Week 5 - Ach Flashcards
Describe the route of the greater saphenous vein from the foot to the femoral triangle.
Begins: medial end of the dorsal venous arch of the foot
Ascends: obliquely/medial to knee
Terminates: into the femoral vein by passing through the femoral triangle into an opening in the fascia lata (saphenous opening)
Where is the femoral triangle located?
Groin region, medial anterior thigh
What are the boundaries of the femoral triangle?
Superior: Inguinal ligament
Lateral: Sartorius
Medial: Adductor longus
What are the contents of the femoral triangle?
Lateral –> Medial
N: Femoral nerve
A: External iliac artery
V: External iliac vein
E: Empty (inguinal lymph nodes)
L: Lacunar ligament
Where is the constant location of the greater saphenous vein?
Why is it important?
- 1 cm in front of the medial malleolus
- important to know in case the need arises for an emergency transfusion (aka “Saphenous Cut down”)
Describe the nerve supply to the lower extremity.
(spinal cord –> terminus)
Spinal cord –> Lumbar plexus (L2-L4) –> Femoral Nerve
***Innervates the muscles in the anterior thigh***
Describe the blood supply to the lower extremity.
Descending aorta –> External iliac artery –>
Femoral artery (inguinal ligament) –> Popliteal artery (adductor hiatus)
What are the major branches of the Femoral artery?
- Deep (Profunda) femoral artery
- Lateral Circumflex Femoral artery
- Perforating branches
- Medial Circumflex Femoral artery
- Lateral Circumflex Femoral artery
What are the muscular components of the anterior compartment of the thigh?
- Sartorius
- Iliopsoas
- Pectineus
- Quadriceps femoris:
- Rectus femoris
- Vastus lateralis
- Vastus medialis
- Vastus intermedius
***Knee Extensors (femoral nerve)
What are the muscular components of the medial compartment of the anterior thigh?
- Gracilis
- Adductor magnus (tibial & obturator nerves)
- Adductor longus
- Adductor brevis
***Thigh Adductors (supplied by Obturator nerve)
What is the strongest flexor of the hip joint?
Iliopsoas
Where do all 4 heads of the quadriceps femoris insert?
Tibial tuberosity via the patellar ligament.
Why are the Medial & Lateral Circumflex Femoral Artery particularly important clinically?
Because it provides major branches to the head and neck of the femur.
(especially the medial circumflex femoral artery)
What vessels make up the Cruciate anastomosis?
- 1st perforating artery (of Deep femoral)
- Inferior Gluteal branches
- Medial Circumflex Femoral arteries
- Lateral Circumflex Femoral arteries
What vessels make up the Trochanteric anastomosis?
- Superior Gluteal
- Inferior Gluteal
- Medial Circumflex Femoral artery
- Lateral Circumflex Femoral artery
Why are the Cruciate and Trochanteric anastomoses important?
Provide blood to the lower limb in the event of an occlusion of the femoral artery above the origin of the deep femoral artery.
Where does a femoral hernia form?
Femoral ring
(Medial-femoral canal)
What is a hip pointer?
A bruise or contusion of the bone over the iliac crest OR
an avulsion of the muscles from the iliac crest (usually sartorius or rectus femoris).
What is a “Charley horse”?
Contusion and tearing of muscle fibers enough to result in a thigh hematoma (collection of blood).
–> Leads to pain & stiffness
When is saphenous nerve injury likely to occur?
Cutting the area approximately 1 cm anterior to the medial malleolus.
- during “Saphenous cut down”
- vein grafting
What symptoms does injury to the Saphenous nerve produce?
Pain and/or numbness along the medial border of the foot.
What is Osgood-Schlatter disease?
An epiphysitis of the tibial tuberosity where the patellar ligament attaches resulting in pain in the area.
Usually occurs in adolescents (9-13 yoa), and is aggravated by activity.
What is a groin pull?
Strain, stretching, and possibly tearing of the proximal attachments of the anteromedial thigh muscles/adductor muscles of the thigh.
Occurs in sports that require quick starts:
-sprinting, baseball, football, gymnastics
What nerve and lumbar plexus segments does the Patellar Tendon Reflex (knee jerk) test?
Femoral nerve & L2-L4 spinal cord segments
What are the bones of the tarsus (foot)?
- Talus
- Calcaneus
- Cuboid (lateral)
- Navicular (medial)
- Cuneiforms (3-lateral, intermediate, medial)
- 5 Metatarsals
- 14 Phalanges
Where is the transverse tarsal joint?
Joint between:
Talus/Calcaneous & Navicular/Cuboid
(a.k.a. Talocalcaneonavicular joint & Calcaneocuboid joint)
Why is the Transverse Tarsal joint important?
- Allows inversion/eversion of the foot
- Standard method of surgical amputation occurs at this joint.
What is the Subtalar Joint?
Joint/space between the Talus & Calcaneus
What are the muscular components of the anterior leg?
- Tibialis anterior (dorsiflexion, inversion)
- Extensor digitorum longus (dorsiflexion, toe extension)
- Extensor hallucis longus (dorsiflexion, great toe extension)
- Fibularis tertius (dorsiflexion, eversion)
***Innervated by Deep Fibular Nerve***
What are the muscular components of the lateral compartment of the leg?
