Lower Limb Flashcards

1
Q

lateral rotator group

A

musculature of the gluteal region

  • primarily involved in lateral rotation of femur at hip
  • lateral (external) rotator muscles
  • located deep to gluteal muscles
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2
Q

what are the 6 lateral rotator muscles that run from the bony pelvis to the greater trochanter and upper posterior femur?

A
piriformis
obturator internus
superior and inferior Gemelli
quandratrus femoris
obturator externus
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3
Q

piriformis

A
  • originates from pelvic surface of lateral part of sacrum

- leaves pelvic cavity through the greater sciatic foramen to attach to femur

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4
Q

obturator internus

A
  • originates on obturator membrane of pelvis
  • tendon exits pelvis through lesser sciatic foramen to insert onto femur
  • pudendal canal formed with obturator membrane and carries structures that supply the perineum
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5
Q

superior gemelli

A
  • the superior gemellus runs above the obturator internus
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6
Q

inferior gemelli

A

runs below the obturator internus

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7
Q

quadratus femoris

A

runs from ischial tuberosity to femur

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8
Q

obturator externus

A

runs from outer surface of the obturator membrane to the femur

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9
Q

blood supply of gluteal muscles

A
  • branches of internal iliac artery
  • primarily the superior and inferior gluteal arteries
  • enter gluteal region through greater sciatic foramen (superior and inferior to the piriformis muscle)
  • continue to travel along posterior surface of ilium (deep to gluteus maximus)
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10
Q

venous drainage of gluteal muscles

A

each arterial branch has a corresponding venous branch that travels alongside it – venous branches drain into internal iliac vein

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11
Q

innervation of the gluteal region arises from which plexus

A

the sacral plexus

  • located deep to gluteus maximus
  • pass through greater sciatic foramen
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12
Q

superior gluteal nerve

A

supplies motor innervation to gluteus medium, gluteus minimus and tensor fasciae latae

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13
Q

inferior gluteal nerve

A

supplies motor innervation to the gluteus maximus

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14
Q

posterior femoral cutaneous nerve

A

supplies sensory info to the skin of the posterior thigh

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15
Q

sciatic nerve

A

supplies the muscles that make up the posterior thigh – largest nerve in the body

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16
Q

pudendal nerve

A

supplies motor innervation to the anal sphincters and the urethral sphincters and sensory innervation to the perineum, penis, scrotum, labia majora and clitoris

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17
Q

what is the pathway of the sciatic nerve (L4-5 and S1-3)

A
  • after forming the sacral plexus, leaves pelvis via greater sciatic foramen and emerges below piriformis muscle
  • runs deep to gluteus maximus
  • passes superficial to lateral rotator muscles where it enters the posterior thigh deep to hamstring muscles
  • innervates muscles of posterior thigh (biceps femoris, semimembranosus and semiteninosus) and the hamstring portion of the adductor magnus
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18
Q

hip joint

A

ball and socket synovial joint between head of femur and acetabulum of hip bone

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19
Q

acetabular labrum

A
  • rim of fibrocartilage that deepens the cavity of the acetabulum
  • by deepening the acetabulum, more than half of the femoral head can fit
  • greatly improves stability
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20
Q

ligamentum teres

A
  • acts as a secondary stabilizer of the hip joint

- supplements work of capsular ligament

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21
Q

fibrous capsule

A
  • thick and strong group of ligaments that help hold the femoral head in the acetabulum
  • ligaments oriented in spiral fashion around the hip joint (tighten during extension and go slack during flexion)
  • capsule is weakest in its posteroinferior region
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22
Q

compartments of the thigh

A
  • compartments formed by intermuscular septa
  • anterior compartment = quandriceps muscle group and sartorius muscle
  • posterior compartment = hamstring
  • medial compartment = adductors
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23
Q

adductors

A
  • most are triangular in shape
  • originates from pubis
  • insert onto linea aspera of femur
  • pectineus, adductor brevis, adductor longus, gracilis, adductor magnus
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24
Q

