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GSSE Anatomy > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

What are the borders of the femoral triangle? What muscles form the floor?

A

Inferior border of inguinal ligament
Medial border of sartorius
Medial border of adductor longus

  • iliacus
  • psoas major
  • pectineus
  • adductor brevis
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2
Q

What are the 4 superficial branches of the femoral artery that come off in the thigh?

A

superficial external pudendal artery
deep external pudendal artery
superficial circumflex iliac artery
superficial epigastric artery

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3
Q

What is the surface anatomical landmark for the femoral artery?

Where does the femoral sheath end distally?

A

Midway between pubic tubercle and ASIS

The sheath ends 1 inch below the inguinal ligament

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4
Q

What are the tarsal bones? (7)

A 
Talus
Calcaneus
Navicular
Cuboid
Medial, intermediate and lateral cuneiform
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5
Q

What are the key support structure of the foot arches?

A 
MEDIAL LONGITUDINAL
Bony: none
Ligamentous:
- plantar aponeurosuis
- spring ligament 
Muscular:
"pull of FHL is most important single factor in maintaining medial longitudinal arch of the foot" p. 249
- aBductor hallucis
- medial FDB
- tib ant

LATERAL LONGITUDINAL
Bony: none
Ligamentous: 
- plantar aponeurosis
- short plantar ligament
- long plantar ligament
Muscular
- fibularis longus 
- FDL

TRANSVERSE
Bony: intermediate and lateral cuneiforms
Ligamentous:
- deep transverse ligament alongmetatarsal heads
- plantar aponeurosis
Muscular:
- fibularis longus

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6
Q

What is the windlass mechanism?

A

Extension of the toes pulls the calcaneus towards the heads of metatarsals and heightens the plantar arch, giving more stability.

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7
Q

Where does inversion and eversion of the foot take place?

What are the predominant muscles responsible and the relevant myotomes?

A

Subtalar joint (talocalcaneal joint)

EVERT: lateral compartment (L5-S1)

INVERT: tib ant, tib post (L4)

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8
Q

Which is the most commonly sprained ligament of the ankle? What movements does it limit?

A

Anterior talofibular ligament

Inversion during plantar flexion

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9
Q

What are the definitions of Supination and Pronation of the foot.

A

Plantarflexion, adduction and inversion

Eversion, dorsiflexion and abduction.

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10
Q

What are the anterior compartment muscles of the leg (not thigh)?
What nerve innervates these structures?

A 
Medial to lateral
- Tibialis anterior
- Extensor hallucis longus
- EDL 
- peroneus tertius
All innervated by deep peroneal nerve
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11
Q

What are the muscles of the lateral compartment of the leg?

What nerve innervates these structures?

A
  • Peroneus longus
  • Peroneus brevis

Superficial peroneal nerve

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12
Q

What are the muscles of the posterior compartment of the leg?
What nerve innervates these structures?

A 
SUPERFICIAL
- gastrocnemius
- soleus
- plantaris lil bish
DEEP
- popliteus
- tibialis posteiror
- flexor digitorum longus
- flexor hallucis longus
(tom dick and harry anterior to posterior at ankle)
Innervated by the tibial nerve.
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13
Q

The order of structures that pass through the tarsal tunnel, from anterior to posterior

A

Tom, Dick And Very, Nervous Harry

Tibialis posterior flexor
Digitorum longus
Artery (posterior tibial)
Vein (posterior tibial)
Nerve (tibial)
flexor Hallucis longus
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14
Q

Describe the principle of foot muscle innervation.

A

Apart from EDB and first 2 dorsal interossei, ALL intrinsic muscles are innervated by either medial or lateral plantar branches of the tibial nerve.

EDB: deep peroneal nerve
First 2 dorsal interossei: deep peroneal nerve

All intrinsics left are innervated by lateral plantar nerve except 1LAFF muscles

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15
Q

What muscles are in the different layers of the foot?

