Lower Limb III and IV Flashcards
Muscles of the posterior compartment of the thigh action and names
Extend the thigh and flex the leg
Semitendinosus, semimembranosus, and biceps femoris
(And Hamstring head of adductor Magnus muscle)
Semitendinosus muscle: origin, insertion, innervation, action
Ischial tuberosity Medial part of proximal tibia Tibial division of the sciatic nerve Extends thigh, flex leg, medially rotates leg *huge tendon of origin
Semimembranosus muscle
Ischial tuberosity Medial condolences of the tibia Tibial division of the sciatic nerve Extend thigh, flex and medially rotate the leg *huge tendon of insertion
Biceps femoris: long head
Ischial tuberosity
Head of fibula
Tibial division of the sciatic nerve- (because it comes off of the ischial tuberosity)
Extends thigh, flexes and laterally rotates the leg
Biceps femoris: short head
Linea aspera
Head of fibula
Common fibular division of the sciatic nerve (because it comes off of the femur)
Extends the thigh, flexes and laterally rotates the leg
Nerve supply to the posterior compartment of the thigh
Sciatic nerve (L4, 5, S1, 2, 3)- splits into tibial and common fibular (Peroneal) nerve Posterior femoral cutaneous nerve (S1, 2, 3) (medial to sciatic) innervates the skin of posterior thigh and over popliteal fossa
Blood supply to muscles of the posterior thigh
Perforating Arteries of the profunda femoris enter the posterior compartment and provide muscular branches to the hamstrings
Bursa
Sacs that secrete synovial fluid anywhere there is friction over bone by a tendon, muscle, etc
Clinical significance- can become inflamed or irritated “bursitis”
Pes anserinus
Three conjoined tendons on the medial aspect of the knee
From anterior to posterior: sartorius, gracilis, semitendinosus
Clinical significance: pes anserinus bursa lies between the pes anserinus tendons and the more deeply located semimembranosus tendon; can become inflamed (pes anserinus bursitis)
3 different nerves supplying these muscles: femoral n, obturator n, and tibial nerve, resp.
Adductor magnus: adductor part
Ischiopubic ramus (pubicfemoral portion)
Shaft of the femur
Obturator nerve
Adducts/flexes the thigh
Adductor Magnus: hamstring part
Ischial tuberosity (ischocondylar portion)
Adductor tubercle of femur (where the adductor hiatus is)
Tibial division of the sciatic nerve
Adducts and extends the thigh
Capsule of the knee joint extends from:
And is strengthened by:
Femur to tibia
Fibers of the fascia lata, IT tract, tendons of the vasti, hamstrings, and sartorius muscles
*fascia lata becomes the cural fascia to strengthen
patellar ligament extends from and helps:
Apex of the patella to the tuberosity of the tibia; helps hold the patella in place and serves as part of the “tendon” of the quadriceps femoris muscle
Oblique popliteal ligament extends from and reinforces:
Lateral femur to the posterior tibia to reinforce posterior surface of the joint capsule
Extension of the semimembranosus*
Arcuate popliteal ligament extends from and acts to:
Lateral condolences of the femur to the head of the fibula to arch over the tendon of the popliteus muscle; stabilize the posterior aspect of the knee
Anterior cruciate ligament extends from and acts to:
The front of the intercondylar eminence to the medial surface of the lateral femoral condyle posteriorly
Checks extension and anterior slipping of the tibia on the femur (or posterior displacement of the femur on the tibia)
Posterior cruciate ligament extends from
Posterior intercondylar fossa and to the lateral surface of the medial femoral condyle anteriorly
Checks flexion and posterior slipping of tibia on the femur (or anterior displacement of the femur on the tibia)
Medial meniscus
Crescent shaped; Cartilaginous structure Attached to the tibia anterior to the ACL and to the posterior intercondylar area
Deepens the medial tibial condyle; the medial (tibial) collateral ligament is firmly attached to the medial meniscus
Not very mobile
Lateral meniscus
Nearly circular, attached to the tibia anterior to the ACL; posteriorly attached behind the intercondylar eminence anterior to the medial meniscus
Has more movement because it has no attachment to the lateral (fibular) collateral ligament
Functions of the menisci
Deepen the tibial plateaus to accommodate the femoral condyles
Medial/tibial collateral ligament
Broad flat band located slightly posterior on the medial side of the knee. Attached proximally to the medial epicondyle of femur right below adductor tubercle. Distal attachment to the medial condyle of the tibia.
