LE Notes

Question 1

The kidney is [periotneal/retroperitoneal]. It is situated partly agains the __ and partly agains the __ and is surrounded by ___.

Answer 1

The kidney is RETROPERITONEAL. It is situated partly against the DIAPHRAGM and partly against the POSTERIOR BODY WALL MUSCLES. It is surrounded by FAT, CONNECTIVE TISSUE, and RENAL FASCIA.

Question 2

The kidney does/does not move with respiration. Why?

Answer 2

DOES move with respiration because it sits partly against diaphragm.

Question 3

Which kidney sits higher in the abdomen? At what levels do both sit?

Answer 3

LEFT kidney (ribs 11 & 12) is higher than right kidney (rib 12)

Question 4

The abdominal aorta begins at the ___ [opening for aorta in diaphragm] and ends at ___ vertebral level where it biforcates into ___. In the abdomen, branches include the ___, ___ (L_), ___ (L_), ___, ____, and ___.

Answer 4

Abdominal aorta begins at the AORTIC HIATUS of diaphragm and ends at L4. Biforcates into 2 COMMON ILIAC AA. Abdominal branches: Celiac trunk, Superior Mesenteric a. (L1), Inferior Mesenteric a. (L3), Renal a., Suprarenal a., Gonadal a. (Testicular a. in males, Ovarian a. in females)

Question 5

Aortic aneurysms occur because of 2 reasons… They often present as ___. They [can/cannot] be repaired, but a ruptured aneurysm has [high/low] mortality rate, about __-__%.

Answer 5

Congenital or acquired weakness in arterial wall. Often present as pulsating back pain. CAN be repaired, but ruptured aneurysm has HIGH mortality rate (50-70%)

Question 6

The kidneys are supplied by the ___ arteries which come off of the __ around the level of the ___. About ___% may have ___ aa. (extras) that enter the hilus or somewhere else on the kidney.

Answer 6

Kidneys are supplied by the RENAL arteries. Left and Right renal arteries come off of the AORTA around the level of the SUPERIOR MESENTERIC A. (L1). About 30% have ABERRANT AA. that enter the hilus or somewhere else on kidney

Question 7

Venous drainage of the kidneys goes to the ___ via ___ vv. The IVC runs [ant/post] to the Right renal artery.

Answer 7

Venous drainage: L and R renal veins dump into IVC. IVC runs ANTERIOR to R renal a.

Question 8

The kidney consists of the outer part called the ___, the ____ (the rest of the kidney), and a system of ducts.

Answer 8

Outer part = cortex.

Rest of kidney minus cortex = Medulla

Question 9

The pyramids are found in what part of the kidney? What do they do? How many are in each kidney? What are papillae?

Answer 9

Pyramids are found in the MEDULLA of the kidney. There are about ~10ish pyramids per kidney and they are part of the filtering system. Each pyramid comes to a tip called the PAPILLAE. There, it starts to drain the urine into the duct system of the kidney

Question 10

Describe the duct system of the kidney beginning at the pyramids.

Answer 10

Each pyramid comes to a tip called the PAPILLAE. Each papillae has a MINOR CALYX associated with it, which is the first part of the duct system. Minor calicies empty into ~3 MAJOR CALICIES which drain into the RENAL PELVIS which drains into the URETER.

Question 11

The gonadal vessels from [ant/post] to the ureter

Answer 11

Gonadal vessels cross ANTERIOR to ureter.

Question 12

The ureters run downward and [laterally/medially] [anterior/posterior] to the psoas major. They are crossed [anteriorly/posteriorly] by the gonadal vessels. Better stated, from anterior to posterior you see ___.

Answer 12

Ureters run downward and MEDIALLY, ANTERIOR to psoas major. Ureters are crossed ANTERIORLY by gonadal vessels. Ant to post: Gonadal vessels, Ureter, psoas major

Question 13

Describe hydronephrosis.

Answer 13

Hydronephrosis: may occur in pregnancy. Distention of kidney due to enlargement of OVARIAN A. which compresses the URETER.

Question 14

The ureter runs [ant/post] to the sacroiliac joint. It is a duct made of __.

Answer 14

ANTERIOR to sacroiliac joint. Duct made of SMOOTH MUSCLE

Question 15

The suprarenal glands are [peritoneal/retroperitoneal]. The right adrenal is __ shaped, and the left adrenal is __ shaped. Their function is only [endocrine/exocrine]. Describe that function.

Answer 15

Suprarenal glands are RETROPERITONEAL. Right = TRIANGULAR shaped. Left = HALF MOON shaped.
Function: ONLY ENDOCRINE. Cortex secretes CORTICOSTEROID (normally part of stress response). Medulla secretes EPINEPHRINE (nervous/excited chemical!)

Question 16

The __ is the muscle important in hip hiking.

Answer 16

Quadratus lumborum

Question 17

The ___ overlaps quadratus lumborum anteriorly. It sits [lateral/medial] to QL.

Answer 17

The PSOAS MAJOR overlaps QL anteriorly and sits MEDIALLY to QL

Question 18

The __ and __ join. Together, they’re referred to as the Iliopsoas and act in ___.

Answer 18

Psoas major and Iliacus joint = Iliopsoas. STRONG HIP FLEXORS

Question 19

The psoas minor is found in ___%. It does/does not contribute to the iliopsoas.

Answer 19

Psoas minor = <50%. DOES NOT contribute to iliopsoas. Has some action to posteriorly tilt pelvis, but not very functionally important

Question 20

Psoas major can [increase/decrease] lumbar lordosis. Why? Similarly, it can cause [tight/loose] hip flexors. Why?

Answer 20

Psoas major can INCREASE lumbar lordosis by pulling on its origin on the lumbar spine. Also can cause TIGHT hip flexors via its attachment to the lesser trochanter

Question 21

There are areas of thickened fascia over the ___, ___, ___, and ___. These areas of fascia are continuous with the ___.

Answer 21

Quadratus lumborum, psoas, diaphragm, and iliacus. These are continuous with the TRANSVERSALIS FASCIA.

Question 22

The diaphragm is __ shaped when relaxed and during expiration. It takes its origin from the right and left ___, as well as thickened fascia over the ___, ___, and ___. The diaphragm fibers arch up and insert on the ___.

Answer 22

Diaphragm is DOME shaped when relaxed and during expiration. Originates from RIGHT CRUS, LEFT CRUS, and thickened fascia over the QUADRATUS LUMBORUM (Lateral arcuate ligament), PSOAS (Medial Arcuate ligament), and Aorta (Median Arcuate Ligament). Fibers insert on CENTRAL TENDON

Question 23

3 apertures in the diaphragm. Name them and give the vertebral level at which they are found.

Answer 23

• Vena Caval Aperature (highest, sits at T8. Goes THROUGH CENTRAL TENDON)
• Esophageal Aperature (T10. Right crus of diaphragm loops around esophagus and strengthens the sphincter)
• Aortic Aperature (lowest, most posterior [right against vertebral bodies], at T12)

Question 24

The lumbrosacral plexus forms within the substance of the __ muscle from the [dorsal/ventral] rami of ___-____, plus some communication from ___.

Answer 24

Lumbrosacral plexus: forms within substance of PSOAS muscle.

From VENTRAL rami of L1-L4 plus some T12 (subcostal n.)

Question 25

L_ joins __ to form the lumbrosacral trunk. This joins the sacral plexus (S_,,) to form the ____. What does that innervate?

Answer 25

L4 joins L5 to form lumbrosacral trunk. This joins sacral plexus (S1,2,3) to form LUMBROSACAL PLEXUS. This innervates some lower trunk but mostly lower ribs

Question 26

The subcostal N. comes from ___ and runs under the ___.

Answer 26

Subcostal n. = from T12, runs under 12th rib

Question 27

Branches from L1 appear [medial/lateral] to psoas and run ant/post to QL.

Answer 27

Branches from L1 appear LATERAL to psoas and run across ANTERIOR to QL.

Question 28

The iliohypogastric n. ([upper/lower] branch of L___) appears on the [med/lat[ border of the psoas [ant/post] to the quadratus lumborum. It becomes cutaneous lower down and innervates the ___. It supplies the ___ muscles.

Answer 28

Iliohypogastric n. is the UPPER branch from L1. Appears on LATERAL border of psoas ANTERIOR to QL. Cutaneous: middle groin. Motor: Abdominal muscles

Question 29

Ilioinguinal N. ([upper/lower] branch of L___). May come off together with ___ n. It exits at the [med/lat] border of the psoas and goes through the ___. It provides cutaneous innervation to the ___ as well as the ___.

Answer 29

Ilioinguinal n. (LOWER branch from L1). May come off together with iliohypogastric n. Exits at LATERAL border of psoas and goes through the SUPERFICIAL INGUINAL RING. It provides cutaneous innervation to the PUBIC REGION, ANTERIOR SCROTUM or LABIA MAJORA. Also gives cutaneous innervation to UPPER MEDIAL THIGH

Question 30

The genitofemoral n. (L___) pierces and lies on the ANTERIOR surface of the ___. It has 2 parts: ___ and ___. The first part runs more [medially/laterally], leaves the abdomen through the ___, joins the contents of the ___, and supplies the ___. The second part runs more [medially/laterally], goes under the ___ and supplies the ___.

