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MSK anatomy > Muscles Of The Leg, Neurovasculature Of The Leg And The Foot > Flashcards

Muscles Of The Leg, Neurovasculature Of The Leg And The Foot Flashcards

1
Q

Popliteal fossa

A

A diamond-shaped depression behind the knee joint

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2
Q

Medial superior borders of popliteal fossa

A

Semimembranosus and Semitendinosus

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3
Q

Lateral superior border of popliteal fossa

A

Biceps femoris

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4
Q

Inferomedial and inferolateral borders of the popliteal fossa

A

2 heads of the gastrocnemius

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5
Q

Contents of the popliteal fossa

A

Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve

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6
Q

What is the popliteal artery a continuation of

A

Femoral artery

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7
Q

What does the popliteal artery bifurcate into

A

Anterior and posterior tibial arteries

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8
Q

Tibial nerve

A

Descends through midline of popliteal fossa and innervates posterior leg muscldx

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9
Q

Common fibular nerve

A

Travels along the superolateral border of the popliteal fossa alongside the tendon of the biceps femoris
Wraps around the neck of the fibula and then splits into a superficial and deep branch

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10
Q

Superficial fibular nerve

A

Innervates lateral leg muscles

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11
Q

Deep fibular nerve

A

Innervates anterior leg muscles

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12
Q

What separates the leg into compartments

A

Inter muscular septa extending from the deep fascia

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13
Q

Number of muscles in the anterior leg

A

4-
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
(fibularis tertius)

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14
Q

Innervation of anterior leg muscles

A

Deep fibular nerve

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15
Q

Function of anterior leg muscles

A

Dorsiflexors of the foot
Extensors of the toes

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16
Q

Function of tibialis anterior

A

Dorsiflexion and inversion of the foot

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17
Q

Path of tibialis anterior

A

Crosses the anterior aspect of the ankle and inserts into the medial cuneiform

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18
Q

Path of extensor hallucis longus

A

It’s tendon crosses the anterior aspect of the ankle and inserts onto the distal phalanx of the great toe

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19
Q

Function of extensor hallucis longus

A

Extensor of great toe
Dorsiflexion of the foot

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20
Q

Path of extensor digitorum longus

A

4 tendons
Cross the anterior aspect of the ankle and insert into the distal phalanges of the toes 2-5

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21
Q

Extensor retinacula

A

Covers the extensor tendons at the ankle joint

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22
Q

Function of extensor digitorum longus

A

Extend toes
Dorsiflexion of foot

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23
Q

Path of fibularis tertius

A

Extends from fibula to base of the 5th metatarsal

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24
Q

Function of fibularis tertius

A

Weakly Dorsiflexion and evert the foot
-small weak and not present in all people

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25
Q

Muscles of the lateral leg

A

2-
Fibularis longus
Fibularis brevis

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26
Q

Function of the lateral leg muscles

A

Evert foot at subtalar joint

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27
Q

What innervates the lateral leg muscles

A

Superficial fibular nerves

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28
Q

Path of fibularis longus

A

Fibula
Inserts onto the plantar surface of the medial cuneiform bone
Travels posterior to lateral malleoljs
Most superficial

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29
Q

Fibularis brevis

A

Inserts onto the 5th metatarsal
Travels posterior to lateral malleolus
Most deep

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30
Q

Function of posterior leg muscles

A

Plantarflexion
Flexion of the toe

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31
Q

Innervation of the posterior leg muscles

A

Tibial nerve

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32
Q

Superficial posterior leg muscles

A

Gastrocnemius
Soleus
Plantaris

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33
Q

What do the tendons of the superficial posterior leg insert into

A

Calcaneus via the calcaneal tendons (Achilles)

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34
Q

Function of gastrocnemius

A

Flexion of knee
Plantarflexion

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35
Q

Path of gastrocnemius

A

Most superficial
Attaches via 2 heads to distal femur

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36
Q

Function of soleus

A

Compressed deep veins of leg - important for venous return

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37
Q

Path of soleus

A

Large flat muscle deep to gastrocnemius
Attached to soleal line of tibja

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38
Q

Plantaris

A

Very small muscle located close to popliteal fossa
Gives rise to very long thin tendon which merges with the calcaneal tendon
Non-essential

