Lower limb Flashcards
Muscles in anterior thigh
Quadriceps Femoris, Sartorius, Pectineus, Iliopsoas
muscles in medial thigh
adductor brevis, longus and magnus, gracilis, obturator externus
muscles in posterior thigh
biceps femoris, semimembranosus, semitendinosus
gluteal muscles
gluteus maximus, minimus, medius, tensor fasia lata, prirformis, obturator internus, sup and inf gemelli, quadratus femoris
Name of Hip joint
acetabulofemoral joint
name of knee joint
tibiofemoral joint
ankle joint name
talocrural
3 bones that make up hip bone
ilium, pubis, ischium
what is the acetabular notch
permits vessels to enter joint and gives attachment for ligament of head of femur
3 ligaments around the hip joint
iliofemoral, pubofemoral, ischiofemoral
what kind of joint is tibiofemoral joint
hinge synovial
tibial plateau is deepened by…
medial and lateral meniscus
what is ACL
A-anterior cruciate ligament
P-osteriorly ans inserts on
EX-ternal lat femroal condyle
what is PCL
P-posterior cruciate runs
A-nteriorly and inserts on
IN-ternal medial femoral condyl
what does ACL prevent
anterior displacement of tibia relative to femur
what does PCL prevent
posterior displacement od tibia relative to femur
what kind of bone is patella
sesamoid
where does patella form
within tendon of quadriceps femoris
What keeps patella attached
QF muscle-QF ligament-patella-patellar ligament- tibial tuberosity
why do we have a patella?
changes the angle the quadriceps inserts on the tibia - increasing strength by 10-50% (less in flexion more in extension)
what does patella articulate with
anterior - apex inferior and attaches to patellar ligament
posterior - large lateral and smaller medial facet articulate with femur
Name the tarsal bones
medial, intermediate and lateral cuneiforms
Navicular
Talus
Cuboid
Calcaneus
what type of joint is the talocrural joint
hinge synovial joint
what bones are involved in the talocrural joint
tibia, fibula and talus
what are the movements of the talocrural joint
dorsiflexion and plantarflexion
when do most talocrural injuries occur?
when ankle is plantarflexed - less stable
why does dorsiflexion make the ankle more stable?
anterior part of trochlea fits more snugly in the mortise
parts of the deltoid ligament
Anterior Tibiotalar
Posterior tibiotalar
Tibiocalcaneal
Tibionavicular
parts of the lateral ligament
anterior talofibular
posterior talofibular
calcaneofibular
what is the most commonly sprained ligament and why
lateral - excessive INversion
what ligament bridges the calcaneous and navicular and supports the talar head
Spring (plantar calcaneonavicular) ligament
what ligaments extend between the calcaneous and the cuboid
short and long plantar ligaments
what helps maintain longitudinal arch of the foot and what is is important for
plantar ligaments and plantar aponeurosis
VIP - shock absorption
what are limb muscles grouped into compartments by
sleeves of fascia and septa
what is the name of the fascia surrounding the thigh
fascia lata
what is the function of the fascia lata
compresses muscles, increasing blood flow
3 compartments of the thigh
anterior, medial, posterior
action and innervation of anterior compartment
flexion of hip, extension of knee
femoral N
action and innervation of medial compartment
adduction of hip
obturator nerve
action and innervation of posterior compartment
extension of hip, flexion of knee
sciatic N
attachments and action of sartorius muscle
ASIS to medial proximal tibia
flex, abduct, laterally rotate hip; flex knee
attachments and action of pectineus
pectineal line of pubis to pectineal line of femur
Adduct, flex hip
what are the 4 heads of the quadriceps femoris
rectus femoris
vastus medialis
vastus lateralis
vastus intermedius
origin of the 4 heads of the quadriceps femoris
RF- AIIS
VM-intertrochanteric line, linea aspera
VL - greater trochanter, linea aspera
VI- anterior femur
where do the heads of the quadriceps femoris insert
patella
what is the action of quadriceps femoris
extend knee, RF flexes hip
what 2 muscles make up iliopsoas
psoas major and iliacus
origin of iliopsoas
PM- T12-L5 vertebrae
Iliacus - Iliac fossa
insertion and action of iliopsoas
insert: lesser trochanter
action: main flexor of hip
what are the borders of the femoral triangle
S - sartorius
A - adductor longus
IL - inguinal ligament
Roof - fascia lata
Floor- iliopsoas, pectineus, adductor longus
what are the contents of the femoral triangle
N - femoral N
A - femoral artery
V - femoral vein
E - empty space
L - lymphatics
what is function of femoral canal
space for expansion of vein
what are the exceptions to the innervation of the anterior compartment of thigh
Psoas major - anterior rami of L1-L3
Pectineus - femoral AND obturator
what is femoral nerve formed by
anterior rami of L2,3,4 spinal nerve
(2,3 lift my knee, 3,4 kick the door)
what path does femoral N take
