Lower Limb

Front Of Leg And Dorsum Of Foot

Question 1. Briefly explain the superficial and deep fascia of the front of leg and dorsum of the foot. How deep fascia divides leg into compartments?
Answer:

The superficial and deep fascia of the front of leg and dorsum of the foot

Front Of Leg Superficial Fascia

Superficial fascia over the front of leg and dorsum of foot contains:

• Superficial vein
• Cutaneous nerves
• Lymphatics
• Unnamed arteries

Front Of Leg Deep Fascia

• The deep fascia of leg is very strong and encloses the leg like a tight sleeve.
• However, at places, the tibia and fibula is subcutaneous and covered by the periosteum only.
• Extensions of the deep fascia form intermuscular septa that divide the leg into compartments.
• The anterior intermuscular septa are attached to anterior border of the fibula whereas the posterior intermuscular septa are attached to the posterior border of the fibula.
• They divide the leg into anterior, posterior, and lateral compartments.
• Around the ankle, they are thickened and form the extensor, peroneal and flxor retinaculum.

Question 2. Write a note on the extensor retinaculum of the lower limb.
Answer:

Extensor retinaculum of the lower limb

• It is the thickened part of deep fascia in front of ankle
• It is of 2 in number.

1. Superior extensor retinaculum
   • It is band-shaped
   • Attached
     • Medially: To the lower part of anterior border of the tibia
     • Laterally: To the lower part of anterior border of fibula
2. Inferior extensor retinaculum
   • It is ‘Y’ shaped
   • The stem of ‘Y’ lies laterally while the upper and lower bands medially.

Read And Learn More: Anatomy Question And Answers 

• Attachments
  • The stem is attached laterally to the anterior nonarticular part of the superior part of the calcaneus in front of the sulcus calcanei.
  • The upper band is attached to the anterior border of the medial malleolus.
  • Lower band is attached to the plantar aponeurosis.
• Structures Passing Undercover
  • Tibialis anterior
  • Extensor hallucis longus
  • Anterior tibial vessels
  • Deep peroneal nerve
  • Extensor digitorum longus
  • Peroneus tertius.
• Function
  • Stabilizing the tendon passing beneath it.

Question 3. List the muscles of the dorsum of foot. Write their origin, insertion, nerve supply, and actions.
Answer:

The muscles of the dorsum of foot

• Intrinsic muscles: Only one
  • Extensor digitorum brevis.
• Extrinsic muscles:
  • Tibialis anterior
  • Extensor hallucis longus
  • Extensor digitorum longus
  • Peroneus tertius.

Muscles of Anterior Compartment of the Leg and Dorsum of the Foot

Mnemonics

 

• Leg: Anterior muscles of leg ‘The Hospitals Are Not Dirty Places’:
  • T: Tibialis anterior
  • H: Extensor hallucis longus
  • A: Anterior tibial artery
  • N: Deep fiular nerve
  • D: Extensor digitorum longus
  • P: Peroneus tertius.

Lateral Compartment Of Leg

Question 4. Give the boundaries and contents of lateral compartment of leg.
Answer:

Lateral Compartment Of Leg Boundaries

• Anterior: Anterior intermuscular septum
• Posterior: Posterior intermuscular septum
• Medial: Lateral surface of fibula
• Lateral: Deep fascia of the leg.

Lateral Compartment Of Leg Contents

• Muscles: Peroneus longus, peroneus brevis
• Nerves: Superficial peroneal nerve
• Arteries: Small branches supplying muscles
• Venous branches: Draining into short saphenous veins.

Question 5. Write a note on the peroneal retinaculum.
Answer:

Peroneal retinaculum

Deep fascia over the lateral side of the ankle is modified to form two thick bands known as the superior and inferior peroneal retinaculum.

Superior Peroneal Retinaculum

• Attached
  • Anteriorly: To the back of the lateral malleolus
  • Posteriorly: To the lateral surface of the calcaneus and superficial transverse septum of the leg.

Inferior Peroneal Retinaculum

• Attached
  • Superiorly: To the anterior part of the superior surface of the calcaneus, close to the stem of the inferior extensor retinaculum
  • Inferiorly: To the lateral surface of the calcaneus.
• Structures under Peroneal Retinaculum
  • Tendons of peroneus longus and peroneus brevis
  • Under superior peroneal retinaculum, both tendons are enclosed in a single synovial sheath, whereas under inferior peroneal retinaculum, they are enclosed in a separate synovial sheath.
• Function
  • Stabilizing the tendons of peroneus longus and peroneus brevis.

Medial Side Of Leg

• It is formed by the medial surface of the shaft of tibia.
• Most of the part is subcutaneous.
• But in the upper part, the tibial collateral ligament and three muscles namely sartorius, gracilis, and semitendinosus are inserted.
• A great saphenous vein and saphenous nerve runs through this compartment.

Question 6. What is guy ropes?
Answer:

Guy ropes

The muscles which are inserted into one point over the upper part of the medial side of the tibia are however originate wide apart from the hip bone and represent different compartments. They act as 3 strings of a tent and stabilize the bony pelvis known as ‘guy ropes’.

Question 7. What is anserine bursa?
Answer:

Anserine bursa

• It is a complicated synovial bursa several diverticula present over the upper part of the medial surface of the tibia.
• It helps to separate and reduce frictions (between the tendons of sartorius, gracilis, and semitendinosus and separates this from the tibial collateral ligament).

Anserine Bursa Clinical Anatomy

• Anserine bursitis is the inflammation of the anserine bursa

Back Of Leg Or Calf

Question 8. Give a brief description of calf region mentioning about boundaries and subdivision of the posterior compartment of leg.
Answer:

Calf region mentioning about boundaries and subdivision of the posterior compartment of leg

Corresponds to the front of the forearm. It extends from the popliteal fossa above to the ankle below.

• Superficial Fascia
  • It contains:
    • Small or short saphenous vein
    • Great saphenous vein
    • Cutaneous nerves.
• Deep Fascia
  • Deep fascia bounds and subdivides the posterior compartment of leg.

Boundaries and Subdivision of Posterior Compartment of Leg

Posterior Compartment Of Leg Boundaries:

• Anteriorly: Tibia, interosseous membrane, fibula, posterior intermuscular septum
• Posteriorly: Deep fascia of leg

Posterior Compartment Of Leg Subdivision:

• It is subdivided into 3 by the deep fascia. They are:
  • Superficial
  • Middle
  • Deep

Contents of the posterior compartment are distributed in these three divisions.

Question 9. Write a note on flexor retinaculum of lower limb.
Answer:

Flexor retinaculum of lower limb

It is a band formed at the medial side of the ankle by the thickening of the deep fascia of leg.

• Attachments
  • Anterior: To posterior border and hip of medial malleolus
  • Posterolaterally: To the medial tubercle of the calcaneus.
• Structures Passing Deep to Retinaculum
  • The septa passes to the underlying bone from the retinaculum and divides it into 4 compartments.
  • Structures passing from medial to lateral are:
• Function
  • Stabilizing the tendons passing underneath it.

Flexor Retinaculum Of Lower Limb Clinical Anatomy

These structures are passing through tarsal tunnel and if the nerve get compressed, it leads to tarsal tunnel syndrome.

Mnemonics

• Medial malleolus: Order of tendons, artery, nerve behind it.
  • ‘Tom, Dick, And Nervous Harry’:
  • From anterior to posterior:
  • Tibialis
  • Digitorum
  • Artery
  • Nerve
  • Hallicus

Full names for these are Tibialis Posterior, Flexor Digitorum Longus, Posterior Tibial Artery, Posterior Tibial Nerve, and Flexor Hallicis Longus.

Question 10. List the muscles of the posterior compartment of the leg. Write their origin, insertion, nerve supply, and actions.
Answer:

Posterior Compartment Of The Leg They are categorized into:

• Superficial muscles:
  • Gastrocnemius
  • Soleus
  • Plantaris
• Deep muscles:
  • Popliteus
  • Flexor digitorum longus
  • Flexor hallucis longus
  • Tibialis posterior.

