MSCT Week 4: Lower Limb Flashcards
Major Functions of the Lower Limb
2 listed
- Support the body weight
- Move the body weight
Gluteal Region
between the iliac crest and the gluteal fold that defines the lower limit of the buttocks
Each of the two pelvic bones of the gluteal region is formed by?
childhood fusion of 3 bones
- Ilium
- Ischium
- Pubis

Anterior Thigh boundaries
between the inguinal ligament and the knee joint

Posterior Thigh Boundaries
Between the Gluteal Fold and the Knee
Thigh bone is?
Femur
Leg Boundaries
between the knee and ankle joints
The bones of the leg?
- Tibia
- Fibula
Bones of the foot
3 listed
- Tarsals
- metatarsals
- phalanges
How is muscular energy reduced to maintain a standing position
The ligaments of the hip and knee joints and the shapes of the articular surfaces “locks” the joints in position to reduce the muscular energy required to maintain a standing position
Identify Anatomical Parts


Identify


Identify Movements


The Hip Joint Description & Function
2 parts
- a synovial joint between the head of the femur and cup-shaped acetabulum on the lateral surface of the pelvic bone
- it is a multi-axial ball and socket joint designed for stability and weight bearing
Acetabular Labrum Description & Function
2 listed
- the fibrocartilaginous collar on the rim of the acetabulum on the lateral surface of the pelvic bone
- it deepens the acetabulum and prevents the femoral head from moving inferiorly
Acetabular labral tears

Ligament of the head of the femur Description
connective tissue that attaches the head of the femur to the acetabular fossa
The femoral head is supplied by?
A branch of the obturator artery supplies femoral head through a branch inside the head of the femur ligament
The synovial membrane around the hip joint attaches to?
The articular surfaces of the femur and acetabulum
Identify


Identify


Fibrous capsule or membrane of the hip joint Description & Function
- surrounds the synovial membrane
- holds the femoral neck in the acetabulum
How many ligaments around the fibrous capsule of the hip? what are they called?
3
- Iliofemoral ligament
- Pubofemoral ligament
- Ischiofemoral ligament
Iliofemoral Ligament location
Anterior

Pubofemoral ligament location
Anteroinferior

Ischiofemoral ligament Location
Posteroinferior

Identify


Largest synovial joint in the body
The knee
The knee joint is formed by the articulations of?
- The medial and lateral femoral condyles
- the medial and lateral tibial condyles
- the patella
The stability of the knee joint relies on?
- Quadriceps
- hamstrings
- ligaments
Ligaments of the knee joint
4 listed
- Medial or tibial collateral ligament (MCL or TCL)
- Lateral or fibular collateral ligament (LCL or FCL)
- Anterior Cruciate Ligament (ACL)
- Posterior Cruciate Ligament (PCL)
Medial collateral ligament origin and insertion
- extends from the medial epicondyle of the femur and attaches on the medial aspect of the tibia
- it is attached to the capsule and medial meniscus
Medial collateral ligament Function
prevents lateral displacement of the tibia under the femur
Identify


What prevents lateral displacement of the tibia under the femur
Medial collateral ligament
Lateral collateral ligament Origin and Insertion
extends from the lateral epicondyle of the femur and attaches to the head of the fibula
Lateral collateral ligament Function
Prevents medial displacement of the tibia under the femur
Cruciate ligaments description and properties
3 listed
- cross each other in the intercondylar region of the knee
- they are inside the capsule but outside the synovial membrane
- they connect the tibia and femur and restrict anterior to posterior movement of the knee joint
Anterior Cruciate Ligament Origin and Insertion
it extends from the lateral femoral condyle to the anterior tibia

Anterior Cruciate Ligament Function
- Keeps the tibia from moving anteriorly on the fixed femur
- it resists hyperextension and is weaker than the PCL
Posterior Cruciate Ligament Origin and Insertion
it extends from the medial femoral condyle to the posterior tibia

Posterior Cruciate Ligament Function
- keeps the tibia from moving posteriorly on the fixed femur
- Tension on it is greatest when the knee is flexed
Identify


