Anterior and medial thigh Flashcards
Describe the basic topography of the lower extremity, including the boundaries of the buttock, thigh, leg, knee and foot. Describe what bones constitute each region.
• Buttock: pelvis • Thigh: femur • Leg: tibia and fibula • Knee: patella • Foot: tarsal, metatarsal and phalanges
Outline the superficial venous drainage of the thigh. Where does the great saphenous vein drain? Through what opening in the deep fascia does it travel?
· Great saphenous vein: drain into femoral vein at the saphenous opening
· Small saphenous vein: drains into popliteal v
What are saphenous vein grafts? How may they be used clinically?
- The blockages in the coronary artery are not removed but will be bypassed using the saphenous vein from the leg and/or the internal mammary artery from the chest. The saphenous vein is removed from the leg and one end of the saphenous vein graft is sewn to the largest artery in the body (aorta) and the other end is sewn past the obstruction into the coronary artery. The internal mammary artery is freed at one end in the chest and sewn past the obstruction into the coronary artery. Either graft reroutes the flow of oxygen-rich blood to the heart muscle.
. What is a saphenous cutdown? Where is it performed and what vein is targeted? What nerve is at risk for damage in this procedure? If the nerve is damaged, what clinical complaints would the patient
have?
- Venous cutdown is an emergency procedure in which the vein is exposed surgically and then a cannula is inserted into the vein under direct vision. It is used to get vascular access in trauma and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein is most commonly used.
- It is performed on the surface above medial malleolus.
- Saphenous nerve is at risk for damage at this procedure. It is strictly a sensory nerve; it has no motor component. The saphenous innervates the skin over the medial, anteromedial, and posteromedial aspect of the lower leg from knee to ankle. Clinical complaints include pain and numbness of foot
Describe the deep veins of the thigh. What is deep vein thrombosis? How is it characterized
clinically—what symptoms would the patient have?
- Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs.
- Located underneath the deep fascia of the lower limb, accompanying the major arteries. Large deep vein in the thigh. It receives blood from the inner thigh and proceeds superiorly and medially running alongside the profunda femoris artery to join with the femoral vein approximately at the level of the inferior-most portion of the ischial tuberosity.[1]
- Swelling, warmth, erthyma (inflammation), and infection in the affected leg. Rarely, there may be swelling in both legs. Pain in your leg. The pain often starts in your calf and can feel like cramping or a soreness.
What are varicose veins in the lower limb? What is incompetent in this condition? In what direction does the blood flow to create varicose veins?
Superficial veins empty into deep veins through perforating veins that have one-way valves to prevent blood from flow backward.
· Incompetent valves do not allow blood to flow toward heart, causing reverse flow and result in varicose veins.
Fascia lata
Stocking of deep fascia that continues inferiorly to the leg and ankle as the crural fascia
Illiotibial tract
Lateral thickening of the fascia lata between ileum and tibial tuberosity. Anterosuperior part bears a muscle (tensor fascia latae)
What is the saphenous opening (hiatus)? What passes through it?
Oval opening formed by free margin of fascia lata below inguinal ligament
Gr. Saphenous vein passes through the opening to empy into the femoral vein
What is the Femoral triangle? What is it anatomically bounded by?
Inguinal ligmanet
addutor longus m
Sartorius m
What does the femoral triangle contain?
Femoral nerve
Femoral sheath (femoral artery,vein, deep inguinal lymph nodes)
Whats in the lateral compartment of the femoral sheath?
The intermediate compartment?
The medial compartment? (femoral canal, femoral ring)
Where do you palpate the femoral pulse?
In the femoral triangle
Where are the inguinal lymph nodes located?
Which ones are the horizontal and vertical groups?
Which are the upper medial corner?
The anterior compartment of the thigh is compartmentalized by what?
The two things that makes this up are what?
Inwardly extended deep fascia
Medial intermuscular septum
Lateral intermuscal septum
Rectus femoris (RF) m.
Orig:
Ins:
Action:
Vastus intermedius m (Vi)
Origin
ins
action
What are all the muscles in this photo? Also the straight head and reflect head at top
Sartorius m (S)
Orig
Ins
Action
Pectineus m (P)
Orig
Ins
Action
Illiopsoas m are what?
