lower limb Flashcards
Where is the tarsal tunnel located?
is a fibro-osseous space located on the posteromedial aspect of the ankle
What is the function of the tarsal tunnel?
acts as a passageway for tendons, nerves and vessels to travel between posterior leg and foot
What forms the boarders of the tarsal tunnel? Floor, roof.
Floor- medial aspect of tibia talus and calcaneus
roof- flexor retinaculum
What passes through the tarsal tunnel?
Tom, Dick, And, Very, Nervous, Harry
tibialis posterior tendon
flexor Digitorum longus tendon
Posterior tibial artery and vein
Tibial Nerve
Flexor hallucis longus tendon
How is the tarsal tunnel divided?
Into fibrous compartments: 1. containing neurovascular structures, other three containing muscle tendons.
What is Tarsal tunnel syndrome?
Entrapment and compression of the tibial nerve as it passes through the tarsal tunnel
In tarsal tunnel syndrome what sensory and motor signs/symptoms will be seen?
Sensory: Altered sensation in distribution of tibial nerve- sole of foot
Motor: only in severe disease, weakness and wasting of intrinsic muscles of the foot.
What forms the bones of ankle joint?
Tibia, fibula, taulus
Tibia and fibula bound together by what? to form what shape?
tibiofilbular ligaments and forms mortise
What is the medial ligament of the ankle? And where does it attach?
Deltoid ligament- attaches to medial malleolus
The deltoid ligament consists of how many ligaments and where do these attach and insert?
four ligmanents, attach to medial malleoulus and insert into navicular, talus, calcaneous.
What is the function of the deltoid ligament?
Prevent over eversion.
What are the three distinct and separate ligaments of the lateral ankle?
Anterior talofibular- spans between the lateral malleolus and lateral aspect of the talus.
posterior talofibular- spans between the lateral malleolus and the posterior aspect of the talus.
calcaneofibular- spans between the lateral malleolus and the calcaneus.
What is the significance of the ‘ankle ring’?
Ankle conceptualised as a ring in coronal plane. Upper- tib and fib, lower subtalar joint, sides ligaments
If one breaks likely other aspects of ring broken.
What movements occur at the ankle?
dorsi and plantar- eversion and inversion occur at subtalar joint.
What is the arterial supply to the ankle joint?
malleolar branches of the anterior tibial, posterior tibial and fibular arteries.
Subtalar joint is formed between what bones?
inferior talus and superior calcaneous
What ligaments support the subtalar joint?
posterior talocalcaneal ligament
medial talocalcaneal ligament
lateral talocalcaneal ligament
Additional- interosseous talocalcanelal ligament.
What is the nerve root branches of tibial nerve?
L4-S3
What sensory and motor functions does the tibial nerve have?
Sensory: innervates the skin of the posterolateral leg, lateral foot and sole of foot
Motor: innervates the posterior compartment of the leg and the majority of intrinsic foot muscles
Where does the tibial nerve arise?
Arises at the apex of the popliteal fossa.
what is the course of the tibial nerve? Start, down leg, into foot- include innervations along the way.
Start- popliteal fossa- gives branches to superficial posterior compartment of leg. Here gives branches to sural nerve.
Leg- posterior to tibia supplying deep muscles of the posterior leg.
Foot- through tarsal tunnel immedialtel distal to tarsal tunnel terminates by dividing into sensory branches innervating sole of foot.
What are the motor functions of the tibial nerve?
innervates muscles of the posterior leg and intrinsic foot muscles.
The posterior compartment of the legs muscles can be divided into superficial and deep muscles. What are the superficial muscles?
Plantaris- plantar flexion of ankle
Soleus- plantarflexion of ankle
gastrocnemius- flexion of knee and plantar flexion
The posterior compartment of the legs muscles can be divided into superficial and deep muscles. What are the deep muscles?
Popliteus- unlocks knee by laterally rotating femur on tib
flexor hallucis longus- flex greater toe and plantarflexion
flexor digitorum longus- flexion of digits 2-5 and plantar flexion of ankle
tibialis posterior- inversion of foot and plantarflexion of ankle
Which branches of the tibial nerve innervate the intrinsic muscles of the foot (minus extensor digi brevis and extensor hallucis brevis)?
Medial and lateral plantar branches of the tibial nerve.
What forms the sural nerve?
the tibial and common fibular nerve
tibial nerve supplies the foot sensory via 3 main branches what are these?
Medial calcaneal branches
medial plantar nerve
lateral plantar nerve
Medial calcaneal branches of tibial nerve arise where and innervate what?
These arise within the tarsal tunnel, and innervate the skin over the heel.
medial plantar nerve innervates what?
