Lower Limb Flashcards
What are the nerve roots of the lat. fem. cut. n. of thigh?
L2 and L3
What are the nerve roots of the femoral nerve?
L2, L3, L4
What are the nerve roots of the obturator nerve?
L2, L3, L4
What are the nerve roots of the superior gluteal nerve?
L4, L5, S1
What are the nerve roots of the inferior gluteal nerve?
L5, S1, S2
What are the nerve roots for nerve to obturator internus and superior gemellus?
L5, S1, S2
What are the nerve roots for the nerve to the quadratus femoris and inferior gemellus?
L4, L5, S1
What are the nerve roots to the posterior cut. n. of thigh?
L4, L5, S1
What are the sciatic nerve roots?
L4, L5, S1, S2, S3
Where does the lumbosacral plexus or nerve roots come from?
the intervertebral foramen of the lumbar and sacral spine
What kind of nerves are the lumbosacral plexus?
mixed nerves just like brachial plexus
Where does the lumbosacral trunk arise from?
L4 and L5 nerves
What are the three pelvic ligaments?
sacroiliac, sacrospinous and sacrotuberous
Which ligament forms the greater sciatic notch into a foramen?
the sacrospinous ligament
Where does the sacrospinous ligament attach?
the sacrum and the ischial spine (posterior)
What are the ligaments and parts that make up the hip joint?
acetabular labrum, transverse acetabular ligament and the ligament of the head of the femur
What is the articular capsule?
a bag that holds itself over the bones and produces synovial fluid
What are the ligaments of the hip?
iliofemoral, ischialfemoral, pubofemoral
When is hip ligamentum the tightest?
When your hip is in extension because the ligaments are anterior
When is the only time the sacroiliac joint moves?
during birth
What two joints make up the pelvic girdle?
sacroiliac and hip joints
What is three names for the three fused bones?
innominate
ox coxae
1/2 pelvis
What is the IT band?
iliotibial band
What muscle is associated with the IT band?
tensor fascia lata
What are the main veins in the leg?
femoral, great saphenous, popliteal, short saphenous
What is in the femoral triangle?
the saphenous opening
What borders the femoral triangl?
the sartorius, adductor longus and the inguinal ligament
What is in the saphenous opening?
the femoral vein, femoral artery and femoral nerve
What does NAVEL stand for?
Nerve Artery Vein Empty space Lymphs
What are the three muscle groups of the thigh?
- anterior/quadriceps
- medial/adductors
- posterior/hamstrings
What do the hamstrings do?
thigh/hip extension
leg flexion
What do the quads do?
hip flexion
leg extension
What do the adductors do?
adduct the thigh
What is the anterior gateway to the lower limb?
inguinal ligament
Which muscle does not go under the inguinal ligment?
psoas
What muscles make up the quads?
rectus femoris
vastus lateralis
vastus medialias
vastus intermedius
Where do the quads go and how?
to the patella via the quad tendon
Whats another name for the quad tendon?
patellar tendon
If its muscle to bone…
If its bone to bone…
muscle to bone = tendon
bone to bone = ligament
What is the only lateral muscle?
tensor fascia lata
What is another name for the sartorius muscle?
tailors muscle
What movements can the sartorius do?
at hip: abduct, laterally rotate and flex
at knee: flex
Where is vastus medialis for the most part?
posterior femur
What is vastus intermedius deep to?
rectus femoris
What are the three biggest hip flexors?
Name two additional in the thigh?
psoas + (- doesn’t cross hip)
iliacus
iliopsoas
thigh: sartorius and rectus femoris
Most of the anterior leg muscles are innervated by the..
femoral nerve
What movements to the medial/adductor group do?
flex, adduct and rotate the hip
What nerve innervates the medial group?
obturator
List the medial thigh muscles including the adductors?
adductor magnus, longus, brevis
pectineus
gracilis
What lies under pectineus?
adductor brevis
What muscles tendon is sometimes used to replace knee tendons?
gracilis
What is the adductor hiatus and what runs through it?
hole in muscle that allows blood vessels to go through
femoral artery/vein go through adductor hiatus to back of the leg
What do the femoral artery and vein become when they go through the adductor hiatus?
popliteal artery and vein
Is there a saphenous artery?
