Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Lower Limb T utorial SUBTITLE By Srijan Curpad BSc (Hons) th 4 Year Medical Student University College London Saturday 20 April (time) @ BRITISHINDIANMEDICASSOCIATION @BINDIANMEDICS BRITISH INDIAN MEDICAL @BIMA ASSOCIATION BIMA Preclinical seriesWHO AM I Hi my name is Srijan I am currently a 4 year medical student at UCL. I have just completed my iBSc year where I did Oncology. I have an interest in Trauma and Orthopaedics and Neurology. Your pictureTOPICS COVERED I. Bones and articulations II. Muscles III. Innervation IV. Arterial and venous supply V. Lymphatics VI. SBA questionsI. Bones and articulations The Hip and Pelvis 2539 8868I. Bones and articulations The Hip and Pelvis • The hip involves the head of the femur which articulates with the acetabulum of the pelvis. • Tmultiple planesnd-socket joint, it has a wide range of motion in • Common injuries are Hip fractures. 2539 8868I. Bones and articulations The Knee 2539 8868I. Bones and articulations The Knee •patella. This joint is used in flexion and extensionur, tibia and • Common conditions are: Tendonitis, Bursitis and Arthritis 2539 8868I. Bones and articulations The Ankle 2539 8868I. Bones and articulations The Ankle • The ankle joint is composed of the tibia and fibula superiorly inversion and eversion ley The joint allows for flexion, extension, • Good mnemonic for tarsal bones: Tiger Cub Needs MILC • Common conditions are: Sprains, Fractures, tendonitis and arthritis 2539 8868I. Bones and articulations The Foot 2539 8868II. Muscles Proximal Muscles 2539 8868II. Muscles Proximal Muscles • The proximal muscles are mainly those of the hip. • Gluteus Maximus: Extension and external rotation of the thigh • Gluteus Medius: Abducts and medial rotates the thigh • Gluteus Minimus: Abducts and medial rotates the thigh • Pisiformis: Lateral Rotation and abductiond medial rotation • Obturator inturnus: Lateral rotation and abduction • Gemelli superior and inferior: Lateral rotation and abduction • Quadratus femoris: Lateral rotation 2539 8868II. Muscles Thigh Muscles 2539 8868II. Muscles Thigh Muscles • Anterior • Vastus Lateralis: Extends knee joint and stabilises the patellaation at the hip • Vastus intermeidus: Extends knee joint and stabilises patella • Vastus Medialis: Extends knee joint and stabilises the patella • Rectus femoris: Flexes thigh at hip and extends at knee joint • Sartorius: Flexes at hip and knee, is an abductor and lateral rotator at the hip • Pectineus: Adduction and flexion at hip • Posterior • Biceps femoris: Flexes the knee and extends leg at hip • Semimembranosus: Flexes the leg at knee. Extends the thigh at the hip. Medially rotates the thigh and leg at hip and knee joint, respectively. • Medial • Adductor magnus: Adducts the thigh • Adductor longus: Adduction and medial rotation of thigh • Adductor brevis: Adducts the thigh • Obturator exturnus: Laterally rotates the thigh • Gracillus: Adducts the thigh at the hip and flexes the leg at the knee 2539 8868II. Muscles Leg Muscles 2539 8868II. Muscles Leg Muscles • Posterior superficial: • Gastrocnemius: Plantarflexion • Plantaris: Plantarflexion • Soleus: Plantarflexion • Posterior deep: • Popliteus: Laterally rotates femur • Tibialis posterior: Inversion and plantar flexion • Flexor digitorum longus: Flexes lateral 4 toes • Flexor Hallucis Longus: Flexes big toe • Anterior • Tibialis anterior: Dorsiflexion and inversion • Extensor hallucis longus: Dorsiflexion and extension of big toe • Fibularis tertius: Eversion and dorsiflexion • Lateral • Fibularis (Peroneus) longus: Eversion and plantar flexion • Fibularis (Peroneus) brevis: Eversion 2539 8868III. Innervation Lumbar Plexus Mnemonic: I I Get Laid On Fridays 2539 8868III. Innervation Sacral Plexus Mnemonic: Some Irish Sailors Pester Polly 2539 8868III. Innervation Dermatomes and Myotomes 2539 8868III. Innervation Main Nerves 2539 8868III. Innervation Ilioinguinal nerve (L1) • Motor: Internal obliques and transvers abdominus • Sensory: Upper middle thigh (anterior) 2539 8868III. Innervation Iliohypogastric nerve (L1) • Sensory: Posterolateral gluteal skin in pubic region 2539 8868III. Innervation Genitofemoral nerve (L1-L2) • Motor: Innervates cremasteric muscle • Sensory: Genital branch: skin of anterior scrotum or skin over mons pubis and labia majora . Femoral branch: Skin on upper anterior thigh. 