Lower Limb Flashcards
86
Q
what does the pelvic girdle consist of? where do those parts fuse? what are its joints?
A
ilium, ishium, pubis
fushed together at the acetabulum
sacroiliac joints and hip joints
87
Q
what is the function of the pelvic girdle?
A
it suspends lower limb away from the axial skeleton to increase range of motion
girdle itself has limited mobility
88
Q
what type of joint is the sacroiliac joint?
A
gliding joint
89
Q
what ligaments resist motion at the sacroiliac joints?
A
posterior sacroiliac ligaments
90
Q
what type of joint is the hip joint?
A
ball and socket
91
Q
what ligaments strengthen the articular capsule of the hip joint? what do they reinforce? what motions do they resist?
A
- iliofemoral ligament- strongest in the hip joint; reinforces anterior part of capsule; resists extension
- pubofemoral ligament- reinforces the anterior and inferior parts of the capsule; resists abduction
- ischiofemoral ligament- reinforces the posterior part of the capsule; resists extension by screwing the femoral head into the acetabulum
92
Q
what can happen as the result of a fracture of the femoral head?
A
avascular necrosis (from disruption of the medial circumflex femoral artery which is the main arterial blood source to head and neck)
patients will have thigh laterally rotated by short lateral rotators of the thigh at the hip and by the gluteus maximus
93
Q
a dislocation of the head of the femur most commonly occurs in what direction?
A
posterior
94
Q
what can occur as the result of dislocation of the head of the femur?
A
thigh is shortened and medically rotated by gluteus medius and minimus muscles
sciatic nerve may be compressed (resulting in weakness of muscles in the posterior thigh, leg, and foot and paresthesia over the posterior and lateral parts of the leg and the dorsal and plantar surfaces of the foot)
95
Q
what makes up the knee joint and what type of joint is it?
A
medial and lateral condyles of the femur and tibeal plateau
modified hinge-joint
96
Q
what ligaments of the articular capsule and ligaments within the articular capsule strengthen the knee?
A
patellar ligament
oblique popliteal ligament
fibular and tibial collarteral ligaments
anterior cruciate ligament
posterior cruciate ligament
(ACL and PCL are intracapsular)
97
Q
what is the patellar tendon an extension of? what parts of the knee capsule does it strength?
A
extension of the quadriceps tendon
strengthens the anterior and lateral parts
98
Q
what does the oblique popliteal ligament arise from and what part of the capsule does it strengthen?
A
part of the semimembranosus tendon
posterior part of the capsule
99
Q
where do the fibular and tibial collateral ligaments originate and attach to? what parts of the joint to they support?
A
fibular: supports lateral part of joint; extends from the lateral epicondyle of the femur to attach to head of the fibula; same as lateral collateral ligament (LCL)
tibial: supports medial part of the joint: extends from the medial epicondyle of the femur to attach to the medial aspect of the tibia and deep fibers are attached to medial meniscus; same as medial collateral ligament (MCL)
100
Q
what motions do the fibular and tibial collateral ligaments limit?
A
abduction and adduction of the knee when knee is flexed
101
Q
where do the ACL and PCL originate and attach?
A
ACL= APEX ligament… attaches to Anterior aspect of the tibia and courses Posteriorly and EXternally/laterally to attach to lateral condyle of the femur
PCL= PAIN ligament… attaches to Posterior aspect of the tibia and courses Anteriorly and INternally/medially to attach to the medial condyle of the femur
102
Q
what motions do the ACL and PCL resist? when is each most taut? which is weaker?
A
ACL is weaker than the PCL
ACL is most taut during knee extension; resists hyperextension by preventing antior displacement of the tibia on the femur
PCL is most taut when knee is flexed and resists excessive flexion by preventing posterior displacement of the tibia on the femur
*anterior drawer test vs. posterior drawer test
103
Q
compare the medial and lateral menisci (where are they, their shape, mobility)
what is their main function?
