Module 5 Flashcards
Where is the psoas muscle location? What is its actions? What nerve innervates it?
Originates: T12-L5 TP, VB, and VD
Insertion: less trochanter
Actions: flexes the hip
Nerve: Femoral nerve
Where is the gracilis muscle location? What is its actions? What nerve innervates it?
O: inferior pubic symphysis, body and inferior
ramus of pubis
I: Medial proximal anterior tibial shaft (via
pes anserine tendon)
A: adduct and flex thigh, assists in medial
rotation of leg, *probably medially rotates
flexed knee
N: Obturator
What are the four quadriceps muscles?
Vastus lateralis
Vastus intermedius
Vastus medialis
Rectus Femoris
What are the lateral hip rotators?
Piriformis
Quadratus femoris
Obturator externus
Obturator internus
What are the muscles that make up the hamstrings?
Semimembranosus
Semitendinosus
Biceps Femoris
What muscles attach to form the Achilles tendon?
Gastrocnemius and soleus
Where is the flexor hallicus longus muscle location? What is its actions? What nerve innervates it?
O: Inferior 2/3 of posterior fibula and interosseous membrane
I: inferior surface of distal phalange toe
A: flexion of great toe (hallux), plantarflexion
N: Tibial nerve
What’s the difference between tarsals vs talus?
Tarsals are the 7 bones in the foot. (Talus, Calcaneus, Navicular, Cuneiform I, II, III (medial, middle/intermediate,
lateral), Cuboid)
Talus is the second largest tarsal bone and is located in the hindfoot, above the calcaneus.
What part of the lumbar plexus does the iliohypogastric nerve originate from?
L1
What part of the lumbar plexus does the genitofemoral nerve originate from?
L1, 2
What part of the lumbar plexus does the Nerve to the psoas and iliacus nerve originate from?
L2-4
What part of the lumbar plexus does the Obturator nerve originate from?
L2-4
What part of the lumbar plexus does the ilioinguinal nerve originate from?
L1
What part of the lumbar plexus does the Lateral femoral cutaneous nerve originate from?
L2, 3
What part of the lumbar plexus does the femoral nerve originate from?
L2-4
What two nerves from L1, eventually combine?
Iliohypogastric and ilioinguinal nerves
What muscles are innervated from the iliohypogastric and ilioinguinal?
Internal oblique and transversus abdominus muscles
What do the cutaneous branches of the iliohypogastric and ilioinguinal innervate?
The skin of the groin and perineum
Which one of the iliohypogastric or the ilioinguinal nerve provides more superior and posterior fibers of the skin?
Iliohypogastric nerve
What kind of surgical repair can cause damages to the small branches of the lumbar plexus?
Inguinal hernia
What might a patient who had a recent surgery with unexplained groin pain/paresthesia could be experiencing?
Iatrogenic Damage to L1-2 Branches
What branch of the genitofemoral nerve innervates the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females?
Genital branch
What branch of the genitofemoral nerve supplies sensation to the upper anterior thigh?
Femoral branch
What is the entrapment of the lateral femoral cutaneous nerve called?
Meralgia Parethetica
What muscles should we note due to the lateral exit of the lateral femoral cutaneous nerve (L2, 3)?
Muscle spasms in the Tensor fascia latea, sartorius, iliacus
What division of the lumbar plexus does the nerve to the psoas and iliacus derived from?
Posterior diversion of VPRs of L2-4
What muscles makes up the traditional innervation of the femoral nerve as it descends to the leg?
Quadriceps, pectineus, and sartorius
What muscle can be involved in low back pain associated with acute and repetitive trauma as well as poor posture, poor breathing technique, and other sedentary lifestyle habits?
Quadratus Lumborum
What VPR is the Quadratus lumborum innervated by?
The ventral primary rami of T12-L4
What portions in the diversions forms the femoral nerve?
Posterior diversion of the nerves and the Obturator from the anterior diversion
What happens embryologically to cause the posterior diversion muscles to be on the anterior surface?
