Bio 502 Fall 2016: Lecture #4: Thigh & knee
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Which structure(s) marks the superior anterior boundary from the pelvis to the thigh?
The inguinal ligament
Which structures travel within the femoral triangle?
Femoral artery, femoral nerve & femoral vein, and lower limb lymphatics
True or False: the femoral nerve travels through the femoral triangle outside of the femoral sheath.
TRUE. The femoral artery and vein and the lower limb lymphatics are enclosed within the femoral sheath, the femoral nerve is outside of it.
True or false: adductor longus participates in the floor of the femoral triangle.
TRUE. The floor of the femoral triangle is formed by iliopsoas, pectineus and adductor longus.
What is the functional significance of the valgus angle of the knee?
It places the knees in the midline of the body which helps reduce vertical and horizontal fluctuations of the center of mass during bipedal locomotion, thereby conserving energy.
True or false (if false, provide the correct information): muscles in the posterior compartment of the thigh extend the leg at the knee.
FALSE. muscles in the posterior compartment of the thigh flex the leg at the knee.
What is the primary source of innervation in the medial compartment of the thigh and which muscles are the exceptions?
The obturator nerve (andi ts branches) supplies most of the medial compartment of the thigh. Pectineus and the hamstring portion of adductor magnus are the exceptions.
List the primary arterial branches of the deep artery of the thigh
- 1) medial circumflex femoral artery
- 2) lateral circumflex femoral artery
- 3) 1st-3rd perforating arteries
- 4) artery of the adductors
Select the statement(s) that best associate(s) structures to their communicating region:
A) The sciatic nerve passes into the gluteal region through the superior opening in the greater sciatic notch
B) The femoral nerve, artery and vein pass through the adductor hiatus
C) The superior and inferior gluteal nerves pass through the greater sciatic foramen
D) The obturator foramen & canal allow passage of the obturator nerve, artery and vein, and the nerve to piriformis
E) The sacrotuberous and sacrospinous ligaments participate in transforming the greater sciatic notch into the greater sciatic foramen
Using anatomical landmarks, describe the path of the medial circumflex femoral artery between its origin and the abdominal aorta.
- 1) The abdominal aorta travels to the left of the spinal column and bifurcates at L4
- 2) bifurcates into the right and left common iliac arteries
- 3) They travel toward the SI joint where they bifurcate into the internal and external iliac arteries
- 4) the external iliac artery travels toward the inguinal ligament and passes deep to it to enter the anterior compartment of the thigh
- 5) in the thigh, it is renamed the femoral artery
- 6) the deep artery of the thigh branches from the femoral artery near the proximal aspect of the femoral artery
- 7) the medial circumflex femoral artery is generally the first and largest branch from deep femoral and comes off medially, then dives deep
Derive the arterial path of the medial circumflex femoral artery starting at the abdominal aorta.
Abdominal aorta/left or right common iliac arteries/external iliac artery/femoral artery/deep artery of the thigh/medial circumflex femoral artery
When are psoas major and iliacus active during the walking gait?
They are active during the initial swing period when you are not walking at your optimal speed (speeding up or slowing down).
Trace the innervation of sartorius from the target to the appropriate spinal levels and indicate which levels are primary.
- Sartorius/femoral nerve/L2&L3
- Both levels are primary
Trace the common fibular nerve back to its spinal levels.
Common fibular nerve/Sciatic nerve/L4, L5, S1, S2
What are the spinal levels of iliacus? Provide the primary level(s), as well.
L2 and L3, with primary from L2
List all of the muscles in the thigh that insert along the linea aspera
- 1) adductor brevis
- 2) adductor longus
- 3) adductor magnus, adductor portion
True or false (if false, provide the correct information): all of the muscles in the anterior compartment are active during terminal swing. Provide the functions of any that are active at this period.
FALSE. the quads are acting to extend the leg at the knee. But none of the other muscles in the anterior thigh act during terminal swing.
Give the function of biceps femoris and explain why the muscle is able to participate in each action.
- Short and long head: flex the leg at the knee and laterally rotates the leg at the knee. Both muscles cross posterior and lateral to the knee joint, so both are able to flex and laterally rotate the knee.
- Long head ONLY: extend the thigh at the hip joint and laterally rotate the thigh. Long head also crosses posterior to the hip joint, so it is able to act on the thigh.
- Lateral rotation of the leg and thigh occur because the fibers travel posteriorly and laterally through the thigh and when they contract, the leg and thigh are pulled posteriorly and laterally, resulting in lateral rotation.
