Upper Leg 1 Flashcards
list boney landmarks of patella (i think we just need to id this) but just incase..
articular surface facets: lateral, medial, vertical, odd
list the bony landmarks of femur
head, neck (fracture site), greater trochanter, lesser trochanter, adductor tubercle, medial condyle, lateral condyle, medial epicondyle, lateral epicondyle, patellar surface, intercondylar fossa/notch, popliteal fossa
list bony landmarks of the tibia
medial condyle, lateral condyle, tibial tuberosity, medial plateau, lateral plateua, medial malleolus
list bony landmarks of fibula
head of fibula, lateral malleolus
list landmarks of the foot
tarsals (calcaneous, talus, cuboid, navicular, 3 cuneiforms)
metatarsals
phalanges (big toe has 2, rest have 3)
bony land marks of hip joint
acetabulum labrum, acetabulum margin, acetabulum lunate, acetabular notch, head of femur/fovea capitis
4 hip joint problems (clinical anatomy)
total hip replacement
childhood conditions: legg calve perthes, transient synovitis, SCFE
dislocation of hip (trauma - POSTERIOR dislocation is most common from car accidents; children-CHD congenital hip dislocation in newborn) -less common then shoulder dislocation
osteoarthritis
list the ligaments of the hip
iliofemoral ligament (Y)
pubofemoral ligament
ischiofemoral ligament
ligamentum teres
describe the ligaments of the hip (4)
iliofemoral ligament (Y)-largest, anterior, resists extension (Especially standing) ((it kind of swings around to the front and splits into two)
pubofemoral ligament-anterior inferior, resists abduction ((resist doing an open split)
ischiofemoral ligament-posterior, rests extension like the Y ligament, resists medial rotation
ligamentum teres -round ligament at head of femur–attaches to fovea capitis and is a critical pathway for the acetabular branch of the obturator artery (critical during growth)
list the blood supply to the hip
medial circumflex a
lateral circumflex a
acetabular branch of obturator artery
–AVN avascular necrosis = clinical
what muscles are involved in hip flexion?
iliopsoas (psoas major and iliacus)
rectus femoris
sartorius
hip adduction?
pectineus adductor longus adductor brevis adductor magnus gracilis
hip abduction?
gluteus minimus
gluteus medius
TFL
hip extension?
gluetus maximus
biceps femoris long head
semimembranosus
semitendinosus
external rotation of the hip
piriformis superior gemellus obturator internus inferior gemellus quadratus gemoris obturator externus gluteus maximus biceps femoris sartorius
internal rotation of hip
gluteus minimus gluteus medius TFL semimembranosus semitendinosus
describe the deep facia lata
dense CT layer btwn subcutaneous tissue and muscle
- forms fibrous septa that separates muscles and surrounds muscles
- helps contracting muscles move blood and lymph towards thorax
A. iliotibial tract
B. intermuscular septums: medial, lateral, and posterior (NO anterior)
describe the iliotibial tract
conjoint aponeurosis of the TFL and GLUTEUS MAXIMUS
-from the iliac tubercle down to the lateral condyle of the tibia (Gerdy’s Tubercle)
list muscles of the anterior thigh
psoas major psoas minor iliacus tensor fasciae latae sartorius rectus femoris vastus lateralis vastus medialis vastus intermedius articularis genu
describe the psoas major and psoas minor
major:
P: t12-l5 vertebrae/discs; and TP of all lumbar vertabrae
D: lesser trochanter of femur
N: ventral rami of lumbar nerves
A: flex hip, influence posture of pelvis in wt bearing
minor:
P:T12-L5 vertabrae and discs
D: Pectineal line, iliopectineal eminence via iliopectineal arch
N: Ventral rami of lumbar nerves
A: a little stability of pelvis otherwise NO direct influence on hip motion
describe iliacus and tensor fasciae late
iliacus
P: iliac crest, iliac fossa, ala of sacrum, anterior sacroiliac (SI) ligaments
D: tendon of psoas major, lesser trochanter, femur distal to lesser trochanter
N: femoral N
A: flex hip, influence posture of pelvis in wt bearing (same as psoas major)
TFL:
P: ASIS, anterior iliac crest
D: iliotibial tract (lands on the lateral tibial condyle)
N: superior gluteal N
A: abduct, internal rotation, flex hip, keep knee extended, steadies trunk on thigh
describe sartorius and articularis genu
sartorius:
P: ASIS and superior notch that is below the asis
D: superior medial surface of tibia (pes aserinus)
N: femoral N
A: flex, abduct, external rotation of hip, flex knee joint
articularis genu: small muscle in distal femur
P: body of femur?