Identify


Medial and Lateral Menisci description and function
C-shaped fibrocartilage between the articulating condyles that help make the surfaces more congruent and serve as shock absorbers
Most common menisci injury
The medial meniscus is more frequently injured than the lateral due to its attachment to the MCL
Synovial membrane of the knee joint description & function
2 listed
- attaches to the margins of the articular surfaces and menisci
- it forms pouches or bursa that provide low-friction movement for tendons such as the (Suprapatellar bursa and subpopliteal recess)
Fibrous capsule of the knee Description & Function
3 listed
- encloses the articular cavity
- it is partly formed and reinforced by muscle tendons
- the upper end of the popliteal muscle is enclosed by the fibrous membrane
Patellar Ligament Description
- The patellar Ligament is the continuation of the quadriceps tendon
- it connects the patella to the tibia

Identify


Most commonly injured structures in the knee
Called the Unhappy Triad of O’Donahue
- MCL
- Medial Meniscus
- ACL
Resultant from a blow to the lateral aspect of the knee with the foot planted on the ground
The injury is often accompanied by an audible snap and immediate pain and swelling
Unhappy Triad of O’Donahue
- Called the Unhappy Triad of O’Donahue
- MCL
- Medial Meniscus
- ACL
- Resultant from a blow to the lateral aspect of the knee with the foot planted on the ground
- The injury is often accompanied by an audible snap and immediate pain and swelling
The Ankle Joint Description

- Is a synovial hinge joint between the talus, tibia and fibula.
- the distal ends of the fibula are anchored together by medial (deltoid) and lateral ligaments to create a deep socket for the upper body of the talus

Lateral Ligament of the ankle description
Composed of 3 ligaments
is the most commonly sprained by foot inversion
- Posterior talofibular ligament
- Anterior talofibular ligament
- Calcaneofibular ligament
Most common sprain of the ankle
Anterior talofibular ligament due to foot inversion
Medial Deltoid Ligament of the ankle inferior attachment sites
is divided into four parts based on the inferior points of attachment
- posterior tibitalar
- tibiocalcanela
- tibionavicular
- anterior tibiotalar parts

Sprain of the Medial Deltoid Ligament of the ankle usually occurs how?
most often occurs by foot eversion
Identify


Identify


Lachman Test Procedure, Structure Tested and Positive Result

Anterior Drawer Test Procedure, Structure Tested and Positive Result

Posterior Drawer Test Procedure, Structure Tested and Positive Result

Valgus Stress Test Procedure, Structure Tested and Positive Result

Varus Stress Test Procedure, Structure Tested and Positive Result

McMurray Test Procedure, Structure Tested and Positive Result

Patellar Apprehension and Patellofemoral Grind Test Procedure, Structure Tested and Positive Result

Valgus
when the foot is more lateral (knock-kneed)

Varus
When the foot is more medial (bow-legged)

The muscles in the gluteal region do what?
- Abduct
- extend
- laterally rotate
the femur relative to the pelvic bone
Deep Muscles of the Gluteal Region
4 listed
are lateral rotators of the femur at the hip joint
- Piriformis
- obturator internus
- the gemelli (twins)
- quadratus femoris

Superficial Muscles of the Gluteal Region

Abduct (gluteus minimus and medius)
extend the hip (gluteus maximus)
the tensor fasciae latae muscle stabilizes the knee in extension by acting on the iliotibial tract (a band of deep fascia that passes down the lateral side of the thigh to attach to the proximal end of the tibia)

Iliotibial tract
(a band of deep fascia that passes down the lateral side of the thigh to attach to the proximal end of the tibia)

Identify


Identify


Nerves enter the gluteal region from?
- The pelvis through the greater sciatic foramen
- most are in the plane between the superficial and deep muscles

Superior Gluteal Nerve innervates and location
- gluteus medius
- gluteus minimus
- tensor fascia latae
Passes superior to the piriformis muscle

The nerve to the quadratus femoris also supplies?
Gamellus Inferior
The nerve to the obturator internus supplies and location & roots
- Gemellus superior & the obturator internus
- passes through the lesser sciatic foramen to innervate
- L5-S2 Spinal Nerves
The posterior femoral cutaneous nerve of the thigh innervates
innervates the skin of the gluteal region, the posterior thigh, and posterior leg

