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Anatomy > Lower limbs > Flashcards

Lower limbs Flashcards

1
Q

What does tibial and fibular mean ?

A

Tibial - medial
Fibular - lateral or peroneal

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2
Q

During development of the lower limbs , they rotate medially

What are the impacts of this on muscle arrangement

A

Extensors are anterior
Flexors are posterior

Knee points forward
Dorsum of foot is anterior

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3
Q

Identify the parts of the hip bone and upper tibia

A
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4
Q

Identify the bones of the foot

A
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5
Q

Identify the structures of the bones of the foot

A
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6
Q

Describe the fascia of the thigh

A

Very strong and non-distensible
Divides lower limbs into compartments via membranes that attach to linea aspera
Thickened laterally - iliotibial tract

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7
Q

gluteal muscles - action, attachments, innervation

A

Extend, abduct and rotate hip

Attachments :

gluteus maximus - originates from posterior ilium, sacrum and coccyx. inserts into the iliotibial tract and the gluteal tuberosity of the femur.

Gluteus medius - Originates from the gluteal surface of the ilium and inserts into the lateral surface of the greater trochanter.

Gluteus minimus - Originates from gluteal surface of the ilium and converges to form a tendon, inserting to the anterior side of the greater trochanter.

Actions:

Gluteus minimus and medius have the same actions - Abducts and medially rotates the lower limb. During locomotion, it secures the pelvis, preventing pelvic drop of the opposite limb.

Gluteus maximus - hip extension/external rotation.

Innervation:

gluteus maximus - inferior gluteal nerve
Gluteus minimus and medius - superior gluteal nerve

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8
Q

hamstrings - functions, attachments, innervations

A

Semitendinosus is most medial; it originates from ischial tuberosity of the pelvis, and inserts onto the medial surface of the tibia.

semimbranosus sits in between

biceps femoris - long head originates from ischial tuberosity of pelvis, short head originates from linea aspera of femur; most lateral ; both insert into the head of the fibula

all 3 perform:
Extension of hip
Flexion of knee
semimembranosus and semitendinosus also involved in medial rotation

All innervated by sciatic nerve

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9
Q

Clinical relevance of ischial tuberosity

A

Often site of hamstring injuries
Tearing of proximal attachment of hamstring

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10
Q

Label the posterior compartment of thigh

A
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11
Q

Label the surface anatomy of the anterior compartment of the thigh

A

The anterior compartment involved in hip flexion and knee extension

Medial compartment involved in adduction of thigh

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12
Q

Adductor muscles of thigh

A

Adductor Magnus, brevis and longus
Gracilis - weak adductor; longest and thinnest of adductor muscles (be most graceful with the Gracilis)
Pectineus - highest up

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13
Q

Label the surface anatomy of the posterior compartment of the leg

A
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14
Q

Describe groin strain

A

Strain/tear of proximal attachment of adductor muscles

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15
Q

Describe the muscles of the posterior leg

A

Superficially - all plantarflex of ankle(let you go one your tippy toes) ; 3 headed triceps surae (soleus, and the 2 heads of gastrocnemius) involved in producing most of the force ,
deep veins run through here and muscle contraction aids in venous return (solely in particular is alway contracted)

Deep group - popliteus(unlocking knee), tibialis posterior(ankle invertor) , flexor digitorum longus (toe flexion), flexor hallucis longus (toe flexor)

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16
Q

Identify the foot evertors

A

Fibularis longus
Fibularis brevis
Fibularis tertius

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17
Q

Identify the muscles in the anterior compartment of leg

A

Dorsiflexors of ankle and extensors of toes: all supplied by deep fibular nerve

Tibialis anterior (in front of tibia) - dorsiflexor 
Extensor digitorum longus - extends the toes (except for big toe)
Extensor hallucis longus - extends the big toe (hallucis = big toe)

Found on the more lateral side on the fibula

Fibularis longus - eversion and plantar flexion (superficial fibular nerve)
Fibularis tertius - evertor and dorsiflexor (not present in all people )
Fibularis brevis - evertor (superficial fibular nerve

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18
Q

Lumbar plexus

A

Consists of nerve roots L1-L4

Femoral nerve L2-4 —> most of anterior compartment of thigh (quads, sartorius, pectineus, iliacus); branches off into saphenous vein further down to provide cutaneous innervation to anteromedial knee/leg/foot
Obturator nerve L2-4 —> most of medial compartment of thigh

