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Lower Limb I Flashcards

1
Q

What is the lower limb divided into?

A
  • gluteal region
  • leg
  • thigh
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2
Q

What does the hip bone result from?

A
  • the fusion of three bones : the ilium, the ischium, and the pubis.
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3
Q

What is the structure name where the 3 bones of the pelvis meet?

A
  • acetabulum
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4
Q

During development what are the 3 bones of the pelvis separated by?

A
  • Y shaped cartilage
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5
Q

Label this image

A
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6
Q

What type of Joint is the Hip joint?

A
  • ball-and-socket synovial joint
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7
Q

What name is given to the part of the lower limb distal to the knee?

A
  • leg
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8
Q

Name two bony features that are found only on the femur?

A
  • greater and lesser trochanters
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9
Q

Which structure attaches to the pubic tubercle?

A
  • pubic tubercle
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10
Q

What is the weight bearing surface of the acetabulum called?

A
  • lunate
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11
Q

Which is the largest of the pelvic bones?

A
  • ilium
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12
Q

What forms the boundaries of attachment for the gluteal muscles?

A
  • posterior, anterior and inferior gluteal lines
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13
Q

Where does the inguinal ligament attach?

A
  • to the pubic tubercle
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14
Q

What are the 3 surfaces of the acetabulum?

A
  • lunate surface and within it is a hollow area called the acetabular fossa
  • inferiorly the ridge surrounding the acetabulum is called the acetabular notch
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15
Q

Label this image

A
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16
Q

What does the head of the femur articulate with and what does it form?

A
  • acetabulum
  • hip joint
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17
Q

What is the shaft of the femur like anteriorly and posteriorly?

A
  • anteriorly : smooth
  • posteriorly : raised ridge called the linea aspera
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18
Q

Label this image

A
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19
Q

Label this image

A
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20
Q

What structures attaches to the anterior superior iliac spine (ASIS)?

A
  • inguinal ligament
  • sartorius
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21
Q

What is the vertebral level of highest point of Iliac Crest?

A
  • L4
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22
Q

What is the vertebral level of posterior superior iliac spine (PSIS) – (exam the skeleton)

A
  • S1 and S2
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23
Q

What 9 important structures pass through the Greater sciatic notch?

A
  • piriformis
  • the superior gluteal vein and artery
  • superior gluteal nerve
  • the inferior gluteal vein and artery
  • inferior gluteal nerve
  • the sciatic
  • posterior femoral cutaneous nerves
  • internal pudendal artery and veins
  • and the nerves to the internal obturator and quadratus femoris muscles.
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24
Q

This bony landmark is an important landmark when used in conjunction with the umbilicus for locating the Appendix (McBurneys point). What is the bony landmark?

