B6.028 Gluteal Region, Posterior Thigh, Anterior Thigh, Femoral Triangle, and Medial Thigh Flashcards
thigh
from hip joint to knee joint
leg
from knee joint down
3 palpable landmarks in gluteal region
posterior superior iliac spine (possible dimple)
greater trochanter of the femur
ischial tuberosity
purpose of gluteal and posterior thigh muscles
act at the hip and knee joints
many powerful anti-gravity muscles
which two portions of the pelvis are aligned anatomically
anterior superior iliac spine
pubic tubercle
(forward facing mickey mouse ears)
which 3 ligaments act as anchors for large gluteal muscles
sacrospinous ligament
sacrotuberous ligament
sacroiliac ligament
deep fascia of the thigh
“fascia lata”
wraps around entire thigh region
lateral aspect thickens to form “iliotibial tract”
continuous with deep fascia of the leg
iliotibial tract
connects the gluteus maximus to the lateral leg (tibia)
4 superficial gluteal muscles
gluteus maximum
gluteus medius
gluteus minimum
tensor fascia latae
major function of gluteus muscles
resist gravity during the gait and posture
largest skeletal muscle
gluteus maximum
can be up to 4 lb
function of iliotibial track
dramatically increases the length of the lever arm used by gluteus maximum
function of bursas in the hip joint
minimize excessive shearing during extreme jumping, walking/running, or climbing
trochanteric bursa
between gluteus maximus and greater trochanter
ischial bursa
between ischial tuberosity and skin when sitting
gluteofemoral bursa
between iliotibial track and vastus lateralis
function of piriformis muscle
does not have an important function
useful anatomical marker that divides superior vs inferior gluteal regions
important vessels/nerves that exit the pelvis above the piriformis
superior gluteal nerve, artery and vein
important vessels/nerves that exit the pelvis below the piriformis
inferior gluteal nerve, artery, and vein
sciatic nerve
major branches of internal iliac artery
superior gluteal
inferior gluteal
what is the sciatic nerve composed of
2 separate nerves: tibial and common fibular
do not exchange fibers
major nerves to the gluteal region
superior gluteal
inferior gluteal
sciatic
posterior femoral cutaneous
result of injuries to superior gluteal nerve
waddling or hip drop gait
pelvis cannot be maintained in a level position
sciatica
irritation and inflammation of sciatic nerve due to chronic pressure
causes of sciatic nerve damage
thick wallets, prolonged sitting on rigid surfaces
unsafe intramuscular injection into inferior gluteal quadrants
how to do an anesthetic block of the sciatic nerve
inject anesthetics a few centimeters inferior to the midpoint of the line joining the posterior superior iliac spine and the superior greater trochanter
3 posterior thigh muscles (hamstrings)
semitendinosus
semimembranosus
biceps femoris
general parameters of hamstring muscles
originate from ischial tuberosity (pelvis)
cross 2 joints - hip and knee - to attach to leg bone
extend the thigh at the hip joint (extend the trunk) and flex the knee, but not both simultaneously
innervated by tibial nerve
short head of biceps femoris is an exception to these
common hamstring injuries
hamstring strain or avulsion of ischial tuberosity
why cant you extend a fully flexed hip and flex a knee at the same time
hamstring tendons are unusually long, but the muscle fiber bundles are too short to accomplish both actions simultaneously (not enough muscle contraction length)
describe the arteries to the posterior thigh
external iliac > femoral > profundal femoris (deep femoral) > medial and lateral circumflex femoral arteries
extensive anastomosis around hip
what is unusual about the blood supply to the posterior thigh
no big, main artery
supplied by tributaries from anterior thigh arteries
anastomoses between internal and external iliac crests
branches of inferior gluteal (internal iliac) join deep femoral branches (external iliac)
arteries that contribute to femoral anastomosis also comprise a potential “bypass” should a blockage occur in the femoral artery
which nerves of the gluteal region are from the posterior rami
superior cluneal
middle cluneal
which nerves of the gluteal region are from the anterior rami
inferior cluneal (posterior femoral cutaneous)
nerves of the sacral plexus
nerves: superior gluteal, inferior gluteal, posterior femoral cutaneous
branches: piriformis, obturator, quadratus femoris
anatomy of great saphenous vein
originates from dorsum of foot passes anterior to the medial malleolus runs behind the medial side of knee joint remains medial on the distal thigh ascends to the saphenous opening dives deep to join the femoral
anatomy of small saphenous vein
originates from lateral foot/sole
passes posterior to lateral malleolus
runs on posterior surface of calf
drains into popliteal vein
what is the saphenous opening
defect in the upper anterior thigh fascia
crural fascia
deep fascia of the leg
where is the femoral nerve
passes behind inguinal ligament at the midpoint
branches of the femoral nerve
muscular: to anterior thigh muscles
