REVIEW QUESTIONS ON THE LOWER LIMB General Anatomy FINALS A 42-year-old man is admitted to the emergency department after his automobile hit a tree, and he is treated for a pelvic fracture and several deep lacerations. Physical examination reveals that dorsiflexion and inversion of the left foot and extension of the big toe are very weak. Sensation from the dorsum of the foot, skin of the sole, and the lateral aspect of the foot has been lost and the patellar reflex is normal. The foot is everted and plantar flexed. Which of the following structures is most likely injured? A. The lumbosacral trunk at linea terminalis B. L5 and S1 spinal nerves torn at the intervertebral
foramen C. Fibular (peroneal) division of the sciatic nerve at the neck of the fibula D. Sciatic nerve injury at the doorway to the gluteal region E. Tibial nerve in popliteal fossa A. The lumbosacral trunk consists of fibers from a portion of the ventral ramus of L4 and all of the ventral ramus of L5 and provides continuity between the lumbar and sacral plexuses. The deep fibular (peroneal) nerve receives supply from segments of L4, L5, and S1. It supplies the extensor hallucis longus, and extensor digitorum longus, the
main functions of which are extension of the toes and dorsiflexion of the ankle. L5 is responsible for cutaneous innervation of the dorsum of the foot. Injury to L4 would affect foot inversion by the tibialis anterior. Injury to L4 in the lumbosacral trunk would not affect the patellar tendon reflex, for these fibers are delivered by the femoral nerve. A 23-year-old man is admitted to the emergency department with a deep, bleeding stab wound of the pelvis. After the bleeding has been arrested, an MRI examination gives evidence that the right ventral primary ramus of L4 has been transected. Which of the following problems will most likely be seen during physical examination? A. Reduction or loss of sensation from the medial
aspect of the leg B. Loss of the Achilles tendon reflex C. Weakness of abduction of the thigh at the hip joint D. Inability to evert the foot E. Reduction or loss of sensation from the medial aspect of the leg and loss of Achilles tendon reflex A. The ventral ramus of L4 contains both sensory and motor nerve fibers. Injury from a stab wound could result in loss of sensation from the dermatome supplied by this segment. A dermatome is an area of skin supplied by a single spinal nerve; L4 dermatome supplies the medial
aspect of the leg and foot. Loss of the Achilles tendon reflex relates primarily to an S1 deficit. The Achilles tendon reflex is elicited by tapping the calcaneus tendon, which results in plantar flexion. The obturator internus and gluteus medius and minimus are responsible for abduction of the thigh and are innervated by nerves L4, L5, and S1 (with L5 usually dominant). Nerves L5, S1, and S2 are responsible for eversion of the foot (S1 dominant). A 30-year-old male suffered a superior gluteal nerve injury in a motorcycle crash in which his right lower limb was caught beneath the bike. He is stabilized in the emergency department. Later he is examined and he exhibits a waddling gait and a positive Trendelenburg sign. Which
of the following would be the most likely physical finding in this patient? A. Difficulty in standing from a sitting position B. The left side of the pelvis droops or sags when he attempts to stand with his weight supported just by the right lower limb. C. The right side of the pelvis droops or sags when he attempts to stand with his weight supported just by the left lower limb. D. Weakened flexion of the right hip E. Difficulty in sitting from a standing position B. Injury to the superior gluteal nerve results in a characteristic motor loss, with paralysis of gluteus medius
and minimus. In addition to their role in abducting the thigh, the gluteus medius and minimus function to stabilize the pelvis: When the patient is asked to stand on the limb of the injured side, the pelvis descends on the opposite side, indicating a positive Trendelenburg test. The gluteal, or lurching, gait that results from this injury is characterized by the pelvis drooping to the unaffected side when the opposite leg is raised. In stepping forward, the affected individual leans over the injured side when lifting the good limb off the ground. The uninjured limb is then swung forward. A 45-year-old male is treated at the hospital after he fell