The inferior gluteal nerve innervates
gluteus maximus muscle

The piriformis muscle is innervated by branches of?
L5, S1 and S2 spinal nerves
The Pudendal Nerve is the nerve of the?
Perineum

Pudenal nerve roots
S2-S4

Inferior gluteal nerve roots
- L5
- S1
- S2
Obturator internus nerve roots
- L5
- S1
- S2
Quadratus Femoris nerve roots
- L4
- L5
- S1
Superior Gluteal Nerve Roots
- L4
- L5
- S1
Trendelenburg sign/gait
an abnormal gait (as with walking) caused by weakness of the abductor muscles of the lower limb (gluteus medius and gluteus minimus
people with injury of the superior gluteal nerve have weakness of abducting the thigh at the hip

people with an injury of this nerve have weakness of abducting the thigh at the hip
Superior Gluteal Nerve
the upper end of the popliteal muscle is enclosed by?
The Fibrous Capsule of the Knee
Identify


Describe the Trendelenburg Sign

The Superior and Inferior Gluteal Arteries supply?
The gluteal region

The Superior and Inferior Gluteal Arteries originate from
from the internal iliac artery which is a terminal branch of the aorta

Identify


How many compartments does the thigh have?
3
Anterior compartment
Medial compartment
Posterior compartment

The compartments of the thigh are separated by?
intermuscular fascial septa
Anterior compartment of the thigh functional contents and muscle action
- Femoral Nerve
- Branches of the femoral artery
- Extension of the Leg

Medial Compartment of the Thigh Functional Contents & muscle Action
- Obturator Nerve
- Branches of the deep femoral artery and obturator artery
- Adduction of the thigh
- Gracilis also flexes the knee

Posterior Compartment of the Thigh Functional Contents
- Tibial division of sciatic nerve (common fibular division of sciatic nerve to short head of biceps femoris)
- Perforating branches of deep femoral artery
- Flexion of the leg
- Extension of the thigh

Anterior compartment of the thigh muscles
Quadriceps femoris
- Rectus Femoris
- Vastus Lateralis
- Vastus Medialis
- Vastus intermedius
Sartorius
Psoas Major
Ilicus (iliopsoas)
Rectus femoris function
- flexes the thigh at the hip joint
- extends the leg
Vastus Lateralis Function
Extend the leg
Vastus Medialis Function
Extend the leg
Vastus intermedius Function
Extend the leg
Sartorius Function
- Flexes the thigh
- Flexes the leg
- laterally rotate the thigh
- medially rotate the leg
Psoas major Function
Flex the thigh
Iliacus AKA
Iliopsoas
Iliacus Function
Flex the thigh
Muscles of the medial compartment of the thigh
- Gracilis (not shown)
- Pectineus (not shown
- Adductor Longus
- Adductor Brevis
- Adductor Magnus
- Obturator Externus

Gracilis Function
- Adduct the thigh
- medially rotate the thigh
- flex the knee
Pectineus Function
- Adduct the thigh
- medially rotate the thigh
Adductor Longus Function
- Adduct the thigh
- medially rotate the thigh
Adductor Brevis Function
- Adduct the thigh
- medially rotate the thigh
Adductor Magnus Function
- Adduct the thigh
- medially rotate the thigh
Obturator Externus Function
- Laterally Rotates the thigh
Posterior compartment muscles
Hamstrings
- Biceps femoris
- Semitendinosus
- Semimembranosus

The posterior compartment muscles mainly
Extend the thigh at the hip and flex the leg at the knee and rotate both joints
Biceps Femoris heads
Has 2 heads long and short
the long head crosses the hip and knee joints
the short head does not

Biceps Femoris Function
- Flex the leg at the knee joint
- extend the leg at the hip joint
Semitendinosus Function
- flex the knee
- extend the hip
Semimembranosus Function
- flex the knee
- extend the hip
Pes Anserinus AKA
Goose’s Foot

