Lower Extremities Quiz 5 Flashcards
—-> PICTURES
Joints of the PELVIS:
Strong, weightbearing, compound joints. Limited mobility compared to other synovial joints to allow for transfer of weight. Between the sacrum and ilium.
Bound by: 4 ligaments???
posterior and anterior sacroiliac ligaments,
sacrotuberous and sacrospinous ligaments
—-> PICTURES
Joints of the PELVIS:
____ cartilaginous joint formed by the union between the bodies of the pubic bones.
Interpubic disc, wider in women than men.
Bouded by: 2 ligaments????
Secondary
inferior/superior pubic ligament
Joints of the PELVIS:
- Lumbosacral Joints: BEtween ___and ___#
- IV Joint
- —> PICTURES
- ____ligaments, unite transverse processes of L5 to the ilia.
Sacrococcygeal Joint: what type?____cartilaginous joint with IV disc. Bounded by anterior and posterior sacrococcygeal ligaments.
L5 and S1
secondary
(??????) PELVIC CAVITY BORDERS:
Anteroinferior pelvic wall: Formed by bodies and rami of ___ bone and _____
Lateral Pelvic walls: Formed by hip bones and obturator foramen. padded by ____ muscles
Posterior pelvic wall: Bony wall and roof (sacrum and coccyx). What muscle leaves pelvis through greater sciatic foramen????
Pelvic Floor: pelvic diaphragm.
___ and___ muscles
Pubic bones and pubic symphysis
obturator internus
piriformis
levator ani and coccygeus muscles
Male versus Female:
greater pelvis ?
lesser pelvis
general structure?
male: deep, narrow and deep, thick and heavy
Female: Shallow, Wide and shallow (pass babies), thin/light
Sacral Plexus:
On posterolateral wall of the lesser pelvis .
- Siatic Nerve: Gives innervation? , also what rami? . Passes through the ____ __foramen.
- Pudendal Nerve: Innervation? and anterior rami. Chief sensory nerve to ______ ____. Supplies skin and muscles of the ______
- Superior Gluteal Nerve: innervation?? anterior rami. Supplies 3 muscles???
- Inferior Gluteal Nerve : innervation??? anterior rami. Supply what ?
L4- S3, anterior rami…..greater sciatic foramen.
S2-S4, external genetalia. PERINEUM
L4-S1, supplies gluteus medius, gluteus minimus and tensor fascia lata.
L5-S2, supply GLUT MAX
Obturator Nerve from ____plexus. Anterior rami of what innervation?
Divides into anterior and posterior branches and leaves via obturator foramen. Supplies ____ _____ muscles.
LUMBAR . L2-L4.
MEDIAL THIGH
(TIME??????)
COCCYGEAL PLEXUS: anterior rami of ____,___ innervation and ____nerves.
Supplies coccygeus and part of _____muscle.
- Pelvic autonomic nerves
- via four routes:
Sacral sympathetic trunks: provides _pre/postsynaptic?__fibers to the sacral plexus for ____innervation of the lower limb.
Periarterial plexuses: Provide postsynaptic, sympathetic, vasomotor fibers to the superior ___,___, and interal iliac arteries.
Hypogastic plexuses- Males and females area.
Pelvic splanchnic nerves- pre/postsynaptic _para/symp?____and visceral afferent fibers.
S4, S5 and coccygeal nerves.
Coccygeus and LEvator ANI
- postsynaptic fibers , sympathetic
- rectal, ovarian
- presynaptic parasympathetic
MAJOR VESSELS: common iliac artery branches into _____-_____#
External Iliac artery and Internal iliac artery.
IIArtery:
Posterior branches: 2
Anterior Branches: 5
??? just list them, look at location, supplies??
C5-S1
P: iliolumbar artery, lateral sacral artery
A: Umbilical artery, obturator artery, inferior gluteal , internal pudendal , uterine artery (branch to vagina
Fascia:
Transversalis fascia, continuous with the fascia of: quadrates lumborum, psoas, diaphragm, iliacus.
lateral arcuate ligament, formed by thickend fasica over quadrates lumborum. attaches to ???
read
LUMBAR PLEXUS: formation within psoas muscle from ventral rami of _____-____ plus communication from T12 )subcostal nerve.
