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Anatomy Test 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, prevents “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 ligament?

A

prevents pubic symphysis from moving anterosuperiorly

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5
Q

What is the function of the sacrospinous ligament?

A

Prevents sacrum from moving postero-superiorly

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6
Q

What is the function of the iliolumbar ligament?

A

control lateral flexion of the vertebral column on the hip

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7
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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8
Q

Name the capsular ligaments of the hip joint.

A

Anteriorly: iliofemoral (superior) and pubofemoral (inferior
Posteriorly: ischiofemoral

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9
Q

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

A

Extension: gluteus maximus
Flexion: psoas & iliacus (iliopsoas)

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10
Q

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

A

Adduction: medial compartment muscles (adductor longus, adductor magnus, adductor brevis, and pectineus & gracilis)
Abduction: gluteus medius & minimus

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11
Q

Which muscles act on the acetabulofemoral sling in internal rotation?

A

Internal rotation: tensor fascia lata

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12
Q

Which muscles act on the acetabulofemoral sling in external rotation?

A

External rotation: piriformis, superior gemellus, obturator internus, inferior gemellus & quadratus femoris + external obturator

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13
Q

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

A

External rotation = lateral rotation

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14
Q

What is the role of the rotators in gait?

A

The external rotators externally rotate the swimming 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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15
Q

List the bursae of the hip.

A

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

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16
Q

What is the bursa of the hip?

A

A sac of synovial membrane with thin synovial fluid layer in between

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17
Q

What is the function of a bursa?

A

The slippery walls that allow free movement of overlying skin or muscle over bony protuberances

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18
Q

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

A

The medial collateral ligament

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19
Q

Why is this attachment clinically important?

A

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

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20
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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21
Q

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

A

The ACL controls forward movement of the tibia on the femur

The PCL controls posterior movement of these bones

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22
Q

What muscles comprise the tibiofemoral sling?

A

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

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23
Q

What actions do the muscles of the tibiofemoral sling produce?

A

The quadriceps – extend the knee
The short head of the biceps femoris – flexes the knee
Hamstrings: flex knee
Biceps femoris externally/lateral rotates knee
Semi’s + popliteus + pes ansurinus medially/internally rotate knee
I

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24
Q

Name the two-joint muscles of the knee.

A

These muscles span both the hip and knee joint and therefore act on both joints.
The rectus femoris coupled with the three vasti muscles = the quadriceps muscle

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25
Q

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

A

They stabilize the hip and mobilize the knee

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26
Q

What is the function of the hamstring muscles?

A

They flex the knee and extend the hip

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27
Q

Name the hamstring muscles

A

Hamstrings = the long head of the biceps femoris, semitendinosus, and semimembranosus

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28
Q

Which muscles comprise the pes anserinus (goose foot)?

A

The sartorius, gracilis, and semitendinosus (say grace before serving tea)

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29
Q

What movement the muscles of the pes anserinus control?

A

They internally rotate and flex the knee. Facilitates sitting cross-legged. They are two joint muscles

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30
Q

What is/are the individual actions of the muscles of the pes?

A

The sartorius: (extensor compartment) flexes the hip
Gracilis: (adductor compartment) adducts the hip
Semitendinosus: (flexor compartment) extends the hip

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31
Q

Name the major ligamentous structures that control the arches of the foot.

A

The short plantar ligament, long plantar ligament, and plantar calcaneonavicular (spring) ligament

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32
Q

Which of these ligaments is/are the deepest?

A

The plantar calcaneonavicular (spring) ligament

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33
Q

With regard to the talocural and other slings, what is the axiom regarding origin and insertion?

A

The deeper the origin of the muscle in the leg, the more distal its tendinous insertion in the foot

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34
Q

What is footslap?

A

The plantar surface of the foot slaps down, rather than being lowered down slowly

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35
Q

What causes footslap?

A

The loss of the tibialis anterior muscle

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36
Q

Which nerve would be involved in footslap?

A

The deep branch of the peroneal nerve

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37
Q

Which muscles and compartments are involved in eversion and inversion?

A

Eversion: lateral leg compartment (peroneus longus & peroneus brevis)
Inversion: deep posterior compartment (tibialis posterior), anterior compartment (tibialis anterior)

38
Q

Which muscles are involved in the toe-PIP sling?

