Chapter Five: The Lower Limb The Thigh Flashcards
1
Q
the shaft and distal femur
A
- the head of the femur is joined to the shaft via the neck
- the shaft of the femur is round
- running down its posterior surface is a straight double line called the linea aspera
- at the proximal end the two parts of the linea aspera diverge
- medial line runs to lesser trochanter
- lateral line goes to the gluteal tuberosity
2
Q
popliteal surface
A
- inferiorly the lines diverge leaving a smooth space behind the knee
- space is the popliteal surface
3
Q
lateral epicondyle and medial epicondyle
A
- lateral line (or lip) runs down to the lateral epicondyle
- medial one goes to the medial epicondyle
4
Q
distal femur
A
- characterized by two large, almost identical articular condyles, one medial one lateral
- large and round when viewed from the side
- more prominent posteriorly and separated by the intercondylar notch
- anteriorly the patellar surface rises up from between the condyles
- proximal to the condyles at the sides are two epicondyles
- the medial epicondyle has a prominent feature proximally which is the adductor tubercle
5
Q
the proximal tibia
A
- the proximal tibia has two flat condyles which articulate with the femoral condyles
6
Q
prominent intercondylar emminence
A
- found between the two flat condyles that articulate with the femoral condyles
7
Q
the proximal fibula
A
- the proximal fibula does not articulate with the femur
- femur has a proximal head and neck
- head nestles under the lateral tibial condyle to form the proximal tibiofubular joint
8
Q
tibial tuberosity
A
- roughened area just below and in front of the condyles
9
Q
gerdys tubercle
A
- located below the lateral tibial condyle
- tubercle for the insertion of the iliotibial band
10
Q
compartments of the thigh: fascia lata
A
- deep to the fascia of the thigh is the fascia lata
- fascia lata is thickened laterally to form the iliotibial band
11
Q
the anterior compartment
A
- contains extensors of the knee
- innervated by the femoral nerve
- contains one single muscle called quadriceps femoris
- includes vastus medialis, vastis lateralis, vastus intermedius and rectus femoris
12
Q
sartorius
A
- individual muscle
- longest muscle in the body, a two-joint muscle
- flexes the hip and the knee joint
- narrow muscle originating on the anterior superior iliac spine and passes down and medially across the compartment remaining superficial
- goes behind the knee joint and flexes it
- inserts on the anterior tibia, below the medial tibial condyle
- femoral nerve S2,S3,S4
13
Q
quadricep group
A
- all quadriceps femorus muscles insert onto the patella
- the patella is the largest of the sesamoid bones
- connected in turn to the tibia (at the tibial tuberosity) by the patellar tendon (ligamentum patellae)
- any muscle pulling on the patella extends the knee
14
Q
rectus femoris
A
- the rectus femoris is a straight muscle of the thigh
- originates on the anterior inferior iliac spine
- most superficial of the group and runs straight down to insert on the superior border of the patella
- flexes the hip and extends the knee (kicking motion)
15
Q
vastus medialis and lateralis
A
- three vasti originate on the femur and insert on the patella
- they function to extend the knee
- both originate from their own sides of the linea aspera and wrap around the femur and insert onto the patella
- vastus medialis inserts more distally and horizontally than its opposite muscle
- this pulls the patella medially to keep it infront of the knee joint
16
Q
vastus intermedius
A
- takes origin from the shaft of the femur and inserts behind the rectus femoris onto the superior border of the patella
17
Q
iliopsoas muscle
A
- originates in the back and pelvis
- inserts on the lesser trochanter
- the PSOAS comes from the transverse processes of the lumbar vertebrae
- the iliacus originates from the blade of the ilium
- they come together across the front of the pelvis and their thick tendon passes in front of the hip joint before insertion
- the iliopsoas functions to flex and laterally rotate the hip joint
- the muscle is innervated by several branches from the lumbar plexus
18
Q
The femoral triangle
A
- region at the top of the anterior compartment
- innervated triangle with an inguinal ligament
- ligament runs between the ASIS and sartorius
19
Q
Femoral artery, vein and nerves
A
- passes through the triangle from the base to the apex
- nerve is on the lateral side of triangle
- vein is on the medial side of the triangle
- artery and vein run underneath the sartorius on their way to the knee
20
Q
The femoral sheath
A
- sheath is a three compartment sac protruding into the top of the thigh, underneath the inguinal ligament from the abdominal cavity
- artery runs in the lateral compartment
- veins run in the middle compartment
21
Q
Femoral canal
A
- medial compartment contains fat and lymph nodes
22
Q
Blood supply and innervation of the anterior compartment
A
- femoral artery is the continuation of the external iliac artery as it passes under the inguinal ligament
