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Gluteal Region Question And Answers

Question 1. Give a description of the gluteal region. Mention about the superficial and deep fascia.
Answer:

Gluteal Region

It is a large area covering the side and back of the pelvis. It extends from the iliac crest to the gluteal fold. The muscles, nerves, and vessels in the pelvis are covered by the gluteus maximus muscle and buttock.

• Superficial Fascia
  • It contains:
    • A thick layer of fat, especially in females.
    • Cutaneous nerves.
• Deep Fascia
  • Thck over the gluteus medius muscle.
  • But it is thin over the gluteus maximus muscle and encloses the muscle on splitting.

Read And Learn More: Anatomy Question And Answers 

Question 2. List the muscles of the gluteal region.
Answer:

Muscles Of Gluteal Region They are:

• Intrinsic muscles are:
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Pyriform
  • Superior Gemelli
  • Inferior Gemelli
  • Obturator internus
  • Obturator externus
  • Quadratus femoris.
• Extrinsic Muscle
  • Tensor fascia lata.

Question 3. Write a note on the gluteus maximus muscle.
Answer:

Gluteus Maximus Muscle

Gluteus Maximus Origin

• Outer slope of a dorsal segment of the iliac crest
• Posterior gluteal line
• Posterior part of gluteal surface of ilium behind the posterior gluteal line
• Aponeurosis of erector spinae
• Dorsal surface of lower part of the sacrum
• Side of coccyx
• Sacrotuberous ligament
• Fascia covering gluteus medius.

Gluteus Maximus Insertion

• Deep fiers of lower part of the muscle are inserted into the gluteal tuberosity
• The greater part of muscle is inserted into the iliotibial tract.

Gluteus Maximus Nerve Supply

• Inferior gluteal nerve.
• Gluteus Maximus Actions
• Chief extensor of the hip joint
• Assist in standing up from the sitting position.

Question 4. What are the structures undercover gluteus maximus?
Answer:

The Structures Undercover Gluteus Maximus

Structures Undercover Gluteus Maximus

1. Muscles
   • Gluteus medius
   • Gluteus minimus
   • Reflcted head of rectus femoris
   • Pyriformis
   • Obturator internus with 2 gemelli
   • Quadratus femoris
   • Obturator externus
   • Origin of 4 hamstrings
   • Insertion of upper fiers of adductor magnus
2. Vessels
   • Superior gluteal vessels
   • Inferior gluteal vessels
   • Inferior pudendal vessels
   • Ascending branch of medial circumflex femoral artery
   • Trochanteric anastomosis
   • Cruciate anastomosis
   • First perforating artery
3. Nerves
   • Superior gluteal nerve
   • Inferior gluteal nerve
   • Sciatic nerve
   • The posterior cutaneous nerve of thigh
   • Nerve to quadratus femoris
   • Pudendal nerve
   • Nerve to obturator internus
   • Perforating cutaneous nerves
4. Bones And Joints
   • Ilium
   • Ischium with ischial tuberosity
   • Upper end of the femur with the greater trochanter
   • Sacrum
   • Coccyx
   • Hip joint
   • Sacroiliac joint
5. Ligaments
   • Sacrotuberous
   • Sacrospinous
   • Ischiofemoral
6. Bursae
   • Trochanteric bursa of gluteus maximus
   • Bursa of the ischial tuberosity
   • Bursa in between the gluteus maximus and vastus lateralis

Question 5. Write about the origin, insertion, nerve supply, and actions of gluteus medius and minimus.
Answer:

Question 6. Write about the origin, insertion, nerve supply, and actions of the remaining muscles of the gluteal region.
Answer:

Muscles Of Gluteal Region Clinical Anatomy

• In the normal posture, the weight is equally distributed on both the lower limbs and the center of gravity falls between the two limbs.
• If the right limb is lifted of the ground, this normal balancing mechanism is disturbed. Naturally, there will be a tendency for the right pelvis to sink from the normal horizontal plane.
• This is prevented by the pull of the left gluteus medius and minimus, and the right pelvis is raised from the normal horizontal plane.
• This mechanism helps to balance the body, when one tends to stand on one leg or even running.
• But when paralysis of these abductors of one side occurs, the opposite side pelvis sinks. This is a positive Trendelenburg sign, the resulting gait is called lurching gait.

(1) Dotted arrow shows the normal action of the limb;
(2) Solid arrow shows the paralyzed muscle and
(3) Hollow arrow shows the dipping of the normal limb

• Intramuscular Injections are given in the anterosuperior quadrant of the gluteal region over the gluteus medius and minimus as it is the safest site.
• When the gluteus maximus is paralyzed, patient cannot stand up from a sitting position without support.
• Bursae associated with gluteus maximus is prone to bursitis. If it is over ischial tuberosity, it is called ‘never’s bottom’.

Question 7. Briefly explain gluteal ligaments.
Answer:

• Sacrotuberous Ligaments
  • Ligament which extends from side to side of the sacrum and coccyx to the medial of the ischial tuberosity.
• Sacrospinous Ligament
  • Ligament which extends from the ischial spine to the side of the sacrum and coccyx.
• Sacrotuberous and sacrospinous ligaments converts the greater and lesser sciatic notch to greater and lesser sciatic foramen respectively.

