Posterior Leg FINAL Flashcards
greater and lesser sciatic foramen
-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
glute blood supply
-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
gluteus maximus
-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
trendelenburg gait
-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)
lateral/external rotators
-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
gluteal intramuscular injection
-between posterior superior iliac spine and superior aspect of greater trochanter
-careful of sciatic
nerve and artery to posterior thigh
-tibial nerve (from sciatic)
-biceps femoris short heat- common fibular nerve
-deep femoral artery and inferior gluteal artery
hamstrings
-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
pes anserinus
-stabilize medial knee joint
sciatic nerve
-L2-S3
-branch of sacral plexus
-ventral primary rami
-sciatica- unilateral, compression by disc herniation, spondylolithesis, disc degeneration
trochanteric bursitis and ischial bursitis
-trochanteric- females MC, overuse, ex. runners, ballet dancers
-ischial- sitting too long, prolonged injury
hip joint ligaments
-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
development dysplasia
-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
osteoarthritis of hip
-frayed and rough
-bones compensate for lost cartilage and grow outwards -> bone spurs (osteophytes)
-joint space narrowing, sclerosis, osteophytes, chondral cysts
hip structures
-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
hip fractures
-intracapsular vs extracapsular
-intracapsular -> high chance of avascular necrosis (disruption of medial circumflex femoral artery)
-extracapsular- MC intertrochanteric fracture
-intracapsular- MC sub-capital
sural cutaneous nerves
-tibial nerve- gives of medial sural
-common fibular nerve- gives of lateral sural and communicating branch
popliteal neurovascular anterior to posterior
-anterior to posterior:
-tibial nerve
-popliteal artery
-popliteal vein
-popliteal artery -> gives off genicular arteries
-small saphenous enters
popliteal artery branches
-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
bakers cysts
-popliteal cysts
-medial aspect
-between medial head of gastrocnemius and semimembranosus
-can rupture and release fluid
plantaris muscle
-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
triceps surae
-gastrocnemius medial and lateral heads
-soleus
tibialis posterior
-plantar flexion
-inversion
-tibial nerve
-posterior tibial artery
-fibular muscles eversion
-tibialis anterior and extensors- dorsiflex
popliteus
-popliteal artery
-tibial nerve
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
posterior hip dislocation
-adducted and medially rotated
-little bit shorter
-careful of medial circumflex femoral and sciatic nerve
-deceleration injury usually^^
what muscles do the fibular artery supply??
cutaneous innervation to dorsal foot
-superficial fibular nerve
-between big toe- deep fibular nerve
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!
foot bones
-hindfoot- calcaneus, talus
-midfoot:
-navicular
-medial cuneiform
-intermediate cuneiform
-lateral cuneiform
-cuboid
-forefoot:
-metatarsals (5)
-phalanges (14)
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
syndesmotic sprain
-high ankle sprain
-injury to distal tibiofibular syndesmosis with possible disruption of distal tibiofibular ligaments and interosseous membrane
joints in the foot
-subtalar- between talus and calcaneus
-transverse tarsal joint: 2 joints:
-talonavicular
-calcaneocuboid joint
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
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
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
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
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
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
plantar foot muscles
-dorsal interossei- dorsal side -> abduct
-plantar interossei- plantar side -> adduct
-lateral plantar nerve
hallux valgus
-bunion
-deformity
-pressure from improperly fitted footwear or degenerative joint disease
-lateral deviation of great toe
-L in vaLgus -> lateral
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*
spring ligament
-supports head of talus at peak of medial longitudinal arch of foot
-connects calcaneal and navicular
flat feet
-fallen arches
-inferomedial displacement of head of talus
-MC secondary to dysfunction of tibialis posterior
diabetes feet
-lateral and medial plantar nerves compromised
-loss of sensation
-poor blood flow -> foot ulcers
-infection and possible amputation
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
knee bursitis
-housemaids knee
-skin and patella
-subcutaneous infrapatellar bursitis- skin and tibial tuberosity
-deep infrapatellar bursitis- patellar ligament and tibia
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!
ankle sprain
-inversion
-anterior or posterior talofibular ligament (part of lateral ligament) can be torn
-can break fibula
-calcaneofibular ligament can also tear
femur fracture
-commonly injures popliteal artery
