Overview of the lower limb 01/10/18 Flashcards
Where does the lower limb begin?
Extends from the pelvis
What are the 3 functions of the lower limb?
Support body weight
Locomotion
Maintain balance
What are the six regions of the lower limb?
Gluteal Femoral Knee Leg Ankle Foot
What is the proper name of the Hip joint?
Acetabulo-femoral joint
What type of joint is the hip joint?
Ball and Socket
Synovial
What 4 movements is the hip joint able to do?
Flexion-extension
Abduction-adduction
Medial-lateral rotation
Circumduction
Where are synovial joints found?
Within strong joint capsules
What formation are the ligaments of the hip in?
Spiral formation
What are the three ligaments of the hip joint?
Iliofemoral
Ischiofemoral
Pubofemoral
Why are the hip ligaments arranged in this (spiral) formation?
So that when the hip moves the joint compacts and stabilizes
What is the primary blood supply to the head of the femur?
The medial circumflex femoral artery
What arteries are damaged in femoral neck fractures?
Intracapsular retinacular arteries
What kind of joint is the knee joint?
Modified synovial hinge joint
What are the 2 functions of the knee joint?
Flexion/extension
Slight rotation
What are the 3 articulations of the knee complex?
Medial Tibiofemoral
Lateral Tibiofemoral
Patellofemoral
What are the 3 extracapsular ligaments of the knee?
Patellar
Lateral (fibular) collateral
Medial (tibial) collateral
What are the 2 intra-articular ligaments of the knee?
Anterior cruciate (ACL) Posterior cruciate (PCL)
What is the difference between the patellar ligament and the patellar tendon?
They are the same thing
What are the characteristics of the lateral collateral ligament and why?
Thin and cord like as there are lots of other structures around it for support
What are the characteristics of the medial collateral ligament and why?
Thick
More robust than LCL
Withstands more force
What are the menisci?
Crescent shaped fibrocartilage
What is the function of the ACL?
Prevents the anterior movement of the tibia on the femur
What is the function of the PCL?
Prevents the posterior movement of the tibia on the femur
How do the ACL and PCL interact?
They cross over
What is the Q angle?
The angle between the following two lines:
The Asis and the mid-point of the patella
Which gender is likely to have a greater Q angle?
Females as they have wider hips for child bearing
How do nerves enter/exit the pelvis and perineum?
Through the greater and lesser sciatic foramen
Which ligaments separates the greater and lesser sciatic foramen?
Sacrospinous and sacrotuberous
What region is through the greater sciatic foramen?
Gluteal
What region is through the lesser sciatic foramen?
Perineum
For injections, what is the gluteal region divided into and what is the best region?
Quadrants
ULQ
What are the 3 nerves that enter the pelvis via the gluteal region?
Sciatic
Pudenal
Posterior cutaneous nerve of the thigh
Where does the sciatic nerve originate from?
L4-S3
What is the largest nerve in the body?
Sciatic
Where does the sciatic nerve supply?
Posterior thigh
All leg and foot muscles
Most of the skin via tibial and fibular branches
Where does the Pudenal nerve originate?
S2-S4 (keeps the gut off the floor)
What is the principle nerve to the perineum?
Pudenal
Where does the posterior cutaneous nerve of the thigh originate?
S1-S3
Where does the posterior cutaneous nerve of the thigh supply?
Skin over posterior thigh
Popliteal fossa
Lateral perineum
Upper medial thigh
What are the 4 superficial muscles of the gluteal region?
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia latae
What are the 3 functions of the superficial thigh muscles?
Extension
Abduction
Medial rotation
What does the inferior gluteal nerve supply?
Gluteus maximus
What supplies all other superficial gluteal muscles?
Superior gluteal nerve
What are the 4 deep muscles of the gluteal region?
Piriformis
Obturator internus
Gemelli (superior and inferior)
Quadratus femoris
What are the 2 functions of the deep muscle group?
Lateral rotation of thigh
Hip stabilisers
What supplies the deep gluteal muscles?
Nerves from the sacral plexus
What does a tight piriformis cause?
Sciatica
What is a Trendelenberg gait and what causes it?
An abnormal walk caused by reduced function of the superior gluteal nerve and weak hip abduction by the gluteus medius
Which hip drops in trendelenberg gait?
The contralateral hip
Where does the sciatic nerve exit the gluteal region?
Inferior to the piriformis
What artery supplies the sciatic nerve?
