Lower Limb

Front 1

Interstitial line (L4)

Back 1

Draw line from iliac crests across body at level of L4

For bone marrow extraction/ transplant (as well as sternum)

Front 2

*Study picture of hip bone, be able to identify bones, ligaments, where muscles, what passes through, etc

Back 2

*What muscle is here pisiform muscle; Or what is this? Greater sciatic foramen

Smaller hole, obturator foramen, covered by obturator membrane, forms obturator canal w/ligaments on where obturator nerve/ vessels pass. Also surrounded by obturator in/externus muscles

Front 3

Differences between Male and Female pelvis

Back 3

Male: thick/heavy, deep, narrow, heart-shaped pelvic inlet, small pelvic outlet, round obturator foramen, large acetabulum

Female: thin/ light, shallow, wide, oval/rounded pelvic inlet, large pelvic outlet, oval obturator foramen, small acetabulum

Front 4

angle of inclination during childhood? During adulthood? Old age?

Back 4

145 degrees

125- 126 degrees

120 degrees

Consist of collagen fibers and others which give elasticity; as grow up, weight of body presses on bone and angle gets smaller

Front 5

Osteomalacia

Back 5

softening of the bones from vitamin D deficiency or problems with the metabolism of vitamin D

Front 6

Rickets

Back 6

childhood disorder involving softening and weakening bones from lack of vitamin D, calcium, or phosphate.

Front 7

Vitamin D

Back 7

good for proper calcification of bones; if lacking; can cause bow-legs

Front 8

Osteoporosis

Back 8

the thinning of bone tissue and loss of bone density over time

Front 9

Hormones responsible for function/ integrity/ health of bone

Back 9

sex hormones, such as progesterone
in older age (50 or so), when going through menopause, due to physiological process where hormone activity decreases, bringing possibility of osteoporosis---> person more prone to fractures; often believe that fall leads to fracture but also possible that fracture happened that causes a fall

Front 10

Congenital dislocation of the hip

Back 10

Common birth defect, more in female infants. Either the acetabulum fails to form completely or the ligaments of the hip joint are loose.

Front 11

1. Coxa vasa
2. Coxa valve

Back 11

1. angle is small
2. angle is wide

can cause problems with knee joints; Inside knee joint is meniscus, causing pressure on meniscus--> rupture

Front 12

Fibula

Back 12

Used sometimes for bone grafting

Mid-shaft fractures of tibia + fibula are common distal fractures in Skiers (boot of ski pushes into mid-shaft)

Front 13

Disorders:
1. Periostitis
2. Detach tendon
3. Osgood-schlatter disease

Back 13

1. In extreme extension (kicking ball, etc), tendon may raise pereosteum (membrane around bone) and inflame it (inflammation of pereosteum)
2. or even may detach tendon or
abvulsion of bone– (condition where bone may be too raised and bone comes out, may have to be screwed in) rupture of the growth plate at the tibial tuberosity

Front 14

Patella

Back 14

Sesamoid bone- (developed in way of tendons)
Biggest sesamoid bone of body

Front 15

tendon of quadriceps femoris

Back 15

If below patella is patellar ligament if above is quadriceps femoris

Front 16

Quadricep (anterior thigh muscle)

Back 16

Chief extensor and flexion of knee
Has 4 parts all from iliac spine and femur (Rectus femoris (also flexes hip joint),Vastus intermedius, vastus medialis, and vastus lateralis)
Innervation: L2-L4 (femoral nerve)

Front 17

Dorsal hip muscles:
1. Tensor fascia lata
2. Gluteus maximus
3. Gluteus medius &minimus

Back 17

1. Innervation: superior gluteal nerve (L4-L5).
Function: Abduction, medial rotation and flexion of the thigh, protects the knee joint.
2. Innervation: Inferior gluteal N. (L5- S2)
Function: powerful extensor of hip joint, lateral rotator, active in rising, sitting, climbing
3. Innervation: superior gluteal N. (L5-S1)
Function: Abduction, medial rotation of thigh, It keeps pelvis level when opposite leg is raised.

