Thigh 1&2 Flashcards
1
Q
Osseous features of os coxa from postero-lateral view
A
Acetabulum ischial tuberosity & oblique line ischial ramus inferior pubic ramus (=ischiopubic ramus) pubic tubercle iliopectineal eminence ASIS
2
Q
Osseous features of os coxa from medial view
A
Obturator foramen ischial tuberosity ischial ramus inferior pubic ramus pecten pubis (pectineal line of pubis) superior pubic ramus AIIS ASIS
3
Q
Osseous features of Femur, anterior view
A
Head Neck Greater & Lesser Trochanter Intertrochanteric line Medial & lateral epicondyles Adductor tubercle Patellar surface
4
Q
Osseous features of Femur, posterior view
A
Head Neck Greater & lesser trochanter Trochanteric fossa Intertrochanteric crest Pectineal line Gluteal tuberosity Linea Aspera (medial &lateral lips) Medial & lateral supracondylar lines Popliteal surface Medial & lateral condyles Medial & lateral epicondyles Intercondylar notch (fossa) & line i
5
Q
From proximal to distal, the pectineal line -> ? -> ?
A
Pectineal line -> medial lip -> medial epicondyle
6
Q
From proximal to distal the gluteal tuberosity -> ? -> ?
A
Gluteal tuberosity -> lateral lip -> lateral epicondyle
7
Q
Proximal Femur Medial View
A
Fovea capitis (pit) Trochanteric fossa (of greater trochanter) Sprial Line (continuation medially of intertrochanteric line)
8
Q
Proximal Femur Posterior View
A
Pectineal line Quadrate tubercle (of intertrochanteric crest)
9
Q
Where is the popliteal tendon located when knee is extended vs flexed?
A
Popliteal tendon is located in the vertical (anterior) groove when knee extended & in the oblique (posterior) groove when knee is fully flexed
10
Q
What separates the patellar & tibial articular surfaces of the femoral condyles?
A
the sulci menisci
(lateral sulcus meniscus & medial sulcus meniscus). Look for a “ridge”
11
Q
Anterior surface of patella consists of
A
Base (superior border)
Apex (inferior border)
12
Q
Posterior surface of patella
A
medial facet
lateral facet
attachment for patellar ligament
13
Q
which facet on the patella is larger and deeper?
A
the lateral facet
14
Q
What is the largest sesamoid bone?
A
Patella
Forms within quadriceps femoris tendon
15
Q
What is the only bone the patella articulates with?
A
Femur (patellar surface)
16
Q
By what age does the patella usually ossify?
A
puberty
17
Q
Femur has how many ossification centers?
A
5
1 primary center (shaft)
4 secondary centers
18
Q
From 1-4 years of age ossification pattern
A
femoral head present, but no greater trochanter
19
Q
from 4-14 years of age ossification pattern
A
greater trochanter apparent, but open triradiate suture and no lesser trochanter
20
Q
Femoral angle of inclination
A
angle between neck and shaft
21
Q
Femoral angle of declination (torsion)
A
Anterior projection of neck from shaft
22
Q
Superficial subcutaneous fascia
A
Superficial fatty (Camper's) Deep membranous (Scarpa's)
23
Q
Deep investing fascia
A
Fascia lata: thickened laterally, thin medially
continues as fascia cribosa over saphenous hiatus; thoracolumbar fascia in back; investing crural fascia in leg; intermuscular septa of thigh & leg
24
Q
Saphenous hiatus (fossa ovalis)
A
oval shaped opening in deep fascia, allows for passage of great saphenous vein
25
Iliotibial band
thickened tendon in lateral part of fascia lata
| helps keep knee extended and provides lateral stability when standing
26
where does the IT band attach?
attaches to ilium proximally and to lateral condyle of tibia (gerdy's tubercle) distally
receives insertion of tensor fascia lata m and gluteus maximus m
27
Anterior Compartment
"Quads" & other muscles
Knee extensors & thigh flexors
Femoral nerve
Femoral artery branches
28
Posterior compartment
"hamstrings"
thigh extensors & knee flexors
sciatic n (primarily tibial n)
perforating branches from profunda femoris a
29
Medial compartment
thigh adductors
obturator n
medial circumflex, profunda femoris & obturator arteries
30
what compartments does the medial intermuscular septum separate?
anterior and medial compartments
31
what compartments does the lateral intermuscular septum separate?
anterior and posterior compartments
32
what compartments does the posterior intermuscular septum separate?
