Anatomy Gluteal Region, Thigh, Popiteal fossa Flashcards
What gives innervation to the anterior compartment of the arm?
musculocutaneous nerve
What gives innervation to the anterior compartment of the forearm and hand?
median and ulnar nerve
What gives innervation to the shoulder?
axillary nerve
What gives innervation to the posterior compartment of your arm and forearm?
radial nerve
What are the three anterior division nerves?
musculocutaneous
median
ulnar
What are the two posterior division nerves?
axillary (shoulder)
radial (arm and shoulder)
What are three especially important nerves of the lumbo-sacral plexus?
femoral, obturator, and sciatic
Is the obturator nerve an anterior or posterior division nerve?
Its an anterior division nerve
Is the femoral nerve an anterior or posterior division nerve?
posterior division nerve
What 2 nerves make up the sciatic nerve?
common peroneal (fibular nerve) and tibial nerve
What lumbar nerves contribute to the femoral and obturator nerves?
What nerves contribute to the sciatic nerve?
L2,L3,L4
L4,L5,S1,S2,S3
Posterior division nerves innervating fetal posterior compartment muscles are (blank)
extensors
Anterior division nerves innervating fetal anterior compartment muscles are (blank)
flexors
Are the tibial (thigh, leg, foot); and obturator (thigh) nerve, anterior or posterior division nerves?
anterior division nerves
Are the femoral (thigh), gluteals (hip), peroneal (fibular) (thigh, leg, foot) anterior or posterior division nerves?
posterior division nerves
The lower limb undergoes (blank) rotation so that the original posterior compartment becomes the adult anterior compartment in the fetus.
What does this mean about nerve division distribution?
180 degree medial
means posterior division nerves innervate anterior compartment and anterior division nerves innervate posterior compartment
The anterior compartment of the legs are considered (blank).
Posterior compartments of the leg are considered (blank)
extensors
flexors
Describe the distribution of the tibia, femoral and obturator nerve during the fetal period. Now describe it at birth, now describe it at 8-11 months.
tibia anterior, obturator lateral, femoral posterior
femoral lateral, obturator medial/anterior, and tibia posterior
femoral anterior, tibia posterior, and obturator medially
(blank) nerves from a plexus innervate muscles by groups or compartments.
terminal nerves
Muscles in a compartment or group share similar (blank)
functions
What innervates the anterior compartment of the thigh?
femoral nerve
What innervates the anterior compartment of the leg?
peroneal nerve
What innervates the posterior compartment of the thigh?
tibial nerve
What innervates the posterior compartment of the leg?
tibial nerve
What nerve contributions allow for hip flexion in the anterior compartment?
L2-3
What nerve contributions allow for knee extension in the anterior compartment?
L3-L4
What nerve contributions allow for ankle dorsiflexion in the anterior compartment?
L4-5
What nerve contributions allow for hip extension in the posterior compartment?
L4-L5
What nerve contributions allow for knee flexion in the posterior compartment?
L5-S1
What nerve contributions allow for ankle planterflexion in the posterior compartment?
S1-2
What nerve contributions allow for plantar foot muscles?
S2-3
How do you remember the innervation to the anterior compartment muscles?
When you kick your leg out in front of you you will be flexing your hip, extending our knee and dorsiflexing your ankle (putting toes toward ceiling) and the innervation starts at L2-3 and goes down by 2. So hip flexion L2-3
Knee extension L3-4
Ankle dorsiflexion L4-5
How do you remember the innervation to the posterior compartment muscles?
When you kick your leg out behind you what will you do. Extend your hip, knee flexion, ankle plantarflexion, plantar foot muscles Start at L4-5 Hip extension L4-5 Knee flexion L5-S1 Ankle plantarflexion S1-2 Plantar foot muscles S2-3
What is dorsi flexion?
take top of foot towards the ceiling
What is plantar flexion?
bottom part of foot towards ground
What is hip extension?
kicking your foot back
The dermatome of the little toe is ?????
S1
The dermatome of the big toe is ????
L4/L5
When you get a herniated disc ( at L5, SI) where will you feel pain?
little toe and big toe :)
The lower limb (extremity) is specialized for what?
locomotion and support for body weight
Since the lower limb extremities is specialized for locomotion and to support body weight, what does this necessitate for joint and muscle structure?
muscles need a good blood supply and must be large
Joints must sacrifice mobility for strength
What are the four segments of the lower limb?