Superfiial Muscles of Back of Leg

Deep Muscles of Back of Leg

Posterior Compartment Of The Leg Clinical Antomy

• Calf muscles are very important in circulation. There are valveless venous sinuses in these muscles and blood is filled in these sinuses. When these muscles contract, blood is pumped out, and when the muscle relaxes, blood is sucked in from superficial veins through perforators. So they act as peripheral hearts.
• When the calf muscles are at rest for a long time, especially in bed-ridden patients, the venous sinuses can develop thrombosis, which eventually dislodges and block arteries.
• Tendocalcaneal, otherwise known as the Achilles tendon is very strong, however can get ruptured in tennis players.
• Tendocalcaneal reflux is usually tested to assess deep tendon reflexes in CNS examination.

Leg And Dosum Of Foot Multiple Choice Questions

Question 1. Which of the following is not attached to fibula?

1. Tibialis anterior
2. Extensor hallucis longus
3. Extensor digitorum longus
4. Peroneus tertius

Answer: 1. Tibialis anterior

Question 2. Violent inversion of foot will lead to the avulsion of a tendon that is inserted into the tuberosity of the fifth metatarsal bone. Identify the tendon:

1. Peroneus Brevis
2. Peroneus longus
3. Peroneus Tertius
4. Tibialis posterior

Answer: 1. Peroneus Brevis

Question 3. Which of the following muscles act on both knee and ankle joints?

1. Soleus
2. The short head of biceps
3. Gastrocnemius
4. Long head of biceps femoris

Answer: 3. Gastrocnemius

Question 4. Pes anserine is the term used for insertion of the following muscles:

1. Semitendinosus
2. Semimembranosus
3. Sartorius
4. Gracilis

Answer: 2. Semimembranosus

 

Lower Limb Introduction

• The lower limb and upper limb are similar in their basic structure.
• However, with the evolutionary process, functions of lower limb has modified into the transmission of body weight and locomotion and became bulkier and stronger with lesser mobility compared to the upper limb.

Lower Limb Related Terms

1. Hip bone: Is made of 3 elements; ilium, pubis, and ischium
2. Hip girdle: Left and right hip bones form the hip girdle which articulates with the sacrum posteriorly at the sacroiliac joint
3. Bony pelvis: Made of 2 hip bones, sacrum, and coccyx
4. Hip joint: Articulation between hipbone and femur
5. Gluteal region: Overlies the side and back of the pelvis including hip and buttocks
6. Hip/coxa: Superolateral part of gluteal region
7. Buttocks/natis: Inferomedial rounded bulge of gluteal region
8. Inguinal region/groin: The junction between the anterior abdominal wall and thigh. Indicated by a groove
9. Ham/peoples: Represent the lower part of back of the thigh and back of knee
10. Calf/sura: Posterior part of the leg
11. Malleoli: Bony prominence formed by the lower end of the tibia and fibula on medial and lateral part of the ankle respectively

The upper surface of the foot/pes is called the dorsum and the lower surface is called the sole or plantar surface.

Front Of Thigh Introduction

• The front of thigh extends from the hip to the knee joint. It corresponds to back of arm.

Front Of Thigh Question And Answers

Question 1. Briefly explain the superficial fascia of the front of thigh.
Answer:

The superficial fascia of the front of thigh

It has 2 layers on the front of thigh near the inguinal region:

1. Superficial fatty layer
2. Deep membranous layer

• These layers are continuous with corresponding layers of the anterior abdominal wall
• In between these two layers following are situated:
  • Cutaneous nerves
  • Cutaneous arteries
  • Termination of saphenous vein and its tributaries
  • Superficial inguinal lymph nodes.

Read And Learn More: Anatomy Question And Answers 

Superficial fascia of the front of thigh Clinical Anatomy

• The membranous layer of superficial fascia is attached in a linear fashion to the deep fascia of the thigh along a horizontal line that extends laterally from the pubic tubercle about 8 cm.
• This attachment helps to prevent the passage of collected urine from anterior abdominal wall to the front of thigh due to injury of the urethra.

Question 2. Explain in detail about deep fascia of the thigh/fascia lata and their modifications.
Answer:

Deep fascia of the thigh

Deep fascia of the thigh is also known as fascia lata. It is strong and envelopes the thigh like a sleeve.

Deep fascia of thigh Attachments

1. Superiorly
   • Anterior part: Attached to the ASIS, inguinal ligaments and pubic tubercle
   • Lateral part: Iliac crest
   • Posterior part: To sacrum, coccyx, sacrotuberous ligament
   • Medially: Pubis, pubic arch, ischial tuberosity.
2. Inferiorly
   • On the front side of knee: Attached to subcutaneous bony prominence and joint capsule
   • On the back of knee: Continuous on the popliteal fascia.
3. Modification of Fascia Lata
   • Fascia lata presents 3 modifications in the thigh.

Iliotibial Tract

• It is the lateral thickened portion of fascia lata with 5 cm width.
• It splits into superficial and deep lamina superiorly.

Iliotibial Tract Attachments

• Superiorly: Superficial lamina attached to the tubercle of the iliac crest. Deep lamina attached to the capsule of hip joint.
• Inferiorly: Smooth area on the anterior surface of the lateral condyle of the tibia.
• It encloses the 3/4th part of the gluteus maximus and tensor fascia lata muscle in between the 2 lamina in the upper part.
• Function: Support knee in extension and partial flexion.

Saphenous Opening

• It is an oval-shaped opening in the fascia lata.
• Location: Th center of the opening lies 4 cm below and 4 cm lateral to pubic tubercle
• Structures passing through are:
  • Great saphenous vein.
  • Superficial epigastric and superficial external pudendal vessel.
  • Few lymph vessels connect superficial and deep inguinal lymph nodes.

Intermuscular Septa: Intermuscular septa divide the thigh into three compartments:

1. Lateral intermuscular septa
2. Medial intermuscular septa
3. Posterior intermuscular septa.

Iliotibial Tract Clinical Anatomy

Fascia lata is attached to the inguinal ligament. In the lying down position, when hip is extended, the anterior abdominal wall is stretched and palpation of abdominal contents becomes difficult due to the pull of the fascia lata. Therefore semi flexed hip position is preferred.

Question 3. Write a note on the femoral triangle explaining its boundaries and contents.
Answer:

Femoral triangle explaining its boundaries and contents

It is a triangular depression on the front of the upper 1/3rd of the thigh below the inguinal ligament.

Femoral Triangle Boundaries

• Lateral: Medial border of sartorius
• Medial: Medial border of adductor longus
• Base: Inguinal ligament
• Apex: Formed by the meeting of medial and lateral boundaries. It is directed downwards
• Floor: From lateral to medial
  • Iliacus
  • Psoas major (tendon)
  • Pectineus
  • Adductor longus muscles lies.
• Roof: Made by skin, superficial fascia, deep fascia
  • Superficial fascia consists of:
    • Branch of the femoral artery and accompanying veins
    • Superficial inguinal lymph nodes
    • Femoral branch of genitofemoral nerve
    • Branches of ilioinguinal nerve
    • Upper part of great saphenous vein.

Femoral Triangle Mnemonics

• Femoral triangle: Boundaries ‘So I May Always Love Sally’:
• Superiorly: Inguinal ligament
• Medially: Adductor longus
• Laterally: Sartorius

Femoral Triangle Contents

• Femoral artery and its branches
• Femoral vein and its branches
• Femoral nerve
• Deep inguinal lymph nodes
• The lateral cutaneous nerve of thigh
• Femoral branch of genitofemoral nerve
• Fibrofatty tissue.

Femoral Triangle Mnemonic Femoral triangle: Arrangement of contents

NAVEL

• From lateral hip towards medial navel:
• Nerve (directly behind sheath)
• Artery (within sheath)
• Vein (within sheath)
• Empty space (between vein and lymph)
• Lymphatics (with deep inguinal node).

Question 4. Write a note on the femoral sheath explaining about its boundaries and contents.
Answer:

Femoral sheath

• It is a funnel-shaped sleeve of fascia enclosing the upper 3 to 4 cm of femoral vessels.