- between psoas major and iliacus
- deep to inguinal ligament
- branches in femoral triangle to motor and sensory
- innervates skin and muscles
- terminal sensory branch enters adductor canal
what is the terminal sensory branch of the femoral N
saphenous nerve
attachments and action of gracilis
pubis (inf ramus) to medial proximal tibia
adduct hip, flex knee
attachments and action of adductor longus
pubis (body) to linea aspera
adduct hip
attachments and action of adductor brevis
pubis (body and inf ramus) to linea aspera
adduct hip
attachments and action of adductor magnus
adductor: isciopubic ramus to linea aspera; adduct and flex hip
hamstring: ischial tuberosity to adductor tubercle; extend hip
attachments and action of obturator externus
obterator membrane to greater trochanter
laterally rotate hip
where is the adductor canal
between femoral triangle and adductor hiatus, deep to sartorius
walls on adductor canal
anterolateral: vastus medialis
posterior: adductor longus and brevis
opens inferiorly to adductor hiatus
contents of adductor canal
N to vastus medialis
Saphenous N
Femoral artery and vein
what is the adductor hiatus
an opening in adductor magnus tenson
what passes through adductor hiatus to get to where
femoral vessels to enter popliteal fossa - now popliteal artery and vein
what nerve innervates medial compartment of thigh
obturator nerve
what is obturator n formed by
L2,3,4 anterior rami
path of obturator nerve
- medial to psoas major
- exits pelvis via obturator canal
- divides into anterior and posterior branch
- pass anterior and posterior to adductor brevis
- innervate skin and muscles of medial thigh
what is the exception for innervation by obturator n in medial compartment
hamstring part of adductor magnus - sicatic nerve
what causes varicose veins
damaged valve allows backflow from deep to superficial veins
buildup of blood
treatment for varicose veins
surgical removal, laser therapy, sclerotherapy
origin, ascension and drainage of great saphenous vein
O - medial foot
A - medial leg, thigh
D -femoral vein
origin, ascension and drainage of small saphenous vein
O - lateral foot
A - posterior leg
D - popliteal vein
what does iliohypogastric and ilioinguinal supply
abdominal skin and muscles
what does genitofemoral N supply
scrotal muscle and sensation to medial thigh
what does lateral femoral cutaneous n supply
sensation to lateral thigh
what is the lumbar plexus
plexus of nerves formed by L1-L4 anterior rami
where is lumbar plexus located
posterior to psoas major muscle
what is the action of the muscles in the gluteal region
muscles that abduct and laterally rotate hip
what is the greater sciatic foramen
an opening allowing structures from pelvis to enter gluteal region
what is the iliotibial tract
thickening of fascia lata, inserts on lateral tibial condyle
attachment, function and innervation of Tensor Fascia Lata
A - iliac tubercule - iliotibial tract
F - flex hip, stabilise knee
I - superior gluteal nerve
what is iliotibial band syndrome
overuse injury, pain as band passes over lateral femoral epicondyle or greater trochanter
attachment, function and innervation of Gluteus maximum
A - sacrum, sacrotuberous ligament, ilium -> iliotibial tract, gluteal tuberosity
F - extend, laterally rotate hip
I - inferior gluteal nerve
attachment, function and innervation of gluteus medius
A - ilium (between post and ant gluteal lines) ->greater trochanter
F - abduct, medially rotate hip
I - sup. gluteal n
attachment, function and innervation of gluteus minimus
A - ilium (between ant and inf gluteal lines) ->greater trochanter
F - abduct, medially rotate hip
I - sup. gluteal n
What are the 5 muscles that rotate the hip
Piriformis
Sup. Gemellus
Obturator Internus
Inf Gemellus
Quadratus Femoris
where do the hip rotators originate
Piriformis - sacrum
Sup. Gemellus - ischial spine
Obturator Internus - obturator membrane
Inf Gemellus - ischial tub
Quadratus Femoris - ischial tuberosity
where do the hip rotators insert
greater trochanter
function of the 5 muscles around the hip joint
laterally rotate extended hip, abduct flexed hip
innervation of the muscles around the hip joint
Nerve to piriformis
N to obturator internus (+sup.gem)
N to quadratus femoris (+inf.gem)
where is the sacral plexus located
anterior to piriformis
what is the sacral plexus formed by
L4-S4 anterior rami
what is Trendelenburg Gait
gluteus medius impaired. it keeps pelvis steady when contralateral limb off ground. if left affected, falls to right
Attachment, innervation and action of hamstring muscles
Attach: ischial tuberosity
I: Sciatic (tibial division)
A: extend hip and flex knee
what are the 3 hamstring muscles
semitendinosus ->tibia
semimembranosus->tibia
biceps femoris (long head)->fibula
what is the non-hamstring muscle in the posterior compartment
