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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
contents of popliteal fossa
fat terminal small saphenous vein popliteal vessels tibial and common fibular nerves
26
boundaries of popliteal fossa
superolaterally - biceps femoris superomedially - semimembranosus/semitendinosus inferior - medial/lateral gastrocnemius roof - popliteal fascia
27
the calcanael tendon is made up of tendons of what muscles?
gastrocnemius and soleus
28
where does calcanael tendon attach
calcanael tuberosity of calcaneus
29
describe drainage of superficial lymphatics
follow saphenous veins, drain to superficial inguinal nodes then to external iliac nodes
30
describe drainage of deep lymohatics
ollow deep veins to popliteal nodes then to deep inguinal odes, then to external iliac nodes
31
where does lymph drain after external iliac nodes
common iliac
32
where can you locate the femoral artery
approx 3cm inferior to midpoint ingional ligament
33
attachements of inguinal ligament
ASIS to pubic tubercle
34
location of femoral hernia?
femoral canal, medial femoral triangle
35
femoral nerve innervation and saphenous branch
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
36
sensory innervation of thigh?
anterior cutaneous nerve of thigh, branch of femoral lateral cutaneous nerve of thigh cutaneous branch of obturator nerve
37
what compartment is iliopsoas, proximal/distal attachments, action, nerve supply
``` anterior thigh PA - iliac fossa and umbar transverse processes DA - lesser trochanter femur Hip flexion anterior rami lumbar nerves ```
38
what compartment is vastus medius/intermedius/lateralis, proximal/distal attachments, action, nerve supply
``` anterior PA- Shaft of femur DA - patella and tibial tuberosity knee extension femoral nerve ```
39
what compartment is rectus femoris, proximal/distal attachments, action, nerve supply
``` anterior PA - ASIS DA - patella and tibial tuberosity knee extension and hip flexion femoral nerve ```
40
what compartment is sartorius, proximal/distal attachments, action, nerve supply
``` anterior PA - ASIS DA - medial proximal tibia flexion of hip and knee femoral nerve ```
41
muscle of quadriceps femoris
rectus femoris vastus lateralis vastus intermedius vastus medius
42
what compartment is adductor magnus, proximal/distal attachments, action, nerve supply
medial PA ischiopubic ramus and ischial tuberosity DA adductor tubercle of femur adduction obturator nerve, except hamstring part which is tibial
43
what compartment is adductor brevis, proximal/distal attachments, action, nerve supply
``` medial PA pubis DA posterior femur long linea aspera adduction obturator nerve ```
44
what compartment is adductor longus, proximal/distal attachments, action, nerve supply
``` medial PA - pubis DA posterior femur along linea aspera adduction obturator nerve ```
45
what compartment is gracilis, proximal/distal attachments, action, nerve supply
``` medial PA pubis DA superomedial aspect tibia adduction and knee flexion obturator nerve ```
46
describe quadriceps femoris compartment in relation to each other
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
47
describe the medial thigh compartment in relation to each other
gracilis is most medial | adductor brevis and longus are anterior to magnus, brevis is superior
48
borders of gluteal region
superior - iliac crests inferior by gluteal fold laterally by greater trochanter of femur
49
what compartment is gluteus maximus, proximal/distal attachments, action, nerve supply
``` superficial gluteal region PA - iliac crest, sacrum, sacrotuberous ligament and coccyx DA - iliotibial tract Hip extension, lateral rotation inferior gluteal nerve ```
50
what compartment is gluteus medius, proximal/distal attachments, action, nerve supply
``` gluteal region PA external ileum DA lateral greater trochanter femur abduction and medial rotation of thigh superior gluteal nerve ```
51
what compartment is gluteus minimus, proximal/distal attachments, action, nerve supply
``` gluteal region PA external ileum DA superior greater trochanter femur abduction and medial rotation of thigh superior gluteal nerve ```
52
attachments of iliotibial tract
ASIS to lateral of lateral tibial condyle at gerdy tubercle
53
describe lumbar puncture
patient on left side and fully flexed | visualise iliac crest and identify plane between them
54
what compartment is quadratus femoris, proximal/distal attachments, action, nerve supply
``` deep gluteal region PA ischial tuberosity DA interochanteric crest lateral thigh rotation nerve to quadratus femoris ```
55
