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SF1 Unit 1 Post Exam 1 > Lumbosacral Plexus and Blood Supply to Lower Limb- Wilson > Flashcards

Lumbosacral Plexus and Blood Supply to Lower Limb- Wilson Flashcards

1
Q

Spinal nerves do not give rise to the lumbosacral plexus. What does?

A

ventral primary rami

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2
Q

What is comprised of the lumbar plexus?

A

L1, L2, L3, L4

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3
Q

What is comprised of the sacral plexus?

A

L4, L5, S1, S2, S3, S4

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4
Q

Limb muscles develop from what 2 myotomic cell groups?

A
  • dorsal muscle mass (extensors)

- ventral muscle mass (flexors)

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5
Q

Which myotome does the dorsal and ventral muscle mass come from?

A

hypomere

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6
Q

Damaged nerve from what division of the brachial plexus will you get wrist drop?

A

posterior division

extensors of the hand are innervated by radial nerve

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7
Q

Lateral femoral cutaneous nerve is derived from what roots of the lumbar plexus?

A

L2, L3

innervates the skin of the lateral thigh, hip joint

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8
Q

The mixed femoral nerve is derived from what roots of the lumbar plexus?

A

L2, L3, L4 (posterior division)

innervates the anterior compartment muscles of the thigh:

  • psoas major (innervated by direct branches of lumbar plexus)
  • iliacus
  • vastus medialis
  • vastus intermedius
  • vastus lateralis
  • rectus femoris
  • sartorius
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9
Q

The obturator nerve is derived from what roots of the lumbar plexus?

A

L2, L3, L4 (anterior division)

innervates the medial compartment of the thigh:

  • pectineus
  • obturator externus
  • adductor brevis
  • adductor longus
  • adductor magnus
  • gracilis
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10
Q

The lumbosacral trunk that joins to sacral plexus is consisted of what roots?

A

L4 and L5

L5 has no distribution to the lumbar plexus

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11
Q

The upper limb rotates _________.The lower limb rotates medially. Thus the extensors are _________and the flexors are _________, opposite to the upper limb.

A

laterally
anterior
posterior

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12
Q

The posterior division of the lumbar plexus innervates what compartment of the thigh?

A

anterior compartment of thigh which are the extensors

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13
Q

The anterior division of the lumbar plexus innervates what compartment of the thigh?

A

MEDIAL compartment of thigh which are adductors

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14
Q

The tibial nerve is derived from which part of the lumbar plexus?

A

NONE

tibial nerve is derived from the SACRAL plexus not the lumbar plexus

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15
Q

The femoral nerve goes through what ligament?

A

inguinal ligament

femoral nerve gives fibers that innervate the skin and muscles of the anterior compartment of the thigh

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16
Q

The obturator nerve goes through foramen?

A

obturator foramen

obturator nerve gives fibers that innervate the skin and muscles of the medial compartment of thigh

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17
Q

Why is there a lumbosacral plexus?

A

axons from L4 and L5 can be distributed within the sacral plexus

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18
Q

The posterior division from L4 to S2 of the sacral plexus gives rise to what nerves?

A

common fibular branch of the sciatic nerve which innervates short head of the biceps femoris

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19
Q

What are the nerves that are derived from the common fibular nerve?

A
  • superior gluteal nerve (L4, L5, S1) –> gluteus medius, gluteus minimus, tensor fascia lata
  • Inferior gluteal nerve (L5, S1, S2)–> gluteus maximus
  • nerve to the piriformis (S1, S2)
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20
Q

The anterior division from L4 to S2 of the sacral plexus gives rise to what nerves?

A 
tibial branch of the sciatic nerve: innervates the posterior muscle mass of the thigh and leg 
THIGH
-semimembranosus
-semitendinousus 
-long head of the biceps femoris

Tibial nerve for the LEG

  • gastrocnemius
  • soleus
  • plantaris (long tendon!!)
  • popliteus
  • tibialis posterior
  • flexor hallucis longus
  • flexor digitorum longus
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21
Q

The common fibular nerve branches into what nerves?

A
  • superficial fibular nerve

- deep fibular nerve

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22
Q

What are the nerves derived from the tibial nerve?

