Lower Limbs Flashcards
Identify femur, patella, tibia, fibula, tarsals, metatarsals, phalanges
Do it
What’re the main bones of the leg
femur, patella, tibia, fibula, tarsals, metatarsals, phalanges
What’re the important bony features of the bones of the leg? Know where they are
Greater trochanter of femur, proximal head of the fibula, lat. and med. malleolus, sesamoid bones
What is a sesamoid bone
Bone embedded within a tendon or muscle
What’re the arches in the foot
Medial, lateral and transverse arch
Test gluteus medius/minimum
lie on side with lower limb fully extended. Abduct limb against resistance at distal end of thigh. Palpate contraction of gluteus medius just inferior to iliac crest. (nerve = superior gluteal L5, S1
Trendelenberg test
tests integrity of abductors at hip joint. Stand on both legs, both right and left side of pelvis should remain at the same level. Examiner stand behind and feel the pelvis. Ask subject to raise one leg. Pelvis should remain horizontal. If pelvis on raised leg side drops down, test is positive – loss/weakness of motor function of abductor muscles (gluteus medius and minimus) in supporting leg
Test iliopsoas muscle
hip flexor in the anterior compartment of the thigh/pelvis.
Patient lies supine with knee flexed at 90 degrees
Stand with hand placed on individual’s flexed knee
Patient further flexes against resistance
What is the anterior quadriceps group of muscles
rectus femoris, vastus medialis, intermedius, lateralis
Test the anterior quadriceps group
Subject sits on edge of couch, knees bent to 90 degrees. Examiner resist extension of leg. Palpate contracting quadriceps on anterior thigh. (Nerve = femoral, L2,3,4)
What’re the hamstrings group of muscles
Biceps femoris, semitendinosus, semimembranosus
What is the adductor group of muscles of the thigh
Adductor longis, brevis and magnus
Test the adductor group of muscles of the thigh
Lie on side, support upper leg, request them to adduct lower leg against resistance. (Nerve = obturator nerve L2,3,4)
Test the tibialis anterior
subject turn foot inwards and upward (inversion) while examiner grasps the forefoot to oppose the movement. Tendon becomes prominent and is palpated just below and anterior to the medial malleolus (Nerve = deep fibular (peroneal) L4,5)
Test the fibulas longus and brevis
Subject asked to turn foot outwards and plantar flex (eversion) while examiner grasps forefoot to oppose movement. Tendons become prominent and palpated just below lateral malleolus (Nerve = superficial fibular L5, S1, S2)
What are the calf muscles
gastrocnemius, soleus, calcaneal tendon
Test the calf muscles
Subject stands on toes. Muscle belies, calcaneal tendon is seen and palpated in the calf area and on the posterior side of the ankle. (Nerve = tibial S1, S2)
Nerve supply to gluteal muscles
gluteal nerve
Nerve supply to Tensor fascia lata
superior gluteal L5, S1
Nerve supply to Iliopsoas muscles
femoral nerve and direct branches of lumbar plexus
Nerve supply to quadriceps group
Nerve = femoral, L2,3,4
Nerve supply to hamstrings
nerve = tibial division of sciatic L5, S1, S2 except for biceps short head = common fibular division L5, S1, S2
Nerve supply to adductor group
= obturator nerve L2,3,4
Nerve supply to tibialis anterior
deep fibular (peroneal) L4,5
Nerve supply to fibularis (peroneus) longus and brevis
superficial fibular L5, S1, S2
Nerve supply to o Calf muscles – gastrocnemius, soleus, calcaneal tendon
(Nerve = tibial S1, S2)
Where do you palpate the femoral pulse
at mid-inguinal point between ASIS and pubic symphysis
Where do you palpate the popliteal pulse
subject lies prone with knee flexed. Palpated in inferior part of popliteal fossa in relation to the tibia
Dorsalis pedis pulse
palpate just lateral to extensor hallucis longus tendon (this can be found by asking subject to dorsiflex toes while resisting movement
Tibialis posterior pulse
palpate just behind medial malleolus
Surface mark long and short saphenous vein
Do it
Describe long saphenous vein
runs upwards 2cm in front of the medial malleolus, along medial side of leg, hands width along the medial side of patella, along medial side of thigh to saphenous opening in inguinal region.
