Lower limb further study Flashcards
Define a hinge joint. Name some hinge joints in lower limb
Hinge joint definition:
-Allows movement only in one plane
Classical: talofibular, tibiotalar
-Interphalangeal joints (also in upper limb)
Modified: Knee (allows slight degree of rotation)
Define and name some gliding joints
Definition: articular surfaces are nearly flat, allowing bones to glide over one another
Patello-femoral
Talo-calcaneal
Nerve root gluteal nerves
Superior: L4-S1
inferior: L5-S2
Pudendal nerve root
S2-S4
Name muscles that attach to linea aspera
Adductors longus, brevis, magnus
Short head biceps femoris
Vastus medialis
Gluteus maximus: gluteal tuberosity at superior surface
Name structures that attach to anterior superior iliac spine
-Inguinal ligament
-Sartorius
-Tensor fascia lata
Name structures that attach to anterior inferior iliac spine
Straight head rectus femoris
Where does rectus femoris attach?
Straight head:
-anterior inferior iliac spine
Reflected head:
-Top of acetabulum
What structures are attached to iliotibial band?
Tensor fascia lata
Gluteus maximus
What is the function of iliotibial band?
Stabilises knee with knee extended (gluteus maximus, tensor fascia lata)
What are the main extensors of the hip?
Gluteus maximus
True hamstrings
Hamstring part of adductor magnus
What muscles cause internal rotation of hip?
-Pectineus
-Gracilis
-Adductors
Describe innervation of hamstring muscles
Semitendanosis, semimembranosus, biceps femoris long head: tibial division sciatic nerve
Hamstring part of adductor magnus: tibial division sciatic nerve
Short head biceps femoris: peroneal nerve
How is the thigh divided into thirds?
Upper 1/3rd: femoral triangle
Middle 1/3rd: hunter’s canal
Lower 1/3rd: popliteal fossa
What tendons are inserted along the antero-medial surface of proximal tibia?
Sartorius, gracilis, semitendinosus (anterior to posterior)
–> pes anserinus
(say grace before ten)
Describe the attachments of the anterior and posterior cruciate ligaments, and describe their orientation
Anterior:
–> O: medial tibial spine
–> I: lateral femoral condyle
Posterior:
–> O: medial tibial condyle
–> I: lateral femoral spine
ACL: front to back
PCL: back to front
Indication for operative management patellar fracture
Extensor lag >20 degrees (lack of full knee extension with full contraction of quadriceps)
2-3mm displacement
Open #/loose bodies
What is the course of the long saphenous vein?
-Formed by dorsal venous arch foot
-Ascends 2cm in front of medial malleolus, runs along medial border o tibia to knee
-Passes posterior to medial condyle at knee
-Empties into sapheno-femoral junction 4cm below and lateral to pubic tubercle
What is the course of the short saphenous vein?
-Formed by dorsal venous arch
-Moves up posterior leg, passing posterior to lateral malleolus
-Runs along lateral border achilles tendon
-Moves between two heads gastrocnemius and empties into popliteal vein in popliteal fossa
What nerve accompanies long saphenous vein?
Saphenous nerve
What nerve accompanies short saphenous vein?
Sural nerve
Describe action of muscles in lateral compartment of leg
Eversion of foot
Describe management of compartment syndrome
-Take down dressing and cast
-Maintain BP
-Elevate leg to level of heart
-Analgesia
-Review neurovascular status
-Reassess
Compartment pressure monitoring–> for unconscious patients
Fasciotomy within 1 hr of diagnosis of compartment syndrome
–> 2 incisions 15cm long
–> 1 medial: 2cm behind medial border tibia (opens posterior superficial and deep compartments)
–> 1 lateral: 2cm lateral to lateral edge of tibia (opens anterior and lateral compartments)
Name structures that run over extensor (anterior) aspect of ankle
TEA DEPt
Tibialis anterior
EHL
Anterior tibial artery
Deep peroneal nerve
EDL
Peroneus tertius
Name structures that run behind medial malleolus
Tom, dick and very naughty harry (anterior to posterior)
Tibialis posterior
flexor Digitorum longus
posterior tibial Artery
posterior tibial Vein
tibial Nerve
flexor Hallucis longus
What is the insertion of tibialis anterior muscle?
Base 1st metatarsal, medial cuneiform
What is insertion of tibialis posterior?
Navicular bone, medial cuneiform
What is the insertion of the three peroneus muscles?
Longus: under foot, attaches lateral surface medial cuneiform and first metatarsal (same as tibialis anterior)
Brevis: Base 5th metatarsal
Tertius: base 5th metatarsal (dorsal)
Describe cuntaneous innervation to dorsal aspect of foot
Mostly superficial peroneal
1st webspace: deep peroneal
Lateral: sural nerve
Describe cutaneous innervation to plantar aspect of foot
Medial: medial plantar
Lateral: lateral plantar
Calcaneal area: tibial
Saphenous: small amount posteromedial
Sural: small amount posterolateral
Name structures in different layers of foot (plantar to dorsal)
1st: 3 small muscles
2nd: long flexor tendons and lumbricals (important)
3rd: small muscles
4th: peroneus longus, tibialis posterior tendon, interossei
Myotomes lower limb
L2: hip flexors
L3: knee extensors
L4: ankle dorsiflexors
L5: Long toe extensors
S1: ankle plantarflexors
