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Questions and Answers
The femoral triangle is a significant transition area in the lower limb.
True
The pelvis and lower limb bones are not covered in the learning outcomes of the lecture.
False
The anterior and medial compartments of the thigh include muscles and have specific innervation.
True
Varicose veins cannot develop from any complications related to treatment.
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There are no saphenous veins mentioned in the learning outcomes.
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Clinical landmarks for examination of the anterior and medial thigh are included in the learning outcomes.
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The popliteal fossa is located on the front of the knee.
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The recommended reading includes various anatomical texts and atlases.
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Fascia lata is a structure found in the thigh and gluteal region.
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The iliofemoral ligament connects the iliac crest to the knee.
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The small saphenous vein ascends along the anterior side of the leg.
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Varicose veins are characterized by dilated and elongated superficial veins.
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Valves in healthy veins help prevent blood from flowing backwards.
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Great saphenous vein drains into the popliteal vein.
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The tensor fascia lata muscle attaches to the iliotibial tract.
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Blood accumulation in veins due to incompetent valves is referred to as varicose veins.
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The superior boundary of the femoral triangle is the inguinal ligament.
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The floor of the femoral triangle includes the gluteus medius muscle.
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The femoral nerve is contained within the femoral sheath.
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Lymph nodes are one of the contents of the femoral triangle.
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The great saphenous vein drains into the popliteal fossa.
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The femoral canal is located in the medial compartment of the femoral sheath.
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Anatomically, the femoral ring is considered a weak area through which abdominal content can protrude.
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The apex of the femoral triangle is continuous with the popliteal fossa.
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A patellar fracture usually occurs from a direct blow to the front of the knee.
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Patellar dislocation results in the patella slipping medially.
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Non-displaced patellar fractures require 6-8 weeks of immobilization in a cast.
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Surgical treatment is often needed for displaced patellar fractures.
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Rehabilitation for a patellar dislocation can take between 6 to 10 weeks.
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The femoral artery is a continuation of the brachial artery.
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The popliteal artery is found at the popliteal fossa.
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The adductor hiatus marks the transition point from the femoral artery to the popliteal artery.
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The medial circumflex artery branches off the profunda femoris artery.
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The anterior tibial artery is found in the posterior compartment of the leg.
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The lateral circumflex artery is the main artery of the anterior compartment.
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The obturator artery is a branch of the external iliac artery.
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Deep venous thrombosis occurs primarily in the upper extremities.
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Thrombi that break loose in the veins can become emboli.
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The great saphenous vein is part of the superficial venous system.
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The presence of clots in deep veins does not lead to swelling in peripheral tissues.
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Perforating branches of the deep femoral artery penetrate the adductor magnus.
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The superficial circumflex iliac artery is a deep artery.
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The iliotibial tract connects the tuberculum of the iliac crest to the just below the ankle.
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Varicose veins occur when valves in veins properly connect to prevent backflow.
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The small saphenous vein ascends on the medial side of the dorsal venous arch.
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Fascia lata supports muscle contraction efficiency by limiting outward extension.
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The great saphenous vein drains into the femoral vein.
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Varicose veins are characterized by normal and elongated superficial veins.
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The saphenous nerve has a close relationship with the great saphenous vein in the thigh.
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Blood return from the lower limbs to the heart is solely dependent on active muscle contraction.
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Femoral hernias cannot present clinically.
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The fascia lata is found in the lower limb but not in the thigh.
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The saphenous veins play a significant role in venous drainage of the lower limb.
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The boundaries and contents of the femoral triangle are essential to understand in anatomy.
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The anterior compartment of the thigh is primarily responsible for flexing the hip and extending the knee.
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The femoral triangle is located on the back of the thigh.
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Valves in the veins help blood flow backward in healthy veins.
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The popliteal fossa is situated at the back of the knee.
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The lateral boundary of the femoral triangle is formed by the medial margin of the adductor longus muscle.
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The femoral nerve is housed within the femoral sheath.
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The femoral canal contains loose connective tissue, fat, and lymphatics.
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The roof of the femoral triangle is formed by connective tissue.
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The great saphenous vein drains into the femoral artery.
