Lower Limb Flashcards
Superficial muscles of back of leg.
There are three superficial muscles on back of leg.
Gastrocnemius , Soleus and Plantaris
1) Gastrocnemius - It is large powerful muscle and has 2 heads, medial and lateral. The 2 heads of gastrocnemius and Soleus are together referred as gastro Soleus or triceps surae.
Nerve supply is of tibial nerve
2) Soleus - It is a sole shaped multipennate muscle which is deep to Gastrocnemius.
Nerve supply is tibial nerve.
Gastrocnemius and Soleus are strong plantar flexor of foot at ankle joint and gastrocnemius is flexor at knee joint.
Soleus is more powerful whereas gastrocnemius is more faster. Soleus helps to overcome inertia of the body like bottom gear of car and gastrocnemius is quick acting works like 2nd gear increasing speed of car.
Plantaris is also present which is rudimentary and has tibial nerve supply.
Deep muscles of back of leg.
4 deep muscles are
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
All are supplied by Tibial nerve.
Popliteus helps in unlocking of knee joint by lateral rotation of femur on tibia.
Tibialis posterior involved in plantar flexor of ankle foot, inverts foot at subtalar joint and support medial longitudinal arch of foot.
Digitorum longus flexes distal phalanges
Hallucis longus flexes distal phalanx of big toe.
Interesting facts about back of leg.
Soleus acts as peripheral heart as it pushes venous blood upwards m
Soleus acts like first gear which gastrocnemius acts like higher gear during walking and running.
Tendocalcaneus is strongest tendon of the body.
All muscles of back of leg or calf are supplied by Tibial nerve
Posterior tibial artery is palpated between medial malleolus and calcaneus under flexor retinaculum.
Posterior tibial artery ends by dividing into medial and lateral plantar arteries .
Clinical anatomy of back of leg
1) Posterior tibial pulse is palpated in doubtful cases intermittent claudication where person gets cramps and severe pain in calf pain due to lack of blood supply.
2) Posterior tibial pulse is felt against calcaneus.
3) The long tendon of Plantaris is used for tendon transplantation in the body.
4) Tendocalcaneus can rupture in tennis player 5cm above it’s insertion and so plantar flexion is not possible.
5) Wearing high heels for long periods can cause change in posture. Knees are excessively bent with lumbar vertebrae pushed forward . There is lot of stress on muscles of back and of calf.
Chapter 1 Lower limb Clinical anatomy.
1) Iliac crest is used for bone marrow biopsy.
2) Weavers bottom occur in people who sit continuously for long time causing inflammation of ischial tuberosity bursa.
3) Forced medial rotation of thigh and leg can cause fracture of shaft of femur below age of 16, Tear of medial meniscus between 14-40, potts fracture above 40-60, fracture of neck of femur above 60 yrs.
4) Medial surface of Tibia and Fibula are used for bone grafts.
5) Common peronneal nerve is present around neck of Fibula. It develops into superficial peronneal and deep peronneal nerve. Damage to deep part causes paralysis of dorsiflexors and damage to superficial causes paralysis of evertors of foot causing foot drop.
Chapter 3 Important points
1) Inflammation of prepatellar bursa is housemaids knee.
2) Inflammation of subcutaneous infrapatellar bursa is called clergyman knee.
3) Femoral artery can be compressed at mid-inguinal point against head of femur.
4) Bilateral absence of femoral pulse at mid-inguinal point can occur due to coarctation or narrowing or thrombosis of aorta.
5) Stab at Apex of femoral traingle can cut off vessels of lower limb.
6) Femoral artery is superficial in femoral traingle hence can be used for passing catheters.
7) Femoral vein is used for intravenous infusion in children and person with peripheral circulatory failure.
8) Intramuscular injection are given in posterolateral aspect of thigh in vastus lateralis muscle.
9) Sartorius is longest muscle of body.
10) Saphenous is longest cutaneous nerve.
11) Femoral hernia is common in females and Inguinal hernia common in males.
Chapter 4 Important points
1) Disease in hip joint can cause referred pain in knee joint and medial side of thigh due to common nerve supply of obturator nerve and femoral nerve which arise from same segment but dorsal and ventral division of 2,3,4.
2) Gracilis muscle is used for transplantation of other muscles.
3) Adductor magnus and pectineus are hybrid muscles.
4)
Chapter 5 Important points
1) When gluteus maximus is paralysed, a person cannot stand up from sitting position without support.
2) Intramuscular injection are given in anterosuperior quadrant in gluteus medius and minimus.
3) Lurching gait in which gluteus medius and minimus is paralysed. In such a condition person bends on paralysed side while walking to lift his other foot. Bilateral side causes waddling gait.
4) Trendelenburg gait-
When a person stands on one leg then gluteus medius and minimus raise the opposite unsupported side. Failure to do it results in above condition occuring in paralysis of medius and minimus.
5) Schiatic nerve block is done at 1.5 cm below midpoint of posterior superior iliac spine and greater trochanter of femur.
6) Piriformis syndrome occurs when schiatic nerve gets compressed by Piriformis causing pain in buttock.
7) Gluteus maximus is antigravity muscle.