A
both are intracapsular, fibrocartilages that attach to tibia and act as shock absorbers
medial meniscus: shape of C and is less mobile; attached to deep fibers of the tibial collateral ligament
lateral meniscus: shape of o; more mobile; separated from the fibular collatoeral ligament by the tenson of the popliteus
104
Q
what are the three most common injuries at the knee? (terrible triad)
A
tibial collateral ligament (MCL), medial meniscus, ACL
105
Q
when can a “terrible triad” injury of the knee occur? when is only the ACL torn not the other two? what signs will be exhibited with either of the situations?
A
blow to lateral aspect of the knee when foot is on the ground can sparin the tibial collateral ligament and tear the attached medial meniscus
patients with a medial meniscus tear will have pain when lef is medially rotated at the knee
ACL tears can occur when TCL and MM are injured or a blow to anterior aspect of flexed knee can tear only ACL
torn ACL will exhibit an anterior drawer sign- tibia may be displaced anteriorly form the femur in the flexed knee
106
Q
does the fibula articulate with the knee joint?
A
no, not directly
it does articulate with the tibia and talus
107
Q
what are the ankle joints?
A
talocrural, subtalar, and transver tarsal joints
108
Q
what is the talocrural joint formed by and what type of joint is it?
A
formed by articulation between the trochlea of the talus and the lateral and medial malleoli of the fibula and tibia, respectively
hinge joint (permits dorsiflexion and plantarflexion)
109
Q
is the foot more stable in dorsiflexed position or plantarflexed? why?
A
dorsiflexed
anterior part of the superior surface of the trochlea of the talus is wider than the posterior part of the talocrural joint
110
which tendons enter the sole of the foot after passing posterior and inferior to the medial malleolus?
tendons of the tibialis posterior, flexor digitorum longus, flexor hallucis longus muscles
111
what tendons enter the sole of the foot after passing posterior and inferior to the lateral malleolus?
tendons of the fibularis/peroneus longus and fibularis/peroneus brevis muscles
112
what ligaments strengthen the talocrural joint? which is the stronger of the two?
deltoid/medial ligaments and lateral ligaments
deltoid is stronger
113
the deltoid ligament has __ components... what are they?
4 components
- anterior and posterior tibiotalar
- tibiocalcaneus
- tibionavicular
114
the lateral ligaments has __ components... what are they?
3 components
- anterior and posterior talofibular
- calcaneofibular ligament
115
are inversion or eversion ankle sprains more common at the talocrural joint? what ligament and what part of the lateral ligament is most commonly torn during that?
inversion ankle sprains
the anterior talofibular part of the lateral ligament
116
what forms the subtalar joint and what type of joint is it?
articulation between the talus and calcaneus
ball and socket joint
117
what actions does the subtalar joint permit and what are they?
supination- combination of plantar flexion, inversion and adduction
pronation- combination of dorsiflexion, eversion, and abduction
118
what forms the transverse tarsal joints? what motions do the joint allow?
formed by the articulation of the talus with the navicular and the calcaneus with the cuboid
contribute to inversion and eversion with the subtalar joint
119
what muscles generally are contained in the sole of the foot?
short abductors and flexors of the great toe and little toe, respectively
(lacks the eminences and opponens muscles of the hand)
120
what is the action of the quadratus plantae muscle?
plantar muscle that acts to straighten out the oblique pull of the flexor digitorum longus tendons
(no counterpart in the hand)
121
what is the course of the femoral artery (origin, path, areas supplied)?
begins at the inguinal ligament from the extnal iliac artery
courses lateral to the femoral vein and medial to the femoral nerve through the femoral triangle in the anterior thigh
enters adductor canal to become the popliteal artery (after passing through the adductor hiatus)
profunda femoral artery gives rise to lateral and medial circumflex arteries--\>thigh, head and neck of femur, hip joint (medial is main source for the head and neck of femur)
profunda artery also gives rise to 4 perforating arteries that supply the medial thigh and pass through the adductor magnus to supply the muscles in the posterior thigh
122
what is the cruciate anastomosis? what is its clinical importance?
