Anatomy Notes PDF

## Special Structures - Femoral Triangle - Location: Triangular depression in the upper one third of the medial compartment of the thigh - Base: Inguinal ligament - Medially: Adductors - Laterally: Sartorius - Apex: - Floor: Iliacus, Pectineus, Adductor Longus - Roof: Ski...

## Special Structures - Femoral Triangle - Location: Triangular depression in the upper one third of the medial compartment of the thigh - Base: Inguinal ligament - Medially: Adductors - Laterally: Sartorius - Apex: - Floor: Iliacus, Pectineus, Adductor Longus - Roof: Skin, Superficial fascia. - Contents: - Most medial Structure - Inguinal lymph nodes: - Veins, arteries, nerves - Femoral Sheath - Covering, separation between structures. - Femoral sheath is a connective sheath that covers inguinal lymph nodes (medial compartment), intermediate (femoral veins) - lateral compartment (femoral arteries). - The cor opening of the medial compartment of femoral triangle is called femoral ring. - Most medial compartment femoral canal. - Extraperitoneal tissue that closes the opening is called femoral septum. - Adductor canal contains the following: - Terminal part of the femoral artery - Femoral vein - Deep lymph vessels - Saphenous nerve, the nerve to the vastus medialis, and the terminal part of the obturator nerve. ## Femoral Triangle - The femoral triangle is a triangular depression situated in the upper part of the medial aspect of the thigh just below the inguinal ligament. - Its boundaries are as follows: - Superiorly: inguinal ligament - Laterally: Sartorius muscle - Medially: Adductor longus muscle - Floor: Gutter shaped and formed from lateral to medial by the iliopsoas, the pectineus, and the adductor longus - Roof: Skin and fasciae of the thigh - The major contents of the femoral triangle are as follows: - Femoral nerve and its terminal branches - Femoral sheath - Femoral artery and its branches - Femoral vein and its tributaries - Deep inguinal lymph nodes ## Adductor (Subsartorial) Canal - The adductor canal is an intermuscular cleft situated on the medial aspect of the middle third of the thigh deep to the sartorius muscle. - It begins above at the apex of the femoral triangle and ends below at the opening in the adductor magnus (the adductor hiatus). - It has three walls: - The anteromedial wall is formed by the sartorius muscle and fascia. - The posterior wall is formed by the adductor longus and magnus. - The lateral wall is formed by the vastus medialis. ## Hip Joint - Synovial Joint, ball and socket joint. - Articulation - Head of femur articulates with acetabulum of hip bone - Fibrous membrane that covers the joint cavity from outside. - Synovial membrane that provides inner linings of joint cavity. - Synovial fluid that is inside the joint cavity. Produce by Synovial membranes provides lubrication, nutrition. - Hyaline Cartilage. - The articulating surface of a bone. - Acetabular labrum (joint socket) - It is a fibrocartilagenous structure, that deepens joint so cavity to accommodate head of femur. - Ligaments - Intracapsular - Extracapsular - Iliofemoral, pubio femoral, ischial femoral. ## Iliofemoral Ligament - Inverted Y shaped ligament - Upper: AIIS - Lower: intertrochanter line - Function: It provides stability to the joint & prevents extension ## Pubofemoral Ligament - Triangular shaped - Upper: Superior ramus of Pubis - Lower: Intertrochanter line - Function: It prevents abduction and extension ## Ischialfemoral Ligament - Spiral shaped - Upper: Body of Ischium - Lower: Greater trochanter of femur: - Function: Prevents extension ## Sprain - Ligamentous injuries ## Intracapsular Ligament - Ligament of head of femur attaches at foviacapitas to acetabulum. - Function: Internal stability - Transverse acetabular ligament, it attaches with acetabular labrum. - Movements: - Flexion: Iliopsas. - Extension: Hamstrings, gluteus maximus - Aduction: Gluteus minimas, medius - Adduction: Adductors. - Medial rotation: Gluteus minimas, medius. - Lateral rotation: Priformis - Clinical: - CDH: Congenital dislocation of hip joint by birth. Head