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Tri 3 - Gross Anatomy II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

psoas origin

A

transverse processes of all lumbar vertebrae, sides of vertebral bodies and intervertebral discs from T12 to L5

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2
Q

psoas insertion

A

fibers run inferiorly and laterally; leave abdomen and enter thigh by passing under inguinal ligament; end in a tendon that inserts into lesser trochanter of femur

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3
Q

psoas innervation

A

ventral rami of L1 to L3 spinal nerves

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4
Q

psoas actions

A

flexes thigh at hip joint; if thigh is fixed, it flexes trunk

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5
Q

iliacus origin

A

iliac fossa

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6
Q

iliacus insertion

A

fibers converge to insert into lateral side of tendon of psoas major muscle, which ends in lesser trochanter of femur (combined muscles are referred to as iliopsoas)

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7
Q

iliacus innervation

A

femoral nerve

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8
Q

iliacus actions

A

flexes thigh at hip joint; if thigh is fixed, it flexes trunk

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9
Q

psoas minor

A

absent in about 40% of individuals

located entirely within abdomen, anterior to psoas major muscle

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10
Q

psoas minor origin

A

sides of vertebral bodies of T12 and L1 and intervertebral disc between them

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11
Q

psoas minor insertion

A

muscle fibers give rise to a long flat tendon which inserts into iliopubic eminence

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12
Q

psoas minor innervation

A

ventral rami of L1 and L2 spinal nerves

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13
Q

psoas minor action

A

weak flexor of trunk

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14
Q

quadratus lumborum origin

A

iliolumbar ligament and posterior part of iliac crest

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15
Q

quadratus lumborum insertion

A

fibers run superiorly and medially and insert into inferior border of 12th rib and transverse processes of upper 4 lumbar vertebrae

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16
Q

quadratus lumborum innervation

A

ventral rami of T12 to L3 (or L4) spinal nerves

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17
Q

quadratus lumborum actions

A

depresses and fixes 12th rib, holding it down against traction exerted by diaphragm in inspiration

lateral flexion of trunk to same side of contracting muscle (unilateral contraction)

may extend lumbar part of vertebral column (bilateral contraction)

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18
Q

iliolumbar ligament

A

extends from transverse process of L5 to posterior part of iliac crest

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19
Q

diaphragm sternal part

A

smallest part; fibers originate from posterior surface of xiphoid process

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20
Q

diaphragm costal part

A

fibers originate from internal surface of lower 6 ribs and their costal cartilages

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21
Q

diaphragm lumbar part

A

medially, it originates from 2 vertical tendinous columns  right and left crura

right crus attaches to vertebral bodies of upper 3 or 4 lumbar vertebrae and intervertebral discs in between

left crus (shorter) attaches to vertebral bodies of upper 2 or 3 lumbar vertebrae and intervertebral discs in between

medial borders of right and left crura are connected by median arcuate ligament (crosses over anterior surface of aorta)

lateral to crura, muscle fibers of lumbar part originate from medial and lateral arcuate ligaments

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22
Q

medial arcuate ligament

A

thickened, upper margin of fascia that covers anterior surface of psoas major muscle; extends from body of L2 to tip of transverse process of L1

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23
Q

lateral arcuate ligament

A

thickened, upper margin of fascia that covers anterior surface of quadratus lumborum muscle; extends from tip of transverse process of L1 to 12th rib

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24
Q

diaphragm anterior view

A

diaphragm curves up into right and left domes
right dome is slightly higher than left due to large size of right lobe of liver
during expiration, right dome reaches upper border of 5th rib (or 4th intercostal space) and left dome reaches lower border of 5th rib

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25
Q

diaphragm lateral view

A

diaphragm looks like inverted letter “J”

posterior attachment to vertebral column is lower than anterior attachment to sternum

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26
Q

diaphragm main openings

aortic hiatus

A

located posterior, rather than within diaphragm; bounded by body of T12, right and left crura and median arcuate ligament; transmits aorta (becomes abdominal aorta as it passes through it) and thoracic duct

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27
Q

diaphragm main openings

esophageal hiatus

A

located anterior and superior to aortic hiatus (level of T10); transmits esophagus, anterior and posterior vagal trunks and esophageal branches of left gastric vessels

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28
Q

diaphragm main openings

caval opening

A

located anterior, superior and to the right of esophageal hiatus (level of T8), in central tendon; transmits IVC and branches of right phrenic nerve

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29
Q

other structures piercing diaphragm

A

greater, lesser and least (lowest) splanchnic nerves pierce crura

sympathetic trunk enters abdomen by passing posterior to medial arcuate ligament (least splanchnic nerve may pass posterior to medial arcuate ligament with sympathetic trunk)

sternocostal triangle (hiatus); small gap between sternal and costal origins of diaphragm; transmits superior epigastric vessels

azygos vein may pierce right crus or pass through aortic hiatus; hemiazygos vein pierces left crus

