Lecture 4 Flashcards
Pectineus
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
Illiopsoas
Anterior Thigh Muscle
Origin: Formed by Psoas Major and Illiacus
Insertion: Lesser Trochanter via lliopsoas tendon
Action:
Nerve Supply:
Illiacus
Anterior Thigh Muscle Origin: Illiac Fossa, lateral sacrum Insertion: Lesser Trochanter Action: Flexes and Externally rotates Thigh Nerve Supply: Femoral
Psoas Major
Anterior Thigh Muscle Origin: Lumbar Vertebrae Insertion: Lesser Trochanter Action: Flexes and Externally rotates Thigh Nerve Supply: L2 and L3
Tensor Fascia Lata
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
Sartorius
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
Quadriceps Femoris
Anterior Thigh Muscle
Origin: Consists of Rectus Femoris and Vasti
Insertion:Tibial tuberosity via Patella tendon (Patella interposed as sesamoid bone)
Action:
Nerve Supply:
Rectus Femoris
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
Vastus Lateralis
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
Vastus Intermedius
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
Vastus Medialis
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
Adductor Longis
Medial Thigh Muscle Origin: Body of pubis Insertion: Linea Aspera Action: Adducts, Flexes thigh Nerve Supply: Obturator
Adductor Brevis
Medial Thigh Muscle Origin: Inferior Pubic Ramus Insertion: Linea Aspera Action: Adducts, Flexes thigh Nerve Supply: Obturator
Adductor Magnus
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)
Gracilis
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
Obturator Externus
Medial Thigh Muscle Origin: Obturator foramen and membrane Insertion: Posterior intertrochanteric fossa Action: Externally rotates thigh Nerve Supply: Obturator
What is the Fascia Lata?
Lower limb deep fascia
Runs down the thigh, attaches to the knee
Continuous with the Fascia in the leg
What are some features of Dense Fascia?
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
What are the relative attachments of the Fascia Lata?
Superior to pubic ligaments, pubis and inguinal ligament
Lateral to illiac crest
Posterior to sacrum, coccyx and ishcial tuberosity
What 3x structures is the attachment of the Fascia Lata Superior to?
Pubic Tubercle
Pubis
Inguinal ligament
What structure is the attachment of the Fascia Lata Lateral to?
Illiac Crest
What 3x structures is the attachment of the Fascia Lata Posterior to?
Sacrum
Coccyx
Ischial Tuberosity
How many compartments are in the thigh?
3
How are compartments of the thigh formed/outlined?
- Fascia Lata
2. Intermuscular Septae (anterior, medial and posterior)
What is the strongest intermuscular septum in the thigh compartment?
LATERAL intermuscular septum and therefore EASIER to find
the others are relatively weaker and harder to find
What are some features of the Tensor Fascia Lata Muscle?
(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
What influence does the embryological origin have on the tensor fascia lata muscle?
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)
What are some features of the IT Band?
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
What is the Saphenous Opening?
Anterior part of the Fascia Lata has a Deficiency
located Inferiorly to the Inguinal Ligament
Saphenous Vein passes through and meets the Femoral Vein
Where does the Great Saphenous vein run?
OUTSIDE the deep fascia
down the Medial side of the leg
How any compartments are in the leg?
4 distinct compartments
What are the 2x benefits in knowing the attachments of muscles?
- helps show what 2x things it pulls closer together (what the movement is going to effect)
- during Trauma muscle can Pull off a bit of bone - muscle or tendon can rip, muscle stronger than bone
What is a generalised feature for muscles within compartments?
muscles within compartment, surrounded by fascia, generally have the SAME
- action
- nerve and bloody supply
- start, grow and work together
What parts do spinal nerves have?
Motor AND sensory parts to them, after the plexus
What parts do peripheral nerves have?
Potentially will also have motor and sensory parts to them
What do motor branches of peripheral nerves control?
supply/control muscles
What do sensory branches of peripheral nerves control?
go to the skin for sensation
-got it’s sensory fibres from a spinal nerves , due to the Plexus
What is an example of a large plexus?
Brachial plexus
supplies the upper limb
What are the components of the CNS?
Brain + Spinal Cord
Inside the spinal Canal
What are the components of the PNS?
Everything OUTSIDE the spinal canal (left the protection on the spinal canal)
Peripheral nerves go out into the periphery and supply muscles
Where are plexuses located?
Outside of the spinal cord
spinal nerves go out into plexus, mix, and then come out as peripheral nerves
What can peripheral nerves be composed of?
Spinal nerves contribute to one or more peripheral nerves
Therefore, peripheral nerves can be made up of 1x or more spinal nerves
How are Spinal nerves names?
according to where they come from (Numbers)
e.g. T1, T2, T3
How are Peripheral nerves named?
have Names
e.g. obturator
Why is it important to remember which spinal level peripheral nerves come from?
could injure spinal nerve/cord (e.g. H3) and that would effect how the peripheral nerve(s) (Paul and Priscila) work
What are the possible combinations of a peripheral nerve after exiting the plexus?
H1 H2 H3 H1 + H2 H2 + H3 H1 + H2 + H3 Note: it is unusual to Skip a level (H1 + H3) WITHOUT H2 ASwell
What is a plexus?
Not a single thing (on diagram)
Thick mesh of nerve fibres
Within or Wrapped around a muscle
What are the main points about the Femoral Nerve?
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
What is the largest branch of the femoral nerve?
