lower limb Flashcards

1
Q

lumbar plexus content

A

femoral (L2-L4)
obturator (L2-L4)
sciatic nerve - lumbosacral trunk (L4-L5)+sacral nerves (S1-S3)

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2
Q

root of nerves of lumbar plexus from pelvis to lower limb

A

femoral - subingual space
obturator - obturator canal
sciatic nerve - greater sciatic foramen

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3
Q

superficial veins at sciatic hiatus

A

superficial epigastric
superficial circumflex iliac
accessory saphenous
greater saphenous

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4
Q

cutaneous nerves of the lower limb

A

lateral thigh:
lateral cutaneous T12
lateral cutaneous nerve of thigh L2-L3

anterior thigh:
femoral branch of genitofemoral L1-L2

medial thigh:
ilioinguinal L1
cutaneous branch of obturator L2-L4

all:
anterior cutaneous branch of femoral L2-L4

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5
Q

boundaries of the femoral triangle

A
roof:
fasciae latae
cribiform fascia
subcutaneous tissue
skin

base:
inguinal ligament

lateral:
sartorious

medial:
adductor longus

floor:
iliopsoas
pectineus

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6
Q

content of femoral triangle

A

femoral nerve, artery, vein and lymph (NAVL)

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7
Q

femoral sheath composition and what it does

A

transversalis and iliopsoas fascia

adventitia of femoral vessels

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8
Q

what is the space medially within the femoral sheath

A

femoral canal

contains fat and lymphatics

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9
Q

muscles of the anterior compartment of the leg

A

iliacus
psoas major
pectineus
sartoriuous

quadriceps:
rectus femoris
vastus lateralis 
vastus medialis
vastus intermedius
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10
Q

role of muscles of anterior compartment and which muscles do extra

A

extend knee (quadriceps)
flex hip (all other)
pectineus - adducts hip and assists in medial rotation
sartorious - abducts, laterally rotates and flexes knee
rectus femoris - flexes hip

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11
Q

pectineus attachment

A

superior ramus of pubis to pectineal line of femur

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12
Q

sartorious attachment

A

anterior superior iliac spine to superior medial tibia

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13
Q

rectus femoris attachment

A

AIIS and ilium above acetabulum to quadriceps tendon then tibial tuberosity via patellar ligament

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14
Q

vastus lateralis attachment

A

greater trochanter to quadriceps tendon then tibial tuberosity via patellar ligament

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15
Q

vastus medialis attachment

A

intertrochanteric line to quadriceps tendon then tibial tuberosity via patellar ligament

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16
Q

vastus intermedius attachment

A

anterior and lateral shaft of femur to to quadriceps tendon then tibial tuberosity via patellar ligament

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17
Q

what nerve is found deep to the inguinal ligament

A

femoral nerve

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18
Q

branches of the femoral nerve

A

muscular
articular
cutaneous - saphenous is terminal

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19
Q

root values for the anterior muscle compartment:
iliacus, *pectineus and sartorious
psoas major
quadriceps

A

femoral (L2-L3) *sometimes obturator
anterior rami (L1-L3)
femoral (L2-L4)

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20
Q

muscles of medial compartment of the leg

A
gracilis
adductor longus
adductor brevis
adductor magnus
obturator externus
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21
Q

role of muscles of the medial compartment and which muscles do extra

A

hip adductors
gracilis - flexes knee
adductor brevis - may assist flexion
obturator externus DOES NOT ADDUCT - laterally rotates thigh

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22
Q

root values for medial compartment muscles:
gracilis
adductor longus, braves and *magnus
obturator externus

A

obturator (L2-L3)
obturator (L2-L4) *also sciatic (L4)
obturator (L3-L4)

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23
Q

obturator nerve branches

A

anterior and posterior division
muscular branches
(anterior is cutaneous to middle)

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24
Q

location of the adductor canal

A

starts at apex of femoral canal to adductor hiatus

under distal sartorious

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25
Q

boundaries of adductor canal

A

sartorious
vastus medialis
adductor longus

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26
Q

what passes through the adductor canal

A

femoral vessels (veins and arteries) and the saphenous nerve (between sartorious and gracilis)

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27
Q

arterial supply to the anterior and medial thigh

A

femoral artery from the external iliac (eventually becoming popliteal through the adductor hiatus)
profunda femoris is a branch
obturator artery from the internal iliac
posterior and anterior branches

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28
Q

where does profunda femoris branch off and what branches does it have

A

deep to adductor longus
3-4 perforating branches through adductor magnus
medial (posterior) and lateral (anterior) circumflex branches (they join anteriorly and with inferior gluteal to form cruciate anastomosis)

