Sem 2 - G - Anterior & Medial thigh - Muscles, Adductor canal, Femoral/Obturator nerve&arteries, Cruciate anastamoses

Question 1

What are the three compartments of the thigh and what is the main overall function of each compartment?

Answer 1

Anterior compartment of the thigh - flex hip, extend knee Medial compartment of the thigh - adduct thigh Posterior compartment of the thigh - extend hip, flex knee

Question 2

* What is the indentation in the head of the femur known as? * What ligament inserts here? * What line connects the greater and lesser trochanter? * What is the depression in the medial aspect of the greater trochanter known as and what muscles attach here?

Answer 2

The indentation in the head of the femur is known a the fovea capitis - the ligament of the head of the femur (ligamentum teres) inserts here attaching femur to acetabulum * The greater and lesser trochanters are connected by the intertrochanteric line * Depression in the medial aspect of greater trochanter is the trochanteric fossa - obturator internus, obturator externus, superior gemellus and inferior gemellus muscles attach here

Question 3

Anterior aspect of femur is very smooth suggesting it is less of a site for muscle attachment What is the ridge of roughened surface on the posterior surface of the shaft of the femur known as? What does it split into distally on the femur?

Answer 3

Ridge of roughened surface on the posterior aspect of the femur is known as the linea aspera which splits into the medial and lateral supracondylar lines

Question 4

Anterior aspect of the femur has a smooth articular surface, what is this? What lies on either side of this smooth articular surface? What lies just above the medial epicondyle where the medial supracondylar line ends?

Answer 4

Anterior smooth articular surface is the patella surface which has a medial and lateral epicondyle Just above the medial condyle where the medial supracondylar line ends is the adddctor tubercle - attachment of adductor magnus fibres here

Question 5

Where does the pectineal line run from?

Answer 5

Pectineal line runs from the the lesser trochanter to the medial aspect of the linea aspera

Question 6

What are the anterior thigh muscles?

Answer 6

Flexors of the hip

• * Iliacus
• * Psoas major
• * Pectineus
• * Sartorius

Extensors of the knee - quariceps femoris

• * Vastus lateralis
• * Vastus intermedius
• * Vastus medialis
• * Rectus femoris

Question 7

State the attachment, nerve supply and function of the iliacus

Answer 7

Iliacus Attaches from the iliac fossa and joins with the psoas to insert as iliopsoas onto the lesser trochanter of the femur Nerve supply - femoral nerve (L2,3 roots) Function - flex the hip

Question 8

State the attachment, nerve supply and function of the psoas major

Answer 8

Psoas major

• Superficial fibres from vertebral bodies and IV discs of T12-L4 vertebrae and deep fibres from transverse processes of L1-L5 vertebrae
• Inserts with iliacus as iliopsoas onto the lesser trochanter of the femur
• Nerve supply - Anterior rami L1-L3 spinal nerves
  
  • * Flexes hip,
  • * Unilateral contraction laterally flexes trunk
  • * Bilateral contraction raises trunk from supine

Question 9

State the attachment of the pectineus What does this contribute to in the femoral triangle?

Answer 9

Pectineus attaches from the superior ramus of pubis to the pectineal line of the femur Pectineus forms the medial floor of the femoral triangle

Question 10

What is the nerve supply of the pectineus? What is the function of the pectineus?

Answer 10

Pectineus is supplied by the femoral nerve (L2,3 roots) and occasionally also recieves a branch from the obturator nerve

Pectineus adducts and flexes the hip, and assists with medial rotation of the hip

Question 11

State the attachments of the sartorius muscle? What is its nerve supply?

Answer 11

Sartorius attaches from anterior superior iliac spine (ASIS) to the superior part of the medial surface of the tibia Its nerve supply is the femoral nerve (L2,3)

Question 12

What is special about the sartorious muscle in relation to its function?

Answer 12

As the sartiorus originates from the ASIS, it crosses the anterior aspect of the hip joint therefore flexing it It then travels obliquely across the thigh so can abduct and laterally rotate the hip and travels posterior to the knee distally so can flex the knee Only muscle that can both flex the hip and flex the knee

Question 13

State the sartious attachments, nerve supply and function

Answer 13

Sartious ASIS to superior part of medial surface of tibia

Nerve supply - Femoral nerve (L2,3 roots)

Function -

• Flexes, abducts and laterally rotates the hip
• Flexes the knee and medially rotates the knee when flexed

Question 14

What are the 4 muscles making the quadriceps femoris and what is the common distal attachment?

Answer 14

4 muscles Rectus femoris Vastus intermedius, lateralis and medialis Attach to the patella distally by the quadriceps tendon and to the tibial tuberosity via the patellar tendon (ligament)

Question 15

What is the proximal attachment of each of the quadriceps muscles?

