3. Lower Limb, Thigh, Knee Flashcards

(50 cards)

1
Q

Flexors of the hip joint:

A

pectineus,
iliopsoas (psoas major, iliacus)
sartorius

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2
Q

Quadriceps femoris muscles

A

rectus femoris,
vastus lateralis,
vastus medialis
vastus intermedius)

the quadriceps tendon and the patella ligament

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3
Q

Adductor muscles

A

adductor longus,
adductor brevis,
adductor magnus,

gracilis and obturator externus

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4
Q

Vessels of femoral triangle

A

’ Femoral artery and its profunda femoris branch (profunda means deep)
– Femoral vein
– Lymphatics
– Great (long) saphenous vein

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5
Q

PECTINEUS muscle

A

Origin
• Pectineal line of the superior pubic ramus

Insertion
• Upper and linea aspera of femur

Action
• Flexes and the adducts the thigh at the hip joint

Nerve supply
• Femoral nerve (l3,l4) - anterior branch

Pectineus = muscle
• Originates at superior pubic ramus

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6
Q

4 things in loose connective tissue

A

– fat
– cutaneous nerves
– superficial veins
– lymphatic vessels and nodes

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7
Q

Compartments of thigh

A
  • Anterior = contains quads and pectineus
    • Posterior = hamstring muscles supplied by sciatic
    • Medial compartment
    • Femur
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8
Q

Deep fascia of lower limb - attachments

A

Covers lower limb like stocking

– inguinal ligament
– iliac crest
– Sacrum, coccyx, sacrotuberous lig, ischial tuberosity/ ischiopubic ramus

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9
Q

Deep fascia of lower limb - names

A
  • in the thigh = “fascia lata”

* in the leg = “crural fascia”

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10
Q

Fascia lata (deep fascia)

A

Laterally thickened to form iliotibial tract

– inserts into anterolateral tubercle of tibia (Gerdy’s tubercle)**

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11
Q

Tensor fascia lata - muscle

A
  • Supplied by superior gluteal nerve

* Adduction of hip

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12
Q

Deep fascia forms 3 compartments of thigh

A

• Anterior
• Medial
• Posterior
Compartments separated by intermuscular septum
• Infection in one compartment can spread along fascia planes

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13
Q

Deep fascia - saphenous opening

A
  • Inguinal ligament = 4cm inferior and lateral to pubic tubercle, drains vascular beds
    • The superficial vein (great saphenous) dives through deep fascia to join the deep venous system (femoral vein)
    • The membranous layer blends into the deep fascia above the saphenous opening and forms perforated cribiform fascia over the opening : pierced by great saphenous v, lymphatics, smaller veins
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14
Q

Superficial fascia of anterolateral abdominal wall organised into 2 layers:

A
  • Camper’s fascia – fatty layer

* Scarpa’s fascia – membranous layer

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15
Q

Great saphenous vein

A

Formed by dorsal vein of great toe and dorsal venous arch of foot

  • Has multiple valves… these can “go wrong” (varicose veins) = aids blood going up as gravity likes to pull it down
  • Receives several tributaries especially near termination
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16
Q

Great saphenous vein - surface markings

A

• anterior to medial malleolus
→ hand’s breadth post to medial border of patella
→passes through saphenous opening

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17
Q

Lymphatic drainage

A

Superficial lymphatic vessels accompany saphenous vein
lots of lymph that End in the vertical group of superficial inguinal lymph nodes

• Lymphatic vessels from the superficial nodes pass through cribriform fascia 
– directly to external iliac lymph nodes 
– some pass to deep inguinal lymph nodes on medial aspect of femoral vein
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18
Q

3 compartments of thigh - nerves

A
  • Anterior group innervated by femoral nerve
    • Medial group by obturator nerve ( has two branches anterior and posterior)
    • Posterior group by sciatic nerve
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19
Q

Anterior compartment of the thigh

A

Usually the largest compartment
• Includes femur and anterior thigh muscles – flexors of hip – extensors of knee

3 major muscles in anterior thigh
• pectineus
• sartorius
• quadriceps femoris (the end of the iliopsoas muscle passes into the anterior compartment too)

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20
Q

Anterior compartment muscles

Sartorius

A

• Sartorius = attaches to anterior inferior illaic spine

Tailors muscle = all the functions of Sartorius:
• Hip - flexes, abducts, laterally rotates
• Knee - flexes (medial rotating when flexed

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21
Q

Anterior compartment muscles -

Illiopsoas

A

Most powerful hip flexor walking and climbing
• Maintains posture while standing

2 muscles, with a common tendon inserting on lesser trochanter

Innervation:
• Psoas major = anterior rami first three lumbar nerves (mainly L2)
• Iliacus = femoral nerve (L2,3)

22
Q

How to remember order of vessels in femoral triangle

A
NAVY 
	• Nerve
	• Artery 
	• Vein
	• Y front
Goes from lateral to medial (nerve is medial)

