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Lower Limb Circ Nerv
Circulation and nerves of the lower limb Lecture notes
| Mixed | Answer/Def |
|---|---|
| What is the pathway of blood from heart to the lower limb? | left vent - ascending aorta - aortic arch - descending aorta(thoracic and abdominal)- abdominal aorta- left and right common iliac - external and internal iliac(sacroilial joint) - external iliac artery supplies the maj internal also contribute |
| What are the branches of the internal iliac artery? | Superior gluteal artery Inferior gluteal artery Internal pudendal artery Obturator artery |
| How does superior gluteal artery gets into LL? | Passes from the pelvic cavity to the gluteal region via the greater sciatic foramen above piriformis muscle |
| How does inferior gluteal artery gets into the gluteal region? | Enters teh gluteal region via the greater sciatic foramen, below piriformis muscle |
| How does obturator artery gets into LL? | Lies on lateral wall of pelvis and passes through obturator canal |
| What does external iliac artery become and where? | It passes under the inguinal lig and becomes femoral artery |
| What are the 4 branches of femoral artery? | 1- Superficial epipgastric artery 2- Superficial circumflex iliac artery 3- External pudendal arteries 4- Profunda femoris artery(deep artery of thigh) |
| What does femoral artery pass to get into the popliteal fossa? | Adductor canal |
| What are the branches of profunda femoris? And what does it do? | Medial and lateral circumflex femoral arteries 3-4 perforators There are rich anastomoses around the hip w the gluteal vessels(w branches of internal iliac) and around the knee Supplies the post compartment of the thigh |
| What anastomosis do we have for our hip joint? | 1-Trochanteric anastomosis 2-Cruciate anastomosis |
| What do we have(arteries) in trochanteric anastomosis? | 1-2 Medial and lateral circumflex femoral arteries 3-4 superior iand nferior gluteal arteries |
| What do we have(arteries) in cruciate anastomosis? | 1- First perforator 2- Inferior gluteal artery 3,4 Lateral and medial circumflex femoral arteries |
| What are the two types of fractures do we have for hip joint? | 1-Subcapital fracture 2- Intertrochanteric fracture |
| Which hip joint fracture is more problematic in terms of b.supply? | B. supply of femoral head may be affected by fracture of teh femoral neck(note the retinacular vessels passing on the neck to the head) |
| What is the borders of the popliteal artery? | Between hiatus tendineus and lower border of popliteus muscle |
| Where is it in the popliteal fossa? both depth and hortizontal? | Deepest structure in the popliteal fossa and medial aspect |
| What are the branches of the popliteal artery? | Gives rise to 5 genicular branches |
| How does popliteal artery exit popliteal fossa? | By passing through tendinous arch of soleus |
| What does popliteal artery branch into as termination? | Posterior and anterior tibial arteries |
| What is the function of the popliteal artery? | Supplies the knee joint |
| What might compromise popliteal artery? | Dislocation of the knee and fractures of the lower femur |
| What is critical for popliteal artery? | Second most common site of aneurysm |
| What are the arteries that supply knee joint? | 1- 5 genicular branches of popliteal artery? 2- Popliteal artery??(branches of the femoral artery?) 3- Branch of the profunda femoris(descending branch of lat circ femoral artery) 4-A branch from the ant. tib artery join and form genicular anastomosis |
| Collateral circ, if there is a blocakge between the femoral artery and external iliac artery how can blood reach the popliteal artery? | Long way check the slide Or via the anastomoses between obturator artery and branches of profunda femoris |
| What nerve does accompany the anterior tibial artery as it descends? | deep fibular(peroneal) nerve |
| What does the anterior tibial artery supply? | Anterior compartment muscles |
| What does the anterior tibial artery become into? | Dorsalis pedis |
| What are the branches of dorsalis pedis? | 1- Arcuate branch 2- 1st dorsal metatarsal branch i- Dorsal digital arteries |
| Where do we feel the pulse of dorsalis pedis? | Felt in the first intermetatarsal space |
| What nerve accompanies the posterior tibial artery? | Tibial nerve as the artery descends deep to the soleus muscle |
| What are the branches of posterior tibial artery? | It gives off the fibular, circumflex fibular and nutrient arteries |
| What does the posterior tibial artery supply? | Posterior ocmpartment muscles of the leg(plantar flexors) |
| What does the posterior tibial artery become into and where? | Becomes the medial and lateral plantar arteries after running posterior to the medial malleolus |
| where can we feel the pulse of posterior tibial artery? | behind the medial malleolus |
