Thigh and Knee Flashcards
Where is the patella located and what is its function?
Changes the angulation fo the tendon to increase the moment force (its capacity to pull)
Sesimoid bone - interculated into a tendon. Located inside the quadriceps femoris tendon which inserts on the tibia. Allows that force to be stronger.
What is the adductor canal and what is its significance?
Adductor magnis inserts on adductor tubercle of the femur, making a little opening called the adductor canal.
The adductor canal is where the femoral artery will pass to get back posteriorly and change name.
Label the following structures
What is the venous drainage of the thigh and knee?
What is the thickening of the fascia lata?
Greater saphenous vein comes down the medial side of the thigh and leg, eventually onto the dorsal aspect of the foot, running with the saphenous nerve.
- Runs through a gap called the saphenous hiatus (break in the fascia lata, where the tensor fascia lata inserts) where it drains into the femoral vein
- Has an accessory saphenous vein near groin
Thickening of the fascia lata is the ilio-tibial band
What is the cutanous innevation of the thigh and knee?
List spinal segments and important significance of different nerves.
- Lateral femoral cutaneous off the lumbar plexus (L2 & L3)
- Anterior femoral cutaneous off the femoral nerve - does anterior surface of the thigh (L2-L4)
-
Posterior femoral cutaneous does the back of the thigh (S1-S3)
- Runs with the sciatic nerve
- Femoral branch of the genitofemoral nerve causes cremasteric reflex when you touch the thigh (L1)
-
Obterator nerve on the medial aspect of the thigh, exits the obterator foramen does muscles in the medial compartment of the thigh then terminates doing skin on medial part of the thigh, just above the knee. (L2-L4)
- This is why a broken hip can manifest inner knee skin pain - lesion of obterator nerve at the obterator foramen
How is the tissue fluid of the lower extremity drained?
What is the clinical significance of their location?
Lymph nodes in the groin. Similar to axilla lymph nodes draining the arm.
As a result if someone has inflamation in the lower extremity, you should palpate the groin where their lymph nodes are located.
What are the different muscle compartments of the thigh?
What muscles are in the anterior compartment and their origins/insertions/actions?
How are the muscles of the anterior compartment innervated?
What are muscles are near the anterior compartment?
If you lose superior gluteal nerve, what sign does the patient present with?
Anterior compartment, anterio-medial compartment, and posterior compartment
Anterior compartment:
- Sartorius, “taylor’s muscle,” originates from anterior superior iliac spine and inserts on medial side of the tibia - crosses hip joint (flexes) and knee joint (flexes).
-
Quadreceps femoris, “4-bellied” on femur. Major extensor of the leg.
- Rectus femoris - arises just below the anterior superior iliac spine and inserts on the common quadriceps tendon (encircles the patella and then continues as the quadraceps tendon/patellar ligament) which inserts of the tibial tuberosity. Crosses 2 joints (weak flexor of the thigh)!
- Vastus lateralis, Vastus intermedias, Vastus medialis - all arise from the femur and insert into common quadraceps tendon. Cross 1 joint!
- Pectinius, comes off the pubic bone and extends onto the thigh, weak flexor of the thigh.
All innervated by the femoral nerve; pectinius may receive some innervation from the obterator nerve as well.
- Psaos major + Iliacus form Iliopsoas, one muscle that inserts on the lesser trochanter of the femur. (powerful flexors of the thigh
- Tensor fascia lata
Trendelenburg walk
What muscles are in the anteriomedial compartment? What is another name for this comparment and the anterior compartment?
What is the innervation of the muscles and the nerve pathway?
What other muscles can be seen near this compartment?
Adductor compartment (anterior compartment is called the flexor compartment because it does some flexing of the thigh in addition to extension of the knee)
- First muscle you will see is the adductor longus
- Most medial muscle in the groin is the gracilis (location of
“pulled groin”) - Deep to the adductor longus (have to cut it) is the adductor brevis, runs the same direction, just deep and smaller
- Deep to adductor longus and adductor brevis is a larger muscle that runs all the way to the adductor tubercle of the femur - the adductur magnus
- Can be seen from the posterior side which is why the adductur magnus muscle can get some innervation from the sciatic nerve which does the things posteriorly
- Deep muscle running across from the obterator foramen to the femur is obterator externus
All innervated by the obterator nerve - comes out of the obturator foramen, splits around the adductor brevis into superficial and deep branches then does skin of upper/medial knee.
