MD1101 Flexors and Adductors of the Hip PDF

Flexors and adductors of the hip Dr Rachel Beatty University [email protected] ofGalway.ie Learning Outcomes Identify the fascia lata and intramuscular septae of the lower limb Discuss the muscles and innervation of the anterior, medial and posterior co...

Flexors and adductors of the hip Dr Rachel Beatty University [email protected] ofGalway.ie Learning Outcomes Identify the fascia lata and intramuscular septae of the lower limb Discuss the muscles and innervation of the anterior, medial and posterior compartments of the thigh Describe the anatomy of the long and short saphenous veins. Explain how varicose veins may develop and why complications may arise from treatment Interpret radiological imaging of the bones and vessels of the thigh Describe the femoral triangle and its contents Demonstrate clinical landmarks on examination of the anterior, medial and posterior thigh University ofGalway.ie University ofGalway.ie Iliopsoas Primary Hip Flexor Psoas major Psoas major ANTERIOR RAMI (L1,2,3) Iliacus –T12 – L5 ASIS Iliacus FEMORAL –Iliac fossa NERVE (L2,3,4) Inguinal ligament Iliopsoas –Common tendon –Lesser trochanter Lesser trochanter University ofGalway.ie University ofGalway.ie The femur ANTERIOR POSTERIOR University ofGalway.ie  External iliac nodes Superficial inguinal nodes Inguinal ligament Deep inguinal nodes Great saphenous vein University Popliteal nodes (deep) ofGalway.ie Behind knee  IVC Common iliac vein Internal iliac Veins of the lower limb External iliac Inf. and sup. gluteal veins Inguinal ligament Obturator veins *The fascia lata Femoral vein What veins are superficial to the fascial lata? Popliteal vein Ant. and post. tibial veins Small/short saphenous Superficial veins Great saphenous University ofGalway.ie Anterior compartment of the thigh University ofGalway.ie Anterior compartment of the thigh Tensor fascia Lata** Iliopsoas* Sartorius Quadriceps femoris ** Superior gluteal nerve *Iliacus and psoas major have different nerve innervation Femoral nerve University ofGalway.ie Sartorius – ASIS (Anterior superior iliac spine) – Pes Anserinus Lit. “Goose Foot” Site of attachment of sartorius, gracilis and semitendinosus muscles “Say Grace before Tea” Sartorius, Gracilis, Semitendinosis University ofGalway.ie  Anterior Posterior Tensor Fascia Latae Gluteus medius Gluteus minimus Gluteus maximus Tensor fasciae latae - Stabilizes the hip Iliotibial tract - Stabilizes the knee during extension Fascia lata University ofGalway.ie LATERAL VIEW Quadriceps femoris University ofGalway.ie Rectus femoris University ofGalway.ie Quadriceps femoris FEMORAL NERVE (L2,3,4) Tibial tuberosity ANTERIOR University ANTERIOR POSTERIOR ofGalway.ie University ofGalway.ie Knee movements Knee Extension (jerk) L3,4 University ofGalway.ie Root values Knee Extension (jerk) L3,4 Plantarflexion (jerk) S1,2 University ofGalway.ie Medial compartment ANTERIOR Lateral Medial University POSTERIOR ofGalway.ie  Pectineal line Medial Obturator compartment Adductor brevis externus Gracilis Adductor brevis Pectineus for perforating Adductor longus arteries Adductor magnus OBTURATOR NERVE (L2-4) Pes anserinus University ofGalway.ie Pectineus Adductor brevis Gracilis Pectineus Adductor longus Adductor magnus FEMORAL NERVE (L2-4) Exception Pes anserinus University ofGalway.ie Adductor longus Adductor brevis Gracilis Pectineus Adductor longus Adductor magnus OBTURATOR NERVE (L2-4) Pes anserinus University ofGalway.ie Adductor brevis Adductor brevis Gracilis Pectineus Adductor longus Adductor magnus OBTURATOR NERVE (L2-4) Pes anserinus University ofGalway.ie Adductor magnus Adductor brevis Gracilis Pectineus Adductor longus Adductor magnus Adductor and Hamstring* part OBTURATOR NERVE (L2-4) Pes anserinus University ofGalway.ie Gracilis Adductor brevis Gracilis Pectineus Adductor longus Adductor magnus OBTURATOR NERVE (L2-4) Pes anserinus Pes anserinus University ofGalway.ie  Greater Sciatic Foramen Sacrotuberous Ligament Apertures of Inguinal ligament Sacrospinous Ligament the pelvis Obturator Canal Obturator membrane Lesser Sciatic Foramen Gap betweenUniversity inguinal ofGalway.ie ligament and pelvic bone ANTERIOR POSTERIOR University ofGalway.ie Femoral triangle Important anatomical landmark Boundaries Lateral Sartorius Medial Adductor Longus Superior Inguinal ligament Iliopsoas, pectineus & Floor adductor longus Access point to arterial and University Roof Fascia lata venous systems ofGalway.ie Lateral femoral cutaneous nerve Femoral nerve NAVeL University ofGalway.ie Bony landmarks Medial third of the way between Anterior Superior Iliac Spine and pubic symphysis 2 finger breaths below inguinal ligament University ofGalway.ie Femoral sheath Extension of transversalis fascia, pectineal fascia Fossa Ovalis: entry of great saphenous vein Femoral nerve NOT included in sheath University ofGalway.ie  IVC Aorta Femoral artery Psoas major Inguinal ligament Femoral nerve Femoral sheath Femoral artery Lymphatics - Travels down subsartorial canal (with vein, N to V. Medialis & saphenous N) Femoral artery Pubic - Through adductor hiatus Femoral vein symphysis - Changes name to popliteal artery Adductor canal Profunda femoris artery Branches from femoral artery in the femoral triangle Passes deep to the adductor longus muscle Popliteal artery University (behind knee) ofGalway.ie Profunda femoris Anterior Posterior University ofGalway.ie Adductor hiatus Femoral artery changes name to the popliteal artery Frequent site of atherosclerotic lesion University ofGalway.ie L2-L4 University ofGalway.ie Femoral nerve From Lumbar plexus – L2 – L4 Motor: – Quadriceps femoris – Sartorius – Iliacus Sensory – Anterior cutaneous to thigh – Saphenous nerve University ofGalway.ie The femoral nerve University ofGalway.ie Cutaneous innervation University ofGalway.ie University ofGalway.ie L2-L4 University ofGalway.ie The obturator nerve Hilton’s law University ofGalway.ie University ofGalway.ie University ofGalway.ie Cutaneous innervation University ofGalway.ie Dermatomes A dermatome is an area of skin in which sensory nerves derive from a single spinal nerve root University ofGalway.ie