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82 Cards in this Set

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psoas major and iliacus; run deep to inguinal ligament; only muscle that attaches to lesser trochanter; most powerful flexor of hip; forms part of floor of femoral triangle
arises from pecten of pubis and runs down to attach into pectineal line, which is small elevation just distal to lesser trochanter; some flexion of thigh, can adduct, and some internal rotation
arises from ASIS, runs distally and attaches into medial tibia, a specialized tendinous component, pes anserine; runs lateral to medial; flex knee, externally rotate hip, abduct hip, flex thigh
tensor fascia lata
arises from nearby bony parts of ASIS; short muscle; gluteal muscle; migrated to anterior part of thigh and functions like it; but innervated by gluteal nerve
remaining adductors
adductor longus-arises from inf pubic ramus and inserts into medial lip of linea aspera; gracilis-nearby origin sinilar to longus and runs down and attaches to medial tibia
rectus femoris, vastus intermedius, lateralis, medialis; functions: flex hip, extend knee; dislocate patella laterally (lower horizontal fibers of medialis compensate)
pes anserine
3 muscles descend and interdigitate; sartorius, gracilis, semitendonius-attach to medial knee (upper medial aspect of tibia) and help reinforce medial knee jt; reinforces laterally with anserine bursa-one of the most commonly inflamed bursae of body
vastus intermedius
deep portion is special part called articularis genu-doesn't run with other parts of muscle but goes directly into capsule (superior aspect of capsule-suprapatella bursa); muscle contract millisecs before full extension of knee and pulls redundant suprapatella bursa out of way
Gerdy's tubercle
lateral epicondyle of tibia; attachment of the thickening of fascia lata called iliotibial band; 2 muscles attach: tensor fascia lata
femoral triangle
inguinal lig, sartorius, adductor longus; N-A-V-L (lat to med)
adductor canal
vastus medialis (anterolateral), adductor longus and magnus (posteriorly), med border of subsartorial canal (roof); carries femoral neurovascular structures, cutaneous br. of obturator n to medial thigh, 2 br. of femoral n-nerve to vastus medialis and saphenous n (cutaneous br + longest n)
obturator nerve
lumbar plexus (L2-L4); anterior branch-supplies gracilis, adductor longus and brevis; posterior br- supplies adductor magnus and brevis (maybe)/ innervates both the hip (ant br) and knee jts (post br)
tibial nerve
femoral nerve
remaining muscles of ant thigh except tensor fascia lata (quads and sartorius); innervates knee and hip jts
minimus-attaches between anterior and inferior gluteal lines; medius-between anterior and posterior lines; maximus-attaches to ilium posterior to posterior line
true hamstrings arise from ischial tuberosity, cross the hip and knee jts, and attach to tibia or fibula; from lateral to medial-biceps femoris (long and short heads), semitendinosus, semimembranous (oblique popliteal lig); biceps tilted laterally, semi's tilted medially; primarily supplied by branches of perforating aa (from deep femoral a, which run along tibial nerve)
gluteus maximus
largest muscle of body; arises from posterior of posterior line, sacrum, coccyx, and deeply from sacrotuberous ligament; 1/4 inserts into femur on 3rd trochanter, 3/4 inserts into IT band; innervated by inferior gluteal nerve; primary function is to give short burst of extension in thigh but also involved in lateral rotation of hip
tensor fascia lata
internal rotato; pulls IT band anteriorly; primary function is to flex hip by assisting iliopsoas and rectus femoris
gluteus medius
originates btwn ant and post gluteal lines and above ant gluteal line to run all the way to iliac crest; gluteal injection; inserts into greater trochanter (directly lateral to gr troch-allows muscle to be a good adductor); superior gluteal nerve
gluteus minimus
arises from inferior to inferior gluteal line and attaches to greater trochanter (more anterior); primarily internal rotator of hip, can assist in abduction; superior gluteal nerve
