o Tuesday june 22, 2015

Question 1

Deep fascia of the thigh = FASCIA LATA

Answer 1

this fascia limits outward extension of contracting muscles, making muscular contraction more efficient in compressing the veins to push blood toward the heart.
o Fascia lata attaches to and continuu with:
 Inguinal ligament, pubic arch, body of pubis and pubic tubercle. The Scarpa fascia or the membraneous layer of subcutaneous tissue of inf. Abd wall also attaches to fascia lata inf. to inguinal ligament.
 Iliac crest
 Scrum, coccys. Sacrotuberous ligament, ischial tuberosity posteriorly
 Superficial aspects of bones around the knee and the deep fascia of leg

Question 2

Deep fascia of the leg = Crural fascia

Answer 2

 Is continuous with fascia lata and attaches to the anterior and medial border of tibia, from where it continuous with peristoneum.
 Crural fascia also forms distally the extensor retinacula
 The interosseous membrane and the intermuscular septa divide the leg into 3 compartments: anterior or dorsoflexor, lateral or fibular and posterior or plantarflexor. And, also the intermuscular septa divides the plantar flexor from the posterior compartment into superficial and deep parts.

Question 3

o Iliotibial tract (IT band)

Answer 3

– extends from iliac tubercle to anterolateral tibial tubercle (Gerdy tubercle) on the lateral condyle of tibia
 Lateral thickening of fascia lata
 Also serves as aponeurosis for a couple of muscles
 Gluteus maximus
 Tensor fascia latae
 Attaches
 Iliac tubercle
 Gerdy’s tubercle ( anterolateral tibial tubercle)

Question 4

o Intermuscular Septa

Answer 4

 Attach fascia lata to linea aspera
 Lateral intermuscular septum
• Strong
• Coming off deep surface of ITB
 Medial intermuscular septum (not quite as strong)
 Posterior intermuscular septum (not quite as strong)
 Divides thigh muscles into 3 compartments, formed by fascia lata and 3 fascial intermuscular septa (lateral, medial and posterior intermuscular septa)
 Anterior, medial, & posterior compartments
 Anterior: flexors of thigh and extensors of knee; similar innervation
 Medial: adductors of thigh; similar innervation
 Posterior: extensors of thigh and flexors of knee; similar innervation

Question 5

• Superficial Veins

Answer 5

great saphenous vein, small saphenous vein and abundant perforating vein

Question 6

o Great saphenous vein

Answer 6

= dorsal digital vein (of great toe) + dorsal venous arch of the foot
 Ascend ant. To Medial malleolus and passes post to medial condyle of femur=> anastomosis with Sm. Saphenous vein and it also enters the opening in Fascia Lata where it empties into Femoral Vein
 Coming up the dorsum of the foot and medial aspect of leg, dumps into femoral vein where the inguinal canal is

Question 7

o Small saphenous vein

Answer 7

dorsal digital vein of 5th digit + dorsal venous arch =>lateral malleolus (lateral marginal vein) => lateral border of calcaneal tendon=> passes through midline of fibula=> enters deep fascia between heads of gastrocnemius muscle and Dumps into popliteal vein

Question 8

o Abundant perforating veins

Answer 8

pass between superficial and deep fascia and contain valves that allow blood to flow from superficial to deep veins. This veins penetrate fascia at OBLIQUE angles so that prevent blood from flowing from deep to superficial. This pattern of blood flow from superficial to deep is important because it enables muscular contraction to propel blood toward the heart against PULL of GRAVITY => MUSCULOCUTANEOUS PUMP.

