Lower Limb Anatomy Flashcards
What vein passes in front of the medial malleolus?
Great saphenous vein
Branch off femoral vein
What artery runs behind the medial malleolus?
Posterior tibial artery
Where you find the posterior tibial pulse
Where do you find the popliteal pulse (of the popliteal artery)?
Deep in the popliteal fossa
Specifically describe where you will find the femoral pulse (of the femoral artery)?
At the mid inguinal point, half way between the ASIS (anterior superior iliac spine) and pubic symphysis
Dorsalis pedis artery is a continuation of what artery?
Anterior tibial artery
Give two locations where the dorsalis pedis artery can be found
1) 1/3 laterally away from the medial malleolus
2) lateral to the extensor hallucis longus tendon
In the lower limb, what veins mark the pre-axial border and the post-axial border?
Pre-axial border: Great/Long saphenous vein
Post-axial border: Small/Short saphenous vein
In the leg, which nerve is found laterally and medially?
- Femoral nerve (Saphenous nerve)
- Common fibular nerve
Saphenous nerve is found medially
Common fibular nerve is found laterally
In the genital area, which nerve is found most medially?
Ilioinguinal nerve or Genitofemoral nerve?
Ilioinguinal nerve
Is the sural nerve found medially or laterally in the posterior leg?
Laterally
Describe the lower limb myotomes
L2: hip flexion L3: knee extension L4: ankle dorsiflexion L5: great toe extension (lift up) S1: ankle plantar flexion S2: great toe flexion (sit down)
What ligament forms the greater sciatic foramen?
Where does this ligament attach?
The sacrospinous ligament attaches to the sacrum and the ischal spine (part of the ischium)
What ligament forms the lesser sciatic foramen?
Where does the ligament attach?
Sacrotuberous ligament connects to the sacrum and ischial tuberosity (part of the ischium)
Name the 3 hip bones.
What cartilage connects the 3 hip bones?
Ischium, pubis and ilium bones are all connected by the triradiate cartilage
What is the name of the connection between the inferior pubic ramus and the inferior ischial ramus
Ischiopubic ramus
Name an intracapsular ligament of the hip.
Where does it attach to?
Ligamentum teres is attached to the fovea capitis (of the head of the femur) and acetabulum
Name 2 extracapsular hip ligaments that prevent hyperextension of the hip.
Are these ligaments found anteriorly or posteriorly?
Iliofemoral and pubofemoral ligaments are both found anteriorly
What is the function of ischiofemoral ligament?
Where does the ischofemoral ligament attach to?
Prevents excessive medial rotation
Attaches to the greater tuberosity (of the posterior femur) and ischium
What does the sciatic nerve divide into?
Where does this first occur?
Into the common fibular nerve and tibial nerve, when the sciatic nerve crosses the popliteal fossa
Describe how the obturator artery is involved in supplying blood to the head of the femur?
Ligamentum teres artery branches off from obturator artery.
Ligamentum teres artery is WITHIN the ligamentum teres
What arteries supply both the synovial membrane and the femoral head?
Where do these arteries branch off from?
Retinacular arteries branch off from the medial circumflex femoral artery MCFA
Name 2 main branches of the Profunda femoris artery and state whether these arteries supply the anterior or posterior femoral head
MCFA: Medial circumflex femoral artery supplies the posterior femoral head
LCFA: lateral circumflex femoral artery supplies the anterior femoral head
What is between the greater trochanter and lesser trochanter posteriorly and anteriorly?
Posteriorly: intertrochanteric crest
Anteriorly: intertrochanteric line
Where does the gluteus maximus insert?
Gluteal tuberosity (of the posterior femur)
Name 4 muscles that extend the thigh at the hip joint
Gluteus maximus
Semimembranosus muscle
Semitendinosus muscle
Biceps femoris- long head
Semimembransosus muscle and semitendinosus muscle - which one is more superficial?
Semitendinosus muscle
Where does the gluteus medius and gluteus minimus muscles insert?
Gluteus minimus - greater trochanter (of femur - anteriorly)
Gluteus medius - greater trochanter (of femur - laterally)
What common bone do all 3 gluteal muscles originate from?
Ilium
Gluteus maximus originates from the iliac crest
What 3 muscles insert in the pes anserinus?
What nerves innervate these muscles?
