Lower Extremity, Snell Flashcards
Pelvic girdle: # of bones
4
Pelvic girdle: Bones
1) 2 hip bones
2) Sacrum
3) Coccyx
Hip bone: Articulates with the head of the femur
Acetabulum
Hip bone: Articular vs non articular: Acetabular fossa
Non articular
Hip bone: Runs between asis and psis
Iliac crest
Hip bone: Articulates with the opposite hip bone
Pubic bone at the pubic crest and tubercle
Hip bone: Obturator foramen is bound by
1) Ischium
2) Pubis
Femur: Fits into the acetabulum
Head
Femur: Small depression at the center of the head
Fovea capitis
Femur: Fovea capitis is for the attachment of
Ligament of the head
Femur: Vessel conveyed along the ligament of the head to enter the bone at the fovea
Obturator artery
Femur: Junction of neck and shaft
1) Trochanters
2) Intertrochanteric line
Femur: Attached to the intertrochanteric line
Iliofemoral ligament; pubofemoral at lower end
Femur: Ridge on the posterior portion of shaft
Linea aspera
Femur: Medial margin of linea aspera continues below as
Medial supracondylar ridge
Femur: Lateral margin of linea aspera continues below as
Lateral supracondylar ridge
Femur: Medial supracondylar ridge ends as the
Adductor tubercle
Femur: On the posterior surface of the shaft below the greater trochanter
Gluteal tuberosity for gluteus maximus
Femur: Flat triangular area on the posterior surface of the lower end
Popliteal surface
Femur: Lateral and medial condyles are separated posteriorly by
Intercondylar notch
Femur: Lateral and medial condyles are separated anteriorly by
Articular surface for patella
Femur: Superior to the condyles
Medial and lateral epicondyles
Femur: Adductor tubercle is continuous with
Medial epicondyle
Femur: Main blood supply to the head
Medial femoral circumflex
Femur: Common complication of femoral neck fractures due to interruption of the main blood supply to the head
Avascular necrosis of head
Sesamoid bone
A bone that develops within a tendon
Largest sesamoid bone in the body
Patella
Patella: Lies within the tendon of the
Quadriceps femoris
Patella: Shape
Triangular
Patella, apex: Superior vs inferior
Inferior
Patella, apex: Connected to what bone
Tuberosity of tibia
Patella, apex: Connected to the tuberosity of the tibia by the
Ligamentum patellae
Patella: Posterior surface articulates with
Condyles of femur
Tibia: Medial vs lateral
Medial
Tibia: Articulate with the lateral and medial condyles of femur
Lateral and medial condyles
Tibia: Lateral aspect of the lateral condyle
Oval articular facet for the head of fibula
Tibia: Anterior border is prolonged downward to form
Medial malleolus
Tibia: Provides attachment for interosseous membrane
Lateral border of tibia
Tibia: Lower end shows a wide, rough depression on its lateral surface for articulation with
Fibula
Fibula: T/F Takes part in articulation at the knee joint
F
Fibula: T/F Forms part in the ankle joint
T
Fibula: Forms the upper end (2)
1) Head
2) Articular surface for lateral condyle of tibia
Fibula: Distal end
1) Styloid process
2) Lateral malleolus
Fibula: Shaft attached to tibia by
Interosseous membrane
Fibula: Winds around neck
Common peroneal nerve
Tarsal Bones
The Circus Needs More Interesting Little Clowns
1) Talus
2) Calcaneum
3) Navicular
4) Medial cuneiform
5) Intermediate cuneiform
6) Lateral cuneiform
7) Cuboid
Tarsal Bones: Largest bone of the foot
Calcaneum
Tarsal Bones, calcaneum: Articulations
1) Superiorly with the talus
2) Anteriorly with the cuboid
Tarsal Bones, calcaneum: Shelflike ridge on medial surface