posterior and medial compartments
33
Quadriceps Femoris
Attachments: all converge as quadriceps tendon then into patellar ligament to insert at tibial tuberosity (know specific attachments to patellar borders)
Collective action: extend knee joint. Rectis femoris also flexes thigh
Innervation: Femoral nerve
34
Rectus Femoris (anterior thigh)
From: AIIS (straight tendon) & groove above acetabulum (reflected tendon)
To: superior border of patella & tibial tuberosity (via patellar ligament/tendon)
Action: flex thigh*, extend knee
Nerve: Femoral n
35
Vastus Laterals (anterior thigh)
From: lateral lip lf linea aspera, lateral lip of gluteal tuberosity, anterior and inferior borders of greater trochanter, lateral supracondylar line
To: lateral border of patella and tendon of quadriceps femoris, and tibial tuberosity (via patellar lig)
Action: extend knee
nerve: Femoral n
36
Vastus medialis (anterior thigh)
From: distal intertrochanteric line, medial intermuscular septum, tendons of a. longus & magnus, proximal medial supracondylar line, medial lip of linea aspera
To: medial border of patella and tendon of quadriceps femoris, and tibial tuberosity (via patellar lig)
action: extend knee
nerve: femoral n
37
Vastus intermedius (anterior thigh)
From: proximal 2/3's of anterior-lateral femur
To: quadriceps tendon and tibial tuberosity (via patellar ligament/tendon)
action: extend knee
nerve: femoral n
38
Iliopsoas (anterior thigh)
Iliacus + psoas major
Joint insertion to lesser trochanter of femur
Flexes thigh
Innervated: femoral n
39
Articularis Genu (anterior thigh)
Anterior surface of distal femur (deep to v. intermedius)
Draws synovial membrane of knee (proximally)
Innervated: femoral n
40
Sartorius (anterior thigh)
ASIS to superior-medial tibial body
Many functions = sitting "cross legged"
Innervated: femoral n.
41
Muscles in medial thigh
```
Pectineus
Obturator externus
Adductor brevis
Adductor longus
Gracilis
Adductor magnus
```
42
Action/innervation of medial thigh muscles
Adduction of thigh/hip
| Mostly innervated by Obturator nerve
43
Gracilis (medial thigh)
From: pubic symphysis (inferior half), pubic body, inferior pubic ramus
To: proximal medial tibia
Actions: Adduct and medial rotate thigh; flex knee
Nerve: Obturator N (anterior branch)
44
pes anserinus
Gracilus
Semitendinous
Sartorius
insert on proximal tibia
45
What forms the floor of femoral triangle?
Pectineus m
46
Pectineus (medial/anterior thigh)
From: pecten pubis and bone just anterior to pubic body (between pubc tubercle and iliopectineal eminence)
To: pectineal line of femur
Action: flex, adduct, and laterally rotate thigh
nerve: Femoral OR Obturator N (ant. branch)
If present: accessory obturator n.
47
Obturator externus (medial thigh)
From: external aspect of ischial ramus
To: intertrochanteric fossa
action: flex, adduct, laterally rotate thigh
nerve: obturator n (posterior branch)
48
Adductor longus (medial thigh)
from: pubic body (front)
to: medial lip of linear aspera (betwen vastus medialis and adductor magnus)
action: flex, adduct thigh
nerve: obturator n. (ant. division)
49
What forms the medial border of the femoral triangle?
Adductor longus
50
Adductor brevis (medial thigh)
From: pubic body and inferior pubic ramus (between gracilis and obt. externus)
To: proximal linear aspera
Action: flex and adduct thigh
nerve; obturator n (ant. division)
51
what does the obturator nerve split around?
adductor brevis
52
Adductor magnus (medial thigh)
Adductor part:
From: inferior pubic ramus & ischial ramus
To: gluteal tuberosity, lina aspera
Innervation: Obturator n (post. division)
Actions: flex and adduct thigh
```
Hamstring part:
From: ischial tuberosity (triangle part)
To: adductor tub. & medial supracondylar line
innervation: sciatic n (tibial n)
Actions: extend thigh
```
53
What neovasculature structure is NOT part of the femoral sheath?
Femoral nerve
54
Femoral sheath
continuation of transversalis fascia
Contents: Artery, Vein, Lymph
Has 3 compartments
55
Femoral "NAVL" =
nerve, artery, vein, lymph
| found in femoral triangle from lateral -> medial
56
Subsartorial structures
Adductor canal - intermuscular tunnel for femoral neurovasculature
Adductor hiatus - passage in adductor magnus m. distal end of adductor canal
57
Hamstrings (posterior thigh)
Collective actions: extend thigh (most) & flex knee (all)
Collective origin: ischial tuberosity (most)
innervation: sciatic n.: tibial portion (most)
58
is the short head of Biceps Femoris a hamstring?
technically no. It is grouped with them but it is not attached to ischial tuberosity, not innervated by same nerve, and doesn't affect the hip.
