Anat Intro/Anterior & Medial Thigh (1)

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Anat Intro/Anterior & Medial Thigh (1)
2014-02-26 00:25:56
MBS Anatomy
Exam 1
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  1. Name the Planes
    coronal (frontal) plane
    • transverse (axial) plane
    • used for CAT Scans/MRIs (radiological imaging)
    • rule is you're standing at a person's feet & looking up toward their head
  4. Afferent
    conducting a nerve impulse FROM the periphery TOWARD the CNS (periphery → CNS)
  5. Efferent
    conducting a nerve impulse away from the CNS toward a target muscle (CNS → periphery)
  6. Flexion
    bending or making a decreasing angle between bones or body parts such that 2 ventral surfaces are brought closer together
  7. Extension
    • bending or making an INCREASING angle between 2 ventral surfaces
  8. Abduction
    • movement away from the median plane
    • (when a child is ABDUCTED he/she is taken AWAY)
  9. Adduction
    • movement toward the median plane
    • (when you ADD something you are putting it TOGETHER)
  10. Ankle/Foot Movement
    • Inversion ~ "sickling"
    • Eversion ~ "winging"
    • Dorsiflexion (extension): "when you flex your foot"
    • Plantarflexion: "when you point your foot"
  11. During a movement, which part of the muscle moves least & which part moves most?
    • muscle origin: moves least
    • muscle insertion: moves most (where muscle progresses into tendon & connects to a bone) & causes most of the action during contraction
    • movement = muscle contraction
  12. What are the 2 major functions of the lower limb?
    • 1. weight bearing (& balance)
    • 2. locomotion
    • must be mobile around 3 joints & achieve stability as a bipedal organism
    • lower limb is divided into 4 regions separated by joints: 1. hip, 2. thigh, 3. leg (tibia/fibula/calf/shin region), & 4. foot
  13. Locomotion: The Gait Cycle
    • consists of alternating cycles of stance (foot is completely or partially on the ground) & swing (foot is off the ground) phases
  14. Bony Pelvis
    consists of 2 paired (L & R) hip bones + the sacrum
  15. Hip Bones
    • comprised of the Ilium, Pubis, & Ischium (among others)
  16. Ilium
    • contains iliac crest [what you can feel as "hip bones"]
    • + the ASIS & AIIS (anterior superior/inferior iliac spine)
    • + the PSIS & PIIS (posterior superior/inferior iliac spine)
  17. Anterior Inferior Iliac Spine (AIIS)
    • on the ilium anterior but inferior to the ASIS
    • where the rectus femoris muscle attaches (one of the quadriceps muscles)
  18. Pubis
    • consists of superior ramus & inferior ramus (ramus means branch)
    • + the pubic tubercle
    • both pubis' are fused by the pubic symphysis, a bar of cartilage that units the 2 pubic bones in midline
    • Pubis PICTURE
    • Inguinal Ligament
    • runs from the Anterior Superior Iliac Spine (ASIS) on the ilium to the pubic tubercle on the pubis
    • serves as a passageway for soft tissues as they course anteriorly from the lower abdomen (trunk) to the thigh region (lower extremity)
    • it demarcates the superior border of the femoral triangle
  20. Ligament
    structure that connects 2 or more bones
  21. Aponeurosis of the External Oblique
    • flat tendanous sheet over the abdominal muscles
    • its lower edge forms the inguinal ligament (folds underneath itself - forms a kind of trough)
  22. Ischium
    • posterior part of the pelvis
    • rounded protuberance = ischial tuberosity ["sits bones" - what you feel when sitting]
  23. Acetabulum
    • a depression where the 3 hip bones (ilium, pubis, ischium) merge to form the socket of hip joint where the head of the femur (ball) sits
  24. Obturator Foramen
    • cavity formed by the fusion of the inferior ramus of the pubis & the ramus of the ischium
    • opening is for the obturator nerve to pass through (supplies muscles in the medial part of the thigh)
    • is covered over by a layer of fascia
  25. Condyles
    • knuckle-like processes on the distal end of the femur
    • medial & lateral
    • articulate w/ the upper surface of the tibia (plateaus) to form part of the knee joint
    • patella fits between the medial & lateral condyles
  26. Epicondyles
    • ridges on the top of the knuckle-like process on the distal end of the femur ABOVE the condyles
    • epi means above
    • medial & lateral
  27. Linea Aspera
    • ridge that runs length-wise along the posterior portion of the shaft of the femur
    • where medial adductor muscles in the medial part of the thigh that originate on the pelvis INSERT (when they contract they can pull the femur toward the midline)
