Leg 1&2 Flashcards
1
Q
Proximal articular surface between tibia and fibula
A
Fibular facet
2
Q
Distal “articular” surface between tibia and fibula
A
Fibular notch
3
Q
Distinct osseous landmarks on tibia
A
tuberosity medial malleolus medial condyle interncondylar eminence lateral condyle soleal line vertical line nutrient foramen
4
Q
Surfaces of tibial shaft
A
3 surfaces:
medial, lateral, posterior
5
Q
Borders of tibial shaft
A
3 borders:
anterior, medial, lateral
6
Q
surfaces of distal tibia
A
5 surfaces
anterior, posterior, medial, lateral, inferior
7
Q
the anterior surface of the distal tibia is continous with what?
A
the lateral surface of the tibial shaft
8
Q
what tibial border does the interosseous membrane attach to?
A
lateral border (interosseous crest)
9
Q
structures on the tibial plateau
A
lateral condyle medial condyle intercondylar eminence - medial and lateral tubercle anterior intercondylar fossa posterior intercondylar fossa
10
Q
what structures attach in the posterior intercondylar fossa?
A
posterior cruciate ligament
medial meniscus
lateral meniscus
11
Q
what structres attach in the anterior intercondylar fossa?
A
lateral meniscus
anterior curciate ligament
medial meniscus
12
Q
where is the groove for the joint capsule?
A
anterior tibia superior to the plafond
13
Q
where is the malleolar sulcus? what forms it?
A
posterior tibia
Formed by tendons of tibialis posterior and FDL
14
Q
Deltoid ligament attachments (distal tibia)
A
anterior colliculus
intercollicular sulcus
posterior colliculus
15
Q
Osseous landmarks of fibula
A
Apex (both superior and inferior)
head
neck
lateral malleolus
16
Q
primary function of fibula
A
muscle attachments. it is largely non-weight bearing
17
Q
lateral malleolar fossa attachments
A
posterior tibiofibular and posterior talofibular ligaments
*great landmark for orienting the fibula
18
Q
surfaces of fibular shaft
A
anterior
posterior
lateral
medial
19
Q
borders of fibular shaft
A
anterolateral
anteromedial (aka interossous crest; most constant border)
posteromedial
posterolateral
20
Q
where does the medial surface of the fibula lie?
A
posterior to the interosseous ligament
21
Q
fibular head attachments
A
biceps femoris
fibular collateral ligament
22
Q
Lateral surface of fibula attachments
A
origin of peroneus longus and brevis
23
Q
medial surface of tibia attachments
A
distally shaft is subcutaneous -shin
24
Q
proximal medial surface of tibia attachements
A
semimembranosus gracilis sartorius semitendinosus quadriceps tibial collateral ligament iliotibial band
25
anterior surface of fibula attachments
origin of EDL, EHL, peroneus tertius
26
lateral surface of tibia attachments
origin of tibialis anterior and EDL
27
What muscle originates from distal anterior fibula?
peroneus tertius
28
After giving rise to the peroneus tertius, the ___ surface of fibula becomes what?
anterior surface becomes a border
29
posterior surface of tibia attachments
origin of soleus, FDL, tibialis posterior, insertion of popliteus
30
medial surface of fibula attachments
origin of tibialis posterior
| *only reason for a medial surface is this muscle
31
posterior surface of fibula attachments
origin of soleus, FHL
32
soleus originates from where
soleal line
33
what does the vertical line separate?
origin of FDL and tibialis posterior are separated by the vertical line
34
Crural fascia forms what?
intermuscular septa that divide the leg into compartments that share action, innervation, and blood supply
35
venous flow is aided by what?
crural fascia
36
anterior intermuscular septum separates what two compartments?
anterior compartment and lateral compartment
37
posterior intermuscular septum separates what two compartments?
lateral compartment and superficial posterior compartment
38
interosseous membrane separates what compartments?
anterior compartment and deep posterior compartment
39
transverse intermuscular septum separates what compartments
deep posterior compartment and superficial posterior compartment
40
Anterior compartment
action: dorsiflexion
innervation: deep peroneal nerve
blood supply: anterior tibial artery
41
Lateral compartment
Action: eversion
INnervation: superficial peroneal nerve
Blood supply: perforationg branches from anterior tibial and peroneal arteries
42
superficial posterior compartment
action: plantarflexion
innervation: tibial n
blood supply: posterior tibial a
43
deep posterior compartment
action: flexion of digits
innervation: tibial n
blood supply: posterior tibial and peroneal a
44
where does lateral compartment get it's blood supply?
