Musculoskeletal: Anatomy - Lower limb summary Flashcards
Three compartments of the thigh
Anterior
Posterior
Medial (adductor)
Nerve supply to anterior compartment of the thigh
Femoral nerve (L2-4)
Exceptions are psoas major which is innervated by anterior rami L1-3, and pectineus which may receive a branch of the obturator nerve
Arterial supply to anterior compartment of the thigh
Femoral artery (continuation of the external iliac artery)
Exception is iliopsoas, supplied by iliolumbar artery (amongst others)
Actions of the anterior compartment of the thigh
Primarily hip flexion and knee extension
Others:
- Hip abduction and lateral rotation by sartorius
- Knee flexion by sartorius
- Hip adduction by pectineus
Proximal attachment of rectus femoris
AIIS
Proximal attachment of vastus lateralis
Greater trochanter
Lateral lip of linea aspera
Proximal attachment of vastus intermedius
Femoral shaft
Proximal attachment of vastus medialis
Intertrochanteric crest
Medial lip of linea aspera
Proximal attachment of psoas major
T12-L4
Proximal attachment of iliacus
Iliac fossa
Boundaries of the femoral triangle
Base: inguinal ligament
Lateral: medial border of sartorius
Medial: lateral border of adductor longus
Floor: iliopsoas, pectineus
Roof: cribiform fascia, fascia lata (deep fascia of thigh), skin and subcutaneous tissue
Contents of the femoral triangle
From lateral to medial:
Nerve (femoral)
Artery (femoral)
Vein (femoral)
Empty space (canal)
Lymphatics
Boundaries of the popliteal fossa
Superolateral: biceps femoris tendon
Superomedial: semimembranosus
Inferolateral: lateral head of gastrocnemius, plantaris
Inferomedial: medial head of gastrocnemius
Contents of the popliteal fossa. How are they arranged from medial to lateral and superficial to deep?
Tibial nerve (bisects)
Common fibular nerve
Posterior cutaneous nerve of thigh
Popliteal artery
Popliteal vein
Small saphenous vein (pierces popliteal fascia and terminates by entering popliteal vein)
Popliteal lymph nodes and vessels
Medial to lateral: artery -> vein -> nerve (remember common fibular needs to go lateral so this is the most lateral structure)
Superficial to deep: I will NVA remember this (nerve -> vein -> artery)
What forms the adductor hiatus?
Distal attachments of adductor and hamstring parts of adductor magnus
Actions of the medial compartment of the thigh
Hip adduction
Others:
- Hip lateral rotation by obturator externus
- Hip extension by hamstring part of adductor magnus
- Hip flexion by adductor part of adductor magnus
Nerve supply to medial compartment of the thigh
Obturator nerve (L2-4)
Exception is hamstring part of adductor magnus which is innervated by tibial part of sciatic nerve (L4-S3)
Arterial supply of medial compartment of the thigh
Obturator artery
Branch of the internal iliac
Proximal attachment of gracilis
Body of pubis
Proximal and distal attachments of obturator externus
Proximal: obturator foramen and surrounding bone
Distal: posterior greater trochanter
Muscles of the anterior compartment of the thigh
- Iliopsoas
- Sartorius
- Quadriceps femoris:
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis - Pectineus
Proximal and distal attachments of the two parts of adductor magnus
Adductor part: ischial and inferior pubic rami -> linea aspera
Hamstring part: ischial tuberosity -> adductor tubercle, medial supracondylar line of femur
Proximal and distal attachments of adductor longus
Proximal: pubis
Distal: linea aspera (long fan-shaped)
Why is adductor longus an anatomical landmark in the medial thigh?
Separates anterior and posterior divisions of obturator nerve
Proximal and distal attachments of adductor brevis
Proximal: pubis, inferior pubic rami
Distal: linea aspera (proximal to adductor longus)
Which three muscles form the pes anserinus?
Sartorius
Gracilis
Semitendinosus
Actions of the posterior compartment of the thigh
Hip extension and knee flexion
Others:
- Hip and knee lateral rotation by biceps femoris
- Hip and knee medial rotation by semitendinosus and semimembranosus
Nerve supply of the posterior compartment of the thigh
Sciatic nerve (L4-S3)
Arterial supply of the posterior compartment of the thigh
Inferior gluteal artery
Perforating branches of profunda femoris
Common proximal attachment of the muscles of the posterior compartment of the thigh
Ischial tuberosity
Exception is short head of biceps femoris which attaches to linea aspera
Common insertion of biceps femoris
Head of fibula
Distal attachment of semimembranosus
Medial tibial condyle
Boundaries of the adductor canal
Anterolateral: vastus medialis
Medial (roof): sartorius
Posterior: adductor longus and magnus
Where does the adductor canal run?
From apex of femoral triangle to adductor hiatus
Contents of the adductor canal
Femoral artery
Femoral vein (posterior to artery)
Saphenous nerve
Nerve to vastus medialis
Which two muscles form the femoral sheath?
Transversalis
Iliopsoas
Three compartments of the femoral sheath and their contents
Lateral: femoral artery
Intermediate: femoral vein
Medial: femoral canal (with connective tissue, fat, lymphatics +/- deep inguinal lymph node)
Where does the femoral canal run?
From the femoral ring to the proximal saphenous opening
All within the femoral triangle
Boundaries of the femoral ring
Anterior: medial inguinal ligament
Posterior: pectineus
Lateral: femoral vein
Medial: lacunar ligament
Closed by femoral septum
Describe the position of the femoral artery relative to the femoral vein as it traverses the thigh
Base of femoral triangle: lateral to vein
Apex of femoral triangle: anterior to vein
Adductor canal: anteromedial to vein
I.e. crosses over top of vein from lateral to medial within the femoral triangle