Lower Limb Anterior Flashcards
Sartorius
-innervated by femoral nerve
-flexes, abducts and laterally rotates hip joint
-flexes knee joint
lower limb function
-locomotion
-supporting body weight
-maintaining balance
-connected to trunk by pelvic girdle (sacrum, hip bones, pubic symphysis)
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius (quadricep)
-femoral nerve (L2,3,4)
-extend knee joint
-rectus femoris also stabilizes hip joint and helps iliopsoas flex hip joint
pelvic girdle and weight distribution
-fibula does not bare any weight (no articulation with femur)
-talus- keystone of longitudinal arch formed by tarsal Azzand metatarsal -> distribute weight evenly between heel and forefoot
-femurs are oblique (inferomedially pointed) so knees are directly inferior to trunk -> center of gravity
-more oblique in women bc wider pelvis
femoral region
-between gluteal, abdominal, and perineal regions proximally
-knee region distally
-boundary between the abdominal and perineal regions and the femoral region is demarcated by the inguinal ligament anteriorly and the ischiopubic ramus of the hip bone medially
knee region
-prominences (condyles) of the distal femur and proximal tibia, head of fibula, patella, and joints between
-posterior knee -> fat filled hollow transmitting neurovascular structures called -> popliteal fossa
leg/crural region
-lies between the knee and the narrow distal part of the leg
-includes most of tibia (shin bone) and fibula (calf bone)
-leg connects knee and foot (ankle joint)
-calf is posterior
talocrural region (ankle)
-includes the medial and lateral prominences (malleoli) that flank the ankle (talocrural) joint
foot region
-includes the tarsus, metatarsus, and phalanges
-great toe (hallux) has only 2 phalanges (digital bones) -> other toes have 3
-superior- dorsum of foot; inferior- plantar region
gluteal region
-between the trunk and free lower limbs
-superior border- iliac crest
-medial border- intergluteal cleft
-inferior border- gluteal fold
-hip region- hip joints and greater trochanter of femur
lower limb development
-limb buds- lateral aspect of L2-S2 of trunk
-toes superior, soles anterior
-torsion around long axis
-medial rotation and permanent pronation
-hip flexion anteriorly, extension posteriorly
-knee extends anteriorly, flexes posteriorly
pelvic girdle
-sacrum + right and left hip bones
-pubic symphysis
-pelvic girdle = axial skeleton
body weight
-transferred from vertebral column through sacro-iliac joints
-pelvic girdle through hip joints
-oblique femurs to support erect bipedal posture
-knees are adjacent and placed directly inferior to trunk while standing
-distal end of each femur articulates with patella and tibia
-fibula DOES NOT articulate with femur
-weight from tibia is transferred to the talus
-longitudinal arch formed by tarsal and metatarsal bones
hip bone
-fusion of 3 primary bones
-ilium, ischium and pubis
-triradiate cartilage separate them -> fuse 15-25 years old
hip bone: ilium
-largest part of the hip bone
-superior part of acetabulum
-ASIS and AIIS
-iliac crest, PSIS, and PIIS
-superior border of greater sciatic notch
hip bone: ischium
-forms the posterior inferior part of the acetabulum
-ischial rami
-inferior margin of greater sciatic notch
-ischial spine- forms demarcation of lesser sciatic notch
-ischial tuberosity- supports body weight when sitting
hip bone: pubis
-forms anterior part of the acetabulum
-body articulates with left pubis at pubic symphysis
-pubic crest
-pubic tubercles- attachment for inguinal ligament
-superior and inferior pubic rami
hip bone: obturator foramen
-bounded by pubis and ischium and their rami
-obturator membrane
-obturator nerve and vessels
greater and lesser sciatic foramen
-sacrotuberous ligament
acetabulum
-large cup shaped cavity
-lunate surface of the acetabulum
-articulates with the head of the femur
-acetabular fossa
-acetabular notch- inferior
-lack of cartilage - hip pain
femur
-longest and heaviest bone in the body
-head of the femur- covered with articular cartilage > fovea
-head attached to body via neck
-greater trochanter
-lesser trochanter
-angle of inclination- M>F
-shaft of femur
-adductor tubercle
-lateral and medial epicondyle
-lateral and medial condyle
-patellar surface
-linea aspera posteriorly bifurcates
angle of inclination
-neck projects superomedially to oblique shaft of femur
-angle is largest at young age
-126 for adults
-and decreases with old age
-male > female
-increased width between acetabula and greater obliquity of shaft
-angle allows for more mobility -> head and neck are perpendicular to acetabulum
-BUT strains the neck -> increase fractures
patella
-large sesamoid bone
-located anterior to the mid-condylar region of femur
-articulates with patellar surface of femur
-articular surface (posterior) covered with thick layer of articular cartilage
-apex tip of knee
tibia and fibula
-tibia is large and weight bearing
-tibia articulates with the condyles of femur superiorly and the talus inferiorly
-fibula functions as an attachment for muscles and stability of the ankle joint
-these bones are connected by the interosseous membrane
surface anatomy
-ischial tuberosity- supports sitting
-greater trochanter of femur - hips
-medial and lateral condyles of femur - knee
-patella
-adductor tubercle
-tibial tuberosity
-medial tibia
-lateral (more distal and posterior) and medial malleolus
-medial and lateral tibial condyles
-neck of fibula
-distal shaft of fibula
iliapsoas
-psoas muscle + iliacus
-anterior hip flexors*
-blood supply- iliolumbar artery (branch of internal iliac artery and medial circumflex artery (branch of profunda femoris)
psoas muscle
