Module 4: The lower limb Flashcards
Muscles of gluteal region
Gluteal muscles (max, med, min)
Lateral (external) rotator muscles
Lateral rotator muscles
Lateral rotation of femur at hip joint, deep to gluteal muscles
Lateral rotator muscles
Piriformis
Obturator internus
Superior and inferior gemelli
Quadratus femoris
Obturator externus
Piriformis
Attaches to the pelvic surface of the lateral part of the sacrum and leaves the pelvic cavity through the greater sciatic foramen to attach femur
Obturator internus
Originates on obturator membrane of pelvis and its tendon exits the pelvis through the lesser sciatic foramen to insert on femur
Superior and inferior gemelli
Run above and below obturator internus
Quadratus femoris
Runs from ischial tuberosity
Obturator externus
Runs from outer surface of obturator membrane to femur
Gemellus pain syndrome
Strained gemelli muscles when trying to aid in flexion at the hip joint
Symptoms of gemellus pain syndrome
Compressed posterior femoral cutaneous muscle
Reduced range of motion at hip, numbness in skin of posterior thigh
Blood supply to gluteal region
Branches of internal iliac artery: superior and inferior gluteal arteries
Venous supply to gluteal region
Superior and inferior gluteal veins, drain into internal iliac vein
Internal iliac artery stenosis
Narrowing of the internal iliac arteries reduces blood supply to the structures supplied by branches of the internal iliac artery
Symptoms of internal iliac artery stenosis
Cramping of muscles in lower back, hip, buttock or thigh, further induced by exercise
Innervation of gluteal region
Sacral plexus
- superior and inferior gluteal nerve
- posterior femoral cutaneous nerve
- sciatic nerve
- pudendal nerve
Superior gluteal nerve
Supplies motor innervation to gluteus medius, gluteus minimus and tensor fasciae latae
Inferior gluteal nerve
Supplies motor innervation to gluteus maximus
Posterior femoral cutaneous nerve
Supplies sensory innervation to skin posterior thigh
Sciatic nerve
Largest nerve in body, supplies muscles that make up the posterior thigh
L4, L5, S1-S3
Pudendal nerve
Motor innervation to anal sphincters and the urethral sphincter
Sensory innervation to the perineum, the penis, the scrotum, labia majora and clitoris
Pathway of sciatic nerve through the gluteal region
After forming from the sacral plexus, the sciatic nerve leaves the pelvis via the greater sciatic foramen and emerges below the piriformis muscle
Pathway of sciatic nerve through posterior thigh
Passes superficial to the lateral rotator muscles, where it enters the posterior thigh deep to hamstring muscles
Piriformis syndrome
Caused by compression of the sciatic nerve by the piriformis muscle
Symptoms of piriformis muscle
Pain, tingling, numbness at affected site, pain can radiate to lower back where the spinal nerves converge to from the sciatic nerve, down the thigh, along the same path as sciatic nerve
The hip joint
Ball and socket synovial joint
Acetabular labrum
Rim of fibrocartilage that deepens the acetabulum, allowing more than half the femoral head to fit
Ligamentum teres
Secondary stabilizer of hip joint supplementing work of capsular ligament
Fibrous capsule
Thick and strong group of ligaments that help hold head of femur in acetebulum
Traumatic posterior hip sublaxation
Sublaxation (partial dislocation) occurs when the head of the femur is forced partially out of the acetabulum
What can result from posterior hip sublaxation?
