MSK 5 - Lower Limbs 1 Flashcards
How many bones is the hip bone composed of?
3 seperate bones on each side
What 3 bones form hip bone?
- 3 bones on each side
- Ilium
- Ischium
- Pubis
What is a?
Anterior superior iliac spine (ASIS)
What is b?
Iliac crest
What is c?
Iliac fossa
What is d?
Pubic tubercle
What is e?
Pubic crest
What is f?
Obturator foramen
What is g?
Acetabular cavity
What is h?
Ischial spine
What is i?
Ischial tuberosity
What bone is 1?
Ilium
What bone is 2?
Ischium
What bone is 3?
Pubis
What is the longest bone in the body?
The Femur is the longest bone in the body and runs from the hip joint to the knee joint, it is exclusively found in the thigh
What is a?
Neck of femur
What is b?
Lesser troachanter of femur
What is c?
Lateral condyle of femur
What is d?
Greater trochanter of femur
What is e?
Medial condyle of femur
What is f?
Head of femur
What is g?
Intertrochanteric line
What does the femur articular with proximally?
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
What does the femur head articulate with?
Acetabulum of hip
What are the superficial veins of the lower limb?
The two superficial veins are the great sephenous vein and lesser sephenous vein
What are the great and lesser sephanous veins tributaries of?
Dorsal venous arch of foot
What does the great sephanous vein drain into?
Femoral vein at medial aspect of thigh
Does great sephanous vein drain into femoral vein at lateral or medial aspect of thigh?
Medial
What is A?
Great sephanous vein
What is B?
Lesser sephanous vein
What is C?
Dorsal venous arch
Which superficial vein ascends anterior to the medial malleolus of the tibia?
Great saphenous vein
Which superficial 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
What are varicose veins?
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
What is it called when varicoe veins become inflammed?
Thrombophlebitis
What do the deep veins of lower leg ascend with?
Their respective major arteries
How does blood ascend in the deep veins?
Muscle contractions
What is deep vein thrombosis?
If a thrombus occurs in the deep veins of the lower leg this is called a deep vein thrombosis.
What are possible complications of DVT?
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.
What are the 3 groups of lymphatics where lymph from lower limbs drains?
- Superficial inguinal
- Deep inguinal
- Popliteal
Lymphatics accompanying the following drain where:
- great sephanous vein
- lesser sephanous vein
- Greater sephanous vein
- Superficial inguinal nodes
- Small sephanous vein
- Popliteal lymph nodes
Where must an infection be to cause enlargement of inguinal lymph nodes?
Any structure inferior to level of umbilicus, including lower limbs
How does sensory supply of lower limbs differ from upper limbs?
However, the major difference is that the sensory supply comes from the lumbar and sacral plexus (not just the brachial plexus).
What dermatome supplies the anterior of knee?
L3
What dermatome supplies the big toe?
L5
What dermatome supplies the little toe?
S1
What dermatome supplies:
- A
- B
- C
- D
A - L1
B - S3
C - S4
D - L2
What dermatome supplies:
- E
- F
- G
- H
E - L3
F - L4
G - L5
H - S1
What dermatome supplies:
- I
- J
- K
- L
I - S2
J - L2
K - S3
L - S4
What dermatome supplies:
- M
- N
- O
- P
M - coccyx
N - S5
O - L3
P - S2
What dermatome supplies:
- Q
- R
- S
- T
Q - L5
R - L4
S - S1
T - L5
In general, what plexus supplies sensory innervation to:
- anterior leg
- posterior leg
Anterior leg - lumbar plexus
Posterior leg - sacral plexus
What dermatome supplies the:
- testicles
- penis
Testicles - S4
Penis - S3
What kind of joint is the hip joint?
Ball and socket
Why is the hip joint more stable than the shoulder joint?