Femoral Sheath Boundaries:

• Base
  • Directed upwards
• Apex
  • Directed downwards merging with the connective tissue of femoral vessels
• Anterior wall
  • Formed by fascia transversalis
• Posterior wall
  • Formed by fascia iliaca
• Lateral wall
  • Vertical
• Medial wall
  • Oblique, directed downward, and laterally

The sheath is divided into 3 compartments by septa:

• Lateral/arterial compartment: Contains of:
  • Femoral artery
  • Femoral branch of genitofemoral nerve
• Intermediate/venous compartment: Contains of:
  • Femoral vein
• Medial/lymphatic compartment or femoral canal: Contains:
  • Lymph node of cloquet or rosenmuller
  • Fibrofatty tissue.

Question 5. Write a short note on femoral canal.
Answer:

Femoral Canal

• It is the medial compartment of femoral sheath.
• Conical shape, wide above at base and narrow below about 1.5 cm long and 1.5 cm wide at the base.
• Base is called Femoral ring.
• The boundary of femoral ring is important:
  • Anterior: Inguinal ligament
  • Medial: Sharp edge of lacunar ligament
  • Posterior: Pecten pubis
  • Lateral: Femoral vein.
• Usually, a fatty areolar tissue called the femoral septum closes the femoral ring.

Femoral Canal Clinical Anatomy

• The femoral ring is a weak zone in the groin region.
• When conditions which increase abdominal pressure (for example, pregnancy) or conditions which weaken the femoral ring furthermore (for example, old age), intra-abdominal contents especially loop of the bowel can herniated through it and is known as femoral hernia.
• Femoral hernia is more common in females due to a larger femoral ring as a result of wider pelvis.

Question 6. Enumerate the muscles of front of thigh.
Answer:

Front Of Thigh Intrinsic muscles

• Sartorius
• Quadriceps femoris: 4 muscles
  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedius
  • articularis genu

Front Of Thigh Extrinsic muscles

• Iliacus
• Psoas major
• Pectineus
• Adductor longus
• Tensor fascia lata

Question 7. List all the four muscles belonging to quadriceps femoris with their origin, insertion, nerve supply, and actions.
Answer:

Rest of Muscles of Anterior Compartment of Thigh

Quadriceps Femoris Clinical Anatomy

The anterolateral region of thigh is used for giving intramuscular injections in infants and children and for self-injection in adults since it is the safest.

Question 8. Write a note on adductor or hunters or sub sartorial canal explaining about its extent, boundaries, and contents.
Answer:

Adductor

It is an intramuscular tunnel situated medial 1/3rd of thigh.

Adductor or Hunters or Subsartorial Canal Extend

• Above: Apex of the femoral triangle
• Below: Tendinous opening in the adductor magnus

Adductor or Hunters or Subsartorial Canal Shape

• Triangular on cross-section.

Adductor or Hunters or Subsartorial Canal Boundaries

• Anterolateral wall:
  • Vastus medialis
• Posterior/flor:
  • Adductor longus
  • Adductor Magnus below
• Medial/roof:
  • Strong fibrous membrane
  • Sartorius muscle.

Adductor or Hunters or Subsartorial Canal Contents

• Femoral artery
• Femoral vein
• Saphenous nerve
• Nerve to vastus medialis
• Anterior and posterior division of obturator nerve
• Descending genicular artery.

Adductor or Hunters or Subsartorial Canal Clinical Anatomy

The femoral artery is exposed and ligated in the adductor canal during the surgery for popliteal artery aneurysm known as hunter’s operation.

Front Of Thigh Multiple Choice Questions

Question 1. The Profunda femoris artery leaves the femoral triangle through:

1. Apex
2. Behind the sartorius
3. Between psoas major and pectineus
4. Between pectineus and adductor longus

Answer: 4. Between pectineus and adductor longus

Question 2. Femoral branch of the genitofemoral nerve is located in:

1. Femoral canal
2. Inguinal canal
3. Middle compartment of femoral sheath
4. Lateral compartment of femoral sheath

Answer: 4. Lateral compartment of femoral sheath

Question 3. When the s1 root is irritated, patient experiences pain in which of the following?

1. Medial aspect of thigh
2. Gluteal region
3. Popliteal fossa
4. Lateral side of foot

Answer: 4. Lateral side of foot

Question 4. Which of these pairs does not shares common nerve supply?

1. Soleus and popliteus
2. Gluteus medius and tensor fasciae latae
3. Quadratus femoris and superior gemellus
4. Obturator externus and adductor brevis

Answer: 3. Quadratus femoris and superior gemellus

Question 5. The femoral hernia is manually reduced by pushing the hernia sequentially in the following directions:

1. Upwards, backwards and medially
2. Forwards upwards and laterally
3. Backwards, downwards and medially
4. Downwards, backwards and upwards

Answer: 4. Downwards, backwards and upwards

 

Medial Side Of Thigh Question And Answers

Question 1. Give a description of medial side of the thigh with its boundaries and contents.
Answer:

Medial side of the thigh

• Medial side of the thigh contains adductors of the hip joint, hence called adductor compartment.
• The adductor compartment of the thigh is well-developed compared to its counterpart in upper limb which is only represented by weak coracobrachialis muscle.

Medial Side Of Thigh Boundaries

• Anterior: Anterior intermuscular septum separating medial side from front/extensor compartment of thigh
• Posterior: Ill defied posterior intermuscular septum separating it from back/flexor compartment of thigh.

Medial Side Of Thigh Contents

• Muscles:
  • Intrinsic
    • Adductor longus
    • Adductor brevis
    • Adductor magnus
    • Gracilis
    • Pectineus
  • Extrinsic
    • Obturator externus
  • Nerves:
    • Obturator nerve
    • Accessory obturator nerve (in 30% of individuals only).
  • Arteries:
    • Obturator artery
    • Medial circumflex femoral artery.

Question 2. List the muscles of adductor compartment of the thigh. Mention the nerve supply of hybrid muscles among them.
Answer:

The muscles of adductor compartment of the thigh

Arranged into 3 layers:

1. First/Anterior layer: Consists of:
   • Pectineus
   • Adductor longus
   • Gracilis
2. Second/Middle layer: Adductor brevis
3. Third/Posterior layer: Adductor Magnus

• All the muscles of medial compartment are supplied by the obturator nerve
• But 2 muscles have a dual nerve supply
  • Pectineus supplied by femoral and obturator nerve
  • Adductor Magnus by posterior division of obturator nerve and tibial part of sciatic nerve.

Question 3. Write a short note on the adductor magnus muscle.
Answer:

Adductor Magnus Muscle Origin

• Inferolateral part of the ischial tuberosity
  • Ramus of the Ischium
  • Lower part of the
  • Inferior ramus of pubis

Adductor Magnus Muscle Insertion

• Medial margin of gluteal tuberosity
  • Linea aspera
  • Medial supracondylar line
  • Adductor tubercle

Adductor Magnus Muscle Nerve Supply

• Dual nerve supply
  • The posterior division of the obturator nerve supplies the adductor part
  • Tibial part of sciatic nerve supplies the hamstring part

Read And Learn More: Anatomy Question And Answers 

Adductor Magnus Muscle Action

• Extension of hip
• Flexion of knee

Question 4. Write a short note on pectineus muscle.
Answer:

Pectineus Muscle Origin

• Pecten pubis
• The upper half of the pectineal surface of superior ramus of the pubis
• Fascia covering the pectineus

Pectineus Muscle Insertion

• Line extending from the lesser trochanter to linea aspera

Pectineus Muscle Nerve Supply

• Dual nerve supply
  • Femoral nerve
  • Anterior division of obturator nerve

Pectineus Muscle Actions

• Adduction of thigh
• Flexion of thigh

Question 5. Explain about the origin, insertion, nerve supply, and actions of rest of the muscles of adductor compartment of thigh.
Answer:

Adductor compartment of thigh

Medial Side Of Thigh Multiple Choice Questions

Question 1. The riders bone is found in the tendinous origin of:

1. Adductor longus
2. Adductor brevis
3. Adductor Magnus
4. Gracilis

Answer: 1. Adductor longus

Question 2. Which among these is not an intrinsic muscle of the medial side of thigh?

1. Adductor longus
2. Adductor Magnus
3. Pectineus
4. Obturator externus

Answer: 4. Adductor magnus

Question 3. Which muscle among these is supplied by the sciatic nerve?

