LE Neurovascular Flashcards
How do we find the femoral artery? What are the borders of the femoral triangle?
Femoral triangle borders. Superiorly = inguinal ligament. Medially = adductor longus. Laterally = sartorius (hip flexion, AB, ER).
Femoral triangle contents: Femoral Nerve, Femoral Artery, Femoral Vein, Empty Space, Lymph Nodes.
What course does the femoral artery take (including all branches to foot)?
Femoral artery, after leaving the femoral triangle, runs behind adductor longus and in front of adductor brevis and adductor magnus before diving through the adductor magnus in the adductor hiatus to the posterior/medial side of the leg. This is where it becomes the popliteal artery.
The popliteal artery runs deep within the popliteal fossa, making it difficult to palpate.
Distal to the popliteal fossa and deep to the two gastrocnemius heads, the popliteal artery dividies into the anterior and posterior tibial arteries.
The posterior tibial artery runs down the back of the leg between deep flexors and the gastronemius/soleus complex.
As it goes towards the ankle, it lies just posterior to tibialis posterior.
At the medial malleolus, it passes through the tarsal tunnel, under the flexor retinaculum before it divides into the medial and lateral plantar arteries. (Done)
The anterior tibial artery branches off the popliteal artery and pierces through the IO membrane distal to the tibial tuberosity and fibular head, to travel through the anterior compartment of the leg along the IO membrane.
At the ankle, it runs deep to the extensor retinaculum*. As it *emerges on the dorsum of the foot, it is called the dorsal pedal artery. It is located lateral to the tendon of the extensor hallucis longus and runs over the dorsal aspect of the navicular. (Done)
Describe the course of the femoral nerve. What muscles does it innervate? How do you assess neural tension?
Femoral nerve exits L2-L4 intervertebral foramen. It runs under iliacus and passes under the inguinal ligament, just lateral to the femoral artery.
Below the inguinal ligament, the femoral nerve breaks up into several different branches to supply muscles of the anterior thigh.
Motor innervation: iliacus, psoas major, pectineus, sartorius, and all four heads of the quadriceps.
Neural Tension: Can be assessed with the prone knee flexion test.
Describe the course of the saphenous nerve. What are two ways you can assess neural tension or nerve irritation?
The saphenous nerve is a cutaneous branch of the femoral nerve. Interested in as therapists because of its pain-generating capabilities.
It branches off the femoral nerve after crossing the inguinal ligament and courses the same path as the femoral artery.
Travels beneath sartorius and pierces the fascia lata between the tendons of sartorius and gracilis; becomes cutaneous. May become entrapped here.
Then passes along the medial side of the tibia, accompanied by the great saphenous vein; descends behind the medial border of the tibia and terminates at the dorsal-medial aspect of the foot.
Tinel’s test: Can be performed at the pes anserinus between the tendons of sartorius and gracilis
Neural Tension: Assessed with prone knee flexion and ankle positioned in PF and EV .
Describe the course of the sciatic nerve and motor innervations.
The sciatic nerve is part of the sacral plexus and consists of L4-S3. Comprised of the tibial nerve and common peroneal nerve components.
Sciatic nerve exits the greater sciatic foramen at the midsection of the PSIS and ischial tuberosity*. This is where the nerve leaves the pelvis. Sciatic nerve becomes more superficial between the ischial tuberosity and the greater trochanter where it emerges from underneath the piriformis. *Runs to the gluteal fold down the posterior aspect of the thigh, between the biceps femoris and semitendinosus. Proximal to the popliteal fossa, the sciatic nerve splits into tibial and common peroneal nerves.
Motor innervation of the tibial component (proximal to the knee joint): semitendinosus, semimembranosus, long head of the BF and the posterior portion of the adductor magnus.
Describe the course of the tibial nerve. List motor innervations.
Tibial nerve follows the same course as the posterior tibial artery.
Runs down the middle of the tibia between the two gastroc heads, deep to the soleus, and runs medially where it passes posterior to the medial malleolus. This is another area of possible neural entrapment; nerve is superficial enough to perform a Tinel’s test.
Continues onto the plantar surface of the foot where it becomes the medial and lateral plantar nerves.
Motor innervation: Gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus.
Describe the course of the common peroneal nerve and motor innervation. Discuss branches too.
The common peroneal nerve (branch of the sciatic nerve) will travel lateral and inferior to the tendon of the biceps femoris. It winds around the neck of the fibual and pierces the peroneus longus. Common entrapment site (may be secondary to trauma or habitual leg crossing).At the fibular head, the nerve divides into superfical and deep branches. Motor innervation: biceps femoris short head
Superficial peroneal nerve: runs deep to the peroneus longus and continues down the foot to become a sensory nerve. Repeated ankle sprains or prolonged sitting on your feet may over time cause a chronic stretch pathology and lead to pain. Motor innervation: peroneus longus and peroneus brevis.
Deep peroneal nerve: Runs deep to the tibialis anterior and extensor digitorum longus*, *emerging just medial to the tibialis anterior. Follows the same course as the anterior tibial artery, running down the leg and under the extensor retinaculum (where it is compressed by the EHL tendon and EHB muscle belly). Motor innervation: tibialis anterior, extensor digitorum brevis and longus, extensor hallucis longus, and peroneus tertius.
Describe the course of the sural nerve.
The sural nerve is a branch of the tibial nerve with communicating branches from the common fibular nerve. The two meet halfway down the lower leg to travel down the lateral portion of the foot posterior to the lateral malleolus.
Sensory innervation: Lateral border of the foot
Straight Leg Raise Biases.
Patient supine with legs extended. Grasp calcaneus with distal hand to control inversion and eversion. Place proximal hand on forefoot to control PF and DF.
While maintaining ankle biases and knee extension, therapist will passively flex hip until reproduction of syptoms. Face the patient to observe any changes in facial expression that signify discomfort.
Tibial Nerve: Hip flexion, knee extension, ankle dorsiflexion and eversion (TED)
Sural Nerve: Hip flexion, knee extension, ankle dorsiflexion and inversion (SID)
Peroneal Nerves: Hip flexion, knee extension, ankle plantarflexion and inversion (PIP).