medial and lateral circumflex femoral arteries, inferior gluteal atery, and first perforating artery contribute to cruciate anastomosis in the posterior thigh
can contribute to collateral circulation of lower limb is the femoral artery becomes occluded
123
what is the course of the popliteal artery?
beings at the adductor hiatus as a continuation of the femoral artery
courses through the popliteal fossa posterior to the knee with the tibial nerve
gives rise to 5 genicular arteries that supply the knee joint
ends when it divides into the anterior and posterior tibial arteries at the inferior border of the popliteus
124
what is the course of the anterior tibial artery and what does it supply?
enters the anterior compartment of the leg proximal to the interosseous membrane between the tibia and fibula
courses with the deep fibular/peroneal nerve and supplies the anterior compartment of the leg
continues as the dorsalis pedis
125
what is the course of the dorsalis pedis, what are its branches and what do they supply?
comes from the anterior tibial artery, on the dorsal aspect of the foot
branches into an arcuate artery, which gives rise to digital branches that supply the toes and a deep plantar artery, which contributes to a plantar arterial arch in the sole of the foot
126
where would one feel for the dorsalis pedis pulse?
compressing the dorsal artery of the foot against the tarsal bones lateral to the tendon of the extensor hallucis longus
127
what is the course of the posterior tibial artery? what are its branchs and what do they supply?
arises from the popliteal artery and courses through posterior compartment of leg with the tibial nerve
supplies the posterior compartment of the leg
gives rise to the fibular artery--\>supplies the posterior leg and sends perforating branches into lateral compartment of the leg (fibularis longus and brevis muscles)
passes into foot (behind the medial malleolus) to divide into medial and lateral plantar arteries--\>supply sole of the foot
128
what are the branches of the internal iliac artery?
superior gluteal artery
inferior gluteal artery
obturator artery
129
what is the course of the superior gluteal artery and what does it supply?
enters the gluteal region with superior gluteal nerve superior to the piriformis after passong through the greater sciatic foramen
supplies the gluteus medius and minimus, some of maximus
130
what is the course of the inferior gluteal artery and what does it supply?
enters the gluteal region with the inferior gluteal nerve inferior to the priformis muscle after passing through the greater sciatic foramen
supplies the gluteus maximus, short lateal rotators of the hip, promixal parts of the hamstrings
131
what is the course of the obturator artery and what does it supply?
enters the medial thigh with the obturator nerve, after passing through the obturator foramen
supplies the adductor muscles, obturator externus, pectineus, and gracilis muscles
132
which veins of the lower limb are superficial?
great saphenous and small saphenous veins
133
what is the course of the great saphenous vein?
arises from medial aspect of the dorsal venous arch of the foot
courses anterior to the medial malleolus, though medial aspect of the leg (with the saphenous nerve) and through the medial thigh
drains into the femoral vein after passing through the saphenous hiatus (fault in fascia lata)
134
what is the course of the small saphenous vein?
arises from the lateral aspect of the dorsal venous arch of the foot
courses posterior to the lateral malleolus and then through the posterior leg (with the sural nerve)
passes between the two heads of the gastrocnemius muscle and drains into the popliteal vein
135
in general, what are the deep veins of the lower limb and where do they course?
course with arteries of the same name (arteries from the iliac, femoral, politeal, posterior and anterior tibial arteries)
136
what nerve plexuses innervate the lower limb and where can they be found?
lumbar plexus: formed by ventral rami of L1-L4 (partly T12) and is found on posterior abdominal wall and greater plexus
lumosacral plexus: formed by ventral rami of L4-S3 and found in the lesser pelvis
137
what do the ventral rami of the lumbar plexus branch into (divisions and nerves)?
