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Gross Anatomy 2 > Vessels and Nerves of the Pelvis and Lower Limb > Flashcards

Vessels and Nerves of the Pelvis and Lower Limb Flashcards

1
Q

nerves from what vertebral level form the sacral plexus?

A

S1-4 and part of S5

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2
Q

what is the root value of the lumbosacral trunk?

A

L4+5

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3
Q

what nerve and spinal nerves from which vertebral level form the sciatic nerve?

A

lumbosacral trunk (L4+5) and S1-S3

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4
Q

what is the root value of the sciatic nerve?

A

L4-S3

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5
Q

what does the sciatic nerve innervate?

A

posterior compartment of the thigh, its branches supply all the muscles of the leg and foot

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6
Q

what is the route of the sciatic nerve through the pelvis?

A

disappears through the greater sciatic notch and comes deep to the long head of biceps femoris

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7
Q

what is the root value of the superior gluteal nerve?

A

L4-S1, from sacral plexus

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8
Q

what does the superior gluteal nerve innervate?

A

gluteus medius and minimis

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9
Q

what is the root value of the inferior gluteal nerve?

A

L5-S2, from sacral plexus

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10
Q

what does the inferior gluteal nerve innervate?

A

gluteus maximus

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11
Q

what is the root value of the nerve to obturator internus?

A

L5-S1

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12
Q

what does the nerve to obturator internus innervate?

A

obturator internus and gemellus superior

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13
Q

what is the root value for the nerve to quadratus femoris?

A

L4-S2

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14
Q

what does the nerve to quadratus femoris innervate?

A

quadratus femoris and gemellus inferior

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15
Q

what is the root value of the nerve to piriformis?

A

direct from S1-2

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16
Q

what does the nerve to piriformis innervate?

A

piriformis

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17
Q

what nerves supplies the levator ani?

A

direct from S4 and pudendal nerve (S2-4)

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18
Q

what is the root value of the nerves supplying the levator ani?

A

S2-4

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19
Q

what spinal nerves supply the coccygeus muscle?

A

S4+5

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20
Q

what is the root value of the pudendal nerve?

A

S2-4

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21
Q

what does the pudendal nerve innervate?

A 
levator ani
external anal sphincter
external urethral sphincter
bulbospongiosus
ischiocavernosus
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22
Q

what is the route of the pudendal nerve through the pelvis?

A

through the greater sciatic notch, along the ischial spine, through the ischioanal (rectal) fossa and perineum

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23
Q

where does the autonomic nervous supply to the pelvis come from?

A

superior and inferior hypogastric plexus

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24
Q

what effect does the sympathetic nervous supply have on the pelvic contents?

A

‘fight or flight’
decrease movement of rectum
contracts internal anal and urethral sphincters
relaxes bladder detrusor
vasoconstriction of artries
relaxes and contracts the uterus (also under hormonal control)
contracts ductus deferens and seminal vesicles during ejaculation

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25
Q

what effect does parasympathetic nervous supply have on the pelvic contents?

A

‘rest and digest’
increases motility of rectum and anal canal
relaxes internal anal sphincter
inhibits contraction of internal urethral sphincter
contracts detrusor
vasodilation (aiding erection)
no effect on seminal vesicles, ductus deferns and uterus

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26
Q

what nerves supply parasympathetic innervation to the pelvis and what is their root value?

A

pelvic splanchnic nerves (S3-4)

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27
Q

what nerves supply somatic sensory and sympathetic innervation to penis?

A

dorsal nerve of the penis (from pudendal)

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28
Q

what nerves supply parasympathetic innervation to the penis?

A

cavernosus nerves (from prostatic nerve plexus)

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29
Q

what nerves supply somatic motor innervation to the perineal muscles?

A

perineal branch of the pudendal nerve

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30
Q

what nerves supply somatic sensory innervation to the scrotum?

A 
anterior scrotal (from ilioinguinal and genitofemoral nerves)
posterior scrotal (from perineal branch of pudendal)
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31
Q

what nerve supplies somatic sensory innervation to the female anterior perineum?

A

anterior labial (from ilioinguinal and genitofemoral nerves)

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32
Q

what nerve supplies somatic sensory innervation of the female posterior perineum?

