MSK 1 - Lower Limbs Flashcards
what 3 bones make up the hip bones?
- ilium
- ischium
- pubis
name 1, 2 and 3?
- ilium
- ischium
- pubis
a
anterior superior iliac spine (ASIS)
b
iliac crest
c
iliac fossa
d
pubic tubercle
e
pubic crest
f
obturator foramen
g
acetabular cavity
h
ischial spine
i
ischial tuberosity
The ____\_ is the longest bone in the body and runs from the hip joint to the knee joint, it is exclusively found in the thigh
Femur
a
neck
b
lesser trochanter
c
lateral condyle
d
greater trochanter
e
medial condyle
f
head
g
intertrochanteric line
The femoral head articulates with the acetabulum of the hip to form the ___ _____
hip joint
The two hemi-pelvises articulate in the midline at the _____ ________
pubic symphysis
Similar to the upper limb the lower limb has both superficial and deep veins
The two superficial veins are the great ________ vein and lesser ________ vein
They begin as the main tributaries from the _____ venous arch of the foot, ascending superiorly, with the _____ saphenous vein draining into the femoral vein at the ______ aspect of the thigh
saphenous
saphenous
dorsal
great
medial
a
Great saphenous vein
b
Lesser saphenous vein
c
Dorsal venous arch
Which superficial vein ascends anterior to the medial malleolus of the tibia?
Great saphenous vein
Which vein ascends posterior to the lateral malleolus?
Lesser saphenous vein
Which superficial vein empties into the femoral vein?
Great saphenous vein
Which superficial vein empties into the popliteal vein?
Lesser saphenous vein
Clinical – Varicose Veins:
what are they, how are they caused and what are their effects?
Valves are present in the saphenous vein to prevent pooling of blood in the legs
If these valves become incompetent, the thin vessels dilate, and become torturous forming varicose veins
These are normally asymptomatic; however, they can become problematic if they become inflamed (thrombophlebitis).
The deep veins of the lower leg ascend with their respective major _______.
Due to the effects of gravity the blood return in these veins is reliant on ______ contraction pumping the blood upwards – problems arise if this __________ is lost, or the vessels are damaged
arteries
muscle
contraction
Clinical – Deep Vein Thrombosis:
what is it and what are its effects?
Venous status (stagnation) is an important cause of thrombus (blood clot) formation.
A number of risks increase this occurring in the lower limb – you will likely cover in your clinical sessions.
If a thrombus occurs in the deep veins of the lower leg this is called a deep vein thrombosis.
If a thrombus becomes dislodged and migrates away its source it is called an embolus.
If this lodges in the lungs then it is a pulmonary embolus, a potentially life-threatening clinical condition.
The lymphatics in the lower limb drain into 3 groups of nodes, what are they?
Superficial Inguinal
Deep Inguinal
Popliteal
Lymphatic vessels accompanying the great saphenous vein drain into the ________ inguinal nodes. The lymphatics accompanying the small saphenous vein drain into the _______ lymph nodes
superficial
popliteal
Enlargement of the inguinal lymph nodes can be caused by what?
infection to any structure lying inferior to the level of the umbilicus, including the lower limb
They can also become enlarged in intra-abdominal/pelvic malignancies
The embryological development of the dermatomes in the lower limb draws parallels with the upper limb.
However, the major difference is that the sensory supply comes from the ______ and _____ plexus (not just the brachial plexus
lumbar
sacral
The region supplied by the lumbar plexus is shown in purple and the sacral plexus in green
The anterior of the knee is commonly supplied by the L_ dermatome
The big toe is commonly supplied by the L_ dermatome, and the little toe by the S_ dermatome.
3
5
1
what type of joint is the hip joint?
The hip joint is a ball and socket synovial joint. It is a strong and stable multiaxial joint
Why is the hip joint more stable than the shoulder joint?
The socket is deeper at the hip and have stronger muscles and ligaments
What is the acetabular labrum?
A ring of fibrocartilage which lines the acetabular rim of the hip joint
Which part of the acetabular cavity does it cover - and what is its function? (acetabular labrum)
Runs around the acetabulum and adds to the depth of the acetabulum, increasing usrface area
ligaments of the hip joint:
a
iliofemoral
ligaments of the hip joint:
2
pubofemoral
ligaments of the hip joint:
3
ischiofemoral
The _________ ligament prevents hyperextension of the hip joint and the _________ ligament prevents hyper abduction of the hip joint
iliofemoral
pubofemoral
The movements at the hip joint are what?
- Flexion
- Extension
- Abduction
- Adduction
- Internal Rotation
- External Rotation
- Circumduction (a combination of the above)
1
iliacus
2
Psoas major
3
pectineus
where do the iliacus, psoas major and pectineus arise?