from his bicycle. Radiographic examination reveals fractures both of the tibia and the fibula. On physical examination the patient has a foot drop, but normal eversion (Fig. 5-1). Which of the following nerves is most likely injured? A. Tibial B. Common fibular (peroneal) C. Superficial fibular (peroneal) D. Saphenous E. Deep fibular (peroneal) E. The deep fibular (peroneal) nerve is responsible for innervating the muscles of the anterior compartment of the
leg, which are responsible for toe extension, foot dorsiflexion, and inversion. Injury to this nerve will result in foot drop and also loss of sensation between the first and second toes. Injury to the tibial nerve affects the posterior compartment muscles of the leg, which are responsible for plantar flexion and toe flexion, as well as the intrinsic muscles of the sole of the foot. A 49-year-old construction worker is admitted to the emergency department with a painful lump on the proximal medial aspect of his thigh. Radiographic and physical examinations reveal that the patient has a herniation of abdominal viscera beneath the inguinal ligament into the
thigh. Through which of the following openings will a hernia of this type initially pass to extend from the abdomen into the thigh? A. Femoral ring B. Superficial inguinal ring C. Deep inguinal ring D. Fossa ovalis E. Obturator canal A. The femoral ring is the abdominal opening of the femoral canal. A femoral hernia passes through the femoral ring into the femoral canal deep and inferior to the inguinal ligament. It can appear as a bulging at the saphenous
hiatus (fossa ovalis) of the deep fascia of the thigh, the hiatus through which the saphenous vein passes to the femoral vein. The superficial inguinal ring is the triangular opening in the aponeurosis of the external abdominal oblique and lies lateral to the pubic tubercle. The deep inguinal ring lies in the transversalis fascia lateral to the inferior epigastric vessels. Herniation into either of these two openings is associated with an inguinal hernia. A 37-year-old male is admitted to the hospital after an injury to his foot while playing flag football with friends on a Saturday morning. A series of radiographs demonstrates a fracture involving the talocrural (tibiotalar, ankle) joint.
Which movements are the major ones to be affected by this injury? A. Plantar flexion and dorsiflexion B. Inversion and eversion C. Plantar flexion, dorsiflexion, inversion, and eversion D. Plantar flexion and inversion E. Dorsiflexion and eversion A. The talocrural (tibiotalar, ankle) joint is a hinge-type synovial joint between the tibia and talus. It permits dorsiflexion and plantar flexion, and fracture of this joint would affect these movements.
After dividing the overlying superficial tissues and gluteal musculature in a 68-year-old female patient, the orthopedic surgeon carefully identified the underlying structures. The key landmark in the gluteal region, relied upon in explorations of this area, is provided by which of the following structures? A. Gluteus medius B. Obturator internus tendon C. Sciatic nerve D. Piriformis muscle E. Spine of the ischium
D. The piriformis muscle arises from the pelvic surface of the sacrum, passes through the greater sciatic notch, and inserts at the greater trochanter. It is considered the key to gluteal anatomy; the greater sciatic foramen is the door. The gluteus medius lies posterior to the piriformis. The sciatic nerve emerges from the greater sciatic foramen, through the infrapiriformic space. The spine of the ischium separates the greater and lesser sciatic foramina. A 16-year-old male received a superficial cut on the lateral side of his foot while playing football and is admitted to the emergency department where the wound is sutured.