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19
Q

Sacral plexus

A

Encompasses L4-S4
Superior gluteal nerve L4-S1
Inferior gluteal nerve L5-S2
Sciatic nerve L4-S3
- tibial nerve posterior compartment of thigh
- common fibular nerve
- superficial ; lateral compartment of leg
- deep ; anterior compartment of leg

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20
Q

Descirbe the course of the sciatic nerve

A

Originates from lumbosacral plexus
Leaves pelvis via sciatic foramen
Passes behind the piriformis
Travels posterior to the anterior muscles of thigh
Enters posterior thigh
Terminates by bifurcating into the tibial and common fibular nerve at the apex of the popliteal fossa

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21
Q

Anterior thigh trauma associated with which nerve

A

Femoral L2-4
This affects action of muscles in the anterior thigh

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22
Q

Hip surgery is used to reapair damage to which nerve?

A

Superior gluteal nerve L4-S1
This can affect gluteus medius and minimus

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23
Q

Posterior hip dislocation is associated with damage to which nerve/muscles

A

Sciatic nerve L4-S3
This can affect function of posterior thigh

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24
Q

Fracture to fibula neck can cause damage to which nerve/muscles

A

Common fibular nerve
This can affect function of lateral and anterior leg

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25
Q

Outline the arterial supply of the lower limb

A

Abdominal aorta —> common iliac a. —> external and internal iliac a.

External iliac —> femoral artery as soon as it passes under inguinal ligament —> Profunda femoris artery (deep artery of thigh ) ; cruciate anastamosis of the hip joint occurs here

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26
Q

Describe the areas where pulses of the lower limb can be idntified

A
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27
Q

Femoral hernia

A

Abdominal contents typically small intestine can pass through the femoral ring - a weak area in the femoral canal of the femoral sheath (size of little fingertip) and compress the femoral vein and great saphenous vein

Can result in necrosis of abdominal contents

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28
Q

What are the main circulatory problems of the lower limbs

A

Arterial insufficient
Venous insufficiency
Lymphoedema

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29
Q

Identify the different movements of the lower limbs

A
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30
Q

Describe the muscles of the anterior thigh compartment

Function and innervation

A

Pectineus - adduction/medial rotation/flexion of thigh ; femoral L2/3

Iliopsoas - primary flexor of thigh; consists of psoas major/minor and iliacus; also maintains lumbar lordosis (Posture); anterior rami of lumbar nerves L1/2 and femoral nerve partially

Sartorius - flexes hip and knee ; femoral nerve L2/3

Quadriceps fermoris - rectus fermoris, vastus intermedium’s and vastus medialis ; great extensor of knee; femoral nerve L2/3/4

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31
Q

Describe the popliteal fossa

Boundaries and content

A

Boundaries - hamstrings superiorly and gastronemius inferiorly (back of knee)
Content - common fibular nerve, tibial nerve, popliteal vein(deep to tibial nerve)/artery (deep to popliteal vein)

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32
Q

External iliac artery becomes the ___ ____ as soon as it passes under the inguinal ligament

A

Femoral artery

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33
Q

As soon as the femoral artery goes through thre adductor hiatus in the _____ _____ and travels posterior it is called the ____ ____

A

Adductor Magnus ; Popliteal artery

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34
Q

Label the arrangement of the tendons and neurovascular structures inside the ankle

A

The structure that pass behind the medial malleolus are all from the posterior compartment - they form the tarsal tunnel

Tom, Dick And Very Nervous Harry
Tibial is posterior tendon, flexor Digitorum longus tendon, posterior tibial Artery, tibial Nerve, flexor Hallucis longus tendon

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35
Q

Intramuscular injections of the gluteal region

Describe how you would identify the safe region

A

Safe region - identify the superior iliac spine on the posterior side of body, then continue a line across to the superior aspect oif the greater trochanter ; form another line by going midway across from iliac crest

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36
Q

What is trendelenburgs test

A

Ask patient to walk and view them from behind

If pelvis descends on the unsupported side, this indicates the gluteus medius and minimus are weak or paralysed due to damage to the superior gluteal nerve

Often seen in patients post hip replacement surgery

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37
Q

How to take popliteal pulse

What can a weak pulse indicate?