adductor magnus

A
  • deepest and largest muscle of the medial compartment
  • inserts along the length of the linea aspera
  • adducts the thigh, can also extend and medially rotate the thigh at the hip joint
  • at most distal insertion site, a smaller “hamstring” part inserts on the adductor tubercle of the femur (forms adductor hiatus)
  • adductor hiatus allows passage of vessels between anterior and posterior thigh
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25
Q

hamstrings

A
  • 3 muscles that originate from ischial tuberosity of ischium and insert on posterolateral (fibula) and posteromedial (tibia) aspects of knee
  • extend hip and flex knee
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26
Q

the femoral triangle

A
  • area in upper anterior thigh that contains major neurovascular structures
  • bounded superiorly by inguinal ligament, laterally by sartorius muscle and medially by adductor longus muscle
  • has a muscular floor (iliopsoas and pectineus) and roof formed mainly by fascia lata
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27
Q

blood supply of hip and thigh originates from which artery?

A

supplied by external iliac artery which passes deep to the inguinal ligament and continues as femoral artery

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28
Q

arterial branches to the hip

A
  • deep femoral artery (profunda femoris) and circumflex arteries
  • multiple branches that anastomose around neck of femur
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29
Q

arterial branches to the thigh

A
  • profunda femoris artery (deep femoral artery) and superficial femoral artery
  • profunda femoris artery is the main source of blood to thigh, femoral artery supplies the rest
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30
Q

venous drainage of thigh and lower limb

A

femoral vein

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31
Q

what is the longest tributary of the femoral vein

A

great saphenous vein (drains superficial tissues of most of the lower limb and empties into femoral vein in upper thigh)

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32
Q

pathway of femoral artery and vein

A
  • the femoral triangle contains the femoral artery and vein
  • descend through femoral triangle to its apex where they pass into the adductor (Hunter’s) canal deep to sartorius and superficial to adductor magnus
  • from canal they pass through the adductor hiatus to the posterior knee where they become the popliteal artery and vein
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33
Q

femoral nerve

A
  • one of the largest in the leg
  • innervates the quadriceps muscles and skin of anterior thigh
  • runs alongside femoral artery and vein in the femoral triangle
34
Q

obturator nerve

A
  • innervates muscles of medial compartment (adductors) of thigh via motor branches
  • innervates skin of medial thigh via cutaneous branch
35
Q

lateral cutaneous nerve

A

sensory nerve supply to skin on lateral aspect of thigh above knee

36
Q

sciatic nerve

A

motor innervation to hamstring muscle

37
Q

patellar ligament

A

continuation of quadriceps tendon, helps keep patella in proper position

38
Q

collateral ligament

A

lateral and medial collateral ligaments stabilize the hinge motion of the knee, prevents excessive medial and lateral movements

39
Q

medial collateral ligament (MCL)

A
  • broader than lateral ligament

- joins distal femur to the proximal tibia

40
Q

lateral collateral ligament

A

joins distal femur at head of fibula

41
Q

cruciate ligaments

A

deep ligaments of knee that prevent the femur and tibia from sliding backward and forward

42
Q

anterior cruciate ligament (ACL)

A

prevents anterior dislocation of the tibia on the fixed femur

43
Q

posterior cruciate ligament (PCL)

A

prevents posterior dislocation of the tibia on the fixed femur

44
Q

menisci of the knee

A
  • C-shaped fibrocartilaginous pads on the condyles of the tibia
  • function to deepen the articular surface of the tibia, increasing stability
  • shock absorbers
45
Q

muscles of the posterior compartment of the leg

A
  • responsible for plantar flexion of foot at ankle

- popliteus, gastrocnemius, plantaris

46
Q

popliteus

A
  • deepest muscle of posterior compartment
  • origin: lateral femur
  • insertion: posterior side of tibia
47
Q

gastrocnemius

A
  • 2 heads that originate on the medial and lateral sides of the femur
  • insertion: calcaneus (hence crossing 2 joints)
  • can flex leg and foot
48
Q

plantaris

A
  • long thin muscle
  • origin: posterolateral femur
  • insertion: calcaneus
49
Q

popliteal fossa

A

diamond shaped area on posterior aspect of knee

- many important nerves and vessels that travel between thigh and leg found here

50
Q

superior/medial border of the popliteal fossa

A

semimembranosus

51
Q

superior/lateral border of the popliteal fossa

A

biceps femoris

52
Q

interior/lateral border of the popliteal fossa

A

plantaris and lateral head of the gastrocnemius (inferior to plantaris)

