My lower limb Flashcards
Where does The head of the femur articulate within the Pelvis?
The acetabulum of the pelvis
What joint movement do muscles in the anterior thigh region do at the hip joint?
Flex the thigh at the hip joint
What joint movement do muscles in the medial thigh region do at the hip joint?
adduct the thigh at the hip joint.
What joint movement do muscles in the Posterior thigh region do at the hip joint?
extend the thigh at the hip joint.
What joint movement do muscles in the ANTERIOR thigh region do at the KNEE joint?
extend the leg at the knee joint.
What joint movement do muscles in the POSTERIOR thigh region do at the KNEE joint?
flex the leg at the knee joint.
What surrounds the
thigh like a sleeve?
Deep fascia - the fascia lata
What are muscles in the anterior part of the thigh innervated by?
by the femoral nerve (spinal nerves L2-L4).
What are the 7 muscles of the anterior thigh
Quadriceps femoris – a group of four large muscles.
Sartorius
Iliopsoas
Pectineus
What are the four quadracpes muscles
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
What are the muscles of the Medial thigh, Lateral to most medial? (there are 5 of them)
- Obturator externus
- Adductor brevis
- Adductor longus
- Adductor magnus
- Gracilis
What are muscles of the medial thigh innervated by?
innervated by the obturator nerve (spinal nerves L2-L4).
What is the femoral artery a continuation of?
external iliac artery.
Where does the Femoral artery become the Popliteal artery?
At the distal part of the posterior thigh (the popliteal fossa), proximal to the knee
What is the Obturator artery a branch of? What does it anastomose with
The obturator artery is a branch of the internal iliac artery. It travels through the
obturator canal into the medial compartment of the thigh. It anastomoses with
branches from the femoral artery.
What is the femoral triangle?
What does it do?
The femoral triangle is a wedge-shaped area located within the superomedial aspect of the anterior thigh.
It acts as a conduit for structures entering and leaving the anterior thigh.
What are the contents of the Femoral triangle?
Femoral nerve – innervates the anterior compartment of the thigh, and provides sensory branches for the leg and foot.
Femoral artery – responsible for the majority of the arterial supply to the lower limb.
Femoral vein – the great saphenous vein drains into the femoral vein within the triangle.
Femoral canal – contains deep lymph nodes and vessels
NAVEL (Lateral to medial)
What are The femoral artery, vein and canal are contained within?
within a fascial compartment – known as the femoral sheath.
What is the Acronym for the contents of the femoral triangle?
(lateral to medial) – NAVEL: Nerve, Artery, Vein, Empty space (allows the veins and lymph vessels to distend to accommodate different levels of flow), Lymph nodes.
What muscle is attached to the fascia lata on the lateral side of the leg? What does it do?
The tensor fascia lata - it tenses the fascia lata
What do all the 4 quadraceps muscles insert onto?
The quadraceps tendon, which runs over the patella to insert onto the tibial tuberosity via the patellar ligament
What can happen to the patella due to the angles of the tibia and femur in respect to the hip, knee and ankle joint?
What counteracts this?
The patella has a slight tendency to move laterally during contraction of the quadriceps muscles when the knee is straight.
If the muscles pull very strongly it is possible the patella would dislocate laterally.
The VASTUS MEDIALIS counteract this by pulling the patella inwards (medially) when contracting
What is the adductor hiatus?
a hiatus (gap) between the adductor magnus muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa.
Where is the Great Saphenous vein? what does it drain?
Great Saphenous Vein is extremely long. It runs superficially from the inner ankle up the medial side of the leg and thigh until it drains into the Femoral Vein, AT THE FEMORAL TRAINGLE!
What is the order of the 3 adductor muscles in the thigh, from most superficial to deepest?
Adductor Longus, Adductor Brevis (in the crevice), Adductor Magnus.
What artery and nerve supplies all muscles in the medial compartment of the thigh? (that is the obturator externus, and Adductor Brevis, Longus and Magnus)
All the medial thigh muscles are innervated by the obturator nerve, which arises from the lumbar plexus. Arterial supply is via the obturator artery.
What are the muscles of the Anteriror thigh innervated by?
The femoral nerve.
