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Semester 2 - MSK > 13. Anterior and medial compartments of the thigh > Flashcards

13. Anterior and medial compartments of the thigh Flashcards

1
Q

What three compartments can the musculature of the thigh be split into?

A

Anterior, medial and posterior

Each compartment has a distinct innervation and function.

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2
Q

What are the muscles in the anterior compartment of the thigh innervated by?

A

Mostly the femoral nerve (L2-L4)

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3
Q

What do the muscles in the anterior compartment of the thigh act to do?

A

Generally act to extend the leg at the knee point

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4
Q

What is the arterial supply to the anterior compartment of the thigh?

A

Via the branches of the femoral artery: the lateral and medial femoral circumflex arteries and the profunda femoris branch

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5
Q

What muscles are in the anterior thigh?

A

Pectineus, sartorius, quadriceps femoris

The iliopsoas muscle insertion is also in the anterior compartment of the thigh,

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6
Q

What does the iliopsoas consist of?

A

iliacus and psoas major: separate origin, muscle belly and innervation; share a common insertion and function hence why they are commonly referred to as iliopsoas.

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7
Q

Where does the psoas major originate?

A

Transverse processes of the T12-L5 vertebrae and the lateral margins of the intervertebral discs between them

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8
Q

Where does the iliacus originate?

A

iliac fossa of the pelvis

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9
Q

Where does the psoas major and iliacus insert?

A

Insert together onto the lesser trochanter of the femur

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10
Q

What are the actions of the iliopsoas?

A

Flexes the lower limb at the hip joint and assists in lateral rotation of the femur at the hip joint

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11
Q

From what are the iliopsoas innervated by?

A
  • psoas major: anterior rami of L1-L3

- iliacus: femoral nerve

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12
Q

What does the quadriceps femoris consist of?

A

rectus femoris, vastus lateralis, vastus medius, vastus intermedius

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13
Q

Where do the quadriceps femoris insert?

A

Unite proximal to the knee joint and insert onto the base of the patella via the quadriceps tendon

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14
Q

How is the patella attached to the tibia?

A

patellar ligament

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15
Q

What is the role of the quadriceps femoris?

A

Main extensor of the knee

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16
Q

Describe the vastus lateralis:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the greater trochanter and the lateral lip of the linea aspera
  • inserts via the quadriceps tendon into the base of the patella
  • extends the knee joint and stabilises the patella
  • innervated by femoral nerve
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17
Q

Describe the vastus intermedius:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the anterior and lateral surfaces of the femoral shaft
  • inserts into the base of the patella via the quadriceps tendon
  • acts to extend the knee joint and stabilise the patella
  • innervated by femoral nerve
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18
Q

Describe the vastus medialis:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the intertrochanteric line of the femur and the medial lip of the linea aspera
  • inserts into the base and medial aspect of the patella via the quadriceps tendon. The horizontal inferior fibres are known as the vastus medialis obliquus
  • acts to extend the knee joint and stabilise the patella. Contraction of the VMO resists lateral displacement of the patella
  • innverated by femoral nerve
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19
Q

Describe the rectus femoris:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates as two tendons: the anterior tendon arises from the anterior inferior iliac spine of the pelvis; the posterior tendon arises from a groove above the rim of the acetabulum. The two unite and the muscle belly runs straight down the leg
  • inserts onto the base of the patella via the quadriceps tendon
  • action is to flex the thigh at the hip joint and extend the leg at the knee joint - only muscle of the quadriceps that crosses both the hip and knee joints
  • innervated by femoral nerve
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20
Q

Describe the sartorius:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the anterior superior iliac spine
  • attaches to the medial aspect of the proximal tibia as part of the pes anserinus (along with gracilis and semitendinous)
  • action is to flex, abduct and laterally rotate the thigh at the hip joint. It also flexes and medially rotates the tibia at the knee joint
  • innervated by femoral nerve
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21
Q

Describe the shape of the sartorius muscle

A

The sartorius is the longest muscle in the body. It is long and thin, running across the thigh in an inferomedial direction from lateral. The sartorius is positioned
more superficially than the other muscles in the thigh.

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22
Q

What is the pectineus muscle?

A
  • flat muscle that forms the base of the femoral triangle
  • can have a dual innervation so can be considered a transitional muscle
  • between the anterior thigh and medial thigh compartments
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23
Q

Describe the pectineus:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the pectineal line on the anterior surface of the superior pubic ramus
  • inserts on the pectineal line on the posterior surface of the femur, just inferior to the lesser trochanter
  • acts to adduct and flex the thigh at the hip joint
  • innervated by femoral nerve. May also receive a branch from the obturator nerve
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24
Q

What are the muscles in the medial compartment of the thigh?

