Quiz 2- Lec 11-12 Flashcards
anterior hip muscles:
list
- psoas minor (absent in 40-50% of cases)
- iliacus
- psoas major (iliacus + psoas major = iliopsoas)
which anterior hip muscle is absent 40-50% of the time?
psoas minor
psoas major: origin & insertion
- o:
- ventral fibers from IV discs and vertebral bodies (T12-L5);
- dorsal fibers from inferior edges of transverse processes of L1-L5
- ins: all fibers converge into single muscle belly and thru combined tendon w/ iliacus into LESSER TROCHANTER
psoas major: innervation
L1-L3
(twigs from ventral rami)
psoas major: action
- *major hip flexor
- side-bending
- pelvic stabilization during gait;
- other actions are considered (lat. rotation of flexed hip & active during sit-ups & leg raises – hip flexion component)
iliacus: origin and insertion
- o: iliac fossa, internal lip of iliac crest, lateral part of pelvic surface of sacrum, ventral sacroiliac and iliolumbar ligaments
- i: thru combined tendon w/ psoas major into lesser trochanter and femoral shaft distal to lesser trochanter
iliacus: innervation
- *L2-L3
(fibers/twigs from ventral rami); diff’t from psoas major
iliacus: action
- *major hip flexor
- pelvic stabilization during gait;
- other actions are considered (lat. rotation of flexed hip & active during sit-ups & leg raises – hip flexion component)
*NOT side-bending (but psoas major incl. this)
psoas minor: origin & insertion
- o: (anterior to major) from T12 & L1 vertebral bodies and disc
- i: iliopubic eminence (where pubis and ilium meet)
psoas minor: innervation
L1
(twig from ventral ramus)
psoas minor: action
- weak trunk flexion (controversial)
- & NO ACTION AT HIP; does not cross hip joint!
which muscles provide stability to hip joint anteriorly?
psoas major and iliacus muscles
identify:
- hip joint capsule
- iliopectineal bursa
identify where the following movements occur:
- trunk flexion
- hip flexion
- external (lateral) rotation
describe the blood supply to the lower limb?
- aorta
- common iliac
- external iliac
- femoral (after crossing deep to inguinal)
- internal iliac artery and branches
- superficial circumflex iliac
- deep circumflex iliac
- inguinal ligament
- femoral artery
where does SUPERIOR GLUTEAL ARTERY leave the pelvis?
through L4/5 and S1
*L4/L5 is lumbosacral trunk
where does INFERIOR GLUTEAL ARTERY leave the pelvis?
through S3/S4
where does OBTURATOR ARTERY leave the pelvis?
- originates from anterior division of internal iliac artery
- travels along the obturator fascia of the pelvic sidewall, between the obturator nerve and vein, to reach the obturator foramen
- leaves pelvis through OBTURATOR CANAL
contents of obturator canal
- connects the pelvis to the thigh
- contents: obturator artery, obturator vein, and obturator nerve all travel through the canal.
*internal pudendal artery: course
- exits the pelvic cavity through the greater sciatic foramen, inferior to the piriformis muscle, to enter the gluteal region.
- It then curves around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen.
4 gateways to lower extremity from abdomiopelvic cavity
“LOGS”
- Lesser sciatic foramen
- Obturator canal
- Greater sciatic foramen
- Subinguinal space
identify the following:
subinguinal space: contents
- femoral vessels & nerve, lymphatics,
- Iliopsoas & pectineus muscles
obturator canal: contents
obturator vessels (artery and vein) and obturator nerve
greater sciatic foramen: contents
- superior and inferior gluteal vessels & nerves
- sciatic nerve, pudendal nerve,
- internal pudendal vessels,
- posterior cutaneous nerve of the thigh,
- nerves to the small lateral rotators of the thigh,
- tendon of piriformis
lesser sciatic foramen: contents
- pudendal nerve and internal pudendal vessels
- tendon of obturator internus,
- nerve to obturator internus
vertebral levels involved in lumbar plexus (per Dr. Washburn)
(T12), L1-L4
*subcostal nerve should be included
sacral plexus: vertebral levels
L4-S4
which nerves are called “border nerves” (in lumbar plexus)
- iliohypogastric
- ilioinguinal
- genitofemoral
mnemonic for LUMBAR PLEXUS
(dr. washburn’s extended cut)
Summers, I twice get laid on fridays- Awesome!!
