lower limb Flashcards
what is the primary function of the hip joint
weight bear
what joins the pelvic girdle anteriorly and posteriorly
anterior - pubic symphis
posterior - sacroiliac joints
what are most trauma patients assumed to have
pelvic fracture
what are the 2 muscles in the lateral compartment of the leg
fibulas longus and brevis
what forms the floor of the popliteal fossa
knee joint capsule / posterior surface of femur
where is shentons line (fractured neck of femur)
medial edge of the femoral neck and the inferior edge of the superior pubic ramus
what parts of the femur form the know joint
medial and lateral condyles
where does the external iliac become the femoral artery
under inguinal ligament entering removing triangle
mid ASIS and pubic symphis
what are the dynamic soft tissue constraints of the knee
quadriceps, hamstrings, medial and lateral gastrocnemius, popliteus
what muscle does the fibular nerve supply directly
short head of the biceps femoris
superficial - lateral compartment, deep - anterior compartment
what lies between the tibia and the fibula
interosseous membrane
which surface of the ilium provides attachment of the gluteal muscles
external surface
what nerve innervates the quadriceps femoris
femoral nerve
what is the innervation of the flexor digitorum longus
tibial nerve
what is the function of the iliofemoral ligament
prevents hyperextension of hip joint
what does the sacrospinous ligament run between
sacrum to ischial spine
forms greater sciatic foramen
what is the most common vein to have varicose veins
great saphenous
what is the innervation of the piriformis
nerve to piriformis
what are the actions of the sartorius
flex, abduct and rotate hip
flex knee
does the sciatic nerve have a direct sensory function
no - but terminal common fibular and fibular do
how does varicose veins occur
incompetent valves in the deep veins cause blood to flow back into the superficial veins, increasing intra-luminal pressure causing them to become dilated and torturous
what are the deep muscles of the posterior leg
popliteus
tibialis posterior
flexor digitorum longus
flexor hallucis longus
what test is performed to assess the anterior cruciate ligament
anterior drawer test - pull tibia forwards and if it moves the ligament is torn
what is the only muscle of the deep posterior compartment of the leg to act on the knee
popliteus
what muscle does the lumbar plexus sit in
psoas major on posterior abdominal wall
what type of joint is the hip
synovial ball and socket
what makes the hip joint more stable than the shoulder
multi-axial
deeper socket
what are the anterior and posterior margins of the iliac crest
ASIS - anterior superior iliac spine
PSIS - posterior superior iliac spine
what are the 3 different bones of the foot
tarsals
metatarsal - connect phalanges to tarsals
phalanges - toes
what 2 bones articulate in the subtalar joint
calcaneus (superior surface) and
talus (inferior surface)
how will damage to the fibular nerve present
foot drop - lose ability to dorsiflex foot at the ankle joint foot permanently plantar flexed
loss of sensation over dorsal of foot and lateral side of leg
what is the innervation of the semimembranosus
tibial part of sciatic nerve
what are the actions of the popliteus
laterally rotates femur on the tibia - unlocking the knee joint in extension
what are the 3 main groups of deep lymph nodes in the lower leg
anterior tibial, posterior tibial , fibular
what are the actions of the tibialis posterior
inverts and plantar flexes the foot
maintains medial arch of foot
what muscles medially rotate the knee
semimembranous, semitendinous, graciles, sartorius, popliteus
what passes through the obturator foramen
obturator nerve, artery and vein
what spinal roots are tested by the calcanea tendon reflex
S1-2
what are the attachments of flexor hallucis longus
posterior surface of fibula to plantar surface of phalanx of the great toe
what is the function of the posterior cruciate ligament
prevents posterior dislocation of the tibia onto the femur
what hole does the obturator nerve pass through on the lateral wall
obturator foramen
what joint joins the left and right hip bones
pubic symphis
what is the action of the posterior leg muscles
plantar flex and invert the foot
what does the obturator nerve terminate as
pierces fascia lata to become cutaneous branch of obturator nerve
what is the function of the collateral knee ligaments
stabilise hinge motion of knee - preventing excessive medial or lateral movement
what are the main functions of the pelvis
transfer weight from upper axial skeleton to lower
attatchment of muscles and ligaments
protects pelvic viscera
what are the attachments of the rectus femoris
originates from ilium just superior to acetabulum
runs straight down leg
attaches to patella by quadriceps femoris tendon
what is the longest muscle in the body
sartorius
what type of joint is the distal tibio-fibular joint
syndesmosis fibrous joint
what is the innervation of the pectineus
femoral nerve
- may also receive a branch from obturator nerve
what is the superior border of the femoral triangle
inguinal ligament (runs from the anterior superior iliac spine to the pubic tubercle)
what muscle attaches to the lesser trochanter
illiopsoas
where does the long head of the biceps femoris originate
ischial tuberosity of pelvis
which of the tibia and fibula is more lateral
fibula
where is the lateral ligament of the ankle
lateral malleolus - 3 ligs to tibia, talus, calcaneus
what is the primary action of the medial ligament
resist over-eversion of the foot
what is the function of the anterior cruciate ligament
precent anterior dislocation of the tibia onto the femur and hyperextension of the knee
what binds the tibia and fib together
interosseous membrane
what layer of plantar muscles do the tendon os flexor digitorum longus pass through
2nd
what is a strangulated hernia
hernia with a compromised blood supply (compressing on vessel)
what is the appearance of the plantaris
mostly long tendon
what is the common function of the 2 muscles in the lateral compartment of the leg
eversion - turning the sole of the foot outwards
also weakly plantar flex the ankle joint
what may occur if there is damage to the medial circumflex femoral artery
avascular necrosis of the femoral head
what 2 muscles make up the iliopsoas
psoas major
iliacus
what are the attachments of the iliopsoas
psoas major- lumbar vertebrae
iliacus - iliac fossa
to lesser trochanter of femur
what are dynamic factors that maintain the integrity of the foot arches
