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
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2
Q

popliteal surface

A
  • inferiorly the lines diverge leaving a smooth space behind the knee
  • space is the popliteal surface
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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
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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
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5
Q

the proximal tibia

A
  • the proximal tibia has two flat condyles which articulate with the femoral condyles
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6
Q

prominent intercondylar emminence

A
  • found between the two flat condyles that articulate with the femoral condyles
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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
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8
Q

tibial tuberosity

A
  • roughened area just below and in front of the condyles
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9
Q

gerdys tubercle

A
  • located below the lateral tibial condyle
  • tubercle for the insertion of the iliotibial band
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
Q

lateral femoral circumflex artery

A
  • supplies the quadriceps and the hip joint
26
Q

profunda femoris artery

A
  • 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
Q

femoral nerve

A
  • 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
Q

medial/adductor compartment

A
  • this compartment contains the adductors of the hip (thigh)
  • innervated by the obturator nerve
29
Q

muscles of the medial compartment

A
  • 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
Q

anterior layer: gracilis

A
  • 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
Q

anterior layer: pectineus

A
  • uppermost of the three insertions on the linea aspera
  • dual innervation, served by both the femoral and obturator nerves
32
Q

anterior layer: adductor longus

A
  • inserts belwo the pectineus on the linea aspera
33
Q

posterior layer: adductor brevis

A
  • inserts behind the pectinous
  • the adductor magnus is deep to it
34
Q

posterior layer: adductor magnus

A
  • has a space inferiorly called the adductor hiatus (through which the femoral vessels pass)
  • deep to the adductor brevis
35
Q

posterior layer: hamstring

A
  • below the adductor hiatus
  • part of the adductor magnus
  • inserts into the adductor tubercle
36
Q

posterior layer: adductor tubercle

A
  • on the medial epicondyle
  • innervated by the tibial division on the sciatic nerve
37
Q

blood and nerve supply to the adductor compartment: obturator artery

A
  • 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
Q

blood and nerve supply to the adductor compartment: obturator nerve

A
  • passes into the compartment in concert with the vessels
  • immediately splits into an anterior and posterior branch
39
Q

blood and nerve supply to the adductor compartment: anterior branch

A
  • supplies the adductor longus, adductor brevis, gracilis, pectineus and the hip joint
40
Q

blood and nerve supply to the adductor compartment: posterior branch

A
  • serves adductor magnus, obturator externus and the knee joint
41
Q

posterior compartment: muscles of the medial compartment

A
  • 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
Q

posterior compartment: biceps femoris

A
  • 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
Q

posterior compartment: semitendinosus

A
  • 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
Q

posterior compartment: semimembranosus

A
  • 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
Q

blood and nerve supply to the compartment

A
  • 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
Q

the popliteal fossa

A
  • 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
Q

tibial nerve

A
  • runs straight down the middle of the fossa
  • tibial nerve is accompanied in this space by the popliteal artery and vein
48
Q

common peroneal nerve

A
  • follows buceps muscle to the lateral border of the fossa
  • the goes around the neck of the fibula
49
Q

short saphenous vein

A
  • at the anterior angle of the fossa
  • superficial vein goes deep to join the popliteal vein