Final Flashcards
What actions do the anterior compartment of the thigh do?
Hip flexion
Knee Extension
What action does the medial compartment of the thigh do?
Adductor
What invests the LE?
Deep Fascia
What separates the compartments of the thigh and what are those compartment?
Fibrous septa of the fascia lata & crural fascia
Anterior, medial & posterior
Where does the fascia lata attach superiorly?
Inguinal ligament, pubic arch, body of pubis & pubic tubercle
Where does the fascia lata attach laterally & posteriorly?
Iliac crest
Where does the fascia lata attach posteriorly to?
Sacrum, coccyx, sarcrotuberous ligament & ischial tuberosity
What is an extremely strong, thickened lateral compartment of the fascia lata?
Iliotibial band
What muscles does the iliotibal band enclose?
Tensor fascia lata & Gluteus maximus
Where does the IT band attach at distal?
Gerdy’s tubercle on the tibia
What permits the passage of the great saphenous vein and where?
Saphenous opening
Inferior to medial part of the inguinal ligament
What is the name of the deep fascia of the leg and what is it continuous with?
Crural fascia
Continuous with the fascia lata
Which veins contain more valves? superficial or deep?
Deep
What are the 2 major superficial veins?
Great & small saphenous veins
What combines to give rise to the great saphenous veins?
Dorsal vein of great toe & dorsal venous arch
Where does the great saphenous vein empty into?
Femoral vein
What combines to form the small saphenous vein?
Dorsal vein of the small toe & dorsal venous arch
Where does the small saphenous vein empty into?
Popliteal vein
What doe pulsations from arteries & compression from muscles aid in?
Venous return
Why does perforating veins always allow blood from superficial to deep only?
Pierce the deep fascia and valves
What are the boundaries of the femoral triangle?
Superiorly: Inguinal ligament
Medially: Adductor longus muscle
Laterally: Sartorius Muscles
Apex: Where sartorial m & adductor longus muscle cross
Roof: Fascia lata, subcutaneous tissue & skin
Floor: iliopsas & pectinous mm
What are the contents of the femoral triangle?
Femoral N & branches
Femoral Sheath
Femoral A
Femoral V
Lymph Nodes
What is the femoral sheath?
Funnel shaped fascial tube extending 4 cm inferiorly from inguinal ligament
What is the femoral sheath a continuation of?
Transveralis fascia of abdominal wall & fascia covering the iliopsoas muscle
Blends with outer layer of femoral vessels (tunica adventitia)
What does the femoral sheath allow?
Femoral vessels to glide easily beneath the inguinal ligament during movement of the hip (flex/ext)
What are the three compartments of the femoral sheath & what is the contents?
Lateral: femoral artery
Intermediate: Femoral Vein
Medial: is the femoral canal (normally empty)
What is the proximal opening into the femoral canal?
Femoral ring
What are the boundaries of the femoral ring?
Laterally: Fascial partition b/w femoral canal & vein
Posteriorly: Superior ramus of pubis covered by pectinous m
Medially: Lacunar ligament
Anteriorly: Medial aspect of inguinal ligament
What is the inguinal ligament and what it is formed by?
Retinaculum
Formed from aponeurosis of external oblique muscle of the anterior abdominal wall
Fibers of the inguinal ligament that attach to the superior pubic ramus make up what?
Lacunar ligament
Fibers of the inguinal ligament that attach most posterior & laterally projecting represent what?
Pectineal ligament
What muscles make up the anterior compartment of the thigh?
Sartorius
Pectineus
Iliopsoas
Tensor of fascia lata
Quadriceps femoris
All muscle in the anterior compartment of the thigh are innervated by the femoral nerve except?
Psoas major & Tensor fascia lata
What muscles make up the medial compartment of the thigh?
Gracilis
Adductor Longus
Adductor brevis
Adductor Magnus
Branches of the obturator nerve innervate the muscles of medial compartment except?
Part of adductor Magnus
What is the adductor canal?
Narrow fascial tunnel coursing about 15 cm long in the thigh, deep to middle 1/3 of sartorius muscle
What does the adductor canal provide a passage way for?
Provides passage through the musculature for vessels to reach the popliteal fossa
Where the does the proximal end of the adductor canal begin and what is the distal end?
