9.13.2006 Anteromedial Thigh & Hip Joint
Terms
undefined, object
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- The ______ is a cup-like depression in the hip where the _________ articulates.
- acetabulum; head of the femur
- The ____________ bones (3) articulate at the acetabulum.
- pubis; ischium; ileum
- The obturator foramen is circumscribed by:___ & ____.
- ishium & pubic bones
- Tlooking from within the pelvis outward, the acetabulum is located _____ to the obturator foramen.
- posteriolateral
- The analagous structure to tubercles of the humerous are _______ of the femur.
- trochanters
- The ________ trochanter is more posteriorly located.
- lesser
- The femur has slight ________ convexity.
- anterior
- The condylar surface of the knee articulates with _____.
- patella (and tibia)
- The ___________ is located ANTRERIORLY between the greater and lesser trochanter.
- intertrochanteric line
- The ___________ is located POSTERIORLY between the greater and lesser trochanter.
- intertrochanteric crest
- The roughened area lateral to lesser trochanter is called ___________.
- gluteal tuberosity (it's also the superior lateral line of linea aspera)
- The ___________ is where the gluteus maximus inserts.
- gluteal tuberosity
- The roughened, raised line on the posterior surface of the body of femur is _____.
- linea aspera
- The linea aspera descends and gives off ___________.
- medial and lateral lips
- The medial and lateral lips of the linea aspera descend and give off ______.
- medial and lateral supracondylar ridges
-
On the medial epicondyle, there is a bony protuberance called the ______.
What attaches here? -
adductor tubercle;
hamstring part of adductor magnus - The angle that the neck of femur makes w/long axis of femur is called _____ & is about ____º
- angle of inclination; 126
- In females, the angle of inclination is ____ (smaller or larger). Females hips are broader because _____.
- smaller; they have to adjust for smaller angle by tilting femur (greater trochanter)more latrally
- The hip joint is ______ compared to the glenohumeral joint, and is ______ mobile.
- tighter (more stability); less
- The _____ is the thickening around the edge of the acetabulum.
- acetabular labrum
- ___________ is a roughened area located on the lateral aspect of the superior tibia.
- GERDY'S TUBERCLE
- ________ attaches to Gerdy's tubercle.
- IT (IleoTibial) tract
- _____ is a centrally located 'lump' where the ___ attaches.
- tibial tuberosity
- ________ attaches to the tibial tuberosity.
- Quadriceps tendon (indirectly from patella)
- The ________ ligament is said to be strongest in the body. It runs from ____ to _____.
-
Iliofemoral (Y ligament of Bigelow);
AIIS to intertrochanteric line - The ______ ligament is medial to the iliofemoral lig.
- pubofemoral
- The ILIOPECTINEAL BURSA rests deeply between gap in _____, and superficially on the _____ muscle.
- iliofemoral & pubofemoral ligaments; iliopsoas
- Iliofemoral ligament limits ____ of thigh to about ___º.
- extension; 30 degrees
- The _______ keeps you from kicking yourself in the back of the head.
- iliofemoral ligament (limits you to 30º motion)
- The _____ ligamentS resist the amound of ABduction that one can do.
- pubofemoral; ischiofemoral
- A super deep ligament of the hip is the _______.
- zona orbicularis
- Clinically the only way to dislocate head of femur from acetabulum is ____________.
- by stretching or disrupting the acetabular labrum
- The ligament of the head (of the femur) helps to reduce the amount of _______.
- adduction
- The ligament of the head is most taut in _____ of the hip joint.
- adduction
- The _________ supplies the head of the femur, but may not be sufficient enough to supply entire head of femur.
- artery of the ligament of the head
- The artery of the ligament of the head arises most often from _______.
- posterior branch of the obturator artery
- The artery of the ligament of the head can sometimes arise from _______.
- medial circumflex artery of femur
- The overlying labrum in the gap of the acetabulum (_____ aspect) is called the ______.
-
ANTERIOR ASPECT;
TRANSVERSE ACETABULAR LIGAMENT - The ligament of the head runs right into ________.
- acetabular notch
- The aDductors of the thigh can be temporarily knocked out so that the legs will fully aBduct by ________.
- Palpating obturator crest & injecting anesthesia so the obturator nerve will temp. be knocked out.
- The main blood contribution to the proximal neck & head of femur is by ________.
- lateral & medial circumflex arteries of femur.
- The external iliac artery divides into ______.
- femoral artery & deep femoral artery
- From the profundi femoral artery comes the ___ & ____.
- Medial & lateral circumflex femoral arteries
- The ______ gives most of the blood supply to proximal femur, while the _____ supplies the surrounding muscles & soft tissue.
