First Slide Deck Flashcards
Regions of the Lower Extremity
Gluteal Thigh (femoral) Knee Patellar (anterior) Popliteal (posterior) Leg (crural) Anterior Calf (sural) Foot (pedal)
Pelvic girdle is attached to the vertebral column (sacroiliac joints)
Hip bones are firmly attached at the midline
Knee has stabilizing ligaments and muscles on which it depends
Fibula does not enter into the knee joint
Bones of the foot are large and adapted for bearing weight
Flexor versus extensor surfaces
Features of the Lower Limb
Features of the Lower Limb
Pelvic girdle is attached to the vertebral column (sacroiliac joints)
Hip bones are firmly attached at the midline
Knee has stabilizing ligaments and muscles on which it depends
Fibula does not enter into the knee joint
Bones of the foot are large and adapted for bearing weight
Flexor versus extensor surfaces
STRENGTH VERSUS LOCOMOTION
Weight-bearing appendage needs strength
Locomotion appendage needs flexibility and range of motion
Structural compromise between stability and range of motion
Weight-bearing appendage needs ___
strength
Locomotion appendage needs flexibility and ____
range of motion
Structural ____ between stability and range of motion
compromise
Os Coxae (ilium, ischium, pubis) Femur Patella Tibia Fibula Tarsals (7) Metatarsals (5) Phalanges (14)
Bones of the Lower Extremity
Bones of the Lower Extremity
Os Coxae (ilium, ischium, pubis) Femur Patella Tibia Fibula Tarsals (7) Metatarsals (5) Phalanges (14)
Ilium
Ischium
Pubis
Hip (os coxae) component
Hip (os coxae) component
Ilium
Ischium
Pubis
Bones fuse in late teens / early 20s to form a single bone, the os coxae AKA ____
innominate bone
Slide 8, 9 for views of the hip
check it
Skin dimples mark the position of the ____
posterior superior iliac spines
The dimples are typically more visible in women than in men
Skin dimples mark the position of the posterior superior iliac spines
Slide three for lower limb definitions
aight
Consists of complete ring composed of hip bones, pubic symphysis, and sacrum
Bony pelvis
Bony Pelvis has?
complete ring composed of hip bones, pubic symphysis, and sacrum
The portion of the bony pelvis superior to the pelvic brim is the ____.
false (greater) pelvis
The portion of the bony pelvis inferior to the pelvic brim is the ____.
true (lesser) pelvis
The___ contains the urinary bladder, portions of the large intestine, and internal organs of the reproductive system
pelvic cavity
Bones of males are generally ____, and have larger surface markings than those of females of comparable age and physical stature
larger and heavier
Most structural differences in the female pelvis are adaptations to requirements of ____
pregnancy and childbirth
False pelvis shallow in female (left), ___ in male
deep
Pelvic brim (inlet) larger and more __ in female
oval
Acetabulum smaller and faces ____ in female, faces laterally in male
anteriorly
Obturator foramen oval in female, ___ in male
round
Pubic arch ____° angle in female, < 90° in male
> 90
Check slide 16, 17, 18 for male/female pelvis slides
DO IT
False pelvis shallow in female (left), deep in male
____ larger and more oval in female
Acetabulum smaller and faces anteriorly in female, faces laterally in male
_____ oval in female, round in male
Pubic arch > 90° angle in female, < 90° in male
Pelvic brim (inlet)
Obturator foramen
Iliac crest more/less curved in female?
less
Ilium more/less vertical in female
less
Greater sciatic notch ___ in female
wider
____ more movable and more curved anteriorly in female
Coccyx
___ shorter and wider in female
Sacrum
Pelvic outlet wider in?
female
Ischial tuberosity shorter, farther apart, and more medially projecting in female; whereas in males it’s
longer, closer together, and more laterally projecting in male
Slide 18
Slide 20 for some bone deets
word
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
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
Coxa ___ = less (horizontal neck)
Coxa ___ = more (vertvaraical neck)
vara
valga
The angle of ____ varies with age, sex, and development of the femur. It may also change with pathological processes that weaken the neck of the femur, such as rickets.
inclination
Slides 19-23 for coxa vara, coxa valga
He has the same definition several times… hint, hint
Leg—Osteology?
