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230 Cards in this Set
- Front
- Back
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superficial fascia of the thigh contains:
(4) |
nerves, vessels, fat, lypmh
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deep fascia of the lower limb is VERY:
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strong
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deep fascia of the thigh is called:
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fascia lata
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deep fascia of the leg is called:
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crural fascia
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***fascia late is THICK along the:***
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lateral thigh
- called the ITB - gluteal max. and TFL tendon contribute to it |
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TFL =
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***primary ABductor of the hip***
- also some flexion |
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superior gluteal nerves innervates ALL:
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ABductors of the hip,
which includes TFL |
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superficial veins have:
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valves
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deep veins course with:
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major arteries
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***function of perforating veins = ***
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to connect the superficial veins to the deep
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***perforating veins have valves to:***
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keep blood from coming back into superficial veins
=> one-way street |
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***varicose veins*** =
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dilated, torturous veins due to incompetent venous valves
(blood has backed up into superficial veins) |
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severe cases of varicose valves =>
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ulcerations at the ankle
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treatments for varicose veins:
(3) |
1. compression stockings
2. surgical removal (stripping) of veins 3. laser therapy |
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2 major superficial veins =
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1. great saphenous (largest vein)
2. small saphenous |
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both major superficial veins originate at:
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the feet
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great saphenous vein drains into:
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***femoral vein*** (deep)
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small saphenous vein drains into:
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***popliteal vein*** (deep)
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3 forces that push blood back up to heart:
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1. muscular contractions
2. valves 3. pulsing arteries |
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most lymph of the lower limb drains into:
(2) |
superficial and deep inguinal nodes, beneath the inguinal lig.
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superficial inguinal lymph nodes receive lymph from:
(4) |
1. skin
2. perineum 3. gluteal region 4. lower abdomen |
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superficial inguinal lymph nodes drain into:
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deep inguinal lymph nodes
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deep inguinal nodes drain into:
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external iliac nodes
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2 kinds of Anterior Thigh muscles:
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1. hip flexors
2. knee extensors |
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***chief flexor of thigh*** =
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iliopsoas
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iliopsoas:
(3) |
1. ***also performs lateral rotation***
2. passes under ingiunal lig. 3. inserts onto lesser trochanter |
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***fractures at neck of femur =>
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iliopsoas spasm => ****leg shortened and laterally rotated****
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ALL anterior thigh muscles are innervated by:
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the Femoral nerve
(except for TFL) |
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"knee extensors" =
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quads
- RF, VM, VL, VI |
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quads form the quadricep tendon =>
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patella => patellar ligament below the knee
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RF also:
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flexes the hip
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**Femoral nerve**
(3) |
1. L2-L4
2. gives off several anterior cut. branches in thigh 3. terminates as saphenous nerve |
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muscles the Femoral nerve innervates:
(4) |
1. iliopsoas
2. quads 3. pectineus 4. sartorius |
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saphenous nerve:
(2) |
1. cutaneous
2. largest sensory nerve in the body |
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Osgood-Schlotter Disease:
(5) |
1. affects mostly athletic boys age 10-15
2. stress from quads => inflammed tibial tuberosity 3. pain BELOW knee 4. local therapy like icing, or cast 5. self-correcting b/c it's self-limiting |
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***Medial Thigh muscles are:***
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adductors
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3 adductor muscles:
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AL, AB, Adductor Magnus
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other muscles grouped in Medial compartment:
(3) |
1. pectineus
2. gracilis (~muscle grafts) 3. obturator externus (lateral rotation) |
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pectineus:
(2) |
1. inn. by Obturator nerve
2. A = flexion AND adduction |
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adductor Magnus =
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biggest and most powerful adductor
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***ALL adductors are innervated by:***
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the Obturator nerve
(L2-L4) |
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adductor Magnus is split into 3 portions:
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1. minimus portion (sup.)
