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(PA school) Gross Anatomy > Lecture 13: Lower Extremity pt 1 > Flashcards

Lecture 13: Lower Extremity pt 1 Flashcards

1
Q

List the 6 regions of the lower extremities (that exist for descriptive purposes)

A

1) Gluteal region (buttocks and hip) – transition zone
2) Hip joint
3) Femoral region (thigh)
4) Knee region (joint)
5) Leg or crural region
6) Ankle or talocrural region (joint)
7) Foot region

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2
Q

What makes up mature hip bones?

A

Fusion of 3 primary bones

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3
Q

1) Are the 3 bones that make up the hip bones still separated at puberty? Explain
2) When does cartilage disappear and begin to fuse?
3) When does fusion finish?

A

1) At puberty still separated by triradiate cartilage
2) Cartilage disappears and begin to fuse ~ 15-17 y/o
3) Fusion complete by age 20-25 y/o

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4
Q

List the 3 bones of the hip bones and some features of each

A

1) Ilium: body, ala, iliac crest
2) Ischium: body, ramus
3) Pubis: body, superior & inferior rami, symphysis

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5
Q

1) What is the acetabulum?
2) What is it made of?
3) What lines it?

A

1) Articular “socket” for femoral head
2) 3 bones
3) Labrum

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6
Q

What are the two parts of the hip joint?

A

Femoral head and acetabulum

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7
Q

Why are there usually multiple pelvic fractures?

A

Rings usually break in 2 or more places

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8
Q

What bones make up the LE?

A

1) Hip bones – 3 bones, acetabulum
2) Femur
3) Patella (sesamoid)
4) Tibia
5) Fibula
6) Tarsus (7 bones)
7) Metatarsus (5)
8) Phalanges (14)

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9
Q

1) What is the main part of the femur called?
2) What are the features of the proximal femur?
3) What are the features of the distal femur?
4) What rests on top of the distal femur?

A

1) Shaft
2) Head w articular cartilage, neck, and trochanters
3) Femoral epicondyles & condyles (articular cartilage)
4) Patella

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10
Q

1) What are the trochanters of the proximal femur?
2) What is the head of the femur covered with? Where is it not covered?

A

1) Greater and lesser
2) Articular cartilage except for fovea

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11
Q

What surface landmark is on the proximal femur?

A

Greater trochanter

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12
Q

Explain the angle of inclination

A

1) When we’re born, the angle of inclination is abt 135 degrees
2) Reaches about 125 degrees in adulthood
3) As elderly people age, that angle decreases even more, can cause neck of femur to snap off

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13
Q

Explain the torsion angle of the femur

A

At the axis of the femoral head and neck there’s about a 12 degree angle. If the angle is larger the toes will point inward; sometimes kids start with outward pointing toes.

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14
Q

What does the angle of inclination + torsion angle allow for?

A

Rotatory movements of the femoral head within the obliquely placed acetabulum to convert into flexion and extension, abduction and adduction and rotational movement of the thigh.

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15
Q

1) What does a decreased AI (angle of inclination) cause? In who is this common?
2) What causes in-toeing?

A

1) Increased stress on femoral neck; elderly
2) Increased torsion angle (anteversion)

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16
Q

1) What is the most common rotational deformity seen in pediatric orthopedics?
2) What is the most frequent cause of in-toeing in children between the ages of 3-10 years?

A

1) In-toeing gait (pigeon-toed)
2) Femoral anteversion/torsion

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17
Q

1) Each year over ____________ older (>65) people are hospitalized for”hip fractures”.
2) What percent of femoral neck fractures are caused by falling?

A

1) 300,000
2) > 95%

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18
Q

1) ___[Wo/men]____ experience three-quarters of all hip fractures.
2) The average cost of a hip fracture is what according to the American Academy of Orthopedic Surgeons (Nov 5, 2015)?

A

1) Women
2) $26,912

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19
Q

1) What does the colloquial term “hip fracture” usually refer to?
2) What do pelvic fractures convey?