posterior division--\>femoral nerve
anterior division--\>obturator nerve
138
what do the ventral rami of the lumbosacral plexus divide into (divisons and nerves?)
posterior--\>common fibular/peroneal (superior and inferior gluteal nerves also contain posterior division fibers)
anterior--\>tibial nerves
139
During development, the lower limb undergoes a ______ rotation so that flexor muscles that were in the _____ embryo are then situated ______ and extensor muscles that were ____ in the embryo come to be situated \_\_\_\_\_\_. As a result the medial and posterior compartments of the thigh, the posterioer compartment of the leg, and the plantar muscles of the foot are innervated by the _____ or ____ nerves, which contain _____ division fibers. Muscles in the anterior compartment of the thigh and anterior and lateral compartments of the leg and the dorsum of the foot are innervated by the _____ or ______ nerves, which contain ______ division fibers.
During development, the lower limb undergoes a MEDIAL rotation so that flexor muscles that were in the ANTERIOR embryo are then situated POSTEROMEDIALLY and extensor muscles that were POSTERIOR in the embryo come to be situated ANTEROLATERALLY. As a result the medial and posterior compartments of the thigh, the posterioer compartment of the leg, and the plantar muscles of the foot are innervated by the OBTURATOR or TIBIAL nerves, which contain ANTERIOR division fibers. Muscles in the anterior compartment of the thigh and anterior and lateral compartments of the leg and the dorsum of the foot are innervated by the FEMORAL or COMMON FIBULAR nerves, which contain POSTERIOR division fibers.
140
what forms the lumbosacral trunk and what is its course?
fibers of L4 and L5 form the lumbosacral trunk
lumbosacral trunk emerges from medial aspect of the psoas major, corsses the pelvic brim, joins with the ventral rami of S1-S3 to form the lumbosacral plexus
141
where do the terminal and collateral nerves of the lumbosacral plexus exit the pelvis?
greater sciatic foramen
142
The nerves from the superior rami of the lumbar and lumosacral plexus (L2-L4) innervate muscles where? and thus at on what joints?
anterior and medial thigh
acting on hip and knee joints
143
The nerves that contain fibers from the inferior rami of the lubar and lumbosacral plexus (#1-S3) innervate what muscles? and thus act on what joints?
the leg
joints of the ankle and foot
144
the femoral nerve contains posterior division fibers from which ventral rami?
L2-L4
145
what is the course of the femoral nerve? what does it innervate?
emerges from lateral border of the psoas major in the iliac fossa and passes into the anterior thigh, posterior to the inguinal ligament and lateral to the femoral artery
innervates muscles in the anterior compartment of the thigh: 4 heads of quadriceps femoris, iliopsoas, sartorius, pectineus (which all act to flex thigh at hip and extend leg at knee)
innervates skin of the anterior and medial thigh (medial and intermediate cutaneous nerves)
also gives rise to the saphenous nerve
146
what is the longest branch of the femoral nerve and the only branch of the lumbar plexus to cross the knee joint?
saphenous nerve
147
what is the course of the saphenous vein and what does it innervate?
branch from femoral
enters adductor canal but leaves without passing through the adductor hiatus
courses with the great saphenous vein and innervates the skin of the medial side of the leg and foot
148
what is a common way the femoral nerve can be damaged? what symptoms are associated?
damaged in the abdomen by an abscess of the psoas major or pelvic neoplam
patients experience weakness in flexion of thigh, abiliy to extend leg at knee, and diminish patellar tendon reflex
149
what are examples of common ways the saphenous nerve can be damaged? what are associated symptoms?
during surgical procedure of the leg to remove varicose veins or great saphenous vein or lacerated as it pierces wall of adductor canal
patients experience pain and parethesia in the skin of the medial aspect of the leg and foot
150
what fibers from what rami are contained in the obturator nerve?
contains anterior division fibers from the L2-L4 ventral rami
151
what is the course of the obturator nerve and what does it innervate?