- Fibularis longus (plantarflexion, eversion)
- Fibularis brevis (plantarflexion, eversion)
***Innervated by the Superficial Fibular Nerve***
What blood vessel supplies the muscles of the anterior compartment of the leg?
Anterior tibial artery
What blood vessel supplies the lateral compartment of the leg?
Fibular branch of Posterior Tibial artery
Damage to the Common Fibular Nerve results in what clinical symptom?
Foot drop & Steppage gait
(Inability to dorsiflex and evert the foot, toes do not clear the floor during swing phase of walking)
What does the Common Fibular Nerve split into?
Superficial Fibular nerve
&
Deep Fibular nerve
What structure does the Deep Fibular nerve run in close proximity to on the anterior leg?
Anterior Tibial Artery
What does the Anterior Tibial Artery continue into the foot as?
Dorsalis Pedis artery
What is the names of the superior and inferior bands that hold the fibular muscles in place as they pass behind the lateral malleolus?
Superior & Inferior Fibular Retinacula
What two things hold the extensor tendons (and their synovial sheaths) in place to prevent bowstringing?
Superior Extensor Retinaculum
&
Inferior Extensor Retinaculum
What are the 3 muscles on the dorsum of the foot?
- Extensor digitorum brevis (deep fibular nerve)
- Extensor hallucis brevis (deep fibular nerve)
- 4 Dorsal interosseus muscles (lateral plantar nerve)
What three arteries does the Dorsalis Pedis artery terminate as?
Arcuate artery (arch)
&
First dorsal metatarsal artery
&
Deep plantar arteries
Where can the Dorsalis Pedis artery and Deep Fibular nerve be found on the dorsum of the foot?
Lateral to tendon of Extensor Hallicus Longus
What does occlusion of the Dorsalis pedis artery lead to?
- Pain
- Pallor
- Paresthesia
- Paralysis
- Pulselessness
Where does the tendon of Fibularis brevis attach?
5th metatarsal
Where does the tendon of Fibularis Longus attach?
plantar surface of first metatarsal
What nerve supplies the cutaneous distribution of the dorsum of the foot, digits 2-4, and have of great toe and 5th digit?
Superficial fibular nerve
What is the most important muscle in stability of the knee joint?
Quadriceps muscle
What meniscus is attached firmly to its surrounding ligament?
Medial meniscus –> Medial Collateral Ligament
(Tibial Collateral Ligament)
Where do meniscal tears heal best?
Outermost part (outer 1/3) where here is good blood supply
What muscle tendon separates the Lateral Collateral Ligament from the joint capsule?
Popliteus
What cruciate ligament is excluded from the synovial cavity?
BOTH: Anterior Cruciate Ligament & Posterior Cruciate Ligament
What movements does the ACL resist?
Posterior displacement of the femur on the tibia.
&
Hyperextension
What movements does the PCL resist?
Anterior displacement of femur on tibia.
&
Hyperflexion
(main stabilizer of femur when walking downhill)
What are the shapes of the medial and lateral meniscus?
Medial: C-shaped
Lateral: circular
What is the “Unhappy Triad” injury?
Tear/Rupture of:
- Anterior Cruciate Ligament (ACL)
- Tibial Collateral Ligament (MCL)
- Medial meniscus
What bodily position often leads to an “Unhappy Triad” injury?
Twisting motion (of the hip) & Fixed foot
What are shin splints?
Mild compartment syndrome in the anterior compartment (tibialis anterior strain).
What four bursa surround the knee joint and touch the synovial cavity?
- Suprapatellar (decreases quad friction)
- Popliteus (popliteus muscle/head of fibula)
- Gastrocnemius (medial head of gastroc)
- Semimembranous (medial gastroc/tendon of semimembranous muscle)
What three bursa in the knee region do not touch the synovial cavity?
- Prepatellar - housmaid’s knee
- Infrapatellar - clergyman’s knee
- Deep infrapatellar (patellar ligament/anterior tibia)
What is Ski Boot Syndrome?
Deep Fibular Nerve Entrapment
- occurs deep to inferior extensor retinacular and EHL
- causes pain in dorsum of foot radiating to 1st web space
- due to tight ski boot/shoe
What ligament was discovered within the last year?
Anterolateral Ligament (ALL)
(next to LCL)
What is the most commonly injured joint in the body?
Talocrural joint
(between tiba and talus, affects medial malleolus)
What are the four parts of the Medial Deltoid Ligament?
- Anterior tibiotalar
- Tibionavicular
- Tibiocalcaneal
- Posterior tibiotalar
What kind of sprain involves the Medial Deltoid Ligaments?
Eversion sprain
What is “Pott’s Fracture”?
Forced Eversion –>
Torn Medial Deltoid ligaments
Fractured medial malleolus
Fractured Fibula
Torn Anterior Tibiofibular Ligament
What are the three Lateral Collateral Ligaments of the ankle?
- Anterior Talofibular (ATFL - most commonly torn)
- Calcaneofibular
- Posterior Talofibular (PTFL)
What kind of injury involves the Lateral Collateral Ligaments of the ankle?
Inversion sprain
What kind of ankle sprains are the most common?
Inversion Sprains
(Anterior Talofibular Ligament spain)
Eversion takes place at what joint?
Subtalar joint
