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Lower leg


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Gluteal region has 3 main mucles - name them
Gluteus medius
Gluteus minimus
Tensor fasciae latae
All 3 gluteal muscles act as _ and _
Hip abductors
Medial rotators
All 3 gluteal muscles receive _ nerve and artery
Superior gluteal
Name pelvic muscles in order
Gluteus maximus
Superior gemellus
Obturator internus
Inferior gemellus
Quadratus femoris
Obturator externus
All pelvic muscles are _ but gluteus maximus is also very good _
Lateral rotators of hip
Hip extensor
All classic lateral rotators insert into _
Greater trochanter
Piriformis gets blood supply from both _ and _
Inferior and superior gluteals
Name muscles of anterior thigh
Rectus femoris
Vastus medialis, intermedius, lateralis
Quadriceps femoris function is to _
Extend knee
Which muscles of anterior compartment span two joints
Sartorius and rectus femoris
Anterior compartment of thigh is innervated by _
Femoral nerve
Name medial thigh muscles
Adductor longus
Adductor brevis
Adductor magnus
Medial thigh muscles are all _
hip adductor
Medial thigh muscles are innervated by _
Obturator nerve
Which muscle of medial thigh compartment spans two joints
In addition to being _ , gracilis is also _
Hip adductor
Knee flexor
Name adductors from anterior to posterior
Hamstring part of adductor magnus is innervated by _
Sciatic nerve
Name muscles of posterior thigh
Biceps femoris
Hamstring part of adductor magnus
Posterior thigh muscles are also called
Biceps femoris has dual innervation
Long head innervated by _
Short head innervated by _
Hamstring muscles except _ are innervated by _
Short head of biceps
Blood supply to posterior thigh is by _
Perforating branches of profunda femoris
All hamstrings originate from _
Ischial tuberosity
Hamstrings function is _ and _ (except _ )
Extension of the hip
Flexion of the knee
Adductor magnus - extension of hip only
Name anterior leg muscles
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis Tertius
All anterior leg muscles share function of _
Tibialis anterior and Extensor hallucis longus do _
Extensor digitorum longus
Fibularis Tertius do _
All muscles of anterior leg are innervated by _ , blood supply by _
Deep fibular
Anterior tibial
Lateral leg muscles are
Fibularis longus
Fibularis brevis
Lateral leg muscles share function of _
Lateral leg muscles are innervated by _
Blood supply is _
Superficial fibular
Fibular artery
Name muscles of posterior leg
Tibialis posterior
Flexor digitorum longus
Flexor Hallucis Longus
Which muscle unlocks knee
Popliteus inserts at
Tibia shaft
_ and _ converge in Achilles tendon which inserts in _
Functions of gastrocnemius, soleus, plantaris
Knee flexion
Function of tibialis posterior and flexor hallucis longus
Flexor digitorum does _ only
All posterior leg muscles have blood supply from _
Tibial artery
Soleus has innervation from 3 nerves - they are _
Posterior tibial
Gastrocnemius is innervated by _ as well as _
Name muscles of dorsal foot
Extensor hallucis brevis
Extensor digitorum brevis
Muscles of dorsal foot originate from _ , insert to _
Innervation of dorsal foot
Deep fibular
Blood supply to dorsal foot
Dorsalis pedis
1st layer of plantar foot
Abductor hallucis
Abductor digiti minimi
Flexor digitorum brevis
2nd layer of plantar foot
Quadratus plantae
3d layer of plantar foot
Flexor hallucis brevis
Adductor hallucis
Flexor digiti minimi
Plantar foot , layer 4
Dorsal and Plantar interossei
Plantar foot muscles are supplied by _ nerve, except _ muscles which are supplied by _ nerve
Lateral plantar
Abductor hallucis
Flexor digitorum brevis
1st lumbrical
Flexor hallucis brevis
Medial plantar
Interossei mnemonic
DAB - dorsal - abduction
PAD - plantar - adduction
Medial and lateral plantar arteries come from _
Posterior tibial
Dorsalis pedis and arcuate arteries come from _
Anterior tibial
Which cutaneous nerve provides most innervation to dorsum of foot
Superficial fibular
Which artery is used to palpate pulse on foot
Dorsalis pedis
Muscle that provides major support to transverse arch
Fibularis longus
SI joint is what type of joint
Plane, in infant articular surfaces are almost flat, in adults rough
Ligaments of SI joint
Ventral, dorsal, interosseous SI ligaments
Hip joint is what kind of joint
Ball and socket joint
Capsule of hip joint has two layers - what are they
Longitudinally arranged superficial layer
Deep layer that makes circular ZONA ORBICULARIS
Strongest ligament of the body is _
Iliofemoral ligament
Origination and insertion of iliofemoral ligament
Origin - AIIS, rim of acetabulum
Insertion - intertrochanteric line
Shape of iliofemoral ligament
y shaped , medial and lateral
Iliofemoral ligament mainly prevents _
hip extension
Lateral part of iliofemoral ligament restricts _
Medial part of iliofemoral ligament restricts _
Lateral rotation + adduction
Medial rotation
Describe ischiofemoral ligament
Originates from ischium below acetabulum - runs almost horizontally over the neck of the femur, attaches to root of greater trochanter and iliofemoral ligament
Some fibers run to zona orbicularis
Ischiofemoral ligament restricts
Medial rotation
Describe pubofemoral ligament
Weakest of external ligaments
Originates from obturator crest and membrane, attaches at neck of femur at lesser trochanter, some fibers radiate to zona orbicularis
Pubofemoral ligament restricts _
Innervation of ligamentum teres capitis femoris
Femoral nerve
Superior and inferior gluteal nerves
Blood supply of ligamentum teres
-Medial and lateral femoral circumflex
-Obturator artery
-Superior and inferior gluteal arteries
Knee joint is what type of joint?