Four days later the patient returns to the hospital with high fever and swollen lymph nodes. Which group of nodes will first receive lymph from the infected wound? A. Popliteal B. Vertical group of superficial inguinal C. Deep inguinal D. Horizontal group of superficial inguinal E. Internal iliac A. The popliteal lymph nodes are the first to receive lymph from the foot. These nodes will then drain into the deep inguinal nodes and then to the external iliac
nodes. The superficial inguinal and internal iliac nodes do not receive lymph from the foot. A 45-year-old male presents at the local emergency clinic with the complaint of a painful knee and difficulty in walking. A CT scan examination reveals a very large cyst in the popliteal fossa compressing the tibial nerve. Which movement will most likely be affected? A. Dorsiflexion of the foot B. Flexion of the thigh C. Extension of the digits
D. Extension of the leg E. Plantar flexion of the foot E. The tibial nerve is responsible for innervating the posterior compartment of the leg. These muscles areresponsible for knee flexion, plantar flexion, and intrinsic muscle functions of the foot. Compression of this nerve can affect plantar flexion of the foot. Dorsiflexion of the foot would be compromised if the deep fibular (peroneal) nerve were compressed by this Baker cyst. Flexion of the thigh is a function of muscles supplied by lumbar nerves and the femoral nerve. The deep fibular (peroneal) nerve is also responsible for extension of the digits, whereas the femoral
nerve is responsible for extension of the leg. A 19-year-old football player was hit on the lateral side of his knee just as he put that foot on the ground. Unable to walk without assistance, he is taken to the hospital. An MRI examination reveals a torn medial collateral ligament. Which structure would most likely also be injured due to its attachment to this ligament? A. Medial meniscus B. Anterior cruciate ligament C. Lateral meniscus D. Posterior cruciate ligament E. Tendon of the semitendinosus
A. The medial meniscus is firmly attached to the medial (tibial) collateral ligament. Damage to the medial collateral ligament often causes concomitant damage to the medial meniscus because of this relationship. The anterior cruciate ligament lies inside the knee joint capsule but outside the synovial cavity. It is taut during extension of the knee and may be torn when the knee is hyperextended. If this were damaged along with the medial meniscus and medial cruciate ligament, an unhappy triad (of ODonahue) injury would result. The lateral meniscus is not attached to the medial collateral ligament but receives muscular attachment to the popliteus muscle. The posterior
cruciate ligament also lies outside of the synovial cavity and limits hyperflexion of the knee. A 49-year-old man underwent a coronary bypass graft procedure using the great (long) saphenous vein. Postoperatively the patient complains of pain and general lack of normal sensation on the medial surface of the leg and foot on the limb from which the graft was harvested. Which nerve was most likely injured during surgery? A. Common fibular (peroneal) B. Superficial fibular (peroneal) C. Lateral sural D. Saphenous
E. Tibial D. The great saphenous vein is commonly used in coronary artery bypass grafts. Because branches of the saphenous nerve cross the vein in the distal part of the leg, the nerve can be torn out of the limb if the vein is stripped from the ankle to the knee. Stripping the vein in the opposite direction can protect the nerve and lessen the postoperative discomfort of patients. The saphenous nerve is responsible for cutaneous innervations on the medial surface of the leg and the medial side of the foot. Injury to this nerve will result in a loss of sensation and also can create chronic dysesthesias in the area.
A 22-year-old football player is admitted to the hospital with pain and swelling over the lateral aspect of the ankle. The emergency inversion department doctor diagnoses
sprain. Which ligament was most likely injured? A. Calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid an B. The calcaneofibular ligament is a round cord that passes posteroinferiorly from the tip of the lateral malleolus to the lateral surface of the calcaneus. A forced inversion of the foot can result in tearing of the calcaneofibular ligament
and sometimes the anterior talofibular ligament as well. Both of these ligaments act to stabilize the foot and prevent an inversion injury. The long plantar ligament passes from the planter surface of the calcaneus to the groove on the cuboid and is important in maintaining the longitudinal arch of the foot. The short plantar ligament is located deep (superior) to the long plantar ligament and extends from the calcaneus to the cuboid and is also involved in maintaining the longitudinal arch of the foot. A 72-year-old woman is admitted to the hospital with a painful right foot. A CT scan examination reveals a thrombotic occlusion of the femoral artery in the proximal
part of the adductor canal. Which artery will most likely provide blood supply to the leg through the genicular anastomosis? A. Medial circumflex femoral B. Descending branch of the lateral circumflex femoral C. First perforating branch of the deep femoral D. Inferior gluteal E. Descending genicular branch of femoral B. The lateral circumflex femoral artery arises from the deep femoral (profunda femoris) artery of the thigh and sends a descending branch down the length of the femur to
