The Lower Extremity
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| What are the muscles of the anterior compartment of the thigh? | -tensor fascia
-sartorius
-quadriceps femoris
-articularis genu
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| What are the 4 parts of the quadriceps femoris? | -rectus femoris
-vastus medialis
-vastus intermedius
-vastus lateralis
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| Where does articularis genu lie? | deep to the quadriceps
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| What are the muscles of the medial compartment of the thigh? | -pectineus
-gracilis
-adductor brevis
-adductor longus
-adductor magnus
-obturator externus
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| What is a pulled groin? | The stretching or tearing of the adductor longus and part of the adductor magnus muscles
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| What are the 8 Gluteal muscles? | Gluteus maximus, medius and minimus,
Piriformis, gemellus superior and inferior, obturator internus, and quadratus femoris
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| What is the iliotibial band? | a thickening of the deep fascia on the lateral side of the thigh
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| What muscles form the iliopsoas muscle? | Psoas major and Iliacus muscles
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| What is genu valgum? | (knock kneed) It is where the distal aspect of the tibia is bet outward.
Valgus= bent outward
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| What is genu varum? | (bow legged) It is where the distal aspect of the tibia is bent inward.
Varus=bent inward
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| What is chondromalacia patellae? | It is soreness and aching around and deep to the patella.
It is seen in runners and weight lifters.
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| What is osteoarthritis of the knee? | It is the breakdown of the articular cartilage along with the development of osteophytes. It leads to joint replacement.
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| Popliteal cysts have similar symptoms with what else? | Deep vein thrombosis
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| What are the three most common knee injuries? | medial meniscus, tibial collateral ligament and anterior cruciate ligament
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| What is the function of the lateral and medial menisci? | They distribute the force of the femur over the condyles of the femur
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| What type of joint is the knee? | It is a hinge type of synovial joint. It is biaxial.
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| What are the motions allowed by the knee joint? | flexion and extension
and slight medial and lateral rotation
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| What are the capsular ligaments of the knee? | -articular capsule
-ligamentum patellae
-oblique popliteal
-arcuate popliteal
-tial collateral
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| What is the one extracapsular ligament of the knee? | fibular collateral
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| What are the two intracapsular ligaments of the knee? | anterior and posterior cruciate ligaments
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| What are the muscles of the posterior compartment of the thigh? | -biceps femoris (long and short head)
-semitendinosus
-semimembranosus
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| Congenital hip dislocation is caused by what? | a shallow acetabulum
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| Hip resurfacing or replacement is usually caused by what? | degenerative joint disease (DJD)
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| If the artery in the ligamentum capitis femoris or arteries in the femoral neck are ruptured, what can happen? | necrosis of the femoral head
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| What type of joint is the hip joint? | ball and socket type of synovial joint and triaxial
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| what are the motions allowed by the hip joint? | extension/ flexion, abduction/adduction, medial/lateral rotation
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| What are the 4 major capsular ligaments of the hip? | -articular capsule
-iliofemoral
-ishiofemoral
-pubofemoral
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| What are the two intracapsular ligaments of the hip joint? | ligamentum capitis femoris and transverse acetabular
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| What deepens the acetabulum? | acetabular labrum or fibrocartilage
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| Why are the fibers of the ligaments of the hip important? | They give stability.
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| In what direction is patellar dislocation common? | lateral direction
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| What structures are located on the posterior side of the patella? | medial and lateral facets
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| What type of bone is the patella? | sesamoid
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| What are the structures at the distal end of the femur? | medial and lateral condyles, medial and lateral epicondyles, patellar surface, intercondylar notch and the adductor tubercle
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| What are the important structures on the shaft of the femur? | linea aspera, spiral line, gluteal tuberosity, and the medial and lateral supracondylar lines
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| What are the structures of the proximal end of the femur? | head with fovea capitis femoris, neck, great and lesser trochanter, intertrochanteric line, and intertrochanteric crest
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| What is the angle of inclination? | It is the angle between the longitudinal axis of the shaft of the femur and the longitudinal acis of the neck of the femur
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| What is coxa vara? | decreased angle of inclination
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| What is coxa valga? | increased angle of inclination
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| What is a hip pointer? | It is a contusion of the iliac crest.
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| What is Trendelenburg gait? | It is when the pelvis dips to the opposite side of weightbearing.
