Hisham Lower Limb Anatomy Flashcards
1
Q
What three bones form each pelvic bone?
A
(1) ilium — Superior
(2) ischium — anteroinferior
(3) pubis — posteroinferior
These bones fuse during childhood.
2
Q
Where does the ilium articulate?
A
with the sacrum.
3
Q
How is the pelvic bone anchored to the vertebral column?
A
anchored to the end of the vertebral column by the sacrotuberous and sacrospinous ligaments.
4
Q
What does the ischial tuberosity provide?
A
provides attachment for many of the muscles in the posterior compartment of the thigh.
5
Q
What is associated with the ischiopubic ramus and body of the pubis?
A
associated mainly with muscles in the medial compartment of the thigh.
6
Q
What is the iliac crest?
A
The top of the ilium is the iliac crest, which ends anteriorly as the anterior superior iliac spine and posteriorly as the posterior superior iliac spine.
7
Q
What is the tuberculum of the iliac crest (iliac tubercle)?
A
a prominent lateral expansion of the iliac crest just posterior to the anterior superior iliac spine.
8
Q
Where is the anterior inferior iliac spine located?
A
on the anterior margin of the ilium.
9
Q
What is the iliopubic eminence?
A
a raised area of ilium where the ilium fuses with the pubis.
10
Q
Where does the gluteal surface of the ilium face?
A
posterolaterally.
11
Q
What are the three curved lines on the gluteal surface?
A
The three curved lines are the inferior, anterior, and posterior gluteal lines.
12
Q
What muscle attaches to the anterior inferior iliac spine?
A
rectus femoris muscle .
13
Q
What are the landmarks of the gluteal surface of the ilium?
A
It is marked by 3 curved lines ( inferior,anterior,and posterior gluteal lines),which divide the gluteal surface into 4 regions;
(1) Inferior gluteal line— rectus femoris muscle attachment
- Anterior inferior iliac spine
- roughened patch of bone between the superior
margin of the acetabulum and the inferior gluteal
line
(2) Anterior gluteal line — gluteus minimus Attachment
Originates from between inferior and anterior
gluteal lines
(3) Posterior gluteal line— gluteus mideus attachment
Originates from between anterior and posterior
gluteal lines
— gluteus maximus attachment
Originates posterior to the posterior gluteal line
14
Q
Where do the 3 gluteus muscles attach?
A
The gluteus minimus muscle originates from between inferior and anterior gluteal lines
The gluteus medius muscle attaches to bone between the anterior and posterior gluteal lines
The gluteus maximus muscle attaches posterior to the posterior gluteal line.
15
Q
What is the ischial tuberosity associated with?
A
It is associated mainly with the hamstring muscles of the posterior thigh.
16
Q
How is the ischial tuberosity divided?
A
It is divided into upper and lower areas by a transverse line.
The upper area is further subdivided into lateral and medial parts by an oblique line.
17
Q
What is the orientation of the upper area of the ischial tuberosity?
A
The upper area is oriented vertically and is further subdivided into two parts (lateral and medial) by an oblique line.
18
Q
What attaches to the medial part of the upper area of the ischial tuberosity?
A
The combined origin of the semitendinosus muscle and the long head of the biceps femoris muscle.
19
Q
What attaches to the lateral part of the upper area of the ischial tuberosity?
A
The semimembranosus muscle.
20
Q
What provides attachment in the lateral region of the ischial tuberosity?
A
Part of the adductor magnus muscle.
21
Q
What supports body weight when sitting?
A
The medial part of the ischial tuberosity, which faces inferiorly and is covered by connective tissue and a bursa.
22
Q
Where is the sacrotuberous ligament attached?
A
To a sharp ridge on the medial margin of the ischial tuberosity.
23
Q
What is the type of the hip joint?
A
Ball and socket synovial joint (diarthrosis or diarthrodal joint)
24
Q
What are the components of the hip joint?
A
Articulation of the acetabulum with the femoral head
25
What is the structure that covers or lines the hip joint?
Both of the acetabulum and femoral head are covered or lined by an articular hyaline cartilage
26
What are the components of the acetabulum?
Formed at the union of 3 bones
(1) Ilium ---- Superior
---- Articulates with the sacrum
(2) Ischium ---- anteroinferior
(3) Pubis ---- Posteroinferior
27
What is the function of the acetabulum?
Holds the femoral head inside the acetabulum by the rim of the acetabular labrum enclosing it beyond its equator so increasing hip stability
28
What are the features of the hip joint capsule?
(1) Very thick and dense
- much more so than the capsule in shoulder joint
- thickest and strongest anteriorly,where there is the
most resistance
(2) Tight in extension
(3) More relaxed in flexion
29
Which side of the hip joint capsule is the thickest and strongest?
Anteriorly
30
Why the anterior side of the hip joint capsule is the thickest and strongest?
There is the most resistance
31
What is the condition of the hip joint capsule in extension and flexion?
- tight in extension
- more relaxed in flexion
32
What is the most characteristic feature of the acetabulum?
Triradiate cartilage
33
Define the triradiate cartilage?
A growth plate
34
What is the shape of the triradiate cartilage?
Y- shaped
35
What is the function of the triradiate cartilage?
Separates the 3 pelvic bones (ilium,ischium and pubis)
36
What is the attachment of the transverse ligament?
joins anterior and posterior ends of the articular hyaline cartilage
37
What is the other name for head of the femur ligament?
(1) Femoral head ligament or ligament of femoral head
(2) Ligamentum teres
38
What is the attachment of the ligament of femoral head(ligamentum teres)?
Acetabular notch to the fovea on the femoral head
39
What is the significance of the femoral head ligament(ligamentum teres)?
(1) Contains arterial supply to the head of femur in
children.Therefore,a nutrient artery to the head of
the femur runs through the ligament,however,its
contribution to the blood supply of the head of the
femur is negligible.
(2) This is the only intracapsular ligament of the hip
40
What is the femur?
(1) bone of the thigh and
(2) the longest bone in the body.
41
What characterizes the proximal end of the femur?
It has a head and neck, and two large projections (the greater and lesser trochanters) on the upper part of the shaft.
42
What is the shape of the head of the femur?
spherical and articulates with the acetabulum of the pelvic bone.
43
What is the fovea?
A non-articular pit on the medial surface of the femur's head for the attachment of the ligament of the head (ligamentum teres).
44
What is the orientation of the neck of the femur?
(1) It projects superomedially from the shaft
(2) at an angle of approximately 125°
(3) projects slightly forward.
45
What is the function of the orientation of the neck of the femur?
It increases the range of movement (ROM) of the hip joint.
46
What are the greater and lesser trochanters?
They are attachment sites for muscles that move the hip joint.
47
Where does the greater trochanter extend from?
(1) It extends superiorly from the shaft
of the femur
(2) just lateral to the region where the
shaft joins the neck of the femur.
48
What is found on the medial surface of the greater trochanter?
It is deeply grooved to form the trochanteric fossa.
49
What is the attachment site for the obturator externus muscle?
A distinct oval depression on the lateral wall of the trochanteric fossa.
50
What attaches to the anterolateral surface of the greater trochanter?
The gluteus minimus.
51
What attaches to the lateral surface of the greater trochanter?
The gluteus medius.
52
What muscles are attached to the greater trochanter of the femur?
Mnemonic; P-GOGO
(1) Piriformis,
(2) Gemillus superior and inferior,
(3) Obturator internus,
(4) Gluteus medius and minimus.
53
54
What is the size of lesser trochanter?
The lesser trochanter is smaller than the greater trochanter
55
What is the shape of the lesser trochanter?
blunt conical shape.
56
What is the orientation of the lesser trochanter?
It projects posteromedially from the shaft of the femur
57
What is the location of the lesser trochanter?
just inferior to the junction with the neck.
58
What is the anatomical significance of the lesser trochanter?
