Lower Limb 1 Flashcards
Name the two main superficial veins of the lower limb
Great saphenous vein
Small saphenous vein
Which superficial vein ascends anterior to the medial malleolus of the tibia?
Great saphenous vein
Which vein ascends posterior to the lateral malleolus?
Small saphenous vein
Which superficial vein empties into the femoral vein?
Great saphenous vein
Which superficial vein empties into the popliteal vein?
Small saphenous vein
Varicose veins are more common in which superficial vein?
Great saphenous vein
What route do the deep veins of the lower limb take?
Accompany all the major arteries in the limbs
Give 3 important arrangements of lymph nodes
Superficial inguinal
Deep inguinal
Popliteal lymph nodes
Lymphatic vessels accompanying the great saphenous vein end where?
Superficial inguinal nodes
Lymphatic vessels accompanying the small saphenous vein enter what group of lymph nodes?
Popliteal lymph nodes
Enlargement of inguinal lymph nodes are common due to infection where?
Lower limb
Trunk inferior to the umbilicus (such as the perineum)
The medial knee is what dermatome?
L3
The little toe is what dermatome?
S1
The hip joint is what type of joint?
Ball and socket synovial joint
What is the acetabular labrum?
Fibrocartilaginous ring
What is the function of the iliofemoral ligament?
Prevents hyperextension of the hip joint
What is the function of the pubofemoral ligament?
Prevents hyper abduction of the hip joint
Name the 3 ligaments of the hip joint
Iliofemoral ligament
Ischiofemoral ligament
Pubofemoral ligament
Name all the movements permitted at the hip joint
Flexion/ extension
Abduction/ adduction
External (medial)/ internal (lateral) rotation
Circumduction
Name the 3 main hip flexors
Iliacus
Psoas major
Pectineus
What is the chief flexor of the thigh?
Psoas
What is the main extensor of the hip joint?
Gluteus maximus
Name some other extensors apart from the gluteus maximus
Hamstrings (comprised of 3 individual muscles) Adductor magnus (posterior part)
Name the 6 muscles of the medial (adductor) compartment of the thigh.
Which two muscles arent always included in this group?
Why?
Gracilis Adductor magnus Adductor Longus Adductor Brevis Obturator externus Pectineus
Obturator Externus is sometimes excluded from this group
-Spatially, it is in this location, but functionally, it is more similar to the other lateral rotator group muscles
Pectineus is also sometimes excluded from this group
-It has the same function as the others in this group, but different innervation – namely, the femoral nerve
What nerve generally supplies the adductor compartment of the thigh?
Obturator nerve
How does the obturator nerve exit the pelvis?
Via the obturator canal which passes through the obturator foramen
Why are the abductors of the hip joint essential for a normal walking gait?
Each time one limb is raised from the ground that side of the pelvis becomes unsupported and will tend to drop
It is the contraction of the abductors on the opposite side of the pelvis which prevent this.
(Contraction of deep gluteal muscles on the supporting leg)
Lateral (external) rotators cross the hip joint on which side?
Posterior
The piriformis and obturator internus arise and insert where?
Both arise from inner pelvic walls and exit the pelvis via the greater and lesser sciatic foramina to attach to the greater trochanter of the femur
Medial (internal) rotators cross the hip joint on the anterior surface
Which muscles are the medial rotators of the hip joint?
Gluteus Medius
Gluteus Minimus
Tensor fasciae latae
The muscles of the thigh are organised into 3 compartments.
What are they?
Anterior/ quadriceps/ extensors (of the knee)
Medial/ adductors (of the hip)
Posterior/ hamstrings/ flexors (of the knee)
How many heads does quadriceps femoris have?
Name them
4 (quad)
Rectus femoris
Vastus lateralis
vastus intermedius
Vastus medialis
Which nerve innervates the anterior thigh muscles?
Femoral nerve
What is the action of the rectus femoris on the hip joint?
Stabilises (helps fix in position)
Helps iliopsoas flex hip joint
The 4 parts of the quadriceps femoris unite to form the quadriceps tendon proximal to the patella.
What does this continue as?
Where does it insert?
Continues as the patellar ligament distal to the patella
Attachment on the tibial tuberosity
What are the 3 actions of sartorius on the hip joint?