59
which "semi" muscle is part of the pes anserinus?
Semitendinosus
| NOT semimembranous
60
Sudden contraction of hamstrings can cause what? (typically in younger, athletic individuals)
Avulsion of the ishial tuberosity.
61
Biceps Femoris - long head (posterior thigh)
From: ischial tuberosity (below oblique line) & sacrotuberous lig.
to: lateral side of styloid process (fibula and lateral condyle (of tibia) with short head
actions: extend, laterally rotate thigh; flex knee and laterally rotate a flexed knee.
nerve: tibial n.
62
Biceps Femoris - short head (posterior thigh)
From: lateral lip of linea aspera (between a. magnus and v. lateralis); lateral supracondylar line, and lateral intermuscular septum
to: lateral side of styloid process (fibula) and lateral condyle (of tibia) with long head
actions: flex knee and laterally rotate a flexed knee
nerve: common peroneal n.
63
Semitendinosus (posterior thigh)
From: ischial tuberosity (below obique line - with biceps femoris, long head)
To: proximal medial surface of tibia via a very long tendon (hence name)
actions: extend thigh; flex knee and medial rotate a flexed knee
nerve: tibial n
64
Semimembranosus (posterior thigh)
from: ischial tuberosity (upper lateral portion of oblique line, just above semitendinous and biceps femoris)
to: medial condyle of tibia (in a groove) and posterior surface of medial condyle of femur
actions: extend thigh; flex knee and medial rotate a flexed knee
nerve: tibial n
65
what does the semimembranosus give rise to?
oblique poplieal ligament and fascia around popliteal muscle
66
Popliteal Fossa contents
```
Nerves: tibial n w/ medial sural n
common peroneal n w/ lateral sural n
vessels: popliteal a w/ genicular aa
popliteal v w/ small saphenous v
muscles: plantaris m, popliteus m
```
67
What are the boundaries of the popliteal fossa? (diamond shaped)
Semimembranosus, biceps femoris, gastrocnemius
| ?
68
Plantaris (popliteal fossa)
from: lateral supracondylar line and oblique popliteal lig.
to: posterior calcaneus
actions: flex knee, plantar flex ankle
innervated: tibial n.
69
Popliteus (popliteal fossa)
from: groove on lateral condyle of femur, arcuate popliteal lig, and lateral meniscus
to: proximal soleal line of tibia
actions: flex, roates, and unlocks knee
innervated: tibial n
70
Why are the dermatomes "spiraled"?
due to medial rotation of lower limb in development
71
What do the Posterior division nerves do?
typically knee extensors, abductors
| think posterior division causes big and away movements
72
what do the Anterior division nerves do?
typically knee flexors, adductors
| think anterior division causes inwards motions
73
Lumbar Plexus L1-L4
Motor: anterior & medial thigh mm
Cutaneous: anterior, lateral, & medial thigh, some leg
74
Sacral Plexus L4/L5-S4
Motor: posterior thigh mm, all of leg mm, all of foot mm
Cutaneous: posterior thigh, most of leg, all of foot
75
Ilioinguinal & iliohpyogastric nerves
L1
76
Genital Femoral N
L1, L2
77
Lateral Femoral Cutaneous N
L2, L3
78
Femoral N
L2, L3, L4
79
Obturator N
L2, L3, L4
80
LumboSacral trunk
L4, L5
81
Superior gluteal n
L4-S1
82
Inferior gluteal n
L5-S2
83
Posterior Femoral Cutaneous n
S1, S2, S3
| *mixed anterior and posterior divisions
84
Common Peroneal N
L4-S2
85
Sciatic N
L4-S3
| *mixed anterior and posterior divisions
86
Tibial n
L4-S3
87
Which nerve can become entrapped by tight pants; obesity; heavy belts; over hip extension?
Lateral femoral cutaneous n.
| Leads to tingling, numbness, or burning in lateral thigh (meralgia paresthetica)
88
femoral nerve supplies muscular branches to?
all anterior thigh mm
89
which nerve travels in adductor canal but does not exit through adductor hiatus?
Saphenous n
90
Anterior cutaneous branches of femoral nerve
Intermediate femoral cutaneous branch; medial femoral cutaneous branch; infrapatellar branch of saphenous n
(femoral n continues in leg as cutaneous branches of saphenous n)
91
What is the subsartorial nerve plexus?
