Lower Limb Part 1 Flashcards
what is an innominate bone
this is the coxal bone or the hip bone. that is a flattened irregularly shaped bone
what is the pelvis
2 hip bones and sacrum
what is the coxal bone made up of
ilium
ischium
pubis
- these complete fusion around the age of 20-25 years old
read chapers 3
pages 327-337, 350-355, 357-362
what is the angle of inclination
angle between the femoral neck to the femoral shaft
what does the angle of inclination allow
allows for greater mobility places the head and neck more perpendicular to the acetabulum
what is the angle of a child, normal adult, and in older populations
child = 135 degrees
normal adult= 126 degrees
older population= 120 degrees
why might the angle of inclination change
due to pathological process that weaken the neck of the femur
what is the coxa vara
the angle of inclination is decreased
what is the coxa valga
the angle of inclination is increase
what type of fascia is seen in the thigh
superficial
deep
what type of fascia is the deep fascia of the thigh
this invest the lower limb like ann elastic stocking
- contains the fascia lata ( iliotibial tract)
what type of fascia is the deep fascia of the leg
- the crural fascia
- extensor retinacula
what is the iliotibial tract
lateral thickening of deep fascai
– this is tendinous reinforcements form the TFL and gluteus maximus
where does the iliotibial tract start and end
from iliac tubercle to anterolateral tubercle of tibia
what is intermuscular septum
this is the fascia separating the muscles into compartments
what are the muscle compartments of the thigh
anterior
medial
posterior
what are the muscle compartments of the leg
anterior
lateral
posterior
where can the saphenous opening be found
inferiro to inguinal ligament whcih is a hole in the fascia lata
what is the fascia that surounds the opening of the fascia lata
the cribiform fascia
what is the cribiform fascia
subcutaneous tissue spreads over saphenous opening and closing it
What is the gluteal region ( buttocks)
transitional area between trunk and limbs
what are some gluteal region ligaments
sacrotuberous
sacrospinous
what is the sacrotuberous ligament of the gluteal region
goes from sacrum dorsal surface to ischial tuberosity
what is the sacrospinous ligament of the gluteal region
goes from margins of sacrum to ischial spine
what do the gluteal region ligaments create
they create the greater and lesser sciatic foramen
what is the greater sciatic foramen
helps with passage for strucutes in and out of the pelvis
what are the greater sciatic boundries
greater sciatic notch, sacrotuberous lig, and sacrospinus Lig
what takes up most of the greater sciatic forament space
the piriformis
what come out/ in above the pirifomris
superior gluteal vessel, Superior gluteal n
what come out/in below the piriformis
inferior gluteal vessels, internal pudendal vessels, inferior gluteal n., pudendal n , sciatic n, posteriro femoral cutaneous n., nerve to quadratus femoris, terve to obturator internus
what are some structures that pass from the perineum through the greater sciatic forament
internal pudendal a, nerve to obturator internus, pudendal n
what is the lesser sciatic foramen
passage for structures in and out of perineum
what are the boundries of the lesser sciatic formane
ischial tuberosity, sacrospinous lig, sacrotuberous lig
what is the path of nerve to obturator internus
travels through the greater sciatic forament inferior to the piriformis , but then loops back aroudn to reenter the pelivis through the lesser sciatic foramen
what is the path of the internal pudendal artery
it exits the pelvic cavity through the greater sciatic foramen to enter the gluteal region. it then curves aroudn the sacrospinous ligament to enter the perineum throgh the lesser sciatic foramen
what are the m. of the gluteal region
gluteus max, med, min
plus the lateral rotators
what does the gluteal region do for the tfl
tightens the fascia lata allowing the thigh mm. to increase the power
what are some different ways the sciatic n wraps around the pirirforms
normal= it comes below the m. toghether 1= the tibial n is below the m and the common fibular n is going through the m. 2= the tibial n is going belwo and the common fiibular is going above the m.
where do the nerves of the lower limb come from
lumbar and sacral plexus
what is the spinal ns of the lumbar plexus
Ventral rami of L1-L4
and help from the subcostal n (T12)
what are the spinal ns of the scaral plexus
ventral rami of L4-L5
ventral rami of S1-4
( 2 main ns. are the sciatic and pudendal nn)
what is the lumbosacral trunk
descending part fo L4 unites with anterior ramus of L5 then joins sacral plexus
– this is not part of lumbar plexus
what is the cocygeal plexus
S5 and Co which form the coccygeal nerve
what are the nerves of the gluteal region and posterior thigh
1= gluteal nerves= cutaneous nerves - superior cluneal n. -middle cluneal n. -inferior cluneal n. 2=deep nerves
What is the spinal n. of the superior cluneal n.