A

Knee needs to be flexed ti relax fascia and hamstrings
Place finger inferiorly and press down hard
Weak pulse = popliteal artery rupture after knee dislocation, Popliteal artery entrapment syndrome (PAES) from excessively large calf muscles, popliteal artery aneurysm, peripheral artery disease from CHF

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38
Q

Calcaneal tendon reflex

A

Assesses the fucntion of the tibial nerve and its innervation of the gastronomeus, soleus and triceps surae

Tap the calcaneal tendon with hammer, the foot should be initially flat; after tapping, plantarflexion should occur

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39
Q

Label the different parts of the hip bone

A
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40
Q

Muscles responsible for flexion of hip

A

Psoas major, iliacus, pectineus, rectus femoris, and sartorius

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41
Q

Identify the muscles responsible for hip extension

A

Gluteus maximums and hamstrings (semitendinosus, semimembranosus, and bicep femoris)

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42
Q

Identify the muscles responsible for abduction of leg

A

Gluteus maximus, medius and minimus
Tensor fascia lata

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43
Q

Identify the muscles responsible for leg adduction

A

Adductor Magnus, longus and brevis
Gracilis
Pectineus

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44
Q

Identify the muscle responsible for internal rotation of leg

A

tensor fasciae latae, adductors longus and brevis, pectineus and the anterior fibers of gluteus medius and minimus.

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45
Q

Identify the muscles responsible for external rotation of the leg

A

Gluteus maximus, piriformis , obturator internus, gemellus superior and inferior, quadratus femoris, and obturator

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46
Q

identify the deep hip muscles

A

Patched Good Often Go On Quilts (mnemonic for order of muscles from top to bottom)

Piriformis Gemellus superior Obturator internis Gemellus inferior Obturator exterminator Quadrator femoris

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47
Q

Describe the quadriceps and sartorius - actions, attachments, innervations

A

Sartorius - originates from Anterior superior iliac spine of the pelvic bone and inserts on the top of tibia; involved in hip flexion, external rotation, and abduction ; femoral nerve

Quadriceps - vastus lateralis/intermedius/medialis all originate from femur but rectus femoris originates from anterior iliac spine of pelvic bone ; all insert on the patellar tendon; all extend knee (rectus femoris also flexes hip) ; femoral nerve

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48
Q

The anterior, posterior and medial compartments of the thigh are innervated by which nerves?

A 
Anterior = femoral 
Medial = Obturator 
Posterior = sciatic
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49
Q

Patellar reflex

A

Striking the patellar tendon just below the patella causes the quads to contract
Test L3/4

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50
Q

identify muscles A-F

A

A= vastus lateralis
B= vastus intermedius
C= rectus femoris
D= vastus lateralis
E= Sartorius
F=Adductor Magnus

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51
Q

Course of Obturator nerve through thigh

A

L2-4
Descends through psoas major and emerges medially
Then enters the medial thigh via the obturator canal

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52
Q

Label this CT scan through the leg

A
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53
Q

most common lower limb muscles to get strained

A

hamstrings, rectus femoris, gastrocnemius

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54
Q

Calf strains

A

Most commonly occurs in medial gastrocnemius
Substaintial pain and swelling in first 24 hours ; pain on resisted plantarflexion
Also called tennis leg as typical presentation is of a middle aged tennis player who suddenly extends knee
Treated with NSAIDs, ice, rest, elevation, physio

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55
Q

Describe the posterior compartment of the leg ; name the muscles and describe their action, innervation and attachments if necessary

A

Collectively all muscles of posterior leg are innervated by the tibial nerve

Superficially ; 3 plantarflexors :

Gastrocnemius - (gastro means belly -cnemius means calf)
Soleus just underneath gastrocnemius ; both join to form the calcaneous tendon
Plantaris is even deeper to gastrocnemius and soleus

Deep layer ; deriving from the tibia, fibular and interosseus membrane

Tibialis posterior runs down behind medial malleolus
Flexor digitorum longus
Flexor hallucis longus

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56
Q

Structures passing behind the medial malleolus

A 
Tom Dick And Not Harry
Tibialis post (tendon|) , flexor Digitorum (tendon) , tibial Artery, tibial Nerve, flexor Hallucis longus
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57
Q

