LM 6.3: Thigh Flashcards
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?
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
what is the course of the great saphenous vein?
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
which nerves give cutaneous sensation to the gluteal region?
superior, middle and inferior cluneal nerves
which nerve runs along the course of the great sphenous vein? what does it innervate?
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
what are the 2 main superficial veins of the lower limb?
- great saphenous vein
2. small saphenous vein
what is venae comitantes?
the veins surrounding an artery
what are perforating veins?
connections between deep and superficial veins
what are varicose veins?
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)
what is a potential consequence of varicose veins?
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
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?
pectineus
aka pulled groin
what is a pulled groin?
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
what is a strain?
tearing or stretching of muscle or tendon
what is a sprain?
tearing or stretching of ligament
what are the anteromedial thigh muscles that could be injured during a pulled groin?
- obturator externus
- adductor brevis
- adductor longus
- pectineus
what are the 3 compartments of the thigh?
- anterior
- medial
- posterior
what is the action and innervation of the 3 compartment s of the thigh?
- anterior = flexion of hip and extension of the knee
innervated by femoral nerve
- medial = adduction of the hip
innervated by obturator nerve
- posterior = extension of the hip and flexion of the knee
what are the anterior thigh muscles? what is their innervation and distal attachment?
- sartorius
- quadriceps femoris
rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis
- pectineus
all of these are innervated by the femoral nerve and attach at the tibial tuberosity!
which muscles make up the quadriceps femoris?
- rectus femoris
- vastus lateralis
- vastus intermedius
- vastus medialis
what is the attachment and innervation of the sartorius muscle?
proximal attachment = anterior superior iliac spine, i.e. ASIS
distal attachment = tibial tuberosity
innervation = femoral nerve
action = helps you sit cross-legged
what is the attachment, action and innervation of the rectus femoris?
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
what is the attachment, action and innervation of the vastus lateralis?
distal attachment = tibial tuberosity
action = extends knee; straightens the knee
innervation = femoral nerve
what is the attachment, action and innervation of the vastus medialis?
distal attachment = tibial tuberosity
action = extends knee
innervation = nerve to vastus medialis (which is a branch of the femoral nerve)
what is the attachment, action and innervation of the vastus intermedius?
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
what is the attachment, action and innervation of the pectineus?
proximal attachment = pubis
distal attachment = pectineal line of femur
action = flexes and adducts hip
innervation = femoral nerve
what is the course of the femoral nerve?
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
what are the two important nerve branches of the femoral nerve?
- saphenous nerve
2. nerve to vastus medialis
what is the function of the saphenous nerve?
provides cutaneous innervation to medial side of the leg
what are the 5 muscles of the medial thigh compartment?
- gracilis
- adductor longus
- adductor brevis
- adductor magnus
- 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
how are the adductor longus, brevis and magnus oriented in relation to each other?
the adductor longus it the most anterior followed by the brevis and the magnus is the most posterior
what innervates the gracilus?
obturator nerve
what is the action and innervation of the adductor longus muscle?
action = adducts thigh
innervation = obturator nerve
it’s in the same coronal place as the pectineus but inferior to it
what is the action and innervation of the adductor brevis muscle?
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
what is the action and innervation of the adductor magnus muscle?
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
what does the ligament of the adductor magnus form? why is it important?
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
what is the attachment, action and innervation of the obturator externus?
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
what is the course of the obturator nerve?
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
what are the 3 muscles of the posterior compartment of the thigh? what nerve innervates them?
- semitendinosus
- semimembranosus
- biceps femoris (short and long head)
all innervated by sciatic nerve!
what is the action and innervation of the semitendinosus?
it’s located posterior to semimembranosus
it has a prominent inferior tendon
action = extends thigh; flexes leg
innervation = sciatic nerve
what is the action and innervation of the semimembranosus?
it’s located anterior to semitendinosus
notable thinness superiorly
action = extends thigh; flexes leg
innervation = sciatic nerve
what is the action and innervation of the biceps femoris?
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
which nerve roots does the sciatic nerve originate from?
L4-S3
what does the sciatic nerve turn into? when does this happen?
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
what does the common fibular nerve branch into?
once it passes the popliteal fossa, wraps around the neck of the fibula anteriorly
it then branches into the superficial and deep fibular nerve
what does the tibial nerve branch into?
medial and lateral plantar nerves once it reaches the foot
they supply the majority of the muscles of the foot
when does the external iliac artery become the femoral artery?
once it passes inferior to the inguinal ligament
when does the femoral artery become the popliteal artery?
after it passes through the adductor hiatus
what does the anterior tibial artery turn into?
it turns into the dorsal artery of the foot aka dorsalis pedis artery after it crosses between the medial and lateral malleoli
what is the span of the femoral artery?
in-between the inguinal ligament and the adductor hiatus
after it passes through the adductor hiatus it becomes the popliteal artery
what are the branches of the femoral artery?
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
what is the pneumonic for the arrangement of the femoral nerve, artery, vein and lymphatics?
NAVAL
nerve, artery, vein and lymphatics from lateral to medial
