Extremities

Iliohypogastric

- runs across transversus abdominalis & internal oblique, supplies them, supplies the skin suprapubic region.

How many branches derive from the common fibular division of the sciatic nerve?

-Lateral sural cutaneous -Sural communicating -Deep fibular -Superficial fibular

What muscles make up triceps surae

-Soleus -Gastrocnemius medial and lateral head

Genitofemoral

(L1-L2) - runs through and across psoas major & divides into 2 Branches: Genital & Femoral

Direct blood supply to lateral compartment of lower leg?

Fibular Artery?

What muscle has its origin on Flexor digitorum longus?

Lumbricals

Origin: Ischial spine Insertion: Intertrochanteric fossa Greater Trochanter

Superior Gemellus

Genital branch -

enters inguinal canal, supplies scrotum or labia majora.

Obturator (Anterior Division)

(L2-L4) - medial border of psoas major, enters thigh via the obturator foramen. Innervates adductors of the thigh & innervates a patch of skin medial (adductor area) above the knee.

N. to quadratus femoris

(L4-S1) - enters via greater sciatic foramen innervates hip joint, inferior gemellus & quadratus femoris

Superior gluteal n

(L4-S1) - exits via greater sciatic foramen emerges along the superior border of piriformis. Supplies Glut. Medius, Minimus, TFL

Sciatic n

(L4-S3) - exits greater sciatic foramen emerges from the inferior border of piriformis and runs to the popliteal fossa and branches into the tibial (anterior division& common fibular (common peroneal)(posterior division)

A 49yr. old overweight male presents with numbness and burning pain of his anterior/ lateral right thigh. Your most likely diagnosis is?

Lateral femoral cutaneous nerve entrapment

Which muscle listed is the primary or strongest dorsi-flexor of the ankle?

Tibialis anterior

Tarsal tunnel syndrome typically involves a lesion of which nerve?

Tibial

What joint of the pelvis is synovial in the anterior and syndesmosis in the posterior?

SI joint

Cutaneous innervation to medial knee and calves

Saphenous N.

The strongest tendon below the hip of the lower extremity is the______.

Calcaneal/ Achilles

What is the first artery off femoral triangle?

Deep femoral/Profundus femoris

Femoral (Posterior division)

(L2-L4) - lateral border of psoas major & separates into several anterior femoral cutaneous branches and the saphenous n., passes under the inguinal ligament. Supplies knee extensors & thigh flexors. Provides sensation to anteromedial thigh.

What muscle listed below is not found in the second layer (plantar) of the foot?

Flexor digiti minimi brevis

Lateral femoral cutaneous

(L2-L3) runs over iliacus to pass under inguinal lig. & supply the skin over lateral thigh

What two tendons from posterior compartment of the lower leg pass through the medial malleolar groove?

-Tibialis Posterior -Flexor digitorum longus

How many muscle in posterior compartment of leg?

7

How many phases are in the gait cycle?

8

What cutaneous nerve supplies the distal medial thigh region?

Obturator

What muscle make up medial floor of femoral triangle?

Pectineus

Inferior gluteal n

(L5-S2) - exits via greater sciatic foramen emerges along the inferior border of piriformis. Supplies Glut. Maximus.

N. to obturator internus

(L5-S2) - exits via greater sciatic foramen then re-enters the pelvis via the lesser sciatic foramen innervates superior gemellus & obturator internus

Perforating cutaneous n.

(L5-S2) - passes through the sacrotuberous ligament. Skin over lower medial gluteal region,

N. to piriformis

(S1 / S2) - deep to piriformis.

Posterior femoral cutaneous n

(S1-S3) *exits greater sciatic foramen runs deep to gluteus maximus and emerges from its inferior border.

Pudendal n.

(S2-S4) - exits greater sciatic foramen, re-enters the pelvis via the lesser sciatic foramen & innervates most of the perineum.

Femoral branch

passes under inguinal lig., innervates skin over the Femoral Triangle

Location of Gerdy's Tubercle

-Anterior Superior Lateral Tibial -Iliotibial tract attaches there

Bony insertions of the long plantar ligament?

-Calcaneus -Cuboid -Metatarsals 2-4 bases

Four arterial pulses in lower extremity

-Dorsalis Pedis -Popliteal -Femoral -Posterior Tibial

What is the subsartorial canal?(Adductor/Hunters canal)

-Femoral artery and vein -Nerve to vastus medialis and lateralis

What two tendons from posterior compartment of the lower leg pass through the Lateral malleolar groove?

-Fibularis longus and Brevis

Name two posterior compartment on second layer on plantar side of foot?

-Flexor digitorum longus -Flexor Hallicus longus

Dorsal venous arch drains into which two ascending veins

-Greater saphenous (Medial side of foot) -Lesser saphenous(lateral side of foot)

The blood supply to the muscles of the lateral compartment of the leg is derived primarily from which of the following arteries?

