Sem 2 RA Week 3 Flashcards

Question

Answer 1

External iliac changes name to femoral once passes deep to inguinal ligament → continues towarda adductor hiatus profunda femoris - can see perforating branches + lateral and medial circumflex **important anastamosis (cruciate)** - posterior to proximal end of femur, involves med + lat circumflex femoral arteries, perfroarting branch from PF, inf. gluteal artery **presence of inf. gluteal (int. iliac) means alternative route for bloodflow into thigh if blockage in proximal part of femoral artery**

Answer 2

great saphenous vein empties into femoral vein (so does superficial epigastric)

Answer 3

3 bones = ilium, pubis, ischium ischial spine separates greater + lesser sciatic notch

Answer 4

greater sciatic notch will form part of greater sciatic foramen in conjunction with sacrotuberous + sacrospinous ligament

Answer 5

pronounced angle between shaft of femur + head&neck of femur = **angle of inclincation** angle means distal end of femur is located more medially from the proximal end - important for position of knee joint relative to the hip joint **angle of anteversion (torsion)** - best be seen by viewing femur from superior position. Long axis of head+neck of femur is not in line with axis that runs through distal condyles of femur → angle between 2 lines called angle of torsion has implications for muscle attachment + movements

Answer 6

indent = fovea connecting greater + lesser trochanter = intertrochanteric line

Answer 7

most superficial muscle in gluteal region sacrum, sacrotuberous ligament + ileum behind posterior gluteal line → iliotibial tract (¾) and gluteal tuberosity of femur (¼) function = extends hip, assists lateral rotation Innervation = inferior gluteal nerve (L5, S1, S2)

Answer 8

ASIS and anterior iliac crest → iliotibial tract function = tenses fascia latae and iliotibial tract + supports femur on tibia during standing innervation = superior gluteal nerve (L4, L5, S1)

Answer 9

inferior gluteal nerve pic B (once glut max reflected)

Answer 10

deep to gluteus maximus ilium between posterior + anterior gluteal lines → greater trochanter of femur (lateral surface) function = abducts and medially rotates hip innervation = superior gluteal nerve (L4, L5, S1)

Answer 11

just deep to gluteus medius ilium between anterior and inferior gluteal lines → greater trochanter of femur (anterior surface) function = abducts + medially rotates hip Innervation = superior gluteal nerve (L4, L5, S1)

Answer 12

anterior sacrum + sacrotuberous ligament → greater trochanter of femur (superior border) passes through greater sciatic foramen function = laterally rotates hip innervation = anterior rami S1, S2

Answer 13

pelvic surface of obturator membrane → medial side of greater trochanter (trochanteric fossa) passes through lesser sciatic foramen function = laterally rotates hip innervation = nerve to obturator internus (L5, S1)

Answer 14

superior = ischial spine inferior = ischial tuberosity → blend with tendon of obturator internus function = laterally rotate hip superior = nerve to obturator internus inferior = nerve to quadratus femoris

Answer 15

orange arrow = course of OI as it passes through lesser sciatic foramen, will lie in between superior + inferior gemelli muscles black arrow = tendon of OI

Answer 16

ischial tuberosity → quadrate tubercle on intertrochaneric crest of femur function = laterally rotates hip innervation = nerve to quadratus femoris (L5, S1)

Answer 17

outer surface of obturator membrane → passes posterior to neck of femur → trochanteric fossa on medial side of greater trochanter function = laterally rotates hip innervation = obturator nerve (L3, L4)

Answer 18

gluteus medius + minimus attaching on anterior + lateral parts of greater trochanter = produce medial rotation + abduction

Answer 19

L4 - S3 **tibial** leaves below piriformis **common peroneal** may leave below, above or through piriformis

Answer 20

pic superior emerge superior to piriformis and vice versa superior nerves + vessels divide into superficial + deep branches Deep branch courses anteriorly in plane between gluteus medius + minimus deep branch of nerve terminates by suplying tensor fascia latae

Answer 21

lies on posterior aspect of sciatic nerve S1, S2, S3 supplies skin of posterior thigh but also gives inferior clunial nerves to skin of inferior half of buttock

