M: Living anatomy of the lower limb Flashcards
What does the gluteal fold mark?
The inferior border of gluteus maximus and the boundary between the gluteal and posterior thigh regions
What muscles contribute to the quadriceps and which 3 are visible on the anterior surface of the thigh?
1) Rectus femoris
2) Vastus lateralis
3) Vastus medialis
4) Vastus intermedialis
Top 3 are visible on the anterior surface of the thigh
Where does the iliac crest run from?
The anterior superior iliac spine to the posterior superior iliac spine
Posterior superior iliac spines may be difficult to palpate as covered by fat, how else can they be located?
Located by permanent skin dimples lateral to the midline caused by the attachment of the overlying fascia to the PSIS
A line joining the dimples marking the position of the PSIS passes through what?
The S2 spinous processes, the midline of the sacroiliac joints and bifurcation of the iliac arteries
What structures within the vertebral column terminate at S2?
The arachnoid and dura mater
What is the supracristal plane?
A line joining the highest points of the iliac crest which passes through the intervertebral disc between L4 and L5 vertebra
What forms the base of the femoral triangle?
Inguinal ligament
What forms the medial border of the femoral triangle?
Medial margin of adductor longus
What forms the lateral border of the femoral triangle?
Medial margin of Sartorius muscle
What forms the floor of the femoral triangle?
Formed medially by pectineus and adductor longus muscles and laterally by iliopsoas muscle
Where does the apex of the femoral triangle point, what is it continuous with?
Points inferiorly
Continuous with the adductor canal
What are the contents of the femoral triangle?
Femoral nerve, artery and vein and lymphatics
What are the superomedial boundaries of the popliteal fossa?
Semimembranous and semitendinous
What is the superolateral boundary of the popliteal fossa?
Biceps femoris
What is the inferior border of the popliteal fossa?
Medial and lateral heads of gastrocnemius
What are the contents of the popliteal fossa?
Popliteal artery and vein
Tibial nerve
Common fibular nerve
Common fibula nerve wraps around what?
The neck of the fibula
Which are the 4 pulse points in the limb which are used in clinical examinations?
1) Femoral pulse points
2) Popliteal pulse points
3) Posterior tibial pulse point
4) Dorsalis pedis pulse point
Where is the femoral pulse point palpated?
Halfway between the ASIS and pubic tubercle, slightly inferior to the inguinal ligament
What clinical procedures might be carried out on the femoral artery?
Angioplasty and stent placement
Coronary artery stenting
Where can the popliteal artery be palpated?
In the popliteal fossa
How can you aid palpation of the popliteal artery?
Flex the knee with the foot resting on the ground to relax hamstrings
Where can the pulse of the posterior tibial artery be palpated?
Posterior to the medial malleolus
Where can the dorsalis pedis artery be palpated?
Palpated lateral to the tendon of the extensor hallucis longus
Why might it be necessary to palpate all the pulse points of the lower limb during an examination?
Any vascular stenosis can be identified, need to palpate all as it may be a distal narrowing
Where do the superficial veins of the lower limb originate from?
From the dorsal venous arch of the foot
What are the main superficial veins of the lower limb?
Great and small saphenous veins
What is the course of the great saphenous vein?
From medial side of dorsal venous arch runs up medial side of leg, knee, thigh to pass through an opening in the deep fascia covering femoral triangle and join with the femoral vein
What is the course of the small saphenous vein?
From lateral side of dorsal venous arch, passes behind the distal end of the fibula (lateral malleolus), and up the back of the leg to penetrate deep fascia and join the popliteal vein posterior to the knee
What is the mechanism behind varicose veins?
Failure of venous valves allows blood to flow backwards down the veins and results in venous hypertension when standing - excess pressure leads to widening of veins, so valves don’t close properly. Blood flows back into leg along these veins and causes pooling and bulging
Where is the best place to test the L3 dermatome?
Lower medial side of the thigh
Where is the best place to test the L5 dermatome?
Medial side of digit 2
How would you test mainly for the L3 and L4 myotomes?
Extension of the knee
How would you test mainly for the S1 and S2 myotomes?
Plantar flexion of the foot
What movement would you expect to occur when eliciting the knee reflex, what vertebral levels are being tested?
Extension of knee
L3,L4
How would you test the knee reflex?
Patient sit on the couch with the leg dangling or the knee should be flexed and you should support the weight of the leg with the arm. The patellar ligament is tapped with the hammer halfway between the patellar and the tibial tuberosity
How would you elicit the ankle reflex?
Push the foot into the dorsiflexed position and tap the calcaneal tendon superior to its insertion on the calcaneal bone
What movements would you expect to occur when eliciting the ankle reflex, what vertebral levels are being tested?
Plantar flexion
S1 vertebral level
