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MB2 Rheumatology and Orthopaedics > Lower limb anatomy > Flashcards

Lower limb anatomy Flashcards

1
Q

superficial muscles of the gluteal region?

A

gluteus maximus, gluteus medius, gluteus minimus, tensor fascia lata

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2
Q

superficial muscles of the gluteal region act to do what?

A

extensors, abductors, medial rotators of thigh except gluteus maximus which is a lateral rotator

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3
Q

what nerves innervate the superficial gluteal muscles

A

superior gluteal, medial and minimal gluteal and tensor fascia lata
inferior gluteal - gluteus maximus

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4
Q

what is trendelenburg’s gait

A

superior gluteal nerve doesn’t properly innervate gluteus medius or minimus. standing straight on one leg the pelvis will tilt to unsupported side

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5
Q

deep muscles of gluteal region, function and nerve innervation

A

piriformis, obturator internus, gemelli, quadratus femoris
lateral rotators and hip stabilisers
sacral plexus

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6
Q

what ligaments form the greater and lesser sciatic foramen

A

sacrotuberous and sacrospinous ligaments

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7
Q

gluteal region is divided into 4 regions. where are the lines of divisions

A

iliac crest vertically

superior aspect of greater trochanter of femur horizontally

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8
Q

what does the posterior cutaneous nerve of thigh innervate

A

skin over posterior of thigh, popliteal fossa, lateral perineum, upper medial thigh

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9
Q

what does pudendal nerve innervate and where does it exit in spinal cord

A

perineum

S2-S4

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10
Q

what does sciatic nerve exit, what does it supply and what does it branch to

A

exits L4-S3, inferior to piriformis
supplies posterior thigh, all leg and foot muscles and most of skin
branches to tibial nerve and common fibular

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11
Q

what supplies blood to sciatic nerve

A

artery to sciatic nerve

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12
Q

contents of femoral triangle

A

Femoral sheath - fem artery, vein
femoral nerve
femoral canal - deep inguinal lymph nodes and fat

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13
Q

boundaries of femoral triangle

A 
superior - inguinal ligament 
medial - adductor longus 
lateral - sartorius 
floor - iliopsoas laterally and pectineus medially
roof - fascia lata
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14
Q

what is compartment syndrome and how is it managed

A

increased swelling in tissue compartments affecting muscle and nerve
emergency fasciotomy

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15
Q

muscles in anterior thigh compartment, function and nerve innervation

A

flexors - pecinus, sartorius, iliopsoas
extensors - quadriceps femorus
femoral nerve (L2,3,4), psoas major (L1,2,3)

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16
Q

muscles in medial thigh compartment, function and nerve innervation

A

Adduction - adductor brevis, adductor longus, adductor magnus, gracilis, obturator externus
all innervated by obturator nerve (L2,3,4) except hamstring part of adductor magnus which is innervated by tibial nerve

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17
Q

muscles in posterior thigh compartment, function and nerve innervation

A

extensors of thigh and flexor of leg - semitendinosus, semimembranosus, biceps femoris (long and short head)
tibial nerve, except short head biceps femoris - common fibular nerve

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18
Q

muscles in anterior leg compartment, function and nerve innervation

A

dorsiflexors of ankle, extensors of toes
tibialis anterior, extensor digitoum longus , extensor hallucis longus, fibularus tertius
deep fibular nerve (L4,L5)

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19
Q

muscles in posterior leg compartment, function and nerve innervation

A 
superficial are plantarflexors - soleus, plantaris, gastrocnemius 
deep are toe flexors and ankle plantarflexors - popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior 
tibial nerve (S1,S2)
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20
Q

muscles in lateral leg compartment, function and nerve innervation

A

evert foot, weakly plantarflex ankle - fibularis longus, fibularis brevis
superficial fibular nerve (L5,S1,S2)

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21
Q

range of movement of hip?

A

flexor-extension
abduction-adduction
medial/lateral rotation
circumduction

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22
Q

ligaments of hip joint

A

iliofemoral anterior and superior to pubofemoral
pubofemoral anterior
ischiofemoral posteriorly
ligament to head of femur - not a supportive ligament

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23
Q

blood supply to hip joint? where is it from?

