Lecture 12: Anterior and medial thigh Flashcards
Name important parts of femur - gen
Head
Neck
Lesser and greater trochanters
Shaft
Describe surfaces of femur anterior view
Patellar suffice
Lateral and medial epicondyles
Lateral and medial condyles
What is only visible on posterior femur
Pectineal line
Linea aspera
Supracondylar ridges
Medial and lateral condyles and epicondyles
Describe tibia and fibula
Connected via interosseous membrane
Solid joint - syndesmosis
Describe tibia
Lateral and medial tibial condyles
Tibial tuberosity
Soleal line
What is intercondylar eminence
In middle of tibial condyles
Cruciate ligament attachment
Describe fibula
Head and neck
More lateral
Smaller
What is tibial plateau
Femoral condyles sit on lateral and medial condyles of tibia
Describe malleoli
Form angle joint
Medial = tibial
Lateral = on fibula
What type of joint knee
Synovial - modified hinge joint - condylar
Movements of knee Joint
Primarily flexion extension in Sagittal plane
Some medial/lateral axial rotation -bc modified hinge join - in transverse plane
Describe knee extension
Sagittal plane around transverse axis
120-150 depress extensive arc
But in some people = extra 5-10 degrees of motion = hyper extension
What is knee axial rot
Medial= 10 degrees
Lateral rotation = 30-40 degrees
Rotation of tibia relative to femur with knee flexed = while sitting with foot off grounf
If force motion = bad, too much lateral = can create instability
Name anterior thigh muscles hip flexors/knee extensors
Psoas major and ilaicus
Describe psoas major attachments/innervation
From t12-l4/5 to lesser trochanter as iliopsoas
Innervation = l1-3
Under inguinal lig
Describe iliacus muscle attachments/innervation
From iliac fossa to lesser trochanter femur as iliopsoas
Innervation = femoral nerve
Describe iliopsoas
Iliacus and psoas major fuse to form iliopsoas - common tendon attaches to lesser trochanter
True ales over superior pubis ramus - where they join
What is function of iliopsoas
Hip flexion - pull femur and hip Joint into flexion
Weak lateral rotation (bc lesser trochanter on posterior side)
Where does iliopsoas come out of pelvis
Under inguinal ligament via muscular compartment with lateral femoral cutaneous and femoral nerves
Name anterior thigh msucles
Sartorius
Quadriceps
Describe sartorius - name
Latin for tailor - when engaged in all its hip functions = Sartorius contributes to sitting cross legged in a tailors position - assis en taileur
Describe sartorius - gen
Strapped muscle
Describe sartorius - attachments
Asis to anteromedial tibia in pes anserinus
(Entire length of thigh)
Describe sartorius - functions
Hip flexion, lateral rotation and abduction
(Anterior to hip joint, lat to medial over thigh so abduction)
Weak knee flexion (post to knee joint)
Describe quadriceps femoris
4 heads of femur
Make up quadriceps
= rectus femoris, vastus lateralis, vastus intermedius, vastus medialis
Describe rectus femoris attachments
Ant sup inf iliac spine (aiis) to quadriceps tendon
Describe vastus group attachments
Femur shaft to quadriceps tendon
(Crosses knee joint only)
Describe tendons - quadriceps
All heads of quadriceps converge on to quadriceps tendon - passes knee joint and embeds patella (patella develops in developing quadriceps tendon)
Below knee = called patellar ligament
(Bone to bone, ligament inserts on tibial tuberosity - anterior to knee joint)
Common functions quadriceps
Knee extension
But rectus femoris also does hip flexion - along with iliopsoas bc crosses hip and knee joint
Name medial thigh muscles
Hip adductors =
Pectineus, adductor longus, adductor brevis, gracilis, adductor Magnus
Attachments pectineus
Pubis to pectineal line on femur - upper linea aspera
(Most superior, to pos aspect femur)
Attachments adductor longus
Pubis - superior ramus to linea aspera
Attachments adductor brevis
Pubis to linea aspera
(Deep to pectineus and adductor longus)
Attachments gracilis