intrinsic muscles of the foot
long flexor tendons
tendon of tibialis anterior and fibularis longus
what is the largest nerve in the body
sciatic nerve - 2cm wide
which is the largest, most superficial of the gluteal muscles
gluteus maximus
what branch of the femoral artery is given off in the femoral triangle
profunda femoris
which is the most lateral of the hamstrings
biceps femoris (then semitendonous)
what is fascia defined as
sheet or band of fibrous tissue lying deep to the skin that lines, invests and separates structures within the body
what are the attachments of the anterior cruciate ligament
anterior intercondylar region of tibia to intercondylar fossa of femur
where is the dorsalis pedis pulse best felt
dorsal of foot lateral to extensor hallucis longus tendon
what is the innervation of the gluteus minimis
superior gluteal nerve
what nerve innervates all medial thigh muscles
obturator nerve (L2-4)
what are the attachments of the tibialis posterior
interosseous membrane between tibia and fibula (posterior)
posterior to medial malleolus
plantar surface of medial tarsal bones
what are the actions of extensor digitorum longus
extension of the lateral 4 toes
dorsiflexion of the foot
what are the attachments of the piriformis
anterior surface of sacrum
through greater sciatic foramen
greater trochanter of femur
what nerve innervates the lateral compartment of the leg
superficial fibular nerve (L4-S1)
where does the popliteal artery birfucate
lower border of popliteus
what are the 3 parts of the hip bone
ilium
pubis
ischium
what is a patents true leg length measured between
ASIS to medial malleolus
what is the action of the flexor hallucis longus
flexes great toe
what are the actions of the gastrocnemius
plantar flexes at the ankle joint
flex knee
who sustains most neck of femur fractures
elderly population with osteoporotic bones after low energy fall
what are the attachments of the medial (tibial) collateral ligament
medial epicondyle of femur to medial condyle of tibia
what is the major articulation of the knee joint
femoral condyles
tibial platueau - in between the medial and lateral condyles of tibia
what is the innervation of the each part of the adductor magnus
adductor - obturator nerve
hamstring - tibial component of sciatic nerve
what are the actions of the gemelli
lateral rotation and abduction
where do all the superficial muscles of the posterior leg insert
calcaneus of the foot (heel bone) via the calcanea tendon
what 3 things unite on the posterior surface of the knee to form the popliteal vein
anterior tibial vein
posterior tibial vein
fibular vein
how would you test the power of the tibias anterior
ask patient to stand on heel
list the tarsal bones
talus calcaneus navicular cuboid 3 cuneiforms
what are the attachments of extensor digitorum brevis
calcaneus to long extensor tendons of four lateral digits
what movements can happen at the ankle
dorsiflexion, plantar flexion
what arteries supply the gluteal region
superior and inferior gluteal - branches of internal iliac
why does a popliteal artery aneurysm impact the other structures in the fossa
popliteal fascia is tough and non-extensible
e.g. tibial nerve
which bones of the foot articulate with the metatarsals (tarsi-metatarsal joint)
cuboid and 3 cuneiforms
what is the main action of the superficial gluteal muscles
abduct and extend the femur at the hip joint
what is the sensory function of the tibial nerve
via sural nerve - posterolateral leg + lateral side of foot
sole of the foot - medial calcaneal branches, medial and lateral plantar nerve
where do the superficial inguinal nodes receive lymph from
penis, scrotum, perineum, buttock and abdominal wall
what side of the leg is the small saphenous vein
posterior
what is pes planus
flat foot - loss of longitudinal arches
where is the femoral pulse felt
midway between pubic symphis and anterior superior iliac spine (mid inguinal point)
why can pain from the knee be referred to the hip and vice versa
innervated by the sciatic, femoral and obturator nerves
what direction does the sartorius run down the thigh in
inferomedial
what are the attachments of semimembranosus
ischial tuberosity (superior to biceps femoris/ semitendonosus) medial tibial condyle
how do the deep gluteal muscles help to stabilise the hip joint
pull femoral head into acetabulum
what muscle does the sciatic nerve enter the gluteal region directly inferior to
piriformis
what is the point of an adductor canal block with LA
sensory anaesthesia for procedures involving the distal things and femur, knee and lower medial side
what movements are possible at the hip joint
flexion, extension
abduction, adduction
lateral rotation, medial rotation
what is the innervation of extensor hallucis brevis
deep fibular nerve
what is the innervation of the fibularis longus
superficial fibular nerve
where is the adductor canal
thigh, extends from apex of femoral triangle to the adductor hiatus of the adductor magnus (15cm long)
what are the 3 muscles in the 1st layer of plantar foot muscles
abductor hallucis
flexor digitorum brevis
abductor digiti minimi
what does the head of the femur articulate with
acetabulum of pelvis
what is the fascia lata
deep fascial investment of the whole thigh musculature and is analogous to a strong, extensible and elasticated stocking
what are the 4 main pulse points in the lower limb
femoral
popliteal
posterior tibial
dorsalis pedis
what are the actions of tensor fascia lata
flex, abduct and internal rotate the hip
tenses fascia lata
what are the attachments of the posterior cruciate ligament
posterior intercondylar region of tibia to anteromedial femoral condyle
what tissue in the ls a popular choice for transplantation
facia late
well vascularised, high concentration of connective tissue fibres
what muscles in the gluteal region does the sciatic nerve cross
superior gemellus, obturator internus, inferior gemellus, quadratus femoris
(enters posterior thigh bu passing deep to long head of biceps femoris)
which of the ankle ligaments is known as the deltoid ligament
medial
what is a complication if an intracapsular hip joint fracture
avascular necrosis - medial femoral circumflex artery damaged
what foramen doest the sciatic nerve enter the gluteal region through
greater sciatic foramen
what are the most superficial contents of the popliteal fossa
tibial and common fibular nerve (branches of the sciatic nerve)
what can the superficial lymphatic vessels of the legs be divided into
medial - follow great saphenous vein to sub inguinal nodes
