L38 Anterior and Medial Thigh Flashcards
Iliopsoas
PA: T12-L5 vertebrae
DA: lesser trochanter
Act: hip flexor (primary)
Inn: femoral n (iliacus)
anterior rami (psoas)
Pectineus
PA: sup. pubic ramus
DA: pectineal lines
Act: hip flexor, adductor
Inn: femoral n
Sartorius
PA: ASIS
DA: proximomedial tibia
Act: hip flexion, abduction, lateral rotation, knee flexion medial knee rotation
Inn: femoral n
What are the four heads of quadriceps femoris?
Rectus femoris, vastus intermedius, vastus lateralis, vastus medialis
What is the one muscle of knee extension?
Quadriceps femoris
Rectus femoris
PA: AIIS
DA: tibial tuberosity
Act: knee extension, hip flexion
Inn: femoral n.
Vastus intermedius
PA: anterolateral femur
DA: tibial tuberosity
Act: knee extension
Inn: femoral n
Vastus lateralis
PA: linea aspera
DA: tibial tuberosity
Act: knee extension
Inn: femoral n
Vastus medialis
PA: linea aspera
DA: tibial tuberosity
Act: knee extension
Inn: femoral n
What is the common insertion of quadriceps femoris?
How does it continue to the leg?
All four heads of quadriceps femoris come together to form the quadriceps tendon–>patella (sesamoid bone)–>patellar ligament–>tibial tuberosity
This is why they all insert on the tibial tuberosity
When do limb buds appear and when do they rotate in the LE?
Limb buds appear week 4
LE rotates 90 degrees medially in the 7th week, posture persists through infancy
When does the LE change to outward alignment and what is it called?
Changes from varus to valgus (outward) alignmnent when person starts to walk at 1.5 years
Maximum valgus at 3 years old
What are the 3 joints in the LE?
Coxofemoral (os coxae, femur)
Tibiofemoral (femur, tibia, patella)
Talocrural (tibia, fibula, talus)
What is the Iliotibial tract and what muscles insert into it?
Lateral thickening of fascia lata
Acts as aponeurosis for glueteus maximus and tensor fascia lata muscles
IT band inserts into the anterolateral tubercle of the tibia
What are the anterior leg dermatomes?
Anterior LE: L1-S1
L3 medial knee
L4 medial foot
What are posterior LE dermatomes?
Primarily S1 and S2, S1 laterally
L5 bottom of foot
What is the saphenous opening?
What are the two main veins of the LE and where do they drain?
Opening in fascia lata where the great saphenous v. drains to the femoral v.
Great saphenous vein drains most of the leg to the femoral v.
Small saphenous v. drains posteriolateral leg and lateral foot, drains into popliteal vein in popliteal fossa
Lateral side of dorsal venous arch drains into the small saphenous v.
What are the two main lymph nodes of the LE and where do they drain?
Superficial inguinal nodes: with great saphenous v. does antero-medial leg and medial foot (most superficial leg)
Popliteal nodes: with small saphenous v. does posterolateral leg and lateral foot superficial, but does most deep leg and foot
Popliteal drains to deep inguinal nodes–>external iliac nodes–>common iliac nodes
Superficial inguinal nodes–>deep inguinal and external iliac nodes–>common iliac nodes
Internal iliac nodes also drain to common iliac nodes and do the deep gluteal region
How are the fascial compartments arranged in the leg?
Where do they septa arise from?
Anterior, medial, posterior compartents
Septa arise from the linea aspera on the back of the femur
What are the main arteries and nerves of the anterior thigh?
What are the main actions of the anterior thigh?
Deep femoral and femoral aa.
Femoral nerve (L2-L4)
Hip flexion, knee extension
Where do most hip flexors attach?
Where do most knee extenders attach?
Lesser trochanter: hip flexion
Tibial tubersity: knee extension
When could you have pain with iliopsoas movement?
During flexion of the hip
If retroperitoneal, posterior abdominal wall associated structures are diseased (kidney, ureter, colon, pancreas, appendix)
What is a psoas abscess?
How can you test for this?
Lumbar region infection may spread to psoas sheath and into thigh from the abdomen
Iliopsoas test: extend affected side to see if pain
Where do you test for the L4 reflex?
Patellar ligament
What is the main course of the femoral nerve?
What does it innervate?
from L2-L4 anterior rami
Motor: anterior thigh
Sensory: medial leg via saphenous branch
Saphenous brach is the only named branch of the femoral nerve
Course: lateral to psoas major, deep to inguinal ligament, within femoral canal (sheath)
What is the course of the femoral artery and where does it come from?
What are its branches?
What does it innervate?