Contents of the tarsal tunnel

A

Tibialis posterior
Flexor Digitorum longus
Flexor Hallucis longus

Tom, Dick and Harry

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58
Q

Foot muscles

A

Dorsal muscles :
Extensors digitorum brevis - originates in foot; extension of all toes except big toe
Extensor hallucis brevis - orginates in foot ; extension of big toe
Dorsal interossei - abduction of metatarsals
Abductor hallucis - medial side of foot ; abducts big toe
Abductor digiti minimi - abducts little toe

PAD DAB
Plantar Adducts , Dorsal Abducts

plantar muscles - 10 in total; collectively act to stabilises arches of foot and individually to control movement of toes

Quadratus plantae
Flexor hallucis brevis (bottom of foot)
Flexor digiti minimi brevis
Lumbricals of foot
Adductor hallucis - adducts big foot
Plantar interossei - adduction of metatarsals

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59
Q

Innervation of anterior and posterior leg

A

Femoral nerve branches into sensory saphenous nerve that innervates the medial aspect of leg

Sciatic splits into the tibial and common fibular nerve just above the popliteal fossa

Tibial nerve passes through popliteal fossa of posterior leg - innervates all of the posterior deep leg muscles

Common fibular winds around the neck of fibula and emerges anteriorly ; it then splits into the superficial fibular nerve (lateral leg) and deep fibular nerve (anterior leg)

60
Q

Outline the venous supply/lymphatic drainage of the lower limb

A

The great saphenous vein is superficial to the fascia lata and joins up with the femoral vein via the saphenous opening ; drains most of thigh

Small saphenous vein drains most of leg ; it enters perforating veins which carry the blood to deep msucles - this helps with venous return

All lymph vessels drain into the inguinal region

Femoral sheath contains the femoral artery, vein and lymphatic vessels

61
Q

What are the boundaries and contents of the femoral triangle

A

Inguinal ligament - base
Pectinues - part of floor
Adductor longs = medial boundary
Sartorius - lateral boundary

Content - femoral nerve/artery/vein/canal with lymphatic vessels; remember the order ; great spahenous and profunda femoris veins also included here

62
Q

Identify the boundaries and contents of the popliteal fossa

A

Biceps femoris - supero lateral boundary
Semimembranosuis and semitendinosis tendon form the supero medial boundary
Lateral and medial heads of gastrocnemius form the inferior boundaries

Contents - tibial nerve, popliteal vein just below, and popliteal artery even deep, common fibular nerves, lymphatic vessels

63
Q

Describe femoral nerve block

A

Used to reduce pain cause by femur fractures / anterior thigh wounds or during quad tendon repair/ quad biopsy/ long saphenous vein stripping

used for patients who cannot tolerate general anaesthetic e.g elderly/CHF/COPD

Performed via ultrasound guidance and local anaesthetic
Locate femoral crease - from ASIS to pubic symphysis and move lateral then medial; palpate the femoral pulse ; needle insertion site is 1-2cm right of the femoral arterial pulse
On ultrasound view femoral nerve has popcorn or honeycomb appearance

64
Q

Gracilis can be used in

A

Transplantation to the face to treat facial paralysis
Used as its got a very long tendon and muscle part
Possible to remove the muscle with its vein, nerve and artery still intact

65
Q

Describe runners knee (chondromalacia patellae)
Causes
Symptoms
Treatment

A

Inflammation of enderside of patella and softening of the surrounding cartilage caused by acute injury or chronic friction

Secondary causes - tight IT band, neuromas, bursitis overuse, malalignment, core instantly, patellar maltracking

Painful movement - typically felt after prolonged sitting
Typical in young athletes or older adults

Treatment - RICE , NSAIDs, physiotherapy

66
Q

Femoral artery cannulation
Uses
Describe the procedure

A

Used for critically ill patients - refractory shock and respiratory failure
Allows:
Continuous blood pressure/gas measurement (PO2, PCO2, pH)
Continuous cardiac function measurement
Repeated blood samples for laboratory tests

67
Q

Femoral vein cannulation
Indication
Procedure
Risks

A

Indications:

Inability to obtain peripheral venous access elsewhere
IV infusion for patients in cardiac arrest /for concentrated or irritated drugs
Haemodialysis
Transvenous cardiac pacemaker

