Surface anatomy of the lower limbs

Question 1

How do you palpate the tubercle of the iliac crest? What does this tubercle give attachment to?

Answer 1

Palpate 5-7cm posterior to the ASIS. Gives attachment to the iliotibial tract.

Question 2

How do you palpate the AIIS?

Answer 2

Palpate approximately 2cm above the rim of the acetabulum

Question 3

How do you locate the greater trochanter of the femur?

Answer 3

Locate the most lateral part of the iliac crest and pass your fingers 10cm downwards onto the surface of the thigh.

Question 4

How do you palpate the ischial tuberosity?

Answer 4

Sit down on a chair and place your hands on the gluteal regions. Large bony tuberosities can be easily felt.

Question 5

Which structures attach to the ischial tuberosities?

Answer 5

• Each of the hamstrings
• Adductor magnus
• Sacrotuberous ligament

Question 6

Where is the patella located?

Answer 6

Between the quadriceps tendon superiorly and the patellar tendon inferiorly

Question 7

How do you palpate the tibial tuberosity?

Answer 7

Pass your fingers down the patellar tendon

Question 8

Which other tubercle is present on the medial side of the femur?

Answer 8

Adductor tubercle

Question 9

How do you palpate the head of the fibula?

Answer 9

Palpate approximately 1cm posteriolateral to the lateral condyle of the tibia.

Question 10

How do you palpate the sustentaculum tali?

Answer 10

Palpate the tip of the medial malleolus and then pass your fingers inferiorly by 1cm.

Question 11

How do you palpate the peroneal tubercle of the lateral side of calcaneous?

Answer 11

Place your fingers on the lateral malleolus and move your fingers forwards and downwards 1cm.

Question 12

Which nerve roots does the achillies tendon reflex test?

Answer 12

S1

Question 13

How do you palpate the tendon of tibialis anterior?

Answer 13

Dorsiflex the ankle and locate the most medial tendon

Question 14

How do you find the small extensors of the foot?

Answer 14

Less easy to palpate but you may be able to see a slight swelling on the dorsal aspect ot the foot, 2cm anterior to the lateral malleolus.

Question 15

How do you palpate the femoral artery?

Answer 15

Palpable in the groin, just below the midpoint of the inguinal ligament.

It lies relatively superficial in the femoral triangle but then runs under sartorius, through the adductor hiatus and becomes the popliteal artery in the popliteal fossa.

Question 16

How do you palpate the popliteal artery?

Answer 16

This vessel lies deep in the popliteal fossa and is normally difficulat to palpate.

To aid detection of a pulse, bend the knee to 45° to release the tension of the surrounding tendons.

Question 17

How do you palpate the anterior tibial artery?

Answer 17

Branch of the popliteal artery that lies deep in the anterior compartent of the leg.

It becomes palpable on the anteromedial aspect of the ankle joint between the tendons of extensor hallucis longus and extensor digitorim longus.

It forms several branches to supply the dorsum of the foot, including dorsalis pedis artery.

Question 18

How do you palpate dorsalis pedis artery?

Answer 18

Palpable in the space between the 1st and 2nd metatarsals

Question 19

How do you palpate the posterior tibial artery?

Answer 19

Lies deep in the posterior compartment, under gastrocnemius and soleus.

It is palpable posterior to the medial malleolus between the tendons of flexor digitorum longus and flexor hallucis longus (medial to the tibial nerve).

Question 20

How do you palpate the great saphenous vein?

Answer 20

Easy to locate at or near the medial malleolus, even in individuals with a higher BMI.

Question 21

How do you palpate the small saphenous vein?

Answer 21

Can be easily located at or near the lateral malleolus, though in some infividuals it may be palpable on the posterior surface of the calf, once they have been standing for long periods of time.

Question 22

How do you palpate the tibial nerve?

Answer 22

Lies within the popliteal fossa but then passes deep to gastrocnemius and soleus in the calf.

It becomes palpable at the posterior surface of the medial malleolus before passing into the sole of the foot to form the medial and lateral plantar nerves.

Question 23

How do you palpate the common peroneal nerve?

Answer 23

Formed from the sciatic nerve in the thigh and passes down the medial side of the tendon of biceps femoris.

It becomes palpable as it passes around the head of the fibula before dividing into deep and superficial peroneal nerves.

Question 24

How do you palpate the deep peroneal nerve?

Answer 24

Lies deep in the anterior compartment of the leg until it crosses the anterior surface of the ankle.

It can be palpated lateral to dorsalis pedis artery, between the tendons of extensor hallucis longus and extensor digitorum longus.

Question 25

How do you palpate the superficial peroneal nerve?

Answer 25

Lies on the anterolateral aspect of the leg and becomes palpable medial to the anterior border of the lateral malleolus.