Anatomy Topic 3 Case 9 Flashcards
What is the fascia lata?
- Outer layer of deep fascia in the lower limb
What is the iliotibial tract?
- Thickened longitudinal band of the fascia lata
- Descends along lateral margin of lower limb
- From tuberculum of iliac crest to just below the knee
Where is the saphenous opening located? What passes through it?
- Anterior aspect of thigh
- Just inferior to inguinal ligament
- Great saphenous vein
What is the femoral triangle?
- Wedge shaped depression formed by muscles in the upper thigh
- At the junction between the abdominal wall and the lower limb
What forms the base of the femoral triangle?
- Inguinal ligament
What forms the medial border of the femoral triangle?
- Medial margin of adductor longus muscle
- In medial compartment of the thigh
What forms the lateral border of the femoral triangle?
- Medial margin of sartorius muscle
- In anterior compartment of the thigh
What forms the floor of the femoral triangle?
- Medially by pectineus and adductor longus muscles
- Laterally by iliopsoas muscle
What forms the apex of the femoral triangle?
- Adductor canal
Where is the gluteal region located?
- Posterolateral to bony pelvis and proximal femur
How does the gluteal region communicate with the pelvic cavity and perineum?
- Greater sciatic foramen (pelvic cavity)
- Lesser sciatic formane (perineum)
Outline five muscles in the deep group of the gluteal region
- Piriformis
- Obturator internus
- Gemellus superior
- Gemellus inferior
- Quadratus femoris
Identify the origin, insertion, action and innervation of piriformis
- Origin: Anterior surface of sacrum
- Insertion: Superior border of greater trochanter of femur
- Action: Lateral rotation of extended femur at hip joint
- Innervation: S1 + S2
Identify the origin, insertion, action and innervation of obturator internus
- Origin: Deep surface of obturator membrane
- Insertion: Medial side of greater trochanter of femur
- Action: Lateral rotation of extended femur at hip joint
- Innervation: L5 + S1 (Nerve to Obturator Internus)
Identify the origin, insertion, action and innervation of gemellus superior
- Origin: External surface of ischial spine
- Insertion: Medial side of greater trochanter of femur
- Action: Lateral rotation of extended femur at hip joint
- Innervation: L5 + S1 (Nerve to Obturator internus)
Identify the origin, insertion, action and innervation of gemellus inferior
- Origin: Upper aspect of ischial tuberosity
- Insertion: Medial side of greater trochanter of femur
- Action: L5 + S1 (Nerve to Quadratus femoris)
- Innervation: Lateral rotation of extended femur at hip joint
Identify the origin, insertion, action and innervation of quadratus femoris
- Origin: Lateral aspect of ischium
- Insertion: Quadrate tubercle on intertrochanteric crest
- Action: L5 + S1 (Nerve to Quadratus femoris)
- Innervation: Laterally rotates femur at hip joint
Identify four muscles in the superficial group of the gluteal region
- Gluteus minimus
- Gluteus medius
- Gluteus maximus
- Tensor fascia latae
Identify the origin, insertion, action and innervation of gluteus minimus
- Origin: Between anterior and inferior gluteal lines
- Insertion: Facet on anterolateral surface of greater trochanter
- Action: Abducts femur at hip joint, medial rotation of thigh, prevents pelvic drop on opposite swing side during walking,
- Innervation: Superior gluteal nerve, (L4 + L5)
Identify the origin, insertion, action and innervation of gluteus medius
- Origin: Between anterior and posterior gluteal lines
- Insertion: Facet on lateral surface of greater trochanter
- Action: Abducts femur at hip joint, medial rotation of thigh, prevents pelvic drop on opposite side during walking
- Innervation: Superior gluteal nerve (L4 + L5)
Identify the origin, insertion, action and innervation of gluteus maximus
- Origin: Behind posterior gluteal line
- Insertion: Gluteal tubercle and iliotibial tract
- Action: Extension of femur at hip joint, lateral rotation and abduction of thigh
- Innervation: Inferior gluteal nerve (L5 + S1)
Identify the origin, insertion, action and innervation of tensor fascia latae
- Origin: Lateral aspect of iliac crest between anterior superior iliac spine and tubercle of crest
- Insertion: Iliotibial tract of fascia lata
- Action: Stabilises knee in extension
- Innervation: Superior gluteal nerve (L4+L5)
What is Trendelenburg sign?
