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37 Cards in this Set

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divisions of lower extremity
- The lower extremity includes the gluteal region and all structures inferior to it
- Divisions of the lower extremity:
o Gluteal region
o Thigh (hip to knee)
o Popliteal fossa (posterior aspect of knee)
o Leg (knee to ankle)
o Foot (dorsal and plantar aspects)
bones of lower extremity
hip bones, femur, patella, tibia (medial bone of leg), fibula (lateral bone of leg), 7 tarsals (calcaneus, talus, navicular, cuboid, medial, intermediate, and lateral cuneiforms), 5 metatarsals (proximal part is the base, distal part is the head), 14 phalanges (proximal, middle, distal; the hallux (big toe) has a proximal and distal phalanx only)
femur
o Head
o Neck
o Shaft (body) with linea aspera (on posterior surface)
o Medial and lateral femoral condyles (distal)
tibia
o Medial and lateral tibial condyles (proximal)
o Shaft (body)
o Medial malleolus is the distal protuberance on medial side of the ankle
fibula
o Head (proximal protuberance)
o Shaft (body)
o Lateral malleolus is the distal protuberance on lateral side of the ankle
hip joint
o Acetabulum of the hip bone articulates with the femoral head
o Ball and socket synovial joint
o Flexion reduces the angle between the thigh and trunk anteriorly
o Extension increases the angle between the thigh and trunk anteriorly
o Abduction draws the thigh away from the midline of the body
o Adduction draws the thigh towards the midline of the body
o Medial rotation femur rotates medially along its long axis
o Lateral rotation femur rotates laterally along it long axis
knee joint
o Femoral condyles articulate with the tibial condyles
o Hinge synovial joint
o Flexion brings the leg closer to the posterior aspect of the thigh
o Extension draws the leg away from the posterior aspect of the thigh
ankle (talocrural) joint
o Talus articulates with distal tibia and lateral malleolus of the fibula
o Hinge synovial joint
o Dorsiflexion brings the foot closer to the anterior aspect of the leg (directs toes superiorly)
o Plantarflexion draws the foot away from the anterior aspect of the leg (directs toes inferiorly)
subtalar joint
o Synovial joint between the talus and the calcaneus
o Eversion causes the sole to face laterally
o Inversion causes the sole to face medially
metatarsophalangeal (MTP) joints
o Synovial joints between the metatarsals and the proximal phalanges
o Flexion of toes (towards the ground)
o Extension of toes (away from the ground)
o Abduction (movement away from the second digit)
o Adduction (movement towards the second digit)
interphalangeal (IP) joint
o Hinge synovial joints between the phalanges
o Proximal interphalangeal joints (PIPs) are located between the proximal and middle phalanges
o Distal interphalangeal joints (DIPs) are located between the middle and distal phalanges
o The hallux has a single IP joint between its proximal and distal phalanges
o Flexion of toes (towards the ground)
o Extension of toes (away from the ground)
superficial fascia of LE
o Contains: fat, cutaneous nerves, superficial veins, lymphatic vessels and lymph nodes
deep fascia of LE
o Dense connective tissue (very strong)
o Invests the lower extremity muscles like an elastic stocking; prevents muscles from bulging during contraction; efficient mechanism to pump blood back to the heart
fascia lata
o Deep fascia of the thigh
o Firmly attached to inguinal ligament, pubis, iliac crest, sacrum, coccyx, and ischial tuberosity
o Lateral thickening of fascia lata is the iliotibial tract (or band)
o Oval shaped window in the fascia lata is the saphenous opening; it is located just inferior to the inguinal ligament; the great saphenous vein passes through this opening
o 3 intermuscular septa arise from the fascia lata and attach to the linea aspera of the femur
o These septa divide the thigh into 3 compartments: anterior, posterior, and medial
crural fascia
o 2 intermuscular septa arise from the crural fascia and attach to the tibia
o These septa (along with the interosseous membrane between the tibia and fibula) divide the leg into 3 compartments: anterior, posterior, and lateral
o Another septum separates the posterior compartment into superficial and deep layers
o Near the ankle joint, the deep fascia forms extensor and flexor retinacula; these bands keep tendons in place around the ankle joint
veins of lower extremity
o There are superficial and deep veins in the lower extremity
o These veins all have valves, but the valves are more numerous in the deep veins
superficial veins of LE
great saphenous vein, small saphenous vein
great saphenous vein
• Arises from dorsal aspect of the foot
• Passes anterior to the medial malleolus of the ankle
• Ascends along the medial aspect of the leg and thigh
• Enters the saphenous opening in the fascia lata
• Drains into the femoral vein
• Receives numerous tributaries as it ascends, and anastomoses with the small saphenous vein
saphenous cut down procedure
• The great saphenous vein can be accessed anterior to the medial malleolus to administer medications, fluids, etc. The procedure is effective even in infants, the obese and dehydrated patients (with collapsed veins).