Answer 15

* Rectus femoris - mainly from anterior inferior iliac spine (AIIS) &some fibres to ilium above acetabulum * Vastus lateralis - mainly from lateral linea aspera and some fibres from greater trochanter of femur * Vastus medialis - intertrochanteric line and medial aspect of linea aspera * Vastus intermedius-anterior & lateral shaft of femur

Question 16

What is the function of the quadriceps femoris and what is their nerve supply?

Answer 16

Quadriceps femoris - extend the knee (rectus femoris also flexes the hip as it passes anterior to the joint)

Nerve supply - L2-4 femoral nerve

Question 17

What is important about the arrangement of the fibres of the vastus medialis?

Answer 17

The lower vastus medialis fibres come into the patella almost horizontally

This is important because during normal extension of the knee, the patella is also moved slightly laterally and therefore these horizontal medial fibres counteract this lateral pull to maintain patellar position prevententing patellar dislocation

Question 18

State again the attachments of the quadriceps femoris

Answer 18

Rectus femoris - AIIS and ilium above acetabulum Vastus lateralis - lateral linea aspera and greater trochanter Vastus medialis - intertrochanteric line and medial linea aspera Vastus intermedius - anterior and lateral shaft of femur

Question 19

The femoral nerve passes deep to the inguinal ligament medial to ASIS on tendon of iliopsoas What does it give off imediately after passing into the femoral triangle? What is the final branch of the femoral nerve?

Answer 19

The femoral nerve after passing under the inguinal ligament gives * Muscular branches to the anterior thigh * Articular branches to the hip and knee jooint * Cutaneous branches to the anteromedial thigh

The final branch is the saphenous nerve which innervates the anteromedial knee, leg and foot

Question 20

What are the muscles of the medial thigh?

Answer 20

Gracilis Adductor longus Adductor brevis Adductor magnus Obturator externus

Question 21

What is the most medial medial compartment muscle? What is the most posterior? Where do the adductor longus and brevis lie in relation to one another?

Answer 21

Most medial, medial compartment of the thigh muscle is the gracilis

Most posterior, medial compartment of the thigh muscle is the adductor magnus

• Adductor longus lies superficial to the adductor brevis

Question 22

What is the attachment of the gracilis?

Answer 22

Body and inferior ramus of pubic bone to the superior part of the medial surface of the tibia

Question 23

What other muscles attach at the superior part of the medial surface of the tibia?

Answer 23

The sartorious and semintendanosus muscles also insert at the superior part of the medial surface of the tibia

Question 24

State the attachments of the gracilis, its function and nerve supply

Answer 24

Gracilis

Body and inferior ramus of pubic bone to the superior part of the medial surface of the tibia

• Function - adducts the hip and flexes the knee (passes posterior to knee joint at distal insertion), medial rotation of knee also
• Nerve supply - obturator nerve (L2,3 roots)

Question 25

State the attachment, function and nerve supply of the adductor longus

Answer 25

Adductor longus Attachment - body of pubis to middle 1/3rd of linea aspera Function - adduction of thigh Nerve supply - Obturator nerve L2,3,4

Question 26

State the attachment, function and nerve supply of the adductor brevis What movement may it sometimes assist?

Answer 26

Adductor brevis * Attachment - body and inferior ramus of pubic bone to the pectineal line and proximal linea aspera * Function - adduction of the thigh but may also assists in flexion of hip * Nerve supply -Obturator nerve (L2,3,4)

Question 27

Magnus means great in latin hence why adductor magnus has its name What are the attachments of the addcutor magnus? (separate into adductor and hamstring parts)

Answer 27

The adductor part of the adductor magnus arises from the ischiopubic ramus and inserts into the linea aspera of the femur The hamstring part of the adductor magnus arises at the ischial tuberosity and inserts into the medial supracondylar line and adductor tubercle

Question 28

What is the function and nerve supply to the adductor magnus?

Answer 28

Obturator nerve supplies adductor magnus except hamstring part which is innervated by the tibial division of the sciatic nerve (L4 root) Function - Adduction of thigh Adductor part flexes the thigh and hamstring part extends the thigh

Question 29

State the attachments of the adductor magnus, its function and nerve supply

Answer 29

* Adductor part - ischipubic ramus to linea aspera * Hamstring part - ischial tuberosity to medial supracondylar line and adductor tubercle * Function - Adduction of thigh. Adductor part flexes thigh & hamstring part extends thigh * Innervation - Obturator nerve (L2,3,4). Hamstring part - tibial division of sciatic nerve (L4 root)

Question 30

What is the only muscle of the medial compartment of the thigh that does not adduct the thigh? What is its attachment, function and nerve supply?

