Practical Exam 4- Legs, Neck, and Others Flashcards
Saphenous Opening (Hiatus)
About 4 cm Inferior to the Inguinal Ligament
Great Saphenous passes deeply through the opening and drains into the femoral vein.
Lymph Nodes
Horizontal Group- Inguinal Ligament
Vertical Group- Proximal Great Saphenous
They are both located in the proximal thigh
The Horizontal Group is about 2 cm below the Inguinal Ligament. Almost run parallel to it
The Vertical Group is around the proximal end of the Great Saphenous Vein and essentially runs parallel to that
Great Saphenous Vein
Runs along the Anterior/Lateral Side of the Thigh and Leg
From Inferior to Superior, the veins that drain into the Great Saphenous are Dorsal Venous Arch of the the Foot, Different Perforating and Superficial Veins (External Pudendal, Epigastric, and Circumflex Iliac), and then the Accessory Saphenous Vein
Ends after going through the Saphenous Hiatus around the Inguinal Ligament when it becomes the Femoral Vein
Perforating Veins of Saphenous
Connect the Great Saphenous Vein to the Deep Venous System
Accessory Saphenous Vein
The Median Cubital of the Leg
Connects the Small Saphenous to the Great Saphenous
Drains the Superficial Fascia and skin of the Medial Side of the Thigh
May be connected very proximally to the Great Saphenous
Superficial External Pudental Artery
Essentially courses from the Groin area laterally to the Saphenous Hiatus
Most Inferior and Medial Branch
Artery Follows the same path as the Vein
Superficial Circumflex Iliac Artery
Essentially courses from the hip Medially to the Saphenous Hiatus while following the Inguinal Ligament
Only Lateral Vein
Artery follows the same path as the Vein
Saphenous Nerve
Accompanies Great Saphenous Vein in LEG
A branch of Femoral Nerve that pierces the Deep Fascia on the Medial Side of the knee
Cutaneous Branch of Obturator Nerve
Innervates skin of the Medial Thigh
Anterior Cutaneous Branches of Femoral Nerve
and Lateral Femoral Cutaneous Nerve
Innervates the skin of the Anterior Thigh
These branches enter the Superficial Fascia Lateral to the Great Saphenous Vein
Passes deep to the lateral end of the Inguinal Ligament and innervates the skin of the Lateral Thigh
Superficial Fibular Nerve
Innervates Dorsum of Foot Toes
Fascia Lata
Deep Fascia in the thigh
The Lateral Portion is particularly strong and is called the Iliotibial Tract
Iliotibial Tract
Thick portion of the Fascia Lata running on the Lateral side of the Thigh running from the Hip to Knee.
Crural Fascia
The deep fascia of the Leg
Pedal Fascia
The Deep Fascia of the Foot
Flexor Retinaculum of the Foot
The portion of the Retinaculum on the Posterior and Medial side connecting the Calcaneus
Superior Extensor Retinaculum
Band of Retinaculum running along the Anterior Side about where ankle high socks would sit
Inferior Extensor Retinaculum
Y Shaped
This portion of the Extensor Retinaculum is more on the top of the Foot
Extensor Hallucis Brevis and Extensor Digitorum Brevis
Origin: Superolateral Surface of Calcaneus, Lateral Talocalcaneal Ligament, and Cruciate Crural Ligament
Insertion: Dorsal Surface of base of Proximal Phalanx of Great Toe and Lateral sides of tendons of Extensor Digitorum Longus to Digits 2-4
Action: Aids the Extensor Digitorum Longus in Extending 4 Medial Digits
Nerve: Deep Fibular Nerve
Blood Supply: Dorsalis Pedis, Lateral Tarsal, Arcuate, and Fibular Nerves
Extensor Digitorum Longus
Origin: Lateral Condyle of Fibula, Medial Fibular Shaft surface, upper part of Interosseus Membrane
