Lower Body Flashcards
Pelvic Girdle
Sacrum attaches to Ossa Coxae via Sacroiliac joint.
Lower Extremity of sacrum is the Coccyx
Inner space is called the Pelvic Inlet
Two anterior foremen known as the obturator foremen
Ossa Coxae attached via pubic symphysis
Front of Os Coxa marked by anterior superior iliac spine (AsIS), anterior inferior iliac spine (AiIS) and Pubic Tubercule.
True Pelvis : Coccyx-Bottom of Pubic Symphysis to Top of Pubic Symphysis-Sacral Promontory
False Pelvis : Anterior attached to Abdominal wall.
Sacrum (Anterior)
Promontory attached to most inferior lumbar spine.
Anterior Sacral Foramina
Coccyx
Sacrum (Posterior)
Median Sacral Crest
Auricular Surface lateral of Sacrum
Sacral Canal: Holds Spinal Cord
Sacral Hiatus
Sacral Comua: Coccyx attachment
Os Coxae (Lateral Anterior)
Ilium
Iliac crest
Anterior Superior Iliac Spine, Anterior Inferior Iliac Spine
Acetabulum
Body of Pubis, Pubis
Inferior Ramus of pubis
Obturator Foramen
Os Coxae (Lateral Posterior)
Posterior Superior Iliac Spine
Posterior Inferior Iliac spine
Greater Sciatic notch (Greater Sciatic Foramina)
Ischial body
Ischial spine
Lesser Sciatic Foramina
Ischial tuberosity
Ischium
Ischial Ramus
Os Coxae (Medial)
Iliac Crest
Iliac Fossa
Arcuate line
Superior Ramus of pubis
Pubic tubercule
Pubis interior
Articuler surface of pubis
Inferior ramus of pubis
Pelvic Foramen
Sciatic Foramen (greater and lesser): Split by sacrospinous ligament
Lesser Sciatic Foramen inferior border: Sacrotuberous ligament
Femur
Femoral head : Attach to Acetabulum, ball and socket joint
Neck
Greater Trochanter - Intertrochanteric crest - Lesser trochanter(Medial)
Gluteal Tuberosity (Posterior)
Shaft
Linea Aspera (Posterior)
Lateral supracondylar ridge
Adductor tubercule
Epicondyle (Lateral and medial)
Condole (Lateral and medial)
Popliteal Surface (posterior
Patellar Surface (anterior)
Intercondylar fossa
Patella
Base (Superior)
Apex (Inferior)
Lateral articular facet (dip, wider, smoother)
Medial articular facet (bump, narrow, rough)
Tibia
Intercondylar eminence
Lateral and medial condyle (articular surfaces)
tibial tuberosity (Patellar tendon attachment)
Anterior crest
Medial Malleolus
Articular surface
Soleal line (Soleus Muscle)
Fibula
Head of Fibula (below tibial condyle not articulating with femur)
Lateral Malleolus
Foot
Dorsal
Talus: troches of talus articulates with tibia and fibula
Calcaneus
Navicular
Cuboid
Cuneiforms (Medial, intermediate, and lateral)
Metatarsals
Phalanges (Proximal, Middle, Distal(except Hallux))
Joints
Sacroiliac: Sacrum and Coxal
Pubic symphysis: Pubic bones
Hip: coxal and femur
Knee: Synovial, modified hinge joint (Tibiofemoral, femoropatellar)
Ankle: tibia and fibula with talus
Toe: adjacent phalanges
Knee Joint
Synovial, Modified hinge joint : Glides and rotates
Strength: Quadricep femoris muscle
Tendon of quadriceps femoris attaches to patella and moves down to patellar ligament
TCL (medial) FCL (Lateral)
ACL: Lateral Condyle(femur) to anterior intercondylar space, prevent anterior translation of femur
PCL: Medial Condyle(femur) to posterior intercondylar area, prevent posterior translation of femur
Patellar retinacula: Vastus medial is, lateralis aponeuroses
Medial patellar retinaculum, lateral patella retinaculum
Meniscus: Shock absorbing
Fascia Latae
Deep fascia that invests the thigh
IT band
Gluteal Muscles
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Tensor Fasciae Latae
Deep
Piriformis
Other deep lateral rotators