A

perineal branch (from posterior cutaneous of the thigh and pudendal)

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33
Q

what nerve supplies somatic sensory innervation of the labia?

A

posterior labial (from pudendal)

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34
Q

what nerve supplies somatic sensory innervation to the orifice of vagina?

A

deep branch of pudendal

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35
Q

what nerve supplies somatic motor innervation to the superficial perineal muscles?

A

muscular branches of the pudendal

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36
Q

what nerve supplies somatic motor and sensory innervation to the clitoris and deep perineal muscles?

A

dorsal nerve of the clitoris (from pudendal)

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37
Q

what nerve supplies parasympathetic innervation to the bulb of vestibule and clitoris?

A

cavernosus nerve (from utero-vaginal plexus)

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38
Q

what nerves provides sensory innervation to the anterior skin of the pelvis?

A

ilioinguinal, genitofemoral and pudendal nerves

dermatomes: L1+2, S3+4

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39
Q

what nerves supply sensory innervation to the genitalia?

A

pudendal nerve

dermatomes: S3+4

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40
Q

what nerve gives rise to the dorsal nerve of the penis?

A

pudendal nerve

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41
Q

what nerve plexus gives rise to the cavernosus nerves?

A

prostatic/utero-vaginal nerve plexus

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42
Q

what nerves give rise to the anterior scrotal nerve?

A

ilioinguinal and genitofemoral nerves

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43
Q

what nerve gives rise to the posterior scrotal nerve?

A

perineal branch of pudendal

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44
Q

what nerves give rise to the anterior labial nerve?

A

ilioinguinal and genitofemoral nerves

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45
Q

what nerve gives rise to the posterior labial nerve?

A

pudendal

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46
Q

what nerve gives rise to the dorsal nerve of the clitoris?

A

pudendal

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47
Q

what is the terminal cutaneous branch of the femoral nerve which supplies the anteromedial knee, leg and foot?

A

saphenous nerve

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48
Q

what muscles do the femoral nerve innervate?

A

pectineus, sartorius, rectus femoris, vasti muscles (vastus lateralis, medialis and intermedius)

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49
Q

what region of the thigh do the cutaneous branches of the femoral nerve innervate?

A

anteromedial thigh

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50
Q

what does the articular branches of the femoral nerve innervate?

A

hip and knee

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51
Q

what does the muscular branches of the femoral nerve innervate?

A

anterior thigh

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52
Q

what are the three branches of the femoral nerve?

A

muscular, articular and cutaneous

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53
Q

what is the route of the femoral nerve through the pelvis?

A

passes deep to inguinal ligament, medial to ASIS, on tendon of iliopsoas

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54
Q

what is the root value of the femoral nerve?

A

L2-4

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55
Q

what is the root value of the superior clunial nerve?

A

L1-3

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56
Q

what is the root value of middle clunial nerve?

A

S1-3

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57
Q

what is the root value of the posterior cutaneous nerve of the thigh?

A

S1-3

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58
Q

what supplies the skin of the inferior half of buttocks?

A

inferior clunial nerve

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59
Q

where does the posterior cutaneous nerve of the thigh lie?

A

on the posterior aspect of the sciatic nerve

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60
Q

where does the common peroneal nerve leave the sciatic nerve?

A

below, above or through piriformis

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61
Q

where does the tibial nerve leave the sciatic nerve?

A

below piriformis

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62
Q

what are the two main branches of the sciatic nerve?

A

tibial and common peroneal

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63
Q

what is the root value of the sciatic nerve?

A

L4-S3

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64
Q

what nerves give cutaneous innervation to the gluteal and posterior thigh?

A 
superior clunial (L1-3)
middle clunial (S1-3)
posterior cutaneous nerve with inferior clunial branches (S1-3)
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65
Q

what is the root value of the cutaneous branch of the obturator nerve?

A

L2-4

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66
Q

what is the root value of the ilioinguinal nerve?

A

L1

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67
Q

what is the root value of the femoral branch of the genitofemoral nerve?

A

L1+2

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68
Q

what is the root value of the anterior cutaneous branches of the femoral nerve?

A

L2-4

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69
Q

what is the root value of the lateral cutaneous nerve of the thigh?

A

L2+3

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70
Q

what nerves supply cutaneous innervation to the thigh?