of femur dislocate from acetabulum. - DDH: Developmental dislocation displasia of hip joint, not formed head of femur. ## Bone is a living tissue - Tissue death - Avascular neckrosis: AVN - Death of head of femur neckrosed due to damage of nerve supply. - Teatment: Implant ## Nerve Supply - Cutaneous (medial vide) (anterior side of thigh) - Medial cutaneous & intermediate cutaneous nerve of thigh - Muscular supply to - Pectineus - Sartorius - Posterior divide into - Cutaneous - Muscular - Quadriceps - Saphenege nerve (It supply medial side of leg, then passes in front & medial malocks) & supply medial border of foot. - Clinical: - If femoral nerve is damaged then the knee extension is difficult/affected. - Movement lost (effect quadriceps) ## Avascular Necrosis - Damage of nerve supply result in necroses of femur head (death) - Treatment: Complete joint replace - Common in old age ## Femoral Nerve - Largest branch of lumbosacral plexus - Origin: Tibia & lumbar plexus - Nerve Root: L2,3,4 - It starts at lateral border of psoas muscle within abdomen. - Pathway: - It passes b/w iliacus & psoas muscle → enter in thigh → lateral to femoral artery → i.com below the inguinal ligament. - It divide in to 2 division (anterior & posterior) - Anterior Auther give 2 cutaneous & ## Obturator Nerve - Origin : Lumbosacral Plexus - Nerve Root: L2,3,4 - It start medial border of psoas muscle within the abdomen → enter into lateral wall of pelvis into pelvis → obtrator foramen. - Anterior division: supply to adductor longus & brevis & gracilis - Posterior division: supply to adductor magnus & obtrator externus - Clinical: - Adductor tightness (spasticity) - Due to Spasticity (thin legs) - Due to Flaccidity (polio) - Due to C.N.S damage (crossed legs) - Due to P.N.S damage (brain damage) - Affect lower posture affect ## Tibia - Determination: - Upper end expanded and lower end is narrow. - Lower end downward projection will be medially. - Sharpest border of shaft shoud be antercally. - Upper End: - Two condyle (medial & lateral) - Between inter condylor area - Tibial tuberosity (anteriorly) - All quads give insertion here - Medial Condyle: - Semi membranosis - Lateral condyle: - It band (gerday's tubercle) - Ant border: Below ischial tuberosity - Post-lat border: Below lateral condyle facet - Medial border: Above medial malleolus - Lateral surface: - Tibial tuberosity (Ant border) - Tibiali's anterior (0) - Dorsiflenor of foot. - It's a my musde, main rehabilitation muscle - Medial surface: - Blw ant & med border. - 3 muscle give common insertion: - Semitend enosus (I) - Sartorius (I) - Gracilis (I) - Pes anserine is a common word for all these folo muscles ## of femur - Medial side of femur - Ligaments. - Extracapsular - Ligamentum Patella (Quads muscle) - Lower end of femur/patella - Tibial tuberosity. - Continuation of quads - Anterior stability to joint - Lateral colateral ligament. ## Thigh - Front: Knee region muscles anteriorally perform extension. (Quads) extensors. - Backside: flexors - Medial: adductors - Anterior tilt: Loadases (Pregnant) - Posterior tilt: back flat - Lateral tilting: abductors weakness, helping medius, minimus → gait - One leg weight bearing, pdvis drop of unsupported leg side, opposite side will be have weak muscles ## Trendelenburg Side - Quadretus Lomborum, hip abductors - Knee extension: quads. - Long standing of knee: IT bands. - Tenderness: pain on touch. - Hip extensors: Hamstrings, flexor gluteus maxima - Hip flexors: iliasoas, sartoreus - Abductors: medius, minimus - Adductor: Atmedial compartment muscles. - Lateral rotator: Obturator exteenus, piriformis, Sartoreus ## Iliotibial Tract - Band like structure - Deep fascia of thigh fascia ladae. - Gluteus maximus fibers, tensor fasciae latae - Lateral aspect of thigh. - (Ilium) upper attachment. - (Tibia) lower attachment. - Action: - Maintain prolong standing, it keep knee extends. - Knee Normal standing: Quads. - Prolong standing = IT band. - Overuse of IT band. ## IT Band Syndrome - Pain in lateral side, job of prolong standing - Inflammation of IT band due to overuse.