Anterior Thigh & Femoral Triangle Flashcards
Which structure is not encased by the femoral sheet within the femoral triangle? Femoral Nerve Femoral Artery Femoral Vein Lymphatics?
FEMORAL NERVE
What anterior thigh muscle must be retracted to expose the adductor canal and its contents? Adductor magnus Gracilis Rectus femoris Sartorius Vastus intermedius
Sartorius
A serious complication of fractures of the femoral neck is avascular necrosis of the femoral head. This usually results from rupture of which artery?
Acetabular branch of obturator
Deep circumflex iliac
Descending branch of lateral circumflex femoral
Medial circumflex femoral
Second perforating branch of lateral circumflex
Medial Circumflex Femoral
An obturator hernia that compresses the obturator nerve in the obturator canal may affect the function of all of the following muscles EXCEPT: Adductor brevis Adductor longus Gracilis Obturator externus Pectineus
Pectineus
Which of the following is NOT located within the adductor canal? Saphenous nerve Femoral artery Nerve to vastus medialis Femoral vein Deep femoral artery
DEEP FEMORAL ARTERY
The adductor canal contains: the femoral artery, femoral vein, saphenous nerve, and nerve to vastus medialis. Adductor longus and magnus make the posterior boundary of the canal, and vastus medialis is the lateral boundary of the canal. The roof of the canal is formed by sartorius.
Blood flow around an occlusion of the femoral (superficial femoral) artery at the apex of the femoral triangle could be provided by:
Anterior tibial recurrent
Descending branch of the lateral circumflex femoral
Descending genicular
Medial circumflex femoral
Perforating branches of the deep femoral
Descending branch of lateral circumflex femoral
-The descending branch of the lateral circumflex femoral artery anastamoses with both the descending genicular branch of the femoral artery as well as the lateral superior genicular branch of the popliteal artery. These connections provide collateral circulation to the knee and leg. This could help blood flow around an occlusion to the proximal femoral artery. The anterior tibial recurrent artery is an artery that supplies the knee–it is a branch of the anterior tibial artery and it is not an artery that could help blood flow around an obstruction in the femoral artery. The descending genicular artery branches from the femoral artery just superior to the adductor hiatus. If the femoral artery was occluded, this artery would not recieve blood flow.
In the middle third of the thigh, the superficial and deep femoral arteries are separated by: Adductor longus Adductor magnus Gracilis Pectineus Vastus medialis
The correct answer is: Adductor longus
The femoral artery is superficial to adductor longus, while the deep femoral artery is deep to adductor longus. Since adductor longus is the posterior border of the adductor canal, this explains why the femoral artery is considered part of the adductor canal, while the deep femoral artery is not in the adductor canal. The deep femoral artery runs deep to the adductor canal, but immediately superficial to adductor brevis and magnus.
Following surgical opening of the adductor canal, a patient experienced a loss of cutaneous sensation of the medial side of the leg. Which nerve was cut? Ilioinguinal Femoral Obturator Medial sural cutaneous Saphenous
SAPHENOUS
Name the innervations to the following Leg regions:
- Anterior Leg
- Medial Thigh
- Posterior Thigh
- Posterior Leg & Foot
- Anterior Leg
- Lateral Leg
- Femoral Nerve
- Obturator N.
- Sciatic N.
- TIBIAL
Medial Plantar = LAFF (Lumbrical, Abductor Hallucis, Flexor Hallucis Brevis, Flexor Hallucis Longus) - Deep Fibular N. (dorsiflexion)
- Superficial Fibular N. (eversion of foot)
During a routine physical exam, the physician taps a patient’s patellar ligament with a reflex hammer and elicits a knee-jerk reflex. Which of the following nerves mediates this patellar reflex?
A. Common fibular B. Femoral C. Obturator D. Saphenous E. Tibial
B) Femoral N.
QUADRICEPS TENDON –> extends the knee
You are called to see a 35-year-old man who was admitted to hospital earlier that day. He was involved in a road traffic accident and sustained a fracture of his left tibia. He is now complaining of pain, and on examination his leg appears white and cold. You are unable to palpate his foot pulses. He is diagnosed with compartment syndrome affecting the extensor compartment of his leg. Which nerve supplies the extensor compartment of the leg?
a. Deep peroneal nerve (Fibular)
b. Femoral nerve
c. Sciatic nerve
d. Superficial peroneal nerve
e. Sural nerve
A) Deep Peroneal N.
Achilles Tendon is responsible for what reflex? The tibialias Anterior?
