Lower limb Flashcards
Limb bud formation
week 4 upper
week 5 lower
Hip bone fusion
starts 15-7, complete 20-25
ischiopubic ramus 9
Intertrochanteric line and crest
line ant
crest post
angle of inclination
135 3y
126 adult
120 old
smaller women
Talus articulates
no muscular or tendinous attachments
articulates tib fib, calcaneous and navic
Calcaneous articulates
talus and cuboid
Cuboid articulates
calcaneous, navicular, L cuneiform, 4,5 metatarsals
lat groove for tendon peroneus longus
Navicular articulates
talus, cuneiform, cuboid
attaches ligaments of arch of foot
iliotibial tract
lateral thickening
shared aponeurosis TFL and glut max
attaches lateral tubercle of tibia
Great saphenous vein course
ant to med maleolus, post medial condyle femur, in saphenous opening fascia lata
small saphenous vein course
post lateral maleoulus
through dep fascia mid fibula
between heads gastroc
joins popliteal
deep veins leg
dorsal venous arch -> ant tibial
plantars -> post tibial and fibular
all then to popliteal
Lymph drainage leg
with great saphenous vein to superficial inguinal and external iliac
with small saphenous / deep to popliteal to deep inguinal
Innervation dorsum foot
lateral sural
medial malleolus saphenous
rest superficial peroneal/ fibular except web 1st toe deep
Innervation sole of foot
calcaneal
lat plantar - also nail bed lat 1.5
med plantar - also nail bed med 3.5
Femoral cutaneous innervation leg
anterior cutaneous - ant med thigh
saphenous - med leg and foot
Key dermatomes lower limb
L3 knee
L5 sole of foot
S1 lat foot and leg
S2 back of leg
S2/3 penis
S3 what you sit on
Hip adduction/ abduction
add L234
ab L5S1
Hip int/ext rot
Ankle inversion/ eversion
int/ inv L45
Ext / evers L5S1
Pectineus attachment
superior pubic ramus to pectineal line femur
Pectineus innervation and action
Femoral and obturator
hip flexion and adduction
Psoas major attachment
T12-L5 and all L TPs to lesser trochanter femur
Psoas major and minor innervation and action
L1,2 anterior rami
hip flexion + vertebral flexion
Psoas minor attachment
T12-L1 to iliopubic eminence via iliopectineal arch and pecton pubis
Iliacus attachment
iliac crest and fossa to tendon psoas major and lesser trochanter
Iliacus innervation and action
femoral L2,3
hip flexion
Sartorius attachment
ASIS to superior medial tibia via pes anserinus
Sartorius innervation and action
Femoral L23
flexion, abduction, external rotation
Quadriceps femoris muscles and innervation
Femoral nerve
rectus femoris
Vastus - lateralis, intermedialis, medialis
Rectus femoris insertion
anterior inferior iliac spine
Vastus lateralis insertion
greater trochanter femur
Vastus intermedialis insertion
anteriior and lateral surfaces shaft femur
Vastus medialis insertion
intertrochanteric line
Medial thigh muscles not supplied by obturator
pectineus - femoral
adductor magnus hamstring portion - sciatic
Adductor innervation and action
obturator + sciatic for hamstring part magnus
Adduction + extension with magnus
Adductor insertion
inferior pubic ramus to
brevis - pectineal line and linea aspera
longus - linea aspera
magnus - supracondylar and adductor tubercle
Gracillis insertion
body and inf ramus pubis to sup tibia medially via pes anserinus
Gracillis innervation and action
obturator
adduction, flex knee, medial rot
Obturator externus attachment
obturator foramen and membrane to trochanteric fossa femur
Obturator externus innervation and action
obturator
lateral rotation thigh
stabilise head of femur
Pes anserinus
tendon attaching to medial superior tibia
made of sartorius, semitendinous and gracillis
Borders and contents femoral triangle
Borders: inguinal ligament, sartorius, adductor longus
Contents NAVL, saphenous vein joins, femoral nerve splits
lunate lymph node
Femoral sheath formed from
transversalis and iliopsoas fascia
Femoral sheath contains
femoral vein and artery and femoral canal with come lymph vessels
Femoral canal borders
lat - septum
post - pectineus and sup ramus
med - lacunar lig
ant - inguinal lig
Femoral artery course
mid ing lig
