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Human Form > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Lower Limb Fascia

A
  • Characteristics
    • Rich in fat
    • Very strong in lower limb
      • Efficient venous compression
  • Fascia Lata
    • Deep fascia of thigh
    • Saphenous opening
      • Hiatus in fascia lata
      • Cribiform Fascia
  • Crural Fascia
    • Deep fascia of leg
  • Extensor Retinacula
    • Ankle
  • Intermuscular Septae
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2
Q

Sacrum Osteology

A
  • 5 fused vertebrae
  • Joints
    • Sacroiliac
    • Sacrococcygeal
  • Sacral Promontory
  • Alae Wings
  • Foramena
  • Sacral Canal
  • Auricular Surfaces
  • Sexual Dimorphism
    • Males
      • Tilted forward
    • Females
      • Tilted back
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3
Q

Coccyx Osteology

A
  • 5 fused vertebrae
  • Sacrococcygeal Joint
    • Fibrocartilaginous
      • Very strong
    • Some movement during defecation and birth
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4
Q

Ilium

A
  • Acetabulum
    • Fusion of Triradiate Cartilage
    • ~25 years
  • Crest
  • Anterior Superior Iliac Spine (ASIS)
  • Anterior Inferior Iliac Spine (AIIS)
  • Posterior Superior Iliac Spine (PSIS)
  • Posterior Inferior Iliac Spine (PIIS)
  • Greater Sciatic Notch
  • Iliac Fossa
  • Iliac Tuberosity
  • Auricular Surface
  • Ala
  • Gluteal Lines
    • Posterior
    • Anterior
    • Inferior
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5
Q

Ischium

A
  • Sit bone
  • Ischial Spine
  • Lesser Sciatic Notch
  • Body
  • Ischial Tuberosity
  • Ischial Ramus
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6
Q

Pubis

A
  • Rami
    • Superior
      • Acetabulum
    • Inferior
      • Ischium
  • Pubic Body
    • Pubic Symphysis
  • Pubic Tubercle
  • Pubic Crest
  • Pectineal Line
    • Ridge on Superior Ramus
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7
Q

Femur

A
  • Proximal
    • Head
    • Fovea Capitis
    • Neck
    • Greater Trochanter
    • Lesser Trochanter
    • Intertrochanteric Crest
  • Anterior
    • Intertrochanter Line
    • Shaft
    • Medial Epicondyle
    • Lateral Epicondyle
    • Medial Condyle
    • Lateral Condyle
    • Patellar Surface
    • Adductor Tubercle
  • Posterior
    • Greater Trochanter
    • Lesser Trochanter
    • Intertrochanteric Crest
    • Linea Aspera
      • Proximal
        • Pectineal Line (Medial)
        • Gluteal Tuberosity (Lateral)
      • Distal
        • Medial Supracondylar Line
        • Lateral Supracondylar Line
    • Intercondylar Fossa
    • Popliteal Surface
  • Articulations
    • Hip
      • Acetabulum
    • Knee
      • Tibiofemoral Joint
      • Patellofemoral Joint
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8
Q

Patella

A
  • Base
  • Apex
  • Front is rough
  • Back is smooth
  • Articular Facets
    • Medial Femoral Condyle
    • Lateral Femoral Condyle
  • Sesamoid Bone
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9
Q

Iliacus

A
  • O
    • Iliac Fossa
    • Ala of Sacrum
  • I
    • Lesser Trochanter
  • N
    • Femoral n. L2, L3
  • A
    • Flexes thigh at hip
    • Bends trunk
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10
Q

Psoas Major

A
  • O
    • Lumbar transverse processes
  • I
    • Lesser Trochanter
  • N
    • Femoral n. L1-L3
  • A
    • Flexes thigh at hip
    • Trunk flexion
    • Trunk lateral flexion
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11
Q

Psoas Minor

A
  • O
    • Bodies T12, L1
  • I
    • Pectineal Line of pubis
  • N
    • Branch from L1
  • A
    • Trunk flexor
  • Sometimes absent
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12
Q

Thigh Anterior Compartment

A
  • Act on Hip and Knee
    • Sartorius
    • Rectus Femoris
  • Act on Knee
    • Articularis Genus
    • Vastus Medialis
    • Vastus Intermedius
    • Vastus Lateralis
  • Quadriceps Femoris
    • Rectus Femoris
    • 3 Vasti
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13
Q

Sartorius

A
  • O
    • ASIS
  • I
    • Upper medial surface of tibial shaft
  • N
    • Femoral n. L2, L3
  • A
    • Thigh
      • Flexion
      • Abduction
      • Lateral Rotation
    • Leg
      • Flexion
        • Medial Rotation when flexed
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14
Q

Rectus Femoris

A
  • O
    • AIIS
    • Ilium above Acetabulum
  • I
    • Quadriceps Tendon to Patella
    • Patellar Ligament to Tibial Tuberosity
  • N
    • Femoral n.
  • A
    • Flexes thigh at hip
    • Extends leg at knee
  • Fusiform Muscle
    • Spindle shaped
      • Widest in the middle and tapers at ends
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15
Q

Vastus Medialis

A
  • O
    • Intertrochanteric Line
    • Medial Lip of Linea Aspera
  • I
    • Medial Border of Patella
    • Patellar Ligament to Tibial Tuberosity
  • N
    • Femoral n.
  • A
    • Extends leg at knee
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16
Q

Vastus Intermedius

A
  • O
    • Anterior and lateral upper 2/3 of femur shaft
  • I
    • Quadriceps Tendon to Patella
    • Patellar Ligament to Tibial Tuberosity
  • N
    • Femoral n.
  • A
    • Extends leg at knee
  • Fibres often fused with Vastus Medialis
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17
Q

Vastus Lateralis

A
  • O
    • Greater Trochanter
    • Lateral Lip of Linea Aspera
  • I
    • Quadriceps Tendon to Patella
    • Patellar Tendon to Tibial Tuberosity
  • N
    • Femoral n.
  • A
    • Extends leg at knee
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18
Q

Articularis Genus

A
  • O
    • Anterior surface of the lower femoral shaft
  • I
    • Synovial Membrane of knee joint
  • N
    • Femoral n.
  • A
    • Pulls Suprapatellar Bursa superioryly during knee extension
    • Prevents impingement of the Synovial Membrane between patella and femur
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19
Q