emerges from medial side of psoas major, crosses pelvic brim, courses anteriorly and inferiorly in the lesser pelvis to the obturator foramen then through the obturator externus into medial thigh
divides into anterior branch (passes theough adductor longus and brevis) and posterior branch (passes between adductor brevis and adductor magnus)
innervates muscles in the medial thigh (adductor longus, brevis, and magnus, gacilis, and obturator externus)... which act to adduct the thigh and assist in hip flexion
innervtes skin in the small region of the medial thigh
152
where is the obturator nerve most commonly lesioned? what are the symptoms associated?
in the pelvis (pelvic neoplasm or pregnancy)
patients unable to adduct the thigh at hip and may have paresthesia in skin of the medial thigh
153
what are the five collateral nerves of the lumbar plexus? what are their spinal nerve origins?
subcostal nerve (T12)
iliohypogastric nerve (T12-L1)
ilioinguinal nerve (L1)
genitofemoral nerve (L1, L2)
lateral femoral cutaneous nerve (L2, L3)
154
what is the path of the subcostal nerve and what does it innervate?
passes between the psoas major and quadratus lumborum muscles inferior to the 12th rib
innervates abdominal muscles and overlying skin of the lateral and anterior abdominal wall
155
what is the path of the iliohypogastric nerve and what does it innervate?
emerges between the psoas and quadratus lumborum muscles inferior to the subcostal nerve
innervates abdominal mucles and skin of the inguinal and hypogastric regions of the lateral and anterior abdominal wall
156
what is the path of the ilioinguinal nerve and what does it innervate?
courses inferior to the iliohypogastric nerve
pierces the inguinal canal and passes trhough the superficial inguinal ring to innervate the skin of the medial thigh, and labium majus or anterior aspect of the scrotum
above the superificlal inguinal ring it will innervate the abdominal muscles and skin of the inguinal and hypogastric regions of the lateral and anterior abdominal wall
157
what is the path of the genitofemoral nerve and what does it innervate?
courses through and then anterior to the psosas major muscle
divides into a femoral branch: passes posterior to the inguinal ligament and innervates skin of the medial thigh, and a genital branch: enters inguinal canal through the deep inguinal ring and innervates the cremasteric muscle
158
what is the path of the lateral femoral cutaneous nerve and what does it innervate?
emerges lateral to the psoas major muscle then crosses the iliacus to reach the ASIS then descends into the lateral thigh after passing posterior to the inguinal ligament
innervates anterolateral thigh
159
what is a common site/cause of lateral femoral cutaneous nerve lesions and what are the associated symptoms?
may be compressed as it passes posterior to the lateral part of the inguinal ligament just medial to the ASIS (meralgia paresthetica)
pain and paresthesia in the anterolateral thigh
160
What are the terminal nerves of the lumbosacral plexus and what are their spinal cord origins?
superior gluteal nerve (posteror division fibers from L4, L5, S1)
inferior gluteal nerve (posterior division fibers from L5, S1, S2)
tibial nerve (anterior division fibers from L4, L5, S1-S3)
common fibular/peroneal nerve (posterior division fibers from L4, L5, S1, S2)
superficial fibular nerve (L4, L5, S1)
deep fibular nerve (L5, S1, S2)
161
what is the course of the superior gluteal nerve and what does it innervate?
enters gluteal region with the superior gluteal artery by passing through the greater sciatic foramen superior to the piriformis muscle
innervates the gluteus medius, gluteus minimus, and tensor fasciae latae muscles
162
what are symptoms associated with a superior gluteal nerve lesion?
- weakness in ability to abduct the thigh at the hip
- waddling or Trendelendburg gait in which pelvis sags on side opposite the nerve lesion during unsupported stage of walk
163
what is the course of the inferior gluteal nerve and what does it innervate?
enters gluteal region by passin through the greater sciatic foramen inferior to the piriformis muscle
innervates the gluteus maximus
164
what symptoms are associated with an inferior gluteal nerve lesion?
