Lower Limb Flashcards
1
Q
Superior attachments of fascia lata
A
Inguinal ligament, pubic arch, body of pubic tubercle, Scarpa’s fascia, iliac crest, sacrum, coccyx, sacrotuberous ligament, ischial tuberosity
2
Q
What is the iliotibial tract
A
Shared aponeurosis of the tensor fasciae latae and gluteus maximums and fibres from fascia lata
3
Q
Attachments of iliotibial tract
A
Iliac tubercle to the anterolateral tubercle of the tibia (Gerdy’s tubercle)
4
Q
Inferior attachments of fascia lata
A
Exposed bones around knee, deep fascia of the leg inferior to the knee
5
Q
What are the compartments of the thigh formed by?
A
Fascia lata and 3 fasciae intermuscular septa that arose from its deep aspect and attach to the lines aspera of the femur
6
Q
Attachments of lateral intermuscular septum (strongest of the three)
A
From deep iliotibial tract to the lateral lip of the lines aspera and lateral supracondylar line of the femur
7
Q
Where is the saphenous opening?
A
Inferior to the medial part of the inguinal ligament, approximately 4cm inferolateral to the pubic tubercle
8
Q
What is the cribriform fascia?
A
Fibrofatty tissue covering the saphenous opening, pierced by numerous openings for efferent lymphatic vessels from the superficial inguinal lymph nodes and the great saphenous vein and its tributaries
9
Q
What is the falciform margin?
A
The superior, lateral and inferior margins of the saphenous opening that form a sharp crescentic edge
10
Q
Where does the great saphenous vein enter the femoral vein?
A
After passing through the saphenous opening and cribriform fascia
11
Q
Differences between superficial and deep veins in the leg
A
Superficial veins run independent of named arteries, deep are deep to the deep fascia and accompany all major arteries.
Deep veins have more valves
12
Q
Course of the great saphenous vein
A
Ascends anterior to the medial malleolus, passes posterior to the medial confuse of the femur (about a hand’s breadth posterior to the medial border of the patella), traverses the saphenous opening in the fascia lata
13
Q
What is the origin of gluteus Maximus?
A
External surface of ala of ileum, dorsal surface of sacrum, coccyx and sacrotuberous ligament
14
Q
What is the insertion of gluteus maximus?
A
Gluteal tuberosity of femur, deep fibres insert into ITB
15
Q
What is the innervation of gluteus maximus?
A
Inferior gluteal nerve (L5, S1, S2)
16
Q
What is the action of gluteus maximus?
A
- Extends thigh
- Assists lateral rotation
- Steadies thigh
- Assists in raising trunk from a flexed position
17
Q
What is the origin of gluteus medius?
A
External surface of ileum between ASIS and PSIS
18
Q
What is the insertion of gluteus medius?
A
Lateral surface of GT or femur
19
Q
What is the innervation of gluteus medius?
A
Superior gluteal nerve (L5, S1)
20
Q
What is the action of gluteus medius?
A
- abducts thigh
- Medial rotation of thigh
- Steadies pelvis (injury= trendelenburg gait)
21
Q
What is the origin of gluteus minimus?
A
Inferior aspect of external surface of ilium
22
Q
What is the insertion of gluteus minimus?
A
Anterior surface of GT of femur
23
Q
What is the nerve supply of gluteus minimus?
A
Superior gluteal nerve (L5, S1)
24
Q
What is the origin of piriformis?
A
- Anterior surface of sacrum
2. Sacrotuberous ligament
25
What is the insertion of piriformis?
Superior border of GT
26
What is the innervation of piriformis?
Direct branches from central rami of S1 and S2
27
What is the action of piriformis? Also of obturator inter us, superior gamellus, inferior gamellus, quadratics femoris
1. Laterally rotates extended thigh
2. Abduction of flexed thigh
3. Steadies femoral head in acetabulum
28
What is the origin of obturator internus?
1. Pelvic surface of obturator membrane
| 2. Surrounding bone
29
What is the insertion of obturator internus?
Medial surface of GT of femur
30
What is the nerve supply to obturator internus?
Nerve to obturator internus (L5, S1)
31
What is the origin of superior gamellus?
Ischial spine
32
What is the insertion of superior gamellus?
Medial surface of GT of femur
33
What is the nerve supply to superior gamellus?
Nerve to obturator internus (L5, S1)
34
What is the origin or inferior gamellus?
Ischial tuberosity
35
What is the insertion of inferior gamellus?
Medial surface of GT of the femur
36
What is the innervation of inferior gamellus?
Nerve to quadratics femoris (L5, S1)
37
What is the origin of quadratus femoris?
Lateral border of ischial tuberosity
38
What is the insertion of quadratus femoris?