lateral - small saphenous to popliteal nodes
what is the innervation of the soleus
tibial nerve
what are the muscles in the posterior aspect of the thigh
hamstrings - biceps femoris, semitendinosus, semimebranous
is the ankle joint more stable in dorsiflexion or plantarflexion
dorsiflexion
malleolar grip stronger as anterior talus held
what is the innervation of the tibias anterior
deep fibular nerve
what is the first major branch of the lumbar plexus
iliohypogastric nerve (L1) - innervates internal obliques and transverses abdominaux
what are the attatchments of gracilis
inferior pubic rami to medial surface of tibia
what is the innervation of the fibularis brevis
superficial fibular nerve
what is the order of the structures behind the medial malleolus from anterior to posterior
tibialis posterior flexor digitorum longus posterior tibial artery posterior tibial vein tibial nerve flexor hallucis longus
what 3 things are involved in the unhappy triad of the knee
medial collateral ligament rupture
medial meniscus tear
ACL tear
what are the contents of the femoral triangle lateral to medial
femoral nerve
femoral artery
femoral vein
NAV Y VAN
what 2 nerves innervate all the muscles in the plantar aspect of the foot
medial plantar or lateral plantar nerve (both branches of tibial nerve)
what covers the head of the femur giving it a smooth surface
articular cartilage
what is the bony projection on the medial distal tibia
medial malleolus
what is the fascial compartment in the femoral triangle
femoral sheath
what are the actions of the piriformis
lateral rotation
abduction
what is the function of the posterior and anterior sacroiliac ligaments
connect spine to pelvis
which ligament creates the greater sciatic foramen
sacrospinous
what is the innervation of extensor digitorum brevis
deep fibular nerve
what are the actions of the pectineus
adduction and flexion at the hip joint
what forms the roof of the popliteal fossa
popliteal fascia and skin
what is the innervation of the superior gemelli
nerve to obturator internus
what does the femoral vein change into at the adductor hiatus
popliteal vein
what are the 4 signs of osteoarthritis of the knee
osteophytes
loss of joint space
subchondral cysts
subchondral sclerosis
which muscles does the obturator nerve innervate (L2-4)
medial compartment of the thigh - adductor longus/ magnus/ brevis, gracilis, obturator externus
what are the actions of the tibialis anterior
dorsiflexion and inversion of the foot
what 4 bursa communicate with the knee
suprapatellar
prepatella
infra patella
semimembranous (posterior)
what connects the greater and less trochanter of the femur anteriorly
intertrochanteric line
what is the only part of the head of femur not covered in articular cartilage
fovea for the ligament of the head of femur
what are the static soft tissue constraints of the knee
collateral ligaments cruciate ligament capsule meniscii ITB
how many phalanges are in each foot
14
3 on each toe and 2 on big toe
what are the superficial muscles in the gluteal region (abductors and extensors)
glut maximus
glut medius
glut minimis
tensor fascia lata
what are the attachments of the obturator externus
membrane of obturator foramen
passes under neck of femur
attaches to greater trochanter
which of the ankle ligaments is weaker
lateral
which muscle divides the gluteal region into superior and inferior
piriformis - through greater sciatic foramen
which surface of the ilium has the iliac fossa
inner surface
concave shave, illiacus muscle
what are the 2 parts of the adductor magnsu muscle
adductor and hamstring
what shape is the gluteus medius
fan shaped
lies between gluteus medium and minimis
what does the inferior ischial ramus combine with to got the ischiopubic ramus
inferior pubic ramus
what are the actions of the anterior compartment of the leg
dorsiflex and invert the foot at the ankle joint
where on the fibula would you find the common fibular nerve
posterior and lateral surface
where is the soleus in relation to the gastrocnemius
deep
what is the main extensor of the knee
quadriceps femoris
what is the obturator artery a branch of
internal iliac artery
what muscles extend the knee
quadriceps femoris
what are the attachments of the plantaris
lateral supracondylar line of the femur
tendon runs down leg between gastrocnemius and soleus to calcaneal tendon
what are the 2 major causes of a swelling in the popliteal fossa
bakers cyst
popliteal artery aneurysm
when does the popliteal vein become the femoral vein
adductor canal
what is the function of the pubofemoral ligament
prevents excessive abduction and extension
what are the roots of the obturator nerve
L2, 3, 4
which is more prominent, the lateral or medial malleolus
lateral
why is the femoral artery suitable for procedures such as coronary angiography
located superficially within the femoral triangle so is easy to access
what nerve innervates the skin of of the gluteal region
iliohypogastric
what is the subtler joint between
talus and calcaneus
where is the pubofemoral ligament
superior pubic rami and intertrochanteric line of femur, reinforcing the capsule anteriorly and inferiorly
what do the quadriceps femurs attach to distally
form patella tendon that attaches to the patella
what are the attachments of the fibularis brevis
inferolateral surface of the fibular shaft - tendon joins with fibular longus into foot
posterior to lateral malleolus to tubercle on metatarsal V
what is the iliotibial tract
longitudinal thickening of the fascia lata - strengthened posteriorly bu fibres from the gluteus maximus
what is the superolateral border of the popliteal fossa
biceps femoris
is the fibula part of the knee joint
no
what muscles does the sciatic foramen innervate
tibial - posterior compartment of thigh, posterior compartment of leg, sole of foot
common fibular - short head of biceps femoris, anterior and lateral compartments of leg and extensor digitorum brevis
what prevents the pelvis from dropping each time a limb is lifted off the ground
contraction of the contralateral abductors
what are features of a tibial nerve compression
weakened or absent plantar flexion
paraesthesia of foot and posterolateral leg
what are the 3 main extra capsular ligaments of the hip joint
iliofemoral (y shape, strongest)
pubofemoral
ischiofemoral
when do the arches of the foot usually develop
at 2-3
babies have flat feet + subcutaneous fat
where does the biceps femoris tendon insert
head of fibula
what muscles adduct the hip joint
adductor longus/ brevis/ magnus
pectineus, gracilis, obturator externus
