Femoral Triangle, Adductor Canal, Gluteal Region (lecture)

Question 1

Femoral Triangle

Answer 1

A triangle Depression in the superior/anterior thigh

Many large neurovascular structures pass through and can be accessed easily

Question 2

Boundaries of the Femoral Triangle

Answer 2

Mnemonics: SAIL (Sartorius, Adductor longus, and Inguinal ligament)

Superiorly: Inguinal Ligament
Medically: Medial border of the adductor longus
Laterallly by the sartorius

Apex: medial border of the sartorius crosses the lateral border of the adductor longus muscle

Question 3

Contents of Femoral Triangle

From Lateral to Medial

Answer 3

1. Femoral nerve and its branches
2. Femoral sheath and its contents
   Femoral artery
   Femoral vein and its proximal tributaries (Great saphenous vein)
   Deep inguinal lymph nodes and associated lymph vessels in the femoral canal

Question 4

Fascia Lata defect: Saphenous Opening

Answer 4

Great saphenous vein passes through the saphenous opening to drain into the femoral vein

Question 5

Femoral Canal

Answer 5

Medial compartment of the femoral sheath

Entrance: femoral ring (rigid structure bounded by ligaments and a muscle)

Question 6

Femoral hernias

Answer 6

Femoral ring is the usual originating site

Passes through the ring, into the femoral canal and ultimately pass through the saphenous opening

In the Femoral Triangle

Question 7

Lymphatic vessels

Superficial

Answer 7

Lie in superficial fascia; some follow the great saphenous vein and others drain foot and leg and join those associated with smaller sphaneous vein or drain into the popliteal nodes

Question 8

Lymphatic vessels:

Deep

Answer 8

Accompany the blood vessels

Question 9

Popliteal lymph nodes

Answer 9

In the popliteal fossa

Question 10

Superficial inguinal lymph nodes

Horizontal Group

Answer 10

Inferior and parallel to the inguinal ligament and drain penis, scrotum, labia, perineum, buttock , abdominal wall;

Question 11

Superficial inguinal lymph nodes:

Vertical group

Answer 11

Lies along the terminal part of the great saphenous vein and receives drainage from vessels associated with the great saphenous vein

Question 12

Deep Inguinal Lymph Nodes

Answer 12

Deep to the deep fascia along the medial side of the femoral vein and receive drainage from deep lymphatics of the lower extremity and superficial nodes

Question 13

Adductor Canal (subsartorial canal, Hunter Canal)

15 cm in the middle third of thigh

Answer 13

Extends from the apex of femoral triangle to the adductor hiatus in the tendon of the adductor magnus muscle

Provides intermuscular passageway for the femoral artery and vein, saphenous nerve, and nerve to the vastus medialis muscle

Enables femoral vessels to emerge in the popliteal fossa and be renamed the popliteal vessels

Question 14

Boundaries of the Adductor Canal

Answer 14

Vastus medialis anteriorly and laterally

Adductors longus and magnus posteriorly

Sartorius medially. It overlies the canal, forming its roof

Question 15

Medial and Lateral Circumflex femoral Arteries

Answer 15

Principle blood supply to the head of the femur

Medial is the main

Question 16

Retinacular (Nutrient) arteries

Answer 16

Arising mainly from the medial circumflex femoral artery and pass along the femoral neck beneath the capsule

Question 17

Artery of the ligament of the head of the femur

Answer 17

Branch of the obturator artery that provides variable (0-20%) of the blood supply to the head of the femur in the adult

Question 18

Gluteal Region

Answer 18

The intergluteal cleft separates the buttocks

Gluteal folds (sulcus) marks the lower limit of the butt and upper limit of the thigh

Level of iliac crests: superior border

Question 19

Innervation of the skin of the gluteal region

Answer 19

Just be familiar that the clunial nerves supply this region

Question 20

Ligaments of the Gluteal Region

Answer 20

Sacrospinous ligament: from sacrum to ischial spine

Sacrotuberous ligament: sacrum to ischial tuberosity.

Question 21

Gluteal Tuberosity

Answer 21

A rough, bumpy ridge of bone coursing inferiorly from the intertrochanteric crest to the superior end of the linea aspera

Serves as attachment site for the gluteus Maximus muscle

Question 22

Intertrochanteric Crest

Answer 22

smooth, thick ridge of bone that forms the posterior junction of the femoral neck and shaft; runs obliquely from the greater trochanter to the lesser trochanter. Near the center of the crest is a small tubercle for the attachment of the quadratic Femoris muscle

Question 23

Iliotibial band (IT band)

Answer 23

Longitudinal fibrous reinforcement of fascia lata

Attaches from iliac tubercle to lateral condyle of tibia

Gluteus maximus and tensor fasciae latae muscles insert into the IT band

Question 24

IT band syndrome

Answer 24

Common cause of lateral knee pain

Results from excessive friction between the IT band and lateral femoral epicondyle

Question 25

Muscles of the Gluteal Region

Answer 25

They all point roughly in the direction of, and connect outright with, the greater trochanter (except gluteus maximus)

