Lower Limb Flashcards
Which nerve is largely responsible for plantarflexion of the foot at the ankle, and flexion of the toes? Which nerve and its two muscles are the exceptions?
Tibial nerve Fibularis longus and brevis, superficial fibular nerve
Which muscles and nerves are largely involved in inversion of the foot? Generally speaking, muscles that attach where also aid in inversion?
Tibialis anterior (deep fibular) Tibialis posterior (tibial nerve) Muscles that attach on the medial aspect of foot (near hallucis)
Which nerve supplies the entirety of the anterior compartment of the leg?
Deep fibular
Which nerve supplies the lateral compartment of the leg?
Superficial fibular (peroneal)
Which nerve supplies the anterior compartment of the leg?
Deep fibular (peroneal)
Loss of the Achilles tendon reflex relates primarily to a deficit of which nerve root?
an S1 deficit.
If the ______ nerve were injured, eversion of the foot and plantar flexion would be lost in addition to dorsiflexion and inversion.
common fibular (peroneal) #4 Gray
What actions of the foot and ankle would be lost with an injury to the superficial fibular nerve? Because of which muscles?
Eversion, due to the fibularis longus and brevis.
An injury to which nerve would result in foot drop with normal eversion?
Deep fibular
Describe the borders of the femoral triangle (floor, roof, superior, medial, lateral, and apex)
-Floor: iliopsoas (laterally), and pectineus (medially). -Roof: Fascia lata, and cribiform fascia. -Superiorly by the inguinal ligament (thickened inferior margin of external oblique aponeurosis) that forms the base of the femoral triangle. -Medially by the lateral border of the adductor longus. -Laterally by the sartorius -the apex of the femoral triangle is where the medial border of the sartorius crosses the lateral border of the adductor longus.
Name the contents of the femoral triangle (lateral to medial)
-Femoral nerve and its (terminal) branches. -Femoral sheath and its contents: • Femoral artery and several of its branches. • Femoral vein and its proximal tributaries (e.g., the great saphenous and profunda femoris veins). • Deep inguinal lymph nodes and associated lymphatic vessels.
Which muscles make up the pes anserinus and where does it insert?
-Gracilis, semitendinosus, and sartorius. -Inserts into the superior part of the medial surface of the tibia.
To which two bony landmarks does the inguinal ligament attach? What is the space it creates beneath it called?
-ASIS and pubic tubercle. -Retro-inguinal space
What is the innervation for adductor magnus?
Adductor part: Obturator nerve Hamstring part: Tibial part of SCIATIC NERVE
What is the most anterior of the adductor muscles?
Adductor longus
What unique feature is useful in identifying the adductor brevis muscle in dissections and cross-sections?
As the obturator nerve emerges from the obturator canal to enter the medial compartment of the thigh, it splits into an anterior and a posterior division. The two divisions pass anterior and posterior to the adductor brevis.
1.) What are the boundaries of the adductor canal (anterior, posterior, medial, lateral, and roof)? 2.) What does it provide passage to? 3.) What are the contents of the adductor canal (4)? p.556 Moore
1.) Anteriorly and laterally – Vastus medialis. Posteriorly – Adductors longus and magnus. Medially (and roof) – Sartorius 2.) Provides INTERmuscular passage for the femoral vessels to the popliteal fossa (where they become the popliteal vessels). 3.) Femoral artery and vein, saphenous nerve, nerve to vastus medialis.
The femoral sheath does not enclose the ______ because it passes through the __________ compartment.
-femoral nerve -muscular compartment.
The muscular and vascular lacunae/compartments in the retro-inguinal space are partitioned by what structure?
Iliopectineal arch
Which is anterior and posterior – Intertrochanteric line, intertrochanteric crest.
Intertrochanteric line = Anterior Intertrochanteric crest = Posterior
What muscles insert on the greater trochanter of the femur (5)?
Obturator internus, gemelli, piriformis, gluteus minimus, Gluteus medius. *NOT GLUTEUS MAXIMUS* #20 Grays
1.) Where is the apex of the femoral triangle? 2.) What structure begins at this location? 3.) What structures lie deep to the apex of the triangle?
1.) The apex of the femoral triangle occurs at the junction of the adductor longus and sartorius muscles. 2.) The subsartorial (Hunter) canal begins at this location. 3.) Immediately deep to this anatomic point lie the femoral artery, femoral vein, deep femoral artery, and deep femoral vein, often overlying one another in that sequence. #21 Grays
What structures pass beneath the superior extensor retinaculum (5)? (medial to lateral)
- Tibialis anterior 2. Extensor hallucis longus 3. Anterior tibial vessels and nerve 4. Extensor digitorum longus 5.) Peroneus tertius p.590 Moore
What structures are enclosed by the stem of the ‘Y’ formed by the inferior extensor retinaculum (2)?
Peroneus tertius and EHL tendons.
What structures does the medial compartment of the sole contain (4)?
1.) ABductor hallucis 2.) Flexor hallucis brevis 3.) Flexor hallucis longus tendon, 4.) The medial plantar nerve and vessels. p.610 Moore
What structures does the central compartment of the sole contain (6)?
