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Musculoskeletal Module > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

Pectineus

A 
Anterior Thigh Muscle
-belongs to BOTH Anterior and MEdial Compartment
Origin: Superior Pubic Ramus
Insertion: Inferior to Lesser Trochanter
Action: Adducts and Flexes Thigh
Nerve Supply: Femoral +/- Obturator
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2
Q

Illiopsoas

A

Anterior Thigh Muscle
Origin: Formed by Psoas Major and Illiacus
Insertion: Lesser Trochanter via lliopsoas tendon
Action:
Nerve Supply:

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3
Q

Illiacus

A 
Anterior Thigh Muscle
Origin: Illiac Fossa, lateral sacrum
Insertion: Lesser Trochanter
Action: Flexes and Externally rotates Thigh
Nerve Supply: Femoral
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4
Q

Psoas Major

A 
Anterior Thigh Muscle
Origin: Lumbar Vertebrae
Insertion: Lesser Trochanter
Action: Flexes and Externally rotates Thigh
Nerve Supply: L2 and L3
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5
Q

Tensor Fascia Lata

A

Anterior Thigh Muscle (see also Gluteal and Posterior Thigh Muscles)
Short
Above hip
Origin: ASIS, iliac crest
Insertion: Lateral condyle of tibia (ITB)
Action: Adducts thigh, dynamic stabiliser
Nerve Supply: Superior Gluteal

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6
Q

Sartorius

A

Anterior Thigh Muscle
S shaped curve
Long and thin
Tailors muscle- prominent as you sit cross legged, & runs medially like tailors’ inseam
Origin: ASIS
Insertion: Superior part of the medial tibia (Pes Anserinus)
Action: Flexes, abducts, externally rotates thigh, flexes leg
Nerve Supply: Femoral

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7
Q

Quadriceps Femoris

A

Anterior Thigh Muscle
Origin: Consists of Rectus Femoris and Vasti
Insertion:Tibial tuberosity via Patella tendon (Patella interposed as sesamoid bone)
Action:
Nerve Supply:

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8
Q

Rectus Femoris

A

Anterior Thigh Muscle
“Rectus” = straight
Origin:2x superior attachments 1) Straight head: AIIS. 2) Reflected Head: Rim of superior acetabular
Insertion: Superior Patella/Knee Cap (Quads Tendon)
Action: Flexes thigh. Extends Leg
Nerve Supply: Femoral

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9
Q

Vastus Lateralis

A

Anterior Thigh Muscle
LAteral Bulk of thigh muscle
Origin: Greater trochanter (femur), Linear aspera
Insertion: Superior (lateral) Patella (Quads Tendon)
Action: Extends Leg
Nerve Supply: Femoral

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10
Q

Vastus Intermedius

A

Anterior Thigh Muscle
Deep to Rectus (sits on femur under rectus femorus)
Origin: Superior 2/3 femoral shaft, lateral intermuscular septum
Insertion: Superior Patella (Quads Tendon)
Action: Extends Leg
Nerve Supply: Femoral

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11
Q

Vastus Medialis

A

Anterior Thigh Muscle
Medial side of thigh
Origin: Intertrochanteric line, medial intermuscular septum (deep rel. to Lateralis and Femoris)
Insertion: Superior Patella (Quads Tendon)
Action: Extends Leg
Nerve Supply: Femoral

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12
Q

Adductor Longis

A 
Medial Thigh Muscle
Origin: Body of pubis
Insertion: Linea Aspera
Action: Adducts, Flexes thigh
Nerve Supply: Obturator
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13
Q

Adductor Brevis

A 
Medial Thigh Muscle
Origin: Inferior Pubic Ramus
Insertion: Linea Aspera
Action: Adducts, Flexes thigh
Nerve Supply: Obturator
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14
Q

Adductor Magnus

A

Medial Thigh Muscle (see also Gluteal and Posterior Thigh Muscles)
“magnus” = big
covers all medial, but has hole in bottom
belonging to 1/2 Medial and 1/2 Lateral compartment
Origin: Adductor part:inferior pubic ramus. Hamstring part: ischial tuberosity
Insertion: Linea Aspera, medial supracondylar ridge, adductor tubercle
Action: adducts thigh, can both flex and extend thigh by different fibres
Nerve Supply: Adductor part: Obturator. Hamstring part: Sciatic (Tibial)

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15
Q

Gracilis

A

Medial Thigh Muscle
Origin: body of pubis
Insertion: Superior part of medial tibia (Pes Anserinus)
Action: Adducts thigh, flexes and internally rotates leg
Nerve Supply: Obturator

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16
Q

Obturator Externus

A 
Medial Thigh Muscle
Origin: Obturator foramen and membrane
Insertion: Posterior intertrochanteric fossa
Action: Externally rotates thigh
Nerve Supply: Obturator
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17
Q

What is the Fascia Lata?

