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Quadratus femoris originates from

Ischial tuberosity

1

Quadratus femoris insertion

Inter trochanteric line

2

Contusion

Bruise. Bleeding from ruptured capillary and infiltration of blood into the muscles, tendons and soft tissue.

3

Saphenous opening, locations and margins

In the fascia lata, infero lateral to the pubic tubercle
Margins - medial is smooth but the rest form the falciform margin (sharp edge)

4

Cribriform fascia

Layer of subcutaneous tissue spread over saphenous opening.

5

Crural fascia

Deep fascia of the leg

6

Contents of saphenous opening

Great saphenous vein, efferent lymphatics

7

The great saphenous vein

Anterior to medial malleolus.
Posterior to the medial condyle of the femur
Anastamose with small saphenous vein
Goes into saphenous opening
Empties into femoral vein

8

Anterior thigh muscles

Pectineus
Iliopsaos
Sartorius
Quadriceps femoris

9

Medial thigh muscles

Obturator nerve

Adductor x 3
Gracilus
Obturator externus - lateral rotator

10

Hip pointer

Contusion of the iliac crest (anterior)

11

Charley horse

Cramping of the muscle of the thigh, pain and stiffness

Can be due to ischemia, contusion following damage to blood vessels and hematoma

12

Patellar tendon reflex

Place hand on top of thigh muscle to feel if it works

13

Runners knee ( chondromalacia patellae)

Soness and aching around or deep to patella

Quadriceps imbalance
Trauma to the patella
Extreme flexion of the knee

14

Gracilus transplantation

Muscle in the forearm
Replacement for non functional sphincter

15

Groin pulls

In quick start activities and stretching; affects flexor and adductor muscles

16

Femoral triangle

Inguinal ligament
Sartorius - medial border of
Adductor longus - lateral border of

17

Retroinguinal space

Under inguinal ligament, divided into two compqrtments by illiopsoas fascia.
Lateral - muscular and femoral nerve, medial - vascular ; veins arteries and lymphatics

18

Contents of the femoral triangle

Lateral to medial.
Nerve, artery, vein, femoral canal, deep inguinal lymph nodes

19

Adducter canal

Apex of femoral triangle to adductor hiatus,
Anteriorly - Sartorius,
Posterodeially - adductor longus and magnus,
Laterally - Vastus medialis.

20

Femoral sheath

Passes deep to inguinal ligament, encloses proximal parts of the femoral vessels and creates the femoral canal medial to it. DOES NOT ENCLOSE THE FEMORAL NERVE.

Terminates by becoming part of the tunica adventita.

Lateral compartment - artery, medial compartment - femoral sheath, intermediate compartment - nerve.

21

Femoral canal

Medial edge of femoral sheath and the femoral vein.
Goes down until the sapehnous opening.
Allows the femoral vein to expand when venous return increases and may contain deep inguinal lymph nodes

22

Femoral ring

Opening of the femoral sheath proximally

23

Profunda femoral artery

Lateral and medial circumflex arteries

Perforating arteries - 1 - branches to adductor brevis and magnus, 2 - forms two branches which supply posterior femoral muscles and anastamose with the other two perforating branches of the profunda, gives off NUTRIENT ARTERY, 3 - posterior femoral, may also give rise to nutrient artery.

24

Greater sciatic foramen.

Divided by the piriformis Muscle.

Above, Superior gluteal VAN,
Below, sciatic, Inferior gluteal VAN, Pudendal VAN ( Internal AN), nerve to obturator internus and gemellus superior, nerve to guadratus femoris and gemellus inferior.

25

Lesser sciatic foramen.

Obturator internus muscle tendon.

26

Gap between inguinal ligament.

Femoral branch of genito femoral nerve, Lateral cutaneous nerve of the thigh, Femoral VAN, Muscles-iliopsoa, pectineus.

27

Femoral artery

Continuation of external iliac,
Below the inguinal ligament forms superficial epigastric (goes towards umbilicus) , superficial iliac circumflex (supplies groin integument, superficail fascia and lymph nodes), superficial external pudendal (to gentalia), deep external pudendal.

Sartorius, vastus medialis, adductores

Profunda femoris - at first it lies lateral to the femoral artery. Then it spirals backwards around it to the medial side of the femur where it goes down and perforates the adductor magnus at the fourth space.

28

Obturator artery

From internall iliac. In 20% not there, replaced by inferior epigastric artery.

Goes through obturator foramen

Anterior branch - obturator externus, pectineus, adductors of the thigh, gracilus.
Posterior branch - muscles attached to ischial tuberosity.

29

Obturator canal.

Obturator nerves and vessels.

30

Femoral nerve

L2 - L4.
Originates in psoas major,
Goes posterolaterally to the midpoint of the inguinal ligament,
Enters femoral triangle,
Branches to anterioir thigh muscles.

