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MSK Anatomy > The Lower Limb > Flashcards

The Lower Limb Flashcards

1
Q

What are the functions of the lower limb

A

supports body weight - designed for this
Locomotion
Maintaining balance

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2
Q

What are the 6 regions of the lower limb

A 
gluteal 
femoral 
knee
leg 
ankle 
foot
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3
Q

What forms the sciatic foramen

A

The foramen is split into the greater and lesser parts by the sacrotuberous and sacrospinous ligaments

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4
Q

What is the function of the sciatic foramen

A

Allows nerves to enter and exit the pelvis and perineum

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5
Q

What structures pass through the greater sciatic foramen

A

Those that supply the pelvis

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6
Q

What structures pass through the lesser sciatic foramen

A

Those that supply the perineum

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7
Q

How is the gluteal region divided and what is the clinical relevance

A

Divided into quadrants
Important in injection site
Upper lateral quadrant has less important structures so is commonly used

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8
Q

What is the largest nerve in the body

A

The sciatic nerve

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9
Q

Where does the sciatic nerve originate

A

L4-S3

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10
Q

What does the sciatic nerve supply

A

posterior thigh, all the leg and foot muscles and most of the skin
Branches in order to do this

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11
Q

What are the 2 main branches of the sciatic nerve

A

Tibial
Common fibular
This branching occurs in the distal thigh

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12
Q

Where does the pudendal nerve originate from

A

S2-4

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13
Q

What does the pudendal nerve supply

A

Principal nerve to the perineum

Supplies the perineum, genitals and pelvic floor muscles

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14
Q

Where does the posterior cutaneous nerve of the thigh originate

A

S1-S3

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15
Q

What does the posterior cutaneous nerve of the thigh supply

A

skin over posterior thigh, popliteal fossa, lateral perineum and upper medial thigh

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16
Q

List the superficial muscles of the gluteal region

A

gluteus maximus, gluteus medius, gluteus minimus, tensor fascia latae

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17
Q

What is the function of the superficial muscles of the gluteal region

A

extensors, abductors and medial rotators of thigh

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18
Q

Which of the superficial gluteal muscles is the largest

A

gluteus maximus

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19
Q

What innervates the superficial gluteal muscles

A

Inferior gluteal nerve supplies the gluteus maximum

Superior gluteal supplies the others (L5-S2)

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20
Q

List the deep muscles of the gluteal region

A

piriformis, obturator internus, gemelli and quadratus femoris

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21
Q

What innervates the deep muscles of the gluteal region

A

Nerves from the sacral plexus

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22
Q

What is the function of the deep muscles of the gluteal region

A

lateral rotators of thigh and hip stabilisers

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23
Q

What can happen if the piriformis muscle becomes tight

A

it can entrap the sciatic nerve and lead to sciatica type symptoms

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24
Q

Describe the path of the sciatic nerve

A

Usually exits inferior to the piriformis
Usually most lateral structure leaving the sciatic foramen
Passes down in the posterior thigh

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25
Q

What are the boundaries of the femoral triangle

A 
Superior - inguinal ligament 
Medial - adductor longus 
Lateral -sartorius
Floor - iliopsoas and pectineus
Roof - deep fascia
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26
Q

What are the contents of the femoral triangle

A

Femoral nerve
Femoral artery
Femoral Vein
Lymphatics

(NAVY)

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27
Q

How many compartments does the thigh have

A

3

Anterior, medial and posterior

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28
Q

How many compartments does the leg have

A

3

anterior, posterior and lateral

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29
Q

What forms the compartments within the limb

A

The muscles are surrounded by a deep fascia that will then invaginate to form intermuscular septums

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30
Q

The action and nerve supply of the muscles within a compartment are generally the same - true or false

A

True

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31
Q

What is compartment syndrome

A

Occurs when there is increased pressure within a compartment - due to fluid or bleeding etc
This can affect the function and flow of blood vessels/nerves in the area
Will become very painful and can lead to
odd neural symptoms and vascular necrosis

