Anatomy Gross I Lower Limb
Fascia, Vessels, and Cutaneous Nerves of Lower Limb Fascia lata = deep fascia of the thigh. It attaches to: inguinal ligament, pubic arch, body of pubis, pubic tubercle iliac crest, sacrum, coccyx, sacrotuberous ligament, ischial tuberosity, & exposed portions of bone. o Encloses large thigh muscles especially laterally where it is thickened to form the iliotibial tract (IT band) Extends from iliac tubercle to the anterolateral tibial tubercle (Gerdy tubercle) Venous Drainage of Lower Limb o Superficial veins Great saphenous vein is formed by the union of the dorsal digital vein of the great toe, and the dorsal venous arch of the foot Ascends anterior to the medial malleolus Passes posterior to the medial condyle of the femur Anastomoses freely with the small saphenous vein Traverses into the saphenous opening in the fascia lata Empties into the femoral vein Small saphenous vein arises on the lateral side of the foot from the union of the dorsal digital vein of the 5th dorsal digit with the dorsal venous arch Ascends posterior to the lateral malleolus as a continuation of the lateral marginal vein Passes along the lateral border of the calcaneal tendon Inclines to the midline of the fibula and penetrates the deep fascia Ascends between the heads of the gastrocnemius muscle Empties into the popliteal vein in the popliteal fossa o Perforating veins penetrate the deep fascia close to their origin from the superficial veins. They contain valves that allow blood to flow only from the superficial veins to the deep veins. o Deep veins in the lower limb accompany all the major arteries and their branches. Deep veins in the lower limb are typically paired, and are contained within a sheath with an artery. Lymphatic Drainage in the Lower Limb Cutaneous Innervation of the Lower Limb o Most cutaneous innervation originates from the lumbar and sacral plexuses Dermatomes S1 and S2 pass inferiorly down the posterior aspect of the limb separating near the ankle to pass to the lateral and medial margins of the foot L1-L5 extend as bands from the posterior midline of the trunk into the limb; passing laterally and inferiorly around the limb to its anterior and medial aspects, reflecting medial rotation
Thigh and Gluteal Region Anterior Thigh Muscles o Flexors of the Hip and Extensors of the Knee Pectineus- flat quadrangular muscle, located in the anterior part of the superomedial aspect of the thigh, that adducts and flexes the thigh and assists with medial rotation of the thigh Iliopsoas (chief flexor of the thigh)- formed by the merger of 2 muscles (psoas major and iliacus). This muscle is also a postural muscle, active during standing in
maintaining normal lumbar lordosis and, indirectly, the compensatory thoracic kyphosis. Sartorius- "tailor's muscle"- most superficial muscle of the anterior compartmentpasses obliquely (lasterally to medially) across the thigh. It acts on both the hip and the knee, and when acting bilaterally, the muscles bring the lower limbs into the cross-legged sitting position. Quadriceps Femoris-extensors of the leg Rectus femoris- "kicking muscle" crosses hip joint and helps the iliopsoas flex this joint. Its ability to extend the knee is compromised during hip flexion. Vastus Lateralis- largest component of quadriceps- located on lateral aspect Vastus Intermedius- lies deep to the rectus femoris between vastus medialis and vastus lateralis Vastus Medialis- covers the medial aspect of the thigh Articular muscle of the knee- small, flat muscle; derivative of the vastus intermedius; attaches superiorly to the inferior part of the anterior aspect of the femur and inferiorly to the synovial membrane of the knee joint and the wall of the suprapatellar bursa The quadriceps continue to form the patellar ligament (quadriceps tendon) which attaches to the tibial tuberosity Medial Thigh Muscles o Adductor Group- innervated by the obturator nerve; main action = adduct the thigh, stabilize stance when standing on both feet, correct lateral sway of the trunk, contribute to flexion of the extended thigh and to extension of the flexed thigh when running or against resistance Adductor longus- most anterior muscle Adductor brevis- deep to the pectineus and adductor longus muscles Adductor magnus- largest adductor muscle; composed of adductor and hamstring "parts"; the parts differ in their attachments, nerve supply and main actions Gracilis- long, strap-like muscle lying along the medial side of the thigh and knee; it is the only adductor muscle to cross and act at the knee joint as well as the hip joint Obturator Externus- deeply placed, fan-shaped muscle in the superomedial part of the thigh o Adductor hiatus is an opening or gap between the distal aponeurotic attachment of the adductor part of the adductor magnus and the tendon of the hamstring part leading to the anterior compartment of the thigh into the popliteal fossa. Transmits the femoral artery and vein from the adductor canal to the popliteal fossa
