Lower Limb Anatomy For The MRCS Part A(Matary+miscellaneous) Flashcards
Define the femoral triangle
It is a subfascial space
What is the shape of the femoral triangle?
Is a triangular depression
What is the location of the femoral triangle?
(1) Situated in the front of the upper 1/3rd of the medial aspect of the the thigh
(2) Just below the inguinal ligament
Discuss the boundaries of the femoral triangle
What is the superior(base) boundary of the femoral triangle?
Inguinal ligament
What is the lateral boundary of the femoral triangle?
Medial border of sartorius
What is the medial boundary of the femoral triangle?
Medial border of adductor longus(so the muscle also shares in the floor)
What is the apex of the femoral triangle?
Meeting of the medial border of sartorius laterally and the medial border of adductor longus medially(the beginning of the adductor canal or hunter’s canal)
What is the significance of the apex of the femoral triangle?
The beginning of the adductor canal(hunter’s canal)
What is the shape of the floor of the femoral triangle?
Gutter shape
What is the the floor of the femoral triangle?
From lateral to medial(mnemonic;IPA):
(1) Iliopsoas(iliacus and psoas major muscle)-Iliacus lies posterior to the femoral nerve in the femoral triangle
(2) Pectineus
(3) Adductor longus
Discuss the roof of the femoral triangle
What is the location of the superficial fascia of the thigh in femoral triangle?
Just a finger breadth below the inguinal ligament
What are the constituents of the superficial fascia of the roof of the femoral triangle?
(1) Superficial fatty layer
(2) Deep membranous layer
What are the structures between the skin and the superficial fascia of the roof of the femoral triangle of the thigh?
Mnemonic;FEET GI
(1) superficial branch of (F)emoral artery
(2) superficial (E)pigastric vessels
(3) superficial (E)xternal pudendal artery
(4) (T)-shaped superficial inguinal lymph nodes(palpable below the inguinal ligament)
(5) (G)reat(long)saphenous vein
(6) (I)lioinguinal nerve
Where is the superficial inguinal lymph nodes can be palpable?
Palpable below the inguinal ligament
What is the other name of the deep fascia of the thigh?
Fascia lata
What does the deep fascia of the the thigh(fascia lata)contain ?
The saphenous opening which is a defect or a gap in the deep fascia of the thigh covered by cripriform fascia
What is covering the saphenous opening?
Cripriform fascia
Discuss the contents of the femoral triangle
What is the arrangement of the contents of the femoral triangle?
1st/At the apex-structures are arranged from anterior to posterior:-
(1) Femoral artery
(2) Femoral vein
(3) Profunda femoris vein
(4) Profunda femoris artery
2nd/In order from lateral to medial(other structures):-
(1) Great(Long) saphenous vein-lies lateral to the femoral vein
(2) Structures lie more laterally are
1)Deep and superficial inguinal lymph nodes
2)Lateral cutaneous nerve of the thigh
3)Femoral branch of the genitofemoral nerve
What is the other name of the femoral sheath?
Crural sheathe
Define the femoral sheath
Is a downward protrusion of the fascial lining of the abdominal wall into the thigh(i.e.,it is a subfascial tunnel or space)
What is the location of the femoral sheath?
Below the middle part of inguinal ligament
What is the shape of the femoral sheath?
A funnel shape sleeve or conical
What is the size of the femoral sheath?
(1)1 inch(2.5 cm) -1.56 inch(4 cm)-i.e.,it has a variable length and terminates by blending in with the adventitia
of the femoral blood vessels.4 cm long laterally and 1 cm long medially
(2)The femoral sheath surrounds the femoral vessels and lymphatics for about 1 inch(2cm) to 1.57 inch(4 cm).
4 cm below the inguinal ligament.
Discuss the formation of the femoral sheath
It is formed within the abdomen from:-
(1) Transversalis fascia
(2) Psoas fascia
What is the extension of the femoral sheath?
Extends from the abdomen,inferior to the inguinal ligament,into femoral triangle.