Sustentaculum tali
Tarsal Bones, calcaneum: Function of sustentaculum tali
Supports talus
Talus: Articulations
1) Superiorly with the tibia and fibula
2) Inferiorly with the calcaneum
3) Anteriorly with the navicular bone
Talus: Muscles attached
None
Navicular: Attached to its tuberosity
Tibialis posterior tendon
Cuboid: Deep groove on inferior aspect is attached to
Peroneus longus tendon
Cuneiform: Wedge shape maintains
Transverse arch of foot
Metatarsals: Attached to the prominent tubercle on the base of 5th metatarsal
Peroneus brevis tendon
Hip joint: Bridges the acetabular notch
Transverse acetabular ligament
Hip joint: Ligaments
1) Iliofemoral
2) Ischiofemoral
3) Pubofemoral
Hip joint: Strongest and most important ligament
Iliofemoral ligament of Bigelow
Iliofemoral ligament: Shape
Inverted Y
Iliofemoral ligament: Base attached to
ASIS
Iliofemoral ligament: 2 limbs attached to
Intertrochanteric line
Iliofemoral ligament: Resists
Hyperextension and lateral rotation
Pubofemoral ligament: Shape
Triangular
Pubofemoral ligament: Base
Superior ramus of pubis
Pubofemoral ligament: Apex
Lower end of intertrochanteric line
Pubofemoral ligament: Resists
Abduction and lateral rotation
Ischiofemoral ligament: Shape
Spiral
Ischiofemoral ligament: Attachments
1) Body of ischium
2) Greater trochanter
Ischiofemoral ligament: Limits
Medial rotation
Ligament of head of femur: Shape
Flat and triangular
Ligament of head of femur: Apex
Fovea capitis
Ligament of head of femur: Base
1) Transverse acetabular ligament
2) Margins of acetabular notch
Ligament of head of femur: Resists
Adduction, slightly
Hip joint: Nerve supply (3)
1) Femoral
2) Obturator
3) Sciatic
Hip joint: Flexion (4)
RAISe
1) Rectus femoris
2) Adductors
3) Iliopsoas
4) Sartorius
Hip joint: Extension (2)
1) Gluteus maximus
2) Hamstrings
Hip joint: Abduction (5)
1) Gluteus medius
2) Gluteus minimus
3) Sartorius
4) Tensor fascia lata
5) Piriformis
Hip joint: Adduction (5)
Shorten the GAAAP
1) Gracilis
2) Adductor longus
3) Adductor brevis
4) Adductor magnus
5) Pectineus
Hip joint: Lateral rotation (7)
GQ POG
1) Gluteus maximus
2) Quadratus femoris
3) Piriformis
4) Obturator internus and externus
5) Superior and inferior gemelli
Hip joint: Medial rotation (3)
1) Anterior fibers of gluteus medius
2) Anterior fibers of gluteus minimus
3) Tensor fascia lata
Hip joint: Combination of all movements
Circumduction
Hip joint: Anterior
Femoral vessels and nerves
Hip joint: Posterior
Sciatic nerve
Hip joint: Stability depends on
1) Gluteus medius and minimus
2) Head of femur
3) Neck of femur
Hip joint: Hip sinks on opposite unsupported side
Trendelenburg sign
Knee joint: Articulations
1) Condyles of femur superiorly
2) Condyles of tibia and their menisci inferiorly
3) Lower end of femur and patella anteriorly
Knee joint: Type between tibia and femur
Synovial hinge
Knee joint: Type between patella and femur
Synovial gliding
Knee joint: Capsule is deficient
Anteriorly where it pouches superiorly beneath the quadriceps tendon forming the suprapatellar bursa
Knee joint: Extracapsular ligaments
1) Ligamentum patellae
2) Lateral collateral ligament
3) Medial collateral ligament
4) Oblique popliteal ligament
Knee joint: Ligamentum patellae is a continuation of
Quadriceps femoris tendon
Knee joint: Lateral collateral ligament is attached to
1) Lateral condyle of the femur superiorly
2) Head of fibula inferiorly
Knee joint: Lateral collateral ligament is separated from the lateral meniscus by the
Popliteus
