LL Muscle and Fascia
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Questions and Answers

Which nerve emerges above the piriformis muscle?

  • Posterior femoral cutaneous nerve
  • Inferior gluteal nerve
  • Superior gluteal nerve (correct)
  • Sciatic nerve

    • What is the primary function of the gluteus maximus muscle?

  • Medial rotation and flexion of the thigh
  • Abduction of the thigh
  • Lateral rotations and extension of the thigh (correct)
  • Medial rotation of the thigh

    • Which muscle is located directly inferior to the gluteus minimus muscle?

  • Gluteus maximus
  • Piriformis muscle (correct)
  • Quadratus femoris
  • Tensor fasciae latae

    • What structures emerge below the piriformis muscle?

    <p>Inferior gluteal vessels and nerves</p> Signup and view all the answers

    Which component does the intermuscular septae primarily separate?

    <p>Muscles of similar functions</p> Signup and view all the answers

    Where do most gluteal muscles insert?

    <p>Greater trochanter of the femur</p> Signup and view all the answers

    What is one reason the hip joint is considered to be very stable?

    <p>More than half of the femoral head fits within the acetabulum.</p> Signup and view all the answers

    Which area should NOT be used for intramuscular injections to avoid injury?

    <p>Gluteal prominence.</p> Signup and view all the answers

    Which movement is NOT permitted by the hip joint?

    <p>Inversion.</p> Signup and view all the answers

    What role does the acetabular labrum play in the hip joint?

    <p>Increases the depth and stability of the acetabulum.</p> Signup and view all the answers

    Where should intramuscular injections in the buttock area be administered to minimize risk?

    <p>Superolateral quadrant.</p> Signup and view all the answers

    Which blood vessel is most likely to be associated with the gluteal region?

    <p>Superior and Inferior gluteal artery.</p> Signup and view all the answers

    What is the main arterial supply of the femoral head?

    <p>Retinacular arteries</p> Signup and view all the answers

    What complication can arise from damage to the arteries supplying the hip joint?

    <p>Avascular necrosis of the femoral head</p> Signup and view all the answers

    Which structure is primarily responsible for enclosing the saphenous opening?

    <p>Cribriform fascia</p> Signup and view all the answers

    What is the purpose of the saphenous opening?

    <p>To allow passage of the great saphenous vein</p> Signup and view all the answers

    Which arteries are branches of the deep femoral artery that supply the hip joint?

    <p>Lateral femoral circumflex and medial femoral circumflex arteries</p> Signup and view all the answers

    Where is the saphenous opening located in relation to the inguinal ligament?

    <p>inferior and lateral</p> Signup and view all the answers

    Which condition is associated with the risk of avascular necrosis of the femoral head?

    <p>Damage to retinacular arteries</p> Signup and view all the answers

    Which fascia is a derivative of the membranous layer of the superficial fascia?

    <p>Cribriform fascia</p> Signup and view all the answers

    What is the primary action of the sartorius muscle when both sides are contracted?

    <p>Flexes the hip and knee while laterally rotating the thigh</p> Signup and view all the answers

    Which structure does the patellar ligament connect to?

    <p>Tibial tuberosity</p> Signup and view all the answers

    Which group of muscles form the patellar retinacula?

    <p>Vastus lateralis and vastus medialis</p> Signup and view all the answers

    What is another common name for the sartorius muscle due to its function?

    <p>Tailor muscle</p> Signup and view all the answers

    What is the significance of the patella within the knee joint biomechanically?

    <p>It increases the leverage of the quadriceps during knee extension</p> Signup and view all the answers

    What is the primary insertion point of the iliopsoas muscle?

    <p>Lesser trochanter</p> Signup and view all the answers

    Which statement about the psoas minor muscle is accurate?

    <p>It may be inconsistent in presence and function.</p> Signup and view all the answers

    What is considered the primary action of the iliopsoas muscle?

    <p>Flexion of the hip</p> Signup and view all the answers

    Where is the psoas minor located when present?

    <p>Anterior to psoas major</p> Signup and view all the answers

    In which anatomical region does the iliopsoas muscle primarily originate?

    <p>Vertebral column</p> Signup and view all the answers

    Which structure is located medial to the femoral vein within the femoral sheath?

    <p>Deep inguinal lymph nodes</p> Signup and view all the answers

    What is the main clinical significance of understanding the femoral triangle?

    <p>Avoiding damage during surgical procedures</p> Signup and view all the answers

    Which compartment of the femoral sheath contains the femoral artery?

    <p>Lateral compartment</p> Signup and view all the answers

    Which structure is NOT enclosed by the femoral sheath?

    <p>Femoral nerve</p> Signup and view all the answers

    What potential risk is associated with a femoral hernia repair?

    <p>Damage to the femoral nerve</p> Signup and view all the answers

    During a femoral tap for arterial blood gas studies, which anatomical feature is critical to identify?

    <p>Femoral triangle</p> Signup and view all the answers

    What is the function of the deep inguinal lymph nodes within the femoral sheath?

    <p>Draining lymph from the lower limb</p> Signup and view all the answers

    What are the two layers that make up joint capsules?

    <p>Internal Synovial Membrane and External Fibrous Layer</p> Signup and view all the answers

    How can the safe area for injection in the gluteal region be identified?

    <p>By drawing a line to the greater trochanter</p> Signup and view all the answers

    Which component of the joint capsule may thicken to form ligaments?

    <p>External Fibrous Layer</p> Signup and view all the answers

    What muscular landmark corresponds to the upper limit related to the safe injection site?

    <p>Piriformis muscle</p> Signup and view all the answers

    What is the primary distal attachment for the semimembranosus muscle?