What is the function of the femoral sheath?
(1)Encloses the upper 4 cm of the femoral vessels
(2)It allows easy and smooth gliding of the femoral vessels during flexion and extension of the hip at the hip
joint.
Discuss the walls of the femoral sheath
There are 3 walls for this anatomical structure
1st/Anterior wall-1) continuous above with the fascia transversalis
2)It is pierced by the femoral branch of the genitofemoral nerve
2nd/Posterior wall-continuous with psoas fascia or fascia iliacus
3rd/Medial wall-lacunar ligament
Discuss the compartments of the femoral sheath
Two anteroposterior thin fibrous septa divide the femoral sheath into 3 compartments:
1st/Lateral compartment-contents
(1) common femoral artery-the femoral artery as it enters the thigh beneath the inguinal ligament occupies the lateral compartment of the femoral sheath,i.e.,lies laterally in the femoral sheath
(2) femoral branch of the genitofemoral nerve-pierces the anterior wall of the femoral sheath,running
on the anterior surface of the external iliac artery
2nd/Intermediate(middle)compartment-contents:
common femoral vein-the femoral vein as it leaves the thigh lies medial to the common femoral artery and occupies the intermediate compartment
3rd/Medial compartment-Femoral canal
What divides the femoral sheath into compartments?
Septa:-
(1) two
(2) anteroposterior
(3) thin
(4) fibrous
(5) divide the femoral sheath into 3 compartments
What are the features of the septa that divide the femoral sheath into compartments?
(1) two
(2) anteroposterior
(3) thin
(4) fibrous
(5) divide the femoral sheath into 3 compartments
What are the contents of the lateral compartment of the femoral sheath?
(1)common femoral artery
The common femoral artery as it enters the thigh beneath the inguinal ligament,occupies the lateral compartment of the femoral sheath,i.e.,it lies laterally in the femoral sheath
(2)the femoral branch of the genitofemoral nerve
Pierces the anterior wall of the femoral sheath running on the anterior surface of the external iliac artery
What is the other name of the intermediate compartment of the femoral sheath?
Middle compartment
What are the contents of the intermediate compartment of the femoral sheath?
Common femoral vein-The femoral vein as it leaves the thigh:
(1) lies medial to the common femoral artery(i.e.,lies medially in the femoral sheath
(2) occupies the intermediate(middle)compartment
What are the contents of the medial compartment of the femoral sheath?
Femoral canal
Define the femoral canal
The small medial compartment for the lymph vessels is termed the femoral canal
What is the location of the femoral canal?
The femoral canal lies at the medial aspect of the:-
(1) Femoral sheath-the femoral canal is the most medially located in the femoral sheath
(2) Femoral vein-the femoral canal lies medial to the femoral artery
What is the size of the femoral canal?
It is about 0.5 inch to 1.5 inch
What is the shape of the femoral canal?
Funnel shape
What are the boundaries(borders) of the femoral canal?
What is the other name of the inlet of the femoral canal?
(1) Base
(2) Femoral ring
Define the femoral ring
(1) It is the upper opening of the femoral canal
(2) Represents the mouth of the femoral canal in the abdomen
What is the structure that closes the femoral ring?
Femoral septum
Define the femoral septum
Is a condensation of extra peritoneal tissue and fat
What is the function of the femoral septum for the femoral ring?
These functions occurs in the following sequence:
(1) plugs the opening of the femoral ring
(2) closes the femoral ring
What are the relations and boundaries of the femoral septum in the femoral ring?
What are the relations(boundaries)of the femoral ring?
What is the other name for outlet of the femoral canal?
(1) Apex
(2) Saphenous opening
Define the saphenous opening
Is a defect or a gap in the deep fascia of the thigh(fascia lata)and covered by cripriform fascia
What is the location of the saphenous opening?
(1) In front of the thigh
(2) Just below the inguinal ligament
(3) It is situated about 1.5 inch(4 cm) below and lateral to the pubic tubercle
What are the landmarks of the saphenous opening?