1) pelvic girdle; hip bones and sacrum
2) thigh
3) leg
4) foot
What are the three pelvic girdle ligaments?
sacrotuberous, sacrospinas, sacroiliac
How does the obturator internus course?
attaches to inside of the obturator internus membrane and travels through the lesser sciatic notch and attaches to the intertrochanteric fossa
How does the obturator externus course?
attaches to outside of obturator membrane passes posterior to the femur and attaches to the intertrochanteric fossa
What are these:
ischiofemoral ligament, iliofemoral ligament, pubofemoral ligament
ligaments of the hip joint
What is the linea aspera?
is a ridge of roughened surface on the posterior aspect of the femur, to which are attached muscles and intermuscular septum.
Where are the trochanters?
near the head of the femur
Where are the epicondyle and chondyles located on the femur?
near the end of the femur
Why is a femoral neck fracture especially serious?
due to possibility of blood supply interrpution
Spontaneous regression of blood supply in the femur in children results (blank)
legg calve perthes disease
What are three common femoral fractures?
fracture of femoral neck
intertrochanteric fracture
spiral fracture
Lymphatic drainage of all superficial structures go to the (blank). Where do they go after this?
inguinal nodes.
iliac nodes
Lymphatic drainage of all deep structures go to the (blank).
popiteal node
What are the superficial veins of the leg and thigh?
the greater and lesser saphenous veins
Why do you get varicose veins?
incompetent valves between the superficial and deep vessels
What does the femoral artery and deep femoral artery (profunda femoris) come off of?
external iliac
What arteries supply the head of the femur?
medial and lateral femoral circumflex
Where does the popliteal artery come off of?
comes off of the superificial femoral artery
Where does the posterior tibial artery come off of?
off the popiteal artery
Where does the posterior tibial and anterior tibial artery come off of?
popliteal artery
When does the external iliac become the femoral artery?
as soon as it crosses the inguinal ligament
What are the branches off the profunda femoris?
lateral femoral circumflex
medial femoral circumflex
perforating arteries
Does the deep femoral artery leave the thigh?
no
What muscle does the perforating ateries of the deep femoral artery pierce through to get to the posterior and medial compartments of the thigh?
adductor magnus
How does the femoral artery get from the anterior compartment muscles of the thigh to the posterior compartment muscles?
by passing through the adductor hiatus where the femoral artery then becomes the popiteal artery
What is the tib fib trunk?
it is the point where the posterior tibial artery branches into the fibular artery.
What does the cruciate anastomosis do?
provides collateral circulation around the hip joint
What are all the components of the cruciate anastomosis?
inferior gluteal artery
medial femoral circumflex artery
lateral femoral circumflex artery
1st perforating branch of the deep femoral artery
The cruciate anastomosis is clinically relevant because if there is a blockage between the femoral artery and external iliac artery, blood can reach the popliteal artery by means of the anastomosis. Please describe the rout of blood from the internal iliac to the popiteal.
The route of blood is through the internal iliac, to the inferior gluteal artery, to the first perforating branch of the deep femoral artery, to the lateral circumflex femoral artery, then to its descending branch into the superior lateral genicular artery and thus into the popliteal artery
The fascia lata surrounds the thigh and divides into three compartments which are the….?
anterior, medial and posterior
What is the femoral aponeurosis made from?
transversalis fascia
What do you find in the femoral canal?
only lymphatics
What travels beside the femoral canal?
the femoral artery and vein which are within the femoral sheath
How does the saphenous vein get into the femoral sheath?
it pierces through the femoral aponeurosis into the femoral sheath
Going from medial to lateral, what is the orientation of the femoral sheath?
medial -femoral canal w/ lymphatics
middle- femoral vein
lateral- femoral artery
Where does the femoral nerve lie?
lateral to the femoral sheath
The femoral sheath is made of tranvseralis fascia which blends with the (blank)
fascia of the thigh
So if you have a femoral hernia will it bulge down very far?
no because the fascia lata will prevent this from happening
What are the boundaries of the femoral canal?
inguinal ligament superiorly
lacunar ligament medially
pectineal ligament inferiorly
femoral vein/artery laterally
Where do you get femoral hernias?
pass through femoral canal in protrude in femoral triangle
How is the femoral triangle formed?
