MSK System - Lower Limb Flashcards
What three bones form the hip bone?
Ilium
Ischium
Pubis
What foreamen is found within the hip bone?
Obturator foreamen
What is the longest bone in the body?
Femur
Where is the femur located?
In the thigh, between the hip joint to the knee joint
What is the name of the femur head depression? What ligament attaches to this area?
Fovea
Ligament of the femur head
Where does the ligament of the femur head extend from?
It extends from the fovea to the transverse acetabular ligament
What three arteries supply the head of the femur?
Obturator nerve
Medial circumflex femoral artery
Lateral circumflex femoral artery
Which vessel is the main blood supply to the femoral head?
Medial femoral circumflex artery
In which patients does femur neck fractures tend to occur in?
Older female with osteoporosis
What line exists between the greater and lesser trochanter of the femur?
Intertrochanteric
What line exists in the shaft of the femur?
Linea aspera
What does the femoral head articulate with? What joint does this form?
The acetabulum of the hip
Hip joint
Where do the two hemi-pelvises articulate?
Pubic symphysis
What two superficial veins drain the lower limb?
Great saphenous vein
Lesser saphenous vein
Where do the great and lesser saphenous veins arise?
Dorsal venous arch of the foot
What vein does the great saphenous vein drain into?
Femoral vein
On what aspect of the lower limb is the great saphenous vein located?
Medial
What vein does the lesser saphenous vein drain into?
Popliteal vein
On what aspect of the lower limb is the lesser saphenous vein located?
Posterior
Which superficial vein ascends anterior to the medial malleolus of the tibia?
Great saphenous vein
Which superficial vein ascends posterior to the lateral malleolus of the tibia?
Lesser saphenous vein
What are varicose veins?
A condition in which the valves within the leg become incompetent, causing the vessels to dilate and become tortuous
What is thrombophlebitis?
A condition in which varicose veins become inflamed
What pushes blood upwards in the veins of the lower limb?
Muscle contraction
What is deep vein thrombosis?
A condition in which venous stagnation occurs due to thrombus formation in the deep veins of the lower leg
What is a complication of deep vein thrombosis?
It can dislodge and migrate away from its source. It can then lodge in the lungs - pulmonary embolus
What three lymph nodes drain the lower limb?
Superficial inguinal
Deep inguinal
Popliteal
On what aspect of the lower limb are superficial inguinal lymph nodes located? Where are they located in relation to the deep inguinal lymph nodes?
Medial
Superior
On what aspect of the lower limb are deep inguinal lymph nodes located? Where are they located in relation to the superficial inguinal lymph nodes?
Medial
Inferior
On what aspect of the lower limb are popliteal lymph nodes located?
Posterior
What lymph vessels drain into the superficial inguinal lymph nodes?
Those accompanying the great saphenous vein
What lymph vessels drain into the popliteal lymph nodes?
Those accompanying the lesser saphenous vein
What causes enlargement of the inguinal lymph nodes?
Infection inferior to the level of the umbilicus, including the lower limb
Intra-abdominal/pelvic malignancies
What plexus supplies sensory sensation to the lower limb?
Lumbar plexus
Sacral plexus
What dermatome supplies the anterior aspect of the knee?
L3
What dermatome supplies the big toe of the foot?
L5
What dermatome supplies the little toe of the foot?
S1
What type of joint is the hip joint?
Synovial ball and socket
Why is the hip joint more stable than the shoulder joint?
It has a deeper socket
The ligaments are stronger and bigger
Describe the articulation of the hip joint
Socket - Acetabular labrum
Ball - Femoral head
What does the acetabular labrum cover? What is its function?
Femoral head
To add stability to the hip joint by deepening the socket
What are the three ligaments of the hip joint?
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
What is the strongest ligament of the hip joint?
Iliofemoral
Where is the iliofemoral ligament located?
It is located between the ilium of the hip and the femoral head
Anterior aspect of hip joint
Where is the pubofemoral ligament located?
It is located between the pubis of the hip and the femoral head
Anterior aspect of hip joint
Where is the ischiofemoral ligament located?
It is located between the ischium of the hip and the femoral head
Posterior aspect of hip joint
What is the function of the iliofemoral ligament?
It prevents hyperextension of the hip joint
What is the function of the pubofemoral ligament?
It prevents hyperabduction of the hip joint
What are the three main hip flexors?
Iliacus
Psoas major
Pectineus
What is the collective name used to refer to the iliac and psoas major?
Iliopsoas
Where does the iliopsoas arise from and extend to?
It arises from the inner pelvis and posterior abdominal wall
It extends to the lesser trochanter of the femur
What nerve lies between the psoas major and the iliacus?
Femoral nerve
What nerve runs on the surface of the iliopsoas?
Genitofemoral nerve
Where does the pectineus arise from and extend to?
It arises from the pubis bone
It extends to the femur
What nerve supplies the pectineus muscle?
