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JAFFY Anatomy > S2 - Lower Limb (leg) > Flashcards

S2 - Lower Limb (leg) Flashcards

1
Q

common peroneal (fibular) nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically

A
  • L4-S2
  • motor: common branch supplies short head of biceps femoris, superficial branch supplies lateral compartment, deep branch supplies anterior compartment
  • sensory: lateral aspect of lower leg, dorsal aspect of foot
  • runs laterally down the posterior leg, splits into deep and superficial branches (superficial is @ risk of damage inferior to knee joint)
  • deep branch runs over dorsum of foot and branches into medial and lateral cutaneous nerves of the foot
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2
Q

tibial nerve:
- what roots is it made up of
- motor innervation
- sensory innervation
- where does it run anatomically

A
  • roots: L4-S3
  • motor: hamstrings (except short head of biceps femoris) and posterior compartment of leg
  • sensory: posterolateral lower leg, plantar surface of the heel
  • runs posteriorly down the middle of the leg, goes posterior to medial malleolus
  • emerges on plantar surface of foot and divides into medial and lateral plantar nerve
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3
Q

where does the dorsals pedis a. run?

A
  • in between the 1st and 2nd toes
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4
Q

superficial veins of the leg

A
  • great/long saphenous vein: starts @ dorsum of foot, over medial malleolus, runs posterior to knee, emerges into medial thigh and drains into femoral v. in femoral triangle
  • small/short saphenous vein: starts on lateral foot, runs up posterior leg, drains into popliteal vein in popliteal fossa
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5
Q

describe the deep veins of the leg + thigh

A
  • basically same as arteries
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6
Q

describe the arterial supply of the leg

A
  • popliteal artery: emerges down from popliteal fossa and divides into anterior tibial artery
  • anterior tibial artery runs thru proximal aperture in interosseous membrane
  • posterior division divides further into the peroneal (anterior) and posterior tibial artery
  • posterior tibial artery goes down and passes medially into the foot > divides into lateral and medial plantar arteries > deep plantar arch
  • peroneal artery runs along fibula and ends laterally at the foot
  • anterior tibial artery runs along interosseous membrane and turns into dorsalis pedis (b/n 1st and 2nd toes)
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7
Q

what do the tibial and fibular arteries supply?

A
  • anterior tibial: anterior compartment of lower leg + dorsal aspect of foot
  • posterior tibial: posterior compartment of lower leg + plantar aspect of foot
  • fibular: lateral compartment of lower leg
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8
Q

difference between medial and lateral condyles of the tibia

A
  • medial: larger, raised and lifted up (complete fossa)
  • lateral: smaller, smooth, sloped away on the posterior side
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9
Q

what are A, B, C, D?

A
  • A = lateral epicondyle
  • B = lateral condyle
  • C = adductor tubercle
  • D = medial epicondyle
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10
Q

what are E, F, G, H, I?

A
  • E = medial condyle
  • F = intercondylar line
  • G = medial supracondylar line
  • H = lateral supracondylar line
  • I = intercondylar fossa
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11
Q

what are A, B, C, D?

A
  • A = tibial tuberosity
  • B = lateral condyle
  • C = intercondylar eminences (lateral + medial)
  • D = medial condyle
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12
Q

structure and function of the knee menisci

A
  • S = wedge-shaped fibrocartilage attached to the top of the tibia
  • F = deepens articular space, disperses force and synovial fluid
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13
Q

how do the medial and lateral menisci differ?

A
  • ends of the medial meniscus are attached further apart, whereas lateral = closer together
  • medial = attached to joint capsule whereas lateral = free from joint capsule
  • lateral = smaller
  • therefore lateral is more mobile and LESS prone to injury
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14
Q

4 ligaments of the knee joint

A
  • ACL
  • PCL
  • MCL
  • LCL
    (patellar ligament is an extension of quadriceps tendon)
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15
Q

where do the ACL and PCL attach?

