MSK 2

What part of the femur articulates with the acetabulum of the pelvis to form the hip joint?

Head

What part of the femur connects the head of the femur with the shaft and it set at an angle of approximately 125^o to the shaft? → allows for increased range of movement

Neck

What is the most lateral palpable projection of bone that originates from the anterior aspect, just lateral to the neck of the femur?

Greater trochanter

What lower limb muscles attach to the greater trochanter?

• Gluteus medius and minimus

• Vastus lateralis

• Piriformis (pelvic)

What projects from the posteromedial side of the femur, just inferior to the neck-shaft junction and is the site of attachment for iliopsoas?

Lesser trochanter

What is the ridge of bone that runs in an inferomedial direction on the anterior surface of the femur, spanning between the two trochanters?

Intertrochanteric line

What does the intertrochanteric line turn into as it passes the lesser trochanter on the posterior surface?

Pectineal line

What it the site of attachment for the iliofemoral ligament?

Pectineal line

What is the site of anterior attachment for the hip joint capsule?

Intertrochanteric line

What exhibits lateral and medial lips that provide attachments for many muscles and three intermuscular septa?

Linea aspera

What does the medial border of the linea aspera become?

Pectineal line

What does the lateral border of the linea aspera become?

Gluteal tuberosity

Where does the gluteus maximus attach?

Gluteal tuberosity

What extracapsular hip joint ligament?:

• Y-shaped ligament

• Anterior inferior iliac spine to intertrochanteric line

• Strongest ligament in body

Iliofemoral ligament

What extracapsular hip joint ligament?:

• Superior pubic ramus to capsul

Pubofemoral ligament

What extracapsular hip joint ligament?:

• Ischium and acetabulum to greater trochanter

• Seen posteriorly

Ischiofemoral ligament

What intracapsular hip joint ligament bridges the gap in the acetabulum?

Transverse acetabular ligament

What intracapsular hip joint ligament?:

• “Ligament of head of femur”

• Contains a branch of obturator artery that supplies blood to femoral head

  • more important for developing femur in childhood

Ligamentum teres

What is the ring of fibrocartilage around the acetabular rim, is deep to joint capsule, and acts as a seal on the hip joint, holding the femoral head in place (vacuum effect)?

Labrum

What part of the hip joint is similar in composition to a ligament and the inner lining produces synovial fluid?

Capsule

What is the deep fascia of the gluteal region and thigh and is continuous with crural fascia of the leg and deep fascia of the foot?

Fascia lata

What is the portion of fascia lata covering gluteal muscles?

Gluteal fascia

What structure in the lateral leg is a thickening of the fascia lata?

Iliotibial tract

What is the lumbosacral plexus composed of?

Formed by part of anterior ramus of L4 and all of anterior ramus of L5

Roots of the lumbosacral trunk

L4-S3

Roots of obturator nerve

L2,L3,L4

Roots of femoral nerve

L2,L3,L4

Roots of sciatic nerve

L4,L5,S1,S2,S3

Roots of superior gluteal nerve

L4,L5,S1

Roots of inferior gluteal nerve

L5,S1,S2

Roots of posterior femoral cutaneous nerve

S1-S3

What provides the cutaneous sensory innervation to skin of posterior thigh?

Posterior femoral cutaneous nerve

What passes through the greater sciatic foramen above piriformis muscle?

Superior gluteal nerve, artery, and vein

What passes through the lesser sciatic foramen?

Obturator internus muscle tendon

What passes through the greater sciatic foramen below the piriformis muscle?

• Sciatic nerve

• Inferior gluteal nerve, artery, and vein

• Posterior femoral cutaneous nerve

• Nerve to obturator internus and gemellus superior muscles

• Nerve to quadratus femoris and gemellus inferior muscles

What passes the gap between inguinal ligament and pelvic bone?

