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125 Cards in this Set
- Front
- Back
Functions of the lower extremity
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-weight bearing
-locomotion -maintenance of equilibrium |
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Composition of Pelvis (bones)
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-2 innominate/coxal bones (ilium, ischium, pubis)
-sacrum -coccyx |
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Sex differences of pelvic girdle
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-subpubic angle: male=70deg., female=90-100deg.
-females have wider sacral width and iliac flare -females tend to have less thigh muscle development |
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Joints of the pelvic girdle
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-sacroiliac joint
-hip joint -pubic symphysis |
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SI joint stabilizer ligaments
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-sacrospinous ligament (dorsal sacrum to ischial spine)
-sacrotuberous ligament (dorsal sacrum to ischial tuberosity) |
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Boundaries of the greater sciatic foramen
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-anterior sacroiliac lig. (sup)
-sacrotub (post) -sacrospin (inf) -greater sciatic notch (ant) |
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Boundaries of lesser sciatic foramen
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-spine of ischium (sup/posterior)
-sacrotuberous (post/inf) -tuberosity of ischium (inf) -lesser sciatic notch (ant) |
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Contents of greater sciatic foramen
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-piriformis
-sciatic nerve -internal pudendal bv/n. -sup./inf. gluteal nerve/bv -posterior femoral cutaneous nerve |
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Contents of the lesser sciatic foramen
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-obturator internus
-internal pudendal vessels -pudendal nerve |
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Hip joint
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-acetabulum articulates with the head of the femur
-lunate lines inside of acetabulum but is incomplete -ligament of the head of the femur attached to inferior aspect -fibrous joint capsule w/deep synovial membrane |
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Diagnostic measurements of the lower extremity
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-angle of inclination
-quadriceps angle -angle of torsion |
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Angle of inclination/normal measurement
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-angle between median axis of femoral head and axis of femoral shaft
-normal=125deg. |
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Coxa valga
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-angle of inclination > 125 deg.
-leads to genu varum ("bowed-legs") -lengthens the lower extremity -increases load on femoral head, decreases load on femoral neck |
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Coxa varum
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-angle of inclination <125 deg.
-leads genu valga ("knocked-knees") -shortens lower extremity -reduces load on femoral head, increases load on femoral neck |
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Quadriceps angle/normal measurement
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-angle between axis that connects ASIS-patella midpoint and axis between patella midpoint-tibial tubercle
-men: 12 deg. -women: 17 deg. -estimates degree of genu valgum--part of basis of sex differences |
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Sex differences in lower extremity function
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-females: less muscular thigh development, less-developed VMO, increased flexibility in knee joint/genu valgum
-females: more muscular thigh development, VMO hypertrophy, less knee flexibility/genu varum |
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Angle of torsion/normal measurement
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-angle between axis of femoral condyles at knee and axis of femoral head
-normal=8-15 deg. |
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Abnormal angles of torsion
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-anteversion=increased angle-->pigeon-toed
-retroversion=decreased-->duck feet -abnormal angle causes the natural femur/extremity position to shift so as to maximize femoral head articulation with acetabulum |
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Capsular ligaments and purpose
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-iliofemoral
-ischiofemoral -pubofemoral -restrict extension of the hip |
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Hip disolaction (posterior)
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-most common, often MVC
-displacement/tearing of ischiofemoral ligament, ligament of femoral head -critical because possibility of disruption of sciatic nerve |
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Fascia lata
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-extension of inguinal ligament
- |
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Femoral sheath
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-continuation of iliacus/transversalis fascia inferior to inguinal ligament
-contains femoral a. v. |
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Anterior fascia
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-area of venous drainage
-saphenous opening: allows for passage of femoral a. and v. |
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Muscles of the gluteal region
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-gluteus maximus
-gluteus medius -gluteus minimus |
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Gluteus maximus function & innervation
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-extends, laterally rotates the thigh
-inferior gluteal nerve |
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Gluteus medius location
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-deep/superior to maximus
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Gluteus medius/minimus action/innervation
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-abducts/medially rotates the thigh
-superior gluteal nerve |
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Gluteus minimus location
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-deep to gluteus medius
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Clinical presentation of hip abductor weakness
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-trendelengurg gait
-pelvis tilts away from affected side while walking -gluteals (med/min) are abductors and help to keep pelvis level (tends to sink during leg swing); if they are weak, pelvis on opposite side will sink |
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Lateral rotators of the hip (5/6), general attachments, innervation
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-piriformis
