The Leg and Thigh Flashcards
What are the muscles of the deep posterior compartment?
- tibialis posterior
- flexor hallucis longus
- flexor digitorum longus
What are the actions of gastrocnemius?
- plantar flexion
- knee flexion (weak)
Gastrocnemius and soleus are sometimes collectively referred to as…
triceps surae
What muscles, together, are sometimes called the triceps surae?
gastrocnemius and soleus
What are the attachment points of tibialis anterior?
S/P: anterior, lateral, superior 1/2 of the tibia, interosseous membrane
I/D: base of the first MT, first (medial) cuneiform
What are the actions of flexor digitorum longus?
- PIP/DIP, MTP flexion of 2nd-5th toes
- plantar flexion
- inversion
What are the muscles of the superficial posterior compartment?
- gastrocnemius
- soleus
- plantaris
What are the attachment points of extensor hallucis longus?
S/P: anterior middle fibula and interosseous membrane
I/D: base of the distal phalanx of the first toe (dorsal surface)
How is the connective tissue sheath, around tendons that pass through the retinacula, structured?
Connective tissue outer layer for structure and protection with a synovial inner layer for lubrication (as the tendon moves)
What are the attachment points of Popliteus?
S/P: lateral condyle of the femur
I/D: posterior proximal surface of the tibia, superior to the soleal line
What’s the a.k.a. for peroneus?
Fibularis
What does the anterior ligament of fibular head attach?
anterior proximal tibia – anterior proximal fibula
What’s the name of the tunnel that the flexor retinaculum makes?
tarsal tunnel
What’s the fascia of the calf continuous with?
plantar aponeurosis
What are the actions of extensor digitorum longus?
- extension of 2nd to 5th toes (MTPs, PIPs, DIPs)
- dorsiflexion
- eversion
What are the attachment points of gastrocnemius?
S/P: 2 heads attaching to the medial and lateral femoral condyles
I/D: calcaneus (via the achilles tendon)
What are the actions of flexor hallucis longus?
- 1st MTP, 1st IP flexion
- plantar flexion
- inversion
What do muscles in a compartment have in common?
They have similar functions and share the same nerve and blood supply
What are the attachment points of peroneus longus?
S/P: lateral proximal 2/3rds of fibula
I/D: base of the 1st MT, 1st (medial) cuneiform (plantar surface)
What are the attachment points of peroneus tertius?
S/P: anterior distal fibula
I/D: base of the 5th MT (dorsal surface)
What’s the a.k.a. for the achilles tendon?
calcaneal tendon
What are the attachment points of extensor digitorum longus?
S/P: proximal three quarters of the anterior fibula, interosseous membrane
I/D: middle and distal phalanges of lateral four toes (dorsal surface)
What are the actions of peroneus tertius?
- dorsiflexion
- eversion
What are the attachment points of peroneus brevis?
S/P: lateral distal 2/3rds of fibula
I/D: tuberosity of the 5th MT
What are the attachment points of flexor hallucis longus?
S/P: lower 2/3rds of posterior fibula, interosseous membrane
I/D: plantar surface of 1st distal phalanx
What is the action of soleus?
plantar flexion
What are the muscles of the lateral compartment?
- peroneus longus
- peroneus brevis
Which muscles share the achilles tendon?
gastrocnemius and soleus
What type of joint is the distal tibiofibular?
fibrous (it’s a thickening of the interosseous membrane at its distal end)
Which tendons pass behind the medial malleolus?
Tendons of: -tibialis posterior -flexor hallucis longus -flexor digitorum longus (Tendons of the deep posterior compartment)
What are the attachment points of tibialis posterior?
S/P: posterior tibia, interosseous membrane, fibula
I/D: navicular tuberosity and surrounding bones
Why/where would you find a tendon sheath around a tendon in the distal leg?
Where there is a possibility of friction between the tendons and retinacula
What are the attachment points of soleus?
S/P: proximal posterior fibula, soleal line (tibia), middle 1/3rd of medial border of tibia
I/D: calcaneus (via the achilles tendon)
What’s the femoral triangle?
