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Musculoskeletal System > Week 7 - Osteology of the lower limb, anterior thigh > Flashcards

Week 7 - Osteology of the lower limb, anterior thigh Flashcards

1
Q

Which muscles are found in the medial compartment of the thigh?

A
  • Obturator externus
  • Adductor brevis
  • Adductor longus
  • Adductor magnus
  • Gracilis
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2
Q

Which muscles are found in the anterior compartment of the thigh?

A
  • Psoas major
  • Iliacus
  • Pectineus
  • Sartorius
  • Recturs femoris
  • Vastus lateralis
  • Vastus medialis
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3
Q

What is the iliopsoas?

A

The posts major and the iliacus come together to form a tendon
- Hence why they are commonly referred to as 1 muscle

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4
Q

What are the actions of the iliopsoas?

A
  • Flexes the lower limb at the hip joint

- Assists in lateral rotation at the hip joint

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5
Q

What are the attachments of the adductor brevis?

A
  • Originates from the body of the pubis and inferior pubic rami
  • Attaches to the linea aspera on the posterior aspect of the femur
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6
Q

What innervates the adductor brevis?

A

Obturator nerve

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7
Q

What are the actions of the adductor brevis?

A

Adduction of the thigh

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8
Q

What are the attachments of the obturator externus?

A
  • Originates from the membrane of the obturator foramen and adjacent bone
  • Attaches to the posterior aspect of the greater trochanter
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9
Q

What innervates the obturator externus?

A

Obturator nerve

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10
Q

What are the actions of the obturator externus?

A

Laterally rotates the thigh

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11
Q

What are the attachments of the adductor magnus?

A

Adductor part:
- Originates from the inferior rami of the pubis and the rami of the ischium
- Attaches to the linea aspera of the femur
Hamstring part
- Originates from the tibial tuberosity
- Attaches to the adductor tubercle on the distal and medial side of the femur

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12
Q

What are the actions of the adductor magnus?

A

Both parts adduct the thigh

  • Adductor part also flexes the thigh
  • Hamstring part also extends the thigh
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13
Q

What innervates the adductor magnus?

A
  • Adductor part: obturator nerve

- Hamstring part: tibial nerve

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14
Q

What are the attachments of the adductor longus?

A
  • Originates from the pubis
  • Expands into a fan shape
  • Attaches broadly to the linea aspera of the femur
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15
Q

What are the actions of the adductor longus?

A
  • Adduction of the thigh

- Medial rotation of the thigh

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16
Q

What innervates the adductor longus?

A

Obturator nerve

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17
Q

What are the attachments of the gracilis muscle?

A
  • Originates from the inferior rami of the pubis and the body of the pubis
  • Descends almost vertically down the leg
  • Attaches to the medial surface of the tibia, in-between the tendons of the sartorius (anteriorly) and the semitendinous (posteriorly)
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18
Q

What are the actions of the gracilis muscle?

A
  • Adduction of the thigh at the hip

- Flexion of the leg at the knee

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19
Q

What innervates the gracilis muscle?

A

Obturator nerve

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20
Q

What are the attachments of the psoas major?

A
  • Originates from the lumbar vertebrae

- Inserts into the lesser trochanter of the femur, along with the iliacus

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21
Q

What innervates the psoas major?

A

Anterior rami of L1-L3

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22
Q

What are the attachments of the iliacus?

A
  • Originates from the iliac fossa of the pelvis

- Inserts onto the lesser trochanter of the femur, along with psoas major

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23
Q

What innervates the iliacus?

A

Femoral nerve

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24
Q

What are the attachments of the pectineus?

A
  • Originates from the pectineal line on the anterior surface of the pelvis
  • Attaches to the pectineal line on the posterior side of the femur, just inferior to the lesser trochanter
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25
Q

What are the actions of pectineus?

A
  • Adduction at the hip joint

- Flexion at the hip joint

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26
Q

What innervates pectineus?

A

Femoral nerve

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27
Q

What are the attachments of sartorius?

A
  • Originates from the anterior superior iliac spine

- Attaches to the superior, medial surface of the tibia

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28
Q

What are the actions of sartorius?