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30
Q

diaphragm actions

A

most important muscle used in inspiration

helps anterior abdominal muscles to increase intra-abdominal pressure  assists with evacuation of pelvic contents (micturition, defecation, parturition)

helps in weight-lifting; increased intra-abdominal pressure helps to support vertebral column and prevents flexion (assists extensor back muscles in lifting heavy weights)

thoracoabdominal pump; contraction and descent of diaphragm increases intra-abdominal pressure and decreases intra-thoracic pressure; helps blood in IVC to move up into right atrium and lymph in abdominal lymph vessels to ascend in thoracic duct

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31
Q

hiatal hernia

A

protrusion of part of stomach into mediastinum through esophageal hiatus of diaphragm

two main types: paraesophageal and sliding

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32
Q

paraesophageal hiatal hernia:

A

less common; cardial part of stomach remains in abdomen; a pouch of peritoneum containing part of fundus of stomach extends through esophageal hiatus into mediastinum

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33
Q

sliding hiatal hernia

A

more common; abdominal part of esophagus, cardia and part of fundus of stomach slide superiorly through esophageal hiatus into mediastinum

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34
Q

congenital diaphragmatic hernia

A

seen in about 1 in 2000 newborns

caused by failure of one or both pleuroperitoneal membranes (folds) to close pericardioperitoneal canals (canals that communicate peritoneal and pleural cavities along posterior body wall); allows abdominal viscera to enter pleural cavity

in 85 to 90% of cases hernia is on left side; parts of intestines, spleen, stomach may enter thoracic cavity; compress heart and lungs (lungs are usually hypoplastic)

large defects are associated with high mortality rate (75%) from pulmonary hypoplasia and dysfunction

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35
Q

lumbar plexus

A

formed within psoas major muscle by ventral rami of L1, L2, L3 and part of L4 spinal nerves (remaining part of ventral ramus of L4 joins ventral ramus of L5 to form lumbosacral trunk, which contributes to form sacral plexus)

branches of lumbar plexus supply anterior abdominal wall, external genitalia and lower limb

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36
Q

ventral ramus of L1 bifurcates

A

upper branch divides into iliohypogastric and ilioinguinal nerves; lower branch joins a small branch of ventral ramus of L2 to form genitofemoral nerve

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37
Q

ventral rami of L2, L3 and L4 branch

A

into anterior and posterior divisions

anterior divisions of L2, L3 and L4 form obturator nerve

posterior divisions of L2, L3 and L4 form femoral nerve

posterior divisions of L2 and L3 form lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve)

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38
Q

branches of lumbar plexus emerge from lateral and medial borders of psoas major muscle and from its anterior surface

A

from lateral border (in descending order): iliohypogastric, ilioinguinal, lateral femoral cutaneous and femoral nerves

from medial border: obturator nerve

from anterior surface: genitofemoral nerve

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39
Q

lumbar part of sympathetic trunk

A

consists of 3 to 5 interconnected ganglia

continuous above with thoracic part of sympathetic trunk and below with sacral part of sympathetic trunk

enters abdomen by passing posterior to medial arcuate ligament of diaphragm

runs along medial border of psoas major muscle on bodies of lumbar vertebrae

inferiorly, it passes posterior to common iliac vessels to become continuous with sacral part of sympathetic trunk

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40
Q

lumbar part of sympathetic trunk branches

A

receives white communicating rami (contain preganglionic sympathetic fibers) from upper 2 lumbar spinal nerves

gives off gray communicating rami (contain postganglionic sympathetic fibers) to all lumbar spinal nerves

lumbar splanchnic nerves (contain preganglionic sympathetic and visceral afferent fibers): originate from lumbar sympathetic trunk and run medially to join aortic or superior hypogastric plexuses

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41
Q

aortic plexus

A

autonomic plexus formed anterior to abdominal aorta

receives fibers from thoracic (greater, lesser and lowest/least) splanchnic nerves, lumbar splanchnic nerves and vagus nerves

contains prevertebral ganglia (celiac, aortico-renal, superior and inferior mesenteric)

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42
Q

superior hypogastric plexus

A

downward continuation of aortic plexus, inferior to bifurcation of abdominal aorta
located between right and left common iliac vessels and anterior to body of L5 and sacral promontory

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43
Q

structures at renal hilum (A-P)

A

renal vein
renal artery
renal pelvis

lymph vessels and autonomic nerves also pass through hilum

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44
Q

kidney anterior anatomical relations

A

right kidney: liver, 2nd part of duodenum, right colic flexure, coils of small intestine

left kidney: spleen, stomach, pancreas, left colic flexure, coils of small intestine

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45
Q

kidney posterior anatomical relations

A

right kidney: psoas major, quadratus lumborum, transversus abdominis, diaphragm, 12th rib, subcostal, iliohypogastric and ilioinguinal nerves

left kidney: same + 11th rib (left kidney is higher than right)

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46
Q

contents of renal sinus

A 
branches of renal artery
 tributaries of renal vein
 minor and major calyces
 renal pelvis
 lymph vessels
 autonomic nerves
 adipose tissue
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47
Q

ureter

A

retroperitoneal organ along its entire course

begins in abdomen as a continuation of renal pelvis

descends on psoas major muscle; passes anterior to bifurcation of common iliac artery

descends on lateral wall of pelvis, anterior to internal iliac artery, to level of ischial spine

turns forward to reach base of urinary bladder

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48
Q

ureter constrictions

A

where renal pelvis joins ureter

at pelvic brim (where it crosses bifurcation of common iliac artery)

where it pierces wall of urinary bladder (narrowest part)