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The femoral ring is a weak area through which abdominal contents may protrude.
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The femoral artery passes through the adductor hiatus to reach the popliteal fossa.
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The medial boundary of the femoral triangle is formulated by the iliopsoas muscle.
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Varicose veins are primarily found in the deep veins of the legs.
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The maximum pressure in the great saphenous vein occurs when standing.
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The iliopsoas is the most powerful extensor of the leg.
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Adductor muscles of the thigh are innervated by the femoral nerve.
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The sartorius muscle flexes the thigh and extends the leg.
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The quadriceps group is primarily responsible for extending the leg at the knee.
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Flexion of the thigh at the hip is achieved by the action of the hamstring group.
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Vastus medialis and vastus lateralis are part of the hamstring group.
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The femoral triangle contains important neurovascular structures.
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Incompetent valves in veins can lead to the development of varicose veins.
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The pectineus muscle is innervated by the obturator nerve.
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The gracilis muscle assists in adducting the thigh and flexing the leg.
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The rectus femoris is involved in both flexing the thigh at the hip and extending the leg at the knee.
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The popliteal artery is found in front of the knee joint.
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The adductor magnus has two parts: the adductor part and the hamstring part.
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Patellar dislocation occurs when the patella slips out of its normal position in the patellofemoral groove.
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Rehabilitation for a patellar fracture typically takes 10 to 14 weeks.
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A manual repositioning of the patella for dislocation always requires surgical intervention.
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A non-displaced patellar fracture necessitates immobilization for a period of 4-6 weeks.
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The femoral artery is a continuation of the external iliac artery and transitions into the popliteal artery at the popliteal fossa.
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Swelling and impaired mobility are common symptoms following a patellar dislocation.
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The lateral circumflex artery primarily supplies blood to the medial compartment of the thigh.
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Deep femoral artery branches only supply blood to the posterior compartment of the thigh.
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Femoral nerve is located in the femoral triangle and is a key component of the structure.
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The adductor hiatus allows for the passage of the popliteal artery into the thigh.
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The fasical layer known as fascia lata is only present in the foot and does not extend to the thigh.
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Femoral hernias can present clinically with symptoms such as groin pain and bulging in the femoral region.
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The lateral circumflex artery is primarily responsible for the blood supply of the medial compartment of the thigh.
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Clinical landmarks for examination in the anterior and medial thigh include the greater trochanter and the femoral canal.
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The great saphenous vein is the longest vein in the body and plays a primary role in draining the deep venous system.
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Valves in veins are crucial for preventing backflow, and their incompetence can lead to conditions like varicose veins.
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The femoral triangle contains the femoral nerve, which is primarily responsible for innervating the medial compartment of the thigh.
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A patellar fracture is often attributed to indirect trauma rather than direct blow.
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The pelvis is made up of the ilium, pubis, and ischium.
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The greater trochanter is located at the proximal end of the femur.
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The medial epicondyle is a prominent feature at the distal end of the femur.
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The tarsal tunnel is located on the lateral side of the ankle.
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The ischial spine is a structure found on the pubis.
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The obturator nerve provides sensory innervation to the skin of the lateral thigh.
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The lesser sciatic notch is larger than the greater sciatic notch.
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The femoral nerve innervates the pectineus muscle.
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The anterior sacral foramina are located on the posterior side of the sacrum.
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Typically, a femoral hernia is more common in males than in females.
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The fovea for the ligament of the head of the femur is found on the femoral neck.
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Deep fascia of the thigh is described as weak and flexible.
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The sartorius muscle is innervated by the obturator nerve.
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A patellar fracture typically results from indirect trauma to the knee.
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The saphenous nerve is a branch of the femoral nerve.
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An adductor hiatus serves as a space for the femoral artery to transition into the popliteal artery.
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The lateral circumflex artery is the main artery supplying the medial compartment of the thigh.
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The floor of the femoral triangle consists solely of the adductor longus muscle.
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The medial margin of the sartorius muscle forms the lateral boundary of the femoral triangle.
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The femoral sheath contains the femoral nerve along with the femoral artery and vein.
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The great saphenous vein drains directly into the popliteal vein.
