The Lower Limb

Question 1

What vessels provide superficial venous drainage of the lower limb?

Answer 1

Great saphenous vein and short saphenous vein

Question 2

Where do the superficial veins terminate?

Answer 2

Great saphenous terminates in the femoral vein; the short saphenous terminates in the popliteal vein

Question 3

What is the pattern of venous blood flow?

Answer 3

Venous flow is superficial to deep

Question 4

What structural defect causes varicose veins?

Answer 4

Valves that ensure the unidirectional flow of blood from superficial to deep become damaged allowing the blood to flow back to the surface and pool in painful varicosities

Question 5

What is the fascia lata?

Answer 5

The deep fascia of the thigh

Question 6

What is the function of the tensor fascia lata and into what does it attach?

Answer 6

The tensor fascia lata functions in tensing the fascia lata and is also an internal rotator of the hip. It extends from the lateral aspect of the iliac crest to the lateral tibial condyle

Question 7

Name a medial deficiency in the fascia lata.

Answer 7

The saphenous opening

Question 8

What structures come off the fascia lata and pass inward towards the femur?

Answer 8

Intermuscular septae

Question 9

Be able to label a cross section thru: mid-thigh region, mid-leg region, foot

Answer 9

IMPORTANT!

Question 10

What are the muscles of the anterior compartment of the thigh?

Answer 10

sartorius, iliacus, psoas major, pectineus, quadriceps femoris (rectus femoris, vasti lateralis, intermedius and medialis)

Question 11

What is the innervation and blood supply of the anterior compartment of the thigh?

Answer 11

Femoral nerve, except for the psoas major (lumbar plexus). Supplied by femoral artery.

Question 12

What are the muscles of the posterior compartment of the thigh?

Answer 12

biceps femoris, semitendinosus, semimembranosus, adductor magnus (hamstring portion)

Question 13

What is the innervation of the posterior compartment of the thigh? blood supply?

Answer 13

Tibial division of the sciatic nerve, except for the short head of the biceps (peroneal division of the sciatic). supplied by the perforating branch of profunda femoris and inferior gluteal artery

Question 14

What are the muscles of the medial compartment of the thigh?

Answer 14

gracilis, adductor longus, adductor brevis, adductor magnus (adductor portion), obturator externus.

Question 15

What is the innervation of the medial compartment of the thigh? blood supply?

Answer 15

Obturator nerve. Supplied by perforating branch of profunda femoris and the obturator artery.

Question 16

What muscles are in the anterior compartment of the leg?

Answer 16

tibialis anterior, ext. digitorum longus, peronius tertius, ext. hallucis longus, ext. digitorum brevis.

Question 17

What is the innervation of the anterior compartment of the leg? blood supply?

Answer 17

Deep peroneal nerve. Blood supply is anterior tibial artery

Question 18

What are the muscles of the lateral compartment of the leg?

Answer 18

peroneus longus and brevis

Question 19

What is the innervation of the lateral compartment of the leg? Blood supply?

Answer 19

Superficial peroneal nerve. Supplied with blood by the peroneal artery

Question 20

What are the muscles of the posterior compartment of the leg? (superficial and deep)

Answer 20

superficial group = gastrocnemius, plantaris and soleus. Deep group = popliteus, fl. digitorum longus, fl. hallucis longus, and tibialis posterior.

Question 21

What is the innervation of the posterior compartment of the leg? Blood supply?

Answer 21

Tibial nerve. Blood supply is via the posterior tibial and peroneal arteries

Question 22

What are the muscles of the first layer of the foot? innervation?

Answer 22

Abductor hallucis, fl. digitorum brevis, and abductor digiti minimi. All innervated by the medial plantar nerve except the abductor digiti minimi (lateral plantar nerve).

Question 23

What are the muscles of the second layer of the foot? innervation?

Answer 23

Quadratus plantae and 4 lumbricals. Quadratus and lumbricals 2-4 are innervated by the lateral plantar nerve and the 1st lumbrical is innervated via the medial plantar nerve

Question 24

What are the muscles of the third layer of the foot? innervation?

