Ligament (its corresponding ligament)
114
Which Menisci is nearly circular, smaller, and more freely movable?
Lateral Meniscus
115
Which Menisci is C-shaped, larger, and concomitant tearing occurs with tearing of the tibial collateral ligament dues to their firm attachment to each other?
Medial Meniscus
116
What connects the Lateral Meniscus and Medial Meniscus anteriorly?
Transverse Ligament of the Knee
117
What Intra-articular Ligaments crisscross within the articular capsule of the knee joint but are outside the synovial joint cavity?
Cruciate Ligaments
- Anterior Cruciate Ligament (ACL)
- Posterior Cruciate Ligament (PCL)
118
What Cruciate ligament is the weaker of the two and extends from Anterior intercondylar eminence of tibia to medial side of the lateral femoral condyle?
Anterior Cruciate Ligament (ACL)
119
When is the ACL slack and when is it taunt?
```
Slack:
-Flexed Knee
Taunt:
-Fully Extended Knee
(Preventing hyperextension)
```
120
What does the ACL prevent?
Posterior Displacement of femur on the tibia
| Anterior displacement of tibia relative to Femur
121
The Stronger Posterior Cruciate Ligament (PCL) extends from where to where?
Posterior Intercondylar eminence of tibia to lateral side of the medial femoral condyle
122
What does the PCL tighten?
Flexion of the Knee Joint
123
What does the PCL prevent?
Anterior displacement of the femur on Tibia
| Posterior displacement of tibia relative to femur
124
The PCL is the main stabilizing factor for the femur when?
Weight bearing flexed knee (i.e. Walking downhill)
125
Fibular Collateral Ligament is separated from the capsule, where does it arise and insert?
```
Arise:
Lateral condyle of Femur
(Near origin of popliteus muscle)
Insert:
Lateral head of fibula
```
126
What are the Bursae of the Knee?
Suprapatellar Bursa
Prepatellar Bursa
Infrapatellar Bursa
127
Twisting strain to the knee may cause what?
"Triad of Injuries"
- ACL tear
- Tibial Collateral Ligament tear
- Medial Meniscus Tear
128
A severe force directed anteriorly w/ the knee semiflexed may cause what to tear? What does this allow with the articulation of the bones at the knee?
ACL Tear
| -Allows Tibia to slide anteriorly from femur
129
What test is used to evaluate the integrity of the ACL? What does endpoint laxity suggests?
Anterior Drawers Test
| Endpoint Laxity: Ruptured ACL
130
If a patient landed on their tibial tuberosity with the knee flexed what injury may occur and what other structures may be injured in conjunction?
PCL tear
| Tibial or Fibular Ligament Tears
131
The PCL prevents the femur from sliding anteriorly to the tibia, what test is used to evaluate the integrity of the PCL and what does endpoint laxity in this test suggest?
Posterior Drawers Test
| Endpoint Laxity: PCL Rupture
132
What is another name for runner's knee?
Patellofemoral Stress Syndrome (very common)
133
During flexion and extension of the knee the patella tracks laterally in addition to normal superior and inferior movement within the femoral condyles (grooves), this causes what?
Patellofemoral Stress Syndrome (Runner's Knee)
134
The increased pressure on the joint causes aching, tenderness, pain around or under the patella which is worsened when?
Seated for a period of time and get up
Walking down stairs
Squatting
135
What are some of the predisposing factors/causes that bring on Patellofemoral Stress Syndrome?
- Walking, running, jogging, same side of slopped road
- Running hills
- Running Long Distances
- Genu Valgum (Knock knees)
