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MSK > 4 - Femoral Triangle and Anteromedial Thigh > Flashcards

4 - Femoral Triangle and Anteromedial Thigh Flashcards

1
Q

Clinical Scenario and what do I ned to know

A
  • Fractured neck of fracture - femoral nerve block.
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2
Q

Fascia Lata

A

Is a dense layer of CT that separates the muscles and muscular compartments from each other

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3
Q

Where does the fascia lata attach?

A
  • Attaches superiorly to the pubic tubercle, pubis and inguinal ligament
  • Laterally to the iliac crest
  • Posteriorly to the sacrum, coccyx, ischial tuberosity
  • Extends down the knee and is continuous with the fascia of the leg
  • Laterally blends with the tendon of Tensor of Fascia Lata to form the illiotibal band/tract which attaches to the lateral tibia inferior to knee
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4
Q

Tensor Fascia Lata action

A

Tenses the deep fascia/fascia lata

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5
Q

Where does the facia lata have a deficiency and why?

A

Anteriorly and inferior to the inguinal ligament is a deficiency called the Saphenous Opening where the Great Saphenous Vein passes through to meet the femoral vein

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6
Q

Which intermuscular septa in the thigh is the strongest?

A

Lateral

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7
Q

Anterior Compartment Muscles?

A 
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Vastus Intermedias 
Sartorius

Tensor Fascia Lata is NOT anterior compartment muscle

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8
Q

Rectus Femoris

A 
O = AIIS and acetabulum  
I = Quadriceps tendon at superior patella
Action = Flexes thigh and extends leg 
Nerve = Femoral Nerve
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9
Q

Vastus Lateralis

A 
O = Greater trochanter and Linea Aspera
I = Quadriceps Tendon
Action = extends leg
Nerve = Femoral
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10
Q

Vastus Medialis

A

O = Intertrochanteric Line and medial intermuscular septa

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11
Q

Vastus Intermedius

A

O = Superior 2/3 femoral shaft and lateral intermuscular septa
I = Quad Tendon and onto tibial tuberosity
Action = extends leg
Femoral N

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12
Q

Sartorius

A

O = ASIS
I = Pes Anserinus (medial suprior tibia)
Action: Abducts, flexes and externally rotates the hip and flexes the leg
Femoral N

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13
Q

Tensor Fascia Lata

A

NOT part of anterior compartment
Small - not present in older as fatty tissue if not mobile
Part of gluteal region but as moved around as our legs have come round anteriorly
O = ASIS and Iliac Crest
I = Blends into the ITB into the lateral condyle of the tibia

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14
Q

Muscles of the Medial Thigh Compartment?

A 
One head of adductor magnus
Adductor Longus
Adductor Brevis
Pectineus 
Gracillis
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15
Q

Adductor Magnus

A

O = Inferior pubic ramus (and hamstring part at ischial tuberosity)
I = Linea aspera, medial suprachondylar ridge, adductor tubercle
> Adduct thigh and can both flex thigh and extend thigh with different fibres
> Obturator N (and Tibial)

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16
Q

Adductor Brevis

A

O = Inferior pubic ramus
I = Linea aspera
> adduct and flex thigh
> obturator N

17
Q

Adductor Longus

A

O = Body of pubis
I = Linea Aspera
> Adduct and flex hip
> Obturator N

18
Q

Pectineus

A

O = Superior pubic ramus
I = Inferior to lesser trochanter
> Adducts and flexes thigh
> Obturator and Femoral

19
Q

Gracillis

A

O = Body of pubis
I = Pes Anserinus (superior medial tibia)
> Adduct thigh, flex and internally rotates leg

20
Q

What levels do the femoral nerve and obturator nerve come from?

A

L2 L3 L4

21
Q

Does one spinal nerve contribute to one peripheral nerve?

A

No. Spinal nerves can contribute to multiple peripheral nerves and peripheral nerves can arise from multiple spinal nerves/levels
I.e. a nerve is peripheral when it exits the plexus and is given a name. It may have L1 & L2 or L2 & L3 but usually don’t miss a level like L1 & L3

22
Q

Spinal nerves/peripheral nerves have…

A

Both sensory and motor components

23
Q

Femoral Nerve

Spinal levels, branches, motor supply, sensory distribution

A
  • L2 L3 L4
  • Branches into the saphenous nerve (cutaneous)
  • Anterior Comp (Sartorius, RF, VM, VI, VL) as well as some of pectineus, psoas and iliacus in pelvis
  • sensory distribution supplies all of the anterior thigh to the knee, MEDIAL leg and MEDIAL foot by saphenous
24
Q

Obturator Nerve

Spinal levels, branches, motor supply, sensory distribution

A
  • L2 L3 L4
  • NO branches (smaller nerve)
  • Innervates medial compartment (Add.magnus/brevis/longus/gracillis/some of pectineus and obturator externus of the pelvis)
  • Cutaneous to medial thigh
25
Q

What are the boundaries of the femoral triangle?

A

Superior: Inguinal Ligament
Lateral: Sartorius
Medial: ADDUCTOR LONGUS

Floor is pectineus and iliopsoas and the Roof is fascia lata. The triangle is a fascial space.

26
Q

Contents of the femoral triangle?

A
  • femoral artery, femoral vein (artery and vein run together in a sheath), lymphatics, femoral nerve
27
Q

What order are the femoral triangle contents in?

A 
Nerve
Artery
Vein
Empty
Lymphatics
Artery is halfway from ASIS along inguinal ligament and is pulsing. Nerve is lateral
28
Q

Femoral Nerve Block

A

Rather than lots of medicine and pain killers with side effects but anaesthetic around nerve causing pain (Ant muscles -stop moving and skin)

29
Q

Central Access

A

Femoral artery and vein is somewhere you can access the central circulation i.e. blood transfusion during trauma in femoral vein (cannulation) and femoral artery is good place to take pulse and cardiac angiography

30
Q

Femoral Hernia?

A

The femoral ring is weak in the lower abdominal wall and so is a site for hernia. More common in women than men. The tigh can be at risk of strangulation if the hernia extends beyond the femoral canal through the saphenous opening

31
Q

What does the femoral sheath contain?

A

The femoral artery, vein and lymphatics NO NERVE. The medial part of the sheath as the femoral canal of which the opening is the femoral ring

32
Q

What is the adductor canal?

A
  • Can see in cross section DEEP to the middle third of sartorius
  • provides a passage for the femoral vessels to pass through the thigh into the popliteal fossa
  • bounded medially by sartorius, laterally by adductor longus and magnus and laterally by vastus medialis
  • inlet is the apex of the femoral triangle
  • outlet is the adductor hiatus of the adductor magnus
  • contents are the femoral artery, nerve, vein, saphenous nerve
33
Q

Two clinical applications of the Great Saphenous Vein

A
  1. Saphenous vein graft; vein is removed and transplanted such as in coronary bypass when an artery isn’t available. Good to use as is superficial and easy to get to without damaging structures and redundancy of veins in the leg
  2. Intravenous delivery of fluid replacement when more commonly used, peripheral veins fail/collapse
  3. Cannulation of vein for central access to heart i.e. for blood pressure measurements
34
Q

What muscles does the femoral nerve supply?

A

Iliacus, RF, VM, VI, VL, Sartorius and some of pectineus

MSK (29 decks)

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