-a depression in the superomedial thigh (inferior to the inguinal ligament) observable during hip flexion
Boundaries:
-superiorly: inguinal ligament
-medially: adductor longus
-laterally: sartorius
-floor (medial to lateral): pectinius, iliopsoas
-roof: fascia lata
An a.k.a. for “calf”
surae
What keeps the tendons from the anterior compartment from bowing when muscles contract?
Superior and inferior extensor retinaculum
What does the posterior ligament of fibular head attach?
posterior proximal tibia – posterior proximal fibula
What are the actions of the tibialis posterior?
- plantar flexion
- inversion
What are the actions of extensor hallucis longus?
- extension of the first toe (MTP, IP)
- assists in dorsiflexion
- inversion (minimal)
What are the actions of peroneus brevis?
- eversion
- plantar flexion (weak)
What actions does tibialis anterior perform?
- dorsiflexion
- inversion
- eccentrically contracts to prevent anterior foot from dropping when walking
What are the actions of Popliteus?
- flexion of the knee (very weak because attachments are so close to the joint)
- medial rotation of the knee for unlocking of the screw-home mechanism
What are the muscles of the anterior compartment?
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- peroneus tertius
What are the muscles of the deep posterior compartment?
- tibialis posterior
- flexor hallucis longus
- flexor digitorum longus
What actions does plantaris perform?
- plantar flexion (weak)
- knee flexion (weak)
Where are anterior and posterior tibiofibular ligaments located?
distal end
What are the muscles of the superficial posterior compartment?
- gastrocnemius
- soleus
- plantaris
What are the muscles of the lateral compartment?
- peroneus longus
- peroneus brevis
What are the attachment points of flexor digitorum longus?
S/P: posterior middle tibia
I/D: plantar surface of distal phalanges of lateral 4 toes
What are the actions of peroneus longus?
- eversion
- plantar flexion (weak)
What type of joint is the proximal tibiofibular and what movements are allowed?
- synovial plane
- limited superior glide with dorsiflexion
- limited inferior glide with plantar flexion
What are the compartments of the leg?
- anterior compartment
- lateral compartment
- superficial posterior compartment
- deep posterior compartment
What two muscles form a stirrup on the plantar surface?
peroneus longus and tibealis anterior
What are the attachment points of plantaris?
S/P: distal lateral supracondylar ridge of the femur
I/D: calcaneus
What keeps the tendons of the lateral compartment from bowing when muscles contract?
superior and inferior peroneal retinaculum
Tendons of which two muscles pass behind the lateral malleolus?
peroneus longus and peroneus brevis
What’s the Screw Home Mechanism?
When the knee is fully extended, the tibia rotates laterally which locks the knee into a more stable position - this is the screw home mechanism. To flex the knee, the popliteus medially rotates the tibia to “unlock” the knee and allow it to flex.
The inferior attachment of the posterior fibres of adductor magnus attach to:
the adductor tubercle
Which direction does the head of the femur face?
medially, superiorly, anteriorly
Which direction does the acetabulum face?
laterally, inferiorly, anteriorly
Which side of the femur is the intertrochanteric line? crest?
line: anterior
crest: posterior
Where is the gluteal tuberosity located?
superior lateral lip of linea aspera (just inferior to greater trochanter on posterior aspect of femur)
Where is pectin pubis?
superior edge of the superior pubic ramus (aka pectineal line [of pubic bone]) (CA! there is also a pectineal line on the femur)
Where is the pectineal line of the femur?
extends from inferior lesser trochanter (CA! there is also a pectineal line on the superior pubic ramus)
This is a rough ridge with two lips (medial and lateral) on the posterior surface of the femur.
linea aspera
Where is the popliteal fossa (aka popliteal surface)?
triangular area on the inferior posterior surface of the femur between where medial and lateral supracondylar lines branch out toward the condyles
Where does the iliofemoral ligament attach, what does it check and what’s its aka?