The external iliac a. becomes the femoral a. once it passes under the inguinal ligament
Once it passes through the adductor hiatus (opening in adductor magnus m) it has a name change to the popliteal a.
Near the head and neck of the femur, the deep femoral a. branches off the femoral a.
This deep artery of the thigh is the main supplier of the thigh
Off it, there are two branches that create an anastomoses and supply the hip: medial and lateral femoral circumflex aa.
There are also perforating aa. off the deep artery of the thigh that supply all thigh compartments
What is the course of the lateral and medial femoral circumflex aa?
Both branches of the deep artery of the thigh
Off the lateral femoral circumflex: ascending branch, transverse branch, descending branch
Medial femoral circumflex a: wraps posterior to the femur, travels between iliopsoas and pectineus, principle supply to the femoral head
If cut off: femoral head avascular necrosis and Legg-Clave-Perthes disease
What are the main arteries and nerves of the medial thigh?
What is the primary action of the medial thigh?
Deep femoral and obturator aa.
Obturator nerve (L2-L4) except adductor magnus hamstring portion (sciatic tibial division)
Obturator a. and n. come together through the obturator canal
Hip adduction
Adductor longus
PA: body of pubis
DA: linea aspera
Act: hip adduction
Inn: obturator n
Gracilis
PA: inferior pubic ramus
DA: proximomedial tibia
Act: hip adduction, flexion
Inn: obturator n
Adductor brevis
PA: inf pubic ramus
DA: linea aspera
Act: hip adduction
Inn: obturator n
Adductor magnus, adductor portion
PA: inf pubic ramus
DA: linea aspera
Act: hip adduction,
flexion
Inn: obturator n
Adductor magnus, hamstring portion
PA: ischial tuberosity
DA: adductor tubercle
Act: hip adduction,
extension
Inn: tibial div. of sciatic
n (L4)
What is a muscle that can be easily removed for transplants?
What muscles are affected by a groin pull?
Gracilis removal yields no significant deficits
Groin pull is strain or tearing of anteromedial thigh mm. near proximal attachment of inferiror pubic ramus and body of pubis (adductor mm). Associated with sprinting
What is the course of the main nerve of the medial thigh?
Obturator nerve (L2-L4) comes through the obturator canal
Anerior and posterior branches are separated by aductor brevis
What is the main course of the obturator artery?
supplies medial thigh
supplies femoral head via “artery to the head of the femur”
anterior and posterior branches
travels with obturator n.
What is Legg-Calve-Perthes disease? (LCPD)
Avascular necrosis of the femoral head, ususally in young boys
femoral head degenerates
may require surgical intervention
What is the femoral triangle?
What are its borders?
Region where neurovasculature enters the anterior thigh
Superior border: inguinal ligament
Lateral border: sartorius
Medial border: Adductor longus
What are the contents of the femoral triangle?
What is the femoral sheath, and what are its contents?
Femoral triangle contents: NAVEL
Femoral n.
Femoral a.
Femoral v.
empty space
lymphatics
Femoral sheath allows gliding of structures during hip movement, AVEL is part of femoral sheathj
Can feel femoral pulse, place for femoral compression
What are the compartments of the femoral sheath?
What are the contents of these compartments?
What is the opening to the femoral canal called?
Lateral compartment: femoral a.
Intermediate compartment: femoral v.
Medial compartment or Femoral canal: lymphatics, fat, loose CT, allows for expansion during venous return
Opening to femoral canal or medial compartment = femoral ring
What are the landmarks for femoral catheter placement?
When do you use femoral vein versus artery?
ASIS and pubic tubercle
Vein for right cadiac angiography: veing goes to right atrium
Artery for left cardiac angiography: artery comes from left ventricle
Describe femoral hernias.
3% of all hernias
Herniation of ileum on right side most likely
typically enters femoral canal through femoral ring
mass is palpable at the saphenous opening, inferior to the inguinal ligament, inferlateral to pubic tubercle
More common in females: broader pelvis, broader femoral ring
Don’t confuse with saphenous varix: dilation of saphenous v. in femoral triangle
More lateral and inferior than an inguinal hernia through the superficial ring
What is the Adductor (Hunter) Canal?
What are its borders?
From femoral triangle to adductor hiatus
Conducts neurovasculature to popliteal fossa
Contains femoral a/v and saphenous n.
Borders: vastus medialis, sartorius, adductor longus
What enters and exits adductor canal?
What does not exit?
Femoral a/v exit the canal through the adductor hiatus to become popliteal a.v
Saphenous n. and artery do not exit the canal through the adductor hiatus, but pierce the adductor magnus muscle and supply cutaneous medial leg/foot