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29
Q

what do the posterior and anterior branches of the obturator artery supply

A

anterior - muscles of medial compartment

posterior - muscles attached to ischial tuberosity

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30
Q

gracilis attachment

A

body and inferior ramus of pubis to superior medial surface of tibia

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31
Q

adductor longus attachment

A

body of pubis to medial 1/3 linea aspera

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32
Q

adductor brevis attachment

A

body and inferior rams of pubis to pectineal line and proximal linea aspera

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33
Q

adductor magnus attachment

A

pubic ramus and ischial tuberosity to linea aspera, medial supracondylar line and adductor tubercle

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34
Q

obturator externus attachment

A

margin of obturator foramen and membrane to trochanteric fossa

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35
Q

long axis of shaft of femur crosses the long axis of head and neck (wider hips = narrower)

A

angle of inclination

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36
Q

neck angle slightly anteriorly

A

angle of anteversion

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37
Q

lines at inferior posterior section of femur

A

supracondylar lines

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38
Q

Muscles of gluteal region (8)

A
gluteus maximus 
piriformis
obturator internus
gemelli
quadratus femoris
gluteus medius
gluteus minimus
tensor fasciae latae
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39
Q

the lateral rotators of the hip and any other action they preform

A
*gluteus maximus - extends hip
piriformis 
obturator internus
gemelli
quadratus femoris
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40
Q

the medial rotators of the hip

A

gluteus medius and gluteus minimus

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41
Q

muscle has the role of support

A

tensor fasciae latae

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42
Q

what muscles are innervated by superior gluteal nerve (L4-S1)

A

gluteus medius
gluteus minimus
tensor fasciae latae

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43
Q

innervation of the gluteus maximus

A

inferior gluteal nerve (L5-S2)

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44
Q

innervation of the gemelli

A

superior - obturator internus (L5-S1)

inferior - quadratus femoris (L5-S1)

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45
Q

gluteus maximus attachment

A

sacrum, sacrotuberous ligament and ilium to iliotibial tract (3/4) and gluteal tuberosity (1/4)

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46
Q

gluteus medius attachment

A

ilium between posterior and anterior gluteal lines to greater trochanter of femur

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47
Q

gluteus minimus attachment

A

ilium between anterior and inferior gluteal lines to greater trochanter of femur

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48
Q

gemelli attachments

A

superior - ischial spine to tendon of obturator internus (greater trochanter of fossa)
inferior - ischial tuberosity to tendon of obturator internus

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49
Q

tensor fasciae latae attachments

A

anterior iliac crest and ASIS to iliotibial tract

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50
Q

gluteal vessels and nerves separate to form superior and inferior around what muscle

A

piriformis

51
Q

posterior cutaneous nerves of the thigh

A

middle clunial nerves (S1-S3)
superior clunial nerves (L1-L3)
inferior clunial nerves (S1-S3)

52
Q

what forms the articular surfaces of the hip joint

A

acetabulum - fat pad in synovial membrane, transverse acetabular ligament, bridging notch, lunate surface
head of femur - articular cartilage, fovea where ligament head sits
fibrous capsule

53
Q

ligaments of hip joint

A

iliofemoral
pubofemoral
ischiofemoral

54
Q

attachment of iliofemoral ligament

A

AIIS to intertrochanteric line

55
Q

attachment of pubofemoral ligament

A

iliopubic eminence to lower intertrochanteric line

56
Q

attachment of ischiofemoral ligament

A

posterior aspect of acetabulum to greater trochanter

57
Q

what do iliofemoral, pubofemoral and ischiofemoral ligaments limit

A

iliofemoral - extension, lateral rotation, adduction and abduction
pubofemoral - extension, lateral rotation and abduction
ischiofemoral - extension, medial rotation and adduction

58
Q

blood supply to the hip joint

A

medial and lateral circumflex iliac arteries

acetabular branch

59
Q

muscles of the posterior thigh compartment (hamstrings)

A

semitendinous
semimebranous
biceps femoris

60
Q

innervation of the hamstrings

A

tibial division of the sciatic nerve (L5-S2)

*short head of biceps femurs - common peroneal division of the sciatic (L5-S2)

61
Q

actions the hamstrings preform

A

extend hip and flex knee

  • lateral rotation - biceps femoris
  • medial rotation - semimembranous, semitendinous, gracilis and sartorious
62
Q

popliteal fossa boundaries

A

roof - deep fascia (pierced by short saphenous and sural)

superior - tendon of biceps femoris laterally and semitendinous and semimembranous medially

inferiorly - medial and lateral heads of gastrocnemius

floor - popliteal surface of femur, knee joint capsule, popliteus muscle, oblique popliteal ligament, middle genicular vessels

63
Q

contents of popliteal fossa

A

popliteal artery
popliteal vein
tibial and common peroneal divisions of the sciatic

