2.5.1. ANAT LAB - Anterior and Medial Thigh Flashcards
What muscle attaches to the ASIS (anterior superior iliac spine)?
Sartorius
What muscle attaches to the AIIS (anterior inferior iliac spine)?
Rectus femoris
Which hip bone contributes to the superior part of the acetabulum?
The ilium
Which hip bone forms the postero-inferior part of the hip bone?
Ischium
Which hip bone forms the anteromedial part of the hip bone?
Which part of the acetabulum does this bone also contribute to?
The pubis bone
Anterior part of the acetabulum
Define “angle of inclination”
What is the average angle in adults (in degrees)?
Angle formed between the neck and shaft of the femur
Average in adults is 126 degrees (and it decreases with age)
Define “angle of declination” (aka the torsion angle)
What is the average angle in males and females?
When viewing the femur superiorly, the angle observed between the long axis of the head/neck of the femur and the transverse axis of the femoral condyles.
The average is 12 degrees in females and 7 degrees in males.
Which joint & artery are we MOST worried about with a fracture of the distal or interior femur, and why??
We are most worried about the knee joint because fractures of the distal/inferior femur can be complicated by the separation of condyles.
We are concerned about hemorrhage of popliteal artery, which could compromise blood supply to the leg
Proximal fractures of the femur are usually due to _____ trauma
Indirect
Which artery is the source of the internal iliac arteries?
Common iliac artery
What areas does the internal iliac artery supply?
It is the principal artery of the pelvis; it supplies most of the blood to the pelvic viscera and some to the musculoskeletal part of the pelvis
It also supplies branches to the gluteal and medial thigh regions, as well as the perineum.
Explain the route of the obturator artery.
It typically arises close to the origin of the umbilical artery; runs anteroinferiorly on the obturator fascia on the lateral wall of the pelvis and passes between the obturator nerve and vein.
What is the largest branch of the posterior division of the internal iliac arter?
What does it supply?
The largest branch is the superior gluteal artery.
It supplies the gluteal muscles of the booty
Describe the general pathway of venous drainage from the lower extremity into the pelvis.
Superficial veins are in the subcutaneous tissue and run independent from named arteries; the deep veins are deep to the deep fascia and accompany all major arteries. Superficial and deep veins have valves, which are more numerous in deep veins.
Describe the general pathway of lymphatic drainage from the lower extremity into the pelvis.
Superficial lymphatic vessels converge on and accompany the saphenous veins and their tributaries → end at the superficial inguinal lymph nodes→ most lymph then directly passes to the external iliac lymph nodes and some passes to the deep inguinal lymph nodes
Define “musculovenous pump”.
Muscular contractions in the limbs function with the venous valves to move blood toward the heart (against gravity)
Femoral triangle:
Superior border
Lateral border
Medial border
Floor (2)
Superior border: Inguinal ligament
Lateral border: medial border of Sartorius
Medial border: lateral border of Adductor Longus
Floor: Iliopsoas and Pectineus muscles
Where is the most common originating site of a femoral hernia?
The anterior abdominal wall
Iliopsoas:
Origin
Insertion
Innervation
Action
Origin: T12-L5 vertebrae; transverse processes of all lumbar
Insertion: Lesser trochanter of femur
Innervation: L1, L2, L3
Action: Stabilizing hip joint and flexing thigh at hip joint
Sartorius:
Origin
Insertion
Innervation
Action
Origin: ASIS
Insertion: Superior part of medial surface of tibia
Innervation: Femoral nerve
Action: Flexes, adducts, and laterally rotates thigh at joint; flexes leg at knee joint
Rectus femoris:
Origin
Insertion
Innervation
Action
Origin: AIIS
Insertion: Base of patella; patellar ligament to tibial tuberosity
Innervation: Femoral nerve
Action: Extend leg at knee joint
What is a “compartment syndrome”?
(HINT: It has to do with increased intra-compartmental pressure within these water-tight osseo-fascial barriers).
How is it relieved?
Such “barriers”, when at normal compartmental pressures, make muscle function extremely efficient. But infections (which cause swelling within this tight space) or bleeding into a compartment can increase the pressure enough to shut off circulation to the limb! This situation is called a “compartment syndrome” and is heralded by pain. It is a surgical emergency, since the pressure builds fast and there is serious risk of tissue necrosis and an amputation may become necessary if this is not corrected immediately.
The pressure must be relieved by cutting into the fascia along the length of the muscle envelope to release the pressure and thus save the limb. It can be done in the field or on the ward to save time.