Gluteal Region Multiple Choice Questions

Question 1. Th structure coming through the lesser sciatic foramen is:

1. Tendon of obturator internus
2. Pudendal nerve
3. Internal pudendal artery
4. Nerve to obturator internus

Answer: 1. Tendon of obturator internus

Question 2. For surgical access to the femoral neck, the greater trochanter is separated. All the muscles will be removed with greater trochanter, except:

1. Piriformis
2. Gluteus medius
3. Gluteus minimus
4. Quadrats femoris

Answer: 4. Quadrats femoris

Question 3. Which of the following has the same root value as that of tibial nerve?

1. Sciatic nerve
2. Common peroneal nerve
3. Obturator nerve
4. Accessory obturator nerve

Answer: 1. Sciatic nerve

Question 4. Which of the following muscle is not supplied by obturator nerve?

1. Part of adductor magnus inserted into linea aspera
2. Obturator internus
3. Obturator externus
4. Gracilis

Answer: 2. Obturator internus

Question 5. Trendelenburg sign is positive in defective:

1. Gluteus maximus muscle
2. Gluteus medius
3. Gluteus minimus
4. Both b and c

Answer: 4. Both b and c

Back Of Thigh Question And Answers

Question 1. Give a description of back of the thigh. What are its contents?
Answer:

Back Of The Thigh

The back of the thigh extends from the gluteal fold above to the back of the knee joint below. It is completely separated from the anterior compartment by the lateral intermuscular septum but incompletely separated by an ill-defined posterior intermuscular septum with the medial compartment.

Back Of Thigh Contents

• Muscles
  • Hamstring muscles
  • Short head of biceps femoris.
• Nerve
  • Sciatic nerve.
• Arteries
  • Arterial anastomosis in back of the thigh
  • Perforating branches of the profundal femoris artery.

Read And Learn More: Anatomy Question And Answers 

Question 2. Write a note on the hamstring muscles. Explain their origin, insertion, nerve supply, and actions.
Answer:

Hamstring Muscles

1. Semitendinosus
2. Semimembranosus
3. Biceps femoris (only long head)
4. Ischial head of adductor magnus.

• Characteristic features of hamstring muscles are All of them:
  • Arises from the ischial tuberosity
  • Inserted into either one bone of leg
  • Supplied by the tibial part of the sciatic nerve
  • Are floors of knee and extensors of the hip joint.
• The tibial collateral ligament of the knee joint morphologically represents the degenerated tendon of the adductor magnus muscle which is attached below to the tibia, so it is considered as hamstring muscle.
• The short head of biceps femoris is not considered as hamstring muscle.

Hamstring Muscles Biceps Femoris

Rest of Muscles of Posterior Compartment of Thigh

Hamstring Muscles Clinical Anatomy

• If hamstring muscles are paralyzed gluteus maximus muscle alone is not capable of maintaining erect poster, person cannot stand.
• In some persons hamstrings are short and they cannot touch the toe when extending the knee and they are not fit for gymnastics.

Question 3. Draw the cross-section at the level of mid-thigh.
Answer:

The Cross-Section At The Level Of Mid-Thigh

Question 4. Write a note on the popliteal fossa with its boundaries and contents. How popliteal artery, tibial nerve, and popliteal vein are arranged in the popliteal fossa?
Answer:

Popliteal Fossa With Its Boundaries

The popliteal fossa is a diamond-shaped depression, lying behind of knee joint, the lower part of the femur, and upper part of the tibia, best felt at the back of the semi-fixed knee joint.

Popliteal Fossa Boundaries

1. Superomedially
   • Semitendinosus and semimembranosus
2. Inferomedially
   • The medial head of the gastrocnemius
3. Inferolaterally
   • The lateral head of the gastrocnemius and plantaris muscle
4. Floor/anterior wall
   • From above downwards:
     • The popliteal surface of the femur
     • The capsule of knee joint and oblique popliteal ligament
     • Popliteal fascia covering popliteus muscle
   • The popliteal surface of the tibia
5. Roof/posterior wall
   • Deep fascial popliteal fascia
   • Superficial fascia containing
     • Small saphenous vein
     • Cutaneous nerves
       • The terminal part of posterior cutaneous nerve of thigh
       • The posterior division of medial cutaneous nerve of the thigh
       • Sural communicating nerve

Popliteal Fossa Contents

• Popliteal artery and branches
• Popliteal vein and branches
• Tibial nerve and branches
• Common peroneal nerve and branches
• Popliteal pad of fat
• The terminal part of posterior cutaneous nerve of thigh
• Descending genicular branch of obturator nerve
• Terminal part of the short saphenous vein.

Arrangements Of The Popliteal Artery, Tibial Nerve And Popliteal Vein In Popliteal Fossa

• In the upper part of the popliteal fossa from medial to lateral side: Artery, vein, nerve (AVN)
• In the middle part of the popliteal fossa from superficial to deep: Nerve, vein, artery (NVA)
• In the lower part of the fossa from medial to lateral
• side: Nerve, vein, artery (NVA).

Sole Of Foot Question And Answers

Question 1. Give a description of the sole of foot with the peculiarities of skin, superficial fascia, and deep fascia.
Answer:

The Sole Of Foot

The region in the upper limb corresponding to the sole of the foot is hand. However, due to functional difference, sole and hand differ in their anatomical arrangements.

Sole Of Foot Skin of Sole

• It is specialized because:
  • It is thick and hairless
  • It is creased for grip
  • Firmly adherent to the underlying deep fascia
  • It has numerous sweat glands.