NO
From the most superficial to deep list the layers of the adductors/medial group?
pectineus, longus, gracilis
brevis
magnus
What is the exception of the innervation rule?
biggest and smallest muscles exception:
pectineus –> femoral nerve
adductor magnus has two parts:
1) adductor/oblique - obturator nerve
2) extensor/hamstring/vertical - sciatic nerve
If we are looking at the posterior knee what gives this away?
the condyles
What is the path for the femoral artery and vein to get to the popliteal fossa?
subsartorial canal
Name the order of the blood supply to the thigh?
abdominal aorta
common iliac artery
internal and external iliac arteries
external iliac artery becomes femoral artery and profunda femoris artery
What does evulsion mean?
to tear a muscle off the bone
Name a bursa on the posterior thigh and where it is specifically?
ischial bursa
between gluteus maximus and the ischial tuberosity
What is the main hip extensor?
gluteus maximus
Which muscles are crucial for gait? Why?
gluteus medius and minimus
level the ground hip while the other leg is swinging forward when we walk
Which two muscles are leg abductors?
gluteus medius and minimus
What is it called if you pinch the SGN?
trendelenberg gait - dropping of pelvis on both sides
What is the purpose of the foot on the ground when walking?
resists hip adduction to stabilize or level the pelvis
List the lateral rotator muscles?
piriformis superior gemellus obturator internus inferior gemellus obturator externus quadratus femoris
Obturator internus bends 90 degrees over what structure?
ischium
Where are the superior gluteal nerve and artery? What do they supply?
superior to piriformis
gluteus medius, minimus and tensor fascia lata
Where are the inferior gluteal nerve and artery? What do they supply?
inferior to piriformis
gluteus maximus
Where does the sciatic nerve appear in the gluteal region?
under pirifomris
What is bundle around the sciatic nerve called? And what is inside?
epinuerium
two nerves: tibular and fibular portion
What innervates piriformis?
nerve to piriformis and ventral rami S1 and S2
What innervates the obturator externus?
obturator nerve
List the posterior thigh muscles
semimembranosus, semitendenosus, biceps femoris
What two muscles border the popliteal fossa?
semimembranosus and biceps femoris
What is the common origin and innervation of the hamstrings?
ischial tuebrosity and the sciatic nerve
What are the differences in the moves of the long and short head of biceps femoris?
long head: extends hip and flexes knee
short head: flexes knee
Which nerve innervates the long head and which nerve innervates the short head?
long head: tibial portion of sciatic nerve
short head: common peroneal portion (fibular) of sciatic nerve
What muscles make up the tripod/inverted muscles?
semitendenosus
gracilis
sartorius
What is the tripod/inverted muscles?
three different msucles, three different nerves, three different functions but the same insertion (pes anserinis) and all two joint muscles
Where is pes anserinis?
anterior medial part of tibia
What is another name for pes anserinis?
Goose’s foot
List the knee ligaments?
fibular/lateral collateral lig (LCL)
tibial/medial collateral lig (MCL)
patella ligament
Where does the LCL attach?
lateral femur to lateral fibula
What is the purpose of the LCL?
keeps knee from sliding sideways
Where does the MCL attach?
medial femur to medial tibia
What is the purpose of the MCL?
prevent medial movement of tibula or femur
What does the quadriceps tendon attach to?
the patella (seisamoid bone)
How can you test the LCL?
push on the side of the leg, prevents the knee from bending like book
How does the femur articulate with the tibia?
the femoral condyles articulate with the tibial plateau covered in hyaline cartilage
What is the articularis genu muscle? Attachments and function?
hooks up to vastus intermedialis and inserts on the suprapatellar bursa and joint capsule
it pulls/tightens the bursa and capsule during knee extension
What is the bursa on the knee called?
the prepatellar bursa
Where is the prepatellar bursa?
just under skin on top of the patella
What is housemaids knee?
inflammation (bursitis) of the prepatellar bursa
Name the cruciate ligaments
the anterior cruciate ligament (ACL)
posterior cruciate ligament (PCL)
Where does the ACL attach?
the anterior tibia plateau to the lateral femoral condyle
Where does the PCL attach?
the posterior tibia plateau to the inside of the medial femoral condyle
Do the ACL and PCL have blood supply?
No, avascular - bathed in synovial fluid
What is the function of the ACL?`
prevents anterior movement of the tibia
and posterior movement of the femur
What is the function of the PCL?
prevents posterior movement of the tibia
and anterior movement of the femur
the ACL tightens during ______
the PCL tightens during ______
ACL - knee extensions
PCL - knee flexion
Name the other ligaments of the posterior knee
oblique popliteal ligament (removed with capsule)
arcuate popliteal ligament (fibula to popliteal fossa)
meniscofemoral ligament
What makes up the tibial plateau?
menisci and ligaments
What are the differences between the medial and lateral menisci?
medial is less filled in
lateral is thicker/more filled in but small that medial
What is the purpose of the transverse ligament of the knee?
prevents the menisci from moving forward during extension
Where are the coronary ligaments of the knee? and what are their function?
all around the outside of the knee to hold the meniscus to the tibia
Is there space between the MCL and MM?