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| What is the Trendenlenburg's test used for? | It is used to test the osseomuscular integrity of the hip joint.
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| What muscles make up the hamstrings? | long head of the biceps, the semitendinosus, and semimembranosus
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| Where does the hamstring originate? | ischial tuberosity
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| Where are intragluteal injections done? | the upper lateral quadrant of the gluteal region
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| What are the contents of the femoral triangle? | femoral artery and vein, profunda femoral artery and vein, and femoral nerve and its branches
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| What is the femoral artery within the femoral triangle cannulated for? | left cardiac angiography
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| What is the femoral vein within the femoral triangle cannulated for? | right cardiac angiography
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| What runs through the adductor canal? | femoral artery and vein and the saphenous nerve
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| What can the great saphenous veins be used for? | They are harvested for heart bypass surgery.
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| What is the gluteal region vasculized by? | superior and inferior gluteal arteries
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| What are the routes of the superior and inferior gluteal arteries? | They are branches of the internal iliac artery that leave the pelvis through the greater sciatic foramen. They enter the gluteal region superior and inferior to the piriformis muscle
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| What compartments does the profunda femoral artery vascularize? | anterior, medial and posterior comparments of the thigh
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| Where is a femoral pulse palpated? | within the femoral triangle close to a midinguinal point
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| What are the branches of the femoral artery? | -profunda femoral
-meidal and lateral femoral circumflex
-perforating arteries
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| What compartment does the obturator artery vascularize? | medial compartment
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| What are the major branches of the popliteal artery? | -sural
-genicular
-anterior and posterior tibial
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| What are the contents of the popliteal fossa? | 0popliteal artery and vein and their genicular branches
-tibial and common peroneal nerves
-popliteal lymph nodes
-termination of the small saphenous vein
-fatty tissue
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| What is the lumbosacral plexus derived by? | Ventral rami of L1-L5, S1-S5 and Co1
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| The lumbar and sacral portions of the lumbosacral plexus innervate what? | the lower extremity, lower abdominal wall and most of the perineum
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| The coccygeal portion of the lumbosacral plexus innervates what? | the anococcygeal region
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| What are the major portions of the lumbar portion of the lumbosacral plexus? | -lateral femoral cutaneous
-femoral
-oburator
-lumbosacral trunk
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| What are the branches of the femoral nerve? | -medial femoral cutaneous
-intermediate femoral cutaneous
-saphenous
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| What are the major branches of the sacral postion of the lumbosacral plexus? | -superior and inferior gluteal
-posterior femoral cutaneous
-sciatic
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| What are the two main branches of the sciatic nerve? | tibial and common peroneal nerve
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| What is the sural nerve formed by? | the tibial and common peroneal nerves
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| What are the branches of the tibial nerve? | -medial calcaneal
-medial plantar
-lateral plantar
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| What are the branches of the common peroneal nerve? | superficial and deep peroneal nerves
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| What are radiculopathies? | injury at nerve root
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| What are the cutaneous nerves of the gluteal region? | Superior, middle and inferior cluneal
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| The gluteus maximus, medius and minimus originate where? | Gluteal surface of ala of ilium
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| What is the action of the piriformis, obturator internus, gemellus superior and inferior, and quadratus femoris? (all gluteal muscles except gluteus mm) | Laterally rotate the thigh
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| Where does the iliopsoas insert? | the lessor trochanter of femur
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| What is the action of the iliopsoas? | Major flexor of the thigh
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| What is the action of all of the quadriceps femoris muscles? | Extends the leg
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| What is the action of the tensor fascia lata? | It stabilizes the hip joint. Steadies the femur on the tibial condyles.
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| What is the action of the Sartorius muscle? | It abducts, flexes, and laterally rotates the thigh. It flexes and medially rotates the leg.
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| What is the action of the articularis genu? | It retracts the capsule of the knee joint during extension.
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| What is the innervation of the hamstrings? | tibial portion of the sciatic nerve
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| What three muscles insert on the pes anserinus? | sartorius, gracillis, and semitendinosus
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| What are the proximal structures of the tibia? | medial and lateral condyles, and the tibial tuberosity
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| What are the distal structures on the tibia? | medial malleolus, fibular notch, and medial malleolar sulcus
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| What is the function of the fibula? | It carries no weight but rather serves for muscular attachment.
