Hips and thigh Flashcards
Which bone forms the medial malleolus?
The tibia
Which bone forms the lateral malleolus?
The fibula
What forms the superior border of the femoral triangle?
Inguinal ligament
What forms the lateral border of the femoral triangle?
medial border of sartorius
What forms the medial border of the femoral triangle?
Medial border of adductor longus
What are the contents of the femoral triangle? lateral to medial
Femoral nerve, artery, vein, femoral canal (contains lymph nodes)
Where does the great saphenous vein drain into?
The femoral vein
What is the pathway of the great saphenous vein?
From the dorsal vein of hallux and dorsal venous arch of the foot, runs anterior to medial malleolus, ascends along the medial surface of the leg, runs posterior to the medial epicondyle of the femur, then along the medial thigh, passes through saphenous opening
What is the saphenous opening?
An opening in fascia lata through which the great saphenous vein passes
In which layer are the superficial inguinal lymph nodes found?
Underneath campers fascia
Where is the saphenous opening in relation to the femoral triangle?
Immediately medial and comes from deep to the triangle
Where are the two groups of superficial inguinal lymph nodes?
Horizontal (just below inguinal ligament) and vertical group (Around great saphenous vein)
Which nerve supplies the skin of the anterolateral thigh?
Lateral femoral cutaneous nerve (L2,3)
Which nerve supplies the skin of the middle of the anterior thigh?
Anterior cutaneous branches of the femoral nerve (L2-4)
Which nerve supplies the skin of the posterior thigh and popliteal fossa?
Posterior femoral cutaneous nerve (S1-S3)
Which nerve supplies the skin of the medial thigh?
Cutaneous branch of obturator nerve
What is the patella plexus?
A bunch of superficial nerves around the knee, they are mainly the terminations of the cutaneous nerves of the thigh
Which nerve is the saphenous nerve (L3,4) a branch of?
Femoral nerve
What does the saphenous nerve supply?
Pre patella skin and skin on the medial side of the leg and foot
What is the pathway of the saphenous nerve?
From femoral nerve, descends through femoral triangle, enters adductor canal crosses femoral artery to become medial, exits canal and pierces fascia lata, becomes sub cutaneous as it comes between gracilis and sartorius tendons
The tendons of which muscles does the saphenous nerve pass through to get to the skin?
Gracilis and Sartorius
What is the function of fascia lata?
To keep the muscles in their place, to increase venous return
Where is the fascia lata?
It is a deep fascia covering the whole thigh, it is continuous with scarpas fascia the and the crural fascia
What is the crural fascia?
The deep fascia of the leg
What are the attachments of the fascia lata?
It attaches to all major prominences of the pelvis and those of the knee
What is the iliotibial band?
The thick part of the fascia lata on the lateral aspect of the thigh
What is the function of the iliotibial band?
Its attachment to the tensor fascia lata muscle means it acts as an abductor, medial rotator and flexor of the thigh
Where does the femoral vein drain into?
External iliac vein
What are the tributaries of the femoral vein?
Deep femoral vein, great saphenous vein, lateral circumflex femoral veins, medial circumflex femoral veins
What are the attachments of sartorius?
O: ASIS
I: Proximal end of tibia via pes anserinus
What is the innervation to sartorius?
Femoral nerve (L2-3)
What are the actions of sartorius?
Hip joint: thigh flexion, thigh abduction, thigh external rotation
Knee joint: leg flexion, leg internal rotation
What is the femoral sheath a continuation of?
transversalis fascia
What are the three compartments of the femoral sheath?
Medial, intermediate, lateral
What is the medial compartment of the femoral sheath known as?
The femoral canal
What does the intermediate compartment of the femoral sheath contain?
The common femoral vein
What does the lateral compartment of the femoral sheath contain?
Common femoral artery
What are the borders of the femoral canal?
Medial: lacunar ligament
Lateral: femoral vein
Anterior: inguinal ligament
Posterior: superior pubic rami, pectineus
What is the function of the femoral canal?
Allows distension of the femoral vein so it can cope with increased venous return
What does the femoral canal contain?
