Anterior/Medial Thigh (lecture) Flashcards
Innervation of the Lower Limb
Cutaneous
Lumbar Plexus: Anterior and Medial Thigh
Upper anterior leg; medial leg
Sacral Plexus: Lower buttocks, posterior thigh and leg, lower anterior leg and foot
Posterior rami of lumbar and sacral nerves: Upper buttocks
Lumbar Plexus Nerve Names and Muscles Innervated
L1-iliohypogastric L1-ilioinguinal L1,2-genitofemoral L2,3-lateral femoral cutaneous L2,3,4-femoral L2,3,4-obturator L4,5-lumbosacral trunk
Iliohypogastric
Lateral cutaneous branch
Spinal component: L1
Distribution to lower limb: lateral gluteal region
ilioinguinal
L1
Upper Medial Thigh
Genitofemoral
Genital branch, femoral branch
L1 and L2
Distribution: upper Medial thigh and upper anterior thigh
Lateral femoral cutaneous
L2 and L3
Distribution: lateral and anterolateral thigh
Obturator Nerve
L2-4
Distribution: Medial thigh, just above the knee
Femoral Nerve
Anterior cutaneous branches and saphenous
L2,L3: anterior and anteromedial thigh
L3,4: Medial side of knee, leg and ankle
Sacral Plexus Components
S1-S4
Some contributions from L4 and L5
Posterior femoral cutaneous
(Inferior cluneal branches and perineal branch)
(Sacral Plexus L4-S4)
S1-S3
Distribution: Lower buttock, posterior thigh
Lower buttock
Uppermedial thigh
Sural Nerve
Sacral Plexus
S1, S2
Dist: Posterior leg
Lateral side and the Dorsum of the foot
Lateral Sural Cutaneous
Sacral Plexus
S1 and S2
Lateral side of the leg
Medial Calcaneal
Sacral plexus
S1 and S2
Heel
Medial Plantar
Sacral Plexus
L4 and L5
Sole of the foot, adjacent sides of first 4 toes
Lateral Plantar
Sacral Plexus
S1 and S2
Dist: lateral sole of the foot, sides of toes 4 and 5
Deep Fibular
Sacral Plexus
L4 and L5
Adjacent sides of the dorsum, toes 1 and 2
Superficial Fibular
Sacral Plexus
L4, L5 and S1
Dist: Anterior lower leg and ankle, the dorsum of the foot, adjacent sides toes 1-4
Superior cluneal
Dorsal rami of lumbar and sacral nerve
L1-L3
Upper buttock
Middle Cluneal
Dorsal rami of lumbar and sacral nerves
S1-3
Medial aspect of the buttock
Lumbosacral Plexus
Motor innervation nerves
L2,3,4: Femoral L2,3,4: obturator L4,5,S1-3: Sciatic L4,5,S1: Superior Gluteal L4,5,S1: Nerve to quadratic femoris L5,S1,2: Inferior gluteal L5,S1,2: Nerve to obturator interns S1,2: Nerve to piriformis
Dermatologist of lower limb
L1-5: Anterior Region
S1-2: Posterior region
S3-5: Coccygeal Region
Venous Drainage of the Lower Limb
Small (lesser, short) Saphenous: Ascends: behind lateral malleolus, runs straight up middle of calf to pierce they deep fascia in the lower popliteal space (terminates here)
Great (long) Saphenous: origin is from the dorsal venous arch of foot, ascents in front of medial malleolus, posterior to medial condyles of tibia and femur, along medial side of thigh to saphenous opening
Varicose Veins
Valves of superficial veins become incompetent
Regions of lower limb
Anterior thigh Medial Thigh Gluteal region Posterior thigh Popliteal Fossa Anterior leg Posterior leg Lateral leg Foot
Fascia Lata
Reinforced lateral by the Iliotibial tract (Band)
IT Band
Compartment Syndrome
Develops when swelling or bleeding occurs within a compartment. Fascia doesn’t stretch, this causes increased pressure on capillaries, nerves and muscles in the compartment
Blood Supply to a joint
Arterial blood supply of a joint is derived from the Periarticular Anastomosis of blood vessels
Nerve Supply to a Joint
Supplied by all the nerves which innervate the muscles producing movement at that joint
Muscle’s Distal Attachment (insertion)
Moveable end of the muscle that attaches to the bone being pulled
Muscle’s Proximal Attachment (Origin)
End of the muscle attached to a fixed (stabilized) bone
Hip Joint
Type: Ball and Socket (enarthrosis)
Movements: circumspection of the lower limb, which is combination of flexion, extension, abduction, and addiction that allows the limb to circumscribe a cone
Articular Surfaces: Acetabulum of the hip bone and head of the femur
Ligaments of the Hip Joint
Acetabular Labrum: depends acetabulum
Transverse acetabular: crosses notch and completes a rim of acetabulum
Round Ligament: Intracapsular; extends from the acetabular notch and transverse acetabular ligament to the fovea of the femur
Iliofemoral: From ASIS to the intertrochanteric line; prevents overextension
