L/E Flashcards
lumbar plexus
arises from L1 -4, anterior to lumbar TP’s and within the psoas muscle
“ interested in getting lunch on friday?”
illiohypogastic
illioinguinal
gentiofemoral
lateral femoral cutaneous
femoral
obturator
Sacral plexus
from lumbrasacral trunk L4/5 and S1-4 spinal roots
posterior pelvic wall
Anterior branches: Nerve to quadratus femoris, nerve to obturator internus, pudendal nerve, nerves to levator ani and external anal sphincter
Posterior branches: Nerve to piriformis , superior gluteal nerve, inferior gluteal nerve, posterior femoral cutaneous nerve, perforating cutaneous nerve, pelvic splanchnic nerves
Terminal branch: Sciatic nerve (divides into tibial and common fibular/peroneal nerves)
Superior gluteal nerve, inferior gluteal nerve, posterior cutaneous nerve of thigh, pudendal nerve, sciatic nerve (SIPPS)
internal oblique
deep to external oblqitue and superfiscal to TA
O: anterior illiac crest
I: inferior ribs 10/11/12, lina alba
A: b/l trunk flexion, compression of viscera, expiration
u/l ipsi rotation and side flexion
external oblique
superfiscal to internal oblique
O: lateral surface ribs 5- 12
I: lina alba pubic tubercle
A: trunk felxion, compression of viscera, expiration
u/l ipsi side felxion, contra rotation
TA
deep to external and internal obliques
run from posterior to antieror lateral banding around the abdomen
A: compression of viscera, exhalation, unilateral ipsis trunk rotation
rectus abdominus
anterior abdominal wall
O: pubic symphisis and crest
I: xiphod process and costal cartiliges 5- 7
trunk flexion, compression of viscera, expiration
piraformis
O; anteriro surface of sacrum
I; greater trochanter of femor
A; external rottion and abductino of the hip, stabilizes the femor in the socket
I:nerve to piraformis
GOGO muscles
superior gemullus
inferior gemullus
obtrator internus
obtrator externus
ER and abduction of the hip / stablizes head of femur in socket
quad fem
O: ischial tub
I: introchanteric crest of femor
A: er ro tation of hip
O : nerve to quad fem
illliopsoas
O: lumbar Tp’s and illiac fossa
I: passes under the inguinal ligament and attaches to lesser trochanter of femor
A: flexion and ER of the hip, flexion of the trunk, lateral trunk flexion (psaos major ipsi)
glute min
O: gluteal surface of illium
I: anterior aspect of greater trochanter
A; thigh abduction, anteior part dose hip IR, pelvis stabilization
N: superior gluteal
glute med
O: gluteal surface of ollium
I: lateral aspect of greater trochanter
A; thigh abduction, the anterior part does IR ofthe hip, pelvic stabilizartin
I: superior gluteal nerve
glute max
O: superior surface of illuim , sacrum, coccyx, thoracolumbar fascioa, sacrotuberous lig
I: greater tuberosity of femor and ITB
A: hip extension/abduction,
N: inferior gluteal nerve
TFL/ITB
O: outer lip of anterior illiac crest, ASIS
I: ITB, lateral condyle of tibia
A; internal rotator of the hip, external rotation at the knee, hip and knee stabilization
N:superior gluteal nerve
quad lumb:
O: illiac crest, iliolumbar numbar lig
I: inferior border of rib 12, tps of L1-L4
A: trunk extension, ipsilateral side flexion,
quads
O:
rectus femoris: AIIS, anterior acetabular groove
vastus lateralis: Intertrochanteric line, greater trochanter, gluteal tuberosity, linea aspera of femur
vatus intermeidias:Anterior surface of femoral shaft
vastus medials:Intertrochanteric line, pectineal line of femur, linea aspera, medial supracondylar line of femur
I: tibial tuberosity vis the patellar tendon
A: extension at the knee, rec fem flexion at hip
N:femoral
hamstrings
bicep femoris
O: lomg head (intial tub/scrotuberus lig), short head ( linea aspera of femur (lateral lip), lateral supracondylar line of femur)
I:head of fibula
N: tibial, common fibular (both branches of sciatic)
semitendinosus
O: ischial tuberosity
I:proximal medail tibial condyle (pes anserine)
N: tibial
semimembranosus
o: ischial tuberosity
I: medial condyle to tibia
N: tibial
A: flexion of knee, extension at hip, stabilization of hip and knee
aductor longus
O: pubis lateral to symphysis
I: medial thrid of linea aspera of femor
A: Thigh flexion, Thigh adduction, Thigh external rotation; Pelvis stabilization
N: obtrator
adductor brevis
O: anterior pubis, inferior pubic ramus
I: linea aspera of femor