Insertion: Dorsum of Middle and Distal Phalanges of Digits 2-5
Action: Extend toes 2-5 and Dorsiflexes Ankle
Nerve: Deep Peroneal Nerve
Blood Supply: Anterior Tibial Artery
Tibialis Anterior
Origin: Lateral Condyle of Tibia, Lateral Surface of Tibial Shaft, Interosseus Membrane, and Deep surface of Fascia Cruris
Insertion: Medial and Plantar surfaces of the Base of 1st Metatarsal and Cuneiform
Action: Dorsiflexion of Ankle and Invertor of Foot
Nerve: Deep Peroneal Nerve
Blood Supply: Anterior Tibial Artery
Extensor Hallicus Longus
Origin: Anterior Surface of Fibula and Interosseus Membrane
Insertion: Base and Dorsal surface of Distal Phalanx of Great Toe
Action: Extends Great Toe and Dorsiflexes Ankle
Nerve: Deep Peroneal Nerve
Blood Supply: Anterior Tibial Artery
Fibularis Tertius
Origin: Medial Fibular Shaft surface and Anterior Intermuscular Septum
Insertion: Dorsal Surface of base of 5th Metatarsal
Action: Dorsiflex, Evert, and Abduct the Foot
Nerve: Deep Peroneal Nerve
Blood Supply: Anterior Tibial Artery
Femoral Triangle
Pulse of Femoral Artery can be palate do here
Superior- Inguinal Ligament
Lateral- Sartorius Muscle
Medial- Adductor Longus Muscle
In the Floor- Iliopsoas and Pectineus Muscle
Contents- Femoral Nerve, Femoral Artery, Femoral Vein, and Femoral Sheath- “VAN” from Medial to Lateral
Femoral Sheath
Lateral Compartment
Intermediate Compartment
Medial Compartment (For Expansion)
Lateral Compartment contains the Femoral Artery
Intermediate Compartment Contains the Femoral Vein
Medial Compartment contains the lymphatic system (Vertical)
The Femoral sheath is also called the Femoral Canal and the proximal opening in the Abdomen is called the Femoral Ring
Deep Artery of the Thigh
Courses parallel to the Femoral Artery but is Posterior to the Adductor Longus Muscle
Supplies the Medial and Posterior Compartments on the Thigh
Lateral Circumflex Femoral Artery
Passes Deep to Rectus Femoris
Usually arises from the Deep Artery of the Thigh very close the Femoral Artery, but sometimes arises directly from Femoral Artery
Passes Laterally, Deep to the Superior end of the Rectus Femoris Muscle
Supplies the Muscles and Soft Tissues of the Lateral part of the Thigh in 3 branches: Ascending Branch, Transverse Branch, and Descending Branch
Medial Circumflex Femoral Artery
Typically arises from the deep artery of the thigh close to the Femoral Artery
Passes Posteriorly between the Pectineus and Iliopsoas muscles
Important blood supply to the Head and Neck of the Femur
Pectineus
Origin: Superior Ramus of Pubis
Insertion: Pectineal line of Femur
Action: Adducts and Flexes Thigh; Assists with Medial Rotation
Nerve: Femoral Nerve
Blood Supply: Medial Circumflex Femoral Artery and Obturator Artery
Iliopsoas
Iliacus
Psoas Major
Origin: Iliac Crest, Iliac Fossa, Ala of Sacrum, and Anterior Sacroiliac Ligaments
Insertion: Tendon of Psoas Major, Lesser Trochanter, and Femur
Action: Flexes thigh at hip joint and stabilizes the joint
Nerve: Femoral Nerve (L2,L3)
Blood Supply: Iliac Branches of Iliolumbar Artery
Origin: Sides of T12-L1 and discs
Insertion: Pectineal Line, Iliopectineal Eminence via Iliopectineal Arch
Action: Flexes thigh at hip joint and stabilizes the joint
Nerve: Anterior Rami of Lumbar Nerves (L1, L2)
Blood Supply: Lumbar branches of Iliolumbar Artery
Sartorius
Origin: Anterior Superior Iliac Spine and notch below it
Insertion: Superior part of Medial surface of Tibia
Action: Abducts, Laterally Rotates, and Flexes thigh; Flexes knee
Nerve: Femoral Nerve