A

1) “Hip fracture” commonly used to convey fracture of femoral neck
2) Convey fracture to pelvic girdle, usually causing two breaks in the “ring”

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20
Q

What is a relatively easy type of femoral fracture to repair?

A

Femoral neck fracture

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21
Q

What are the 4 surface landmarks of the distal femur?

A

1) Epicondyles (“above” the condyles)
2) Adductor tubercle (adductor m.)
3) Condyles (articular surface)
4) Patella (big sesamoid bone)

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22
Q

1) What bone is also a surface anatomy landmark?
2) What type of bone is it?
3) What are its two surfaces?
4) Where are its apex and base?

A

1) Patella
2) Sesamoid
3) Medial & lateral articular surfaces
4) Apex usually inferior, base usually superior

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23
Q

What are the two bones of the lower leg? Which is weight bearing?

A

1) Tibia (shin): Weight bearing
2) Fibula: Minimal weight bearing

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24
Q

What are 3 tibial articulations?

A

1) Femur condyles superiorly
2) Talus inferiorly
3) Fibula at proximal and distal ends.

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25
Q

Where does the distal end of the tibia rest? What does this form?

A

Medial malleolus; medial and posterior mortise of ankle joint

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26
Q

What part of the tibia may be mistaken for a fracture?

A

Nutrient foramen and canal

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27
Q

1) Where does the distal end of the fibula rest? What does this form?
2) What locks the fibula to tibia proximally and distally?

A

1) Lateral malleolus distally; lateral part of “mortise” of ankle joint
2) Interosseous membrane (with tibia)

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28
Q

What are the surface landmarks of the tibia and fibula?

A

1) Pes anserine (SGT insert)
2) Patella
3) Quad tendon
4) Patella ligament
5) Joint line & condyles
6) Medial and lateral collateral ligs.
7) Tibial tuberosity
8) Gerdy’s tubercle (ITB insert G)
9) Adductor tubercle
10) Body
11) Anterior border
12) Medial surface
13) Med malleolus
14) Head of fibula
15) Lateral malleolus

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29
Q

1) What ROMs of the knee joint should be tested?
2) What should you palpate?

A

1) Active and passive
2) Quad tendon, patella, and patella ligament @ origin & insertion at tibial tuberosity

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30
Q

What should you palpate medially and laterally on the knee joint?

A

1) Medially: epicondyle with adductor tubercle, medial joint line, medial meniscus, MCL, tibial condyle, and pes anserine (tibia for insertion of SGT)
2) Laterally: epicondyle, lateral joint line, fibular head, LCL, tibial condyle and Gerdy tubercle (tibia for ITB)

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31
Q

What are the 3 categories of special tests for the knee joint? What tests are within each?

A

1) Collateral ligament integrity: Valgus and Varus stress
2) ACL/PCL integrity: anterior/posterior draw, Lockman, Pivot shift
3) Meniscal integrity: McMurry

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32
Q

What is the Mortise view (of the ankle)?

A

~20 deg. oblique

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33
Q

Why are ankle injuries usually lateral?

A

Ankle inverts further than it does evert

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34
Q

The direct weight bearing is between what two bones of the distal shin?

A

Tibia and talus (tibiotalar joint)

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35
Q

A fracture of medial malleolus is probably from an _____[eversion/ inversion]____ injury

A

inversion

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36
Q

1) What are the two bones of the hind foot?
2) What are the 3 bones of the mid foot?
3) What are the 2 bones of the fore foot?

A

1) Talus and calcaneus
2) Navicular, cuboid & cuneiforms
3) Metatarsus, phalanges

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37
Q

What are the surface anatomy landmarks of the foot?

A

1) Talus
2) Calcaneus and Achilles tendon
3) Navicular
4) Cuboid
5) 3 cuneiforms
6) MT
7) 1st and 5th MTP
8) 1st MTP sesamoids
9) Base of 5th MT

38
Q

Surface anatomy:
1) What is at the base of 5th MT?
2) What is just distal to f. brevis insertion?
3) What are the features of the big toe (hallux)?

