Anatomy- Femoral triangle, anterior and medial thigh Flashcards
what is the superior border of the femoral triangle
inguinal ligament
what is the medial border of the femoral triangle
lateral border of adductor longus
what is the lateral border of the femoral triangle
medial borer of sartorius
what is the floor of the femoral triangle
iliopsoas and pectineus
what is the roof of the femoral triangle
deep fascia (fascia lata)
what are the contents of the femoral triangle
femoral nerve
femoral artery
femoral vein
lymphatics
how do you remebr the positions of the contents of the femoral triagnle
from lateral to medial NAVY nerve artery vein lYmphatics
what hernia forms in the femoral lymphatic canal
femoral hernias
what envelops the femoral artery and vein
the femoral sheath
what is the femoral sheath
a short tube of transversalis and iliopsoas fascia from the abdominal wall which surrounds the most proximal parts of the vessels
what happens to the femoral sheath inferiorly
blends with the adventitia of femoral artery and vein
does the femoral sheath contain the femoral nerve
no, lies outside and lateral to the sheath
where does the femoral nerve leave the spinal chord
L2,3,4- is formed in lumbar plexus
where does the saphenous nerve come from
(sensory) branches from the femoral nerve to leave the adductor canal distally by passing from medial compartment between sartorius and gracilis
what are the three compartments of the thigh
anterior, medial and posterior
within the anterior compartment of the thigh, what are the flexors of the thigh
pectineus
iliopsoas
sartorius
rectus femoris
within the anterior compartment of the thigh, what is the extensor of the leg
quadriceps femoris
vastus lateralis
vastus mediallis
vastus intermedius
what nerve innervates the muscles of the anterior thigh
all femoral nerve (L2,3,4) except psoas major (L1,2,3)
in the medial compartment of the thigh what are the adductors of the thigh
adductor longus adductor brevis adductor magnus gracillis obturator externus
what nerve innervates the components of the medial compartment of the thigh
all obturator nerve (L2,3,4)
except hamstring part of adductor magnus (tibial nerve)
in the posterior compartment of the thigh, what are the extensors of the thigh and flexors of the leg
semitendinosus
semimembranosus
biceps femoris
what is the innervation of the posterior compartment of the thigh
all tibial division of sciatic nerve (L5, S1, S2)
short head biceps femoris (common fibular division of sciatic nerve)
what does the femoral nerve supply after it passes through the medial compartment of the thigh (between sartorius and gracilis)
the fascia and skin of the anteromedial aspects of the knee and leg and the medial aspect of the foot
what does the saphenous nerve accompany in the leg
the saphenous vein
what is a femoral hernia
increased abdominal pressure causing peritoneum (+/- abdo contents) herniating into the femoral canal
what does the femoral canal contain and form
contains inguinal lymph nodes and adipose tissue
forms most medial part of of the femoral sheath
what supplies the majority of the blood to the head of the femor
the medial and lateral circumflex femoral arteries through their retinacular branches
where do the medial and lateral circumflex arteries travel in the hip joint
pass superiorly in relation to the femoral neck and capsule of the hip joint
what are the circumflex femoral arteries medial and lateral
named according to the aspect of the profunda femoris artery from which they emerge
what artery creates the femoral pulse
femoral artery
what is the inferior border of the external oblique aponeurosis
the inguinal ligament
what is the external oblique aponeurosis
the flattened tendon of the most superficial of the anterolateral abdominal wall muscles
what does the inguinal ligament run between
the anterior superior iliac spine (ASIS) and the pubic tubercle
what does the inguinal ligament form and contain
a gutter which’s medial half contains the inguinal canal
what does the inguinal canal contain
men- spermatic chord
women- round ligament
both have genitofemoral and ilioingional nerves
what is the relation of the inguinal ligament and the femoral vessels, femoral nerve and iliopsoas muscle/combined tendon
the femoral nerve and vessels plus iliopsoas muscle/combined tendon enter/ leave the lower limb by passing deep (posterior) to the inguinal ligament in the retroinguinal space
what is the fascia lata
the deep fascia of the thigh
what do the muscles of the anterior thigh main act to do
flex at the hip and extend at the knee
what is the proximal attachment of the iliopsoas
iliac fossa (iliacus)
and
lumbar transverse processes/ IV discs (psoas major)
what is the distal attachment of the iliopsoas
lesser trochanter of the femur
what is the nerve supply of the iliopsoas
anterior rami of lumbar spinal nerves (psoas major L1,2,3)
what is the proximal attachment of the sartorius
ASIS
what is the distal attachment of the sartorius
medial surface of proximal tibia (via pes anserinus)
what is the pes anserinus
combined tendon of the sartorius, gracilis and semitendinosus
what is the role of the iliopsoas
flexion at the hip
