Lower limb Flashcards
What is the angle of the neck of femur to the shaft
135 degrees
When the intertrochanteric line continues past the lesser trochanter what is it known as
Pectineal line
The ileofemoral ligament attaches where
Intertrochanteric line
Intracapsular NOFs risk injury to which artery
Medial femoral circumflex artery
Where is the linea aspera found
On the posterior aspect of the shaft of the femur
Where is the adductor tubercle of the femur and what attaches there
At the end of the medial supracondylar line, the adductor Magnus attaches there
The intercondylar fossa at the distal end of the femur has facets for the attachment of what
ACL
PCL
What type of bone is the patella
Sesamoid bone
How many facets does the patella have and what do they articulate with
2 facets on the posterior surface
Medial facet - articulates with the medial condyle of the femur
Lateral facet - articulates with the lateral condyle of the femur
What are the two functions of the patella
Leg extension - enhances the leverage that the quadriceps tendon can exert on the femur, increasing the efficiency of the muscle
Protection - protects anterior aspect of joint
Describe the proximal tibia
Widened by medial and lateral condyles to aid weight bearing - these form a flat surface known as the tibial plateau which articulates with the femoral condyles
In-between the condyles is the intercondylar eminence which is the main site for the attachment of ligaments and menisci
What is the shape of the tibia
Prism shaped
Where is the soleal line found
On the posterior surface of the tibia
Where soleus inserts
Where does the patella ligament attachment
Onto the tibial tuberosity on the anterior surface of the tibia
Where on the tibia is appropriate for IO access
Anteromedial surface 2-3cm below the tibial tuberosity
Proximal to the medial malleolus
The tendon of tibialis posterior is found on a groove of which bone
Posterior surface of the tibia
What are the 3 articulations of the fibula
Proximal tibiofibular joint - articulates with the lateral condyle of the tibia
Distal tibiofibular joint - articulates with the fibular notch of the tibia
Ankle - articulates with the talus
Which malleolus is more prominent
Lateral malleolus
How many tarsal bones are there and what are they called
7
Talus
Calcaenus
Navicular
Cuboid
Lateral, intermediate and medial cuneiform
How are the tarsal bones organised
3 rows
Proximal - talus, calcaneus
Intermediate - navicular
Distal - cuboid + 3 cuneiforms
What are the 3 articulations of the talus
Ankle joint - between the talus and the bones of the leg
Subtalar joint - between the talus and the calcaneus
Talonavicular joint - between the talus and navicular
What is the main function of the talus
To transmit force to the calcaneus
It is wider anteriorly compared to posteriorly which gives additional stability
Which is the largest tarsal bone
Calcaneus
What are the articulations of calcaneus
Subtalar (talocalcaneal joint) - between the calcaneus and the talus
Calcaneocuboidal joint
Where does the Achilles tendon attach
The calcaneal tuberosity on the posterior aspect of the calcaneus
Tibialis posterior tendon inserts into which tarsal bone
Navicular
The plantar aspect of the cuboid has a groove for which tendon
Fibularis longus
Which muscles attach to the medial cuneiform
Tibialis anterior
Tibialis posterior
Fibularis longus
Which muscles attach to the lateral cuneiform
Flexor hallucis brevis
Stress fractures of the metatarsal bones commonly occur where
Necks of 2nd and 3rd metatarsal
Proximal 5th metatarsal
The fibrocartilaginous collar around the hip joint is what
Acetabular labrum
Where does the joint capsule of the hip extend to
Edge of acetabular proximally
Edge of intertrochanteric line anteriorly and femoral neck posteriorly distally
What are the intracapsular ligament of the hip joint
Ligament of head of femur
What are the extracapsular ligament of the hip joint
Ileofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Describe the ileofemoral ligament
Y shaped ligament
Arises form the anterior inferior iliac spine and then bifurcates before inserting into the intertrochanteric line of the femur
Prevents hyperextension
Describe the pubofemoral ligament
Spans between the superior pubic rami and intertrochanteric line of the femur reinforcing the joint anteriorly and inferiorly
Prevents abduction and extension
Describe the ischiofemoral ligament
Spans between the body of the ischium and the greater trochanteric line, reinforces the capsule posteriorly
Prevents hyperextension, holds femoral head in joint
What is the vascular supply of the hip
Medial and lateral circumflex femoral arteries
Branches of the profunda femoris arteries