posterior compartment
45
compartment syndrome
trauma to structures within compartments may result in hemorrhage, edema, or inflammation
strength of crural fascia precludes outward swelling of tissues leading to compression of neurovasculature
treatment includes fasciotomy of affected compartment
if untreated, may lead to ischemia, necrosis, or atrophy of affected tissues
46
Tibialis anterior
ANTERIOR COMPARTMENT
Origin: Lateral surface of tibia, interosseous membrane
insertion: medial plantar border of medial cuneiform and 1st met
Action: dorsiflexion & inversion of ankle, supination of intertarsal joints
47
Extensor digitorum longus
ANTERIOR COMPARTMENT
origin: anterior surface of fibula, proximal tibia, interosseous membrane
insertion: extensor expansion of digits 2-5
action: extension of MP joints of digits 2-5, dorsiflexion and eversion of ankle, pronation of intertarsal joints
48
Peroneus tertius
ANTERIOR COMPARTMENT
origin: inferior 1/3 of anterior surface of fibula
insertion: base of 5th met (not the tuberosity)
Action: dorsiflexion and eversion of ankle, pronation of intertarsal joints
49
Extensor hallucis longus
ANTERIOR COMPARTMENT
Origin: anterior surface of fibula, interosseous membrane
insertion: dorsal base of distal phalanx of hallux
action: extension of 1st MP and ankle joints, supination of intertarsal joints
50
Extensor hallucis capsularis
ANTERIOR COMPARTMENT
origin: extension of extensor hallucis longus tendon
insertion: medial surface of 1st MP joint capsule
action: pull capsule out of MP joint to prevent entrapment
51
What are the muscles of the anterior compartment?
```
tibialis anterior
extensor digitorum longus
peroneus tertius
extensor hallucis longus
(extensor hallucis capsularis)
```
52
Peroneus longus
LATERAL COMPARTMENT
origin: superior 2/3 of lateral surface of fibula
insertion: lateral base of medial cuneiform and 1st met
action: plantarflexion and eversion of ankle, pronation of intertarsal joints
53
peroneus brevis
LATERAL COMPARTMENT
origin: inferior 2/3 of lateral surface of fibula
insertion: tuberosity of 5th met
action: plantarflexion and eversion of ankle, pronation of intertarsal joints
54
what should you remember about the peroneus tertius?
it is located in the anterior compartment and has a different action & innervation than peroneus longus and brevis
55
Muscles that pass anterior to the malleoli are __? Those that pass posterior to the malleoli are __?
```
anterior = dorsiflexors
posterior = plantarflexors
```
56
Muscles of the lateral compartment
peroneus longus
| peroneus brevis
57
Gastrocnemius
POSTERIOR COMPARTMENT: superficial
Origin: medial head: medial condyle of femur; lateral head: lateral condyle of femur
insertion: middle 1/3 of posterior calcaneus via tendo calcaneus
action: plantarflexion of ankle, supination of intertarsal joints, flexion of knees
58
Does the gastrocnemius attach on the tibia?
Nope. Goes from femur to calcaneus
59
Soleus
POSTERIOR COMPARTMENT: superficial
origin: posterior surface of head and shaft of fibula, soleal line of tibia
insertion: middle 1/3 of posterior calcaneus via tendo calcaneus
action: plantarflexion of ankle
60
Plantaris
POSTERIOR COMPARTMENT: superficial
Origin: lateral supracondylar line of femur
insertion: middle 1/3 of posterior calcaneus
action: plantarflexion of ankle, flexion of knee
61
muscles of the superficial posterior compartment?
Gastrocnemius, soleus, plantaris
62
Flexor digitorum longus
POSTERIOR COMPARTMENT: deep
origin: posterior tibial shaft medial to vertical line, distal to soleal line
insertion: plantar base of distal phalanges of digits 2-5
action: flexion of DIP joints, plantarflexion of ankle, supination of intertarsal joints
63
flexor hallucis longus
POSTERIOR COMPARTMENT: deep
origin: posterior surface of fibula, interosseous membrane
insertion: plantar base of distal phalanx of hallux
action: plantarflexion of ankle
64
tibialis posterior
POSTERIOR COMPARTMENT: deep
origin: posterior surface of tibia lateral to vertical line, interosseous membrane, medial surface of fibula
insertion: navicular tuberosity, sustantaculum tali, all three cuneiforms, bases of mets 2-4
action: plantarflexion of ankle, supination of intertarsal joints
65
Popliteus
POSTERIOR COMPARTMENT: deep
origin: lateral condyle of femur
insertion: psterior surface of tibia proximal to soleal line
action: flexion & rotation ("unlocking") of the knee
66
the popliteus ___ rotates ____ when leg is fixed and ___ rotates ___ when leg is free
laterally rotates femur when leg is fixed
| medially rotates tibia when leg is free
67
muscles of deep posterior compartment?
Flexor digitorum longus
flexor hallucis longus
tibialis posterior
popliteus
68
Two main nerves that supply leg?
common peroneal nerve (L4-S2)
tibial nerve (L4-S3)
(come from sciatic)
69
blood supply to leg comes from what?
branches of popliteal artery (which comes from femoral)
Posterior tibial a
Anterior tibial a
70
nerve that supplies the largest component of leg?
