Lower Limb I Flashcards
Major functions of the lower limb
Support body weight and move it
Regions of the lower limb
Gluteal, anterior and posterior thigh, leg, foot
Gluteal region
Posterolateral, between iliac crest and gluteal fold
Bones of the gluteal region
Two pelvic bones
Pelvic bone formation
Formed by ilium, ischium, and pubis
Anterior thigh region
Between inguinal ligament and knee joint
Posterior thigh region
Between gluteal fold and knee
Bone of the thigh
Femur
Leg region
Between the knee and ankle joint
Bones of the leg
Tibia and fibula
Foot region
Distal to ankle joint
Bones of the foot
Tarsals, metatarsals, phalanges
Center of gravity
Vertical line anterior to the S2 vertebra, posterior to the hip joints, anterior to ankle and knee joints, directly above feet
Movements at the hip joint
Flexion, extension, abduction, adduction, medial and lateral rotation, and circumduction
Abduction of the hip
Can be abduction of the femur on a fixed pelvis or abduction of the pelvis on a fixed femur, ultimately angle between pelvis and femur decreases
Movements of the knee
Flexion and extension
Movements of the ankle
Dorsiflexion and plantarflexion
Acetabular labrum
Fibrocatilaginous collar on the rim of the acetabulum, prevents femoral head from moving inferior
Acetabular labrum tear clinical presentation
Pain in hip when bearing weight, flexion and internal rotation, painful audible clicking, transient locking, giving away of hip
Ligament of the head of the femur attachments
Head of femur to acetabular fossa
Ligament of the head of the femur blood supply
Obturator artery (also supplies femoral head)
Fibrous capsule of hip
Surrounds synovial membrane to hold femoral neck in the acetabulum
Three ligaments around fibrous capsule
Iliofemerol, pubofemoral, ischiofemoral
Iliofemoral ligament
Anterior to hip joint
Pubofemoral ligament
Anteroinferior to hip joint
Ischiofemoral ligament
Posteroinferior to hip joint
Weight-bearing articulation in knee
Between femur and tibia
Quadricep pulling articulation in knee
Between patella and femur
Lateral and medial menisci function
Cushion knee joint, accommodate changes in the shape of the articular surface during movement
Synovial membrane of knee joint attachment
Attaches the margins of the articular surfaces and menisci
Pouches formed by synovial membrane and role
Suprapatellar bursa and subpopliteal recess, provide low-friction movement for tendons
Fibrous capsule of knee
Encloses articular cavity and is formed and reinforced partly by muscle tendons
Patella ligament
Continuation of the quadriceps femoris tendon, connects patella to tibia
Medial collateral ligament
Stabilizes hinge motion of knee, attaches to the medial meniscus
Lateral collateral ligament
Stabilizes hinge motion of knee
Cruciate ligaments
Anterior and posterior, cross in the intercondylar region of knee and connect tibia and femur
Anterior cruciate ligament function
Keeps the tibia from moving anteriorly on fixed femur
Anterior cruciate ligament attachment
Lateral femoral condyle to anterior tibia
Posterior cruciate ligament function
Keeps the tibia from moving posteriorly on fixed femur
Posterior cruciate ligament attachment
Medial femoral condyle to posterior tibia
Unhappy triad of O’Donahue
Tear in ACL, MCL, and medial meniscus, caused by lateral force applied to planted leg, snap is audible and immediately painful and swollen
Gluteal region movements
Abduction, extension, lateral rotation of the femur relative to the pelvis
Deep muscles of the gluteal region role
Lateral rotation of the femur at the hip joint
Deep muscles of the gluteal region names
Piriformis, obturator internus, the gemelli, and quadratus femoris
Superficial muscles of the gluteal region role
Abduct and extend the hip, stabilize the knee in extension
Superficial muscles of the gluteal region names
Gluteus minimus, gluteus maximus, gluteus medius, tensor fasciae latae
Gluteus minimus and gluteus medius role
Abduction of the hip
Gluteus maximus role
Extension of the hip
Tensor fasciae latae muscle role
Stabilizes knee in extension by acting on the iliotibial tract
Iliotibial tract
Band of deep fascia passing down the lateral side of the thigh to attach to the proximal end of the tibia
Location of nerves in gluteal region
Enter through greater sciatic foramen of pelvis in the plane between superficial and deep muscles, superior gluteal nerve passes superior to piriformis, all others pass inferior
Superior gluteal nerve spinal nerves
L4, L5, S1
Superior gluteal nerve innervation
Gluteus minimus, gluteus medius, tensor fascia latae
Nerve to quadratus femoris spinal nerves
L5, S1
Nerve to quadratus femoris innervation
Quadratus femoris, gemellus inferior
Nerve to obturator internus spinal nerves
L5, S1
Nerve to obturator internus innervation
Gemellus superior, passes through lesser sciatic foramen to obturator internus
Posterior cutaneous nerve of the thigh spinal nerves
S1-S3
Posterior cutaneous nerve of the thigh innervations
Skin of the gluteal region, posterior thigh, posterior leg
Inferior gluteal nerve spinal nerves
L5, S1, S2
Inferior gluteal nerve innervation
Gluteus maximus
Piriformis muscle innervation
Branches of S1 and S2 spinal nerves
Pudendal nerve spinal nerves
S2-S4
Pudendal nerve innervations
Muscles of the perineum and skin of the genitals
Trendelenburg sign/gait cause
Injury to the superior gluteal nerve, which innervates the hip abductors, gluteus minimus and medius
Trendelenburg sign
Patient standing on affected limb, pelvis drops over swing limb and abduction of the pelvis on the fixed femur does not occur
Trendelenburg gait