Modified hinge joint - some rotation is possible especially when knee is flexed
Name articular surfaces of knee joint
Tibial condyles
Femoral condyles
Medial and lateral patellar retinacula are expansions of _
Tendon of quadriceps
Lateral and medial patellar retinacula attach to _
Tibial condyles in front of collateral ligaments
Patellar ligament goes from _ to _ . Its an extension of _ ligament
Patella to tibial tuberosity
There are two popliteal ligaments - name them and describe
Oblique and arcuate
Oblique - expansion of semimembranosus tendon laterally radiating to the capsule
Arcuate - originates from fibular head, arches over popliteus
Describe medial collateral ligament
Also called tibial ligament
-Flattened triangular ligament
-From medial femoral epicondyle to tibia below tibial condyle
-Attached to medial meniscus
Describe lateral collateral ligament
Also called fibular ligament
-Cord like thin ligament
-From lateral femoral epicondyle to head of fibula
- NOT attached to meniscus or capsule
-Tendon of popliteus separates it from capsule
Synovial membrane covers inner side of knee joint except _ and _
Cruciate ligaments and knee surface
Infrapatella synovial fold extends from _ to _
Infrapatellar fat to crucial ligament
Infrapatellar fat pad is inserted between_
Synovial and fibrous membranes of the capsule under patella
Communicating bursae is _
Non communicating bursae is _
Infrapatellar and prepatellar
Anterior cruciate ligament goes from _ to _
Medial surface of LATERAL femoral condyle to anterior intercondylar area on tibia
ACL prevents _
PCL prevents _
Anterior displacement of tibia
Posterior displacement of tibia
Posterior cruciate ligament goes from _ to _
Lateral surface of MEDIAL femoral condyle to posterior intercondylar area of tibia
Medial meniscus is _ in shapee while lateral is _ in shape
Almost circular
What connects menisci anteriorly
Transverse genicular ligament
Medial meniscus is fused with _
Tibial (medial) collateral ligament
Why is rotation of the knee possible in flexion
Collateral ligaments relax - cruciate are contracted
Which ligaments contract in extension
Anterior cruciate and collateral ligaments
which rotation of knee is bigger in range
When you have genu varum, your knee sticks out _
genu valgum _
Medial side of foot has how many ligaments ? Lateral? Why?
Medial - 4
Lateral -3, no navicular bones so no navicular ligaments
Ankle joint is what kind of joint
Combined, medial ligaments are called _
Which ligaments comprise deltoid ligament
Anterior and posterior tibiotalar
Name lateral ligaments of the foot
Anterior and posterior talfibular
Innervation of ankle joint
Deep fibular
Blood supply ankle joint
Malleolar network
Subtalar joint is what kind of joint
Subtalar joint movements
Talocalcaneonavicular joint is what kind of joint_
Ball and socket
Ligament that prevents head of talus to sink between calcaneus and navicular bone
Plantar calcaneonavicular ligament - spring ligament
Tarsometatarsal and intermetatarsal joints are what kind of joints
Name 3 types of hip x rays
AP hip
AP pelvis
Lateral - frog leg
Describe AP view of the hip
Patient on the back
Hips and knees are extended
Feet inverted
Lesser trochanter - posterior
What can you evaluate with AP of the hip
Femoral head
Femoral neck
Lesser and greater trochanter
Iliopectineal line
In frog leg position (lateral x ray ) hip is _
Externally rotated
In which x ray can you see angle of inclination
Which structure can NOT be evaluated in lateral hip x ray
Femoral neck
What does AP of pelvis give you
Symmetry of pelvis and proximal femurs
What things do you see on xray with DJD
Subchondral sclerosis
Joint space narrowing
Which fracture of femur is more dangerous - at neck or proximal
At neck because you damage medial circumflex femoral artery and acetabular branch of obturator artery might not be enough so you get avascular necrosis of the head of the femur.
