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Movement Term 2 > Lecture 4: Neurovasculature of the Lower Limb > Flashcards

Lecture 4: Neurovasculature of the Lower Limb Flashcards

1
Q

From where do the superior and inferior gluteal arteries branch?

A

Internal iliac

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2
Q

What is the clinical importance of the anastomosis between branches of the internal iliac and profunda femoris arteries (cruciate anastomosis).

A

Allows blood to bypass a blockage of the external iliac or proximal femoral arteries.

e.g. superior gluteal artery anastamoses with inferior gluteal artery

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3
Q

Where does the femoral artery begin?

A

Inguinal ligament - a continuation of the external iliac

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4
Q

What is the obdurator artery a branch of?

A

Branch of the internal iliac

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5
Q

What are the important arteries of the thigh?

A

Anterior compartment

  • Femoral artery
  • Continuation of external iliac
  • Boundary - inguinal ligament

Posterior compartment

  • Perforating arteries (4)
  • profunda femoris artery

Medial compartment

  • Obturator artery
  • A branch of the internal iliac
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6
Q

What happens to the femoral artery at the knee?

A
  • The femoral artery passes from the anterior compartment to enter the popliteal fossa
  • Here it is named the popliteal artery
    Pulsation can best be felt when the knee is flexed
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7
Q

What is the genicular anastamosis?

A

Maintains blood supply to the leg during knee flexion which may impinge the popliteal artery.

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8
Q

What are the branches of the genicular anastamosis?

A
  • Superior lateral
  • Superior medial
  • Middle
  • Inferior lateral
  • Inferior medial
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9
Q

What are the main arteries of the leg?

A

Anterior compartment

  • Anterior tibial artery
  • Terminal branch of popliteal artery

Posterior compartment

  • Posterior tibial artery
  • Terminal branch of popliteal artery

Lateral compartment

  • Fibular artery
  • Branch of posterior tibial artery
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10
Q

What are the main arteries of the foot?

A

Dorsal aspect
- Dorsalis pedis artery
- Continuation of anterior tibial artery
Plantar aspect
- Medial and lateral plantar arteries
- Bifurcation of posterior tibial artery

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11
Q

What are the 6 Ps and what is their relevance?

A 
Pain
Pallor
Perishingly cold
Pulseless
Paraesthesia
Paralysis

Signs and symptoms of the acutely ischemic leg.

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12
Q

What is peripheral vascular disease?

A
  • The arteries of the pelvis and lower limbs are affected by the same disease processes as other arteries (coronary, cerebral) = atherosclerosis
  • The lower limb arteries can become occluded by embolus or thrombus
  • Acute ischaemia – usually acute occlusion by thrombus or emboli; can also be caused by trauma or compartment syndrome
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13
Q

What are the possible presentations of chronic ischaemia?

A
  • Asymptomatic
  • Intermittent claudication – mild
  • Intermittent claudication - severe
  • Rest pain / night pain
  • Tissue loss / ulceration / gangrene
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14
Q

What are the superficial veins of the lower limb?

A
  • Great and short saphenous veins.
  • Lie in subcutaneous tissue, superficial to deep fascia
  • Drain into deep veins (femoral and popliteal)
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15
Q

What are the features of the deeps veins of the lower limb?

A
  • Accompany the major arteries
  • Anterior and posterior tibial veins and the fibular veins are actually venae comitantes.
  • These joint to form the popliteal vein which in turn becomes the femoral vein.
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16
Q

What is the function of the perforating veins?

A
  • Drain blood from the superficial veins to the deep veins
  • Contain valves to prevent backflow
  • Venous return from deep venous aided by
    muscular contraction - ‘muscle pump’
    deep fascia - ‘compression stocking’
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17
Q

What is the clinical importance of the femoral vein?