A

lateral cutaneous branch of T12
lateral cutaneous nerve of the thigh (L2+3)
anterior cutaneous branches of femoral (L2-4)
femoral branch of genitofemoral (L1+2)
ilioinguinal (L1)
cutaneous branch of obturator (L2-4)

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71
Q

what does the vertical group of lymph nodes drain?

A

lymph from superficial lower limb

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72
Q

what do the lateral nodes of the horizontal group of lymph nodes drain?

A

posterior abdominal wall

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73
Q

what do the medial nodes of the horizontal group of lymph nodes drain?

A

anterior abdominal wall and lower half of anal canal

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74
Q

what are the two groups of the superficial lymph nodes at the junction between the pelvis and thigh?

A

horizontal and vertical groups of lymph nodes

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75
Q

where does the accessory saphenous vein drain to?

A

great saphenous vein

close to where it drains to the femoral vein

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76
Q

what is the route of the short saphenous vein?

A

small vessels in the foot unite to form the short saphenous vein in the midline of the posterior leg
drains into the popliteal vein posterior to the knee

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77
Q

what is the route of the great saphenous vein?

A

starts medial to big toe
passes anteriorly to the ankle, comes posterior to the knee, back to the anterior surface of the thigh
drains into the femoral vein

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78
Q

at what vertebral level does the aorta bifurcate into the common iliac arteries?

A

L4

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79
Q

what do the common iliac arteries divide into?

A

internal and external iliac branches

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80
Q

where does most of the blood supply to the pelvis come from?

A

internal iliac artery

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81
Q

what does each internal iliac artery divide into?

A

anterior and posterior divisions

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82
Q

what are the branches of the anterior division of the internal iliac artery common to both genders?

A 
umbilical (giving rise to superior vesicle)
obturator
inferior vesicle (vaginal in females)
inferior gluteal
middle rectal
internal pudendal
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83
Q

what do the inferior vesicle and middle rectal arteries in males supply?

A

prostate, seminal vesicles and ductus deferens

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84
Q

where do the testicular arteries arise from?

A

abdominal aorta @L2

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85
Q

what do the uterine and vaginal arteries supply?

A

uterus and vagina

uterine artery gives rise to the vaginal artery

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86
Q

what does the internal pudendal artery supply in females?

A

lower parts of the vagina and opening

87
Q

where do the ovarian arteries arise from?

A

abdominal aorta @L2

88
Q

what are the branches of the posterior division of the internal iliac artery?

A

iliolumbar
lateral sacral
superior gluteal
(PILS)

89
Q

what does the obturator artery supply?

A

pelvic muscles
head of femur
ilium

90
Q

what does the obturator artery arise from?

A

internal iliac

91
Q

what does the superior vesical artery supply?

A

superior aspect of bladder

ductus deferens

92
Q

what does the superior vesical artery arise from?

A

umbilical

93
Q

what does the ductus deferens artery supply?

A

ductus deferens

94
Q

what does the ductus deferens artery arise from?

A

superior/inferior vesical

95
Q

what does the inferior vesical artery supply?

A

urinary bladder
ureter
seminal vesicles
prostate

96
Q

what does the inferior vesical artery arise from?

A

internal iliac

97
Q

what does the middle rectal artery supply?

A

rectum
seminal vesicles
prostate

98
Q

what does the middle rectal artery arise from?

A

internal iliac

99
Q

what does the internal pudendal artery supply?

A

perineum

anal canal

100
Q

what does the internal pudendal artery arise from?

A

internal iliac

101
Q

what does the inferior gluteal artery supply?

A

levator ani
coccyeus
piriformis
gluteal muscles

102
Q

what does the inferior gluteal artery arise from?

A

internal iliac

103
Q

what does the vaginal artery supply?

A

vagina

bladder

104
Q

what does the vaginal artery arise from?

A

uterine artery

105
Q

what does the iliolumbar artery supply?

A

cauda equina
iliacus
psoas
quadratus lumborum

106
Q

what does the iliolumbar artery arise from?

A

posterior division of internal iliac

107
Q

what does the lateral sacral artery supply?

A

vertebral canal

piriformis

108
Q

what does the lateral sacral artery arise from?