Question 9

DEEP VEINS OF LOWER LIMB

Answer 9

o Are usually paired and have veanae comitantes. They are in the same vascular sheat with the artery whose pulsation also helps the veins to be compressed and move the blood => popliteal vein => femoral vein + Profunda femoris vein => inguinal canal deep and become EXTERNAL ILIAC VEIN

Question 10

Lymphatics:

Answer 10

• Superficial lymphatic vessels (follow saphenous vein) => superficial inguinal lymph nodes =>external iliac lymph nodes or internal iliac lymph nodes
• Lymphatics which followed the small saphenous vein => popliteal lymph node
• Deep lymphatics of leg => popliteal lymph nodes => deep inguinal lymph nodes =>external inguinal lymph nodes

Question 11

• Anterior Compartment

Answer 11

flexors of hip and extensors of knee – femoral nerve

Question 12

Iliopsoas = Chief Flexor of Hip Joint, origin

Answer 12

 Iliacus: iliac crest & fossa, ala of sacrum, anterior sacroiliac ligaments
 Psoas major: spinous process of T12-L5 vertebrae, discs and transverse processes

Question 13

iliopsoas - insertion

Answer 13

 lesser trochanter of femur

Question 14

ilipsoas - action

Answer 14

 Flexes hip at thigh, posture

Question 15

ilipsoas innervation

Answer 15

 Anterior rami of L1-L3  Femoral nerve

Question 16

o Pectineus

Answer 16

	Origin: Pecten pubis

	Insertion: Pectineal line of femur and proximal linea aspera
	Action: Adducts and flexes thigh 
	Assists with medial rotation of thigh
	Innervation
	Femoral nerve (L2, L3)
	Perhaps obturator nerve

Question 17

o Sartorius tailor muscle is Most superficial in ant. Thigh. It passes both hip and knee joint!!!

Answer 17

 Origin: ASIS
 Insertion : medial surface of tibia ( gracilis and semitendinosus= PEs Anserinus)
 Action
 Flexes, abducts and laterally rotates thigh at hip
 Flexes leg at knee and internal rotation
 Innervation
 Femoral nerve L2-L3

Question 18

o Quadriceps femoris

Answer 18

 Origin: rectus femoris, vastus medialis, lateralis and intermedius and articularis genu

 Insertion
 Quad tendon to base of patella to patellar ligament to tibial tuberosity
 Action
 Hip: steadies hip joint, assists in hip flexion
 Knee: extends the leg at the knee
 Innervation
 Femoral nerve (L2-L4)

Question 19

o Vastus Lateralis

Answer 19

	Origin
	Greater trochanter and lateral lip of linea aspera
	Insertion
	Quad tendon to base of patella to patellar ligament to tibial tuberosity
	Action
	Extends leg at knee
	Innervation
	Femoral nerve

Question 20

o Vastus Medialis

Answer 20

	Origin
	Intertrochanteric line and medial lip of line aspera
	Insertion
	Quad tendon to base of patella to patellar ligament to tibial tuberosity
	Action
	Extends leg at knee
	Innervation
	Femoral nerve

Question 21

o Vastus Intermedius

Answer 21

	Origin
	Anterior & lateral surfaces of shaft of femur
	Insertion
	Quad tendon to base of patella to patellar ligament to tibial tuberosity
	Action
	Extends leg at knee
	Innervation
	Femoral nerve

Question 22

o Articularis Genu – small flat muscle

Answer 22

 Origin
 Inferior part of anterior femur at suprapatellar recess
 Insertion - suprapatellar recess of knee joint capsule
  Action - extension of knee and prevents entrapment of capsule
 Pulls membrane superiorly during knee extension
 Innervation
 Femoral nerve

Question 23

o Innervation to Anterior Compartment

Answer 23

 Femoral nerve
 Hip flexion- L2
 Knee extension- L3, L4

Question 24

• Medial Compartment (ADDUCTOR group - innervation, muscles

Answer 24

superficial layer: pectineus, Adductor longus, and brevis, gracilis
innervated by obturator nerve with 1 exception: pectineus has also femoral nerve
Deep layer: adductor magnus and Obturator externus innervated by obturator nerve (l3-L4) and with 1 exception for adductor magnus which is also innervated by superficial (part of muscle) by tibial nerve (L4)

Question 25

o Adductor longus – most anterior muscle

Answer 25

	Origin
	Body of pubis inferior to pubic crest
	Insertion
	Middle 1/3 of linea aspera
	Action 
	Adducts thigh

Question 26

o Gracillis – only one to cross and act at KNEE and HIP Joint!!!

