Lower limb Flashcards
Surface anatomy for the sciatic nerve in the buttock?
Midway between greater trochanter and ischial tuberosity
What is the mid inguinal point?
SA for what?
Midway between anterior superior iliac spine and pubic symphysis
Structures medial to lateral in the popliteal fossa?
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve
Each nerve in the leg supplies…
- Lat. cuteaneous nerve
- Lateral thigh
- Obturator
- Medial thigh just below the groin
- Femoral nerve
- Middle of thigh and upper knee
- Posterior cuteaneous nerve of the thigh
- Posterior thigh and middle of popliteal fossa
- Saphenous nerve (branch of femoral)
- Medial lower knee, medial lower leg and medial arch of foot (not toes), posterior medial lower leg
- Common fibular nerve
- Lateral lower leg, dorsum of foot
- Tibial nerve
- Posterior lower leg in the middle, heel and lateral foot
Contents of anterior thigh compartment?
Quadriceps and sartorius
Contents of medial thigh compartment?
Adductors and obturator nerve
Posterior thigh compartment contents?
Hamstrings and sciatic nerve
Action and innervation of Psoas major?
Hip flexion
L1-3
Action and innervation of Ilacus?
Hip flexion
Femoral nerve
Why is the leg shorted and externally rotated in NOF?
Iliopsoas attach to lesser trochanter so shortens and externally rotates the LL
Action and innervation of sartorius?
Flexes the hip, laterally rotates and abducts the hip
Femoral nerve
Action and innervation of Quadriceps femoris?
Extend the knee
Femoral nerve
Action and innervation of 3 vasti muscles?
Extend the knee
Femoral nerve
Action and innervation of rectus femoris?
Flexes the hip and extends the knee
Femoral nerve
Where does the great saphenous vein start?
The great saphenous vein forms on the dorsum of the foot as the continuation of the medial marginal vein of the foot.
2.5cm anterior to the medial malleolus
Great saphenous vein course in relation to the tibia?
It then passes anteriorly to the medial malleolus to ascend at first medial to and then posterior to the medial aspect of the tibia.
Where does the great saphenous vein lie in the thigh?
Medial
Where does the great saphenous vein enter the femoral vein?
3.5cm below and lateral to the pubic tubercle
Course of the small saphenous vein foot to PF
Lateral foot then posterior thigh
What does the saphenous vein become?
Popliteal vein
Where do superficial leg lymph drain into?
Superficial inguinal nodes inferior to the inguinal ligament
Where do deep leg lymph drain into?
Deep inguinal nodes medial to the femoral vein
What does the femoral triangle extend as?
Adductor canal
Base of the femoral triangle
Inguinal ligamentt
Boundaries of the femoral triangle
Proximal
Medial
Lateral
Inguinal ligament
Medial border of adductor longus
Medial border of sartorius
What creates the floor of the femoral triangle?
Iliopsoas
Pectineus
Adductor longus
Femoral triangle contents
NAVLY
Lateral - > Medial
Femoral nerve
F Artery
F Vein
Lymph nodes (deep)
F. A / V & femoral canal surrounded by what?
Femoral sheath
What is transmitted in the femoral canal?
Lymphatics
Where do femoral hernias occur?
In the femoral canal (below the inguinal ligament)
Which nerves may become compressed near he inguinal ligament?
Lat. cutaenous nerve of the high
Femoral canal boundaries
Medial
Lateral
Ant.
Post.
Lacunar ligament
Femoral vein
Pictineus ligament
Inguinal ligament
Surface anatomy for the F. artery
Mid inguinal point
How for the femoral blood vessels enter the popliteal fossa?
Via the adductor hiatus (distal end of the the adductor canal)
Gluteus maximus
Action
Innervation
Extension of the hip and external rotator
Inferior gluteal
Gluteus minimus
Action
Innervation
Hip abduction and medial rotation
Superior gluteal nerve
Piriformis
Action
Innervation
Lateral rotation (+ abduction)
Piriformis nerve
Which muscles are synergistic femoral lateral rotators and hip stabilisers:
piriformis, obturator internus and
quadratus femoris
3 hamstrings muscles
Biceps femoris
Semitendinosus
Semimebranosus
Biceps femoris
Action
Innervation
Knee flexion and lateral leg rotation
Sciatic nerve
Semitendinosus
Action
Innervation
Knee flexion, extend hip, medially rotate hip and knee
Sciatic nerve
Semimebranosus
Action
Innervation
Knee flexion, extend hip, medially rotate hip and knee
Sciatic nerve
Which quadrant of the buttock does the sciatic nerve run through?
Inferior medial
What causes a trendelenburg gai?
Weakness of the abductor muscles of the gluteal region (medius and minimus)
Where does the extra capsular arterial ring of the hip joint sit?
Base of the femoral neck
Gluteus medius
Action
Innervation
Abduction and medial rotation of the lower limb
Superior gluteal nerve
Borders of the popliteal fossa
Medial proximal - Semi mem / tendon
Lateral proximal - bicepsfemoris
Medial / lateral distal - heads of gastrocnemius
Deepest structure in the popliteal fossa?
Popliteal artery
4 contents of popliteal fossa
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve (common peroneal nerve)
Where does the small saphenous vein drain into the popliteal vein?
The small saphenous vein pierces the popliteal fascia and passes between the two heads of gastrocnemius to empty into the popliteal vein.
Why is the medial meniscus vulnerable to injury?
It’s anchored to the patella capsule
What muscle plays a key role in ‘unlocking the knee’
The popliteus muscle may play a role in initiating unlocking of the knee because it reverses the direction of automatic external rotation that occurs in the final stages of knee extension
Where can the common fibular nerve be damage ?
