Anterior & Medial Thigh Flashcards by Aloki M

The femoral triangle is the major…

Transitional area

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What forms the vascular portion of the thigh?

Femoral sheath

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What is a femoral hernia?

Protrusion of abdominal contents into the femoral canal

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Who is more common to get femoral hernias?

Females

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Where are femoral hernias located?

Inferior to inguinal ligament

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What are the three compartments of the thigh?

Anterior, medial, posterior

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What innervates the anterior compartment of the thigh?

Femoral nerve and anterior rami from the lumbar plexus (L1-4)

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What nerve levels are the femoral nerve

L2-L4

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What is the medial compartment innervated by?

Obturator nerve at levels L2-4

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What is the posterior compartment innervated by?

Sciatic nerve at L5-S2

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What is the function of the anterior compartment of the thigh?

Hip flexion, knee extension

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Key concept to remember

If it crosses the joint, it ACTS on the joint

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What is the primary function of the medial compartment

Adduction @ hip
Closing the legs

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What is the floor of the femoral triangle made of?

Iliacus, pectineus, psoas major

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What is the mnemonic for the contents of the femoral triangle?

NAVL -> femoral nerve, femoral artery, vena cava, lymphatics

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What lymphatic nodes are in the femoral triangle?

Superficial inguinal nodes, deep inguinal node (eloquets node)

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What comes off the femoral vein?

The great saphenous vein

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What vein is used in bypass surgery?

Great saphenous vein

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What is the sublingual hiatus made of?

NAVL

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What is the femoral sheath derived from?

Transversalis and iliac fascia

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What are the spaces in the femoral sheath? What do they enclose?

Lateral -> femoral artery
Intermediate -> femoral vein
Medial -> femoral canal

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What is the most important space of the femoral sheath?

Medial -> femoral canal

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Describe a femoral nerve block

During knee surgery, need to anesthetize the nerve using bony landmarks

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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