Lower limb and hip Flashcards
what are the 6 regions of the lower leg?
gluteal, femoral, knee, leg, ankle and foot.
what is the proper name for your butt crack?
intergluteal cleft
what are the superficial muscles of the gluteal region?
the gluteus maximus, the gluteus medius, the gluteus minimus and the tensor fascia latae
what is the tensor fascia latae?
a superficial gluteal muscle and the muscular part of the fascia latae.
what movements of the thigh do the superficial gluteal muscles carry out?
extensors, abductors and medial rotators of the thigh.
what two nerves supply the gluteal region and what structures do they innervate?
the inferior gluteal nerve supplies the gluteus maximus. the superior gluteal nerve does the other three muscles.
where is the inferior gluteal neurovascular bundle located?
deep to the gluteus maximus.
what nerve roots are included in the inferior gluteal nerve?
L1, S1 and S2.
what are the four deep muscles of the gluteal region?
piriformis, obturator internus, gemeli and quadratus femoris.
what movements do the deep muscles of the gluteal region cause?
lateral rotation of the thigh and they stabilise the hip
what plexus supplies the gluteal region?
the sacral plexus.
what does the gluteus maximus attach to?
the iliac crest, sacrum, the sacrotuberous ligament, the coccyx, the gluteal tuberosity of the femur and the iliotibial tract.
what is the iliotibial tract otherwise called?
the iliotibial band.
what is the main function of the gluteus maximus?
extension of the hip. used climbing stairs or getting up from a chair.
where do the gluteus medius and minimus both attach?
to the ilium and the anterolateral aspect of the greater trochanter of the femur.
what movements do the gluteus medius and minimus cause?
abduct and medially rotate the thigh.
where is the gluteus medius nerve located?
deep to the gluteus medius
what can damage to the gluteus medius and minimus called?
trendelenburgs gate.
what movement do the deep layer of gluteal muscles cause?
lateral rotation of the hip.
where do all the deep gluteal muscles attach to laterally?
the greater trochanter of the femur
what role other than movement do the deep gluteal muscles serve?
stabilise the head of the femur in the acetabulum.
where do nerves enter and exit the pelvis and perineum?
via the greater and lesser sciatic foramen.
what does the greater sciatic foramen have travelling through it?
the piriformis muscle (mainly)
what does the lesser sciatic foramen contain?
the pudendal nerves and vessels (mostly)
what splits the sciatic notch into the greater and lesser foramen?
the sacrotuberous and sacrospinous ligaments
what quarter of the gluteal region should we inject into?
the upper left lateral quadrant.
what is the largest nerve in the body?
the sciatic
what does the sciatic nerve supply?
posterior thigh, all leg, intrinsic foot muscles and most of the skin.
what is the principle nerve to the perineum?
the pudendal nerve.
where does the pudendal nerve form and then emerge?
in the sacral plexus and emerges in the middle of the gluteal region.
what does the pudendal nerve supply?
supplies the muscles, skin and fascia and much of the perineum.
what nerve roots form the posterior cutaneous nerve of the thigh?
S1-S3
what does the posterior cutaneous nerve supply?
skin of the posterior thigh, popliteal fossa, lateral perineum and upper medial thigh.
What type of nerve is the posterior cutaneous nerve of the thigh?
What fibres does it contain?
Somatic nerve.
Contains sensory and sympathetic fibres.
Where does the sciatic nerve emerge?
Into the middle of the gluteal region.
If we see a nerve exiting inferior to the piriformis, what nerve is this?
The sciatic
What is the sciatic nerve comprised of?
The tibial and common fibular nerve wrapped in connective tissue.
What is usually the most lateral thing exiting the greater sciatic foramen?
The sciatic nerve.
Where does the sciatic nerve separate in around 12% of people?
As it leaves the pelvis
What parts of the gluteal region does the sciatic nerve supply as it passes down into the posterior thigh?
None of it
Where does the sciatic nerve go as it descends down the leg?
Descends down the posterior thigh then its branches pass through the popliteal fossa and then the posterior and lateral compartments of the leg into the foot.
What vessel supplies the sciatic nerve?
The artery to the sciatic nerve.
Where does the sciatic nerve most commonly split into the common fibular and tibial nerve?
The inferior third of the thigh
Where does the common fibular nerve enter the anterior compartment of the leg?