The ball of the hip is entirely surrounded by the socket of the pelvis, whereas the shoulder is more similar to a golf ball resting on a tree
What is the ring of cartilage called that surrounds the acetabulum of hip
Acetabular labrum
What part of the acetabular cavity does the acetabular labrum cover?
The rim, increases the depth of the acetabulum
What are the 3 main ligaments of the hip joint?
- Ilio-femoral ligament
- Pubofemoral ligament
- Ischiofemoral ligament
What do the following ligaments prevent:
- ilio-femoral
- pubofemoral
- Ilio-femoral
- Prevents hyperextension of hip joint
- Pubofemoral
- Prevents hyper abduction of hip joint
What is 1?
Ilio-femoral ligament
What is B?
Pubofemoral ligament
What is C?
Ischiofemoral ligament
What movements can be done at the hip?
- Flexion
- Extension
- Abduction
- Adduction
- Internal rotation
- External rotation
- Circumduction (combination of above)
What are the muscles of hip flexion?
- Iliacus
- Psoas major
- Pectineus
What is 1?
Iliacus
What is 2?
Psoas major
What is 3?
Pectineus
Iliacus:
- origin
- insertion
- innervation
- Origin
- Inner pelvis and posterior abdominal wall
- Insertion
- Greater trochanter of femur
- Innervation
- Lumbar plexus
Psoas major:
- origin
- insertion
- Origin
- Inner pelvis and posterior abdominal wall
- Insertion
- Greater trochanter of femur
At the insertion on the greater trochanter of femur what happens?
Iliacus and psoas major share a common tendon, becoming called iliopsoas muscle
Pectineus:
- origin
- insertion
- Origin
- Pubis bone
- Insertion
- Femur
What supplies:
- iliacus
- psoas major
- pectineus
Hip flexors all supplies by lumbar plexus
What are the 3 functional groups of the hip extensors?
- Gluteus maximus
- Hamstrings (composed of 3 muscles)
- Posterior part of adductor magnus
What is the main extensor of the hip joint?
Gluteus maximus
Is the gleteus maximus superficial or deep muscle?
This is a large superficial muscle which you sit on! It is used when standing from a sitting position, and when climbing stairs.
What innervates the extensors of the hip?
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 movement is A?
Adduction
What is B?
Abduction
In what compartment of thigh are adductor muscles found?
Medial compartment
What nerve supplies most of the adductor compartment?
The adductor compartment is mostly supplied by the obturator nerve (aside from the posterior part of adductor magnus)
What part of the adductor compertment is not supplied by the obturator nerve?
Posterior part of adductor magnus
What plexus does the obturator nerve come from and how does it exit the pelvis?
Comes from lumbar plexus
Exits pelvis via obturator canal
What is 1?
Gluteus medius
What is 2?
Gluteus minimus
What is 3?
Piriformis
What are the hip adductors?
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracilis
- Obturator externus
What compartment of thigh does hip adduction?
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.
Attachment of muscles to what allows hip abduction?
Greater trochanter of femur
What are the hip abductors?
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Piriformi
What is the most superficial muscle in the gluteal region?
Gluteus maximus is largest and most superficial
What is 1?
Gluteus medius
What is 2?
Gluteus minimus
What is 3?
Piriformis
Why are abductors of hip essential for normal walking gait?
Every time you raise one leg off the ground, the abductors of the opposite side of the pelvis contract to provide stability
Nerves from what plexus supplies the abductor compartment?
Sacral plexus
At what joint does rotation of lower limbs occur at?
Rotation of the lower limb only occurs effectively at the hip joint
What is:
- lateral rotation of hip
- medial rotation of hip
Turning the inside of the foot to face forward, requires lateral rotation of the hip
Turning the inside of the foot to face backwards, requires medial rotation of the hip
Muslces that allow external rotation attach where?
Muscles involved in external rotation cross the joint on the posterior side.
These lie deep within the pelvis and attach onto or around the greater trochanter.
What muscles are involved in external rotation?