1. Adductor longus
2. Adductor Magnus
3. Pectineus
4. None of the above

Answer: 4. None of the above

Question 4. Which among these is action of the adductor magnus muscle?

1. Extension of hip
2. Flexion of knee
3. Flexion of hip
4. Both a and b

Answer: 4. Both a and b

Question 5. Which is the nerve of the adductor compartment of the thigh?

1. Sciatic nerve
2. Obturator nerve
3. Femoral nerve
4. Sural nerve

Answer: 2. Obturator nerve

 

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.

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.

Read And Learn More: Anatomy Question And Answers 

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

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

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

Read And Learn More: Anatomy Question And Answers 

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.

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 base is distal
    • At the base it divides into 5 processes
    • Each process splits into superfiial 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 sole
      • It protects deeper structure in the sole
      • Helps to maintain the longitudinal arch of foot
      • It gives origin to the first layer of sole.
  • Deep transverse metatarsal ligaments.
  • Fibrous flexor sheaths.

Read And Learn More: Anatomy Question And Answers 

Sole Of Foot Clinical Anatomy

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

Question 2. List the muscles of sole of 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 Second Layer of Sole of Foot

Muscles of Third Layer of Sole of Foot

Muscles of Fourth Layer of Sole of Foot

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

Arches Of Foot

• Human foot is uniquely architectured to perform complex functions.
• Arches of foot helps 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 shape of bones.
• Arches of 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 are 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 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.

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.

Read And Learn More: Anatomy Question And Answers 

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 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
  • Fracture of neck of 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 femur.
  • A time gap is given for the fracture segment to unite if it is young individuals. Hip replacement surgeries are more preferred in elderly patients.
  • Shenton’s line is a continuous curve formed by the upper border of the obturator foramen and lower margin of neck of the femur seen in a normal X­ray pelvis. But following posterior dislocation and fracture of neck of femur, this line is disrupted.
  • Shoemaker’s line is an line extending from the greater trochanter, advancing through the anterior superior iliac spine, to pass through the umbilicus. But in fracture of neck of femur or in posterior dislocations, this line passes below the umbilicus.

Question 2. Explain in detail about 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

It 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

• It is a modified hinge type of synovial joint.
• It 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
• It 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 femur articulate with the lateral and medial condyles of the tibia respectively. It is of condylar type.
• Patella articulates with the femur. It is of saddle type.
• Attached on
  • Femur
    • ½ to 1 cm beyond the articular margines 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 origine of the popliteus muscle.
  • Tibia
    • ½ to 1 cm beyond the articular margines except:
      • Posteriorly where it encloses the tendon of the popliteus muscle.
      • It is lined inside by a synovial membrane.

Knee Joint Ligamentum patellae

• It is the central part of the common tendon of insertion of quadriceps femoris (the remaining portion of tendon forms lateral and medial patellar retinacula)
• It 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

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

Fibular collateral ligament/Lateral ligament

• It is a short, strong, and cord-like ligament located on the lateral side of knee joint.
• It is attached above to the lateral epicondyle of the femur just above the popliteal groove and below, it is attached to the head of 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.
• It is also free from the capsule separated by inferior lateral genicular nerves and vessels.

Oblique popliteal ligament

• It is an expansion from the tendon of the semimembranosus muscle located posteriorly.
• It runs upwards and laterally blending with the capsule of knee joint.
• It is attached to an intercondylar line of femur.
• It strengthens the capsule posteriorly and is in close relation with the knee joint.
• It 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)

• It 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.
• It prevents the anterior displacement of tibia.

Posterior cruciate ligament (PCL)

• It 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.
• It 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 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 tibial condyle
  • 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 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 tibia.
• The posterior horn of the lateral meniscus is attached to the medial condyle of the femur by anterior and posterior meniscofemoral ligaments.
• 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 tibia ensuring best congruence with the condylar surface of femur.
• They act as shock absorbers.
• They help to lubricate the joint cavity.
• Flexion and extension of the knee joint is taking 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 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
    • Lateral head of the gastrocnemius
    • Plantaris
    • Common peroneal nerve
  • Posteromedially
    • 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 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 knee to remain in a standing position without much muscular effort.
  • This is possible due to the fact that the anteroposterior diameter of medial condyle of 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 tibia.
  • So the lateral condyle act 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 for injuries and damages.
• Injury to the anterior cruciate ligament causes anterior dislocation of the tibia and anterior drawers sign will be positive. Injury to the posterior cruciate ligament causes posterior dislocation of 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 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, knee joint is more prone for 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

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

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.

Deltoid Ligament Deep part

• It has the same superior attachment as that of 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 foot is in the ground, this movement occurs in their 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 nerve supply of the lower limb.
Answer:

Nerve supply of the lower limb

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

Obturator Nerve Origin

• From lumbar plexus.

Obturator Nerve Root Value

• L2, L3, L4

Obturator Nerve Beginning

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

Obturator Nerve Termination

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

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

Sciatic Nerve

• It is the thickest nerve in the body.
• It is the nerve of the posterior compartment of 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

• It leaves the pelvis by passing through greater sciatic foramen below piriformis muscle and enters 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 gluteal maximus, it enters the back of thigh and runs vertically downwards up to the superior angle of popliteal fossa.

Sciatic Nerve Termination

• It splits to the tibial and common peroneal nerve at the level of 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 longer time, compression of sciatic nerve leads to paresthesia of lower limb known as sleeping foot
• When compression of nerve root of the sciatic nerve occurs, patient complains of shooting pain along the cutaneous distribution of sciatic nerve. The pain starts in the gluteal region, then back to the thigh, then the lateral side of leg, to the dorsum of 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

• It is smaller terminal branch of sciatic nerve.

Common Peroneal Nerve Root Value

• L4, L5, S1, S2.

Common Peroneal Nerve Beginning

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

Common Peroneal Nerve Course

• It descends downwards along the medial side of the tendon of the biceps femoris up to the lateral angle of the popliteal fossa.
• It further descends downwards to turn around the lateral surface of fiula.
• The rest of 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

• It is a large terminal branch of sciatic nerve.

Tibial Nerve Root Value

• L4, L5, S1, S2, S3.

Tibial Nerve Beginning

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

Tibial Nerve Course

• It 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 lateral to the medial side, superficial to it.
• It descends downwards to the back of leg as a neurovascular bundle along with the posterior tibial artery and passes deep to the flexor retinaculum.

Tibial Nerve Termination

• It terminates as medial and lateral plantar nerves as it lies deep to flexor retinaculum.

Tibial Nerve Branches and Innervations

Tibial Nerve Clinical Anatomy

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

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

The cutaneous innervations of lower limb

Cutaneous supply of the lower limb originating from the lumbar and sacral plexus. In addition, T12, and L1 spinal segments also provides 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 obturator nerve.
• The medial cutaneous nerve of thigh—a branch of femoral nerve.

Posterior Aspect of Thigh

• Posterior nerve of the thigh: Direct branch of sacral plexus.

Patellar Plexus

• The skin over the patella, ligamentum patellae, and upper end of tibia are supplied by a plexus of nerves around them.
• These are formed from branches from:
  • The lateral cutaneous nerve of thigh
  • The intermediate cutaneous nerve of thigh
  • 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 an obese or elderly people, lateral cutaneous nerve of thigh may get compressed by inguinal ligament in its course and may present with pain and numbness over the anterolateral aspect of the thigh called as 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 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 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

 

Blood Supply And Lymphatic Drainage Of Lower Limb Question And Answers

Arterial Supply Of Lower Limb

Question 1. Explain in detail about the femoral artery under the headings—origin, course, relations, and branches.
Answer:

The femoral artery

Read And Learn More: Anatomy Question And Answers 

Chief artery of the lower limb.

Femoral Artery Origin

• Continuation of the external iliac artery.
• Begins behind the inguinal ligament at the level of mid inguinal point.

Femoral Artery Extend and Course

• Runs downwards and medially through the femoral triangle and adductor canal.
• At the lower end of the adductor canal, i.e. junction between the upper 2/3rd and lower 1/3rd of thigh, it passes through the opening of the adductor magnus muscle to enter popliteal fossa.
• From there it continues as a popliteal artery.