what compartment is obturator internus, proximal/distal attachments, action, nerve supply
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
what compartment is superior/inferior gemellus, proximal/distal attachments, action, nerve supply
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
what compartment is piriformis, proximal/distal attachments, action, nerve supply
``` deep gluteal region PA anterior sacrum DA superior greater trochanter laterally rotates extended thigh and abducts flexed thigh ant ramus S1, S2 ```
58
describe course of sciatic nerve, exit from spinal cord and distribution
L4-S3 enters gluteal region through intra-piriform foramen, deep to gluteus maximus all post compartment thigh and all of leg
59
describe course of inferior gluteal nerve, exit from spinal cord and distribution
L5-S2 enters gluteal region through intra-piriform foramen, divides into branches and pierces gluteus maximus supplies gluteus maximus
60
describe course of nerve to quadratus femoris and distribution
enters gluteal region by intra-piriform foramen, deep to sciatic nerve hip joint, inf gemellus and quadratus femorus
61
describe course of nerve to obturator internus and distribution
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
describe course of pudendal nerve, exit from spinal cord and distribution
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
describe course of posterior cutaneous nerve of thigh, exit from spinal cord and distribution
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
what compartment is semitendinosus, proximal/distal attachments, action, nerve supply
``` 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
what compartment is semimembranosus, proximal/distal attachments, action, nerve supply
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
what compartment is biceps femoris, proximal/distal attachments, action, nerve supply
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
which hamstring muscle is not a true hamstring and why
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
distal attachment of hip capsule
ischiotrochanteric crest
69
describe the acetabular labrum and its function
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
describe the termination of the small saphenous vein in the popliteal fossa
passes through deep popliteal fascia to drain into popliteal vein
71
what is contained in the major neurovascular bundle of the popliteal fossa
``` tibial nerve popliteal vein (from posterior tibial) and popliteal artery ```
72
where does the sciatic nerve division most commonly take place
superior apex of popliteal fossa if not already done so in gluteal region/post thigh
73
describe path of tibial nerve through popliteal fossa
descends vertically
74
describe the path of common fibular nerve through popliteal fossa
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
what do the sural nerves supply and where do they come from
skin and fascia on posterolateral leg and foot | tibial and common fibular nerves
76
when is the common fibular nerve at risk
compression against neck of fibula and fractures of fibular neck
77
what are the genicular anastomoses and their function?
anastomoses around knee joint, leg and foot. important in partial occlusion of the popliteal artery during full knee flexion
78
from anterior to posterior, name the structures passing through the tarsal tunnel
``` tendons of tibialis posterior flexor digitorum longus posterior tibial artery tibial nerve tendon of flexor hallucis longus tom dick and harry ```
79
what compartment is gastrocnemius, proximal/distal attachments, action, nerve supply
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
what compartment is soleus, proximal/distal attachments, action, nerve supply
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
what compartment is plantaris, proximal/distal attachments, action, nerve supply
``` superficial posterior PA lateral supracondylar line femur, popliteal ligament DA calcaneus via calcaneal tendon weakly plantarflexes ankle tibial nerve ```
82
what compartment is tibialis posterior, proximal/distal attachments, action, nerve supply
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
what compartment is flexor digitorum longus, proximal/distal attachments, action, nerve supply
deep posterior PA - posterior surface tibia DA bases of distal phalanges of lateral 4 digits tibial nerve flexes 4 lateral digits, plantarflexes ankle
84
what compartment is popliteus, proximal/distal attachments, action, nerve supply
deep posterior PA lateral condyle femur and lateral meniscus DA posterior surface tibia weakly flexes knee, medially rotates tibia tibial nerve