    <p>Posterior part of medial condyle of the tibia</p> Signup and view all the answers

    Which action is primarily associated with the adductor magnus (hamstring part)?

    <p>Adducts and extends the thigh</p> Signup and view all the answers

    Which nerve primarily innervates the semimembranosus muscle?

    <p>Tibial division of the sciatic nerve</p> Signup and view all the answers

    What role does the pes anserinus play in the context of the tendons involved?

    <p>It is the insertion point for multiple tendons including the semitendinosus.</p> Signup and view all the answers

    Which statement about the knee joint is correct?

    <p>It is classified as a synovial modified hinge joint.</p> Signup and view all the answers

    Which muscle has a proximal attachment at the ischial tuberosity?

    <p>Semitendinosus</p> Signup and view all the answers

    Which action occurs when the knee is flexed in relation to the semitendinosus and semimembranosus muscles?

    <p>They rotate the leg medially.</p> Signup and view all the answers

    What is the anatomical region that lies between the gluteal, abdominal, and perineal regions proximally?

    <p>Femoral region</p> Signup and view all the answers

    Which ligament demarcates the boundary between the abdominal/perineal regions and the femoral region anteriorly?

    <p>Inguinal ligament</p> Signup and view all the answers

    Which bony landmark is located anteriorly to the femoral region?

    <p>Anterior Superior Iliac Spine (ASIS)</p> Signup and view all the answers

    What is the transitional area between the trunk and the free lower limb known as?

    <p>Inguinal region</p> Signup and view all the answers

    Which component is found medially at the boundary of the femoral region?

    <p>Ischiopubic ramus</p> Signup and view all the answers

    Which structures are included in the knee joint?

    <p>Distal femur and patella</p> Signup and view all the answers

    What is the primary function of the popliteal fossa?

    <p>It transmits neurovascular structures</p> Signup and view all the answers

    Which bones primarily constitute the leg?

    <p>Tibia and fibula</p> Signup and view all the answers

    What is often misunderstood by laypersons regarding anatomical terminology?

    <p>They refer to the whole lower limb as 'the leg'</p> Signup and view all the answers

    What role does deep fascia play in the lower limbs?

    <p>Encloses and organizes muscle groups</p> Signup and view all the answers

    Which of the following best describes the fascial disposition in the lower limbs?

    <p>It varies between different compartments</p> Signup and view all the answers

    What does knee cap refer to in anatomical terms?

    <p>Patella</p> Signup and view all the answers

    What are the main movements associated with the lower limbs?

    <p>All basic movements including rotation</p> Signup and view all the answers

    What is the main arterial supply to the hip joint?

    <p>Retinacular arteries</p> Signup and view all the answers

    Which condition can result from damage to the arteries supplying the hip joint?

    <p>Avascular necrosis</p> Signup and view all the answers

    Which structure allows for the passage of the great saphenous vein into the femoral vein?

    <p>Saphenous opening</p> Signup and view all the answers

    Where is the saphenous opening located relative to the inguinal ligament?

    <p>Inferior and lateral</p> Signup and view all the answers

    What is the function of the cribriform fascia?

    <p>Enclose the saphenous opening</p> Signup and view all the answers

    What artery primarily supplies the head of the femur?

    <p>Artery to the head of the femur</p> Signup and view all the answers

    What anatomical feature is formed by the inferolateral presenting margin of the saphenous opening?

    <p>Falciform margin</p> Signup and view all the answers

    Which structure is located below the medial part of the inguinal ligament?

    <p>Saphenous opening</p> Signup and view all the answers

    Which muscle is located directly above the piriformis muscle?

    <p>Gluteus medius</p> Signup and view all the answers

    What is the primary function of the tensor fasciae latae muscle?

    <p>Flexion and abduction of the thigh</p> Signup and view all the answers

    Which of the following muscles does NOT make up the triceps coxae group?

    <p>Quadratus femoris</p> Signup and view all the answers

    Which structure does the intermuscular septae primarily separate?

    <p>Muscles with similar functions</p> Signup and view all the answers

    What nerve is considered the most significant for supplying the lower limb?

    <p>Sciatic nerve</p> Signup and view all the answers

    Which muscle is found directly inferior to the gluteus minimus?

    <p>Piriformis</p> Signup and view all the answers

    Which of the following muscles is NOT typically found in the gluteal region?

    <p>Rectus femoris</p> Signup and view all the answers

    Where do almost all gluteal muscles insert?

    <p>Greater trochanter of the femur</p> Signup and view all the answers

    What is the primary function of the Anterior Cruciate Ligament (ACL)?

    <p>Prevent posterior displacement of the femur</p> Signup and view all the answers

    Which ligament is described as the weaker of the two cruciate ligaments?

    <p>Anterior Cruciate Ligament (ACL)</p> Signup and view all the answers

    Where does the Patellar Ligament attach?

    <p>Tibial tuberosity</p> Signup and view all the answers

    What function does the Posterior Cruciate Ligament (PCL) serve during hyperflexion?

    <p>Prevents rolling of the femur anteriorly</p> Signup and view all the answers

    What is one of the key features of the joint capsule of the knee joint?

    <p>Is reinforced by both intracapsular and extracapsular ligaments</p> Signup and view all the answers

    The internal lining of the articular cavity of the knee joint is composed of which type of membrane?

    <p>Synovial membrane</p> Signup and view all the answers

    What is the primary role of the anterior ligament of the knee joint?

    <p>Provide anterior stabilization</p> Signup and view all the answers

    Which of the following is NOT classified as an extracapsular ligament in the knee joint?

    <p>Anterior Cruciate Ligament (ACL)</p> Signup and view all the answers

    What does the term 'goosefoot' refer to in terms of muscle attachment?