attaches: AIIS, acetabular rim - intertrochanteric line of the femur
checks: extension, abduction, lateral rotation
aka: Y ligament
Where does the pubofemoral ligament attach and what does it check?
attaches: superior pubic ramus - iliofemoral ligament
checks: abduction
Where does the ischiofemoral ligament attach and what does it check?
attaches: ischial part of the acetabular rim - femoral neck and medial greater trochanter
checks: hyperextension
Where does the sacrotuberous ligament attach and what does it check?
attaches: dorsal surface of sacrum, coccyx and PSIS - superior ischial tuberosity
checks: hyperextension
Where are the trochanteric bursa located?
superficial: between gluteus maximus and greater trochanter
deep: between gluteus medius and the greater trochanter
What moves over the iliopectineal bursa?
iliopsoas (like on a pulley)
This bursa overlies the ischial tuberosity
ischiogluteal bursa
What’s the fascia of the thigh called?
fascia lata
The fascia of the thigh thickens laterally – this very strong part of the fascia lata is called the…
iliotibial band (tract)
What are the attachment points and actions of psoas major?
S/P: sides of the T12-L5 vertebrae and the associated intervertebral discs
I/D: lesser trochanter of the femur
action: works with iliacus to flex the hip joint
action: flexes the lumbar spine when you’re already somewhat forward flexed
What are the attachment points and actions of iliacus?
S/P: iliac fossa
I/D: lesser trochanter
action: works with psoas major to flex the hip joint
action: pulls the hip bone anteriorly (anterior tilt)
What are the attachment points and actions of gluteus maximus?
S/P: external and posterior surface of the ilium, posterior surface of the sacrum and coccyx, sacrotuberous ligament
I/D: 3/4 of the fibres attach into the iliotibial band, remaining fibres attach to the gluteal tuberosity
action: hip joint extension
action: hip joint lateral rotation
action: hip abduction
What are the attachment points and actions of gluteus medius?
S/P: external ilium (anterior 2/3rds)
I/D: lateral surface of the greater trochanter
action: hip joint abduction
action: pelvic support during weight bearing
action: anterior fibres - hip joint medial rotation, flexion
action: posterior fibres - hip joint lateral rotation, extension
What are the attachment points and actions of gluteus minimus?
S/P: external ilium (deep to gluteus medius)
I/D: anterior surface of the greater trochanter (deep to gluteus medius)
action: hip joint abduction
action: hip joint medial rotation
action: anterior fibres - hip joint flexion
What are the attachment points and actions of tensor fascia lata?
S/P: outer ASIS I/D: iliotibial band (approximately 1/3rd down the thigh) action: hip joint flexion action: hip joint abduction action: hip joint medial rotation
What are the short hip lateral rotators?
- piriformis
- gemellus superior
- obturator internus
- gemellus inferior
- obturator externus
- quadratus femoris
What’s the translation for piriformis?
pear shaped
What are the attachment points and actions of piriformis?
S/P: anterior sacrum traveling through the greater sciatic notch
I/D: posteromedial aspect of the greater trochanter
action: hip joint lateral rotation
action: hip joint abduction (when the hip is flexed to approximately 60º)
action: hip joint medial rotation (when the hip is flexed greater than 60º)
What are the attachment points and actions of obturator internus?
S/P: inner margin of the obturator foramen
I/D: posteromedial aspect of the greater trochanter
action: hip joint lateral rotation
What are the attachment points and actions of gemellus superior?
S/P: ischial spine
I/D: posteromedial aspect of the greater trochanter (via the tendon of obturator internus)
action: hip joint lateral rotation
What are the attachment points and actions of gemellus inferior?
S/P: ischial tuberosity (superior aspect)
I/D: intertrochanteric crest
action: hip joint lateral rotation
What are the attachment points and actions of obturator externus?
S/P: outer margin of the obturator foramen
I/D: posteromedial aspect of the greater trochanter
action: hip joint lateral rotation
Describe the shape and location of the patella
triangle-shaped sesamoid bone in the tendon of the quadriceps tendon
What are the surfaces and ridge of the posterior aspect of the patella?