Sole Of Foot Superficial Fascia

• It is thick and dense over weight-bearing points. It contains:
  • Subcutaneous fat
  • Cutaneous nerves.

Read And Learn More: Anatomy Question And Answers 

Sole Of Foot Deep Fascia

• It is modifid to form:
  • Plantar Aponeurosis
    • It is the thickened part of the fascia covering the sole
    • It represents the distal part of plantaris muscle
    • It is triangular in shape
    • The apex is proximal and the base is distal
    • At the base, it is divided into 5 processes
    • Each process splits into the superficial and deep slip
    • Superficial slip is attached to the skin
    • Deep slip again splits and embraces the flexor retinaculum.
    • Functions:
      • It fies the skin to the sole
      • It protects deeper structure in the sole
      • Helps to maintain the longitudinal arch of the foot
      • It gives origin to the first layer of the sole.
  • Deep transverse metatarsal ligaments.
  • Fibrous flexor sheaths.

Sole Of Foot Clinical Anatomy

Plantar fasciitis can occur due to stretching of palmar aponeurosis in policemen.

Question 2. List the muscles of the sole of the foot. Give their nerve supply and actions.
Answer:

The Muscles Of Sole Of Foot

• There are 18 intrinsic muscles and 4 extrinsic tendons in the sole.
• Intrinsic muscles are arranged in 4 layers.
• They are chiefly concerned about maintaining the arches of the foot.

Muscles of First Layer of Sole of Foot

Muscles Of The Second Layer Of The Sole Of The Foot

Muscles of Third Layer of Sole of Foot

Muscles of Fourth Layer of Sole of Foot

Question 3. Explain in detail about the arches of the foot by classifying and comparing them.
Answer:

Arches Of Foot

• The human foot is uniquely architectured to perform complex functions.
• Arches of the foot help in weight bearing, fast walking, running, and jumping.
• These arches are maintained by intrinsic and extrinsic muscles of the sole in addition to ligaments, aponeurosis, and the shape of bones.
• Arches of the foot are classified into:
  • Longitudinal:
    • Medial
    • Lateral
  • Transverse:
    • Anterior
    • Posterior

Arches Of Foot Functions

• It distributes body weight to the weight-bearing parts of the sole.
• They act as springs and help in walking and running.
• They also act as shock absorbers while stepping and jumping.
• The soft tissue of the sole is protected due to the concavity created by the arches.

Arches Of Foot Clinical Anatomy

• Flat Foot (Pes Planus): Occurs due to medial longitudinal arch deformity.
• High-Arched Foot (Pes Cavus): Occurs due to exaggeration of the longitudinal arch of the foot.
• Club Foot/Talipes: Combined defect of ankle and foot resulting in an inability to walk normally. For example, talipes equinus, talipes varus, talipes valgus, etc.

Mnemonics

• Tarsal bones of ankle ‘Tiger Cubs Need MILC’:
  • Superior, then clockwise on right foot:
  • Talus
  • Calcaneus
  • Navicular
  • Medial cuneiform
  • Intermediate cuneiform
  • Lateral cuneiform
  • Cuboid

Sole Of Foot Multiple Choice Question

Question 1. Which is the main joint of the medial longitudinal arch?

1. Calcaneocuboid
2. Subtalar
3. Talocalcaneonavicular
4. Ankle

Answer: 3. Talocalcaneonavicular

Joints Of Lower Limb Question And Answers

Question 1. Explain in detail about hip joint under the headings—type, articular surfaces, ligaments, factors providing stability to the joint, relations, bursae around the joint, blood supply, nerve supply, movements, and muscles involved.
Answer:

Hip Joint

• It is homologous with the shoulder joint of upper limb.
• But it is more stable at the cost of mobility compared to shoulder joint which is more mobile at the cost of stability.

Hip Joint Type

• Ball and socket type of synovial joint.
• It is simple and multiaxial joint.

Hip Joint Articular Surfaces

• Head of the femur articulates with the acetabulum of the hip bone.
• Head of femur is covered with hyaline cartilage except at the fovea capitis.
• Acetabulum have a horse shoe-shaped lunate articular surface with an acetabular notch and an acetabular fossa.
• The articular surface of the acetabulum is also covered with cartilage.

Read And Learn More: Anatomy Question And Answers 

Hip Joint Ligaments

• Capsular Ligament
  • Unlike in the shoulder joint, joint capsule is strong and dense limiting the wide range of movements.
  • Attachments:
  • Medially on the hip bone, on the outer aspect of the acetabular labrum, and transverse acetabular ligament.
  • Laterally on the femur, anteriorly to the intertrochanteric line, and posteriorly about 1 cm in front of the intertrochanteric crest.
    • The joint capsule is thick and strong anterosuperior where maximum stress occurs especially when standing and running.
      • It is thin and loose posteroinferiorly through which dislocation of hip joint occurs commonly.
      • The capsule is made up of two layers of fibers. The inner circular and outer longitudinal fibers.
      • Joint capsule is lined inside by a synovial membrane.
• Iliofemoral Ligament/Ligament of Bigelow
  • It is an inverted y­shaped ligament located anterior aspect of the joint and it is blended with the joint capsule.
  • Its apex is attached to the lower half of the anterior inferior iliac spine and the base to the intertrochanteric line.
  • It is one of the strongest ligaments of the body preventing falling body backwards in a standing posture
• Pubofemoral Ligament
  • It is a triangular-shaped ligament located anteromedially to the joint.
  • Its base is directed upwards and attached to the iliopubic eminence, superior pubic ramus, and obturator crest.
  • Its apex is directed downwards and blends with the anteroinferior part of the capsule and medial band of iliofemoral ligament.
• Ischiofemoral Ligament
  • It is a relatively weak ligament located posteriorly.
  • It is attached superiorly to the ischium and inferiorly to the greater trochanter deep to the iliofemoral ligament.
• Ligament of Head of Femur/Round Ligament/ligament
  • Terms of Head of Femur
    • It is a flt triangular ligament.
    • Its apex is attached to the fovea of head of femur and the base to the transverse acetabular ligament.
    • It transmits arterial branches from the obturator and medial circumflex femoral arteries to the head of femur.
  • Acetabular Labrum
    • It is a fibrocartilaginous rim attached to the acetabular margin.
    • It deepens the acetabulum and grasps the head of femur in its position.
  • Transverse Acetabular Ligament
    • It bridges the acetabular notch making it into the acetabular foramen.
    • The acetabular foramen transmits the vessels and nerves to the hip joint.

