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Limbs anatomy > lower limb nerves and vessels > Flashcards

lower limb nerves and vessels Flashcards

1
Q

What do the posterior divisions of the spinal nerves supply? Why?

A

Anterior compartments

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2
Q

Where does the femoral nerve enter the thigh?

A

comes through into thigh below inguinal ligament in femoral triangle

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3
Q

what does the femoral nerve supply?

A

anterior compartment of thigh and iliopsoas

has anterior cutaneous branch which innervates most of ant thigh

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4
Q

what is the terminal branch of the femoral nerve?

A

saphenous nerve - sensory to medial aspect of leg

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5
Q

what spinal nerves make up the femoral nerve?

A

L2,3,4

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6
Q

describe the path of the sciatic nerve

A

usually comes out of the greater sciatic foramen below piriformis

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7
Q

what does the sciatic nerve supply?

A
  • posterior compartment of thigh
  • all muscles below the knee via tibial and common peroneal branches
  • supplies hamstrings
  • some sensory branches to back of thigh
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8
Q

what spinal nerves form the sciatic nerve?

A

formed from lumbosacral trunk (L3,4,5) and sacral nerves S1,2,3

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9
Q

describe the passage of the obtruator nerve

A

passes through obtruator foramen

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10
Q

what does the obtruator nerve supply?

A
  • medial (adductor) compartment of thigh

- supplies patch of skin on medial thigh superior to knee

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11
Q

what spinal nerves form the obtruator nerve?

A
  • lumbar plexus

- L2,3,4

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12
Q

describe the passage of the inferior gluteal nerve

A

passes through greater sciatic foramen with the inferior gluteal artery BELOW piriformis

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13
Q

what does the inferior gluteal nerve innervate?

A

gluteus maximus

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14
Q

what spinal nerves make up the inferior gluteal nerve?

A

L5-S2

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15
Q

describe the passage of the superior gluteal nerve

A

passes through greater sciatic foramen with superior gluteal artery ABOVE piriformis

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16
Q

what does the superior gluteal nerve innervate?

A
  • gluteus minimus and medius

- tensor fasciae latae

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17
Q

what spinal nerves make up the superior gluteal nerve?

A

L4-S1

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18
Q

describe the passage of the tibial nerve

A
  • forms from sciatic nerve in popliteal fossa
  • passes down intercondylar eminence
  • passes along shaft of tibia
  • then crosses behind medial malleolus
  • forms medial and lateral plantar nerves
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19
Q

what does the tibial nerve innervate?

A
  • post compartment of leg
  • most intrinsic muscles of foot
  • sensory to back of leg, sole of foot
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20
Q

what spinal nerves make up the tibial nerve?

A

L4-S3

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21
Q

describe the passage of the common peroneal nerve

A
  • froms from sciatic nerve
  • crosses lateral side of knee
  • passes behind head of fibula
  • crosses anteriorly to give off a deep and superficial peroneal branch
  • also gives off sural communicating branch
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22
Q

what does the common peroneal nerve supply?

A
  • anterior and lateral compartments of leg

- sensory to anterior and lateral aspects of leg and dorsum of foot

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23
Q

describe the passage of the deep peroneal

A
  • passes down interosseus membrane

- ends up with its terminal branches innervating a little V shape, half of 1st and 2nd digits

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24
Q

what does the deep peroneal innervate?

A

anterior compartment of leg

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25
Q

what spinal nerves make up the deep peroneal?

A

L4-S1

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26
Q

describe the passage of the superficial peroneal

A

passes down lateral shaft of fibula

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27
Q

what does the superficial peroneal innervate?

A
  • lateral compartment of leg

- terminal branch is cutaneous supply to dorsum of foot

28
Q

what branches make up the superficial peroneal?

29
Q

which area of the skin does the post cutaneous nerve of thigh innervate?

A

area from just below buttock to end of the popliteal fossa in middle
S1,2

30
Q

What area of skin does the saphenous nerve innervate?

A

medial anterior and post part of leg

31
Q

what part of the skin does the lateral sural cutaneous nerve supply?

A

lateral part of leg on ant and post parts

32
Q

what area of skin does the sural nerve supply?

A

small patch of skin on posterior part of leg, in midline

33
Q

what muscles in particular does the femoral nerve supply?

A

Anterior compartment:

  • psoas and illiacus
  • pectineus
  • sartorius
  • rectus femoris
  • vastus medialis
  • vastus intermedius
  • vastus lateralis
34
Q

what muscles in particular does the obtruator nerve supply?

A

Medial compartment:

  • obtruator externus
  • adductor brevis
  • adductor longus
  • part of adductor magnus
  • gracilis
35
Q

What muscles in particular does the sciatic nerve supply?

A

Posterior compartment:

  • biceps femoris
  • semimembranosus
  • semitendinosus
  • part of adductor magnus
36
Q

What muscles in particular does the deep peroneal nerve supply?