- weakness in ability to laterally rotate and extend the thigh at the hip
- difficulty climbing stairs or rising from a chair due to difficulty extending thigh from a flexed position
- gluteus maximus gait- thrust their torso posteriorly in an attempt to coutract the weakness of the gluteus maximus
165
what is the course of the tibial nerve? what does it branch into and where?
enters gluteal region with common fibular nerve in the sciatic nerve by passing through the greater sciatic foramen inferior to the piriformis
courses through posterior thigh deep to hamstring and separates from common fibular at superior border of the popliteal fossa
then courses in the posterior part of the leg with the posterior artery and then passes thorugh the tarsal tunnel and into th sole of the foot after coursing behind the medial malleolus
divides into the medial and lateral plantar nerves distal to the tarsal tunnel
166
what does the tibial nerve innervate in general?
muscles in the posterior thigh, posterior leg and plantar foot
167
what does the medial plantar nerve innervate?
medial plantar nerve (L5, S1, S2) innervates 4 muscles in the sole of the foot: flexor digitorum brevis, flexor hallucis brevis, abductor hallucis, first lumbrical; common and digital plantar branches innervate skin of the medial side of the sole of the foot and medial 3 1/2 digits
- similar to median nerve in hand
## Footnote
168
what does the lateral plantar nerve innervate?
lateral plantar nerve (L5, S1, S2) innervates the rest of the intrinsic foot muscles (quadratus plantae, flexor digiti minimi brevis for toe 5, lumbricals II-IV, interrossei, dorsal interossi, abductor digiti minimi, adductor halluscis, plantar interossi); common and digital plantar branches innervate the skin of the alteral side of the sole of the foot and lateral 1 1/2 digits
- similar to ulnar nerve of the hand
169
what are common causes of sciatic nerve lesions?
- susceptible to damage from an intramuscular injection in the lower medial quadrant of the gluteus maximus muscle
- compressed from posterior dislocation of the femur
- L5 and S1 roots of the sciatic nerve compressed by intervertebral disk herniations
170
where are common sites for tibial nerve lesions and what are symptoms associated?
- in the gluteal region--\>weakness in ability to flex leg at the knee and plantar flex at the ankle
- compressed at the ankle as it courses through the tarsal tunnel adjacent to the medial malleolus (tarsal tunnel syndrome)--\>pain and parethesia in the sole of the foot
171
what is the course of the fibular nerve and what does it innervate?
emerges from the pelvis with the tibial nerve inferior to the piriformis muscle in sciatic nerve into the posterior thigh
innervates the short head of the biceps femoris in posterior thigh then separates from the tibial at the superior border of the popliteal fossa
courses laterall along the tendon of the biceps femoris and spiral around the neck of the fibula into the lateral leg
enters the fibularis longus muscle and divides into the superficial and deep fibular nerves
172
where/how is the common fibular nerve commonly lesioned and what are associated symptoms?
frequently lesioned in the lower leg such as when it passes around the neck of the fibula
- footdrop from loss of dorsiflexion at the ankle and loss of eversion
- pain and parethesi in the lateral leg and dorsum of the foot
- with footdrop, may also have steppage gait- raise affected leg high off the ground and foot slaps ground when walking
piriformis syndrome: nerve compressed by piriformis when it passes through it rather than anterior to it with the tibial nerve
173
what is the course of the superficial fibular nerve and what does it innervate?
innervates the fibularis longus and brevis muscles in the lateral leg
emerges from distal third of lateral leg to innervate skin of the lateral leg and dorsum of the foot (except for the first dorsal webbed space between the great toe and second toe)
174
where is a common site of supericial fibular nerve lesion and what are associated symptoms?
lesioned as the nerve emerges from the lateral compartment of the leg
pain and parethesia in the dorsal aspect of the foot
175
what is the course of the deep fibular nerve and what does it innervate?