Specifically state where the pes anserinus is
Say Grace (before) Tea.
Sartorius muscle - innervated by femoral nerve
Gracilis muscle - innervated by obturator nerve
Semitendinosus muscle - innervated by tibial nerve (branch from sciatic nerve)
Pes anserinus is at the anteromedial surface of the proximal tibia
Name 4 muscles that abduct the thigh at the hip joint
(Major muscles:)
Gluteus medius
Gluteus minimus
(Assisters:)
Sartorius muscle
Tensor fascia lata muscle
Name 6 muscles that laterally rotate the thigh at the hip joint
Obturator exturnus Obturator internus Gemellus superior Gemellus inferior Piriformis muscle Quadratus femoris
Name the 5 main peripheral nerves of the anterior thigh and state what spinal nerve roots make each nerve.
I Get Leftovers on Friday
Ilioinguinal nerve: L1 Genitofemoral nerve: L1, L2 Lateral (femoral) cutaneous nerve (of thigh): L2, L3 Obturator nerve: L2, L3, L4 Femoral nerve: L2, L3, L4
What 2 muscles does the superior gluteal artery supply?
Gluteus medius and gluteus minimus
Discuss the exit of 4 nerves from the greater sciatic foramen into the gluteal region, relative to the piriformis muscle.
What spinal nerve roots make up each nerve?
SISP
Superior gluteal nerve: enters GSF above the piriformis. L4, L5, S1
Inferior gluteal nerve: enters GSF below the piriformis. L5, S1, S2
Sciatic nerve: enters GSF below the piriformis. L4-S3
Posterior femoral cutaneous nerve: enters GSF below the piriformis. S1, S2, S3
Name 4 muscles that flex the thigh at the hip joint
(Anterior rami of lumbar plexus:)
Psoas major
(Femoral nerve:)
Iliacus
Sartorius
Rectus femoris
What is the origin of all 3 hamstrings?
Ischial tuberosity
What bursa is directly behind the quadriceps tendon?
Suprapatellar bursa
What bursa is directly in front of the patella?
Subcutaneous prepatellar bursa
What space is the patella found in?
Trochlear groove
What connects the patella to the tibial tuberosity?
What bursa can be found in front and behind this structure?
Superficial infrapatella bursa is found in front of the patellar ligament and the deep infrapatellar bursa can be found behind this ligament
What bursa is found in the posterior knee?
Semimembranosus bursa
Describe the attachments of the posterior and anterior cruciate ligaments (intracapsular ligaments)
ACL: Proximal attachment - posterolateral femoral intercondylar fossa. Distal attachment - medial meniscus and anteromedial tibial intercondylar eminence
PCL: Proximal attachment: medial border and roof of femoral intercondylar fossa. Distal attachment: posterolateral tibial intercondylar eminence
What membrane is between the fibula and tibia?
Interosseous membrane
What and specifically where is the the origin of the soleus muscle?
Soleal line is found on the lateral posterior tibia
Name a function of the anterior cruciate ligament
Prevents anterior translocation of the tibia
State 2 functions of the posterior cruciate ligament
- Prevents the femur from sliding off the anterior edge of the tibia (whilst walking down a slope)
- Stabilises the flexed knee
Name 3 extracapsular knee ligaments
Medial collateral ligament
Lateral collateral ligament
Popliteal ligament
What is the function of the medial and lateral collateral ligaments?
MCL: prevents excessive lateral/valgus angulation of the tibia
LCL: prevents excessive medial/varus angulation of the tibia
Name 4 muscles that extend the leg at the knee joint
Rectus femoris
Vastus intermedius
Vastus lateralis
Vastus medialis
Name 5 muscles that flex the leg at the knee joint
Gracilis Sartorius Biceps femoris Semimembranosus Semitendinosus
Name 2 muscles that both medially rotate the thigh and leg at their respective joints
Semimembranosus
Semitendinosus
What is the superior, lateral, medial, roof and floor borders of the femoral triangle?
Superior: inguinal ligament
Lateral: (medial border of) sartorius
Medial: (lateral border of) adductor longus
Floor: adductor longus (iliacus, psoas muscle, pectineus)
Roof: fascia lata
Where is the midpoint of the inguinal ligament?
Midpoint between the anterior superior iliac spine and pubic tubercle
Anatomically, where can the femoral artery be found?
