Lower Limb

Question 1

What is iliotibial tract and what is its functions?

Answer 1

The thickening of fascia lata on the lateral side of the thigh is called the iliotibial tract. Functions:
1. Iliotibial tract stabilizes knee both in extension and partial flexion, i.e., during walking and running.
2. In leaning forwards with slightly flexed knees, it is the only antigravity force to support the knee.

Question 2

What are the modifications of deep fascia of thigh?

Answer 2

• Saphenous opening: Oval gap 4 cm below
and lateral to pubic tubercle. Upper, lateral and lower margins form a crescentic sharp edge and medially deep part of fascia passes behind the femoral sheath.
• Cribriform fascia: Cover the saphenous opening and is pierced by great saphenous vein, two superficial arteries
and lymphatics.
• Iliotibial tract: Receives insertion of 3⁄4 of
gluteus maximus and tensor fasciae latae.

Question 3

What are the boundaries of femoral triangle?

Answer 3

It is bounded by (Figs 3.12 to 3.14)
• Laterally: Medial border of sartorius.
• Medially: Medial border of adductor longus.
• Base: Inguinal ligament.
• Apex: Directed downwards and is formed
by meeting of medial and lateral
boundaries.
• Roof:
– Skin,
– Superficia l fascia and – Deepfascia.
• Floor:
– Laterally by iliacus and psoas major.
– Medially by adductor longus and
pectineus.

Question 4

What are the contents of femoral triangle?

Answer 4

• Femoral artery
• Branches of femoral artery:
– Deep branches: Profunda femoris, deep external pudendal, descending geni- cular, saphenous and muscular.
– Superficial branches: Superficial exter- nal pudendal, superficial epigastric and superficial circumflex iliac.
• Femoral vein (medial to artery) and its tributaries
• Femoral sheath
• Femoral nerve (lateral to artery)
• Nerve to pectineus
• Femoral branch of genitofemoral nerve
• Lateral cutaneous nerve of thigh and
• Deep inguinal lymph nodes.

Question 5

What is femoral sheath?

Q.150 How is femoral sheath formed?

Answer 5

It is a funnel shaped fascial sleeve enclosing the upper 11⁄2 inches of the femoral vessels (Fig. 3.15). It is formed by the downward extension of the abdominal fasciae. The anterior wall is formed by fascia transversalis and posterior wall by fascia iliaca.

Question 6

What are the parts of femoral sheath?

Answer 6

The cavity within femoral sheath is divisible in three parts. Lateral part contains femoral artery and femoral branch of genitofemoral nerve. Middle part contains femoral vein and medial part is called femoral canal.

Question 7

What is femoral canal?

Answer 7

It is the medial compartment of the femoral sheath. It is conical and 1⁄2 inch wide at base and 1⁄2 inch long.

Question 8

What is femoral ring?

Answer 8

The base or upper end of the femoral canal is called the femoral ring.
The femoral ring is filled by condensed extraperitoneal tissue, the femoral septum, containing a lymph node and covered by parietal peritoneum.

Question 9

What are the contents of femoral
canal?

Answer 9

Lymph node of cloquet or Rosenmuller).

Question 10

Why is a femoral hernia commoner in females?

Answer 10

Because the femoral canal is larger in the females due to the greater width of the pelvis and smaller size of the femoral vessels. In the females, there is a rise in intra- abdominal pressure due to pregnancy predisposing to femoral hernia.

Question 11

What is the clinical importance of the femoral canal?

Answer 11

The femoral canal is a potential point of weakness in the lower abdominal wall through which a viscus (intestines or urinary bladder) may protrude and give rise to a femoral hernia

Question 12

What are the boundaries of the adductor canal?

Answer 12

Posteriorly:
• Adductor longus above and
• Adductor magnus below.
Anteriorly: Vastus medialis.
Medially: Sartorius which lies on a fascial sheet extending across the anterior and posterior walls.

Question 13

What is the extent of the adductor canal?

Answer 13

It extends from the apex of the femoral triangle to the tendinous opening in the adductor magnus.

Question 14

What are the contents of the adductor canal?

Answer 14

• Femoral artery.
• Femoral vein.
• Descending genicular branch of the femoral artery.
• Saphenous nerve.
Nerve to vastus medialis

Question 15

What are the boundaries of the popliteal fossa?

