Review of the Lower Limb Anatomy Flashcards
What are the hip ligaments?
- pubo-femoral ligament
- ischio-femoral ligament (posterior)
- ligamentum teres (femoral head to acetabulum)
- ilio-femoral ligament
What is Shenton’s line?
- inferior border of superior pubic ramus along inferomedial border of neck of femur
- if not smooth = indicates femoral neck fracture
What is special about the ilio-femoral ligament?
- largest and strongest
- anteriorly so posterior is weaker = hip tends to dislocate posteriorly
What are the fibres of the ligaments?
- straight = most movable in flexion
- twisted = most stable in extension
How does the femoral artery supply the hip?
- profunda femoris
- to femoral head, neck, trochanters
- medial to femur
- gives off lateral and medial circumflex arteries
How does the obturator artery supply the hip?
- artery to the head of the femur
- important in development but loses function in adults
How can femoral fracture result in avascular necrosis?
- if fracture is high enough can cut off circumflex arteries
Where should the gluteal intramuscular injection be placed?
- in upper outer quadrant
- due to vast number of structures in gluteal region
What are the ligaments of the gluteal region?
- sacrospinous
- sacrotuberous
What passes through the greater sciatic foramen?
- sciatic nerve
- piriformis
- pudendal nerve
- superior and inferior gluteal neurovascular bundle
What passes through the lesser sciatic foramen?
- pudendal nerve
- tendon of obturator internus
What are the 3 gluteal muscles?
- gluteal maximus
- gluteal medius
- gluteal minimus
What is the action of the gluteal muscles?
- gluteus maximus = hip extension, hip lateral rotator/abduction
- gluteus medius = abduction hip/leg stabilising pelvis
- gluteus minimus = abduction of hip/leg stabilising pelvis
What is the innervation of the gluteal muscles?
- gluteal maximus = inferior gluteal nerve
- gluteal medius = superior gluteal nerve
- gluteal minimus = superior gluteal nerve
Where does the gluteus maximus insert on?
- onto gluteal tuberosity of the femur
What are the lateral rotators apart from the gluteal muscles?
- piriformis
- nerve supply is L5-S2
What is the Trendelenburg test?
- tests superior gluteal nerve
- stand on 1 leg and opposite side droops as affected
What is the function of the anterior compartment?
- hip flexion
- knee extension
What innervates the anterior compartment?
- femoral nerve
What are the muscles of the anterior compartment?
- iliopsoas
- rectus femoris
- sartorius
- pectineus
What are the attachments of the muscles of the anterior compartment?
- iliopsoas (spine to lesser trochanter)
- rectus femoris (from AIIS)
- sartorius (ASIS to tibia)
- pectineus (pubis to femur)
What is the function of the medial compartment?
- hip adduction
What is the innervation of the medial compartment?
- obturator nerve
apart from hamstring portion of adductor magnus
Where do the muscles of the medial compartment attach?
- to the pelvis distally to linea asperea
What are the muscles of the medial compartment?
- adductor magnus
- adductor longus
- adductor brevis
- gracilis
What is the function of the posterior compartment?
- hip extension
- knee flexion
What is the innervation of the posterior compartment?
- tibia division of the sciatic nerve
Where do the hamstrings originate?
ischial tuberosity
distally attach on tibia
therefore act to flex the knee joint
What are the muscles of the posterior compartment?
- semitendinosus
- semimembranosus
- biceps femoris (long head)
What is the pes anserinus?
- insertion of sartorius, gracilis, semitendinosus
What are the boundaries of the femoral triangle?
- inguinal ligament
- sartorius
- adductor longus
What does the femoral triangle contain?
NAVEL
What passes through the adductor hiatus?
- femoral artery
- then becomes popliteal artery
What is the largest joint in the body?
- knee
What are the 3 articulations of the knee joint?
- lateral femoral and tibial condyles with corresponding meniscus
- medial formal and tibial condyles with corresponding meniscus
- patella and femur
What does the stability of the knee depend on?
- strength and action of surrounding muscles and tendons
- ligaments connecting femur and tibia
What are the collateral ligaments of the knee?
- fibular (lateral) = not attached to joint capsule
- tibial (medial) = thickening of joint capsule
What is the function of the posterior cruciate ligament?
- stops tibia moving backward on femur
- helps stabilise knee in flexion
- prevents tibia externally rotating
- stronger than ACL
- prevents femur sliding anteriorly on tibia
- rupture = posterior drawer sign
What is the function of the ACL?
- stops tibia moving forward on femur
- helps stabilise knee in extension
- prevents hyperextension and excessive internal rotation
- prevents femur sliding posterior on tibia
- rupture = anterior drawer sign
What are the features of the medial meniscus of the knee?
- C shaped
- broader posteriorly than anteriorly
- anteriorly attached to ACL
- firmly adhered to tibial collateral ligament
What are the features of the lateral meniscus of the knee?
- nearly circular
- smaller and more freely movable than medial
- attached to PCL
What does the popliteal fossa contain?
- popliteal artery (media)
- popliteal vein
- tibial nerve (lateral) into common peroneal nerve and sural nerve
What are the 3 compartments of the leg?
- anterior compartment
- posterior compartment
- lateral compartment
What is the function of the leg anterior compartment, nerve supply and blood supply?
- dorsiflexion and extension of digits
- deep peroneal nerve
- anterior tibial artery
What is the function of the leg posterior compartment, nerve supply and blood supply?
- plantarflexion and flexion of digits
- tibial nerve
- posterior tibial artery
What is the function of the leg lateral compartment, nerve supply and blood supply?
- eversion
- superficial peroneal nerve
- fibular artery
What is the popliteal artery divisions?
- anterior tibial
- dorsalis pedis
- deep peroneal perforating branches
- posterior tibial
- medial and lateral plantar
What does the sciatic nerve divide into?
- tibial nerve
- common peroneal
What compartments does the tibial nerve supply?
- superficial posterior compartment (calf muscles, ankle plantar flexors)
- deep posterior compartment (plantar flexors of the foot)
What does the common peroneal nerve supply?
- superficial peroneal nerve (lateral compartment, eversion)
- deep peroneal nerve (anterior compartment, dorsiflexion)
What type of joint is the ankle joint?
- hinge joint
What makes up the ankle joint?
- tibia, fibula, talus bones
What is the ankle reinforced by laterally?
- anterior talofibular ligament
- posterior talofibular ligament
- calcaneofibular ligament
What is the ankle reinforced by medially?
- deltoid ligament
