60 Questions
Which nerve innervates the medial thigh?
Obturator nerve (L2-L4)
Which nerve is responsible for motor innervation of the posterior thigh and leg, as well as the plantar foot?
Tibial nerve (L4-S3)
Which nerve supplies the perineum and travels with the internal pudendal artery?
Pudendal nerve (S2-S4)
Which sacral plexus nerve provides sensory innervation to the posterior thigh?
C & D
Which nerve is responsible for motor innervation of the anterior and lateral leg, as well as the dorsal foot?
Common peroneal nerve (L4-S2)
Which division of the lumbar plexus innervates the anterior thigh?
Posterior division
According to Hilton's Law, which of the following is true?
A sensory nerve supplying a joint also supplies the skin overlying the insertions of these muscles.
Which of the following nerves is responsible for the sensory innervation of the hip joint capsule?
A & B
Which of the following structures is NOT part of the anterior compartment of the thigh?
Quadratus femoris
Which of the following is the correct sequence of appearance of the secondary ossification centers in the femur?
Distal epiphysis, head, greater trochanter, lesser trochanter
Which of the following structures is NOT a bony prominence on the proximal end of the femur?
Gluteal tuberosity
Which artery supplies the medial thigh region and passes through the obturator canal?
Obturator artery
What is the name of the cartilaginous growing area of a long bone located in the metaphysis?
Physis
Which of the following statements about the linea aspera of the femur is INCORRECT?
It is located on the anterior aspect of the femur
Which of the following statements about the ossification of long bones is CORRECT?
Endochondral ossification occurs in all long bones
What is the innervation of the adductor magnus hamstring portion?
Tibial nerve
Which nerve supplies the gluteus maximus muscle?
Inferior gluteal nerve
What is the action of the gracilis muscle?
Adduct thigh
Which nerve innervates the obturator externus and superior gemellus muscles?
Obturator nerve
What is the blood supply to the posterior thigh muscles primarily derived from?
Perforating arteries from the profunda femoris artery
Which of the following muscles originates from the superolateral quadrant of the ischial tuberosity?
Semimembranosus
Which of the following structures is located in the inferomedial quadrant of the ischial tuberosity?
Fibro-adipose pad
Which of the following statements about the ischial tuberosity is INCORRECT?
It is the attachment site for the gluteus maximus muscle.
Which of the following is the correct order of the hamstring muscles from lateral to medial?
Biceps femoris(short head), biceps femoris (long head), semitendinosus, semimembranosus
Which of the following structures is NOT located near the ischial tuberosity?
Iliac crest
What is the function of the fibro-adipose pad located in the inferomedial quadrant of the ischial tuberosity?
It acts as a cushion when sitting.
Match each blood supply to its description
Descending Genicular Artery = Travels with the saphenous nerve through the adductor canal Medial Circumflex Femoral Artery = Comprised of ascending and transverse branches Lateral Circumflex Femoral Artery = Comprised of ascending, descending and transverse branches Perforating branches = Perforate the Adductor Magnus muscle
Match each hip arterial anastomosis to its branches
Trochanteric = Superior gluteal/ Inferior gluteal Cruciate = Inferior gluteal/ Transverse branches of 3 &4 Trochanteric = Ascending branches of medial and lateral circumflex femoral arteries Cruciate = Ascending branches of 1st perforator
Match each nerve to its innervation span
Femoral = L2-L4 Obturator = L2-L4 Tibial = L4-S3 Common Peroneal = L4-S2
Match each nerve to its plexus
Lumbar plexus = Femoral nerve (posterior division) Sacral plexus = Pudendal nerve Lumbar plexus = Obturator nerve (Anterior division) Sacral plexus = Sciatic nerve (tibial: anterior/ common peroneal: posterior)
Match each nerve to its innervation site
Femoral nerve = Anterior thigh/ pectineus, et al. Obturator nerve = Medial thigh/ obturator internus muscle Tibial nerve = Posterior thigh and leg/ plantar foot/ hamstring portion of adductor magnus Common Peroneal nerve = Anterior and lateral leg/dorsal foot/ short head of biceps femoris
Match each sacral plexus nerve to its division.
Posterior Division = Posterior Femoral cutaneous nerve (S1-S3) Anterior Division = Pudendal nerve (S2-S4) Posterior Division = Superior gluteal/ Inferior gluteal (sensory to hip joint) Anterior Division = N. to quadratus femoris (sensory to hip joint)/ inferior gemellus / N. obturator internus/ Superior gemellus
Match each intermuscular septum to the compartments it separates
Medial septum = Anterior/Medial Posterior Septum = Medial/Posterior Lateral Septum = Anterior/Posterior N/A = N/A
The attachments of the intermuscular septa include the linea aspera and the superficial surface of the fascia latae.