Hip Joint Factors Providing Stability To The Hip Joint

• Acetabulum is deep and the depth is increased by the presence of acetabular labrum
• Strong ligaments.
• Strength of the surrounding muscles.
• Length and obliquity of the neck of femur.

Hip Joint Relations

• Anteriorly: Tendon of iliopsoas separated from the joint capsule by the bursa, femoral vessels, and nerve.
• Posteriorly: From below upwards:
  • Tendon of obturator externus covered by Quadratus femoris
  • Obturator internus and gemelli
  • Piriformis
  • Sciatic nerve
  • Gluteus maximus
• Superiorly: Reflcted head of rectus femoris covered by gluteus minimus, gluteus medius and gluteus maximus.
• Inferiorly: Lateral fiers of pectineus and obturator externus, gracilis, adductor longus, brevis, Magnus, and hamstring muscles.

Bursae Around Hip Joint

• Subgluteal bursa
• Subpsoas bursa.

Hip Joint Arterial Supply

• Medial circumflex femoral artery
• Lateral circumflex femoral artery
• Obturator artery
• Superior gluteal artery
• Inferior gluteal artery.

Hip Joint Nerve Supply

• Femoral nerve via nerve to rectus femoris
• The anterior division of obturator nerve
• Nerve to quadratus femoris
• Superior gluteal nerve.

Movements And Muscles Involved

Mnemonics

• Hip: Lateral rotators “Play Golf Or Go On Quaaludes”:
• From top to bottom:
  • Piriformis
  • Gemellus superior
  • Obturator internus
  • Gemellus inferior
  • Obturator externus
  • Quadratus femoris

Hip Joint Clinical Anatomy

• Dislocation Of Hip Joint
  • Hip joint can dislocate congenitally or accidentally.
  • Congenital dislocation of the hip joint should be identified soon after birth and treated.
  • Accidental dislocation of the hip occurs most commonly posteriorly because the joint capsule and ligaments on the posterior aspect of the joint is weak.
  • This type of dislocation can injure the sciatic nerve.
  • Anterior dislocations of the hip joint are very rare because the joint capsule and the ligaments of the anterior aspect of the joint are very strong.
• Fracture Of Neck Of Femur
  • Fractures of the neck or femur can occur in individuals, especially females after the age of 60 due to osteoporosis. The limb is shortened and laterally rotated because of the pull of the muscles of the back. It leads to avascular necrosis of the neck of the femur.
  • A time gap is given for the fracture segment to unite if it is young individuals. Hip replacement surgeries are preferred in elderly patients.
  • Shenton’s line is a continuous curve formed by the upper border of the obturator foramen and lower margin of the neck of the femur seen in a normal X­ray pelvis. But following posterior dislocation and fracture of the neck of the femur, this line is disrupted.
  • Shoemaker’s line is a line extending from the greater trochanter, advancing through the anterior superior iliac spine, to pass through the umbilicus. But in fracture of neck of the femur or in posterior dislocations, this line passes below the umbilicus.

Question 2. Explain in detail about the knee joint under the headings—type, articular surfaces, ligaments, bursae around the joint, blood supply, nerve supply, movements and muscles involved, and locking and unlocking of the knee joint.
Answer:

Knee Joint

The Knee Joint is the largest joint in the body. It is also more complex than other joints due to the presence of three articulations.

Knee Joint Type

• Knee Joint is a modified hinge type of synovial joint.
• Knee Joint is a compound joint. It incorporates two condylar joints between the condyles of femur and tibia and one saddle joint between the femur and patella.

Knee Joint Ligaments

• Fibrous articular capsule
• Knee Joint is very thin and deficient anteriorly where it is replaced by quadriceps femoris, patella and ligamentum patellae.

Knee Joint Articular Surfaces

• The lateral and medial condyles of the femur articulate with the lateral and medial condyles of the tibia respectively. It is of condylar type.
• The patella articulates with the femur. It is of saddle type.
• Attached on
  • Femur
    • ½ to 1 cm beyond the articular margins except:
      • Anteriorly where it is replaced by the suprapatellar bursa in the middle
      • Posteriorly where it is attached to the intercondylar line
      • Laterally where it encloses the origin of the popliteus muscle.
  • Tibia
    • ½ to 1 cm beyond the articular margins except:
      • Posteriorly where it encloses the tendon of the popliteus muscle.
      • It is lined inside by a synovial membrane.

