Lower limb Flashcards
Borders of the femoral triangle
superior - inguinal ligament
lateral - medial border of sartorius
medial - medial border of adductor longus
floor - pectineus, iliopsoas and adductor longus
root - fascia lata
Content of femoral triangle
Femoral nerve
Femoral artery
Femoral vein
Femoral lymph nodes/canal
Content of femoral sheath
Femoral artery, vein and canal
Borders of Femoral canal
Roof - inguinal ligament
lateral - femoral vein
medial - lacunar ligament
floor - pectineal ligament
Content of femoral canal
lymph nodes
femoral hernia
Borders of adductor canal/hunter’s canal
Roof - sartorius
Floor - adductor longus and magnus
Lateral - vastus medialis
extends from the apex of femoral triangle to adductor hiatus
Content of hunter’s canal
femoral artery
femoral vein
saphenous nerve
Borders of Popliteal fossa
inferior - 2 heads of gastrocnemius and plantaris lateral - biceps femoris medial - semimembranosus floor - posterior joint capsule roof - popliteal fascia
Content of popliteal fossa
popliteal artery popliteal vein tibial nerve common peroneal nerve Popliteal lymph nodes
Hip joint
Ball and socket joint, articular cartilage
Acetabulum (pubis, ischium, ilium) and femoral head
3 ligaments
pubofemoral (superior pubic rami to intertrochanteric line)
ischiofemoral (ischium to greater trochanter) - weaker point
iliofemoral (AIIS to intertrochanteric line) - strongest point
ligament of head of femur (contains a branch of obturator artery)
medial circumflex femoral artery (branch of profunda femoris) supplies the femoral head
Hip muscles - superficial abductors and extensors
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor Fascia Lata
Gluteus maximus
origin - posterior surface of Ilium, sacrum, coccyx
insertion - Gluteal tuberosity of the femur, fascia lata
innervation - inferior gluteal nerve
action - Extensor
Gluteus medius
origin - ilium
insertion - lateral surface greater trochanter of femur
innervation - superior gluteal nerve
action - abductor, internal rotation
gluteus minimus
origin - ilium
insertion - anterior greater trochanter of femur
innervation - superior gluteal nerve
action - abductor hip, internal rotation
Tensor fascia lata
origin - anterior iliac crest, ASIS
insertion - iliotibial tract (popliteal fascia, lateral condyle of tibia)
innervation - femoral nerve
action - abductor and internal rotation
Hip muscles - deep lateral rotators
Piriformis
Gemelli
Obturator internus
Quadratus femoris
Piriformis
origin - anterior surface of sacrum insertion - greater trochanter of femur innervation - nerve to piriformis action - lateral rotation, abduction passes through the GREATER sciatic foramen
Gemellus superior and inferior
origin - ischial spine and inferior from ischial tuberosity
insertion - greater trochanter of femur
innervation - nerve to obturator internus and quadratus femoris
action - lateral rotation
Obturator internus
origin - Pubis, ischium at the obturator foramen
insertion - greater trochanter of femur
innervation - nerve to obturator internus
action - lateral rotation
passes through the LESSER sciatic foramen
Quadratus femoris
origin - Ischial tuberosity
insertion - quadrate tuberosity on the intertronchanteric line
innervation - nerve to quadratus femoris
action - lateral rotation
Contents of greater sciatic foramen
Superior gluteal artery and nerve Piriformis Inferior gluteal artery and nerve Sciatic nerve internal pudendal artery and nerve nerve to quadratus femoris and obturator internus posterior femoral cutaneous nerve
Content of lesser sciatic foramen
Obturator internus
Nerve of obturator internus
pudendal nerve
internal pudendal vessels
Greater sciatic foramen
Anterolaterally - greater sciatic notch of ilium
Posteromedially - sacrotuberous ligament
inferiorly - Sacrospinous ligament
Superiorly - anteriror sacroiliac ligament
Lesser sciatic foramen
Anterior - tuberosity of ischium
Superior - sacrospinous ligament
posterior - sacrotuberous ligament
Attachment of fascia lata
Posterior - sacrum and coccyx
Lateral - iliac crest
Anterior - inguinal ligament, superior pubic rami
Media - Ischiopubic rami, ischial tuberosity , sacrotuberous ligament
Distally - lateral tibial condyle
Anterior compartment of thigh