Answer 24

fl. hallucis brevis, adductor hallucis and fl. digiti minimi. All innervated by the lateral plantar nerve, except the fl. hallucis brevis (medial plantar nerve)

Question 25

What are the muscles of the fourth layer of the foot? innervation?

Answer 25

Interossei. All innervated by the lateral plantar nerve.

Question 26

What is the blood supply for the four layers of the foot?

Answer 26

medial and lateral plantar arteries

Question 27

What are the general actions for the posterior compartment?

Answer 27

Extend the hip joint and flex the leg on the thigh at the knee; when the leg is flexed, the biceps can rotate the leg laterally on the thigh. Semimembranosus/tendinosis rotate it medially.

Question 28

what are the hamstring muscles?

Answer 28

Two joint muscles of the posterior compartment taking origin from the ischial tuberosity

Question 29

what is the significance of the hamstrings two-joint span?

Answer 29

They extend the hip and flex the knee

Question 30

what supplies the hamstrings with motor innervation? blood?

Answer 30

the sciatic nerve innervated the hamstrings while they receive blood from the perforating branch of the profunda femoris artery

Question 31

what are the boundaries of the popliteal fossa?

Answer 31

Upper lateral: biceps femoris Upper medial: semimembranosus Lower lateral & medial: gastrocnemius Floor: popliteus

Question 32

what are the major contents of the popliteal fossa?

Answer 32

The popliteal artery and vein, genicular arteries, small saphenous vein, common peroneal (fibular) and tibial nerves, popliteus muscle

Question 33

What are the boundaries of the femoral triangle?

Answer 33

Lateral: sartorius Medial: adductor longus Roof: fascia lata & cribriform fascia Base: inguinal ligament

Question 34

What muscles comprise the floor of the femoral triangle?

Answer 34

The pectineus and iliopsoas

Question 35

Give the order of structures passing under the inguinal ligament from lateral to medial.

Answer 35

NAVEL: femoral nerve, artery, vein, empty space, lymphatic

Question 36

What is the clinical significance of the E (empty space)?

Answer 36

Femoral hernias protrude here

Question 37

Which of these components of NAVEL enclosed in the femoral sheath?

Answer 37

Primarily the femoral artery and vein although the empty space (femoral canal) and the lymphatic vessel are also enclosed. The femoral nerve is NOT a component within the sheath

Question 38

From what tissue does the sheath arise in the abdominal wall?

Answer 38

The fascia transversalis

Question 39

What other structure(s) passes into the thigh under the inguinal ligament?

Answer 39

The iliopsoas muscle, lateral femoral cutaneous nerve, and pectineus muscle

Question 40

Be able to label a diagram of the branching of the femoral artery as it passes down through the thigh.

Answer 40

IMPORTANT. Diagrams on page 277 and 290.

Question 41

When does the external iliac artery become the femoral artery?

Answer 41

When it passes under the inguinal ligament

Question 42

When does the femoral artery become the popliteal artery?

Answer 42

When it passes through the adductor hiatus into the popliteal fossa

Question 43

What are the terminal branches of the popliteal artery?

Answer 43

The anterior and posterior tibial arteries

Question 44

Which major vessel supplies blood to the gluteal region?

Answer 44

The internal iliac artery (via the superior and inferior gluteal arteries)

Question 45

Which major vessel supplies blood to the lower limb?

Answer 45

The femoral artery

Question 46

What is the first large branch off the femoral artery?

Answer 46

The profunda femoris artery

Question 47

What is meant by perforating branch?

Answer 47

They pass back into the posterior compartment of the thigh

Question 48

What compartments are supplied by the deep femoral artery and its perforating branches?

Answer 48

The posterior compartment of the thigh

Question 49

In the region of the hip and upper thigh, list the anastomoses that may occur.

Answer 49

The cruciate anastomosis: lateral/medial circumflex femoral arteries, superior/inferior gluteal arteries, perforating branches of the profunda femoris

Question 50

Which vessel(s) contribute to the plantar arch?

Answer 50

The lateral plantar artery and dorsalis pedis artery

Question 51

Which vessel(s) contribute to the arcuate artery on the dorsum of the foot?

Answer 51

The dorsalis pedis artery off the anterior tibial artery

Question 52

Which vessel(s) give off the major digital supply in the foot?

