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*MSK Jeny > S4) The Thigh > Flashcards

S4) The Thigh Flashcards

1
Q

What is the femur?

A

The femur is the only bone in the thigh and acts to transmit forces from the tibia to the hip joint

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2
Q

Identify the structures visible in the proximal area of the femur

A
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3
Q

Describe the structure and function of the head in the proximal area of the femur

A
  • Structure: smooth surface with a depression on the medial aspect (ligament of head of femur attaches)
  • Function: articulates with the acetabulum of the pelvis to form the hip joint
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4
Q

Describe the structure and function of the neck in the proximal area of the femur

A
  • Structure: cylindrical, projecting in a superior and medial direction
  • Function: connects the head of the femur with the shaft
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5
Q

Describe the structure and function of the greater trochanter in the proximal area of the femur

A
  • Structure: bony projection angled superiorly and posteriorly, lateral to the neck
  • Function: attachment site for many of the muscles in the gluteal region
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6
Q

Describe the structure and function of the lesser trochanter in the proximal area of the femur

A
  • Structure: smaller bony projection, on the posteromedial side of the femur, inferior to the neck-shaft junction
  • Function: attachment site for the psoas major and iliacus muscles
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7
Q

Describe the structure and function of the intertrochanteric line in the proximal area of the femur

A
  • Structure: a ridge of bone running inferomedially on the anterior surface of the femur, connecting the two trochanters
  • Function: attachment site for the iliofemoral ligament
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8
Q

Describe the structure and function of the intertrochanteric crest in the proximal area of the femur

A
  • Structure: ridge of bone that connects the two trochanters on the posterior surface of the femur
  • Function: attachment site for quadratus femoris (quadrate tubercle)
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9
Q

What is the pectineal line?

A

The pectineal line is the line formed when the intertrochanteric line passes the lesser trochanter on the posterior surface of the proximal femur

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10
Q

What are linea aspera?

A

Linea aspera are roughened ridges of bone found on the posterior surface of the femoral shaft

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11
Q

Describe the features of the linea aspera in the proximal region of the posterior femur

A
  • Pectineal line → medial border of the linea aspera
  • Gluteal tuberosity → lateral border of the linea aspera
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12
Q

Describe the features of the linea aspera in the distal region of the posterior femur

A
  • Linea aspera widens and forms the floor of the popliteal fossa
  • The medial and lateral borders form the medial and lateral supracondylar lines
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13
Q

Identify the structures visible on the anterior surface of the distal femur

A
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14
Q

Identify the structures visible on the posterior surface of the distal femur

A
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15
Q

Describe the articulations of the medial and lateral condyles of the distal femur

A
  • Posterior & inferior surfaces articulate with the tibia and menisci
  • Anterior surface articulates with the patella
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16
Q

Describe the structure and function of the intercondylar fossa in the distal femur

A
  • Structure: a depression on the posterior surface of the femur, between the two condyles
  • Function: contains two facets for attachment of internal knee ligaments
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17
Q

Where do the posterior and anterior cruciate ligaments of the knee attach to on the distal femur?

A
  • Facet for attachment of the posterior cruciate ligament – found on the medial wall of the intercondylar fossa (large, rounded, flat)

- Facet for attachment of anterior cruciate ligament – found on the lateral wall of the intercondylar fossa (smaller)

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18
Q

Identify the 4 muscles found in the anterior thigh

A
  • Pectineus
  • Sartorius
  • Quadriceps femoris muscles
  • Iliopsoas
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19
Q

Which two individual muscles compose the illiopsoas muscle?

