anterior and medial thigh Flashcards
what are the two major superficial veins?
great and small saphenous vein
the union of the dorsal vein of the great toe and the dorsal venous arch give rise to?
the great saphenous vein
what does the great saphenous vein empty into?
femoral vein
where does the great saphenous vein run?
superiorly along medial aspect of the leg and thigh and traveling through an opening in fascia lata aptly called saphenous opening
what does the small saphenous vein arise from?
the lateral side of the foot where the dorsal vein of the small toe meets the dorsal venous arch
what does the small saphenous vein empty into?
the popliteal vein
what are perforating veins?
they pierce the deep fascia and always allow blood from superficial to deep only because of the presence of valves
what are risk factors for a DVT?
virchow’s triad (hypercoaguability, stasis, and endothelial injury)
what could a DVT lead to?
pulmonary embolism
where does fascia lata attach?
attaches superiorly to the inguinal ligament, pubic arch, body of pubis and pubic tubercle; laterally and posteriorly to the iliac crest and posteriorly to the sacrum, coccyx, sacrotuberous ligament, and ischial tuberosity
what is the iliotibial tract?
extremely strong, thickened lateral component of the fascia lata
what does the IT band enclose?
muscles and tensor fascia lata and the gluteus maximus
where does the IT band attach distally?
to the tubercle of the lateral condyle of the tibia (Gerdy’s tubercle)
what does the saphenous opening allow for and where is it?
inferior to the medial part of the inguinal ligament, permits the passage of the great saphenous vein
what is crural fascia?
deep fascia of the leg continuous with fascia lata
what is the femoral triangle?
a junction region between the trunk and lower limb
what is the superior boundary of the femoral triangle?
inguinal ligament
what is the medial boundary of the femoral triangle?
adductor longus m
what is the lateral boundary of the femoral triangle?
sartorius m
what is the roof of the femoral triangle?
fascia lata and subcutaneous tissue and skin
what is the floor of the femoral triangle?
iliopsoas and pectineus m
what are the contents of the femoral triangle?
femoral n (and its branches)
femoral sheath (and its contents)
femoral artery (and many of its branches)
femoral vein (and tributaries)
lymph nodes
what is the femoral sheath?
a funnel shaped fascial tube extending about 4cm inferiorly from the inguinal ligament
what is the femoral sheath a continuation of?
transversalis fascia of the abdominal wall and the fascia covering the iliposoas m
what does the femoral sheath allow for?
femoral vessels to glide easily beneath the inguinal ligament during movements of the hip
what are the 3 compartments of the femoral sheath?
the lateral, intermediate, and medial compartment
what occupies the lateral compartment of the femoral sheath?
femoral artery
what occupies the intermediate compartment of the femoral sheath?
femoral vein
what occupies the medial compartment of the femoral sheath?
femoral canal which is normally empty
t/f: the femoral nerve is in the femoral sheath
false it enters the thigh lateral to the sheath not in it
what is the proximal opening to the femoral canal?
the femoral ring
what is the lateral boundary of the femoral ring?
a fascial partition between the femoral canal and femoral vein
what is the posterior boundary of the femoral ring?
the superior ramus of the pubis covered by pectineuis m and its fascia
what is the medial boundary of the femoral ring?
lacunar ligament
what is the anterior boundary of the femoral ring?
medial aspect of the inguinal ligament
what is a hernia?
a protrusion of viscera through a hole
what is a femoral hernia?
a loop of small intestine protrudes through the femoral ring into the femoral canal. it is bounded laterally by the femoral vein and medially by the lacunar ligament. the hernia sac may cause a protrusion in the femoral triangle and may be felt just inferolaterally to the pubic tubercle. it may end up in the superficial layer of the thigh by extending through the saphenous opening. if it strangulates -> ischemia -> infarction -> necrosis
what is the inguinal ligament?
retinaculum formed from the aponeurosis of the external oblique muscle of the anterior abdominal wall. the fibers attaching to the pubic tubercle medially
what is the lacunar ligament?
the fibers that attach to the superior pubic ramus
what is the pectineal ligament?