- Piriformis
- Obturator internus
- Obturator externus
- Superficial and inferior gameli
- Quadratus femoris
Muscles involved in internal and external rotation are anterior or posterior?
External rotation - posterior
Internal rotation - anterior
What are the medial rotators of the hip joint?
- Quadratus femoris
- Piriformis
- Tensor fascia lata
Muscles of the thigh can be organised into what?
- 3 compartments
- Anterior
- Posterior
- Medial
How many heads does the quadriceps femoris have?
4 heads
What are the 4 heads of the quadriceps femoris?
- Rectus femoris
- Vastus lateralis
- Vastus medialis
- Vastus intermedius
What is 1?
Sartorius
What is 2?
Rectus femoris
What is 3?
Vastus intermedius
What is 4?
Vastus lateralis
What is 5?
Adductor longus
What is 6?
Gracilis
What is 7?
Adductor brevis
What is 8?
Adductor magnus
What is 9?
Gluteus maximus
What nerve innervates the quadratis femoris muscles?
Femoral nerve (L2-L4)
What are the nerve roots of the femoral nerve?
L2-L4
What is the action of rectus femoris on the hip joint?
Stabilises hip joint
What happens to the 4 distal parts of the quadriceps femoris?
The 4 parts of the quadriceps unite to form the quadriceps tendon proximal to the patella. Distal to the patella this continues as the patellar tendon, inserting into the anterior aspect of the tibia.
What does the quadriceps tendon continue as distal to patella?
Patellar tendon
Where does the patellar tendon insert?
Anterior aspect of tibia
To which part of the tibia does the patellar ligament attach?
Tibial tuberosity
Why are the quadriceps unique in there action?
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.
What action do the quadriceps have on:
- hip
- knee
- Flexion of hip joint
- Extension of knee joint
How can the quadriceps flexing the hip but extending the knee embryologically be explained?
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.
What is the longest muscle in the body?
Sarortius muscle
What is the most superficial muscle in the anterior compartment of thigh?
Sartorius muscle
Sartorius:
- origin
- insertion
- action
- Origin
- Anterior superior iliac spine
- Insertion
- Pes anserinus on medial aspect of tibia
- Action
- Flexion of hip
- Abduction of hip
- Lateral rotation of hip
- Flexion of knee
How is the sartorius able to carry out the same action at the hip and 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.
With the sartorius muscle, what 2 others insert ontot he pes amserinus on medial aspect of tibia?
? and ?
How do the muscles in the medial compartment of the thigh act on the hip joint?
Adduct
Which nerve innervates the medial thigh muscles?
Obturator nerve
Through which bony foramen does the obturator nerve enter the thigh?
Obturator foramen
What is 1?
Adductor brevis
What is 2?
Adductor longus
What is 3?
Adductor canal
What structures pass through the adductor canal?
- Femoral artery
- Femoral vein
- Saphenous nerve
What fossa do the structures that pass throught the adductor canal enter?
Popliteal fossa
What do the neurovascular structures on the anterior aspect of limb enter through?
Femoral triangle
The femoral triangle of lower limbs is equivalent to what of upper limbs?
Axilla
What are the following boundaries of the femoral triangle:
- medial
- lateral
- base
- floor
- Medial
- Adductor longus muscle
- Lateral
- Sartorius muscle
- Base
- Inguinal ligament
- Floor
- Iliopsoas muscle laterally
- Pectineus muscle medially
What muscles forms the floor of the femoral triangle:
- medially
- laterally
- Medially
- Pectineus muscle
- Laterally
- Iliopsoas muscle
What are the 3 major structures present in the femoral triangle?
- Femoral nerve
- Femoral artery
- Femoral vein
What is the connective tissue tube that surrounds proximal parts of femoral vessels called?
Femoral sheath
What femoral vessels does the femoral sheath not surround?
Femoral nerve
What does the femoral sheath create next to the femoral vessels?
