Lower Limb Flashcards
what is the name for thepart of the skeleton that forms the lower limb?
the inferior appendicular skeleton
what is the lower limb attached to the axial skeleton by? (1)
the pelvic girdle
what are the 4 regions of the lower limb?
- gluteal
- thigh
- leg
- foot
what are the two ligaments that extend from the sacrum to the ischium?
- sacro-spinous ligament
- sacro-tuberous ligament
origin and insertion of sacrospinous ligament:
origin - lateral margin of sacrum
insertion - ischium spine
sacro-tuberous ligament origin and insertion
origin - Posterior superior iliac spine (PSIS)
insertion - ischial tuberosity
what do the ligaments extending from sacrum to ischium form? (2)
the greater and lesser sciatic foreamen
what are the parts of the gluteus from superficial to deep: (3)
- Gluteus Maximus
- Gluteus Medius
- Gluteus Minimus
what are the lateral rotators of the thigh? (5)
- Piriformis
- Superior Gemellus
- Inferior Gemellus
- Obturator internus
- Quadratus Femorus
Gluteus Maximus origin (4)
- posterior surface of ileum
- Posterior surface of sacrum
- Sacro tuberous ligament
- Ischial tuberosity
insertion of gluteus maximus (2) and % of fibres going to each insertion
- Iliotibial tract - 75%
- Gluteal tuberosity - 25%
where is the gluteal tuberosity located on the femur?
superior posterior shaft
what does the iliotibial tract help in stabilisation of?
the knee joint
gluteus medius origin (1)
external surface of ileum - between posterior and anterior gluteal line
insertion of gluteus medius (1)
greater trochanter of femur
gluteus minimus origin (1)
external surface of ileum - between posterior and inferior gluteal lines
insertion of gluteus minimus (1)
greater trochanter of femur
function of gluteus maximus (2)
- hip extension
- lateral rotation of femur
gluteus medius and minmus functions (2)
- medial rotation of femur
- abduction of femur
Piriformis origin and insertion (1 & 1)
origin - anterior surface of sacrum
insertion - greater trochanter of femur
what does the piriformis pass through to enable its attachment onto the greater trochanter? (1)
- the greater sciatic foramen
what nerve passes alongisde the piriformis? (1)
sciatic nerve
which muscle lies just inferior to piriformis? (1)
superior gemellus
origin (1) and insertion (1) of superior gemellus
- origin - ischial spine
- insertion - greater trochanter of femur
origin (1) and insertion (1) of inferior gemellus
- origin - ischial tuberosity
- insertion - greater trochanter of femur
quadratus femoris origin (1) and insertion (1)
- origin - ischial tuberosity
- insertion - intertrochanteric crest
where is the intertrochanteric crest found? (1)
runs between the greater and lesser trochanters of the femur
obturator internus origin (1) and insertion (1)
- origin - inside surface of obturator foramen
- insertion - greater trochanter of femur
what does the obturator internus pass out of in order to reach its attachment (1)
the lesser sciatic foramen
obturator externus origin (2) and insertion (1)
- origin - obturator membrane & ischiopubic ramus
- insertion - greater trochanter of femur
function of quadratus femoris as well as laterally rotating femur (1)
steadies femoral head in acetabulum
what is the acetabulum? (4)
- concave
- cup-shaped socket
- in pelvis
- forms hip joint
what junction is the acetabulum located next to?
the junction of the three pelvic bones:
1. ilium
2. ischium
3. pubis
function of obturator externus (1)
- external rotation of hip
what are the 5 muscles groups acting at the hip joint?
- short rotators
- flexors
- adductors
- abductors
- extensors
which of the 5 muscle groups acting at the hip lies the deepest?
- the short rotator muscles
how many short rotator muscles are the?
6
what are the 6 rotator muscles of the hip?
- piriformis
2. obturator externus - obturator internus
- gemellus superior
- gemellus inferior
- quadratus femoris
what are the three hip abductor muscles
- gluteus medius
- gluteus minimus
- tensor fascia lata
what is the fascia lata? (2)
- a continuous sheet of dense fibrous tissue
- surrounds all muscles of the thigh
what is the thickening of the fascia Lata on the outer aspect of the thigh? (1)
iliotibial tract
where does the iliotibial tract extend from and to? (2)
ilium to tibia
what attaches the iliotibial tract to the femur? (1)
strong fibrous septum
for which muscles does the iliotibial tract act as the tendon of insertion? (2)
Gluteus maximus
Tensor fascia Lata
origin and insertion of Tensor Fascia Lata? (2)
- origin - iliac crest
- insertion - iliotibial tract
what is the largest nerve of the lower extremity?
the sciatic nerve
what are the 2 gluteal nerves called?
superior
inferior
what does the sciatic nerve supply? (2)
- posterior thigh muscles
- almost everything below knee
origin of gluteal and sciatic nerves (1)
sacral plexus
how many and what roots form the sacral plexus?
