Lower Extremities

Question 0

Regions of lower extremity

Answer 0

Gluteal

Thigh

Knee

Leg

Ankle

Foot

Question 1

Function of lower extremity

Answer 1

Support weight to body

Stable foundation for standing, walking, running

Question 2

Fascial compartments - THIGH

Answer 2

Anterior compartment

Posterior compartment

Medial compartment

Question 3

Flexors of the thigh

Extensors of the leg

Femoral nerve

Consists of: ILIOPSOAS, TENSOR FASCIA LATA, SARTORIUS, PECTINEUS, QUADRICEPS FEMORIS (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)

Answer 3

Anterior thigh muscles

Question 4

Continuation of internal iliac artery

Passes through the obturator foramen close to femoral ring (where it may complicate the surgery repair of femoral hernia)

Answer 4

Obturator artery

Question 5

Branches of obturator artery

Answer 5

Muscular branches to adductor muscles

Artery of Ligamentum Teres (artery to the head of femur)

• in children, it supplies thread of femur proximal to epiphyseal growth plate
• after the epiphyseal growth plate closes, it’s role becomes insignificant

Question 6

Continuation of external iliac artery

Enters the femoral triangle posterior to inguinal ligament & midway between ASIS & symphysis pubis
- palpation of femoral pulse, ABG, percutaneous arterial catheterization can be performed at this location

Gives off the Profunda femoris artery

Answer 6

Femoral artery

Question 7

Profunda femoris artery branches into:

Answer 7

4 perforating arteries

Medial circumflex artery
- main blood supply to the head & neck of femur in adults

Lateral circumflex artery

Question 8

Continuation of femoral artery at the adductor hiatus in adductor magnus muscle

Extends through popliteal fossa where popliteal pulse can be palpated against the popliteal muscle with the leg flexed

Answer 8

Popliteal artery

Question 9

Branches of popliteal artery

Answer 9

Genicular arteries

Anterior tibial artery

Posterior tibial artery

Question 10

Descends on anterior surface of interosseous membrane with deep peroneal nerve

Terminate as dorsalis pedis artery

Dorsalis pedis artery lies between extensor hallucis longus & extensor digitorum longus tendons midway between medial & lateral malleolus (site of palpating dorsal pedal pulse)

Answer 10

Anterior tibial artery

Question 11

Behind medial malleolus with tibial nerve (site of palpating lost tibial pulse)

Answer 11

Posterior tibial artery

Question 12

Branches of posterior tibial artery

Answer 12

Peroneal artery
- behind lateral malleolus

Medial plantar artery

Lateral plantar artery
- forms the plantar arch which connects to the dorsalis pedis artery

Question 13

COLLATERAL CIRCULATION

Around the hip joint (cruciate anastomosis)

Answer 13

• inferior gluteal artery
• medial & lateral femoral circumflex arteries
• 1st perforating branch of the profundus femoris artery

Question 14

COLLATERAL CIRCULATION

Around the head of femur (trochanteric anastomosis)

Answer 14

• superior & inferior gluteal arteries

- medial & lateral femoral circumflex arteries

Question 15

Usually occurs where femoral artery gives off the Profunda femoris artery

SSX: 6 Ps (pain, paralysis, paresthesia, pallor, poikilothermia, pulselessness)

Answer 15

Acute arterial occlusion

Question 16

MC cause: atherosclerosis

Usually involves the femoral artery near the adductor hiatus & popliteal artery

Diabetic Px: anterior & posterior tibial artery, peroneal artery are susceptible to occlusion

SSX: intermittent claudication (profound fatigue or aching on exertion but never after sitting/standing relieved by 5-10 minutes rest); ischemic pain

Answer 16

Chronic arterial occlusive disease

Question 17

⬆️ in interstitial fluid pressure (>30mmHg within an osseofascial compartment –> compromise microcirculation –> muscle & never damage

Anterior thigh compartment: involves the femoral artery artery & nerve

Anterior leg compartment: involves the anterior tibial artery & deep peroneal nerve

SSX: swollen, tense compartment, pain on passive stretching, pink color, warmth, present of pulse over the involved compartment

Answer 17

Compartment syndrome

Question 18

Travels with saphenous nerve

Passes anterior to medial malleolus (site for venous puncture or catheter insertion)

Ascends along medial aspect of the leg & thigh

Empties into the femoral vein within the femoral triangle

Answer 18

Great saphenous vein

Question 19

Travels with sural nerve

Passes posterior to lateral malleolus

Ascends along lateral aspect of the leg

Empties into the popliteal vein within the popliteal fossa

Answer 19

Lesser saphenous vein

Question 20

Communicating venous system

Answer 20

Connects the deep & superficial veins with valves (allows only blood flow from superficial veins –> deep veins)

Incompetent valves –> back flow of blood into the superficial veins (superficial veins <– deep veins) leading to varicose veins

Question 21

Blood clot (thrombus) most commonly within the deep veins of the lower limb

May lead to pulmonary embolus

Tx:
IV heparin for 5-7 days followed by warfarin (Coumadin) for 3 months
- * Coumadin is teratogenic

Answer 21

Deep venous thrombosis

Question 22

Virchow triad

Answer 22

Venous stasis (prolonged immobilization, CHF, obesity)

Hypercoagulation (OCP use, pregnancy)

Endothelial damage