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Clinical Anatomy > Nerves and Vasculature of the Lower Limb > Flashcards

Nerves and Vasculature of the Lower Limb Flashcards

1
Q

What is the Lumbar Plexus?

A

Network of nerves formed within psoas major muscle by ventral rami of L1 to L4 nerves

Largest and most important branches of lumbar plexus are the obturator & femoral nerves

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2
Q

What is the Origin of the Obturator Nerve?

A

Lumbar plexus (L2/L3/L4)

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3
Q

What is the course and distribution of the Obturator Nerve?

A

Course
Begins at level of iliac crest posteriorly  descends through psoas major muscle  pierces psoas fascia and emerges from its medial border It then travels posteriorly to the common iliac arteries laterally along the pelvic wall towards then obturator foramen  leaves pelvis through obturator foramen  enters thigh
Distribution
Supplies adductor muscles of thigh and skin on anterior, medial & posterior surfaces of proximal thigh

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4
Q

How is the obturator nerve damages?

A

Direct trauma or fascial impingement commonest causes. The patient would complain of Medial thigh sensory loss/dysaesthesia
Weakness of adductors manifest as leg instability
A rare cause of adductor weakness, but needs to be considered

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5
Q

What is the origin, course and distribution of the femoral nerve?

A

Origin
L2/L3/L4

Course
Forms in abdomen  pierces psoas major muscle  runs inferolaterally within it  emerges between psoas major and iliacus, just superior to midpoint of inguinal ligament  enters femoral triangle
NAVY - lateral to femoral vessels  divides into branches
Distribution
Supplies anterior thigh muscles
Articular branches to hip and knee joints
Cutaneous branches to anteromedial thigh

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6
Q

What is the origin, course and distribution of the Saphenous nerve?

A

Origin
Terminal SENSORY cutaneous branch of femoral nerve

Course
Arises in femoral triangle  descends with femoral vessels through femoral triangle & adductor canal  descends through thigh and leg with great saphenous vein  passes anterior to medial malleolus & ends on medial side of foot

Distribution
Supplies skin on medial side of leg
Supplies skin on medial side of foot as far anteriorly as head of 1st metatarsal

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7
Q

What is the origin, course and distribution of the Lateral Femoral Cutaneous Nerve?

A

Origin
Lumbar plexus (L2/L3)

Course
Passes deep to inguinal ligament, 2-3 cm medial to anterior superior iliac spine

Distribution
Anterior branches to skin on lateral & anterior parts of thigh
Posterior branch to skin from level of greater trochanter to proximal knee

Impingement causes meralgia paraesthica

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8
Q

What is the sacral plexus?

A

Large plexus of nerves located in true pelvis
Closely related to anterior surface of piriformis muscle

Formed by lumbosacral trunk (ventral rami of L4/L5 nerves united) and ventral rami of S1 to S4 nerves

All branches leave pelvis via greater sciatic foramen, except for nerve to piriformis muscle, perforating cutaneous nerves and those supplying the pelvic diaphragm

Main nerves of sacral plexus are sciatic & pudendal nerves

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9
Q

What is the Sciatic nerve?

A

Largest nerve in body
 2cm wide
So large that it has its own blood supply from inferior gluteal artery

Made up of tibial & common fibular nerves loosely bound together by same connective sheath

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10
Q

What is the origin of the sciatic nerve?

A

Greatest part of sacral plexus
From ventral rami of L4-S3 that converge at the inferior border of piriformis to form the sciatic nerve

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11
Q

What is the course of the sciatic nerve?

A

Enters gluteal region via inferior part of greater sciatic foramen  emerges as most lateral structure at inferior border of piriformis muscle

Medial to it are inferior gluteal nerves and vessels, internal pudendal vessels and pudendal nerves
Runs inferolaterally under gluteus maximus, midway between greater trochanter & ischial tuberosity  rests on ischium  passes posterior to obturator internus, quadratus femoris and adductor magnus  descends along posterior aspect of thigh  ends at superior angle of popliteal fossa, usually halfway down thigh, by dividing into tibial & common fibular nerves

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12
Q

What is the distribution of the sciatic nerve?

A

Supplies no structures in the gluteal region

Supplies skin of foot, most of leg, posterior thigh muscles and all leg and foot muscles

Also supplies articular branches to all joints of the lower limb

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13
Q

What is the origin, course and distribution of the tibial nerve?