5
L4, L5, S1, S2, S3
what muscle typically overlies the sacral plexus?
piriformis
how do all three nerves (sciatic and 2 gluteals) leave the pelvis? (1)
through the greater sciatic foramen
what muscles does the superior gluteal nerve supply? (3)
- gluteus Medius
- Gluteus Minimus
- Tensor Fascia Lata
what does the inferior gluteal nerve supply (1)
Gluteus maximus
what 2 muscles lie deep to the sciatic nerve as it runs down the thigh?
- quadratus femoris
- adductor magnus
what does the sciatic nerve supply in the thigh? (4)
- Semitendinosus
- Semimembranosus
- Biceps Femoris
- Posterior part of adductor magnus
which hip muscles have their own individual nerve supply? (4)
- Psoas major
- Piriformis
- Obturator internus
- Quadratus Femoris
what are the main Parts of the femur (12)
- head
- neck
- greater trochanter
- lesser trochanter
- intertrochanteric crest
- intertrochanteric line
- Pectineal line
- Linea Aspera
- Medial epicondyle
- Lateral epicondyle
- Medial condyle
- Lateral condyle
what is the Linea Aspera of the Femur (2)
- a prominant ridge
- on the posterior shaft of the femur
what is the pectineal line of the femur (3)
- a bony ridge
- on the anterior side
- at the proximal part
whats the difference between an epicondyle and a condyle? (2)
epicondyle - a** bony projection **located near a condyle that often serves as a site for muscle attachment
condyle - a rounded articular surface at the end of a bone, often part of a joint
compartments of the upper limb vs lower limb: anteriorvs posterior
anterior:
* upper limb - flexors
* lower limb - extensors
Posterior:
* upper limb - extensors
* lower limb - flexors
anterior thigh supply: vein, artery and nerve
vein - femoral
artery - femoral
nerve - femoral
medial thigh supply: vein, artery and nerve name
vein - femoral
artery - femoral
nerve - obturator
posterior thigh supply: vein, artery and nerve name
vein - profunda femoris
artery - profunda femoris
nerve - sciatic
anterior leg (lower leg) supply: vein, artery and nerve name
vein - anterior tibial
artery - anterior tibial
nerve - deep fibular
most superior part of pelvis
iliac crest
lateral leg supply: vein, artery and nerve name
vein - anterior tibial
artery - anterior tibial & fibular
nerve - superficial fibular
posterior leg (lower leg) supply: vein, artery and nerve name
vein - posterior tibial
artery - posterior tibial
nerve - tibial
what are the nerves that supply the foot (6)
- sural nerve
- saphenous nerve
- deep fibular nerve
- superficial fibular nerve
- medial plantar nerve
- lateral plantar nerve
movements of the thigh: anterior, medial and posterior compartment
anterior - extension of leg
posterior - flexion of leg
medial - adduction of thigh
movements of leg (lower): anterior (2), lateral (1) and posterior (2)
anterior:
* dorsiflexion of foot
* extenson of digits
lateral:
* eversion of foot
posterior:
* plantar flexion of foot
* flexion of digits
which artery gives rise to the femoral artery?
external iliac artery
lower limb arterial division names (10)
- external iliac
- femoral artery
- popliteal
- fibular
- posterior tibial
- anterior tibial
- lateral plantar
- medial plantar
- superficial plantar arch
- deep plantar arch
when does the external iliac artery turn into femoral artery?
- at the inguinal ligament
what branch does the femoral artery give off?
profunda femoris
when does the femoral artery become the popliteal artery?
at the adductor hiatus
what 2 branches does the popliteal artery split into?
- posterior tibial
- anterior tibial
what branch does the posterior tibial artery give off?
fibular artery
what are the main veins of the lower limb? (5)
- femoral
- popliteal
- fibular
- anterior tibial
- posterior tibial
superficial veins of the lower limb and where they arise from
- Great Saphenous - arises from femoral vein
- Small Saphenous - arises from popliteal vein
what roots form the lumbar plexus?
