Anatomy Of Leg

Front 1

iliopsoas

Back 1

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

Front 2

pectineus

Back 2

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

Front 3

sartorius

Back 3

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

Front 4

tensor fascia lata

Back 4

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

Front 5

remaining adductors

Back 5

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

Front 6

quads

Back 6

rectus femoris, vastus intermedius, lateralis, medialis; functions: flex hip, extend knee; dislocate patella laterally (lower horizontal fibers of medialis compensate)

Front 7

pes anserine

Back 7

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

Front 8

vastus intermedius

Back 8

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

Front 9

Gerdy's tubercle

Back 9

lateral epicondyle of tibia; attachment of the thickening of fascia lata called iliotibial band; 2 muscles attach: tensor fascia lata

Front 10

femoral triangle
(Scarpa's)

Back 10

inguinal lig, sartorius, adductor longus; N-A-V-L (lat to med)

Front 11

adductor canal

Back 11

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)

Front 12

obturator nerve

Back 12

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)

Front 13

tibial nerve

Back 13

hamstrings

Front 14

femoral nerve

Back 14

remaining muscles of ant thigh except tensor fascia lata (quads and sartorius); innervates knee and hip jts

Front 15

Glutes

Back 15

minimus-attaches between anterior and inferior gluteal lines; medius-between anterior and posterior lines; maximus-attaches to ilium posterior to posterior line

Front 16

hamstrings

Back 16

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)

Front 17

gluteus maximus

Back 17

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

Front 18

tensor fascia lata

Back 18

internal rotato; pulls IT band anteriorly; primary function is to flex hip by assisting iliopsoas and rectus femoris

Front 19

gluteus medius

Back 19

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

Front 20

gluteus minimus

Back 20

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

Front 21

piriformis

Back 21

arises from S2-S4; lateral rotator of hip; fills the majority of diameter of greater sciatic foramen

Front 22

superior and inferior gamellus (triceps coxae)

Back 22

superior-arises from ischial spine; inferior-arises from ischial tuberosity; lateral rotators; attach medial aspect of greater trochanter

Front 23

obturator internus
(triceps coxae)

Back 23

inferior to ischial spine, takes 90 deg bend and runs out to attach to greater trochanter

Front 24

quadratus femoris

Back 24

inferior to inferior gamellus; arises from ischial tuberosity and runs laterally to attach to quadrate tubercle (on trochanteric crest)

Front 25

obturator externus

Back 25

leaves external aspect of pelvis and runs around anterior or deep to quadratus femoris and attaches to quadrate tubercle (crest)

Front 26

lateral rotators of hip

Back 26

piriformis, 2 gamellae, 2 obturator and quadratus femoris

Front 27

cluneal nerves

Back 27

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)

Front 28

sciatic nerve

Back 28

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)

Front 29

anomaly of sciatic n

Back 29

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)

Front 30

popliteal fossa

Back 30

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

Front 31

deep to fossa, 2 muscles

Back 31

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)

Front 32

two thickenings of posterior knee

Back 32

1)oblique popliteal lig (of Winslow); 2)arcuate popliteal lig

Front 33

superficial ligs of hip

Back 33

1)iliofemoral-Y lig of Bigelow, first and strongest, limits extension (@ about 30 deg);2)pubofemoral, limits abduction; 3) ischiofemoral, limits abduction

Front 34

deep femoral artery

Back 34

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

Front 35

hip jt innervation

Back 35

femoral, obturator (anterior), superior gluteal , n to quadratus femoris (?)

