Lower limb 1+2 anatomy Flashcards
What 3 bones make up the hip bone?
- Ilium bone
- Pubis
- Ischium
What are the two superficial veins of the lower limb?
- Great saphenous vein
- Small saphenous vein
What superficial vein ascends posterior to lateral malleolus?
Small saphenous vein
What superficial vein empties into femoral vein?
Great saphenous vein
What superficial vein empties into popliteal vein?
Small saphenous vein
What superficial vein is varicose veins (dilated) more common in?
Great saphenous vein
Venous stasis is important in thrombus formation (DVT). What is it caused by?
- Muscular inactivity (long flight)
- External vein pressure (compression)
What are the three main lymph node groups of lower limb?
- Superficial inguinal
- Deep inguinal
- Popliteal
What lymph node group does the lymphatic vessels accompanying the great saphenous vein drain into?
Superficial inguinal
What lymph node group does the lymphatic vessels accompanying the small saphenous vein drain into?
Popliteal
What are the dermatomes of the lower limbs?
L1-S5
What type of joint is the hip joint?
Synovial ball and socket joint
What is the acetabular labrum?
Ring of cartilage surrounding acetabulum. Covers outer rim of cavity
What is the function of acetabular labrum?
Deepen joint/increase articulating surface of hip joint
What are the three ligaments of the hip joint?
- Iliofemoral
- Pubofemoral
- Ischiofemoral
What excessive movement does iliofemoral ligament prevent?
Hyperextension
What excessive movement does pubofemoral ligament prevent?
Hyperabduction
What does ischiofemoral ligament help with?
Stabilises hip in extension. Weakest of three ligaments
What movements occur at hip joint?
Flexion/extension, abduction/adduction, lateral/medial rotation, circumduction
What are the three hip flexors? What is the chief flexor of thigh?
- Iliacus
- Psoas major
- Pectineus
Iliopsoas is chief thigh flexor
What is the action of the pectineus?
Adducts and flexes hip
What is the action of sartorius?
Flexes, abducts and laterally rotates hip. Flexes knee
Action of iliopsoas?
Flexion of hip
What are the extensors of hip joint?
- Biceps femoris (long and short head)
- Semitendinosus
- Semimembranosus
- Gluteus maximus
Chief extensor of hip?
Gluteus maximus
What adductor muscle also helps in extension of hip?
Adductor magnus
What are the adductor muscles?
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracillis
- Obturator externus
What nerve generally innervates adductor muscles?
Obturator nerve
What are the abductor muscles?
- Gluteus medius/minimus
- Piriformis
- Superior/inferior gemellus
- Obturator internus
As there is no exclusive abductor compartment, how do these muscles carry out their role?
Via their attachment to greater trochanter
How do abductor muscles help in walking gait?
Contract on opposite side of pelvis when limb on other side is raised to prevent dropping. This positive clinical sign is called trendelenburg gait, and can be due to damage to the nerve(s) supplying abductor muscles (eg in hip replacement surgery)
Lateral rotators of the hip cross the hip joint on the posterior side. What are these muscles?
- Quadratus femoris
- Superior/inferior gemelli
- Piriformis
- Obturator internus
What foramen do the piriformis and obturator internus travel through?
- Piriformis: Greater sciatic foramen
- Obturator internus: Lesser sciatic foramen
Medial rotators of the hip travel across the anterior surface of the hip joint. What muscles are the medial rotators of the hip joint?
- Gluteus medius and minimus
- Tensor fasciae latae
What 4 muscles form the quadriceps femoris (main part of anterior thigh region)
- Rectus femoris
- Vastus lateralis
- Vastus intermedialis (found deep to rectus femoris)
- Vastus medialis
What nerve innervates quadriceps femoris?
Femoral nerve (L2, 3, 4)
What is the main action of the quadriceps femoris on
a: hip
b: knee
a: Flexion (rectus femoris does this)
b: Extension (all)
The quadriceps femoris unites to form what tendon/ligament:
a: proximal
b: distal
to the patella?
a: Quadriceps tendon
b: Patellar ligament
What is the action of sartorius muscle on
a: hip
b: knee
a: Flexes, abducts, lateral rotation
b: Flexion
Innervation of sartorius?
Femoral nerve (L2, 3, 4)
What are the medial thigh (adductor group) muscles?
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracilis
What nerve innervates the medial thigh muscles?
Obturator nerve. Enters through obturator foramen
What is the action of gracilis on knee joint?
Flexion, medial rotation
What goes through the adductor hiatus?
- Superficial femoral artery
- Femoral vein
What artery is the femoral artery a continuation of?
External iliac artery
When does the external iliac artery become femoral artery?
When crossing under inguinal ligament
The femoral artery enters the thigh between which two bony landmarks?
Anterior superior iliac spine and pubic tubercle
What branch of the femoral artery travels posteriorly towards the hamstrings?
Profunda femoris artery
what is the femoral vein a continuation of?
Popliteal vein
When the femoral vein crosses under inguinal ligament, what vein does it continue as?
External iliac vein
What two veins drain into femoral triangle?
Profunda femoris vein and great saphenous vein
Does the femoral nerve enter the femoral triangle medial or lateral to the femoral vessels?
Lateral
Name muscles supplied by the femoral nerve
- Vastus muscles
- Rectus femoris
- Pectineus
- Iliacus
- Sartorius
What is the femoral triangle?
Triangular depression below inguinal ligament
What is the medial and lateral boundary of the femoral triangle?
