Lower Limb And Foot Flashcards
Hip, thigh, leg and foot
Label this diagram of a pelvis.
1=gluteal lines
2=posterior superior iliac spine
3=posterior inferior iliac spine
4=greater sciatic notch
5=body of ilium
6=ischial spine
7=lesser sciatic notch
8=body of ischium
9=ischial tuberosity
10=ramus of ischium
11=inferior pubic ramus
12=obturator crest
13=pubic tubercle
14=superior pubic ramus
15=acetabular notch
16=acetabular margin
17=lunate surface
18=acetabulum
19=anterior inferior iliac spine
20=anterior superior iliac spine
21=gluteal surface
22=iliac crest
23 obturator foramen
24=anterior superior iliac spine
25=iliac fossa
26=anterior inferior iliac spine
27=arcuate line
28=iliopubic eminence
29=superior pubic ramus
30=pecten pubis
31=pubic tubercle
32=symphyseal surface
33=obturator groove
34=inferior pubic ramus
35= ramus of ischium
36=ischial tuberosity
37=body of ischium
38=lesser sciatic notch
39=body of ilium
40=ischial spine
41=greater sciatic notch
42=posterior inferior iliac spine
43=auricular surface for sacrum
44=posterior superior iliac spine
45=iliac tuberosity
46=iliac crest
47=obturator foramen
48=ilium
49=ischium
50=pubis
Label this diagram of a femur.
1=neck
2=lateral epicondyle
3=patellar surface
4=fovea capitis
5=head
6=lesser trochanter
7=intertrochanteric line
8/15=adductor tubercle
9/16=medial epicondyle
10=gluteal tuberosity
11=linea aspera
12=medial and lateral supracondylar lines
13=intercondylar fossa
14=medial condyle
17=lateral epicondyle
18=lateral condyle
19=intertrochanteric crest
20=greater trochanter
What is osteitis pubis?
It is an inflammatory condition affecting the pubic symphysis. Occurs in athletes. Symptoms include pain in the pelvic region, worsened when doing twisting activities. Corticosteroids may be administered.
Label this diagram of the leg.
1=intercondylar eminence
2=lateral condyle
3=head
4=proximal tibiofibular joint
5=fibula
6=distal tibiofibular joint
7=lateral malleolus
8=articular surface
9=medial malleolus
10=tibia
11=anterior crest
12=interosseous membrane
13=tibial tuberosity
14=medial condyle
15=articular surface of medial condyle
16=articular surface of lateral condyle
17=head of fibula
18=fibula
19=lateral malleolus
Label the ligaments shown in this diagram.
(LIGAMENT)
1=anterior sacroiliac
2=superior pubic
3=arcuate pubic
4=(interpubic disc), pubic symphysis
5=iliofemoral
6=inguinal
7=iliolumbar
8=anterior longitudinal
Which two ligaments divide the greater and lesser sciatic foramen?
The sacrospinous and sacrotuberous ligaments
List the contents of the greater sciatic foramen.
Piriformis
Superior to piriformis: superior gluteal nerve, artery and vein.
Inferior to piriformis: sciatic, posterior cutaneous nerve of thigh, nerve to QF, nerve to OI and pudendal nerves. Inferior gluteal nerve, artery and vein. Internal pudendal artery and vein.
List the contents of the lesser sciatic foramen.
Tendon of obturator internus.
Superior to tendon of OI: pudendal nerve, internal pudendal artery and vein.
Inferior to tendon of OI: nerve to obturator internus.
List the 3 intrinsic hip ligaments.
Ischiofemoral, pubofemoral, iliofemoral
List the muscles of the hip, classify them.
Anterior: iliacus, psoas major/minor
Posterior, superficial: gluteus maximus/medius, minimus, tensor fascia lata
Posterior, deep: piriformis, obturator internus, gemellus superior/inferior, quadratus femoris
Medial: obturator externus.