Muscles iliacus and psoas major arise from the inner pelvis and posterior abdominal wall, passing downwards and attaching onto the greater trochanter of the femur through a common tendon. At this point they are known as the iliopsoas muscle.
Muscle pectineus arises from the pubis bone passing distally to attach onto the femur
- iliacus 2. Psoas major 3. pectineus
All of the above muscles are supplied by branches from what?
the lumbar plexus, a common theme for the muscles found at the anterior and medial aspects of the pelvis and thigh
The extensors of the hip are arranged into 3 functional groups, what are htey?
- Gluteus Maximus
- Hamstrings (Comprised of 3 muscles)
- Posterior Part of Adductor Magnus
what is the main extensor of the hip joint?
The gluteus maximus is the main extensor of the hip joint
This is a large superficial muscle which you sit on! It is used when standing from a sitting position, and when climbing stairs
The extensors of the hip are arranged into 3 functional groups
- Gluteus Maximus
- Hamstrings (Comprised of 3 muscles)
- Posterior Part of Adductor Magnus
what supplies these?
These muscles are supplied by branches from the sacral plexus (L4 to S3), a common theme for muscles found in the posterior aspect of the pelvis and thigh
what is hip adduction and abduction movement?
The adductor muscles are found in the ______ compartment of the thigh, and when they contract infer ________ of the hip joint.
Adduction of the hip is the movement of a straightened leg _______ crossing the axis of the other leg
medial
adduction
inwards
The adductor compartment is mostly supplied by what?
the obturator nerve (aside from the posterior part of adductor magnus), a nerve from the lumbar plexus, which exits the pelvis via the obturator canal.
name 1, 2 and 3
what is responsible for hip abduction?
There is no specific abductor compartment of the thigh, but rather the deep gluteal muscles carry out this role via. their attachment to the greater trochanter of the femur
name the abductors of the hip labelled in the diagram:
1
Gluteus medius
name the abductors of the hip labelled in the diagram:
2
Gluteus minimus
name the abductors of the hip labelled in the diagram:
3
Piriformis
The abductors of the hip joint are ________ for a normal walking gait
Every time you raise one leg off the ground, the abductors of the ________ side of the pelvis contract to provide stability
essential
opposite
The abductor compartment is supplied by branches of the ______ plexus
sacral
Rotation of the lower limb only occurs effectively where?
at the hip joint
Turning the inside of the foot to face forward, requires _______ rotation of the hip
Turning the inside of the foot to face backwards, requires _______ rotation of the hip
external
internal
Muscles involved in external rotation cross the joint on the _______ side.
These lie deep within the pelvis and attach onto or around the greater trochanter.
posterior
whata re the muscle sinvolved in external rotation?
1) Piriformis
2) Obturator Internus
3) Obturator Externus
4) Superior and Inferior Gamelli
5) Quadratus Femoris
Muscles involved in internal rotation cross the joint on the _______ side
anterior
what are the muscles involved in internal rotation?
- gluteus medius
- Gluteus minimus
- Tensor Fascia Lata
Muscles of the thigh are organized into 3 compartments the _______ compartment, _____ compartment, and _________ compartment
anterior
medial
posterior
what makes up most of the anterior compartment?
Quadriceps Femoris is a four – headed muscle which forms the main bulk of the anterior thigh region
What are the 4 heads or parts of the quadriceps femoris?
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
Which nerve innervates these anterior group muscles?
Branch from the posterior division of the femoral nerve
What is the action of rectus femoris on the hip joint?
Flexion and extend the knee
The 4 parts of the quadriceps unite to form what?
To which part of the tibia does the patellar ligament attach?
Tibial tuberosity (small bony bump on the anterior aspect of the tibia
Although the quadriceps are located in the anterior thigh, they have opposing actions on 2 joints. They ____ the hip joint, whilst _________ the knee joint
flex
extending
Although the quadriceps are located in the anterior thigh, they have opposing actions on 2 joints. They flex the hip joint, whilst extending the knee joint
why is this?
This can be explained through embryological development. In the first trimester, the lower limb bud rotates from a lateral, extended position to one where the original anterior surface becomes the sole of the foot, as seen in an adult.
In this final anatomical position, hip and knee movements occur in opposition to one another. The quadriceps flex the hip, whilst extend the knee joint.
This is the longest muscle in the body, and the most superficial in the anterior compartment of the thigh
what is it?
sartorius muscle
Sartorius muscle runs across from is proximal origin at the anterior superior iliac spine, to the pes anserinus (gooses foot!) on the medial aspect of the tibia along with 2 other muscles
what are the 2 other muscles?
Gracilis and Semimembranosus (maybe semitendinosus)
sartorius muscle - It has a _______ action on the hip joint when compared to the quadriceps muscle
weaker
What are the 3 actions of sartorius on the hip joint?
- weak flexor
- Assists in abduction
- Laterally rotates the thigh at hip joint
It also flexes the leg at knee joint.