Answer 26

 Origin
 inferior pubic ramus, below the pubic symphysis Insertion
 Superior part of medial surface of tibia, along with tendons of Sartorius and semitendinosus
 Action
 Adducts thigh, flexes leg at hip
knee joint: flexion and internal roatation

Question 27

o Adductor brevis – posterior – deep to pectineus and adductor longus

Answer 27

 Origin
 inferior pubic ramus
 Insertion
 medial lip of linea aspera, in the middle third of femur
 Action
 Adducts thigh at hip up to 70 degrees and extend past 80 degree
 stabilizes pelvis in coronal and sagittal planes

Question 28

o Adductor Magnus = adductor and hamstring

Answer 28

 Origin
 Adductor part: inferior pubic ramus, ramus of ischium
 Hamstrings part: ischial tuberosity
 Insertion
 Adductor part: gluteal tuberosity, linea aspera, medial supracondylar line
 Hamstrings part: adductor tubercle of femur
 Action
 hip jont: Adducts thigh; extends thigh and tendinous insertion also internal rotate
 - stabilizes pelvis in coronal and sagittal plane
innervated by:
deep part- obturator nerve
superficial part is tibial nerve

Question 29

o Obturator externus – fan shaped, deeply placed

Answer 29

	Origin
	Margins of obturator foramen and membrane
	Insertion
	Trochanteric fossa of femur
	Action
	hip joint: adduct and Laterally rotates thigh
	Steadies femoral head in acetabulum
stabilizes pelvis in sagittal plane

Question 30

o Innervation of Medial Compartment

Answer 30

 Obturator nerve (L2, L3, L4)
 Exception:
 Pectineus
• May also receive contribution from femoral nerve
 Adductor magnus
• Hamstrings portion gets innervation from sciatic nerve L4, tibial part

Question 31

• The Adductor Hiatus

Answer 31

the hole in adductor magnus and tendon of hamstring
o Opening in distal aspect of adductor magnus
o Hamstrings and adductor portions of adductor magnus
o Passageway for vascular structures (femoral artery & vein) to pass between anterior/medial thigh and popliteal fossa
o After popliteal fossa they are called the popliteal artery & vein

Question 32

• Main action of adductor muscles

Answer 32

o Adduct hip joint and other include: correct lateral sway of trunk, stabilize stance when standing on both feet; flexion of extended hip joint, extension of flexed hip joint when running or against resistance

Question 33

• Femoral triangle

Answer 33

o Triangular depression inferior to inguinal ligament
o Boundaries
 Base of triangle: inguinal ligament
 Medially: lateral border of adductor longus
 Laterally: Sartorius muscle coming down
 Apex: where Sartorius crosses adductor longus
o Muscular Floor
 Iliopsoas
 Pectineus
o Roof: fascia lata, cribiform fascia, subcut. fascia and skin
o Contents
 N: femoral nerve
 A: femoral artery
 V: femoral vein + proximal tributiaries
 E: empty space from Femoral canal
 L: lymphatics
 Femoral Canal: empty space & lymphatics
 Femoral Sheath: femoral artery ( continuation of external iliac artery) vein, femoral branch of genitofemoral nerve,empty space & lymphatics

Question 34

Retro-inguinal space

Answer 34

connects trunk to abdominopelvic cavity to lower limb; created by the inguinal ligament spans the gap into ASIS and PUBIC Tubercle =. 2 compartments by iliopsoas fascia
Muscular compartment: - iliopsoas muscle and femoral nerve
Medial compartment: veins, arteries, lymphatics pass between greater pelvis and femoral triangle

Question 35

Femoral nerve: (L2-L4) follow

Answer 35

• Abdomen =.descends through pelvis =.midpoint of inguinal ligament =. Deep to retro-inguinal space =. Enters femoral triangle and divides intoterminal branches before ant. Thigh muscles.
   Saphenous branch (terminal branch) = Descends femoral triangle = runs with femoral artery between Sartorious and Gracilis near Adductor hiatus and supply skin on anteromedial aspects of knee, leg and foot.

