Lower Extremity Flashcards
Label a superficial N. diagram for the LE
see notes
Describe the nerve supply to the LE in regards to compartments
ant/ext. compartment = femoral N.
med./adductor compartment = obturator N.
post/flex. compartment = sciatic N.
Sartorius
O: ASIS
I: medial tibial condyle
A: hacky sack position (hip flexion, abd,lat. rot., knee flex & med. rot.
N: femoral N (L2-L3) –> branch = nerve to sartorius
Rectus Femoris
O: AIIS
I: base of patella and tibial tuberosity (through patellar lig.)
A: hip flexion, knee ext.
N: femoral N. (L2-L4) –> branch = nerve to rec. fem
Vastus Lateralis
O: intertrochanteric line, inf. border of greater trochanter, glut tuberosity, lateral lip of linea aspera
I: lateral margin of patella and tibial tuberosity (through patellar log.)
A: ext. of knee
N: femoral N. (L2-L4) - branch = nerve to vastus lateralis
Vastus Medialis
O: intertrochanteric line, medial lip of linea aspera, medial supracondylar line
I: medial border of patella and tibial tuberosity (through patellar lig.)
A: ext. of knee, prevents lateral dislocation of patella at last 30° of knee ext.
N: femoral N. (L2-L4 - branch = nerve to vastus medialis
Vastus Intermedius
O: anterior and lat. surfaces of upper femur, linea aspera, lateral supracondylar line
I: base of patella and tibial tuberosity (through patellar lig.) - deepest fibres attach to capsule
A: ext. of knee
N: femoral N. (L2-L4) - branch = nerve to vastus intermedius
Iliacus
O: upper iliac fossa, Ala of sacrum, AIIS
I: lesser trochanter of femur (w Psoas Major)
A: hip flexion, also some lat. rot of hip b/c ant. attachment of illiim
N: femoral N. (L2-L3)
Psoas Major
O: TVP of all lumbar, VB of TXII-LV, and intervertebral discs
I: lesser trochanter of femur
A: *hip flexion, reverse fx = (hip stabilized) - pulls lumbar region ant. so increase in lumbar lordosis
N: L1-L4
Adductor Longus
O: body of pubis inf. to pubic crest
I: linea aspera
A: adduction of hip, some hip flexion
N: obturator (L2-L4)
Adductor Brevis
O: body and inf. ramus of pubis
I: pectineal line and linea aspera
A: adduction of hip, flexion of hip
N: obturator (L2-L4)
Gracilis
O: body and inf. ramus of pubis
I: medial tibial condyle
A: adduction of hip, flexion and med. rot of knee (leg)
N: obturator (L2-L3)
Adductor Magnus
Adductor Portion
O: ischiopubic ramus
I: glut tuberosity, linea aspera, and medial supracondylar line
A: add/flex of hip
Hamstring Portion: O: ischial tuberosity I: adductor tubercle A: extension of hip N: sciatic (L4)
N: obturator (L2-L4), and sciatic (L4) - dual innervation
Describe the femoral sheath
a fascial envelope with 3 longitudinal compartments
1) lateral - femoral A.
2) intermediate - femoral V.
3) medial - aka femoral canal - lymph nodes
*entrance to femoral canal is known as the femoral ring - loops of intestine can pass through here and lead to femoral hernia
What is the femoral triangle?
-a transitional area (major blood vessels and Nn. leave one area to get to the next
Floor = illiopsoas, pectineus, add. longus
Med border - add. longus/gracilis
Lat. border - sartorius
Sup. border - inguinal lig.
Fill in diagram of femoral N. path and it’s branches
see notes
Complete a LE Artery diagram
see notes
Biceps Femoris
O: ischial tuberosity (long head), linea aspera & lat. supracondylar line (short head)
I: head of fibula
A: *knee flexion, lat. rot and hip ext.
Reverse Fx: post. pelvic tilt, decr. lumbar lordosis
N: tibial N (long head), common fibular (short head) divisions of sciatic (L5-S2)
Semi-tendinosus
O: ischial tuberosity
I: medial surface of tibia
A: knee flexion and med. rot.; hip ext and post. tilt of pelvis
N: tibial division of Sciatic (L5-S2)
What is polio gait caused by?
Lost quads, no heel strike (no knee ext.)
Semi-membranosus
O: ischial tuberosity
I: medial condylar groove
A: knee flexion and med. rot.; hip ext and post. tilt of pelvis
N: tibial division of Sciatic (L5-S2)
Draw the acronym for lumbar plexus
S ubcostal - T12 I liohypogastric - L1 I lioinguinal - L1 G enitofemoral - L1-L2 L at. cut. N of thigh - L1-L2 O turator L2-L3-L4 F emoral L2-L3-L4
Name the borders of the popliteal fossa and the contents
Sup - hamstrings
Lat - biceps femoris
Med - semi-tendonosus
Inf. - gastroc (lat & med heads)
Contents:
- popliteal A&V (continuation of femoral A&V
- tibial and common fib divisions of sciatic N.