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| What is another name for the fibula's distal extremity? | the lateral malleolus
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| What 3 parts make up the ankle? | the distal extremity of tibia, fibula and talus
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| What is the proximal structure of the fibula? | the apex or styloid process which points posteriorly
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| How can you tell the difference between a right and left fibula? | The right fibula's styloid process will point posterior. The articular facet for the talus will be seen anterior. The malleolar fossa will be posterior.
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| How do fractures of the fibula commonly occur? | They occur proximal to the lateral malleolus and are commonly associated with fracture dislocation of the ankle joint.
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| What are the tibia and fibula connected by? | the tibiofibular syndesmosis and the interosseous membrane
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| What is the tibiofibular joint? | It is a synovial joint formed by the head of the fibula and the lateral condyle of the tibia.
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| How is the tibiofibular syndesmosis formed? | It is formed by the fibular notch on the distal extremity of the tibia and the distal aspect of the shaft of the fibula.
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| What is the only non synovial joint of the lower extremity? | tibiofibular
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| What does the deep fascia of the leg region give rise to? | septa that form the anterior, lateral, and posterior compartment of muscles
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| What is the deep transverse fascia? | The posterior compartment of the leg is further divided into a deep and superficial compartment by this septa.
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| What vessels are in the superficial posterior compartment? | There are no vessels or nerves.
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| All of the leg muscles except what muscle are extrinsic? | the popliteus
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| Tendons passing anterior to the ankle joint axis are... | dorsiflexors
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| Tendons passing posterior to the ankle joint axis are... | plantarflexors
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| What is the primary function of the anterior leg muscles? | dorisflexion of the foot for toe clearance during the swing phase and the prevention of foot slap at heel strike
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| What are the anterior compartment of the leg muscles? (4) | -tibialis anterior
-extensor hallucis longus
-extensor digitorum longus
-peroneus (fibularis) tertius
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| What are the two lateral compartment leg muscles? | Peroneus (fibularis) longus and brevis
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| What is the primary function of the lateral compartment leg muscles? | pronation (eversion) and plantarflexion of the foot
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| What two joints do the lateral compartment muscles cross to allow pronation? | subtalar and midtarsal
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| What are the three muscles of the superficial posterior compartment of the leg? | gastrocnemius, soleus, and plantaris
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| What is the primary function of the superficial posterior leg muscles? | plantarflexion
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| What are the four muscles of the deep posterior compartment of the leg? | popliteus, flexor hallucis longus, flexor digitorum longus, and tibialis posterior
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| What is the primary function of the deep posterior leg muscles? | plantarflexion and supination
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| What is the action of the popliteus muscles? | It unlocks the knee joint at the beginning of flexion. The unlocking is slight lateral rotation.
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| What is venae commitantes? | It means accompanying vein. Artery is accompanied by paired veins. There are cross connections as you go up. The pulse of the artery helps venous return.
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| What is found in the space between the flexor hallucis and flexor digitorum longus? | The posterior tibial artery and tibial nerve are found here. You take the posterior tibia pulse here.
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| What is the insertion of the gastrocnemius and soleus? | the posterior surface of the calcaneus via the tendo calcaneus
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| What is the insertion of the flexor digitorum longus? | distal phalanges of the lesser digits
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| What is the insertion of the flexor hallucis longus? |
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| What is the innervation of the anterior compartment of the leg? | deep peroneal (fibular) nerve
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| What is the innervation of lateral compartment of the leg muscles? | superficial peroneal (fibular) nerve
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| What is the innervation of the posterior compartment of the leg? (superficial and deep) | the tibial nerve
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| What is anterior compartment syndrome? | It is an increased pressure within the anterior compartment of the leg which compresses the nerve and vascular supply to the muscles. Loss of function of the anterior compartment muscles results in foot drop and loss of sensation in the first web space.
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| What are spin splints? | It is pain at the front of the leg usually during exercise. Pain is due to an inflammation of the periosteum at the origin of the tibialis anterior.
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| What do the superficial veins flow into? | the great saphenous vein and small saphenous vein
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| The leg is vascularized by what three arteries? | the anterior and posterior tibial artery and the peroneal artery
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| What is the path of the anterior tibial artery? | It is a branch of the popliteal artery. It courses through the interosseous membrance and descends in the anteior compartment of the leg. It's name changes to dorsalis pedis artery on the talcural joint.
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| What does the posterior tibial artery divide into? | medial and lateral plantar arteries, and peroneal artery
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