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Lower Limb test8

Lower Limb

QuestionAnswer
1.Study the markings of each lower limb bone.
Pelvic Girdle (Hip) The hip is formed by a pair of hip bones (os coxae, or coxal) Together with the sacrum and the coccyx, these bones form the bony pelvis
pelvic girdle(hip) ilium, ischium, pubis
Ilium is a large flaring bone that forms the superior region of the coxal bone Articulates with the sacrum (sacroiliac joint)
Ilium Major markings include the iliac crest, four spines: anterior/posterior (superior, inferior) iliac spine, greater sciatic notch, iliac fossa, and the pelvic brim
Ischium The ischium forms the posteroinferior part of the hip bone The thick body articulates with the ilium, and the thinner ramus articulates with the pubis
Ischium Major markings include the ischial spine, lesser sciatic notch, and the ischial tuberosity
Pubis The pubic bone forms the anterior portion of the hip bone It articulates with the ischium and the ilium
Pubis Major markings include superior and inferior rami, pubic tubercle, pubic arch, pubic symphysis, and obturator foramen (along with ilium and ischium)
acetabulum is the socket formed where the three part of the hip bone converge
The Lower Limb The three segments of the lower limb are the thigh, leg, and foot They carry the weight of the erect body, and are subjected to exceptional forces when one jumps or runs
The Lower Limb Femur, Leg= Tibia, fibula
Femur The sole bone of the thigh is the femur, the largest and strongest bone in the body It articulates proximally with the hip and distally with the tibia and fibula
femur Major markings include the head, fovea capitis, greater and lesser trochanters, gluteal tuberosity, lateral and medial condyles and epicondyles, linea aspera, and the intercondylar fossa
Leg The tibia and fibula form the skeleton of the leg
Leg They are connected to each other by the interosseous membrane They articulate with the femur proximally and with the ankle bones distally
Tibia Receives the weight of the body from the femur and transmits it to the foot
Tibia Major markings include medial and lateral condyles, intercondylar eminence, the tibial tuberosity, and medial malleolus
Fibula Sticklike bone with slightly expanded ends located laterally to the tibia Major markings include the head and lateral malleolus
Foot The skeleton of the foot includes the tarsus, metatarsus, and the phalanges (toes) The foot supports body weight and acts as a lever to propel the body forward in walking and running
Tarsus Composed of seven bones that form the posterior half of the foot Body weight is carried primarily on the talus and calcaneus
Tarsus Talus articulates with the tibia and fibula superiorly, and the calcaneus inferiorly Other tarsus bones include the cuboid and navicular, and the medial, intermediate, and lateral cuneiforms
Metatarsals Five (1-5) long bones that articulate with the proximal phalanges
Phalanges The 14 bones of the toes Each digit has three phalanges except the hallux, which has no middle phalanx
2. Name the 7 tarsal bones talus, calcaneus, medial cuneiform, middle(intermediate) cuneiform, lateral cuneiform, navicular, cuboid
3. Which bone is a weight-bearing bone in the leg? Tibia
4. Study the structures and functions of the knee joint medial collateral ligament,lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, and meniscus
Knee joint: The largest and most complex joint of the body, consisting of 3 joints within a single synovial cavity: an intermediate patellofemoral joint, a lateral tibiofemoral joint, and a medial tibiofemoral joint.
Articular capsule Tibial(medial) and fibular(lateral) collateral ligament: prevent side-to-side movement.
Anterior Cruciate ligament limits the hyperextension of the knee and prevents the anterior sliding of the tibia on the femur.
Posterior cruciate ligament prevents the posterior sliding of the tibia on the femur.
medial (tibial) collateral ligament prevent side to side sliding
Tibial collateral ligament. Broad, flat ligament on the medial surface of the joint that extends from the medial condyle of the femur to the medial condyle of the tibia
Tibial collateral ligament. Tendons of the sartorius, gracilis, and semitendinosus muscles, all of which strengthen the medial aspect of the joint, cross the ligament.
The tibial collateral ligament is firmly attached to the medial meniscus.
lateral(fibular)collateral ligament prevent side to side sliding
Fibular collateral ligament. This strong, rounded ligament on the lateral surface of the joint extends from the lateral condyle of the femur to the lateral side of the head of the fibula
Fibular collateral ligament. It strengthens the lateral aspect of the joint. is covered by the tendon of the biceps femoris muscle, and the tendon of the popliteal muscle is deep to it.