Tibia
Fibula
Slide 25, 26
tibia
Fibula
Talus Calcaneus Navicular Cuboid Cuneiforms (3)
Tarsals (7 bones)
7 tarsal bones?
Talus Calcaneus Navicular Cuboid Cuneiforms (3)
How many metatarsals?
5
How many phalanges?
14
Slide 28, 29 for a foot
check it
Fractures of the metatarsals can occur when a heavy object falls on the foot, or when a heavy object rolls over the foot.
Sciecne
Metatarsal fractures are also common among dancers, especially female ballet dancers, who place the full weight of their body on the tips of their toes. Additional forces result from ballet movements
Sports
Slide 31, 32
ok
The bones of the foot are arranged in ___ that are held in position by ligaments and tendons
two arches
What are the two arches of the foot?
Longitudinal arch, which has two parts
Transverse arch
distribute body weight over the soft and hard tissues of the foot
provide leverage while walking
yield as weight is applied because they are not rigid, and spring back when the weight is lifted, thus storing energy for the next step and helping to absorb shocks
Functions of the arches
Functions of the arches
Distribute weight
Provide leverage
yield weight (energy storage/absorption)
The MEDIAL part of the longitudinal arch originates at the ____, rises to the talus, and descends through the navicular, the three cuneiforms, and the heads of the three medial metatarsals
calcaneus
The MEDIAL part of the longitudinal arch originates at the calcaneus, rises to the talus, and descends through the navicular, the three cuneiforms, and the heads of the ____
three medial metatarsals
The LATERAL part of the longitudinal arch also originates at the calcaneus. It rises at the cuboid, and descends to the heads of the _____
two lateral metatarsals
The transverse arch is formed by the ___, the three cuneiforms, and the bases of the five metatarsals
cuboid
The __ of the foot normally carries about 40% of the weight, and the heel carries about 60%
ball
High-heeled shoes changes the normal distribution so that the __ of the foot may carry up to 80%. As a result, the fat pads at the ball of the foot are damaged, structural changes in bones may occur, and joint pain develops
ball
Deep to subcutaneous tissue
Connects “skin” to bone
FASCIA
Forms compartments
Provides tight fitting sleeve of support for upright posture
FASCIA
Fascia lata/Iliotibial band
Crural fascia
Retinacula
FASCIA
Deep fascia of the thigh
Superior attachment: inguinal ligament
Defect: saphenous hiatus
Fascia Lata
Fascia Lata superior attachment?
inguinal ligament
Lateral thickening of the fascia lata attached distally to the lateral tibial condyle
Insertion of gluteus
maximus and tensor fasciae latae muscles
Septa dividing the three compartments arise here
Iliotibial tract
Lateral thickening of the fascia lata attached distally to the lateral tibial condyle
Iliotibial tract
Insertion of gluteus maximus and tensor fasciae latae muscles
Iliotibial tract
Septa dividing the three compartments arise here
Iliotibial tract
Deep fascia of the leg
Attachment: anterior and medial borders of the tibia, where it is continuous with its periosteum
Crural Fascia
Crural intermuscular septa plus the interosseous membrane divide the leg into three compartments
Crural Fascia
Crural fascia thickens to form the ____ near the ankle
extensor retinacula
divides into right and left common iliac arteries at about the level of the fourth lumbar vertebra
Abdominal aorta
Primarily an artery of the pelvis, it supplies pelvic viscera and perineum
Supplies superior portions of the lower limb via gluteal arteries and obturator artery
Internal iliac
‘Femoral’ distal to the inguinal ligament
External iliac
‘Femoral’ distal to the ?
inguinal ligament
‘Popliteal’ distal to the adductor hiatus
External iliac
‘Popliteal’ distal to the ___?
adductor hiatus
Anterior tibial artery -> ___?