A

1) Fibularis brevis insertion
2) Fibularis tertius
3) 2 phalanges and 2 sesamoids planter surface of MT-P joint

39
Q

Surface anatomy:
1) Where do bunions typically occur?
2) Where are Taylors bunions?
3) How many tarsal bones are there and what do they provide?

A

1) Medial MTP joint
2) Lateral 5th MTP joint
3) 7; provide flexibility and shock absorption during weight bearing

40
Q

Surface anatomy:
1) What bone is weight bearing (and the only tarsal bone to articulate with the leg)?
2) What envelops the calcaneus? What does this continue as?
3) What does the navicular bone refer to?

A

1) Talus
2) Achilles tendon; continues as plantar aponeurosis
3) Tarsus and carpus (scaphoid)

41
Q

1) What is a Lisfranc injury/ Lisfranc fracture?
2) What usually causes it?
3) What’s its main symptom?

A

1) An injury of the foot in which one or more of the metatarsal bones are displaced (dislocated) from the tarsus
2) Weight bearing and twisting injury (soccer or football cleats anchoring foot, cutting and twisting or upper body, etc)
3) Midfoot pain

42
Q

1) What is the transition between the glutes and thigh called?
2) What is the Fascia Lata? What does it do?

A

1) Gluteal fold
2) Deep fascia of the thigh; investing like a stocking, compression, support.

43
Q

1) What is the IT tract/ band/ ITB of the thigh?
2) Where does it insert?

A

1) Aponeurosis of tensor facia lata and gluteus maximus muscles
2) Iliac (GERDY) tubercle to anterolateral tibial tubercle

44
Q

1) What muscle is the saphenous opening/ hiatus in?
2) What vein goes through it? Where does it go?
3) Where is the saphenous opening in relation to the inguinal ligament?

A

1) Fascia lata
2) Greater saphenous v. (superficial) to femoral v. (deep)
3) Inferior

45
Q

What are the fascia of the thigh?

A

1) Superficial fascia (SQ)
2) Deep or investing fascia (continuous from Fascia Lata)
-3 compartments

46
Q

What are the fascial components of the leg? Which is continuous from the Fascia Lata? Which is divided into 3 compartments?

A

1) Crural fascia (deep investing): continuous from Fascia Lata, septa divide into 3 compartments
2) Transverse intermuscular septum

47
Q

1) What makes up the superficial fascia/ SQ of the thigh?
2) What forms the thigh’s deep or investing fascia (continuous from Fascia Lata)?

A

1) Fatty tissue and superficial veins
2) Fascia lata and 3 intermuscular septa

48
Q

What are the 3 compartments formed by the deep/ investing fascia (continuous from Fascia Lata) of the thigh?

A

1) Anterior: knee extend, hip flex
2) Medial: hip adductor
3) Posterior: hamstrings

49
Q

What are the 3 compartments formed by the Crural fascia (deep investing) of the leg?

A

1) Anterior: dorsiflexor compartment
2) Lateral: foot evertor compartment
3) Posterior: plantar flexor compartment

50
Q

1) What does the transverse intermuscular septum divide into two parts?
2) What are these two parts?

A

1) Posterior fascia compartment of lower leg into superficial and deep parts
2)
Superficial = calf muscles (cross knee and ankle)
Deep = foot plantar flexors (cross ankle)

51
Q

1) When does compartment syndrome usually occur?
2) What about exertional compartment syndrome?

A

1) Usually following trauma, blood clot or infection
2) Exercise

52
Q

1) What are the symptoms of compartment syndrome?
2) Are these symptoms present in the entire leg?

A

1) Pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements).
2) Numbness, tingling, or pain may be present in the entire lower leg and foot

53
Q

What are the two categories of veins in the lower extremities? Where are each?

