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AoL > Vessels and nerves of the lower limb > Flashcards

Vessels and nerves of the lower limb Flashcards

1
Q

Overall, outline the organisation of spinal nerves in terms of what they supply

A 
C1-4 : neck
C5-T1 : upper limb
T2-L1 : trunk
L2-S3 : lower limb
S2-C1 : perineum
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2
Q

Where do nerves to the lower limb emerge from the spinal cord

A

Lumbosacral plexus

Femoral n. supplies anterior compartment of thigh.

Obturator n. supplies medial (adductor) compartment of thigh.

Sciatic n. (or its terminal branches Tibial and Common Peroneal ns.) supply the remaining compartments (i.e. post. thigh, ant. and post. leg, foot)

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3
Q

Outline the nerves present in the buttock and posterior thigh

A

ABOVE piriformis:

Superior gluteal nerve

BELOW piriformis

Inferior gluteal nerve (winds back up toward gluteus maximus)

Sciatic nerve

Posterior cutaneous nerve of thigh

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4
Q

Outline the nerves present in the leg and foot

A

Sciatic nerve splits into tibial nerve (medially) and common peroneal nerve (laterally)

Common peroneal winds around the fibula to the lateral and anterior portions of the leg. Gives off sural communicating branch

Tibial branch continues down the posterior leg, gives off medial sural cutaneous nerve, which connects with the sural communicating nerve to form the sural nerve (sensory to the calf)

Tibial branch then splits into the medial and lateral plantar nerve

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5
Q

Which spinal cord segments make up the common peroneal nerve.

What about the superficial peroneal nerve

What about the deep peroneal nerve

A

Common= L4-S2

Superficial peroneal nerve (for the lateral muscles of the leg) L4-S1

Deep peroneal nerve (for anterior muscles of the leg) .. L5-S2

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6
Q

Which muscles does the tibial nerve supply

A

The posterior leg

and its branches supply the muscles on the plantar side of the foot too

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7
Q

T/F the tibial nerve supplies all the intrinsic muscles of the foot

A

F… tibial supplies all the muscles in the sole of the foot via medial and plantar nerves

but intrinsic muscle on the dorsum of the foot (extensor digitorum brevis) is supplies by the deep peroneal nerve

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8
Q

Which muscles are suppied by the medial and lateral plantar nerves

A

These nerves are branches of the the tibial nerve

Medial plantar:

Abductor hallucis,
FDB, FHB, lumbrical to the second digit

Lateral plantar: all other muscles in the sole of the foot (but not any that come from the posterior leg e.g. FHL, which is supplies by tibial)

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9
Q

Outline the spinal cord levels contributing to femoral nerve

A

Femoral Nerve (L234, posterior fibres)

Iliopsoas (+L1), ant. thigh

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10
Q

Outline the spinal cord levels contributing to obturator nerve

A

(L234, anterior fibres)

Medial (adductor) compartment of thigh

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11
Q

Outline the spinal cord levels contributing to sciatic nerve

A

(L345S123, ant. & post. fibres)

Post. thigh; leg; foot

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12
Q

Outline the spinal cord levels contributing to superior gluteal nerve

A

(L45S1)

Gluteus medius and minimus, Tensor fascia lata

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13
Q

Outline the spinal cord levels contributing to inferior gluteal nerve

A

(L5S12) (Gluteus maximus)

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14
Q

What type of mucles do the anterior divisions and the posterior divisions of a limb plexs supply

A

Anterior divisions = flexor muscles
Posterior divisions = extensor muscles

(C5-T1 = upper limb
L2-S3 = lower limb)

referring to SEGMENTAL MOTOR SUPPLY

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15
Q

State the principles of segmental supply

A

Muscles supplied by two adjacent segments
Same action on joint = same nerve supply
Opposing muscles 1-2 segments above or below
More distal in limb = more caudal in spine

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16
Q

Outline the segmental supply to the lower limb (Hip, knee and ankle)

A

HIP
Flex L2L3

Extend L4L5

KNEE
Extend L3L4

Flex L5S1

ANKLE

Dorsiflex (ext) L4L5

Plantarflex (flex) S1S2

Inversion L4

Eversion L5S1

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17
Q

Fibers from which root make up th posterior cutaneus nerve of the thigh

A

S1, S2

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18
Q

T/F the area to which sensory innervation from S1 is provided medial to the area for S2

A

F…. on the posterior surface, S1 has a strip running straight down the leg laterally, and S2 medially

S1 then innervates the lateral side of the plantar surface of foot, and S2 the medial side of the plantar surface of the foot, with a bit of L5 in between the two on the plantar surface

Remember L3 runs to the knee and L4 runs to the floor

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19
Q

Which spinal nerves provide sensation to the genitals

A

S2/3

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20
Q

What are autonomous zones

A

These are the regions where single nerve roots supply distinct and non-overlapping areas of skin

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21
Q

Where can autonomous zones be found in the lower limb

A

S1, in the lateral calf (S1)

L3 (in the upper thigh an infero-medially point ing segment) and

L4 in lower thigh and over the knee also inferomedially )

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22
Q

The obturator nerve supplies sensory cutaneous innervation where

A

Medial thigh

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23
Q

You just have to learn the peripheral cutaneous nerves

A

…..

