Hip Region and Thigh Flashcards
In anatomy, what are the names given to the top and bottom of the leg?
Upper leg = THIGH
Lower leg (knee downwards) = LEG
What does the superficial fascia of the thigh and leg contain?
Greater saphenous vein
Lesser saphenous vein
Cutaneous nerves
Where does the greater saphenous vein start?
Dorsal-venous arch = where the dorsal veins of the 1st and 5th digit meet
Does the greater saphenous vein run medial or lateral initially?
What structure does it encounter as it does this and where does it travel in relation to this structure?
Medially
It travels 1 finger breadth ANTERIOR to the MEDIAL MALLEOULUS
Where does the grater saphenous vein travel after it has passed the medial malleolus?
Explain its route until just before it joins a larger vein.
It travels medially along the leg, posteriorly at the knee, back medially along the thigh then travels anteriorly to the front of the thigh
What vein does the greater saphenous join?
What structures does it interact with in the process?
The greater saphenous punctures the fascia lata (deep fascia of the thigh) at the saphenous opening
What is the name of the fascial layer that covers the thigh?
Fascia lata
What is the name of the fascial layer that covers the back of the knee?
Popliteal fascia
What is the name of the fascial layer that covers the leg?
Crural fascia
What is the name of the fascial layer that covers the bottom of the foot?
Which bone does this attach to (heel bone)?
Plantar fascia
The calcaneous bone
Which nerve follows the path of the greater saphenous vein?
What does this supply?
Which nerve is this a branch of and is this anterior or posterior?
Which structure does this nerve pass through as it travels downwards?
Saphenous nerve
It supplies medial leg and foot cutaneously
It is a posterior branch of the femoral nerve
It travels through the adductor canal and adductor hiatus
How many compartments are there in the thigh?
3
How many compartments are there in the leg?
3
Where is the start of the lesser saphenous vein?
At the dorsal-venous arch, same as the greater saphenous vein
Where does the lesser saphenous vein run after it has started?
Laterally
It runs inferior and posterior to the lateral malleolus
It then travels posteriorly up the leg
What vein does the lesser saphenous join?
What structures does it interact with in the process?
It joins the popliteal nerve
It punctures the popliteal fascia to do this
Which nerve follows the lesser saphenous nerve?
What nerve is this a branch of? (Be specific as to which branches form which nerves)
What does this nerve do?
Sural nerve
It is made from a combination of branches of the sciatic nerve branches:
- tibial nerve
- common fibular nerve
It supplies the lateral foot and leg cutaneously
What function do the muscles of the anterior compartment of the thigh have?
1) extension of the knee
2) flexion of the hip
What function do the muscles of the posterior compartment of the thigh have?
1) flexion of the knee
2) extension of the hip
What function do the muscles of the medial compartment of the thigh have?
Hip ADDUCTION
What function do the muscles of the anterior compartment of the leg have?
1) dorsiflexion of the foot
2) inversion of the foot
What function do the muscles of the posterior compartment of the leg have?
1) plantar flexion of the foot
2) inversion of the foot
What function do the muscles of the lateral compartment of the leg have?
1) eversion of the foot only
Which two muscles cause foot inversion?
Which compartments are they in?
1) tibialis anterior = anterior compartment
2) tibialis posterior = posterior compartment
Which nerve supplies the anterior compartment of the thigh?
What are it’s roots?
Femoral nerve
Roots = L2-L4
Which nerve supplies the medial compartment of the thigh?
What are it’s roots?
Obturator never
Roots = L2-L4
Which nerve supplies the posterior compartment of the thigh?
What are it’s roots?
Sciatic nerve
Roots = L4-S3
Which posterior thigh muscle section is innervated by the common fibular part of the sciatic nerve?
The short head of biceps femoris
What are the muscles of the posterior compartment of the thigh?
What are their innervations?
Biceps femoris (common fibular part of the sciatic nerve)
Semitendinous (tibial part of the sciatic nerve)
Semimembranous (tibial part of the sciatic nerve)
What are the two divisions of the sciatic nerve?
Which is anterior and which is posterior?
Which compartment does each supply in the leg?
1) anterior division = tibial = supplies posterior compartment of leg
2) posterior division = common fibular = supplies anterior and lateral compartment of leg
NB: division orientation = OPPOSITE to the compartment it supplies
Which nerve supplies the sole of the foot?
Tibial nerve branch of the sciatic nerve which ends up forming the medial and lateral plantar nerves
Which nerve supplies the dorsum of the foot?
Common fibular branch of the sciatic nerve
What are the 2 divisions of the common fibular nerve and what does each innervate?
What are the nerve roots for each?
1) superficial fibular nerve = lateral leg = roots L4-S1
2) deep fibular nerve = anterior leg = roots L4-S1
What does the superior gluteal nerve innervate?
What are it’s roots?
L4-S1
Gluteus minimus, medius and tensor fascia lata
What does the inferior gluteal nerve innervate?
What are it’s roots?
Gluteus maximus
L5-S2
What is the pathway of the common fibular nerve distal to the knee?
