Lower Limb Anatomy: Hip & Thigh Muscles

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Questions and Answers

In a patient presenting with acute compartment syndrome of the lower limb, which of the following pathophysiological mechanisms is MOST directly responsible for subsequent peripheral nerve ischemia?

  • Elevation in interstitial pressure within the closed fascial compartment, surpassing capillary perfusion pressure and impeding microcirculation. (correct)
  • A precipitous decline in interstitial pressure, causing nerve fiber compression and hypoxia.
  • Stimulation of sensory nerve endings causing referred pain into adjacent dermatomes.
  • Vasodilation of arterioles within the affected compartment, leading to increased blood flow and edema.

A patient experiences significant trauma to the lateral aspect of their thigh, directly impacting the iliotibial tract (ITB). Which biomechanical consequence would MOST likely manifest due to the compromised structural integrity of the ITB?

  • Attenuation of patellar tracking, predisposing the patient to lateral patellar subluxation.
  • Potentiation of knee flexion moment, leading to exaggerated flexion during gait.
  • Diminished dynamic stabilization of the knee joint, increasing susceptibility to varus forces. (correct)
  • Increased range of motion in hip abduction due to reduced tension across the hip joint.

Following a motor vehicle accident, a patient presents with a compromised obturator nerve. Which specific functional deficit would be MOST anticipated upon clinical examination?

  • Diminished capacity for thigh adduction against resistance. (correct)
  • Compromised ability to extend the hip against gravity.
  • Impaired dorsiflexion and eversion of the foot.
  • Defective external rotation of the thigh at the hip joint.

In a complex surgical reconstruction of the posterior hip, complete transection of the piriformis muscle inadvertently occurs. Assuming no other muscular or neural damage, which of the following compensatory mechanisms would MOST likely develop to preserve overall hip function?

<p>Synergistic enhancement of the obturator internus and gemelli muscles to maintain external rotation functionality. (A)</p> Signup and view all the answers

During a high-speed skiing accident, an individual sustains a forceful impact to the anterior superior iliac spine (ASIS), resulting in an avulsion fracture. Which of the following kinematic impairments would MOST likely arise during subsequent ambulation?

<p>Compromised hip flexion and external rotation secondary to disruption of the sartorius origin. (A)</p> Signup and view all the answers

A patient presents with Trendelenburg gait, characterized by excessive pelvic drop on the swing phase. Which biomechanical deficiency is MOST directly responsible for this gait pattern?

<p>Weakness or dysfunction of the hip abductors (gluteus medius and minimus) on the stance leg side. (B)</p> Signup and view all the answers

A patient undergoes a complex reconstructive surgery of the hip, involving reattachment of the gluteus maximus tendon. What aspect of ambulation would be MOST immediately and significantly impacted during the initial postoperative period?

<p>Difficulty ascending stairs or inclines due to compromised hip extension strength. (C)</p> Signup and view all the answers

A 65-year-old patient presents with chronic hip pain and radiographical evidence of advanced osteoarthritis, particularly affecting the articular cartilage of the acetabulum. Which of the following BEST describes the primary biomechanical consequence of articular cartilage degradation in this context?

<p>Increased coefficient of friction within the hip joint, diminishing ease of movement and increasing stress on subchondral bone. (A)</p> Signup and view all the answers

A patient is diagnosed with a rare genetic condition affecting collagen synthesis, resulting in weakened ligaments throughout the body. Which ligament would MOST critically compromise the stability of the hip joint, predisposing it to dislocation?

<p>The iliofemoral ligament, given its primary role in resisting hyperextension and anterior translation of the femoral head. (C)</p> Signup and view all the answers

A surgeon is planning a hip replacement procedure and needs to carefully consider the innervation of the gluteus medius and minimus muscles to prevent iatrogenic injury. Damage to which nerve poses the GREATEST risk of causing a postoperative Trendelenburg gait?

<p>The superior gluteal nerve. (B)</p> Signup and view all the answers

During a cadaveric dissection, a medical student attempts to delineate the boundaries of the femoral triangle. Which combination of anatomical structures correctly defines this region?

<p>Inguinal ligament, sartorius, and adductor longus. (B)</p> Signup and view all the answers

A patient presents with anterior thigh pain and weakness in knee extension following a penetrating injury. If imaging reveals compression of the femoral nerve within the iliacus muscle, which of the following specific muscles would be MOST significantly impacted?

<p>The rectus femoris, given its role as both a hip flexor and knee extensor. (B)</p> Signup and view all the answers

Following a complex surgical procedure involving the medial thigh, a patient exhibits sensory deficits along the medial aspect of the thigh and impaired adduction. What specific nerve has MOST likely sustained iatrogenic damage?

