anterior and medial thigh Flashcards
Femoral triangle
- provides passage of the femoral nerve, femoral artery, and femoral vein from the abdomen to the thigh
kind of like axilla
Popliteal fossa
- located posterior to the knee provides passage for neurovascular structures between the thigh and the leg
Tarsal tunnel
-provides passage for neurovascular structures and several flexor tendons entering the foot
______ traverses beneath the inguinal ligament and becomes the femoral artery
External iliac artery
Femoral artery passes through the adductor hiatus and becomes the _______
popliteal artery (behind the knee)
Popliteal artery gives rise to
anterior and posterior tibial arteries
Anterior tibial becomes the ________ in the foot while the posterior tibial gives rise to ________
dorsal pedal artery (dorsalis pedis) plantar arteries (medial and lateral)
fascia of the lower limb
superficial and deep
superficial fascia
contains cutaneous nerves, superficial vessels, lymphatics, and variable amounts of fat
deep fascia
(very strong)- invests the lower limb like a sleeve
deep fascia of the thigh
fascia lata
deep fascia in the leg
crural fascia
fascia lata attaches superiorly to
inguinal ligament and iliac crest and sacrum
This fascia lata is extremely thick laterally where it forms the ______
iliotibial tract or band
This iliotibial band also receives aponeurotic contributions from the ______ and a small muscle called the _______
gluteus maximus muscle tensor fascia lata (TFL)
TFL muscle action
abductor of the hip (and a flexor)
innervation of TFL
superior gluteal nerve L4, L5 S1
the fascia lata create 3 intermuscular septum that attach to the posterior aspect of the femur
anterior
medial
posterior
2 major superficial veins of lower limb
great saphenous
small saphenous
superficial veins in the limbs ultimately drain into
deep veins
pierces the deep fascia behind the knee and enters the popliteal vein (a deep vein)
small saphenous
ascends up the leg and thigh, passes through an opening in the fascia lata (saphenous hiatus) to enter the femoral vein (deep vein)
great saphenous vein
Lymphatic vessels in the lower limb eventually drain into the _______ located just inferior to the inguinal ligament
superficial and deep inguinal nodes
receive lymph from superficial tissues (skin and subcutaneous tissues)
superficial inguinal nodes
Deep inguinal nodes also receive lymph from
muscles, tendons and joints within the limb (deeper structures and tissues)
Many deep inguinal nodes are located beside the
femoral vein and within the “femoral canal”
anterior thigh muscles
- Hip Flexors Muscles
- Knee Extensors Muscles
all muscles that pass anterior to the hip joint
hip flexors
anterior thigh muscle innervation
femoral nerve (some exceptions)
iliopsoas muscle
formed by the merger of two muscles- psoas major and theiliacus
chief or primary flexor of the hip (thigh)
iliopsoas
also assits with lateral rotation of the hip[
Iliopsoas passes ____ to the inguinal ligament then inserts into the
deep
lesser trochanter of the femur
a fracture of the neck of the femur (hip fracture) produces this characteristic appearance
externally/laterally rotated and shorted extremity
iliopsoas contracts/spasms and pulls the femur proximal and rotates the thigh and leg laterally
psoas muscle arises from spinal level
T12 - L4
extraperitoneal structure which riesides in close proximity to numerous organs:
iliopsoas
muscle predisposed to infetion
iliopsoas, blood supply, proximity to other organs, etc
Clinical features of psoas abscess
Fever, low back pain, and hip/thigh pain (Psoas Sign…pain on extension of thigh…stretches the muscle)
risk factors for psoas abscess
AIDS, immunocompromised, IV drug use, diabetes
what will the patient look like with a psoas abscess when they present
Patients will often prefer to be in a flexed/fetal position to relieve tension on the muscle
tx of psoas abscess
surgical drainage and IV abx
the great extensor of the leg
quadriceps femoris - actually made of 4 muscles
quadricep muscles
- Rectus femoris
- Vastus medialis
- Vastus lateralis
- Vastus intermedius
sesmoid bone in patellar tendon
patella (knee cap)
Quadriceps tendon continues as the ______ inserts into the tibial tuberosity
patellar tendon (a.k.a. patellar ligament)
innervation of quardiceps femoris
femoral nerve
L2, L3, L4 kicks the garbage out the door
hip flexor and knee extensor
rectus femoris
Formed by the ventral rami of L2, 3 & 4
femoral nerve
kicks the garbage out the door
action of sartorius
abducts, externally rotates and flexes the hip
function of saphenous nerve
provides sensation along the medial lower leg and foot (cutaneous nerve)
longest sensory nerve in the body
saphenous nerve (termination of femoral)
demographic of osgood-schlatter disease
common pediatric knee problem that often affects active/athletic youngsters between the ages of 10 -15
