Lecture 15 Flashcards
How many plexuses in the body
3
What do the three plexuses of the supply
Cervical – supplies the neck
Brachial – supplies the upper limb
Lumbosacral – supplies lower limb (derived from the anterior rami of L1–S4)
What part of the spinal nerve contributes to a plexus
Anterior rami
What supplies the muscles, skin and joints in the thoracic region
- the posterior rami
Three main nerves supply the lower limb:
- Sciatic (tibial & common fibular)
- Femoral
- Obturator
Plus – gluteal nerves
Nerves also supply the joints over which they pass, and other tissues such as skin
Each nerve has branches that supple a ___ _____ __ ___ this is important when ______ _____ ________
• Each nerve has branches that supply a specific area of skin
• Important when diagnosing nerve injuries
How many venous systems do the limbs have?
Two
Two locations of veins and what they are surrounded in in each location
Deep
• Within muscle compartments
• Within the superficial fascia
Superficial
• Accompany the arteries
Features of veins
• Veins have low blood pressure
• Venous blood in the lower limb needs to move against gravity
• These veins have valves to prevent
back-flow against gravit
Two key superficial veins
– Great saphenous (drains into femoral vein)
– Small saphenous (drain into popletreil behind knee)
Function of superfcial veins
- thermoregulation
- return blood
What muscles act over the hip and/or knee joints?
Hamstrings and rectus femoris crosses both the hip and knee joint
What muscles crosses the hip and knee anteriorly ?
Quadriceps (rectus femoris)
What muscle cross the hip joint anteriorly
Iliopsoas
What muscle crosses the knee and hip joint posteriorly
Hamstrings
Rectus femoris
What muscles crosses the hip joint posteriorily
Hamstrings
Gluteus maximus
What muscles cross the hip joint medially?
Adductors
What muscle crosses the hip joint laterally
Abductors
Muscles in each compartment share a common…
- function
- blood and nerve supply
Intermuscular septum
What nerve supplies the anterior muscles of the thigh?
Femoral nerve
What nerve supplies the medial muscles of the thigh
Obturator nerve
What nerves supply the posterior region of the thigh
Tibial nerve ( with one exception) - BICEPS FEMORIS - short head (supplied by common fibular nerve)
What is biceps femoris (short head) supplied by
Common fibular nerve
The external iliac artery becomes the _____ artery as it passes under the ……………………. ligament
Femoral
Inguinal
The main blood supply of the muscles in the thigh is the ……………… artery and vein
Deep femoral
Origin and insertion of the hip flexor iliopsoas
Origin
• Iliacus: Iliac fossa and crest
• Psoas: T12–L5 vertebrae and discs
Insertion
• Lesser trochanter
Function of iliopsoas
• Strong hip flexor
• Flexes trunk if legs fixed
Parts of the quadriceps femoris (anterior comaprtment of the thigh)
• Rectus femoris
• Vastus medialis
• Vastus intermedius
• Vastus lateralis
Where does the rectus femoris attach to?
Anterior inferior iliac spines (hip)
Quadreceps tendon (knee)
Role of rectus femoris at the hip joint
Flexion
Role of rectus femoris at the knee joint
Extention
Rectus femoris
What compartment is sartorius in
Anterior
Sartorius
Attachment sites of sartorius
• Anterior superior iliac spine (ASIS)
• Medial side tibia (pes anserinus)
Pes anserinus has muscles attaching to it from…
All of the 3 compartments
Functions of sartorius on the knee and hip
(Has an oblique orientation)
• Hip: flexes, abducts, externally rotates
• Knee: flexes
Origin of rectus femoris
Anterior inferior iliac spine (AIIS)
Insertion of rectus femoris
Quadriceps femoris tendon —-> patella —-> patellar ligament —-> tibial tuberosity
What is the femoral triangle
• Inverted triangle, a transition area from pelvis into thigh
Boundaries of the femoral triangle
• Superior (base): inguinal ligament
• Medial: adductor longus
• Lateral: sartorius
Contents of the femoral triangle from medial to lateral
VAN
Origins and insertions of the hip extensor, gluteus maximus
Origin: posterior ilium, sacrum and coccyx
Inerstion: gluteal tuberotsity and iliotibial bond (ITB)
(Oblique orientation)
Function of gluteus maximus
Extends hip
(Kinda helps with abdauction and external rotation)
What nerve and blood supplies the gluteus maximus ?
Inferior gluteal
Three muscles of the hamstrings
• Semitendinosus
• Semimembranosus
• Biceps femoris (long and short heads)
What compartment of the thigh are the hamstrings in?
Posterior
Origin of hamstrings
• Ischial tuberosity
Insertion of hamstrings
• Semimembranosus – medial tibial condyle
• Semitendinosus – pes anserinus
• Biceps femoris – head of fibula
Locations of the hamstrings
• Semimembranosus –
medial tibial condyle
• Semitendinosus – pes
anserinus
• Biceps femoris – head of
fibula
Action of the hamstrings on the hip
Extension
Action of the hamstring on the knee
- flexion and rotation
Nerve innervation of the hamstrings
• Tibial nerve – all of the
muscles except the
short head of biceps
femoris (which is
innervated by the
common fibular nerve)
Hamstrings injuries
• Sprinting or kicking – usually excess flexion
• Most commonly involves biceps femoris long head
What muscles are the hip adductors
• Three “adductors” (adductor brevis, longus, magnus)
• Pectineus
• Gracilis
Where do the hip adductors originate? Where do they innervate?
Origin • Pubic bone (except for adductor magnus, which attaces to ischium)
Attach then to the femur (linea aspera)
(Gracilis = attaches at pes anserinus)
Adductor Magnus features
- has an adductor part and a hamstring part - the adductor part attaches to the pubic bone but hamstring part attaches to the Ishial tuberosity
- contributes to adduction and hip extension
Attachments
• Pubic bone and ischium
• Femur (linea aspera) and adductor tubercle
CONTAINS AN ADDUCTOR HIATUS – passage of femoral artery into popliteal space
Nerve supply to the adductor muscles = obtrator nerve
Nerve supply to the adductor muscles =
obtrator nerve
What is Adductor hiatus
– passage of
femoral artery into popliteal space
Functions of hip adductors
• Stabilise single-leg stance, together with the abductors
• Adductor magnus contributes to hip extension
• Adductor longus contributes to hip flexion (e.g., kicking with medial side of the foot in soccer)
• Groin strain
What component are hip adductors in?
Medial compartment
What nerve are hip adductors innervated by
Obturtor nerve
Where does the obturator nerve enter the thigh through?
the obturator canal (foramen in the obturator membrane)
Origin & insertion of Gluteus medius
− Ilium, between anterior and posterior gluteal lines
− Greater trochanter
Origin & insertion Of Gluteus minimus
- ilium between anterior and inferior gluteal lines
- greater trochanter
Origin & insertion of Tensor fascia lata
− Anterior superior iliac spine (ASIS
− Iliotibial band
Hip abductors
Gluteus medius
Gluteus minimus
Tensor fascia lata
- laterally
Blood and nerve supply of hip abductors
- superior gluteal nerve
- superior gluteual artery and vein
nerves and vessels that supply gluteus maximus?
- inferior gluteal nerve
- gluteal vein and artery
Hip abductors - function
Abduction and internal rotation
Lets u stand on one leg - Maintain pelvis horizontal during single-leg stance
Hip abductors – dysfunction
• they usually Maintain pelvis horizontal during single-leg stance
• Muscle weakness or nerve injury: dropping of contralateral side of the pelvis (Trendelenburg sign/gait)