3,2,3,1

A

1st layer (3)

  • FDB
  • abductor hallucis
  • abductor digiti minimi

2nd layer (2)

  • tendons of FDL and FHL
  • quadratus plantae
  • lumbricals

3rd layer (3)

  • flexor digiti minimi
  • flexor hallucis brevis
  • adductor hallucis
4th layer (1)
- interossei (plantar and dorsal)
(PAD AND DAB)
- tendons of fibularis longus and tibialis posterior
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16
Q

What is the axis of abduction and adduction in the fooot?

A

Down the 2nd phalanx

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17
Q

Which artery supplies the medial and lateral plantar arches of the foot? Where is a good landmark for its palpation and what are its close tendinous relations?

A

Posterior tibial artery
2.5 cm in front of the medial border of the tendo calcaneus
Runs between Flexor digitorum longus and flexor hallucis longus.

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18
Q

In which layer of the foot do the neurovascular structures lies?

A

Between 1st and 2nd layers.

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19
Q

What are the structures that run through the extensor retinaculum of the foot from medial to lateral?

A
  • tendons of tib anterior
  • tendons of EHL
  • anterior tibial arterty (turning into DPedis)
  • deep peroneal nerve
  • tendons of EDL
  • fibularis tertius
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20
Q

Describe the stabilising ligaments of the ankle joint.

A

CAPSULE
- extends along articular margin of all 3 bones except anterior talus where it pushes anteriorly onto neck of talus

MEDIAL
- deltoid ligament: continuous attachment from medial tubercle of talus along edge of the sustentaculum tali and spring ligament to the tuberosity of the navicular (see fig 3.40 and 3.43)

LATERAL

  • anterior talofibular ligament : most commonly injured
  • posterior talofibular ligament
  • calcaneofibular ligament (see fig 3.41/3.46)
21
Q

Which myotomes represents hip flexion/extension?

A

F: L2/L3
E: L4/L5

Adduction and medial rotation are same as flexion

Abduction and lateral rotation are same as extension

22
Q

Which myotome represents knee flexion/extension?

A

F: L5/S1
E: L3/L4

23
Q

Which myotomes represent ankle dorsi/plantarflexion?

A

DF: L4/5
PF: S1/S2

24
Q

What muscles of the foot are supplied by the medial plantar nerve?

A

Intrinsics : 1LAFF

  • 1st Lumbrical
  • Abductor hallucis
  • Flexor hallucis brevis
  • Flexor digitorum brevis
25
Q

Which of the quads muscles crosses the hip joint?

A

The rectus femoris

26
Q

Which two muscles are contained in the fascia lata?

A

Tensor fascia lata and gluteus maximus

27
Q

What are the boundaries of the femoral ring?

A

MEDIAL: lacunar ligament
POSTERIOR: pectineal ligament
LATERAL: femoral vein
ANTERIOR: medial aspect of inguinal ligament

28
Q

Which nerve contains the most proprioceptive fibres to the knee joint?

A

Nerve to vastus medialis (equal in size to saphenous nerve)

29
Q

Which muscles of the anterior compartment of the thigh are supplied by the deep vs superficial branches of the femoral nerve?

A

Superficial: pectineus/sartorius
Deep: quadriceps (3 x vastus + rectus femoris)

30
Q

What are the 3 factors that discourage lateral dislocation of the patella?

A
  • bony: forward prominence of lateral condyle of femur
  • ligamentous: medial patellar retinaculum
  • muscular: lowest fibres of vastus medialis

p.201 fig 3.12

31
Q

Where is the adductor canal? (subsartorial canal) What are the important structures passing through?

A

betwen vastus MEDIALIS and front of adductor muscles below the apex of femoral triangle
ROOF: fascia which contains subsartorial plexus
FLOOR: adductor longus, adductor magnus

CONTENTS

  • femoral artery
  • femoral vein
  • saphenous nerve
  • nerve to vastus medialis

p. 202

32
Q

What is the subsartorial plexus? What purpose does it serve?