Lower extremity limb bud rotate medially
Where does the saphenous nerve lead to?
Medial knee, leg, and medial ankle
What are the muscles that flex the hip and innervated by the femoral nerve?
Pectineus (L2-3)
Iliopsoas (L2-4)
Sartorius (L2-3)
Rectus Femoris (L2-4)
What are the muscles that extend the leg at the knee?
Quadriceps femoris (L2-4)
What happens with femoral nerve entrapment?
Quadriceps weakness, decreased patellar reflex, anterior thigh pain, and medial calf pain (saphenous nerve involvement)
What phase of a person’s gait might be dysfunctional if we have femoral nerve entrapment?
Swing phase gait
What division of the VPR makes the Obturator nerve?
L2-4
What portion of the thigh does the Obturator nerve innervate?
Adductors of the thigh
Where does the Obturator nerve pass through before it gets to the lower extremity?
Obturator foramen
What muscles are innervated by the Obturator nerve?
Obturator externus (L3, 4)
Adductor longus (L2-4)
Adductor brevis (L2-4)
Gracilis (L2-4)
Pectineus (L2-3)
Adductor magnus, anterior portion (L2-4)
What can happen to the Obturator nerve in the pelvic floor during pregnancy?
In the 3rd trimester of pregnancy entrapments, uterine fibroid or endometriosis tumors can make the Obturator nerve vulnerable
What are some of the ways the Obturator nerve can become entrapped?
Pubic ramus fracture
Hematomas,
Pregnancy
Where is the cutaneous innervation by the femoral nerve?
Anterior compartment of the thigh all the way to the medial side of the ankle
Where is the cutaneous innervation by the Obturator nerve?
Medial portion of the thigh
What are the pain patterns of to differentiate between L4 Radiculopathy versus Femoral Neuropathy?
L4 Radiculopathy: deep, aching, sclerotogenous type pain; shooting pain in the dermatomal pattern
Femoral Neuropathy: Cutaneous pain, sharp at first. Chronically: numbness in the cutaneous branch or saphenous nerve
What are the motor functions to differentiate between L4 radiculopathy versus Femoral Neuropathy?
L4 Radiculopathy: Tibialis anterior weakness - dorsiflexion, inversion of the foot… May present as foot drop
Femoral Neuropathy: Hip flexor weakness, knee extensor weakness; may appear with atrophy if chronic; NO FOOT DROP
What are the reflex functions of the differentiate from L4 radiculopathy versus Femoral Neuropathy?
L4 radiculopathy: 1+/4+ patellar reflex
Femoral Neuropathy: Dimished, due to loss of the quadriceps innervation
What are the gait to differentiate between L4 radiculopathy versus Femoral Neuropathy?
L4 Radiculopathy: May exhibit steppage gait with foot drop
Femoral Neuropathy: Difficulty with the swing phase due to hip flexor weakness
What are the Palpation/Ortho to differentiate between L4 radiculopathy versus Femoral Neuropathy?
L4 Radiculopathy: SLR, Dejerine/Valsalva, root tension signs
Femoral Neuropathy: Tinel’s at the femoral triangle
In the lumbosacral, where do the somatic structures of the lower extremity arise from?
VPR of L4-S3
In the sacral plexus, where do the pelvic viscera arise from?
S2-4
What are the main muscular branches of the lumbosacral plexus?
Superior gluteal nerve
Lumbosacral trunk
Inferior gluteal nerve
Common fibular nerve
Tibial nerve
Posterior femoral nerve
Pudendal nerve
Sciatic nerve
What spinal segment are the Lumbosacral trunk arise from?
L4-L5
What spinal segment are the Nerve to piriformis arise from?
S1-S2
What spinal segment are the Sciatic nerve arise from?
Common fibular division (L4-L5, S1-S2)
Tibial division (L4-L5, S1-S3)
What spinal segment are the Pelvic splanchnic nerve arise from?