femoral triangle
adductor canal
through adductor hiatus and becomes popliteal
Profunda femoris course
inf to ing lig in femoral triangle from femoral
between pectineus and adductor longus
posterior to adductor longus on medial femur - gives off 3-4 perforating arteries
Medial circumflex femur course
from profunda med post
between pectineus and iliopsoas
gives off retinacular
main supplier head and neck femur
Lateral circumflex femur course
ascending, descending and transverse branches
deep to sartorius and rectus femoris
Obturator artery course
80% from internal iliac, 20% from inferior epigastric
through obturator foramen to medial thigh
Splits into A and P - go either side of adductor brevis
Relationship femoral vein to artery
distal vein is posterolateral
mid point is posterior
prox is medial
Contents adductor canal
Femoral vain and artery
Saphenous nerve
Nerve to vastus medialis
Adductor canal borders
ant and lat - vastus medialis
post - adductor longus and magnus
medial and roof - sartorius
Cruciate anastomosis femoral head
transverse medial circumflex
transverse lateral circumflex
ascending branch 1st perforating
descending inferior gluteal
Ligaments making sciatic foramen
sacrotuberous - converts notch into foramen
sacrospinous - converts foramen into sup and inf
Superficial gluteal muscles
TFL, glut med, min and max
all supplied by superior gluteal nerve except glut max which is supplied by inf gluteal
TFL insertion and action
ASIS to iliotibial tract
abduct and medially rotate
Gluteus medius insertion and action
between post and ant gluteal lines to lat surface greater trochanter
abducts and medially rotate
Gluteus minimus insertion and action
between ant and inf gluteal lines to ant surface greater trochanter
abducts and medial rotation
Gluteus maximus insertion and action
Ilium, sacrum, coccyx and sacrotuberous ligament to iliotibial tract
extends thigh, external rotation, standing
Deep gluteal muscles
lateral rotation and stability +- abduction
insert near intratrochanteric crest (post)
piriformis
obturator internus
inferior and superior gemilli
quadratus femoris
Piriformis insertion, action, innervation
ant sacrum, sarotuberous lig to superior border greater trochanter
lat rot, abduct
s1+2
Obturator internus insertion, action, innervation
obturator membrane to medial surface greater trochanter
lat rot and abduct
inferior obturator
sup and inf gemelli insertion, action, innervation
sup ischial sine, inf ischial tuberosity to medial greater trochanter
lat rot and abd
sup - inf obturator nerve
inf - nerve to quad femoris
quadratus femoris insertion, action, innervation
lateral ischial tuberosity to intratrochanteri crest
lat rot and steady femoral head
L5/S1
Hamstring muscles and prox attachment
semitendinous, semimembranous, long head biceps femoris
from ischial tuberosity
innervated tibial division sciatic
short head biceps femoris
from linea espera and lat supra condylar line femur to lat head fibula with long head
innervated fibular division sciatic
distal attachment semimembranous
post medial epicondyle tibia
forms oblique popliteal ligament
distal attachment semitendinous
sup medial tibia in pes anserinus
Sciatic nerve course
L4-S3
converge inf border piriformis
sciatic foramen inf to piriformis, deep to glut max
descends on adductor magnus, deeps to biceps femoris
bifurcates apex popliteal fossa
Sciatic nerve supplies
post muscles thigh
all muscles leg and foot
sensory leg except saphenous
all joints
Sup gluteal nerve
L4-S1
through greater sciatic foramen sup to piriformis
between glut med and min to TFL (supplies all of these)
Inf gluteal nerve
L5-S2
greater sciatic foramen inf to piriformmis
deep to inf glut max which it supplies
Post cut nerve thigh
S1-3
greater sciatic foramen inf to piriformis
deep to glut max
supplies post skin and popliteal fossa
Borders popliteal fossa
sup med semimembranous
sup lat biceps femoris
inf gastroc
sup to deep in popliteal fossa
nerves: tibial, common fib, post cut nerve thigh
vein
artery
(also lat to med)