Cutaneous branch to the anteromedial thigh and a branch known as the saphenous nerve goes lateral to femoral sheath, goes through adductor canal, passes superficially between sartorius and gracilus, supplies the anteromedial aspects of the knee, leg and foot.

31

Obturator nerve.

Same origin as femoral nerve,
Descends along the posterior abdominal wall, passes the pelvic cavity and goes through the obturator canal.
Medial compartment, obturator externus through which it goes through
Except part of adductor magnus from ischium (sciatic) and pectineus (femoral).
Medial side of upper thigh.

32

Sciatic nerve.

L4 to S3, goes below piriformis,
Become common fibular nerve and tibial nerve.
Adductor magnus originating from ischium, all muscles in the leg and foot.
Skin on the lateral side of the leg.

33

Adductor magnus - adductor part?

Ischiopubic ramus.

34

Adductor magnus - hamstring part?

Ischial tuberosity.

35

Superior Gluteal.

L4 to S1, Innervates gluteus medius, minimus and tensor fascia lata.

36

Inferior gluteal nerve.

L5 to S2, Gluteus maximus.

37

Lateral cutaneous nerve of the thigh.

L2 and L3. Can go through the inguinal ligament or under it.

38

Ilio inguinal.

L1, Skin on the medial side of the upper thigh and perineum.

39

What nerves have their exclusive supply from the plexus?

Quadratus femoris and obturator internus.

40

Stuff that goes underneath the inguinal ligament.

Remember the nerves, femoral, femoral branch of genito femoral and lateral cutaneous nerve of the thigh.

41

Piriformis.

Sacrum to greater trochanter.

42

Femoral hernia.

Lymphatic vessels pass through femoral canal.

43

Osteochondrosis.

Stress and irritation of epiphyseal plates resulting from physical activity and rapid growth.

44

Hip fracture.

Actually a fracture of the femoral head, neck and trochanters.

45

Angle of inclination of the femur.

Usually 125 in adult. As you grow older angle decreases.

46

Implications of coxa vara.

Shortening of the leg with limited passive abduction.

47

Three types of tibial fractures.

Transcervical, spiral and inter trochanteric.

48

Dislocated epiphysis of the femur.

Pain that radiates to the knee, epiphysis slips slows resulting in coxa vara of the limb.

49

Intracapsular fractures.

Degeneration of the femoral head.

50

Common cause of fracture of the greater trochanter and femoral shaft.

Motor injuries, sports.

51

Spiral fracture of the femur.

Fractures override and comminuted. Take like a year to heal.

52

fractures of the distal femur.

misalignment of the articular surfaces of the knee, haemorrhage of the popliteal artery.

53

Osgood- schlatter disease.

Disruption of the epiphyseal plate at the tibial tuberosity which results in inflammation of the tuberosity with chronic pain.

54

Scarpa fascia.

Inferior abdominal wall.

55

Iliotibial,tract insertion on the tibia.

Gerdy tubercle.

56

Lateral intermuscular septum.

Is relatively strong to the other tow fascia of the leg. Comes from Iliotibial tract to upper lip on linea aspera.

57

Small saphenous vein.

behind lateral malleolus, lateral border of calcaneal tendon, penetrates deep fascia, two heads of gastrocnemius, empties into the popliteal vein.

58

Adaptation of the perforating veins?

Run oblique to the fascia so that when the muscles contract they arecompressed.

59

Varicose.

Dialated.

60

Psoas abscess.

A retroperitoneal pyoenic infection in the abdomen or pelvis might be the cause. TB and Crohns disease.

Edema in the proximal part of the thigh, Just below the inguinal ligament. CAN BE CONFUSED WITH A MISPLACED FEMORAL HERNIA.

61

Paralysis of quadriceps.

Cannot extend the leg against resistance. Weakness of vastus lateralis or medialis can present as abnormal patellar movement and loss of stability.

62

Patellar fracture.

Sudden contraction of quadriceps or trauma.

Abnormal ossification of the patella can be mistaken for fractures.

63

Patellar tendon reflex.

Femoral nerve, L2 to L 4.

64

Injury to adductor longus.

Ossification of the tendons of this muscle in horseback riders as they continually adduct the legs to prevent falling from the horse.

65

Palpation of the Femoral artery.

Midway between asis and pubic tubercle.

66

Compression of the femoral artery.

Pressing directly posterior against superior pubic ramus.

67

Cannulatin of the femoral artery.

Inferior to the midpoint of the inguinal ligament.

68

Laceration of the femoral artery.

Arteriovenous shunt between femoral artery and vein can form.

69

Cruciate anastamoses of the hip.

Four way meeting of the Medial and later circumflex femoral arteries with the inferior gluteal artery and the first perforating branch.

70

Is the Femoral vein superficial?

Yes but IT IS NOT A SUPERFICIAL VEIN!!! Acute thrombosis of this vein can be life threatening.

71

Saphenous Varix.

Differential diagnosis to a Psoas abscess. A localised dilation of the terminal part of the great saphenous vein. Should only be considered if varicose veins present.

