The anterior and medial thigh week 4 Flashcards Preview

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Flashcards in The anterior and medial thigh week 4 Deck (40):
1

patellofemoral syndrome

sometimes referred to as "runner's knee". involves pain around the knee cap and anterior aspect of the knee that often affects athletes. is caused by weakness and/or tightness of the muscles surrounding the knee as well as mal-alignment of the patella

2

ilitobial band syndrome and "snapping hip syndrome"

can be associated with patellofemoral syndrome. results from irriation and excessive tightness of the IT band. often affects runners as well (like patellofemoral syndrome) but involves pain in the lateral aspeck of the knee below the joint line (where IT band inserts into tibia). Problems with the IT band can also occur proximally, a condition known as "snapping hip syndrome". proximal part of the IT band is tight and inflamed. 

3

trochanteric bursitis

bursa overlying the greater trochanter of the hip becomes inflamed often as a result of injury from either overuse or trauma (although not the only causes). may occur whn ppl have a leg length discrepancy. pts experience pain at the lateral aspect of the hip which is different than groint pain experienced with hip arthritis

4

What are the fascias of the lower limb? What is contained in them and what is their fxn?

superficial fascia: lies deep to the skin and consists of loose CT and fat that contains cutaneous nerves, superficial veins (great saphenous and small saphenous), and lymphatic vessels and lymph nodes

deep fascia of thigh is called fascia lata and of leg is called crura. the deep fascia surround the thigh and leg to limit outward bulging of muslces, facilitate venous return in deep veins, spearate muscles with similar fxns and innervations into compartments, and surround invidiual muscles which allows them to act independently

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5

Where is the saphenous opening located? What passes through this opening?

the saphenous opening is an aperture in the fascia lata just inferior to the medial end of the inguinal ligament which allows the great saphenous vein to pass from the superficial facia to the deep fascia to end as a tributary to the femoral vein

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6

What is the iliotibial tract/band? What 2 muscles attach here and what are their fxns?

the iliotibial tract/band (IT band) is a lateral thickening of the fascia lata into which the gluteus maximus and the tensor fascia lata muscles attach to maintain extension of the leg at the knee after othe rmuscles have actively exenteded it

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7

What divides muscles in the thigh and leg into comparments? What are those compartments.

thigh:  intermuscular septa are extensions of the deep aspect of the fascia lata that attach to the femur and diveide the thigh into anterior, posterior, and medial compartments

leg: intermusclular septa are extesions of the deep aspect of the crura which along with the interosseus membrane divide the leg into anterior, posterior, and lateral compartments

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8

Identify the indicated structures. What are their functions?

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9

What is the plantar aponeurosis? What is its fxn? What is a condition of the plantar aponeurosis and what is a possible tx option?

The plantar aponeurosis is thickening of the deep fascia in the sole of the foot and supports the longitudinal arches and the deeper structures of the foot. Can get plantar fasciitis for variety of reasons such as flat 
or high arches. Is worse in the morning bc sleep with feet 
in plantarflexion. Can be treated with a splint that holds 
feet in dorsiflexion during sleep

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10

Veins draining from the lower limb form superficial and deep groups. What are names of these veins and where are they located? What are their tracks though the lower ext?

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The deep veins typically follow the arteirs and the femoral vein is the major deep vein that drains the lower limb

The superficial veins form 2 major channels:

great saphenous vein: originates from medial side of the dorsal venous arch of the foot and ascends on the medial side of the leg, knee, and thigh to end as a tributary to the femoral vein just inferior to the inguinal ligament

small saphenous vein: originates from the lateral side of the dorsal venous arch of the foot, ascends on the posterior aspect of the leg and penetrates deep fascia to joint the popliteal vein posterior to the knee

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11

What are varicose veins and what is their cause? Where do they usually occur?

frequently the great saphenous vein and its tributaries become varicose (dilated so the cusps of their valves do not close). performating branches exist btwn the superficial and deep veins. varicose veins develop when the valves that usually prevent blood flow from deep to superficial veins (through perforating veins) are incompetent.

12

What is venous stasis? What may it be caused by? Why may venous stasis be dangerous?

Venous stasis refers to pooling of blood in the lower limb (esp the leg) often due to inactivity and decreased/ineffective muscular contraction. It is an important cause of blood DVT formation which if breaks free, may travel to the lung and obstruct the pulmonary artery and cause death (PE)

 

13

Most lymphatic vessels in the lower limb drain into _____ and ____ inguinal nodes in fascia just inferior to the ____ ligmament. 

superificial

deep

inguinal

14

List the 3 lymphatics of the lower ext, where they are located anatomically, where they receive lymph from, and what they drain into.

superificial inguinal nodes: parallel the inguinal ligament. receive lymph from the gluteal region, the lower abdominal wall, and superficial regions of the lower limb. drain into external iliac nodes

deep inguinal nodes: lie medial to the femoral vein. receive lymph from deep lymphatics associated with the femoral vein. interconnect with superificial inguinal nodes and drain into external iliac nodes

popliteal nodes: small collection of deep lymph nodes that lie posterior to the knee near the popliteal vessels. receive lymph from superficial vessels associated with the small saphenous vein and from deep areas of the leg and foot. ultimately drain into superifical and deep inguinal nodes

15

True or false: Nerves in the thigh and leg are peripheral nerves branches of the lumbosacral plexus.