2. adductor portion (middle) 3. hamstring portion (inf) |
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both the minimus and adductor portions of the adductor Magnus are innervated by:
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the Obturator nerve
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the hamstring portion of adductor Magnus is innervated by:
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the Sciatic nerve
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***where is the adductor hiatus located?***
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b/w the adductor and hamstring portions of adductor Magnus
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***what travels through the adductor hiatus?***
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the femoral vessels
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which 3 muscles insert onto the pes anserinus of the Medial tibia?
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1. Gracilis
2. Sartorius 3. ST |
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Obturator canal allows passage of:
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obturator VAN
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obturator VAN supplies:
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the Medial compartment of the leg
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the Obturator nerve splits into:
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anterior and posterior divisions
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the anterior division of the Obturator nerve lies on AB and innervates:
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skin of Medial thigh, right above the knee
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the gap beneath the inguinal ligament is divided into the Muscular and Vascular lacunae by:
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the iliopectineal arch
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Muscular lacuna contains:
(3) |
1. iliopsoas
2. Lateral femoral cut. nerve 3. Femoral Nerve |
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Vascular lacuna contains:
(3) |
1. femoral vessels
2. fem. branch of the genitofemoral nerve 3. lymphatics |
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floor of the femoral triangle =
(3) |
iliopsoas, pectineus, and AL
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roof of femoral triangle =
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skin - very superficial, vulnerable to injury
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a **femoral sheath** within the triangle encloses:
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the femoral vessels and femoral canal
- NOT the Femoral Nerve |
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roof of the femoral sheath =
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the femoral ring
- through which hernias can enter |
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femoral sheath is split into 3 compartments:
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Lateral, intermediate, Medial
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Lateral compartment of the femoral sheath contains:
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femoral artery
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intermediate compartment of the femoral sheath contains:
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the femoral vein
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Medial compartment of the femoral sheath contains:
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the femoral canal, which contains deep lymph nodes
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mnemonic for contents of femoral TRIANGLE:
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NAVELL
(Lateral to Medial) E = empty space L = Lymph of empty space L = lacunar ligament |
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femoral hernias:
(3) |
1. more common in women
2. protrude through femoral ring 3. in time, can protrude through subcutaneous tissue beneath skin |
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***the lacunar ligament, Medial to the femoral canal, can:***
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strangulate the herniated bowels
=> necrosis of bowels |
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adductor canal:
(3) |
1. under sartorius
2. femoral vessles travel through it to reach adductor hiatus 3. also called Hunter's canal |
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4 structures of the adductor canal:
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1.femoral artery
2. femoral vein 3. saphenous nerve 4. nerve to VM |
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cutaneous innervation of the thigh:
(3) |
1. Lateral femoral cut.
2. Femoral Nerve's anterior cut. branches 3. Obturator nerve's anterior branch |
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the femoral artery becomes the popliteal after:
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the adductor hiatus
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***the Lateral and Medial circumflex arteries of the deep femoral supply:***
(2) |
1. proximal femur
2. head of femur |
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the perforating branches of the deep femoral artery:
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1. pierce add. Magnus
2. supply posterior compartment |
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the tri-radiate cartilage holds:
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all 3 hip bones together until they fuse around age 25
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lunate surface = upside-down U =
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articulation of femur at acetabulum
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the lunate surface does not extend:
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**inferiorly**
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congenital hip dislocation =
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head of femur sits outside of acetabulum
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Ortalani's maneuver =
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putting head back into acetabulum
- "clunk" sound |
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Barlow's maneuver =
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opposite of Ortalani's
- checks to make sure hip is not congenitally dislocated |