Answer 22

middle clunical = posterior aspect of sacrum superior = superior half of buttock posterior = inferior half of buttock + posterior thigh

Answer 23

ligament attaching to fovea = attaches to floor of acetabulum

Answer 24

hip bone = capsule follows margins of articular surface on femur - capsule does not attach around articular margin, instead attaches along margin of neck of femur

Answer 25

iliofemoral ligament (upper + lower bands) A**_II_**S → intertrochanteric line function = limits extension, lat rotation, adduction (upper), abduction (lower)

Answer 26

extnded = taut flexed = relaxed

Answer 27

pubofemoral iliopubic eminence → lower part of intertrochanteric line function = limits extension, lat rotation + abduction

Answer 28

ischiofemoral (lies posteriorly) posterior aspect of acetabulum → greater trochanter function = limits extension, medial rotation, adduction

Answer 29

all of them limit extension trunk limits flexion of hip

Answer 30

artery of head of femur (travels in ligament of head of femur) - it is a branch of obturator artery medial + lateral circumflex arteries - branches of profunda femoris in anterior thigh

Answer 31

hamstrings ## Footnote semitendinosus, semimembranosus + biceps femoris function = extend hip, flex knee

Answer 32

semitendinosus (located in medial aspect of posterior compartment) ischial tuberosity → medial surface of superior tibia innervation = tibial division of sciatic (L5, S1, S2) note long tendon hence name

Answer 33

semimembranosus ischial tuberosity → posterior surface of medial condyle of tibia innervation = tibial division of sciatic (L5, S1, S2)

Answer 34

biceps femoris **long head** = ischial tiberosity **short head** = linea aspera + lateral supracondylar line of femur → head of fibula long head = tibial division of sciatic (L5, S1, S2) short head = common peroneal division of sciatic (L5, S1, S2)

Answer 35

red + yellow arrows = semitendinosus

Answer 36

extension of hip + flexion of knee

Answer 37

L4-S3 deep to long head of biceps femoris divisions = tibial + common peroneal divisions

Answer 38

roof = deep fascia pierced by: * sural nerve (supplies cutaneous innervation to leg + foot) * short saphenous vein

Answer 39

superior = diverging tendons of hamstrings * biceps femoris laterally * semimembranosus + semitendinosus medially inferior = medial and lateral heads of gastrocnemius

Answer 40

popliteal artery popliteal vein terminal branches of sciatic = tibial nerve + common peroneal nerve

Answer 41

popliteal surface of femur capsule of knee joint popliteus muscle

Answer 42

pic middle genicular artery is branch of popliteal artery, pierces through knee joint capsule to supply cruciate ligaments (accompanied by middle genicular vein)

Answer 43

continuation of femoral artery Adductor hiatus (name change femoral to popliteal) → inferior border of popliteus 5 genicular branches: middle (cruciate ligaments), medial + lateral superior, medial + lateral inferior terminal branches = anterior tibial + posterior tibial artery

Answer 44

pic A - next to tibial nerve is common peroneal arrows = genicular arteries (med + lat sup + inf)

Answer 45

Photograph A shows the anterior compartment of the thigh. Sartorius originates from the anterior superior iliac spine (ASIS) and crosses the anterior compartment from lateral to medial to insert at the medial side of the knee. Photograph B shows the medial side of the knee, where sartorius is the most superior muscle to attach to this area of the tibia. The femoral artery, vein and the saphenous branch of the femoral nerve descend the anterior compartment of the thigh inferior to sartorius in the sub-sartorial (adductor) canal. Sartorius acts to flex, abduct and laterally rotate the hip joint; it also acts to flex and medially rotate the knee joint.

Answer 46

Photograph A shows the anterior surface of the thigh. Rectus femoris is part of the quadriceps muscle group that extends the knee. Rectus femoris attaches to the anterior inferior iliac spine then descends the thigh to attach to form part of the quadriceps tendon, it therefore passes over the anterior surface of the hip joint and will also flex the hip joint. Photograph B shows the quadriceps tendon as it passes over the surface of the patella. The patella is a large sesamoid bone that forms inside the quadriceps tendon in response to the stresses on the tendon due to movement of the knee joint.

