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MSK Week 3 > LM 6.3: Thigh > Flashcards

LM 6.3: Thigh Flashcards

1
Q

There is one vein in particular that bothers her the most. She points to it on the posterior lateral aspect of her calf. What is the most likely name of this vein?

which nerves runs along with it?

A

small saphenous vein

runs on the posterior part of the leg on the calf and drains into the popliteal vein = deep vein on the back of the knee

the sural nerve runs lateral to it in the calf

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2
Q

what is the course of the great saphenous vein?

A

it originates on the dorsal aspect of the foot then travels anteriorly to the medial malleolus in the foot then travels up the leg medially

it then travels posterior to the knee then resurfaces anterior medially in the thigh

it then ends at the saphenous opening in the groin area where it drains into the femoral vein

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3
Q

which nerves give cutaneous sensation to the gluteal region?

A

superior, middle and inferior cluneal nerves

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4
Q

which nerve runs along the course of the great sphenous vein? what does it innervate?

A

it is joined in its course by the saphenous nerve between the ankle and the knee

the saphenous nerve provides cutaneous innervation to the medial aspect of the leg and the foot

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5
Q

what are the 2 main superficial veins of the lower limb?

A
  1. great saphenous vein

2. small saphenous vein

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6
Q

what is venae comitantes?

A

the veins surrounding an artery

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7
Q

what are perforating veins?

A

connections between deep and superficial veins

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8
Q

what are varicose veins?

A

in a person without varicose veins, the muscles in the leg contract and the deep veins become compressed and the blood travels back towards the heart and as it does so it leaves an area of theoretical empty space within the deep veins which allows blood from the superficial veins to pass through the perforating veins to the deep veins

vericose veins reflect stasis of blood both at superficial and deep levels

so they result from from incompetent venous valves – valves prevent inferior flow of blood but in the case of varicose veins, the blood isn’t properly moving back towards heart and it becomes overflowed int the valve and the vale becomes incompetent

if there’s inadequate flow of blood you could get a thrombus = stationary blood clot

varicose = dilated and tortuous (squiggly)

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9
Q

what is a potential consequence of varicose veins?

A

pulmonary embolism

if there’s inadequate flow of blood you could get a thrombus = stationary blood clot

if the blood clot becomes mobile and go to the lungs where it could cause a PE

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10
Q

You are the sports medicine physician for a professional soccer team. During a game, you see a player excessively abduct his right hip and go down in pain. As you approach him on the field, you see that he is holding the superior aspect of his medial thigh. He tells you, “I think I pulled my groin, doc.” Which muscle did he most likely strain?

A

pectineus

aka pulled groin

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11
Q

what is a pulled groin?

A

it’s a straining of anteromedial thigh muscles from their proximal attachment (usually the pubis)

usually seen in sports that require quick starts, such as soccer, basketball, hockey and baseball

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12
Q

what is a strain?

A

tearing or stretching of muscle or tendon

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13
Q

what is a sprain?

A

tearing or stretching of ligament

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14
Q

what are the anteromedial thigh muscles that could be injured during a pulled groin?

A
  1. obturator externus
  2. adductor brevis
  3. adductor longus
  4. pectineus
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15
Q

what are the 3 compartments of the thigh?

A
  1. anterior
  2. medial
  3. posterior
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16
Q

what is the action and innervation of the 3 compartment s of the thigh?

A
  1. anterior = flexion of hip and extension of the knee

innervated by femoral nerve

  1. medial = adduction of the hip

innervated by obturator nerve

  1. posterior = extension of the hip and flexion of the knee
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17
Q

what are the anterior thigh muscles? what is their innervation and distal attachment?

A
  1. sartorius
  2. quadriceps femoris

rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis

  1. pectineus

all of these are innervated by the femoral nerve and attach at the tibial tuberosity!

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18
Q

which muscles make up the quadriceps femoris?

A
  1. rectus femoris
  2. vastus lateralis
  3. vastus intermedius
  4. vastus medialis
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19
Q

what is the attachment and innervation of the sartorius muscle?

A

proximal attachment = anterior superior iliac spine, i.e. ASIS

distal attachment = tibial tuberosity

innervation = femoral nerve

action = helps you sit cross-legged

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20
Q

what is the attachment, action and innervation of the rectus femoris?

A

proximal attachment = Anterior inferior iliac spine, i.e. AIIS

distal attachment = tibial tuberosity

action = flexes hip; extends knee

it’s the only muscle in the quadriceps femoris that can flex the hip!

innervation = femoral nerve

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21
Q

what is the attachment, action and innervation of the vastus lateralis?

A

distal attachment = tibial tuberosity

action = extends knee; straightens the knee

innervation = femoral nerve

22
Q

what is the attachment, action and innervation of the vastus medialis?

A

distal attachment = tibial tuberosity

action = extends knee

innervation = nerve to vastus medialis (which is a branch of the femoral nerve)

23
Q

what is the attachment, action and innervation of the vastus intermedius?

A

proximal attachment = shaft of femur (deep to rectus femorus)

distal attachment = tibial tuberosity

action = extends knee (does NOT act on the hip)

innervation = femoral nerve

24
Q

what is the attachment, action and innervation of the pectineus?