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the hip joint has the strongest:
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articular capsule
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the hip joint is strengthened by 3 ligaments:
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1. iliofemoral
2. pubofemoral 3. ishciofemoral |
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iliofemoral ligament:
(3) |
1. strongest lig
2. ***prevents hyperextension of hip*** 3. aka Y-lig of Bigelow |
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***the pubofemoral ligament prevents:***
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**hyperABduction**
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the ishiofemoral ligament is found:
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posteriorly
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***when standing, all 3 intrinsic ligaments of the hip joint are:***
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spiraled,
provided tightness and stability to the hip |
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acetabular labrum:
(2) |
1. ligament of hip
2. surrounds acetabulum |
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***the acetabular labrum forms the:***
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**transverse acetabular ligament** below the lunar surface
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ligament of the head:
(2) |
1. connects transverse acetabular ligament with femoral head
2. houses small "artery of the head" |
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***blood supply to hip joint/femoral head:***
(4) |
1. Medial circumflex
2. Lateral circumflex 3. retinacular arteries (femoral neck vessels) 4. artery of the head |
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**what is the major blood contributor to the hip joint/head of femur?**
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the Medial circumflex artery
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artery of the head comes off of:
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the obturator artery
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***femoral neck fractures:***
(2) |
1. associated with osteoporosis
2. => rupture of femoral neck vessels => AVN of femoral head |
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AVN =
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avascular necrosis, a medical emergency
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an intertrochanteric fracture is usually a result of:
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an elderly fall
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spiral fractures of the femur:
(2) |
1. femur breaks at the shaft
2. ~~ violent injury, like a car accident |
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structures passing through the Greater Sciatic Foramen:
(7) |
1. superior gluteal VAN's (above Piriformis)
2. Piriformis 3. Sciatic nerve 4. posterior fem. cut. nerve 5. inferior gluteal vessels 6. Pudendal Nerve 7. internal pudendal artery |
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structures passing through the Lesser Sciatic Foramen:
(3) |
1. obturator internus tendon
2. Pudendal nerve (returning) 3. internal pudendal artery (returning) => pudendal canal |
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the GSF and LSF are created by:
(2) |
sacrotuberous and sacrospinous ligaments
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***Gluteus Maximus Action:***
(2) |
1. extension
2. Lateral rotation of the hip |
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nerve supply to G. Max =
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inferior gluteal nerve
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***the G. Max is used mainly to:***
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rise from a chair
- not so much when walking |
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G. Medius and G. Minimus:
(2) |
1. ABductors of the hip
2. ***critical for stabilizing the pelvis for walking*** |
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when walking, the G Medius and Minimus will contract on which side?
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the side of the standing leg, allowing the swinging leg to come through without fear of the pelvis tilting
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**gluteal gait** =
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loss of G. Medius and G. Minimus => lurching walk as center of gravity shifts to side with damage, allowing swinging leg to come through despite pelvic tilt
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what test is used to see if damage to G. Medius and G. Minimus / superior gluteal nerve has occurred?
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the Trendelenburg test
- stand on one leg, see which side corresponds with the pelvis tilting |
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Lateral rotators of the hip:
(5) |
1. Piriformis
2. Sup. Gemellis 3. Ob Int. 4. Inf. Gemillis 5. QF |
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which muscle does the sacral plexus lies on top of?
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the Piriformis
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the Gemellis twins assist:
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the Ob. Internus
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QF is a powerful:
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Lateral rotator
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Post. Compartment Muscles of the Thigh:
(3) |
1. SM
2. ST 3. BF |
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ALL post. compartment muscles are innervated by:
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the Sciatic Nerve
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**blood supply to posterior compartment of thigh:**
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perforating branches of the deep femoral artery,
which pierce Add. Magnus |
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***Action of post. compartment muscles*** =
(2) |
1. extension of hip
2. flexion of knee |
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popliteus =
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flexor of knee
- **unlocks** knee from full extension |
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which post. compartment muscle is the most commonly injured hamstring?
