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Lower extremity MW

QuestionAnswer
Innervation of hip Femoral, obturator, Superior glutelal, quadratous femoris, Inferior gemellus Fu%^&@# I slipped Oh Nerveto quadratus Fem
Innervation of knee Sciatic, femoral, Obturator
Innervation of ankle Tibial, Deep Peroneal
Innervation of MTP and IP Tibial
Hip flexion muscles and nerves iliacus/Psoas, pectinius, rectus femoris, sartorius, all with Femoral n, adductors magnus, brevis and longus- obturator nerve, TFL with superior gluteal nerve (FOS)
Hip extension muscles and nerves Biceps femoris, semi membranousus, semitendinosus (sciatic n), adductor magnus (obturator), gluteus max (inf. Gluteal n).
Hip adduction Adductors magnus, intermedius, brevis, gracilis (obturator), pectinius (femoral n)
Hip abduction and internal rotation Gluteus min, med and TFL all with superior gluteal nerve
Hip ext rotation Piriformis (nerve to piriformis), obturator internus, superior gemelli (nerve to obturator internus), inferior gemelli, quadratus femoris (nerve to quad fem), sartorius (femoral)
Knee extension Vastus group (M,L, I, quadratus fem) all femoral nerve
Knee flexion Sartorius (femoral n), semimembrinosis, semitendinosis, biceps femoris (long and short head) (sciatic), poplitius, gastrocnemius (tibial n),
What nerves flex the knee Femoral, sciatic and tibial
What position demonstrates all 4 movements of the sartorius Turning your foot to look at the sole or sitting cross legged
Which tendons join to form conjoint tendon at pes anserine bursa Sartorius (fem nerve), semitendinosis (sciatic), gracilis (obturator n)
Ankle dorsiflex Tibialis anterior, Extensor digitorum, EHL (all deep peroneal nerve)
Ankle plantar flexion Gastroc, FHL, FDL, soleus, post tibialis (tibial nerve) peronal longus and brevis (superficial peroneal nerve)
How many muscle to plantar flex foot 5- peroneus longus and brevis (superfical peroneal nerve), gastroc, soleus, post tibial (innervated by tibial nerve)
What muscles invert the Ankle Tibialis anterior (deep peroneal n)
What muscle everts foot Peroneus longus and brevis (superficial peroneal n)
Path of LFCN In pelvis descends the medial psoas major crosses the ASIS inferior pubic ramus boots through the moves on into the medial thigh compartment above the sartorius and next to the TFL
Roots of obturator L2-L4
Roots of sciatic nerve L4-S3 (common peroneal and tibial
Sciatic nerve muscles Add mag, biceps femoris (hip ext and knee flex) semis,
Hip flexors RIPPS Psoas, iliacus, pectinius, rectus fem, sartarius RIPPS
Femoral nerve L2-4 sartorius, vastus, rectus F, RIPPS
Hip flexors No need for grace but takes a lot- iliacus and PPRS (pectinius, psoas, rectus fem sartorius) Femoral n. L2-4
Hip innervation- Obturator, femoral and what 3 others? Gemellis, superior gluteal and nerve to quadratus femoris
Saphenous nerve Branch of femoral- sensory to medial lower leg
LFCN L2,3
Gen fem n L1,2
Ilioinguinal n L1
Iliohypogastric T12-L1
Trendelenberg gait Gluteus min and medius weakness L4,5 S1 nerve root- superior gluteal nerve
Tibial nerve block location pneumonic Tom Dick ANd Harry tibialis posterior tendon, flex dig long, artery nerve flex hallus longus
Superficial peroneal nerve located between Peroneus Brevis and EDL
ACTIONS OF GEMELLI MUSCLES ABDUCT AND EXT ROTATE HIP, STABILIZE HIP JOINT
Piriformis tests Freiberg 1, 2, pace, beatty FAIR
Explain different piriformi tests Lie on tummy, bend knees and let ankles drop to lateral sides- Freiberg, lie on back and internally rotate hip- Freiberg 2, then lie on good side, flex knee and lift leg- Beatty, then do FAIR, then sit and resist abduction- Pace
L5 reflex Hold semimembranous, semitendinosis and hit. Jerking medial thigh
Target for medial branch block Upper edge of transverse process, ventrocranially to the mamilloaccessory ligament. Transverse and articular processes landmarks
Third lumbar level equates to which medial branch? L2
% of back pain caused by Facets 36%
What are the 5 muscles to examine for L5 Tibialis ant, peroneus longus (eversion) mixed L5/S1, tib post (inversion) mixed L5 S1, Hamstrings weak, Gluteus medius (abduction of knees) L5.