D: proximal end of synovial membrane of knee joint AND distal femur
A: pulls synovial capsule to prevent pinching of the synovium
list and describe the nerves of the anterior thigh
- lateral femoral cutaneous- sensory of lateral thigh
- femoral nerve- sensory anterior thigh; motor= rectus femoris, vastus lateralis, vastus medialis, vastas intermedius, sartorius, iliacus, pectineus
*enters the thigh DEEP to the inguinal ligament and IN the femoral triangle
Descrbe the femoral triangle boundaries and contents
boundaries: superior/base= inguinal ligament medial= adductor longus lateral =sartorius apex= point where sartorius and adductor longus meet (bottom ish) -also the start of the adductor canal floor=adductor longus, pectineus, iliopsoas (iliopsoas are more lateral) roof= fascia lata and cribiform fascia
contents: femoral VAN (vein is the most medial, nerve is the most lateral) profunda femoris artery profunda femoris vein inguinal lymph nodes
describe the saphenous opening
opening in fascia lata that lets the superficial great saphenous vein to dump into femoral vein and lets lymphatic vessels dump into deep inguinal lymph nodes
describe the femoral sheath, femoral ring, and femoral canal
as a group: pathway for femoral artery, vein, and lymphnodes to pass UNDER the inguinal ligament (no nerves included here)
femoral sheath: funnel shaped fascial tube
- divided into 3 compartments:
- lateral compartment - femoral artery
- intermediate compartment- femoral vein
- medial compartment - this is the femoral canal
femoral ring - oval shaped opening to femoral canal
femoral canal- sends femoral artery vein and lymphnodes under the inguinal ligament
–*site of femoral hernia
describe the adductor canal/subsartorial
boundaries:
anterior/lateral= vastus medialis
posterior=adductor longus and adductor magnus
medial/roof=sartorius
contents: femoral artery femoral vein saphenous nerve nerve to vastus medialis
where does the femoral artery supply?
what does the femoral vein drain?
supplies leg and foot
drains popliteal, profunda femoris, and great saphenous veins
list and describe the arteries of the thigh
- femoral artery - blood to leg and foot
- descends in adductor canal, passes thru adductor hiatus, goes to posterior knee “popliteal fossa”->becomes the popliteal artery which passes inferior to popliteus dividing into anterior and posterior tibial arteries (anterior pops off to form new artery which also branches into the genicular anastomsoes-superior medial, superior lateral, middle, inferior medial, inferior lateral) - deep femoral artery- major artery supplying the thigh with perforating branches going to the adductor magnus and hamstrings (ST SM)
- lateral femoral circumflex - hip
- medial femoral circumflex -hip
describe the veins of the thigh
A. superficial veins:
- great saphenous vein -medial leg starting at medial malleolus, drains into femoral vein at saphenous opening just below the inguinal ligament
- small/lesser saphenous vein -posterior leg, becomes popliteal vein in the popliteal fossa which then becomes the femoral vein as it enters the adductor hiatus
B. Deep veins: run up the leg with arteries and dump or merge into the femoral vein
-clinical DVT formed in the deep veins from immobilization, CHF, Obesity etc
C. communicating venous system veins: connect superficial to deep, one way valves into the deep veins, ** muscular pump** pushing blood up to heard (ex. compress small saphenous vein btwn gastrocneumius muscles??)
-clinical = vericose veins = blood flows from deep to superficial and pools
D. Femoral vein- continues from the popliteal vein after the adductor hiatus and becomes the external iliac vein as it passes into pelvis deep to the inguinal ligament
superficial veins dump into deep veins and are also connected to deep veins by the communicating venous system veins which dump into femoral vein
list the muscles of the medial thigh
pectineus adductor longus adductor brevis adductor magnus gracilis obturator externus
obturator nerve innervates ..
