Anterior & Medial Thigh
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| What is the angle of inclination? | Angle between axis of the femoral head and neck and the axis of the shaft
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| How does the angle of inclination change with age? | Large in youth and smaller in old age
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| What is the average adult angle of inclination? What are the differences between a male and female angle of inclination? | 126 degrees - tends to be smaller in females because the wider pelvis spaces out the acetabula more
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| What does a decrease in the angle of inclination lead to? | Coxa vara which shortens the lower limb and limits abduction of the hip
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| What does an increase in the angle of inclination lead to? | Coxa valga which lengthens the lower limb
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| What is the angle of torsion? | Angle between the axis of the femoral neck and the transverse axis that passes through the femoral epicondyles
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| What is a normal angle of torsion? | 12 to 14 degrees
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| What is an increase in the angle of torsion that leads to a "toeing in" gait? | Anteversion
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| What is a decrease in the angle of torsion that leads to a "toeing out" gait? | Retroversion
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| What is the large sesamoid bone within tendon of the quadriceps femoris muscle? | Patella
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| What is the function of the patella? | Protect knee joint and to improve the angle of approach of the quadriceps femoris tendon to the tibial tuberosity
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| What is the medial bone of the leg whose shaft flares out superiorly into medial and lateral condyles? | Tibia
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| What characteristic is seen at the proximal end of the anterior border of the tibia? | Tibial tuberosity
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| What is the thin, lateral bone of the leg that has a knob-like head that is surmounted by an apex? | Fibula
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| In general, what is the action of the anterior muscle group of thigh muscles at the hip and knee? What is the innervation? | Anterior group of thigh muscles contain flexors of hip and extensors of the knee and is innervated by the femoral nerve
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| In general, what is the action of the posterior muscle group at the hip and knee? What is the innervation? | Posterior group of thigh muscles contain extensors of the hip and flexors of the knee and is innervated by the tibial portion of the sciatic nerve
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| What forms the medial muscle group? What is the innervation? | Formed by hip adductors and is innervated by the obturator nerve
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| What type of functions are associated with muscles in the gluteal region? | Muscles in the gluteal region are abductors and lateral rotators of the thigh
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| Where is the attachment for the common tendon of the quadriceps femoris? | Attaches to the base and medial and lateral borders of the patella
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| Where do the tendinous fibers from the vastus medialis and lateralis muscles extend? What are they called? | Expand over the sides of the knee capsule as the medial and lateral patellar retinacula that insert into the proximal tibia
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| What is the extremely strong, flat connective tissue structure that is the continuation of the quadriceps tendon to the tibial tuberosity from the inferior border of the patella | Patellar ligament
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| Rectus femoris is a subdivision of quadriceps femoris. What are the attachments of rectus femoris? | Arises by 2 heads; straight head is attached to anterior inferior iliac spine and reflected head arises from a point just above margin of the acetabulum; two tendons of origin combine into a fusiform muscle belly
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| What is the function of rectus femoris? | Since it arises above the hip joint, it also flexes the hip, besides extending the knee
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| Vastus lateralis is a subdivision of quadriceps femoris. What are the attachments of the vastus lateralis? | Arises mainly from posterior surface of femur on and above the lateral lip of the linea aspera; covers most of lateral surface of femur but is separated from the bone by the underlying vastus intermedius
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| Vastus medialis is a subdivision of quadriceps femoris. Where does the vastus medialis arise? | From the lower portion of the intertrochanteric line, the medial lip of the linea aspera, and the medial intermuscular septum
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| What part of quadriceps femoris lies deepest? | Vastus intermedius
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| Where does the vastus intermedius arise? | From an extensive portion of the anterior and lateral surfaces of the femoral shaft
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| What is the small muscle that lies deep to the inferior part of the vastus intermedius? | Articularis genu
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| What are the attachments of the articularis genu? | Arises from distal, anterior surface of the femur and inserts into the suprapatellar bursa
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| What is the function of the articularis genu? | Retracts suprapatellar bursa during knee extension, presumably to prevent entrapment of the bursa between the patella and femur
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| When is the rupture of the quadriceps tendon most common? When is a patellar ligament rupture most common? | Rupture of quadriceps tendon is most common in people over 40 and patellar ligament rupture occurs more often in people under 40
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| When would an individual experience a rupture of the quadriceps tendon or a patellar ligament rupture? | Frequently occurs during a forceful eccentric contraction fo the quadriceps muscle, such as would occur if the knee where in a semi-flexed position with the foot planted when the quadriceps contracted strongly