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49
Q

ureter anterior anatomical relations

A

right ureter: 2nd part of duodenum, right colic and ileocolic vessels, right ovarian/testicular vessels, lower part of mesentery of small intestine

left ureter: left colic vessels, left ovarian/testicular vessels, sigmoid mesocolon

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50
Q

ureter posterior anatomical relations

A

psoas major, genitofemoral nerve, bifurcation of common iliac artery (same on both sides)

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51
Q

right suprarenal gland

A

is pyramidal in shape; caps upper pole of right kidney; related anteriorly to right lobe of liver and IVC; related posteriorly to diaphragm

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52
Q

left suprarenal gland

A

is crescent-shaped; caps upper pole of left kidney and extends along its medial border; related anteriorly to pancreas, lesser sac and stomach; related posteriorly to diaphragm

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53
Q

adrenal gland internal structure

A

consists of 2 layers with different functions and embryological origin

cortex (outer layer, originates from mesoderm) and medulla (inner layer, originates from ectoderm [neural crest cells]

equivalent to sympathetic ganglia; cells are innervated by preganglionic sympathetic fibers)

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54
Q

hormones secreted by cortex

A

mineralocorticoids (aldosterone): involved in regulation of electrolyte and water balance

glucocorticoids (cortisol): involved in regulation of carbohydrate, protein and fat metabolism

small amounts of sex hormones

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55
Q

hormones secreted by medulla

A

catecholamines (epinephrine and norepinephrine)

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56
Q

adrenal arterial supply

A

superior suprarenal arteries: branches of inferior phrenic artery

middle suprarenal artery: paired visceral branch of abdominal aorta

inferior suprarenal artery: branch of renal artery

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57
Q

adrenal venous drainage

A

right suprarenal vein drains into IVC

left suprarenal vein drains into left renal vein

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58
Q

common iliac artery

A

terminal branch of abdominal aorta

originates at level of L4; runs inferiorly and laterally

terminates at level of L5/S1 intervertebral disc by dividing into external and internal iliac arteries

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59
Q

external iliac artery

A

continuation of common iliac artery; runs along medial border of psoas major muscle

enters thigh by passing under inguinal ligament to become femoral artery

gives 2 branches just before it enters thigh: inferior epigastric and deep circumflex iliac arteries (supply lower part of anterior abdominal wall)

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60
Q

inferior vena cava

A

formed by union of right and left common iliac veins at the level of L5

ascends on right side of abdominal aorta, anterior to lumbar vertebral column; passes posterior to right lobe of liver (contained in a deep groove); pierces central tendon of diaphragm (at level of T8); drains into right atrium of heart

tributaries closely correspond with branches of abdominal aorta, except unpaired visceral branches (veins that correspond with unpaired visceral branches of abdominal aorta drain into portal system)

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61
Q

IVC visceral tributaries

A

right and left renal veins
right suprarenal vein (left drains into left renal vein)
right ovarian/testicular vein (left drains into left renal vein)
hepatic veins

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62
Q

IVC parietal tributaries

A

inferior phrenic veins
4 pairs of lumbar veins
median sacral vein usually terminates in left common iliac vein

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63
Q

pre-aortic lymph nodes

A

lie anterior to abdominal aorta around origin of its unpaired visceral branches 

drain lymph from organs those branches supply with arterial blood
lymph from stomach, small intestine, colon, spleen, pancreas, gallbladder and liver drains into pre-aortic nodes (celiac, superior mesenteric and inferior mesenteric lymph nodes)

efferent vessels from celiac and superior mesenteric nodes form intestinal trunk

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64
Q

para-aortic nodes (lateral aortic or lumbar nodes)

A

lie on either side of abdominal aorta

receive lymph from abdominal wall, kidneys, suprarenal glands and testes/ovaries

efferent vessels from upper para-aortic nodes form right and left lumbar trunks.

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65
Q

thoracic duct

A

right and left lumbar trunks and intestinal trunk join to form thoracic duct

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66
Q

sacral plexus

A

formed by lumbosacral trunk (ventral ramus of L5 spinal nerve + part of ventral ramus of L4 spinal nerve), ventral rami of S1, S2 and S3 spinal nerves and part of ventral ramus of S4 spinal nerve (remainder of ventral ramus of S4 joins coccygeal plexus)

sacral plexus lies against posterior pelvic wall, anterior to piriformis muscle

ventral rami branch into anterior and posterior divisions  branches of sacral plexus contain fibers from anterior and/or posterior divisions of specific ventral rami

branches of sacral plexus supply muscles and part of skin of gluteal region, muscles and skin of posterior thigh, muscles and skin of entire leg and foot (except skin over medial aspect of leg and medial border of foot) and muscles and skin of perineum

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67
Q

sciatic nerve

A

largest nerve in body; composite nerve consisting of common fibular (peroneal) nerve (formed by fibers from posterior divisions of L4, L5, S1 and S2 ventral rami) and tibial nerve (formed by fibers from anterior divisions of L4, L5, S1, S2 and S3 ventral rami)