From the popliteal fossa superficial to the neck of the fibula.
What does the common fibular nerve divide into and where?
Divides at the fibular neck into the superficial fibular nerve and the deep fibular nerve.
What does the superficial fibular nerve supply?
Supplies the lateral compartment of the leg and the skin/fascia of the dorsum of the foot.
What does the deep fibular nerve supply?
The muscles of the anterior compartment of the leg and the skin of the first interdigital cleft.
Where is the common fibular nerve most vulnerable to injury?
What types of injury can cause damage?
Tight plasters etc can cause compression damage against the neck of the fibula and fractures of the fibular neck can damage it.
What are the boundaries of the femoral triangle?
Superior -the inguinal ligament
Medially - the lateral border of adductor Longus
Laterally - the medial border of sartorious.
What makes up the floor of the femoral triangle?
Iliopsoas laterally and the pectineus medially
What makes the roof of the femoral triangle?
The fascia latae
What are the contents of the femoral triangle from lateral to medial?
Nerve, artery, vein and canal.
What parts of the femoral triangle are wrapped in the femoral sheath?
The most proximal parts of the femoral artery and vein.
What is contained in the femoral canal?
Deep inguinal lymph nodes and fat.
What part of the femoral sheath does the femoral canal form?
The most medial part.
What fascias make up the femoral sheath?
Transversalis and iliopsoas fascia from the abdominal wall
Where does the femoral nerve lie in relation to the femoral sheath?
Outside and lateral to it.
What fascia separates the different compartments in the leg?
Intermuscular septum
What are the compartment of the thigh?
Anterior, posterior and medial.
What are the compartment of the leg?
Anterior, posterior and lateral
What general rule can we follow when thinking of the action and innervation of the muscles in the same compartments of the legs?
How does the thigh differ from this rule?
They all have a similar action and are supplied by the same nerve.
In the thigh this is similar but there is an all but one rule.
What are the muscles of the anterior compartment of the thigh?
The pectineus, iliopsoas, sartorius and the quadriceps femoris.
What action does contraction of the quadriceps femoris cause?
Extension of the leg
What are the three flexor muscles of the thigh?
Pectineus, iliopsoas and sartorius.
What is the iliotibial tract made of?
Thickening of the fascia latae
Where does the iliotibial tract attach?
The ASIS and the Gerdy tubercle of the lateral tibial condyle.
What is the function of the iliotibial tract?
It supports the knee joint.
Where does the iliopsoas attach?
The iliacus part attaches to the iliac fossa.
The posts part attaches to the transverse processes of the lumbar spine.
The combined muscle then attaches to the lesser trochanter of the femur.
What nerve supplies the iliopsoas muscle?
The anterior rami of the lumbar spinal nerves.
Where does the sartorius attach?
From the ASIS to the medial surface of the proximal tibia.
What nerve supplies sartorius?
The femoral nerve
What are the four parts of the quadriceps femoris?
The rectus femoris, the vastus lateralis/intermedius/medius
Where does the rectus femoris attach?
From the ASIS to the patella via the quadriceps tendon and then the tibial tuberosity via the patella tendon/ligament
Where do the three vastus muscles of the quadriceps femoris attach?
From the shaft of the femur to the patella via the quadriceps tendon and then the tibial tuberosity via the patella tendon/ligament
What nerve supplies the quadriceps femoris?
The femoral nerve.
What are the muscles of the medial compartment of the thigh?
Adductor Longus, brevis and Magnus. Gracilis and obturator externus.
What two parts does the adductor Magnus have?
The hamstring part and the adductor part.
What nerve supplies all the muscles in the medial compartment of the thigh except the hamstring part of Magnus?
The obturator nerve
What action does contraction of the medial muscles of the thigh cause?
Adduction if the thigh
What nerve supplies the hamstring part of adductor Magnus?
The tibial nerve.
What is the most medial muscle in the medial compartment of the thigh?
Gracilis.
What is the only hamstring (not really a hamstring?) to cross the the knee joint in addition to the hip joint?
Gracilis
Where does Gracilis attach?
The pubic bone to the medial shaft of the tibia.
Where does obturator externus attach?
From the obturator membrane and surrounding bone to the trochanteric fossa.
Where do the adductor Longus and brevis attach?
From the pubic bone to the linea aspera
Where do the two parts of adductor Magnus attach?
