Lower limb Flashcards
What are the functions of the lower limb?
Support the body, locomotion, maintain balance
what are the six regions of the lower limb?
Gluteal, femoral, knee, leg, ankle, foot
The acetabulo-femoral joint is which type of joint?
ball and socket
What are the movements of a ball and socket joint?
flexion-extension, abduction-adduction, medial-lateral rotation and circumduction
The synovial joint of the acetabulo-femoral joint is…
within strong joint capsules, external fibrous layer (spiral ligaments) and internal membranous layer
What are the two types of ligaments found in the acetabulo-femoral joint?
intracapsular and extracapsular
what are are the intracapsular ligaments?
ligament of head of femur - ligamentum teres of the femur/ round ligament of the femur
what does the round ligament of the femur contain?
the obturator artery - minor source of arterial supply to the hip joint
What are the extracapsular ligaments?
Iliofemoral ligament, pubofemoral, ischiofemoral
What is the primary blood supply to the head of the femur?
the medial circumflex artery
What are the two branches of the deep artery of the thigh/ profunda femoris artery?
the medial and the lateral circumflex femoral arteries
damage to the medial circumflex femoral artery can result in what condition?
avascular necrosis of the femoral head
What arteries are damaged in a femoral neck fracture?
intracapsular retinacular arteries
Why is the medial circumflex femoral artery responsible for majority of the arterial supply?
because the lateral circumflex femoral artery has to penetrate through the thick iliofemoral ligament
what arteries provide additional blood supply to the hip joint?
the artery to head of femur and the superior/inferior gluteal arteries
The knee complex is which type of joint?
modified synovial hinge joint
what is the movement of the synovial hinge joint?
main movement is flexion and extension but there is some slight rotation
what are the three articulations of the knee complex?
medial and lateral tibiofemoral articulation and the patellofemoral articulation
where is the additional joint in the knee complex?
near the proximal tibiofibular joint
what is the weight bearing joint of the knee?
tibiofemoral joint
what are the three types of ligaments found in the knee joint?
extracapsular, intra-articular, menisci
what are the extracapsular ligaments of the knee joint?
patellar ligament, lateral(fibular)collateral ligament, medial (tibial) collateral ligament
what are the intra-articular ligaments within the joint capsule of the knee?
anterior cruciate and the posterior cruciate
what are the menisci (medial and lateral) ligaments of the knee joint?
crescent shaped fibrocartilage
what determines joint integrity of the knee joint?
the anterior and posterior drawer signs
what happens to the Q angle in genu varum?
it decreases
what happens to the Q angle in genu valgum?
it increases
how do nerves enter/exit the pelvis and the perineum?
via the greater and lesser sciatic foramen
the passageway for structures into the gluteal region and perineum is via the?
greater sciatic and lesser sciatic foramen respectively
the greater and lesser sciatic foramen are formed by which ligaments?
the sacotuberous and sacrospinous ligaments
the gluteal region is divided into how many parts for injections?
4 parts?
which part has more muscle in the gluteal region for injections?
the upper two quarters
what are the 3 main nerves that enter or exit the pelvis via the gluteal region?
sciatic, pudendal and posterior cutaneous nerve of thigh
at which level is the sciatic nerve found?
L4 to S3
at which level is the pudendal nerve found?
S2-S4
at which level is the posterior cutaneous nerve of the thigh found?
S1-S3
what is the largest nerve in the body?
the sciatic nerve
what areas of the body does that sciatic nerve supply?
posterior thigh, all leg and foot muscles and most of the skin via the tibial and common fibular branches
what is the principle nerve to the perineum?
the pudendal
what areas of the body does the posterior cutaneous nerve of the thigh supply?
skin over posterior thigh, popliteal fossa, lateral perineum and upper medial thigh
what are the two types of muscle groups found in the gluteal region?
the superficial muscle group and the deep muscle group
what are the functions of the superficial muscle group?
they are the extensors, the abductors and medial rotators of the thigh
what are the 4 muscles of the superficial muscle group of the gluteal region?
gluteus maximus and gluteus medius and the gluteus minimus and the tensor fascia latae
what nerves supply the superficial muscle group?
inferior gluteal supplies gluteus maximus and superior gluteal supplies all others
what are the 4 muscles of the deep muscle group?
piriformis, obturator internus, Gemelli (superior and inferior) and quadratus femoris
what are the functions of the deep muscle group?
lateral rotators of the thigh and hip stabilisers
what nerve innervates the deep muscle group?
the sacral plexus
What is the trendelenberg gait?
when there is reduced function of superior gluteal nerve the hip will drop on the contralateral side due to weak hip abduction by the gluteus medius causing a distinct gait
where does the sciatic nerve exit?
inferior to piriformis, most lateral usually exiting the greater sciatic foramen
what is the arterial supply of the sciatic nerve
artery to the sciatic nerve
what area does the sciatic nerve not supply?
the gluteal region, it just passes down into the posterior thigh
what are the two portions of the sciatic nerve and describe them?
the tibial nerve, larger and medial and the common fibular - smaller and lateral
how many compartments is the thigh divided into?
