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MSCT-LM > W5 Lower limb > Flashcards

W5 Lower limb Flashcards

1
Q

• Leg general

A 
o	Three compartments separated by interosseous membrane and intermuscular septa
o	Muscles of the leg plantarflex and dorsiflex the foot
o	Invert (supinate) and evert (pronate)
o	Extend and flex toes
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2
Q

• Anterior compartment

A 
o	4 muscles: tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularus teritus
o	Deep fibular nerve
o	Anterior tibial artery
o	Dorsiflexion and inversion of foot
o	Extension of toes
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3
Q

• Tibialis anterior

A

o Anterior compartment
o Dorsiflexes and inverts foot
o Deep fibular nerve

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4
Q

• Extensor hallucis longus

A

o Anterior compartment
o Dorsiflexes foot and extends great toe
o Deep fibular nerve

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5
Q

• Extensor digitorum longus

A

o Anterior compartment
o Dorsiflexes foot and extends lateral four toes
o Deep fibular nerve

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6
Q

• Fibularus tertius

A

o Anterior compartment
o Dorsiflexes foot
o Deep fibular nerve

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7
Q

• Lateral compartment

A

o 2 muscles
o Superficial fibular nerve
o Fibular artery
o Eversion and plantar flexion

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8
Q

• Fibularis longus

A

o Lateral compartment
o Plantarflexes and everts foot
o Superficial fibular nerve

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9
Q

• Fibularis brevis

A

o Lateral compartment
o Everts foot
o Superficial fibular nerve

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10
Q

• Posterior compartment

A 
o	3 superficial muscles 
o	4 deep muscles
o	Tibial nerve
o	Posterior tibial artery
o	Plantar flexion and inversion of foot
o	Flexion of toes
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11
Q

• Gastrocnemius

A

o Posterior compartment
o Superficial
o Plantarflexes foot and flexes knee
o Tibial nerve

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12
Q

• Soleus

A

o Posterior compartment
o Superficial
o Plantarflexes foot
o Tibial nerve

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13
Q

• Plantaris

A

o Posterior compartment
o Superficial
o Plantarflexes foot and knee
o Tibial nerve

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14
Q

• Tibialis posterior

A

o Posterior compartment
o Deep
o Plantarflexes and inverts foot
o Tibial nerve

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15
Q

• Flexor digitorum longus

A

o Posterior compartment
o Deep
o Flexes lateral four toes and inverts foot
o Tibial nerve

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16
Q

• Flexor hallucis longus

A

o Posterior compartment
o Deep
o Flexes great toe and inverts foot
o Tibial nerve

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17
Q

• Popliteus

A 
o	Posterior compartment
o	Deep
o	Stabilizes and unlocks knee joint 
o	(rotates femur laterally from fixed tibia)
o	Tibial nerve
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18
Q

• Lumbar plexus

A

o Anterior rami of L1-L4

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19
Q

• Sacral plexus

A

o Anterior rami of L4-S5

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20
Q

• Lumbosacral plexus

A

o Combo of lumbar and sacral

o Provide sensory and motor innervation to lower limb

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21
Q

• Femoral nerve

A

o L2, L3, L4
o Motor branches to anterior compartment muscles and pectineus
o Two sensory branches: anterior cutaneous nerve to the thigh and saphenous nerve
o Saphenous nerve goes through adductor canal to supply sensation to medial leg and malleolus

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22
Q

• Obturator nerve

A

o L2, L3,L4
o Motor branches to medial compartment of thigh and adductor magnus
o Cutaneous branch to skin above medial side of knee

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23
Q

• Sciatic nerve

A

o L4, L5, S1, S2, S3

o Divides into tibial and common fibular nerves proximal to popliteal fossa (behind knee)

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24
Q

• Common fibular nerve

A

o L4, L5, S1, S2
o Branch of sciatic nerve
o Splits into superficial fibular nerve and innervates lateral compartment of leg and overlying skin of foot)
o And deep fibular nerve that innervates anterior compartment of leg and overlying skin of leg and between great and 2nd toe

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25
Q

• Tibial nerve

A

o L4, L5, S1, S2, S3

o Innervates posterior compartment of leg and is sensory to overlying skin and plantar surface of the foot

26
Q

• Obturator canal

A

o Through obturator foramen passing inferior to the superior pubic ramus
o Obturator nerve passes through here

27
Q

• Greater sciatic foramen

A 
o	Below piriformis muscle: 
	Sciatic nerve
	Inferior gluteal nerve
	Posterior femoral cutaneous nerve
	Nerves to obturator internus and quadratis femoris

o Above piriformis muscle
 Passing between gluteus medius and minimus
 Superior gluteal nerve

28
Q

• Lesser sciatic foramen

A

o Pudendal nerve passes from gluteal region into perineum

29
Q

• Inferior to inguinal ligament

A

o Femoral nerve
o Femoral branch of genitofemoral nerve
o Lateral cutaneous nerve of thigh

30
Q

• Obturator sensory endpoint

A

o Medial thigh above the knee

31
Q

• Femoral sensory endpoint

A

o Medial malleolus

32
Q

• Tibial sensory endpoint

A

o Lateral malleolus (sural nerve)

33
Q

• Superficial fibular sensory endpoint

A

o Dorsum of the foot

34
Q

• Deep fibular sensory endpoint

A

o Between the first two toes

35
Q

• Deep fibular nerve lesions

A

o Anterior compartment syndrome

o Anterior tarsal tunnel syndrome at the extensor reticulum

36
Q

• Anterior compartment syndrome

A

o Deep fibular nerve
o Drop foot
o Inability to dorsiflex the foot causing patient to use high steppage gait to walk
o Sensory loss in triangular region between the first and second toes