Blood Supply: Profunda Femoris and Lateral Circumflex Femoral Arteries
Rectus Femoris
Origin: Anterior Inferior Iliac Spine and Ilium Superior to Acetabulum
Insertion: Base of Patella and Tibial Tuberosity via patellar Ligament
Action: Extends leg at knee and flexes thigh at hip
Nerve: Femoral Nerve
Blood Supply: Profunda Femoris and Lateral Circumflex Femoral Arteries
Vastus Lateralis
Origin: Greater Trochanter, Lateral Lip of Linea Aspera of Femur
Insertion: Base of Patella and to Tibial Tuberosity via Patellar Ligament
Action: Extends leg at Knee
Nerve: Femoral Nerve
Blood Supply: Lateral Circumflex Femoral and Profunda Femoris Arteries
Vastus Medialis
Origin: Intertrochanteric Line, Medial lip of Linea Aspera of Femur
Insertion: Base of Patella and to Tibial Tuberosity via Patellar Ligament
Action: Extends leg at Knee
Nerve: Femoral Nerve
Blood Supply: Femoral and Profunda Femoris Arteries
Vastus Intermedius
Origin: Anterior and Lateral surfaces of body of Femur
Insertion: Base of Patella and to Tibial Tuberosity via Patellar Ligament
Action: Extends Leg at Knee
Nerve: Femoral Nerve
Blood Supply: Lateral Circumflex Femoral and and Profunda Femoris Arteries
Quadriceps Femoris Tendon
The tendons of the four Quadriceps (Vastus Lateralis, Medialis, and Intermedius and Quadriceps Femoris) united and is attached to the Patella
Patellar Tendon
Attaches the Patella to the Tibial Tuberosity, so the Inferior Attachment of the Quadriceps Tendon and Muscles is ultimately on the Tibial Tuberosity
Gracilis
Origin: Body and Inferior Ramus of Pubis
Insertion: Superior Part of Medial Surface of Tibia
Action: Adducts thigh at hips and stabilizes joint, acts with Psoas Major
Nerve: Obturator Nerve
Blood Supply: Profunda Femoris Artery, Medial Circumflex Femoral Artery
Adductor Longus
Origin: Body of Pubis Inferior to Pubic Crest
Insertion: Middle Third of Linea Aspera of Femur
Action: Adducts thigh at hip
Nerve: Obturator Nerve (Anterior Division)
Blood Supply: Profunda Femoris and Medial Circumflex Femoral Arteries
Adductor Brevis
Origin: Body and Inferior Pubic Ramus
Insertion: Pectineal Line and Proximal Part of Linea Aspera of Femur
Action: Adducts thigh at Hip, Weak Hip Flexor
Nerve: Obturator Nerve
Blood Supply: Profunda Femoris, Medial Circumflex Femoral, and Obturator Arteries
Adductor Magnus
Origin: Inferior Pubic Ramus, Ramus of Ischium (Hamstring part is the Ischial Tuberosity)
Insertion: Gluteal Tuberostiy, Linea Aspera, Medial Supracondylar Line (Hamstring Part is the Adductor Tubercle of Femur)
Action: Adductor Part: Adducts and Flexes Thigh; Hamstring Part: Extends Thigh
Nerve: Adductor Part: Obturator Nerve; Hamstring Part: Sciatic Nerve (Tibial Division)
Blood Supply: Femoral, Profunda Femoris, and Obturator Arteries
Obturator Nerve
Innervates Medial Compartment of the Thigh
Originates in the Lumbar Plexus, runs through the Pelvis and and Anterior branch crosses the anterior surface of Adductor Brevis while a Posterior branch crosses the posterior side
Anterior and Posterior Branch of Obturator Nerve
Anterior is in front of Adductor Brevis
Posterior is behind Adductor Brevis
Small Saphenous Vein
Runs along the Posterior side of the Lower Limb
Seems to appear around the area of the Popliteal Fossa where it pierces the deep fascia and Drains into the Popliteal Vein
Sural Nerve
Courses with Small Saphenous
Pierces the Deep Fascia halfway down the Posterior aspect of the Leg
Innervates the skin of the Lateral aspect of the Ankle and Foot
Cluneal Nerves
Innervates the skin of the Gluteal Region