Femoral Artery Relations in Femoral Triangle

• Anterior: Skin, superficial fascia, deep fascia, the anterior wall of the femoral sheath.
• Posterior: Psoas major, pectineus, adductor longus muscles.
• Femoral vein lies posterior to the femoral artery
• Above the level of apex of the femoral triangle, femoral vein lies medial to femoral artery.
  • At the level of apex of femoral triangle, the femoral vein lies directly behind to femoral artery.
  • Below the level of the apex of femoral triangle, femoral vein it crosses and lies lateral to femoral artery.
• Femoral nerve lies lateral to the upper part of femoral artery.
• Femoral branch of the genitofemoral nerve also lies lateral to the upper part of the femoral artery.
• The Profunda femoris artery and its companion vein lies posterior to the femoral artery in its upper part, lower down they are separated by adductor muscle.

Femoral Artery Branches

• In the femoral canal
  • Three superficial branches:
    • Superficial epigastric artery
    • Superficial external pudendal artery
    • Superficial circumflx iliac artery.
  • Three deep branches:
    • Profunda femoris artery
    • Deep external pudendal artery
    • Muscular branches.
• In the adductor canal
  • Muscular branches
  • Descending genicular artery.
• Clinical Anatomy
  • Femoral artery pulsations can be felt in the femoral triangle just below the mid-inguinal point.
  • Since femoral artery is superficial in the femoral triangle, blood can be easily withdrawn for arterial blood gas analysis.
  • It is the preferred artery for coronary artery angiography and angioplasty.
  • Since femoral vein runs behind the femoral artery in the apex of the triangle any stab wounds in this area can be fatal.

Mnemonics

• Femoral artery deep branches: ‘Put My Leg Down Please’
  • Profundus femoris (deep femoral artery)
  • Medial circumflex femoral artery
  • Lateral circumflex femoral artery
  • Descending genicular arteries
  • Perforating arteries

Question 2. Explain about profunda femoris artery under the headings—origin, course, termination, and branches.
Answer:

Profunda Femoris Artery Origin

• The largest branch of femoral artery.

Profunda Femoris Artery Course

• Arises from the lateral side of femoral artery 4 cm below the inguinal ligament in the femoral triangle.
• Gives of lateral and medial circumflex arteries.
• Descends down close to femur giving branches to muscles and terminal branches.

Profunda Femoris Artery Termination

• After piercing adductor magnus ends at the posterior part of leg.

Profunda Femoris Artery Branches

• Muscular branches
• Medial circumflex femoral artery
• Lateral circumflex femoral artery
• Four perforating arteries.

Profunda Femoris Artery Clinical Anatomy

• Since it lies close to the shaft of the femur, a fracture of femur or surgery in the area may injure the artery.

Question 3. Write a short note on the obturator artery.
Answer:

Obturator Artery

• It is a branch of the internal iliac artery.
• It accompanies obturator nerve in pelvis and passes through the obturator canal.
• Then, it divides into medial and lateral branches and anastomose with medial circumflex femoral artery.
• They supply:
  • Neighboring muscles
  • Fat in acetabular fossa
  • Head of femur through round ligament.

Question 4. Write a short note on medial circumflex femoral artery.
Answer:

Medical Circumflex Femoral Artery

• Branch of profunda femoris artery
• It divides into 2 branches:
  • Ascending branch
    • It anastomosis with the ascending branch of the lateral circumflex femoral artery and superior gluteal artery to form trochanteric anastomosis.
    • This anastomosis gives of retinacular branches which supply the head of femur.
  • Transverse branch
    • It anastomosis with the transverse branch of lateral femoral circumflex, inferior gluteal, and fist perforating branch of profunda femoris to form a cruciate anastomosis.
• Before the terminal branches, it gives off
  • Muscular branches
  • Acetabular branches to supply fat in acetabular fossa
  • Branch supplying head of femur.

Medical Circumflex Femoral Artery Clinical Anatomy

Intracapsular fracture of the neck of the femur can cause avascular necrosis of the head of the femur due to damages to retinacular branches.

Question 5. Explain the popliteal artery under the headings—origin, course, termination, relation, and branches.
Answer:

Popliteal artery

Popliteal Artery Origin

• Continuation of femoral artery.

Popliteal Artery Course

• From the adductor hiatus, it runs downwards and slightly laterally, to reach the lower border of popliteal muscle.

Popliteal Artery Termination

• Terminates at the lower border of popliteus into anterior and posterior tibial arteries.

Popliteal Artery Relation

• Anterior/deep relations:
  • Popliteal surface of femur
  • Back of knee joint
  • Fascia covering popliteus muscle
• Posterior/superficial relations:
  • Popliteal vein
  • Tibial nerve
• Laterally:
  • Upper part of artery related to biceps femoris and lateral condyle of femur
  • Lower part related to plantaris and lateral head of the gastrocnemius muscle
• Medially:
  • Upper part related to biceps femoris and lateral condyle of the femur
  • Lower part is related to tibial nerve, popliteal vein, and medial head of the gastrocnemius.

Popliteal Artery Branches

• A number of large muscular branches
• Cutaneous branches
• Genicular branches—5 in number:
  • Medial and lateral superior genicular branches
  • Middle genicular branch
  • Medial and lateral inferior genicular branches
  • They form anastomosis around the knee joint.

Popliteal Artery Clinical Anatomy

• Popliteal pulsation is felt by flexing the knee and palpating the popliteal artery in the popliteal fossa, against the underlying femur. It is difficult to feel.
• Popliteal artery aneurysm is the most common arterial aneurysm.

Question 6. Write a short note on the anterior tibial artery.
Answer:

Anterior Tibial Artery Beginning

• The smaller terminal branch of the popliteal artery.
• It begins on the back of leg at the lower border of the popliteus, opposite the tibial tuberosity.

Anterior Tibial Artery Course

• Reaches front of leg through an opening in the upper part of the interosseous membrane.
• Runs downward in between the muscles of leg and continues as dorsalis pedis artery from the point between medial and lateral malleolus.

Anterior Tibial Artery Branches

• Muscular branches to anterior compartment of leg
• Cutaneous branches
• Branches to knee and ankle joints.

Question 7. Write a short note on posterior tibial artery.
Answer:

Posterior Tibial Artery Beginning

• Larger terminal branch of popliteal artery.
• It begins at the lower border of the popliteus, between the tibia and fibula, and deep to the gastrocnemius.

Posterior Tibial Artery Course

• It runs down through the flexor muscles to reach at the level between the medial malleolus and medial tubercle of the calcaneus and pass under flexor retinaculum.

Posterior Tibial Artery Termination

• Terminates by dividing into medial and lateral plantar arteries under the flxor retinaculum.

Posterior Tibial Artery Branches

• Muscular branches
• Articular branches to knee and ankle joints
• Nutrient artery to tibia.

Question 8. Write a short note on dorsalis pedis artery.
Answer:

Dorsalis Pedis Artery Beginning

• Continuation of anterior tibial artery.
• Begins in front of the ankle between two malleoli as the ‘continuation of the anterior tibial artery.’

Dorsalis Pedis Artery Course

• Runs along the medial side of dorsum of foot from the midpoint of medial and lateral malleoli.
• From there, it runs downwards to reach the proximal end of 1st metatarsal space.
• It eventually enters to sole to complete the plantar arch by meeting lateral plantar artery.

Dorsalis Pedis Artery Branches

• Lateral tarsal artery
• Medial tarsal artery, both supplying tarsal bones and joints
• First dorsal metatarsal artery
• Arcuate artery → gives of 2nd, 3rd, and 4th dorsal metatarsal arteries.

Question 9. Explain in brief about medial plantar artery, lateral plantar artery, and plantar arch.
Answer:

Medial Plantar Artery

• Division of posterior tibial artery.
• Runs along medial border of foot and terminates by giving of digital arteries.

Lateral Plantar Artery

• Division of posterior tibial artery
• It runs laterally between the 1st and 2nd layer of muscles of sole and becoming continues with plantar
  arch.

Plantar Arch

• It is located in between 1st and muscle layers.
• Formed by the union of continuation of dorsalis pedis artery medially and lateral plantar artery laterally.
• Gives of four plantar metatarsal arteries, each of them again gives of two digital branches.