Knee Joint Ligamentum Patellae

• Knee Joint Ligamentum is the central part of the common tendon of insertion of quadriceps femoris (the remaining portion of tendon forms lateral and medial patellar retinacula)
• Knee Joint Ligamentum is 7.5 cm in length and 2.5 cm in width.
• Superiorly, it is attached to the apex of the patella and inferiorly to smooth upper part of the tibial tuberosity.

Tibial Collateral Ligament/Medial Ligament

• Tibial Collateral Ligament is a long and strong fibrous band located at the medial side of the knee joint.
• Tibial Collateral Ligament has two parts—superficial and deep.
• The superficial part is longer, attached above to the medial epicondyle of femur just below the adductor tubercle and below to the medial border and posterior part of the medial surface of the shaft of the tibia.
• The Tibial Collateral Ligament covers the inferior medial genicular nerves and vessels, and the anterior part of the tendon of the semimembranosus.
• The Tibial Collateral Ligament is crossed superficially by the tendon of the sartorius, gracilis, and semitendinosus.
• The deep part is shorter, attached above the medial epicondyle of the femur just below the adductor tubercle and below to the medial condyle of tibia above the groove for the tendon of the semimembranosus.
• The Tibial Collateral Ligament blends with the fibrous capsule and peripheral margin of the medial meniscus in the middle.

Fibular Collateral Ligament/Lateral Ligament

• The fibular Collateral Ligament is a short, strong, and cord-like ligament located on the lateral side of the knee joint.
• The fibular Collateral Ligament is attached to the lateral epicondyle of the femur just above the popliteal groove and below, it is attached to the head of the fibula in front of its apex.
• In the lower part, the ligament is crossed by the tendon of the biceps femoris.
• Unlike the medial ligament, the lateral ligament does not blend with the lateral meniscus due to the presence of the tendon of the popliteus.
• The fibular Collateral Ligament is also free from the capsule separated by inferior lateral genicular nerves and vessels.

Oblique Popliteal Ligament

• The Oblique Popliteal Ligament is an expansion from the tendon of the semimembranosus muscle located posteriorly.
• The Oblique Popliteal Ligament runs upwards and laterally blends with the capsule of the knee joint.
• The Oblique Popliteal Ligament is attached to an intercondylar line of the femur.
• The Oblique Popliteal Ligament strengthens the capsule posteriorly and is in close relation with the knee joint.
• The Oblique Popliteal Ligament is pierced by middle genicular vessels and nerves, the posterior division of the obturator nerve.

Arcuate Popliteal Ligament

• It is a posterior expansion from the short part of the fibular collateral ligament.
  • Anterior and Posterior Cruciate Ligaments
    • They are two thick and strong intracapsular fibrous bands crossing each other like ‘X’, hence the name
      cruciate.
    • They are named anterior and posterior according to their site of attachment in the tibia.
    • They are considered to be the direct bonds of union between the tibia and femur.
    • They maintain anteroposterior stability of the knee joint.

An Anterior Cruciate Ligament (ACL)

• ACL is attached below to the anterior part of the intercondylar area of the tibia and runs upwards, backward, and laterally to get attached on the posterior part of the medial surface of the lateral condyle of femur.
• ACL prevents the anterior displacement of tibia.

Posterior Cruciate Ligament (PCL)

• PCL is attached below the posterior part of the intercondylar area of tibia and runs upward forward and medially to the anterior part of the lateral surface of the medial condyle of femur.
• PCL prevents the posterior displacement of tibia.

Menisci/Semilunar Cartilages Of Knee Joint

• They are crescent or semilunar-shaped intra­articular discs made up of fibrocartilage.
• They divide the joint cavity into two. The upper compartment (meniscofemoral) and the lower compartment (meniscotibial).
• Each meniscus has:
  • Two ends: Anterior and posterior attached to the tibia
  • Two borders: Thck, convex, fixed outer border and thin, concave, free inner border
  • Two surfaces: Concave upper surface for the articulation with the femur. The flat lower surface which rests on the peripheral 2/3rd of the tibial condyle
  • The peripheral part is vascular and the inner part is avascular nourished by the synovial fluid.

Medial Meniscus

• Almost semicircular.
• Has anterior and posterior horns and both are attached to the intercondylar area of the tibia.
• It is attached to the deep part of the tibial collateral ligament.

Lateral Meniscus

• Almost circular.
• It also has anterior and posterior horns and both are attached to the intercondylar area of the tibia.
• The posterior horn of the lateral meniscus is attached to the medial condyle of the femur by anterior and posterior meniscofemoral ligaments.
• The medial part of the tendon of the popliteus muscle is attached to the lateral meniscus.
• This, the movements of the lateral meniscus is controlled by the popliteus muscle and anterior and posterior meniscofemoral ligaments.

Mnemonics

Menisci attachments in the knee ‘Each meniscus has something attached to it:

• The medial meniscus has the medial collateral ligament.
• The lateral meniscus is attached to the popliteal muscle.

Functions of Menisci

• Menisci increase the concavity of the condylar surface of the tibia ensuring the best congruence with the condylar surface of the femur.
• They act as shock absorbers.
• They help to lubricate the joint cavity.
• Flexion and extension of the knee joint take place in the upper compartment made by the menisci where as medial and lateral rotation take places in the lower compartment.
• Since they are innervated by sensory nerves, they have a proprioceptive role too.