what part of the calcaneus bone does the achilles tendon attach to
calcanea tuberosity
what is the difference in the innervation of the heads of the biceps femoris
long - tibial part of sciatic nerve
short - common fibular part of sciatic nerve
what is the innervation of the gluteus maximus
inferior gluteal nerve
what is the innervation of the inferior gemelli
nerve to quadratus femoris
what tendon does the common fibular nerve follow
biceps femoris tendon
what is the innervation of the tibialis posterior
tibial nerve
what is the socket made by the tibia and fibula that connects to the talus called
mortise
what is the only bone in the thigh
femur
where do the extrinsic muscles of the foot arise
anterior, lateral and posterior compartments of the leg - mainly responsible for eversion, inversion, plantar flexion and dorsiflexion
which of the ankle ligaments is weaker
lateral
resists inversion so more likely to be damaged
what are the two facets on the posterior surface of the patella and what do they articulate with
medial facet - medial condyle of femur
lateral facet - lateral condyle of femur
where does the sciatic nerve birfucate
apex of popliteal fossa
what is a characteristic sign of damage to the superior gluteal nerve
trendelenburg sign
what ligament attaches to the intertrochanteric line
iliofemoral ligament
what are the attachments of the abductor hallucis
medial tubercle of calcaneus
proximal phalanx of big toe
is the flexor digitorum longus longer then flexor hallucis longus
no
what is the action of the hamstrings
extend hip
flex knee
what increases the range go flexion of the hip joint
knee flexed
relaxed hamstring muscles
what is an anatomical landmark for the common fibular nerve
fibularis longus - small space where the muscle originates from the head and the neck of the fibula
what is the sensory function of the ilioinguinal nerve (L1)
supplies skin on upper middle thigh
males - root of penis, anterior scrotum
females - mons pubis, labia majora
what is the innervation of the flexor hallucis longus
tibial nerve
which is the most common way for the hip to be displaced
posterior
affected limb becomes shortened and medially rotated
what is the action of the talus
transmit forces from the tibia to the calcaneus
what is the dermatome of the little toe
S1
what indentation is there on the posterior side of the ilium
greater sciatic notch
where is the greater trochanter of the femur
most lateral projection of bone
anterior aspect , just lateral to neck
what muscles does the superficial fibular nerve innervate
lateral compartment of the leg - fibularis longus and brevis
what are the actions of the foot lumbricals
flex at metatarsophalangeal joint
extend interphalangeal joint
what muscle does the sacral plexus sit anterior to
piriformis
what vein does the small saphenous vein empty into
popliteal vein - in popliteal fossa
what 2 joints does the gracilis muscle cross
hip and knee
where does the small saphenous vein empty into the popliteal vein
popliteal fossa - pierces popliteal fascia
what is the innervation of the adductor longus, magnus and brevis
obturator nerver L2-4
what is the action of the adductor longus
adduction of the thigh
what is the action of flexor digitorum longus
flexes lateral 4 toes
what is the RICE protocol for treating muscle strain
rest, ice, compression, elevation
what would be seen in damage to the tibial nerve
loss of plantar flexion
loss of toe flexion
weakened inversion - tibialis anterior can still weakly invert
where does the great saphenous vein terminate
drains into femoral vein immediately inferior to inguinal ligament
what are the 3 main articulations of the hip joint
sacroiliac joint - sacrum
pubic symphis -
hip joint - head of femur
what injury sustains a calcaneal tendon rupture
forceful plantar flexion of the foot
what is the bony projection at the distal lateral surface of the fibula
lateral malleolus
what would happen to the knee if you removed a menisci
become arthritic
what are the attatchments of extensor hallucis longus
medial surface of fibular shaft
tendon attaches to base of distal phalanx of the big toe
what is enclosed by the superior and inferior pubic rami
obturator foramen
what is the sensory function of the common fibular portion of the sciatic nerve
skin on anterolateral surface of leg and dorsal aspect of foot
what ligament supports the contents of the femoral triangle during flexion of the hip
inguinal ligament
what is the deepest muscle in the deep compartment of the leg
tibialis posterior
what are the actions of obturator externus
adduction and lateral rotation of thigh
what is the lateral border of the femoral triangle
medial border of sartorius
what forms the roof of the femoral triangle
fascia lata
what nerve innervates the anterior compartment of the thigh
femoral nerve (L2-4)
what is the action of the semitendonous
flex leg at knee joint
extension of thigh at hip
medially rotates thigh at hip joint and leg at knee joint =
what is the innervation of the fibulas tertius
deep fibular nerve
which muscle does the semitendonous cover most of
semimembranous
what are the attachments of the gluteus maximus
gluteal (posterior surface) of ilium. sacrum and coccyx
to iliotibila tract and the gluteal tuberosity of the femur
what are the attachments of extensor hallucis brevis
calcaneus to proximal phalanx of great toe
what are the actions of the extensor hallucis longus
extension of great toe
dorsiflexion of foot
what is the innervation of the sartorius
femoral nerve
what is the innervation of the gluteus medius
superior gluteal nerve
what are the actions of the quadratus plantae
assists flexor digitorum longus in flexing lateral four digits
is the medial or lateral epicondyle of the knee bigger
medial
what part of the hip bone is most inferior/ posterior
ischium
what forms the floor of the femoral triangle
pectinous, iliopsoas and adductor longus muscles
what is the femoral artery a continuation of
external iliac artery
what are the attachments of fibulas tertius
originates with extensor digitorum longus then tenon attaches to metatarsal V
what is the course of the pudendal nerve in the pelvis
leaves through the greater sciatic foramen and re-enters through the lesser sciatic foramen
what is the innervation of the popliteus
tibial nerve
where does each section of the adductor magnus arise
adductor - inferior rami of pubis to linea aspera of femur
hamstring - ischial tuberosity to adductor tubercle of femur
what is a positive trendelenburg sign
patient asked to stand unassisted on each leg - pelvis drops on unsupported leg