A

proximal attachment = pubis

distal attachment = pectineal line of femur

action = flexes and adducts hip

innervation = femoral nerve

25
Q

what is the course of the femoral nerve?

A

it originates from the ventral rami of lumbar spinal nerves

in the pelvis it runs between the iliacus laterally and the psoas major medially; it runs deep to the inguinal ligament

it then branches into multiple motor and cutaneous branches right after passing by the inguinal ligament

26
Q

what are the two important nerve branches of the femoral nerve?

A
  1. saphenous nerve

2. nerve to vastus medialis

27
Q

what is the function of the saphenous nerve?

A

provides cutaneous innervation to medial side of the leg

28
Q

what are the 5 muscles of the medial thigh compartment?

A
  1. gracilis
  2. adductor longus
  3. adductor brevis
  4. adductor magnus
  5. obturator externus

these muscles are all innervated by the obturator nerve and all adduct the thigh

*except the obturator externus which laterally rotates the hip

29
Q

how are the adductor longus, brevis and magnus oriented in relation to each other?

A

the adductor longus it the most anterior followed by the brevis and the magnus is the most posterior

30
Q

what innervates the gracilus?

A

obturator nerve

31
Q

what is the action and innervation of the adductor longus muscle?

A

action = adducts thigh

innervation = obturator nerve

it’s in the same coronal place as the pectineus but inferior to it

32
Q

what is the action and innervation of the adductor brevis muscle?

A

it’s located deep to adductor longus and inferior to obturator externus

action = adducts thigh

innervation = obturator nerve; its anterior and posterior divisions pass anterior and posterior to the adductor brevis muscle

33
Q

what is the action and innervation of the adductor magnus muscle?

A

it’s located posterior to adductor brevis – it’s the most posterior of medial thigh muscles

action = adducts thigh

innervation:
obturator nerve and tibial part of
sciatic nerve

34
Q

what does the ligament of the adductor magnus form? why is it important?

A

it forms the adductor hiatus

this allows the femoral vein and artery to pass through! it’s a this point that they change names to th popliteal vein and artery

35
Q

what is the attachment, action and innervation of the obturator externus?

A

proximal attachment =
external surface of obturator membrane

action = laterally rotates thigh (instead of adducting the thigh like the other medial thigh muscles)

innervation = obturator nerve

36
Q

what is the course of the obturator nerve?

A

it innervates the medial

it exits the pelvis through the obturator foramen which is the hole created by the obturator membrane

after it goes through the hole, it splits into anterior and posterior branches which pass A and P to the adductor brevis, respectively

it innervates the medial compartment muscles of the thigh and the skin of the medial thigh

37
Q

what are the 3 muscles of the posterior compartment of the thigh? what nerve innervates them?

A
  1. semitendinosus
  2. semimembranosus
  3. biceps femoris (short and long head)

all innervated by sciatic nerve!

38
Q

what is the action and innervation of the semitendinosus?

A

it’s located posterior to semimembranosus

it has a prominent inferior tendon

action = extends thigh; flexes leg

innervation = sciatic nerve

39
Q

what is the action and innervation of the semimembranosus?

A

it’s located anterior to semitendinosus

notable thinness superiorly

action = extends thigh; flexes leg

innervation = sciatic nerve

40
Q

what is the action and innervation of the biceps femoris?

A

attachment:
long head attaches proximally to ischial tuberosity; distal attachment is fibula

short head proximally attaches to femur and distally to the fibula

action:
leg flexion by both heads

thigh extension by long head ONLY

innervation = sciatic nerve

41
Q

which nerve roots does the sciatic nerve originate from?

A

L4-S3

42
Q

what does the sciatic nerve turn into? when does this happen?

A

the sciatic nerve exits the hip then descends down the leg until it gets to the popliteal fossa (posterior knee)

there it branches into the tibial nerve and common fibular nerve

43
Q

what does the common fibular nerve branch into?

A

once it passes the popliteal fossa, wraps around the neck of the fibula anteriorly

it then branches into the superficial and deep fibular nerve

44
Q

what does the tibial nerve branch into?

A

medial and lateral plantar nerves once it reaches the foot

they supply the majority of the muscles of the foot

45
Q

when does the external iliac artery become the femoral artery?

A

once it passes inferior to the inguinal ligament

46
Q

when does the femoral artery become the popliteal artery?

A

after it passes through the adductor hiatus

47
Q

what does the anterior tibial artery turn into?

A

it turns into the dorsal artery of the foot aka dorsalis pedis artery after it crosses between the medial and lateral malleoli

48
Q

what is the span of the femoral artery?

A

in-between the inguinal ligament and the adductor hiatus

after it passes through the adductor hiatus it becomes the popliteal artery

49
Q

what are the branches of the femoral artery?

A

deep artery of the thigh aka profound femoris artery

the medial and lateral circumflex femoral arteries come off of the deep artery of the thigh and they later anastomose with each other after wrapping around the femur

50
Q

what is the pneumonic for the arrangement of the femoral nerve, artery, vein and lymphatics?

A

NAVAL

nerve, artery, vein and lymphatics from lateral to medial

MSK Week 3 (10 decks)

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