-
MEDIAL CIRCUMFLEX-bone;
LATERAL CIRCUMFLEX-muscles & soft tissue. - Fracturing the neck of the femur could cause necrosis of the head (and later disarticulation & FRACTURE of hip) b/c _______.
- Circumflex arteries supplying hip can be disrupted thereby causing necrosis
- The circumflex vessels are found just _____ to the capsule of the hip joint.
- deep
- The hip is innervated by which nerves?
- obturator (anterior division); femoral; accessory obturator; superior gluteal; n. to quadratus femoris
- HILTON'S LAW describes the hip's innervation: _______.
- neres that innervate muscles that cross a joint probably also innervate that joint sensory-wise as well
- Between 5-8% of population has _____________ nerve. Where does it run?
- accessory obturator; ABOVE OBTURATOR FORAMEN & over pubic bone.
- The superior gluteal nerve innervates _______ muscles & as well as ______.
- gluteus medius & minimus; hip joint
- The quadratus femorus is a _____ rotator of hip that is innervated by ______.
- lateral; nerve of quadratus femoris
- The femoral nerve runs _____ to hip joint.
- ANTERIOR
- Since HIPS are normally DISLOCATED ______, one is likely to injure the _____.
- posteriorly; SCIATIC NERVE
- The _______ is the fascia of the thigh.
- fascia lata
- Fascia lata has a defect in a place in it, which is covered by _______.
- cribriform fascia
- Cribriform fascia has _____ (like swiss cheese).
- holes
- The holes in the cribriform fascia (that is in defect of fascia lata) allow for ____.
- saphenous vein to penerate that deep fascia & enter into its central vein
- The _____ is the longest vein in the body.
- great saphenous vein
- The great saphenous vein BEGINS in the ______ and runs _____ to the MEDIAL MALLEOLUS.
- dorsal venous arch of foot; ANTERIOR
- The great saphenous vein runs in the _____ portion of the leg & thigh & empties into _____.
- middle; femoral vein
- The femoral artery is an extension of ______ below ____.
- external iliac; inguinal ligament
- As the femoral artery courses the ANTERIOR thigh, it will change its name to ____ once it goes through ___.
- popliteal artery; adductor hiatus
- The deep femoral artery gives off ______, as well as ______.
- femoral circumflex aa; perforating arteries
- The perforating arteries of the deep femoral aa. provide blood to ____ & ______.
- some ADDUCTOR muscles; hamstrings
- The medial femoral circumflex runs _____ to proximal femur, then pierces ________.
- ANTERIOR; area b/tw iliopsoas & pectineus muscles
- The posterior compartment of the thigh contains ______.
- hamstring muscles
- The medial compartment of the thigh contains ____.
- most of adductor muscles
- The quadriceps from the majority of the _____ portion of the thigh.
- anterior
- The iliopsoas muscle is compromised of ____ & ____.
- Psoas major; iliacus muscles
- The iliopsoas is the only muscle that attaches on the ______.
- lesser tronchanter
- The iliopsoas runs ____ to the inguinal ligament.
- deep
- The ________ is the most powerful hip flexor.
- iliopsoas
- The ____ &____ form the floor of femoral triangle.
- iliopsoas & pectineus
- The pectineus arises from ____ & attaches to _____.
- pecten of pubis; pectineal line (distal to lesser trochanter)
- The actions of pectineus are varied. They include _____.
- minimal flexion of the thigh; adduction; some internal rotation
- The sartorius muscle is the crossing legs (indian style) muscle. Actions include:____.
- external rotation of hip; abduction of hip; flex the knee; flex thigh
- The sartorius arises from the _____ and attaches to the _____.
- ASIS; medial tibia (pes anserine).
- The tensor fascia lata arises from _____ and is actually a _____ muscle.
- bony parts of ASIS; gluteal
- The tensor fascia lata is innervated by ____, and has function of _____.
- superior gluteal nerve; anterior thigh muscle
- The adductor longus arises from ___ & inserts into ____.
- inferior pubic ramus; medial lip if linea aspera
- The gracilis arises from ____ & inserts into ______.
- inferior pubic ramus; medial tibia
- The main adductors of the thigh are the _____ & ____.
- adductor longis & gracilis
- The _______ muscles are more or less fused and hard to separate.
- vastus (medialis; intermedius; lateralis)
- The action of the quadriceps is _____ & ____.
- flex the hip; extend the knee
- The sctions of the hamstrings are ___ & ___.
- extend the hip; flex the knee
- The only one of the quad muscles to cross hip joint is _______.
- rectus femoris
- The rectus femoris arises from ___ & extends to _____.