Front 36

cribiform fascia

Back 36

defect in fascia lata for great saphenous vein to penetrate

Front 37

great saphenous vein

Back 37

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

Front 38

SI joint

Back 38

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

Front 39

genicular anastomisis around the knee

Back 39

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

Front 40

ligaments of knee

Back 40

1)extracapsular; 2)capsular; 3)intracapsular

Front 41

intrinsic ligs of knee

Back 41

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

Front 42

extrinsic ligs of knee

Back 42

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

Front 43

intracapsular ligs

Back 43

anerior cruciate (ACL); posterior cruciate (PCL); Posterior meniscofemoral

Front 44

muscles around knee

Back 44

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

Front 45

muscles and knee movements

Back 45

1)Quads-extension-primarily rectus femoris
2)hamstrings-flexion
3)lateral rotators-biceps femoris (inserts on lateral aspect of fibular head)
4)medial rotators-semimembranosus, semitendinsus, and popliteus(when leg is flexed)

Front 46

popliteus muscle

Back 46

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"

Front 47

clinical assns of knee

Back 47

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

Front 48

clinical assns *continued*

Back 48

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)

Front 49

saphenous nerve (off femoral)

Back 49

cutaneous: anteromedial leg (not thigh)

Front 50

lateral sural cutaneous nerve (off common fibular)

Back 50

antero- and postero- lateral aspects

Front 51

medial sural cutaneous nerve (off tibial)

Back 51

between saphenous and lateral sural nerves

Front 52

superficial fibular nerve

Back 52

distal lateral

Front 53

musculovenous pump

Back 53

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

Front 54

tibia

Back 54

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

Front 55

fibula

Back 55

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)

Front 56

interosseus membrane

Back 56

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

Front 57

tibia-fibula articulation

Back 57

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

Front 58

ankle jt movements

Back 58

dorsiflexion and plantarflexion

Front 59

movement @ subtalus-transverse tarsal jt

Back 59

eversion and inversion

Front 60

anterior compartment of anterolateral leg

Back 60

function: dorsalflexion and some toe extension
innervation: deep fibular nerve (off common fibular)
blood: anterior tibial artery and veins (off popliteal)

Front 61

posterior compartment of AL leg

Back 61

function: plantarflexion and flexors of toes
innervation: tibial nerve
blood: posterior tibial artery and veins

Front 62

lateral compartment of AL leg

Back 62

function: eversion of foot
innervation: superficial fibular nerve
blood: fibular artery, br of posterior tibial artery

Front 63

deep fascia modifications

Back 63

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)

Front 64

Anterior compartment: tibialis anterior

Back 64

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

Front 65

Anterior compartment: extensor hallicus longus

Back 65

arises from middle 1/2 of fibula (medial) and interosseus membrane, inserts into distal phalanx of great toe
function: dorsiflexes and extends great toe

Front 66

Anterior compartmen: extensor digitorum longus

Back 66

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

Front 67

Anterior compartment: fibularis tertius

Back 67

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)

Front 68

Lateral compartment of AL leg: fibularis longus

Back 68

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

Front 69

Lateral compartment: fibularis brevis

Back 69

arises lower 2/3 of shaft of fibula, attaches after passing lateral malleolus onto tuberosity of base of 5th metatarsal
function: everter and plantarflexion

Front 70

clinical assns: fibula

Back 70

middle 1/3 used for bone grafts and has nutrient artery so retains its own blood supply

Front 71

C.A.: fibular nerve

Back 71

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*

Front 72

compensation for Foot Drop

Back 72

"long limp"
swing out foot
"steppage gate"-extra flexion of thigh and knee

Front 73

Posterior compartment: gastrocnemius

Back 73

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)

Front 74

Posterior compartment: plantaris

Back 74

absent in 10%; can fuse into Achilles tendon or insert directly into calcaneus; tendon known as "freshman's nerve"

Front 75

Posterior compartment: soleus

Back 75

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

Front 76

Posterior compartment: flexor hallucis longus

Back 76

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

Front 77

Posterior compartment: flexor digitorum longus

Back 77

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*

Front 78

tibialis posterior

Back 78

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

Front 79

Achilles tendon

Back 79

tendons of soleus,plantaris and gastrocnemius

Front 80

tibial nerve

Back 80

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*

Front 81

posterior tibial artery

Back 81

palpate posterior to medial malleolus (invert ankle)

Front 82

tarsal tunnel syndrome

Back 82

entrapment of tibial nerve deep to flexor retinaculum; results in cutaneous and motor dysfunction to muscles and skin innervated distally