Lower Limb II Flashcards
Compartments of the leg
Anterior, lateral, posterior
General motions of the leg muscles
Plantarflexion, dorsiflexion, inversion (supination) and eversion (pronation) of the foot, extension and flexion of the toes
Anterior compartment innervation
Deep fibular nerve
Anterior compartment bloody supply
Anterior tibial artery
Anterior compartment movements
Dorsiflexion and inversion of foot, extension of toes
Anterior compartment muscles
Tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularus tertius
Tibialis anterior
Dorsiflexes and inverts foot
Extensor hallicus longus
Dorsiflexes foot and extends the great toe
Extensor digitorum longus
Dorsiflexes foot and extends lateral four toes
Fibularus tertius
Dorsiflexes foot
Lateral compartment innervation
Superficial fibular nerve
Lateral compartment blood supply
Fibular artery
Lateral compartment movements
Eversion and plantar flexion of foot
Lateral compartment muscles
Fibularis longus, fibularis brevis
Fibularis longus
Plantar flexion and eversion of foot
Fibularis brevis
Eversion of foot
Posterior compartment innervation
Tibial nerve
Posterior compartment blood supply
Posterior tibial artery
Posterior compartment movements
Plantar flexion and inversion of foot, flexion of toes
Posterior compartment muscles
Gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallicus longus, popliteus
Posterior compartment superficial muscles
Gastrocnemius, soleus, plantaris
Posterior compartment deep muscles
Tibialis posterior, flexor digitorum longus, flexor hallucis longus, popliteus
Gastrocnemius
Plantar flexion of foot and flexion of knee
Soleus
Plantar flexion of foot
Plantaris
Plantar flexion of foot and flexion of knee
Tibialis posterior
Plantar flexion and inversion of foot
Flexor digitorum longus
Flexion of lateral four toes and inversion of foot
Flexor hallicus longus
Flexion of great toe and inversion of foot
Popliteus
Stabilizes and unlocks knee joint by rotating femur laterally from fixed tibia
Lumbar plexus spinal nerves
Anterior rami of L1-L4 spinal nerves
Sacral plexus spinal nerves
Anterior rami of L4-S5 spinal nerves
Lumbosacral plexus
Lumbar and sacral plexus collectively, supply sensory and motor innervation to lower limb
Femoral nerve motor and sensory branches
Has motor branches to the anterior compartment muscles and the pectineus, has two sensory branches, the anterior cutaneous nerve to the thigh and saphenous nerve to the medial leg and malleolus
Obturator nerve motor and sensory branches
Has motor branches to the medial compartment of the thigh and adductor magnus, has a cutaneous branch to the skin above the medial side of the knee
Sciatic nerve divisions
Tibial and common fibular nerves proximal to the popliteal fossa
Common fibular nerve divisions
Superficial fibular nerve and deep fibular nerve
Superficial fibular nerve innervation
Lateral compartment of the leg and overlying skin of leg and foot
Deep fibular nerve innervation
Anterior compartment of the leg and overlying skin of leg and between the great and 2nd toe
Tibial nerve innervation
Posterior compartment of the leg and sensory to overlying skin and plantar surface of the foot and 5th toe
Four major routes nerves and vessels use to get into the lower limb
Obturator canal, greater sciatic foramen, lesser sciatic foramen, inferior to inguinal ligament
Obturator canal route
Through the obturator foramen, passing inferior to the superior pubic ramus
Obturator canal nerve
Obturator nerve
Greater sciatic foramen route
Above the piriformis between the gluteus medius and minimus or below the piriformis muscle
Greater sciatic foramen nerves
Sciatic nerve, inferior gluteal nerve, pudendal nerve, posterior femoral cutaneous nerve, nerves to obturator interns and quadratus femoris (all below piriformis), superior gluteal nerve (above piriformis)
Lesser sciatic forament route
From gluteal region into perineum
Lesser sciatic foramen nerve
Pudendal nerve
Inferior to inguinal ligament route
Below the inguinal ligament into lower limb
Inferior to inguinal ligament nerves
Femoral nerve, femoral branch of genitofemoral nerve, lateral cutaneous nerve of thigh
Obturator nerve sensory endpoint
Medial thigh above knee
Femoral nerve sensory endpoint
Medial malleolus
Tibial nerve sensory endpoint
Lateral malleolus (sural nerve)
Superficial fibular nerve sensory endpoint
Dorsum of the foot
Deep fibular nerve sensory endpoint
Between the first two toes
Deep fibular nerve spinal nerves
L4-S2
Deep fibular nerve common entrapment regions
Anterior compartment syndrome, anterior tarsal tunnel syndrome at the extensor retinaculum
Deep fibular nerve motor loss - anterior compartment syndrome
Drop foot - inability to dorsiflex the foot, patient uses high stoppage gait to walk
Deep fibular nerve motor loss - anterior tarsal tunnel syndrome
Weakness in toe extension
Deep fibular nerve lesion sensory loss
Triangular region between the first and second toes
