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ACEM Primary Written > Musculoskeletal: Anatomy - Lower limb summary > Flashcards

Musculoskeletal: Anatomy - Lower limb summary Flashcards

1
Q

Three compartments of the thigh

A

Anterior
Posterior
Medial (adductor)

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2
Q

Nerve supply to anterior compartment of the thigh

A

Femoral nerve (L2-4)
Exceptions are psoas major which is innervated by anterior rami L1-3, and pectineus which may receive a branch of the obturator nerve

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3
Q

Arterial supply to anterior compartment of the thigh

A

Femoral artery (continuation of the external iliac artery)
Exception is iliopsoas, supplied by iliolumbar artery (amongst others)

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4
Q

Actions of the anterior compartment of the thigh

A

Primarily hip flexion and knee extension

Others:
- Hip abduction and lateral rotation by sartorius
- Knee flexion by sartorius
- Hip adduction by pectineus

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5
Q

Proximal attachment of rectus femoris

A

AIIS

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6
Q

Proximal attachment of vastus lateralis

A

Greater trochanter
Lateral lip of linea aspera

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7
Q

Proximal attachment of vastus intermedius

A

Femoral shaft

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8
Q

Proximal attachment of vastus medialis

A

Intertrochanteric crest
Medial lip of linea aspera

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9
Q

Proximal attachment of psoas major

A

T12-L4

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10
Q

Proximal attachment of iliacus

A

Iliac fossa

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11
Q

Boundaries of the femoral triangle

A

Base: inguinal ligament
Lateral: medial border of sartorius
Medial: lateral border of adductor longus
Floor: iliopsoas, pectineus
Roof: cribiform fascia, fascia lata (deep fascia of thigh), skin and subcutaneous tissue

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12
Q

Contents of the femoral triangle

A

From lateral to medial:
Nerve (femoral)
Artery (femoral)
Vein (femoral)
Empty space (canal)
Lymphatics

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13
Q

Boundaries of the popliteal fossa

A

Superolateral: biceps femoris tendon
Superomedial: semimembranosus
Inferolateral: lateral head of gastrocnemius, plantaris
Inferomedial: medial head of gastrocnemius

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14
Q

Contents of the popliteal fossa. How are they arranged from medial to lateral and superficial to deep?

A

Tibial nerve (bisects)
Common fibular nerve
Posterior cutaneous nerve of thigh
Popliteal artery
Popliteal vein
Small saphenous vein (pierces popliteal fascia and terminates by entering popliteal vein)
Popliteal lymph nodes and vessels

Medial to lateral: artery -> vein -> nerve (remember common fibular needs to go lateral so this is the most lateral structure)

Superficial to deep: I will NVA remember this (nerve -> vein -> artery)

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15
Q

What forms the adductor hiatus?

A

Distal attachments of adductor and hamstring parts of adductor magnus

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16
Q

Actions of the medial compartment of the thigh

A

Hip adduction

Others:
- Hip lateral rotation by obturator externus
- Hip extension by hamstring part of adductor magnus
- Hip flexion by adductor part of adductor magnus

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17
Q

Nerve supply to medial compartment of the thigh

A

Obturator nerve (L2-4)
Exception is hamstring part of adductor magnus which is innervated by tibial part of sciatic nerve (L4-S3)

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18
Q

Arterial supply of medial compartment of the thigh

A

Obturator artery
Branch of the internal iliac

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19
Q

Proximal attachment of gracilis

A

Body of pubis

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20
Q

Proximal and distal attachments of obturator externus

A

Proximal: obturator foramen and surrounding bone
Distal: posterior greater trochanter

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21
Q

Muscles of the anterior compartment of the thigh

A
  1. Iliopsoas
  2. Sartorius
  3. Quadriceps femoris:
    - Rectus femoris
    - Vastus lateralis
    - Vastus intermedius
    - Vastus medialis
  4. Pectineus
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22
Q

Proximal and distal attachments of the two parts of adductor magnus

A

Adductor part: ischial and inferior pubic rami -> linea aspera
Hamstring part: ischial tuberosity -> adductor tubercle, medial supracondylar line of femur

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23
Q

Proximal and distal attachments of adductor longus

A

Proximal: pubis
Distal: linea aspera (long fan-shaped)

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24
Q

Why is adductor longus an anatomical landmark in the medial thigh?