A
  • Psoas major
  • Illiacus
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20
Q

Describe the structure, function and innervation of the psoas major muscle

A
  • Structure: insert as the same tendon with the illiacus

- Function: hip flexion, lateral rotation (both muscles)

- Innervation: anterior rami of L1-3

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21
Q

State the origin and attachment of the psoas major

A
  • Origin: lumbar vertebrae
  • Attachment: lesser trochanter of the femur (with illiacus)
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22
Q

Describe the structure, function and innervation of the illiacus muscle

A
  • Structure: insert as the same tendon with the psoas major
  • Function: hip flexion, lateral rotation (both muscles)
  • Innervation: femoral nerve
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23
Q

State the origin and attachment of the illiacus muscle

A
  • Origin: iliac fossa of the pelvis
  • Attachment: lesser trochanter of the femur (with psoas major)
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24
Q

Which 4 muscles compose the quadriceps femoris?

A
  • Rectus femoris
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
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25
Q

State the function and innervation of the vastus lateralis muscle

A

- Function: knee extension and stabilises the patella

- Innervation: femoral nerve

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26
Q

State the origin and attachment of the vastus lateralis muscle

A
  • Origin: greater trochanter and the lateral lip of linea aspera
  • Attachment: base of patella
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27
Q

State the function and innervation of the vastus intermedius muscle

A

- Function: knee extension and stabilises the patella

- Innervation: femoral nerve

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28
Q

State the origin and attachment of the vastus intermedius muscle

A
  • Origin: anterior and lateral surfaces of the femoral shaft
  • Attachment: base of the patella
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29
Q

State the function and innervation of the vastus medialis muscle

A

- Function: knee extension and stabilises the patella

- Innervation: femoral nerve

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30
Q

State the origin and attachment of the vastus medialis muscle

A
  • Origin: anterior and lateral surfaces of the femoral shaft
  • Attachment: base of patella
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31
Q

State the function and innervation of the rectus femoris muscle

A

- Function: hip flexion, knee extension

- Innervation: femoral nerve

32
Q

State the origin and attachment of the rectus femoris muscle

A
  • Origin: ilium (superior to the acetabulum)
  • Attachment: base of patella
33
Q

Describe the structure, function and innervation of the sartorius muscle

A
  • Structure: superficial, long and thin, runs in an inferomedial direction

- Function: hip flexion, knee flexion, abduction, lateral rotation

- Innervation: femoral nerve

34
Q

State the origin and attachment of the sartorius muscle

A
  • Origin: anterior superior iliac spine (ASIS)
  • Attachment: superomedial surface of the tibia
35
Q

Describe the structure, function and innervation of the pectineus muscle

A
  • Structure: flat muscle, forms the base of the femoral triangle (transitional muscle between anterior thigh and medial thigh)

- Actions: hip flexion, adduction

- Innervation: femoral nerve (& obturator nerve)

36
Q

State the origin and attachment of the pectineus muscle

A
  • Origin: pectineal line on the anterior surface of the pelvis
  • Attachment: pectineal line on the posterior side of the femur (inferior to the lesser trochanter)
37
Q

The muscles of the medial thigh are collectively known as the hip adductors.

Identify the five muscles in this group

A
  • Gracilis
  • Obturator externus
  • Adductor brevis
  • Adductor longus
  • Adductor magnus
38
Q

Describe the neurovascular supply of the muscles of the medial thigh

A
  • Innervation via obturator nerve
  • Arterial supply via the obturator artery
39
Q

Describe the structure, function and innervation of the adductor magnus muscle

A
  • Structure: lies posteriorly, consists of an adductor part and a hamstring part
  • Function: adduction (both), flexion (adductor part) extension (hamstring part)

- Innervation: adductor part – obturator nerve, hamstring part – tibial nerve

40
Q

State the origin and attachment of the adductor magnus muscle

A
  • Adductor part

I. Origin: inferior rami of pubis & ramis of ischium

II. Attachment: linea aspera of femur

  • Hamstring part

I. Origin: ischial tuberosity

II. Attacment: adductor tubercle & medial supracondylar line of femur

41
Q

Describe the structure and function of the adductor longus muscle

A
  • Structure: large and flat, partially covers adductor brevis and magnus, forms the medial border of the femoral triangle