- L1-L4
dermatome definition: and example
the cutaneous area supplied by a single spinal nerve root
example: L2
cuteaneous innervation definition and example
the area of skin innervated by a specific cutaneous nerve
example - lateral cutaneous nerve of thigh
what movements are the superficial muscles of the hip joint associated with? (2)
- abduction
- extension
what movements are the deep muscles of the gluteal region associated with? (1)
lateral rotation
why is the relationship between the piriformis and sciatic nerve significant?
anatomic variability of the sciatic nerve - the sciatic nerve may pass above, below or through the piriformis muscle
what is the most common course of the sciatic nerve in relation to the piriformis muscle?
sciatic nerve passes below piriformis
what is piriformis syndrome?
where the sciatic nerve passes through the piriformis muscle
what happens in piriformis syndrome (3)
compression or irritation of the sciatic nerve causes:
* paresthesia along sciatic nerve path
3 for medial
what are the boarders of the gluteal region?
lateral - lateral thigh
superior - iliac crest
medial - sacrum, coccyx, and anus
inferior - inferior boarder of gluteus maximus
what is the iliotibial tract also known as?
the IT band
what is the nerve and artery that passes through the greater sciatic foramen, superior to piriformis?
nerve - superior gluteal nerve
artery - superior gluteal artery
where does the inferior gluteal artery and inferior gluteal nerve pass in relation to piriformis? (2)
- through greater sciatic foramen
- inferior to piriformis
what is the deep fascia of the posterior thigh called?
the fascia lata
what groups of muscles make up the ‘hamstring muscles’?
most lateral to medial for extra point
- Biceps Femoris
- Semitendionsus
- Semimembranosus
Biceps femoris two heads origin:
long head - ischial tuberosity
short head - midshaft of femur
insertion of Biceps femoris (1)
head of fibula
which head of biceps femoris is more lateral?
short head
Origin and insertion of Semitendinosus
origin - ischial tuberosity
insertion - Pes anserinus
what is the Pes anserinus? (3)
- Part of the tibia
- medial superior side
- common insertion point of tendons
what tendons insert onto the Pes anserinus of the tibia? (3)
- semitendinosus
- Gracillis
- Sartorius
how to distinguish between semitendinosus and semimembranosus?
semitendinosus - half of it is tendon
semimembranosus - broader, membranous appearance
Semimembranosus origin and insertion
origin - ischial tuberosity
insertion - posterior medial condyle of tibia
what inserts lower, semimembranosus or semitendinosus?
Semitendinosus
hamstrings muscle function as a whole? (2)
knee flexion
hip extension
what muscle of the hamstrings is not involved in hip extension and why?
- short head of biceps
- does not originate from ischial tuberosity like other hamstring muscles
what determines whether the hamstrings produce knee flexion, hip extension, or both? (1)
what other muscles are acting in opposition to them at the time
what other muscles are involved
how hamstrings produce hip extension: (2)
- quadricep flexion
- hamstring flexion
what other muscles are involved
how hamstrings produce knee flexion (2)
- hip flexor flexion
- hamstring flexion
what is the popliteal fossa? (2)
- a diamond-shaped depression at the back of the knee joint
- serves as a transition between thigh and calf
contents of the popliteal fossa: (8)
- popliteal artery
- popliteal vein
- tibial nerve
- common fibular nerve
- sural nerve
- sural communicating nerve
- popliteal lymph nodes
- small saphenous vein
superior and inferior
boarders of the popliteal fossa (3 & 2)
superior:
* medial - semitendinosus & semimembranosus
* lateral - Biceps Femoris
Inferior:
* medial - medial head of gastrocnemius
* lateral - lateral head of gastrocnemius
what are the superficial structures located on top of the popliteal fossa? (3)
- sural nerve
- sural communicating nerve
- small saphenous vein
where the sural nerve comes from?
tibial branch of the sciatic nerve
where does the sural communicating nerve come from?
the common fibular branch of the sciatic nerve
what does the small saphenous vein drain into?
the popliteal vein
path of sciatic nerve from gluteal region to where it divides: (5)
- passes out of pelvis via greater sciatic foramen
- passes below piriformis
- passes between hamstring muscles
- divides into 2 branches prior to popliteal fossa
- tibial and common fibular/peroneal branches
how to tell which is the tibial branch and common fibular branch of sciatic nerve (2)
- tibial - medial side & thick
path of tibial nerve (3)
- passes through popliteal fossa
- passes between 2 heads of gastrocnemius
- travels to posterior leg
what does the tibial nerve supply in the posterior thigh? (3)
- semitendinosus
- semimembranosus
- long head of biceps femoris
what does the common fibular nerve supply in posterior thigh? (1)
- short head of biceps femoris
what are the posterior muscles of the thigh supplied by? (blood)
- profunda femoris artery
what do the popliteal vein and artery pass though before reaching the popliteal fossa?