Answer 30

Genitofemoral n. (L1, 2). Pierces and lies on anterior surface of PSOAS MAJOR. 2 Parts:
(A) Genital branch - more medially, leaves abdomen through DEEP RING and joins contents of SPERMATIC CORD. It supplies the CREMASTER M. and SKIN OF SCROTUM or LABIA MAJORA.
(B) Femoral branch - more lateral, goes UNDER INGUINAL LIGAMENT, and provides cutaneous innervation to ANTERIOR THIGH

Question 31

The lateral femoral cutaneous n. (L___) emerges [medial/lateral] to the psoas. It runs across the ___ muscle, a little lower than what other nn? It emerges below the lateral portion of the ___ and crosses over/under the ligament. It innervates ___ and provides ONLY cutaneous/motor innervation.

Answer 31

Lateral Femoral Cutaneous N. (L2,3)
-Emerges LATERAL to psoas, runs across ILIACUS muscle lower than the ilioinguinal or iliohypogastric nn. Emerges below lateral portion of INGUINAL LIGAMENT (Crosses under ligament). It provides ONLY CUTANEOUS innervation and innervates the skin of the LATERAL THIGH down to the knee

Question 32

The femoral n. (L___) passes [medial/lat] to psoas and runs in the groove between the ___. It crosses under the ___. It provides motor innervation to the ___ and cutaneous innervation to the ___.

Answer 32

Femoral n. (L2,3,4) runs passes LATERAL to psoas and runs in groove between PSOAS AND ILIACUS. It crosses under INGUINAL LIGAMENT. Motor: Muscles of anterior thigh (quads), Cutaneous: Ant/medial thigh and medial leg (mediocutaneous n. of the leg) to the ankle

Question 33

The obturator n. (L___) runs [medial/lat] to psoas along the ____. It exits the ___ foramen through the ___ canal in the upper part of the ____. It provides motor innervation to the __ and cutaneous innervation to the ___.

Answer 33

Obturator N. (L2,3,4): runs MEDIAL to psoas along the LATERAL PELVIC WALL. It exits the OBTURATOR FORAMEN through the OBTURATOR CANAL in the upper part of the OBTURATOR MEMBRANE. Motor: Adductor muscles on medial thigh, Cutaneous: Skin of medial thigh

Question 34

Lumbrosaocral trunk (L___) runs [lat/medial] to psoas and runs into the ___. It contributes to and combines with the ___ in the pelvis. It runs [sup/deep] to the obturator n.

Answer 34

Lumbrosacral trunk (L4,5) runs MEDIAL to psoas and runs into PELVIS. Combines with SACRAL PLEXUS in pelvis, and runs DEEP to Obturator n.

Question 35

The sciatic n. (give nerve levels) is made of 2 components: (1) ___ n. (L__, S__) which innervates the ___; (2) ____ n. (L__, S__) which innervates the ___.

Answer 35

Sciatic n. (L4,5,S1,2,3) has 2 compnents:

(1) Tibial N. (L4,5,S,1,2,3) - supplies posterior leg, posterior thigh
(2) Common peroneal (fibular) (L4,5,S1,2) - supplies lateral and anterior leg

Question 36

The common peroneal n. is a branch of ___. It further divides into the ___ and ___.

Answer 36

Common peroneal (fibular) (L4,5,S1,2) is a component of the SCIATIC N.. It further divides into

• SUPERFICIAL PERONEAL (FIBULAR) (L5, S1,2)
• DEEP PERONEAL (FIBULAR) (L4,5,S1)

Question 37

Give the nerve roots that contribute to the superior gluteal n. and the inferior gluteal n.

Answer 37

Superior gluteal n - L4,5, S1

Inferior gluteal n. - L5, S1,2

Question 38

The pudendal n. provides sensation in the ___.

Answer 38

Pudendal n. - sensation in perineum, genitals, urogenital triangle

Question 39

Small branches of the lumbrosacral plexus are sent to the __, __, and ___.

Answer 39

Piriformis, obturator internus, levator ani

Question 40

Pelvic organs are draped with ___ which causes the formation of ___ and ____.

Answer 40

Pelvic organs are draped with PERITONEUM (dips between organs, but doesn’t actually suspend them); forms POUCHES and “LIGAMENTS”

Question 41

___ is the space between the bladder and rectum in males.

Answer 41

Rectovesical pouch

Question 42

___ is the space between the rectum and the uterus in females.

Answer 42

Rectouterine pouch

Question 43

___ is the space between the bladder and uterus in females.

Answer 43

Vesicouterine pouch

Question 44

The broad ligament consists of __ (#) layers of peritoneum that fuse together after draping over the ___. Within the broad ligament are the ____ and ___ situated in the ___ and ___ respectively.

Answer 44

Broad ligament = 2 layers of peritoneum that fuse after draping uterus. The ROUND LIGAMENT is in the ANTERIOR LAMINA and the PROPER LIGAMENT of the OVARY is in the POSTERIOR LAMINA.

Question 45

The round ligament runs along the ___, through the ___ to the ___. It is in the ____.

Answer 45

Round ligament = runs along PELVIC RIM through DEEP RING to LABIA MAJORA. Runs in ANTERIOR LAMINA of broad ligament

Question 46

The “Proper” Ligament of the Ovary runs between the ___ and ___ in the ____. It stabilizes the relative to the ___.

Answer 46

Proper ligament of the ovary stabilizes (and runs between) the ovary relative to the uterus

Question 47

The bladder is located posterior to the ___. It rests on ___ in females and ___ in males. It is made of interlacing ___, called ___.

Answer 47

Bladder is post. to PUBIC SYMPHYSIS. Rests on PELVIC DIAPHRAGM (Pelvic floor) in female. Rests on PROSTATE in male. Made of interlacing SMOOTH MUSCLE called DETRUSOR MUSCLE

Question 48

Describe the openings to the bladder

Answer 48

Ureters - 2 in the base (back side of bladder)

Urethra - one opening from the neck of the bladder (goes through pelvic floor and through prostate in men)

Question 49

Describe the sphincters in the bladder. Where are they and how are they innervated?

Answer 49

Internal urethral sphincter (Smooth muscle, PARASYMPATHETIC)

External urethral sphincter (Skeletal muscle, VOLUNTARY)

Question 50

During urination (AKA ___), [parasympathetic/sympathetic] innervation contracts the ___ muscle in the bladder and relaxes the [internal/external] sphincter. Additionally, we [voluntarily/involuntarily] relax the [internal/external sphincter]

Answer 50

Urination = MICTURITION

PARASYMPATHETICS contract DETRUSOR muscle to relax INTERNAL SPHINCTER

Voluntary relaxation of EXTERNAL sphincter

Question 51

The ureters pass [ant/post] to the bifurcation of the common iliac aa. They pass [ant/post] to the sacroiliac joint and taper [medially/laterally] as they insert into the ___.

Answer 51

Ureters pass ANTERIOR to bifurcation of common iliac aa. and ANTERIOR to sacroiliac joint before they taper medially and end in the BASE OF THE BLADDER.

Question 52

List the main features of the male pelvis contents.

Answer 52

Prostate gland, Seminal vesical, urethra

Question 53

The prostate gland is situated between the __ and __. It makes secretions that add to the ___. It contains a large amount of ___ and ___. Prostatic tissue usually forms the wall of the ___.

Answer 53

Prostate gland: Between BLADDER and UROGENITAL DIAPHRAGM. Makes secretions that add to EJACULATE. Contains large amount of SMOOTH MUSCLE and DUCTS. Prostatic tissue usually forms wall of the PROSTATIC URETHRA (part that passes through prostate gland)

Question 54

Describe the problems to the bladder/urethra caused by Prostatic hypertrophy.

Answer 54

It compresses the urethra, and urine backs up into the bladder. This stretches the bladder and its muscles so that they are no longer efficient. Men need to urinate often because they are not fully emptying their bladder each time.

Question 55

The seminal vesical lies against the ___ (border side) bladder. Its secretions add to the ___. The duct of the seminal vesicle joins the ___ to form the ___ which empties into the ___.

Answer 55

The seminal vesical lies against the POSTERIOR-LATERAL BLADDER. Its secretions add ot the ejaculate. The duct of the seminal vesicle joins the VAS DEFERENS to form the COMMON EJACULATORY DUCT which empties into the PROSTATIC URETHRA

Question 56

In men, the urethra consists of three parts. Name them and describe where they pass.

Answer 56

PROSTATIC (through prostate)
MEMBRANOUS (passes through pelvic floor muscles; very short; sphincters act on urethra here)
PENILE (travels through penis to outside world)

Question 57

Describe the contents of the female pelvis.

Answer 57

Ovary, Uterine tube (AKA oviduct, Fallopian tube), Uterus, Broad Ligament, Vagina, Rectum

Question 58

The ovary is __-shaped and ~__cm long. It is suspended from the ___ of the broad ligament by ___. It is attached to the lateral pelvic wall by the ___. It is attached at its medial end to the uterus by the ___.

Answer 58

The ovary is ALMOND-shaped and ~3 long. It is suspended from the POSTERIOR LAMINA of the broad ligament by MESOVARIUM. It is attached to the lateral pelvic wall by the SUSPENSORY LIGAMENT OF THE OVARY. It is attached at its medial end to the uterus by the PROPER OVARIAN LIGAMENT (in the broad ligament).

Question 59

The ovarian vessels, artery, and vein are covered in fascia, and together they make up the ___.