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39
Q

Which tendon in the leg is used to repair or replace damaged ligaments or tendons as a graft

A

Plantaris

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40
Q

Deep muscles of posterior leg

A

4-
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus

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41
Q

What do the tendons of the tibialis posterior, FHL and FDL insert into

A

Travel posterior to medial malleolus and insert into the plantar surface of the bones of the foot

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42
Q

Path of popliteus

A

Located deep in the popliteal fossa
Attached to tibia and femur

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43
Q

Function of popliteus

A

Small degree of rotation of the knee
Unlocks the knee

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44
Q

Function of tibialis posterior

A

Plantarflexion
Inversion

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45
Q

Function of flexor hallucis longus

A

Flexes the great toe via insertion on distal phalanx
Plantarflexion

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46
Q

Function of flexor digitorum longus

A

Flexion of toes
Plantarflexion

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47
Q

Insertion of flexor digitorum longus

A

Distal phalanges of 2-5

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48
Q

Dorsum of foot

A

Superficial veins and extensor tendons visible under the skin
Contains a small muscle called the extensor digitorum brevis

49
Q

Innervation of extensor digitorum brevis

A

Deep fibular nerve

50
Q

Extensor digitorum brevis

A

Located laterally in dorsum of foot
Inserts onto tendons of the extensor digitorum longus

51
Q

Plantar aponeurosis

A

Located superficial to muscles in sole of foot
Supports foot and provides a layer of protection

52
Q

Sole of the foot

A

Muscles arranged in 4 layers

53
Q

Innervation of the sole of the foot muscles

A

Medial and lateral plantar nerves (branch of tibial nerve)

54
Q

Branches of the popliteal artery

A

Anterior and posterior tibial arteries

55
Q

Anterior tibial artery

A

Pierces the interosseous membrane to enter the anterior leg compartment
Distally crosses the anterior aspect of the ankle joint and enters the dorsum of the foot

56
Q

Dorsalis pedis artery

A

Continuation of anterior tibial artery
Palpable in foot lateral to the tendon of extensor hallucis longus
Gives rise to branches that travels between the metatarsals and anastomose with arteries in the plantar aspect of the foot

57
Q

Posterior tibial artery

A

Supplies posterior compartment of leg and sole of foot
Gives rise to fibular artery
Travels posterior to the medial malleolus along with the tendons of tibialis posterior, FHL and FDL to enter plantar aspect of foot

58
Q

Bifurcation of the posterior tibial artery

A

Medial and lateral plantar arteries to supply the sole

59
Q

Where is the posterior tibial artery palpable

A

Posterior to the medial malleolus to enter the plantar aspect of the foot

60
Q

Where is the anterior tibial artery palpable

A

Lateral to the tendon of the extensor hallucis longus

61
Q

Which 2 arteries anastomose in the foot

A

Dorsalis pedis
Plantar arteries

62
Q

What supplies the forefoot and toes

A

Metatarsal and digital arteries

63
Q

Which arteries form the deep plantar arch

A

Lateral plantar artery
Branch of Dorsalis pedis

64
Q

Which veins unite to form the popliteal vein

A

Posterior tibial
Anterior tibial
Fibular

65
Q

2 major superficial veins of the leg

A

Great and small saphenous veins

66
Q

Great saphenous vein

A

Dorsal venous network drains medially to the great saphenous vein
Travels anterior to medial malleolus
Terminates in femoral vein in femoral triangel

67
Q

Small saphenous vein

A

Dorsal venous network drains laterally into small saphenous vein
Travels posterior to lateral malleolus
Terminates at popliteal vein in popliteal fossa

68
Q

Where does the great saphenous vein terminate

A

Femoral triangle

69
Q

Where does the small saphenous vein terminate

A

Popliteal fossa

70
Q

Common fibular nerve sensory innervation

A

Skin over the anterolateral leg and dorsum of foot

71
Q

Tibial nerve - sensory

A

Most of the skin on the plantar surface of the foot

72
Q

Branches of the tibial nerve

A

Medial and lateral plantar nerves in sole of foot

73
Q

Medial and lateral plantar nerves

A

Innervate all intrinsic muscles of the plantar aspect of the foot
Digital nerves branch from them and supply the toes

74
Q

Innervation of the toes

A

Digital nerves that branch from the medial and lateral plantar nerves

75
Q

Tarsal tunnel

A

Tendons of the deep posterior compartment of the leg travel to foot
Covered by a flexor retinaculum