State the classification, origins, insertions, actions and nerve supply of iliacus.
Classification: hip, anterior
Origins: iliac fossa (pelvis), iliac crest, anterior sacroiliac ligaments and sacroiliac joint capsule
Insertion: lesser trochanter
Actions: hip flexion, lateral rotation
Nerve supply: femoral nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of psoas major.
Classification: hip, anterior
Origins: Bodies/intervertebral discs and transverse processes of L1 to L5
Insertion: lesser trochanter
Actions: hip flexion, lateral rotation
Nerve supply: lumbar plexus (L1-3)
State the classification, origins, insertions, actions and nerve supply of psoas minor.
Classification: hip, anterior
Origins: bodies/intervertebral discs of T12 and L1
Insertions: pecten pubis, iliopubic eminence
Actions: flexion of L spine
Nerve supply: lumbar plexus (L1)
State the classification, origins, insertions, actions and nerve supply of gluteus maximus.
Classification: hip, posterior, superficial
Origins: posterior ilium, sacrum and coccyx, sacrotuberous ligament, thoracolumbar fasia
Insertions: iliotibial tract, gluteal tuberosity
Actions: extension and lateral rotation of hip
Nerve supply: inferior gluteal nerve (L5,S1,S2)
State the classification, origins, insertions, actions and nerve supply of gluteus medius/minimus.
Classification: hip, posterior, superficial
Origins: outer ilium, gluteal aponeurosis
Insertion: lateral/anterior surface of greater trochanter
Actions: abduction and medial rotation of the thigh
Nerve supply: superior gluteal nerve (L4,L5,S1)
State the classification, origins, insertions, actions and nerve supply of tensor fasciae latae.
Classification: hip, posterior, superficial
Origins: ASIS, anterior iliac crest
Insertions: iliotibial tract
Actions: abduction, flexion and medial rotation of hip. Tension of iliotibial tract (part of fasciae lata), providing a stable gait.
Nerve supply: superior gluteal nerve (L4,L5,S1)
State the classification, origins, insertions, actions and nerve supply of piriformis.
Classification: hip, posterior, deep
Origins: anterior sacrum (S2-4), sacrotuberous ligament
Insertion: superior greater trochanter
Actions: lateral rotation and abduction of hip
Nerve supply: nerve to piriformis (S1,2)
State the classification, origins, insertions, actions and nerve supply of obturator internus.
Classification: hip, posterior, deep
Origins: internal obturator membrane, borders of obturator foramen
Insertion: medial greater trochanter (through LSF) (with tendons of GS and GI)
Actions: lateral rotation, abduction of thigh
Nerve supply: nerve to obturator internus (L5, S1)
State the classification, origins, insertions, actions and nerve supply of gemellus superior/inferior.
Classification: hip, posterior, deep
Origins: ischial spine/tuberosity
Insertions: medial greater trochanter (with tendon of OI)
Actions: lateral rotation and abduction of thigh
Nerve supply: nerve to OI/QF (L5,S1)
State the classification, origins, insertions, actions and nerve supply of quadratus femoris.
Classification: hip, posterior, deep
Origins: lateral ischial tuberosity
Insertions: quadrate tubercle (on intertrochanteric crest)
Actions: lateral rotation of thigh
Nerve supply: nerve to quadratus femoris (L4,L5,S1) (sacral plexus)
State the classification, origins, insertions, actions and nerve supply of obturator externus.
Classification: hip, medial
Origin: external surface of obturator membrane and surrounding bone
Insertion: trochanteric fossa
Action: lateral rotation, adduction and of hip
Nerve supply: obturator nerve (L3,4)
State the boundaries of the popliteal fossa.
Superior/medial: semimembranosus
Superior/lateral: long head of biceps femoris
Inferior/medial and lateral: medial and lateral heads of gastrocnemius
Floor: femur, popliteus, oblique popliteal ligament (from tendon of semimembranosus)
State the contents of the popliteal fossa from lateral to medial.