A

Temporary access:

  • Trauma
  • Burns
  • Otherwise very difficult access (shock, IVDU, thrombosed peripheral veins, obesity)
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18
Q

What is the clinical importance of the great saphenous vein

A
  • Lies immediately in-front of the medial malleolus

- Site can be used in emergencies to obtain IV access

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19
Q

Why might varicose veins ulcerate?

A

The veins become dilated and incompetent

Blood then may stagnate in the skin – leading to breakdown and ulceration

20
Q

From what branches is the lumbar plexus formed?

A

Anterior rami of L1-L4

21
Q

From what branches is the sacral plexus formed?

A

Anterior rami of L4-S5

22
Q

What joins the sacral plexus?

A

Lumbosacral trunk - branch of L4 anterior ramus that joins L5.

23
Q

What does the lumbar plexus give rise to?

A
  • Obturator nerve (L2-L4)

- Femoral nerve (L2-L4)

24
Q

What does the sacral plexus give rise to?

A
  • Sciatic nerve (L4-S3)

- Superior (L4-S1) and inferior (L5-S2) gluteal nerves

25
Q

What are the features of the femoral nerve?

A
  • Supplies anterior compartment of thigh
  • Passes under inguinal ligament to enter thigh
  • Terminal branch is saphenous nerve which passes through adductor hiatus to supply skin of medial leg
26
Q

What are the features of the obturator nerve?

A
  • Supplies medial compartment of thigh

- Divides into anterior and posterior branches that lie on either side of adductor brevis

27
Q

What are the features of the sciatic nerve?

A
  • Supplies posterior thigh and all of the leg and foot
  • Really composed of 2 nerves: Tibial nerve (anterior divisions of anterior rami) and Common fibular nerve (posterior divisions of anterior rami)
  • Usually bifurcates in distal thigh, however, already separate as leave the pelvis in 12% population
28
Q

What are the features of the common fibular (peroneal) nerve?

A
  • bifurcates into superficial and deep branches
  • duperficial branch supplies lateral compartment of the leg
  • deep fibular supplies anterior compartment of the leg
  • vulnerable as it winds round the neck of the fibula
29
Q

What would be the consequence of injury to the common fibular/peroneal nerve

A

Paralysis of dorsiflexor muscles resulting in ‘foot-drop’ and altered gait

30
Q

What is supplied by the tibial nerve?

A
  • Supplies posterior compartment of the leg

- Bifurcates deep to the flexor retinaculum into medial and lateral plantar nerves.

31
Q

What is the medial plantar nerve?

A

Smaller than lateral – only supplies 4 muscles but supplies skin to posteromedial 3 ½ digits

32
Q

What is the lateral plantar nerve?

A

Supplies all other plantar muscles and skin to posterolateral 1 ½ digits

33
Q

Which myotomes are responsible for lateral external rotation of the hip?

A

L1 and L5

34
Q

Which myotomes are responsible for medial internal rotation of the hip?

A

L1, L2, L3

35
Q

Which myotomes are responsible for abduction of the hip?

A

L5 and S1

36
Q

Which myotomes are responsible for adduction of the hip?

A

L1, L2, L3 & L4

37
Q

Which myotomes are responsible for inversion of the foot?

A

L4 and L5

38
Q

Which myotomes are responsible for eversion of the foot?

A

L5 and S1

39
Q

Which myotomes are responsible for dorsiflexion of the FOOT?

A

L5 and S1

40
Q

Which myotomes are responsible for plantarflexion of the foot AND ankle?

A

S1 and S2

41
Q

Which myotomes are responsible for the dorsiflexion of the ANKLE?

A

L4 and L5

42
Q

Which myotomes are responsible for extension of the hip?

A

L4 and L5

43
Q

Which myotomes are responsible for flexion of the hip?

A

L2 and L3

44
Q

Which myotomes are responsible for flexion of the knee?

A

L5 and S1

45
Q

Which myotomes are responsible for extension of the knee?

A

L3 and L4

Movement Term 2 (14 decks)

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