It is the attachment site for the combined tendons of psoas major and iliacus muscles.
59
Describe the proximal end of the tibia?
(1) in the transverse plane — expanded - for weight-bearing
(2) in the horizontal plane — consists of a medial condyle and a lateral condyle, which are both flattened and overhang the shaft.
60
What is the common peroneal nerve's relation to the fibula?
The common peroneal nerve lies against the posterolateral aspect of the neck of the fibula.
61
What ligaments reinforce the fibrous membrane of the knee joint?
Three ligaments reinforce the external surface of the fibrous membrane and stabilize the joint.
62
What separates the medial and lateral condyles of the tibia?
The superior surfaces of the medial and lateral condyles are articular and separated by an intercondylar region, which contains sites of attachment for strong ligaments (cruciate ligaments) and interarticular cartilages (menisci) of the knee joint.
63
What are the features of the tibial tuberosity?
(1) roughened
(2) perforated area on the tibia
(3) serves as a site of attachment for muscles.
64
What is the role of the fibula?
The fibula is the lateral bone of the leg and does not take part in the
(1) formation of the knee joint
(2) weight-bearing.
65
What is the shape of head of the fibula?
a globe-shaped expansion
66
What is the location of the head of the fibula?
at the proximal end of the fibula
67
What is the main feature of the head of the fibula?
a circular facet for articulation with the lateral condyle of the tibia.
68
What is the site of articulation of the fibular head to the lateral condyle of tibia?
a circular facet for articulation with the lateral condyle of the tibia.
69
70
What three extracapsular ligaments reinforce the external surface of the fibrous membrane and stabilize the hip joint?
Along the intercondylar line,3 ligaments attach continuous with the hip joint capsule:-
(1) Iliofemoral ligament,
(2) Pubofemoral ligament,
(3) Ischiofemoral ligament
71
What is the general attachment of the 3 extracapsular ligaments of the hip joint?
Along the intercondylar line,3 extracapsular ligaments attach continuous with hip joint capsule
(1) Iliofemoral ligament
(2) Pubofemoral ligament
(3) Ischiofemoral ligament
72
What is the general function of the 3 extracapsular ligaments of the hip joint?
(1) Stabilise the hip joint
(2) Protect the hip against hyperextension in addition to
abduction for pubofemoral ligament
73
Where is the origin (apex) of the iliofemoral ligament attached?
The apex is attached to the ilium between the anterior inferior iliac spine and the margin of the acetabulum.
74
What is the shape of the iliofemoral ligament?
inverted Y- shape
75
What is the location of the insertion (base) of the iliofemoral ligament?
along the intertrochanteric line of the femur.
76
What is the function of the iliofemoral ligament?
protects the hip against hyperextension
77
Where is the pubofemoral ligament located?
anteroinferior to the hip joint.
78
What is the shape of the pubofemoral ligament?
Triangular
79
What are the sites of attachments of the pubofemoral ligament?
+Origin (base or Medial attachment)
(1) acetabulum
(2) iliopubic eminence at the superior pubic ramus
(3) adjacent bone, and
(4) obturator membrane;
+Insertion (lateral attachment)
(1) lesser trochanter
(2) intertrochanteric line
(3) blends with the
- fibrous membrane and
- iliofemoral ligament.
80
What is the function of the pubofemoral ligament?
Protects the hip against
(1) Extension or Hyperextension
(2) Abduction
81
What is the location of the ischiofemoral ligament?
Posteroinferior to the acetabulum
82
What does the ischiofemoral ligament reinforce?
It reinforces the posterior aspect of the fibrous membrane of the hip joint.
83
What are the sites of attachment of the ischiofemoral ligament?
+Origin (Medial attachment) : —
ischium, just posteroinferior to the acetabulum;
+Insertion (lateral attachment): —
greater trochanter deep to the iliofemoral ligament.
84
What is the function of the ischiofemoral ligament?
(1) Protects the hip against hyperextension
(2) stabilises the femoral head in acetabulum
(3) Posterior support to the fibrous membrane of the hip joint
85
Enumerate hip flexors
Mnemonic: RIPS
(1) Rectus femoris
(2) Iliopsoas
(3) Pectineus
(4) Sartorius
86
Enumerate hip extensors
(1) Gluteus maximus
(2) Hamstrings
- Semitendinosus
- Semimembranosus
- Biceps femoris
87
Enumerate hip abductors
Mnemonic: GPT
(1) Gluteus medius and minimus
(2) Piriformis
(3) Tensor fascia lata
88
Enumerate hip adductors
Mnemonic: GAP/Q
(1) Gracilis
(2) Adductors
- Adductor longus
- Adductor brevis
- Adductor magnus
(3) Pectineus
(4) Quadriceps femoris may also contribute
89
Enumerate hip lateral (external) rotaters
Mnemonic: G/OPQ
(1) Gracilis
(2) Obturator internus and externus
(3) Piriformis
(4) Quadriceps femoris
90
Enumerate hip medial (internal) rotators
(1) Gluteus medius (anterior fibres)
(2) Adductor longus
(3) Adductor brevis
(4) Tensor fascia lata (TFL)
91
Discuss blood supply of the hip joint
92
What is the origin of the medial and lateral circumflex femoral arteries
Profunda femoris
93
What is the location of the point at which medial and lateral circumflex femoral arteries anastomose?
94
What is the course of the medial and lateral circumflex femoral arteries right after their anastomoses?
95
What is the clinical significance of the anastomoses the medial and lateral circumflex femoral arteries around the hip joint?
96
Discuss nerve supply of the hip joint
97
Discuss lymphatic drainage of the hip joint
98
What is the clinical significance of the lymphatic drainage to the hip joint?
infection in the hip joint space may manifest as inguinal lymphadenopathy on the ipsilateral side
99
Discuss embryology of hip joint
100
What are the four major routes for structures to pass from the abdomen and pelvis into the lower limb?
(1) Obturator Canal,
(2) Greater Sciatic Foramen,
(3) Lesser Sciatic Foramen,
(4) Gap Between Inguinal Ligament and Pelvis.
101
What structures pass through the greater sciatic foramen above the piriformis muscle?
Superior gluteal nerve, artery, vein.
102
What structures pass through the lesser sciatic foramen?
Mnemonic; PIN+ obturator internus muscle
(1) Pudendal nerve,
(2) Internal pudendal vessels.
(3) Nerve to obturator internus
(4) Obturator internus muscle tendon,
103
What structures pass through the greater sciatic foramen below the piriformis muscle?
Mnemonic; PIN
(1) Sciatic nerve (10% pass through it, < 1% above it)
(2) Inferior gluteal nerve, artery, vein,
(3) Pudendal nerve,
(4) Internal pudendal artery and vein,
(5) Posterior femoral cutaneous nerve,
(6) Nerve to obturator internus and Gemellus superior muscles,
(7) Nerve to quadratus femoris and Gemellus inferior muscles.
104
What structures pass through both ,the greater and lesser sciatic foramen?
105
Discuss boundaries of greater sciatic foramen
106
What borders the obturator canal?
Above by the
(1) obturator groove on the inferior surface of the superior ramus of the pubic bone, and
(2) muscles attached to the obturator membrane.
107
What is the content of the obturator canal?
Obturator nerve and vessels.
108
What structures pass through the gap between the inguinal ligament and pelvic bone?
(1) Psoas major,
(2) iliacus,
(3) pectineus muscles,
(4) Femoral artery,
(5) Femoral vein,
(6) Lymphatics,
(7) Femoral branch of genitofemoral nerve,
(8) Lateral cutaneous nerve of thigh,
(9) Femoral nerve.
109
What is the root value of the lumbar plexus?
Anterior rami of spinal nerves L2-L3 and part of L4
110
What is the root value of the lumbosacral trunk?
