Lower limb 1 Flashcards
What are the bones which make up the hip?
Ilium
pubis
ischium
what are the prominence of the hip bone?
ASIS - anterior superior iliac spine Anterior inferior iliac spine Pubic tubercle Pubic symphysis acetabulum ischial spine, ischial tuberosi
How wide is the femoral neck?
It is 3/4ths the radius of the femoral head.
What connects the greater and lesser trochanters?
Anteriorly - the intertrochanteric line
Posteriorly - the intertrochanteric crest
What type of joint is the pubic symphysis? What is in the middle of it?
Secondary cartilaginous joint between the two superior rami of the pubis bone.
in the middle is a thick fibrocartilaginous interpubic disc.
What are the main superficial veins of the lower limb?
The long saphenous vein.
The short saphenous vein.
The dorsal venous arch.
Where does the long saphenous vein drain into?
The deep femoral vein (in the femoral triangle).
Where does the short saphenous vein drain into?
the popliteal vein.
What is the course of the long saphenous vein?
IT ascends anteriorly to the medial malleolus of the tibia
What is the course of the short saphenous vein?
It ascends posteriorly to the lateral malleolus of the tibia.
What are the 3 groups of lymph nodes in the leg?
- superficial inguinal lymph nodes
- deep inguinal lymph nodes
- popliteal lymph nodes
What does the superficial inguinal lymph nodes drain? what does it drain into?
penis, scrotum, buttocks, lower abdominal wall (below umbilicus), perineum, lymphatics accompanying the great saphenous vein.
The external iliac lymph nodes.
What does the deep lymph nodes drain? What do they drain into?
Glans penis and clitoris.
drains into the external iliac lymph nodes.
What does the popliteal lymph nodes drain? What do they drain into?
lymphatics accompanying the small saphenous vein.
They drain into the superficial and deep inguinal lymph nodes.
Which dermatome supplies the big toe?
L5
Which dermatome supplies the knee?
L3
Which dermatome supplies the little toe?
S1
What are the ligaments which hold the femoral head in the acetabulum - the joint capsule?
Ilio-Femoral (thickest)
Pubofemoral
Ischiofemoral
What type of joint is the hip?
Synovial - ball and socket.
What is the acetabular labrum?
A rim of fibrocartilage which adds to the depth of the acetabulum.
Where is the thinnest part of the joint capsule?
On the inferior side
Where is the joint capsule attached to?
The intertrochanteric line anteriorly.
The neck of the femur posteriorly.
What does the rotation of the hip ligaments mean?
relaxed during flexion - allow for rotation of the hip.
Tighten during extension of the hip - prevent rotational movement.
Which hip ligament is anterior?
Iliofemoral - prevents hyperextension
Pubofemoral - prevents hyperabduction and hyperextension
Which hip ligament is posterior?
Ischiofemoral - prevents hyperextension of the hip.
Which ligaments attach the pelvis to the sacrum and vertebrae?
Iliolumbar ligament. Sacroiliac ligament (anterior and posterior).
What covers the obturator foramen?
The obturator membrane.
Which ligaments creates the greater and lesser sciatic foramen?
The sacrotuberous and sacrospinous ligaments.
What muscle is the main flexor of the hip and where does it insert?
The iliopsoas muscle - inserts into the lesser trochanter - with a common tendon.
What is the thickest part of the fascial stocking of the thigh called?
The iliotibial band.
Which muscle is the main extensor of the hip?
The gluteus Maximus
Which muscles are in the medial compartment of the thigh? (adductor muscles)?
Adductor magnus adductor longus adductor brevis gracilis Pectineus
Which nerve innervates the adductor compartment of the thigh?
The obturator nerve supplies all (apart from the posterior part of adductor Magnus).
The Pectineus is innervated by the femoral nerve.
What is the line on the femur called (where the adductor Magnus inserts)?
Linea aspera.
What is the gap called in adductor Magnus?
The adductor hiatus - femoral artery
femoral nerve
saphenous nerve
as they exit the canal they go into the popliteal fossa.
What is special about the gracilis muscle?
Its the only adductor muscle which runs past the knee and inserts onto the tibia.
What is the nerve innervation of the adductor Magnus?
Anteriorly - obturator nerve,
Posteriorly - sciatic nerve.
Which muscles keep the pelvis level?
The gluteus medius and gluteus minimus.
Which nerve is harmed in trendelenburgs gait?
The superior gluteal nerve.
Which muscles abduct the hip?
Tensor fascia lata
gluteus medius
gluteus minimus
Which nerve are the hip abductors supplied by?
The superior gluteal nerve.
Which muscles can externally rotate the hip?
Piriformis
Obturator internus
Obturator externus
Superior and inferior gamelli
Which muscles internally rotate the hip?
Gluteus medius
Gluteus minimis
Tensor fascia lata
Which nerve supplies the anterior compartment?
Femoral nerve
Which nerve supplies the medial compartment?
The obturator nerve
Which nerve supplies the posterior compartment?
The sciatic nerve
Which muscles are in the posterior compartment of the thigh?
