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Anatomy 3 > Functional Lower Limb > Flashcards

Functional Lower Limb Flashcards

1
Q

How does the stress differ between the standing and seated arch of the pelvic joint complex?

A

Standing arch: superior rami of pubic bone stabilizes arch; seated arch: ischiopubic rami stabilize under stress.

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2
Q

What is the function of the pubic symphysis?

A

It holds hip bones together anteriorly, prevent “splaying” under stress.

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3
Q

What influences (controls) the sacroiliac joint?

A

The posterior sacro-iliac ligaments and the bony shape (interlocking) of the joint.

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4
Q

What is the function of the sacrotuberous, sacrospinous and iliolumbar ligaments?

A

Sacrospinous: prevents sacrum from moving postero-superiorly

Sacrotuberous: prevents pubic symphysis from moving anterosuperiorly

Iliolumbar ligaments: control lateral flexion of the vertebral column on the hip.

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5
Q

What is the acetabular labrum and what is its function?

A

The cartilaginous rim of the acetabulum that helps deepen the “fit” of the ball into the socket.

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6
Q

Name the capsular ligaments of the hip joint.

A

Anteriorly: ilifemoral (superior) and pubofemoral (inferior); posteriorly: ischiofemoral.

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7
Q

Which muscles act on the acetabulofemoral sling in extension/flexion?

A

Extension: gluteus maximus, flexion: psoas & ilacus.

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8
Q

Which muscles act on the acetabulofemoral sling in adduction/abduction?

A

Adduction: medial compartment mm. (adductor longus, magnus, brevis, the pectineus & gracilis); abduction: gluteus medius & minimus.

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9
Q

Which muscles act on the acetabulofemoral sling in internal rotation?

A

Internal rotation: tensor fascia lata.

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10
Q

Which muscles act on the acetabulofemoral sling in external rotation?

A

External rotation: piriformis, sup. gemellus, obturator internus, inf. gemellus & quadratus femoris + ext. obturator

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11
Q

Which form of rotation is similar to “lateral” rotation?

A

External rotation = lateral rotation.

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12
Q

What is the role of the rotators in gait?

A

The external rotators externally rotate the swinging limb to prevent its foot from striking on its lateral edge, internal rotators of grounded limb swing the contralateral side of the pelvis forward.

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13
Q

List the bursae of the hip.

A

Know ONLY the most important one, the iliopectineal due to infection of psoas spreading into the hip joint since it communicates with it.

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14
Q

What is a bursae?

A

A sac of synovial membrane with thin synovial fluid layer inbetween.

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15
Q

What is the function of a bursa?

A

The slippery walls allows free movement of skin over bony protuberances.

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16
Q

Which of the two collateral ligaments is attached to a meniscus?

A

The medial collateral ligament.

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17
Q

Why is this attachment clinically important?

A

Lateral trauma may damage medial collateral ligament which in turn disrupts the attached meniscus.

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18
Q

How do these collateral ligaments function as check ligaments of the knee?

A

They tighten as the joint EXTENDS preventing anterior movement of tibia on femoral condyles.

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19
Q

What movement(s) do the cruciate ligaments of the knee joint control/check?

A

The ACL controls forward movement of tibia on femur; the PCL controls posterior movement of these bones.

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20
Q

What muscles comprise the tibiofemoral sling?

A

The quadriceps (vasti lateralis, intermedius, medialis, rectus femoris) and the short head of biceps.

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21
Q

What actions do the muscles of the tibiofemoral sling produce?

A

The quadriceps - extend knee; the short head of biceps flexes the knee.

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22
Q

Name the two-joint muscles of the knee.

A

The rectus femoris coupled with the three vasti mm. quadriceps.

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23
Q

What is the action of these two-joint muscles on both joints?

A

Stabilizes the hip, mobilizes the knee.

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24
Q

What is the function of the hamstring muscles?

A

They flex the knee and extend the hip.