24
Q

Outline the large peripheral cutaneous nerve areas

A

Anterior cutaneous branches of emoral nerve (lateral group) supplies most of the front of the thigh)

Interior clunial nerves/posterior cutanous nerve of the thigh supplies back of thigh and buttock

Saphenous nerve from femoral supplies medial anterior side of leg and wraps around to the medial posterior side too

Lateral sural cutaneous nerve (from common peroneal nerve) supplies the lateral side of the anterior and posterior leg

25
Q

Outline the cutaneous innervation to the foot

A

Note the small area (1st and 2nd toe) supplied by the dorsal digital nerve from the deep peroneal

26
Q

Outline the consequence of prolapsed intervertebral disc prolapse at L5/S1

A

Motor – loss of eversion
Sensory – loss of sensation outer border of foot
Reflex – loss of ankle jerk (S1)
Autonomic – minimal

27
Q

Consequence of Lesion of Common Peroneal Nerve at Fibular Neck

A

Motor – foot drop (loss deep peroneal nerve function which dorsiflexes foot)
Sensory – dorsum of foot at least
Reflex – none
Autonomic – minimal

28
Q

Give an overview of the arterial anatomy of the lower limb

A 
Aorta
Common iliac arteries
External iliac / internal iliac arteries
Femoral artery
(Profunda femoris artery
Circumflex femoral arteries) 
Popliteal artery
“Trifurcation”
Anterior tibial artery – dorsalis pedis artery
Posterior tibial artery 
Peroneal artery
29
Q

The pulses of which arteries can be felt in the lower limb

A

Femoral artery pulse (femoral triangle)

Politeal artery (popiteal fossa)

Posterior tibial artery pulse

Dorsalis pedis (a continuation of the anterior tibial artery)

30
Q

At which point does the femoral artery and vein become popliteal artery and vein

A

The femoral artery and vein pass from the anterior compartment to the posterior of the knee (the popliteal fossa) through the hiatus of adductor magnus muscle. After passing posteriorly, they are named the popliteal artery and vein.

31
Q

Where does the anterior tibial artery travel

A

Through the interosseus membrane

32
Q

Outline the arterial supply of the foot

A

Anterior tibial –> dorsalis pedis

Posterior tibial artery –> medial and lateral plantar artery

33
Q

Where can the dorsalis pedis be palpated

A

Lateral to tibialis anterior tendon

34
Q

Where can the posterior tibial artery be palpated

A

Between the medial malleolus and the calcaneal tendon

35
Q

Outline the superficial veins of the lower limb

A 
Dorsal venous arch
Long saphenous vein (into femoral)
Short saphenous vein (into popliteal)
Perforating veins 
Sapheno-femoral junction 
Blood flow from SUPERFICIAL TO DEEP
36
Q

T/f great saphenous is a deep vein

A

F it is a superficial one

37
Q

Which veins drain the knee region

A

Genicular veins

38
Q

Which vein can be found at the medial malleolus

A

Long saphenous vein

39
Q

What is the clinical application of the LSV at the medial malleolus

A

Cut down can occur (veins collapsed due to shock, but you know there is a vein at the medial malleolus)….Shocked patient, ATLS
2cm lateral and proximal to medial malleolus

now the interosseous administratin of fluid can occur

40
Q

What would result from arterial emboism

A

Sudden occlusion
Acute ischaemia
Intermittent claudication (muscle pain commonly in calf during activity, associated with arterial disease)

41
Q

What is compartment syndrome

A

The neuromuscular compartments of the limbs are enclosed in fibrous sheaths which confines them.

42
Q

Differentiate acute compartment syndrome and chronic compartment syndrome

A

Acute compartment syndrome (trauma associated)

Chronic compartment syndrome (exercise-induced)

43
Q

What compartments of the leg are affected by compartment sydrome

A

Commonly the anterior, posterior and lateral compartments of the leg

44
Q

What happens in compartment syndrme

A

Ischaemia caused by trauma-induced increased pressure in a confined limb compartment

Normal pressure = 25mmHg; only need 50-60 to collapse vessels, so pulse still present

45
Q

How can acute compartment syndrome be resolved

A

Emergency fasciotomy required to prevent the death of muscles in the affected compartment.

46
Q

When can varicose veins result

A

Perforating veins connecting superficial and deep veins contain a valve that will allow flow only from superficial to deep. If such a valve is compromised, blood is pushed from deep to superficial veins leading to varicose veins.

47
Q

In which veins are valves present

A

Valves in superficial, deep and perforating veins

48
Q

Which valve in the lower limb venous system is important in varicose veins

A

Sapheno-femoral junction valve most important

49
Q

What is lipodermatosclerosis

A

Skin thickening, of a chronic inflammatory cause in varicose vein

50
Q

What can be a conequence of varicose veins

A

Venous ulcers

Venous leg ulcers can develop after a minor injury, where persistently high pressure in the veins of the legs has damaged the skin.

51
Q

Deep veins follow what

A

The arterial supply

52
Q

What is a DVT

A

Deep venous thrombosis
Clot in deep veins
Proximal or distal

53
Q

What is post-phlebitic syndrom

A

Damage to veins of the leg during DVT

valve dysfunction

Reduced blood being carred out of the foot and leg

Pain swelling and ulcers

54
Q

What is superficial thombophlebitis

A

an inflamed vein near the surface of the skin (usually a varicose vein) caused by a blood clot.

55
Q

Outline venous grafts

A

CABG… arterial by-pass surgery

Vales only allow flow in one direction so graft must be oriented in the correct direction

56
Q

How does venous return usually occur from the calf

A

Deep vessels in the leg are sandwiched between muscle layers, during waling and running the contractions squueze the thin walled veins and push blood up the calves= the calf pump

57
Q

Outline the use of the surgical stockings

A

Immobility (e.g. a long plane journey) means less efficient venous return from the foot and leg. Sluggish deep venous return can lead to Deep Vein Thrombosis (DVT). Elastic surgical socks compress the superficial veins promoting more vigorous deep venous return.

AoL (9 decks)

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