Prox: Where sartorius muscles cross over the adductor longus muscle
Distal: Adductor hiatus
What things pass through the adductor canal?
Femoral artery & veins
Femoral nerves
Saphenous N
Nerve to vastus medialis m
What things pass through the adductor canal and then through the hiatus to the popliteal fossa?
Femoral artery & vein
What is the name of the branch off the femoral artery?
Profunda femoris artery (deep artery of the thigh)
What artery does the deep artery of the thigh give off?
Circumflex femoral arteries
How does the posterior compartment of the thigh get blood?
Deep artery sends several perforating branches
Does the posterior compartment have an artery coursing through it?
No
What is the transitional region from trunk to limb posteriorly?
Gluteal region
What are 3 clinical correlation of Femoral triangle?
Cannulation of femoral A & V
Femoral hernia
What is a hip pointer?
Contusion of iliac crest, usually anterior near ASIS & organ of sartorius muscle caused by collision
What is a charley horse?
Muscle fibers tearing, hematoma in quadriceps causing localized pain
Which muscle is the largest & most powerful adductor in the thigh?
Adductor Magnus
What are the three parts of adductor magnus?
Minimus, adductor & hamstring parts
Where is the adductor portion of adductor Magnus attached and what can it do?
Attached along entire length of linea aspera of femur & inferiorly onto medial supracondylar ridge
Can flex the thigh
What are the difference between the hamstring portion of adductor Magnus & the rest of the muscle?
Attachment: Attached to ischial tuberosity to adductor tubercle
Nerve Supply: Tibial division of sciatic nerve
Main Action: Extend the thigh
True or False: Hamstring portion does not fulfill all the criteria to be a true hamstring
True
What is a pulled groin?
Stretching injury (strain of adductor muscles/and or tearing of their proximal attachments
Within the proximal thigh what nerves travel from the abdominal wall & send branches to innervate the skin?
Subcostal, iliohypogastric & ilioinguinal nerves
What muscle does the genitofemoral nerve pierce & where does it go?
Psoas Major
- Descends on the surface of the muscles to the inguinal region
Where does the lateral femoral cutaneous nerve emerge & where does it travel?
- Emerges Superolateral to femoral nerve from deep to lateral edge of psoas muscle
- Travels laterally to anterolateral thigh by cousin deep to most lateral part of inguinal ligament
What does the lateral femoral cutaneous nerve innervate?
Anterolateral thigh
How does the obturator nerve reach the medial thigh?
Travels through obturator foramen
What muscle does the femoral nerve originate within?
Psoas Major
Where does the femoral nerve travel?
Lateral to pass major on surface of lilacus muscle, then deep to middle of inguinal ligament & into thigh
What does the femoral nerve innervate?
Iliac muscle
Anterior compartment muscle of thigh
What is the farthest reaching branch of the femoral nerve & what does it innervate?
Saphenous nerve
Cutaneous innervation to medial leg & medial aspect of proximal foot
What is the gluteal region bounded by?
Superiorly: Iliac Crest
Medially: Intergluteal cleft
Inferiorly: Gluteal fold
What bones form the aceatublum?
All 3 pelvic bones (ilium, ischium & pubis)
How is the femur oriented and why?
Obliquely to put knees more adjacent & inferior to trunk
What are the prominent feature of the femur?
Head, neck, greater & lesser trochanter & large condyles
What is the angle of inclination?
Obtuse angle b/w basic of femoral neck & femoral shaft
What does the angle of inclination of the femur have to do with mobility?
Arrangement allows for greater mobility of hip joint by placing head & neck of femur more perpendicular to acetabulum
Due to the angle of inclination how can the muscles be oriented?
Rotator muscle oriented laterally
Abductors placed superiorly (freeing lateral surface of femur for attachment of knee extensors)
The articulation of what forms the anterior sacroiliac joint?
Auricular surfaces of sacrum & ilium have irregular surfaces of which interlock
Why is the anterior sacroiliac joint unique?
Synovial joint with very little mobility
What are the thin anterior fibers of the capsule?
Anterior sacroiliac ligaments
What surrounds the posterior sacroiliac joint?
Posterior sacroiliac ligaments
What are the posterior sacroiliac ligaments?
External continuations of deeper interosseous ligaments
What are interosseous ligaments?
