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Questions and Answers

Damage to the obturator nerve would most significantly impair which of the following actions?

  • Flexion of the thigh at the hip joint.
  • Adduction of the thigh at the hip joint. (correct)
  • Extension of the leg at the knee joint.
  • Lateral rotation of the thigh at the hip joint.

A patient presents with an inability to extend their leg at the knee. Which nerve is most likely affected?

  • Obturator nerve.
  • Tibial nerve.
  • Femoral nerve. (correct)
  • Sciatic nerve.

The profunda femoris artery is a major blood supply to which thigh compartment?

  • Anterior compartment.
  • Lateral compartment.
  • Medial compartment. (correct)
  • Posterior compartment.

Which muscle is innervated by both the femoral and sciatic nerves?

<p>Adductor magnus. (D)</p> Signup and view all the answers

The adductor hiatus serves as a passageway for the femoral artery and vein to transition into which vessels?

<p>Popliteal artery and vein. (D)</p> Signup and view all the answers

Which of the following muscles contributes to both flexion and lateral rotation of the thigh at the hip joint?

<p>Sartorius. (D)</p> Signup and view all the answers

Which muscle is NOT located in the medial compartment of the thigh?

<p>Biceps femoris. (C)</p> Signup and view all the answers

Which of the muscle does NOT adduct the thight?

<p>Rectus femoris. (A)</p> Signup and view all the answers

A patient has difficulty raising their trunk from a supine position. Which muscle is mostly likely affected?

<p>Iliopsoas. (C)</p> Signup and view all the answers

Which action is primarily associated with the muscles of the anterior compartment thigh?

<p>Both B and C. (C)</p> Signup and view all the answers

During thigh extension, the iliofemoral, ischiofemoral, and pubofemoral ligaments experience a change. What is the primary mechanical effect of this change on the hip joint?

<p>Enhanced joint stability due to increased ligament tension (B)</p> Signup and view all the answers

A patient presents with a fracture of the femoral neck. Which of the following structures is MOST at risk of being compromised, potentially leading to avascular necrosis of the femoral head?

<p>The ligamentum teres (D)</p> Signup and view all the answers

Following a deep laceration to the anterior thigh, a patient exhibits significant weakness in hip flexion and knee extension. Which of the following muscles is MOST likely affected, given its dual role at both joints?

<p>Rectus Femoris (A)</p> Signup and view all the answers

A surgeon is planning to perform a hip replacement. During the procedure, they need to carefully dissect the ligaments surrounding the hip joint. Damage to which ligament would MOST significantly compromise the hip's resistance to hyperextension?

<p>Iliofemoral ligament (D)</p> Signup and view all the answers

A patient is diagnosed with compartment syndrome in the thigh, specifically affecting the anterior compartment. Which vascular structure is MOST likely to be compressed, potentially exacerbating the condition?

<p>Femoral Artery (A)</p> Signup and view all the answers

A 60-year-old male presents with pain in his groin and thigh. Imaging reveals avascular necrosis of the femoral head. Occlusion of which artery would MOST DIRECTLY lead to this condition?

<p>Medial circumflex femoral artery (A)</p> Signup and view all the answers

A patient reports experiencing numbness and tingling in the anterior thigh. Compression of which structure as it passes under the inguinal ligament would MOST likely cause these symptoms?

<p>Femoral nerve (D)</p> Signup and view all the answers

During a surgical procedure involving the posterior thigh, a surgeon must carefully consider the path of the sciatic nerve. Which anatomical landmark can BEST guide the surgeon in locating and protecting the sciatic nerve during the approach?

<p>Adductor hiatus in the adductor magnus (D)</p> Signup and view all the answers

A patient presents with a chronic groin pain that is exacerbated by hip flexion. Which of the following structures is MOST likely the source of the patient's pain?

<p>Pubofemoral ligament (A)</p> Signup and view all the answers

A patient is involved in a motor vehicle accident, resulting in a pelvic fracture that disrupts blood flow through the external iliac artery. What is the MOST likely immediate consequence regarding blood supply to the lower limb?