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BF
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a pulled hamstring is often accompanied by:
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a hematoma
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Sciatic Nerve is actually 2 nerves:
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1. Tibial Nerve
2. Common Fibular Nerve |
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Gluteal Injections:
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to avoid the Sciatic Nerve, aim for the upper, outer quadrant
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posterior hip dislocation:
(3) |
1. head is popped backward, out of acetabulum
2. often a result of car accidents, as hip is flexed and adducted 3. may cause injury to Sciatic Nerve |
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posterior hip dislocations are considered a medical emergency because:
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they often result in AVN, due to damaged femoral neck vessels
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***classic sign of a posterior hip dislocation:***
(4) |
hip is:
1. shortened 2. adducted 3. flexed 4. MEDIALLY rotated |
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contents of the popliteal fossa:
(5) |
1. pop. vessels
2. Sciatic nerve split 3. small saphenous vein 4. Medial and Lateral sural cut. nerves 5. lymph nodes/vessels |
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sural nerve:
(2) |
1. combination of Medial and Lateral sural cutaneous nerves
2. a great option for nerve grafts |
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the sural nerve innervates:
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cut. along the Lateral leg and foot
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***order of depth of major contents of pop. fossa:***
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deepest = pop. artery
intermediate = pop. vein most superficial = Tibial nerve/Common Fibular nerve |
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Baker/Popliteal cyst:
(3) |
1. painful, benigh mass of synovial fluid
2. occurs following previous knee injury 3. will compress neurovasculature |
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cut. innervation of post. thigh:
(2) |
1. inferior cluneal nerves to lower buttocks
2. post. fem. cut. nerve |
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all cluneal nerves are:
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**dorsal rami**
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tibia's main function =
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weight-bearing
|
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the tibial tuberosity is the attachment of the patellar ligament and is found:
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anteriorly
|
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fibula:
(2) |
1. found Laterally
2. important for stabilizing ankle joint |
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fibula's main function =
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muscle attachment
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3 articulations of the knee joint:
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1. Medial condyles of femur and tibia
2. same for Lateral condyles 3. patellofemoral |
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the knee joint by itself is a _____ joint
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weak;
it needs to be strengthened by muscles and ligaments |
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what stabilizes the knee the most?
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**the quads**
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patellar retinaculum =
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expansion of quads tendon surrounding the anterior of the knee
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what 4 ligaments help stabilize the knee?
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LCL, MCL, ACL, PCL
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LCL:
(2) |
1. form head of fibula to Lateral condyle of the femur
2. a strong cord |
|
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MCL = a strong:
|
band
|
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***deeper fibers of the MCL attach to:***
|
the Medial Meniscus
=> tear of MCL = often a concurrent tear of medial Meniscus |
|
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ACL runs from:
|
the anterior intercondylar area of the tibia to the post. femur
|
|
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***the ACL gets much tighter as knee extends => => prevents:***
|
**hyperextension of the knee**
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ACL rupture:
(3) |
1. 10x more common than PCL rupture
2. part of unhappy triad 3. ***anterior drawer sign: pull tibia forward*** to check ACL integrity |
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unhappy triad =
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ACL, MCL, Medial Meniscus
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PCL tightens during:
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knee flexion
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PCL prevents:
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***femur from sliding forward***
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PCL rupture:
(2) |
1. ~~ car accidents
2. **post. drawer sign: push tibia backward** |
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menisci of the knee:
(3) |
1. crescent-shaped shock absorbers
2. deepen joint cavity 3. commonly torn during twisting knee injuries |
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***menisci have limited blood supply; significance = ***
|
**menisci heal poorly**
- probably need to remove injured piece surgically |
|
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Medial Meniscus:
(3) |
1. C-shaped
2. larger than Lateral Meniscus 3. attached to MCL |
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Lateral Meniscus:
(2) |
1. oval-shaped
2. more mobile than Medial Meniscus |
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popliteus muscle tendon is b/w the:
(2) |
lateral Meniscus and LCL
|
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3 branches of the popliteal artery:
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1. ant. tibial
2. post tibial 3. fibular art. (often coming off of post. tibial) |
|
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what leg compartment does the Tibial nerve innervate?
|
the posterior compartment
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the Common Fibular Nerve splits into:
(2) |
1. superficial fibular nerve (~ Lateral comp)
2. deep fibular nerve (~ ant. compartment) |
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the posterior compartment of the leg is split into:
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the superficial and deep posterior compartments
|
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superficial posterior compartment of the leg:
(2) |
1. **plantarflexors**
2. all innervated by the Tibial Nerve |
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3 muscles of the superficial post. compartment of the leg:
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1. Gastrocs
2. Soleus 3. Plantaris |
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Gastrocs => *rapid* plantarflexion =>
|
jumping muscle
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Soleus => slower plantarflexion =>
|
strolling
|
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Plantaris:
(2) |
1. looooong, thing tendon
2. a proprioceptive muscle |
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triceps surae =
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2 heads of Gastroc + Soleus
|
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Achilles tendon =
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common tendon of triceps surae
|
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3 muscles of the deep posterior compartment of the leg:
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1. Tibialis Post.