(1)Cribriform fascia-a loose connective tissue filling the saphenous opening
(2)Falciform margin
.Definition:is the lower lateral border of the saphenous opening
.Location:lies anterior to the femoral vessels
Define the cripriform fascia
a loose connective tissue filling the saphenous opening
Define the falciform margin and where it is located?
.Definition:is the lower lateral border of the saphenous opening
.Location:lies anterior to the femoral vessels
Define the falciform margin
is the lower lateral border of the saphenous opening
What is the location of the falciform margin?
lies anterior to the femoral vessels
Discuss the direction of borders of the saphenous opening
What are the contents of the femoral canal?
What is the importance of the femoral canal?
What is the physiological importance of the femoral canal?
What is the pathological importance of the femoral canal?
What is the surgical importance of the femoral canal?
Discuss the femoral hernia in relation to the femoral canal
What is the mechanism of the femoral hernia in relation to the femoral canal?
Why is femoral hernia is more common in females?
What is the direction of descend of the femoral hernia?
Discuss the boundaries of the femoral sheath
What is the other name for the adductor canal?
(1) Hunter’s canal
(2) Subsartorial canal
Define the adductor canal
Is an intermuscular cleft
What is the location of the adductor canal?
(1) situated on the medial aspect of the middle 1/3rd of the thigh
(2) immediately distal to the apex of the femoral triangle
(3) deep to the sartorius muscle-since the name subsartorial canal
What is the shape of the adductor canal?
Triangular
Discuss the boundaries of the adductor canal
Where does the adductor canal begin?
It begins above at the apex of the femoral triangle
Where does the adductor canal terminate?
It ends below at the adductor hiatus (the opening in the adductor magnus)
Where does the adductor canal terminate?
It ends below at the adductor hiatus (the opening in the adductor magnus)
Discuss the walls of the adductor canal
Discuss the structure of the walls of the adductor canal?
1st/the anteromedial wall(roof)
(1) a strong fibrous wall on which lies the sartorius muscle
(2) fascia
2nd/the posterior wall(floor)
(1) adductor longus muscle
(2) adductor magnus muscle
3rd/the lateral wall
Vastus medialis muscle
Discuss the structure of the anteromedial wall(roof) of the adductor canal
(1) a strong fibrous wall on which lies the sartorius muscle
(2) fascia
Discuss the structure of the posterior wall(floor)of the adductor canal
(1) adductor longus muscle
(2) adductor magnus muscle
Discuss the structure of the lateral wall of the adductor canal
Vastus medialis muscle
Discuss the contents of the anteromedial wall(roof) of the adductor canal
Superficial femoral vein
Discuss the contents of the posterior wall(floor)of the adductor canal
Superficial femoral artery
Discuss the contents of the lateral wall of the adductor canal
Saphenous nerve
Discuss the contents of of the adductor canal in general
What is the clinical importance of the adductor canal?
Discuss the adductor canal compression syndrome
What is the incidence of the adductor canal compression syndrome?
Young male
What is the aetiology of the adductor canal compression syndrome?
Compression of the femoral artery by the muscultendinous band from the adductor canal
What is the treatment of the adductor canal compression syndrome?
Division of the abnormal band and restoration of the arterial circulation
What is the differential diagnosis of the adductor canal compression syndrome?
Popliteal fossa entrapment
Discuss the popliteal fossa entrapment in relation to the adductor canal compression syndrome
(1) is the main differential diagnosis
(2) her the popliteal pulse disappears on fully extended knee
(3) This is an important differential diagnosis in men with symptoms of acute ischaemia on extension
Discuss the above knee amputation in relation to the adductor canal
Define the popliteal fossa
Intermuscular space
What is the shape of the popliteal fossa
Diamond shaped
What is the location of the popliteal fossa?
(1) situated at the back of the knee
(2) the popliteal fossa is most prominent when the knee is flexed
What is the feature of the popliteal fossa?