courses through the fibularis longus muscle and anterior compartment of the leg with the anterior tibial artery
innervates muscles in the anterior compartment of the leg (tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus teritius muscles)
innervates muscles in dorsum of the foot (extensor digitorum brevis and extensor hallucis brevis muscles)
skin of the webbed space between the great toe and second toe
176
where is a common site of deep fibular nerve lesion and what are associated symptoms?
compressed in the anterior compartment of the leg
footdrop and paresthesia in the skin of the webbed space between the great toe and second toe
177
what are the collateral nerves of the lumbosacral plexus and their origins?
sural nerve (contributons from tibial and common fibular nerves), nerve to quadratus femoris muscle (L4, L5, S1), nerve to obturator internus muscle (L5, S1, S2), posterior femoral cutaneous nerve (anterior and posterior division fibers from S1-S3), nerve to piriformis muscle (S1-S2), perforating cutaneous nerve (S2-S3)
178
what is the course of the sural nerve and what does it innervate?
innervates the skin of the posterior leg and lateral foot
courses with the small saphenous vein in the posterior leg
179
what is the course of the nerve to the quadratus femoris muscle and what does it innervate?
enters the gluteal region after passing through the greater sciatic foramen
innervates the quadratus femoris (duh) and inferior gemellus
180
what is the course of the nerve to the obturator internus muscle and what does it innervate?
enters the gluteal region after passing through the greater sciatic foramen and innervates the superior gemellus
crosses the ischial spine and through the lesser sciatic foramen to innervate the obturator internus (duh)
181
what does the posterior femoral cutaneous nerve innervate?
skin of the posterior thigh and upper calf
182
where does the nerve to the piriformis muscle arise from and what does it innervate?
ventral rami of S1 and S2
innervates the piriformis muscle (duh)
183
where does the perforating cutaneous nerve arise form and what does it innervate?
ventral rami of S2 and S3
innervates skin covering the ischioanal fossa and gluteal region near the anal canal
184
what is the only branch of the lumbosacral plexus to contain both anterior division (S2, S3) and posterior division (S1, S2) fibers?
posterior femoral cutaneous nerve
185
weakness in ability to dorsiflex the foot and altered sensation in skin between the great toe and second toe is caused by lesion in what nerve?
deep fibular/peroneal nerve (tibilais anterior, extensor hallucis longus, extensor digitorum longus)
186
altered sensation in skin covering the great saphenous vein in the leg is caused by a lesion in what nerve?
femoral nerve
187
weakness in ability to abduct thigh at the hip is caused by lesion in what nerve?
superior gluteal nerve (gluteus minimus and medius)
188
a lesion in what nerve would cause weakness of muscles in ability to evert foot and altered sensation in the skin of the dorsal aspect of the foot, but leave ability to extend toes intact?
superficial fibular/peroneal nerve (perioneus longus and brevis)
(toe extension is deep peroneal to extensor hallucis longus/brevis and extensor digitorum longus/brevis)
189
a lesion in what nerve would cause weakness in ability to extend thigh at the hip when arising from a chair and difficulty walking up stairs, but leaves cutaneous sensation intact?
inferior gluteal nerve (gluteus maximus)
190
if a patient develops tarsal tunnel syndrome and has weakness in the ability to flex the great toe, what nerve may be lesioned?
tibial nerve (flexor hallucis longus)
191
a ballet dancer can no longer stand on her "tip toes." what nerve may be lesioned?
tibial nerve
(toe flexors)
\*TIP TOES: Tibial Inverts and Plantarflexes allowing one to stand on TOES
192
when a limb is off the ground during gait, and a patient experiences lateral pelvic tilt toward the unsupported side, what nerve is most likely lesioned?
superior gluteal nerve (gluteus minimus and medius)
193
weakness in ability to adduct the thigh at the hip is most likely caused by a lesion in what nerve?
obturator nerve (adductors, gracilis)
194
a lesion in what nerve would be most likely to cause an inability to flex the thigh at the hip and extend the leg at the knee?
femoral nerve (flexion of femur: rectus femoris, sartorius, pectineus; extension of tibia and fibula: quadriceps femoris)
195
A football player suffers trauma to the lateral part of the leg just distal to the head of the fibula and a nerve is lesioned. What might the patient experience?
