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142 Cards in this Set
- Front
- Back
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What are the fascia of the thigh called? Where does it begin and where is it the thickest? |
Fascia lata Begins around the iliac crest and inguinal ligament Thickest on the lateral side where it forms iliotibial tract |
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How many compartments do we distinguish in the thigh? |
Three: 1. Anterior 2. Posterior 3. Middle (adductor) |
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How many compartments do we distinguish in the leg? |
Four: 1. Anterior 2. Lateral 3. Deep posterior 4. Superficial posterior |
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Arteries of the anterior thigh: |
1. External iliac 2. Femoral artery (from the inguinal ligament) 3. Profunda femoris (in the femoral triangle) |
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Arteries of the posterior thigh: |
1. Internal iliac 2. Obturator artery (through the obturator canal) Bifurcates into: 3. Superior gluteal artery 4. Inferior gluteal artery |
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First branch of the popliteal artery: |
Anterior tibial |
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Second branch of the popliteal artery: |
Posterior tibial |
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Arteries of the lower leg: |
1. Popliteal 2. Anterior tibial 3. Posterior tibial 4. Fibular |
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Dorsalis pedis: course and origin |
Originates from anterior tibial artery Passes over the dorsal aspect of the tarsal bones and immediately lateral to the extensor hallucis tendon |
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Which plantar arch does dorsalis pedis supply? |
Arcuate artery Deep plantar arch |
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Posterior tibial course: |
Bifurcates into lateral and medial plantar artery They then come together to form deep plantar arch |
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What blood vessels supply the head of the femur? Which artery do they come off of? |
Lateral and medial circumflex femoral arteries From profunda femoris |
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Venous drainage of the lower limb: deep veins |
Follow the arteries |
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Venous drainage of the lower limb: superficial veins |
1. Great saphenous vein 2. Small saphenous vein |
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Course of the great saphenous vein: |
- on the medial side of the leg - formed by the dorsal venous arch (on the surface of the foot) - courses anteriorly to the medial malleolus, then posterior to the medial condyle of the knee - drains into the femoral vein |
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What is the clinical significance of the great saphenous vein? |
May be harvested for coronary artery bypass grafts. |
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Course of the small saphenous vein: |
- Forms from the dorsal venous arch - Passes posteriorly to the lateral malleolus, then along the lateral border of the Achilles tendon - moves to the middle, passes between the two heads of the gastrocnemious - drains into the popliteal vein |
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Describe varicose veins: |
Dilated Torturous Elongated Superficial veins |
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What is the mechanism that leads to varicose vein formation? |
Valvular insufficiency leads to retrograde flow of blood from deep to superficial veins |
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Complications of varicose veins: |
Cosmetic Ulceration Tired, heavy, painful legs Leg swelling |
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Lymphatic drainage of the lower limb: |
popliteal nodes - Inguinal lymph nodes - external iliac nodes |
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Name the tarsal bones of the foot: |
Calcaneous Talus Navicular Cuboid Cuneiforms (3) |
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Muscles of the anterior compartment of the thigh: |
Iliopsoas Quadratus femoris Sartorius Pectineus |
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Which nerve innervates the anterior compartment of the thigh? |
Femoral nerve (L2-L4) |
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Which artery provides supply to the anterior compartment of the thigh? |
femoral |
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What is the function of the iliopsoas? |
Hip flexion |
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Where does the iliopsoas originate from? Where does it attach? |
From the lumbar vertebrae To the lesser trochanter of the femur |
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Origin, attachment, action of the sartorius |
From the ASIS to medial malleolus of tibia Flexion, abduction, lateral rotation at the hip Flexion of knee |
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Muscles of the quadriceps femoris: |
Vastus medialis, intermedius, lateralis, rectus femoris |
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Insertion and action of the quadriceps femoris |
Insert onto the tibia via the patellar tendon - patella - patellar ligament Main extensor of the knee |
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Muscles of the medial compartment of the thigh: |
Hip adductors (from medial to lateral): 1. Adductor magnus 2. Adductor longus 3. Adductor brevis 4. Obturator externus |
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Which nerve innervates the medial compartment of the thigh? |
Obturator nerve |