A
  • ACL: goes from lateral aspect of lateral condyle (femur) to medial portion of intercondylar eminence (tibia - same place as medial meniscus attachment)
  • PCL: goes from lateral aspect of medial condyle (femur) to lateral portion of intercondylar eminence (tibia)
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16
Q

when can the patella track laterally?

A
  • doing lots of repetitive action where the knee is not fully extended e.g. running/cycling
  • lateral quads get stronger than medial > patella is pulled laterally
  • bones rub together where they shouldn’t
  • wear away meniscus and joint
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17
Q

function of ACL

A
  • prevents posterior displacement of the femur on a fixed tibia
  • prevents anterior displacement of the tibia on a fixed femur
  • (damaged in hyperextension)
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18
Q

function of PCL

A
  • prevents anterior displacement of the femur on a fixed tibia
  • prevents posterior displacement of the tibia on a fixed femur
  • (damaged w/ hyperflexion)
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19
Q

MCL and LCL differences
- when are they most tight?

A
  • MCL (tibial): attaches to medial meniscus
  • LCL (fibular): not attached to lateral meniscus
  • both are more taut in extension to prevent valgus and varus movement
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20
Q

where do the MCL and LCL attach?

A
  • MCL: medial epicondyle of femur > tibia
  • LCL: lateral epicondyle of femur > styloid process of head of fibula
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21
Q

what are the retinacula of the knee?

A
  • medial + lateral
  • fibrous tissue that provides stability
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22
Q

unhappy triad

A
  • a blow to the lateral side of the knee (> valgus = bow-legged) can damage the MCL, medial meniscus and ACL
  • b/c MCL attaches to medial meniscus and ACL also shares an attachment point w/ the medial meniscus on the joint capsule
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23
Q

impact of tearing ACL/PCL on synovial membrane

A
  • (esp. ACL)
  • likely to damage synovial membrane b/c it runs right around the ligaments
  • leads to significant swelling
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24
Q

4 bursae and fat pad of the knee

A
  • suprapatellar (quadriceps) bursa - under quadriceps tendon
  • prepatellar (anterior to patella)
  • infrapatellar (superficial + deep) - anterior and posterior to patellar ligament
  • semimembranosus - between semimembranosus and gastroc (medial)
  • fat pad is posterior to patellar tendon
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25
Q

describe the articular surfaces of the patella

A
  • lateral facet is larger than the medial facet
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26
Q

describe the boundaries of the popliteal fossa (diamond shape)

A
  • medial: semimembranosus + semitendinosus (superior) and gastrocnemius medial head (inferior)
  • lateral: biceps femoris (superior) and gastrocnemius lateral head + plantaris (inferior)
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27
Q

contents of the popliteal fossa

A
  • sciatic nerve: divides @ the apex of the fossa into common peroneal (runs more posterior) nerve and tibial nerve (runs more anterior down middle of the posterior leg)
  • popliteal artery
  • popliteal vein (formed by the veins paired w/ the anterior and posterior tibial a. and small saphenous v.)
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28
Q

compartments of the lower leg

A
  • anterior
  • superficial + deep posterior (separated by transverse intermuscular septum)
  • lateral (bordered by the anterior and posterior crural septa)
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29
Q

muscles in the posterior superficial compartment and what movement are they responsible for?
- also what nerve innervates them?

A
  • gastroc
  • soleus
  • plantaris
  • plantar flexion
  • tibial nerve
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30
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • gastrocnemius (medial and lateral belly) - posterior superficial
  • origin: medial and lateral condyles (femur)
  • insertion: both heads have a common tendon which unites w/ the soleus tendon to form calcaneal tendon > inserts onto calcaneus
  • innervation: tibial nerve
  • movement: plantar flexion and knee flexion
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31
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • soleus (deep to gastroc) - multipennate (anti-gravity) - posterior superficial
  • origin: back of tibia and fibula
  • insertion: joins w/ gastroc tendon to form calcaneal tendon > inserts onto calcaneus
  • innervation: tibial nerve
  • movement: plantar flexion
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32
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • plantaris - posterior superficial
  • origin: lateral epicondyle of femur
  • insertion: runs with calcaneal tendon > inserts onto calcaneus
  • innervation: tibial nerve
  • movement: weak plantar flexion
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33
Q

what muscles are in the deep posterior compartment and what nerve innervates them?