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The femoral canal contains loose connective tissue and lymphatics.
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The apex of the femoral triangle is connected to the adductor hiatus.
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A femoral hernia can occur due to weakness in the femoral ring's posterior boundary.
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The femoral ring's anterior boundary consists of the pectineal ligament.
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Patellar dislocation typically involves the patella slipping laterally.
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Manual repositioning of a patellar dislocation can be achieved by flexing the leg.
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A non-displaced patellar fracture requires 4-6 weeks of immobilization in a splint.
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Rehabilitation after a patellar fracture can last up to 16 weeks.
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The femoral artery is a continuation of the external iliac artery.
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The profunda femoris artery does not have any perforating branches.
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Swelling and impaired mobility are common symptoms experienced during a patellar dislocation.
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The medial circumflex artery branches off the deep femoral artery.
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Deep venous thrombosis primarily occurs in the lower extremities.
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The anterior tibial artery predominantly serves the medial compartment of the leg.
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Study Notes
Femoral Region
- The femoral region is a key area in the lower limb, serving as a transition point between the thigh and the leg.
- The femoral triangle's boundaries are the inguinal ligament superiorly, the medial margin of the adductor longus muscle medially, and the medial margin of the sartorius muscle laterally.
- The floor of the femoral triangle is formed by the adductor longus, pectineus, and iliopsoas muscles.
- The femoral triangle's roof is composed of fascia lata.
- The contents of the femoral triangle include the femoral nerve, femoral artery, femoral vein, lymph nodes, and the great saphenous vein.
- The femoral sheath surrounds the femoral artery and vein but not the femoral nerve.
- The femoral sheath's three compartments contain the femoral artery laterally, the femoral vein in the middle, and the femoral canal medially, which holds loose connective tissue, fat, and lymphatics.
- The popliteal fossa is located at the back of the knee and is a key transition point between the thigh and the leg.
Fascia Lata
- Fascia lata is a dense layer of connective tissue that covers the muscles of the thigh.
- The iliotibial tract is a thickened lateral portion of fascia lata that runs from the iliac crest to just below the knee.
- The tensor fascia lata and gluteus maximus muscles attach to the iliotibial tract and work to extend the leg.
Superficial Veins of the Leg
-
Small saphenous vein:
- Located on the lateral side of the leg.
- Passes posteriorly to the lateral malleolus.
- Ascends in the posterior leg, close to the sural nerve.
- Drains into the popliteal vein.
-
Great saphenous vein:
- Located on the medial side of the leg.
- Passes anteriorly to the medial malleolus.
- Ascends along the medial side of the leg, knee, and thigh, close to the saphenous nerve.
- Drains into the femoral vein.
Varicose Veins
- Varicose veins are dilated, elongated, tortuous superficial veins with incompetent or congenitally absent valves.
- Valves in healthy veins prevent blood from flowing backward.
- Varicose veins develop when the valve leaflets no longer meet effectively, leading to blood accumulation in the superficial veins.
Muscles and Innervation in Anterior and Medial Thigh Compartments
-
Anterior Compartment:
- Muscles: Sartorius, quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius), and iliopsoas.
- Innervation: Femoral nerve.
-
Medial Compartment:
- Muscles: Adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.
- Innervation: Obturator nerve.
Blood Supply to the Thigh
-
Femoral artery:
- A continuation of the external iliac artery.
- Palpable in the femoral triangle inferior to the inguinal ligament.
- Passes through the adductor canal and hiatus, transitioning to the popliteal artery at the popliteal fossa.
-
Branching:
-
Deep (profunda) artery of the thigh:
- Main artery of the anterior compartment.
- Gives off lateral and medial circumflex femoral branches, and perforating branches (x4) that penetrate the adductor magnus.
- Other branches: Superficial epigastric, superficial circumflex iliac, superficial and deep external pudendal arteries.
-
Deep (profunda) artery of the thigh:
-
Obturator artery:
- The primary artery of the medial compartment.
- Branch of the internal iliac artery.
Deep Venous System
- Deep veins run along the major arteries of the thigh.