A
  • ASIS
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25
Label this image with 1) arcuate line 2) superior ramus 3) ASIS 4) iliac crest 5) iliopubic eminence 6) obturator foramen
26
Label this image with 1) ischial tuberosity 2) obturator crest 3) obturator groove 4) iliopubic eminence 5) superior ramus of pubic 6) inferior ramus of pubis
27
What attaches to the pubic tubercle?
* inguinal ligament
28
Label this image with 1) lesser trochanter 2) pectineal line 3) nutrient foramen 4) intertrochanteric crest 5) gluteal line 6) linea aspera 7) greater trochanter 8) femoral head
29
Label this image with 1) fovea capitis 2) head 3) lesser trochanter 4) intertrochanteric line 5) gluteal tuberosity 6) neck 7) greater trochanter 8) intertrochanteric crest 9) linea aspera 10) medial and lateral super condylar lines 11) intercondylar fossa 12) medial condyle 13) adductor tubercle 14) medial epicondyle 15) lateral epicondyle 16) patellar surface 17) lateral condyle
30
Label this image with 1) shaft 2) medial supracondylar line 3) medial lip of linea aspera 4) nutrient foramen 5) popliteal surface 6) lateral lip of linea aspera 7) lateral supracondylar line
31
What 5 muscles attach to the greater trochanter?
* gluteus medius * gluteus minimus * piriformis * obturator externus * obturator internus.
32
What muscle attaches to the lesser trochanter?
* iliopsoas
33
What important ligament attaches superior to the Intertrochanteric line?
* iliofemoral ligament
34
What is the deep fascia of the thigh called?
* fascia latae
35
What opening does the fascia latae have?
* saphenous opening below the inguinal ligament
36
Where does the saphenous vein drain into?
* the femoral vein
37
What does the fascia latae form laterally?
* thickened laterally to form a band or tract called the iliotibial tract
38
What is the function of the iliotibial tract?
* stabilize the knee joint and provides attachment for a muscle called the tensor fasciae latae
39
What is the function of the tensor fasciae latae?
* helps with abduction of the hip joint
40
Linea Aspera: Which two quadriceps femoris muscles attach to this structure?
* medial lip : the vastus medialis * lateral lip : the vastus lateralis
41
What are the 4 quadriceps muscles?
* Vastus medialis * vastus lateralis * vastus intermedius * rectus femoris
42
Label these muscles
43
What structure is found under the inguinal ligament?
* the femoral triangle
44
What 2 muscles make up the floor of the femoral triangle?
* iliopsoas * pectineus
45
What is the iliopsoas formed from?
* the union of psoas major and the iliacus which is within the iliac fossa
46
What is the function of iliopsoas?
* powerful flexor of the hip joint
47
What is the origin and insertion of pectineus?
* attaches from the pubic bone and inserts close to the lesser trochanter
48
Where does the sartorius attach and insert?
* attaches from the ASIS to the medial part of the upper tibia
49
What are the 3 functions of the sartorius?
* flexes the knee joint * extends the hip joint * As it crosses from lateral to medial it is involved in internal rotation of the hip joint
50
Where do the 4 muscles of the quadriceps insert?
* converge onto the quadriceps tendon which encloses the patella and inserts into the tibial tuberosity
51
What is the function of the quadriceps?
* extend knee joint
52
Where does the rectus femoris attach?
* AISIS
53
What is the function of the rectus femoris?
* lexes the hip joint as well as extending the knee
54
Label this image with 1) ASIS 2) profunda femoris 3) sartorius 4) obturator nerve 5) iliotibial tract 6) great saphenous vein 7) rectus femoris 8) inguinal ligament 9) tensor fasciae latae 10) iliacus 11) femoral : nerve, artery, vein 12) pectineus 13) gracilis 14) psoas major 15) iliopsoas 16) adductor longus 17) saphenous nerve
55
Label these muscles
56
Label these muscles
1. Gluteus medius 2. Gluteus minimus 3. Piriformis 4. Obturator internus + the gemelli 5. Quadratus femoris
57
Which of the gluteal muscles is the most superficial?
* gluteus maximus
58
Where does the gluteus maximus attach?
* onto the sacrum and posterior part of the iliac crest
59
What do the fibers of the gluteus maximus converge with?
* converge onto the fasciae latae and part of it also inserts onto the greater trochanter of the femur
60
What is the function of gluteus minimus?
* medial rotator of the hip joint
61
Where does the quadratus femoris attach?
* quadrate tubercle of the femur
62
What is the landmark for the origin of the sciatic nerve?
* piriformis
63
What relation does the sciatic nerve have to the piriformis, gemelli, obturator internus and quadratus femoris?
