Lower Limb Flashcards
What is the blood supply to the anterior compartment of the leg?
Anterior tibial artery
What are the muscles of the anterior compartment of the leg?
- Tibialis anterior
- EHL
- EDL
- Peroneus tertius
What is the nerve supply to the anterior compartment of the leg?
Deep peroneal nerve
What arteries supply the trochanteric anastomoses ?
Superior and inferior gluteal arteries
Medial and lateral circumflex femoral
Where is the growth plate for the head of femur?
Intra capsular
Where is the growth plate for the trochanter?
Extra capsular
Obturator nerve?
L2, L3, L4
Branches unite in substance of psoas major
Crosses SIJ to enter lesser pelvis - lies lateral to internal iliac vessels and ureter
1. Medial compartment of thigh - obturator externus, adductor longus, adductor brevis, adductor Magnus, gracilis
2. Cutaneous branch - often absent - skin and facia of distal 2/3rds of medial aspect
What does the anterior branch of the obturator nerve innervate?
- Adductor brevis
- Adductor longus
- Gracilis
What does the posterior branch of the obturator nerve innervate?
- Obturator externus
2. Part of adductor Magnus
Boundaries of adductor canal
- Vastus medialis - laterally
- Adductor longus and Magnus- posteromedially
- Sartorius - anterior
Profounda femoris
- Largest branch of femoral artery
Popliteal artery
- Deepest structure in popliteal fossa
End: lower border of popliteus - divides in to anterior tibial and posterior tibial artery
Anterior tibial artery
- Enters the anterior compartment of leg via an opening in the interosseous membrane
- Descends with the deep peroneal nerve
- Enters foot under the extensor retinaculum to become Dorsalis pedis (EHL medial and EDL lateral)
Posterior tibial artery
- Passes deep to soleus and gastrocnemius
- Tibial nerve is initially medial but crosses posteriorly to lie on the lateral side
- Passes through tarsal tunnel
- Passes behind medial malleolus - divides in to medial planter and lateral planter
- Supplies posterior compartment
Contents of tarsal tunnel
- Posterior tibial artery
- Tibialis posterior
- FDL
- FHL
- Tibial nerve
Peroneal artery
- Arises near origin of posterior tibial artery
- Descends behind fibula
- Lateral compartment
Muscles of lateral compartment
- Peroneus longus
- Peroneus brevis
- Superficial peroneal nerve
Muscles of deep posterior compartment
- FHL
- FDL
- Popliteus
- Tibialis posterior
- Posterior tibial artery
- Tibial nerve
Muscles of the superficial posterior compartment
- Gastrocnemius
- Soleus
- Plantaris
- Short saphenous vein
- Sural nerve
Sciatic nerve
L4/5 S1/2/3
Two branches
1. Tibial nerve
2. Common fibular nerve (common peroneal nerve)
Superficial peroneal nerve
- Cutaneous innervation anterior lower third of leg
2. Cutaneous innervation dorsum of foot
Femoral nerve
- Quadriceps femoris
- Sartorius
- Pectineus
Anterior femoral cutaneous nerve
Sensory innervation medial and anterior thigh
Lateral sural cutaneous nerve (branch of common peroneal nerve)
Innervation of skin lateral side of leg
Sural nerve
- Runs down the posterior leg with long saphenous nerve
2. Sensory innervation to posterior surface of lower leg and lateral side of foot
Saphenous nerve (branch of femoral nerve)
Sensory innervation to medial side of leg and foot
Femoral sheath
- Lateral compartment - FA
- Intermediate compartment - FV
- Medial compartment - Femoral canal
Cutaneous branches of femoral nerve
From anterior division - Medial and intermediate cutaneous nerves of thigh - supply skin of medial and anterior surfaces of thigh
From posterior division - saphenous nerve - runs down medial side of leg as far as medial malleolus, terminates in the region of the ball of big toe
Obturator canal
- Obturator artery
- Obturator vein
- Obturator nerve
Origin of deep peroneal nerve
From common peroneal nerve at the lateral aspect of the fibula deep to peroneus longus
Deep peroneal nerve
L4/5 S1/2
Course of deep peroneal nerve
Pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg
Passes anteriorly down to the ankle joint, midway between the two malleoli
Muscles innervated by deep peroneal nerve
- Tibialis anterior
- EHL
- EDL
- Peroneus tertius
- EDB
Web space of 1st and 2nd toes
Actions of deep peroneal nerve
- Dorsiflexion of ankle joint
- Extension of all toes
- Eversion of the foot
Piriformis
Passes through greater sciatic foramen
Lies along side the superior border of the superior gemellus
Inserts on to apex of greater trochanter
Nerve supply - anterior rami of s1 and s 2
ACL
Prevents backward displacement of femur on tibia
Limits extension of lateral condyle of the femur
Posterior cruciate ligament
Prevents femur from sliding over the tibial plateau
Hx of problems walking down stairs
Superior gluteal nerve
Ventral rami of L4 to S1 Leaves the pelvis through greater sciatic foramen 1. Gluteus medius 2. Gluteus minimums 3. TFL
Femoral canal boundaries
- Anterosuperiorly - inguinal ligament
- Posteriorly - Pectineal ligament
- Medially - lacunae ligament
- Laterally - femoral vein