| What arteries do we have in the plantar compartment of the foot? | Lateral and medial plantar arteries |
| What are the branches of the medial and lateral plantar arteries? | superficial and deep plantar arches, respectively |
| What arch gives rise to plantar digital arteries of the phalanges? | Deep plantar arch |
| What are the superficial veins of the lower limb? | Great (long) saphenous vein and small (short) saphenous vein |
| Where do our superficial veins originate from? | Originate from the dorsal venous network of the foot and dorsal veins of foot |
| What does the great saphenous vein join to? | femoral vein |
| How does the great saph vein join femoral vein? | pierces fasica lata |
| What does the small saph vein form? | With the deep veins it forms the popliteal vein |
| How does the small saph vein form the popliteal vein? | penetrates the deep fascia of the leg in the popliteal fossa |
| How do the deep veins of the LL ascend? | they ascend internal to the deep fascia of the LL |
| What is the name for the deep veins? | Vena comitantes, mostly paired w arteries of the same name ie anterior and posterior tibial veins |
| What is the borders/travel of femoral vein? | It ascends in the adductor canal from the popliteal vein it enters the femoral sheath and ends as the external iliac vein |
| What are the sources of the femoral vein? | receive s drainage from profunda femoris, great saphenous and other small branches |
| From what vein type to what type do we have the venous flow? | Superficial to deep veins |
| What helps the venous blood flow against gravity? | arterial pulsation and contraction of muscels |
| What prevents backflow in veins? | valves |
| How does the lymph drainage of the lower limbs work? | 1- Supfic lymph vessels accompany the supfic veins 2- LV w great saphenous vein drain to the superficial ingui lymph N -deep ingu N - ext iliac N 3- LV w small saphenous vein enter the poplit lymph N 4-DEEP LV DV poplit nodes w fem vein to deep ingui N |
| Where do we have the superficail inguinal nodes? | T alonginguinal lig and saphenous vein |
| From where do the superficial inuinal nodes receive? | Anterior abdominal wall (under umbilicus)\ Skin of the back below iliac crest Gluteal region Perineum Superfiical lower limb |
| What is femoral canal and ring and what does it contain? | Femoral canal is a short and conical space between the medial wall of the femoral sheath and the femoral vein Contains deep inguinal lymph nodes |
| Where do we have the deep inguinal nodes in terms of position? | In the femoral triangle, medial to femoral vein |
| From where do the deep inguinal nodes receive lymph? | LL(deep lymph vessels w fem vessels including from popliteal nodes) Superficial inguinal nodes(some can proceed directly to external iliac nodes) External genitalia |
| What is the drain journey after deep and superficial inguinal nodes? | External iliac nodes - common iliac nodes - lumbar lymph nodes - cisterna chyli - thoracic duct - pirogov's venous angle(left) - venous system |
| What roots do we have for the lumbar plexus-sacral plexus (lumbosacral) | Ventral rami of L1-S4 |
| What do the lumbosacral plexuses supply? | Lower limbs, parts of the abdominal wall, pelvis and perineum |
| What are the largest nerves from these plexuses enthering the thigh and their roots? | Femoral nerve(L2-4) and Sciatic nerve (L4-S3) |
| Summary of nerves of the LL and where do they supply | Superior and inferior gluteal nerves, obturator nerve(medial compartment of thigh), Femoral nerve(anterior of thigh), sciatic nerve(posterior compartment of thigh, leg and sole of foot) common fibular nerve, superficial branc(lat leg) deep branch(ant leg) |
| In which muscle is lumbar plexus(L1-4) is formed? | within the psoas major muscle |
| Behind which ligament does the femoral nerve descend? | Inguinal ligament |
| Where does the femoral nerve travel in the thigh? | Femoral triangle |
| What are the branches of the femoral nerve? | Gives off muscular, anterior cutaneous femoral and saphenous branches |
| What are the areas innervated by sensory branches of the femoral nerve? | 1-Hip joint 2- Knee joint 3- skin on the anterior surface of teh thigh(by ant cut fem branch) 40 Skin of teh medial leg and foot(by saphenous nerve) |
| What are the muscles innervated by femoral nerve? | 1-Iliacus 2-Muscles in the anterior compartment of the thigh -Quadriceps femoris -Sartorius -Pectineus |
| Is your saphenous nerve terminal muscular or cutaneous nerve? | Terminal Cutaneous |
| What vessel does our saphenous nerve accompany? | Great saphenous vein |
| In what situations can saphenous nerve be damaged/ be at risk? | In venous access(cut-down) or varicose vein surgery |
| Where does the saphenous nerve innervate? | Supplies the skin on the medial surface of the knee, anteromedial surface of leg and medial malleolus |