A
  • At the hip joint = flexor, abductor and lateral rotator
  • At the knee joint = flexor
    The “tailor’s muscle” so allows you to sit cross-legged
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29
Q

What innervates sartorius?

A

Femoral nerve

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30
Q

What is quadriceps femoris?

A

One of the most powerful muscles of the body

  • Forms the main bulk of the thigh
  • Consists of 4 individual muscles (3 vastus and rectus femoris)
  • Main extensor of the knee
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31
Q

Where does quadriceps femoris attach?

A

To the patella via a tendon

- The patella then attaches to the tibia by the patella tendon

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32
Q

What are the 3 vastus muscles in quadriceps femoris?

A
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
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33
Q

What is the action of the vastus muscles?

A

Collectively, they extend at the knee joint

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34
Q

What innervates the vastus muscles?

A

Femoral nerve

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35
Q

What are the attachments of rectus femoris?

A
  • Originates from the ilium, just superior to the acetabulum
  • Runs straight down the leg
  • Attaches to the patella by the quadriceps femoris tendon
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36
Q

What are the actions of rectus femoris?

A
  • Flexes the leg at the hip joint

- Extends at the knee joint

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37
Q

What bones are found in the lower limb?

A
  • Pelvic girdle (hip bones, sacrum, coccyx)
  • Femur
  • Tibia
  • Fibula
  • Foot bones
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38
Q

What are the articulations of the hip bone?

A
  • Sacroiliac joint: articulation with sacrum
  • Pubic symphysis: articulation with the corresponding hip bone
  • Hip joint: articulation with the head of femur
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39
Q

What are the 3 parts that make up the hip bone?

A
  • Ilium
  • Ischium
  • Pubis
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40
Q

What was the structure of the hip bone prior to puberty?

A

Triradiate cartilage separated the ilium, ischium and pubis

- They begin to fuse at the age of 15-17

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41
Q

What is the acetabulum?

A

A cup-shaped socket

  • Formed by the fusion of the ilium, ischium and pubis
  • The head of the femur articulates with it to form the hip joint
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42
Q

What is the structure of the ilium?

A
  • The superior part of the hip bone
  • The widest and largest of the 3 parts
  • Immediately above the acetabulum, it expands to form the wing
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43
Q

Describe the wing of ilium

A

It has 2 surfaces:
- Inner: concave, known as the iliac fossa
- External: convex, provides attachments to the gluteal muscles, also known as the gluteal surface
The superior margin of the wing is thickened, forming the iliac crest
- The iliac crest extends from the anterior superior iliac spine to the posterior superior iliac spine

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44
Q

Which muscles attach to the ilium?

A
  • Gluteal muscles attach to the external surface of the ilium at the anterior, posterior and inferior gluteal lines
  • The iliacus muscle attaches medially at the iliac fossa
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45
Q

What is the structure of the pubis?

A

The most anterior portion of the hip bone
Consists of a body and superior + inferior rami
- The body is located medially
- The superior rami extends laterally from the body, forming part of the acetabulum
- The inferior rami projects towards, and joins, the ischium

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46
Q

What does the pubis articulate with?

A

Its opposite pubis body

- At the pubic symphysis

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47
Q

What encloses the obturator foramen?

A
  • Inferior and superior pubic rami

- Ischiopubic ramus

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48
Q

What passes through the obturator foramen?

A
  • Obturator nerve
  • Obturator artery
  • Obturator vein
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49
Q

What is the structure of the ischium?

A
  • The posterioinferior part of the hip bone
  • Composed of a body and an inferior + superior ramus
  • The inferior ischial ramus combines with the inferior pubic ramus to form the ischiopubic ramus
  • The posteroinferior aspect of the ischium forms the ischial tuberosities
  • On the posterior aspect of the ischium there is an indentation known as the greater sciatic notch
50
Q

Which ligaments attach to the ischium?

A

Sacrospinous:
- Runs from the ischial spine to the sacrum
- This creates the greater sciatic foramen
The sacrospinous ligament and the sacrotuberous ligament run from the sacrum to the ischial tuberosity
- Forms the lesser sciatic foramen

51
Q

What transcends through the greater sciatic foramen?