- Occurs in people with weak abductor muscles (gluteus minimus and medius)
- Pelvic drop on swing limb when patient stands on one leg
- Typically occurs with damage to superior gluteal nerve associated with fracture lesions and surgery
Outline the course of the inferior gluteal artery
- Originates from anterior trunk of internal iliac artery
- Leaves pelvic cavity through greater sciatic foramen inferior to piriformis
- Descends into posterior thigh where it anastomoses with branches of femoral artery
Outline the course of the superior gluteal artery
- Originates from posterior trunk of internal iliac artery
- Leaves pelvic artery through the greater sciatic foramen superior to piriformis
- Descends into superior and deep branches
- Superficial branch passes onto gluteus maximus
- Deep branches pass onto gluteus medius and minimus
Outline the venous drainage of the gluteal region
- Superior and inferior gluteal veins
- Which follow superior and inferior gluteal arteries
- Join pelvis plexus of vein
Outline the course of the superior gluteal nerve
- Passes above piriformis
- Supples gluteus minimus and medius
- Terminates by innervating tensor fascia lata
Outline the course of the sciatic nerve
- Enters gluteal region through greater sciatic foramen inferior to piriformis
- Descends between superficial and deep muscles, crossing obturator internus and gemellus muscles
- Enters thigh at lower margin of quadratus femoris
Outline the course of the nerve to quadratus femoris
- Enters gluteal region through greater sciatic foramen inferior to piriformis
- Lies anterior to the plane of the deep muscles
- Descends along ischium deep to obturator internus and gemellus muscles
- Ends by penetrating quadratus femoris
Outline the course of the nerve to obturator internus
- Enters gluteal region through greater sciatic foramen inferior to piriformis
- Passes over ischial spine and through lesser sciatic foramen to innervate the obturator internus
Outline the course of the inferior gluteal nerve
- Enters gluteal region through greater sciatic foramen inferior to piriformis
- Passes along posterior surface of sciatic nerve
- Penetrates gluteus maximus
Outline the lymphatic drainage of the gluteal region
- Deep vessels drain into internal iliac nodes
- Superficial vessels drain into superficial inguinal nodes
What is the thigh?
- Region between hip and knee joints
How is the thigh separated from the abdominal wall?
- Inguinal ligament
How is the thigh separated from the gluteal region?
- Gluteal fold superficially
- Gluteus maximus and quadratus femoris on deeper planes
Identify the compartments of the thigh and the function associated with them
- Anterior compartment: muscles that flex and extend leg at knee joint
- Posterior compartment: muscles that extend the thigh at the hip joint
- Medial compartment: muscles that adduct the thigh at the hip joint
Identify 7 muscles in the anterior compartment of the thigh
- Psoas major
- Iliacus
- Vastus medialis
- Vastus intermedius
- Vastus lateralis
- Rectus femoris
- Sartorius
Identify the origin, insertion, action and innervation of psoas major
- Origin: Posterior abdominal wall
- Insertion: Lesser trochanter of femur
- Action: Flexion of thigh at hip joint
- Innervation: Anterior rami of L1 + L2
Identify the origin, insertion, action and innervation of iliacus
- Origin: Posterior abdominal wall
- Insertion: Lesser trochanter of femur
- Action: Flexion of thigh at hip joint
- Innervation: Femoral nerve (L2+L3)
Identify the origin, insertion, action and innervation of vastus medius
- Origin: Medial part of intertrochanteric line
- Insertion: Quadriceps femoris tendon, medial border of patella
- Action: Extension of leg at knee joint
- Innervation: Femoral nerve (L3+L4)
Identify the origin, insertion, action and innervation of vastus intermedius
- Origin: Upper two thirds of anterior and lateral surfaces of femur
- Insertion: Lateral condyle of tibia
- Action: Extension of leg at knee joint
- Innervation: Femoral nerve (L3+L4)
Identify the origin, insertion, action and innervation of vastus lateralis
- Origin: Lateral part of intertrochanteric line
- Insertion: Quadriceps femoris tendon, lateral part of patella
- Action: Extension of leg at knee joint
- Innervation: Femoral nerve (L3+L4)
Identify the origin, insertion, action and innervation of rectus femoris
- Origin: Anterior inferior iliac spine
- Insertion: Quadriceps femoris tendon
- Action: Flexion of thigh at hip joint, extension of leg at knee joint
- Innervation: Femoral nerve (L3+L4)
Identify the origin, insertion, action and innervation of sartorius
- Origin: Anterior superior iliac spine
- Insertion: Inferomedial to tibial tuberosity
- Action: Flexion of thigh at hip joint, flexion of leg at knee joint
- Innervation: Femoral nerve (L2, L3)
Identify six muscles in the medial compartment of the thigh
- Gracils
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Obturator externus
Identify the origin, insertion, action and innervation of gracilis
- Origin: Body of pubis, ischiopubic ramus
- Insertion: Medial surface of proximal shaft of tibia
- Action: Obturator nerve
- Innervation: Adduction of thigh at hip joint, flexion of leg at knee joint
Identify the origin, insertion, action and innervation of pectineus
- Origin: Pectineal line
