The anterior and medial thigh week 4 Flashcards
patellofemoral syndrome
sometimes referred to as “runner’s knee”. involves pain around the knee cap and anterior aspect of the knee that often affects athletes. is caused by weakness and/or tightness of the muscles surrounding the knee as well as mal-alignment of the patella
ilitobial band syndrome and “snapping hip syndrome”
can be associated with patellofemoral syndrome. results from irriation and excessive tightness of the IT band. often affects runners as well (like patellofemoral syndrome) but involves pain in the lateral aspeck of the knee below the joint line (where IT band inserts into tibia). Problems with the IT band can also occur proximally, a condition known as “snapping hip syndrome”. proximal part of the IT band is tight and inflamed.
trochanteric bursitis
bursa overlying the greater trochanter of the hip becomes inflamed often as a result of injury from either overuse or trauma (although not the only causes). may occur whn ppl have a leg length discrepancy. pts experience pain at the lateral aspect of the hip which is different than groint pain experienced with hip arthritis
What are the fascias of the lower limb? What is contained in them and what is their fxn?
superficial fascia: lies deep to the skin and consists of loose CT and fat that contains cutaneous nerves, superficial veins (great saphenous and small saphenous), and lymphatic vessels and lymph nodes
deep fascia of thigh is called fascia lata and of leg is called crura. the deep fascia surround the thigh and leg to limit outward bulging of muslces, facilitate venous return in deep veins, spearate muscles with similar fxns and innervations into compartments, and surround invidiual muscles which allows them to act independently
Where is the saphenous opening located? What passes through this opening?
the saphenous opening is an aperture in the fascia lata just inferior to the medial end of the inguinal ligament which allows the great saphenous vein to pass from the superficial facia to the deep fascia to end as a tributary to the femoral vein
What is the iliotibial tract/band? What 2 muscles attach here and what are their fxns?
the iliotibial tract/band (IT band) is a lateral thickening of the fascia lata into which the gluteus maximus and the tensor fascia lata muscles attach to maintain extension of the leg at the knee after othe rmuscles have actively exenteded it
What divides muscles in the thigh and leg into comparments? What are those compartments.
thigh: intermuscular septa are extensions of the deep aspect of the fascia lata that attach to the femur and diveide the thigh into anterior, posterior, and medial compartments
leg: intermusclular septa are extesions of the deep aspect of the crura which along with the interosseus membrane divide the leg into anterior, posterior, and lateral compartments
Identify the indicated structures. What are their functions?
What is the plantar aponeurosis? What is its fxn? What is a condition of the plantar aponeurosis and what is a possible tx option?
The plantar aponeurosis is thickening of the deep fascia in the sole of the foot and supports the longitudinal arches and the deeper structures of the foot. Can get plantar fasciitis for variety of reasons such as flat
or high arches. Is worse in the morning bc sleep with feet
in plantarflexion. Can be treated with a splint that holds
feet in dorsiflexion during sleep
Veins draining from the lower limb form superficial and deep groups. What are names of these veins and where are they located? What are their tracks though the lower ext?
The deep veins typically follow the arteirs and the femoral vein is the major deep vein that drains the lower limb
The superficial veins form 2 major channels:
great saphenous vein: originates from medial side of the dorsal venous arch of the foot and ascends on the medial side of the leg, knee, and thigh to end as a tributary to the femoral vein just inferior to the inguinal ligament
small saphenous vein: originates from the lateral side of the dorsal venous arch of the foot, ascends on the posterior aspect of the leg and penetrates deep fascia to joint the popliteal vein posterior to the knee
What are varicose veins and what is their cause? Where do they usually occur?
frequently the great saphenous vein and its tributaries become varicose (dilated so the cusps of their valves do not close). performating branches exist btwn the superficial and deep veins. varicose veins develop when the valves that usually prevent blood flow from deep to superficial veins (through perforating veins) are incompetent.
What is venous stasis? What may it be caused by? Why may venous stasis be dangerous?
Venous stasis refers to pooling of blood in the lower limb (esp the leg) often due to inactivity and decreased/ineffective muscular contraction. It is an important cause of blood DVT formation which if breaks free, may travel to the lung and obstruct the pulmonary artery and cause death (PE)
Most lymphatic vessels in the lower limb drain into _____ and ____ inguinal nodes in fascia just inferior to the ____ ligmament.
superificial
deep
inguinal
List the 3 lymphatics of the lower ext, where they are located anatomically, where they receive lymph from, and what they drain into.
superificial inguinal nodes: parallel the inguinal ligament. receive lymph from the gluteal region, the lower abdominal wall, and superficial regions of the lower limb. drain into external iliac nodes
deep inguinal nodes: lie medial to the femoral vein. receive lymph from deep lymphatics associated with the femoral vein. interconnect with superificial inguinal nodes and drain into external iliac nodes
popliteal nodes: small collection of deep lymph nodes that lie posterior to the knee near the popliteal vessels. receive lymph from superficial vessels associated with the small saphenous vein and from deep areas of the leg and foot. ultimately drain into superifical and deep inguinal nodes
True or false: Nerves in the thigh and leg are peripheral nerves branches of the lumbosacral plexus.