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Which artery provides supply to the medial compartment? |
Obturator artery |
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What is the principal action of the muscles in the medial compartment? |
Hip adduction |
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Name muscles in the posterior compartment of the thigh: |
1. Biceps femoris 2. Semitendinosus 3. Semimembranosus |
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Which nerve innervates the posterior compartment of the thigh? |
Sciatic nerve |
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What is the function of the posterior compartment of the thigh? |
Knee flexion Hip extension |
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Main artery to the posterior compartment of the thigh: |
Branches from profunda femoris |
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Muscles of the gluteal region: superficial |
Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia lata |
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Blood supply to gluteus maximus: |
inferior gluteal artery |
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Blood supply to gluteus minimus and medius and tensor fascia lata: |
Superior gluteal artery |
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Where is the origin of the gluteal muscles? |
Ilium |
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Where does the tensor fascia lata insert? |
On the iliotibial tract |
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What is the principal action of gluteus maximus? |
Extension of the hip |
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What is the principal action of gluteus medius and minimus? |
Abduction at the thigh |
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What is the principal action of tensor fascia lata: |
Stabilises the knee in extension Stabilises the hip |
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Name the muscles of the deep gluteal compartment: |
Piriformis Gemellis superior Obturator internus Gemellis inferior Quadratus femoris |
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Name the nerve supplying the deep gluteal muscles: |
Nerve to obturator internus (ob int, gem sup) Nerve to quadratus femoris (gem inf, quad fem) |
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Name the main action of the muscles in the deep gluteal compartment. |
Lateral rotation of the femur Abduction |
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Name the main muscles of the anterior compartment of the leg: |
tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius |
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name the nerve supplying the anterior compartment of the leg: |
deep perineal nerve |
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name the main artery supplying the anterior compartment of the leg: |
anterior tibial |
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name the main action of the anterior compartment of the leg? |
dorsiflexion extension of the digits |
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name the muscles of the deep posterior compartment of the leg |
posterior tibialis flexor hallucis longus flexor digitorum longus popliteus |
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name the muscles of the superficial posterior compartment of the leg: |
gastrocnemious plantaris soleus |
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name the nerve supplying the deep posterior compartment of the leg: |
tibial nerve |
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name the nerve supplying the superficial posterior compartment of the leg: |
tibial nerve |
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name the artery supplying the deep posterior compartment of the leg: |
posterior tibial |
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name the artery supplying the superficial posterior compartment of the leg: |
sural artery |
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what is the main action of the muscles of the deep posterior compartment of the leg? |
Plantarflexion Flexion of digits |
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what is the main action of the muscles of the superficial posterior compartment of the leg? |
plantarflexion |
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What are the main muscles responsible for foot inversion? |
Tibialis anterior and posterior |
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What are the main muscles responsible for foot eversion? |
Peroneus longus and brevis |
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What are the muscles in the lateral compartment of the leg? |
peroneus longus peroneus brevis |
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what nerve supplies the lateral compartment of the leg? |
superficial peroneal |
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what artery supplies the lateral compartment of the leg? |
fibular |
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structures that insert behind the medial malleolus: |
Tendons of the deep posterior compartment plus tibial nerve and posterior tibial artery. |
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Function of ACL: |
limits anterior displacement of the tibia |
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What sign is associated with torn ACL? |
Anterior drawer sign |
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What is the function of PCL? |
Limits posterior displacement of the tibia |
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What sign is associated with torn PCL? |
Posterior drawer sign |
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What is the function of medial collateral ligament? |