Fibrous capsule and ligamentum teres can be torn or disrupted
Compartments of thigh
- Anterior
- Medial
- Posterior
Medial compartment
Adductors
Originate from pubis and insert into linea alba of femur
Muscles of medial compartment
Pectineus
Adductor brevis
Adductor longus
Gracilis
Adductor magnus
Adductor magnus insertion
Length of linea aspera
Adductor magnus action
Adducts thigh, extends and medially rotates the thigh at the hip joint
Hamstring part of adductor magnus
Inserts on adductor tubercle on femur to form the adductor hiatus
Adductor hiatus
Allows passage of vessels btwn the anterior and posterior thigh
Adductor magnus strain
Tearing of a muscle when muscle has been forced to stretch or contract beyond its limits
Symptoms of adductor magnus strain
Limited movement of hip, affecting one’ gait, pain with adduction, extension and medial rotation of thigh, can result in trigger points
Localization of pain in adductor magnus strain
Deep aching pain radiates to pelvis area, near origin of adductor magnus
Pain at front or back of thigh along body of the muscle
Pain may radiate to knee, near insertion of adductor magnus
Posterior compartment muscles
Semitendinosus
Semimembranosus
Biceps femoris
Posterior compartment muscles origin and insertion
Ischial tuberosity and posterolateral and posteromedial aspects of knee
Action of posterior compartment muscles
Extend hip and flex knee
The femoral triangle
Area in upper anterior thigh that contains major neurovascular structures
Borders of femoral triangle
Superior: Inguinal ligament
Lateral: sartorius
Medial: adductor longus
Floor: lliopsoas and pectineus
Roof: fascia lata
Femoral artery- branches to hip
Deep femoral artery (profunda femoris) and the circumflex arteries w multiple branches around neck of femur
Femoral artery- branches to thigh
Profunda femoris artery and superficial femoral artery
Femoral vein
Drains thigh and rest of lower limb
Longest tributary is great sapheneous vein
Great sapheneous vein
Drains superficial tissues of most of lower limb and empties into femoral vein in upper thigh
Pathway of femoral artery and vein through adductor hiatus
Descend through femoral triangle to its apex where they pass into adductor (Hunter’s) canal deep to sartorius and superficial to adductor magnus
Pathways of femoral artery and vein to popliteus
From canal they pass through adductor hiatus to posterior knee where they change their name to politeal artery and vein
Avascular necrosis of femoral head
Occurs when blood supply to femoral head is disrupted; caused by trauma to joint or bone
Symptoms of avascular necrosis of femoral head
Necrosis of bone tissue, affected joint pain during weight bearing activities ion later stages, persisting pain when laying down
Nerve supply of hip and thigh
Femoral nerve
Obturator nerve
Lateral cutaneous nerve
Sciatic nerve
Femoral nerve
Innervates quadriceps muscles and skin of anterior thigh, runs along femoral artery and vein in femoral triangle
Obturator nerve
Innervates muscles and skin of medial compartment of thigh
Lateral cutaneous nerve
Innervates skin on lateral aspect of thigh above knee
Obturator nerve entrapment
Occurs due to inflammation of adductor muscles bc the obturator nerve travels in btwn adductor longus and adductor brevis
Consequences of obturator nerve entrapment
Pain that follows course of the nerve along medial thigh and can radiate into groin or knee
Sensory changes caused by obturator nerve entrapment
Numbness ad paresthesia (pins and needles) of medial thigh
Motor changes caused by obturator nerve entrapment
Adductor weakness, limited ROM at hip joint, pain that worsens with activity
Ligaments of the knee
Patellar ligaments
Collateral ligaments
Cruciate ligaments
Patellar ligament
Continuation of quadriceps tendon and helps keep patella in proper position
Collateral ligaments
Medial and lateral
Stabilize hinge motion of the knee, prevent excessive lateral and medial movement
Medial collateral ligament (MCL)
Joins distal femur to proximal tibia
Lateral collateral ligament (LCL)
Joins distal femur to head of fibula
Cruciate ligaments
Deep ligaments of the knee that prevent the femur and tibia from sliding forwards and backwards
Anterior cruciate ligament (ACL)
Prevents anterior dislocation of tibia on fixed femur
Extends from lateral femoral condyle to intercondylar surface of tibia
Posterior cruciate ligament (LCL)
Prevents posterior dislocation of tibia on fixed femur
Extends from medial femoral condyle to the posterior lateral intercondylar surface of tibia
Menisci of knee
C-shaped fibrocartilaginous pads on condyles of tibia that function to deepen the articular surface of the tibia to increase stability
Medial meniscus: cresent shaped
Lateral meniscus: circular
Causes of medial meniscus tear
Jumping, suddenly changing direction, rotation of knee joint, getting up quickly
Symptoms of medial meniscus tear
Localized pain of affected knee, swelling, stiffness, pain with weight bearing movements
Action of posterior compartment of leg
Plantarflexion of foot and ankle
Popliteus
O: lateral femur
I: posterior surface of itbia
Gastrocnemius
O: medial/lateral sides of femur
I: calcaneus
A: Flex leg and foot
Plantaris
O: posterolateral femur
I: calcaneus
Border of popliteal fossa (diamond)
Superior medial: semimembranosus
Superior lateral: biceps femoris
Inferior medial: medial head of gastrocnemius
Inferior lateral: lateral head of gastrocnemius
Medial gastrocnemius strain cause
Stretching/contracting muscle beyond its limits
Symptoms of medial gastrocnemius strain
Calf pain, tenderness localized to medial head of gastrocnemius at knee, pain and weakness when flexing leg at knee joint
Popliteal artery
Continuation of femoral artery within popliteal fossa
What does the popliteal artery bifurcate into?