Iliacus Psoas major vastus lateralis, medialis, intermedius rectus femoris Sartorius Pectineus
Iliacus
origin - anterior surface of Ilium
insertion - lesser tubercle of femur
innervation - femoral nerve
action - flexor
Psoas major
origin - Transverse process of L2-4
insertion - lesser tubercle of femur
innervation - L1-L3
action - flexor
Vastus lateralis
origin - greater trochanter and lateral lip of linea aspera
insertion - patellar tendon
innervation - femoral nerve
action - knee extensor
Vastus intermedius
origin - anterior and lateral surface of femoral shaft
insertion - patellar tendon
innervation - femoral nerve
action - knee extensor
vastus medialis
origin - intertrochanteric line and medial lip of linea aspera
insertion - patellar tendon
innervation - femoral nerve
action - knee extensor
Rectus femoris
origin - Acetabulum and AIIS
insertion - patellar tendon
innervation - femoral nerve
action - hip flexor and knee extensor
Sartorius
origin - ASIS
insertion - Superior medial surface of tibia
innervation - femoral nerve
action - hip flexor, lateral rotation, knee flexor
Pectineus
origin - Pectineal line on the anterior surface of pelvis
insertion - pectineal line inferior to lesser trochanter
innervation - femoral nerve
action - adduction and hip flexion
Muscles in the medial compartment of the thigh
Adductor magnus Adductor longus Adductor brevis Obturator externus Gracilis
Adductor magnus
origin - inferior pubic rami & ischial tuberosity
insertion - linea aspera, adductor tubercle/medial supracondylar line of femur
innervation - obturator and tibial
action - adduction
Adductor longus
origin - pubis
insertion - linea aspera
innervation - obturator nerve
action - adduction, medial rotation
Adductor brevis
origin - pubis and inferior pubic rami
insertion - linea aspera
innervation - obturator
action - adduction
Obturator externus
origin - obturator membrane
insertion - greater trochanter
innervation - obturator
action - lateral rotation
Gracilis
origin - inferior rami and body of pubis
insertion - medial surface of tibia, between sartorius and semitendinosus
innervation - obturator
action - adduction, flexion of knee
Muscles of posterior compartment of thigh
Bicep femoris
Semimembranosus
Semitendinosus
Biceps femoris
origin - Ischial tuberosity (long head), short head = linea aspera
insertion - Head of fibula
innervation - sciatic nerve/Common peroneal
action - flexion of knee
Semimembranosus
origin - ischial tuberosity
insertion - medial tibial condyle
innervation - sciatic nerve/tibial
action - flexion of knee
Semitendinosus
origin - ischial tuberosity
insertion - medial surface of tibia
innervation - sciatic nerve/tibial
action - flexion of knee
Proximal Femur
Head - joint with acetabulum with ligament teres
Neck - common fracture line
Greater trochanter - gluteal, lateral rotators
Lesser trochanter - hip flexors
intertrochanteric line = becomes pectineal line posterior to lesser trochanter
Shaft of femur
Linea aspera - attachment of adductor muscles
Gluteal tuberosity
Medial supracondylar line = adductor tubercle
Distal femur
Condyles - articular surface of knee joint
Epicondyles - attachment for ligaments and muscles
Intercondylar fossa - ACL (lateral), PCL (medial)
Knee joint
Hinge joint, synovial joint
Joint capsules
Bursa = Infrapatella, Suprapatella, subpatella, semimembranosus bursa
Ligaments - medial collateral (semimembranosus lies underneath), lateral collateral, ACL/PCL, patellar
Meniscus - medial C shaped (attached to medial collateral), lateral circular
Anterior compartment of the lower leg
Tibialis anterior
peroneus tertius
Extensor hallucis longus
Extensor digitorum longus
Tibialis anterior
origin - lateral surface of tibia
insertion - medial cuneiform and 1st base of MTP
innervation - deep peroneal
action - dorsiflexion, inversion
Peroneus longus
origin - medial surface of fibula
insertion - 5th MTP
innervation - deep peroneal
action - dorsiflexion, eversion
Extensor hallucis longus
origin - fibula shaft
insertion - Distal phalanx of big toe
innervation - deep peroneal
action - dorsiflexion
Extensor digitorum longus
origin - lateral condyle of tibia and medial surface of fibula
insertion - distal phalanx
innervation - deep peroneal
action - dorsiflexion
Lateral compartment of lower leg