Anterior rami of L4-L5
111
What is the root value of the sacral plexus?
Root value of the lumbosacral plexus (anterior rami of L4-L5)+ anterior rami of S1-S3 and part of S4
112
113
What is the root value of the femoral nerve?
The femoral nerve is the largest branch of lumbar plexus It carries contributions from the dorsal division of the anterior (ventral) rami of L2 to L4 segments of spinal cord.
114
What is the course of the femoral nerve?
It forms in the abdomen within the substance of psoas major muscle.
It lies in the groove between the psoas major and iliacus muscles outside femoral sheath
It passes through (i.e.,penetrates) psoas major muscle then emerges from its lateral border to reach the anterior compartment of the thigh
It descends posterolaterally through the pelvis to the midpoint of the inguinal ligament
It leaves the abdomen by passing under or behind the inguinal ligament and through the gap between the inguinal ligament and superior margin of the pelvis to enter the femoral triangle ,on the anteromedial aspect of the thigh, lateral to the femoral vessels.
It has a short course of about 2.5 cm below the inguinal ligament.
It ends by dividing into anterior and posterior divisions 2.5 cm below the inguinal ligament
115
Where is the femoral nerve located in relation to the femoral artery in the femoral triangle?
it is lateral to the femoral artery.
116
What muscles does the femoral nerve innervate?
+ It innervates all muscles in the anterior compartment of the thigh
+ In the abdomen, gives rise to branches that innervate the iliacus and Pectineus muscles.
117
What branches does the femoral nerve give rise to in the abdomen?
It gives rise to branches that innervate the iliacus and pectineus muscles.
118
What cutaneous (areas of skin) supply does the femoral nerve innervate?
It innervates skin over the
(1) anterior aspect of the thigh,
(2) anteromedial side of the knee,
(3) medial side of the leg, and
(4) medial side of the foot through its branch, the
Saphenous Nerve.
119
What are the branches of the femoral nerve?
120
What is the origin of the medial cutaneous nerve of the thigh?
it is one of the two branches of the anterior division of the femoral nerve distal the inguinal ligament, the other branch is the intermediate (anterior) cutaneous nerve of the thigh
121
What is the course of the medial cutaneous nerve of the thigh?
(1) arises from the femoral nerve distal to the inguinal ligament
(2) travels along the sartorius
(3) pierces through the deep fascia
(4) becomes superficial at the upper 1/3rd of the thigh
122
What is the function of the medial cutaneous nerve of the thigh?
provides cutaneous innervation to the medial thigh
123
What is the other name of intermediate cutaneous nerve of the thigh?
(1) intermediate (anterior) femoral cutaneous nerve
(2) anterior cutaneous nerve of the thigh
124
What is the function of the intermediate cutaneous nerve of the thigh?
innervates anterior thigh
125
What is the origin of the saphenous nerve?
a purely sensory nerve that arises from the femoral nerve
126
What is the root value of the saphenous nerve?
L2-L4
127
What is the course of the saphenous nerve?
(1) It descends in the femoral triangle and accompanies the femoral artery and femoral vein in the adductor canal(Hunter's canal).
(2) It then travels on the posteromedial border of the knee and at this exact point it is accompanied by saphenous vein and could be injured by placement of the posteromedial portal(used to visualise posterior cruciate ligament and posterior horn of lateral meniscus)
(3) pierces through the medial deep fascia of the knee(fascia lata) between sartorius and gracilis muscles to become subcutaneous.
(4) It travels superficially down the
+ anteromedial lower leg
+ ankle over the medial malleolus
+ 1st metatarsal head
+ dorsum of the foot
128
What is the function of the saphenous nerve?
Supplies sensation to the skin of the
(1) anteromedial lower leg
(2) ankle over the medial malleolus
(3) 1st metatarsal head
(4) a part of the arch of the foot medially
(5) dorsum of the foot medially
129
What is the origin of the lateral cutaneous nerve of the thigh?
from the femoral nerve (L2-L3) and is purely sensory
130
What is the effect (manifestation) of the saphenous nerve entrapment (injury)?
(1) deep thigh ache
(2) Paraesthesia in the cutaneous distribution of nerve
(3) knee pain
131
What is the root value of the lateral femoral cutaneous nerve of the thigh?
Posterior surface of ventral rami of L2-L3
132
What is the function of the lateral cutaneous nerve of the thigh?
Purely sensory and Supplies the
(1) Lower lateral quadrant of the gluteal region
(2) anterior and lateral thigh and
(3) lateral knee
132
What is the course of the lateral cutaneous nerve of the thigh?
The nerve emerges from the lateral border of psoas muscle, anterior to the iliac crest, and passes between iliacus and iliac fascia crossing the iliacus. Enters the thigh posterior or under the lateral end inguinal ligament , medial to the anterior superior iliac spine (ASIS). From there, it becomes superficial and innervates the lateral thigh. The most common site of impingement is under the inguinal ligament.It pierces the fascia lata 10 cm inferior to the ASIS and divides into two branches:
• Anterior branch supplies skin and fascia of the anterolateral surface of the knee
• Smaller posterior branch supplies the skin and fascia on the lateral part of the upper leg between the greater trochanter and distal 1/3rd of the thigh
133
What is the other name for lateral cutaneous nerve of the thigh entrapment (injury)?
meralgia paraesthetica
134
What is the origin of the posterior cutaneous nerve of the thigh?
Sacral plexus
135
What is the other name of the posterior cutaneous nerve of the thigh?
posterior femoral cutaneous nerve
135
What is the sex incidence of lateral cutaneous nerve of the thigh entrapment?
More common in men
136
What is the function of the posterior cutaneous nerve of the thigh?
innervates the skin to the posterior
(1) thigh
(2) leg
(2) perineum
136
What are the risk factors of the lateral cutaneous nerve entrapment?
Mnemonic; SCOPA
(1) Surgery
(2) tight Clothing,
(3) Obesity,
(4) Pregnancy
(5) tense Ascites,
137
137
What is the effect (manifestation) of the lateral cutaneous nerve of the thigh entrapment?
(1) It presents with paraesthesia & numbness in the upper lateral thigh on the affected side. (2) Symptoms are worsened by standing and relieved by sitting
(3) Examination reproduces the pain by compression below the anterior superior iliac spine (ASIS) and hip extension. The motor examination is intact.
138
What is the root value of the obturator nerve?
The obturator nerve originates from lumbosacral plexus as anterior (ventral) division of ventral rami L2 to L4 segments of spinal cord.
L3 is main segment and L2 is occasionally absent
138
What is the management of the lateral cutaneous nerve of the thigh entrapment?
(1) NSAIDs.
(2) TENS and
(3) Local anaesthetic injections
(4) ultrasound-guided injections.
(5) In severe cases, operative decompression may be performed..
139
What is the main segment of the root value of obturator nerve?
L3
140
What is the difference between the root value of the obturator and femoral nerves?
The obturator nerve originates from lumbosacral plexus as anterior (ventral) division of ventral rami L2 to L4 segments of spinal cord.
L3 is main segment and L2 is occasionally absent
The femoral nerve is the largest branch of lumbar plexus It carries contributions from the dorsal division of the anterior (ventral) rami of L2 to L4 segments of spinal cord.
141
What is the course of the obturator nerve?
The branches of the obturator nerve unite in the substance of psoas major
It descends vertically along the posterior abdominal wall,
Emerges from the medial border of the passes through the pelvic cavity, and enters the thigh by passing through the obturator canal.
142
What muscles does the obturator nerve innervate?
(1) all muscles in the medial compartment of the thigh, except the part of the adductor magnus muscle that originates from the ischium and the pectineus muscle.
(2) obturator externus muscle
143
What additional muscle does the obturator nerve innervate?
Obturator externus muscle
144
What area of skin does the obturator nerve innervate?