-superior gemellus -obturator internus -inferior gemellus -quadratus femoris -general attachments: posterior hip--greater trochanter/ intertrochanteric crest -innervation? |
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Lateral rotator of hip (6/6), attachment, innervation
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-obturator externus (anterior quadratus femoris)
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Adductor longus attachments/action/innervation
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-pubic crest to midshaft posterior femur
-adducts, flex thigh; also internal rotation due to anterior bowing of femur making distal attachment anterior to axis of femoral head -obturator nerve |
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Compartments of the thigh
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-anterior
-posterior -medial |
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Fascia of thigh
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-lateral intermuscular septum separates anterior/posterior compartments
-medial intermuscular septum separates anterior/medial compartments |
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Muscles of anterior compartment of the thigh
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-rectus femoris*
-vastus medialis* -vastus lateralis* -vastus intermedius* *make up "quads" -sartorius |
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Action of the muscles of anterior thigh
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-flex hip
-extend knee |
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Innervation of the muscles of anterior compartment of thigh
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femoral nerve
|
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Bloody supply of the muscles of anterior compartment of thigh
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femoral artery
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Muscles of medial compartment of thigh
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-adductor longus
-adductor brevis (deep to adductor longus) -adductor magnus -gracilis |
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Action of muscles of medial compartment of thigh
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-adduct thigh
-medially rotate thigh |
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Innervation of muscles of medial compartment of thigh
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obturator nerve
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Blood supply of muscles of medial compartment of thigh
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obturator artery
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Adductor magnus attachments, action, innervation
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-hamstring part: ischial tuberosity-adductor tubercle of distal femur, extends thigh, tibial division of sciatic nerve
-adductor part: ischial tuberosity-posterior femur, adducts thigh, obturator nerve |
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Muscles of the posterior compartment of the thigh
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-"hamstrings"
-biceps femoris (long & short heads) -semimembranous -semitendinosus |
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Action of muscles of posterior compartment of thigh
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-extend hip
-flex knee |
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Innervation of muscles of posterior compartment of thigh
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tibial division of the sciatic nerve
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Blood supply of muscles of posterior compartment of thigh
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-profunda femoris artery
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Lateral "aspect" of thigh
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-iliotibial tract: thickening of the fascia lata
-attaches to gluteus maximus and tensor fasciae latae -runs alongside of thigh muscles and attaches at knee |
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Femoral nerve (spinal nerve) origin
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L2-L3-L4
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Femoral nerve course
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-saphenous branch descends through femoral triangle
-enters adductor canal -posterior/deep to inguinal ligament |
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Obturator nerve (spinal nerve) origin
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L2, L3, L4
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Obturator nerve course
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-emerges inferior to superior pubic ramus
-splits into anterior/posterior branch |
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Sciatic nerve course
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-between greater trochanter and ischial tuberosity
-splits (@biceps femoris?) into common fibular nerve and tibial nerve |
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Borders/contents of femoral triangle
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-inguinal ligament, adductor longus, sartories
-contains femoral nerve, a. and v. |
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Joints of the knee
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-tibiofemoral
-patellofemoral -superior (proximal) tibiofibular |
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Movements of the leg at the knee joint
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-flex (heel towards butt)/extension
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Function of the popliteus/attachment
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-tibia laterally rotates as the knee reaches full extension b/c of large medial condyle of femur
-popliteus attaches to lateral condyle of femur and posterior tibia; medially rotates the tibia to allow for initiation of flexion -i.e. "unlocks" the knee |
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Patellofemoral joint
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-posterior surface of patella covered w/thick hyaline cartilage
-patella slides w/in trochlear groove of the femur |
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Patella (sesamoid) bony landmarks
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-base (superior)
-rounded anterior surface -apex (inferior) -flat posterior w/two articular surfaces: lateral (larger) and medial (smaller) |
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Purpose/location of patellar ligament
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-anterior to sesamoid;lying overtop
-resists knee flexion |
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Bursae of knee/function
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-suprapatellar bursa: lubrication for patellar tendon; articularis genu prevents bursa from collapsing into joint
-several other bursa (infrapatellar;subpopliteal recess) w/in joint |
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Fibrous capsule of knee joint attachment