Neurovascular Structures and Relationships in Anteromedial Thigh Femoral Triangle o Subfascial space in the anterosuperior third of the thigh o Appears as a triangle when the thigh is: flexed, abducted, and laterally rotated o Boundaries include: Superior: inguinal ligament which forms the base of the femoral triangle Medial: adductor longus Lateral: sartorius; the apex is where the lateral border of the sartorius crosses the medial border of the adductor longus o Contents of the femoral triangle: Femoral nerve and its terminal branches Femoral sheath and its contents Femoral artery and several of its branches
Femoral vein and its proximal tributaries (great saph. & deep saph.) Deep inguinal lymph nodes and associated lymphatic vessels Adductor Canal o Extends from the apex of the femoral triangle, to the adductor hiatus in the tendon of adductor magnus o Provides intermuscular passage for the femoral artery and vein, the saphenous nerve, and the nerve to vastus medialis, delivering the femoral vessels to the politeal fossa where they become popliteal vessels o Boundaries: Anteriorly and laterally: vastus medialis Posteriorly: adductor longus and adductor magnus Medially: sartorius Femoral Nerve (L2-L4) o Largest branch of the lumbar plexus o Originates in the abdomen within the psoas major and descends posterolaterally through the pelvis to the midpoint of the inguinal ligament Then passes deep to this ligament and enters the femoral triangle After entering the triangle, the femoral nerve divides into several terminal branches to the anterior thigh muscles Sends articular branches to the hip and knee joints and provides cutaneous branches to the anteromedial thigh Terminal cutaneous branch of the femoral nerve is the saphenous nerve, which descends through the femoral triangle, lateral to the femoral sheath Becomes superficial by passing between the sartorius and gracilis when the femoral vessels transverse the adductor hiatus Cutaneous sensation to the anteromedial knee, leg and foot Femoral Sheath o Funnel shaped, fascial tube of varying length that passes deep to the inguinal ligament and encloses proximal parts of the femoral vessels and creates the femoral canal medial to them o Does not enclose the femoral nerve Femoral Artery o Chief artery of the lower limb is the continuation of the external iliac artery distal to the inguinal ligament Enters the femoral triangle deep to the midpoint of the inguinal ligament, lateral to the femoral vein Lies posterior to the fascia lata and descends on the adjacent borders of the iliopsoas and pectineus, which make up the floor of the femoral triangle Bisects the femoral trangle and exits at its apex to enter the adductor canal, deep to sartorius Exits the adductor canal by passing through the adductor hiatus and becoming the popliteal artery o Deep artery of the thigh is the largest branch of the femoral artery and the chief artery to the thigh Arises from the femoral artery in the femoral triangle Gives off perforating arteries that wrap around the posterior aspect of the femur and supply the adductor magnus, hamstring and vastus lateralis muscles o Circumflex femoral arteries are usually branches of the deep artery of the thigh but may arise directly from the femoral artery Encircle the thigh and anastomose with each other and other arteries, and supply the thigh muscles and the proximal end of the femur
o Medial circumflex femoral artery supplies most of the blood to the head and neck of the femur via its branches, the posterior retinacular arteries. o Lateral circumflex femoral artery passes laterally across the joint capsule, mainly supplying muscles on the lateral side of the thigh Femoral Vein o Continuation of the popliteal vein proximal to the adductor hiatus o Becomes the external iliac vein o The deep vein of the thigh, formed by the union of the 3 or 4 perforating veins, enters the femoral vein inferior to the inguinal ligament and inferior to the termination of the great saphenous vein. Obturator Artery and Nerve o Obturator artery usually arises from the interal iliac artery Passes through the obturator foramen, enters the medial compartment of the thigh, and divides into anterior and posterior branches, which straddle the adductor brevis muscle Supplies the obturator externus, pectineus, adductors of the thigh, and gracilis Posterior branch gives off an acetabular branch that supplies the head of the femur o Obturator nerve descends along the medial border of the psoas muscle and enters the thigh through the obturator foramen Divides into anterior and posterior branches which straddle the adductor brevis Anterior branch