Common peroneal nerve, tibial nerve, popliteal vein, popliteal artery
State the tests for ACL tears.
Lachman’s test-move tibia anteriorly relative to femur.
Pivot shift test-internally rotate an elevated and extended leg, apply valgus (medial) stress, flex the knee in this manner. Produces a disconcerting feeling.
Anterior drawer test-flex knee, sit on foot, push posteriorly and pull anteriorly, ensuring a firm end point.
State the tests for meniscal tears.
McMurray’s test-flex hip and knee fully, laterally rotate foot, medially pivot knee or oppositely.
Ege’s test-a McMurray’s test that is weightbearing. Squatting with a fully externally/internally rotated foot.
What is O’Donohue’s unhappy triad of the knee?
Ruptured MCL, ACL and damage to the medial meniscus
State the posterior thigh muscles.
Biceps femoris, semitendinosus, semimembranosus. These collectively make up the hamstring. They all originate from the ischial tuberosity. They are all innervated by the tibial part of the sciatic nerve (L5,S1,S2)
State the classification, origins, insertions, actions and nerve supply of biceps femoris.
Classification: posterior thigh
Origins: ischial tuberosity (long head) and lateral lip of linea aspera and lateral supracondylar line of femur (short head)
Insertion: head of fibula
Actions: hip extension (long head), flexion and lateral rotation of knee (both heads)
Nerve supply: LH-tibial sciatic nerve SH-common peroneal nerve (L5,S1,S2)
State the classification, origins, insertions, actions and nerve supply of semitendinosus.
Classification: posterior thigh
Origin: ischial tuberosity
Insertion: medial proximal tibia
Action: extension and medial rotation of hip, flexion and medial rotation of knee
Nerve supply: tibial sciatic nerve (L5,S1,S2)
State the classification, origins, insertions, actions and nerve supply of semimembranosus.
Classification: posterior thigh
Origin: ischial tuberosity
Insertion: posterior medial condyle of tibia
Action: extension and medial rotation of hip, flexion and medial rotation of knee.
Nerve supply: tibial sciatic nerve (L5,S1,S2)
State the muscles of the anterior thigh.
(Iliopsoas), quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius, involved in locking of knee), sartorius. All innervated by femoral nerve (L2-4).
State the classification, origins, insertions, actions and nerve supply of sartorius.
Classification: anterior thigh
Origin: ASIS of pelvis
Insertion: medial proximal tibia
Actions: flexion, abduction and lateral rotation of hip, flexion and medial rotation of knee
Nerve supply: femoral nerve (L2,3)
State the classification, origins, insertions, actions and nerve supply of rectus femoris.
Classification: anterior thigh, quadriceps femoris
Origin: straight head: AIIS, reflected head: iliopubic eminence
Insertion: patella-patellar ligament-tibial tuberosity
Action: knee extension, hip flexion
Nerve supply: femoral nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of vastus lateralis.
Classification: anterior thigh, quadriceps femoris
Origins: greater trochanter and lateral lip of linea aspera
Insertion: patella-patellar ligament-tibial tuberosity
Action: knee extension
Nerve supply: femoral nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of vastus medialis.
Classification: anterior thigh, quadriceps femoris
Origin: medial lip of linea aspera
Insertion: patella-patellar ligament-tibial tiberosity
Action: knee extension
Nerve supply: femoral nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of vastus intermedius.
Classification: anterior thigh, quadriceps femoris
Origin: anterior and lateral surfaces of femur
Insertion: patella-patellar ligament-tibial tiberosity
Action: knee extension
Nerve supply: femoral nerve (L2-4)
State the muscles found in the medial thigh.
Adductor longus, adductor brevis, adductor magnus, gracilis, pectineus.
State the classification, origins, insertions, actions and nerve supply of adductor longus.