It innervates skin on the medial side of the upper thigh.(upper medial thigh)
145
146
What is the root value of sciatic nerve?
The sciatic nerve is the largest nerve of the body and carries contributions from L4 to S3.
147
What are the two divisions of the sciatic nerve?
The sciatic nerve divides into the common fibular nerve and the tibial nerve.
148
What is the root value of common fibular nerve?
The common fibular nerve carries posterior divisions of L4 to S2.
149
What is the root value of tibial nerve?
The tibial nerve carries anterior divisions of L4 to S3.
150
What muscles does the sciatic nerve innervate?
The sciatic nerve innervates all muscles in the posterior compartment of the thigh, the part of the adductor magnus originating from the ischium, and all muscles in the leg and foot.
151
What areas of skin does the sciatic nerve innervate?
The sciatic nerve innervates skin on the lateral side of the leg and the lateral side and sole of the foot.
152
What are the gluteal nerves?
The gluteal nerves are major motor nerves of the gluteal region.
153
What does the superior gluteal nerve innervate?
The superior gluteal nerve innervates the gluteus medius and minimus muscles, and the tensor fasciae lata muscle.
154
What is the root value of the superior gluteal nerve?
The superior gluteal nerve carries contributions from the anterior rami of L4 to S1.
155
Where does the inferior gluteal nerve leave the pelvis?
The inferior gluteal nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle.
156
What does the inferior gluteal nerve innervate?
The inferior gluteal nerve supplies the gluteus maximus.
157
What are the ilio-inguinal and genitofemoral nerves?
They are terminal sensory branches that descend into the upper thigh from the lumbar plexus.
158
Where does the ilio-inguinal nerve originate?
The ilio-inguinal nerve originates from the superior part of the lumbar plexus.
159
What does the ilio-inguinal nerve innervate?
Its terminal branches innervate skin on the medial side of the upper thigh and adjacent parts of the perineum.
160
Where does the genitofemoral nerve pass?
The genitofemoral nerve passes anteroinferiorly through the psoas major muscle.
161
What does the genital branch of the genitofemoral nerve innervate?
The genital branch innervates anterior aspects of the perineum.
162
What does the femoral branch of the genitofemoral nerve innervate?
The femoral branch innervates skin over the upper central part of the anterior thigh.
163
164
What are the main components of the bones of the foot?
The bones of the foot consist of the tarsal bones, metatarsals, and phalanges.
165
How many tarsal bones are there?
There are seven tarsal bones.
166
What are the names of the tarsal bones?
The tarsal bones are the calcaneus, talus, cuboid, navicular, and three cuneiforms.
167
How are the tarsal bones organized?
The tarsal bones are organized in two rows with an intermediate bone between the two rows on the medial side.
168
What movements occur at the joints between the tarsal bones?
Inversion and eversion of the foot occur at joints between the tarsal bones.
169
What is the major artery supplying the lower limb?
The major artery supplying the lower limb is the femoral artery.
170
How does the femoral artery form?
The femoral artery is the continuation of the external iliac artery as it passes under the inguinal ligament.
171
Where does the femoral artery enter the thigh?
The femoral artery enters the femoral triangle in the anterior aspect of the thigh.
172
What do the branches of the femoral artery supply?
The branches supply most of the thigh and all of the leg and foot.
173
What are the superior and inferior gluteal arteries?
The superior and inferior gluteal arteries are vessels supplying parts of the lower limb.
174
Where do the superior and inferior gluteal arteries originate?
They originate in the pelvic cavity as branches of the internal iliac artery.
175
How does the superior gluteal artery exit the pelvis?
The superior gluteal artery leaves the pelvis through the greater sciatic foramen above the piriformis muscle.
176
How does the inferior gluteal artery exit the pelvis?
The inferior gluteal artery leaves through the same foramen but below the piriformis muscle.
177
What is the obturator artery?
The obturator artery is a branch of the internal iliac artery that passes through the obturator canal.
178
What does the obturator artery supply?
The obturator artery supplies the medial compartment of the thigh.
179
180
What is fascia lata?
Fascia lata is a deep fascia that is particularly thick in the thigh and gluteal region.
181
What is the iliotibial tract?
The iliotibial tract is a thickened longitudinal band of fascia lata that descends along the lateral margin of the limb from the tuberculum of the iliac crest to a bony attachment just below the knee.
182
What muscles are enclosed by the fascia lata in the gluteal region?
The superior aspect of the fascia lata splits to enclose the tensor fasciae latae muscle anteriorly and the gluteus maximus muscle posteriorly.
183
What is the saphenous opening?
The saphenous opening is a prominent aperture in the fascia lata on the anterior aspect of the thigh, allowing the great saphenous vein to pass from superficial fascia through deep fascia to connect with the femoral vein.
184
Where is the center of the saphenous opening located?
The center of the saphenous opening is 3-4 cm lateral to the pubic tubercle.
185
What is the femoral triangle?
The femoral triangle is a wedge-shaped depression formed by muscles in the upper thigh at the junction between the anterior abdominal wall and the lower limb.
186
What are the borders of the femoral triangle?
base — inguinal ligament,
medial border — medial margin of the adductor longus muscle,
lateral margin — medial margin of the sartorius muscle.
187
What forms the floor of the femoral triangle?
Mnemonic; PIA
1) iliopsoas muscle,
2) pectineus muscle,
3) adductor longus muscle.
188
Where does the apex of the femoral triangle point?
The apex of the femoral triangle points inferiorly and is continuous with the adductor canal.
189
What happens to the femoral artery and vein in the adductor canal?
The femoral artery and vein pass inferiorly through the adductor canal and become the popliteal vessels behind the knee.
190
What structures are arranged from lateral to medial in the femoral triangle?
1) femoral nerve,
2) femoral artery,
femoral vein, and lymphatic vessels.
191
Where can the femoral artery be palpated?
1) in the femoral triangle
2) just inferior to the inguinal ligament, 3) midway between the anterior superior iliac spine and the pubic symphysis.
192
193
What is the origin of the Piriformis muscle?
Anterior surface of sacrum between anterior sacral foramina
194
What is the insertion of the Piriformis muscle?
Medial side of superior border of greater trochanter of femur
195
What is the innervation of the Piriformis muscle?
Branches from S1 and S2
196
What is the function of the Piriformis muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
197
What is the origin of the Obturator internus muscle?
Anterolateral wall of true pelvis; deep surface of obturator membrane and surrounding bone
198
What is the insertion of the Obturator internus muscle?
Along length of superior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
199
What is the innervation of the Obturator internus muscle?
Nerve to obturator internus (L5, S1)
200
What is the function of the Obturator internus muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
201
What is the origin of the Gemellus superior muscle?
External surface of ischial spine
202
What is the insertion of the Gemellus superior muscle?
Along length of inferior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
203
What is the innervation of the Gemellus superior muscle?
Nerve to obturator internus (L5, S1)
204
What is the function of the Gemellus superior muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
205
What is the origin of the Gemellus inferior muscle?
Upper aspect of ischial tuberosity
206
What is the insertion of the Gemellus inferior muscle?
Quadrate tubercle on the intertrochanteric crest of the proximal femur
207
What is the innervation of the Gemellus inferior muscle?
Nerve to quadratus femoris (L5, S1)
208
What is the function of the Gemellus inferior muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
209
What is the origin of the Quadratus femoris muscle?
Lateral aspect of the ischium just anterior to the ischial tuberosity
210
What is the insertion of the Quadratus femoris muscle?
Linear facet on the anterolateral aspect of the greater trochanter
211
What is the innervation of the Quadratus femoris muscle?
Nerve to quadratus femoris (L5, S1)
212
What is the function of the Quadratus femoris muscle?
Laterally rotates femur at hip joint
213
What is the origin of the Gluteus minimus muscle?
External surface of ilium between inferior and anterior gluteal lines
214
What is the insertion of the Gluteus minimus muscle?