- vertical ridge
- lateral and medial articular facets (articulate with condyles of femur)
What portion of body weight does the fibula carry?
carries about 1/6th of body weight
Where is the apex of the fibula and what’s its aka?
superior end of fibula (top of the head)
aka: styloid process
The superior surface of the tibia between its condyles
intercondylar eminence
The two projections on the superior surface of the tibia
lateral and medial intercondylar tubercles
What is the aka for the media condyle of the tibia?
medial tibial plateau
The large prominence lateral and superior to the tibial tuberosity:
gerdy’s tubercle (aka lateral tibial tubercle)
What attaches to gerdy’s tubercle?
iliotibial band
On the posterior aspect of the tibia, this line travels in an inferomedial direction from the lateral condyle to medial mid shaft
soleal line
Which bone does the patella articulate with?
femur (patellar surface)
What kind of joint is the knee joint?
synovial modified hinge (modified because when flexed we get a bit of rotation)
In which direction does the patella move when the knee flexes and extends?
- moves inferiorly during flexion
- moves superiorly and then laterally during extension
Which condyle of the femur projects farther anteriorly and why?
lateral femoral condyle projects farther anteriorly than medial, which prevents the patella from tracking too far laterally
What’s the translation for “varus” and “valgus”?
to return; to go out
What are the attachment points of the fibular (lateral) collateral ligament and what does it check?
attaches: lateral epicondyle of femur - fibular head
checks: varus deviation
What are the attachment points of the tibial (medial) collateral ligament and what does it check?
attaches: medial epicondyle of the femur - medial condyle of the tibia
attaches: deep fibres attach to medial meniscus (the ligament is a thickening of the joint capsule)
checks: valgus deviation
What are the attachment points of the anterior cruciate ligament and what does it check?
attaches: anterior intercondylar area of the tibia - posterior and medial side of the lateral femoral condyle
(slack when the knee is flexed and taut when the knee is in full extension)
checks: anterior translation of the tibia on the femur and knee extension
What are the attachment points of the posterior cruciate ligament and what does it check?
attaches: posterior intercondylar area of the tibia - anterior and lateral side of the medial femoral condyle
(slack when the knee is extended and taut when the knee is in full flexion)
checks: posterior translation of the tibia on the femur and knee flexion
What are menisci and where do they attach?
plates of fibrocartilage attached to the articular surfaces of the tibia
What are the functions of menisci?
- shock absorbtion
- deepen the articulation
Which ligament does the medial meniscus attach to?
medial collateral ligament
What connects the menisci anteriorly?
transverse ligament of the knee
What attaches the menisci to their respective tibial condyles/plateaus?
medial and lateral coronary ligaments
Where is the suprapatellar bursa located, what is it connected to, and what holds it in place/retracts it?
- located between the tendon of the quadriceps and femur
- connected to the joint capsule
- articularis genus muscle holds it in place and retracts it during knee extension
Where is the subcutaneous prepatellar bursa located and what’s the layman’s term for inflammation here?
- between skin and patella
- inflamm. known as housemaid’s knee
Where is the subcutaneous infrapatellar bursa located and what’s the layman’s term for inflammation here?
- between skin and proximal tibia (in the area of the tibial tuberosity)
- inflamm. known as carpet layer’s knee or clergyman’s knee)
Where is the deep infrapatellar bursa located?
between the tendon of the quadriceps and the anterior tibia (superior to the tibial tuberosity)
Where is the pes anserine bursa located?
between the tendons of the pes anserinus muscles and the medial tibia
What is the translation for pes anserine?
goose’s foot
From anterior to posterior, what are the pes anserine muscles?
- sartorius
- gracilis
- semitendinosus
Where is the media semimembranosus bursa located and what’s the layman’s term for inflammation here?
- between the tendons of the medial semimembranosus muscles and the medial gastrocnemius
- inflamm. known as baker’s cyst)
Where is the bursa deep to the iliotibial band located and what’s the layman’s term for inflammation here?
