anatomy dissection 1 Flashcards
what is the femoral triangle bordered by ?
inguinal ligament superiorly, sartorius laterally and adductor longus medially
what forms the floor of the femoral triangle ?
iliopsoas laterally and pectineus medially
what does the femoral triangle contain (going from lateral to medial)?
femoral nerve, artery, vein and canal
what defect can occur in the femoral canal?
is the location of femoral hernia formation
what envelopes the femoral artery and vein ?
femoral sheath
what spinal cord levels does the femoral nerve arise from ?
L2,3,4 and is formed in the lumbar plexus
describe how the saphenous nerve branches off from the femoral nerve ?
branches from the femoral nerve to leave the adductor canal distally by passing between sartorius and gracilis (from the medial compartment).
what areas does the saphenous nerve supply and what does the nerve accompany ?
supplies the antereomedial aspects of the knee and leg and the medial aspect of the foot. It accompanies the great saphenous vein
describe how a femoral hernia may arise ? and how it may present ?
increased intrabdominal pressure causes peritoneum (+/- abdominal contents) to herniate into the femoral canal. Can present as a painful lump in the groin, below and lateral to the pubic tubercle
what does the femoral canal contain ? and what does it form (in terms of location)?
only the deep inguinal lymph nodes and adipose tissue. forms the most medial part of the femoral sheath
how are the deep inguinal lymph nodes situated in the femoral canal ?
run in a chain and are medial to the femoral vein
which artery does the medial and lateral circumflex femoral arteries arise from ?
profunda femoris artery
what is the femoral pulse ?
it is the pulse of the femoral artery
what does palpating the femoral pulse allow you to locate ? and what procedures is this helpful for ?
`by palpating the femoral pulse (aka artery) it allows you to then locate both the femoral vein and nerve. This can be used for cannulation and nerve block procuedures.
list some of the procedures that the femoral artery can be used as a route of access to do ?
Can be used an as access route in angiograms, coronary artery stenting, aortic & mitral valve replacements, aortic aneurysm repair, contralateral femoral artery stenting, contralateral uterine artery embolisation etc. (interventional radiology/endovascular approach).
what structure is the inguinal ligament the inferior border off?
external oblique aponeurosis
Describe the route of the inguinal ligament
Runs between the anterior superior iliac spine (ASIS) and the pubic tubercle, and forms a “gutter”. The medial half of this gutter contains the inguinal canal, which contains the spermatic cord (in males) or the round ligament (in females).
how do the femoral vessels, nerve and the iliopsoas muscle/combined tendon enter/leave the lower limb?
by passing deep (posterior) to the inguinal ligament in the retroinguinal space.
where can the inguinal ligament be palpated ?
between the external oblique apenurosis and the deep fascia of the thigh (fascia lata)
describe the muscles of the anterior thigh, including prox and distal attachments along with functions and nerve supply
Muscle
Proximal Attachments
Distal Attachments
Action
Nerve Supply
Iliopsoas
Iliac fossa (iliacus) and lumbar transverse processes/IV discs (psoas major)
Lesser trochanter of femur
Flexion at the hip
Anterior rami of lumbar spinal nerves
Sartorius
ASIS
Medial surface of proximal tibia (via pes anserinus)
Flexion at the hip and knee
Femoral nerve
Quadriceps femoris
Rectus femoris
ASIS
Patella (via quadriceps tendon) then tibial tuberosity (via patellar tendon/ligament)
Extension of the knee (and weak flexion of the hip for rectus femoris)
Vastus lateralis
Shaft of femur
Vastus intermedius
Vastus medius
describe the knee jerk test
It is a deep tendon reflex elicited by striking the patellar ligament with a tendon hammer to suggest a sudden stretch of the quadriceps muscle. This normally produces a reflex contraction of the quadriceps and slight extension at the knee joint.
what does a positive knee jerk test confirm ?
that the muscle, its nerve supply (femoral nerve: spinal roots L2-L4), the spinal cord connections (reflex arc) and descending controls from the brain which normally act to prevent unwanted recurrent reflexes from occurring during normal functioning.
what is the function of the muscles in the medial compartment of the thigh?
action is to adduct the thigh at the hip joint
what are the different muscles of the medial thigh ?
They are: gracilis and adductors brevis, longus & magnus.
Adductor magnus has an “adductor” part and a “hamstring” part.
what muscle in the medial thigh is the most medial and describe its route ?