The popliteal fossa is comparable to the cubital fossa of the upper limb in that both connect the upper and lower segments of the limb
Discuss the boundaries of the popliteal fossa
What is the lateral boundary of the popliteal fossa?
.Above: biceps femoris .Below: (1)lateral border of gastrocnemius muscle (2)plantaris
What is the medial boundary of the popliteal fossa?
.Above: (1)semitendinosus (2)semimembranosus .Below medial border of gastrocnemius muscle
What is the anterior wall(floor)boundary of the popliteal fossa?
1st/upper part Popliteal surface of the femur 2nd/middle part Back of the knee capsule 3rd/lower part (1)Fascia covering the popliteus muscle (2)Popliteus muscle-the lower limit of the popliteal fossa is the distal border of the popliteus muscle
Discuss the roof boundary of the popliteal fossa
What are the contents of the superficial fascia of the roof of the popliteal fossa?
(1) the upper part of the short saphenous vein
(2) branches of posterior cutaneous nerve of the thigh
Define the popliteal fascia in the roof of the popliteal fossa
Deep fascia of the roof
What are the features of the popliteal fascia in the roof of the popliteal fossa?
(1) It is a downward extension of the fascia lata
(2) It is pierced by the small saphenous vein
Discuss the contents of the popliteal fossa
What are the muscles which are contained in the popliteal fossa?
(1) Semitendinosus
(2) Semimembranosus
(3) Gastrocnemius
(4) Plantaris
What are the vessels which are contained in the popliteal fossa?
(1) Popliteal artery and its tributaries
- popliteal artery is the deepest structure in the popliteal fossa
- the popliteal pulse can be difficult to locate as it lies deep to the popliteal and tibial nerves
- it is best felt by flexing the knee with the patient prone and pushing the finger tips deep into the popliteal fossa.
(2) Popliteal vein and its tributaries
- intermediate in position
- lies deep to the tibial nerve
(3) Small saphenous vein
- pierces the deep fascia to enter the popliteal fossa
N.B:PCL is separated from the popliteal vessels by oblique popliteal ligament
What is the relation of the popliteal vessels and the posterior collateral ligament(PCL)?
The posterior collateral ligament(PCL) is separated from the popliteal vessels by the oblique popliteal ligament
What are the nerves which are contained in the popliteal fossa?
What is the deepest structure in the popliteal fossa?
Popliteal artery and its tributaries
What are the most superficial structures in the popliteal fossa?
Discuss the arrangements of the contents in the popliteal fossa
Which structure is more superficial in the popliteal fossa?
Tibial nerve(medial popliteal nerve)
What is the location of the tibial nerve in the popliteal fossa?
(1) It is the most superficial structure in the popliteal fossa
(2) In the upper part of the fossa(i.e., the upper part of the tibial nerve) lies lateral to the popliteal vessels
(3) In the lower part of the fossa(i.e.,the lower part of the tibial nerve ) lies superior to the popliteal vessels
What is the course of the tibial nerve in the popliteal fossa?
(1) Bisects the popliteal fossa from the upper to the lower angle
(2) It then passes superficial to the popliteal vessels to lie medially
What are the types of the retinacula around the ankle?
There are two retinacula:
(1) Extensor retinaculum
(2) Flexor retinaculum
How did the retinacula around the ankle form?
These are fromed by thickened deep fascia
What is the function of the retinacula around the ankle?
Their function is to maintain the position of long tendons crossing the ankle
Enumerate the structures that pass anterior or superficial to the extensor retinaculum on the anterior surface of the ankle from medial to lateral
(1) Saphenous nerve and great saphenous vein(anterior to medial malleolus)
(2) Superficial peroneal nerve
Enumerate the structures that pass deep or posterior to the extensor retinaculum from medial to lateral
Enumerate the structures that pass behind the medial malleolus beneath the flexor retinaculum from medial to lateral
Draw a schematic diagram illustrating the structures around the ankle(extensor and flexor retinacula)
What the significance of the femoral artery?