A

gracilis, adductor longus, adductor brevis, adductor magnus, obturator externus

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25
Q

What is the job of the muscles of the medial compartment of the thigh?

A

Hip adductors

26
Q

What are the medial thigh muscles innervated by?

A

Obturator nerve, which arises from the lumbar plexus (anterior divisions of L2,3,4)

27
Q

What is the arterial supply of the medial thigh?

A

The obturator artery

28
Q

What is the adductor magnus and what does it consist of?

A
  • largest medial thigh muscle - lies posteriorly

* can be divided into the adductor component and the hamstring component

29
Q

Describe the adductor magnus:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • adductor component originates from the inferior ramus of the pubis and the ischium and inserts onto the linea aspera of the femur
  • the hamstring component originates from the ischial tuberosity and inserts onto the adductor tubercle and medial supracondylar line of the femur
  • the insertions of the two components are separated by the adductor hiatus - gap for femoral vessels
  • both components act to adduct the thigh. The adductor component also flexes the thigh, with the hamstring component extending the thigh
  • adductor component is innervated by the obturator nerve, the hamstring component is innervated by the tibial component of the sciatic nerve
30
Q

What is the adductor longus?

A
  • large, flat muscle
  • practically overlies the adductor brevis and magnus
  • forms the medial border of the femoral triangle
31
Q

Describe the adductor longus:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the body of the pubis and expands into fan shape
  • attaches broadly to the middle third of the linea aspera of the femur
  • adducts thigh
  • innervated by obturator nerve
32
Q

What is the adductor brevis?

A
  • short muscle lying proximal and deep to the adductor longus
  • situated between the anterior and posterior divisions of the obturator nerve so can be used as an anatomical landmark
33
Q

Describe the adductor brevis:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the body of the pubis and the inferior pubic ramus
  • attaches to the linea aspera on the posterior surface of the femur, proximal to the adductor longus
  • adducts thigh
  • innervated by obturator nerve
34
Q

What is the gracilis?

A
  • most superficial and medial of medial thigh muscles

* crosses both the hip and knee joints

35
Q

Describe the gracilis:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the the inferior pubic ramus and the pubis body
  • descending almost vertically, it inserts onto the medial surface of the proximal tibia, between the tendons of the sartorius (anteriorly) and the semitendinous (posteriorly) as part of the pes anserinus
  • acts to adduct thigh at the hip and flex the leg at the knee
  • innervated by obturator nerve (L2-L4).
36
Q

Describe the obturator externus:

  • where does it originate
  • where does it insert
  • what is its action
  • what is it innervated by
A
  • originates from the external surface of the obturator membrane and from the adjacent bone
  • passes posterior to the neck of the femur and inserts onto the posterior aspect of the greater trochanter
  • adduction and lateral rotation of the thigh
  • innervated by obturator nerve
37
Q

What is the femoral triangle?

A

An anatomical region of the proximal anterior thigh through which many large neurovascular structures pass

38
Q

What are the borders of the femoral triangle?

A
  • Superior border: formed by the inguinal ligament that runs from the anterior superior iliac spine to the pubic tubercle. The inguinal ligament acts as a flexor retinaculum, supporting the contents of the femoral triangle during flexion at the hip
  • lateral border: formed by the medial border of the sartorius muscle
  • medial border: formed by the medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle
40
Q

What is the roof and the base of the femoral triangle composed of?

A
  • roof lies anteriorly and is formed by the fascia lata

* base lies posteriorly and is formed by the pectineus, iliopsoas and adductor longus muscl

42
Q

What does the femoral triangle contain, from lateral to medial?

A
  • Femoral nerve
  • Femoral artery
  • Femoral vein - the great saphenous vein drains into the femoral vein within the triangle
  • Femoral canal - empty space + lymphatics

NAVEL

44
Q

Which structures does the femoral sheath enclose?

A

Femoral artery, vein and canal

44
Q

What are the femoral canal borders?

A
  • medial border: lacunar ligament
  • lateral border: femoral vein
  • anterior border: inguinal ligament
  • posterior border: pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle

• opening is located at superior border - the femoral ring. This is closed by a connective tissue layer - the femoral septum. The septum is pierced by the lymphatic vessels exiting the canal

44
Q

What does the femoral canal contain?