A

nerve to obturator internus: superior gemellus and obturator internus m.
nerve to quadratus femoris: inferior gemellus and quadratus femoris

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23
Q

Spasms and hypertrophy of the piriformis will cause dysfunction of axons in this nerve due to the pressure placed on it. What nerve emerges into the gluteal inferior to the piriformis?

A

sciatic nerve

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24
Q

The two divisions of the sciatic nerve are still separate even as they form one sciatic nerve. True or false?

A

True!!!!

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25
Q

The tibial division of the sciatic nerve innervates the ____________compartment of the thigh.

A

posterior

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26
Q

As the sciatic nerve goes down the thigh, it passes this region where it divides into the common fibular and tibial nerves.

A

popliteal fossa behind the knee joint

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27
Q

The common fibular nerve goes off laterally to wrap around the fibula to reach the anterior lateral compartment of the lower limb. The common fibular nerve crosses the neck of the fibula becoming what?

A
  1. deep fibular nerve

2. superficial fibular nerve

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28
Q

What does the deep fibular and the superficial fibular nerve innervate respectively?

A

-deep fibular nerve innervates the anterior compartment of the LEG:
tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius

-superficial fibular nerve innervates the lateral muscle compartment of the leg:
fibularis longus, fibularis brevis

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29
Q

The common fibular and the tibial nerve give off the lateral cutaneous branch and the medial cutaneous branch respectively to form this nerve which innervates the posterior skin of the leg?

A

sural nerve ???

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30
Q

After crossing behind the medial malleolus, the tibial nerve terminates as what?

A
  1. medial plantar nerve

2. lateral plantar nerve

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31
Q

Flexor digitorium brevis and 1st lumbrical of the foot are innervated by what nerve?

A

medial plantar nerves

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32
Q

The medial and lateral plantar nerve are synonymous to what nerves in the hand?

A
  • median nerve

- ulnar nerve

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33
Q

The anterior femoral cutaneous and the saphenous nerve are derived from what division of the lumbar plexus?

A

posterior division of the lumbar plexus: femoral nerve

  • anterior femoral cutaneous nerve innervates the anterior portion of the thigh
  • femoral nerve TERMINATES as the saphenous nerve which innervates the medial portion of the leg anteriorly and posteriorly
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34
Q

The cutaneous branch of this nerve innervates the adductor compartment of the thigh.

A

obturator nerve

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35
Q

Lesion of the dorsal root and or the spinal nerve results in decreased sensation in a ___________dermatome.

A

single

Lesions proximal to a plexus produce a sensory loss in a single dermatome.

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36
Q

Lesion of a ventral or dorsal primary ramus results in decreased sensation in a _________of a dermatome.

A

portion

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37
Q

The posterior femoral cutaneous nerve, also known as the posterior cutaneous nerve of the thigh, is a sensory branch of what plexus?

A

sacral plexus

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38
Q

The lateral femoral cutaneous nerve is derived from what plexus?

A

lumbar plexus

the only cutaneous branch from L2 and L3 to innervate the lateral portion of the thigh

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39
Q

A lesion of a ventral primary rami results in decreased sensation restricted to a _________of a dermatome.

A

portion

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40
Q

What does it mean if sensory loss involves 2 or more dermatomes?

A

you are dealing with the TERMINAL branches of the lumbosacral plexus

41
Q

T10 and L1 are usually landmarks for what on the body?

A

T10- umbilicus

L1- inguinal ligament

42
Q

The main blood supply to the lower limb arises from what?

A

external iliac artery

43
Q

The external iliac artery changes its name to what when it passes beneath the inguinal ligament?

A

femoral artery

44
Q

This terminates as the common iliac which divides into the external and internal iliac arteries .

A

abdominal aorta

45
Q

Which divisions of the common iliac go to the pelvic and lower limb respectively?

A
  • internal iliac goes to the pelvic region

- external iliac goes to the lower limb

46
Q

Why is the femoral artery a good location to take pulse and catheterization?

A
  • bissects inguinal ligament
  • very superficial
  • lies anterior to femoral head
  • can be compressed against the femoral head to control hemorrhage
47
Q

The femoral artery passes the adductor hiatus (canal) and changes name to?

A

popliteal artery

48
Q

A catheter in the femoral artery or vein enters what side of the heart?