Elongate facet on the lateral surface of the greater trochanter
215
What is the innervation of the Gluteus minimus muscle?
Superior gluteal nerve (L4, L5, S1)
216
What is the function of the Gluteus minimus muscle?
Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh
217
What is the origin of the Gluteus medius muscle?
External surface of ilium between anterior and posterior gluteal lines
218
What is the insertion of the Gluteus medius muscle?
Posterior aspect of iliotibial tract of fascia lata and gluteal tuberosity of proximal femur
219
What is the innervation of the Gluteus medius muscle?
Superior gluteal nerve (L4, L5, S1)
220
What is the function of the Gluteus medius muscle?
Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh
221
What is the origin of the Gluteus maximus muscle?
Fascia covering gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spinae, dorsal surface of lower sacrum, lateral margin of coccyx, external surface of sacrotuberous ligament
222
What is the insertion of the Gluteus maximus muscle?
Powerful extensor of flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh
223
What is the innervation of the Gluteus maximus muscle?
Inferior gluteal nerve (L5, S1, S2)
224
What is the function of the Gluteus maximus muscle?
Powerful extensor of flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh
225
What is the origin of the Tensor fasciae latae muscle?
Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest
226
What is the insertion of the Tensor fasciae latae muscle?
Iliotibial tract of fascia lata
227
What is the innervation of the Tensor fasciae latae muscle?
Superior gluteal nerve (L4, L5, S1)
228
What is the function of the Tensor fasciae latae muscle?
Stabilizes the knee in extension
229
230
What is the origin of the Piriformis muscle?
Anterior surface of sacrum between anterior sacral foramina.
231
What is the insertion of the Piriformis muscle?
Medial side of superior border of greater trochanter of femur.
232
What is the innervation of the Piriformis muscle?
Branches from S1 and S2.
233
What is the function of the Piriformis muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint.
234
What is the origin of the Obturator internus muscle?
Anterolateral wall of true pelvis; deep surface of obturator membrane and surrounding bone.
235
What is the insertion of the Obturator internus muscle?
Along length of superior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon.
236
What is the innervation of the Obturator internus muscle?
Nerve to obturator internus (L5, S1).
237
What is the function of the Obturator internus muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint.
238
What is the origin of the Gemellus superior muscle?
External surface of ischial spine.
239
What is the insertion of the Gemellus superior muscle?
Along length of inferior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon.
240
What is the innervation of the Gemellus superior muscle?
Nerve to obturator internus (L5, S1).
241
What is the function of the Gemellus superior muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint.
242
What is the origin of the Gemellus inferior muscle?
Upper aspect of ischial tuberosity.
243
What is the insertion of the Gemellus inferior muscle?
Quadrate tubercle on the intertrochanteric crest of the proximal femur.
244
What is the innervation of the Gemellus inferior muscle?
Nerve to quadratus femoris (L5, S1).
245
What is the function of the Gemellus inferior muscle?
Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint.
246
What is the origin of the Quadratus femoris muscle?
Lateral aspect of the ischium just anterior to the ischial tuberosity.
247
What is the insertion of the Quadratus femoris muscle?
Linear facet on the anterolateral aspect of the greater trochanter.
248
What is the innervation of the Quadratus femoris muscle?
Nerve to quadratus femoris (L5, S1).
249
What is the function of the Quadratus femoris muscle?
Laterally rotates femur at hip joint.
250
What is the origin of the Gluteus minimus muscle?
External surface of ilium between inferior and anterior gluteal lines.
251
What is the insertion of the Gluteus minimus muscle?
Elongate facet on the lateral surface of the greater trochanter.
252
What is the innervation of the Gluteus minimus muscle?
Superior gluteal nerve (L4, L5, S1).
253
What is the function of the Gluteus minimus muscle?
Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh.
254
What is the origin of the Gluteus medius muscle?
External surface of ilium between anterior and posterior gluteal lines.
255
What is the insertion of the Gluteus medius muscle?
Posterior aspect of iliotibial tract of fascia lata and gluteal tuberosity of proximal femur.
256
What is the innervation of the Gluteus medius muscle?
Superior gluteal nerve (L4, L5, S1).
257
What is the function of the Gluteus medius muscle?
Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh.
258
What is the origin of the Gluteus maximus muscle?
Fascia covering gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spinae, dorsal surface of lower sacrum, lateral margin of coccyx, external surface of sacrotuberous ligament.
259
What is the insertion of the Gluteus maximus muscle?
Iliotibial tract of fascia lata.
260
What is the innervation of the Gluteus maximus muscle?
Inferior gluteal nerve (L5, S1, S2).
261
What is the function of the Gluteus maximus muscle?
Powerful extensor of flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh.
262
What is the origin of the Tensor fasciae latae muscle?
Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest.
263
What is the insertion of the Tensor fasciae latae muscle?
Iliotibial tract of fascia lata.
264
What is the innervation of the Tensor fasciae latae muscle?
Superior gluteal nerve (L4, L5, S1).
265
What is the function of the Tensor fasciae latae muscle?
Stabilizes the knee in extension.
266
267
What is the origin of the Psoas major?
Posterior abdominal wall (lumbar transverse processes, intervertebral discs, and adjacent bodies from TXII to LV and tendinous arches between these points)
268
What is the insertion of the Psoas major?
Lesser trochanter of femur
269
What is the innervation of the Psoas major?
Anterior rami (1, L2, L3)
270
What is the function of the Psoas major?
Flexes the thigh at the hip joint
271
What is the origin of the Iliacus?
Posterior abdominal wall (iliac fossa)
272
What is the insertion of the Iliacus?
Lesser trochanter of femur
273
What is the innervation of the Iliacus?
Femoral nerve
274
What is the function of the Iliacus?
Flexes the thigh at the hip joint
275
What is the origin of the Vastus medialis?
Femur - medial part of intertrochanteric line, pectineal line, medial lip of the linea aspera, medial supracondylar line
276
What is the insertion of the Vastus medialis?
Quadriceps femoris tendon, medial border of patella
277
What is the innervation of the Vastus medialis?
Femoral nerve (L2, L3, L4)
278
What is the function of the Vastus medialis?
Extends the leg at the knee joint
279
What is the origin of the Vastus intermedius?
Femur - upper two-thirds of anterior and lateral surfaces
280
What is the insertion of the Vastus intermedius?
Quadriceps femoris tendon, lateral margin of patella
281
What is the innervation of the Vastus intermedius?
Femoral nerve (L2, L3, L4)
282
What is the function of the Vastus intermedius?
Extends the leg at the knee joint
283
What is the origin of the Vastus lateralis?
Femur - lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity, lateral lip of the linea aspera
284
What is the insertion of the Vastus lateralis?
Quadriceps femoris tendon, lateral margin of patella
285
What is the innervation of the Vastus lateralis?
Femoral nerve (L2, L3, L4)
286
What is the function of the Vastus lateralis?
Extends the leg at the knee joint
287
What is the origin of the Rectus femoris?
Straight head originates from the anterior inferior iliac spine; reflected head originates from the ilium just superior to the acetabulum
288
What is the insertion of the Rectus femoris?
Quadriceps femoris tendon, patella
289
What is the innervation of the Rectus femoris?
Femoral nerve (L2, L3, L4)
290
What is the function of the Rectus femoris?
Flexes the thigh at the hip joint and extends the leg at the knee joint
291
What is the origin of the Sartorius?
Anterior superior iliac spine
292
What is the insertion of the Sartorius?
Medial surface of tibia just interomedial to tibial tuberosity
293
What is the innervation of the Sartorius?
Femoral nerve (L2, L3)
294
What is the function of the Sartorius?
Flexes the thigh at the hip joint and flexes the leg at the knee joint
295
296
What are the muscles in the medial group of the thigh?
