Lower limb-6/20/23

What does the pelvic girdle link?

lower limbs and axial skeleton

What makes up the pelvic girdle?

pelvis, sacrum and coccyx

what forms acetabulum?

ilium, ischium and pubis

Fovea capitis

small depression near center of head attachment site

no hyaline cartilage

propioception

Lumbosacral joint

attaches pelvic girdle to axial skeleton (sacrum w/L5)

What are the bony landmarks of girdle

sacral promontory, iliopectineal lines, arcuate lines(ilium), pectineal lines(pubis), pubic crests and tubercles

False vs true pelvis

above or below iliopectineal line

What attaches to the proximal and distal end of the femur

articulate with pelvis proximally, patella/tibia distally

Angle of inclination

Normal: 120-135

Coxa vara:

Coxa valga

>135

distal ends of femur move laterally, knees turn in

Iliolumbar ligament

L4-5 transverse processes spanning over to ilium

Sacrococcygeal joint

posterior and anterior sacrococcygeal ligaments

Pubic symphysis

cartilaginous and allows for movement

Sacroiliac joints

ilium side: fiber cartilage

sacral side: hyaline cartilage

Supporting ligaments of SI joint

Posterior SI and sacrotuberous ligaments

Anterior SI ligaments=ilium to sacrum

Sacrospinous=distal sacrum to ischial spine

Structures passing through greater sciatic foramen

sup. gluteal n/a

inf. gluteal n/a

post. fem. cut. n

n. to quadratus femoris

(PIN) Pudenal n., Int. pudenal a/v, nerve to obturator internus

Structures passing through lesser sciatic foramen

PIN re-enter pelvis via this structure

obturator internus

Sciatica vs. piriformis

spinal dysfunction vs. compressed sciatic nerve at L3-5,S1

Ligaments of hip joint

Pubofemoral

iliofemoral or Y ligament of Bigalow

Ischiofemoral

Ligamentum capitis femoris

Gluteus maximus

fxn: hip extensor, assists in knee extension via iliotibial band

Innervation: Inferior gluteal n.

Gluteus minimus

Fxn: hip abd., flex, internal rotation

Innervation: superior gluteal n.

Gluteus medius

Fxn: deltoid of hip

Inn: superior gluteal n.

Trendelenburg sign

weakness in medius, being unable to hold pelvis level when affected person is standing only on ipsilateral lower limp

Tensor fascia latae

supplied by superior gluteal n.

iliotibial tract, btw. middle and upper third of thigh

Piriformis

n. to piriformis

lies next to gluteus minimus, emerges from GSF

Obturator internus

n. to obturator internus

emerges from LSF

Gemellus superior and inferior

small muscles lying adjacent to tendon of obturator internus

n. to obturator internus and n. to quadratus femoris respectively

Quadratus femoris

n. to quadratus femoris

Muscles used to produce active ext. rotation

Piriformis, obturator internus, gemellus superior/inferior, quadratus femoris, obturator exturnus

Muscles for hip abduction

Piriformis, obturator internus, gemellus superior/inferior, obturator exturnus

Hip adduction

quadratus femoris

Pubofemoral

limits hip abd.

iliofemoral or Y ligament of Bigalow

limits hip extension

Ischiofemoral

limits hip internal rotation

Ligamentum capitis femoris

forms acetabular notch to fovea capitis(provides blood vessels to head of femur)

What are the layers of fascia in the thigh?

superficial fatty layer, deep membranous layer, deep investing layer or fascia latae

What does fascia latae form?

Fascia latae blends from the muscle tensor fascia latae and condenses laterally to form the IT band

What is the cutaneous innervation of the medial thigh?

Obturator nerve: anterior branch

What is the cutaneous innervation of the posterior thigh

Posterior femoral cutaneous nerve S1-S3

What is the distal continuation of the external iliac artery

The femoral artery once it passes the inguinal ligament

What are the branches of the femoral artery?

Superficial epigastric artery and superficial circumflex iliac artery

What is the name for the deep femoral artery?