arises from S2-S4; lateral rotator of hip; fills the majority of diameter of greater sciatic foramen
superior and inferior gamellus (triceps coxae)
superior-arises from ischial spine; inferior-arises from ischial tuberosity; lateral rotators; attach medial aspect of greater trochanter
obturator internus
(triceps coxae)
inferior to ischial spine, takes 90 deg bend and runs out to attach to greater trochanter
quadratus femoris
inferior to inferior gamellus; arises from ischial tuberosity and runs laterally to attach to quadrate tubercle (on trochanteric crest)
obturator externus
leaves external aspect of pelvis and runs around anterior or deep to quadratus femoris and attaches to quadrate tubercle (crest)
lateral rotators of hip
piriformis, 2 gamellae, 2 obturator and quadratus femoris
cluneal nerves
important sensory nerves for posterior aspect of gluteal region; superior-arises from dorsal rami of L1-L3; middle-arises from d.r. of S1-S3; inferior-arises from branch of sacral plexus called posterior cutaneous femoral nerve (indirectly arises from ventral rami of S1-S3-turns @ the inferior border of gluteus maximus)
sciatic nerve
longest of body; main component of sacral plexus and leaves inferior to piriformis; enters gluteal region by crossing over the lateral rotators such as quadratus femoris; anterior to gluteus maximus and about 1/2way btwn ischial tuberosity greater trochanter; descends down posterior thigh and deep to hamstrings; 2 nerves encapsulated in common fascia until splitting @ posterior knee: tibial and common peroneal (fibular)
anomaly of sciatic n
in 12% of people, sciatic nerve divides near the piriformis (pierces piriformis); in 0.5%, sciatic divides early with the common peroneal n running superior to piriformis (can be entrapped)
popliteal fossa
diamond shape, borderd medially by semimembranosus, laterally by biceps femoris tendon, and inferiorly by 2 heads of gastrocnemius; posterior to anterior:nerves of sciatic, popliteal vein, popliteal artery
deep to fossa, 2 muscles
1)plantaris; 2) popliteus-1st muscle to contract when flexing knee from full extension (unlocks knee so hamstrings can take over; one of 2 muscles to pierce a joint capsule)
two thickenings of posterior knee
1)oblique popliteal lig (of Winslow); 2)arcuate popliteal lig
superficial ligs of hip
1)iliofemoral-Y lig of Bigelow, first and strongest, limits extension (@ about 30 deg);2)pubofemoral, limits abduction; 3) ischiofemoral, limits abduction
deep femoral artery
also known as profundi femoral artery-branches: medial circumflex-supplies proximal femur; lateral circumflex-surrounding muscles and soft tissue; 4 perforating branches-branch that perforates some of adductor muscles and terminate primarily in hamstrings
hip jt innervation
femoral, obturator (anterior), superior gluteal , n to quadratus femoris (?)
cribiform fascia
defect in fascia lata for great saphenous vein to penetrate
great saphenous vein
longest vein, begins from dorsal venous arch in foot, runs anterior to medial malleolus, runs up medial part of leg, thigh and drains into femoral
SI joint
small, synovial jt; 4 deg of mobility (can increase during gestation for females); fuses around 4th decade for men, 5th decade for women; more ligamentous support posteriorly than anteriorly
genicular anastomisis around the knee
5 genicular artery branches (off popliteal); descending genicular branch of femoral a, descending genicular br of lateral femoral cutaneous a, anterior recurrent and circumflex fibular branches of anterior tibial artery
ligaments of knee
1)extracapsular; 2)capsular; 3)intracapsular
intrinsic ligs of knee
patellar-runs from apex of patella to tibial tuberosiy, distal end of quadriceps femoris tendon, helps replace fibrous capsule anteriorly; oblique popliteal-expansion from semimembranous muscle, reinforces posterior aspect; arcuate popliteal-Y-shaped wtih stem attached to head of fibula, passes over popliteus muscle; tibial collateral (MCL)-runs from medial epicondyle of femur to medial condyle of tibia and upper part of medial surface of tibia
extrinsic ligs of knee
fibular collateral (LCL)-lies deep to tendon of biceps femoris, extends from lateral epicondyle of femur to head of fibula, separated by from lateral meniscus by tendon of popliteus