72

Cannulation of the femoral vein.

Right cardiac angiography,p and administration of fluids.

73

Medial to Femoral hernia.

Lacunar ligament.

74

Femoral hernias are generally more common in?

Females.

75

Strangulation of the femoral hernia.

Sharp boundries of the femoral ring and concave margin of lacunar ligament.

76

Replaced or accessory obturator artery.

Enlarged pubic branch of inferior epigastric artery which takes th place of the obturator artery or joins it as an accesory obturator artery.

Could be involved in a strangulated femoral hernia.

77

Trochanteric bursitis.

Friction causing inflammation of the Trochanteric bursa resulting from repetitive actions like climbing stairs. Diffuse pain in lateral thigh.

78

Ischial Bursitis.

Results from excessive friction between ischial bursa and tuberosity. Calcification of the bursa if chronic.

79

Injury to superior gluteal nerve.

Hip drop, Gluteal gait, steppage gait or swing out gait.

80

Gluteal gait.

Waddling gait.

81

Steppage gait.

Lift foot higher than necessary.

82

Anaesthesia of sciatic nerve.

Midpoint of PSIS and superior border of greater trochanter.

83

A pain in the gluteal region can result from?

Compression of the sciatic nerve by the piriformis.

84

Intragluteal injections are good because.

The muscles are thick and large or great area for absorpion.

Put little finger on PSIS and Thumb on greater trochanter. Safe zone between middle and index fingers.

85

Profunda femoris artery and veins are between which muscles.

Vastus medialis and Adductor brevis.

86

Femoral artery and vein are between which muscles?

Adductor longus and vastus medialis.

87

FDP IS LIKE FDS.

Because the sheath splits into two.

88

Transverse septum.

In front of soleus. Thicker towards the calcaneum. Continuous with the flexor retinaculum.

89

Pott's fracture.

Fracture of the distal tibia and fibula. Eversion of the foot.

90

Third malleolus.

Posterior tibia.

91

How is the calcaneus commonly fractured?

Falling from a height on to the foot.

92

Bursa which can become irritated in long distance runners??

Behind achilles and behind and under calcaneus.

93

Boundaries of the tarsal tunnel.

Medial malleolus and calcaneus.

94

Hallux valgus.

Lateral deviation of big toe.

95

Condition related to the insertion of peroneus brevis.

Avulsion of the tubercle of the fifth metatarsal.

96

FHL and FDL in the foot.

FHL goes under FDL and gives a slip to FDL to straighten FDLZ pull on toes and increase its power.

97

Which is stronger? FDL or FHL?

FHL.

98

Superior peroneal retinaculum.

Distal fibula, lateral malleolus and calcaneum.

99

Three components of the lateral ligament of the ankle.

Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament..

100

Injury to the tibial nerve.

Foot drop and loss of sensation on the sole of the foot.

101

How to distuingish a popliteal aneurysm?

Feel for a thrill (palpable pulsation) or hear abnormal arterial sound (bruit).

102

How can blood reach the rest of the leg if the femoral artery is litigated?

Blood bypasses through the genicular anastamoses.

103

Shin splints.

Strain of the tibialis anterior. Pain and oedema, lower two thirds of tibia.

Caused due to Microtrauma, excessive use, untrained persons. Sudden overuse, muscles tender.

104

Deep fibular nerve entrapment.

Excessive use of muscles in anterior compartment. Ski boot syndrome.

Tight shoes.

Pain in the dorsum of the foot going to the web of skin between first and second toes.

105

Superficial fibular nerve entrapment.

Ankle sprains. Pain, Paresthesia on the lateral side of the leg.

106

Fabella.

A bean shaped bone in the gastrocnemius.

107

Acessory soleus.

Pain and swelling with prolonged exercise.

108

Posterior tibial pulse.

Behind medial malleolus.

109

Crucial anastamosis.

Inferior gluteal, Medail and lateral femoral arteries.

110

Intertrochanteric fracture, will it cause avascular necrosis of the femoral head?

No.

111

Is the tibia or fibula more likely to be a part of a compound fracture?

The tibia, because its anterior surface is subcutaneous.

112

Whats the most common site for a fibular fracture?

Just proximal to the lateral malleolus. Common in fracture-dislocation of the ankle in an inversion injury.

113

At what age does the tibial tuberosity form?

10 years.

114

Osgood-Schlatter disease.

Disruption of the epiphyseal plate at the tibial tuberosity. Can cause chronic recurring pain during adolescence,

115

What is the Nelatons line and what is it used for?

Its a theoretical line drawn from the ASIS to the Ischial tuberosity. The greater trochanter should lie within this line. Imagine this line look at the hip in a lateral position.

116

What is Bryant's triangle.

A line drawn from the ASIS to the greater trochanter and an right angle triangle drawn on this line (a vertical from the greater trochanter and a horizontal from the ASIS. Used to determine upward displacement of the trochanter in fractures.