- The deep venous system includes the femoral vein, popliteal vein, anterior and posterior tibial veins, and fibular vein.
Deep Venous Thrombosis
- Deep vein thrombosis (DVT) occurs when blood clots form in the deep veins.
- DVT develops when blood becomes stagnant, commonly due to inactivity or injury.
-
Consequences of DVT:
- Emboli: Broken loose thrombi can travel in the bloodstream and lodge in other vessels.
- Swelling: Clots restrict blood flow, leading to peripheral tissue swelling.
- Propagation: DVT can extend into the femoral veins.
Lymphatics
- The superficial inguinal lymph nodes are located in the groin area.
Femoral Hernia
- Femoral hernias occur when abdominal contents push through the femoral ring, a weak point in the femoral canal.
-
Boundaries of the femoral ring:
- Anterior: Inguinal ligament
- Lateral: Femoral vein
- Medial: Lacunar ligament
- Posterior: Pectineal ligament
Patellofemoral Joint Injuries
-
Patellar fracture:
- Common knee injury resulting from a direct blow to the front of the knee.
- Non-displaced fracture: Treated with immobilization in a cast for 4-6 weeks.
- Displaced fracture: Requires surgery followed by quadriceps strengthening.
-
Patellar dislocation:
- Occurs when the patella slips out of its normal position in the patellofemoral groove due to a direct blow or sudden twisting of the leg.
- Presentation: Intense pain, lateral slippage of the patella, swelling, and impaired mobility.
- Treatment: Manual repositioning, possible orthopedic reduction, and rehabilitation for 6-16 weeks.
Anatomy of the Lower Limb
- The lower limb is divided into the gluteal region, thigh, leg, and foot.
- The fascia lata covers the thigh and gluteal region.
- The iliotibial tract (IT tract) is a thickened portion of the fascia lata, extending from the iliac crest to below the knee.
- The IT tract is an attachment site for the tensor fascia lata and gluteus maximus muscles, assisting in leg extension.
Superficial Veins of the Leg
- The small saphenous vein originates on the lateral side of the dorsal venous arch, passing posterior to the lateral malleolus, ascending the posterior leg close to the sural nerve, and drains into the popliteal vein.
- The great saphenous vein originates on the medial side of the dorsal venous arch, passing anterior to the medial malleolus, ascending the medial side of the leg near the saphenous nerve, and drains into the femoral vein.
Varicose Veins
- Varicose veins are dilated, elongated, and tortuous superficial veins due to incompetent or absent valves.
- These veins, most common in the legs, are caused by blood pooling in superficial veins, particularly when standing for long periods (e.g., the great saphenous vein).
- Symptoms include pain, swelling, skin thickening, and ulceration.
- Treatment options include vein obliteration, support stockings, elevating legs, and exercise.
Muscle Actions and Movement
- Muscles that cross a joint will act on that joint.
- Joint movement is not solely determined by one muscle but by the combined action of:
- Prime movers: Muscles primarily responsible for a movement.
- Antagonists: Muscles with opposite actions.
- Synergists: Muscles assisting prime movers.
Anterior Compartment of the Thigh
- Muscles: Quadriceps group (leg extensors), iliopsoas (trunk/hip flexor), sartorius (thigh and leg flexor), and tensor fascia lata.
- Innervation: Femoral nerve (except for the tensor fascia lata which is innervated by the superior gluteal nerve).
Medial Compartment of the Thigh
- Muscles: Adductors of the thigh.
- Innervation: Obturator nerve (except for the pectineus and a portion of the adductor magnus which are innervated by the femoral nerve).
Muscles of the Anterior Thigh
- Rectus femoris: From the anterior inferior iliac spine (AIIS) to the quadriceps femoris tendon; extends the leg at the knee and flexes the thigh at the hip; innervated by the femoral nerve.
- Vastus lateralis: From the femur to the quadriceps femoris tendon and lateral patella; extends the leg at the knee; innervated by the femoral nerve.
- Vastus intermedius: From the femur to the quadriceps femoris tendon; extends the leg at the knee; innervated by the femoral nerve.
- Vastus medialis: From the femur to the quadriceps femoris tendon and medial patella; extends the leg at the knee; innervated by the femoral nerve.