- ASIS; tibial tuberosity
- The 3 vastus muscles arise from ____ & extend to _____.
- femur; patella then tibial tuberosity
- A new way to think about patellar ligaments is: Patella is ____. It floats in ____. Therefore, patella acts as ______.
- largest sesamoid bone in the body; quadriceps tendon; fulcrum, helping the knee to extend w/less energy.
- The patella can be thought as giving _____ so the quads don't have to work so hard.
- more mechanical advantage
- The quadriceps as a whole tend to ___ the patella ___.
- subluxate/dislocate the patella LATERALLY
- The vastus medialis has ____ fibers that attach directly to patella & _____.
- HORIZONTAL; compensate for lateral pull
- For someone with chronic patella dislocations, a PT may ___________.
- accentuate fxn of lower fibers of vastus medialis
- The rectus femoris actually has 2 tendons of attachment: ___ & ___.
- straight one in ASIS & a reflected one that reflects in semilunar fashion over acetabulum
- The _____ tendon of the rectus femoris is the oldest embryologically.
- reflected tendon
- The pex anserine attach into _______ & help _____.
- medial portion of proximal tibia; reinforce & strengthen medial knee joint
- The ____, _____, & ____ form the pes anserine by interdigitating w/eachother.
- SGSt--Sartorius; gracilis; semitendinosis
- A deep special portion of the vastus intermedius is called the _______.
- articularis genu
- The articularis genu doesn't attach into tibia, but rather into ___.
- capsule surrounding knee joint
- The articularis genu attaches into _____ portion of the capsule, called _____.
- superior; suprapatella bursa
- The purpose of the articularis genu attaching into the suprapatella bursa is ______.
- it contracts milliseconds before full knee extention, pulling suprapatella bursa out so it can't be pinched b/tw femur & knee
- _______ is for the attachment of the IT BAND/TRACT.
- Gerdy's tubercle
- The ______ attaches into IT tract (eventually into Gerdy's tubercle).
- tensor fascia lata
-
Borders of femoral triangle:
superior:_____, lateral:___, medial:______. - S:inguinal ligament; L:medial aspect of sartorius; M:lateral aspect of adductor longus
- Femoral triangle contents are: ___, ___, ___, ___.
- NAVL-Nerve, Artery, Vein, Lymphatics
- The femoral artery can be found 1/2 way between what 2 structures?
- ASIS & pubic symphisis
- DEEP to sartorious, the order of NAVL is:
- LATERAL to MEDIAL
- The vessels & branches of the femoral nerve travel to apex of triangle, they run deep to the sart. into _____.
- adductor canal (subsartorial canal)
- Two branches of the femoral nerve are ____ & ____.
- nerve to vastus medialis; saphenous nerve
- The ______ is the longest nerve in the body.
- saphenous nerve
- The saphenous nerve runs along with the ________. It is a ______ of femoral n.
- saphenous vein; cutaneous branch
- Adductor canal borders: Anterolateral:____; Medially (roof): ____; Posteriorly: ______
- Anterolateral: vastus med.; Posterior: adductor longus & magnus; Medially: sartorius
- The adductor canal carries: ________, _____, ____, & ____
- femoral NAVL; saphenous nerve; nerve to vastus medialis; cutaneous branch of obturator nerve
- The protrusion of fascia (iliopsoas & transversalis) form the _________.
- femoral sheath
- The femoral sheath runs out with _____ about 3 cm into thigh & then fuses w/adventitia.
- femoral vessels (artery & nerve)& lymph node
- The femoral sheat is located DEEP to _________.
- inguinal ligament
- The femoral nerve rests on the _______.
- iliopsoas
- The _____ separates femoral NERVE from the vessels (in femoral ring).
- iliopectineal arch (band of fascia tissue)
- The femoral canal holds the ________.
- lymphatic chain of thigh
- The medial border of the femoral ring is the _______.
- lacunar ligament
- The pectineus helps form boundary of ________.
- femoral ring
- The lymph node that sits just inside femoral ring is called _____.
- node of cloacae
- The node of cloacae is one of 3 ________.
- deep inguinal nodes
- Scarpa's triangle borders: Superior:_____; Medial:____; Inferolateral:______
- S:inguinal ligament; M: adductor longus; IL:sartorios
- The femoral nerve passes ____ to inguinal ligament and then does what?
- INFERIOR; splays into many little branches (cauda equina of lower limb)
- The femoral sheath is a prolongation of _____ over proximl portion of fem. vess.
- pelvic fascia
- The great saphenous vein penetrates femoral sheath to drain into ________.