A
  • Lower limb neurovasculature

- Piriformis muscle

52
Q

What are the common ways of fracturing the hip bones?

A
  • Direct trauma (e.g. vehicular accident)

- Forces transmitted from the lower limb (e.g. a heavy fall on the feet)

53
Q

Where do fractures often occur on the hip bones?

A
  • Pubic rami
  • Acetabulum
  • In the region of the sacroiliac joint
54
Q

What is a common complication of a hip bone fracture?

A

Soft tissue injury

- The bladder and urethra are at high risk of damage

55
Q

What is the pelvic girdle?

A
  • A ring-like structure
  • Located in the lower part of the trunk
  • Connects the axial skeleton to the lower limbs
  • Consists of: 2 hip bones, sacrum, coccyx
56
Q

What are the articulations within the pelvis?

A
  • Sacroiliac joints (2): between the ilium of the hip bones and the sacrum
  • Sacrococcygeal symphysis: between the sacrum and coccyx
  • Pubic symphysis: between the pubis bodies of the 2 hip bones
57
Q

What are the functions of the pelvic girdle?

A
  • Transfer of weight from the upper axial skeleton to the lower appendicular components of the skeleton, especially during movement
  • Provides attachment for a number of muscles and ligament used in locomotion
  • Contains and protects the abdominopelvic and pelvic viscera
58
Q

What is the main function of the femur?

A

To transmit forces from the tibia to the hip joint

- Also acts as the place of origin and attachment f many muscles and ligaments

59
Q

Describe the proximal part of the femur

A

Forms the hip joint with the pelvis
Consists of:
- Head (has a smooth surface with a depression on the medial surface for the attachment of the ligament of the head)
- Neck (connects the head of the femur with the shaft, cylindrical, projects in a superior and medial direction)
- 2 bony processes (trochanters)
- Intertrochanteric line
- Intertrochanteric crest

60
Q

What is the intertrochanteric line?

A
  • A ridge of bone that runs in an inferomedial direction on the anterior surface of the femur
  • Connects the 2 trochanters together
  • The iliofemoral ligament attaches here
  • After it passes the lesser trochanter on the posterior surface, it is known as the pectineal line
61
Q

What is the intertrochanteric crest?

A
  • A ridge of bone that connects the 2 trochanters together
  • It sticks out more than the intertrochanteric line
  • Located on the posterior surface of the femur
  • There is a rounded tubercle on its superior half called the quadrate tubercle
  • – The quadrates femoris attaches here
62
Q

Describe the femur trochanters?

A

Greater:
- A projection of bone that originates from the anterior shaft, just lateral to where the neck joints
- Angled superiorly and posteriorly
- Can be found on both the anterior and posterior sides of the femur
- The site of attachment of the abductor and lateral rotator muscles of the leg
Lesser
- Much smaller than the greater trochanter
- Projects from the posteromedial side of the side, just inferior to the neck-shaft junction
- The psoas major and iliacus muscles attach here

63
Q

Describe the shaft of the femur

A
  • Descends in a slight medial direction
  • – This brings the knees closer to the body’s centre of gravity, increasing stability
  • On its posterior surfaces there are roughened ridges of bone called the linea aspera
64
Q

Describe the linea aspera

A

Roughened ridges of bone on the posterior surface of the femur

  • Proximally, the medial border becomes the pectineal line
  • The lateral border becomes the gluteal tuberosity
  • – Gluteus maximus attaches to it
  • Distally, it widens and forms the floor of the popliteal fossa
  • – The medial and lateral borders form the medial and lateral supracondylar lines
65
Q

Describe the distal part of the femur

A

Consists of:
Medial and lateral condyles
- Rounded areas at the end of the femur
- The posterior and inferior surfaces articulate with the tibia and menisci of the knee
- The anterior surface articulates with the patella
Medial and lateral epicondyles
- Bony elevations on the non-articular areas of the condyles
- The area of attachment of some muscles and the collateral ligaments of the knee joints
Intercondylar fossa
- A depression found on the posterior surface of the femur
- It lies in between the 2 condyles
- It contains 2 facets for attachment of internal knee ligaments
Facet for attachment of the posterior cruciate ligament
- Found on the medial wall of the intercondylar fossa
- A large rounded flat face
- The posterior cruciate ligament of the knee attaches to it
Facet for attachment of the anterior cruciate ligament
- Found on the lateral wall of the intercondylar fossa
- Smaller than the facet on the medial wall

66
Q

What are the 2 types of femoral neck fractures?

