Lower Extremity Flashcards
course of the ACL
Lateral femoral condyle to anterior tibia
course of the PCL
Medial femoral condyle to posterior tibia
Valgus deformity
Distal bone in joint moves away from midline “knock kneed”
Varus deformity
Distal bone in joint moves toward midline “bow-legged”
course of MCL
Medial epicondyle of femur to medial condyle of tibia
course of LCL
Lateral epicondyle of femur to head of fibula
where do the menisci sit
Between the tibia and femoral condyles
most commonly injured knee ligament
ACL
tests for ACL injury
anterior drawer test, Lachman test
dashboard injury
PCL
test for PCL injury
posterior drawer test
valgus stress causes
MCL injury
varus stress causes
LCL injury
components of unhappy triad
ACL injury, MCL injury, medial meniscus tear
cause of unhappy triad
Force applied to knee with foot planted (force pushing toward midline)
test for meniscus tear
McMurray test
insertion of patellar tendon
tibial tuberosity
sign of a patellar fracture
cannot extend knee against gravity
major flexors of hip joint
iliopsoas, tensor fasciae latae, sartorius, pectinius
major extensors of hip joint
gluteus maximus, hamstrings
muscles of hamstrings
semimembranosus, semitendinosus, biceps femoris
function of hamstrings
extend hip, flex knee, rotate hip
hip abductors
gluteus medius, gluteus minimus
hip adductors
adductor longus, adductor brevis, adductor magnus, pectineus, gracilis
deep muscles of hip external rotation
piriformis, obturator internus, gemellus superior/inferior, obturator externus, quadratus femoris
contributing muscles of hip internal rotation
gluteus medius/minimus, tensor fasciae latae, adductor longus/brevis, pectineus
superior gluteal nerve innervates
gluteus minimus/medius, tensor fasciae latae
origin of superior gluteal nerve
sacral plexus, L4-S1
Trendelenburg’s sign
damage to superior gluteal nerve
Inferior gluteal nerve innervates
Gluteus maximus
damage to inferior gluteal nerve results in
weakness of hip extension
major blood supply to femoral neck
medial circumflex femoral artery
Obturator nerve innervates
thigh adductors/obturator externus, skin of medial thigh
course of obturator nerve
through posterior pelvis
origin of femoral nerve
nerve roots L2-L4
femoral nerve innervates
anterior compartment of thigh
branches of femoral nerve
anterior cutaneous, saphenous
anterior cutaneous nerve innervates
skin of anteromedial thigh
saphenous nerve innervates
skin on medial leg and foot
absent patellar reflex is a sign of
femoral nerve damage
origin of sciatic nerve
L4-S3
what is the largest nerve in the body
sciatic nerve
branches of sciatic nerve
common peroneal (aka common fibular), tibial
branches of common peroneal nerve
superficial and deep
common peroneal nerve innervates
short head of the biceps femoris
superficial fibular nerve innervates
muscles of lateral lower leg, fibularis longus/brevis, foot eversion muscles
deep fibular nerve innervates
tibialis anterior, extensor digitorum longus, extensor hallucis longus, intrinsic muscles of foot
deep fibular nerve functions
dorsiflexion, toe extension
common peroneal nerve innervates (sensory)
lateral shin and dorsum of foot
course of common peroneal nerve
wraps around fibula
common symptom of peroneal nerve injury
foot drop
course of tibial nerve
down the leg, posterior to tibia, at foot travels through tarsal tunnel under medial malleolus
tibial nerve innervates
posterior leg muscles, sensory to heel/toe
actions of muscles supplied by tibial nerve
plantarflexion, toe flexion, inversion
sciatic nerve innervates
muscles of posterior thigh, and its branches innervate muscles of leg and foot
injury that can cause sciatic nerve damage
posterior hip dislocation
Most common radiculopathy occurs at
spinal root L5
What terminal branch is most affected by L5 radiculopathy?
Common peroneal nerve
What terminal branch is most affected by S1 radiculopathy?
Tibial
what terminal branch is most affected by L2/L3/L4 radiculopathy?
Femoral
test for lumbar radiculopathy
straight leg raise test
Innvervation of gluteus maximus
inferior gluteal nerve
Blood supply of gluteus maximus
inferior gluteal artery
Action of gluteus maximus
thigh extension/external rotation
innvervation of gluteus medius
superior gluteal nerve
blood supply of gluteus medius
superior gluteal artery
action of gluteus medius
hip abduction, thigh internal rotation
innervation of gluteus minimus
superior gluteal nerve
blood supply of gluteus minimus
superior gluteal artery
action of gluteus minimus
hip abduction, thigh internal rotation
innvervation of tensor fasciae latae
superior gluteal nerve
action of tensor fasciae latae at the hip
internal rotation and weak abduction
action of tensor fasciae latae at the knee
external rotation, weak flexion/extension
3 major ligaments of the hip
iliofemoral, pubofemoral, ischiofemoral
hip ligament that prevents excessive abduction
pubofemoral
ankle joint is most stable in dorsiflexion or plantarflexion
dorsiflexion
medial ankle ligament
deltoid
lateral ankle ligaments
anterior talofibular, posterior talofibular, calcaneofibular
classic mechanism of ankle sprain
inversion on a plantarflexed foot
ankle ligament most at risk of sprain
anterior talofibular
subtalar joint location
between inferior surface of talus and superior surface of calcaneus
subtalar joint function
inversion/eversion
2 functional groups of muscles in the gluteal region
superficial abductors/extensors, deep external rotators
muscles of the deep external rotators group from superior to inferior
piriformis, gemellus superior, obturator internus, gemellus inferior, obterator externus, quadratus femoris
innveration of mucles of deep external rotators group
nerves named after the muscles they innervate except for the gemellus superior (obturator internus) and gemellus inferior (quadratus femoris)
what structures run above and below piriformis?