Anterior cruciate ligament (ACL).(close to patella) grips on the anterior part of tibia and posterior side of femur prevent sliding anterior sliding prevents hyperextension
Anterior cruciate ligament (ACL). extends posteriorly and laterally from a point anterior to the intercondylar area of the tibia to the posterior part of the medial surface of the lateral condyle of the femur
Anterior cruciate ligament (ACL). limits hyperextension of the knee (which normally does not occur at this joint) and prevents the anterior sliding of the tibia on the femur
Anterior cruciate ligament (ACL). This ligament is stretched or torn in about 70 percent of all serious knee injuries
Posterior cruciate ligament (PCL) (by the intercondylar fossa behind posterior) grips the posterior side tibia and anterior part of femur to prevent posterior sliding of the tibia
Posterior cruciate ligament (PCL) extends anteriorly and medially from a depression on the posterior intercondylar area of the tibia and lateral meniscus to the anterior part of the lateral surface of the medial condyle of the femur
Posterior cruciate ligament (PCL) prevents the posterior sliding of the tibia (and anterior sliding of the femur) when the knee is flexed, a very important function when you walk down stairs or a steep incline.
Articular discs (menisci). Two fibrocartilage discs between the tibial and femoral condyles help compensate for the irregular shapes of the bones and circulate synovial fluid.
Medial meniscus. The anterior end of this semicircular, C-shaped piece of fibrocartilage is attached to the anterior intercondylar fossa of the tibia, in front of the ACL.
Medial meniscus. Its posterior end is attached to the posterior intercondylar fossa of the tibia between the attachments of the posterior cruciate ligament and lateral meniscus
Lateral meniscus. This nearly circular piece of fibrocartilage approaches an incomplete O in shape
Lateral meniscus. Its anterior end is attached anteriorly to the intercondylar eminence of the tibia, and laterally and posteriorly to the ACL.
Lateral meniscus. Its posterior end is attached posteriorly to the intercondylar eminence of the tibia, and anteriorly to the posterior end of the medial meniscus.
Lateral meniscus. The anterior surfaces of the medial and lateral menisci are connected to each other by the transverse ligament of the knee and to the margins of the head of the tibia by the coronary ligaments
5. What is the “unhappy triad”? The most common type of knee injury in football usually involves three structures, which sometimes refer as the “unhappy triad”.
5. What is the “unhappy triad”? 1. rupture of tibial(medial) collateral ligament, associated with tearing of anterior cruciate ligament (ACL), and 3. medial meniscus.
6. Study the origin, insertion, and action of each muscle listed in the tables.
What muscles insert on the lesser trochanter of the femur? Psoas major, iliacus
What muscles insert on the greater trochanter of the femur? gluteus medius, piriformis
Name 6 muscles attach to (origin or insertion) the linea aspera of the femur? gluteus maximus, adductor longus, adductor magnus, vastus lateralis, vastus medialis, biceps femoris
Move the femur Ilipsoas: psoas major, iliacus; gluteus maximus gluteus medius tensor fasciae latae piriformis
Psoas major O: lumbar vertebrae I: lesser trochanter of femur A:Flex thigh, laterally rotate thigh N:femoral nerve (lumbar spinal nerves L2-L3)
Iliacus O:Iliac fossa I: Lesser trochanter of femur A: Flex thigh, laterally rotate thigh N: femoral nerve
Gluteus maximus O: Iliac crest, sacrum, coccyx I: Iliotibial tract & linea aspera (gluteal tuberosity A:Extends thigh, laterally rotates thigh primary fxn extension of hip N:Inferior gluteal
Gluteus medius O: Ilium I: Greater trochanter of femur A:Abducts thigh, medially rotates thigh Only one medial rotation N: Superior gluteal
Tensor fasciae latae O: Iliac crest I: Tibia by way of iliotibial tract A: N:Superior gluteal
Piriformis O: Anterior sacrum I: Greater trochanter of femur A: Abducts thigh, laterally rotates thigh N: sacral spinal nerves , S1-S2, mainly S1
Medial (adductor) compartment of the thigh adductor longus (anterior to gracilis) gracilis (long, middle ruler muscle) adductor magnus (posterior to gracilis, magnus= large big huge muscle)
Gracilis O: Inferior ramus of pubic I:Medial of tibia A: Adducts and flexes thigh N: Obturator Nerve
Adductor longus O: Pubic symphysis I: Linea aspera A: Adducts and flexes thigh N:Obturator Nerve