- Plantar Flexion (pointing foot)
2. Dorsiflexion
After the Femoral A. travels through the Adductor Hiatus, what is its name change?
POPLITEAL A.
What branch is vital for the cruciate anastomoses to the superior lateral genicular artery in the knee?
Descending Lateral Femoral Circumflex
The popliteal artery divides into what branches at the knee?
Superior Medial & LATERAL Genicular
Inferior Medial & Lateral Genicular
Which artery that travels on top of the interposes membrane becomes the DORSALIS PEDIS after passing the inferior retinaculum?
Anterior Tibial A.
Which artery forms the Plantar (DEEP) Arch? Which formss the dorsal (superficial Arch)?
- Lateral PLantar A.
2. Dorsalis Pedis
Which vein is often used for grafts for HEART BYPASS?
GREAT SAPHENOUS Vein
What are the 3 muscles of the femoral triangle? Which muscles form the FLOOR of the triangle?
- Sartorius (Lateral)
- Adductor Longus (medial)
- Inguinal Ligament (superior)
Iliopsoas & Pectineus
Which artery gives off the Medial & Lateral Femoral Circumflex branches?
DEEP FEMORAL A.
What arteries are in the cruciate anastomoses?
FILM
- Inferior Gluteal
- Medial Femoral Circumflex
- Lateral Femoral CIrcumflex
- First Perforating Branch of Deep Femoral
What is the function of the Iliopsoas Muscle?
Flex the hip!
What nerve supplies cutaneous innervation to the medial thigh?
SAPHENOUS Nerve –> Off of Femoral
Where does the obturator Nerve begin to split?
On top of Adductor Brevis
What are the muscles of Pez Ansirinus (goose’s foot)?
SGT
- Sartorius
- Gracilis
- Semitendinosus
What travel’s through Alcock’s Canal? Though the Obturator Canal?
- Pudendal N & internal Pudendal A.
2. Obterator N + Artery
What provides cutaneous innervation to the femoral Triangle?
Genitofemoral
What provides the cutaneous innervation to the Lateral Aspect of the thigh?
Lateral Femoral Cutaneous
What ventral Rami make up the Sacral Plexus?
L4,L5
S1,2,3
What innervates ILipsoas Muscle?
Iliacus - Femoral N.
Psoas - Ventral Rami L1-4
Pectineus Muscle is innervated by what? Adductor Magnus?
BOTH Obturator & Femoral N.
- Adductor Magnus
OBTERATOR + Sciatic Nerve
What is the function of the QUADRICEPS muscles? What muscles make up the Quadriceps? What innervates them? What is Articulates Genu? Innervated by?
extend knee
- Femoral N.
- Rectus Femoris - FLEX HIP***(only one)
- Vastus Medialis
- Vastus Lateralis
- Vastus Intermedialis
– Innervated by FEMORAL N.
- Articularis Genu =prevent compression/entrapment, raises the synovial membrane during KNEE extension
= FEMORAL N.
What are the muscles of the medial thigh? What is their primary function? What are they innervated by?
- Pectineus - Obterator N + Femoral N.
- Adductor Longus - OBTERATOR Nerve for the rest
- Adductor Brevis
- Adductor Magnus - Obterator N + Sciatic N.(hamstringpart = extend thigh)
- Obterator Externus –> LATERAL ROTATOR
- Gracilis
ALL ARE ADDUCTORS OF THE THIGH, except Obturator Externus which is a Lateral Rotator
Obterator A. is a branch of what?
Internal Iliac (Anterior Division)
What is the function & Innervation of the Following compartments of the leg?
- Anterior
- Lateral
- Posterior
- Anterior - DORSIFLEXION - Deep FIbular N.
- Lateral - EVERSION - Superficial FIbular N.
- Posterior - PLANTAR FLEXION - Tibial Nerve*
What is compartment syndrome?
increased tissue pressure compresses capillaries, leading to loss of blood necrosis of tissue
What are the muscles of the ANTERIOR LEG? What are these muscles innervated by? What are their functions?
- Tibialis Anterior - DORSIFLEX + Invert foot
- Extensor Hallucis Longus - Extends BIG TOE + Dorsiflex foot
- Extensor Digitorum Longus - extends toes (dorsiflex foot)
- Fibularis Peroneus Tertius - DORSIFLEX & EVERT*** foot
ALL INNERVATED BY DEEP FIBULAR N.
- held in place by Superior & Inferior Retinacula
Overuse of which muscle can lead to separation from the periosteum, leading to pain and “shin splints”?
Tibialis Anterior!!!!