Gluteus Maximus
Origin: Posterior ilium, sacrum, and coccyx
Insertion: Gluteal tuberosity and iliotibial tract
Action: extend hip, lateral rotation of hip (thigh)
Innervation: Inferior gluteal nerve
Stand and sit muscle
Stair muslce
Gluteus medius
Origin: outer surface and crest of ilium
Insertion: Greater trochanter
Action: Hip abduction (thigh)
Innervation: Superior gluteal nerve
Pelvic stabilization
Single leg stable
Gluteal minimus
Abduct hip (thigh)
Superior gluteal nerve
Pelvic stabilization
Single leg stable
Tensor Fasciae Latae
Anterior iliac crest
IT
Flex hip (thigh)
Abduct hip (thigh)
Superior gluteal nerve
Piriformis
passes through greater sciatic Foramen
Lateral rotation of the hip (thigh)
Anterior Hip
Psoas major
Iliacus
(Iliopsoas)
Flex hip joint
pass through inguinal ligament to become iliopsoas
Psoas Major
Lumbar vertebrae
Lesser trochanter (medial)
Flex hip (thigh)
Flex trunk
Lumbar spinal nerve
Iliacus
Iliac fossa (spread)
Lesser trochanter (medial)
Flex hip (thigh)
Flex trunk
Femoral nerve
Thigh Muscles (Anterior Compartment)
Knee (leg) extensors : Except sartorius
Femoral Nerve innervation
Quadricep femoris group
Rectus femoris
Vastus medial is
Vastus Lateralis
Vastus intermedius
Sartorius
Anterior Iliac spine attachment
medial surface of proximal tibial insertion
Flex hip, flex knee
Femoral Nerve innervation
Rectus Femoris
Anterior inferior iliac spine attachment
Tibial tuberosity via patellar ligament
Flex hip
Extend knee (leg)
Femoral nerve innervation
Vastus lateralis
Lateral lip of linea aspera (femoral lip)
Tibial tuberosity via patellar ligament
Extend knee (leg)
Femoral nerve innervation
Vastus medial is
Medial lip of linea aspera
Tibial tuberosity via patellar ligament
Extend Knee (leg)
Femoral nerve innervation
Vastus intermedius
Anterior shaft of proximal femur attachment
Tibial tuberosity via patellar ligament
Extend knee (leg)
Femoral nerve innervation
Medial Thigh muscles
Adductor group
Obturator nerve innervation
Gracilis
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Pubic bone attachment
Medial surface of proximal tibial insertion
Adductor of hip (thigh)
Flex knee (leg)
Obturator nerve
Pectineus
Pubic bone attachment
Posterior surface of proximal femur
Adductor hip (thigh)
Flex hip (thigh)
Femoral nerve and obturator nerve innervation
Adductor longus
Pubic bone attachment
Linea aspera of femur (posterior)
Adductor of hip (thigh)
Obturator nerve innervation
Adductor brevis
Pubic bone attachment
Posterior surface of proximal femur insertion
Adductor of hip (thigh)
Obturator nerve
Adductor magnus
Adductor part and hamstring part separate insertion
Pubic bone and ischium attachment
Linea aspera of femur and adductor tubercule
Obturator nerve innervation
Adductor Hiatus
Femoral vessel pass through from anterior thigh to posterior thigh and then popliteal fossa
Posterior Thigh Muscles
Hamstring muscles
Tibial nerve innervation
Bicep femoris: Long head
Short head : innervated by common fibula nerve, doesn’t cross hip joint, no hip extension only knee flexion
Semitendinosus
Semimembranosus
Bicep femoris (long head)
Ischial tuberosity attachment
Head of fibula insertion
Extend hip (thigh)
Flex knee (leg)
Tibial nerve innervation
Bicep femoris (short head)
Linea aspera attachment
Head of fibula insertion
Flex knee (leg) ONLY
Common fibula nerve innervation (NOT TIBIAL)
Semitendinosus
Ischial Tuberosity attachment
Medial surface of proximal tibial
Extend hip (thigh)
Flex knee (leg)
