Vessels and nerves - Lower limbs Flashcards
What travels through the greater sciatic foramen above the piriformis muscle? (3)
Superior gluteal artery, nerve and vein
What travels through the lesser sciatic foramen? (3)
Obturator internus muscle tendon
Pudenal nerve
Internal pudenal vessels (pass into perineum from gluteal region)
What travels through the greater sciatic foramen below the piriformis muscle ? (10)
Sciatic nerve
Inferior gluteal nerve, artery and vein
Inferior pudenal artery and vein
Posterior femoral cutaneous nerve
Nerve to obturator internus and superior gemellus muscle
Nerve to quadratus femoris and inferior Gemellus muscles
What passes through the obturator canal? (2)
Obturator nerve
Obturator vessels
What passes through the subinguinal space? (8)
Femoral nerve Psoas major Iliacus Pectineus Femoral artery and vein Lymphatics Femoral branch of genitofemoral nerve Lateral cutaneous nerve og thigh
What branch does the femoral artery give off?
The deep artery of the thigh
What branches does the deep artery of the thigh give off and where do they supply?
Lateral and medial circumflex arteries. Lateral supplies the anterior compartment and medial supplies medial compartment. Also gives off 3-4 perforating branches that supply posterior compartment of the thigh
What is the most important blood supply to the femoral head in adults?
Medial circumflex artery
What are the superior and inferior arteries branches of?
`The internal iliac artery and they contribute to the cruciate anastomosis
What is the obturator artery a branch of?
Internal iliac artery
What are the branches of the obturator artery and any branches these give off?
Divides into anterior and posterior branches. Posterior branch gives off the acetabular branch to the head of the femur.
Supplies medial compartment
Contents of the femoral triangle from lateral to medial
Femoral nerve
Femoral sheath - Femoral artery, femoral vein, lymphatics
Fat
What is the saphenous opening for?
Opening in the fascia lata for the great saphenous vein to join the femoral vein
What is the adductor hiatus for?
Allows contents of the adductor canal into the popliteal fossa
Femoral artery and vein, not branches of femoral nerve
What nerve innervates most of the muscles of the anterior compartment? and what are the exceptions?
The femoral nerve (L1-L3)
- psoas major = anterior rami L1-L3 (directly innervated)
- Quadriceps femoris primarily innervated from spinal cord segments L3&4
What nerve innervates most of the muscles of the medial compartment? and what are the exceptions?
The obturator nerve (L2-L4)
- Pectineus = femoral nerve (L2, L3)
- Hamstring part of Magnus = sciatic nerve, tibial part
What nerve innervates most of the muscles of the posterior compartment? and what are the exceptions?
Tibial division of sciatic nerve
- Short he’d
ad of biceps femoris = common fibular division of sciatic nerve
What are the dorsal divisions of the lumbosacral plexus?
Femoral nerve (L2-L4) to anterior compartment
What are the ventral divisions of the lumbosacral plexus?
Obturator nerve (L2-L4) or medial compartment
Tibial division of sciatic nerve (L4-S3) for posterior compartment
What is the route of the great saphenous vein
From union of dorsal venous arch and dorsal vein of big toe and then it travels within the superficial fascia of the medial ankle, leg and thigh
What is the route of the small saphenous vein?
From lateral side of dorsal venous arch and then travels within the superficial fascia of the posterior leg, then penetrates deep fascia to join the popliteal vein
What is special about the perforating veins of the small saphenous vein?
Connect superficial to deep and they are valved so the blood only flows from superficial to deep
What 4 arteries contribute the branches to the vehicular anastomosis?
1) Popliteal artery
2) Femoral artery
3) Lateral circumflex femoral artery
4) Anterior tibial artery
What 4 branches of the popliteal artery contribute to the vehicular anastomosis?
Superior medial, Superior lateral, Inferior medial and inferior lateral vehicular artery
If there is occlusion of the femoral artery how does blood get to the leg before the branching of the profunda femoris?