- Quadriceps femoris tendon: Connects the four muscles (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius) to the patella.
- Patellar tendon: Connects the patella to the tibial tuberosity, extending the leg at the knee.
Iliopsoas
- Composed of the psoas and iliacus muscles.
- Psoas: Originates from the posterior abdominal wall (lumbar vertebrae and discs) and inserts into the lesser trochanter of the femur.
- Iliacus: Originates from the iliac fossa and inserts into the lesser trochanter of the femur.
- Iliopsoas flexes the thigh at the hip (most powerful hip flexor) and is innervated by the L1-3 nerves.
Sartorius
- Originates from the anterior superior iliac spine (ASIS) and inserts onto the medial tibia.
- Flexes the thigh at the hip, flexes the leg at the knee, abducts and laterally rotates the thigh.
- Innervated by the femoral nerve.
Adductor Muscles
- Pectineus: Originates from the pectineal line of the pubis and inserts into the oblique line of the femur; adducts and flexes the thigh; innervated by the femoral nerve.
- Adductor longus: Originates from the pubis and inserts mid-femur; adducts and medially rotates the thigh; innervated by the obturator nerve.
- Adductor brevis: Originates from the pubis and inserts onto the proximal femur (upper 1/3 of linea aspera); adducts and medially rotates the thigh; innervated by the obturator nerve.
-
Adductor magnus: Has two parts:
- Adductor part: Originates from the ischiopubic ramus and inserts into the femur (adductor tubercle); adducts and medially rotates the thigh; innervated by the obturator nerve.
- Hamstring part: Originates from the ischial tuberosity and inserts onto the femur; adducts and medially rotates the thigh; innervated by the sciatic (tibial) nerve.
- Gracilis: Originates from the inferior pubic ramus and inserts onto the tibia; adducts the thigh, flexes the leg, and medially rotates the leg; innervated by the obturator nerve.
Femoral Triangle
- A wedge-shaped depression in the upper thigh formed by muscles.
- Boundaries:
- Superior: Inguinal ligament
- Medial: Medial margin of the adductor longus.
- Lateral: Medial margin of the sartorius muscle.
- Floor: Adductor longus (medial), pectineus (medial), iliopsoas (lateral).
- Roof: Fascia lata.
-
Contents:
- N: Femoral nerve.
- A: Femoral artery.
- V: Femoral vein.
- E: Empty space.
- L: Lymph nodes.
- Great saphenous vein: Enters the femoral triangle to drain into the femoral vein.
Adductor Canal
- A fascial canal continuous with the apex of the femoral triangle.
- Contains the femoral artery and vein, which pass through the adductor hiatus into the popliteal fossa.
Femoral Sheath
- Surrounds the femoral artery and vein (not the femoral nerve).
- Contains three compartments:
- Lateral: Femoral artery.
- Intermediate: Femoral vein.
- Medial: Femoral canal (contains loose connective tissue, fat, and lymphatics; entrance is the femoral ring).
- Extends superiorly with the transversalis fascia and inferiorly with connective tissue surrounding vessels. Allows the femoral artery and vein to glide during hip movement.
Femoral Hernia
- A protrusion of abdominal content through the femoral ring (a weak area).
- Boundaries of the femoral ring:
- Anterior: Inguinal ligament.
- Lateral: Femoral vein.
- Medial: Lacunar ligament.
- Posterior: Pectineal ligament.
Patellar Fractures and Dislocations
-
Fractures:
- Among the most common knee injuries.
- Usually caused by a direct blow to the front of the knee.
- Non-displaced fractures: Treated with 4-6 weeks of immobilization in a cast.
- Displaced fractures: Require surgical treatment followed by quadriceps strengthening.
-
Dislocations:
- Result from a direct blow or sudden twist of the leg.
- The patella slips out of its normal position in the patellofemoral groove (causes intense pain); often slips laterally.
- Treated with manual repositioning by extending the leg or with orthopaedic reduction.
- Causes swelling and impaired mobility.
- Rehabilitation takes 6-16 weeks.
Blood Supply of the Thigh
-
Femoral artery:
- Continuation of the external iliac artery.
