Anterior and Medial Thigh SDL Flashcards
What are the muscles of the thigh surrounded by?
Fascia lata
How are the muscles of the thigh divided into anterior, medial and posterior compartments?
The fascia lata forms three intermuscular septa that run deep into the thigh and attach to the linea aspera of the femur
How does the fascia lata respond when the muscles of the thigh contract? What is the purpose of this?
The fascia lata does not stretch to accommodate their outward movement; instead the fascia lata resists the contracting muscles which helps to compress the veins of the thigh and aid venous return.
What is the iliotibial tract?
A thickened band of the fascia lata on the lateral side of the thigh
What muscles insert on the iliotibial tract?
Gluteus maximus and tensor fascia lata (TFL)
Describe the course of iliotibial tract. Where does it insert?
The iliotibial tract runs down the lateral aspect of the thigh, over the lateral part of the knee joint and inserts onto the lateral aspect of the tibia.
What is the function of the iliotibial tract?
It acts to stabilise the hip and knee
What is the main bulk of the anterior thigh formed by? What are the other muscles in the anterior thigh?
- Quadriceps muscles form the bulk
- Sartorius
- Pectineus
- Iliopsoas
What muscles comprise the quadriceps femoris?
- Vastus intermedius
- Vastus lateralis
- Vastus medialis
- Rectus femoris
What innervates the quadriceps muscles?
The femoral nerve (L2-4)
How do the quads insert?
They converge onto a common tendon - the quadriceps tendon - which runs anterior to the knee joint and onto the patella. The patellar ligament then connects the patella to a bony protuberance on the proximal anterior tibia called the tibial tuberosity.
Which quad muscle contributes to flexion of the hip?
Rectus femoris
Where does rectus femoris originate? Where do the vasti originate?
Rectus femoris - AIIS
Vasti - femur
Common action of the quad?
Extension of the knee (but rectus femoris also flexes hip)
How is the knee jerk reflex performed?
To test the knee jerk reflex, the patient sits on a couch with the leg dangling or the knee is flexed with the examiner supporting the weight of the leg with their arm. The examiner palpates for the patella and the tibial tuberosity, finds the halfway point between the two (i.e. the patella ligament) and taps with the tendon hammer.
What does the knee jerk reflex test?
This reflex tests the femoral nerve and the spinal nerves that it contains, i.e. L2, 3 and 4.
What would you expect to see with a normal knee jerk reflex?
Sudden kicking movement of the lower leg in response to a sharp tap on the patellar tendon
What part of the femoral triange does pectineus form?
The medial part of the floor
What part of the femoral triange does iliopsoas form?
The lateral part of the floor
What are the actions of pectineus?
Contributes to both flexion and adduction of the hip joint
What is pectineus innervated by?
Femoral nerve
Origin of pectineus? Insertion?
Origin: the pectineal line of pubis on the superior pubic ramus
Inserts: pectineal line on the femur (just inferior to the lesser trochanter)
What makes sartorius recognisable?
Lies obliquely across the thigh
Does sartorius act strongly on its own?
No - it has several actions, but does not act strongly on its own; generally, it is a muscle that assists others
Innervation of sartorius?
Femoral nerve
Action of sartorius?
At the hip joint, it is a flexor, abductor and lateral rotator. At the knee joint, it is also a flexor.
origin and insertion of sartorius?
ASIS –> superior part of the medial aspect of the tibia
What is the femoral artery a continuation of?
The external iliac artery
What is the major branch that leaves the femoral artery? What does this branch supply? What does this branch give rise to?
- Profunda femoris - the main artery of the thigh
- Gives rise to 3 or 4 perforating branches that supply the posterior compartment of the thigh
The femoral artery continues to course down the anterior thigh. How does it enter the popliteal fossa?
Via the adductor hiatus - a gap in the tendon of adductor magnus
What is the adductor canal?
the passageway through which the femoral artery travels from the apex of the femoral triangle to the adductor hiatus
What are the 2 systems of veins in the lower limb?
Superficial and deep
What do all the veins in the lower limb ultimately drain back towards?
The femoral vein
What does the femoral vein continue proximally as?
The external iliac vein
What vein accompanies profunda femoris? What does this vein drain into?