    <p>The arrangement of muscles on the medial tibia</p> Signup and view all the answers

    Which muscles are represented in the common tendinous insertion found on the medial surface of the tibia?

    <p>Sartorius, Gracilis, and SemiTendinosus</p> Signup and view all the answers

    Which mnemonic can help remember the muscles contributing to the common tendinous insertion?

    <p>SGT - Sartorius, Gracilis, and SemiTendinosus</p> Signup and view all the answers

    Which muscle is primarily referred to as the 'horseback-riding muscle'?

    <p>Sartorius</p> Signup and view all the answers

    Where is the proximal attachment of the Adductor Longus muscle located?

    <p>Body of the pubis inferior to the pubic crest</p> Signup and view all the answers

    Which ligament of the hip joint primarily prevents hyperextension?

    <p>Iliofemoral</p> Signup and view all the answers

    What is the primary role of the pubofemoral ligament?

    <p>Prevents over abduction</p> Signup and view all the answers

    Among the three main ligaments of the hip joint, which one is considered the weakest?

    <p>Pubofemoral</p> Signup and view all the answers

    What is a potential complication of improper injection technique in the anterolateral part of the thigh?

    <p>Nerve injury</p> Signup and view all the answers

    Where does the iliofemoral ligament primarily reinforce the hip joint?

    <p>Anterosuperiorly</p> Signup and view all the answers

    Which structure acts as the primary intracapsular ligament of the hip joint?

    <p>Ligamentum teres</p> Signup and view all the answers

    What anatomical reference can be used to identify a safe zone for injections in the thigh?

    <p>ASIS and iliac tubercle</p> Signup and view all the answers

    Which ligament is involved in reinforcing the hip joint posteriorly?

    <p>Ischiofemoral ligament</p> Signup and view all the answers

    What structure is contained within the medial compartment of the femoral sheath?

    <p>Deep inguinal lymph nodes</p> Signup and view all the answers

    Which nerve primarily innervates the pectineus muscle?

    <p>Femoral nerve</p> Signup and view all the answers

    Which action is performed by the pectineus muscle on the thigh?

    <p>Flexes and adducts</p> Signup and view all the answers

    Why is it important to know the location of the femoral artery during clinical procedures?

    <p>To perform arterial blood gas studies</p> Signup and view all the answers

    What does the middle compartment of the femoral sheath contain?

    <p>Femoral vein</p> Signup and view all the answers

    What clinical procedure might benefit from lymph node sampling in the inguinal region?

    <p>Assessment of cancer spread</p> Signup and view all the answers

    In which anatomical region does the deep inguinal lymph node reside?

    <p>Medial compartment of the femoral sheath</p> Signup and view all the answers

    What is the significance of the femoral canal in clinical practice?

    <p>It helps in assessing lymphatic spread of disease.</p> Signup and view all the answers

    What anatomical feature contributes to the stability of the hip joint?

    <p>The acetabular labrum deepening the socket</p> Signup and view all the answers

    Which movement is permitted by the hip joint?

    <p>Medial rotation</p> Signup and view all the answers

    What is a recommended site for administering intramuscular injections in the buttock?

    <p>Superolateral quadrant</p> Signup and view all the answers

    Which of the following structures is NOT considered an intrinsic stabilizing factor of the hip joint?

    <p>Articular cartilage covering the femur</p> Signup and view all the answers

    What anatomical relationship does the acetabulum have with the femoral head?

    <p>More than half of the femoral head fits within the acetabulum</p> Signup and view all the answers

    Which action is NOT performed by the hip joint?

    <p>Pronation</p> Signup and view all the answers

    Why is the hip joint classified as a ball-and-socket joint?

    <p>One surface is convex and the other is concave</p> Signup and view all the answers

    What should be avoided during intramuscular injections in the gluteal region?

    <p>Injecting in the gluteal prominence</p> Signup and view all the answers

    What is the primary role of the rectus femoris within the quadriceps femoris?

    <p>To extend the knee when the hip is flexed</p> Signup and view all the answers

    Which of the following statements is true regarding the vastus intermedius muscle?

    <p>It lies between the rectus femoris and vastus lateralis.</p> Signup and view all the answers

    How many heads does the quadriceps femoris consist of?

    <p>Four</p> Signup and view all the answers

    Which muscle originates from the anterior inferior iliac spine?

    <p>Rectus femoris</p> Signup and view all the answers

    What is the anatomical position of the sartorius muscle?

    <p>Runs diagonally from the anterior superior iliac spine</p> Signup and view all the answers

    What structure does the quadriceps tendon encompass?

    <p>The patella</p> Signup and view all the answers

    Which muscle is commonly referred to as the 'kicking muscle'?

    <p>Rectus femoris</p> Signup and view all the answers

    Which muscles comprise the vasti group of the quadriceps?

    <p>Vastus lateralis, vastus medialis, and vastus intermedius</p> Signup and view all the answers

    What condition is characterized by inflammation of the prepatellar bursa?

    <p>Housemaid's knee</p> Signup and view all the answers

    Which of the following describes genu varum?

    <p>Medial angulation of the leg in relation to the femur</p> Signup and view all the answers

    Which structure is the deepest in the popliteal fossa?

    <p>Popliteal artery</p> Signup and view all the answers

    What characterizes infrapatellar bursitis?

    <p>Inflammation of the superficial infrapatellar bursa</p> Signup and view all the answers

    Which nerve is located posterior to the popliteal artery and anterior to the tibial nerve in the popliteal fossa?

    <p>Tibial nerve</p> Signup and view all the answers

    What is the primary boundary of the superomedial side of the popliteal fossa?