A. weakness in ability to plantar flex the foot
B. loss of ability to invert the foot
C. altered sensation in the skin of the medial aspect of the leg
D. altered sensation in the skin of the dorsal aspect of the foot
E. weakened ability to flex the toes
Lesion to the common fibular nerve--\>
result in footdrop and altered sensation in the skin of the dorsal aspect of the foot: D
196
An elderly woman who suffers from osteoporosis falls and "breaks her hip." The orthopedic surgeon recommends that the proximal part of the femur be replaced with a prosthesis because of the likelihood of avascular necrosis of the head of the femur.
What artery supplying the neck and head of the femur might have been lacerated by the fracture?
A. inferior gluteal artery
B. medial circumflex femoral artery
C. pudendal artery
D. profunda femoral artery
E. obturator artery
B. this is the main source of arterial blood supply to the head and neck of the femur
the profunda femoral artery (a branch of the femoral artery which is a branch of the external iliac artery) will give rise to the lateral and medial circumflex arteries that supply the thigh, head and neck of femur, and the hip joint
197
A traumatic injury to the lateral aspect of a patient's knee tears several structures at the knee joint. An examination reveals a positive anterior drawer sign and a clicking sound when the patient attends to extend the leg at the knee.
Of the following structures, which one was most likely spared from being stretched or torn in this knee injury?
A. medial meniscus
B. tibial collateral ligament
C. fibular collateral ligament
D. anterior cruciate ligament
E. tendon of the sartorius muscle
A lateral blow to the knee will usually injure the terrible triad: ACL, MCL/tibial collateral ligament, medial meniscus
will also tear tendons that cross the medial aspectr of the joint such as the sartorius
least likely, is C which is on the lateral side of the joint
198
A health care worker inadvertently administers an injection to the gluteal region that results in a lesion to a nerve. The patient begins to walk with an altered gait. Upon raising the left foot off the ground during gait, the patient leans to the right, and when standing on the right foot without leaning, the left buttock seems to sag.
what muscle might have been weakened by the nerve lesion?
A. gluteus maximus
B. gluteus medius
C. piriformis
D. semitendinosus
E. quadratus femoris
B
lesion would be the to superior gluteal nerve
- weakness in ability to abduct thigh at hip and keep pelvis level during gait
- waddling/Trendelenburg gait - pelvis sags on side of unsupported limb because of weakness of gluteus medius muscle
199
A cross-country runner begins to experience leg and foot pain during and after training for an upcoming season. The pain radiates from the anterolateral leg into the dorsal aspect of the foot. Dorsiflexion and extension of the toes are performed only with pain. The leg appears to be swollen in the area of the pain.
Which of the following arteries may have been compressed by the swelling?
A. popliteal artery
B. anterior tibial artery
C. posterior tibial artery
D. peroneal artery
E. medial plantar artery
B
courses through the anterior comparment of the leg
200
A 56-year-old man develops numbness and tingling in the lower limb followed by progressive muscle weakness. You suspect the main's peripheral neuropathy may be a side effect of a drug he is taking. You order a biopsy of a cutaneous nerve in the posterior leg that accompanies the small saphenous vein. Which of the following nerves was biopsied?
A. tibial
B. superficial fibular
C. sural
D. saphenous
E. deep fibular
C
sural nerve is a cutaneous nerve that innervates the posterior leg
the saphenous nerve supplies the medial leg
superficial fibular supplies the lateral leg
tibial and deep fibular nerves do not have cutaneous branches in the leg