Superior Cluneal Nerves come from Posterior Rami of L1-L3 and innervate the Upper Buttock
Middle Cluneal Nerves come from Posterior Rami of S1-S3 and innervate the Middle Buttock
Inferior Cluneal Nerves come from Posterior Cutaneous Nerve of the Thigh and wrap around the Inferior border of the Gluteus innervate get the Lower Buttock
Gluteus Maximus
Origin: Ilium Posterior to Posterior Gluteal Line, Dorsal Surface of Sacrum/Coccyx, Sacrotuberous Ligament
Insertion: Iliotibial Tract and Tuberosity of Femur
Action: Extends Flexed Thigh, Assists in Lateral Rotation, and Abducts Thigh
Nerve: Inferior Gluteal Nerve
Blood Supply: Inferior Gluteal Arteries
Inferior Gluteal Artery and Vein
Located near the center of the muscle
Gluteus Maximus also receives blood from the Superior Gluteal Artery, but Inferior only supplies Maximus
Inferior Gluteal Nerve
Supplies Gluteus Maximus Only
Gluteus Medius
Origin: Lateral surface of Ilium
Insertion: Lateral surface of Greater Trochanter of Femur
Action: Abducts/medially rotates thigh at hips and steadies pelvis on leg with opposite leg is raised
Nerve: Superior Gluteal Nerve
Blood Supply: Superior Gluteal Artery
Piriformis
Origin: Anterior Surface of Sacral Segments 2-4, Sacrotuberous Ligament
Insertion: Superior Border of Greater Trochanter of Femur
Action: Laterally rotates extended thigh, Abducts flexed thigh at hip
Nerve: Ventral Rami of L5, S1, S2
Blood Supply: Superior and Inferior Gluteal Arteries, Internal Pudendal Artery
Superior Gluteal Artery, Vein, and Nerve
Superior to Piriformis
Exit the Pelvic Cavity and Enter the Gluteal Region by passing above the Superior border of the Piriformis Muscle
Sciatic Nerve
Supplies Posterior Thigh and Leg
The Largest Nerve in the Body
Divides into the Tibial Division (Medial Popliteal Nerve) and the Common Fibular Division (Lateral Popliteal Nerve)
Inferior and Superior Gemellis
Superior attaches the the Ischial Spine superior to the Obturator Internus Muscle and Inferior attaches to the Ischial Tuberosity inferior to the Obturator Internus Muscle
Other attachment is with the Obturator Internus Tendon to the Greater Trochanter of the Femur
Lateral Rotators of the Thigh
Obturator Internus Muscle
Medial attachment is on the inner surface of the margin of the Obturator Foramen and the Inner Surface of the Obturator Membrane
Exits the Lesser Pelvis by passing through the Lesser Sciatic Foramen
Lateral attachment is on the medial side of the Greater Trochanter of the Femur and is a Lateral Rotator
Nerve to Obturator Internus
Supplies the Obturator Internus
Quadratus Femoris
Inferior to Inferior Gamellus, Ishium to Intertrochanteric Crest (Lateral Rotator)
Origin: Lateral Margin of Ischial Tuberosity
Insertion: Quadrate Tubercle on Intertrochanteric Crest of Femur
Action: Laterally Rotates Thigh at Hip
Nerve: Nerve to Quadratus Femoris
Blood Supply: Medial Circumflex Femoral Artery
Tensor Fascia Latae
Anterior Superior Iliac Spine (ASIS) to IT Band (Adductor and Medial Rotator of Thigh)
Origin: Anterior Superior Iliac Spine and Anterior part of Iliac Crest
Insertion: Iliotibial Tract
Action: Abducts, medially rotates, and flexes thigh at hip. Helps keep knee extended
Nerve: Superior Gluteal Nerve
Blood Supply: Ascending branch of Lateral Circumflex Femoral Artery
Pes Anserinus
Common Insertion of Semitendinosis, Sartorius, and Gracilis
Located at the proximal end of the Tibia
Biceps Femoris Long and Short Head
Origin: Long Head: Ischial Tuberosity; Short Head: Linea Aspera and Lateral Supracondylar Line of Femur