Muscles and nerve ant compartment leg
tibialis anterior
extensor hallucis longus
extensor digitorum longus + fibularis tertius (share synovial sheath)
deep fibular nerve
superior extensor retinaculum
sup to maleoli
inferior extensor retinaculum
from calcaneous
houses tendons extensor digitorum longus and fibularis tertius
y shaped
tibialis anterior attachments
lat condyle tib, lat surface tib, io membrane to cuneiform and base 1st mt
extensor hallucis longus attachments
ant surface fibula + IO membrane to dorsal distal big toe
Extensor digiti longus attachments
lat condyle tibia, IO membrane, mid fibula to lat 4 mid and dist phalanges
fibularis teritus attachments
inf 1/3 fibula + IO membrane to dorsum base 5th MT
Cutaneous nerve femoral triangle
Genitofemoral
Structures under superior extensor retinaculum med to lat
Tim has a very nasty disease paratyphoid
Tibialis ant
Extensor Hallucis longus
Artery
Vein
Nerve
Extensor Digutirum longus
Peroneustertius
Sacroiliac joint type
Synovial plane joint
Muscles inserting trochanteric fossa femur
obturator externus muscle and internus
superior gemellus and inferior gemellus
Fibularis longus
eversion + plantarflexion
superior fibular nerve
from head + sup 2/3 fibula to 1st metatrsal base and medial cuneiform
Fibularis brevis
eversion + plantarflexion
superior fibular nerve
from inf 2/3 lat fibula to dorsal surface tuberosity lat 5th MT
Muscles superficial posterior compartment
gastroc, soleus, plantaris
innervation tibial S1,2
arterial tibial
attach to calcaneal tendon distally
gastrocnemius insertion and action
lat condyle and sup to medial condyle femur
plantarflexes in knee extension
soleus insertion and action
pos head and surface fibula, soleal line and mid 1/3 medial tib
plantarflexes ankle independent knee position
Plantaris insertion and action
lateral supracondylar line femur, oblique popliteal lig
weakly assists gastroc
Deep muscles posterior compartment
popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
Popliteus attachments
lat condyle femur and lat meniscus to posterior surface tibia
Popliteus innervation and action
tibial L45S1
unlocks knee rotating 5 degrees on tibia
med rot tibia
Flexor hallucis longus attachments
inf 2/3 post fibula + IO membrane to base distal phalynx big toe
Flexor hallucis longus innervation and action
tibial S2,3
flexes big toe + weak plantar flexion
Flexor digitorum longus attachments
medial tibia inf to soleal line to base distal phalanges lat 4 digits
Flexir digitorum longus innervation and action
Tibial S2,3
flex lat 4 toes and plantarflexes
Tibialis posterior attachments
post tib fib and io membrane to navicular, cuneiform, cuboid, calcaneous 2,3,4 MT
Tibialis posterior innervation and action
L4,5
plantarflexion
foot inversion
Sural nerve
made from tibial and common peroneal
travels between heads gastroc with small saphenous
skin to lat foot and leg
Tibial nerve
on popliteus the tibialis posterior
bifurcates inf to flexor retinaculum
muscles post leg and knee joint
Common peroneal nerve
medial border biceps femoris
around neck fibula then divides
skin lat post leg and knee joint
Superficial peroneal nerve
between fibularis longus and neck fibula
pierces deep fascia distal 1/3 becomes SC
fib longus and brevis and skin dditsal 1/3 ant leg and dorsum foot
Deep peroneal nerve
between fibularis longus and neck fibula
through EDL to IO membrane
muscles and leg and dorsum foot + skin 1st web
Popliteal artery
ends inf border popliteus
provides genicular arteries to knee
becomes ant and post tibial
Anterior tibial artery
from popliteal comes through IO membranes
descends between tibialis anterior and extensor digitorum longus
becomes dorsalis pedis
Dorsalis pedis artery
divides into plantar and arcuate pierces first IO space via deep plantar to contribute plantar arch
fibular artery
branch of posterior tibial
travels in post compartment
perforating branches supply lateral compartment
Muscles 1st layer foot
abductor hallucis
flexor digitorum brevis
abductor digiti minimi
Muscles 2nd layer foot