Classification: medial thigh
Origin: body of pubis (below pubic crest)
Insertions: middle of linea aspera
Actions: adduction, flexion and medial rotation of hip
Nerve supply: obturator nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of adductor brevis.
Classification: medial thigh
Origins: body of pubis and inferior pubic ramus
Insertion: proximal linea aspera
Actions: adduction, flexion and medial rotation of hip
Nerve supply: femoral nerve (L2-4)
State the classification, origins, insertions, actions and nerve supply of adductor magnus.
Classification: medial thigh
Origins: adductor head: inferior pubic ramus and ischial ramus/hamstring head: ischial tuberosity
Insertions: adductor head: gluteal tuberosity, linea aspera and medial supracondylar line/hamstring head: adductor tubercle
Actions: adduction, flexion/ extension, medial rotation of the hip
Nerve supply: obturator nerve (L2-4)/tibial sciatic nerve (L4)
State the classification, origins, insertions, actions and nerve supply of pectineus.
Classification: medial thigh
Origins: pecten pubis
Insertion: pectineal line of femur
Actions: adduction, flexion and medial rotation of hip
Nerve supply: femoral nerve (L2,3) (ON sometimes)
What muscles terminate at the pes anserinus tendon and where does it attach?
Sartorius, gracilis and semitendinosus end in this conjoined tendon. This tendon attaches to the medial aspect of the proximal tibia, located below the medial tibial plateau.
State the boundaries of the femoral triangle.
Superior: inguinal ligament
Medial: adductor longus
Lateral: sartorius
Floor: iliopsoas and pectineus
Roof: skin and fascia lata
State the contents of the femoral triangle from lateral to medial.
Femoral nerve, artery, vein, Cloquet’s nodes (deep inguinal lymph). The empty space is known as the femoral canal.
Sacral plexus; state: location, root values, the terminating branches and their root values.
Pelvis, on the anterior piriformis
L4-S4
Sciatic (L4-S3), superior gluteal (L4,L5,S1), inferior gluteal (L5,S1,S2), pudendal (S2,3,4), N. to QF (L4,L5,S1), N. to OI (L5,S1,S2), posterior femoral cutaneous (S1,2,3), pelvic splanchnic (S2,3,4)
Lumbar plexus; state: location, root values and terminating branches.
Psoas major, in the retroperitoneal space
T12-L4
Femoral (L2-4), obturator (L2-4), lumbosacral trunk (L4,5 to SP), iliohypogastric (L1), ilioinguinal (L1), genitofemoral (L1,2), lateral cutaneous nerve of thigh (L2,3)
Which quadrant is considered the “safe injection site”?
Upper right quadrant of the gluteal region
What are the terminal divisions of the sciatic nerve?
Tibial nerve, common peroneal nerve
Label this diagram of a right foot.
1=calcaneum
2=talus
3=cuboid
4=navicular
5a=medial cuneiform
5b=intermediate cuneiform
5c=lateral cuneiform
6=metatarsals 1-5
7=phalanges 1-5
State the muscles of the anterior leg.
Tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius. All innervated by the deep peroneal (fibular) nerve.
State the classification, origins, insertions, actions and nerve supply of tibialis anterior.
Classification: leg, anterior
Origins: proximal 2/3rds of lateral tibia and interosseous membrane
Insertions: medial cuneiform and base of 1st metatarsal
Actions: dorsiflexion and inversion
Nerve supply: deep peroneal nerve (L4,5)
State the classification, origins, insertions, actions and nerve supply of extensor hallucis longus.
Classification: leg, anterior
Origins: middle 2/3rds of fibula and interosseous membrane
Insertions: base of 1st distal phalanx (hallux)
Actions: extension of MTP and IP joints, dorsiflexion and eversion of foot.
Nerve supply: deep peroneal nerve (L4,5)
State the classification, origins, insertions, actions and nerve supply of extensor digitorum longus.