A

if placed in the femoral artery it goes to the left side of heart
-if placed in the femoral vein it goes to the right side of heart

Both hold true regardless of which left or right femoral artery/vein you place the catheter in

49
Q

The femoral artery gives access to the arterial system of a patient. True or false?

A

TRUEEE!!!!

femoral artery is derived all the way from the aorta

50
Q

What is the major branch of the femoral artery?

A

deep femoral artery

51
Q

What is the main blood supply to the head of the femur?

A

medial and lateral femoral circumflex

NOTE: these arteries anastomose

52
Q

What arteries are involved in the healing process of a fracture in the hip?

A

medial and lateral femoral circumflex arteries

53
Q

Why is the cruciate anastomosis at the level of the lesser trochanter important?

A

it provides a collateral route if the femoral artery is occluded

54
Q

What arteries are the cruciate anastomosis made up of?

A

Transverse limb:

  • medial circumflex
  • lateral circumflex

Vertical limb:

  • ascending branch of the 1st perforating artery
  • descending branch of the inferior gluteal artery (from the internal iliac artery)
55
Q

What do the perforating arteries from the deep femoral artery supply?

A

the hamstrings of the thigh

56
Q

Where do the medial and lateral femoral circumflex arteries go to respectively?

A
  • medial femoral circumflex artery: medially to the neck of the femur
  • lateral femoral circumflex artery: laterally to the neck of the femur
57
Q

The popliteal artery is a continuation of the femoral artery after it transverses the adductor hiatus. The popliteal artery gives what branches that ANASTOMOSE around the knee?

A
  • superior medial genicular artery
  • superior lateral genicular artery
  • inferior medial genicular artery
  • inferior lateral genicular artery
58
Q

What is the reason for anastomosis in joint or collateral route developments in joints?

A

kinking in joints

59
Q

The popliteal artery terminates at the inferior border of the popliteus by dividing into what?

A

anterior tibial artery

posterior tibial artery

60
Q

Why is the popliteal artery important?

A

it is a second good location for feeling pulse

61
Q

The anterior tibial artery pierces and runs on what to supply the anterior compartment of the leg?

A

interosseous membrane

-anterior TIBIAL artery supplies the ANTERIOR compartment of leg

62
Q

The anterior tibial artery terminates at the malleoli as what?

A

dorsalis pedis artery

63
Q

What is the dorsalis pedis artery significant?

A
  • it is a third location where you can feel the pulse (Examine the pulse) as it runs superficially
  • can check for peripheral arterial disease from which stroke can occur
64
Q

What artery supplies the posterior compartment of the leg?

A

posterior tibial artery which runs medially

65
Q

What is the major branch of the posterior tibial artery that supplies the DEEP compartment of the leg?

A

fibular artery which runs laterally

The fibula is lateral.

66
Q

The posterior tibial artery runs with what nerve in between the tendons of flexor hallucis longus and flexor digitorum?

A

tibial nerve

67
Q

The posterior tibial artery crosses the ankle posterior to the medial malleolus, between what two muscles?

A

flexor hallcius longus and flexor digitorum longus

68
Q

Why is the posterior tibial artery significant?

A

it is a fourth location for measuring pulse at the ankle

69
Q

The posterior tibial artery terminates as what?

A
  1. lateral plantar artery
  2. medial plantar artery

they both lie in between the 1st two muscle layers of the foot

70
Q

What are the four locations where the pulse may be taken at the lower limb?

A
  • femoral head: femoral artery
  • posterior side of knee: popliteal artery
  • dorsal surface of the foot: dorsalis pedis artery (termination of anterior tibial artery)
  • medial ankle: posterior tibial artery
71
Q

A weak pulse on one side may be a sign of what?

A

peripheral artery disease (PAD) or obstruction

-these could be due to the development of plaques within arteries

72
Q

What is claudication and how does it develop?

A

pain and cramping in the muscles of the leg which is induced by exercise due to obstruction of the arteries

-tissue ischemia develops distal to a vascular lesion

73
Q

Why is venous return from the lower limb often an issue?

A

getting blood back to the heart from the lower limb is an issue because we stand erect

  • gravity pulls down on blood to go to the big foot
  • same veins in the upper limb its just that gravity makes it easier in the upper limb
74
Q

Veins of the lower limb are organized into what 3 groups?