Quadratus plantae
Lumbricals
Muscles 3rd layer foot
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
Muscles 4th layer foot
Plantar IO - unipenate , lat 3
Dorsal IO - bipenate 1-5
Muscles dorsum foot
Extensor digitorum brevis
Extensor hallucis brevis
Action lumbricals
flex proximal phalanx, extension med and distal phalanx
from tendon flex digi longus to medial aspects expansion lat 4 digits
Muscles innervated medial plantar S2,3
Abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, medial lumbrical
Medial plantar nerve
between abductor hallucis and flexor digitorum brevis
muscular and cutaneous branches
Lateral plantar nerve
between quadratus plantae and fexor digitorum brevis
superficial and deep branches
Hip Ligaments
Iliofemoral - strongest,
AIIS to intertrochanteric line
stops hyperextension
Pubofemoral
from pubic bone to joint capsule and iliofemoral
stops overabduction
Ischiofemoral - post acetabulum to femoral neck
weakest
prevents hyperflexion
Main muscles hip flexion
illopsoas and adductor magnus
Main muscles hip flexion and adduction
adductors, gracilis and pectineus
Main muscles hip abduction and med rot
glut med, min and TFL
Nerve supply hip
femoral, superior gluteal, obturator, nerve to quadratus femoris
Main stabiliser knee and patella
quadriceps knee
vastus medialis patella
LCL
stronger than MCL
separated from meniscus by popliteal tendon
Splits biceps femoris tendon in 2
MCL
attached to meniscus
posteriorly blends with capsule
Oblique popliteal ligament
expansion of semimembranous
from posterior medial tibial condyle
blends with knee joint capsule
Arcuate popliteal ligament
posterior fibular head to posterior surface knee joint
Intraarticular ligaments knee
ACL, PCL (medial)
coronary - peripheries
transverse - joins menisci ant
post - attaches firmly post
Menisci
med bigger and more damages, more C shaped, less mobiles
lat almost circular more mobile
Innervation knee
anterior - femoral, posterior - sciatic / tibial, lat - common fibular
Knee bursae communicating with joint
suprapatellar, popliteus, anserine, gastrocnemius
GAPS
Knee flexion degrees
120 ip extended, 140 flexed, 160 passive
hamstrings and short head biceps
knee medial rotation degrees
10 when flexed, 5 extended
flexed - semimembranosus and tendinous
extended popliteus
Knee lateral rotation degrees
30-40 when flexed
biceps femoris
Tibiofibular joint types
prox - plane synovial
dist - compound fibrous
only move on dorsiflexion foot
Lateral ligaments ankle
ant talofibular - weak, goes ant med
neck of talus
post talofibular - strong, postmed horizontal
lat tubercle talus
calcaneofibular - post inf
Deltoid ligament ankle
medial, strong
attaches calcaneous, navicular and talus
4 parts
tibionavicular
tibiocalcaneal
A+P tibiotalar
Nerve supply ankle
saphenous, tibial, sural, superficial and deep peroneal
Subtalar joint
talocalcaneal
plane synovial
ligaments med lat post and IO(strong)
inversion and eversion
transverse talar joint
calcaneocuboid (modified saddle/plane) and talonavicular part talocalcaneonavicular (ball and socket)
allows forefoot to rotate on hindfoot
Forefoot MTPJ joint type
condyloid synovial
Forefoot IPJ joint type
hinge synovial
Superficial to deep ligaments foot
plantar aponeurosis
long plantar
short plantar (calcaneocuboid)
calcaneonavicular (spring - continuation deltoid ligament)
Medial longitudinal arch foot bones
calcaneous, talus, navicular, 3 cuneiform, 1st 3 MTs
Lateral longitudinal arch foot bones
calcaneous, cuboid, 4+5 MT
Transverse arch foot bones
bases of metatarsals, cuboid, 3x cuneiform
Muscles attaching tibia and fibula
Extensor digitorum longus
Tibialis posterior
Age capitate ossifies
1
Age pisiform ossifies
10
Age upper end humerus fuses with shaft
20
Age lower end humerus fuses with the shaft
15
Age medial epicondyle elbow fuses
20
CRITOE
1 3 5 7 9 11
Age ossification centers appear
Sciatic artery is a branch of
Inferior gluteal artery
Bones in the midtarsal joint
Talus, calcaneus, navicular, cuboid
Drainage into popliteal lymphnodes
Dorsolateral foot and leg
