Module 4: The Lower Limb Flashcards
Lateral rotator group
-this group of muscle are muscles are primarily involved in lateral rotation of femur at joint
Lateral rotator group compartments
-superficial
-intermediate
-deep
Superficial compartment of lateral rotator group
-gluteus medius
-gluteus maximus
Intermediate group of lateral rotator group
-gluteus medius
-lateral rotators
Deep group of lateral rotator group
-gluteus minimus
-lateral rotators
Lateral rotator muscles
-piriformis
-obturator internus
-superior and inferior gemelli
-quatratus femoris
-obturator externus
Piriformis
-attaches from pelvic surface of lateral sacrum and attaches to femur
Obturator internus
-originates on obturator membrane of pelvis and inserts on the femur
Superior and inferior gemelli
-run above and below obturator internus
Quadratus femoris
-runs from ischial tuberosity to femur
Obturator externus
-runs from outer surface of obturator membrane to femur
Gemellus pain syndrome
-muscle spasm of overworked gemelli muscles can put pressure on surrounding nerves
What is the main nerve involved in gemellus pain syndrome
-posterior femoral cutaneous nerve
Posterior femoral cutaneous nerve
-runs over gemelli muscles and can become compressed
Gemellus pain syndrome symptoms
-reduced range of motion of hip
-numbness in posterior thigh skin
Blood supply of the gluteal region
-branches of internal iliac artery, primarily superior and inferior gluteal arteries
How do gluteal region arteries enter the gluteal region
-through greater sciatic foramen
-superior and inferior to piriformis muscle
Venous drainage of gluteal region
-each arterial branch has a corresponding venous branch that travels alongside it
-drain into internal iliac vein
Internal iliac artery stenosis
-narrowing of internal iliac arteries reduces blood supply to structures supplied by branches of internal iliac artery
How is iliac artery stenosis usually caused
-typically a concequence of atherosclerosis
Internal iliac artery stenosis symptoms
-cramping of muscles in lower back, hip, buttock or thigh
-futher induced by exercise
Innervation of the gluteal region
-superior gluteal nerve
-inferior gluteal nerve
-posterior femoral cutaneous nerve
-sciatic nerve
-pudendal nerve
Superior gluteal nerve
-motor innervation to gluteus medius, gluteus minimus, and tensor fasciae latae
Inferior gluteal nerve
-motor innervation to gluteus maximus
Posterior femoral cutaneous nerve
-sensory innervation to skin of posterior thigh
Sciatic nerve
-largest nerve in body, supplies muscles that make up posterior thigh
Pudendal nerve
-motor innervation to anal sphincters and urethral sphincter
-also provides cutaneous sensory innervation
What are the nerve roots of the sciatic nerve
-L4, 5 & S1, 2, 3
Pathway of sciatic nerve in gluteal region
-after forming from sacral plexus, sciatic nerve leaves pelvis via grater sciatic foramen and emerges below piriformis muscle
-runs deep to gluteus maximus
Pathway of sciatic nerve through posterior thigh
-passes superficial yo lateral rotator muscles, where it enters the posterior deep to the hamstrings
Piriformis syndrome (sciatica)
-may be caused by compression of the sciatic nerve by piriformis muscle, specifically at the site where nerve emerges over lateral rotator muscles from under piriformis
Stabilizers of the hip joint
-acetabular laburm
-ligametum teres
-fibrous capsule
Acetabular labrum
-deepening of acetabulum with a rim of fibrocartilage
-this means that more than half of the femoral head can fit, greatly improving stability of the joint
Ligamentum teres
-acts as a secondary stabilizer of the hip joint, supplementing the work of the capsular ligament
Fibrous capsule
-thick and strong group of ligaments that hold the head of the femur in the acetabulum
How are fibrous capsule ligaments arranged
-oriented in a spiral fashion around the hip joint so they can tighten during extension and go back during flexion
Traumatic posterior hip subluxation
-occurs when head of femur is forced partially out of acetabulum
-most common mechanism is a fall on flexed and adducted hip
-fibrous capsule and ligamentum teres can be torn or disrupted
Traumatic posterior hip subluxation symptoms
-pain
-limited hip mobility
Compartments of the thigh
-anterior
-medial
-posterior
Action of medial compartment of thigh
-adductors
Muscles of the medial compartment of the thigh
-pectineus
-adductor brevis
-adductor longus
-gracilis
-adductor magnus
Where do the medial compartment muscles originate and insert
-originate from pubis and insert onto linea aspera of femur
Adductor magnus
-deepest and largest muscle of medial compartment