Gracilis - descends along the medial aspect of the thigh, it is the only hamstring which crosses both the knee and hip joint.
describe how the adductor brevis, longus and magnus relate to each other
Adductors brevis and longus lie anterior to adductor magnus; adductor brevis lies superior to adductor longus.
what are the muscles of the medial thigh compartment all innervated by except for the ‘‘hamstring part’’ of the adductor magnus
obturator nerve (L2-4)
what is the ‘‘hamstring part’’ of the adductor magnus innervated by ?
tibial nerve
how do the obturator nerve, artery and vein enter the medial compartment ?
through the obturator foramen in the hip
where does the obturator nerve branch into anterior and posterior branches
at the upper boarder of the adductor brevis
what is the anterior cutaneous nerve of the thigh a branch of ?
the femoral nerve (L2-4)
what is the lateral cutaneous nerve of the thigh a branch of ?
the lumbosacral plexus (L2-3)
describe the lymph drainage of the lower limb
(hint lymph draing tends to follow veins)
Lymph following the great saphenous vein drains into the superficial inguinal lymph nodes located in the superficial fascia around the vein.
Lymph from the superficial inguinal nodes then drains mostly into the external iliac nodes and some to the deep inguinal nodes.
Lymph following the small saphenous vein drains into popliteal lymph nodes, located in the popliteal fossa.
Lymph from the popliteal nodes then drains into the deep inguinal nodes.
where does lymph from the deep inguinal lymph nodes drain too ?
drains into external iliac lymph nodes hence untlimatley all lymph from the lower limb drains into the external iliac lymph nodes
describe the innervation of the posterior compartment of the thigh and all the compartments of the leg and then nervous supply to the foot
The sciatic nerve supplies the muscles in the posterior compartment of thigh and through its divisions also supplies the muscles within all the compartments of the leg and the intrinsic muscles of the foot.
Roughly where does division of the sciatic nerve occur and what does it divide into?
Division can occur anywhere between the gluteal region and the popliteal fossa (most commonly inferior 1/3rd of thigh).
Divides into the tibial and common fibular nerve
what are the 4 muscles of the hamstrings ?
semimembranousus, semitendinosus (medially) and the long and short heads of biceps femoris (laterally).
what do 3 of the 4 hamstring muscles attach to ?
the ischial tubersoity
what do the tendons of the hamstrings bound to ?
the popliteal fossa superomedially and superolaterally
what is the function of the hamstrings ?
As a unit the hamstrings span the hip and knee joints and act to extend and flex these joints respectively.
what does the biceps femoris attach to?
the lateral aspect of the head of the fibula
why is the short head of the biceps femoris not considered a true hamstring muscle ? (3)
It attaches proximally to the linea aspera of the femur, not to the ischial tuberosity.
It does not cross the hip joint and therefore does not contribute to the movement of the hip joint.
It supplied by the common fibular branch of the sciatic nerve rather than the tibial branch.
what does both the semimembranosus and semitendinosus attach too?
to the proximal tibia
what is special about the semitendinosus ? (hint its part of the reason for its name)
it has a longer tendon than the other muscles
what is special about the semimembranosus muscle ? (hint its partly the reason for its name)
it has a shiny membranous appearance
what is the acetabular labrum?
is a ring of cartilage that surrounds the acetabulum of the hip.
what does the acetabular labrum do ?
it increases the depth of the acetabulum
what attaches the femur to depth of the acetabulum ?
the ligament of the head of the femur
what happens to the ligament of the head of the femur during dislocation of the hip ?
it is ruptured
what runs with the ligament of the head of the femur ? and is obliterated in adults but present in kids
the artery to the head of the femur, it only supplies a small amount of oxygenated blood to the head of the juvenile femur.
what type of joint is the hip joint ?
synovial ball and socket joint
what is the intertrochanteric line ?
is the line between the greater and lesser trochanter and where the fibrous capsule form the synovial hip joint joins onto the femur
how is the intertrochanteric capsule clinically relevant to hip fractures?
provides a boarder which means hip fractures can be classified as intracapsular (in the capsule) or extracapsular (outside the capsule)
describe the blood supply to the hip
deep femoral artery gives rise to the medial and lateral circumflex femoral arteries which give rise to the retinacular arteries
what are the retinacular arteries at risk of during a hip fracture ? andnwhat type of hip fracture puts them at risk of this
at risk of being sheared if an intracapsular hip fracture is severe enough
where is the gluteal region located ?
lies between the back and the posterior thigh and posterior to the pelvis
what is the gluteal region bound by superiorly and inferiorly ?
bounded superiorly by the iliac crest and inferiorly by the gluteal fold/sulcus
where does the intergluteal cleft lie ?
between the buttocks
what marks the lateral extent of the gluteal region?
the greater trochanter of the femur
what 3 muscles make up the superficial muscle layer of the gluteal region ?
gluteus maximus, medius and minimus
what muscle is the most superficial and largest muscle of the gluteal region
gluteus maxmius
what are the attachments of the gluteus maximus muscle ?
attaches to the iliac crest, sacrum, sacrotuberous ligament and coccyx proximally and distally onto the iliotibial tract