Adductor magnus O: Inferior ramus of pubic & ischium I: Linea aspera A:Adducts and flexes thigh N: Obturator Nerve, Sciatic nerve
ANTERIOR (EXTENSOR) COMPARTMENT OF THE THIGH Quadriceps femoris & sartorius
Quadriceps femoris Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius
Rectus femoris O: Ant. Inf. iliac spine I: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament A:All four heads extends leg at knee Joint; (rectus femoris Alone also flexes Thigh) N: Femoral Nerve
Vastus lateralis O: Greater trochanter & linea aspera (posterior of femur) I: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament A: All four heads extends leg at knee Joint; (rectus femoris Alone also flexes Thigh) N:Fe
Vastus medialis O: linea aspera I: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament A: All four heads extends leg at knee Joint; (rectus femoris Alone also flexes Thigh) N: Femoral Nerve
Vastus intermedius O: Ant. femur (shaft) I: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament A: All four heads extends leg at knee Joint; (rectus femoris Alone also flexes Thigh) N: Femoral Nerve
sartorius (oblique anterior side of thigh) O: Ant. sup. iliac spine (cross ur hip) I:Medial surface of tibia A: Flexes leg at knee. Flexes, abducts, laterally rotates thigh N:Femoral Nerve
POSTERIOR (FLEXOR) COMPARTMENT OF THE THIGH hamstrings: biceps femoris (lateral), semitendinosus (medial superficial), semimembranosus (medial deep)
biceps femoris (lateral) O: Long head: ischial tuberosity; short head: linea aspera I: Head of fibula A: All three: flexes leg And extends thigh N: Sciatic nerve
semitendinosus (medial superficial) O:Ischial tuberosity I:Medial surface & condyle of tibia A:All three: flexes leg And extends thigh; both insert tibia extension of the hip & flexion of knee N:Sciatic nerve
semimembranosus (medial deep) O:Ischial tuberosity I:Medial surface & condyle of tibia A:All three: flexes leg And extends thigh; both insert tibia extension of the hip & flexion of knee N:Sciatic nerve
Move foot & toes
ANTERIOR COMPARTMENT OF THE LEG tibialis anterior, extensor hallucis longus, extensor digitorum longus
tibialis anterior O: Lateral condyle & body of tibia I: 1st (medial)cuneiform & 1st metatarsal A:Dorsiflexes foot inverts foot (no toes) N:Deep fibular (peroneal) nerve
Extensor hallucis longus O: I: A: Dorsiflexes foot & Extends great toe (big toe) N:Deep fibular (peroneal) nerve
Extensor digitorum Longus O: I: A: Dorsiflexes foot & Extends toes ( 4 toes) N: Deep fibular (peroneal) nerve
LATERAL (FIBULAR) COMPARTMENT OF THE LEG peroneus (fibularis) longus, peroneus ( fibularis) brevis
peroneus (fibularis) longus O: Head & body of fibula, lateral condyle of tibia I: 1st metatarsal & 1st cuneiform A: Both muscles plantar flex foot & evert foot primary fxn evertion N:Superficial fibular nerve
peroneus ( fibularis) brevis O: I: A: Both muscles plantar flex foot & evert foot N: Superficial fibular nerve
SUPERFICIAL POSTERIOR COMPARTMENT OF THE LEG gastrocnemius, soleus
gastrocnemius O: Lateral and medial condyles of femur I: Calcaneus by way of calcaneal (Achilles) tendon (both muscles) A: Plantar flexes foot ( weight bearing muscle) N: Tibial nerve
soleus O: head of fibula & medial border of tibia (leg bone) I: Calcaneus by way of calcaneal (Achilles) tendon (both muscles) A: Plantar flexes foot N:Tibial nerve
DEEP POSTERIOR COMPARTMENT OF THE LEG tibialis posterior ( middle, small, narrow), flexor digitorum longus (medial all 4 toes, cross over), flexor hallucis longus ( lateral, big toe, but large)
Tibialis posterior O: I: A: Plantar flexes foot & inverts foot N: Tibial nerve
Flexor digitorum longus O: I: A: Plantar flexes foot & flexes toes N: Tibial nerve
Flexor hallucis longus O: I: A:Plantar flexes foot & flexes great toe N:Tibial nerve
7. Study the lumbar plexus and sacral plexus:
Lumbar plexus: femoral nerve, obturator nerve
Lumbar plexus - Anterior rami of spinal nerves L1-L4. - Supplies the anterolateral abdominal wall, external genitals, and part of the lower extremity. The major nerves are the femoral and the obturator
Femoral nerve - Deep to inguinal ligament, lateral to femoral artery. - Supplies flexors of thigh, extensors of leg; skin on front and medial thigh, medial leg and foot. - Injury: inability to extend the leg and loss of sensation in the skin over anteromedial thigh
Obturator nerve - Through obturator foramen. - Supplies adductor muscles of leg, skin over medial thigh.