Anterior tibial artery dorsalis pedis
Posterior tibial artery -> ___?
medial and lateral plantar arteries
Slide 45-47?
BLOOD
Lower limb has superficial and deep veins
Novel concept
In the subcutaneous tissue
Not accompanied by corresponding arteries
Have valves (less dense in arrangement than deep vein valves)
Superficial veins
Not accompanied by corresponding arteries
Superficial veins
Deep to the deep fascia
Accompany all major arteries
Have valves (more dense in arrangement than superficial veins)
Deep veins
Superficial venous drainage
Great and small saphenous
Formed by union of the dorsal vein of the great toe and the dorsal venous arch
Ascends anterior to medial malleolus accompanied by the saphenous nerve
Great saphenous
Passes posterior to the medial condyle of the femur
Anastomoses frequently with the small saphenous vein
Empties into the femoral vein
Great saphenous
Great saphenous empties into the?
femoral vein
Formed by union of the dorsal vein of the small toe and the dorsal venous arch. Ascends posterior to lateral malleolus accompanied by sural nerve
Empties into the popliteal vein in the popliteal fossa
Small saphenous
Slide 50 for visual
ok
Interconnect superficial and deep veins
Perforating veins
Contain valves that allow blood to flow only from superficial veins to deep veins
Perforating veins
Permit diameter of saphenous veins to remain fairly constant even as the veins ascend (normally, veins become larger closer to the heart since they receive more blood on their way to the heart), because blood is shunted from superficial veins to deep veins
Perforating veins
Permit diameter of saphenous veins to remain fairly constant even as the veins ascend (normally, veins become larger closer to the heart since they receive more blood on their way to the heart), because blood is shunted from ____
(Perforating veins)
superficial veins to deep veins
Accompany deep arteries of the lower limb
Generally occur as paired frequently interconnecting veins, rather than as a single structure
Deep veins
Receive blood from superficial veins via perforating veins
Musculovenous pump assists in movement of blood to heart
Have greater density (and more) valves than superficial veins
Deep veins
Slide 53-55….
legs
Incompetent venous valves can cause veins to become dilated and tortuous, a condition called varicose veins, or varices
Varicose Veins
Although the condition may occur in veins in most any part of the body, the great saphenous vein and its tributaries are particularly susceptible
Varicose Veins
The valves causing the problem are generally valves of the saphenous vein(s), or of the perforating veins.
Varicose Veins
Veins close to the surface, especially the ____, are highly susceptible to varicosities, whereas deeper veins are not as vulnerable due to the surrounding skeletal muscles
saphenous vein
Extrinsic muscle of lower extremity?
Psoas major
Iliac region (iliacus) Gluteal region Thigh compartments (3) Leg compartments (3) Dorsum of the foot Sole of the foot
Intrinsic muscles of lower extremity
Muscles of the Posterior Abdominal Wall?
‘Iliopsoas’
- Psoas major (and minor)
- Iliacus
‘Iliopsoas’?
- Psoas major (and minor)
- Iliacus
Origin: transverse processes of lumbar vertebrae
Insertion: lesser trochanter of femur
Psoas major (and minor)
Psoas major (and minor) origin and insertion?
Origin: transverse processes of lumbar vertebrae
Insertion: lesser trochanter of femur
Action: flexion of hip, flexion of vertebral column
Innervation: lumbar spinal nerves
Psoas major (and minor)
Psoas major (and minor) action and innervation?
Action: flexion of hip, flexion of vertebral column
Innervation: lumbar spinal nerves
Origin: iliac fossa, sacrum
Insertion: lesser trochanter of femur
Iliacus
Iliacus origin and insertion?
Origin: iliac fossa, sacrum
Insertion: lesser trochanter of femur
Action: flexion of hip
Innervation: femoral nerve
iliacus
Iliacus action and innervation?