Pubis (sup pubic rmaus v close to pubic tubercle) to anteromedial tibia in pes aserinus
(Crosses 2 joints = knee and hip)
Common function medial though msucles
Hip adduction
Additional functions of pectineus, adductor longus and brevis
Hip lateral rotation
Weak hip flexion
Additional function gracilis
Weak hip and knee flexion (knee medial rot too)
Describe adductor Magnus
Largest of adductors
2 parts = adductor and hamstring parts
Adductor portion adductor Magnus attachments
Pubis and ischial tuberosity to linea aspera
hamstring portion adductor Magnus attachments
Pubis and ischial tuberosity to adductor tubercle on medial epicondyle of femur
What is adductor tubercle
Raised egde on medial epicondyle
Adductor portion adductor Magnus Functions
Hip adduction = main
Lateral rotation
Weak flexion - bc on linea aspera
hamstring portion adductor Magnus Functions
Assist hamstrings with hip extension
Why don’t adductor Magnus 2 parts have same function
Bc positions of parts of msucles
What is pes anserinus
Common tendon for distal attachment of 3 msucles located on proximal anteromedial tibia
Trick to remember pes anserinus
Say grace before tea
= Sartorius, gracilis and semiTendinosus msucles
Name the 2 nerves that provide motor innervation to anterior and medial thigh
Obturator nerve = l2-4
Femoral nerve = l2-4
Innervation obturator externus
Obturator nerve L2-4
Innervation adductor longus
Obturator nerve L2-4
Innervation adductor brevis
Obturator nerve L2-4
Innervation adductor part of adductor Magnus
Obturator nerve L2-4
Innervation gracilis
Obturator nerve L2-4
Innervation pectineus
Femoral nerve L2-3
Sometimes = Obturator nerve L2-4
INNERVATION Sartorius
Femoral nerve L2-3
Innervation quadriceps
Femoral nerve L2-3
Sensory Innervation anterior thigh
Lateral femoral cutaneous = l2-3
Anterior femoral cutaneous from femoral nerve
Sensory Innervation Medial thigh
Obturator nerve
Sensory Innervation Proximal thigh
Genitofemoral nerve - femoral branch l1-2
Ilioinguinal nerves l1
Sensory Innervation Medial knee and leg
Saphenous from femoral nerve
Describe arterial supply to anterior and medial thigh
Mainly from branches of dee[p formal artery to individual msucles
Describe deep venous drainage of anterior/medial thigh
Accompanying deep femoral vein
Describe superficial venous drainage ant/med thigh
To great saphenous vein - draining into femoral vein at femoral triangle
Describe femoral artery
Not many local branches
Mostly takes care of distal end
Describe deep femoral artery
Branches to femoral head/nec
And to anterior/medial thigh
Describe perforating branches of deep femoral artery
Pierce through adductor magnus
End up posterior compartment and supplies it
Also provides blood to adductor Magnus
Describe adductor hiatus
Gap between adductor and hamstring parts of adducto Magnus
Here Is where femoral —> popliteal Artery = name changes
What is femoral triangle
Important area in proximal anterior thigh - muscles and neurovascualture here
Via inguinal spaces = near inguinal ligament
Pelvis/trunk —> lower limb passage
Superior border femoral triangle
Inguinal ligament
lateral border femoral triangle
Medial edge of sartorius
medial border femoral triangle
Lateral edge of adductor longus
floor of femoral triangle
Pectineus and iliopsoas
Roof of femoral triangle
Fascia lata and skin over it
Contents femoral triangle
Femoral artery, vein, inguinal lymph nodes = vascular compartments
Femoral nerve = muscular compartment
How to remember contents femoral triangle
NAVIL (LATERAL TO MEDIAL)
N=femoral nerve
A = femoral artery
V = femoral vein
Il= inguinal lymph nodes
Clinical correlate of femoral triangle
Femoral hernias
Femoral canal = potential space, normally contains lymph nodes and fat, narrower than inguinal canal
Weak spot here = can cause hernias
Describe early stage femoral hernia
Gut loop poke way though femoral canal
Bulge in groin/upper thigh, may move in and out with activity
Describe late stage femoral hernia
Loop cna become strangulated = BAD :(