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32
Q

How do you treat compartment syndrome

A

Fasciotomy

Cut into the fascia tp release the pressure

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33
Q

Which group is more likely to get chronic compartment syndrome

A

Athletes

Enlarged muscles can put pressure on the vasculature and nerves

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34
Q

Which muscles are found in the anterior compartment of the thigh

A

Pectineus
Iliopsoas
Sartorius
Quadriceps femoris

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35
Q

Which muscles are the flexors of the thigh

A

Pectineus
Iliopsoas
Sartorius

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36
Q

Which muscles are the extensors of the leg

A

Quadriceps femoris

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37
Q

Which nerve supplies the anterior compartment of the leg

A

Femoral nerve

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38
Q

Which level does the femoral nerve originate

A

L2,L3,L4

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39
Q

Which muscles are found in the medial compartment of the thigh

A

adductor longus, adductor brevis, adductor magnus, gracilis,
obturator externus

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40
Q

What is the function of the muscles in the medial compartment of the thigh

A

Adductors of the thigh

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41
Q

Which nerve supplies the medial compartment of the leg

A

The obturator nerve

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42
Q

Which level does the obturator nerve originate from

A

L2,3,4

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43
Q

What muscles are found in the posterior compartment of the thigh

A

semitendinosus, semimembranosus biceps femoris

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44
Q

What nerves supply the posterior compartment of the thigh

A

Tibial division of sciatic nerve

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45
Q

Which level does the tibial division of the sciatic nerve originate

A

L5, S1 and S2

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46
Q

What muscles are found in the anterior compartment of the leg

A

tibialis anterior, extensor digitorum longus,
extensor hallucis longus,
fibularis tertius

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47
Q

What is the function of the muscles in the anterior compartment of the leg

A

Dorsiflexors of ankle & extensors of toes

Extend the foot or dorsal flex the foot

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48
Q

What nerve supplies the anterior compartment of the leg

A

deep fibular nerve

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49
Q

Which level does the deep fibular nerve arise from

A

L4, L5

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50
Q

What is the result of damage to the dorsiflexor muscles

A

Foot drop
Cannot flex the foot upwards
Will have to raise knee up higher or swing round to the side
Often trip due to toes dragging or you hear a foot slap as they cannot control the foot hitting the ground

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51
Q

What muscles are found in the lateral compartment of the leg

A

fibularis longus, fibularis brevis

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52
Q

What are the functions of the muscles in the lateral compartment of the leg

A

evert the foot

Weakly plantarflex the ankle

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53
Q

What nerve supplies the lateral compartment of the leg

A

superficial fibular nerve

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54
Q

Where does the superficial fibular nerve originate from

A

L5, S1, S2

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55
Q

Which muscle are found in the posterior compartment of the leg

A

Superficial group - gastrocnemius, soleus, plantaris

Deep group - popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior

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56
Q

What is the function of the superficial muscle group of the posterior compartment of the leg

A

plantarflexors of the ankle

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57
Q

What nerve supplies the superficial muscle group of the posterior leg compartment

A

Tibial nerve

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58
Q

What name may be used to refer to the 3 muscles in the superficial group of the posterior leg compartment

A

Triceps surae

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59
Q

Which leg muscle can you take out without a negative effect

A

Plantaris

for this reason it is commonly used for tendon repair

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60
Q

What are the functions of the deep group of the posterior leg compartment

A

Flexor of toes

Plantarflexors of the ankle

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61
Q

Which nerve supplies the deep group of the posterior leg compartment

A

tibial nerve

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62
Q

How is the flexor hallucis longus suited to its function

A

It is responsible for moving the big toe

It is a large muscle as most of our weight moves through this toe

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63
Q

What type of joint is our hip joints

A

Ball and socket
Head of the femur is the ball and the socket is the acetabulum of the hip
It’s a synovial joint with strong capsule

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64
Q

Which movements can the hip joint perform

A

flexion-extension
abduction-adduction
medial-lateral rotation
circumduction

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65
Q

What forms the ligaments in the hip joint

A

thick part of fibrous layer of joint capsule

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66
Q

Name the 3 ligaments from the hip joint to femur

A

iliofemoral
pubofemoral
ischiofemoral

67
Q

What is the function of the ligaments in the hip joint

A

Strengthens the joint capsule

Stabilises the joint

68
Q

Describe the blood supply to the hip joint

A

The medial and lateral circumflex arteries branch from the deep femoral artery
These wrap around the joint and anastamose
The artery to the head of the femur branches off the obturator

69
Q

What are the movements of the knee joints

A

Main is flexion-extension

Some medial-lateral rotation can occur - few degrees

70
Q

What type of joint is the knee

A

Hinge joint
Synovial joint
Has an external fibrous layer and internal membranous layer

