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Anatomy 1b > Limbs 4 > Flashcards

Limbs 4 Flashcards

1
Q

What are the two routes of venous return in the lower limb?

A
  • deep (accompanying arteries)
  • superficial (close to limb surface)
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2
Q

What do many of the deep distal veins form?

A

Venae comitantes

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3
Q

What are the main deep veins of the lower limbs?

A
  • femoral vein
  • deep femoral vein
  • anterior tibial vein
  • posterial tibial vein
  • popliteal vein
  • peroneal vein
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4
Q

What are venae comitantes?

A

Multiple veins forming a network of smaller veins with arteries which they accompany

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5
Q

What are the benefits of veins forming venae comitantes?

A
  • heats exchange
  • arteries promote venous flow
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6
Q

What allows only distal to proximal blood flow in the lower limb veins?

A

Valves in the veins

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7
Q

What is the calf pump?

A
  • deep veins are sandwiched between layers of calf muscles
  • contraction of muscles squeezes deep veins pushing blood towards heart
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8
Q

What are the main superficial veins of the lower limb?

A

Long and short saphenous vein

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9
Q

Where do the superficial veins arise from?

A

Dorsal venous network of the foot

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10
Q

What do the saphenous veins drain into?

A
  • long = femoral vein
  • short = popliteal vein
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11
Q

Where does the long saphenous vein run from?

A
  • on medial side of leg
  • passes anterior to the medial malleolus at the ankle
  • continues superiorly and medially in the leg
  • more posteriorly at the knee
  • medial in the thigh until the vein passes anterior to the femoral triangle
  • drains into the femoral vein through the saphenous opening in fascia lata
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12
Q

Where does the short saphenous vein run from?

A
  • lateral side of leg
  • passes posteriorly to the lateral malleolus at the ankle
  • runs superiorly on the posterior
  • drains into the popliteal vein after piercing the fascia over the popliteal fossa
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13
Q

What can the superficial veins of the lower limb be used for?

A

Can be harvested for venous grafts, mostly coronoary artery bypass grafts

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14
Q

What happens if the valves which allow blood flow from superficial to deep veins are compromised?

A
  • varicose veins
  • blood is pushed from deep to superficial veins
  • deep venouse return is slowed down
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15
Q

What do varicose veins increase the risk of?

A

DVT due to sluggish deep venous return

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16
Q

What are the two areas of nodes on the lower limb?

A
  • popliteal nodes
  • inguinal nodes
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17
Q

What do the popliteal nodes drain?

A

Distal limb (legs, toes)

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18
Q

What do the inguinal nodes drain?

A
  • lower limb
  • pudendal region
  • perineum
  • anus
  • parts of lower abdomen
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19
Q

What is the superficial drainage of the lymphnodes?

A
  • posterior lymph vessels run with short saphenous vein
  • drain into popliteal nodes in popliteal fossa
  • lymph nodes continue in association with femoral vein
  • vessels running with long saphenous vein drain into superficial inguinal nodes in inguinal region close to saphenous opening and inguinal ligament
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20
Q

What is the deep lymphatic drainage of the lower limb?

A
  • most drainage of the distal lower limb drains into the deep inguinal nodes
  • some also drains into popliteal nodes
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21
Q

Where does lymphatic drainage of the lower limb go up to?

A

Drainage via iliac vessels passing through iliac nodes

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22
Q

What are the important anatomical spaces of the lower limb?

A
  • femoral triangle
  • popliteal fossa
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23
Q

What are the borders of the femoral triangle?

A
  • superior = inguinal ligament
  • medial = adductor longus muscle
  • lateral = sartorius muscle
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24
Q

What is the femoral triangle covered by?

A

Skin and deep fascia (fascia lata)

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25
Q

What runs through the opening in the fascia lata?

A

Long saphenous vein entering the triangle to drain into femoral vein

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26
Q

What does the femoral triangle contain?

A
  • femoral nerve
  • femoral artery
  • femoral vein
  • superficial and deep lymphnodes
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27
Q

What happens when the femoral nerve enters the femoral triangle?

A

Branches into many smaller nerves to supply its muscular and cutaneous targets

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28
Q

What can be palpated in the femoral triangle?

A

Arterial pulse

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29
Q

What can the femoral artery and vein be accessed for in the femoral triangle?

A

Catheterisation for procedures involving coronary arteries or other parts of the heart

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30
Q

What is the popliteal fossa?

A

Diamond shaped opening in the back of the knee

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31
Q

What are the borders of the popliteal fossa?

