Limb anatomy exam Flashcards
Attachments of gluteus maximus
Originates from lateral sacrum, coccyx and gluteal surface of ilium at posterior gluteal line
INsertion: gluteal tuberosity
Attachments of gluteus medius
-Originates from gluteal surface of ilium, between posterior and anterior gluteal lines
-Inserts into lateral surface of greater trochanter
Attachments of gluteus minimus
Originates from gluteal surface of ilium between anterior and inferior gluteal lines
Inserts on anterior greater trochanter
Attachments of piriformis:
Anterior sacrum
INserts superior aspect greater trochanter
What is the attachment of the iliotibial tract/
-Origin; Tubercle of iliac crest
-Insertion: lateral tibial condyle
What muscles insert into iliotibial tract?
-Tensor fascia lata
-Gluteus maximus
What is the clinical significance of iliotibial tract?
-Stabilises knee in extension and in partial flexion. Is important in walking/running
Origin and insertion of quadriceps
-Vastus medialis: medial linea aspera–> Medial patella
-Vastus lateralis: lateral linea aspera –> lateral patella
-Vastus intermedius: proximal anterior femoral shaft –> patella
-Rectus femoris:
–> straight head: anterior inferior iliac spine
–> reflected head: acetabular rim
–> insertion: patella and tibial tubercle
Origins and insertions of the hamstrings
Origin:
–> All ischial tuberosity except for short head of biceps femoris (linea aspera_
Insertion:
–> biceps femoris: fibular head
–> others: Medial tibia/tibial condyle (membranosus
innervation of hamstring muscles
All tibial except for short head of biceps (peroneal)
What are the actions of the hamstring muscles?
-All 3 muscles: flexion of leg at knee, extension of thigh at hip
Biceps:
-Lateral rotation of hip and knee
Semitendinosus and semimembranous:
–> medially rotate thigh at hip joint and leg at knee joint
What structures are at risk in supracondylar fracture of the femur?
-femoral/popliteal artery
-femoral nerve
-hamstrings/quadriceps/their tendons
-tendons/ligaments of the knee joint
What runs in femoral canal?
Fat
lymphatics
Cloquet’s node
Femoral branch of genitofemoral nerve
Point out lateral cutaneous nerve of thigh
.
What happens with transection of femoral nerve
Loss of knee extension
Also supplies hip flexors (depending on level): pectineus, iliacus, sartorius
Sensation
–> anteromedial thigh (anterior cutaneous branches of femoral nerve)
–> medial leg and foot (saphenous nerve)
What does the saphenous nerve innervate?
Medial lower leg
Medial foot
What nerve innervate biceps femoris?
Short head: Peroneal nerve
Rest: tibial nerve
Sensation lower leg
Thigh
-Lateral: lateral femoral cutaneous nerve (lumbar plexus)
-Medial: medial femoral cutaneous nerve (femoral nerve)
-POsterior: posterior femoral cutaneous nerve
Lower leg
Superficial peroneal: anterolateral, dorsum of foot except first webspace
Deep peroneal: First webspace
Sural: lateral foot and lower leg
Saphenous: medial foot and lower leg
Sole: medial and lateral plantar nerves from tibia (lateral is in ulnar nerve distribution)
Action of nerve innervating biceps femoris
: Tibial nerve innervates posterior compartment of the leg and sole of the foot
What is the innervation of gluteus medius?
-Superior gluteal nerve (L4-S1)
Attachments of deltoid ligament
Superior:
–> medial malleolus
Inferior:
–> Tuberosity of navicular
–> neck and body of talus
–> sustetaculum tali on calcaneum/spring ligament
What are the parts of the deltoid ligament?
-Anterior tibiotalar (deep)
-Tibionavicular
-Tibiocalcaneal
-posterior tibiotalar
What are the parts of the lateral collateral ligament?
-Anterior talofibular
-POsterior taloribular
-Calcaneofibular
What are the parts of the syndesmosis?
-Anterior inferior tibiofibular ligament
-Posterior inferior tibiofibular ligament
-Interosseous membrane
-Inferior transverse tibiofibular (deep fibres of posterior tibiofibular)
What is the midtarsal joint of chopart?What type of joint is it?
-Articulation of calcaneus with the cuboid (calcaneocuboid joint) (saddle)
-Articulation of the talus with the navicular (talocalcaneonavicular joint (ball and socket)
What movements occur at the subtalar (talocalcaneal) joint?
-Inversion and eversion of the foot
Which muscles perform inversion and eversion?
-Inversion: tibialis anterior and posterior (with some help from the extensor and flexor hallucis longus muscles)
-Eversion: peroneus longus and brevis
What is the type of the subtalar (talocalcaneal) joint?
Synovial plane joint
What is the type of the ankle (talocrural) joint?
Synovial hinge joint
What are the bones forming the ankle joint
Trochlear surface of the talus, lower end of tibia and fibula
Movements at the ankle joint and muscles?
Plantar flexion:
-all muscles except popliteus
Dorsiflexion:
-All muscles naterior compartment
Why is the ankle joint most stable in dorsiflexion?
-Wider anterior side of trochlea is immobilised by tibial articulation
-In plantarflexion, the narrow posterior side is articulating more and so more movement is possible
What is the type of inferior tibiofibular joint?
-A syndesmosis joint
What is the associated injury in syndesmotic fracture?
Fractures of the lateral malleolus
What makes up the achilles tendon?
-Soleus
-Gastrocnemius
-Plantaris
Structures passing behind medial malleolus
as previous
Structures deep to extensor retinaculum
Tibialis anterior
Extensor hallucis longus
Anterior tibial vessels
Anterior tibial nerve
Extensor digitorum longus
Peroneus tertius
Tom has very nice dogs and pigs
What are the arteries of the foot?