Pubofemoral: From the superior pubic ramus, joins the iliofemoral ligament, checks abduction
Ischiofemoral: From ischium behind acetabulum to blend with the capsule, checks medial rotation
Anterior Compartment of the Thigh
Flexor of the hip joint and extensors of the knee
Muscles are innervated by the femoral nerve
Blood supply via femoral artery
Pectineal line of femur
A ridge running down the posterior surface of the shaft of the femur from the lesser trochanter; attachment of the pectineus muscle
Linea Aspera
Aspera is a latin adjective meaning round or uneven. Crest of bone on the posterior shaft in the middle third. Attachment for many muscles
Adductor tubercle
On the superior aspect of the medial condyle; attachment site for the membranous expansion of the adductor magnus muscle
Lesser Trochanter
Smaller projecting protuberance at the medial base of the femoral neck; psoas major, ilacus, upper part of adductor Magnus attach here
Pectineus
Anterior Compartment of the Thigh
Prox: Pubis
Distal: pectineal line of femur
innervation: Femoral nerve, may get twig from obturator
Action: adducts and flexes thigh
Sartorius
Anterior Compartment of the Thigh
prox: ASIS
Distal: medial surface of proximal tibia
Innervation: femoral nerve
Action: Flexes, abducts and laterally rotates the thigh; flexes leg at knee joint
Psoas Major
Anterior Compartment of the Thigh
Prox: T12 and lumbar vertebrae
Distal: Lesser trochanter of femur
Innervation: Anterior Rami of lumbar nerves (1-3)
Action: Flexes thigh
Psoas Minor
Anterior Compartment of the Thigh
Prox: T12/L1 vertebral bodies
Distal: iliopubic eminence
Innervation: anterior rami of lumbar nerves (L1-L2)
Action: Flexes thigh
Iliacus
Anterior Compartment of the Thigh
Prox: iliac crest/fossa
Distal: tendon of the psoas major/lessser trochanter
Innervation: Femoral Nerve
Action: Flexes thigh
Quadriceps Femoris:
Rectus Femoris
(Anterior Compartment of the Thigh)
Prox: AIIS
Distal: Via quads tendon to base of patella; the patellar tendon attaches the patella to the tibial tuberosity
Innervation: femoral nerve
Action: extends leg/flexes thigh
Quad femoris:
Vastus Lateralis
(Anterior Compartment of the Thigh)
Prox: Greater trochanter and linea aspera of femur
Distal: Via quads tendon to base of patella; the patellar tendon attaches the patella to the tibial tuberosity
Innervation: Femoral Nerve
Action: Extend leg
Quad Femoris:
Vastus medialis
(Anterior Compartment of the Thigh)
prox: Intertrochanteric line and linea aspera of femur
Distal: Via quads tendon to base of patella; the patellar tendon attaches the patella to the tibial tuberosity
Innervation: femoral nerve
Action: Extend leg
Quad Femoris:
Vastus Intermedius
(Anterior Compartment of the Thigh)
Prox: shaft of the femur
Distal: Via quads tendon to the base of patella; the patellar tendon attaches the patella to the tibial tuberosity
Innervation: Femoral Nerve
Action: Extend leg
Medial Compartment of the Thigh
Is an adductor compartment
Muscles have their origin on bone around the obturator for amen and insert into the femur
Most muscles innervated by obturator nerve
Blood supply via profound a femoris and obturator arteries
Adductor Longus
Medial Compartment of Thigh
Prox: pubic bone
Distal: linea aspera of the femur
Innervation: obturator nerve
Action: adducts thigh
Adductor Brevis
Medial compartment of Thigh
Prox: Pubic bone
Distal: pectineal line and linea aspera of the femur
Innervation: obturator nerve
Action: adducts thigh
Adductor Magnus
Medial compartment of the thigh
Prox: Adductor part: ischiopubic ramus; Hamstring: ischial tuberosity
Distal: adductor: shaft of femur; Hamstring: adductor tubercle of the femur
Innervation: adductor: obturator nerve; Hamstring: Tibial division of the sciatic nerve
Main actions: adductor: adducts/flexes thigh; Hamstring: adducts/extends thigh
Gracilis
Medial compartment of the thigh
Prox: pubic bone
Distal: medial condyle of tibia
Innervation: obturator nerve
Action: adducts thigh, flexes leg, helps rotate leg medially
Obturator externus (Medial compartment of the thigh)
Prox: margins of obturator foramen and obturator membrane
Distal: posterior side of femur; on and around greater trochanter of the femur
Innervation: obturator nerve
Main action: laterally rotate thigh; steadies head of femur in acetabulum