Procedure and relevant anatomy

place patient in supine or slightly declined and externally rotate and abduct leg ; Locate the femoral triangle, and feel femoral pulse - femoral vein medial to pulse and at the midpoint of inguinal ligament 2-4cm below

risks:

infection, thrombosis, haematoma, nerve damage, bladder perforation

68
Q

Paralysis of quadriceps

What happens as a result
Causes

A

Can lead to severe disability as knee will be unstable and cannot be fully extended our locked in extension = giving way of knee joint ; it is an essential muscle involved in many daily activities such as climbing stairs or getting up from a chair

Can occur as a complication of anticoagulant therapy - due to a compressive haematoma of the psoas in the pelvis ; can also occur after hip or pelvic surgery

69
Q

Injury to common fibular nerve

A

Caused typically by tibia fracture
Dorsiflexion is gone
Eversion may be affected

70
Q

Peripheral nerve disease
What is it
Causes
Typical symptoms
Treatment

A

Causes - uncontrolled diabetes, shingles, side effects of drugs, trauma, excessive alcohol use, tumours, autoimmune diseases e.g lupus

Typical symptoms:

numbness and tingling in the feet or hands
burning, stabbing or shooting pain in affected areas
loss of balance and co-ordination
muscle weakness, especially in the feet

If autonomic nerves are affected, signs and symptoms might include:

Heat intolerance
Excessive sweating or not being able to sweat
Bowel, bladder or digestive problems
Drops in blood pressure, causing dizziness or lightheadedness

Treatment - NSAIDs, anti-seizure, antidepressants

71
Q

Varicose veins

A

Swollen and elaborated veins in leg and feet

Other symptoms :
aching, heavy and uncomfortable legs
swollen feet and ankles
burning or throbbing in your legs
muscle cramp in your legs, particularly at night
dry, itchy and thin skin over the affected vein

Can be blue/dark purple and bulging
Predisposes you to DVT

72
Q

Weak femoral pulse indicates

A

Coarction of aorta

73
Q

Nervous roots for femoral nerve

A

L2-L4

74
Q

Features of synovial joints

A

2 bones separated by a joint cavity (synovial fluid inside)

Joint capsule surrounds the cavity - consists of fibrous capsule and synovial membrane

The ends of the bones are covered by articular cartilage

Richly innervated

Each has an anastomosis

75
Q

Describe the structure and function of the hip joint

A

Strong and stable joint
Ball and socket type of synovial joint
Enables a wide range of movements flexion/extension/abduction/adduction/inward and outward rotation

Innervated by femoral nerve

76
Q

Identify the ligaments of the hip joint and briefly describe the fucntion of each

A

Iliofemoral ligament prevents hyper extension - very strong

Pubofemoral ligament prevents excessive abduction

Ischiofemoral ligament limits internal rotations - weak

Together, these 3 ligaments stabilise the hip joint

77
Q

Label the vascular supply of the femur

A
78
Q

Muscles attaching to hip joint

A

Hamstrings - ischial tuberosity
Gluteal muscles
Iliopsoas
Pectineus
Sartorius
Rectus femoris
Adductor muscles ‘Gracilis

79
Q

Describe the main features for knee joint

A

Hinge synovial joint
Actions - primarily flexion and extension ; limited rotation
when fully extended the knee is locked - allows weight bearing

80
Q

Muscles attaching to the knee joint

A

Hamstrings
Quadriceps

81
Q

Which direction does hip dislocation typically occur

A

Posteriorly

82
Q

Describe the function of the anterior/posterior cruciate ligaments

A

Anterior cruciate ligament (ACL) - limits posterior rolling of femur on tibia/prevents hyperextension; the weaker ligament

Posterior cruciate ligament (PCL) - limits anterior rolling of femor on tibia /prevents hyperflexion

83
Q

Describe the role of the tibial (medial) and fibular (lateral) collateral ligament

A

Together they keep the tibia and femur in the correct positions, preventing them from sliding over each other laterally

84
Q

Describe how to test the collateral ligaments

A

Take leg in the hands with knee straight.
Gently abduct the knee – to test fibular collateral
Gently adduct the knee – to test tibial collateral
There should be very little movement

85
Q

Describe how to test the cruciate ligaments

A

Patient lies with knee flex at 90 degrees.
Sit on the foot of the leg to be tested.
Pull the leg forward from the tibia – this test the anterior cruciate
Push the leg back – this tests the posterior cruciate
It is called the ‘Drawer Test’
There should be little movement