biceps femoris (short head)
attachments, innervation and action of bicep femoris short head
linea aspera of femur to fibula
I: sciatic fibular division
A: flex knee
what muscles insert on medial proximal tibia (Pes anserinus)
Sgt Goose
Sartorius, Gracillus, semiTendinosus
where does sciatic N originate
L-4-S3 anterior rami
what path does sciatic n take
deep to biceps femoris
enters popliteal fossa
divides into tibial and common fibular n
causes of sciatica
intervertebral disc is bulging and compressing any of the L4-S3 nerve roots
compression by piriformis due to spasm or variation in exit of sciatic n
what is sciatica
pain felt radiating along the course of the sciatic n
what are the borders of the popliteal fossa
biceps femoris(superloaterally)
semitendinosus and semimembranosus (superomedially)
medial and lateral heads of gastrocnesmius (inferiorly)
roof: popliteal fascia, skin
floor: femur, popliteus muscle
contents of popliteal fossa
tibial and common fibular n
small saphenous vein
fat, lymph nodes
popliteal artery and vein
what are the 3 types of muscle contraction
concentric, isometric, eccentric
what happens in concentric muscle contraction
muscle contracts and shortens
what happens in isometric muscle contraction
muscle contracts but length does not change
what happens in eccentric muscle contraction
muscle contracts and lengthens
what are agonists
muscles causing the movement by contraction
what are antagonists
slowly relaxes as agonist contracts would usually produce opposing movement
what are synergists
contract at same time as agonist
No. of muscles in posterior compartment of lower limb, action @ ankle and innervation
7
plantarflexion
Tibial
No. of muscles in anterior compartment of lower limb, action @ ankle and innervation
4
dorsiflexion
deep fibular
No. of muscles in lateral compartment of lower limb, action @ ankle and innervation
2
eversion
superficial fibular
what is leg surrounded by
crural fascia
what are the superficial muscles of the posterior compartment of the leg
plantaris
gastrocnemius
soleus
what are the deep muscles of the posterior compartment of the leg
popliteus
flexor digitorum longus
tibialis posterior
flexor hallucis logus
Gastrocnemius origin, action
medial and lateral femoral condyles -> calcaneal tendon
explosive actions, flex knee
Soleus origin, insertion, action
fibula&soleal line of tibia -> calcaneal
standing and musculovenous pump
plantaris origin, insertion, action
femur -> calcaneal tendon
weak plantarflexion, proprioceptive
popliteus origin, insertion, action
lateral femoral condyle -> post. proximal tibia
unlock and weakly flex knee
flexor hallucis longus origin, insertion, action
fibula, interosseous membrane -> distal phalanx 1
plantarflex, flex hallux
tibialis posterior origin, insertion, action
fibula, interosseous membrane, tibia->navicular, cuneiforms, cuboid, 2-4 metatarsals
plantarflex, inverts
flexor digitorum longus origin, insertion, action
tibia-> distal phalanges 2-5
flexes digits 2-5
where is the tarsal tunnel
posterior to medial malleolus and deep to flexor retinaculum
what is retinaculum
a fascial band that holds tendons down and prevents bowstringing
tarsal tunnel contents
T ibialis posterior
flexor Digitorum longus
posterior tibial Artery
Vein
tibial Nerve
flexor Hallucis longus
what is the medical term for shin splints
medial tibial stress syndrome
what structures are in the superficial fascia of the posterior leg
sural n and small saphenous vein
fibularis longus origin, insertion, action
originate on fibula, pass posterior to lateral malleolus
runs under foot->1st metatarsal, medial cuneiform
evert and plantarflex
fibularis brevis origin, insertion, action
originate on fibula, pass posterior to lateral malleolus
metatarsal 5
evert and plantarflex
fibularis tertius origin, insertion, action
interosseous membrane and fibula->5th metatarsal
dorsiflex, evert
extensor digitorum longus origin, insertion, action
tibia, interosseous membranem fibula-> phalanges of digits 2-4
dorsiflex, extend digits 2-4
extensor hallucis longus origin, insertion, action
interosseous membrane and fibula->distal phalanx of hallux
dorsiflex, extend digit 1
tibialis anterior origin, insertion, action
tibia and interosseous membrane-> 1st metatarsal, medial cuneiform
dorsiflex, invert
what is bi-pedal walking due to
fibularis longus insertion moved medially across sole
development of fibularis tertius
what results from deep or common fibular nerve damage
weak dorsiflexion, high stepping gait and foot drop
describe the tibial n path
under soleal arch
between 2 layers of posterior compartment
tarsal tunnel
divides into medial and lateral plantar n
what 2 nerves are in the posterior leg
tibial and common fibular
what are the main vessels in the posterior leg
popliteal a divides into posterior tibial a and anterior tibial a
