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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
Q

flexor retinaculum

A

-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
Q

posterior hip dislocation

A

-adducted and medially rotated
-little bit shorter
-careful of medial circumflex femoral and sciatic nerve
-deceleration injury usually^^

27
Q

what muscles do the fibular artery supply??

A
28
Q

cutaneous innervation to dorsal foot

A

-superficial fibular nerve
-between big toe- deep fibular nerve

29
Q

foot drop and foot slap

A

-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
Q

foot bones

A

-hindfoot- calcaneus, talus
-midfoot:
-navicular
-medial cuneiform
-intermediate cuneiform
-lateral cuneiform
-cuboid
-forefoot:
-metatarsals (5)
-phalanges (14)

31
Q

calcaneal (achilles) tendon

A

-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
Q

syndesmotic sprain

A

-high ankle sprain
-injury to distal tibiofibular syndesmosis with possible disruption of distal tibiofibular ligaments and interosseous membrane

33
Q

joints in the foot

A

-subtalar- between talus and calcaneus
-transverse tarsal joint: 2 joints:
-talonavicular
-calcaneocuboid joint

34
Q

deltoid ligament

A

-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
Q

plantar fascia / plantar fasciitis

A

-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
Q

plantar foot muscles: extrinsic

A

-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
Q

plantar foot muscles: intrinsic second layer

A

-quadratus plantae- lateral plantar nerve
-lumbricals- medial 1- medial; medial 3- lateral plantar nerve
-both have medial and lateral plantar artery

38
Q

plantar foot muscles layer 3

A

-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
Q

medial and lateral sesamoids of foot

A

-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
Q

plantar foot muscles

A

-dorsal interossei- dorsal side -> abduct
-plantar interossei- plantar side -> adduct
-lateral plantar nerve

41
Q

hallux valgus

A

-bunion
-deformity
-pressure from improperly fitted footwear or degenerative joint disease
-lateral deviation of great toe
-L in vaLgus -> lateral

42
Q

arches of foot

A

-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
Q

spring ligament

A

-supports head of talus at peak of medial longitudinal arch of foot
-connects calcaneal and navicular

44
Q

flat feet

A

-fallen arches
-inferomedial displacement of head of talus
-MC secondary to dysfunction of tibialis posterior

45
Q

diabetes feet

A

-lateral and medial plantar nerves compromised
-loss of sensation
-poor blood flow -> foot ulcers
-infection and possible amputation

46
Q

MCL, ACL, PCL tears

A

-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
Q

knee bursitis

A

-housemaids knee
-skin and patella
-subcutaneous infrapatellar bursitis- skin and tibial tuberosity
-deep infrapatellar bursitis- patellar ligament and tibia

48
Q

pott fracture

A

-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
Q

ankle sprain

A

-inversion
-anterior or posterior talofibular ligament (part of lateral ligament) can be torn
-can break fibula
-calcaneofibular ligament can also tear

50
Q

femur fracture

A

-commonly injures popliteal artery

Anatomy (34 decks)

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