A
  • Tom, Dick and Harry (+pop)
  • tibialis posterior (deepest posterior muscle)
  • flexor digitorum longus
  • flexor hallucis longus
  • popliteus
  • tibial nerve
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34
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • tibialis posterior - posterior deep
  • origin: interosseous membrane
  • insertion: goes behind medial malleolus, fans out underneath the foot
  • innervation: tibial nerve
  • movement: plantar flexion, inversion
35
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- function?

A
  • popliteus - posterior deep
  • origin:
  • insertion: half lateral meniscus, half lateral condyle of femur
  • innervation: tibial nerve
  • function: lateral rotation of the femur on a fixed tibia to help the knee come out of full extension and posteriorly draw the lateral meniscus
36
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • flexor hallucis longus (lateral to flexor digitorum longus) - posterior deep
  • origin: posterior fibula
  • insertion: goes underneath foot (deep to flexor digitorum longus) and supplies big toe
  • innervation: tibial nerve
  • movement: big toe + plantar flexion + inversion
37
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • flexor digitorum longus - posterior deep (medial to flexor hallucis longus)
  • origin: posterior tibia
  • insertion: goes underneath foot and supplies little toes (superficial to flexor hallucis longus)
  • innervation: tibial nerve
  • movement: little toe + plantar flexion
38
Q

which muscles are in the lateral compartment of the leg?
- which nerve innervates them?

A
  • fibularis longus and brevis
  • superficial peroneal nerve
39
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • fibularis/peroneus longus (superficial to brevis) - lateral
  • origin: proximal fibula
  • insertion: behind lateral malleolus, onto plantar surface, inserts on base of 1st metatarsal
  • innervation: superficial peroneal nerve
  • movement: eversion, weak plantar flexion
40
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • fibularis/peroneus brevis (deep to longus) - lateral
  • origin: lateral distal fibula
  • insertion: behind lateral malleolus, onto base of 5th metatarsal
  • innervation: superficial peroneal nerve
  • movement: eversion, weak plantar flexion
41
Q

which muscles sit in the anterior compartment of the leg?
- which nerve innervates them?

A
  • Tom, Dick and Harry (+ tertius=traitor b/c anterior instead of lateral)
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • fibularis/peroneus tertius
  • deep peroneal nerve
42
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • tibialis anterior - anterior
  • origin: lateral tibia and interosseous membrane
  • insertion: 1st cuneiform and 1st metatarsal (ends medially)
  • innervation: deep peroneal and recurrent genicular nerves
  • movement: dorsiflexion, inversion
43
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • extensor hallucis longus (deep to extensor digitorum longus) - anterior
  • origin: interosseous membrane + fibula
  • insertion: big toe
  • innervation: deep peroneal nerve
  • movement: dorsiflexion (including. big toe)
44
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • extensor digitorum longus (superficial to extensor hallucis longus) - anterior
  • origin: fibula
  • insertion: 4 little toes
  • innervation: deep peroneal nerve
  • movement: dorsiflexion (inc little toes)
45
Q

what is this muscle?
- what is its origin and insertion?
- innervation?
- movement?

A
  • fibularis/peroneus tertius - anterior
  • origin: fibula
  • insertion: big toe
  • innervation: deep peroneal nerve
  • movement: eversion, dorsiflexion
46
Q

MCL and LCL of the ankle (tibia, fibula, talus)

A
  • LCL: calcaneofibular ligament, anterior talofibular, posterior talofibular ligament
  • deltoid (medial collateral) ligament (tibionavicular, anterior tibiotalar, posterior tibiotalar ligaments)
47
Q

describe the articulation of the other joints in the foot and what movements do they do?