Superior and inferior gluteal arteries also provide some supply
What does the spiral orientation of the external hip ligaments allow
For them to become tighter when the joint is extended
Describe the reciprocal fashion in which the ligaments and muscles of the hip joint work
Anteriorly - where the ligaments are strongest, the medial flexor are fewer and weaker
Posteriorly - where the ligaments are weakest, the medial rotators pull the head of the femur into the acetabulum
Which muscles are responsible for flexion of the hip
Iliopsoas
Rectus Femoris
Sartorius
Pectineus
Which muscles are responsible for extension of the hip
Gluteus maximus
Semimembranous
Semitendinous
Biceps femoris
Which muscles are responsible for abduction of the hip
Gluteus medius
Gluteus minimus
Piriformis
Tensor Fascia Latae
Which muscles are responsible for adduction of the hip
Adductors longus, brevis and Magnus
Pectineus
Gracilis
Which muscles are responsible for lateral rotation of the hip
Biceps femoris
Gluteus maximus
Piriformis
Assisted by Obturators, gemelli and quadratus femoris
Which muscles are responsible for medial rotation of the hip
Anterior fibres of gluteus medius and minimus, tensor fascia latae
What restricts extension at the hip
Iliofemoral ligament and the joint capsule
What kind of hip dislocation is most common and why
Posterior dislocation
Femoral head is forced posteriorly and tears through the posterior and inferior aspect of the joint capsule where it is weakest
Which nerve is at risk in a posterior dislocation
Sciatic nerve
What are the articulating surfaces of the knee
Tibiofemoral
Patellofemoral
What is the blood supply of the knee
Supplied by the genicular anastomosis which is formed from genicular branches of the femoral and popliteal arteries
What are the menisci of the knee formed from and what is their function
Fibrocartilage discs
2 functions - to deepen the articular surface of the tibia, increasing stability of the joint
To act as shock absorbers
What is the medial meniscus attached to
The tibial collateral ligament
The joint capsule
Intercondylar attachment
How many bursa are associated with the knee and what are they
4
Suprapatellar
Prepatellar
Infrapatellar
Semimebranous
Which bursa in the knee is split into two and where is it found
Infrapatellar bursa
Deep bursa - lies between the tibia and the patellar ligament
Superficial bursa - patella ligament and the skin
Which bursa is found at the posterior aspect of the knee joint
Semimembranous
Name the ligaments associated with the knee
Patellar ligament
Medial collateral ligament
Lateral collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament
Where does the anterior cruciate ligament attach
Anterior intercondylar region of the tibia, blending with the medial meniscus
Ascends posteriorly to attach to the femur in the intercondylar fossa
What is the function of the ACL
Prevents anterior dislocation of the knee
Where does the posterior cruciate ligament attach
Attaches at the posterior intercondylar region of the tibia, ascends anteriorly to attach to the anteromedial condyle
What is the function of the PCL
Prevents posterior dislocation of the knee
What are the movements of the knee
Extension
Flexion
Lateral rotation
Medial rotation
Which muscles facilitate knee extension
Quadriceps femoris
Which muscles facilitate knee flexion
Hamstrings
Gracilis
Sartorius
Popliteus
Which muscles facilitate lateral rotation of the knee
Biceps femoris
Which muscles facilitate medial rotation of the knee
Semimembranous
Semitendinous
Gracilis
Sartorius
Popliteus
What is housemaids knee
Prepatellar bursitis
Caused by friction between the skin and the patella
What is clergyman knee
Infrapatellar bursitis
Caused by friction between the skin and the tibia
What is the unhappy triad of the knee
rupture of the medial meniscus, medial collateral ligament and ACL
What type of joint is the proximal tibiofibular joint
Plane type synovial joint - bones glide over each other to produce movement
Which structures support the proximal tibiofibular joint
Anterior and posterior superior tibiofibular ligaments
Lateral collateral ligament of the knee joint
Biceps femoris
What is the blood supply
Inferior genicular arteries and anterior tibial recurrent arteries
Which nerve innervates the proximal tibifibular joint
Common fibular nerve
Nerve to popliteus
What type of joint is the distal tibiofibular joint
Fibrous joint
What structures support the distal tibiofibular joint
Interosseous membrane
Anterior and posterior inferior tibiofibular ligaments
Inferior transverse tibiofibular ligament
What does the posterior inferior ligament continue as
Inferior transverse tibiofibular ligament
What is the arterial supply of the distal tibiofibular joint