Gracilis, Obturator externus, Adductor magnus, Adductor brevis, Adductor longus
297
What is the origin of Gracilis?
A line on the external surfaces of the body of the pubis, the inferior pubic ramus, and the ramus of the ischium
298
What is the insertion of Gracilis?
Medial surface of proximal shaft of tibia
299
What is the innervation of Gracilis?
Obturator nerve (L2, L3)
300
What is the origin of Pectineus?
Pectineal line (pecten pubis) and adjacent bone of pelvis
301
What is the insertion of Pectineus?
Oblique line extending from base of lesser trochanter to linea aspera on posterior surface of proximal femur
302
What is the innervation of Pectineus?
Femoral nerve (L2, L3)
303
What is the origin of Adductor longus?
External surface of body of pubis (triangular depression inferior to pubic crest and lateral to pubic symphysis)
304
What is the insertion of Adductor longus?
Linea aspera on middle one-third of shaft of femur
305
What is the innervation of Adductor longus?
Obturator nerve (L2, L3)
306
What is the origin of Adductor brevis?
External surface of body of pubis
307
What is the insertion of Adductor brevis?
Posterior surface of proximal femur and upper one-third of linea aspera
308
What is the innervation of Adductor brevis?
Obturator nerve (L2, L3)
309
What is the origin of Adductor magnus?
Adductor part - ischiopubic ramus; Hamstring part - ischial tuberosity
310
What is the insertion of Adductor magnus?
Adductor tubercle and supracondylar line
311
What is the innervation of Adductor magnus?
Obturator nerve (anterior division) (L2, L3, L4); Sciatic nerve (tibial division) (L2, L3, L4)
312
What are the hamstring muscles?
Biceps femoris, Semitendinosus, Semimembranosus
313
What is the origin of Biceps femoris?
Long head - interomedial part of the upper area of the ischial tuberosity; short head - lateral lip of linea aspera
314
What is the insertion of Biceps femoris?
Head of fibula
315
What is the innervation of Biceps femoris?
Sciatic nerve (L5, S1, S2)
316
What is the origin of Semitendinosus?
Inferomedial part of the upper area of the ischial tuberosity
317
What is the insertion of Semitendinosus?
Medial surface of proximal tibia
318
What is the innervation of Semitendinosus?
Sciatic nerve (L5, S1, S2)
319
What is the origin of Semimembranosus?
Superolateral impression on the ischial tuberosity
320
What is the insertion of Semimembranosus?
Groove and adjacent bone on medial and posterior surface of medial tibial condyle
321
What is the innervation of Semimembranosus?
Sciatic nerve (L5, S1, S2)
322
What is the function of Gracilis?
Adducts thigh at hip joint and flexes leg at knee joint
323
What is the function of Pectineus?
Adducts and flexes thigh at hip joint
324
What is the function of Adductor longus?
Adducts and medially rotates thigh at hip joint
325
What is the function of Adductor brevis?
Adducts and medially rotates thigh at hip joint
326
What is the function of Adductor magnus?
Adducts and medially rotates thigh at hip joint
327
What is the function of Obturator externus?
Laterally rotates thigh at hip joint
328
What is the function of Biceps femoris?
Flexes leg at knee joint; extends and laterally rotates thigh at hip joint and laterally rotates leg at knee joint
329
What is the function of Semitendinosus?
Flexes leg at knee joint and extends thigh at hip joint; medially rotates thigh at hip joint and leg at knee joint
330
What is the function of Semimembranosus?
Flexes leg at knee joint and extends thigh at hip joint; medially rotates thigh at hip joint and leg at knee joint
331
332
What is the popliteal fossa?
The popliteal fossa is a diamond-shaped space behind the knee joint formed between muscles in the posterior compartments of the thigh and leg.
333
What are the superomedial boundaries of the popliteal fossa?
The superomedial boundaries are formed by the distal ends of the semitendinosus and semimembranosus muscles.
334
What are the superolateral boundaries of the popliteal fossa?
The superolateral boundary is formed by the distal end of the biceps femoris muscle.
335
What forms the lower part of the popliteal fossa?
The lower part is formed medially by the medial head of the gastrocnemius muscle and laterally by the plantaris muscle and the lateral head of the gastrocnemius muscle.
336
What forms the floor of the popliteal fossa?
The floor is formed by the capsule of the knee joint, adjacent surfaces of the femur and tibia, and more inferiorly, by the popliteus muscle.
337
What forms the roof of the popliteal fossa?
The roof is formed by deep fascia, which is continuous above with the fascia lata of the thigh.
338
What are the major contents of the popliteal fossa?
The major contents are the popliteal artery, popliteal vein, and the tibial and common fibular nerves.
339
Where do the tibial and common fibular nerves originate?
They originate proximal to the popliteal fossa as the two major branches of the sciatic nerve.
340
How does the tibial nerve descend in the popliteal fossa?
The tibial nerve descends vertically through the popliteal fossa and exits deep to the margin of the plantaris muscle to enter the posterior compartment of the leg.
341
How does the common fibular nerve exit the popliteal fossa?
The common fibular nerve exits by following the biceps femoris tendon over the lower lateral margin of the popliteal fossa and continues to the lateral side of the leg.
342
What covers the roof of the popliteal fossa?
The roof is covered by superficial fascia and skin.
343
What important structures are found in the superficial fascia of the popliteal fossa?
The important structures include the sural nerve and small saphenous vein.
344
Where does the small saphenous vein ascend?
The small saphenous vein ascends vertically in the superficial fascia on the back of the leg from the lateral side of the dorsal venous arch in the foot.
345
What is the function of the posterior cutaneous nerve of the thigh?
It descends through the thigh superficial to the hamstring muscles, passes through the roof of the popliteal fossa, and continues inferiorly with the small saphenous vein to innervate skin on the upper half of the back of the leg.
346
347
What is the knee joint?
The knee joint is the largest synovial joint in the body.
348
What are the main articulations of the knee joint?
It consists of the articulation between the femur and tibia (weight-bearing) and the articulation between the patella and femur (directs pull of quadriceps femoris muscle).
349
What is the function of the menisci in the knee joint?
Two fibrocartilaginous menisci accommodate changes in the shape of the articular surfaces during joint movements.
350
What type of joint is the knee joint?
The knee joint is a hinge joint that allows mainly flexion and extension.
351
What reinforces the knee joint?
The knee joint is reinforced by collateral ligaments on each side and two strong cruciate ligaments.
352
What is the locking mechanism of the knee joint?
The knee joint has an efficient 'locking' mechanism to reduce muscle energy required to keep the joint extended when standing.
353
What covers the articular surfaces of the knee joint?
The articular surfaces are covered by hyaline cartilage.
354
What are the two menisci in the knee joint?
The two menisci are the medial meniscus and lateral meniscus, both C-shaped fibrocartilaginous cartilages.
355
How are the menisci attached?
Both menisci are attached at each end to facets in the intercondylar region of the tibial plateau.
356
What is the function of the collateral ligaments?
The collateral ligaments stabilize the hinge-like motion of the knee.
357
Where is the fibular collateral ligament attached?
It is attached superiorly to the lateral femoral epicondyle and inferiorly to the fibular head.
358
Where is the tibial collateral ligament anchored?
It is anchored superiorly to the medial femoral epicondyle and descends to attach to the medial surface of the tibia.
359
What are the cruciate ligaments?
The cruciate ligaments interconnect the femur and tibia and cross each other in the sagittal plane.
360
Where does the anterior cruciate ligament attach?
It attaches to a facet on the anterior part of the intercondylar area of the tibia and ascends to the femur.
361
Where does the posterior cruciate ligament attach?
It attaches to the posterior aspect of the intercondylar area of the tibia and ascends to the medial wall of the femur.
362
363
What happens to the knee joint when standing?
The knee joint is locked into position, reducing the amount of muscle work needed to maintain the standing position.