<p>Compromised blood flow to the foot and toes (D)</p> Signup and view all the answers

If a patient experiences damage to the ascending branch of the lateral circumflex femoral artery, which of the following complications is MOST likely to arise due to impaired blood supply?

<p>Impaired blood supply to the hip joint capsule and surrounding muscles, causing pain and limiting range of motion. (D)</p> Signup and view all the answers

A surgeon performing a hip arthroplasty needs to carefully dissect around the obturator artery to avoid complications. If the obturator artery is inadvertently damaged, what is the MOST significant risk to the patient?

<p>Avascular necrosis of the femoral head due to disruption of blood flow through the ligamentum teres femoris. (B)</p> Signup and view all the answers

A patient presents with a deep laceration on the medial aspect of their thigh, just superior to the knee. After initial assessment, active hemorrhage from the great saphenous vein is noted. Which of the following describes the MOST appropriate next step in managing this patient's venous bleeding?

<p>Apply direct pressure to the wound while preparing for possible surgical repair of the great saphenous vein. (D)</p> Signup and view all the answers

A patient reports numbness in the anterior thigh after a recent surgery involving the inguinal region. Given the anatomical relationships within the femoral triangle, which nerve is the MOST likely to have been iatrogenically injured?

<p>Femoral nerve (B)</p> Signup and view all the answers

During a surgical procedure to repair a femoral hernia, a surgeon inadvertently damages the medial border of the femoral triangle. Which structure is MOST at risk for injury?

<p>Adductor longus muscle (D)</p> Signup and view all the answers

A patient is diagnosed with lymphedema in the lower limb due to lymphatic vessel compression. Considering the anatomical location of the femoral canal, which of the following structures is MOST likely responsible for this compression?

<p>Enlarged lymph nodes within the femoral canal. (C)</p> Signup and view all the answers

A patient presents with weakness in hip abduction and foot eversion following an injury. Based on the nerve supply of the lower limb, damage to which nervous plexus is MOST likely?

<p>Lumbar plexus (C)</p> Signup and view all the answers

Damage to the superior gluteal nerve results in a characteristic gait abnormality. Which of the following compensatory mechanisms is MOST likely observed in a patient with this nerve injury?

<p>Trendelenburg gait, characterized by a drop in the pelvis on the contralateral side during single-leg stance. (D)</p> Signup and view all the answers

A patient has a lesion in the anterior compartment of the thigh. Which of the following clinical presentations would be MOST consistent with this condition?

<p>Difficulty with knee extension and hip flexion, without sensory deficits. (B)</p> Signup and view all the answers

A patient is unable to extend their knee against resistance but hip flexion is normal. Which specific muscle is MOST likely affected?

<p>Vastus Intermedius (A)</p> Signup and view all the answers

Which combination of actions is uniquely performed by the semitendinosus and semimembranosus muscles?

<p>Extend the trunk at the hip when the thigh and leg are flexed, in addition to extending the thigh and flexing the leg. (D)</p> Signup and view all the answers

If the superior gluteal nerve were severed, which specific actions would be most significantly compromised?

<p>Abduction and medial rotation of the thigh at the hip. (A)</p> Signup and view all the answers

A patient presents with an inability to extend their thigh at the hip. Damage to which nerve and corresponding arterial supply is most likely responsible?

<p>Inferior gluteal nerve and inferior gluteal artery. (A)</p> Signup and view all the answers

Which statement accurately contrasts the vascular supply to the posterior thigh compartment and the gluteal region?

<p>The posterior thigh primarily relies on perforating branches of the profunda femoris artery and popliteal artery, while the gluteal region is supplied by the superior and inferior gluteal arteries and the medial circumflex femoral artery. (C)</p> Signup and view all the answers

What is the functional consequence of selectively weakening the gluteus medius muscle?

<p>Difficulty maintaining a level pelvis during single-leg stance, leading to a Trendelenburg gait. (A)</p> Signup and view all the answers

How does the innervation of the biceps femoris muscle differ from that of the semitendinosus and semimembranosus muscles, and what functional implication does this have?