71
Q

What muscle(s) is mainly responsible for knee extension

A

The Quads

72
Q

What muscle is mainly responsible for knee flexion

A

Hamstrings

Popliteal muscle at back of knee starts the process

73
Q

Name the extracapsular ligaments of the knee

A

Patellar tendon
Lateral (fibular) collateral ligament
Medial (tibial) collateral ligament

74
Q

Describe how the medial and lateral collateral ligaments are suited to their function

A

Lateral is more cord like as surrounded by many other structures for support
Medial is much thicker/wider as it needs to be more supported

75
Q

Name the intra-articular ligaments of the knee

A 
anterior cruciate (ACL)
posterior cruciate (PCL)
76
Q

What are the 3 articulations of the knee joint

A

2 x femerotibial

1 x femeropatellar

77
Q

What is the main function of the PCL

A

Stops the tibia moving backwards

Stabilises knee

78
Q

What group commonly tear their ACL

A

Athletes

Common to tear with a twisting injury

79
Q

Describe the menisci of the knee

A

Crescent shaped fibrocartilage that surround the condlyes of the femur
Medial and lateral ones
Absorb forces through knee joint

80
Q

What are the boundaries of the popliteal fossa

A

superolaterally – biceps femoris
superomedially – semimembranosus
inferiorly – gastrocnemius
roof – popliteal fascia

81
Q

What are the contents of the popliteal fossa

A

lots of fat - for cushioning
terminal small saphenous vein
popliteal vessels
tibial and common fibular nerves

82
Q

What is the importance of the many blood vessels in the popliteal fossa

A

A bent knee will kink the popliteal vessel – reduces blood supply
As a result there are many blood vessels to compensate

83
Q

Describe the calcaneal tendon

A

Commonly known as achilles
Thickest and strongest in the body
Attaches to the calcaneal tuberosity of the calcaneus

84
Q

What is the ankle jerk test

A

Achilles tendon is tapped
Normal result is plantarflexion
Tests S1, S2 nerve roots

85
Q

Describe the path of the superficial lymphatics

A

Follow the saphenous veins
drain to the superficial inguinal lymph nodes
then the external iliac nodes

86
Q

Describe the path of the deep lymphatics

A

follow deep veins
Then to popliteal lymph nodes
deep inguinal lymph nodes
external iliac lymph nodes

87
Q

What are common sites of fracture in the pelvis in osteoporosis

A

Pubis rami

Sacroiliac joints

88
Q

Which bones are in the hindfoot

A

Calcaneus

Talus

89
Q

Which bones are in the midfoot

A

Cuboid
Navicular
Medial, intermediate and lateral cuneiforms

90
Q

Which bones are in the forefoot

A

Metatarsals

Phalanges - proximal, middle and distal

91
Q

What name is given to the joint between the talus and navicular

A

Acetabulum pedis

92
Q

What is the main blood supply to the femoral head

A

Medial circumflex artery

93
Q

List all the vessels that supply the femoral head

A

Medial circumflex
Lateral circumflex
Branch of the obturator

94
Q

Describe the usual outcome of a intracapsular hip fracture

A

Usually disrupts the blood supply

Needs a hip replacement

95
Q

Describe the usual outcome of a extracapsular hip fracture

A

Often preserves the blood supply

Can be repaired without replacement - blood supply allows healing

96
Q

Which muscles are the primary hip flexors

A

Iliacus

Psoas major

97
Q

What is the origin and insertion of the iliacus

A

Origin - iliac crest/inner aspect of ilium

Insertion - lesser trochanter of femur

98
Q

What is the origin and insertion of the psoas major

A

Origin - transverse process of L1-L5

Insertion - lesser trochanter of femur

99
Q

What are the signs of a psoas abscess

A

Common in immunocompromised or PWID
Patient will look very unwell
Will sit with their hip flexed - most comfortable

100
Q

Which muscles are the secondary hip flexors

A

Rectus femoris

Sartorius

101
Q

What is the origin and insertion of the rectus femoris

A

Origin - AIIS

Insertion - tibia (via patella tendon)

102
Q

What is the origin and insertion of the sartorius

A

Origin - ASIS

Insertion - tibia

103
Q

What is an avulsion fracture

A

When contraction of the muscle or tendon pulls off part of the bone it is attached to
Common in kids as bones still developing
Can happen to ASIS and ischium

104
Q

Which clinical issues can affect the hip adductors

A

Adductor tendinopathy - common in footballers
Osteitis pubis
Spasticity in NM conditions - leads to balance issues when sitting