A:thigh flexion, thigh adduction, thigh external rotation; pelvis stabilization
N: obtrator
adductor magnus
O: inferior pubic ramus, ishcial ramus, ishcial tuberoisity
I:Adductor part: Gluteal tuberosity, linea aspera (medial lip), medial supracondylar line
Ischiocondylar part: Adductor tubercle of femur
A:Adductor part:
Hip joint - Thigh flexion, thigh adduction, thigh external rotation
Hamstring part:
Hip joint - Thigh extension, thigh internal rotation
Entire muscle: Pelvis stabilization
N:Adductor part: Obturator nerve (L2-L4)
Ischiocondylar part: Tibial division of sciatic nerve (L4
pectinus
O: superior pubic ramus
I: pectinial line and lina aspera of femor
A:Thigh flexion, thigh adduction, thigh external rotation, thigh
internal rotation; pelvis stabilization
N: femoral and obturator nerves
gracillis
O:Anterior body of pubis, inferior pubic ramus, ischial ramus
I: medial surface of proximal tibia via pes anserine
A:Hip joint: Thigh flexion, thigh adduction;
Knee joint: leg flexion, leg internal rotation
N: Obturator
tib anterior
O: lateral surface of tibia and interousseus membrane
I: medial cuneform bone base of metatarsal 1
A: dorsiflexion, inversion
N: deep fibular
extensor digitorium longus
O:medial surface of fibula, lateral tibial condyle, interosseus membrane
I: distal middle phalanges 2-5
A: Metatarsophalangeal and interphalangeal joints 2-5: Toe extension;
Talocrural joint: Foot dorsiflexion;
Subtalar joint: Foot eversion
N: deep fibular
extensor hallucis longus
O: middle thrid medial surface of fibula, interosseus membrane
I: base of distal phalanx of great toe
A:Metatarsophalangeal and interphalangeal joint 1: toe extension; talocrural joint: foot dorsiflexion
N: deep fibular nerve
fibularis tertius
O:Medial surface (distal third) of fibula, interosseous membrane (anterior surface), anterior intermuscular septum
I: dorsal surface base of metatarsal 5
A: Df and eversin
N: deep fibular
gastroc
O: posteior lateral and medial condyle of femor
I: Posterior surface of the calcacneous via the calcaneal tendon
A; PF
N: tibail
plantaris
O: Lateral supracondylar line of femur, oblique popliteal ligament of knee
I: posterior calcaneous via calcaneal tendon
A:PF
N:tibial
soleus
O: Soleal line, fibula head and posteriro tibia
I: calcaneal tuberosity via calcalneal tendon
A: posture/PF
N:tubial
tib posterior
O: posterior tibia fibula and interosseus
I: Tuberosity of navicular bone, all cuneiform bones, cuboid bone, bases of metatarsal bones 2-4
A: Talocrural joint: Foot plantarflexion
Subtalar joint: Foot inversion
Supports medial longitudinal arch of foot
N: tibial
flexor hallucies longus
O: Distal 2/3 of) Posterior surface of fibula, interosseous membrane, posterior intermuscular septum of leg, fascia of tibialis posterior muscle
I: base of distal pahalanx of big toe
A:Metatarsophalangeal and interphalangeal joint 1: Toe flexion;
Talocrural joint: Foot plantar flexion;
Subtalar joint: Foot inversion
N: tibial
flexor digitorum longus
O: posteriro tibia
i: base of distal phalanx 2-5
a:Metatarsophalangeal and interphalangeal joints 2-5: toe flexion
Talocrural joint: foot plantar flexion
Subtalar joint: foot inversion
n: tibial
popliteus
O:Lateral condyle of femur, posterior horn of lateral meniscus of knee joint
I: posterior proximal tinia
A: unlocks knee joint, knee joint stabilization
N: tibial
fibularis longus
O: head of fibula, laterl surface of fibula
I: first metatarsal and medial cuneform
A: DF and Ev
N: superfiscal fibular nerve
fibularis brevis
O: distal 2/3 of fibuala
I: tuberosiyt of 5th metatarsal
A: DF and EV
N: superfiscal fibular
sartorius
O: ASIS
I: medail tibia via pes anserine
A: FAbER, flexion abdution externalrotation
N: femoral nerve
femoral nerve
L2-4
anterior thigh
Motor functions: Innervates the anterior thigh muscles that flex the hip joint (pectineus, iliacus, sartorius) and extend the knee (quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius),
Sensory functions: Supplies cutaneous branches to the anteromedial thigh (anterior cutaneous branches of the femoral nerve) and the medial side of the leg and foot (saphenous nerve).
obturator nerve
L2-4
Motor functions: Innervates the muscles of the medial compartment of the thigh (obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis).
