Spaces, Nerves, and Arteries of the Lower Limb Flashcards
What is the adductor canal?
Canal connecting the femoral triangle to popliteal fossa
What is the anteromedial border of the adductor canal?
Sartorius - forms roof
Vastoadductor membrane
What is the anterolateral border of the adductor canal?
Vastus medialis
What is the posterior border of the adductor canal?
Superior - Adductor longus
Inferior - adductor magnus
What are the contents of the adductor canal?
Femoral artery
Femoral vein
Motor nerve to vastus medialis (from femoral nerve)
Saphenous nerve (from femoral nerve)
Do the nerves that pass into the adductor canal exit the adductor hiatus? Explain.
Nerve to vastus medialis disappears into muscle
Saphenous nerve pierces the medial wall/vastoadductor membrane to become cutaneous
What branches from the femoral artery in the adductor canal?
Descending genicular artery
accompanies saphenous nerve
How does the spatial relationship of femoral artery and vein change as they proceed inferiorly down the thigh?
Femoral Triangle:
artery lies lateral to vein
Adductor canal:
artery lies anterior to vein - puts artery in more protected position as it enters popliteal fossa
Popliteal fossa:
femoral artery will lie adjacent to post side of femur (covered by popliteus) and deep to popliteal vein
What muscles are in the anterior crural compartment?
Tibialis anterior Extensor digitorum longus Fibularis tertius Extensor hallucis longus Extensor digitorum brevis
What common functions do anterior crural compartment muscles share? Common innervation?
Dorsiflexion of the foot
Inn: deep fibular nerve
What common functions do lateral crural compartment muscles share? Common innervation?
Fibularis longus and brevis both:
evert foot
plantar flex foot
Inn: superficial branch of fibular nerve
What common functions do the superficial posterior crural muscles do? Common innervation?
Gastronemius, soleus, and plantaris
- all plantar flex the foot
Inn: tibial nerve
What common functions do the deep posterior crural muscles do? Common innervation?
Flexor digitorum longus, flexor hallucis longus, tibialis posterior, (technically popliteus too, according to Buck)
Except popliteus, they all:
plantar flex the feet
Inn: tibial nerve
What is the superolateral border of the popliteal fossa?
tendon of biceps femoris
What is the superomedial border of the popliteal fossa?
Tendon of semimembranosus and semitendinosus mm
What is the inferolateral border of the popliteal fossa?
Lateral head of the gastrocnemius
What is the inferomedial border of the popliteal fossa?
Medial head of the gastrocnemius
What is the roof of the popliteal fossa?
popliteal fascia of fascia lata
What is the floor of the popliteal fossa?
Capsule of the knee, post surface
popliteus mm
What are the nerves that go through the popliteal fossa?
Sciatic nerve
- divides into tibial and fibular components (varies)
Femoral nerve
- termination of post femoral cutaneous nerve
Tibial nerve
- contains muscular and cutaneous branches
Fibular nerve
- contains cutaneous branches
What are the blood vessels that go through the popliteal fossa?
Popliteal vein and tributaries
- drains knee joint and lesser saphenous
Popliteal artery and branches
Popliteal LNs and vessels
What are the branches of the popliteal artery?
Lateral and medial superior genicular arteries
Lateral and medial inferior genicular arteries
Middle genicular arteries
Sural branches (2)
Anterior tibial artery
Posterior tibial artery
What are the branches of the anterior tibial artery?
Posterior course:
Posterior tibial recurrent artery
Circumflex fibular artery
Anterior course:
anterior tibial recurrent artery
medial and lateral malleolar branches
dorsalis pedis artery
What are the branches of the dorsalis pedis artery?
Lateral and medial tarsal arteries
arcuate arteries
first dorsal metatarsal arteries
deep plantar arteries
What are the branches of the posterior tibial artery?
Circumflex fibular artery Fibular artery - posterior lateral malleolar aa Communicating branch Post medial malleolar medial calcaneal aa medial and lateral plantar aa
What are the cord levels for femoral nerve?
L2
L3
L4
What are the cord levels for obturator nerve?
L2
L3
L4
What are the cord levels for sciatic nerve?
L4
L5
S1
S2
S3
What function do all the quadriceps femoris share?
Extension of the leg
- grouping doesn’t include articularis genu
What are the borders of the femoral triangle?
Superior: inguinal ligament Medial: adductor longus Lateral: sartorius Roof: fascia lata Floor: pectineus, iliopsoas
What is in the femoral sheath?
Femoral sheath: partitioned prolongation of transversalis fascia
Contains: femoral artery and vein
What are the branches of the femoral artery? Where does it ‘terminate’?
Deep femoral
- 4 other branches we don’t need to know at this time
Descending genicular
- saphenous
- articular branch
Terminates when it enters adductor hiatus, becomes popliteal aa
What are the branches of profunda femoral aa?
Lateral femoral circumflex aa
What are the branches of the lateral femoral circumflex aa?
Ascending
Transverse
Medial femoral circumflex
Perforating arteries
What are the branches of the obturator artery? What do they supply?
Obturator aa is a branch off of internal iliac artery
Anterior and posterior branches
Supplies acetabulum and head of femur, sends branches to medial femoral mm
What is the cord level for saphenous nerve?
L4 - see pg. 249 of Buck book
What actions do the muscles that attach at the pes anserinus have in common?
Flexion and medial rotation of the tibia when tibia is flexed
What cord levels make up superior gluteal nerve?
L4
L5
S1
What cord levels make up the inferior gluteal nerve?
L5
S1
S2
What are the components of the sciatic nerve? (pg. 261)
FYI - Sciatic nerve is largest peripheral nerve of the body, principle nerve of sacral plexus
Tibial : anterior divisions of ventral rami
L4
L5
S1
S2
S3
Common Fibular: posterior divisions of ventral rami
L4
L5
S1
S2
What are the cord levels of superficial fibular nerve?
L5
S1
S2
Also: provides medial and intermediate dorsal cutaneous nerves, which then provide dorsal digital branches to toes
What are the cord levels of the deep fibular nerve?
L4
L5
How are the distal phalanges of the foot flexed?
By flexor digitorum longus, through the bifurcation of flexor digitorum brevis
What are the arteries that supply the plantar foot? What do they branch from?
Posterior tibial
Lateral Plantar aa
- plantar arterial arch
- 3 plantar metatarsal aa - gives off proper plantar digital aa
- anastamosis with deep plantar branch of dorsalis pedis
Medial plantar aa
- 1st proper plantar digital aa
What branches from medial plantar nerve?
Proper digital branch to medial great toe
Common digital nerves
- proper digital nerves at webs between toes 1-3
- muscular branch to 1st lumbrical
What muscles are innervated by medial plantar nerve?
1st lumbrical
Abductor hallucis
Flexor hallucis brevis
Flexor digitorum brevis
What are the branches of the lateral plantar nerve?
Superficial branch
- proper digital nerve to lateral 5th digit
- muscular branches
- common digital nerve - supplies proper digital nerves to 4th and 5th digits
Deep branch
- accompanies plantar arterial arch, provides mm branches