True.
What are the boundaries of the obturator canal? What structures does this canal connect? What passes through the obturator canal?
- bound by the pubic bone superiorly and the obturator membrane inferiorly
- connects the abdominopelvic cavity and the medial thigh
- obturator nerve and vessels pass through the obtuator canal
What are the boundaries of the gap btwn the inguinal ligament and pelvic bone? What structures does this gap connect? What passes through the this gap?
- bounded by the inguinal ligament anteriorly and the pelvic bone posteriorly
- connects the abdominopelvic cavity and the anteriormedial thigh
- psoas major, iliacus, and pectineus muscles
femoral vein, artery, and nerves as wells as lymphatics of the lower limb
femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh
What muscles are in the anterior compartment of the thigh? What are they innervated by? What is the major blood supply to this compartment?
- sartorius, ilopsoas (formed from terminal ends of iliacus and psoas major), rectus femoris, vastus lasteralis, vastus intermedius, and vastus medialis (rectus femoris and vastus muscles form the quadriceps)
- innervated by the femoral nerve (except psoas major which is innervated by ventral rami of L2-L4). femoral nerve is ventral rami of L2, L3, and L4
- femoral artery
The iliopsoas is composed of the psoas major and iliacus. What is the origin, insertion, fxn, and innervation of the psoas major and the iliacus?
psoas major:
origin: lateral aspects of T12-L4 vertebrae and lumbar transverse processes
insertion: lesser trochanter of femur
fxn: ilopsoas acts to flex the thigh at the hip joint and is the most powerful flexor of the thigh
innervation: L2-L4 ventral rami
iliacus:
origin: iliac crest and fossa, internal and ala of the sacrum
insertion: lesser trochanter of femur
fxn: ilopsoas acts to flex the thigh at the hip joint and is the most powerful flexor of the thigh
innervation: femoral nerve. NOTE: the femoral nerve can be found just superficial to the iliopsoas
What is the origin, insertion, fxn, and innervation of the sartorius?
origin: anterior superior iliac spine
insertion: superior medial tibia
fxn: flexes, abducts, and laterally rotates the thigh at the hip joint; flexes the leg at the knee joint
innervation: femoral nerve
The rectus femoris, vastus medialis, vastus intermedialis, and vastus lateralis make up the quadriceps femoris. What are the origins, insertions, fxn, and innervation of the muscles of the quadriceps femoris?
rectus femoris:
origin: anterior inferior iliac spin and rim of the acetabulum
vastus medialis:
origin: intertrochanteric line and medial linea asperia
vastus lateralis:
origin: greater trochanter and lateral linea aspera
vastus intermedius:
origin: anterior and lateral shaft of the femur
All muscles have the same insertion, fxn, and innervation:
insertion: patella and tibial tuberosity via the patellar ligament
fxn: NOTE: the rectus femoris is the only part of the quadriceps that crosses the hip joint and therefore is the only part that flexes the thigh at the hip. (the iliopsoas is a much more powerful hip flexor). the main action of the quadriceps is to extend the leg at the knee
innervation: femoral nerve
Identify the muscles of the anterior thigh.
What are the boundaries of the femoral triangle? What structures pass through the femoral triangle? What structures are and are not contained in the sheath? What are the compartments of the sheath and their contents?
base: inguinal ligament
medial border: adductor longus (medial compartment of thigh)
lateral border: sartorius
floor (lateral to medial): iliopsoas, pectineus, adductor longus
contents are NAVEL from lateral to medial
- femoral nerve
- femoral artery
- femoral vein
- empty space and lymphatic vessels
The contents of the femoral triangle are enveloped in a connective tissue sheath except for the femoral nerve!
lateral compartment: femoral artery
intermediate compartment: femoral vein
medial compartment (femoral canal): loose connective tissue and lymphatic vessels. allows expansion of the femoral vein
see pg 72 of course notes for visual of sheath
What is the course of the femoral artery and vein in the thigh after the femoral triangle? What vessels do they turn into and where?
The femoral artery and vein leave the femoral triangle and pass deep to the sartorius muscle in the adductor (sub-sartorial) canal. They pass from the anterior thigh to the popliteal fossa (region posterior to knee) via the adductor hiatus, an opening/gap in the adductur magnus near its insertion on the femur. within the popliteal fossa the femoral artery and vein are referred to as the popliteal artery and vein