-superior attachments- transverse processes of lumbar vertebrae T12-S1
-inferior attachments- lesser trochanter of femur
-innervation- anterior rami of lumbar nerves -> L1, L2
iliacus
-superior attachments- superior 2/3 of iliac fossa, ala of sacrum, and anterior sacro-iliac ligaments
-inferior attachments- tendon of psoas major, lesser trochanter, and femur
-innervated- femoral nerve
subcutaneous tissue/superficial fascia
-deep to skin
-hip and thigh is continuous to anterolateral abdominal wall and buttocks
-deep fascia -> strong and limited outward extension -> works to push venous blood up
fascia lata
-iliotibial tract
-deep fascia of the thigh
-surrounds muscles of thigh especially laterally -> iliotibial tract
-iliotibial tract from iliac tubercle to anterolateral tibial tubercle (gerdy)
-tensor fascia Lata is superior to iliotibial tract
fascial compartments of the thigh
-3 intermuscular septa spread out from inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur
-anterior- femoral nerve
-medial- obturator nerve
-posterior- sciatic nerve
nerves and dermatomes
-S3/S4- genitals
-S3,S2,S1- (in that order) - posterior leg
-L1,L2,L3,L4,L5- anterior leg
-axial line- line that separates dermatomes supplied from discontinuous spinal levels -> posterior medial
lumbar plexus (ventral rami L2, 3, 4)
-anterior thigh- femoral nerve (posterior division) -> ventral rami L2-L4
-medial thigh- obturator nerve (anterior division) -> ventral rami L2-L4
-lumbosacral trunk- ventral rami L5-S3 -> connected by small bundle of axons L4 that join with L5
flexors of the hip
-pectineus
-satorius
-rectus femoris (kicking muscle)
-iliopsoas
extensors of the leg (quadriceps femoris)
-rectus femoris (kicking muscle)
-vastus lateralis
-vastus intermedius
-vastus medialis
-quadriceps tendon independent attachment to base of patella
-indirectly via patellar ligament of tibial tuberosity
-extension at knee*
femoral triangle
-superiorly (base)- inguinal ligament
-medially- adductor longus muscle
-laterally- sartorius muscle
-floor- laterally (iliopsoas) and medially (pectineus)
-roof- fascia lata, cribriform fascia, subcutaneous tissue, skin
-contents:
-femoral nerve, vein (great saphenous and profunda femoris), artery, and deep inguinal lymph nodes
vascular compartment- femoral sheath
-prolongation of transveralis and iliopsoas fascia -> form a funnel
-femoral nerve is outside the sheath!
-continuous with tunica adventitia of the vasculature
-3 tubes within the sheath:
-lateral tube- femoral artery
-middle tube- femoral vein
-medial (femoral canal)- lymphatics
-medially pierced by great saphenous vein and lymphatics
-allows femoral artery and vein to glide deep to inguinal ligament during movements of hip joint
-deep the fascia lata
saphenous ring
-saphenous vein enters the sheath via the saphenous ring
-goes from superficial to fascia lata to deep
femoral canal
-compartment in the femoral sheath
-holds lymphatics but also is empty space
-allows for vein to dilate when venous return increases or intraabdominal pressure causes stasis of vein
-cloquet node
adductor canal (intermuscular passage)
-entrance at the apex of femoral triangle
-AKA subsartorial canal and hunters canal
-anteriorly and laterally- vastus medialis
-posteriorly- adductors longus and magnus
-medially sartorius
-adductor hiatus- opening in the hamstring part of the adductor magnus
-from apex to adductor hiatus
-intermuscular passage for femoral artery and vein, saphenous nerve, nerve to vastus medialis -> to the popliteal fossa
-between the anterior and medial compartments
common femoral artery- superficial branches
-superficial circumflex iliac artery
-superfical epigastric artery
-superficial external pudendal artery
femoral artery and branches
-external iliac becomes femoral artery past inguinal ligament
-chief artery to lower limb
-profunda femoris artery (deep femoral artery)
-medial femoral circumflex
-lateral femoral circumflex- ascending, transverse, descending
-descending genicular artery- to form anastomosis of knee
-Femoral supplies: anterior & anteromedial aspects of thigh
profunda femoris artery
-deep femoral artery of thigh**
-largest branch
-gives off 3-4 perforating arteries
-profunda is the chief artery of thigh
-arises from the femoral artery in the femoral triangle
-separated from femoral artery by the adductor longus
-Gives off Perforating arteries supply adductor magnus, hamstring, vastus lateralis muscles
-passes between pectinus & adductor longus supplies muscles in medial, posterior and lateral part of anterior compartment
medial femoral artery
-MAJOR blood supply to head and neck of femur
-usually branches off the profundus femoris but may arise from the femoral artery
-between iliopsoas & pectineus muscle origin either off femoral or profunda
motor innervation and muscles- obturator nerve
-obturator nerve (anterior division) L2-L4
-obturator externus
-pectineus
-adductor brevis
-adductor longus
-adductor magnus**
-gracilis
-**adductor minimis is part of adductor magus
obturator artery
-branch of anterior division internal iliac
-anterior division:
-obturator externus
-pectineus
-adductors of thigh
-gracilis
-profunda femoris artery
flexion at knee
-hamstring
dorsi/plantar flexion
-dorsi- flexes up
-plantar- gas pedal
knee ligaments
-ACL
-PCL
-medial and lateral collateral ligament
meniscus
-cartilage
-decreases force to tibia
-on the tibia plateau
-medial knee pain with tear to meniscus
-knee locks up when it gets caught on itself*
mordis
-joint between the lateral and medial malleolus
spongy bone
-bone marrow
-bone marrow typically aspirated from iliac crest
talonavicular fracture
-navicular bone fracture -> concern for necrosis
-not a lot of blood supply to navicular bone