Resist valgus forces on the knee |
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What is the function of lateral collateral ligament? |
Resist varus forces on the knee |
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What is an 'unhappy triad' |
Torn MCL, ACL and medial meniscus |
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What is the role of the menisci of the knee? What are the complications of torn meniscus? |
Deepen the articular surface of the tibia Shock absorption The inner (white zone) menisci are avascular, so heal very poorly. They receive nutrients from synovial fluid by diffusion. |
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Which muscle assists in locking and unlocking the knee? Describe the knee locking process. |
When the lower limb is maximally extended, the femur rotates medially on the tibia and the knee 'locks' in an extended position. The tensor fascia lata and gluteus maximus tense the iliotibial tract to provide stability and quad muscles can relax. When popliteus contract, it rotates the femur laterally on the tibia leading to unlocking of the knee. |
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Risk factors for osteoarthritis: |
Non-modifiable: Age Female gender Modifiable: Obesity and overweight Previous injuries (i.e. ACL rupture of unhappy triad) Sports activities Muscle weakness |
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Name the four bursae of the knee |
1. Suprapatellar bursa 2. Prepatellar bursa 3. Infrapatellar bursa 4. Semimembranosus bursa |
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What graft can be used to repair the ACL? |
Patellar tendon |
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What type of joint is the ankle joint? |
Hinge |
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What are the articulating surfaces of the ankle joint? |
1. The mortise (formed by tibia and fibula) 2. The talus bone |
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Name the tarsal bones of the foot: |
Calcaneus Talus Navicular Cuneiform (3) Cuboid |
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What movements does the ankle joint allow? |
Plantarflexion Dorsiflexion |
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What movements do the talar joints allow? |
Eversion and inversion |
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What injury commonly leads to foot drop? |
"Bumper injury" of the common fibular nerve |
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What is Trendelenburg gait? |
Pelvis drop due to injury to superior gluteal nerve which supplies gluteus medius and minimus. |
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Intrinsic muscles of the foot: plantar group, first layer |
Flexor digitorum brevis Abductor hallucis Abductor digiti minimi |
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Intrinsic muscles of the foot: plantar group, second layer |
Quadratus plantae Lumbricals |
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Intrinsic muscles of the foot: plantar group, third layer |
Flexor digiti minimi brevis Flexor hallucis brevis Adductor hallucis |
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Intrinsic muscles of the foot: plantar group, fourth layer |
Interossei PAD DAB |
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Intrinsic muscles of the foot: dorsal group |
Extensor digitorum brevis |
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Which nerve innervates the dorsal intrinsic muscles of the foot? |
Deep fibular nerve |
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Which two nerves innervate the plantar intrinsic muscles of the foot? Which nerve do they branch off of? |
Tibial nerve - medial and lateral plantar nerves |
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Describe the pathogenesis of hallux valgus |
Bunion Tendons of flexor hallucis longus and extensor hallucis longus insert onto the distal part of the toe The tension of these tendons causes the medial displacement of the MTP joint |
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Joints of the pelvis: |
Sacroiliac - synovial plane Pubic symphysis - cartilaginous joint The hip joint - ball and socket |
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Ligaments of the pelvis: |
Anterior and posterior sacroiliac Sacrospinous (sacrum to ischial spine) Sacrotuberous (sacrum to ischial tuberosity) |
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The hip joints: articulating surfaces |
The head of the femur Acetabulum of the pelvis |
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What is the ligament of the head of the femur? |
Aka foveal ligament Important in childhood - strengthens the hip joint |
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Factors contributing to the stability of the hip joint |
Acetabular labrum Foveal ligament (intracapsular) Iliofemoral, ischiofemoral and pubofemoral ligament (extracapsular) Joint capsule |
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What is the danger of intracapsular fracture of the femur? |
Risk of avascular necrosis of the head of the femur |
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Which blood vessels supply the head of the femur? |
The medial and lateral circumflex arteries from profunda femoris |
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The ankle joint ligaments |
Medial (deltoid) ligament Lateral ligamet (posterior and anterior talofibular, calcaneofibular) |
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Which ligament resists overinversion of the ankle? |
Lateral |
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Which ligament resists over-eversion of the ankle? |
Deltoid |
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What foot position does ankle sprain usually occur in? |