Venous Drainage of Lower Limb

Question 10. What are the peculiarities of venous drainage of the lower limb? How it is classified?
Answer:

The peculiarities of venous drainage of the lower limb

• The venous drainage of lower limb is working against gravity.
• But a number of factors help to make the venous return from lower limb efficient. They are:
  • Calf pump/the peripheral heart: Contraction of calf muscles squeezes the blood up along the deep veins from venous sinuses present in them.
  • Accompanying arteries exerts pressure on veins by arterial pulsations.
  • Valves in the vein support the blood column against gravity and ensure unilateral blood flw.
  • Arterial pressure and overflow from capillary bed.
  • Negative intrathoracic pressure.
  • Veins in the lower limb are more muscular.
• Veins of lower limb are classifid into 3 groups:
  • Superficial veins
  • Deep veins
  • Perforating veins
• Blood is being drawn from the lower limb via superficial veins and deep veins and eventually reaches the femoral vein.
• The perforator veins connect and ensure unilateral blood flow from superficial to deep veins.

Question 11. How is the superficial venous system in the lower limb is organized? Explain in detail about long and short saphenous veins under the headings—formation, course, termination, tributaries, and valves.
Answer:

• It consists of dorsal venous arch, long saphenous vein, short saphenous vein, and tributaries situated in the superficial fascia.
• Two dorsal digital veins form one dorsal metatarsal vein. Four dorsal metatarsal veins unites and forms dorsal venous arch on the dorsum of the foot over the proximal part of the metatarsal bones.
• This dorsal venous arch ascends up medially as a great saphenous via and laterally as short saphenous vein.
• They are enriched by a number of tributaries.
• A considerable amount of blood is drained by them to deep veins directly or via perforators.

Great Saphenous Vein

• Longest vein in the body
• Easily seen in the lower limb (saphenous = easily seen).
  • Formation
    • By union of the medial end of dorsal venous arch of the foot and medial marginal vein of the foot.
  • Course
    • It runs upward and medially to reach the posteromedial aspect of the knee joint.
    • From there it ascends to reach up to the level of saphenous opening.
    • It reaches the saphenous opening by piercing the cribriform fascia and drains into a femoral vein after piercing the femoral sheath.
    • Throughout its course, it receives tributaries.
  • Termination
    • In the femoral triangle.
  • Valves
    • Consists of 10–20 valves.
  • Tributes

Short/Small Saphenous Vein

• Formation
  • Union of the lateral marginal vein with lateral end of dorsal venous arch.
  • After formation, it ascends behind the lateral malleolus along the lateral edge of the talocalcaneal, accompanied by the sural nerve to reach back of leg.
  • It pierces the back of leg to reach the deep fascia and progresses through the head of the gastrocnemius and eventually drains to the popliteal vein after piercing deep fascia.

• Termination
  • In to popliteal vein in the popliteal fossa.
• Valves
  • It have 7–13 valves.

Question 12. Write a note on the deep veins of lower limb. Explain separately about the femoral vein.
Answer:

Deep Veins Of Lower Limb

• The major deep veins of lower limb are:
  • Deep vein of sole → medial and lateral plantar veins
  • Venae comitantes accompanying dorsalis pedis, anterior tibial, and posterior tibial arteries
  • Popliteal vein
  • Femoral vein
• They are located in the tight fascial compartments.
• Thy, below the knee are arranged as pair of venae comitantes along with arteries, but above knee, they are almost individual.
• More valves are provided to them.

Femoral Vein

• It is the upward continuation of the popliteal vein and continues as the external iliac vein beyond the inguinal ligament.
  • Course
    • Begins at the lower end of adductor canal
    • Ascend up in the adductor canal and enters the femoral triangle
    • Though the middle compartment in the femoral triangle, it ascends upwards and continues as an external iliac vein behind the inguinal ligament.
  • Tributaries
    • Great saphenous vein
    • Profunda femoris vein
    • Medial and lateral circumflex veins
    • Deep external pudendal vein
    • Direct muscular tributaries.
  • Clinical Anatomy
    • The femoral vein is the most commonly used vein for 4 infusions in case of peripheral circulatory failure and in infants.
    • This vein is also used to insert a catheter into right atrium and ventricle to measure pressure.

Question 13. Classify and list the perforating veins.
Answer:

Perforating veins

• They communicate superfiial veins with deep veins.
• Called as perforators because they perforate deep fascia.
• They are of 2 types:
  • Indirect perforators: Connect superficial vein to deep vein only through muscular veins
  • Direct perforators: Connect superficial and deep veins directly
• Among them, five to six are important. They are:
  • Adductor canal/Hunterian perforator: Great saphenous vein ↔ femoral vein at the lower part of adductor canal
  • Knee perforator/Boyd’s perforator: Great saphenous vein ↔ posterior tibial vein below the knee close to tibia
  • Lateral ankle perforator: Short saphenous vein ↔ peroneal vein at junction of middle and lower 1/3rd of leg
  • Three medial ankle perforators (of Cockett): Great saphenous vein ↔ posterior tibial vein
    • Upper medial
    • Middle medial
    • Lower medial.

Perforating Veins Clinical Anatomy

• Incompetency of the valves or other mechanisms helping venous return from lower limb can cause varicose veins and deep vein thrombosis.
• In about 80% of individuals, external iliac vein possesses a valve which prevents high back pressure by blood column on the saphenofemoral valve located in the femoral triangle. In those when the valve is absent, chances of occurrence of varicose veins are higher.
• Calf muscles: Are known as the peripheral heart.

Question 14. Explain in detail about lymphatic drainage of lower limb.
Answer:

Lymphatic drainage of lower limb

The lymph nodes of lower limb are classified into:

Superficial lymph nodes: Includes superficial inguinal lymph nodes

Deep lymph nodes: Includes:

• Deep inguinal lymph nodes
• Popliteal lymph nodes
• Anterior tibial lymph nodes.

Superficial Inguinal Lymph Nodes: They are arranged in T shape into two groups:

1. Upper horizontal group
   • Have lateral set and medial set
2. Lower vertical group.

Deep Inguinal Lymph Nodes

• Four to five in number.
• Located in the medial side of upper part of the femoral vein in the femoral triangle.
• The most proximal node of this group is known as (the gland of Cloquet or Rosenmuller) which lies in the femoral canal.
• All the lymphatics from the lower limb ultimately drain into deep inguinal node directly or indirectly
• Only deep part of the gluteal region and upper aspect of the posterior part of the thigh are not drained by them.

Clinical Anatomy

• Lymphadenopathy of vertical groups of lymph nodes are seen in infection to the lower limb.
• Filariasis is characterized by lymphangitis, lymphadenitis, and lymphedema and is manifested in the lower limb fist before appearing in any other parts of the body.

Blood Supply And Lymphatic Drainage Of Lower Limb Multiple Choice Questions

Question 1. Which of the following is not a branch of dorsal pedis artery?

1. First dorsal metatarsal
2. Tarsal branches
3. First plantar metatarsal
4. Arcuate

Answer: 3. First plantar metatarsal

Question 2. Which genicular artery pierces the fibrous capsule of the knee joint?

1. Descending genicular
2. Middle genicular
3. Anterior tibial recurrent
4. Circumflex fibular

Answer: 2. Middle genicular

Question 3. Boyd’s perforator vein is located in the:

1. Saphenous ring
2. Hunterian canal
3. Below the knee close to the tibia
4. Popliteal fossa

Answer: 3. Below the knee close to the tibia

Question 4. How many valves can be presents in the great saphenous veins?

1. None
2. Two to four
3. Ten to twenty
4. Around thirty

Answer: 3. Ten to twenty

 

Blood Supply And Lymphatic Drainage Of Upper Limb Question And Answers

Question 1. Outline the arterial supply of upper limb.
Answer:

The arterial supply of upper limb

• From the arch of the aorta, the brachiocephalic trunk originates.
• The subclavian artery is the main branch of this trunk.
• The subclavian artery continues as the axillary artery.
• The axillary artery enters and gives blood supply to the upper limb.

Question 2. Explain in detail about the axillary artery under the headings—beginning, course, relations, branches, and termination.
Answer:

Axillary artery

It is the continuation of the subclavian artery and gives blood supply to the upper limb.

