Lower Ext Review Part 2

i. Lateral border – Sartorius
ii. Medial border – Adductor longus
iii. Superior border – Inguinal Ligament
iv. Roof – fascia lata

i. Femoral Nerve
ii. Femoral Artery
iii. Femoral Vein
iv. Empty space (femoral canal)
v. Inguinal Lymph nodes within femoral canal

The femoral nerve is located in the femoral triangle but outside the femoral
sheath

i. Superomedial – semimembranosus & semitendinosus
ii. Superolateral – biceps femoris
iii. Inferior – heads of gastrocnemius
iv. Roof- deep fascia and small spagenous v.
v. Popliteus muscles and popliteal surface

i. Popliteal artery(deepest)
ii. Popliteal vein
iii. Tibial nerve
iv. Common peroneal nerve (superficial)

-located on the medial aspect of the ankle, bounded by the flexor retinaculum
which extends from the medial malleolus to the medial surface of the calcaneus

-binds the tendons of the deep muscles of the posterior leg to the posterior aspect of themedial malleolus as they pass forward to ends the sole of the foot

i. Tibialis posterior tendon
ii. Flexor Digitorum longus tendon
iii. Posterior tibial Artery
iv. Posterior tibial Vein
v. Tibial Nerve
vi. Flexor Hallucis longus tendon || notes:Tom, Dick, and A Very Nervous Harry

compression of the tibial nerve as it travels through the tarsal tunnel – if
compression occurs more distally, the medial or lateral plantar nerves may be involved

1. Hyper-dorsiflexion
2. Pain worse when foot pronated
3. Tenderness in flexor retinaculum

Subartorial or Hunter's canal

Intermuscular cleft on the medial aspect of the middle third of the thigh between the
Sartorius muscle and inside the tendon of the Adductor magnus muscle

i. Lateral border – Sartorius
ii. Medial border – Adductor longus
iii. Superior border – Inguinal Ligament
iv. Roof – fascia lata

i. Femoral artery
ii. Femoral vein
iii. Saphenous nerve
iv. Nerve to vastus medialis
v. Lymphatic vessels

-Located in the tendon of the adductor magnus, which opens in the popliteal fossa

The hip joint is a synovial ball & socket joint - functionally, it is classified as a ball &
socket or enanthrosis – movements allowed by ball & socket joints = flexion, extension,
AB/ADuction, external/internal rotation

Hip Joint (synovial ball & socket joint)- Articulation between the head of the femur and the
acetabulum of the hip bone

Knee joint – hinge joint – articulation between the tibial and femoral condyles and the patella, which results in three separate articulation

Tibial (medial) collateral ligament (MCL) – connects medial epicondyle of femur to
medial aspect of tibia
1. Attached to capsule and medial meniscus
2. Prevents lateral displacement (valgus) of tibia – tibia is going further from
midline
3. Tear is commonly caused by trauma to lateral knee

Fibular (lateral) collateral ligament (LCL) – connects lateral epicondyle of femur to
head of fibula
1. NOT attached to lateral meniscus
2. Prevents medial displacement (varus) of tibia – tibia is getting closer to midline
3. Tear is commonly caused by trauma to medial knee

Anterior cruciate ligament (ACL) – attaches to the anterior aspect of the tibia, courses
superiorly, posteriorly, and laterally to the lateral condyle of the femur
1. Intracapsular
2. Prevents anterior displacement of tibia
3. Tension of the ACL is greater when the knee is extended and resists
hyperextension
4. Weaker than the PCL
5. Tearing of the ACL allows the tibia to be easily pulled forward (anterior
drawer sign)

i. Lateral border – Sartorius
ii. Medial border – Adductor longus
iii. Superior border – Inguinal Ligament
iv. Roof – fascia lata

i. Lateral border – Sartorius
ii. Medial border – Adductor longus
iii. Superior border – Inguinal Ligament
iv. Roof – fascia lata

External iliac artery → femoral artery → popliteal artery → 2 ways:
▪ Anterior tibial artery → dorsal pedis
▪ Posterior tibial artery → medial/lateral plantar artery & fibular arter

Medial collateral (deltoid) ligaments (strong) – rarely sprained but is so, would be via
EVERSION

Medial collateral (deltoid) ligaments (strong) – rarely sprained but is so, would be via
EVERSION

. Ankle joint (synovial hinge-type joint) – articulation between the low end of the tibia, the
malleoli above, and the trochlea of the talus below

1. Anterior tibiotalar ligament
2. Posterior tibiotalar ligament
3. Tibionavicular ligament
4. Tibiocalcaneal ligament

Lateral collateral ligaments VIA INVERSION
1. Anterior talofibular ligament. Anterior drawer "suction sign" is most commonly used test
2. Posterior talofibular ligament

The three most common injured structures are the knee are tibial (medial) collateral ligament,
medial meniscus, the ACL