dorsal rami of L1-L3
What does the the superior cluneal n. supply
superior 2/3 of the the buttock
what is the spinal n. of the middle cluneal n.
dorsal rami of S1-S3
What does the the middle cluneal n. supply
skin over sacrum and adjacent buttock
what is the spinal n. of the inferior cluneal n.
derived rom posterior femoral cutaneous n ( S2-S3)
What does the the inferior cluneal n. supply
larger, innervates inferior half of buttock
what are deep nerves of the gluteal/ posterior thigh regioin
all are branches of scaral plexus
all leave pelivs via greater sciatic formane
EXCEPT superior gluteal n . they emerge inferior to pirifomris m.
what is the spinal n. of the superior gluteal n.
L4-S1
what are the branches of the superior glureal n.
- superior branch
- inferior branches
what does the superior branch of the superior gluteal n. supply
gluteus medisu
what does the inferior branch of the superior gluteal n. supply
gluteus medius
minimus
tensor fasciae latae
what are the spinal ns. of the inferior glutteal n
L5-S2
what do the branches of the inferior gluteal n innverate
glutues max
what are the spinal ns. of the sciatic n.
L4-S3
largest nerve in humans
what does the sciatic n supply
no muscles in gluteal region
supplies muscles in posterior compartment of thigh
what are the branches of the sciatic n.
tibial n.
common fibular n
( they separate about half way down the thigh)
what are the spinal ns of the posterior cutaneous ne of the thigh
S1-S3
what does the posterior cutaneous ne of the thigh supply
skin of buttock, perineum, posterior thigh, upper meidal thigh
what are the spinal ns of the nerve to the quadratus femoris m.
L4-S1
what does the nerve to the quadratus femoris m. supply
articular br. → to hip joint
muscular br. → quadratus femoris and inferior gemellus m.
what are the spinal nn. of the nerve to the obturator internus
L5-S2
what does the nerve to the obturator internus supply
obturator internus and superior gemellus
what are the spinal nn. of the pudendal n.
S2-S4
what does the pudendal n. supply
structures in the perineum
genitalia, sphincter urethra, anal sphincter
what are the arteries of the gluteal and posterior thigh region
all are branches of internal iliac artery
- superior gluteal a
- inferior gluteal a
- internal pudendal a.
what is the superior gluteal a path
leaves pelvis thorugh greater sciatic foramen- superiorr to teh piriformis
what are the branches of the superior glureal a.
superficial branch
deep branch
what does the superficial branch of the superior gluteal a supply
gluteus maximus
what does the deep branch of the superior gluteal a supply
gluteaus medius
gluteaus minimus
TFL
what is the path of the inferior gluteal artery
leaves pelvis through greater sciatic formaen inferior to the pirifomris m
what does the infereior gluteal a supply
to gluteus max, obturator internus, quadratus fem, superior part of hamstring mm.
what is the internal pudendal a path
leaves pelvis through greater sciatic foramen and descends posteriro to the ischial spine then reenters the pelivs vis lesser sciatic foramen and enters perineum with pudendal nerve
what does the pudendal a supply
muscles in perineal region and external gentialia
what are the veins of the lower limb form the internal iliac v
gluteal veins
what are some superficial vv of the lower limb
- small saphenous
- great saphenous
where does the small saphenous v begin
on lateral foot
what creates the small saphenous v
union of dorsl venous arch and dorsal vein of little toe
what is the path of the small saphenous v
passes posterior to lateral malleolus and ascends along the lateral side of the calcaneal tendon to popliteal fossa
what does the small saphenous v run with
the sural n.
where does the small saphenous v end
by unitin with popliteal v.
what creates the great saphenous v
dorsal veins of great toe joins dorsal venous arch
what is the great saphenous v path
ascends medially pssing anterior to medial malleolus with spahenous nerve to knee then pass 10cm posterior to medial border of patella then pass through saphenous opening enters femoral v.
how does the deep veins travel
they accompany the major aa.
what are the deep veins
anterior tibial v
fibular vein
posterior tibial v
where do all the deep veins drian into
popliteal v
what creates the posterior tibial v
plantar arch unites with the medial and lateral plantar vv
what are perforating veins
drain blood from superficial veins to deep veins- valves allow only this one way flow
and they perforate fascia of muscles
what are some cutaneous ns. of the lower limb
- subcostal n
- ilioinginal n
- genitofemoral n
- iliohypogastric n
- lateral cutaneous n. of thigh
- anterior cutaneous br of femoral n
- posterior cutaneous n of thigh
- cutaneous br. of obturator n.
what is the spinal n of subcostal n
T12
what does the subcostal n supply
skin of hip inferior to anterior iliac crest and anterior to greater trochanter
what is the spinal n of ilioinguinal n
L1
what does the ilioinguinal n supply
skin of superomedial area of thigh, over medial femoral triangle
what is the spinal n of iliohypogastric n
L1
what does the iliohypogastric n supply
superolateral quadrant of buttock
what are the branches of the genitofemoral n
femoral br.
genital br
what is the spinal n of the femoral br.