Tibial nerve innervation
Semimembranosus
Ischial tuberosity attachment
Posterior surface of medial condyle of tibia insertion
Extend hip (thigh)
Flex knee (leg)
Tibial nerve innervation
Pes Ansérine
Sartorius
Gracilis
Semitendinosus
Insert on proximal tibia
Rules Leg muscle
Any tendon crossing ANTERIOR will at least DORSIFLEX foot
Any tendon crossing POSTERIOR will at least PLANTARFLEX foot
Any TIBIALIS (medial) muscle will at least INVERT food
Any FIBULARIS (lateral) muscle will at least EVERT food
Leg Muscle
Anterior, lateral, posterior
Separated by crural fascia
Crural Fascia
Deep fascia that invests in the leg
Anterior Compartment Leg Muscle
Dorsiflexors of the ankle (foot) and extensors of the toes
Deep fibula nerve innervation
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
Tibialis anterior
Anterior tibia and interosseous membrane attachment
Medial cuneiform and base of metatarsal 1 insertion
Dorsiflex foot
Invert foot
Deep fibular nerve innervation
Extensor hallucis longus
Anterior fibula and interosseous membrane attachment
Dorsal surface of base of distal phalanx of hallux insertion
Dorsiflex foot
Extend hallux
Deep fibular nerve innervation
Extensor digitorum longus
Anterior tibia, anterior fibular, and interosseous membrane attachment
Dorsal surface of middle and distal phalanges of digits 2-5 insertion
Dorsiflex foot
Extend digits 2-5
Deep fibular nerve
Fibularis tertius
Anterior fibula and interosseous membrane attachment
Base of metatarsal 5 insertion
Dorsiflex foot
Evert foot
Deep fibular nerve innervation
Lateral leg muscles
Plantar flexor the ankle (foot) and evert the foot
Both innervated by the superficial fibular nerve
Fibularis longus
Fibularis brevis
Fibularis longus
Lateral fibula attachment
Base of metatarsal 1 and medial cuneiform insertion
Plantar flexion of foot
Evert foot
Superficial fibular nerve innervation
Fibular brevis
Lateral fibula attachment
Base of metatarsal 5
Plantar flexion of foot
Evert foot
Superficial fibular nerve
Posterior leg muscles (superficial)
Plantar flexors of the ankle
Innervated by tibial nerve
Gastrocnemius
Soleus
Plantaris
Gastrocnemius muscle
Medial and lateral femoral condyles attachment
Calcaneal tuberosity via calcaneal tendon insertion
Flex knee (leg)
Plantar flex (foot)
Tibial nerve innervation
Soleus Muscle
Soleal line of tibia and fibula
Calcaneal tuberosity via calcaneal tendon
Plantar flexion of foot
Tibial nerve
Plantaris
lateral supracondylar ridge of femur attachment
Calcaneal tuberosity insertion
Flex knee (leg)
Plantar flexion of foot
Tibial nerve innervation
Posterior leg muscle (deep)
Plantar flexors and flexors of toes
Tibial nerve innervation
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Popliteus
Lateral femoral condyle attachment
Posterior tibia superficial to Soleal line
Flexion of knee (leg)
Medial rotation of tibia
Tibial nerve innervation
Tibialis posterior muscle
Posterior tibia, posterior fibula, and interosseous membrane attachment
Navicular, all cuneiforms, cuboid, metatarsal 2-4 insertion
Plantar flex foot
Invert foot
Tibial nerve innervation
Flexor Hallucis longus
Posterior fibula and interosseous membrane attachment
Base of the distal phalanx of hallux
Plantar flex foot
Flex hallux
Tibial nerve innervation
Flexor digitorum longus
Posterior tibia attachment
Base of distal phalanx of digits 2-5 insertion
Plantar flex foot
Flex digits 2-5
Tibial nerve innervation
Tarsal Tunnel
Tendon of Tibialis posterior
Tendon of flexor digitorum longus