no they hook together
Once you damage the hyaline cartilage of the knee does it grow back?
no now you have fibrocartilage
What are the tests you can do on cruciate ligament laxity?
the anterior drawer test - anterior cruciate test
pull on leg from the back towards you
the head of tibia will pop out anteriorly if the ACL is torn
posterior drawer test - posterior cruciate test
push drawer back in
What does the popliteus do?
unlocks the knee
when the foot is on the ground it causes the femur to rotate laterally to unlock
when foot is off the ground it will rotate femur medially
What happens if your popliteus is not functioning?
you have to do funky hip movements to unlock the knee
What is the terrible triad injury?
damage the MM, MCL and the ACL
If you have a positive anterior drawer test what does this mean?
you have loosened or torn your ACL
Where does the short saphenous vein and the sural nerve travel?
between the gastrocs
What is the triceps surae?
the three big muscles in posterior leg
medial and lateral gastrocs and the soleus
What is the densest bone in the body?
calcaneus
What borders the popliteal fossa?
gastrocs, semitendenosus and biceps femoris
What are the three connections of the fibula to tibia?
1) superior tibiofibular joint
2) interosseous membrane
3) inferior tibiofibular joint
Why is fascia clinically important?
compartment syndrome
What fascia do we have in the shank?
superficially - fascia lata
deep - crural fascia
Where does compartment syndrome typically happen?
in the front of the shank because excess blood flow in confined space
What is supination of the foot?
plantar flexion and inversion
What is pronation of the foot?
dorsiflexion and eversion
What is genu valgum?
also known as knock knee
pronation - eversion of foot when walking
What is genu varum?
also known as bow legged
supination - inversion of foot when walking
Why don’t we lose blood supply to our leg when we kneel?
because there are genicular anastomoses
artery to artery
How do you isolate the soleus?
plantar flexing with bent knee
What does down the hatch represent?
the muscle bellies from medial to lateral in the posterior leg
flexor digitorum longus, tibialis posterior, flexor hallucis longus
What does tom, dick and harry stand for?
the muscle tendons of the deep posterior leg muscles from medial to lateral
tibialis posterior, flexor digitorum longus and flexor hallucis longus
travel posterior to the medial malleolus
Which arteries, veins or nerves travel with the tendons of the posterior leg?
the tibial nerve and posterior tibial nerve and artery
What is the gateway to the foot?
posterior to the medial malleolus
Which tendon of the leg goes under the foot at 90 degrees?
fibularis longus
What holds the tendons of the fibularis’ in place?
the superior and inferior fibular retinaculum on the lateral side of the foot
Which muscle causes the most trouble with compartment syndrome?
tibialis anterior
What is the purpose of the extensor retinaculum?
to hold the tendons of the anterior leg muscles in place
What type of joints are the hip and knee?
hip is ball and socket
knee is hinge
What type of joint is the ankle joint?
hinge joint
Which bones does the cuboid articulate with?
the 4th and 5th metatarsals
What is the name of the joint made by the talus and calcaneus?
the subtalar joint
What are the movements at the subtalar joint?
inversion and eversion
sliding of talus on calcaneous
What movements does the ankle joint perform?
dorsiflexion and plantar flexion
Which bones make up the ankle joint?
tibia
fibula
talus
The lateral ligament consists of which three ligaments and they all have a common attachment of?
- anterior talofibular
- posterior talofibular
- calcenofibular
all from the lateral malleolus
What is another name of the medial ligament?
deltoid ligament
What are the deltoid ligaments?
- Anterior tibiotalar
- Posterior tibiotalar
- Tibiotalar
- Tibionavicular
Where does the tibiocalcaneal ligament attach?
medial malleolus to the sustentaculum tali of calcaneous
Where does the tibionavicular ligament attach?
the medial navicular and the spring ligament
What are the arches of the foot?
medial longitudinal
lateral longitudinal
transverse arch
What is the key stone bone and of which arch is it part of?
the talus in the medial longitudinal arch
Which bones make up the medial longitudinal arch?
calcaneus talus navicular 3 cuneiforms 3 medial metatarsals and phalanges
Which bones make up the lateral longitudinal arch?
calcaneus
cuboid
2 lateral metatarsals and phalanges
Which bones make up the transverse arch?
3 cuneiforms
cuboid
bases of metatarsals
What contributes to arch support?
shape of bones
supporting ligaments
intrinsic/extrinsic muscles and tendons
plantar aponeurosis
What are the three supporting ligaments of the foot?
long plantar ligament
short plantar ligament
spring ligament
What is another name for the spring ligament?
calcaneonavicular ligament
Where does the spring ligament attach?
sustentaculum tali to the navicular bone
Name the tendons that run in the plantar base of the foot?