Axillary Artery Beginning

• At the outer border of the first rib as a continuation of the subclavian artery.

Axillary artery Course

• It runs from the apex to the base of the axilla along the lateral wall closer to the anterior wall than the posterior wall.
• During its course, it is crossed by the pectoralis minor muscle which divides it into three parts:

1. The first part is superior or proximal to the muscle.
2. The second part, posterior or deep to the muscle
3. Third part is inferior or distal to the muscle.

Axillary artery Relations

1. First part
   • Axillary artery and cords of brachial plexus are enclosed in an axillary sheath
   • Lateral and posterior cords are lateral to the axillary artery
   • Medial cord lies posterior to axillary artery
2. Second part
   • Cords are arranged according to their name
   • Lateral cord lies lateral to artery
   • Medial cord lies medial to artery
   • Posterior cord lies posterior to artery
3. Third part
   • Superolaterally musculocutaneous nerve and inferolaterally median nerve lies
   • The ulnar nerve lies medial to axillary artery
   • Posterosuperiorly axillary nerve and posteroinferiorly radial nerve lies

Read And Learn More: Anatomy Question And Answers 

Axillary artery Branches of

• First Part
  • Superior thoracic artery
    • Supplies the muscles and medial wall of axilla
• Second Part
  • Thracoacromial artery
    • Gives of 4 branches right angle to each other, supplying pectoral muscles and sternoclavicular joint
  • Lateral thoracic artery
    • It supplies pectoralis major, pectoralis minor, and serratus anterior muscles
    • In females, it supplies breasts also
• Third Part
  • Subscapular artery
    • It is the largest branch of the axillary artery.
    • It gives of circumflex scapular artery which passes through upper triangular intermuscular space to reach the infraspinatus fossa.
  • Anterior circumflex humeral artery
    • It passes in front of the surgical neck of the humerus and anastomoses with the Posterior circumflex humeral artery.
    • It gives of an ascending branch to give blood supply to the head of the humerus and shoulder joint.

Question 3. Write a note on anastomosis around scapula.
Answer:

Anastomosis around scapula

• Anastomosis around scapula is formed between the branches of the first part of subclavian artery and third part of the axillary artery
• It basically occurs at two sites:

1. Around the body of scapula
   • The arterial branches contributing to this are:
     • Suprascapular artery (branch of thyrocervical trunk from the subclavian artery)
     • Deep branch of the transverse cervical artery (branch of thyrocervical trunk form the subclavian artery)
     • Circumflex scapular artery (branch of the third part of an axillary artery).
2. Over the acromion process
   • The arterial branches contributing to this are:
   • Acromial branch of the suprascapular artery (branch of the subclavian artery)
   • Acromial branch of the thoracoacromial artery (branch of an axillary artery)
   • Acromial branch of the posterior circumflex humeral artery (branch of an axillary artery).

Anastomosis around scapula Clinical Anatomy

If anywhere between the first part of the subclavian and the third part of the axillary artery is blocked, anastomosis around the scapula opens, and collateral circulation comes into action to ensure adequate blood supply to the upper limb.

Question 4. Explain in detail about the brachial artery under the headings—beginning, course, relations, branches, and termination.
Answer:

Brachial artery is the main artery of the arm.

Brachial Artery Beginning

• It is the continuation of the axillary artery from the lower border of the teres major muscle.

Brachial Artery Course

• It runs downwards and laterally in front of the arm to cross the elbow joint.
• After crossing, at the level of the neck of radius, it divides into radial and ulnar arteries in the cubital fossa.

Brachial Artery Relations

• It is superficial throughout its course and is accompanied by venae comitantes.

1. Anteriorly
   • The median nerve crosses from lateral to the medial side in the middle of the arm
   • Bicipital aponeurosis and medial cubital vein cover the artery in the elbow joint
2. Posteriorly
   1. Triceps brachii
   2. Radial nerve and profunda brachii artery
3. Medially
   • Upper part related to ulnar nerve and basilica vein
   • Lower part related to the median nerve
4. Laterally
   • The upper part related to coracobrachialis, biceps brachii, and median nerve
   • Tendon of biceps brachii in the elbow
   • In the elbow, the structures from the medial to lateral side are:
     • Median nerve
     • Brachial artery
     • Biceps brachii tendon
     • Radial nerve (deeper)

Brachial Artery Branches

• Muscular branches to muscles of anterior compartment of the arm
• Profunda brachii artery
• Nutrient artery to humerus
• Superior ulnar collateral artery
• Inferior ulnar collateral artery
• Radial artery
• Ulnar artery

Brachial Artery Termination

• The brachial artery divides into radial and ulnar arteries in the cubital fossa at the level of neck of radius.

Brachial Artery Clinical Anatomy 

• Brachial artery pulsations can be felt in the cubital fossa medial to the tendon of the biceps brachii. The pulsations are used in measuring blood pressure in auscultatory method.
• Injury to the brachial artery is one of the major complications in the supracondylar fracture of the humerus.

Question 5. Write a short note on anastomosis around the elbow joint.
Answer:

Anastomosis around the elbow joint

• Anastomosis around elbow joint connects brachial artery with the upper end of radial and ulnar arteries.
• This anastomosis nourishes the ligaments and bones of the elbow joint.
• It exits:
  • In front of medial epicondyle
  • In front of lateral epicondyle
  • Behind medial epicondyle
  • Behind lateral epicondyle
  • Above the olecranon fossa.

Anastomosis around elbow joint Clinical Anatomy

• This anastomosis becomes more significant when a block or injury occurs anywhere between the brachial artery and radial and ulnar arteries.

Question 6. Explain about radial artery under the headings—beginning, course, relations, branches, and termination.
Answer:

Radial artery

Radial Artery Beginning

• In the cubital fossa brachial artery divides into radial and ulnar arteries.
• Radial artery is the smaller terminal branch of the brachial artery.

Radial Artery Course

• It is more superfiial compared to ulnar artery.
• It runs downwards along the convexity of the lateral side of the forearm and turns posteriorly to reach the anatomical snuf box in the arm.
• From the anatomical snuff box, radial artery enters the palm where it continues as deep palmar arch.

Radial Artery Relations: It is accompanied by two venae comitantes.

1. Anteriorly
   • Brachioradialis in the upper part
   • Skin, superficial and deep fascia in the lower part
2. Posteriorly
   • The muscles attached to the anterior surface of the radius
3. Medially
   • Pronator teres in the upper 1/3rd
   • Tendon of flexor carpi radialis in the lower 2/3rd
4. Laterally
   • Brachioradialis
   • Radial nerve

Radial Artery Branches

• Muscular branches
• Radial recurrent artery
• Palmar carpal branch
• Superficial palmar branch: Joins with the terminal branch of the ulnar artery to continues as superficial palmar arch.

Radial Artery Termination It continues as deep palmar arch in the palm.

Radial Artery Clinical Anatomy

• The radial pulse is routinely palpated in the general examination of patients.
• It is felt at the ventral aspect, just above the wrist against the radius bone where the radial artery is covered by only skin and superficial fascia.

Question 7. Explain about ulnar artery under the headings—beginning, course, relations, branches, and termination.
Answer:

Ulnar Artery Beginning

• In the cubital fossa brachial artery divides into radial and ulnar arteries.
• Ulnar artery is the larger terminal branch of the brachial artery.

Ulnar Artery Course

• In the upper 1/3rd of the forearm, ulnar artery runs obliquely downwards to reach the anterolateral aspect.
• In the lower 2/3rd of the forearm, the ulnar artery runs vertically downwards.
• It enters the palm superfiial to flxor retinaculum.

Ulnar Artery Relations: Ulnar artery is accompanied by two venae comitantes.

1. Anteriorly
   • Muscles arising from the common flexor origin and median nerve in the upper half
   • Skin and superficial fascia in the lower half
2. Posteriorly
   • Brachioradialis
   • Flexor digitorum profundus
3. Medially
   • Ulnar nerve
   • Flexor carpi ulnaris
4. Laterally
   • Flexor digitorum superfiialis

Ulnar Artery Branches

• Muscular branches
• Anterior and posterior ulnar recurrent arteries
• Common interosseous artery
• Anterior and posterior ulnar
• Superfiial palmar branch:
  • Continues as a superficial palmar arch to anastomose with superficial palmar branch of radial artery
• Deep palmar branch:
  • Anastomoses with the direct continuation of the radial artery to form deep palmar arch.