Knee joint: Medial collateral ligament is attached to
1) Medial condyle of femur superiorly
2) Medial surface of shaft of tibia
Knee joint: Medial collateral ligament is strongly attached to
Medial meniscus
Knee joint: Strengthens the back of capsule
Oblique popliteal ligament
Knee joint: Oblique popliteal ligament is an expansion of
Semimembranosus
Knee joint: Intracapsular ligaments
Cruciate ligaments
Knee joint: Cruciate ligaments are termed anterior and posterior according to
Tibial attachments
Anterior cruciate ligament: Attachments
1) Anterior intercondylar area of tibia inferiorly
2) Upward, backward, and laterally to the lateral femoral condyle
Posterior cruciate ligament: Attachments
1) Posterior intercondylar area of tibia inferiorly
2) Upward, forward, and medially to the medial femoral condyle
Knee joint: Upper surface of menisci are in contact with
Femoral condyles
Knee joint: Lower surface of menisci are in contact with
Tibial condyles
Knee joint: Each meniscus is attached to the tibia by
Anterior and posterior horns
Knee joint: Function of menisci
Deepen the articular surfaces of tibial condyles
Knee joint: Medial vs lateral, damaged more frequently
Medial
Knee joint, synovial membrane: Prolonged downward posteriorly to form the popliteal bursa behind
Popliteus tendon
Knee joint, synovial membrane: Reflected backward from the ligamentum patellae to form
Infrapatellar fold
Knee joint, bursae: Largest
Suprapatellar bursa
Knee joint, bursae: Always communicate with knee joint
1) Suprapatellar
2) Popliteal
Knee joint, bursae: Between patella and skin
Prepatellar bursa
Knee joint, bursae: Between ligamentum patella and skin
Superficial infrapatellar bursa
Knee joint, bursae: Between ligamentum patella and tibia
Deep infrapatellar bursa
Knee joint, bursae: Semimembranosus bursa lies between
Semimembranosus tendon and medial condyle of tibia
Knee joint: Nerve supply (4)
1) Femoral
2) Obturator
3) Common peroneal
4) Tibial
Knee joint, muscles: Flexion
1) Biceps femoris
2) Semitendinosus
3) Semimembranosus
Knee joint, muscles: Extension
Quadriceps femoris
Knee joint, muscles: Medial rotation
1) Sartorius
2) Semitendinosus
3) Gracilis
Knee joint, muscles: Lateral rotation
Biceps femoris
Knee joint: Most stable in what position
Full extension
Knee joint, muscles: Most important muscle group that stabilizes the knee joint and capable of stabilizing it in the presence of torn ligaments
Quadriceps femoris
Ankle joint: Formed by articulations among which bones
1) Tibia
2) Malleoli
3) Talus
Ankle joint: Type of joint
Synovial hinge
Ankle joint: Stronger, medial vs lateral ligament
Medial
Ankle joint: Nerve supply
1) Deep peroneal
2) Tibial
Ankle joint: More extensive, inversion vs eversion
Inversion
Ankle joint muscles: Eversion (4)
1) Peroneus longus
2) Peroneus brevis
3) Peronius tertius
4) Lateral tendons of extensor digitorum longus
Gluteal region: Boundaries
1) Iliac crest superiorly
2) Fold of the buttock inferiorly
Gluteal region muscles: Inferior gluteal nerve
Gluteus maximus
Gluteal region: Superior gluteal nerve (3)
1) Gluteus medius
2) Gluteus minimus
3) Tensor fascia latae
Gluteal region: S1 and S2
Piriformis
Gluteal region: Sacral plexus (4)
1) Obturator internus
2) Superior and inferior gemelli
3) Quadratus femoris
Gluteal region, fascia: Deep fascia is continuous with
Fascia lata
Gluteal region: Deep fascia splits to enclose
Gluteus maximus
Greater sciatic foramen is formed by
1) Greater sciatic notch