A

Intracapsular and extracapsular

67
Q

Describe an intracapsular femoral neck fracture

A
  • More common in the elderly, especially women
  • A result of a minor trip or stumble
  • Occurs within the capsule of the hip joint
  • It can damage the medial femoral circumflex artery (may lead to avascular necrosis of the femoral head)
  • The distal fragment is pulled upwards and rotated laterally
  • Clinically, this manifests as a shorter leg length, with the toes pointing laterally
68
Q

Describe an extracapsular femoral neck fracture

A
  • More common in young and middle aged people
  • In these fractures, the blood supply to the head of femur is intact
  • The leg is shortened and laterally rotated
69
Q

How do fractures of the femoral shaft occur?

A
  • Relatively uncommon
  • Require a lot of force
  • Usually a consequence of a traumatic injury, such as a vehicular accident
70
Q

How do femoral shaft fractures present?

A

A spiral fracture:

  • Can present with leg shortening, due to the fragments overriding (pulled by the attached muscles)
  • Since the method of injury is usually high energy, the surrounding soft tissues may also be damaged
  • Femoral nerve palsy is a possible sequelae
  • It is important to ensure the blood supply from the femoral artery hasn’t been compromised, as it supplies the remainder of the lower limb
71
Q

Describe the tibia

A
  • The main bone of the leg
  • Forms what is commonly known as the shin
  • Expands at the proximal and distal ends, articulating at the knee and ankle joints respectively
  • Second largest bone in the body
  • Functions as a weight bearing structures
  • Split into 3 parts: proximal, shaft and distal
72
Q

Describe the proximal part of the tibia

A
  • Widened by the medial and lateral condyles
  • – Aids in weight bearing
  • – They form a flat surface, known as the tibial plateau, which articulates with the femoral condyles to form the major articulation of the knee joint
  • Located between the condyles is a region called the intercondylar eminence
  • – Consists of 2 tubercles and a roughened area
  • – The main site of attachments for the ligaments and the menisci of the knee joint
  • – The tibial intercondylar tubercles fit into the intercondylar fossa of the femur
  • Tibial tuberosity
  • – Located on the anterior surface of the proximal tibia, inferior to the condyles
  • – Where the patella ligament attaches
73
Q

Describe the shaft part of the tibia

A

Has 3 borders and 3 surfaces (anterior, posterior and lateral)

  • Anterior border:
  • – The start of the anterior border is marked by the tibial tuberosity
  • – Palpable down the anterior surface of the leg as the shin
  • – The periosteal covering of the tibia is susceptible to damage
  • Posterior surface:
  • – Marked by a ridge of bone called the soleal line
  • – Runs inferomedially
  • – Eventually blends with the medial border of the tibia
  • – The soleus muscle originates from here
  • Lateral border:
  • – Also known as the interosseous border
  • – Gives attachment to the interosseous membrane
74
Q

Describe the distal part of the tibia

A
  • Widens to help with weight bearing
  • There is a bony projection continuing inferiorly on the medial side
  • – Called the medial malleolus
  • – Articulates with the tarsal bones to form part of the ankle joint
  • On the posterior surface, there is a groove where the tibialis posterior muscle attaches
  • Laterally, there is a notch where the fibula is bound to the tibia (called the fibula notch)
75
Q

Describe tibial fractures

A
  • Relatively common
  • Occur most frequently in the middle-aged and elderly
  • If the fibula is not fractured, it supports the tibia, so displacement of the fragments is minimal
  • The proximal end is the most vulnerable to damage
  • – Usually results from some traumatic accident
  • – The condyles may be broken up in the fracture
  • – It is not uncommon for there to be injury to the ligaments of the knee
  • At the ankle, the medial malleolus can be fractured
  • – Caused by the ankle being twisted inwards
  • – The talus of the foot is forced against the medial malleolus, causing a spiral fracture
76
Q