85
what compartment is flexor hallucis longus, proximal/distal attachments, action, nerve supply
deep posterior PA posterior surface fibula, inferior interosseous membrane DA - distal phalanx big toe flexes great toe, weakly plantarflexes ankle tibial nerve
86
what is an unhappy triad knee injury
meniscal tear ACL rupture MCL rupture
87
describe how the ACL passes across the knee
passes superior, lateral and posterior to attach to lateral femoral condyle
88
describe how the PCL passes across the knee
passes superiorly and anteriorly to attach to medial femoral condyle
89
what is the suprapatella bursa and what does it act to do | if it becomes swollen how would it appear
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
what does the common fibular nerve divide into to supply
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
what compartment is tibialis anterior, proximal/distal attachments, action, nerve supply
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
what compartment is extensor digitorum longus, proximal/distal attachments, action, nerve supply
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
what compartment is extensor hallucis longus, proximal/distal attachments, action, nerve supply
``` anterior PA middle anterior fibula DA dorsal aspect of distal phalanx great toe deep fibular nerve extends great toe and dorsiflexion ```
94
what compartment is fibularis tertius, proximal/distal attachments, action, nerve supply
``` anterior PA inferior anterior fibula DA dorsum of base of 5th metatarsal deep fibular nerve dorsiflexes ankle and everts foot ```
95
what compartment is fibularis longus, proximal/distal attachments, action, nerve supply
``` Lateral PA head and superior lateral fibula DA base of 1st metatarsal and medial cuneiform superficial fibular nerve eversion of foot and plantarflexion ```
96
what compartment is fibularis brevis, proximal/distal attachments, action, nerve supply
``` lateral PA inferior lateral fibula DA dorsal surface of lateral 5th metatarsal superficial fibular nerve eversion of foot and plantarflexion ```
97
nerve roots supplying superficial and deep fibular nerves?
deep - L4, L5 | superficial - L5, S1, S2
98
Joints of the foot?
``` subtalar mid tarsal tarsometatarsal MTP interphalangeal ```
99
where is the subtalar joint located
between talus and calcaneus
100
what are the 2 midtarsal joints and what do they do
calcaneocuboid and talocaneonavicular | inversion by tibialis anterior and posterior and eversion by fibularis muscles
101
what is the function of the arches of the foot
shock absorption increased weight bearing capacity by weight redistribution 'push off' spring in function
102
what are all 3 arches of the foot supported by
plantar aponeurosis
103
3 arches of the foot?
medial longitudinal arch lateral longitudinal transverse arch
104
what bones and muscles make up the transverse arch
cuboid, cuneiforms and bases of 5 metatarsals | fibulas longs and tibialis posterior
105
what bones make up the lateral longitudinal arch
calcaneus, cuboid and metatarsals 4/5
106
what bones and muscles make up the medial longitudinal arch
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
what are intrinsic muscles with reference to the foot
muscles that attach proximally and distally within the foot
108
where are the intrinsic muscles of the foot located and how many layers do they form
mostly compartments in sole of foot | 3 layers or between metatarsals
109
lymphatic drainage of the foot?
follows great and small saphenous vein
110
superficial veins of the foot?
dorsal venous arch giving rise to great saphenous vein medially and small saphenous laterally
111
deep veins of the foot?
drain into anterior and posterior tibial and fibular veins that join to form the popliteal vein
112
dorsalis pedis- where is pulse taken, what is it a branch of, what does it branch to give
lateral to EHL tendon branch of anterior tibial artery branches give the arcuate artery on dorsum of foot
113
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
branches of the posterior tibial artery contribute to the deep plantar arch arise metatarsal arteries, branching into digital arteries - 4 per toe
114
motor supply to intrinsic muscles of the foot?
tibial nerve to muscles of sole and deep fibular to muscles of the dorsum
115
sensory nerve supply to dorsum of foot?
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
sensory nerve supply to plantar foot
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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