supplies the adductor longus, adductor brevis, gracilis, and pectineus Posterior branch supplies obturator externus and adductor magnus Gluteal Region and Posterior Thigh Sacrotuberous and sacrospinous ligaments convert the sciatic notches in the hip bones into the greater and lesser sciatic foramina Greater sciatic foramen is the passageway for structures entering or leaving the pelvis whereas the lesser sciatic foramen is the passageway for structures entering or leaving the perineum Gluteal muscles o Gluteus maximus- extension and lateral rotation of the thigh; functions primarily between the flexed and standing positions, as when rising from the sitting position, straightening from the bending position, walking uphill upstairs and running o Gluteus medius and minimus- fan shaped muscles that lie deep to the maximus; they are abductors and medial rotators of the thigh o Tensor fascia lata- lies on the lateral side of the hip, enclosed between two layers of fascia lata; primarily a flexor of the thigh o Piriformis, obturator internus, superior & inferior gemelli, and quadratus femoris- covered by inferior half of gluteus maximus, are lateral rotators of the thigh but also stabilize the hip joint Gluteal Bursae o Membraneous sacs containing a capillary layer of synovial fluid, separate the gluteus maximus from adjacent structures o Located in areas of friction (between a muscle and a bony prominence) to reduce friction and permit free movement Trochanteric bursa- separates the superior fibers of gluteus maximus from the greater trochanter of the femur Ischial bursa- separates the inferior part of the gluteus maximus from the ischial tuberosity Gluteofemoral bursa- separates the iliotibial tract from the superior part of the proximal attachment of the vastus lateralis Posterior Thigh Muscles
o Hamstrings- extension of the hip joint and flexion of the knee joint Semitendinosus Semimembranosus Biceps femoris (long head) All arise from the ischial tuberosity and are innervated by the tibial division of the sciatic nerve Short head of the biceps femoris is located in the posterior compartment, is not a hamstring. It is innervated by the fibular division of the sciatic nerve Nerves of the Gluteal Region and Posterior Thigh o Skin of the gluteal region is richly innervated by the superficial gluteal nerves, the superior, middle, and inferior clunial nerves o Deep gluteal nerves are the: sciatic, posterior cutaneous nerve of the thigh, superior gluteal, and inferior gluteal nerves, nerve to the quadratus femoris, pudendal nerve, and nerve to the obturator internus Branches of the sacral plexus and leave the pelvis through the greater sciatic foramen Pudendal nerve supplies no structures in the gluteal region; it supplies structures in the perineum o Sciatic nerve is the largest nerve in the body and is a continuation of the main part of the sacral plexus Runs inferolaterally under cover of the gluteus maximus, midway between the greater trochanter and the ischial tuberosity and descends from the gluteal region into the posterior thigh, where it lies on the adductor magnus and is crossed posteriorly by the long head of the biceps femoris Receives a named branch of the inferior gluteal artery, the artery to the sciatic nerve Has 2 divisions, the tibial division, and the common fibular divison (in the thigh) Supplies no structures in the gluteal region; it innervates the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. It also supplies articular branches to all lower limb joints. Vasculature of Gluteal Region and Posterior Thigh o Arteries arise either directly or indirectly from the internal iliac arteries o Superior and inferior gluteal arteries leave the pelvis through the greater sciatic foramen and pass superior and inferior to the piriformis o Internal pudendal artery enters the gluteal region through the greater sciatic foramen inferior to the piriformis and enters the perineum through the lesser sciatic foramen Does not supply the buttock o Deep artery of the thigh is the chief artery of the thigh giving off perforating arteries which pierce the adductor magnus to enter the posterior compartment and supply the hamstrings o Veins of the gluteal region are tributaries of the internal iliac veins that drain blood from the gluteal region o Superior and inferior gluteal veins accompany the corresponding arteries through the greater sciatic foramen, superior and inferior to the piriformis Communicate with tributaries of the femoral vein thereby providing an alternate route for the return of blood from the lower limb if the femoral vein is occluded or has to be ligated o Internal pudendal veins accompany the internal pudendal arteries and join to form a single vein that enters the internal iliac vein Drain blood from the perineum Perforating veins accompany the arteries of the same name to drain blood from the posterior compartment of the thigh into the deep vein of the thigh Communicate inferiorly with the popliteal vein and superiorly with the inferior gluteal vein