A

The plantar intrinsic muscles (abductor digiti minimi, flexor digitorum brevis, abductor hallucis)

39
Q

Which muscles are involved in the toe-DIP sling?

A

The toe DIP extension: extensor hallucis longus, extensor digitorum longus
Tor DIP flexion: flexor digitorum longus, flexor hallucis longus, and quadratus plantae

40
Q

What actions would be exhibited by each sling?

A

Toe PIP sling: abduction and flexion

Toe DIP sling: one for extension the other for flexion

41
Q

List the two-joint muscles of the ankle.

A

The gastrocnemius and soleus

42
Q

What is the action of the gastronemius and soleus?

A

The gastrocnemius flexes the knee

The soleus plantar flexes the ankle

43
Q

List the 3 parts of the lumbosacral plexus as well as the vertebral levels involved in each. Which is purely sensory?

A

Lumbar plexus – L1 – L4
Sacral plexus – L4 and L5 + S1 – S3
Coccygeal plexus – S4, S5 and Co1
None–all are mixed sensory and motor.

44
Q

What is the role of the lumbosacral trunk?

A

It takes innervation from L4 and L5 down into the sacral plexus

45
Q

What are the root values for the femoral, obturator, sciatic, and pudendal nerves?

A

Femoral (L2, L3, L4)
Obturator (L2, L3, L4)
Sciatic (L4, L5, S1, S2, S3)
Pudendal (S2, S3, S4)

46
Q

What are the modalities of the femoral, obturator, sciatic, and pudendal nerves?

A

They are MIXED nerves – contain both motor and sensory fibers

47
Q

Which vertebral levels also contain pelvic splanchnic autonomic fibers?

A

S2 – S4

48
Q

What is the specific modality of the pelvic splanchnic nerves?

A

Preganglionic parasympathetic

49
Q

List 4 purely sensory nerves formed in the lumbar plexus.

A

The ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous

50
Q

Which of these nerves is restricted to the anterior abdominal wall?

A

The iliohypogastric

51
Q

Which nerves of the lumbar plexus deal with the external genitalia?

A

The ilioinguinal and genitofemoral

52
Q

Which divisions of the spinal nerve (anterior/posterior) are involved in the formation of the obturator nerve? The femoral nerve?

A

Obturator: anterior divisions of L2-4
Femoral: posterior divisions of L2-4

53
Q

Which divisions of the spinal nerve (anterior/posterior) are involved in the formation of the lumbosacral trunk? tibial division of the sciatic? peroneal division?

A

Lumbosacral trunk: anterior & posterior divisions of L4/5
Tibial division of sciatic: anterior divisions of L4-S3
Peroneal (fibular) division of sciatic: posterior divisions of L4-S2

54
Q

What action of which structure(s) does the femoral nerve control?

A

Hip flexion & knee extension

55
Q

What muscles are controlled by the femoral nerve?

A

The iliopsoas, quadriceps, pectineus, and sartorius

56
Q

In which specific compartment would the majority of these muscles be contained?

A

The anterior compartment of the thigh

57
Q

What action of which structure(s) does the obturator nerve control?

A

Adduction of the lower limb

58
Q

What muscles are controlled by the obturator nerve?

A

The adductor longus, adductor brevis, oblique head of magnus, gracilis, (possibly the pectineus), and external obturator

59
Q

In which specific compartment would the majority of these muscles be contained?

A

The medial compartment of the thigh

60
Q

What action of which structure(s) does the peroneal division of the sciatic nerve control?

A

Ankle dorsiflexion

61
Q

What muscles are controlled by the peroneal division of the sciatic nerve?

A

The tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis (peroneus) longus and brevis, and the intrinsic dorsal muscles of the foot

62
Q

In which specific compartment would the majority of these muscles be contained?

A

The anterior compartment of the leg

63
Q

What action of which structure(s) does the tibial division of the sciatic nerve control?

A

Hip extension and lateral rotation, knee and toe flexion, and ankle plantar flexion

64
Q

What muscles are controlled by the tibial division of the sciatic nerve?

A

The short lateral rotators (superior and inferior gemelli, internal obturator, quadratus femoris), adductor magnus (hamstring portion), semitendinosus, semimembranosus, long head of the biceps femoris, gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum, flexor hallucis longus, plantar intrinsic muscles of the foot

65
Q

In which specific compartment would the majority of these muscles be contained?

