LOWER LIMB Flashcards
MUSCULOSKELETAL SYSTEM
Hip: radiology
MUSCULOSKELETAL SYSTEM
Knee: radiology
MUSCULOSKELETAL SYSTEM
Foot: radiology
MUSCULOSKELETAL SYSTEM
Thigh: anterior compartment
quadriceps + sartorius + pectineus
Femoral Nerve (L2 - L4)
MUSCULOSKELETAL SYSTEM
Thigh: medial compartment
gracilis + adductor longus + adductor brevis + adductor magnus (anterior portion)
Obturator Nerve (L2-L4)
MUSCULOSKELETAL SYSTEM
Thigh: posterior compartment
semitendinosus + semimebranosus + adductor magnus (posterior portion) + biceps femoris (long head)
Tibial Nerve (L4-S3)
MUSCULOSKELETAL SYSTEM
Transverse Section: thigh
MUSCULOSKELETAL SYSTEM
Leg: anterior compartment
Deep Fibular Nerve
(L4-S2)
MUSCULOSKELETAL SYSTEM
Leg: lateral compartment
Superficial Fibular Nerve
(L4-S2)
MUSCULOSKELETAL SYSTEM
Leg: posterior compartment
Tibial Nerve
(L4-S3)
MUSCULOSKELETAL SYSTEM
Hip: muscles
MUSCULOSKELETAL SYSTEM
Foot: dorsal
MUSCULOSKELETAL SYSTEM
Foot: plantar
NERVE SUPPLY
Lumbossacral Plexus
ventral rami of
L2 through S3
NERVE SUPPLY
Terminal Nerves: Lumbossacral Plexus
- Femoral Nerve
- Obturator Nerve
- Tibial Nerve
- Commom Fibular Nerve
- superficial fibular nerve
- deep fibular nerve
Sciatic Nerve = Tibial + Commom Fibular
NERVE SUPPLY
Collateral Nerves: Lumbossacral Plexus
- Superior Gluteal Nerve
- Inferior Gluteal Nerve
- Nerve to Superior Gemellus and Obturator Internus
- Nerve to Inferior Gemellus and Quadratus Femoris
- Lateral Femoral Cutaneous Nerve
- Posterior Femoral Cutaneous Nerve
NERVE SUPPLY
Motor Innervation: Segmental Innervation
- Hip (anterior side) → L2 + L3
- Knee (anterior side) → L3 + L4
- Ankle (anterior side/dorsiflexion) → L4 + L5
- Hip (posterior side) → L4 + L5
- Knee (posterior side) → L5 + S1
- Ankle (posterior side/plantar flexion) → S1 + S2
NERVE SUPPLY
Sensory Innervation: Upper Leg
(8)
- Lateral Femoral Cutaneous Nerve (L2+L3 - posterior divisions)
- Genitofemoral (L1+L2)
- Ilioinguinal (L1)
- Anterior Femoral Cutaneous Nerve (branch from Femoral Nerve L2+L3+L4)
- Posterior Femoral Cutaneous Nerve (S1+S2 posterior divisions + S2+S3 anterior divisions)
- Superior Cluneal Nerve (L1+L2+L3 - posterior divisions)
- Middle Cluneal Nerve (S1+S2+S3 - posterior divisions)
- Iliohypogastric (L1)
- Last Thoracic Nerve (T12)
NERVE SUPPLY
Sensory Innervation: Lower Leg and Foot
- Superficial Fibular Nerve (S1+S2 - posterior divisions)
- Deep Fibular Nerve (L4+L5 - posterior divisions)
- Tibial Nerve (L4 - S3 - anterior divions)
- Lateral Plantar
- Medial Plantar
- Sural Nerve (peroneal + tibial branches)
- Saphenous Nerve (branch of Femoral Nerve)
NERVE SUPPLY
Femoral Nerve
- L2 - L4 → posterior divisions
- Anterior Compartment of Thigh
- Flex Hip + Extend Knee
- Lesion
- weakness (flex hip and extend knee)
- sensory loss (anterior thigh, medial leg and foot)
NERVE SUPPLY
Obturator Nerve
- L2 - L4 → anterior divisions
- Medial Compartment of Thigh
- Adduction + Medial Rotation (thigh)
- Lesion
- weakness of motor function
- sensory loss in medial thigh
NERVE SUPPLY
Tibial Nerve
- L4 - S3 → anterior divisions
- Muscles
- Thigh
- posterior compartment
- flex knee + extend thigh
- Leg
- posterior compartment
- plantar flex foot + inversion
- Foot
- plantar muscles
- flex digits + inversion
- Thigh
- Lesions