Transverse Ligament:

• It connects the anterior end of the lateral and medial menisci.
  • Bursae Around Knee Joint
    • Around 13 bursae are found around the knee.
  • Anteriorly
    • Subcutaneous prepatellar bursa
    • Subcutaneous infrapatellar bursa
    • Deep infrapatellar bursa
    • Suprapatellar bursa.
  • Laterally
    • Bursa deep to the lateral head of the gastrocnemius
    • Bursa in between the fibular collateral ligament and biceps femoris
    • Bursa in between the fibular collateral ligament and tendon of popliteus
    • Bursa in between tendon of popliteus and lateral condyle of tibia.
  • Medially
    • Bursa deep to the medial head of gastrocnemius
    • Anserine bursa
    • Bursa deep to the tibial collateral ligament
    • Bursa deep to the semimembranosus.

Relations of Knee Joint

• Anteriorly
  • Anterior bursae
  • Ligamentum patellae
  • Patellar plexus of nerves
• Posteriorly
  • At the middle
    • Popliteal vessels
    • Tibial nerve
  • Posterolaterally
    • The lateral head of the gastrocnemius
    • Plantaris
    • Common peroneal nerve
  • Posteromedially
    • The medial head of the gastrocnemius
    • Semitendinosus
    • Semimembranosus
    • Gracilis
    • Popliteus at its insertion
• Medially
  • Sartorius
  • Gracilis
  • Semitendinosus
  • Great saphenous vein
  • Saphenous nerve
  • Semimembranosus
• Laterally
  • Biceps femoris
  • Tendon of origin of popliteus

Relations of Knee Joint Blood Supply

• Five genicular branches of the popliteal artery
• Descending genicular branch of femoral artery
• Descending branch of lateral circumflex femoral artery
• Two recurrent branches of the anterior tibial artery
• Circumflex fibular branch of the posterior tibial artery.

Relations of Knee Joint Nerve Supply

• Sciatic nerve through its genicular branches of tibial and common peroneal nerve
• Femoral nerve
• Obturator nerve through its posterior division.

Movements And Muscles Involved

• Locking and Unlocking of the Knee Joint
  • The locking mechanism helps the knee to remain in a standing position without much muscular effort.
  • This is possible due to the fact that the anteroposterior diameter of the medial condyle of the femur is larger than that of the lateral condyle.
  • As a result, towards the end of extension movement, the lateral condyle of the femur is fully occupied whereas a portion of the medial condyle is still unused by the tibia.
  • So the lateral condyle acts as an axis around which the femur rotates medially on the tibia to engage the medial condyle completely.
  • This is done by the extensors of the knee joint, especially vastus medialis.
  • Now the knee joint is locked and the muscles around the joint can relax at the expense of taut ligaments.
  • This mechanism is a blessing when one stands.
  • Unlocking is done by the popliteus muscle by laterally rotating the femur on the tibia.
  • Now the flexors can act and flex the knee joint.
• Clinical Anatomy
  • The knee joint is:
    • Largest joint in the body
    • Compound joint
    • Weight-bearing joint.
• Due to these specialties, it is more prone to injuries and damages.
• Injury to the anterior cruciate ligament causes anterior dislocation of the tibia and the anterior drawers sign will be positive. Injury to the posterior cruciate ligament causes posterior dislocation of the tibia, and the posterior drawers sign will be positive.
• The medial meniscus is more prone to injury than the lateral meniscus. this is due to the fact that the medial meniscus is fied to the capsule and tibial collateral ligament whereas the lateral meniscus is protected by the pull of the popliteus muscle with which it is attached.
• As age advances, the knee joint is more prone to osteoarthritis.
• If fluid is collected in the joint cavity, the patellar tap shows a floating patella, and fluid is aspirated from either side of the ligamentum patellae.

Question 3. Write a short note on the deltoid ligament.
Answer:

Deltoid Ligament

• The Deltoid Ligament is a very strong triangular ligament seen on the medial side of the ankle joint
• Deltoid Ligament has superficial and deep parts.

The Deltoid Ligament Superficial Part

• It has 3 sets of filters and all of them have a common superior attachment to the apex and margins of medial malleolus.
• But they have different attachments in the inferior part.
• Anterior fibers or talonavicular fiers are attached inferiorly to the tuberosity of the navicular bone and to the medial margin of the spring ligament.
• Middle fibers or talocalcaneal fiers are attached inferiorly to the whole length of sustentaculum tali.
• Posterior fibers or posterior tibiotalar fibers are attached to the medial tubercle and to the adjoining part of the medial surface of the talus.

The Deltoid Ligament Deep Part

• It has the same superior attachment as that of the superficial part.
• Inferiorly it is attached to the anterior part of the medial surface of the talus.

Question 4. Explain about inversion and eversion of the foot by comparing them.
Answer:

Inversion And Eversion Of The Foot By Comparing Them

Inversion And Eversion Of The Foot Joints Taking Part

• Subtalar joint
• Talocalcaneonavicular joint
• Transverse tarsal/midtarsal joint.

Inversion And Eversion Of The Foot Axis of Movement

• Around the oblique axis

Inversion And Eversion Of The Foot Functional Significance

• Helps to walk in uneven and sloppy ground.
• When the foot is in the ground, this movement occurs in its modified form called supination and pronation.

Mnemonic

Inversion vs Eversion Muscles in Leg

• Second letter rule for inversion/eversion:
  • Eversion muscles:
    • pEroneus longus
    • pEroneus brevis
    • pEroneus tertius
  • Inversion muscles:
    • tIbialis anterior
    • tIbialis posterior.

