Lower Limb Flashcards
What is the path of the small saphenous vein?
Passes on the lateral side of dorsum of foot, then passes below + behind lateral malleolus.
What is the path of great saphenous vein?
Passes on medial side of dorsum of foot, and in front of medial malleolus
What accompanies the small saphenous vein?
Sural nerve
What accompanies the great saphenous vein?
Saphenous nerve
What is the iliotibial tract?
Thickened lateral part of deep fascia, between iliac crest + lateral part of tibial tuberosity
What muscles are attached to the iliotibial tract?
Tensor fascia lata
Gluteus maximus muscle
What is the saphenous opening?
Found in deep fascia
Small opening
4cm below + lateral to pubic tubercle
What four muscles make up the gluteal region?
- Gluteus Maximus
- Gluteus medius
- Gluteus minimus
- Tensor fascia lata
What is the nerve supply to the gluteal region muscles?
Superior gluteal nerve
Except for the gluteus maximus which is supplied by the inferior gluteal nerve
What is the action of the gluteal region muscles?
Medial rotation
Except the gluteus maximums which does lateral rotation
What are the abductors of the hip?
Gluteus medius + gluteus minimus
What is the normal action of the abductors of the hip?
Prevent the tilting of the pelvis to the unsupported side
What is the cause of Trendelenburg gait?
Paralysis of gluteus medius/minimus muscle or injury to superior gluteal nerve
What is Trendelenburg sign?
Trunk is flexed from side to side in each step
What are the four small lateral rotator muscles of the hip joint?
Piriformis muscle
Obturator internus
Gemelli
Quadratus Femoris
What muscles are attached to the greater tuberosity?
POGQ
Abductors (gluteus medius/minimus)
Lateral Rotators (piriformis, obturator, gemelli, quadratus)
What structures pass through the greater sciatic foramen?
Piriformis
Structures above piriformis - superior gluteal vessels + superior gluteal nerve
Structures below piriformis - infer
What structures pass through both sciatic foramen?
Nerve to obturator internus muscle
Internal pudendal vessels
Pudendal nerve
What muscles make up the anterior chamber of thigh?
Sartorius
Psoas Major
Iliacus
Quadriceps
What nerve supplies the muscles of the anterior thigh?
Femoral nerve
What is the origin of the psoas major?
Transverse processes of T12 + all lumbar vertebrae
What is the insertion of the iliopsoas muscle?
Lesser trochanter of the femur
What are the four heads of quadriceps?
Vastus medialis
Vastus Lateralis
Vastus intermedius
Rectus femoris
What is the insertion of the quadriceps?
Forms a common tendon
Inserted into upper border of patella, through ligamentum patellae into tibial tuberosity
What are the boundaries of the femoral triangle?
Roof: skin, superficial/deep fascia
Medial: adductor longus
Lateral: sartorius muscle
Base: inguinal ligament
Apex: overlap of sartorius on adductor longus
Floor: APPI
Adductor longus, Pectineus, Psoas major, Iliacus
What are the contents of the femoral triangle?
Nerves:
genitofemoral nerve, lateral cutaneous branch of thigh, femoral nerve + branches
Blood vessels:
femoral artery, vein
Lymph node:
deep inguinal lymph nodes
What are the boundaries of the femoral sheath?
Anterior: fascia transveralis
Posterior: fascia iliaca
Medial + lateral: fusion of 2 fascia
What are compartments of the femoral sheath?
3 compartments
Lateral = femoral artery + femoral branch of genitofemoral nerve
Middle = femoral vein
Medial = femoral canal (fat + LN)
What are the boundaries of femoral canal?
Anterior: fascia transversalis
Posterior: fascia iliaca
Lateral: medial septum of sheath
Medial: fusion of anterior/posterior fascia
Apex: fusion of wall
Base: femoral ring
What are the boundaries of the femoral ring?