L1-L2
what does the femoral br. supply
supply skin over lateral femoral triangle
what is the spinal n of the genital br.
L1-L2
what doe the genital br. supply
supply external genitalia
what is the spinal n of the lateral cutaneous n. of thigh
L2,L3
what does the lateral cutaneous n. of thigh supply
direct br. of lumbar plexus to skin on anterior and lateral aspects of thigh
what is the spinal n of the anterior cutaneous br. of the femoral n
L2-L4
what does the anterior cutaneous br. of the femoral n supply
supply skin on anterior and medial sided of thigh
what is the spinal n of the posterior cutaneous n. of the thigh
S1-S3
what does the posterior cutaneous n. of the thigh supply
branch of sacral plexus, supplies the skin on posterior aspect of the thigh and posterior to knee
what is the spinal n of the cutaneous br. of obturator n
L2-L4
what does the cutaneous br. of obturator n supply
skin of middle part of medial thigh
what are the popliteal fossa nerves
- tibial n
- comon fibular n
- sural n.
what happens to the sciatic n in the superior popliteal fossa
the sciatic n
what does the tibial n supply
in fossa br. to soleus, gastroc, plantaris , popliteus
what is the branch of the tibial n
medial sural cutaenous n
where does the common fibular n divide
around the neck of the fibula
what are the branches of the common fibular n
superficial fibular n
deep fibular n
lateral sural cutaneous n
what forms the sural n
medial sural n ( of tibial n ) and the lateral sural cutaenous n (from common fibular n )
why are the thigh mm. put into their groups
by there location, action, nerve supply and are separated by intermuscular septa
where can the pectineus m found
in 2 different layers
- lateral part ( lateral femorall n )
- -meidal part ( branch from obturator n )
what does the sartorius cover up
the femoral artery
what is the controversy m of the thigh
the vastus medialsi is the VMO
what is so different about the vmo
it is reported to have a more oblique orientation creating a better pull on patella medially
BUT many anatomists beleve they are parallel
what are the articualr m of the knee
they arise from the vastus intermedius fiber
O: ant. surface fo femur above patell
I: synovial capsule of knee and wall of suprapatellar bursa
A: pulls synovial capsule superiorlyduring extension of knee so it willnot get cuaght in knee joint
what are the medial and lateral patellar retinacula
portions of quadriceps tendon inserted onto upper tibia and contribute to knee joint capsule
what is the patella
large triangular sesamoid bone in the tendon of the quadriceps
what attaches patella ligament attach too
the tibial tuberosity
what does the patella ligaments articulate with
the patellar groove of the femur
what does the patella ligament do
increases leverage for muscles of lower limbs
what is the continuation of the patellar ligament
of the tendon of quadricpes
read slides
64
what divides the obturator n
the adductor brevis
then it becomes the anterior and posterior
what does the anterior obturator n supply
adductor longus, gracillis, adductor brevis
what does the posterior obturator n supply
obturator externus, adductor magnus, adductor brevis, articular to knee
what is the adductor hiatus
opening in the aponeruotic attachment leads inot popliteal fossa
what is the adductor minimus
upper fibers of adductor magnusm
– sometimes the upper fivers are separate
what forms the Pes Anserinus
the gracilis , sartorius, and semitendious
what doe the SGT FOS
gracilis , sartorius, and semitendious
femoral n, obturatorn, sciatic n.
what is the femoral triangle and adductor canal
triangular subfascial sace in superomedial 1/3 of the thigh
where can the femoral triangle and adductor canal be found
inferior to the inguinal ligament when thigh is actively flexed at hip joint
what are the main contians of the femoral triangle and adductor canal
femoral vessels and branches of femoral nerve
what are the boundaries of the femoral triangle and adductor canal
superior= inguinal ligaments form base medially= lateral border of adductor longus laterally= medial border of sartoris ( femoral pulse )
what are the spinal n of femoral n
L2-L4 ( largest branch of lumbar plexus )
what does the femoral n divid into
muscular and cutaneous brnaches
what does the femoral n supply
the anterior thigh m, knee and hip joints and to skin o n anteromedial side of lower limb
what does anterior division of the femorla n supply
cutaneous and muscular to pectineus and sartoris
what does the posterior division of the femoral n supply
muscular to quadriceps and articualr to knee
what is the saphenous n
cutaneous branch of femoral n.