A
  • superiorly = semimembranosus (tendon of the hamstring) and biceps femoris muscles
  • inferiorly = lateral and medial heads of the gastrocnemius muscles
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32
Q

What does the popliteal fossa contain?

A
  • tibial and common peroneal nerves
  • popliteal artery and vein
  • popliteal lymph nodes
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33
Q

What can be palpated at the popliteal fossa?

A

Pulse of the popliteal artery

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34
Q

Which nerve leaves the popliteal fossa at the head of the fibula and what does it divide into?

A
  • common fibular nerve
  • divides into superficial and deep fibular nerves
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35
Q

What forms the tibial and common peroneal nerves?

A

Bifurcation of the sciatic nerve

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36
Q

What is the adductor canal?

A
  • muscle-lined gutter
  • starts at the inferior apex of the femoral triangle and ends at the hiatus of adductor magnus
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37
Q

What passes through the adductor canal?

A
  • saphenous nerve
  • femoral artery and vein
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38
Q

What is the tarsal tunnel?

A
  • channel between the medial malleolus and the calcaneus
  • overlayed by flexor retinaculum
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39
Q

Which vessels enter the foot via the tarsal tunnel?

A

Posterior tibial artery and tibial nerve

40
Q

Label this diagram of the tarsal tunnel

A

-

41
Q

What is the clinical importance of the arteries of the lower limb?

A
  • supply blood to tissues
  • can be used to assess vascular health
  • can be used to access the heart for cardiac procedures e.g angioplasty, angiography
42
Q

Which arteries supply most of the lower limb?

A
  • left and right iliac arteries
  • found in the iliac regions of the pelvis
43
Q

How does the abdominal aorta give rise to the iliac arteries?

A
  • abdominal aorta bifurcates into left and right common iliac arteries
  • common iliac arteries bifurcate into internal and external iliac arteries
44
Q

What does the internal iliac artery supply?

A
  • buttock and medial thigh
  • smaller branch of common iliac artery
45
Q

What does the external iliac artery supply?

A
  • forms femoral artery
  • supplies rest of the limb and medial thigh
  • larger branch of the common iliac artery
46
Q

What are the arteries of the hip, buttock and thigh?

A
  • external iliac artery
  • deep femoral artery
  • femoral artery
  • popliteal artery
  • superior and inferior gluteal arteries
47
Q

Where does the external iliac artery become the deep femoral artery?

A

When it passes into the thigh behind the deep inguinal ligament

48
Q

Where does the deep femoral artery become the popliteal artery?

A

When it goes from running anteriorly down thigh to posteriorly into the popliteal fossa

49
Q

What is the deep femoral artery a branch of?

A

The femoral artery

50
Q

What is the main artery of the thigh?

A

Deep femoral artery

51
Q

What is the hiatus of adductor magnus?

A

Opening in the adductor magnus muscle which gives rise to the adductor canal

52
Q

What is the blood supply of the head of the femur?

A
  • lateral and medial circumflex arteries (mostly medial)
  • ligament of the head of the femur
53
Q

At what stage in life is the artery of the head of the femur important?

A

In children, helps with growing bone

54
Q

What can happen when the head of the femur has an intracapsular fracture?

A
  • arteries become damaged
  • avascular necrosis of the femoral head
55
Q

What are the main arteries of the knee, leg and foot?

A
  • femoral artery
  • popliteal artery
  • genicular (knee) branches
  • tibial artery
  • anterior tibial artery
  • posterior tibial artery
  • peroneal artery
  • medial plantar artery
  • lateral plantar artery
  • dorsal pedis artery
56
Q

Label this diagram of the arteries of the knee, leg and foot

A
57
Q

Which pulses can be palpated in the knee, leg and foot?

A
  • popliteal pulse
  • medial tibial pulse
  • dorsalis pedis pulse
  • determine vascular health of the lower limb
58
Q

What does the dorsalis pedis artery give rise to?

A

Arcuate artery

59
Q

What do the lateral and medial plantar arteries give rise to?

A

Plantar arch

60
Q

What is a nerve plexus?

A
  • network of nerves
  • formed when peripheral spinal nerve roots merge and split
  • new multi-segmental peripheral nerves arise from plexus
61
Q

What is the main plexus which supplies the lower limb?

A

Lumbo-sacral plexus

62
Q

Which three nerves arise form the lumbar part of the lumbo-sacral plexus?

A
  • lateral cutaneous nerve of the thigh
  • femoral nerve
  • obturator nerve
63
Q

Fibres from which level form the lumbosacral trunk?