    <p>Semitendinosus</p> Signup and view all the answers

    Suprapatellar bursitis commonly results from what issue?

    <p>Infection of the synovial cavity</p> Signup and view all the answers

    What anatomical feature obliterates the dimples next to the patellar ligament when the leg is extended?

    <p>Deep infralateral bursitis</p> Signup and view all the answers

    Which muscle in the anterior compartment of the leg is primarily responsible for dorsiflexion of the ankle and inversion of the foot?

    <p>Tibialis anterior</p> Signup and view all the answers

    Which compartment of the leg is NOT categorized under the four main compartments described?

    <p>Superficial dorsal compartment</p> Signup and view all the answers

    What is the primary innervation for the muscles found in the anterior compartment of the leg?

    <p>Deep fibular nerve</p> Signup and view all the answers

    Which muscle primarily extends the lateral four digits of the foot?

    <p>Extensor digitorum longus</p> Signup and view all the answers

    What is the main action of the muscle Tibialis anterior?

    <p>Dorsiflexion and inversion</p> Signup and view all the answers

    Which statement about the Extensor hallucis longus muscle is incorrect?

    <p>It also acts to plantarflex the foot.</p> Signup and view all the answers

    How many muscles are located in the anterior compartment of the leg?

    <p>Four</p> Signup and view all the answers

    Which of the following muscles is NOT typically found in the anterior compartment of the leg?

    <p>Fibularis longus</p> Signup and view all the answers

    What is the main action of the Fibularis Tertius muscle?

    <p>Extends the great toe and dorsiflexes the ankle</p> Signup and view all the answers

    What is a significant risk factor for developing leg compartment syndrome in this patient case?

    <p>Hypothyroidism while taking simvastatin</p> Signup and view all the answers

    Which nerve supplies the Fibularis Longus muscle?

    <p>Superficial peroneal nerve</p> Signup and view all the answers

    What complication arises from increased pressure within a limb compartment?

    <p>Decreased nerve transmission</p> Signup and view all the answers

    What is the first step in treating leg compartment syndrome?

    <p>Performing a fasciotomy</p> Signup and view all the answers

    What anatomical structure is cut during a fasciotomy to relieve compartment syndrome?

    <p>Muscle fascia</p> Signup and view all the answers

    Which symptom is NOT associated with leg compartment syndrome?

    <p>Loss of appetite</p> Signup and view all the answers

    Which component is crucial for the surgeon to know when treating leg compartment syndrome?

    <p>Locations of muscle compartments</p> Signup and view all the answers

    What is the consequence of untreated compartment syndrome?

    <p>Potential limb loss</p> Signup and view all the answers

    Which muscle lies between the tibialis anterior and extensor digitorum longus?

    <p>Fibularis Tertius</p> Signup and view all the answers

    Chief flexor of the thigh

    <p>Iliopsoas</p> Signup and view all the answers

    Chief extensor of the leg

    <p>Quadriceps Femoris</p> Signup and view all the answers

    Anterior muscles of the thigh usually function as

    <p>flexors of the thigh and extensors of the knee</p> Signup and view all the answers

    Triceps coxae function

    <p>Abduction and lateral rotation of thigh</p> Signup and view all the answers

    Most deep muscles of the gluteal region function as

    <p>lateral rotators of the thigh</p> Signup and view all the answers

    Almost all muscles of the ____ region, insert around the greater trochanter of the femur

    <p>Gluteal</p> Signup and view all the answers

    Most muscles of the gluteal region are lateral rotators except

    <p>Gluteus medius, minimus, and tensor fascia latae</p> Signup and view all the answers

    Muscles that keep the pelvis level

    <p>Gluteus medius, minimus, and tensor fascia latae</p> Signup and view all the answers

    workhorse muscle of hip extension

    <p>biceps femoris</p> Signup and view all the answers

    only muscle that has attachments tot he vertebral column, pelvic bone, and the femur

    <p>Iliopsoas</p> Signup and view all the answers

    Parts of the Adductor Magnus and their function

    <p>Function: Adducts + Adductor part (Adductor Minimus; anterior) - flexes thigh at hips Hamstring part - extends thigh</p> Signup and view all the answers

    Boundaries of Popliteal Fossa

    <p>Diamond shaped</p> <p>Superior</p> <ul> <li>Lateral: Biceps Femoris</li> <li>Medial: Semitendinosus Inferior</li> <li>Lateral: Lateral head of Gastrocnemius</li> <li>Medial: Medial head of Gastrocnemius</li> </ul> Signup and view all the answers

    Contents of Popliteal fossa?

    Q1: Which among them is the most superficial?

    <ol> <li>Small Saphenous Vein</li> <li>Popliteal vessels</li> <li>Tibial and Common peroneal nerve</li> <li>Posterior femoral cutaneous nerve</li> <li>Popliteal lymph nodes and lymphatic vessels</li> </ol> <p>Q1: Tibial nerve</p> Signup and view all the answers

    Which is more visible in the popliteal fossa?

    <p>Popliteal vein</p> Signup and view all the answers

    The sciatic nerve divides into the ________ at the __________

    <p>The sciatic nerve divides into the tibial and common peroneal nerve at the superior angle of the popliteal fossa</p> Signup and view all the answers

    Tarsal Tunnel

    1. contents
    2. location

    <ol> <li> <p>(medial to lateral: Tom Dick And Very Nervous Harry) Tibialis Posterior Flexor Digitorum Longus (Artery) Posterior Tibial (Vein) Posterior Tibial (Nerve) Tibial Flexor Hallucis Longus</p> </li> <li> <p>behind medial malleolus</p> </li> </ol> Signup and view all the answers

    Type of joint of the ankle joint

    <p>Hinge type (Synovial)</p> Signup and view all the answers

    Which among statements about the Talocrural joint is true?

