BMS MSK Lecture 12 Fall 2023 PDF

BMS Anatomy Lecture 12 Anterior & Medial Thigh Muscles (In-Person Class) Presented By: Dr. K. Lumsden; [email protected] (Toronto Campus) Dr. M. Doroudi; [email protected] Boucher Campus) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph...

BMS Anatomy Lecture 12 Anterior & Medial Thigh Muscles (In-Person Class) Presented By: Dr. K. Lumsden; [email protected] (Toronto Campus) Dr. M. Doroudi; [email protected] Boucher Campus) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph.D. FAAA (Author), 9th ed. Lower Limb Chapter; Pages: 713 – 720 Deep fascia of the thigh (Fascia lata) Three intermuscular septae are derived from the fascia lata in the thigh and divide it into 3 compartments: ³ The anterior (extensor) compartment ³ The medial (adductor) compartment ³ The posterior (flexor) compartment 2 Extensor Muscles of knee Joint (with exception!) (Femoral Nerve) Thigh Compartments Mainly Flexor Muscles of knee J. (Sciatic Nerve) Adductor Muscles of hip J. (Mainly Obturator Nerve) Psoas Major – Ori: - Bodies and TPs of L1 – L5 – Ins: - Lesser trochanter of femur 4 Function: 1.Flex. of thigh (hip J.) 2.Lat. Rot. of thigh (hip J.) 3.Flex. of trunk@ the spinal joints. 4.Lat. Flex. of trunk@ the spinal joints. 5.Anterior tilt of pelvis @ the hip Nerve Innervation: Lumbar plexus (L1, L2, 3) 5 Iliacus – Ori: - Iliac fossa - Sacral Ala – Ins: - Lesser trochanter of femur r The psoas major and the iliacus muscles are considered to be the iliopsoas M. because of their common distal attachment onto the lesser trochanter of femur. 6 Function: 1.Flex. of thigh (hip J.) 2.Lat. Rot. of thigh (hip J.) 3.Anterior tilt of pelvis @ the hip Nerve Innervation: Femoral Nerve 7 Psoas Major Muscle Note Muscle contracture and its role on lumbar hyper lordosis 8 Extensor Muscles of knee Joint (with exception!) (Femoral Nerve) Anterior compartment of Thigh Anterior Compartment of Thigh (All muscles in this compartment are innervated by femoral N.) Sartorius – Ori: Anterior superior iliac spine (ASIS) – Ins: Proximal part of medial surface of shaft of tibia (forms Pes anserine tendon) 10 Function: 1. Flex of thigh (hip J.) 2. Abd. of thigh (hip J.) 3. Lat. Rot. of thigh (hip J.) 4. Flex of leg @ knee J. 5. Med. Rot. of leg @ knee J. N: Femoral 11 Quadriceps femoris Rectus femoris –Ori: Straight (Ant.) head: AIIS Reflected (Post.) head: Groove above the brim of acetabulum Ins: Base of patella via the quadriceps tendon and then to tibial tuberosity via the patellar ligament (tendon) 12 Function: 1. Ext. of leg (knee J.) 2. Flex. of thigh (hip J.) Nerve: Femoral 13 Quadriceps femoris Vastus lateralis Ori: – Intertrochanteric line – Gluteal tuberosity – Lateral lip of linea aspera Ins: Lateral border of patella via the quadriceps tendon and then to tibial tuberosity via the patellar ligament (tendon) 14 Function: 1. Ext. of leg (knee J.) Nerve: Femoral 15 Quadriceps femoris Vastus medialis Ori: - Intertrochanteric line - Medial lip of linea aspera - Medial supracondylar line. Ins: Medial border of patella via the quadriceps tendon and then to tibial tuberosity via the patellar ligament (tendon) 16 Function: 1. Ext. of leg (knee J.) Nerve: Femoral 17 Quadriceps femoris Vastus intermedius – Ori: Anterior and lateral surfaces of body of femur – Ins: Base of patella via the quadriceps tendon and then to tibial tuberosity via the patellar ligament (tendon) 18 Function: 1. Ext. of leg (knee J.) Nerve: Femoral 19 Articularis genus – Ori: anterior surface of the lower part of the body of the femur – Ins: upper part of the capsule and synovial membrane of the knee joint. – Fun: It elevates the capsule and the synovial membrane of the knee joint and prevents them from being pinched during extension of the leg. 20 Medial Compartment of Thigh Adductor Muscles of hip J. (Mainly Obturator Nerve) Pectineus – Ori: Superior ramus of pubis (Pectineal line of pubis) – Ins: pectineal line of femur 22 Function: 1. Add. of thigh (hip J.) 2. Flex. of thigh(hip J.) N: Femoral* 23 Adductor longus – Ori: Anterior surface of pubis – Ins: Middle part of linea aspera 24 Function: 1. Add. of thigh (hip J.) 2. Flex. of thigh (hip J.) 3. Lat. Rot of thigh (hip J.) N: Obturator 25 Adductor Brevis – Ori: Body & Inferior ramus of pubis – Ins: Proximal 1/3 of linea aspera of femur 26 Function: 1. Add. of thigh (hip J.) 2. Flex. of thigh (hip J.) 3. Lat. Rot of thigh (hip J.) N: Obturator 27 Adductor magnus v Ori: Anterior head (adductor part): - Ischiopubic ramus Posterior head (hamstring or ischial part): Ischial tuberosity 28 Adductor magnus vIns: Anterior head (adductor part): –Linea aspera –Gluteal tuberosity –Medial supracondylar line Posterior head (hamstring or ischial part): –Adductor tubercle 29 30 Function: 1. Add. of thigh (hip J.) 2. Flex. of thigh (hip J.) (the Ant. or pubic attachment) 3. Ext. of thigh (hip J.) (the Post. or Hamstring or ischial attachment) 4.Lat. Rot of thigh @ hip J. N: Anterior head (Pubic) by obturator N. and post. Head (Hamstring or Ischial) by tibial N. Adductor Hiatus Gracilis Ori: – Body of pubis – Inferior ramus of pubis Ins: Proximal part of medial surface of shaft of tibia (forms Pes anserine tendon) 33 Function: (4 ) (2 Movements on hip J. and 2 on knee J.) 1. Add. of thigh (hip J.) 2. Flex. of thigh (hip J.) 3. Flex. of leg (knee J.) 4. Med. Rot. of leg (knee J.) N: Obturator 34 Adductor Muscles Notes In patients with cerebral palsy, these muscles are spastics, hence Scissor's Gait!, need tenotomy Role of Gracilis is surgical reconstruction Adductor Magnus is also known as 4th hamstring! 35 Pes Anserinus Sarterious, gracilis and semitendinosus muscles attach to the upper medial side of the tibia in a three-pronged pattern, so their combined tendons of insertion are often termed the pes anserinus (Latin for goosefoot) 36 Femoral Triangle 37 Clinical Correlation = Femoral Triangle Femoral triangle Borders = “SAIL” – Sartorius – Adductors – Inguinal Ligament Contents = “NAVEL” – Nerve – Artery – Vein – Empty Space – Lymph The femoral canal is an inverted cone-shaped fascial space medial to the femoral vein within the upper femoral triangle. It is only 12 cm long and opens superiorly as the femoral ring. It mainly serves to allow the femoral vein to expand when there is increased venous return from the lower limb 39 Femoral Hernia 40 Femoral Hernia 41