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State the functions of the lower limb
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State structure and function of inguinal ligament
- Structure: goes from ASIS to pubic tubercle
- Function: passageway for nerves, vessels, and muscles from abdomen into the thigh
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Describe superfiscial fascia of lower limb
- Continous layer over whole limb
- Areaolar tissue containing fat
- Carries superfiscial vessels and nerves in between fat
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Describe deep fascia of the thigh
- Thick membrane like covering
- Attached to inguinal ligament, iliac crest, sacrum, coccyx, and pubic bone above
- Continuous with deep fasci of leg below
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What is the saphenous opening?
- Hole in the facial lata on the anterior aspect of thigh
- Located inferior to medial end of inguinal ligament
- Enterance for great saphenous vein
- Which passes from superfiscial fascia to deep fascia to meet the femoral vein
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What is the femoral triangle
- A triangular shaped depression in upper thigh
- Apex points downwards
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What are the boundaries of femoral triangle
- Laterally: medial border of Sartoria
- Medially: lateral border of Adductor longus
- Superiorly: Inguinal ligament
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What makes up the floor of the femoral triangle?
From lateral to medial: the ileopsoas and the pectineus muscles
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What are the contents of the femoral triangle?
From lateral to medial: femoral nerver, artery, vein, and lymphatics
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The word fascia comes from the Latin word fascis, meaning ______
A bundle because it bundles things together
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Decribe the path of the great saphenous vein
- Originates in the medial part of the dorsal venous arch
- Passes in front of medial malleolus
- Up the medial side of leg
- 4 finger width from medial border of patella
- Joins femoral vein in femoral triangle
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Describe path of small saphenous vein
- Originates from lateral part of dorsal venous arch
- Curves from lateral to posterior side of leg
- Joins popliteal vein behind the knee
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What are Langer’s lines?
- Natural crease lines in the skin
- Surgical incisions are made along these lines
- Avoid obvious scars
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describe the femoral artery
- Major artery supplying the lower limb
- Continuation of External Iliac artery
- Begins under the inguinal ligament
- Passes inferiorly and medially in adductor canal
- Ends through the adductor hiatus in adductor magnus muscle
- Becomes the popliteal artery
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Where can u find the femoral pulse?
Mid inguinal point: half way between ASIS and pubic symphysis
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Name the branches of the femoral artery
- Profunda femoris
- Lateral circumflex femoral
- Medial circumflex femoral
- Perforating arteries
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Describe the femoral nerve
- Originates from lumbar lexus (L2, L3, L4)
- Enters femoral triangle
- Divides into anterior and posterior divisions
- Supplies anterior compartment of thigh
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Describe lymph drainage of lower limb
Drain into superficial and deep inguinal nodes
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What is the adductor canal?
- Aponeurotic tunnel in middle third of thigh
- Extends from apex of femoral triangle to adductor hiatus
- Contains femoral artery, vein, saphenous nerve, and nerve to vastus medialis
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What are the borders of the Adductor canal?
- Front and lateral: Vastus medialis
- Behind: Adductor longus and magnus
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Breifly describe the muscular compartments of the thigh
- Divided into 3 parts seperated by intermuscular septa:
- anterior (quads)
- medial (adductors)
- posterior (hamstrings)
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Discuss the actions of muscles
- Muscles act on joints which they cross
- Contraction will move the point of insertion towards point of origin
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Define the following:
- Concentric contraction: muscle shorten
- Eccentric contraction: muscle lengthens
- Muscles act as opposing pairs
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Name the muscle of the anterior compartment of the thigh. List their functions
- Functions: flex the hip joint, extend the knee joint.
- Names:
- Illiacus
- Psoas
- Quadriceps (Vastus medialis, lateralis, intermedialis, Rectus femoris)
- Sartorius
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State the origin, insertion, action, and innervation of the PSOAS muscle
- Origin: lumbar vertebrae
- Insertion: lesser trochanter
- Action: hip flexion
- Nerve supply: lumbar plexus (L1, L2, L3)
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State the origin, insertion, innervation and action of the Illiacus muscle
- Origin: iliac fossa
- Insertion: lesser trochanter
- Action: hip flexion
- Nerve supply: femoral nerve (L2, 3, 4)
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State the origin, insertion, action and nerve supply of Vastus medialis
- Origin: medial shaft of femur
- Insertion: patella through the quadriceps tendon
- Action: extend knee
- Nerve supply: femoral nerve (L2, 3, 4)
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State the origin, insertion, action and nerve supply of Vastus Lateralis
- Origin: lateral shaft of femur
- Insertion: patella through the quadriceps tendon
- Action: knee extension
- Nerve supply: femoral nerve (L2, 3, 4)
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State the origin, insertion, action and nerve supply of Vastus Intermedius
- Origin: anterior shaft of femur
- Insertion: patella through quadriceps tendon
- Action: knee extension
- Nerve supply: Femoral Nerve (L2, 3, 4)
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State the origin, insertion, action and nerve supply of Rectus femoris
- Origin: straight head- AIIS, relected head – ilium
- Insertion: patella through quadriceps tendon
- Action: flexes hip, extends knee
- Nerve supply: Femoral nerve (L2,3, 4)
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State the origin, insertion, action and nerve supply of Sartorius muscle
- Origin: ASIS
- Insertion: anteromedial aspect of proximal tibia
- Action: flexes hip and knee
- Nerve supply: femoral nerve (L2,3,4)
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What is the obturator canal?