- Function: adduction, medial rotation

42
Q

State the origin and attachment of the adductor longus muscle

A
  • Origin: pubis
  • Attachment: linea aspera of the femur (broadly)
43
Q

Describe the structure and function of the adductor brevis muscle

A
  • Structure: short muscle, lying underneath the adductor longus and between the anterior and posterior divisions of the obturator nerve

- Function: adduction

44
Q

State the origin and attachment of the adductor brevis muscle

A
  • Origin: body of pubis and inferior pubic rami
  • Attachment: linea aspera of the femur (proximal to the adductor longus)
45
Q

Describe the structure and function of the obturator externus muscle

A
  • Structure: small muscle, located most superiorly

- Function: lateral rotation

46
Q

State the origin and attachment of the obturator externus muscle

A
  • Origin: membrane of the obturator foramen, and adjacent bone
  • Attachment: posterior aspect of the greater trochanter (passes under the neck of femur)
47
Q

Describe the structure and function of the gracilis muscle

A
  • Structure: most superficial and medial muscle

- Function: adduction, knee flexion

48
Q

State the origin and attachment of the gracilis muscle

A
  • Origin: inferior rami and body of the pubis
  • Attachment: superomedial surface of the tibia (between sartorius and semitendinosus tendons)
49
Q

What is the femoral triangle?

A

The femoral triangle is a hollow area in the anterior thigh in which many large neurovascular structures pass through

50
Q

Identify and describe the superior, lateral and medial borders of the femoral triangle

A

- Superior border: inguinal ligament (ASIS → pubis tubercle)

- Lateral border: medial border of the sartorius muscle

- Medial border: medial border of the adductor longus muscle

51
Q

Identify and describe the anterior and posterior borders of the femoral triangle

A
  • Roof: fascia lata
  • Base: pectineus, iliopsoas and adductor longus muscles
52
Q

Describe the role of the inguinal ligament

A

The inguinal ligament acts as a flexor retinaculum, supporting the contents of the femoral triangle during flexion at the hip

53
Q

What are the contents of the femoral triangle?

A
  • Femoral nerve
  • Femoral artery
  • Femoral vein
  • Femoral canal (deep lymph nodes and vessels)

Femoral artery, vein and canal are contained in a femoral sheath

54
Q

The femoral canal is located in the anterior thigh, within the femoral triangle.

Describe and identify its borders

A
  • Medial border: lacunar ligament
  • Lateral border: femoral vein
  • Anterior border: inguinal ligament
  • Posterior border: pectineal ligament, superior ramus of the pubic bone, pectineus muscle
55
Q

Describe the opening of the femoral canal

A

The femoral ring is the opening to the femoral canal, located at its superior border and enclosed by a connective tissue layer (femoral septum)

56
Q

What are the contents of the femoral canal?

A
  • Deep lymph node (lacunar node)
  • Empty space
  • Lymphatic vessels (draining the deep inguinal lymph nodes)
  • Loose connective tissue
57
Q

What is the purpose of the empty space in the femoral canal?

A

The empty space allows distension of the adjacent femoral vein, so it can cope with increased venous return, or increased intra-abdominal pressure

58
Q

What is the adductor canal?

A

The adductor canal is a narrow conical tunnel (15 cm long) located in the thigh, extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus

59
Q

Identify and describe the borders of the adductor canal

A
  • Anterior: sartorius
  • Lateral: vastus medialis
  • Posterior: adductor longus and adductor magnus
60
Q

Describe the contents of the adductor canal

A
  • Femoral artery
  • Femoral vein
  • Nerve to the vastus medialis
  • Saphenous nerve
61
Q

What happens to the femoral artery and vein once they exit the adductor canal?

A

As the femoral artery and vein exit the canal, they become the popliteal artery and vein respectively

62
Q

What is the adductor hiatus?