    <p>More stable during dorsiflexion</p> Signup and view all the answers

    Which action makes the ankle joint more prone to injuries?

    <p>Plantarflexion</p> Signup and view all the answers

    What makes up the Triceps Surae

    <p>2 heads of Gastrocnemius + Soleus</p> Signup and view all the answers

    Part of the lower leg that is used in grafting

    <p>Plantaris</p> Signup and view all the answers

    Which ligament resists inversion of the ankle joint?

    <p>Lateral ligament</p> Signup and view all the answers

    Ankle sprain:

    1. What excessive action usually leads to this?
    2. This is a painful injury to? (Muscle/Ligament/Tendon)

    <ol> <li>Excessive inversion of foot</li> <li>Ligament/Tendon</li> </ol> Signup and view all the answers

    Ankle strain:

    1. This is a painful injury to? (Muscle/Ligament/Tendon)

    <p>Muscle</p> Signup and view all the answers

    Which ligament is stronger?

    <p>Medial ligament</p> Signup and view all the answers

    Most important ligament in the foot? Why?

    <p>Plantar Fascia Ligament</p> <blockquote> <p>helps balance and give strength during walking (windlass mechanism)</p> </blockquote> Signup and view all the answers

    Which function of the arches of the foot is true?

    <p>Integrity is maintained by the shape of the bones</p> Signup and view all the answers

    Which does not make up the Medial Longitudinal arch?

    <p>Cuboid</p> Signup and view all the answers

    Which does not make up the Lateral Longitudinal arch?

    <p>1st to 3rd metatarsals</p> Signup and view all the answers

    This functions in balancing the body

    <p>Lateral longitudinal arch</p> Signup and view all the answers

    Which does not form the transverse arch?

    <p>Calcaneus</p> Signup and view all the answers

    Most important ligament that supports the lateral longitudinal arch

    <p>Tendon of Fibularis Longus</p> Signup and view all the answers

    Failure of this ligament will lead to flat foot deformity

    <p>Spring Ligament</p> Signup and view all the answers

    Ligaments that contributes to the dynamic support of the foot?

    <p>tendons of FHL and FDL</p> Signup and view all the answers

    Pes Planus is due to?

    <p>aka flat foot = due to decrease in medial longitudinal arch</p> Signup and view all the answers

    Pes Cavus is due to?

    <p>aka high arch = exaggeration of medial longitudinal arch</p> Signup and view all the answers

    Trendelenburg Test

    1. aka?
    2. Clinical assessment for?
    3. What muscles is affected by a negative result?

    <ol> <li>Unilateral leg test</li> <li>hip dysfunction</li> <li>Gluteus minimus and medius</li> </ol> Signup and view all the answers

    Allows passage of the great saphenous vein and its tributaries as it drains into the femoral vein

    <p>Fossa Ovalis</p> Signup and view all the answers

    Layers of the Fascia that forms the femoral sheath

    <p>Fascia iliaca and fascia transversalis</p> Signup and view all the answers

    Which compartment of the leg is responsible for dorsiflexion?

    <p>Anterior Leg: Tibialis anterior, EDL, EHL, Fibialis tertius</p> <p>Other compartments plantar flexion</p> Signup and view all the answers

    What innervates the anterior leg compartment?

    <p>Deep Fibular Nerve</p> <p>Tibialis Anterior, EDL, EHL, Fibularis tertius</p> Signup and view all the answers

    What innervates the lateral leg compartment?

    <p>Superior Fibular nerve</p> Signup and view all the answers

    What innervates the posterior leg compartment?

    <p>Tibial nerve</p> Signup and view all the answers

    Muscle assists in flexion of the knee, plantar flexion, and raises the heels when walking

    <p>Gastrocnemius</p> Signup and view all the answers

    Which among the leg muscles contributes to the inversion of the foot?

    <p>Tibialis anterior and posterior</p> Signup and view all the answers

    Which compartments are the two parts of adductor magnus located?

    <p>2 parts:</p> <ol> <li>Adductor Minimus - Medial Thigh</li> <li>Hamstring ischiocondylar - Posterior Thigh</li> </ol> Signup and view all the answers

    Innervation of the Medial thigh

    <p>Obturator nerve</p> Signup and view all the answers

    Innervation of posterior thigh

    <p>mostly sciatic nerve (tibial n.)</p> Signup and view all the answers

    Chief lateral rotator and extensor of thigh

    1. Innervation

    <p>Gluteus maximus</p> <ol> <li>Inferior gluteal n.</li> </ol> Signup and view all the answers

    Deep gluteal muscles mostly function as?

    <p>Lateral rotators</p> Signup and view all the answers

    Innervation of Anterior Thigh

    <p>Femoral n</p> Signup and view all the answers

    Study Notes

    Gluteal Region Anatomy

    • The gluteal region contains muscles covered by a layer of fascia.
    • The superior gluteal vessels and nerves emerge from the piriformis muscle.
    • The inferior gluteal vessels and nerves exit below the piriformis muscle.
    • The sciatic nerve, the largest nerve of the lower limb, emerges below the piriformis muscle.
    • Other structures emerging below the piriformis muscle include the posterior femoral cutaneous nerve.

    Muscles of The Gluteal Region

    • Gluteus maximus, gluteus medius, gluteus minimus, and piriformis are all muscles of the gluteal region.
    • The triceps coxae consists of the superior gemellus, obturator internus, and inferior gemellus muscles.
    • Below the triceps coxae is the quadratus femoris muscle.
    • The tensor fasciae latae muscle marks the beginning of the gluteal region.
    • The tensor fasciae latae muscle is found on the anterolateral aspect of the thigh.