A

Origin
Sciatic nerve

Course
Forms at apex of popliteal fossa & descends through middle of it
Lies on popliteus muscle
Superficial to popliteal artery & vein
Runs inferiorly on tibialis posterior with popliteal and tibial vessels
Terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves

Distribution
Supplies posterior muscles of leg (soleus, gastrocnemius, plantaris, and popliteus)
Articular branches to knee joint

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14
Q

What is the origin, course and distribution of the medial plantar nerve?

A

Origin
Large terminal branch of tibial nerve

Course
Passes distally in foot between abductor hallucis and flexor digitorum brevis
Divides into muscular and cutaneous branches

Distribution
Supplies skin of medial side of sole and sides of first three digits
Supplies abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and 1st lumbricals

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15
Q

What is the origin, course and distribution of the lateral plantar nerve?

A

Origin
Smaller terminal branch of tibial nerve

Course
Passes laterally in foot between quadratus plantae and flexor digitorum brevis muscles
Divides into superficial and deep branches

Distribution
Supplies quadratus plantae, abductor digiti minimi, flexor digiti minimi brevis
Deep branch supplies plantar and dorsal interossei, lateral 3 lumbricals, and adductor hallucis
Supplies skin on sole lateral to line splitting 4th digit

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16
Q

What is the origin, course and distribution of the Common Fibular (Peroneal) Nerve?

A

Origin
Sciatic nerve

Course
Forms at apex of popliteal fossa  follows medial border of biceps femoris along superolateral boundary of popliteal fossa  Leaves fossa superficial to lateral head of gastrocnemius  over posterior aspect of head of fibula  winds around fibular neck deep to fibularis longus (susceptible to injury)  divides into deep & superficial fibular nerves

Distribution
Supplies skin on lateral part of posterior aspect of leg via its branch, lateral sural cutaneous nerve
Articular branch to knee joint

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17
Q

What is the origin, course and distribution of the Superficial Fibular Nerve?

A

Origin
Common fibular nerve

Course
Arises between fibularis longus and neck of fibula  descends in lateral compartment of leg  pierces deep fascia in distal third of leg to become cutaneous and send branches to foot and digits

Distribution
Supplies fibularis longus and brevis muscles
Skin on distal third of anterior surface of leg, dorsum of foot and all digits except lateral side of 5th and adjoining sides of 1st and 2nd digits

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18
Q

What is the origin, course and distribution of the Deep Fibular Nerve?

A

Origin
Common fibular nerve

Course
Arises between fibularis longus and neck of fibula Passes through extensor digitorum longus and descends on interosseous membrane  Crosses distal end of tibia  passes deep to extensor retinaculum to enter dorsum of foot
Distribution
Supplies anterior muscles of leg
Supplies extensor digitorum brevis
Dorsum of foot and skin on adjoining sides of 1st and 2nd digits (dorsal web of great toe)
Sends articular branches to joint it crosses

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19
Q

What is the origin, course and distribution of the Sural Nerve (Sensory)?

A

Origin
From both tibial & common fibular nerves

Course
Descends between heads of gastrocnemius and becomes superficial at middle of leg
Descends with small saphenous vein
Passes inferior to lateral malleolus to lateral side of foot

Distribution
Supplies skin on posterior and lateral aspects of leg
Lateral side of foot including part of heel

20
Q

What is the origin, course and distribution of the Pudendal Nerve?

A

Origin
Sacral plexus
Ventral rami of S2/S3/S4

Course
Accompanies internal pudendal artery  leaves pelvis inferior to piriformis muscle via greater sciatic foramen  hooks around sacrospinous ligament  enters perineum via lesser sciatic foramen

Distribution
Supplies muscles of perineum, including external anal sphincter
Sensory to genitalia

21
Q

What is the origin, course and distribution of the Superior Gluteal Nerve?

A

Origin
Ventral rami of L4/L5/S1

Course
Leaves pelvis through greater sciatic foramen superior to piriformis and runs between gluteus medius and minimus

Distribution
Supplies gluteus medius and minimus and tensor fascia lata

22
Q

What is the origin, course and distribution of the Inferior Gluteal Nerve?