all muscles of the medial thigh except the pectineus (femoral nerve) and 1/2 adductor magnus (tibial part of sciatic nerve)
describe pectineus and adductor longus
pectineus: P: superior ramus of pubis D: pectineal line of femur (just below leser trochanter) N: femoral A: adduct, flex, medially rotate thigh
adductor longus P: body of pubis below the pubic crest D: middle 1/3 of linear aspera of femur N: obturator anterior division A: adduct thigh
describe rectus femoris and vastus lateralis
P: ASIS, ilium superior to acetabulum
D: base of patella by ligament to the tibial tuberosity
N: femoral
A: extends knee joint and slightly flexes hip
vastus lateralis:
p: greater trochanter line and medial lip of linea aspera of femur
D: base of patella by ligament to tibial tuberosity
N: femoral
A: extends knee joint
describe vastus medialis and vastus intermedius
medialis:
P: intertrochanteric line and MEDIAL lip of linea aspera of femur (remember that the lateralis was the lateral lip)
D: base of patella by ligament to tibial tuberosity
N: femoral
A: extend knee joint
–>**obliquus vastus medialis (VMO) **= distal fibers that prevent the patella from tracing laterally (this is basically the bottom chunk of vm from what i can see in pics)
intermedius:
P: anterior and lateral surfaces of body of femur
D: bsae of patella by ligament to tibial tuberosity
N: femoral
A: extends knee joint
list the quadriceps femoris muscles (4) and what they have in common
rectus femoris vastus lateralis vastus medialis vastus intermedius all innervated by femoral nerve, and D attachment is at the base of patella by ligament to tibial tuberosity!
Describe the adductor brevis and adductor magnus
brevis:
P: body and inferior ramus of pubis (pectineus was the superior ramus of pubis)
D: pectineal line and proximal part of linea aspera (adductor longus was the middle 1/3)
N: obturator ANTERIOR
A: adduct thigh and some flexion
longus: two parts 1. adductor part, 2. hamstring part
P: adductor: inferior ramus of pubis and ramus of ischium
hamstring: ischial tuberosity
D: adductor: gluteal tuberosity (post/lateral/superior of femur) and medial supracondylar line ; ** forms ADDUCTOR HIATUS**-arch that the femoral artery and vein pass posteriorly thru
hamstring: adductor tubercle (below the medial cupracondylar)
N: adductor: obturator POSTERIOR division
hamstring: tibial part of sciatic nerve
A: adduct thigh
adductor part: flex thigh
hamstring part: partly extends thigh
describe gracilis and obturator externus
p: body of inferior ramus of pubis
D: superior part of medial surface of tibia (SGTsaygracebeforetea)
N: obturator
A: adduct, flex, helps medial rotation of thigh/leg
externus:
p: margins of obturator foramen and obturator membrane
D: trochanteric fossa of femur
N: Obturator
A: lateral rotation, steadies head of femur in acetabulum
list and describe nerves of the medial thigh
obturator nerve- motor: adductor longus, brevis, (1/2) magnus, gracilis, obturator externus
sensory: small oval patch on medial thigh
what attaches to the lip of linea aspera (and where)
vastus lateralis = lateral vastus medialis = medial adductor longus = middle 1/3 adductor brevis =proximal adductor part of adductor magnus =not specified biceps femoris short head- not specified
attachments to the ramus of pubis:
adductor magnus adductor part=inferior ramus
gracilis= body of inferior ramus
pectineus = superior ramus
adductor longus = body of ramus ? pubis below pubic crest (sheet doesnt specify ramus)
adductor brevis =body and inferior ramus
describe two structures of the gluteal hip
- greater sciatic foramen - greater sciatic notch and sacrospinous ligament
- lesser sciatic foramen -lesser sciatic notch and sacrotuberous ligament
list the muscles of gluteal region
gluteus maximus gluteus medius gluteus minimus piriformis obturator internus superior gemellus inferior gemellus quadratus femoris obturator externus
list the nerves of the gluteal region
from the sacral plexus
- sciatic nerve
a. tibial part
b. common fibular part - superior gluteal
- inferior gluteal
- nerve to obturator internus
- nerve to quadratus femoris
- pudendal nerve
describe the gluteus maximus and medius
gluteus maximus:
P: the back of the ilium to the posterior gluteal line, dorsal sacrum and coccyx, sacrotuberous ligament
D: iliofibial tract (lands on lateral condyle of tibia) but some fibers insert on gluteal tuberosity of femur
N: inferior gluteal nerve
A: extend, lateral rotation, steadies thigh, assists with standing up, stabilizes knee because its attached to iliotibial tract)
medius:
P: external surface of ilium btwn anterior and posterior gluteal lines
D: lateral surface of greater trochanter of femur
N: superior gluteal nerve
A: abduct, medial rotation, keeps pelvis level when opposite leg is raised
(same action and nerve as minimus)
describe the gluteus minimus and piriformis
minimus:
P: external surface of ilium between anterior and inferior gluteal lines
D: anterior surface of greater trochanter of femur
N: superior gluteal nerve
A: abduct, medial rotation thigh, keep pelvis level when opposite leg is raised