Femoral canal
Is the femoral canal found medial or lateral to femoral vessels?
Medial
What does the femoral canal contain?
Lymphatics
What are in the following compartments of the femoral sheath:
- lateral
- intermediate
- medial
- Lateral
- Femoral artery
- Intermediate
- Femoral vein
- Medial
- Deep inguinal lymph nodes
What are the contents of the femoral canal?
- Fat and loose connective tissue
- Deep inguinal lymph node (Cloquet node)
What lymph node is found in the femoral canal?
Deep inguinal lymph node (Cloquet node)
What is a weak area in the anterior abdominal wall?
Femoral ring
What can cause femoral hernia?
Similar to inguinal hernias, activities that increase intra-abdominal pressure can cause abdominal contents to push into this area and become trapped.
Is femoral hernia more common in men or woman?
Woman
What is the femoral artery a continuation of?
External iliac artery
Where does the femoral artery begin?
It begins at the inguinal ligament as a continuation of the external iliac artery.
What does the femoral artery enter the thigh between?
- Between 2 bony surface markings
- Anterior superior iliac spine
- Pubis tubercle
What is the deep branch of the femoral artery?
Profunda femoris (deep femoral artery)
What is the femoral vein a contuation of?
Popliteal vein
What does the femoral vein become and where?
Entering the femoral triangle and becoming the external iliac vein as it passes under the inguinal ligament
What 2 important veins drain into the femoral vein in the femoral triangle?
- Profunda femoris vein
- Greater sephanous vein
What is the largest branch of the lumbar plexus?
Femoral nerve
Does the femoral nerve pass superficial or deep to inguinal ligament?
Deep
Does the femoral nerve enter the femoral triangle medial or lateral to femoral vessels?
Lateral
What is the adductor canal also called?
Subartorial canal or Hunter’s canal
What is the adductor canal?
Fascial sheath
What do the neurovascular structures of the anterior thigh pass distally towards the apex of femoral triangle?
They begin to pass deep through the musculature called in a fascial sheath called the adductor canal.
What does the adductor canal reach after going deep?
Adductor hiatus
The adductor hiatus is an anatomical opening in what muscle?
Adductor longus muscle
What arterial change happens in the adductor canal?
The anterior femoral artery becomes the posterior popliteal artery
What are the 2 plexuses that supplies the lower limbs?
Lumbar plexus
Sacral plexus
What are the ventral roots of the lumbar plexus?
L1-L4
(T12 contributes 50% of the time)
Through what do the ventral roots of the lumbar plexus emerge?
Through the psoas major muscle on the posterior abdominal wall
What nerves does the lumbar pelxus give of immediately?
- Lateral femoral cutaneous nerve
- Femoral nerve
- Obturator nerve
What is A?
Lateral femoral cutaneous nerve
What is B?
Femoral nerve
What is C?
Obturator nerve
What are the 2 main motor nerves of the lumbar plexus that supplies the lower limbs?
- Femoral nerve
- Obturator nerve
Identify one main sensory nerve of the lumbar plexus supplying the lower limb?
Lateral femoral cutaneous nerve
What are the nerve root values of:
- lateral femoral cutaneous nerve
- femoral nerve
- obturator nerve
- Lateral cutaneous nerve
- L2-L3
- Femoral nerve
- L2-L4
- Obturator nerve
- L2-L4
What nerve do the L1-L2 roots of lumbar plexus give of?
- Ilioinguinal
- Iliohypogastric
- Genitofemoral
- (covered in GI anatomy do not contribute to lower limbs aside from small sensory area by genitofemoral nerve in upper medial thigh)
What is A?
Obturator nerve
What is B?
Transversus abdominus
What is C?
Internal oblique
What is D?
Genitofemoral nerve
What is E?
Ilio-inguinal nerve
What is F?
Lateral femoral cutaneous nerve
What is G?
Iliohypogastric nerve
What is H?
Femoral nerve
What is I?
Iliacus