105
Q

Which muscles are the hip adductors

A 
adductor brevis 
adductor longus 
adductor magnus 
Pectineus 
Gracilis
106
Q

What is the common site of origin of the hip adductors

A

Inferior pubic rami

107
Q

What is the site of insertion of the adductor brevis, longus and magnus

A

Linea aspera of femur

108
Q

What is the site of insertion of the pectineus

A

Pectineal line of femur

109
Q

What is the site of insertion of the gracilis

A

Tibia

110
Q

Which muscles are the hip abductors

A

Gluteus minimus
Gluteus medius
Tensor fascia lata

111
Q

What is the origin and insertion of the gluteus minimus and medius

A

Origin - ilium

Insertion - greater trochanter of femur

112
Q

What causes a Trendelenburg gait

A

Weakness of the hip abductors

113
Q

What is a Trendelenburg gait

A

Patient will fall to one side as they walk - toward the leg that’s off the ground

May compensate and throw body the opposite way when walking - T lurch

114
Q

What is the origin and insertion of the tensor fascia lata

A

Origin - iliac crest

Insertion - lateral tibia via the iliotibial tract

115
Q

What is the origin and insertion of the gluteus maximus

A

Origin - posterior aspect of ilium/sacrum

Insertion - iliotibial tract

116
Q

What is the function of the gluteus maximus

A

Hip extensor

Helps with posture

117
Q

Which muscles are hip extensors and knee flexors

A

Hamstrings

- Biceps femoris, semimembranosus and semitendinosus

118
Q

What is the origin and insertion of the biceps femoris

A

Origin- Long head: Ischial tuberosity Short head: Linea aspera
Insertion: Fibula head

119
Q

What is the origin and insertion of the semimembranosus

A

Origin - ischial tuberosity

Insertion - posterior tibia

120
Q

What is the origin and insertion of the semitendinosus

A

Origin - ischial tuberosity

Insertion - medial tibia

121
Q

Where does true hip pain present

A

In the groin

122
Q

What is the function of the collateral ligaments

A

Resists varus/valgus stresses at the knee
Stops excessive movement in the coronal plane
Found in medial and lateral side of joint

123
Q

What is the function of the anterior cruciate ligament

A

Resists anterior translation and external rotation of the tibia on the femur

124
Q

What is the function of the posterior cruciate ligament

A

Resists posterior translation of the tibia on the femur

125
Q

What are the functions of the menisci

A

Load transfer (“shock absorbers”)
Increase femero-tibial conformity
Stabilise the knee during movement
Lubricate the knee

126
Q

Which muscles make up the quadriceps muscle

A

Rectus femoris
Vastus intermedius
Vastus medialis
Vastus lateralis

127
Q

What is the site of origin and insertion of the vastus intermedius

A

Origin - anterolateral proximal femur

Insertion - tibia via patellar tendon

128
Q

What is the site of origin and insertion of the vastus medialis

A

Origin - medial edge of linea aspera of femur and greater trochanter
Insertion - tibia via patellar tendon

129
Q

What is the site of origin and insertion of the vastus lateralis

A

Origin - medial edge of linea aspera and lesser trochanter

Insertion - tibia via patellar tendon

130
Q

Which structures are part of the extensor mechanism of the knee

A 
Quadriceps muscle 
Quadriceps tendon 
Patella 
Patella tendon 
Tibial tubercle
131
Q

Which factors may predispose to patellar insufficiency

A 
Genu valgum 
Femoral head anteversion 
Weak quadriceps 
Laxity of ligaments 
Wide Q angle - women
132
Q

Which muscles make up the hamstring

A

Biceps femoris
Semimembranosus
Semitendinosus

133
Q

What is the site of origin and insertion of the gastrocnemius

A

Origin - femoral condyles

Insertion - calcaneus via the Achilles tendon

134
Q

What is the site of origin and insertion of the soleus

A

Origin - broad area on posterior tibia

Insertion - calcaneus via the Achilles tendon

135
Q

What is the site of origin and insertion of the plantaris

A

Origin - lateral femoral condyle

Insertion - calcaneus via the Achilles tendon

136
Q

What is the site of origin and insertion of the tibialis anterior

A

Origin - lateral surface of proximal tibia

Insertion - medial cuneiform and base of 1st metatarsal

137
Q

Name the ligaments of the ankle

A

Medial - deltoid ligament

Lateral - lateral ligament complex

138
Q

What is the origin and insertion of the tibialis posterior tendon

A

Origin: Posterior proximal tibia /fibula
Insertion: Navicular / plantar surface of medial cuneiform

