Lecture 4: Lower Limb/Knee Flashcards
Popliteal Fossa (3)
- posterior aspect of knee
- main path by which vessles and nerves pass between thigh and leg
- feel for politeal artery
- divides into anterior and posterior tibial artery
Popliteal artery becomes… (2)
- anterior tibial artery
2. posterial tibial artery
Bones of knee (3)
- Patella
- Tibia
- Fibula
Patella (3)
fractures?
- Kneecap
- sesamoid bone
- patellar fractures usually result from direct trauma to bones or sudden contraction of quadriceps muscles
Tibia
location key landmarks (2)
main bone of lower leg, shin bone, medial to fibula
2nd largest bone- key weight bearing structure
key locations: tibial tuberosity, medial malleolus
Fibula (3)
lateral aspect
more for attachment site of muscles
lateral malleolus
Muscles of lower leg (3 types )
- Anterior leg muscles
- Posterior leg muscles
- lateral leg muscles
Knee Joint
type/ROM
3 bones involved
2 articulations
synovial hinge, allows for flexion and extension
patella, femur, tibia + 2 minisci
articulations:
1. tibiofemoral: medial and lateral condyles of femur articulating with tibial condyles
- Patellofemoral: anterior aspect of distal femur articulating with patella
Tibiofemoral articulation in knee joint
- tibiofemoral: medial and lateral condyles of femur articulating with tibial condyles
Patellofemoral articulation in knee joint
anterior aspect of distal femur articulating with patella
Menisci (2 types)
in knee joint
shock absorbers
- lateral
- medial
2 Ligaments of Knee Joint
- cruciate
- connect femur and tibia- cross eachother=cruciate
- ACL (ANT.)
- PCL (POST) - collateral
- sabilize hing motion of knee, preventing excessive medial or lateral movement
- LCL (LAT.)
- MCL (med.)
ACL rupture
Method of injury
dx (3)
manage
triad
common athletic injury
MOI: usually related to sharp turns when knee is twisted while foot is firmly on the ground
dx: radiographs can dx rupture, US accurate to dx complete tears, MRI sensitive and specific
can be managed operatively, and non op
unhappy triad: ACL, MCL, medial meniscus
ROM of knee (4)
- extension
- flexion
- lateral rotation
- medial rotation
Bursa of Knee (4)
- Suprapatella
- Perpatella
- Infrapatella
- Semimembranosus
Pes anserinus
what (3) muscles
where?
also called “goose foot’
isterts on:
- sartorius
- gracillis
- semitendinosus
*conjoining proximally on medial side of tibia
Osgood-Schlatter Disease
partial avulsion of tibial tuberosity
-repetative stress on tuberosity may cause it to separate from tibia.
avulsed fragment continues to grow with intervening space filled with new bone of fribrous connective tissue so tibial tuberosity is enlarged
*more common in children who play sports
Deep Vein Drainage of LE: foot & leg
- Dorsal venous arch=main structure
- arch drains into superficial veins
- anterior tibial vein formed when veins from the arch penetrate deep into the leg
Deep vein drainage of Le: thigh
popliteal vein enters thigh it is called femoral vein
deep vein of thigh is other main venous structure in the thigh
femoral vein leaves thigh by running underneath inguinal ligament, at which point, it is known as external iliac vein
politeal -> femorus -> external iliac
Deep vein drainage of LE: gluteal reagion
drained by inferior and superior gluteal veins, empty into the internal iliac vein
Superficial Venous drainage of LE: great saphenous vein
formed by doral venous arch of foot and dorsal vein of big toe
ascends the medial side of leg, passing anteriorly to the medial malleolus at the ankle and posteriorly to the medial condyle at the knee
as vein moves up leg, it receives tributaries from other superficial veins- great saphenous vein terminates by draining into the femoral vein immediately inferior to the inguinal ligament
-great saphenous vein can be harvestes and used as a vessel in coronary artery bypass
Superficial venous drainage of the LE: small saphenous vein
formed by doral venous arch of foot, dorsal vein of the little toe.
moves up posterior side of led, passes posteriorly the lateral malleolus, along lateral border of the calcaneal tendon. moves between two heads of gastrocnemius muscle and empties into the politeal vein in popliteal fossa
Deep vein thrombosis
formation of blood clott within deep veins of lower limbs, causing blockage of vessel
cause: veous stasis, hypercoaguability, endothelial injury
casues pain sweeling and tenderness of affected limbs
main complication of PE thrombus can become dislodged and travel into pulmonary circulation to prevent blood from returning to heart
Genu valgum
angular deformity at knee where the the apex of the deformity points towards the midline
Genu Valrum
is an angular deformity at the knee where the apex of the deformity point away from the midline
Anterior Leg Muscles
movement (2)
components (2)
muscles (3)
- dorsiflexion/extension
- deep fibular nerve
- anterior tibial artery - muscles
a. extensor digitorum longus
b. extensor hallicus longus
c. tibialis anterior
Posterior Leg Muscles
movement (2)
components (4)
1) plantarflexion and flexion
2) tibial nerve
- popliteal artery, post tibular and fibular arties
3. muscles DEEP -flexor hallicus longus -flexor digitorum longus -tibialis posterior SUPERFICIAL -gastrocnemius -soleus
Lateral Leg Muscles
movement (2)
components (2)
muscles (2)
- evert foot and weakly plantarflex
- superficial fibular nerve
- fibular artery - muscles
- fibularis longus
- fibularis brevis
Anterior muscles (3)
- tibialis anterior
- extensor hallicus longus
- extensor digotrum longus
Lateral Muscles (2)
- fibularis longus
2. fibuaris brevis
Posterior muscles(5)
DEEP
- Tibialis posterior
- flexor hallicus longus
- flexor digitorum longus
SUPERFICIAL
- soleus
- gastrocnemius
Cruciate ligaments
2 types
2 ligaments connect femur and tibia, cross each other
- ACL-anterior
- PCL-posterior
Collateral ligaments
2 types
- act to stabilize the hinge motion of the know, preventing excessive medial or lateral movement
- LCL-lateral
- MCL-medial
Extension Knee (1)
- quadriceps femoris
- I: tibial tuberosity
Flexion Knee (4)
- hamstrings
- gracillis
- popliteus
- sartorius
Lateral roation (1)
- biceps femoris when knee is flexed
Medial rotation (5)
- semimebranosus
- semitendinosus
- gracilis
- sartorius
- popliteus
* when knee is flexed
Suprapatella bursa
- extension of synovial cavity of the knee
2. locate between the quadriceps femoris and the femur
Prepatella bursa
- between apex of patella and skin
Infrapatella bursa
- Deep bursa
- lies between tibia and patella ligament - superficial
- lies between the patella ligament and the skin
semimembranosus bursa
- posteriorly in the knee joint
2. between the semi membranous muscle and the medial head of the gastrocnemius
Posterior tibial and fibular veins
- of the foot and leg
2. formed when plantar veins on foot combine
Popliteal vein
comprised of what 3 veins?
posterior surface knee
anterior tibial + posterior tibial + fibular veins
