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Anatomy > Lower Limb Review > Flashcards

Lower Limb Review Flashcards

1
Q

What is the tarsal tunnel?

A

-Fibro-osseous space - on posteromedial aspect of ankle

= passageway for tendons, nerves & vessels to travel between posterior leg & foot

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2
Q

Structure of tarsal tunnel?

A

-Formed by bony floor & CT

-Floor = concave surface formed by medial aspect of tibia, talus & calcaneus

-Is converted into tunnel by flexor retinaculum (spans obliquely between medial malleolus & medial tubercle of calcaneus - forms roof)
-Flexor retinaculum = continuous with deep fascia of leg & foot

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3
Q

Name the contents of the tarsal tunnel - i.e., structures that pass posterior to the
medial malleolus.

A

Anterior to posterior:

-Tom = tibialis posterior tendon
-Dick = flexor digitorum longus tendon
-and = artery (posterior tibial artery)
-a
-Very = vein (posterior tibial vein)
-Nervous = nerve (tibial nerve)
-Harry = flexor hallucis longus tendon

–> 4 fibrous compartments – 1 contains neurovascular structures & other 3 contain muscle tendons

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4
Q

Where is the pulse point of the posterior tibial artery?

A

Medial Malleolus
–> as tibial nerve & posterior tibial artery & vein pass posterior to medial malleolus (through tarsal tunnel)

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5
Q

Where is the pulse point of the dorsalis pedis artery?

A

1st metatarsal space

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6
Q

Fill in the arterial supply to the lower limb.

A
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7
Q

Give the most important divisions of the arterial supply to the lower limb.

A
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8
Q

Fill in the venous drainage of the lower limb.

A
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9
Q

What helps remember the venous drainage of the lower limb?

A

-Think want to drain to femoral vein -> then to external iliac -> then to common iliac
-Or for other side - want to get to internal iliac

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10
Q

Fill in the motor innervation to the lower limb.

A
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11
Q

Summarise the lumbar plexus.

A
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12
Q

Summarise the sacral plexus.

A
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13
Q

Draw the boundaries of the femoral triangle.

A

-Roof = fascia Lata
-Superior = inguinal ligament (runs from ASIS to pubic tubercle)
-Medially = medial border of adductor longus muscle - rest of this muscle forms part of floor of triangle
-Laterally = medial border of sartorius
-Floor = pectineus, adductor longus, iliopsoas

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14
Q

What are the components of the femoral triangle?

A

Lateral to medial:

-Femoral nerve = N
-Femoral artery = A
-Femoral vein – the great saphenous vein drains into the femoral vein within the triangle = V
-Femoral canal – contains deep lymph nodes & vessels = E,L
NAVEL
*Femoral artery, vein & canal are contained within a fascial compartment – known as femoral sheath

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15
Q

What is the empty space for in the femoral triangle?

A

Empty space (allows the veins and lymph vessels to distend to accommodate different levels of flow)

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16
Q

Where does the deep femoral artery arise?

A

From the femoral artery

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17
Q

What is the adductor canal?

A

-Extends from apex of femoral triangle to adductor hiatus of adductor magnus
-Acts as passageway for structures moving between ant. thigh & posterior leg

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18
Q

What are the contents of the adductor canal?

A

*Femoral artery
*Femoral vein (posterior to the artery)
*Femoral nerve =
-Nerve to vastus medialis
-Saphenous nerve

As femoral artery & vein exit canal - are called popliteal artery & vein

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19
Q

What are the borders of the adductor canal?

A

-Anteromedial = sartorius
-Lateral = vastus medialis
-Posterior = adductor longus & adductor magnus

20
Q

What is the popliteal fossa?

A

-Diamond shaped area located on post. knee
-Main path - vessels & nerves pass between thigh & leg

21
Q

What are the borders of the popliteal fossa?

A

-Superomedial border – semimembranosus
-Superolateral border – biceps femoris
-Inferomedial border – medial head of gastrocnemius
-Inferolateral border – lateral head of gastrocnemius & plantaris

(Roof = 2 layers - popliteal fascia & skin)

22
Q

What is the popliteal fascia continuous with?

A

Fascia Lata of leg

23
Q

What are the contents of the popliteal fossa?

A

-Popliteal artery
-Popliteal vein
-Tibial nerve
-Common fibular nerve (or common peroneal nerve)

24
Q

How would you position your patient to
palpate the popliteal artery?

A

Knee flexed

25
Q

Label these structures of the popliteal fossa & before this point.

A
26
Q

Where is the pulse point of the dorsalis pedis artery?

A

1st metatarsal space

27
Q

Describe how the anterior tibial artery becomes the dorsal pedis artery.

A

Anterior Tibial Artery:
*Traverses the interosseous membrane
*Courses distally
*Passes deep to the extensor retinaculum
= then renamed Dorsalis Pedis – dorsum of foot

28
Q

How to remember the course of deep veins draining the lower limb?

A

They follow the course of arterial supply

29
Q

Do the deep and superficial veins link?

A

Yes - there are communicating vessels between

30
Q

Name a problem that can arise in the deep veins.