A

The gluteal region & posterior compartment of the thigh/leg

66
Q

Hip abduction is the function of which of the gluteal muscles?

A

The gluteus medius and gluteus minimus

67
Q

Which nerve is responsible for innervating these gluteal muscles?

A

The superior gluteal nerve

68
Q

Denervation of these muscles results in which gait deformity?

A

Medius lurch (the Trendelenberg sign)

69
Q

Hip adduction is the function of which thigh compartment?

A

The medial compartment of the thigh

70
Q

Name the muscles found in the medial compartment? innervation?

A

The adductor longus, brevis, and magnus, and the gracilis; The obturator nerve

71
Q

Lesion of the obturator nerve produces which type of gait dysfunction?

A

A broad-based stance and gait dysfunction

72
Q

Partial/total obturator neurectomites are used to counteract which gait dysfunction?

A

Scissor gait

73
Q

In anterior motion of the lower limb joints, which muscles are involved in hip flexion?

A

In hip flexion: iliopsoas, pectineus, sartorius, and rectus femoris

74
Q

In anterior motion of the lower limb joints, which muscles are involved in knee extension? innervation?

A

In knee extension: the quadriceps; femoral nerve

75
Q

Which muscles function in dorsiflexion of the ankle?

A

The tibialis anterior

76
Q

Which muscles function in eversion of the ankle? innervation?

A

The peroneus longus & brevis (lateral compartment of the leg); common peroneal (fibular) nerve

77
Q

Lesion of this nerve results in what type of gait dysfunction?

A

A lesion of/trauma to the common (or deep) peroneal nerve cause foot drop and steppage gait

78
Q

What are the posterior motions of the lower limb joints?

A

Posterior motions: hip extension & lateral rotation, knee and toe flexion, ankle plantar flexion

79
Q

Which specific nerve(s) is/are responsible for innervation of the muscles controlling these posterior motions?

A

The tibial division of sciatic nerve

80
Q

Which specific nerve(s) is/are responsible for innervation of the muscles controlling these posterior motions? List the two muscle exceptions to this innervation.

A

The gluteus maximus (most powerful hip extensor – inferior gluteal nerve), piriformis (branch from peroneal – fibular – division of sciatic) and short head of the biceps femoris (peroneal – fibular – division of sciatic)

81
Q

What do lesions to the tibial division of sciatic nerve?

A

Lesions of/trauma to the tibial division of sciatic nerve = gait defects + loss of sensation to sole of foot

82
Q

List the muscles that may have dual innervation as well as the nerves involved.

A

Pectineus: obturator and femoral nerves
Biceps femoris: long head = tibial division of sciatic, short head = peroneal division
Adductor magnus: oblique head + obturator, straight head + tibial division of sciatic nerve

83
Q

Why is it actually unsafe to perform intramuscular injections in the gluteal region?

A

The superior gluteal artery & nerve run in the so-called “safe” area of the buttock

84
Q

What might be the consequence of an injury here?

A

A paralyzed gluteus medius/minimus – gluteal lurch (positive Trendelenberg sign) in gait

85
Q

Which dermatomes of the lower limb are clinically important? Why?

A

The most important is L5 found on the dorsum and sole of the foot. The dermatome of L5 if denervated (loss of sensation to the bottom of the foot) results in severe gait dysfunction (can’t feel the foot hit the ground)

86
Q

What ligamentous structure helps contain the intervertebral discs within their location?

A

The posterior longitudinal ligament

87
Q

What clinical implication does this have if the disc does herniate?

A

It forces the disc to herniated posterolaterally – in a direction that will result in pinching a spinal nerve exiting the intervertebral foramen

88
Q

Which discs normally herniate? in which direction does the disc herniate?

A

The lower lumbar due to weight and stress on these discs (L4-L5); posterolaterally

89
Q

What structure would be “pinched” if the disc between L4/L5 herniated?

A

Spinal nerve L5 (exiting below the herniated disc)

90
Q

Where would the pain of a pinched disc between L4/L5 be felt?

A

It would be a dull ache along the route of the sciatic nerve (sciatica) all the way down to the cutaneous sensation of pain on the dorsum and sole of the foot

91
Q

Which cord levels control upward movement of the thigh, leg, foot and toes respectively in the seated position?

A

L2-S1

92
Q

Which cord levels control downward movement of the thigh, leg foot and toes in this position?

A

L5-S2

Anatomy Test 3 (8 decks)

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