Lecture 2: Anterior Medial Thigh Flashcards
Where does the Great Saphenous Vein travel?
Starts at the medial side of dorsal venous arch of foot
Travels medial side of leg and thigh
Terminates in femoral vein on anterior thigh in saphenous opening
What veins are tributaries for Great Saphenous Vein?
External Pudendal Vein
Superficial Circumflex Iliac Vein
Superficial Epigastric Vein
Where are the two groups of Superficial Inguinal Lymph Nodes located in the Femoral Triangle?
Superior Horizontal Group: Along the Inguinal Ligament
-drains anterior inferior abdominal wall
Inferior Vertical Group: On either side of Great Saphenous Vein
-drains superficial tissue of lower extremity
The Superficial Lymph Node does not drain what superficial lower extremity structure?
What structure does drain it?
Dorsolateral foot and Posterior Calf
Popliteal Lymph Nodes
What does the Lateral Femoral Cutaneous Nerve innervate?
What spinal roots contribute to it?
Sensory anterior and lateral thigh
L2 and L3
What does the Femoral Branch of Genitofemoral Nerve innervate?
What spinal roots contribute to it?
Sensory: Scrotum/Labia Majora/Medial Thigh
Motor: Cremaster Muscle
L1 and L2
What does the Obturator Nerve innervate?
What spinal roots contribute to it?
Sensory: Medial Thigh
Motor: Obturator Externus, Adductor Longus, Adductor Brevis, Gracilis, Pectineus, Adductor Magnus Muscles
L2-L4
What is Meralgia Paresthetica?
Which nerve is impinged?
Tingling and numbness of lateral thigh
Impingment of Lateral Femoral Cutaneous Nerve
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What is the Fascia Lata?
Deep connective tissue that surrounds thigh
- mostly horizontal fibers (except around IT band)
- Attaches to Gerdy’s tubercle*
What muscular compartments are found in Fascia Lata?
Anterior and Medial
What is the Iliotibial tract?
Thickened part of the Fascia Lata on the lateral side
- Vertical Fibers
- Aponeurosis of gluteus maximus and Tensor Fascia Lata
- Inserts into Gerdys tubercle*
What septum is contiguous with the Iliotibial Tract?
The Lateral Intermuscular Septum
Which compartment is stronger, the Anterior Thigh, or the Posterior Thigh?
Anterior Thigh
What muscles flex the hip?
Sartorius Muscle
Iliopsoas (Iliacus and Psoas Major) Muscle
Pectineus Muscle
Which muscles extend the knee?
Quadriceps Femoris:
Rectus Femoris
Vastus Lateralis
Vastus Intermedius
Vastus Medialis
Psoas Major Muscle
What are its attachments?
Origin: Transverse process of lumbar vertebrae and vertebral bodies of T12-L5
Insertion: Lesser Trochanter of Femur
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Psoas Major Muscle
What are its action?
- Flex thigh at hip and trunk
- Stabilize hip joint
- Flexes vertebral column
Psoas Major Muscle
What is the innervation and blood supply?
Innervation: L1-L3 Ventral Rami
Blood Supply: Iliolumbar Artery
Iliacus Muscle
What are its attachments?
Origin: Superior Iliac Fossa
Insertion: Lesser Trochanter of Femur
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Iliacus Muscle
What are its actions?
- Flexes thigh
- Stabilizes Acetabulofemoral joint
Iliacus Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Medial Circumflex Femoral Artery
Sartorius Muscle
What are its attachments?
Origin: ASIS
Insertion: Pes Anserinus (proximal end of tibia)
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Sartorius Muscle
What are its actions?
- Flex the hip
- Abduct Hip
- Laterally Rotate Thigh
- Flex the leg at the knee
* Think of Captain Morgan Pose*
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Sartorius Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Profunda Femoris Artery and Saphenous Branch of Descending Genicular Artery
Rectus Femoris Muscle
What are its attachments?
Origin: AIIS
Insertion: Tibial Tuberosity via Patellar Ligament
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Rectus Femoris Muscle
What is its action?
