5 LE Thigh + Knee Flashcards
fascial layers of the thigh (femur)
superficial fascia
deep fascia
superficial fascia of the thigh
subcutaneous (deep to skin)
- contains loose CT, fat, cutaneous nerves, superficial vessesls
important veins in superficial fascia
great saphenous vein
small saphenous vein
great saphenous vein
longest vein found in body (thigh)
- superficial fascia
- commonly used for heart bypass surgery (acts like an artery)
- common site for long term IV
- common site for varicose veins
- inner thigh/calf
medial malleolus to femoral vein
small saphenous vein
lateral malleolus to popliteal vein
- superficial fascia
- posterior “calf” vein
deep fascia of the thigh
“fascia lata”
- wraps thigh like strong elastic stocking
FCN deep fascia
(1) increase effectiveness of venous pump
(2) compartmentalize muscles
(3) prevent excessive bulging of the muscles
specializations of deep fascia
iliotibial tract (IT band)
saphenous opening
iliotibial tract (IT band)
thickening of longitudinal fascial fibers on lateral thigh
- from iliac tubercle to lateral condyle femur
- shared aponeurosis of tensor fascia lata + gluetus maximus
(specializations of deep fascia)
saphenous opening
gap in fascia lata inferior to inguinal ligament
specializations of deep fascia
saphenous opening = passage for
(1) great saphenous vein
(2) lymph vessels
thigh muscle compartments
anterior group (6) medial group (5) posterior group (3)
anterior thigh muscles
(quadriceps femoris) rectus femoris vastus lateralis vastus medialis vastus intermedius
sartorius
GENERAL A/N anterior thigh muscles
A: extend leg @ knee (not sartorius)
N: femoral nerve
rectus femoris
anterior thigh muscle (quadriceps femoris group)
O: AIIS + ilium above acetebaulum
I: tibial tuberosity via patellar tendon
A: extend leg @ knee + flex thigh @ hip
N: femoral nerve (L2, L3, L4)
kicking a soccer ball
vastus lateralis
anterior thigh muscle (quadriceps femoris group)
O: greater trochanter + lateral linea aspera
I: tibial tuberosity via patellar tendon
A: extend leg @ knee
N: femoral nerve (L2, L3, L4)
vastus medialis
anterior thigh muscle (quadriceps femoris group)
O: intertrochanteric line + medial linea aspera
I: tibial tuberosity via patellar tendon
A: extend leg @ knee
N: femoral nerve (L2, L3, L4)
vastus intermedius
anterior thigh muscle (quadriceps femoris group)
O: anterior / lateral shaft of femur
I: tibial tuberosity via patellar tendon
A: extend leg @ knee
N: femoral nerve (L2, L3, L4)
sartorius
anterior thigh muscle
O: ASIS
I: superior medial tibia
A: flex + abduct + laterally rotate thigh @ knee
N: femoral nerve (L2 – L3)
tailor’s muscles (crossed-leg in sitting position)
medial thigh muscles
(medial femoral group)
gracilis
pectineus
(adductor group)
adductor longus
adductor brevis
adductor magnus
GENERAL A/N medial thigh muscles
A: adduct thigh
N: obturator nerve
gracilis
medial thigh muscle (medial femoral group)
O: inferior pubic ramus
I: superior medial tibia
A: adduct thigh @ hip
N: obturator nerve (L2 – L3)
pectineus
medial thigh muscle (medial femoral group)
O: superior pubic ramus
I: pectineal line of femur
A: adduct + flex thigh
N: obturator + femoral nerve (L2, L3, L4)
adductor longus
medial thigh muscle (adductor group)
O: body of pubis
I: medial linea aspera
A: adduct thigh
N: obturator nerve (L3 – L4)
adductor brevis
medial thigh muscle (adductor group)
O: inferior pubic ramus
I: medial linea aspera
A: adduct thigh
N: obturator nerve (L3 – L4)
adductor magnus
medial thigh muscle (adductor group)
O: inferior pubic ramus
ischial tuberosity
I: linea aspera
adductor tubercle of femur
A: (adductor portion) adduct + slight flexion of thigh AND (hamstring portion) extend thigh
N: (adductor portion) obturator nerve (L3 – L4)
AND (hamstring portion) tibial nerve (L3 – L4)
two separate parts, twisted fibers, GROIN PULL
groin pull
injury to adductor magnus b/c tendinous fibers are twisted, thus easily strained
posterior thigh muscles
(hamstrings)
semimembranosus
semitendinosus
biceps femoris
GENERAL A/N posterior thigh muscles
A: extend thigh + flex leg @ knee
N: tibial nerve
semimembranosus
posterior thigh muscle (hamstring)
O: ischial tuberosity
I: posterior medial condyle tibia
A: extend thigh @ hip AND flex/medially rotate leg @ knee
N: tibial nerve (S1 – S2)
semitendinosus
posterior thigh muscle (hamstring)
O: ischial tuberosity
I: medial tibia
A: extend thigh @ hip AND flex/medially rotate leg @ knee
N: tibial nerve (S1 – S2)
short head of biceps femoris
posterior thigh muscle (hamstring)
O: lateral + inferior linea aspera
I: lateral head of fibula
A: extend thigh @ hip AND flex + laterally rotate leg @ knee
N: common fibular nerve (L5, S1 – S2)
long head of biceps femoris
posterior thigh muscle (hamstring)
O: ischial tuberosity
I: lateral head of fibula
