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WEEK 26:
Anterior and medial aspects of the lower limb:
| Question | Answer |
|---|---|
| great saphenous vein location | superficial on anterior/ medial aspect of leg |
| iliotibial tract | where fascia lata is thickened laterally |
| where is the fascia lata thickened laterally | iliotibial tract |
| saphenous opening | gap/ hiatus in fascia lata where the great saphenous vein passes through |
| fascia lata | tough layer of fascia surrounding the thigh muscles |
| where does the great saphenous vein pass | through the saphenous opening in the fascia lata |
| femoral sheath contains (3) | femoral artery, vein, and lymph nodes |
| femoral canal location | most medial compartment of femoral sheath |
| where is the adductor/ Hunter's canal (Subsartorial) | in middle third of thigh extending from the apex of the femoral triangle to the opening the add |
| what type of tunnel is the adductor/ Hunter's canal (Subsartorial) | aponeurotic tunnel |
| adductor/ Hunter's canal (Subsartorial) is bounded where | bounded in front and laterally by the vastus medialis, behind by the adductor longus and magnus |
| adductor/ Hunter's canal (Subsartorial) is bounded in front and laterally by | vastus medialis |
| adductor/ Hunter's canal (Subsartorial) behind by (2) | adductors longus and adductors magnus |
| adductor/ Hunter's canal (Subsartorial) contains (4) | femoral artery, femoral vein, saphenous nerve, and nerve to vastus medialis |
| hamstring portion is innervated by | tibial nerve |
| where is the adductor canal | from apex of femoral triangle to adductor hiatus |
| anterior thigh muscles (4) | pectineus, sartorius, iliopsoas, and quadriceps |
| when is the vastus intermedius seen | when you go deep to rectus femoris |
| tensor of fascia lata and iliotibial tract is | lateral of thigh |
| medial thigh muscles (5) | adductor longus, adductor brevis, adductor magnus, gracilis, and obturator externus |
| adductor brevis location | is deep to pectineus/ adductor longus |
| adductor hiatus | opening at distal attachment of adductor magnus where femoral vessels pass through popliteal fossa |
| anterior leg muscles are | dorsiflexors of ankle |
| anterior leg muscles innervated by | deep fibular nerve |
| muscles in the anterior leg (4) | tibialis anterior (Tom), extensor digitorum longus (Dick), fibularis (most lateral of anterior leg muscles), and extensor hallucis longus (Harry) |
| which muscle is the most lateral of the anterior leg muscles | fibularis tertius |
| pneumonic for muscles in anterior leg | Tom, Dick And Very Nervous Harry |
| what is included in the tarsal tunnel (5) | tibialis posterior tendon, flexor digitorum tendon, posterior tibial artery (and veins), tibial nerve, and flexor hallucis longus tendon |
| roof of the tarsal tunnel | flexor retinaculum |
| floor of the tarsal tunnel | medial malleolus and calcaneus bone |
| femoral nerve block clinical importance | femoral nerve (L2-4) can be blocked 2cm inferior to inguinal ligament 1 finger breath lateral to femoral artery |
| gracilis clinical importance | used in transplantation because it has reliable blood supply and be transplanted eg reconstructive surgery |
| paralysis of quadriceps | cant extend knee and is caused by femoral nerve injury |
| patellar tendon reflex (knee jerk) results | normally leg kicks out but if absent suggests femoral nerve damage |
| chondromalacia patellae (runner's knee) | softening/ damage of cartilage under patella caused by overuse and muscle imbalance leading to anterior knee pain which worse when climbing stairs or sitting for a long time |
| injury to common fibular nerve | usually occurs due to a fracture of fibular neck leading to foot drop, loss of sensation on lateral leg and dorsum of foot, and high stepping gait |
| varicose veins | dilated superficial veins which is caused by valve failure (blood pools), long standing, pregnancy - leading to visible twisted veins, aching, swelling and risk of ulcers |
| peripheal nerve disease | damage to peripheral nerves leading to weakness, loss of sensation, and reduced reflexes |
| location of the quadriceps | anterior compartment from hip to knee |
| function of quadriceps | extend knee |
| causes of DVT (Virchow's triad) | stasis (immobility), hypercoagulability, and endothelial injury |
| femoral hernia refers to | femoral ring is a weak area and a loop of intestines can protrude though and into femoral canal forming a lump, and can also pass through saphenous opening |
| femoral canal has high risk | hernia risk |
| what is a major source of blood supply to the thigh | deep artery of the thigh (profunda femoris) |
| branches of the femoral artery (4) | deep artery (profunda femoris), lateral circumflex femoral, medial circumflex femoral, and perforating arteries |
| major deep vein draining the lower limb is | femoral vein (and tributaries) |
| major deep vein draining the lower limb becomes | external iliac vein when it passes under the inguinal ligament to enter the abdomen and follows the course of the femoral artery |
| the major deep vein becomes the external iliac vein when it | passes under inguinal ligament to enter the abd |
| great saphenous vein drains into | femoral vein |
| small saphenous vein drains into | popliteal vein |
| perforating vein connect | superficial veins to deep veins enabling use of musculovenous pump to push return blood against gravity |
| varicose veins | venous return opposed by gravity where valves stop backflow away from heart but poor venous return from lower limb puts pressure on valve - valve becomes hardened with fibrous tissue over time leading to sensory irritation/ pain and valve cant close |