Resists forces that would push the knee joint medially. Fused to the medial meniscus
Lateral/Fibular collateral ligament
Rounded, more narrow and less broad than medial collateral ligament. Stretches downward from lateral epicondyle of femur to the head of the fibula. Not fused with lateral meniscus, so it is less susceptible to injury*
The popliteal fossa is bounded by
Superolaterally- biceps femoris muscle
Superomedially- semimembranosus and semitendinosus muscles
Inferolaterally and inferomedially- the lateral and medial heads of the gastrocnemius muscle
Posteriorly- skin and the popliteal fascia form the roof
when the femoral artery and vein come out of the adductor hiatus, they are renamed:
What covers the entrance of the femoral vessels into the popliteal fossa (adductor hiatus)
Exits hiatus (posterior) to become the Popliteal artery and vein Intermuscular septum (saphenous nerve passes under this instead of the adductor hiatus)
Contents of the popliteal fossa
Termination of the small saphenous vein
Popliteal artery and vein (continuation of the femoral vessels)
Tibial and common fibular nerves (divisions of sciatic nerve)
Posterior cutaneous nerve of the thigh
Popliteal lymph nodes and lymphatic vessels
Plantaris muscle
Lateral side of the distal femur Calcaneal tendon Tibial nerve Weak plantarflexion VERY long tendon, muscle belly is high up, but action is way below
Popliteus muscle
Lateral epicondyle of femur Posterior surface of the proximal tibia Tibial nerve Weakly flexes knee; unlocks extended knee Passes under the ACL
Interosseus membrane
Strong, fibrous sheet that connects the interosseous margin of the tibia and the interosseus margin of the fibula, filling the gap between the two bones except at the proximal and distal ends where there exists openings in the membrane that allow for the passage of vessels.
Stabilizes the tibiofibular junction and provides attachment for many of the leg muscles and transmits force down the leg
Joints of the ankle and foot- names, types and actions
Talocrural joint (hinge jt at ankle)- dorsiflexion and plantarflexion. Medial malleolus of tibia and lateral malleolus of fibula and talus. Subtalar joint (talocalcaneal, gliding jt.)- inversion and eversion
- dorsiflexion (Dorsum or top of the foot up) and plantarflexion (plantar or bottom of the foot points back)
- inversion (plantar surface faces in/medially) and eversion (plantar surface faces out)
Lateral collateral ligament (complex) of the ankle
Set of three ligaments that resists inversion of the ankle joint: posterior talofibular ligament, anterior talofibular ligament, calcaneofibular ligament.
More commonly injured than the medial collateral (deltoid) ligament of the ankle
Run from the lateral malleolus to the talus and calcaneus
Deltoid (medial) ligament of the ankle
Attaches the medial malleolus to multiple tarsal bones to stabilize the side of the ankle joint and prevent excessive eversion of the ankle
Anterior parts of the ligament limit plantar flexion and posterior parts of the ligament limit dorsiflexion
What divides the leg into its posterior deep and superificial compartments?
Intermuscular septum
What divides the leg into anterior and posterior compartments
Interosseous membrane
Posterior and anterior crural septa (extension of the fascia lata now around the leg)
Anterior compartment of the leg: actions, nerve, blood supply
Dorsiflexion of the foot, extensors of the digits (some inversion and eversion)
Deep fibular (peroneal) nerve
Anterior tibial artery
Any tibialis muscle is an: Any peroneus (fibularis) muscle is an:
Invertor
Evertor
Tibialis anterior muscle
Lateral condyle of tibia
Medial cuneiform and base of 1st metatarsal
Deep fibular nerve
Dorsiflexes ankle and inverts the foot
Extensor digitorum longus muscle
Lateral condyle of tibia and proximal fibula
Phalanges of toes 2-5
Deep fibular nerve
Extends lateral four digits and dorsiflexes ankle
Extensor hallucis longus muscle
Fibula
Base of distal phalanx of great toe (hallux)
Deep fibular nerve
Extends great toe and dorsiflexes ankle
Fibularis (peroneus) tertius
Distal fibula
5th metatarsal
Deep fibular nerve
Dorsiflexes ankle and aids in eversion of the foot
What extends across the tendons superior/inferior to the ankle joint to bind them down?