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68
Q

superior gluteal nerve

A

formed by fibers from posterior divisions of L4, L5 and S1 ventral rami

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69
Q

inferior gluteal nerve

A

formed by fibers from posterior divisions of L5, S1 and S2 ventral rami

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70
Q

nerve to piriformis

A

formed by fibers from posterior divisions of S1 and S2 ventral rami

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71
Q

nerve to quadratus femoris

A

formed by fibers from anterior divisions of L4, L5 and S1 ventral rami

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72
Q

nerve to obturator internus

A

formed by fibers from anterior divisions of L5, S1 and S2 ventral rami

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73
Q

posterior cutaneous nerve of thigh (posterior femoral cutaneous nerve)

A

formed by fibers from anterior divisions of S2 and S3 ventral rami and from posterior divisions of S1and S2 ventral rami

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74
Q

pudendal nerve

A

formed by fibers from anterior divisions of S2, S3, and S4 ventral rami

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75
Q

pelvic splanchnic nerves

A

originate from ventral rami of S2, S3 and S4 spinal nerves; contain preganglionic parasympathetic fibers; join inferior hypogastric plexus

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76
Q

boundaries of gluteal region

A

superior: iliac crest
inferior: gluteal fold (skin fold that separates gluteal region from posterior thigh)
medial: natal (intergluteal) cleft; cleft between right and left buttocks
lateral: line connecting ASIS to greater trochanter

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77
Q

superior clunial nerves

A

dorsal rami of L1-L3 spinal nerves; supply skin of superior part of gluteal region

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78
Q

medial clunial nerves

A

dorsal rami of S1-S3 spinal nerves; supply skin of medial part of gluteal region

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79
Q

inferior clunial nerves

A

branches of posterior cutaneous nerve of thigh; curve around inferior border of gluteus maximus to supply skin of inferior part of gluteal region

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80
Q

lateral cutaneous branch of iliohypogastric nerve

A

supplies skin of superolateral part of gluteal region

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81
Q

lateral cutaneous nerve of thigh

A

supplies skin of inferolateral part of gluteal region

82
Q

gluteus maximus origin

A

outer (gluteal) surface of ilium (behind posterior gluteal line), posterior surfaces of sacrum and coccyx, sacrotuberous ligament

83
Q

gluteus maximus insertion

A

fibers run inferiorly and laterally; most fibers insert into iliotibial tract; deeper and lower fibers insert into gluteal tuberosity of femur

84
Q

gluteus maximus innervation

A

inferior gluteal nerve

85
Q

gluteus maximus action

A

extension of thigh at hip joint (important in rising from sitting position and in climbing stairs), lateral rotation of thigh at hip joint, provides stability to extended knee (via iliotibial tract)

86
Q

gluteus medius

A

fan-shaped muscle; inferior part covered by gluteus maximus; superior part covered by gluteal aponeurosis

87
Q

gluteus minimus

A

fan-shaped muscle; lies deep to gluteus medius

88
Q

gluteus medius origin

A

outer (gluteal) surface of ilium (between anterior and posterior gluteal lines)

89
Q

gluteus medius insertion

A

fibers pass inferiorly and laterally to attach to lateral surface of greater trochanter of femur

90
Q

gluteus minimus origin

A

outer (gluteal) surface of ilium (between anterior and inferior gluteal lines)

91
Q

gluteus minimus insertion

A

fibers pass inferiorly and laterally to attach to anterior surface of greater trochanter of femur

92
Q

gluteus medius/minimus innervation

A

superior gluteal nerve

93
Q

gluteus medius/minimus actions

A

abduction and medial rotation of thigh at hip joint

during walking, when foot of opposite side is taken off the ground and thrust forward, gluteus medius and minimus steady pelvis on supporting lower limb (prevent pelvis from tilting downward on unsupported side)

paralysis of gluteus medius and minimus; when patient stands on lower limb on the side of paralysis, pelvis sinks on opposite, unsupported side (positive Trendelenburg’s sign)

94
Q

tensor fasciae latae origin

A

outer edge of iliac crest between ASIS and tubercle of iliac crest

95
Q

tensor fasciae latae insertion

A

fibers run inferiorly and slightly posteriorly; insert into iliotibial tract

96
Q

tensor fasciae latae innervation

A

superior gluteal nerve

97
Q

tensor fasciae latae actions

A

helps with flexion, abduction and medial rotation of thigh at hip joint

provides stability to extended knee (via iliotibial tract)

98
Q

piriformis origin

A

within pelvis, from anterior surface of sacrum, lateral to anterior sacral foramina (S2-S4 sacral segments)

99
Q

piriformis insertion

A

it passes laterally and inferiorly; exits pelvis via greater sciatic foramen; inserts into upper border of greater trochanter

100
Q

piriformis innervation

A

nerve to piriformis (supplies piriformis inside pelvis, does not enter gluteal region)

101
Q

piriformis action

A

lateral rotation of thigh at hip joint, steadies femoral head in acetabulum

102
Q

obturator internus origin

A

pelvic (internal) surface of obturator membrane and bony margins of obturator foramen

103
Q

obturator internus insertion

A

muscle tapers posteriorly to a narrow belly and tendon; enters gluteal region via lesser sciatic foramen; joined by superior and inferior gemelli in gluteal region; together they insert into medial surface of greater trochanter

