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Anatomy > Posterior Leg FINAL > Flashcards

Posterior Leg FINAL Flashcards

1
Q

greater and lesser sciatic foramen

A

-greater sciatic foramen above the sacrospinous ligament
-lesser sciatic foramen- below sacrospinous ligament and to the right of sacrotuberous ligament
-ABOVE PIRIFORMIS- superior gluteal nerve, vein, and artery
-BELOW PIRIFORMIS- sciatic nerve, inferior gluteal artery, vein, and nerve, posterior femoral cutaneous nerve
-internal pudendal nerve and artery- exits greater sciatic foramen below piriformis and exit at lesser sciatic foramen
-obturator externus - in the lesser sciatic foramen
-VARIATION- sciatic nerve can split early -> common fibular nerve can go over or through piriformis

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2
Q

glute blood supply

A

-INTERNAL ILIAC ARTERY
-gluteus maximus- inferior and superior gluteal arteries
-gluteus minimus, medius, tensor fasciae latae- superior gluteal artery
-lateral rotators- inferior gluteal artery
-hamstrings- inferior gluteal artery

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3
Q

gluteus maximus

A

-extends the hip from flexed position
-climbing stairs, rising from sitting
-walking, heel strike
-gluteus maximus slows forward motion of trunk by arresting flexion of hip
-weak gluteus maximus- lurch trunk backward to interrupt forward motion during heal strike -> compensates for lack of hip extension
-laterally rotates thigh

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4
Q

trendelenburg gait

A

-weakness of hip abductors (gluteus medius, minimus, and tensor fasciae latae)
-compensated gait- pt leans towards weak side to compensate
-uncompensated gait- pelvis sags on contralateral side of weakness
-trendelenberg test- standing on both feet equally -> stable
-if you lift one foot and pelvis sags to upsupported side -> +
-+ test -> functional impairment often due to superior gluteal nerve lesion or fracture of femur
-L4-S3 region
-can be caused by improper gluteal injection damaging sciatic n
-can cause foot slap (but for other reasons)

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5
Q

lateral/external rotators

A

-stabilize
-landmarks orthopedic surgery on hip joint
-superior to inferior:
-piriformis
-superior gemellus
-obturator internus
-inferior gemellus
-quadratus femoris
-obturator internus, inferior gemellus, and quadratus femoris- sometimes called tricpes coxae bc tendons are merged
-sacral plexus innervates

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6
Q

gluteal intramuscular injection

A

-between posterior superior iliac spine and superior aspect of greater trochanter
-careful of sciatic

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7
Q

nerve and artery to posterior thigh

A

-tibial nerve (from sciatic)
-biceps femoris short heat- common fibular nerve
-deep femoral artery and inferior gluteal artery

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8
Q

hamstrings

A

-semitendinosus, semimembranosus, biceps femoris long head
-must attach at ischial tuberosity, innervated by tibial nerve, and cross hip and knee joint
-biceps femoris short head does not cross hip joint and is innervated by common fibular nerve
-portion of adductor magnus attaches at ischial tuberosity and is innervated by tibial nerve but does not cross knee joint

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9
Q

pes anserinus

A

-stabilize medial knee joint

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10
Q

sciatic nerve

A

-L2-S3
-branch of sacral plexus
-ventral primary rami
-sciatica- unilateral, compression by disc herniation, spondylolithesis, disc degeneration

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11
Q

trochanteric bursitis and ischial bursitis

A

-trochanteric- females MC, overuse, ex. runners, ballet dancers
-ischial- sitting too long, prolonged injury

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12
Q

hip joint ligaments

A

-stability while still providing free range of movement
-iliofemoral ligament (Y ligament)- reinforces capsule anteriorly, prevents hyperextension of femur while standing
-pubofemoral ligament- strengthens capsule anterior and inferiorly, prevents abduction of femur
-ischiofemoral ligament- reinforces capsule posteriorly, prevents excessive medial rotation and hyperextension

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13
Q

development dysplasia

A

-DDH
-MC orthopedic disorder in newborns
-shallow acetabulum or loose ligaments
-dislocated- most severe -> head of femur out of socket
-dilocatable- can be easily pushed out of socket
-subluxable- loose in socket and can be moved
-tx- harness or brace
-no tx past 2 -> pain, waddling, deformity
-no tx- osteoarthritis