<p>The obturator nerve, given its innervation of the adductor muscles and sensory branches to the medial thigh. (C)</p> Signup and view all the answers

A researcher is investigating the biomechanical properties of the hip joint capsule. Which of the following structural adaptations would BEST enhance joint stability while permitting a wide range of motion?

<p>Regional thickening and specific collagen fiber alignment that resists common dislocation forces, complemented by thinner areas that allow for greater joint excursion. (D)</p> Signup and view all the answers

During a gait analysis study, a subject demonstrates excessive hip adduction during the stance phase. Which primary muscular imbalance would MOST likely contribute to this abnormality?

<p>Weakness of the hip abductors (gluteus medius and minimus), failing to adequately stabilize the pelvis. (C)</p> Signup and view all the answers

A patient with a history of iliopsoas bursitis presents with pain exacerbated by hip flexion and external rotation. Which of the following biomechanical interventions would MOST effectively attenuate the compressive forces contributing to this patient's pain?

<p>Activity modification to minimize prolonged hip flexion and external rotation, reducing direct compression on the bursa. (D)</p> Signup and view all the answers

A patient presents with pain and limited range of motion following a hip arthroscopy. If excessive scar tissue formation within the joint capsule is suspected, which biomechanical property is MOST likely altered, contributing to the clinical presentation?

<p>Diminished viscoelasticity, impairing the tissue's ability to dissipate energy and adapt to changing loads. (A)</p> Signup and view all the answers

A highly trained endurance athlete exhibits eccentric hypertrophy of the vastus lateralis muscle. Which physiological adaptation would be MOST prominent at the molecular level within the muscle fibers?

<p>Augmented sarcomere addition in series, leading to increased muscle fiber length and maximal shortening velocity. (C)</p> Signup and view all the answers

A patient undergoing rehabilitation following a hamstring strain demonstrates persistent weakness in knee flexion and hip extension. Which of the following therapeutic interventions would MOST effectively address the underlying neuromuscular deficits at the level of motor unit recruitment?

<p>Progressive resisted exercises emphasizing both concentric and eccentric contractions, coupled with biofeedback to enhance motor unit activation. (D)</p> Signup and view all the answers

A forensic anthropologist discovers skeletal remains with a prominent linea aspera. What potential inferences can be accurately derived concerning the individual’s likely biomechanical profile?

<p>The individual possessed robust lower limb musculature, with substantial development of muscles such as the vastus lateralis and brevis. (C)</p> Signup and view all the answers

A patient presents with a synovial sarcoma impinging directly upon the femoral nerve within the femoral triangle. Clinically, this compression would MOST likely manifest as:

<p>Weakness in hip flexion, impaired knee extension, and sensory deficits along the anterior thigh and medial leg. (C)</p> Signup and view all the answers

A patient suffers a complete rupture of the ligamentum teres. What is the MOST direct biomechanical consequence concerning hip joint function, assuming the absence of any concurrent pathology?

<p>Minor alteration in hip joint proprioception (B)</p> Signup and view all the answers

A patient is diagnosed with piriformis syndrome. Which intervention is BEST supported by current evidence to resolve the underlying cause of the condition in the long-term?

<p>A comprehensive exercise program to address underlying biomechanical imbalances, complemented by neural mobilization techniques. (C)</p> Signup and view all the answers

A patient presents with hip pain following a marathon. Imaging reveals inflammation of the bursa located between the gluteus maximus tendon and the greater trochanter. Which of the following functional impairments would be MOST likely observed during gait analysis?

<p>Reduced hip extension during terminal stance due to pain experienced with gluteus maximus contraction. (A)</p> Signup and view all the answers

A track athlete is diagnosed with snapping hip syndrome due to the iliopsoas tendon sliding over the iliopectineal eminence. Which movement would MOST likely exacerbate this patient’s symptomatic presentation?

<p>Hip flexion from a relatively straight position. (A)</p> Signup and view all the answers

Dissection of a cadaver reveals total absence of the sartorius muscle within the femoral triangle. How, mechanically, would this affect gait mechanics?

<p>There will effectively no appreciable impact. (C)</p> Signup and view all the answers

Following a traumatic injury to the medial thigh, a patient is unable to cross their legs. This would point strongly to severe trauma to which specific muscle?

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

During a complex femoral reconstruction, a novice surgeon decides to lengthen the Rectus Femoris by 6cm. What MOST immediate effect will THIS have, assuming the other knee flexors and hamstrings remain the same?