Action: flexion of hip
Innervation: femoral nerve
Slide 60
Muscles
The hip joint is a multiaxial ball-and-socket type of ___joint that provides both stability and a wide range of movement
synovial
bony structure: femoral head is ball, and the cup-like acetabulum is the socket
ligaments
musculature
Stabilizing factors of the hip joint
Hip movements on slide 63, 64
rad
the central part of the acetabulum, it is the non-articular part and occupied by a synovial fatpad
Acetabular fossa
the true articular surface. It is lined with hyaline cartilage
Lunate surface
the inferior part of acetabulum. It is bridged by the transverse ligament
Acetabular notch
fibrocartilage lip that increases the depth of the acetabulum, and grasps the femoral head beyond its equator
Acetabular labrum
Slide 66 for hip view
stuff
follows the bony rim of the cup-shaped acetabulum
acetabular labrum
acetabular labrum composed of?
fibrocartilage
deepens the acetabular fossa, and helps stabilize the head of the femur in the acetabulum
acetabular labrum
The acetabular surface is smooth and lined by ____
articular cartilage
The head of the femur is also covered by articular cartilage on its surface, except?
where the ligament of the head of the capsule attaches
AKA ligament of head of the femur
Ligamentum capitis femoris
This ligament extends from the acetabular notch to the fovea of the head of the femur
Ligamentum capitis femoris
It is weak, and is of little importance in strengthening the hip joint
Ligamentum capitis femoris
It usually contains a small artery to the head of the femur (obturator artery)
Ligamentum capitis femoris
The ____ is both strong and loose, permitting free movement of the hip joint
fibrous articular capsule
Attachments of the articular capsule?
Proximal attachment is the edge of acetabulum and transverse acetabular ligament
Distal attachments are to the intertrochanteric line and femoral neck
Ligaments of the articular capsule are parts of the capsule that are thicker than others. What are the four?
Iliofemoral
Pubofemoral
Ischiofemoral
Ligament of the femoral head
prevents hyperextension
one of the strongest
ligaments in the body
Y-shaped
AKA Ligament of Bigelow
Iliofemoral ligament
(prevents overabduction)
Pubofemoral ligament
prevents hyperextension
Ischiofemoral ligament
The ____ loses the greater sciatic foramen.
sacrospinous ligament c
The ____ attaches the PSIS, PIIS, sacrum and cocyx to the ischial tuberosity. The lesser sciatic notch is converted to the lesser sciatic foramen by the sacrospinous ligament and the sacrotuberous ligaments.
sacrotuberous ligament
slide 71
Slide 71-71 for
ligaments of the pelvis
The hip joint is most stable when it is ___ and/or bearing weight.
fully extended
___ dislocation of the hip joint is reasonably common. Because the hip joint is strong and stable, acquired dislocation is uncommon, however a head-on automobile collision may dislocate the hip.
Congenital
The ____ separates the buttocks (gluteal prominences)
intergluteal (natal) cleft
The ____ is formed by the inferior border of the gluteus maximus, and marks the lower limit of the buttock and the upper limit of the thigh
gluteal sulcus
Act on the hip joint: Abduct and adduct the femur Rotate the femur External rotation – toes lateral Internal rotation – toes medial Flex and extend the femur
GLUTEAL MUSCLES
Superficial Muscles of the Gluteal region?
Gluteus maximus, medius, and minimus
Superior (medius and minimus) and inferior gluteal (maximus) nerves
Extension (maximus -> rising from a seated position) & abduction (medius-minimus)
Gluteus maximus, medius, and minimus
Piriformis Obturator internus Obturator externus Superior gemellus Inferior gemellus Quadratus femoris
‘Short’ lateral rotators (deep) of gluteal region
Origin: iliac crest and sacrum
Insertion: gluteal tuberosity
Gluteus Maximus
Action: extends thigh at hip joint, laterally rotates thigh
Innervation: inferior gluteal nerve
Gluteus Maximus
Gluteus Maximus OIAI?
