Limbs Flashcards
What are the veins of the lower limbs and where are they situated?
In the superficial fascia; greater (long) saphenous vein, lesser (short) saphenous vein
What are the fascia of the lower limbs?
Fascia lata, popliteal fascia, crural fascia, plantar fascia
What are the six main nerves of the lower limb?
- Superior gluteal
- Inferior gluteal
- Femoral
- Obturator
Sciatic: - Tibial
- Common fibular (common peroneal): superficial fibular and deep fibular
What does the saphenous vein empty into?
Femoral vein, in deep fascia of the groin (cribriform opening)
What are the 5 longitudinal bundles of the foot connected by?
transverse metatarsal ligaments
How do the intramuscular septa divide the thigh?
Anterior compartment: knee extensors (quadriceps femoris, femoral nerve (L2-L4)
Adductor/medial compartment: obturator nerve (L2-L4)
Posterior compartment: flexors of the knee, but mainly extend the hip joint (hamstrings), sciatic nerve
Which muscles are responsible for inversion of the foot?
Tibialis anterior (anterior compartment) and tibialis posterior (posterior compartment)
Which muscles are responsible for eversion of the foot?
Lateral compartment muscles + extra anterior muscle
How is the lower leg divided?
Anterior compartment: deep fibular (peroneal) nerve
Lateral compartment: superficial fibular (peroneal) nerve
Posterior compartment: tibial nerve (6 muscle: 3 deep (flexion of the digits) and 3 superficial (plantar flexion)
What is the biggest nerve in the body?
Tibial nerve
What is the main arterial supply of the hip joint?
Profunda femoris (from femoral artery which comes from external iliac)
What is the arterial supply to the lower leg?
Popliteal artery divides into: anterior tibial (–> dorsal pedis –> arcuate arteries), posterior tibial and peroneal (fibular) artery
What is the osteology of the hip joint?
Acetabulum: lunate surface + acetabular fossa + acetabular notch + acetabular labrum + transverse acetabular ligament (forms acetabular foramen)
Head of the femur contains fovea –> non-articular
What is the importance of the inter-trochanteric line and the trochanteric fossa?
Inter-trochanteric line: where capsule of hip joint attaches (posteriorly 2/3 down the neck)
Trochanteric fossa: attachment of lateral rotators
Along which axis does rotation of the femur occur?
Mechanical axis (3 degrees off vertical axis); extra: anatomical axis (6 degrees off vertical axis)
What are the angles of declination and inclination?
Declination: angle at which neck extends from the shaft: head is more in front compared to shaft
Inclination: when young start with coxa valga, problematic for support, women have lower angle of inclination –> osteoporosis –> higher risk of neck fracture
What is the blood supply to the head of the femur?
60% from lateral (mostly) and medial femoral circumflex arteries from profunda femoris, obturator artery also gives rise to artery in ligament of head of the femur
What is the difference between intertrochanteric line and crest?
Line: anterior
Crest: posterior
What are the capsular ligaments of the hip joint?
Iliofemoral ligament: strongest
Pubofemoral ligament: from iliopubic eminence
Ischiofemoral ligament: runs posteriorly to attach to greater trochanter
What is the zona orbicularis?
Band that goes around capsule of hip joint
How do patients with cerebral palsy or loss of motor tone tend to arch?
Backwards
What happens in neck fracture of the hip?
Limb is shortened, femur is drawn upwards, medial rotators are weakened because attachment is closer –> lateral rotation, 8/10 in females
Where does the iliopsoas tendon attach?
Lesser trochanter
How do intertrochanteric and cervical fractures of the hip differ in severity?
intertrochanteric: not a problem for arterial supply
Cervical: leaves only obturator artery –> not strong enough –> avascular necrosis of the head of the femur
What happens in hip dislocation?
Shortening of the limb and internal rotation; medial rotators are attached to the ileum and greater trochanter –> go into spasm and stretch; lateral rotators are shortened –> weak; shente’s line is disrupted
What are the gluteal lines on the ileum?
Posterior: gluteus maximus
Anterior: gluteus medius
Inferior: gluteus minimus
What are the ligaments that connect the sacrum to the hip pelvic bones?
Sacrotuberous ligament, sacrospinous ligament (these two form lesser sciatic foramen in between
Where does the gluteus maximus attach and how is it innervated?
gluteal tuberosity (minor) + iliotibial tract (thickening of fascia lata important in extension of the knee; inferior gluteal nerve (L5,S1,S2)
What are the functions of the gluteus medius and minimus, where do they attach and what is their innervation?
Hip abductors; prevent from falling (anti-gravity muscles); attach to greater trochanter; superior gluteal nerve (L4,L5,S1)
Where do the lateral rotators attach to?
Trochanteric fossa; piriformis (exits from greater sciatic notch), superior and inferior gemelli, obturator internus and quadratus femoris
What is trendelenburg’s sign?
Drop of pelvis when lifting the leg opposite to weak gluteus medius
What are the muscles of the anterior compartment of the thigh?
Vastus lateralis, rectus femoris, vastus medialis and sartorius
What are the muscles of the medial compartment of the thigh?
Gracilis, adductor magnus, adductor longus, adductor brevis, pectineus, obturatur externus
What are the muscles of the posterior compartment of the thigh?