- adductor hiatus - opening in adductor hiatus
general term
what are the main branches of the popliteal artery? (1)
- genicular branches
what do the genicular branches supply? as a whole? (2)
- knee joint
- surounding soft tissue
what are the 5 knee flexor muscles?
- Biceps Femoris
- Semitendinosus
- Semimembranosus
- Sartorius
- Gracillis
Sartorius origin (2) and insertion (1)
origin:
* superior head - ASIS
* inferior head - notch between ASIS & AIIS
insertion:
* Pes anserinus
Gracillis origin (2) and insertion (1)
origin:
* pubic symphysis
* pubic crest
insertion:
* Pes anserinus
medial side
what does the obturator nerve supply? (4)
- obturator externus
- adductor brevis
- adductor longus
- anterior part of adductor magnus
what does the femoral nerve supply? (4)
- iliacus
- pectineus
- all 4 heads of quadriceps
- sartorius
muscles surrounding knee from below: (3)
- popliteus muscle
- Plantaris muscle
- Gastrocnemius muscle
popliteus origin and insertion
- origin - superior part of posterior tibia
- insertion - lateral epicondyle of femur
what does the tendon of popliteus pass through in order to reach its insertion point?
- capsule of knee
function of popliteus (2)
- minor flexor of knee
- medial rotation of tibia
what muscle lies superficial to popliteus?
- plantaris
origin and insertion of plantaris
origin - lateral epicondyle of femur
insertion - calcaneous
what is the calcaneous?
The heel bone
what muscle does the tendon of plantaris travel over?
soleus
what muscle lies superficial to both plantaris and popliteus?
gastrocnemius
orign (2) and insertion of gastrocnemius (1)
origin:
* two heads - medial & lateral condyles of femur
insertion:
* calcaneus
what do the two head of gastrocnemius join with in order to form a large tendon?
soleus tendon
what do the distal tendons of the soleus muscle and gastrocnemius form?
- the calcaneal tendon
function of the gastrocnemius (2)
- slight flexion of knee
- plantar flexion of ankle
from a posterior view, which of the following lies the deepest?
popliteal artery
popliteal vein
sciatic nerve
popliteal artery
branches of the popliteal artery above the knee (2)
lateral suprior genicular artery
medial superior genicular artery
branches of the popliteal artery at the knee (2)
branches to both heads of gastrocnemius
branches of the popliteal artery below the knee (2)
lateral inferior genicular artery
medial inferior genicular artery
muscles involved in plantar flexion: (3)
- gastrocnemius
- soleus
- plantaris
extrinsic muscles involved in flexing the digits of the foot: (2)
- flexor digitorum longus
- flexor hallucis longus
the superficial vs deep muscles of the posterior legs actions
3 superficial muscles - plantar flexion
3 deep muscles - flex digits/ invert foot
muscles involved in inverting foot (4)
- tibialis anterior
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus
what are the three superficial muscles of the posterior leg?
- gastrocnemius
- soleus
- plantaris
what are the three deep muscles of the posterior leg?
- tibialis posterior
- flexor hallucis longus
- flexor digitorum longus
what muscles of the hamstrings are involved in medial (2) & lateral (1) rotation?
Lateral rotation - biceps femoris
medial rotation - semitendinosus & semimembranosus
how many tarsal bones are there, and what are they called? (posterior-anterior)
7:
1. Calcaneus
2. Talus
3. Navicular
4. cuboid
5. lateral cuneiform
6. intermediate cuneiform
7. medial cuneiform
how many metatarsals are there?
5 - one for each toe
how are the metatarsals named?
1-5, starting from medial side (big toe)
unique featues of the 1st, 2nd, and 5th metartasal?
1st - much bigger than the rest
2nd - longest
5th - prominent tubercle at base
how many phalanges per toe? (2)
- all have three phalanges
- apart from big toe which has 2
what are the 2 planes of the arch of the foot?
- side to side arch
- end to end arch
what are the flexor muscles of the big toe?