Obturator nerve
What plexus supplies the anterior and medial aspects of the pelvis and thigh?
Lumbar
What component of the thigh are the hip flexors contained within?
Anterior
What is the main flexor of the thigh?
Iliopsoas muscle
What are the three extensors of the hip joint?
Gluteus maximus
Hamstrings
Adductor magnus - posterior aspect
What three muscles make up the hamstrings?
Semitendinous
Semimembranous
Biceps femoris (long head)
What is the main extensor of the hip joint?
Gluteus maximus
What component of the thigh are the hip extensors contained within?
Posteior
What plexus supplies the posterior aspects of the pelvis and thigh?
Sacral plexus
What is the action of the posterior thigh compartment on the knee joint?
Flexion
What component of the thigh are the hip adductors contained within?
Medial
What is adduction of the hip?
Movement of a straightened leg inwards crossing the axis of the other leg
What nerve supplies the adductors of the hip?
Obturator nerve from lumbar plexus
How does the obturator nerve exit the pelvis?
Via the obturator canal
Where is the obturator canal located?
It is located lateral to the pubic symphysis
What two muscles form the obturator canal?
Obturator externus
Obturator internus
What are the five hip adductors?
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
What hip adductor runs down the medial aspect of the thigh?
Gracilis
What thigh muscle can be used for transplantation to replace damaged muscles due to its lack of function?
Gracilis
What muscle is more superior - adductor brevis or longus?
Adductor brevis
What muscle is more anterior - adductor brevis or longus?
Adductor longus
What hip adductor is largest and most posterior?
Adductor magnus
What two nerves supply the adductor magnus muscle?
Obturator nerve
The tibial branch of the sciatic nerve
What muscles conduct hip abduction?
Deep gluteal muscles, which are located on the posterior aspect of the thigh under the gluteus maximus
Where do hip abductors attach to?
The greater trochanter of the femur
What are the three main hip abductors?
Gluteus medius
Gluteus minimus
Piriformis
What hip abductor is most deep - gluteus medius or minimus?
Gluteus minimus
What is the action of the hip abductors?
Each time you raise one leg off the ground, the abductors of the opposite side of the pelvis contract to provide stability
Involved in climbing stairs rather than walking
What occurs when there is injury to the abductor muscles of the thigh?
Trendelenburg gait
What plexus supplies the hip abductors? What nerve innervates the thigh abductors?
Sacral
Superior gluteal nerve
Which nerve damage causes a positive Trendelenburg sign?
Superior gluteal nerve
What is external rotation of the hip?
Turning the inside of the foot to face backwards
What five muscles are involved in external rotation of the hip?
Piriformis
Obturator internus
Gluteus minimus
Superior and inferior gamelli
Quadratus femoris
Where do the external rotators of the hip cross the joint? Where do they attach to?
Posterior aspect
Greater trochanter of femoral head
Where are the superior and inferior gamelli located?
They are located above and below the obturator internus muscle
What three muscles are involved in internal rotation of the hip?
Gluteus medius
Gluteus minimus
Tensor fascia lata
What is internal rotation of the hip?
Turning the inside of the foot to face forward
Where do the internal rotators of the hip lie? Which aspect of the hip joint do they cross?
Posterior aspect
Anterior aspect
What is the quadriceps femoris?
A four-headed muscle which forms the main bulk of the anterior thigh region
What are the four heads of the quadriceps femoris?
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
On what aspect of the thigh does the vastus lateralis muscle lie?
Anterior, lateral
On what aspect of the thigh does the vastus medalis muscle lie?
Anterior, medial
Where does the vastus intermedius lie?
Between the vastus lateralis and vastus medialis
What muscle is more anterior - vastus lateralis or medialis?
Vastus lateralis
What nerve innervates the anterior thigh muscles?
Femoral
What is the action of the rectus femoris muscle on the hip joint?
Flexion of the hip joint
What do the heads of the quadriceps femoris muscle form? Where do they unite?
Quadriceps tendon
Proximal to the patella
What does the quadriceps tendon continue as once it passes the patella?
Patellar ligament
Where does the patellar tendon attach?
The tibial tuberosity
What is the action of the quadriceps femoris on the hip joint and the knee joint?
It flexes the hip joint
It extends the knee joint
What muscle lies on top of the vastus intermedius?
Rectus femoris
What is the longest muscle in the body?
Sartorius
What is the most superficial muscle in the anterior compartment of the thigh?
Sartorius
What are the four functions of the sartorius muscle?
Flexion of the hip joint
Flexion of the knee joint
External rotation of the hip joint
Abduction of the hip joint
What muscle is used to place your right foot on your left knee and then slide the foot down your leg? Why?
Sartorius
It assist with medial rotation of the tibia on the femur
What nerve supplies the sartorius?
Anterior division of the femoral nerve
Where does the sartorius muscle arise and extend to?
It arises in the ASIS
It extends to the pes anserinus on the medial aspect of the tibia
Which three thigh muscles extend to the pes anserinus of the tibia?