Quadratus tubercle on intertrochanteric crest of femur and inferior to this
39
What is the innervation of quadratus femoris?
Nerve to quadratus femoris (L5, S1)
40
What is the general innnervation of the anterior thigh?
Directly/ indirectly by the lumbar plexus, situated in the posterior abdominal wall and formed by the ventral primary rami of L1 to L4
41
What are the nerve roots of the femoral branch of the genitofemoral nerve?
L1, L2
42
What does the femoral branch of the genitofemoral nerve innervate?
Skin over the femoral triangle
43
What is the course of the femoral branch of the genitofemoral nerve?
Lies in hollow femoral sheath of saphenous opening, passes superficially through the sheath's anterior wall and fascia lata
44
What is the root of the ilio-inguinal nerve?
L1
45
What does the ilio-inguinal nerve innervate? (3 things)
1. Lowest part of the anterior abdominal wall
2. Medial branches- external genitalia
3. Main branch supplies skin under the medial end of the inguinal ligament
46
What is the root of the lateral cutaneous branch of the subcostal nerve
T12
47
What does the lateral cutaneous branch of subcostal nerve innervate
Skin anterior to the GT of the femur
48
What is the root of the lateral cutaneous branch of the iliohypogastric nerve?
L1
49
What does the lateral cutaneous branch of iliohypogastric nerve innervate?
Skin over lateral part of anterior thigh below the iliac crest
50
What is the root of the medial cutaneous nerve of the thigh?
Anterior branch of the femoral nerve (L2, L3)
51
What does the medial cutaneous nerve of the thigh innervate?
Anterior and medial thigh down to the knee
52
What does the intermediate cutaneous nerve of the thigh innervate?
Anterior and medial thigh down to the knee
53
What is the root of the intermediate cutaneous nerve of the thigh?
Anterior branch of the femoral nerve (L2, L3)
54
What is the root of the saphenous nerve?
Femoral nerve L4
55
What does the saphenous nerve innervate?
Skin below knee joint, infrapatellar branch contributes to patella plexus
56
What is the root of the lateral cutaneous nerve of the thigh?
Branch of the lumbar plexus; L2, L3
57
What does the lateral cutaneous nerve of the thigh innervate?
Skin over lateral part of anterior thigh
58
What is the course of the lateral cutaneous nerve of the thigh?
From lateral border of psoas across the iliac fossa, then gets incorporated in fascia lata
It then passes behind or pierces the inguinal ligament where it lies in a fibrous tunnel 1cm medial to the ASIS.
Passes below fascia lata and then branches and each branch pierces the fascia lata individually
59
What is the origin of pectineus?
Pecten pubis on superior ramps of pubis
60
What is the insertion of pectineus?
Pectineal line of femur
61
What is the innervation of pectineus? (2)
1. Femoral nerve (L2, L3)
| 2. Branch of obturator nerve
62
What is the action of pectineus? (2)
1. Adducts thigh
| 2. Flexes thigh
63
What is the origin of Adductor Longus?
Body of Pubis (inferior Ramus to Pubic crest)
64
What is the insertion of adductor longus?
Middle third of linea aspera
65
What is the innervation of adductor longus?
Anterior branch of obturator nerve (L2, L3, L4)
66
What is the action of adductor longus?
Adducts thigh
67
What is the origin of adductor brevis? (2)
1. Body of Pubis
| 2. Inferior Ramus of Pubis
68
What is the insertion of adductor brevis? (2)
1. Pectineal (spiral) Line
| 2. Proximal part of linea aspera
69
What is the innervation of adductor brevis?
Obturator nerve (L2. L3, L4)
70
What is the action of adductor brevis? (2)
1. Adducts thigh
| 2. Partially flexes thigh
71
What is the origin of adductor magnus? (2)
1. Adductor- ischiopubic ramus
| 2. Hamstring- Ischial tuberosity
72
What is the origin of adductor magnus? (4)
1. Adductor- Gluteal tuberosity
2. Adductor- Medial line aspera
3. Adductor- Medial supracondylar line
4. Hamstring- Adductor tubercle of femur
73
What is the innervation of adductor magnus? (2)
1. Adductor- Obturator nerve (L2, L3, L4)
| 2. Hamstring- tibial portion of sciatic nerve
74
What is the action of adductor magnus? (3)
1. Adducts thigh
2. Adductor- flexes thigh
3. Hamstring- extends thigh
75
What is the origin of gracilis? (2)
1. Body of pubis
| 2. Inferior ramus of pubis
76
What is the insertion of gracilis?
Superior part of the medial surface of the tibia
77
What is the innervation of gracilis?