False
The origins of the medial compartment of the thigh are the pubis (adductor magnus: ischial tuberosity). The insertions of the medial compartment of the thigh are the linea aspera (Adductor magnus: adductor tubercle, pectineal line)
True
What are the actions of the medial compartment muscles?
Adduct/Flex the thigh
What separates the anterior and posterior divisions of the obturator nerve (L2-L4)
Adductor brevis
What are the actions of the posterior thigh muscles?
1)Extension of the hip/thigh 2)Flexion of the knee/leg 3)Antagonist to the muscles of the anterior thigh
Match each muscle of the posterior compartment of the thigh to its origin
Semitendinosus/ Long head of biceps femoris = Superomedial quadrant of the ischial tuberosity Semimembranosus = Superolateral quadrant of the ischial tuberosity Biceps femoris short head = Linea Aspera Adductor Magnus hamstring portion = Inferolateral quadrant of the ischial tuberosity
Match each hamstring muscle to its insertion
Biceps Femoris (long head) = Head of the fibula Biceps Femoris (Short head) = Head of the fibula Semitendinosus = Proximal Medial tibia (Posterior compartment) Semimembranosus = Medial condyle of the tibia
Match each border of the popliteal fossa with its description
Superomedial = Semimembranosus and semitendinosus muscles Superolateral = Biceps femoris tendon Inferomedial = Medial head of gastrocnemius muscle Inferolateral = Lateral head of gastrocnemius muscle and plantaris muscle
List the contents of the popliteal fossa from superficial to deep
Tibial nerve (L4-S3), popliteal vein, popliteal artery
What is an example of the deep vein (Venae Commitantes)?
Popliteal Vein
What is the lesser saphenous vein a tributary of?
The popliteal vein (It drains to the popliteal vein)
List the actions of perforating veins
- Connect superficial and deep veins
- Shunt blood to deep veins
- Close when muscles contract
List all of the popliteal fossa branches of the femoral artery
- 2 superior genicular arteries (Medial/Lateral)
- 2 sural arteries (end arteries to gastrocnemius)
- Middle genicular artery (Not part of the genicular anastomosis)
- 2 Inferior genicular arteries (medial/lateral)
What is not a branch that is formed due to the trifurcation of the femoral artery?
All of the above are formed
B.L., a 65-year-old woman, submitted to cardiac catheterization (thin, flexible tube (catheter) is guided through a blood vessel to the heart) in order to measure the pressures in the chambers of her heart. A catheter was inserted in her right femoral vein in the femoral triangle and floated through the iliac veins and the inferior vena cava to the right heart, where diagnostic procedures were performed without incident. Four hours after completion of the procedure, however, B.L. began to complain of a painful throbbing in her right groin. Over the course of the next hour, the pain worsened and she began to experience numbness and tingling in her right anteromedial thigh and leg. On examination, her right leg felt cool and a mass was observed in the right groin. No distal pulses could be felt in the leg. B.L. was immediately taken up to surgery for exploration of the groin region.
Given what you know about the anatomy of the inguinal region and the anteromedial thigh, what structure would NOT be at risk as it pertains to catheterization in the groin region?
Obturator nerve
Refer back to the case study from question #48 for the following question:
What do you think caused the mass in the groin?
A & C
Refer back to the case study from question #48 for the following question:
How would you explain the numbness and absence of distal pulses?
Compression of neurovasculature
A marathon runner, while training for an upcoming race began showing a series of symptoms: • A deep, tight ache in the lower part of their right buttock and proximal posterior thigh • Pain is worse in the morning and slightly better by the later afternoon. • Sitting on firm surfaces is uncomfortable • Jogging or trying to run hurts immediately as soon as they push off into a stride (extend thigh and bending knee). They can run through it, but it remains painful and gets sorer if they continue.
What is the diagnosis?
Proximal hamstring tendinopathy
19-year-old presented to a hospital with bilateral pain and swelling in their thighs.
- 3 nights prior had attended a 45-minute spinning class for the first time.
- After class, they noted pain and swelling in thighs, but did not seek medical attention until 3 days later – noted dark urine
- Initial findings: • tight, painful thigh compartments with extreme tenderness on passive motion • tingling and numbness in right leg • High anterior compartment pressures of the right thigh were measured
Compartment syndrome
What is the treatment for compartment syndrome?
Emergency fasciotomy
In which demographic is avulsion fracture of the ischial tuberosity most commonly seen?
Adolescent athletes
“A 24-year-old female patient visited a pain clinic with the chief complaint of right popliteal fossa area pain and intermittent swelling for 2 years. There was no history of trauma or any other known medico-surgical history. Although she had visited many local clinics for 2 years, she could not be diagnosed properly. In addition, the medications and physical therapy from different local clinics did not help to improve her symptoms. The pain became worse when she changed her position from sitting to standing, with characteristics like sharp pricking, pulling and picking. The severe pain was rated 6 to 8 on the visual analogue scale (VAS). Sometimes, soft tissue swelling was accompanied with pain in affected area.”