104
Q

obturator internus innervation

A

nerve to obturator internus

105
Q

obturator internus action

A

lateral rotation of thigh at hip joint, steadies femoral head in acetabulum

106
Q

superior gemellus

A

Origin: posterior surface of ischial spine

Insertion: with tendon of obturator internus into medial aspect of greater trochanter

Innervation : nerve to obturator internus

Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum

107
Q

inferior gemellus

A

Origin: upper part of ischial tuberosity

Insertion: with tendon of obturator internus into medial aspect of greater trochanter

Innervation: nerve to quadratus femoris

Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum

108
Q

quadratus femoris

A

Origin: upper part of lateral border of ischial tuberosity

Insertion: fibers pass laterally; insert into quadrate tubercle (on intertrochanteric crest of femur) and area inferior to it

Innervation: nerve to quadratus femoris

Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum

109
Q

posterior cutaneous nerve of thigh

A

branch of sacral plexus (anterior divisions of ventral rami of S2 and S3 spinal nerves and posterior divisions of ventral rami of S1 and S2 spinal nerves)  leaves pelvis through greater sciatic foramen, inferior to piriformis

descends deep to gluteus maximus, just medial to sciatic nerve  as it leaves gluteal region, passes superficial to long head of biceps femoris  continues on back of thigh superficial to hamstring muscles and deep to fascia lata

110
Q

posterior cutaneous nerve of thigh branches:

A

inferior clunial nerves: curve around inferior border of gluteus maximus  supply skin of inferior part of gluteal region

perineal branches: supply skin of superomedial thigh and adjacent perineum

cutaneous branches to back of thigh and upper leg

111
Q

superior gluteal nerve

A

branch of sacral plexus (posterior divisions of ventral rami of L4-S1 spinal nerves)  leaves pelvis through greater sciatic foramen, superior to piriformis, with superior gluteal vessels

runs forward between gluteus medius and gluteus minimus

112
Q

superior gluteal nerve branches:

A

muscular branches to gluteus medius, gluteus minimus and tensor fasciae latae

articular branch to hip joint

113
Q

inferior gluteal nerve

A

branch of sacral plexus (posterior divisions of ventral rami of L5-S2 spinal nerves)

leaves pelvis through greater sciatic foramen, inferior to piriformis, with inferior gluteal vessels

supplies gluteus maximus

114
Q

pudendal nerve

A

branch of sacral plexus (anterior divisions of ventral rami of S2-S4 spinal nerves)

leaves pelvis through greater sciatic foramen, inferior to piriformis, with internal pudendal vessels (most medial structure inferior to piriformis); curves around posterior aspect of ischial spine; passes through lesser sciatic foramen to enter perineum

115
Q

nerve to obturator internus

A

branch of sacral plexus (anterior divisions of ventral rami of L5-S2 spinal nerves)

leaves pelvis through greater sciatic foramen, inferior to piriformis and just lateral to pudendal nerve and internal pudendal vessels; gives a branch to superior gemellus; passes through lesser sciatic foramen; supplies obturator internus

116
Q

nerve to quadratus femoris

A

branch of sacral plexus (anterior divisions of ventral rami of L4-S1 spinal nerves)

leaves pelvis through greater sciatic foramen, inferior to piriformis  descends deep (anterior) to obturator internus and gemelli  supplies quadratus femoris, inferior gemellus and hip joint

117
Q

superior and inferior gluteal arteries

A

branches of internal iliac artery (originate within pelvis)

leave pelvic cavity and enter gluteal region via greater sciatic foramen with corresponding nerves

divide into branches distributed throughout gluteal region

118
Q

internal pudendal artery

A

branch of internal iliac artery (originates within pelvis)

accompanies pudendal nerve through gluteal region and into perineum

has no important branches in gluteal region

119
Q

veins of gluteal region

A

superior and inferior gluteal and internal pudendal veins; accompany arteries of same name; drain into internal iliac vein

120
Q

sciatic foramen structures

A 
piriformis muscle
sciatic nerve
posterior cutaneous nerve of thigh
superior and inferior gluteal nerves
nerve to obturator internus
nerve to quadratus femoris
pudendal nerve
superior and inferior gluteal vessels
internal pudendal vessels
121
Q

lesser sciatic foramen

A

obturator internus muscle
nerve to obturator internus
pudendal nerve
internal pudendal vessels

122
Q

cutaneous innervation anterior thigh L-M

A

lateral cutaneous branch of subcostal nerve

femoral branch of genitofemoral nerve

ilioinguinal nerve

lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve): supplies skin along lateral aspect of thigh

anterior cutaneous nerves of thigh (anterior femoral cutaneous nerves): branches of femoral nerve  supply skin of anterior and medial aspects of thigh

anterior branch of obturator nerve: supplies small area of skin on medial aspect of thigh

123
Q

posterior thigh innervation

A

posterior cutaneous nerve of thigh (posterior femoral cutaneous nerve)