Peroneus longus
Peroneus brevis
Peroneus longus
origin - lateral surface of fibula and lateral tibial condyle
insertion - medial cuneiform and base of 1st MTP
innervation - superficial peroneal
action - eversion, plantar flexion
Peroneus brevis
origin - shaft of fibula
insertion - tubercle of 5th MTP
innervation - superficial peroneal
action - everision
Posterior compartment of leg
Superficial
Plantaris
Soleus
Gastrocnemius
Plantaris
origin - lateral supracondylar line of femur
insertion - achilles tendon
innervation - tibial nerve
action - plantar flexion
Soleus
origin - soleal line of tibia and proximal fibula
insertion - achilles tendon
innervation - tibial nerve
action - plantar flexion
Gastrocnemius
origin - medial and lateral condyle of femur
insertion - achilles tendon
innervation - tibial nerve
action - plantar flexion, knee flexor
Posterior compartment of lower leg
Deep
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Popliteus
Tibialis posterior
origin - Interosseous membrane
insertion - navicular and medial cuneiform
innervation - tibial nerve
action - plantar flexion, inversion
flexor digitorum longus
origin - medial surface of tibia
insertion - distal phalanx
innervation - tibial nerve
action - plantar flexion
flexor hallucis longus
origin - posteriro surface of fibula
insertion - distal phalanx of big toe
innervation - tibial nerve
action - plantar flexion
Popliteus
origin - Posterior surface of tibia
insertion - lateral condyle of femur, lateral meniscus
innervation - tibial nerve
action - laterally rotates knee for UNLOCKING
Patella
SESSAMOID BONE
patellafemoral groove
patellofemoral articulation thus part of knee joint
Exhances the extension of knee by quadriceps
Tibia
Medial bone in lower leg Weight bearing bone Patella ligament attaches to TIBIAL TUBEROSITY Posterior surface - SOLEAL LINE Medial malleolus Fibular notch
Fibula
Lateral bone of lower leg
attaches to the lateral condyle of tibia
Posterior, lateral surface lies the common peroneal nerve at the fibular neck
Forms the lateral malleolus
Tarsal bones
Talus Calcaneus Navicular Cuboid 3 cuneiforms
Joints of talus bone
3 articulations Ankle joint subtalar joint - calcaneus talonavicular joint Fracture can lead to AVN
Joints of Calcaneus
2 articulations
Subtalar joint
Calcaneocuboid joint
Ankle joint
hinge type joint, synovial joint joint between the talus and tibia/fibula DELTOID ligament (medial) - talus, calneous, navicular Lateral ligament - talofibular (anterior and posterior), calcaneofibular ligament
Pott’s fracture dislocation
Bimaleolar or trimaleolar fracture
Segond fracture
avulsion fracture of the lateral tibial plateau with ACL injury
Osgood schlatter disease
chronic avulsion fracture of tibial tuberosity where the patella ligament inserts
Maisonneuve fracture
Spiral fracture of proximal fibula
Tilofibular syndesmosis/deltoid ligament disruption/medial malleolus fracture
Jones fracture
extra articular fractue of base of 5th MTP
Weber A fracture
below the talar dome
transverse
Weber B fracture
at level of talar dome spiral syndesmosis injury medial malleolus fracture deltoid ligament injury
Weber C fracture
above the level of talar joint
tilofibular syndesmosis diruption
medial malleolus fracture or deltoid ligament injury
Subtalar joint
plane synovial joint
Posterior talar articular surface and posterior calcaneal articular facet
Joint capsule
3 ligaments - posterior/medial/lateral talocalcaneal ligament
Interosseous talocalcaneal ligament
Muscles in the dorsum of the foot
Extensor pollicis brevis
Extensor digitorum brevis
Extensor hallucis brevis
origin - calcaneus and extensor retinaculum
insertion - proximal phalanx of big toe
innervation - deep peroneal nerve
action - extend great toe at MTP
Extensor digitorum brevis
origin - calcaneus and extensor retinaculum
insertion - long extensor tendons
innervation - deep peroneal nerve
action - extension at MTP, IPJ
Muscles of foot - plantar 1st layer
Abductor hallucis
FLexor Digitorum brevis
Abductor digiti minimi
Abductor hallucis
origin - calcaneus, flexor retinaculum and plantar aponeurosis
insertion - medial base of proximal phalanx
innervation - medial plantar nerve
action - abduct the big toe
Flexor digitorum brevis
origin - calcaneus, plantar aponeurosis
