lower limb lessons from class Flashcards
popliteal fossa
common fib - lateral
tib - verticle
vein
artery (deepest - hard to palpate)
and a bursa in this area
from lateral to medial -
art, vein, tibial nerve
what unlocks knee joint?
popliteal
similar bursa - in arm
Baker’s Cyst?
cutital bursa (elbow)
if baker’s cyst gets infected - big problem - can infect joint
sural nerve - cutaneous, acoompanies what vein?
small saphenous - from tibial nerve
genicular arteries? 4 - to genuflect
all around knee - kneeling - praying
genicular arteries? 4 - “to genuflect”
all around knee - kneeling - praying
popteal pulse, disease common in
smokers
124 degree to take pulse
pop muscle runs lateral to medially - obliquely
sciatic nerve divides into?
common peroneal - divides super and deep
tibial - runs vertial -
all divides above knee
common peroneal wraps around neck of fib
sural nerve - cutaneous branch of tibial nerve - communicates w? provides some foot - runs down back of leg
fib nerve
small saphenous vein
blocking popliteal nerve?
if near knee - blocks sural too - for foot surgery -
or achilles tendon
corrective foot surgery
foot debridgement
typially blocks “terminal branches of sciatic nerve”
genicular anastamosis
around the joint
and a variety of other arteries work togther
anterior tibial
posterio tibial, etc
genicular anastamosis
around the knee joint
and a variety of other arteries work togther
anterior tibial
posterio tibial, etc
ankle joint
synovial hinge
A hinge joint is a common class of synovial joint that includes the ankle, elbow, and knee joints. Hinge joints are formed between two or more bones where the bones can only move along one axis to flex or extend.Jul 3, 2018
ankle joint?
synovial hinge
A hinge joint is a common class of synovial joint that includes the ankle, elbow, and knee joints. Hinge joints are formed between two or more bones where the bones can only move along one axis to flex or extend.
How many hinge joints are in the human body?
[3][4] The hinge joints of the body include the elbow, knee, interphalangeal (IP) joints of the hand and foot and the tibiotalar joint of the ankle.Apr 5, 2020
great saphenous vein?
runs all the way down medially leg to big toe
foot nerve
sural, deep, cutaneous peroneal and then saphenous
what surrounds a stocking on the leg?
deep fascia - two intermuscular septa in leg - and three in thigh
tibia separates which compartments of leg?
anterior and lateral
and then the septa separate the other two compartments
lateral compartment of leg?
2 muscles - have word “fibula in them”
tiny - everts foot -
posterior compartment is huge - with superficial and deep posterior compartments
muscle to big toe?
surprisingly in leg - runs from lateral side
flexor hallosus (big toe) longus
anterior compartment of leg
dorsiflexors of ankle - deep fibular n - “deep peroneal n”
invert foot at subtala joint
anterior tibial artery
tibial anterior
extensor hallucis (big toe)
extensor digitorum (most toes)
fibularis tertisu - 5th toe
on top of foot - interesting m - digitorum brevis
extends from big toe - to all of toes - nothing like this similar in hand
posterior compartment of leg
tibialis anterior
deep fibular nerve
extensor hallucis longus
extensor digitorum longus
anterior compartment pathologies?
foot drop
if m paralyzed, toe lifting is impossible
foot drop
can’t dorsiflex foot
if deep peroneal n damaged, if sciatic n damages - foot drop
steppage gait - need to raise foot very high - put toes down first
chroinc and exertional comparment syndrome CECS
repetitive exertion - deep fasica doesn’t allow m to expand - m gets compressed - burning - subsides w/in 15 min or rest - skiers, long distance runnerse, etc
other things that acn look like Cecs?
tibial and fib stress fracture
shin splints
popliteal artery aneurysm
findings
weak toe extension
pain on toe flexion
diminished sensation in first web
other things that acn look like Cecs?
tibial and fib stress fracture
shin splints
popliteal artery aneurysm
findings
weak toe extension
pain on toe flexion
diminished sensation in first web
deep fib nerve supplies web space and anterior compartment
anterior tibial artery?