2) Sacrotuberous and sacrospinous ligaments
Lesser sciatic foramen is formed by
1) Lesser sciatic notch
2) Sacrotuberous and sacrospinous ligaments
Greater sciatic formen contents
Piriformis PINS PINS
1) Piriformis
2) Posterior cutaneous nerve of thigh
3) Inferior and superior gluteal nerve
4) Nerve to obturator internus
5) Sciatic nerve
6) Pudendal nerve
7) Internal pudendal vessels
8) Nerve to quadratus femoris
9) Superior and inferior gluteal vessels
Lesser sciatic foramen contents
PINT
1) Pudendal nerve
2) Internal pudendal vessels
3) Nerve to obturator internus
4) Tendon of obturator internus
Thigh: Compartments
1) Anterior
2) Posterior
3) Medial
Thigh: Deep fascia
Fascia lata
Thigh: Deep fascia, shape
Trouser
Thigh: Deep fascia attached superiorly to
Pelvis
Thigh: Thickening of fascia lata on lateral side
Iliotibial tract
Thigh: Iliotibial tract is attached superiorly to
Iliac tubercle
Thigh: Iliotibial tract is attached inferiorly to
Lateral condyle of tibia
Thigh: Iliotibial tract is the insertion of
1) Gluteus maximus
2) Tensor fascia lata
Thigh: Gap in deep fascia in front of the thigh just below the inguinal ligament
Saphenous opening
Thigh: Saphenous opening transmits
1) Great saphenous vein
2) Branches of femoral artery
3) Lymphatic vessels
Thigh: Saphenous opening is filled with loose connective tissue called
Cribriform fascia
Thigh, nerve supply: Anterior compartment
Femoral
Thigh, nerve supply: Posterior compartment
Sciatic
Thigh, nerve supply: Medial
Obturator
Femoral triangle: Borders
SAIL
1) Sartorius laterally
2) Adductor longus medially
3) Inguinal ligament superiorly
Femoral triangle: Contents
1) Femoral nerve
2) Femoral sheath
3) Femoral artery
4) Femoral vein
5) Inguinal nodes
Femoral sheath: Downward protrusion of
1) Fascia transversalis
2) Fascia iliaca
Femoral sheath: Approx ___ below inguinal ligament
1in or 2.5cm
Femoral sheath: Contents (lateral to medial)
1) Femoral artery
2) Femoral vein
3) Lymphatic vessels
Thigh, anterior compartment: All are supplied by femoral nerve except
Psoas
Thigh, anterior compartment: Psoas muscle is supplied by
Lumbar plexus
Thigh, anterior compartment: Muscles (7)
VIP PQRST [1) Vastus lateralis, intermedius, medialis] 2) Iliacus 3) Psoas 4) Pectineus 5) Quadriceps femoris [6) Rectus femoris] 7) Sartorius 8) Tensor fascia lata
Thigh, anterior compartment: Quadriceps femoris group
1) Rectus femoris
2) Vastus lateralis
3) Vastus intermedius
4) Vastus medius
Thigh, medial compartment: Muscles (5)
1) Gracilis
2) Adductor longus
3) Adductor brevis
4) Adductor magnus
5) Obturator externus
Thigh, posterior compartment: Muscles
1) Biceps femoris
2) Semitendinosus
3) Semimebranosus
4) Adductor magnus
Thigh: Small medial compartment of femoral sheath occupied by lymphatics
Femoral canal
Thigh: Site of femoral hernia
Femoral canal
Thigh: Upper opening of femoral canal filled by extra peritoneal fat (femoral septum)
Femoral ring
Femoral ring: Anterior
Inguinal ligament
Femoral ring: Posterior
Superior ramus of pubis and pectineal ligament
Femoral ring: Lateral
Femoral vein
Femoral ring: Medial
Lacunar ligament
Femoral hernia: Women vs men
Women
Femoral ring: Hernial sac
Below and lateral to the pubic tubercle
Femoral ring: Hernial sac neck, anterior
Inguinal ligament
Femoral ring: Hernial sac neck, posterior
Pectineal ligament
Femoral ring: Hernial sac neck, lateral
Femoral vein
Femoral ring: Hernial sac neck, medial
Lacunar ligament
Intermuscular cleft on the medial aspect of the middle 3rd of thigh beneath the sartorius