Fibular artery
Anterior and posterior tibial arteries
What is the nerve supply of the distal tibiofibular joint
Deep peroneal nerves
Tibial nerve
Describe the ankle joint
Hinge joint
Formed by the tibia, fibula and talus
Tibia and fibula bound together by strong tibiofibular ligaments, forms a mortise which the body of the talus snugly fits in
What are the movements of the ankle joint
Dorsiflexion
Plantarflexion
In which movement is the ankle joint less stable
Plantarflexion
Describe the medial ligament of the ankle
Medial ligament arises from the medial malleolus, spans out to create four ligaments which attach to the talus, calcaneus and navicular bones
What is the function of the medial ligament
To resist over-eversion of the foot
Describe the lateral ligament of the ankle
Lateral ligametn arises from the lateral malleolus, it consists of 3 distinct ligaments
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
What is the function of the lateral ligament
To resist over inversion of the foot
which muscles facilitate plantarflexion
Muscles in the posterior compartment of the the leg
Gastrocnemius
Soleus
Plantaris
Posterior Tibialis
Which muscles facilitate dorsiflexion
Muscles in the anterior compartment of the leg
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
What is the arterial supply of the ankle
Malleolar branches of the anterior tibial, posterior tibial and fibular arteries
Why is the lateral ligament of the ankle more likely to be damaged
It is weaker than the medial ligament
It resists inversion
Which is the ligament most likely to be irreversibly damaged
Anterior talofibular ligament
What is a Potts fracture
A bimalleolar fracture (lat and medial malleolus)
Trimalleolar fracture (lat, medial malleoli and distal tibial fracture)
Which bones articulate in the subtalar joint
Posterior talar surface
Posterior calcaneal articular facet
Which 3 ligaments support the subtalar joint capsule
Posterior talocalcaneal ligament
Medial talocalcaneal ligament
Lateral talocalcaneal ligament
Which ligament supports the subtalar joint within the joint capsule and where is it found
Interossesous talocalcaneal ligament
Found in the sinus tarsi - small cavity between the talus and calcaneus
What is the movements of the subtalar joint
Eversion
Inversion
Which muscles produce the movements at the subtalar joint
Eversion - lateral compartment muscles
Inversion - tibialis anterior
What is the blood supply of the subtalar joint
Posterior tibial artery
Fibular artery
What is the nervous innveration of the subtalar joint
Plantar aspect - Medial or lateral plantar nerve
Dorsal aspect - Deep fibular nerve
The femoral artery is a continuation of which artery
External iliac artery
When does the external iliac artery form the femoral artery
When it crosses under the inguinal ligament and enters the femoral triangle
what is the first branch of the femoral artery and where does this arise
Profunda femoris
Arises from the posterolateral aspect of the femoral artery in teh femoral triangle
What are the 3 branches of the profunda femoris and what do they supply
Perforating branches - perforate adductor Magnus and supply the muscles in the medial and posterior thigh
Lateral femoral circumflex - wraps around anterior, lateral femur supplying some of lateral muscles
Medial femoral circumflex - posterior neck of femur, supplies head and neck
After the femoral triangle in which structure does the femoral artery travel
Adductor canal
Where does the femoral artery terminate and what does it become
The adductor canal ends at an opening in the adductor Magnus, the adductor hiatus, the femoral artery goes through this into the posterior compartment of the leg, becoming the popliteal arteyr
What does the obturator artery arise from and what does it branch into and supply
Internal iliac artery
Branches into
1. Anterior branch - pectinous, obturator externus, adductor muscles, gracilis
2. Posterior branch - Deep gluteal muscles
What supplies the gluteal region
Inferior gluteal artery
Which artery does the inferior gluteal artery arise from
External iliac artery
Where does the popliteal artery terminate and by dividing into what
At the inferior border of popliteus
Anterior tibial artery and tibioperoneal trunk
What does the tibialperoneal trunk divide into and what is there path
Posterior tibial artery - runs alongside the muscles in the deep posterior compartment of the leg, enters sole of foot via tarsal tunnel with the tibial nerve
Fibular artery - runs posterior to the fibula
What does the anterior tibilar artery become in the foot
Dorsalis pedis artery
Which nerve is susceptible to compression due to a politeal artery aneurysm, and how would this present