in foot near big toe - can take a pulse here
n? deep cutaneous branch of peroneal N
common fibular nerve injury?
anterior and later compartment can’t work
foot drop - steppage gait
loss of eversion of foot and dorsiflexion of the ankle causes foot-drop
lateral compartment - 2 muscles
evert goot, innervated by superficial fib n,
fib artery
fibularis longus,
fibularis brevis
superficial fib nerve supplies what part of top of foot?
almost ALL - except sural lateral, web -deep, medial - saphenous
shin splits? tibia
inflammation of bone - bone can get remodeled, fractures, athletes - can be in front or behind
caused from excessive pulling of muscles where attached to bone.
posterior compartment - two groups
plantar flexion of ankle -
tibial n,
TIP TOES -
two arteries
posterior tibial artery and fibular artery
can invert foot
posterior tibial arter y - divides fro other artery at bottom of popliteal
soleus - easy to get a thrombus here - and die
so let’s keep an eye on that one
The soleus connects the bottom of the knee to the heel. A strain, which is strained stretch or tear to to a muscle or tendon, to the soleus is caused by strenuous exercise and improper body alignment. Pain is felt on the side of the calf after activity.
gastrocnemius m?
two joint muscle - helps walking - in posterior - pulls heel up
must be near achilles tendon?
superficial - soleus below
plantaris m
VERY long tendon - back of knee - all way down to calcaneal tendon -
popliteus
unlocks knee joint, runs behind knee from lateral to media
flexor digitorum longun
down medially leg, wraps under foot - and then to toes
tibialis posterior
deepest muscle - down leg
talus?
only bone that has no attachment to m
achilles tendon
running on hills, repetitive stress - avasular tendon
Great saphenous vein?
Great Toe - with saphenous n
flexor retinaculum
site for palplation of posterio tibial artery
lateral malleolus? fibula?
medial malleolus - both on tibia?
Number of tarsal bones?
7 tiger cubs need MILC
valgus, varus?
varus (Inward)
Whenever the distal part is more lateral, it is called valgus. Whenever the distal part is more medial, it is called varus.
forefoot varus more common - varus - medial border is raised - excessive pronation
congential clubfoot?
insufficient amniotic fluid - envionmental causes
plastarflexion equinus and INVERTED (varus)
hindfood, forfoot is inverted -
tendon of tibialis anterior?
sends tendons out to all metatarslas?
arches of foot? 3
transverse -
medial
lateral
medial (inner) _ high point is calcaneous HIGHEST
calcaneus, talus, navicular, etc
Ligaments: Spring ligament (plantar calcaneo navicular lig) and
plantar fascia
Tendons tibilis posterior, tibialis anterior, fibularis longus
LATERAL (outer) - high point is cuboid
Lig: long plantar, plantar fascia, plantar calcaneocurboid
Tendons - extensors of 5 digit
absorbs shocks, distributes weight
place for neurovascular things to be
Spring lig - plantar calcaneo navicular lig
supports talus -
long plantar lig - - more superficial than short plantar (plantar calcaneo cuboid lig)
running across transversely -
Tendonius longus
pes cavus, pex planus
high arch (inversion - burns, residual clubfoot, compartment syndrome)
, flat food
pes cavus, pex planus
high arch (inversion - burns, residual clubfoot, compartment syndrome)
excessive supination
flat food
pes cavus (cave), pex planus
high arch (inversion - burns, residual clubfoot, compartment syndrome)
excessive supination
flat food
retinaculum of foot 4 in foot
vs in hand (wrist)
deep fascia - protect
flexor - from heel to medial malleolus
fibular - superior and inferior (from heel to fib)
superior extensor
inferior extensor - two bands like a y running medially
retinaculum of foot 4 in foot
vs in hand (wrist)
deep fascia - protect - contain fluid - synovial sheaths
flexor - from heel to medial malleolus
fibular - superior and inferior (from heel to fib)
superior extensor
inferior extensor - two bands like a y running medially
deep fascia - sole of foot
plantar aponeurosis - from calcaneum - widens w/ 5 slips = to each digit
superficial to nerves, blood vessels and M
supports arches
adductor policus in hand - what nerve?
ulnar - HY
medial planter and lateral plantar nerve
median - ulnar correspond
long thoracic… c?
c 5, 6, 7
weakened muscles in carpal tunnel?
