L15: Musculo-neuro-vascular systems of the anterior and posterior compartments of the thigh

Question 1

surface anatomy of the Anterior Thigh

Answer 1

ASIS: Anterior superior iliac spine
Tensor Fasciae Latae
Sartorius
Vastus Lateralis
Rectus Femoris
Vastus Medialis
Iliotibial Tract
Patella

Question 2

surface anatomy of Lateral thigh

Answer 2

Gluteus maximus and tensor fasciae latae insert into iliotibial tract
At the knee, the iliotibial tract narrows as it approaches its insertion (lateral tibial condyle(Gerdy ’s tubercle) and is quite superficial (9)
Tendon of biceps fermoris is just posterior to this

Question 3

surface anatomy of Posterior Thigh

Answer 3

Gluteal Fold
Iliotibial Tract
Tendons at the Knee:
*Semitendinosus (medially)
*Biceps Femoris Long Head (laterally)

Popliteal Fossa, you can take your pulse from here!

Question 4

fascia of the thigh

Answer 4

*Fascia (connective tissue) divides the lower limb into compartments, just like it did with the upper limb.
*Superficial thigh is covered by fascia lata
*Fascia lata is thickened on the lateral thigh and is called the iliotibial tract or band. Tensor fascia latae is a muscle that tightens this band

Question 5

Thigh compartments

Answer 5

Fascia lata and its septae divide the thigh into three compartments:
*Anterior compartment
*Posterior compartment
*Medial compartment

Each compartment has its own main innervation which supplies most of the muscles of that compartment

Question 6

Muscles of thigh; Anterior Compartment (8)

Answer 6

• pectineus
• Iliopsoas
  
  • psoas major
  • iliacus
• sartorius
• quadriceps femoris
  
  • rectus femoris
  • vastus lateralis
  • vastus medialis
  • vastus intermedius

Question 7

muscles of the thigh; Posterior compartment (3)

Answer 7

• semitendinosus
• semimembranosus
• biceps femoris

Question 8

pectineus, origin + insertion

Answer 8

origin: superior pubis ramus (pectineal line)

insertion: pectineal line of femur, inferior to lesser trochanter

Question 9

Pectineus, Innervation + action

Answer 9

innervation: femoral nerve (L2,L3), sometimes branch from obturator nerve contributes too

actions: adducts hip, flexes hip, externally rotates hip

Question 10

Iliopsoas, origin + insertion:

Answer 10

iliopsoas: Psoas major and iliacus

Origin:
- Psoas major: lateral part of T12-L5 vertebral bodies
- Iliacus: iliac fossa and crest, ala of sacrum, and sacro-iliac ligaments

insertion: Both muscles merge to insert into lesser trochanter of femur

Question 11

Iliopsoas, innervation + actions

Answer 11

innervation:
- psoas major: direct branches from L1-3 anterior rami
- iliacus: femoral nerve (L2,L3)

Actions: flexes thigh at hip. most powerful hip flexor, lateral rotation at hip, stabilisation of leg when standing, maintenance of posture

Question 12

Sartorius, origin + insertion

Answer 12

longest muscle in the body, crosses hip and knee joints

origin: ASIS- Anterior Superior Iliac Spine

Insertion: medial to tibial tuberosity

Question 13

Sartorius, innervation + actions

Answer 13

innervation: femoral nerve

actions: flexes, abducts, externally rotates thigh at hip joint, flexes leg at knee joint

Question 14

Rectus Femoris, origin + insertion

Answer 14

This muscle has 2 heads and sits superficial to vastus intermedius

origin:
- straight head: AIIS
- Reflected head: Ilium, superior to acetabulum

insertion: quadriceps tendon, and hence into tibial tuberosity via patellar ligament

Question 15

Vastus Lateralis; origin + insertion

Answer 15

origin: greater trochanter and lateral lip of linea aspera of femur

insertion: quadriceps tendon, and hence into tibial tuberosity via patellar ligament

Question 16

Vastus Lateralis; innervation + action

Answer 16

innervation: femoral nerve

action: extends leg at knee joint

Question 17

Vastus Medialis; origin + insertion

Answer 17

origin:
- intertrochanteric line of femur
- medial lip of linea aspera of femur

Insertion: quadriceps tendon, and hence into tibial tuberosity via patellar ligament

Question 18

Vastus Medialis; innervation + Action

Answer 18

innervation: femoral nerve

action: extends leg at knee joint

Question 19

Vastus Intermedius; origin + insertion

Answer 19

lies deep to rectus femoris. Only visible if rectus is resected.

origin: anterior and lateral shaft of femur

Insertion: quadriceps tendon, and hence into tibial tuberosity via patellar ligament