  28. Greater & Lesser Trochanter
    • lesser: where the psoas major muscle attaches
  29. Intertrochanteric Line (spiral line of the femur)*
    • a line located on the anterior side of the proximal end of the femur that stretches between the lesser trochanter & the greater trochanter forming the base of the neck of the femur
    • iliofemoral ligament attaches above the line
    • the lower half gives origin to the upper part of the Vastus medialis
  30. Intertrochanteric Crest & Line*
    mark the transition between the femoral neck & shaft
  31. Tibia & Fibula
    • the tibia is more medial & bears weight, while the fibula ("pin-like") is lateral & doesn't bear any weight
    • both bones flare out near the ankle joint into a malleolus (lateral on the fibula, medial on the tibia)
    arrow on the right points to the Tibial Tuberosity, a bony prominence where the patellar ligament attaches (a continuation of the quadriceps muscle in the thigh)
  33. Fascia Lata
    the deep fascia of the thigh - forms a "stocking" around all the muscles in the thigh
  34. Great Saphenous Vein
    • a long, slender vein that exists superficial to fascia lata
    • & runs from dorsal surface of foot up the medial side of leg, behind knee, & up medial inner thigh
    • is a superficial vein that drains blood from the skin/other superficial tissues in the lower limb
    • has tributaries that extend over much of the thigh
    • will pierce through the fascia lata & join a deeper vein, the femoral vein (through a perforating vein), which returns to the inferior vena cava
  35. Saphenous Opening
    • an oval opening in the superomedial part of the fascia lata of the thigh that transmits the great saphenous vein & other smaller vessels (eg. superficial epigastric artery, superficial external pudendal artery) + the femoral branch of the genitofemoral nerve
  36. Small Saphenous Vein
    starts on the lateral side of the foot, runs up the back of the leg, then pierces the fascia lata behind the knee
  37. Saphenous Cutdown
    • can locate the vein anterior to medial malleolus & insert into it a catheter to inject possibly large amounts of drug or fluid into the venous system
    • great saphenous vein is also used during the repair of coronary arteries
  38. Varicose Veins
    • enlarged tributaries of the great & small saphenous veins that arise when valves in the perforating veins become incompetent
    • this leads to retrograde venous blood flow into the superficial veins
    • may be associated w/ venous stasis ulcers, fungal & bacterial infections, phlebitis (inflammation of the veins), or deep venous thrombosis
  39. Inguinal Region (Groin Region)
    region below the inguinal ligament in the upper part of the thigh
  40. Superficial Inguinal Lymph Nodes
    • consist of the superolateral, superomedial, & vertical lymph nodes that lie in the inguinal region
    • drain lymph from the superficial skin & subcutaneous tissues BELOW the umbilicus (belly button)
    • can be visualized using a lymphangiogram (dye is injected & picked up by lymphatic channels)
  41. Deep (Investing) Fascia
    a fascia (layer of fibrous connective tissue) which can surround individual muscles & also divide groups of muscles into compartments
  42. Concept of Compartments
    • muscles in the extremities (upper & lower limbs) are packaged into compartments
    • within a compartment there is 1 major artery & 1 major nerve
    • the contents of 1 compartment are contained in a tough connective tissue called the deep fascia
    • muscles in a compartment all perform a similar function
  43. Posterior Compartment
    • contain the hamstring muscles - can extend (straighten) the thigh at the hip & flex the leg at the knee
    • muscles cross both the hip joint & the knee joint posteriorly
    • muscles here are supplied by the tibial division of the sciatic nerve
  44. Muscles that will Flex the Thigh at the Hip
    • need to look inside the abdomen at those muscles
    • psoas, iliacus, & iliopsoas muscle
    • Psoas Major Muscle
    • originates off lumbar vertebrae, merges with the iliacus muscle, & ends in a tendinous attachment to the lesser trochanter (femur)
    • contributes to flexion & external rotation in the hip joint
    • forms part of a group of muscles called the hip flexors, whose action is primarily to lift the upper leg towards the body when the body is fixed or to pull the body towards the leg when the leg is fixed
    • Iliacus Muscle
    • fills the iliac fossa
    • merges with the psoas muscle & ends in the iliopsoas tendon which inserts at the lesser trochanter
    • Iliopsoas Muscle