The exception is the Iliopsoas muscle:
The psoas major is innervated by anterior rami of L1-3, while the iliacus is innervated by the femoral nerve.
What are the 4 superficial Gluteal muscles?
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia latae
Where does the Gluteus Maximus Originate and insert? What is its action?
Originates from the posterior surface of
the ilium, the sacrotuberous ligament and the sacrum.
Inserts on the iliotibial tract, with a smaller proportion attaching onto the gluteal
tuberosity.
It is an extensor of the hip and is important
for standing from a sitting position.
It also acts as a lateral rotator of the hip. Because
it inserts into the iliotibial tract, it stabilises the knee joint.
Where do Gluteus Medius and Minimus Originate and insert?
What are their actions
- they both attach to
anterior parts of the posterior surface of the ilium. They both insert onto the LATERAL ASPESCT OF THE
greater trochanter.
Because of their similar bony attachments, they move the hip in
the same way – they abduct and medially rotate it
How do the Gluteus Medius and minimus help with walking?
They contract to keep the pelvis level when walking so that it does not tilt to the side that is unsupported. If paralysed or weak = results in a limp
What is the Origin and insertion of the Tensor fascia Latae?
Originates on the ASIS and inserts onto the Iliotibial band, which itself inserts onto the proximal tibia.
What is the innervation of the 4 superficial gluteal muscles?
Gluteus maximus is innervated by the inferior gluteal nerve.
Gluteus medius and minimus, and TFL, are innervated by the superior gluteal nerve.
What are the 4 deep gluteal muscles?
Piriformis
The superior and inferior gemelli
Obturator internus
Quadratus femoris
Describe the pathway of the Piriformis, where it originates, inserts, and what it is related to.
It Originates from the anterior surface of the sacrum, passes through the greater sciatic foramen and inserts on the greater
trochanter.
The nerves of the sacral plexus lie over it in the pelvis. The sciatic nerve
emerges below its inferior border in the gluteal region
Where do the other deep gluteal muscles originate and insert from? (Superior and inferior Gemmell, Obturator internus, and quadratus femoris)
They originate from the ischium except the obturator internus, which arises from the obturator membrane. They all insert onto, or close to, the greater trochanter.
What is the action of the deep gluteal muscles?
To primarily stabilise and laterally rotate the hip joint.
the Glut Maximus also laterally rotates the hip
What are the 4 muscles of the posterior thigh?
semimembranosus
semitendinosus
biceps femoris.(a long and a short head)
hamstring part of adductor magnus
What are the 3 posterior muscles that are known as the hamstring muscles? what are their actions at the Hip and Knee? What are they innervated by?
- semimembranosus, semitendinosus and the long head of
biceps femoris
As a group these muscles:
are attached proximally to the ischial tuberosity
extend the hip
flex the knee
are innervated by the tibial part of the sciatic nerve
Where do the Semimembranosus and semitendinosus insert? Where do they long and short heads of Biceps femoris insert?
Semimembranosus and semitendinosus insert on the medial aspect of the proximal
tibia. The long head of biceps femoris forms a common tendon with the short head,
which inserts onto the head of the fibula
What is the short head of Biceps femoris innervated by? What is its action?
Flexion of the knee, innervated by the common peroneal nerve
What are the gluteal muscles supplied by? What is this a branch of?
Where do these vessels leave the pelvis?
The superior and inferior gluteal arteries,
which are branches of the internal iliac artery
They leave the pelvis via the greater
sciatic foramen to enter the gluteal region.
What artery are the hamstring muscles supplied by?
The hamstring muscles are
supplied by three or four perforating arteries that arise from the profunda
femoris.
Where does the Sciatic nerve leave the pelvis?
via the greater sciatic foramen and enters the gluteal
region inferior to the lower border of piriformis.
What are the two nerves that really make up the sciatic nerve?
What do these two nerves innervate?
The nerve is really composed of two
separate nerves bound together – the tibial nerve and the common peroneal
(common fibular) nerve.
The tibial nerve innervates the muscles of the posterior thigh and posterior leg.
The common peroneal (common fibular) nerve innervates the muscles of the
anterior and lateral leg.
What is the popliteal fossa?
The popliteal fossa is a diamond shaped area located on the posterior aspect of the knee. It is the main path by which vessels and nerves pass between the thigh and the leg.