A

Separates anterior and posterior divisions of obturator nerve

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25
Q

Proximal and distal attachments of adductor brevis

A

Proximal: pubis, inferior pubic rami
Distal: linea aspera (proximal to adductor longus)

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26
Q

Which three muscles form the pes anserinus?

A

Sartorius
Gracilis
Semitendinosus

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27
Q

Actions of the posterior compartment of the thigh

A

Hip extension and knee flexion

Others:
- Hip and knee lateral rotation by biceps femoris
- Hip and knee medial rotation by semitendinosus and semimembranosus

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28
Q

Nerve supply of the posterior compartment of the thigh

A

Sciatic nerve (L4-S3)

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29
Q

Arterial supply of the posterior compartment of the thigh

A

Inferior gluteal artery
Perforating branches of profunda femoris

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30
Q

Common proximal attachment of the muscles of the posterior compartment of the thigh

A

Ischial tuberosity

Exception is short head of biceps femoris which attaches to linea aspera

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31
Q

Common insertion of biceps femoris

A

Head of fibula

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32
Q

Distal attachment of semimembranosus

A

Medial tibial condyle

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33
Q

Boundaries of the adductor canal

A

Anterolateral: vastus medialis
Medial (roof): sartorius
Posterior: adductor longus and magnus

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34
Q

Where does the adductor canal run?

A

From apex of femoral triangle to adductor hiatus

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35
Q

Contents of the adductor canal

A

Femoral artery
Femoral vein (posterior to artery)
Saphenous nerve
Nerve to vastus medialis

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36
Q

Which two muscles form the femoral sheath?

A

Transversalis
Iliopsoas

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37
Q

Three compartments of the femoral sheath and their contents

A

Lateral: femoral artery
Intermediate: femoral vein
Medial: femoral canal (with connective tissue, fat, lymphatics +/- deep inguinal lymph node)

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37
Q

Where does the femoral canal run?

A

From the femoral ring to the proximal saphenous opening
All within the femoral triangle

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38
Q

Boundaries of the femoral ring

A

Anterior: medial inguinal ligament
Posterior: pectineus
Lateral: femoral vein
Medial: lacunar ligament
Closed by femoral septum

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39
Q

Describe the position of the femoral artery relative to the femoral vein as it traverses the thigh

A

Base of femoral triangle: lateral to vein
Apex of femoral triangle: anterior to vein
Adductor canal: anteromedial to vein

I.e. crosses over top of vein from lateral to medial within the femoral triangle

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40
Q

Which artery supplies the femoral head and neck?

A

Medial circumflex femoral

41
Q

Contents of the greater sciatic foramen

A

NIP SNIP (infrapiriform):

Nerve to quadratus femoris
Inferior gluteal artery and vein
Posterior cutaneous nerve of thigh

Sciatic nerve
Nerve to obturator internus
Internal pudendal artery and vein
Pudendal nerve

Suprapiriform:
Superior gluteal artery, nerve and vein

42
Q

Contents of the lesser sciatic foramen

A

PINTO:
Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus
Tendon of Obturator internus

43
Q

Function of the superficial gluteal muscles

A

Primarily hip abduction +/- extension

Others:
- Hip lateral rotation by gluteus maximus
- Hip medial rotation by gluteus medius and minimus, and tensor fascia lata

44
Q

Distal attachments of gluteus maximus

A

Gluteal tuberosity
Iliotibial tract -> lateral tibia

45
Q

What is the main extensor of the hip?

A

Gluteus maximus

46
Q

Nerve supply to the superficial gluteal muscles

A

Gluteus maximus: inferior gluteal n. (L5, S1-2)
All others: superficial gluteal n. (L5, S1)

47
Q

Actions of gluteus maximus

A

Hip extension, assists with lateral rotation

48
Q

Actions of gluteus medius and minimus, and tensor fascia lata

A

Hip abduction, medial rotation and extension

49
Q

Actions of the deep gluteal muscles

A

Lateral rotation
Abduction by all except quadratus femoris

50
Q

Nerve supply to the deep gluteal muscles

A

Obturator internus: nerve to obturator internus (L5, S1)
Superior gemellus: nerve to obturator internus (L5, S1)
Inferior gemellus: nerve to quadratus femoris (L5, S1)
Quadratus femoris: nerve to quadratus femoris (L5, S1)
Piriformis: nerve to piriformis (S1-2)

51
Q

Which three muscles make up the triceps coxae?