If you fracture femur proximally vessels are not damaged and you have good prognosis
Describe position of the leg in femur fracture
Shortened and externally rotated since greater trochanter is displaced and gluteus medius, minimus, piriformis all insert there
Name types of xrays of knee
Patella on xray appears as _
Shadow overlying distal femur
Why does joint space between tibia and femur appear large on plane x ray
Menisci and cartilage are not visible on plane x rays
How can you differentiate age by looking at knee x ray only
Growth plates in children are visible, in adult they are ossified and not visible (can only see epiphyseal scars)
Distance from lateral condyle to lateral tibial plateau should be same as _
Distance from medial condyle to medial tibial plateau
Lateral vs Medial tibial plateau on lateral x ray
Lateral is flatter
Medial more curved
Describe sunrise view of the knee
Tangential x ray of patella - patella is perpendicular to the film
Sunrise view of knee is used to see _
Patellofemoral articulation
When do fractures of tibial plateau usually occur
As a result of decceleration injury --> MVA or falling on extended legs
Should also suspect other injuries like aorta or spleen rupture
If on x ray patella is in two pieces it means patient has _
Avulsion fracture - rupture of ligament or tendon inserting on the bone breaks part of the bone with it
Fractured fibula with fractured malleoli is called
Potts fracture
Unhappy triad injury - describe and cause
Cause - lateral blow to the knee
Medial meniscus
Tibial collateral ligament
If you have fracture to the neck of the fibula what nerve is damaged and what happens as result
Common peroneal (deep peroneal) nerve is damaged
You get foot drop because your extensors are paralyzed and you cant dorsiflex
What is the best way to visualize distal tibial fracture
CT scan
Describe fat, tendons, muscles as seen on MRI
Fat - white
Tendons - black
Muscles - various shades of grey
Why is MRI darker in coronal view
Fat is blocked and fat shows up white on the MRI
Subinguinal hiatus is located _
Between bony rim of pelvis and inguinal ligament
Lacuna musculonervosa includes _
Iliopsoas covered by fascia
Femoral nerve
Lateral cutaneous femoral nerve
Lateral vasorum includes
Femoral artery and vein
Lacuna lymphatica includes
Lymph vessels and nodes in connective tissue (femoral ring)
Borders, floor and roof of femoral triangle
Superior - inguinal ligament
Lateral - sartorius
Medial - adductor longus
Roof - fascia lata with saphenous hiatus
Floor - Iliopsoas, pectineus + fascia
Sapenous hiatus - what is it, what passes through
Opening in fascia lata, covered by cribiform fascia
- Great saphenous vein
-External pudendal artery
-Superficial epigastric artery
-Superficial circumflex iliac artery
Femoral canal is _ canal
Internal and external opening of femoral canal
External - saphenous opening
Internal - lacuna lymphatica (femoral ring)
Borders of femoral canal
Anterior - fascia lata
Posterior - pectineal fascia
Lateral - femoral vein
Obturator artery is a branch of _ . It passes through _
Internal iliac
Obturator canal
Branches of obturator artery
Anterior branch - adductors
Posterior branch - muscles of ischial tuberosity
Acetabular branch - artery of ligamentum capitis femoris of femoral head
Femoral artery is a cotinuation of _ It passes through -
External iliac from inguinal ligament
Runs in subinguinal hiatus --> femoral triangle --> adductor canal and gets to popliteal fossa as popliteal artery
Branches of femoral artery
Superficial circumflex iliac
Superficial epigastric
External pudendal
Deep femoral
Descending genicular
Deep femoral artery runs between _
Adductor longus
Adductor magnus
Describe branches of deep femoral artery
Lateral circumflex femoral --> has 3 branches -
Medial circumflex femoral --> has 2 branches
Perforating arteries - perforate adductor magnus and go to flexor compartment of the thigh
Describe path and branches of descending genicular artery
Runs in adductor canal with femoral artery --> perforates vasoadductor membrane --> leaves adductor
canal and descends on the medial side of the knee passing between sartorius and gracilis
-Muscular branches - to vastus medialis
-Articular branches - to knee joint
Great saphenous vein runs _ and enters _
Medial side of the leg
Femoral vein through saphenous hiatus
Lymph from lower leg drains to _
Superficial inguinal nodes
Cutaneous innervation of superior lateral part of thigh
Iliohypogastric nerve
Cutaneous innervation of proximal anteromedial thigh
Describe innervation and branches of genitofemoral nerve
Genital branch - runs in inguinal canal and innervates upper most part of medial thigh just under inguinal ligament
Femoral branch - passes through subinguinal hiatus in the middle of inguinal ligament and innervates small area distal to inguinal ligament
