Thigh Flashcards
L1 sensory innervation of anterior thigh
Ilio hypogastric - lower anterior abdominal wall
Femoral branch of Genito femoral - upper 1/3 of anterior thigh below lingual ligament
Ilio lingual - upper 1/3 medial thigh and external genitalia
L2 & L3 sensory intervation of anterior thigh
Lateral femoral cutaneous - L2 &L3 to lateral aspect of thigh
Anterior branch of obturator - L3 to middle 1/3 of medial thigh
Ant. And medial femoral cutaneous - L2&L3 to distal 2/3 of anterior thigh and distal 1/3 of medial thigh
Posterior sensory innervation of thigh
Ilio hypogastric - L1 upper lateral gluteal
Dorsal rami L1-L3 - medial gluteal region
Dorsal rami s1-S3 - posterior sacrum
Lateral femoral cutaneous - L2&L3 distal 2/3 of lateral thigh
Ant branch of obturator - L3 to medial aspect of middle 1/3 of post thigh
Post femoral cutaneous- S1-S3 to middle of posterior thigh from gluteal fold and below
Medial femoral cutaneous- L3 to distal 1/3 of medial thigh
Pathway of greater saphenous vein
1 inch medial from medial malleolus, 4 inch posterior of medial patella , drains into saphenous vein at saphenous hiatus (2 inch away and 1 inch below public tubercle)
Lesser saphenous vein pathway
1 Inch behind lateral malleolus, posterior leg, through adductor hiatus, turns into popliteal vein, through adductor canal and turns into femoral vein
Sartorius
Origin: ASIS
I: medial aspect of medial tibial condyle
Innervation: femoral nerve
F: hip flexion and lateral rotation, knee flexion and medial rotation when knee flexed
Vastus lateralis
O: shaft of femur
I: QF tendon
I: femoral nerve
F: prime mover for extension of knee and some hip flexion
Rectus femoris
O: straight head - AIIS
Reflected head - shallow groove on acetabulum
I: QF tendon
I: femoral nerve
F: extension of knee and some hip flexion
Vastus medialis
O: shaft of femur
I: QF tendon
I: femoral nerve
F: extension of knee and some hip flexion
VMO
O: lowest VM fibers
I: medial patella
I: femoral nerve
F: prevent lateral dislocation of patella at end range of knee extension
Vastus intermedius
O: shaft of femur
I: QF tendon
I: femoral nerve
F: extension of knee and some hip flexion
Pectineus
O: pecten of pubis
I: pectineal line
I: anterior division of obturator nerve
F: adduction and flexion of hip
Adductor brevis
O: body of pubis
I: posterior proximal femur and upper 1/3 linea aspera
I: anterior division of obturator nerve
F: adduction of hip
Adductor longus
O: body of pubis
I: middle 1/ 3?linea aspera
I: anterior division of obturator nerve
F: adduction of hip
Gracilis
O: body of pubis
I: medial condole of tibia
I: anterior division of obturator nerve
F: adduct hip and medial knee rotation in knee flexion
Adductor magnus
ischiofemoral
O: ischiofemoral - ischiopubic ramus
I: linea aspera
I: post branch obturator nerve
F: prime hip adductor
Adductor magnus
Ischiocondylar
O: ischial tuberosity
I: adductor tubercle
I: tibial division sciatic nerve
F: extend hip
Obturator externus
O: obturator membrane and boney region of obturator foremen margin
I: med. greater trochanter
I: post obturator
F: lateral hip rotation
Femoral triangle border
Superior: Inguinal ligament
Medial: adductor longus
Lateral: sartorius
Femoral triangle content medial to lateral
Femoral vein (intermediate compartment of sheath), femoral artery (lateral compartment of shear), femoral nerve
Femoral artery pathway
Passes inguinal ligament where it turns from external iliac to femoral artery
Passes through triangle and through adductor canal
Through hiatus and then changes to popliteal artery
Deep femoral artery branches
- Lateral and medial circumflex arteries circles around proximal end of femur
- 4 perforating arteries that pass through adductor magnus insertion
Saphenus nerve
Splits from femoral nerve near femoral triangle and travels medially. Crosses knee joint and enters leg on medial side
Obturator nerve
Mixed nerve from L2,3,4
Anterior branch (anterior to adductor brevis)
- sensory: middle 1/3 of medial thigh