True.

16

What are the boundaries of the obturator canal? What structures does this canal connect? What passes through the obturator canal?

1. bound by the pubic bone superiorly and the obturator membrane inferiorly

2. connects the abdominopelvic cavity and the medial thigh

3. obturator nerve and vessels pass through the obtuator canal

17

What are the boundaries of the gap btwn the inguinal ligament and pelvic bone? What structures does this gap connect? What passes through the this gap?

1. bounded by the inguinal ligament anteriorly and the pelvic bone posteriorly

2. connects the abdominopelvic cavity and the anteriormedial thigh

3. psoas major, iliacus, and pectineus muscles

femoral vein, artery, and nerves as wells as lymphatics of the lower limb

femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh

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18

What muscles are in the anterior compartment of the thigh? What are they innervated by? What is the major blood supply to this compartment?

1. sartorius, ilopsoas (formed from terminal ends of iliacus and psoas major), rectus femoris, vastus lasteralis, vastus intermedius, and vastus medialis (rectus femoris and vastus muscles form the quadriceps)

2. innervated by the femoral nerve (except psoas major which is innervated by ventral rami of L2-L4). femoral nerve is ventral rami of L2, L3, and L4

3. femoral artery

19

The iliopsoas is composed of the psoas major and iliacus. What is the origin, insertion, fxn, and innervation of the psoas major and the iliacus?

psoas major:

origin: lateral aspects of T12-L4 vertebrae and lumbar transverse processes

 insertion: lesser trochanter of femur

 fxn: ilopsoas acts to flex the thigh at the hip joint and is the most powerful flexor of the thigh

innervation: L2-L4 ventral rami

iliacus:

origin: iliac crest and fossa, internal and ala of the sacrum

insertion: lesser trochanter of femur

fxn: ilopsoas acts to flex the thigh at the hip joint and is the most powerful flexor of the thigh

innervation: femoral nerve. NOTE: the femoral nerve can be found just superficial to the iliopsoas

20

What is the origin, insertion, fxn, and innervation of the sartorius?

origin: anterior superior iliac spine

insertion: superior medial tibia

fxn: flexes, abducts, and laterally rotates the thigh at the hip joint; flexes the leg at the knee joint

innervation: femoral nerve

21

The rectus femoris, vastus medialis, vastus intermedialis, and vastus lateralis make up the quadriceps femoris. What are the origins, insertions, fxn, and innervation of the muscles of the quadriceps femoris?

rectus femoris:

origin: anterior inferior iliac spin and rim of the acetabulum

vastus medialis:

origin: intertrochanteric line and medial linea asperia

vastus lateralis:

origin: greater trochanter and lateral linea aspera

vastus intermedius:

origin: anterior and lateral shaft of the femur

All muscles have the same insertion, fxn, and innervation:

insertion: patella and tibial tuberosity via the patellar ligament

fxn: NOTE: the rectus femoris is the only part of the quadriceps that crosses the hip joint and therefore is the only part that flexes the thigh at the hip. (the iliopsoas is a much more powerful hip flexor). the main action of the quadriceps is to extend the leg at the knee

innervation: femoral nerve

22

Identify the muscles of the anterior thigh.

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23

What are the boundaries of the femoral triangle? What structures pass through the femoral triangle? What structures are and are not contained in the sheath? What are the compartments of the sheath and their contents? 

base: inguinal ligament

medial border: adductor longus (medial compartment of thigh)

lateral border: sartorius

floor (lateral to medial): iliopsoas, pectineus, adductor longus

contents are NAVEL from lateral to medial

1. femoral nerve

2. femoral artery

3. femoral vein

4. empty space and lymphatic vessels

The contents of the femoral triangle are enveloped in a connective tissue sheath except for the femoral nerve!

lateral compartment: femoral artery

intermediate compartment: femoral vein

medial compartment (femoral canal): loose connective tissue and lymphatic vessels. allows expansion of the femoral vein

see pg 72 of course notes for visual of sheath

 

 

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24

What is the course of the femoral artery and vein in the thigh after the femoral triangle? What vessels do they turn into and where?

