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Y1 TP2 Musculoskeletal System > 3. Lower Limb, Thigh, Knee > Flashcards

3. Lower Limb, Thigh, Knee Flashcards

1
Q

Flexors of the hip joint:

A

pectineus,
iliopsoas (psoas major, iliacus)
sartorius

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2
Q

Quadriceps femoris muscles

A

rectus femoris,
vastus lateralis,
vastus medialis
vastus intermedius)

the quadriceps tendon and the patella ligament

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3
Q

Adductor muscles

A

adductor longus,
adductor brevis,
adductor magnus,

gracilis and obturator externus

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4
Q

Vessels of femoral triangle

A

’ Femoral artery and its profunda femoris branch (profunda means deep)
– Femoral vein
– Lymphatics
– Great (long) saphenous vein

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5
Q

PECTINEUS muscle

A

Origin
• Pectineal line of the superior pubic ramus

Insertion
• Upper and linea aspera of femur

Action
• Flexes and the adducts the thigh at the hip joint

Nerve supply
• Femoral nerve (l3,l4) - anterior branch

Pectineus = muscle
• Originates at superior pubic ramus

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6
Q

4 things in loose connective tissue

A

– fat
– cutaneous nerves
– superficial veins
– lymphatic vessels and nodes

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7
Q

Compartments of thigh

A
  • Anterior = contains quads and pectineus
    • Posterior = hamstring muscles supplied by sciatic
    • Medial compartment
    • Femur
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8
Q

Deep fascia of lower limb - attachments

A

Covers lower limb like stocking

– inguinal ligament
– iliac crest
– Sacrum, coccyx, sacrotuberous lig, ischial tuberosity/ ischiopubic ramus

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9
Q

Deep fascia of lower limb - names

A
  • in the thigh = “fascia lata”

* in the leg = “crural fascia”

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10
Q

Fascia lata (deep fascia)

A

Laterally thickened to form iliotibial tract

– inserts into anterolateral tubercle of tibia (Gerdy’s tubercle)**

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11
Q

Tensor fascia lata - muscle

A
  • Supplied by superior gluteal nerve

* Adduction of hip

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12
Q

Deep fascia forms 3 compartments of thigh

A

• Anterior
• Medial
• Posterior
Compartments separated by intermuscular septum
• Infection in one compartment can spread along fascia planes

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13
Q

Deep fascia - saphenous opening

A
  • Inguinal ligament = 4cm inferior and lateral to pubic tubercle, drains vascular beds
    • The superficial vein (great saphenous) dives through deep fascia to join the deep venous system (femoral vein)
    • The membranous layer blends into the deep fascia above the saphenous opening and forms perforated cribiform fascia over the opening : pierced by great saphenous v, lymphatics, smaller veins
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14
Q

Superficial fascia of anterolateral abdominal wall organised into 2 layers:

A
  • Camper’s fascia – fatty layer

* Scarpa’s fascia – membranous layer

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15
Q

Great saphenous vein

A

Formed by dorsal vein of great toe and dorsal venous arch of foot

  • Has multiple valves… these can “go wrong” (varicose veins) = aids blood going up as gravity likes to pull it down
  • Receives several tributaries especially near termination
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16
Q

Great saphenous vein - surface markings

A

• anterior to medial malleolus
→ hand’s breadth post to medial border of patella
→passes through saphenous opening

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17
Q

Lymphatic drainage

A

Superficial lymphatic vessels accompany saphenous vein
lots of lymph that End in the vertical group of superficial inguinal lymph nodes

• Lymphatic vessels from the superficial nodes pass through cribriform fascia 
– directly to external iliac lymph nodes 
– some pass to deep inguinal lymph nodes on medial aspect of femoral vein
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18
Q

3 compartments of thigh - nerves

A
  • Anterior group innervated by femoral nerve
    • Medial group by obturator nerve ( has two branches anterior and posterior)
    • Posterior group by sciatic nerve
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19
Q

Anterior compartment of the thigh

A

Usually the largest compartment
• Includes femur and anterior thigh muscles – flexors of hip – extensors of knee

3 major muscles in anterior thigh
• pectineus
• sartorius
• quadriceps femoris (the end of the iliopsoas muscle passes into the anterior compartment too)

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20
Q

Anterior compartment muscles

Sartorius

A

• Sartorius = attaches to anterior inferior illaic spine

Tailors muscle = all the functions of Sartorius:
• Hip - flexes, abducts, laterally rotates
• Knee - flexes (medial rotating when flexed

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21
Q

Anterior compartment muscles -

Illiopsoas

A

Most powerful hip flexor walking and climbing
• Maintains posture while standing

2 muscles, with a common tendon inserting on lesser trochanter

Innervation:
• Psoas major = anterior rami first three lumbar nerves (mainly L2)
• Iliacus = femoral nerve (L2,3)

22
Q

How to remember order of vessels in femoral triangle

A 
NAVY 
	• Nerve
	• Artery 
	• Vein
	• Y front
Goes from lateral to medial (nerve is medial)

Femoral artery
• Midpoint between anterior superior iliac spine and pubic tubercle

23
Q

Quadriceps femoris -4 muscles

A

(rectus femoris, vastus lateralis, vastus medialis and vastus intermedius)