Thigh Anterior Compartment Clinical Notes

A
  • Iliopsoas Tendonitis
    • Snapping hip
  • Patellar Discolation
  • Patellar Fracture
  • Patellar Tendon Reflex
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20
Q

Thigh Medial Compartment

A
  • Adductor Longus
  • Adductor Brevis
  • Adductor Magnus
  • Gracilis
  • Pectineus
  • Obturator Externus
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21
Q

Adductor Longus

A
  • O
    • Body of Pubis
  • I
    • Medial lip of the Linea Aspera
  • N
    • Femoral n.
  • A
    • Thigh adduction
    • Thigh medial rotation
    • Minimal hip flexion
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22
Q

Adductor Brevis

A
  • O
    • Pubic Ramus inferior to Pubic Body
  • I
    • Upper medial lip of Linea Aspera
  • N
    • Femoral n.
  • A
    • Thigh adduction
    • Thigh medial rotation
    • Minimal hip flexion
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23
Q

Adductor Magnus

A
  • 2 Parts
    • Pubofemoral
      • Adductor
    • Ischialcondylar
      • Hamstring
  • O
    • Adductor Part
      • Inferior Ramus of Pubis
    • Hamstring Part
      • Ischial Tuberosity
  • I
    • Adductor Part
      • Medial lip of Linea Aspera
    • Hamstring Part
      • Adductor Tubercle of Femur
  • N
    • Adductor Part
      • Obturator n.
    • Hamstring Part
      • Tibial part of Sciatic n.
  • A
    • Thigh adduction
    • Adductor Part
      • Thigh flexion
    • Hamstring Part
      • Thigh Extension
  • Key Landmark
    • Adductor hiatus
  • Perforations for deep arteries
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24
Q

Gracilis

A
  • O
    • Body and Inferior Ramus of Pubis
  • I
    • Superior medial surface of tibia
  • N
    • Obturator n.
  • A
    • Thigh adduction
    • Thigh flexion at hip
    • Leg flexion at knee
    • Leg medial rotation at knee
  • Only adductor muscle to cross both hip and knee joints
  • Horsebackriding
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25
Q

Pectineus

A
  • O
    • Pectineal line of Pubis
  • I
    • Pectineal line of Femur
  • N
    • Femoral n.
  • A
    • Hip flexion
    • Thigh adduction
    • Thigh medial rotation
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26
Q

Obturator Externus

A
  • O
    • Margins of Obturator Foramen
  • I
    • Trochanteric Fossa of Femur
  • N
    • Obturator n.
  • A
    • Thigh lateral rotation
    • Steadies head of femur in acetabulum
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27
Q

Femoral Triangle

A
  • Lateral Border
    • Sartorius
  • Medial Border
    • Adductor Longus
  • Superior Border
    • Inguinal Ligament
      • ASIS to Pubic Tubercle
      • Common herniation site
  • Floor
    • Iliopsoas
    • Pectineus
    • Adductor Longus
  • Roof
    • Fascia Lata
    • Skin of thigh
  • SAIL
  • Contents (NAVEL)
    • N
      • Femoral Nerve
    • A
      • Femoral Artery
    • V
      • Femoral Vein
    • E
      • Empty Space
      • Allows femoral v. and lymph canal to extend out
    • L
      • Lymph Canal
        • Femoral Canal contains deep inguinal lymph nodes and vessels
    • Femoral Sheath
      • Femoral a., v., and canal
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28
Q

Thigh Medial Compartment Clinical Notes

A
  • Groin Strain
  • Riders Bones
    • Tendons ossify
    • Adductor Longus most often
  • Femoral Pulse
  • Access
    • Draw blood
    • Angiography
  • Trauma
    • Pressure to Femoral Triangle to avoid blood loss if no other options
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29
Q

Adductor Canal

A
  • Conical tunnel in middle 1/3 of thigh
  • Borders
    • Anterior
      • Sartorius
    • Lateral
      • Vastus Medialis
    • Posterior
      • Adductor Longus
      • Adductor Magnus
  • Contents
    • Femoral a.
    • Femoral v.
    • Femoral nerve branches
  • Adductor Canal Block
    • Local anesthetic
  • Adductor Canal Compression Syndrome
    • Hypertrophy of Vastus Medialis
    • Entrapment of neurovascualr bundle
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30
Q

Gluteal Muscles

A
  • Superficial
    • Gluteus Maximus
    • Gluteus Medius
    • Gluteus Minimus
    • Tensor Fasciae Latae
  • Deep
    • Piriformis
    • Obturator Internus
    • Gemellus Superior
    • Gemellus Inferior
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31
Q

Gluetus Maximus

A
  • O
    • Gluteal surface of hte Ilium behind the Posterior Gluteal Line
    • Lower Sacrum
    • Lateral margin of Coccyx
  • I
    • Posterior aspect of IT tract
    • Gluteal Tuberosity of Greater Trochanter\
  • N
    • Inferior Gluteal n.
  • A
    • Main extensor of thigh
    • Assists with lateral rotation and abduction of thigh
    • Lateral stabilizer of hip and knee joints
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32
Q

Gluteal Medius

A
  • O
    • Gluteal surface of the Ilium between anterior and posterior gluteal lines
  • I
    • Lateral surface of Greater Trochanter
  • N
    • Superior Gluteal n.
  • A
    • Abducts femur at hip
    • Stabilizes pelvis in coronal plane
    • Medially rotates thigh
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33
Q

Gluteus Minimus

A
  • O
    • Gluteal surface of the Ilium between anterior and inferior gluteal lines
  • I
    • Anterolateral aspect of Greater Trochanter
  • N
    • Superior Gluteal n.
  • A
    • Abducts femur at hip
    • Stabilizes pelvis in coronal plane
    • Medially rotates thigh
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34
Q

Tensor Fasciae Latae

A
  • O
    • Outer edge of Iliac Crest (Anterior and Superior Spines to Iliac Tubercle)
  • I
    • Lateral Condyle of Tibia through IT tract
  • N
    • Superior Gluteal n.
  • A
    • Flexion, Abduction, Medial Rotation at thigh
    • Weak extension of knee
    • Tautens IT band and braces knee especially when opposite foot is lifted
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35
Q

Ligaments Linking Pelvis to Sacrum

A
  • Sacrospinous Ligament
    • Ischial Spine
    • Sacrum
  • Sacrotuberous Ligament
    • Ischial Tuberosity
    • Sacrum
  • Turn Sciatic Notches into Sciatic Foramina
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36
Q

