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Human Anatomy 2 > Abdominal Wall, Anterior & Medial Thigh > Flashcards

Abdominal Wall, Anterior & Medial Thigh Flashcards

1
Q

Quadratus Lumborum

A

Origin:
1. L5 TP
2. iliac crest

insertion:
1. L1-4 TP
2. rib 12

Action:
1. depresses rib 12
2. ipsilateral trunk lateral flexion

Innervation: T12-L4

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2
Q

Psoas Major

A

Origin:
1. Bodies and intervertebral discs of T12-L5
2. Lumbar TP L1-L5

Insertion:
1. Lesser trochanter of femur

Action:
1. Hip flexion
2. hip ER
3. trunk lateral flexion (ipsilateral)

Innervation:
1. ventral rami L2-L3

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3
Q

Iliacus

A

Origin:
1. iliac fossa

Insertion:
1. lesser trochanter

Action:
1. hip flexion

Innervation:
1. Femoral nerve L2-L4

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4
Q

External Oblique

A

Origin:
1. outer surfaces of ribs 5-12

Insertion:
1. iliac crest
2. aponeurosis ending in linear alba (joining of each side of aponeurosis)

Action:
1. compress abdominal contents
2. B/L = trunk flexion
3. U/L = contralateral trunk rotation
4. U/L = ipsilateral trunk lateral flexion

Innervation:
1. Ventral Rami of T7-T12

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5
Q

Internal Oblique

A

Origin:
1. thoracolumbar fascia
2. iliac crest
3. inguinal ligament

Insertion:
1. linea alba
2. costal cartilages 7-10

Action:
1. compress abdominal contents
2. B/L = trunk flexion
3. U/L = ipsilateral trunk rotation and trunk lateral flexion

Innervation:
1. ventral rami of T8-L1

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6
Q

Transverse Abdominis

A

Origin:
1. iliac crest
2. inguinal ligament
3. thoracolumbar fascia
4. costal cartilage 7-12

Insertion:
1. pubis
2. linea alba
3. xiphoid process of sternum

Action:
1. compress abdominal contents

Innervation:
1. ventral rami of T7-L1

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7
Q

Rectus Abdominis

A

Origin:
1. pubis

Insertion:
1. xiphoid process
2. costal cartilages 5-7

Action:
1. compress abdominal contents
2. trunk flexion

Innervation:
1. ventral rami T7-T12

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8
Q

Quadriceps

Vastus Medialis

A

Origin:
1. medial lip of linea aspera of femur

Insertion:
1. patella via quadriceps tendon

Action:
1. knee extension

Innervation:
1. femoral L2-L4

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9
Q

Quadriceps

Vastus Lateralis

A

Origin:
1. lateral lip of linea aspera of femur

Insertion:
1. patella via quadriceps tendon

Action:
1. knee extension

Innervation:
1. femoral L2-L4

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10
Q

Quadriceps:

Vastus Intermedius

A

Origin:
1. upper 2/3rd of anterior and lateral femur

Insertion:
1. patella via quadriceps tendon

Action:
1. knee extension

Innervation:
1. femoral L2-L4

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11
Q

Quadriceps

Rectus Femoris

A

Origin:
1. anterior inferior iliac spine (AIIS)

Insertion:
1. patella via quadriceps tendon

Action:
1. knee extension
2. hip flexion

Innervation:
1. femoral L2-L4

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12
Q

Sartorius

A

Origin:
1. ASIS

Insertion:
1. medial proximal tibia (pes anserinus)

Action:
1. hip flexion
2. hip abduction
3. hip ER
4. knee flexion

Innervation:
1. femoral L2,L3

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13
Q

Gracilis

A

Origin:
1. pubis
2. ischium

Insertion:
1. pes anserinus

Action:
1. Hip adduction
2. knee flexion

Innervation:
1. obturator nerve L2, L3

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14
Q

Pectineus

A

Origin:
1. pubis

Insertion:
1. between greater trochanter of femur and linea aspera

Action:
1. hip adduction
2. hip flexion

Innervation:
1. femoral L2, L3

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15
Q

Adductor Longus

A

Origin:
1. pubis
Insertion:
1. linea aspera
2. middle 1/3 of femur (linea aspera)

Action:
1. hip adduction
2. Hip IR

Innervation:
1. obturator nerve L2-L4

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16
Q

Adductor Brevis

A

Origin:
1. pubis

Insertion:
1. upper 1/3 of linea aspera

Action:
1. hip adduction
2. Hip IR

Innervation:
1.obturator nerve L2,L3

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17
Q

Adductor Magnus

A

Origin:
1. adductor part: pubis
2. hamstring part: ischial tuberosity

Insertion:
1. adductor part: medial femur
2. hamstring part: adductor tubercle/medial epicondyle of femur