What are the borders of the popliteal fossa?
Superomedial border – semimembranosus and semi tendinosus
Superolateral border – biceps femoris.
Inferomedial border – medial head of the gastrocnemius.
Inferolateral border – lateral head of the gastrocnemius and plantaris.
What are the contents of the Popliteal fossa? (medial to lateral)
Popliteal artery (continuation of the femoral artery)
Popliteal vein
Tibial nerve (innervates muscles of the posterior leg)
Common fibular nerve (common peroneal nerve)
What does the common peroneal (fibular) nerve split into? What do these innervate?
The common peroneal nerve wraps around the
neck of the fibula and then splits into a superficial and a deep branch.
The
superficial peroneal nerve innervates the muscles of the lateral leg and the
deep peroneal nerve innervates the muscles of the anterior leg
Where would be a safe place to do a intramuscular injection?
The only safe place is the Upper outer quadrant of the buttock. Avoid the sciatic nerve!
What vein enters the popliteal vein in the popliteal fossa?
The short saphenous vein
What is more medial - semimebranosus or semitendinous muscle?
SemiMembranosus! It is a bit thinner than semi tendinosus as well
what is the most lateral of the 3 hamstring muscles?
Biceps Femoris is the most lateral of the 3 hamstring muscles. Note its close association with Semitendinosus. The Long Head is much larger, more medial and posterior than the Short Head
In the popliteal fossa, what is the arangement of the nerves?
Tibial Nerve is in the middle more of the popliteal fossa. The common fibular nerve is more lateral
Posterior thigh muscles: what is their arrangement from lateral to medial?
Biceps Femoris (short head), Biceps Femoris (long head), Semitendinous, then semimembraneous
Where does the sacrospinous ligament run between?
The sacrum to the ischial spine.
Where does the sacrotuberous ligament run from and to?
The sacrum to the ischial tuberosity (at the a back of the sacrum)
What does the sacrospinous ligament divide?
the greater sciatic foramen from the lesser sciatic foramen
Semimembranous, Semitendinnous and Biceps femoris long head are the hamstring muscles innervated by the Tibial branch of the sciatic nerve. What innervates the hamstring part of the adductor magnus?
Also the tibial branch of the sciatic nerve nerve. (psyche!)
What nerve innervates the adductor part of the adductor magnus?
The obturator nerve
What innervates the short head of the biceps femoris? What is its action?
the common peroneal (fibular) nerve, and it only flexes the at the knee. It does not extend at the hip.
What nerve lies between the adductor longus and adductor brevis?
The obturator nerve.
What are the sciatic nerve roots?
L4 - S3 (lumbosacral plexus).
What is the difference between Condyle and Epicondyle?
The condyle is smooth and round whereas epicondyle is rough.
Epicondyle is a projection on the condyle
condyle forms an articulation with another bone. whereas epicondyle provides sites for the attachment of muscles
What does the proximal part of the tibia form?
The medial and lateral tibial condyles.
What is on the superior surfaces of the tibial condyles?
The Medial and lateral tibiail plateaus. They are flat and articulate with the femoral condyles to form the knee joint
What lies between the tibial plateaus?
The intercondylar tubercles
What does the patellar ligmaent insert to on the tibia?
The tibial tuberosity. It projects from the upper anterior surface of the tibia and is
palpable.
landmarks of the tibia - what is the soleal line?
An oblique ridge of bone on the posterior surface of the tibia
What are the 7 tarsal bones?
the talus, calcaneus (heel bone),
navicular, cuboid and three cuneiforms (medial, intermediate and lateral)
What makes up the
- Hindfoot
- Midfoot
- Forefoot
Talus and Calcaneus are hindfoot
navicular, cuboid and 3 cuneiforms are midfoot
The Metatarsals and phalanges comprise the forefoot
Where do Metatarsophalangeal joints lie?
between the metatarsals and the
proximal phalanges.
Where do Interphalangeal joints lie?
lie between the phalanges.
How many phalanges does each toe have
Big toe - 2 (only one IPJ)
Toes 2-5 3 (two IPJ)
What are the 3 muscles in the anterior lower compartment of the leg
Tibialis anterior
Extensor hallucis longus (EHL)
Extensor digitorum longus (EDL)