Medial: Adductor longus
Lateral: Sartorius
Base of femoral triangle?
Inguinal ligament
What is the femoral sheath?
Funnel shaped fascia surrounding proximal part of femoral vessels and forming femoral canal for lymphatic vessels
What does the lateral, intermediate, and medial compartments of the femoral sheath cover?
Lateral: femoral artery
Intermediate: femoral vein
Medial: femoral canal
As well as fat and loose conn. tissue, what is in femoral canal?
Deep inguinal lymph nodes
Where in femoral region do hernias commonly occur?
Femoral ring in ant. abdominal wall
Are femoral hernias more common in males or females?
Females
What are the contents of the adductor canal?
- Superficial femoral artery
- Femoral vein
- Femoral nerve branches
What are the two main nerves of the lumbar plexus?
Femoral and obturator nerve
What nerve roots contribute to the formation of lumbar plexus?
T12-L4
What regions of the thigh do femoral and obturator nerve innervate?
Femoral: anterior
Obturator: medial
What is the root value of obturator and femoral nerve?
L2-4
How is the pelvic girdle joined anteriorly and posteriorly?
Anteriorly: pubic symphysis
Posteriorly: sacroiliac joints
What enters/leaves the
- greater sciatic foramen
- lesser sciatic foramen
Greater sciatic foramen: Structures entering/leaving pelvis
Lesser sciatic foramen: Structures entering/leaving perineum
What 4 muscles make up the superficial layer in the gluteal region?
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Tensor fasciae latae
What 4 muscles make up the deep layer in the gluteal region?
- Piriformis
- Obturator internus
- Superior/inferior gemelli
- Quadratus femoris
What is the deep fascia of the thigh called?
Fascia lata
Which part of the fascia lata is the iliotibial tract?
Lateral part
What two muscles attach to the iliotibial tract?
Gluteus maximus and tensor fasciae latae
What are the actions of gluteus maximus?
Lateral rotation and extension of hip joint
What nerve innervates gluteus maximus?
Inferior gluteal nerve (L5, S1-2)
What are the actions of gluteus medius, minimus and tensor fasciae latae?
Abduction and internal rotation of hip joint
What nerve innervates gluteus medius, minimus and tensor fasciae latae?
Superior gluteal nerve (L4-5, S1)
What is the action of the deep gluteal muscles on hip joint?
Hip joint stabilising, lateral rotation
Anterior to which posterior pelvic muscle is the roots of sacral plexus found?
Piriformis
What ventral root values form sacral plexus?
L4-5, S1-4
What nerves are two main branches of sacral plexus?
Sciatic nerve, pudental nerve
What root values form the lumbosacral trunk?
L4-5
Other than sciatic and pudental nerve, what are other branches of sacral plexus?
- Nerve to piriformis (S1-2)
- Post. femoral cutaneous
- Nerve to quadratus femoris
- Nerve to obturator internus
- Nerve to levator ani and coccygeus
Inferior to what muscle does the sciatic nerve enter the gluteal region?
Piriformis
What are the two terminal branches of sciatic nerve?
- Tibial
- Common fibular
Does sciatic nerve innervate any gluteal muscles?
No
What is the action of hamstring muscles on hip and knee joint?
Hip: Extension
Knee: Flexion
What nerve innervates posterior thigh muscles? What branches innervate what muscles?
Sciatic nerve
- Tibial division: Semitendinosus/Semimembranosus/long head of biceps femoris
- Common fibular division: Short head of biceps femoris
Is the fibula involved in the knee joint?
No
What type of joint is the knee?
Synovial hinge
Where does the lateral collateral ligament extend from/to?
From lateral epicondyle of femur
To lateral surface of head of fibula
What muscle tendon passes deep to LCL separating it from lateral meniscus?
Popliteus muscle
Where does medial collateral ligament extend from/to?
From medial epicondyle of femur
To medial condyle and upper part of medial surface of tibia
Why is firm attachment of MCL to medial meniscus clinically important?
MCL damage can injure medial meniscus too. Get ‘unhappy triad’ of ACL, medial meniscus and tibial collateral ligament torn
What does the ACL help to prevent?
Posterior displacement of knee and hyperextension
What does PCL help to prevent?
Anterior displacement of knee and hyperflexion
What are the main functions of menisci? (c shaped plates of fibrocartilage on articular surface of tibia)
Deepen articular surface of knee joint, help in shock absorption and stability
What meniscus is attached to MCL?
Medial meniscus
What muscles flex the knee?
- Sartorius
- Gracilis
- Hamstring muscles
- Gastrocnemius
- Popliteus
What muscles extend the knee?
-Quadriceps
What bursa communicates with articular cavity of knee joint? Clinical significance?
Suprapatellar bursa. Stabbing above patella can lead to infected knee
Action of sartorius on hip?
- Flexion
- Abduction
- Lateral rotation
Innervation of sartorius?
Femoral nerve
Action of pectineus on hip?
- Internal rotation
- Adduction
- Flexion
What passes through greater sciatic foramen?
Obturator nerve
What excessive movement does iliofemoral ligament prevent?
Hyperextension
Innervation of tensor fasciae latae?
Superior gluteal nerve
Root value of femoral nerve?
L2-4
Action of biceps femoris on knee
Extension
Nerve supply to semitendinosus?
Tibial division of sciatic nerve
Innervation of gluteus medius?
Superior gluteal nerve