Saphenous n
71
True or false: cutaneous nerves are not the same as dermatomes
TRUE
| damage to cutaneous nerves and dermatomes result in different sensory deficits that can aid in dianosis
72
Sural nerve
| cutaneous innervation
= medial sural cutaneous (from tibial) + communicating branch of lateral sural cutaneous (from common peroneal)
73
what does the sural nerve follow and become?
follows small saphenous vein into foot, becoming the lateral dorsal cutaneous
74
saphenous nerve
(cutaneous innervation)
branches from what and follows what
branch of femoral
| follows the great saphenous vein into the foot
75
common peroneal nerve supplies?
muscular and cutaneous targets primarily in LEG
76
tibial nerve supplies?
muscular and cutanous targets primarily in FOOT
77
Branches of common peroneal nerve
Deep peroneal
- > lateral sural cutaneous
- > recurrent articular branch
- > lateral terminal branch
- > medial terminal branch
Superficial peroneal
-> intermediate and medial dorsal cutaneous
78
Deep peroneal supplies motor innervation to?
```
tibialis anterior
EDL
EHL
peroneus tertius
(anterior compartment)
```
79
Superficial peroneal supplies motor innervation to?
Peroneus longus
peroneus brevis
(lateral compartment)
80
Tibial n supplies motor innervation to?
```
Popliteus
Gastrocnemius
Soleus
Plantaris
FDL
FHL
Tibialis posterior
(posterior compartment)
```
81
What is the most commonly injured nerve in the lower limb?
Common peroneal nerve
vulnerable in fracture of fibular neck and knee dislocation
results in unopposed plantarflexion and inversion = foot drop
82
What sensory deficits would be present in common peroneal nerve injury?
Entire lateral leg and dorsum of foot
| lateral sural cutaneous, superficial peroneal, sural (partially), medial terminal branch of deep peroneal n
83
If only the deep peroneal nerve were injured what sensory and muscular deficits would manifest?
Sensory: Space between 1st and 2nd toes is supplied by medial terminal branch of deep peroneal.
Motor: Deep peroneal n supplies anterior compartment. Anterior compartment does DORSIFLEXION. Would have a drop foot gait?
84
Would you expect sensory or motor deficits to be the most noticeable in a superficial peroneal nerve injury? Why?
Motor? Because it is motor innervation to lateral compartment (peroneus longus and brevis). Would not be able to plantarflex/evert.
Would also have decreased sensory to dorsum of foot (medial 1st toe, lateral 2nd toe -medial 5th toe) due to medial & intermediate dorsal cutaneous branches.
85
Injury to tibial nerve is rare but will most frequently happen where/why?
Popliteal fossa or as a result of compartment syndromes
86
What muscular deficits would occur if the tibial nerve were injured?
Posterior compartments would be affected.
General action of deep compartment: flexion of digits
General action of superficial compartment: plantarflexion
87
What muscular deficits would occur if the tibial nerve were injured? what compartment would be most affected?
Posterior compartments would be affected:
popliteus, gastroc, soleus, plantars, FDL, FHL, tib post.
General action of deep compartment: flexion of digits
General action of superficial compartment: plantarflexion
88
What sensory deficits would manifest if the tibial nerve were injured?
Medial sural cutaneous - middle of posterior calf
Part of sural - lateral ankle, dorsum of 5th met
Medial & lateral plantar nerves - plantar sensation
89
The arterial supply to the leg is from
popliteal artery
90
what forms anastomosis around the knee?
genicular arteries
91
__ arteries are muscular branches from popliteal to what 3 muscles?
Sural arteries
| to the popliteus, soleus, and gastroc
92
What bifurcates into anterior and posterior tibial arteries?
Popliteal artery
93
What is the main blood supply to anterior compartment of the leg?
Anterior Tibial artery
94
what are the branches of the anterior tibial artery? (5)
```
Posterior tibial recurrent
anterior ibial recurrent
circumflex fibular
anterior medial malleolar
anterior lateral malleolar
```
95
What nerve follows the anterior tibial recurrent artery?
Recurrent articular branch of the deep peroneal nerve
96
What is the main blood supply to the posterior compartment?
Posterior tibial artery
97
what are the branches of the posterior tibial artery? (8)
```
Peroneal
Nutrient artery to tibial
Posterior medial malleolar
posterior lateral malleolar
communicating
medial calcaneal
medial plantar
lateral plantar
```
98
What are the branches of the peroneal artery?
nutrient (to fibula)
posterior lateral malleolar
lateral calcaneal
99
Superficial veins of the leg
great saphenous v
| small saphenous v
100
deep veins of the leg
popliteal vein
| -distal to popliteal fossa deep veins form venae comitantes that follow arteries and take the same names