Superficial fibular nerve spinal nerves
L4-S2
Superficial fibular nerve common entrapment regions
High lesion at the head of the fibula, low lesion with a lateral ankle sprain
Superficial fibular nerve motor loss - high lesion
Loss of foot eversion and/or subtler pronation and ankle stability
Superficial fibular nerve motor loss - low lesion
None
Superficial fibular nerve lesion sensory loss
Lateral leg, lateral malleolus and dorsum of foot
Tibial nerve spinal nerves
L4-S3
Tibial nerve common entrapment regions
Popliteal region from knee trauma such as dislocation or a blow, tarsal tunnel entrapment at the medial malleolus
Tibial nerve motor loss - knee trauma
Unable to plantar flex or invert/supinate the foot, effects gait, loss of toe flexion, abduction and adduction, patient will not push off
Tibial nerve motor loss - tarsal tunnel
Loss of intrinsic foot function
Tibial nerve sensory loss - knee trauma
Loss of sensation on the posterolateral aspect of the lower one third of the leg, lateral malleolus, and lateral border of the foot, heel and sole of the foot and toes
Tibial nerve sensory loss - tarsal tunnel
Loss of sensations on the anterior sole of the foot and plantar surface of the toes
Femoral nerve spinal nerves
L2-L4
Femoral nerve common entrapment region
Anterior dislocation of the femur from trauma or injury from pelvic or hip surgery, abdominal or hernia repair
Femoral nerve lesion motor loss
Inability to flex the thigh or extend the knee - patient will lock their knee into extension
Femoral nerve lesion sensory loss
Medial side of leg, medial malleolus (saphenous nerve) or medial knee (medial cutaneous nerve)
Obturator nerve spinal nerves
L2-L4
Obturator nerve common entrapment region
Compression in the obturator tunnel from pelvic fracture or injury, pregnancy, tumors
Obturator nerve lesion motor loss
Inability to adduct the hip and weakness of knee flexion (gracilis) and external hip rotation (obturator externus) which creates difficulty with the gait exhibiting an externally rotated foot
Obturator nerve lesion sensory loss
Medial patch of skin just above the knee, may also complain of groin or pubic symphysis pain
Major artery supplying lower limb
Femoral artery
Femoral artery path
Continuation of the external iliac artery when it passes under the inguinal ligament and enters the femoral triangle
Femoral triangle borders
Superior - inguinal ligament
Medial - medial border of adductor longus
Lateral - medial border of the sartorius
Vessels in the femoral triangle
Femoral nerve, artery, vein, and lymphatics
Femoral sheath
Fascia enclosing the femoral nerve, artery, vein and lymphatics in the femoral triangle
Femoral pulse
Can be palpated in the femoral triangle inferior to the inguinal ligament and midway between the anterior superior iliac spin and the pubic symphysis
Branches of the internal iliac artery in the pelvis
Superior gluteal artery, inferior gluteal artery (both to gluteal region), obturator artery (to medial compartment of thigh)
Collateral circulation to the hip joint
Anastomoses between branches of the deep femoral (medial and lateral femoral circumflex and 1st perforating branch), branches of the obturator artery, and branches of the superior and inferior gluteal arteries
Common cause of avascular necrosis of the femoral neck and head
Insufficiency of the medial femoral circumflex artery
Collateral circulation to the knee joint
Anastomoses of the descending branch of the lateral circumflex femoral (from deep femoral), descending genicular branch of the femoral artery (branch before femoral artery enters the adductor canal), genicular branches from the popliteal artery, the circumflex fibular artery and recurrent branches from the anterior tibial artery
Compartment syndrome definition
Fascia lata do not expand, swelling in a compartment leads to increased pressure, compressing muscles, blood vessels, and nerves
Compartment syndrome causes - acute
Trauma such as a car accident, crush injury, or surgery
Compartment syndrome causes - chronic
Repetitive activities such as running, pressure increases during activity
Compartment syndrome common locations
Leg and forearm
Compartment syndrome treatment
Fasciotomy (cutting the skin and fascia) to relieve pressure
Ankle joint articulations
Between the talus, tibia, and fibula
Ankle joint movements
Dorsiflexion and plantar flexion of the foot on the leg
Ankle joint ligaments
Medial (deltoid) and lateral ligaments at the distal ends of the tibia and fibula
Lateral ligament components
Posterior talofibular ligament, anterior talofibular ligament, calcaneofibular ligament
Most commonly sprained ligaments
Lateral ligament, specifically the anterior talofibular ligament
Lateral ligament sprain cause
Foot inversion
Medial (deltoid) ligament components
Tibionavicular part, tibiocalcaneal part, posterior tibiotalar part, anterior tibiotalar part
Medial ligament sprain cause
Foot eversion