Mid inguinal point
Where does the popliteal artery enter and exit the popliteal fossa?
Enters: Through the adductor hiatus
Exits: Underneath the tendon of the soleus muscle
Name 3 joints that are involved in inversion/eversion of the foot
Subtalar joint
Calcaneocuboid joint
Talocalcaneonavicular joint
Anterior muscles in the leg are found more laterally.
Name 4 muscles in the anterior leg, from superficial to deep.
Tibialis anterior
(EDL) Extensor digitorum longus
Extensor hallucis longus
Fibularis tertius
Name 2 muscles found in the lateral compartment of the leg, superficially to deep.
Fibularis longus
Fibularis brevis
What is the Achille’s tendon made up of?
Gastrocnemius (lateral and medial) muscle tendon
Plantaris muscle tendon
Soleus muscle tendon (found under lateral gastrocnemius)
(These are all superficial muscles found in the posterior leg)
Popliteus muscle is one of the deep muscles found in the posterior leg.
Name the 3 other muscles, from medially to laterally.
Flexor digitorum longus
Tibialis posterior
Flexor hallucis longus
What artery supplies all the anterior leg muscles?
Anterior tibial artery
What forms the floor, roof and lateral border of the popliteal fossa?
Floor: popliteal surface of femur
Roof: popliteal fascia and skin
Lateral border: plantaris and lateral head of gastrocnemius muscle
Out of all the popliteal fossa contents, what is the most superficial and deepest structure?
Superficial: tibial nerve
Deep: popliteal artery
What 3 muscle tendons insert in the medial cuneiform?
Tibialis posterior
Tibialis anterior
Fibularis longus
What specifically articulates with the tibia and fibula to form the ankle joint?
Trochlear of the talus
Which bone is found more medially?
Navicular bone or cuboid bone?
Navicular
Name the 5 nerves that innervate the sole of the foot
Medial planter nerve Lateral plantar nerve Saphenous nerve Medial calcaneal nerve Sural nerve
(All, except Saphenous nerve, are branches from tibial nerve)
Name 5 ligaments of the foot.
State their functions.
State whether they are found medially or laterally.
Medially:
Deltoid ligament - prevents hypereversion of the foot
Laterally:
Posterior inferior tibiofibular ligament - don’t know function
Anterior inferior tibiofibular ligament - don’t know function
Anterior talofibular ligament - prevent hyperinversion of the foot
Calcaneofibular ligament - prevent hyperinversion of the foot
Name the 2 bursa associated with the calcanel tendon that minimise friction whilst walking.
Discuss where the bursa are found.
Deep calcaneal bursa - between calcaneal tendon and calcaneus
Subcutaneous calcaneal bursa - between the skin and calcaneal tendon
What 2 muscles lead to subtalar inversion?
Tibialis anterior
Tibialis posterior
What 3 muscles cause eversion of the subtalar joint?
Fibularis tertius
Fibularis longus
Fibularis brevis
What 4 muscles cause ankle dorsiflexion?
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis teritus
What muscles cause ankle plantarflexion?
Tibialis posterior
Gastrocnemius (lateral and medial)
Soleus
What structures pass behind the medial malleolus?
From anterior to posterior
Tom, Dick, And Very Nervous Harry
Tibialis posterior tendon Flexor digitorum longus tendon Posterior tibial artery Posterior tibial vein Tibial nerve Flexor hallucis longus tendon
(All structures enter the tarsal tunnel, which is underneath the flexor retinaculum - which connects to the medial malleolus and calcaneus)
Small Saphenous vein drains into what vein (A)?
And what vein does vein A drain into?
Small saphenous vein -> Popliteal vein -> Femoral vein
Femoral vein drains into what vein?
External iliac vein
What test tests for
A) small knee joint effusion (1)
B) large knee joint effusion (1)
Small knee joint effusion - sweep test
Large knee joint effusion - patellar tap
Knee pain can also radiate to which 2 joints?
Hip and ankle
What is the difference between saddle anaesthesia and saddle paraesthesia?
What dermatomes (sensory loss) are affected?
Saddle anaesthesia - complete sensory loss in S1 and S2
Saddle paraesthesia - sensations (tingling, numbness) felt in S1 and S2 dermatomes (can eventually develop into complete loss of sensation
These sensations can also be felt in the groin (L1, S3, S4) and inner thigh (L3)