A

Lower limb deep fascia
Runs down the thigh, attaches to the knee
Continuous with the Fascia in the leg

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18
Q

What are some features of Dense Fascia?

A

Dense CT
separates both Muscles and Muscular compartments
White, Shiny and thick
-surrounds and packages everything in in the lower limb
-STOCKING + INVESTS in compartments

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19
Q

What are the relative attachments of the Fascia Lata?

A

Superior to pubic ligaments, pubis and inguinal ligament
Lateral to illiac crest
Posterior to sacrum, coccyx and ishcial tuberosity

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20
Q

What 3x structures is the attachment of the Fascia Lata Superior to?

A

Pubic Tubercle
Pubis
Inguinal ligament

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21
Q

What structure is the attachment of the Fascia Lata Lateral to?

A

Illiac Crest

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22
Q

What 3x structures is the attachment of the Fascia Lata Posterior to?

A

Sacrum
Coccyx
Ischial Tuberosity

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23
Q

How many compartments are in the thigh?

A

3

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24
Q

How are compartments of the thigh formed/outlined?

A
  1. Fascia Lata

2. Intermuscular Septae (anterior, medial and posterior)

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25
Q

What is the strongest intermuscular septum in the thigh compartment?

A

LATERAL intermuscular septum and therefore EASIER to find

the others are relatively weaker and harder to find

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26
Q

What are some features of the Tensor Fascia Lata Muscle?

A

(tensor of fascia lata)

  • attached to the rest of deep fascia especially on the LATERAL side of the thigh
  • located on the superior aspect close to the hip
  • sits ANTERIORLY, even though it embryologically started Posteriorly –> considered to be a gluteal muscle
  • SAME nerve and blood supply as gluteal embryological origin
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27
Q

What influence does the embryological origin have on the tensor fascia lata muscle?

A

adult= sits Anteriorly
embryologically/started Posteriorly
considered to be a Gluteal muscle.
has the same Nerve & Blood supply as the gluteal embryological origin
(developed and evolved - overtime things have twisted around)

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28
Q

What are some features of the IT Band?

A

Illio Tibial Band/Tract
Fascia Lata blending Laterally with the Tendon of TFL (tensor Fascia Lata)
ITB then attaches to the Lateral aspect of the Tibia

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29
Q

What is the Saphenous Opening?

A

Anterior part of the Fascia Lata has a Deficiency
located Inferiorly to the Inguinal Ligament
Saphenous Vein passes through and meets the Femoral Vein

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30
Q

Where does the Great Saphenous vein run?

A

OUTSIDE the deep fascia

down the Medial side of the leg

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31
Q

How any compartments are in the leg?

A

4 distinct compartments

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32
Q

What are the 2x benefits in knowing the attachments of muscles?

A
  1. helps show what 2x things it pulls closer together (what the movement is going to effect)
  2. during Trauma muscle can Pull off a bit of bone - muscle or tendon can rip, muscle stronger than bone
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33
Q

What is a generalised feature for muscles within compartments?

A

muscles within compartment, surrounded by fascia, generally have the SAME

  • action
  • nerve and bloody supply
  • start, grow and work together
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34
Q

What parts do spinal nerves have?

A

Motor AND sensory parts to them, after the plexus

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35
Q

What parts do peripheral nerves have?

A

Potentially will also have motor and sensory parts to them

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36
Q

What do motor branches of peripheral nerves control?

A

supply/control muscles

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37
Q

What do sensory branches of peripheral nerves control?

A

go to the skin for sensation

-got it’s sensory fibres from a spinal nerves , due to the Plexus

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38
Q

What is an example of a large plexus?

A

Brachial plexus

supplies the upper limb

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39
Q

What are the components of the CNS?

A

Brain + Spinal Cord

Inside the spinal Canal

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40
Q

What are the components of the PNS?

A

Everything OUTSIDE the spinal canal (left the protection on the spinal canal)
Peripheral nerves go out into the periphery and supply muscles

41
Q

Where are plexuses located?

A

Outside of the spinal cord

spinal nerves go out into plexus, mix, and then come out as peripheral nerves

42
Q

What can peripheral nerves be composed of?

A

Spinal nerves contribute to one or more peripheral nerves

Therefore, peripheral nerves can be made up of 1x or more spinal nerves

43
Q

How are Spinal nerves names?

A

according to where they come from (Numbers)

e.g. T1, T2, T3

44
Q

How are Peripheral nerves named?

A

have Names

e.g. obturator

45
Q

Why is it important to remember which spinal level peripheral nerves come from?

A

could injure spinal nerve/cord (e.g. H3) and that would effect how the peripheral nerve(s) (Paul and Priscila) work

46
Q

What are the possible combinations of a peripheral nerve after exiting the plexus?