Quadratus fermoris can also be seen in this compartment (below obturator externus)
What is the main action of the posterior compartment of the thigh?
What are the muscles of the posterior compartment of the thigh?
What nerve innervates this compartment?
What other muscles are visible in this compartment?
What is the blood supply to this compartment?
Slight hip extenders and knee flexors
- Most lateral is the biceps femoris
- Long head arises from the ishcial tuberosity on the pelvis and then inserts laterally on the head of the fibula (crosses knee and hip joint)
- Short head arises from linea aspera of the femur itself and inserts on the lateral side of the head of the fibula as well (crosses knee joint only)
- Semimebranosus (flatter appearance, like a membrane) muscle and semitendinosus (base more tendinous) muscle also arise from the ischial tuberosity of the pelvis and insert on the medial side of the knee on the tibia (cross knee and hip joint)
All innervated by the sciatic nerve as it runs down. Sciatic nerve broken into 2 parts: tibial and common fibular (separated by whether dual or single action).
- Semimembranosous, semitendinosus, and long head of biceps femoris muscles are done by the tibial portion of the sciatic nerve
- Short head of the biceps femoris is done by the common fibular portion of the sciatic nerve.
Adductor magnus is visible
Muscles supplied by perforating branches coming through the adductor magnus. Artery branches off the deep femoral artery (from femoral artery).
What is the muscular innervation of the anterior compartment of the thigh?
Anterior compartment = femoral nerve
- Fans out after inguinal ligament and gives off different muscular branches. Terminal branch runs medial and becomes saphanous vein doing cutaneous innervation of the leg
- One branch is anterior femoral cutaneous branch
What is the muscular innervation of the anteriomedial compartment of the thigh?
What is the nerve’s pathway down the leg?
Obturator nerve (L2-L4)
Splits around the adductor brevis - superficial branch going anterior to the muscle and the deep branch going posterior to the adductor brevis.
Does muscles of the anteriormedial compartment and then does cutenous/medial aspect of the thigh.
What is the muscular innervation of the posterior compartment of the thigh?
Sciatic nerve (L4-S3)
Tends to be more L4 & L5
What is the blood supply to the anterior thigh?
What is the blood supply to the medial and posterior thigh?
Identify the femoral triangle and its contents
What are imporant landmarks within the space?
How is the space used clinically?
Contents: femoral nerve, artery and vein - run into that big femoral triangle
- Empty space filled with lymphatics within the femoral canal
- Lacunar ligament (coming off the inguinal ligament) bends around onto the pectineal line of the pelvis
- femoral sheath is an extension of the transversalis fascia on the inside of the peritoneum - defect in the sheath is the saphenous hiatis where the saphenous vein comes into the femoral vein
NAVEL (from lateral to medial)
Relevant because want to put a line in the femoral artery or vein (if want to put in artery feel the strong pulse, if want to put it in the vein - go medial to the pulse)
Define the borders and contents of the popliteal fossa
When does the femoral artery become the popliteal artery?
Diamond shaped structure posterior to the knee
Femoral becomes popliteal artery when it comes out of the adductor hiatus
Contents (superficial to deep):
- Skin, posterior femoral cutaneous nerve, short saphenous vein
- Femoral nerve divides into:
- Common fibular nerve (lateral on head of the fibula)
- Tibial nerve (runs right down the center of the leg)
- Branches - sural nerves
- Popliteal artery
- Popliteal vein
- Back of femur
What are the anastomoses connections around the knee?
Connects femoral and the deep femoral superiorly down to the tibial and fibular arteries (terminal branches of the popliteal) inferiorly
What is the pes anserinus?
What are the external components of the knee capsule?
What are differentiating elements of the exernal structures adn their clinical relevance?
Popliteal is on the posterior side
Fibular collateral is separate from the knee capsule/separted by a bursa. Alternatively, the tibular collateral is not separated form the knee capsule.
Thus if you get any tears of the capsule it can have an impact on the tibular collateral ligament as well.
What are the internal components of the knee capsule?
Femoral condyles sit on the tibial plate. Tibial plate itself is just a flat plate so developed cartalagenous C-shaped structures (menisci) that give the tibial plate more substance for femoral condyles to sit into.
Capsule is held together inside by two ligaments (cruciate ligaments - anterior and posterior) that cross over eachother.
- Ligaments prevent anterior or posterior displacement of the tibia on the femur