Answer 59

Ovarian vessels, artery, and vein covered in fascia an dmake up the SUSPENSORY LIGAMENT OF THE OVARY

Question 60

The uterine tube is AKA ___ or ___. It extends from the __ to the ___ and connects the ___cavity with the ___ cavity. It is about __ cm long and is draped in peritoneum called ___.

Answer 60

Uterine tube AKA oviduct, fallopian tube. Extends from UTERUS to OVARY and connects UTERINE CAVITY with PERITONEAL CAVITY. About 10cm long, draped in peritoneum called MESOSALPINX (part of broad ligament)

Question 61

Describe the 4 parts of the uterine tube

Answer 61

(1) Infindibulum - has fimbrae [finger-like projections] to sweep ovulated egg into tube, trumpet-like opening
(2) Ampulla - wide, thin walled, egg is usually fertilized here

(3) Isthmus - narrow, near uterus
(4) Uterine portion - passes through uterine wall (where it implants)

Question 62

The uterus is __-shaped and sits behind the ___, anterior to the ___. It is about __cm long and __cm wide. It has 3 parts: __, __, and __.

Answer 62

Uterus is PEAR-SHAPED and sits behind BLADDER, anterior to the RECTUM. 8cm long, 5cm wide. Parts: (1) Fundus (above uterine tubes), (2) Body [or corpus], (3) Cervix - narrow inferior part that protrudes into vagina

Question 63

The ___ is the actual opening of the uterus into the vagina, while the ___ is the narrow inferior part of the uterus that protrudes into the vagina.

Answer 63

The EXTERNAL OS is the actual opening of the uterus into the vagina, while the CERVIX is the narrow inferior part of the uterus that protrudes into the vagina.

Question 64

The uterus is oriented in situ so that it slants [forward/backward]. This is called ___ and is generally about __degrees from vertical, leaving the [ant/post] surface of the uterus to be completely covered by peritoneum.

Answer 64

The uterus is oriented in situ so that it slants FORWARD. This is called ANTEFLEXION and is generally about 45 from vertical, leaving the POSTERIOR surface of the uterus to be completely covered by peritoneum.

Question 65

Name & describe the 3 parts of the broad ligament

Answer 65

Mesovarium - suspends ovary from posterior lamina
Mesosalpinx - surrounds uterine tube
Mesometrium - main part of broad ligament next to uterus

Question 66

The vagina is about __cm long. It has ___ which are recesses around the cervix at the upper end of the vagina. The posterior ___ is covered with peritoneum and is adjacent to the ___ pouch.

Answer 66

Vagina = 10 cm long. Recesses around cervix = fornices. Posterior FORNIX is covered with PERITONEUM, and is adjacent to the RECTOUTERINE POUCH

Question 67

The rectum begins at ___ (vertebral level) and is continuous with the ___. It turns __ degrees as it passes through the ___. This helps with ___ and reduces direct pressure of fecal matter on ___. The rectum does/does not have tenae coli. The rectum features one longitudinal coat of ___.

Answer 67

The rectum begins at S3 (vertebral level) and is continuous with the ANAL CANAL. It turns 90 degrees as it passes through the PELVIC DIAPHRAGM. This helps with CONTINENCE and reduces direct pressure of fecal matter on ANAL SPHINCTERS. The rectum DOES NOT have tenae coli. The rectum features one longitudinal coat of SMOOTH MUSCLE.

Question 68

The pelvic outlet is the lower opening of the __. It is bounded by the __ and ___ (posteriorly), ___, and ___. It is closed by a muscular sheet known as the ___

Answer 68

Pelvic outlet = lower opening of PELVIS. Bounded by SACRUM & COCCYX (posteriorly), ISCHIAL TUBEROSITIES, PUBIC SYMPHYSIS (and inferior pubic ramus as you go anteriorly)
It is closed by a muscular sheet = PELVIC DIAPHRAGM

Question 69

The pelvic diaphragm is a muscular sheet that forms a sling/hammock and controls the ___ and supports __. The __, __,and __ pass through the pelvic diaphragm, and the pelvic diaphragm acts as sphincters for these. Most important muscle of pelvic diaphragm is __.

Answer 69

Pelvic diapghram controls PELVIC OUTLET and supports PELVIC ORIGINS. URETHRA, VAGINA, and RECTUM all pass through. Most important = LEVATOR ANI

Question 70

Describe the named subportions of th elevator ani.

Answer 70

Pubococcygeus (looks like a V anteriorly); a part of this = puborectalis= sphincter and support for rectum

Iliococcygeus (from fascia over obturator internus = tendinous arch)

Coccygeus (most posterior, AKA ischiococcygeus)

Question 71

The internal iliac a. branches from the __ anterior to the sacroiliac joint. It gives off branches of internal iliac supply to the pelvic organs and 3 branches to the lower limb. Describe these 3 branches and where they exit the pelvis.

Answer 71

Internal iliac a. branches from COMMON ILIAC A.
3 branches go to lower limb:
(1) Superior gluteal a. [exits pelvis through greater sciatic foramen above piriformis]
(2) Inferior gluteal a. [leaves pelvis through greater sciatic foramen below piriformis]
(3) Obturator a. [runs forward with obturator n., exits through obturator canal]

Question 72

The sacral plexus is part of the ___. It is comprised of [dorsal/ventral] primary rami of ____ and ___ (spinal cord levels). It arises from the anterior surface of the ___ and lies on the ant/post surface of the ___ muscle. Many of its branches leave through the ___.

Answer 72

Sacral plexus = part of LUMBROSACRAL PLEXUS. It is comprised of VENTRAL PRIMARY RAMI of L4 and L5 (lumbrosacral trunk) and S1-4. It arises from the anterior surface of SACRUM and lies on ANTERIOR surface of PIRIFORMIS muscle. Branches leave through greater sciatic foramen

Question 73

Describe the path of the greater (great) saphenous vein (hit the origin, relationship to structures at ankle and knee, and what it empties into)

Answer 73

• Originates in medial border of dorsum of foot
• Runs ANTERIOR to medial malleolus
• Runs POSTERIOR to medial border of patella (runs behind the knee)
• Empties into FEMORAL V. in the groin through a defect in the deep fascia called the SAPHENOUS HIATUS

Question 74

Describe the path of the Lesser (small) saphenous vein (hit the origin, relationship to structures at ankle, and what it empties into)

Answer 74

• From Lateral side of the dorsum of the foot
• Runs POSTERIOR to lateral malleolus (and up the back of the leg)
• Empties into Popliteal v.

Question 75

The deep fascia of the leg is AKA ___. It attaches to ____ and divides the LE into compartments via the ___. The deep fascia is thickened laterally called the ___. This thickening acts as a “tendon” for the ___ and ___ muscles. The Deep fascia forms the ___ which helps to stabilize the patella as well as the ___ which support the ankle tendons.

Answer 75

The deep fascia of the leg is AKA FASCIA LATA (in the thigh). It attaches to ALL SUPERFICIAL BONY PROMINENCES and divides the LE into compartments via the INTERMUSCULAR SEPTA. The deep fascia is thickened laterally called the ILIOTIBIAL BAND. This thickening acts as a “tendon” for the TENSOR FASCIA LATA and GLUTEUS MAXIMUS muscles. The deep fascia forms the PATELLA RETINACULUM which helps to stabilize the patella as well as the the ANKLE RETINACULA which support the ankle tendons.

Question 76

Name the spinal cord levels contributing to the following nerves:

• Iliohypogastric
• Genitofemoral
• Ilioinguinal
• Lateral (femoral) cutaneous n. of the thigh

Answer 76

• Iliohypogastric (L1)
• Genitofemoral (L1,2)
• Ilioinguinal (L1)
• Lateral (femoral) cutaneous n. of the thigh (L2,3)

Question 77

Which nerve innervates the skin between the great and 2nd toes?

Answer 77

Deep Peroneal (Fibular) n.

Question 78

Which nerve innervates the dorsum of the foot?

Answer 78

Superficial Peroneal (Fibular) N.

Question 79

Which nerve innervates the sole of the foot?

Answer 79

Medial and lateral plantar nn. (terminal branches of tibial n.)

Question 80

L1 dermatome

Answer 80

Uppermost thigh, groin

Question 81

L2 dermatome

Answer 81

Midthigh

Question 82

L3 dermatome

Answer 82

Thigh to medial knee

Question 83

L4 dermatome

Answer 83

Medial leg

Question 84

L5 dermatome

Answer 84

Lateral leg, dorsum of foot

Question 85

S1 dermatome

Answer 85

Lateral foot, posterior leg

Question 86

S2 dermatome

Answer 86

Posterior thigh

Question 87

S3-C3 Dermatomes

Answer 87

Buttocks to anus

Question 88

L1, 2 Myotome

Answer 88

Hip flexion

Question 89

L3, 4 Myotome

Answer 89

Quads (knee extension), Adduction

Question 90

L4, 5 Myotome

Answer 90

Dorsiflexion, Inversion

Question 91

L5 Myotome

Answer 91

Abduction, Great toe Extension

Question 92

L5, S1 Myotome

Answer 92

Hamstrings (knee flexion), Eversion

Question 93

S1, 2 Myotome

Answer 93

Glutes (hip extension), Plantar flexion

Question 94

Nerves innervating the anterior, medial, and posterior compartments of the thigh.

Answer 94

Anterior = Femoral n.
Medial = Obturator n.
Posterior = Tibial portion of sciatic n.

Question 95

Nerves innervating anterior, lateral, and posterior compartments of the leg.