- Defficiency at the top of obturator foramen
- Conducts the obturator nerve and vessels
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Name the muscles of the medial compartment of the thigh. State their function
- Function: adduct, stabilize stance, lateral rotation
- Names:
- Gracilis
- Pectinius
- Adductor Longus
- Adductor Magnus
- Adductor Brevis
- Obturator Externus
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State the origin, insertion, action and nerve supply of Gracilis muscle
- Origin: pubis
- Insertion: superior surface of tibia
- Action: adducts thigh, flexes leg
- Nerve supply: Obturator nerve (L2,3,4)
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State the action and nerve supply of the Pectineus
- Action: Adducts and flexes thigh
- Nerve supply: Femoral Nerve (L2,3,4)
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State the origin, insertion, action and nerve supply of Obturator Externus
- Origin: obturator membrane
- Insertion: trochanteric fossa
- Action: lateral rotation
- innervation: Obturator nerve (L2,3,4)
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State the origin, insertion, action and nerve supply of Adductor Longus
- Origin: pubis
- Insertion: middle linea aspera
- Action: adducts thigh
- Nerve supply: Obturator nerve (L2,3,4)
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State the origin, insertion, action and nerve supply of Obturator Brevis
- Origin: pubis
- Insertion: upper linea aspera
- Action: adducts thigh
- Innervation: obturator nerve (L2,3,4)
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State the origin, insertion, action and nerve supply of Adductor Magnus
- 2 parts
- Adductor Part:
- Origin: pubis
- Insertion: linea aspera (which is a ridge on the posterior side of the femur)
- Nerve supply: Obturator (L2,3,4)
- Action: adducts thigh
- Hamstring part:
- Origin: ischial tuberosity
- Insertion: Adductor tubercle
- Nerve supply: Sciatic nerve (tibial part) L4-S3
- Action: adducts thigh
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Describe the sacrospinal ligament
Runs from the sacrum to ischial spine
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Describe the sacrotuberous ligament
Runs from sacrum to ischial tuberosity
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Describe the greater sciatic foramen
- Major route from pelvis to gluteal region
- Piriformis muscle runs through it
- Divides it into upper and lower part
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Name the structures which pass through the greater sciatic foramen
- Above piriformis:
- superior gluteal nerve and vessels
- Below piriformis:
- sciatic nerve
- inferior gluteal nerves and vessels
- pudenal nerve and internal pudenal vessels
- posterior cutaneous nerve of thigh
- nerves to obturator internus; gammelli; and quadratus femoris
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Describe the lesser sciatic foramen
- Connects gluteal reagion with perineum
- Structures passing through:
- - Tendon of obturator internus
- - Pudenal nerve and internal pudenal vessels
- (which exit the pelvis through GSF and enter perineum through LSF)
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What is the largest nerve in the body? What are its roots?
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Describe the path of Sciatic nerve. What does it supply?
- Path:
- leaves pelvis through GSF (under piriformis)
- passes through gluteal region
- enters posterior compartment of thigh
- Supplies:
- all muscles in posterior compartment of thigh
- part of adductor magnus
- all muscles in leg and foot
- skin on lateral side of leg, and lateral side of sole of foot
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What is sciatica?
- Pain in lower limb
- Due to compression of lumbar spine nerve root
- Irritates of sciatic nerve
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Name the Gluteal muscles. State their function
- Function: Abduct, extend, laterally rotate hip joint
- Names:
- Superfiscial
- - Gluteus minimus, maximus, and medius
- - Tensor of fascia lata
- Deep
- - Piriformis
- - Obturator internus
- - Gamellus superior and inferior
- - Quadratus femoris
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State the origin, insertion, action and nerve supply of Gluteus Maximus
- Origin: external surface of ileum, sacrum, coccyx
- Insertion: Posterior part of iliotibial tract, gluteal tuberosity, proximal femur
- Action: hip extension
- Nerve supply|: Inferior gluteal nerve (L5, SI, S2)
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State the origin, insertion, action and nerve supply of Gluteus Medius
- Origin: external surface of ileum, gluteus minimus
- Insertion: greater trochanter
- Action: hip abduction, reduce pelvic drop
- Nerve supply: Superior gluteal nerve (L4, L5, S1)
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State the origin, insertion, action and nerve supply of Gluteus Minimus
- Origin: external surface of ileum
- Insertion: greater trochanter
- Action: hip abduction, reduce pelvic drop
- Nerve supply: Superior gluteal nerve (L4, L5, S1)
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State the origin, insertion, action and nerve supply of Tensor of Fascia Lata
- Origin: iliac crest
- Insertion: anterior part of iliotibial tract
- Action: stabilize knee in extension
- Nerve supply: Superior gluteal nerve (L4, L5, S1)
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Describe Superior gluteal nerve
- Passes through GSF above piriformis
- Passes laterally between medius and minimus
- Supplies medius, minimus, and tesor fascia lata
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Describe the Inferior gluteal nerve
- Passes through GSF below piriformis
- Innervates gluteus maximus
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Describe pudenal nerve
- Passes through GSF below piriformis
- Passes over sacrospinous ligament and into peineum via LSF
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What is the iliotibial tract?
- Longitudinal fibrous reinforcement of fascia lata.
- Runs down the lateral thigh to attach to the upper tibia
- Attachments: gluteus maximus (posterior part) and tensor fascia lata (anterior part)
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Describe gluteal arteries
- Superior:
- starts from internal ileac artery
- enters gluteal region with superior gluteal nerve
- divides into superficial and deep branches
- supplies adjacent muscles and part of hip
- Inferior:
- starts from internal iliac artery
- enters gluteal region with inferior gluteal nerve
- supplies adjacent muscles
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