Lower ext Flashcards
whats the pelvic girdle components and function
the sacrum and right/left hip bones
joined anteriorly at the pubic symphysis
Specializes in locomotion, supporting body weight and maintaining balance
Gluteal region made up of
sacrum and coccyx
sacrum made up of
Sacrum:
Five fused, originally separate, vertebrae
Sacral hiatus
Allows filum terminale of the spinal cord to pass and attach to the coccyx
Results from the absence of laminae and the spinous process of the S4-S5 vertebrae
posterior sacral foramina
sacral cornua
sacral hiatus
Coccyx
4 fused vertebrae
Hip bone(Gluteal region)
Ilium
Contributes to the superior portion of the acetabulum
Articulates with sacrum
Ischium
Contributes to the posterior-inferior part of the acetabulum
Pubis
Contributes to the anterior portion of the acetabulum
Articulates with other pubis at pubic symphysis
Illium
Illiac fossa, anterior superior iliac spine, anterior inferior iliac spine, posterior superior iliac spine, posterior inferior iliac spine, greater sciatic notch, iliac crest
ischium
Ischium
Contributes to the posterior-inferior part of the acetabulum
ischial tuberosity, ischial spine, lesser sciatic notch, acetabulum
pubis
Pubic symphysis
Contributes to the anterior portion of the acetabulum
Articulates with other pubis at the pubic symphysis
Hip ligaments
Sacrospinous ligament (sacrum to ischial spine), Sacrotuberous ligament (sacrum to ischial tuberosity)
Foramen
Greater sciatic foramen, lesser sciatic foramen, obturator foramen
Femur
Greater trochanter, lesser trochanter, head, lateral and medial epicondyles, lateral and medial condyles
- Connects hip and joints
- Longest and heaviest bone in the body
Tibia
Tibia: lateral and medial condyles, medial malleolus.
Articulates with femoral condyles superiorly
Articulates with talus inferiorly
Weight bearing
Fibula
Fibula: head of the fibula, lateral malleolus/styloid process.
Lies posterolateral to tibia
Main action is for muscle attachment
Tibia and Fibula connected together by interosseous membrane
Gluteus Maximus (LE)Inn/Act
Inferior gluteal nerve/extends hip and lateral rotation of the hip
Tensor fascia latae (FL)inn/act inn/action
Superior gluteal nerve/flexes hip joint
Gluteus medius( deep )inn/action Gluteus minimus (deep )inn/action
Superior gluteal nerve/abduct hip
Piriformis (deep) inn/action
Anterior rami s1, s2/ stabilizes hip joint
Sartorius inn/action
femoral nerve/Abducts and flexes hip joint laterally, Flex and rotate knee medially
rectus femoris vastus lateralis vastus medialis *Vastus intermedius inn/act
femoral nerve/Extends knee joint
Rectus femoris flex hip also
Adductor longus adductor brevis adductor magnus Gracillis inn/act
Obturator nerve/Adducts hip….
Gracillis flexes knee.
Semitendinosus (medial) inn/act Semimembranosus (medial) inn/act ------------------------------------ Biceps femoris (lateral) inn/act
Tibial division of sciatic nerve/ flexes knee joint, Extend hip joint, rotate leg medially ----------------------------- same but rotate leg laterally and Long head: tibial division of sciatic nerve Short head: fibular/peroneal division of sciatic nerve/
Popliteal fossa(Boundaries)
Boundaries:
Biceps femoris superiolaterally
Semimembranosus and semitendinosus superiomedially
Lateral and medial heads of gastrocnemius inferolaterally and inferomedially
Skin/ fascia posteriorly
Posterior capsule of the knee joint anteriorly
Gastrocnemius and
Soleus.