Answer 95

Anterior = Deep peroneal (fibular) n.
Lateral = superifical peroneal (fibular) n.
Posterior = Tibial n.

Question 96

Nerves innervating dorsal and plantar foot

Answer 96

Dorsum = Deep peroneal (fibular) n.

Plantar - Medial and lateral plantar nn. (terminal branches of tibial n.)

Question 97

Describe the borders of the femoral triangle (superior, lateral, medial, and floor)

Answer 97

Superior: Inguinal ligament
Lateral: Sartorius
Medial: Adductor longus
Floor: Iliopsoas, pectineus

Question 98

Describe the contents of the femoral triangle

Answer 98

NAVEL (lateral to medial)

Femoral N., Femoral A., Femoral V., Femoral canal [Empty Space + Lymph]

Question 99

What is enclosed in the femoral sheath?

Answer 99

Femoral A., femoral V, Lymph vessels/nodes

*The Femoral Nerve is NOT contained in the femoral sheath

Question 100

The femoral sheath is pierced by the ___ at the ___ to get access to the femoral vein.

Answer 100

Femoral sheath pierced by SAPHENOUS V. at SAPHENOUS HIATUS to access femoral vein

Question 101

The femoral sheath is a ___-shaped, downward prolongation of __.

Answer 101

Funnel-shaped downward prolongation of FASCIA

Question 102

The femoral sheath has 3 compartments. Describe each and its contents.

Answer 102

Lateral compartment: femoral a.
Middle compartment: femoral v.
Medial (smallest): femoral canal.

*Medial contains CT, lymph vessels, and nodes. Transmits efferent channels to external and internal iliac nodes. Acts as dead space for vein so vein can expand with LE activity.

Question 103

The adductor canal is AKA __. It is a narrow ___ that begins at the ___ of the femoral triangle. It ends at the ___ and contains ___ en route to the ____. It lies [sup/deep] to the sartorius and runs in a groove between the __ and __ muscles.

Answer 103

Adductor canal = Hunter’s Canal
- Narrow FASCIAL TUNNEL beins at APEX of FEMORAL TRIANGLE and ends at ADDUCTOR HIATUS. Contains FEMORAL VESSELS on their way to the POPLITEAL FOSSA. Lies DEEP to sartorius in the groove between ADDUCTOR LONGUS and VASTUS MEDIALIS

Question 104

The obturator a. is a branch of the ___ a. It supplies the area of the ___, ___, and ___.

Answer 104

Obturator a. is branch of INTERNAL ILIAC A. It supplies area of OBTURATOR FORAMEN, ACETABULUM, & HEAD OF FEMUR

Question 105

The femoral a. is a continuation of the ___ after it passes under the __. Its major branches include the ___ before it changes its name to the ___ a. at the ___ of the muscle.

Answer 105

Femoral a. = continuation of EXTERNAL ILIAC A. after passes under INGUINAL LIGAMENT. Its major branches are the PROFUNDA FEMORIS A. (branches to medial and lateral femoral circumflex aa. to supply neck of femur, as well as 4 perforating branches into posterior compartment). Changes name to POPLITEAL A. at the TENDINOUS HIATUS of ADDUCTOR MAGNUS

Question 106

The profunda femoris a. is a branch of the ___ a. It gives rise to the ___ and ____. It also gives off four perforating branches. These are sent to the ____ compartment by perforating the ___ muscle close to its insertion on the ___ to supply the [ant/post] thigh.

Answer 106

The profunda femoris a. is a branch of the FEMORAL A. It gives rise to the MEDIAL FEMORAL CIRCUMFLEX A and LATERAL FEMORAL CIRCUMFLEX A. It also gives off four perforating branches. These are sent to the POSTERIOR compartment by perforating the ADDUCTOR MAGNUS muscle close to its insertion on the LINEA ASPERA to supply the POSTERIOR thigh.

Question 107

Which quadriceps muscle originates from the anterior surface of the femur?

Answer 107

Vastus intermedius

Question 108

The pectineus muscle is in the __ compartment. Its innervation is from the ___ n. and its action is to ___.

Answer 108

Pectineus = anterior compartment, DUAL innervation from Femoral N. and Obturator N. Flexes hip AND Adducts the thigh

Question 109

The tensor fascia lata is innervated by the ___. Its origin on the ___ is shared with what other muscle?

Answer 109

TFL innervated by SUPERIOR GLUTEAL N. It has a shared origin with the SARTORIUS on the ASIS and it also originates on the iliac crest

Question 110

Of the anterior thigh muscles, which are 2 joint muscles? Which cross only 1 joint?

Answer 110

2 joint: Sartorius, Rectus femoris

1 joint: Vastus lateralis, vastus medialis, vastus intermedius, Pectineus

Question 111

The quadriceps muscles converge and insert on the ___. As a group, they act to do __.

Answer 111

Quads insert on QUADRICEPS FEMORIS TENDON. Act to do knee EXTENSION. Note: below the patella is the patellar ligament (patella –> tibial tuberosity)

Question 112

Name the muscles that comprise the adductor group of the thigh.

Answer 112

Adductor longus, adductor brevis, Obturator Externus, Gracillis, Adductor Magnus

Question 113

Which is the only muscle of the adductor group to cross the knee (and is therefore a 2 joint muscle)?

Answer 113

Gracillis

Question 114

Which muscle of the adductor group is dually innervated? Describe its innervation.

Answer 114

Adductor Magnus is dually innervated. Fibers from pubis innervated by OBTURATOR N., fibers from Ischium (hamstring portion) innervated by TIBIAL N.

Question 115

Which muscle of the anterior compartment of the thigh is dually innervated? Describe its innervation.

Answer 115

Pectineus - femoral n. and obturator n.

Question 116

The opening at the distal attachment of the adductor magnus is called the ___.

Answer 116

ADDUCTOR HIATUS

Question 117

What is the pes anserinus? Where is it?

Answer 117

Pes anserinus = “Foot of the Goose” …common insertion point for the SARTORIUS, GRACILLIS, and SEMITENDINOSUS tendons on the upper, medial tibia

Question 118

What is the Thomas test?

Answer 118

Test for tight hip flexors (iliopsoas). Lie supine, pull knees to chest, hold behind one knee and put opposite leg down straight. Normal: hamstring touches table. Bend the “down” leg: if that leg goes up (at the thigh) with knee flexion, indicates tightness of rectus femoris in addition to hip flexors

Question 119

What is the gluteal fold?

Answer 119

Gluteal fold = skin crease over hip joint

Question 120

The ___ ligament runs from the anterior surface of the sacrum to the ischial spine. This ligament closes off the ___ notch to form the ___ foramen.

Answer 120

SACROSPINOUS ligament: anterior sacrum –> ischial spine. Sacrospinous ligament closes off GREATER SCIATIC NOTCH to form the GREATER SCIATIC FORAMEN

Question 121

The ___ ligament runs from the lateral surface of the sacrum to the ischial tuberosity. This ligament closes off the ___ notch to form the ___ foramen.

Answer 121

SACROTUBEROUS ligament: lateral sacrum to ischial tuberosity. Sacrotuberous ligament closes off the LESSER SCIATIC NOTCH to form the LESSER SCIATIC FORAMEN

Question 122

The large bursa between the tendon of the gluteus maximus and the greater trochanter is called the __.

Answer 122

Trochanteric bursa

Question 123

A __ exits between the top of the gluteus maximus and the gluteus minimus.

Answer 123

A fascial plane separates the superior portion of the glut max from the glut med

Question 124

What runs superior to the piriformis? What runs inferior to the piriformis?

Answer 124

SUPERIOR to piriformis: Superior gluteal n. and a.

INFERIOR to piriformis: Inferior gluteal n. and a., Posterior femoral cutaneous n., sciatic n.

Question 125

What passes through the lesser sciatic foramen?

Answer 125

Obturator internus

Question 126

Describe the orientation of the superior and inferior gemelli in relation to the obturator internus.

Answer 126

Superior gemellus is SUPERIOR to obturator internus, and Inferior gemellus is INFERIOR to obturator internus

Question 127

The superior and inferior gluteal aa. are branches from the ___ artery. They both exit the pelvis via the ___ foramen: the ___ exits above the ___ muscle, and the ___ exits below the __ muscle.

Answer 127

Superior and inferior gluteal aa. = branches of INTERNAL ILIAC A. Both exit via the GREATER SCIATIC FORAMEN: superior goes out above PIRIFORMIS and inferior goes out below piriformis

Question 128

The posterior femoral cutaneous n. of the thigh runs [above/below] piriformis and runs [superifical/deep] to deep fascia. It supplies the cutaneous innervation to the ___.

Answer 128

Posterior femoral cutaneous n. of thigh runs BELOW piriformis, DEEP to deep fascia. Supplies cutaneous innervation to POSTERIOR THIGH

Question 129

The sciatic n. is usually [above/below] piriformis. It splits into 2 parts: ___ and ___.

Answer 129

Sciatic n. is usually BELOW piriformis. It splits into the TIBIAL N. and COMMON PERONEAL N. generally at the level of the popliteal fossa

Question 130

The superior gluteal n. exits the pelvis via the ___. It appears [above/below] piriformis and innervates the ___, ___, and ___ muscles.

