Unit Exam 4- Lower Limb, Pelvis, Head, and Neck Flashcards
Lower Limb Function
Support, Locomotion, and Maintenance of Equilibrium
Weight- Axial Skeleton->Pelvis->Hip->Lower Limb
Propulsive Force- L. Limb->Hip->Pelvis->Axial Skeleton
Regions of Lower Limb
Gluteal Region, Thigh, Knee, Leg, and Ankle and Foot
Fascia Lata
Deeper, strong investing layer of fascia that limits outward expansion of muscle to aid blood return
Continuous except superiorly at Saphenous Opening
Iliotibial Band
Thick portion of Fascia Lata on the lateral side of the leg
Runs from Hip to Knee
Great Saphenous Vein
Largest and Longest vein in the Body
Runs from the Foot to the Groin in Subcutaneous tissue
Accompanied by the Saphenous Nerve around the Tibia
Small Saphenous Vein
Begins Posterior to the Lateral Malleolus
Passes along the lateral side of the Foot with the Sural Nerve and ascends along the Lateral side of the Calcaneal Tendon
Passes between two heads of Gastrocnemius to the Popliteal Fossa
Ends in the Popliteal Vein (Sometimes in the Great or Accesory Saphenous)
Accessory Saphenous Vein
Essentially the Median Cubital Vein of the leg
Connects the Great and Small Saphenous
Deep Veins
All paired with an artery
Contained within a Vascular Sheath
Deep Veins: Femoral, Politeal, Anterior Tibial, Posterior Tibial, Fibular, and Deep vein of Thigh
Popliteal Vein
Becomes the Femoral Vein of the Thigh passes the Knee into the Leg
Femoral Vein
Becomes the External Iliac Vein once it passes the Inguinal Ligament
Deep Vein of Thigh
This vein is received by the Femoral Vein before the Inguinal Ligament
Vein Drainage in Reverse
Femoral Breaks into 3: Deep Vein of Thigh, Popliteal, and Great Saphenous
Deep Vein of the Thigh leads nowhere
Great Saphenous only leads to Dorsal Venous Arch near the Big Toe.
Popliteal splits into Small Saphenous and Fibular
Small Saphenous only leads to Dorsal Veinous Arch near the Little Toe
As Fibular goes towards Popliteal, Anterior Tibial and Posterior Tibial joins it. It also ends at the Plantar Veins which leads into Fibular and Posterior Tibial. The Dorsal Veinous Arch leads into Anterior Tibial. Also some of Great Saphenous perforates into the Anterior Tibial
Femoral Triangle
Lateral Border is Sartorius Muscle Superior Border is the Inguinal Ligament Medial Border is Adductor Longus Muscle In the Triangle: Most Lateral is Femoral Nerve Lateral is the Femoral Artery Intermediate is Femoral Vein Medial is space filled with Areolar Tissue Lymph Nodes From Medial to Lateral Is "VAN"
Adductor Hiatus
Tendinous Opening in the Adductor Muscle where the Femoral Vein and Artery leave the Adductor Canal
Compartment Syndrome
Fascical Compartments are closed spaces, sustained intense use, blunt trauma, burns can lead to edema within a compartment
Pressure rises to a point where small nerves and blood vessels are compressed and blood flow and pulses are diminished
Happens because Fascia is very tight and not elastic
Varicose Veins
Great Saphenous Veins becomes engorged such that valves are not effective and blood flows back under gravity.