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25
Name the hamstring mm.
Hamstrings = the long head of biceps femoris, semitendinosus, and semimembranosus.
26
Which muscles comprise the pes anserinus?
The sartorius, gracilis, and semitendinosus (Say Grace before Serving Tea).
27
What movement the muscles of the pes anserinus control?
They rotate and flex the knee.
28
What is/are the individual actions of the muscles of the pes?
The sartorius: flexes the hip; gracilis: adducts the hip; and semitendinosus: extends the hip.
29
Name the major ligamentous structures that control the arches of the foot.
The short plantar ligament, long plantar ligament, and plantar calcaneonavicular (spring) ligament.
30
Which of these ligaments is/are the deepest?
The plantar calcaneonavicular (spring) ligament.
31
With regard to the talocrural and other slings, what is the axiom regarding origin and insertion?
The deeper the origin of the muscle in the leg, the more distal its tendinous insertion in the foot.
32
What is footslap? What causes footslap? Which nerve is involved?
The plantar surface of the foot slaps down, rather than being lower down slowly. Cause: The loss of the tibialis anterior muscle. Nerve: The deep branch of the peroneal nerve.
33
Which muscles and compartments are involved in eversion and inversion?
Eversion: lateral leg compartment (peroneus longus & brevis); inversion: deep posterior compartment (tibialis posterior), anterior compartment (tibialis anterior).
34
Which muscles are involved in the toe-PIP sling?
The plantar intrinsic mm. (abductor digiti minimi, flexor digitorum brevis, abductor hallucis).
35
Which muscles are involved in the toe-DIP sling?
Toe DIP extension: ext. hallucis longus, and ext. digitorum longus; toe DIP flexion: flexor digitorum longus, flexor hallucis longus, and quadratus plantae.
36
What actions would be exhibited by each sling?
Toe PIP sling: abduction and flexion; Toe DIP sling: one for extension the other for flexion.
37
List the two-joint muscles of the ankle
The gastrocnemius and soleus.
38
What is the action of these two-joint muscles?
The gastrocnemius flexes the knee; the soleus plantarflexes the ankle.
39
List the 3 parts of the lumbosacral plexus as well as the vertebral levels involved in each.
Lumbar (L1-4), sacral (L4-S3), and coccygeal (S4-Co1).
40
Which of these ventral rami contain purely sensory fibers?
None, all ventral rami are mixed sensory and motor.
41
What is the role of the lumbosacral trunk?
It takes innervation from L4 and L5 down into sacral plexus.
42
What are the root values for the femoral, obturator, sciatic, and pudendal nn.?
Femoral (L2-4); obturator (L2-4), sciatic (L4-S3), and pudendal (S2-4).
43
What are the modalities of the femoral, obturator, sciatic, and pudendal nn.?
They are MIXED nerves - contain both motor and sensory fibers.
44
Which vertebral levels also contain pelvic splanchnic autonomic fibers?
S2-4.
45
What is the specific modality of the pelvic splanchnic nn.?
Preganglionic parasympathetic.
46
List 4 purely sensory nerves formed in the lumbar plexus.
The ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous.
47
Which of these nerves is restricted to the anterior abdominal wall?
The iliohypogastric
48
Which nerves of the lumbar plexus deal with the external genitalia?
The ilioinguinal and genitofemoral.
49
Which divisions of the spinal nerve (anterior/posterior) are involved in the formation of the obturator n.? the femoral n.?, the lumbosacral trunk?, the tibial division of the sciatic n., the peroneal (fibular) division of the sciatic n.
1) Obturator: anterior divisions of L2-4 2) femoral: posterior divisions of L2-4 3) lumbosacral trunk: anterior & posterior divisions of L4/5 4) tibial division of sciatic: anterior divisions of L4-S3 5) peroneal (fibular) division of sciatic: posterior divisions of L4-S2.
50
What action of which structure(s) does the femoral nerve control?
Hip flexion & knee extension.
51
What muscles are controlled by the femoral nerve?
The iliopsoas, quadriceps, pectineus, and sartorius.
52
In which specific compartment would the majority of these muscles be contained?
The anterior compartment of the thigh.
53
What action of which structure(s) does the obturator nerve control?
Adduction of the lower limb.
54
What muscles are controlled by the obturator nerve?
The adductor longus, adductor brevis, oblique head of magnus, gracilis, (possibly the pectineus), and external obturator.
55
In which specific compartment would the majority of these muscles be contained?
The medial compartment of the thigh.
56
What action of which structure(s) does the peroneal division of the sciatic nerve control?
Ankle dorsiflexion.
57
What muscles are controlled by the peroneal division of the sciatic nerve?
The tibialis anterior, ext. digitorum longus, ext. hallucis longus, fibularis (peroneus) longus and brevis, and the intrinsic dorsal mm. of foot.
58
In which specific compartment would the majority of these muscles be contained?