Saphenous Nerve
cutaneous nerve, as descends Medially down the leg
What are the main points about the Obturator Nerve?
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
What is the femoral triangle?
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
What is the Femoral Triangle bound superiorly by?
Inguinal Ligament
What is the Femoral Triangle bound medially by?
Adductor Longus
What is the Femoral Triangle bound laterally by?
Satorius
What 2x things make up the Floor of the Femoral triangle?
Illiopsoas + Pectinius
What 3x things make up the Roof of the Femoral triangle?
Fascia Lata
Subcutaneous Tissue and Skin
What are the contents of the Femoral Triangle Laterally to Medially?
Laterally –> Medially “NsAVIgate the femoral triangle from lateral to medial”
Femoral Nerve -> F. Sheath -> F. Artery -> F. Vein -> Lymphatic vessels
What are some extra points about the Femoral Nerve?
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
What is the most lateral structure in the Femoral Triangle?
Femoral Nerve
What groups of muscles does the femoral nerve supply?
Hip Flexor + Knee Extensor
What is the terminal branch of the Femoral nerve and what type of nerve does this become?
Saphenous nerve
Cutaneous nerve
What are the main features of the Femoral Sheath?
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
What does the Femoral sheath contain?
AVL artery, veins, lymphatics
NNot the Femoral NNerve
Where does the femoral sheath start?
Inguinal ligament
What is the medial part of the Femoral Sheath called?
Femoral Canal
- a SUBcompartment of the sheath
- Proximal part/end = femoral Ring
What is another name for Satorius?
Tailors muscle
- s-shaped curve, long and thin
1. prominent as you sit cross legged
2. runs across medially like the tailors inseam
What makes up the lateral bulk of the thigh muscle?
Vastus Lateralis
What is the relationship between the ITB and the TFL?
TFL attaches onto the ITB on the Lateral Condyle of the Tibia (deep fascia which attached to the proximal tibia)
Where do runners and cyclists often feel pain?
pain in Knee due to the ITB band
What is the most inferior adductor structure?
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
Which adductor structure contains a hole, and where abouts is the hole located?
Adductor Magnus
Inferiorly/at the bottom
What compartment does the Adductor Magnus belong to?
50:50
1/2 Medial Compartment
1/2 Posterior Compartment
What is the role of the Inguinal Ligament?
Runs down the front of the hip
differentiates b/w Abdomen and Lower limb
“superior boundary of the lower limb”
What composes the Superior Boundary of the Lower Limb?
Inguinal ligament
Differentiate b/w Abdomen and Lower Limb
What is the relationship between External illiac and Inguinal Ligament?
External Iliac runs Laterally
Underneath ligament
Pops into Proximal thigh
What are the main features of the Adductor Canal?
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
What is another name for the adductor canal?
Subsatorius canal
-as runs DEEP/”sub” to the Middle 1/3 of Satorius
What is the Input and Output of the Adductor Canal?
Input= Apex of Femoral triangle Output= Adductor Hiatus in Add. Magnus
What is the role of the Adductor Canal?
To act as a passage for the femoral vessels to run through the thigh, and reach the popliteal fossa where they become popliteal vessels
What are the 4x Contents of the Adductor Canal?
Femoral Artery
Femoral Vein
Saphenous Nerve
Nerve to Vastus Medialis
What is the adductor canal bound Medially by?
Satorius
What 2x structures is the adductor canal bound posteriorly by?
Adductor Longus
Adductor Magnus
What is the adductor canal bound Laterally by?
Vastus Medialis
What are the 2x clinical applications for the Femoral Pulse/Femoral Artery?
Femoral Pulse
- Arterial Samples
- when unable to collect peripheral samples (when peripherally shut down in shock) - Cardio Angiography
- catheter passed up femoral artery to aorta and coronary arteries + contrast inserted
When is the Femoral Artery used clinically for Arterial samples?
Femoral Pulse
when unable to collect peripheral blood samples
-when peripherally shut down in shock
When is the Femoral Artery used clinically for Cardiac Angiographies?
Femoral Pulse
Catheter is passed up the femoral artery
to the aorta and coronary arteries
contrast is inserted
What are the 4x main clinical applications relating to the femoral structures and vessels?
Femoral Pulse
Cannulation of Femoral Vein
Femoral Nerve Block
Femoral Hernia
What is the clinical application for the Femoral Vein?
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)
Why is the Femoral Vein often used for arterial samples?
Relatively easy to find and access
What measurements can be collected by doing a cannulation of the Femoral Vein?
Blood samples
Pressure Measurements
of the RIGHT RH side of the heart
Via what 3x structures are blood samples and pressure measurements recorded during a Cannulation of the Femoral Vein?
External illiac vein
Common illiac vein
IVC
What is the clinical application for a Femoral Nerve block relevant?
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
After a hip or femoral fracture, what does the option of a femoral nerve block replace?
instead of large doses of oral or intravenous analgesics
What are the main features of a Femoral Hernia?
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
What is the weakest place in the lower abdominal wall?
Femoral ring
-therefore site for a Hernia (usually loop of small intestine)
What is the risk of the Femoral Ring being the weakest place in the lower abdominal wall?
site for a Femoral Hernia
usually a loop of small intestine
Which gender are femoral hernias more common in?
women
When is there a risk of Strangulation?
When hernia extends past Femoral Canal, Saphenous Opening and into Thigh
What happens if a Femoral Hernia extends past the Femoral Canal, Saphenous opening and into the thigh?
risk of Strangulation