Posterior tibial artery
Tibial nerve
Tendon of flexor hallucis longus
Tom, Dick, And Nervous Harry
Muscles of the Dorsum of the Foot
Extensors of the toes
Both innervated by the deep fibular nerve
Extensor hallucis brevis
Extensor digitorum brevis
Extensor hallucis brevis muscle
Superior surface of anterior calcaneus attachment
Base of proximal phalanx of hallux
Extensor of hallux
Deep fibular nerve innervation
Extensor digitorum brevis muscle
Superior surface of anterior calcaneous attachment
Extensor digitorum longus tendon of digits 2-4 insertion
Extend digits 2-4
Deep fibular nerve innervation
Plantar surface foot muscle
Flexors and abductor of toes
Four layers
Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi
Abductor hallucis muscle
Calcaneous and plantar aponeurosis attachment
Medial side of proximal phalanx of hallux insertion
Abduct hallux
Medial plantar nerve innervation
Flexor digitorum brevis muscle
Calcaneus and plantar aponeurosis attachment
Side of middle phalanges digits 2-5 insertion
Flex digits 2-5
Medial plantar nerve innervation
Abductor digiti minimi muscle
Calcaneus and plantar aponeurosis attachment
Lateral side of proximal phalanx of digit 5
Abduction digits 5
Lateral plantar nerve innervation
Heart to Aorta
Left Ventricle
Ascending aorta
Aortic arch
Descending thoracic aorta
Descending abdominal aorta (split from thoracic via diaphragm)
Abdominal aorta branching
Descending abdominal aorta (split at L4 spine)
Right common iliac artery Left common iliac artery
External iliac - Internal iliac External iliac - Internal iliac
Internal Iliac artery
Obturator artery (Medial compartment of thigh)
Superior gluteal artery (Gluteal region)
Inferior gluteal artery (Gluteal region)
Superior gluteal artery and vein
Superior to Piriformis muscle (landmark muscle)
Nerves travel with artery and vein
Feeds into gluteus medialis and minimis
Inferior Gluteal artery and vein
Inferior to Piriformis muscle (Landmark)
Feeds gluteus Maximus
External iliac artery gives off/continues to
Femoral artery
Deep femoral artery
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Fibular artery
External iliac artery pass through
Inguinal ligament to continue into femoral artery
Femoral artery pass through
The adductor hiatus to become popliteal
*or Continues into deep femoral
Femoral artery
Comes from external iliac artery
Anterior thigh, travels deep to sartorius through adductor hiatus
Deep femoral artery
Non terminal branch off femoral artery
Branches of dorsilaterally from the femoral artery
Popliteal Artery
Femoral artery pass through adductor hiatus
Behind knee to popliteal fossa
Divide into anterior and posterior tibial arteries
Anterior tibial artery
Pass through interosseous membrane from popliteal to anterior side of tibia
Travels with deep fibular nerve
Pass the ankle to become dorsalis pedis artery (anterior/dorsal of foot)
Dorsalis Pedis artery
Anterior tibial becomes the dorsalis pedis at the ankle
Posterior tibial artery
Part of tarsal tunnel
Splits into fibular artery
Fibular artery
Non terminal branch off posterior tibial artery
Posterior tibial artery movement
Bifurcates into lateral and medial plantar arteries
Anastomosis
Conjoining of multiple arteries into a system of arteries
Deep veins
Named the same as the corresponding arteries
Reverse order of arteries (excepte common iliac veins join to become vena cava)
Superficial
Located within subcutaneous layer.
Begin on the dorsum of the foot.