Major Arteries of the Thigh
Femoral Artery, Deep Artery of the Thigh, Medial and Lateral Circumflex Femoral Artery, and Obturator
Femoral Artery
Continuation of External Iliac Artery Distal to Inguinal Ligament
Supplies Anterior and Anteriomedial aspects of the Thigh
Deep Artery of the Thigh
Branches off of the Femoral Artery 1-5 cm Inferior to the Infuinal Ligament
Perforating Arteries pass through Adductor Magnus
Supply muscles in Medial, Posterior, and Lateral part of Anterior Compartments
Medial and Lateral Circumflex Femoral Arteries
Deep Arteries of the Thigh- May arise from Femoral Artery
Medial supplies most of blood to head and neck of Femur and joins Inferior Gluteal Artery
Lateral Supplies Anterior part of Gluteal Region, winds around Femur, and joins Genicular Periarticular Anastomosis
Obturator Artery
Comes from Internal Iliac Artery or (in 20%) as an Accessory
Anterior Branch supplies Obturator Externus, Pectineus, Adductors of the Thigh, and Gracilis
Posterior Branch supplies muscles attached to the Ischial Tuberosity
Major Arteries of the Leg
Popliteal and Genicular, Anterior Tibial, Posterior Tibial, Fibular, Dorsal Artery of the Foot, and Lateral Plantar Artery
Study Slide 30 from power point of Lower Limb
Lymphatic Drainage of the Lower Limb
Superficial Lymphatic Vessels accompany the Saphenous Veins and Tributaries
Deep Lymphatic Vessels accompany Deep Veins
Cutaneous Nerves of Lower Limb
Originate from the Lumbar and Sacral Plexus from L1-S3
Genitofemoral Nerve Sensory Location
About where Iliopsoas (or Hip Flexors are)
Ilioinguinal Nerve Sensory Location
Most medial- Crotchal Region
Obturator Nerve Sensory Location
Medial, just Inferior to the Ilioinguinal Nerve Sensory Location
Femoral Nerve Sensory Location
Pretty much the whole Intermediate portion of the Thigh and also covers the knee
Saphenous Nerve Sensory Location
All of the Medial and almost all of the Anterior of the Leg and the Posterior Medial Half of the Calf/Leg
Big Butts
Allow for Superior Muscle Place and Angled Femur
Angleness of the Hips
They are angled for Bipedal Locomotion and Stability
Compartments of the Thigh
Anterior Compartment (Lateral Intermuscular Septum- Between Ant/Post), Posterior Compartment, and Medial Compartment (Medial Intermuscular Septum- Between Ant/Med) IT Band is on the Outside of the Anterior Comparment
Trendelenburg Gait
Abnormal Gait caused by weakness of the Abductor Muscles (Glutes)
Possibly a Lesion of the Superior Gluteal Nerve
Causes them to have to Rotate/Swing their Pelvis while walking
Piriformis is a Landmark of the Gluteal Region
It determines the names of Blood Vessels and Nerves
Iliopsoas
Chief Flexors of the Thighs
Important Antigravity Postural Muscles- Help Maintain Erect Posture at the Hip Joints
Sartorius
The most Superficial Muscle in the Anterior Part of the Thigh
Quadriceps Femoris
3 Vastus muscls only act on the Knee
Rectus Femoris acts on the Knee and Hip
Important Functions are Rising from Sitiing, Walking up Stairs, Absorbing Jarring shock from Heel Strikes while walking
All muscles insert into the Common Quadriceps Tendon and on to the Tibial Tuberosity
Adductors of the Thigh
They Stabilize the Stance and Correct Lateral Sway of the Trunk (Rocking Boat) and on Uneven Surfaces
All are supplied by the Obturator Nerve
Ischial Tuberosity
The Portion of the Pelvis that I’m sitting on… Saddle Bones
Hamstring Muscles
Span the Hip and Knee Joints making them Extensors of the Thigh and Flexors of the Leg
Deep Fibular Nerve
The most commonly severed nerve in the Body
Superficial Muscles of the Leg
Gastrocnemius, Soleus, and Plantaris
All are innervated by Tibial Nerve and insert into the Calcaneus via the Calcaneal Tendon
Deep Posterior Leg
Popliteus, Flexor Hallucis Longus, Flexor Digitorum Longus, and Tibialis Posterior
Foot and Muscles
20 muscles- 14 muscles on the sole arranged into 4 Layers
Vast Majority of the muscles of the foot are dedicated to Gait, maintaining weight bearing arches of the foot, and supporting stance
Pivot Point
The Point where the motion of the rotating body is 0
Perpendicular to the Joint Motion
Femoral Nerve
Lateral to the Great Vessels
Originates from L2-L4
Outside of the Femoral Sheath
Innervates Sartorius, Quadriceps, and Pectineus Iliacus
Sciatic Nerve
Originates L4-L5, S1-S3
Enters through the Sciatic Foramen below the Piriformis
Deep to Gluteus Max
Branches into Tibial Nerve and Common Fibular Nerve
Obturator Nerve
L2-L4
Passes through Obturator Canal
