Conference 7 : Hip and Thigh Flashcards
name the two groups of anterior thigh muscles
hip flexors and quadriceps/knee extensors
what are the quadriceps/knee extensors?
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
whats the BFD about the rectus femoris?
its the only quadricep/knee extensor that ALSO flexes the thigh; this is because it crosses the hip joint
name the medial compartment thigh muscles and their primary function
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)
What are the posterior thigh muscles, what do they do and what is their arterial blood supply?
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
name the gluteal region muscles and whats their main function
main function is thigh ABduction and rotators
gluteus maximus gluteus medius gluteus minimus tensor fascia latae piriformis
describe the relationship between the top of the greater trochanter and the LATERAL margin of the acetabulum
forms a right angle. in injury to the hip, this angle will be disrupted
why is the hip joint stable?
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
whats the BFD about the isciofemoral ligament
spirals around the femur and therefore draws the head of the femur into the acetabulum
when are the iliofemoral and ischiofemoral ligaments tense?
during extension
therefore, they RESIST hyperextension
the bottom of the fibula and tibia each have a weird name - what is it
Lateral malleolus (fibuLa) medial malleolus (tibia)
What forms the roof of the femoral triangle
fascia lata, subcutaneous tissue, skin
what are the borders of the femoral triangle
adductor longus (medial)
sartorius (lateral)
inguinal ligament (base)
pectinous and iliopsoas (floor)
name the structures within the femoral triangle
femoral nerve, artery, vein, empty space, lacunar ligament
What does the great saphenous vein drain into?
femoral vein
what does the L of NAVEL stand for?
lacunar ligament
what direction does NAVEL run?
lateral to medial
whats the strongest flexor of the hip?
iliopsoas
how can we divide the adductor muscles?
three layers -anterior, middle, posterior
name the muscles in the anterior layer of the adductor muscles
pectinous, adductor longus
name the muscles in the middle layer of the adductor muscles
adductor brevis, gracili
name the muscles in the posterior layer of the adductor muscles
adductor magnus innervated by both obturator AND tibial nerves
Whats the test for trendelenberg sign
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
whats the only muscle to insert on the lesser trochantor
iliopsoas
skin innervation for anteromedial thigh
anterior cutaneous branches of femoral nerve (L2, L3, L4)
skin innervation for lateral thigh
lateral femoral cutaneous nerve
skin innervation for lower medial thigh
obturator nerve
whats the actual/full name for the IT band?
iliotibial tract
Name the structures that EMERGE from the GREATER sciatic foramen
superior gluteal n. piriformis inferior gluteal n. sciatic n. posterior femoral cutaneous n. pudendal n.
structures that pass through the lesser sciatic foramen
pudendal n.
obturator internus
where should gluteal injections be given?
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
Name two places where you have poor blood supply and explain why thats concerning
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
Whats the most powerful EXTERNAL rotator of the hip?
Gluteus maximus
physiological splinting
when a fracture occurs, the muscles around the fracture in order to prevent any excessive motion / worsening of the fracture
What muscles accomplish medial / inward rotation of the thigh?
pectinous, gluteus minimus, gluteus medius, tensor fascia latae
What three vessels come off of the internal iliac artery?
superior gluteal artery, inferior gluteal artery and obturator artery
anastomosis
two vessels coming from two sources communicate with one another through the capillaries; not something we can see visually in lab
name some areas of the body where collateral circulation occurs
shoulder
elbow
hip (most clinically relevant)
3 sites of the hip where anastomoses can occur
- ASIS
- Cruciate (upper posterior thigh)
- Obturator foramen
Anterior superior iliac spine
one of the anastomoses of the hip; includes
- iliac branch of iliolumbar
- superior gluteal
- deep circumflex iliac
- ascending branch of the lateral circumflex femoral
Cruciate anastomoses
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
Obturator foramen
one of the anastomoses of the hip; includes
- obturator artery
- medial circumflex femoral artery
What is the main external rotator of the thigh?
gluteus maximus
saphenous nerve
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
what do the superficial inguinal lymph nodes drain?
- entire lower limb
- gluteal region
- abdominal wall below umbilicus
- perineum including lower vaginal and anal canal
*exception: does not drain the testes
What innervates the tensor fascia lata
superior gluteal nerve
name the muscles that insert on the greater trochanter
gluteus medius
gluteus minimus
piriformis
name the muscles that insert on the lesser trochanter
common tendon of the psoas major and iliopsoas muscle
**iliopsoas is the only muscle that inserts here!!
where are the two places that the inguinal ligament attach?
anterior superior spine of the ilium to the pubic tubercle
how can you locate the femoral artery on a patient?
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.
easy to see sign of gait abnormality
pelvic dip/sag
indicates trendelenberg
What muscle(s) and nerve(s) should you think of if patient has trendelenberg sign
gluteus medius and minimus
superior gluteal nerve
pes anserinus
goose foot; common tendon insertion of gracilis, sartoris and semitendinous muscles; all three tendons are webbed together
femoral hernia
herniation of the bowel can come into the femoral canal
describe the space next to the femoral vein
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
fovea
center of the head of the femur; the ligament of the femoral head attaches here
where does the gluteus maximus insert?
gluteal tuberosity
is the hip more stable in extension or flexion?
extension
where does the external iliac artery become the femoral artery?
at the inguinal ligament
what does the femoral artery become ?
politeal artery
when does the femoral artery become the politeal artery?
after passing through the adductor hiatus
what does the politeal artery branch into?
anterior tibial artery and posterior tibial artery
Adductor canal
sartorius (roof) vastus medialis (anterolateral) adductor longs and adductor magnus (posterior)
adductor canal contents
femoral artery, femoral vein, saphenous nerve
clinical relevance of great saphenous vein
very resistant to plaque; therefore, used as graft in coronary artery bypass graft surgery
what does hamstring muscles refer to?
the posterior thigh muscles
what are the muscles in the posterior thigh
biceps femoris (most lateral)
semitendinosus
semimembranosus
Baker’s cyst
enlargement of bursa between gastrocnemius and semi membranous muscle; caused by accumulation of fluid in the knee joint
are the biceps femoris innervated by the same nerve?
no, long head has tibial innervation
short head has common peroneal nerve innervation
what nerve is the tibial nerve a branch of?
sciatic nerve; the other branch is the common fibular (peroneal) nerve
explain the clinical relevance of the common fibular (peroneal) nerve
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
popliteal fossa
diamond shape depression; posterior to knee;
from medial to lateral
AVNN
popliteal artery, popliteal vein, tibial nerve, common fibular nerve