anastomose with the superior medial genicular artery and the superior lateral genicular artery. The medial circumflex femoral artery is responsible for supplying blood to the head and neck of the femur, and it does not anastomose with distal vessels at the knee. The first perforating artery sends an ascending branch that anastomoses with the medial circumflex femoral and the inferior gluteal artery in the buttock. A 75-year-old woman is admitted to the hospital after falling in her bathroom. Radiographic examination reveals an extracapsular fracture of the femoral neck. Which
artery is most likely at risk for injury? A. Inferior gluteal B. First perforating branch of deep femoral C. Medial circumflex femoral D. Obturator E. Superior gluteal C. The medial circumflex femoral artery is responsible for supplying blood to the head and neck of the femur by a number of branches that pass under the edge of the ischiofemoral ligament. This artery is most likely at risk for injury in an extracapsular fracture of the femoral neck. The
inferior gluteal artery arises from the internal iliac and enters the gluteal region through the greater sciatic foramen, below the piriformis. The first perforating artery sends an ascending branch that anastomoses with the inferior gluteal artery in the buttock. The obturator artery arises from the internal iliac artery and passes through the obturator foramen. A 56-year-old male with advanced bladder carcinoma suffers from difficulty while walking. Muscle testing reveals weakened adductors of the right thigh. Which nerve is most likely being compressed by the tumor to result in walking difficulty?
A. Femoral B. Obturator C. Common fibular (peroneal) D. Tibial E. Sciatic B. The obturator nerve arises from the lumbar plexus and enters the thigh through the obturator canal. This nerve is responsible for innervation of the medial compartment of the thigh (adductor compartment). Injury to this nerve can result in weakened adduction and difficulty walking. The femoral nerve innervates muscles of the anterior compartment of the thigh that are responsible for hip flexion
and leg extension. The sciatic nerve branches into the com mon fibular (peroneal) and tibial nerves. The common fibular (peroneal) nerve branches into the deep and superficial branches of the fibular (peroneal) nerve responsible for innervation of the anterior and lateral compartments of the leg, respectively. Upon removal of a leg cast, a 15-year-old boy complains of numbness of the dorsum of his right foot and inability to dorsiflex and evert his foot. Which is the most probable site of the nerve compression that resulted in these symptoms? A. Popliteal fossa
B. Neck of the fibula C. Lateral compartment of the leg D. Anterior compartment of the leg E. Medial malleolus B. The common fibular (peroneal) nerve winds around the neck of the fibula before dividing into superficial and deep branches that go on to innervate the lateral and anterior compartments of the leg, respectively. These compartments are responsible for dorsiflexion and eversion of the foot, and injury to these nerves would result in deficits in these movements. The tibial nerve lies superficially in the popliteal fossa. This nerve innervates the
posterior compartment of the leg, so compression in this area would result in a loss of plantar flexion and weakness of inversion. The lateral compartment of the leg is innervated by the superficial fibular (peroneal) nerve and is mainly involved in eversion of the foot. A 32-year-old patient received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured a motor nerve in the area. Later, he had great difficulty rising to a standing position from a seated position. Which muscle was most likely affected by the injury? A. Gluteus maximus
B. Gluteus minimus C. Hamstrings D. Iliopsoas E. Obturator internus A. The gluteus maximus is innervated by the inferior gluteal nerve, and this muscle is responsible for extension and lateral rotation of the thigh. It is the primary muscle used to rise from a seated position. The gluteus minimus is innervated by the superior gluteal nerve and is responsible for abduction of the thigh. Hamstring muscles are innervated by the tibial portion of the sciatic nerve, and these are responsible for extension of the thigh and flexion
of the leg. The iliopsoas muscle is innervated by L1 and L2 and the femoral nerve, and it flexes the thigh. The obturator internus is innervated by the nerve to the obturator internus and is a lateral rotator of the thigh. During the preparation of an evening meal a female medical student dropped a sharp, slender kitchen knife. The blade pierced the first web space of her foot, resulting in numbness along adjacent sides of the first and second toes. Which nerve was most likely injured? A. Saphenous
B. Deep fibular (peroneal) C. Superficial fibular (peroneal) D. Sural E. Common fibular (peroneal) B. The medial branch of the deep fibular (peroneal) nerve accompanies the dorsalis pedis artery and innervates the skin between the contiguous sides of the first and second toes. The saphenous nerve is responsible for cutaneous innervation of the anteromedial aspect of the leg and foot. The superficial fibular (peroneal) nerve innervates most of the dorsum of the foot, with the exception of the area where sensation was lost (medial branch of deep fibular nerve). The common fibular (peroneal) nerve gives