Answer 15

Superolaterally: Biceps femoris tendon.
Fig. 3.15: Diagram showing femoral sheath

Superomedially:
Inferomedially:
Inferolaterally:
See Figure 3.16.
Semimembranosus and Semitendinosus.
Medial head of gastroc- nemius.
Lateral head of gastroc- nemius and plantaris.

Question 16

Which structures form the floor of the popliteal fossa?

Answer 16

From above downwards:
• The popliteal surface of the femur
• The capsule of the knee joint • Popliteal fascia.

Question 17

What is the relationship between the tibial nerve and popliteal vessels in the popliteal fossa?

Answer 17

From superficial to deep lie, the tibial nerve, popliteal vein and popliteal artery. The popliteal artery is crossed by the popliteal vein and tibial nerve posteriorly from the lateral to medial side.

Question 18

What are the contents of popliteal fossa?

Answer 18

• Popliteal artery and its branches.
• Popliteal vein and its tributaries.
• Tibial nerve and its branches.
• Common peroneal nerve and its
branches.
• Genicular branch of obturator nerve. • Posterior cutaneous nerve of thigh. • Popliteal lymph nodes.
• Fat.

Question 19

Name the structures passing through greater sciatic foramen.

Answer 19

• Piriformis
• Structures passing above piriformis
– Superior gluteal nerve
– Superior gluteal vessels
• Structures passing below piriformis
– Inferior gluteal vessels
– Internal pudendal vessels
– Inferior gluteal nerve
– Sciatic nerve
– Posterior cutaneous nerve of thigh – Nerve to quadratus femoris
– Pudendal nerve
– Nerve to obturator internus.

Question 20

Name the structures passing through lesser sciatic foramen.

Answer 20

• Tendon of obturator internus
• Internal pudendal vessels
• Pudendal nerve
• Nerve to obturator internus.

Question 21

Q.177 Name the bony prominences felt in the leg and foot.

Answer 21

• Medial and lateral condyles of tibia.
• Tibial tuberosity: In front of upper part of
tibia, 2.5 cm below the line passing
between tibia condyles.
• Head of fibula: Posterolaterally at level of
tibial tuberosity.
• Anterior border and medial surface of
tibia.
• Medial malleolus of tibia: On medial side of
ankle.
• Lateral malleolus of fibula.

Question 22

What are the attachment of inferior extensor retinacula?

Answer 22

It is a Y-shaped retinacula.
• Stem: Attached to anterior and articular
part of superior surface of calcaneum.
• Upper band: Attached to anterior border
of medial malleolus.
• Lower band: Attached to plantar apo-
neurosis.

Question 23

Name the structures passing deep to inferior extensor retinacula.

Answer 23

• Tibialis anterior
• Extensor hallucis longus
• Deep peroneal nerve • Anterior tibial vessels.

Question 24

Name the muscles of posterior compartment of leg.
Superficial muscles:

Answer 24

• Gastrocnemius,
• Soleus and
• Plantaris.
Deep muscles:
• Popliteus,
• Flexor digitorum longus, • Flexor hallucis longus and • Tibialis posterior.

Question 25

Name the structures passing under the flexor retinaculum.

Answer 25

From medial to lateral and above down- wards are:
• Tibialis posterior tendon
• Flexor digitorum longus tendon • Posterior tibial vessels • Tibial nerve
• Flexor hallucis longus tendon.

Question 26

Name the muscles found in different layers of sole of foot.

Answer 26

From without inwards:
First layer:
• Flexor digitorum brevis • Abductorhallucis
• Abductordigitiminimi.
Second layer:
• Flexor digitorum accessorius • Lumbricals: Four in number
Third layer:
• Flexor hallucis brevis
• Flexor digiti minimi brevis • Adductorhallucis
Fourth layer: Three plantar and four dorsal interossei.

Question 27

What is plantar aponeurosis and what are its functions?

Answer 27

It is the thickened central part of the deep fascia of sole.
Functions:
• Provides attachment to skin of sole.
• Gives origin to muscles of first layer of
sole.
• Protects the digital vessels and nerves and
deeper muscles.
• Helps in maintaining the longitudinal arch
of the foot.

Question 28

What are the functions of interossei of sole?

Answer 28

• Dorsal interossei: Abductors of the toes. • Plantar interossei: Adductors of the toes.