Popliteal Fossa Mostly fat-filled diamond shaped space posterior to the knee. All important vessels and nerves from the thigh to the leg pass through this fossa o Boundaries Superolaterally: biceps femoris Superomedially: semimembranosus Inferolaterally & inferomedially: by the lateral and medial heads of the gastrocnemius Posteriorly: skin and popliteal fascia (roof) Anteriorly: popliteal surface of the femur, posterior capsule of the knee joint, and the popliteus fascia covering the popliteus muscle o Contents: Termination of the small saphenous vein Popliteal artery and vein and their branches and tributaries Tibial and common fibular nerves Posterior cutaneous nerve of the thigh Popliteal lymph nodes and lymphatic vessels Fascia of the Popliteal Fossa o Subcutaneous tissue contains: fat, small saphenous vein, 3 cutaneous nerves (posterior cutaneous nerve of the thigh, medial and lateral sural cutaneous nerves) Vessels in Popliteal Fossa o Popliteal artery is a continuation of the femoral artery, it begins where the femoral artery passes through the adductor hiatus Passes through the popliteal fossa and ends at the inferior border of the popliteus by dividing into the anterior and posterior tibial arteries Is the deepest structure in the fossa 5 genicular branches supply the joint capsule and ligaments of the knee joint superior lateral, superior medial, middle, inferior lateral, & inferior medial genicular arteries provide collateral circulation around the knee o Popliteal Vein is formed at the distal border of the popliteus as a continuation of the posterior tibial vein Nerves in Popliteal Fossa o Sciatic nerve usually ends at the superior angle of the popliteal fossa by dividing into the tibial and common fibular nerves Tibial nerve-more medial-is the larger terminal branch of the sciatic nerve, is the most superficial of the 3 main central components of the popliteal fossa While in the fossa, it gives branches to the soleus, gastrocnemius, plantaris, and popliteus muscles A named branch = medial sural cutaneous nerve which joins the sural communicating branch of the common fibular nerve at the highly variable level to form the sural nerve o Sural supplies nerve the lateral side of the leg and ankle Common fibular nerve- lateral- smaller terminal branch of sciatic nerve- begins at the superior angle of the popliteal fossa and follows closely the medial border of the biceps femoris and its tendon along the superolateral boundary of the popliteal fossa Leaves the fossa by passing superficial to the lateral head of the gastrocnemius and then passes over the posterior aspect of the head of the fibula Winds around the fibular neck, where it is vulnerable to injury
o Here, it divides into its terminal branches, the superficial and deep fibular nerves Posterior cutaneous nerve of the thigh supply the skin that overlies the popliteal fossa Leg Anterior compartment of the leg o Dorsiflexor (extensor) is located anterior to the interosseous membrane o Superior extensor retinaculum- strong, broad band of deep fascia that passes from the fibula to the tibia proximal to the malleoli o Inferior extensor retinaculum- y shaped band of deep fascia, attaches laterally to the anterosuperior surface of the calcaneus Forms a strong loop around the tendons of the fibularis tertius and extensor digitorum longus muscles o Tibialis anterior o Extensor digitorum longus o Extensor hallucis longus o Fibularis tertius o Deep fibular nerve- one of 2 terminal branches of the common fibular nerve, is the nerve of the anterior compartment Arises between the fibularis longus muscle and the neck of the fibula o Anterior tibial artery- supplies structures in the anterior compartment. It is the smaller branch of the popliteal artery Becomes dorsal artery of the foot Lateral Compartment of the Leg o Everter compartment contains 2 muscles Fibularis longus and brevis that pass posterior to the lateral malleolus o Superficial fibular nerve is the nerve in the lateral compartment. It is a terminal branch of the common fibular nerve After supplying the 2 muscles, it continues as a cutaneous nerve, supplying the skin on the distal part of the anterior surface of the leg and nearly all the dorsum of the foot o Lateral compartment does not have an artery running through it Muscles are supplied proximally by perforating branches of the anterior tibial artery and distally by perforating branches of the fibular artery Posterior Compartment of the Leg o Plantarflexor compartment is the largest of the 3 leg compartments Superficial muscle group in the posterior compartment o Gastrocnemius o Soleus o Plantaris 2 heads of gastroc and soleus share a common tendon, the calcaneal tendon, that attaches to the calcaneus o these 2 muscles (2 heads + soleus) form the triceps surae elevates the heel and thus depresses the foot, therefore generating as much as 93% of the plantarflexion force Soleus is an antigravity muscle and is shaped as an inverted U Plantaris is a small muscle with a short belly and a long tendon o It is absent in 5-10% of people o Tendon can be removed for grafting without causing disability Subcutaneous calcaneal bursa lies between the skin and the calcaneal tendon, and a deep bursa of the calcaneal tendon located between the tendon and the calcaneus
