L38 Anterior and Medial Thigh

Question 1

Iliopsoas

Answer 1

PA: T12-L5 vertebrae
DA: lesser trochanter
Act: hip flexor (primary)
Inn: femoral n (iliacus)
anterior rami (psoas)

Question 2

Pectineus

Answer 2

PA: sup. pubic ramus
DA: pectineal lines
Act: hip flexor, adductor
Inn: femoral n

Question 3

Sartorius

Answer 3

PA: ASIS
DA: proximomedial tibia
Act: hip flexion, abduction, lateral rotation, knee flexion medial knee rotation
Inn: femoral n

Question 4

What are the four heads of quadriceps femoris?

Answer 4

Rectus femoris, vastus intermedius, vastus lateralis, vastus medialis

Question 5

What is the one muscle of knee extension?

Answer 5

Quadriceps femoris

Question 6

Rectus femoris

Answer 6

PA: AIIS
DA: tibial tuberosity
Act: knee extension, hip flexion
Inn: femoral n.

Question 7

Vastus intermedius

Answer 7

PA: anterolateral femur
DA: tibial tuberosity
Act: knee extension
Inn: femoral n

Question 8

Vastus lateralis

Answer 8

PA: linea aspera
DA: tibial tuberosity
Act: knee extension
Inn: femoral n

Question 9

Vastus medialis

Answer 9

PA: linea aspera
DA: tibial tuberosity
Act: knee extension
Inn: femoral n

Question 10

What is the common insertion of quadriceps femoris?

How does it continue to the leg?

Answer 10

All four heads of quadriceps femoris come together to form the quadriceps tendon–>patella (sesamoid bone)–>patellar ligament–>tibial tuberosity

This is why they all insert on the tibial tuberosity

Question 11

When do limb buds appear and when do they rotate in the LE?

Answer 11

Limb buds appear week 4

LE rotates 90 degrees medially in the 7th week, posture persists through infancy

Question 12

When does the LE change to outward alignment and what is it called?

Answer 12

Changes from varus to valgus (outward) alignmnent when person starts to walk at 1.5 years

Maximum valgus at 3 years old

Question 13

What are the 3 joints in the LE?

Answer 13

Coxofemoral (os coxae, femur)

Tibiofemoral (femur, tibia, patella)

Talocrural (tibia, fibula, talus)

Question 14

What is the Iliotibial tract and what muscles insert into it?

Answer 14

Lateral thickening of fascia lata

Acts as aponeurosis for glueteus maximus and tensor fascia lata muscles

IT band inserts into the anterolateral tubercle of the tibia

Question 15

What are the anterior leg dermatomes?

Answer 15

Anterior LE: L1-S1

L3 medial knee

L4 medial foot

Question 16

What are posterior LE dermatomes?

Answer 16

Primarily S1 and S2, S1 laterally

L5 bottom of foot

Question 17

What is the saphenous opening?

What are the two main veins of the LE and where do they drain?

Answer 17

Opening in fascia lata where the great saphenous v. drains to the femoral v.

Great saphenous vein drains most of the leg to the femoral v.

Small saphenous v. drains posteriolateral leg and lateral foot, drains into popliteal vein in popliteal fossa

Lateral side of dorsal venous arch drains into the small saphenous v.

Question 18

What are the two main lymph nodes of the LE and where do they drain?

Answer 18

Superficial inguinal nodes: with great saphenous v. does antero-medial leg and medial foot (most superficial leg)

Popliteal nodes: with small saphenous v. does posterolateral leg and lateral foot superficial, but does most deep leg and foot

Popliteal drains to deep inguinal nodes–>external iliac nodes–>common iliac nodes

Superficial inguinal nodes–>deep inguinal and external iliac nodes–>common iliac nodes

Internal iliac nodes also drain to common iliac nodes and do the deep gluteal region

Question 19

How are the fascial compartments arranged in the leg?

Where do they septa arise from?

Answer 19

Anterior, medial, posterior compartents

Septa arise from the linea aspera on the back of the femur

Question 20

What are the main arteries and nerves of the anterior thigh?

What are the main actions of the anterior thigh?

Answer 20

Deep femoral and femoral aa.

Femoral nerve (L2-L4)

Hip flexion, knee extension

Question 21

Where do most hip flexors attach?

Where do most knee extenders attach?

Answer 21

Lesser trochanter: hip flexion

Tibial tubersity: knee extension

Question 22

When could you have pain with iliopsoas movement?

Answer 22

During flexion of the hip

If retroperitoneal, posterior abdominal wall associated structures are diseased (kidney, ureter, colon, pancreas, appendix)

Question 23

What is a psoas abscess?

How can you test for this?

Answer 23

Lumbar region infection may spread to psoas sheath and into thigh from the abdomen

Iliopsoas test: extend affected side to see if pain

Question 24

Where do you test for the L4 reflex?

Answer 24

Patellar ligament

Question 25

What is the main course of the femoral nerve? What does it innervate?

Answer 25

from L2-L4 anterior rami Motor: anterior thigh Sensory: medial leg via saphenous branch Saphenous brach is the only named branch of the femoral nerve Course: lateral to psoas major, deep to inguinal ligament, within femoral canal (sheath)

Question 26

What is the course of the femoral artery and where does it come from? What are its branches? What does it innervate?

