3 - Zill - Anterior and Medial Thigh

Question 1

What muscles form the walls of the abdomen?

Answer 1

Rectus Abdominis, External Oblique

Question 2

Inguinal Ligament - Attachment points

What passes under here and in what order?

Answer 2

Thicked fascia of external oblique muscle, ASIS to Pubic Tubercle

(lateral to medial) Femoral:

Nerve

Artery

Vein

Lymph

Question 3

Iliotibial Tract (IT Band)

What does it receive insertion of?

Answer 3

Thickened later part of fascia lata; extends leg after muscles have extended knee.

Provides lateral stability when standing.

Origin: Ilium

Attachment: Lateral condyle of tibia

Tensor Fascia Lata and Gluteus Maximus insert to IT

Question 4

Saphenous Opening

Answer 4

Oval shaped defect in deep fascia, allows pasage for Great Saphenous vein

Lateral Side is sharp = Falciform margin

Question 5

Cutaneous Nerve for Gluteal Region

Answer 5

Posterior Cutaneous Nerve of Thigh

Question 6

Cutaneous nerve for lateral portion of thigh?

Answer 6

Lateral Femoral Cutaneous Nerve of Thigh

Question 7

Major Action / Nerve For:

Anterior Compartment

Posterior Compartment

Medial Compartment

Lateral Compartment

Answer 7

Anterior: Knee Extension / Femoral Nerve

Posterior: Knee Flexion / Tibial part of Sciatic Nerve

Medial: Hip ADductors / Obturator Nerve

Lateral: Hip ABductors / Sup. and Inf. Gluteal Nerve

Question 8

Four Muscles of Quadriceps

Which muscle crosses both hip and knee joints?

Common attachment?

Answer 8

Rectus Femoris (middle, on-top)

Vastus Lateralis (lateral)

Vastus Medialis (medial)

Vastus Intermedius (midd, bottom)

All attach to quadriceps tendon

Question 9

What is the order of structures from the quads to the patella to tibia?

Answer 9

Quad Muscles

Quadriceps Tendon

Patella

Patellar Tendon

Tibia

Question 10

What is the mechanical function of the patella?

Answer 10

Increase mechanical advantag of the quadriceps by increasing angle of insertion

Question 11

What nerves does a patellar tendon reflex test?

Answer 11

L2

L3

L4

(Femoral Nerve)

Question 12

Hip Pointer

Answer 12

Contusion of muscles at Anterior Superior Iliac Spine (ASIS)

Question 13

Sartorius actions

Answer 13

Flex hip

Flex knee

ASIS to tibia via Pes Anserinus

Question 14

Pes Anserinis

Answer 14

Common tendon formed from:

Sartorius

Gracilis

Semitendinosus

Question 15

Ilippsoas

Answer 15

Thigh flexor - composed of Iliacus and Psoas

Origin: ilium (iliacus), T12-L5 (psoas)

Attachment: Femur

Question 16

Pectineus

Answer 16

Origin: Pubis

Attachment: Femur

Action: Flex hip

Question 17

What innervates all anterior compartment muscles?

Answer 17

Femoral Nerve (L2, 3, 4)

Question 18

What is the action of the muscles of the medial compartment?

How are they innervated?

Answer 18

ADduct thigh

All obturator nerve, except hamstring portion of Adductor Magnus is Tibial Sciatic Nerve

Question 19

Where do the Adductor Longus and Adductor Brevis insert?

Which is deeper?

Answer 19

Linea Aspera of Femur

Adductor Brevis

Question 20

Adductor Magnus

What are two parts?

Where to they Originate and Insert?

What is often clinically related to this muscle?

Answer 20

a. Adductor Part

Origin: Pubis / Ischium

Insert: Linea Aspera of Femur

Action: Adduct Thigh

Innervation: Obturator Nerve

b. Hamstring Part

Origin: Ischial Tuberosity

Insert: Adductor Tubercle of Femur (lower)

Action: Extends Thigh

Innervation: Tibial Part of Sciatic Nerve

- - -

Tear or stretch of adductor group at pubis is Pulled Groin

Question 21

What is a tear or stretch of adductor group muscle(s) called?

Answer 21

Pulled Groin

Question 22

Gracilis

Answer 22

Origin: Pubis

Insertion: Tibia via Pes Anserinus

Action: ADduct thigh, flex knee

Question 23

Deep muscle that is difficult to see, which rotates femur laterally?

What does it cover?

Answer 23

Obturator Externus

Obturator Foramen

Question 24

What innervates all medial compartment muscles?

Answer 24

Obturator nerve (L2, 3, 4)

All except hamstring portion of adductor magnus, which is Tibial Sciatic Nerve

Question 25

What are the contents of the Femoral Triangle in order from Lateral to Medial?

Answer 25

Femoral: Nerve Artery Vein Lymphatics

Question 26

Femoral Sheath

Answer 26

Surrounds femoral artery and vein, **not nerve** Continuation of **transversalis fascia**

Question 27

Where do lymph vessels of the lower limb pass through to drain to external iliac nodes in abdomen?

Answer 27

Femoral Canal

Question 28

Femoral Hernia

Answer 28

**Femoral Ring** is point of weakness in abdominal wall; loop of bowel can protrude into **Femoral Canal** and become strangulated

Question 29

Femoral Hernia vs Inguinal Hernia

Answer 29

Femoral = **below** inguinal ligament Inguinal = **above** inguinal ligament Femoral = **closer to femur**

Question 30

When does the External Iliac become the Femoral Artery? When does the Femoral Artery become the Popliteal Artery? What route does it travel?

Answer 30

Inguinal Ligament Adductor Hiatus Anterior to Posterior due to limb development

Question 31

What is the pathway of the femoral artery starting from External Iliac?

Answer 31

External Iliac (Inguinal Ligament) Femoral Artery (Adductor Hiatus) Popliteal Artery (tibia/fibula) Anterior Tibial Artery / Posterial Tibial Artery

Question 32

What are the anastomoses at the joints of the lower extremities?

Answer 32

Hip - Cruciate Anastomosis Knee - Genicular Anastomosis

Question 33

What is the primary supplier of blood for the foot?

Answer 33

Posterior Tibial Artery

Question 34

Profunda Femoris What does it branch to?

Answer 34

Largest branch of femoral, posterior to femoral triangle Passes between **pectineus** and **adductor longus** **- - -** Branches: 1. Medial Femoral Circumflex (femur head) 2. Lateral Femoral Circumflex (lateral thigh)

Question 35

Medial Femoral Circumflex

Answer 35

Primary blood supply to head of femur If disrupted, femur head can die

Question 36

Ichemic Necrosis of Head of Femur What are two sources of blood for femur head?

Answer 36

Can be caused due to falling and fracture of hip, which damages **medial femoral circumflex artery** **- - -** 1. Obturator Artery 2. Medial femoral circumflex artery

Question 37

Perforating Arteries

Answer 37

Provide blood to posterior compartment of thigh Perforate adductor magnus

Question 38

Where are the curciate anastomosis of the hip found?

Answer 38

Posterior to the joint

Question 39

Where can you ligate the femoral artery and still have blood supply? Why? What blood vessels supply the limb with blood?

Answer 39

**Above** Profunda Femoris - - Cruciate Anastomosis can maintain blood supply around hip - - 1. Medial Femoral Circumflex Artery 2. Lateral Femoral Circumflex Artery 3. First Perforating Artery

Question 40

What is the most common population to experience femoral hernias?

Answer 40

Older females