Insertion: Lateral Side of Head of Fibula
Action: Flexes and Laterally Rotates Leg, Extends thigh at High
Nerve: Sciatic Nerve (Long=Tibial Division) (Short=Common Fibular Division)
Blood Supply: Perforating Branches of Profunda Femoris, Inferior Gluteal, and Medial Circumflex Femoral Arteries
Gastrocnemius
Origin: Medial head- Posterior Nonarticular surface of Medial Femoral Condyle; Lateral Head- Lateral Surface of Femoral Lateral Condyle
Insertion: The Deep Tendon of Soleus which is the formation of the Achilles Tendon; Inserts on the Middle Third of Posterior Calcaneal Surface
Action: Powerful Plantar Flexor of Ankle
Nerve: Tibial Nerve
Blood Supply: A Sural Branch of the Popliteal Artery
Soleus
Origin: Posterior Aspect of Fibular Head, Upper quarter of Posterior Surface of Fibular, Middle Third of Medial Border of Tibial Shaft, and Posterior Surface of a Tendinous Arch Spanning the two sites of Bone Origin
Insertion: Unites with Gastrocnemius Aponeurosis to form the Achilles Tendon and inserting on posterior Calcaneus Surface
Action: Powerful plantar Flexor of Ankle
Nerve: Posterior Tibial, Peroneal, and Sural Arteries
Blood Supply:
Plantaris
Origin: Inferior Aspect of Lateral Supracondylar Line of Distal Femur
Insertion: Middle Third of Posterior Calcaneal Surface medial to Achilles Tendon
Action: Tibial Nerve
Nerve: Sural Arteries
Blood Supply:
Semitendonosis
Origin: Ischial Tuberosity
Insertion: Superior Part of of Medial Surface of Tibia
Action: Flexes Knee, Extends Thigh
Nerve: Sciatic Nerve (Tibial Division)
Blood Supply: Perforating branch of Profunda Femoris and Medial Circumflex Femoral Arteries
Semimembranosus
Origin: Ischial Tuberostiy
Insertion: Posterior part of Medial Condyle of Tibia
Action: Flexes Leg, Extends Thigh
Nerve: Sciatic Nerve (Tibial Division)
Blood Supply: Perforating branch of Profunda Femoris and Medial Circumflex Femoral Arteries
Popliteal Artery and Vein
Located in the Popliteal Fossa (Knee Pit)
Located deep to the Tibial Nerve
Enclosed by a connective tissue sheath
Tibial Nerve
Exit the Popliteal Fossa by passing deep to the Tendinous Arch of the Soleus Muscle
It is the Medial Split from the Sciatic Nerve
Passes deep to the Plantaris and Gastrocnemius muscles at the Inferior Border of the Popliteal Fossa
Common Fibular Nerve
The Most Frequently Injured Nerve in the Body- Injury causes impairment of Eversion, Dorsifelxion of the Foot, and Extension of the Toes (Foot Drop)
The Lateral Portion of the Sciatic Nerve split
It Parallels the Biceps Femoris Tendon and passes superficial to the Lateral Head of the Gastrocnemius Muscle and Plantaris Muscle
Splits into a Deep Fibular Nerve and Superficial Fibular Nerve
Genticular Arteries: Superior (Proximal to Origin of Gastrocnemius) and Inferior (Distal to Attachment of Gastrocnemius)
The Superior ones are located deep in the Politeal Fossa, proximal to the attachments of the Gastrocnemius muscle
The Inferior ones pass deep (distal) to the Superior Attachments of the Gastrocnemius muscle
They are both branches of the Popliteal Artery
Anterior Tibial Artery
This artery runs along the same side as the Deep Fibular Nerve
It passes Posteriorly over the Superior border of the Interosseus Membrane
Posterior Tibial Artery
Runs along the side of the Tibial Nerve after exiting the Popliteal Fossa by passing deep to the Tendinous Arch of the Soleus Muscle
Fibular Artery
Branches off of the Posterior Tibular Artery and runs more Laterally posterior to the Fibula