Lymphatic vessels, the lacunar lymph node
What is the femoral ring?
The base of the femoral canal
Which artery does the femoral artery come off?
External iliac artery
What are the branches of the femoral artery?
(Do Princesses Sew Sweet Superhero Dresses)
Descending genicular artery, Profunda femoris artery, Superficial epigastric, Superficial external pudendal, Deep external pudendal
Where does the femoral artery and vein run?
Medial and anterior to the femur
Where does the deep femoral vein drain into?
the femoral vein
Where does the deep artery of the thigh lie in relation to the femoral artery?
posterior and medial - although it emerges laterally
Which arteries supply the surgical neck of the femur?
The medial and lateral circumflex femoral arteries
What is the pathway of the superficial external pudendal artery?
Comes off the femoral artery, pierces femoral sheath, then crosses the spermatic cord/round ligament
What is the pathway of the superficial circumflex iliac artery?
Comes off the femoral artery, travels superiolaterally along the superficial surface of the inguinal ligament
What is the pathway of the deep external pudendal artery?
It comes off the femoral artery and travels towards the superficial aspect of the obturator foramen
What is are the nerve roots of the femoral nerve?
L2-L4
What muscles does the femoral nerve innervate?
pectineus, sartorius, iliacus, quadriceps femoris muscles
What sensory area does the femoral nerve supply?
The middle anterior aspect of the thigh
Where does the femoral nerve split into its anterior (cutaneous) to posterior (motor) branches?
at the lateral circumflex femoral artery
What are the attachments of psoas major?
O: vertebral bodies of T12-L4, transverse processes pf L1-L5
I: Lesser trochanter of femur as iliopsoas tendon
What is the action of psoas major?
Flexion of the thigh, lateral rotation of the thigh, lateral flexion of the trunk
What is the innervation of psoas major?
Anterior rami of spinal nerves L1-L3
What are the attachments of iliacus?
O: Iliac fossa
I: Lesser trochanter of femur
What is the action of iliacus?
Thigh/trunk flexion
What is the innervation to iliacus?
Femoral nerve (L1-L3)
What are the attachments of pectineus?
O: Superior pubic rami
I: Pectineal line of femur, linea aspera of femur
What are the actions of pectineus?
Hip joint: thigh flexion, thigh adduction, external and internal rotation
What is the innervation to the pectineus muscle?
Femoral nerve (L2, L3) (Obturator nerve (L2, L3))
What are the nerve roots of the obturator nerve?
L2-L4
Which muscles does the obturator nerve innervate?
Adductor longus, brevis, adductor portion of magnus, gracilis, obturator externus
What area of the skin is supplied by the obturator nerve?
The medial thigh, hip joint and knee joint
Which nerve supplies the quadriceps?
Femoral nerve (L2-L4)
What is the common insertion of the quadriceps muscles?
Tibial tuberosity via patella ligament
What are the origins of rectus femoris?
ASIS, supra-acetabular groove
What are the origins of vastus medialis?
Intertrochanteric line, pectineal line of femur, linea aspera
What are the origins of vastus lateralis?
Intertrochanteric line, greater trochanter, gluteal tuberosity
What are the origins of vastus intermedius?
Anterior surface of femoral shaft
What are the actions of the quadriceps muscle?
Extension of the leg at the knee. (Flexion of the thigh at the hip - rectus femoris only)
Where is the lateral intermuscular septum?
Between vastus lateralis and the hamstring muscles
What is the adductor hiatus?
An opening in the distal part of the fascia of adductor magnus
What goes through the adductor hiatus?
Femoral artery and vein
What are the attachments of adductor longus?
O: body of pubis
I: Middle third of linea aspera of femur (Medial lip)
What are the actions of adductor longus?
Hip joint: thigh flexion, adduction, external rotation
What are attachments of adductor brevis?
O: anterior body of pubis
I: Linea aspera of femur (medial lip)
What are the actions of adductor brevis?
Hip joint: flexion, adduction, external rotation
What is the innervation of adductor brevis, longus, gracilis and the adductor portion of magnus?