inn/act
Tibial nerve/Plantar flexes ankle, flexes knee joint
Flexor hallucis longus (most lateral)
inn/act
tibial nerve/Flexes great toe
Flexor digitorum longus(Most medial)
Tibial nerve/Flexes lateral 4digits
Tibialis posterior(Middle
Tibial nerve/Plantar flexes ankle, inverts foot
Popliteus
weakly flexes knee
Femoral artery track
Femoral artery adductor hiatus to popliteal artery posterior tibial artery
fibular artery
anterior tibial artery (front of l. leg) dorsalis pedis artery
Femoral artery also feeds profunda femoris
FYI
FYI
Great Saphenous vein—-
Femoral vein
Lumbar plexus
L1-L4 “I Invariably Get Lazy On Fridays” Iliohypogastric, Ilioinguinal, Genitofemoral, Lateral femoral cutaneous, Obturator, Femoral “2 nerves from 1 nerve root” Iliohypogastric (L1), Ilioinguinal (L1) “2 nerves from 2 nerve roots” Genitofemoral (L1-L2), Lateral femoral cutaneous (L2-L3) “2 nerves from 3 nerve roots” Obturator (L2-L4), Femoral (L2-L4)
Sacral plexus
L4-S3
L4-S2 contribute to COMMON FIBULAR/PERONEAL nerve
L4-S3 contribute to TIBIAL nerve
Common Fibular and Tibial nerve join to become SCIATIC nerve (L4-S3)
Largest nerve in the body
Really two nerves loosely bound together in same connective tissue sheath
S1-S3 contribute to the posterior femoral cutaneous nerve
Inguinal ligament
Ligament from the Illium to the sacral bone
psoas/pectinus
circled fyi
Femoral triangle
Subfascial space
Base is the INGUINAL LIGAMENT
Medial border is the medial edge of ADDUCTOR LONGUS
Lateral border is the SARTORIUS
Apex where Sartorius crosses lateral border of adductor longus
Floor formed by ILIOPSOAS laterally and PECTINEUS medially
Roof formed by FASCIA LATA, subcutaneous tissue and skin
NAvy
Femoral Nerve
Femoral Artery
Femoral Vein
Adductor canal
From the femoral triangle the neurovascular bundle continues along the ADDUCTOR CANAL
Adductor canal runs deep to the Sartorius with the Adductor magnus and Adductor longus posteriorly and the Vastus medialis anteriolaterally
Intermuscular passageway for the femoral artery/vein and saphenous nerve (terminal branch of the femoral nerve)
Ends at the adductor hiatus in the tendon of Adductor magnus which allows the femoral artery/vein to pass posteriorly and become popliteal vessels
Saphenous nerve continues anteromedial to leg region
Note position of saphenous nerve in relation to femoral artery as courses through adductor canal
where would you do a lower peripheral nerve block
With femoral Nerve
What effect will a saphenous nerve block have
Will block from the knee
Femoral nerve
spine location
L2-L4 largest branch of the lumbar plexus
Originates in the abdomen within the psoas major muscle
After entering femoral triangle it divides into several terminal branches to the anterior thigh muscles and cutaneous innervation to anteromedial thigh
Saphenous nerve
terminal cutaneous branch of the femoral nerve
Runs through the adductor canal
Continues to leg region to supply skin and fascia on the anteromedial aspects of the knee, leg, and foot
Lateral cutaneous nerve of the thigh
Cutaneous innervation of the lateral thigh
Femoral artery
MAin artery of LE
ext illiac artery—>femoral artery begins at the inguinal ligament——->becomes popliteal artery
Follows adductor canal and exits via adductor hiatus of Adductor magnus to become popliteal artery
Deep artery of the thigh
(profunda femoris artery): largest branch of femoral artery and main artery of thigh
obturator Artery and function
internal iliac artery —-Obturator artery.
travels with the obturator nerve through the obturator foramen
Supplies obturator externus,pectineus,adductors of thigh, gracillis.
Sciatic nerve
posterior thigh innervation
(remember Saphenous nerve!)
Made up of Common fibula(peroneal) nerve and tibial nerve.
No gluteal region supply 1.Innervates posterior thigh. 2.Leg and foot muscles 3.Most of the skin of the leg and foot 4.
Posterior femoral cutaneous nerve (Posterior cutaneous nerve of thigh):
Runs medially to Sciatic nerve
Provides cutaneous/sensory information to posterior thigh
Deep artery of thigh/Profunda femoris artery
Deep penetrating branch of femoral artery
supplies posterior thigh compartment muscles
Popliteal artery:
Enters posterior compartment once femoral artery passes through adductor hiatus of adductor magnus
Supplies leg region
Tibial nerve
Posterior leg.
Supplies all muscles of in the posterior compartment of the leg
Continues to the sole of the foot where supplies plantar nerves of the foot
Largest of the two terminal branches of the sciatic nerve
Runs through the popliteal fossa with popliteal vessels passing between the heads of the gastrocnemius and deep to the soleus. Continues behind medial malleolus of the tibia between the flexor hallucis longus and the flexor digitorum longus
Sural nerve
Cutaneous sensation only
Formed by the union of cutaneous branches from the tibial and common fibular/peroneal nerves
Runs superficial and between the two heads of the gastrocnemius muscle, continues posterior to the lateral malleolus of fibula.