Answer 30

Obturator externus Attaches from the outer surface of the obturator membrane and margins of obturator foramen to travel posterior to the neck of femur inserting into the trochanteric fossa Function - lateral rotation of the hip (not an adductor) Nerve supply - Obturator nerve (L3,4 roots)

Question 31

The obturator nerve is formed from the anterior division of L2-4 anterior rami and travels along the lateral pelvic wall to pass through the obturator canal What muscle does the obturator nerve divide into its anterior and posterior branches around?

Answer 31

The obturator nerve divides into anterior and posterior divisions which pass anterior and posterior relative to the adductor brevis

Question 32

Which divisions of the obturator nerve supply which muscles?

Answer 32

Anterior division descends between adductor longus and brevis and gives branches to the adductor longus, brevis and gracilis (and in rare cases can give a branch to the pectineus) Posterior division descends through the obturator externus to give branches to obturator externus and adductor magnus

Question 33

Which division of the obturator nerve gives the cutaneous branches to the upper medial thigh?

Answer 33

The anterior division of the obturator nerves gives cutaneous branches to provide peripheral cutaneous innervation to the upper medial thigh

Question 34

Underneath the sartorius is where the femoral vessels will continue to run as they leave the femoral triangle What is the canal at the apex of the femoral triangle known as and what muscle does it underly?

Answer 34

Adductor canal - extends from the apex of the femoral triangle and it underlies the distal half of the sartious muscle

Question 35

The adductor canal serves as a passageway for structures moving between the anterior thigh and posterior leg. Where does the adductor canal end and what are its borders?

Answer 35

The adductor canal runs from the apex of the femoral triangle to the adductor hiatus * Anterior border - sartorius * Lateral border - vastus medialis * Posterior border - adductor longus and magnus

Question 36

What is the adductor hiatus formed between?

Answer 36

The adductor hiatus is a gap between the adductor magnus muscle and the femur allowing for communication between the anterior thigh and popliteal fossa

Question 37

What are the contents of the adductor canal? Do all the structures pass through the adductor hiatus?

Answer 37

* Adductor canal contents * \* Femoral artery and vein * \* Nerve to vastus medialis * \* Saphenous nerve Only the femoral artery and vein pass through the adductor hiatius into the popliteal fossa to become the popliteal artery & vein

Question 38

What two muscles does the saphenous nerve pass between after leaving the adductor canal?

Answer 38

The saphenous nerve passes between the sartiorus and gracilis after leaving the adductor canal to supply the skin of the anteromedial knee, leg and foot

Question 39

Femoral artery formed as external iliac passes below the inguinal ligament Gives off the very large profunda femoris What muscles does the profunda femoris lie deep to and what branches does the profunda femoris artery give off?

Answer 39

Profunda femoris artery lies deep to the adductor longus and immediately gives of medial and lateral circumflex femoral arteries as well as giving off 3-4 perforating arteries which perforate the adductor magnus

Question 40

What do the branches of the profunda femori supply?

Answer 40

\* Lateral circumflex femoral artery wraps around the anterior and lateral side of the femur supplying some of the more lateral anterior thigh muscles \* Medial circumflex femoral artery wraps around the posterior side of the femur supplying the head & neck of femur \* The perforating branches pierce the adductor magnus to wrap around the femur contributing to the supply of muscles in the medial &posterior thigh

Question 41

Which arteries form the cruciate anastamsosis?

Answer 41

The cruicate anastamosis is formed by the * Inferior gluteal artery * Medial circumflex femoral artery * Lateral circumflex femoral artery * Ascending branch of 1st perforating artery

Question 42

Why is the cruciate anastamosis clinically relevant?

Answer 42

The cruciate anastamosis is clinically relevant because if there is a blockage in the femoral artery, there is an alternative blood pathway to supply blood to the popliteal artery and therefore supply blood to the leg

Question 43

How does blood travel from the cruicate anastamosis to the popliteal artery?

Answer 43

Blood travels via the internal iliac artery through the inferior gluteal artery and down the descending branch of the lateral circumflex femoral artery into the superior lateral genicular artery and thus into the popliteal artery

Question 44

What is the obturator artery a branch off?

Answer 44

The obturator artery is a branch of the anterior division of the internal iliac artery

Question 45

The obturator artery arises from the internal iliac artery in the pelvic region. It descends via the obturator canal to enter the medial thigh, bifurcating into two branches: What do the anterior and posterior branches of the obturator artery supply?

Answer 45

Anterior branch of the obturator artery supplies the medial compartment of the thigh Posterior branch of the obturator artery supplies muscles which attach to the ischial tuberosity