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ACEM Primary > Musculoskeletal: Anatomy - Anterior and medial regions of thigh > Flashcards

Musculoskeletal: Anatomy - Anterior and medial regions of thigh Flashcards

1
Q

List the four muscles of the anterior thigh. Which of these are hip flexors and which are knee extensors?

A

Hip flexors:
1. Pectineus
2. Iliopsoas: iliacus, psoas major, psoas minor
3. Sartorius

Knee extensors:
4. Quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

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2
Q

Proximal and distal attachment, innervation, and main actions of pectineus

A

Proximal: superior ramus of pubis
Distal: pectineal line of femur (inferior to lesser trochanter)
Innervation: femoral n. (L2, L3)
Action: hip adduction and flexion (assists medial rotation)

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3
Q

Proximal and distal attachment, innervation, and main actions of psoas major

A

Proximal: sides of T12-L5 vertebrae and discs, transverse processes of lumbar vertebrae
Distal: lesser trochanter
Innervation: anterior rami of lumbar nerves (L1, L2, L3)
Action: hip flexion and stabilisation, maintenance of posture

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4
Q

Proximal and distal attachment, innervation, and main actions of psoas minor

A

Proximal: sides of T12-L1 vertebrae and discs
Distal: pectineal line and iliopubic eminence via iliopectineal arch
Innervation: anterior rami of lumbar nerves (L1, L2)
Action: hip flexion and stabilisation

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5
Q

Proximal and distal attachment, innervation, and main actions of iliacus

A

Proximal: iliac crest, iliac fossa, ala of sacrum, anterior sacro-iliac ligaments
Distal: tendon of psoas major, lesser trochanter, and femur distal to it
Innervation: femoral n. (L2, L3)
Action: hip flexion and stabilisation

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6
Q

Proximal and distal attachment, innervation, and main actions of sartorius

A

Proximal: ASIS
Distal: superior part of medial surface of tibia
Innervation: femoral n. (L2, L3)
Action: hip flexion, abduction and lateral rotation; knee flexion (medially rotating leg when knee is flexed)

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7
Q

Proximal and distal attachment, innervation, and main actions of rectus femoris

A

Proximal: AIIS and ilium superior to acetabulum
Distal: via quadriceps tendon to base of patella, indirectly via patellar ligament to tibial tuberosity
Innervation: femoral n. (L2, L3, L4)
Action: knee extension, stabilises hip joint and assists iliopsoas to flex hip

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8
Q

Proximal and distal attachment, innervation, and main actions of vastus lateralis

A

Proximal: greater trochanter, lateral lip of linea aspera
Distal: via quadriceps tendon to base of patella, indirectly via patellar ligament to tibial tuberosity, also attaches via lateral patellar retinacula
Innervation: femoral n. (L2, L3, L4)
Action: knee extension

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9
Q

Proximal and distal attachment, innervation, and main actions of vastus medialis

A

Proximal: intertrochanteric line, medial lip of linea aspera
Distal: via quadriceps tendon to base of patella, indirectly via patellar ligament to tibial tuberosity, also attaches via medial patellar retinacula
Innervation: femoral n. (L2, L3, L4)
Action: knee extension

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10
Q

Proximal and distal attachment, innervation, and main actions of vastus intermedius

A

Proximal: anterolateral shaft of femur
Distal: via quadriceps tendon to base of patella, indirectly via patellar ligament to tibial tuberosity
Innervation: femoral n. (L2, L3, L4)
Action: knee extension

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11
Q

Why is the sartorius so-named?

A

Its four actions produce the cross-legged sitting position used by tailors

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12
Q

What is the chief flexor of the thigh?

A

Iliopsoas

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13
Q

Proximal and distal attachment, innervation, and main actions of adductor magnus

A

Proximal: adductor part from inferior pubic ramus and ischial rambus, hamstring part from ischial tuberosity
Distal: adductor part to gluteal tuberosity, linea aspera and medial supracondylar line; hamstring part to adductor tubercle
Innervation: adductor part by obturator n. (L2-4) and branches of posterior division, hamstring part by tibial part of sciatic n. (L4)
Action: hip adduction, in isolation adductor part flexes and hamstring part extends hip

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14
Q

Proximal and distal attachment, innervation, and main actions of adductor longus

A

Proximal: body of pubis inferior to pubic crest
Distal: middle third of linea aspera
Innervation: obturator n. (L2-4) and branch of anterior division
Action: hip adduction

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15
Q

Proximal and distal attachment, innervation, and main actions of adductor brevis

A

Proximal: body and inferior ramus of pubis
Distal: pectineal line and proximal linea aspera
Innervation: obturator n. (L2-4) and branch of anterior division
Action: hip adduction, some flexion