Answer 47

The other quadriceps muscles are the vastii. Photograph A shows vastus intermedius that lies inferior to rectus femoris. Photograph B shows vastus lateralis and vastus medialis. Note that vastus medialis has more distal muscle fibres than vastus lateralis, a feature that is thought to help prevent dislocation of the patella. All of the vastii appear to form one large sheet of muscle. All of the quadriceps muscles help to form the quadriceps tendon, so all of the muscles can extend the knee joint. The vastii muscles originate from the femur so do not cross the hip joint and cannot act upon it. Photograph C shows the quadriceps tendon passing over the patella to form the patellar tendon that attaches to the tibia. You may have noticed that the hip joint follows the general rules of movement you have seen in the rest of the body so far –if a muscle crosses the anterior surface of a joint it flexes it, if it crosses the posterior surface of a joint it extends it. Due to the embryological rotation of the lower limb, the opposite happens at the knee joint. For example, the quadriceps muscles cross the anterior surface of the knee joint and they extend the knee; the hamstrings cross the posterior surface and they flex the knee.

Answer 48

You have already seen pectineus and iliopsoas forming the floor of the femoral triangle. Iliopsoas originates as psoas from the lumbar vertebrae and iliacus from the iliac fossa, it inserts into the inferior trochanter of the femur and acts to flex the hip joint. Pectineus originates from the superior pubic rami and inserts into the linea aspera of the femur, it also acts to flex the hip. These muscles (and obturator externus) are odd ones out in the anterior compartment as they are either not supplied by the femoral nerve or are only partially supplied by the femoral nerve. Iliopsoas is innervated by the femoral nerve (iliacus part) but also by direct branches of the lumbar ventral rami (psoas part). Pectineus may be innervated by the femoral nerve, the obturator nerve or a combination of both nerves depending on the individual. Obturator externus lies deep in the anterior compartment and is the counterpart of obturator internus on the inner surface of the obturator membrane. It attaches to the greater trochanter of the femur and laterally rotates the hip. It is innervated by the obturator nerve, as this nerve pierces through obturator externus on its way to the medial compartment of the thigh.

Answer 49

The femoral artery is a direct continuation of the external iliac artery as it passes under the inguinal ligament to enter the femoral triangle. It terminates as the popliteal artery posterior to the knee in the popliteal fossa. It divides to form small branches (circumflex iliac and external pudendal are shown) but its main branches supply the thigh itself. Photograph A shows the femoral artery branching to form a profunda femoris (or deep femoral) artery that will form medial and lateral circumflex branches and many muscular branches. The rest of the artery passes down the anterior compartment in the sub-sartorial canal and then passes through the adductor hiatus to reach the popliteal fossa. Photograph B shows the femoral vein which is a continuation of the popliteal vein. It passes through the adductor hiatus and into the sub-sartorial canal before ascending to the femoral triangle where it is joined by the great saphenous vein.

Answer 50

The femoral nerve is the main nerve supply of the anterior compartment supplying the quadriceps muscles, sartorius, iliacus and often pectineus. It also provides sensory innervation to the anterior surface of the thigh and also to the medial side of the leg via its saphenous branch. Photograph A shows the femoral nerve lying outside the femoral sheath that covers the femoral artery and vein. Photograph B shows the femoral nerve dividing into many branches to supply the anterior compartment.

Answer 51

Photograph A shows the medial compartment of the thigh – this is also called the adductor compartment as all of the muscles adduct the hip joint. The most medial muscle is gracilis – named due to its delicate gracile shape. It inserts into the medial side of the knee, but is the most inferior muscle to do so – this is shown in photograph B. All of the adductors are innervated by the obturator nerve.

Answer 52

Photograph A shows adductor longus. You have seen adductor longus forming the medial border of the femoral triangle. Adductor longus attaches to the pubic bone and the linea aspera of the femur. Photograph B shows adductor brevis, which as its name suggests is shorter that adductor longus. It attaches to the inferior ramus of the pubic bone and the linea aspera.