Strong fibers that connect the tuberoses of sacrum & ilium
What does the orientation of the interossus ligament do to the ilia?
Pulls it inward when body weigh drives sacrum downward
What do the iliolumbar ligaments do?
Strengthen lumbrosacral joints by spanning from transverse process of L4,5 to ilium
Where does the sacrotuberous ligament run?
Posterior ilium & lateral sacrum & coccyx to ischial tuberosity
Where does the sacrospinous ligament run?
From lateral sacrum & coccyx to ischial spine
What force does the sacrospinous & sacrotuberous ligament resist?
Anterior/Inferior rotation of sacrum from body weight
What is the greater sciatic foramen an opening for?
Structures entering or leaving the pelvis
What is the lesser sciatic foramen an opening for?
Structures entering or leaving the perineum
What is the name of the part on the femur that is not covered with articular cartilage>
Central area called the fovea
What attaches to the fovea?
ligament of femoral head (ligament teres)
Why are the surfaces of the femoral head not congruent when standing upright?
B/c acetabulum faces anteriorly, laterally & inferiorly
- Angle of femoral neck & head
What part of the femoral head is exposed when standing upright?
Anterior portion
Where is the lunate surface of the acetabulum and what does it cover?
Covered with cartilage at the periphery, covers the rim
What is the acetabular notch?
Inferiorly the lunate surface of the acetabulum is deficient this makes the acetabular notch
What is the labrum & what does it do?
Lip of cartilage
Extends off the rim to keep socket & adds about 10% more surface area to acetabulum
What is the transverse acetabular ligament & what does it span?
Inferior continuation of labrum & spans the notch
What is the acetabular fossa?
Deepest, most central part of acetabulum
- Formed mainly by ischium
What are the movements of the hip joint?
Flexion- Extension
Adduction- Abduction
Medial - Lateral Rotation
Cirumduction
Where does the capsule of the hip attach to?
Proximally: From acetabular rim & transfers acetabular ligament
Anteriorly: Intertrochanteric line
T/F: There is an attachment of the capsule to the femur posteriorly
F
What are the 3 intrinsic ligament that support the hip joint?
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Where does the iliofemoral ligament span & what does it prevent?
Spans AIIS & acetabular rim to intertrochanteric line
Prevents hyperextension of hip by screwing the femoral head into the acetabulum
Where does the pubofemoral ligament span & what does it prevent?
- Spans from obturator crest (of pubic bone) to blending with capsule & iliofemoral ligament
- Prevents hyperabduction but also tightness during extension
Where does the ischiofemoral ligament span and what does it limit?
Posterior, Spans from ischial part of acetabular rim to neck of femur, medial to greater trochanter
- Not as strong as other but limits hyperextension
Of the intrinsic ligaments of the hip joint, which is the weakest?
Ischiofemoral ligament
What is the main blood supply of the hip?
Medial circumflex femoral artery
What does the medial circumflex femoral artery arise from and where?
Arises from deep femoral artery near the neck of the femur
Where do penerating branches of the deep femoral artery pierce the capusle?
Posterior side
If the medial circumflex artery was damaged would the femoral head be able to get enough blood?
No because the artery to the femoral head is not significant enough to sustain it
Where does the artery to the femoral head arise from?
Obturator artery
What is the similarities of the superficial gluteal muscles?
- Proximal attachment to Ala & margins of the ilium
- Mainly extend, abduct & medially rotate
What is the similarities of the deep gluteal muscles?>
- Smaller
-Distal attachments on or near the intertrochanteric crest of femur - Laterally rotate & stabilize hip joint by steading femoral head in acetabulum
What is the most superficial gluteal muscle and what is the attachments?
- Gluteus maximus
- Attached posterior to posterior gluteal line on ilium & along sacrum, coccyx, & sacrotuberous ligament
- Most fibers insert into ITB, some directly onto gluteal tuberosity
When is the gluteus maximus most active?
Extending thigh from flexed position
What are the actions of gluteus maximus?
Extending thigh from flexed position
Laterally rotate
Steady thigh going from sitting to standing
True or false: Glutues maximus is active when standing upright
False
What are the shared attachments and actions of gluteus maximus & minimus?