76
Q

Borders of the tarsal tunnel

A

Medial malleolus
Calcaneus
Flexor retinaculum

77
Q

Contents of the tarsal tunnel from most anterior/superior to posterior/inferior
(Tom, dick and very nervous harry)

A

Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus tendon

78
Q

Dermatome area supplied by the femoral nerve

A

Anterior thigh
Anteromedial leg (via the saphenous nerve)

79
Q

Dermatome area supplied by the Obturator nerve

A

Medial thigh

80
Q

Dermatome area supplied by the common fibular nerve

A

Anterolateral leg and dorsum of foot

81
Q

Dermatome area supplied by the tibial nerve

A

Sole of foot

82
Q

Dermatome area supplied by the superficial fibular nerve

A

Lower Anterolateral leg
Most of dorsum of foor

83
Q

Dermatome area supplied by the deep fibular nerve

A

1st interdigital web space

84
Q

How are dermatomes on the anterior lower limb arranged

A

Oblique strips

85
Q

How are dermatomes in the posterior surface of the lower limb arranged

A

More vertically

86
Q

Approximate region innervated by L1

A

Over the inguinal oigamnet

87
Q

Approximate region innervated by L2

A

Proximal half of anterior thigh

88
Q

Approximate region innervated by L3

A

Distal anterior thigh
Medial aspect of knee

89
Q

Approximate region innervated by L4

A

Lateral thigh
Anterior knee
Anteromedial leg
Medial malleolus
Medial foot
Great toe

90
Q

Approximate region innervated by L5

A

Lateral leg
Distal anterior leg
Dorsal and plantar strip down the middle of the foot
Dorsal and plantar surfaces of toes 2-4

91
Q

Approximate region innervated by S1

A

Vertical strip of skin in middle of posterior thigh and leg
Distal lateral leg
Lateral malleolus
Little toe

92
Q

Approximate region innervated by S2

A

Vertical strip of skin over the posterior aspect of the thigh and leg
Plantar strip of skin in the foot and heel

93
Q

How to test the dermatome region of L1

A

Region over inguinal ligament

94
Q

How to test the dermatome region of L2

A

Upper anterior thigh

95
Q

How to test the dermatome region of L3

A

Medial aspect of knee

96
Q

How to test the dermatome region of L4

A

Anteromedial leg

97
Q

How to test the dermatome region of L5

A

Anterolateral leg

98
Q

How to test the dermatome region of S1

A

Little toe/lateral side of foot

99
Q

Common fibular nerve injury and foot drop

A

The common fibular nerve is located relatively superficially as it wraps around the neck of the fibula. Fractures of the fibular neck, caused by a lateral blow to the leg, can injure the nerve. This leads to weakness of the anterior and lateral leg muscles. The foot cannot be dorsiflexed, and the toes will drag on the ground when walking. This condition is called foot drop. Patients may compensate either by lifting the leg higher when walking (by flexing the hip and knee to a greater degree) or by swinging the affected leg out laterally – both allow the toes to clear the ground without catching.

100
Q

Deep vein thrombosis

A

Thrombus, or clot, can develop in the deep veins of the leg. If this occurs, venous return from the leg is impaired, causing swelling, pain, redness, and warmth of the affected leg. It is important to recognise and treat DVT, as the clot may migrate proximally and enter the pulmonary circulation, causing pulmonary embolism – a potentially fatal condition.

101
Q

Compartment syndrome

A

Because the deep fascia and intermuscular septa of the leg do not stretch, swelling in one of the compartments of the leg (e.g. caused by oedema or bleeding) increases pressure in the compartment and compresses muscles, nerves, and blood vessels. Once the pressure exceeds capillary perfusion pressure, ischaemia and infarction of the tissues occurs if not treated promptly by releasing the fascia (fasciotomy).

102
Q

Achilles tendon rupture

A

The typical mechanism of this injury is a sudden, forceful plantarflexion of the ankle, such as pushing off from the ground to jump or run, or by sudden, forceful dorsiflexion of the ankle, stretching the calcaneal tendon. Patients present with pain and altered gait, as they cannot plantarflex the foot to push-off from the ground when walking.