Origin: iliac crest and sacrum
Insertion: gluteal tuberosity
Action: extends thigh at hip joint, laterally rotates thigh
Innervation: inferior gluteal nerve
Origin: ilium
Insertion: greater trochanter of femur
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
Gluteus Medius
Gluteus Medius OIAI?
Origin: ilium
Insertion: greater trochanter of femur
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
Origin: ilium
Insertion: greater trochanter of femur
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
Gluteus Minimus
Gluteus Minimus OIAI?
Origin: ilium
Insertion: greater trochanter of femur
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
Origin: sacrum
Insertion: greater trochanter of femur
Piriformis
Action: laterally rotates and abducts thigh at the hip joint
Innervation: piriformis nerve
Piriformis
Piriformis OIAI?
Origin: sacrum
Insertion: greater trochanter of femur
Action: laterally rotates and abducts thigh at the hip joint
Innervation: piriformis nerve
Origin: ischial spine
Insertion: greater trochanter of the femur
Superior Gemellus
Action: rotates the thigh laterally; also helps abduct the thigh
Innervation: nerve to the obturator internus and superior gemellus
Superior Gemellus
Superior Gemellus OIAI?
Origin: ischial spine
Insertion: greater trochanter of the femur
Action: rotates the thigh laterally; also helps abduct the thigh
Innervation: nerve to the obturator internus and superior gemellus
Origin: ischial tuberosity
Insertion: greater trochanter of the femur
Inferior Gemellus
Action: rotates the thigh laterally; also helps abduct the thigh
Innervation: nerve to the quadratus femoris and inferior gemellus
Inferior Gemellus
Origin: ischial tuberosity
Insertion: intertrochanteric crest of femur
Quadratus Femoris
Action: rotates the hip laterally (stabilizes hip joint)
Innervation: nerve to the quadratus femoris and inferior gemellus
Quadratus Femoris
Origin: inner (posterior) surface of membrane covering obturator foramen
Insertion: greater trochanter of femur
Obturator Internus
Action: rotates the thigh laterally; also helps abduct the thigh
Innervation: nerve to the obturator internus and superior gemellus
Obturator Internus
Origin: outer (anterior) surface of membrane covering obturator foramen
Insertion: trochanteric fossa of femur
Obturator Externus
Action: rotates the thigh laterally; also helps abduct thigh
Innervation: obturator nerve
Obturator Externus
Slide 88-90 for muscles of hip and thigh
rad
deep artery of the thigh = deep peroneal artery
Deep femoral artery
Supplies portions of anterior compartment of thigh
_____ branch supplies head and neck of femur
(Deep femoral artery)
Medial circumflex femoral
______ branch in turn has branches: ascending branch that supplies part of gluteal region, a transverse branch that supplies part of the femur, and a descending branch that descends to knee and joins genicular anastomoses
(deep femoral artery)
Lateral circumflex femoral
Supplies head of femur
branch of obturator artery within the ligament of head of femur
Supplies muscles of medial compartment of thigh (adductors of thigh and gracilis)
Obturator artery, a branch of the internal iliac
supplies piriformis, all 3 gluteal muscles, and tensor fasciae latae
Superior gluteal artery
supplies piriformis, quadratus femoris, and gluteus maximus
Inferior gluteal artery
Slide 93 for gluteal arteries
aight
Muscles of the anterolateral abdominal wall
Skin of inferior abdomen and buttock
(portion of lumbar plexus)
Iliohypogastric portion of lumbar plexus
Muscles of the anterolateral abdominal wall
Skin of superior medial aspect of thigh
(portion of lumbar plexus)
Ilioinguinal
Cremaster muscle
Skin over middle anterior surface of thigh, scrotum in male, labia majora in female
Genitofemoral
The ___ muscle is a muscle that is developed to its fullest extent only in males
cremaster
Its function is to raise and lower the ___ in order to regulate the temperature of the testis and promote spermatogenesis.