Question 20

Vastus Intermedius; innervation + action

Answer 20

innervation: femoral nerve

action: extends leg at knee joint

Question 21

Patellar Disclocation

Answer 21

caused by a direct blow to patella or sudden twist of leg

patella slips from its normal position in the patellofemoral groove

usually slips laterally

Question 22

Patellar Fracture

Answer 22

• usually caused by trauma directly to anterior knee or sudden contraction of quadriceps
• if bony fragments become displaces, requires surgery to reapproximate the fragments
• if bony fragments are nondisplaced, knee immobilised in cast for 6 weeks

Question 23

Semitendinosus; origin + insertion

Answer 23

in between semimembranosus and biceps femoris

origin: ischial tuberosity

insertion: medial to tibial tuberosity, part of pes anserinus

Question 24

Semitendinosus; innervation + actions

Answer 24

innervation: tibial division of sciatic nerve

actions: extends hip joint, flexes knee joint, medial rotation of leg at knee when knee is flexed, can extend trunk when rising from seated position

Question 25

Semimembranosus; origin + insertion

Answer 25

most medial of the three hamstrings origin: ischial tuberosity insertion: -posterior part of medial tibial condyle -oblique popliteal ligament

Question 26

Semimembranosus; innervation + action

Answer 26

innervation: sciatic nerve (tibial division) actions: extends thigh at hip joint, flexes leg at knee joint, internal rotation of leg at knee when knee is flexed

Question 27

Biceps femoris; origin + insertion

Answer 27

most lateral of the 3. this muscle has 2 heads: long and short head origin: - long head: ischial tuberosity - short head: lateral part of linea aspera in middle third of femur, lateral supracondylar line insertion: lateral part of fibular head

Question 28

Biceps Femoris; innervation + actions

Answer 28

innervation: -long head: sciatic nerve (tibial division) -short head: sciatic nerve (fibular division) actions: extends thigh at hip joint, flexes leg at knee joint, external rotation of leg at knee joint when knee is flexed

Question 29

Hamstring in situ ''MTLS''

Answer 29

Medial to lateral - Membranosus - Tendinosus - Long head - Short head

Question 30

Muscle injury grades: 1-3

Answer 30

1. minor tear or overstretch of muscle fibres. Pain but function intact 2. Partial tear across muscle. Pain and weakened function 3. Complete tear across muscle. Pain and complete loss of function

Question 31

Thigh: cutaneous innervation

Answer 31

Cutaneous (sensory) innervation of the thigh is provided mostly by cutaneous branches of the femoral nerve *Anterior and medial surface: anterior and medial cutaneous branches of the femoral nerve *Posterior surface: posterior femoral cutaneous nerve *Lateral surface: lateral femoral cutaneous nerve Other contributions include: *Genitofemoral nerve *Cutaneous branch of obturator nerve

Question 32

arterial supply to lower limb

Answer 32

heart | Descending Aorta | Common iliac artery | | internal iliac artery external iliac artery | | supplies gluteal region goes on to become & pelvic region femoral artery

Question 33

femoral artery where does it come from?

Answer 33

*Inguinal Ligament is a complex ligament strung between ASIS and the pubic tubercle. *As external iliac artery passes under the midpoint of inguinal ligament it changes name to femoral artery *Femoral Artery supplies very little of thigh directly. *It gives off a deep branch, profunda femoris, which supplies the thigh

Question 34

Profunda Femoris

Answer 34

*Arises from postero-lateral part of femoral artery in the femoral triangle (next lecture) *Medial and lateral circumflex femoral branches supply proximal femur (neck + head) *It runs deep in the thigh, alongside the femur supplying it and the deep muscles of the thigh *Perforating branches: These wrap around the femur and supply all 3 thigh compartments. Usually there are 3-4 in total. *Descending genicular branch: These supply the proximal knee

Question 35

Femoral Artery where does it go ?

Answer 35

*Distally, it passes posterior to femur through a gap in the adductor magnus muscle called the adductor hiatus. *It continues distally to enter the space at the back of the knee; the popliteal fossa. *At this point the femoral artery becomes known as the popliteal artery.

Question 36

venous drainage of the lower limb

Answer 36

right atrium of heart ^ inferior vena cava ^ common iliac vein ^ ^ internal iliac vein external iliac vein ^ ^ superior and inferior common femoral gluteal vein vein (main vein of thigh)

Question 37

Venous drainage of thigh superficial system

Answer 37

Superficial System *The superficial regions of the thigh are drained by the Great Saphenous Vein *Subsequently, the Great Saphenous Vein pierces through a gap in the fascia lata and drains directly into the Common Femoral Vei

Question 38

Venous Drainage of Thigh Deep system

Answer 38

Deep System *The deep regions of the thigh are drained by 3-4 deep perforating veins which subsequently drain into the profunda femoris vein *The profunda femoris vein subsequently joins with the femoral vein to form the common femoral vein