Adductor canal
Adductor canal: Aka (2)
1) Subsartorial canal
2) Hunter’s canal
Adductor canal: Walls, posterior
Adductor magnus
Adductor canal: Walls, lateral
Vastus medialis
Adductor canal: Walls, anteromedial
Sartorius
Adductor canal: Contents
1) Femoral artery and vein
2) Deep lymph vessels
3) Saphenous nerve
4) Nerve to vastus medialis
Popliteal fossa: Shape
Diamond
Popliteal fossa: Contents
1) Popliteal vessels
2) Small saphenous vein
3) Common peroneal nerve
4) Tibial nerve
5) Posterior cutaneous nerve of thigh
6) Connective tissue and lymph nodes
Popliteal fossa: Boundaries, lateral
1) Biceps femoris superiorly
2) Gastrocnemius and plantaris inferiorly
Popliteal fossa: Boundaries, medial
1) Semimembranosus and senitendinosus superiorly
2) Gastrocnemius inferiorly
Leg: Compartments
1) Anterior
2) Posterior
3) Lateral
Leg: Muscles of anterior compartment (4)
1) Tibialis anterior
2) Extensor digitorum longus
3) Extensor hallucis longus
4) Peroneus tertius
Leg: Nerve supply to the anterior compartment
Deep peroneal
Leg: Muscles of lateral compartment (2)
1) Peroneus longus
2) Peroneus brevis
Leg: Nerve supply to the lateral compartment
Superficial peroneal nerve
Leg: Posterior compartment, superficial group (3)
1) Gastrocnemius
2) Plantaris
3) Soleus
Leg: Posterior compartment, deep group (4)
1) Popliteus
2) Flexor digitorum longus
3) Flexor hallucis longus
4) Tibialis posterior
Leg: Posterior compartment is supplied by
Tibial nerve
Muscle on dorsum of foot
Extensor digitorum brevis
Ankle, retinacula: Attached to the distal ends of the anterior borders of tibia and fibula
Superior extensor retinaculum
Ankle, retinacula: Y-shaped band located in front of the ankle joint
Inferior extensor retinaculum
Ankle, retinacula: From medial malleolus to medial surface of calcaneum
Flexor retinaculum
Arches of foot: Forms the transverse arch (3)
1) Base of metatarsals
2) Cuboid
3) 3 cuneiform bones
Arches of foot: Forms the lateral longitudinal arch (3)
1) Base of 4th and 5th metatarsals
2) Cuboid
3) Calcaneum
Arches of foot: Medial longitudinal arch (3)
1) First 3 metatarsals
2) Navicular
3) Talus
4) 3 cuneiform bones
Femoral artery: Continuation of the
External iliac artery
Femoral artery: Begins at
Behind inguinal ligament
Femoral artery: Leaves anterior thigh through
Opening in adductor magnus
Femoral artery: Enters popliteal space as
Popliteal artery
Femoral artery: Branch that arises just below the inguinal ligament and runs upward to the abdominal wall
Superficial epigastric artery
Femoral artery: Large branch that supplies the structures of the 3 compartments of the thigh
Profunda femoris
Vessels of the trochanteric anastomosis (4)
1) Medial femoral circumflex
2) Lateral femoral circumflex
3) Superior gluteal
4) Inferior gluteal
Important connection between internal iliac and femoral arteries
Cruciate anastomosis
Popliteal artery: Continuation of the
Femoral artery
Popliteal artery: Begins at
Opening of the adductor magnus
Popliteal artery: Ends at
Lower border of popliteus
Popliteal artery: Divides into
Anterior and posterior tibial arteries
Anterior tibial artery: Arises at
Popliteal fossa
Anterior tibial artery: Branch of
Popliteal artery
Anterior tibial artery: Supplies
Anterior compartment of leg
Anterior tibial artery: Ends as
Dorsalis pedis
Dorsalis pedis artery: Continuation of
Anterior tibial artery
Dorsalis pedis artery: Joins what artery to form the plantar arch
Lateral plantar artey
Posterior tibial artery: Descends into