2. FDL 3. FHL |
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Tibialis Post Actions:
(3) |
1. plantarflexion
2. inversion 3. flexion of toes |
|
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FHL = powerful:
|
pushoff muscle
|
|
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all 3 of the deep posterior muscle tendons pass through:
|
the tarsal tunnel, found Medially
|
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all deep posterior compartment muscles are innervated by:
|
the Tibial Nerve
|
|
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tarsal tunnel contents, from ant. to posterior:
(5) |
1. TP
2. FDL 3. post. tibial Artery 4. tibial Nerve 5. FHL |
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|
before splitting, the popliteal artery gives off:
|
several genicular arteries to the knee
|
|
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the anterior tibial art. supplies:
|
the anterior compartment of the leg
|
|
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the posterior tibial artery supplies:
|
the post. compartment of the leg
|
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once the posterior tibial artery goes through the tarsal tunnel, it splits into:
(2) |
the Lateral and Medial plantar arteries
|
|
|
the fibular artery supplies:
|
the lateral compartment of the leg
|
|
|
Common Fibular Nerve:
(2) |
1. courses around head of fibula - susceptible to injury here
2. divides into deep and superficial fibular nerves |
|
|
both the superficial and the deep fibular nerves supply:
|
cut. innervation to dorsum of foot
|
|
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Lateral compartment of the leg:
(2) |
1. **everters**
2. inn'd by superficial fibular nerve |
|
|
2 muscles of the Lateral compartment of the leg:
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1. fibularis longus
2. fibularis brevis |
|
|
the fibularis longus tendon passes through:
|
groove of the cuboid
|
|
|
anterior compartment of the leg:
(2) |
1. ***ALL dorsiflexors***
2. inn'd by deep fibular nerve |
|
|
3 muscles of the anterior compartment of the leg:
|
1. Tibialis Anterior
2. EDL 3. EHL |
|
|
which muscle is the prime dorsiflexor of the foot?
|
TA
|
|
|
drop foot = result of:
|
loss of deep fibular nerve/ damage to leg's anterior compartment muscles
=> exaggerated steppage gait to compensate for LOSS OF Dorsiflexion ~~ audible slap |
|
|
the anterior tibial artery becomes:
|
the dorsalis pedis
|
|
|
Compartment Syndrome =
|
paralysis, diminished pulse in leg
|
|
|
Compartment Syndrome is the result of:
|
swelling from trauma or overuse compressing on neruovasculature
|
|
|
cut. innervation of the foot:
|
mostly by superficial fibular nerve,
while deep fibular supplies cut. to flip-flop triangle (b/w 1st and 2nd toe) |
|
|
***trochlea of the talus is wider _________;***
|
anteriorly
=>=> ankle is much less stable when **plantarflexed** |
|
|
most important lateral ankle ligament =
|
anterior talofibular Lig.
- stabilizes inversion of ankle |
|
|
which ankle ligament is torn the most?