What is the diagnosis?
Popliteal fossa pain
A possible cause of popliteal fossa pain is venous malformation. This most commonly occurs with the veins.
False
Match each medial thigh muscle to its origin.
Gracilis = Inferior ramus & body of pubis Adductor longus = Body of pubis, lat. to pubic symph. Adductor brevis = Inferior ramus & body of pubis Pectineus = Pectin pubis (sup ramus)
Match each medial thigh muscle to its insertion
Gracilis = Proximal medial tibia Adductor longus = Linea aspera, middle 1/3 Adductor brevis = Linea aspera, superior 1/3 Pectineus = Pectineal line of femur
Match each portion of adductor magnus to its orgin/insertion
Adductor magnus (adductor) = O: Inferior ramus (pubis); Ischial ramus Adductor magnus (hamstring) = I: Adductor tubercle femur Adductor magnus (adductor) = I: Linea aspera, entire length Medial supracondylar ridge Adductor magnus (hamstring) = O: Ischial tuberosity, inferolat. part
Match each posterior compartment muscle with its action.
Biceps Femoris (long head) = flex the knee, laterally rotate knee extend hip joint Biceps femoris (short head) = flex the knee, laterally rotate knee extend hip joint Semitendinosus = extend thigh flex knee, medially rotate tibia Semimembranosus = extends thigh flexes knee & helps to medially rotate knee (when flexed)
Study Notes
Thigh Innervation
- Obturator nerve (L2-L4) innervates medial thigh
- Tibial nerve (L4-S3) innervates posterior thigh and leg, plantar foot
- Femoral nerve (L2-L4) innervates anterior thigh
- Pudendal nerve (S2-S4) supplies perineum and travels with internal pudendal artery
- Sciatic nerve (L4-S3) travels in posterior compartment and divides into tibial and common peroneal nerves
- Lumbosacral plexus provides motor innervation to the thigh and leg
Motor Innervation
- Lumbar plexus (T12-L4) provides motor innervation to the thigh
- Femoral nerve (L2-L4) provides motor innervation to the anterior thigh, including pectineus and iliopsoas
- Obturator nerve (L2-L4) provides motor innervation to the medial thigh, including obturator externus and adductor magnus
- Sacral plexus (L4-S4) provides motor innervation to the posterior thigh and leg, including gluteal muscles and hamstring muscles
- Sciatic nerve (L4-S3) provides motor innervation to the posterior thigh and leg, including hamstring muscles and gastrocnemius
Sensory Innervation
- Anterior division of lumbar plexus provides sensory innervation to the hip joint and anterior thigh
- Posterior division of lumbar plexus provides sensory innervation to the posterior thigh and leg
- Obturator nerve (L2-L4) provides sensory innervation to the medial thigh and hip joint
- Femoral nerve (L2-L4) provides sensory innervation to the anterior thigh and hip joint
- Posterior femoral cutaneous nerve provides sensory innervation to the posterior thigh and gluteal region
- Pudendal nerve (S2-S4) provides sensory innervation to the perineum and genital area
Hip Joint
- Articular surfaces of the hip joint include the lunate surface of the acetabulum and the head of the femur
- Intrinsic ligaments of the hip joint include the ligament of the head of the femur, transverse acetabular ligament, and fibrous capsule
- Blood supply to the head and neck of the femur is provided by the retinacular arteries, which are branches of the obturator artery
- Fractures of the neck of the femur can lead to avascular necrosis of the femoral head
Thigh Muscles
- Anterior compartment of the thigh includes the quadriceps muscles (vastus lateralis, vastus intermedius, rectus femoris, and vastus medialis)
- Medial compartment of the thigh includes the adductor muscles (adductor longus, adductor brevis, and adductor magnus)
- Posterior compartment of the thigh includes the hamstring muscles (biceps femoris, semimembranosus, and semitendinosus)
- Intermuscular septa separate the compartments of the thigh and attach to the femur and linea aspera
Long Bones
- Long bones, such as the femur, are formed through endochondral ossification
- The diaphysis of a long bone is the middle part of the bone and is the site of primary ossification
- The epiphyses of a long bone are the ends of the bone and are the sites of secondary ossification
- The growth plate, or physis, is the cartilaginous area between the diaphysis and epiphysis where bone growth occurs
Femur
- The femur is the longest, strongest bone in the body
- The proximal end of the femur includes the head, neck, and greater and lesser trochanters
- The distal end of the femur includes the medial and lateral femoral condyles and the intercondylar fossa
- The femur has a pectineal line, spiral line, and linea aspera, which are attachment sites for muscles
- The femur ossifies through a primary ossification center in the diaphysis and secondary ossification centers in the epiphyses
Prepare for your LEA I Midterm Exam 2 with this review focusing on concepts such as medial thigh, long bone development, hip joint, and popliteal fossa. Covering topics like endochondral ossification and X-ray interpretation of newborn foot.
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