S2-S4
What spinal segment are the Nerve to levator ani arise from?
S3-S4
What spinal segment are the Nerve to Obturator intemus arise from?
L5, S1-S2
What spinal segment are the Pudendal nerve arise from?
S2-S4
What spinal segment are the Posterior femoral cutaneous nerve arise from?
S1-S3
What spinal segment are the superior gluteal nerve arise from?
L4-L5, S1
What spinal segment are the inferior gluteal nerve arise from?
L5, S1-S2
What spinal segment are the nerve to Quadratus femoris arise from?
L4-L5, S1
What are the muscular innervation of the tibial nerve?
Sciatic nerve
Biceps femoris
Semitendinous
Adductor magnus
Semimembranosus
Gastrocnemius
Plantaris
Popliteus
Soleus
Tibialis posterior
Flexor hallicus longus
Flexor digitorum longus
Abductor hallicus
Flexor digitorum brevis
Flexor hallicus brevis
Lumbricals
What are the muscular innervation of the common fibular nerve?
Biceps femoris
Tibialis anterior
Fibularis longus
Extensor digitorum longus
Extensor hallucis longus
Fibularis tertius
Extensor digitorum brevis
What does the superior gluteal nerve innervate?
Gluteus medius and Gluteus minimus
What does the inferior gluteal nerve innervate?
gluteus maximus
What nerve innervates the piriformis?
Nerve to piriformis
What are the clues for nerve entrapment?
Injury, muscle spasms, or compression
What are the clues for trigger points?
Pain, weakness, or dysfunction
What are the patterns look like for sciatica?
The trigger point pattern for gluteus minimus looks very similar, but the pain does not reach the foot.
What are the two divisions of the sciatic nerve? Where do they split?
Tibial and Common Fibular
In the popliteal fossa
What nerve innervates the short head of the biceps femoris?
Common fibular nerve
What compartment of the leg does the tibial nerve innervate?
Posterior calf and bottom of the foot
What compartment of the leg does the common fibular nerve innervate?
Anterior and lateral calf and top of the foot
What are the primary innervation in the calf from the tibial nerve?
Gastrocnemius/Soleus; popliteus, plantaris, Tibialis posterior, flexor digitorum longus, flexor hallicus longus (“Tom, Dick, and Harry”)
Which tibial compartment syndrome is more serious?
Acute compartment syndrome
What is acute compartment syndrome?
Pressure (from bleeding and inflammatory products) building up around the group of muscles post trauma (usually).
What is chronic compartment syndrome?
Chronic use/ overuse of muscles. Surgery is not usually needed… decrease workout intensity and frequency
What is tarsal tunnel syndrome? Where does the pain occur?
Similar to carpal tunnel syndrome in the hand
The muscle’s tendon sheathes become inflamed with use/over use and compress of the nerve, resulting in referred pain in the distributions of the medial and lateral plantar nerves. Pain and electrical sensations in the heel, sides, and bottoms of the feet can occur.
Where does the aural nerve innervate?
Skin on the lateral posterior leg
What two nerves come together to make the sural nerve?
Medial communicating branch: tibial
Lateral communicating branch: common fibular
What does the medial plantar nerve innervate? What are the spinal segments they make up?
Abductor hallucis: L5-S1
Flexor hallicus brevis: L5-S1
Flexor digitorum brevis: L5-S1
First lumbrical: L5-S1
What does the lateral plantar nerve innervate? What are the spinal segments they make up?
Three lateral lumbricals, Quadratus plantae: L5-S1
Flexor digiti minimi brevis: S1-S2
Abductor digiti minimi: S1-S2
Adductor hallucis S1-S2
Plantar interossei (PAD): S1-S2
Dorsal interossei (DAB): S1-S2
Where on the bottom of the foot does the tibial nerve innervate?
Posterior and medial heel
Where on the bottom of the foot does the sural nerve innervate?