124
Q

great saphenous vein

A

originates from medial end of dorsal venous arch of foot  ascends anterior to medial malleolus and along medial aspect of leg (with saphenous nerve)  passes posteromedial to knee joint (approximately a hand’s breath posterior to medial border of patella)  runs superiorly along medial aspect of thigh  in upper thigh passes through saphenous opening (opening in fascia lata)  drains into femoral vein

connected to deep veins via several perforating veins along its course  blood flows from superficial to deep veins through these perforating veins (valves prevent flow in opposite direction)  if valves become incompetent, perforating veins leak blood during muscular contraction  superficial veins become dilated and varicose

125
Q

small saphenous vein

A

originates from lateral end of dorsal venous arch of foot  passes inferior and then posterior to lateral malleolus  in lower ⅓ of leg, it lies just lateral to calcaneal (Achilles) tendon  as it ascends in leg, it inclines slightly medially to reach midline of calf  pierces crural fascia (dep fascia of leg) in middle or upper ⅓ of leg  drains into popliteal vein

along its course in foot and leg it is accompanied by sural nerve

connected to deep veins of leg via perforating veins  also communicates with great saphenous vein

126
Q

superficial inguinal lymph nodes

A

lie in superficial fascia

efferent vessels from superficial inguinal lymph nodes pass through saphenous opening; drain into deep inguinal lymph nodes

127
Q

superficial inguinal lymph nodes horizontal group

A

lies just below and parallel to inguinal ligament; receives superficial lymph vessels from anterior abdominal wall (below umbilicus), perineum and gluteal region

128
Q

superficial inguinal lymph nodes vertical group

A

lies along terminal part of great saphenous vein; receives all superficial lymph vessels of lower limb (except those from lateral foot and lateral leg; accompany small saphenous vein and drain into popliteal lymph nodes)

129
Q

deep fascia of thigh

A

encloses thigh like a stocking

thickened along lateral aspect to form iliotibial tract

130
Q

deep fascia saphenous opening:

A

gap in fascia lata in superomedial part of anterior aspect of thigh

transmits great saphenous vein, small superficial branches of femoral vessels and efferent lymph vessels from superficial inguinal lymph nodes

131
Q

inferior inguinal muscular space

A

located lateral to interlacunar ligament; contains psoas major and iliacus muscles, femoral nerve and lateral cutaneous nerve of thigh

132
Q

inferior inguinal vascular space

A

located medial to interlacunar ligament; contains femoral artery and vein, lymphatics and femoral branch of genitofemoral nerve

133
Q

muscles of anterior compartment

A

sartorius
pectineus
quadriceps femoris
iliopsoas

134
Q

sartorius origin

A

ASIS

135
Q

sartorius insertion

A

fibers run inferiorly and medially

insert into upper part of medial surface of shaft of tibia (part of pes anserinus together with gracilis and semitendinosus)

136
Q

sartorius innervation

A

femoral nerve

137
Q

sartorius actions

A

flexion, abduction and lateral rotation of thigh at hip joint

flexion and medial rotation of leg at knee joint

138
Q

pectineus origin

A

pectineal line (pecten pubis) of superior ramus of pubis

139
Q

pectineus insertion

A

fibers pass inferiorly and laterally; attach to posterior aspect of femur between lesser trochanter and upper end of linea aspera (pectineal line of femur)

140
Q

pectineus innervation

A

femoral nerve (occasionally, it also receives some innervation from obturator nerve)

141
Q

pectineus action

A

flexion and adduction of thigh at hip joint

142
Q

quadriceps femoris

A

rectus femoris
vastus medialis
vastus intermedius
vastus lateralis

143
Q

rectus femoris origin

A

straight head: AIIS; reflected head; ilium, immediately above acetabulum

rectus femoris is the only head of quadriceps femoris that originates from hip bone

144
Q

vastus lateralis origin

A

upper part of intertrochanteric line, base of greater trochanter, lateral border of gluteal tuberosity and linea aspera

145
Q

vastus medialis origin

A

lower part of intertrochanteric line, spiral line and linea aspera

146
Q

vastus intermedius origin

A

anterior and lateral surfaces of shaft of femur

147
Q

quadriceps femoris insertion

A

4 muscles pass distally and form quadriceps femoris tendon that encloses patella; distal to patella, patellar ligament is functionally the continuation of quadriceps femoris tendon; extends from lower part of patella to tibial tuberosity

148
Q

quadriceps femoris innervation

A

femoral nerve

149
Q

quadriceps femoris action

A

extension of leg at knee joint (4 heads)

rectus femoris: flexion of thigh at hip joint

150
Q

iliopsoas insertion

A

lesser trochanter of femur

151
Q

iliopsoas innervation

A

ventral rami L1-L3

femoral nerve

152
Q

iliopsoas action

A

flexion of thigh at hip joint

acting from below (femur fixed): flexion of trunk

153
Q

muscles of medial compartment

A 
gracilis
 adductor longus
 adductor brevis
 adductor magnus
 obturator externus
154
Q

gracilis origin

A

body and inferior ramus of pubis

155
Q

gracilis insertion

A

fibers run vertically down; insert into upper part of medial surface of shaft of tibia; only muscle of medial compartment that crosses knee joint (part of pes anserinus together with sartorius and semitendinosus)