<p>Total inability to perform a full, uncompensated knee extension. (B)</p> Signup and view all the answers

A patient suffers a severe proximal hamstring avulsion. Which subsequent biomechanical implication would BEST directly affect their athletic capacity?

<p>Large decline in strength/power for running. (A)</p> Signup and view all the answers

Research scientists find a totally effective means of increasing muscular cross-sectional area (CSA) in humans. If the ONLY muscular adaption resulting from this process is a 30% increase in CSA, what change would researchers find in human hip extension given maximal effort?

<p>Increase in maximum isometric torque of ~30%. (D)</p> Signup and view all the answers

A patient exhibits motor weakness related to an issue with the tensor fascia latae. This means what other motion will the patient probably have issues with?

<p>Stabilisation of knee during extension. (C)</p> Signup and view all the answers

A scientist is artificially increasing the amount of the Obturator nerve in a mammal, leading to hypertrophy around the Obturator nerve. How would this affect the animals likely function?

<p>A stronger adduction. (C)</p> Signup and view all the answers

A doctor treats a 10 year old patient through intense physical motion. This causes severe and immediate damage to the iliofemoral ligament. Which issue would be MOST directly observable?

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

Following a major thigh injury, a patient is only able to weakly adduct their thigh. Which muscle group is MOST responsible for this specific malfunction?

<p>Hip Adductors. (A)</p> Signup and view all the answers

A surgeon is trying to cut the gluteus medius only without disrupting anything other functionality. How would this affect the patient's movement?

<p>Substantial drop in force capacity during swing phase. (A)</p> Signup and view all the answers

Following a high-speed motorcycle accident, a patient suffers massive damage to the quadratus femoris. What specific symptom most directly effects the patient's movement at discharge?

<p>The effect on normal movement will be negligible. (D)</p> Signup and view all the answers

Total and complete removal of the Iliacus will cause a huge deficiency in which specific movement?

<p>Huge reduction in hip flexion power. (A)</p> Signup and view all the answers

A previously healthy patient presents with a limp. You determine their adductor Magnus isn't firing. Which symptom are they MOST likely exhibiting given THIS information?

<p>The patient would have much, much less capacity to stay stable during cutting maneuvers. (A)</p> Signup and view all the answers

In a novel surgical procedure, scientists were somehow able to completely reconstruct an adductor longus that was lost in a major skiing accident only a few days previously. How big will this have to be to have the SAME torque output it previously had given the new, reconstructed, ligaments?

<p>This needs about the same cross-sectional area compared to its pre-injured state. (C)</p> Signup and view all the answers

Flashcards

Fascia Lata

The outer layer of deep fascia in the lower limb, forming a thick, stocking-like membrane.

Iliotibial Tract (ITB)

A thickened lateral portion of the fascia lata. Extends from the iliac tubercle to the lateral condyle of the tibia.

Fascial Septa

Divisions used to separate the limbs.

Compartment Syndrome

Increased interstitial pressure, resulting in peripheral nerve and muscle ischemia.

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Anterior Hip Muscles

Hip muscles located anterior to the Os Coxa.

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Posterior Hip Muscles

Hip muscles in the gluteal region.

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Lateral Hip Muscles

Lateral hip muscles, specifically the TFL.

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Anterior Thigh Muscles

Anterior thigh muscles.

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Medial Thigh Muscles

Medial thigh muscles.

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Posterior Thigh Muscles

Posterior thigh muscles.

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Fascia Lata

Outer layer of deep fascia in the lower limb that forms a thick stocking like membrane.

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Action of the Gluteus Maximus.

hip extension; Hip lateral rotation

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Action of Gluteus Medius and Minimus

Hip abduction; Hip medial rotation; Hold pelvis level during walking

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Action of the Tensor Fasciae Latae (TFL)

Dynamic stabilisation of knee joint, resists varus forces, contributes to knee extension

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Quadriceps Femoris

Anterior thigh muscles that flex the hip and extend the knee.

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Action of the Psoas Major

Strong hip flexor and important postural muscle

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Hip Adductors

Medial compartment muscles that adduct the hip

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Hamstrings

Posterior thigh muscles that extend the hip and flex the knee.

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Action of Gluteus Medius and Minimus

Muscles for Hip abduction; Hip medial rotation

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Iliopsoas (Psoas Major + Iliacus)

The most significant hip flexor and very important stabilizer (but great moment arm as flexor, but very strong)

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Study Notes

  • Regional & Functional Anatomy of the Lower Limb I is presented by Dr Rossana Nogueira for the Medical Program MEDI12-201 at Bond University.