intracapsular ligs
anerior cruciate (ACL); posterior cruciate (PCL); Posterior meniscofemoral
muscles around knee
muscles are main support for knee (not ligaments); well-toned quadriceps femoris can help prevent injury, especially lower fibers of vastus medialis and lateralis-send off aponeurotic expansions called medial and lateral patellar retinacula-attach to sides of patella and keep aligned; tendency to displace patella laterally (quads) but is prevented by lower fibers of vastus medialis, which run horizontally
muscles and knee movements
1)Quads-extension-primarily rectus femoris
3)lateral rotators-biceps femoris (inserts on lateral aspect of fibular head)
4)medial rotators-semimembranosus, semitendinsus, and popliteus(when leg is flexed)
popliteus muscle
arises from lateral epicondyle of femus inside knee joint and passes immediately downward and medially to insert into upper posterior aspect of tibia; when knee is fully extended, tibia is fixed, and popliteus can pull femur and laterally rotate it; "key of the knee"
clinical assns of knee
1)Unhappy triad-foot is fixed and leg is forcibly abducted, stressing medial aspect of knee; tears ACL, MCL (or tibial) and medial meniscus
2)anterior drawer sign-pull leg forward to check for excessive anterior movement of tibia on femur; checks ACL tear
3)posterior drawer sign-push on leg to check for excessive posterior movement; tests PCL
clinical assns *continued*
1)arthroscopy-trim lateral meniscus; ACL graft from patella lig or hamstring tendon
2)prepatella bursitis-pple who work on knees causes excess synovial fluid or blood in bursa or joint cavity; aspirate from lateral aspect with knee slightly flexed (use triangular area:lateral epicondyle of femur, apex of patella, Gerdy's tubercle)
saphenous nerve (off femoral)
cutaneous: anteromedial leg (not thigh)
lateral sural cutaneous nerve (off common fibular)
antero- and postero- lateral aspects
medial sural cutaneous nerve (off tibial)
between saphenous and lateral sural nerves
superficial fibular nerve
distal lateral
musculovenous pump
perforating veins have one-way valves, only permit flow from superficial to deep; in lower limb, blood is pumped against gravity by contraction of muscle (deep fascia is around muscles so pressure exerted is on deep veins
only weight bearing bone of leg-transfers all weight from femur to talus; proximally expands to form medial and lateral tibial condyles with intercondyle area btwn; triangular bone with 3 surfaces: anterior and medial, are subcutaneous and palpable (shin), and lateral surfaces; medial malleolus-distal, anterior prominence with lateral facet for talus articulation; inferior end of tibia also has articulation facet for talus
long, slender with head, neck and shaft; ends distally as lateral malleolus projects 1 cm farther than medial on tibia; articulates with talus on its medial aspect; most of shaft and neck are covered with muscles and not subcutaneous, but distal part of shaft and lateral malleolus are subcutaneous (palpable)
interosseus membrane
most fibers run inferior from tibia to fibula: 8 of 9 muscles attaching to fibula pull downward (exception: biceps femoris) and this resists downward pull
tibia-fibula articulation
1)superior tibiofibular jt-plane, synovial with is flat and planar
2)inferior tibiofibular jt-syndesmosis, a fibrous jt where bones are united by ligs-integrity of this jt for stability of ankle jt b/c lateral malleolus has to be pressed against talus
ankle jt movements
dorsiflexion and plantarflexion
movement @ subtalus-transverse tarsal jt
eversion and inversion
anterior compartment of anterolateral leg
function: dorsalflexion and some toe extension
innervation: deep fibular nerve (off common fibular)
blood: anterior tibial artery and veins (off popliteal)
posterior compartment of AL leg
function: plantarflexion and flexors of toes
innervation: tibial nerve
blood: posterior tibial artery and veins
lateral compartment of AL leg
function: eversion of foot
innervation: superficial fibular nerve
blood: fibular artery, br of posterior tibial artery
deep fascia modifications