A

1) Superficial: in SQ
(great and small saphenous)
2) Deep veins: in deep fascia within compartments

54
Q

What are two superficial veins of the leg? Where are each and what forms them?

A

1) Great saphenous vein: Dorsum of foot and medial aspect of leg
-Dorsal digital vein of the great toe and dorsal venous arch of the foot
2) Small saphenous vein: Lateral (and posterior) aspect of leg
-Dorsal digital vein of 5th digit & dorsal venous arch

55
Q

1) What do the deep leg veins accompany? What do they travel within?
2) What do perforating veins do?

A

1) Major arteries, travel within vascular sheath with artery
2) Communicate between deep and superficial veins

56
Q

What type of veins have one-way valves and go superficial to deep (except foot – deep to superficial)?

A

Perforating veins

57
Q

What does the musculovenous pump do to blood in the vessels of the leg?

A

Move from:
1) Saphenous to femoral vein
2) Small saphenous to popliteal vein to femoral vein

58
Q

1) Where does the great saphenous vein run?
2) Where does it ascend?

A

1) Dorsomedial foot and leg to femoral vein
2) Anteromedially

59
Q

The great saphenous vein ascends anteromedially. While it does this, where is it in relation to?:
1) The medial malleolus
2) Medial condyle
3) Saphenous opening in fascia lata

A

1) Anterior to medial malleolus
2) Posterior to medial condyle (about hands breath posterior to medial margin of patella)
3) Traverses it into the femoral vein

60
Q

start 11/21 content

A
61
Q

1) Where does the small saphenous vein run?
2) What does it empty into/ continue as?

A

1) Dorsolateral foot to posterior leg
2) Popliteal vein

62
Q

Where does the small saphenous vein ascend?

A

-Posterior to lateral malleolus
-Inclines to midline to penetrate the deep fasci & ascends between heads of the gastrocnemius mm.

63
Q

1) What veins accompany major arteries in vascular sheath?
2) What 3 things aid in venous return superiorly to IVC?

A

1) Deep veins
2) Pulsation of artery + muscle contraction + venous valves

64
Q

1) What type of veins have similar anastomosis around the joints to the arteries?
2) What two venous arches are in the foot?

A

1) Deep veins
2) Dorsal and plantar arches in the foot

65
Q

List some deep veins

A

Fibular, anterior + posterior tibial, popliteal, femoral, profundis, ext. iliac veins

66
Q

1) Varicose veins from venous HTN cause what?
2) What is post DVT syndrome?

A

1) Venous reflux and damage to vein valves
2) Thrombophlebitis

67
Q

What are 3 treatments for thrombophlebitis/ post-dvt syndrome?

A

Tx: “the vein shop”:
1) Striping
2) Sclerosing
3) Endovascular therapy

68
Q

What are the two categories of lymphatics of the leg?

A

Superficial and deep

69
Q

Regarding superficial lymphatics of the LE: what two things do they follow? Where?

A

1) Greater saphenous v.; to superficial inguinal nodes to deep inguinal & iliac lymph nodes
2) Small saphenous v.; drain to popliteal nodes then accompany deep v. & lymphatics

70
Q

Describe deep lymphatics of the LE; what do they accompany? To where?

A

Deep veins; to popliteal nodes > deep inguinal nodes > iliac nodes

71
Q

1) What is the major artery to lower extremity?
2) What supplies the posterior and lateral aspects of the thigh with blood?
3) What is usually a branch of internal iliac artery that supplies the medial compartment of the thigh?

A

1) Femoral artery
2) Profunda femoris artery
3) Obturator artery

72
Q

What 2 things does the popliteal artery branch into? Describe the courses of each

A

Anterior and posterior tibial arteries (distal to popliteal fossa (leg))
1) Anterior tibial a.: to anterior compartment of leg to ankle to become Dorsal Pedis a.
2) Posterior tibial a.: to posterior compartment of leg to become medial and lateral plantar aa.

73
Q

If you want to see if there’s an occlusion in the aorta, would you look into the arteries or veins of the leg?