139
Q

What is the origin and insertion of the plantar fascia

A

Origin: Tuberosity of calcaneus

Insertion: Heads of metatarsals

140
Q

What is the femoral sheath

A

Short tube of transversalis and iliopsoas fascia from abdominal wall that envelopes the femoral artery and vein

Does not surround the nerve

141
Q

Describe the path and function of the saphenous nerve

A

Branches from femoral nerve
Leaves adductor canal by passing between the sartorius and gracilis

Supplies fascia and skin in anteromedial aspects of knee, leg and medial aspect of foot

142
Q

What is the clinical use of the femoral artery

A

Access route for many procedures: angiograms, stents, valve replacement

143
Q

Where does the inguinal ligament run

A

Between the ASIS and pubic tubercle

144
Q

How to the femoral vessles and nerves enter/leave the lower limb

A

Pass deep to inguinal ligament in the retroinguinal space

145
Q

What is the knee jerk test

A

Deep tendon reflex elicited by striking the patellar ligament
Causes sudden contraction of quadriceps
Confirms muscle function, femoral nerve function and spinal cord connection

146
Q

List the sensory innervation of the thigh

A

Anterior cutaneous nerve of the thigh
Lateral cutaneous nerve of the thigh
Cutaneous branch of the obturator nerve

147
Q

Describe the drainage of lymph following the great saphenous vein

A

Drains to superficial inguinal nodes then to external iliac nodes

148
Q

Describe the drainage of lymph following the small saphenous vein

A

Drains to popliteal lymph nodes then to deep inguinal nodes then finally external iliac nodes

149
Q

What are the attachments of gluteus maximus

A

iliac crest, sacrum, sacrotuberous ligament and coccyx proximally
Iliotibial tract distally

150
Q

What are the attachments of gluteus medius and minimus

A

external/posterior aspect of ilium proximally

greater trochanter distally

151
Q

What is found in the inferior gluteal neurovascular bundle

A

inferior gluteal artery, vein and nerve (L5-S2)

Supplies glute max

152
Q

What is found in the superior gluteal neurovascular bundle

A

superior gluteal artery, vein and nerve (L5-S2)

Supplies glute medius and minimus

153
Q

What is the iliotibial tract

A

Thickening of the fascia lata (deep fascia of the thigh)
Runs from ASIS to lateral tibial condyle
It supports the knee

154
Q

What is the tensor fascia latae

A

Muscular part of the fascia lata (deep fascia of thigh)

In proximal portion of iliotibial tract

155
Q

What is the function of the acetabular labrum in the hip

A

Increases the depth of the acetabulum

156
Q

Describe the ligament to the head of the femur

A

Attaches femur to depth of acetabulum
Ruptured in dislocation
Artery to the head of the femur runs within it but is obliterated by adulthood

157
Q

What is the function of the genicular anastomoses

A

Provides collateral blood supply to the knee joint

Important in flexion as the popliteal artery can be temporarily occluded

158
Q

Which structures pass through the tarsal tunnel

Tom Dick and Very Nervous Harry

A 
Tibialis anterior tendon
Flexor digitorum longus tendon
Posterior tibial artery and veins
Tibial nerve
Flexor hallucis longus tendon
159
Q

What is the proximal and distal attachments of the popliteus

A

Prox - lateral condyle of femur and meniscus

Distal - posterior surface of tibia

160
Q

What is the proximal and distal attachments of the flexor hallucis longus

A

Prox - inferior 2/3 of posterior surface of fibula

Distal - base of distal phalanx of big toe

161
Q

What is the proximal and distal attachments of the flexor digitorum longus

A

Prox - posterior surface of tibia and by a tendon to fibula

Distal - bases of distal phalanges of 4 digits

162
Q

What is the proximal and distal attachments of the tibialis posterior

A

Prox - interosseous membrane, posterior surfaces of tibia and fibula
Distal - tuberosity of navicular, cuneiform and cuboid, bases of 2nd-4th metatarsal

163
Q

Where do you find the prepatellar bursae

A

Superficial to patella

164
Q

Where do you find the infrapatellar bursae

A

Inferior to patella

Superficial to the patellar ligament

MSK Anatomy (4 decks)

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