    Hip Joint Anatomy

    • The hip joint is a ball and socket joint.
    • The head of the femur (ball) fits into the acetabulum of the hip bone (socket).
    • The hip joint is very stable due to the acetabular labrum, ligaments, and thickened joint capsule.
    • The hip joint is supplied by the medial and lateral femoral circumflex arteries and the artery to the head of the femur.
    • The artery to the head of the femur is a branch of the obturator artery.
    • Main arterial supply to the hip joint is from the retinacular arteries which originate from the medial circumflex arteries.
    • Damage to the arteries can lead to avascular necrosis of the femoral head.

    Femoral Region Anatomy

    • The fascia lata has a gap called saphenous opening or fossa ovalis.
    • Fossa ovalis is located below the medial part of the inguinal ligament.
    • It is approximately 4 cm inferolaterally from the pubic tubercle.
    • The falciform margin encloses the fossa ovalis.
    • The cribriform fascia is derived from the superficial fascia.
    • The cribriform fascia allows passage of the great saphenous vein and its tributaries, as well as the efferent lymphatic vessels.

    Intramuscular Injections in the Gluteal Region

    • Intramuscular injection is a safe procedure performed in the superolateral quadrant of the buttock.
    • Gluteal prominence should be avoided for intramuscular injections.

    Nerve Injuries

    • Injury to the superior gluteal nerve will affect movement of the abductor muscles and lateral rotation of the femur.
    • Injury to the superior gluteal nerve will cause difficulty in walking and standing on one leg.
    • Injury to the inferior gluteal nerve will cause weakness in extension and external rotation of the thigh.
    • Injury to the inferior gluteal nerve will lead to difficulty climbing stairs and getting up from a chair.
    • Injury to the sciatic nerve will affect the muscles of the lower limb and can cause loss of sensation.

    Important Notes

    • Intramuscular injections should be administered in the superolateral quadrant of the buttock.
    • Avascular necrosis of the femoral head occurs when the blood supply to the femoral head is compromised.

    Joint Capsule

    • Composed of two layers: external fibrous layer and internal synovial membrane
    • Synovial membrane surrounds the joint/synovial cavity
    • External fibrous layer thickens to form ligaments

    Gluteal Region

    • Safe area for intramuscular injections is the superior lateral portion of the gluteal region
    • Can locate safe area by drawing an imaginary line from skin dimple to superior border of greater trochanter
    • Area above the line is safe

    Femoral Triangle

    • Femoral sheath encloses femoral artery, vein, and deep inguinal lymph nodes
    • Femoral nerve is not enclosed in the sheath
    • Femoral triangle important for procedures like hernia repair, nerve block, blood extraction, and catheterization

    Iliopsoas Muscle

    • Originates from the vertebral column
    • Inserts into the lesser trochanter
    • Composed of psoas major and iliacus muscles
    • Psoas minor is a small, inconsistent muscle present in ≈60% of the population

    Sartorius Muscle

    • Flexes the hip and knee joint
    • Abducts and laterally rotates the thigh
    • Known as the "tailor muscle" due to cross-legged position when sewing

    Semimembranosus Muscle

    • Rotates the leg medially when the knee is flexed
    • Encloses the tendon of semitendinosus
    • Insertions include the superior part of the medial portion of the tibia
    • Part of the pes anserinus, along with sartorius and gracilis muscles

    Knee Joint

    • Largest and most stressed joint in the body
    • Classified as a synovial modified hinge joint
    • Allows flexion, extension, and limited medial and lateral rotation when flexed

    Fascia of the Femoral Region

    • The Fascia Lata, which is a deep fascia of the femoral region, is a thick layer of connective tissue that encases the thigh muscles.
    • The fascia lata is continuous with the abdominal aponeurosis superiorly and the fascia of the leg inferiorly.
    • It extends to the gluteal region, overlying the greater trochanter.
    • It also extends anteriorly to the ASIS.

    Femoral Region

    • The femoral region lies between the gluteal and abdominal regions proximally, and the knee region distally.
    • It includes most of the femur (thigh bone).
    • The transition from the trunk to the free limb occurs abruptly in the inguinal region.

    Gluteal Region

    • The gluteal region includes the gluteus maximus, gluteus medius, gluteus minimus, piriformis, superior and inferior gemelli, obturator internus, quadratus femoris, and tensor fasciae latae muscles.
    • The gluteal region is covered by gluteal fascia.
    • Almost all gluteal muscles insert around or within the vicinity of the greater trochanter of the femur.

    Hip Joint

    • The hip joint is supplied by the medial and lateral femoral circumflex arteries, coming from the deep femoral artery and the artery to the head of the femur, which is a branch of the obturator artery.
    • The main arterial supply comes from the retinacular arteries arising from the medial circumflex arteries.

    Knee Joint

    • The knee joint includes the prominences (condyles) of the distal femur and proximal tibia, head of the fibula, and patella (knee cap).
    • It has a well-defined, fat-filled hollow, transmitting neurovascular structures, called the popliteal fossa.

    Knee Ligaments

    • The joint capsule of the knee joint is reinforced by intracapsular and extracapsular ligaments.
    • Intracapsular (Cruciate) Ligaments
      • The cruciate ligaments are criss-crossing structures within the joint capsule but outside the synovial cavity.
      • They maintain contact between the femoral and tibial condyles during motion of the knee.
      • The anterior cruciate ligament (ACL) prevents posterior displacement of the femur on the tibia.
      • The posterior cruciate ligament (PCL) prevents anterior displacement of the femur on the tibia.
    • Extracapsular (Capsular or Intrinsic) Ligaments
      • Include:
        • Patellar ligament: an extension of the quadriceps tendon that extends to the tibial tuberosity.
        • Fibular (Lateral) Collateral Ligament
        • Tibial (Medial) Collateral Ligament

    Sphenoid Opening

    • The sphenoid opening or hiatus (fossa ovalis) is a gap/opening/hiatus or defect in the fascia lata.
    • It is located below the medial part of the inguinal ligament.
    • It is approximately 4 cm inferolaterally from the pubic tubercle.