(same nerve and action as medial)
piriformis:
P: anterior surface of sacrum and sacrotuberous ligament
D: superior border of greater trochanter
N: branches of ventral rami
A: lateral rotation, extends, and abducts flexed thigh, steadies femoral head in acetabulum
describe obturator and superior gemellus
obturator internus:
P: pelvic surface of obturator membrane and surrounding bones
D: medial surface of greater trochanter/trochanteric fossa of femur
N: nerve to obturator internus
A: lateral rotation, extends, and abducts flexed thigh, steady femoral head in acetabulum
superior gemellus: 2 parts
P:superior= ischial spine, inferior=ischial tuberosity
D: gemellus muscle blends with obturator internus tendon and it attaches to greater trochanter of femur
N: nerve to obturator internus
A: lateral rotation, extends, abducts flexed thigh, steadies femoral head in acetabulum
describe inferior gemellus, quadratus femoris, and obturator externus
inferior gemellus: 2 parts
P: superior= ischial spine, inferior = ischial tuberosity (same as superior gemelles)
D: gemellus muscle blends with obturator internus tendon as it attaches to greater trochanter of femur (Same as superior gemellus)
N: nerve to quadratus femoris
A: lateral rotation, extends, abducts flexed thigh, steadies femoral head in acetabulum
quadratus femori:
P: lateral border of ischial tuberosity
D: quadrate tubercle on intertrochanteric crest of femur
N: nerve to quadratus femoris
A: lateral rotation, extends, abducts flexed thigh, steadies femoral head in acetabulum
obturator externus
P: margins of obturator foramen and membrane
D: trochanteric fossa
N: obturator nerve
A: lateral rotation, extends, abducts flexed thigh, steadies femoral head in acetabulum
specific areas that these muscles attach on the trochanter of the femur
anterior = g. minimus
lateral = g. medius
superior = piriformis
trochanteric fossa / medial = obturator internus, externus, superior and inferior gemellus
quadrate tubercle intertrochantic crest = quadratus femoris
what do the muscles of the gluteal region (except the gluteus max, med, min) have in common?
they have the same action
A: lateral rotation, extends, abducts flexed thigh, steadies femoral head in acetabulum
gluteus min and med have the same nerve and action: superior gluteal nerve and abduct, medial rotation, keep pelvis level when opposite leg is raised
gluteus max also laterally rotates and extends the thigh, but it also steadies the thigh and assist in standing up and keeping knee stable
describe the nerves of the gluteal region
- sciatic largest nerve in body -breaks into tibial and common fibular parts
- leaves pelvis thru the greater sciatic foramen and varies on how it passes by the piriformis, then it goes down the Posterior thight
- motor: just the hamstrings and all muscles below the knee! not in the butt
- sensory:posterior thigh, posterior lateral anterior lower leg and all of food except the medial part - superior gluteal
- leaves the pelvis thru greater sciatic foramen and SUPERIOR to piriformis
- motor: gluetus medius, gluteus minimus, TFL - Inferior gluteal
- leaves pelvis thru the greater sciatic foramen and INFERIOR to the piriformis
- motor: gluteus maximus - nerve to obturator internus
- motor: obturator internus and superior gemellus - nerve to quadratus femoris
- motor: quadratus femoris and inferior gemellus - pudendal nerve
- leaves pelvis thru greater sciatic foramen and INFERIOR to piriformis and LATERAL to the sacrospinus ligament where it reenters the pelvis thru the LESSOR SCIATIC FORAMEN
- motor: perineal muscles (not gluteal region)
- sensory: perineal region
list the muscles of the posterior thigh “hamstrings”
biceps femoris long head
biceps femoris short head
semitendinosus
semimembranosus
describe the muscles of the posterior thigh (all 4)
- biceps femoris long head
p: ischial tuberosity
D: lateral head of fibula, *split by LCL
N: tibial part of sciatic
A: flex leg, lateral rotation of leg with flexed knee, extend thigh at hip(this extension of thigh is unique to the long head)
biceps femoris short head:
P:linear aspera and lateral supracondular line of femur
D: lateral head of fibula, split by LCL
N: common fibuler part of sciatic
A: flex and lateral rotation of leg (*no direct effect on hip)
ST: P: ischial tuberosity (same as sm) D: medial superior tibia (SGT) N:tibial part of sciatic (same as sm) A: extend thigh, flex and medially rotate leg with flexed knee (same as sm)
SM:
P:ischial tuberosity (same as ST)
D:posterior medial tibial condyle, reflective attachment forms oblique popliteal ligament (which goes to lateral femoral condyle)
N: tibial part of sciatic (Same as ST)
A: extend thich, flex and medially rotate leg with flexed knee (same as ST)
tibia part of sciatic nerve innervates
biceps femoris long head
ST
SM
biceps femoris short head innervated by the common fibular part of sciatic nerve
describe the vessels of the posterior thigh
- profunda femoris artery/ deep femoral artery
- largest branch off femoral artery chief artery of thigh!!