A

Superior gemellus
Inferior gemellus
Obturator internus

52
Q

Which is stronger: lateral or medial collateral?

53
Q

Which is stronger: anterior or posterior cruciate?

54
Q

Describe the attachments of the anterior and posterior cruciate ligaments

A

ACL: from anterior intercondylar tibia to posteromedial aspect of lateral femoral condyle
PCL: from posterior intercondylar tibia to anterolateral aspect of medial femoral condyle

55
Q

Which is more mobile: medial or lateral meniscus?

A

Lateral
Medial attached to MCL and more prone to tear

56
Q

Which bursa can enlarge to produce a Baker’s cyst?

A

Semimembranosus

57
Q

Which bursae communicate with the knee joint?

A

Suprapatellar
Popliteus
Anserine
Gastrocnemius

58
Q

Which artery pierces the joint capsule to supply the knee joint?

A

Middle genicular artery (branch of popliteal)

59
Q

Four muscles of the anterior compartment of the leg

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Fibularis tertius

60
Q

Actions of the anterior compartment of the leg

A

Ankle dorsiflexion

Others:
- Inversion by tibialis anterior
- 2nd-5th digit extension by EDL
- Great toe extension by EHL
- Fibularis tertius aids eversion

61
Q

Nerve supply of the anterior compartment of the leg

A

Deep fibular nerve (L4-5)

62
Q

Arterial supply of the anterior compartment of the leg

A

Anterior tibial artery

63
Q

Structures passing under the superior extensor retinaculum

A

From medial to lateral:
Timothy Has A Very Nasty Disease, ParaTyphoid:
- Tibialis anterior
- EHL
- Artery, vein, nerve
- EDL
- Peroneus Tertius

64
Q

Which muscle of the anterior compartment originates from both the tibia and fibula?

A

Extensor digitorum longus

65
Q

Distal attachment of tibialis anterior

A

Medial cuneiform
Base of 1st metatarsal

66
Q

Distal attachment of fibularis tertius

A

Base of 5th metatarsal

67
Q

Which nerve accompanies the anterior tibial artery?

A

Deep fibular nerve (L4-5)

68
Q

What ligament is the principle connection of the tibiofibular syndesmosis?

A

Interosseous tibiofibular ligament

69
Q

Which artery becomes the deep plantar artery?

A

First dorsal metatarsal (from dorsalis pedis -> from anterior tibial)

70
Q

Describe the course of the anterior tibial artery in the leg

A

Popliteal becomes anterior tibial at the inferior border of the popliteus
Travels through a gap in the superior interosseous membrane
Descends on IOM between TA and EDL
Becomes dorsalis pedis at ankle joint

71
Q

Nerve supply of the lateral compartment of the leg

A

Superficial fibular nerve (L5, S1-S2)

72
Q

Action of the lateral compartment of the leg

A

Ankle eversion
Weak plantar flexion

73
Q

Distal attachment of fibularis longus

A

Same as tibialis anterior:
- Medial cuneiform
- Base of 1st metatarsal

74
Q

Distal attachment of fibularis brevis

A

Base of 5th metatarsal

75
Q

Which travels above the fibular trochlear on the calcaneus: fibularis longus or brevis?

A

Fibular brevis travels above
Fibularis longus travels below

76
Q

Arterial supply of the lateral compartment of the leg

A

Perforating branches of anterior tibial artery proximally, and fibular artery (branch of posterior tibial) distally

77
Q

Structures behind the medial malleolus

A

From anterior to posterior:

Tom, Dick And Very Naughty Harry:
- Tibialis posterior
- flexor Digitorum longus
- posterior tibial (Vein) and (Artery)
- tibial Nerve
- flexor Hallucis longus

78
Q

Describe the course of the tibial nerve in the leg

A

Runs down middle of calf deep to soleus
Gives off medial sural cutaneous nerve (forms communicating branch of common fibular to form sural nerve)
Divides into medial and lateral plantar nerves posteroinferior to medial malleolus

79
Q

Arterial supply of the posterior compartment of the leg

A

Posterior tibial artery

80
Q

Which is the larger branch of the popliteal artery: anterior or posterior tibial?