branches to hip and knee joints
all terminal branches form within the femoral triangle
saphenous nerve
only femoral nerve branch which travels below the knee joint
serves the skin of the medial leg and foot
femoral cutaneous branches
anterior femoral cutaneous (medial anterior thigh)
saphenous (medial leg and heel)
superficial cutaneous branches of the femoral artery
superficial epigastric
inferior epigastric
superficial circumflex iliac
external pudendal (superficial and deep)
femoral artery tributaries to muscle
deep femoral > medial femoral and lateral femoral circumflex > 3 perforating arteries
blood supply to the head of the femur and hip joint
medial circumflex femoral- posterior retinacular arteries
lateral circumflex femoral-anterior retinacular arteries
these two branches anastomose with inferior gluteal artery and 1st perforating branch of the deep femoral
fracture of the femoral neck
endangers retinacular arteries of the femoral neck
4 bursae at the insertion of the quadriceps femoris
prepatellar (subcutaneous)
suprapatellar (sebtendinous)
subcutaneous infrapatellar
deep infrapatellar
which bursa communicates with the joint cavity
suprapatellar
most common site of quadriceps tendon bursitis
important in infections
how might the psoas muscle be infected
a retroperitoneal pyogenic infection can arise from lung or vertebral column due to TB or enteritis (Crohns), infiltrating the investing fascia of the psoas
pus accumulation in the psoas
pus accumulation in the thoracic portion may infiltrate through muscle into the inguinal region and then into the hip joint synovial space via communicating bursae
differential of edema in the inguinal region
psoas abscess inguinal hernia femoral hernia inguinal lymph node enlargement local dilation of the great saphenous vein
poor or unequal quad function
can cause arthritis or trauma to the knee joint, abnormal patella wear, resulting in loss of knee joint stability and function
chondromalacia patellae
runners knee
deterioration of the patellar articular cartilage due to excessive wear
observed in young and old
can be caused by repeated misaligned quad contractions or by excessive rising from a squatting position under heavy loads
patellar fractures
caused by direct blows such as front end auto collisions
abnormal ossification of the patella
multiple ossification centers
may be bipartite or tripartite
sometimes mistaken as fractures
what is the femoral triangle
triangular compartment inferior to the inguinal ligament in the superficial space
boundaries of the femoral triangle
inguinal ligament
sartorius
adductor longus
contents of femoral triangle
iliopsoas muscle
femoral nerve
femoral sheath (femoral artery, vein, and canal)
roof/anterior wall of the femoral triangle
fascia lata has an opening just below the inguinal ligament called the saphenous opening
saphenous opening/hiatus
size of a quarter
covered by delicate perforated CT layer called the cribriform fascia
what is the femoral canal
cone shaped potential space that extends to the saphenous opening
typically contains fat, loose CT, and lymph nodes
clinical importance of femoral canal
potential passageway for femoral hernia
femoral triangle from lateral to medial
nerve artery vein canal lacunar ligament
clinical considerations for the femoral triangle
palpate femoral artery
compress femoral artery against superior ramus of pubic bone
place catheter into femoral artery for left cardiac angiography
place catheter into femoral vein for right cardiac angiography
femoral venipuncture site for fluid infusion
femoral hernia
more frequent in females deep to inguinal ligament, soft subcutaneous lump never enters scrotum distinct from inguinal hernia can lead to strangulated intestine
obturator artery
provides blood supply to medial adductor muscle group
from internal iliac
anastomose with circumflexes from deep femoral for collateral circulation
anastomoses between internal and external iliac
- inferior gluteal and circumflex femoral arteries
- obturator and deep femoral artery twigs
- internal pudendal and external pudendal
obturator nerve
from L2-L4 exits pelvic cavity at the obturator foramen
splits into 2 branches:
superficial- runs between adductor longus and brevis
deep- runs posterior to adductor brevis
pulled groin
strain and possible tearing of the proximal attachments of the adductor muscle groups
usually occurs in sports requiring quick acceleration from a rest position
cause of pes anserinus bursitis
3 thin, strap like muscles all insert at the upper part of the medial surface of the tibia
due to close proximity of these muscles tendons to the knee joint capsule, there is an intervening bursa to reduce friction during gait
symptoms of pes anserius bursitis
pain and tenderness on the inside of the knee, 5-7 cm below the joint
runners susceptible
common clinical problems affecting gluteal and thigh regions
deep and superficial VT pelvic and hip fractures muscle strain injuries hip, gluteal, and back pain OA and RA of the hip bursitis at gluteal and trochanteric friction points