Femoral artery
• Midpoint between anterior superior iliac spine and pubic tubercle

23
Q

Quadriceps femoris -4 muscles

A

(rectus femoris, vastus lateralis, vastus medialis and vastus intermedius)

Rectus femoris originates on ilium
Vastus muscles originate around the proximal end of the femur
1 common insertion (quadriceps tendon)

All 4 innervated by femoral nerve

24
Q

Retinacula

A

(connective tissue) play role in keeping patella aligned over femur

25
major muscles in the medial thigh:
* Gracilis * Obturator externus * Adductor brevis * Adductor longus * Adductor magnus * Pectineus also acts as adductor
26
Nerve supply to medial thigh muscles
Obturator nerve supplies these muscles, all of which adduct the thigh
27
Adductors - all adductor muscles
* Obtruator externus * Pectineus * Adductor longus, brevis, magnus (insert into linea aspera) * Grasilis
28
Adductor magnus
Adductor part of magnus will also flex the thigh (weakly) Proximal origin of hamstring part of magnus more posterior - ischial tuberosity- and inserts onto adductor tubercle so extends the hip (sciatic nerve)
29
Adductor magnus contains adductor hiatus
Adductor hiatus – pes anserinus Opening between the 2 distal attachments of adductor magnus • Transmits femoral artery and vein from adductor canal to popliteal fossa (posterior knee) Pes anserinus • Sartorius • Gracilis • s.tendinousous
30
Pes anserinus
* Sartorius * Gracilis * s.tendinousous
31
Gracilis (slender) and obturator externus
* Lateral or external rotator * Perforations for branches of arteries * Adductors canal/ hunters canal
32
Boundaries of Femoral triangle
* Superiorly – inguinal ligament * Medially – medial border of adductor longus * Laterally – medial border of sartorius * Floor- pectineus and Iliopsoas * Roof – fascial lata, cribriform fascia, skin, subcutaneous tissue
33
Retro- inguinal space
---> behind inguinal ligament Gets things out of pelvic part into thigh Inguinal ligament = ASIS → pubic tubercle Retro-Inguinal Space is deep to ligament… Important passageway between abdominal cavity and lower limb
34
Femoral nerve (L2-L4)
Divides into several branches to: • anterior thigh muscles • articular branches to hip and knee, • cutaneous branches to anteromedial side of thigh • Continues as the saphenous nerve through adductor canal - but comes out bet wee n s a rto riu s and gracilis Saphenous nerve accompanies saphenous veinm
35
Femoral sheath
Fascial tube • 4cm long • deep to inguinal ligament • blends with adventitia of femoral vessels • Allows femoral artery and vein to glide deep to inguinal ligament during movemen
36
Femoral canal
Short and blind ending canal • Allows femoral vein to expand eg exercise • Contains fat and lymphatics, sometimes deep inguinal lymph node (Cloquet's node) - allows expansion
37
Boundaries of femoral ring Opening of femoral canal
Laterally – septum between femoral vein and canal • Posteriorly – pectineus (superior ramus of pubis) • Medially – lacunarligament • Anteriorly – Inguinalligament
38
Femoral artery
First branches • Superficial epigastric • Superficial circumflex iliac • Superficial and deep external pudendal
39
Profunda femoris Artery
• main artery of thigh, gives off 3 -4 perforating arteries which supply all 3 compartments of thigh and hip (giving off the circumflex femoral vessels)
40
Femoral vein
A continuation of popliteal vein • Receives profunda femoris vein (formed by union of 3 or 4 perforating veins), saphenous vein and other tributaries • Continues as the external iliac vein
41
Adductor canal - boundaries
* laterally and anteriorly = vastus medialis * posteriorly = adductor longus and magnus * anteriorly and medially –sartorius (forms the roof)
42
What is in the adductor canal ?
* femoral artery * femoral vein * saphenous nerve (from femoral) * nerve to vastus medialis
43
2 important sites for muscle attatchment
Anterior superior illiac spine | Anterior inferior illioc spine
44
Function of femoral candl
Allow femoral vein to expand when there is increased venous return from lower limb - roulte for efferent lymphatic drainage from deep inguinal nodes
45
Actions of quadriceps femoris muscles
Extend leg or knee joint | Flex thigh at hip joint
46
Vastus medialis function
Sends some fibres horizontally to insert onto patella to stabilise patella and prevent patella dislocation
47
Virchows triad
3 factors important in venous thrombosis development - venous stasis - activation of blood coagulation - vein damage
48
Femoral hernia
Protrusion of abdominal viscera through femoral ring - found below and lateral to pubic tubercle
49
Inguinal hernia
- found above and medial to pubic tubercle
50
Typical sites for valvular incompetence
``` Mid proximal thigh (hunteran perforator) Proximal calf (boyd perforators) ```