Tibial nerve
Weakened/absent plantar flexion
Paraesthesia of foot and posterolateral leg
What are the 2 main arteries in the foot
Dorsalis pedis
Posterior tibial artery
What does the posterior tibial artery divide into
Lateral and medial plantar arteries
What are the 2 venous drainage systems in the lower leg
Deep venous system
Superficial venous system
Where are the deep veins of the leg found
Underneath the deep fascia of the legs, accompanying the arteries
Where are the superficial veins of the leg found
Subcutaneous tissue
Describe the deep veins of the foot and leg
Dorsal venous arch is teh main structure in the foot, but it mainly drains to superficial veins
Some deep drainage to form the anterior tibial vein
Medial and lateral plantar veins combine to form the posterior tibial and fibular veins
On the posterior surface of the knee, the anterior tibial, posterior tibial and fibular veins unite to form the popliteal vein
Through which structure does the popliteal vein enter the thigh
Adductor canal
When the popliteal vein enters the thigh what is it known as
Femoral vein
Other than the femoral vein, what other deep veins are in the thigh
Profunda femoris vein
What does the femoral vein drain into
External iliac vein
What is the gluteal region drained by and what does this drain into
Inferior and superior gluteal veins
Drains into internal iliac vein
Describe the path of the great saphenous vein
Formed by dorsal venous arch of the foot
Ascends on medial side of leg, anterior to medial malleolus, posterior to medial condyle at knee
Terminates by draining into femoral vein immediately inferior to inguinal ligament
Describe the path of the short saphenous vein
Formed by dorsal venous arch of foot and dorsal vein of little toe
Moves up posterior aspect of leg, posterioer aspect of lateral malleolus
Between 2 heads of gastrocnemius and drains into popliteal vein
Describe the lymphatic drainage of the lower limb
Superficial vessels - which can be split into medial and lateral groups
Medial vessels - follow long saphenous vein drain into inguinal nodes
Lateral vessels - follow short saphenous vein drain into popliteal nodes
Deep lymphatic vessels - split into anterior tibial, posterior tibial and peroneal - they accompany the artery and drain into popliteal nodes
Where are the inguinal lymph nodes found
In the femoral triangle
How are the inguinal lymph nodes divided
Divided by their position in relation to the horizontal line drawn at the level of the termination of teh great saphenous vein
Above the line - superficial inguinal nodes
Below the line - sub-inguinal nodes (deep and superficial)
Where would you find the superficial inguinal nodes and what drains to them
Form a line below the inguinal ligament
Drain penis, scrotum, perineum, buttock and abdominal wall
Where would you find the superficial sub inguinal lymph nodes and what drains to them
Located on each side of the proximal section of the great saphenous vein.
They receive afferent input primarily from the superficial lymphatic vessels of the lower leg.
The popliteal nodes drain to which nodes
Deep inguinal nodes
What is the fascia lata
Deep fascial investment of the musculature of the thigh
How does the fascia late split the thigh into compartments, and how many compartments will be formed
Gives rise to 3 inter muscular septae that attach centrally to the femur dividing it into 3 compartments - anterior medial and lateral
Where is the fascia lata the thickest and why
Thickest along the superolateral aspect of the thigh, due to fascial condensations from gluteus Maximus and medius
Thick around the knee due to reinforcing fibres from the quadriceps tendon
Which intermuscular septa of the fascia lata is the strongest
The lateral intermuscular septa
What opening is found in the fascia lata and where is it
Saphenous opening
Just inferior to the inguinal ligament
What is the iliotibial tract
Longitudinal thickening of the fascia lata, strengthened superioposteriorly by fibres from gluteus Maximus
WHere does the IT tract extend from and to
Iliac tubercle to the lateral tibial condyle
What movement does the IT tract facilitate
Extensor, abductors and lateral rotator of the hip
Also provides lateral stabilisation of the hip
Where is tensor fascia lata found
From the iliac crest descending inferiorly to the super-lateral thigh
It inserts into the anterior aspect of the junction of the upper and middle third of the thigh
What is the action of tensor fascia lata
Acts as a flexor, abductor and internal rotator of the hip
Helps reduce the overall force needed to move the hip joint
It functions to tighten the fascia lata, and so abducts and medially rotates the lower limb.