| How does the obturator nerve enters thigh? | Passess through the obturator canal |
| What are the sensory innervation of obturator nerve? | 1-hip joint 2-upper half of medial thigh 3- knee joint |
| What are the motor innervation of obturator nerve? | 1-Obturator externus 2-Muscles in the medial compartment of the thigh -Adductor magnus -Adductor longus -Adductor brevis -Gracilis |
| What are teh nerve roots for obturator nerve? | L2-4 |
| What are the nerve roots for sacral plexus? | L4-S4 |
| What is the ame of the L4 and L5 trunk in sacral plexus? | Lumbosacral trunk |
| Where is the sacral plexus located? | Located on the surface of the posterior pelvic wall, deep to the piriformis muscle |
| Where does the superior gluteal nerve go through? | Exits pelvis through suprapiriform space Runs laterally between the gluteus medius and minimus |
| What muscles does the sup glut nerve supply? | gluteus medius, gluteus minimus, and tensor fasciae latae |
| What are the nerve roots for superior gluteal nerve? | L4-S1 |
| Through where does inferior gluteal nerve go? | exits pelvis thorugh infrapiriform space |
| What muscles does the inferior gluteal nerve innervate? | gluteus maximus |
| What are the nerve roots for inferior gluteal nerve? | L5-S2 |
| Through where does the sciatic nerve go into gluteal region? | Enters the gluteal region thorugh infrapiriform space Descends deep to gluteus maximus, midway between the ischial tuberosity and the greater trochanter behind the hip joint |
| Where do we perform intragluteal injections and why? | superolateral quadrant of the buttock, away from the majority of neurovascular structures, namely sciatic nerve |
| What area is the sensory innervation of the sciatic nerve? | Hip joint |
| What are the muscles innervated by sciatic nerve? | -Muscles in the posterior compartment of the thigh: hamstring muscles - aDDUCTOR MAGNUS(IN ADDITION TO THE OBTURATOR NERVE) |
| What are the final branches of the sciatic nerve? | Tibial nerve and common fibular(peroneal) nerve |
| What are the 3 compartments of the leg and what nerve innervates the muscles in them? | 1-Lateral compartment(superficial fibular nerve, evertors of foot) 2-Anterior compartment(deep fibular nerve, dorsiflexors of foot and toes) 3- Posterior compartmetn(tibial nerve, plantar flexors of foot and toes) |
| What are the nerve roots of tibial nerve? | L4-S3 |
| What are the branches of the tibial nerve? | Medial sural cutaneous branch |
| What are the final branches of tibial nerve and where does it branch off? | Passes into the sole behind medial malleolus deep to the flexor retinaculum Divides into the medial and lateral plantar nerves |
| What are the sesonry innervation of tibial nerve? | Ankle joint and skin of the heel |
| What are the motor innervation of the tibial nerve? | -Hamstring muscles except short head of biceps femoris??? -Plantaris -Popliteus -muscles in the superficial posterior comp of leg --Gastrocnemius --Soleus -Deep post comp --Tibialis post --Flexor hallucis longus --Flexor digitorum longus |
| What muscles does the medial plantar nerve innervate? | 1-Abductor hallucis 2-Flexor hallucis brevis 3-Flexor digitorum brevis 4-Lumbrical 1 |
| What area of skin is innervated by medial plantar nerve? | Anterior two third of the sole and adjacent surfaces of teh medial 3.5 toes |
| What muscles does the lateral plantar nerve supply? | -All the plantar muscles? |
| What area of the skin is supplied by LPN | lateral side of the anterior two thirds of the sole and the adjacent planttar surfaces of the 1.5 digits |
| From which nerve do we get plantar digital nerves? | Lateral Plantar nerve |
| What are the nerve roots for common fibular nerve? | L4-S2 |
| What are the branches of common fibular nerve? | Lateral cutaneous sural branch, superficial and depp fibular nerves |
| What muscles does the common fibular nerve supply? | Short head of biceps femoris |
| How do we form sural nerve? | Formed by lateral cutaneous sural branch from common fib nerve and medial cutaneous sural branch from tibial nerve |
| How can we use sural nerve? | As graft |
| What area of the skin is innervated by sural nerve? | Supplies the skın on the lower posterolateral surface of the leg and the lateral sıde of the foot(and little toe) |
| What are the nerve roots for deep fibular nerve? | L4-5 |
| What is the motor innervation of the deep fibular nerve? | Muscles in the anterior comp of leg -Tibialis anterior -Extensor hallucis longus -Extensor digitorum longus -Fibulari tertius Extensor digioturm brevis Extensor hallucis brevis |
| Superficial Fibular Nerve roots? | L5-S2 |
| What is the sensory innervaton of superficial fibular nerve? | ankle joint Skin on anterior distal leg SKin on dorsum of fot |
| What muscles are supplied by superficial fibular nerve? | Lateral comp of leg -Fibularis longus -Fibularis brevis |
Created by:
Mustafak