364
What change occurs in the femoral surfaces during knee flexion?
In flexion, the surfaces are the curved and rounded areas on the posterior aspects of the femoral condyles.
365
What change occurs in the femoral surfaces during knee extension?
As the knee is extended, the surfaces move to the broad and flat areas on the inferior aspects of the femoral condyles. Consequently, the joint surfaces become larger and more stable in extension.
366
What role does medial rotation of the femur play in the locking mechanism?
Medial rotation of the femur on the tibia during extension tightens all the associated ligaments.
367
How does the body's center of gravity affect knee extension when standing?
The body's center of gravity is positioned along a vertical line that passes anterior to the knee joint, helping to keep the knee extended.
368
What muscle unlocks the knee?
The popliteus muscle unlocks the knee by initiating lateral rotation of the femur on the tibia.
369
370
What are the compartments of the leg?
The leg contains 4 compartments: anterior, lateral, and two posterior.
371
What is the origin of the Tibialis anterior?
Lateral surface of tibia and adjacent interosseous membrane.
372
What is the insertion of the Tibialis anterior?
Medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of metatarsal I.
373
What is the innervation of the Tibialis anterior?
Deep fibular nerve (L4, L5).
374
What is the function of the Tibialis anterior?
Dorsiflexion of foot at ankle joint; inversion of foot; dynamic support of medial arch of foot.
375
What is the origin of the Extensor hallucis longus?
Middle one-half of medial surface of fibula and adjacent surface of interosseous membrane.
376
What is the insertion of the Extensor hallucis longus?
Dorsal surface of base of distal phalanx of great toe.
377
What is the innervation of the Extensor hallucis longus?
Deep fibular nerve (L5, S1).
378
What is the function of the Extensor hallucis longus?
Extension of great toe and dorsiflexion of foot.
379
What is the origin of the Extensor digitorum longus?
Proximal one-half of medial surface of fibula and related surface of lateral tibial condyle.
380
What is the insertion of the Extensor digitorum longus?
Via dorsal digital expansions into bases of distal and middle phalanges of lateral four toes.
381
What is the innervation of the Extensor digitorum longus?
Deep fibular nerve (L5, S1).
382
What is the function of the Extensor digitorum longus?
Extension of lateral four toes and dorsiflexion of foot.
383
What is the origin of the Fibularis tertius?
Distal part of medial surface of fibula.
384
What is the insertion of the Fibularis tertius?
Dorsomedial surface of base of metatarsal V.
385
What is the innervation of the Fibularis tertius?
Deep fibular nerve (L5, S1).
386
What is the function of the Fibularis tertius?
Dorsiflexion and eversion of foot.
387
What is the origin of the Gastrocnemius?
Medial head - posterior surface of distal femur just superior to medial condyle; lateral head - upper posterolateral surface of lateral femoral condyle.
388
What is the insertion of the Gastrocnemius?
Via calcaneal tendon, to posterior surface of calcaneus.
389
What is the innervation of the Gastrocnemius?
Tibial nerve (S1, S2).
390
What is the function of the Gastrocnemius?
Plantarflexes foot and flexes knee.
391
What is the origin of the Plantaris?
Interior part of lateral supracondylar line of femur and oblique popliteal ligament of knee.
392
What is the insertion of the Plantaris?
Via calcaneal tendon, to posterior surface of calcaneus.
393
What is the innervation of the Plantaris?
Tibial nerve (S1, S2).
394
What is the function of the Plantaris?
Plantarflexes foot and flexes knee.
395
What is the origin of the Soleus?
Soleal line and medial border of tibia; posterior aspect of fibular head and adjacent surfaces of neck and proximal shaft; tendinous arch between tibial and fibular attachments.
396
What is the insertion of the Soleus?
Via calcaneal tendon, to posterior surface of calcaneus.
397
What is the innervation of the Soleus?
Tibial nerve (S1, S2).
398
What is the function of the Soleus?
Plantarflexes the foot.
399
What is the origin of the Popliteus?
Lateral femoral condyle.
400
What is the insertion of the Popliteus?
Posterior surface of proximal tibia.
401
What is the innervation of the Popliteus?
Tibial nerve (L4 to S1).
402
What is the function of the Popliteus?
Stabilizes knee joint (resists lateral rotation of tibia on femur).
403
What is the origin of the Flexor hallucis longus?
Posterior surface of fibula and adjacent interosseous membrane.
404
What is the insertion of the Flexor hallucis longus?
Plantar surface of distal phalanx of great toe.
405
What is the innervation of the Flexor hallucis longus?
Tibial nerve (S2, S3).
406
What is the function of the Flexor hallucis longus?
Flexes great toe.
407
What is the origin of the Flexor digitorum longus?
Medial side of posterior surface of the tibia.
408
What is the insertion of the Flexor digitorum longus?
Plantar surfaces of bases of distal phalanges of the lateral four toes.
409
What is the innervation of the Flexor digitorum longus?
Tibial nerve (S2, S3).
410
What is the function of the Flexor digitorum longus?
Flexes lateral four toes.
411
What is the origin of the Tibialis posterior?
Posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula.
412
What is the insertion of the Tibialis posterior?
Mainly to tuberosity of navicular and adjacent region of medial cuneiform.
413
What is the innervation of the Tibialis posterior?
Tibial nerve (L4, L5).
414
What is the function of the Tibialis posterior?
Inversion and plantarflexion of foot; support of medial arch of foot during walking.
415
416
What muscles are in the lateral compartment?
Fibularis longus and Fibularis brevis
417
What is the origin of the Fibularis longus?
Upper lateral surface of fibula, head of fibula, and occasionally the lateral tibial condyle
418
What is the origin of the Fibularis brevis?
Lower two-thirds of lateral surface of shaft of fibula
419
Where does the Fibularis longus insert?
Undersurface of lateral sides of distal end of medial cuneiform and base of metatarsal I
420
Where does the Fibularis brevis insert?
Lateral tubercle at base of metatarsal V
421
What is the innervation of the lateral compartment muscles?
Superficial fibular nerve (L5, S1, S2)
422
What is the function of the Fibularis longus?
Eversion and plantarflexion of foot; supports arches of foot
423
What is the function of the Fibularis brevis?
Eversion of foot
424
425
What is the major blood supply to the leg and foot?
The popliteal artery is the major blood supply to the leg and foot.
426
Where does the popliteal artery enter the leg?
The popliteal artery enters the posterior compartment of the leg from the popliteal fossa behind the knee.
427
What muscles does the popliteal artery pass between?
The popliteal artery passes between the gastrocnemius and popliteus muscles.
428
What are the two major branches of the popliteal artery?
The popliteal artery divides into the anterior tibial artery and the posterior tibial artery.
429
What do the sural arteries supply?
The sural arteries supply the gastrocnemius, soleus, and plantaris muscles.
430
What does the posterior tibial artery supply?
The posterior tibial artery supplies the posterior and lateral compartments of the leg and continues into the sole of the foot.
431
What muscles does the posterior tibial artery descend on?
The posterior tibial artery descends on the superficial surfaces of the tibialis posterior and flexor digitorum longus muscles.
432
What are the two major branches of the posterior tibial artery?
The two major branches are the circumflex fibular artery and the fibular artery.
433
What does the circumflex fibular artery connect with?
The circumflex fibular artery connects with the anastomotic network of vessels surrounding the knee.
434
Where does the fibular artery descend?
The fibular artery descends along the lateral side of the posterior compartment adjacent to the medial crest on the posterior surface of the fibula.
435
What artery is associated with the anterior compartment of the leg?
The artery associated with the anterior compartment of the leg is the anterior tibial artery.
436
How does the anterior tibial artery enter the anterior compartment?
The anterior tibial artery passes forward into the anterior compartment through an aperture in the interosseous membrane.