A

Arteries

74
Q

Where can pulses be palpated on the LE? (4 places)

A

1) Femoral artery
2) Popliteal artery
3) Posterior tibial artery
4) Dorsal pedis pulse

75
Q

1) Where does the femoral artery go through?
2) What arteries does it branch into?*

A

1) Adductor canal and hiatus
2) Profunda femoral artery and circumflex arteries

76
Q

1) What artery is found in the posterior popliteal fossa?
2) Which artery is at the knee?

A

1) Popliteal a. (from superficial femoral)
2) Geniculate arteries (from superficial femoral and popliteal)

77
Q

1) What artery is on the anterior foot?
2) What about the posterior foot?

A

1) Dorsal pedis a
2) Plantar aa.

78
Q

The sciatic, femoral, & obturator nerves have what two kinds of sensory branches?

A

Motor and cutaneous

79
Q

What dermatome is the anterior thigh compartment? What innervates it?

A

L2-4; femoral nerve

80
Q

1) What are the two motor functions of the femoral nerve?
2) What are the two sensory functions of the femoral nerve? What branches are these performed as?

A

1) Flexors of the hip + extensors of the knee
2) Anterior cutaneous n. for thigh
and Saphenous n. for medial calf and foot

81
Q

1) When can saphenous nerve injury occur?
2) What can this cause and why?

A

1) During harvesting of saphenous vein for bypass grafting
2) Pain and/or paresthesia medial aspect of the calf & foot; no motor division

82
Q

What dermatome is the medial thigh compartment? What supplies it?

A

L2-4; obturator

83
Q

1) What is the motor function of the obturator nerve? What’s the exception?
2) What is the sensory function of the obturator nerve?

A

1) Adductors of the thigh (L2-4)
-*Except hamstring part of adductor magnus m. innervated by tibial nerve
2) Medial thigh sensation

84
Q

Where does the sciatic nerve come from? (dermatome and plexus)
1) What are its two major branches?
2) What does one of those branch into?

A

L4-S3; sacral plexus:
1) Tibial nerve (posterior thigh and leg)
2) Common fibular nerve: into superficial and deep fibular (peroneal) nerves (anterior and lateral leg)

85
Q

What motor and sensory functions is the sciatic nerve responsible for? Why?

A

1) Branches provide ALL motor below knee
2) Most sensory below knee
-Saphenous nerve is from the femoral n. on medial aspect of leg and foot

86
Q

1) What is the tibial nerve a branch of?
2) Where does it come from?
3) What part of the thigh does it supply and what does it supply it with?

A

1) Sciatic nerve
2) L4-S3
3) Posterior thigh compartment; supplies motor to muscles

87
Q

1) What are the two motor functions of the tibial nerve? (branch of sciatic nerve)
2) What two branches does this nerve use to provide sensory innervation? What two areas are supplied?

A

1) Hamstrings: semi-T & semi-M (flex knee & extend hip) and hamstring pt of adductor m.
2) Medial sural n. and sural n.; calf region and heel of foot

88
Q

1) Where do the plantar nerves originate?
2) What spinal nerves do they come from?
3) What are the two types of plantar nerves?

A

1) Tibial nerve
2) S1-2
3) Lateral & medial

89
Q

1) Where does the plantar nerves supply motor innervation to?
2) What two places does the plantar nerves supply with sensory innervation?

A

1) Intrinsic muscle of foot
2) Plantar surface + other nerves

90
Q

1) What is the common fibular nerve a branch of? What spinal level does it come from?
2) What 2 parts of the leg does it supply?

A

1) Sciatic nerve; L4-S2
2) Anterior and lateral compartment

91
Q

1) What is the motor function of the common fibular nerve?
2) What does the common fibular nerve branch into to provide sensory innervation? Where to?

A

1) Dorsiflexion and Eversion of the foot
2) Lateral sural n.; lateral leg & foot, dorsum of foot

(PA school) Gross Anatomy (52 decks)

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