Dorsalis pedis:
-continuation of anterior tibial and begins as anterior tibial crosses ankle joint
-Crosses tarsal bones and then passes inferiorly as deep plantar artery
Medial and lateral plantar arteries
-Supply the sole of the foot
-Branches of the posterior tibial artery
-lateral plantar artery forms plantar arch with dorsalis pedis
Where would you palpate dorsalis pedis and posterior tibial?
-DP: lateral to EHL tendon
-PT: halfway betwween posterior border of medial malleolus and achilles tendon
Demonstrate the foot pulses on this actor?
-DP found between first two metatarsals
-PT: 2-3cm below and behind medial mal
What movements does EHL perform?
-Extension of big toe
-Dorsiflexion of foot
-Assists with inversion of foot
What vessels would you find deep to EHL
Anterior tibial artery and vein
What nerve lies deep to EHL?
Deep peroneal nerve
Where would you test sensation of S1?
`Lateral aspect of foot
Where would you test L4?
Medial malleolus
Where would you test deep peroneal nerve/superfiical/sural?
-1st webspace
-Superfiical : dorsum of foot
-Sural: lateral malleolus
At what joint does dorsiflexion occur?
-Ankle joint between tibia/fibula and talus
What muscles are involved in dorsiflexion?
-Tibialis anterior
-EHL
-Extensor digitorum longus
-Peroneus tertius
What muscles are involved in plantarflexion?
-Posterior compartment except for popliteus (superficial and deep)
What action occurs when tibialis anterior and posterior contract together?
=Inversion
At which joint does inversion occur?
-Subtalar joint
What muscles are responsible for ankle eversion?
-Peroneus brevis and longus
Which nerve innervates peroneus brevis and longus?
-Superfiical peroneal nerve
What motor and sensory function is lost with damage to superficial peroneal nerve?
-Inability to evert the foot and loss of sensation over the dorsum of the foot, apart from the first web space which is innervated by the deep peroneal nerve
Identify the lower limb dermatomes
L1: groin crease
L2: lateral thigh
L3: medial lower thigh
L4: medial malleolus (medial lower leg)
L5: second toe
S1: little toe
S2: posterior thigh
SOle:
–> medial sole; L4
–> mid sole: L5
–> lateral: S1
What are the myotomes of the lower limb?
-L2 hip flexion
-L3 knee extension
-L4: dorsiflexion
-L5: toe extensors
-S1: plantarflexion
Origins of peroneus longus, brevis and tertius
Peroneus longus
Origin: superolateral fibula, lateral tibial condyle
Insertion: crosses under foot and attaches to bones on the medial side–> medial cuneiform and the base of the 1st metatarsal
Peroneus brevis
-originates from inferolateral surface of fibular sharft
–> Attaches to tubercle on 5th metatarsal
Peroneus tertius
–> O: medial fibula
–> I: 5th metatarsal
Tibialis anterior and posterior origin and insertion
Anterior:
–> O: lateral surface of the tibia
—> I: medial cuneiform bone and the base of metatarsal I.
Posterior
-O: posterior surface and interosseous membrane of the tibia and fibula.
-I: medial tarsal bones.
Extensor hallucis longus and extensor digitorum attachments
EHL
Attachments:
O: fibular shaft.
I: base of the distal phalanx of the great toe.
Extensor digitorum
Originates from the lateral condyle of the tibia and the medial surface of the fibula.
The fibres converge into a tendon, which travels onto the dorsal surface of the foot.
The tendon splits into four and each tendon inserts onto a toe(middle and distal phalanges)
What arches are there of the foot?
Medial longitudinal
Lateral longitudinal
Transverse
What forms the medial longitudinal arch?
Calcaneus, talus, navicular
3 cuneiform
3 medial metatarsal
What is the function of the medial longitudinal arch?
High arch concerned with the elastic propulsion of the foot during walking
What are the factors maintaining the medial longitudinal arch?
Ligaments
–> interosseous ligaments
–> plantar aponeurosis
–> long plantar ligament
–> Deltoid and spring ligaments (plantar calcaneonavicular ligament)
Muscles
–> Tibialis anterior and posterior
–> short muscles of the big toe
–> FHL
What forms the lateral longitudinal arch?
Calcaneus
Cuboid
2 lateral metatarsal
What is the function of the lateral longitudinal arch?
Low arch concerned mainly with body weight transmission
What supports the lateral longitudinal arch?
Ligaments
–> interosseous ligaments
–> plantar aponeurosis
–> short planter ligament
Muscles
–> 3 peronei muscles
–> short muscles of little toe
What are the components of the transverse arch?
-Cuboid, 3 cuneiform
-Bases of metatarsals
What is the function of the transverse arch?
Elastic propulsion of foot and body weight transmission
What are the factors maintaning the the transverse arch?
Ligaments
–> interosseous ligaments
Muscles
–> peroneus longus
–> Transverse head of adductor hallucis
Identify ligaments on medial and lateral aspects of the ankle?
Deltoid
–> anterior tibiotalar (deep)
–> tibionavicular
–> tibiocalcaneal
–> posterior tibiotalar
LCL:
–>Anteiror talofibular
–> posterior talofibular
–> calcaneofibular
Origin and insertion of deltoid
Name structures that run on extensor aspect (dorsum) of foot
TEA DEPt
Tibialis anterior
EHL
Anterior tibial artery
Deep peroneal nerve
EDL
Peroneus tertius
