Blood Supply Hip Thigh Popliteal Fossa PDF

Functional Anatomy Lower Extremity: Blood Supply Hip/Thigh/Popliteal Fossa Jason Dring, PT, DPT Contributions by E. Costello, PT, PhD Blood Supply LE Femoral Artery - supplies anterior & anteromedial surface of thigh –Changes name from external iliac aa after crossing ingu...

Functional Anatomy Lower Extremity: Blood Supply Hip/Thigh/Popliteal Fossa Jason Dring, PT, DPT Contributions by E. Costello, PT, PhD Blood Supply LE Femoral Artery - supplies anterior & anteromedial surface of thigh –Changes name from external iliac aa after crossing inguinal ligament Profunda Femoral Artery (Deep Femoral a) - arises from femoral a. near inguinal ligament; gives rise to perforating branches through add magnus m.(4) to supply posterior thigh.  Cut femoral a Profunda femoral/d eep femoral a. Perforatin g branches of the profunda femoral/d eep femoral a. Blood Supply LE Medial Femoral Circumflex Artery - usually arises from profunda femoral a. but can arise from femoral a.; primary blood supplier to the head & neck of femur via posterior retinacular aa; terminates by dividing into ascending/transverse branches Lateral Femoral Circumflex Artery - usually arises from profunda femoral a. but can arise from femoral a.; primarily supplies lateral hip muscles; ascending to gluteal region; transverse around femur; descending to knee  External iliac aa A. Vasculature of the thigh. B. Femoral artery and its branches. Citation: Chapter 36. Thigh, Morton DA, Foreman K, Albertine KH. The Big Picture: Gross Anatomy; 2011. Available at: https://accessmedicine.mhmedical.com/content.aspx? bookid=381&sectionid=40140047 Accessed: September 18, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved  Quadrat us femoris Br. Of Medial femoral circumflex a. exits below QF (posterior view) Perforating AA. From profunda Adductor femoral a. hiatus Popliteal a & v Small Saphenous v. Medial Femoral Circumflex Artery - usually arises from profunda femoral a. but can arise from femoral a.; primary blood supplier to the head & neck of femur via posterior retinacular aa; terminates by dividing into ascending/transverse branches Lateral Femoral Circumflex Artery - usually arises from profunda femoral a. but can arise from  Artery to Retinacular Arteries the head of the femur via obturator a Retinacular arteries arising from medial (and lateral) femoral circumflex arteries are the main supply to the hip joint Citation: Chapter 35. Gluteal Region and Hip, Morton DA, Foreman K, Albertine KH. The Big Picture: Gross Anatomy; 2011. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=381&sectionid=40140046 Accessed: October 01, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved *Note position of medial femoral circumflex a. between pectineus & iliopsoas  Cruciate Anastomosis of the Hip Cruciate Anastomosis includes:  Transverse branch of x lateral femoral circumflex A. x x  Medial Femoral Circumflex A.  Inferior Gluteal A. (see posteriorly)  First Perforating Artery from Profunda Femoral A. (see posteriorly) Cruciate Anastomosis Hip: Transverse branch of lateral femoral circumflex A. Medial femoral circumflex A. Inferior Gluteal A. (see posterior) First Perforating Artery from Profunda Femoral A. (See posterior) Cruciate Anastomosis Hip: Transverse branch of lateral femoral circumflex A. Medial femoral circumflex A. Inferior Gluteal A. (see posterior) First Perforating Artery from Profunda Femoral A. (See posterior)  Cruciate Anastomosis Hip: Transverse & ascending branch of lateral femoral circumflex A. Medial femoral circumflex A. Inferior Gluteal A. (see posterior) First Perforating Artery from Profunda Femoral A. (See posterior) https://www.memorangapp.com/flashcards/195895/Lower+Limb+I%2C+II%2C+III%2C+IV+%26+V/  Blood supply interrupted with fracture of the femoral neck http://www.wheelessonline.com/images/hip65.jpg ascular Necrosis of Femoral Head Avascular necrosis (aka: aseptic necrosis, osteonecrosis) is a condition that results from poor blood supply to an area of bone Normal causing bone death. Poor blood supply may lead to ischemia and necrosis of bone tissue causing weakening of the bone with eventual collapse. Avascular necrosis can be caused by trauma and damage to the blood vessels that supply bone its oxygen. AVN  Avascular Necrosis Other risk factors for avascular necrosis: – systemic steroids, sickle cell anemia, alcohol abuse, RT (radiation therapy) Femur at high risk b/c it is an end organ and lined with articular cartilage where arteries can not penetrate Arterial supply restricted to small space Requires a hemiarthroplasty or THR if in adult – But can vary depending on the severity of the degradation of the femoral head  Legg-Calve Perthes Disease Child Avascular Necrosis Unknown origin 1/1200 children: Boys> girls Age: 4-7* Treatment: historically casting/bracing/ was used but evidence suggests outcomes no different as compared to no treatment. THR if later in life.  LCP video  Slipped Capital Femoral Epiphysis (SCFE)  Epiphysis of the femoral head may slip away from the femoral neck due to a weakened epiphyseal plate  Causes: acute trauma or repetitive microtrauma with shear stress; gradual slippage with associated hip pain that may refer to the knee; antalgic gait  SCFE usually occurs in: children between 10 and 16 years old* Overweight Boys > girls Most common among children of African descent Classified 2 types: stable and unstable (unable to weight bear)  Typically, an emergent situation Long Bone  SCFE Treatment Common treatment: "in- situ fixation." the bone is held in place with a single central screw keeps the femur from slipping and closes the growth plate Good results with few complications Prophylactic bilateral surgical intervention - sometimes Conservative treatment (NWB) ~ poorer outcomes  SCFE vs. Perthes Disease SCFR Perthes Usually occurs in active children Usually occurs in children ages ages 10-14 4-7 Often related to stature (obese Not typically related to stature or tall/thin) Presents with pain with Limping initially and then slippage. Limping note later complaints of pain in later stages Hip flexion contracture is rare Hip flexion contracture common (limb may be hyperextended)  Lower Limb/Leg, including the knee, Blood Supply Popliteal artery Popliteal vein Small Saphenou s Vein Great Saphenous Vein Ascends anterior to B the medial l malleolus o o Passes posterior to d the medial condyle F of the femur l o Passes through w saphenous opening/fossa ovalis Empties into femoral vein https://en.wikipedia.org/wiki/File:Great_saphenous_vein.png  Blood Supply in Popliteal Fossa Popliteal Artery - continuation of femoral artery; ends at the superior border of the popliteus mm Branches of Popliteal Artery - Genicular Arteries (x5): superomedial, superolateral, middle, inferomedial, inferolateral Genicular Arteries supply articular capsule & ligaments of knee Genicular Anastomosis: includes all 5 genicular arteries: 1. sup lat genicular genicular 2. sup med genicular arteries (x5) 3. inf med genicular & 4. inf lat genicular, & descending 5. middle genicular (can’t see middle genicular branch genicular in this view) of femoral a. (anteriorly) descending branch of the lateral femoral circumflex a. recurrent branch of anterior tibial a.  2 3 1 1 Genicular Anastomosis includes: 1. genicular arteries (x5) - Middle 1 genicular aa not 1 shown 2. descending genicular branch of femoral a. (anteriorly) 4 3. descending br. of lateral femoral circumflex a. 4. recurrent branch of anterior tibial  Knee Anastomoses (Genicular aa x 5) Superior Superior lateral medial genicula genicula r aa r aa Middle genicula r aa Inferior lateral Inferior genicula medial r aa genicula r aa  Genicular Anastomoses Review Lateral Medial Question, comments, concerns https://www.jeffalytics.com/wp-content/uploads/2013/10/Lots-of-Information.jpg