Answer 130

Superior gluteal n. exits pelvis via the GREATER SCIATIC FORAMEN. It appears ABOVE the piriformis and innervates the GLUTEUS MEDIUS, GLUTEUS MINIMUS, AND TENSOR FASCIA LATA

Question 131

The inferior gluteal n. exits the pelvis via the ___. It appears [above/below] piriformis and innervates the ___ muscle(s).

Answer 131

Inferior gluteal n. exits pelvis via GREATER SCIATIC FORAMEN. Appears BELOW piriformis and innervates ONLY the GLUTEUS MAXIMUS

Question 132

The posterior compartment of the thigh is innervated by the __ n.

Answer 132

TIBIAL n.

Question 133

The biceps femoris has DUAL innervation: the __ head is innervated by the ___ n., and the ___ head is innervated by the ___ n.

Answer 133

Long head = tibial part of sciatic n., Short head = common peroneal part of sciatic n.

Question 134

The pes anserinus is formed by the insertion of the ___, ___ and ___ into the ____. All three muscles do ____, but each has a secondary action as well. Name them

Answer 134

Pes anserinus formed by insertion of SARTORIUS, GRACILLIS, and SEMITENDINOSUS into medial, upper tibia. All do KNEE FLEXION, but individually:
Sartorius - flex, ER hip
Gracillis - mostly abduction of hip
Semitendinosus - Extend hip

Question 135

____ exist between tendons and the tibial collateral ligament in the Pes anserinus.

Answer 135

Anserine bursa exists between tendons and tibial collateral ligament

Question 136

The semimembranosus lies ___ in the hamstring group. It is ___ to the semitendinosus.

Answer 136

Semimembranosus = medial. Lies anterior and deep to semitendinosus

Question 137

The sciatic n. diverges into _ (#) branches close to the upper end of the ___. Describe the course of the branches.

Answer 137

Sciatic n –> 2 branches:

(1) Common peroneal: goes LATERAL under cover of BICEPS FEMORIS, around neck of fibula, then divides into SUPERIFICAL PERONEAL and DEEP PERONEAL
(2) TIbial N. goes straight down in post. compartment

Question 138

The popliteal fossa is __-shaped, located ____, and filled with ___ which serves to protect its contents.

Answer 138

Popliteal fossa = diamond-shaped, behind the knee, filled with FAT

Question 139

Describe the floor of the popliteal fossa

Answer 139

Floor = femur, joint capsule, popliteus muscle

Question 140

Describe the boundaries of the popliteus muscle

Answer 140

Superior lateral: biceps femoris
Superior medial: Semimembranosus, semitendinosus
Inferior medial: Medial head of gastrocnemius
Inferior lateral: lateral head of gastrocnemius and plantaris

Question 141

Describe the contents of the popliteal fossa

Answer 141

Fat, lymph nodes, tibial n, common fibular n, popliteal vessels.

Question 142

Describe the relationship between the vessels in the most inferior part of the popliteal fossa

Answer 142

Nerve is most posterior, then Popliteal vein, then Popliteal artery is most anterior

Question 143

The popliteal a. is a continuation of the __ a. after it passes through the ___. The popliteal a. ends by dividing into the ___ and ___ aa.

Answer 143

Popliteal a. is a continuation of FEMORAL A. after it passes through ADDUCTOR HIATUS. Popliteal a. ends by dividing into POSTERIOR TIBIAL A. and ANTERIOR TIBIAL A.

Question 144

Several branches of the ___ a supply the knee joint

Answer 144

Several branches of the POPLITEAL A. supply the knee joint

Question 145

The knee joint is between the ___, ___, and ___. The knee joint does NOT involve the ___.

Answer 145

The knee joint is between the MEDIAL AND LATERAL FEMORAL CONDYLES, TIBIAL PLATEAU, and PATELLA. The knee joint does NOT involve the FIBULA

Question 146

The clinical name for the knee joint is the ___. It is a ___ joint with __ (#) degrees of freedom involving __/__ and ____.

Answer 146

Knee joint = Tibiofemoral joint

CONDYLOID joint with 2 degrees of freedom: Flex/extend and ROTATION

Question 147

In terminal knee extension (last ~10 degrees), the tibia rotates [internally/externally] on the femur. Why does this occur?

Answer 147

Tibia rotates EXTERNALLY on the femur because one condyle is longer than the other. This occurs because the medial femoral condyle is longer than the lateral femoral condyle

Question 148

The [femoral/tibial] articular surface is twice as large/long as the [femoral/tibial] surface.

Answer 148

The FEMORAL surface is 2x as large as the TIBIAL surface!

Question 149

When the knee goes into flexion in an open chain movement, the [tibia/femur] rolls and glides [ant/post] on the [tibia/femur], and the [tibia/femur] rotates [internally/externally]. When the knee goes into extension (open chain), the [tibia/femur] rolls and glides [ant/post] on the [tibia/femur]. During closed chain movements, what happens?

Answer 149

OPEN CHAIN
Flexion: TIBIA rolls/glides POSTERIORLY, rotating INTERNALLY
Extension: TIBIA rolls/glides ANTERIORLY, rotating EXTERNALLY

CLOSED CHAIN
Flexion: Femur rolls/glidles ANTERIORLY, rotating EXTERNALLY
Extension: Femur rolls/glides POSTERIORLY, rotating INTERNALLY

Question 150

The joint capsule consists of 2 layers __ and ___

Answer 150

Fibrous joint capsule (outer), Synovial layer of joint capsule (inner)

Question 151

The fibrous joint capsule in the knee is attached above the ____ posteriorly, margins of ___ , ___, and ____, and the margins of the ___.

Answer 151

Fibrous joint capsule in knee attached above INTERCONDYLAR FOSSA posteriorly, and the margins of FEMORAL CONDYLES, PATELLA, PATELLAR LIGAMENT, and the margins of TIBIAL CONDYLES

Question 152

The fibrous joint capsule of the knee is strengthened posteriorly by…

Answer 152

Posteriorly strengthened by OBLIQUE POPLITEAL LIGAMENT (expansion of semimembranosus tendon) and ARCUATE LIGAMENT

Question 153

The fibrous joint capsule of the knee is strengthened laterally by…

Answer 153

Laterally strengthened by ILIOTIBIAL TRACT, PATELLAR RETINACULUM, LATERAL COLLATERAL LIGAMENT

Question 154

The fibrous joint capsule of the knee is strengthened medially by…

Answer 154

Medially strengthened by PATELLAR RETINACULUM, MEDIAL COLLATERAL LIGAMENT

Question 155

The fibrous joint capsule of the knee is strengthened anteriorly by…

Answer 155

Anteriorly strengthened by QUADRICEPS TENDON, PATELLA, PATELLAR LIGAMENT, and PATELLAR RETINACULUM

Question 156

The synovial layer of the joint capsule of the knee lines a single, extensive, slightly complex cavity that is ___ -shaped. The joint capsule is continuous with the ___ bursa, bursae under each head of the ___, and ___ bursa under the popliteus muscle.

Answer 156

Synovial joint layer, cavity is KIDNEY shaped
Capsule is continuous with SUPRAPATELLAR BURSA, BURSAE under each head of gastroc, POPLITEAL BURSA under popliteus muscle

Question 157

The ACL and PCL are enclosed within the ____ capsule, but not the ___ capsule

Answer 157

ACL and PCL are enclosed within the FIBROUS capsule, but NOT the SYNOVIAL capsule

Question 158

What is a Baker’s Cyst?

Answer 158

Not truly a cyst, really an inflammed bursa. With a knee injry, fluid can settle into the popliteal bursa (found under popliteus muscle)

Question 159

Menisci are made up of ___, much like what other two structures elsewhere in the body?

Answer 159

Menisci = fibrocartilage, like the disc in TMJ and the intervertebral discs

Question 160

Menisci in the knee attach to the perimeter of the ___ by ___ ligaments. The medial edge is attached/not attached. The menisci are attached at ___ to the ___ ridge. They are [thinner/thicker] at the [middle/edges]. What does this serve to do? Can you function without menisci?

Answer 160

Menisci attach to perimeter of TIBIAL PLATEAU by CORONARY LIGAMENTS. The medial edge of the meniscus is FREE/NOT ATTACHED. Menisci are attached at HORNS to the INTERCONDYLAR RIDGE. They are THICKER/WIDER on the PERIPHERY (EDGE). This adds contour to the articulating surface, deepens the joint, and makes it more stable. You CAN function without menisci

Question 161

The medial meniscus of the knee is __-shaped. It is more/less firmly attached than the lateral meniscus. It is also attached to the __ ligament. Its free ends point [lat/med].

Answer 161

Medial meniscus is C shaped. It is MORE firmly attached than the lateral meniscus. It is also attached to the MEDIAL COLLATERAL LIGAMENT. All of this additional anchoring makes it more likely to tear than the lateral meniscus. The free ends of the meniscus point MEDIALLY

Question 162

The lateral meniscus is __-shaped. It is larger/smaller than the medial meniscus. It is separated from the joint capsule by the __ muscle. It is/is not attached to the joint capsule. It is/is not attached to the lateral collateral ligament. Its free ends point [lat/med].

Answer 162

Lateral meniscus is O-shaped. It is SMALLER than medial meniscus. Separated from joint capsule by POPLITEUS muscle. It is NOT attached to the joint capsule OR to the lateral collateral ligament. Its free ends point medially. It is less likely to tear than the medial meniscus because it can move around a bit!

Question 163

There are a lot of ligaments to think about at the knee! Name them all before we chat about them.