Posterior compartment of leg
Posterior tibial artery: Terminates where
Behind medial mallelous
Posterior tibial artery: Terminates as
Medial and lateral plantar arteries
Veins: Drains medial side of leg
Great saphenous vein
Veins: Drains lateral side of leg
Small saphenous vein
Great saphenous vein: Ascends behind vs in front of medial malleolus
In front
Great saphenous vein: Ascends through the leg with
Saphenous nerve
Great saphenous vein: In front vs behind knee
Behind
Great saphenous vein: Joins femoral vein by passing through
Saphenous opening in the deep fascia
Great saphenous vein: Tributaries near its termination
1) Superficial circumflex iliac
2) Superficial epigastric
3) Superficial external pudendal
Great saphenous vein: Constant position
Anterior to medial malleolus
Vein: Most commonly used as a bypass graft
Great saphenous vein
Small saphenous vein: Behind vs in front of lateral malleolus
Behind
Small saphenous vein: Ascends accompanied by
Sural nerve
Small saphenous vein: Drains into
Popliteal vein
All lymph vessels of the lower limb drain into
Deep inguinal nodes
Superficial inguinal nodes: Location
Below the inguinal ligament
Superficial inguinal nodes, horizontal group: Receives lymph from (5)
1) Anterior abdominal wall below umbilicus
2) Perineum
3) External genitalia (except testes)
4) Lower half of anal canal
5) Skin of buttocks
Superficial inguinal nodes, vertical group: Receives lymph from
Most of the superficial vessels of lower limb
Deep inguinal nodes: #
3
Deep inguinal nodes: Location
Medial side of femoral vein and femoral canal
Deep inguinal nodes: Drain into
External iliac nodes
Popliteal nodes: Receive lymph from (3)
1) Lateral side of foot
2) Back of calf
3) Lateral side of calf
Femoral nerve: Arises from
Lumbar plexus (L234)
Femoral nerve: Terminates by dividing into
Anterior and posterior divisions
Femoral nerve: Cutaneous branches supply (3)
1) Medial surface of thigh
2) Anterior surface of thigh
3) Medial side of foot
Obturator nerve: Arises from
Lumbar plexus (L234)
Obturator nerve: Divides into
Anterior and posterior divisions
Obturator nerve: Cutaneous branch
Medial side of thigh
Sciatic nerve: Arises from
Sacral plexus (L45S123)
Sciatic nerve: Appears below what muscle
Piriformis
Sciatic nerve: Covered by what muscle
Gluteus maximus
Sciatic nerve: Divides into
1) Tibial nerve
2) Common peroneal nerve
Tibial nerve: Divides into
Medial and lateral plantar nerves
Tibial nerve: Cutaneous branches
1) Sural nerve
2) Medial calcaneal nerve
Tibial nerve: Cutaneous supply
1) Calf
2) Back of leg
3) Lateral border of foot
4) Lateral side of little toe
5) Medial surface of heel
Common peroneal nerve: Pierces
Peroneus longus
Common peroneal nerve: Divides into
Superficial and deep peroneal
Superficial peroneal nerve: Cutaneous supply
Dorsum of foot except between the first and second toes
Deep peroneal nerve: Cutaneous supply
Between the first and second toes
Foot drop
Sciatic nerve lesion
Hamstrings
1) Semitendinosus 2) Semimembranosus 3) Biceps femoris
Femoral artery: Pulse
Midway between asis and symphysis pubis
Popliteal artery: Pulse
Popliteal space provided the deep fascia is fully relaxed by passive flexion of knee
Anterior tibial artery: Pulse
1) Extensor hallucis longus medially
2) Extensor digitorum longus laterally
Dorsalis pedis artery: Pulse
1) Extensor hallucis longus medially
2) Extensor digitorum longus laterally
Posterior tibial artery: Pulse
Midway between medial malleolus and heel