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MSK II > Anterior & Medial Thigh > Flashcards

Anterior & Medial Thigh Flashcards

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12
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Osgood-Schlatter Disease (OSD) is a common pediatric knee problem that often affects active/athletic youngsters between the ages of 10 -15

Stress from the powerful quadriceps muscle inflames the not yet fully developed tibial tuberosity

Kids typically complain of pain just below the knee along the top of the shin

OSD is a self-limiting condition that typically last between 1-3 years

Most kids respond well to local therapy (rest, ice, decreased activity)

Occasionally…symptoms are so severe that a cast is applied to limit motion until the tuberosity totally ossifies

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31
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External iliac artery traverses beneath the inguinal ligament and becomes the ____

A

femoral artery

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32
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nFemoral artery passes through the adductor hiatus and becomes the___

A

popliteal artery (behind the knee)

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33
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Popliteal artery gives rise to __ and __

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anterior and posterior tibial arteries

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34
Q

Anterior tibial becomes the _____ in the foot while the posterior tibial gives rise to ____

A

dorsal pedal artery (dorsalis pedis); plantar arteries (medial and lateral)

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35
Q

Deep fascia of the thigh is referred to as the ____

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fascia lata

36
Q

Deep fascia in the leg is referred to as the ____

A

crural fascia

37
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The iliotibial band recieves fascia from

A

fascia lata and also receives aponeurotic contributions from the gluteus maximus muscle and a small muscle called the tensor fascia lata (TFL)

38
Q

TFL is an ____ of the hip (and a flexor of the hip) because it positioned on the anterior/lateral aspect of the hip joint

A

abductor

39
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TFL is innervated by the ____

A

superior gluteal nerve (L4, L5, & S1)

40
Q

Distally, the Iliotibial (IT) band inserts into a tubercle on the lateral condyle of the tibia called ___ and the patellar retinaculum

A

(Gerdy’s tubercle)

41
Q

anterior portion of the lower limb

A

hip flexors & knee extensors

42
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medial portion of the lower limb

A

hip adductors

43
Q

2 major Superficial Veins of the lower limb

A
  1. Great Saphenous Vein
  2. Small Saphenous Vein
44
Q

Small Saphenous pierces the deep fascia behind the knee and enters the ____ (a deep vein)

A

popliteal vein

45
Q

Great Saphenous ascends up the leg and thigh, passes through an opening in the fascia lata (saphenous hiatus) to enter the _____ (deep vein)

A

femoral vein

46
Q

_____ vein is a common choice of

surgeons when performing vascular bypass graft surgery

A

Great Saphenous

47
Q

Superficial nodes eventually drain into the _____

A

deep inguinal nodes

48
Q

Deep inguinal nodes eventually drain into the ____ within the abdomen/pelvis

A

external iliac nodes

49
Q

Many deep inguinal nodes are located beside the femoral vein and within the ___

A

“femoral canal”

50
Q

The anterior thigh muscles can be divided into two groups:

A
  1. Hip Flexors Muscles
  2. Knee Extensors Muscles
51
Q

These anterior thigh muscles are essentially _____ innervated

A

femoral nerve

52
Q

Formed by the merger of two muscles- psoas major and the iliacus

A

Iliopsoas Muscle

53
Q

Iliopsoas muscle is the chief ____ of the hip (thigh)

A

flexor

54
Q

Iliopsoas passes deep to the inguinal ligament then inserts into the ___ of the femur

A

lesser trochanter

55
Q

Fractures of the neck of femur (above the insertion of the iliopsoas muscle) produce a characteristic appearance of the affected limb

A

The fractured extremity presents externally (laterally) rotated and shortened

56
Q

Psoas Abscess

A

Psoas arises from the lateral borders of T12 ~ L4, passes beneath the inguinal ligament, merges with the iliacus muscle…and inserts onto the lesser trochanter

The combined “iliopsoas” is an extraperitoneal (or retoperitoneal) structure which resides in close proximity to numerous organs:

vAppendix

vColon

vSmall bowel

vKidneys/Ureters

vPancreas

Hence, infections in these organs can spread to the iliopsoas muscle

In addition, the muscles rich vascular supply predispose it to hematogenous spread of infection from distant sites

Clinical features: Fever, low back pain, and hip/thigh pain (Psoas Sign…pain on extension of thigh…stretches the muscle)

Risk Factors: Diabetes, IV Drug abuse, AIDS, Immunosuppression

Patients will often prefer to be in a flexed/fetal position to relieve tension on the muscle

Treatment: Surgical drainage and IV antibiotics

57
Q

Extensors of the Knee

A

Quadriceps Femoris

  1. Rectus femoris
  2. Vastus medialis
  3. Vastus lateralis
  4. Vastus intermedius
58
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All 4 parts of the quadriceps femoris insert into the _____ and function in knee extension/flexsion

A

quadriceps tendon/ extension

59
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quadriceps femoris is innervated by

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nInnervated by the femoral nerve (L2, L3 & L4)