Deep Muscle Group o Popliteus o Flexor digitorum longus o Flexor hallucis longus o Tibialis posterior Popliteus is a thin, triangular muscle in the floor of the popliteal fossa o Acts on the knee joint Flexor hallucis longus is the powerful flexor of all the joints of the great toe o Delivers a final thrust via flexion of the great toe for the preswing of the gait Flexor digitorum longus is smaller than the flexor hallucis longus, even though it moves 4 digits. It passes diagonally into the sole of the foot, superficial to the tendon of the flexor hallucis longus and divides into 4 tendons Tibialis posterior is the deepest muscle in the group, lies between the flexor digitorum longus and the flexor hallucis longus in the same plane as the tibia and fibula within the deep subcompartment o Main role is to support or maintain (fix) the medial longitudinal arch during weight bearing Tibial nerve is the larger of the 2 terminal branches of the sciatic nerve Runs from the popliteal fossa between the heads of the gastroc. Supplies all muscles in the posterior compartment of the leg At the ankle, the nerve lies between the flexor hallucis longus and flexor digitorum longus Tibial nerve divides into the medial and lateral plantar nerves o Medial sural cutaneous nerve (a branch of the tibial nerve) unites with the sural communicating branch of the common fibular nerve to form the sural nerve Sural nerve supplies the skin of the lateral and posterior part of the inferior 1/3 of the leg and the lateral side of the foot Posterior tibial artery is the larger terminal branch of the popliteal artery which provides blood supply to the posterior compartment of the leg and to the foot After giving off the fibular artery (its largest branch), the tibial artery passes inferomedially on the posterior surface of the tibialis posterior Divides into the medial and lateral plantar arteries on the sole of the foot Fibular artery arises inferior to the distal border of the popliteus and tendinous arch of soleus Passes along medial side usually within flexor hallucis longus Gives muscular branches to the muscles in the posterior and lateral compartments of the leg Gives rise to the nutrient artery of the fibula Gives rise to a perforating branch and a terminal lateral malleolar and lateral calcaneal membrane o Perforating branch pierces the interosseus membrane and passes to the dorsum of the foot Circumflex fibular artery arises from the origin of the anterior or posterior tibial artery at the knee and passes laterally over the neck of the fibula to join the genicular anastomosis around the knee Large nutrient artery of the tibia arises from the origin of the anterior or posterior tibial artery Pierces the tibialis posterior and enters the nutrient foramen in the proximal 1/3 of the posterior surface of the tibia
Foot
Deep Fascia of the Foot o Plantar aponeurosis- thick central part of the fascia of the sole of the foot Muscles of the Foot o Muscles of the dorsum of the foot are the extensor digitorum brevis and extensor hallucis brevis Nerves of the foot o Tibial nerve divides into the medial and lateral plantar nerves These nerves supply the intrinsic muscles of the foot Except the extensor digitorum brevis and extensor hallucis brevis which are supplied by deep peroneal nerve o Cutaneous innervation: Medially by the saphenous nerve Superiorly by the deep peroneal nerve (and between 1st and 2nd digits) and the superficial peroneal nerve Inferiorly by the medial and lateral plantar nerves Laterally by the sural nerve (including part of the heel) Posteriorly by the calcaneal branches of the tibial and sural nerves Arteries of the foot o Major source of blood supply to the foot = dorsal artery of the foot (dorsalis pedis) and is the direct continuation of the anterior tibial artery o Medial plantar artery supplies the muscles of the great toe and the skin on the medial side of the sole and has digital branches that accompany digital branches of the medial plantar nerve o Lateral plantar artery Venous drainage of the foot o Subcutaneous dorsal venous arch o Superficial veins from a plantar venous network drain either the medial or lateral border of the foot and converge with the dorsal venous arch Lymphatic drainage of the foot