Fibular

What muscle of the foot is innervated by medial plantar nerve?

1st lumbrical

How many muscle in lateral compartment of leg?

2

How many muscles make up floor of femoral triangle?

2

What three muscles make up upper and lower medial border of popliteal fossa?

2 upper-semimembranous and semitendinosus 1 lower-Medial head of gastrocnemius

How many muscle in anterior compartment of leg?

4

Ilioinguinal

Ilioinguinal (L1) - Innervates internal oblique, passes through inguinal canal innervates the proximomedial thigh, root of penis, upper scrotum or mons pubis and labia majora

A construction worker has his common fibular nerve completely severed and all contents destroyed when a plate glass window falls and strikes his fibular head region. Which of the following actions can not be performed as a result?

Eversion of foot

How many interosseous muscle do we have of the foot?

7 muscles (3 pad, 4 dab)

The quadratus plantae muscle receives its nerve supply from which spinal nerve roots?

S2,S3

What muscle of the foot is innervated by medial plantar nerve in first layer?

Abductor hallicus and flexor digitorum brevis

What functional muscle group will be innervated by Obturator N?

Adductor compartent

Medial muscle border of femoral triangle?

Adductor longus

Popliteal artery divides into what two branches?

Anterior and Posterior Tibial

Nerve branch that lies between Adductor longus and brevis

Anterior branch of obturator

A patient presented to you with pain in the anterior lower leg causing an inability to dorsiflex their foot after beginning a running program. They also complained of having a loss of sensation of the foot(dorsal surface) between digits 1&2.

Anterior compartment syndrome.

Excessive anterior movement of the tibia when pulling the tibia forward on the leg with the knee in non weight bearing flexion( a positive anterior drawer sign) indicate damage to which structure?

Anterior cruciate ligament

The "Terrible Triad of O' Donohue" refers to an injury of the knee involving the following structures of the knee?

Anterior cruciate ligament, medial collateral ligament, medial meniscus

Which nerves innervate the adductor brevis?

Anterior division or branch of obturator n.

Describe where pans anserine is located?

Anterior superior proximal tibia, below medial meniscus

The most injured ligament with a high ankle inversion sprain is the?

Anterior tibiofibular.

What muscle lies deep to the vastus intermedius who's action retracts the synovial capsule of the patella during leg extension to prevent pinching?

Articularis genu

What plantar side of foot is considered neurovascular layer?

Between 1st and 2nd

Which muscle listed helps form the superior lateral Wall or margin of the popliteal fossa?

Biceps femoris (long head)

O: Linea aspera and lateral supracondylar ridge I: Lateral head of fibula

Biceps femoris (short head)

Which muscle is supplied by the common fibular nerve?

Biceps femoris(short head)

Sural communicating comes from what branch of sciatic nerve?

Common Fibular

Deep fibular comes from?

Common fibular

Greater saphenous vein dumps into

Femoral vein (femoral triangle)

A patient presented to you with pain in the anterior lower leg causing an inability to dorsiflex their foot after beginning a running program. They also complained of having a loss of sensation of the foot(dorsal surface) between digits 1&2.The loss of sensation to the dorsum of the foot between the web of digits 1&2 due to the injury of what nerve?

Deep Fibular.

The cutaneous innervation on the anterior medial aspect of tibia (lower leg) is supplied by which nerve?

Deep fibular

The extensor digitorum brevis muscle is innervated by which nerve?

Deep fibular

Which of the following nerves innervates the fibularis tertius muscle?

Deep fibular

Two vein in femoral triangle

Femoral vein and Great saphenous

In the following joint combinations, identify the incorrect joint/ classification:

Distal tibiofibular-synovial plane

In the following combination, identify the INCORRECT muscle/innervation.

Extensor hallucis brevis-superficial fibular nerve.

A construction worker served his tibial nerve just distal to the popliteal fossa. Which of the following muscles would remain intact and fuctional?

Extensor hallucis longus

In a patient with a lumbar herniated disc (L4) causing an L5 radiculopathy, which of following muscles is MOST likely to exhibit weakness upon manual muscle testing?

Extensor hallucis longus.

Which muscle listed is not innervated by the deep fibular nerve?

Fibularis brevis

The primary blood supply to the foot extensors of the distal phalanges and the great toe is delivered by which of the following arteries?

Fibulary artery

Action of pectineus muscle?

Flexes the hip joint and medially rotates and adducts the thigh

Which of the following is not a constituent within the tarsal tunnel?

Flexor digitorum brevis tendon

What muscle of the foot is innervated by medial plantar nerve in third layer?

Flexor hallicus brevis

Superficial/roof of tarsal tunnel

Flexor retinacalum

Cutaneous innervation to the femoral triangle is supplied by which of the following nerves?

Genitofemoral

Iliacus and Psoas Major come together to form?

Iliopsoas

What muscle make up lateral floor of femoral triangle?

Iliopsoas

Where is quadrate tubercle located?

