Lower limb Flashcards
List the structures of the femur
- Head of femur
- Neck of femur
- Inferior acetabular notch = break at edge of socket
- Transverse acetabular ligament = ligament across inferior acetabular notch
- Greater trochanter
- Lesser trochanter
- Lateral and medial condyle
- Patellar surface
Label the structures of the femur
List the muscles of the anterior thigh
- Sartorius
- Quadriceps
- Rectus femoris
- Vatus lateralis
- Vatus intermedius
- Vastus medius
- Poas
- Iliacus
- Tensor fascia lata
Describe the site, attachment, action and nerve supply of the sartorius muscle
- Site: Anterior thigh
- Attachments: ASIS - medial aspect of tibia
- Movement: hip flexion and lateral rotation, knee extension
- Nerve supply: femoral
Describe the site, attachment, action and nerve supply of the psoas and iliacus muscle
Psoas
- Site: anterior hip
- Attachment: lumbrar spine - lesser trochanter
- Movement: hip flexion, trunk flexion
- Nerve supply: branch of lumbar plexus
Iliacus
- Site: anterior hip
- Attachment: Iliac fossa - lessser trochanter
- Movement: Hip flexion
- Nerve supply: femoral
Describe the site, attachment, action and nerve supply of the quadriceps muscles
Rectus femoris
- Site: anterior thigh
- Attatchment: attaches to the ASIS - tibial tuberosity via quadriceps tendon
- Movement: Knee extension, hip flexion
- Nerve supply: femoral nerve
Vastus lateralis, vastus intermedius and vastus medialis
- Site: Vastus lateralis - antero-lateral thigh, vastus intermedius - anteior thigh. vastus medialis - antero-medial thigh
- Attatchment: attach to femur - tibial tuberosity via quadriceps tendon
- Movemement: knee extension
- Nerve supply: femoral nerve
Describe the location, action and nerve supply of the tensor fascia lata
Location: Fascia lata lies within fascia of antero-lateral hip
Role: By tensing the fascia lata it provides lateral support to the knee as the knee comes into extension
Nerve supply: femoral nerve
Describe the borders ( + floor and roof) and contents of the femoral triangle
Muscles
Borders
- Lateral border - Sartorius
- Medial border - Adductor longus
- Superior border - Inguinal ligament
- Floor - Pectineus, distal tendon of iliacus and psoas
- Roof - skin
Innervation - Femoral
- Nerve
- Artery
- Vein
- Y-fronts (i.e., the midline)
Label the structures of the femoral triangle
Label the structure of the anterior thigh and leg. Also mention any muscles that are deep and not shown
Vastus intermedialis is deep to rectus femoris
List the muscles of the medial thigh and their main role
Gracialis
Adductor muscles
- Adductor longus
- Adductor Brevis
- Adductior magnus
Pectineus
Role: Adduction of lower limbs
Which muscle in the medial compartment of the thigh has a role in adduction AND extension of the hip joint?
Adductor magnus
Describe the site, attachment, action and nerve supply of Gracillis
- Site - medial thigh
- Attatchment - heads from pelvis, along medial side and attaches to medial aspect of tibia. Shares attachment with sartorius and semitendinosus
- Action - Hip adduction, knee flexion
- Nerve supply - Obturator nerve
Describe the site, attachment, action and nerve supply of the adductor muscles
Adductor longus (most superficial and longest muscle)
Adductor brevis - deep and proximal to adductor longus
Adductor magnus - proximal to adductor brevis and largest, most powerful muscle of the hip
Attachment: body of pubis, inferior to pubic crest and lateral to the pubic symphysis
Movement: Hip adduction
Innervation: obturator nerve
Describe the site, attachment, action and nerve supply of pectineus
- Site: Antero-medial thigh
- Attachment: Body of pubis - medial aspect of tibia
- Movement: hip adduction
- Nerve supple: femoral nerve
a) What muscles do the posterior portion of the adductor muscles share an attachment with? Where is this attachment?
b) A portion of the adductor magnus of the ‘hamsting portion’ will recieve the same nerve supply. What is the nerve supply?