Tibialis posterior
Fibularis longus
flexor hallucis longus
flexor digitorum longus
What is the plantar aponeurosis? Describe its shape and attachments and functions.
thickening of deep fascia
goes from the calcaneal tuberosity and diverges into digital bands connected by the superficial transverse metatarsal ligaments and attaches to bones and ligaments
supports the longitudinal arch
What is the name of the retinaculum that makes the tarsal tunnel?
flexor retinaculum
Which tendon hooks under the sustentaculum tali?
flexor hallucis longus
List all the extrinsic muscles of the foot?
fibularis longus fibularis brevis flexor hallucis longus flexor digitorum longus tibialis posterior
Which muscles/tendons are in layer 1 of the foot?
abductor hallucis
abductor digit minimi
flexor digitorum brevis
Which muscles/tendons are in layer 2 of the foot?
quadratus plantae
lumbricals
flexor hallucis longus tendon
flexor digitorum longus tendon
How many lumbricals are there?
4
Which muscles/tendons are in layer 3 of the foot?
flexor hallucis brevis
adductor hallucis
flexor digit minimi
Which muscles/tendons are in layer 4 of the foot?
dorsal interossei
plantar interossei
fibularis longus tendon
tibialis posterior tendon
Describe the pathway the anterior tibial artery takes after it divides from the peroneal artery?
passes between the tibia and fibia to the anterior leg where it is between tibialis anterior and extensor digitorum longus
once it passes under the extensor retinaculum it becomes the dorsal pedis artery that is now between extensor digitorum longus and extensory hallucis longus
it now forms the arcuate, metatarsal and digital arteries
Describe the pathway the posterior tibial artery takes after it divides from the peroneal artery?
passes along the surface of the deep posterior leg muscles
passes posterior to the medial malleolus and divides into the medial and lateral plantar arteries
the medial and lateral plantar arteries form the deep plantar arch, metatarsal and digital arteries
Where are pulse points for the foot?
the posterior tibial artery - by the medial malleolus and calcaneus
the dorsal pedis artery - between the extensor hallucis longus and extensor digitorum longus tendons
What is the farthest area away from the heart that you can take a pulse?
the dorsalis pedis artery
Where is the small saphenous vein compared to the great saphenous vein in the ankle?
small saphenous is posterior to the lateral malleolus and the great saphenous is anterior to the medial malleolus
Where does the small saphenous vein travel in the leg compared to the great saphenous?
small - posterior leg
great - medial leg
Where do the small saphenous and great saphenous vein come from?
the dorsal venous arch
When does the tibial nerve divide into the medial and lateral plantar nerves?
after it travels posterior to the medial malleolus
Which tendons does the medial plantar nerve travel between?
the flexor digitorum brevis and abductor hallucis
Which foot muscles does the medial plantar nerve innervate?
abductor hallucis
flexor digitorum brevis
flexor hallucis brevis
1st lumbrical
Which part of the foot does the medial plantar nerve supply sensory information to?
medial posterior side and the medial 4.5 toes
Which part of the foot does the lateral plantar nerve supply sensory information to?
the lateral side and the lateral 1.5 digits
Which muscles in the foot does the deep fibular nerve innervate and which sensory areas?
extensor digitorum brevis
extensor hallucis brevis
and the webbing between the 1st and 2nd toe
Which muscle does the deep fibular nerve travel under in the leg?
tibialis anterior
Which artery does the deep fibular nerve travel with in the foot?
dorsalis pedis artery
Which nerve innervates the skin of the top of the foot?
superficial fibular nerve
Which nerve innervates the skin of the lateral side of the top of the foot?
the sural nerve
Which nerve innervates the skin of the heel?
medial calcaneal nerves
Which nerve innervates the skin of the medial ankle?
the saphenous nerve
What is tarsal tunnel syndrome?
the compression of the structure in the tarsal tunnel
What passes through the tarsal tunnel?
tibialis posterior flexor digitorum longus flexor hallucis longus tibial nerve posterior tibial artery and vein
What causes tarsal tunnel?
varicose veins
swollen tendons
injury causing swelling
conditions such as diabetes and arthritis
What are the symptoms of tarsal tunnel?
tingling, pain, numbness along the bottom of the foot - lateral and medial plantar nerves from the tibial nerve
weakness in toe flexion, adduction and abduction - medial and lateral plantar nerves innervate all the muscles of the bottom of the foot
What happens if you pinch the superior gluteal nerve?
lose functions of medius and minimus and therefore would present with trendelenburg gait
grounded leg cannot resist adduction and therefore you lose the stabilization of pelvic level
What are the two heads of the rectus femoris?
straight and reflected
Do the ligaments of the hip go over or under the capsule?
over top