by inguinal ligament, sartorius muscles, and adductor longus
What is the roof of the adductor canal?
the sartorious muscle
The femoral vessels will pass (blank) to the adductor longus and then pierce the adductor magnus to enter the adductor canal.
anterior
What do you use the femoral artery for when trying to find info about the heart?
femoral pulse catheterization (aorta and branches, coronary arteries, mesentaric arteries
What do you use the femoral vein for when trying to find info about the heart?
catheterization (IVC, right heart, pulmonary circulation)
What do the psoas and illiacus form and where does this happen?
they combine to form the iliopsoas as they exit the pelvis
Which nerve is found in the medial thigh?
the obturator nerve
Which nerve is found in the anterior thigh?
the femoral nerve
Where does the iliopsoas muscle attach to on the femur?
the lesser trochanter (posterior side of top of femur)
What does the iliopsoas muscle function in?
causes flexor of the hip and unwinds to cause lateral rotation
What nerve innervates the anterior compartment of the thigh?
femoral nerve
What nerve innervates the medial compartment of the thigh?
obturator nerve
What nerve innervates the posterior compartment of the thigh?
sciatic nerve
What is the longest muscle in the body?
the sartorius
What muscle is just medial to the iliopsoas muscle?
pectineus
What are all the muscles of the quadriceps femoris?
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
What are the anterior thigh muscles?
pectineus
sartorius
quadriceps
While the pectineus is innervated by the femoral nerve it is also innervated by the (blank).
obturator nerve
The sartorius inserts posteriorly medially below the knee at the (blank)
pes anserinus (on the tibia)
Sartorious muscle crosses the hip joint anteriorly, therefore what kind of movement does it do?
does flexion of hip joint, lateral rotation and flexes knee
Three out of the four quadricept muscles DO NOT pass the hip joint, which one does?
rectus femoris
What movement does the quadricep allow for?
for extensions at the knee
rectus flexes thigh also
The quadriceps come together and make the platella tendon which goes further down to make the (blank)and attaches to the tibial tuberosity
plateller ligament
Where is the vastus intermedius?
underneath the rectus femoris
(Blank) is really a gluteal muscle by innervation but flexes thigh and is seen in anterior compartment.
tensor fascia lata
Which muscle is lateral and which muscle is medial in the thigh, the sartorius or tensor fascia lata?
the sartorius is medial and the tensor fascia lata is lateral
the iliacis muscle and the psoas muscle are powerful (blank) and are innervated by femoral nerves.
hip flexors
The (blank) assists in flexing, weak abduction and lateral rotation of hip, and flexion of knee
sartorius muscle
What does the tensor fascia lata muscle do and what is it innervated by?
it is a hip abductor
superior gluteal nerve
What does the pectineus muscle do?
it causes hip adduction
hip flexion
What innervates iliacus and psoas muscles?
femoral and obturator
What nerve travels with the femoral artery and vein in the adductor canal and where does it come from?
the saphenous nerve
Is branch off the femoral nerve
How does the femoral nerve, artery, vein and the saphenous nerve travel?
the femoral nerve stays anterior, the saphenous nerve (branch of femoral nerve), femoral artery and femoral vein travel anterior to posterior and innervate the posterior thigh
Does the femoral nerve travel in the femoral sheath?
no it passes lateral to it
Once the femoral artery, vein and saphenous nerve travel through the femoral sheath where do they go?
through teh adductor magnus hiatus into the popliteal fossa (space behind your knee).
What is this:
The narrow space in the middle third of the thigh between the vastus medialis and adductor muscles, converted into a canal by the overlying sartorius muscle.
Adductor canal (subsartorial canal; Hunter’s canal).
Where does the adductor canal extend?
from the apex of the femoral triangle to the adductor hiatus (in the tendon of the adductor magnu)
What does the adductor canal contain?
it contains the femoral vessels and the sephenous nerve
Where does the femoral nerve arise from and what does it supply?
L2-4
supplies anterior thigh an iliopsoas muscle
What is the femoral nerve important for?
thigh flexion and knee extension
What does the saphenous branch do and where does it go?
it gives cutaneous innervation in the leg onto the medial side of the foot
How do I remember the borders of the femoral triangle?
SALI likes triangles
Sartorius
adductor longus
inguinal ligament
HOw does the femoral nerve give cutaneous innervation to the leg and thigh?