1.) FDB 2.) Tendons of FHL and FDL (and the muscles of FDL) 3-4.) QP and lumbricals 5.) AdH 6.) Lateral plantar nerve and vessels. p.610 Moore
What structures does the lateral compartment of the sole contain (2)?
1.) ABductor digiti minimi brevis 2.) Flexor digiti minimi p.610 Moore
How would one palpate the EDB? (location, and position of foot/toes)
-Lateral part of dorsum of foot, anterior to malleolus. -When TOES ARE EXTENDED, the small fleshy belly can be felt. p.614 Moore
1.) What is the primary function of the plantar muscles? 2.) When are they most active?
1.) To resist forces that tend to reduce the longitudinal arch as weight is received at the heel (posterior end of arch), and then transferred to the ball of the foot and great toe (anterior end of arch). 2.) Most active when stabilizing the foot for propulsion (push-off), a time when forces tend to flatten the foot’s transverse arch.
Describe the action and pennate of bipennate for the interossei of the foot.
-Plantar interossei ADduct (PAD) and arise from a single metatarsal as unipennate muscles. -Dorsal interossei ABduct (DAB) and arise from two metatarsals as bipennate muscles. p.611 Moore
Which tarsals articulate with which cuneiforms?
Navicular – Articulates with all three cuneiforms posteriorly. Cuboid – Lateral cuneiform laterally
Which tarsal articulate with which metatarsals?
Medial, middle, and lateral cuneiforms with the 1st, 2nd, and 3rd metatarsals, respectively. Lateral cuneiform with 3rd AND fourth metatarsal. Cuboid – 4th and 5th metatarsal
1.) Which three tendons pass posteroinferior to the medial malleolus (from top to bottom)? 2.) Which bone do they ALL come in contact with before moving onto the plantar aspect of the foot?
1.) TP – FDL – FHL 2.) The TALUS
To which tarsals does TP attach? Which is its primary attachment?
-Navicular, cuboid, all three cuneiforms, 2nd-4th metatarsal. -1˚ attachment is NAVICULAR p.601 Moore
What is the most anterior muscle is the posterior compartment of the leg? Which muscles does it lie between?
TP – Lies between FDL (medial) and FHL (lateral) p.601 Moore
How and where to palpate TP?
Invert foot against resistance and palpate immediately POSTERIOR to the MEDIAL MALLEOLUS. p.602 Moore
Which two tarsals have grooves for FL tendon?
Calcaneus and cuboid Netter – Plate 512
Which tarsal(s) has a groove for FHL tendon?
Calcaneus Netter – Plate 512
Which muscles make up the calcaneal tendon (aka _____)?
aka Achilles tendon 1.) Plantaris 2.) Soleus 3.) Gastrocnemius
Which two structures (vessels) unite in the saphenous opening?
Great saphenous vein (from medial leg) and femoral vein
Where do the femoral artery and vein pass to and from the femoral triangle? Where are they going?
-Inferiorly at the apex of the femoral triangle. -Passing to and from the ADDUCTOR CANAL and the inferior portion of the femoral triangle (apex). p.551 Moore
Name six structures (lateral to medial) within the proximal retro-inguinal space (two muscles, two vessels, a nerve, etc.)
Iliopsoas – Femoral nerve (within iliopsoas) – Femoral artery – Femoral vein – Femoral canal – Pectineus p.552 Moore
Name the three compartments of the femoral sheath and their contents
1.) Lateral compartment: Femoral artery 2.) Intermediate compartment: Femoral vein 3.) Medial compartment: Femoral canal p.553 Moore
Give the boundaries of the femoral ring (medial, lateral, anterior, posterior)
Medial: Lacunar ligament Lateral: Vertical septum between the femoral canal and vein. Anterior: Medial part of inguinal ligament Posterior: Superior ramus of pubis covered by pectineus and it fascia. p.553 Moore
1.) The saphenous nerve accompanies the _______ and _______ through the adductor canal. 2.) It becomes superficial by passing between the _______ and _______ when the femoral vessels traverse the adductor hiatus at the distal end of the canal.
-femoral artery and vein -sartorius and gracilis p.553 Moore
The medial plantar nerve courses within the medial compartment of the sole between the ____ and _____ muscle layers.
-1st and 2nd muscle layers
Initially, the lateral plantar nerve (and _____) run laterally between the muscles of the _____ and _____ layers of plantar muscles. Their deep branches then pass ________ between the muscles of the _____ and _____ layers.
-and artery. -1st and 2nd layers. -medially between the muscles of the 3rd and 4th layers
Cutaneous innervation of the foot is supplied medially by the ___________, which extends distally to the___________.
-saphenous nerve - head of 1st metatarsal. p.624 Moore
The common border of distribution of the medial and plantar nerves extends along the _____________.
-4th metacarpal and toe or digit. (This is similar to the pattern of innervation of the palm of the hand.)
Cutaneous innervation of the foot is supplied laterally by ___________.
Laterally by the sural nerve, including part of the heel.
Cutaneous innervation of the foot is supplied posteriorly (heel) by ____________.
Medial and lateral calcaneal branches of the tibial and sural nerves, respectively.