Sensory functions: Cutaneous branches of the obturator nerve innervate the skin of the medial thigh.
sciatic nerve
L4-S3
largest nerve in thebody
Innervates the muscles of the posterior thigh (biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve).
Indirectly innervates (via its terminal branches) all the muscles of the leg and foot.
inferior to piraformis
at popliteal foss bificates into tibial and common fibular nerve
piraformis syndrome
tibial nerve
L4-S3
Sensory: Innervates the skin of the posterolateral leg, lateral foot and the sole of the foot.
Motor: Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.
arisies in the popliteal fossa, runs behind medial malleolus
tarsal tunnel sydrome
common fibula
L4-S2
Motor: Innervates the short head of the biceps femoris directly. Also supplies (via branches) the muscles in the lateral and anterior compartments of the leg.
Sensory: Innervates the skin of the lateral leg and the dorsum of the foot.
deep and superfiscal fibular nerve
foot drop
deep fibula
L4-S2
Motor function: Innervates the muscles in the anterior compartment of the leg, as well as some of the intrinsic muscles of the foot.
Sensory function: Supplies the triangular region of skin between the 1st and 2nd toes.
superfiscal fibula
L4-S1
Motor: Innervates the muscles in the lateral compartment of the leg.
Sensory: Supplies the anterolateral aspect of the distal leg and the majority of the dorsum of the foot (apart from the webbing between the hallux and the second digit).
lateral cutenous nerve of theigh
arises from the lumbar plexus
sensory innervates lateral thigh
lateral cuteous nerve of the calf
common fibular
sensory upper lateral lower leg
possterior cutaneous nerve of the thigh
from sacral plexus
sensory posterior thigh and upper lower leg
saphenous nerve
sensory medial lower leg to medial malleolus
sural nerve
sensory lateral lower leg, lateral heel
Lumbar radiculopathy
a condition describing a group of signs and symptoms relted to a compressed or irritated nerve
disck herniation, stenosis, osteophyts, spondyloss, swelling/inflammation
test vis
1) dermatomes
2) myotomes
3) deep tendon reflexes
4) special tests
dermatomal procedure and lumbar innervation
test area accessible and exposed bare skin, patient closes eyes, test bilateral proximal to distal, if ligth touch impared can test crude touch ( sharp dull) and temperature)
L4 crosses over the patella
L5 most of the toes on dorsum of the foot
????
L/E myotomal procedure
mvts tested in neutral postitioing
hold dont let me move you
5-8 sec
test bilaterally if possible
L1/2 hip flexion
L3 kne extension
L4 dorsiflexion
L5 big toe extension
S1 PF, eversion, hip extension
S2 knee flexion, hip extension, ankle PF
L/E deep tendon refelxes
L3 /4 patellar
L4 /5 tib posterior
L5 /S1 medial hamstring
S1/2 lateral hamstring
S1/2 achillies
0 no response
1+ decreased response
2+normal response
3+exagerated response
4+clonus/very brisk
SLUMP
patient in seated
therpist instructs patient o place hans behind bak and go into a slumped posturing, round shoudlers and chin to chest
passive extension of the uninvoved kniee that repeats tst on invovled side
if symptoms have notbeen reproduced then DF is added
syptomsomtes of low back pain, radiating pain in posterior leg are recreated- pateitn extends neck to see if it relives pain
+ symtpoms elciited, pain releif with neck extension
SLR
Pt is supine unaffected side first
therpist adducts medial rotates hip keeping knee fully extended
therpist flexes patients hip unil paitent indicates pain or tihgtness in posterior thigh
before 35 nerve slack being taken up
at 35 nerve roots are now under tension
at 60-70 sciateic roots tense over disc
aboce 70 pain is likely MSK ie hamstring test
SID- sural, DF and IV
TED-tbial, DF and EV
PIP-peroneal/common fibular, IV PF
crossover sign
when performing an SLE on the unaffected side the pateint expereinces pain in the affected leg
inidcatio of a alrge disc buldge
sign of the buttock
SLR performed untill restriction
knee is flexed to see if more ROm is available-there should be slack
++ hip felxion does not increase when knee is fleced, an indication of pathology behind the hip joint in the buttocks ( bursittis, tumor, absvess
bowstring test