- runs through the femoral sheath, down the triangle, then into the subsartorial cabal and passes through the adductor hiatus to end up behind the knee
23
Q
Femoral artery branches
A
- 3 main branches
- all arise in the femoral triangle
24
Q
medial femoral circumflex artery
A
- contributes to the upper back of the thigh and the hip joint
25
lateral femoral circumflex artery
- supplies the quadriceps and the hip joint
26
profunda femoris artery
- the largest branch
- runs deep and parallel to the femoral artery
- sends branches to the posterior compartment
- the femoral vein has the exact same fate and nomenclature
27
femoral nerve
- enters the thigh, underneath the inguinal ligament but lateral to the femoral sheath
- runs a couple cm before breaking into many branches
- supplies all of the anterior compartment muscles as well as the medial compartment
- supplies the skin on the inside of the leg
28
medial/adductor compartment
- this compartment contains the adductors of the hip (thigh)
- innervated by the obturator nerve
29
muscles of the medial compartment
- the muscles all originate from the pubis and most of them insert on the medial lip of the linea aspera
- the muscles are arranged into two layers from anterior to posterior
30
anterior layer: gracilis
- long slender muscle originating from the pubis and inserting on the upper tibia in company with the sartorius
- this forms the medial border of the thigh
- adducts and flexes and medially rotates the hip
- weak flexor of the knee
31
anterior layer: pectineus
- uppermost of the three insertions on the linea aspera
- dual innervation, served by both the femoral and obturator nerves
32
anterior layer: adductor longus
- inserts belwo the pectineus on the linea aspera
33
posterior layer: adductor brevis
- inserts behind the pectinous
- the adductor magnus is deep to it
34
posterior layer: adductor magnus
- has a space inferiorly called the adductor hiatus (through which the femoral vessels pass)
- deep to the adductor brevis
35
posterior layer: hamstring
- below the adductor hiatus
- part of the adductor magnus
- inserts into the adductor tubercle
36
posterior layer: adductor tubercle
- on the medial epicondyle
- innervated by the tibial division on the sciatic nerve
37
blood and nerve supply to the adductor compartment: obturator artery
- obturator artery is a branch of the internal iliac artery, that passes through the obturator canal and enters the compartment
- splits into several branches which supply the muscles
38
blood and nerve supply to the adductor compartment: obturator nerve
- passes into the compartment in concert with the vessels
- immediately splits into an anterior and posterior branch
39
blood and nerve supply to the adductor compartment: anterior branch
- supplies the adductor longus, adductor brevis, gracilis, pectineus and the hip joint
40
blood and nerve supply to the adductor compartment: posterior branch
- serves adductor magnus, obturator externus and the knee joint
41
posterior compartment: muscles of the medial compartment
- hamstring compartment
- hamstrings arise from the ischial tuberosity
- crosses the hip and knee joints
- extends hip and flexes knee
- innervated by the tibial division of the sciatic nerve
42
posterior compartment: biceps femoris
- three true hamstrings with four heads
- two headed muscle is the biceps femoris
- it is a long head and is a true hamstring
- runs from the ischial tuberosity
- inserts on the head of the fibula
- joined by the short head which arises on the linea aspera
- short head is innervated by the common peroneal division of the sciatic nerve
43
posterior compartment: semitendinosus
- half is a tendon
- the other two hamstrings insert onto the tibia
- medially disposed
- has a proximal muscular belly
- turns into a long round tendon
- inserts below the medial tibial condyle with sartorius and gracilis via pes anserinus (gooses foot)
44
posterior compartment: semimembranosus
- half is a membrane
- has a flat aponeurotic origin
- muscular belly passes down the thigh
- medial to the semitendonosus
- tendon inserts behind the medial condyle of the tibia
45
blood and nerve supply to the compartment
- blood supply to the compartment is via the penetrating branches of the profunda femoris artery
- the compartment is innervated by the sciatic nerve which enters the thigh and runs under the long head of the biceps
- goes straight down the back of the thigh and enters the popliteal fossa
- splits into the tibial and common peroneal nerves
46
the popliteal fossa
- diamond shaped space behind and superior to the knee joint
- its sides are the hamstrings proximally and the two heads of the gastrocnemius distally
- contains the sciatic nerve which branches early on into the tibial and common peroneal branches
47
tibial nerve
- runs straight down the middle of the fossa
- tibial nerve is accompanied in this space by the popliteal artery and vein
48
common peroneal nerve
- follows buceps muscle to the lateral border of the fossa
- the goes around the neck of the fibula
49
short saphenous vein
- at the anterior angle of the fossa
- superficial vein goes deep to join the popliteal vein
