Lower limb

Question 1

Lower limb Myotomes

Answer 1

L2,L3 lift my knee - hip flexion
L3, L4 kick the door- knee extension
L4,5 toes to the sky -dorsiflexion
L4,L5 extend my thigh - hip extension
L5, S1 kick my bum - knee flexion
S2, S2 point my toes - plantarflexion
L4,L5 ankle inversion
L5, S1 ankle eversion

Question 2

Medial Longitudinal Arch

Answer 2

tuberosity of the calcaneus posteriorly, talus, navicular and the HEADS of the three metatarsal bones anteriorly. Muscles are indispensable to the arch maintenance (not so much bony).
PLANTAR APONEUROSIS IS THE MOST IMPORTANT LIGAMENT. FHL is also important

Question 3

ACL

Answer 3

attached to anterior part of tibial plateau between anterior horns of medial and lateral menisci
Ligament ascends posterolaterally attached to posteromedial aspect of lateral femoral condyle
weaker than PCL
Prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint.

Question 4

Ankle ligaments

Answer 4

Medial ligament - 4 parts (deltoid ligament)
tibionavicular, tibiocalcaneal, anterior and posterior tibiotalar

Lateral ligament -
calcaneofibular ligament
anterior and posterior talofibular ligament

Question 5

Anterior leg compartment muscles

Answer 5

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Fibularis tertius
Innervated: deep fibular nerve

Question 6

Lateral leg compartment muscles

Answer 6

Fibularis longus and brevis
innervated superficial peroneal nerve

Question 7

Posterior leg compartment muscles

Answer 7

Superficial GPS
- gastromnemius medial and lateral
- Plantaris
- soleus
–> calcaneal tendon
–> innervated tibial nerve

Deep
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
–> innervated tibial nerve

Question 8

Layers of the foot

Answer 8

First layer: flexor digitorum brevis, abductor hallucis and abductor digiti minimi

Second layer: tendon of flexor hallucis longus, tendon of flexor digitorum longus, quadratus plantae and lumbricals

Third layer: flexor hallucis brevis, adductor hallucis and flexor digiti minimi breivs

Fourth layer: interosseous muscles (dorsal and plantar), tendon of peroneus longus and tendon of tibialis posterior

Question 9

Adductor canal

Answer 9

Anteromedial – Sartorius.
Lateral – Vastus medialis.
Posterior – Adductor longus and adductor magnus.
structures from anterior thigh to posterior leg
femoral artery and vein (posterior to artery) move backwards to politeal artery and vein
vastus medialis and saphenous nerve

Question 10

Popliteal fossa borders & contents

Answer 10

Superomedial – semimembranosus.
Superolateral – biceps femoris.
Inferomedial – medial head of the gastrocnemius.
Inferolateral – lateral head of the gastrocnemius and plantaris.

Contents: (med to lateral)
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve (common peroneal nerve)

Question 11

Femoral triangle

Answer 11

conduit for structures entering and leaving anterior thigh SAIL
Roof – fascia lata skin
Floor – pectineus, iliopsoas, and adductor longus muscles.
Superior border – inguinal ligament (a ligament that runs from the anterior superior iliac spine to the pubic tubercle).
Lateral border – medial border of the sartorius muscle.
Medial border – medial border of the adductor longus muscle.

Contents lateral to medial NAVEL

Question 12

contents of greater sciatic foramen

Question 13

contents of lesser sciatic foramen

Answer 13

P: pudendal nerve
I: internal pudendal artery and vein
N: nerve to obturator internus
TO: tendon of obturator internus

Question 14

Lateral longitudinal arch

Answer 14

calcaneus, cuboid and the lateral two metatarsals

Question 15

Muscle functions:
1) Tibialis anterior
2) Tibialis posterior
3) Peroneus longus
4) Peroneus brevis
5) Peroneus tertius

Answer 15

1) dorsiflexion and inversion (deep fib n)
2) plantarflexion and inversion (tibial n)
3) eversion and dorsiflexion (sup fib n)
4) eversion and dorsiflexion (sup fib n)
5) inversion and dorsiflexion (deep fib n)

Question 16

Knee joint ligaments
-extracapsular and intracapsular

Answer 16

Extracapsular ligaments of the knee joint x5
Patellar ligament
Fibular (lateral) collateral ligament
Tibial (medial) collateral ligament
Oblique collateral ligament
Arcuate popliteal ligament

Intra-articular ligaments of the knee joint
Cruciate ligaments- anterior and posterior
The menisci-medial and lateral
Transverse ligament of the knee

Question 17

Sciatic nerve course

Answer 17

The sciatic nerve is the largest nerve in the body. It is a continuation of the sacral plexus.

The most lateral nerve entering the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels and the pudendal nerve.

Runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles. It descends in the posterior thigh deep to biceps femoris

Question 18

Lower limb venous drainage

Answer 18

Superficial and deep
- superficial: great and small saphenous eins&raquo_space;» drain into deep ; both have many valves deep >superficial
- deep made up of 3 veins- anterior tib posteroir tib and fibular vein (medial and lateral cutanous foot veins)» popliteal vein&raquo_space;> femoral vein deep to inguinal ligament&raquo_space;> external iliac vein

Question 19

Dorsalis pedis artery course

Answer 19

continuatoin of the tibilais atnerior atrtery below the ankle- starts midway between the malleoli and goes anteriorly deep to the extensor retinaculum between the flexor hallucis longus and flexor digitorium longus tendons in the first interosseous space. Gives off two branches (1st metatarsal artery and deep plantar artery) one of which contributes to the deep palmar branch with the lateral plantar artery