<p>The biceps femoris has both a tibial and fibular division innervation via the sciatic nerve, while the semitendinosus and semimembranosus receive only tibial innervation, which allows for slight differences in knee flexion and hip extension contributions. (B)</p> Signup and view all the answers

Damage specifically to the medial circumflex femoral artery would most significantly affect the blood supply to which group of muscles and what would be the primary functional deficit?

<p>Hip rotator muscles, potentially leading to instability and ischemic necrosis of the femoral head. (A)</p> Signup and view all the answers

A patient is diagnosed with piriformis syndrome, resulting in compression of the sciatic nerve. Which of the following symptoms would you expect, and how do they relate to the anatomy of the region?

<p>Pain radiating down the posterior aspect of the thigh and leg, potentially accompanied by muscle weakness, due to the sciatic nerve passing near or through the piriformis muscle. (B)</p> Signup and view all the answers

How do the actions of the gluteus medius and minimus muscles relate to the function of the tensor fascia lata (TFL), and how does this synergy contribute to lower limb stability?

<p>The gluteus medius and minimus abduct and medially rotate the thigh, while the TFL assists in hip flexion and abduction and knee stabilization through the iliotibial tract, contributing to pelvic and lower limb stability during movement. (D)</p> Signup and view all the answers

A surgeon needs to perform a procedure involving the obturator internus muscle. What other muscles must the surgeon be mindful of due to their close anatomical relationship, and what common action do these muscles share?

<p>Piriformis, superior gemellus, and inferior gemellus; all laterally rotate the thigh at the hip. (A)</p> Signup and view all the answers

Flashcards

Lateral Circumflex Femoral Artery

Branch of the deep femoral artery that circles the femur laterally, it has ascending and descending branches.

Artery of Ligamentum Teres Femoris

Provides blood flow to the femoral head. Branches from the obturator artery via the internal iliac artery.

Great Saphenous Vein

A superficial vein that runs along the medial side of the leg and thigh, draining into the femoral vein.

Femoral Triangle Borders

Sartorius muscle, adductor longus muscle and inguinal ligament.

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Fascia Lata

Deep fascia enclosing thigh muscles.

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Femoral Sheath

Funnel-shaped sleeve enclosing the femoral artery, vein, and canal.

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Femoral Canal

Medial compartment of the femoral sheath containing lymphatic vessels and nodes.

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Lumbosacral Plexus

Formed from lumbar and sacral nerves to supply the lower limb.

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Thigh Muscle Compartments

Anterior, medial, lateral and posterior.

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Anterior Compartment Thigh Muscles

Sartorius, rectus femoris, vastus lateralis, vastus medialis.

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Lower Limb Regions

Regions of the lower limb: hip, thigh (femoral), knee (patellar/popliteal), leg (crural), ankle, and foot.

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Lower Limb Bones

Bones of the lower limb include the os coxa (pelvis), femur, patella, tibia, fibula, 7 tarsals, 5 metatarsals, and 14 phalanges.

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Femur Key Features

The femur's key features include the head, neck, shaft (diaphysis), and condyles.

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Femur: Additional Features

The femur also features the greater and lesser trochanters, gluteal tuberosity, linea aspera, epicondyles, and patellar surface.

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Hip Joint Ligaments

The iliofemoral, pubofemoral, and ischiofemoral ligaments support the hip joint.

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Ligament Action During Thigh Extension

These ligaments twist when the thigh is extended, enhancing hip joint stability.

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Hip Joint Details

The lunate surface is within the acetabulum, and the ligamentum teres (ligament of the femoral head) is also present.

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Outline: Lower Limb Blood Flow

Overview of blood flow to the lower limb.

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Blood Flow into Thigh

The external iliac vessels pass under the inguinal ligament to enter the thigh.

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Thigh Arterial Blood Flow

The external iliac artery becomes the femoral artery, which branches into the profunda femoris (deep artery of thigh) and gives rise to the popliteal artery via the adductor hiatus.

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Quadriceps Femoris Tendon

The tendon connecting all four quadriceps muscles to the patella.

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Femoral Artery (Thigh)

The main artery supplying blood to the anterior thigh compartment.