Lateral side of foot from heel to base of the fifth metatarsal
Where on the bottom of the foot does the saphenous nerve innervate?
Medial arch of the foot
Where on the bottom of the foot does the medial plantar nerve innervate?
Medial anterior portion of the foot from big toe to half of the fourth digit
Where on the bottom of the foot does the lateral plantar nerve innervate?
Lateral anterior portion of the foot from half of the fourth digit to fifth digit
What is a well known entrapment called of the medial and lateral plantar nerves?
Morton’s neuroma
Where does the irrigation occur in Morton’s Neuroma?
Between the third and fourth digit
What are some of the symptoms of Morton’s Neuroma?
Painful, difficult walking, and gait changes may lead to spinal involvement
What are some of the causes of Morton’s Neuroma?
Wearing high-heeled or tight shoes may contribute
What are the two branches of the common fibular nerve?
Superficial branch and deep branch
What does the superficial fibular branch innervate?
Fibularis longus and brevis, sensory branches over the dorsal and lateral foot
What does the deep fibular branch innervate?
Fibularis tertius, tibialis anterior, extensor digitorum longus and brevis, extensor hallucis longus, sensory branches to the web between the great and second toe.
What are the cutaneous distribution of the saphenous nerve from? What portion of the leg does it cover?
from the femoral nerve
Medial lower leg to the medial ankle
What are the cutaneous distribution of the sural nerve from? What portion of the leg does it cover?
From the common fibular nerve
Fifth digit
What is the most common entrapment of the lower extremities?
Common fibular nerve entrapment
What does damage at the fibular head affect?
Affects both branches, though the deep branch muscular loss is most prominent
What does anterior tarsal tunnel syndrome affect?
Affects the deep branch separately as the nerve crosses the joint at the metatarsal - cuneiform bones just distal to the extensor retinaculum
What does foot drop mean?
What are some of the problems related to foot drop?
Disc lesion, sciatic nerve damage, peripheral nerve injury, stroke, or multiple sclerosis
Where is the cutaneous distribution of the femoral nerve and obturator nerve in the thigh?
Lateral femoral cutaneous
Anterior femoral cutaneous
Posterior femoral cutaneous
Obturator: medial thigh
Where is the cutaneous distribution of the sural nerve and saphenous nerve in the superior calf?
Lateral sural cutaneous: branch of the common fibular; anterior and lateral calf
Medial sural cutaneous: branch of the tibial; posterior medial/lateral calf
Saphenous nerve: branch of the femoral nerve; superior and inferior, anterior and posterior medial calf to the medial malleolus (this is the only nerve below the knee NOT derived from the sciatic nerve
Where is the cutaneous distribution of the sural nerve and superficial fibular nerve in the inferior calf?
Lateral and medial sural nerves join to form the sural nerve which continues down the posterior lateral surface of the calf to the lateral foot.
Superficial fibular nerve: lower half of the anterior lateral calf, anterior side lateral malleolus, and dorsum of the foot, NOT the web between great and second toes.
Where is the cutaneous distribution of the superficial fibular nerve, deep nerve, medial calcaneal branch of tibial, and medial and lateral plantar nerves in the foot?
Superficial fibular nerve: dorsal foot
Deep fibular nerve: web between great and second toe
Medial calcaneal branch of tibial: calcaneus
Medial and lateral plantar nerves: plantar foot; distribution reminiscent of median and ulnar in the hand, respectively.
What is the muscle tested and reflex tested of L4 spinal nerve?
Muscle tested: Tibialis anterior
Reflex tested: Patellar
What is the muscle tested and reflex tested of L5 spinal nerve?
Muscle tested: Extensor Hallicus Longus
Reflex tested: Medial Hamstring
What is the muscle tested and reflex tested of S1 spinal nerve?
Muscle tested: Fibularis Longus
Reflex tested: Achilles
What is lumbar stenosis?
Narrowing of the spinal canal, causing instability
What is spondylolisthesis?
Vertebral body sides forward/backwards