Describe the fibula

A
  • A bone in the leg
  • Found laterally to the tibia
  • At the proximal end it has an enlarged head
  • – This contains a facet for articulation with the lateral condyle of the tibia
  • On the posterior and lateral surface of the fibular neck, the common fibular nerve can be found
  • The fibular shaft has 3 surfaces: anterior, lateral and posterior
  • – The leg is split into 3 compartments, so each surface faces its respective compartment
  • – Distally, the lateral surface continues inferiorly and is called the lateral malleolus
77
Q

What is the main function of the fibula?

A

Acts as an attachment for muscles

78
Q

What is the most common place for a fibular fracture?

A

The lateral malleolus

79
Q

How can a lateral malleolus fracture occur?

A
  • By forced external rotation of the ankle
  • – This force of the talus against the bone causes a spiral fracture
  • By the foot being twisted outwards (eversion)
  • – The talus presses against the lateral malleolus
80
Q

What is the role of the bones of the foot?

A
  • They provide mechanical support for the soft tissues

- Help he foot to withstand the weight of the body

81
Q

How can the bones of the foot be divided into 3 categories?

A
  • Tarsals
  • Metatarsals
  • Phalanges
82
Q

What are the tarsals?

A

A set of 7 irregularly shaped bones

  • Situated proximally in the foot, in the ankle area
  • Organised into 3 rows: proximal, intermediate and distal
83
Q

Which bones are found in the proximal group of tarsal bones?

A

Talus and calcaneus

- They form the bony framework around the proximal ankle and heel area

84
Q

Describe the talus bone

A
  • The most superior of the tarsal bones
  • Has 3 articulations
  • – Superiorly: ankle joint = between the talus and the bones of the leg
  • – Inferiorly: subtalar joint = between the talus and calcaneus
  • – Anteriorly: talnavicular joint = between the talus and navicular
  • Main function = to transmit forces from the tibia to the heel bone
  • Numerous ligaments attach to it
85
Q

Describe the calcaneus bone

A
  • Lies underneath the talus bone
  • Has 2 articulations:
  • – Superiorly: subtalar joint
  • – Anteriorly: calcaneocuboid joint = between the calcaneus and the cuboid
  • It is thick and sturdy
  • Acts to transmit forces from the talus to the ground
  • The posterior aspect of the calcaneus is marked by the calcaneal tuberosity
  • – The achilles tendon attaches to it
86
Q

Which bones are found in the intermediate group of tarsal bones?

A

Only 1 bone: the navicular

87
Q

Describe the navicular bone

A
  • Articulates with:
  • – The talus posteriorly
  • – The cuneiform bones anteriorly
  • – Cuboid bone laterally
  • On its plantar surface, there is a tuberosity for the attachment of the tibialis posterior tendon
88
Q

Which bones are found in the distal group of tarsal bones?

A
  • Cuboid
  • 3 cuneiform bones
  • They articulate with the metatarsals of the foot
89
Q

Describe the cuboid bone

A
  • Most lateral bone in the distal row
  • Articulates with:
  • – The calcaneus posteriorly
  • – 2 metatarsals anteriorly
  • Shaped like a cube
  • Its inferior surface is marked by a groove for the fibularis longus muscle
90
Q

Describe the cuneiform bones

A
  • Lateral, intermediate and medial cuneiform bones
  • Articulate with the navicular posteriorly
  • The shape of the bones helps form a transverse arch across the foot
91
Q

Describe the metatarsals

A
  • Located in the midfoot, between the tarsals and phalanges
  • Numbered I-V (medial to lateral)
  • Each has a similar structure
  • – Consist of a distal head and proximal base
  • – These are joined by a shaft of bone
  • Have 3 articulations
  • – Proximally: tarsometatarsal joint = between the metatarsal bases and the cuneiforms or cuboid bones
  • – Laterally: intermetatarsal joint = between the metatarsal and the adjacent metatarsals
  • – Distally: metatarsophalangeal joint = between the metatarsal head and the proximal phalanx
  • They connect the phalanges to the tarsals
92
Q

Describe the phalanges

A
  • The bones of the toes
  • Each toe has 3 phalanges (a proximal, distal and intermediate)
  • – Except the big toe, which only has 2
93
Q

Which of the tarsal bones are most frequently fractured?