* beneath piriformis * over the gemelli and obturator internus * over quadratus femoris
64
Why is the gluteal region divided into quadrants?
* demarcate safe and unsafe sites of injection
65
If you want to inject someone in the buttock which quadrant do you go for and why?
* upper lateral quadrant to avoid sciatic nerve
66
What is the function of the gluteal muscles?
* abductors and extensors of the hip joint
67
What are the boundaries of the gluteal region?
* Superior – Iliac crest * Inferior – Gluteal fold * Lateral – greater trochanter * Medial - intergluteal cleft
68
What is the origin and insertion of the gluteus maximus muscle?
* Originates from the gluteal (posterior) surface of the ilium * inserts into the iliotibial tract and the gluteal tuberosity of the femur.
69
What is the innervation of the gluteal nerve?
* innervated by the inferior gluteal nerve (L5-S2)
70
What is the innervation of gluteus medius?
* superior gluteal nerve (root L4,L5 and S1)
71
What is the innervation of gluteus minimus?
* superior gluteal nerve (L4, L5, S1)
72
What is the action of the gluteus medius?
* Anterior: abduct, assist in flexion and medial rotation of hip. * Posterior : abduct, assist in ext and lateral rotation of hip.
73
What is the action of the gluteus minimus?
* abduction of the hip * preventing adduction of the hip * Medial rotation of thigh.
74
Where are the superior gluteal nerves and vessels in relation to piriformis?
* superior
75
Where are the Inferior gluteal nerves and vessels in relation to piriformis?
* inferior
76
Where does the piriformis arise and exit from?
* arises midway between the posterior superior iliac spine and the ischial tuberosity * exits the gluteal region midway between the greater trochanter and the ischial tuberosity.
77
Label these muscles and identify the obturator internus tendon
78
What is the action of piriformis?
* rotates the femur during the hip extension and abducts the femur during flexion of the hip
79
What is the action of obturator internus?
* External rotation of extended thigh * Abduction of flexed thigh * Stabilization of hip joint
80
What are the actions of the gemelli?
* gemellus superior and gemellus inferior help to steady the femoral head in the acetabulum. * laterally rotate the extended thigh * abduct the flexed thigh at the hip by assisting the internal obturator.
81
What is the function of quadratus femoris?
* laterally rotate thigh
82
What is the function of obturator externus?
* Lateral rotation
83
What is the function of the sacrotuberous ligament?
* important in preventing body weight from rotating the pelvic girdle forwards
84
Label these muscles
85
Label the sacrotuberous and sacrospinous ligament
86
which surgical procedure is associated with the sacrospinous ligament?
* hysterectomy
87
The sacrotuberous and sacrospinous ligaments bound which foramen?
* greater sciatic foramen
88
Which people are more likely to develop sciatic nerve problems?
* People involved in sports that require excessive use of gluteal muscles (i.e. ballet dancers, ice/roller skaters, cyclists, mountain climbers)
89
What is the origin and insertion of the sartorius?
* Origin : anterior superior iliac spine (ASIS) * Insertion : proximal end of tibia below medial condyle (via pes anserinus)
90
What is the origin and insertion of the tensor fasciae latae?
* Origin : outer lip of anterior iliac crest, ASIS * Insertion : Iliotibial tract
91
What is the innervation of the sartorius?
* femoral nerve L2 and L3
92
What is the innervation to the tensor fasciae latae?
* superior gluteal nerve, L5 and S1
93
Where is the origin, insertion and innervation of iliacus?
* Origin : upper two-thirds of the iliac fossa * Insertion : base of the lesser trochanter of femur * Innervation : femoral nerve
94
What is the origin,insertion and innervation for psoas major?
* Origin : transverse processes of T12-L4 * Insertion : in the lesser trochanter of the femur * Innervation : Lumbar plexus via anterior branches of L1-L3 nerves
95
What is the origin, insertion and innervation of the quadriceps femoris muscles?
* Origin : anterior surface of femoral shaft * Insertion : tibial tuberosity (via patellar ligament), patella, (Lateral condyle of tibia) * Innervation : Femoral nerve (L2-L4)
96
What is the action of the quadriceps?
* leg extension * rectus femoris flexes the hip joint as well as extending the knee
97
What is the action of the iliopsoas?
* hip flexion, and is the strongest of the hip flexors
98
Which quadricep muscle does not insert into the patella?
* most inferior vastus medialis
99
What is the origin and insertion of pectineus?