The femoral gives cutaneous branches:
lateral femoral cutaneous-> lateral cutaneous of thigh
Anterior cutaneous branch-> anterior cutaneous innervation to thigh
Saphenous nerve-> anterior cutaneous innervation leg
What do the adductor muscles of the medial thigh do?
adducts and medially rotates thigh
What are the adductors of the medial thigh?
What are they innervated by?
Give Me Lots of Berries Please
Gracilis, adductor magnus, adductor long, adductor brevis, pectineus
Obturator nerve
What is the one medial thigh muscle that does not function in adduction or medial rotation? What does this muscle function in?
the obturator externus
lateral rotation
What muscle muscle of the medial muscle group of the thigh is innervated by 2 different nerves?
Which nerves innervate what?
the adductor magnus
It has 2 heads. The high head is the adductor head innervated by obturator. The lower head is the hamstring head innervated by tibial nerve (sciatic nerve)
Sometimes this nerve innervates the adductor compartment if the obturator nerve doesnt feel like it?
pectineus nerve
Where does the obturator nerve split?
around adductor brevis
Where do the superior cluneal nerves come from?
the dorsal rami of L1-L3
Where do the medial cluneal nerves come from?
the dorsal rami of S1-S3
Where do the inferior cluneal nerves come from?
branch off posterior cutaneous nerve of thigh
What are the cutanous nerves of the posterior lateral region of the thigh called?
cluneal nerves
What are the four gluteal muscles?
gluteus maximus
gluteus medius
gluteus minimus
tensor fasciae latea
Where does the gluteus maximus come from and where does it go?
comes from the ilium, sacrum, sacrotuberous ligament and attaches to gluteal tuberosity of the femur and iliotibial tract (on posterior lateral side of femur)
What is a powerful extensor at the hip joint that is required from stopping of the swing phase of walking?
gluteus maximus
What two things, together attach at the greater trochanter of the femur?
gluteus medius and minimus
What are needed for walking and planting your foot so that you can keep your posture when you walk? What happens if you lose these muscle?
gluteus medius and gluteus minimus
tranelenburg gate
What muscle attaches to the IT band?
tensor fasciae latae
Which nerves innervate the gluteus maximus, gluteus minimus, and gluteus medius?
The gluteus maximus is innervated by the inferior gluteal nerve
the superior gluteal nerv goes to minimis and medius
Where does the gluteus medius and minimus attach?
gluteal surface and lines of ala (wing) of ilium; greater trochanter of femur
Where is the iliotibial tract?
the lateral side of the thigh called the IT band
What does this: extends thigh (as in rising from sitting position) assists in lateral rotation
gluteus maximus
What does this:
abduct and medially rotate thigh; keep pelvis level during swing phase
Gluteus medius and minimus
Both the obturator internus and externus do what kind of movement?
lateral rotation
If you reflect the gluteus medius, what will you see?
the gluteus minimus
if you are look at the posterior side of the cadever, can you see any of the gluteus medius?
yes you can see the aponeurosis of the gluteus medius
Using the piriformis as the landmark, are the gluteus medius and minimus above this or below this?
they are above the piriformis
What can happen if the sciatic nerve comes out through the piriformis?
you can get piriformis syndrome due to impingment of the nerve which can present itself as a herniated disc
Collectively, the (blank) muscles function like the deltoid does at the shoulder joint
gluteal
How does the gluteus minimus and medius help in walking?
it prevents the pelvis from falling when the femur is fixed and allows for hip abduction
Which gluteal artery is part of the cruciate anastomosis?
the inferior gluteal artery
What nerve roots make up the sciatic nerve?
L4, L5, S1, S2, S3
Name the most common to least common way that the sciatic nerve passes in relation to the piriformis
under (87%)
branched (through and under) 12%
Branched (over and under) .5-1%
Where should you give an intragluteal injection and why?
upper lateral quadrant so you miss the sciatic nerve (which is medial and inferior on the posterior thigh)
Where do you find the superior gluteal nerve and what does it innervate?
you find it above the piriformis and it innervates the gluteus minimus, gluteus medius and tensor fasciae latae
Where do you find the inferior gluteal nerve and what does it innervate?
below the piriformis and it innervates the gluteus maximus
If you have problems with the (blank) you will get the trenedlenburg sign
superior gluteal nerve
How does the gluteus medius and minimus maintain the stability of the pelvis?
it abducts the hip on the weight bearing side.