• Psoas major, iliacus, pectineus muscles

• Femoral nerve, artery, and vein

• Lymphatics

• Femoral branch of genitofemoral nerve

• Lateral cutaneous nerve of thigh

What muscle?:

• O: Ilium; sacrum; coccyx; sacrotuberous ligament

• I: Gluteal tuberosity of femur; iliotibial tract (blending of tissue)

• N: Inferior gluteal nerve

• B: Inferior and superior gluteal arteries

• A: Extends and rotates thigh laterally; main thigh extender

Gluteus maximus

What muscle?:

• O: Posterior wing of ileum between iliac crest and anterior and posterior gluteal lines

• I: Greater trochanter

• N: Superior gluteal n.

• B: Superior gluteal a.

• A: Abducts and rotates thigh medially; stabilizes pelvis

Gluteus medius

Where would you find gluteus minimus?

Deep to gluteus medius

Damage to what nerve causes a compensation where a patient’s trunk leans toward the affected side due to weakness of the gluteus medius and minimus?

Superior gluteal nerve

Where does the piriformis exit the pelvis?

Greater sciatic notch

Where does obturator internus exit the pelvis?

Lesser sciatic notch

What structure lies over greater trochanter and is deep to the IT band?

Trochanteric bursa

What nerves are bundled together to form the sciatic nerve?

• Tibial n. (L4-S3)

• Common fibular n. (L4-S2)

Where does the sciatic nerve exit the pelvis?

Inferior to piriformis

In most individuals (87%), how does the sciatic nerve exit the pelvis in reference to the piriformis muscle?

Inferior

Where does the sciatic nerve branch off into the common fibular and tibial nerve?

Popliteal region

Where are intramuscular injections given?

Superolateral gluteal quadrant

What muscle is targeted in IM injections?

Gluteus medius

What does the femoral artery give off in the thigh?

Profunda femoris artery

What do the superior and inferior gluteal arteries branch from?

Internal iliac artery

Where do does the superior gluteal artery exit the pelvis?

Superior to piriformis muscle

Where does the inferior gluteal artery exit the pelvis?

Inferior to the piriformis muscle

What supplies the femoral head and neck?

Medial femoral circumflex artery

What area is highly susceptible to avascular necrosis and can cause collapse?

Femoral head

What artery passes deep between adductor longus and adductor magnus and gives off lateral and medial circumflex femoral arteries?

Deep femoral artery

What artery continues medially from the femoral artery and then posterior?

Popliteal artery

What are the deep veins of the leg?

• Anterior and posterior tibial veins

• Popliteal

• Femoral veins

• Common iliac-vena cava

What are the superficial veins of the leg?

• Great saphenous

• Small saphenous

Pathway of the saphenous vein

Ascends medial thigh → passes through saphenous hiatus → drains into femoral vein

What lymph nodes are posterior to knee joint and drain to inguinal nodes?

Popliteal nodes

What lymph nodes receive all lymphatic drainage from lower limb?

Inguinal nodes

What vein?

• Originates from lateral side of dorsal venous arch in foot

• Drains into popliteal vein posterior to knee joint

• Accompanied by sural nerve in posterior leg

Saphenous vein

What are the cutaneous nerves of the thigh?

• Lateral femoral cutaneous n.

• Medial and intermediate femoral cutaneous nn. (femoral n.)

• Saphenous n. (femoral n.)

What nerve supplies the anterior compartment?

Femoral nerve

What nerve supplies the medial compartment?

Obturator nerve

What nerve supplies the posterior compartment?

Sciatic nerve

What are the boundaries of the femoral triangle?

• Superiorly: Inguinal ligament

• Medially: Adductor longus muscle

• Laterally: Sartorius muscle

What makes up the floor of the femoral triangle?

• Iliopsoas muscle

• Pectineus muscle

• Adductor longus muscle

What vessel is NOT contained within the femoral sheath?

Femoral nerve

What is the proximal opening of the femoral canal into the abdominal cavity?

Femoral ring

What is within the femoral triangle from lateral to medial?