53
Q

inferior/medial border of the popliteal fossa

A

medial head of the gastrocnemius

54
Q

common fibular/peroneal nerve

A

innervates muscles of the lateral and anterior compartments of the leg

55
Q

tibial nerve

A

descends posteriorly through popliteal fossa, innervates muscles of posterior leg

56
Q

superficial fibular/peroneal nerve

A

innervates muscles of lateral compartment of leg

57
Q

deep fibular/peroneal nerve

A

innervates muscles of anterior compartment of leg

58
Q

contents of popliteal fossa

A

popliteal artery
popliteal vein
tibial nerve
common peroneal nerve

59
Q

tarsal bones

A

7 irregularly shaped bones that make up midfoot and hindfoot

  • calcaneus
  • talus
  • cuboid
  • navicular
  • medial cuneiform
  • intermediate cuneiform
  • lateral cuneiform
60
Q

calcaneus

A

forms heel

61
Q

talus

A

larger bone, part of ankle joint

62
Q

cuboid

A

square shaped

63
Q

navicular

A

good landmark b/c of long rectangular shape

64
Q

medial cuneiform

A

articulates with 1st metatarsal

65
Q

intermediate cuneiform

A

articulates with 2nd metatarsal

66
Q

lateral cuneiform

A

articulates with 3rd metatarsal

67
Q

arches of the foot

A
  • 3 arches formed by tarsal and metatarsal bones, supported by ligaments and tendons
  • medial longitudinal arch
  • lateral longitudinal arch
  • transverse arch
  • shape allows foot to act like a spring, bearing weight of body and absorbing shock produced during locomotion
68
Q

the ankle joint

A
  • synovial joint
  • formed by bones of leg (tibia and fibula) articulating with foot (talus)
  • hinge joint permitting dorsiflexion and plantar flexion of foot
  • strengthened by tendons and ligaments
69
Q

ligaments of foot and ankle

A
  • deltoid ligament
  • spring ligament
  • plantar fascia
70
Q

deltoid ligament

A
  • helps stabilize ankle during plantar flexion, external rotation and pronation
  • runs between tibia and talus
71
Q

spring ligament/calcaneonavicular ligament

A
  • runs between navicular and calcaneus bone

- helps stabilize medial longitudinal arch and the talus

72
Q

plantar fascia/plantar aponeurosis

A
  • longest ligament in foot

- thick fascia that helps to support the medial longitudinal arch of the foot

73
Q

intrinsic muscles of the foot

A
  • located in sole of foot

- collectively act to stabilize arches of foot and individually to control movement of digits

74
Q

extrinsic muscles of foot

A
  • arise from anterior, posterior and lateral compartments of leg
  • mainly responsible for eversion, inversion, plantarflexion and dorsiflexion of foot
75
Q

tibialis posterior muscle

A

important extrinsic muscle attaching onto navicular of foot

76
Q

arterial supply of ankle and foot

A
  • 2 main arteries: dorsalis pedis artery and posterior tibial artery
77
Q

dorsalis pedis artery

A
  • branch of anterior tibial artery
  • supplies dorsum of foot
  • connected to other more minor branches via anastomoses
78
Q

posterior tibial artery

A
  • travels down posterior ankle where it forms smaller anastomosing branches to supply the plantar surface of the foot
79
Q

venous drainage of foot

A
  • dorsal surface of foot drained by dorsal venous arch
  • drains to the small saphenous vein laterally
  • drains to the great saphenous vein medially
  • dorsal venous arch drains distal structures of foot such as toes via smaller branches
80
Q

tibial nerve

A

descends in posterior compartment of leg supplying muscles and enters foot to supply intrinsic muscle and skin of plantar surface

81
Q

deep fibular nerve

A

descends in anterior compartment of leg supplying muscles and part of skin on dorsum of foot

82
Q

superficial fibular nerve

A

descends lateral compartment of leg supplying muscles and skin of lower anterior leg and most of skin of dorsum of foot