What nerve gives cutaneous innervation between the 1st and 2nd toes?
Deep Fibular N.
What are the muscles of the LATERAL LEG? What are their innervations? What are their functions?
- Fibularis Longus - EVERTS FOOT*
- passes under the foot from LAT to MEDIAl and insert onto 1st metarsal - FIbularis Brevis - EVERTS FOOT
- both have weak plantar flexion
INNERVATED BY SUPERFICIAL FIBULAR N. - gives cutaneous innervation to the dorsal of the foot (except between 1st & 2nd toes)
What is the biggest dermatome which travels over the knee? Which dermatomes are on the back of the thigh?
L4!
Thigh = S1,S2
What muscles are innervated by the medial plantar nerves?
Medial Planar: LAFF
Lumbrical (Medial 1)
Abductor Hallucis
Flexor Digitorum Brevis
Flexor Hallicis Brevis
What muscles binds the Adductor Canal? What does it contain?
Adductor canal bounded
- laterally by vastus medialis,
- posteriorly by add. longus & magnus,
- superiorly by Sartorius mm.;
**contains femoral A & V.
Does OBTURATOR EXTERNUS medially or laterally rotate the HIP?
OBTERATOR EXTERNUS
- Outside the obterator foramen to the Greater trochanter
LATERALLY ROTATES**
- Obterator Internus does the same
What are the abductors of the hip? What innervates them?
ABDUCTORS: (Superior Gluteal N.)
Gluteus Medius
Gluteus Minimus
Tensor Fascia Lata
What are the LATERAL ROTATORs of the hip?
- Obterator Externus (Obterator N.)
- Obterator Internus (N. to obterator Internus)
- Gemelli (Superior = Nerve to Obterator Internus, Inferior = Nerve to Quadratus Femoris)
- Piriformis (Nerve to Piriformis, Ventral Rami L5, S1, S2)***
- Quadratus Femoris
- Gluteus Maximus
What are the extensors of the hip?
Extensors:
Hamstrings:
- Semitendinosus
- Semimembranosus
- Long Head of Biceps (all done by Tibial portion of Sciatic N.)
- short head - common peroneal - Adductor Magnus – POSTERIOR part* - Sciatic N.
- Gluteus Maximus – Inferior Gluteal N.
What are the medial rotators of the hip?
MEDIAL ROTATORS:
- Gluteus Medius
- Gluteus Minimus
- Tensor Fascia Lata
- Supplied by SUPERIOR GLUTEAL N.
MEDIAL ROTATORS who also function to ABDUCT*****
What are the adductors of the hip?
ADDUCTORs:
Adductor Longus Adductor Brevis Adductor Magnus Gracilis Pectineus Obturator Externus
What are the boundaries of the poplateal fossa? What are the contents of the fossa, medial to lateral?
- Semimebranosus
- Biceps Femoris
- Medial Head of Gastrocnemius
- Lateral Head of Gastrocnemius
MEDIALLY:
Popliteal Artery (DEEPEST STRUCTURE***), Vein
Tibial Nerve
Common Peroneal Nerve
What is the nerve that can be injured by a car bumper?
Common Peroneal N.
Injury to what nerve can cause foot drop?
Common Peroneal
- Tibialis Anterior Muscle
(Deep Branch more specifically)
What innervates Extensor Digitorum Brevis & Extensor Hallucis Brevis?
Deep Fibular N.
What muscle passes through the lesser sciatic foramen? Gluteus minimus Obturator internus Piriformis Quadratus femoris Superior gemellus
Obterator Internus
As a patient with paralyzed gluteus medius and minimus muscles on the left side attempts to stand on the left limb only, the right side of the pelvis typically: Drops Elevates Rotates laterally Rotates medially Thrusts forward
DROPS
When the femur is fractured, the broken distal end often turns posteriorly to enter the popliteal fossa due to muscle traction. Because of its position deepest in the fossa, which structure is most vulnerable to laceration? Common fibular n. Lesser saphenous v. Popliteal a. Popliteal v. Tibial n.
he correct answer is: Popliteal artery
The popliteal fossa contains the popliteal artery, popliteal vein, common fibular nerve, and tibial nerve. The popliteal artery is the deepest structure in the fossa–it lies on the posterior side of the knee joint. So, it is the structure that would be most likely to be lacerated by the broken distal end of the femur. The popliteal vein lies superficial to the artery, and the tibial nerve lies superficial to the popliteal vein. These three structures are right in the middle of the fossa. The common fibular nerve descends toward the fibular neck, on the lateral side of the popliteal fossa. The lesser saphenous vein drains the superficial posterolateral lower limb. It eventually terminates in the popliteal vein.