Profunda femoris vein - drains into the femoral vein
What tributary does the femoral vein receive in the femoral triange?
The great saphenous vein
Where does the great saphenous vein travel from?
The great saphenous vein is a major superficial vein that travels from the medial side of the ankle, all the way up the medial side of the leg and thigh and into the femoral vein
What must the great saphenous vein travel through to reach the femoral vein?
a defect in the fascia lata that overlies the femoral triangle – the saphenous ring
What forms the roof of the femoral triange?
The fascia lata, subcutaneous tissue and skin
What are the boundaries of the femoral triangle?
the inguinal ligament superiorly, the medial border of sartorius laterally and the lateral border of adductor longus medially
Where can the femoral artery be palpated?
Midway between the ASIS and pubic tubercle
What does the superficial location of the femoral vessels mean?
- Easy for clinical access
- Vulnerable to injury
Within the femoral triange, what are the femoral artery and vein enclosed in?
A fascial tunnel called the femoral sheath
What is the femoral sheath subdivided into?
3 compartments; lateral, intermediate and medial
What does the lateral compartment of the femoral sheath contain?
The femoral artery
What does the intermediate compartment of the femoral sheath contain?
Femoral vein
What does the medial compartment of the femoral sheath contain?
The femoral canal and lymphatics
What is the proximal entrance to the femoral canal?
The femoral ring
Why is the femoral ring of clinical significance? What is this condition called?
Femoral hernia
The femoral ring is weak and in some people the gut extends through the femoral ring and into the canal. From here, the gut can potentially extend even further, through the saphenous opening in the fascia lata and into the thigh. The patient presents with a lump in the ‘groin’ which may be painful.
What are the dangers of a femoral hernia?
obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply, so it doesn’t die
Where do the muscles of the medial compartment of the thigh arise from?
arise from the external surface of the pubis and pubic rami
What are the muscles of the medial thigh?
- Adductor longus
- Adductor magnus
- Adductor brevis
- Gracilis
- Obturator externus
- (Pectineus can also adduct the hip)
What is the nerve of the medial compartment?
The obturator nerve (L2-4)
Describe the orientation of msucles of the adductor group?
comprises two superficial muscles - adductor brevis and adductor longus – and a large, deeper muscle called adductor magnus.
Origin and insertion of adductor brevis?
Origin: body and inferior pubic ramus
Inserts: (superior half of the medial lip of) linea aspera
Origin and insertion of adductor longus?
Origin: body of the pubis
Inserts: (middle third of the medial lip of the) linea aspera
Why is adductor magnus different?
Has 2 part: hamstring part and adductor part
Origin and insertion of adductor part of adductor magnus?
Origin: inferior pubic ramus
Inserts: gluteal tuberosity, linea aspera
Action of adductor part of adductor magnus?
Adducts the thigh but also the adductor component also flexes the thigh
Innervation of adductor part of adductor magnus?
Adductor part is innervated by the obturator nerve (L2-L4)
Origin and insertion of hamstring part of adductor magnus
Origin: Ischial tuberosity
Inserts: Adductor tubercle and medial supracondylar line of the femur
Action of hamstring part of adductor magnus
Adducts the thigh with the hamstring portion extending the thigh.
Innervation of hamstring part of adductor magnus?
The hamstring part is innervated by the tibial component of the sciatic nerve (L4-S3)
What travels through the small apertures in the adductor magnus muscle?
Perforating branches of the profunda femoris
Location of obturator externus?
Obturator externus is a deep muscle of the medial compartment
Origin and insertion of obturator externus?
Origin: Margin of the obturator foramen and obturator membrane
Inserts: Posterior aspect of the greater trochanter.
Action of obturator externus?
Adduction and lateral rotation of the thigh.
Location of gracilis?
Gracilis lies most medial in the medial compartment
origin and insertion of gracilis?
Origin: Body of pubis and inferior ramus
Inserts: Superior part of the medial aspect of the tibia
Action of gracilis?
Adduction of the thigh at the hip, and flexion of the leg at the knee.
Diagram of medial compartment
How does gracilis differ from other medial compartment muscles?
Inserts on tibia so can act on knee as well as hip
Which arteries supply the medial compartment?
Obturator artery
What passes through the adductor hiatus?
the femoral vessels
What is the nerve of the medial compartment?
