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Odd Numbered Conference > Conference 7 : Hip and Thigh > Flashcards

Conference 7 : Hip and Thigh Flashcards

1
Q

name the two groups of anterior thigh muscles

A

hip flexors and quadriceps/knee extensors

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2
Q

what are the quadriceps/knee extensors?

A

rectus femoris
vastus lateralis
vastus intermedius
vastus medialis

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3
Q

whats the BFD about the rectus femoris?

A

its the only quadricep/knee extensor that ALSO flexes the thigh; this is because it crosses the hip joint

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4
Q

name the medial compartment thigh muscles and their primary function

A

they are all ADductors

adductor brevis
adductor longus
adductor magnus
gracialis

*all innervated by obturator (BUT, note that the adductor magnus is also innervated by the tibial nerve on the posterior side)

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5
Q

What are the posterior thigh muscles, what do they do and what is their arterial blood supply?

A

they are all hip extensors/knee flexors, and they are all supplied by the peripheral branch of the deep femoral artery

biceps femoris
semi-tendinous
semi-membraneous

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6
Q

name the gluteal region muscles and whats their main function

A

main function is thigh ABduction and rotators

gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae
piriformis
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7
Q

describe the relationship between the top of the greater trochanter and the LATERAL margin of the acetabulum

A

forms a right angle. in injury to the hip, this angle will be disrupted

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8
Q

why is the hip joint stable?

A

there is a good bony fit thanks to the acetabulum being augmented (Aka deeper) by the presence of the acetabular labrum

strong iliofemoral and ischiofemoral ligaments

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9
Q

whats the BFD about the isciofemoral ligament

A

spirals around the femur and therefore draws the head of the femur into the acetabulum

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10
Q

when are the iliofemoral and ischiofemoral ligaments tense?

A

during extension

therefore, they RESIST hyperextension

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11
Q

the bottom of the fibula and tibia each have a weird name - what is it

A 
Lateral malleolus (fibuLa) 
medial malleolus (tibia)
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12
Q

What forms the roof of the femoral triangle

A

fascia lata, subcutaneous tissue, skin

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13
Q

what are the borders of the femoral triangle

A

adductor longus (medial)
sartorius (lateral)
inguinal ligament (base)
pectinous and iliopsoas (floor)

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14
Q

name the structures within the femoral triangle

A

femoral nerve, artery, vein, empty space, lacunar ligament

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15
Q

What does the great saphenous vein drain into?

A

femoral vein

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16
Q

what does the L of NAVEL stand for?

A

lacunar ligament

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17
Q

what direction does NAVEL run?

A

lateral to medial

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18
Q

whats the strongest flexor of the hip?

A

iliopsoas

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19
Q

how can we divide the adductor muscles?

A

three layers -anterior, middle, posterior

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20
Q

name the muscles in the anterior layer of the adductor muscles

A

pectinous, adductor longus

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21
Q

name the muscles in the middle layer of the adductor muscles

A

adductor brevis, gracili

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22
Q

name the muscles in the posterior layer of the adductor muscles

A

adductor magnus innervated by both obturator AND tibial nerves

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23
Q

Whats the test for trendelenberg sign

A

ask patient to stand on one leg; if OPPOSITE side of pelvis sags, patient is POSITIVE.

+ result = gluteus medium and minimum of the supporting leg are NOT fxn normally

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24
Q

whats the only muscle to insert on the lesser trochantor

A

iliopsoas

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25
Q

skin innervation for anteromedial thigh

A

anterior cutaneous branches of femoral nerve (L2, L3, L4)

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26
Q

skin innervation for lateral thigh

A

lateral femoral cutaneous nerve

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27
Q

skin innervation for lower medial thigh

A

obturator nerve

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28
Q

whats the actual/full name for the IT band?

A

iliotibial tract

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29
Q

Name the structures that EMERGE from the GREATER sciatic foramen

A 
superior gluteal n.
piriformis 
inferior gluteal n. 
sciatic n. 
posterior femoral cutaneous n. 
pudendal n.
30
Q

structures that pass through the lesser sciatic foramen

A

pudendal n.

obturator internus

31
Q

where should gluteal injections be given?

A

upper outer quadrant of the gluteal region

because you want to avoid the sciatic n. and the other neuromuscular structures in the gluteal region

note that the lower lateral quadrant doesn’t have a lot of nerves/arteries that you could damage, but it also doesn’t have much muscle that you could inject into

32
Q

Name two places where you have poor blood supply and explain why thats concerning

A

Head of the femur, distal tibia

concerning because fracture healing is slower and have increased of necrosis because if the blood supply is knocked out you don’t have much to compensate for it

33
Q

Whats the most powerful EXTERNAL rotator of the hip?

A

Gluteus maximus

34
Q

physiological splinting

A

when a fracture occurs, the muscles around the fracture in order to prevent any excessive motion / worsening of the fracture

35
Q

What muscles accomplish medial / inward rotation of the thigh?

A

pectinous, gluteus minimus, gluteus medius, tensor fascia latae

36
Q

What three vessels come off of the internal iliac artery?