- lymph nodes
What type of joint is the knee joint?
-hinge joint
Describe the orientation of the PCL
PAIN
Post. cruciate lig
Anterior in direction
INternal condyle (medial condyle) of femur
Origin = post. intercondylar area Insertion = medial condyle of femur
Describe the orientation of the ACL and it’s attachments
APEX
Ant. cruciate lig
Posteriorly in direction
EXternal (lateral) condyle of femur
Origin = ant. intercondylar area Insertion = lat. condyle of femur
What is the purpose of the ACL and PCL?
- ant and post. stability
- they are stronger/more stable with medial rotation (med rot. makes ligs shorter = holds everything tighter)
The collateral ligaments in the knee are most stretched in what position?
Lateral rotation
Tip: think “co-lateral” lig are stretched in lateral rot.
List the ligaments of the knee joint and their function
- ACL, PCL (ant. post. stability)
- MCL, LCL (med. and lat. stability)
- oblique popliteal lig. (prevents hyperext. of knee w. arcuate lig.) - is a continuation of semimembranosus tendon
- arcuate lig. -
- meniscofemoral lig. (from lat. meniscus to med. femoral condyle - sometimes called humphrey lig.
What is the purpose of menisci in the knee joint?
- shock absorber
- deepen tibial plates
What is the purpose of the horns (ant. and post) of the menisci in the knee joint?
-acts as a pivot point, the horns are where the menisci attach to the bone - allows menisci to slide
Which menisci is more mobile?
lateral b/c it is attached to politeus M. (muscle has more mvm’t than the MCL which is attachement point of medial meniscus
Does the knee joint roll then glide when going from extension to flexion or glide to roll?
rolls for first 20° knee flexion, then replaced with gliding - gliding has more friction - so with arthritis - safest mvm’t range is 15-20° flex maximum. (at 90° movm’t is purely gliding)
Tibialis Anterior
O: lateral tibial condyle, lateral surface of tibia, interosseous membrane
I: *medial cuneiform, base of 1st MT
A: DF of ankle, inversion of foot
N: Deep Fibular N. (L4,L5)
Extensor Hallucis Longus (EHL)
O: shaft of fibula, interosseous membrane
I: 1st DIP
A: ext of 1st MTP, PIP and DIP, ankle DF
N: Deep Fibular N. (L5-S1)
Extensor Digitorum Longus (EDL)
O: lateral tibial condyle, ant. surface of fibula, interosseous membrane
I: mid and distal phalanges of lateral 4 toes
A: ext of MTP, PIP and DIP of lateral 4 toes, ankle DF
N: Deep fibular N. (L5,S1)
Fibularis Tertrius
O: surface of fibula (distal, ant.), interosseous membrane
I: base of 5th MT
A: ankle DF, eversion
N: Deep fibular N. (L5,S1)
*considered anterior compartment b/c of innervation
Fibularis Longus
Lateral Compartment O: head of fibula I: medial cuneiform, base of 1st MT (passes underneath foot (plantar aspect) to medial cuneiform) A: *eversion, PF N: superficial fibular (L5-S2)
Fibularis Brevis
Lateral Compartment O: surface of fibula (distal, lateral) I: base of 5th MT A: PF and eversion of foot N: superficial fibular (L5-S2)
What holds the tendons of the lateral compartment in place (prevents them from bowing?)
Fibular retinaculum
-stretches from calcaneus to lateral malleolus
Complete a diagram of the LE innervation
see notes
What is a steppage gait?
gait pattern when fibular nerve is damaged (ant. compartment)
-this causes foot drop from lack of active DF, so steppage gait increase in hip flexion to kick knee out to allow passive DF of foot via momentum
Gastrocnemius
O: lateral and medial femoral condyles
I: post. calcaneus
A: PF, assist knee flexion
N: tibial N. (S1-2)
Soleus
O: fibular head, *soleal line, post. surface tibia
I: post. calcaneus
A: *PF, stability of leg on foot
N: tibial N. (S1-2)
The soleus M. and gastroc M. together are called what?
Triceps Surae
Plantaris
O: lateral condyle of femur I: post. surface of calcaneus A: PF, assist flexion of knee N: tibial N. (S1-2) *some ppl don't have this M. - not that useful
Popliteus
O: lateral femoral condyle, lateral meniscus
I: post. surface of tibia
A: knee flex, med rot. of leg (lat. rot. of thigh), pulls lat. meniscus posteriorly in knee flexion to prevent entrapment between femur and tibia
N: tibial N. (L4-S1)
Flexor Hallucis Longus
O: post. fibula
I: base of 1st DP (passes behind medial malleolus
A: *big toe flexion (all joints), PF of ankle, supports medial longitudinal arch
N: tibial N (S2-S3)
Flexor Digitorum Longus
O: post. surface of tibia
I: DP of lateral 4 toes (passes behind medial malleoulus)
A: *flexion of lateral 4 toes (all joints), PF ankle, support of longitudinal arches of foot
N: tibial (S2-S3)
Tibialis Posterior
O: post. surface fibula, interosseus membrane
I: navicular tuberosity, cuboid, cuneiforms, bases of 2nd-4th MT’s
A: PF, inversion, maintain medial longitudinal arch*
N: tibial N. (L4,L5)
Which structures go through the tarsal tunnel?