- Posterior ilium, greater trochanter
- Abduct & medially rotate thigh
- Keep Pelvis level when the contralateral limb is in swing phase
True or False: Tensor Fascia lata functions as medius & minimus do
True
What are the attachments of the tensor of fascia lata?
Prox: ASIS & anterior iliac crest
Distal: Gerry’s tubercle
All smaller gluteal muscles can abduct the flexed thigh except?
Quadratus femoris
What is the roll of the smaller muscles of the gluteal region?
Lateral rotators of thigh
Steady femoral head in acetabulum
What nerves supply the skin of the butt?
Clunial nerves
True or False: Superior & middle clonal nerves are anterior rami coming from upper lumbar & sacral levels
False- Posterior Rami
Where do the deep gluteal nerves arise from?
Sacral plexus (L4-S3)
What do all the deep gluteal nerves pass through?
Greater sciatic foramen
All the deep gluteal nerves pass through the greater sciatic foramen and emerge inferior to piriformis muscle except?
Superior gluteal nerve
Where doe the superior gluteal nerve emerge from to innervate what?
- Above piriformis
- Innervate gluteus medius, gluteus minimus & tensor of fascia lata
What does the inferior gluteal nerve innervate?
Gluteus maximus
What does the nerve to quadratus femoris innervate?
inferior gemellus & quadratus femoris
What does posterior cutaneous nerve of the thigh innervate?
Large area of skin including:
- inferior half of butt
- Posterior thigh
- Popliteal fossa
- Lateral perineum
- Upper medial thigh
What nerve does the posterior cutaneous nerve give off?
Inferior clonal nerve
What does the pudenal nerve innervate in the gluteal region & posterior thigh?
Nothing
Where does the pudenal nerve go and how does it get there?
Most medial nerve that dives back into the pelvis through the lesser sciatic foramen
What does the nerve to obturator internus innervate in gluteal region?
Superior gemellus & obturator internus
The nerve to obturator internus ends up where and how does it get there?
Pelvis through inferior sciatic foramen
What provides the main blood supply to the pelvis?
Internal iliac artery
Where doe the external iliac artery course?
Stay anterior, pass through femoral canal to supply lower extremity structures
What arteries of the gluteal region emerge through the greater sciatic foramen?
Superior gluteal artery
Inferior gluteal artery
Internal pudendal artery
The superior gluteal emerges (blank) to piriformis whereas inferior gluteal artery emerges (blank) to piriformis?
Superior
Inferior
What is the name of the artery that gives off the artery to the sciatic nerve?
Inferior gluteal artery
What does the inferior gluteal artery supply?
Glut max
obturator internus
quadratus femoris
superior part of hamstring
What two arteries often participate with anastomoses around the hip?
Superior & inferior gluteal arteries
What does the internal pudendal artery course with and where does it go & what does it supply?
Pudenal nerve
Goes back into pelvis through lesser sciatic foramen
Supply perineal skin, external genitalia & perineal muscles
Deep artery of thigh gives off branches to posterior thigh called? What do they penetrate?
Perforating branch
Aponeurotic aspect of adductor Magnus
What criteria must a muscle meet to be considered a true hamstring?
- Prox attachment to ischial tuberosity
- Span & act on 2 joints: (extend thigh & flex leg)
- Innervated by tibial division of sciatic nerve
Does short head of bicep femoris meet any criteria to be a hamstring?
No
Where doe the sciatic nerve typically emerge?
From pelvis inferior to piriformis muscle through the greater sciatic foramen
Within sciatic nerve large sheath it is really 2 separate nerves named what?
Tibial nerve & common fibular nerve
Does the sciatic nerve innervate anything in the gluteal region?
No
Of the posterior thigh what does the tibial part innervate?
Hamstrings & hamstring part of adductor magnus
Of the posterior thigh what does the common fibular part innervate?
SHort head of biceps femoris
Everything inferior to the knee is innervated by branches of the sciatic nerve except for one exception which is?
Saphenous nerve
What are the 3 main divisions of the thorax?
Mediastinum: central compartment, housing all thoracic contents except lungs
Paired Lateral pulmonary cavities: Occupied by lungs
What bones make up the thoracic cage?
- 12 pairs of ribs & associated costal cartilages
- 12 thoracic vertebrae & intervening IVD
- Sternum
What is the primary function of the thoracic cage?