A

posterior division of internal iliac

109
Q

does the venous patternof the pelvic veins match the arteries?

A

yes

110
Q

what is the root value of the obturator nerve?

A

anterior divisions of L2-4

111
Q

what nerve runs along the lateral wall of the pelvis to the obturator canal?

A

obturator nerve

112
Q

where does the obturator nerve give muscular branches to?

A

medial thigh

113
Q

what are the anterior and posterior branches of the obturator nerve named in relation to?

A

adductor brevis

114
Q

what does the anterior branch of the obturator nerve innervate?

A

cutaneous to middle part of medial thigh, adductor longus, gracilis, adductor brevis and rarely pectineus

115
Q

what does the posterior branch of the obturator nerve innervate?

A

obturator externus and adductor magnus

116
Q

what passes through the adductor hiatus to reach the popliteal fossa?

A

femoral vessels

117
Q

what muscles do the saphenous nerve pass between to supply the skin of the anteromedial knee, leg and foot?

A

sartorius and gracilis

118
Q

what is the femoral artery continuous with?

A

external iliac

119
Q

what does the femoral artery supply?

A

anterior and anteromedial thigh

120
Q

what is the route of the femoral artery? (from the femoral triangle)

A

femoral triangle, through adductor canal to adductor hiatus (where it becomes the popliteal artery)

121
Q

what is the origin of the superficial external pudendal artery?

A

femoral artery

122
Q

what is the main branch of the femoral artery?

A

profunda femoris

123
Q

what are the branches of profunda femoris?

A

medial and lateral circumflex

124
Q

what is the profunda femoris deep to and what does it’s perforating branches supply?

A

deep to adductor longus

perforate through the adductor magnus

125
Q

what is the obturator artery a branch of?

A

internal iliac artery

126
Q

what is the route of the obturator artery?

A

passes through the obturator foramen to the medial compartment of thigh to give anterior and posterior branches

127
Q

what does the anterior branch of the obturator artery supply?

A

muscles of medial compartment

128
Q

what does the posterior branch of the obturator artery supply?

A

msucles attached to the ischial tuberoisty

129
Q

what arteries is the cruciate anastomoses formed from?

A

inferior gluteal
medial and lateral circumflex femoral arteries
1st perforating branch of profunda femoris

130
Q

what are the two branches of the sciatic nerve?

A

tibial and common peroneal (or common fibular) divisions

131
Q

what is the popliteal artery a continuation of?

A

femoral artery

132
Q

where does the popliteal artery run?

A

from adductor hiatus to inferior border of popliteus (where it terminates as anterior and posterior tibial arteries)

133
Q

what are the 5 branches of the popliteal artery?

A
  1. medial superior genicular
  2. lateral superior genicular
  3. middle genicular
  4. medial inferior
  5. lateral inferior
134
Q

what are the relations of the knee joint?

A

patellar tendon

tendons of quadriceps, biceps femoris, sartorius, semimembranosus, semitendinosus and gracilis

135
Q

what bones articulate at the knee joint and what names are given to these articulations?

A

femur, tibia and patella
femoropatellar (femur and patella)
femorotibial (femur and tibial, x2)

136
Q

what type of joint is the knee joint?

A

modified hinge joint

137
Q

what are the articular surfaces of femur at the knee joint?

A

patellar surface, medial and lateral condyles and intercondylar fossa/notch

138
Q

what are the articular surfaces of the tibia at the knee joint?

A

medial and lateral condyles and the intercondylar eminence

139
Q

what are the articular surfaces of the fibula at the knee joint?

A

medial and lateral facet

140
Q

where does the capsule of the knee attach anteriorly and posteriorly?

A

anteriorly: fuses with the quadriceps tendon and patellar ligament
posteriorly: encloses the intercondylar fossa of the femur; opens posteriorly to the lateral condyle of the tibia for popliteus muscle

141
Q

what do the medial and lateral alar folds cover?

A

the inner surface of the fat pads on either side of the patellar ligament

142
Q

what are the four extracapsular ligaments of the knee?

A

oblique popliteal
arcuate popliteal
medial (tibial) collateral (MCL)
lateral (fibular) collateral (LCL)

143
Q

what is the oblique popliteal ligament formed from and what is its role?