Tom Dick And Not Harry
Tib post eDl post. tibial A. tibial N. fHl
There are 3 joints between the tibia and fibula. What are they, what type of joint are they, and what ligaments are involved with each?
superior tibio fibular - synovial planar; ant. ligament of fibular head
middle Tibiofibular joint - syndesmosis joint; interosseous lig.
inferior tibiofibular joint - syndesmosis joint; ant and post. tibiofibular ligaments
Abductor Hallucis
O: plantar aponeurosis, inf. surface of calacaneus
I: med. surface of PP of 1st toe
A: abduction and flexion of 1st toe
N: medial plantar (S1-S3)
Flexor Digitorum Brevis
O: inf. surface of calcaneus
I: med. and lat. surfaces of base of middle phalanges of lateral 4 toes
A: flexion of lateral 4 toes
N: medial plantar (S1-S3)
Abductor Digiti Minimi
O: med. and lat. tubercles of calcaneal tuberosity
I: lat. surface of base of proximal phalanx of 5th toe
A: flexion and abduction of 5th toe
N: lateral plantar (S2-S3)
Quadratus Plantae
O: med. and lat. plantar surface of calcaneus
I: lateral border of FDL tendon
A: flexion of lateral 4 toes (assists)
N: lateral plantar (S2-S3)
Lumbricals of foot
O: tendons of FDL
I: medial side of dorsal digital expansion of lateral 4 toes
A: flexion of MTP’s and extension of PIP’s and DIP’s of lateral 4 toes
*note - no bony attachment - soft tissue to soft tissue
N: medial plantar (first lumbrical), lateral plantar (lateral 3 lumbricals)
Flexor Hallucis Brevis
O: plantar surface of cuboid
I: med. and lat (two heads) surfaces of base of proximal phalanx of 1st toe
A: flexion of MTP of 1st toe
N: medial plantar (S2-S3)
Adductor Hallucis
O: bases of 2nd - 4th MT’s (oblique and transverse head); fibularis longus tendon (oblique head)
I: lat. surface of base of proximal phalanx of 1st toe
A: adduction of 1st toe, maintenance of transverse arch of foot
N: deep branch of lateral plantar nerve (S2-S3)
Flexor Digiti Minimi Brevis
O: base of 5th MT and fibularis longus tendon
I: base of PP of 5th toe
A: flexion of MTP of 5th toe
N: superficial branch of lateral plantar N. (S2-S3)
Plantar Interossei
O: medial surfaces of 3rd-5th MT’s
I: medial surfaces of dorsal digital expansion of corresponding toe
A: adduction of 3rd-5th toes
N: lateral plantar N. (S2-S3)
*PAD - plantar does ADduction
Dorsal Interossei
O: adjacent surfaces of 1st-5th MT’s
I: medial PP of 2nd toe; lateral PP of 2nd-4th toes; dorsal digital expansion
A: abduction of 2nd-4th toes
N: lateral plantar N. (S2-S3)
- DAB - dorsal does ABduction
- 2nd toe is the axis of reference for abduction/adduction - so 2nd toe does abduction in 2 directions (no adduction)
Extensor Digitorum Brevis
O: lateral calcaneal surface, inf. band of extensor retinaculum
I: lateral tendons of EDL for 2nd-4th toes, dorsal digital expansion of those toes
A: extension of MTP’s and IP’s of 2-4th toes
N: deep fibular nerve (L5-S1)
Extensor Hallucis Brevis
O: lateral calcaneal surface, inf. band of extensor retinaculum
I: base of proximal phalanx of 1st toe
A: extension of MTP of 1st toe
N: deep fibular nerve (L5-S1)
Describe the innervation of the foot
-See notes diagram
Label the arterial diagram of the foot
-See notes diagram
What is the technical name for the ankle joint? What type of joint is it? What are the supporting ligaments?
Talocrural joint - hinge joint
Medial lig - post. tibio-talar, tibio-navicular, ant. tibio-talar
Lateral lig - post. talo-fibular, calcaneo-fibular, ant. talo-fibular
What are the ligaments of the transverse tarsal joint?
long plantar lig, short plantar lig, plantar calcanei-navicular (spring), plantar cuboido-navicular (not imp.)
What are the ligaments supporting the subtalar joint?
-med, lat, post, interosseous talo-calcaneal lig’s
Which ligaments maintain the horizontal arches and therefore, are the most important supportive ligaments of the foot?
-plantar metatarsal, plantar tarso-metatarsal, plantar plate, deep transverse metatarsal
Name the 3 arches of the foot
- medial longitudinal arch
- lateral longitudinal arch
- transverse
What two muscles are the most important in maintaining the medial longitudinal arch?
- fibularis longus
- tibialis posterior