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Femoral Nerve (Thigh)

The main nerve innervating the anterior thigh compartment muscles.

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Quadriceps Femoris Action

Extend the leg at the knee joint.

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Sartorius Action

Flex, abduct, and laterally rotate the thigh at the hip joint.

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Iliopsoas Muscle Actions

Flexes the thigh at the hip joint, raises trunk when lying supine, and is a postural muscle

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Adductor Canal

Passage for neurovascular structures from the femoral triangle to the popliteal fossa.

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Profunda Femoris & Obturator Arteries

Supply blood to the medial compartment of the thigh.

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Obturator Nerve (Thigh)

Innervates most of the medial compartment thigh muscles.

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Adductor Muscles Action

Adduct the thigh at the hip joint.

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Hamstring muscles action

Extend thigh at hip and flex leg at knee.

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Gluteus Maximus action

Extends thigh at hip

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Gluteus Medius & Minimus actions

Abduct and medially rotate thigh at hip

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Deep gluteal rotator muscles action

Laterally rotate thigh at hip & stabilize femoral head.

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Muscles of the posterior compartment of the thigh

Posterior thigh muscles: biceps femoris (long & short heads), semitendinosus, semimembranosus

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Function of the Gluteus Maximus

Extend thigh at the hip.

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Function of the Gluteus Medius and Minimus

Abduct and medially rotate the thigh at the hip.

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Blood supply to the gluteal region

Superior gluteal artery and vein, inferior gluteal artery and vein, and medial circumflex femoral artery and vein.

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Action of Piriformis and Obturator Internus

Muscles of the gluteal region which laterally rotates the thigh at the hip and steadies the femoral head in the hip joint.

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Innervation of gluteal muscles

Superior gluteal nerve (to gluteus medius, minimus, and tensor fascia lata) and inferior gluteal nerve (to gluteus maximus).

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Study Notes

  • Human Anatomy - ANTH/EEB/NURS 250 - Lecture 4.2

Lower Limb Regions

  • Regions include the hip, femoral (thigh), knee (patellar/popliteal), crural (leg), ankle and foot

Lower Limb Bones

  • Bones include the os coxa (pelvis), femur, patella, tibia and fibula
  • The foot bones include 7 tarsals, 5 metatarsals and 14 phalanges

Thigh: Femur

  • The femur is divided into the head, neck, shaft (diaphysis), condyles, greater and lesser trochanter, gluteal tuberosity, linea aspera, epicondyles and patellar surface

Thigh: Hip Joint

  • Ligaments of the hip include the iliofemoral, pubofemoral and ischiofemoral ligaments that TWIST when the thigh is EXTENDED
  • The hip joint also includes the lunate surface (within acetabulum) and ligamentum teres (ligament of the femoral head)

Lower Limb: Blood flow overview

  • Lower limb blood flow is supplied via the external iliac artery and the external iliac vein

Thigh: Blood flow into the thigh

  • Thigh blood flow enters via the inguinal ligament and superficial inguinal ring, then into the external iliac artery and vein

Thigh: Arterial Blood Flow

  • Arterial blood flow progresses from the external iliac artery to the femoral artery
  • From there, blood reaches the adductor hiatus (in the adductor magnus muscle) then the popliteal artery
  • Blood flow continues into the profunda femoris artery (deep artery of the thigh), medial circumflex femoral artery, and lateral circumflex femoral artery
  • The lateral circumflex femoral artery is divded into an ascending and a descending branch

Hip: Blood flow to the femoral head

  • Blood reaches the femoral head via the artery of the ligamentum teres femoris and the obturator artery (branch of the internal iliac artery)

Thigh: Great Saphenous Vein & Femoral Triangle

  • The femoral triangle constists of the femoral nerve, femoral artery and femoral vein
  • The great saphenous vein is on the medial side of the dorsal venous arch and connects to the femoral vein
  • The femoral triangle is bordered by the sartorius muscle, adductor longus muscle and inguinal ligament