Courses distally between the Tibial Posterior Muscle and the Flexor Hallucis Longus Muscle
Supplies blood to the Lateral Compartment of the Leg and Lateral side of the Posterior Compartment of the Leg by means of Several Small Branches
Popliteus
Origin: Anterior Part of the Popliteal Groove on Lateral Surface of Lateral Femoral Condyle
Insertion: Posterior Surface of Tibia in a fan-like fashion, just Superior to the Popliteal Line
Action: Rotates Knee Medially and Flexes Leg on the Thigh
Nerve: Tibial Nerve
Blood Supply: Medial Inferior Genicular Branch of Popliteal Artery and Muscular Branch ofPosterior Tibial Artery
Flexor Digitorum Longus
Origin: Posterior Surface of Tibia Distal to Politeal Line
Insertion: Plantar Surface of bases of 2-5 distal phalanges
Action: Flexes toes 2-5 and also helps in plantar Flexion of ankle
Nerve: Tibial Nerve
Blood Supply: Muscular branch of Posterior Tibial Artery
Flexor Hallucis Longus
Origin: Inferior 2/3 of Posterior Surface of Fibula and Lower part of Interosseus Membrane
Insertion: Plantar Surface of base of Distal Phalanx of Great Toe
Action: Flexes Great Toe, Helps Supinate Ankle, and is a very weak Plantar Flexor of Ankle
Nerve: Tibial Nerve
Blood Supply: Muscular Branch of Peroneal and Posterior Tibial Artery
Tibialis Posterior
Origin: Posterior Tibia, Interosseus Membrane, and Proximal half of Posterior Fibula
Insertion: Tuberosity of Navicular Bone, All Cuneiforms, Cuboid, and bases of Metatarsals 2-4
Action: Plantarflexes Foot at Ankle and Inverts Foot
Nerve: Tibial Nerve
Blood Supply: Fibial Artery
Platysma
Covers the Lower Part of the Posterior Triangle
Passes superficial to the Clavicle and attaches to the Superficial Fascia of the Deltoid and Pectoral Regions
Attached to the Mandible, Skin of the Cheek, Angle of the Mouth, and Orbicularis Oris Mucle
Innervated by the Cervical Branch of the Facal Nerve (CN VII)
Posterior Triangle
Anterior Border- The Posterior Border of the Sternocleidomastoid
Posterior- Superior Border of the Trapezius
Inferior- Middle third of the Clavicle
Superficial (Roof)- Investing Layer of the Deep Cervical Fascia
Deep (Floor)- Muscles of the Neck Covered by Prevertebral Fascia
External Jugular Vein
The vein in the Superficial Fascia deep to the Platysma Muscle
Begins posterior to the Angle of the Mandible and crosses the Superficial surface of the Sternocleidomastoid Muscle
Drains into the Subclavian Vein
Retromandibular Vein (Posterior Branch of External Jugular Vein)
Runs beneath the Parotid Gland and then drains into the External Jugular Vein at the same point as the Posterior Auricular Vein
Runs right behind the Jaw
Posterior Auriclular Vein
Runs posterior to the Ear and then drains into the External Jugular Vein at the same point as the Retromandibular Gland
Runs behind the ear
Anterior Jugular Vein
In the Superficial Fascia and near the Anterior Midline
Begins near the Hyoid Bone and courses inferiorly near the midline to the Suprasternal Region
Passes laterally deep to the Sternocleidomastoid Muscle to join the External Jugular Vein in the Root of the Neck
Communicating Vein
Along the Anterior border of the Sternocleidomastoid Muscle
Connects the Common Facial Vein with the Anterior Jugular Vein
Sternocleidomastoid Muscle
Originates on the Sternum and Clavicle
Inserts on the Mastoid Process
Flexes Neck, Raises Sternum, and Laterally Rotates Head
Transverse Cervical Nerve
Passes transversely across the Sternocleidomastoid Muscle and Neck
Supplies the skin of the Anterior Triangle of the Neck