Back Limbs Flashcards

femoral nerve
Terms Definitions
heel
calx
leg
crus
knee
genu
LATERAL FOOT
SURAL NERVE
Is psoriasis contagious?
No
Femoral nerve
L2,3,4 posterior divisons
gracilis
ORIGIN: outer ischiopubic ramusINSERTION: upper medial shaft of tibiaACTION: flexes knee, adducts femur & assists medial rotation of tibiaNERVE: obturator nerve
LATERAL THIGH
LATERAL FEMORAL CUTANEOUS NERVE
True pelvis
Same as pelvic inlet
semimembranosus
o: ischial tuberosityi: posterior part of medial condyle of tibian: tibial division of sciatic n.m: extend thigh; flex leg and rotate it medially; when thigh and leg are flexed, can extend trunk
tibialis posterior
o: interosseous membrane, posterior surface of tibia inferior to soleal line and posterior surface of fibulai: tuberosity of navicular, cuneiform, and cuboid and bases of metatarsals 2-4n: tibial n.m: plantarflexes ankle and inverts foot
Structures pass between the perineum and gluteal region through the lesser sciatic foramen
 
The most important with respect to the lower limb is the tendon of the obturator internus muscle.

The nerve and artery of the perineum (the internal puden
MEDIAL FOOT
FEMORAL NERVE VIA SAPHENOUS NERVE
ANTERIOR LEG
FEMORAL NERVE VIA SAPHENOUS NERVE
An autoimmune blostering d/o associated w/ Celiac's dz.
Dermatitis herpetiformis
Coccygeus
Lies on posterior abdomen floor.
Aids in deffecation 
helps to form the pelvic diaphram
 