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-margins of femoral condyle to margins of tibial condyles
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Major ligaments of the knee
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-Anterior cruciate ligament (ACL)
-Posterior cruciate ligament (PCL) -Medial collateral ligament (MCL) -Lateral collateral ligament (LCL) -Medial meniscus -Lateral meniscus |
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ACL attachments
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-intercondylar fossa/posteromedial aspect of lateral femoral condyle (proximal)
-anterior intercondylar area (medial to anterior attachment of lateral mensicus) (distal) -lateral to PCL |
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PCL attachments
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-intercondylar fossa; posterolateral aspect of medial femoral condyle (proximal)
-posterior interondylar area (distal) -medial to ACL |
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ACL function
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resists anterior displacement of tibia
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PCL function
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prevents posterior displacement of tibia
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MCL function/attachment
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-resists genu valgus stress (knock-kneed)
-can be injured from blow to outside of knee -closely applied to joint capsule/medial meniscus |
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LCL function
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-resists genu varus stress
-injured from blow to inside of knee -lateral condyle to origin to distal attachment of biceps femoris |
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Muscles that provide knee support
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-"pes anserine"=goose's foot (b/c attachments looks like goose foot)
-sartorius -gracilis -semitendinosus |
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Menisci purpose
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-medial & lateral
-medial="C" shaped and larger; attached to MCL -lateral="O" shaped and smaller -absorb shock, decrease friction, increase contact area for joint |
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tibiofibular joints
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-proximal/distal ends articulate at notches
-crural interosseus membrane between the shafts of the bones provides stability |
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Movements of the foot at the ankle joint
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-plantar flex (toes point down); dorsiflexion
-inversion (medial edge rotate towards midline); eversion -flexion (towards sole of foot)/extension of toes -abduction (big toe away from others)/adduction of toes |
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Joints of the ankle/foot
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-talocrural
-talocalcaneal joint/subtalar joints -tarsometatarsal joints -metatarsalphalangeal joints -proximal interphalangeal joints -distal interphalangeal joints |
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Talocrural joint
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-"mortise" joint
-talus fits into section formed by lateral malleolus, distal tibia, and medial malleolus |
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Compartments of the leg
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-anterior
-lateral -posterior superficial -posterior deep |
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Deep fascia that surrounds anterior compartment of the leg?
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Anterior intermuscular septum
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Deep fascia that surrounds lateral compartment of the leg?
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Posterior intermuscular septum
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Deep fascia that surrounds posterior superficial compartment of the leg?
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transverse intermuscular septum
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Deep fascia that surrounds posterior deep compartment of the leg?
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interosseus membrane
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Muscles of the anterior compartment of the leg
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-tibialis anterior
-extensor hallucis longus -extensory digitorum longus -fibularis teritius |
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Action of muscles of anterior compartment of the leg
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-dorsiflexion
-inversion -toe extension |
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Innervation of muscles of anterior compartment of the leg
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deep fibular nerve
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Blood supply of muscles of anterior compartment of the leg
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anterior tibial artery
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Muscles of lateral compartment of the leg
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-fibularis longus (most superficial)
-fibularis brevis |
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Action of muscles of lateral compartment of the leg
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-eversion
-plantar flexion |
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Innervation of muscles of lateral compartment of the leg
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superficial fibular nerve
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Blood supply of muscles of lateral compartment of the leg
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fibular artery
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Muscles of the posterior superficial compartment of the leg
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-gastrocnemius (two heads, medial and lateral) + soleus (deep to gastro) = triceps surae
-plantaris (mostly tendon alongside medial edge of soleus) |
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Actions of the posterior superficial compartment of the leg
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-plantar flexion
-knee flexion (only gastro and plantaris) |
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Innervation of the posterior superficial compartment of the leg
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tibial nerve
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Bloody supply of the posterior superficial compartment of the leg
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posterior tibial artery
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Muscles of the posterior deep compartment of the leg
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-popliteus (exception--very superior to others)
-flexor digitorum longus -flexor hallucis longus -tibialis posterior |