Piriformis

A
  • O
    • Anterior surface of Sacrum
    • Sacrotuberous Ligament
  • I
    • Superior border of Greater Trochanter
  • N
    • Nerve to Piriformis
  • A
    • Laterally Rotate hip
    • Abduct hip
    • Stabilizes hip
  • Landmark
    • Superior Gluteal a.
    • Inferior Gluteal a.
    • Sciatic n. is inferior
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37
Q

Obturator Internus

A
  • O
    • Pelvic surface of obturator membrane and surrounding bones
  • I
    • Medial surface of Greater Trochanter
  • N
    • Nerve to Obturator Internus
  • A
    • Lateral Rotation of hip
    • Abduction of hip
  • Triceps Coxae
    • Obturator Internus
    • Gemellus Superior
    • Gemellus Inferior
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38
Q

Gemellus Superior

A
  • O
    • Ischial Spine
  • I
    • With Obturator Internus tendon to upper border of Greater Trochanter
  • N
    • Nerve to Obturator Internus
  • A
    • Lateral Rotation of hip
    • Abduction of hip
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39
Q

Gemellus Inferior

A
  • O
    • Ischial Tuberosity
  • I
    • With Obturator Internus tendon to upper border of Greater Trochanter
  • N
    • Nerve to Quadratus Femoris
  • A
    • Lateral Rotation of hip
    • Abduction of hip
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40
Q

Quadrator Femoris

A
  • O
    • Lateral border of Ischial Tuberosity
  • I
    • Below Intertrochanteric Crest
  • N
    • Nerve Quadratus Femoris
  • A
    • Lateral Rotation of femur
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41
Q

Semitendinosus

A
  • O
    • Ischial Tuberosity
  • I
    • Medial surface of Tibia
  • N
    • Tibial part of Sciatic Nerve
  • A
    • Flexes leg at knee
    • Extends thigh at hip
    • Medially rotates thigh at hip
    • Medially rotates leg at knee
  • Can be harvested for ACL Reconstruction
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42
Q

Pes Anserinus

A
  • Goose Foot
  • Conjoined tendons of 3 muscles insert onto anteromedial surface of proximal tibia
    • Gracilis Tendon
    • Sartorius
    • Semitendinosus
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43
Q

Semimembranosus

A
  • O
    • Ischial Tuberosity
  • I
    • Medial Condyle of Tibia
  • N
    • Tibial part of Sciatic Nerve
  • A
    • Flexes leg at knee
    • Extends thigh at hip
    • Medially rotates thigh at hip
    • Medially rotates leg at knee
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44
Q

Biceps Femoris

A
  • O
    • Long Head
      • Ischial Tuberosity
    • Short Head
      • Linea Aspera
  • I
    • Lateral side of head of Fibula
  • N
    • Long Head
      • Tibial part of Sciatic Nerve
    • Short Head
      • Common Fibular part of Sciatic Nerve
  • A
    • Flexes knee
    • Extends thigh at hip
    • Laterally rotates hip and knee
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45
Q

Adductor Magnus (Hamstring Part)

A
  • O
    • Ischial Tuberosity
  • I
    • Adductor Tubercle of Femur
  • N
    • Tibial part of Sciatic Nerve
  • A
    • Extends thigh
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46
Q

Hip Joint

A
  • Ball and Socket
  • Synovial Joint
  • Stable
    • Weight bearing at expense of mobility
    • Femur head fits completely into concavity of the Acetabulum
  • Movements
    • Flexion/Extension
    • Abduction/Adduction
    • Medial/Lateral Rotation
    • Circumduction
  • Articulation
    • Head of Femur
    • Lunate Surface of Acetabulum
    • Acetabular Fossa is NOT articulating
  • Hyaline Cartilage
    • Head of Femur
    • Lunate Surface
    • Not Fovea
  • Ligaments
    • Ligament of Head of Femur
      • Intracapsular
      • Acetabular Fossa to Fovea
      • Encloses branch of Obturator a.
    • Transverse Acetabular Ligament
      • Bridges deficiency in bony rim inferiorly
    • Iliofemoral Ligament
    • Pubofemoral Ligament
    • Ischiofemoral Ligament
  • Acetabular Labrum
    • Fibrocartilaginous collar
    • Increases depth of Acetubulum
  • Capsule
    • Attached to the bone outside the Acetuabular Labrum and Transverse Ligament
    • Anteriorly
      • Intertrochanteric Line
    • Posteriorly
      • Neck of Femur proximal to Intertrochanteric Crest
    • Zona Orbicularis
      • Neck of Femur formed by circular fibres of articular capsule
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47
Q

Spiral Ligaments of Hip

A
  • Iliofemoral Ligament
    • Y shaped
    • Located anteriorly
    • Proximal Attachment
      • AIIS
      • Acetabular rim
    • Distal Attachment
      • Intertrochanteric Line
    • Prevents hyperextension
  • Pubofemoral Ligament
    • Located anteroinferiorly
    • Proximal Attachment
      • AIIS
      • Acetabular rim
    • Distal Attachment
      • Intertrochanteric Line
    • Prevents hyperextension
  • Ischiofemoral Ligament
    • Located posteriorly
    • Proximal Attachment
      • Ischium of pelvis
    • Distal Attachment
      • Greater Trochanter
    • Prevents hyperextension
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48
Q

Tibia

A
  • Shin Bone
  • Strong weight-bearing bone
  • Proximal
    • Proximal Tibiofibular joint
  • Distal
    • Distal Tibiofibular joint
  • Tibial Plateau
    • Load-bearing
  • Medial Condyle
  • Lateral Condyle
  • Intercondylar Eminence
    • Non-articulating
    • Non-weightbearing
    • Attachment for ligaments of knee
  • Tibial Tuberosity
  • Superior Fibular Articular Facet
  • Shaft
  • Soleal (Popliteal) Line
  • Medial Malleolus
  • Inferior Fibular Articular Facet
49
Q

Fibula

A
  • Attachment for muscles
  • Articulation
    • Proximal Tibiofibular Joint
      • Lateral condyle of proximal Tibia
      • Does NOT articulate with femur
    • Distal Tibiofibular Joint
      • Forms lateral malleolus of ankle
      • More prominent than medial malleolus
  • Head
  • Articular Facet
    • For articulation with lateral condyle of tibia
  • Neck
  • Lateral Malleolus
50
Q

