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Lower Limb > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Femoral triangle borders

A

Medial - medial border of adductor longus

Lateral - sartorius

Superior - inguinal ligament

Roof - fascia lata

Floor - AL, pect, posts, iliacus (M to L)

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2
Q

Origin of the hamstrings (M to L)

A

Ischial tuberosity

ST, SM, BF (long head)

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3
Q

Insertion of the short rotators (S to I)

A

Piriformis

Superior gemellus

Obturator internus

Inferior gemellus

Obturator externus

Quadratus femoris

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4
Q

Anastomoses of hip

A

Trochanteric

  • Superior gluteal A
  • Inferior gluteal A
  • Medial Cx Fem A
  • Lateral Cx Fem A

Cruciate

  • Inferior gluteal A
  • Medial Cx Fem A
  • Lateral Cx Fem A
  • Ascending 1st Perf
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5
Q

Relations of N + A to Psoas

A

Medial - ext iliac A + V

Deep / Medial - obt N

Lateral - femoral N

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6
Q

Root values of gluteal muscles

A
  1. Superior gluteal N = L4, L5, S1
  2. Inferior gluteal N = L5, S1, S2
  3. N to obturator internus = L5, S1, S2
  4. N to quadratus femoris = L4, L5, S1

1 + 4 / 2 + 3 = same

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7
Q

Closely assoc. structures to iliopsoas muscle

A

Medially @ the pelvic brim -> iliac vessels

@ insertion site -> medial femoral Cx A

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8
Q

Ligaments of the hip

A
  1. Iliofemoral (strong, anterior)
  2. Ischiofemoral (weak, posterior)
  3. Pubofemoral (small, posteroinferior)
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9
Q

Innervation of anterior thigh / hip flexors

A
  1. Psoas (L1, 2, 3)
  2. Iliacus (L2, 3, 4 - femoral N)
  3. Pectineus (L2, 3, 4 - femoral N, remember pectinous = watershed)
  4. Rectus femoris (L2, 3, 4 - femoral N)
  5. Sartorius (L2, 3, 4 - femoral N)
  6. VM, VI, VL (L2, 3, 4 - femoral N)
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10
Q

Pes anserine insertion

A

Common insertion site for (Say Grace Before Tea, Mum):

  1. Sartorius
  2. Gracilis
  3. Semitendinosus
  4. Semimembranosus
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11
Q

Surgical approach to pes anserine

A

Harvest semitendinosus / gracilis

Terminal branch of saphenous N @ risk as it runs between sartorius + gracilis

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12
Q

Additional structures within the femoral triangle (NOT NAVI)

A

Lateral cutaneous N of thigh crosses the lateral corner of the triangle

Femoral br of genitofemoral N (L1 / L2)

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13
Q

Structure related to sartorius in lower thigh

A

Saphenous N lies posterior to sartorius as it exits out of Hunters canal

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14
Q

Surgical considerations assoc. w/ vastus lateralis

A

Perforators from profound femurs runs deep to VL + need to be identified + ligated to prevent excessive bleeding

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15
Q

Obturator N supply

A

Ant division:

  1. Pectineus (watershed)
  2. Add B
  3. Add L
  4. Gracilis
  5. Sensory

Post division:

  1. Obt E
  2. Add M
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16
Q

Landmark for division of anterior / posterior Obturator N

A

Add B

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17
Q

Landmark for division of anterior / posterior Obturator N

A

Add B

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18
Q

Add Magnus rule of 2s

A

Origin

  1. Pubic
  2. Ischial

Insertion

  1. P - glut tub / linea aspera / supracondylar ridge
  2. I - adductor tubercle

N supply

  1. P - post division of Obt N
  2. I - tib portion of Sciatic N

A supply

  1. Proximal = obt A
  2. Distal = profunda femoris perforators

Function

  1. P - true adduction
  2. I - hip extension
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19
Q

Unique feature of gracilis

A

Only adductor that DOES NOT insert into the linea aspera

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20
Q

Piriformis as a landmark (structures above + below)

A

Above:
1. Superior gluteal A + N

Below:

  1. Sciatic N
  2. Inferior gluteal A + N
  3. Perf cut N
  4. Post Fem cut N
  5. N to QF
  6. N to obt Int
  7. Pudendal N
  8. Pudendal A + V
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21
Q

Structures via the lesser sciatic foramen

A
  1. Tendon of obt int
  2. N to obt int
  3. Internal pudendal A + V
  4. Pudendal N
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22
Q

Vessel @ risk with posterior hip approach

A

MCFA - deep branch crosses the tendon of obt ext (behind QF) -> travels superiorly posterior to the conjoint tendon (SG / OI / IG) to perforate into the capsule

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23
Q

Relation fo sciatic N to the short rotator muscles

A

Anterior to piriformis but posterior to obturator internus

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24
Q

Innervation of the gemelli muscles

A

Sup G - N to obt int

Inf G - N to QF

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25
Q

Landmarks for MFCA

A

Space between the inferior edge of inf G + superior edge of QF (lying on OR posterior to obt ext)