- external iliac vein
- The fascia lata of the leg is fused on the _______ of inguinal ligament.
- UNDERSIDE
- Femoral branches of the ______ nerve supply skin ____ to femoral triangle.
- genitofemoral; SUPERFICIAL
- There're lots of superficial inguinal lymph nodes located ____ to fascia lata.
- SUPERFICIAL
- The lymphatic chain for NAVL is composed of _____ lymph nodes ____ to fascia lata.
- 1-3; DEEP
- The femoral artery arises from __________.
- external pudendal artery
- The most proximal lymph node is the ________.
- node of clocae
- The cutaneous nerves of the anterior thigh are primarily from ___________.
- lateral femoral cutaneous & femoral nerve
- The lateral cutaneous nerve is a direct branch of _____.
- lumbar plexus
- The femoral nerve is a direct branch off the ____ and gives off ___ & ____.
- lumbar plexus; medial & intermediate cutaneous nerve
- The medial thigh is mainly innervated by ______.
- femoral nerve & branches (medial & intermediate cutaneous nerves)
- There are 2 other nerves that just touch in the medial thigh: ___ & ___.
- femoral branch of genitofemoral; anterior branch of obturator
- The femoral branch of the genitofemoral nerves supplies ______.
- proximal part of thigh
- The anterior branch of the obturator nerve supplies ___.
- area just proximal to knee
- The saphenous nerve is the ____ branch of _____ nerve.
- cutaneous; femoral
- What does the saphenous nerve with respect to the adductor hiatus?
- leaves early & runs through PES ANSERINE
- Once the saphenous leaves add. hiatus and runs through pes anserine, it gives off ______ that supplies _____.
- 1st major branch (INFRAPATELLAR branch); skin inferior to patella
- After saphenous nerve leaves adductor hiatus early & gives off its branch, it runs with __________.
- great saphenous vein
- In case of femoral artery occlusion, there is an anastamosis called _______.
- cruciate anastamosis
- The cruciate anastamosis of fem artery involves what 4 structures?
- both circumflex arteries; first perforating artery; inferior gluteal artery
- The adductor magnus has 2 components: _____ & _____.
- true adductor portion; descending, vertical portion
- The true adductor portion of adductor magnus attaches on _______ & is innervated by ________.
- proximal femur; obturator nerve
- The descending adductor portion of adductor magnus attaches to _____ & forms ____.
- adductor tubercle; adductor hiatus
- The descending adductor portion of adductor magnus is the ____ component. What is it innervated by?
- HAMSTRING; tibial nerve, part of sciatic nerve; NOT OBTURATOR!!!
- The ________ innervates the hamstrings
- tibial nerve
- The obturator internis & obturator externis are _____ rotators of the hip.
- LATERAL
- You can do more _____ than ____ rotation of the hip.
- LATERAL-more; internal
- The perforating arteries travel between ____ & ____ to get to hamstrings.
- deficits in the adductor brevis and magnus(lat side of muscle & med sideof femur)
- The hamstring part of the adductor magnus attaches to ______.
- adductor tubercle (medial aspect of inferior femur)
- The adductor muscles are innervated by ______. Where does it come from?
- obturator--L2-L4
- The obturator nerve splits ______ (when?).
- soon after exiting the obturator foramen
- The ANTERIOR branch of the obturator supplies ____, ___, & _____.
- gracilis; adductor longus & brevis
- The POSTERIOR branch of the obturator supplies ____ & maybe _____.
- adductor magnus and MAYBE brevis
- Which nerves innervate both the hip and knee joints?
- obturator & femoral
- The ______ branch of the obturator nerve innervates the hip.
- anterior
- The ______ branch of the obturator nerve innervates the knee.
- posterior
- The ______ branch innervates the skin in the medial thigh.
- ANTERIOR
- If you have an obturator hernia, where can the referred pain be?
- medial thigh & medial knee
- What can the pectineus be innervated by?
- obturator; accessory obturator; femoral, or a combo of the forementioned
- The Howship Romberg sign is _________ pain from _______.
- medial knee pain or pain or sensory deficit in middle medial thigh
- Someone could present Howship Romberg sign from ___.
- obturator nerve compression (like from obturator hernia)
- Knee pain could be from a herniated disc (nucleus pulposos) that impinges ____?
- L2, L3, or L4 (messes with obturator nerve, so sends referred pain to knee or medial thigh)
- Knee pain could be referred and coming from _____ or ____.
- obturator hernia; herniated nucleus pulposus
- The quads and sartorius are innervated by ______.
- femoral nerve
- The tensor fascia lata is in anterior compartment of leg, but is innervated by __.
- superior gluteal nerve