Joints Of Lower Limb Multiple Choice Questions

Question 1. The number of ossification centers in the lower limb (on one side) in full term newborns are_____:

1. Six
2. Five
3. Two
4. One

Answer: 2. Five

Question 2. In Clergyman’s knee, which bursa is affected?

1. Prepatellar
2. Suprapatellar
3. Subcutaneous infrapatellar
4. Semimembranosus

Answer: 3. Subcutaneous infrapatellar

Question 3. What is the deformity if patient walks on the toes?

1. Talipes varus
2. Talipes valgus
3. Talipes equinus
4. Talipes calcaneus

Answer: 3. Talipes equinus

Question 4. Which of the following is maximally taut while walking downhill?

1. Medial collateral ligament
2. Posterior cruciate ligament
3. Lateral collateral ligament
4. Anterior cruciate ligament

Answer: 2. Posterior cruciate ligament

Question 5. What is true about lateral meniscus?

1. Attached to fibular collateral ligament
2. Attached to popliteus
3. Bucket hand tear is common
4. Semicircular in shape

Answer: 2. Attached to the popliteus

Nerve Supply Of Lower Limb Question And Answers

Question 1. Give an outline of the nerve supply of the lower limb.
Answer:

Nerve Supply Of The Lower Limb

• The nerves of lower limb originate from:
  • Lumbar plexus (L1-L4)
  • Sacral plexus (L4-S4)
• Three main nerves originate from the plexus and innervate the lower limb. They are:
  • Femoral nerve: Nerve of the anterior compartment of the thigh.
  • Obturator nerve: Nerve of the medial compartment of the thigh.
  • Sciatic nerve: Nerve of the posterior compartment of thigh.

Mnemonics

• Thgh: Innervation by compartment ‘MAP OF Sciatic’:
  • Medial compartment: Obturator
  • Anterior compartment: Femoral
  • Posterior compartment: Sciatic

So all the thigh muscles in that compartment get innervated by that nerve.

• The sciatic nerve divides into the tibial nerve and the common peroneal/common fibular nerve, a little above the popliteal fossa.
  • The tibial nerve divides into:
    • Medial plantar nerve
    • Lateral plantar nerve.
  • Common peroneal/common fibular nerve divides into:
    • Superficial peroneal nerve
    • The deep peroneal nerve.

Read And Learn More: Anatomy Question And Answers 

Question 2. Explain in detail about the femoral nerve under the headings—origin, root value, beginning, course, termination, branches, and innervation.
Answer:

Femoral Nerve

It is the nerve of the anterior compartment of the thigh.

Femoral Nerve Origin

• Largest branch of lumbar plexus.

Femoral Nerve Root Value

• L2, L3, L4

Femoral Nerve Beginning

• Emerges at the lateral border of psoas major in the abdomen.

Femoral Nerve Course

• It enters the thigh posterior to the inguinal ligament just lateral to the femoral sheath.

Femoral Nerve Termination

• Below the level of the inguinal ligament, it divides into anterior and posterior divisions separated by the lateral circumflex femoral artery.

Femoral Nerve Branches and Innervation

Femoral Nerve Clinical Anatomy

• Rarely in stab wounds in the groin region, the femoral nerve can get injured and paralysis of the quadriceps femoris with or without loss of sensation on the anterior and medial aspects of the thigh can occur.

Question 3. Explain in detail about the obturator nerve under the headings—origin, root value, beginning, course, termination, branches, and innervations.
Answer:

Obturator Nerve It is the chief nerve of the medial compartment of the thigh.

Obturator Nerve Origin

• From lumbar plexus.

Obturator Nerve Root Value

• L2, L3, L4

Obturator Nerve Beginning

• Emerges from the medial border of the psoas major muscle within the abdomen.
• It crosses the pelvic brim and runs downwards through the obturator foramen.

Obturator Nerve Termination

• The obturator nerve terminates after exiting through the obturator canal by dividing into anterior and posterior divisions.

Obturator Nerve Branches and Innervations

Obturator Nerve Clinical Anatomy

• In disease to the knee joint, pain may get referred to hip joint also because the obturator nerve supplies both joints.

Question 4. Explain in detail about the sciatic nerve under the headings—origin, root value, beginning, course, termination, relations, branches, and innervations.
Answer:

Sciatic Nerve

• Sciatic Nerve is the thickest nerve in the body.
• Sciatic Nerve is the nerve of the posterior compartment of the thigh.

Sciatic Nerve Origin

• Arises from sacral plexus.

Sciatic Nerve Root Value

• L4, L5, S1, S2, S3.

Sciatic Nerve Beginning

• From pelvis.

Sciatic Nerve Course

• The sciatic nerve leaves the pelvis by passing through the greater sciatic foramen below the piriformis muscle and enters the gluteal region.
• From the gluteal region, it runs downwards with slight lateral convexity between the ischial tuberosity and greater trochanter.
• At the lower border of the gluteal maximus, it enters the back of the thigh and runs vertically downwards up to the superior angle of the popliteal fossa.

Sciatic Nerve Termination

• The sciatic nerve splits to the tibial and common peroneal nerve at the level of the upper 2/3rd and lower 1/3rd of the thigh.

Sciatic Nerve Relations

• Deep relations: From above downwards:
  • Body of ischium
  • Tendon of obturator internus
  • Quadratus femoris
  • Adductor magnus.
• Superficial relations: From above downwards:
  • Gluteal Maximus
  • Long head of biceps femoris.