Superior/inferior extensor retinaculum
Lateral compartment of the leg: actions, nerve, blood supply
Plantar flexors and principal evertors of foot
Superficial fibular (peroneal) nerve
No specific artery* fibular branch of the posterior tibial artery supplies compartment
Fibularis longus muscle
Fibular head and shaft- passes behind lateral malleolus under the foot to first metatarsal bone to go medially
1st metatarsal and medial cuneiform
Superficial fibular nerve
Everts foot and weakly plantarflexes
Fibularis brevis
Distal fibula- comes down and stays lateral*
Tuberosity of 5th metatarsal bone
Superficial fibular nerve
Everts foot and weakly plantarflexes
The lateral aspects of the ankle and foot showing the peroneal tendons passing deep to what that holds them down?
Superior and inferior fibular (peroneal) retinacula (specialized fascia)
Superficial fibular nerve: origin, tract, supplies
Originates from common fibular nerve, arises between fibularis longus and neck of fibula and descends in the lateral compartment of leg; pierces deep fascia in distal third of leg to become cutaneous
Supplies lateral compartment muscles; skin on distal third of anterior surface of leg and dorsum of foot
Deep fibular nerve: origin, tract, supplies
Originates from common fibular nerve, arises between fibularis longus and neck of fibula; passes through the extensor digitorum longus and descends on the interosseous membrane; crosses the distal end of tibia and enters dorsum of foot.
Supplies the anterior compartment of the leg muscles; skin of first interdigital cleft on dorsum of foot
Artery of the anterior compartment of the leg- origin, tract
Anterior tibial artery
Originates from popliteal artery and passes between tibia and fibula into anterior compartment through a gap in the superior part of the interosseous membrane and descends on this membrane between the tibialis anterior and extensor digitorum longus muscles
Posterior compartment of the leg: action, attachments, nerve, blood supply
Plantarflexors, two flexors of the digits
Attach to calcaneus via tendon calcaneus (superficial group); tarsal bones or distal phalanges (deep group)
Tibial nerve
Posterior tibial artery
Gastrocnemius muscle- lateral and medial head
Lateral head origin- lateral condyle of femur
Medial head origin- medial condyle of femur
Calcaneal tendon
Tibial nerve
Plantarflexes ankle when knee is extended; flexes leg at knee joint
Soleus muscle
Soleal line and proximal tibia
Calcaneal tendon
Tibial nerve
Plantarflexes ankle
Flexor hallucis longus
Posterior surface of fibula
Great toe
Tibial nerve
Flexes great toe, weak plantarflexion, supports medial longitudinal arch of foot
Flexor digitorum longus
Posterior surface of tibia
Phalanges of toes 2-5
Tibial nerve
Flexes toes 2-5, plantarflexes ankle, supports longitudinal arch
Tibialis posterior
Posterior surface of tibia and fibula
Plantar surface of several tarsal bones
Tibial nerve
Plantarflexes ankle and inverts foot
Long tendons and the principal vessels and nerves from posterior compartment of the leg pass posterior to the medial malleolus, deep to the what that holds them down to enter the sole of the foot?
Flexor retinaculum
Cutaneous nerves of the leg
Saphenous nerve from femoral to supply medial area
Lateral sural cutaneous nerve from common fibular to supply lateral area
Superficial fibular nerve to lateral leg and dorsum of foot
Deep fibular nerve between 1st and 2nd toe
Sural nerve accompanies short saphenous vein in back of leg to innervate posterior middle of leg and lateral foot
Tract/fusion of common fibular nerve and tibial nerve in posterior compartment of leg
Runs out of sight as it wraps around neck of fibula and gives off lateral sural cutaneous nerve, which gives gives off sural communicans, which connects to a branch of the tibial nerve called the medial cutaneous sural nerve to pop out of sural fascia to become the sural nerve.