|
the anterior talofibular ligament
- often occurs when ankle is plantarflexed and inverted |
|
|
Medial ankle ligaments = deltoid ligaments;
(3) |
- much stronger than lateral ankle ligaments
- all arise form Medial malleolus - stabilize eversion |
|
|
the cuboid bone is found:
|
laterally
|
|
|
talus:
(3) |
1. NO muscular attachments
2. trochlea = superior articulaitng surface 3. posterior tubercle provides groove for FHL |
|
|
the neck of the talus =
|
entry site for arteries that supply the talus
|
|
|
fractured talus:
(2) |
1. ~~ **forced** dorsiflexion
2. if fractured at neck, => AVN |
|
|
calcaneus:
(2) |
1. articulates with talus at the subtalor joint
2. has sustentaculum tali |
|
|
sustentaculum tali:
(2) |
1. found Medially
2. tendon of FHL passes beneath it |
|
|
calcaneal fracture:
(2) |
1. ~~ jumping from great height
2. often results in severe arthritis |
|
|
with calcaneal fractures, you MUST rule out:
|
associated spinal fractures, especially at Lumbar vertebrae
|
|
|
the base of the 5th metatarsal has a large tuberosity for:
|
fibularis brevis
|
|
|
the 1st metatarsal has two:
|
sesamoid bones on the bottom
|
|
|
most common metatarsal fracture =
|
fracture of 5th metatarsal
- **especially is fibularis brevis overcompensates for inversion by everting too hard** |
|
|
plantar aponeurosis =
|
thickened plantar fascia at center
|
|
|
functions of plantar aponeurosis:
(3) |
1. protection
2. compartmentalization 3. muscular attachment |
|
|
intrinsic muscles of the 1st layer:
(3) |
1. ABH
2. FDB 3. ABDM |
|
|
extrinsic muscles of the 2nd layer:
(2) |
1. FDL tendon
2. FHL tendon |
|
|
intrinsic muscles of the 2nd layer:
(2) |
1. QP
2. Lumbricals (4) |
|
|
***QP corrects the Medial pull of:***
|
FDL
- pulls laterally so that toes are flexed straight back |
|
|
****neurovasculature of the foot enters at:****
|
the 2nd layer
|
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intrinsic muscles of the 3rd layer:
(3) |
1. FDMB
2. Add. H 3. FHB |
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which muscles runs in between the two sesamoid bones of the 1st metatarsal?
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FHB
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intrinsic muscles of the 4th layer:
(7) |
3 plantar IO's
4 dorsal IO's |
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Action of 3 plantar IO's =
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adduction of toes 3-5
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Action of 4 dorsal IO's =
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ABduction of toes 2-4
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***the Medial plantar nerve innervates:****
(4) |
1. FDB
2. ABH 3. FHB 4. 1st Lumbrical (near big toe) |
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***ALL intrinsics of the foot are innervated by nerve roots:***
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S2 and S3
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the Tibial nerve gives off:
(2) |
1. Medial plantar nerve
2. Lateral plantar nerve |
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the Medial plantar nerve has 2 functions:
(2) |
1. supply 4 plantar intrinsics
2. provide cut. inn. to Medial 3 and a half toes |
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the Lateral plantar nerve's **superficial branch** provides:
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cut. inn. to lateral 1.5 digits
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the Medial plantar art. supplies:
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muscles of toe/medial side of foot
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the lateral plantar art. ultimately becomes the:
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deep plantar arch
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deep plantar arch (from lateral plantar art.):
(2) |
1. anastomoses with deep plantar art. of dorsalis pedis
2. gives off plantar metatarsals |
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|
uncontrolled diabetes => 3 opothies:
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1. retinopathy
2. nephronopathy 3. neuropathy |
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neuropathy =
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loss/diminished function of **sensory** neurons
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some of the first sensory neurons to go =
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cut. branches to foot
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loss of cutaneous branches to foot => ulcers =>
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severe infections => amputation
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subtalor joint:
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1. aka talocalcaneal joint
2. stabilized by the IO talocalcaneal lig. 3. **works in unison with the transverse tarsal joint** |
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transverse tarsal joint =
(2) |
talonavicular joint + calcaneocuboid joint
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what ligament provides stability to the transverse tarsal joint?
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the bifurcate ligament
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ALL 3 - subtalor and transverse tarsal joint - work together to allow:
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inversion/eversion during gait
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arches of the feet provide:
(2) |
1. shock absorption
2. weight bearing |
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things that strengthen arches:
(3) |
1. shape of interlocking bones
2. pedal ligaments 3. TA, TP, FL, FHL |