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16
Q

Proximal and distal attachment, innervation, and main actions of obturator externus

A

Proximal: margins of obturator foramen and obturator membrane
Distal: trochanteric fossa
Innervation: obturator n. (L3-4)
Action: lateral rotation of hip, steadies head of femur in acetabulum

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17
Q

Proximal and distal attachment, innervation, and main actions of gracilis

A

Proximal: body and inferior ramus of pubis
Distal: superior part of medial surface of tibia
Innervation: obturator n. (L2-3)
Action: hip adduction (assists with medial rotation), knee flexion

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18
Q

Three compartments of the thigh. Which nerves innervate each?

A
  1. Anterior (flexor; largest, includes femur): femoral n.
  2. Medial (adductor): obturator n.
  3. Posterior (extensor): tibial portion of sciatic n.
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19
Q

Where do the intermuscular septa attach in the thigh?

A

From fascia lata to linea aspera

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20
Q

Which muscle is a transitional muscle between anterior and medial compartments?

A

Pectineus: receives dual innervation from femoral and obturator n., both adducts and flexes thigh

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21
Q

What is the longest muscle in the body?

A

Sartorius

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22
Q

What is the great extensor of the leg?

A

Quadriceps femoris

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23
Q

What is the largest sesamoid bone in the body?

A

Patella

24
Q

What forms the medial and lateral retinaculae?

A

Medial formed by tendon of vastus medialis
Lateral formed by tendon of vastus lateralis

25
Q

Which muscle is called the “kicking muscle” and why? What is a common injury associated with this muscle?

A

Rectus femoris: efficient in knee extension and hip flexion from position of hip hyperextension
May be avulsed from AIIS during kicking, reducing thigh flexion strength by up to 17%

26
Q

What is the articularis genu? What are its attachments?

A

Articular muscle of the knee, derived from vastus intermedius
Attaches to anteroinferior femur and synovial membrane of knee and wall of suprapatellar bursa

27
Q

Describe the passage of the anterior and posterior divisions of the obturator n.

A

Obturator n. divides into anterior and posterior divisions as it emerges from obturator canal to enter medial compartment of thigh
Passes anterior and posterior to adductor brevis

28
Q

Which three muscles insert into the superomedial tibia via pes anserinus?

A

Sartorius from anterior (flexor) compartment
Gracilis from medial (adductor) compartment
Semitendinosus from posterior (extensor) compartment

29
Q

What is the function of pes anserinus? What structure performs the converse function?

A

Common insertion of sartorius, gracilis and semitendinosus which stabilises medial aspect of extended knee
Gluteus maximus and tensor fascia lata similarly stabilise the lateral side via iliotibial tract

30
Q

What is the adductor hiatus and what structures does it transmit? Where is it located?

A

Opening between distal attachments of adductor and hamstring parts of adductor magnus
Located just lateral and superior to adductor tubercle
Transmits femoral artery and vein from adductor canal to popliteal fossa

31
Q

Describe the boundaries and contents of the femoral triangle

A

Medial wall: lateral part of adductor longus
Lateral wall: sartorius
Base: inguinal ligament
Apex: sartorius overlies adductor longus
Floor: iliopsoas laterally and pectineus medially
Roof: fascia lata, cribiform fascia, subcut tissue, skin
Contents: NAVEL (femoral Nerve, femoral Artery, femoral Vein, Empty space (femoral canal), Lymphatics*)
* Contained in femoral sheath

32
Q

Where is the adductor canal and what traverses it?

A

Deep to sartorius, inferiorly from apex of femoral triangle
Major neurovascular bundle (femoral nerve, artery, vein, lymphatics) traverses middle third of the thigh

33
Q

What is the largest branch of the lumbar plexus?

A

Femoral n.

34
Q

Describe the passage of the femoral n.

A

Originates in abdo within psoas major
Descends posterolaterally through pelvis to midpoint of inguinal ligament
Passes deep to ligament and enters femoral triangle lateral to femoral vessels
Divides into several branches to anterior thigh muscles, also sends articular branches to hip and knee joints, and provides cutaneous branches to anteromedial thigh (anterior cutaneous branches and saphenous n.)

35
Q

What are the two cutaneous branches of the femoral n.?

A

Anterior cutaneous branches
Saphenous n. (terminal cutaneous branch)

36
Q

Describe the passage of the saphenous n.

A

Descends through femoral triangle, lateral to femoral sheath
Accompanies femoral artery and vein through adductor canal
Becomes superficial by passing between sartorius and gracilis (does not travel through adductor hiatus)
Runs anteroinferiorly to supply anteromedial knee, leg and foot

37
Q

How does the femoral sheath form and how does it terminate?