Arteries in posterior compartment of leg
Posterior tibial artery
Fibular artery
Posterior tibial artery tract
Terminal branch of popliteal artery, supplies posterior compartment of leg; close to its origin it gives off the fibular artery; terminates distal to flexor retinaculum by dividing into medial and lateral plantar arteries
Fibular artery tract
Descends in the posterior compartment of the leg from the posterior tibial artery to the posterior intermuscular septum; supplies posterior compartment and has perforating branches that supply muscles of the lateral compartment of the leg
Muscles of the dorsum of the foot: originate, insert, action, nerve
Originate from calcaneus
Insert into digits
Action is extension
Deep fibular nerve
Extensor digitorum brevis
Calcaneus
Long extensor tendons of toes 2-4
Deep fibular nerve
Aids the extensor digitorum longus in extending the four lateral toes
Extensor hallucis brevis
Calcaneus
Phalanx of the great toe
Deep fibular nerve
Aids extensor hallucis longus in extending the great toe
Blood supply to the dorsum of the foot
Dorsalis pedis artery
Dorsalis pedis artery tract
The anterior tibial artery continues on the dorsum of the foot and is renamed
It ends by dividing into the arcuate and the larger deep plantar artery
The artery can be palpated lateral to the extensor hallucis longus tendon
Palpation useful when assessing peripheral vascular disease
Cutaneous nerve supply to the dorsum of the foot
Sural nerve- lateral metatarsal
Superificial fibular nerve- dorsum of foot and digits
Deep fibular nerve- between 1st and 2nd toe
Intrinsic muscles of the foot: action, innervation, divisions, blood supply
Maintain the arches of the foot so we can stand on uneven surfaces
Divided into four layers
Innervated by the medial and lateral plantar nerves (from tibial nerve)
From arteries that are derived from the posterior tibial artery- medial, lateral. And the deep plantar artery (from the dorsalis pedis artery)
Axis of reference fro abduction and adduction of digits
Second toe
Muscles of the foot- first layer
3 short muscles attached to calcaneus and phalanges
Flexor digitorum brevis
Abductor hallucis
Abductor digiti minimi
Flexor digitorum brevis
Calcaneal tuberosity
Middle phalanges of the lateral four toes
Medial plantar nerve
Flexes lateral four digits
Abductor hallucis
Calcaneal tuberosity
Medial side of proximal phalanx of great toe
Medial plantar nerve
Abducts great toe
Abductor digiti minimi
Calcaneal tuberosity
Lateral side of the proximal phalanx of 5th toe
Lateral plantar nerve
Abducts the 5th toe
Muscles of the foot- second layer
Two muscles, two tendons (FHL/FDL), muscles attach to flexor digitorum longus
Quadratus plantae
Lumbricals
Quadratus plantae
Calcaneus
Tendon of the flexor digitorum longus muscle
Lateral plantar nerve
Assists FDL in flexing lateral four digits
Lumbricals
Tendons of the flexor digitorum longus
Extensor expansions of the lateral four toes
Medial (medial 2) and lateral plantar nerves (lateral 3)
Flex proximal phalanges, extend middle and distal phalanges of the lateral four digits
Muscles of the foot- third layer
Two muscles for big toe, one muscle of little toe
Flexor hallucis brevis
Adductor hallucis (transverse and oblique head)
Flexor digiti minimi brevis
Flexor hallucis brevis (with sesamoids)
Lateral tarsal bones
Proximal phalanx of the great toe
Medial plantar nerve
Flexes the great toe
Adductor hallucis- transverse and oblique heads
Plantar ligaments and bases of metatarsals
Lateral side of the proximal phalanx of the great toe
Lateral plantar nerve
Adducts great toe (moves toward second toe)
Flexor digiti minimi brevis
5th metatarsal bone
Proximal phalanx of the 5th toe
Lateral plantar nerve
Flexes the 5th toe
Muscles of the foot- fourth layer
Interossei muscles
Adductors (PAD)= plantar interossei
Abductors (DAB)= dorsal interossei
Tendons of the fibularis longus and the tibialis posterior muscles
Plantar interossei
Plantar aspect of the medial side of shafts of metatarsals 3-5
Medial sides of bases of phalanges of 3-5 digits
Lateral plantar nerve
Adducts the digits 3-5 and flex metatarsophalangeal joints
Dorsal interossei (four muscles)
Adjacent sides of shafts of metatarsals 1-5
Phalanx of 2-4
Lateral plantar nerve
Abducts digits 2-4 and flex metatarsophalangeal joints