Around the neck of the fibula
Which artery branches from the aorta to supply the lower leg?
What artery does this eventually become and when?
External iliac
Femoral artery after it bypasses under the inguinal ligament
What is the largest branch of the femoral artery?
Profunda femoris
What is another name for the common fibular nerve?
Common peroneal
Which thigh compartments does the profunda femoris supply?
Medial and posterior thigh
What are the boarders of the femoral triangle?
Superior boarder = inguinal ligament
Lateral boarder = medial part of sartorius muscle
Medial boarder = adductor longus
Floor = adductor longus
When does the femoral artery become the popliteal artery?
Once it penetrates Adductor Magnus through the adductor hiatus
Where does the gluteal region blood supply arise from?
Branches of the INTERNAL iliac arteries
Where dels the hip joint get its arterial supply from?
Branches of the profunda femoris
Which artery supplies the anterior thigh compartment?
Femoral
Explain the route the femoral artery takes to become the popliteal artery.
Travels in anterior compartment, anterior to posterior of femur bone, pierces adductor hiatus in the adductor Magnus muscle (found in the medial compartment)
What does the popliteal artery branch into?
1) anterior tibial artery
2) posterior tibial artery
Explain the course of he anterior tibial artery.
Popliteal artery is posterior to knee
Branches to form anterior tibial
Anterior tibial travels posterior to anterior BETWEEN fibula and tibia
Eventfully forms dorsalis pedis artery (pulse point)
What does the posterior tibial artery further divide into?
1) peroneal artery
2) plantar arteries
Name 4 pulse points of the lower limbs.
1) femoral
2) popliteal
3) posterior tibial
4) dorsalis pedis
What is the vein supply mirroring in the lower limb?
The arterial supply
Where are the only lymphatic nodes in the lower limb?
Deep nodes in the popliteal fascia
Which nodes in the thigh region does the whole lower limb drain to?
What else drains here?
Superficial inguinal nodes
Anterior abdomen
Genitals
Lower back
Gluteal region
What are the 2 types of lymphatic drainage vessels?
What structures does each follow?
1) deep lymphatic drainage (follows arteries)
2) superficial lymphatic drainage (follows great saphenous vein)
How common are anterior and posterior hip dislocations?
Posterior = 9/10
Anterior = 1/10
What position would the lower limb be in for each type of hip dislocation?
Posterior dislocation
= hip flexion
= adduction
= internal rotation
Anterior dislocation
= mild hip flexion
= abduction
= external rotation
What is a normal hip join flexion range?
What limits this?
Unlimited, limited only but soft tissues
What is a normal hip join extension range?
What limits this?
20 degrees limited by ligaments
What is a normal hip joint abduction range?
60 degrees
What is a normal hip joint adduction range?
30 degrees
What is the main arterial supply to the inside of the capsule of the hip joint?
What may damage to this this cause? (And therefore require thinking about during hip fractures)
Medial femoral circumflex artery (a profunda femoris branch)
Avascular necrosis of the femoral head/neck
What are the trochanters of the femur used for?
Muscle attachment
Which muscle inserts to the lesser trochanter?
Iliopsoas
Which muscle inserts to the quadratic tubercle?
Quadratus femoris
What is the normal angle of the axis of the femur between the neck and shaft?
What is this angle called?
125 degrees
Angle of inclination
What is an abnormally low angle of inclination called?
Who may you see this in?
Coxa vara
Elderly
What is an abnormally high angle of inclination called?
Who may you see this in?
Coxa vaga
Children
What is the angle of anteversion/declination/torsion?
What is a normal angle?
The angle the neck is at compared to the centre of the femur
It is usually 15 degrees forwards
What is the femoral shaft angle/an atomic axis of the femur?
Why is this needed?
The angle between the distal and proximal ends of the femur caused by the neck pushing the femur away from the hip, usually about 6 degrees, to keep the weight of the body held by the distal femur
Which ligament fills the gap of the inferior part of the acetabulum?
Transverse acetabular ligament
Which ligament attaches the acetabulum to the femoral head?
What is the name of the notch in the femoral head to which this ligament attaches?
Which artery travels with this and what is it a branch of?
Ligament of the head of the femur
Fovea
The acetabular branch of the obturator artery (with the obturator being a branch of the internal iliac artery)
What 3 ligaments strengthen the hip joint capsule?
Which is the strongest?
1) pubofemoral
2) iliofemoral (strongest = biggest bone) - Y shape
3) ishiofemoral
Which line can you look at on an X-ray to see if a dislocation or displaces fracture may be present?
Shenton’s line
Where is worst for femoral fractures for poor salvageability of the head of the femur?
In the capsule = vessels will not survive = avascular necrosis
Which gluteal muscles air above the hip joint and can therefor abduct the hip?
Minimus and medius
What are the 3 main foramen in the pelvic region?
Greater sciatic foramen
Lesser sciatic foramen
Obturator foramen
What separated greater from lesser sciatic foramen?
Why is it called this?
Sacrospinous ligament
It attaches to sacrum and ischial spine