156
Q

gracilis innervation

A

obturator nerve

157
Q

gracilis action

A

adduction of thigh at hip joint

flexion and medial rotation of leg at knee joint

158
Q

adductor longus origin

A

body of pubis

159
Q

adductor longus insertion

A

fibers diverge as they pass inferiorly and laterally  insert into middle ⅓ of linea aspera

160
Q

adductor longus innervation

A

obturator nerve

161
Q

adductor longus action

A

adduction and flexion of thigh at hip joint

162
Q

adductor brevis origin

A

body and inferior ramus of pubis

163
Q

adductor brevis insertion

A

fibers diverge as they pass inferiorly and laterally; insert into posterior surface of femur, just lateral to pectineal line, and proximal part of linea aspera

164
Q

adductor brevis innervation

A

obturator nerve

165
Q

adductor brevis action

A

adduction and flexion of thigh at hip joint

166
Q

adductor magnus origin

A

inferior ramus of pubis, ramus of ischium and ischial tuberosity

167
Q

adductor magnus insertion

A

medial border of gluteal tuberosity, linea aspera, medial supracondylar line and adductor tubercle of femur

168
Q

adductor magnus

adductor part

A

consists of fibers that originate from inferior ramus of pubis and ramus of ischium and insert into medial border of gluteal tuberosity, linea aspera and medial supracondylar line of femur

169
Q

adductor magnus

hamstring part

A

most medial part of muscle  consists of fibers vertically oriented that extend from ischial tuberosity to adductor tubercle of femur

170
Q

adductor magnus innervation

A

adductor part: obturator nerve

hamstring part: tibial division of sciatic nerve

171
Q

adductor magnus action

A

adductor part: adduction of thigh at hip joint

hamstring part: extension of thigh at hip joint

172
Q

adductor hiatus

A

gap in lower part of adductor magnus that communicates adductor canal with popliteal fossa
as femoral vessels pass through adductor hiatus, they become popliteal vessels

173
Q

obturator externus

A

Origin: outer surface of obturator membrane and bony margins of obturator foramen

Insertion: fibers converge and pass inferior and then posterior to hip joint  insert into trochanteric fossa on medial surface of greater trochanter

Nerve supply: obturator nerve

Action: lateral rotation of thigh at hip joint

174
Q

femoral triangle

A

triangular, depressed area in upper part of anterior thigh

femoral triangle is continuous inferiorly with adductor (subsartorial) canal

175
Q

femoral triangle boundaries

A

superior: inguinal ligament
lateral: medial border of sartorius
medial: medial border of adductor longus (some authors consider lateral border of adductor longus as medial boundary)
floor (from lateral to medial): iliopsoas, pectineus and adductor longus muscles
roof: overlying fascia lata

176
Q

adductor canal

subsartorial, hunter’s

A

intermuscular space located on medial aspect of middle ⅓ of thigh

begins superiorly at apex of femoral triangle and ends inferiorly at adductor hiatus
triangular in cross-section

177
Q

adductor canal walls

A

medial wall: sartorius
anterior wall: vastus medialis
posterior wall: adductor longus and adductor magnus

178
Q

adductor canal contents

A

femoral artery and vein
saphenous nerve
nerve to vastus medialis (both are branches of femoral nerve)
genicular branch of posterior division of obturator nerve

179
Q

femoral triangle contents

A 
lateral cutaneous nerve of thigh
femoral nerve and artery and their branches
femoral vein and its tributaries
femoral branch of genitofemoral nerve
deep inguinal lymph nodes
adipose tissue
180
Q

femoral artery

A

main arterial supply to lower limb

begins at the level of inguinal ligament, as a continuation of external iliac artery

ends at adductor hiatus: after adductor hiatus, it enters popliteal fossa and becomes popliteal artery

descends first through femoral triangle and then through adductor canal

in upper part of femoral triangle, it lies between femoral nerve (lateral to artery) and femoral vein (medial to artery)

in lower part of its course, it lies anterior to femoral vein

181
Q

femoral artery branches

A

its initial segment gives off small branches that contribute to supply inferior part of anterior abdominal wall and external genitalia (superficial epigastric, superficial circumflex iliac and superficial and deep external pudendal arteries)

muscular branches (supply muscles of anterior and medial compartments of thigh)

profunda femoris (deep femoral) artery

descending genicular artery: small branch that originates from femoral artery close to adductor hiatus  contributes to arterial anastomosis around knee joint

182
Q

profunda femoris (deep femoral) artery

A

largest and most important branch of femoral artery

chief source of blood supply to thigh muscles

originates from femoral artery in upper part of femoral triangle

as it descends, it passes posterior to femoral artery

leaves femoral triangle by passing between pectineus and adductor longus, then it descends posterior to adductor longus and anterior to adductor brevis and magnus (adductor longus separates profunda femoris artery from femoral artery)

terminates as 4th perforating artery

183
Q

profunda femoris (deep femoral) artery branches

A

medial and lateral circumflex femoral arteries
perforating arteries
muscular branches (supply neighboring muscles)

184
Q

medial and lateral circumflex femoral arteries

A

arise from profunda femoris near its origin, in femoral triangle (may originate directly from femoral artery)

circumflex femoral arteries pass around upper part of shaft of femur, give off branches to muscles of anterior and medial compartment of thigh, femur, hip joint and knee joint