- Extend leg at the knee p**owerfully
- Helps iliopsoas flex thigh
- Steadies hip joint
Rectus Femoris Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Lateral Circumflex Femoral Artery
Vastus Lateralis Muscle
What are its attachments?
Origin: Greater Trochanter and Lateral Lip of Linea Aspera
Insertion: Tibial Tuberosity via Patellar Ligament
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Vastus Lateralis Muscle
What is its action?
Extend the leg at knee joint
Vastus Lateralis Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Lateral Circumflex Femoral Artery
Vastus Medialis Muscle
What are its attachments?
Origin: Intertrochanteric Line and Medial Lip of Linea Aspera
Insertion: Tibial Tuberosity via Patellar Ligament
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Vastus Medialis Muscle
What is its action?
Extend the leg at knee joint
Vastus Medialis Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Femoral Artery, Deep Femoral Artery, Superior Medial Genicular Branch of Popliteal Arteryd
Vastus Intermedius Muscle
What are its attachments?
Origin: Anterior and Lateral Surface of Femoral Body
Insertion: Tibial Tuberosity via Patellar Ligament
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Vastus Intermedius Muscle
What is its action?
Extend the leg at knee joint
Vastus Intermedius Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Lateral Circumflex Femoral Artery
Articularis Genu Muscle
What are its attachments?
Origin: Anterior surface of distal femur
Insertion: Anterior Capsule of Knee
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Articularis Genu Muscle
What is its action?
Tightens caupsule of knee during leg extension
Articularis Genu Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve
Blood Supply: Femoral Artery
What muscles insert at Pes Anserinus?
What are its innervations?
Sartorius Muscle: Femoral Nerve
Gracilis Muscle: Obturator Nerve
Semitendenous Muscle: Tibial Branch of Sciatic Nerve
What is Osgood Schlatter Disease?
Inflammation of the area just below the knee where patellar tendon attaches to the shinbone
- -Most common in children where running/jumpin can pull* Patellar Ligament causing a slight (incomplete) avulsion of the Tibial Tuberosity.
- -Osteogenesis can lead to a bony growth at the location of the avulsion.*
Pectineus Muscle
What are its attachments?
Origin: Superior Pubic Ramus
Insertion: Pectineal Line of the Femur
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Pectineus Muscle
What is its action?
- Adduction of the thigh
- Flexion of the thigh
Pectineus Muscle
What is its innervation and blood supply?
Innervation: Femoral Nerve (Despite being in the Medial Compartment)
Blood Supply: Medial Circumflex Femoral Artery
Adductor Longus Muscle
What are its attachments?
Origin: Body of Pubis inferior to Pubic Crest
Insertion: Middle 1/3 of the linea aspera
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Adductor Longus Muscle
What is its action?
Adduction of the thigh
Adductor Longus Muscle
What is its innervation and blood supply?
Innervation: Obturator Nerve
Blood Supply: Deep Femoral Artery
Adductor Brevis Muscle
What are its attachments?
Origin: Body and Inferior Pubic Ramus
Insertion: Pectineal Line and Proximal Linea Aspera
Adductor Brevis Muscle
What is its action?
- Adducts thigh
- Assists in flexion of hip
Adductor Brevis Muscle
What is its innervation and blood supply?
Innervation: Obturator Nerve
Blood Supply: Deep Femoral Artery
Adductor Portion of the Adductor Magnus Muscle
What is its attachments?
Origin: Inferior Ramus of Pubis and Ramus of Ischium
Insertion: Gluteal tuberosity, linea aspera, medial supracondylar line;
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Adductor Portion of the Adductor Magnus Muscle
What is its action?
- Adduction of Thigh
- Flexion of the Thigh
Adductor Portion of the Adductor Magnus Muscle
What is its innervation and blood supply?
Innervation: Obturator Nerve
Blood Supply: Deep Femoral Artery
Hamstring Portion of Adductor Magnus Muscle
What are its attachments?