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26
Q

Surgical considerations for superior gluteal N

A

SGN is 5cm proximal / above the tip of the GT

@ risk w/ lateral (Hardinge) hip approach when splitting the glut med muscle

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27
Q

Order of structures inserting onto fibular head

A

From A to P

  1. LCL
  2. Popliteofibular lig
  3. Rectus femoris
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28
Q

Common Fib N relation to fibular

A

Passes posterior to the tendon of biceps femoris as it inserts into the fibula

Passes around the neck of the fibula

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29
Q

Gerdy’s tubercle

A

Lateral condyle of the tibia

Insertion point for the ITB

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30
Q

Attachments of the fascia lata

A

Proximal - inguinal ligament, ASIS, iliac crest, PSIS, ischiopubic ramus

Distal - patella, inferior portion of tibial condyles, head of fibular

Is continuous posteriorly w/ the popliteal fossa (where transverse fibres strengthen it) + then the deep fascia of the calf

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31
Q

Muscles enclosed by fascia lata

A
  1. Glut max

2. TFL

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32
Q

Femoral ring borders

A

A = inguinal ligament

P = pectineal lig + pectineus (covering superior pubic ramus)

M = lacunar ligament

L = femoral vein

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33
Q

Cloquet’s node

A

LN located in the femoral canal

Drains the clitoris in F + the glans penis in M

34
Q

Genitofemoral N course in fem sheath

A

Fem br (L1) of GF N

Runs on the anterior surface of ext iliac A

Pierces the anterior wall of the fem sheath

35
Q

Fem A br in the fem triangle

A

x4 superficial:

  1. Superficial Cx iliac A
  2. Superficial epigastric A
  3. Superficial external pudendal A
  4. Deep external pudendal A

x1 deep:
1. Profunda femoris

36
Q

Cx of cannulating fem A

A
  1. Retroperitoneal haemorrhage
  2. Gut perforation
  3. AV fistula
37
Q

Superficial epigastric A

A

Emerges from saphenous opening

Supplies the skin / subcut as it passes toward the umbilicus

38
Q

Superficial external pudendal A

A

Emerges medially from saphenous opening

Passes anterior to spermatic cord / round lig to supply scrotal skin / subcut

39
Q

Deep external pudendal A

A

Emerges more medially from saphenous opening than the SEPA

Passes posterior to spermatic cord / round big to supply scrotal skin / subcut

40
Q

Superficial Cx Iliac A

A

Pierces FL lateral to saphenous opening

Passes superolaterally toward ASIS where it forms anastomosis w/ other vessels

41
Q

Course of medial Cx fem A

A

Passes posteriorly between psoas + pectineus into the adductor compartment

Passess posteriorly between obt ext + add b into the posterior compartment

Visible between inf gemellus + QF as it divides

@ risk w/ posterior approach to the hip

42
Q

Course of lat Cx fem A

A

Lies under sartorius

Ask br @ risk w/ anterior approach to the hip (lies between sartorius + TFL)

43
Q

Fem vein course

A

Enters fem triangle posterior to fem A

In the fem sheath it comes to lie medial to fem A

Just below the fem sheath the greater saphenous vein joins its anteromedial side through the cribriform fascia

44
Q

Gluteal IM inj

A

Upper outer quadrant of the gluteal region

Gluteal region = extends from the iliac crest to the gluteal fold

45
Q

Stability of the hip joint

A

Result of the adaptation of the articulating surfaces of acetabulum + femoral head to each other

46
Q

Mobility of the hip joint

A

Results from the femur having a neck that is much narrower than the equatorial diameter of the head

47
Q

Haversian fat pad

A

Occupies the central non-articular portion of the acetabulum

48
Q

Hip capsule attachment

A

Anteriorly extends to the intertroch line

Posteriorly it extends for only 1/2 this distance to 1/2 along the femoral neck

Capsule is loose but extremely strong

49
Q

Clinical implications of iliofemoral lig

A

Limits extension @ the hip J

Forms the fulcrum or axis around which the neck of the femur rotates in dislocation of the hip joint

50
Q

Weakest hip lig

A

Ischiofemoral lig

51
Q

Bursae of the hip

A
  1. Under glut med / min @ GT
  2. Under glut max (over isch tub, GT + upper part of VL)
  3. Iliac bursa - extends upwards beneath iliacus
52
Q

Structures that separate the fem A + V + N from the hip joint

A

Fem A - psoas

Fem V - pectineus

Fem N - iliacus

53
Q

Structure that separates sciatic N from the hip joint

A

Obt internus + gemelli

54
Q

Ant approach to hip (Smith Peterson)

A

Between sartorius + TFL (identifying LCFA)

Detaching TFL, RF + ant glut med + iliacus

55
Q

Ant/Lat approach to hip (Watson Jones)

A

Between TFL + glut med (identifying LCFA)

Exposes the capsule under the ant fibres of glut med / min

56
Q

Post approach to hip (Moore)