off a cutaneous branch, the sural nerve, which innervates the lateral aspect of the leg and lateral side of the foot. Following an injury suffered in a soccer match, a 32year-old female is examined in a seated position in the orthopedic clinic. Holding the right tibia with both hands, the clinician can press the tibia backward under the distal part of her femur. The left tibia cannot be displaced in this way. Which structure was most likely damaged in the right knee? A. Anterior cruciate ligament B. Lateral collateral ligament C. Medial collateral ligament D. Medial meniscus E. Posterior cruciate ligament
E. The posterior cruciate ligament is responsible for preventing the forward sliding of the femur on the tibia. The anterior cruciate displacement ligament prevents posterior
of the femur on the tibia. The lateral collateral ligament limits extension and adduction of the leg. The medial meniscus acts as a shock absorber and cushions the articular surfaces of the knee joint. A 22-year-old woman is admitted to the emergency department after another vehicle collided with the passenger side of the convertible in which she was riding. Radiographic examination reveals an avulsion fracture of the greater trochanter. Which of the following muscles would continue to function normally if such an injury was incurred?
A. Piriformis B. Obturator internus C. Gluteus medius D. Gluteus maximus E. Gluteus minimus D. The gluteus maximus inserts into the gluteal tuberosity and the iliotibial tract. Although the gluteus maximus would continue to contract at the regions of insertion, their orientation would be displaced by the fracture. The obturator
gluteus medius, gluteus minimus, internus, and piriformis all insert on some aspect of the greater trochanter of the femur. The news reported that the 58-year-old ambassador received a slashing wound to the upper medial thigh and
died from exsanguination in less than 2 minutes. What was the most likely nature of his injury? A. The femoral artery was cut at the inguinal ligament. B. A vessel or vessels were injured at the apex of the femoral triangle. C. The femoral vein was transected at its junction with the saphenous vein. D. The medial circumflex femoral was severed at its origin. E. The deep femoral artery was divided at its origin. B. The apex of the femoral triangle occurs at the junction
of the adductor longus and sartorius muscles. The subsartorial (Hunter) canal begins at this location. Immediately deep to this anatomic point lie the femoral artery, femoral vein, deep femoral artery, and deep femoralvein, often overlying one another in that sequence. This has historically been a site of injuries with a meat cleaver. For this reason, injuries at this location are referred to as the butchers block injury. Fatal loss of blood can occur in just a few minutes if pressure, or a tourniquet, is not applied immediately. The common iliac artery becomes the femoral artery at the inguinal ligament. The saphenous vein joins the femoral vein at the saphenous hiatus, or fossa ovalis.
A 72-year-old female suffered a hip dislocation when she fell down the steps to her garage. Which of the following structures is most significant in resisting hyperextension of the hip joint? A. Pubofemoral ligament B. Ischiofemoral ligament C. Iliofemoral ligament D. Negative pressure in the acetabular fossa E. Gluteus maximus muscle C. The iliofemoral ligament is the most important ligament reinforcing the joint anteriorly that would resist both hyperextension and lateral rotation at the hip joint. The
pubofemoral ligament reinforces the joint inferiorly and limits extension and abduction. The ischiofemoral ligament reinforces the joint posteriorly and limits extension and medial rotation. Negative pressure in the acetabular fossa has nothing to do with resisting hyperextension of the hip joint but does help resist dislocation of the head of the femur. The gluteus maximus muscle extends and laterally rotates the thigh and does not particularly resist hyperextension. A 75-year-old man is transported to the emergency department with severe pain of his right hip and thigh. A radiographic examination reveals avascular necrosis of the
femoral head. Which of the following conditions most likely occurred to produce avascular necrosis in this patient? A. Dislocation of the hip with tearing of the ligament of the head of the femur B. Intertrochanteric fracture of the femur C. Intracapsular femoral neck fracture D. Thrombosis of the obturator artery E. Comminuted fracture of the extracapsular femoral neck C. An intracapsular femoral neck fracture causes avascular necrosis of the femoral head because the
fracture damages the radicular branches of the medial and lateral circumflex arteries that pass beneath the ischiofemoral ligament and pierce the femoral neck. Until an individual reaches about 6 to 10 years of age, blood supply to the head of the femur is provided by a branch of the obturator artery that runs with the ligament of the head of the femur. Thereafter, the artery of the ligament of the head of the femur is insignificant. Intertrochanteric fracture of the femur would not damage the blood supply to the head of the femur but would cause complications because the greater trochanter is an attachment site for several gluteal muscles.