86
Q

Role of menisci

A

Important in shock absorption
Medial meniscus less mobile than the lateral meniscus

87
Q

Unlocking of knee

A

Popliteus contracts to laterally rotate the femur on the tibia

88
Q

Locking the knee

A

In full extension the knee is locked due to medial rotation of femur on the tibia
This allows many muscle to relax

89
Q

Label the arteries supplying the knee

A
90
Q

Bakers cysts

A

Maybe from bursa, can also be sacs formed from synovial membrane
causes : osteoarthritis, inflammation post sports injury, gout , RA
Likely to interfere with knee movement

91
Q

Describe the main features of the ankle joint

A

Stronger & more stable during dorsiflexion
Relatively unstable during plantarflexion
Hinge type synovial joint
Tibia/fibula forms a mortise(cavity) into which body of talus fits

92
Q

Identify the ankle evertors

A

Fibularis longus and brevis (lateral)
Fibularis Terisus also aids (anterior)

93
Q

Identify the arteries of the leg and ankle .

A
94
Q

Identify the invertors of the foot

A

Tibialis anterior/posterior

95
Q

Identify the medial ligament of the ankle joint

A

Deltoid ligaments - 4 in total

Strong set of ligaments - more stability medially than laterally

96
Q

Mostly commonly injured ankle ligament

A

Anterior talofibular ligament

97
Q

Describe the pott fracture

A

Due to foot being forcibly everted
Medial ligaments strong – can fracture medial malleolus
Talus moves in a lateral direction – fracturing lateral malleolus or fibula

98
Q

Identify the 7 tarsal bones

A

Talus
Calcaneus
Navicular
Cuboid
3 cuneiforms (medial, intermediate, lateral)

99
Q

Describe the transverse tarsal joint

A

Comping joint - consists of 2 joints

Usual site for surgical amputation (e.g. due to diabetes)

100
Q

Hilton law - what is it ?

A

The nerve suppling the muscles that cross over and act on a joint, also innervate that joint.

101
Q

identify the deep gluteal muscles

A
102
Q

function of popliteus

A

forms the floor of the popliteal fossa ; involved in medial and lateral rotation of knee; unlocks knee via laterally rotating the femur on the tibia

103
Q

identify the muscles/tendons of the posterior leg on this diagram

A
104
Q

Identify the deep muscles of the posterior leg

A
105
Q

injury to inferior gluteal nerve

A

loss of hip extension = gluteus maximus lurch - trunk leans backwards on heel strike https://www.youtube.com/watch?v=bTQ5ID7Tpa4

106
Q

sciatic nerve roots

A

L4/5; S1/S2/S3

107
Q

injury to sciatic nerve; clinical presentation and causes

A

foot drop ; weakness of knee flexion, difficulty with inversion/plantar flexion; weak or absent calcaneal reflex ; causes - hip dislocation/acetabulum fracture

108
Q

damage to tibial nerve ; clinical features and causes

A

causes - post knee dislocation, hypertrophy of soleus leading to entrapment; fractures of tibia/fibula; tarsal tunnel syndrome(pain and paresthesia of sole of foot) ; typical symptoms are weakness and pain in the foot/toes/ankle

109
Q

Idenitify the muscles and spinal segmental values responsible for flexion/adduction/medial rotation of hip

A

L2/3

flexion - Iliopsoas, Sartorius, tensor fascia latae, pectineus, adductors longus/brevis/magnus(anterior part), Gracilis

adduction - pectineus, adductors, obturator extensor, Gracilis

medial rotation - gluteus medius/minimus (anterior parts), tensor fascia latae

110
Q

Identify the muscles and spinal segmental values responsible for extension/abduction/lateral rotation of hip

A

L4/5

extension = gluteus maximus/hamstrings/posterior part of adductor magnus

abduction = gluteus medius/minimus & tensor fascia latae

lateral rotation = Obturator externus/internus, piriformis, gemelli, quadratus femoris, gluteus maximus

111
Q

Identify the muscles and spinal segmental values responsible for knee extension

A

primarily quads, weakly tensor fascia latae

L3/4

112
Q

Identify the muscles and spinal segmental values responsible for knee flexion

A

L5/S1

primarily hamstrings and secondarily the Gracilis/sartorius/gastrocnemius/popliteus

113
Q

Identify the muscles and spinal segmental values responsible for ankle dorsiflexion and plantarflexion

A

Dorsiflexion = L4/5 Tibialis anterior, extensor Hallucis longus, extensor digitorum longus

Plantarflexion = S1/2 triceps surae (gastrocnemius + soleus), plantaris , flexor hallucis longus, flexor Digitorum longus, tibialis posterior, Fibularis longus/brevis

114
Q

Identify the muscles responsible and spinal segmental values responsible for foot inversion/eversion

A

Inversion= L4 Tibialis anterior and posterior

Eversion = L5/S1 Fibularis longus/brevis/tertius

115
Q

What is the adductor canal ?