If L2 contributions to the femoral nerve were non-functional would you be able to extend the leg at the knee? Explain your answer
Yes because the muscles that extend the leg at the knee receive primary spinal fibers from L3 and L4 in the femoral nerve and they would remain functional.
If all of the fibers contributing to the femoral nerve was non-functional would you be able to flex your thigh at the hip joint? Explain your answer.
Somewhat. Psoas major is innervated by the anterior rami of L1, L2 and L3 and it would remain functional.
True or false: All four of the quadricep femoris muscles can extend the leg at the knee and flex the thigh at the hip. Explain your answer.
FALSE: only rectur femoris can act on the thigh because it is the only muscle that crosses the hip joint.
True or false: The two heads of biceps femoris are the straight head and the long head.
FALSE: the heads are the long head and the short head.
List the muscles in the posterior compartment of the thigh.
- 1) biceps femoris, short head and long head
- 2) semitendinosus
- 3) semimembranosus
What are the spinal levels of the sciatic nerve?
What are the primary branches of the sciatic nerve and what are their spinal levels?
- Tibial: L4 - S3
- Common fibular: L4 - S2
True or false: Both heads of bicpes femoris insert into the head of the fibula.
Trace the superior blood supply of the psoas major mucle back to the abdominal aorta.
Psoas major/lumbar arteries/abdominal aorta
What type of joint is the knee joint?
A synovial hinge joint or a bycondylar synovial joint
True or false: the tibiofibular articulation is NOT a part of the knee joint.
What is the primary weight-bearing articulation of the knee joint?
The articulation between the distal femur and the proximal tibia
True or false: The menisci are connected to the tibial plateau along their inferior surfaces.
FALSE. The inferior surfaces of the menisci are left unattached which allows synovial fluid to bathe the inferior surface, providing them with nutrients and helping reduce friction.
Describe the relationship between the medial meniscus and the fibrous joint capsule of the knee, as well as the functional significance of this relationship.
The medial meniscus is attached to the fibrous joint capsule of the knee and to the medial collateral ligament. Consequently, the medial meniscus is less mobile compared with the lateral meniscus. This relative immobility may be the reason that the medial meniscus is torn more frequently than the lateral.
List the ligaments of the knee that are included within the synovial membrane of the knee joint.
None of them are included within the synovial membrane.
List four ligaments of the knee joint
- 1) Tibial collateral ligament (AKA medial collateral ligament, both are fine)
- 2) fibular collateral ligament (AKA lateral collateral ligament, both are fine)
- 3) Anterior cruciate ligament
- 4) posterior cruciate ligament
- 5) Patellar ligament
- 6) oblique popliteal ligament
- 7) transverse ligament
Describe the function of the quadriceps femoris muscle during the walking gait, including the portions during which it is active and the muscles that are acting with it.
- The quads are active during initial contact, loading response and terminal swing. No other muscles act with the four quadriceps to perform the same action.
- During initial contact and loading response they are acting to prevent flexion of the leg at the knee joint. During terminal swing, they are acting to actively extend the leg at the knee.
The following statement(s) is/are true regarding the walking gait:
A) Forefoot rocker occurs during pre-swing B) The body’s center of mass reaches its peak height during mid-stance
C) Gastrocnemius and soleus act during loading response to restrain the forward rotation of the leg about the ankle
D) Gluetus minimus and gluteus medius pull the stance side pelvis onto the stance side leg while the swing side leg is not in contact with the ground
E) The lower limb passes beneath the body during initial swing
A)Describe the path of general somatic efferent nerve fibers from the spinal cord to a generic limb target, including transitions and unions along the way
B) state what type of information (AKA signal, impulse) these fibers carry and their potential targets
- A) The impulse originate in the spinal cord. They exit the spinal cord via the ventral/anterior root. Join with fibers from the posterior root to form the spinal nerve. The fibers continue via the anterior ramus and proceed out to their intended muscular target.
- B) GSE fibers carry motor impulses from the CNS to the skeletal muscles, skin, and joints.
The anterior roots at levels L4 and L5 are rendered completely non-functional. Which muscles in the gluteal region and thigh will the patient be:
A) completely non-functional
B) compromised, but still functional
For each muscle, list their associated spinal levels
- A) Entirely non-functional:
- no muscles are completely non-functional
- B) Compromised:
- G. Max (L5, S1, S2)
- G. Med and Min (L4, L5, S1)
- TFL (L4, L5, S1)
- the gemelli, obturator internus & quadratus femoris (L5, S1)
- Quadriceps (L2, L3, L4)
- Adductor longus (L2, L3, L4)
- Both portions of adductor magnus (L2, L3, L4)
- All muscles in the posterior compartment of the thigh (L5, S1, S2)
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