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14
Q

osteoarthritis of hip

A

-frayed and rough
-bones compensate for lost cartilage and grow outwards -> bone spurs (osteophytes)
-joint space narrowing, sclerosis, osteophytes, chondral cysts

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15
Q

hip structures

A

-hyaline cartilage- covers lunate surface and femoral head
-ligament of head of femur usually transmits artery of femoral head (branch of obturator artery) -> minor role in blood supply
-supplied by medial and lateral circumflex femoral arteries primarily

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16
Q

hip fractures

A

-intracapsular vs extracapsular
-intracapsular -> high chance of avascular necrosis (disruption of medial circumflex femoral artery)
-extracapsular- MC intertrochanteric fracture
-intracapsular- MC sub-capital

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17
Q

sural cutaneous nerves

A

-tibial nerve- gives of medial sural
-common fibular nerve- gives of lateral sural and communicating branch

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18
Q

popliteal neurovascular anterior to posterior

A

-anterior to posterior:
-tibial nerve
-popliteal artery
-popliteal vein

-popliteal artery -> gives off genicular arteries
-small saphenous enters

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19
Q

popliteal artery branches

A

-superior and inferior lateral/medial genicular arteries -> collateral circulation in case of popliteal artery aneurysms
-tibialis anterior and tibialis posterior
-tibialis posterior -> fibular artery
-fibular artery supplies lateral calf

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20
Q

bakers cysts

A

-popliteal cysts
-medial aspect
-between medial head of gastrocnemius and semimembranosus
-can rupture and release fluid

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21
Q

plantaris muscle

A

-insignificant
-tendon is often used to replace damaged tendons in forearm and hand
-typically joins calcaneal tendon or inserts independently on calcneal tuberosity in position medial to calcaneal tendon

22
Q

triceps surae

A

-gastrocnemius medial and lateral heads
-soleus

23
Q

tibialis posterior

A

-plantar flexion
-inversion
-tibial nerve
-posterior tibial artery
-fibular muscles eversion
-tibialis anterior and extensors- dorsiflex