A

superior gluteal artery, inferior gluteal artery and obturator artery

37
Q

anastomosis

A

two vessels coming from two sources communicate with one another through the capillaries; not something we can see visually in lab

38
Q

name some areas of the body where collateral circulation occurs

A

shoulder
elbow
hip (most clinically relevant)

39
Q

3 sites of the hip where anastomoses can occur

A
  1. ASIS
  2. Cruciate (upper posterior thigh)
  3. Obturator foramen
40
Q

Anterior superior iliac spine

A

one of the anastomoses of the hip; includes

  • iliac branch of iliolumbar
  • superior gluteal
  • deep circumflex iliac
  • ascending branch of the lateral circumflex femoral
41
Q

Cruciate anastomoses

A

one of the anastomoses of the hip; includes

  • inferior gluteal
  • medial circumflex femoral
  • transverse branch of the lateral circumflex femoral
  • ascending branch of the first perforator
42
Q

Obturator foramen

A

one of the anastomoses of the hip; includes

  • obturator artery
  • medial circumflex femoral artery
43
Q

What is the main external rotator of the thigh?

A

gluteus maximus

44
Q

saphenous nerve

A

branch of the femoral nerve; runs with the femoral vessels through the adductor canal, which is deep to the sartorial and superficial to the adductor muscles

45
Q

what do the superficial inguinal lymph nodes drain?

A
  • entire lower limb
  • gluteal region
  • abdominal wall below umbilicus
  • perineum including lower vaginal and anal canal

*exception: does not drain the testes

46
Q

What innervates the tensor fascia lata

A

superior gluteal nerve

47
Q

name the muscles that insert on the greater trochanter

A

gluteus medius
gluteus minimus
piriformis

48
Q

name the muscles that insert on the lesser trochanter

A

common tendon of the psoas major and iliopsoas muscle

**iliopsoas is the only muscle that inserts here!!

49
Q

where are the two places that the inguinal ligament attach?

A

anterior superior spine of the ilium to the pubic tubercle

50
Q

how can you locate the femoral artery on a patient?

A

the inguinal ligament, which runs from the anterior superior spine of the ilium to the pubic tubercle, should be found first. find this by palpating either of these bony landmarks, if possible. then, approximately halfway between the two bony landmarks, go directly under the inguinal ligament, and you should be right on top of the femoral artery. note that the femoral artery is a great landmark for the rest of the NAVEL.

51
Q

easy to see sign of gait abnormality

A

pelvic dip/sag

indicates trendelenberg

52
Q

What muscle(s) and nerve(s) should you think of if patient has trendelenberg sign

A

gluteus medius and minimus

superior gluteal nerve

53
Q

pes anserinus

A

goose foot; common tendon insertion of gracilis, sartoris and semitendinous muscles; all three tendons are webbed together

54
Q

femoral hernia

A

herniation of the bowel can come into the femoral canal

55
Q

describe the space next to the femoral vein

A

the “empty space” is a misnomer. he called it the “femoral canal” and emphasized that it is not a “space” but is actually filled with fat and lymphatics

56
Q

fovea

A

center of the head of the femur; the ligament of the femoral head attaches here

57
Q

where does the gluteus maximus insert?

A

gluteal tuberosity

58
Q

is the hip more stable in extension or flexion?

A

extension

59
Q

where does the external iliac artery become the femoral artery?

A

at the inguinal ligament

60
Q

what does the femoral artery become ?

A

politeal artery

61
Q

when does the femoral artery become the politeal artery?

A

after passing through the adductor hiatus

62
Q

what does the politeal artery branch into?

A

anterior tibial artery and posterior tibial artery

63
Q

Adductor canal

A 
sartorius (roof) 
vastus medialis (anterolateral) 
adductor longs and adductor magnus (posterior)
64
Q

adductor canal contents

A

femoral artery, femoral vein, saphenous nerve

65
Q

clinical relevance of great saphenous vein

A

very resistant to plaque; therefore, used as graft in coronary artery bypass graft surgery

66
Q

what does hamstring muscles refer to?

A

the posterior thigh muscles

67
Q

what are the muscles in the posterior thigh

A

biceps femoris (most lateral)
semitendinosus
semimembranosus

68
Q

Baker’s cyst

A

enlargement of bursa between gastrocnemius and semi membranous muscle; caused by accumulation of fluid in the knee joint

69
Q

are the biceps femoris innervated by the same nerve?

A

no, long head has tibial innervation

short head has common peroneal nerve innervation

70
Q

what nerve is the tibial nerve a branch of?

A

sciatic nerve; the other branch is the common fibular (peroneal) nerve

71
Q

explain the clinical relevance of the common fibular (peroneal) nerve

A

goes around the fibular neck; therefore, extremely vulnerable to injury; it is the most common site of PERIPHERAL NERVE INJURY in the lower limb; foot drop because paralyzes dorsiflexors

72
Q

popliteal fossa

A

diamond shape depression; posterior to knee;
from medial to lateral
AVNN
popliteal artery, popliteal vein, tibial nerve, common fibular nerve

Odd Numbered Conference (11 decks)

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