Answer 26

The external iliac a. becomes the femoral a. once it passes under the inguinal ligament Once it passes through the adductor hiatus (opening in adductor magnus m) it has a name change to the popliteal a. Near the head and neck of the femur, the deep femoral a. branches off the femoral a. This deep artery of the thigh is the main supplier of the thigh Off it, there are two branches that create an anastomoses and supply the hip: medial and lateral femoral circumflex aa. There are also perforating aa. off the deep artery of the thigh that supply all thigh compartments

Question 27

What is the course of the lateral and medial femoral circumflex aa?

Answer 27

Both branches of the deep artery of the thigh Off the **lateral femoral circumflex**: ascending branch, transverse branch, descending branch **Medial femoral circumflex** a: wraps posterior to the femur, travels between iliopsoas and pectineus, principle supply to the femoral head If cut off: femoral head avascular necrosis and Legg-Clave-Perthes disease

Question 28

What are the main arteries and nerves of the medial thigh? What is the primary action of the medial thigh?

Answer 28

Deep femoral and obturator aa. Obturator nerve (L2-L4) except adductor magnus hamstring portion (sciatic tibial division) Obturator a. and n. come together through the obturator canal Hip adduction

Question 29

Adductor longus

Answer 29

PA: body of pubis DA: linea aspera Act: hip adduction Inn: obturator n

Question 30

Gracilis

Answer 30

PA: inferior pubic ramus DA: proximomedial tibia Act: hip adduction, flexion Inn: obturator n

Question 31

Adductor brevis

Answer 31

PA: inf pubic ramus DA: linea aspera Act: hip adduction Inn: obturator n

Question 32

Adductor magnus, adductor portion

Answer 32

PA: inf pubic ramus DA: linea aspera Act: hip adduction, flexion Inn: obturator n

Question 33

Adductor magnus, hamstring portion

Answer 33

PA: ischial tuberosity DA: adductor tubercle Act: hip adduction, extension Inn: tibial div. of sciatic n (L4)

Question 34

What is a muscle that can be easily removed for transplants? What muscles are affected by a groin pull?

Answer 34

Gracilis removal yields no significant deficits Groin pull is strain or tearing of anteromedial thigh mm. near proximal attachment of inferiror pubic ramus and body of pubis (adductor mm). Associated with sprinting

Question 35

What is the course of the main nerve of the medial thigh?

Answer 35

Obturator nerve (L2-L4) comes through the obturator canal Anerior and posterior branches are separated by aductor brevis

Question 36

What is the main course of the obturator artery?

Answer 36

supplies medial thigh supplies femoral head via "artery to the head of the femur" anterior and posterior branches travels with obturator n.

Question 37

What is Legg-Calve-Perthes disease? (LCPD)

Answer 37

Avascular necrosis of the femoral head, ususally in young boys femoral head degenerates may require surgical intervention

Question 38

What is the femoral triangle? What are its borders?

Answer 38

Region where neurovasculature enters the anterior thigh Superior border: inguinal ligament Lateral border: sartorius Medial border: Adductor longus

Question 39

What are the contents of the femoral triangle? What is the femoral sheath, and what are its contents?

Answer 39

Femoral triangle contents: NAVEL Femoral n. Femoral a. Femoral v. empty space lymphatics Femoral sheath allows gliding of structures during hip movement, AVEL is part of femoral sheathj Can feel femoral pulse, place for femoral compression

Question 40

What are the compartments of the femoral sheath? What are the contents of these compartments? What is the opening to the femoral canal called?

Answer 40

Lateral compartment: femoral a. Intermediate compartment: femoral v. Medial compartment or **Femoral canal:** lymphatics, fat, loose CT, allows for expansion during venous return Opening to femoral canal or medial compartment = femoral ring

Question 41

What are the landmarks for femoral catheter placement? When do you use femoral vein versus artery?

Answer 41

ASIS and pubic tubercle Vein for right cadiac angiography: veing goes to right atrium Artery for left cardiac angiography: artery comes from left ventricle

Question 42

Describe femoral hernias.

Answer 42

3% of all hernias Herniation of ileum on right side most likely typically enters femoral canal through femoral ring mass is palpable at the saphenous opening, inferior to the inguinal ligament, inferlateral to pubic tubercle More common in females: broader pelvis, broader femoral ring Don't confuse with saphenous varix: dilation of saphenous v. in femoral triangle More lateral and inferior than an inguinal hernia through the superficial ring

Question 43

What is the Adductor (Hunter) Canal? What are its borders?

Answer 43

From femoral triangle to adductor hiatus Conducts neurovasculature to popliteal fossa Contains femoral a/v and saphenous n. Borders: vastus medialis, sartorius, adductor longus

Question 44

What enters and exits adductor canal? What does not exit?

Answer 44

Femoral a/v exit the canal through the adductor hiatus to become popliteal a.v Saphenous n. and artery do not exit the canal through the adductor hiatus, but pierce the adductor magnus muscle and supply cutaneous medial leg/foot