Protective of thoracic & abdominal contents
What are the 3 parts of the sternum?
manbrium
body
xiphoid process
What is the name of the junction between the manubrium & body?
Manubiostenal joint or sternal angle
Articulation of what 3 bones make up the xiphisternal joint?
7th rib attaching at junction of body & xipohiod process
What represents the inferior limit of the thoracic cavity?
Xiphoid process
The facets on the head of ribs articulate with vertebrae of same numerical level & one superior except?
1st rib articulates with T1 & ribs 10-12 with their respective vertebrae
Which ribs attach to the sternum directly via their costal cartilages?
True ribs 1-7
False ribs articulate to what via their costal cartilages?
Next superior rib
Where do floating ribs end?
Abdominal musculature
Which ribs are false ribs?
8-10
which ribs are floating ribs?
11-12
What are costal grooves?
Concavities on the inferior, internal borders of ribs for intercostal nerves & vessels
Where are intercostal spaces present and what are they named for?
B/w each successive rib & named for superior rib
What is the costovertebral joints?
b/w head of ribs & vertebral bodies
What is the costotransverse joint?
b/w tubercle of ribs & transverse process of thoracic vertebrae
What is the costochondral joint?
b/w ribs & costal cartilage
What is the sternocostal joint?
b/w costal cartilage & sternum
What joints of thorax are synchondroses?
All costochondral joint
1st rib/manubrium (1st sternocostal joint)
Xiphisternal joint
Where do symphyses occur in the thorax?
Posteriorly b/w thoracic vertebral bodies
Anteriorly at manubriosternal joint
What are the boundaries of the superior thoracic aperture?
Posteriorly: Vertebrae T1
Laterally: 1st rib & their costal cartilage
Anteriorly: Superior border of manubrium
What structures pass through superior thoracic aperture?
Trachea, esophagus, nerves & vessels that supply/drain the head, neck & upper extremity
What are the boundaries of the inferior thoracic aperture?
Posteriorly: T12 vertebrae
Posterolaterlly: 11th & 12th pairs of ribs
Anterolaterally: costal margins, made up of costal cartilages 7-10
Anteriorly: Xiphisternal joint
What covers the inferior thoracic aperture?
diaphragm
What abdominal viscera lay superior to the plane of the inferior thoracic apenture?
liver, stomach, spleen
How do the external intercostal run?
Inferoanteriorly b/w successive ribs b/w tubercles & costochondral junctions
When are the eternal intercostal most active?
Inspiration, maintaining the tone of muscles & elevating the ribs during forced inspiration
What are the external intercostal continuous with?
External oblique muscles
How do the internal intercostals run and what are they continuous with?
Inferoposteriorly
Continuous with internal oblique muscles
When are internal intercostal most active?
Expiration
What do intercostal nerves & vessels travel between?
Internal intercostals & innermost intercostals
Where do the transverse thoracic muscles run and what is their action?
- 4-5 slips of muscle deep on anterior wall from diploid process & body of sternum running to costal cartilages
- Help w/ inspiration & proprioceptive role
What is transverse thoracic muscles continuous with?
Transverse abdominis layer inferiorly
Where do the subcostal muscles run & what is their action?
- Span 2-3 ribs oriented inferoposteriorly
-Depress ribs
What is the primary muscle of inspiration?
Diaphragm
What are the 3 hiatus in the diaphragm?
Inferior vena cava, aorta & espousal
Where do internal thoracic arteries & vein run?
internal anterior thoracic wall, running on either side of the sternum
What does the internal thoracic artery divide into?
Musculophrenic & superior epigastric
What artery supplies the first 6 intercostal spaces?
Anterior intercostal arteries
What artery supply intercostal spaces 7-9 & the diaphragm?
Musculophrenic
What artery supplies anterior abdominal wall supplying muscles?
Superior epigastric
What does the pulmonary cavities contain?
Lungs & pleura
What separates the pulmonary cavities and what does it contain?
Mediastinum & all other thoracic structures
What lines the entire thoracic wall?
Endothoracic fascia
What does the end-thoracic fascia cover?
Apices of lungs superior to 1st rib
How many lobes the right lung have?
3
What is the pleural sleeve?
Reflection of pleura where all tubular structures enter/exit the lung
What compromises the root?