Between which tendons does the dorsalis pedis artery run on the dorsum of the foot?
Runs anteromedially between the EHL and EDL tendons.
How can you easily distinguish between the lateral and medial plantar arteries when looking at both?
Lateral is MUCH LARGER than the medial. Also, it accompanies the nerve of the same name. p.620 Moore
The terminal branches of the posterior tibial artery pass deep to the ________ muscle as the medial and lateral plantar arteries, which accompany the similarly named nerves.
abductor hallucis (AH) p.620 Moore
The dorsal and plantar interossei and both supplied by which nerve?
Lateral plantar nerve
The deep plantar artery passes deeply between the heads of the ________ muscle to enter the sole of the foot.
first dorsal interosseous p.619 Moore
The anterior tibial artery descends along the interosseous membrane between _______ and _______ muscles.
tibialis anterior and extensor digitorum longus p.594 Moore.
The popliteal artery ends at the lower border of the _______ muscle by dividing into anterior and posterior tibial arteries
popliteus p.594
The deep fibular nerve arises between _______ and ________; passes through ________ muscle and descends on interosseous membrane.
-fibularis longus muscle and neck of fibula -extensor digitorum longus p.593 Moore
The common fibular nerve forms as the sciatic bifurcates at the ________ and follows the medial border of _________. It passes over posterior aspect of head of fibula and then winds around neck of fibula deep to the _______ muscle.
-apex of the popliteal fossa. -biceps femoris and its tendon. -deep to the fibularis longus muscle. p.593 Moore
List the tendons from lateral to medial on the superficial dorsum of the foot.
Fibularis tertius, extensor digitorum longus, extensor hallucis longus, tibialis anterior.
1.) The artery runs anterior/posterior? to the medial malleolus, from which it is separated by the tendons of the _____ and _____ muscles. 2.) Inferior to the medial malleolus, it runs between the tendons of the _____ and ______.
1.) TP and FDL muscles 2.) FHL and FDL p.602 Moore
The fibular artery descends obliquely toward the fibula and passes along its medial side, usually within the ______ muscle.
FHL p.602 Moore
What are the four major contents of the popliteal fossa?
1.) Termination of the small saphenous vein. 2.) Popliteal arteries and veins and their branches and tributaries. 3,4.) Tibial and common fibular nerves. p.584 Moore
What are the borders of the popliteal fossa (superolateral and medial, inferolateral and medial)?
-Superolaterally by the biceps femoris (superolateral border). -Superomedially by the semimembranosus, lateral to which is the semitendinosus (superomedial border). -Inferolaterally and inferomedially by the lateral and medial heads of the gastrocnemius, respectively (infero- lateral and inferomedial borders). p.584 Moore
After it branches off of the femoral artery, profunda femoris passes deeply between ______ and ________ muscles; descending posterior to latter on medial side of femur.
pectineus and adductor longus p.555 Moore
After it branches off of the deep femoral artery, the medial circumflex femoral artery passes medially and posteriorly between _______ and _______ muscles.
pectineus and iliopsoas muscles. p.555 Moore
After it branches off of the deep femoral artery, the lateral circumflex femoral artery passes laterally deep to _______ and _______ muscles.
sartorius and rectus femoris p.555 Moore
What is the innervation for pectineus?
Femoral nerve AND OBTURATOR p.545 Moore
What is the innervation for TFL?
Superior gluteal nerve
The posterior branch of _______ gives off the _______ branch which supplies the head of the femur.
Posterior branch of OBTURATOR ARTERY gives off the ACETABULAR BRANCH.
When the thigh is flexed, the inferior border of the gluteus maximus moves superiorly, leaving the ________ subcutaneous.
ischial tuberosity p.565 Moore
You do not sit on your gluteus maximus; you sit on the fatty fibrous tissue and the ________.
ischial bursa p.565 Moore
When the iliopsoas is paralyzed, the ________ undergoes hypertrophy in an attempt to compensate for the paralysis.
tensor fasciae latae p.569 Moore
Which ligament is responsible for partitioning the greater and lesser sciatic foramen? What structure fills most of it?
Sacrospinous ligament – Piriformis p.563 Moore
The tendon of which muscle creates the oblique popliteal ligament?
Semimembranosus p.572 Moore
Why are the semi-‘s less secondary knee flexors when compared to the biceps?
Because when the knee is flexed to 90°, the tendons of the medial hamstrings or “semi-” muscles (semitendinosus and semi- membranosus) pass to the medial side of the tibia, producing slight rotation of the tibia. p.572 Moore
The ______ nerve bisects the popliteal fossa. The common fibular nerve follows the tendon of the _______.
The tibial nerve bisects the popliteal fossa. The common fibular nerve follows the tendon of the biceps femoris. p.581 Moore
What are the borders and contents of the popliteal fossa?
Superolateral: Biceps femoris Superomedial: Semimembranosus/semitendinosus Inferior: Gastrocs lateral and medial heads Floor: Popliteus Contents (medial to lateral): Popliteal artery, vein, Tibial nerve, common fibular nerve. *Termination of the Small saphenous vein – a branch of the popliteal vein – lying atop gastrocs*