Describe short saphenous vein
passes posteriorly to the lateral malleolus at the ankle, runs superiorly on the posterior leg to drain into the popliteal vein after piercing the fascia over the popliteal fossa.
Map dermatomes L1 to S2
Do it
Test patellar tendon. What nerve?
sit with legs dangling. Strike patella tendon, should see brisk extension of the knee joint & should be able to palpate simultaneous contraction of the quadriceps on anterior thigh. L4
Test ankle jerk. What nerve?
sit with legs dangling. Strike the calcaneal tendon while holding the foot slightly dorsiflexed. Should see plantar flexion of ankle joint. S1
Surface mark sciatic nerve
first palpate PSIS, ischial tuberosity, greater trochanter. Nerve leaves the greater sciatic notch, enters gluteal region at midpoint between PSIS and ischial tuberosity. Forms downward curve to pass into thigh around midpoint between greater trochanter and ischial tuberosity before reaching popliteal fossa.
Test motor function of the sciatic nerve
Subject lies prone, knee flexed to 30 degrees. Resist further flexion. Hamstring tendons seen around popliteal region, muscle contraction palpable on posterior side of mid-thigh
Where does the sciatic nerve exit the vertebral column and what does it supply
supplies hamstring muscles & all muscles below level of knee (through its divisions) (L3,4,5,S1,S2
Test motor function of the gluteal nerve
. Lie on side with lower limb fully extended. Abduct limb against resistance at distal end of thigh. Palpate contraction of gluteus medius just inferior to iliac crest.
What does the gluteal nerve supply
supplies gluteus medius, minimus, maximus
What does the femoral nerve supply
supplies psoas, iliacus, pectineus, sartorius, rectus femoris, vastus
What does the obturator nerve supply
supplies obturator externus, adductor brevis, adductor longus, adductor magnus, gracilis
What does the superficial peroneal nerve supply
supplies peroneus longus, brevis
What does the deep peroneal nerve supply
supplies extensor digitorum longus, brevis, extensor hallucis longus, tibialis anterior, peroneus tertius
Test motor function of the femoral nerve
Flex hip against resistance and extend knee
Test motor function of the obturator nerve
Lie on side, support upper leg, request them to adduct lower leg against resistance.
Test motor function of the superficial peroneal nerve
Subject asked to turn foot outwards and plantar flex (eversion) while examiner grasps forefoot to oppose movement.
Test motor function of the deep peroneal nerve
Subject turn foot inwards and upward (inversion) while examiner grasps the forefoot to oppose the movement
Demonstrate how to define the Gluteal “safe area”
- Superior lateral quadrant of the buttock
- Avoid hitting the sciatic nerve (and superior gluteal nerve and vessels) during i.m. injection
- Between the tubercle of the iliac crest and the anterior superior iliac spine
- Place index finger on ASIS and spread fingers posteriorly until the middle finger feels the tubercle of the iliac crest
- The triangle between those 2 fingers is the safe area for i.m. injections
Define the femoral triangle borders
outlined by inguinal ligament (superiorly), adductor longus (medially), sartorius (laterally
What does the femoral triangle contain
Contains femoral nerve, artery, vein (lateral to medial)
Define the popliteal fossa borders
outlined by biceps femoris (superolaterally), semimembranosus (superomedially), lateral and medial gastrocnemius (inferiorly), skin and fascia (posteriorly), femur (anteriorly).
What does the popliteal fossa contain
Contains popliteal artery, vein, tibial and common peroneal nerve, short saphenous vein, popliteal lymph nodes
Test the hamstring group of muscles
Subject lies prone, knee flexed to 30 degrees. Resist further flexion. Hamstring tendons seen around popliteal region, muscle contraction palpable on posterior side of mid-thigh (nerve = tibial division of sciatic L5, S1, S2 except for biceps short head = common fibular division L5, S1, S2)
What are the gluteal muscles (5)
Gluteus medius, minimus and maximus, tensor fascia lata and iliopsoas
What are the three groups of thigh muscles
Anterior quadriceps group, hamstrings, adductor group
Nerve supply to the gluteal medius
Superior gluteal L5, S1