Organized into a superficial and deep group

Question 26

Superficial Gluteal Group

Answer 26

Actions: abduction and extension of the thigh

Prox: the external surface of the ilium

Distal: IT band/ Gluteal tuberosity (Maximus) or greater trochanter (mediums and minimus)

Blood and nerve supply: inferior and superior gluteal vessels and nerves

Question 27

Gluteus Maximus

Sup Gluteal muscle

Answer 27

Prox: ilium and sacrum and sacrotuberous ligament
Distal: IT band and proximal femur
Innervation: inferior gluteal nerve
Actions: extends the thigh and assists in lateral rotations

Question 28

Gluteus Medius

Sup gluteal muscle

Answer 28

Prox: lateral surface of the ilium
Distal: greater trochanter of the femur
Innervation: Superior Gluteal nerve
Action: abduct and medially rotate the thigh

Question 29

Gluteus Minimus

Sup gluteal muscle

Answer 29

Prox: lateral surface of the ilium
Distal: Greater trochanter of the femur
Innervation: superior gluteal nerve
Action: abduction and medially rotate the thigh

Question 30

Tensor Fasciae Latae

Sup Gluteal Muscle

Answer 30

Prox: ASIS
Distal: IT band
innervation: superior gluteal nerve
Action: abduct and medially rotate the thigh

Question 31

Deep Gluteal Group of Muscles

Answer 31

Are small lateral rotators and stabilizers of the hip joint

Attach from the sacrum and ischium to the greater trochanter or adjacent to it

Question 32

Piriformis (deep gluteal muscle)

Answer 32

Prox: anterior surface of the sacrum
Distal: greater trochanter
Innervation: nerve to piriformis
Action: laterally rotates the thigh

Question 33

Obturator Internus (Deep gluteal muscle)

Answer 33

Prox: obturator foramen and obturator membrane
Distal: greater trochanter
Innervation: Nerve to obturator internus
Action: laterally rotates the thigh

Question 34

Superior and inferior gemelli (deep Gluteal muscle)

Answer 34

Superior Prox: ischial spine. Inferior prox: ischial tuberosity
Distal: greater trochanter
Innervation: Sup: nerve to the obturator internus
Inf: nerve to the quadratus femoris
Action: Laterally rotates the thigh

Question 35

Quadratus femoris (deep gluteal muscle)

Answer 35

Prox: Ischial Tuberosity
Distal: Intertrochanteric crest of femur
Nerve to the quadratus femoris
Action: laterally rotates the thigh

Question 36

Structures passing above the Piriformis Muscle

Answer 36

Vessels: superior gluteal vessels
Nerves: Superior Gluteal nerve

Question 37

Structures passing below the piriformis muscle

Answer 37

Vessels: inferior gluteal vessels
Internal pudendal vessels
Nerves: inferior Gluteal nerve, sciatic nerve, posterior femoral cutaneous nerve, nerve to quadratus femoris, nerve to obturator internus, pudendal nerve

Other: superior gemellus, tendon of the obturator internus, inferior gemellus, and quadratus femoris

Question 38

Superior Gluteal Artery

Answer 38

Largest branch of internal iliac artery
Enters gluteal region through the greater sciatic foramen superior to piriformis muscle

Under gluteus maximus: divides into branches that supply buttocks

Question 39

Inferior Gluteal Artery

Answer 39

Another branch of internal iliac artery, enters gluteal region through the greater sciatic foramen inferior to the piriformis muscle and descends on the medial side of the sciatic nerve

Supplies muscles of buttocks and back of thigh

Question 40

Superior Gluteal Nerve (L4,5, S1)

Answer 40

Passes through the greater sciatic foramen immediately superior to the pisiformis. Passes btwn gluteus medius and minimus and supplies both muscles as well as tensor fasciae latae

Question 41

Inferior Gluteal Nerve (L5, S1,2)

Answer 41

Traverses the greater sciatic foramen just inferior to the pisiformis muscle and supplies the gluteus maximus

Question 42

Sciatic Nerve

Answer 42

Largest nerve in the human body
L4,5,S1,2,3 segments of sacral plexus
emerges from the greater sciatic foramen inferior to piriformis muscle
Travels in the posterior compartment of the thigh posterior to the adductor magnus muscle
Contains tibial division and common fibular division
Will divide into tibial nerve (posterior compartment of leg and plantar foot) and common fibular nerve (nerve of anterior and lateral compartments of the leg)

Question 43

Piriformis Syndrome

Answer 43

TIghtness or spasm causes the muscle to compress and irritate the sciatic nerve. Brings lower back and buttock pain that is sometimes severe

May be confused with sciatica

Question 44

Positive Trendenlenburg’s Sign

Answer 44

Stability of the hip joint when a person stands on one leg with the foot of the opposite leg raised above the ground depends on the gluteus medius and minimus muscles being functionally normal. If the hip abductors are weak or paralyzed, then the pelvis will sink downwards on the opposite, unsupported side