A

Talus and calcaneus

94
Q

Describe talus fractures

A

Can occur in 2 places: neck or body
Neck:
- Caused by excessive dorsiflexion of the foot
- The neck of the talus is pushed against the tibia
- The blood supply to the talus may be disturbed, leading to avascular necrosis of the bone
Body:
- Usually occur from jumping from a height
The malleoli of the leg bones act to hold the fragments together, so there is little displacement of the fracture pieces

95
Q

Describe calcaneus fractures

A
  • Often fractured in a ‘crush’ type injury
  • Most common mechanism = falling onto the heel from a height
  • – The talus is driven into it
  • – The bone can break into several pieces (a comminuted fracture)
  • – Upon x-ray it will appear shorter and wider
  • Even after treatment, a calcanea fracture can cause further problems
  • – The sub-talar joint is usually disrupted, causing the joint to become arthritic
  • – The patient will experience pain upon inversion and eversion
  • – Can make walking on uneven ground particularly painful
96
Q

How can fractures of the metatarsal bones occur?

A
  • Direct blow to the foot = most common method, usually from a heavy object dropping onto the foot
  • Stress fracture = an incomplete fracture caused by repeated stress to the bone; common in athletes
  • Excessive inversion of the foot = if the foot is violently inverted, the fibulas brevis muscle can tear off the base of metatarsal V
97
Q

What is the femoral triangle?

A

A hollow in the anterior thigh region

- Many neuromuscular structures pass through it

98
Q

What are the borders of the femoral triangle?

A
  • Superior = the inguinal ligament
  • Lateral = the medial border of the sartorius muscle
  • Medial = medial border of the adductor longus muscle
  • Floor = rest of adductor longs, the pectineus and iliopsoas
  • Roof = fascia lata
99
Q

Where is the inguinal ligament found?

A

From the anterior superior iliac spine to the pubis tubercle

100
Q

What is the role of the inguinal ligament in the femoral triangle?

A

Acts as a flexor retinaculum

- Supports the contents of the femoral triangle during flexion at the hip

101
Q

What are the contents of the femoral triangle?

A
  • Femoral nerve: inmervates the anterior compartment of the thigh and provides sensory branches for the leg and foot
  • Femoral artery: responsible for the majority of the arterial supply to the lower limb
  • Femoral vein: the great saphenous vein drains into it
  • Femoral canal: a structure which contains deep lymph nodes and vessels
102
Q

What is the femoral sheath?

A

A fascial compartment within the femoral triangle

- It contains the femoral artery, vein and canal

103
Q

How can the femoral pulse be measured?

A
  • Just inferior to where the femoral artery crosses the inguinal ligament, it can be palpated to measure the femoral pulse
  • It crosses exactly midway between the pubic symphysis and ASIS
  • Th presence of the pulse means that blood is reaching the lower extremity
104
Q

Why is the femoral artery clinically relevant?

A

It is located superficially in the femoral triangle so is easy to access
- Can be used for coronary angiography and can be catheterised to draw blood for arterial blood gases

105
Q

What is a hernia?

A

A condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it

106
Q

What is a femoral hernia?

A

Part of the bowel pushes into the femoral canal, underneath the inguinal ligament

  • Manifests clinically as a lump/bulge in the area of the femoral triangle
  • Usually requires surgical intervention to treat
107
Q

What is the femoral canal?

A

An anatomical compartment located in the anterior thigh, within the femoral triangle
- The smallest and most medial part of the femoral sheath

108
Q

What are the borders of the femoral canal?

A
  • Medial: lacunar ligament
  • Lateral: femoral vein
  • Anterior: inguinal ligament
  • Posterior: pectineal ligament, superior rami of the pubi and the pectineus muscle
109
Q

Where is the opening to the femoral canal found?