185
Q

perforating arteries

A

there are usually 4 (4th perforating artery is the terminal branch of profunda femoris artery

perforating arteries pierce adductor brevis and/or adductor magnus (close to their femoral insertion)  reach posterior compartment of thigh

provide chief blood supply to posterior compartment muscles

186
Q

trochanteric anastomosis:

A

located near trochanteric fossa of femur; established between branches of superior gluteal, inferior gluteal, medial circumflex femoral and lateral circumflex femoral arteries

187
Q

cruciate anastomosis

A

located at the level of lesser trochanter; established between branches of inferior gluteal, medial circumflex femoral, lateral circumflex femoral and 1st perforating arteries

188
Q

trochanteric AND cruciate anastomoses

A

provide connections between branches of internal iliac and femoral arteries; become important if there is an occlusion of femoral artery proximal to origin of profunda femoris artery

189
Q

femoral vein

A

begins at adductor hiatus, as a continuation of popliteal vein

ascends through adductor canal and femoral triangle, first posterior and then medial to femoral artery

terminates at the level of inguinal ligament, where it becomes continuous with external iliac vein

tributaries: great saphenous vein + veins that accompany branches of femoral artery (share same name)

190
Q

obturator artery

A

usually originates in pelvis from anterior division (trunk) of internal iliac artery

runs anteriorly on lateral pelvic wall with obturator nerve and vein  leaves pelvis and enters medial compartment of thigh via obturator canal (upper part of obturator foramen)

divides into anterior and posterior branches  pass around margins of obturator foramen

gives branches to muscles in medial compartment of thigh and to hip joint

191
Q

obturator vein

A

receives tributaries that correspond to branches of obturator artery

drains into internal iliac vein

192
Q

deep inguinal lymph nodes

A

lie along medial side of upper part of femoral vein

receive lymph from superficial inguinal lymph nodes

also receive lymph from all deep tissues of lower extremity

deep structures located above knee drain directly into deep inguinal lymph nodes

deep structures from knee down drain first into popliteal lymph nodes; efferent vessels from popliteal lymph nodes accompany femoral vessels and drain into deep inguinal lymph nodes

efferent vessels from deep inguinal lymph nodes drain into external iliac lymph nodes

193
Q

femoral sheath

A

fascia that lines abdominal walls (endoabdominal fascia) extends into upper thigh to form femoral sheath

femoral sheath surrounds femoral vessels and lymphatics for about 1 inch inferior to inguinal ligament (does not surround femoral nerve); blends inferiorly with adventitia of femoral vessels

194
Q

femoral sheath lateral compartment

A

contains femoral artery

195
Q

femoral sheath intermediate compartment

A

contains femoral vein

196
Q

femoral sheath medial compartment

A

it is known as femoral canal

contains lymph vessels and usually one of the deep inguinal lymph nodes

upper end of femoral canal is known as femoral ring

femoral canal is the site of femoral hernias (protrusion of abdominal contents through femoral canal into upper thigh)

197
Q

femoral nerve

A

largest branch of lumbar plexus (posterior divisions of ventral rami of L2-L4 spinal nerves)

emerges from lateral border of psoas major within abdomen  descends in interval between psoas major and iliacus

enters thigh by passing inferior to inguinal ligament in muscular space (lacuna)

in femoral triangle, it is located lateral to femoral artery, outside femoral sheath

terminates by dividing into multiple branches about 4 cm inferior to inguinal ligament

198
Q

femoral nerve branches

A

muscular branches to iliacus, sartorius, pectineus and 4 heads of quadriceps femoris

anterior cutaneous nerves of thigh (anterior femoral cutaneous nerves): supply skin of anterior surface and part of medial surface of thigh

articular branches to hip and knee joints

saphenous nerve

199
Q

saphenous nerve

A

longest branch of femoral nerve

runs inferiorly and medially, first in femoral triangle and then in adductor canal (passes anterior to femoral vessels in adductor canal)

becomes superficial on medial side of knee between tendons of sartorius and gracilis; descends along medial side of leg with great saphenous vein; passes anterior to medial malleolus; runs along medial border of foot, usually as far as 1st metatarsophalangeal joint (ball of great toe)

supplies skin of medial aspect of leg and along medial border of foot to ball of great toe

200
Q

obturator nerve

A

branch of lumbar plexus (anterior divisions of ventral rami of L2-L4 spinal nerves)

emerges from medial border of psoas major; runs anteriorly on lateral wall of pelvis with obturator artery and vein; leaves pelvis and enters medial compartment of thigh via obturator canal (upper part of obturator foramen)

within obturator canal, it divides into anterior and posterior branches (divisions)

201
Q

obturator nerve anterior branch

A

descends posterior to adductor longus and anterior to adductor brevis

supplies adductor longus, adductor brevis and gracilis (occasionally pectineus), hip joint and a small cutaneous area on medial aspect of thigh

202
Q

obturator nerve posterior branch

A

pierces obturator externus; descends posterior to adductor brevis and anterior to adductor magnus; supplies obturator externus and adductor part of adductor magnus (occasionally adductor brevis) and knee joint

Tri 3 - Gross Anatomy II (20 decks)

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