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MJM > L16 - Nerves and vessels of the lower limb > Flashcards

L16 - Nerves and vessels of the lower limb Flashcards

1
Q

What are the 3/4 generic layers of blood vessels?

A
  1. Endothelium
  2. Tunica intima
    - Endothelium
    - Internal elastic membrane
  3. Tunica media
    - Muscle
    - External elastic membrane
  4. Tunica adventitia
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2
Q

Where does the descending aorta commence and end??

A
  • Commences at the end of the aortic arch
  • Continues down into the abdomen
  • Ends by bifurcating into the left and right iliac arteries
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3
Q

What are the two parts to the descending aorta called?

A
  1. The thoracic aorta

2. The abdominal aorta

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4
Q

Where does the thoracic aorta commence/ end?

A
  • Commences at the sternal angle of Louis - the manubriosternal junction (on the thoracic plane)
  • Ends at the aortic hiatus of the diaphragm
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5
Q

Generally where does the thoracic aorta supply arterial blood to?

A
  1. Muscles of the chest wall

2. Spinal cord

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6
Q

What is the aortic hiatus of the diaphragm?

A
  • A hole in the diaphragm
  • The lowest and most posterior of the large apertures
  • Located at approximately vertebral level T12
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7
Q

What is the sternal angle an anatomical landmark for?

A
  1. 2nd coastal cartilages
  2. Manubriosternal joint
  3. Bifurcation of trachea
  4. Start of right and left bronchi
  5. Left recurrent laryngeal nerve branches off the main vagus nerve
  6. Divides the mediastinum into superior and inferior mediastinum - aka the thoracic plane, it separates the superior and inferior mediastinum
  7. Thoracic duct (lmpahtic vessel) crosses from the right side of the body to the left side
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8
Q

Where does the abdominal aorta commence/ end?

A
  • Commences at the T12 vertebral level

- Ends at L3/4 intervertebral disc (there will be some individual variation therefore may differ, but better to use L4)

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9
Q

Why does the abdominal aorta have two phases and what are they called?

A
  1. Suprarenal segment
  2. Infrarenal segment
    - Abdominal aorta can be said to be divisible into 2 parts at vertebral level L1-2 IVD, the level at which renal arteries branch off
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10
Q

What are the five major arteries of the abdomen that arise by branching from the abdominal aorta?

A
  1. Coeliac artery (L1)
  2. Mesenteric arteries
    - Superior mesenteric artery (L1)
    - Inferior mesenteric artery (L3)
  3. Renal arteries (L1/2 IVD)
  4. Common iliac arteries
    - Left common iliac artery (L4/5)
    - Right common iliac artery (L4/5)
  5. Arteries supplying the spinal cord (all vertebral levels L1)
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11
Q

What is the supracristal plane?

A
  • Top of iliac crest of pelvic bone
  • At L4 vertebrae
  • Transverse plane
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12
Q

Describe the arterial tree of the lower limb

A
  1. Common iliac artery
    - Branch internal iliac artery
  2. External iliac artery
  3. Common femoral artery (at groin crease)
    - Branch profunda femoris artery
  4. Superficial femoral artery
  5. Popliteal artery (either side of knee crease)
  6. Tibio-peroneal trunk
    - Peroneal artery
  7. Tibial arteries
    - Anterior and posterior
  8. Dorsalis pedis and posterior tibial artery
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13
Q

Where does the common iliac artery begin?

A
  • L3/4 IVD disc
  • Supracristal plane
  • Umbilicus
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14
Q

Where is the external iliac artery located?

A

L5-S1 IVD

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15
Q

Where is the femoral artery located?

A

The external iliac artery passes beneath the inguinal ligament in the lower part of the abdomen and becomes the femoral artery

  • Ends by entering the adductor canal
  • Ends at the apex of the femoral triangle
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16
Q

Where is the popliteal artery located?

A
  • A continuation of the femoral artery
  • Starts at the opening of the adductor canal and ends at the adductor hiatus (at the lower border of the popliteus muscle)
  • Located in the knee and the back of the leg
  • Runs across the popliteal fossa, posterior to the knee joint, and then travels between the gastrocnemius and popliteal muscles of the posterior compartment of the leg
  • In the popliteal fossa, the popliteal artery gives off a series of geniculate arteries to supply the knee joint
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17
Q

Where is the posterior tibial artery located?

A
  • Runs down the leg just below the knee
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18
Q

Where is the anterior tibial artery located?

A
  • Passes in front of the ankle joint and continues into the dorsalis pedis artery onto the dorsum of the foot lateral to the tendon of the extensor hallucis longus and medial to the extensor digitorum longus and deep peroneal nerve
19
Q

What is the adductor canal?

