Lecture 13: Lower Extremity part 2 Flashcards
MSK of LE
1) What 2 muscle groups does the anterior thigh compartment supply?
2) What nerve and artery supply here?
1) Flexors of the hip and extensors of the knee
2) Femoral nerve and femoral a. branches
1) What group does the medial thigh compartment supply?
2) What nerve and artery supply here? What is the exception?
1) Adductor group (adduct hip)
2) Obturator nerve and artery
-exception is hamstring portion of adductor magnus (innervated by tibial nerve)
What 2 things from the anterior thigh act across the hip and knee joint?
(impnt)
1) Sartorius (tailor’s muscle)
2) Rectus femorus
1) What anterior thigh muscle is the chief flexor of hip joint?
2) What innervates each part?
1) Iliopsoas
2) Psoas major: L1-2-3
Iliacus: femoral n.
-What group of anterior thigh muscles is an extensor of the knee joint?
-What 4 muscles are a part of this group? Which has 2 specific jobs you need to know?
Quadriceps femoris
1) Rectus femoris: flex hip and extend knee
2) Vastus lateralis
3) Vastus medialis
4) Vastus intermedius
1) Where is the quadriceps tendon?
2) What innervates the quadriceps and the anterior compartment? What supplies blood to the anterior compartment?
3) What two anterior muscles act across the hip and knee joint?
1) Anterior at patella
2) Femoral nerve, femoral artery
3) Sartorius and rectus femoris
1) Where does the articularis genu muscle come from?
2) What does it do? Why?
1) Vastus Intermedius m.
2) Pulls synovium superiorly during knee extension; to avoid pinching between patella and femur (PFPS)
What bursa can be found at the anterior thigh? What is this continuous with?
Suprapatellar bursa; joint space
1) What group of muscles are in the medial thigh compartment? What do they do?
2) What nerve innervates here? What is the exception?
3) What 2 actions does this compartment contribute (when walking/running)?
1) “Adductor group”; ADDuct hip joint/stabilize
2) Obturator n.; except for hamstring part of adductor magnus (innervated by the tibial br. of sciatic n.)
3) Flexing extended hip + extending flexed hip
List 5 super medial thigh muscles
(not super important to know all of)
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
How do the two parts of the adductor magnus differ?
What are these 2 parts? What nerve innervates each? What does each do?
Differ in their attachments, nerve supply and action
1) Adductor part: obturator nerve; flexes hip
2) Hamstring part: tibial br of sciatic nerve; extends hip
1) What is the only adductor group to cross and act on BOTH hip (adducts) and knee joints (flexes and rotates medially)?
2) The 3 SGT tendons insert where?
1) Gracilis
2) Pes Anserine
What does the obturator muscle do? (2 things)
Laterally rotates hip, pulls femoral head into acetabulum
1) What is the retro-inguinal space deep to?
2) What divides this space?
3) What lies laterally outside the femoral sheath?
1) Deep to inguinal ligament
2) Divided by psoas fascia
3) Femoral nerve
1) What are the 3 compartments of the femoral sheath?
2) What canal does it contain? What does this canal contain?
1) Lateral (femoral a.), intermediate (femoral v.), and medial (femoral canal) compartments
2) Femoral canal; lymphatics, LN, fat, etc
1) Where is the femoral triangle?
2) What does it contain?
3) What does the pulse here locate?
1) Inferior to inguinal ligament
2) Femoral nerve, artery, vein, & (NAV) (lateral to medial)
3) The artery
What are the boundaries of the femoral triangle? Describe these 2 locations
1) Base: inguinal ligament
2) Apex: deep to medial margin sartorius crossing deep to lateral margin adductor longus at the proximal adductor canal
The femoral triangle courses through the __________ hiatus
adductor
1) The adductor canal is an intramuscular passage for what artery, vein, and nerves?
2) What is located at the proximal end of the adductor canal?
1) Femoral artery & vein, saphenous nerve, & nerve to vastus medialis
2) Apex of femoral triangle
What is located at the distal end of the adductor canal? What does this allow for?
Adductor hiatus; passage of AV posteriorly to popliteal fossa
1) What are access for right and left heart catheterizations?
2) What are now often used instead?
1) Femoral vessels
2) UE vessels
1) What is percutaneous coronary intervention (PCI) (aka coronary angioplasty)?
2) What does it require? Define this procedure
1) A nonsurgical procedure that improves blood flow to yourheart.
2) Cardiac catheterization: the insertion of a catheter tube and injection of contrast dye, usually iodine-based, into your coronary arteries.
1) What pathology can occur at the femoral canal?
2) Who is it more common in?
3) What complication can this condition have?
1) Femoral canal hernia
2) Females
3) May strangulate
What spinal nerves does the femoral nerve come from?