The femoral artery and vein leave the femoral triangle and pass deep to the sartorius muscle in the adductor (sub-sartorial) canal. They pass from the anterior thigh to the popliteal fossa (region posterior to knee) via the adductor hiatus, an opening/gap in the adductur magnus near its insertion on the femur. within the popliteal fossa the femoral artery and vein are referred to as the popliteal artery and vein

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25

The femoral vein and artery lie btwn what to muscles?

iliopsoas and pectineus (note pectineus is a medial thigh muscle and iliopsoas is anterior)

26

Describe the branches of the femoral artery and what they supply.

The largest branch of the femoral artery is the deep artery of the thigh (profunda femoral artery). It is a major source of blood supply to the thigh supplying muscles in each of the three compartments.

The following branches arise form the deep artery of the thigh:

medial circumflex femoral artery is the primary soruce of blood supply to the hip joint. variable amounts of additional blood supply to the hip joint come from the artery to the head of the femur, a branch of the obturator artery which runs in the ligamentum teres as well as the gluteal arteries.

lateral circumflex femoral artery has a descending branch that will anastamose with the popliteal artery near the knee (providing a route of collateral circulation)

three to four perforating arteries pass through the adductor magnus muscle to enter and supply the posterior compartment of the thigh

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27

What are the branches of the femoral nerve and what do they innervate?

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there are numerous muscular branches to supply the iliopsoas (iliacus portion), pectineus, quadriceps femoris muscles, and sartorius.

anterior cutaneous branches pierce through the fascia lata and innervate the skin on hte front of the thigh and knee

one long cutaneous branch, the saphenous nerve, supplies the skin of the medial leg and foot

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28

What muscles are in the medial compartment of the thigh? What is their blood and nervous supply and how do they pass through to supply these muscles?

1. gracilis, pectinues, adductor longus, adductor brevis, adductor magnus, obturator externus

2. the obturator artery enters the medial compartment of the thigh through the obturator canal and provides blood supply to the surrounding muscles. the obturator nerve enters the medial compartment through the obturator canal and divides into anterior and posterior branches (divided by the adductor brevis) which innervate all muscles of the medial comparment except the pectineus (which is innervated by the femoral nerve) and the hamstring part of the adductor magnus

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29

What is the group innervation and fxn of the muscles of the medial compartment of the thigh?

innervation: obturator and femoral nerve

fxn: adduct and flex the hip join

30

What is the origin, insertion, innervation, and fxn of the pectineus?

origin: pectin pubis (see pg 392 of atlas)

insertion: proximal femur at the pectineal line

fxn: adducts and flexes thigh at the hip joint

innervation: femoral nerve (may be innervated by the obturator nerve)

31

What is the origin, insertion, innervation, and fxn of the adductor brevis?

origin: inferior pubis ramus

insertion: proximal linea aspera of the femur

fxn: adducts and flexes the thigh at the hip joint

innervation: obturator nerve

32

What is the origin, insertion, innervation, and fxn of the adductor longus?

origin: superior pubis ramus and pubic symphysis

insertion: middle 1/3 of linea aspear of femur

fxn: adducts and flexes the thigh at the hip joint

innervation: obturator nerve

33

What is the origin, insertion, innervation, and fxn of the adductor magus?

origin: inferior pubic ramus, ischial ramus, ischial tuberosity

insertion: posterior femur (gluteal tuberosity, linea aspera, medial supracondylar line).medial femoral condyle (adductor tubercle)

fxn: adduction and extension of the thigh at the hip joint

innervation: obturator nerve and tibial nerve

 

34

What is the origin, insertion, innervation, and fxn of the gracilis?

origin: inferior pubic ramus below the pubic symphysis

insertion: superior part of medial tibia

fxn: adducts the thigh at the hip joint, flexes leg at the knee joint, and medially/internally rotates the leg at the knee joint when the knee is flexed

innervation: obturator nerve

35

What is the origin, insertion, innervation, and fxn of the oburator externus?

origin: outer surface of the obturator membrane and surrounding bone

insertion: trochanteric fossa of the femur

fxn: laterally/externally rotates the thigh at the hip joint

innervation: obturator nerve

36

Identify these muscles of the medial comparment of the thigh.

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37

Identify these muscles of the medial comparment of the thigh.

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38

Identify these muscles of the medial compartment of the thigh.

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39

What are the branches of the obturator nerve and what do they innervate?

The divsions of the obturator nerve are nadmed anterior and posterior bc of their positions with respec to the adductor brevis muscle. The anterior branch desced on the anterior surface of the adductor brevis just posterior (deep) to the adductor longus. The posterior branch descends posterior to the adductor brevis on the anterior surface of the adductor magnus muscle. Together, these branches innervate the adductor longus, adductor brevis, adductor magnus, obturator externus, gracilis, and sometimes the pectineus. It also innervates the skin of the medial thigh. 

40

What nerve supplies this area of the skin?

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