Flexes
Abducts
Laterally rotates the thigh at hip joint
(it also flexes the knee joint)
The sartorius is able to carry out the same action (flexion) at the hip and knee, which is unusual.
How is this possible?
It spirals around the thigh from lateral to medial, crossing the hip joint anteriorly and the knee joint posteriorly
Adductor hiatus is in which muscle?
What passes through it?
Adductor magnus
Femoral artery and vein
The femoral artery is the main artery of the thigh.
It is a continuation of which artery?
At what point does this name change occur?
External iliac
Inguinal ligament
The femoral artery enters the thigh midway between which 2 bony surface markings?
Anterior superior iliac spine
Pubic tubercle
Name the large branch of te femoral artery which passes posteriorly toward the hamstrings
Profunda femoris (Deep femoral artery)
Superficial femoral artery becomes the popliteal
The femoral vein is a continuation of which vein?
Popliteal vein
The femoral vein passes under the inguinal ligament to continue as which larger vein?
External iliac vein
Which two important veins drain into the femoral vein in the femoral triangle?
Profunda femoris vein
Graet saphenous vein
Cannulation of which vein is used to carry out right cardiac angiography?
Femoral vein
What is the largest branch of the lumbar plexus?
Femoral nerve
What is the path of the femoral nerve once it is given off from the lumbar plexus?
Passes deep to the inguinal ligament and enters the femoral triangle lateral to the femoral vessels
List the muscles supplied by the femoral nerve
Sartorius
Pectineus
Iliacus
Quadriceps femoris
What are the similarities and differences between the femoral triangle and the axilla?
Femoral triangle is the equivalent of the axilla, but whereas the axilla is protected by the adducted upper limb, the femoral triangle is exposed because of our change from a quadripedal to a bipedal stance
Which structure forms the base of the femoral triangle?
Iliopsoas
What is the medial and lateral boundary of the femoral triangle?
Medial = Adductor longus muscle Lateral = Sartorius muscle
Name the 3 major structures of the femoral triangle from lateral to medial
Nerve
Artery
Vein
(Vein medial -> V shape of legs)
What is the femoral sheath?
The femoral sheath is a funnel shaped fascial tube which surrounds the proximal parts of femoral vessels (but not the nerve) and creates the femoral canal medial to them, which contains lymphatic vessels
What are the 3 compartments of the femoral sheath?
What do they contain?
Lateral -> femoral artery
Intermediate -> femoral vein
Medial -> Deep inguinal lymph node (cloquet node)
What are the contents of the femoral canal?
Fat + loose connective tissue
A few lymphatic vessels and sometimes a deep inguinal lymph node (cloquet node)
The adductor canal is also called what?
Subsartorial canal
Hunter’s canal
Describe the origin, route and termination of the adductor canal in detail.
As the femoral neurovascular structures leave the apex of the femoral triangle distally they begin to burrow beneath the muscularture to create a tunnel -> adductor canal
Canal continues to pass increasingly posteriorly through the thigh until it arrives at the plane of the adductor musculature.
Here it passes through the adductor hiatus within the tendon of adductor magnus and thereby emerges into the popliteal fossa, posterior to the knee joint.
Where does the anterior femoral artery become the posterior popliteal artery?
Adductor hiatus
What are the posterior, lateral and medial boundaries of the adductor canal?
Posteriorly = Adductor longus and magnus Laterally = Vastus medialis Medially = sartorius
Why is the adductor canal also called Hunter’s canal?
John Hunter described the exposure and ligation of femoral artery in this canal for treating patients with aneurysm of popliteal artery
The lumbar plexus of nerves emerge where?
Through psoas major muscle on the posterior abdominal wall
Which nerve roots (ventral rami) contribute to the formation of the lumbar plexus?
L1-L4
What are the two main branches of the lumbar plexus?
What do they supply?
Obturator nerve which innervates the adductor compartment of the thigh
Femoral nerve which innervates the anterior compartment of thigh
What are the segmental values (root value) of the two major nerves of the lumbar plexus?
Obturator (L2-L4) Femoral Nerve (L2-L4)
How do the obturator nerve and femoral nerve relate to the psoas muscle?
Obturator nerve = Medial to psoas major
Femoral nerve = lateral to psoas major