A

a narrow intermuscular passageway for the femoral artery and vein, the saphenous nerve into the popliteal fossa

bound by vastus medialis, adductors longus/Magnus and sartosius

116
Q

what is the iliotibial tract?

what are its 3 main functions ?

A

also called IT band is a longitudinal thickening of fascia lata

found from iliac tubercule to the lateral tibial condyle

functions:

117
Q

Identify the labels

A
118
Q

Identify the three parts of the hip bone (shown in orange, green and purple)

A

Orange = ilium

green = ischium

purple = pubis

119
Q

Tarsal tunnel syndrome

A

Entrapment of tibial nerve due to excessive pressure

Symptoms an be felt anywhere along the tibial nerve, most commonly felt in sole of foot or inside ankle. This can feel like:

  • sharp, shooting pains
  • pins and needles
  • an electric shock
  • a burning sensation

causes - flat feet, varicose veins, benign bony growths in tarsal tunnel, trauma, diabetes, arthritis, tumours

120
Q

Location of extensors hallucis longus and Tibialis anterior tendons in relation to medial and lateral maleoli ?

A

They lie in between

121
Q

Which tendons pass Posteriorly to the lateral malleolus?

A

Fibularis longus and brevis

122
Q

which muscles does the obturator nerve innervate?

A

All adductors except for hamstring part of adductor magnus

Gracilis

Obturator externus

123
Q

Label the major veins of the leg

A
124
Q

spinal segmental values of obturator and femoral nerves

A

Obturator - L2,3,4 anteriorly

femoral - L2,3,4 Posteriorly

125
Q

Label the missing nerves

A
126
Q

Dorsalis pedis pulse

how is it taken

what does its absence indicate?

A

The dorsalis pedis artery pulse can be palpated lateral to the extensor hallucis longus tendon

It’s absence can indicate peripheral vascular disease, hypovolemia, or CHF

127
Q

Label the features of the knee

A
128
Q

what are the functions of the sacrotuberous and sacrospinous ligaments

A

assist in pelvic stability by preventing rotation of the ilium past the sacrum. this stops the pelvis from excessively twisting, preventing lower back pain and sacroiliac joint strain

129
Q

Identify the key phases of the gait cycle

A

Stance phase (60%) - foot on ground

  • heel strike (initial contact)
  • loading response (foot flat)
  • mid stance
  • terminal stance
  • pre swing

swing phase (40%) - foot off ground

  • mid swing
  • terminal swing
130
Q

Eccentric vs concentric contractions

A

Eccentric - lengthening of muscle

concentric - shortening of muscle

131
Q

Muscles preventing excessive rotation during gait

A

Tensor fascia lata

gluteus medius

iliopsoas

132
Q

Hip muscle action during heel contact and loading response

A

Eccentric load on ankle dorsiflexors, knee extensors and hip abductors

contractions of hip abdoctors (tensor fascia lata, gluteus minimus, gluteus medius)

133
Q

Knee locking is performed by

A

quadriceps

134
Q

Foot movements during walking

A

First contact is at the heel, the foot then “rolls” on its lateral side onto the forefoot before it is pushed off the ground via the big toe.