24
Q

popliteus

A

-popliteal artery
-tibial nerve

25
flexor retinaculum
-medial posterior -tarsal tunnel -tarsal tunnel anterior to posterior: -tibialis posterior -flexor digitorum longus -posterior tibial artery -posterior tibial vein -tibial nerve -flexor hallucis longus - travels through fibro-osseous tunnel deep to susteniculum tali -Tom, Dick, and A, Very, Nervous, Harry
26
posterior hip dislocation
-adducted and medially rotated -little bit shorter -careful of medial circumflex femoral and sciatic nerve -deceleration injury usually^^
27
what muscles do the fibular artery supply??
28
cutaneous innervation to dorsal foot
-superficial fibular nerve -between big toe- deep fibular nerve
29
foot drop and foot slap
-medial and lateral plantar nerve -DROP- complete paralysis of foot dorsiflexor muscles -> toe points towards floor when picked up -DROP COMPENSATION- to prevent dragging toes -> increasing knee flexion -> steppage gait -SLAP- weakness -> during heal strike foot cant lower slowly -> it slaps down -MC cause- compression of common fibular nerve or deep fibular -other neurologic causes- charcot marie tooth disease, diabetic neuropathy, MS -have large arches!
30
foot bones
-hindfoot- calcaneus, talus -midfoot: -navicular -medial cuneiform -intermediate cuneiform -lateral cuneiform -cuboid -forefoot: -metatarsals (5) -phalanges (14)
31
calcaneal (achilles) tendon
-attaches to calcaneal tuberosity -retrocalcaneal bursa -> irritation/inflammation -> pain at heel and ankle TEAR: -microscopic tears of collagen in tendon -> tendinitis -> can lead to tendon rupture (avoid steroids!) -going out to do a lunge -watershed area -irregular mass in posterior calf -difficulty plantar flexing -easy to do dorsiflex bc no opposing pull -tomson's test- squeeze gastrocnemius and look for flexion -> no flexion -> tendon tear
32
syndesmotic sprain
-high ankle sprain -injury to distal tibiofibular syndesmosis with possible disruption of distal tibiofibular ligaments and interosseous membrane
33
joints in the foot
-subtalar- between talus and calcaneus -transverse tarsal joint: 2 joints: -talonavicular -calcaneocuboid joint
34
deltoid ligament
-medial collateral ankle ligament -fan shaped -attached to medial malleolus of tibia, navicular, talus, calcaneus -prevents extreme ROM (eversion mainly) -4 parts: -tibionavicular ligament -tibiocalcaneal ligament -anterior tibiotalar ligament -posterior tibiotalar ligament
35
plantar fascia / plantar fasciitis
-plantar fascia- deep fascia of sole of foot -plantar aponeurosis -plantar fasciitis- MC heel pain -> repeated microtrauma to plantar fascia -running for long time -persistent -anterior to calcaneal tuberosity -P.S.- heel pain can also be caused by tarsal tunnel syndrome -> compression of tibial nerve
36
plantar foot muscles: extrinsic
-abductor hallucis- medial plantar artery -flexor digitorum brevis- medial and lateral plantar artery -abductor digiti minimi- lateral plantar artery and nerve -abductor hallucis and flexor digitorum brevis- medial plantar nerve
37
plantar foot muscles: intrinsic second layer
-quadratus plantae- lateral plantar nerve -lumbricals- medial 1- medial; medial 3- lateral plantar nerve -both have medial and lateral plantar artery
38
plantar foot muscles layer 3
-flexor hallucis brevis- medial plantar a&n -adductor hallucis - lateral plantar a&n -flexor digiti minimi brevis - lateral plantar a&n -medial and lateral plantar nerves and arteries
39
medial and lateral sesamoids of foot
-within the 2 tendons of flexor hallucis brevis -sesamoids increase mechanical advantage of flexor hallucis brevis -assist in weight bearing -determine line of action of the muscle -disruption of sesamoids -> disruption of normal functioning of metatarsophalangeal joint
40
plantar foot muscles
-dorsal interossei- dorsal side -> abduct -plantar interossei- plantar side -> adduct -lateral plantar nerve
41
hallux valgus
-bunion -deformity -pressure from improperly fitted footwear or degenerative joint disease -lateral deviation of great toe -L in vaLgus -> lateral
42
arches of foot
-medial longitudinal- largest and most significant -lateral longitudinal arch- more shallow -transverse arch- anteriorly across -anterior and posterior aspects of the longitudinal arches are weight bearing -> calcaneal tuberosity and metatarsals and sesamoid bones of 1st metatarsal -maintained by posterior tibial ligament and intrinsic plantar ligaments*
43
spring ligament
-supports head of talus at peak of medial longitudinal arch of foot -connects calcaneal and navicular
44
flat feet
-fallen arches -inferomedial displacement of head of talus -MC secondary to dysfunction of tibialis posterior
45
diabetes feet
-lateral and medial plantar nerves compromised -loss of sensation -poor blood flow -> foot ulcers -infection and possible amputation
46
MCL, ACL, PCL tears
-MCL- blow to lateral extended knee or lateral twisting of flexed leg -> causes tear of medial meniscus -ACL- anterior drawer sign- tibia slides anterior under femur, ACL can also happen with MCL -PCL- posterior drawer sign- tibia slides posteriorly under fixed femur -> landing on tibia tuberosity when knee is flexed
47
knee bursitis
-housemaids knee -skin and patella -subcutaneous infrapatellar bursitis- skin and tibial tuberosity -deep infrapatellar bursitis- patellar ligament and tibia
48
pott fracture
-excessive eversion -dislocation -pulls on medial (deltoid) ligament -> avulsing medial malleolus -talus moves laterally and shears off lateral malleolous / breaks fibula -posterior tibia can also shear off by talus!
49
ankle sprain
-inversion -anterior or posterior talofibular ligament (part of lateral ligament) can be torn -can break fibula -calcaneofibular ligament can also tear
50
femur fracture
-commonly injures popliteal artery

Anatomy (34 decks)

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