* Origin : pectineal line of pubis * insertion : posterior surface of femur, along the pectineal line and proximal part of linea aspera
100
Why is the pectineus part of the anterior compartment even though it is described as being in the medial compartment?
* innervated by the femoral nerve
101
What is the origin and insertion of the adductor longus?
* Insertion: middle third of linea aspera * Origin: pubic body just below the pubic crest
102
What are riders bones?
* tendons of the adductor longus that ossify in horseback riders
103
What is the innervation to the adductor longus?
* anterior branch of obturator nerve
104
What are the nerve roots of the obturator nerve?
* L2, L3, L4
105
Label this image
106
What is the origin, insertion and innervation of the gracilis?
* Origin: ischiopubic ramus * Insertion : tibia (pes anserinus) * Innervation : anterior branch of obturator nerve
107
Which muscle can be used in transplantation and why?
* gracilis * relatively weak adductor it can be removed without noticeable loss of its actions on the leg
108
What is the origin, insertion and innervation of adductor brevis?
* Origin: anterior surface of the inferior ramus and body of the pubis * Insertion :the lesser trochanter and linea aspera of the femur * Nerve : obturator
109
Where does the adductor magnus attach?
* all the way down the linea aspera on the medial side * adductor tubercle is where the hamstring part of the adductor magnus attaches
110
What is the common action of the muscles in the medial compartment if the thigh and what is the exception?
* adductors
111
What is the nerve supply to the adductor compartment and what is the exception?
* obturator nerve (L2, L3, L4) which supplies the medial compartment * Except for the hamstring part of adductor magnus which is supplied by the sciatic L5/S1
112
What 3 muscles make up the pes anserinus and what compartments are they from?
* medial compartment (gracilis) * anterior compartment (sartorius * posterior compartment (semitendinosus)
113
What is the pes anserinus?
* three muscles converging onto the proximal part on the shaft of the tibia * this insertion is known as the pes anserinus (goose foot)
114
Which muscles form the medial and lateral boundaries of the femoral triangle?
* sartorius + adductor longus
115
Which of the hamstrings inserts onto the head of the fibula?
* biceps femoris
116
Which muscle from the medial compartment attaches to the adductor tubercle of the femur?
* adductor magnus
117
Why is piriformis a significant anatomical landmark?
* sciatic nerve origin
118
Label these muscles 1. ASIS 2. iliopsoas 3. gracilis 4. vastus lateralis 5. sartorius 6. tensor fasciae latae 7. adductor longus 8. adductor magnus 9. superficial inguinal ring 10. pectineus 11. semimembranosus 12. semitendinosus 13. iliotibial tract 14. short and long head of biceps femoris 15. recturs femoris
119
What is the function of the hamstring muscles?
* extend the hip * flex the knee
120
Where is the origin of the hamstrings?
* tuberosity of the ischium
121
Where is the insertion for the hamstrings?
* head of the fibula laterally or onto the shaft of the tibia on the medial side
122
What are the 2 sites of attachment of the biceps femoris?
* ischial tuberosity * on the shaft of the femur, its distal attachment is onto the head of the fibula
123
Action of biceps femoris?
flexion of the leg
124
What is the innervation for biceps femoris?
* long head: tibial nerve * short head: common fibular nerve
125
What is the action and innervation of the semitendinosus?
* Medially rotates leg at knee when knee is flexed. * It also extends thigh at hip * innervation : tibial division of sciatic nerve (L5-S2)
126
What is the action and innervation of the semimembranosus?
* Extension of hip and flexion of knee * Tibial part of sciatic nerve (L5, S1 and S2)
127
Label this image
1. Femoral artery 2. Profunda femoris 3. Femoral vein 4. Popliteal artery + vein
128
What is the femoral artery a continuation of?
* external iliac
129
What is the superficial venous drainage of the thigh ?
* Superficial venous drainage via the great and short saphenous veins
130
What branch does the femoral artery give off and what does this supply?
* profunda femoris artery (usually lateral) and it supplies blood to the quadriceps muscles
131
What is the femoral vein continuous with?
* external iliac vein
132
Where does the great saphenous vein run?
* runs through the subcutaneous fat and through the saphenous opening to join the femoral vein in the femoral triangle
133
Into what canal does the femoral artery pass into and where is this?