Obturator nerve (L2-L4)
What are the attachments of adductor magnus?
O: Inferior pubic rami, ischial ramus, ischial tuberosity
I: Gluteal tuberosity, linea aspera, medial supracondylar line, adductor tubercle of femur
What are the actions of adductor magnus?
Adductor part: Thigh flexion, adduction, external rotation
Hamstring part: Thigh extension, internal rotation
What are the attachments of gracilis?
O: anterior body of pubis, inferior pubic rami, ischial ramus
I: Medial surface of proximal tibia via pes anserinus
What are the actions of gracilis?
Hip joint: Thigh flexion, thigh adduction
Knee joint: leg flexion, leg internal rotation
What are the attachments of obturator externus?
O: Anterior surface of obturator membrane, bony boundaries of obturator foramen
I: Trochanteric fossa of femur
What are the actions of obturator externus?
Hip joint: Thigh external rotation, abduction
What is the innervation to obturator externus?
Obturator nerve (L3, 4)
What is the natal cleft?
The cleft between the two bum cheeks
Where is the gluteal aponeurosis?
Overlying gluteus medius
What are the attachments of gluteus maximus?
O: lateroposterior surface of sacrum and coccyx, gluteal surface of ilium, thoracolumbar fascia
I: Iliotibial tract, gluteal tuberosity of femur
What are the actions of gluteus maximus?
Hip joint: Thigh extension, external rotation, abduction (Superior part), adduction (Inferior part)
What is the innervation and blood supply to gluteus maximus?
Innervation: Inferior gluteal nerve (L5, S1, S2)
Blood supply: Inferior gluteal and superior gluteal arteries
What are the attachments of gluteus medius?
O: Gluteal surface of ilium
I: Lateral aspect of greater trochanter of femur
What are the actions of gluteus medius?
Hip joint: Thigh abduction, internal rotation
What is the innervation and blood supply to the gluteus medius?
Innervation: Superior gluteal nerve (L4-S1)
Blood supply: Superior gluteal artery
What are the attachments of gluteus minimus?
O: Gluteal surface of ilium
I: Anterior aspect of greater trochanter of femur
What are the actions of gluteus minimus?
Thigh abduction, internal rotation
What is the innervation and blood supply to gluteus minimus?
Innervation: Superior gluteal nerve (L4-S1)
Blood supply: Superior gluteal artery
Which artery do the inferior and superior gluteal arteries arise from?
Internal iliac artery - inferior from anterior division, superior from posterior division
What does the inferior gluteal artery supply?
Deep muscles of the gluteal region, gluteus maximus and pelvic floor
What does the superior gluteal artery supply?
Gluteus muscles, tensor fascia lata, some deep glute muscles
What are the nerve roots of the superior gluteal nerve?
L4-S1
What are the nerve roots of the inferior gluteal artery?
L5-S2 - posterior divisions
What does the superior gluteal nerve supply?
Gluteus medius, minimus, tensor fascia lata
What does the inferior gluteal nerve supply?
Gluteus maximus
What are the six short external rotators of the hip?
Piriformis, gemellus superior, inferior, obturator internus, externus, quadratus femoris
What are the attachments of piriformis?
O: Anterior surface of sacrum, gluteal surface of ilium
I: Greater trochanter of femur
What are the actions of piriformis?
Hip joint: Thigh external rotation, abduction
What is the innervation to piriformis?
Nerve to piriformis (S1-S2) - posterior divisions
Which structures pass through the greater sciatic foramen?
PIN & PINS
Posterior cutaneous nerve of the thigh, Inferior gluteal vessels and nerves, Nerves to quadratus femoris, Pudendal nerve, Internal pudendal vessels, Nerve to obturator internus, Sciatic nerve
What are the nerve roots of the sciatic nerve?
L4-S3
Which muscular compartments does the sciatic nerve supply?
Posterior thigh, posterior, anterior and lateral leg
What are the attachments of the inferior gemellus?