A
  • subtalar: talus and calcaneus (plane/gliding)
  • talocalcaneonavicular joint: talus, calcaneus, navicular
  • cuboid and calcaneus
  • inversion and eversion
48
Q

what are A, B, C, D, E?

A
  • A = cuneiforms (medial, intermediate, lateral)
  • B = navicular
  • C = talus
  • D = cuboid
  • E = calcaneus (the shelf on the left is called the sustentaculum tali)
49
Q

ligaments which support the subtalar and TCN joints

A
  • calcaneo-navicular (spring) ligament
  • long and short plantar ligaments
  • cervical ligament
  • bifurcate ligament
  • interosseous talocalcaneal ligament
  • calcaneofibular ligament
50
Q

3 arches of the foot

A
  • medial longitudinal (higher): talus, navicular, cuneiforms, metatarsals I-III
  • lateral longitudinal: calcaneus, cuboid, metatarsals III-V
  • transverse: from medial to lateral (cuneiforms, cuboid, bases of metatarsals I-V)
51
Q

function of the foot arches

A
  • act as a spring for weight bearing + shock absorption
52
Q

which muscles support the medial and lateral arches of the foot?

A
  • medial: flexor hallucis longus tendon, flexor digitorum longus tendon, tibialis posterior + anterior, extensor hallucis longus, extensor digitorum longus
  • lateral: fibularis brevis + longus (flat foot = less lateral arch)
53
Q

what are A, B, C, D?

A
  • A = styloid process (for LCL)
  • B = head of fibula (biceps femoris tendon - lateral)
  • C = neck of fibula
  • D = lateral malleolus
54
Q

what are A, B, C?

A
  • A = medial malleolus
  • B = articular surface for talus
  • C = fibular notch
55
Q

what types of joints are the proximal and distal tibiofibular joints?

A
  • proximal = plane/gliding (lined by hyaline cartilage)
  • distal = syndesmosis (not lined by hyaline cartilage or a joint capsule)
56
Q

ligaments of the proximal and distal tibiofibular joints

A
  • proximal: anterior superior tibiofibular, posterior superior tibiofibular, LCL
  • distal: anterior inferior tibiofibular, posterior inferior tibiofibular
57
Q

function of the interosseous membrane (tibia and fibula)

A
  • transmits force/absorbs shock
  • therefore a blow to one bone could damage the other
  • contains a hole (aperture) at the proximal and distal end for neurovasculature
58
Q

is the gastroc or soleus more likely to be injured?
- test for injured achilles

A
  • gastroc b/c crosses 2 joints and can undergo eccentric contraction
  • soleus injury is low risk but can still occur
  • thompson test: lie prone w/ foot hanging off bed, squeeze gastroc
59
Q

compartment syndrome

A
  • bleeding of a particular artery can cause pressure > blockage of blood flow and poor perfusion of muscles in that particular compartment
60
Q

mechanisms which aid venous return

A
  • valves (one way flow)
  • venous comitantes (paired w/ arteries so arterial pulsations helps push blood thru veins)
  • skeletal muscle contractions
61
Q

which ligaments may be damaged by eversion and inversion?

A
  • eversion: deltoid ligament (medial malleolus)
  • inversion: lateral collateral ligament of ankle (lateral dorsum)
62
Q

pes anserinus (“goose foot”) bursitis

A
  • semitendinosus, gracilis and sartorius conjoin and insert together at the anteromedial proximal tibia
  • looks like a goose foot
  • the bursa underneath this tendon can get inflamed = common knee pain
63
Q

intracapsular vs extracapsular NOF fractures

A
  • intracapsular – can damage the medial femoral circumflex/retinacular arteries + and cause avascular necrosis of the femoral head
  • extracapsular – blood supply to head of femur is intact > avascular necrosis is unlikely
64
Q

why can’t we pronate and supinate our legs?