the fibers most posterior and laterally projecting
what is hip pointer?
a contusion of the iliac crest, usually anterior near the ASIS and origin of the sartorius muscle caused by collisions
what is a charley horse?
tearing of muscular fibers +/- hematoma in the quadriceps muscle causing localized pain
what is the patellar tendon reflex?
myotatic or deep tendon reflex. the tapping of the reflex hammer activates muscle spindles in the quadriceps-> these impulses travel through the femoral nerve (L2-L4) to spina segments L2-L4 and return through motor fibers of the femoral nerve causing muscle contraction.
what is a “pulled groin”
a stretching injury- strain of the adductor muscles and/or tearing of their proximal attachments
what activities lead to a “pulled groin”?
activities requiring quick-starts: baseball, tennis, hockey
what is the adductor canal?
a narrow fascial tunnel coursing about 15 cm ling in the thigh, deep to the middle 1/3 of the sartorius muscle
what does the adductor canal provide a passageway through the musculature for?
the vessels to reach the popliteal fossa (“hunter canal”)
where does the proximal end of the adductor canal begin?
where the sartorius muscle crosses over the adductor longus
what is the distal end of the adductor canal?
adductor hiatus (the opening between the aponeurotic attachment of the adductor part of the adductor magnus and the tendon of the hamstring part)
what enters the adductor canal?
femoral artery and vein, saphenous n and n to vastus medialis m
what completes the entire course of the canal and continue through the hiatus to the popliteal fossa?
the femoral artery and vein
what is the fascial cover providing a partial “roof” for the muscles on the anterior thigh?
anteromedial intermuscular septum aka “vastoadductor membrane”
when does the external iliac artery change name and to what?
as it travels inferiorly, deep to the inguinal ligament and enters the femoral triangle into the femoral artery
what is the name of the large deep branch of the femoral artery?
profunda femoris artery (aka deep artery of the thigh)
what does the profunda femoris artery give off?
the circumflex femoral artery
which compartment only has perforating branches no artery coursing through it?
the posterior
what is cannulation of the femoral artery?
by entering the femoral artery just inferior to the midpoint of the inguinal ligament, a catheter can be inserted and advanced against the direction of arterial flow, ultimately ending up in the left heart- the left ventricle- and coronary artery angiography can be achieved
what is the popliteal artery a continuation of and when does it get its name?
continuation of femoral artery on the posterior aspect of the distal thigh- as the femoral artery crosses the adductor hiatus and emerges posterior to the distal femur, it changes its name to the popliteal artery
what does the popliteal artery divide into?
2 terminal branches, the anterior and posterior tibial arteries
what nerves in the proximal thigh travel from the posterior abdominal wall and send branches to innervate skin?
subcostal, iliohypogastric, and ilioinguinal nerves
where does the genitofemoral nerve run?
pierces the psoas major muscle and descends on the surface of the muscle to the inguinal ligament
where does the lateral femoral cutaneous nerve run?
emerges superolateral to the femoral nerve from deep to the lateral edge of the psoas major and travels far laterally to supply the anterolateral thigh by coursing deep to the most lateral part of the inguinal ligament
where does the obturator nerve run?
reaches the medial thigh by traveling though the obturator foramen
where does the saphenous nerve run?
it is the terminal branch of the femoral nerve and provides cutaneous innervation to the medial leg and the medial aspect of the proximal foot
what is the largest branch of the lumbar plexus that originates within the psoas major muscle?
the femoral nerve
where does the femoral nerve travel?
lateral to the psoas major on the surface of the iliacus muscle, deep to the middle of the inguinal ligament and into the thigh
what does the femoral nerve supply?
the anterior compartment muscles of the thigh and gives several cutaneous branches to the skin on the anterior thigh
what is the furthest reaching terminal branch of the femoral nerve?
saphenous nerve
where does the saphenous nerve travel?
enters the adductor canal but exits medially before completing the canal
what does the saphenous nerve supply?
skin on the medial leg inferiorly past the medial malleolus and onto the medial surface of the foot