-inserts on linea aspera
-can adduct, extend, and medially rotate thigh at hip joint
Parts of the adductor magnus
-smaller hamstring part
-adductor hiatus
Smaller hamstring part of adductor hiatus
-inserts on adductor tubercle of femur
Adductor hiatus
-formed by smaller hamstring part
-important for passage of vessels between anterior and posterior thigh
Adductor magnus strain
-tearing of the muscle
Who is adductor magnus strain common in
-soccer, hockey, and football players
Adductor magnus strain symptoms
-limited movement of hip, affecting gait
-pain with adduction, extension, or medial rotation
-pain and aching in groin, thigh and knee
Muscles of the posterior compartment of the thigh
-semitendinosus
-semimembranosus
-biceps femoris
What is the posterior thigh compartment known as
-hamstrings
Origin and insertion of muscles of posterior thigh
-originate from ischial tuberosity and insert on posteriolateral and posteromedial aspects of the knee
Action of the posterior muscles of the thigh
-extending hip and flexing knee
Artery branches to the hip
-deep femoral artery
-circumflex arteries
Artery branches to the thigh
-deep femoral artery
-superficial femoral artery
Femoral vein
-drains thigh and lower limb
Longest tributary of femoral vein
-great saphenous vein
What does great saphenous vein drain
-superficial tissues of lower limb
What does the femoral triangle contain
-contains femoral artery and vein
Where is the adductor hiatus located
-deep to sartorius and superficial to adductor magnus
Adductor hiatus
-pass from anterior knee to posterior knee
Avascular necrosis of femoral head
-blood supply to femoral head is disrupted
-from trauma to bone
-can result in necrosis or tissue death
Avascular necrosis of femoral head symptoms
-pain with weight bearing
-pain lying down
-pain may affect groin, thigh, or buttocks
Nerve supply of hip and thigh
-femoral nerve
-obturator nerve
-lateral cutaneous nerve
-sciatic nerve
Femoral nerve
-quadriceps muscles and skin of anterior thigh
-runs alongside femoral artery and vein in femoral triangle
Obturator nerve
-muscles of medial compartment as well as skin of medial thigh
Lateral cutaneous nerve
-skin on lateral aspect of thigh above knee
Sciatic nerve
-hamstring muscles
Obturator nerve entrapment
-can be caused by inflammation of adductor muscles
-usually impingement between adductor longus and brevis
Obturator nerve entrapment
-pain along medial thigh, can radiate to groin or knee
-numbness
-pins and needles (paresthesia)
-adductor weakness
-limited ROM
-pain that worsens with activity
The knee joint ligaments
-patellar ligament
-collateral ligament
-cruciate ligament
Patellar ligament
-continuation of quadriceps tendon and helps keep patella in proper position
Collateral ligament
-stabilize hinge motion of knee
-preventing excessive medial or lateral movement
What are the collateral ligaments
-MCL
-LCL
MCL
-joins distal femur to proximal tibia
LCL
-joins distal femur to head of fibula
Cruciate ligaments
-prevent femur and tibia from sliding forwards or backwards
What are the cruciate ligaments
-ACL
-PCL
ACL
-prevents anterior dislocation of tibia on fixed femur
PCL
-prevents posterior dislocation of tibia on fixed femur
Menisci of the knee function
-c-shaped fibrocartilage pads on condyles of tibia
-deepen articular surface of tibia to increase stability
Menisci of the knee
-medial meniscus
-lateral meniscus
Medial meniscus tear
-can happen during activities that involve jumping, changing direction suddenly or rotation on knee joint
Medial meniscus tear symptoms
-popping sensation
-localized pain in knee
-swelling
-stiffness
-pain and difficulty with weight bearing
Muscles of the posterior leg
-popliteus
-gastrocnemius
-plantaris
Popliteus
-deepest muscle of posterior compartment
-originating on lateral femur and inserting on posterior surface of tibia
Gastrocnemius
-2 heads that originate on the medial or lateral sides of the femur and inserts on the calcaneus
-crosses 2 joints
-can flex leg and foot
Plantaris
-long thin muscle originates on the posterolateral femur and inserting on the calcaneus
Borders of the popliteal fossa
-semimembranosus
-biceps femoris
-plantaris
-medial and lateral head of gastrocnemius
Medial gastrocnemius strain
-high risk for strain because it crosses 2 joints
Medial gastrocnemius strain symptoms
-calf pain
-possible palpable bulge
-tenderness localized to medial head of gastrocnemius at the knee
-pain and weakness when flexing leg at the knee joint
Arteries of knee and leg in order
-femoral artery
-popliteal artery
-anterior tibial artery