Anterior: inguinal ligament
Posterior: pectineal line + ligament
Medial: lacunar ligament
Lateral: femoral vein
What is the importance of the femoral canal?
Allows expansion of femoral vein in increased venous return
Can result in femoral hernia
What is the beginning of the femoral artery?
behind mid-inguinal point
What is the end of femoral artery?
lower end of adductor canal and as the popliteal artery
What is the clinical importance of the deep external pudendal artery?
Passes near the saphenous opening
What are the branches of the profunda fermoris artery?
Lateral and medial circumflex artery
What artery supplies the head of the femur?
Lateral and medial circumflex artery
What is the origin of the femoral nerve?
lumbar plexus
What are the roots of the femoral nerve?
posterior divisons of ventral rami of L2/3/4 spinal nerves
What does the femoral nerve supply?
Anterior compartment of thigh
Where does the saphenous nerve supply?
Branch of femoral nerve and supplies leg + foot
What are the boundaries of the popliteal fossa?
Upper medial: semimembranous + semitendonsus
Upper lateral: biceps femoris
Lower lateral: lateral head of gastrocnemius + plantaris
Lower medial: medial head of gastrocnemius
What are the contents of the popliteal fossa?
popliteal artery (deepest)
popliteal vein
common peroneal nerve
tibial nerve (superficial)
What are the muscles of the anterior compartment of leg?
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
What is the nerve supply of the anterior compartment of leg?
Deep peroneal nerve
What is the action of the muscles of anterior compartment of leg?
Dorsiflexion of foot
What is action of tibialis anterior?
Dorsiflexion of foot
Inversion of foot
What is action of peroneus tertius?
Dorsiflexion of foot
Eversion of foot
What are the branches of the deep peroneal nerve?
Muscular: anterior compartment of leg
Sensory: skin of 1st web space
Where does the anterior tibial artery end?
Midway between 2 malleoli, in front of ankle joint by continuing as dorsalis pedis artery
What muscles make up lateral compartment of leg?
Peroneus longus
Peroneus brevis
What is action of lateral compartment of leg?
Eversion of foot
Plantar flexion of foot
What are the branches of superficial peroneal nerve?
Muscles of lateral compartment of leg
Cutaenous:
Skin of dorsum of foot, except:
1. adjacent sides of big + 2nd toes
2. Lateral side of little toe = sural
3. Medial side of foot = saphenous
What causes injury to common peroneal nerve?
fracture neck of fibula
What happens as result of injury to common peroneal nerve?
Motor: paralysis of anterior + lateral compartment of leg
= loss of dorsiflexion + eversion of foot
Sensory: loss of sensation except to lateral side of little toe + medial side of foot
What is the deformity seen in injury of common peroneal nerve?
Drop foot
What muscles make up the superficial group of muscles in back of leg?
Gastrocnemus
Soleus
Plantaris
What is the nerve supply of superficial group of muscles in back of leg?
Tibial Nerve
What is the action of superficial group of muscles in back of leg?
Plantar flexion of foot
What are the deep muscles of the back of leg?
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
What is the nerve supply to the deep muscles of the back of leg?
Tibial nerve
What is the action of the deep muscles of the back of leg?
Plantar flexion of foot
What is the action of the deep muscles of the back of leg?
Plantar flexion of foot
What structures are found deep to the flexor retinaculum?
Tom Does Very Nice Hats
Tibialis posterior tendon (anterior)
Flexor digitorum longus tendon
Posterior tibial vessels
Tibial nerve
Flexor hallucis longus (posterior)
Where does the lateral cutaenous root arise?
L2 + L3
What does the branches of the saphenous nerve supply?
Skin of medial side of leg + dorsum of foot
What nerves supplies the muscles of the medial compartement?
Obturator nerve
What is meralgia paraesthetica?
entrapment of compression of nerve near ASIS + inguinal ligament
What is the nerve supplying the skin over + below patella?
