Musculoskeletal: Anatomy - Lower limb summary Flashcards by Hannah Meiklejohn

Three compartments of the thigh

Anterior
Posterior
Medial (adductor)

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Nerve supply to anterior compartment of the thigh

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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Arterial supply to anterior compartment of the thigh

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

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Actions of the anterior compartment of the thigh

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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Proximal attachment of rectus femoris

AIIS

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Proximal attachment of vastus lateralis

Greater trochanter
Lateral lip of linea aspera

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Proximal attachment of vastus intermedius

Femoral shaft

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Proximal attachment of vastus medialis

Intertrochanteric crest
Medial lip of linea aspera

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Proximal attachment of psoas major

T12-L4

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Proximal attachment of iliacus

Iliac fossa

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Boundaries of the femoral triangle

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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Contents of the femoral triangle

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

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Boundaries of the popliteal fossa

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

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

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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What forms the adductor hiatus?

Distal attachments of adductor and hamstring parts of adductor magnus

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Actions of the medial compartment of the thigh

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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Nerve supply to medial compartment of the thigh

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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Arterial supply of medial compartment of the thigh

Obturator artery
Branch of the internal iliac

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Proximal attachment of gracilis

Body of pubis

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Proximal and distal attachments of obturator externus

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

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Muscles of the anterior compartment of the thigh

Iliopsoas
Sartorius
Quadriceps femoris:
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
Pectineus

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Proximal and distal attachments of the two parts of adductor magnus

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

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Proximal and distal attachments of adductor longus

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

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

Separates anterior and posterior divisions of obturator nerve

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Proximal and distal attachments of adductor brevis

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

Which three muscles form the pes anserinus?

Sartorius Gracilis Semitendinosus

Actions of the posterior compartment of the thigh

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

Nerve supply of the posterior compartment of the thigh

Sciatic nerve (L4-S3)

Arterial supply of the posterior compartment of the thigh

Inferior gluteal artery Perforating branches of profunda femoris

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

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

Common insertion of biceps femoris

Head of fibula

Distal attachment of semimembranosus

Medial tibial condyle

Boundaries of the adductor canal

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

Where does the adductor canal run?

From apex of femoral triangle to adductor hiatus

Contents of the adductor canal

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

Which two muscles form the femoral sheath?

Transversalis Iliopsoas

Three compartments of the femoral sheath and their contents

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

Where does the femoral canal run?

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

Boundaries of the femoral ring

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

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

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

Which artery supplies the femoral head and neck?

Medial circumflex femoral

Contents of the greater sciatic foramen

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

Contents of the lesser sciatic foramen

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

Function of the superficial gluteal muscles

Primarily hip abduction +/- extension Others: - Hip lateral rotation by gluteus maximus - Hip medial rotation by gluteus medius and minimus, and tensor fascia lata

Distal attachments of gluteus maximus

Gluteal tuberosity Iliotibial tract -> lateral tibia

What is the main extensor of the hip?

Gluteus maximus

Nerve supply to the superficial gluteal muscles

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

Actions of gluteus maximus

Hip extension, assists with lateral rotation

Actions of gluteus medius and minimus, and tensor fascia lata

Hip abduction, medial rotation and extension

Actions of the deep gluteal muscles

Lateral rotation Abduction by all except quadratus femoris

Nerve supply to the deep gluteal muscles

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)

Which three muscles make up the triceps coxae?

Superior gemellus Inferior gemellus Obturator internus

Which is stronger: lateral or medial collateral?

Lateral

Which is stronger: anterior or posterior cruciate?

Posterior

Describe the attachments of the anterior and posterior cruciate ligaments

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

Which is more mobile: medial or lateral meniscus?

Lateral Medial attached to MCL and more prone to tear

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

Semimembranosus

Which bursae communicate with the knee joint?

Suprapatellar Popliteus Anserine Gastrocnemius

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

Middle genicular artery (branch of popliteal)

Four muscles of the anterior compartment of the leg

Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis tertius

Actions of the anterior compartment of the leg

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

Nerve supply of the anterior compartment of the leg

Deep fibular nerve (L4-5)

Arterial supply of the anterior compartment of the leg

Anterior tibial artery

Structures passing under the superior extensor retinaculum

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

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

Extensor digitorum longus

Distal attachment of tibialis anterior

Medial cuneiform Base of 1st metatarsal

Distal attachment of fibularis tertius

Base of 5th metatarsal

Which nerve accompanies the anterior tibial artery?

Deep fibular nerve (L4-5)

What ligament is the principle connection of the tibiofibular syndesmosis?

Interosseous tibiofibular ligament

Which artery becomes the deep plantar artery?

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

Describe the course of the anterior tibial artery in the leg

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

Nerve supply of the lateral compartment of the leg

Superficial fibular nerve (L5, S1-S2)

Action of the lateral compartment of the leg

Ankle eversion Weak plantar flexion

Distal attachment of fibularis longus

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

Distal attachment of fibularis brevis

Base of 5th metatarsal

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

Fibular brevis travels above Fibularis longus travels below

Arterial supply of the lateral compartment of the leg

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

Structures behind the medial malleolus

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

Describe the course of the tibial nerve in the leg

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

Arterial supply of the posterior compartment of the leg

Posterior tibial artery

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

Posterior tibial

Which muscles make up the triceps surae?

Medial and lateral heads of gastrocnemius Soleus

Three superficial muscles of the posterior compartment of the leg

Gastrocnemius Soleus Plantaris

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

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

Four deep muscles of the posterior compartment of the leg

Popliteus Flexor hallucis longus Flexor digitorum longus Tibialis posterior

Distal attachment of tibialis posterior

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

Layers of the sole

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)

How many plantar and how many dorsal interossei are there?

3x plantar 4x dorsal

Which has two heads: dorsal or plantar interossei?

Dorsal

Arterial supply of the sole

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

Medial longitudinal arch bones

Calcaenus Talus Navicular Cuneiforms 3 medial metatarsals

Three tendons which maintain the medial longitudinal arch

Tibialis anterior Tibialis posterior Fibularis longus

Lateral longitudinal arch bones

Calcaneus Cuboid 2 lateral metatarsals

Transverse arch bones

Cuboid Cuneiforms Base of metatarsals

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

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

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

Dorsiflexion (larger anterior part of talus held in mortise)

Ligaments of the ankle joint

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

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

Anterior talofibular

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

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

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

Abductor hallucis Flexor hallucis brevis 2nd toe lumbrical Flexor digitorum brevis All others innervated by lateral plantar nerve

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

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