- subcostal
- iliohypogastric
- ilioinguinal
- genitofemoral
- lateral femoral cutaneous
- femoral
- obturator
- accessory obturator
which nerves receive ventral rami from POSTERIOR/DORSAL DIVISION FIBERS
- lateral femoral cutaneous nerve of thigh
- muscular branches to psoas & iliacus muscle
- FEMORAL NERVE
which nerves receive ventral rami from ANTERIOR/VENTRAL DIVISION FIBERS?
- accessory obturator nerve(often absent)
- *OBTURATOR NERVE
which nerve is innervated by:
T12, L1
ILIOHYPOGASTRIC
which nerve is innervated by:
T12
SUBCOSTAL
which nerve is innervated by:
L1
ILIOINGUINAL
which nerve is innervated by:
L1, L2
GENITOFEMORAL
which nerve is innervated by:
L2, L3
LATERAL FEMORAL CUTANEOUS
which nerve is innervated by:
L2, L3, L4
(DORSAL/POSTERIOR DIVISION)
FEMORAL
which nerve is innervated by:
L2, L3, L4
(VENTRAL/ANTERIOR DIVISION)
OBTURATOR
which nerve is innervated by:
L3, L4
(DORSAL/POSTERIOR DIVISION)
ACCESSORY OBTURATOR, though this is often absent
identify the nerves in the image below:
pink arrow
iliohypogastric
identify the nerves in the image below:
orange arrow
ilioinguinal
identify the nerves in the image below:
green arrow
lateral femoral cutaneous
identify the nerves in the image below:
blue arrow
obturator
identify the nerves in the image below:
purple arrow
lumbosacral trunk
identify the dermatomes on the map
where is L3 dermatome?
above knee; anteromedially
where is S1 dermatome?
over lateral aspect of foot, posterior heel, and skin over Achille’s/posteior calf
where is the L5 dermatome?
lateral aspect of calf, and medial aspect of foot, esp BIG TOE
what are the 2 layers of the superficial fascia?
- superficial fatty (Camper’s fascia)
- deep membranous (Scarpa’s fascia)
what layer of superficial fascia is called “Camper’s” Fascia?
superficial fatty fascia
what layer of superficial fascia is called “Scarpa’s” Fascia?
deep membranous fascia
fatty Camper’s fascia (abdomen) is continous with what fascia of the thigh?
the fatty superficial fasica of the thigh
is the membranous superficial (Scarpa’s) fascia of the abdomen continuous with the deep fascia of the thigh?
NO, it is not continuous w/ deep fascia (aka fascia lata) of the thigh
where does the membranous superficial (Scarpa’s) fascia of abdomen attach?
to the deep fascia of the thigh, 1 finger’s breadth INFERIOR to the inguinal ligament
which layer of superficial fascia (subcuntaneous tissue) of the abdomen is CONTINUOUS with the thigh?
superficial fatty (Camper’s) fascia
which layers contribute to walls of the femoral sheath?
- transversalis fascia
- iliac fascia
what layers are SUPERFICIAL to the peritoneum?
extraperitoneal fascia (endoabdominal fasica),
which incl. transversalis fascia and iliac fascia
peritoneum
- the serous membrane forming the lining of the abdominal cavity
- covers most of the intra-abdominal (or coelomic) organs
- composed of a layer of mesothelium supported by a thin layer of connective tissue
- this peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves.
femoral sheath: composed of which layers
formed by a prolongation downward, behind the inguinal ligament, of:
- the abdominal fascia
- the transverse fascia being continued down in front of the femoral vessels, &
- the iliac fascia behind them
in which space is the femoral sheath found?
contained w/in femoral triangle
femoral canal: contents
femoral artery, vein, lymph node
(Femoral VAL)
where is the femoral nerve found?
travels with the iliopsoas; encased by the fascia iliaca
femoral canal: define
anatomical compartment, located in the anterior thigh.
It is the smallest and most medial part of the femoral sheath
what are the 3 compartments of the FEMORAL SHEATH?
- LATERAL - femoral branch of genitofemoral nerve & femoral artery
- INTERMEDIATE - femoral vein
- MEDIAL - lymphatics and lymph node of “Cloquet”
what passes under the inguinal ligament?
“PIP Fem NAV”
- Psoas major
- iliacus
- pectineus
- Femoral nerve, artery, and vein