- flexor hallucis longus
- flexor hallucis brevis
it contains 2 distinct parts!
flexor hallucis brevis origin (2) and insertion (2)
medial part:
* origin - cuboid bone
lateral part:
* origin - lateral cuneiform bone
insertion of both:
* medial & lateral sesamoid
* base of proximal phalanges of big toe
where are the lateral and medial sesamoid bone located in the foot? (1)
bottom of MP joint
which is bigger, the lateral or medial sesamoid bone of the big toe?
medial sesamoid bone
what are the short muscles of the big toe? (3)
- flexor hallucis brevis
- adductor hallucis
- adbuctor hallucis
contains 2 heads of origin
origin (2) and insertion (1) of adductor hallucis
origin:
* oblique head - base of mid three metarsals
* transverse head - deep transverse metatarsal ligament
insertion;
* medial sesamoid bone
origin (1) and insertion (2) of abductor hallucis:
origin - medial side of calcaneus
insertion - medial sesamoid bone & base of proximal phalanges
what tendon runs between the two halves of flexor hallucis brevis?
flexor hallucis longus tendon
what are the two heads of flexor hallucis brevis?
medial part
lateral part
what muscles merge with the medial head of flexor hallucis brevis? (2)
- adductor hallucis (both heads)
- abductor hallucis
what is the most medial muscle of all the foot muscles?
abductor hallucis
what are the two short muscles of the little toe?
- flexor digiti minimi brevis
- abductor ditigi minimi
abductor digiti minimi origin and insertion
origin - calcaneus
insertion - proximal phalanges of 5th toe
flexor digiti minimi brevis origin and insertion
origin - 5th metatarsal
insertion - proximal phalanges of little toe (medial side)
what are the two long toe flexor muscles?
- flexor hallucis longus
- flexor digitorum longus
what tendon passes through the flexor digitorum longus origin?
tibialis posterior
flexor hallucis longus origin and insertion:
origin - distal two thirds of fibula
insertion - distal phalanges of big toe
flexor digitorum longus origin and insertion
origin - distal two thirds of tibia
insertion - 4 tendons, distal phalanges of each toe
what are considered the three medial leg muscles?
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior
which of the three medial leg muscles lie the deepest?
tibialis posterior
what do the three medial leg muscle tendons pass underneath in order to reach the foot?
the flexor retinaculum
what of the two long flexor toe muscles is more medial?
flexor digitorum longus
surprising! tendons cross over in plantar aspect of foot
what happens to the flexor hallucis and digitorum longus tendons in the plantar aspect of the foot?
they cross over each other
which tendon of the long toe flexors lies deeper in the foot
flexor hallucis longus
what does the tendon of flexor hallucis longus pass through within the foot in order to reach big toe?
flexor tendon sheath of big toe
what side are the short toe flexor muscles located on the foot?
plantar aspect
what are the intrinsic muscles of the foot, dorsal (2) vs plantar (9)
Plantar muscles:
1. interossei
2. lumbricals
3. flexor accessorius
4. flexor digitorum brevis
5. flexor hallucis brevis
6. flexor digiti minimi brevis
7. abductor digiti minimi
8. abductor hallucis
9. adductor hallucis
Dorsal muscles:
1. extensor digitorum brevis
2. extensor hallucis brevis
how many interossei in the foot are there?
7:
* 2 for each 3 middle toes
* 1 for 5th toe
origin and insertion of interossei
origin - shaft of metatarsals
insertion - proximal phalanges of each toe
function of interosseous muscles of foot (1)
- flex toe at MP joint
what are the middle group of short toe flexor muscles?
- lumbricals
- flexor accessorius/ quadratus plantae
- flexor digitorum brevis
what tendon is the middle group of short toe flexor muscles closely located to?
flexor digitorum longus tendon
how many lumbricals are there in the foot, and what is their arrangement
- 4
- likeweise to hand
flexor accessorius origin and insertion:
origin - calcaneus
insertion - tendon of flexor digitorum longus
function of flexor accessorius
flex lateral 4 toes at PIP and MTP joint
flexor digitorum brevis origin and insertion
origin - calcaneus
insertion - base of middle phalanges of lateral 4 toes
function of flexor digitorum brevis: (2)
flexion of PIP and MTP joint
what lies superficial to flexor digitorum brevis
the plantar aponeurosis
muscles found in the lateral leg (2)
- fibularis brevis
- fibularis longus
function of the lateral leg muscles together (3)
- eversion of foot
- plantar flexion of foot
- aid in lateral arch support
what do the tendons of the lateral muscles travel beneath before entering the foot?
the fibular retinaculum
what is another name for the fibularis brevis and longus?
- peroneus longus
- peroneus brevis
origin and insertion of fibularis brevis:
origin - lower two thirds of fibula
insertion - 5th metacarpal
origin and insertion of fibularis longus
origin - upper two thirds of fibula
insertion - 1st metacarpal & medial cuneiform bone
what innervates the muscles of the lateral leg? (1)
the common fibular nerve
how many layers are there in the plantar muscles of the foot?