mechanism of Osgood-Schlatter
Stress from the powerful quadriceps muscle inflames the not yet fully developed tibial tuberosity
TX for osgood-schlatter
self limiting and will last 1-3 years, responds well to local therapy (ice, rest); could apply a cast if it is so severe, so the tuberosity totally ossifies
hip flexor muscles
pectineus
psoas major and iliacus
tensor fascia lata
sartorius
knee extensor muscles
rectus femorus
vastus medialis
vastus lateralis
vastus intermedius
anterior thigh muscles are innervated by the
femoral nerve… except for the tensor fascia lata is innervated by the superior gluteal nerve
medial thigh muscles
5 muscles that collectively adduct the hip:
adductor longus
adductor brevis
adductor magnus
gracilis
obturator externus
innervation of medial thigh muscles
obturator nerve L2, L3, L4 (w some exceptions)
largest and most powerful medial thigh muscle
adductor magnus
parts of the adductor magnus
minumus - most superior
adductor - middle portion
hamstring portion - attaches to adductor tubercle of femur
innervation of adductor magnus
minimus and adductor portion = obturator nerve
hamstring portion innervated by sciatic nerve
Between the adductor and hamstring portion of the adductor magnusm, there is a small opening called the adductor hiatus- which secures and protects the passage of the _______ as they enter the popliteal fossa
femoral artery and vein
pectineus
can both flex and adduct the hip…hence can be innervated by both femoral and/or obturator
long, thin adductor muscle (can be used for muscle grafts)
gracilis
sartorius
long, thin muscle which abducts, externally rotates, and flexes the hip
Both gracilis and sartorius insert into the ______ on the medial tibial condyle along with the semitendinosus
pes anserinus
gateways to the lower limb
- obturator canal
- under the inguinal ligament
- greater sciatic foramen
- lesser sciatic foramen
tensor fascia lata innervation
superior gluteal nerve
small cutaneous sensory branch of the obturator nerve
provides sensation to the medial thigh region
Beneath the ______ lies a crescent-shaped “gap” between the hip bone and the inguinal ligament
inguinal ligament
gap beneath inguinal ligament is divided into
two parts split by the iliopectineal arch:
muscular lacuna (lateral)
vascular lacuna (medial)
muscular lacuna
located laterally in the inguinal ligament
- iliopsoas muscle
- femoral nerve
- lateral femoral cutaneous nerve
vascular lacuna
more medial uneder the inguinal ligament
- femoral artery
- femoral vein
- femoral branch of the genitofemoral nerve
- lymphatics
femoral triangle borders
superior border: inguinal ligament
medial border: adductor longus
lateral border: sartorius
contents of femoral triangle
femoral nerve
femoral artery
femoral vein
femoral sheath
goes around artery and vein, not nerve!
protects the femoral artery and vein under the inguinal ligament, from hip movements
femoral canal
contains deep lymphatic structures
node of cloquet
femoral hernia demographic
more common in females than males
top of the femoral canal
femoral ring
lateral compartment of femoral sheath
femoral artery
intermediate compartment of femoral sheath
femoral vein
medial compartment :
femoral canal - contains deep lymphatic nodes
lacunar ligament
next to the femoral canal that houses deep lymph nodes, the lacunar ligament is tense and has a “sharp” edge that could contrict bowel contents if bowel is herniated through femoral sheath of saphenous opening
Femoral hernia
- is a protrusion of abdominal viscera (loop of bowel) through the femoral ring and into the femoral canal
- Initially the hernia is contained within the femoral canal but with time
- can enlarge and pass through the saphenous hiatus into the subcutaneous tissues
occasionaly the ______ can strangulate the loop of bowel and interfere with blood supply resulting in death or necrosis of the intestine segment
lacunar ligament
adductor canal location
middle 1/3rd of the thigh beneath the sartorius muscle
structures in adductor canal
femoral artery
femoral vein
saphenous nerve (sensory breanch of femoral nerve)
nerve to vastus medialis
chief artery to the lower limb
common femoral artery
the ________ arteries arise from the _____ and supply the proximal femur/head
circumflex - medial and lateral
deep femoral artery
perforating branches of the femoral artery
pierce the adductor magnus and help vascularize muscles within the posterior compartment
Lateral femoral cutaneous nerve
supplies superior lateral thigh region.
has numerous small anterior cutaneous branches that innervate skin of the thigh
Femoral nerve
This nerve can become entrapped or pinched beneath the inguinal ligament…called “Meralgia” causing burning pain and/or paresthesia to the outer thigh
lateral femoral cutaneous nerve