Pes Anserinus is what?
is the common insertion of the tendons of the sartorius, gracilis and semitendinosus muscles of the proximal tibia

The common insertion of the sartorius, gracilis and semitendinosus muscles
Pes Anserinus

Identify


Identify


Identify


The compartments of the leg are separated by?
Interosseous membrane and intermuscular fascial septa
The Anterior Compartment of the leg grossly contains
- 4 muscles
- deep fibular nerve
- Anterior Tibial Artery
- Dorsiflexion and inversion of Foot
- Extension of toes

The Lateral Compartment of the Leg contains
- 2 muscles
- Superficial Fibular Nerve
- Fibular Artery
- Eversion and plantar flexion of foot

The posterior compartment of the leg contains & action
- 3 superficial muscles
- 4 deep muscles
- Tibial nerve
- Posterior tibial artery
- Plantar flexion
- inversion of foot
- flexion of toes

Identify


Muscles of the anterior compartment of the leg
- Tibialis Anterior
- Extensor hallucis longus
- Extensor digitorum longus
- fibularis tertius

Anterior compartment of the leg muscles action All have in common
2 listed
- dorsiflex the foot
- extend the toes
is the most commonly sprained by foot inversion
Lateral ligaments of the ankle
- Posterior talofibular ligament
- Anterior Talofibular ligament
- Calcaneofibular Ligament
Lateral compartment muscles of the leg
- Fibularis Longus
- Fibularis Brevis
Lateral compartment muscles action all have in common
everts foot
Posterior compartment superficial and deep muscles of the leg
Superficialis muscles
- Gastrocnemius
- Soleus
- Plantaris
Deep Muscles
- Tibialis posterior
- Flexor Digitorum longus
- Flexor hallucis longus
- popliteus

Identify


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Compartment Syndrome Description
occurs when increased pressure within a fascial compartment compromises the blood supply, innervation and function of the tissues within that space
Symptoms of Compartment Syndrome
- pain
- numbness
- swelling
Compartment syndrome properties
5 listed
- may be acute, following trauma
- may be chronic, seen most often in athletes
- most common in the anterior leg but can occur in other compartments of leg, forearm, hand, foot
- Acute compartment syndrome (ACS) following injury is a surgical emergency
- ACS is relieved by cutting the skin and fascia (fasciotomy)
Identify


Acute Compartment syndrome is treated with

Lumbosacral plexus is formed by?
the anterior (ventral) rami of L1-L4 Spinal nerves
The femoral nerve is formed by?
The ventral rami of L2-L4
Femoral Nerve Motor to?
- Motor to the anterior compartment of the thigh and the pectineus
The saphenous nerve travels through
the adductor canal (opening in the aponeurosis of the adductor magnus)
An aponeurosis is?
A flat tendon
Obturator nerve is formed by?
L2-L4 Ventral Rami of spinal nerves

Obturator nerve Motor Functions
- motor to the medial compartment of the thigh and the Adductor Magnus
- innervates part of pectineus along with femoral nerve

The Sacral plexus is formed by?
Ventral Rami of L4-S5 Spinal nerves
The sciatic nerve tibial division
has a tibial division that supplies the posterior compartment of the thigh, except the short head of the biceps femoris

The Biceps Femoris Short head is innervated by?
The common Fibular Division of the Sciatic nerve
Sciatic nerve divisions
- Tibial division
- Common Fibular (peroneal) nerves

Common Fibular (peroneal) nerves location
proximal to the popliteal fossa (the space behind the knee)
The tibial nerve innervates
the posterior compartment of the leg and is sensory to overlying skin and the plantar surface of the foot (and the 5th toe)
The common fibular nerve splits into
- The superficial fibular nerve
- The deep fibular nerve
The superficial fibular nerve innervates?
The lateral compartment of the leg and is sensory to overlying skin of the leg and foot
The deep fibular nerve innervates?
the anterior compartment of the leg and overlying skin of leg and between the great and 2nd toe

Identify


Describe the major branches of the lumbosacral plexus

Four major routes by which nerves and vessels pass into the lower limb
- Obturator Canal
- Greater Sciatic Formation
- Lesser Sciatic Foramen
- Inferior to inguinal ligament