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| Where will the patella be located when there is a complete rupture of the quadriceps tendon or a patellar ligament rupture? | Patella usually lies more inferiorly than normal in quadriceps tendon ruptures and more superiorly than normal in patellar ligament ruptures
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| What will a patient be unable to do with a quadriceps tendon/patellar ligament rupture? | Inability to extend the knee
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| What is the flat, quadrangular muscle that arises from the pecten pubis and inserts into the pectineal line of the femur? | Pectineus
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| What is the function of pectineus? | Adducts and flexes the thigh
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| What is the muscle that is a combination of the distal parts of two muscles, the iliacus and the psoas major? | Iliopsoas
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| Describe the course and attachment of the distal parts of iliacus and psoas major as they form iliopsoas. | Converge in a strong tendon that passes posterior to the inguinal ligament and anterior to the hip joint capsule before attaching to the lesser trochanter
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| What is the function of iliopsoas? | Strong flexor of the thigh
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| What is the long, strap-like muscle that crosses both the hip and the knee? | Sartorius
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| What are the attachments of sartorius? | Arises from ASIS and inserts on the upper medial surface of the tibial shaft
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| What is the function of the sartorius? | Flexes both the hip and knee, assists in lateral rotation, abduction of femur
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| What are the three muscles that make up the pes anserinus? | Gracilis, semitendinosus, and sartorius
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| In general, where do all of the medial thigh muscles arise from? | Arise from the external surface of the pubic ramus and/or the ramus of ischium
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| What is the innervation of all of the medial thigh muscles? | Inntervated by the obturator nerve
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| In general, what is the primary action of most of the medialk thigh muscles? | Adduct the thigh
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| What are the three adductor muscles? | Adductor longus, adductor brevis, and adductor magnus
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| What medial thigh muscle is the most anterior of the three adductor muscles and lies in the same plane and just medial to the pectineus? | Adductor longus
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| What are the attachments of adductor longus? | Arises from the superior ramus of the pubis and inserts by wide tendon into the middle 1/3 of the medial lip of the linea aspera
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| What is the action of adductor longus? | Adducts the thigh and assists in its flexion
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| What medial thigh muscle lies deep to pectineus and adductor longus? | Adductor brevis
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| What are the attachments of adductor brevis? | Originates from the body and inferior ramus of the pubis and it inserts into th elower 2/3's of the pectineal line and upper half of the medial lip of the linea aspera
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| What is the action of adductor brevis? | Adducts thigh and weakly flexes it
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| What muscle is found on the medial side of the thigh as a long, thin muscle? | Gracilis
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| What are the attachments of gracilis? | Arises from inferior pubic ramus and inserts into uppermost portion of shaft of tibia as part of the pes anserinus
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| What is the function of the gracilis muscle? | Adducts the thigh and assists in flexing and medially rotating the leg
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| What medial thigh muscle lies deep to the origins of the adductor muscles? | Obturator externus
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| What are the attachments for obturator externus? | Arises from the external part of the superior and inferior pubic rami, ramus of ischium and the external surface of the obturator membrane and inserts into the trochanteric fossa after passing posterior to the capsule of the hip joint
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| What is the primary action of obturator internus? | Laterally rotates the thigh
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| What are the attachements of adductor magnus? | Arises from the inferior pubic ramus, the ramus of ischium, and from the ischial tuberosity; it attaches to the whole length of the linea aspera
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| The adductor magnus is actually a combination of two muscles. Describe the adductor minimus component of adductor magnus. | Uppermost fibers that are horizontal and may assist in flexion of the thigh
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| The adductor magnus is actually a combination of two muscles. Describe the ischiocondylar portion of adductor magnus. | Most medial fibers that run vertically downward after arising from the ischial tuberosity and ultimately form a rounded tendon that ends on the adductor tubercle
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| What is the function of adductor magnus? | Powerful adductor of the thigh
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| What is the intermuscular space in the upper 1/3 of the anteromedial thigh that lies deep to the fascia lata? | Femoral triangle
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| What forms the roof of the femoral triangle? | Fascia lata
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| What forms the floor of the femoral triangle? | Iliopsoas laterally and pectineus medially; these muscles slope towards each other such that the floor forms a sulcus
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| What are the side of the femoral triangle bounded with? | Base is the inguinal ligament; lateral border is the sartorius and the medial border is the adductor longus
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| What are the contents of the femoral triangle (from lateral to medial)? | Femoral nerve, femoral artery, femoral vein, deep inguinal lymph nodes, and lymphatics