Obturator nerve (L2, L3)
78
What is the action of gracilis? (3)
1. Adducts thigh
2. Flexes leg
3. Medial rotation of thigh
79
What is the origin of obturator externus? (2)
1. Obturator Foramen's margins
| 2. Obturator membrane
80
What is the insertion of obturator externus?
Greater trochanter of femur
81
What is the innervation of obturator externus?
Obturator nerve (L3, L4)
82
What is the action of obturator externus? (2)
1. Lateral rotation of thigh
| 2. Steadies head of femur in acetabulum
83
What is the course of the obturator artery?
Enters medial compartment of thigh through obturator canal along with the obturator nerve
84
What does the obturator artery supply?
Medial compartment and hip joint
85
What is the origin of the obturator artery?
Originates as a branch of the internal iliac artery in the pelvic cavity
86
What is the importance of the obturator artery in ortho?
A branch of its posterior division forms the Artery to head of Femur
87
What is the origin of rectus femoris? (2)
1. Straight head- Anterior Inferior Iliac Spine
| 2. Reflected head- outer surgace of ilium above acetabulum
88
What is the insertion of rectus femoris? (2)
1. Reflected head- merges with posterior aspect of straight head
2. Fused bellies- becomes tendonous and fuses with aponeurosis that becomes patella tendon
89
What is the innervation of rectus femoris?
Femoral nerve (posterior divisions of L2, L3, L4)
90
What is the action of rectus femoris? (2)
1. Steadies hip joint
| 2. Helps iliopsoas in flexing thigh
91
What is the origin of vastus lateralis? (4)
1. Halfway up intertrochanteric line
2. GT
3. Gluteal tuberosity
4. Lateral lip of linea aspera
92
What is the insertion of vastus lateralis?
Extensive aponeurosis on deep aspect of muscle belly
93
What is the innervation of vastus lateralis?
Femoral nerve (posterior divisions of L2, L3, L4)
94
What is the action of vastus lateralis?
Part of quadriceps- extends leg at knee joint
95
What is the origin of vastus medialis? (5)
1. Mid-point of intertrochanteric line
2. Lesser trochanter
3. Spiral line
4. Medial lip of linea aspera
5. Upper half of medial supracondylar line
96
What is the insertion of vastus medialis?
Extensive aponeurosis on deep aspect of muscle belly
97
What is the innervation of vastus medialis?
Femoral nerve (posterior divisions of L2, L3, L4)
98
What is the action of vastus medialis? (2)
1. Part of quadriceps- extends leg at knee joint
| 2. Lower fibres run horizontally and fix patella preventing its lateral displacement
99
What is the origin of vastus intermedius?
Anterior and lateral surfaces of shaft of femur
100
What is the insertion of vastus intermedius?
Extensive aponeurosis on deep aspect of muscle belly
101
What is the innervation of vastus intermedius?
Femoral nerve (posterior divisions of L2, L3, L4)
102
What is the action of vastus intermedius?
Part of quadriceps- extends leg at knee joint
103
What goes through the greater sciatic foramen?
Sciatic nerve, superior and inferior gluteal nerves and vessels, pudendal nerve (also passes back through the lesser), posterior femoral cutaneous nerve, nerves to obturator internus and quadratus femoris
104
What goes through the lesser sciatic foramen?
Tendon of obturator internus, pudendal nerve, internal pudendal vessels, nerve to obturator internus
105
What movements occur at the subtalar joint?
Inversion and ever soon
106
What is the ligament of Humphrey?
Meniscofemoral ligament that passes ANTERIOR to the PCL
107
What is the ligament of Wrisberg?
Meniscofemoral ligament that passes POSTERIOR to the PCL
108
Where do the meniscofemoral ligaments originate from?
The posterior horn of the lateral meniscus
109
What is the anterolateral border of the subsartorial (Hunter’s) canal?
Vastus medialis
110
What’s the posteromedial border of the subsartorial (Hunter’s) canal?
Adductor Longus, adductor magnus
111
What is the anteromedial (roof) of the subsartorial (Hunter’s) canal?
Sartorial
112
What are the contents of the subsartorial (Hunter’s) canal?
Femoral artery, femoral vein, saphenous nerve, nerve to vastus medialis
113
What are the contents of the first layer of the foot?
Flexor digitorum brevis, Abductor hallucis, Abductor digit minimi
114
What are the contents of the second layer of the foot?
Tendon of flexor hallucis longus, tendon of flexor digitorum longus, flexor accessorius (quadratus plantae)
115
What are the contents of the third layer of the foot?
Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis
116
What are the contents of the fourth layer of the foot?
Interossei, tendons of tibialis posterior and peroneus longus lying deeply against the under surface of the tarsus
117
Where do the nerves and arteries of the sole of the foot lie?