A: extend thigh @ hip AND flex + laterally rotate leg @ knee
N: tibial nerve (S1 – S3)
knee
(hinge synovial joint)
largest + most superficial joint
- most stable position = erect/extended
knee movements (3)
(1) flexion
(2) extension [locked knee]
(3) rotation [only when flexed]
knee articulations
femorotibial (lateral/medial)
femoropatellar
knee joint stability dependent upon:
(1) strength/actions of surrounding muscles/tendons [primarily quadriceps femoris]
(2) ligaments connecting femur and tibia
quadriceps femoris FACT
most thigh/knee injuries due to this muscle group
- preventable w/ appropriate condition of quads
articular capsule
(joint/fibrous capsule)
thin, outer layer
- synovial membrane
major ligament groups of articular capsule
extracapsular (outside capsule)
intra-articular
extracapsular ligaments
patellar ligament
fibular (lateral) collateral ligament [FCL]
tibial (medial) collateral ligament [TCL]
patellar ligament
distal quadriceps tendon
fibular (lateral) collateral ligament [FCL]
strong + cord-like
- separated from lateral meniscus by popliteus tendon
lateral epicondyle to lateral fibular head
tibial (medial) collateral ligament [TCL]
strong + flat
- weaker than FCL
- medial fibers attached to medial meniscus
medial epicondyle to medial tibia
most injuries to medial ligaments
collateral ligaments FACT
taut when knee extended
- increase stability when standing
- prevent rotation when flexed
intra-articular ligaments
(cruciate ligaments)
anterior cruciate ligament [ACL]
posterior cruciate ligament [PCL]
(menisci)
coronary ligaments
transverse ligaments
cruciate ligament
maintain contact btwn femur + tibia
ACL + PCL
anterior cruciate ligament [ACL]
poor blood supply
- taut when knee extended (prevents hyperextension >180˚)
- weaker than PCL
ATTACHMENTS anterior cruciate ligament [ACL]
anterior intercondylar area of tibia
extends superiorly, posteriorly, and laterally to attach to medial side of lateral condyle of femur
when knee flexed @ right angle, ACL
(1) limits medial rotation
(2) stops anterior movement of tibia
(3) increase lateral rotation
posterior cruciate ligament [PCL]
stronger than ACL
- taut when knee flexed (prevents hyperflexion)
ATTACHMENTS posterior cruciate ligament [PCL]
posterior intercondylar area of tibia, extends superiorly and anteriorly to the lateral side of the medial condyle of the femur
when knee flexed @ right angle, PCL does the following:
(1) weight-bearing
(2) major stabilizer when flexed [ie. walking downhill]
(3) limits medial rotation
(4) prevents posterior movement
posterior drawer sign
(flexed knee) tibia slides into the femur joint
anterior drawer sign
(flexed knee) tibia slides out of femur joint
menisci
crescents of fibrocartilage
- thicker @ external margins
- taper internally
**rims around knee
menisci FCN
(1) deepen articular surface [prevent rocking/side-to-side motion of femur]
(2) shock absorption
ligaments of the menisci
coronary ligaments
transverse ligaments
coronary ligaments
spans menisci to tibial condyle
transverse ligament
(knee) joins menisci on anterior edge
types of menisci
medial meniscus
lateral meniscus
medial meniscus
“C” shaped
- more firmly anchored to tibia [intercondylar areas]
- attachement to tibial collateral ligament
lateral meniscus
smaller + circular
- more movable [no fibular collateral ligament attachment]
- popliteus tendon separates from fibular collateral ligament
- joined to PCL + femur by posterior meniscofemoral ligament
posterior meniscofemoral ligament
joins lateral meniscus to femur + PCL
bursae of knee joint
fluid-filled sacs
types of bursae in knee
suprapatellar
prepatellar
infrapatellar
~12
bursae FCN
(1) shock absorption
(2) keeps tendons in correct orientation [slides easily]
movements of the knee joint
flexion
extension
rotation (2)
flexion of the knee
mainly via HAMSTRING
- limited by contact btwn leg/thigh
extension of knee
mainly via QUADRICEPS FEMORIS
- movement limited by cruciate + collateral ligaments
medial rotation of knee
only possible when knee flexed
popliteus, semimembranosus, semitendinosus
- movement checked by cruciate + collateral ligaments
lateral rotation of knee
biceps femoris
- movement checked by collateral ligaments
“unhapppy triad”
common knee injuries to:
(1) MCL
(2) medial meniscus
(3) ACL
Q-angle
femur (diagonal) + tibia (vertical) = angle @ knee btwn long axes of bones
- places middle of knee joint directly inferior to head of femur [centers weight-bearing line in the knee]
genu varum
“bowlegged”
decreased Q-angle
- line of weight-bearing medial to center of knee
- puts stress on medial cartilages + FCL
children 1st learning to walk (1-2 years)
Geenou’s legs
genu valgum
“knock-kneed”
increased Q-angle
- line of weight-bearing lateral to center of knee
- puts stress on lateral cartilages + TCL
children (2-4 yrs)
**Zeng’s legs)