The anterior compartment of the leg.
59
What action of which structure(s) does the tibial division of the sciatic nerve control?
Hip extension and lateral rotation, knee and toe flexion, and ankle plantarflexion.
60
What muscles are controlled by the tibial division of the sciatic nerve?
The short lateral rotators (sup/inf. gemelli, int. obturator, quadratus femoris), adductor magnus (hamstring portion), semitendinosus, semimembranosus, long head of biceps, gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum, flexor hallucis longus, plantar intrinsic mm. of foot.
61
In which specific compartment would the majority of these muscles be contained?
The gluteal region & posterior compartment of thigh/leg.
62
Hip abduction is the function of which of the gluteal mm.?
The gluteus medius and gluteus minimus.
63
Which nerve is responsible for innervating these gluteal mm.?
The superior gluteal nerve.
64
Denervation of these muscles results in which gait deformity?
Medius lurch (the Trendelenberg sign).
65
Hip adduction is the function of which thigh compartment?
The medial compartment of the thigh.
66
Name the muscles found in this compartment?
The adductor longus, brevis, and magnus, and the gracilis .
67
What nerve innervates these mm.?
The obturator nerve.
68
Lesion of this nerve produces which type of gait dysfunction?
A broad-based stance and gait dysfunction.
69
Partial/total obturator neurectomites are used to counteract which gait dysfunction?
Scissor gait.
70
In anterior motion of the lower limb joints, which muscles are involved in hip flexion?
In hip flexion: iliopsoas, pectineus, sartorius and rectus femoris.
71
In anterior motion of the lower limb joints, which muscles are involved in knee extension?
In knee extension: the quadriceps.
72
Name the nerve(s) that innervates these muscles?
The femoral nerve.
73
Which muscles function in dorsiflexion of the ankle?
The tibialis anterior.
74
Which muscles function in eversion of the ankle?
The peroneus longus & brevis (lateral compartment of the leg).
75
Which nerve(s) innervates these muscles?
The common peroneal (fibular) nerve.
76
Lesion of this nerve results in what type of gait dysfunction?
A lesion of/trauma to the common (or deep) peroneal n. cause foot drop and steppage gait.
77
What are the posterior motions of the lower limb joints?
Posterior motions: hip extension & lateral rotation, knee and toe flexion, ankle plantarflexion.
78
Which specific nerve(s) is/are responsible for innervation of the muscles controlling these posterior motions?
The tibial division of sciatic nerve.
79
List the two muscle exceptions to this innervation.
The gluteus maximus (most powerful hip extensor - inf. gluteal n.), piriformis (branch from peroneal - fibular - division of sciatic) and short head of the biceps femoris (peroneal - fibular -division of sciatic).
80
Lesions to this nerve result in?
Lesions of/trauma to the tibial division of sciatic nerve = gait defects + loss of sensation to sole of foot.
81
List the muscles that may have dual innervation as well as the nerves involved.
pectineus: obturator and femoral nn.; biceps femoris: long head = tibial division of sciatic, short head = peroneal division; and adductor magnus: oblique head + obturator, straight head + tibial division of sciatic n.
82
Why is it actually unsafe to perform intramuscular injections in the gluteal region?
The superior gluteal artery & nerve run in the so-called “safe” area of the buttock.
83
What might be the consequence of an injury here?
A paralysed gluteus medius/minimus - gluteal lurch (positive Trendelenberg sign) in gait.
84
Which dermatomes of the lower limb are clinically important? why?
The most important is L5 found on the dorsum and sole of the foot. The dermatome of L5 if denervated (loss of sensation to bottom of foot) results in severe gait dysfunction (can’t feel foot hit the ground).
85
What ligamentous structure helps contain the intervertebral discs within their location?
The posterior longitudinal ligament.
86
What clinical implication does this have if the disc does herniate?
It forces the disc to herniate posterolaterally - in a direction that will result in pinching a spinal nerve exiting the intervertebral foramen.
87
Which discs normally herniate?
The lower lumbar due to weight and stress on these discs (L4 - L5).
88
In which direction does the disc herniate?
Posterolaterally.
89
What structure would be "pinched" if the disc between L4/L5 herniated?
Spinal nerve L5 (exiting below the herniated disc).
90
Where would the pain of as pinched disc between L4/L5 be felt?
It would be a dull ache long route of sciatic nerve (sciatica) all the way down to the cutaneous sensation of pain on dorsum and sole of the foot.
91
Which cord levels control upward movement of the thigh, leg, foot and toes respectively in the seated position?
L2-S1.
92
Which cord levels control downward movement of the thigh, leg foot and toes in this position?
L5-S2

Anatomy 3 (8 decks)

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