    Cribriform Fascia

    • It is a derivative of the membranous layer of the superficial fascia.
    • It allows passage of the great saphenous vein and its tributaries as it drains into the femoral vein, as well as efferent lymphatic vessels coming from the superficial inguinal lymph nodes.

    Iliotibial Tract

    • It is a thick band of fascia that covers the lateral aspect of the thigh, providing support and stability.
    • It originates from the iliac crest and inserts on the lateral tibial condyle.

    Leg

    • The leg is the part of the lower limb that lies between the knee and the foot.
    • It includes most of the tibia (shin bone) and fibula (calf bone).
    • The leg connects the knee and the foot.

    Hip Joint

    • The hip joint is a ball and socket joint that allows for three axes of movement: flexion and extension, abduction and adduction, and medial and lateral rotation.
    • The hip joint's articular surfaces are the head of the femur (ball) and the acetabulum of the hip bone (socket).
    • The hip joint is a very stable joint due to the following factors:
      • The acetabulum houses more than half of the femoral head and is further deepened by the fibrocartilaginous ring attached to its rim called the Acetabular labrum.
      • Strong extracapsular ligaments provide reinforcement.
      • A thickened joint capsule contributes to stability.
    • Extracapsular ligaments of the hip joint:
      • Iliofemoral ligament:
        • Also known as the Y ligament of Bigelow.
        • It is the strongest ligament in the body.
        • It strengthens the anterosuperior aspect of the hip joint.
      • Pubofemoral ligament:
        • Reinforces the hip joint inferomedially.
      • Ischiofemoral ligament:
        • Reinforces the hip joint posteriorly.
        • It is the weakest among the three ligaments.
    • The only intracapsular ligament in the hip joint is the ligamentum teres, which is very weak and has little clinical significance.

    Intramuscular Injections

    • Intramuscular injections can be given safely in the buttock/thigh following specific techniques:
      • Superolateral quadrant of the buttock.
      • Anterolateral part of the thigh, where the needle will penetrate the tensor fascia latae.
    • A technique involves using your fingers to mark the injection site: place your index finger over the anterior superior iliac spine (ASIS) and your middle finger on the iliac tubercle. The triangular area between your index and middle fingers is a safe zone for administering the intramuscular injection.
    • Complications of improper intramuscular injection technique include nerve injury, hematoma, and abscess formation.

    Femoral Sheath

    • The femoral sheath is divided into three compartments:
      • Lateral compartment: contains the femoral artery.
      • Middle compartment: encloses the femoral vein.
      • Medial compartment, known as the femoral canal: contains the deep inguinal lymph nodes, also called nodes of Cloquet.

    Muscles of the Thigh

    • Pectineus Muscle:

      • Proximal attachment: Superior pubic ramus.
      • Distal attachment: Pectineal line of the femur.
      • Nerve: Femoral nerve (L2, L3) and Accessory Obturator nerves.
      • Action: Flexes, adducts, and medially rotates (internal rotation) the thigh.

    • Quadriceps Femoris:

      • Consists of four heads:
        • Rectus Femoris:
          • Called the kicking muscle because it is used when the thigh is hyperextended and the knee is flexed during the initiation of kicking.
          • It crosses both the hip and knee joints.
          • It is the only muscle of the quadriceps femoris that crosses the hip joint because it arises from the anterior inferior iliac spine.
        • Vastus lateralis:
        • Vastus medialis:
        • Vastus intermedius:
          • Lies just beneath the rectus femoris.
      • The four parts of the quadriceps femoris converge distally to form the quadriceps tendon, which encloses the patella.

    • Sartorius:

      • The longest muscle in the body.
      • It runs obliquely from the anterior superior iliac spine to the upper section of the medial surface of the tibia.
      • It crosses both the hip and knee joints.

    • Gracilis:

      • Part of the "goosefoot" muscle group.
      • It is located in the medial compartment of the thigh.

    • Semitendinosus:

      • Part of the "goosefoot" muscle group.
      • It is located in the posterior compartment of the thigh.

    • Adductor Longus:

      • It is the "horseback riding" muscle.
      • Proximal attachment: Body of the pubis inferior to the pubic crest.
      • Distal attachment: Middle third of linea aspera of the femur.

    "Goose Foot"

    • A common tendinous insertion of muscles from each compartment of the thigh.
    • Made up of the sartorius (anterior compartment), gracilis (medial compartment), and semitendinosus (posterior compartment) muscles.
    • Mnemonic: “SGT”/Sergeant.

    Knee Conditions

    • Housemaid's Knee / Prepatellar Bursitis: Inflammation of the prepatellar bursa, commonly found in people who work on their knees without using knee pads.
    • Clergyman's Knee / Infrapatellar Bursitis: Inflammation of the superficial infrapatellar bursa.
    • Suprapatellar Bursitis: Inflammation of the suprapatellar bursa, usually caused by an infection of the synovial cavity.
    • Deep Infralateral Bursitis: Causes the disappearance of the dimples that normally occur on each side of the patellar ligament when the leg is extended.
    • Genu Varum (Bowleg): Characterized by a medial angulation of the leg in relation to the femur.
    • Genu Valgum (Knock-knee): Characterized by a lateral angulation of the leg in relation to the femur.

