MSK Session 6c: medial thigh

Question 1

Form of adductor longus?

Answer 1

Fan shaped

The most anterior

Question 2

Adductor longus origin?

Answer 2

Body of pubis, inferior to the pubic crest

Question 3

Adductor longus insertion?

Answer 3

Middle 1/3 of linea aspera

Question 4

Adductor longus innervation?

Answer 4

Obturator nerve (anterior, L2,3,4)

Question 5

Adductor longus action?

Answer 5

ADduction of thigh

Question 6

Adductor brevis location?

Answer 6

Deep to adductor longus. In between the anterior and posterior divisions of the obturator nerve

Question 7

Adductor brevis origin?

Answer 7

Body and inferior pubic ramus

Question 8

Adductor brevis insertion?

Answer 8

Pectineal line and proximal part of linea aspera

Question 9

Adductor brevis innervation?

Answer 9

Obturator nerve (L2,3,4)

Question 10

Adductor brevis action?

Answer 10

ADducts thigh

Some flexion

Question 11

Adductor magnus adductor part origin?

Answer 11

Inferior pubic ramus

Question 12

Adductor magnus adductor part insertion?

Answer 12

Gluteal tuberosity, linea aspera, medial supracondylar line

Question 13

Adductor magnus adductor part innervation?

Answer 13

Obturator nerve (posterior, L2,3,4)

Question 14

Adductor magnus adductor part action?

Answer 14

ADducts and flexes thigh

Question 15

Adductor magnus hamstring part origin?

Answer 15

Ischial tuberosity

Question 16

Adductor magnus hamstring part insertion?

Answer 16

Adductor tubercle of femur

Question 17

Adductor magnus hamstring part innervation?

Answer 17

Tibial part of sciatic nerve (L4)

Question 18

Adductor magnus hamstring part action?

Answer 18

ADducts and extends thigh

Question 19

What is the adductor hiatus?

Answer 19

A hole in adductor magnus
Femoral artery passes through to reach the popliteal area, and other perforating vessels use it to enter the posterior thigh

Question 20

Gracilis form?

Answer 20

Long and thin
The most medial and superficial of the adductors
Crosses the knee and the hip where it has synergistic action
From ‘goose’s foot’ goes superiorly

Question 21

Gracilis origin?

Answer 21

Body and inferior pubic ramus

Question 22

Gracilis insertion?

Answer 22

Superior part of medial surface of tibia

Question 23

Gracilis innervation?

Answer 23

Obturator (L2,L3)

Question 24

Gracilis action?

Answer 24

ADducts thigh
Flexes
Helps medial rotation

Question 25

Obturator externus form?

Answer 25

Flat, small, deep, superior

Question 26

Obturator externus origin?

Answer 26

Margins of obturator foramen and obturator membrane

Question 27

Obturator externus insertion?

Answer 27

Trochanteric fossa of femur

Question 28

Obturator externus innervation?

Answer 28

Obturator nerve (L3,L4)

Question 29

Obturator externus action?

Answer 29

Lateral rotation
ADduction
Steadies head of femur in acetabulum

Question 30

Arteries of upper part of lower limb?

Answer 30

Common iliac into external and internal iliac

External iliac into femoral, profunda femoris, medial circumflex and lateral circumflex

Question 31

Deep veins of lower limb?

Answer 31

Foot: dorsal venous arch, mostly drains into superficial veins, some drain deep into leg forming anterior tibial vein
Plantar foot: medial and lateral plantar veins
Combine in leg to posterior tibial and fibular veins
Unite to form popliteal vein
Enters thigh through adductor canal into femoral vein
Also profunda femoris vein which empties into femoral vein
Leaves thigh underneath inguinal ligament becoming external iliac vein
Gluteal region: inferior and superior gluteal veins that drain into internal iliac

Question 32

Superficial veins of lower limb?

Answer 32

Great saphenous vein: from dorsal venous arrch and dorsal vein of hallux. Ascends up medial side of leg, passes anteriorly to medial malleolus and posterior to medial condyle at knee. Drains into femoral vein inferior to inguinal ligament
Small saphenous vein: from dorsal venous arch of foot and dorsal vein of little toe. Moves up posterior side, passes posterior to lateral malleolus, along lateral border of calcaneal tendon, moves between the two heads of gastrocnemius and empties into popliteal vein

Question 33

Lymph nodes?

Answer 33

Superificial inguinal
Deep inguinal
Popliteal

Question 34

Contents of femoral canal?

Answer 34

Lymph nodes (lacunar node), lymph vessels (draining into deep inguinal nodes) and empty space
Most medial and smallest (~1.3cm)

Question 35

Contents of femoral sheath?

Answer 35

Femoral artery, femoral vein, lymph

Question 36

Purpose of empty space in the femoral triangle?

Answer 36

Allows veins and lymph vessels space to distend based on flow

Question 37

Borders of femoral canal?

Answer 37

Opening: femoral ring at superior border
Medial: lacunar ligament
Lateral: femoral vein
Anterior: inguinal ligament
Posterior: pectineal ligament, pectineus and superior rami of pubis

Question 38

Contents of femoral triangle?

Answer 38

Lateral to medial: nerve, artery, vein, canal
--> NAVEL:
Nerve (femoral)
Artery (femoral)
Vein (femoral)
Empty space
Lymph

A, V and L enclosed in femoral sheath

Question 39

Borders of femoral triangle?

Answer 39

Superior: inguinal ligament (runs from ASIS to pubic tubercle)
Lateral: medial border of sartorius
Medial: medial border of adductor longus
Roof: fascia lata
Floor: pectineus, iliopsoas and adductor longus

Question 40

Describe where the femoral pulse can be palpated?

Answer 40

Initial part is superficial
Patient supine
Midway between the ASIS and the pubic symphysis: MID INGUINAL POINT

Midpoint of inguinal ligament is halfway between ASIS and pubic tubercle, so deep

Question 41

Clinical relevance of femoral artery

Answer 41

Angiography, femoral stab to get a fast blood sample, cannulation here as central access for drugs, or for a nerve block in a #NoF