Answer 52

The plantar arch

Question 53

Name the major superficial veins of the lower limb.

Answer 53

Short and long (great) saphenous veins

Question 54

To what structure do the superficial veins lie superficial?

Answer 54

the deep fascia

Question 55

With what do perforating veins communicate?

Answer 55

The deep veins of lower limb

Question 56

What is the perforating veins clinical significance in varicose veins?

Answer 56

The valves facilitating superficial to deep venous flow are damaged and blood pools superficially

Question 57

Which nerves supply cutaneous innervation to the dorsum of the foot?

Answer 57

Deep peroneal nerve, superficial peroneal nerve, sural nerve, and saphenous nerve

Question 58

What structure(s) keep the extensor tendons from bowstringing?

Answer 58

The superior and inferior extensor retinaculae

Question 59

Which vessel(s) supply the dorsum of the foot?

Answer 59

The anterior tibial artery via the dorsalis pedis artery

Question 60

What functional type of synovial joint is the hip joint?

Answer 60

A ball and socket/multiaxial synovial joint

Question 61

Name 3 ligaments that strengthen the capsule of the hip joint.

Answer 61

The pubofemoral, ischiofemoral and iliofemoral ligaments

Question 62

Which of these 3 ligaments is the strongest and most important?

Answer 62

The iliofemoral

Question 63

Where is the ligament of the head of the femur?

Answer 63

Within the joint capsule running from the floor of the acetabulum to a pit in the head of the femur

Question 64

What is the nerve supply to the hip joint?

Answer 64

Innervation: primarily the femoral and obturator nerves

Question 65

What is the arterial supply of the hip joint?

Answer 65

Blood supply: the medial and lateral circumflex femoral, superior and inferior gluteal arteries

Question 66

What is the anterior relationship of the hip joint?

Answer 66

muscles of the femoral triangle – pectineus, iliopsoas, and rectus femoris as well as the femoral artery and nerve

Question 67

What is the posterior relationship of the hip joint?

Answer 67

the short lateral rotators of the hip (piriformis, obturator internus, superior/inferior gemelli and quadratus femoris) and sciatic nerve

Question 68

What is the inferior relationship of the hip joint?

Answer 68

tendon of the obturator externus

Question 69

What is the superior relationship of the hip joint?

Answer 69

gluteus maximus, medius, and minimus

Question 70

What functional type of synovial joint is the knee joint?

Answer 70

Condylar/hinge type of synovial joint

Question 71

The capsule of the knee joint is defective anteriorly and communicates with what synovial lined sac?

Answer 71

The suprapatellar bursa

Question 72

What other bursae are found in this region?

Answer 72

Prepatellar, deep infrapatellar, and subcutaneous infrapatellar bursae

Question 73

What does a posterior defect allow to enter the joint?

Answer 73

The popliteus muscle

Question 74

What structures assist in guiding the articulation of the knee joint and are found within the synovial cavity?

Answer 74

the menisci

Question 75

What are these intra-articular structures composed of?

Answer 75

fibrocartilage

Question 76

what of these intra-articular structures is attached to a collateral ligament?

Answer 76

the medial meniscus

Question 77

Name two other ligaments found within the synovial cavity.

Answer 77

There are NONE. The anterior and posterior cruciate ligaments are NOT within the synovial cavity (they are within the joint capsule but lay outside the synovial membrane)

Question 78

What is the blood supply to the knee joint? Sensory innervation?

Answer 78

Blood supply: genicular branches of the popliteal artery | Innervation: sciatic, femoral and obturator nerves

Question 79

What functional type of synovial joint is the ankle (talocural) joint?

Answer 79

Hinge-type synovial joint

Question 80

Which of the ligaments is thick and fan-shaped?

Answer 80

The deltoid (medial)

Question 81

What is the superior attachment of this fan-shaped ligament?

Answer 81

the medial malleolus

Question 82

What are the three distinct bands of the lateral ankle ligament?

Answer 82

The anterior and posterior talofibular ligaments as well as the calcaneofibular ligament

Question 83

What nerves innervate the ankle joint?

Answer 83

The tibial and deep peroneal nerves