Walking: the Gait Cycle Gait cycle consists of one cycle of swing and stance by one limb Stance phase begins with heel strike and ends with push off from the forefoot Swing phase begins after push off, when the toes leave the ground, and ends when the heel strikes the ground o Swing phase = 40% o Strike phase = 60% Joints of the Lower Limb Hip Joint o Multiaxial ball and socket type of synovial joint o Head of the femur is covered with articular cartilage Reinforced by iliofemoral ligament which attaches to the anterior inferior iliac spine and acetabular rim proximally and the intertrochanteric line distally Prevents hyperextension of the hip Reinforced by the pubofemoral ligament which arises from the obturator crest of the pubic bone and passes laterally and inferiorly to merge with the fibrous layer of the joint capsule Reinforced by the ischiofemoral ligament which arises from the ischial part of the acetabular rim and spirals superolaterally to the neck of the femur
o Blood supply is via medial and lateral circumflex femoral arteries which are branches of the deep artery of the thigh o Nerve supply is from the femoral nerve, obturator nerve, superior gluteal nerve, and nerve to quadratus femoris Knee joint o Hinge type of synovial joint allowing flexion and extension combined with gliding and rolling and with rotation about the vertical axis o Patellar ligament is the distal portion of the quadriceps and passes to the tibial tuberosity Reinforced by the following ligaments: MCL, LCL, ACL, and PCL Medial meniscus is C shaped Lateral meniscus is O shaped o There are at least 12 bursae around the knee o Nerves surrounding the knee are branches of the femoral, tibial, and common peroneal nerves as well as the obturator and saphenous nerves Tibiofibular Joints o Superior joint is plane type of synovial joint o Tibiofibular syndesmosis is a compound fibrous joint Ankle joint o Hinge type of synovial joint Reinforced by: anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament o Movements include: dorsiflexion and plantarflexion o Arteries are derived from the malleolar branches of the fibular and anterior and posterior tibial arteries o Nerves are derived from the tibial nerve and deep peroneal nerve Joints of the foot o Subtalar and transverse tarsal joints allow for inversion and eversion Arches of the Foot o Transverse arch- runs from side to side and is formed of the cuboid, cuneiforms, and bases of the metatarsals
Fractures of Hip Bone -Small piece of bone is torn away with a piece of tendon Femoral Fractures -Neck of the femur is frequently fractured in osteoporotic females Coxa Vara and Coxa Valga -Decreased angle of inclination = coxa vara causes mild passive abduction of the hip -Increased angle of inclination = coax valga Tibial and Fibular Fractures -Tibial shaft is a common site of compound fractures Bone Grafts -Fibula is site of bone grafting Fractures of Foot Bones -Calcaneal fractures occur in people who fall on their heels (usually breaks in several places) -Fractures to the talar neck may cause severe dorsiflexion
-"Dancer's Fracture" = fracture to the metatarsals from placing entire body weight on that area Varicose Veins, Thrombosis & Thromboembolism -varicose veins form when the valves that usually prevent blood flow from the deep veins through the perforating veins to the superficial veins are incompetent -Veins of the lower limbs are subject to venous thrombosis (blood clotting) -Thrombosis that breaks free could lead to pulmonary thromboembolism Saphenous Vein Grafts -Great Saphenous is often surgically harvested for grafting Enlarged Inguinal Lymph Nodes -Abrasions and minor sepsis are caused by pathogenic microorganisms or their toxins in the blood or other tissues Hip and Thigh Contusions -Contusions cause bleeding Paralysis of the Quadriceps -Weakness of the quads is typically a result of trauma and can result in abnormal patellar movement and loss of joint stability Patellar Tendon Reflex -tests the L2-L4 nervesdiminution or absence of the patellar tendon reflex may result from any lesion that interrupts the innervation of the quadriceps muscle Chondromalacia Patellae -"runner's knee"is a common knee problem that results from quadriceps imbalance and may result from a blow to the patella or from extreme flexion of the knee Groin Pull -involves flexor and adductor thigh muscles Transplantation of Gracilis -can be used to replace muscles in the hand (for example), and will take on the new actions while maintaining its old nerve and blood supply Femoral Pulse and Cannulation of the Femoral Artery -palpable just inferior to the inguinal ligament and may be compressed to control lower limb bleeding Cannulation of the Femoral Vein -Not usually palpable Femoral Hernia -Femoral ring is an area of femoral hernia in which abdominal viscera (often small intestine) comes through the ring and into the canal -more common in women than men Trochanteric and Ischial Bursitis -type of friction bursitis is characterized by point tenderness over the greater trochanter, however, the pain radiates along the iliotibial tract