scrotum
Skin over lateral, anterior, and posterior aspects of thigh
lumbar plexus
Lateral cutaneous nerve of thigh
Flexor muscles of thigh
Extensor muscles of leg
Skin over anterior and medial aspect of thigh, and medial side of leg and foot
femoral plexus
Adductor muscles of leg
Skin over medial aspect of thigh
(portion of lumbar plexus)
Obturator
OBTURATOR nerve supplies the ___group (in general)
adductor
Adductor group of muscles in the medial (adductor) compartment of the thigh: adductor magnus, adductor longus, adductor brevis, and what two other muscles?
pectineus, gracilis
Sciatic nerve Superior gluteal nerve Inferior gluteal nerve Pudendal nerve: supplies the perineum (branches of?)
Sacral plexus
Gluteus minimus, gluteus medius, and tensor fasciae latae muscles
Superior gluteal
A characteristic motor loss resulting in weakened abduction of the thigh by the gluteus medius
A disabling gluteus medius limp
A gluteal gait, which is a compensatory list of the body to the weakened gluteal side
Superior Gluteal Nerve Injury
When the ____ are inactive due to superior gluteal nerve injury, their supporting and steadying action is lost. The pelvis falls on the side of the raised limb.
gluteus medius and gluteus minimus
Slide 104-106
When weight is on both feet, the pelvis is evenly supported, and does not sag.When the weight is borne by one foot, the muscles on the same side normally hold the pelvis so it will not sag
Gluteus maximus muscle
Inferior gluteal plexus
Nerve to piriformis goes to …
piriformis
Tibial
Common fibular (common peroneal)
Sciatic
Good sciatic visual on slide 110
Gastrocnemius, plantaris, soleus, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus and medial/lateral plantar` nerve of foot all receive innervation from?
Tibial nerve, from the sciatic
Abductor hallucis, flexor digitorum brevis, flexor hallucis muscles (and first lumbrical)
Skin over medial two-thirds of plantar surface of foot innervated by?
Medial planter nerve (from tibial)
Remaining plantar muscles of foot
Skin over lateral one-third of plantar surface of foot innervated by?
Lateral plantar (from tibial)
Superficial fibular
Deep fibular receive from?
Common fibular… via scaitic
Fibularis longus, fibularis brevis muscles
Skin over distal third of anterior aspect of leg, and dorsum of foot innervared by?
Superficial fibular
from common fibular
Tibialis anterior, extensor hallucis longus, fibularis tertius, extensor digitorum longus, extensor digitorum brevis muscles
Skin on adjacent sides of great and second toes innervated by?
deep fibular (from common fibular)
The sciatic nerve exits the pelvic cavity through the greater sciatic foramen below the ___
piriformis
slide 115
causes compression and irritation of the sciatic nerve in the buttock, and is a cause of buttock pain and sciatica outside the spine.
Piriformis Syndrome
In about 10% of the population, the sciatic nerve passes through ___ instead of under it as normal. Conditions which cause the muscle to become short and contracted increase the nerve compression. Not all cases are due to the nerve passing through the muscle.
piriformis
buttock pain is common as well as sciatic symptoms in the leg. In some people the whole sciatic nerve passes through the muscle at one place, and in others the sciatic nerve is in two parts, with each part passing through at a different level.
Piriformis syndrome symptoms
(piriformis syndrome)The sciatic component of the pain in the leg can be in the dermatome of any of the nerves that comprise the sciatic nerve i.e.?
L4, L5, S1, and S2.
Piriformis treatment?
releasing the contracted piriformis muscle with the combination of exercises, acupuncture, and trigger point injections may be useful. Surgery may occasionally be necessary wherein the tendon is released from its attachment to the superior part of the greater trochanter of the femur.
The gluteal region is a common site for ___ because the muscles are thick and large, providing for good absorption
intramuscular injections
The concept that injections should be given in the “cheek” of the buttock is dangerous because the ___ lies deep to this area
sciatic nerve
Injections into the buttock should always be made superior to a line extending from the posterior superior iliac spine to the superior border of the ___
greater trochanter