A

Origin
Ventral rami L5/S1/S2

Course
Leaves pelvis through greater sciatic foramen inferior to piriformis and divides into branches

Distribution
Supplies gluteus maximus

23
Q

What is the origin, course and distribution of the Clunial Nerves (Superior, Middle & Inferior)?

A

Origin
Superior: Dorsal rami L1/L2/L3
Middle: Dorsal rami S1/S2/S3
Inferior: Ventral rami S2/S3

Course
Superior: Across iliac crest
Middle: Exit via posterior sacral foramina & enter gluteal region
Inferior: Curves around inferior border of gluteus maximus

Distribution
Supplies skin of gluteal region to greater trochanter

24
Q

What is the origin, course and distribution of the Superior Gluteal Artery?

A

Origin
Internal iliac artery

Course
Enters gluteal region through greater sciatic foramen superior to piriformis and divides into superficial and deep branches
Anastomoses with inferior gluteal & medial circumflex femoral arteries

Distribution
Superficial branch supplies gluteus maximus
Deep branch supplies gluteus medius and minimus and tensor fascia lata

25
Q

What is the origin, course and distribution of the Inferior Gluteal Artery?

A

Origin
Internal iliac artery

Course
Enters gluteal region through greater sciatic foramen inferior to piriformis  medial to sciatic nerve
Anastomoses with superior gluteal artery and joins cruciate anastomosis of thigh

Distribution
Supplies gluteus maximus, obturator internus, quadratus femoris and superior part of hamstrings

26
Q

What is the origin, course and distribution of the Internal Pudendal Artery?

A

Origin
Arise directly or indirectly from the internal iliac arteries

Course
Enters gluteal region through greater sciatic foramen and descends posterior to ischial spine
Enters perineum through lesser sciatic foramen

Distribution
Supplies external genitalia and muscles in perineal region

27
Q

What is the origin, course and distribution of the Obturator Artery?

A

Origin
Internal iliac artery

Course
Passes through obturator foramen enters medial compartment of thigh
Divides into anterior and posterior branches

Distribution
Anterior branch supplies obturator externus, pectineus, adductors of thigh and gracilis

Posterior branch supplies muscles attached to ischial tuberosity

28
Q

What is the origin, course and distribution of the Femoral Artery?

A

Origin
Continuation of external iliac distal to inguinal ligament

Course
Begins at midpoint of inguinal ligament, midway between ASIS & pubic symphysis  enters femoral triangle, passing deep to the inguinal ligament  lies lateral to femoral vein and medial to femoral nerve  descends on iliopsoas & pectineus  bisects femoral triangle at its apex  enters adductor canal, deep to sartorius  exits by passing through adductor hiatus  becomes popliteal artery

Distribution
Supplies anterior and anteromedial surface of thigh

29
Q

What is the origin, course and distribution of the Deep Artery of the Thigh?

A

Origin
Femoral artery about 4cm distal to inguinal ligament

Course
Passes inferiorly, deep to adductor longus

Distribution
Anterior compartment of thigh

30
Q

What is the origin, course and distribution of the Popliteal Artery?

A

Origin
Femoral artery

Course
Continuation of femoral artery at adductor hiatus in adductor magnus  popliteal fossa  inferolaterally to inferior border of popliteus  ends at lower border of popliteus muscle by dividing into anterior and posterior popliteal tibial arteries

Distribution
Genicular branches supply capsule & ligaments of knee
Muscular branches supply hamstrings, gastrocnemius, soleus & plantaris muscles

31
Q

What is the origin, course and distribution of the Anterior Tibial Artery?

A

Origin
Popliteal artery

Course
Passes between tibia and fibula into anterior compartment of the leg through gap in superior part of interosseous membrane  descends on interosseous membrane between tibialis anterior and extensor digitorum longus  becomes dorsalis pedis artery at level midway between malleoli, distal to extensor retinaculum

Distribution
Supplies muscles of anterior compartment
Branches contribute to arterial networks around ankle

32
Q

What is the origin, course and distribution of the Dorsalis Pedis Artery?

A

Origin
Anterior tibial artery

Course
Continuation of anterior tibial artery distal to inferior extensor retinaculum and runs deep to it  runs between extensor hallucis longus and extensor digitorum longus tendons on dorsum of foot  descends anteromedially to first interosseous space

Distribution
Muscles on dorsum of foot
Major source of blood supply to toes

33
Q

What is the origin, course and distribution of the Posterior Tibial Artery?