- between the iliotibial band and lateral femoral epicondyle
- inflamm. known as IT band friction syndrome or runner’s knee
What are the quadriceps muscles?
- rectus femoris
- vastus lateralis
- vastus medialis
- vastus intermedius
What’s the common inferior attachment of the quadriceps and where does it attach inferiorly?
- quadriceps tendon aka patellar ligament
- attaches to tibial tuberosity via the patellar ligament
What are the attachments and actions of rectus femoris?
S/P: AIIS and superior to acetabular rim
I/D: tibial tuberosity
action: hip flexion
action: knee extension
Which quadriceps muscles cross the hip joint?
just rectus femoris
What are the attachments and actions of vastus lateralis?
S/P: lateral lip of linea aspera
I/D: tibial tuberosity
(deep to IT band)
action: knee joint extension
What are the attachments and actions of vastus medialis?
S/P: medial lip of linea aspera
I/D: tibial tuberosity
action: knee joint extension
What are the attachments and actions of vastus intermedius?
S/P: proximal 2/3rds of the femur
I/D: tibial tuberosity
(deep to rectus femoris)
action: knee joint extension
What are the attachments and actions of vastus medialis obliquus?
S/P: medial distal femur, vastus medialis, adductor magnus
I/D: medial patella
action: knee joint extension
action: pulls patella medially (to prevent excessive lateral tracking)
What are the attachments and actions of articularis genus?
S/P: anterior distal femur
I/D: proximal articular capsule of the knee joint
action: pulls the capsule proximally during knee extension to prevent pinching of the capsule
What are the attachments and actions of sartorius?
S/P: ASIS I/D: proximal anteromedial tibia action: hip joint flexion action: hip joint abduction action: hip joint lateral rotation action: knee joint flexion action: knee joint medial rotation (when the knee is already flexed) all actions: think crossing leg figure 4 and pull to medially rotate the knee
What’s the longest muscle in the body?
sartorius
What are the attachments and actions of pectineus?
(floor of the femoral triangle) S/P: anterior pubic bone I/D: just inferior to the lesser trochanter on the pectineal line action: hip adduction action: hip flexion (weak)
What are the attachments and actions of adductor brevis?
S/P: anterior pubic bone
I/D: proximal linea aspera
action: hip adduction
action: hip flexion
What are the attachments and actions of adductor longus?
S/P: anterior pubic bone
I/D: linea aspera (middle 1/3rd)
action: hip adduction
action: hip flexion
What are the attachments and actions of gracilis?
S/P: anterior pubic bone I/D: proximal anteromedial tibia action: hip adduction action: knee flexion action: knee medial rotation (the only hip adductor to cross the knee; the longest hip adductor)
What are the attachments and actions of adductor magnus anterior fibres (adductor part)?
S/P: anterior pubic bone
I/D: linea aspera, supracondylar line
action: hip adduction
actino: hip flexion
What are the attachments and actions of adductor magnus posterior fibres (hamstring part)?
S/P: ischial tuberosity
I/D: adductor tubercle (tubercle just above medial epicondyle)
action: hip adduction
action: hip extension
Where is the adductor hiatus?
inferior to the distal anterior fibres of adductor magnus
What are the hamstring muscles?
- biceps femoris (short and long heads)
- semitendinosus
- semimembranosus
What are the attachments and actions of biceps femoris - long head?
S/P: ischial tuberosity I/D: fibular head action: hip extension action: knee flexion action: knee lateral rotation
What are the attachments and actions of biceps femoris - short head?
S/P: linea aspera (mid-shaft)
I/D: fibular head
action: knee flexion
action: knee lateral rotation (slight)
What are the attachments and actions of semitendinosus?
S/P: ischial tuberosity I/D: proximal anteomedial tibia action: hip extension action: knee flexion action: knee medial rotation
What are the attachments and actions of semimembranosus?
S/P: ischial tuberosity I/D: posterior aspect of the medial condyle of the tibia action: hip extension action: knee flexion action: knee medial rotation