L4 and L5 join, form lumbosacral trunk, goes to pelvis sacral plexus. All ventral rami to extremities have anterior and posterior division fibers.
NERVES:
Iliohypogastric: what innervation, what division, appears on lateral border of what muscle, runs anterior to what muscle, becomes cutaneous 1 inch above superficial ring, and SUPPLIES WHAT MUSCLE
Ilioinguinal nerve: anterior divisoin, may come off together with ___nerve, goes through superficial ring. Cutaneous to anterior scrotum or labia majora.
—>Cutaneous branch to _____
Genitofemeral nerve: pierces and lies on anterior surface of psoas major. 2 branches???
—-> each supplies??
Lateral femoral cutaneous nerve: innervate? what division? emergest lateral to psoas, runs acoss ilacus major, emerges below inguinal ligament.
—-»»>cutaneous to skin of lateral ______, down to ___
Femoral Nerve; innervate? LARGEST nerve, division? . Run in groove beween ___ and ___. motor to muscles of _____ ____.
—-»»>Cutaneous to ___/___ thigh and leg to the ____
Obturator Nerve: inervation? division? innervates what muscle? cutaneous to skin of ___?
Lumbosacral Trunk : part of L4, all of L5. Contains anterior and posterior division fibers , medial to psoas, runs into pelvis anterior to sacroiliac joint. contributes to scral plexus
L1: anterior, lateral of psoas major, anterior to quadrates lumborum, supplies abdominal muscles
L1: iliohypogastric nerve. medial thigh
L1,2 : Genital branch, supplies cremaster , skin of scotum or labia majora.
And Femoral Branch, goes under inguinal ligament , supplies cutaneous to ANTERIOR THIGH.
L2, 3, posterior, lateral thigh, down to knee
L2,3,4 posterior, psoas and iliacus , anterior thigh, anterior/medial thigh and leg to the ankle.
L2,3,4 anterior , adductor muscles of medial thigh
Branches of Aorta:
T12 L1 L1,2 L2 L3 L4
Inferior phrenic artery, Celia trunk (3 branches)
Superior mesenteric
Renal artery
gonadal artery
inferior mesenteric artery
bifurcation of aorta into 2 common iliac artery: EXT and INTernal.
median sacral artery at bifurcation of aorta.
Fascia of the lower limb
____ lata, deep fascia of the thigh, encloses large thigh muscles. separates thigh into anterior, medial, and posterior fascial compartments
___fascia, deep fascia of the leg. Forms extensor retinaculum distally. divides leg into anterior dorsiflexor, later fibular and posterior plantar flexor compartments.
fascia lata
crural fascia
Superficial Veins of the Leg:
___ ___ vein, formend by union of dorsal digital vein of the great toe and the dorsal _____ _____.
Ascends anterior to the medial malleolus. Passes posterior to medial condyle . Empties into ____vein. Then dump into external iliac vein, then inferior vena cava.
___ ___vein, starts on lateral foot by union between dorsal digital vein on the 5th digit and the dorsal venous arch. Ascends posterior to lateral malleolus, penetrates deep fascia at midline of fibula , empties into ____ vein in popliteal fossa.
great saphenous vein, dorsal venous arch
femoral vein
small saphenous vein, popliteal vein
Femoral Nerve:
___-____
largest branch of lumbar plexus. Innervates ___thigh muscles. Terminal cutaneous branch is ____nerve.