- motor: adductor muscles aside from Magnus and obturator externus
Posterior branch: posterior to brevis
- motor: adductor Magnus and obturator externus
Biceps femoris
Long head
O: ischial tuberosity
I: head of fibula
I: tibial division
F: prime mover knee flexion, some hip extension and when knee is flexed, lateral tibial rotation
Biceps femoral
Short head
O: shaft of femur
I: head of fibula
I: common fibular division
F: prime mover knee flexion, some hip extension and when knee is flexed, lateral tibial rotation
Semi tendinosus
O: ischial tuberosity
I: medial condyle of tibia (pes anserine)
I: tibial division
F: flex knee and extension of hip. When knee flexed, medial knee rotation
Semi membranosus
O: ischial tuberosity
I: shallow groove medial to medial
Condyle of tibia
I: tibial division
F: flex knee and extension of hip. When knee flexed, medial knee rotation
Politeus
O; lat epicondlye of femur
I: posterior tibia above soleal line
I: tibial div
F: open chain: med knee rotation
Closed chain: femur lateral rotation and assist in knee flexion
Bifurcation of sciatic nerve
Junction of Proximal 2/3 and distal 1/3 on posterior thigh
Head of femur blood supply
Medial and lateral circumflex femoral arteries
Most important blood supply to posterior thigh
Perforating arteries from deep
Femoral artery
- penetrate through adductor Magnus
Knee joint type and articulating surfaces
Synovial joint
1. Tibiofemoral joint - tibial plate and femoral condyle (modified hinge joint)
2. Patelo femoral- patellar groove and posterior aspect of patella (planar joint)
Extrinsic knee ligaments
Patellar - from patella to tibial tuberosity
Medial collateral ligament - medial femoral epicondyle to medial proximal tibia
- some fibers blend with capsule
LCL- lateral epicondle to head of fibula
PCL- posterior intercondylar area to medial femoral condyle
ACL - anterior intercondylar area to lateral femoral condyke
Function of ACL & PCL
Antero posterior stability
PCL: prevent posterior glide of tibia against femur
Ant: prevent anterior glide of tibia against femur
Menisci attachments
Anterior and posterior Horns are only bony attachment of menisci
Both anterior horns are attached to transverse ligament
Medial menisci : attached to fibrous capsule of joint (and therefore indirect attachment to MCL)
Lateral meniscus: attached to popliteus tendon
Movement of menisci
Lateral glides 2x as much as medial meniscus (can accommodate better and therefore less injured)
Meniscus function
In extension: shock absorbers
Flexion: increase congruency between convex posterior femur and flat tibial plate
Which muscles provides posterior knee stability
Popliteus
- pulls lateral meniscus posterior in flexion to prevent impingement
Most stable knee position
Extension
- MCL and LCL become stretched and stable when knee is laterally rotated and extended
- medial rotation increases stretch and stability in cruciate ligaments
Supra patellar bursa
Extension of synovial membrane
- articularis genus pulls this up in knee extension to prevent impingement
Support of knee fibrous membrane
Medial: MCL (attached to capsule)
Lateral: LCL (not attached) and ITB (some attachment)
Post: oblique popliteal ligament (extension of semi membranous tendon) and
Ant: quad tendon
Knee joint gliding vs rotation in flexion
0-20 degrees of flexion = rolling
20-90: rolling gradually relaxed by gliding
90+ : gliding (comes with increased friction and OA risk)
Proximal tibio fibular joint ligaments
Joint between head of fibula and fibular facet on tibia
Support:
Anterior and posterior ligament
Interosseous membrane
Poplietal fossa borders
Superior med: semi mebranosus and tendinosus
Superior lat: biceps femoris
Inferior lat: lat gastric and plantar
Inferior med: medial gastroc head
Popliteal fossa content
Tibial nerve (most superficial)
Common fibular nerve
Popliteal vein (mid layer)
Popliteal artery (deepest)
What makes the Sural nerve
Communicating sural from common fibular division and medial sural nerve from tibial division