great saphenous vein grafts
used in coronary bypass surgery because (a) the vein is superficial and easily accessible; (b) the wall of the great saphenous vein contains a high percentage of muscular and elastic fibers; and (c) the vein is long, with long distances between tributaries (easy to harvest usable lengths)
small saphenous vein
• Arises from lateral side of foot
• Passes posterior to the lateral malleolus of the ankle
• Enters popliteal fossa and drains into popliteal vein
preforating veins of LE
o Connect the superficial and deep veins
o Contain valves that allow blood to flow only from sf  deep veins
o When muscles contract, blood in the deep veins is propelled to the femoral and then external iliac veins (musculovenous pump)
o Valves in the perforating veins prevent reflux of blood from the deep to superficial veins
gluteal region lymphatics
o Lymph from superficial tissues of the gluteal region > superficial inguinal lymph nodes > external iliac lymph nodes
o Lymph from deep tissues of the gluteal region > superior and inferior gluteal lymph nodes > internal iliac lymph nodes
thigh, leg, foot lymphatics
o Superficial lymphatic vessels accompanying the great saphenous vein drain into superficial inguinal lymph nodes
o Superficial lymphatic vessels accompanying the small saphenous vein drain into the popliteal lymph nodes > deep inguinal lymph nodes
o Deep lymphatic vessels accompany the deep veins (e.g., popliteal, femoral) and drain into deep inguinal lymph nodes located medial to the femoral vein
o Both superficial and deep lymphatic vessels drain into the external iliac nodes
lumbosacral plexus
lumbar plexus (ventral rami L1-L4; iliohypogastric, ilioinguinal, genitofemoral, obturator, femoral); sacral plexus (ventral rami L4-S4; lumbosacral trunk, superior gluteal, inferior gluteal nerve, sciatic)
dermatomes of lower extremity
see M&A 5.9
deep veins
o Accompany major arteries and share the same names
varicose veins
occur when valves in the perforating veins become incompetent, allowing large amounts of blood to reflux from deep to superficial veins. The superficial veins are unable to handle this large volume and become distended.
iliohypogastric nerve
L1
Sensory: skin of superolateral gluteal region and suprapubic region
Motor: abdominal muscles
ilioinguinal nerve
L1
Sensory: skin of superomedial thigh
Motor: abdominal muscles
genitofemoral nerve
(L1-L2)
o Femoral branch: sensory to skin of superomedial thigh
o Genital branch: sensory to skin of scrotum or labia majora; motor to cremaster muscle
obturator nerve
(L2-L4)
o Emerges medial to psoas major
o Courses along lateral wall of pelvis and exits via obturator canal
o Motor: medial compartment of thigh
o Sensory: skin of medial thigh
femoral nerve
(L2-L4)
o Emerges lateral to psoas major
o Passes deep to inguinal ligament
o Motor: anterior compartment of thigh
o Sensory: skin of anteromedial thigh, leg, and foot
lumbosacral trunk
(L4-L5)
o descends medial to psoas major and joins the ventral rami of S1-S4 as they emerge from the anterior sacral foramina (and through piriformis)
superior gluteal nerve
o Exits pelvis via greater sciatic foramen superior to piriformis
o Motor: gluteus medius, gluteus minimus, tensor fascia lata
inferior gluteal nerve
o Exits pelvis via greater sciatic foramen inferior to piriformis
o Motor: gluteus maximus
sciatic nerve
o Largest nerve in the body
o Exits pelvis via greater sciatic foramen inferior to the piriformis
o Enters gluteal region (but does NOT innervate gluteal muscles)
o Motor: posterior compartment of thigh, all compartments of leg & foot
o Sensory: skin of foot and most of leg
o Note: the sciatic n. is actually a combination of two nerves, the common fibular (peroneal) n. and the tibial n.