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| What is the fascial sleeve formed around the proximal portions of the femoral artery and vein by extensions of the fascial laminae that line the abdominal cavity? | Femoral sheath
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| Where does the sleeve fuse with the vascular fascia in relation to the inguinal ligament? | 3 to 4 centimeters distal to the inguinal ligament
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| Three compartments (lateral, intermediate, and medial) make up the femoral sheath. How are these compartments formed? | Two septa pass between the anterior and posterior lamina
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| What is located in the lateral compartment of the femoral sheath? | Femoral artery
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| What is located in the intermediate compartment of the femoral sheath? | Femoral vein
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| What is located in the medial compartment? | Femoral canal which contains a slight amount of CT and a few lymphatic vessels and the deep inguinal lymph nodes
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| What is the femoral ring? | The small, proximal abdominal opening of the femoral canal
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| What are the boundaries (lateral, medial, posterior, and anterior) of the femoral ring? | Lateral: partition between femoral canal and femoral vein; medial: lacunar ligament; posterior: superior ramus of pubis covered by pectineus; anterior: medial part of inguinal ligament
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| What complications can result in the femoral ring area? Why do they develop here? | Femoral hernias - because of the rigidness of the femoral rings, herniated structures can become strangulated when their blood supply is compromised
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| Are femoral hernias more common in males or females? Why? | Females - because they tend to have a wider pelvis
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| What is a pseudoaneurysm? | A dilated artery with disruption of one or more layers of the arterial wall
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| What are the implications of a pseudoaneurysm? | A pseudoaneurysm can compress surrounding structures such as nerves and veins, leading to localized or radiating pain and impaired venous flow and edema; it can also lead to emboli or thrombus formation, arteriovenous fistula, and infection
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| What is the intermuscular tunnel which runs between the extensors of the knee and adductors of the thigh muscles? | Adductor canal
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| Describe the location and extent of the adductor canal. | Starts where sartorius crosses the adductor longus and ends at the upper limit of the adductor hiatus (a separation in the tendinous insertion of the adductor magnus)
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| What are the boundaries (anterolaterally, posteromedially, and anteromedially) of the adductor canal | Anterolateral: fasica of the vastus medialis; posteromedial: fascia of adductor longus and adductor magnus; anteromedial: deep layer of the fascial sheath of sartorious
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| What forms the the roof of the adductor canal? | Sartorius
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| What are the main structures that pass through the adductor canal? Describe their relationship to one another. | Femoral artery and vein - artery is generally anterior to vein; saphenous nerve enters canal lateral to vessels, crosses them anteriorly, and lies medial to them at the lower end of the canal; and nerve to vastus medialis
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| What are the only structures that pass through the adductor hiatus? | Femoral vein and artery
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| Where can deep vein thrombosis commonly occur in the lower limb? | Femoral, deep femoral, and popliteal veins
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| When would DVT develop? | Predisposed to forming during vascular stasis, injury to vessel wall, or under hypercoagulability conditions
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| What is the origin of the femoral nerve? | From the ventral rami L2, L3, and L4
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| Describe the course of the femoral nerve. | Enters the thigh posterior to the inguinal ligament, deep to the iliac fascia, where it lies on the surface of the iliopsoas muscle, just lateral to femoral artery; then breaks up into a number of muscular and cutaneous branches
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| What does the muscular branches of the femoral nerve innervate? | Sartorius, quadriceps femoris, iliacus, and usually pectineus
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| What are the cutaneous branches of the femoral nerve? | Anterior femoral cutaneous and saphenous nerves
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| What is the origin of the obturator nerve? | Arises from anterior branches of L2, L3, and L4
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| Describe the course of the obturator nerve. | Passes through obturator canal into thigh and divides into an anterior and posterior branch
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| Describe the course of the anterior and posterior branches of the obturator nerve. | Anterior branch descends on surface of adductor brevis, deep to pectineus and adductor longus; posterior branch descends posterior to adductor brevis under deep fascia of adductor magnus
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| What do the muscular branches of obturator nerve innervate? | Adductor longus, gracilis, adductor brevis, adductor magnus, obturator externus, and sometimes pectineus
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| What is the origin of the tibial nerve? | Part of sciatic nerve and has L4-S3 spinal cord segments represented within it
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| Describe the course of the tibial nerve. | Leaves pelvis via greater sciatic foramen and passes inferior to piriformis muscle; descends between greater trochanter and ischial tuberosity along back of thigh
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| What does the tibial nerve innervate in the thigh? | Hamstring muscles which includes ischiocondylar part of adductor magnus
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