A

expansion of semimembranosus tendon

reinforce posterior capsule

144
Q

what is the arcuate popliteal ligament formed from and what is its role?

A

thickening of the capsule over popliteus

strengthens posterolateral joint capsule

145
Q

what is the medial collateral ligament formed from?

A

strong flat thickenings of the capsule of the knee

146
Q

where does the medial collateral ligament run from and to?

A

medial epicondyle of femur -> medial epicondyle and superior medial surface of the tibia

147
Q

what do the deep fibres of the medial collateral ligament attach to?

A

medial meniscus

148
Q

where does the lateral collateral ligament run from and to?

A

lateral epicondyle of femur to lateral head of fibula

149
Q

where is the tendon of popliteus found in relation to the LCL?

A

deep to it

150
Q

what affect does the LCL have on the tendon of biceps femoris?

A

splits it into two

151
Q

what is the gross structure of the LCL?

A

strong and cord like

152
Q

what are the intercapsular ligaments of the knee?

A

anterior and posterior cruciate ligaments (ACL and PCL)

153
Q

what is the role of the cruciate ligaments during flexion of the knee?

A

maintain contact of the femoral and tibial articular surfaces
taut in every position

154
Q

what limits medial rotation of the tibia to 10o?

A

becuase the cruciate ligaments wind around each other

155
Q

where is the anterior cruciate ligament found?

A

anterior intercondylar area of the tibia to the medial side of the lateral condyle of femur

156
Q

how many degrees does the anterior cruciate ligament spiral between the tibia and femur?

A

110o

157
Q

what is the role of the anteromedial band of the anterior cruciate ligament?

A

limits flexion

158
Q

what is the role of the posteriolateral band of the anterior cruciate ligament?

A

limits extension

159
Q

what does the anterior cruciate ligament prevent?

A

hyperextension of the knee
keeps the femur from sliding posteriorly on the tibia
limits medial rotation of the femur when the foot is planted

160
Q

where does the posterior cruciate ligament run?

A

from posterior intercondylar area of tibia to the lateral side of the medial condyle of femur

161
Q

which cruciate ligament is closely aligned to the centre of rotation of the knee?

A

posterior cruciate ligament

162
Q

what does the anterolateral band of the posterior cruciate ligament limit?

A

flexion

163
Q

what does the posterior cruciate ligament prevent?

A

the femur from sliding anteriorly on the tibia, particularly when the knee is flexed?

164
Q

what are the menisci?

A

wedges of fibrocartilage

165
Q

what is the role of the menisci?

A 
deepen articular surface
function as shock absorbers
166
Q

what are the names of the menisci?

A

medial and lateral

167
Q

what is the shape of the medial meniscus?

A

c-shaped

broad posteriorly

168
Q

what is the medial meniscus attached to?

A

the tibial collateral ligament (TCL)

169
Q

what shape is the lateral meniscus?

A

circular

170
Q

is the lateral meniscus freely movable or attached?

A

freely movable

171
Q

what muscle does the lateral meniscus provide attachment for?

A

popliteus

172
Q

what supplies cutaneous innervation to the anterior leg?

A 
anterior cutaneous branches of femoral
lateral sural cutaneous nerve
lateral dorsal cutaneous nerve of the foot (termination of sural)
saphenous nerve (from femoral)
deep and superficial peroneal
173
Q

what does the anterior tibial artery continue as in the foot?

A

dorsalis pedis

174
Q

what are the branches of the dorsalis pedis?

A

lateral tarsal artery
deep plantar artery
arcuate artery

175
Q

what does the deep plantar artery supply?

A

the sole of the foot

176
Q

what is the route of the arcuate artery and what does it anastomose with?

A

runs across metatarsals

anastomoses with the lateral tarsal artery to supply the metatarsal and digital arteries

177
Q

what vein drains the foot?

A

dorsal venous arch which connects the short and great saphenous veins

178
Q

what is the role of the periarticular genicular anastomosis?

A

allows the blood supply to the leg to be retained when the knee is flexed as flexion causes a kink in the popliteal artery

179
Q

what arteries form the periarticular genicular anastomosis?

A

5 genicular branches
descending genicular artery
descending branch from lateral circumflex
recurrent branches of the tibial artery

180
Q

what gives rise to the genicular branches?