What innervates tensor fascia lata
Superior gluteal nerve
What is scarpas fascia and what does it blend with in the leg
Scarpas fascia is the superficial layer of fascia of the abdominal wall, it blends with the fascia lata just below the inguinal ligament
What are the attachments of the fascia lata in the pelvis and hip region
Posterior- sacrum and coccyx
Lateral - iliac crest
Anterior - inguinal ligament, superior pubic rami
Medial - inferior ischiopubic rami, ischial tuberosity, sacrotuberous ligaments
What are the 2 groups of gluteal muscles
Superficial abductors and extendors
Deep lateral rotators
Which muscles are the superficial abductors and extendors of the gluteal region
Gluteus maximus, medius and minimis
Tensor fascia lata
Which muscles are the deep lateral rotators of the gluteal region
Quadratus femoris
Piriformis
Gemellus superior and inferior
Obturator internus
What is the blood supply of the gluteal muscles
Superior gluteal and inferior gluteal arteries - both branches of the external iliac artery
Where does gluteus Maximus attach
Originates from the gluteal (posterior) surface of the ilium, sacrum and coccyx.
The fibres slope across the buttock at a 45 degree angle and insert onto the iliotibial tract and gluteal tuberosity of the femur.
What is the action of gluteus Maximus
Main extensor of the thigh
Assists with lateral rotation
What is the innervation of gluteus Maximus
Inferior gluteal nerve
Where does gluteus medius attach
Originates from the gluteal surface of the ilium and inserts into the lateral surface of the greater trochanter.
What is the action of gluteus medius
Abduction and medial rotation
Stabilisation of the pelvis, stops it dropping to one side
What innervates gluteus medius
Superior gluteal nerve
What is the attachment of gluteus minimus
Ilieum, converges to form a tendon attaching to the greater trochanter of the femur
What is the action of gluteus minimus
Abduction and medial rotation
Stabilisation of the pelvis, stops it dropping to one side
Which 2 gluteal muscles have the same action
Medius
Minimus
What is Trendelenbrug positive and which nerve is injurid
Patient asked to stand unassisted on one leg, pelvic drop will occur on the unsupported leg
Due to weakness of gluteus medius and minimus following superior gluteal nerve injury
Which deep gluteal muscle is the most superior
Piriformis
where does piriformis attach
Anterior surface of sacrum
Greater trochanter of femur - fibres travels inferiorly and laterally through the greater sciatic foramen to insert here
What is the action of piriformis
Lateral rotation and abduction
What is the innervation of piriformis
Nerve to piriformis
Where is obturator internus found and which structure does it form a wall of
Originates from the pubis and ischium at the obturator foramen.
Attaches to the greater trochanter of the femur, having travelled through the lesser sciatic foramen
Forms the lateral wall of the pelvic cavity
What is the action of obturator internus
Lateral rotation and abduction
What is the innervation of obturator internus
Nerve to obturator internus
Where do the gemelli attach
Superior - from the ischial spine
Inferior - from the ischial tuberosity
They both attach onto the greater trochanter
What is the action of the gemelli
Lateral rotation and abduction
The gemelli have different nerve supplies, what are they
Superior - nerve to obturator internus
Inferior - nerve to quadratus femoris
Where does quadratus femoris attach
From the lateral aspect of the ischial tuberosity
Attaches to the quadrate tuberosity on the intertrochanteric crest
What is different about quadratus femoris compared to the other deep gluteal muscles
Only does lateral rotation
The others do lateral rotation and abduction
What is the innervation of quadratus femoris
Nerve to quadratus femoris
Summarise the anterior compartment of the upper limb (movement, innervation, blood supply)
Extend the lower limb at the knee
Innervation - femoral nerve
Blood supply - femoral artery
List the muscles in the anterior compartment of the leg
Psoas Major
Iliacus
Rectus femoris
Vastus Medialis
Vastus lateralis
Sartorius
Pectineus
What compromise Iliopsoas and where do they form a common tendon
Iliacus
Psoas
Form a common tendon under the inguinal ligament
What is the action of iliopsoas
Flexion of the thigh at the hip
What is the nerve supply to iliopsoas
Psoas - innervated by anterior rami of L1-3
Illacus - femoral nerve
What makes up quadratus femoris
Vastus lateralis
Vastus Intermedius
Vastus medialis
Rectus femoris
What innervates quadratus femoris
Femoral nerve
What is the combined action of quadratus femoris
Extension of the knee joint, secondary function of stabilising the patella
What is the additonal movement that rectus femoris facilitates