Proximal Tibiofibular Joint

A
  • Articulation
    • Head of Fibula
    • Lateral Condyle of Tibia
  • Plane
  • Synovial
  • Slight movement during plantar/dorsi flexion
  • Capsule
    • Anterior Tibiofibular Ligament
    • Posterior Tibiofibular Ligament
  • Blood Supply
    • Inferior Lateral Genicular
    • Anterior Tibial Recurrent
  • Nerve
    • Common Fibular (Peroneal N.)
    • Nerve to Popliteus (from Tibial N.)
51
Q

Distal Tibiofibular Joint

A
  • Articulation
    • Distal medial surface of Fibula
    • Fibular Notch of Tibia
  • Fibrous Joint
    • Syndesmosis
      • Strong joint to prevent movement
  • Very limited movement
    • Dorsiflexion
  • Essential for ankle joint stability
  • Ligaments
    • Anterior Inferior Tibiofibular L.
      • AiTFL
    • Posterior Inferior Tibiofibular L.
      • PiTFL
    • Transverse Tibiofibular L.
      • TrTFL
    • Interosseous L.
  • Blood Supply
    • Perforating branch of Fibular a.
    • Medial malleolar branches of Anterior and Posterior Tibial a.
  • Nerve
    • Deep Fibular n.
    • Tibial n.
    • Saphenous n.
  • High Ankle Sprain
    • Injury to distal tibiofibular syndesmosis ligaments
    • Dorsiflexion and eversion of the ankle plus internal rotaiton of the tibia
    • Radiographically manifests as widening of tibiofibular “clear space” to >6mm
52
Q

Foot Osteology

A
  • Tarsals
    • Calcaneus
    • Talus
    • Cuboid
    • Navicular
    • Cuneiform X3
  • Metatarsals
    • 1
      • Hallux
    • 2-5
  • Phalanges
    • 2 for Hallux
    • 3 for other toes
53
Q

The Circus Needs More Interesting Little Clowns

A
  • Talus (2)
  • Calcaneus (1)
  • Navicular (4)
  • Medial Cuneiform (5)
  • Intermediate Cuneiform (5)
  • Lateral Cuneiform (5)
  • Cuboid (3)
54
Q

Foot Movements

A
  • Dorsiflexion
  • Plantarflexion
  • Inversion
    • Sole of foot inwards
  • Eversion
    • Sole of foot outwards
  • Flexion/Extension of Digits
  • Abduction/Adduction of Digits
55
Q

Knee Joint

A
  • Hinge
  • Synovial
  • Movements
    • Flexion/Extension
    • Small rotation when flexed
    • Screw-Home Mechanism
  • Articulations
    • Tibiofemoral
      • Femur condyles
      • Tibial condyles
      • Weight-bearing
    • Patellofemoral
      • Patellar Facets
      • Patellar Groove on anterior surface of femur
    • Patella
      • Sesmoid bone
      • Gives leverage
      • Not as much force required for flexion/extension
  • Capsule
    • Fibrous Membrane
    • Synovial Membrane
      • Attaches to edge of the articular cartilage of joint surfaces
    • Anteriorly
      • Continuous with Quadriceps Tenodn, Patella, Patellar Ligament
    • Posteriorly
      • Encloses Femoral Condyles and Intercondylar Fossa
    • Superiorly
      • Articular margins of Femoral Condyles
    • Inferiorly
      • Articular margin of Tibial Plateau
      • Gaps allows Popliteus Tendon to pass out of capsule to attach to Tibia
56
Q

Menisci

A
  • Fibrocartilagous
  • Medial and Lateral
  • Shock absorbers
  • Deepend articular surface of Tibia
  • C shape
  • Wider outside, thinner inside (wedge)
  • Attached to Intercondylar area of Tibia
  • Coronary Ligaments
    • Attach Menisci to Tibial Condyles
  • Transverse Ligament
    • Menisomeniscal Ligament
    • Connects anterior margins of medial and lateral menisci
  • Medial (Tibial) Collateral Ligament
    • Medial Meniscus attaches to MCL
    • Damage to MCL can result in meniscus tearing
57
Q

Knee Joint Ligaments

A
  • Coronary L.
  • Transverse L.
  • Patellar L.
    • Continuation of Quadriceps Femoris Tendon distal to Patella
    • Attaches to Tibial Tuberosity
  • Oblique Popliteal L.
    • Tendinous expansion of Semimembranosus
  • Arcuate Popliteal L.
    • Lateral Condyle to Fibular Head
    • Strengthens capsule posterolaterally
  • Medial (Tibial) Collateral L.
    • MCL
    • From Medial Femoral Epicondyle
    • To Medial Shaft of Tibia
    • Also attaches to Medial Meniscus
    • Pain when medially rotate knee
  • Lateral (Fibular) Collateral L.
    • From Lateral Femoral Epicondyle
    • To Head of Fibula (lateral surface)
    • NOT attached to Lateral Meniscus
    • Pain when laterally rotate knee
  • Anterior Cruciate L.
    • ACL
    • From Anterior Intercondylar area of the Tibia
    • To Lateral Condyle of Femur
    • Prevents anterior dislocation of the tibia onto the femur
    • Prevents knee hyperextension
    • Anterior Drawer Test
  • Posterior Cruciate L.
    • PCL
    • From Posterior Intercondylar area of the Tibia
    • To Medial Condyle of Femur
    • Prevents posterior dislocation of the tibia on the the femur
    • Prevents knee hyperflexion
    • Posterior Drawer Test
    • Dashboard injuries
58
Q

Knee Bursae

A
  • Suprapatellar Bursa
    • Between quadriceps and femur
  • Prepatellar/Subcutaneous Bursa
    • Between apex of patella and skin
    • Housemaid’s Knee
  • Infrapatellar Bursa
    • Deep
      • Between tibia and patellar ligament
    • Superficial
      • Between patellar ligament and skin
    • Clergyman’s Knee
  • Semimembranosus Bursa
    • Posterior to knee joint
    • Between semimembranosus and gastrocnemius
  • Popliteal Cyst
    • Baker’s Cyst
    • Swelling and rupture of synovial bursa behind knee
59
Q