A

Forms from inferior prolongation of transversalis and iliopsoas fascia
Terminates by blending with the adventitia of the femoral vessels

38
Q

What is the femoral canal and what is its purpose? What is its distal boundary and what are its contents?

A

Medial subcompartment of the femoral sheath
Allows femoral vein (in adjacent intermediate compartment of femoral sheath) to expand as needed
Extends distally to proximal edge of saphenous opening
Contains loose connective tissue, fat, few lymphatic vessels +/- deep inguinal lymph node (lacunar node)

39
Q

What is the femoral ring?

A

Base of the femoral canal

40
Q

Outline the boundaries of the femoral ring

A

Lateral: vertical septum between femoral canal (medial compartment of femoral sheath) and femoral vein (intermediate compartment of femoral sheath)
Medial: lacunar ligament
Posterior: superior ramus of pubis, pectineus
Anterior: medial part of inguinal ligament
Closed by femoral septum

41
Q

Outline the boundaries of the adductor canal

A

Anterolateral: vastus medialis
Posterior: adductors longus and magnus
Medial and roof: sartorius

42
Q

What structures are carried in the adductor canal?

A

Femoral artery
Femoral vein
Saphenous nerve
Nerve to vastus medialis

43
Q

Between what structures are limb measurements made to determine if shortening is present?

A

Thigh: between ASIS and distal lateral femoral condyle
Whole limb: between ASIS and medial malleolus

44
Q

Describe the course of the femoral vein relative to the femoral artery within the thigh

A

Medial to artery at base of femoral triangle
Posterior to artery at apex of femoral triangle
Posterolateral to artery within adductor canal

45
Q

Five arteries of the anteromedial thigh

A

Femoral
Profunda femoris
Medial circumflex femoral
Lateral circumflex femoral
Obturator

46
Q

Describe the origin, course and distribution of the femoral artery

A

Origin: continuation of external iliac (distal to inguinal ligament)
Course: bisects femoral triangle, courses adductor canal, terminates as it traverses adductor hiatus to enter popliteal fossa (becomes popliteal artery)
Distribution: anterior and anteromedial thigh

47
Q

Describe the origin, course and distribution of profunda femoris

A

Origin: femoral artery 1-5cm inferior to inguinal ligament
Course: between pectineus and adductor longus, descends posterior to adductor longus on medial femur
Distribution: perforating arteries pierce adductor magnus to supply medial, posterior and lateral part of anterior compartments

48
Q

Describe the origin, course and distribution of the medial circumflex femoral artery

A

Origin: profunda femoris
Course: posteromedially between pectineus and iliopsoas, enters gluteal region (gives rise to posterior retinacular arteries), terminates into transverse and ascending branches
Distribution: most of blood to head and neck of femur, transverse branch joins cruciate anastomosis, ascending branch joint inferior gluteal

49
Q

Describe the origin, course and distribution of the lateral circumflex femoral artery

A

Origin: profunda femoris
Course: laterally deep to sartorius and rectus femoris; divides into ascending, transverse and descending arteries
Distribution: ascending branch supplies anterior gluteal region, transverse winds around femur, descending joins genicular peri-articular anastasmosis

50
Q

Describe the origin, course and distribution of the obturator artery

A

Origin: internal iliac typically (20% from inferior epigastric)
Course: through obturator foramen to medial compartment, divides into anterior and posterior branches over adductor brevis
Distribution: anterior branch supplies obturator externus, pectineus, adductors, and gracilis; posterior branches supply muscles attached to ischial tuberosity

51
Q

What is chondromalacia patellae?

A

“Runner’s knee”
Softening of the articular cartilage of the patella commonly due to quadriceps imbalance

52
Q

What finding on XR suggests ossification abnormality of the patella rather than fracture?

A

BILATERAL bipartite or tripartite patella

53
Q

When does the patella ossify?

A

Age 3-6

54
Q

What nerve and spinal cord segments are tested by the patellar tendon reflex?

A

Femoral n.
Spinal cord segments L2-4

55
Q

Which thigh muscle may be transplanted without noticeable loss of its actions on the leg?

A

Gracilis

56
Q

Three possible causes of proximal thigh swelling

A

Femoral hernia
Psoas abscess
Saphenous varix

57
Q

Are femoral hernias more common in males or females? Why

A

Females
Due to wider pelvis and smaller inguinal canals and rings
May also occur after multiple pregnancies due to enlargement of femoral ring over time

ACEM Primary (103 decks)

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