1. Lower Extremity Forum 2011

2. Psoas major, iliacus, pectineus muscles Femoral artery, vein, nerve
Describe the content of the subinguinal hiatus (space between the inguinal ligament and the pelvic rim)
Psoas major, iliacus, pectineus muscles
Femoral artery, vein, nerve
Femoral nerve not included in the femoral sheath
Parent branch of artery is external iliac artery
Lymphatics
Lateral cutaneous nerve of thigh (lateral femoral nerve of thigh)
Located near the ASIS

3. Describe the borders and content of the femoral triangle
Base = inguinal ligament
Medial border is adductor longus
Lateral border is the medial part of the sartorius muscle
Floor is the pectineus, adductor longus
And some of the iliopsoas
Fascia latae forms the roof of the triangle
Continues with fascial canal all the way to the adductor canal
Contains the femoral artery, nerve, vein, and lymphatics

4. Describe the walls and content of the adductor canal
Forms the apex of the femoral triangle
Covered by fascia, roof is sartorius vasculoductor membrane
Comprised of fascia
Contains femoral artery, femoral vein, saphenous nerve for some of time (from femoral), genicular artery
Descends medially down the thigh and shoots out posteriorly thorough the adductor canal
Goes through the adductor magnus muscle
Opens into the popliteal fossa; now popliteal artery/vein

5. Describe the adductor hiatus
Opening at the end of the adductor canal
Deposits the femoral artery and vein into the posterior portion of the leg via the opening at the distal portion of the adductor magnus
Will now become the popliteal artery/vein

6. Describe the borders and contents of the popliteal fossa
Superior Medial Border is the semitendonosus
Superior Lateral Border is biceps emoris
Inferior Medial Border is the medial head of the gastrocnemius
Inferior Lateral Border is the lateral head of the gastrocnemius
Plantaris muscle included on inferior lateral border
Popliteal artery, vein, and Tibial nerve (AVN- aviation up)
Common fibular included? NOT QUITE

7. Buildup of synovial fluid behind the knee
Describe the pathogenesis of the Baker’s cyst and the prepatellar bursitis
Buildup of synovial fluid behind the knee
Caused by knee arthritis, meniscus injury, herniation or tear of the joint capsule
In popliteal fossa; hurts more during extension
Impairs flexion and extension at the knee joint
Inflammation and swelling of the prepatellar bursa (lies right on top of patella)
Housemaid’s knee; inability to flex the knee
Repetitive kneeling will cause this

8. Describe the pathogenesis of the foot drop
Results from a non-functional tibialis anterior
Common fibular nerve injury
Passes behind the head of the fibula
From head or neck fracture of the fibula
Loss of dorsiflexion
loss of sensation on the dorsum of the foot and lateral aspect of the leg
paralysis of all muscles in the anterior and lateral compartments

9. Describe the unhappy triad and the Pott fracture
MCL (tibio-collateral ligament), ACL, and medial meniscus have been torn
Usually results from impact to lateral portion of leg
Fracture of distal fibula
Often goes with a fracture of the medial malleolus or rupture of the deltoid ligament
Avulsion fracture is when medial malleolus comes off with it
Torn anterior tibiofibular
Comes from forced eversion of foot

10. Describe the cutaneous innervation of the lower limb
L2-L3 is from ass to knee, with L2-L4 coming from the obturator on the inner thigh
Page

11. Describe the borders of the femoral canal and the symptoms of the femoral hernia
Femoral canal borders:
Do not need to know for exam
Femoral hernias more common in women because they have a larger superior pubic ramus
Portion of abdominal cavity protrudes into femoral canal (usually portion of the small intestine)
Can be strangulated
Poor blood supply occurs with death of nearby tissues resulting (pinching femoral vein, artery perhaps)

12. Describe the pes anserinus
Results from combinations of tendons of gracilis, sartorius, and semitendonosus
Found out at the medial border of the tuberosity of the tibia
Can be used to help repair a torn ACL
SGT FOS
Sart, grac, semitendinosus/femoral, obturator, sciatic

13. Describe the course of the saphenus nerve and the descending genicular artery
Great saphenous nerve branches off from the femoral nerve and goes with it through the adductor canal
DOES NOT go through the adductor hiatus
Breaks medially to innervate medial side of leg
Breaks through fascia between sartorius and gracilis
Will supply skin on medial leg, knee, and foot
Des. Genicular Artery arises from femoral artery in adductor canal just before it passes adductor hiatus
anastomose around the knee joint with other genicular arteries (these come form the popliteal artery)
Also gives rise to a saphenous branch
Only genicular a. that comes off the femoral

14. Describe the venous circulation of the lower limb
Great saphenous drains the medial leg and thigh anteriorly
Wraps posteriorly around knee very briefly, then comes back to the anteriomedial leg
Pierces the femoral canal fascia to enter the canal near the groin
Small saphenous vein drains the posterior medial leg and then enters into popliteal fossa
Now named popliteal vein; goes through adductor hiatus and becomes femoral vein
Dorsal venous arch of foot gets the top of foot

15. Describe the anatomy of the lesser and greater sciatic foramina
Split in two by the Piriformis muscle
The main point of reference for gluteal region
Goes through the hole made by the ilium, sacrum, and sacrotuberous and sacrospinous ligaments
Part goes over the piriformis, another goes under piriformis
OVER= superior gluteal artery, nerve, vein
UNDER= sciatic nerve, inferior gluteal artery, vein, nerve, posterior femoral cutaneous nerve, nerve to obturator internus and gemellus superior, nerve to quadratus femoris/gemellus inferior
Lesser sciatic foramen goes under the ilium
Obturator internus muscle tendon, and pudendal artery and nerve also pass through this

16. Describe the ligaments supporting the plantar arch
Medial and lateral plantar arches at deep level
Fall of medial arch results in flat foot
Spring ligament involved
Tibialis anterior and posterior/fibularis longus support the arch on the lateral and medial sides
Ligaments are the static support
Muscles are the dynamic support

17. Describe the arterial supply of the femoral head and the possible fracture sites
The lateral circumflex femoral artery and the medial circumflex femoral artery (goes posterior)
Some blood from superior and inferior gluteal aa.
Artery of obturator internus also supplies some blood
Medial circumflex femoral artery supplies more; main supplier to head and neck of femur
If broken, femur dies
Possible fracture sites are the femoral neck, intertrochanteric fossa, femoral shaft
If neck not injured, blood supply could be safe