Plantarflexion - that's when the narrow part of the talus is articulating with the mortise and the joint is the most unstable |
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What is the ankle ring? |
Ring in coronal plane - mortise, lateral and medial ligaments, subtalar joint. When it breaks, it usually does so in two locations |
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Retinacula of the ankle joint: |
Flexor retinaculum - medial side - forms the tarsal tunnel which contains tendon of tibialis posterior, flexor hallucis longus and posterior tibial artery and vein. Extensor retinaculum - lateral side |
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What is the plantar aponeurosis? |
Thick connective tissue on the plantar side of the foot which supports the arches of the foot |
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Name the three arches of the foot: |
Anterior transverse Lateral longitudinal Medial longitudinal Occur between weight-bearing points of the foot |
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What is the function of the arches of the foot? |
Shock absorption Springboards for propelling weight forward Adapt to changes of surface contour for added stability |
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Pes anserinus: |
Say grace before tea Sartorius Gracilis Semiteninosus |
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Where does pes anserinus insert? |
On the medial side of the tibia |
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Muscles that flex the thigh |
Iliopsoas Rectus femoris Sartorius |
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Muscles that extend the thigh |
Gluteus maximus Hamstrings |
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Muscles that abduct the thigh |
Gluteus medius and minimus |
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Muscles that adduct the thigh |
Adductor (medial) compartment: adductor magnus, longus, brevis, obturator externus, pectineus |
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Muscles that laterally rotate the thigh |
Gluteus maximus Deep gluteal muscles Sartorius |
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Muscles that medially rotate the thigh |
Gluteus medius and minimus |
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What type of bone is patella? |
Sesamoid bone |
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What roots are tested by the knee jerk reflex? |
L3-4 |
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Which roots are tested by the ankle jerk reflex? |
S1-2 |
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Femoral nerve: roots, sensory and motor function |
L2-L4 Sensory: anteromedial thigh Motor: hip flexion, knee extension |
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Obturator nerve: roots, sensory and motor function |
L2-L4 Sensory - upper part of medial thigh Motor: adduction |
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Sciatic nerve: roots, sensory and motor function |
L4-S3 Sensory - all of tibial, common fibular Motor - Hip extension, knee flexion, foot |
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Tibial nerve: roots, sensory and motor function |
L4-S3 Sensory: posterolateral side of the leg, lateral and plantar side of the foot Motor: Plantarflexion |
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Superficial fibular: roots, sensory and motor function |
L4-S1 Sensory: majority of skin over dorsum of the foot Motor: Eversion |
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Deep fibular: roots, sensory and motor function |
L4-L5 Sensory: webbing between 1st and 2nd toe Motor: Dorsiflexion |
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Normal gait cycle: |
1. Heel strike 2. Foot flat 3. Midstance 4. Heel off 5. Toe off 6. Initial swing 7. Mid swing 8. Terminal swing |
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Parkinsonian gait: |
shuffling |
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Ataxic gait |
Broad |
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common presentation of the fracture of neck of the femur: |
Shortened, externally rotated Painful |
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common presentation of the fracture of the head of the femur: |
posterior |
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what is the pathogenesis of spinal disc herniation? |
Nucleus pulposus ruptures and breaks through annulus fibrosus |
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Causes of disc herniation: |
1. Age-related degeneration 2. Childbirth 3. Weight-lifting 4. Trauma |
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What is the most common site for disc herniation? |
Between L4-L5 and L5-S1 |
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Complications of slipped disc: |
Nerve root compression resulting in: 1. Sciatica 2. Weakness 3. Sensory loss |
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What is cauda equina syndrome? |
Near compression of cauda eqina (below L1-L2), usually due to massive disc herniation. It is a surgical emergency. |
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Symptoms of cauda equina: |
Severe pain Saddle anaesthesia Bowel and urinary incontinence Weakness of muscles |
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Main spine flexors |
Rectus abdominis Psoas major |
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Main spine extensors |
Erector spinae |
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How is lateral bending of the spinal column achieved? |
When extensors and flexors only contract on one side. |
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Examples of lateral flexors: |
Latissimus Dorsi Longissimus thoracis Multifidus |