Weakness in climbing stairs or jumping would indicate a lesion of which nerve? Tibial Superior gluteal Inferior gluteal Obturator Femoral
Inferior Gluteal
- GLUTEUS MAXIMUS
During surgical repair of a popliteal artery aneurism, ligation of the femoral artery at mid-thigh would not interrupt supply to the hamstring muscles because the
Genicular anastomosis ensures blood supply to the posterior thigh
Cruciate anastomosis ensures blood supply to the posterior thigh
Perforating branches of the deep femoral artery supply the posterior thigh
Obturator artery supplies the posterior thigh
Anterior and posterior femoral circumflex arteries anastomose with the inferior gluteal artery
Perforating Branches of DEEP FEMORAL
The medial thigh muscles rotate the femur medially, counterbalanced by muscles of the \_\_\_\_\_\_\_\_\_\_\_\_\_ thigh, including the \_\_\_\_\_\_\_\_\_\_\_ muscle, which rotates the femur laterally. Lateral; tensor fasciae latae Anterior; rectus femoris Lateral; piriformis Posterior; biceps femoris Posterior; quadriceps femoris
The correct answer is: Lateral; piriformis
A good way to answer this question is to look for a muscle that is a lateral rotator of the thigh and then make sure that the compartment that it is listed with is correct. Piriformis laterally rotates the thigh; it is a member of the lateral compartment which includes other muscles that laterally rotate the thigh, like obturator internus and the superior and inferior gemellus muscles. So, this is the best answer.
Tensor fasciae latae is in the lateral compartment, but it’s a medial rotator of the thigh, so this is not a correct answer. Rectus femoris is one of the quadriceps muscles, found in the anterior compartment of the thigh. This compartment extends the knee and flexes the hip, but these muscles do not rotate the thigh. Biceps femoris is a muscle in the posterior compartment–it’s a hamstring muscle that extends the hip and flexes the knee.
The hamstrings muscles are supplied by branches of which artery? Deep femoral Fibular Obturator Pudendal Superficial femoral
Deep Femoral
Because of its muscle attachments, a fracture to the ischial tuberosity would affect which movement of the lower limb? Abduction of the thigh Dorsiflexion of the foot Extension of the leg Flexion of the leg Flexion of the thigh
FLEXION OF LEG
- would affect hamstring muscles***
(ALL FROM ISCHIAL TUBEROSITY - except short head of biceps femurs –> femur)
In a hunting accident, an arrow pierces the mid-calf of a hunter. A major artery is lacerated in the posterior leg, and you notice that the sole of his foot is cold and pale. The dorsum of the foot is warm and normally colored. The artery that seems to be injured is the: fibular artery posterior tibial artery femoral artery popliteal artery medial plantar artery
The correct answer is: Posterior tibial artery
The popliteal artery divides into two arteries: the posterior tibial artery and anterior tibial artery. The posterior tibial artery supplies the posterior compartment of the leg with blood. It also passes into the sole of the foot, where it branches to form the medial and lateral plantar arteries. So, the injury to the posterior surface of the leg and the lack of perfusion to the foot all point to an injury to the posterior tibial artery.
A patient complains of localized pain in a swollen lower calf and cannot strongly plantar flex his foot. What tendon may have ruptured? calcaneal fibularis tertius flexor digitorum longus flexor hallucis longus tibialis anterior
The correct answer is: calcaneal
Gastrocnemius and soleus insert on the calcaneus via the calcaneal tendon, a tendon of the lower calf which is the thickest and strongest tendon of the body. These muscles are important plantarflexors of the foot, so it is likely that the tendon connected to these muscles has been damaged.
While on vacation in Florida following her final exams, a scuba diving medical student is accidentally speared by her diving partner. The end of the spear passes medial to lateral, posterior to the medial malleolus. It severs an artery there, which is the: anterior tibial dorsalis pedis fibular medial plantar posterior tibial
The correct answer is: Posterior tibial
The posterior tibial artery passes from the posterior compartment of the leg, behind the medial malleolus, before entering the foot. In the foot, it splits to form the medial and lateral plantar arteries. Remember–this is one of the structures that is lined up behind the flexor retinaculum in a very characteristic way. To review, the order here is, from anterior to posterior: tendon of Tibialis posterior, tendon of flexor Digitorum longus, posterior tibial Artery (and vein), tibial Nerve, and tendon of flexor Hallucis longus. So, T, D, A, N, H equals Tom, Dick, ANd Harry.