Semimembranous, semitendinous, biceps femoris (long head and short head –> only one that allows lateral rotation)
What are the boundaries of the femoral triangle?
Inguinal ligament, sartorius and adductor longus
What are the structures within the femoral triangle?
Y: lymphatics
V: femoral vein
A: femoral artery
N: femoral nerve
What are the boundaries of the popliteal fossa and what does it contain?
Semimembranous, biceps femoris, medial and lateral head of gastrocnemius + plantaris; contains popliteal vessels, tibial nerve + common peroneal nerve on the side + popliteal nodes
What is baker’s cyst?
cyst in the popliteal fossa
What is the structure of the knee joint?
Capsule: absent anteriorly
Synovium and bursae (many)
Ligaments: collateral (tibial and fibular), cruciate (anterior and posterior –> inside capsule but extrasynovial), meniscofemoral, oblique popliteal, arcuate
Nerve supply: femoral, obturator, common peroneal, tibial
Blood supply: genicular arteries
What are the tendons below and above the patella?
Above: quadriceps tendon
Below: patellar tendon to tibial tuberosity
What does anterior dislocation of the tibia mean?
Ruptured anterior cruciate ligament
Where does the patella sit and how do its medial and lateral articulations differ?
Sits in intercondolar groove/notch; medial articulation is smaller than lateral
In which direction does patello-femoral dislocation occur?
Laterally; vastus medialis opposes action of vastus lateralis and vastus intermediate + medial condyle projects less
What is the Q angle and how is it increased?
Angle between quadriceps tendon and patellar tendon at full extension of the knee; increases in: genu valgum, increased femoral anteversion, external tibial torsion, laterally positioned tibial tuberosity, tight lateral retinaculum; female have wider hips and therefore larger Q angle
How do the medial and lateral menisci differ?
Medial is larger than lateral
What is the coronary ligament?
Attaches the meniscus to the outside
Why does the lateral meniscus allow more movement?
Not attached to lateral to lateral collateral ligament, more ball shaped, less likely to be torn
What is a parrot beak tear?
Tear of the horn of the meniscus
Is a meniscus injury likely to be repaired?
No; it is avascular
What is the importance of the popliteus muscle?
Unlocks the knee, attaches to the lateral epicondyle of the femur, goes through the capsule of the knee joint at the back
Which muscles form the pes anserinous and where is it situated?
Gracilis, sartorius, semitendinous; antero-medial surface of the tibia
Where does the biceps femoris attach?
Head of the fibula
Where does the iliotibial tract attach?
lateral side of the tibia
Where does the lateral collateral ligament attach?
Head of the fibula
What is the vastus retinaculum?
tendon of vastus medialis
What is the difference between genu varum and valgum?
Genu varum (bow leg), genu valgum (knock-knee: lateral angulation of leg in relation to thigh)
What are the differences between the anterior and posterior cruciate ligaments?
ACL: taut in extension, most likely to rupture
PCL: 3x the thickness of the anterior one, taut in flexion, runs medially
What is the name of the test that checks ACL and PCL rupture?
Lackman test
What is the unhappy triad?
ACL, medial meniscus tear, medial collateral ligament tear
How do the cruciate ligaments avoid being in the synovial compartment?
Infrapatellar fat pad prevents synovium from going down but not up, synovial membrane wraps around cruciate ligaments; tear –> bleeding –> can be repaired because vascularised unlike menisci
What are the bursae of the knee?
Suprapatellar bursa, popliteus bursa, gastrocnemius bursa –> communicate with the joint
anserine bursa: separates pes anserinus from tibia
What are the two types of knee bursitis?
Pre-patellar burstis: housemaid’s knee
Infra-patellar bursitis: superficial and deep, clergymen’s knee
What can fracture to the tibia lead to?
Fat gets into the blood vessels –> pulmonary embolism
What are the muscles of the anterior compartment of the lower leg and what is its nerve and blood supply?
extensors of the ankle —> dorsiflexion, extensor digitorum, extensor hallucis longus and tibialis anterior + (fibularis tertius); nerve supply: deep fibular nerve, artery: anterior tibial artery
What are the muscles of the lateral compartment of the lower leg and what is its nerve supply?
Fibularis longus and brevis (plantar flexors), nerve supply: superficial fibular nerve
What are the muscles of the posterior compartment of the lower leg and what is its nerve supply?
deep transverse septum divides in two, tibial nerve, posterior tibial artery + fibular artery —> perforating branches for lateral group
superficial muscles act as plantar flexors: lateral and medial gastrocnemius (arises from epicondyles of the femur) + soleus (arises below knee joint) + plantarus (often absent) —> Achille’s tendon (calcaneus)
Deep muscles act as flexors of the digits: flexor digitorum longus, flexor hallucis longus, posterior tibial
How do the superior and inferior tibio-fibular joints differ?
Superior: synovial (not many clinical problems)
Inferior: syndesmosis (stabilise joint)
What are the bones of the foot?
Lateral and medial malleoli, talus, calcaneus, navicular, coneiforms (3 in front of navicular), cuboid (interacts with calcaneus, flat joint), metatarsals, phalanges