Front 18

Deep dorsal muscles aka Ventral hip muscles (gluteal region):
1. Piriformis
2. obturator internus, superior and inferior gemellus
3. quadratus femoris

Back 18

1. Innervation: Sacral plexus S1-S2
Function: lateral rotator and abductor of the thigh, keeps femur head in acetabulum. **muscle may partially or totally be absent.

2. Function: lateral rotators, are stronger than medial rotators and control the balance
Innerv, Sup. Gemellus: N. to Obturator int.
Innerv, inf. Gemellus: N. to quadratus femoris.
3. lateral rotator of thigh when
extended and abductor of thigh when flexed.
Innvervation: quadratus femoris

Front 19

1. Blood supply of gluteus maximus

2. Blood supply of gluteus medius/ minimus

Back 19

1. Inferior Gluteal artery

2. Superior gluteal artery

Front 20

Positive Trendelenberg sign

Back 20

standing on one leg, the pelvis drops on the side opposite to the stance leg
Weakness/ Paralysis of gluteus medius/ minimus

Front 21

Waddling gait

Back 21

having to lift the leg due to injury to the superior gluteal nerve

Front 22

Person fell down on side (tensor fascia lata) damaging superior gluteal nerve (L5-S1), what function is affected?

Back 22

Problem with walking, can’t abduct and rotate, will have waddling gait

Front 23

Person is asked to stand on one leg, but pelvis on opposite side drops (unable to stabilize hips). What muscles/ nerves are involved? Name of disorder?

Back 23

Positive trendenlenberg sign
gluteus medius/ minimus
Superior gluteal nerve (L5- S1)

Front 24

Hamstring muscles: (posterior thigh)
Long head of biceps, Semitendinous,
Semimembranous, Adductor magnus (ischial part).

Back 24

Innervation: All innervated by tibial branch (L5-S2) of sciatic nerve (L4-S3).
Hybrid muscle, adduction of leg, strong flexors of knee joint, weak extensors of hip joint, lateral and medial rotator

Front 25

Adductor hiatus

Back 25

femoral artery/ vein passes through here; then part of muscle that goes towards the back of the leg is part of the hamstring then becoming the Popliteal artery and vein

Front 26

Adductor magnus

Back 26

Hamstring portion innervated by sciatic nerve

Adductor portion by obturator nerve

Front 27

Posterior superficial muscles of lower leg: The Triceps Surae:
Soleus, Gastrocnemius, and Plantaris

Back 27

Innervation: tibial nerve (S1-S2).
Function: best plantar flexors, active in Walking

Front 28

Achilles tendon (calcaneal tendon)

Back 28

most powerful tendon and important in walking

Front 29

Anterior thigh muscle: Sartorius

Back 29

Acts on 2 joints; flexor at both hip and knee joints
Innvervation: femoral nerve (L2- L4)

Front 30

Anterior thigh muscle: Iliopsoas

Back 30

Strong flexor of hip, flexes body laterally
Innervation: lumbar plexus/ femoral nerve

Front 31

Adductors of thigh:
1. Adductor longus, brevis, gracilis,
2. magnus, pectineus

Back 31

Function all: Adductor of thigh; flexor at hip/ knee joints
Innvervation 1 &2: Obturator nerve (L2-L4)
Innvervation 2: femoral nerve (L2- L3), magnus hamstring part= tibial

Front 32

Tibialis Anterior

Back 32

Dorsiflexion and supination of foot at ankle joint
Innervation: Deep peroneal nerve (L4-L5)

Front 33

Extensor hallucis longus

Back 33

Dorsiflexion of big toe
Innervation: deep peroneal nerve (L4-L5)

Front 34

Front part of leg: Extensor digitorum longus

Back 34

Dosiflexion of foot and other digits
Innervation: Deep peroneal nerve (L4-L5)