This nerve supply skin and fascia to anterior-medially portion of : 3
L2-L4
anterior thigh muscle
saphenous nerve
anterior knee, leg, and foot
femoral artery: continuation of the ____ ___artery distal to the inguinal ligament. It gives off the Largest branch, _____ ___ artery. It then gives off 3 branches.
which one supplies to head and neck of the femur?
which one supplies to muscles on lateral thigh
external iliac artery
deep profunda artery/ deep artery of the thigh
medial circumflex femoral artery
lateral circumflex femoral artery
perforating arteries
Femoral Vein: continuation of ___vein proximal to adductor hiatrus. passes inguinal ligament and becomes ___ __vein.
popliteal vein, external iliac vein
ARTERIES OF GLUTEAL REGION and POSTERIOR THIGH:
- Superior gluteal ARTERY, superficial branch :supplies gluteal ____ . Deep branch: supplies gluteal ____ and ___ and ___
- inferior gluteal, supplies ____, ____,___, and ____
- internal pudendal - supplies ___ and muscles in ___region
- perforating arteries- supplies ___and ___
- supplies gluteus maximus .
deep branch supplies gluteus medius and minimus and tensor of fascia lata. - gluteus maximus, obturator internus, quadratus, femoris, and superior hamstrings
- external genetalis and muscles in perineal region
- hamstrings and vastus lateralis
Popliteal fossa:
- termination of ____ ___vein
- popliteal artery and vein
- ___ and ___ nerves
- posterior ___ nerve of the thigh
- popliteal lymph nodes and lymphatic vessels.
- ___ fascia covering over neurovascular structures
-Nerves in Popliteal fossa:
______nerve, medial , larger terminal branch of sciatic nerve
_____ nerve, supplies lateral side of leg and ____.
____ ___nerve, lateral, smaller terminal branch of sciatic nerve.
- small saphenous vein
- tibial and common fibular nerves
- posterior cutaneous nerve of the thigh
-popliteal fascia
tibial nerve
sural nerve: leg and ankle
common fibular nerve
Nerves of the foot:
- skin on medial side of foot , what nerve?
- skin on dorsum of foot and all digits?
- extensor digitorum brevis and skin on sides of 1st and 2nd digits, what nerve?
- skin of medial side of so and sides of 1st three digits, what nerve? (3.5 digits)
- quadratus plantae, abductor digiti minimi and flexor digiti minimi, what nerve?
- lateral aspect of hindfoot and midfoot
- skin of heel
- saphenous nerve
- superficial fibular nerve
- deep fibular nerve
- medial plantar nerve
- lateral plantar nerve
- sural nerve
- calcaneal branches
Hip Joint:
blood supply , medial and lateral circuflex femoral arteries
Nerve supply: anteriorly: Inferiorly Superiorly Posteriorly
femoral nerve
obturator nerve
superior gluteal nerve
nerve to quadratus femoris
ligaments:
patellar ligament- patella to tibial tuberosity
-____ ____ ligatment- lateral epicondyle of femur to head of fibula
-____ ___ ligament- expansion of meimebranosus tendon
- ____ ___ligament- posterior strenghthening
- cruiciate ligaments
-anterior cruciate ligament
-posterior cruciate ligament
___ is a crescentic plates of fibrocartilage on surface of tibia. Medial and lateral
fibular collateral ligament
tibial collateral ligament
arcuate popliteal ligament
menisci
Tibiofibular Joints:
Superior tibiofibular joint and the tibiofibular syndesmosis (inferior joint). Joined by interosseus membrance
read
Ankle Joint:
what type of synovial joint?
LIgaments: anterior talofibular , posterior talofibular,
calcaneofibular , medial ligament of the ankle
dorsiflexion , muscle in __compartment of the leg
plantarflexion, muscle in __compartment of leg.
hinge
anterior
posterior
Fascia of Anterolateral Abdominal Wall:
Subcutaneous tissue:
Superficial fatty layer is?
Deep membranous layer is?
Endoabdominal fascia: Lines the internal aspect of the abdominal wall and varying thickness.
Parietal peritoneum: lines the abdominal cavity.
camper fascia
scarpa fascia
Rectus Sheath: All three aponeuroses go to rectus abdominis. Deep to that: 2 fascia????
- In upper part of abdomen, internal oblique aponeurosis splits, anterior part fuses with EXTERNAL oblique aponeurosis and passes anterior to RECTUS abdominis, posterior fuses with TRANSVERSES APONEUROSIS and passes to rectus abdominis.
- Point of transition between lower, thin, posterior layer of Rectus sheath and upper thicker layer with tendinous fibers is called ???
transversalis fascia
parietal peritoneum
Arcuate line
Vessels of Anterolateral Ab wall:
- Superior epigastric vessels and branches from musculophrenic verssels from ?