Flexion of the hip joint
It is the only quadriceps to cross both joints
Where does Sartorius attach to
From the ASIS to the superior, medial surface of the tibia
What is the action of sartorius
Flexor
Abductor
Lateral rotator
What innervates sartorius
Femoral nerve
Pectineus contributes to the floor of which structure
Femoral triangle
What is the action of pectineus
Adduction and flexion at the hip joint
What is the innervation of pectineus
Femoral nerve
May also get a branch from the obturator nerve
What are the muscles of the medial compartment of the thigh, what are they collectively known as and what nerve innervates them
Gracilis
Obturator externus
Adductor brevis
Adductor Longus
Adductor Magnus
Adductors of the thigh
Innervated by obturator nerve
Which is the largest muscle in the medial compartment
Adductor magnus
What are the two components of the adductor Magnus and their actions
Adductor component - adducts and flexes the thigh
Hamstring component - Adducts and extends the thigh
what is the innervation of adductor magnus
Adductor - obturator nerve
Hamstring - tibial component of sciatic nerve
The adductors attach to which part of the femur
Linea Aspera
Adductor longus forms the medial border of which structure
Femoral triangle
Adductor brevis separates which structures
Anterior and posterior branches of the obturator nerve
What are the actions of obturator externus
Adduction
Lateral rotaton
What is the function of Gracilis
Adduction of the thigh
Flexion of the knee
What are the muscles in the posterior compartment of the thigh, what is their action and innervation
Hamstrings - biceps femoris, semitendinous, semimembranous
Action - extend at the hip, flex at the knee
Innervation - sciatic nerve
Where does the tendon of biceps femoris insert
Head of fibula
What is the action of biceps femoris
Flexion at knee
Extension at hip
Lateral rotation of hip and knee
What is the innervation of the two head of biceps femoris
Long head - tibial part of sciatic nerve
Short head - common fibular part of sciatic nerve
Which hamstring is found on the medial aspect of the posterior thigh and what lies medial and deep to this
Semitendinous
Semimembranous
What is the action of semitendinous and semimembranous
Flexion of knee
Extension of hip
Medial rotation of hip and knee
The tibial part of the sciatic nerve supplies which hamstrings
Semitendinous
Semimembranous
Long head of biceps femoris
Sudden and forceful contraction of the hamstrings can produce an avulsion fracture of which structure
Ischial tuberosity
How many muscles are in the anterior compartment of the leg, what are they called, what is their combined function and what nerve supplies them
4
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Fibularis teritus
Dorsiflexion and inversion of the foot
Deep fibular nerve (L4-S1)
Which is the strongest dorsiflexor of the foot
Tibialis anterior
What lies deep to tibialis anterior
Extensor digitorum longus
What is the action of extensor hallucis longus
Extension of the toe
Dorsiflexion of the foot
Which of the dorsiflexors are not present in all individuals
Fibularis teritus
What are the muscles in the lateral compartment of the leg, what is their action and what innervates them
Fibularis longus and brevis
Action - eversion
Supplied by the superficial fibular (peroneal) nerve
Where does the tendon of fibularis longus insert
Posterior to the lateral malleolus
The posterior compartment of the leg can be subdivided into how many compartments
2 - superficial and deep
Which muscles are in the superficial posterior compartment
Gastrocnemius
Soleus
Plantaris
Which two muscles converge to form the calcaneus tendon
Gastrocnemius and soleus
What is the innervation of the superficial muscles of the posterior compartment
Tibial nerve
What is the action of the muscles in the superficial posterior compartment of the leg
Plantarflexion at the ankle joint
Flexion at the knee joint from Gastrocnemius and planters
Which 2 bursa lie in the superficial posterior compartment of the leg
Subcutaneous calcaneal bursa
Deep bursa of the calcaneal bursa
Which muscles are in the deep posterior compartment of the leg
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
Which muscle in the deep posterior compartment of the leg acts on teh knee and what does it do
Popliteus
Laterally rotates the femur relative to the tibia - unlocking the knee so that flexion can occur
Which of the muscles in teh deep posterior compartment of the leg contribute to plantarflexion
Tibialis posterior
What is the innervation of the deep posterior compartment of the leg
Tibial nerve
Which muscle in the deep posterior compartment of the leg contributes to the medial arch of the foot
Tibialis posterior