Sartorius
Gracilis
Semimembranous
What are the clinical features of pes anserinus bursitis?
Pain on the medial, proximal aspect of the tibia
What are the three actions of the sartorius on the hip joint?
Flexion
Abduction
External rotation
What is the action of the sartorius on the knee joint?
Flexion
How does the sartorius exert flexion on both the hip and knee joint?
It spirals around the thigh from lateral to medial, crossing the hip joint anteriorly and the knee joint posterior-medially
What three neurovascular structures pass through the obturator canal?
Obturator artery
Obturator vein
Obturator nerve
Which fossa do the neurovascular structures pass through after the obturator canal?
Popliteal fossa
What do the neurovascular structures of the anterior aspect of the lower limb enter through?
Femoral triangle
What muscle forms the medial border of the femoral triangle?
Adductor longus
What muscle forms the lateral border of the femoral triangle?
Sartorius
What structure forms the base of the femoral triangle?
Inguinal ligament
Which vessel is located at the midpoint of the inguinal ligament?
Femoral artery
What two muscles forms the floor of the femoral triangle?
Iliopsoas
Pectineus
What three structures pass through the femoral triangle?
Femoral artery
Femoral vein
Femoral nerve
What is the femoral sheath?
A funnel shaped connective tissue tube which surrounds the proximal part of the femoral vessels (but not the nerve)
What is contained within the femoral canal?
Lymphatic vessels
Fat and loose connective tissue
What are the three compartments of the femoral sheath?
Lateral
Intermediate
Medial
What is contained within the lateral compartment of the femoral sheath?
Femoral artery
What is contained within the intermediate compartment of the femoral sheath?
Femoral vein
What is contained within the medial compartment of the femoral sheath?
Femoral canal
What is a femoral hernia?
A condition in which an increase in abdominal pressure can cause abdominal contents to push into the femoral ring and become trapped
Which gender is most commonly affected by femoral hernias?
Females
What is the main artery of the lower limb?
Femoral artery
Where does the femoral artery begin?
Inguinal ligament
What is the femoral artery a continuation of?
External iliac artery
Between which two bony landmarks does the femoral artery enter the thigh?
ASIS
Pubic symphysis
What is the deep artery of the lower limb?
Profunda femoris
What is the profounda femoris artery a branch of?
External iliac artery
What is the main vein of the lower limb?
Femoral vein
What is the femoral vein a continuation of?
Great saphenous vein
What does the femoral vein drain into? Where?
External iliac vein
As it passes under the inguinal ligament
What two veins drain into the femoral triangle?
Profunda femoris
Greater saphenous
Which vein is cannulated for a right cardiac angiography?
Femoral vein
What is the largest nerve of the lumbar plexus?
Femoral nerve
Where does the femoral nerve enter the femoral triangle in relation to to the femoral vessels?
Laterally
What is the main branch of the femoral nerve?
Saphenous nerve
What aspect of the leg and foot does the saphenous nerve supply?
Medial aspect
Where do the neurovascular structures of the anterior thigh pass after the femoral triangle?
Adductor canal
Where does the adductor canal originate and extend?
It arises from the apex of the femoral triangle to the adductor hiatus of the adductor magnus
In which muscle is the adductor canal located in?
Adductor magnus
Where do the neurovascular structures of the anterior thigh pass after the adductor canal?
Adductor hiatus, which is an opening in the adductor magnus tendon
What happens to the anterior femoral artery as it passes through the adductor hiatus?
It becomes the popliteal artery
What are the four contents of the adductor canal?
Femoral artery
Femoral vein
Saphenous nerve
Vastus medialis nerve
What canal lies underneath the sartorius muscle?
Adductor canal
What roots form the lumbar plexus?
The ventral roots of L1 - L4
Where do the roots of the lumbar plexus emerge?
Through the psoas major muscle on the posterior abdominal wall
What are the three terminal branches of the lumbar plexus that innervate the lower limb?
Lateral cutaneous nerve
Femoral nerve
Obturator nerve
What are the two motor nerves of the lumbar plexus supplying the lower limb? What are their nerve roots?
Femoral nerve
Obturator nerve
L2-L4
What sensory nerve of the lumbar plexus supplies the lower limb? What is its nerve roots?
Lateral cutaneous nerve
L2-L3
What lumbar plexus nerve is most medial?
Obturator nerve
What lower limb nerve is most lateral?
Lateral cutaneous nerve
What is the pelvic girdle?
A bony ring consisting of the sacrum and both hip bones
What joins the pelvic girdle anteriorly?
The pubic symphysis
What type of joint is the pubic symphysis?
Secondary cartilaginous joint
What joins the pelvic girdle posteriorly?
The sacroiliac joints
What type of joint are the sacroiliac joints?
Synovial plane joint
What are the two ligaments of the pelvic girdle?
Sacrotuberous ligament
Sacrospinous ligament