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Lower extremity MW
| Question | Answer |
|---|---|
| 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
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