3 - anterior, medial and posterior
how many compartments is the leg divided into?
3 - anterior, posterior and lateral compartments
muscles within each compartment generally have?
similar actions and same nerve supply
what is compartment syndrome?
fascia creates enclosed space, when there is increased pressure caused by swelling of tissue or increase in fluid (bleeding) it affects functions of the muscles or nerves in the compartment which can be acute or chronic
how do you treat compartment syndrome?
fasciotomy - to relieve pressure in emergency
in the anterior compartment of the thigh what are the flexors?
pectineus, iliopsoas, sartorius, rectur femoris
in the anterior compartment of the thigh what are the extensors?
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
what nerve supplies the anterior compartment of the thigh?
femoral nerve (L2, L3, L4) except psoas major - (L1-L3)
what are the boundaries of the femoral triangle and what makes them?
superior - inguinal ligament medially - lateral border of the adductor longus laterally - medial border of sartorius floor - iliopsoas and pectineus roof - deep fascia (fascia lata)
what are the contents fo the femoral triangle lateral to medial?
femoral Nerve, femoral Artery, femoral Vein and lYmphatics (NAVY)
what are the adductors of the medial compartment of the thigh?
adductor longus, adductor brevis, adductor magnus, gracilis and obturator externus
what nerve supplies the medial compartment of the thigh?
L2 - L4 - obturator nerve except the hamstring part of the adductor magnus which is innervated by the tibial nerve
what are the extensors of the posterior compartment of the thigh and flexors of the leg?
semitendinous, semimembranosus and biceps femoris
what is the nerve supple of the posterior compartment of the thigh?
all tibial division of the sciatic nerve (L5,S1,S2) short head biceps femoris (common fibular division of the sciatic)
what are the superficial muscles of the posterior compartment of the leg?
gastocnemius, soleus and plantaris
what are the deep muscles of the posterior compartment of the leg?
popliteus, flexor hallucis longus, flexor digitorum longus and tibialis posterior
what innervates all tje muscles of the psoterior compartment of the leg?
the tibial nerve
the superficial group of muscles in the posterior compartment of the leg are?
plantarflexors of the ankle
the deep group of muscles in the posterior compartment of the leg are?
flexors of the toes and plantar flexors of the ankle
the anterior compartment of the leg muscles are?
dorsiflexors fo ankle and extensors of toes
the muscles of the anterior compartment of the leg are?
tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius
what nerve innervates the anterior compartment of the leg?
the deep fibular nerve - L4,L5
what are the lateral compartment of leg muscles?
evert the foot and weakly plantar flex the ankle
what are the muscles of the lateral compartment of the leg?
fibularis longus, fibularis brevis
what nerve innervates the lateral compartment of the leg?
the superficial fibular nerve
what is deep fibular nerve palsy?
loss of muscle action in anterior compartment of the leg and reduced or absent dorsiflexion
what are the boundaries of the popliteal fossa?
superolaterally - biceps femoris
superomedially - semimembranosus
inferiorly - gastrocnemius
roof - popliteal fascia
what are the contents of the popliteal fossa?
lots of fat, terminal small saphenous vein, popliteal vessles, tibial and common fibular nerves
features of the calcaneal tendon?
achilles tendon, thickest and strongest in the body, 15cm long, tendons of gastrocneius and soleus together, attaches to calaneal tuberosity of the calcaneus
what is the ankle jerk reflex?
normal result in plantarflexion, tests S1,S2 nerve roots
what is the course of the superficial lymphatics of the lower limb?
follows the saphenous veins, drain to superficial inguinal lymoh nodes and then into the external iliac lymph nodes
what is the course of the deep lymphatics of the lower limb?
follow deep veins, (popliteal lymph nodes), deep inguinal lymph nodes and external iliac lymph nodes
from external to common iliac through which lymphatics?
lumbar lymphatics