Knee Arterial Supply

A
  • Genicular Anastomosis
    • Vessel network around knee
    • Compensates for narrowing of popliteal artery during knee flexion
  • Femoral a.
    • Descending Genicular a.
  • Popliteal a.
    • Superior Genicular a.
      • Medial
      • Lateral
    • Middle Genicular a.
    • Inferior Genicular a.
      • Medial
      • Lateral
  • Anterior Tibial a.
    • Anterior Tibial recurrent branches
    • Posterior Tibial recurrent branches
  • Posterior Tibial a.
    • Circumflex Fibular a.
60
Q

Knee Innervation

A
  • Sciatic n.
    • Tibial n.
    • Common Peroneal (Fibular) n.
  • Femoral n.
  • Obturator n.
61
Q

Knee Movements

A
  • Flexion
    • Hamstrings
    • Sartorius
    • Gracilis
    • Popliteus
    • Gastrocnemius
    • Plantaris
  • Extension
    • Quadriceps Femoris
    • Tensor Fascia Latae
  • Rotation when Leg Flexed
    • Internal Rotation
      • Semitendinosus
      • Semimembranosus
    • External Rotation
      • Biceps Femoris
  • Screw-Home Mechanism
    • Locking and unlocking (popliteus) of knee joint
    • Locks knee decreasing the work performed by the quadriceps while standing
62
Q

Knee Injuries/Clinical Conditions

A
  • Terrible Triad
    • When one is torn, likely another is torn
    • ACL
    • MCL
    • Medial (FibroCartilagous) Meniscus
    • 3 C’s
  • Meniscal Tears
    • Variety of types
  • Patellar Discocation
  • Knee Replacement
  • Varus Deformity
    • Bow legged
    • Rum
  • Valgus Deformity
    • Knock knees
    • Gum
  • Popliteal Cyst
    • Swelling of Semimembranosus Bursa
  • Popliteal Aneurysm
63
Q

Popliteal Fossa

A
  • Diamond shaped fat filled space
  • Borders
    • Superomedial Border
      • Distal end of Semimembranosus
      • Distal end of Semitendinosus
    • Superlateral Border
      • Distal end of Biceps Femoris
    • Inferomedial Border
      • Medial head of Gastrocnemius
    • Inferolateral Border
      • Lateral head of Gastrocnemius
      • Lateral head of Plantaris
    • Floor
      • Posterior surface of knee joint capsule
      • Oblique Popliteal L.
      • Posterior surface of femur
      • Fascia covering Popliteal muscle
    • Roof
      • Popliteal Fascia
        • Continuous with Fascia Lata
        • Perforated by Short Saphenous v. and Sural n.
      • Skin
    • Contents
      • Tibial n.
      • Common Fibular (Peroneal) n.
      • Small Saphenous v.
      • Popliteal v.
      • Politeal a.
64
Q

Leg Anterior Compartment

A
  • Tibialis Anterior
  • Extensor Hallucis Longus
  • Extensor Digitorum Longus
  • Fibularis (Peroneus) Tertius
  • Movement
    • Dorsiflexion of foot
    • Extension of toes
    • Inversion of foot
    • Eversion of foot
  • Innervation
    • Deep Fibural (Peroneal) N.
65
Q

Tibialis Anterior

A
  • O
    • Lateral Condyle of Tibia
    • Upper surface of Tibia
    • Interosseous Membrane
  • I
    • Medial side of Medial 1st Cuneiform
    • Base of 1st Metatarsal
  • N
    • Deep Fibular (Peroneal) n.
  • A
    • Dorsiflexion of foot
    • Inversion of foot
66
Q

Extensor Hallucis Longus

A
  • O
    • Medial surface of fibular shaft
    • Interosseous Membrane
  • I
    • Base of distal phalanx of hallux
  • N
    • Deep Fibular (Peroneal) n.
  • A
    • Dorsiflexes foot
    • Extends hallux
67
Q

Extensor Digitorum Longus

A
  • O
    • Distal part of medial surface of Fibula
  • I
    • Dorsal base of 5th Metatarsal
  • N
    • Deep Fibular (Peroneal) n.
  • A
    • Dorsiflexion
    • Everts foot
  • Tendon
    • Begins superior to ankle
    • Divides into 4
    • Extensor Expansion
    • 2 Lateral Bands
      • Fuse and insert into base of distal phalanx
    • 1 Central Band
      • Inserts into base of middle phalanx
68
Q

Fibularis (Peroneus) Tertius

A
  • O
    • Distal part of medial surface of Fibula
  • I
    • Dorsal base of 5th Metatarsal
  • N
    • Deep Fibular (Peroneal) n.
  • A
    • Dorsiflexion
    • Everts foot
69
Q

The Hospitals Are Not Dirty Places

A
  • Tibialis Anterior
  • Extensor Hallucis Longus
  • Artery anterior tibial
  • Nerve Deep Fibular
  • Extensor Digitorum Longus
  • Peroneus Tertius
70
Q

Ankle Retinacula

A
  • Superior Extensor Retinaculum
    • Fibula to Tibia
  • Inferior Extensor Retinaculum
    • Y shaped
    • Upper surface of Calcaneus to Medial Malleolus and Fascia and Plantar Aponeurosis
  • Flexor Retinaculum
    • Structures which pass behind the Medial Malleolus
      • Tendons of deep flexor muscles surrounded by synovial sheaths
      • Posterior Tibial a.
      • Tibial n.
71
Q

Leg Lateral Compartment

A
  • Fibularis (Peroneus) Longus
  • Fibularis (Peroneus) Brevis
  • Fibular (Peroneal) N.
  • Movement
    • Eversion
    • Walking on toes
    • Pushing off with big toe
72
Q

Fibularis (Peroneus) Longus

A
  • O
    • Upper lateral surface of Fibula
  • I
    • Lateral side of Medial Cuneiform
    • Base of 1st Metatarsal
  • N
    • Superficial Fibular (Peroneal) n.
  • A
    • Plantarflexion
    • Eversion
  • Tendon goes underneath foot
    • Acts as stirrup to support foot arches
73
Q

Fibularis (Peroneus) Brevis

A
  • O
    • Lower 2/3 lateral surface of Fibula
  • I
    • Inserts distally into base of Metatarsal 5
  • N
    • Superficial Fibular (Peroneal) n.
  • A
    • Eversion
74
Q

Leg Posterior Compartment

A
  • Superficial Layer
    • Gastrocnemius
    • Plantaris
    • Soleus
  • Deep Layer
    • Popliteus
    • Flexor Hallucis Longus
    • Flexor Digitorum Longus
    • Tibialis Posterior
  • Neurovasculature lies in the deep layer but supplies both parts
  • Movement
    • Plantarflexion
    • Inversion
    • Flexion of toes
75
Q