437
What does the anterior tibial artery become in the foot?
The anterior tibial artery continues onto the dorsal aspect of the foot as the Dorsalis Pedis Artery.
438
What does the anterior tibial artery give rise to distally?
The anterior tibial artery gives rise to an anterior medial malleolar artery and an anterior lateral malleolar artery.
439
What does the recurrent branch of the anterior tibial artery connect with?
The recurrent branch connects with the anastomotic network of vessels around the knee joint.
440
441
What is the tibial nerve associated with?
The tibial nerve is associated with the posterior compartment of the leg.
442
Where does the tibial nerve pass in the leg?
The tibial nerve passes under the tendinous arch formed between the fibular and tibial heads of the soleus muscle and vertically through the deep region of the posterior compartment of the leg.
443
How does the tibial nerve exit the posterior compartment of the leg?
It leaves the posterior compartment at the ankle by passing through the tarsal tunnel behind the medial malleolus.
444
What does the tibial nerve supply in the foot?
It supplies most intrinsic muscles and skin.
445
What branches does the tibial nerve give rise to in the leg?
It gives rise to branches that supply all the muscles in the posterior compartment and two cutaneous branches: the sural nerve and medial calcaneal nerve.
446
What is the common fibular nerve associated with?
The common fibular nerve is associated with the lateral compartment of the leg.
447
Where does the common fibular nerve divide?
It divides into the superficial fibular nerve and the deep fibular nerve after passing around the neck of the fibula.
448
What does the superficial fibular nerve innervate?
The superficial fibular nerve innervates the lateral compartment of the leg.
449
What are the cutaneous branches of the common fibular nerve?
The cutaneous branches are the sural communicating nerve and the lateral sural cutaneous nerve.
450
What is the deep fibular nerve associated with?
The deep fibular nerve is associated with the anterior compartment of the leg.
451
Where does the deep fibular nerve originate?
It originates in the lateral compartment of the leg as one of the two divisions of the common fibular nerve.
452
What muscles does the deep fibular nerve innervate?
It innervates all muscles in the anterior compartment.
453
What does the deep fibular nerve supply in the foot?
It supplies the extensor digitorum brevis, contributes to the innervation of the first two dorsal interossei muscles, and supplies the skin between the great and second toes.
454
455
What type of joint is the ankle joint?
The ankle joint is synovial in type.
456
Which bones are involved in the ankle joint?
The ankle joint involves the talus of the foot and the tibia and fibula of the leg.
457
What movements does the ankle joint mainly allow?
The ankle joint mainly allows hinge-like dorsiflexion and plantar flexion of the foot on the leg.
458
How is the distal end of the fibula anchored to the tibia?
The distal end of the fibula is firmly anchored to the larger distal end of the tibia by strong ligaments.
459
What is the subtalar joint?
The subtalar joint is between the large posterior calcaneal facet on the inferior surface of the talus and the corresponding posterior talar facet on the superior surface of the calcaneus.
460
What movements are allowed by the subtalar joint?
The subtalar joint allows inversion and eversion.
461
What is the sinus tarsi?
The sinus tarsi is located between the talus and calcaneus.
462
What ligaments reinforce the talocalcaneonavicular joint?
The talocalcaneonavicular joint is reinforced by the interosseous talocalcaneal ligament, talonavicular ligament, and plantar calcaneonavicular ligament (spring ligament).
463
What is the bifurcate ligament?
The bifurcate ligament is a Y-shaped ligament that reinforces the lateral part of the talocalcaneonavicular joint.
464
What structures are attached to the bifurcate ligament?
The arms of the bifurcate ligament are attached to the dorsomedial surface of the cuboid and the dorsolateral part of the navicular.
465
What is the flexor retinaculum?
The flexor retinaculum is a strap-like layer of connective tissue that spans the bony depression formed by the medial malleolus and surrounding structures.
466
What structures are located on the posterior surface of the medial malleolus?
The structures include the tendons of the tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, and flexor hallucis longus.
467
Where can the pulse of the posterior tibial artery be felt?
The pulse of the posterior tibial artery can be felt midway between the heel and medial malleolus.
468
What is the function of the extensor retinacula?
The extensor retinacula strap the tendons of the extensor muscles to the ankle region and prevent tendon bowing during extension of the foot and toes.
469
What are the two types of extensor retinaculum?
The two types are the superior extensor retinaculum and the inferior extensor retinaculum.
470
What structures pass through the extensor retinaculum?
Structures include the tendons of the extensor digitorum longus, fibularis tertius, dorsalis pedis artery, extensor hallucis longus, and tibialis anterior.
471
472
What is the posterior tibial artery?
The posterior tibial artery enters the foot through the tarsal tunnel on the medial side of the ankle and posterior to the medial malleolus.
473
Where can the pulse of the posterior tibial artery be palpated?
Midway between the medial malleolus and the heel, where the artery is covered only by a thin layer of retinaculum, superficial connective tissue, and skin.
474
What does the posterior tibial artery bifurcate into?
It bifurcates into a small medial plantar artery and a larger lateral plantar artery.
475
What is the function of the lateral plantar artery?
The lateral plantar artery passes anterolaterally into the sole of the foot and curves medially to form the deep plantar arch.
476
What is the dorsalis pedis artery?
The dorsalis pedis artery is the continuation of the anterior tibial artery and begins as the anterior tibial artery crosses the ankle joint.
477
Where can the pulse of the dorsalis pedis artery be felt?
On the dorsal surface of the foot by palpating the vessel against the underlying tarsal bones between the tendons of the extensor hallucis longus and extensor digitorum longus.
478
What branches come from the dorsalis pedis artery?
Branches include tarsal arteries, the arcuate artery, and the first dorsal metatarsal artery.
479
What does the tibial nerve supply?
The tibial nerve supplies the heel and bifurcates into a large medial plantar nerve and a smaller lateral plantar nerve.
480
What does the deep fibular nerve innervate?
It innervates the extensor digitorum brevis and contributes to the innervation of the first two dorsal interossei muscles.
481
What is Morton's neuroma?
An enlarged common plantar nerve, usually in the third interspace between the third and fourth toes.
482
What is the pathology associated with Morton's neuroma?
Perineural fibrosis.
483
What happens to the common plantar nerve during the 'push-off' phase of walking?
The inter digital nerve is sandwiched between the ground and the deep transverse metatarsal ligament, which can compress the common plantar nerve.
484
485
486
What is the longitudinal arch of the foot?
The longitudinal arch is formed between the posterior end of the calcaneus and the heads of the metatarsals, being highest on the medial side and lowest on the lateral side.
487
What is the transverse arch of the foot?
The transverse arch is highest in a coronal plane that cuts through the head of the talus and disappears near the heads of the metatarsals.
488
What innervates the intrinsic muscles of the foot?
All intrinsic muscles are innervated by the medial and lateral plantar branches of the tibial nerve, except for the extensor digitorum brevis, which is innervated by the deep fibular nerve.
489
How can the gluteal region be divided for sciatic nerve injections?
The gluteal region can be divided into quadrants using two lines from palpable bony landmarks: one vertical from the highest point of the iliac crest and one horizontal midway between the iliac crest and ischial tuberosity.
490
Where is the femoral pulse located?
The femoral pulse is located inferior to the inguinal ligament and midway between the anterior superior iliac spine and the pubic symphysis.
491
492
Where can the popliteal pulse be found?
The popliteal pulse is found deep in the popliteal fossa near the midline when the knee is semiflexed.
493
Where is the posterior tibial pulse located?
The posterior tibial pulse is located posteroinferior to the medial malleolus in the groove between the medial malleolus and the heel.
494
Where can the dorsalis pedis pulse be found?
The dorsalis pedis pulse passes distally over the tarsal bones between the tendon of the extensor hallucis longus and the tendon of the extensor digitorum longus to the second toe.