Actual structures passing into & out of the lung at the hilum
What are the strucutres of the root of the lung?
Bronchus, pulmonary artery, Superior & inferior pulmonary veins
What is the pulmonary ligament?
Double layer pleural structure continuons with sleeve but inferior to root
What is the lingula?
Inferior, anterior projection of the superior lobe that tucks around the apex of the heart
What is found on the left lung in regards to impression?
Cardiac notch
Cardiac impression
Grooves for aortic arch & descending aorta
Where does the trachea begin, terminate & into what?
Begin: inferior to cricoid cartilage
Terminate: Level of sternal angle into right & left main bronchi
Where does the trachea ascend & enter?
Anterior to esophagus entering superior mediastinum
What is the transverse thoracic plane?
Horizontal plane running from sternal angle anteriorly to T4-T5 IV disc
What is the inferior mediastinum subdivided into?
Anterior, middle & posterior compartments
What makes up the mediastinum?
Pericardium & contents
Contents:
- Pericardial sac
- Heart
- Cardiac nerve plexus
- Roots of great vessels (Ascending aorta, SVC/IVC & pulmonary trunk
What are the 2 layers of the pericardium? And what do they blend into?
External fibrous Pericardium –> tunica adventitia of great vessels superiorly & central tendon of diaphragm inferiorly
Parietal layer–> become visceral layer of serous pericardium
What innervated the pericardium?
Cardiac nerve plexus
-Autonomic fibers from vagus nerve
- Sympathetic nerves
What supplies general sense to pericardium?
Phrenic nerve
What supplies blood to pericardium?
Pericardiophrenic artery
What forms the base of the heart?
Left atrium (some right)
What forms the apex of the heart?
inferolateral part of left ventricle
What are the 4 surfaces of the heart?
Anterior (Sternocostal)–> right ventricle
Diaphragmatic –> left ventricle
Right Pulmonary –> right atrium
Left pulmonary –> left ventricle
What are the 4 borders of the heart?
Right–> right atrium
Inferior –> main right ventricle
Left Border –> left ventricle (little bit of left auricle)
Superior –> right & left atria & auricles
What are the component of the abdominal wall?
-Musculoaponeurotic walls
- Diaphragm
- Pelvic floor muscles
- Lumbar section of vertebral
What bounds the anterolateral abdominal wall?
Superiorly: Cartilages of 7th-10th ribs & diploid process
Inferiorly: Inguinal ligament & superior margins of anterolateral aspect of pelvic girdle
What does the linea semilunaris represent?
lateral limit of rectus sheath
What are the component of rectus sheath?
External abdominal oblique & aponeurosis + Internal abdominal oblique & aponeurosis + Transverse abdominal & aponeurosis
What does the abdominal aorta branch into that supplies the abdominal wall?
Posterior intercostal artery
What does the external iliac/femoral artery branch into that supplies the abdominal wall?
superficial epigastric, circumflex iliac & inferior epigastric
What is the inguinal canal formed to permit ?
Descent of testes
What are the lateral & medial crura ?
Parts of external oblique aponeurosis which surround superficial inguinal ring
What is the inguinal falx (conjoint tendon)?
Medial reinforcement of posterior wall of inguinal canal formed by fused aponeuroses of internal oblique & transverse abdomens
What are lateral umbilical folds?
Inferior epigastric a. & v
What are the meidal umbilical folds>
obliterated umbilical arteries
What is the medial umbilical fold (single) ?
obliterated urachus
What are the boudaries of the inguinal triangle?
Medially: rectus abdominis
Inferiorly: Inguinal ligament & inferior epigastric artery & vein
What is the deep inguinal ring in?
Transverse abdominal muscle lateral to vessels
What structures does the iliohypogastric innervate?
- Skin over iliac crest
- Upper inguinal & hypogastric regions
- Superolateral quadrant of buttock
- Internal oblique
- Transverse abdominal muscles
What does the ilioinguinal innervate?
- Skin of lower inguinal region
- Mons pubis/labia majora
- Adjacent medial thigh
Inferiormost internal oblique & transverse abdominal muscles
What does the genitofemoral nerve pierce & split into?
Psoas major
Femoral & genital branch
What type of innervation does the parietal part of the peritoneum receive?
Somatic