Question 8. Write a note on the superficial palmar arch.
Answer:

Superficial palmar arch

• It is formed by the anastomosis of ulnar artery with radial artery in the hand.
• It is an arterial arch and the convexity is directed toward the fingers.

Superficial Palmar Arch Formation

• It is formed by the direct continuation of the ulnar artery (superficial palmar branch) beyond the flexor retinaculum.
• The superficial palmar branch arches in the palm and finally anastomose with the superficial palmar branch of the radial artery on the lateral side and completes the arch.

Superfiial Palmar Arch Relations

• Superficial
  • Palmar aponeurosis
• Deep
  • Flexor tendons of flxor digitorum superfiialis and flxor digitorum profundus
  • Lumbricals
  • Digital branch of ulnar and median nerves.

Superficial Palmar Arch Branches

• Four digital arteries
• Cutaneous branches to the palm.

Question 9. Write a note on the deep palmar arch.
Answer:

Deep palmar arch

• It is the direct continuation of the radial artery
• The convexity is towards fingers
• The arch is completed by the anastomosis with deep palmar branch of the ulnar artery.

Deep Palmar Arch Relations

• Superficial
  • Long flexor tendons of fingers
  • Lumbricals
• Deep
  • Metacarpals
  • Interosseous muscles

Question 10. Give an outline of venous drainage of upper limb.
Answer:

Venous drainage of upper limb

• Venous drainage of upper limb is divided into two groups:

1. Superficial
2. Deep

• The superficial group of veins are located in the superficial fascia
• Deep groups of veins are located deep to the muscles and accompany arteries known as venae comitantes.

Question 11. What are the main superficial veins of the upper limb? Describe about each of them mentioning their formation, tributaries, course, and termination.
Answer:

Main superficial veins of the upper limb

• They lies in the superficial fascia.
• They runs away from the pressure points, so they are absent in the palm, along the ulnar border of the forearm, and in the back of the arm. Due to this reason, they are having a spiral course, from the dorsal surface of hand to ventral surface of the arm.
• They comprise of:
  • Dorsal venous arch
  • Cephalic vein
  • Basilic vein
  • Median cubital vein.

Superficial Veins Of Upper Limb Dorsal Venous Arch

• It is a network of veins situated on the dorsum of hand.
• Tributaries
  • Three dorsal metacarpal veins
  • A dorsal digital vein from the medial side of little finger
  • A dorsal digital vein from the radial side of the index finger
  • Two dorsal digital veins of the thumb
  • Veins draining palm of hand
  • Dorsal venous arch drains into cephalic and basilic veins.

Superficial Veins Of Upper Limb Cephalic Vein

• It is the preaxial vein of upper limb and is homologous with the great saphenous vein of lower limb.
• Formation
  • It is the continuation lateral end of the dorsal venous arch.
• Course
  • It runs over the roof of the anatomical snuff box and ascends along the radial border of the forearm. It continues upwards in front of elbow joint and lateral border of biceps brachii to pierce deep fascia at the lower border of the pectoralis muscle
  • From there, it runs in the cleft between the deltoid and pectoralis muscle up to the infraclavicular fossa where it pierces the clavipectoral fascia to drain into the axillary vein
  • The cephalic vein is accompanied by the lateral cutaneous nerve of the forearm.
• Termination
  • The cephalic vein after piercing the clavipectoral fascia, drains into the axillary vein.

Superficial Veins Of Upper Limb Basilic Vein

• It is the postaxial vein of upper limb and is homogenous with that of the short saphenous vein of lower limb.
• Formation
  • It is the continuation of the medial end of the dorsal venous arch.
• Course
  • It ascends along the back of the medial border of the forearm and winds around the border below the level of the elbow joint to reach in front of the forearm.
  • From there, it ascends upwards along the medial border of biceps brachii and pierces the deep fascia at the level of the middle of the arm.
  • Under the deep fascia, it joins with the brachial veins and run along the medial side of the brachial artery to continue as the axillary vein.
• Termination
  • It continues as the axillary vein at the level of the lower border of the teres major.

Median Cubital Vein

• It is a venous channel between the cephalic and basilic veins in the cubital fossa.
• The cephalic vein is carrying a larger quantity of impure blood compared to more efficient basilic vein.
• So medial cubital vein shunts the extra volume of blood from the cephalic to the basilic vein ensuring efficient venous drainage.
• It begins from the cephalic vein 2.5 cm below the bend of the elbow.
• It runs obliquely upwards and medially.
• It terminates in a basilic vein 2.5 cm above the bend of the elbow.
• The median vein of the forearm is one of the tributaries.
• Deep veins communicate with media cubital veins through perforators.

Question 12. List the deep veins of upper limb.
Answer:

Deep veins of upper limb They comprise:

• Venae comitantes of radial, ulnar and brachial arteries
• Axillary vein
• They receive venous drainage from superficial veins.

Deep Veins of upper limb Clinical Anatomy

• As the perforator veins fies the medial cubital vein, it is the favorite site of intravenous injections and blood withdrawals.
• Making a fit will increase the venous return as this activity squeezes the blood in the muscles of hand into the dorsal venous arch.

Question 13. Write a note on lymphatic drainage of upper limb.
Answer:

Lymphatic drainage of upper limb

Lymphatic drainage of upper limb consists of lymph vessels and nodes arranged as superficial and deep groups.

The superficial Group of Lymph Nodes are:

• Infraclavicular nodes
• Deltopectoral nodes
• Superficial cubital/supratrochlear nodes.

The deep Group of Lymph Nodes are:

• Axillary lymph node
• Deep cubital node.

Superficial Lymph Vessels

• They are located in the subcutaneous tissue.
• They are larger in number than deep lymph vessels.
• They drain lymph from the skin and subcutaneous tissues.
• Lymph vessels from the lateral side lateral of the upper limb including lateral two digits follow the cephalic vein and drain into the infraclavicular lymph node which is a superficial lymph node
• Lymph vessels from the medial side of the upper limb including the medial three digits follows the basilic vein and drain into a lateral group of axillary lymph node which is a deep lymph node.
• But some of the medial lymph vessels terminate in the supratrochlear or epitrochlear lymph nodes which are superficial lymph nodes.
• Few lymph vessels from the thumb drain into deltopectoral lymph nodes.

Deep lymph vessels

• They are lesser in number than deep lymph vessels.
• They drain lymph from the structure deep to deep fascia including. For example, Muscles
• They follow the arteries and drains into a lateral group of axillary lymph nodes.

Deep Lymph Vessels Clinical Anatomy

• Lymphangitis is the inflmmation of lymph vessels and can occur due to injury to any part of the upper limb
• Axillary lymph nodes can become enlarged and painful followed by infections in any part of the upper limb.

Blood Supply And Lymphatic Drainage Of Upper Limb Multiple Choice Questions

Question 1. Epitrochlear lymph nodes are located along:

1. Median cubital vein
2. Cephalic vein above elbow
3. Basilic vein above elbow
4. Brachial artery

Answer: 3. Basilic vein above elbow

Question 2. Which is not a branch of deep palmar arch?

1. Proximal perforation
2. Recurrent
3. Palmar metacarpal
4. Common palmar digital

Answer: 4. Common palmar digital

Question 3. Which is not a branch of third part of the axillary artery?

1. Thracoacromial artery
2. Posterior circumflex humeral artery
3. Subscapular artery
4. Anterior circumflex humeral artery

Answer: 1. Thracoacromial artery

Question 4. Anastomosis around the scapula occurs between:

1. The first part of the subclavian artery and first part of the axillary artery
2. The first part of the subclavian artery and the third part of the axillary artery
3. The second part of subclavian artery and first part of the axillary artery
4. The second part of the subclavian artery and the third part of the axillary artery

Answer: 2. First part of the subclavian artery and the third part of axillary artery

Question 5. Anastomosis around the elbow joint exists at all these sites, except:

1. Behind medial epicondyle
2. Behind lateral epicondyle
3. Above the olecranon fossa
4. Around the neck of radius

Answer: 4. Around neck of the radius