what is the role of sartorius
flexion at the hip and knee
what are the four muscles making up the quadriceps femoris
rectus femoris (most superficial) vastus lateralis (most lateral) vastus intermedius (under rectus f) vastus medius (most medial)
what is the proximal attachment of the rectus femoris
ASIS
what is the distal attachment of the rectus femoris
patella (via quadriceps tendon) then tibial tuberosity (via patellar tendon/ligament)
what is the proximal attachment of the vastus muscles
shaft of femur
what is the distal attachment of the vastus muscles
patella (via quadriceps tendon) then tibial tuberosity (via patella tendon/ligament)
what is the role of the quadriceps femoris
extension of the knee (and weak flexion of the hip for rectus femoris)
what nerve supplies the sartorius and qyadriceps femoris
femoral nerve
what is the knee jerk and how is it produced
a deep tendon reflex excited by striking the patellar ligament with a tendon hammer to suggest a sudden stretch of the quadriceps muscle. produces a reflex contraction of the quadriceps and slight extension at the knee joint
what does the knee jerk test
the function of the muscle and its nerve supply (femoral nerve (L2-4), the spinal chord connection (reflex arc) and descending controls from the brain
what is the role of the muscles in the medial compartment of the thigh
adduct the thigh at the hip joint
what muscles make up the medial compartment
gracilis
adductors; brevis, longus and magnus
plus:
pectineus and obturator externis
what nerve innervates the medial compartment of the thigh
all obturator (L2-4) except hamstring part of adductor magnus (tibial nerve (sciatic)) and pectineus (femoral)
what is the role of pectineus
adduct and flex thigh at hip
what is the extra role of adductor longus and magnus
can medially rotate the thigh
what is the adductor hiatus and what does it do
gap in adductor magnus which allows the femoral artery and vein to pass through into popliteal fossa
where does the obturator externis proximally attach to and what is its role
attaches to lateral/external surface of obturator membrane to the greater trochanter of femur
laterally rotates the femur- DOESNT ADDUCT
what is the most medial muscle int the anterior thigh compartment
gracilis
why can the gracilis act as a weak flexor of the knee
as it is only hamstring to pass both knee and hip joint
what is the order of the adductor muscles
adductors brevis and longus lie anterior to magnus, with brevis superior to longus
what is the proximal attachment of the gracilis and adductor brevis and longus
body of pubis
what is the proximal attachment of the adductor magnus
has two
-hamstring part ischial tuberosity
-adductor part ischiopubic ramus
where does the obturator externis distally attach to and what innervates it
trochanteric fossa (greater trochanter)
obturator
what is the distal attachment of gracilis
medial surface of proximal tibia (between sartorius and semtendinosus attachments)
where does the adductor longus distally attach
middle third of posterior shaft of femur along the linea aspera
where does the adductor brevis distally attach to
upper 1/3rd of posterior shaft of femur along the linae aspera
where does the adductor magnus distally attach
has two
-hamstring part adductor tubercle of the femur
-adductor part posterior surface of femur along linae aspera
how does the obturator nerve enter the medial compartment of the thigh
via obturator foramen in the hip bone
what happens to the obturator nerve at the upper border of the adductor brevis
divides into anterior and posterior branches
where can the anterior branch of the obtruator nerve be located
between adductors longus (anteriorly) and brevis (posteriorly) in superior part of anterior compartment
what are the three compartments of the femoral sheath
one for femoral artery, one for femoral vein, one for lymphatic (femoral canal- femoral hernia)
what other artery is in the femoral triangle
the right profunda femoris artery (deep artery of the thigh)
how do you remeber the border of the femoral triangle
SAIL (from lateral to superior)
- sartorius
- adductor longus
- inguinal ligament
what three nerves provide sensory innervation of the thigh
anterior cutaneous nerve of the thigh (branch of femoral)
lateral cutaneous nerve of the thigh (branch of the lumbosacral plexus L2-3)
cutaneous branch of the obturator nerve (L2-4)
what does lymph from superficial structures tend to follow
great and small saphenous veins
where does lymph from the great saphenous vein drain into
the superficial inguinal lymph nodes (located in superficial fascia around the vein)
where does lymph from the superficial inguinal lymph nodes drain into
the external iliac nodes- some into deep inguinal nodes
where does lymph following the small saphenous vein drain into
popliteal lymph nodes located in the popliteal fossa
where does lymph from the popliteal nodes then drain into
deep inguinal nodes
where are the deep inguinal nodes found
deep to the deep fascia of the thigh (fascia lata) medial to the femoral vein
where do deep inguinal nodes drain into
external iliac nodes
where does all lymph from lower limb ultimately drain to
external iliac nodes