(see at level of iliac crests)
what divisions form the sacral plexus
anterior rami of S1,2,3,4
some L4 and L5
what are the attachments of flexor digitorum longus
medial surface of the tibia to plantar surface of lateral 4 digits
what is the only intracapsular ligament of the hip joint
ligament of head of femur - runs form acetabulum to fovea of femur
encloses artery of head of femur
what is the sensory function of the obturator nerve (L2-4)
innervates skin over medial thigh
which muscles plantarflex the ankle joint
posterior compartment of the leg - gastrocnemius, soleus, plantaris, tibialis posterior
what does foot eversion and inversion help walking on
uneven ground
what muscles flex the knee
hamstrings, gracilis, sartorius, poplitues
what are the actions of the gluteus maximus
extensor of thigh
lateral rotation
where can you palpate the tendons of EDL
dorsal surface of foot
where is the lesser trochanter of the femur
posterior, medial side
inferior to neck-shaft junction
what muscles flex the hip joint
iliopsoas rectus femoris sartorius pectineus tensor fascia lata gracilis
what are the attatchments of the soleus muscles
soleal line of the tibia
calcaneal tendon
where are the superficial veins of the leg located
subcutaneous tissue
what part of the pubic bones form the acetabulum
superior pubic ramus
what are the actions of the soleus muscle
plantar flex foot at ankle joint
what structure does the ilioinguinal nerve pass through
superficial inguinal ring
what are the sensory functions of the femoral nerve
anterior cutaneous branch - skin on anterior thingh
saphenous branch - medial side of leg
what is the ankle joint between
talus, tibia and tibia
what is the function of the ischiofemoral ligament
prevents hyperextension and hold femoral head in acetabulum - spiral orientation becomes tighter when joint is extended
what are the root values of the sciatic nerve
L4- S3
what are the 2 major superficial veins of the lower limb
great saphenous
small saphenous
what forms the most distal row of tarsal bones
cuboid and 3 cuneiforms
what nerves innervate the ankle joint
tibial and deep fibular
where does the vastus intermedius originate
anterior and lateral femoral shaft
what are the 5 muscles in the medial compartment of the leg
gracilis obturator externes adductor brevis adductor longus adductor magnus
what type of joint is the ankle
synovial hinge
what are the nerve roots of the pudendal nerve
S2, 3, 4
what is the motor function of the genitofemoral nerve (L1-2)
cremasteric muscle (genital branch)
what are the attachments of the gemelli
superior - ischial spine
inferior - ischial tuberosity
both attach to greater trochanter
what is the sensory function of the pudendal nerve
penis and clitoris and most of the skin of the perineum
what bones form the ankle joint
tibia, fibula, talus
where does the small saphenous vein terminate
drains into popliteal vein in popliteal fossa
how does the popliteal vein enter the thigh
adductor canal
what type of joint is the proximal tibio-fibular joint
synovial plane
what are the attachments of the lateral (fibular) collateral ligament
lateral epicondyle of femur to lateral condyle of tibia
what is the mid point of the inguinal ligament
halfway between ASIS and pubic tubercle
what is the popliteal fossa
fat filled diamond shape found on posterior side of the knee
main path that structure move from thigh to leg
what is the innervation of the plantaris
tibial nerve
what is the most anterior part of the hip bone
pubic bone
when does the femoral vein become the external iliac vein
under inguinal ligament
what are passive factors that maintain the integrity of the foot arches
shape of united bones plantar aponeurosis long plantar ligament short plantar ligament spring ligament - calconeonavicular
what is in the femoral canal
deep lymph nodes and lymphatic vessel
what separates the 3 parts of the hip bones before puberty (15-17)
triradiate cartilage
which foramen does the piriformis travel through
greater sciatic foramen
what are the attachments of the popliteus
posterior surface of proximal tibia
lateral condyle of femur/ lateral meniscus
what 2 extrinsic muscles of the foot are on the dorsal surface
extensor digitorum brevis
extensor hallucis brevis
where is flexor digitorum brevis in relation to abductor hallucis and abductor digit minimi
middle
what are the motor functions of the pudendal nerve
skelteal muscles in perineum
external urethras sphincter
external anal sphincter
levator ani
what separates the lateral meniscus from the posterior cruciate ligament
tendon of popliteus
what is the main action of the deep gluteal muscles
laterally rotate
what are the contents of the adductor canal
femoral artery
fermoral vein
nerve to vastus medialis
the saphenous nerve (cutaneous branch of femoral nerve)
what type of bone is the patella bone
sesamoid bone - position within the quadricep tendon
what are the actions of actions extensor digitorum brevis
aids extensor digitorum longus in extending lateral 4 toes
what part of the tibia articulates to the fibula proximally
lateral condyle
what are the sensory functions of the genitofemoral nerve (L1-2)
genital branch - skin of anterior scrotum in males, skin over mons pubis and labia majora in females
femoral branch - skin on the upper anterior thigh
what nerve innervates the anterior compartment of the leg
deep fibular nerve (l4-5)
what are the motor functions of the femoral nerve
anterior thigh muscles
hip flexors - illaicus, pectineus, sartorius
knee extensors - quadriceps femoris
what is the deepest muscle in the anterior compartment of the leg
extensor hallucis longus
what symptoms would be seen in obturator nerve damage
weka adduction of the thigh
paraesthesia on the medial aspect of the thigh
what is the popliteal fascia continuous with
fascia lata of the leg
what are the 4 muscles in the anterior compartment of the leg
tibialis naterior
extensor digitorum longus
extensor hallucis longus
fibularis tertius
what artery is the dorsalis pedis artery a continuation of
anterior tibial
what muscle produces inversion of the foot at the subtalar joint
tibialis anterior
what is a Potts fracture
bimalleolar +/- distal tibia fracture
how can the sartorius flex both the knee and the hip
spiral around thigh from anterior hip to posterior knee
where is the tibial tuberosity
anterior surface of proximal tibia inferior to condyles
what is the largest muscle in the medial compartment
adductor magnus
posterior to others
what occurs in DDH and what are the clinical features