Sciatic Nerve Branches and Innervations

Sciatic Nerve Clinical Anatomy

• When a person sits on a hard surface for a longer time, compression of the sciatic nerve leads to paresthesia of the lower limb known as sleeping foot
• When compression of the nerve root of the sciatic nerve occurs, the patient complains of shooting pain along the cutaneous distribution of the sciatic nerve. The pain starts in the gluteal region, then back to the thigh, then the lateral side of the leg, and to the dorsum of the foot.

Question 5. Explain in detail about the common peroneal nerve under the headings—origin, root value, beginning, course, termination, branches, and innervations.
Answer:

Common Peroneal Nerve Origin

• Common Peroneal Nerve is a smaller terminal branch of the sciatic nerve.

Common Peroneal Nerve Root Value

• L4, L5, S1, S2.

Common Peroneal Nerve Beginning

• Begins as a smaller terminal branch of the sciatic nerve in the back of the thigh.

Common Peroneal Nerve Course

• Common Peroneal Nerve descends downwards along the medial side of the tendon of the biceps femoris up to the lateral angle of the popliteal fossa.
• Common Peroneal Nerve further descends downwards to turn around the lateral surface of fibula.
• The rest of the nerve lies in the substance of the peroneus longus muscle.

Common Peroneal Nerve Termination

• Terminates as superficial and deep peroneal nerves.

Common Peroneal Nerve Branches and Innervations

Common Peroneal Nerve Clinical Anatomy

• Injury to the common peroneal nerve causes ‘foot drop’ and the person has a stepping gait.

Question 6. Explain in detail about the tibial nerve under the headings—origin, root value, beginning, course, termination, branches, and innervations.
Answer:

Tibial Nerve Origin

• Tibial Nerve is a large terminal branch of the sciatic nerve.

Tibial Nerve Root Value

• L4, L5, S1, S2, S3.

Tibial Nerve Beginning

• Larger subdivision of the sciatic nerve in the back of the thigh.

Tibial Nerve Course

• Tibial Nerve runs vertically downwards from the superior angle to the inferior angle of the popliteal fossa.
• In the popliteal fossa, it crosses the popliteal artery from the lateral to the medial side, superficial to it.
• The Tibial Nerve descends downwards to the back of the leg as a neurovascular bundle along with the posterior tibial artery and passes deep to the flexor retinaculum.

Tibial Nerve Termination

• Tibial Nerve terminates as medial and lateral plantar nerves as it lies deep in the flexor retinaculum.

Tibial Nerve Branches and Innervations

Tibial Nerve Clinical Anatomy

• Tarsal tunnel syndrome is caused by compression of the tibial nerve in the tarsal tunnel.

Question 7. Explain in detail about the cutaneous innervations of the lower limb.
Answer:

The Cutaneous Innervations Of The Lower Limb

Cutaneous supply of the lower limb originating from the lumbar and sacral plexus. In addition, T12, and L1 spinal segments also provide nerve fibers for the cutaneous supply.

Anterior Aspect of Thigh

• Seven cutaneous nerves supply skin of the front of thigh.
• They are emerging from the lumbar plexus.

Medial Aspect of Thigh

• Cutaneous branch of the obturator nerve.
• The medial cutaneous nerve of the thigh—a branch of the femoral nerve.

Posterior Aspect of Thigh

• The Posterior Nerve Of The Thigh: Direct branch of sacral plexus.

Patellar Plexus

• The skin over the patella, ligamentum patellae, and upper end of the tibia are supplied by a plexus of nerves around them.
• These are formed from branches from:
  • The lateral cutaneous nerve of the thigh
  • The intermediate cutaneous nerve of the thigh
  • The medial cutaneous nerve of thigh
  • Infrapatellar branch of the saphenous nerve.

Front, Dorsum, Lateral, and Medial Side of Leg

Back Of Leg

Sole Of Foot

Clinical Anatomy

Sometimes in obese or elderly people, the lateral cutaneous nerve of the thigh may get compressed by the inguinal ligament in its course and may present with pain and numbness over the anterolateral aspect of the thigh called meralgia paresthetica.

Question 8. Draw the dermatomes of the lower limb
Answer:

The Dermatomes Of The Lower Limb

Nerve Supply Of Lower Limb Multiple Choice Questions

Question 1. Which is not a branch of the common perineal nerve?

1. Lateral inferior genicular
2. Recurrent genicular
3. Sural
4. Sural communicating

Answer: 3. Sural

Question 2. Which dermatome is located over the medial border of the foot?

1. S1
2. S2
3. L4
4. L5

Answer: 3. L4

Question 3. Which nerve is tested if a physician pinches the skin of a patient between big toe and the second toe?

1. Superfiial perineal
2. Deep perineal
3. Sural
4. Saphenous

Answer: 2. Deep perineal

Question 4. The lateral cutaneous branch of the following nerves enters the gluteal region:

1. Subcostal and iliohypogastric
2. Subcostal, ilioinguinal and iliohypogastric
3. Subcostal and ilioinguinal
4. Iliohypogastric and ilioinguinal

Answer: 1. Subcostal and iliohypogastric

Question 5. Foot drop can be caused due to the injury of:

1. Obturator nerve
2. Femoral nerve
3. Sciatic nerve
4. Anterior tibial nerve

Answer: 3. Sciatic nerve