Hip, buttock and thigh (B)

Question 1

What small muscle is found underneath vastus intermedius?

Answer 1

Articularis genu

Question 2

What bursa is found just above the knee joint?

Answer 2

Suprapatellar bursa

Question 3

What movement are the muscles in the medial compartment of the thigh responsible for?

Answer 3

Adduction of the hip

Question 4

Which muscles make up the medial compartment of the thigh?

Answer 4

Obturator externus 
Gracilis 
Adductor brevis 
Adductor longus 
Adductor magnus

Question 5

Where do most of the muscles of the medial compartment attach proximally?

Answer 5

Pubic bone

Question 6

Describe the structure of adductor magnus.

Answer 6

It has a broad attachment to the shaft of the femur (medial lip of the linea aspera) and then a smaller attachment to the adductor tubercle (just superior to the medial epicondyle)
The gap in between is called the hiatus of adductor magnus

Question 7

What movements are the muscles of the posterior compartment of the thigh responsible for?

Answer 7

Hip extension

Knee flexion

Question 8

Which muscles make up the posterior compartment of the thigh?

Answer 8

Semitendinosus
Semimembranosus
Biceps femoris

Question 9

Where do the muscles of the posterior compartment attach proximally?

Answer 9

Ischial tuberosity

Question 10

Describe the attachments of biceps femoris.

Answer 10

The long head of biceps femoris comes from the ischial tuberosity and the short head comes off the shaft of the femur (lateral lip of linea aspera)
They cross over laterally to attach to the head of the fibula

Question 11

What are the borders of the femoral triangle?

Answer 11

Superior – Inguinal Ligament
Lateral – Sartorius
Medial – Adductor Longus

Question 12

What are the contents of the femoral triangle (medial to lateral)?

Answer 12

Deep inguinal lymph nodes
Femoral Vein
Femoral Artery
Femoral Nerve

Question 13

What is the name given to the opening in the fascia lata over the femoral triangle and what is its purpose?

Answer 13

Saphenous Opening – it allows the draining of the long saphenous vein into the femoral vein
The margin of the saphenous opening is called the Falciform Margin
slide 33

Question 14

What structures form the Adductor Canal?

Answer 14

Anterior – Vastus Medialis
Posterior – Adductor Longus and Adductor Magnus
Medial – Sartorius

Question 15

What are some other names for the Adductor Canal?

Answer 15

Hunter’s Canal

Subsartorial Canal

Question 16

What are the contents of the Adductor canal?

Answer 16

Femoral artery
Femoral vein
Saphenous nerve (major branch of the femoral nerve)

Question 17

Where does the sciatic nerve lie within the gluteal region?

Answer 17

Inferior medial quadrant (NOTE: there are variations in terms of the emergence of the sciatic nerve relative to piriformis)

Question 18

What two nerves does the sciatic nerve divide into?

Answer 18

Tibial Nerve

Common Peroneal Nerve

Question 19

Where would you perform an intramuscular injection into the gluteal region?

Answer 19

Superior lateral quadrant (to avoid the sciatic nerve which is in the inferior medial quadrant)

Question 20

What does the sciatic nerve supply?

Answer 20

Muscles of the posterior compartment of the thigh (hamstrings)
All the muscles below the knee (supplies by the two branches of the sciatic)

Question 21

What test is used to assess the function of the hip abductors?

Answer 21

Trendelenberg test
When a patient lifts one foot off the floor, their hip abductors (gluteus medius and gluteus minimus) should contract to keep the pelvis level despite the extra weight of the raised foot on the opposite side

Question 22

Describe the structure of the acetabulum.

Answer 22

The acetabulum has a depression in the middle (acetabular fossa) and a lunate surface (surrounding the fossa)
There is an acetabular notch, which is filled in by the transverse acetabular ligament

Question 23

What is the small depression on the head of the femur called?

Answer 23

Fovea capitis (fovea=pit, capitis= head) ie a depression on the head of the femur
This is the attachment of the ligamentum teres

Question 24

What are the ligaments of the hip joint?