A 
H1
H2
H3
H1 + H2
H2 + H3
H1 + H2 + H3
Note: it is unusual to Skip a level (H1 + H3) WITHOUT H2 ASwell
47
Q

What is a plexus?

A

Not a single thing (on diagram)
Thick mesh of nerve fibres
Within or Wrapped around a muscle

48
Q

What are the main points about the Femoral Nerve?

A

L2-L4
covers anterior part of thigh and medial side of leg
Motor branches to the Anterior (quads) compartment
-covers large amount of lower limb
Sensory distribution to Anterior Thigh
-Big branch: thigh -> medial side of thigh & knee -> leg
Major/Largest Branch = Saphenous Nerve
-saphenous nerve has sensory distribution to medial leg

49
Q

What is the largest branch of the femoral nerve?

A

Saphenous Nerve

cutaneous nerve, as descends Medially down the leg

50
Q

What are the main points about the Obturator Nerve?

A 
L2-L4
Motor supply to 
- Obturator Externus
-Adductor Magnus (anterior part)
Adductor Brevis, Adductor Longus
Gracilis
Sensory distribution only a Small amount of Medial side of Distal thigh
51
Q

What is the femoral triangle?

A

Fascial space
Superior aspect of the thigh
Bound superiorly by Inguinal Ligament, Medially by Adductor Longus, Laterally by Satorius
Floor= Illiopsoas + Pectineus
Roof= Fascia Lata + subcutaneous tissue and skin
Contents (Lat-> Med) : Femoral Nerve -> F. Sheath -> F. Artery -> F. Vein -> Lymphatic vessels

52
Q

What is the Femoral Triangle bound superiorly by?

A

Inguinal Ligament

53
Q

What is the Femoral Triangle bound medially by?

A

Adductor Longus

54
Q

What is the Femoral Triangle bound laterally by?

A

Satorius

55
Q

What 2x things make up the Floor of the Femoral triangle?

A

Illiopsoas + Pectinius

56
Q

What 3x things make up the Roof of the Femoral triangle?

A

Fascia Lata

Subcutaneous Tissue and Skin

57
Q

What are the contents of the Femoral Triangle Laterally to Medially?

A

Laterally –> Medially “NsAVIgate the femoral triangle from lateral to medial”
Femoral Nerve -> F. Sheath -> F. Artery -> F. Vein -> Lymphatic vessels

58
Q

What are some extra points about the Femoral Nerve?

A

Formed within Psaos Major
passes under Midpoint of Inguinal Ligament
Most lateral structure in Femoral triangle
Supplies Hip Flexor and Knee Extensors
Terminal branch = Saphenous Nerve = Cutaneous nerve as descends medially

59
Q

What is the most lateral structure in the Femoral Triangle?

A

Femoral Nerve

60
Q

What groups of muscles does the femoral nerve supply?

A

Hip Flexor + Knee Extensor

61
Q

What is the terminal branch of the Femoral nerve and what type of nerve does this become?

A

Saphenous nerve

Cutaneous nerve

62
Q

What are the main features of the Femoral Sheath?

A

Starts at Inguinal Ligament and extends inferiorly
Contains Femoral AVL Artery, Veins and Lympahtics
NNOT the NNerve
Medial part contains the femoral Canal - a Sub-compartment of the sheath. - its proximal end = called the Femoral Ring

63
Q

What does the Femoral sheath contain?

A

AVL artery, veins, lymphatics

NNot the Femoral NNerve

64
Q

Where does the femoral sheath start?

A

Inguinal ligament

65
Q

What is the medial part of the Femoral Sheath called?

A

Femoral Canal

  • a SUBcompartment of the sheath
  • Proximal part/end = femoral Ring
66
Q

What is another name for Satorius?

A

Tailors muscle

  • s-shaped curve, long and thin
    1. prominent as you sit cross legged
    2. runs across medially like the tailors inseam
67
Q

What makes up the lateral bulk of the thigh muscle?

A

Vastus Lateralis

68
Q

What is the relationship between the ITB and the TFL?

A

TFL attaches onto the ITB on the Lateral Condyle of the Tibia (deep fascia which attached to the proximal tibia)

69
Q

Where do runners and cyclists often feel pain?

A

pain in Knee due to the ITB band

70
Q

What is the most inferior adductor structure?

A 
MAGNUS
"magnus" = big
longis and brevis are superior
comes down and covers all of the medial compartment of thigh
50:50 Medial and Psoterior compartment s
Hole in bottom
71
Q

Which adductor structure contains a hole, and where abouts is the hole located?

A

Adductor Magnus

Inferiorly/at the bottom

72
Q

What compartment does the Adductor Magnus belong to?

A

50:50
1/2 Medial Compartment
1/2 Posterior Compartment

73
Q

What is the role of the Inguinal Ligament?