Weekly Learning Outcomes

  • Describe the anatomy of the hip, thigh, and gluteal region, including ligamentous structures.
  • Describe the thigh and leg muscles including fascial compartments and how they contribute to concentric movements of lower limb joints.
  • Specifically learn about:
  • Hip muscles
  • Thigh muscles (anterior, medial, and posterior compartments)

Surface Anatomy of the Lower Limb

  • Anatomical landmarks are the visible or palpable surface features that correspond to underlying structures.
  • Key landmarks on the lower extremity include:
  • ASIS / AIIS (Anterior Superior Iliac Spine / Anterior Inferior Iliac Spine)
  • Inguinal ligament
  • Greater trochanter
  • Quadriceps femoris
  • Patella
  • Popliteal fossa
  • Gastrocnemius muscles
  • Medial/lateral malleolus
  • Calcaneal (Achilles) tendon

Pelvis & Lower Extremity

  • The pelvis and lower extremity include the following structures:
  • Pelvic girdle (Os Coxae + sacrum + coccyx)
  • Thigh
  • Knees
  • Leg
  • Ankle
  • Foot
  • Muscular regions include:
  • Gluteal region
  • Thigh
  • Leg
  • Foot
  • Lower extremity divisions:
  • Gluteal: Superficial / deep
  • Thigh: Anterior, posterior, medial
  • Leg: Anterior, posterior, lateral
  • Foot: Plantar / dorsi flexors

Fascia Lata

  • The fascia lata is the outer layer of deep fascia in the lower limb that forms a thick "stocking-like" membrane.
  • It lies deep to the superficial fascia and is continuous with the deep fascia of the leg.
  • The iliotibial tract (ITB) is a thickened lateral portion of the fascia lata, from the iliac tubercle to the lateral condyle of the tibia.
  • Fascial septa separate the limbs into compartments.
  • Compartment Syndrome (Clinical Significance):
  • Increased interstitial pressure resulting in peripheral nerve and muscle ischemia.
  • Acute surgical emergency.

Lower Limb Compartments

  • Hip:
  • Anterior (Muscles anterior to the Os Coxa)
  • Posterior (Gluteal region)
  • Lateral (TFL)
  • Thigh:
  • Anterior
  • Medial
  • Posterior
  • Leg:
  • Anterior
  • Lateral
  • Posterior
  • Foot: Dorsal & Plantar

Arthrology of the Hip

  • Key features include;
  • Greater sciatic foramen
  • Obturator canal
  • Lesser sciatic foramen
  • Obturator membrane
  • Gap between inguinal ligament and pelvic bone.

Posterior Compartment: Deep Gluteal Muscles

  • Muscles include:
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quadratus femoris

Hip - Posterior Compartment: Gluteal Muscles

  • Gluteus Maximus:
  • Strong hip extensor; powerful lat rotator
  • Assistance in abduction & adduction (sup & inf fibres)
  • Gluteus Medius/Minimus: Hip abductors | Muscle | Attachments | Action | |-----------------|--------------------------------------------------------|-------------------------------------------------| | Gluteus Maximus | O: Ilium, post glut line, sacrum &coccyx I: ITB & gluteal tuberosity of femur | Hip extension; Hip lateral rotation | | Gluteus Medius | O: External surface of ilium I: Greater trochanter (lat surface) | Hip abduction; | | Gluteus Minimus | O: External surface of ilium I: Greater trochanter (ant surface) | Hip Medial rotation Holds pelvis secure over stance leg Prevents pelvic drop |

Posterior Compartment: Deep Layer

Muscle Attachments Action
Piriformis O: Anterior surface of sacrum I: Greater trochanter of femur Hip lateral rotation (extended femur)
Obturator internus O: Inner obturator membrane I: Greater trochanter of femur Hip abduction & lateral rotation (flexed femur)
Obturator externus O: Outer obturator membrane I: Greater trochanter of femur -
Gemellus superior O: Ischial spine I: Greater trochanter of femur -
Gemellus inferior O: Ischial tuberosity I: Greater trochanter of femur -
Quadratus femoris O: Lateral aspect of the ischium I: Quadrate tubercle on femur Hip lateral rotation

Posterior Compartment: Gluteal Muscles Functions

  • Extensor: Gluteus Maximus
  • Abductors: Gluteus Medius & Gluteus Minimus
  • Rotators: Piriformis, Obturator Internus, Gemelli, Quadratus Femoris