A

medial and lateral circumflex femoral arteries from profunda femoris, originally femoral
artery to head of femur - limited from branch of obturator

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24
Q

ligaments of knee joint

A

extracapsular - patellar, lateral and medial collateral ligaments
intra-articular - anterior and posterior cruciate
menisci - fibrocartilage and medial and lateral
anterior/posterior drawer signs

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25
Q

contents of popliteal fossa

A

fat
terminal small saphenous vein
popliteal vessels
tibial and common fibular nerves

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26
Q

boundaries of popliteal fossa

A

superolaterally - biceps femoris
superomedially - semimembranosus/semitendinosus
inferior - medial/lateral gastrocnemius
roof - popliteal fascia

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27
Q

the calcanael tendon is made up of tendons of what muscles?

A

gastrocnemius and soleus

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28
Q

where does calcanael tendon attach

A

calcanael tuberosity of calcaneus

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29
Q

describe drainage of superficial lymphatics

A

follow saphenous veins, drain to superficial inguinal nodes then to external iliac nodes

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30
Q

describe drainage of deep lymohatics

A

ollow deep veins to popliteal nodes then to deep inguinal odes, then to external iliac nodes

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31
Q

where does lymph drain after external iliac nodes

A

common iliac

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32
Q

where can you locate the femoral artery

A

approx 3cm inferior to midpoint ingional ligament

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33
Q

attachements of inguinal ligament

A

ASIS to pubic tubercle

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34
Q

location of femoral hernia?

A

femoral canal, medial femoral triangle

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35
Q

femoral nerve innervation and saphenous branch

A

L2,3,4
innervates skin and fascia on anteromedial knee and thigh
saphenous nerve is a branch of femoral that runs between sartorius and gracilis to accompany great saphenous vein

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36
Q

sensory innervation of thigh?

A

anterior cutaneous nerve of thigh, branch of femoral
lateral cutaneous nerve of thigh
cutaneous branch of obturator nerve

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37
Q

what compartment is iliopsoas, proximal/distal attachments, action, nerve supply

A 
anterior thigh 
PA - iliac fossa and umbar transverse processes
DA - lesser trochanter femur 
Hip flexion
anterior rami lumbar nerves
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38
Q

what compartment is vastus medius/intermedius/lateralis, proximal/distal attachments, action, nerve supply

A 
anterior 
PA- Shaft of femur 
DA - patella and tibial tuberosity 
knee extension 
femoral nerve
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39
Q

what compartment is rectus femoris, proximal/distal attachments, action, nerve supply

A 
anterior 
PA - ASIS
DA - patella and tibial tuberosity 
knee extension and hip flexion 
femoral nerve
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40
Q

what compartment is sartorius, proximal/distal attachments, action, nerve supply

A 
anterior 
PA - ASIS
DA - medial proximal tibia 
flexion of hip and knee 
femoral nerve
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41
Q

muscle of quadriceps femoris

A

rectus femoris
vastus lateralis
vastus intermedius
vastus medius

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42
Q

what compartment is adductor magnus, proximal/distal attachments, action, nerve supply

A

medial
PA ischiopubic ramus and ischial tuberosity
DA adductor tubercle of femur
adduction
obturator nerve, except hamstring part which is tibial

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43
Q

what compartment is adductor brevis, proximal/distal attachments, action, nerve supply

A 
medial 
PA pubis
DA posterior femur long linea aspera 
adduction
obturator nerve
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44
Q

what compartment is adductor longus, proximal/distal attachments, action, nerve supply

A 
medial 
PA - pubis
DA posterior femur along linea aspera 
adduction 
obturator nerve
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45
Q

what compartment is gracilis, proximal/distal attachments, action, nerve supply

A 
medial 
PA pubis
DA superomedial aspect tibia
adduction and knee flexion
obturator nerve
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46
Q

describe quadriceps femoris compartment in relation to each other

A

vastus medius is most medial and vastus lateralis is most lateral
rectus femorus lies between the two and vastus intermedius is posterior to rectus femoris and inferior

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47
Q

describe the medial thigh compartment in relation to each other

A

gracilis is most medial

adductor brevis and longus are anterior to magnus, brevis is superior

48
Q

borders of gluteal region

A

superior - iliac crests
inferior by gluteal fold
laterally by greater trochanter of femur

49
Q

what compartment is gluteus maximus, proximal/distal attachments, action, nerve supply

A 
superficial gluteal region
PA - iliac crest, sacrum, sacrotuberous ligament and coccyx
DA - iliotibial tract 
Hip extension, lateral rotation 
inferior gluteal nerve
50
Q

what compartment is gluteus medius, proximal/distal attachments, action, nerve supply