Both from the pubic bone and adductor part to the entire length of linea aspera and the hamstring part to the adductor tubercle on the medial epicondyle of the tibia.
How do the obturator nerve,artery and vein enter the medial compartment of the leg?
Via the obturator foramen of the hip bone.
What does the obturator nerve first divide into and where?
Anterior and posterior branches at the upper border of the adductor brevis.
What arteries does the abdominal aorta split into?
The common iliac arteries
What does the common iliac artery split into?
The internal and external iliac arteries.
What does the external artery split into?
The femoral and deep femoral artery (profunda femoris)
What vessel does breaking the mid-shaft of the femur commonly damage?
The deep femoral artery.
What muscles are contained in the posterior compartment of the thigh?
Semitendinosus, semimembranosus and the biceps femoris.
What actions do the muscles in the posterior compartment of the thigh cause?
Extension of the thigh and flexion of the leg.
What nerve supplies all the muscles in the posterior compartment of the thigh except the short head of the biceps femoris?
The tibial division of the sciatic nerve.
What nerve supplies the short head of biceps?
The common fibular division of the sciatic.
Where are the hamstring muscles located?
In the posterior compartment of the thigh.
What are the two parts of the biceps femoris?
The long and short heads
What is the most lateral hamstring muscle?
The biceps femoris
Why is the short head is the biceps femoris not considered a true hamstring?
It attaches to the linea aspera of the femur and not the ischial tuberosity.
It doesn’t cross the hip joint
It is supplied by the common fibular and not the tibial nerve.
What is the semitendinosus called that?
It has a long tendon
Why is the semimembranosus called that?
It has a membranous appearance
Where does the biceps femoris attach?
The ischial tuberosity (linea aspera for the short head) to the head of the fibula.
What roots make up the femoral nerve?
L2,L3 and L4
What plexus is the femoral nerve formed in?
Lumbar
Where does the saphenous nerve branch from and where does it pass through?
It branches off of the femoral nerve to leave the adductor canal by passing between the sartorius and the gracilis
What does the saphenous nerve supply?
Supplies the fascia and skin of the anteromedial aspects of the knee and leg and the medial aspect of the foot.
What does the saphenous nerve accompany in the lower leg?
The great saphenous vein
What three sensory nerves supple the thigh?
The anterior and posterior cutaneous nerves of the thigh and the cutaneous branch of the obturator nerve.
Where does the semitendinosus attach?
The ischial tuberosity and the medial surface of the proximal shaft of the tibia.
Where does the semimembranosus attach?
From the ischial tuberosity to the medial tibial condyle.
What muscles are in the anterior compartment of the leg?
Tibialis anterior, extensor digitorum Longus, extensor hallucinating longus and fibular is tertius
What nerve supplies the muscles in the anterior compartment of the leg?
The deep fibular nerve
What actions do the muscles in the anterior compartment of the leg cause?
Dorsi flexion of the ankle and extension of the toes.
What muscles are in the lateral compartment of the leg?
Fibularis Longus and fibularis brevis
What nerve supplies the muscles in the lateral compartment of the leg?
The superficial fibular nerve
What actions do the muscles in the lateral compartment of the leg cause?
They every the foot and weakly plantarflex the ankle.
Where do all the anterior muscles of the leg attach proximally?
To tibia, fibular or interosseus membrane.
Where does the tibialis anterior attach Distally?
To the base of the first metatarsal and medial cuneiform
Where does the extensor hallucis Longus attach Distally?
Distal phalanges of the great toe
Where does the extensor digitorum Longus attach?
All the foot digits
Where does the Fibularis tertius attach distally?
The base of the 5th metatarsal
What separates the anterior and the lateral compartment of the leg?
The anterior intermuscular septum.
What is the smallest compartment of the leg?
The lateral compartment
Where do both the lateral compartment muscles of the leg attach proximally?
To the fibula.
Where does Fibularis brevis attach Distally?
The plantar surface of the base of the fifth metatarsal
Where does the Fibularis Longus attach Distally?
The tendon passes beneath the sole of the foot to reach the base of the first metatarsal
What does the tibial nerve supply in the tibial fossa?
It gives rise to branches that supply both heads of the gastrocnemius as well as the two small deeper muscles of the fossa.
What lies deep to the lateral head of the gastrocnemius in 90% of people?
The small plantaris muscle.