Gastrocnemius

A
  • O
    • Medial Head
      • Posterior surface of Femur just superior to Medial Condyle
    • Lateral Head
      • Lateral Condyle of Femur
  • I
    • Posterior surface of Calcaneus via Calcaneal Tendon (Achilles)
  • N
    • Tibial n.
  • A
    • Plantarflexion
    • Flexes leg at knee
76
Q

Soleus

A
  • O
    • Soleal line on posterior surface of Tibia
    • Posterior aspect of Fibular Head
  • I
    • Posterior surface of Calcaneus via Calcaneal Tendon
  • N
    • Tibial n.
  • A
    • Plantarflexion
77
Q

Plantaris

A
  • O
    • Lateral Supracondylar area of Femur
  • I
    • Posterior surface of Calcaneus via Calcaneal Tendon
  • N
    • Tibial n.
  • A
    • Plantarflexion
    • Flexes knee
  • Small muscle belly
  • Long thin tendon
  • Can harvest for graft
78
Q

Popliteus

A
  • O
    • Lateral Condyle of Femur
  • I
    • Posterior surface of Proximal Tibia
  • N
    • Tibial n.
  • A
    • Stabilizes knee joint
    • Resists Lateral Rotation of Tibia on Femur
  • Screw-Home Mechanism
    • Popliteus ‘unlocks’ knee
      • Foot is Planted
        • Externally rotating Femur
      • Foot is Free
        • Internally rotating Tibia
    • Reduces muscle output while standing
79
Q

Flexor Hallucis Longus

A
  • O
    • Posterior surface of Fibula
    • Interosseous Membrane
  • I
    • Base of distal phalanx of big toe
  • N
    • Tibial n.
  • A
    • Flexes big toe
80
Q

Flexor Digitorum Longus

A
  • O
    • Medial posterior surface of Tibia below Soleal Line
  • I
    • Inserts distally into bases of distal phalanges of toes 2-5
  • N
    • Tibial n.
  • A
    • Flexes toes 2-5
81
Q

Tibialis Posterior

A
  • O
    • Posterior surfaces of Tibia
    • Posterior surfaces of Fibula
    • Posterior surfaces of Interosseous Membrane
  • I
    • Mainly Navicular
    • Variation
  • N
    • Tibial n.
  • A
    • Plantarflexion
    • Inversion
82
Q

Tarsal Tunnel

A
  • Anteromedial to Posterolateral
  • Tom, Dick, And A Very Nervous Harry
    • Tibialis Posterior Tendon
    • Flexor Digitorum Longus Tendon
    • Posterior Tibial Artery
    • Associated Veins
    • Tibial Nerve
    • Flexor Hallucis Longus Tendon
83
Q

Leg Clinical Notes

A
  • Calcaneal Tendonitis
    • Chronic inflammation of tendon
  • Calcaneal Tendon Rupture
    • Patient will be unable to plantarflex the foot against resistance
    • Affected foot will be permanently dorsiflexed
  • Footdrop
    • Paralysis of muscles in anterior compartment of leg
    • Damage to Common Fibular Nerve
    • Unopposed pull of the muscles in posterior leg produces permanent plantarflexion
    • Affected limb can drag along the ground while walking
84
Q

Ankle Joint (Talocrural)

A
  • Hinge
  • Synovial
  • Articulations
    • Tibia
    • Fibula
    • Superior part of Talus
  • Hyaline cartilage
  • Movements
    • Plantarflexion
      • Unstable
    • Dorsalflexion
      • Some movement of superior and inferior Tibiofibular Joints
  • Malleolar Mortise
    • N shape
    • Trochlea of Talus
    • Superior surface of talus figts snugly into mortise formed by leg bones
    • Malleoli grip talus tightly
  • Socket
    • Roof
      • Inferior surface of the distal end of the Tibia
    • Medial
      • Medial Malleolus of Tibia
    • Lateral
      • Lateral Malleolus of Fibula
      • Longer
  • Talus
    • Wedge shaped
    • Wider anteriorly
    • Thinner posteriorly
    • Tighter fit when dorsiflexed
      • Most stable
    • Looser fit when plantarflexed
      • Ankle injuries
  • Capsule
    • Fibrous
      • Attachments
        • Superiorly to tibia
        • Medially and Laterally to malleoli
        • Inferiorly to talus
    • Synovial
      • Loose inside fibrous layer
  • Ligaments
    • Medial (Deltoid) Ligament
      • Medial Malleolus
      • 4 Heads
        • Anterior Tibiotalar
        • Posterior Tibiotalar
        • Tibionavicular
        • Tibiocalcanean
      • Very strong
      • Stabilizes during foot eversion
    • Lateral Ligament
      • Lateral Malleolus
      • 3 Heads
        • Anterior Talofibular
        • Posterior Talofibular
        • Calcaneofibular
      • Stabilizes during foot inversion
  • Arterial Supply
    • Malleolar branches of Fibular a.
    • Anterior Tibial a.
    • Posterior Tibial a.
  • Innervation
    • Tibial n.
    • Deep Fibular n.
  • Fractures
    • Bimalleolar
      • Potts
      • Lateral and medial malleolar fractures
      • Eversion force
    • Trimalleolar
      • Lateral, medial malleolar and posterior tibia fractures
  • Sprains
    • Lateral Ligament
      • Inversion
      • More likely to be damaged
      • Anterior talofibular l. is most at risk of irreversible damage
    • Medial (Deltoid) Ligament
      • Eversion
      • Much stronger
85
Q

Foot Joints

A
  • Subtalar
  • Transverse Tarsal Joint
    • Talocalcaneonavicular
    • Calcaneocuboid
  • Intertarsal Joints
  • Tarsometatarsals (TM Joints)
  • Metatarsophalangeal (MP Joints)
  • Interphalangeal Joints (IP Joints)
  • Arches
    • Formed by tarsal and metatarsal bones
    • Allows for weight distribution
    • Allows for better locomotion
    • Strengthend by ligaments and tendons
  • Tarsal Tunnel
  • Clinical
    • Bunions
      • Hallux Abducto Valgus Deformity
      • Bending inwards of big toes at 1st MP Joint at base of Hallux
      • Caused by improper shoes
      • Conservative treatment involves strengthening Abductor Hallucis
      • Surgical intervention required if bunion is severe
86
Q