Answer 53

The largest adductor of the thigh at the hip is adductor magnus. It is so large it attaches to the inferior ramus of the pubic bone and also the ischial tuberosity. The hamstring muscles of the posterior compartment also attach to the ischial tuberosity, so this part of adductor magnus may be called the ‘hamstring part’. This part of adductor magnus can act to extend the hip. Adductor magnus attaches to the linea aspera but also to the adductor tubercle, this creates an adductor hiatus that allows the passage of the femoral artery and vein into/ and out of the popliteal fossa. Adductor magnus is innervated by the obturator nerve but the hamstring part is innervated by the sciatic nerve.

Answer 54

The obturator nerve is the main nerve of the medial compartment of the thigh. The nerve exits the obturator foramen to reach the medial compartment where it divides into an anterior (superficial) and posterior (deep) branch. Photograph A shows the anterior division that supplies adductor longus, adductor brevis and gracilis. Photograph B shows the posterior division that supplies obturator externus and adductor magnus.

Answer 55

This slide shows the lateral compartment of the thigh. The fascia of the thigh is called the fasciae latae and is thickened laterally to form the iliotibial tract which passes down the length of the lateral border of the thigh to blend with the fascia of the knee. Enclosed within the upper medial part of the iliotibial tract is a small muscle called the tensor fasciae latae, which is innervated by the superior gluteal nerve.

Answer 56

Photograph A shows the posterior compartment of the thigh of a left thigh with the skin removed to show the thick fascia that covers the hamstring muscles. All of the hamstrings attach to the ischial tuberosity and all act to extend the hip joint and flex the knee joint. Photograph B shows the fat and fascia removed to reveal the hamstring muscles. Biceps femoris is the most lateral muscle. Biceps femoris has two heads as its name suggests. Photograph C shows the long head that originates at the ischial tuberosity and the short head that originates from the linea aspera and lateral supracondylar ridge of the femur. Both heads unite to insert into the fibula. All of the hamstring muscles are innervated by the tibial division of the sciatic nerve except the short head of biceps femoris which is supplied by the common peroneal division of the sciatic nerve.

Answer 57

Photographs A and B show the two remaining hamstring muscles – semitendinosus and semimembranosus. Semitendinosus (photograph A) forms a long tendon as it approaches the knee joint; semimembranosus (photograph B) forms a flatter tendon that is more muscular as it approaches the knee. Both muscles insert into the medial side of the tibia. There are 4 muscles that insert here – photograph C shows the arrangement of tendons, with semimembranosus lying under semitendinosus (labelled SM).

Answer 58

In the posterior compartment, the sciatic nerve descends towards the knee and divides to form the common peroneal (lateral) and tibial nerves (medial). Between them, these nerves will form branches that supply all of the muscles of the leg and foot. The division of the sciatic nerve may be at any point between the gluteal region and just superior to the popliteal fossa. The common pattern is seen in photograph A. Photograph B shows the structures in the roof of the popliteal fossa. The fossa is the anatomical space posterior to the knee joint and contains vessels and nerves that supply the leg. The roof is formed from skin and fascia. Running in the fascia is the sural nerve, which may branch from the tibial nerve or the common peroneal nerve or a combination of both nerves. This is a cutaneous nerve that supplies the posterior surface of the calf and lateral side of the foot. Also present in the fascia is the short saphenous vein that drains the lateral side of the dorsum of the foot, the posterior surface of the calf and then joins the popliteal vein in the popliteal fossa.

Answer 59

Photograph A shows a left knee with the skin and fascia removed to show the boundaries of the popliteal fossa. The superior boundaries are formed by biceps femoris (lateral) and semitendinosus and semimembranosus (medial). The inferior boundaries are also muscular and are formed by the medial and lateral heads of gastrocnemius. Gastrocnemius is a muscle of the posterior compartment of the leg (this compartment is also called the calf).

Answer 60

Photographs A and B show the contents of the popliteal fossa in a right knee. The popliteal vein and the tibial nerve run through the middle of the fossa. The common peroneal nerve crosses the lateral side as it passes towards the head of the fibula. The popliteal artery also passes through the fossa but this is deep in the fossa and cannot be seen at the level of dissection shown in the photographs on this slide.

