Sem 2 - F - Femoral triangle - Superficial veins, superficial inguinal lymph nodes, cutaneous nerves, deep fascia, femoral triangle Flashcards
What are the three nerves from the lumbar plexus that provide motor and sensory innervation to the lower limb? What are the nerves from the lumbar plexus providing purely sensory innervation to the lower limb?
The lumbosacral trunk (L4,L5), femoral nerve (L2-4) & obturator nerve (L2-4) provide both motor and sensory innervation to the lower limb
The iliohypogastric (L1), ilioinguinal (L1), genitofemroal (L1,2) and lateral cutaneous nerve of the thigh (L2,3) provide sensory innervation to the lower limb
- How do the sciatic and gluteal nerves and vessels transition from pelvis to lower limb?
- How do the femoral nerves and vessels transition from pelvis to lower limb?
- How do the obturator nerves and vessels transition from pelvis to lower limb?
Sciatic and gluteal nerves and vessels transition via the greater sciatic foramen (superior gluteal above piriformis)
Femoral nerves and vessels transition via via subinguinal space (deep to the inguinal ligament)
Obturator nerves and vessels transition via the obturator canal in the obturator membrane
What is the femoral and obturator nerves formed from and what compartment of the thigh do they supply with motor innervation?
The femoral nerve is formed from the posterior divisions of the anterior rami of L2,3,4 and supplies motor innervation to the anterior thigh
The obturator nerve is formed from the anterior divisions of the anterior rami of L2,3,4 and supplies motor innervation to the medial thigh
What forms the sciatic nerve and what does it supply motor innervation to?
Sciatic nerve is formed from the union of the lumbosacral trunk (L4,5) with sacral nerves S1,2,3
It supplies motor innervation to the posterior thigh and gives two terminal branches to supply motor innervation to everything below the knee (tibial nerve - L4-S3 and fibular nerve - L4-S2)
We will now discuss the superficial structures of the thigh area in more depth
The superficial veins of the lower limb run in the subcutaneous tissue
- What are the two major superficial veins?
The two major superficial veins are the great (long) and small (short) saphenous veins
Describe the course of the great saphenous vein
The great spahenous vein is formed by the dorsal venous arch of the foot and the dorsal vein of the big toe
It runs along the medial aspect of the dorsum of the foot before passing anteriorly to the medial mallelolus at the ankle and running up the anteromedial aspect of the leg before passing posteriorly at the knee joint
As it travels up the thigh, it come anteromedially to drain into the femoral vein via the saphenous hiatus just before the inguinal ligament
What are some tributary branches draining into the great saphenous vein just before it passes through the sapehnous hiatus?
The superficial circumflex iliac vien Superficial epigastric vein Superficial and deep external pudendal veins Accessory saphenous vein
Describe the course of the small saphenous vein?
The small saphenous vein starts at the union of the dorsal venous arch of the foot with the dorsal vein of the little toe where it passes inferior and posterior to the lateral malleolus at the ankle before travelling superior in the posterior aspect of the leg
It travels deep into the popliteal fossa to drain into the popliteal vein
What nerves do the great and small saphenous veins run alongside in the leg?
Great saphenous vein runs alongside the saphenous nerve in the leg
Small saphenous vein runs alongside the sural nerve in the leg
We will now discuss the superficial structures of the thigh area in more depth
There are horizontal and vertical superficial inguinal lymph nodes
- Describe the difference in their drainage?
Horizontal superficial inguinal lymph nodes
- Medial group - drain anterior abdominal wall and lower half of anal canal
- Lateral group - drain posterior abdominal wall
Vertical superficial inguinal lymph nodes
- Drain superficial lymph from the lower limb
We will now discuss the superficial structures of the thigh area in more depth
State what the named nerves supplying cutaneous innervation to each region of the anterior and medial thigh are known as (start with red box, finish with yellow) - state nerve roots
- Red - femoral branch of genitofemoral nerve (L1,2)
- Grey - ilioinguinal nerve (L1)
- Blue - cutaneous branch of obturator nerve (L2,3,4)
- Purple - anterior cutaneous branches of femoral nerve (L2,3,4)
- Green - lateral cutaenous nerve of the thigh (L2,3)
- Yellow - lateral cutaneous branch of T12
We will now discuss the superficial structures of the thigh area in more depth The deep fascia of the lower limb runs continously but has two disticnt names dependent on the region What are the two names?
Deep fascia in the thigh region is the fascia latae
Deep fascia in the leg region is the crural fascia
What is one of the roles of the deep fascia of the lower limb?
The deep fascia of the lower limb helps contain the muscles of the lower limb, means any pressure from muscular contraction is directed inwards to causing the contraction to squeeze veins aiding in venous return to the heart (muscuoloskeletal pump)
What does the fascia latae thicken laterally to form and what muscles insert into this?
The fascia latae thickens laterally to form the iliotibial tract
Both the tensor fascia latae and the gluteus maximus fibres blend into the iliotibial tract
Where does the iliotibial tract run from and what is its function?
The iliotibial tract runs from iliac tubercle to the anterolateral tibial tubercle and helps to support the femur on the tibia when standing
Anterolateral tibial tubercle is also known as the Gerdy tubercle
There is a triangular shape on the anterior upper thigh known as the femoral triangle The femoral triangle has a superior, lateral and medial border as well as a roof and floor
What forms the roof of the femoral triangle? What forms the floor of the femoral triangle?
The roof is formed by the fascia latae, cribriform fascia, subcutaneous tissue and skin
The floor is formed by the pectineus (medially) and iliopsoas muscles (laterally)
The roof of the femoral triangle is formed by the fascia latae, cribriform fascia, subcutaneous tissue and skin
The floor is formed by the pectineus (medially) and iliopsoas muscles (laterally) What is the cribriform fascia?
The cribriform fascia is a protion of deep fascia of the thigh covering the saphenous opening which the great saphenous vein passes through to enter the femoral vein (cribriform is latin from cribrum meaning sieve)
What forms the borders of the femoral triangle?
- Superior border or base - formed by the inguinal ligament
- Medial border - formed by the adductor longus
- Lateral border - formed by the sartorius
What are the contents of the femoral triangle?
From lateral to medial (NAVY)
- Femoral Nerve
- Femoral Artery,
- Femoal Vein and
- lYmphatics (within femoral canal) contained within the femoral sheath
May see profunda femoris artery branch of femoral artery in the triangle
Femoral sheath is a specialised piece of fascia associated with the vasculature of the femoral triangle What structure in the femoral triangle is outwith the femoral sheath and what does this structure travel on? What forms the femoral sheath?
Femoral nerve is outwith the femoral sheath and runs on the surface of the iliopsoas contained within the iliopsoas fascia
Femoral sheath formed anteriorly by the transversalis fascia and posteriorly by the iliopsoas fascia
The sheath compartments are divided into three compartments for artery vein and lymphatcis
The lymphatics medial compartment is known as the femoral canal
- What does the femoral canal contain?
The femoral canal contains lymphatics and fat