Foot Ligaments

A
  • Short Plantar L.
    • Calcaneus to Cuboid
  • Long Plantar L.
    • Calcaneus to Cuboid
    • Fibres continuing to Metatarsals 2-4
  • Plantar Calcaneonavicular (Spring) L.
  • Tendon of Fibularis Longus
87
Q

Dorsum of Foot

A
  • Many of the extrinsic muscles attach
  • 1 intrinsic muscle
    • Extensor Digitorum Brevis
  • Mainly resonsible for assisting the extrinsic muscle EDL
  • Innervated by Deep Fibular n.
  • Extensor Hallucis Brevis
    • Often considered as part of Extensor Digitorum Brevis
88
Q

Extensor Digitorum Brevis

A
  • O
    • Superolateral surface of Calcaneus
  • I
    • Tendons of Extensor Digitorum 2, 3, 4
    • Base of first proximal Phalynx for Extensor Hallucis Brevis
  • N
    • Deep Fibular n.
  • A
    • Assists EDL in extending toes 2-4
89
Q

Sole of Foot

A
  • Covered with thick layer of skin and farry superficial fascia
  • Plantar Aponeurosis (deep fascia)
  • Muscles, nerves, and vessels lie deep to plantar aponeurosis
  • Muscles supplied by
    • Medial/Lateral Plantar arteries and nerves
  • 10 intrinsic muscles
  • Function
    • Control individual movement of the digits
    • Stabilize arches
  • First Layer
    • Most superficial
    • Abductor Hallucis
    • Flexor Digitorum Brevis
    • Abductor Digiti Minimi
  • Second Layer
    • Quadratus Plantae
    • 1st to 4th Lumbricals
    • Tendons of Flexor Digitorum Longus pass through this layer
  • Third Layer
    • Flexor Hallucis Brevis
    • Adductor Hallucis
    • Flexor Digiti Minimi Brevis
  • Fourth Layer
    • 4 Dorsal Interossei
    • 3 Plantar Interossei
90
Q

Abductor Hallucis

A
  • First Layer
  • O
    • Medial process of Calcaneus
  • I
    • Base of proximal phalynx of big toe
  • N
    • Medial Plantar n.
  • A
    • Abducts Hallux at MP Joint
91
Q

Flexor Digitorum Brevis

A
  • First Layer
  • O
    • Calcaneus
  • I
    • Both sides of middle phalanges of digits 2-5
  • N
    • Medial Plantar n.
  • A
    • Flexes toes at proximal IP Joints
92
Q

Abductor Digiti Minimi

A
  • First Layer
  • O
    • Lateral process of Calcaneus
  • I
    • Base of proximal phalynx of digit 5
  • N
    • Lateral Plantar n.
  • A
    • Abducts little toe at MP Joint
93
Q

Quadratus Plantae

A
  • Second Layer
  • O
    • Plantar surface of Calcaneus
  • I
    • Lateral side of Tendon of Flexor Digitorum Longus
  • N
    • Lateral Plantar n.
  • A
    • Assists FDL in flexing toes 2-5
94
Q

1st to 4th Lumbricals

A
  • Second Layer
  • O
    • Tendons of FDL
  • I
    • Dorsal surfaces of proximal phalanges of digits 2-5 through extensor hoods of toes
  • N
    • Medial Plantar n.
      • 1st
    • Lateral Plantar n.
      • 2nd, 3rd, 4th
  • A
    • Flexion of MP Joints
    • Extension of IP Joints
95
Q

Flexor Hallucis Brevis

A
  • Third Layer
  • O
    • Tendon of Tibialis Posterior
    • Cuboid
    • Cuneiforms
  • I
    • Base of proximal phalynx of big toe
  • N
    • Medial Plantar n.
  • A
    • Flexes MP Joint of Hallux
  • Contains 2 Sesmoid Bones
96
Q

Adductor Hallucis

A
  • Third Layer
  • O
    • Oblique Head
      • Bases of Metatarsals 2-4 from Oblique Head
    • Transverse Head
      • Ligaments of MP Joints
  • I
    • Lateral side of base of proximal phalynx of big toe
  • N
    • Lateral Plantar n.
  • A
    • Adducts Hallux
97
Q

Flexor Digiti Minimi Brevis

A
  • Third Layer
  • O
    • Base of Metatarsal 5
  • I
    • Base of proximal phalynx 5
  • N
    • Lateral Plantar n.
  • A
    • Flexes little toe at MP Joint
98
Q

4 Dorsal Interossei

A
  • Fourth Layer
  • O
    • Adjacent sides of Metatarsals 1-5
  • I
    • 1
      • Medial side of 2nd digit
    • 2-4
      • Lateral side of digits 2-4
  • N
    • Lateral Plantar n.
  • A
    • Abduction of toes 2-4 at MP Joints
    • DAB
99
Q

3 Plantar Interossei

A
  • Fourth Layer
  • O
    • Medial sides of Metatarsals 3-5
  • I
    • Medial sides of bases of proximal phalanges 3-5
  • N
    • Lateral Plantar n.
  • A
    • Adduction of toes 3-5 at MP Joints
    • PAD
100
Q

Spinal Nerves

A
101
Q

Lumbosacral Plexus

A
  • Lumbar Plexus
    • L1-L4
    • Passes through lateral to intervertebral foramina
    • Passes through Psoas Major
    • Passes in front of hip joint
    • Branches Innervate
      • Pelvic muscles
      • Anterior thigh muscles
      • Medial thigh muscles
    • Nerves
      • Iliohypogastric n.
      • Ilioinguinal n.
      • Genitofemoral n.
      • Lateral Cutaneous Nerve of thigh
      • Obturator n.
      • Femoral n.
  • Lumbosacral Plexus
    • Communicating branches between lumbar and sacral plexuses
    • Ventral rami of a portion of L4 and all of L5 combine at sacral ala
  • Sacral Plexus
    • S1-S4
    • Emerge from anterior sacral foramina
    • Unite on anterior surface of piriformis to form sacral plexus
    • Descend behind hip joint
    • Branches Innervate
      • Posterior thigh
      • Most of leg
      • Most of foot
    • Nerves
      • Superior Gluteal
      • Inferior Gluteal
      • Sciatic
      • Posterior Cutaneous Nerve of thigh
      • Pudendal
102
Q

