Lower Extremity Flashcards
which nerve roots control heel walking
L4/5
which nerve root controls ankle dorsiflexion
L5
which nerve root controls great toe extension
L5
what nerve root controls toe walking
S1
where does the guteus maximus insert
below the greater trochanter -> iliotibial tract
greater trochanter muscle insertions (6)
gluteus medius
gluteus minimus
gemeli
obturator externus
obturator internus
piriformis
what are the hip extensors (2)
gluteus maximus
hamstrings → semitendonosis, semimembranosis
what are the hip abductors
gluteus maximus, medius, minimus
tensor fascia lata
what are the hip adductors
adductor magnus, longus, brevis
gracilis
pectineus
what are the hip flexors
psoas major
iliacus
iliopsoas
rectus femoris
sartorius
what is this
acetabulum
what bones form the acetabulum
ilium
ischium
pelvis
what is the fovea capitis
what is its fxn
dimple on top of femur
attachment point for ligamentum teres
what is this ligament
ligamentum teres
what is the fxn of the ligamentum teres
stabilizer of hip during adduction, flexion, external rotation
what is the most proximal part of the femur
femoral head
what are the capsular ligaments of the hip (3)
iliofemoral
ischiofemoral
pubofemoral
blood supply to the femoral neck and head comes from
medial and lateral circumflex femoral arteries
ligamentum teres artery
what artery supplies the medial and lateral circumflex arteries
profunda femoris
the femoral head receives blood from the medial/lateral circumflex arteries AND also the
artery of ligamentum teres
what artery supplies the artery of ligamentum teres
obturator artery
avascular necrosis of the femoral head is a result of damage to the __ artery
obturator a → ligamentum teres a
what are the anterior structures of the hip
anterior inferior iliac spine
greater trochanter
iliofemoral ligament
pubofemoral ligament
what are the posterior structures of the hip
ischium
greater trochanter
obturator externus of bursa
iliofemoral ligament
ischiofemoral ligament
which ligament of the hip is both an anterior and posterior structure
iliofemoral
what happens to distal fragments in a femoral neck fx
muscles spasm → pull distal fragments proximally
which muscles determine the movement of distal fragments in a femoral neck fx
strongest muscles
which muscles internally rotate to pull fracture fragments proximally in a femoral neck fx
adducturs
glutei
iliopsoas
where do the hip adductors insert
medial ridge of linea aspera and adductor tubercle of femur
where to the glutei muscles insert
iliotibial tract, gluteal tuberosity of femur
where do the iliopsoas muscles insert
lesser trochanter of femur
where is avascular necrosis of the hip usually seen
femoral head
the femoral head is a __ organ system with
__ collateral circulation
end
poor
the femoral head is especially vulnerable to avascular necrosis if the __ artery is compromised
medial circumflex
compromise of blood supply to a bone causes
ischemia → avascular necrosis
what are some causes of avascular necrosis
trauma
vasculitis
vascospasm → decompression
circulating microemboli
steroids
etoh
pancreatitis
dialysis
what are 4 sources of circulating emboli that can lead to avascular necrosis of the femoral head
hemoglobinopathies
fat emboli
hypercoaguable states
decompression sickness
other than the femoral head, what other bone is especially susceptible to avascular necrosis
scaphoid
rf for avascular necrosis of the thumb
etoh
steroids
bends
arterial embolism/thrombosis
ssa
what structures are in the anterior compartment of the thigh
quadriceps femoris → vastus lateralis, medialis, intermedius, rectus femoris
patellar ligament
sartorius
what nerve innervates the anterior compartment of the thigh
femoral
what n innervates the iliopsoas m
femoral
what muscles are in the medial compartment of the thigh
adductors of femur → longus, brevis, magnus
obturator externus
pectineus
gracilis
all of the muscles of the medial compartment of the thigh are innervated by the __ nerve
except for the __
obturator
pectineus
what nerve innervates the illiopsoas and the pectineus
femoral
what n innervates the pectineus
femoral
what muscles are in the posterior compartment of the thigh
hamstrings → biceps femoris, semitendinosis, semimembranosis
what nerve innervates the posterior compartment of the thigh
sciatic
what does SGT FOS stand for