Intertrochanteric crest, Quadratus femoris attaches to it

Action of Tibialis Posterior muscle?

Inverts and plantar flexes the foot at the ankle

Spinal innervation of two muscles on dorsum of foot?

L5 and S1

A patient with the inability to extend the knee against resistance most likely has sustained a lesion, which of the following nerve roots?

L4 (

The extensor hallucis brevis muscle receives most of its axons from which nerve root level?

L5/S1

Which of the following nerves innervates the abductor digiti minimi of the foot?

Lateral plantar

All the following anatomy listed passes through "Hunter's canal", except?

Lateral femoral cutaneous nerve.

Which structure or vessel listed is not contained within the "femoral triangle "?

Lateral femoral cutaneous nerves

Which of the following statements with respect to lateral femoral cutaneous neuraglia is correct?

Leads to pain &numbness on anterior lateral thigh

What nerves runs with the sural of the posterior calve and empties into popliteal vein

Lesser saphenous vein

Action of have in common with gluteus medius and minimus and tensor fascia lata?

Medially, internally rotate and abduct

The superior gemellus muscle is innervated by which of the following nerves?

Nerves to obturator internus

Which nerves innervate the adductor magnus?

Obturator posterior division & sciatic tibial division

A patient hip/thigh pain presents for a consultation. There is pain paresis (weakness) upon resisted external (lateral) rotation of the posterior hip joint. Which muscle would not be implicated as the primary pain/ weakness generator?

Pectineus.

What muscle tendon is commonly harvested for surgical tendon grafting of the hand?

Plantaris

Nerve branch that lies between Adductor brevis and magnus?

Posterior branch of Obturator

Lina aspera located

Posterior shaft of femur

What palpable artery is located along the medial malleolus of the ankle?

Posterior tibial

The fibular artery branches off from what other arterial branch?

Posterior tibial artery

What muscle has its insertion on Flexor digitorum longus?

Quadratus Plantae

Origin: AIIS Insertion: Tibial tuberosity

Rectus femoris

Name the muscle whose distal tendon inserts into the posterior aspect of the medial condyle of the tibia and continues from medial to lateral across the popliteal fossa as the oblique popliteal ligament.

Semimembranosus.

Name muscle that has distal insertion reflect into ligament of medial condyle of femur?

Semimembranous, Oblique Popliteal ligament

Another name for plantar calcaneal cuboid ligament?

Short plantar

60% of gait cycle occurs during what phase?

Stance phase

Motor innervation to the lateral compartment of lower leg and cutaneous innervation to the majority of the dorsum of the foot is innervated by which of the following nerves?

Superficial fibular.

A Person with a positive Trendelenburg sign has an injury to which nerve?

Superior gluteal

The tensor fascia lata muscle is innervated by which of the following nerves?

Superior gluteal nerve

Cutaneous innervation down the posterior calf and into the lateral foot is provided by which of the following nerves?

Sural

Two branches that form sural nerve?

Sural communicating and medial sural cutaneous

40% of gait cycle occurs during what phase?

Swing phase

Where does posterior tibial artery go?

Tarsal tunnel

What point does tibial nerve bifurcate into two plantar nerves?

Tarsal tunnel ( Medial malleolus)

Pans Anserine

Tendons of Gracilis (Medial), sartorius(Anterior) semitendinosus(Posterior)

What functional muscle group will be innervated by femoral N.

Thigh Flexors, Leg extensors (Quads)

What functional muscle group will be innervated by sciatic nerve?

Thigh extensors and adbductors

Os Coxae (Innominate)

This consists of a fused ilium, ishium, and pubis

Where does anterior tibial artery go?

Through interossues membrane, to anterior compartment

Medial sural cutaneous comes from what branch of sciatic nerve?

Tibial division

innervation of hamstring part of adductor magnus

Tibial division of sciatic nerve

What tendons run through tarsal tunnel

Tibialis Posterior -Flexor digitorum longus -Flexor Hallicus longus

In patient that is suspected of having an SI radiculopathy,which of the muscles listed below would be the least likely to exhibit evidence of paresis?

Tibialis anterior

What muscle on the anterior compartment of lower leg does not have attachment on fibula?

Tibialis anterior

Deformity you see with knocked knee?

Valgus deformity

A Person with a positive Trendelenburg sign will have a swing out gait how?

Will swing away from side of involvement

Subcostal n. (T12)

inferior border 12th rib & supplies pyramidalis m. & skin over the anterior iliac crest & greater trochanter.

The cutaneous termination (branch) of the sural nerve is the

lateral dorsal cutaneous

What action does piriformis and triceps coxae?

laterally rotates extended thigh and abduct a flexed thigh

Where is Adductor tubercle located

medial supracondylar ridge, Hamstring part of adductor magnus attaches to it

Sural n. will supply

skin along distal 2/3rds of posterolateral calf & lateral aspect of foot, over 5th digit.