A
  • extensor digitorum longus
  • extensor hallucis longus
  • tibialis anterior
  • peroneus tertius
  • extensor digitorum brevis
37
Q

What muscles in particular does the superficial nerve supply?

A
  • peroneus longus

- peroneus brevis

38
Q

describe injury to the femoral nerve

A

rarely damaged

commonly during hip replacements

39
Q

describe injury to the lateral cutaneous nerve of the thigh

A

can be compressed when it passes 2cm medial to ASIS at level of inguinal ligament
–> meralgia paraesthetica

40
Q

describe injury to the obtruator nerve

A

rarely

pain in thei region can indicate malignant disease in pelvis

41
Q

describe injury to the superior gluteal nerve

A

Tredelenberg gait

mostly damaged in hip replacements

42
Q

describe injury to the sciatic nerve

A

damaged in hip replacement, trauma, pelvic disease

43
Q

describe injury to the common peroneal nerve

A

vulnerable to damage at hip and level of fibular neck

damaged by trauma, knee replacement, external pressure

44
Q

describe injury to the saphenous nerve

A

common, can be damaged at medial malleolus (after varicose vein surgery) or at level of knee (e.g. ACL surgery)

45
Q

when assessing nerve function, what 4 things should you check?

A
  • motor function - loss of some movements inidicates which part of spinal cord is damaged
  • sensory function
  • reflex function - test monosynaptic reflexes like patellar tendon reflex
  • autonomic function - sweating/redness
46
Q

What would you see if someone had a prolapsed intervertebral disc at L5-S1?

A
  • loss of eversion
  • loss of sensation of outer border of foot
  • loss of ankle jerk (S1)
  • minimal autonomic loss
47
Q

what would you see if someone had injury to the common peroneal nerve at fibular neck?

A
  • no dorsiflexion of foot or eversion (foot drop)
  • loss of sensation on anterior leg, dorsum of foot
  • no reflexive losses
  • minimal autonomic loss
48
Q

describe how the abdo aorta becomes the femoral artery

A

abdo aorta > common iliacs > external/internal iliacs > external iliac becomes femoral at mid inguinal point

49
Q

what does the femoral artery give off?

A
  • profunda femoris

- 3 circumflex branches

50
Q

what are the 4 branches of the femoral artery in the thigh just below the inguinal ligament?

A
  • superficial circumflex iliac
  • superficial epigastric
  • superficial external pudendal artery
  • deep external pudendal artery
51
Q

how does the femoral artery become the popliteal artery?

A
  • femoral artery passes down femoral triangle and femoral canal
  • then passes through adductor hiatus to become popliteal artery in popliteal fossa
52
Q

where would you palpate the femoral artery?

A

mid inguinal point (half way b/ ASIS and PS)

53
Q

describe what happens to the popliteal artery

A

gives off 4 genicular branches (superior, inferior, lateral, medial)
it trifurcates into anterior and posterior tibial arteries
this immediately bifurcates into posterior tibial and peroneal

54
Q

describe the passage of the anterior tibial artery

A

descends down interosseous membrane

crosses ankle in midline to bcome dorsalis pedis artery

55
Q

where is the anterior tibial artery palpable?

A
  • in the V b/ 1st and 2nd digits

- between tendons of EHL and EDL

56
Q

what does the ant tibial artery supply?

A

ant compartment of leg

57
Q

describe the path of the post tibial artery

A

descends down leg behind shaft of tibia

crosses posterior to medial malleolus

58
Q

where is the post tibial artery palpable?

A

half way b/ heel and medial malleolus

59
Q

what does the post tibial artery supply?

A
  • supply posterior compartment of leg

- contributes to plantar arches via lateral and medial plantar arteries

60
Q

describe the passage of the peroneal artery?

A

crosses down shaft of fibula

crosses anteriorly to lateral malleolus

61
Q

what does the peroneal artery supply?

A

lateral compartment

62
Q

describe the passage of the long saphenous vein?

A
  • formed from dorsal venous arch
  • crosses in front of medial malleolus
  • up ant medial side of leg and thigh where it joins femoral
63
Q

describe the passage of the short saphenous vein

A
  • forms from plantar venous network
  • runs up in b/ heads of gastrocnemius
  • drains into popliteal vein by perforating popliteal fossa
64
Q

what are perforating veins?

A

veins from superficial venous system that drain into deep venous system

65
Q

what happens when valves of the perforating veins fail?

A

backflow into them

–> protrude into skin = varicose veins

66
Q

what is a saphenous cut down?

A
  • extreme trauma to get IV access

- incision 2cm proximal and lateral to medial malleolus

67
Q

what is compartment syndrome?

A
  • leg separated into compartments
  • if pressure builds up in one
  • increased pressure in confined compartment can cause ischaemia–> pain

Limbs anatomy (7 decks)

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