Thigh: Femoral Triangle and Superficial Tissues

  • Tissues include the fascia lata (deep fascia enclosing the thigh muscles), femoral sheath (funnel-shaped fascial sleeve enclosing the femoral artery and vein), and femoral canal (medial compartment of the femoral sheath containing lymphatic vessels and nodes)

Lower Limb: Nerves Overview

  • Nerves include the lumbar nerves (lumbar plexus), sacral nerves (sacral plexus) and lumbosacral nervous plexus
  • Specific nerves include the lateral femoral cutaneous n., femoral n., obturator n., superior gluteal n., inferior gluteal n. and sciatic n

Thigh: Muscle Compartments

  • Anterior compartment
  • Medial compartment
  • Posterior compartment

Thigh: Anterior Compartment

  • Muscles include the sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius and quadriceps femoris tendon
  • Blood reaches this compartement via the femoral artery, femoral vein and lateral circumflex femoral artery
  • The femoral nerve innervates this compartment
  • The quadriceps femoris extends the leg at the knee joint
  • The sartorius flexes, abducts and laterally rotates the thigh at the hip joint
  • The rectus femoris flexes the thigh at the hip joint

Hip: Iliopsoas muscle

  • Contains the psoas major and iliacus muscles which are innervated by the femoral nerve
  • These muscles flex the thigh at the hip joint and raise the trunk when lying supine
  • The psoas is also a postural muscle

Thigh: Medial Compartment

  • Muscles include the pectineus, adductor brevis, adductor longus, gracilis, obturator externus and adductor magnus
  • Blood reaches this compartment via the profunda femoris artery, obturator atery, profunda femoris vein and obturator vein
  • Nerves that innervate this compartment include the obturator nerve, femoral nerve for only the pectineus muscle and sciatic nerve for the hamstring portion of the adductor magnus muscle
  • In terms of actions, muscles named “adductor” and gracilis ADDUCT the thigh at the hip joint
  • The pectineus and adductor longus WEAKLY FLEX the thigh at the hip joint
  • The adductor magnus EXTENDS the thigh (hamstring part) at the hip
  • Additionally, the obturator externus LATERALLY ROTATES the thigh at the hip joint

Thigh: Adductor Canal & Hiatus

  • This facilitates the passage for neurovascular structure from the femoral triangle to the popliteal fossa
  • The vastus medialis, adductor longus/magnus, and sartorius all influence this

Thigh: Posterior Compartment

  • The posterior compartment is also known as the hamstrings
  • Muscles incude the semitendinosis, biceps femoris (long head), biceps femoris (short head) and semimembranosus muscles
  • Blood reaches this compartment via the perforating branches of the profunda femoris artery, popliteal artery (distal portions only), perforating branches of the profunda femoris vein and popliteal vein (distal portions only)
  • The sciatic nerve innervates this compartment
  • In terms of actions, the semitendinosus, semimembranosus and biceps femoris all EXTEND the thigh at the hip and FLEX the leg at the knee
  • The semitendinosus and semimembranosus ALSO EXTEND the trunk at the hip WHEN the thigh and leg are flexed

Thigh: Gluteal Region

  • Includes the gluteal aponuerosis (over the gluteus medius), gluteus maximus, gluteus medius, tensor fasica lata and iliotibial tract
  • Blood reaches this region via the superior gluteal artery and vein, inferior gluteal artery and vein and medial circumflex femoral artery and vein
  • Nerves that innervate this region include the superior gluteal nerve (gluteus medius, gluteus minimus and tensor fascia lata) and inferior gluteal nerve (gluteus maximus)
  • Also includes the gluteus minimius, piriformis, superior gemellus, obturator internus, inferior gemellus and quadratus femoris muscles

Thigh: Piriformis and Obturator Muscles

  • Includes the piriformis m., pudendal n., obturator internus m., and obturator externus m. with relevant sacral spinal nerve levels

Thigh: Gluteal Region - Actions

  • Actions of the gluteal region include:
  • Gluteus maximus - EXTEND thigh at hip
  • Gluteus medius & minimus- ABDUCT and MEDIALLY ROTATE thigh at the hip
  • All other muscles - LATERALLY ROTATE thigh at hip and STEADY femoral head in the hip joint

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