A 58-year-old male farmer was accidentally struck with a scythe (a long, curved cutting blade) by another worker while they were cutting wheat. He was admitted to the county hospital with severe bleeding. During physical examination the doctor noted that the patient has foot drop, although sensation was present over the dorsum of the foot and the skin of the posterior calf. Which of the following nerves was injured? A. Femoral nerve B. Sciatic nerve C. Superficial fibular (peroneal) nerve D. Deep fibular (peroneal) nerve E. Common fibular (peroneal) nerve
D. The farm instrument has injured the deep fibular (peroneal) branch of the common fibular (peroneal) nerve. It is vulnerable to injury as it arises from the common fibular (peroneal) at the neck of the fibula. The muscles denervated are largely dorsiflexors of the foot; hence, foot drop and steppage gait can occur. Sensation on the dorsum of the foot is still present; therefore, the superficial branch is mostly or entirely intact, although sensation between the first and second toes would be absent. Femoral nerve injury would result in loss of knee extension. Loss of the sciatic nerve would result in loss of both the tibial and common fibular (peroneal) nerves.
A 45-year-old man is admitted to the emergency department after experiencing a sharp pain while lifting a box of books. He told the physician that he felt the pain in my backside, the back of my thigh, my leg, and the side of my foot. During physical examination it is observed that his Achilles tendon jerk is weakened on the affected side. Which is the most likely cause of injury? A. Disk lesion at L3-4 B. Disk lesion at L4-5 C. Disk lesion at L5-S1 D. Disk lesion at S1-2 E. Gluteal crush syndrome of sciatic nerve or
piriformis syndrome C. The Achilles tendon reflex is a function of the triceps surae muscle, composed of insertion of the gastrocnemius and soleus muscles on the calcaneus. The innervation is provided primarily by spinal nerve S1. The S1 root leaves the vertebral column at the S1 foramen of the sacrum, but a herniated disk at the L5S1 intervertebral space puts the S1 root under tension, resulting in pain and possible weakness or paralysis of S1-supplied muscles, especially the plantar flexors. A disk lesion at L3-4 would affect the L4 spinal nerve (affecting foot inversion and extension); a lesion at L4-5 would cause problems with L5 (hip abduction and knee
flexion). A 55-year-old woman is admitted to the emergency department after an automobile crash. Physical examination reveals that the patients foot is everted and she cannot invert it. A weakness in dorsiflexion and inversion of the foot is noted. Her ipsilateral patellar reflex is reduced in quality, although the Achilles tendon reflex is brisk. Knee extension is almost normal, as are all hip movements and knee flexion. Sensation is greatly reduced on the medial side of the leg. Which of the following nerves is most likely injured? A. Femoral nerve
B. L4 spinal nerve C. L4 and L5 spinal nerves D. Common fibular (peroneal) nerve E. Tibial nerve B. An injury to L4 would cause weakness in the patellar reflex and loss of cutaneous innervation to the medial side of the leg. Patellar reflex is used to test L2 to L4 nerve integrity. The motor side of the reflex is primarily derived from spinal nerves L2 and L3, whereas the sensory side of the arc is said to be principally from L4. The L4 spinal nerve supplies the L4 dermatome on the medial side of the leg and foot, by way of the saphenous nerve. It also supplies foot inversion, a function of the tibialis anterior and tibialis posterior