Via the inferior gluteal artery and cruciate anastomosis
If there is occlusion of the femoral artery how does blood get to the leg after the branching of the profunda femoris?
Via the lateral circumflex femoral artery and vehicular anastomosis
What is the contents of the popliteal fossa from medial to lateral and deep to superficial?
Popliteal artery
Popliteal vein
Tibial nerve (runs deep to the popliteus)
Common fibular nerve (follows margin of biceps femoris)
What is the route of the popliteal artery and what branches does it give off?
Starts at adductor hiatus and passes under the tendinous arch (of soleus) and gives off anterior and posterior tibial arteries
What does the anterior tibial artery pass through?
passes through the hole in the upper interosseous membrane
What is the route of the posterior tibial artery and what does it supply?
Supplies the posterior and lateral compartments and enters the foot via the tarsal tunnel
What branch does the posterior tibial artery give off in the leg and what does it supply?
The fibular artery which gives off a perforating branch through the lower aperture to the anterior tibial artery. This anastomosis is particularly important for lateral blood supply, but it also supplies the posterior compartment.
Describe the route of the anterior tibial artery and what does it supply?
Originates for the popliteal posterior compartment and passes through upper aperture of interosseous membrane. Supplies anterior compartment. Joined by perforating branch of fibular artery and continues into the foot as the dorsalis pedis(when it crosses the foot)
What branches does the anterior tibial artery give off ion the leg?
The anterior medial and anterior lateral malleolar arteries at the very bottom
Where can the posterior tibial artery pulse be felt?
Through flexor retinaculum midway between medial malleolus and calcaneus
Where can the anterior tibial/dorsalis pedis artery pulse be felt?
Dorsal surface of foot between tendons of extensor digitorum longus and extensor hallucis longus
How can you feel the pulse of the popliteal artery?
By pressing hard on the superior part of the popliteal fossa
What is the route of the tibial nerve (branch of sciatic) and what does it supply?
Passes under the tendinous arch with posterior tibial artery and passes through the tarsal tunnel and supplies all muscles in the posterior compartment
What branches does the tibial nerve give off, where do they travel and what do they supply?
Sural nerve - travels between the heads of the gastrocnemius and supplies the skin on posterolateral leg and lateral side of foot
Medial calcaneal nerve - originates near ankle and innervates skin on medial foot and sole
Describe the route of the common fibular nerve (branch of sciatic) and what branches it gives off
Passes down through the tarsal tunnel and then divides into the superficial and deep fibular nerves in the lateral compartment
Where do the branches of the common fibular nerve pass and where do they supply?
Deep fibular nerve - passes through inter muscular septum and descends with anterior tibial artery. Innervates all anterior and some intrinsic foot muscles and skin between first and second toe
Superficial fibular nerve - supplies lateral compartment muscles and dorsal foot
What does the posterior tibial artery branch into in the foot and what are their routes?
Medial plantar artery (small) - travels along medial side of foot to supply big toe and joins deep plantar arch
Lateral plantar artery - becomes deep plantar arch by the interossei muscles and anastomoses with the deep plantar artery by moving laterally and then swinging back medially
What is the route of the dorsalis pedis artery?
Passes between the two heads of the first interosseous to join the deep plantar arch
What are the branches of the dorsalis pedis artery and what do they supply?
Arcuate - passes laterally across the foot and gives off the dorsal MT and dorsal digital arteries
1st dorsal metatarsal - supplies digital branches to 1st and 2nd toes
Venous drainage of the foot?
metatarsal veins > dorsal venous arch > great (medial) and small (lateral) saphenous veins
After going through the tarsal tunnel what branches does the tibial nerve give off?
Medial plantar nerve
Lateral plantar nerve - this has a deep and superficial branch
What is the sural nerve a ranch of and what does it supply?
Branch of tibial from high on leg and sensory innervation to lateral side of foot and little toe
What is the saphenous nerve and where does it supply?
Branch of femoral nerve from thigh, supplies kin on medial proximal foot