135
Q

Pronation and supination of foot

A

Pronation = eversion/dorsiflexion/abduction = foot rounded

supinated = inverison/plantarflexion/adduction = foot flattened

136
Q

unhappy triad knee injury (also called blown knee)

A

refers to injury to ACL/medial meniscus/medial collateral ligament; occurs when lateral blow is made to a fixed knee; often found in contact sports such as rugby/football

symptoms - severe pain inside knee, excessive swelling minutes after injury difficulty putting weight on knee

treatment - MCL heals on its own ACL may need a graft ; meniscectomy - repair or transplant; physiotherapy for many months after

137
Q

Arches of foot

Descirbe the 3 arches

Describe their function

A

Two longitudinal - one medial and one lateral

medial longitudinal arch - more rounded ; doesnt touch the ground when standing

lateral longitudinal arch - flatter; touches the ground when standing

and one transverse arch - also touches ground w

their function is to absorb shock produced during locomotion and provide flexibility , facilitating walking and running

138
Q

Describe pes planus (flat feet)

symptoms

treatment

A

Common condition where longitudinal arches have been lost

symptoms present at 2-3 years

in children present as painful foot/ankle

in adults feet may ached after prolonged use

treatment - arch supporting inserts

139
Q

Hallux valgus

What is it

symptoms

Treatment

A

Progressive foot deformity in which the metatarsophalangeal joint becomes laterally deviated —> abduction of first metatarsal and adduction of phalanges

leads to bunion on medial side - inflammation of soft tissue and bony prominence

in later stages gait becomes impaired (lateral and posterior weight shift , late heel rise, reduced single limb balance)

more common in individuals with flat feet

140
Q

Identify the ligaments of the foot supporting the arches

A
141
Q

Hallux valgus

A

Progressive foot deformity in which the metatarsophalangeal joint becomes laterally deviated —> abduction of first metatarsal and adduction of phalanges

leads to bunion on medial side - inflammation of soft tissue and bony prominence

in later stages gait becomes impaired (lateral and posterior weight shift , late heel rise, reduced single limb balance)

more common in individuals with flat feet

142
Q

Foot amputations

A

Carried out due to diabetic neuropathy /severe infection/severe ulcers/gangrene due to peripheral arterial disease/trauma

amputation carried out below cuneiforms

143
Q

Identify the foot joints

A
144
Q

advantages and disadvantages of knee replacement surgery

A

Advantages - freedom from pain/improved mobility and hence quality of life

disadvantages - knee will never feel as natural; difficult to kneel, numbness near scar, joints can wear out and loosen with time, pain may not be fully resolved (surgery can fail)

145
Q

identify which muscles are concentric and eccentric and the angles of movement of the hip, knee and foot during the stance phases

A

Initial contact

  • hip flexion : 20 degrees
  • knee flexion : 0 degrees
  • ankle dorsiflexion : 0 degrees

loading response

  • hip flexion : 20 degrees
  • knee flexion : 20 degrees
  • ankle plantarflexion 5 degrees
  • concentric muscles: gluteus maximus and hamstrings
  • eccentric muscles: anterior leg muscles

midstance

  • hip flexion : 0 degrees
  • knee flexion : 5 degrees
  • ankle dorsiflexion : 5 degrees
  • concentric muscles : gluteus maximus and quadriceps
  • eccentric muscles : triceps surae

terminal stance

  • hip extension : 20 degrees
  • knee extension : 0 degrees
  • ankle dorsiflexion : 10 degrees
  • eccentric muscles : triceps surae

Pre-swing

  • hip extension: 10 degrees
  • knee flexion : 40 degrees
  • ankle plantar flexion : 15 degrees
  • concentric muscles : triceps surae
  • eccentric muscles : iliopsoas and adductors (quads assist)
146
Q

identify muscles action and the angles of movement of the hip, knee and foot during the swing phase

A

Initial swing

  • hip flexion : 15 degrees
  • knee flexion : 60 degrees
  • ankle plantarflexion : 5 degrees
  • concentric muscles : iliopsoas/adductors/hamstrings/anterior leg muscles

mid swing

  • hip flexion : 25 degrees
  • knee flexion : 25 degrees
  • ankle dorsiflexion : 0 degrees
  • concentric muscles : iliopsoas/adductors/hamstrings/anterior leg muscles

terminal swing

  • hip flexion : 20 degrees
  • knee flexion : 0 degrees
  • ankle dorsiflexion : 0 degrees
  • concentric muscles : quadriceps
  • eccentric muscles : hamstrings
  • isometric muscles : anterior leg muscles
147
Q

Identify the nerves *

A
  1. lateral femoral cutaneous
  2. Obturator nerve
  3. femoral nerve
  4. idk
  5. superior gluteal nerve
  6. inferior gluteal nerve
  7. common fibular nerve
  8. tibial nerve
  9. posterior cutaneous thigh nerve

Anatomy (8 decks)

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