103
Q

Pulses around the ankle

A

The pulsation of the dorsalis pedis artery is usually palpable over the dorsum of the foot, just lateral to the tendon of extensor hallucis longus, between the first and second metatarsals. The pulse of the posterior tibial artery is palpable posterior to the medial malleolus. It is important to be able to palpate both pulses when examining a patient’s vascular system.

104
Q
  1. A patient sustained a traumatic injury which severed his sciatic nerve in his gluteal region. What functional deficits would you expect him to have?
A

Common fibular and tibial nerve affected
o The tibial nerve innervates the muscles in the posterior thigh (hip extensors and knee flexors), the posterior leg and sole of the foot (plantarflexors of the ankle and flexors of the toes). It innervates the skin over the sole of the foot.
o The common fibular nerve innervates the muscles of the anterior leg (deep branch, dorsiflexors of the ankle and extensors of the toes) and lateral leg (superficial branch, everters of the foot). It innervates the skin over the lateral leg and dorsum of the foot.

105
Q
  1. Which muscles attach to the Achilles tendon? If a patient ruptured the tendon, what function deficit would result?
A

o Gastrocnemius, soleus and plantaris.
o Plantarflexion of the ankle joint would be weak / impaired. The patient would present with a limp / abnormal gait, as they would not be able to plantarflex against the ground to push-off when walking.

106
Q
  1. Where is the great saphenous vein formed? Describe its course from its distal origin to its proximal termination.
A

t arises medially from the dorsal venous network on the dorsum of the foot. o It runs proximally, anterior to the medial malleolus.
o It courses up the anteromedial calf and continues superficially to sartorius into the upper thigh to the apex of the femoral triangle.
o It terminates in the femoral vein just below the inguinal ligament.

107
Q
  1. Which muscles flex the toes?
A

o Flexor digitorum longus and flexor digitorum brevis flex toes 2-5.
o Flexor hallucis longus and flexor hallucis brevis flex the great toe.

108
Q
  1. How many muscle layers are in the sole of the foot?
109
Q
  1. A patient presents with an aching, swollen, red and warm calf with no history of trauma, and a recent period of prolonged immobility. What is the likely diagnosis? Which muscles of the leg are key in preventing this condition?
A

o This presentation is highly suggestive of deep vein thrombosis (DVT) – a patient presenting with DVT will often have risk factors for DVT, but not always. Suspected DVT must be recognised, treated and investigated promptly, as they may lead to pulmonary embolism, which is fatal in some cases.
o The muscles of the posterior leg, particularly soleus, are important for returning venous blood to the heart. When we walk or run, the muscles contract, squeezing the deep veins and propelling blood out of the lower limb veins back towards the heart. When our muscles are relaxed, the deep veins fill with blood. If they are relaxed for a prolonged period, stasis of blood within them encourages thrombus formation.

110
Q
  1. Which nerves supply the anterior and lateral compartments of the leg?
A

o Anterior - deep fibular nerve.
o Lateral - superficial fibular nerve.

111
Q
  1. Where is the common fibular nerve vulnerable to injury? What would be the result of an injury to it?
A

o At the head and neck of the fibula.
o Injury would result in foot drop (unable to dorsiflex) and sensory loss over the anterolateral leg and dorsal foot.

112
Q
  1. Which artery supplies the anterior compartment of the leg? Where does this artery arise from?
A

anterior tibial artery, which arises from the popliteal artery.

113
Q
  1. Where are pulses palpable in the leg? Give the name of the arteries and the locations where they can be palpated.
A

popliteal pulse is palpable in the popliteal fossa.
o The posterior tibial pulse is palpable posterior to the medial malleolus.
o The dorsalis pedis pulse is palpable on the dorsum of the foot, lateral to the tendon of extensor hallucis longus.

114
Q

Which vein is commonly used as a graft for coronary arteries

A

Great saphenous vein

115
Q

Which vein runs posterior to the lateral malleolus

A

Small saphenous vein

116
Q

Which vein runs anterior to the medial malleolus

A

Great saphenous vein

117
Q

Which 2 bones does the flexor retinaculum connect

A

Medial malleolus to calcaneus

118
Q

Tom Dick and very nervous harry

A

Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibialis artery
Posterior tibial vein
Tibial nerve
Flexor hallucis longus tendon

MSK anatomy (13 decks)

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