Patient compensates by lurching the trunk to the affected side to maintain the level of the pelvis during gait
Blood supply to the gluteal region
Superior and inferior gluteal arteries
Superior and inferior gluteal arteries origin
Internal iliac artery, a terminal branch from the aorta
Three compartments of the thigh
Anterior, medial, posterior
Anterior compartment blood and nerve supply
Fermoral nerve, branches of the femoral artery
Anterior compartment muscles main function
Extension of the leg at the knee
Anterior compartment muscles names
Quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius), sartorius, psoas major, iliacus
Muscles of quadriceps femoris
Rectus femoris, vastus medialis, vastus lateralis, vastus intermedius
Rectus femoris movement
Flexes thigh at the hip joint and extends the leg
Vastus lateralis movement
Extension of the leg
Vastus medialis movement
Extension of the leg
Vastus intermedius movement
Extension of the leg
Sartorius movement
Flexes the thigh and flexes leg
Psoas major movement
Flexion of the thigh
Iliacus movement
Flexion of the thigh
Psoas major and iliacus origin
Posterior abdominal wall into the upper part of the anterior compartment
Medial compartment nerve and blood supply
Obturator nerve, branches of the deep femoral artery and obturator artery
Medial compartment main function
Adduction of the thigh at the hip joint
Medial compartment muscles names
Gracilis, pectineus, adductor longus, adductor brevis, adductor magnus, obturator externus
Gracilis movement
Adduction of thigh
Pectineus movement
Adduction of thigh
Adductor longus movement
Adduction and medial rotation of thigh
Adductor brevis movement
Adduction and medial rotation of thigh
Adductor magnus movement
Adduction and medial rotation of thigh
Obturator externus movement
Lateral rotation of thigh
Posterior compartment nerve and blood supply
Tibial division of sciatic nerve (common fibular division of sciatic nerve to short head of biceps femoris), perforating branches of deep femoral artery
Posterior compartment main function
Flexion of leg at the knee joint, extension of thigh at hip joint, and rotation of both
Posterior compartment muscles names
The hamstrings (biceps femoris, semitendinosus, semimbranosus)
Muscles of the hamstrings
Biceps femoris, semitendinosus, semimbranosus
Hamstring muscle that does not cross at both the hip and knee joints
Short head of the biceps femoris
Per anserinus
AKA goose’s foot, common insertion of the tendons of the sartorius, gracilis, and semitendious on the proximal tibia
Femoral artery location
Continuation of external iliac artery, starts as the external iliac artery passes under inguinal ligament and into the anterior aspect of the upper thigh
Femoral artery major branch
Deep artery of the thigh (AKA profunda femoris)
Deep artery of the thigh function
Major blood supply to the thigh
Deep artery of the thigh branches
Medial and lateral circumflex femoral arteries, perforating branches
Medial and lateral circumflex femoral arteries compartment
Medial compartment
Perforating branches compartment
Posterior compartment
Obturator artery location
Branch of the internal iliac artery
Obturator artery branches
Anastomose with inferior gluteal and medial circumflex arteries, they are anterior or superficial branch, a posterior or deep branch (branches then to the head of the femur)
Lachman test procedure
Patient supine, knee flexed 30 degrees, grasp and stabilize thigh, move proximal leg anteriorly
Lachmen test structure
ACL
Lachmen test positive result
Excessive forward motion of tibia
Anterior drawer test procedure
Patient supine, knee flexed 90 degrees, sit on dorsum of foot, place hands behind knee and move proximal leg anteriorly
Anterior drawer test structure
ACL
Anterior drawer test positive result
Excessive forward motion of tibia
Posterior drawer test procedure
Patient supine, knee flexed 90 degrees, palms of hand push proximal leg posteriorly
Posterior drawer test structure
PCL
Posterior drawer test positive result
Excessive posterior motion of tibia
Valgus stress test procedure
Patient supine, knee extended or flexed 30 degrees, stabilize lateral aspect of knee, push ankle laterally
Valgus stress test structure
MCL
Valgus stress test positive result
Significant gap in the medial joint space
Varus stress test procedure
Patient supine, knee extended or flexed 30 degrees, stabilize medial aspect of knee, push ankle medially
Varus stress test structure
LCL
Varus stress test positive result
Significant gap in lateral joint space
McMurray test procedure
Examiner passively flexes knee with rotation of tibia or foot, or have patient perform a full two-legged squat
McMurray test structure
Medial and lateral menisci
McMurray test positive result
Pain or popping on external (medial meniscus) or internal (lateral meniscus) rotation, joint line tenderness
Patellar apprehension test procedure
Apply laterally directed force toward medial aspect of patella
Patellar apprehension test structure
Patellofemoral pathology
Patellar apprehension test positive result
Apprehension by patient due to pain or fear that patella will dislocate
Patellofemoral grind test procedure
Apply downward and inferior pressure on patella while patient contracts quadriceps on extended knee
Patellofemoral grind test structure
Patellofemoral pathology
Patellofemoral grind test positive result
Pain with movement or unable to complete test
Valgus and varus refer to…
Angulation within shaft of a bone or at a joint in reference to the most proximal part of a bone or joint
Valgus
When the distal part is more lateral
Varus
When the distal part is more medial