64
Q

what is the oblique popliteal ligament and its role

A

expansion of semimembranous muscle

reinforces knee joint capsule

65
Q

what do the 5 genicular branches of the popliteal artery supply

A

pierce joint to supply the cruciate ligaments

66
Q

terminal branches of the popliteal artery

A

anterior and posterior tibial arteries

67
Q

tendons that laterally rotate the knee joint

A

quadriceps tendon and patellar tendon

68
Q

type of joint at knee

A

modified hinge joint

69
Q

what are the three articulations making up the knee joint

A

femoropatellar - patella on anterior femur

2x femorotibial - lateral/medial femoral condyle with lateral/medial tibial condyle

70
Q

articular surface of the femur tibia and patella

A

femur - patellar surface, lateral and medial condyle, intercondylar fossa
tibia - lateral and medial condyle and intercondylar eminence
patella - (inf->sup) apex, medial and lateral facets

71
Q

attachments of the capsule covering the knee

A

anteriorly fuses with quadriceps tendon

posteriorly encloses intercondylar fossa of femur (opening posterior to lateral condyle for popliteus muscle)

72
Q

synovial membrane attachments

A

alar folds attach to inner surface of fat pads on either side of the patellar ligament
infra patellar fold attaches to the femur
(cruciate ligaments are inter capsular but not it the synovial membrane)

73
Q

bursae around the knee joint associated with synovial cavity

A

suprapatellar - reduces friction
gastrocnemius
semimembranous
popliteus

74
Q

bursae around knee joint not associated with synovial cavity

A

subcutaneous prepatellar
deep + subcutaneous infra patellar
anserine (gracilis, sartorious + semitendinous meet)

75
Q

extracapsular ligaments of the knee

A

oblique popliteal
arcuate popliteal
medial collateral (broad)
lateral collateral (cord-like)

76
Q

role of popliteal ligaments of the knee

A

oblique popliteal - expansion of semimembranous tendon, reinforces posterior
arcuate popliteal - thickened fibres over popliteal muscle, strengthens posteriolateral capsule

77
Q

attachment of medial collateral ligament of the knee

A

medial epicondyle of femur to medial condyle and superior surface of tibia

78
Q

attachment of lateral collateral ligament of the knee

A

lateral epicondyle of femur to lateral head of fibula

79
Q

intracapsular ligaments of the knee

A

anterior cruciate ligament

posterior cruciate ligament

80
Q

role and attachment of anterior cruciate ligament

A

anterior intercondylar tibia to lateral condyle of femur

limits anterior displacement of knee

81
Q

role and attachment of posterior cruciate ligament

A

posterior intercondylar tibia to medial condyle of femur

limits posterior displacement of knee

82
Q

describe the menisci and their role

A

fibrocartilage wedges

shock absorption

83
Q

describe medial meniscus and its attachment

A

C shaped
broad posteriorly
attached to tibial collateral ligament

84
Q

describe lateral meniscus and its attachment

A

circular
freely movable
attached to popliteus

85
Q

blood supply to the knee

A

5 genicular branches from popliteal
descending genicular branch from femoral
descending branch from lateral circumflex
recurring branches from anterior and posterior tibial arteries
all join at periarticular genicular anastomosis

86
Q

septum surrounding the anterior compartment of the lower leg

A

anterior septum

87
Q

septum separating the lateral and posterior compartments

A

posterior septum

88
Q

septum that divides the posterior compartment into deep and superficial

A

transverse inter muscular septum

89
Q

properties of the interosseous membrane

A

surface for muscle attachment and resist pull of muscles attached to fibula
fibres inferolaterally from tibia to fibula

90
Q

what type of joint is the superior tibiofibular joint and its attachments

A

plane synovial

head of fibula to facet on tibial condyle

91
Q

does the superior tibiofibular joint allow any movement

A

slight movement during dorsiflexion of ankle

92
Q

Muscles of the lateral compartment of the lower limb (2)

A

peroneus longus

peroneus brevis

93
Q

Muscles of the anterior compartment of the lower limb (4)

A

tibialis anterior
extensor digitorum longus
peroneus tertius
extensor hallucis longus

94
Q

Action of the muscles of the lateral compartment of the lower leg and nerve supply

A

evertors of the foot

superficial peroneal nerve (L5-S2)

95
Q

Action of the muscles of the anterior compartment of the lower leg (including extras) and nerve supply

A

all extensors (dorsiflexors) of ankle joint and digits
tibialis anterior - inverts foot
peroneus longus - everts foot
deep peroneal nerve (L4-L5)