I (twice) Get Laid On Fridays

A
  • Iliohypogastric n.
  • llioinguinal n.
  • Genitofemoral n.
  • Lateral Cutaneous Nerve of Thigh
  • Obturator n.
  • Femoral n.
  • 2 from 1, 2 from 2, 2 from 3
  • **Obturator and Femoral nerves are important
103
Q

Iliohypogastric Nerve

A
  • Roots
    • L1 with contribution from T12
  • Sensory
    • Innervates skin of lateral hip
    • Innervates skin above inguinal ligament
  • Runs anterior to Psoas Major
104
Q

Ilioinguinal Nerve

A
  • Roots
    • L1
  • Sensory
    • Innervates skin on anteromedial part of thigh
    • Innervates skin of perineum
  • Runs with larger Iliohypogastric n.
105
Q

Genitofemoral Nerve

A
106
Q

Lateral Cutaneous Nerve of Thigh

A
107
Q

Obturator Nerve

A
108
Q

Femoral Nerve

A
109
Q

Some Idiots Sit Pondering Problems

A
  • Superior Gluteal Nerve
  • Inferior Gluteal Nerve
  • Sciatic Nerve
  • Posterior Cutaneous Nerve of Thigh
  • Pudendal Nerve
110
Q

Superior Gluteal Nerve

A
111
Q

Inferior Gluteal Nerve

A
  • Roots
    • L5, S1, S2
  • Motor
    • Gluteus Maximus
  • Leaves pelvis to enter gluteal region through Greater Sciatic Foramen below Piriformis (landmark)
  • Runs between Gluteus Maximus and Gluteus Medius
112
Q

Sciatic Nerve

A
113
Q

Posterior Cutaneous Nerve of Thigh

A
114
Q

Pudendal Nerve

A
115
Q

Other Nerves

A
  • Nerve to Quadratus Femoris
    • L4, S1
    • Muscles
      • Quadratus Femoris
      • Gemellus Inferior
  • Nerve to Obturator Internus
    • L5, S1, S2
    • Muscles
      • Obturator Internus
      • Gemellus Superior
116
Q

Arteries

A
  • Abdominal Aorta
    • Common Iliac Arteries
      • Internal Iliac Artery
        • Supplies
          • Pelvic structures
          • Gluteal region
          • Thigh
        • Obturator a.
        • Inferior Gluteal a.
        • Superior Gluteal a.
      • External Iliac Artery
        • Becomes Common Femoral a.
  • Common Femoral Artery
    • Landmark
      • Inguinal Ligament
      • Enters Femoral Triangle
    • Divisions
      • Deep Femoral Artery
        • Branches
          • Lateral Circumflex a.
            • Supplies lateral thigh
          • Medial Circumflex a.
            • Supplies head and neck of femur
        • Terminates as perforating branches at Adductor Magnus
      • Superficial Femoral Artery
        • Travels through Adductor Canal
        • Bottom of Femoral Triangle to Adducotr Hiatus (opening in Adductor Magnus)
        • Becomes Popliteal a.
  • Popliteal Artery
    • Descends along posterior thigh
    • Passes through Popliteal Fossa
      • Between Gastrocnemius and Popliteus
    • Gives genicular branches to supply knee joiont
    • Terminates at lower border of Popliteus
      • Anterior Tibial a.
      • Posterior Tibial a.
  • Anterior Tibial Artery
    • Enters anterior compartment of leg
    • Passes anteriorly between Tibia and Fibula
    • Through aperture in Interosseous Membrane
    • Descends inferiorly down leg to foot
    • Becomes Dorsalis Pedis Artery
      • Supplies tarsal bones and dorsal aspect of metatarsals
      • Enters sole of foot between metatarsals 1 and 2 to anastomose with Lateral Plantar Artery to form Deep Plantar Arch
  • Posterior Tibial Artery
    • Descends inferiorly along superficial surface of deep leg muscles
      • Fibular Artery
        • Supplies muscles in lateral compartment of leg and adjacent muscles in posterior compartment
    • Enters sole of foot through Tarsal Tunnel
    • Terminates
      • Lateral Plantar Artery
        • Large
        • Deep Plantar Arch
      • Medial Plantar Artery
        • Small
117
Q

Popliteal Fossa Contents

A
  • Tibial Nerve
  • Common Fibular Nerve
  • Small Saphenous Vein
  • Popliteal Vein
  • Popliteal Artery
    • Susceptible to aneurysms
118
Q

Put My Leg Down Please

A
  • Deep Femoral Artery
    • Profunda Femoris (Deep Femoral) Artery branches
    • Medial Circumflex Femoral a.
    • Lateral Circumflex Femoral a.
    • Descending branch of lateral circumflex femoral a.
    • Perforating arteries
119
Q

Veins

A
  • Superficial Venous System
    • Small Veins
    • Located in subcutaneous tissue
  • Deep Venous System
    • Large Veins
    • Located in deep fascia of lower limb
    • Accompany arterial system of lower limb
  • Perforating Veins
    • Connect deep and superficial veins
  • Foot
    • Deep Plantar Venous Arch
    • Lateral Plantar Veins
    • Medial Plantar Veins
    • Drain to Posterior Tibial Vein
    • Deep veins of foot accompany Dorsalis Pedis a.
    • Drain into Anterior Tibial veins
  • Deep Popliteal Vein
    • Behind knee from anterior and posterior Tibial v.
    • Drains Fibular v.
    • Drains into Femoral v.
  • Deep Femoral Vein
    • Runs medially
    • Drains into Femoral v.
  • Femoral Vein
    • Adductor Canal to Inguinal Ligament
    • Drains to External Iliac Vein
  • External Iliac Vein
  • Common Iliac Vein
  • Inferior Vena Cava
  • Dorsal Venous Arch
    • Passes behind Lateral Malleolus and ascends posterior leg
    • Small Saphenous Vein
      • Pierces deep fascia of Popliteal Fossa to join Popliteal v.
      • Pierces Popliteal Fossa to enter diamond
        • Between heads of Gastrocnemius
        • Empties into Popliteal Vein
    • Great Saphenous Vein
      • Arises from medial aspect of Dorsal Venous Arch
      • Ascends anterior to Medial Malleolus
      • Drains into Femoral Vein in Femoral Triangle
  • Varicose Veins
    • Valves prvent blood from flowing backwards
    • Most common in superficial veins of legs

Human Form (3 decks)

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