    • contraction pulls on the femur & elevates it into a flexor position
    • the main flexor muscle of thigh at the hip
    • Pectineus Muscle
    • more medial muscle that helps the iliopsoas to flex & adduct the thigh (muscle fibers are oriented medial → lateral)
    • originates at the pubis & inserts below the lesser trochanter
    • one of the adductor muscles
  49. Anterior Compartment
    • mainly flexors of the thigh at the hip or muscles (like our quadriceps) that extend the muscle at the knee joint
    • all supplied by the femoral nerve or its branches
  50. Quadriceps Muscle
    • has 4 portions that combine to form a common quadriceps tendon: Rectus Femoris, Vastus Intermedius, Vastus Lateralis, & Vastus Medialis
    • the vasti originate off the femur - they DON'T cross the hip joint itself
    • the rectus femoris originates on the AIIS → anteriorly cross the hip joint → joins the other 3 parts of the quadriceps to form the common quadriceps tendon
    • when they contract they pull on the leg & bring it into an extention (main extenders of the leg at the knee joint*)
  51. Femoral Nerve
    supplies the 4 muscles of the quadriceps
  52. Quadriceps Tendon
    attaches to the patella → is extended across the knee joint space → inserts on the tibial tuberosity
    • Sartorius Muscle ("like a tailor")
    • starts on anterior superior iliac spine (ASIS) → runs medially & inferior → goes behind the knee a little → inserts on the upper part of the tibia (crosses both the hip & knee joint)
    • can help 1) flex the thigh at the hip joint (b/c it crosses the joint anteriorly) 2) abduct the thigh 3) flex the leg at the knee joint (b/c it crosses behind the knee joint)
    • supplied by a branch of the femoral nerve
  54. What can weakness in one part of the quadriceps muscle lead?
    quadriceps imbalance, when the patella is pulled in abnormal directions due to one muscle being weak & its opposite being normal → patella can rub against condyle of the femur → knee pain
  55. Iliotibial Tract
    • a thickened layer of fascia lata that surrounds the thigh & has contributions from the tensor fascia lata (originates at the iliac crest) & the gluteus maximus
    • it crosses at the knee joint laterally & inserts at the upper tibia
    • braces the knee when standing straight so we don't have to use a lot of muscle to keep upright
  56. Femoral Triangle
    • passing through the triangle is the femoral Nerve, femoral Artery, & femoral Vein
    • (in that order, lateral → medial, can use mnemonic NAVeL)
    • boundaries are formed by the sartorius, adductor longus, & inguinal ligament
  57. Femoral Sheath
    • a layer of fascia that encloses the femoral artery, vein, & the inguinal lymphatics as they pass from the lower part of the abdomen into the upper part of the thigh through the femoral triangle
    • fascia is derived from that covering the abdomen & the sheath passes over the iliopsoas muscle
    • it's at the femoral triangle where the great saphenous vein penetrates through the femoral sheath & joins the femoral vein
    • the femoral nerve is NOT contained by femoral sheath - has its own fascia
  58. Femoral Canal
    • the medial & smallest compartment of the femoral sheath; contains efferent lymphatic vessels & a lymph node
    • is a potential route for abdominal contents (eg. intestines) in the case of hernia
  59. Femoral Artery
    • continuation of the external iliac artery which comes from the common iliac artery which is one of the branches of the aorta
    • when the external iliac artery passes UNDER the inguinal ligament it becomes the femoral artery (which then goes on to branch into the superficial & deep femoral arteries)
  60. Superficial Femoral Artery
    travels down the back of the thigh → passes through the popliteal fossa in the back of the knee → provides blood to the knee joint → goes on to the leg & foot
  61. Deep Femoral Artery
    • runs more laterally & branches into Circumflex femoral arteries, which supply blood to the HIP joint, particularly the neck & head of the femur*
    • circumflex means to go around/surround something (& potentially connect up) to provide collateral circulation around a particular area
  62. The circumflex arteries produce an __________ between the medial femoral circumflex (which goes posteriorly around the head & neck of the femur) & the lateral femoral circumflex (which goes around anteriorly around the top of the femur)
    • anastomosis
    • medial femoral circumflex: provides arteries to the HEAD of the femur
    • lateral femoral circumflex: provides arteries to the neck & greater trochanter of the femur (?)