- Palpable in the femoral triangle at the mid-inguinal point (inferior to the inguinal ligament).
- Passes through the adductor canal and hiatus, becoming the popliteal artery at the popliteal fossa.
- The femoral artery gives rise to the following branches:
- Profunda femoris (deep femoral artery): Supplies deep muscles of the thigh.
- Medial circumflex femoral artery: Supplies medial aspect of the thigh.
- Lateral circumflex femoral artery: Supplies lateral aspect of the thigh.
- Perforating arteries: Supply posterior thigh muscles.
Pelvic Bones
- The pelvic bone is irregular in shape and made up of three bones: ilium, pubis, and ischium.
- The ilium is the largest bone of the pelvis and has a wing-like shape.
- The pubis is located at the front of the pelvis and joins with the other pubis bone to form the pubic symphysis.
- The ischium is located at the back of the pelvis and has a large, bony prominence called the ischial tuberosity.
Femur
- The femur is the largest bone in the body and is located in the upper thigh.
- The head of the femur is a rounded structure that articulates with the acetabulum of the pelvis.
- The neck of the femur is a narrow region connecting the head to the shaft.
- The greater trochanter is a large, prominent bony prominence located on the lateral side of the femur.
- The lesser trochanter is a smaller bony prominence located on the medial side of the femur.
- The shaft of the femur is the long, straight portion of the bone.
- The medial and lateral epicondyles are bony projections located at the distal end of the femur.
- The medial and lateral condyles are the rounded articular surfaces of the femur that articulate with the tibia.
Deep Fascia of the Thigh
- Very strong and resembles a stocking.
- The femoral triangle is a wedge-shaped depression formed by muscles in the upper thigh.
- Boundaries:
- Superior: Inguinal ligament
- Medial: Medial margin of the adductor longus
- Lateral: Medial margin of the sartorius muscle
- Floor:
- Adductor longus (medial)
- Pectineus (medial)
- Iliopsoas (lateral)
- Roof: Fascia lata
- Contents:
- Femoral nerve
- Femoral artery
- Femoral vein
- Lymph nodes
- Empty space
- The great saphenous vein penetrates the roof of the triangle and drains into the femoral vein.
Femoral Triangle
- The apex of the femoral triangle is continuous with a fascial canal called the adductor canal.
- Muscles surrounding the triangle are:
- Sartorius (lateral)
- Adductor Longus (medial)
- Inguinal Ligament (superior)
- Only the femoral artery and vein pass through the adductor hiatus.
Femoral Sheath
- Surrounds the femoral artery and vein but does not include the femoral nerve.
- Each structure is in its own compartment.
- Lateral compartment: Femoral artery
- Intermediate compartment: Femoral vein
- Medial compartment: Femoral canal, containing loose connective tissue, fat, and lymphatics.
- The femoral sheath continues superiorly with the transversalis fascia and inferiorly with connective tissue around the vessels.
Femoral Hernia
- Protrusion of abdominal content through the femoral ring.
- Boundaries:
- Anterior: Inguinal ligament
- Lateral: Femoral vein
- Medial: Lacunar ligament
- Posterior: Pectineal ligament
- More common in females.
- Can present as a swelling below and lateral to the pubic tubercle.
Nerves of the Thigh
- The femoral nerve (L2-L4) is responsible for motor function of the sartorius, pectineus, and quadriceps muscles.
- The femoral nerve is also responsible for sensory innervation of the anterior thigh and medial side of the leg.
- The obturator nerve (L2-L4) is responsible for motor function of the adductor longus, brevis, and magnus muscles.
- The obturator nerve is also responsible for sensory innervation of the skin of the medial thigh.
Blood Supply to the Thigh
- The femoral artery is the continuation of the external iliac artery.
- It is palpable in the femoral triangle at the mid-inguinal point.
- The femoral artery passes through the adductor canal and becomes the popliteal artery at the popliteal fossa.
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Test your knowledge on the anatomy of the femoral region, including the femoral triangle and its contents. This quiz will cover key structures, boundaries, and the associated vascular and neural components. Ideal for students in health and medical fields.