(NAVEL)

• Nerve (femoral)

• Artery (femoral)

• Vein (femoral)

• Empty space (femoral canal)

• Lymphatics

What hernias are more common in women?

Femoral hernia

What hernias lie inferolateral to pubic tubercle and below inguinal ligament after passing through femoral ring and canal (medial to femoral vein)?

Femoral vein

What is the hernial sac formed by?

Parietal peritoneum

What is it called when the small intestine herniates through the femoral ring into the femoral canal medial to the femoral vessels?

Femoral hernia

How many intermuscular septae in the thigh?

3

Muscles in the anterior compartment of the thigh

• Iliopsoas

• Sartorius

• Vastus medialis

• Vastus intermedius

• Vastus lateralis

• Rectus femoris

Muscles in the medial compartment of the thigh

• Adductor longus

• Adductor brevis

• Adductor magnus

• Gracilis

Muscles in posterior compartment of the thigh

• Semi-membranosus

• Semi-tendinosus

• Long head of biceps femoris

• Short head of biceps femoris

What muscle?:

• O: Iliac fossa, ala of sacrum

• I: Lesser trochanter

• N: Femoral n.

• B: Medial femoral circumflex a., iliac branch of iliolumbar a.

• A: Flexes thigh (with psoas major)

Iliacus

What muscle?:

• O: Anterior-superior iliac spine

• I: Upper medial side of tibia

• N: Femoral n.

• B: Femoral a.

• Action: Flexes and rotates thigh laterally and medially

Sartorius

What muscle allows for cross-legged position (flexion +abduction + lateral rotation)?

Sartorius

What muscle?

• O: Anterior-inferior iliac spine; posterior-superior rim of acetabulum

• I: Base of patella; tibial tuberosity

• N: Femoral n.

• B: Descending branch of lateral femoral circumflex a.

• A: Flexes thigh; extends leg

Rectus femoris

What muscle is the 1 of 4 quad muscles that crosses the hip joint and flexes the thigh?

Rectus femoris

What muscle?

• O: Intertrochanteric line; linea aspera; medial intermuscular septum

• I: Medial patella; tibial tuberosity

• N: Femoral n.

• B: Femoral a.

• A: Extends leg

Vastus medialis

What muscle?

• O: Intertrochanteric line; greater trochanter; linea aspera; gluteal tuberosity; lateral intermuscular septum

• I: Latereal patella; tibial tuberosity

• N: Femoral n.

• B: Latereal circumflex a.

• A: Extends leg

Vastus lateralis

What muscle?

• O: Upper shaft of femur; lower lateral intermuscular septum

• I: Upper patella; tibial tuberosity

• N: Femoral n.

• B: Femoral a.

• A: Extends leg

Vastus intermedius

Motor and sensory of femoral nerve

Motor

• Anterior compartment of thigh

Sensory

• Saphenous n.

• Anterior cutaneous nerve

What nerve innervates the medial side of the thigh and down to medial leg and foot?

Saphenous nerve

What muscle?

• O: Pubis

• I: Pes anserinus to medial tibia

• N: Obturator n.

• B: Obturator a.

• A: Adduct thigh

Gracilis

What 3 muscles create this common tendon insertion?

• Sartorius muscle

• Gracilis tendon

• Semi-tendinosus tendon

What muscle?

• O: Pectineal line on pubis

• I: Posterior femur

• N: Femoral n.

• A: Flex and adduct thigh

Pectineus

What muscle?

• O: Pubis

• I: Posterior femur

• N: Obturator n.

• A: Adducts thigh

Adductor longus

What muscle?

• O: Pubis

• I: Posterior femur

• N: Obturator n.

• A: Adducts thigh

Adductor brevis

What muscle?

• O: Ischiopubis ramus

• I: Posterior thigh

• N: Obturator n.

• A: Adducts thigh

Adductor magnus (adductor)

What muscle?

• O: Ischial tuberosity

• I: Adductor tubercle on femur

• N: Sciatic n. (tibial)

• A: Extends thigh

Adductor magnus (Hamstring)