Obturator nerve (L2-L4)
How does the obturator nerve leave the pelvis?
This nerve courses anteriorly along the lateral wall of the pelvis. It runs through a small defect in the obturator internus muscle (the obturator canal), through the obturator foramen and emerges into the medial aspect of the thigh.
What could cause the obturator nerve to become compressed? Where would symptoms be experienced?
The obturator nerve may be compressed against the lateral wall of the pelvis by a pelvic mass. If an ovarian or uterine mass grows large enough to compress and irritate the obturator nerve, symptoms are experienced in the medial thigh.
Course of the obturator nerve
The obturator nerve runs superficial to adductor brevis, sending branches to innervate the muscles. Sensory branches innervate the skin of the medial thigh.
Match the number to the correct muscle 1-9 and 12
- TFL
- Sartorius
- Iliopsoas
- Pectineus
- Rectus femoris
- Adductor longus
- Vastus lateralis
- Adductor magnus
- Gracilis
- Vastus medialis
Muscle 2 originates from which bony landmark?
ASIS
What is the prime action of muscle 3 on the hip?
Flexion
Bony landmark 6 is the:
AIIS
From which bony landmark does muscle 5 originate?
AIIS
Match the muscle to the correct number.
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
Match the numbers to the correct landmark.
- Head of femur
- Trochanteric fossa
- Neck of femur
- Greater trochanter
- Intertrochanteric crest
- Lesser trochanter
- Gluteal tuberosity
What passes through muscle 4?
Perforating arteries from the profunda femoris
What is vessel 4?
Femoral artery
Where does muscle 2 originate?
Greater trochanter and linea aspera
How does muscle 5 differs from the other quadriceps muscles?
Can act upon the hip jiont
Match the landmark to the correct number.
- Gluteal tuberosity
- Pectineal line
- Medial lip of linea aspera
- Lateral lip of linea aspera
Where does muscle 4 originate from?
Vastus medialis - originates from the intertrochanteric line and linea aspera
Where does muscle 6 insert?
Adductor longus - inserts on the linea aspera
What is structure 11?
Common quadriceps tendon
What are the actions of muscle 9?
Hip adduction and knee flexion
Match the number to the correct structure.
- Iliopsoas
- Sartorius
- Pectineus
- Obturator externus
- Adductor brevis
- Adductor magnus
- Gracilis
Label 1-7
- Iliopsoas
- Obturator externus
- Rectus femoris
- Adductor magnus
- Vastus laterlis
- Vastus medialis
- Gracilis
Which muscle inserts upon landmark A?
This is the adductor tubercle - the hamstring part of adductor magnus inserts here
Identify muscle A.
obturator externus
The nerve seen travelling over muscles 4 and 5 is comprised of fibres from spinal nerves:
L2-L4
Identify vein 6.
Great saphenous vein
What is the muscle that inserts on landmark 2?
Pectineus:
- Innervated by the femoral nerve
- Adducts the thigh
- Flexes the thigh
- Originates from the superior pubic ramus
Landmark 2 is the pectineal line
Where does muscle 5 insert?
Proximal 1/3 of linea aspera
The part of adductor magnus that inserts upon landmark A acts as…?
Extensor of the hip and flexer of the knee
Muscle 2 is innervated by which nerve?
Femoral nerve
Structure 3 inserts upon the proximal fibula. Is this true or false?
False - this is the iliotibial tract/TFL
Which one of the anterior thigh structures have an attachment to landmark 2?
Sartorius (and TFL)
Identify muscle 6
Adductor magnus
The nerve in this image travels into the thigh by passing deep to the inguinal ligament.
Is this statement true or false?
False - this is the obturator nerve
Structure A reaches the femoral vein by travelling though the…?
Saphenous ring
On which bony landmark does muscle A insert?
This is the obturator externus - inserts on the trochanteric fossa
The part of adductor magnus that inserts upon landmark A is innervated by which nerve?
Hamstring part - innervated by the tibial nerve
Muscle 3 inserts onto the…?
Lesser trochanter
Which of the muscle originates from bony landmark 6?
Rectus femoris
Location of the saphenous ring?
An oval opening in the upper mid part of the fascia lata of the thigh.