A

branches from

  • intermediate cutaneous nerve of thigh
  • saphenous nerve
  • anterior division of obturator nerve

supplies fascia lata and skin above medial side of knee

33
Q

What is the relationship of the femoral artery to the femoral vein at the

  • inguinal ligament
  • base of femoral triangle
  • adductor hiatus
A
  • inguinal ligament: lateral
  • femoral triangle: posterior
  • adductor hiatus: medial

p. 202
at all levels in the thigh the artery lies between saphenous nerve and femoral vein

34
Q

Which divisions of the obturator nerve supply which components of the medial compartment of the thigh?

A

anterior division: gracilis, adductor longus and adductor brevis + hip joint

Posterior division: obturator externus, adductor magnus (adductor part) + knee joint

35
Q

Describe the attachments of the capsule of the hip joint.

A

Whole of the neck of the femur anteriorly (fig 3.9 3.10, half the neck of the femur limited by the tendon of obturator externus posteriorly (Fig 3.15)

36
Q

Where do the medial and lateral heads of gastroc arise?

A

Medial: medial condyle at lower end of medial supracondylar line
Lateral: lateral surface of lateral condyle

fig 3.56

37
Q

Is there a synovial sheath around the achilles tendon?

What is the key landmark for its distal attachmend?

A

No, no synovial sheath.
Bursae separate it from deep fascia and upper calcaneus

“middle third of the posterior surface of the calcaneus “ pg 248

38
Q

Describe how these muscles relate to the flexor digitorum longus in the sole of the foot.

  • FHL
  • Flexor accessorius
  • Lumbricals
  • FDB
A 
FHL: tendon passes deep (contributes to medial 2)
Flex Accessorius (quadratus plantae): contributes to each tendon
Lumbricals: originate from FDL tendons
FDB: perforated by FDL, lies in 1st layer of foot
39
Q

In the popliteal fossa, describe the order of the muscular/neurovascular structures from anterior to posterior.

A

fig 3.24/3.22

  • popliteal ligament/popliteus muscle
  • popliteal artery
  • politeal vein
  • tibial nerve (common fibular passes on lateral side of fossa)
40
Q

Which bursa communicates with the knee joint?

A

The popliteus bursa
The suprapatellar bursa
Medial gastroc always
Lateral gastroc sometimes

p. 232

41
Q

What is the direction of the popliteus fibres? What is its purpose?

A

From popliteal surface of tibia, upwards and laterally

  • half in ligament to lateral condyle of femur within knee joint
  • half in fleshy insertion to lateral meniscus

UNLOCKS the knee by pulling on lateral meniscus to rotate the femur (latearlly rotates femur on fixed tibia)

does not even act as a weak flexor of the knee joint p. 226

42
Q

What forms the boundaries of the popliteal fossa?

A

Medial: semimembranosus
Lateral: Biceps femoris long tendon
Lower: gastroc
Roof: fascia lata

43
Q

What is the only muscle supplied by the inferior gluteal nerve?

A

Gluteus maximus

44
Q

What is the surface marking of the sciatic nerve in the buttock?

A

1/3 of the way down from PSIS to ischial tuberosity

In middle third of line from grater trochanter to ischial tuberosity

45
Q

What makes up the tricipital tendon in the hip and where does it insert?

A

Obturator internus
Superior gemellus
Inferior gemellus

Inserts into medial surface of greater trochanter

46
Q

Which nerve supplies tensor fascia lata? What other muscles does it supply and which nerve roots does it contain?

A

SUPERIOR GLUTEAL NERVE

- also supplies glut medius and glut minimus
- L4, L5, S1
inferior gluteal nerve has L5, S1, S2

47
Q

Which nerves supply which muscles of the pes anserinus?

A

SGT FOT

  • sartorius: femoral nerve (superficial)
  • gracilis: obturator nerve (anterior)
  • semiTendinosus: tibial nerve
48
Q

Which nerves innervate the long vs short head of biceps femoris?

A

Long: tibial nerve
Short: common femoral nerve

49
Q

What are 3 muscles that attach to the lesser trochanter?

A
  • adductor magnus
  • iliacus
  • psoas major

GSSE Anatomy (7 decks)

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