Answer 163

Transverse ligament
Medial (Tibial) Collateral Ligament
Lateral (Fibular) Collateral Lig.
Anterior Cruciate Lig
Posterior Cruciate Lig
Oblique Popliteal Lig
Meniscofemoral Lig
Anterolateral Lig

Question 164

The transverse ligament of the knee runs between…

Answer 164

Runs between the menisci ANTERIORLY

Question 165

The medial collateral (tibial collateral) ligament attaches to the __ and ___. It is __ and __ (describe thickness/shape) and acts to ____. It runs between the ___ of the femur and the __ tibia and limits ___ of the leg (genu __).

Answer 165

MCL attaches to MEDIAL MENISCUS and JOINT CAPSULE. It is flat and broad and runs between the MEDIAL EPICONDYLE of the femur to the MEDIAL TIBIA. It REINFORCES the capsule and limits ABDUCTION of leg (genu valgus)

Question 166

The lateral collateral (fibular collateral) ligament is shaped like a ___. It runs from the __ of the femur to the ____. It is/is not attached to the lateral meniscus and/or joint capsule. It is palpable [superior/inferior] to the head of the fibula

Answer 166

The LCL is NOT broad like the MCL, but it is like a cord or pencil
It runs from LATERAL EPICONDYLE of FEMUR to the HEAD OF THE FIBULA. It is NOT attached to the lateral meniscus or joint capsule. It is palpable SUPERIOR to the HEAD OF THE FIBULA

Question 167

The anterior cruciate ligament runs [anteriorly/posteriorly] from the ___ to the ___ tibia. It limits ___ of the [tibia/femur] on the [tibia/femur]. It attaches to the ___.

Answer 167

The anterior cruciate ligament runs ANTERIORLY from the LATERAL FEMORAL CONDYLE to the ANTERIOR, MEDIAL TIBIA tibia. It limits FORWARD GLIDE of the TIBIA on the FEMUR. It attaches to the SUPERIOR CONDYLAR RIDGE.

*LAMP: Lateral femoral condyle –> ACL, Medial femoral condyle –> PCL

Question 168

The posterior cruciate ligament runs from the ___ to the ___. It limits [ant/post] glide of the [tibia/femur] on the [tibia/femur]. It attaches to the ___.

Answer 168

The posterior cruciate ligament runs from the MEDIAL FEMORAL CONDYLE to the POSTERIOR LATERAL TIBIA. It limits POSTERIOR glide of the TIBIA on the FEMUR. It attaches to the SUPERIOR CONDYLAR RIDGE.

*LAMP: Lateral femoral condyle –> ACL, Medial femoral condyle –> PCL

Question 169

The oblique popliteal ligament is the tendinous expansion of the ____ tendon. It supports the capsule [ant/post] and attaches to the ___.

Answer 169

Oblique popliteal ligament is tendinous expansion of SEMIMEMBRANOSUS tendon. Supports the capsule posteriorly and attaches to the LATERAL FEMORAL CONDYLE

Question 170

The meniscofemoral ligament runs from the ___ to the ___ condyle and the ___ ligament.

Answer 170

Meniscofemoral ligament runs from LATERAL MENISCUS to the MEDIAL FEMORAL CONDYLE and POSTERIOR CRUCIATE LIGAMENT

Question 171

The anterolateral ligament runs from the ___ condyle and ___ meniscus to ___. It prevents ___ rotation of the tibia.

Answer 171

The anterolateral ligament runs from the LATERAL FEMORAL CONDYLE and the LATERAL MENISCUS to GERDY’S TUBERCLE. It preventions INTERNAL ROTATION of the tibia

Question 172

There are 2 bursas separate from the synovial compartment in the knee. The ___ bursa is subcutaneous, and may be visible in people who work on their hands and knees. The ___ bursa is deep to the tendon of the semimembranosus.

Answer 172

2 bursas separate from synovial compartment of knee. The PREPATELLAR bursa is subcutaneous. The SEMIMEMBRANOSUS BURSA is deep to the tendon of the semimembranosus

Question 173

The proximal tibiofibular joint occurs between the ___ of the fibula and tibia and the ____. It is a synovial, ___ joint (__ degrees of freedom, type of mvmt: __ ). It is supported by ___ both anteriorly and posteriorly. It is/is not part of the knee joint.

Answer 173

The proximal tibiofibular joint occurs between the HEAD of the FIBULA and TIBIA and the LATERAL TIBIAL CONDYLE. It is a synovial, PLANE joint ( 3 degrees of freedom, type of mvmt: GLIDING ). It is supported by LIGAMENTS both anteriorly and posteriorly. It IS NOT part of the knee joint.

Question 174

The bones of the hip joint consist of the __ (“socket”) and the ___ (“ball”). It is a __ joint with __ degrees of freedom

Answer 174

Bones = acetabulum & head of the femur. Synovial (ball & socket) with 3 degrees of freedom

Question 175

The acetabulum has a rim that is defective [sup/inf]. This opening is referred to as the ___ notch and is bridged by the ___ ligament. The articular surface is ___ shaped, and ___ is only found in this area. The ___ is the central/middle part of the acetabulum and it is non-weightbearing.

Answer 175

The acetabulum has a rim that is defective INFERIORLY. This opening is referred to as the ACETABULAR notch and is bridged by the TRANSVERSE ACETABULAR ligament. The articular surface is HORSE-SHOE shaped, and HYALINE CARTILAGE is only found in this area. The ACETABULAR FOSSA is the central/middle part of the acetabulum and it is non-weightbearing.

Question 176

The head of the femur articulates with the ___. It is __ (fraction) of a sphere in shape and is covered with ___ except over the roughed central area called the ___. More than __ (fraction ) of the head of the femur is contained within the acetabulum.

Answer 176

The head of the femur articulates with the ACETABULUM. It is 2/3 of a sphere and is covered with HYALINE CARTILAGE except over the roughed central area called the FOVEA CAPITIS. Over HALF of the head of the femur is contained within the acetabulum.

Question 177

The neck of the femur forms a __ degree angle with the shaft. The joint capsule of the hip connects at the __ (posterior) and ___ (anterior). The greater and lesser trochanter are within/outside the joint capsule of the hip.

Answer 177

The neck of the femur forms a 125 DEGREE angle with the shaft. The joint capsule of the hip connects at the TROCHANTERIC LINE (posterior) and TROCHANTERIC CREST (anterior). The greater and lesser trochanter are OUTSIDE the joint capsule of the hip.

Question 178

The articular capsule of the hip joint attaches to the __ and ___. On the femur, it attaches to the ___ of the femur anteriorly, to the ___ and ___, and posteriorly just proximal to the ___ crest.

Answer 178

The articular capsule of the hip joint attaches to the LABRUM and TRANSVERSE ACETABULAR LIGAMENT. On the femur, it attaches to the NECK of the femur anteriorly, to the INTERTROCHANTERIC LINE and GREATER TROCHANTER, and posteriorly just proximal to the INTERTROCHANTERIC CREST.

Question 179

The fibrous capsule of the joint is fairly thin/thick. It is reinforced anteriorly by the ___ ligament which limits hip __. A synovial ___ lines almost the entire inner surface of the fibrous capsule.

Answer 179

Fibrous capsule is fairly THICK. Reinforced anteriorly by ILIOFEMORAL LIGAMENT which limits hip extension. The synovial MEMBRANE lines almost the entire inner surface of the fibrous capsule.

Question 180

There are many ligaments at the hip joint. Name them before we discuss them.

Answer 180

Labrum
Iliofemoral Lig. ("Y" Ligament)
Pubofemoral Ligament
Ischiofemoral ligament
Ligamentum Teres

Question 181

The labrum at the hip consists of ___ that attaches to the rim of the acetabulum to ___. It continues across the acetabular notch as the __ ligament.

Answer 181

Labrum consists of FIBROCARTILAGE that attaches to the rim of the acetabulum and DEEPENS the joint. It continues across the acetabular notch as the TRANSVERSE ACETABULAR LIGAMENT

Question 182

Which ligament at the hip is the largest/strongest?

Answer 182

Iliofemoral ligament (Y ligament)

Question 183

The Iliofemoral ligament is [ant/post] to the joint. It runs from the __, ___, and ___ to the ___ and ___. It resists ___ and reinforces the capsule. It appears as an ____.

Answer 183

Iliofemoral ligament is ANTERIOR to the joint. Runs from AIIS, BODY OF ILEUM, & ACETABULAR MARGIN to INTERTROCHANTERIC LINE and GREATER TROCHANTER. Resists HYPEREXTENSION. Appears as an UPSIDE DOWN “Y”

Question 184

The pubofemoral ligament is on the [ant/post] side of the joint. It runs from the ___ and blends with the medial part of the __ ligament. It limits __.

Answer 184

Pubofemoral ligament on ANTERIOR side of joint. Runs from PUBIC PORTION OF ACETABULUM and blends with MEDIAL PART OF ILIOFEMORAL LIGAMENT. It limits ABDUCTION

Question 185

The Ischiofemoral ligament runs from the ___ of the ___ on the [ant/post] side of the joint. It spirals [sup/inf]/[ant/post] to the ___ of the femur, medial to the ____. It limits __ and __.

Answer 185

Ischiofemoral ligament runs from ISCHIAL PORTION of ACETABULAR RIM on the POSTERIOR side of joint. It spirals SUPERIORLY/ANTERIORLY to the neck of the femur, medial to the GREATER TROCHANTER. It limits EXTENSION & INTERNAL ROTATION

Question 186

The ligamentum teres is AKA __. It runs from the __ to the ___. It is surrounded by __. The __ artery travels in it to the ___.