If you carry out these actions, you should find that you come to place the lateral heel onto your opposite patella.
Sartorius is therefore able to carry out the same action (flexion) at the hip and the knee. This is possible as it spirals around the thigh from lateral to medial, crossing the hip joint anteriorly and the knee joint posterior-medially.
How do the muscles in the medial compartment of the thigh act on the hip joint?
adduction
Which nerve innervates the medial thigh muscles?
Obturator nerve form the lumbar plexus
Through which bony foramen does the nerve that innervates the medial thigh muscles enter the thigh?
Obturator canal/foramen
Note that the foramen is almost completely occluded by muscle, leaving only a small canal for the neurovascular structures to pass through.
1
- Adductor brevis
2
- Adductor magnus
3
- Adductor canal
What structures pass through the adductor canal?
Which fossa do they enter after passing through this canal?
Femoral artery, femoral vein, nerve to the vastus medialis and the saphenous nerve
Popliteal fossa
The neurovascular structures of the anterior aspect of the lower limb enter through the ______ ______. This is seen as the equivalent of the axilla in the upper limb
Like the axilla it has structures which make up its _____, ____ and boundaries with a number of anatomically important contents passing through this area heading _______
femoral triangle
floor
roof
distally
The medial boundary of the femoral triangle is the _______ ______ muscle
adductor longus
The lateral boundary is the ________ muscle
sartorius
Which structure forms the base of the femoral triangle?
Inguinal ligament (you revised this during GI Anatomy)
Which muscles form the vast proportion of the floor of the femoral triangle?
- iliopsoas muscle - laterally
- Pectineus - medially
What are the 3 major structures present in the femoral triangle?
1 Femoral nerve
2 Femoral artery
3 Femoral vein
what is the femoral sheath?
The femoral sheath is a funnel shaped connective tissue tube which surrounds the proximal parts of femoral vessels (but not the nerve) and creates the femoral canal medial to them, which contains lymphatic vessels
The femoral sheath is loosely divided into 3 compartments, what are they and what is in them?
lateral - femoral artery
intermediate - femoral vein
medial - lymphatic vessels
What are the contents of the femoral canal?
- Fat and loose connective tissue
- Lymph nodes
Clinical - Femoral Hernia:
what is it?
Are there more common in males or females?
The femoral ring is a weak area in the anterior abdominal wall
Similar to inguinal hernias, activities that increase intra-abdominal pressure can cause abdominal contents to push into this area and become trapped
Are there more common in males or females? Females – due to increased width of the female pelvis
The _______ artery is the main artery of the lower limb
It begins at the inguinal ligament as a continuation of the _______ _____ artery
femoral
external iliac
Femoral artery enters the thigh midway between which 2 bony surface markings?
anterior superior iliac spine
and pubic tubercle
The _______ femoris is the deep artery
profunda
The femoral vein is the continuation of the __________ vein (veins start distally!), and passes proximally entering the femoral triangle and becoming the _______ _____ vein as it passes under the inguinal ligament
popliteal
external iliac
Which two important veins drain into it in the femoral triangle?
- profuna femoris
- Greater saphenous
what is the largest branch of the lumbar plexus?
The femoral nerve is the largest branch of the lumbar plexus
where does the femoral nerve enter the femoral triangle?
The nerve passes deep to the inguinal ligament and enters the femoral triangle lateral to the femoral vessels
What is the Adductor Canal (Subsartorial canal, Hunter’s canal)?
As the neurovascular structures of the anterior thigh pass distally towards the apex of the femoral triangle, they begin to pass deep through the musculature called in a fascial sheath called the adductor canal
This extends deeper and distal until it reaches an anatomical opening in the adductor magnus muscle called the adductor hiatus
This journey has allowed the anterior femoral artery to become the posterior popliteal artery
The lumbar plexus is one of 2 that supply the lower limb, the other being the _______ plexus
sacral
what are the ventral roots forming the lumbar plexus?
The ventral roots of L1 to L4* emerge through the psoas major muscle on the posterior abdominal wall, divide and form a number of terminal branches.
*T12 contributes to the lumbar plexus 50% of the time
a
….lateral….. cutaneous nerve of the thigh
b
..Femoral.. nerve
c
..Obturator… nerve
You’ll have learnt the ilioinguinal, Iliohypogastric and genitofemoral nerves (L1 – L2) in GI Anatomy – what do they do?
they don’t contribute any sensory supply to the lower limb – aside from a small area by the genitofemoral nerve in the upper medial thigh
Identify two main motor nerves of the lumbar plexus supplying the lower limb
- Femoral nerve
- Obturator nerve
Identify one main sensory nerve of the lumbar plexus supplying the lower limb
- Lateral cutaneous nerve
What is the nerve root value of the motor nerves?
L2-4
What is the nerve root value of the sensory nerve?
L2, 3