A

 Lymphatic vessels – draining the deep inguinal lymph nodes.
 Deep lymph node – the lacunar node.
 Empty space.
 Loose connective tissue.

44
Q

What is the function of the femoral canal?

A

The empty space allows distension of the adjacent femoral vein, so it can cope with increased venous return, or with distension due to increased intra abdominal
pressure.

45
Q

What mnemonic is used to remember The surface marking of the Femoral Artery within the femoral triangle?

A

MIPA:
Mid-Inguinal Point = Artery
The mid-inguinal point is midway between the anterior superior iliac spine (ASIS) and the symphysis pubis.
Note: You should not confuse this with the ‘midpoint of the inguinal ligament’, which is the midpoint between the ASIS and the pubic tubercle and is the surface marking of the deep inguinal ring

46
Q

What is the adductor canal?

A
  • narrow conical tunnel
  • 15 cm long
  • extends from the apex of the femoral triangle to the adductor hiatus
  • serves as a passageway for structures passing between the anterior thigh and posterior leg
47
Q

What is the adductor canal bordered by?

A
  • anteriorly bordered by the sartorius
  • laterally bordered by the vastus medialis
  • posteriorly bordered by the adductor longus and adductor magnus
  • apex marked by the adductor hiatus, the space between the insertions of the adductor and hamstring components of the adductor magnus
48
Q

What does the adductor canal contain?

A

superficial femoral artery , femoral vein, nerve to the vastus medialis and the saphenous nerve

49
Q

What is the saphenous nerve a branch of?

A

the largest cutaneous branch of the femoral nerve

50
Q

What do the femoral artery and vein become?

A

As they pass through the adductor canal via the adductor hiatus into the popliteal fossa, they become the popliteal artery and vein

51
Q

Describe the surface anatomy of the femoral vein?

A

Midpoint of inguinal ligament - between the anterior superior ischial spine and the pubic symphysis

52
Q

When is it necessary to puncture the femoral vein with a needle to obtain a blood supply?

A

In a patient with very poor peripheral venous access (e.g. in hypovolaemic shock, or when the peripheral veins have been damaged by chemotherapy)

53
Q

Where is the femoral nerve formed?

A

In the lumbar plexus from the posterior divisions of the L2-L4 roots

54
Q

What does the femoral nerve pass through?

A
  • descends from lumbar plexus
  • passes through fibres of the psoas major muscle and exits as the inferior part of its lateral border, passing behind the fascia iliaca to around the mid-point of the inguinal ligament
  • then passes behind the inguinal ligament to enter the thigh, and splits into an anterior and posterior division around 4cm below the ligament
  • passes through femoral triangle lateral to the femoral vessels and gives off articular branches to the hip and knee joints
55
Q

What are the branches of the femoral nerve?

A
  • the first cutaneous branches to arise from the femoral nerve are the anterior cutaneous branches that arise in the femoral triangle and supply the skin on the anteromedial thigh
  • the terminal cutaneous branch of the femoral nerve is the saphenous nerve that continues through the adductor canal with the femoral artery and vein to supply the skin on the medial side of the leg and the foot (sometimes as far as the great toe)
56
Q

Where is the inguinal ligament?

A

The inguinal ligament connects from the anterior superior iliac spine to the pubic tubercle

57
Q

What is the mid-inguinal point?

A

midway between the ASIS and the pubic symphysis

58
Q

What is the obturator nerve formed by?

A

The anterior divisions of the second, third and fourth lumbar nerves in the lumbar plexus

59
Q

Where does the obturator nerve descend?

A
  • descends through the fibres of the psoas major muscle and emerges from its medial border, running posteriorly to the common iliac arteries and laterally along the pelvic wall to the obturator foramen
  • enters thigh through the obturator canal and splits into the anterior and posterior divisions
60
Q

What does the anterior division of the obturator nerve do?

A
  • descends anterior to adductor brevis and posterior to adductor longus and pectineus
  • gives off branches to the adductor longus, brevis and gracilis muscles (rarely the pectineus muscle)
  • then pierces the fascia lata to become the cutaneous branch of the obturator nerve and supply the skin over the middle part of the medial thigh
61
Q

What does the posterior division of the obturator nerve do?

A
  • descends through the obturator externus which it supplies
  • passes posterior to adductor brevis but anterior to adductor magnus
  • supplies both adductor brevis (which is supplied also by the anterior division) and the adductor component of the adductor magnus
62
Q

What is the hamstring component of the adductor magnus supplied by?

A

Tibial nerve

Semester 2 - MSK (35 decks)

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