The muscles supplied by the recurrent branch of the median nerve (opponens pollicis, flexor pollicis brevis, and abductor pollicis brevis) are most commonly weakened in patients with carpal tunnel syndrome.
The adductor pollicis
is innervated by the deep branch of the ulnar nerve. It functions to flex and adduct the thumb, and injury would lead to a decreased ability to grip.
Finger muscles?
Dorsal interossei muscles are innervated by a branch of the ulnar nerve and function to abduct the digits. The opponens digiti minimi muscle is innervated by the deep branch of the ulnar nerve and brings the fifth digit in opposition with the thumb. The patient in this vignette has normal muscle strength, making both dorsal interossei and opponens digiti minimi muscles less likely to be injured. The third and fourth lumbricals are innervated by the deep branch of the ulnar nerve and function to flex the fourth and fifth metacarpophalangeal joints while extending the interphalangeal joints of the fourth and fifth digits in the same motion.
Osgood Schlatter Disease?
OSD is a musculoskeletal disorder characterized by the gradual onset of knee pain after repetitive activities, typically sports that involve running or jumping. The condition occurs most commonly in growing children: boys between the ages of 12-15 and girls between the ages of 8-12. Overall, the condition presents more frequently in boys.
baker’s cyst? population?
Baker cysts typically form due to degenerative disease such as osteoarthritis or joint injury, and are much more commonly seen in older adult patients with years of chronic disease to their joints.
foot drop?
NOT THE DEEP OR SUPERFICIAL _
The common fibular (peroneal) nerve is the most frequently damaged nerve in the lower limb. Patients experience foot drop, which results from a loss of dorsiflexion at the ankle, as well as loss of eversion. Thus, they may present with an inability to dorsiflex or evert. Patients also have symptoms of pain and paresthesia in the lateral leg and dorsum of the foot. Those with foot drop may also exhibit a steppage gait, as described in the vignette.
plantar faccitis
pain on soul of foot- standing a long time - no insole on shoes
Dorsum of foot
dorsalis pedis artery - continuation of anterior tibila artery
Dorsum of foot - plantar arch
dorsalis pedis artery - continuation of anterior tibila artery
palpate where tarsal bones are
venous drainage
drains into both saphenous veins
each artery has two veins - helps in counter current exchange mechanism
as veins come in- they cool the blood - the artery gives its warmth which takes blood into center of body
nerves on soul of foot?
looks like mostly tibial except when saphenous - which comes from femoral
saphenous nerve comes from what N?
femoral
foot muscles - many come from leg - are there “foot only” muscles?
but in the foot, there are also four layers of Foot Only muscles
1st layer - 2 abductors, 1 flexor - 3 layer?
reversed - 1 adductor - 2 flexors -
2nd and fourth layer simliarly opposite -
2nd - two tendons, 2 muscles - flexor digitorum longus - attached to lumbricals
4th layer -
“preaxial” border - means toward big toe - vs. post axial border -
hand lumbricals are attached to?
The lumbricals are four, small, worm-like muscles on each hand. These muscles are unusual in that they do not attach to bone. Instead, they attach proximally to the tendons of flexor digitorum profundus and distally to the extensor expansions.
flexor hallusus longus goes to what?
The great toe - Where does it start from?
Pott’s fracture?
A Pott’s fracture is a fracture affecting one or both of the malleoli.
Lumbar plexus - I (twice) Got Lunch on Friday
Iliohypo iliioinguinal Genital femoral Lateral femoral obturator femoral
Sacral Plexus - L4 - S4
1 superior
2. inferior
3 sciatic NOT S4 (ends lower 1/3 of thigh and divides)
- (common peroneal - deep - superficial)
- tibial - sural / medial/lateral plantar
4 Posterior femoral cutaneous S1 - S3
5 Pudendal S2 -4
- slit wrist - what muscles may be affected on wrist - if ulnar area damages?
adductor pollicis muscle has an oblique and transverse head, both of which are innervated by the deep branch of the ulnar nerve, allowing the muscle to participate in thumb adduction and thumb MCP flexion. An injury to the ulnar nerve would result in a deficit of both of these actions.