The Obturator Canal is
an opening in the obturator foramen through which the obturator nerve passes

The Greater Sciatic Foramen main channels
- Below the piriformis muscle
- Above the Piriformis muscle

The Sciatic Nerve Below the piriformis muscle
5 listed
- Sciatic nerve
- inferior gluteal nerve
- pudendal nerve
- posterior femoral cutaneous nerve
- nerves to obturator internus and quadratus femoris

The greater Sciatic Foramen Above the piriformis muscle
Between the gluteus medius and minimus
- Superior gluteal nerve
Lesser Sciatic Foramen nerves that pass
Pudendal nerve passes from the gluteal region into perineum
Inferior to inguinal ligament nerves that pass
3 listed
- Femoral nerve
- femoral branch of genitofemoral nerve
- the lateral cutaneous nerve of thigh
Identify


Identify


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Sensory Endpoint of Obturator
medial thigh above knee
Sensory Endpoint of Femoral
Medial Malleolus
Sensory Endpoint of Tibial
lateral malleolus (sural nerve)
Sensory Endpoint of Superficial fibular
Dorsum of the foot
Sensory Endpoint of Deep Fibular
Between the first two toes
Deep Fibular Nerve
- Common entrapment regions
- Muscle Weakness
- Sensory loss

Superficial Fibular Nerve
- Common entrapment regions
- Muscle Weakness
- Sensory loss

Tibial Nerve
- Common entrapment regions
- Muscle Weakness
- Sensory loss

Femoral Nerve
- Common entrapment regions
- Muscle Weakness
- Sensory loss

Obturator Nerve
- Common entrapment regions
- Muscle Weakness
- Sensory loss

Femoral artery
- the major artery supplying the lower limb originating from the external iliac artery when it passes under the inguinal ligament to enter the femoral triangle in the anterior thigh
- It supplies most of the thigh and all of the leg and foot
Borders of the femoral triangle
- inguinal ligament superiorly
- sartorius muscle laterally
- adductor longus muscle medially
The femoral nerve, artery, vein, and lymphatics pass from the abdomen into the lower limb under the?
Inguinal ligament and in the femoral triangle
Femoral Sheath
The femoral vein, artery and lymphatics are enclosed by fascia called the femoral sheath
Femoral pulse
The femoral pulse can be palpated in the femoral triangle just inferior to the inguinal ligament and midway between the anterior superior iliac spine and the pubic symphysis
The superior and inferior gluteal arteries supply
the gluteal region
The obturator arteries supplies
the medial compartment of the thigh


Collateral circulation to the hip joint
anastamoses between

Identify


Collateral circulation of the knee
anastomoses between

Identify


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Identify


Tensor Fascia Lata
the tensor fasciae lata muscle stabilizes the knee in extension by acting on the iliotibial tract (a band of deep fascia that passes down the lateral side of the thigh to attach to the proximal end of the tibia)

Anterior Compartment of the thigh Muscle Actions

Posterior Compartment of the thigh Muscle Actions

Medial Compartment of the thigh Muscle Actions

Muscles of the Anterior Compartment of the thigh
Sartorius
Vastus medialis
Iliopsoas
Rectus femoris
vastus lateralis
vastus intermedius (not shown)
pectineus
iliacus

Muscles of the medial compartment of the thigh
4 listed
- Adductor Longus
- Adductor Brevis
- Adductor Magnus
- Gracilis

Muscles of the Posterior Compartment of the Thigh

Superficial muscles of the posterior leg

Tension on it is greatest on the PCL when
The knee is flexed
Hyperextension of the knee is resisted by?
The ACL
Femoral Nerve Sensory Branches
2 listed
Sensory branches are the anterior cutaneous nerve of the thigh and the saphenous nerve which goes through the adductor canal opening in the aponeurosis of the adductor magnus to the medial leg and malleoulus
Obturator Nerve Sensory Functions
Sensory branch (a cutaneous branch) to the skin above the medial side of the knee
The Biceps Femoris Long head is innervated by?
Tibial Division of the Sciatic Nerve