Hamstring Injuries -often result from the tearing of the muscle at the proximal attachment (ischial tuberosity) Superior Gluteal Nerve -results in motor loss, disabling the gluteus medius and leads to Trendelenburg's gait -swagger occurs when putting weight on side of lesion Injury to Sciatic Nerve -aka piriformis syndrome Intragluteal injections -injections must be given in the superolateral quadrant in order to prevent abscesses Popliteal Pulse -difficult to feel, but weakening/loss is a sign of femoral artery obstruction Popliteal Aneurysm -causes edema and pain in the popliteal fossa Compartment Syndrome in Legs -structures within or distal to compressed area are subject to ischemia and possible permanent injury Injury to Common Fibular (Peroneal) Nerve -most commonly injured nerve of lower limb -severance leads to paralysis of all muscles in the anterior and lateral compartments of the leg as well as "foot drop" -compensations inclide: waddling gait, swing-out gait, & high stepping steppage gait Anterior Tibialis Strain (Shin Spints) -edema and pain in the area of the distal 1/3 of the tibia results from repetitive microtrauma of the tibialis anterior -mild form of compartment syndrome Inflammation and Rupture of Calcaneal Tendon -most severe acute muscular problem of the leg Calcaneal Tendon Reflex -tests S1-S2 nerves Gastrocnemius Strain -"tennis leg" results from partial tearing of the medial belly of the gastroc. at or near its musculotendinous junction caused by over stretching Calcaneal Bursitis -causes pain posterior to the heel and occurs commonly during long distance running Plantar Fasciitis -straining and inflammation of the plantar aponeurosis as a result from running, aerobics, etc. Contusion of Exensor Digitorum Brevis -important in distinguishing this muscle from abnormal edema
Sural Nerve Grafts -used to replace damaged nerves Plantar Reflex -Tests L4-S2 Slight fanning of the lateral 4 toes and dorsiflexion of the great toe are abnormal responses (Babinski sign) indicating brain injury or cerebral disease, except in infants Palpation of the Dorsalis Pedis Pulse -tests peripheral vascular system -the 5 P signs of acute occlusion are: Pain, Pallor, Paresthesia, Paralysis, and Pulseness Hemorrhaging wounds of the sole of the foot -puncture wounds of the sole involving the deep plantar arch and its branches usually result in severe bleeding Fractures of the Femoral Neck -disrupts blood supply to the head of the femur (via medial and lateral circumflex arteries) Surgical Hip Replacement -hip is subject to severe trauma and degeneration and can be fixed with surgery Disolcation of Hip Joint -congenital dislocation of the hip joint is common, occurring more in girls Genu Valgum and Genu Varum -Q angle is the angle between the diagonally placed femur and the vertical tibia -if the Q angle is decreased = genu varum (bowleg) -if the Q angle is increased = genu valgum (knockknee) Knee Joint Injuries -ACL tear usually is accompanied by MCL and medial meniscus tears Bursitis in the Knee Region -prepatellar bursitis- "housemaid's knee" is friction bursitis by friction between the skin and the patella -subcutaneous infrapatellar bursitis- is friction between the skin and the tibial tuberosity -deep infrapatellar bursitis- results in edema between the patellar ligament and the tibia, superior to the tibial tuberosity Ankle Injuries -most frequently injured body part -sprained ankle is nearly always an inversion injury most commonly affecting the anterior talofibular ligament -Pott fracture dislocation of the ankle occurs with the foot is forcibly everted. It often tears the medial malleolus, moving the talus laterally, and breaking the fibula. Tibial Nerve Entrapment -"tarsal tunnel syndrome"- occurs when there is edema and tightness in the ankle involving the synovial sheaths of the tendons of the muscles in the posterior compartment of the leg Hallux Valgus -foot deformity caused by pressure from footwear and degenerative joint diseaselateral deviation of
the great toe -first toe often overlaps the 2nd toe Hammer Toe -deformity in which the proximal phalanx is permanently dorsiflexed at the metatarsophalangeal joint -results in lumbrical weakness as well as the interossei muscles Pes Planus (flatfeet) -acquired deformity that leads to dysfunction of the tibialis posterior -plantar calcaneonavicular ligament fails to support the head of the talus