A

Splitting middle of glut max in line of its fibres

Divide piriformis, obt int + gemelli @ femoral attachments

Sciatic nerve is protected by reflecting obt int / gemelli medially

57
Q

Inj into hip

A

Anterior - 5cm below ASIS, directed upwards / backwards / medially

Lateral - in front of GT + parallel w/ fem neck

58
Q

Borders of pop fossa

A

Superomedial - ST / SM

Superolateral - BF

Inferomedial - med gastroc

Inferolateral - lat gastroc

59
Q

Floor + roof of pop fossa

A

Roof = fascia lata w/ strengthening transverse fibres

Floor (sup to inf)

  1. Femur
  2. Knee capsule
  3. Popliteus fascia
60
Q

Contents of pop fossa

A

Deep to Sup

  1. Popliteal A
  2. Popliteal V
  3. Popliteal LNs
  4. Sciatic N OR tibial / common fibular
61
Q

Course of fem V relative to fem A

A

Lateral @ add hiatus

Posterior in fem triangle

Medial in femoral sheath

62
Q

Borders of add canal

A

M - add longus superiorly, add magnus inferiorly

L - vastus med

Roof - sartorius fascia w/ sub sartorial plexus

63
Q

Contents of add canal

A
  1. Fem A
  2. Fem V
  3. Saphenous N
  4. N to vast m
64
Q

Relation of fem NV bundle

A

@ all times the fem A lies between fem V + saphenous N

65
Q

Course of pop A relative to N

A

Medial + deep to sciatic N @ add hiatus

Lateral to tib N as it enters the solar arch

66
Q

Relation of pop NV bundle

A

@ all times the pop V lies between pop A + tibial N

67
Q

LCL vs MCL

A

LCL:

  • Round, cord-like lig
  • NOT attached to lateral meniscus
  • Taut w/ ext + ‘screw home’ movement

MCL:

  • Broad, flat, strong lig
  • Attached to medial meniscus
  • Limits ext + ‘screw home’ movement
68
Q

Oblique pop lig

A

Thick rounded band, strong ++

Formed from lat expansion from insertion of SM -> slopes to popliteal surface of femur (obliquely)

Limits ext + rotation during screw home movement

69
Q

Screw home mechanism

A

IR of tibia 15 degrees relative to femur

Occurs from 20 degrees flex to O degrees ext

MCL / LCL / OPL - tightens + prevent further IR
ACL - tightens + prevent further ext

Slightly hyperextended position

ER must occur to “unlock” knee before flex can occur
(ER movement - BF, SM ST)

70
Q

Function of the menisci

A
  1. Shock absorbers
  2. Spread synovial fluid
  3. Obscure role in rotation @ the knee
  4. Slightly deepens the articular surface - ?stability
71
Q

Anatomy of meniscal tears

A

MM torn much more commonly (x2) because of its attachment to MCL + therefore is less mobile

LM is attached to popliteus + meniscofemoral lig so can be pulled out of the way when there is a rotational force @ the knee

72
Q

Meniscofemoral lig

A

Arises from the posterior horn of LM + attaches to the lateral aspect of medial femoral condyle

Splits into ant / post divisions around the PCL

73
Q

Order of structures @ ext retinaculum

A

Timothy Has A Very Nasty Diseased Foot

  1. TA
  2. EHL
  3. Dorsal pedis A
  4. Deep fibular N
  5. Dorsal pedis V
  6. EDL
  7. FT
74
Q

Order of structures @ flex retinaculum

A

Tom Dick And Very Naughty Harry

  1. TP
  2. FDL
  3. Posterior tibial A
  4. Posterior tibial V
  5. Posterior tibial N
  6. FHL
75
Q

Baker’s cyst

A

One way valve defect in the posterior capsule of the hip

Forms due to fluid accumulation in out-pouching between the tendon of SM + the medial head of gastroc

76
Q

ACL / PCL blood supply

A

Middle genicular A

77
Q

Medial + lateral meniscus blood supply

A

75% of the meniscus is avascular =.white zone
25% is vascular = red zone

Med / Lat inferior genicular A w/ small contribution from middle genicular A to posterior horn

78
Q

Deltoid lig

A

Medial collateral lig of the ankle - x2 layers

Main stabiliser w/ stance phase of gait

  1. Deep - narrow extending from tib mal -> medial side of the talus (rectangular)
  2. Superficial - triangular shaped, continuous across several attachments
79
Q

Individual components of the deltoid lig

A
  1. Posterior tibiotalar lig
  2. Tibiocalcaneal lig (sustentaculum tali)
  3. Tibionavicular lig
  4. Anterior tibiotala lig
80
Q

Lateral collateral lig of the ankle

A
  1. ATFL (weakest) - flat
  2. Calcaneofibular - rounded, cord-like
  3. PTFL (Strongest)
81
Q

NV plane of the plantar aspect of the foot

A

Between 1st - 2nd muscular layers

82
Q

Muscular layers of the foot

A
  1. Superficial - FDB, AbH, AbDM

NV plane

  1. Intermediate superficial - FHL, FDL (lumbricals on tendons of FDL), QP
  2. Intermediate deep - FHB, AdH, FDM
  3. Deep - IO muscles + deep tendons of FL + TP

Lower Limb (2 decks)

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