Thigh

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Featured Bone in Thigh:: Femur
Main regions of Femur:: -Proximal
-Shaft
-Distal
Proximal Femur Features:: -Head
-Neck
-Greater/lesser trochs
Head of Femur articulates w/:: Acetabulum
Type of joint at hip:: Ball/socket
What muscle inserts at the intertrochanteric crest?: Quadratus femoris
What mucle inserts at the Greater trochanter?: -piriformis
-obterator internus
-gemelli
-gluteus minimus/medius
Where do stress fractures most frequently occur in the femur?: At the neck - if they occur - they don't often.
What is the important feature of the shaft?: Linea aspera - midline posterior ridge that is origin for thigh muscles
What does linea aspera give rise to?: Diverges to form medial/lateral
supracondylar ridges.
Which condyle at the distal femur is larger? Effect:: Medial - to extend thigh/knee, foot externally rotates.
What is between the medial / lateral condyles at posterior femur?: Intercondylar notch
Where do the MCL/LCL attach?: At epicondyles
What invests the muscles of the thigh?: Fascia lata
Attachments of Fascia lata:: Superior: Inguinal ligament, iliac crest, sacrococcyx, sacrotuberous ligament, ischial tuberosity, pubis.
What is the IT band?: Extremely strong part of Fascia lata - from iliac crest to lateral condyle of tibia.
Function of IT band:: -insertion of many muscles
-posture
-keeps thigh muscles aligned as Glut max flexes
What results from overuse of the IT Band? In who?: IT Band Friction Syndrome - inflammation of tissue/bursa beneath IT Band - in runners.
What/where is the Saphenous Opening?: Opening in Fascia Lata - just beneath inguinal ligament (external inguinal canal)
Why is the Saphenous opening important?: It allows the Great Saphenous vein to go into the pelvis and join the femoral vein.
What are the 3 intermuscular compartments in the thigh? -Origin -Insertion: Anterior, Posterior, Lateral
Origin: fascia lata
Insert: linea aspera
3 Muscles in the Anterior Hip:: -Ilipsoas
-Obturator externus
-Tensor Fascia lata
What is the function of Ilipsoas?: -Flexes thigh at the hip joint
-Flexes pelvis on the trunk
Origins of Iliacus + Psoas maj: Common insertion of Iliopsoas:: Psoas maj: T12-L5 vertebrae
Iliacus: Iliac fossa
Common insertion: lesser trochanter
What innervaes -Psoas major -Iliacus: Psoas: ventral rami L1-L3

Iliacus: Femoral nerve
Tensor Fascia Lata: -Function -Nerve: Function: aids power of thigh muscles, keeps IT band tight as Glut max extends the knee.
Nerve: superior gluteal nerve
Actions of Obturator Externus:: -Deep, powerful external (lateral) rotation of thigh
-Weak adductor
Obturator externus -origin -insertion -action: Origin: obturator canal/ligament
Insert: trochanteric fossa
Nerve: obturator nerve
Anterior Thigh Muscles -Main function of all -Nerve to all: Function: knee extension