Innervates the plantar surface of the medial three and a half digits, and the associated sole area.
lateral plantar nerve innervates what?
Innervates the plantar surface of the lateral one and a half digits, and the associated sole area.
How many muscles are in the anterior compartment of the leg?
four
What are the muscles of the anterior compartment of the leg?
- Tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- Fibularis tertius
The anterior compartment of the leg muscles are innervated by what nerve?
Deep fibular nerve (L4-S2)
Tibialis anterior is located where?
Lateral surface of the tibia
What is the function of the tibia’s anterior?
dorsiflex and invert the foot
what innervates the tibia’s anterior?
Deep fibular nerve
Where does the tibialis anterior originate and attach?
originates: lateral surface of the tibia and attaches to the medial cuneiform and the base of metatarsal I.
extensor digitorum longus is found where in relation to tibialis anterior?
Deep and laterally
Extensor digitorum longus originates and attaches where?
Originates: from the lateral condyle of the tibia and the medial surface of the fibula
Attaches: each tendon (4) insert onto a toe
What innervates the Extensor digitorum longus?
The deep fibular nerve
Where is extensor hallucis longus position in relation to extensor digitorum longus and anterior tibialis?
positioned deep to tibialis anterior and extensor digitorum longus. Tendon emerges between the two muscle groups to insert into big toe
Where does extensor hallucis longus originate and attach?
originates: medial surface of fibular shaft
attaches: base of detail phalanx of great toe
what innervates the extensor hallucis longus?
deep fibular nerve
What is the origin and attachment of fibularis tertius?
Origin: extensor digitorum longus from medial surface of fibula
Attaches: 5th metatarsal.
what is the function of fibularis tertius?
eversion and dorsiflexion of the foot
what innervates the fibularis tertius?
deep fibular nerve
what is the action of extensor hallucis longus?
extension of the great toe and dorsiflexion of the foot
what is the action of extensor digitorum longus
extension fo lateral 4 toes and dorsiflexion of foot
Footdrop typically indicates damage to what nerve?
Common fibular nerve
How can the muscles of the foot be divided?
Extrinsic and intrinsic muscles
What are the two intrinsic muscles located within the dorsum of the foot
extensor digitorum brevis and extensor hallucis brevis
What innervates the extensor hallucis brevis and the extensor digitorum brevis
deep fibular nerve
Extensor digitorum brevis origin and attachments?
origin: calcaneus and inferior extensor retinaculum
attaches: long extensor tendons of toes 2-4
What is the action of extensor digitorum brevis?
extension of the lateral four toes
extensor hallucis brevis origin and attachment
origin: calcaneus and inferior extensor retinaculum
attaches: base of proximal phalanx of great toe
Extensor hallucis brevis action
extension of great toe
How many intrinsic muscles of the foot are there in the plantar aspect?
Ten
what are the two muscles in the lateral compartment of the leg?
fibulularis longus and fibulas brevis
What is the function of the muscles in lateral compartment of the leg
eversion
What innervates the fibularis longus and brevis
superficial fibular nerve
what is the origin and attachment of fibularis longus?
origin: superior and lateral surface of fibula and lateral tibial condyle
fibers converge and pass posterior to lateral malleolus
Attach: medial cuneiform and base of metatarsal I
what is the innervation of fibularis longus?
superficial fibular nerve
Fibularis brevis origin and attachment
origin: inferiolateral surface of the fibular shaft
passess post to lateral malleolus with fibularis longus
Attaches: 5th metatarsal
fibularis brevis innervation
superficial fibular nerve
How can the common fibular nerve be found?
Passes between fibularis longus and neck of fibula
The common fibular nerve splits into what nerves
deep and superficial fibular nerve
How many muscles are in the posterior compartment of the leg?
seven muscles
What innervates the muscles of the posterior compartment of the leg
Tibial nerve
How many muscles are in the superficial posterior compartment of the leg?
three
1 gastrocnemius
2 soleus
3 plantaris
The muscles of the superficial compartment of the posterior leg all insert where via what?
insert into calcaneus via the calcanea tendon
there are two bursae associated with the calcanea tendon, what are they?
- subcutaneous calcanea bursa
- deep bursa of the calcanea tendon
What is the origin and attachment of the gastrocnemius?
Origin: lateral head- lateral femoral condyle
medial head- medial femoral condyle
attach- calcanea tendon onto calcaneus
what innervates the gastrocnemius?
tibial nerve
What are the origins and attachments of soleus?
origin- solar line of the tibia and proximal fibula
attach- calcanea tendon
innervation of Soleus
tibial nerve
What percentage of people do not have a plantaris
10%
plantaris origin and attachment
origin: lateral supracondylar line of femur
attach- calcaneal tendon
action of plantaris
plantar flexion and flexion of knee
What are the deep muscles of posterior compartment of leg?
