Popliteal Fossa and Posterior Leg Flashcards

1
Q

What is the popliteal fossa?

A

Space posterior to knee joint

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2
Q

What muscles are the boundaries of the popliteal fossa?

A
Superomedially = semitendinosus and semimembranosus
Superolaterally = biceps femoris
Inferiorly = medial and lateral heads of gastrocnemius
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3
Q

How does the small saphenous vein end in the popliteal fossa?

A

By passing through the deep fascia (popliteal fascia) in the median plane of the limb to drain into the popliteal vein

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4
Q

Where is the neurovascular bundle located in the popliteal fossa?

A

In its median plane

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5
Q

What are the contents of the popliteal neurovascular bundle (from superficial to deep)?

A
Tibial nerve (from sciatic nerve)
Popliteal vein (continuation of posterior tibial vein)
Popliteal artery (continuation of posterior tibial artery)
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6
Q

Where are the popliteal lymph nodes located?

A

Along the popliteal vein in the popliteal fossa

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7
Q

Where does the common sciatic nerve most commonly divide into the tibial and common fibular nerves?

A

The superior apex of the fossa (if not already divided in the gluteal region or posterior thigh)

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8
Q

Where does the tibial nerve pass through?

A

Passes vertically through the fossa

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9
Q

Where is the common fibular nerve located?

A

Skirts the lateral border of the fossa, deep to biceps femoris tendon

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10
Q

Where does the common fibular nerve leave the popliteal fossa?

A

Between the biceps femoris tendon and the lateral head of gastrocnemius to reach the fibular neck

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11
Q

What happens to the common fibular nerve once it reaches the fibular neck?

A

Winds around it before dividing into the deep and superficial fibular nerves

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12
Q

Where are the sural nerves located and what do they supply?

A

Located mainly in superficial fascia of fossa and supply skin and fascia on the posterolateral aspect of the leg and foot

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13
Q

What give rise to the sural cutaneous branches?

A

The tibial nerve = medial sural cutaneous nerve

Common fibular nerve = lateral sural cutaneous nerve

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14
Q

How do the sural cutaneous branches communicate?

A

Via the sural communicating branch

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15
Q

What nerves make up the sural nerve?

A

The medial sural cutaneous nerve and the communicating branch fibres

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16
Q

Where does the sural nerve leave the popliteal fossa to supply?

A

Descends alongside the small saphenous vein in the superficial fascia of the median plane of the posterior compartment of the leg

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17
Q

What does the tibial nerve give branches to inside the popliteal fossa?

A

Both heads of the gastrocnemius, deeper muscles = small plantaris muscle, popliteus muscle

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18
Q

Where is the small plantaris muscle located?

A

Deep to the lateral head of the gastrocnemius (combines inferiorly with the Achilles tendon)

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19
Q

Where is the popliteas muscle located?

A

Deep to plantaris

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20
Q

What are two ways the common fibular nerve can be damaged?

A

Compression injury against neck of fibula, damaged in fractures of the fibular neck

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21
Q

What can compression of the common fibular nerve cause?

A

Dysfunction of the nerve and the muscles it supplies, as well as leading to abnormal sensation in the area of skin supplies by the nerve

22
Q

Why is the popliteal pulse difficult to palpate?

A

Due to deep location of the popliteal artery and presence of popliteal fat

23
Q

How should the patient’s leg be positioned when palpating the popliteal pulse?

A

Flex knee to 30 degrees and relax hamstring muscles

24
Q

What are the superficial muscles of the posterior leg?

A

Gastrocnemius, soleus, plantaris

25
Q

What are the deep muscles of the posterior leg?

A

Popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior

26
Q

What action do the muscles of the posterior leg mostly do?

A

Flex the ankle and toes

27
Q

What movement does tibialis posterior aid in?

A

Assists tibialis anterior (anterior of leg) with inversion of foot

28
Q

What nerve supplies the posterior leg?

A

Tibial nerve = passes through deep to soleus with posterior tibial vessels

29
Q

Where do structures leave the posterior leg?

A

Reach the sole of the foot by passing posterior to the medial malleolus and deep to the flexor retinaculum

30
Q

What structures leave the posterior leg (from anterior to posterior)?

A

Tendons of tibialis posterior and flexor digitorum longus, posterior tibial artery, tibial nerve, tendon hallucis longus

31
Q

What are the two heads and muscle bellies of gastrocnemius?

A

Medial and lateral

32
Q

Where do both heads of gastrocnemius attach?

A
Distally = calcaneus via Achilles tendon
Proximally = to their respective femoral condyle
33
Q

What actions can gastrocnemius perform?

A

Crosses both knee and ankle joint so weak knee flexor and powerful ankle plantar-flexor

34
Q

Where does soleus attach proximally?

A

To neck of fibula and soleal line of tibia (attachment appears to slope inferiorly from lateral to medial)

35
Q

Where does soleus attach distally?

A

Calcaneus via Achilles tendon

36
Q

Where does soleus get its name from?

A

It is shaped like a flat fish (a sole)

37
Q

How is the ankle jerk reflex carried out?

A

Calcaneus tendon struck by tendon hammer just proximal to its insertion into the calcaneus (is deep tendon reflex)

38
Q

What position should the patient be in for an ankle jerk reflex to be performed?

A

Supine, lower limbs externally rotated, knees flexed and ankle dorsiflexed with gastrocnemius and soleus relaxed

39
Q

What is a normal response to the ankle jerk reflex?

A

Involuntary contraction of the gastrocnemius and soleus with ankle slightly plantar flexing

40
Q

What does the ankle jerk reflex confirm?

A

Functions of muscles, their peripheral supply (tibial nerve, S1-2), and the central connections at the spinal cord level and above

41
Q

What are the branches of the popliteal artery present in the popliteal fossa?

A

Anterior tibial artery, posterior tibial artery, fibular artery

42
Q

Where does the popliteal artery divide into the anterior and posterior tibial artery?

A

Immediately distal to the popliteal fossa

43
Q

What is the fibular artery a branch of?

A

Posterior tibial artery

44
Q

Where does the anterior tibial artery supply?

A

Pierces the interosseous membrane to supply the anterior compartment of the leg

45
Q

Where does the posterior tibial artery supply?

A

Posterior compartment

46
Q

What does the posterior tibial artery run with?

A

The tibial nerve, mainly between the superficial and deep muscle

47
Q

Where does the posterior tibial artery leave the posterior compartment of the leg?

A

Passes posterior to the medial malleolus and deep to the flexor retinaculum

48
Q

Where does the posterior tibial artery terminate?

A

In the foot by dividing into medial and lateral plantar arteries

49
Q

Where does the fibular artery branch from the posterior tibial artery?

A

In the proximal half of the posterior compartment of the leg

50
Q

Where does the fibular artery supply?

A

Descends in compartment on posterior intermuscular septum and sends perforating branches through the septum to supply the lateral compartment of the leg

51
Q

Where are the proximal attachments of the deep muscles of the posterior leg?

A

All three muscles connect to tibia (inferior to soleal line), mid-shaft of fibula and the interosseous membrane

52
Q

Where do the tendons of the deep muscles of the posterior leg attach?

A

Pass into sole of foot to attach to medial tarsal bones, distal phalanges of lateral four toes and distal phalanx of great toe