LECTURE 6: LOWER LIMBS Flashcards
What are the bones of the lower limbs?
Femur - thigh bone Tibia - Leg bone closer to midline Fibula - Leg bone farther from midline • Patella • Sesamoid bone • Bones of the foot
What type of joint if the femur?
ball and socket
What does the head of the femur articulate with?
articulates with the acetabulum of the pelvic bone
What is the role of the fovea capitis?
a depression for the ligament of the head of the femur
what are the parts of the proximal femur?
neck, greater (smaller) and lesser (larger) trochanter, linea aspera
What is the patella?
a small sesamoid bone (sits in a tendon and glides across, and isn’t firmly attached to a ligament) that sits in the tendon of quadriceps femoris muscle and articulates with the femur
How is the medial and lateral menisci form?
made from C-shaped fibrocartilage cushion knee and are situated between the condyles of the femur and tibia
What is the calcaneus?
the heel bone
What is the role of the acyls tendon?
plantar flex ankle
What is the attachment of the patella?
Patella is attached to the quadriceps femoris tendon superiorly and patellar ligament inferiorly
What is the patellar reflex?
activation of quadricep muscles to extend knee
What is the role of the collateral ligament?
Prevent lateral/medial displacement of the knee across the femur
What is the Fibular (lateral) collateral ligament?
on lateral side of knee, separated from joint capsule by a bursa
What is the Tibial (medial) collateral ligament?
on medial side of knee associated with medial meniscus
What is the unhappy tirade?
(blown Knee) – when you take out all 3 of the ligaments as in sports injury
What is the role of the anterior cruciate ligament (ACL)?
runs from tibia and medial meniscus to back of femur
• Prevents anterior displacement of the tibia
What is the Draw Test?
tibia slides forward past the femur, then ACL is compromised
What is the role of the posterior cruciate ligament (PCL)?
runs from posterior tibia to posterior femur
• Prevents posterior displacement of the tibia
What is fascia lata?
thick wrap of fascia covers the thigh and gluteal region underneath superficial tissue
What is the fascia lata continuous with?
with Deep Fascia of the Leg, but NOT continuous with fascia of the anterior abdominal wall or perineum
What is the IT Band?
Lateral thickening of fascia lata is the iliotibial tract (IT band) – important for stabilizing the hip and knee on the lateral side via tensor fascia lata muscle in gluteal region
What is the role of the psoas and ilacus muscles?
Psoas major and iliacus muscles from the posterior abdominal wall attach to the lesser trochanter of the femur to flex the hip joint
What is the role of the Sartorius muscle of the anterior thigh?
- “S”- shaped muscle running obliquely downward from ASIS to medial side of tibia
- Action: flexes knee and hip, external rotation and abduction
What is the role of the quads of the anterior thigh?
Vastus group extends knee, but rectus femoris extends knee and flexes at hip
What is the innervation of the anterior thigh muscles?
femoral nerve (aslo innervates Gracilis muscle)
What is the action of the Gracilis muscle of the medial thigh?
adduction of thigh Pectineus
Where do the adductor muscles originate?
the pelvis
What is the action of the abductor muscles?
adduction and medial rotation of the thigh
What is the innervation of the abductor muscles?
• All innervated by the obturator nerve except portion of adductor magnus (sciatic nerve)
What muscles make up the hamstrings?
Biceps femoris – Lateral-most muscle runs from pelvic bone to fibula
Semitendinosus - Positioned on top (posterior) of semimembranosus
Semimembranosus –Medial-most muscle runs from pubic bone to tibia
What is the action of the hamstring muscles?
All flex knee, extend hip from extended position, and rotation of leg in flexed knee position
What is the innervation of the hamstring muscles?
Sciatic nerve
What makes up the boundaries of the femoral triangle?
- Sartorius (L)
- Adductor longus (M)
- Inguinal ligament (S)
How are the femoral vessels formed?
Femoral artery and vein from inside the pelvis (continuation of external iliac artery and vein from inside the pelvis) as they cross inguinal ligament and become the femoral vessels
What is the role of the adductor canal?
allows passage of femoral A/V into the popliteal fossa behind the knee and become the popliteal artery and vein
What are the boundaries of the popliteal fossa?
- Semitendinosus/semimembranosus medially (from hamstrings)
- Biceps femoris laterally
- Two heads of gastrocnemius (from calf) and plantaris, inferiorly
What are the branches of the sciatic nerve int he popliteal fossa?
Tibial and common fibular nerves
What is the innervation of the posterior thigh muscles?
tibial nerve
What is gastrocnemius?
Calf muscle
How is the soleus of the calf formed?
From tibia and fibula into the calcaneal tendon
What is the action of the gastrocnemius and plantar muscle?
Because plantaris and gastrocnemius originate from the distal femur, they help to flex the knee, otherwise this group plantarflexes the foot
What is plantaris?
Small muscle that ends in long tendon that attaches to calcaneal tendon
What is the role of the popliteus muscle?
Triangular muscle near knee; Stabilizes knee, unlocks knee by slightly rotating the knee while in extended position
What is the role of the tibialis posterior?
Inversion and plantar flexion of ankle
What is the role of the flexor hallucis and digitorum longus?
Tendons extend into plantar surface to phalanges; Flex toes
What is the role of the fibularis peroneus longus and brevis?
Eversion of ankle (also plantarflexion)
What is the innervation of the fibularis peroneus longus and brevis?
Superficial fibular nerve (branch of common fibular nerve from sciatic) and deep fibular nerve
What is the innervation of the anterior leg?
Deep fibular nerve (branch of common fibular nerve from sciatic)
What is the action of the tibialis anterior?
Dorsiflexion and inversion of foot
What is the action of the extensor hallucis and digitorum longus?
Dorsiflexion and extension of toes
What is the action of the fibularis tertius?
Dorsiflexion
Where does the femoral and obturator nerves come from?
the lumbar plexus and innervate muscles in the thigh only
Where does the sciatic nerves come from?
comes from the lumbosacral plexus and innervates muscles in the thigh, leg and foot
•Travels through gluteal region in inferior medial area into the posterior thigh and Divides into tibial nerve and common fibular nerve
Where is the posterior tibial artery pulse felt?
behind medial malleolus in the tarsal tunnel
Where is the anterior tibial artery pulse felt?
• Anterior tibial artery becomes dorsalis pedis artery in the dorsal foot (important pulse point)
What is the path of venous drainage in the leg?
Deep structures are drained by veins following the named artery into the femoral vein into the external iliac vein to common iliac to IVC
What drains the superficial structures of the leg?
drained by saphenous veins (like cephalic vein in the upper limbs) from the dorsal venous arch of the foot
What is the action of the ankle?
•Allows for hinge-motion: dorsiflexion and plantarflexion
What is the importance of the tarsal tunnel?
• Many important structures enter the plantar surface of the foot through the tarsal tunnel on the posterior medial side of the foot covered by flexor retinaculum (connective tissue)
What nodes innervate the ankle?
tibial and common fibular nerves
What goes through tarsal tunnel behind medial malleolus, and sheet of fascia loss off the tunnel?
- tendon of the flexor digitalum and halus longus muscle
- tendon of tibialis posteriors
- Tibial vein and artery