Why is the position of flexor hallucis longus in the leg odd
it is found laterally in the leg, where it runs medially in the foot to the great toe
What are the two muscles found on the dorsal aspect of the foot, what is their action and innervation
Extensor digitorum brevis
Extensor hallucis brevis
Responsible for extension of the great toe and the 4 toes,
Innervated by the deep fibular nerve
How many intrinsic muscles of the foot are there on the plantar aspect, and across how many layers
10 intrinsic muscles of the foot
Across 4 layers
Which muscles are found in the first (most superficial) layer of the plantar aspect of the foot
Abductor hallucis
Flexor digitorum brevis
Abductor digit minimi
Which muscles are found in the second layer of the plantar aspects of the foot
Quadratus plantae
Lumbricals - 4 lumbricals, each found medial to their respective tendon of flexor digitorum longus
Which muscles are in the thrid layer of the plantar aspect of the foot
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
Which muscles are in teh fourth layer of the plantar aspect of the foot
Planatr and dorsal interossei
What is the innervation of the plantar muscles of the foot and what is the general rule and exceptions
medial and lateral plantar nerves - branches of the fibular nerve
Muscles lateral - supplied by lateral plantar nerve, (medial = medial)
Interossei - all supplied by lateral plantar
Which spinal roots form the lumbar plexus
L1-L4
Which nerves arise from the lumbar plexus
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral cutaneous
Femoral
Sciatic
What is the root of the iliohypogastric nerve and what does it innervate
L1
Internal oblique and traverses abdominis
Posterolateral gluteal skin in pubic region
What is the root of the ilioinguinal nerve and what does it innervate
L1
Internal oblique and transversus abdominis
Skin of superio-medial thigh
In men - skin over penis and anterior scrotum
In women - Skin over mons pubis and labia majora
What is the root of the genitofemoral nerve and what does it innervate
L1 L2
Genital branch - cremasteric fascia, anterior scrotum/mons pubis and labia majora
Femoral branch - skin of upper anterior thigh
Which muscle does the genitofemoral nerve leave
Psoas Major
What is the root of the lateral cutaneous nerve and what does it innervate
L2, L3
Anterior and lateral thigh down to the level of the knee.
What is the roots of the femoral nerve
L2- L4
Which muscles are innervated by the femoral nerve
Anterior thigh muscles that flex the hip - Sartorius, Pectinous, Iliacus
Knee extenders - quads - rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
Which area receives sensory innervation from the femoral nerve
Anteromedial thigh
Medial side of leg and foot
Anterior cutaneous branch, branch to sartorial and branch to pectinous are anterior branches of which nerve
Femoral nerve
The saphenous nerve and branch to quadriceps femoris are posterior branches of which nerve
Femoral nerve
What are the nerve roots of the obturator nerve
L2-L4
The muscles of medial compartment of the leg are innervated by which nerve
Obturator nerve
Obturator nerve supplie sensation where
Medial thigh
What are the branches of the obturator nerves and where are they found
Anterior branch (anterior to adductor brevis)
Posterior branch (posterior to adductor brevis)
Which nerve roots form the sacral plexus
S1-S4
Which nerves from from the sacral plexus
Superior gluteal
Inferior gluteal
Sciatic
Posterior femoral
Pudendal
Which nerve roots form the superior gluteal nerve, and what does it supply
L4,L5, S1
Gluteus medius, gluteus minimus, tensor fascia lata
Which nerve roots form the inferior gluteal nerve, and what does it supply
L5, S1, S2
Gluteus maximus
Which nerve roots form the posterior femoral cutaneous nerve, and what does it supply
S1,2,3
Innervates the skin of the post thigh and leg and the perineum
Which nerves leaves and then re-enters the sciatic foramen -
Pudendal nerve
Which nerve roots form the pudendal nerve, and what does it supply
S2, S3, S4
Innervates the skeletal muscles in the perineum, external urethral sphincter, external anal sphincter and levator ani
Innervates the penis, clitoris most of the skin of the perineum
The sciatic nerve can be described as which two nerves bundled togetehr adn where do they usually bifurcate
Tibial
Common fibular nerve
Bifurcates at the apex of the popliteal fossa
The sciatic nerve passes through which quadrant of the buttock and why is this important
Lower medial quadrant
Important for giving IM injections - need to be given in the upper lateral quadrant
What is piriformis syndrome
Compression of the sciatic nerve by piriformis muscle
Clinical features include radicular pain, numbness, muscle weakness and buttock tenderness.