* subsartorial canal (Hunter’s canal) which is beneath sartorius
134
What is found in the fibrous femoral sheath?
* femoral artery and vein
135
What does the femoral canal contain?
* lymphatic vessels and a deep inguinal lymph node (Cloquet’s)
136
What is the function of the adductor canal (hunters)?
* anatomical link between the femoral triangle and the popliteal fossa.
137
Where can the femoral pulse be palpated?
* just inferior to the midpoint of the inguinal ligament by pressing firmly.
138
What does the deep femoral artery supply?
* Extensors of the thigh * flexors of the thigh * adductors of the thigh * skin of the medial thigh region * proximal aspect of femur
139
Label the 1) Iliopsoas 2) Femoral artery 3) Pectineus 4) Medial femoral circumflex artery 5) Lateral femoral circumflex artery 6) deep artery of thigh
140
How do you compress the femoral artery to stop blood flow?
* pressing directly posterior against the superior pubic ramus, Iliopsoas and femoral head
141
When does patellofemoral pain occur and what is this also known as?
* runner's knee/ chondromalacia * occurs when the patella rubs on the femur bone underneath
142
What kind of a joint is the hip joint?
* multiaxial synovial ball and socket joint
143
What is the strongest ligament in the hip joint?
* iliofemoral
144
Where does the iliofemoral go from and to?
* near the AISIS and radiating downwards onto the intertrochanteric line of the femur
145
What is the function of the pubofemoral ligament?
* limits abduction
146
What is the function of the iliofemoral ligament for the hip joint?
* prevents hyperextension of the hip joint
147
How is the femoral head attached to the transverse acetabular ligament?
*
148
How is the acetabulum deepened?
* by the acetabular labrum
149
What structure runs within the ligamentum teres?
* acetabular branch of the obturator artery.
150
What 4 arteries form the cruciate anastomosis and what do they supply?
* inferior gluteal * deep femoral * medial circumflex femoral * lateral circumflex femoral * blood supply to fermoral head and neck
151
Label this diagram with the 3 ligaments that make up the hip joint?
152
What does the ligamentum teres attach to?
* the fovea capitis in the head of the femur
153
What closes the obturator foramen?
* obturator membrane
154
What are the 4 weakest areas of the hip that often fracture?
* Weak areas of the pelvis that often fracture are the pubic rami, acetabula, sacroiliac joints, and alae of the ilia.
155
What arteries run parallel to the femoral neck and why is this a risk?
* Retinacular arteries run parallel to the femoral neck making them vulnerable to injury when the neck of the femur fractures
156
What do intracapsular fractures include?
* femoral head and neck
157
What do extracapsular fractures include?
* intertrochanteric * subtrochanteric * femoral shaft fracture
158
What are the boundaries of the femoral Canal?
* Medial border – lacunar ligament. * Lateral border – femoral vein. * Anterior border – inguinal ligament. * Posterior border – pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle.
159
Why do femoral hernias happen more frequently in women?
* wider pelvis hence wider femoral canal
160
What is the difference between a femoral and an inguinal hernia?
* femoral hernia is BELOW & LATERAL to pubic tubercle * Inguinal hernia is ABOVE & MEDIAL.
161
What closes the gap in the inferior border of the rim of the acetabulum?
* transverse acetabular ligament
162
What do the retinacular arteries supply?
* the femoral head
163
Why does an intracapsular fracture not heal?
* intracapsular fracture will disrupt the blood supply to the proximal part of the femur and the fracture will not heal
164
Label this image
* A - head of femur * B - neck of femur * C - intertrochanteric crest * D - greater trochanter * E - lesser trochanter * F - acetabulum * G - ischial tuberosity * H - superior pubic ramus
165
Identify this problem this problem is more likely to increase the risk of what vascular issue?
166
What disease is this?
* osteoarthritis
167
What condition is this?
* congenital dislocation of hip
168
What disease is this and who does it affect?
* Slipped upper femoral epiphysis (SUFE) * Affects younger people
169
What is the epiphysis?
* growing cap on the end of the bone
170
Where does bone growth occur?
* plate of cartilage (the epiphyseal plate) between the epiphysis and the diaphysis which is where growth occurs
171
How can you tell on an X ray if someone has osteoarthritis?
* brighter joint socket * no joint space * thickening of the bone

Clinical anatomy (10 decks)

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