A
  1. Deep veins
  2. Superficial veins
  3. Perforating veins
75
Q

What are characteristics of the types of veins found in the lower limb for deep, superficial, and perforating veins?

A

deep veins: runs with arteries of the same name
superficial: immediately under the skin, cephalic, medial cubital; have NO arteries running with them!!
perforating vein: connects the deep and superficial vein

76
Q

What are the borders of the femoral triangle?

A

lateral border: sartorius
medial border: adductor longus
superior border: inguinal ligament
floor formed by the iliacus, psoas major, pectineus, adductor longus

77
Q

What type of vein is the femoral vein?

A

deep vein as it runs with the femoral artery

78
Q

The lower limb has what 2 major veins that are important for thermal regulation?

A
  1. great saphenous vein

2. lesser saphenous vein

79
Q

The great saphenous vein runs with what NERVE on the medial portion of the LEG?

A

saphenous nerve

80
Q

The great saphenous vein travels from the dorsum of the foot up medially of the leg to go through the femoral triangle.

A

FACTS

it runs on the medial malleolus

81
Q

The lesser saphenous vein travels from the lateral malleolus up the central part of the calf and terminates in the popliteal fossa by joining the popliteal vein.

A

FACTS!!

82
Q

Why are the great and lesser saphenous vein clinically significant?

A

they are clinically important for vascular surgery

83
Q

What are you concerned with replacing the coronary artery with the great or lesser saphenous vein?

A

They have valves so you would need to turn it upside down.

84
Q

The saphenous nerve is a terminal branch of what nerve?

A

femoral nerve

85
Q

What does the deep femoral nerve innervate?

A

NOTHINGG!!!! because there’s no such thing

there is a deep femoral ARTERY that gives rise to the perforating arteries supplying the hamstrings of the thigh

86
Q

What are the hamstrings of the thigh?

A
  • semimembranosus
  • semitendonosus
  • biceps femoris
  • hamstring head of adductor magnus

from medial to lateral thigh

87
Q

What is the purpose of valves in the perforating veins?

A

perforating veins connect the superficial veins with the deep veins

it allows blood flow from the superficial vein to the deep vein BUT it DOES NOT allow blood flow from deep to superficial vein

88
Q

What are the mechanisms in which body returns blood from the big toe to the heart, thus overcoming the pressure of a 4, 5, or 6 ft column of blood?

A
  • valves
  • energy of the arterial pulse is transferred into the venae comitantes generating movement of blood
  • venous calf pump: contraction and relaxation of muscles squeeze the vein and pumps blood towards the heart
  • perforating arteries shunt blood from superficial veins to the deep veins where blood can be pumped back to the heart
89
Q

The fibular vein runs with what muscle?

A

flexor hallucis longus

90
Q

The great and lesser saphenous vein do not have the advantage of being under muscle (they are underneath the skin). So how is their blood pumped back to the heart?

A
  • valves

- perforating veins

91
Q

What occurs if the valves in the legs fail?

A

edema and pooling of blood in the leg

92
Q

What is the importance of venae comitantes?

A
  • they are composed of deep veins
  • they are important for exchange of heat (a countercurrent system)
  • uses some energy of the pulsating artery to return the blood to the heart
93
Q

How is energy of the arterial pulse transferred into the venae comitantes generating movement of blood?

A

the expansion of the arteries during a pulse going to the big toe compresses veins enough to open valves going towards the heart

94
Q

Why is the center of gravity anterior to the rotational axis of the ankles which produces a tendency to sway forward?

A
  1. readiness for flight/fight

2. calf-pump

95
Q

Diseased or damaged valves in the peforating veins allow blood to pool in the superficial veins, where there is no pumping. What is the result?

A

varicose veins

96
Q

What are factors than can predispose someone to varicoses veins?

A
  • obesity

- dunlap disease which puts pressure on the external iliac and femoral vein restricting blood coming back to the heart

97
Q

How can the diaphragm help bring blood back to the heart?

A

diaphragm when it contracts increases the abdominal pressure pushing fluids from high pressure to low pressure towards the heart

98
Q

What nerve does the anterior tibial artery run with?

A

deep fibular nerve

99
Q

Superior and inferior gluteal arteries branch off of what artery?

A

internal iliac artery

SF1 Unit 1 Post Exam 1 (14 decks)

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