Classification: leg, anterior
Origins: lateral condyle of tibia, proximal 3/4ths of fibula and interosseous membrane
Insertions: middle and distal phalanges of 2nd to 5th digits
Actions: extension of lateral 4 MTP and IP joints, dorsiflexion and eversion of foot.
Nerve supply: deep peroneal nerve (L4,L5,S1)
State the classification, origins, insertions, actions and nerve supply of peroneus tertius.
Classification: leg, anterior
Origins: distal 1/3rd of fibula and interosseous membrane
Insertion: dorsal base of 5th metatarsal
Actions: dorsiflexion and eversion of foot
Nerve supply: deep peroneal nerve (L4,L5,S1)
State the muscles of the lateral leg.
Peroneus longus and brevis
State the classification, origins, insertions, actions and nerve supply of peroneus longus.
Classification: leg, lateral
Origins: head and proximal fibula
Insertions: base of 1st metatarsal and medial cuneiform
Actions: eversion and plantar flexion of foot
Nerve supply: superficial peroneal nerve (L5,S1,S2)
State the classification, origins, insertions, actions and nerve supply of peroneus brevis.
Classification: leg, lateral
Origins: distal fibula
Insertion: lateral tuberosity at the base of 5th metatarsal
Actions: eversion and plantar flexion of foot
Nerve supply: superficial peroneal nerve (L5,S1,S2)
State the muscles of the posterior leg.
Superficial: gastrocnemius, soleus, plantaris
Deep: popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior. All innervated by the tibial nerve. Deeps support longitudinal archs.
State the classification, origins, insertions, actions and nerve supply of gastrocnemius.
Classification: leg, posterior, superficial
Origins: (2 heads) lateral condyle of femur, medial head of femur
Insertions: calcaneus by AT
Actions: plantar flexion of ankle and flexion of knee
Nerve supply: tibial nerve (S1,2)
State the classification, origins, insertions, actions and nerve supply of soleus.
Classification: leg, posterior, superficial
Origins: head and proximal fibula, soleal line of tibia
Insertions: calcaneus by AT
Actions: plantarflexion of ankle
Nerve supply: tibial nerve (S1,2)
State the classification, origins, insertions, actions and nerve supply of plantaris.
Classification: leg, posterior, superficial
Origins: lateral supracondylar ridge of femur
Insertions: calcaneus by AT
Actions: plantar flexion of ankle and flexion of knee
Nerve supply: tibial nerve (S1,2)
State the classification, origins, insertions, actions and nerve supply of popliteus.
Classification: leg, posterior, deep
Origin: lateral condyle of femur
Insertion: proximal tibia
Actions: unlocking of knee (lateral rotation of femur), knee flexion
Nerve supply: tibial nerve (L4,L5,S1)
State the classification, origins, insertions, actions and nerve supply of flexor hallucis longus.
Classification: leg, posterior, deep
Origin: posterior fibula
Insertion: base of distal hallux
Action: flexion of hallux, plantar flexion of ankle
Nerve supply: tibial nerve (S2,3)
State the classification, origins, insertions, actions and nerve supply of flexor digitorum longus.
Classification: leg, posterior, deep
Origin: posterior tibia
Insertions: bases of distal phalanges of lateral 4 digits
Actions: flexion of lateral 4 DIP, PIP, MTP joints and plantar flexion of ankle
Nerve supply: tibial nerve (S2,3)
State the classification, origins, insertions, actions and nerve supply of tibialis posterior.
Classification: leg, posterior, deep
Origin: posterior tibia, fibula and interosseous membrane
Insertions: navicular, 3 cuneiforms, cuboid and bases of 2nd, 3rd and 4th metatarsals
Action: inversion and plantar flexion of foot
Nerve supply: tibial nerve (L4,5)
What is the os coxae?
Half the pelvis is the os coxae (hip bone)
Which artery gives off the branch running with the ligament of the head of the femur?