4
what muscles are in the ‘superficial’ layer 1 of the plantar foot (3)
- abductor digiti minimi
- flexor digitorum brevis
- abductor hallucis
what muscles are in layer 2 of the plantar foot (4)
- flexor hallucis longus
- flexor digitorum longus
- lumbricals
- quadratus plantae
what neurovascular structures are found in layer two of plantar foot? (4)
- medial & lateral plantar arteries
- medial & lateral plantar nerves
what muscles are found in layer 3 of the foot (3)
- flexor digiti minimi
- adductor hallucis
- flexor hallucis brevis
what muscles are located in the ‘deepest’ layer 4 of the plantar foot (4)
- plantar interossei
- dorsal interossei
- fibularis longus
- tibialis posterior
lateral rotators of the gluteal region, from superior to inferior, & their origins (5)
- piriformis - anterior surface of sacrum
- superior gemellus - ischial spine
- obturator internus - inside surface of obturator foramen
- inferior gemellus - ischial tuberosity
- quadratus femoris - ischial tuberosity
what is considered the longest muscle of the lateral rotators of the gluteal region?
piriformis - extends to femur all the way from sacrum
sural nerve: origin (2) and innervation (2)
origin:
* unity of tibial and peroneal nerve
innervation:
* sensory innervation to lateral aspect of foot and 5th toe
saphenous nerve origin and innervation (2)
origin:
* femoral nerve
innervation:
* sensory innervation to medial aspect of foot & ankle
deep fibular nerve origin and innervation: (2)
origin:
* common fibular nerve
innervation:
* motor - anterior compartments of leg
* sensory - skin between 1st and 2nd toes
superficial fibular nerve origin and innervation (1)
origin - common fibular nerve
innervation:
* sensory - dorsum of foot
has lots of motor innervation!
medial plantar nerve origin and innervation (5)
origin:
* tibial nerve
innervation:
* sensory - medial sole of foot
motor - abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, 1st lumbrical
lots of motor innervation!
lateral plantar nerve origin and sensory innervation:
origin:
* tibial nerve
Innervation:
* sensory - lateral sole of foot
motor innervation of the lateral plantar nerve: (6)
- abductor digiti minimi
- flexor digiti minimi brevis
- 2nd, 3rd, and 4th lumbricals
- dorsal and plantar interossei
- quadratus plantae
- adductor hallucis
arteries of the foot: (4)
- medial plantar artery
- lateral plantar artery
- dorsalis pedis artery
- arcuate artery
what does the abdominal aorta split into?
common iliac arteries, left and right
what does the common iliac artery split into
internal and external iliac artery
what does the internal iliac artery supply (3)
- pelvic structures
- gluteal region
- medial thigh muscles
what branches of the internal iliac artery supply the gluteal (2) and thigh region (1)
- obturator artery
- Superior gluteal artery
- Inferior gluteal artery
what is the deep branch of the common femoral artery?
- profunda femoris artery
what are the two main branches of the profunda femoris artery
- lateral circumflex artery
- medial circumflex artery
after giving off the profunda femoris branch, what does the common femoral artery turn into?
superficial femoral artery
what does the superficial femoral artery turn into when it travels through the adductor canal in the thigh?
popliteal artery
what branches of the popliteal artery supply the knee joint?
genicular branches
what does the popliteal artery divide into?
- anterior tibial artery
- posterior tibial artery
posterior tibial artery path: (4)
- descends along superficial surface of deep posterior muscles
- gives of fibular artery
- enters foot via tarsal tunnel
- splits into lateral and medial plantar arteries
what does the fibular artery supply? (1)
lateral compartment of leg
anterior tibial artery path: (2)
- passes into anterior compartment of leg through gap in interosseus membrane at its most superior part
- descends down leg until foot
what does the anterior tibial artery become as it enters the foot?
dorsalis pedis artery
main branches of the dorsalis pedis artery (2)
- deep plantar artery
- lateral tarsal artery (arcuate)
what does the deep plantar artery anastomose with, and what it forms
- lateral plantar artery
- forms the deep plantar arch
what are the two systems of venous drainage in the lower limb
deep
superficial
path of veins of the deep venous system: (2)
- accompanies vessels of the arterial system
- follows a similar naming structure to arterial system in lower limb
what system of venous drainge drains into which?
superficial veins drain into deep vein system
what are the two main veins of the superficial venous system in the leg?