O: Ischial tuberosity
I: Medial surface of greater trochanter of femur
What are the actions of the deep gluteal muscles?
Thigh external rotation, abduction, stabilization of the femur
What is the nerve supply to the inferior gemellus?
Nerve to quadratus femoris (L4,5, S1)
What are the attachments of gemellus superior?
O: Ischial spine
I: Medial surface of greater trochanter of femur
What is the innervation to gemellus superior?
Nerve to obturator internus (L5-S1)
What are the attachments of obturator internus?
O: Posterior surface of obturator membrane, bony boundaries of the obturator foramen
I: Medial surface of the greater trochanter of the femur
What is the innervation to obturator internus?
Nerve to obturator internus - L5-S2 anterior divisions
What are the attachments of quadratus femoris?
O: Ischial tuberosity
I: Intertrochanteric crest of femur
What is the innervation to quadratus femoris?
Nerve to quadratus femoris (L4-S1)
What are the attachments of tensor fascia lata?
O: Outer lip of anterior iliac crest, ASIS
I: Iliotibial tract
Which nerve supplies tensor fascia lata?
Superior gluteal nerve (L4-S1)
What are the functions of tensor fascia lata?
Hip joint: internal rotation
Knee joint: leg external rotation.
Stabilises both joints
What is the pathway of the sciatic nerve?
From L4-S3, it descends through the greater sciatic foramen, out from underneath piriformis, then runs down the posterior thigh between the long head of biceps and adductor magnus
What are the attachments of semitendinosus?
O: Ischial tuberosity
I: Proximal end of tibia - medially via pes anserinus
What is the innervation to semi-tendinosus?
Tibial division of sciatic nerve (L5-S2)
What are the actions of semi-tendinosus and semi-membranosus?
Hip joint: Thigh extension, internal rotation
Knee joint: Leg flexion, internal rotation
What are the attachments of semi-membranosus?
O: Superolateral impression of ischial tuberosity
I: Medial condyle of tibia
What is the innervation to semi-membranosus?
Tibial division of sciatic nerve (L5-S2)
What are the attachments of biceps femoris?
O: Long head: ischial tuberosity, sacrotuberous ligament. Short head: linea aspera of femur (lateral lip)
I: Head of fibula
What is the innervation of biceps femoris?
Long head: tibial nerve (L5-S2)
Short head: Common fibular nerve (L5-S2)
What are the actions of biceps femoris?
Hip joint: Thigh extension, external rotation
Knee joint: Leg flexion, external rotation
What are the contents of the popliteal fossa, superficial to deep?
Common peroneal nerve, tibial nerve, popliteal vein, popliteal artery
Whilst in the standing position, on raising the right leg, the ipsilateral pelvis drops downward.
What anatomical structure is most likely to be affected?
Superior gluteal nerve L4,5 S1
Impingement of which nerve causes difficulty rising from a seat and can’t climb stairs?
Inferior gluteal nerve L5, S1-2
What features prevent the knee cap from dislocating laterally?
-
What are the attachments of the medial collateral ligament?
Medial epicondyle femur to medial tibial condyle: valgus stability
What are the attachments of the lateral collateral ligament?
Lateral epicondyle femur to fibula head: varus stability
What are the attachments of the anterior cruciate ligament?
Anterior tibia to lateral intercondylar notch femur: prevents tibia sliding anteriorly (hands in pockets )
What are the attachments of the posterior cruciate ligament?
Posterior tibia to medial intercondylar notch femur: prevents tibia sliding posteriorly
What structures pass through both the greater and lesser sciatic foramen?
PIN
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
What is the ligament at the head of the femur attaching it to the acetabulum?
The foveal/round ligament of the femur
What are the three ligaments of the hip joint?
Iliofemoral, pubofemoral, ischiofemoral
Where is the transverse acetabular ligament?
Connecting each side of the acetabular labrum
Which artery supplies the head of the femur and foveal ligament?
Obturator artery
Which movement does the ACL prevent?
Anterior translation of the tibia on the femur
Which movement does the PCL prevent?
Posterior translation of the tibia on the femur