Front 35

Peroneus Tertius

Back 35

Pronation (eversion) of foot, extending to pinky toe (5th metatarsal)
Innervation: Deep peroneal nerve (L4-L5)

Front 36

Back part of leg: Superficial layer
1. Gastrocnemius (calf muscle)
2. Plantaris
3. Soleus

Back 36

Strong plantar flexors of foot, important in walking and running
Innervation: tibial nerve (S1-S2)
1. Most superficial muscle of triceps surae, active for fast movements (white fiber)
2. small, thin muscle; may be missing in some people
3. hard and sustained motion (red fiber)

Front 37

Posterior leg: Deep
1. Popliteus
2. Flexor Digitorum Longus
3. Tibialis posterior
4. Flexor hallucis longus

Back 37

Innervation: Tibial nerve (L4- S3)
1. Flexion of knee, unlocking of knee joint (rotates femur), medial rotation of leg, protect meniscus; plantar flexion/ supination of foot
2. Most medial (flexes digits)
3. Most posterior
4. On fibular side of leg (goes to big toe)

Front 38

Peroneal (lateral) group:
1. Peroneus Longus
2. Peroneus Brevis

Back 38

Innervation: Superficial peroneal nerve (L5- S1 and S2)
1. Most superficial w/ long tendon
2. Deeper w/ shorter tendon

Front 39

Dorsum of foot:
1. Extensor hallucis brevis
2. Extensor digitorum brevis

Back 39

Tedons superficial to muscles, forming dorsal aponeurosis where muscles and tendons attach (keeps arch of foot)
Innervation: Deep peroneal nerve (L5- S1)
1. Dorsiflexion of big toe
2. Dorsiflexion of digits

Front 40

Sole of foot: Superficial layer
Abductor hallucis, flexor digitorum brevis, abductor digiti minimi

Back 40

Innvervation: Lateral plantar nerves (S2- S3)
Function: indicated by name

Front 41

All muscles of foot innervated by ______ nerve?

Back 41

plantar nerve (which comes from tibial nerve)
Lateral plantar nerves (S2- S3), medial plantar nerves (S2-S3) ((yes, same))

Front 42

If deep peroneal nerve damaged

Back 42

foot drop

Front 43

If superficial peroneal nerve damaged

Back 43

pronation/eversion of foot is compromised

Front 44

Second layer of sole of foot:
Quadratus plantae
Lumbricals

Back 44

Lateral plantar nerve (S2- S3)
Lumbricals are 4 small muscles; plantar flexion of digits = Medial plantar nerve to medial lumbrical, lateral plantar nerve to others

Front 45

Third layer of sole of foot:
1. Flexor hallucis brevis
2. Adductor hallucis
3. Flexor digiti minimi brevis

Back 45

1. Medial plantar nerve (S2- S3)
2. Lateral plantar nerve (S2- S3)
3. Lateral plantar nerve (S2- S3)

Front 46

Fourth layer of plantar region:
1. Plantar Interossei
2. Dorsal Interossei
3. Apponens digiti minimi

Back 46

Innervation: Lateral plantar nerve (S2- S3)
1. Adductor of digits
2. Abductor of digits
3. Beneath flexor digiti minimi brevis

Front 47

Pes planus

Back 47

Flat foot; may lead to trouble with balance; can keep person out of army

Front 48

Blood supply of lower limb

Back 48

Mainly by femoral artery, coming from external iliac artery, & branches of the internal iliac artery

Front 49

Saphenous

Back 49

sensory nerve on medial aspect of leg, posterior and anterior

Front 50

Great Saphenous Vein

Back 50

Runs from medial side of leg from big toe--> drains into femoral vein in femoral triangle

Front 51

Cotents of Subsartorial canal/ Hunter’s canal/ Adductor canal

Back 51

Aponeurotic tunnel in middle 3rd of thigh; contains femoral artery/ vein, nerve and it's branches including saphenous nerve, etc