Question 36

• Femoral Artery (continuation of external iliac artery

Answer 36

o Enters the femoral triangle and crosses underneath the inguinal ligament => deep to fascia lata and descend on sides of iliopsoas and pectineus => Femoral triangle (apex) => adductor canal (deep to sartorious) => adductor hiatus becoming POPLITEAL ARTERY
 arterial branch in the proximal thigh:
 medial/lateral femoral circumflex
 deep artery of thigh (profunda femoris a.)
• comes off femoral artery laterally
• descends posteromedially
• supplies: hamstrings, adductors, vastus medialis, vastus lateralis
o muscular branches
o 3-4 perforating branches coming off lateral side and pokes through adductor magnus
o proximally in thigh it pokes through adductor brevis a little bit
• Anastomoses of the proximal thigh: perforating arteries wrap around posteriorly in the femur and then on the lateral side
• Circumflex femoral arteries
o Typically come off the deep branch of femoral artery, sometimes off the femoral artery
 Medial circumflex a. : supplies much of head and neck of femur via its branch posterior retinaculum artery
 Lateral circumflex a.: to gluteal region, vastus lateralis, genicular anastomosis

Question 37

Obturator Artery and Nerve

Answer 37

o	Internal iliac artery => obturator foramen =. Medial compartment of Thigh and divides inti - Ant. + Post. Branches (adductor brevis m.)
o	Supply: obturator externus m., adductors of thigh, gracilis m.
o	Post. Branch gives off acetabular branch =>head of femur
Obturator nerve (L2-L4)
	-follows psoas m. =.obt. foraen with VAN, divides into branches => straddle adductor brevis
  	- ant branch of obt. n : adductor longus, adductor brevis, gracilis , pectineus
	- post part supplies: adductor magnus m. + obturator externus m.

Question 38

• Adductor Canal

Answer 38

o Begins where Sartorius crosses lateral border of adductor longus
o Lies deep to sartorius (roof of adductor canal)
o Provides passage for femoral artery & vein
 also saphenous nerve
o Ends inferior at adductor hiatus

Question 39

rectus femoris muscle

Answer 39

Originates at AIIS, acetabular roof of hip joint and insert on tibial tuberosity via patellar ligament, It also flexes the hip and extend the knee; being innervated by femoral n. L2-L4

Question 40

contents of ant. compartment of thigh

Answer 40

muscles that flex the hip joint and extend the knee joint, innervated by femoral nerve, and branches of femoral artery and deep femoral artery and their veins

Question 41

medial thigh contents

Answer 41

muscles that primarly adduct, flex and extend the hip joint. And are innervated by obturator nerve and femoral nerve. Arterys found in this compartment include obturator artery and deep artery and vein of thigh

Question 42

anterior compartment thigh muscles

Answer 42

sartorius, and quadriceps femoris ( rectus femoris, vastus medialis, vastus lateralis, vastus intermedius and articularis genu). All innervated by femoral nerve (L2-L4)

Question 43

posterior thigh compartment contains

Answer 43

muscles that extend hip joint and flex the knee joint, the sciatic nerve and deep artery and veins of thigh

Question 44

saphenous nerve

Answer 44

is a terminal branch of femoral nerve and runs from near the knee with great saphenous vein

Question 45

femoral artery branches

Answer 45

deep femoral artery
medial femoral circumflex artery + lateral femoral circumflex artery
perforating arteries, branches of deep femoral artery