insertion - middle phalanges of toes
innervation - medial plantar nerve
action - flex PIPJ
Abductor digiti minimi
origin - calcaneus, plantar aponeurosis
insertion - proximal phalanx of 5th digit
innervation - lateral plantar nerve
action - abduct 5th toe
Muscles of the foot 2nd layer
Quadratus plantae
Lumbricals
Quadratus plantae
origin - calcaneus
insertion - FDL tendons
innervation - lateral plantar nerve
action - assist FDL
Lumbricals
origin - tendons of FDL
insertion - extensor hood of lateral four digits
innervation - medial/lateral plantar nerve
action - flexes MTPJ extends IPJ
Muscle of the foot 3rd layer
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi brevis
Flexor hallucis brevis
origin - Cuboid and lateral cuneiforms
insertion - proximal phalanx of big toe
innervation - medial plantar nerve
action - flexes MTPJ
Adductor hallucis
origin - oblique head (2-4th MTP) and plantar ligaments of MTPJ
insertion - lateral base of proximal phalanx of big toe
innervation - lateral plantar nerve
action - adduct toe
Flexor digiti minimi brevis
origin - base of 5th MTP
insertion - base of proximal phalanx of 5th
innervation - lateral plantar nerve
action - flexion of 5th toe
Muscles of the foot 4th layer
Plantar and dorsal interossei
Only 3 plantar interossei, 4 dorsal interossei
innervation - lateral plantar nerve
action - Dorsal - ABDUCT, plantar - ADDUCT
Femoral artery
arises after inguinal ligament
enters femoral triangle
Profunda femoris
medial and lateral circumflex femoral artery
branches of internal iliac artery in lower limbs
obturator artery
superior gluteal
inferior gluteal
popliteal artery
arises after adductor hiatus medial/lateral superior genicular artery medial lateral inferior genicular artery middle genicular artery sural artery anterior tibial artery (dorsalis pedis) Tibioperoneal trunk (posterior tibial and peroneal)
Veins in the legs - deep
Anterior tibial vein
Posterior tibial vein
popliteal vein - femoral vein
Superficial vein of legs
Great saphenous vein - medial aspect of leg, anterior to medial malleolus
Small saphenous vein - lateral aspect of leg - posterior to lateral malleolus, joins the popliteal vein
Nerve roots of Lumbar plexus
L1-L4
Branches of the lumbar plexus
Iliohypogastric Ilioinguinal Genitofemoral Obturator Femoral Lateral cutaenous nerve of the thigh
Iliohypogastric nerve
L1
internal oblique, transversus abdominis
cutaneous branch above the inguinal ligament and gluteal region
Ilioinguinal nerve
L1
internal oblique, transversus abdominis
cutaneous branch to pubis, root of penis/labia majora
passes through the inguinal canal
Obturator nerve
L2-L4
supplies the medial compartment of the thigh
skin - medial thigh
passes through the obturator foramen
Femoral nerve
L2-L4
supplies the anterior compartment of the thigh
Anterior aspect of thigh
Gives off saphenous nerve - medial malleolus
Genitofemoral nerve
L1-L2
Cremasteric muscle
Skin over the anterior part of scrotum, labia majora
Lateral cutaneous nerve of the thigh
L2-L3
anterior and lateral aspect of thigh
Nerve roots of sacral plexus
L4-S4
Branches of sacral plexus
Superior gluteal nerve inferior gluteal nerve Sciatic nerve nerve to piriformis nerve to obturator internus nerve to quadratus femoris pudendal nerve
Superior gluteal nerve
L4, L5, S1
innervates gluteus medius, minimus
passes ABOVE piriformis
Inferior gluteal nerve
L5, S1, S2
innervates gluteus maximus
passes BELOW piriformis
Sciatic nerve
L4-S3
Tibial nerve and common peroneal nerve
Hamstring muscles
Posterior femoral cutaneous
S1-S3
posterior surface of thigh
Pudendal nerve
S2-S4
levator ani, external urethral sphincter, external anal sphincter
tibial nerve
L4-S3
posterolateral side of leg, lateral side of foot, sole of foot
Posterior compartment of the leg
Terminal branch - plantar nerves
Common peroneal nerve
L4-S3
lateral and anterior compartments
wraps around the fibular neck
gives off lateral sural cutaneous nerve
Deep peroneal nerve
L4/L5 anterior compartment of the leg web of 1st and 2nd toe follows the anterior tibial artery deep to extensor retinaculum
Superficial peroneal nerve
L4-S1
lateral compartment of leg
dorsum of foot
Sural nerve
from common peroneal and tibial nerve
cutaneous branch for lateral malleolus