-Blow to the lateral aspect of the knee with the foot planted on the ground
-Patients with medial meniscus tear have pain when the leg is medially rotated at the knee

Flexor retinaculum – can cause compression of the tibial nerve

Extensor retinaculum – can lead to entrapment of the deep fibular nerve

i. Tibialis posterior tendon
ii. Flexor digitorum longus tendon
iii. Posterior tibial artery
iv. Posterior tibial vein
v. Posterior tibial nerve
vi. Flexor hallucis longus tendon

i. Small saphenous vein
ii. Sural nerve
iii. Fibularis brevis tendon (anterior)
iv. Fibularis longus tendon (posterior)

External iliac artery → femoral artery → popliteal artery → 2 ways:
▪ Anterior tibial artery → dorsal pedis
▪ Posterior tibial artery → medial/lateral plantar artery & fibular arter

Femoral nerve – passes under inguinal ligament, within femoral triangle but outside femoral sheath

Obturator nerve – goes through obturator foramen

Sciatic nerve – through the greater sciatic foramen; descends between the greater & lesser trochanters,
deep to gluteus maximus

Tibial nerve – popliteal fossa; posterior compartment between FDL & FHL; passes under flexor retinaculum medial malleolus

Common peroneal nerve – lies between the tendon of biceps femoris & lateral head of gastrocnemius

Internal oblique

Anterior wall of femoral sheath

Lateral femoral cutaneous nerve – passes posterior to inguinal ligament

Superior & inferior gluteal nerves, sciatic nerve, posterior cutaneous nerve, pudendal nerve, nerve to obturator internus, nerve to quadratus femoris – goes through sciatic foramen

Pudendal nerve & nerve to obturator internus – goes through lesser sciatic foramen

Any mass in the popliteal fossa can compress the tibial nerve resulting in weakened plantar flexion & paresthesia of the foot & posterolateral leg

Bakers cyst (popliteal cyst) – found in popliteal fossa – refers to the inflammation and swelling of the
semimembranosus bursa – a fluid filled sac in the knee joint

A popliteal aneurysm is the dilation of an artery, normal than 50% in diameter
• The popliteal fascia (roof of popliteal fossa) is tough and non-extensible, and so
an aneurysm of the popliteal artery has consequences for the other contents in the
popliteal fossa

An indicatoon of obturator nerve irritation
-Leads to inner thigh pain that may extend to the knee and internal rotation of hip

With depression of the transverse arch of the foot, one can irritate the digital nerves & promote development
of neuroma (commonly found in the second or third cleft) – more likely to occur in runner/ ballet dancers
or extremely tight shoes (heels)

Inflammation of the fluid filled bursae anterior to the patella
o Extra production of fluid leading to pain
o Common occurrence in individuals who spend a lot of time kneeling (i.e., plumbers, carpet
layers, priests)

-One of the most common causes of knee pain in adolescents
-typically affecting boys aged 10-16 y.o. who are particularly active –
- young athletes who play works that require a lot of jumping and/or running & who are experiencing a growth spurt
o Symptoms include pain below the knee cap, inflammation, & swelling
o Xray can show visible calcification of the patellar tendon and along the epiphyseal plate found
in long bones

Muscles
▪ Sartorius (anterior)
▪ Gracilis (medial)
▪ SemiTendinosus (posterior)
Nerves
▪ Femoral nerve
▪ Obturator nerve
▪ Tibial nerve (sciatic)

SGT FOT

Obturator nerve

Sciatic (mostly tibial)

Femoral nerve

All brevis in the lower extremity are in the foot

ABductors are in the first layer

The lumbricals are in the second layer

The ONLY ADDUCTOR is in the third layer

The interossei are in the fourth layer

The extensor digitorum brevis is the MOST and ONLY superficial muscle of the foot

Nerves that contain fibers from the superior rami of the plexus (L2-L4) innervate
muscles in the anterior and medial thigh region that act on the hip & knee joints

Nerves that contain fibers from the inferior rami of the plexus (S1-S3) innervate muscles
of the leg that act on the ankle and foot joints

Femoral nerve - posterior division – L2-L4
- Obturator nerve – anterior division – L2-L4
- Superior gluteal nerve – posterior division - L4-S1
- Inferior gluteal nerve – posterior division - L5-S2
- Sciatic nerve – L4-S3
o Tibial nerve – anterior division – L4-S3
o Common Fibular nerve – posterior division – L4-S2
- Pudendal nerve – S2-S4

the tibial and common fibular nerves travel through the gluteal region and thigh in a common
connective tissue sheath, together called the sciatic nerve

o Iliohypogastric – L1
o Ilioinguinal – L1
o Genitofemoral – L1-L2
o Lateral cutaneous – L2-L3
o Obturator – L2-L4
o Femoral – L2-L4 || notes:"I, I get laid on fridays"

-Superior gluteal – L4-S1
- Inferior gluteal – L5-S2
- Sciatic – L4-S3
- Posterior femoral