Femoral Triangle, Anterior and Medial Thigh

Question 1

What are the borders of the femoral triangle?

Answer 1

Superiorly = inguinal ligament
Laterally = sartorius
Medially = adductor longus

Question 2

What forms the floor of the femoral triangle?

Answer 2

Formed by iliopsoas laterally and pectineus medially

Question 3

What are the contents of the femoral triangle (from lateral to medial)

Answer 3

Femoral nerve, femoral artery, femoral vein and femoral canal (lymphatics)

Question 4

What does the femoral canal contain?

Answer 4

Deep inguinal lymph nodes and adipose tissue (where femoral hernias form)

Question 5

What is contained within the femoral sheath?

Answer 5

The femoral artery and vein

Question 6

What is the femoral sheath?

Answer 6

Short tube of transversalis and iliopsoas fascia from the abdominal wall which surrounds most proximal parts of the femoral artery and vein, blends inferiorly with the adventitia of these vessels

Question 7

Where is the femoral nerve in relation to the femoral sheath?

Answer 7

Outside and lateral to the sheath

Question 8

What is the femoral nerve?

Answer 8

L2-L4, formed in lumbar plexus

Question 9

Where do the saphenous (sensory) branches of the femoral nerve leave via?

Answer 9

Leave adductor canal distally by passing between sartorius and gracilis

Question 10

Where do the saphenous branches of the femoral nerve innervate?

Answer 10

Supply fascia and skin of anteromedial aspects of knee and leg, and medial aspect of the foot where it accompanies the great saphenous vein

Question 11

What is a femoral hernia, and what can cause it?

Answer 11

Can present as painful lump in the groin; increased abdominal pressure causes peritoneum to herniate into canal

Question 12

What aspect of the femoral sheath does the femoral canal form?

Answer 12

Forms most medial part

Question 13

Where do deep inguinal lymph nodes run from?

Answer 13

Run in a chain from the femoral canal to the femoral vein

Question 14

Where do the medial and lateral circumflex arteries supply?

Answer 14

Supply majority of blood to the head of the femur through their retinacular branches

Question 15

Where do the retinacular branches of the medial and lateral circumflex arteries pass?

Answer 15

Pass superiorly in relation to the femoral neck and capsule of hip joint

Question 16

How are the medial and lateral circumflex arteries named?

Answer 16

According to the aspect of the profundal femoris artery from which they emerge

Question 17

What can the femoral pulse be used to locate?

Answer 17

The femoral vein and nerve, which can be used for cannulation and nerve block respectively

Question 18

What is the femoral pulse?

Answer 18

The pulsation of the femoral artery

Question 19

What processes can the femoral artery be used for?

Answer 19

Angiograms, coronary artery stenting, aortic/mitral valve replacements, AA repair

Question 20

Where is the inguinal ligament?

Answer 20

Inferior border of external oblique aponeurosis, runs between ASIS and pubic tubercle (forms a gutter)

Question 21

What is in the medial half of the inguinal ligament?

Answer 21

The inguinal canal

Question 22

Where can the inguinal ligament be palpated?

Answer 22

At the junction between the external oblique aponeurosis and the deep fascia of the thigh (the fascia lata)

Question 23

What structures pass deep to the inguinal canal to enter/leave the lower limb?

Answer 23

Femoral vessels, nerve and iliopsoas muscle/combined tendon all pass deep to the inguinal ligament in the retroinguinal space

Question 24

What are the proximal attachments of the iliopsoas?

Answer 24

Iliac fossa (iliacus), lumbar transverse process/IV discs (psoas major)

Question 25

What muscles make up the anterior compartment of the thigh?

Answer 25

Iliopsoas, sartorius, quadriceps femoris

Question 26

What is the distal attachment and nerve supply of the iliopsoas?

Answer 26

Attaches distally to the lesser trochanter of the femur; supplied by the anterior rami of lumbar spinal nerves

Question 27

What action does the iliopsoas perform?

Answer 27

Flexion at the hip

Question 28

What are the proximal and distal attachments of the sartorius?