Where do you get the blood supply to the gluteus muscles?
superior and inferior gluteal arteries from internal iliac
What are the deep muscles of the gluteal area that function as short lateral rotators (6)?
piriformis gemellus superior obturator internus gemellus inferior obturator externus guadratus femoris (P GO GO Q)
(blank) takes part in the cruciate anastomosis around the head of the femur and may be a contribution to the blood supply to the lower limb in the event of blockage of the femoral.
Inferior gluteal artery
How does the inferior gluteal artery supply the lower limb?
through the descending branch of the lateral femoral circumflex
What innervates the 6 lateral rotator muscles of the gluteal area?
small branches from the lumbosacral plexus (except for obturator externus which is innervated by obturator nerve)
What three muscles attach to the tibial tuberosity anteriorly?
semitendinosis
gracilis
sartorious
What is the least flexible muscle of your body and why?
the hamstring because they work for extension at the hip joint during postural changes and are thus contracted a lot.
can you rotate your knee medially or laterally?
yes you can
What are the 2 places that posterior thigh muscles can arise from?
the ischial tuberosity or the lateral supracondylar line
What are the three places that the posterior thigh muscles can insert into?
1) head of fibula for biceps femoris
2) rough area for semimebranosus below medial condyle of tibia
3) tibia along side the tibial tuberosity anteriorly for semitendinosus muscle
All the posterior thigh muscles will cross two joints except for (blank).
the biceps femoris
What muscles make up the posterior group of the thigh?
Hamstrings muscles:
semitendinosus
long head of biceps femoris
semimembranosus
Other muscles:
short head of biceps femoris (hamstring crossing 1 joint)
adductor magnus (hamstring part, forming the adductor hiatus)
Describe the sciatic nerve
comes out below piriformis muscle and is actually 2 nerves bundled together and may split at various levels
What does the sciatic nerve split into?
the tibial nerve (medial) and the common fibular nerve (lateral)
What does the tibial nerve innervate?
all hamstrings except short head of biceps femoris
What does the common fibular nerve innervate?
short head of the biceps femoris
The only motor innervation to below the knee joint is the (blank)
sciatic nerve (all rest of nerves are cutaneous)
What is the primary blood supply to the hamstrings?
from perforating branches of profunda femoris
What is a common hamstring injury?
avulsion fractures of hip bone (hamstring tendon dissociates from ischial tuberosity)
What is the popliteal fossa?
diamond shaped fossa at posterior aspect of knee
What are the lateral and medial borders of the superior angle of the popliteal fossa?
lateral side: biceps femoris
medial side: semitendinosus and semimembranosus
What are the lateral and medial borders of the inferior angle of the popliteal fossa?
lateral side: gastrocnemius, lateral head
medial side: gastrocnemius, medial head
In the popliteal fossa, describe the orientation of nerve, artery and vein within it
artery, vein, nerve (easy to remember lateral because the nerve gives off common fibular (peroneal) which wraps around the head of the fibula)
What is the superficial contents of the popliteal fossa?
What is the deep contents of the popliteal fossa?
SUP: small saphenous vein
terminal branches of posterior cutaneous nerve of thigh
DEEP: popliteal vessels, tibial nerve and common fibular nerve, genicular arteries, popliteal lymph nodes
What are the genicular arteries?
they anastomose in the knee and bypass the popliteal artery if you flex completely at the knee joint (i,e keep you from becoming ischemic when you flex your knee)
So the femoral artery turns into the popliteal artery as it passes through adductor hiatus in adductor magnus muscle and then this divides into what?
the anterior tibial artery and the posterior tibial artery (tib-fib trunk)
What is the genticuate anastamosis (anastomosis around the knee) made up of?
Inferior medial, and Superior medial Genicular arteries
inferior lateral genicular arteries
and superior lateral genicular arteries,
Descending genicular artery, Descending branch of lateral femoral circumflex artery Anterior tibial recurrent artery
ISMG ISLG DG DBFC ATRA
What does the common fibular nerve divide into?
superficial fibular nerve and deep fibular nerve
Where do you find the tibial nerve and what does it do?
stays in posterior compartment and functional as flexors
Where do you find the fibular nerve
find it anterior and lateral compartments
(blank) are fluid-filled herniations of the synovial membrane of the knee joint”
Popliteal cysts