A

Deep-vein thrombosis (DVT)
= blood clot - forms within deep veins - usually of leg (can occur in arms & mesenteric & cerebral veins)

31
Q

Name a problem that can arise in the saphenous veins.

A

-Varicose Veins
-Bypass graft

32
Q

Label these veins.

A
33
Q

Compare & contrast the functional consequences of lesions affecting inferior gluteal nerve & superior gluteal nerve.

A

-Inferior gluteal nerve = glut. max. - performs extension of hip & helps stabilise knee joint

-Superior gluteal nerve = glut. med. & glut min. - perform medial rotation & abduction of thigh

34
Q

Function of piriformis & in which compartment is it located?

A

-Laterally rotates extended femur & abducts flexed hip
-Deep gluteal compartment

35
Q

What happens is piriformis becomes inflamed, what structure might it impinge upon? What
symptoms would this cause?

A

Damage would impact the Sciatic Nerve - causing:

= Motor consequences
*Hamstrings
*All muscles below the knee

= Sensory consequences:
*Posterior Leg & Plantar foot

36
Q

Label.

A
37
Q

What does damage to the femoral nerve cause?

A

-Quadriceps muscle weakness & wasting
-Loss of knee jerk reflex
-Numbness along medial side of thigh & anteromedial calf (L2-L4 dermatomes)

38
Q

29-year-old presents with flaccid paralysis of muscles in the anterior & lateral compartments of leg, following football challenge.
-X-ray reveals fracture to neck of fibula.
–> Which nerve has been damaged in
this case?

A

Common fibular nerve courses around proximal head of fibula - where it is superficial & susceptible to damage
= superficial fibular nerve (innervates lat. leg)
(ant leg = deep fibular nerve)

–> I think deep fibular nerve is damaged (given the following!)

39
Q

29-year-old presents with flaccid paralysis of muscles in the anterior & lateral compartments of leg, following football challenge.
-X-ray reveals fracture to neck of fibula.
–> What muscles are located within the
affected compartments & what are
their main actions?

A

Ant leg:
-Tibialis anterior
-Extensor hallucis longus
-Extensor digitorum longus
-Fibularis tertius
–> ankle dorsiflexion & aids in inversion of foot & extends toes

Lat leg:
-Fibularis longus
-Fibularis brevis
–> ankle plantarflexion & eversion of foot

40
Q

29-year-old presents with flaccid paralysis of muscles in the anterior & lateral compartments of leg, following football challenge.
-X-ray reveals fracture to neck of fibula.
–> How would this condition affect the
patient’s gait?

A

Cause foot drop (inability to dorsiflex - so foot is permanently plantarflexed) & high stepping gait
–> can’t dorsiflex due to damage to deep fibular nerve - supplying ant. leg - responsible for dorsiflexion

(deep fibular nerve can become entrapped or compressed along - course through ant. leg - causes paralysis of muscles in ant. leg - so patient can’t dorsiflex foot -> meaning because there is no unopposed motion to plantarflexion - their foot drops)

41
Q

A 36-year-old tennis player ruptures calcaneal tendon due to hyper-flexion of dorsum of foot when jumping.
–> Which muscles contribute to formation of calcaneal tendon?

A

-Gastrocnemius
-Soleus
-Plantaris (not always present)

42
Q

A 36-year-old tennis player ruptures calcaneal tendon due to hyper-flexion of dorsum of foot when jumping.
–> What is the innervation of these muscles?

A

Tibial nerve (innervates all muscles in post. leg)

43
Q

A 36-year-old tennis player ruptures calcaneal tendon due to hyper-flexion of dorsum of foot when jumping.
–> What action(s) would the individual no longer be able to perform?

A

*Loss of function of posterior compartment of leg:
-Loss of plantarflexion of foot @ ankle joint
-Weakened inversion of foot (due to loss of tibialis posterior)
-Toe flexors affected & intrinsic foot muscles weakened

44
Q

63-year-old patient presents with long-standing complaint of pain in her back which radiates to her right leg. Upon examination you discover she has numbness on the dorsum of her right foot & reduced ability to extend her toe & dorsiflex
her foot.
–>Which muscles may be affected in
this patient?

A

Deep fibular nerve supplies anterior compartment of leg

45
Q

63-year-old patient presents with long-standing complaint of pain in her back which radiates to her right leg. Upon examination you discover she has numbness on the dorsum of her right foot & reduced ability to extend her toe & dorsiflex
her foot.
–> Which nerve roots may be compressed in her spine?

A

Deep fibular nerve roots are L4-S1

46
Q

Link together how the femoral triangle, adductor canal (& hiatus) & popliteal fossa link together - in terms of arterial supply.

A

Femoral artery passes distally towards apex of femoral triangle & through adductor canal - where it passes through adductor hiatus (opening in the adductor magnus muscle
Through here it enters popliteal fossa (post. to knee joint) - becomes popliteal artery

-Femoral artery = femoral triangle
-Popliteal artery = once enters popliteal fossa (along adductor canal & through adductor hiatus)

Anatomy (21 decks)

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