    Popliteal Fossa (Posterior Knee)

    • Floor/Anterior wall: Consists of the popliteal surface of the femur, the posterior capsule of the knee joint, and the popliteal fascia covering the popliteus muscle.
    • Roof/Posterior wall: Formed by the skin and subcutaneous fascia.
    • Contents:
      • Small saphenous vein: Drains into the popliteal vein.
      • Popliteal vessels:
        • Popliteal artery: Deepest structure in the fossa.
        • Popliteal vein: Lies posterior to the popliteal artery and anterior to the tibial nerve.
      • Tibial and common peroneal nerve:
        • The sciatic nerve divides into the tibial and common peroneal nerve at the superior angle of the popliteal fossa.
        • The tibial nerve is located more medially compared to the common peroneal nerve.
        • The tibial nerve is the most superficial among the 3 main central compartments within the popliteal fossa.
      • Posterior femoral cutaneous nerve
      • Popliteal lymph nodes and lymphatic vessels

    Fascial Compartment of the Leg

    • Crural fascia (deep fascia of the leg): Visible after the removal of skin and subcutaneous tissue.
    • Extensions of the Crural fascia:
      • Anterior intermuscular septum

    Leg Compartments

    • The leg is organized into four compartments: anterior, lateral, superficial posterior, and deep posterior
    • Each compartment is defined by intermuscular septae and bones, primarily the tibia and fibula

    Anterior Compartment Muscles

    • The anterior compartment houses four muscles: tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius
    • These muscles are responsible for dorsiflexing the ankle (lifting the forefoot) and extending the toes
    • Their innervation comes from the deep peroneal nerve

    Muscle Characteristics

    • The tibialis anterior originates from the lateral condyle and superior half of the lateral tibia and interosseous membrane, and inserts on the medial and inferior surfaces of the medial cuneiform and base of the 1st metatarsal. Its action is to dorsiflex the ankle and invert the foot.
    • The extensor digitorum longus originates from the lateral condyle of the tibia and superior three quarters of the medial fibula and interosseous membrane. It inserts on the middle and distal phalanges of the lateral four digits. Its primary action is to extend the lateral four toes and dorsiflex the ankle.
    • The extensor hallucis longus is located in the anterior compartment and is responsible for extending the big toe
    • The fibularis tertius muscle is involved in dorsiflexion and eversion of the foot

    Muscle Summary Tables

    • The document contains tables summarizing the characteristics of each muscle, including attachment points, nerve innervation, and primary function
    • Note: It is important to verify the exact distal attachments and details concerning each muscle as they can vary depending on the source.
    • Further examination and clarification are needed to fully understand the abbreviations and other details presented in the tables

    Diagram Descriptions

    • Figures 41 and 42 visualize anatomical cross-sections of the leg, showcasing the compartments, muscle placements, and bone relationships.
    • These diagrams provide an important visual reference for understanding the anatomy of the leg muscles and their three-dimensional positioning.

    Fibularis Tertius Muscle

    • Distal attachment: Dorsal aspect of base of distal phalanx of great toe (hallux)
    • Nerve: Deep fibular nerve (L4, L5)
    • Main action: Extends great toe and dorsiflexes ankle.
    • Located between tibialis anterior and extensor digitorum longus in cross-section
    • Proximal attachment: Inferior third of anterior surface of fibula and interosseous membrane.
    • Distal attachment: Dorsum of base of 5th metatarsal
    • Nerve: Deep fibular nerve (L4, L5)
    • Main action: Dorsiflexes ankle and aids in eversion of the foot.

    Compartment Syndrome

    • Fascia: Strong, well-defined tissue dividing lower limbs into compartments.
    • Causes: Fractures, bleeding, edema, infection (pus accumulation)
    • Complication: Increased pressure compresses neurovascular structures.
    • Common lower limb complication, but relatively rare.
    • Symptoms: Pain, swelling, and altered sensation in the affected area.
    • Treatment: Surgeons must release the compartment from compression to combat this syndrome.
    • The P's of Leg Compartment Syndrome are Pain, Pulselessness, Poikilothermia, Pallor.

    Lateral Leg Compartment

    • Function: Can weakly plantarflex the foot.
    • Nerve supply: Superficial peroneal or superficial fibular nerve.
    • Tendons: Tendons of both Peroneus longus & Peroneus brevis lie posterior to the lateral malleolus.

    Fibularis Longus Muscle

    • Proximal attachment: Head and superior two-thirds of lateral surface of fibula.

    Case Scenario: Simvastatin-Induced Bilateral Leg Compartment Syndrome and Myonecrosis

    • Patient: 54-year-old hypothyroid male taking thyroxine and simvastatin.
    • Symptoms: Bilateral leg compartment syndrome and myonecrosis.
    • Treatment: Urgent fasciotomies were performed, and the patient recovered without complications after withdrawal of simvastatin.
    • Conclusion: Simvastatin may be a risk factor for compartment syndrome, particularly in patients with hypothyroidism. Increased worldwide use and approval of this drug may increase the incidence of this complication in arteriopathic patients.

    Four Compartment Fasciotomy Procedure

    • Background: Patient was taking cholesterol-lowering drugs, one of which could cause rhabdomyolysis (muscle necrosis).
    • Complication: Increased pressure compresses neurovascular structures, potentially causing discoloration, pallor, bluish tint, coldness, pins and needles sensation, weakness, or loss of function in affected limb muscles. Severe cases can lead to limb loss.
    • Mechanism: Surgeons make incisions to relieve the pressure, typically a medial and lateral incision along the tibia for access to the deep and superficial posterior leg compartments, and a lateral longitudinal incision for access to the lateral and anterior compartments.

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