37
Q

• Anterior tarsal tunnel syndrome at the extensor reticulum

A

o Deep fibular nerve
o Weakness in toe extension
o Sensory loss in triangular region between the first and second toes

38
Q

• Superficial fibular nerve lesions

A

o High lesion at the head of fibula

o Low lesion with lateral ankle sprain

39
Q

• High lesion at the head of fibula

A

o Superficial fibular nerve
o Loss of foot eversion and or subtalar pronation and ankle stability
o Loss of sensation on lateral leg, lateral malleolus and dorsum of the foot

40
Q

• Low lesion with lateral ankle sprain

A

o Superficial fibular nerve
o No weakness
o Loss of sensation on lateral leg, lateral malleolus and dorsum of the foot

41
Q

• Tibial nerve lesions

A

o Popliteal region from knee trauma such as dislocation or a blow
o Tarsal tunnel entrapment at the medial malleolus

42
Q

• Popliteal region from knee trauma such as dislocation or a blow

A

o Tibial nerve
o Unable to plantarflex or invert/supinate foot effecting gait
o Loss of toe flexion, abduction and adduction
o Patient will not push off
o Loss of sensation on the posterolateral aspect of lower one third of leg, lateral malleolus and lateral border of the foot, heal and sole of foot and toes

43
Q

• Tarsal tunnel entrapment at the medial malleolus

A

o Tibial nerve
o Loss of intrinsic foot function
o Loss of sensation on the anterior sole of the foot and plantar surface of the toes

44
Q

• Femoral nerve lesion

A

o Anterior dislocation of the femur from trauma or injury from pelvic of hip surgery, abdominal or hernia repair
o Inability to flex the thigh or extend the knee
o Will be locked in extension of knee
o Loss of sensation to medial side of leg, medial malleolus (saphenous nerve) or medial knee (medial cutaneous nerve)

45
Q

• Obturator nerve lesion

A

o Compression in the obturator tunnel from pelvic fracture or injury, pregnancy or tumor
o Inability to adduct the hip
o Weakness of knee flexion (gracilis) and hip external rotation (obturator externus)
o Difficulty with gait exhibiting an externally rotated foot
o Loss of sensation to medial patch of skin just above knee
o May also complain of groin or pubic symphysis pain

46
Q

• Femoral artery

A

o Continuation of external iliac artery in the abdomen
o Becomes femoral when it passes under inguinal ligament and enters femoral triangle in the anterior thigh
o Supplies most of the thigh and all of the leg and foot

47
Q

• Femoral triangle

A

o Bordered by inguinal ligament superiorly
o Lateral border is sartorious muscle
o Medial border is adductor longus
o Femoral nerve, artery, vein, and lymphatics pass through here under inguinal ligament into the triangle
o Femoral sheath covers vein, artery, and lymphatics
o Femoral pulse can be felt in femoral triangle just inferior to inguinal ligament and midway between anterior aspect of iliac spine and pubic symphysis

48
Q

• Other vessels supplying gluteal region

A

o Superior and inferior gluteal arteries
o Obturator artery in medial compartment of thigh
o All are branches of the internal iliac artery in pelvis
o Follow the path of their nerves

49
Q

• Collateral circulation of hip joint

A

o Anastomoses between branches of deep femoral (medial and lateral femoral circumflex and 1st perforating branch), branches of obturator artery and branches of superior and inferior gluteal arteries
o Insufficiency of medial femoral circumflex artery is most common cause of avascular necrosis of the femoral neck and head

50
Q

• Collateral circulation of knee joint

A

o Anastomoses of descending branch of lateral femoral circumflex and descending genicular branch of femoral artery, genicular branches from popliteal artery, circumflex fibular artery and recurrent branches of popliteal artery
o Descending genicular branch of femoral artery branches just before femoral artery enters adductor canal at the adductor hiatus
o Form a robust anastomotic network around the joint

51
Q

• Compartment syndrome

A

o Deep or investing fascia (fascia lata) do not expand so swelling in the compartment leads to increased pressure which will compress the muscles, blood vessels, and nerves
o Acute: caused by trauma such as car accident, crush injury, surgery
o Chronic: repetitive activities such as running, pressure increases during activity
o Most common in leg and forearm
o Relieved by cutting skin and fascia (fasciotomy)

52
Q

• Ankle joint

A

o Synovial hinge joint between talus, tibia and fibula
o Allows for dorsiflexion and plantarflexion of the foot on the leg
o Distal ends of fibula and tibia are anchored by medial (deltoid) and lateral ligaments to create a deep socket for upper body of the talus

53
Q

• Lateral ligament

A

o Composed of three ligaments
o Most commonly sprained (foot inversion)
o Posterior talofibular ligament
o Anterior talofibular ligament (most commonly injured)
o Calcaneofibular ligament

54
Q

• Medial (deltoid) ligament

A

o Four parts based on inferior points of attachment
o Tibionavicular part
o Tibiocalcaneal part
o Posterior tibiotalar part
o Anterior tibiotalar part
o Sprain of ligament occurs by foot eversion

55
Q

genitofemoral

A
  • lumbar plexus

- L1, L2

56
Q

lateral femoral cutaneous

A
  • lumbar plexus

- L2, L3

57
Q

femoral

A
  • lumbar plexus

- L2, L3, L4

58
Q

obturator

A
  • lumbar plexus

- L2, L3, L4

59
Q

superior gluteal nerve

A

sacral plexus

L4, L5, S1

60
Q

inferior gluteal nerve

A

sacral plexus

L5, S1, S2

61
Q

sciatic

A

sacral plexus

L4, L5, S1, S2, S3

62
Q

posterior femoral cutaneous

A

sacral plexus

S1, S2, S3

MSCT-LM (14 decks)

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