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Musculoskeletal System > Week 11 - Posterior Leg > Flashcards

Week 11 - Posterior Leg Flashcards

1
Q

Where are the pulse points in the lower limb?

A
  • Femoral pulse: mid-inguinal point
  • Popliteal pulse: deep in popliteal fossa, if leg is flexed then the fascia will relax so it will be easier to find
  • Dorsalis pedis: on the dorsum of the foot, just lateral to extensor hallucis longus tendon
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2
Q

What are the superficial muscles in the posterior leg?

A
  • Gastrocnemius
  • Plantaris
  • Soleus
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3
Q

What are the collective actions of the posterior leg muscles?

A
  • Plantarflex foot

- Invert foot

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4
Q

What is the innervation of the superficial muscles in the posterior leg?

A

Tibial nerve

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5
Q

What is the insertion of the superficial muscles in the posterior leg?

A

They all insert into the calcaneus of the foot, via the calcaneal tendon

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6
Q

What are the actions of gastrocnemius?

A
  • Plantarflexes at the ankle

- Flexes at the knee

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7
Q

What is the structure of the gastrocnemius?

A
  • Has 2 heads: medial and lateral

- Converge to form a single muscle body

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8
Q

What is plantaris?

A

A small muscle with a long tendon

  • Found in the superficial posterior leg
  • Absent in 10% of people
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9
Q

What are the actions of plantaris?

A
  • Plantarflexes at ankle joint

- Flexes knee

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10
Q

What are the actions of soleus?

A

Plantarflexes the foot

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11
Q

What is the innervation of the deep muscles in the posterior leg?

A

Tibial nerve

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12
Q

What are the deep muscles in the posterior leg?

A
  • Popliteus
  • Tibialis posterior
  • Flexor digitorum longus
  • Flexor hallucis longus
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13
Q

What is the action of popliteus?

A

Laterally rotates the femur on the tibia, unlocking the joint so that flexion at the knee joint can occur

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14
Q

What is the action of tibialis posterior?

A
  • Inverts the foot
  • Plantarflexes the foot
  • Maintains the medial arch of the foot
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15
Q

What is the action of flexor digitorum longus?

A

Flexes the lateral 4 toes

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16
Q

What is the action of flexor hallucis longus?

A

Flexes the great toe

17
Q

What are the superficial veins of the lower limb?

A
  • Great saphenous vein

- Small saphenous vein

18
Q

What is the path of the great saphenous vein?

A
  • Formed by the dorsal venous arch of the foot and the dorsal vein of the great toe
  • Ascends up the medial side of the leg
  • Passes anteriorly to the medial malleolus
  • Passes posteriorly to the medial condyle at the knee
  • Terminates by draining into the femoral vein immediately inferior to the inguinal ligament
19
Q

What is the path of the small saphenous vein?

A
  • Formed by the dorsal venous arch of the foot and the dorsal vein of the little toe
  • Moves up the lateral, posterior side of the leg
  • Passes posteriorly to the lateral malleolus
  • Moves between the 2 heads of the gastrocnemius
  • Empties into the popliteal vein in the popliteal fossa
20
Q

Describe the deep veins of the lower limb

A

The deep veins accompany and share the name of the major arteries in the lower limb

  • Some veins from the dorsal venous arch penetrate deep into the leg, forming the anterior tibial vein
  • On the plantar aspect of the foot, the medial and lateral plantar veins arise
  • – These combine to form the posterior tibial and fibular veins
  • The anterior tibial, posterior tibial and fibular veins unite to form the popliteal vein
  • – Once this enters the thigh, it is known as the femoral vein
  • – Once this passes underneath the inguinal ligament, it is known as the external iliac vein
  • The deep vein of the thigh drains blood from the thigh muscles
  • Empties into the distal segment of the femoral vein
21
Q

What is the flow of venous blood?

A

Flows from the skin to the superficial veins to the deep veins
- Within the veins are valves that prevent back flow of blood

22
Q

What are varicose veins?

A

If the valves that prevent back flow of blood between the deep and superficial veins are incompetent, then blood can flow back into superficial veins

  • This results in an increase intra-luminal pressure, which the veins cannot withstand
  • – Causes them to become dilated and torturous
  • – This is varicose veins
  • Soft tissue changes can occur with chronic varicose veins
  • – The pressure in the system rises
  • – This damages the cells, causing blood to extrude into the skin
23
Q

Which structures are found behind the medial malleolus?

A

Tom, Dick And Nervous Harry

  • Tibialis posterior
  • Flexor Digitorum longus
  • Tibial Artery
  • Tibial Nerve
  • Flexor Hallucis longus
24
Q

What is ageing and when does it begin?

A
  • A loss of cells
  • A reduction in the cell’s ability to repair
  • Increased genetic mutations
  • Begins when adulthood is reached
25
Q

What are the consequences of ageing?

A
  • Loss of muscle strength and endurance
  • Loss of bone strength
  • Increased fall risk
  • Increased fracture risk
  • Reduction in ability to perform activities of daily living
26
Q

What factors can accelerate bone loss?

A
  • Low reproductive hormone levels
  • Poor calcium and/or vitamin D status
  • Inactivity
  • Endocrine or GI pathologies
27
Q

What are the effects of ageing on muscle?

A
  • Sarcopenia (loss of muscle mass due to loss of muscle fibres and reduced muscle cross-sectional area)
  • Loss of muscle contractility
  • Loss of neuronal innervation
28
Q

What are bisphosphonates and how do they act?

A
  • Anti-resorptive agents
  • Affect osteoclasts
  • Effect on bone: decrease bone turnover, increase bone mineralisation, minimal effect on bone volume
  • They are taken up by osteoclasts, causing inactivation of osteoclasts
29
Q

What are the clinical features of osteoarthritis?

A
  • Pain
  • Stiffness
  • Deformity
  • Joint swelling
30
Q

What are the radiological features of osteoarthritis?

A
  • Decreased joint space
  • Sclerosis
  • Osteophytes
  • Bone cysts
31
Q

How can osteoarthritis be treated?

A 
Non-operative:
- Weight loss
- Exercise/physiotherapy
- Analgesia/NSAIDs
- Joint infection
Operative
- Arthroscopy
- Osteotomies
- Arthrodesis
- Arthroplasty
32
Q

What can the femoral artery be used for clinically?

A

A site for insertion of catheter to gain access to left side of heart

33
Q

What is intermittent claudication?

A
  • Pain on walking that is relieved by rest
  • Build up of atherosclerotic plaque
  • Same risk factors as for coronary artery disease
  • Limits blood flow to muscles (ischaemia and pain)
34
Q

What are the signs of poor perfusion?

A
  • Lack of hair
  • Skin problems
  • Ulcers
  • Infection
  • Skin necrosis
  • Loss of pulses
  • Cold to touch
35
Q

What is a popliteal aneurysm?

A

Abnormal dilatation of popliteal artery

  • Oedema and pain in popliteal fossa
  • Mass with palpable pulsation
36
Q

How could the popliteal artery be damaged?

A

By fracture of the distal femur or dislocation of the knee

37
Q

What assists venous return?

A

Contraction of the calf muscles

  • Contracted muscles compress the deep veins and propel blood to the heart
  • The blood pushed downwards will cause the lower valve to close, preventing blood flow away from the heart

Musculoskeletal System (12 decks)

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