Blue Boxes - Anterior & Medial Thigh

Question 1

This is the term for bleeding from ruptured capillaries and infiltration of blood into the muscles, tendons, and other soft tissues.

Answer 1

Contusion

Question 2

This is the term for a contusion of the Iliac Crest (usually where Sartorius M. attaches to ASIS).

Answer 2

Hip pointer

Question 3

This is the term for the cramping of an individual thigh muscle due to ischemia or contusion and rupture of blood vessels (hematoma).

Answer 3

Charley horse

Question 4

What is the most common sight of thigh hematoma?

Answer 4

Quadriceps – Usually Tendon of Rectus Femoris M.

Question 5

The Transversalis Fascia (on internal abdominal wall) combines with the Psoas Fascia to form a fascial covering for the Psoas Major M. going into the thigh. A pyogenic infection (pus forming) can occur in the abdomen and into the fascia forming an _________.

Answer 5

Abscess

***Usually from TB or Crohn’s Disease

Question 6

A psoas abscess should always be considered when edema occurs in the proximal part of the thigh. However, the abscess is often mistaken for…

Answer 6

Indirect or direct hernia
Enlargement of Inguinal LNs
Saphenous varix

Question 7

People with paralysis of the Quadriceps cannot (FLEX/EXTEND) the leg against resistance.

Answer 7

Extend

Question 8

How do people with paralysis of the Quadriceps walk?

Answer 8

With a forward lean and press on the distal thigh as heel hits ground to prevent inadvertent knee flexion

Question 9

This is a common knee injury for marathon runners and presents in softening of the articular cartilage of the patella.

Answer 9

Chondromalacia Patellae (“Runner’s Knee”)

Question 10

Chondromalacia Patellae is often a result of what?

Answer 10

Quadriceps imbalance

Question 11

A direct blow or a sudden contraction of the quadriceps of the patella may fracture it into two or more pieces. This type of fracture is called…

Answer 11

Transverse patellar fractures

Question 12

In a transverse patellar fracture, how are the fragments usually pulled apart?

Answer 12

Proximal fragment pulled superiorly with quadriceps tendon

Distal fragment remains with patellar ligament

Question 13

The patella ossifies during age 3-6, frequently from different ossification centers. They usually coalesce and form a single bone, but can remain separate. How can we examine the patella in a patient and know it’s an ossification abnormality and not a patellar fracture?

Answer 13

By examining diagnostic images bilaterally. Ossification abnormalities are almost always bilateral.

Question 14

In a patellar tendon reflex, if it’s normal what should contract?

Answer 14

Quadriceps

Question 15

The patellar tendon reflex tests what nerves?

Answer 15

Femoral N. (L2-L4)

***Afferent impulses from spindles travel to the L2-L4 spinal segments and an efferent signal is passed to the quads

Question 16

This muscle is a relatively weak adductor, so it is often transplanted with its nerve and blood vessels as a muscle replacement in the hand or for the external anal sphincter.

Answer 16

Gracilis M.

Question 17

What occurs in a groin injury?

Answer 17

Strain, stretching, and probably some tearing of the proximal attachments of the anteromedial thigh muscles

***Usually flexor and adductor thigh muscles

Question 18

Injury to this muscle often occurs in sports that require fast acceleration, deceleration, and changes in direction. It can also occur in horseback riders and produce pain (“Rider’s strain”).

Answer 18

Adductor Longus M.

Question 19

Ossification sometimes occurs in the tendons of the Adductor Longus M. of horseback riders because they are actively adducting their thighs to keep from falling off the horse. The ossified tendons are sometimes wrongly called…

Answer 19

Rider’s bones

Question 20

With a person laying in a supine position, the Femoral pulse can be felt where?

Answer 20

Between the ASIS and the Pubic Symphysis

Question 21

T/F. Cannulation happens just inferiorly to the Inguinal Ligament and a catheter is inserted into the Femoral A. and eventually reaches the aorta to the left ventricle (for left cards angiology).

Answer 21

True

Question 22

What is the sight for compression of the Femoral A. (in cases of laceration)?

Answer 22

Press posteriorly against the Superior Pubic Ramus, Psoas Major M., and Femoral head

Question 23

The Femoral A. is superficial and more susceptible to laceration. It is often lacerated in conjunction with the Femoral V., and in some cases an ________ ________ occurs as a result of communication between the injured vessels.

Answer 23

Arteriovenous shunt

Question 24

If the Femoral A. is ligated, how can the leg still get blood?

Answer 24

Via the Cruciate Anastomosis

Question 25

Why should we never use the term “superficial” for the Femoral A. and V. (as opposed to its “deep” counterpart)?

Answer 25

Because it could be potentially lethal, considering they are not in subcutaneous tissue and actually lie deep. Pulmonary emboli originate in deep veins, and calling the Femoral V. “superficial” could cause an acute thrombosis to be overlooked.

Question 26

This is the term for the localized dilation of the terminal part of the Great Saphenous V. It may cause edema of the femoral triangle and can be confused with a psoas abscess.

Answer 26

Saphenous Varix

Question 27

What is the differing thing between a psoas abscess and saphenous varix that should be considered?

Answer 27

When varicose veins are present in other parts of the lower limb, a varix should be considered!

Question 28

The Femoral V. is not palpable, but can be found how?

Answer 28

By finding the femoral pulse inferior to the Inguinal L., because the A. is directly lateral to the V.

Question 29

At the level of finding the femoral pulse, it’s important to note that the Femoral V. has no tributaries at this level except the Great Saphenous V. When is it important to differentiate between these two veins?

Answer 29

During a varicose vein operation, you want to make sure you don’t tie off the Femoral V. by mistake

Question 30

The cannulation of the Femoral V. is used for (RIGHT/LEFT) cardiac angiology. A catheter is inserted and passes superiorly to the inferior vena cava and into the atrium.

Answer 30

Right

***Remember, left cardiac angiology uses the Femoral A.

Question 31

Describe a femoral hernia and what it’s bound by.

Answer 31

Small intestine pops through the femoral ring and into the femoral canal.

It’s bound by the Femoral V. laterally and the Lacunar Ligament medially

Question 32

Are femoral hernias more common in males or females? Why?

Answer 32

Females because they have a wider pelvis and smaller inguinal canals and rings

Question 33

An enlarged pubic branch of the Inferior Epigastric A. either takes the place of the ________ or it joins it as an accessory in 20 percent of people.

Answer 33

Obturator A.

Question 34

This accessory or replaced Obturator A. could be involved in strangulated femoral hernias due to its position close to or on the femoral ring. What does this lead to?

Answer 34

Small intestine necrosis