Anterior and posterior tibial arteries
Posterior tibial artery
Supplies posterior compartment of leg
Anterior tibial artery
Supplies anterior compartment of leg
Fibular (peroneal) artery
Branches off posterior tibial artery
Supplies lateral compartment of leg
Great saphenous vein
Drains superficial tissue of most of lower limb
Small saphenous vein
Drains blood from lower leg into popliteal vein
Posterior tibial vein
Drains fibular vein and posterior compartment of leg
Drains into popliteal vein
Anterior tibial vein
Drains anterior compartment of leg
Drains into popliteal vein
Fibular vein
Drains lateral compartment of leg
Drains into posterior tibial vein
Deep vein thrombosis
Formation of blood clot in deep vein
Symptoms of deep vein thrombosis
Pain that starts in calf, feeling like a cramp or soreness due to blockage and pooling of blood near clot, red or discoloured skin and feel warm and swollen
What does the sciatic nerve bifurcate into?
Common peroneal nerve
Tibial nerve
Common peroneal nerve
Innervates muscles of lateral and anterior compartments of leg
Tibial nerve
Descends posteriorly through popliteal fossa and innervates muscles of posterior leg
Superficial fibular nerve
Innervates muscles of lateral compartment of leg
Deep fibular nerve
Innervates muscles of anterior compartment of leg
Contents of popliteal fossa
Popliteal artery and vein
Tibial nerve
Common peroneal nerve
Common peroneal nerve dysfunction
Damage to peroneal nerve leading to loss of movement or sensation in foot and and leg
Common peroneal dysfunction symptoms
Foot drop, muscle atrophy
Arches of the foot
Medial longitudinal arch
Lateral longitudinal arch
Transverse arch
Stress fracture
Small crack in bone or severe bruising of bone due to overuse
Symptoms of stress fracture
Pain that worsens with weight bearing activities and diminishes during rest, swelling on top of foot or side of ankle, difficulty walking
Ankle joint
Synovial hinge joint permitting dorsiflexion and plantarflexion of foot
Ligaments of ankle joint
Deltoid ligament
Spring ligament
Plantar fascia
Deltoid ligament
Stabilize ankle during plantar flexion, external rotation and pronation of foot to prevent overstretching of muscles
Runs btwn tibia and talus
Spring ligament
Runs btwn navicular and calcaneus bone
Helps stabilize medial longitudinal arch and talus
Plantar fascia
Longest ligament
Supports medial longitudinal arch
Deltoid ligament strain
Caused by sudden lateral rotation of ankle
Symptoms of deltoid ligament strain
Pain of medial ankle, swelling, bruising, difficulty walking and bearing weight
Intrinsic muscles of the foot
Stabilize arches of foot, control movement of digits
Where do extrinsic muscles of foot arise from?
Arise from anterior, posterior and lateral compartments of leg
What action are the extrinsic muscles of the foot responsible for?
Eversion, inversion, plantar flexion and dorsiflexion
Tibialis posterior muscle
Imp extrinsic muscle of foot
Attacthes to navicular
Symptoms of posterior tibial tendonitis
Pain, swelling, warm and red localized to area around inside of foot and ankle
Arterial supply of foot
- Dorsalis pedis artery
- Posterior tibial artery
Dorsalis pedis artery
Branches from anterior tibial artery and supplies dorsum of foot
Posterior tibial artery
Supplies plantar surface of foot
Dorsal venous arch
Drains dorsal surface of foot, drains to small saphenous vein laterally and great saphenous vein medially
Varicose veins
Twisted, enlarged veins caused by damaged or weak valves in veins, can cause backflow and pooling of blood in vein
Symptoms of varicose veins
Aching pain and discomfort due to pooling of blood
Tibial nerve
Supplies muscles of posterior compartment of leg and intrinsic muscles of plantar surface of foot
Deep fibular nerve
Supplies muscles of anterior compartment of leg and part of skin of dorsum of foot
Superficial fibular nerve
Supplies muscles of lateral compartment of leg and skin of lower anterior leg and most of skin on dorsum of foot
Tibial nerve dysfunction
Damage to tibial nerve that causes loss of movement or sensation of foot
Symptoms of tibial nerve dysfunction
Burning, numbness or tingling of skin of sole of foot, pain of sole of foot and toes, weakness in muscles that plantarflex foot
What else does the sciatic nerve innervate?
Hamstring portion of adductor magnus