- weakness → flexion of the knee, plantar flexion and inversion
- sensory loss → leg (except medial foot) + plantar foot
NERVE SUPPLY
Commom Fibular Nerve
- Common Fibular
- L4 - S2 → posterior divisions
- short head of biceps femoris → flex knee
- lesion → fracture of neck of fibula
- piriformis syndrome
- Deep Fibular Nerve
- lateral compartment of leg
- eversion
- lesion → foot drop + sensory loss (chinelo)
- Superficial Fibular Nerve
- anterior compartment of leg
- extend digits + dorsiflexion + inversion
- lesion → lost of inversion + sensory loss
NERVE SUPPLY
Superior Gluteal Nerve
- L4 - S1 → posterior divisions
- Muscles
- gluteus medius
- gluteus minimus
- tensor fasciae latae
- Stabilize pervis + abduct hip
- Trendelenburg Gait
NERVE SUPPLY
Inferior Gluteal Nerve
- L5 - S2 → posterior divisions
- Gluteus Maximus
- Lateral rotation of thigh + extension of hip
- Lesion → difficulty of rising from a sitting position or climbing stairs
NERVE SUPPLY
Collateral Nerves
VASCULAR SYSTEM
Femoral Artery
VASCULAR SYSTEM
Popliteal Artery
VASCULAR SYSTEM
Schematic View - venous system
VASCULAR SYSTEM
Superficial Veins
VASCULAR SYSTEM
Deep Veins
VASCULAR SYSTEM
Lymphatic Drainage
SPECIAL ANATOMY
Femoral Triangle
- Boundaries
- sartorius
- inguinal ligament
- adductor longus
- Femoral Sheath (lateral → medial)
- femoral nerve (outside)
- femoral artery
- femoral vein
- femoral canal (femoral hernias)
- femoral lymph nodes
“NAVEL”
SPECIAL ANATOMY
HIP
- Joint → head of the femur + acetabulum
- Capsule
- iliofemoral ligament
- ischiofemoral ligament
- pubofemoral ligament
- Vascular supply
- medial femoral circunflex artery → most important
- fracture femoral neck → avascular necrosis (head of the femur)
SPECIAL ANATOMY
Knee
- Stability → muscles
- quadriceps
- hamstring
- Hamstring Muscle
- semitendinosus
- semimembranosus
- long head of biceps femoris
- Pes anserine
- sartorius
- gracilis
- semitendinosus
SPECIAL ANATOMY
Knee: collateral ligaments
- Tibial Collateral
- most frequently torn (lateral trauma)
- prevents lateral displacement
- attached to medial meniscus
- Fibular Collateral
- not attached to meniscus
- prevents medial displacement
SPECIAL ANATOMY
Knee: cruciate ligaments
- Anterior Cruciate (ACL)
- anterior tibia + lateral condyle of the femur
- prevents anterior displacement
- weaker than posterior cruciate
- tension increases with hyperextension
- anterior drawer sign (leg pulled foward)
- Posterior Cruciate (PCL)
- posterior tibia + medial condyle of the femur
- prevents posterior displacement
- tension increases with hyperflexion
- posterior drawer sing (leg pulled posteriorly)
SPECIAL ANATOMY
Knee: menisci
- Medial Meniscus
- c-shaped
- firmly attached to tibial collateral ligament
- less mobile
- more frequently injured
- medial meniscus tear → pain + medially rotated leg at the knee
- Lateral Meniscus
- circular
- more mobile
SPECIAL ANATOMY
Knee: terrible + unhappy triad
tibial collateral ligament
+
ACL
+
medial meniscus
SPECIAL ANATOMY
Ankle
- Lateral (collateral) Ligament
- posterior talofibular
- calcaneofibular
- anterior talofibular → frequently damaged
- prevents inversion → inversion sprains are most commom
- Medial (delthoid) Ligament
- posterior tibiotalar part
- anterior tibiotalar part
- tibionavicular part
- tibiocalcaneal part