where does the saphenous n go
descend through femoral triangle and passes through the adducto canal BUT not through the adductor hiatus
what does the saphenous n become
superficial between the gracilis and sartorisu
what does the saphenous n supply
the skin and fascia on meidal side of the leg and foot
where does the femoral a come from
continuation of external iliac artery
what are the branches of the femoral a
superifical epigastric a superficial circumflex iliac a superficial external pudendal a deep external pudendal a deep femoral a -- deep artery of the thigh descending genicualr a popliteal a
where does the descending genicualr a. arise
just before it passes through the adductor hiatus
what are the branches of the descending genicular a
- saphenous branch
- musculor articular br.
what does the superifical epigastric a supply
pubis and inferior umbilical region
what does the superficial circumflex iliac a supply
inguinal region and adjacent anterior thigh
what does the superficial external pudendal a supply
upper medial thigh, pubic region
what does the deep external pudendal a supply
pectineus m., adductor longus m, external genitalia
what does the deep femoral a – deep artery of the thigh supply
hip joint, proximal and posterior thigh
what does the descending genicualr a supply
skin and superficial structures of the medial aspect of the knee and upper leg
what are the branches of the deep femoral a.
medial circumflex femoral a
lateral circumflex femoral a
perforating branches
what does medial circumflex femoral a supply
head and neck of femur
what is a branch of the medial circumflex femoral a
posterior retinacular artery
this is often torn in the femoral neck is fractured
what does the lateral circumflex femoral a supply
the mm. on lateral side of thigh
what happens to the transverse branch of the lateral circumflex femoral a
winds around femur
what happens to the descending branch of the lateral circumflex femoral a
joins genicular anastomoses
what does the obturator a do
assist deep femoral artery supply adductor m of the thigh
where does the obturator a travel through
through the obturator foramen entering the thigh
what does the obturator a divide into
anterior and posterior branches
what does the posterior division of the obturator a supply
adductor m, knee capsule, small branch to head of femur
what does the anterior division of the obturator a supply
adductor brevis, skin of_________________?
where does the obturator n arise from
either internal iliac artery or from inferior epigastric artery
where does the femoral v enter from
thigh medial to femoral artery
what does the femoral v pass over
the pectineus
where does the femoral v end
posterior to inguinal ligaments where ti becomes external iliac vein
what happens to the femoral vein in the femoral triangle
it receives the deep femoral v., great saphenous v and other tributaries
what is the femoral sheath
oval, funnel shaped fascial tube
what does the femoral sheath contain
prosimal femoral vessels BUT NOT the femoral nerve
what are the 3 compartments of the femoral sheath
lateral
intermediate
medial
what is in the lateral compartment of the femoral sheath
femoral a
what is in the intermediate compartment of the femoral sheath
femoral v
what is in the medial compartment of the femoral sheath
a space = femoral canal
what is the adductor canal
narrow fascial tunnel in thigh
–intermuscular passage for femoral vessel to popliteal fossa
what can be found in the adductor canal
saphenous n. and femoral a
what happens with the saphenous n
the nerve pierces deep fascia and passes down the medial side of the leg with the great saphenous v.
what leaves the adductor canal
the femoral artery and v leave the canal through the adductor hiatus
what is the popliteal fossa
a diamond shaped region posterior to knee
– between semiten and biceps femoris tendon
what are the boundries of the popliteal fossa
superiorlatrally: by beceps femoris
superomedially: semimembranous and semitendinous
inferolaterally: latera head of gastrocnemius
inferomedially: medial head of gastrocnemius
what are the contents of the popliteal fossa
popliteal vessels ( artery , veins and lymph) tibial nerves common fibular nerves small saphenous veins 4 to 6 popliteal lymph nodes
what is the popliteal a the continuation of
femoral artery
where does the popliteal a start
at adductor hiatus
where does the popliteal a end
at inferior border of popliteus by dividing into anterior and posterior tibial aa.
what are the branches of the popliteal a
- genicular br.
- muscualr br.
what are the branches of the genicular a of the popliteal a
- superior lateral
- superior medial
- middle
- inferior lateral
- inferior medial
= these form the genicular anastomoese aroudn the knee
what does the muscular branches of the popliteal a supply
hamstrings, gastroc, soleus, plantaris
— the sural arteries form the poplitieal artery to muscles in posterior leg that anastomeose with posterior tibial, middle and lateral inferior genicular arteries
where does the popliteal v begin
at distal border of popliteus m.
what is the popliteal v a continuation of
posterior tibial v.
what does the popliteal v become
femoral v as it enters adductor hiatus then becomes external iliac v above inguinal ligament