The abductor pollicis brevis muscle is a thenar (thumb) muscle innervated by the recurrent branch of the median nerve and functions in abduction and opposition of the thumb. The first and second lumbricals and opponens pollicis are also innervated by the median nerve. Although the median nerve is commonly damaged when the wrists are slashed in a suicide attempt, it runs deep in the carpal tunnel and is protected from superficial injury, as seen in this patient. Injury to the median nerve would also present with sensory loss over the first 3½ digits, making these answer choices less likely. The extensor pollicis brevis, located on the dorsal part of the forearm, is innervated by the posterior interosseous nerve (a continuation of the deep branch of the radial nerve). This patient has superficial lacerations on the medial ventral side—not the radial side—of her left wrist and sensory loss over the fifth digit, making extensor pollicis brevis injury less likely.
carpal tunnel syndrome,
which occurs in individuals whose work involves repetitive hand motions. The muscles supplied by the recurrent branch of the median nerve (opponens pollicis, flexor pollicis brevis, and abductor pollicis brevis) are most commonly weakened in patients with carpal tunnel syndrome.
nerve that supplies quads?
femoral n - also supplies iliacus
Femoral b supplies a LOT of anterior lower limb
femoral n?
deep to fascia iliaca
artery and vein - superficial
femoral n?
deep to fascia iliaca
artery and vein - superficial
The fascia iliaca is located anterior to the iliacus muscle (on its surface) within the pelvis. It is bound superolaterally by the iliac crest and merges medially with the fascia overlying the psoas muscle.
What is femoral sheath? Where is it? Is this the fasica iliaca?
The femoral sheath (crural sheath) is formed by a prolongation downward, behind the inguinal ligament, of the abdominal fascia, the transverse fascia being continued down in front of the femoral vessels and the iliac fascia behind them. The femoral sheath is contained within the femoral triangle.
The fascia iliaca is located anterior to the iliacus muscle (on its surface) within the pelvis. It is bound superolaterally by the iliac crest and merges medially with the fascia overlying the psoas muscle.
L5 problem
may not be able to walk - trendelberg problem
dermatome skin over tibia?
L4
over fibula
L5
epideral?
need to NOT penetrate into dural sheath
Gait abnormalities?
Hemiplegic Gait
foot drop - knee extension - seen with upper neuron lesion
have to swing leg - because e
DIPLEGIC - hips and knees are flexed - narrow base, both lakes drag - toes scrape - (scissors gait) - lesion in brain
involve both sides
Steppage gait
EQUINE GAIT - foot drop - can have one nerve injured for example- L5
nueropathic gait -
if bilateral - Charcot marie Tooth disease and other peripheral neruopathies
shoes worn out anteriorly and ?
Waddling Gait -
turns trunk to one side and leift foot - muscular disease - weakness on side where pelvis is higher -
Parkinson’s gate -
basal ganglia - hypokinesia - rigidity - person doesn’t move - small/shuffling steps marche a a petit pas - difficulty to start walking
may have acceleration - short steps - fesinations - hard to turn around is difficult also
Choreiform Gait
basal ganglia disorder - increased movement - huntington’s disease - jerky movements increased jerkiness when walking
Ataxic Gait - cerebellar
alcohol drinkers - broad based gait - lurch to either side,
midline cerebellar disease - may not be able to balance if close eyes -
Sensory Gait
ROMBERG test -
wide based - may fall if close eyes - give the the ROMBERG test
Sensory ataxia a
lumbricals - of hands 4
lateral - media, medial - ulnar nerve
flex metacarpals
position of “function”
hand flexed - fingers extended
if ulnar damaged
all hand claws because interossi for all fingers controlled by ulnar-
palmar interossi missing what muscle?
none on the 3rd finger - ADDUCTS PAD, ADduct
DAB - Abduct
dorsal interossei
adductor pollicis - what nerve?
