Anterior & Medial Thigh Flashcards
The femoral triangle is the major…
Transitional area
What forms the vascular portion of the thigh?
Femoral sheath
What is a femoral hernia?
Protrusion of abdominal contents into the femoral canal
Who is more common to get femoral hernias?
Females
Where are femoral hernias located?
Inferior to inguinal ligament
What are the three compartments of the thigh?
Anterior, medial, posterior
What innervates the anterior compartment of the thigh?
Femoral nerve and anterior rami from the lumbar plexus (L1-4)
What nerve levels are the femoral nerve
L2-L4
What is the medial compartment innervated by?
Obturator nerve at levels L2-4
What is the posterior compartment innervated by?
Sciatic nerve at L5-S2
What is the function of the anterior compartment of the thigh?
Hip flexion, knee extension
Key concept to remember
If it crosses the joint, it ACTS on the joint
What is the primary function of the medial compartment
Adduction @ hip
Closing the legs
What is the floor of the femoral triangle made of?
Iliacus, pectineus, psoas major
What is the mnemonic for the contents of the femoral triangle?
NAVL -> femoral nerve, femoral artery, vena cava, lymphatics
What lymphatic nodes are in the femoral triangle?
Superficial inguinal nodes, deep inguinal node (eloquets node)
What comes off the femoral vein?
The great saphenous vein
What vein is used in bypass surgery?
Great saphenous vein
What is the sublingual hiatus made of?
NAVL
What is the femoral sheath derived from?
Transversalis and iliac fascia
What are the spaces in the femoral sheath? What do they enclose?
Lateral -> femoral artery
Intermediate -> femoral vein
Medial -> femoral canal
What is the most important space of the femoral sheath?
Medial -> femoral canal
Describe a femoral nerve block
During knee surgery, need to anesthetize the nerve using bony landmarks
What is most at risk during a femoral nerve block?
Femoral artery
Describe a femoral angiogram
Can see both the celiac and coronary arteries
What is most at risk during an angiography?
Nerve + vein
What is most at risk during cannulation of the femoral vein?
Femoral artery
What does a femoral hernia go through?
The femoral ring
Where can a femoral hernia emerge from?
Saphenous opening and ascend superficial to the inguinal ligament
What can a femoral hernia look like?
Inguinal hernia
What can a femoral hernia be strangulated by?
Pectineal ligament, lacunar ligament, or the saphenous opening
What are we most concerned a femoral hernia will be strangulated by?
Lacunar ligament
What is included inside a femoral hernia? Layer by layer?
Loops of intestine covered by skin, superficial fascia, femoral sheath (canal inside), and visceral peritoneum
What do the hamstrings transmit?
Adductor hiatus
What is the femoral artery a direct continuation of?
External iliac
What is the adductor hiatus’s main purpose?
Gateway for the femoral vessels to the popliteal fossa
What is the name change when we enter the popliteal fossa?
Popliteal vessels
Iliopsoas innervation, function, attachment
Innervation: femoral nerve
Action: Flexes hip joint, laterally rotates
Attachment: lesser trochanter of femur
What is a psoas abscess?
Occurence due to tuberculosis reaching the bone -> gets into psoas muscle by creeping into the investing fascia
Mass is groin (abscess) -> filled with pus, with high WBC and fever, lateral to femoral triangle
Muscles of the anterior compartment
Sartorius and quadriceps femoris
Function and innervation of anterior compartment
Function: flexes thigh, flexes hip (rectus femoris + sartorius), extends the knee
Innervation: femoral nerve
What four components make up quadriceps femoris?
Rectus femoris, vastus lateralis, vastus intermedius, vastus medialias
What portion of the quadriceps are clinically important?
Vastus medialis
Vastus medialias clinical significance
Atrophy of knee disease -> first portion to give through
When weak, may result in improper tracking of the patella = patellofemoral syndrome or patellar dislocation
Femoral nerve -> important notes
Lots of branches
Muscular branches
Femoral nerve goes all the way down
Innervates skin in compartments -> cutaneous nerve
What are the muscles of the medial compartment of the thigh?
Obturator externes, pectineus, adductor longus, adductor brevis, adductor magnus (obturator and hamstring part), adductor minimus, gracilis
Which muscle is the exception of the medial compartment? Why is it an exception?
Pectineus -> innervated by FEMORAL nerve
What are the muscles of the medial compartment innervated by? What are the functions?
Obturator nerve, adductors
What is the major arterial support of anterior & medial thigh?
Femoral artery
What are the branches of the femoral artery?
Superficial circumflex iliac, superficial external pudendal, deep external pudendal, muscular, deep (profunda) femoral, descending genicular
What is the most clinicially related branch of the femoral artery? Why is it important?
Branch of deep (profunda) femoral artery -> MEDIAL FEMORAL CIRCUMFLEX
Medial femoral circumflex -> main blood supply at the femoral head
What are the boundaries of the femoral triangle?
Inguinal ligament, sartorius and adductor longus
What is the structure immediately lateral to femoral sheath?
Femoral nerve
What is the structure immediately medial to the femoral artery in femoral sheath?
Femoral vein
What are contents of the femoral canal?
Deep inguinal lymph nodes
What is the medial boundary of femoral ring?
Lacunar ligament
What is the chief flexor of the hip?
Iliopsoas
What artery goes to head of femur?
Medial femoral circumflex