A

popliteal artery

181
Q

what gives rise to the descending genicular artery?

A

femoral artery

182
Q

what gives rise to the descending branch from the lateral circumflex artery?

A

femoral artery

183
Q

where is the posterior tibial artery found?

A

on posterior aspect of leg behind the tibia

184
Q

what is the terminal branch of the popliteal artery?

A

tibial artery

185
Q

what is the route of the posterior tibial artery?

A

between heads of gastrocnemius, deep to soleus and runs along the surface of tibialis posterior and flexor digitorum longus

186
Q

what artery does the fibular artery originate from?

A

posterior tibial artery

187
Q

what does the posterior tibial artery terminate as?

A

medial and lateral plantar arteries of the foot

188
Q

where does the fibular artery run?

A

medial to the fibula, usually within the tendon of flexor hallucis longus

189
Q

what is the route of the tibial nerve?

A

between the heads of gastrocnemius, deep to the tendinous arch of soleus, with the posteiror tibial artery, between flexor hallucis longus and flexor digitorum longus at the ankle joint

190
Q

what are the terminal branches of the tibial nerve that supply the sole of the foot?

A

medial and lateral plantar nerves

191
Q

what nerves supply cutaneous innervation to the posterior leg?

A

saphenous nerve (from femoral)
posterior cutaneous nerve of thigh
lateral sural cutaneous nerve
medial sural nerve (sural nerve)

192
Q

what are the branches of the peroneal nerve?

A

superficial and deep peroneal nerves

193
Q

where is the superficial peroneal nerve found?

A

lateral compartment of leg supplying muscles and continuing as a cutaneous nerve

194
Q

what does the superficial peroneal nerve supply?

A

cutaneous innervation to distal anterior surface of leg and most of the dorsum of foot

195
Q

what is the route of the deep peroneal nerve?

A

passes through extensor digitorum longus and travels with anterior tibial artery supplying all anterior compartment muscles, crosses the ankle joint to supply extensor digitorum brevis and external hallucis brevis

196
Q

where does the deep peroneal nerve supply cutaneous innervation to?

A

skin between digits 1+2

197
Q

what muscles do the deep peroneal nerve supply?

A 
tibialis anterior
extensor digitorum longus
extensor hallucis longus
peroneus tertius
extensor hallucis brevis
extensor digitorum brevis
198
Q

what are the terminal branches of the tibial nerve?

A

plantar nerves

199
Q

where do the plantar nerves enter the foot?

A

deep to abductor hallucis

deep to flexor retinaculum

200
Q

where is the medial plantar nerve found?

A

between the abductor hallucis and flexor digitorum brevis muscles

201
Q

what does the medial plantar nerve supply?

A

abductor hallucis
flexor digitorum brevis
1st lumbrical
flexor hallucis brevis

202
Q

what nerve in the foot has deep and superficial branches?

A

lateral plantar nerve

203
Q

between what layers is the superficial branch of the medial plantar nerve found?

A

layers 1+2

204
Q

between what layers is the deep branch of the medial plantar nerve found?

A

layers 3+4

205
Q

what muscles do the lateral plantar nerve supply?

A 
abductor digiti minimi
2nd-4th lumbricals
quadratus plantae
adductor hallucis
flexor digiti minimi brevis
dorsal and plantar interossei
206
Q

what supplies cutaneous innervation of the foot?

A 
saphenous
dorsal lateral cutaneous of foot
superficial peroneal
deep peroneal
medial and lateral plantar
calcaneal branches
207
Q

where are the terminal branches of the posterior tibial artery found?

A

deep to the flexor retinaculum

enter the foot deep to the abductor hallucis

208
Q

what does the medial plantar artery supply?

A

muscles of the hallux

209
Q

does the medial plantar artery form the superficial plantar arch?

A

occasionally

210
Q

where is the lateral plantar artery found?

A

between layers 1+2

211
Q

what layers are the deep plantar arch found between?

A

layers 3+4

212
Q

what does the deep plantar artery arise from and give rise to?

A

from dorsalis pedis

gives the metatarsal arteries

213
Q

what does the lateral plantar artery supply?

A

the plantar metatarsal and digital arteries

Gross Anatomy 2 (16 decks)

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