What do they do?
Where do they attach?
What degrees do you get to in the hip flexion test with knee extended?
With knee flexed?
What is the thomas test? What is positive on the test, and what is negative?
The medial compartment of the leg is compartmentalized by what?
What two septum?
What are the muscles of the medial compartment?
Adductor longus m (AL)
origin
ins
action
Origin: Pubis inferior to public crest
Ins: Linea aspera
ActionL Adducts thigh
Adductor brevis m. (AB)
Origin
Ins
Action
Origin: Inferior ramus of pubis
Ins: Linea aspera
Action: adducts thigh
Adductor magnus m. (AM)
Orig
Ins
Action
Orig: Adductor pt: Inferior ramus of pubis Ramus of ischium
Hamstring pt: Ischial tuberosity
Ins: adductor pt: linea aspera
Hamstring pt: adducotor tubercle
Action: adductor pt: adducts and weakly flexes thigh
Hamstring pt: adducts and weakly extends thigh
Gracilis m.
Orign:
ins:
Action
O: inferior ramus of pubis
I: medial part of tibia
Action: adducts thigh and flexes knee
Which of the muscles in the medial compartment is part of the 1st layer?
middle (2nd) layer?
Posterior (3rd) layer
What nerve is this showing? What are the divisions? What muscle is the anterior and posterior going over/under?
What artery supplies the anterior muscles? What does this artery branch to
Femoral artery
Deep a of thigh (profunda femoris a)
What are the branches of the deep a. of thigh?
Femoral artery passes through adductor hiatus into posterior compartment and changes its name to what?
Popliteal artery
Describe the lymphatic drainage of the lower limb, tracing it all the way back to the thoracic duct.
The lower limb has superficial and deep lymphatic vessels. The superficial lymphatic vessels converge on and accompany the saphenous veins and their tributar- ies. The lymphatic vessels accompanying the great saphe- nous vein end in the superficial inguinal lymph nodes (Fig. 5.9B). Most lymph from these nodes passes to the external iliac lymph nodes, located along the external iliac vein, but some lymph may also pass to the deep in- guinal lymph nodes, located on the medial aspect of the femoral vein. The lymphatic vessels accompanying the small saphenous vein enter the popliteal lymph nodes, which surround the popliteal vein in the fat of the popli- teal fossa (Fig. 5.9D). The deep lymphatic vessels of the leg accompany deep veins and enter the popliteal lymph nodes. Most lymph from these nodes ascends through deep lymphatic vessels to the deep inguinal lymph nodes. Lymph from the deep nodes passes to the external iliac lymph nodes.
What is lymphadenopathy? When inguinal nodes are enlarged, what areas should be examined to determine the cause of their enlargement?
Lymph nodes enlarge when diseased. Abra- sions with minor sepsis, caused by pathogenic microorganisms or their toxins in the blood or
other tissues, may produce moderate enlargement of the superficial inguinal lymph nodes (lymphadenopathy) in otherwise healthy people. Because these enlarged nodes are located in subcutaneous tissue, they are usually easy to palpate.
When inguinal lymph nodes are enlarged, their entire field of drainage—the trunk inferior to the umbilicus, including the perineum, as well as the entire lower limb—should be exam- ined to determine the cause of their enlargement. In female patients, the relatively remote possibility of metastasis of can- cer from the uterus should also be considered because some lymphatic drainage from the uterine fundus may flow along lymphatics accompanying the round ligament of the uterus through the inguinal canal to reach the superficial inguinal lymph nodes.
Explain the potential route of psoas abscess
A potential abscess from lumbar region may follow the psoas muscle and drain inferiorly into the distal attachment of the upper anterior and medial thigh. It will present as a swelling and a growing. In such case the movement of this muscle and the others can be significantly restricted.
What branch of the femoral artery supplies blood to muscles in the posterior compartment?
Perforating brs
Femoral artery passes through adductor hiatus into posterior compartment and changes name to ____ artery
Popliteal