What is the FURCAL nerve? L4- inbetween lumbar plexus and sacral plexus
L5 exam Check wasting of EDB, medial hamstring reflex, ext hallusis longus (big toe), weak tib ant and post (inversion), TFL and glut med/minimus abduction of leg, sensory of dorsum of foot and first web space
H reflex tests best S1 soleus, difference >1.5 msec compared with other side. Wait >3 weeks for better sensitivity
which cervical vertebrae has no ant tubercle? C7
Look for sympathetic nerve inbetween which 2 neck muscles? Longus capitus and longus coli
Paravertebral block feels what pop? Transverse process ligament
Superficial peroneal nerve is found between which 2 muscles? Peroneus brevis and EDL (crural fascia)
LFCN is found where? Above sartorius and iliacus- cat’s eye
Which muscle inserts on the anterior tuberosity of trochanter? Gluteus minimus
Nerve root of tibialis ant L4 and L5!
What percent of back pain is better within 3 months? 90
2 muscles for S1 G max, gastrocs, tib post and peroneus long (inver and eversion of foot)
What causes foot drop? L4/L5, peroneal neuropathy (tib anterior), ALS, ask to invert foot, if can, then it is peroneal neuropathy as post tib (S1) is spared.
S1 radiculopathy Pain down back of leg and sole, loss of achilles reflex, gastroc weakness (plantar flex foot),hip ext (g max, knee flex (biceps femoris), sural nerve intact as gets mixed innervation from common peroneal n.
Foot muscles dorsum from medial to lat for deep peroneal nerve localization Tib ant, EHL, artery, EDL
Valgus varus Draw picture
C5/6 herniation affects which nerve root? C6
L4/5 herniation affects which nerve root?
If lateral then L4 if central then possibly L5
Pes anserine tendons Semitendinosis- from IT, gracilis from the pubis, Sartorius from ASIS
TOM Fuc@$ DICK Long, AN Harry Tibialis posterior, flexor dig longus, artery nerve, Flexor Hallus longus
Local anaesthetics cross membranes in ionized or unionized state? non-ionized. When enter nerve, become ionized with lower pH and can’t cross back.
Tests for piriformis Frieberg 1 (prone, knees bent up and let go to sides- see if assymetry, Freiberg 2 (supine internally rotate hips-), pace (sit- resist abduction), beatty (lie on side and raise leg up on own), FAIR (lie on side, flex knee 90, internally rotate)
Obturator nerve muscles Adductors longus, brevis, magnus and gracilis =adduct, ant fibers of magnus, longus and brevis flex, post fibers of magnus extend hip.
Hip internal rotation muscles Gluteus min and medius, TFL, Add brevis, longus and superior portion of Add magnus
Hip external rotators Piriformis, obturator internus and externus, sartorius, (POS), gemms, and quadratus fem (GQ)
How many hip muscles? 17!
Hip injection danger Ascending branch lateral femoral circumflex artery
What is popped through first- fascia lata or iliaca? Lata. Fem nerve lies under iliaca, artery and vein above
Morton neuroma most commonly found where? 3rd web space. 3ccc phenol plus steroid. Plantar digital nerve
Where is the best starting spot to locate the LFCN? Distal to the asis (3 finger breadths) in the fat space between the TFL and sartorius- then trace cephalad.
Is deep peroneal nerve medial or lateral to artery? Lateral
Created by: Mwansbrough