A 
gluteal region
PA external ileum 
DA lateral greater trochanter femur
abduction and medial rotation of thigh
superior gluteal nerve
51
Q

what compartment is gluteus minimus, proximal/distal attachments, action, nerve supply

A 
gluteal region 
PA external ileum 
DA superior greater trochanter femur 
abduction and medial rotation of thigh
superior gluteal nerve
52
Q

attachments of iliotibial tract

A

ASIS to lateral of lateral tibial condyle at gerdy tubercle

53
Q

describe lumbar puncture

A

patient on left side and fully flexed

visualise iliac crest and identify plane between them

54
Q

what compartment is quadratus femoris, proximal/distal attachments, action, nerve supply

A 
deep gluteal region
PA ischial tuberosity 
DA interochanteric crest
lateral thigh rotation 
nerve to quadratus femoris
55
Q

what compartment is obturator internus, proximal/distal attachments, action, nerve supply

A

deep gluteal region
PA internal surface of obturator membrane
DA trochanteric fossa
lateral rotates extended thigh and abducts flexed thigh
nerve to obturator internus

56
Q

what compartment is superior/inferior gemellus, proximal/distal attachments, action, nerve supply

A

deep gluteal region
PA Sup - ischial spine Inf ischial tuberosity
DA trochanteric fossa
laterally rotates extended thigh and abducts flexed thigh
sup - nerve to obturator internus
inf- nerve to quadratus femoris

57
Q

what compartment is piriformis, proximal/distal attachments, action, nerve supply

A 
deep gluteal region 
PA anterior sacrum 
DA superior greater trochanter 
laterally rotates extended thigh and abducts flexed thigh
ant ramus S1, S2
58
Q

describe course of sciatic nerve, exit from spinal cord and distribution

A

L4-S3
enters gluteal region through intra-piriform foramen, deep to gluteus maximus
all post compartment thigh and all of leg

59
Q

describe course of inferior gluteal nerve, exit from spinal cord and distribution

A

L5-S2
enters gluteal region through intra-piriform foramen, divides into branches and pierces gluteus maximus
supplies gluteus maximus

60
Q

describe course of nerve to quadratus femoris and distribution

A

enters gluteal region by intra-piriform foramen, deep to sciatic nerve
hip joint, inf gemellus and quadratus femorus

61
Q

describe course of nerve to obturator internus and distribution

A

L2-L4
enters gluteal region by intra-piriform foramen, posterior to sacrospinous ligament to enter pelvis by lesser sciatic foramen
obturator internus and superior gemellus

62
Q

describe course of pudendal nerve, exit from spinal cord and distribution

A

S2-4
enters gluteal region by intra-piriform foramen, posterior to sacrospinous ligament to enter pelvis by lesser sciatic foramen
principle nerve to perineum

63
Q

describe course of posterior cutaneous nerve of thigh, exit from spinal cord and distribution

A

S1-3
enters gluteal region through intra-piriform foramen and runs medial to sciatic nerve
skin of inf 1/2 buttock, skin post thigh and popliteal fossa

64
Q

what compartment is semitendinosus, proximal/distal attachments, action, nerve supply

A 
posterior
PA - ischial tuberosity 
DA medial surface of superior tibia 
flexes leg and lateral rotation when leg flexed, thigh extension 
tibial division of sciatic nerve
65
Q

what compartment is semimembranosus, proximal/distal attachments, action, nerve supply

A

posterior
PA - ischial tuberosity
DA posterior part of medial condyle of tibia
flexes leg, extend thigh and medial rotation when leg flexed
tibial division of sciatic nerve

66
Q

what compartment is biceps femoris, proximal/distal attachments, action, nerve supply

A

posterior
PA - long head - ischial tuberosity, short head - linea aspera of femur
DA - lateral side of head of fibula
flexes leg, lateral rotation when flexed, extends thigh
long head, tibial division of sciatic, short head is common fibular division

67
Q

which hamstring muscle is not a true hamstring and why

A

biceps femoris short head
innervated by common fibular, not tibial
doesnt span hip joint so no thigh extension
attaches to linea aspera, not ischial tuberosity

68
Q

distal attachment of hip capsule

A

ischiotrochanteric crest

69
Q

describe the acetabular labrum and its function

A

ring of cartilage extending out from acetabulum

functions to increase hip stability and lesser section of ring helps to grip head of femur better