  63. A fracture of the neck of the femur may rupture which arteries?
    • the medial femoral circumflex arteries
    • this will deprive the head of the femur of its blood supply → avascular necrosis (death of the bone)
  64. How do the superficial femoral artery & vein travel in relation to each other?
    • they travel together down the adductor canal (ALONG WITH the saphenous nerve)
    • the artery starts lateral to the vein but then twists around so the artery becomes anterior to the vein
    • will travel through an opening in the adductor magnus muscle to travel behind the knee where they turn into the popliteal vessels
  65. Arteriogram
    using dye can visualize arteries & tell if there's an occlusion anywhere
  66. Femoral Nerve
    provides motor branches to the quadriceps muscle(s) & to the sartorius
  67. Saphenous Nerve
    • branches from the femoral nerve & runs down the adductor canal between the vastus medialis & the adductor muscles in the medial part of the thigh all the way down to the medial part of the ankle
    • a sensory nerve only (contains no motor branches) - will provide sensation down its path
  68. Medial Compartment
    • contains the adductor muscles - bring the thigh closer to the midline
    • supplied by the obturator nerve
    • originate on the pubis, superior ramus, the body, & the inferior ramus → run laterally → insert on the linea aspera (back of the femur)
    • arranged in 2 planes: an anterior more superficial one & a deeper plane
  69. Gracilis ("Graceful")
    crosses the knee joint from the medial side & inserts near where the sartorius inserts on the upper, medial, anterior part of the tibia
  70. Adductor Brevis
    lies posterior to the superficial adductor muscles
  71. Adductor Magnus
    • lies posterior to the superficial adductor muscles
    • have both horizontally & vertically oriented muscle fibers
    • also has perforations close to its attachments on the linea aspera for branches of the deep femoral artery to perforate the posterior muscles of the thigh
  72. What is the one part of the adductor muscle is not supplied by the obturator nerve? What nerve is it innervated by?
    the hamstring part of the adductor magnus is supplied by the tibial division of the sciatic nerve (instead of the obturator nerve)
  73. Adductor Hiatus ("Opening")
    • an opening where the hamstring part of the adductor magnus becomes a tendon
    • the superficial femoral artery & femoral vein will travel down the lower part of the thigh & pass through this opening, allowing them to go from the medial compartment of the thigh → the posterior compartment of the knee
    • *this is where the femoral artery & vein become the popliteal artery & vein
  74. Lumbar Plexus of Nerves
    give rise to the femoral & obturator nerves
  75. Spinal Nerves
    • there are 31 pairs of spinal nerves
    • 8 in the cervical region, 12 in the thoracic region, & 5 in both the lumbar & sacral region
    • grey matter contains the cell bodies of neurons; white matter contains the neuron axons
  76. Dorsal v. Ventral Roots
    • ventral roots contain motor nerves that stimulate the contraction of muscle (effect nerve fibers CNS → periphery)
    • dorsal roots contain sensory neurons (afferent nerve fibers → periphery)
    • come together to form the typical spinal nerve which then goes on to divide into the typical ventral & dorsal primary ramus
  77. Ventral Primary Rami
    • cover more of the body than the dorsal primary rami in terms of sensation & motor innervation
    • mixed ventral primary rami are what form plexuses, connections between multiple spinal chord levels
    • (Dorsal primary rami only innervate muscles in the back)
  78. Plexus
    • orderly intermingling of the ventral primary rami of spinal nerves
    • eg. the femoral nerve has contributions from L2, L3, & L4
    • the obturator nerve also originates from the 2nd, 3rd, & 4th lumbar part of the spinal chord (from those ventral primary rami)
  79. Femoral Nerve Area of Sensation (blue)
    • thigh: anterior cutaneous branches of the femoral nerve
    • medial side of leg/ankle: provided by saphenous nerve (branch of the femoral nerve)
    • femoral nerve also supplies motor innervation to the quadriceps muscle
  80. Patellar Tendon (Quadriceps) Reflex
    • stimulating sensory fibers carried by the saphenous branch of the femoral nerve back toward the CNS
    • sets up a reflex arc
  81. Obturator Nerve Area of Sensation (blue)
    • mostly innervates the adductor muscles but has an area of sensation on the upper medial part of the thigh
  82. Dermatomes ("slice of skin")
    • an area of skin that is mainly supplied by a single spinal nerve
    • can divide body into 'slices' such that sensation within dermatones will go back to a particular spinal chord level
    • different from sensation provided by peripheral nerve
    • eg. if you damage the ventral primary ramus of L3, might lose sensation along the L3 dermatomes (wouldn't lose it entirely b/c there's some dermatome overlap)
    • eg. if you cut the femoral nerve itself, you would lose sensation in a wider part of the skin (all areas where L2, L3, L4 innervate/are)