Artery to the sciatic nerve
Does the sciatic nerve supply the gluteal region/
No
What are the two portions of the sciatic nerve?
Tibial/Medial
Common fibular/Lateral
What are compartments surrounded/divided by?
An intermuscular septum
What invaginates to form an intermuscular septum?
Deep Fascia
What are the three compartments of the thigh?
Anterior
Medial
Posterior
What are the three compartments of the leg?
Anterior
Posterior
Lateral
What is true about muscles in the same compartment?
They generally have similar actions
They generally have the same nerve supply
What is compartment syndrome?
The fascia creates an enclosed space
When increased pressure occurs (i.e a bleed or swelling) it can affect the functions of muscles and nerves in the compartment
What is the emergency treatment for compartment syndrome?
Fasciotomy
What are the 2 functional groups of muscles in the anterior compartment of the thigh?
Flexors of thigh
Extensors of leg
What are the 4 flexors of the thigh?
Pectineus
Iliopsoas
Sartorius
Rectus femoris
What are the 4 extensors of the leg?
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
What supplies everything in the anterior compartment of the thigh apart from the psoas major?
The femoral nerve (L2,3,4)
What supplies the psoas major/
L1,2,3
What are the 5 boundaries of the femoral triangle?
Superior - inguinal ligament Medial - Lateral border of adductor longus Lateral - Medial border of sartorius Floor - Iliopsoas and pectineus Roof - Deep fascia
What are the contents of the femoral triangle?
Femoral Nerve
Femoral Artery
Femoral Vein
Lymphatics
What is the function of the muscles in the medial thigh compartment/
Adduction of the thigh
What are the 5 adductors of the thigh?
Adductor longus Adductor brevis Adductor magnus Gracilis Obturator externus
What supplies all of the adductors of the thigh?
Obturator nerve (L2,3,4) except the hamstring - tibial nerve
What is the function of the muscles in the posterior compartment of the thigh?
Extension of thigh
Flexion of leg
What are extensors of the thigh and flexors of the leg?
Semitendinosus
Semimebranosus
Biceps femoris
What supplies the extensors of the thigh and flexors of the leg?
Tibial division of sciatic nerve
What supplies the short head of biceps femoris?
The common fibular division of sciatic
What is the function of the Superficial muscles in the posterior compartment of the leg?
Plantarflexors of the ankle
What is the function of the Deep muscles in the posterior compartment of the leg?
Flexors of toes
Plantarflexors of ankle
What are the 3 superficial muscles of the posterior leg compartment?
Gastrocnemius
Soleus
Plantaris
What are the 4 deep muscles of the posterior compartment of the leg?
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibilas posterior
What supplies all the muscles of the posterior leg compartment?
The tibial nerve
What is the function of the muscles in the anterior compartment of the leg?
Dorsiflexors of ankle and extensors of toes
What are the 4 muscles in the anterior compartment of the leg?
Tibialis anterior
Entensor digitorum longus
Extensor hallucis longus
Fibularis tertius
What nerve supplies all of the muscles in the anterior compartment of the leg?
Deep fibular nerve
What is the function of the muscles in the lateral compartment of the leg?
Evert the foot and weakly plantarflex ankle
What are the muscles in the lateral compartment of the leg?
Fibularis longus
Fibularis brevis
What nerve supplies the lateral compartment of the leg?
Superficial fibular nerve (L5,S1,S2)
What does deep fibular nerve palsy cause?
Loss of muscle action in anterior leg compartment
Reduced or absent dorsiflexion
What are the 4 boundaries of the popliteal fossa?
Superolateral - Biceps femoris
Superomedial - semimembranosus
Inferior - Gastrocnemius
Roof - Popliteal fascia
What are the contents of the popliteal fossa?
Lots of fat
Terminal small saphenous vein
Popliteal vessels
Tibial and common fibular nerves
What is the thickest and strongest tendon in the body?
Calcaneal/Achilles tendon
How long is the achilles tendon?
15cm
What two tendons come together to form the achilles tendon/
Gastrocnemius
Soleus
Where does the achilles tendon attach?
Calcaneal tuberosity of the calcaneus
What does the ankle jerk reflex test?
S1,S2 nerve roots
What veins do the superficial lymphatics follow?
Saphenous veins
Where do the superficial lymphatics drain to?
Superficial inguinal nodes then external iliac nodes
What veins do deep lymphatics follow?
Deep veins
Where do the deep lymphatics drain to?
Popliteal lymph nodes then deep inguinal nodes, then external iliac nodes