- popliteus
- flexor digitorum longus
- flexor hallucis longus
- tibialis posterior
Where is the popliteus located?
Behind the knee forming the base of popliteal fossa
What structures does the popliteus bursa separate?
between popliteal tendon and posterior surface of the knee joint
what are the attachments and origin of the popliteus?
origin- lat condyle of femur and lat meniscus of knee
attach- proximal tibia above the origin of soleus
what is the action of popliteus
lat rotation of femur unlocking knee so flexion can occur
Origin and attach of flexor digitorum longus
origin post surface of tibia
attach plantar surface of lat four digits
what innervates the popleteus
tibial nerve
action of flexor digi longus
flex toes
innervation of fdl
tibial nerve
Flexor hallucis longus attach and origin
origin- post surface of fib
attach- plantar surface of big toe
innervation of FHL
tibial nerve
Tibialis posterior lies between what two muscles
fdl and fhl
attachment and origin of tibialis posterior
origin- post surface and interossous membrane of tib and fib
attach- plantar surface of medial tarsal bones
Action of posterior tibilais
inversion and plantar flexion of foot, also contributed to medial arch of foot
innervation of posterior tibialis
tibial nerve
How many compartments are in the thigh
three
1. anterior compartment
2. medial compartment
3. posterior compartment
The anterior compartment of the thigh is mostly innervated by what nerve
femoral nerve L2-L4
what is the nerve root of femoral nerve
L2-L4
Anterior compartment of thigh muscle arterial supply?
anterior compartment of the thigh are a group of muscles that receive arterial supply from the femoral artery.
How many muscles are in the anterior compartment of the thigh?
seven
what are the muscles of the anterior compartment of the thigh? 7
Psoas major
iliacus
rectus femoris
vastus medialis
vastus lateralis
sartorius
pectineus
Iliopsoas is comprised of what muscles
psoas major and lilacus
Iliopsoas origin and attachment
Psoas major- lumbar vertebae
Iliacus- iliac fosa of pelvis
Attach- lesser trochanter of femur
action of ilipsoas
flex hipin
innervation of iliposas
Psoas major- anterior rami of L1-3
Iliacus- femoral nerve
Quadriceps femoris consists of what muscles
the three vastus muscles and the rectus femoris
Vastus Lateralis origin and attachment
Originates from the greater trochanter and the lateral lip of linea aspera of the femur.
attaches- patella via quadrecep tendon
Vastus Lateralis Actions
Extension of the knee joint. It has a secondary function of stabilising the patella.
Vastus Lateralis Innervation
Femoral nerve.
Vastus Intermedius attachment
Originates from the anterior and lateral surfaces of the femoral shaft.
Attachesd to quad tendon
Vastus Intermedius action
Extension of the knee joint. It has a secondary function of stabilising the patella.
Vastus Intermedius innervation
Femoral nerve.
Vastus Medialis Proximal attachment
Originates from the intertrochanteric line and medial lip of the linea aspera of the femur.
attach- patella quad tendon
Vastus Medialis Actions
Extension of the knee joint. It has a secondary function of stabilising the patella.
Vastus Medialis innervation
femoral nerve
Rectus Femoris Attachments
One head originates from the anterior inferior iliac spine and other from the supra-acetabular groove (of the ilium).
The two heads converge into one tendon which attaches to the patella
Rectus Femoris action
Extension of the knee joint and flexion of the hip joint (it is the only muscle of the quadriceps group to cross both the hip and knee joints).
Rectus Femoris innervation
Femoral nerve
Sartorius Attachments
Originates from the anterior superior iliac spine, and attaches to the superior, medial surface of the tibia.
Sartorius Actions hip and knee
At the hip joint, it is a flexor, abductor and lateral rotator. At the knee joint, it is also a flexor.
Sartorius innervateion
femoral nerve
Pectineus is the floor of what anatomical space
femoral triangle
Pectineus attach and origin
Originates from the pectineal line of the pubis bone.
Inserts onto the pectineal line on the posterior aspect of the femur, immediately inferior to the lesser trochanter.
Pectineus action
adduction and flexion at hip
pectineus innervation
femoral nerve, also branches of obturator
How many muscles are in the medial compartment of the thigh?
fiver
What are the muscles of the medial compartment of the thigh?
gracilis
obturator externus
adductor brevis
adductor longs
adductor magnus
All the medial thigh muscles are innervated by what nerve
obturator nerve
All the medial thigh muscles have arterial supply is through what?
obturator artery
What is the largest muscle of the medial compartment?