Front 52

Femoral triangle

Back 52

"SAIL" for Sartorius, Adductor longus and Inguinal Ligament

floor is pectinius, iliopsoas, adductor longus, fascia lata

Front 53

Contents of femoral triangle

Back 53

femoral artery, femoral vein, and femoral nerve; inguinal ligaments

Front 54

Femoral hernia

Back 54

2x more common in women that abdominal structures into femoral triangle.
More medial than psoas abscess which is more lateral (pus filled in iliopsoas compartment; often found in Tuberculosis, Chrohn's disease, etc)

Front 55

Femoral sheath/ ring

Back 55

Thin membrane covering femoral artery, vein and lymphatics; are vascular bundled

Front 56

Foot has ___ arches

Back 56

medial/lateral longitudinal arch, transverse arch
important for stability of person, controlled by cerebellum, but if tissue is poor, person may lose balance

Front 57

If femoral nerve damaged, what will happen? What is injured?

Back 57

Quadriceps muscles, extension of knee; patient unable to extend knee

Quadriceps muscle and femoral nerve

Front 58

A use of great saphenous vein?

Back 58

(coronary bypass surgery)

If vessels on heart (coronary vessels- give blood supply to heart itself) occluded by plaques (athersclerostic plaques), must do graph of vessels using a piece (20cm+) of the great saphenous vein and graph distal to occlusion

Front 59

Iliotibial tract

Back 59

on lateral aspect of leg; 1 to 2 inch wide; 75-80% of it is through this track

Front 60

Extensor hallucis longus muscle hit, now has foot drop. Which nerve was affected?

Back 60

Deep peroneal nerve (dorsiflexion (lifting foot up) of foot; innervates anterior aspect of lower leg/ foot)

Other muscles:
tibialis anterior, extensor digitorum longus, fibularis (peronæus) tertius

Front 61

Hit by car, eversion of right foot is not possible, nerve affected?

Back 61

Superfical peroneal nerve

Muscles:
fibularis longus (also known as peroneus longus) and fibularis brevis (peroneus brevis)

Front 62

Fate of sciatic nerve

Back 62

breaking into tibial and common peroneal nerve

Sciatic Is thickest nerve of body

Front 63

The common peroneal nerve goes around the head of _____

Back 63

Fibula

Front 64

Lumbosacral trunk

Back 64

L4+L5

Front 65

Straight conjugate

Back 65

lowest conjugate at 9.5, but moveable, i.e. during delivery

Front 66

Interspinous diameter

Back 66

Important if shorter than 9.5cm, vaginal delivery may have problems

Front 67

Spinal cord terminates at lower level of

Back 67

L1

Front 68

Spinal tap

Back 68

In newborn, spinal cord is lower, at level of L3, tap at L5

In adults, tap at L3-L5 (L4)

Front 69

CSF function

Back 69

vital for transport of hormones, protects brain/ spine from injury
1. Good for buoyancy (so brain does not crush under own weight
2. Protection from injury
3. Chemical stability
4. Keeps brain right size for space

Front 70

Lumbar puncture: fluid should be clear, if not:
1. Foamy, have fever

Back 70

If glucose levels up and protein high, bacterial meningitis; white blood cells decreased

Front 71

Lumbar puncture: If blood in CSF (red)

Back 71

subarachnoid hemorrhage – rupture; gives severe headache, from intercranial pressure

Front 72

Epidural space

Back 72

— space between bone and dural mater..? important bc nerves have to pass through intervertebral foramen; fat tissue, vessels, veins, etc but in subdural space, not much space, some fluid

Front 73

Subarachnoid space

Back 73

cerebral spinal fluid found here, is clear & produced by structure in ventricals in brain (hollow structures in brain), vessels. choroid plexus, produce CSF (secretion of plasma..?); very diagnostic fluid, get through lumbar puncture/ spinal tap (L3-L4 or L4-L5)

Front 74

Contents of invertebral foramen

Back 74

rootlets of nerves, vessels, dorsal root ganglia