Profunda femoris

Branches of the deep femoral artery

Medial circumflex femoral, lateral circumflex femoral, perforating femoral arteries

Direction of the obturator artery

Arises from the internal iliac artery and exits through the obturator canal, supplies the medial compartment of thigh

Direction of Great Saphenous vein

Begins on dorsum of foot at the big toe, courses anterior to medial malleolus, passes through fovea ovalis(saphenous opening) and terminates in the femoral vein

Direction of small saphenous vein

Begins on the lateral dorsum of the foot, courses posterior to lateral malleolus, terminates in the popliteal vein, pierces through and dumps into femoral vein

Anterior compartment of thigh

sartorius, pectineus, illiacus, psoas major, quadriceps femoris

Function of sartorius

hip flexion and knee/leg rotation (tree pose)

Function of pectineus

hip flexor and adductor

Function of iliacus and psoas major

strong hip flexion

Four heads of the quadriceps femoris

rectus femoris, vastus medialis, vastus lateralis, vastus intermedius

Function of vastus

must work together for knee extension

Function of Rectus femoris

only one to do both hip flexion and knee extension

Medial compartment of the thigh

gracilis, adductor longus, adductor brevis, adductor magnus(oblique fibers), obternus externus

Function of gracilis

Leg adduction, medially rotate tibia

Posterior compartment of the thigh

long/short head of biceps femoris, semimembranous, semitendinous, vertical fibers of adductor magnus

What is the function of both heads of the biceps femoris

long head flexes knee and extends thigh/hip, short head only assists in knee flexion

Function via TFL action

Flex hip via pelvic attachment and extend knee via IT band attachment

What is the function of obturator externus

hip abd., External rotation

Function of adductor magnus (Vertical fibers)

hip extension, knee flexion

Semitendinosus

hip ext, knee flex

Semimembranosus

hip ext., hip flex, internal rotation

What innervates sensory to medial side of leg and foot

saphenous n.

Adductor canal borders

begin where sarotorius crosses adductor longus and ends at adductor hiatus

Contents of adductor canal

femoral a/v, deep lymphatic vessels, saphenous n, n to vastus medialis

Knee joint complex

tibiofemoral (modified hinge, basic knee joint), patellofemoral (gliding), proximal tibiofibular (gliding)

Knee flexors vs. extensors

biceps femoris vs. rectus femoris, IT band, vastus muscles

Osgood schlatter

trouble with knee extension that ranges from mild inflammation to evulsion fracture

Chrondomalacia Patella

deterioration of articular surface/cartilage, patella shiftsPos

Bursae of the knee

16 bursae mitigate friction to tendons that run lateral to the bone

Baker’s cyst

benign swelling of semimembranosus bursa on posterior patella

Articularis Genu

distal femur to suprapatellar, lifts bursa and capsule out of joint during knee extension

Tbia-Pes anserinus

goose’s foot

Formation: sartorius, gracilis, semitendinosus

Collateral ligaments

LCL and MCL are taut in knee extension but relaxed in flexion

Extracapsular ligaments

Oblique and arcuate popliteeal ligaments help form floor of popliteal fossa and provide stability and preventing hyperextension

Intracapsular ligaments

ACL and PCL

Injury to ACL

hyperextension, rotational injuries, anterior displacement of tibia (anterior drawer test)

Injury to PCL

Pushes tibia back under femur, “tibia sags under femur”

Menisci

Deepen surface of condyle, shock absorbers/stabilizers

LCL/Lateral meniscus least injured

coronary(sew meniscus to tibia) and transverse genicular ligaments(med to lat meniscus)

Dorsiflexion

extension, drags foot up

Plantar flexion

flexion (point down)

Fascial compartments of the leg

crural fascia, anterior, lateral, posterior compartments

What innervates anterior compartment of the leg?

deep fibular

What muscles are in the anterior compartment of the leg?

Tibialis anterior, extensor digitorum longus, extensor hallucis longus, Peroneus (fibularis) tertius

What muscles are in the lateral compartment of the leg?

Peroneus longus, peroneus brevis

What innervates the lateral compartment of the leg?

superficial fibular nerve

What is the overall action of the anterior compartment of the leg?

Dorsiflexion

What is the overall action of the lateral compartment of the leg?

Eversion

Overall action of the posterior compartment of the leg

Plantar flexion

What leg muscles are inverters

Tibialis posterior and anterior, extensor hallucis longus

Muscles of the superficial posterior compartment of the leg and overall name

Gastrocnemius, plantaris, soleus: triceps surae

What innervates the posterior compartment of the leg?

tibial n.

Muscles of deep posterior compartment of the leg

popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus

Tom, Dick, and Very Nervous Harry

Tibial posterior, flexor digitorum longus, Posterior tibial artery/vein, tibial n., Flexor hallucis longus

Foot drop

inability to dorsiflex/extend toes, injury to deep fibular n

What does the deep fibular n. run with?

anterior tibial artery

What does the tibial n run with?

posterior tibial artery

Cutaneous innervation of medial and posteromedial leg

saphenous n.

Cutaneous innervation of lateral and anterolateral leg

Lateral sural n.

Cutaneous innervation of lower 1/2 anterior leg

superficial fibular nerve