Lower limb anatomy Flashcards
superficial muscles of the gluteal region?
gluteus maximus, gluteus medius, gluteus minimus, tensor fascia lata
superficial muscles of the gluteal region act to do what?
extensors, abductors, medial rotators of thigh except gluteus maximus which is a lateral rotator
what nerves innervate the superficial gluteal muscles
superior gluteal, medial and minimal gluteal and tensor fascia lata
inferior gluteal - gluteus maximus
what is trendelenburg’s gait
superior gluteal nerve doesn’t properly innervate gluteus medius or minimus. standing straight on one leg the pelvis will tilt to unsupported side
deep muscles of gluteal region, function and nerve innervation
piriformis, obturator internus, gemelli, quadratus femoris
lateral rotators and hip stabilisers
sacral plexus
what ligaments form the greater and lesser sciatic foramen
sacrotuberous and sacrospinous ligaments
gluteal region is divided into 4 regions. where are the lines of divisions
iliac crest vertically
superior aspect of greater trochanter of femur horizontally
what does the posterior cutaneous nerve of thigh innervate
skin over posterior of thigh, popliteal fossa, lateral perineum, upper medial thigh
what does pudendal nerve innervate and where does it exit in spinal cord
perineum
S2-S4
what does sciatic nerve exit, what does it supply and what does it branch to
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
what supplies blood to sciatic nerve
artery to sciatic nerve
contents of femoral triangle
Femoral sheath - fem artery, vein
femoral nerve
femoral canal - deep inguinal lymph nodes and fat
boundaries of femoral triangle
superior - inguinal ligament medial - adductor longus lateral - sartorius floor - iliopsoas laterally and pectineus medially roof - fascia lata
what is compartment syndrome and how is it managed
increased swelling in tissue compartments affecting muscle and nerve
emergency fasciotomy
muscles in anterior thigh compartment, function and nerve innervation
flexors - pecinus, sartorius, iliopsoas
extensors - quadriceps femorus
femoral nerve (L2,3,4), psoas major (L1,2,3)
muscles in medial thigh compartment, function and nerve innervation
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
muscles in posterior thigh compartment, function and nerve innervation
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
muscles in anterior leg compartment, function and nerve innervation
dorsiflexors of ankle, extensors of toes
tibialis anterior, extensor digitoum longus , extensor hallucis longus, fibularus tertius
deep fibular nerve (L4,L5)
muscles in posterior leg compartment, function and nerve innervation
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)
muscles in lateral leg compartment, function and nerve innervation
evert foot, weakly plantarflex ankle - fibularis longus, fibularis brevis
superficial fibular nerve (L5,S1,S2)
range of movement of hip?
flexor-extension
abduction-adduction
medial/lateral rotation
circumduction
ligaments of hip joint
iliofemoral anterior and superior to pubofemoral
pubofemoral anterior
ischiofemoral posteriorly
ligament to head of femur - not a supportive ligament
blood supply to hip joint? where is it from?
medial and lateral circumflex femoral arteries from profunda femoris, originally femoral
artery to head of femur - limited from branch of obturator
ligaments of knee joint
extracapsular - patellar, lateral and medial collateral ligaments
intra-articular - anterior and posterior cruciate
menisci - fibrocartilage and medial and lateral
anterior/posterior drawer signs
contents of popliteal fossa
fat
terminal small saphenous vein
popliteal vessels
tibial and common fibular nerves
boundaries of popliteal fossa
superolaterally - biceps femoris
superomedially - semimembranosus/semitendinosus
inferior - medial/lateral gastrocnemius
roof - popliteal fascia
the calcanael tendon is made up of tendons of what muscles?
gastrocnemius and soleus
where does calcanael tendon attach
calcanael tuberosity of calcaneus
describe drainage of superficial lymphatics
follow saphenous veins, drain to superficial inguinal nodes then to external iliac nodes
describe drainage of deep lymohatics
ollow deep veins to popliteal nodes then to deep inguinal odes, then to external iliac nodes
where does lymph drain after external iliac nodes
common iliac
where can you locate the femoral artery
approx 3cm inferior to midpoint ingional ligament
attachements of inguinal ligament
ASIS to pubic tubercle
location of femoral hernia?
femoral canal, medial femoral triangle
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
sensory innervation of thigh?
anterior cutaneous nerve of thigh, branch of femoral
lateral cutaneous nerve of thigh
cutaneous branch of obturator nerve
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
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
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
what compartment is sartorius, proximal/distal attachments, action, nerve supply
anterior PA - ASIS DA - medial proximal tibia flexion of hip and knee femoral nerve
muscle of quadriceps femoris
rectus femoris
vastus lateralis
vastus intermedius
vastus medius
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
what compartment is adductor brevis, proximal/distal attachments, action, nerve supply
medial PA pubis DA posterior femur long linea aspera adduction obturator nerve
what compartment is adductor longus, proximal/distal attachments, action, nerve supply
medial PA - pubis DA posterior femur along linea aspera adduction obturator nerve
what compartment is gracilis, proximal/distal attachments, action, nerve supply
medial PA pubis DA superomedial aspect tibia adduction and knee flexion obturator nerve
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
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
borders of gluteal region
superior - iliac crests
inferior by gluteal fold
laterally by greater trochanter of femur
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
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
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
attachments of iliotibial tract
ASIS to lateral of lateral tibial condyle at gerdy tubercle
describe lumbar puncture
patient on left side and fully flexed
visualise iliac crest and identify plane between them
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
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
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
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
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
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
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
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
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
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
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
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
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
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
distal attachment of hip capsule
ischiotrochanteric crest
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
describe the termination of the small saphenous vein in the popliteal fossa
passes through deep popliteal fascia to drain into popliteal vein
what is contained in the major neurovascular bundle of the popliteal fossa
tibial nerve popliteal vein (from posterior tibial) and popliteal artery
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
describe path of tibial nerve through popliteal fossa
descends vertically
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
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
when is the common fibular nerve at risk
compression against neck of fibula and fractures of fibular neck
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
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
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
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
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
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
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
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
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
what is an unhappy triad knee injury
meniscal tear
ACL rupture
MCL rupture
describe how the ACL passes across the knee
passes superior, lateral and posterior to attach to lateral femoral condyle
describe how the PCL passes across the knee
passes superiorly and anteriorly to attach to medial femoral condyle
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
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
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
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
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
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
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
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
nerve roots supplying superficial and deep fibular nerves?
deep - L4, L5
superficial - L5, S1, S2
Joints of the foot?
subtalar mid tarsal tarsometatarsal MTP interphalangeal
where is the subtalar joint located
between talus and calcaneus
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
what is the function of the arches of the foot
shock absorption
increased weight bearing capacity by weight redistribution
‘push off’ spring in function
what are all 3 arches of the foot supported by
plantar aponeurosis
3 arches of the foot?
medial longitudinal arch
lateral longitudinal
transverse arch
what bones and muscles make up the transverse arch
cuboid, cuneiforms and bases of 5 metatarsals
fibulas longs and tibialis posterior
what bones make up the lateral longitudinal arch
calcaneus, cuboid and metatarsals 4/5
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
what are intrinsic muscles with reference to the foot
muscles that attach proximally and distally within the foot
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
lymphatic drainage of the foot?
follows great and small saphenous vein
superficial veins of the foot?
dorsal venous arch giving rise to great saphenous vein medially and small saphenous laterally
deep veins of the foot?
drain into anterior and posterior tibial and fibular veins that join to form the popliteal vein
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
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
motor supply to intrinsic muscles of the foot?
tibial nerve to muscles of sole and deep fibular to muscles of the dorsum
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
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