Adductor magnus
The adductor magnus is split into two parts what are they
adductor
hamstring
Adductor Magnus Attachments
Adductor:
-Originates from the inferior rami of the pubis and the rami of ischium
-Attaches to the linea aspera of the femur.
Hamstring part:
– Originates from the ischial tuberosity,
- Attaches to the adductor tubercle and medial supracondylar line of the femur.
Adductor Magnus Actions
Adductor – Adduction and flexion of the thigh
Hamstring – Adduction and extension of the thigh.
Adductor Magnus Innervation
Adductor – Obturator nerve (L2-L4)
Hamstring part – Tibial component of the sciatic nerve (L4-S3).
Adductor Longus forms a boarder of what anatomical space?
medial boarder of femoral triangle
Adductor Longus Attachments + origin
Origin: the pubis bone of the pelvis and expands into a fan shape.
Attach: broad distal attachment along the linea aspera of the femur.
Adductor Longus Actions
Adduction of the thigh.
Adductor Longus Innervation
Obturator nerve (L2-L4).
Adductor Brevis is an important anatomical landmark in the thigh, why?
It separates the anterior and posterior branches of the obturator nerve
Adductor Brevis Attachments
Origin: the body of pubis and inferior pubic rami.
Attaches: to the linea aspera on the posterior surface of the femur (proximal to the adductor longus attachment).
Adductor brevis innervation
obturator nerve L2-L4
Obturator Externus attachment and origin
Origin: from the membrane of the obturator foramen and adjacent bone. It passes under the neck of femur
Attaches onto the posterior aspect of the greater trochanter.
Actions of obturator externus
Adduction and lateral rotation of the thigh.
Innervation of obturator externus
Obturator nerve L2-L4
Gracilis Attachments
Originates from the inferior rami of the pubis and the body of the pubis. It descends down the medial aspect of the thigh and attaches to the medial surface of the tibial shaft.
Gracilis Actions
Adduction of the thigh at the hip and flexion of the leg at the knee.
Gracilis Innervation
Obturator nerve (L2-L4).
Muscles of posterior compartment of the thigh are innervated by what?
Sciatic Nerve L4-S3
the blood supply to posterior compartment of thigh muscles is?
inferior gluteal artery and perforating branches of the deep femoral artery
How many muscles are in the posterior compartment of the thigh?
three
What are the muscles of the posterior compartment of the thigh?
- Bicep femoris
- Semitendinosis
- semimembranosus
How many heads does bicep femoris have?
Two- short and long head
Biceps Femoris origin and attachments
origin:
-Long head- ischial tuberosity of pelvis
-short head- linea aspera on post surface femur
Attach:
-together into head of fibula
Biceps Femoris action
flex at knee and extend at hip, laterally rotates hip and knee
Biceps Femoris innervation
long head- tibial part of sciatic nerve
short head common fibular part of sciatic nerve
Semitendinosus is situated where in the posterior compartment?
medial aspect of posterior thigh, superficial to semimembranosus
Semitendinosus origin and attachment?
Origin: ischial tuberosity of the pelvis
Attaches: medial surface of the tibia.
Semitendinosus actions
flexion knee, extension hip, medial rotation of thigh at hip joint
Semitendinosus innervation?
tibial part of sciatic nerve
Semimembranosus located where in posterior compartment of thigh?
deep to semitendinosus on medial aspect of posterior thigh
Semimembranosus Attachments
Origin: ischial tuberosity (more superiorly than the origin of the semitendinosus and biceps femoris).
Attach: medial tibial condyle.
Semimembranosus action
flex knee, extend hip, medial rotate hip
semimembranosus innervation
tibial part of sciatic nerve
What is the intra capsular ligament in the hip?
ligament of head of femur
What are the extra capsular ligaments of hip joint?
Iliofemoral ligament
pubofemoral
ischiofemoral
What is the blood supply to hip joint?
medial and lateral circumflex femoral arteries
what muscles produce flexion at the hip?
iliopsoas, rectus femoris, sartorius, pectineus
what muscles produce extension at the hip?
gluteus maximus; semimembranosus, semitendinosus and biceps femoris (the hamstrings)
what muscles produce abduction at the hip?
gluteus medius, gluteus minimus, piriformis and tensor fascia latae
what muscles produce adduction at the hip?
adductors longus, brevis and magnus, pectineus and gracilis
what muscles produce lateral rotation at the hip?
biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris.
what muscles produce medial rotation at the hip?
anterior fibres of gluteus medius and minimus, tensor fascia latae