Describe lateral femoral cutaneous nerve
Passes through subinguinal hiatus at ASIS
Perforates fascia lata under it
Innervates lateral thigh
Describe course of femoral nerve
Largest branch of lumbar plexus
Passes through subinguinal hiatus covered by psoas fascia, LATERAL to femoral vessels
Runs in femoral triangle where it divides into branches
Terminal branch is saphenous nerve which goes through adductor canal
Branches of femoral nerve
Articular - knee + hip joints
Muscular --> anterior thigh muscles
Anterior cutaneous branches
Saphenous nerve
Name terminal branch of femoral nerve and describe its path and innervation
Saphenous nerve --> terminal branch, purely sensory, runs in the adductor canal - pierces vaso- adductor membrane, leaves canal and passes between sartorius and gracilis
Cutaneous innervation of anterior medial leg, knee, and medial malleolar region
Describe course of obturator nerve
From lumbar plexus --> goes through obturator canal --> ramifies among adductor muscles
Describe branches of obturator nerve
Muscular branch --> to obturator externus
Anterior --> between adductor longus and brevis, innervates them and gracilis, gives cutaneous innervation to medial proximal thigh just under the area of genitofemoral nerve innervation
Posterior --> to adductor magnus
Which nerve innervated peroneus longus and peroneus brevis
Superficial peroneal
Vastoadductor membrane is attached to _
Adductor magnus
Name branches of internal iliac artery in glueal region
Superior gluteal
Inferior gluteal
Internal pudendal
Muscles that insert to pes anserinus
Nerve to quadratus femoris and inferior gemellus levels
Nerve to obturator internus and superior gemellus levels
Nerve to piriformis levels
S1, S2
Superior gluteal nerves levels
Inferior gluteal nerve levels
Posterior femoral cutaneous nerve levels
Pudendal nerve levels
Sciatic nerve levels
Describe course and innervation of posterior femoral cutaneous nerve
Goes below piriformis
To posterior thigh
Gives off inferior cluneal
Cutaneous innervation of posterior thigh
Branches of sciatic nerve
Muscular branches
2 terminal branches - tibial + common fibular
Blood supply of sciatic nerve
Internal pudendal
Inferior gluteal
Perforating arteries of deep femoral
Path of pudendal nerve
Out of superior gluteal foramen --> turns around sacrospinous ligament --> turns back in lesser sciatic foramen
Boundaries of popliteal fossa
Lateral superior - biceps femoris
Medial superior - semitendinosus + semimembranosus
Inferior - medial and lateral heads of gastrocnemius
Describe path of anterior tibial artery
Perforates interosseous membrane at inferior border of popliteus
On the leg it runs with deep fibular nerve between tibialis anterior and extensor hallucis longus
At distal part of leg it crosses tendon of extensor hallucis longus and runs between it and tendon of extensor digitorum longus
At ankle it becomes dorsalis pedis
Branches of anterior tibial artery
Posterior and anterior recurrent tibial arteries --> to genicular rete
Medial and lateral malleolar arteries
Dorsalis pedis - terminal branch
Describe path and branches of dorsalis pedis
Dorsalis pedis runs on lateral side of extensor hallucis longus, under extensor digitorum brevis, together with deep fibular nerve
Branches : Lateral and medial tarsal
Arcuate - at tarsometatarsal joints, anastomoses with lateral tarsal
Arcuate arteries give following branches - dorsal metatarsal, dorsal digital, perforating branches
Course of common fibular nerve
Runs along biceps femoris at the lateral margin of popliteal fossa
Winds around neck of fibula
Pierces fibularis longus and divides there into superficial and deep branches
Describe branches of common fibular nerve
Later cutaneous sural -> with medial cutaneous sural forms sural that runs with lesser saphenous vein on gastrocnemius, turns around back of medial malleolus and gives cutaneous innervation to lateral side of foot (lateral pinkie) and lateral calcaneal cutaneous branches to heel
Superficial fibular nerve --> predominantly sensory, passes between fibularis longus and fibula and gets to DORSUM of foot --> gives off
-muscular branches
-medial dorsal cutaneous nerve
-intermediate dorsal cutaneous nerve
Deep fibular nerve --> motor to extensor compartment
Gives off muscular and cutaneous branches (to 1st and 2nd toe)
Cutaneous innervation of medial malleolus
Plantar aponeurosis consists of
Superficial longitudinal fibers + deep transverse fibers
Posterior tibial artery supplies _ and divides into_
Plantar foot
Medial and lateral plantar arteries
Describe lateral plantal artery
Between quadratus plantae and flexor digitorum brevis, forms plantar arch which anastomoses with deep branch of dorsalis pedis
Gives plantar metatarsal branches
Medial plantar artery
Superficial and deep branches

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