- deep to femoral artery
- has perforating femoral arteries that supply adductor magnus and hamstrings- > usually they branch from deep femoral but they can come off femoral artery
- > they encircle the thigh and form anastomies with each other and other arteries
- > supply the thigh muscles and proximal end of the femur
- femoral artery
describe the popliteal fossa
boudaries:
superolateral- biceps femoris
superomedial-SM, ST
inferior-two heads of gastrocnemius
roof (this is back of knee)- skin and fascia
floor (anterior of knee)-popliteal surface of femur, oblique popliteal ligament- expansion of the SM tendon, popliteus fasica
contents:
popliteal artery
popliteal vein
small saphenous vein
tibial and common fibular nerves -supply all muscles of leg and foot
popliteal lymphnodes and lymphatic vessels
describe the popliteus muscle
P: lateral part of lateral condyle of femur and lateral meniscus
D: posterior part of tibia above the soleal line (medial/middle ish back of tibia)
N: tibial
A: internal rotation of tibia on the femur (unlock knee to allow it to flex during walking**)
list major components of the knee joint
- tibiofemoral joint
- pattela femoral joint
- menisci
- collateral ligaments
- intraarticular cruciate ligaments
- other ligaments
list and describe the “other ligaments” of knee joint
patellar ligament (EC)–attaches patella to tibial tuberosity (below patella ; above patella is quadracepts tendon)
coronary ligament (meniscotibial)–capsular fibers that attach meniscal margins to the tiba) ((all around knee i think)
oblique popliteal ligament– expansion of SM tendon
arcuate popliteal ligament–from fibular head, over tendon of popliteus, spreads over posterior knee joint (looks like Y right behind LCL)
transverse ligament of knee–slender fibrous band connecting anterior edges of menisci so they can move together
describe genu varum vs genu valgum
varum (bow leg) = medial epicondyles touch and the lateral epicondyles have space btwn so the legs bow out
valgum (knock-knee)=lateral epicondyles touch and the medial epicondyles have space btwn so the knees kiss
what is the motion of the knee joint?
flexion/extension and small amount of medial/lateral rotation
describe the menisci
- fibrocartilage disks: deepen joint surface, reduce shock, provide proprioceptive feedback
- unattached edges in interior but firmly attached at the edges in the intercondylar area of tibia
- the external margins attach to fibrous capsule
- medial meniscus-C shaped semilunar, the posterior part is larger, strong attachment to deep surface of tibial MCL (this is unique to medial)
- lateral meniscus-circular and smaller, freely moveable compared to medial meniscus, ((doesnt mention attaching to the LCL))
describe the collateral ligaments
- MCL - 2 layers, superficial and deep
-attaches the medial epicondyle of femur to the medial tibia plateau
-broad band of ct (superficial layer)
-(deep layer) blends into the joint capsule and medial meniscus (unique to the MCL)
function test: resists valgus stress (put force on lateral condyles thru the medial knee and the MCL should resist it) - LCL-
-attaches the lateral epicondyle of femur to the head of the fibula
-“cord like” easy to palpate if sitting in figure 4
-no attachment to joint capsule or lateral meniscus
-the popliteus tendon passes deep to LCL
-LCL splits biceps femoris tendon into two parts
function test: LCL resists varus stress (force going onto medial thru lateral knee) - Anteriolateral ligament (ALL)
describe the intraarticular cruciate ligaments
they are within the articular joint capsule but NOT in the synovium (they are outside of the synovium)
- named for tibial attachments
- considered intra-articular located outside of synovium and under fibrous portion of the joint capsule
- ACL
- attaches anterior tibia to posterior lateral femoral condyle (back and lateral)
- rests anterior translation of tibia on femur (tibia cant slide forward any more) – forced hyper extension = injuries!!!
- OKC? activity- terminal knee extension 0-30 degrees, quad pulls the tibia anterior
- CKC? activity- increasing knee flexion, reactive forces pushing tibia anterior
- >damaged MCL while knee is flexed means the ACL plays a role in trying to resist valgus stress (odonahues unhappy triad) - PCL
- attaches posterior tibia to inner part of medial femoral condyle (front and medial)
- rests posterior translation of tibia on femur (doesnt let it slide back too far)
- ->injuries from trauma that puts direct force on the tibia plateau (MVA)
describe the unhappy triad (o’donogue)
MCL, ACL, Medial Meniscus damage (hit knee from lateral side and push tibia forward and laterally)