A
  • tibiofibular joint is a fibrous joint = very stable but no movement
65
Q

dorsal intrinsic foot muscles

A
  • extensor digitorum brevis
  • extensor hallucis brevis
66
Q

plantar intrinsic foot muscles

A
  • superficial: abductor digiti minimi, abductor hallucis, flexor digitorum brevis
  • intermediate: quadratus plantae, lumbricals
  • deep: flexor digiti minimi brevis, flexor hallucis brevis, adductor hallucis (2 heads), interossei
67
Q

tarsal tunnel contents

A
  • tibialis posterior tendon
  • flexor digitorum longus
  • posterior tibial artery
  • posterior tibial vein
  • tibial nerve
  • flexor hallucis longus
  • Tom, Dick And Very Naughty Harry
68
Q

motor innervation of the foot

A
  • deep fibular n. (dorsal)
  • medial and lateral plantar nerves - branches of tibial n. (plantar)
69
Q

sensory innervation of the foot

A
  • dorsal: superficial fibular n.
  • plantar: medial plantar nerve (medial 1/3) and lateral plantar nerve (lateral 2/3) - branches of tibial n.
70
Q

Weber classification of ankle fracture

A
  • type A: adduction on inverted foot (distal to syndesmosis)
  • type B: external rotation on inverted foot (@ level of syndesmosis)
  • type C: external rotation on everted foot (proximal to syndesmosis)
71
Q

trimalleolar fracture

A
  • fracture of medial, lateral and distal posterior tibia (posterior malleolus)
72
Q

subtalar dislocation

A
  • usually in medial direction during inversion, sometimes also during eversion
73
Q

talus Fx

A
  • commonly @ neck of talus, due to excessive dorsiflexion
74
Q

ankle sprain

A
  • grade 1, 2, 3 tear
  • inversion most common
75
Q

achilles tear

A
  • occurs during excessive dorsiflexion
  • presents as passive dorsiflexion and absent ankle jerk
76
Q

flat feet

A
  • pes planus (flat), pes cavus (high arched)
  • spring ligament, connecting navicular and calcaneus fails
77
Q

which nerve is involved in foot drop

A
  • common peroneal nerve (L4-S2)
78
Q

how to identify osteoarthritis on Xrays

A
  • subchondral sclerosis
  • osteophytes
  • narrowing of joint space
  • subchondral cysts
79
Q

would there be more swelling in a knee ligament injury or meniscus injury?

A
  • ligament injury b/c ACL and PCL are intracapsular > rupture will tear synovium which can cause swelling and bleeding into joint cavity
  • whereas menisci are avascular
80
Q

why are partial ligament tears more painful than complete ruptures?

A
  • partial = nerve fibres are still intact so more perception of pain
  • complete = can sever nerve fibres = less pain
81
Q

what does the sural nerve do?

A
  • purely sensory nerve
  • sensory innervation to lateral leg and foot
  • (the tibial nerve innervates the posterior muscles of the leg)
82
Q

identify the 4 membranes/septa which compartmentalise the leg

A
  • interosseous membrane: joins tibia and fibula and separates anterior from posterior deep compartments
  • anterior intermuscular septum: separates lateral and anterior compartments
  • posterior intermuscular septum: separates lateral and posterior deep
  • transverse intermuscular septum: separates posterior superficial and deep compartments
83
Q

most common ankle ligaments to damage

A
  • anterior talofibular ligament (ATFL) because it’s weakest
  • also calcaneofibular ligament
  • lateral ligament > inversion strain
84
Q

pott fracture-dislocation

A
  • inversion fracture to fibula
  • lateral force > fracture of medial malleolus

JAFFY Anatomy (14 decks)

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