L 2-3-4
1) What does the femoral nerve provide motor innervation to? What actions does this allow?
2) What does it provide cutaneous sensory innervation?
1) Anterior compartment of thigh; flex hip, extend knee
2) From anterior cutaneous nerve of the thigh and saphenous nerve to medial leg and foot.
1) What does the patella tendon reflex (somatic spinal cord reflex) test?
2) What does it result in?
1) Integrity of femoral nerve (L2-3-4 spinal cord segments)
2) Quadricep’s contraction and extension of the knee
1) What is the primary blood supply to the leg (below knee)?
2) What is the primary artery to the thigh?
1) Femoral artery
2) Profunda femoris a.
What do the both the femoral and profunda femoris arteries contribute to?
Geniculate vessels of knee
1) What crosses deep to inguinal artery to become femoral artery?
2) What descends on adjacent boarders of iliopsoas and pectineus m.?
3) What does the femoral artery eventually branch into?
1) External iliac
2) Femoral artery
3) Popliteal artery
List the path of blood from the external iliac artery to the popliteal artery (4 steps)
1) Ext iliac crosses deep to inguinal artery to become femoral artery
2) Femoral descends on adjacent boarders of iliopsoas and pectineus m.
2) Bisects femoral triangle
3) Exits femoral triangle at apex, enters adductor canal
4) Exits adductor canal via adductor hiatus to become popliteal artery
1) Where do the circumflex arteries originate?
2) Where are the circumflex arteries?
3) What do they supply?
4) What are the two branches?
1) Branch of profunda a. or femoral a. (variable)
2) Encircle thigh/femur
3) Thigh m. and head and neck of femur
4) Lateral and medial circumflex
What do the medial and lateral circumflex femoral arteries supply? What does one branch to?
1) Medial: primary blood supply to head and neck of femur
2) Lateral: primarily supply blood to muscles on lateral thigh; branch to geniculate vessels
1) What can cause AVN of the femoral head?
2) What population may AVN develop in 20% or more of?
1) Trauma-related AVascular Necrosis.
2) People who dislocate a hip.
1) What kind of corticosteroid use can lead to AVN? What percent of nontraumatic AVN do these make up?
2) What lifestyle choice can increase AVN chances?
3) What else can increase chances of AVN? Are the arteries or veins affected?
1) Chronic and long-term use; leads to 35% of all nontraumatic AVN.
2) Excessive alcohol use.
3) Blood clots,inflammation, and damage to thearteries.
-All of these can block blood flow to the bones.
1) What vein is a proximal continuation of popliteal vein?
2) When going proximally, what hiatus does it go through and where does it ascend?
1) Femoral vein
2) Adductor hiatus; ascends in adductor canal
1) What 2 veins contribute to the blood within the femoral vein?
2) Where does it enter? (proximally)
3) What vein does the femoral vein continue as in the trunk? What type of circulation is this?
1) Profunda and great saphenous vs. in femoral triangle
2) Femoral sheath (intermediate compartment)
3) Iliac vein; systemic (Caval) circulation
1) What nerve goes to the medial thigh?
2) What muscle group does it supply innervation to? What’s the exception?
3) What part of the spine does this come from?
1) Obturator
2) Adductor group; except hamstring part of the adductor magnus
3) L2-3-4
1) List the 4 muscles the obturator nerve innervates (motor)
2) Where does it supply with sensory?
1) Obturator externus, pectineus m. (part), adductor muscles*, gracilis m.
*Less the hamstring part.
2) Medial thigh
What is the exception to the rules of the anterior compartment?
Rectus femoris (of quadriceps) and Sartorius mm. act across both hip and knee joints (so act on both joints)
What are the 2 exceptions to the rules of the medial compartment?
1) Hamstring part of adductor magnus innervated by tibial branch of sciatic nerve
2) Gracilis muscle acts across both hip and knee joints
Where does the supracristal plane go through? (spinal level)
Around L4/5
What are the 5 groups of muscles that act on the hip? [hint: named based on actions]
1) Flexors
2) Extensors
3) External rotators
4) Internal rotators
5) Neutral
1) What are the 2 flexors of the hip?
2) What are the 2 extensors?
1) Iliopsoas, sartoris
2) Hamstrings, biceps femoris
What are the 5 external rotators of the hip?
1) Glut Max
2) Pyriformis
3) Int. obturator
4) Gemelli bros.
5) Quadratus fem
1) What are the 3 internal rotators of the hip?
2) What is the neutral muscle of the hip?
1) Gluteus med, gluteus min., TFL
2) Ext obturator
Muscles cause different rotations based on their location on the greater trochanter; explain.
-If muscles insert anterior, they rotate medially (internally).