- Insertion: Oblique line from lesser trochanter to linea aspera on posterior surface of proximal femur
- Action: Femoral nerve
- Innervation: Adduction of thigh at hip joint, flexion of leg at knee joint
Identify the origin, insertion, action and innervation of adductor longus
- Origin: Body of pubis
- Insertion: Linea aspera on middle third of femur
- Action: Obturator nerve
- Innervation: Adduction and medial rotation of thigh at hip joint
Identify the origin, insertion, action and innervation of adductor brevis
- Origin: Body of pubis and inferior pubic ramus
- Insertion: Linea aspera on proximal third of femur
- Action: Adduction and medial rotation of thigh at hip joint
- Innervation: Obturator nerve
Identify the origin, insertion, action and innervation of adductor magnus
- Origin: Ischiopubic ramus
- Insertion: Linea aspera and medial supracondylar line
- Action: Adduction and medial rotation of thigh at hip joint
- Innervation: Obturator nerve anteriorly and sciatic nerve posteriorly
Identify the origin, insertion, action and innervation of obturator externus
- Origin: External surface of obturator membrane
- Insertion: Trochanteric fossa
- Action: Laterally rotates thigh at hip joint
- Innervation: Obturator nerve
Identify three muscles in the posterior compartment of the thigh
- Biceps femoris
- Semitendinosus
- Semimembranosus
Identify the origin, insertion, action and innervation of biceps femoris
- Origin: Long head from ischial tuberosity, short head from linea aspera
- Insertion: Head of fibula
- Action: Flexion of leg at knee joint, extension and lateral rotation of thigh at hip joint, lateral rotation of leg at knee joint
- Innervation: Sciatic nerve
Identify the origin, insertion, action and innervation of semitendinosus
- Origin: Ischial tuberosity
- Insertion: Proximal surface of tibia
- Function: Flexion of leg at knee joint, extension and lateral rotation of thigh at hip joint, lateral rotation of leg at knee joint
- Innervation: Sciatic nerve
Identify the origin, insertion, action and innervation of semimembranosus
- Origin: Ischial tuberosity
- Insertion: Medial tibial condyle
- Action: Flexion of leg at knee joint, extension and lateral rotation of thigh at hip joint, lateral rotation of leg at knee joint
- Innervation: Sciatic nerve
Outline the course of the femoral artery
- Continuation of external iliac artery
- Passes under inguinal ligament to enter femoral triangle
- Passes down thigh in adductor canal and through adductor hiatus
- Becomes popliteal artery behind the knee
What is the largest branch of the femoral artery? What does it give off?
- Profunda femoris
- Medial and lateral circumflex femoral and perforating branches
Outline the course of the obturator artery
- Branch of internal iliac artery
- Enters medial compartment through obturator canal
- Gives off anterior and posterior branches
- Which anastomose with inferior gluteal and medial circumflex femoral arteries
Outline the course of the femoral nerve
- Originates from lumbar plexus (L2-L4)
- Enters femoral triangle by passing under inguinal ligament
- Lies lateral to femoral nerve
- Divides into anterior and posterior branches
Identify a branch of the femoral nerve and what it supplies
- Saphenous nerve, skin on medial side of leg and foot
Outline the course of the obturator nerve
- Originates from lumbar plexus (S2-S4)
- Descends in psoas muscle
- Continues along lateral pelvic wall and passes through obturator canal
- Enters medial compartment of thigh
- Divides into anterior and posterior branches
What does the posterior branch of the obturator nerve supply?
- Obturator externus
- Adductor brevis
- Adductor magnus
What does the anterior branch of the obturator nerve supply?
- Adductor longus
- Gracilis
- Adductor brevis
- Pectineus
Outline the course of the sciatic nerve
- Originates from lumbosacral plexus (L4-S3)
- Enters gluteal region through greater sciatic foramen inferior to piriformis
- Descends between superficial and deep muscles, crossing obturator internus and gemellus muscles
- Enters posterior compartment of thigh
- Divides into tibial and common fibular nerves which supply muscles of the leg
Outline the histological features of skeletal muscle
- Muscle fibres are bundled together into fascicles
- Mass investing muscle fibres is known as endomysium
- Each fascicle is surrounded by loose collagenous tissue known as perimysium
- Fascicles are bundled together
- Mass investing the fascicles is known as epimysium
Identify the histological features of muscle spindles
- Consists of intrafusal fibres
- Nuclear bag intrafusal fibres are dilated, nuclear chain intrafusal fibres are not dilated
- Annulospiral endings wrap around central area
- Flower spray endings are located on either side of annulospiral endings
The sensitivity of muscle spindles is modulated by what type of neurone?
- Gamma motor neurone
Which region of the brain controls facilitation or inhibition of impulses to the muscle spindles?
- Reticular formation of brainstem
What is Pes Anserinus?
- Conjoined tendons of three muscles
- That insert into the proximal surface of the tibia
- Gracilis, semitendinosus, sartorius
Which nerves pass medial and lateral to the psoas major tendon?
- Medial: Obturator nerve
- Lateral: Femoral nerve