Subsartorial nerve plexus is communication between anterior obturator, saphenous, and medial femoral cutaneous
92
What nerve branches are named relative to the adductor brevis m?
Obturator nerve anterior and posterior branches
93
Obturator nerve posterior branch
primarily motor
94
obturator nerve anterior branch
motor and cutaneous
95
Accessory obturator nerve
L3-L4
10% of the population
Deep to pectineus m
96
which part of the obturator nerve helps form the subsartorial nerve plexus?
```
the anterior (cutaneous) branch
(with medial femoral cutaneous branch and saphenous branch)
```
97
Sciatic nerve (L4-S3) branches
```
Tibial n (L4-S3)
Common peroneal n (L4-S2)
```
98
Tibial n
motor to most hamstrings; plantaris m; popliteus m
| Articular branches: medial & middle genicular nn
99
Common peroneal n
Motor to short head biceps femoris
| Articular branches: lateral genicular nn
100
Great saphenous vein drains into?
femoral vein
101
small saphenous vein drains into?
popliteal vein
102
what are the deep veins of the thigh?
Femoral vein
Profunda femoris vein
Popliteal vein
103
Lymphatics drainage
superficial & deep inguinal nodes
| popliteal nodes
104
Femoral artery is a continuation of which artery?
External Iliac a -> Femoral a after the inguinal ligament
105
What does the femoral artery become?
```
Popliteal artery
(after passing through the adductor hiatus)
```
106
What does the popliteal artery split into?
Anterior and Posterior Tibial arteries
107
What is the blood supply to the thigh?
Femoral a and its branches (from Profunda Femoris a)
108
What are the branches of femoral artery?
```
Superficial circumflex iliac a
Superficial epigastric a
Superficial external pudendal aa
Deep external pudendal a
Profunda femoris a
Descending genicular a
Popliteal a
```
109
What are the branches of the profunda femoris artery?
Lateral femoral circumflex (which gives off ascending branch, transverse branch, and descending branch)
Medial femoral circumflex
1st, 2nd, 3rd, and 4th perforating
(4th perforating is the termination of profunda femoris a)
110
which arteries are named relative to adductor brevis?
1st-3rd perforating arteries
111
Cruciate anastomoses
arterial anastomosis at hip joint which unites branches of Internal Iliac and Femoral artery
112
What is the main blood supply to femoral head?
Femoral circumflexes
| retinacular branches
113
What arteries make up the cruciate anastomoses?
1. Inferior gluteal a
2. Medial femoral circumflex a
3. Lateral femoral circumflex a
4. First perforating a.
114
What else supplies the femoral head?
small supply from branch of obturator a (acetabular branch; foveal branch; many names) through the ligament to head of the femur
115
What is a concern when blood supply is disrupted in "hip" fractures?
ischemic necrosis
116
5 articular (genicular) branches of popliteal artery
1. lateral superior genicular a
2. medial superior genicular a
3. middle genicular a
4. lateral inferior genicular a
5. medial inferior genicular a
117
which genicular branch goes directly into the joint?
Middle genicular a
118
where do the sural aa branches (medial and lateral) go?
Gastrocnemius, soleus, and plantaris mm
119
How can blood get from femoral artery to tibial arteries if popliteal artery is blocked?
Descending branch of lateral circumflex femoral artery
| Descending genicular arter
120
At which anatomical locations does the femoral artery begin and end?
Femoral a begins after inguinal ligament and ends as the popliteal a after passing through adductor (subsartorial) hiatus
121
Describe the cutaneous innervation to the anterior thigh - make sure to incorporate all nerves discussed
```
Anteriorly:
Lateral femoral cutaneous n
Anterior cutaneous branches of femoral n (medial & intermediate)
Obturator n
Posteriorly:
Posterior femoral cutaneous n
```
122
What are the boundaries of the femoral triangle? What structures are located within it?
```
Inguinal ligament (base of triangle)
Sartorius m (lateral border)
Adductor longus (medial border)
Pectineus m (forms floor of triangle)
Structures = NAVL
Femoral nerve, artery, vein, and lymph
```
123
What's the difference between the saphenous hiatus and the adductor hiatus (in terms of boundaries and associated structrues)
Saphenous hiatus is where the saphenous nerve exits canal ?
| Adductor hiatus is a passage in adductor magnus m. at the distal end of adductor canal.
124
What three tendons form the pes anserinus?
Gracilis
Semitendinous
Sartorius
125
What three cutaneous nerves form the subsartorial plexus?
anterior branch of obturator
saphenous
medial femoral cutaneous