Rectus femoris originates on ilium
Vastus muscles originate around the proximal end of the femur
1 common insertion (quadriceps tendon)

All 4 innervated by femoral nerve

24
Q

Retinacula

A

(connective tissue) play role in keeping patella aligned over femur

25
Q

major muscles in the medial thigh:

A
  • Gracilis
  • Obturator externus
  • Adductor brevis
  • Adductor longus
  • Adductor magnus
  • Pectineus also acts as adductor
26
Q

Nerve supply to medial thigh muscles

A

Obturator nerve supplies these muscles, all of which adduct the thigh

27
Q

Adductors - all adductor muscles

A
  • Obtruator externus
    • Pectineus
    • Adductor longus, brevis, magnus (insert into linea aspera)
    • Grasilis
28
Q

Adductor magnus

A

Adductor part of magnus will also flex the thigh (weakly)

Proximal origin of hamstring part of magnus more posterior - ischial tuberosity- and inserts onto adductor tubercle so extends the hip (sciatic nerve)

29
Q

Adductor magnus contains adductor hiatus

A

Adductor hiatus – pes anserinus

Opening between the 2 distal attachments of adductor magnus

• Transmits femoral artery and vein from adductor canal to popliteal fossa (posterior knee)

Pes anserinus
• Sartorius
• Gracilis
• s.tendinousous

30
Q

Pes anserinus

A
  • Sartorius
    • Gracilis
    • s.tendinousous
31
Q

Gracilis (slender) and obturator externus

A
  • Lateral or external rotator
    • Perforations for branches of arteries
    • Adductors canal/ hunters canal
32
Q

Boundaries of Femoral triangle

A
  • Superiorly – inguinal ligament
    • Medially – medial border of adductor longus
    • Laterally – medial border of sartorius
    • Floor- pectineus and Iliopsoas
    • Roof – fascial lata, cribriform fascia, skin, subcutaneous tissue
33
Q

Retro- inguinal space

A

—> behind inguinal ligament

Gets things out of pelvic part into thigh

Inguinal ligament = ASIS → pubic tubercle
Retro-Inguinal Space is deep to ligament…
Important passageway between abdominal cavity and lower limb

34
Q

Femoral nerve (L2-L4)

A

Divides into several branches to:
• anterior thigh muscles
• articular branches to hip and knee,
• cutaneous branches to anteromedial side of thigh

• Continues as the saphenous nerve through adductor canal - but comes out bet wee n s a rto riu s and gracilis
Saphenous nerve accompanies saphenous veinm

35
Q

Femoral sheath

A

Fascial tube
• 4cm long
• deep to inguinal ligament
• blends with adventitia of femoral vessels
• Allows femoral artery and vein to glide deep to inguinal ligament during movemen

36
Q

Femoral canal

A

Short and blind ending canal
• Allows femoral vein to expand eg exercise
• Contains fat and lymphatics, sometimes deep inguinal lymph node (Cloquet’s node) - allows expansion

37
Q

Boundaries of femoral ring

Opening of femoral canal

A

Laterally – septum between femoral vein and canal
• Posteriorly – pectineus (superior ramus of pubis)
• Medially – lacunarligament
• Anteriorly – Inguinalligament

38
Q

Femoral artery

A

First branches
• Superficial epigastric
• Superficial circumflex iliac
• Superficial and deep external pudendal

39
Q

Profunda femoris Artery

A

• main artery of thigh, gives off 3 -4 perforating arteries which supply all 3 compartments of thigh and hip (giving off the circumflex femoral vessels)

40
Q

Femoral vein

A

A continuation of popliteal vein
• Receives profunda femoris vein (formed by union of 3 or 4 perforating veins), saphenous vein and other tributaries
• Continues as the external iliac vein

41
Q

Adductor canal - boundaries

A
  • laterally and anteriorly = vastus medialis
  • posteriorly = adductor longus and magnus
  • anteriorly and medially –sartorius (forms the roof)
42
Q

What is in the adductor canal ?

A
  • femoral artery
  • femoral vein
  • saphenous nerve (from femoral)
  • nerve to vastus medialis
43
Q

2 important sites for muscle attatchment

A

Anterior superior illiac spine

Anterior inferior illioc spine

44
Q

Function of femoral candl

A

Allow femoral vein to expand when there is increased venous return from lower limb

  • roulte for efferent lymphatic drainage from deep inguinal nodes
45
Q

Actions of quadriceps femoris muscles

A

Extend leg or knee joint

Flex thigh at hip joint

46
Q

Vastus medialis function

A

Sends some fibres horizontally to insert onto patella to stabilise patella and prevent patella dislocation

47
Q

Virchows triad

A

3 factors important in venous thrombosis development

  • venous stasis
  • activation of blood coagulation
  • vein damage
48
Q

Femoral hernia

A

Protrusion of abdominal viscera through femoral ring

  • found below and lateral to pubic tubercle
49
Q

Inguinal hernia

A
  • found above and medial to pubic tubercle
50
Q

Typical sites for valvular incompetence

A 
Mid proximal thigh (hunteran perforator)
Proximal calf (boyd perforators)

Y1 TP2 Musculoskeletal System (10 decks)

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