acetabulum too shallow
- limited abduction
- leg length discrepancy (affected shorter)
- asymmetrical gluteal or thigh skin folds
which bone forms the ischial tuberosities (sit on)
ischium
what are the attatchments of the adductor longus
pubis to linea aspera of the femur
what type of joint is the knee joint
synovial hinge (modified/ bicondylar)
where does the vastus medialis originate
intertrochanteric line and medial lip of linea aspera
what vein drains into the femoral vein within the femoral triangle
great saphenous vein
where does the head of femur articulate to form the hip joint
acetabulum
what side of the leg iso the great saphenous vein
medial
what are the 4 signs of osteoarthritis on xray
osteophytes
loss of joint space
subchondral cysts
subchondral sclerosis
what is the innervation of the tensor fascia lata
superior fascia lata
where is the anaesthetic injected in an obturator nerve block
inferior to pubic tubercle and lateral to the tendon of the adductor longus muscle
(used in pain for lower limb surgery to chronic hip pain)
what are the 6 major nerves of the lumbar plexus
obturator nerve (L2-4) femoral nerve (L2-4) iliohypogastric nerve (L1) ilioinguinal nerve (L1) genitofemoral nerve (L1-2) lateral cutaneous nerve of the thigh (L2,3)
what does antalgic gait result from
pain on weight bearing
what is the main extensor of the hip joint
gluteus maximus
what is adductor canal compression syndrome
entrapment of the neuromuscular bundle within the adductor canal
hypertrophy of adjacent muscles such as vests medialis
claudication (artery) or neurological (saphenous)
what divisions make up the lumbar plexus
anterior rami of L1,2,3,4
some T12
what may cause a talus neck fracture
excessive dorsiflexion of foot
what depend the acetabulum
acetabulum labrum - fibrocartilaginous collar
what are the attachments of the fibularis longus
superior/ lateral surface of the fibula and the lateral tibial condyle
tendon descends into the foot posterior to lateral malleolus
attaches to medial cuneiform and metatarsal I
where does the ligamentum teres attach
fovea of head of femur
what muscles does the tibial nerve innervate
posterior compartment of leg
superficial - plantaris, soleus, gastrocnemius
deep - popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus
what are the actions of the gluteus minimis
abducts and medially rotates the lower limb
secures pelvis during locomotion
which is the most superficial muscle of the posterior leg
gastrocnemius
what are the attachments of the obturator internus
pubic + ischium at obturator foramen
travel through lesser sciatic foramen
attaches to greater trochanter of femur
what is the mid- inguinal point
halfway between ASIS and centre of pubic symphis (femoral artery palpated)
what is the sensory function of the posterior femoral cutaneous nerve (S1-3)
skin on posterior surface of thigh and leg
skin of perineum
what is the main extensor of the thigh
gluteus maximus
where does the lateral cutaneous nerve of the thigh innervate
anterior and lateral thigh down to the knee
how is the limb positioned in a neck of femur fracture
shortened and externally rotated lower limb
what is the innervation of the extensor digitorum longus
deep fibular nerve
which muscles dorsiflex the ankle
anterior compartment of leg - tibialis anterior, extensor hallucis longus, extensor digitorum longus
what is the action of the fibularis longus
eversion and platarflexion of the foot
also supports lateral and transverse arches of the foot
what are the 4 muscles of the quadriceps
vastus lateralis
vastus intermedius
vastus medialis
rectus femoris
what angle is the neck of femur to the shaft and why
135 - increased range of movement
what are the nerve roots of the sciatic nerve
L4, 5, S1, S2, S3
what are actions of the biceps femoris
mainly flex knee
also extends thigh at the hip and laterally rotates the hip and knee
what nerve innervates the gastrocnemius
tibial nerve
what is different about the main actions of the fibula and tibia
fibula doest weight bear
what are the actions of the gracilis muscle
adduction of thigh at hip
flexion of leg at knee
whst nerve is compressed in tarsal tunnel syndrome
tibial nerve
deep to flexor retinacula
what is the main arterial supply to the hip joint
medial and lateral circumflex - branches of profunda femoris
what ridge of bone marks the posterior shaft of tibia
soleal line
what are the attachments of the semitendonous muscle
ischial tuberosity to medial surface of the tibia
what are the superficial muscles of the posterior leg
gastrocnemius
plantaris
soleus
what connects the greater and less trochanter of the femur posteriorly
throchanteric crest
what are the three compartments of the thigh
anterior
medial
lateral
what are the actions of flexor digitorum brevis
flex lateral 4 digits at proximal interphalangeal joints
what is attached on the plantar surface of the navicular
tibialis posterior tendon
what is the action of the fibularis brevis
eversion of the foot
what muscles laterally rotate the hip (external)
biceps femoris, gluteus maximus, piriformis
what side of the foot is abductor digiti minimi
lateral
what is the action of the anterior compartment of the thigh
extended leg at knee joint
what ligament is the medial meniscus attatched to
medial collateral ligament (tibial) - tear together
where is the medial ligament of the ankle
medial malleolus - 4 different ligaments to the talus, calcaneus and navicular
what are the attachments of extensor digitorum longus
lateral condyle of tibia/ medial surface of fibula
tendon travels to dorsal foot and splints into 4 - each toe
what is the innervation of the quadratus plantae
lateral plantar nerve
which foramen does the obturator internus travel through
lesser sciatic foramen
what is a bursa
synovial fluid filled sac, found between moving structures in a joint with the aim of reducing wear and tear
what is the dermatome of the medial knee
L3
what are the attachments of the pectinous
pectineal line on the anterior surface of pelvis to pectineal line on the posterior side of the femur, inferior to lesser trochanter
where is the iliofemoral ligament
anterior inferior iliac spine - bifurcates and inserts into intertrochanteric line of femur
what is the posterior border of the adductor canal
adductor longus and adductor magnus
what are the attachments of the foot lumbricals
originate from tendons of flexor digitorum longus
extensor hoods of the lateral 4 digits
which part of the pubic bones project towards the ischium
inferior pubic ramus