muscles of the pes anserinus and nerves that innervate them
sartorius, gracilis, semitendinosis
femoral, obturator, sciatic
what is the pes anserinus
tendinous insertions of 3 muscles that attach to the medial side of the tibia
resemble goose foot
what can SGT FOS help you remember
thigh compartments and nerve innervations
most of the large thigh muscles insert into the __
and have what action
proximal tibia and fibula
extend leg at the knee joint
where do the sartorius, gracilis, and semitendinosis insert
at the pes anserinus on the medial proximal tibia
where does the biceps femoris insert
lateral head of the fibula
what is the clinical significance of the fascia lata and iliotibial band
iliotibial band syndrome
what is the gluteal injxn site
upper outer quadrant → ventro-gluteal injection site
the safe injxn site is directly inferior to the
highest point on the iliac crest
what muscle is the gluteal injection site
gluteus medius
why is the gluteus medius the gluteal injection site
thickest of gluteal muscles
free from penetrating nerves and bv
thin layer of fat
what blood vessels are in the lower quadrants of the buttocks
superior gluteal artery and vein
lateral femoral circumflex artery
medial femoral circumflex artery
the inferior lateral border of the lower quadrant of the buttox is the
ischial tuberosity
the vertical division of the planes of the buttocks goes through the
highest point on the iliac crest
the buttocks is divided into what 4 quadrants
upper medial
lower medial
upper lateral
lower lateral
the lower lateral quadrant of the buttocks includes what structures
greater trochanter
insertion of the piriformis
lateral femoral circumflex artery
the lower medial quadrant of the buttocks contains the
ischial tuberosity
piriformis
sciatic n
deep artery of thigh
inferior gluteal artery and vein
lumbar plexus is L _
thru L _
L1
L4
sacral plexus is L _
S _
L4
S1
lower limb dermatomes
L1 - S3
perineum dermatomes
S4 - S5 →
S4 and 5 keep your butt alive
the femoral nerve goes through the __ canal
femoral
the obturator nerve toes through the __ canal
obturator
the sciatic nerve goes through the __ foramen
greater sciatic foramen
what are the branches of the sciatic n
tibial
common fibular
the tibial n innervates the
posterior compartment of leg and sole of foot
the common fibular n innervates
lateral and anterior compartments of leg into foot
the superior and inferior gluteal nerves go through the
greater sciatic foramen
the inferior gluteal n innervates the
gluteal maximus
the superior gluteal n innervates the
gluteus medius
gluteus minimus
tensor fascia lata
the pudendal n comes out of the
greater sciatic foramen
the pudendal n innervates the
perineum
sphincters of bladder and rectum
inguinal ligament dermatome
L1
lateral thigh dermatome
L2
lower medial thigh dermatome
L4
medial great toe dermatome
L4
medial second to dermatome
L5
lateral 5th toe dermatome
S1
back of thigh dermatome
S2
perineum dermatome
S3-5
hip flexion dermatomes
iliopsoas
L1-2
knee extension dermatomes
quads
L3-4
knee flexion dermatomes
hamstrings
L5-S2
ankle plantar flexion dermatomes
S1-S2
achilles
ankle dorsiflexion dermatomes
L4, 5
what is the orientation of the acetabulum
anteriorly and caudally
15 degrees of anteversion
45 degrees of abduction
what 3 nerves come out of the greater sciatic foramen
sciatic
gluteal (s and i)
pudendal
what nerve is the hip extensor and lateral rotator of femur/thigh
gluteus maximus
what muscles act as medial and lateral rotators of the femur
gluteus medius and minimus
weakness of __ muscles leads to trendelenberg gait
gluteus medius and minimus
what are forms the femoral triangle
sartorius
inguinal ligament
adductor longus
what are the contents of the femoral triangle
NAVEL:
nerve (femoral)
artery (femoral)
vein (femoral)
empty (femoral canal)
lymphatics
what forms the popliteal fossa
hamstrings:
semimembranous
semitendinous
biceps femoris
plus
gatrocnemius
popliteal muscles
contents of popliteal fossa
SAVNB
semimembranosous/tendinosus
artery (popliteal)
vein (popliteal, sapenous)
nerves (tibial, common fibular, sural, posterior femoral cutaneous)
biceps femoris
what is the tarsal tunnel
flexor retinaculum → roof
medial malleolus → floor
calcaneus
what is the flexor retinaculum
fibrous tendon → covers tendons of muscles that flex the foot → if entrapped causes tarsal tunnel syndrome