-If they insert posterior, they rotate externally
1) What is the trochanteric bursa?
2) What does it separate?
3) What is it a site of?
4) Is this a surface anatomy landmark?
1) Synovial fluid sac
2) Separate G. maximus from adjacent structures at “friction” sites
3) Inflammation (“bursitis”)
4) Yes
Define bursitis. Is it common?
Inflammation of bursa; common MSK complaint
List and describe the causes of 2 types of bursitis (and what they’re associated with)
1) Trochanteric bursitis: ITB tightness, blunt trauma
2) Ischial bursitis: cycling (poor saddle fit)
1) What are the posterior thigh muscles?
2) Why is only part of one of the muscles considered a part of the same group as the rest?
1) 3 hamstrings: semitendinosus, semimembranosus, and long head of biceps femoris
2) Short head of biceps femoris doesn’t cross hip joint, so not a hamstring
1) What part of ADDuctor magnus is a functional hamstring?
2) What innervates the posterior thigh muscles?
1) Hamstring part of ADDuctor magnus is a functional hamstring
2) Tibial branch of sciatic nerve
1) What group of muscles spans the hip and knee joints from ischial tuberosity to leg?
2) What are the two actions of this group?
1) The hamstrings
2) Extend hip joint and flex knee joint
What make up the Pes anserine?
Sartorius, gracilis, and semitendinosus muscle insertions
1) Where do the nerves of the gluteal region and posterior thigh arise from to innervate the gluteal region? What are these nerves?
2) What do they do to supply the perineum and thigh? What nerves do this?
1) Sacral plexus (superior and inferior gluteal nerves)
2) Pass through to supply perineum (pudendal n.) and thigh (sciatic n.)
What are the two types of gluteal nerves?
Superficial and deep
1) What do superficial gluteal nerves do?
2) What nerves are included in this group? What are these called?
1) Innervate the skin of the region
2) Superior, middle, and inferior gluteal cutaneous nerves called clunial nerves
Deep gluteal nerves:
1) What are the 3 highlighted deep gluteal nerves? What does each innervate?
2) What are the other deep gluteal nerves? What does each innervate?
1) Posterior cutaneous nerve of the thigh, and superior (glut med and min) & inferior gluteal nerves (glut max),
2) Sciatic, nerve to quadratus femoris, pudendal nerve (perineum), & nerve to obturator internus
1) Where does the sciatic nerve come from and how does it leave the pelvis?
2) What are its two branches?
3) What does it innervate? Via what nerve?
1) L4-S3; greater sciatic notch (along with piriformis m. & anterior surface of gemelli bros.)
2) Tibial nerve and fibular (peroneal) nerve
3) Posterior thigh muscles via tibial n.
-& Most everything below the knee via tibial n. and fibular n.
1) Define piriformis syndrome
2) What can the piriformis muscle also irritate? What can this cause?
1) Piriformis syndromeis a condition in which thepiriformis muscle spasms and causes buttock pain.
2) The nearby sciatic nerve; causes pain, numbness and tingling along the back of the leg and into the foot (similar too sciatic pain).
1) What nerve and two muscles are the Trendelenburg test a test of?
2) What can cause someone to fail this test? Why?
1) Superior gluteal nerve and active contraction of the gluteus medius and minimus
2) Injury from hip replacement or trauma; glut max innervated by inferior gluteal n. and inserts into ITB
Why are surface anatomy landmarks of the gluteal region important? Why?
Intramuscular injections in gluteal region; safest in superolateral quadrant (avoids sciatic n.)
1) What supplies the gluteal region with blood?
2) What supplies the posterior compartment of the thigh w blood?
1) Variable, branches of Internal iliac a. Also superior and inferior gluteal aa.
2) No exclusive supply: branches from Inferior gluteal, medial circumflex femoral, perforating arteries of profunda femoris, & popliteal a.
1) What is the chief artery to thigh?
2) What do its perforating branches supply?
3) What does this accomplish?
1) Profunda femoris a.
2) Perforating branches supply posterior thigh muscles
3) Provides a continuing anastomosis from gluteal to popliteal region
Posterior compartment (hamstrings):
1) What innervates this area?
2) What do the hamstring muscles do?
3) What is the remainder of the adductor group from the obturator nerve?
1) Tibial branch of sciatic nerve
2) Cross and act on both hip and knee joints
3) Hamstring part of adductor magnus
1) What is the exception to the general rule about the posterior compartment muscles?
2) What innervates this?
3) What does it act on? Does it cross the posterior hip joint?
1) Short head of biceps femoris is NOT considered a hamstring
2) Common fibular br. of sciatic nerve
3) Only acts on knee joint; does not cross the posterior hip joint