It Splits into Anterior and Posterior going on either side of the Adductor Brevis
Popliteal Fossa
The Knee Pit
Tibial Nerve
Originates from Sciatic
Supplies Gastrocnemius, Plantaris, Soleus, Popliteus
Common Fibular Nerve
Originates from Sciatic
Lateral border of the Popliteal Fossa
THIS NERVE IS THE MOST INJURED NERVE IN THE BODY
Divides into Superficial and Deep Fibular Nerves
Deep Fibular supplies the Extensors of the Leg
Superficial supplies Medial side and Dorsum of the Foot
Plantar Nerves
Medial and Lateral
Innervate the side of the foot indicated by the name
Hip Joint
Wide range of motion, but less than the Shoulder Joint
Mobility is sacrificed for Stability
Allows Flexion/Extension, Abduction/Adduction, Medial/Lateral Rotation, and Circumduction
Ball and Socket Joint
Head of Femur sits in Acetabular Fossa
Articular Capsule covers the Joint from the Greater Trochanter to the Acetabulum (Reinforced by 3 Ligaments)
Acetabular Labrum deepens the Capsule
Iliofemoral Ligament
From AIIS to Trochanteric Line Inverted Y-Shaped Ligament for the Hip Joint Anterior side Limits Extension (Hyperextension) and Lateral Rotation
Pubofemoral Ligament
From Superior Ramus to Intertrochanteric Line
Limits Extension, Abduction, and Lateral Rotation
Ischiofemoral
Posterior side Ligament
Spiral-Shaped attaching Ischium to the Greater Trochanter
Limits Extension and Medial Rotation
Muscles that Act on the hip
They stabilize the Hip, are Lateral Rotators , and are Innervated by the Sacral Plexus
Obturator Internus, Obturator Externus, Gluteus Minimus, Piriformis, Superior Gemellus, Inferior Gemellus, and Quadratus Femoris
Knee Joint
Largest and most complex Synovial Joint in the Body Functions as a Hinge Joint, but allows Flexion/Extension and Medial/Lateral Rotation (at Full Extension) Tibiofemoral Joint (between Tibial and Femoral Condyles) and Patellofemoral Joint (between Patella and Patellar surface of Femur) Fibula does not participate Tibial and Femoral Condyles are separated by C-Shaped pieces of Fibrocartilage
Patella
Largest Seismoid bone in the Body
Menisci
Medial/Lateral Menisci deepen Tibial Condyles and serve as cushions
Medial Meniscus (C) in more open than Lateral (O)
Lateral Miniscus is less likely to tear than Medial
Both are attached to Tibia by Anterior/Posterior Horns
Medial is more fixed allowing it to be more commonly trapped between Tibia and Femur causing injury
Ligaments of Knee Joint
Patellar Ligament- Extends from Inferior Patella to Tibial Tuberosity
Oblique Popliteal Ligament- Tendinous Expansion of Semimembranous- Strengthens poster aspect of Joint Capsule
Artcuate Politeal Ligament- Edge of Articular Capsule that arches over Politeus Muscle as it Exits Joint
Lateral (Fibular) Collateral Ligament- Extends from Lateral Femoral Epicondyle to Head of Fibula (Does not attach to Meniscus)
Medial (Tibial) Collateral Ligament- From Medial Femoral Epicondyle to Tibia (Attaches to Meniscus)
Cruciate Ligaments- Strong Intracapsular Ligaments- Main bond between Femur and Tibia- Anterior and Posterior according to Attachments- PCL Attaches to Medial Condyle of Femur- ACL Attaches to Lateral Condyle of Femur
Bursa of the Knee
Suprapatellar Bursa- Extends Superiorly, Deep to Quadriceps Femoris- Above (Patella)
Prepatellar Bursa- In Subcutaneous Tissue betweeen Patellar Ligament and Skin
Deep Infrapatellar Bursa- There are Many- Between Patellar Ligament and Tibia Bursae associated with Popliteus (As it exits Joint)
Tibia and Fibula
Proximal Tibiofibular Joint- Synovial Joint between head of fibula and Articular Surface on Lateral Condyle of Tibia
Interosseus Membrane- Runs in betweeen and binds Tibia and Fibula together and also provides muscle attachments
Distal Tibiofibular Joint- Fibrous Joint between lower ends of Tibia and Fibula
Calcaneus
Largest and strongest bone of the Foot
Also the first one to Ossify
Ankle Joint
Synovial Hinge Joint
Consists of Deep Socket that embraces upper part of Talus
Ligaments of Ankle
Medial (Deltoid) Ligament- Attaches from Medial Malleolus to Navicular, Talus, and Calcaneus parts- Contains 4 Slips: Anterior Tibiotalar, Posterior Tibiotalar, Tibionavicular, and Tibiocalcaneal
Lateral Ligament- Weaker overall- 3 Bands: Anterior Talofibular Ligament (most frequently sprained), Posterior Talofibular, and Calcaneofibular
Transverse Tarsal Joints
3 Articulations
Allow for Inversion/Eversion
Between Calcaneus/Talus and Navicular/Cuboid
Tarsometatarsal Joints
Between Navicular/Cuneiforms and Metatarsals