Nerve: femoral nerve
Muscles of Anterior Thigh:: -Sartorius
-Quadriceps femoris
Why is Sartorius called "tailor's muscle"?: B/c tailors often cross their legs and develop prominent Sartorius muscles.
Actions of Sartorius:: -Flexes thigh when leg straight
-Abducts/lateral rotates thigh when crossed.
Pes anserinus:: Common insertion of 3 muscles:
-Sartorius
-Gracilis
-Semitendinosis
4 Components of Quadriceps Femoris:: -Rectus femoris
-Vastus lateralis
-Vastus medialis
-Vastus intermedius
Insertion of Quads:: Common insertion at Tibial Tuberosity - contains Patella
Patella - Type of bone: Sesamoid, within the common insertion of quads.
What are the distal divisions of the common Quad tendon? -Superior to patella -Med/Lat to patella -Inferior to patella: Sup = quadriceps tendon
Med/lat = med/lat retinaculum
Inf = patellar ligament
Which muscle of quads is most superficial?: Rectus femoris
Functions of Rectus Femoris: CROSS BOTH HIP/KNEE JOINTS, so:
-Flex hip
-Extend knee
Vastus lateralis -origin -insertion -Action: origin = greater troch
insert = lat patellar retinaculm
action: extends knee, controls mechanics of knee joint
Vastus medialis -origin -insertion -action: origin = intertrochanteric line and linea aspera
insert = medial patellar retinaculum
action = extends knee and pulls patella medially
Vastus intermedius -origin -insertion -action: Origin = lateral surfaces of femur
Insertion = vastus lateralis and medialis (fuses)
Actions = knee joint extension, stepping up
What athletes tend to get Patellar tendinitis?: Jumping - vball, bball
What is Patellar femoral pain syndrome (PFPS)?: Anterior knee pain seen in active or overweight patients
What causes PFPS?: Problems in Patellar tracking with the femur - VMO Vasus Medialis Obliquis
What is the result of VMO?: Vasus medialis obliquis = lateral retinaculum is tighter than medial, so kneecap is doslocated in a lateral dirctn.
What is the main action of all the muscles of the medial thigh?: Adduction
What innervates all the adductor muscles and what is the 1 exception?: Obturator nerve
-EXCEPT PECTINEUS
What is PECTINEUS innervated by?: Femoral nerve
What are the adductor muscles? (5): 1. Gracilus
2. Pectineus
3. Adductor longus
4. Adductor brevis
5. Adductor magnus
What is the weakest adductor?: Gracilus
Gracilus -action -nerve: Actions: adducts/flexes thigh + very weak internal rotator when knee is flexed
Nerve: obturator
What is the origin/insertion of gracilus?: Origin: pubic ramus/body
Insert: pes anserinus
Pectineus -action -nerve: Actions: adduct/flex thigh
Nerve: femoral
What is the origin/insertion of Pectineus?: Origin: pectineal line of pubis
Insert: pectineal line of femur
Adductor Longus -action -nerve: Action: Adducts/flexes thigh, rotates medially
nerve: obturator
A Pulled Adductor longus might be confused with:: inguinal hernia
Adductor brevis -action -nerve: Action = adduction
Nerve = obturator
Adductor Magnus - 2 parts:: -Adductor part
-Hamstring
Adductor Magnus - Adductor part: -action -nerve: Action: adducts/flexes thigh
Nerve: obturator
Adductor Magnus - Hamstrin part: -action -nerve: Action: EXTENSOR and medial rotator
Nerve: Tibial portion of Sciatic nerve
So the 2 exceptions to the innervation of medial thigh mm.:: 1. Pectineus - femoral nerve
2. Hamstring/Adductor Magnus - tibial portion of sciatic nerve.
What is the adductor hiatus?: The junction of the Adductor canal and Popliteal fossa where the femoral vessels pass thru and become popliteal vessels.
What is the Adductor canal?: A canal underneath sartorius - the femoral vessels run w/in it.
Main difference between adductors and hamstrings:: Adductors - flex thigh

Hamstrings - extend thigh
What muscles are in the posterior compartment?: 1. Biceps femoris
2. Semimembranosus (Medial)
3. Semitendinosus (beTween)
So what are the major actions of the hamstrings?: 1. Extend thigh
2. Flex knee
What innervates the hamstrings?: Sciatic nerve
What is the common origin of the hamstrings / 1 exception?: Ischial tuberosity
EXCEPT shorthead biceps fem.
What does semitendinosis do in addition to thigh extension and knee flexion?: Medially rotates
What is the insertion point of Semitendinosis?: Pes anserinus with Gracilus and Sartorius - medial retinaculum.
Semimembranosus -action -insertion -nerve: Action: same, plus medial rotation.
Insertion: posterior medial condyle of femur.
Nerve: tibial portion, sciatic
Biceps femoris insertion:: -Common for Long/Shortheads.
-Lateral collateral ligament - it splits the tendon insertion.
What results from the way the biceps femoris insertion is designed?: Most common site for tears.
Biceps femoris long head -action -nerve: Action: extend thigh, flex knee, AND LATERAL ROTATION
Nerve: tibial portion, sciatic
Main difference between Biceps femoris Longhead vs. Shorthead:: Long = 2-joint muscle; extends thigh, flexes knee.