A

The adductor hiatus is a gap between the adductor and hamstring attachments of the adductor magnus

63
Q

Identify the muscles of the posterior thigh (the hamstrings)

A
  • Biceps femoris
  • Semitendinosus
  • Semimembranosus
64
Q

Describe the structure, function and innervation of the biceps femoris muscle

A
  • Structure: most lateral muscle in posterior thigh, long head and a short head
  • Function: knee flexion, hip extension, lateral rotation
  • Innervation:

I. Long head – tibial part of sciatic nerve

II. Short head – common fibular part of sciatic nerve

65
Q

State the origin and attachment of the biceps femoris muscle

A
  • Origin:

I. Long head – ischial tuberosity of pelvis

II. Short head – linea aspera of femur

  • Attachment: head of the fibula
66
Q

Describe the structure, function and innervation of the semitendinosus muscle

A
  • Structure: largely tendinous muscle, lies medially to the biceps femoris, and covers most of semimembranosus
  • Function: knee flexion, hip extension, medial rotation
  • Innervation: tibial part of the sciatic nerve
67
Q

State the origin and attachment of the semitendinosus muscle

A
  • Origin: ischial tuberosity of the pelvis
  • Attachment: superomedial surface of the tibia
68
Q

Describe the structure, function and innervation of the semimembranosus muscle

A
  • Structure: flattened and broad, located underneath the semitendinosus
  • Function: knee flexion, hip extension, medial rotation
  • Innervation: tibial part of the sciatic nerve
69
Q

State the origin and attachment of the semimembranosus muscle

A
  • Origin: ischial tuberosity (superior to semitendinosus and biceps femoris)
  • Attachment: medial tibial condyle
70
Q

The presence of a femoral pulse means that blood is reaching the lower extremity.

Where can this pulse be palpated?

A
  • In the femoral canal, inferior to where the femoral artery crosses the inguinal ligament
  • It crosses exactly midway between the pubis symphysis and anterior superior iliac spine
71
Q

How does one test the femoral nerve?

A
  • The quadriceps femoris muscles are used to test for femoral nerve palsies
  • The patient is positioned supine with the knee slightly flexed and is asked to extend their leg (at the knee) against resistance
72
Q

What is a fracture of the femoral shaft?

A
  • Femoral shaft fractures are spiral fractures which occur due to a lot of force on the shaft of the femur
  • They are relatively uncommon and cause leg shortening due to bony fragments overriding and the proximal pull of the associated muscles
73
Q

What is a proximal intracapsular femur fracture?

A
  • A proximal intracapsular femur fracture is a fracture within the capsule of the hip joint which commonly occurs in the elderly, especially women
  • It can damage the medial femoral circumflex artery, carries a risk of avascular necrosis and presents with the distal femur fragment being pulled upwards and laterally rotated (shortening)
74
Q

What is a proximal extracapsular femur fracture?

A
  • A proximal extracapsular femur fracture is a fracture outside the hip joint capsule, which occurs more commonly in young and middle aged people
  • The femoral circumflex artery is intact, there is no risk of avascular necrosis and it presents with leg shortening as well as the lateral rotation of the thigh
75
Q

What is a femoral hernia?

A
  • A femoral hernia is a condition where part of the bowel is displaced and protrudes into the femoral canal, underneath the inguinal ligament
  • It presents as a lump or bulge in the area of the femoral triangle
76
Q

What is adductor canal compression syndrome?

A

- Adductor canal compression syndrome is a condition wherein the neurovascular bundle of the adductor canal is entrapped, usually caused by the hypertrophy of the vastus medialis muscle

  • It presents with claudication (femoral nerve) or neurological symptoms (saphenous nerve)
77
Q

What is groin strain?

A
  • Groin strain is a condition wherein the proximal part of the adductor muscles in the medial thigh are strained/torn due to explosive movements of extreme stretching
  • Treatment involves the RICE protocol (rest, ice, compression, elevation)

*MSK Jeny (24 decks)

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