- small saphenous vein
- great saphenous vein
what side of the foot drains into the small saphenous vein? and the main vein that drains into it
lateral aspect of foot - dorsal venous arch
what side of the foot drains into the great saphenous vein? and the main vein that drains into it
medial aspect of foot - medial marginal vein
passage of small saphenous vein: (4)
- arises from lateral aspect of dorsal venous arch
- passes behind lateral malleolus and ascends leg
- ascends posteriorly up leg
- at level of knee drains into popliteal vein
passage of great saphenous vein: (3)
- passes in front of medial malleolus
- runs along medial aspect of leg
- drains into femoral vein
what do perforating veins of the superficial venous system do? (1)
- connect superficial venous system to deep venous system
how is backflow prevented from deep to superficial venous system? (2)
- deep venous system is at a higher pressure
- valves also located at junctions between systems
what type of vein forms if the valves don’t work in the superfical-deep vein drainage?
varicose vein - tortuous dilated vein
what are the muscles in the anterior compartment of the thigh (2)
- sartorius
- quadriceps
functions over two joints
what are the functions of sartorius? (3 & 2)
hip:
* flexion
* weak abduction
* lateral thigh rotation
knee:
* flexion
* medial knee rotation
what are the 4 muscles within quadriceps:
- rectus femoris
- vastus medialis
- vastus intermedius
- vast lateralis
what quadricep muscle has an action at the hip as well as at the knee, and what is this action?
rectus femoris - hip flexion
what similar function do all 4 quadricep muscles have?
knee extension
insertion of the quadricep muscles: (2)
- patella
- tibial tuberosity
Via what ligaemnt does the quadricep muscles insert onto the tibial tuberosity?
patella ligament
what muscle of quadriceps do i have that is particularly overdeveloped?
vastus medialis
advantages of having overdeveloped Vastus medialis (3)
- improved knee stability
- knee injury prevention as distributes forces more evenly across knee joint
- improved knee extension force
what is the medial compartment of the thigh also known as?
adductor compartment
what are the 3 adductor muscles, named from superior-inferior
- adductor Brevis
- adductor longus
- adductor magnus
what is the most medial and most superficial muscle in the medial compartment of the thigh?
medial - gracillis
superficial - gracillis
obturator externus function:
- lateral rotation
- adduction
what are the muscles in the medial compartment of the thigh (6)
- obturator externus
- adductor brevis
- adductor longus
- adductor magnus
- gracillis
- pectineus
what is the Pes Anserine?
- a tendon on the medial aspect of the knee formed by the confluence 3 muscle tendons
what are the 3 muscle tendons that form the pes anserine from superior-inferior?
- Sartorius
- Gracillis
- Semitendinosus
mnemonic to remember pes anserine tendon arrangement from superior-inferior
Say Grace before Tea
what is the femoral triangle (2)
- a triangular shaped depression
- located in upper thigh region
importance of the femoral triangle (2)
- serves as a channel for structures entering and leaving anterior thigh
- contains many important neurovascular structures
clinical significance of the femoral triangle: (3)
- femoral pulse can be measured here
- access to femoral artery
- femoral hernias manifest here
boundaries of the femoral triangle: (3)
superior - inguinal ligament
medial - adductor longus
lateral - sartorius
what makes up the floor of the femoral triangle? (2)
- pectineus
- iliopsoas muscle
what are the contents of the femoral triangle? (from lateral to medial) (4)
- Femoral nerve
- Femoral artery
- Femoral vein
- Femoral canal
what is the femoral canal? (1)
- a canal containing deep lymph nodes and vessels
what is the longest cutaneous branch of the femoral nerve?
- saphenous nerve - sensory innervation to skin on medial side of leg
the nerve and artery that supplies the adductor muscles
obturator nerve and artery
what does the femoral nerve supply (4)
- iliacus
- quadriceps
- pectineus
- sartorius
what does the obturator nerve innervate (4)
- obturator externus
- adductor brevis
- adductor longus
- anterior part of adductor magnus
what are the 5 adductor muscles?
- adductor magnus
- adductor longus
- adductor brevis
- pectineus
- gracillis
the largest adductor muscle:
adductor magnus
origin and insertion (2) of adductor magnus:
- origin - ischiopuic ramus outer boarder
insertion:
* linea aspera - upper
* adductor tubercle of femur - lower
most posted of the 3 named adductor muscles:
- magnus
which is more inferior, adductor longus or brevis?