soleus
ORIGIN: soleal line, middle 1/3 posterior tibia & upper posterior fibulaINSERTION: posterior calcaneus via calcaneal tendonACTION: plantar flexes footNERVE: tibial nerve
quadratus plantae
2nd layer intrinsics of footo: calcaneusi: posterolateral margin of tendon of flexor digitorum longusn: lateral plantar n.m: assists flexor digitorum longus in flexing lateral 4 digits
plantaris
o: lateral supracondylar line of femur and oblique popliteal ligamenti: calcaneal tendon to calcaneal tuberosityn: tibial n.m: weakly assist gastrocnemius in plantarflexing ankle and flexing knee
vastus medialis
o: intertrochanteric line and medial lip of linea aspera of femuri: base of patella and by patellar lig to tibial tuberosityn: femoral nm: extends leg at knee
what are the hamstring?
biceps femoris, semitendinosus, semimembranosus... very subcutaneous (near skin)
When does hidradenitis suppurativa occur?
Only after puberty
Where does pustular psoriasis typically occur?
palms and soles
Transverse abdominis
O - Thoracolumbar fascia, ingunal ligament, iliac crest
I - aponeurosis to linea alba
A - compress abdomen to increase pressur
N - Intercostals 7-12
tensor fascia latae
ORIGIN: outer anterior iliac crestINSERTION: ITB, anterior lateral condyle of tibiaACTION: hip flexion & flexion, abduction & medial rotation of femurNERVE: gluteal nerve
obturator internus
ORIGIN: external obturator membrane & obturator foramenINSERTION: medial greater trochanterACTION: laterally rotates & adducts femurNERVE: sacral plexus
bones of foot
calcaneus, talus (above calcaneus), navicular, cuboid (just infront of talus & calcaneus), cuneiforms 1-3, tarsals, metatarsals & phalanges
popliteus
o: lateral condyle of femur & lateral meniscusi: posterior surface of tibia, superior to soleal linen: tibial n.m: unlocks fully extended knee (laterally rotates femur on planted tibia) & weakly flexes knee
Which mm responsible for rotation (flexed knee)?
medial: semimembranosus, semitendinosus, gracilislateral: biceps femoris
plantar interossei
4th layer intrinsics of foot3 mmo: bases and medial sides of metatarsalsi: medial sides of bases of proximal phalanges of digits 3-5n: lateral plantar n.m: adducts digits 3-5 and flex metatarsophalangeal joints
gluteus maximus
o: posterior of iliac crest, dorsal surface of sacrum and coccyx, sacrotuberous ligamenti: iliotibial tract that inserts into lateral condyle of tibia; some fibers to gluteal tuberosityn: inferior gluteal n.m: extends thigh and assists in lateral rotation; steadies thigh and assists in raising trunk from flexed position
Femoral artery
Begins as the continuation of the external iliac artery distal to the inguinal ligament, descends through the femoral triangle, and enters the adductor canal.
Has a palpable pulsation, which may be felt just inferior to the midpoint of the inguinal ligament.
Is vulnerable to injury because of its relatively superficial position in the femoral triangle.
Includes several branches:
TRANSVERSE ARCH
TENDON OF PERONEUS LONGUS; HIGH ARCHES COULD BE DUE TO SPASTIC CONTRACTION OF THE PERONEUS LONGUS AND TIBIALIS POSTERIOR TENDONS, LIKELY NEUROLOGICAL; FLAT FEET- USUALLY INDICATES MECHANICAL PROBLEM
Describe appearance of erythrodermic psoriasis.
Generalized erythema and scale.
A chronic inflammatory skin disease characterized by pruritus, erythema, a prediliction for skin creases, and a relapsing course.
Atopic Dermatitis (AD)
Saphenous opening
Opening allowing the vein to travel through the cribiform fascia
Muscles of the pelvis diaphram
Levator ani and Coccygeus
SI joint Intrisic ligaments
Anterior SI ligament
Posterior SI ligament
Interosseus SI ligament
Ligaments of the pubic symphysis
Superior pubic ligament
Arcuate ligament (inferior)
Fibrocartilage disc
adductor longus
ORIGIN: inferior pubis & medial to pubic tubercleINSERTION: lower 2/3 linea asperaACTION: adducts & flexes femur, laterally rotates hipNERVE: obturator nerve
Lateral compartment of leg (mm, nerve, blood)
muscles:fibularis longusfibularis brevisnerve:superficial fibular n.vascular: branches of fibular a. from posterior compartment
tensor fasciae latae
o: ant sup iliac spinei: iliotibial tract that attaches to lat condyle of tibian: sup glutealm: abducts, medially rotates and flexes thigh; helps to keep knee extended; steadies trunk of thigh
obturator nerve supply
all medial muscles of thigh... for ADDuction...when you hear obturator think adduction
Describe the Hip (Coxal) Joint
Is a multiaxial ball-and-socket synovial joint between the acetabulum of the hip bone and the head of the femur and allows abduction and adduction, flexion and extension, and circumduction and rotation.
Is stabilized by the acetabular labrum; the fibrous capsule; and capsular ligaments such as the iliofemoral, ischiofemoral, and pubofemoral ligaments.
Has a cavity that is deepened by the fibrocartilaginous acetabular labrum and is completed below by the transverse acetabular ligament, which bridges and converts the acetabular notch into a foramen for passage of nutrient vessels and nerves.
Describe chronic stasis dermatitis.
Cyanotic red plaque over medial malleolus, skin thickening, cycles of healing and recurrent attacks (skin remains thick and dark during healing times)
Describe the clinical presentation of dyshidrotic dermatitis. Describe the areas of distribution.
Intensely pruritic, recurrent, vesicular lesions 1-5mm diameter w/ clear fluid. Palms and soles, lateral aspects of fingers.
What are side effects of dapsone? (4)
Hemolysis, methemoglobinemia, peripheral neuropathy, cross rxn w/ sulfa allergy
Describe acne rosacea.
Papules and pustules w/ central facial redness and telangiectasias
What muscles insert on the upper medial tibia to make up the common point called the pes anserinus?
Sartorius, Gracilis, Semitendinosus
Inguinal ligament
Divides the abdomen and thigh, made up from the fascia of the external oblique
Rectus femorus
O - AIIS
I - Quadriceps tendon into patellar
A - Knee extension
RA - Hip flexion and anterior pelvic tilt
N - Femoral L3,4
Internal oblique
O - Lateral half of inguinal ligament, iliac crest
I - last 3-4 ribs
A - Same side rotation, lateral flexion and trunk flexion
N - Intercostals 8-12
Adductor brevis
O - Body and inferior ramus of pubis
I - Pectineal line, linea aspera
A - Adduction, hip flexion, and medial rotation
N - Anterior obturator - L3
flexor digiti minimi
3rd layer intrinsics of footo: base of 5th metatarsali: base of proximal phalanx of 5th digitn: superficial branch of lateral plantar n.m: flexes proximal phalanx of 5th digit, thereby assisting with its flexion
Define axis of rotation
The point or line which remains stationary during joint movement. The action of a muscle on a joint will be determined by its position relative to the axis of rotation.
Which mm are responsible for adduction at the hip?
adduction: pectineus, gracilis, adductor longus, brevis and magnus
Superficial Vein of LL
The superficial veins form two major channels-the great saphenous vein and the small saphenous vein.