Origin: Ischial Tuberosity
Insertion: Medial Epicondyle of the Femur
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Hamstring Portion of Adductor Magnus Muscle
What is its action?
- Adducts Thigh
- Extends Thigh
Hamstring Portion of Adductor Magnus Muscle
What is its innervation and blood supply?
Innervation: Tibial Branch of the Sciatic Nerve
Blood Supply: Deep Femoral Artery
Gracilis Muscle
What are its attachments?
Origin: Inferior Pubic Ramus and body of pubis
Insertion: Pes Anserinus
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Gracilis Muscle
What is its action?
Adduction of the Hip
Flexion of the Hip
Medial Rotation of the Hip
Gracilis Muscle
What is its innervation and blood supply?
Innervation: Obturator Nerve
Blood Supply: Obturator Artery
Obturator Externus Muscle
What are its attachments?
Origin: Margins of Obturator Foramen and Obturator Membrane
Insertion: Trochanteric Fossa of Femur
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Obturator Externus Muscle
What is its action?
- Lateral Rotation of Thigh
- Holds Head of Femur in Acetabulum
Obturator Externus Muscle
What is its innervation and blood supply?
Innervation: Obturator Nerve
Blood Supply: Obturator Artery
What septum separates the Anterior and Posterior Compartments of the Thigh?
Lateral Intermuscular Septum
What separates the Anterior and Medial Compartments of the Thigh?
Medial Intermuscular Septum
What two compartments of the Thigh do not have a septum between them?
The Posterior and Medial Compartments
What are the boundaries of the adductor canal?
Anteromedial: Sartorius Muscle
Lateral: Vastus Medialis Muscle
Posterior: Adductor Longus and Adductor Magnus Muscles
Runs from apex of femoral triangle to adductor hiatus
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What is found inside the Adductor Canal?
Passageway for structures between anterior thigh and posterior thigh
- Femoral Artery
- Femoral Vein
- Saphenous Artery
- Saphenous Nerve
- Nerve to Vastus Medialis Muscle
What exits the adductor canal?
Femoral Artery and Vein become Popliteal Artery and Vein
How does Saphenous Nerve leave the Adductor Canal?
It pierces through Adductor Magnus and supplies cutaneous medial leg and foot
Does not exit adductor canal
What is a groin pull?
Strain of proximal attachments in anteromedial thigh muscles that deal with flexing and adduction
- Obturator Externus
- Pectineus
- Adductor Brevis, Longus, Magnus
- Gracilis
Groin is junction between trunk and thigh
What nerve roots are being tested when a physician strikes the Calcaneal Tendon with a reflex hammer?
S1-S2
What nerve roots are tested when a physician checks the patellar reflex?
L2-L4
What is it called when a patellar reflex is absent?
Westphal’s Sign
What spinal roots give rise to the Femoral Nerve?
L2-L4
What spinal roots give rise to the Obturator Nerve?
L2-L4
What spinal roots give rise to the Sciatic Nerve?
L4-S3
What spinal roots give rise to the Common Fibular Branch of the Sciatic Nerve?
L4-S2
What spinal roots give rise to the Tibial Branch of the Sciatic Nerve?
L4-S3
Where can the Iliopectineal Bursa be found, and why is it clinically relevant?
Deep to Iliopsoas Muscle and Pectineus
- Mostly on the capsule of the hip joint
- Can become inflamed and lead to groin pain
What two bursae can be found deep to Pes Anserinus on the medial side of the knee?
Bursa of Semimembranosus
Anserine Bursa
What three bursae can be found on the lateral side of the knee?
- Bursa Deep to the IT Tract
- Bursa Deep to the Fibular Collateral Ligament
- Bursa Deep to the Biceps Femoris
Where is the Patellar Ligament found?
Where is the Patellar Tendon found?
Patellar Tendon: Superior to Patella, connecting it to Quadriceps Muscles
Patellar Ligament Inferior to Patella, connecting it to Tibial Tuberosity
What is Hilton’s Law?
A joint is innervated by the same nerves that supply the uscles that move the joint and supply the skin over joint