60
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vertebrae of femoral nerve

A

nInnervated by the femoral nerve (L2, L3 & L4) quick the garbage out the door

61
Q

the ___ of the quadriceps femoris crosses both the hip and knee joints (hence it is considered a hip flexor and knee extensor) meaning increased risk of tear

A

rectus femoris

62
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___ nerve Passes beneath the inguinal ligament

A

femoral

63
Q

Innervates the quadriceps and the sartorius and pectineus muscles

Gives rise to several anterior femoral cutaneous branches to the anterior thigh region

Terminates as the saphenous nerve (also a cutaneous nerve) which provides sensation along the medial lower leg and foot (longest sensory nerve in the body)

A

femoral nerve

64
Q

Medial Thigh Muscles

A

Adductor longus

Adductor brevis

Adductor magnus

Gracilis

Obturator externus

There are 5 muscles in the medial compartment which collectively adduct the thigh at the hip

65
Q

medial thigh muscles mainly innervated by

A

nAll innervated by the Obturator Nerve (L2,3,4) ..with a couple exceptions

66
Q

Largest and most powerful medial thigh muscle

A

Adductor Magnus

67
Q

adductor magnus Classically described as having 3 parts:

A
  1. Minimus portion (most superior portion)
  2. “Adductor” portion (middle portion)
  3. “Hamstring” portion (attaches to the adductor tubercle of femur)
68
Q

adductor magnus

Adductor and minimus portions are innervated by the ____

Hamstring portion is innervated by the ____

A

obturator nerve; sciatic nerve

69
Q

Both ____ and _____ insert into the pes anserinus on the medial tibial condyle (along with the ____ which we will study tomorrow)

A

gracilis, sartorius, and semitendinosus

70
Q

between the

  1. “Adductor” portion (middle portion)
  2. “Hamstring” portion (attaches to the adductor tubercle of femur)
A

adductor hiatus

71
Q

Pectineus function and innervation

A

can both flex and adduct the hip-hence can be innervated by both femoral and/or obturator

72
Q

Gracilis function

A

long, thin adductor muscle (can be used for muscle grafts)

73
Q

Sartorius function

A

long-thin muscle which abducts, externally rotates and flexes the hip

74
Q

nFour major routes which structures pass from the abdomen/pelvis into or out of the lower limbs:

A
  1. Obturator canal
  2. Beneath the inguinal ligament
  3. Greater sciatic foramen
  4. Lesser sciatic foramen
75
Q

Femoral Triangle
Contents:

A

nFemoral Nerve

nFemoral Artery

nFemoral Vein

76
Q

femoral sheath

A

Encloses the proximal portions of the femoral vessels and the femoral canal

Does NOT enclose femoral nerve

77
Q

nProtects the femoral artery and vein beneath inguinal ligament during hip movements

A

femoral sheath

78
Q

femoral sheath is divided into 3 compartments

A

1.Lateral compartment: Femoral artery

●

2.Intermediate compartment: Femoral vein

●

3.Medial compartment: “Femoral canal” which contains deep lymphatic nodes –> Top of the canal is referred to as the “femoral ring”

79
Q

Femoral Hernia

A

nFemoral hernia is a protrusion of abdominal viscera (loop of bowel) through the femoral ring and into the femoral canal

nInitially the hernia is contained within the femoral canal but with time- can enlarge and pass through the saphenous hiatus into the subcutaneous tissues

nThe mass is generally palpated within the femoral triangle (inferior to the inguinal ligament) (ACC Case Faith Herrington)

nOccasionally- the lacunar ligament can “strangulate” the loop of bowel and interfere with blood supply resulting in death or necrosis of the intestine segment

nMore common in females than males

80
Q

Femoral artery and vein then exit the femoral triangle and enter the ____ deep to the sartorius muscle

A

Adductor Canal

81
Q

n4 structures course through this adductor canal:

A
  1. Femoral artery
  2. Femoral vein
  3. Saphenous nerve (a sensory branch of the femoral nerve)
  4. Nerve to vastus medialis (a motor branch
82
Q

Lateral femoral cutaneous nerve-supplies ____ and ____ thigh region. This nerve can become entrapped or pinched beneath the inguinal ligament…called ____ causing burning pain and/or paresthesia to the outer thigh

A

superior lateral; “Meralgia”

83
Q

Femoral artery and vein course through the ___, ___, and ___ finally entering the popliteal fossa behind the knee

A

femoral triangle, adductor canal, and the adductor hiatus

84
Q

Adductor muscles are ____ innervated

A

obturator nerve (L234)

85
Q

nLarge and powerful quadriceps muscle are ___ innervated

A

femoral nerve innervated (L234)

86
Q

____ common pediatric clinical condition causing knee pain

A

Osgood-Schlatter…

87
Q

NAVEL

A

nNAVEL- nerve, artery, vein, empty space and lacunar ligament are important structures from lateral-to-medial beneath the inguinal ligament:

MSK II (5 decks)

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