where do the deep and superficial fibular nerves supply sensory innervation
superficial - skin of anterolateral leg and dorsal of foot
deep - skin between 1st and 2nd toes
what is there terminal cutaneous branch of the femoral nerve
saphenous nerve - medial side of lower leg
what is the deepest of the superficial gluteal muscles
gluteus minimis
what are the attachments of tibias anterior
lateral surface of tibia to the medial cuneiform and he base of metatarsal 1
where does the fascia lata run between
iliac crest and inguinal ligament
to bony prominence of tibia - continues to become the deep fascia of the leg (crural fascia)
what 2 muscles does the tibialis posterior lie between
flexor digitorum longus
flexor hallucis longus
where are the inguinal lymph nodes found
upper aspect of femoral triangle
which ligament creates the lesser sciatic foramen
sacrotuberous
what are the attachments of the gastrocnemius
lateral head - lateral femoral condyle
medial head - medial femoral condyle
combines with soleus to form calcaneal tendon
what is the superomedial border of the popliteal fossa
semimembranous
where does the short head of the biceps femoris originate
linea aspera on posterior surface of femur
where does the popliteal bursa lie
between popliteal tendon and posterior surface of knee joint
what attaches to the intercondylar fossa of the femur
anterior cruciate ligament - lateral condyle
posterior cruciate ligament - medial epicondyle
what 2 arteries supply the foot
posterior tibial
dorsalis pedis
what nerve innervates the posterior leg
tibial nerve
what deep vein is formed from the dorsal side of the foot
anterior tibial
what type of joint is the subtalar joint
synovial plane
what are the attatchments of the gluteus medius
gluteal surface of the ileum
lateral surface of the greater trochanter
what are the sensory functions of the tibial portion of the sciatic nerve
skin on posterolateral and medial surface, sole of foot
what is the anterior border of the adductor canal
sartorius
what are the 2 main functions of the patella
leg extension - enhances the leverage of quadriceps tendon
protection - from trauma
what muscle is the adductor hiatus in
adductor magnum
what is pec cavus
unusual high medial longitudinal arch
less ability to absorb shock when walking leads to increased stress on ball and heel of foot
what is the innervation of the gracilis muscles
obturator nerve (L2-4)
what is the heel bone of the ankle
calcaneus
what are the attachments of the adductor brevis
body of pubis to linea aspera on posterior femur
what are the attachments of flexor digitorum brevis
medial tubercle of calcaneus to middle phalanges of lateral 4 digits
what bone does the fibular nerve wrap around
neck of fibula
what is the dural nerve a branch of
common fibular and tibial nerve
what is a patellar dislocation
patella displaced out of patella femoral groove - most laterally
where does the tensor fascia lata run between
anterior iliac crest (ASIS)
anterior aspect of iliotibial tract
what is the actions of the vastus muscles
extends knee joint
stabilise patella
what are the attachments of the quadratus plantar muscle
medial and lateral surface of calcaneus to tendons of flexor digitorum longus
what part of the knee attaches to the medial and lateral epicondyles
medial and lateral collateral ligaments
what are the roots of the femoral nerve
L2,3,4
where is the iliotibial tract
lateral thigh , extending form the iliac tubercle to the lateral tibial condyle
what is the widest, most superior part of the hip bone
ilium
what are the 2 heads of the gastrocnemius
medial and lateral - converge to form a single belly
where does the sural nerve innervate
posterolateral leg + lateral side of foot
where is the ovoid hiatus
fascia lata just inferior to inguinal ligament (saphenous opening)
entry point of the great saphenous vein
where is the ischiofemoral ligament
body of ischium and greater trochanter of the femur
what 2 bursa are associated with the calcaneal tendon
subcutaneous calcaneal bursa - between skin and calcaneal tendon
deep bursa of the calcaneal tendon -between the tendon and the calcaneus
where are the superficial veins of the leg formed
dorsal venous arch of foot
what is the action of the plantaris
plantar flex ankle joint
flexes knee
what innervates the obturator internus
nerve to obturator internus
what are the functions of the menisci
deepen articular surface to increase stability
shock absorbers
which bursa is inflamed in housemaids knee
prepatellar bursa
what muscles produce eversion of the foot
lateral compartment of the leg - fibularis longus and brevis
where does the gluteus maximus attach to the femur
gluteal tuberosity of the shaft
what shape are menisci
C shaped
what are the actions of the semimembranosus
flexion of leg at knee joint
extension of thigh at hip
medially rotate thigh and leg at knee joint
what are the 2 proximal tarsal bones
talus and calcaneus
what is the main conduit for neuromuscular structures entering and leaving the leg
popliteal fossa
what is the medial border of the femoral triangle
medial border of adducts longus (rest is floor)
what bones form the arches of the foot
tarsal and metatarsal bones - supported by ligaments and tendons in foot
where are the deep veins of the leg located
deep fascia - accompanying major arteries
what is a hernia
a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it
what muscles does the deep fibular nerve innervate
anterior compartment of the leg - tibialis anterior, extensor digitorum longus, extensor hallucis longus
what part of the pubic bones articulate at the pubic symphis
pubic body
where does the extensor digitorum lie in relation to tibias anterior
lateral and deep
what is the deepest structure in the popliteal fossa
popliteal artery
what are the 3 joints of the tibia
proximal tibiofibular
distal tibiofibular
ankle
what muscles attach to the greater trochanter of the femur
gluteus medius
gluteus minimis
piriformis
vastus lateralis
what is the innervation of the iliopsoas
iliacus - femoral nerve
psoas major - L1-3
which of the quadriceps femoris can flex the hip
rectus femoris
what is pathopneumonic on xray of an ACL tear
second fracture - small tear at top of fibula
what are the muscles in the medial compartment of the thigh known as
hip adductors
what is the superior aspect of the patella attached to
quadriceps tendon
in the standing position, what do the gluteus medius and minimis do when the contralateral leg is raised
contract - prevent pelvis dropping on that side
what does the femoral artery change into at the adductor hiatus