70
Q

describe the termination of the small saphenous vein in the popliteal fossa

A

passes through deep popliteal fascia to drain into popliteal vein

71
Q

what is contained in the major neurovascular bundle of the popliteal fossa

A 
tibial nerve
popliteal vein (from posterior tibial) and popliteal artery
72
Q

where does the sciatic nerve division most commonly take place

A

superior apex of popliteal fossa if not already done so in gluteal region/post thigh

73
Q

describe path of tibial nerve through popliteal fossa

A

descends vertically

74
Q

describe the path of common fibular nerve through popliteal fossa

A

skirts lateral border deep to biceps femoris, passes between tendon and lateral gastrocnemius and reaches fibular neck before dividing to deep and superficial fibular

75
Q

what do the sural nerves supply and where do they come from

A

skin and fascia on posterolateral leg and foot

tibial and common fibular nerves

76
Q

when is the common fibular nerve at risk

A

compression against neck of fibula and fractures of fibular neck

77
Q

what are the genicular anastomoses and their function?

A

anastomoses around knee joint, leg and foot. important in partial occlusion of the popliteal artery during full knee flexion

78
Q

from anterior to posterior, name the structures passing through the tarsal tunnel

A 
tendons of tibialis posterior 
flexor digitorum longus 
posterior tibial artery 
tibial nerve 
tendon of flexor hallucis longus 
tom dick and harry
79
Q

what compartment is gastrocnemius, proximal/distal attachments, action, nerve supply

A

superficial posterior
PA - lateral: lateral condyle femur medial: popliteal surface femur
DA - calcaneus by calcaneal tendon
plantarflexes ankle on extension, flexes leg and knee, raises heel on walking
tibial nerve

80
Q

what compartment is soleus, proximal/distal attachments, action, nerve supply

A

superficial posterior
PA posterior head and superior but posterior fibula, soleal line of tibi, tendinous arch
DA - calcaneus by calcaneal tendon
plantarflexes ankle, steadies leg on foot
tibial nerve

81
Q

what compartment is plantaris, proximal/distal attachments, action, nerve supply

A 
superficial posterior
PA lateral supracondylar line femur, popliteal ligament 
DA calcaneus via calcaneal tendon 
weakly plantarflexes ankle 
tibial nerve
82
Q

what compartment is tibialis posterior, proximal/distal attachments, action, nerve supply

A

deep posterior
PA interosseius membrane, posterior surface tibia and fibula
DA tuberosity of calcaneus and bases of 2-4 metatarsals
plantarflex ankle, avert foot
tibial nerve

83
Q

what compartment is flexor digitorum longus, proximal/distal attachments, action, nerve supply

A

deep posterior
PA - posterior surface tibia
DA bases of distal phalanges of lateral 4 digits
tibial nerve
flexes 4 lateral digits, plantarflexes ankle

84
Q

what compartment is popliteus, proximal/distal attachments, action, nerve supply

A

deep posterior
PA lateral condyle femur and lateral meniscus
DA posterior surface tibia
weakly flexes knee, medially rotates tibia
tibial nerve

85
Q

what compartment is flexor hallucis longus, proximal/distal attachments, action, nerve supply

A

deep posterior
PA posterior surface fibula, inferior interosseous membrane
DA - distal phalanx big toe
flexes great toe, weakly plantarflexes ankle
tibial nerve

86
Q

what is an unhappy triad knee injury

A

meniscal tear
ACL rupture
MCL rupture

87
Q

describe how the ACL passes across the knee

A

passes superior, lateral and posterior to attach to lateral femoral condyle

88
Q

describe how the PCL passes across the knee

A

passes superiorly and anteriorly to attach to medial femoral condyle

89
Q

what is the suprapatella bursa and what does it act to do

if it becomes swollen how would it appear

A

extension of synovial cavity to reduce friction on the quadriceps tendon
it appears as a swelling on the lower third of the anterior thigh

90
Q

what does the common fibular nerve divide into to supply

A

superficial fibular nerve, supplying lateral leg muscles and skin of dorsum of foot
deep fibular nerve supplying anterior compartment of leg and skin of first interdigital cleft

91
Q

what compartment is tibialis anterior, proximal/distal attachments, action, nerve supply

A

anterior
PA lateral condyle and superior lateral tibia
DA medial and inferior medial cuneiform and 1st metatarsal
Deep fibular nerve
dorsiflexes foot and inverts