A

Origin
Popliteal artery

Course
Passes through posterior compartment of leg  terminates distal to flexor retinaculum by dividing into medial and lateral plantar arteries

Distribution
Circumflex fibular branch joins anastomoses around knee

Nutrient artery supplies tibia

34
Q

What is the origin, course and distribution of the medial plantar artery?

A

Origin
Posterior tibial artery

Course
Deep plantar arch

Distribution
Supplies mainly muscles of great toe

35
Q

What is the origin, course and distribution of the lateral plantar artery?

A

Origin
Posterior tibial artery

Course
Runs anterolaterally first deep to abductor hallucis then flexor digitorum brevis  medially across foot with lateral plantar nerve  deep plantar arch, which begins opposite base of 5th metatarsal
It is joined by deep plantar artery

Distribution
These arteries with superficial branches of the medial and lateral plantar arteries form the plantar digital arteries supplying adjacent digits

36
Q

What is the origin, course and distribution of the fibular artery?

A

Origin
Posterior tibial artery

Course
Descends in posterior compartment adjacent to posterior intermuscular septum

Distribution
Perforating branches supply lateral compartment of leg

37
Q

What are the Deep Arteries of Foot Dorsal View

A

. Deep Plantar Artery

  1. Dorsal Metatarsal Arteries
  2. Lateral Tarsal Artery
  3. Medial Tarsal Artery
  4. Arcuate Artery
  5. Dorsal Digital Arteries

Lateral Plantar Artery

  1. Deep Plantar Arch
  2. Plantar Metatarsal Arteries
  3. Plantar Digital Arteries
38
Q

Explain the Venous Drainage of Lower Limb.

A

Dorsal digital veins  dorsal metatarsal veins  dorsal venous arch, which communicates with plantar venous arch  great saphenous vein (medially) & small saphenous vein (laterally)

Deep veins of sole start as plantar digital veins that communicate with dorsal digital veins

39
Q

What is the great saphenous vein?

A

Great Saphenous Vein
Formed by union of dorsal vein of great toe and dorsal venous arch of foot  ascends anterior to medial malleolus  posterior to medial condyle of femur  anastomoses with small saphenous vein  through saphenous opening in fascia lata  empties into femoral vein

40
Q

What is the Small Saphenous Vein?

A

Arises on lateral side of the foot from union of dorsal vein of small toe and dorsal venous arch  posterior to lateral malleolus  lateral border of calcaneal tendon  crosses to midline of fibula to enter deep fascia  between heads of gastrocnemius muscle  pierces deep popliteal fascia and empties into popliteal vein in popliteal fossa
Perforating veins shunt blood from superficial veins to deep veins

41
Q

Where is the popliteal vein?

A

Formed at distal border of popliteus
Runs with popliteal artery
Ends at the adductor hiatus where it becomes femoral vein

42
Q

Where is the femoral vein?

A

Continuation of popliteal vein proximal to adductor hiatus  adductor canal, lying posterolateral then posterior to femoral artery  enters femoral sheath lateral to femoral canal  ends posterior to inguinal ligament  becomes external iliac vein

Receives deep vein of thigh, great saphenous vein and other tributaries in inferior part of femoral triangle

43
Q

Where are the gluteal veins?

A

Tributaries of internal iliac veins
Superior and inferior gluteal veins accompany arteries
Form alternative routes for return of blood from lower limb if femoral vein i

44
Q

Where is the internal pudendal veins?

A

Accompany internal pudendal arteries
Drain external genitalia

45
Q

What is the lymphatic drainage of the lower limb?

A

Superficial lymphatic vessels accompany saphenous veins  superficial inguinal lymph nodes  external iliac lymph nodes and deep inguinal lymph nodes (under deep fascia on medial aspect of femoral vein)

Lymphatics accompanying small saphenous vein  popliteal lymph nodes

Deep lymphatic vessels from leg accompany deep veins  popliteal lymph nodes  deep inguinal lymph nodes  external iliac lymph nodes

46
Q

What is the lymphatic drainage of the gluteal region?

A

Lymph from deep tissues of buttocks  superior and inferior gluteal lymph nodes  internal, external and common iliac lymph nodes  lateral aortic lymph nodes

Lymph from superficial tissues  superficial inguinal lymph nodes

Clinical Anatomy (21 decks)

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