A

At its superior border

  • Enclosed by a connective tissue layer called the femoral septum
  • This septum is pierced by the lymphatic vessels exiting the canal
110
Q

What are the contents of the femoral canal?

A
  • Lymphatic vessels (drain the deep inguinal lymph nodes
  • Deep lymph node
  • Empty space (allows distension of the adjacent femoral vein)
  • Loose connective tissue
111
Q

What is the adductor canal?

A

A muscular tunnel in the thigh

  • Begins at the inferior end of the femoral triangle
  • Terminates at the adductor hiatus
112
Q

What are the boundaries of the adductor canal?

A
  • Anterior = sartorius muscle
  • Posteromedial = adductor longus and adductor magnus muscles
  • Lateral = vastus medialis muscle
113
Q

What are the contents of the adductor canal?

A
  • Femoral artery
  • Femoral vein
  • Nerve to vastus medialis
  • Saphenous nerve
  • Branch of obturator nerve
114
Q

What is the lumbosacral plexus?

A

The anterior divisions of the lumbar nerves, sacral nerves and coccygeal nerve
- Usually divided into 3 parts: lumbar plexus. sacral plexus, pudendal plexus

115
Q

What is the lumbar plexus?

A

A network of nerve fibres that supplies the skin and musculature of the lower limb

  • Located in the lumbar region, within the substance of the psoas major muscle
  • Formed by the anterior rami of the lumbar spinal nerves L1, L2, L3 and L4
  • Also receives contribution from T12
  • They divide into several cords
  • – These cords then combine together to form 6 major peripheral nerves of the lumbar plexus
  • – These nerves then descend down the posterior abdominal wall to reach the lower limb
116
Q

What is the sacral plexus?

A

A network of nerve fibres that supplies the skin and muscles of the pelvis and lower limb

  • It is located on the surface of the posterior pelvic wall, anterior to the performs muscle
  • Formed by the anterior rami of the sacral spinal nerves S1, S2, S3 and S4
  • – Also receives contributions from the lumbar spinal nerves, L4 and L5
  • Divide into several cords
  • – These then combine to form the 5 major peripheral nerves of the sacral plexus
  • – Thes descend down the posterior pelvic wall
  • The nerves have 2 main destinations:
  • – Leave the pelvis via the greater sciatic foramen and innervate the gluteal region
  • – Remain in the pelvis and innervate the pelvic muscles, organs and perineum
117
Q

What are the 2 major superficial veins of the leg?

A
  • Great saphenous vein

- Small saphenous vein

118
Q

Describe the passage of the great saphenous vein

A
  • Formed by the dorsal venous arch of the foot and the dorsal vein of the great toe
  • It ascends the medial side of the leg
  • Passes anteriorly to the medial malleolus
  • Passes posteriorly to the medial condyle at the knee
  • As it moves up the leg, it receives tributaries from other small superficial veins
  • It terminates by draining into the femoral vein immediately inferior to the inguinal ligament
119
Q

Describe the passage of the small saphenous vein

A
  • Formed by the dorsal venous arch of the foot and the dorsal vein of the little toe
  • It moves up the posterior side of the leg
  • Passes posteriorly to the lateral malleolus, along the lateral border of the calcaneal tendon
  • It moves between the 2 heads of the gastrocnemius muscle
  • Empties into the popliteal vein in the popliteal fossa
120
Q

What are the consequences of damage to the obturator nerve due to a superior pubic rami fracture?

A
  • Numbness and paraesthesia on the medial aspect of the thigh
  • Patient could present with posture and gait problems due to the loss of adduction
121
Q

How do you test the patella tendon reflex?

A
  • Tap the patellar ligament with a reflex hammer
  • – Should make the leg extend
  • – Should feel the quadriceps contract
  • Tests the integrity of the femoral nerve and the L2-L4 segments of the spinal cord
122
Q

Discuss pulled groin muscles

A

A strain, stretching and probably some tearing of the proximal attachments of the anteromedial thigh muscles have occurred

  • Usually involves the flexor and adductor thigh muscles
  • Usually occurs in sports the require quick starts or extreme stretching

Musculoskeletal System (12 decks)

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