Supplies skin on posterior and lateral aspects of leg and lateral side of foot
Posterior Tibial Artery
Larger terminal branch of the popliteal artery
Blood supply to the posterior compartment of the leg
Passes deep to the Soleus
Runs lateral to the medial malleolus
Terminates in the plantar arteries of the sole of the foot
Fibular artery
Branch of the Posterior Tibial Artery
Supplies the fibula, and posterior and lateral compartment muscles
Fibularis longus Fibularis brevis.
act and inn
Superficial nerve/evert foot
Tibialis anterior
act/inn
Dorsiflexes ankle; inverts foot
deep fibular nerve
Extensor digitorum longus
Extends lateral 4 digits,dorsiflexes ankle
deep fibular nerve
Extensor Hallucis longus
Extends great toe; dorsiflexes ankle, inverts foot
deep fibular nerve
fibularis tertius
Dorsiflexes ankle; eversion of foot
deep fibula nerve
Common fibular nerve
anterior leg
Lateral, smaller terminal branch of the sciatic nerve
Passes superficial to lateral head of the gastrocnemius muscle and winds around the fibular neck
Divides into two terminal branches
Deep fibular/peroneal nerve
Superficial Fibular/Peroneal nerve.
Deep fibular/peroneal nerve
anterior leg
One of the terminal branches of the common fibular nerve
Nerve of the anterior muscle compartment
Continues to dorsum of the foot
Provides sensory between the great and first toes
Travels with anterior tibial vessels
Superficial fibular/peroneal nerve
anterior leg
Terminal branch of the common fibular nerve
Supplies muscles of lateral compartment
Continues as a cutaneous nerve, supplies skin on the distal part of the anterior surface of the leg and nearly all dorsum of the foot
ANterior tibial artery
Smaller terminal branch of the popliteal artery
Passes through interosseous membrane from posterior to anterior compartment to supply structure of the anterior compartment
Ends at the ankle joint, midway between the malleoli where becomes
Dorsalis pedis artery
Dorsal artery of the foot
Lower extremity cutaneous innervation
Ilioinguinal nerve- lumbar plexus (L1)
Iliohypogastric- lumbar plexus (L1)
Genitofemoral nerve- lumbar plexus (L1-L2)
Lateral cutaneous nerve of thigh- lumbar plexus (L2-L3)
Obturator nerve- lumbar plexus (L2-L4)
*Medial and Intermediate cutaneous of thigh- cutaneous branches of the Femoral nerve (L2-L4)
*Lateral cutaneous nerve of calf- cutaneous branches common fibular/peroneal nerve
Saphenous nerve- terminal branch of femoral nerve
Superficial fibular nerve- terminal branch of common fibular nerve
Deep fibular nerve- terminal branch of common fibular nerve
Posterior cutaneous nerve of thigh- sacral plexus (S1-S3)
Sural nerve- terminal branch of the tibial and common fibular nerve
Foot and ankle region cutaneous innervation
Saphenous nerve- terminal branch of femoral nerve
Superficial fibular nerve- terminal branch of common fibular nerve
Deep fibular nerve- terminal branch of common fibular nerve
Sural nerve- terminal branch of the common fibular and tibial nerves
*Tibial, lateral and medial plantar nerves- terminal branch of tibial nerve
Obturator nerve (L2-L4) injury
Superior, medial thigh
Weakness in adduction that results in lateral swinging of the limb with walking due to unopposed abductors
Fermoral nerve injury(L2-L4)
Anterior thigh, medial leg region (Saphenous nerve)
Impaired flexion of the hip and impaired extension of the leg
Lateral femoral cutaneous injury
Lateral thigh.
N/a
Saphenous nerve (distal branch of femoral) injury
Medial aspect of leg.
N/A
Posterior Femoral Cutaneous (S1-S3)
injury
Posterior aspect of the thigh
N/A
Sciatic nerve (L4-S3) injury
Posterior thigh, lateral leg (Common peroneal nerve) and ventral and dorsal aspects of foot (tibial, deep and superficial peroneal nerve).
Impaired extension at the hip and impaired flexion at the knee, loss of dorsiflexion and plantar flexion at the ankle, inversion and eversion of the foot
Common fibular/peroneal nerve (L4-S2)
injury
Lateral upper portion of the leg, dorsum of the foot
Foot drop (loss of dorsiflexion) and inversion of the foot
Deep fibular/peroneal nerve (terminal branch of common fibular nerve)
injury
Space located between the big toe and first toe
Foot drop (loss of dorsiflexion)
Superficial fibular/peroneal nerve (terminal branch of common fibular nerve)
injury
Lower anterior lateral leg, dorsum of the foot
Loss of foot eversion
Tibial nerve L4-S3
injury
Plantar aspect of the foot, posterior lateral lower leg (sural nerve distribution)
Loss of plantar flexion, impaired inversion
Sural nerve (terminal branch of both common fibular nerve and tibial nerve) injury
Posterior lateral lower leg..
N/A impairment.
plantaris
act/inn
Weakly plantar flexes
