Lecture 2: Anterior and medial thigh and femoral triangle

Identify the major bony features of the femur. Recognise the major muscles in the anterior and medial thigh, and explain their actions. Recognise and name the major nerves that enter the lower limb from the trunk and describe the groups of muscles each one supplies. Identify the major blood vessels that enter the lower limb from the trunk and describe the groups of muscles each one supplies/drains in the thigh. Identify the femoral triangle, recognising its boundaries and contents.

Label the missing structure on this diagram

Adductor Longus

What are the boundaries of the femoral triangle? (lateral, medial, superior)

Sartorius muscle, Adductor longus muscle, Inguinal Ligament

What are the boundaries of the femoral triangle? (roof and floor)

Fascia Latte and Skin; 4 muscles (adductor longs, pectineus, posts major, iliacus muscle)

Label structures 1-3

1) Femoral Nerve 2) Femoral Artery 3) Femoral Vein

Label structures 1-5

1) great saphenous vein 2) femoral canal 3) Deep Femoral Vein 4) Deep femoral artery 5) Femoral branch of the genitofemoral nerve

Label structures 1-8

1) iliopsoas 2) pectinous 3) adductor longus 4) gracilis 5) vastus medius 6) quadriceps tendon 7) vastus laterallis 8) rectus femoris

List the muscles in the anterior compartment of the thigh

iliopsoas, pectinous, adductor longus, gracilis, vastus medius, quadriceps tendon, vastus lateralis, rectus femoris, vastus intermedius

Label the muscles

Pectinius, Adductor Magnus, Adductor brevis, Adductor Longus, Gracillis

Label the muscles

1) obturator externus 2) adductor brevis 3) adductor longus 4) adductor Magnus

Fill in the blanks

1) superficial 2) flexes the hip 3) extends the knee 4) extends the knee 5) extends the knee 6) extends the knee

Fill in the blanks for the Rectus Femoris

1) superficial 2) midline 3) Crosses the hip 4) hip joint 5) flexes the hip 6) extends the knee

Fill in the blanks

1) deep 2) femoral shaft 3) extends the knee

Fill in the blanks

1) medial 2) shaft 3) smaller 4) vastus lateralis 5) extends the knee

Fill in the blanks

1) lateral 2) greater trochanter 3) bigger 4) extends the knee

label terms 1-5

1) head 2) neck 3) greater trochanter 4) lesser trochanter 5) shaft

label terms 6-10

6) hip 7) femur 8) tibia 9) fibula 10) medial and lateral condyles

Where does the ligament of the head of the femur insert the femoral head into the acetabelum?

the fovea capsis

where’s the linea aspera and what does is do?

line down the shaft of the femur, for muscle attachment

where’s the patellar surface and what does it do?

anterior surface on distal femur, articulates with posterior surface of patella

what will muscles inserting on the greater trochanter do and why?

abduct the hip, due to location on lateral aspect

what is the lesser trochanter the primary insertion site for?

the illiopsoas muscle

label structures 1-7

1) rectus femoris 2) vastus lateralis 3) vastus intermedius 4) vastus medialis 5) rectus femoris 6) vastus lateralis 7) vastus medialis

name the quadriceps (from medial to lateral)

vastus medialis, vastus intermedius, rectus femoris, vastus lateralis.

what nerve and what artery supplies the quadriceps

the femoral nerve and the femoral artery

fill in blanks 1-7

1) iliacus 2) psoas major 3) internal 4) hip bone 5) inguinal ligament 6) lesser trochanter

fill in blanks 8-12

8) primary hip flexor 9) trunk 10) walking, running and sit ups 11) rotates hip outwards 12) stabilises the spine

What is the angle of inclination at birth and in adulthood?

birth- 150, adulthood- 120-130

Whats it called when the angle of inclination is too inverted?

coxa vara

whats it called when the angle of inclination is too high

coxa valga

What femoral position causes the foot to be tilted inwards?

Femoral Anteversion

What femoral position causes the foot to be tilted outwards

femoral retroversion

Is the femur medially or laterally rotated in femoral ante version?

medially

Is the femur medially or laterally rotated in femoral retro version?

laterally

Label structures 1-4 in the anterior compartment of the thigh

iliotibial band, vastus lateralis, vastus intermedius, rectus femoris

Label structures 5-9 in the anterior compartment of the thigh

kin, Cassius medialis, sartorius, fasia lata, femoral vessles and nerve

Label structures 1-5 of the medial thigh

medial intermuscular septum, adductor longus, gracilis, deep femoral vessels, adductor Magnus

Label structures 1-5 of the posterior thigh

lateral intermuscular septum, biceps femoris, semitendinosus, smeimembrinosus, posterior intermuscular septum