muscles; the first is supplied by the deep fibular (peroneal) nerve, and the second supplied by the tibial nerve. Foot dorsiflexion is weakened because of partial denervation of the extensor digitorum longus, but L5 is still contributing to that function. The foot is everted because the S1-supplied (by the superficial fibular nerve) fibularis (peroneus) longus and brevis are unopposed. The Achilles reflex is also primarily supplied by S1. Hip movements are produced primarily by L5-and S1-supplied muscles, as is knee flexion. A 46-year-old woman stepped on a broken wine bottle on the sidewalk and the sharp glass entered the posterior part of her foot. The patient was admitted to the hospital, and a physical examination concluded that her lateral
plantar nerve had been transected (cut through). Which of the following conditions will most likely be confirmed by physical examination? A. Loss of sensation over the plantar surface of the third toe B. Paralysis of the abductor hallucis C. Paralysis of the interossei and adductor hallucis D. Flexor hallucis brevis paralysis E. Flexor digitorum brevis paralysis C. The lateral plantar nerve innervates the interossei and adductor hallucis. These losses would be obvious when the patient attempts to abduct and adduct the toes.
Sensation would be absent over the lateral side of the sole, the fifth and fourth toes, and half of the third toe. The medial plantar nerve provides sensation over the plantar surface of the first and second toes and half of the third toe as well as function of the so-called LAFF muscles: first lumbrical abductor hallucis, flexor hallucis brevis, and flexor digitorum brevis. A 22-year-old male martial arts competitor was examined by the clinician because of pain and serious disability suffered from a kick to the side of his knee. Physical examination revealed a dark bruise just distal to
the head of the fibula. Which of the following muscles will most likely be paralyzed? A. Tibialis anterior and extensor digitorum longus B. Tibialis posterior C. Soleus and gastrocnemius D. Plantaris and popliteus E. Flexor digitorum longus and flexor hallucis longus A. The common fibular (peroneal) nerve passes around the head of the fibula and gives off deep (L4-5) and superficial fibular (peroneal) nerve (L5, S1-2) branches. The two nerves supply the dorsiflexors and evertors of the foot, respectively. In this case, the tibialis anterior and
extensor digitorum longus are the only muscles listed that are supplied by either of these nerve branches, and both are innervated by the deep fibular (peroneal) nerve. The fibularis (peroneus) brevis and longus are innervated by the superficial fibular (peroneal) nerve and are evertors of the foot. The tibial nerve supplies each of the other muscles listed. A 61-year-old female immigrant had been diagnosed with spinal tuberculosis. The woman had developed a fluctuant, red, tender bulge on one flank, with a similar bulge in the groin on the same side. This presentation is likely due to spread of disease process within the fascia of a
muscle with which of the following actions at the hip? A. Abduction B. Adduction C. Extension D. Flexion E. Internal rotation D. Spinal tuberculosis can spread within the sheath of the psoas major to its insertion with the iliacus upon the lesser trochanter, presenting there also with painful symptoms. The iliopsoas muscle is the principal flexor of the hip joint. Abduction of the hips is performed by the gluteus medius and minimus with assistance from
shortlateral rotator muscles. Extension of the hip is a function of the gluteus muscles. maximus, together with the hamstring Internal rotation is performed by the adductor muscle group. In an accident during cleanup of an old residential area of the city, the Achilles tendon of a 32-year-old worker was cut through by the blade of a brush cutter. The patient is
admitted to the hospital and a laceration of the Achilles tendon is diagnosed. Which of the following bones serves as an insertion for the Achilles tendon? A. Calcaneus B. Fibula C. Cuboid D. Talus E. Navicular A. The Achilles tendon inserts upon the calcaneus bone. This tendon represents a combination of the tendons of gastrocnemius and soleus muscles. The tendon of the plantaris can insert with this tendon.