Artery: obturator artery
Branch: artery to head of femur
What is the epiphyseal growth plate of the acetabulum also known as?
Triradiate cartilage
In adults, what is the normal angle between the long axes of the femoral neck and shaft?
125 degrees
In the pelvic synovial joints, fibrocartilage is found on the articular surface of which bone?
Acetabulum
What ligament of the hip forms the orbicular zone of capsular tightening?
Iliofemoral ligament
In adults, what is the normal femoral neck angle of anteversion?
8 to 15 degrees
In open reduction and fixation (ORIF) procedures, what type of femoral fracture is fixed using a dynamic hip screw?
Intertrochanteric femoral fracture
What essential actions do the deep glutei of the grounded lower limb perform during gait?
Hip stabilization, lateral rotation, abduction and pelvic control
What is the most commonly injured hamstring muscle?
Biceps femoris, especially its long head
In surgical reconstruction of the anterior cruciate ligament, tendon graft protocols sometimes utilize which tendon
Patellar tendon, hamstrings tendon or quadriceps tendon
The superior and inferior gemelli are associated (run alongside) with what muscle tendon?
Obturator internus
Which nerve is most often entrapped in piriformis syndrome?
Sciatic nerve
Where does the straight head of the rectus femoris attach?
AIIS
What branch of the lumbar plexus supplies the skin over the femoral triangle?
Ilioinguinal nerve
What myotome does the efferent loop of the patella tendon reflex test?
L2,3,4, especially L4
The most distal site of cutaneous innervation of the femoral nerve is the skin of the…
Medial side of the leg and foot
What nerve is entrapped in the clinical syndrome ‘meralgia paresthetica’?
Lateral femoral cutaneous nerve
State the inferior and superior attachments of the ACL and PCL.
The superior PCL attaches anteromedially to the medial femoral condyle. The inferior PCL attaches to the posterior intercondylar area of the tibial plateau.
The superior ACL attaches posteromedially to the lateral femoral condyle. The inferior ACL attaches to the anterior intercondylar area of the tibial plateau.
What ligaments tighten and loosen during the locking and unlocking of the knee?
In the knee lock, the ACL, PCL and the lateral/medial collateral ligaments tighten. In the knee unlock, the collateral ligaments loosen, and some of the fibers of the ACL and PCL loosen while some remain taut.
State the borders of the tarsal tunnel.
Roof/medial: flexor retinaculum
Floor: medial surface of tibia, talus, calcaneus and sustentaculum tali
State the contents of the tarsal tunnel from anterior to posterior.
Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, tibial nerve, flexor hallucis longus tendon.
Tom, Dick and very nervous Harry.
‘March’ type stress fractures typically occur in which bones?
March type stress fractures typically occur in the 2nd metatarsal.
Which ligament makes up part of the talocalcaneonavicular joint?
The plantar calcaneonavicular ligament (spring ligament)
Label this diagram of the calcaneus. (7 is listed twice)
1=anterior talar articular surface
2=middle talar articular surface
3=calcaneal sulcus
4=sustentaculum tali
5=posterior talar articular surface
6=upper part of posterior surface
7=insertion of calcaneal tendon (Achilles)
7=articular surface with cuboid bone
8=calcaneal tubercle
9=notch
10=lateral process
11=calcaneal tuberosity
12=medial process
13=groove for FHL
14=posterior talar surface
15=attachment of lateral collateral ligament of ankle
16=fibular trochlea
17=anterior talar articular surface
18=middle talar articular surface
19=calcaneal sulcus
What are the primary roles of the dorsal/plantar interosseous muscles in the hand and foot?
Dorsal interossei abduct and plantar interossei adduct the digits.
State the contents of the anterior compartment of the ankle, from medial to lateral.
TA, EHL, anterior tibial artery, deep peroneal nerve, EDL, PT.
TEADEP
State the contents of the lateral (peroneal) compartment of the ankle, from superior to inferior.
PL, PB