Lateral Compartment: Tensor Fasciae Latae (TFL)

  • Relatively weak, but large flexion and abduction moment arms
  • Dynamic stabilisation of knee joint - resists varus forces
  • Acts as a dynamic ligament
  • Contributes to knee extension

O: Anterior Superior Iliac Spine (ASIS) - Hip abduction;Hip medial rotation;Hip flexion I: Iliotibial Tract (ITB)

Hip / Spine region: ILIOPSOAS

  • Psoas Major + Iliacus make up the Iliopsoas which the The most significant hip flexor and stabiliser. | Muscle | Attachments | Action | |------------|------------------------------------------------------------------------|------------------------------------------------------| | Psoas Major| O: Transverse processes, IVDs, vert bodies T12-L5 I: Lesser trochanter | Hip flexion, Lumbar flexion Postural muscle | | Iliacus | O: Iliac fossa, sacral ala, AIIS I: Lesser trochanter | Hip flexion | | Psoas Minor| O: T12-L1 vertebrae and IV discs I: Pectineal line | Assists in trunk / hip flexion |

Lower Limb Compartments - THIGH

  • Divided into 3 compartments:
  • Anterior (hip flexors / knee extensors) - Femoral nerve
  • Medial (hip adductors) - Obturator nerve
  • Posterior (hip extensors / knee flexors) - Sciatic nerve (tibial / common fibular n.)

Thigh compartments and muscles

  • Anterior Compartment:

  • Muscles: Quadriceps Femoris, Sartorius, and Pectineus

  • Common action: Hip Flexion

  • Quadriceps Femoris and Sartorius (weak)

  • Common action: Knee Extension

  • Medial Compartment: -Muscles: Adductor Longus, Adductor Brevis, Adductor Magnus, and Gracilis

  • Posterior Compartment:

  • Muscles: Biceps Femoris, Semitendinosus, and Semimembranosus

Anterior Compartment: Pectineus / Sartorius

  • Sartorius (Tailor's muscle).
  • Femoral triangle | Muscle | Attachments | Action | |----------|--------------------------------------------------------|---------------------------------------------------| | Pectineus| O: Superior ramus of pubis I: Pectineal line of femur | Hip flexion, Hip adduction | | Sartorius| O: ASIS I: medial surface of tibia (Pes Anserinus - L. goose foot) | Hip flexion (weak), Hip abduction (weak), Knee flexion |

Anterior Compartment: Quadriceps Femoris

Muscle Attachments Actions
Vastus medialis O: Femur - intertrochanteric line, pectineal line I: Quadriceps femoris tendon Knee extension
Vastus intermedius O: Femur-upper two-thirds of anterior and lateral surfaces I: Quadriceps femoris tendon Knee extension
Vastus lateralis O: Femur-greater trochanter; linea aspera I: Quadriceps femoris tendon Knee extension
Rectus femoris O: Anterior inferior iliac spine (AIIS); ilium I: Quadriceps femoris tendon Hip flexion, Knee extension
  • Articularis genus pulls suprapatellar bursa superiorly to prevent compression between femur and patella in knee extension

Medial Compartment: Hip Adductors

  • Adductor Magnus: Divided into Adductor for Hip Adduction and Hamstring for Hip Extension | Muscle | Attachments | Action | |---------------|----------------------------------------------------------------------------------|------------------------------------------| | Gracilis |O: Inferior pubic ramus I: Medial surface of proximal tibia (Pes Anserine) | Hip Adduction, Knee flexion (weak) | |Adductor longus|O: Body of pubis, inf to pubic crest I: Linea aspera of femur | Hip Adduction | |Adductor brevis|O: Body and inferior ramus of pubis I: Linea aspera of femur |Hip Adduction | |Adductor magnus*(2 parts)*|O: (1) Ischiopubic ramus; (2) ischial tuberosity I: (1) linea aspera, (2) adductor tubercle| Hip Adduction, Hip Medial rotation |

Posterior Compartment: Hamstrings

  • Hip extension
  • Knee flexion
  • External/Internal tibial rotation when knee is flexed, innervated by Sciatic nerve. | Muscle | Attachments | Action | |---------------|-------------------------------------------------------|-----------------------------| | Biceps Femoris| O: Long head: ischial tuberosityShort head: lat lip of linea aspera I: Head of fibula | Hip Extension,Knee Flexion | | Semi Tendinosus | O: Ischial tuberosity I: Medial surface of proximal tibia| Knee Flexion | |Semi membranous| O: Ischial tuberosity I: posterior surface of medial tibial condyle | same |

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