Summarise the motor innervations of the sciatic nerve
Posterior compartment of thigh - incl hamstring poriton of adductor magnus
Posterior calf muscles + some intrinsic feet muscles - via tibial nerve
Anterior lower leg, lateral lower leg + some intrinsic feet muscles - via common peroneal nerve
Which branches of the sciatic nerve provide sensory innervation and to where
Tibial nerve – supplies the skin of the posterolateral leg, lateral foot and the sole of the foot.
Common fibular nerve – supplies the skin of the lateral leg and the dorsum of the foot.
Which nerve roots form teh tibial nerve, and what does it supply
L4-S3
Sensory: Innervates the skin of the posterolateral leg, lateral foot and the sole of the foot.
Motor: Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.
List the muscles innervated by the tibial nerve
Gastrocnemius
Soleus
Plantaris
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Which is the only foot muscle to be innervated by the deep fibular nerve
extensor digitorum brevis
What are the 3 sensory branches of the tibial nerve
Medial calcaneal branch
Medial plantar nerve
Lateral plantar nerve
What is the sural nerve a branch of and what does it innervate
Tibial nerve - posterolateral side of the leg and the lateral side of the foot.
What does the common fibular nerve provide motor innervation to
Short head of biceps femoris
Superficial fibular nerve and deep fibular nerve are terminal branches of
Common fibular nerve
Superficial fibular nerve and deep fibular nerve give motor innervation to which muscles
Superficial fibular nerve - lateral compartment - fibularis longus and brevis
Deep fibular nerve - anterior compartment - tibialis anterior, extensor digitorum longus and extensor hallucis longus
What are the cutaneous branches of the common fibular nerve
Sural communicating nerve
Lateral sural cutaneous nerve
Where does the rural communicating nerve innervate and after combining with what
Combines with a branch of the tibial nerve to form the sural nerve, which innervates the skin over the lower posterolateral leg.
Where does the lateral sural cutaneous nerve supply
the skin over the upper lateral leg.
Which nerve sipplie the skin of the first webbed space between hallux and toe 2
Deep fibular
Where is the femoral triangle found
Superomedial aspect of the anterior triangle
Which muscles make up the medial and lateral border of the femoral triangle
Lateral - medial border of sartorius
Medial - Medial border of adductor longus
What makes up the floor of the femoral triangle
Pectineus
Iliopsoas
Adductor longus muscle
What forms the superior border of the femoral triangle
Inguinal ligament
What does the inguinal ligament act as during flexion of the hip
Flexor retinaculum - supports the contents of the femoral triangle
What is the contents of the femoral triangle
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
What is found in the femoral canal
Lymph nodes and vessels
What is enclosed femoral sheath
Femoral artery, femoral vein and canal
What are the borders of the femoral canal
Medial - lacunar ligament
Lateral - Femoral vein
Anterior - Inguinal ligament
Posterior - Pectineal ligament
What are the borders of the adductor canal
Anteromedial - Sartorius
Lateral - vastus medialis
Posterior - Adductor longus and adductor magnus
What passes through the adductor canal
Femoral artery
Femoral vein
Nerve to vastus medialis
Saphenous nerve
What is adductor canal syndrome
Compression of the femoral artery in the adductor canal by hypertrophy of the vastus medialis
What are the borders of the popliteal fossa
Superomedial border - semimembranous
Superolateral border - biceps femoris
Inferomedial border - medial head of gastrocnemius
Inferolateral border - Lateral head of gastrocnemius and planters
The popliteal fossa is continuous with what and forms the roof of which structure
Fascia lata
Popliteal fossa
What is the contents of the popliteal fossa
Med - Lateral
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve (common peroneal)
What is a bakers cyst
Semimembranous bursitis
Which nerve can be compressed from a popliteal artery aneurysm and what are the clinical features
Tibial nerve
CF: Weakened or absent plantar flexion
Paraesthesia of foot
What forms the tarsal tunnel
Medial malleolus
Medial tubercle of the calcaneus
What travels through the tarsal tunnel
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery and vein
Tibial nerve
Flexor hallucis longus tendon