A

At the apex of the femoral triangle is an opening in the adductor magnus - this is the adductor canal
AKA:
- Subsartorial canal
- Hunter’s canal

20
Q

Where can the femoral pulse be palpated?

A

At the mid-inguinal line

21
Q

What shape is the popliteal fossa?

A

Diamond shaped

22
Q

Where can the anterior tibial artery be palpated?

A
  • Above the navicular bone
  • Medial to the tendon of extensor hallucis longus
    (at dorsalis pedis level)
23
Q

Where can the posterior tibial artery be palpated?

A
  • Halfway between the posterior border of the medial malleolus and the achilles tendon (calcaneal tendon)
24
Q

Describe the posterior tibial artery from the popliteal artery

A
  • The larger of the terminal branches of the popliteal artery
  • Descends deep to the soleus and then becomes superficial in the lower third of the leg
  • Passes behind the medial malleolus between tendons of flexor digitorum longus and flexor hallucis longus
25
Q

What does the posterior tibial artery divide into and where does this occur?

A

Below the ankle it divides into medial and lateral plantar arteries which constitute principal blood supply to the foot

26
Q

What are accompanying veins?

A
  • Typically paired veins that accompany an artery

- Found in close proximity with the artery so that the pulsations of the artery aid venous return

27
Q

What is the vasa vasorum?

A

Accompanies (larger) veins

28
Q

What is the venae commitante?

A

Accompanies (larger) arteries

29
Q

What are the spinal roots of the lumbar plexus?

A

Anterior rami of L1-4

  • Forms behind within the psoas major muscle
  • Nerves emerge either lateral or medial to the borders of the psoas
30
Q

What are the roots of the sacral plexus?

A

Anterior rami of L4-S4

31
Q

Which nerves emerge lateral to psoas muscle?

A
  1. The femoral nerve
  2. The iliohypogastric muscle
  3. The ilioinguinal muscle
  4. The lateral cutaneous nerve of the thigh
32
Q

Which nerves emerge medial to psoas muscle?

A
  1. The obturator nerve

2. The lumbosacral trunk

33
Q

What are the terminating nerves of the lumbar plexus?

A
  1. Iliohypogastric nerve
  2. Ilioinguinal nerve
  3. Genitofemoral nerve
  4. Femoral nerve
  5. Obturator nerve
34
Q

What is the sacral plexus composed of?

A
  1. Lumbosacral trunk

2. Sacral spinal segmental outflow

35
Q

Where does the sacral plexus form?

A

Sacral plexus formed within the pelvic cavity

- Plexus lies in relation to piriformis

36
Q

Where does the sacral plexus supply nerves to?

A
  1. Pelvic region
  2. Gluteal region
  3. Perineal region
  4. Lower limb (via the sciatic nerve)
37
Q

What is the sciatic nerve composed of?

A
  1. Pre-axial nerve (tibial nerve)
  2. Post-axial nerve (common peroneal nerve)
    - These nerves are covered in the same sheath in the posterior upper portion of the leg
    - These nerves typically divide near the popliteal fossa
38
Q

What are the neural roots of the sciatic nerve?

A

L4-S4

39
Q

Where does the sciatic nerve emerge from?

A

Emerges through the greater sciatic foramen together with the inferior gluteal artery and inferior gluteal nerve
- Always emerges in relation to piriformis muscle

40
Q

Describe the piriformis-sciatic nerve variation

A
  • Most cases, the common peroneal and tibial nerves travel tgt through the greater sciatic foramen
  • But, in approx 10% of popn, they are separated by in the GSF by all or part of the piriformis muscle (sometimes may emerge through the GSF as two separate nerves)
41
Q

What is piriformis syndrome?

A
  • The piriformis muscle spasms and causes buttock pain
  • Can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot
42
Q

How could piriformis syndrome occur?

A
  • Results from compression of the sciatic nerve around the piriformis muscle
  • If the sciatic nerve passes through piriformis and the muscle undergoes a spasm, the nerve will be compressed (variant of piriformis syndrome)
  • Trauma to the gluteal muscle
  • Spasms of the piriformis muscle
  • Anatomical variation
  • Overuse injury
43
Q

What are some possible symptoms of piriformis syndrome?

A
  • Pain and numbness in the buttocks and down the leg

- Often symptoms are worsened with sitting or running

44
Q

Where does the sciatic nerve enter?

A

Enters the thigh between the ischial tuberosity and greater trochanter

MJM (31 decks)

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