The greater saphenous vein begins at the medial end of the dorsal venous arch of the foot, passes anterior to the medial malleolus, runs on the medial side of the lower limb, and empties into the femoral vein.
The small saphenous vein begins at the lateral end of the dorsal venous arch, passes posterior to the lateral malleolus, ascends on the posterior side of the leg along with the sural nerve, and empties into the popliteal vein.
Muscles of the Foot?
Muscles found entirely in the foot (intrinsic muscles) modify the forces produced by tendons entering the toes from the leg and provide dynamic support for the longitudinal arches of the foot when walking, particularly when levering the body forward on the stance limb just before toe-off.
Describe the rash in the childhood stage of AD.
More dry, less weepy
What is the pathophysiology of seborrheic dermatitis?
Poss. Malasezia furfur (skin saprophyte) or Pityrosporum yeast. Hyperproliferation of skin/excess oil secretion.
How is perioral dermatitis tx? (3)
1)Stop heavy moisturizers, steroids, and cosmetics 3)Use mild soap 4)Topical or oral abx
What innervates the m. of the lateral crural compartment of the leg?
Superficial peroneal n.
which two muscles insert onto the medial cuneiform and 1st metatarsal?
Tibialis Anterior and Fibularis
Layers of fascia in the thigh
Superficial - unremarkable
Deep - fascia lata
What is a moment?
The product of applied force and the perpendicular distance from the force vector to the axis of rotation.
Which mm are responsible for extension at the hip?
extension: gluteus maximus, hamstring muscles
Which mm are responsible for plantarflexion & inversion? Which nerves innervate these mm?
plantarflexion = Lateral and posterior compartments of the leginversion = mm passing medial to subtalar axis (mm. of posterior compartment w/ insertions on foot)flexor hallucis longusflexor digitorum longustibialis posteriortibial n.
what passes through lesser sciatic foramen
1)tendon of obturator internus 2)nerve to obturator internus
Where does phymatous rosacea affect?
MC the nose (rhinophyma), also chin, forehead, eyelids
The exact etiology of perioral dermatitis is unknown, but what are 3 possible causes?
1)Skin intolerance to beauty products 2)Drying agents (benzoyl peroxide, alcohol based products) 3)Bacterial
What do the deep m. of the gluteal region enter the pelvic cavity through?
Greater sciatic foramen
A complication of AD is secondary infection w/ what organisms?
Staph (primary), strep, or herpes
Describe the clinical findings in seborrheic dermatitis.
Moist papules w/ yellow, greasy scaling, erythema, mild pruritus
What muscles do both medially rotate and abduct?
Gluteus medius and Gluteus minimus
How many muscles are the in the posterior thigh region?
4: Semitendinosus, Semimembranosus, Biceps Femoris
What defines the pelvic inlet?
Superiorly the imaginary line b/w the pebic symphysis and the sacral promontary and inferiorly the pelvic diaphram
Describe the mm. that act during each phase of gait.
heel strike:hamstrings decel limb, then stabilize knee (w/ quads)dorsiflexors prevent foot slap (decel descent of foot)gluteus maximus acts w/ hamstrings to decel limb and prevent lurching forward of trunkflat foot:abductors prevent excess pelvic tiltplantarflexors begin to act, providing fwd and upward acceltoe off:plantarflexors contract until just prior to toe offswing:dorsiflexors lift foot to clear group
During stance, how is weight transferred? What special anatomical adaptations make this possible?
During stance phase, wt is transferred from heel to lateral side of the foot, across the ball of the foot to the first metatarsal head and finally to the hallux.foot arches; sesamoid bones around flexor hallucis longus tendo, allowing it to contract even as full body wt is supported on the first metatarsal head at toe-off; sustentaculum tali creates pulley for tendon of flexor hallucis longus
Name the ligaments of the knee.
1) patellar - transmits force of quadriceps to tibia, provides stability in flexion2) lateral (fibular) collateral - prevent side-to-side motion, and provide stability in extension3) medial (tibial) collateral - prevent side-to-side motion, and provide stability in extension4) anterior cruciate - anterior relative to tibia; loose in flexion, tight in extension --> prevents hyperextension, anterior displacement of tibia on femur5) posterior cruciate - loose in extension, tight in flexion --> provides stability in flexion and prevents posterior displacement of tibia on femur6) olbique and arcuate popliteal - relatively weak, provide stability in extension
What are the components of a synovial joint?
Constant: bone, hyaline cartilage, synovial membrane, synovial cavity, synovial fluid, fibrous capsuleOptional: labrum, disk, meniscus (all fibrocartilage & within synovial cavity so not easily repaired because no blood vessels in cavity); fat pad, intracapsular tendon, bursae
Bones of the Leg
The leg contains two bones: the tibia is medial in position, is larger than the laterally positioned fibula, and is the weightbearing bone;
the fibula does not take part in the knee joint and forms only the most lateral part of the ankle joint-proximally, it forms a small synovial joint (superior tibiofibular joint) with the inferolateral surface of the head of the tibia.
What acne med. is very teratogenic and prescription requires signing the Ipledge system?
Oral isotretinoin (accutane, sotret, claravis, amnesteem)
What provides the blood supply to the anterior compartment of the thigh?
Branches of the femoral artery
What is the femoral a. a continuation of and where does it pass under to enter the thigh?
External Iliac a., inguinal ligament
Name the 4 divisions of the lower limb
Gluteal region, thigh, leg, foot
What are the 5 steps for tx AD?
1)Education 2)Prevention 3)Mild sx despite routine care 4)Mid-potency steroids and Calcineurin inhibitors 5)Referral
Describe the secondary eruption of pityriasis rosea.
Collarette of fine scale OR Christmas tree pattern that is symmetric and gen. on trunks and extremities
What are the 2 types of non-inflammatory acne lesions?
Comedones - blackheads (open) and whiteheads (closed)
What muscles are in the fourth layer of the plantar muscles of the feet?
Plantar Interossei, and Dorsai Interossei
Why is walking very energy efficient?
60-70% of input energy is recovered. The ballistic model of human gait - the lower limb acts like an inverted pendulum, taking advantage of gravity. Downward velocity is proportional to the accel due to gravity and the total length of the lower limb. Theoretical max speed of level walking is set by lower limb length.
High "steppage gait" with foot slap and foot drop is an injury of which nerve?How about "pelvic slump"?
steppage gait = common peroneal nerve injurypelvic slump = superior gluteal n. injury
What are the structures of the hip joint?
Acetabular labrum
Is a complete fibrocartilage rim that deepens the articular socket for the head of the femur and consequently stabilizes the hip joint