96
Q

attachment of peroneus longus and tendon

A
lateral fibula (head and upper 1/3) to base of metatarsal and medial cuneiform
tendon passes superior to peroneal trochlea of calcaneus and forms groove on cuboid
97
Q

attachment of peroneus brevis and tendon

A
lateral fibula (lower 2/3) to tuberosity on base 5th metatarsal (lateral)
tendon passes inferiorly to peroneal trochlea of calcaneus and inserts on 5th metatarsal
98
Q

attachment of tibialis anterior

A

lateral condyle of tibia, lateral tibia (superior 1/2) and interosseous membrane to medial cuneiform (medial and inferior) and base of 1st metatarsal

99
Q

attachment of extensor digitorum longus

A

lateral condyle of tibia, medial fibula (superior 3/4) and interosseous membrane to middle and distal phalanges of of lateral 4 digits

100
Q

attachment of preoneus tertius

A

anterior fibula (inferior 1/3) and interosseous membrane to dorsal of base of 5th metatarsal

101
Q

attachment of hallucis longus

A

anterior fibula (middle) and interosseous membrane to base of distal phalanx of hallux

102
Q

what is the thickening of fascia surrounding the ankle

A

extensor retinacula:

superior and inferior

103
Q

attachments of the superior extensor retinaculum

A

anterior border of tibia to lower fibula

104
Q

attachments of the inferior retinaculum

A

Y shape
stem of Y - calcaneus
upper limb - medial malleolus
lower limb - pass medial border to blend with dense fascia of abductor hallucis

105
Q

cutaneous supply to:
knee
lateral leg
medial and anterior leg

A

anterior cutaneous branch of femoral
lateral sural cutaneous
saphenous nerve

106
Q

superficial muscles of the posterior compartment of the lower leg

A

gastrocnemius
plantaris
soleus

107
Q

deep muscles of the posterior compartment of the lower leg

A

popliteus
flexor digitorum longus
flexor hallucis longus
tibialis posterior

108
Q

Role of the muscles of the posterior compartment of the lower leg (including extras)

A

plantarflexion
popliteus - unlocks knee (by lateral rotation of femur on tibia)
tibialis posterior - inverts foot

109
Q

innervation of the superficial muscles of the posterior compartment of the leg

A

tibial nerve (S1-S2)

110
Q

innervation of the deep muscles of the posterior compartment of the leg

A

popliteus - tibial nerve (L4-S1)
flexor digitorium longus and flexor hallucis longus - tibial nerve (L5-S2)
tibialis posterior - tibial nerve (L4-L5)

111
Q

Order of tendons of the deep muscles and associated vessels (medial to lateral) and location

A

tibialis posterior - flexor digitorium longus - posterior tibial artery - posterior tibial vein - tibial nerve - flexor hallucis longus
Tom Dick And Very Naughty Harry

Located in the flexor retinaculum

112
Q

attachment of flexor retinaculum

A

medial malleolus to calcaneous

113
Q

where do all the superficial muscles of the posterior compartment insert

A

tendocalcaneous (to posterior surface of calcaneus)

114
Q

origin of the heads of the gastrocnemius

A

medial head - popliteal surface of femur (superior to medial condyle)
lateral head - lateral condyle of femur

115
Q

origin of plantaris

A

lateral supracondylar line of femur (proximal to lateral head of gastrocnemius)

116
Q

origin of soleus

A

soleal line of tibia and posterior fibula tendinous arch (upper 1/3)

117
Q

attachments of the popliteus

A

lateral condyle of femur and lateral meniscus to above soleal line of tibia

118
Q

attachments of flexor digitorum longus and tendon

A

posterior tibia to distal phalanx 2-4

groove on posterior medial malleolus

119
Q

attachments of flexor hallucis longus and tendon

A

posterior fibula to distal phalanx of hallux

grooves posterior surface of the lower end of tibia and posterior surface of talus

120
Q

attachments of tibialis posterior and tendon

A

posterior tibia, posterior fibula and interosseous membrane to tuberosity of navicular, cuneiforms, cuboid, calcaneus and base of 2-4 metatarsals
deep to flexor digitorum longus - groove on posterior to medial malleolus

121
Q

passage of the tibial nerve and its terminal branches

A

heads of the gastrocnemius and deep to tendinous arch of soleus with posterior tibial artery
medial and lateral plantar nerves

122
Q
cutaneous supply to posterior leg:
back of knee
medial
posterior
lateral
A

posterior cutaneous nerve of thigh
saphenous nerve
medial sural nerve
lateral sural nerve

123
Q

what type of joint is the inferior tibiofibular joint

A

syndesmosis - no movement

*slight movement to accommodate wedging of trochlea of talus during dorsiflexion

124
Q

ligaments supporting the inferior tibiofibular joint

A

anterior and posterior ligaments that are continuous with the interosseous membrane