2539 8868III. Innervation Lateral cutaneous nerve of thigh (L2-L3) • Motor: None • Sensory: Anterior and lateral thigh to the knee 2539 8868III. Innervation Obturator nerve (L2-L4) •adductor brevis, adductor magnus, gracilisnt: Obturator externus, pectineus, adductor longus, • Sensory: Skin over medial thigh 2539 8868III. Innervation Femoral nerve (L2-L4) •of quadriceps femorisrior thigh muscles that flex hip joint: Iliacus, pectineus, sartorius and extend knee all muscles • Sensory: Innervates the anterior thigh and medial aspect of the leg 2539 8868III. Innervation Superior gluteal nerve (L4-S1) • Sensory: Noneates Gluteus Minimus, gluteus Medius and tensor fascia lata 2539 8868III. Innervation Inferior gluteal nerve (L5-S2) • Sensory: Noneates Gluteus Maximus 2539 8868III. Innervation Sciatic nerve (L4-S3) • Motor: Tibial portion: all muscles in posterior compartment of thigh, including hamstring portion of adductor magnus apart from short head of biceps femoris; all muscles in posterior compartment of leg; all muscles in sole of foot. anterior and lateral compartment of leg and extensor digitorum brevis.emoris; all muscles in • Sensory: Tibial portion: skin on posterolateral and medial surfaces of foot and sole of foot. Common fibular portion (common peroneal nerve): skin on anterolateral surface of leg and dorsal aspect of foot 2539 8868III. Innervation Posterior femoral cutaneous nerve of thigh (S1-S3) • Sensory: Innervates the skin on the posterior surface of the thigh and leg and the skin on the perineum 2539 8868III. Innervation Pudendal nerve (S2-S4) •anitor: Skeletal muscle in perineum, external urethral sphincter, external anal sphincter and levator • Sensory: Penis and clitoris and most of skin of perineum 2539 8868IV. Arterial supply • External iliac artery becomes the femoral artery and extends to the popliteal fossa. It then becomes the popliteal artery 2539 8868IV. Venous supply • Long saphenous vein drains into femoral vein Short saphenous vein drains into popliteal vein 2539 8868V. Lymphatic Supply • In general, lymphatic vessels run with veins • POPLITEAL NODES - drain distal limb • INGUINAL NODES - drain limb and pudendal region, perineum, anus, and parts of abdomen 2539 8868VI. SBAs A 26-year-old man is urgently brought to the Emergency Department following a stab injury to his thigh. The trauma team quickly stabilises him, and upon stabilisation, a detailed examination reveals his inability to extend his leg at the knee joint, coupled with a noticeable sensory loss to the anterior and medial thigh. What is the most likely affected nerve? a) Femoral nerve b) Inferior gluteal nerve c) Obturator nerve d) Sciatic Nerve e) Superior gluteal nerve 2539 8868VI. SBAs A 26-year-old man is urgently brought to the Emergency Department following a stab injury to his thigh. The trauma team quickly stabilises him, and upon stabilisation, a detailed examination reveals his inability to extend his leg at the knee joint, coupled with a noticeable sensory loss to the anterior and medial thigh. What is the most likely affected nerve? a) Femoral nerve b) Inferior gluteal nerve c) Obturator nerve d) Sciatic Nerve e) Superior gluteal nerve 2539 8868VI. SBAs A 28-year-old woman presents with difficulty moving her right leg. On examination, she is unable to perform dorsiflexion of her right foot, however, she can perform eversion, inversion, and plantarflexion of the foot. Lower limb examination is otherwise normal. What compartment of the right leg is most likely affected? a) Anterior compartment of the lower leg b) Anterior compartment of the thigh c) Lateral compartment of the lower leg d) Posterior compartment of the lower leg e) Posterior compartment of the thigh 2539 8868VI. SBAs A 28-year-old woman presents with difficulty moving her right leg. On examination, she is unable to perform dorsiflexion of her right foot, however, she can perform eversion, inversion, and plantarflexion of the foot. Lower limb examination is otherwise normal. What compartment of the right leg is most likely affected? a) Anterior compartment of the lower leg b) Anterior compartment of the thigh c) Lateral compartment of the lower leg d) Posterior compartment of the lower leg e) Posterior compartment of the thigh 2539 8868VI. SBAs A 45-year-old man presents to the GP with difficulty in climbing stairs and standing up from a seated position. On examination, he exhibits weakness in hip extension and external rotation. No sensory deficits are noted. What muscle is most likely affected in this patient? a) Gluteus maximus b) Gluteus Medius d) Iliopsoasinimus e) Tensor fascia late 2539 8868VI. SBAs A 45-year-old man presents to the GP with difficulty in climbing stairs and standing up from a seated position. On examination, he exhibits weakness in hip extension and external rotation. No sensory deficits are noted. What muscle is most likely affected in this patient? a) Gluteus maximus b) Gluteus Medius d) Iliopsoasinimus e) Tensor fascia late 2539 8868VI. SBAs A 54-year-old man presents to the GP with complaints of sensation loss. He describes that he is not able to feel anything over the anterior and later aspects of his thigh. What nerve roots could be damaged in this patient ? a) L1-L2 b) L2-L3 c) L3-L4 d) L4-L5 e) L5-S1 2539 8868VI. SBAs A 54-year-old man presents to the GP with complaints of sensation loss. He describes that he is not able to feel anything over the anterior and later aspects of his thigh. What nerve roots could be damaged in this patient ? a) L1-L2 b) L2-L3 c) L3-L4 d) L4-L5 e) L5-S1 2539 8868THANK YOU FOR LISTENING ANY QUESTIONS INSERT QR CODE FOR FEEDBACK FORM BIMA Preclinical series