Answer 186

The ligamentum teres is AKA the Ligament of the Head of the Femur. It runs from the ACETABULAR FOSSA to the FOVEA OF FEMUR. It is surrounded by SYNOVIAL MEMBRANE. A branch of the OBTURATOR A. travels in it to the HEAD OF THE FEMUR.

Question 187

The nervous supply to the hip joint comes from branches of the __, __, __, and __ nn. Why is hip pain sometimes perceived in the knee?

Answer 187

Nervous supply to hip: branches of FEMORAL, OBTURATOR, SCIATIC, AND SUPERIOR GLUTEAL NN.
- Some nn that innervate hip are the same as those that innervate knee. When your hip/knee hurt, the brain may misinterpret where the pain is coming from. Reproduce the pain at hip during physical exam or if they truly have knee pain, you should be able to reproduce pain at knee

Question 188

The sacroiliac joint is formed between the __ and __. The articulating surface is called the ___ surface. That surface is irregular so it adds to the joint’s __.

Answer 188

Sacroiliac joint between SACRUM & ILIUM. Articulating surface = AURICULAR surface, irregular so it adds to stability. *Synovial joint.

Question 189

The articular capsule at the sacroiliac joint is a strong, synovial capsule. It attaches on the edge to articulating surfaces of the __ and __.

Answer 189

Capsule attaches on edge to articulating surfaces of SACRUM and ILEUM

Question 190

The sacroiliac joint is supported by 3 strong ligaments. Describe and tell where they blend.

Answer 190

(1) Interosseus sacroiliac ligament (blends with posterior sacroiliac ligaments)
(2) Posterior sacroiliac ligaments (blends inferiorly with sacrotuberous ligament)
(3) Anterior sacroiliac ligament (thinner, ossifies after 50 years of age)

Question 191

Describe the movement at the sacroiliac joint.

Answer 191

Synovial joint: some sliding, gliding and rotation.

Question 192

The deep fascia is continuous with the __ in the leg.

Answer 192

Deep fascia is continuous with the FASCIA LATA in the leg.

Question 193

The fascia forms thickenings in the ankle called ___. Tendons pass under these, encased in ___. Describe the 3 groups of these thickenings in the ankle.

Answer 193

Fascial thickenings = retinacula. Tendons pass under retinaculum in SYNOVIAL TENDON SHEATHS.

(1) Extensor retinacula (2 anterior bands: superior and inferior)
(2) Peroneal retinaculua (lateral)
(3) Flexor retinaculum (medial/posterior)

Question 194

The extensor retinacula lies __ to the ankle. It consists of 2 bands: the superior band is more ___, and the inferior band is __-shaped, [above/below] the malleoli.

Answer 194

Extensor retinacula lies ANTERIOR to ankle. 2 bands: superior is more HORIZONTAL, inferior is Y-shaped, BELOW THE MALELOLI

Question 195

The peroneal retinacula lies on the __ ankle. The superior peroneal retinaculum has __ (#) compartment(s), with the tendons in a [common/separate] sheath. The inferior retinaculum has __ (#) compartment(s), with the tendons in a [common/separate] sheath.

Answer 195

Peroneal retinacula is LATERAL on the ankle. Superior peroneal retinacula has ONE compartment, COMMON tendon sheath. Inferior retinacula has TWO compartments, tendons in SEPARATE SHEATHS

Question 196

The Flexor retinaculum lies ___/___ on the ankle from the ___ to the ___. It is one single band.

Answer 196

Flexor retinaculum lies MEDIALLY/POSTERIORLY on the ankle from the MEDIAL MALLEOLUS to the CALCANEOUS

Question 197

The deep fascia divides the leg into compartments: __, __, and __

Answer 197

Anterior crural compartment, Lateral crural compartment, Posterior crural compartment (further divided into superficial and deep group via TRANSVERSE SEPTUM)

Question 198

Name the muscles of the anterior compartment of the leg. What nerve innervates them?

Answer 198

Tibialis anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius

I: Deep peroneal (fibular) n.

Question 199

Which muscle has the exact opposite action of the Tibialis Anterior?

Answer 199

Peroneous longus - TA and PL share their insertion!
TA: dorsiflex, inversion
PL: Plantarflex and evert

Question 200

What type of muscle fibers doe the extensor digitorum longus have?

Answer 200

Bipennate

Question 201

Which muscle appears as if it’s the lower part of the Extensor Digitorum Longus?

Answer 201

Peroneus Tertius. BUT keep in mind that while the EDL sends tendons to the distal phalanx of each of 4 toes, the Peroneus Tertius lower fibers give off a tendon that DOESN’T go to a phalanx! Instead, it goes to the tuberosity of the 5th metatarsal

Question 202

Dame the muscles of the dorsum of the foot. What nerve innervates them?

Answer 202

Extensor Hallicus Brevis
Extensor Digitorum Brevis

I: Deep peroneal n. (same as ant. compartment!)

Question 203

Dame the muscles of the lateral compartment of the leg. What nerve innervates them?

Answer 203

(1) Peroneus (fibularis) Longus (more superficial)
(2) Peroneus (fibularis) Brevis (Partly covered by longus)

I: Superficial Peroneal n.

Question 204

What muscle has the exact opposite action of the Peroneus Longus?

Answer 204

Tibialis anterior! They share their insertion
TA: Dorsiflex, invert
PL: Plantarflex, evert

Question 205

List the muscles of the posterior leg. What nerve innervates them?

Answer 205

Gastrocnemius
Plantaris
Soleus
Popliteus
Flexor Hallicis Longus
Tibialis Posterior
Flexor Digitorum Longus

I: Tibial n.

Question 206

Which muscles of the posterior leg are 2 joint muscles? What are their actions?

Answer 206

Gastrocnemius
Plantaris
Action of both: Knee flexion, Plantarflexion

Question 207

What muscles insert into the tendocalcaneus?

Answer 207

Gastrocnemius, Plantaris (via ribbon-like tendon), Soleus

Question 208

Which muscle of the posterior compartment is important in closed chain, e.g. postural adjustments during standing?

Answer 208

Soleus

Question 209

Which muscle is responsible for “unlocking” the knee out of terminal extension (i.e. knee begins flexing). Which way does it cause the tibia to rotate (in open chain)?

Answer 209

Popliteus: causes tibia to rotate INTERNALLY to unlock out of the “screw home” mechanism

Question 210

Using your hand, describe the path of the popliteus muscle.

Answer 210

Put heel of hand on lateral knee (lateral femoral condyle) and wrap fingers around back of knee to upper tibia - that’s its path!

Question 211

The ___ muscle is the most lateral of the deep posterior leg muscles before its tendon crosses to the opposite side to insert on the __.

Answer 211

Flexor hallicis longus is the most LATERAL before it crosses to insert on the DISTAL PHALANX of the GREAT TOE.

Question 212

The ___ is often overlapped by the Flexor Hallicis Longus and the Flexor Digitorum Longus.

Answer 212

TIBIALIS POSTERIOR. Posterior Tib is also important in the dynamic support of the medial (longitudinal) arch of the foot

Question 213

What muscles are the two big inverters of the foot?

Answer 213

Tibialis Posterior and Tibialis Anterior

Question 214

Which muscle of the deep posterior leg originates most medial on the leg? Where does this muscle’s tendon insert?

Answer 214

Flexor Digitorum Longus is the most MEDIAL on the leg. It has to go LATERALLY to reach the distal phalanx of the 4 lateral toes

Question 215

From anterior to posterior (medial malleolus to calcaneus), list the tendons that pass under the flexor retinaculum.

Answer 215

Tom, Dick, ANd Harry

Tibialis Posterior
Flexor Digitorum Longus
Posterior Tibial A.
Tibial N.
Flexor Hallucis Longus (slightly deep)

Question 216

The __ nerve (name roots) runs in the posterior compartment between the superficial and deep groups. It innervates all of the muscles of the posterior compartment.

Answer 216

TIBIAL N. (L4,5, S1,2,3)

Question 217

The common peroneal n. (name roots) passes around the ___ where it divides into deep and superificial branches.

Answer 217

Common peroneal n. passes around the NECK OF THE FIBULA where it divides –> superficial and deep branches.

Question 218

Describe the innervations of the superficial branch of the common peroneal n.

Answer 218

Superficial branch (L5, S1,2): innervates LATERAL compartment muscles plus SKIN of lateral leg and DORSUM of foot (L5, S1, 2)

Question 219

Describe the innervations of the deep branch of the common peroneal n.

Answer 219

Deep branch (L4,5, S1):
Innervates ANTERIOR compartment muscles plus PATCH OF SKIN between great toe and second toe

Question 220

If you lose the common peroneal n., what motor and sensory loss do you see?

Answer 220

Lose anterior and lateral compartments, so…
Lose: dorsiflexion (TA), Eversion (peroneus muscles), toe extension (EHL & EHB)

Weak: Inversion, plantar flexion (b/c peroneus longus)

Sensory: whole dorsum of foot, lateral leg

Question 221

The blood supply of the leg comes from the popliteal a. which divides into the __ and __ at the ___ muscle.

