Anatomy of the thigh and gluteal region

Question 1

Walking gait

Answer 1

• At least one foot always in contact with the ground
• Complete cycle = stride (A-G)
• Stride =stance (A-E) + swing (F)
• Stance = initial double stance (A, B) + single stance (C) + terminal double stance (D, E)

Question 2

Muscles of anterior compartment of the thigh

Answer 2

o	Quadricepts femoris
	Rectus femoris
	Vastus lateralis
	Vastus medialis
	Vastus intermedius
o	Sartorius
o	Iliopsoas = iliacus + psoas major
o      Pectineus

Question 3

Actions of anterior compartment of thigh

Answer 3

• Flex at the hip:
• Extend leg at the knee:
• Flexes the knee:

Question 4

neruvoasculature of anterior compartment of thigh

Answer 4

• Nerve: femoral nerve (L2-L4)
o Except psoas major – unnamed L1-L3 branches.
• Blood: femoral a, v and deep femoral a, V

Question 5

Testing anterior compartment muscles for their innervation

Answer 5

• Hip flexion: spinal cord segment L2-L3
• Knee extension: spinal cord segments L3-L4
• Muscle power graded on a 5 point scale:
o 5 = normal
o 4 = movement against gravity and some resistance
o 3 = movement against gravity
o 2 = movement with gravity eliminated
o 1 = flicker of contraction
o 0 = complete paralysis

Question 6

Medial compartment of thigh muscles

Answer 6

• Pectineus
• Adductor longus
• Adductor brevis
• Adductor magnus
• Gracalis
• Obturator externus

Question 7

Actiosn of medial compartment muscles

Answer 7

• Small contribution to flexion or extension at hip joint.
• Flexes leg at knee:
• Obturator externus laterally rotates at hip joint
• The adductors and pectineus are also lateral rotators at hip joint – note posterior insertion (some texts erroneously say medial rotation).

Question 8

Neurovascular supply of medial compartment

Answer 8

• Nerve
o Obturator n (L2 – L4) enters from pelvis via obturator canal.
• Blood
o Femoral and deep femoral aa, vv (obturator a is small).

Question 9

Inguinal ligament

Answer 9

• Is located at the border of abdominopelvic region and thigh, from the anterior superior iliac spine (ASIS) to the pubic tubercle.
• It forms the lower border of the external abdominal oblique aponeuroses.
• Fascia lata (deep fascia) of thigh is attached to it.
• External iliac vessels and femoral vessels ‘change names’ as they pass this structure

Question 10

Femoral triangle

Answer 10

•	Boundaries
o	Inguinal ligament
o	Sartorius
o	Adductor longus
•	Roof
o	Fascia lata
•	Contents
o	Femoral nerve, artery, vein, canal (lateral to medial) with lymphatics – ‘navel’
o	Located deep to deep fascia, but no overlying muscles

Question 11

Adductor canal

Answer 11

•	Located between vastus medialis, and adductor longus/magnus.
•	Roof: Sartorius
•	Contents
o	Femoral vessels
o	Branches of femoral nerve

Question 12

Femoral sheath

Answer 12

The femoral sheath surrounds femoral a, v, canal but not nerve.

Question 13

Femoral ring boundaries

Answer 13

• Inguinal ligament
• Lacunar ligament
• Superior pubic ramus
• Femoral vein

Question 14

Femoral hernia

Answer 14

• Protrusion of fat or loop of bowel through femoral ring into femoral canal (note: different from inguinal hernia).

Question 15

Femoral artery catheterisation

Answer 15

• For angiography, angioplasty, etc.
• Arterial pulse easily palpated
• Can also catheterise femoral vein – know anatomic relationship.

Question 16

Femoral artery

Answer 16

• Helps to supply thigh

* Terminated by continuing as popliteal artery at adductor hiatus (a gap in the adductor magnus)

Question 17

Deep femoral artery

Answer 17

• A branch of the femoral artery in the femoral triangle

* Supplies much of the thigh

Question 18

Posterior compartment of the thigh muscles

Answer 18

•	Hamstring muscles
o	Semitendinosus
o	Semimembranosus
o	Biceps femoris (long and short heads)
o	Ischial part of adductor magnus

Question 19

Neurovascular supply to posterior compartment

Answer 19

• Nerve
o Sciatic n (L4-S3) – mostly tibial n portion
o Mainly L5 – S2 for posterior compartment
• Blood
o Perforating branches of deep femoral artery, vein

Question 20

Tests for posterior compartment

Answer 20

• Flex leg at knee tests all muscles except:

* Extend thigh at hip tests all muscles except:

Question 21

Gluteus maximus muscle

Answer 21

Actions
•	Extend thigh at hip (e.g. climbing steps, rising from a chair)
•	Lateral rotation at hip
•	Contributed to abduction and adduction
Nerve
•	Inferior gluteal
Testing
•	Extension at hip tests:

Question 22

Gluteus medius, gluteus minimus, tensor fasciae lata

Answer 22

Actions of gluteus medium and minimus
•	Abduction
•	Medially and laterally rotate thigh at hip
•	Contribute to flexion and extension at hip
Actions of tensor fasciae latae
•	Abudct
•	Medially rotate
•	Flex at hip
Nerve
•	Superior gluteal 
Trendelenberg test/sign
•	Normally prevent dip of opposite side of pelvis when only one leg on ground.

Question 23

Short lateral rotators of hip and gluteal region

Answer 23

Located deep the the gluteus maximus. Inlcude:
•	Piriformis
•	Superior gemellus
•	Obturator internus
•	Inferior gemellus
•	Quadratus femoris 
Actions
•	Laterally rotate hip
Nerves
•	Nerve to piriformis
•	N. to obturator internus
•	N. to quadratus femoris

Question 24

Greater and lesser sciatic foramina

Answer 24

• Sacrotuberous and sacrospinous ligaments
• Greater sciatic foramen (GSF): many nerves and blood vessels travel between pelvis and lower limb (gluteal region) via GSF
• LSF: obturator internus, nerves and vessels of perineum from gluteal region to perineum

Question 25

Obturator internus and externus

Answer 25

• From obturator membrane and surrounding hip bone to femur (trochanteric fossa)
• Both laterally (externally) rotate at the hip joint