popliteal artery
what things combine to form the lumosacral trunk
L4-5
S1-4
what nerve innervates the hamstrings
sciatic nerve (L4- S3)
what is the innervation of the extensor hallucinations longus
deep fibular nerve
what movements are available at the knee
flexion
extension
medial/lateral rotation
what are the attatchments of the gluteus minimis
ilium to
anterior grater trochanter of femur
what forms the articulations of the knee joint
posterior patella
lateral and medial condyles of femur
lateral and medial condyles of tibia
what is the patellar ligament
continuation of the quadriceps femoris tendon distal to the patella
attaches ot eh tibial tuberosity
what are the main contents of the popliteal fossa (medial to lateral)
popliteal artery popliteal vein tibial nerve common fibular nerve fat popliteal lymph nodes and lymphatic vessels
which of the articulations in the knee is weight bearing
tibia-femoral - condyles of tibia and femur
what does the patellar ligament run between
apex of patella, tibial tuberosity
what are the deep muscles in the gluteal region (lateral rotators)
quadratus femoris
piriformis
gemellus superior and inferior
obturator internus
what is the name of the joint between the sacrum and the coccyx
sacrococcygeal symphis
what is the artery to the head of femur a branch of
obturator
where is the fascia lata thickest
superolateral aspect of the thigh
what are the main functions of the iliotibial tract
movement - extensor, abductor and lateral rotation of hip
compartmentalisation
sheath for the tensor fascia lata muscle
when can medial and lateral rotation of the knee occur
when the knee is flexed
if not it occurs at the hip joint
what is the actions fo the iliopsoas
flex lower limb at hip joint
lateral rotation
what muscles extend the hip joint
gluteus maximus
hamstrings - semimembranous, semitendinous, biceps femoris
posterior adductor magnus
what are the 2 muscles in the 2nd layer of plantar foot muscles
quadratus plantae
lumbricals
what is the inferior aspect of the patella attached to
patellar ligament
what is the lateral border of the adductor canal
vastus medialis
what is a deep vein thrombosis
formation of a blood clot within the deep veins of the lower limbs causing blockage of the vessel
causes pain, swelling and tenderness of affected limb
what are the nerve roots of the obturator nerve
L2,3,4
what part of the tibia articulates to the fibula distally
fibular notch
what tunnel does the femoral artery travel down the anterior thigh in
adductor canal
what deep veins form on the plantar aspect of the foot
posterior tibial
fibular
what things articulate in the hip joint
pelvic acetabulum
head of femur
what separates he superior and inferior gemelli
obturator interns tendon
what veins drain the gluteal region
superior and inferior gluteal - drain into internal iliac
how many arches are there in the foot
2 longitudinal (medial and lateral) one anterior transverse
what are the actions of the abductor digit minimi
abduct and flex 5th digit
what is the name of the depression in between the 2 condyles of the femurs
intercondylar fossa
what is the inferomedial border of the popliteal fossa
medial head of gastrocnemius
how many dorsal and plantar interossei are there in the foot
3 plantar (unipennate) 4 dorsal ( bipennate)
what is the inferolateral border of the popliteal fossa
lateral head of gastrocnemius
what is the chief flexor of the thigh
iliopsoas
what are the main branches of the sacral plexus
sciatic nerve
pudendal nerve
what nerve innervates the quadriceps femoris
femoral nerve
where does the vests laterals originate
greater trochanter and lateral lip of line aspera
what is the action of the adductor magnus
adduct thigh
adductor component - flex thigh
hamstring component - extend thigh
what 2 bones articulate in the subtler joint
calcaneus and talus
why are IM injections given in the upper lateral quadrant of the gluteal region
avoid damage to the sciatic nerve in the lower medial quadrant
how many lumbricals are in each foot
4
what is the blood supply to the knee
genicular anastomoses from genicular branches of femoral and popliteal arteries
what muscles medially rotate the hip (internal)
glut medius, glut minimus, tensor fascia lata
what are the muscles in the anterior compartment of the thigh
pectineus
sartorius
quadriceps femoris (x4)
(iliopsoas passes through)
which muscle of the quadriceps crosses both the hip and knee joint
rectus femoris
where is the femoral triangle
anterior thigh, below inguinal ligament
what are the nerve roots of the femoral nerve
L2-4
what are the nerve roots of the tibial and common fibular nerves
tibial - L4-S3
common fibular - L4- S2
what are the actions of the gluteus medius
abducts and medially rotate the lower limb
secures pelvis during locomotion
where is the fascia lata thinnest
where it covers the adductor muscles of the medial thigh
what does the common fibular nerve birfucate into
deep and superficial fibular nerve
what nerves supply the knee (hiltons law)
femoral, tibial, common fibular
what things aid the stability of the hip joint
deep acetabulum / acetabular labrum
iliofemoral/ pubofemoral/ ischiofemroal ligaments are very strong
what are the terminal branches of the popliteal artery
anterior tibial
posterior tibial
fibular
what muscles abduct the hip joint
gluteus medius, glut minimis, tensor fascia lata, piriformis
what bursa is inflamed in a bakers cyst
semimembranous bursa
does the gastrocnemius have an action on the knee
flex
what does the sacrotuberous ligament run between
sacrum to ischial tuberosity
forms lesser sciatic foramen
what bones are contained in the pelvic girdle
sacrum
left and right hip bones
what line divides the superficial and sub-inguinal nodes
horizontal at level of termination of great saphenous vein
what are the attatchments of the sartorius
anterior superior iliac spine
to superior, medial surface of the tibia
how do talus body fractures occur
jumping from a height
does the gluteus maximus act in normal posture
no - only used when force is required such as running or climbing
what muscles laterally rotate the knee
biceps femoris
what is the strongest dorsiflexor of the foot
tibialis anterior
what are the 5 major nerves of the sacral plexus
superior gluteal nerve (L4- S1) inferferior gluteal nerve (L5- S2) sciatic nerve (L4-S3) posterior cutaneous nerve of thigh (S1-3) pudendal nerve (S2-4) (some irish sailor pestors poll)
is fibularis longus larger or smaller than fibularis brevis
larger
what muscle unlocks the knee joint in extension
popliteus