Action:
1. hip adduction
2. Hip IR

Innervation:
1. obturator L2-L4 (adductor part)
2. Tibial division of sciatic L4 and obturator L2-L3 (hamstring part)

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18
Q

Obturator Externus

A

Origin:
1. external obturator membrane

Insertion:
1. trochanteric fossa

Action:
1. Hip ER

Innervation:
1. Obturator L2, L3

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19
Q

Abdominal Wall

Boders and functions

A

Borders:

  1. xiphoid process
  2. costal margins
  3. vertebral column
  4. upper parts of pelvic bones

Functions:

  1. protects major viscera
  2. breathing
  3. changes in intra-abdominal pressure
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20
Q

Inguinal ligament

A
  • formed by lower border of exterrnal oblique aponeurosis
  • ASIS => pubic tubercle
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21
Q

Arcuate line

A
  • End of posterior wall of rectus sheath
  • below arcute line, rectus abdominis lies on abdominal fascia
  • this area is then weaker and more likely to have a herination
22
Q

Rectus sheath

A

Superior:

  • upper abdomen = completely encloses RA
  • Anterior wall: EO aponeurosis & 1⁄2 of IO aponeurosis
  • Posterior wall: 1⁄2 of IO aponeurosis & TA aponeurosis

Inferior:

  • Lower abdomen: sheath covers only anterior aspect of RA
  • All aponeuroses anterior to RA
  • Arcuate line
23
Q

Patellar Ligament

A
  • purpose: transmits forces produced by the quads to the tibia
  • Path: continuation of quad femoris tendon
  • attachment: between patella and tibial tuberosity
24
Q

Femoral Triangle

Borders

A
  • base: inguinal ligament
  • medial border: adductor longus
  • lateral border: sartorius
25
Q

Femoral triangle

Contents

A

lateral => medial

  • femoral Nerve
  • femoral Artery
  • femoral Vein
  • Lymphatics

NAVL

Deep lateral = iliopsoas tendon

26
Q

Femoral artery path

A
  1. Starts as the external iliac artery
  2. continues as the femoral artery which arises posteriorly in the femoral triangle and travels between adductor longus and brevis muscles and adductor longus and magnus muscles
  3. branches
27
Q

Branches of the femoral artery

A
  • perforating branches:
  • lateral circumflex artery
  • medial circumflex artery
28
Q

What do each of the branches of the femoral artery supply?

A
  • perforating branches: pierces the adductor magnus muscle to supply the posterior compartment of the thigh
  • lateral circumflex femoral artery: ascending, transverse and descending branches
  • Medical circumflex femoral artery: branches medially and passes around the shaft of the femur, supplies hip

medial circumflex and lateral circumflex are important for the hip joint blood supply

29
Q

quadricep strain

A
  • types of distal quadriceps strain happen occuring most often to rectus femoris
  • common from sprinting, jumpping or kicking under fatigue, weakness, or muscle imbalances
30
Q

Clinical presentation of quadriceps strain

A
  • Sudden pain in the anterior thigh DURING activity requiring explosive muscle contraction
  • there is local pain and tenderness,
  • pain with stretching or contraction
  • if the strain is severe there may be swelling or burising
  • local spasm is palpable at the site of pain
31
Q

Diagnostic testing for quadiceps strain

A

Palpation and observation:

  • looking for pain or brusing in a specific area
  • any bulges or prominent spots of tenderness in the muscle

Resisted Isometrics:

  • looking for pain and decreased strength
  • Strong and painless = normal
  • strong and painless = minor lesion of the muscle or tendon
  • weak and painless = malfunction of the nerve
  • weak and painful = more serious lesion of the muscle or tendon
32
Q

How to differentiate between the quads for possible strain

A
  1. Rectus femoris: pain felt above kneecap, tigger point for this pain is in the front of the hip causin pain to radiate down the thigh, aggrevated when walking down hills
  2. Vastus medialis: pain felt on inner side of the thigh this muscle is often responsible for the buckling knee
  3. Vastus intermedius: pain starts mid to upper thigh in front of hip area espeically when up hills or stairs, causes difficulty with extension after sitting for too long
  4. Vastus lateralis: pain starts on the outsdie of knee and can radiate as high as the hip or down to the calf
33
Q

Treatment for a quad strain

A
  • treated similary to contusion
  • progression may be slower for more severe injuries
  • ongoing preventative program which focuses on general flexibility of thigh and leg muscles
  • focus on strength retraining in respect to the stage of healing
  • low resistenc, high reps concentrically with progression to higher resistenc and eccentric strength
34
Q