(1) The femoral artery is the main arterial supply of the lower limb
(2) It is the main artery of the lower limb and also supplies part of the anterior abdominal wall
Discuss the course of the femoral artery
Where does the femoral artery begin?
(1) Behind the inguinal ligament
(2) At the midinguinal point(midway between the ASIS and symphysis pubis)
(3) The femoral artery is the continuation of the external iliac artery from the pelvis
What is the pathway of the femoral artery in relation to its course?
(1) It enters the thigh deep to the inguinal ligament
(2) Here,it lies at the midinguinal point(which is midway between ASIS and symphysis pubis)
(3) It descends almost vertically towards the adductor tubercle of the femur
(4) Its upper 1/2 lies superficial in the femoral triangle
(5) Its lower 1/2 lies deep in the subsartorial canal
Where does the femoral artery terminate?
(1)At the junction of the upper 2/3 and lower 1/3 of the thigh
(2)Ends by passing through the adductor hiatus(an opening in the adductor magnus muscle between
2 insertions,10 cm above the knee)
(3)Enter the popliteal space as the popliteal artery
What are the superficial branches of the femoral artery?
What are the deep branches of the femoral artery?
Discuss the superficial circumflex iliac artery in relation to the femoral artery
It is a small branch that runs up to the region of the ASIS
Discuss the superficial epigastric artery in relation to the femoral artery?
It is a small branch that
- crosses the inguinal ligament
- runs up to the region of the umbilicus
Discuss the superficial external pudendal artery in relation to the femoral artery
It is a small branch that runs medially to the skin of the scrotum(or labium majus)
Discuss the deep external pudendal artery in relation to the femoral artery
Runs medially to supply the skin of the scrotum(or labium majus)
What are the other names for the Profunda femoris artery?
(1) Deep femoral artery
(2) Deep artery of the thigh
What is the significance of the Profunda femoris artery?
(1) It is the largest branch of femoral artery
(2) It is the main blood supply to the medial and posterior compartments of the thigh
What is the the pathway of the of the Profunda femoris artery in relation to the femoral artery?
What is the origin of the Profunda femoris artery in relation to the femoral artery?
(1) It arises from the posterolateral aspect of the common femoral artery
(2) 2-4 cm distal to the inguinal ligament
What is the course of the Profunda femoris artery in relation to the femoral artery?
Discuss the branches of the profunda femoris artery
What is the other name for the descending genicular artery
Anastomotica magna
Discuss the descending genicular artery
Discuss the relations of the femoral artery
Discuss the relations of the common femoral artery above the origin of the profunda femoris artery
What is the location of the common femoral artery above the origin of the profuda femoris artery?
Lies in the lateral compartment of the femoral sheath
Discuss the anterior relations of the common femoral artery above the origin of the profunda femoris artery
What is the anterior relation of the common femoral artery above the origin of the profunda femoris artery in the upper part of its course?
Skin and fascia:-
In the upper part of its course it is superficial and is covered by skin and fascia roofing the femoral triangle
What is the anterior relation of the common femoral artery above the origin of the profunda femoris artery in the lower part of its course?
Sartorius muscle
In the lower part of its course,it passes deep to the sartorius muscle in the adductor canal
What is the posterior relation of the common femoral artery above the origin of the profunda femoris artery ?
What is the medial relation of the common femoral artery above the origin of the profunda femoris artery?
Femoral vein-it is related to the femoral vein in the upper part of its course
What is the lateral relation of the common femoral artery above the origin of the profunda femoris artery ?
What are the relations of the superficial femoral artery below the origin of the profunda femoris artery?
What are the relations of the superficial femoral artery when it passes first in the femoral triangle?
What are the structures deep to the superficial femoral artery when it passes first in the femoral triangle?
(1) Profunda vessels
(2) Pectineus
(3) Adductor longus muscle
What is the relations of the superficial femoral artery to the femoral vein when it passes first in the femoral triangle?
The femoral vein is first medial and then behind the artery
What are the relations of the superficial femoral artery when it passes in the adductor canal ?