92
Q

what compartment is extensor digitorum longus, proximal/distal attachments, action, nerve supply

A

anterior
PA lateral condyle tibia and superior medial fibula
DA middle and distal phalanges of 4 digits
Deep fibular nerve
dorsiflexes ankle and extends 4 lateral toes

93
Q

what compartment is extensor hallucis longus, proximal/distal attachments, action, nerve supply

A 
anterior 
PA middle anterior fibula 
DA dorsal aspect of distal phalanx great toe 
deep fibular nerve 
extends great toe and dorsiflexion
94
Q

what compartment is fibularis tertius, proximal/distal attachments, action, nerve supply

A 
anterior 
PA inferior anterior fibula 
DA dorsum of base of 5th metatarsal 
deep fibular nerve 
dorsiflexes ankle and everts foot
95
Q

what compartment is fibularis longus, proximal/distal attachments, action, nerve supply

A 
Lateral 
PA head and superior lateral fibula 
DA base of 1st metatarsal and medial cuneiform 
superficial fibular nerve 
eversion of foot and plantarflexion
96
Q

what compartment is fibularis brevis, proximal/distal attachments, action, nerve supply

A 
lateral 
PA inferior lateral fibula 
DA dorsal surface of lateral 5th metatarsal
superficial fibular nerve 
eversion of foot and plantarflexion
97
Q

nerve roots supplying superficial and deep fibular nerves?

A

deep - L4, L5

superficial - L5, S1, S2

98
Q

Joints of the foot?

A 
subtalar 
mid tarsal 
tarsometatarsal 
MTP
interphalangeal
99
Q

where is the subtalar joint located

A

between talus and calcaneus

100
Q

what are the 2 midtarsal joints and what do they do

A

calcaneocuboid and talocaneonavicular

inversion by tibialis anterior and posterior and eversion by fibularis muscles

101
Q

what is the function of the arches of the foot

A

shock absorption
increased weight bearing capacity by weight redistribution
‘push off’ spring in function

102
Q

what are all 3 arches of the foot supported by

A

plantar aponeurosis

103
Q

3 arches of the foot?

A

medial longitudinal arch
lateral longitudinal
transverse arch

104
Q

what bones and muscles make up the transverse arch

A

cuboid, cuneiforms and bases of 5 metatarsals

fibulas longs and tibialis posterior

105
Q

what bones make up the lateral longitudinal arch

A

calcaneus, cuboid and metatarsals 4/5

106
Q

what bones and muscles make up the medial longitudinal arch

A

calcaneus, talus, navicular, 3 cuneiforms and metatarsals 1-3
flexor hallucis longus and attachments of tibialis anterior and attachment of fibularis longus
tibialis posterior

107
Q

what are intrinsic muscles with reference to the foot

A

muscles that attach proximally and distally within the foot

108
Q

where are the intrinsic muscles of the foot located and how many layers do they form

A

mostly compartments in sole of foot

3 layers or between metatarsals

109
Q

lymphatic drainage of the foot?

A

follows great and small saphenous vein

110
Q

superficial veins of the foot?

A

dorsal venous arch giving rise to great saphenous vein medially and small saphenous laterally

111
Q

deep veins of the foot?

A

drain into anterior and posterior tibial and fibular veins that join to form the popliteal vein

112
Q

dorsalis pedis- where is pulse taken, what is it a branch of, what does it branch to give

A

lateral to EHL tendon
branch of anterior tibial artery
branches give the arcuate artery on dorsum of foot

113
Q

medial and lateral plantar arteries - what are they branches of, what do they contribute to and what does the deep plantar arch give rise to

A

branches of the posterior tibial artery
contribute to the deep plantar arch
arise metatarsal arteries, branching into digital arteries - 4 per toe

114
Q

motor supply to intrinsic muscles of the foot?

A

tibial nerve to muscles of sole and deep fibular to muscles of the dorsum

115
Q

sensory nerve supply to dorsum of foot?

A

superficial fibular nerve with deep fibular supplying interdigital cleft
sural nerve supplies the proximal lateral border and saphenous nerve supplies the proximal medial border

116
Q

sensory nerve supply to plantar foot

A

tibial nerve to heel and majority sole (medial and lateral plantar nerves). and sural nerve supplies proximal lateral border and saphenous nerve supplies proximal medial border

MB2 Rheumatology and Orthopaedics (22 decks)

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