Infrapaterallar branch of saphenous nerve
What muscles attach at the greater trochanter?
POGO
Piriformis
Obturator internus
Gemelli + Glutei
Obturator externus
What is the action of the medial compartments of the thigh?
Adduction
What are the roots of the obturator nerve?
anterior divisons of ventral rami of L2,3,4
What does the cutaenous branch of obturator nerve?
skin of medial part of thigh
Where does the adductor canal lie?
medial part of the middle 1/3 of thigh
What are the contents of the adductor canal?
Arteries: femoral
Veins: femoral
Nerves: nerve to vastus medialis muscle + saphenous nerve
Lymphatics
What muscles make up the back of the thigh (hamstring muscles)?
biceps femoris
semi-tendenosus
semi-membranosus
Where is the insertion of the biceps femoris?
styloid process of fibula
What nerve supplies the hamstring muscles?
Sciatic nerve
What is the nerve supply of the biceps femoris?
Long head: tibial branch of sciatic nerve
Short head: common peroneal of sciatic nerve
What is the origin + roots of sciatic nerve?
Sacral plexus
Terminal branch of plexus (L4/5, S1/2/3)
Where does the sciatic nerve end?
Middle of back of thigh
What are the boundaries of the adductor canal?
Antero-lateral wall: vastus medialis
Antero-medial wall: sartorius
Posterior: adductor longus + magnus
What are the terminal branches of the sciatic nerve?
Branches into: tibial nerve + common peroneal nerve
What are the branches of the tibial nerve?
Cutaenous branches:
- sural nerve to lateral side of leg + foot
- calcanean branches of heel
Muscular branches:
- long head of biceps
- posterior compartment of leg muscles
Terminal branches:
- lateral + medial plantar nerves
What muscle is commonly injured in runners with explosive movement (especially if not warmed up)?
Biceps femoris
What are the muscular branches of the sciatic nerve?
hamstring muscles
ischial part of adductor magnus
Where does the common peroneal nerve divide?
lateral side of neck of fibula
high risk of injury if fractures
What does the popliteal artery divide into?
Anterior + posterior tibial artery
Where does the popliteal artery begin?
Opening in adductor magnus muscle
What bones are in front of the cuboid bone?
4th + 5th metatarsal bones
What are the contents of the adductor canal?
Arteries: femoral
Veins: femoral
Nerves: nerve to vastus medialis muscle + saphenous nerve
Lymphatics
What are the boundaries of the adductor canal?
Antero-lateral wall: vastus medialis
Antero-medial wall: sartorius
Posterior: adductor longus + magnus
Where is the insertion of the biceps femoris?
styloid process of fibula
What is the nerve supply of the biceps femoris?
Long head: tibial branch of sciatic nerve
Short head: common peroneal of sciatic nerve
What nerve supplies the hamstring muscles?
Sciatic nerve
What is the origin + roots of sciatic nerve?
Sacral plexus
Terminal branch of plexus (L4/5, S1/2/3)
What muscle is commonly injured in runners with explosive movement (especially if not warmed up)?
Biceps femoris
Where does the sciatic nerve end?
Middle of back of thigh
What are the muscular branches of the sciatic nerve?
hamstring muscles
ischial part of adductor magnus
What are the terminal branches of the sciatic nerve?
Branches into: tibial nerve + common peroneal nerve
What are the branches of the tibial nerve?
Cutaenous branches:
- sural nerve to lateral side of leg + foot
- calcanean branches of heel
Muscular branches:
- long head of biceps
- posterior compartment of leg muscles
Terminal branches:
- lateral + medial plantar nerves
Where does the common peroneal nerve divide?
lateral side of neck of fibula
high risk of injury if fractures
Where does the popliteal artery begin?
Opening in adductor magnus muscle
What does the popliteal artery divide into?
Anterior + posterior tibial artery
What bones are in front of the cuboid bone?
4th + 5th metatarsal bones