Short = 1-joint; only flexes knee
Biceps femoris NERVES -longhead -shorthead: Longhead: tibial portion, sciatic nerve
Shorthead: fibular portion, sciatic nerve
Biceps femoris ORIGINS -longhead -shorthead: Long = ischial tuberosity
Short = linea aspera and supracondylar ridge
What is the Biceps Femoris longhead an important landmark for?: Sciatic nerve - runs btwn BF longhead and Adductor magnus (hamstring portion).
Popliteal Fossa Borders: -Superolateral -Superomedial -Inferomedial -Inferolateral: Superolat: Biceps femoris
Superomed: Semimemb/tendinosis
Inferomed: med head gastrocnem.
Inferolat: lat head gastrocnem.
Contents of the Popliteal fossa:: -Popliteal vein/artery
-Tibial/Common Femoral nerves (branches of sciatic nerve)
-Small saphenous vein
-Popliteal lymph nodes, fat, bursa sac
Which component of Popliteal fossa is subject to injury? Why?: Common peroneal nerve (fibular) - it runs very superficially.
Bakers cyst - what is it?: Ruptured popliteal bursa - causes swelling and inflammation behind the knee.
Where would trauma occur to injur the common peroneal nerve?: Medial aspect of knee
In general, what is the femoral triangle?: A depression inferior to the inguinal ligament when the hip is flexed - check femoral pulse
Boundaries of the Femoral Triangle:: -Sartorius
-Inguinal ligament
-Adductor longus
(floor = iliopsoas/pectineus)
What is the roof of the femoral triangle?: Fascia lata
Contents of the Femoral Triangle:: -Femoral nerve/artery/vein - in that order going lat->med
-Inguinal lymph nodes
-Femoral sheath
If inserting a venous line to the femoral vein, how would you find it?: Check for femoral pulse (artery) then move medially.
4 branches given off from Femoral artern in fem triangle:: 1. Profunda femoris artery
2. Medial circumflex
3. Lateral circumflex
4. Continuation of femoral artery
What area is supplied by the Profunda femoris artery?: This is the "CHIEF ARTERY" of the thigh - supplies:
-Adductor magnus
-Hamstring muscles
What 2 vessels branch from Profunda femoris? What structures does each supply?: 1. Medial circumflex -> head/neck of femur
2. Lateral circumflex -> lateral thigh muscles
Where does the Medial circumflex off Profunda femoris lie?: Between PECTINEUS muscle and ILIPSOAS
Where does the Lateral circumflex off Profunda fem lie?: Deep to SARTORIUS and RECTUS FEMORIS
What runs together to make the Femoral Vein?: -Profunda femoris vein
-Saphenous veins (great/small)
What does the Femoral Vein continue to become? Where?: After passing thru Femoral triangle & posterior to the Inguinal canal becomes External Iliac vein.
What lies within the Femoral Sheath?: Femoral VESSELS - not nerve.
What pierces the femoral sheath?: Great saphenous vein
What does the ADDUCTOR CANAL contain?: -Femoral artery/vein
-Saphenous nerve
What exits the adductor canal? Where does it go?: Femoral artery and vein - to the popliteal fossa
What does not exit the adductor canal? Where does it go?: Saphenous nerve - cutaneous branch of femoral nerve, runs between sartorius/gracilus mm.
-Supplies medial leg
What are the important veins in the thigh region?: 1. Great saphenous
2. Small saphenous
Where does the Great saphenous vein travel?: -Dorsal venous arch of foot
-Up medial leg/thigh
-Thru saphenous opening - inguinal region
What happens to the Great saphenous vein at the thigh?: Joins with femoral in the inguinal fossa.
Why is the great saphenous vein clinically important?: Used in coronary bypass grafts.
Where does the Small saphenous vein run?: Posterior to LATERAL malleolus - up to popliteal fossa

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