- inferior Edpigastric and Deep circumflex iliac vessels from ?
- superficial circumflex and superficial epigastric vessels from the ___artery and ____ vein
- posterior intercostal vessels in 11th intercostal space and anterior branches of subcostal vessels.
- internal throacic vessels
- external iliac vessels
= femoral artery and great saphenous vein
Internal Anterolateral Abdominal Wall:
Five umbilical peritoneal folds pass toward umbilicus:
- 1 medan umbilical fold, from apex of urinary bladder to umbilicus
- 2- medial umbilical folds
- 2- lateral umbilical folds (cover ____vessels
inferior epigastric vessels
Peritoneal Fossae:
Sites for herniations
Potential sites for DIRECT INGUINAL HERNIA: is ____inguinal fossae, between the medial and lateral umbilical folds, called inguinal triangles. Weakness of conjoint tendon allows abdominal contents to pass out through superficial ring.
Lateral inguinal fossae, potential site for most common hernia type in lower abdominal wall is ___inguinal hernia, where the peritoneal sac enters the inguinal canal through the ____ inguinal ring.
MEDIAL inguinal fossae
indirect inguinal hernia
DEEP
(I, L D)
Inguinal Canal: formed in relation to the descent of the gonad during getal development , 4cm long in adult. Contains 3 items???
spermatic cord or ligament of the uterus
blood and lymphatic vessels
ilioinguinal nerves
Rings of the Inguinal Canal:
- opening at each end, is _____ ring. Internal entrance to the canal , evagination of the TRANSVERSALIS FASICA superior to inguinal ligament and lateral to the inferior Epigastric vessels.
Superficial (external) ring, exit from the canal. Between external Oblique to PUBIC TUBERCLE
deep /internal
Inguinal Canal:
Anterior: 2 muscles
Posterior
Floor, 3
Roof, 3
In female, structures passing through are ilioinguinal nerve and round ligament of uterus
In male, ilioinguinal nerve and spermatic cord pass through.
External oblique and internal olique muscle
transversalis fascia
centrally- INGUINAL ligament, medially by lacunar ligament , laterally by iliopubic tract
centrally, internal oblique and trasversus abdominis and laterally by transversalis fasica
Spermatic Cord:
begins at __inguinal ring, passes through the inguinal canal, exits the ___inguinal ring, ends in the scrotum at the posterior border of the testis.
deep inguinal ring, superficial
POSTERIOR Triangle: between trap, clavicle, and SCM, no further divided
roof: investing fascia and what muscle?
floor: Muscles covered by ___ fascia ; there are 6 muscles
contents: what 1 muscle, what nerve, lymph nodes, brachial plexus, thyrocervical trunk
- —-
Anterior Triangle: between SCM, mandible, and midline. subdivided into 4 triangle.
muscular, carotid, digastric, and submental.
What are the 3 muscles that form the boudanries of the triangle?
- Boudaries of the triangleS;
Carotid boundaries ? name 3 of them. SOD
- 3 arteries? CC, IC, EC
- facial nerve, vagus, accessory nerve, hypoglossal , sympathetic chain
Muscular ? name 3 of them. SOH
-what 3 nerves is in it? also what 3 arteries?
Digastric ? anterior/posterior digastric and inferior border of mandible
Submental ? body of hyoid and r/l digastric
platysma
prevertebral fascia
contents: omohyoid, accessory nerve
- –
Anterior:
SCM, Omohyoid, and Digastric
Carotid= Posterior belly of igastric, Superior belly of Omohyoid, and SCM
- arteries= common carotid, internal carotid, and external carotid artery
Muscular= midline hyoid, superior belly omohyoid, and SCM
- ansa cervicalis, vagus nerve, recurrent laryngeal
- arteries= common carotid , superior thyroid , and inferior thyroid artery.
digastric= anterior/posterior belly of digastric, and inferior border of mandible
submental= hyoid, anterior belly of R/L digastric
All extrinsic laryngeal muslces innervate by CNX except ?
stylopharyngeus only CN 9, only muscle with motor innervation from 9