When knee struck from a lateral aspect in the extended position
Roles of the menisci
To deepen the articular surface of the tibia, thus increasing stability of the joint.
To act as shock absorbers by increasing surface area to further dissipate forces.
Which bursa is an extension of the synovial cavity of the knee
Suprapatellar bursa
Unhappy Triad (Blown Knee) - what is damaged?
A lateral force to an extended knee, such as a rugby tackle, can rupture the medial collateral ligament, damaging the medial meniscus in the process. The ACL is also affected, which completes the ‘unhappy triad’.
Soleus
Action
Innervation
Actions: Plantarflexion of the foot at the ankle joint.
Tibial nerve
Gastrocnemius
Action
Innervation
Actions: Plantarflexion at the ankle joint and flexion at the knee joint.
Innervation: Tibial nerve.
Plantaris
Action
Innervation
Actions: Contributes to plantarflexion at the ankle joint and flexion at the knee joint.
Innervation: Tibial nerve.
What bone does the achilles tendon attach to distally
Posterior calcaneus
Most powerful of the deep flexors
Flexor hallucis longus
Flexor hallucis longus
Action
Innervation
Flexes great toe
Inversion of the ankle
Maintains the medial longitudinal arch
Innervation: Tibial nerve
Flexor Digitorum Longus
Action
Innervation
Actions: Flexion of the lateral four toes.
Innervation: Tibial nerve
Tibialis Posterior
Action
Innervation
Actions: Inversion and plantarflexion of the foot. It also contributes to the medial arch of the foot.
Innervation: Tibial nerve
Ant. -> Posteror
Ligaments in the tarsal tunnel (medial foot)
Tibilais posterior (Tom)
Flexor digitorum longus (Dick)
Flexor hallucis longus (Harry)
Ant. - Posterior
All contents of the tarsal tunnel
Tibilais posterior (Tom)
Flexor digitorum longus (Dick)
Posterior tibial artery
Tibial vein (Very)
Tibial nerve (Naughty)
Flexor hallucis longus (Harry)
Fibular artery is a branch of?
Posterior tibial artery
What does the anterior tibial artery become?
Dorsalis pedis
Tibialis anterior
Action
Innervation
Dorsiflex and inversion of the foot
Deep fibular
Extensor hallucis longus
Action
Innervation
Extend big toe
Dorsiflex
Deep fibular
Extensor digitorium
Action
Innervation
Dorsiflexion
Extend 4 toes
Deep fibular
Fibularis tertius
Action
Innervation
Assist dorsiflexion and eversion
Deep fibular
Where is the common fibular nerve commonly damaged
Presentation
Close to neck of femur
Impaired dorsiflexion (high stepping gait)
Fibularis brevis
Action
Innervation
Plantar flex and eversion
Superficial fibular
Fibularis longus
Action
Innervation
Plantar flexion
Eversion
Superficial fibular (peroneal) nerve
Two retinaculum of the foot
Extensor - anteriorly
Peroneal - lateral)
Intrinsic muscles of the foot
There are two intrinsic muscles located within the dorsum of the foot – the extensor digitorum brevis and extensor hallucis brevis.
Proximal group of tarsal bones
Talus, calcaneus
Intermediate tarsal bone
Navicular
Distal tarsal bones
Cuboid & cuneiforms (3)
Medial collateral ligament of the ankle is also called?
Deltoid ligament
4 bands of the deltoid ligament
Tibioavicular
Tibiotalar x 2
Tibiocalcaneal
3 lateral collateral ligaments
Anterior talofibular
Posterior “”
Calcaneofibular
What bones form the medial longitudinal arch
Talus
Calcaneus
Navicular
3 cuneiforms
Medial metatarsals
What bones form the lateral longitudinal arch
Calcaneus, cuboid, 2 lateral metatarsals
What bones form the transverse arch
3 cuneiforms, cuboid and bases of 3 metatarsals
Deepest layer of the sole, 3 muscle groups
Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi
Medial and lateral plantar nerves are the terminal branches of ?
Tibial nerve
Which layer of the foot do the long flexor tendons lie?
2nd
In which layer of the sole does the NV plane lie?
Neurovascular plane lies
between the first and second layers
Which tendons lie in the 4th layer of the foot?
Tendons of tibialis posterior and peroneus longus are part of the fourth.
Insertion in the foot of fibularis longus?
The tendon crosses under the foot, and attaches to the bones on the medial side, namely the medial cuneiform and base of the 1st metatarsal.
Insertion in the foot of tibialis posterior?
The tendon enters the foot posterior to the medial malleolus and attaches to the plantar surfaces of the medial tarsal bones.
Femoral nerve damage presentation
Poor flexion of the hip
Inability to extend the knee
Sensory decline over the anterior and medial aspects of the thigh
Sensory loss on the medial side of the leg and foot up to the ball of the great toe
Obturator nerve damage presentation
Loss of hip adduction
Loss of sensation medial thigh
Damage to the Tibial Nerve presentation
Damage to the tibial nerve is rare, and is often a result of direct trauma, entrapment through narrow space or compression for long period of time. Damage results in loss of plantar flexion, loss of flexion of toes and weakened inversion (The tibialis anterior can still invert the foot).
Fibular nerve most commonly damaged by…
The common fibular nerve is most commonly damaged by a fracture of the fibula, or the use of a tight plaster cast.
Damage to common fibular nerve presentation
Patients with common fibular nerve damage will lose the ability to dorsiflex the foot at the ankle joint. Hence the foot will appear permanently plantarflexed – known as footdrop.
Loss of sensation over the dorsum of the foot, and lateral side of the leg.
All muscles below the knee supplied by which nerve?
Sciatic nerve ( branches of)