Fibrous capsule
Is attached proximally to the margin of the acetabulum and to the transverse acetabular ligament.

Is attached distally to the neck of the femur as follows: anteriorly to the intertrochanteric line and the root of the greater trochanter and posteriorly to the intertrochanteric crest.
Encloses part of the head and most of the neck of the femur.

Is reinforced anteriorly by the iliofemoralischiofemoralpubofemoral ligament, posteriorly by the ligament, and inferiorly by the ligament.
What tendons are found in the dorsum whose m. are not present?
Tendons of extensor digitorum longus, extensor hallicus longus, and tibialis anterior
Who is guttate psoriasis most common in?
Young, healthy people. Typicalll /p strep infection.
What are the boundaries of the popliteal fossa?
Upper - distals ends of the semitendinous and semimembranosus medially and distal end of biceps femoris laterally
Lower - medial head of gastrocnemius medially and lateral head of the gastrocnemius and plantaris m. laterally
How many muscles insert onto the linea aspera
Adductor longus, Adductor Brevis, and the Adductor part of Adductor magnus
What type of cartilage is in the knee?
1) articular cartilage on plateaus of condyles2) menisci (semilunar cartilage) - increase joint congruence, cushion jointmedial meniscus attached to medial collateral ligament (thus more commonly injured)lateral meniscus not attached to lateral collateral ligament
What is the path of the lateral tarsal a.?
A branch of the dorsalis pedis a. higher up.  It anastamoses with the arcuate a. and sends off the 5th metatarsal a. and several medial tarsal a.
What is the function of the fibular and tibial collateral ligaments?
Stabilize the hinge-like motion of the knee
What are the major criteria for dx of AD?
1)Pruritus 2)Affects flexural in adults or extensor/face in infants 3)Chronic or relapsing dermatitis 4)Fam h/o atopic triad d/o
Describe the distribution of skin areas affected by adult AD.
Can be flexural as in children or more localized (hands, periorbital, or anogenital)
What do all the muscle of the abdomen do?
Compress abdomen to increase abdominal pressure
What is found in the walls of the acetabulum?

The wall of the acetabulum consists of nonarticular and articular parts: the nonarticular part is rough and forms a shallow circular depression (the acetabular fossa) in central and inferior parts of the acetabular floor-the acetabular notch is continuous with the acetabular fossa;
the articular surface is broad and surrounds the anterior, superior, and posterior margins of the acetabular fossa
Is the lateral plantar a. the smaller or larger branch and explain its course.
Larger.  It descends to the bases of the metatarsal bones and forms an arcuate a. (the majority of the plantar arterial arch).  The plantar metatarsal a. arise from the arcuate a. and course to the respective toes.
What provides the blood supply to the tarsal tunnel?
Popliteal a. from the femoral a. and combines to the anterior and posterior tibial a.
How common is acne vulgaris? Who is it moct common in?
Affects >90% of the population, MC in adolescents
What is the function of the deep m. of the gluteal region?
Lateral rotation of the of the femur at the hip joint
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