Between the first and second layers- the artery is more marginal than the nerve
118
What is the clinical significance of the lateral femoral cutaneous nerve?
It can get compressed as it passes through the inguinal ligament or where it pierces the fascia lata causing pain in the lateral side of the thigh (meralgia paraesthetica)
119
What is the course of the genitofemoral nerve prior to entering the leg?
It lies on psoas and then the external iliac as it passes into the femoral sheath
120
What is the root of the ilioinguinal nerve?
It is a branch of the ilihypogastric (L1)
121
What does the ilioinguinal nerve supply?
It supplies the the lower fibres of internal oblique
Skin at the root of the penis
Anterior 1/3 of the scrotum
Small area of skin at the medial end of the inguinal ligament
122
What is the nerve supply of the hip joint?
Femoral nerve via nerve to rectus femoris
Sciatic via the nerve to quadratus femoris
Obturator nerve from its anterior division
123
Which ligament prevents hyperextension of the hip?
The iliofemoral ligament
124
Is the anterior tibial vein a tributary of the great saphenous vein?
No
125
How many tarsal bones are there in the foot?
7
126
Where does the medial circumflex artery sometimes branch from other than the profunda femoris artery?
The femoral artery
127
What area of sensation does the sural nerve supply?
The lateral border of the foot
128
Which nerves combine to form the sural nerve?
1. Medial cutaneous branch from the tibial nerve
| 2. Lateral cutaneous branch from the common perineal nerve
129
Which projects more anteriorly the medial or lateral condole of the femur and why?
The lateral to help prevent lateral dislocation of the patella
130
What are the borders of the femoral ring? Mnemonic SLIP
Septa of femoral sheath
Lacunar ligament
Inguinal ligament
Pectineal ligament
131
What is the floor of the femoral triangle?
Adductor longus, pectineus and a wee bit of iliopsoas
132
Are the collateral ligaments extracapsular?
Yes
133
Which bone of the foot contains a groove for the fibularis longus tendon?
The cuboid
134
What is the spring ligament?
AKA plantar calcaneonavicular ligament passes between the sustentaculum tali of the calcaneus and the plantar surface of the navicular
135
What is the deltoid ligament made up of?
Anterior tibiotalar ligament
Tibiocalcaneal ligament
Posterior tibiotalar ligament
Tibionavicular ligament
136
What inserts at the base of the 5th metatarsal?
Peroneus brevis
137
What are the muscle attachments to the linea aspera from medial to lateral?
vastus medialis, adductor longus, adductor brevis, adductor magnus, short head of biceps, vastus lateralis.
138
Which nerve pierces psoas anteriorly?
Genitofemoral nerve
139
Which muscles cause dorsiflexion at the ankle joint?
Tib ant and peroneus tertius
140
Which muscles cause inversion at the ankle joint?
Tib ant and tib post
141
Which muscles cause plantarflexion at the ankle joint?
Tib post and peroneus longus and brevis
142
Which muscles cause eversion at the ankle joint?
Peroneus tertius, peroneus longus and peroneus brevis
143
Which muscle helps to limit flexion of the hip when the knee is extended?
Semimebranosus
144
What part of quads has fleshy fibres extending more distally, lateralis or medialis?
Vastus medialis
145
Is quads power increased by hip extension?
Yes
146
What does the soleus muscle contain?
A rich plexus of veins
147
Are the suprerior and inferior tibio-fibular joints both synovial?
No- the proximal is, but the distal is a fibrous joint
148
What is unusual about the flexor digitorum longus?
Bipennate and arises from both bones in the leg
149
What is the innervation of gastroc?
Tibial nerve
150
Where is the tibial nerve derived from?
The ventral rami of L4-S3
151
Which nerve supplies skin of the medial mall
Femoral (L2-L4)
152
What are the attachments of the deltoid ligament?
Medial mall, sustentaculum tali, talar neck, body of talus, spring ligament, navicular
153
What structures are in the anterior compartment of the leg?
Tibialis anterior, EDL, EHL, peroneus tertius, anterior tibial artery and vein, deep peroneal nerve
154
What structures are in the lateral compartment of the leg?
Peroneus longus and brevis, superficial peroneal nerve
155
What structures are in the superficial posterior compartment of the leg?
Soleus, gastrocnemius, plantaris tendon
156
What structures are in the deep posterior compartment of the leg?
FDL, tibialis posterior, FHL, posterior tibial artery and vein, peroneal artery and vein
157
What is the first branch of the popliteal artery?
Anterior tibial artery
158
What is the terminal branch of the anterior tibial artery
Dorsalis pedis
159
What is the terminal branch of the peroneal artery?
Calcaneal branches
160
What are the terminal branches of the posterior tibial artery?
Medial abs lateral plantar arteries