A

Runs down the front of the hip
differentiates b/w Abdomen and Lower limb
“superior boundary of the lower limb”

74
Q

What composes the Superior Boundary of the Lower Limb?

A

Inguinal ligament

Differentiate b/w Abdomen and Lower Limb

75
Q

What is the relationship between External illiac and Inguinal Ligament?

A

External Iliac runs Laterally
Underneath ligament
Pops into Proximal thigh

76
Q

What are the main features of the Adductor Canal?

A

Subsatorial Canal- as is Deep (“sub”) to Middle 1/3 of Satorius
Inlet=Apex of Femoral triangle
Outlet= Adductor Hiatus in Add. Magnus muscle
Passage for femoral vessels to pass through thigh, reach popliteal fossa, and become popliteal vessels
Bound Medially by Satorius, Posteriorly by Adductor Longus & Magnus, and Laterally by Vastus Medialis
4x Contents= Femoral Artery and Vein, Saphenous nerve & Nerve to Vastus Medialis

77
Q

What is another name for the adductor canal?

A

Subsatorius canal

-as runs DEEP/”sub” to the Middle 1/3 of Satorius

78
Q

What is the Input and Output of the Adductor Canal?

A 
Input= Apex of Femoral triangle
Output= Adductor Hiatus in Add. Magnus
79
Q

What is the role of the Adductor Canal?

A

To act as a passage for the femoral vessels to run through the thigh, and reach the popliteal fossa where they become popliteal vessels

80
Q

What are the 4x Contents of the Adductor Canal?

A

Femoral Artery
Femoral Vein
Saphenous Nerve
Nerve to Vastus Medialis

81
Q

What is the adductor canal bound Medially by?

A

Satorius

82
Q

What 2x structures is the adductor canal bound posteriorly by?

A

Adductor Longus

Adductor Magnus

83
Q

What is the adductor canal bound Laterally by?

A

Vastus Medialis

84
Q

What are the 2x clinical applications for the Femoral Pulse/Femoral Artery?

A

Femoral Pulse

  1. Arterial Samples
    - when unable to collect peripheral samples (when peripherally shut down in shock)
  2. Cardio Angiography
    - catheter passed up femoral artery to aorta and coronary arteries + contrast inserted
85
Q

When is the Femoral Artery used clinically for Arterial samples?

A

Femoral Pulse
when unable to collect peripheral blood samples
-when peripherally shut down in shock

86
Q

When is the Femoral Artery used clinically for Cardiac Angiographies?

A

Femoral Pulse
Catheter is passed up the femoral artery
to the aorta and coronary arteries
contrast is inserted

87
Q

What are the 4x main clinical applications relating to the femoral structures and vessels?

A

Femoral Pulse
Cannulation of Femoral Vein
Femoral Nerve Block
Femoral Hernia

88
Q

What is the clinical application for the Femoral Vein?

A

Cannulation of Femoral Vein
Often used for arterial samples as is relatively Easy to find and access
Long Catheter inserted into femoral vein as it passes through the F. Triangle
Blood Samples or Pressure measurements
Right RH side of Heart
(via External Illiac Vein, Common illiac vein and IVC)

89
Q

Why is the Femoral Vein often used for arterial samples?

A

Relatively easy to find and access

90
Q

What measurements can be collected by doing a cannulation of the Femoral Vein?

A

Blood samples
Pressure Measurements
of the RIGHT RH side of the heart

91
Q

Via what 3x structures are blood samples and pressure measurements recorded during a Cannulation of the Femoral Vein?

A

External illiac vein
Common illiac vein
IVC

92
Q

What is the clinical application for a Femoral Nerve block relevant?

A

Pain relief for hip or femoral fractures
Instead of large doses of oral or intravenous analgesics
Easily located lateral to F Artery in Femoral triangle

93
Q

After a hip or femoral fracture, what does the option of a femoral nerve block replace?

A

instead of large doses of oral or intravenous analgesics

94
Q

What are the main features of a Femoral Hernia?

A

Femoral ring = Weakest place in lower abdominal wall
Therefore is a site for a hernia = loop of small intestine
Woman more common
Hernia extends beyond F Canal, Saphenous opening and into Thigh = risk of strangulation

95
Q

What is the weakest place in the lower abdominal wall?

A

Femoral ring

-therefore site for a Hernia (usually loop of small intestine)

96
Q

What is the risk of the Femoral Ring being the weakest place in the lower abdominal wall?

A

site for a Femoral Hernia

usually a loop of small intestine

97
Q

Which gender are femoral hernias more common in?

A

women

98
Q

When is there a risk of Strangulation?

A

When hernia extends past Femoral Canal, Saphenous Opening and into Thigh

99
Q

What happens if a Femoral Hernia extends past the Femoral Canal, Saphenous opening and into the thigh?

A

risk of Strangulation

Musculoskeletal Module (27 decks)

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