Label structures 1-4

pelvis, acetabulum, femoral head, articular cartilage

label structures 5-7

greater trochanter, femoral neck, femur

Which nerve supplies the posterior thigh?

sciatic

Which nerve supplies the medial thigh?

obturator

Which nerve supplies the anterior thigh?

femoral

Label nerves 1-4

lateral femoral cutaneous, femoral, sciatic, obturator

label structures 1-5

gluteus maximus, gluteus medius, piriformis, greater trochanter, quadratus

label structures 6-8

sciatic nerve, semitendinosus, biceps femoris

label structures 9-11

semimembranousus, tibial nerve, fibular nerve

Which compartment is this and what are structures 1-4

rectus femoris, vastus lateralis, vastus intermedius, vastus medialis

What does rectus femoris do to the knee

extension

what does rectus femoris do to hip

flexion

What does flexion do?

decreases the angle between two bones

what does extension do?

increases the angle between two bones

what affect does vastus intermedius have on the knee?

extension

what affect does vastus intermedius have on the knee

extension

what does vastus lateralis do to the knee

extends and stabilises

Label structures 1-3

vastus lateralis, rectus femoris, vastus medialis

Label structures 1-3

tensor fasciae latae, sartorius, iliotibial band

what does the sartorius do to the hip

flexion, abduction and lateral rotation

What does the sartorius do to the knee

flexion

Whats the role of the iliopsoas?

main flexor of the hip

What is the blood supply to the anterior thigh

femoral artery

What is the innervation to the anterior thigh

femoral nerve

what is the blood supply to the thigh?

iliolumbar, obturator, external iliac, femoral artery

What is the innervation to the illiopsoas?

lumbar plexus and femoral nerve

What is the mnemonic to remember blood supply to the illiopsoas?

I Often Eat Fries

What compartment of the thigh is the iliopsoas part of?

anterior

Whats affect does the iliopsoas have on the hip?

main flexor

Label structures 1-4

psoas major, ilium, iliacus, inguinal ligament

Label structures 5-7

pubic bone, lesser trochanter, femur

Label structures 1 and 2

pectinous, adductor longus

What does pectinous do?

flexion and adduction of the hip, stabilises the pelvis

What is the limit of pectineus flexion?

45 degrees

What compartment is pectineus in?

anterior/ medial

What is the blood supply to pectineus?

obturator artery

What is the innervation of pectineus?

femoral nerve

What muscle is pectineus often confused with?

adductor brevis

Label structures 1-4

pectineus, adductor brevis, adductor longus, gracilis

Label structures 1-6

gluteus minimus, piriformis, gemellus superior, obturator interns, gemellus inferior, quadratus femoris

What does the obturator externus do to the thigh?

lateral rotation plus abduction of the thigh when hip flexed

What is hip abduction

movement of thigh away from bodies midline

What is the innervation and blood supply of the obturator externus

obturator nerve, obturator artery

What group is the obturator part of

lateral rotator muscles

What does the adductor brevis do?

adducts and flexes hip, stabilises pelvis

What does the adductor longus do?

adducts and flexes hip, stabilise pelvis

What are the two portions of the adductor Magnus?

ischiocondular portion, pubofemoral portion

What do the portions of the adductor Magnus do? (ishiocondular and pubofemoral)

both adduct hip, ishiocondular extends hip, pubofemoral flexes the hip

How do you remember the difference between extension and flexion?

extension extends angle between two body parts by straightening joint, flexion reduces angle by bending joint

What supplies the adductors?

deep femoral artery, obturator nerve

What thigh compartment are the adductors part of?

The medial

The pubofemoral region of the adductor Magnus is activated and innervated as a adductor what is the ishioondular portion activated and innervated as?

a hamstring

Label these structures from left to right

adductor magnus, ischiocondular portion, pubofemoral portion

What memorable action does gracilis do (different from standard flexion, adduction etc…)?

Helps you not pee yourself by providing stable anchor for pelvic floor to brace against

What does gracilis do?

flexion and adduction of hip, flexion and medial rotation of knee

What innervates and supplies the medial compartment?

obturator nerve, deep femoral artery

Which compartment is gracilis part of

medial

What is the pes anserinus?

conjoined tendons of semitendinous, sartorius and gracilis

Label structures 1-4

gracilis, semitendinosos, sartorius, pes anserinus

What does pes anserinus mean in English (helps remember job)?

goose foot

How many structures are in the femoral triangle and what types?

4, 1 nerve, 2 vessels, 1 space

What is the memory device for remembering the boundaries of the femoral triangle?

SAIL

What are the borders of the femoral triangle

sartorius muscle (lateral), adductor longus muscle (medial), inguinal ligament (superior), Fascia latte and skin (roof)