A

Posterior tibial

81
Q

Which muscles make up the triceps surae?

A

Medial and lateral heads of gastrocnemius
Soleus

82
Q

Three superficial muscles of the posterior compartment of the leg

A

Gastrocnemius
Soleus
Plantaris

83
Q

Which muscles of the posterior compartment of the leg attaches to both tibia and fibula?

A

Soleus
Tibialis posterior
Flexor digitorum longus (via broad tendon to fibula)

84
Q

Four deep muscles of the posterior compartment of the leg

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

85
Q

Distal attachment of tibialis posterior

A

Base of 2nd-4th metatarsals
Navicular tuberosity
Cuneiforms
Cuboid
Sustentaculum tali of calcaneus

86
Q

Layers of the sole

A

1st layer: abs flex abs (abductor hallucis, flexor digitorum brevis, abductor digiti minimi)
2nd layer: quadratus plantae, lumbricals (+ tendons of long flexors)
3rd layer: flex adds flex (flexor hallucis brevis, adductor hallucis, flexor digit minimi brevis)
4th layer: plantar and dorsal interossei (+ tendons of FL, TA, TP)

87
Q

How many plantar and how many dorsal interossei are there?

A

3x plantar
4x dorsal

88
Q

Which has two heads: dorsal or plantar interossei?

89
Q

Arterial supply of the sole

A

Posterior tibial artery divides into medial and lateral plantar arteries deep to flexor retinaculum
Passes deep to abductor hallucis in the 1st layer of the sole

90
Q

Medial longitudinal arch bones

A

Calcaenus
Talus
Navicular
Cuneiforms
3 medial metatarsals

91
Q

Three tendons which maintain the medial longitudinal arch

A

Tibialis anterior
Tibialis posterior
Fibularis longus

92
Q

Lateral longitudinal arch bones

A

Calcaneus
Cuboid
2 lateral metatarsals

93
Q

Transverse arch bones

A

Cuboid
Cuneiforms
Base of metatarsals

94
Q

What are the most important factors in maintaining the longitudinal arches?

A

Plantar aponeurosis
Long plantar ligament
Plantar calcaneocuboid (short plantar) ligament
Plantar calcaneonavicular (spring) ligament

95
Q

Is the ankle joint more stable in plantar flexion or dorsiflexion?

A

Dorsiflexion (larger anterior part of talus held in mortise)

96
Q

Ligaments of the ankle joint

A

Medial (deltoid)
Lateral:
- Anterior talofibular
- Posterior talofibular
- Calcaneofibular

97
Q

What is the most commonly torn ligament of the ankle joint?

A

Anterior talofibular

98
Q

Nerve roots of the following:
- Femoral nerve
- Obturator nerve
- Sciatic nerve
- Tibial nerve
- Common fibular nerve
- Deep fibular nerve
- Superficial fibular nerve
- Lateral plantar and medial plantar nerve

A

Femoral: L2-4 (posterior division of anterior rami)
Obturator: L2-4 (anterior division of anterior rami)
Sciatic: L4-S3
Tibial: L4-S3
Common fibular: L4-S2
Deep fibular: L4-S2
Superficial fibular: L4-S1
Lateral and medial plantar nerves: S2-3

99
Q

Which muscles of the foot are innervated by the medial plantar nerve?

A

Abductor hallucis
Flexor hallucis brevis
2nd toe lumbrical
Flexor digitorum brevis

All others innervated by lateral plantar nerve

100
Q

Which intrinsic muscle of the foot involved in great toe movement is NOT innervated by the medial plantar nerve?

A

Adductor hallucis (innervated by DEEP BRANCH of lateral plantar nerve)

ACEM Primary Written (150 decks)

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