Semitendinosis (superficial)
semimembranosus (deep)
Biceps femoris
Which muscles are in the anterior compartment of the thigh?
the quadriceps femoris:
- rectus femoris (in the middle)
- vastus mediallis
- vascus lateralis
- vastus intermedius
Sartorius
What is the attachments of the sartorial muscles?
ASIS and medial tibia
What is the function of the sartorial muscle?
Lateral rotation and knee flexion
What lies under the sartorial muscle?
the sub sartorial canal - for the femoral artery, nerve and vein.
What does the sciatic nerve innervate?
The posterior compartment of the thigh and everything distal to the knee.
Where does the common tendon of quadriceps femoris insert?
Into the tibial tuberosity.
When does rotation of the limb buds occur?
In the first trimester.
What action does the quadriceps have on the hip and knee?
They flex the hip and extend the knee.
How does rotation occur embryologically?
The leg rotates from lateral 90 degrees medially so that the sole of the foot is made from the anterior part.
Which muscles insert to the pes anserinus?
- sartorius
- gracilis
- semitendinosus
What does the sartorius muscle do?
Flexes the hip and laterally rotates it.
Flexes the knee and medially rotates it.
What is on the sides of femoral triangle
superior - Inguinal ligament. medial - adductor longus lateral - sartorius on top - tensor fascia floor - Pectineus, iliopsoas
What nerve innervates the iliacus muscle and the psoas muscle?
Iliacus - femoral nerve (L2-L4)
PSoas - L1-L3
What is the order in the femoral triangle from medial to lateral?
Femoral vein
Femoral artery
Femoral nerve
What is the femoral canal?
The gap medial to the femoral vein - a space for fat and lymphatics and for expansion of the femoral vein - parts of the bowel herniate into this.
What is contained within the femoral sheath?
The femoral vein and femoral artery - NOT the femoral nerve.
What are the 3 compartments of the femoral sheath?
median - a space for lymphatics, fat, vein extension, abdominal hernias
middle - femoral vein
lateral - femoral artery
not included - femoral nerve which sits laterally.
Which two bony landmarks does the femoral artery run between?
The ASIS and pubic tubercle (underneath the inguinal ligament)
What is the name for the deep femoral artery?
Profunda femoris
Which 2 veins drain into the femoral vein?
The great saphenous vein
the profunda/deep femoral vein.
What is the adductor canal?
a tunnel in the middle third of the thigh, from the apex of the femoral triangle into the adductor Magnus opening - it allows the femoral vessels to pass from the anterior thigh to the popliteal fossa.
it transmits the femoral artery, vein and nerve.
What are the branches of the lumbar plexus from superior to inferior?
- iliohypogastric - L1
- ilioinguinal -L1
- genitofemoral L1-L2
- lateral cutaneous nerve of thigh - L2-L3
- femoral -L2-L4
- obturator L2-L4
What is the motor nerve roots supplying the lower limb?
L2, L3, L4 (from obturator and femoral)
What are the sensory nerve roots supplying the lower limb?
L2-L3 (lateral femoral cutaneous)
What runs through the greater sciatic foramen?
Things going to the leg.
What runs through the lesser sciatic foramen?
Things running to the perimeun.
Which nerve supplies gluteus Maximus?
inferior gluteal nerve (L5, S1, S2)
Which muscle supplies gluteus medius, gluteus Maximus and tensor fascia lata?
Branch of superior gluteal nerve
What is the function of the gluteus Maximus?
Extension of the hip and lateral rotation of the hip.
Which muscles attach to the iliotibial tract?
thickening of fascia lata.
- tensor facia lata
- gluteus maximus
Which muscle does the sacral plexus sit on?
The piriformis
Which roots make the sacral plexus?
L4, L5, S1, S2, S3, S4.
What is the mnemonic for sciatic plexus?
SIPPS Superior gluteal nerve - L4, L5, S1 inferior gluteal nerve - L5, S1, S2 posterior cutaneous to thigh - S1, S2, S3 Pudendal - S2, S3, S4 Sciatic - L4, L5, S1, S2, S3
Which vertebrae is mostly likely compressed in sciatica?
L5
Which muscle stabilises the knee?
quadriceps - especially rectus femoris
What are the 4 ligaments of the knee?
Lateral collateral ligament
medial collateral ligament
anterior cruciate ligament
posterior cruciate ligament
Which muscle runs deep to the lateral collateral ligament?
Popliteus muscle
Which ligament is most commonly injured?
Medial collateral ligament - its attached to the medial meniscus of the knee.
What is the role of the popliteus muscle?
it releases the knee when its fully extended. it does this by rotating the femur laterally on the tibia.
What are the knee meniscus made from?
Fibrocartilage
What is the function of rectus femoris on its own?
Hip flexor
Which of the hip ligaments are weakest?
Ischiofemoral.
What is attached to the lesser trochanter?
The Iliopsoas tendon.
What type of joint is the proximal tibiofibular?
Plane synovial joint.
What type of joint is the distal tibiofibular joint?
Fibrous joint.
What is the short head of bicep femoris supplied by?
Common fibular branch.