Answer 61

Photograph A shows the tibial nerve, popliteal vein and popliteal artery in the fossa. Note that the artery is deeper and has a thicker, more rounded wall than the vein. The tibial nerve is flatter and has small pink/purple stripes along its length (an artifact of the embalming process). Photograph B shows a deep dissection of the fossa. The popliteal artery will form the anterior and posterior tibial arteries that supply the leg and foot. In the popliteal fossa it branches to form five genicular arteries. Four are shown in the photograph – the superior medial (SMG), the superior lateral (SLG), the inferior medial (IMG) and the inferior lateral (ILG). The middle genicular artery is not shown as this runs deep into the capsule.

Answer 62

Popliteus muscle lies deep in the popliteal fossa and forms part of the floor of the fossa. Photograph A shows popliteus with the contents of the fossa intact and photograph B shows popliteus when the contents have been reflected. Popliteus passes between the lateral surface of the lateral condyle of the femur and the shaft of the femur above the soleal line. It is innervated by the tibial nerve and acts to unlock the knee.

Answer 63

Photograph A shows the left gluteal region with the skin removed to reveal the fat and superficial fascia that covers the gluteal muscles. Photograph B shows the same cadaver with the fat and fascia removed to reveal gluteus maximus – the largest and most superficial of the gluteal muscles. Gluteus maximus attaches to the ilium and sacrum and inserts into the iliotibial tract (some fibres pass to the gluteal tuberosity of the femur). Gluteus maximus is a powerful extensor of the hip and is innervated by the inferior gluteal nerve. Photograph C shows gluteus maximus partially reflected to uncover the inferior gluteal nerve (and vessels) that lie in the fascial plane between the gluteal muscles and pierce the deep surface of gluteus maximus. Gluteus maximus can vary in size between individuals – it is easy to split the muscle as you reflect it. You may find it helpful to pass your fingers under gluteus maximus to find the fascial plane between it and gluteus medius before you begin to section the muscle.

Answer 64

Photograph A shows gluteus maximus completely reflected to reveal gluteus medius. The fat and fascia between the two muscles has also been removed. Gluteus medius originates between the posterior and middle gluteal lines of the ilium and inserts into the greater trochanter of the femur. Photograph B shows gluteus medius reflected and the fat and fascia removed to reveal gluteus minimus. The superior gluteal nerves and vessels lie in the fascial plane between gluteus medius and minimus. Gluteus minimus originates between the middle and inferior gluteal lines of the ilium and inserts into the greater trochanter of the femur. Both gluteus medius and minimus act to abduct and medially rotate the thigh and are innervated by the superior gluteal nerve.

Answer 65

There are several small lateral rotators of the hip deep in the gluteal region. Photograph A shows piriformis. Piriformis originates from the sacrum inside the pelvis and then passes through the greater sciatic foramen to reach the greater trochanter of the femur. It acts to laterally rotate the hip and is innervated by the nerve to piriformis. It is a good landmark structure, the sciatic nerve passes into the gluteal region from beneath piriformis (as shown in photograph A). Photograph B shows that piriformis can also be used to identify the superior and inferior gluteal vessels and nerves, as they pass into the gluteal region superior and inferior to piriformis.

Answer 66

Photograph A shows the tendon of obturator internus. The muscle lies on the internal surface of the obturator membrane but the tendon passes through the lesser sciatic foramen to insert into the greater trochanter of the femur. If you observe the tendon carefully you can see a small muscle immediately above it and a small muscle immediately below it. These are the gemelli muscles – superior gemellus from the ischial spine and inferior gemellus from the ischial tuberosity. Both muscles insert with the tendon of obturator internus into the greater trochanter of the femur. All three muscles act to laterally rotate the hip. Obturator internus is supplied by the nerve to obturator internus – this nerve usually also supplies the superior gemellus muscle. Photograph B shows quadratus femoris (shown by the red plastic strip). It arises from the ischial tuberosity and inserts into the intertrochanteric crest of the femur. It also laterally rotates the hip and is innervated by the nerve to quadratus femoris which usually also innervates the inferior gemellus muscle.

Sem 2 RA Week 3 Flashcards

(95 cards)