Sacral Plexus sciatic nerve: the tibial and the common fibular (peroneal) nerves
Sacral Plexus Arises from L4-S4 and serves the buttock, lower limb, pelvic structures, and the perineum The major nerve is the sciatic, the longest and thickest nerve of the body
Sacral Plexus The sciatic is actually composed of two nerves: the tibial and the common fibular (peroneal) nerves - Supplies the buttock, perineum, and lower extremities.
Superior gluteal nerve gluteus minimus and medius; tensor fasciae latae
Inferior gluteal nerve gluteus maximus
Sciatic nerve hamstring muscles & adductor magnus
Tibial nerve flexor muscles in the posterior compartment of leg
Common peroneal (fibular) nerve lateral (superficial peroneal) and anterior compartments (deep peroneal) of leg
Common peroneal (fibular) nerve injury: footdrop
Sciatica a type of neuritis characterized by severe pain along the path of the sciatic nerve and its branches. Inflammation and infection; most common cause: herniated disc
8. What spinal nerves make up each plexus? Lumbar Plexus (L1-L4) Sacral Plexus (L4-S4)
9. What are the main nerves coming out from the lumbar plexus? Femoral Nerve Obturator Nerve
9. from sacral plexus? Superior gluteal Inferior gluteal Sciatic nerve Tibial nerve Common fibular nerve Superficial fibular nerve Deep fibular nerve
10. What area or muscles are innervated by femoral nerve? Flexors of hip (iliacus, psoas major) Extensor of knee (quadriceps femoris= rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) + sartorius
10. by obturator nerve? Adductors of hip (adductor longus, adductor magnus, gracilis
10. by superior gluteal nerve? Gluteus medius, tensor fasciae latae
10. by inferior gluteal nerve? Gluteus maximus
11. What are the two nerves make up the sciatic nerve? the tibial and the common fibular (peroneal) nerves
12. What area or muscles are innervated by the sciatic nerve? - Supplies the buttock, perineum, and lower extremities; Hamstrings (biceps femoris, semitendinosus, semimembranosus) Adductor magnus
12. by the tibial nerve? Posterior leg muscles (5): gastrocnemius, soleus, tibialis posterior, flexor digitorum longus, flexor hallucis longus
12. deep fibular nerve? Anterior leg muscles (3) = tibialis anterior, Extensor hallucis longus , Extensor digitorum Longus
12. by superficial fibular nerve? Lateral leg muscles (2): fibularis longus, fiburalis brevis
13. What nerve injury would cause a condition called footdrop? Common fibular nerve
14. What muscle is innervated by both obturator and sciatic nerve? adductor magnus
15. What muscles are commonly used as an intramuscular injection site? Intramuscular (IM) injection sites: Gluteus medius, vastus lateralis, and deltoid
16. What muscles and structure form the femoral triangle? Femoral triangle: Boundaries: Superior-medial: inguinal ligament Lateral: sartorius Inferior-medial: adductor longus Floor: iliopsoas
16. What are the contents of the triangle? Contents (medial – lateral): VAN (femoral vein, artery, nerve), deep inguinal lymph nodes, and entrance of great saphenous vein
17.What muscles form the boundary of the popliteal fossa? Popliteal fossa: (diamond-shaped space) Boundaries: superior (medial: semitendinosus, semimembranosus; lateral: biceps femoris) Inferior: gastrocnemius (medial & lateral head)
17. What are the contents of the fossa? Contents: popliteal artery and vein; bifurcation of sciatic nerve into tibial and common fibular nerve; entrance of small saphenous vein
18. Study the great saphenous vein. -The longest vein in the body -Medial side of lower limb; empties into femoral vein at femoral triangle. -Subject to becoming varicose with formation of clots. -Is used in coronary bypass surgery. -Are often used for prolonged IV.
great saphenous vein medial ankle= medial malleolus pass anterior to the medial malleolus of the tibia and then superiorly along the medial aspect of the leg and thigh just deep to the skin
Small (short) saphenous vein: - Lateral side, empties into popliteal veins in the popliteal fossa.
Superficial veins: Great saphenous vein & Small (short) saphenous vein
Created by: nely.nieto