a) Posterior portion of the adductor muscles shares an attachment with the 3 hamstring muscles. The attachment is the ischial tuberosity
b) Sciatic nerve
Label the structures of the medial thigh
Label the structures of the medial thigh
List the muscles in the posterior thigh and describe their main action and their nerve supply
- Biceps femoris
- Semimembranosus
- Semintendinosus
Main adduction: hip extension and knee flexion
Nevre supply: Sciatic nerve
Label the muscles of the posterior thigh
Describe the site, attachment, action and nerve supply of the 3 hamsting muscles
Semimembranosus
- Site - posterior thigh
- Attachment - Ischial tuberosity - medial aspect of tibia (pes anserine insertion)
- Action - Hip extension, knee flexion, medially rotates leg of unplanted limb
- Nerve supply - Tibial portion of sciatic nerve
Semitendinosus
- Site - posterior thighAttachment - ischial tuberosity- postero-medial aspect of tibia. Reflection gives oblique popliteal ligament
- Action - Hip extension, knee flexion, medially rotates leg of unplanted limb
- Nerve supply - Tibial portion of sciatic nerve
Biceps femoris - short head and long head (deep to long head)
- Site -posterior thigh
- Attachment - ischial tuberosity (long head) and linea aspera (short head) to head of fibula
- Action - Hip extension, knee flexion, laterally rotates leg of unplanted limb
- Nerve supply - Tibial portion of sciatic nerve (long head), Common peroneal (fibular) portion of sciatic nerve (short head)
List the muscles of the gluteal region
- Gluteal maximus
- Gluteal medius
- Gluteal minimus
- Piriformis
- Obturator internus
- Superior and inferior gemelli
- Obturator externus
- Quadratus femoris
Describe the site, attachment, action and nerves supply of the gluteal muscles
Gluteal maximus
- Site - Posterior hip
- Attachment: Ilium, sacrum, coccyx and sacrotuberous ligament - posterior femur and lateral aspect of tibia via iliotibial tract
- Function: Hip extension
- Innervation: Inferior gluteal nerve
Gluteus medius and gluteus minimus
- Site: postero-lateral hip
- Attachment: Ilium - greater trochanter
- Action: Hip abduction and medial/internal rotation of hip
- Innervation: Superior gluteal nerve
Describe the site, attachments, nerve supply and action of the following muscles:
a) Piriformis
b) Superior and inferior gemelli
a) Piriformis
- Site - posterior hip
- Attachments - sacrum - greater trochanter
- Action - lateral hip rotation
- Nerve supply - sacral plexus
b) Superior and inferior gemelli
- Site - posterior hip
- Attachments - ischial spine (inferior), ischial tuberosity (superior) - greater trochanter
- Action - lateral hip rotation
- Nerve supply- nerve to obturator internus (superior) and nerve to quadratus femoris (inferior)
Describe the site, attachment, action and nerve supply of obturator internus and obturator externus
Obturator internus
- Site -posterior hip
- Attatchment - Internal aspect of obturator membrane - greater trochanter
- Function - lateral/external hip rotation
- Innervation - Nerve to obturator internus
Obturator externus - lateral short rotator muscles
- Sire - posterior hip
- Attachment - External aspect ofobturator membrane - greater trochanter
- Function - Lateral hip rotation
- Innevation: Obturator nerve
Describe the site, attachment, action and nerve supply of quadratus femoris
- Site: posterior hip
- Attatchment: Ischial tuberosity - greater trochanter
- Action: External/lateral rotation of hip joint
- Nerve supply: Quadratus femoris
Label the muscles of the gluteal region
List the muscles of the anterior leg, their general movement and their innervation
Muscles
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
- Peroneus (fibularis) longus
Movemement: Dorsal flex ankle joint
Innervation: Deep peroneal/fibular nerve
Describe the site, attachment, action and nerve supply of
a) Tibialis anterior
b) Extensor digitorum longus
c) Extensor hallucis longus
a) Tibialis anterior
- Site: anterior leg
- Attachment: upper lateral aspect tibia - 1st MTP/midfood
- Action: Ankle dorsiflexion, ankle invesion. Supports medial longitudinal arch of foot
- Nerve supply: Deep peroneal (fibular) nerve
b) Extensor digitroum longus (splits into 4 tendons distally)
- Site:anterior leg
- Attachment: upper aspet of tibia, interosseous membrane and fibula
- Action: Ankle dorsiflexion of lateral 4 digits
- Nerve supply: deep peroneal (fibular) nerve
c) Extensor hallucis longus
- Site: anterior leg
- Attachment: upper aspect of membrane and fibula
- Action: Ankle dorsiflexion, extension of great toe
- Never supply: deep peroneal (fibular) nerve
Label the muscles of the anterior leg
List the muscles of the lateral leg, their attachment, function and innervation
Muscles
- Fibularis longus - Superfiical to brevis. Attaches to fibula and medial aspect of foot
- Fibularis brevis - Deep to longus. Attaches to fibula and and lateral aspect of foot
- Fibualris tertius - small muscle branching from extensor digitorum. Attaches to lateral aspect of foot
Function - ankle eversion
Innervation - Common fibular nerve
Describe the division of the common fibular nerve
- Divides into a ‘deep fibular nerve’ branch by the anterior department and a ‘superficial fibular nerve’ that supplies the fibular muscle
- Superficial branch travels between the muscles innervating them before appearing in the subutaneous branch supplying the lateral side of the leg before supplying the skin on the top of the foot
Label the structures of the lateral leg
Describe the features that contribute to the direct tracking of the patella and prevent damage of it
- Raised lateral femoral condyle - Resists lateral dislocation of the patella
- Horizontal fibres of vastus medialis - The horizontal fibres of vastus medialis counteract the lateral pull of the quadriceps group of muscles
Why is anterior knee pain more common in women than in men?
The line of the ankle of the femur is more oblique due to wider nature of the female pelvis which is adapted for childbirth
Describe the consequences of patient with a compression of the deep peroneal nerve
- Muscles supplied by deep peroneal nerve will not function anymore
- This leads to a condition called ‘foot drop’ where you can’t lift your toes off the floor
- This becomes a problem when walking, toes do not lift up the floor and get dragged along
- People with foot drop can be seen with scuff marks on the toe of their shoe beacuse they can’t clear the floor and they might develop a high stepping gate, in order to clear the floor as they walk
Label the structures of the gluteal muscle