- longus
origin and insertion of adductor brevis:
- origin - inferior pubis
- insertion - femur
adductor longus origin and insertion:
- origin - body of pubis
- insertion - femur
shortest and longest of the adductor muscles:
- longest - gracilis
- shortest - pectineus
pectineus origin and insertion:
- origin - superior pubic ramus
- insertion - pectineal line of femur
gracilis origin (2)and insertion:
- origin - inferior pubis ramus & ischial tuberosity
- insertion - Pes anserine
the most medial thigh muscle:
- gracilis
what are the 4 hip flexor muscles?
- iliacus
- psoas major
- sartorius
- rectus femoris
what are the two main hip flexor muscles?
- iliacus
- psoas majro
iliacus origin and insertion:
- origin - inner aspect of wing of ileum
- insertion - lesser trochanter
psoas major origin and insertion:
- origin - lumbar spine
- insertion - lesser trochanter
sartorius and rectus femoris origin:
- ASIS - why it helps in hip flexion
what is the deepest of the quadricep muscles?
- vastus intermedius
vastus intermedius origin
- femur shaft
vastus lateralis origin
- linea aspera
vastus medialis origin
- medial edge of linea aspera
what muscle covers the adductor canal?
sartorius
origin and drainage of great saphenous vein:
- origin - dorsal venous arch of foot
- drainage - femoral vein
superficial neurovascular structures of the anterior leg:
- great saphenous vein
- saphenous nerve
- superficial fibular nerve
(2)saphenous nerve innervation:
- sensory, medial side of leg and foot
origin of saphenous nerve:
- femoral nerve
superficial fibular nerve sensory innervation: (2)
- lower 1/3 of lateral leg
- dorsum of foot
motor innervation of superficial fibular nerve: (2)
fibularis longus
fibularis brevis
origin of superficial fibular nerve
common fibular nerve
muscles of the anterior leg (4)
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- fibularis tertius
origin and insertion (2) of tibialis anterior:
- origin - upper lateral tibia
- insertion - medial cuneiform and base of first metatarsal bone
function of tibialis anterior: (2)
- dorsiflexion
- inversion of foot
extensor hallucis longus origin and insertion:
- origin: anterior fibula
- insertion: distal phalanges of big toe
extensor digitorum longus origin and insertion:
- origin - lateral tibial condyle
- insertion - middle and distal phalanges of toes
fibularis tertius origin and insertion:
- origin - fibular shaft
- insertion - 5th metarsal
function of fibularis tertius: (2)
- dorsiflexion
- eversion
muscles from medial to lateral in anterior compartment of leg: (4)
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- fibularis tertius
muscles on dorsum of the foot: (2)
- extensor digitorum brevis
- extensor hallucis brevis
origin and insertion of extensor digitorum brevis:
- origin - calcaneus
- insertion - base of proximal phalanges of middle 3 toes
extensor hallucis brevis origin and insertion:
- origin - calcaneus
- insertion - proximal phalanges big toe
nerve supply of anterior leg muscles
- deep fibuar nerve
sensory innervation of the deep fibular nerves:
- skin between 1st and second toes
artery supply of anterio leg:
- anterior tibial artery
artery supply of dorsum of foot:
- continuation of anterior tibial artery known as dorsalis pedis artery
nerve supply of dorsum of foot:
- deep fibular nerve
which bone of the leg forms the knee joint?
- tibia
which bone of the leg forms the ankle joint?
- both tibia and fibula
what are the joints called that connect the tibia and fibula?
- tibulofibular joint - proximal and distal
difference in joint type between proximal and distal tibiofibular:
- proximal - synovial
- distal - fibrous
what holds the tibia and fibular bones togteher distally?
- anterior tibiofibular ligament
- posterior tibofibular ligament
what bpne articulates with the tibia and fibular to form the ankle joint?
- talus
what holds the ankle joint together on the medial side?
deltoid ligament
what holds the ankle joint together on the lateral side?
- posterior talofibular joint
- anterior talofibular ligament
where do the short extensor muscles of the toe lie in relation to the tendons of the long extensor muscles of the toe?
- beneath the tendons of the long extensors
what muscles does shin splints effect?
- tibialis anterior
sign of common fibular nerve injury:
- foot drop - inability to dorsiflex foot
what are the two parts of the extensor retinaculum in the foot?
- superior
- inferior - y shape
how to remember the tendons & vessels that move pass medial malleolus from anterior to posterior:
- Tom, Dick And Naughty Harry
what does Tom, Dick And Naughty Harry stand for?
- Tibialis posterior
- lexor Digitorum longus
- posterior tibial Artery
- tibial Nerve
- flexor Hallucis longus