What is the structure that the superficial femoral artery lies posterior to it when it passes in the adductor canal?
It lies posterior to sartorius
What is the relation of the superficial femoral artery to the femoral vein when it passes in the adductor canal ?
The femoral vein is first behind and then lateral to the artery
Discuss the surface anatomy of the femoral artery
How to expose the femoral artery?
Discuss the pathway of the popliteal artery
What is the origin of the popliteal artery?
As the continuation of the femoral artery as it traverses the adductor hiatus
Discuss the course of the popliteal artery
Discuss the location of the popliteal artery
What is the location of the popliteal artery in general?
It is deeply placed
How does the popliteal artery enter the popliteal fossa?
Enters the popliteal fossa through the adductor hiatus(the opening in the adductor magnus)
What is the location of the popliteal artery in the popliteal fossa?
It descends as the deepest structure in the popliteal fossa over the floor of popliteal fossa lying on:-
(1) Popliteal surface of femur
(2) Back of capsule of knee joint
(3) Fascia covering popliteus muscle
How does the popliteal artery exist the popliteal fossa?
The popliteal artery exits the popliteal fossa between the gastrocnemius and popliteus muscles
How does the popliteal artery terminate?
Define the adductor hiatus
(1) The opening in the adductor magnus muscle between 2 insertions
(2) 10 cm above the knee joint
Discuss branches of the popliteal artery
What is the other name for the muscular branches of the popliteal artery?
Sural branches
Discuss the muscular(sural) branches of the popliteal artery
Supply the extensor compartment of the leg:-
(1) Gastrocnemius
(2) Soleus
(3) Plantaris
Discuss the 5 genicular branches of the popliteal artery
What is the superior medial genicular artery?
(1) It is a branch of the popliteal artery
(2) Passes over the medial femoral condyle
What is the superior lateral genicular artery?
(1) It is a branch of the popliteal artery
(2) Passes over the lateral side femoral condyle
What is the inferior medial genicular artery?
(1) It is a branch of the popliteal artery
(2) Passes below the medial tibial condyle
What is the inferior lateral genicular artery?
(1) It is a branch of the popliteal artery
(2) Passes below the lateral tibial condyle
What are the terminal branches of the popliteal artery?
(1)  Anterior tibial artery
(2) Posterior tibial artery
What are the anterior(deep) relations of the popliteal artery?
(1) Popliteal surface of the femur
(2) Knee joint-back of the capsule of the knee,oblique popliteal ligament
(3) Popliteus muscle and covering fascia
What are the posterior(superficial) relations of the popliteal artery?
Crossed from lateral to medial by:-
(1) Popliteal vein
(2) Fascia
(3) Skin
(4) Above-Semimembranosus
(5) Below-Gastrocnemius and Plantaris
Discuss the surgical importance of the popliteal artery
Define the posterior tibial artery
Is the largest terminal branch of the popliteal artery
What is the origin of the posterior tibial artery?
Arises as the larger of 2 terminal branches of popliteal artery at the lower border of popliteus muscle
Discuss the course of posterior tibial artery
What is the termination of the posterior tibial artery?
Discuss branches of the posterior tibial artery
Discuss fibular artery as a branch of the posterior tibial artery
Define fibular artery as a branch of posterior tibial artery
Is a large artery
What is the site of origin of fibular artery?
It arises close to the origin of the posterior tibial artery
Discuss the course of fibular artery as a branch of the posterior tibial artery
It descends behind the fibula,either
1) within the substance of the flexor hallucis longus muscle or
2) posterior to it
What is the termination of the tibial artery?
It ends by taking part in the anastomoses around the ankle joint
What are the branches of fibular artery?
The fibular artery gives off
1) numerous muscular branches to the fibula
2) nutrient artery to the fibula
3) perforating branches-pierces the Interosseous membrane to reach the lower part of the front of the leg
Discuss the muscular branches of fibular artery
Discuss the anastomotic branches of posterior tibial artery
Discuss the vena comitantes branches of posterior tibial artery