Greater saphenous - femoral vein
Lesser saphenous - popliteal vein
Great saphenous
Flows back from the ankle all the way to the external iliac
Lesser Saphenous
Flows back into popliteal vein to femoral vein
Drainage scheme
Dorsal venous arch
G. Saphenous - femoral vein - external iliac common iliac- inferior vena cava
L. Saphenous - popliteal vein - femoral vein - external iliac - common iliac - inferior vena cava
Medial and lateral plantar vein - posterior tibial - popliteal - femoral - e. iliac - i. Iliac - i vena cava
Dorsal venous arch - anterior tibial - popliteal - femoral - e. Iliac - i. Iliac - i vena cava
Fibular - posterior tibial - same as above after popliteal
Ventral Rami
All except T1- T12 form plexuses
- Cervical: C1 - C4
- Brachial: C5 - T1
- Lumbar: T12 - L4
-Sacral: L4 - S4
T1-T12 are intercostal nerves
Nerve plexus
Nerve plexus -> Peripheral nerve (Named Nerve) -> Target
Lower limb plexuses : Lumbar (T12-L4), Sacral (L4-S4)
Lumbar Plexus
T12-L4
Emerge anteriorly
Femoral: Anterior thigh
Obturator: Medial thigh
Femoral Nerve
L2-L4 ventral rami
Superficial of iliacus muscle
Deep to inguinal ligament
Into anterior thigh with femoral artery
Anterior thigh, iliacus, half of Pectineus innervated
Obturator Nerve
L2-L4
Medial to psoas major
Enter medial thigh through obturator Foramen
Medial thigh muscle innervation
Sacral Plexus
Superior gluteal n.
Inferior gluteal n.
Common fibular n.
Tibial n.
Sciatic n.
Superior gluteal nerve
L4-S1
Exit pelvis through greater sciatic Foramen
Superior to Piriformis muscle (between glute med and glute min)
Innervated glute med, glute min, and tensor fasciae Latae muscles
Inferior gluteal nerve
L5-S2
Greater sciatic Foramen exit
Inferior to Piriformis (deep to glute max)
Only innervated glute max
Sciatic nerve
L4-S3
Great sciatic Foramen exit
Posterior gluteal region inferior to Piriformis
Tibial and common fib n. Bifurcation
Tibial nerve
L4-S3
Medial division of sciatic nerve
Superficial within popliteal fossa
Innervated posterior thigh (except bicep femoris short head) and all posterior leg muscle
Runs with tarsal tunnel posterior to tibial malleolus
Medial and lateral plantar n. Bifurcation
Medial/Lateral plantar nerves
Division off tibial n.
Intrinsic muscle of plantar foot innervation
Medial plantar: adductor hallucis and flexor digitorum brevis
Lateral plantar: abductor digiti minimi
Common fibular nerve
L4-S2
Lateral division of sciatic nerve
Wraps around the neck of fibula
Superficial and deep fibular n. Bifurcation
Innervated only the biceps femoris short head
Superficial fibular nerve
Lateral division of common fib n.
Between Fibularis longus and brevis
Continues to cutaneous innervation
Innervates lateral leg muscle
Deep fibular nerve
Medial division of common fib
Tibialis anterior and external hallucis longus
Cutaneous innervation in the flip flop region
Anterior leg and both muscle of dorsum foot innervation
damage to common fibers above fibula
Lateral and anterior affected
Foot drop, can’t Dorsiflex and extend digits
Can evert due to damage to deep and superficial
Anesthesia on dorsum of foot
Femoral Triangle
Femoral artery pulse
Medial to lateral (VAN)
Adductor longus
Sartorius
Inguinal ligament
Adductor canal
Quadricep femoris and the medial femoral muscles
Deep to sartorius
Femoral artery
Femoral vein
Saphenous nerve
Popliteal fossa
Pulse difficult to palpate due to depth
Deep to superficial - popliteal artery, vein, tibial nerve, common fibular nerve.