superior and inferior neurovascular bundles
anterior thigh muscles function
extend the leg at the knee
innervation of anterior thigh muscles
femoral nerve
blood supply of anterior thigh muscles
branches of femoral and deep femoral arteries
medial thigh muscles function
adduct the thigh at the hip
medial thigh muscles innervation
obturator nerve
medial thigh muscles blood supply
branches of deep femoral and obturator arteries
posterior thigh muscles function
flex leg at knee, extend thigh at hip
posterior thigh muscles innervation
sciatic nerve
posterior thigh muscles blood supply
perforating branches of deep femoral artery
muscles of anterior compartment of thigh
iliopsoas, sartorius, quadriceps
muscles of quadriceps
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
muscles of medial compartment of thigh
Pectineus, adductor longus, adductor brevis, adductor magnus, gracilis, obturator externus
muscles of posterior compartment of thigh
hamstrings
exception of innervation in posterior compartment
short head of biceps femoris is innervated by common fibular nerve, the rest are tibial
functions of leg anterior compartment
dorsiflexion, inversion, toe extension
innervation of anterior leg compartment
deep fibular nerve
blood supply of anterior leg compartment
branches of anterior tibial artery
lateral leg compartment functions
plantarflexion, eversion
lateral leg compartment innervation
superficial fibular nerve
lateral leg compartment blood supply
branches of the fibular artery
posterior leg compartment functions
plantarflexion, inversion, toe flexion
posterior leg compartment innervation
tibial nerve
posterior leg compartment blood supply
posterior tibial artery
muscles of anterior leg compartment
tibialis anterior, extensor hallucis longus, extensor digitorum longus
muscles of lateral leg compartment
fibularis longus/brevis
muscles of the posterior leg compartment
Gastrocnemius, soleus, plantaris, popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
“true” ankle joint
talocrural
deltoid ligament has how many parts
4
origin of inferior gluteal nerve
Sacral plexus (L5-S2)
lumbar plexus arises from
anterior rami of L1-L4
sacral plexus arises from
anterior rami of S1-S4
lateral cutaneous nerve arises from
lumbar plexus (L2, L3)
femoral nerve arises from
lumbar plexus (L2-L4)
obturator nerve arises from
lumbar plexus (L2-L4)
superior gluteal nerve arises from
sacral plexus (L4-S1)
sciatic nerve arises from
sacral plexus (L4-S3)
posterior femoral cutaneous nerve arises from
sacral plexus (S1-S3)
damage to femoral nerve deficits (motor)
extension of knee, flexion of hip
damage to femoral nerve deficits (sensory)
anterior thigh and medial knee, leg and foot
damage to obturator nerve deficits (motor)
adduction and external rotation of thigh
damage to obturator nerve deficits (sensory)
defined area of medial thigh
damage to superior gluteal nerve deficits (motor)
abduction of thigh/lateral flexion of trunk on fixed limb, trendelenburg gait
damage to superior gluteal nerve deficits (sensory)
none
damage to tibial nerve deficits (motor)
plantarflexion, flexion of toes, inversion
damage to tibial nerve deficits (sensory)
posterolateral leg to lateral malleolus, sole and lateral side of foot
damage to superficial fibular nerve (motor)
eversion, plantarflexion
damage to superficial fibular nerve (sensory)
lateral shin and dorsum of foot
damage to deep fibular nerve (motor)
inversion, dorsiflexion, extension of toes
damage to deep fibular nerve (sensory)
skin between first and second toes
femoral artery arises from
external iliac artery
border differentiating external iliac artery from femoral artery
inguinal ligament (enters femoral triangle)
branches of deep femoral artery
perforating branches, lateral circumflex femoral, medial circumflex femoral
deep femoral artery arises in
the femoral triangle
perforating branches of the deep femoral artery supply the
medial and posterior muscles of thigh
lateral circumflex femoral artery supplies
some lateral thigh muscles
course of femoral artery down thigh
anterior thigh through adductor canal, then passes through adductor hiatus to go into the posterior comaprtment and become the popliteal artery
branches of the popliteal artery that supply the knee joint
genicular
how does popliteal artery terminate
gives rise to posterior and anterior tibial branches
course of posterior tibial artery
gives off fibular branch then continues into sole of foot behind medial malleolus
course of anterior tibial artery
passes anteriorly between tibia and fibula through a gap in the interosseous membrane, then goes into foot where it becomes the dorsalis pedis
gluteal arteries arise from
internal iliac artery
gluteal arteries enter gluteal region through
greater sciatic foramen
collateral circulation at hip joint
medial and lateral circumflex femoral, branch of obturator
collateral circulation at knee joint
descending genicular, a branch of deep femoral, descending lateral femoral circumflex, anterior tibial recurrent, anterior tibial
vascular supply of ankle joint
malleolar and tarsal arteries
causes of compartment syndrome
trauma, overexercise, revascularization, burns
classic symptom of compartment syndrome
pain out of proportion with injury that is aggravated by passive stretch
early sign of compartment syndrome
sensory loss in distribution of the affected nerves