Pectineus:
Origin
Insertion
Innervation
Action
Origin: Superior ramus of pubis
Insertion: Pectineal line of femur, just inferior to the lesser trochanter
Innervation: Femoral nerve (may also receive a branch from the obturator nerve)
Action: Adducts and flexes thigh; assists with medial rotation of thigh
What are the muscles of the quadriceps femoris?
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Vastus lateralis:
Origin
Insertion
Innervation
Action
Origin: Greater trochanter and lateral lip of linea aspera of femur
Insertion: Via quadriceps tendon and attachment to base of patella
Innervation: Femoral nerve
Action: Extend leg at knee joint
Vastus medialis:
Origin
Insertion
Innervation
Action
Origin: Intertrochanteric line and medial lip of linea aspera of femur
Insertion: Via quadriceps tendon and attachment to base of patella
Innervation: Femoral nerve
Action: Extend leg at knee joint
Vastus intermedius:
Origin
Insertion
Innervation
Action
Origin: Anterior and lateral surfaces of shaft of femur
Insertion: Via quadriceps tendon and attachment to base of patella
Innervation: Femoral nerve
Action: Extend leg at knee joint
Adductor longus:
Origin
Insertion
Innervation
Action
Origin: Body of pubis inferior to pubic crest
Insertion: Middle third of linea aspera of femur
Innervation: Obturator nerve
Action: Adducts thigh
Adductor brevis:
Origin
Insertion
Innervation
Action
Origin: Body and inferior ramus of pubis
Insertion: Pectineal line and proximal part of linea aspera of femur
Innervation: Obturator nerve
Action: Adducts thigh
Adductor magnus:
Origin (2)
Insertion (2)
Innervation (2)
Actions
Origin: Adductor part - inferior ramus of pubis, ramus of ischium
Hamstrings part - ischial tuberosity
Insertion: Adductor part - gluteal tuberosity, linea aspera, medial supercondylar line
Hamstrings part - adductor tubercle of femur
Innervation: Adductor part - obturator nerve
Hamstrings part - tibial part of sciatic nerve
Actions: Adducts thigh; Adductor part - flexes thigh; Hamstrings part - extends thigh
Gracilis:
Origin
Insertion
Innervation
Action
Origin: Body and inferior ramus of pubis
Insertion: Superior part of medial surface of tibia
Innervation: Obturator nerve
Action: Adducts thigh; flexes leg; helps rotate leg medially
Obturator externus:
Origin
Insertion
Innervation
Action
Origin: Margins of obturator foramen and obturator membrane
Insertion: Trochanteric fossa of femur
Innervation: Obturator nerve
Action: Laterally rotates thigh; steadies head of femur in acetabulum
What is the adductor canal?
What is another name for it?
It is a long, narrow passageway in the middle third of the thigh; extends from the apex of the femoral triangle to the adductor hiatus
It is also known as Hunter’s canal
Where is the adductor hiatus located?
In the tendon of the adductor magnus
What are the contents of the adductor canal? (4)
Femoral artery
Femoral vein
Saphenous nerve
Nerve to vastus medialis
What artery is the main blood supplier to the femoral head?
The medial femoral circumflex artery
Identify the following:
- Femoral nerve
- Lateral component of femoral sheath
- Medial component of femoral sheath (femoral canal)
The components of the femoral sheath (from lateral to medial) are:
N - Femoral nerve (OUTSIDE the sheath)
A - Femoral artery
V - Femoral vein
L - lymphatics
Identify the following:
- Deep femoral artery (Profunda Femoral artery)
- Lateral circumflex femoral artery
- Medial circumflex femoral artery
- Femoral artery
Identify the following:
- Sartorius muscle
- Adductor longus muscle
- Gracilis
Identify the following:
- Tensor fascia lata muscle
- Iliotibial tract
Identify the following:
- Vastus medialis
- Rectus femoris
- Vastus lateralis
- Patellar tendon/ligament
Identify the following:
- Vastus intermedius
- Vastus lateralis
- Vastus medialis
- Rectus femoris (distal stump) - the rectus femoris has been reflected so that the vastus intermedius can be seen
Identify the following:
- Gracilis
- Adductor longus
- Sartorius
- Rectus femoris
Identify the following:
- Pectineus
- Adductor brevis
- Adductor magnus
- Adductor longus
Identify the following:
- Iliopsoas
- Sartorius (cut edge)
- Femoral and profunda femoral arteries
Identify the following:
- Pubic tubercle
Identify the following:
- Anterior inferior iliac spine (AIIS)
- Anterior superior iliac spine (ASIS)
Identify the following:
- Head of femur
- Greater trochanter
- Lesser trochanter
- Fovea of head
- Medial epicondyle
- Lateral epicondyle
Identify the following:
- Linea aspera
- Fovea of head
- Lateral condyle
- Medial condyle