Answer 24

Iliofemoral ligament (Y shaped)
Ischiofemoral ligament
Pubofemoral ligament
Transverse acetabular ligament

Question 25

Describe how the arrangement of these ligaments changes when the hip is flexed and extended.

Answer 25

When the hip is flexed, these ligaments are relaxed When the hip is extended (e.g. when standing) the ligaments wind, which pulls the head of the femur into the acetabulum and helps stabilise the joint when in the standing position

Question 26

Describe the blood supply to the head of the femur.

Answer 26

The main blood supply is via the medial circumflex femoral artery and the lateral circumflex femoral artery (both from profunda femoris) There is a small blood supply from the artery of the head of the femur (branch of obturator artery - this is more important in children)

Question 27

What type of hip fracture is most likely to need a hip replacement and why?

Answer 27

Intracapsular – this is more likely to disrupt the blood supply and cause avascular necrosis of the head of the femur

Question 28

When does the external iliac artery become the femoral artery?

Answer 28

As it passes under the inguinal ligament

Question 29

What main branch does the femoral artery give off that gives rise to the medial and lateral circumflex femoral arteries?

Answer 29

Profunda femoris

Question 30

At what point do the superficial femoral artery and the femoral vein become the popliteal artery and vein?

Answer 30

As they pass through the hiatus of adductor magnus

Question 31

Which arteries, that supply the buttock and thigh, are branches of the internal iliac?

Answer 31

Superior gluteal and Inferior gluteal arteries | Obturator artery

Question 32

What is the main superficial vein of the thigh?

Answer 32

Long saphenous vein

Question 33

What other veins drain into the saphenous vein before it enters the sapheno-femoral junction?

Answer 33

Superficial circumflex iliac Superficial epigastric Superficial external pudendal Lateral cutaneous nerve of the thigh

Question 34

What are the deep veins of the hip, buttock and thigh region?

Answer 34

``` Popliteal vein Femoral vein External iliac vein Sapheno-femoral junction Venae comitantes of the profunda femoris artery ```

Question 35

What are the main groups of lymph nodes in the thigh?

Answer 35

Deep inguinal lymph nodes Superficial inguinal lymph nodes External iliac lymph nodes

Question 36

Which nerve supplies the anterior compartment and which division of the lumbosacral plexus gives rise to this?

Answer 36

Femoral nerve – posterior division of the lumbosacral plexus (L234)

Question 37

Which nerve supplies the medial compartment and which division of the lumbosacral plexus gives rise to this?

Answer 37

Obturator nerve – anterior division of lumbosacral plexus (L234)

Question 38

``` State which roots are responsible for: Hip flexion Hip extension Knee extension Knee flexion ```

Answer 38

Hip flexion: L23 Hip extension: L45 Knee extension: L34 Knee flexion: L5S1

Question 39

Which nerve supplies the posterior compartment of the thigh and which nerve roots give rise to this nerve?

Answer 39

Sciatic nerve (L45S123)

Question 40

Which nerves supply the gluteal muscles and which nerve roots give rise to these nerves?

Answer 40

Superior gluteal nerve (L45S1) | Inferior gluteal nerve (L5S12)

Question 41

Which nerve roots are responsible for the sensory supply to the: Front of the thigh Back of the thigh Buttock

Answer 41

Front of the thigh: T12, L123 Back of the thigh: S123 Buttock: S234

Question 42

Which nerve roots give rise to the following sensory peripheral nerves:

Answer 42

Subcostal nerve: T12 Ilio-hypogastric nerve: L1 Ilio-inguinal nerve: L1 Genito-femoral nerve: L12 Lateral cutaneous nerve of the thigh: L23 Sensory branches of the femoral nerve: L234 Sensory branches of the obturator nerve: L234 Posterior cutaneous nerve of the thigh: S123 Saphenous nerve: L234 Buttock nerves from the sacral plexus: L1-S3