Iliopsoas bursitis

Clinical presentation

also what causes it

A

most commonly caused by excessive activity

  • pain is reported in inguinal area => radiate into femoral triangle at times
  • palpatble tenderness can be presented by placing the hip into flexion and ER
  • assoicated with RA, OA, osteonecrosis, infections, trauma, overuse, impingement syndrome and hip replacements
35
Q

Iliopsoas bursitis

Diagnostic tests

A
  • palpation of iliopsoas bursa
  • thomas test
36
Q

Iliopsoas bursitis

how to palpate iliopsoas bursa

A
  • pt is hooklying and ER
  • palpate the adductor tubercle and ASIS
  • palpate inguinal ligament into the femoral triangle
  • bursa would be located under the floor of triangle
37
Q

Iliopsoas bursitis

treatment

A
  • rest: avoid any aggravting activites
  • ice
  • NSAIDs
  • exercise: a program targeting the muscles at hip ranging from 4-6weeks
38
Q

what can refer pain to the anterior thigh

A
  • hip
  • SIJ
  • lumbar spine
39
Q

Common causes of anterior thigh pain

A
  • quad contusion
  • quad strain
  • myositis ossificans
40
Q

Less common/should not be missed causes of anterior thigh pain

A
  • stress fracture
  • lumbar spina
  • SIJ
  • hip joint
  • sartoriuos strain
  • avulsion of apophysis of rectus femoris
  • nerve entrapment: lateral cutaneous nerve, femoral cutaneous nerve
  • slipped capital femoral epipysis
  • perthes disease
  • tumor
  • acute compartment syndrome
41
Q

What can refer pain to the abdomen

A
  • Cardiac: MI, myocarditis, pericarditis
  • Pulmonary: Pleural effusion, pneumonia, PE
  • MSK: costochondritis, rib fracture, herniated thoracic disc, muscle spasm
  • Gentiourinary: testicular/ovarian torsion, PID, UTI, ectopic pregnancy, ovarian cyst, hemtaocolpus
  • System: Diabetic ketoacidosis, Hyperthryriodism, lupus, erythematous uremia, vasculitis, sickle cell disease, porphyria
  • CNS: abdominal migraine, depression, functional abdominal pain
  • Infections: strep, EBV mono, rocky mountain spotted fever, herpes zoster lyme disease
42
Q

Differential diagnosis in the abdominal wall

A
  • abdominal wall hernias
  • endometriosis
  • thoracic nerve radiculopathy
  • lower rib pain syndrome
43
Q
A
44
Q

differential diagnosis

thigh

A
  • femoral shaft fracture
  • obturator, femoral or inguinal hernia
  • osteoid osteoma
45
Q

Nerve entrapment

Lateral femoral cutaneous

A
  • L2-L3
  • nerve enters the thigh under inguinal ligament
  • causes: repetitive flexion/extension (cheer/running)
46
Q

Nerve Entrapment

Lateral femoral cutaneous: symptoms

A
  • pain in hip, thigh or groin of proximal anterior lateral leg
  • paresthesia
  • hypersensitivity to touch
47
Q

Nerve entrapment

Lateral femoral cutaneous: treatment

A
  • option can include
  • NSAIDs
  • local injections
  • weight loss
  • rarely surgical excision of nerve
48
Q

Nerve entrapment

Ilioinguinal nerve

A
  • ilioinguinal nerve arises from lumbar plexus
  • passes throug psoas muscles, transvers abdominis muscle adjacent to anterior superior iliac spine
  • entrapment caused by hypertrophy of the abdominal wall musculature or pregnancy
49
Q

Nerve entrapment

Ilioinguinal nerve: symptoms

A
  • hyperextension of hip produces pain in the groin area
  • radiating pain traveling from lower abdomen to genitals and upper inner thigh, burning, stabbing
50
Q

Nerve Entrapment

Ilioinguinal nerve: treatment

A
  • medication
  • radiofrequency ablation
  • surgery
51
Q

Nerve entrapment

Anterior cutaneous nerve entrapment

A
  • one of the most frequent causes of abdominal pain in adults and children
  • the ACN becomes pinched or entrapped within the abdominal wall muscle
  • S&S: abdominal pain in a small local area
52
Q

Medical imaging at this region: anterior thigh

A

MRI:

  • shows quadricep strain/tear
  • fatty atrophy in a tendon from a past injury
  • iliopsoas bursitis

US:

  • quadricep strain/tear
  • iliopsoas bursistis

Human Anatomy 2 (14 decks)

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