-posterior tibial artery
-fibular artery
Veins of knee and leg in order
-fibular vein
-posterior tibial vein
-anterior tibial vein
-small saphenous vein
-great saphenous vein
-popliteal vein
-femoral vein
Deep vein thrombosis
-involves formation of blood clot in deep vein
Mechanism of deep vein thrombosis
-usually includes some combination of decreased blood flow rate, increased tendency to clot, and injury to vessel wall
Risk factors of deep vein thrombosis
-age
-obesity
-trauma
-lack of movement
-use of birth control
Deep vein thrombosis symptoms
-pin in calf
-cramps
-soreness
-red or discoloured skin
-warm and swollen
Innervation of the knee and leg
-sciatic nerve
-common peroneal nerve
-tibial nerve
-superficial fibular nerve
-deep fibular nerve
What does the common peroneal nerve supply
-muscles of lateral and anterior leg compartments
What does the tibial nerve supply
-muscles of posterior leg
What does the superficial fibular nerve supply
-muscles of lateral leg compartment
What does the deep fibular nerve supply
-muscles of anterior leg compartment
Contents of the popliteal fossa
-popliteal artery
-popliteal vein
-tibial nerve
-common peroneal nerve
Common peroneal nerve dysfunction
-occurs when there is damage to peroneal nerve leading to loss of sensation in foot and leg
Common peroneal nerve dysfunction
-nerve dysfunction
-decreased sensation in parts of leg
-impairments of foot (foot drop, impaired gait)
Tarsal bones
-calcaneus
-talus
-cuboid
-navicular
-intermediate, lateral, and medial cuneiforms
Arches of the foot
-medial longitudinal arch
-lateral longitudinal arch
-transverse arch
Arches of the foot function
-allows foot to act as a spring, bearing weight of body and absorbing shock produced during locomotion
Stress fracture
-small crack in bone, or severe bruising in bone
-often caused by overuse and repetitive activity
Stress fracture symptoms
-pain worsens with weight bearing and dimishes with rest
-swelling
-difficulty walking normally
The ankle joint
-formed by bones of leg articulating with the foot
-hinge joint permitting dorsiflexion and plantarflexion of foot
Ligaments of the foot and ankle
-deltoid ligament
-spring ligament
-plantar fascia
Deltoid ligament
-stabilizes ankle during plantar flexion, external rotation and pronation
How does the deltoid ligament run
-runs between tibia and talus
Spring ligament
-stabilizes medial longitudinal arch and talus
Plantar fascia
-plantar aponeurosis
-longest ligament of foot
-helps support medial longitudinal arch of foot
Deltoid ligament sprain
-caused by sudden rotation of ankle
Deltoid ligament sprain symptoms
-pain of the medial ankle
-swelling or bruising
-difficulty walking and bearing weight
Muscles of the foot
-intrinsic muscles of foot
-extrinsic muscles of foot
Intrinsic muscles of foot
-on sole of foot and collectively act to stabilize arches of the foot
-individually control movement of digits
Extrinsic muscles of foot
-rise from anterior, posterior, and lateral compartments of leg
-mainly responsible for eversion, inversion, plantar flexion, and dorsi flexion of the foot
Tibialis posterior
-important extrinsic muscle
-attaches onto navicular
Posterior tibial tendonitis
-supports medial longitudinal arch of foot
-can tear or become inflamed with injury
Posterior tibial tendonitis symptoms
-pain
-swelling
-warmness
-redness
-ankle may be prone to rolling medially
-toes and foot rotate laterally
Arterial supply of ankle and foot
-dorsalis pedis
-posterior tibial artery
Dorsalis pedis
-supplies dorsum of foot
Posterior tibial artery
-supplies plantar surface of foot
Venous drainage of ankle and foot
-dorsal venous arch
-drains distal structures of foot such as toes
Varicose veins
-twisted enlarged veins caused by weak or damaged valves in the veins
-can cause backflow and pooling of blood in vein
-causes them to stretch or twist
How many stages of severity do varicose veins have
-5
Innervation of ankle and foot
-tibial nerve
-deep fibular nerve
-superficial fibular nerve
Tibial nerve
-supplies intrinsic muscles and skin of plantar surface of foot
Deep fibular nerve
-supplied muscles and part of the skin on dorsum of foot
Superficial fibular nerve
-supplies muscles and skin of lower anterior leg and most of skin on dorsum of foot
Tibial nerve dysfunction
-damage to tibial nerve
Tibial nerve dysfunction symptoms
-loss of movement or sensation in foot
-burning
-numbness
-tingling
-localized pain to sole of foot and toes
-weakness of muscles that plantar flex
How can tibial nerve dysfunction occur
-can be caused by direct trauma
-continuous pressure on the nerve
-overuse