extensor retinacula-pass into dorsum of foot
fibular retinacula-tendons of lateral comp. as pass behind lateral malleolus
flexor retinacula-posterior compartment; for deep posterior compartment:runs superiorly from medial malleolus and inferiorly from calcaneus; has septations to give own compartments (TP,FDL,NVB,FHL)
Anterior compartment: tibialis anterior
arises from lateral surface of upper 1/2 of tibia and inserts into medial cuneform of foot and into base of 1st metatarsal
function:passes in front of ankle to dorsiflex and invert
Anterior compartment: extensor hallicus longus
arises from middle 1/2 of fibula (medial) and interosseus membrane, inserts into distal phalanx of great toe
function: dorsiflexes and extends great toe
Anterior compartmen: extensor digitorum longus
arises from upper 3/4 of fibula (medial) and I.M.; tendon splits into 4, each passing to lateral 4 toes via an extensor expansion, which to middle and distal phalanges of long toes
function: dorsiflexes and extends lateral 4 toes
Anterior compartment: fibularis tertius
continuation of EDL, origin is distal portion of fibula (medial) and tendon attaches to base of 5th metatarsal
function: dorsiflexion and everter (inserts on lateral side)
Lateral compartment of AL leg: fibularis longus
more superficial; origin is head and upper 2/3 of shaft of fibula, attaches after passing behind lateral malleolus and inserts onto medial cuneiform and base of 5th metatarsal
function: everts and plantarflexion
Lateral compartment: fibularis brevis
arises lower 2/3 of shaft of fibula, attaches after passing lateral malleolus onto tuberosity of base of 5th metatarsal
function: everter and plantarflexion
clinical assns: fibula
middle 1/3 used for bone grafts and has nutrient artery so retains its own blood supply
C.A.: fibular nerve
Foot Drop: common fibular nerve is directly adjacent to neck of fibula; fracture or compression will paralyze all muscles of anterior and lateral compartment of leg (dorsiflexors)
*most frequently damaged nerve of lower limb*
compensation for Foot Drop
"long limp"
swing out foot
"steppage gate"-extra flexion of thigh and knee
Posterior compartment: gastrocnemius
arises off the lateral and medial supracondylar regions of femur and runs distally to calcaneous; small saphenous vein and sural nerve run in btwn 2 bellies; can flex knee and plantarflex foot (short spurts)
Posterior compartment: plantaris
absent in 10%; can fuse into Achilles tendon or insert directly into calcaneus; tendon known as "freshman's nerve"
Posterior compartment: soleus
homologue of flexor digitorum superficialis; attachments are off tibia (posterior), fibula (head, neck, and proximal 1/3), and sometimes I.M. <makes inverted "U">; *strongest plantarflexor*; arcus tendineus of soleus is where popliteal vessels and tibial nerve descend to posterior leg
Posterior compartment: flexor hallucis longus
arises from fibula (laterally); runs up to base of distal first phalanx; if lost, lose "spring in step"; enters fibrotic canal with actual ledge of bone from calcaneus *sustentaculum talli* which tendon runs inferiorly to ledge and uses it as a pulley
Posterior compartment: flexor digitorum longus
arises from tibia (medially); runs to base of distal phalanx of digits 2-5; FHL and FDL criss-cross (decussate) each other *Knot of Henry*
tibialis posterior
in the middle, arising from tibia , fibula, and I.M.; "claim to fame"-attaches to every bone of midfoot, which includes navicular, cuboid, and cuneiform as well as metatarsals of 2-4; strongest of inverters
Achilles tendon
tendons of soleus,plantaris and gastrocnemius
tibial nerve
innervates every muscle in posterior leg; soon as crosses with medial malleolus, divides into medial and lateral plantar nerves to supply muscles and skin of plantar surface of foot; before this division, the medial calcaneal cutaneous nerve branches off
*lateral calcaneal cutaneous nerve supplied by sural nerve*
posterior tibial artery
palpate posterior to medial malleolus (invert ankle)
tarsal tunnel syndrome
entrapment of tibial nerve deep to flexor retinaculum; results in cutaneous and motor dysfunction to muscles and skin innervated distally