ulnar
upper lesion C5 - C6
Erb’s palsy - waiter’s tip
birthing, grabbing on to a branch
axillary, suprascp, and musculo nerves affected - they run in C5 - C6
can’t abduct arm,
radial nerve - if damage in axilla - what will work -
NOTHING - wrist drop, can’t extend elbow, etc
However, if damage distal to axilla (midshaft) - still have wrist drop - but can extend elbow
carpal tunnel
can be hereditary, hypothyroidism, rheumatoid arthritis.
median nerve - laboror’s nerve
Ulnar n?
musician’s n
Fracture of hook of hamate, wrist damage, medial epycondyle
“card” test - can’t hold paper between fingers
thumb adduction?
hyper pollicus
knocked knee
valgum deformity GUM
elbow fractures - how to treat? what causes?
n elbow dislocation occurs when the bones of the forearm (the radius and ulna) move out of place compared with the bone of the upper arm (the humerus). The elbow joint, formed where these 3 bones meet, becomes dislocated, or out of joint.
most common elbow dislocation?
The two general types of elbow dislocation are:
Simple elbow dislocation: The radius and ulna articulate with the humerus at the elbow. …
Complex elbow dislocation: This injury is a simple dislocation combined with a fracture of the humerus, radius, ulna or a combination of all three bones.
muscle attached to olecronon process?
tricep
if triceps damage to radial nerve at medial groove, still possible?
yes
colles fracture
distal fracture goes dorsally
smith’s
distral fractures goes ventrally
HY - medial four digits of hand - front of digits - no hair - flexion
thumb non hairy skin - when moves medially - flexion - when move laterally - EXTENSION
abduction and adduction
thumb moving away from axis - adduction
abduction - toward axis
which muscle causes this? adductor policies
ulnar nerve
Salter harris fracture?
in a growth plate - in children
TYPE 2 most common -
TYPE 5 - direct impact, most serious - can’t grow more.
foot drop? and fixing via steppage gait
raise knee higher OR use brace
deep fib - extensors can’t dorsiflex
knee flexors to solve problem, raise knee higher
hamstrings flex knee up higher
Tibialis anterior isn’t working
to hold a key- need to Adduct thumb
adductor pollicus - which nerve? ulnar
adduct shoulder?q
lat, bunch of mucles
palmar interossi?
abducts fingers
7 movements of thumb + circumduction +
add, abd, flex, exten, opposition, reopoosion
if can’t extend elbow - what nerve?
radial
if only inability to extend wrist
distal problem
if can’t extend elbow- problem in axilla
2 muscles that flex the wrist
flexor carpi ulnar and radialis
and what else can they do? ABDUCT wrist
radioulnar joint in elbow
pronates, supinates -
2 muscles that cause supination?
supinator and biceps brachii
which division is musculocutanerous from?
anterior
3 posterior from radial
musculo - 2 divisions - upper and middle-
what nerve flexes hip?
ilapsoas - L1 - L2, lumbar spinal nerve, and femoral
what extends knee?
quadriceps, gluteus max, tensor fascia
sartorius?
flexes knee -
epimere
dorsal rami
hypomere?
ventral rami
lateral plate mesoderm? splanchno and somatic
BBC
Bones, Blood, CT
limb muscles from somites
secondary ossif - when appear? except one?
end of long bone - lower end of femur - 9th month - viable - if don’t see this 2day ossif - maybe not 9 months old
which of follwoing bones ossify my membranous
maxilla
which develop the muscle of body wall
hypoaxial division
AER - fgf8 - proximo distal growth
proximal first
antero prosterio
zone of polarizing activity - anterio, postrio pole -
antero prosterio
SSH - ulnar, little finger
Less SSH - thumb develops
zone of polarizing activity - anterio, postrio pole - caudal first - POST axial border - little finger, SSH!
hindlimb TBS4
forelimb is not 4
forelimb TBX5
forelimb is not 4
dorsal ectoberm -
wnt7a
preaxial
radius, thumb
leg: big toe, tibia
post axial develop first or last
first - SSH develops
if excess SSH - absense of radius -