Answer 28

``` Proximal = ASIS Distal = medial surface of proximal tibia (via pes anserinus) ```

Question 29

What nerve supplies the sartorius, and what action does the muscle perform?

Answer 29

Supplied by femoral nerve; performs flexion at hip

Question 30

What are the four muscles that make up the quadriceps femoris?

Answer 30

Rectus femoris, vastus lateralis, vastus intermedius, vastus medius

Question 31

What are the proximal attachments of the muscles which make up the quadriceps femoris?

Answer 31

Rectus femoris = ASIS | Vastus lateralis, intermedius and medius = shaft of femur

Question 32

What is the distal attachment of the quadriceps femoris?

Answer 32

Patella (via quadriceps tendon) then tibial tuberosity (via patellar ligament/tendon), same attachment for all four muscles

Question 33

What action does the quadriceps femoris perform?

Answer 33

Extension of the knee (and weak flexion of the hip for rectus femoris)

Question 34

Which nerve supplies the quadriceps femoris?

Answer 34

The femoral nerve

Question 35

What is the knee jerk reflex?

Answer 35

Deep tendon reflex elicited by striking the patellar ligament with a tendon hammer to suggest a sudden stretch of the quadriceps muscle

Question 36

What is a normal result of the knee jerk reflex?

Answer 36

Reflex contraction of the quadriceps and slight extension at the knee joint

Question 37

What does a positive test result of the knee jerk reflex show?

Answer 37

Functions of the muscle, its nerve supply (femoral nerve, spinal roots L2-4), the spinal cord connections and descending controls from the brain which normally act to prevent unwanted recurrent reflexes from occurring during normal functioning

Question 38

Why are muscles of the medial compartment called the adductor group?

Answer 38

Their action is to adduct the thigh at the hip joint

Question 39

What are the muscles of the medial compartment?

Answer 39

Gracilis, adductor brevis, adductor longus, adductor magnus

Question 40

What are the different parts of the adductor magnus?

Answer 40

Hamstring part and adductor part

Question 41

What are some features of the gracilis?

Answer 41

Most medial muscle of group, thin strap-like muscle descending along the medial aspect of the thigh

Question 42

Which is the only muscle of the medial aspect of the thigh to cross the knee in addition to the hip?

Answer 42

The gracilis (weak flexor of knee)

Question 43

Where does the gracilis insert into?

Answer 43

Superomedial aspect of the tibia

Question 44

Where are the adductors brevis and longus located?

Answer 44

Anterior to the adductor magnus, adductor brevis lies superior to the adductor longus

Question 45

What are the proximal attachments of the muscles of the medial thigh?

Answer 45

Pubis, ischiopubic ramus or ischial tuberosity(hamstring part of adductor magnus)

Question 46

What are the distal attachments of the muscles of the medial thigh?

Answer 46

Posterior surface of the shaft of the femur along the linea aspera, adductor tubercle of femur (hamstring part of adductor magnus)

Question 47

What nerve innervates the muscles of the medial thigh?

Answer 47

All muscles innervated by the obturator nerve (L2-4) except the hamstring part of the adductor magnus (innervated by tibial nerve)

Question 48

Where do the obturator vessel and nerve enter the medial compartment of the thigh?

Answer 48

Via the obturator foramen of the hip joint

Question 49

Where does the obturator nerve divide into its posterior and anterior branches?

Answer 49

Once inside the medial compartment of the thigh at the upper border of the adductor brevis

Question 50

Where is the anterior branch of the obturator nerve located?

Answer 50

Between adductors brevis (anteriorly) and longus (posteriorly) in the superior part of the medial compartment of the thigh

Question 51

What nerves provide sensory innervation to the thigh?

Answer 51

Anterior cutaneous nerve of the thigh = branch of femoral nerve (L2-4) Lateral cutaneous nerve of the thigh = branch of the lumbosacral plexus (L2-3) Cutaneous branch of the obturator nerve (L2-4)

Question 52

What does lymph drainage tend to follow?

Answer 52

Venous drainage

Question 53

Where does lymph from superficial structures (e.g skin, superficial fascia) follow?

Answer 53

The great and small saphenous veins

Question 54

Where does lymph following the great saphenous vein drain into?

Answer 54

Superficial inguinal lymph nodes located in the superficial fascia around the vein, then from there mostly drains into external iliac nodes and some to deep inguinal nodes

Question 55

Where does lymph following the small saphenous vein drain into?

Answer 55

Popliteal lymph nodes located in the popliteal fossa, then from there drains into deep inguinal nodes and finally into the external iliac nodes

Question 56

Where are the deep inguinal nodes located?

Answer 56

Deep to the deep fascia of the thigh (fascia lata) medial to the femoral vein

Question 57

Where does all lymph from the lower limb ultimately drain into?

Answer 57

The external iliac nodes