Lower Limb Textbook Flashcards
What is the importance of the lesser trochanter?
insertion point for iliopsoas muscle
What is the name for the bony ridge between the trochanters? What attaches here?
anteriorly: intertrochanteric line - iliofemoral ligament attaches here, and vastus medialis
posteriorly: intertrochanteric crest. Has the quadrate tubercle where the quadratus femoris inserts
What is the quadratic tubercle? What attaches here?
approximate midpoint of the intertrochanteric crest
quadratus femoris
What is the importance of the linea aspera?
attachment for the adductors of the thigh
6 muscles total
What attaches at the pectineal line?
pectineus
What attaches at the gluteal tuberosity
gluteus maximus
What is the importance of the adductor tubercle?
attachment for adductor magnus
patella
* bone type
* attaches to the base and apex of the patella?
* what do the facets of the patella articulate with?
- sesamoid bone
- base: quadriceps tendon
- apex: patellar tendon/ligament (to tibial tuberosity)
- lateral facet: lateral condyle; medial facet: medial condyle
What is the importance of the soleal line of the tibial tuberosity
attachment point for soleus origin
Which bones of the lower leg are weightbearing?
Tibia only
What does the proximal head of the fibula articulate with?
lateral condyle of the tibia
How many bones are there per foot? What are their divisions?
26
Tarsals (7)
Metatarsals (5)
Phalanges (14)
List the tarsal bones
talus
calcaneus
navicular
cuboid
cuneiforms (medial, intermediate, lateral)
What foot bone bears and distributes the weight of the body to other foot bones?
talus
knee joint
* joint type
* movements
* articulations
- hinge synovial
- flexion/extension; medial and lateral rotation
- tibiofemoral (medial and lateral condyles of femur and medial and lateral condyles of the tibia) and patellofemoral (anterior aspect of the distal femur and posterior surface of patella)
What is the function of the menisci
- increase knee stability
- increase surface area to help attenuate force
List the collateral ligaments of the knee and where they attach
medial collateral ligament: medial epicondyle of the femur to the medial condyle and superior medial surface of the tibia
lateral collateral ligament: lateral epicondyle of the femur to lateral surface of fibula
- NOTE: medial condyle is anatomically coupled to medial meniscus; damage to MCL usually means damage to medial meniscus
What is the name for the intracapsular and extracapsular ligaments of the knee?
intracapsular: cruciate ligaments
extracapsular: collateral ligaments
list the cruciate ligaments of the knee and where they attach
anterior cruciate ligament: anterior intercondylar area of the tibia and extends superiorly and obliquely to attach to the posterior part of the lateral condyle of the femur
posterior cruciate ligament: posterior intercondylar area of the tibia and passes superiorly and anteriorly to attach to the lateral surface of the medial condyle of femur
ankle joint
* joint type
* movement permitted
* bones that contribute
* what are the borders of the ankle joint?
- hinge
- dorsiflexion/plantarflexion
- tibia, fibula, talus
- lateral border: articular facet of the lateral malleolus of the fibula
- medial border: medial malleolus
- superior border: inferior articular surface of the tibia and superior articular surface of the talus
Subtalar joint
* movements permitted
* bones involved
- eversion/inversion
- inferior surface of talus and superior surface of calcaneus
List the ligaments of the ankle, their attachments, and their function
medial/deltoid ligaments: medial malleolus of tibia to talus, calcaneus, and navicular ; prevent excessive eversion
lateral ligaments: anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament ; prevents excessive inversion
What nerve roots make up the femoral nerve
L2-L4
What 2 muscles does the femoral nerve pass between?
psoas major and iliacus
What is within the femoral triangle? List it laterally to medially.
What are its borders?
What is its clinical relevance?
femoral nerve, artery, vein
Superior (base of triangle): Inguinal ligament. Lateral: Medial border of the sartorius muscle. Medial: Medial border of the adductor longus.
Target for anesthetic
How many muscles does the femoral nerve innervate? list them
7
Quadriceps (rectus femoris, vastus intermedius, vastus lateralis, vastus medialis), pectineus, sartorius, ilacus
Weak: hip flexion, hip adduction, external rotation of hip, internal rotation of leg, flexion of leg
Abolished: knee extension
The sensory branch of the femoral nerve that continues distally in the leg is called?
What specific location does it carry sensory information from?
saphenous nerve
Medial leg and foot
describe the continuation of the femoral triangle - what is this called? What travels through here?
adductor canal
saphenous nerve, femoral artery, and femoral vein
What is the adductor hiatus?
opening in the tendon of adductor magnus; passageway anterior to posterior
transmits femoral artery and vein and saphenous nerve
How many muscles does the obturator nerve innervate? List them
5
adductor longus
adductor brevis
gracilus
adductor portion of adductor magnus
obturator externus
Where does the sciatic nerve exit the pelvis?
greater sciatic foramen
Describe the passage of the sciatic nerve after it exits via the greater sciatic foramen
travels posterior-inferior to piriformis
crosses posterior surface of other deep gluteal muscles (superior gemellus, obturator internus, inferior gemellus, quadratus femoris)
enters posterior thigh passing deep to long head of biceps femoris
When does the sciatic nerve separate into the common peroneal/fibular nerve and the tibial nerve
popliteal fossa
How many muscles does the tibial nerve innervate? List them
6
flexor hallucis longus
soleus
gastrocnemius
plantaris
tibialis posterior
flexor digitorum longus
list the branches of the common peroneal/fibular nerve and what they each supply
superficial: lateral compartment of leg; fibularis longus and brevis
deep: anterior compartment of leg; tibialis anterior, extensor hallucis longus, extensor digitorum longus
What does the external iliac artery continue as? And where is the transition point? What does that artery eventually continue as? Where is that transition point
femoral artery at inguinal ligament
popliteal artery at popliteal fossa
terminates at the inferior border of popliteus where it divides into anterior tibial artery and tibioperoneal trunk
tibioperoneal trunk bifurcates into posterior tibial artery and fibular artery
anterior tibial artery: supplies anterior compartment of leg and top of foot
posterior tibial artery: posterior compartment and bottom of foot
fibular artery: lateral compartment of leg
(review this)
Genicular anastomosis
branching network of arteries arising from the popliteal artery
surrounds the knee to maintain its blood supply even in full flexion at the leg at the knee
Describe the venous circulation of the leg
digital veins –> dorsal venous arch –> fibular, posterior tibial, anterior tibial or small saphenous –>
popliteal vein –> femoral vein –> external iliac vein –> common iliac vein –> inferior vena cava
also the deep vein of the thigh (profunda femoris vein) –> common iliac
also dorsal venous arch –> great saphenous –> common iliac –> inferior vena cava
plantar venous arch –> medial and lateral plantar –> posterior tibial –> femoral external iliac
What divides the compartments in the lower leg
intermuscular septa and interossoeus membrane
What forms the pes anserius? Where is it?
Superior to inferior: sartorius, gracilis, and semitendinosus tendon
medial surface of tibia
What anterior leg muscle is absent in 5-17% of the population?
Fibularis (peroneus) tertius
What is the name for both the gastrocnemius and soleus combined?
Triceps surae
What leg muscle crosses both the knee and the ankle joint?
gastrocnemius
What fascial structure separates the deep and superficial posterior compartment
transverse intermuscular septum
In what movement is tibialis posterior and tibialis anterior synergistic?
inversion