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Actions of the posterior deep compartment of the leg
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-plantar flexion
-toe flexion -inversion -knee flexion (popliteus) |
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Innervation of the posterior deep compartment of the leg
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tibial nerve
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Blood supply of the posterior deep compartment of the leg
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posterior tibial artery
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Causes/symptoms/treatment of compartment syndrome
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-trauma, burns, intense use may produce edema or hemorrhage w/in compartments
-compression of nerves/vessels compromises fxn -fasciotomy may be performed |
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Symptoms of anterior compartment syndrome
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-weakness in dorsiflexion or toe extension
-parathesias (tingling) over dorsum of foot |
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Symptoms of deep posterior compartment syndrome
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-weakness in toe flexion and inversion
-parasthesias (tingling) in plantar aspect |
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Symptoms of superficial posterior compartment syndrome
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-weakness in plantar flexion
-dorsolateral foot hypoesthesia (partial/total loss of sensation) |
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Course of the common fibular nerve
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-branches from sciatic nerve
-deep to proximal fibularis longus -curves lateral to neck of fibula -splits deep to fibularis longus |
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Course of superficial fibular nerve
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-begins at bifurcation of common fibular n.
-innervates fibularis longus and brevis m. -emerges as cutaneous branch -innervates lateral compartment of leg |
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Course of deep fibular nerve
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-approaches interosseus membrane
-between tibialis anterior and extensor hallucis longus -descends with anterior tibial artery -innervates anterior compartment of leg |
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Course of tibial nerve
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-joins with popliteal a. v.
-continues with posterior tibial artery -gives off sural n. (posterior cutaneous) -splits into lateral and medial plantar n. in foot -innervates posterior superficial compartment of leg |
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Major ligaments of the ankle
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-medial collateral (deltoid) ligament
-lateral ligament complex |
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Medial collateral (deltoid) ligament attachments/function
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-medial malleoulus to talus, navicular, sustentaculum tali of calcaneous
-stabilizes joint -resists eversion -much stronger than lateral collateral ligaments |
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Tarsal tunnel syndrome
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-tibial n. and posterior tibial a. v. are w/in tarsal tunnel
-entrapment/compression of tibial n. -edema, tightness of ankle -pain, tingling, numbness in plantar -weakness of intrinsic foot muscles |
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Function/attachments of lateral ligament complex of angle
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-lateral malleolus to talus and calcaneous
-stabilize joint -resist inversion -much weaker than medial |
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Typical ankle sprain
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-90% of ankle spains are inversion
-b/c ligaments of lateral complex are weaker/less able to resist inversion than the medial are able to resist eversion |
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Plantar ligaments of the foot
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-long plantar ligament
-short plantar (calcaneocuboid) ligament (deep to long) -plantar calcaneonavicular ligament (spring) |
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What covers plantar surface of foot
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-plantar fascia/plantar apoeneurosis
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First layer of muscles on plantar surface of foot
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-flexor digitorum brevis
-abductor hallucis -abductor digiti minimi |
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Innervation of first layer of muscles on plantar surface of foot
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lateral/medial plantar nn.
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Second layer of muscles on plantar surface of foot
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-quadratus plantae
-lumbricals (from flex digitorum longus) |
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Innervation of second layer of muscles on plantar surface of foot
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lateral/medial plantar nn.
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Third layer of muscles on plantar surface of foot
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-adductor hallucis
-flexor hallucis brevis -flexor digiti minimi brevis |
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Innervation of third layer of muscles on plantar surface of foot
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lateral/medial plantar nn.
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Fourth layer of muscles on plantar surface of foot
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-plantar interossei (3)
-dorsal interossei (4) |
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Innervation of fourth layer of muscles on plantar surface of foot
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lateral plantar nerve
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Muscles of dorsal aspect of foot
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-extensor hallucis brevis
-extensor digitorum brevis |
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Innervation of muscles of dorsal aspect of foot
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deep fibular nerve
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Arterial supply of the foot (plantar)
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pic
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Nerve supply of the foot
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pic
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Arterial supply of foot (dorsal)
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pic
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Arterial supply to leg
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pic
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