A

L4 and L5

64
Q

Which nerves of the sacral part of the lumbosacral plexus supply the lower limb?

A
  • superior and inferior gluteal nerves
  • posterior cutaneous nerve of the thigh
  • sciatic nerve
65
Q

What is the sciatic nerve made up of?

A
  • common peroneal part
  • tibial part
66
Q

What does the superior gluteal nerve supply?

A

L4-S1

67
Q

What does the inferior gluteal nerve supply?

A

L5-S2

68
Q

What does the sciatic nerve supply?

A

L4-S3

69
Q

What does the femoral nerve supply?

A

L2-L4

70
Q

Where does the femoral nerve fun from?

A
  • descends through pelvis
  • passes under inguinal ligament into pelvic triangle laterally
  • divides into a number of muscular and cutaneous branches to the anterior thigh
  • terminal branch is the saphenous nerve
  • travels through adductor canal then superficially to anteromedial ascpects of the knee, leg and foot
71
Q

What does the obturator nerve supply?

A

L2-L4

72
Q

Where does the obturator nerve run from?

A
  • emerges on medial border of the psoas muscle
  • runs inferiorly and anteriorly in the pelvis
  • passes through obturator foramen to supply adductor muscles of the medial compartment
73
Q

Which nerve supplies the hamstring part of the adductor magnus?

A

Tibial part of the sciatic nerve

74
Q

What does the sciatic nerve supply?

A

L4-S3, biggest nerve in the body

75
Q

What does the sciatic nerve divide into?

A

Tibial and fibular nerves

76
Q

Which nerve runs close to the sciatic nerve?

A

Posterior cutaneous nerve of the thigh

77
Q

What is the piriformis muscle?

A
  • one of the lateral rotator groups of gluteal muscles
  • important landmark for the nerves and vessels of the gluteal region
78
Q

How does the piriformis act as a landmark for the nerves and vessels of the gluteal region?

A

Nerves and vessels pass from the buttock into the interior pelvis either superiorly or inferiorly to the piriformis

79
Q

What does the superior gluteal nerve supply?

A

L4-S1

80
Q

Where does the superior gluteal nerve enter the pelvis and what does it innervate?

A
  • above piriformis through greater sciatic foramen
  • innervates gluteus maximus, minimus and tensor fascia lata
81
Q

What does the inferior gluteal nerve supply?

A

L5-S2

82
Q

Where does the inferior gluteal nerve enter the pelvis and what does it innervate?

A
  • inferior to the piriformis via the greater sciatic foramen
  • gluteus maximus only
83
Q

Which other nerves enter the pelvis inferior to the piriformis?

A

Sciatic nerve and posterior cutaneous nerve of the thigh

84
Q

What are the main nerves of the anterior and lateral leg?

A
  • common peroneal (fibular) nerve
  • bifurcates into superficial and deep peroneal nerves
85
Q

What does the superficial peroneal nerve innervate?

A
  • lateral muscles
  • skin of dorsum of foot
86
Q

What do the deep nerves innervate?

A
  • anterior muscles
  • skin of cleft between first and second toes
87
Q

Where does the common peroneal nerve run from?

A
  • leaves popliteal fossa laterally
  • winds around head of fibula
  • bifurcates into deep and superficial peroneal nerves
88
Q

What are the main nerves of the posterior leg and foot?

A
  • tibial nerve
  • branches into medial and lateral plantar nerves
89
Q

What does the tibial nerve innervate?

A

Superficial and deep muscle compartments of the posterior leg

90
Q

Where does the tibial nerve run from?

A
  • passes distally through popliteal fossa into posterior leg
  • runs on surface of tibialis posterior
  • travels posteriorly to the medial malleolus
  • passes under plantar aponeurosis where it divides into lateral and medial plantar nerves
91
Q

Why are the dermatomes of the anterior lower limb distorted, resulting in the anterior dermatome running obliquely?

A

Twisting of lower limb during fetal development

92
Q

What is the general pattern of the dermatomes of the anterior lower limb?

A

L3 to the knee, L4 to the floor

93
Q

What are autonomous sensory zones?

A

Regions of non-overlapping sensory supply from an individual spinal root

94
Q

What is useful to know about innervation of the lower limb?

A

The dermatomes and peripheral cutaneous nerve fields do not match

95
Q

Why do the dermatomes and cutaneous nerve fields not match?

A
  • cutaneous nerves are formed in a plexus
  • cutaneous nerves will have fibres from multiple spinal nerves

Anatomy 1b (9 decks)

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