Answer 221

Blood supply of leg comes from POPLITEAL A. which divides into ANTERIOR TIBIAL A. and POSTERIOR TIBIAL A. on POPLITEUS muscle

Question 222

Describe the course of the anterior tibial a.

Answer 222

Ant. tib. a. = Enters ANTERIOR compartment by crossing ABOVE interosseous membrane. Changes name to DORSALIS PEDIS A. when it crosses ankle joint into foot

Question 223

Describe the course of the Posterior Tibial A.

Answer 223

Post. Tib. A. = runs with Tibial N. Gives off PERONEAL A.

• Peroneal a. runs on LATERAL side of posterior compartment and sends branches to LATERAL compartment
• Posterior Tibial A. continues into foot BEHIND medial malleolus

Question 224

The skin of the sole of the foot is ___. The superficial fascia in that area contains much dense __ and ___.

Answer 224

Skin of sole of foot is THICK, superficial fascia contains dense connective tissue and ADIPOSE. Fat pad on heel helps to cushion and absorb the shock.

Question 225

A feature of the deep fascia on the sole of the foot is the ___. It is the central part of the deep fascia and the [strongest/weakest] and [thickest/thinnest] part of the deep fascia. It attaches posteriorly to the __ and anteriorly to the ___ by ___.

Answer 225

Plantar aponeurosis = central part of deep fasica, strongest/thickest. Attaches posteriorly to CALCANEUS and anteriorly to TOES by 5 BANDS

Question 226

The first layer of muscles in the sole of the foot consists of… They are innervated by the ___ n.

Answer 226

Abductor hallicus, Flexor digitorum brevis, Abductor digiti minimi.

Innervation is NOT same for whole layer:
*Abd Hallicus & FDB = MEDIAL plantar n.

*Abductor Digiti Minimi = LATERAL plantar n!

Question 227

The muscles of the first layer of the foot all originate from the ___

Answer 227

CALCANEUS

Question 228

The second layer of the muscles of the sole of the foot contain __ (#) tendons and __ (#) muscles. Name them! Innervation?

Answer 228

2nd layer = 2 tendons, 2 muscles

Flexor Hallicus Longus Tendon
Flexor Digitorum Longus Tendon
Quadratus plantae (insert into tendon of FDL)
Lumbricals (arise from tendons of FDL)

Innervation:
Medial plantar n. = Quadratus Plantae, 1st lumbrical
Lateral plantar n. = Lumbricals 2-3

Question 229

The third layer of the sole of the foot consists of 3 muscles. Name them! Innervation?

Answer 229

Flexor hallicus brevis, Adductor hallucis, Flexor digiti minimi brevis

Innervation:
Medial plantar n. = Flexor Hallicus Brevis
Lateral plantar n. = Adductor hallucis, Flexor Digiti Minimi Brevis

Question 230

The adductor hallucis has 2 heads: __ and __. It acts to __.

Answer 230

Oblique and transverse heads. Adducts great toe

Question 231

What is the axis for rotation in the foot?

Answer 231

Axis for ABD/ADDuction is the 2nd toe. Move away from the 2nd toe: digits 3,4,5 abduct away. Digit 2 can abduct in either direction!

Question 232

What are the muscles of the 4th layer of the foot?

Answer 232

4th layer: Interossei + Tendons

• 3 Plantar interossei (Adduct), -4 Dorsal interossei (Abduct)
• Posterior tibialis tendon
• Peroneus longus tendon

Question 233

The peroneus longus tendon runs in the __ layer of the sole of the foot, deep to the __.

Answer 233

Peroneus longus tendon runs in 4th layer, deep to LONG PLANTAR LIGAMENT

Question 234

The __ and ___ are continuations of the tibial n.

Answer 234

Tibial n –> medial and lateral plantar nn.

Question 235

The __ and __ are continuations of the posterior tibial a.

Answer 235

Medial and lateral plantar aa.

Question 236

Name the joints that occur in the ankle region

Answer 236

Distal tibiofibular joint
Talocrural joint
Subtalar joint
Midtarsal joint

Question 237

The distal tibiofibular joint is a ___ (joint type). It does/does not have a joint capsule. It is secured by ___ and ligaments as well as the ___.

Answer 237

Distal tibiofibular joint is a SYNDESMOSIS (Fibrous). It does NOT have a joint capsule. It is supported by the ANTERIOR AND POSTERIOR TIBIOFIBULAR LIGAMENTS (hold distal fibula to tibia) and INTEROSSEOUS MEMBRANE

Question 238

The talocrural joint is AKA the ___. It is a __ joint between the ___ and ____. Its action is ___. It is supported by ligaments medially and laterally that all limit ___ at the joint.

Answer 238

The talocrural joint is AKA the MORTISE JOINT. It is a HINGE joint between the TROCHLEA OF THE TALUS and MEDIAL AND LATERAL MALLEOLI. Its action is DORSIFLEXION & PLANTAR FLEXION. It is supported by ligaments medially and laterally that all limit INVERSION/EVERSION at the joint.

Question 239

List the ligaments found at the talocrural joint.

Answer 239

Deltoid (medial) ligament (4 parts) [anterior tibiotalar, tibonavicular, tibiocalcaneal, posterior tibiotalar]
*resist eversion

Lateral ligament (3 parts) [Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament]
*resist inversion

Question 240

The deltoid (medial) ligament runs from the ___ to the __, __, and ___. It is very [strong/weak] and acts to resist [inversion/eversion].

Answer 240

The deltoid (medial) ligament runs from the MEDIAL MALLEOLUS to the NAVICULAR, CALCANEUS (SUSTENTACULUM TALI), and TALUS. It is very STRONG and acts to resist EVERSION.

Question 241

Significant eversion stress is/is not likely to tear the deltoid (medial) ligament. Describe what would happen.

Answer 241

Significant eversion stress is NOT likely to tear the ligament. Instead, you’re likely to tear the bone (i.e. fracture the malleolus). Often, it’s a TRI-MALLEOLAR FRACTURE aka POTTS FRACTURE:
(1) Medial malleolus, (2) Dome of tibia swings off and knocks off lateral malleolus, (3) Chip off of tibia

Question 242

High ankle sprain involves separation of the ___ and possibly the ___.

Answer 242

High ankle sprain involves separating the SYNDESMOSIS and possibly the INTEROSSEOUS MEMBRANE

Question 243

The anterior talofibular ligament is part of the [med/lat] ligament. It runs from the __ to the ___.

Answer 243

Anterior talofibular ligament is part of LATERAL ligament. Runs from HEAD OF TALUS to LATERAL MALLEOLUS

Question 244

The posterior talofibular ligament is [superifical/deep] and runs almost vertical/horizontal]

Answer 244

Posterior talofibular ligament is DEEP and almost HORIZONTAL

Question 245

The subtalar joint consists of __ (#) ____ (joint type) between the __ and ___.

Answer 245

Subtalar joint = 3 (sometimes 2) PLANE FACETS between the TALUS and CALCANEUS

Question 246

The subtalar joint is supported by the ___ ligament which is [superficial/deep] to the plantar ligaments. This ligament runs from the ___ to the ___ and supports the __ and the ___.

Answer 246

The subtalar joint is supported by the CALCANEONAVICULAR (SPRING) ligament which is DEEP to the plantar ligaments. This ligament runs from the SUSTENTACULUM TALI to the NAVICULAR and supports the HEAD OF THE TALUS and the LONGITUDINAL ARCH.

Question 247

Movement at the subtalar joint contributes to __ and ___ of the foot. Differentiate between these movement.s

Answer 247

Pronation and supination of the foot.
Supination/pronation = collapse or increase of the arch; most of this action comes from the subtalar joint
Inversion/eversion = combined movement more at the Mortise joint and involves more of the forefoot
*Inversion = adduction of the foot + supination (COMBINED!)

Question 248

The midtarsal joint is AKA the ___. It is a functional joint comprised of the ___ and ___ joints. It runs almost ___ when looking from above.

Answer 248

The midtarsal joint is AKA the TRANSVERSE TARSAL JOINT. It is a functional joint comprised of the TALONAVICULAR and CALCANEOCUBOID joints. It runs almost HORIZONTAL when looking from above.

Question 249

The long plantar ligament runs between the ___ and the ___. It is more [superficial/deep] than the short plantar ligament. It is a major support of the ___. The peroneus (fibularis) longus tendon runs [superficial/deep] to it.

Answer 249

The long plantar ligament runs between the CALCANEUS and the BASES OF 4 LATERAL METATARSALS. It is more SUPERFICIAL than the short plantar ligament. It is a major support of the LONGITUDINAL ARCH. The peroneus (fibularis) longus tendon runs DEEP to it.

Question 250

The short plantar ligament runs between the __ and ___. It is superficial to the ___ ligament, but deep to the ___ ligament. It also supports the ___.

Answer 250

The superficial plantar ligament runs between the CALCANEUS and the CUBOID. It is SUPERFICIAL to the SPRING LIGAMENT, but DEEP to the LONG PLANTAR LIGAMENT. Also supports the longitudinal arch

Question 251

The lateral arcuate ligament comes from thickened fascia over the ___

Answer 251

Lateral arcuate lig = thickened fascia over QUADRATUS LUMBORUM

Question 252

The medial arcuate ligament comes from thickened fascia over the ___

Answer 252

Medial arcuate lig = thickened fascia over PSOAS

Question 253

The Median arcuate ligament comes from thickened fascia over the ___

Answer 253

Median arcuate lig = thickened fascia over Aorta