Anatomy Block 2: Thigh And Knee Joint

Front 1

The femoral triangle is made up of:

Back 1

-inguinal ligament
-sartorius
-Adductor longus

Front 2

The apex of the femoral triangle is made up of:

Back 2

-medial border of sartorius
-lateral border of adductor longus

Front 3

What are the contents of the femoral triangle from lateral to medial:

Back 3

-Femoral nerve
-Femoral artery
-Femoral vein
-Femoral canal (contains deep inguinal nodes and lymph vessels)

Front 4

The ______ is a funnel shaped fascial tube found in the upper part of the femoral triangle

Back 4

-femoral sheath

Front 5

The three compartments of the femoral sheath contains:

Back 5

-Lateral: femoral artery
-Intermediate: femoral vein
-Medial: femoral canal (contains connective tissue, fat, and lymphatic structure)

**femoral nerve is not in femoral sheath

Front 6

The _____ bisects the femoral triangle

Back 6

femoral artery

Front 7

Pulse in the thigh can be felt in the:

Back 7

-midpoint of the inguinal ligament (between ASIS and pubic tubercle)

Front 8

The femoral artery exits the apex of the femoral triangle to enter ____

Back 8

adductor hiatus

Front 9

The first part of the femoral artery may be compressed against _____ to control bleeding

Back 9

the superior pubic ramus

Front 10

The femoral artery may be cannulated for _____ and _____
It can also be used for ____ especially in children

Back 10

-angiography of heart and coronary vessels
-angioplasty

-blood gas exchange

Front 11

The aberrant obturator artery arises from the _____ and supplies ____

Back 11

-inferior epigastric artery
-area normally supplied by obturator artery

Front 12

The femoral canal has a superior ____ that is the site of _____

Back 12

-femoral ring
-femoral hernia

Front 13

Femoral hernia is constricted medially by the _____. This puts the _____ in danger from hernia or during hernia therapy

Back 13

-lacunar ligament
-aberrant or replaced obturator artery in danger

Front 14

Most common type of hernia is _____

Back 14

inguinal hernia

Front 15

Femoral hernias are mostly found in _____

Back 15

women

Front 16

_____ hernias are inferolateral and _____ hernias are superomedial to the pubic tubercle

Back 16

-femoral
-inguinal

Front 17

The _____ extends from the femoral triangle to the adductor hiatus. The ______ makes up the roof of this structure

Back 17

-adductor canal
-sartorius

Front 18

The contents of the adductor canal:
This canal provides an intermuscular passageway of these vessels to the _____

Back 18

-Femoral artery
-Femoral vein
-Saphenous nerve
-Nerve to the vastus medialis

-posterior aspect of knee (popliteal fossa)

Front 19

The saphenous nerve is a _____ of the femoral nerve
It supplies the _____
It (does/does not) exit the adductor hiatus

Back 19

-cutaneous branch (sensory)
-medal knee, leg and foot
-does NOT

Front 20

_____ is irritation of the right iliopsoas by an inflammatory process in the right lower quadrant of the abdomen

How do you test for this?

Back 20

-iliopsoas sign

-patient is asked to extend the right thigh against resistance with the knee flexed; the test is positive if the patient experiences pain as a result of stretching of the iliacus fascia

Front 21

Tuberculous infection of the lumbar vertebrae or another retroperitoneal infection may track along the psoas ______ producing a bulge in the upper thigh and referred pain to the ______

Back 21

-fascia deep to the inguinal ligament
-hip and/or knee joints

Front 22

The iliopsoas is the chief ____
It is made up of _____

Back 22

-flexor
-iliacus
-psoas major
-psoas minor

Front 23

The action of the pectineus:

Back 23

-flexes hip
-adducts hip

Front 24

Sartorius is a _____ not a prime mover
Its actions are:

Back 24

-synergist

-flexes hip
-extends knee

Front 25

This iliacus of the iliopsoas my avulse:

Back 25

lesser trochanter

Front 26

Rectus femoris may avulse at ____
Its action is:

Back 26

-AIIS (anterior inferior iliac spine)

-flex hip
-extend knee
*knee extension compromised during flexed hip

Front 27

The quadriceps femoris is made up of:
All of their tendons unite distally to form:
The nerves that innervate them are:

Back 27

-Vastus lateralis
-Vastus intermedius
-Vastus medialis
-Rectus femoris

-quadriceps tendon

-femoral nerve (L2-L4)

Front 28

The petellar ligament is a direct continuation of _____ and inserts into the _____

Back 28

-quadriceps tendon
-tibial tuberosity

Front 29

The petellar reflex tests the integrity of _____

Back 29

L3-L4

Front 30

The petellar reflex is an example of a ____

Back 30

-monosynaptic reflex arc (one sensory and one motor)

Front 31

What are the three main adductors in the medial compartment of the leg?

Back 31

-adductor longus
-adductor brevis
-adductor magnus

Front 32

What is the action of the gracilis?
What can it be used for?

Back 32

-flex knee
-weak adductor

-replace external anal sphincter

Front 33

What is the action of the obturator externus?

Back 33

-lateral rotator

Front 34

Groin pull is a strain, stretch, or tearing of what portion of the thigh muscles?

Back 34

-proximal attachments of the anteromedial thigh muscles

Front 35

The adductor longus, brevis, longus, pectineus, and obturator externus are all innervated by what nerve?

Back 35

-obturator nerve (L2, 3, 4)

Front 36

Pes Anserinus, also known as ____, is the insertion of conjoined tendon of 3 muscles to the _____
These three muscles are (from anterior to posterior):

Back 36

-goose foot
-Medial aspect of tibia

-Sartorius (Ant.)
-Gracilis (Medial)
-Semitendinosus (Post.)
*all knee flexors

Front 37

If a patient complains of medial-sided knee pain, this could be:

Back 37

pes anserinus bursitis

Front 38

Give the path of the common iliac artery

Back 38

-common iliac --> external/internal

-external iliac artery --> femoral artery (at inguinal ligament)

-internal iliac artery --> superior and inferior gluteal arteries and obturator artery

Front 39

What artery supplies the reproductive organs and the lower limbs?

Back 39

-internal iliac artery

Front 40

What are the 5 branches of the femoral artery?

Back 40

-profunda femoris (deep femoral) artery
-lateral femoral circumflex artery
-medial femoral circumflex artery
-perforating branches
-descending genicular artery

Front 41

What artery is the main blood supply to the head of the femur?

Back 41

medial femoral circumflex

Front 42

What artery supplies the posterior thigh compartment?

Back 42

perforating branches of the femoral artery

Front 43

After exiting the adductor canal, the femoral artery changes its name to:

Back 43

-popliteal artery

Front 44

The obturator artery is the _____ branch of the internal iliac artery, and enters the ____ compartment of the leg by exiting through the ______

Back 44

-anterior
-adductor compartment
-obturator foramen

Front 45

The obturator artery divides into the anterior and posterior branches, which is separated by the ____

Back 45

-adductor brevis

Front 46

20% of the time, the obturator artery may be replaced by ____ or joined by _____, both of which are usually branches of _____

Back 46

-aberrant or replaced obturator artery
-accessory obturator artery
-inferior epigastric artery

Front 47

The lumbar plexus is formed by ____ within the _____

Back 47

-anterior rami of spinal nerves L1-4 (upper half of 4)

-psoas major

Front 48

The lower half of the anterior rami of L4 and L5 join together to form _____

Back 48

-lumbosacral trunk near ala of sacrum

Front 49

Give the 6 branches of the lumbar plexus and what nerves make them up

Back 49

1. Iliohypogastric n.- L1
2. Ilioinguinal n.- L1
3. Genitofemoral n.- L1, L2
4. Lat. femoral cut. n.- L2, L3
5. Femoral n.- L2, L3, L4
6. Obturator n.- L2, L3, L4

Front 50

The motor branches of the femoral nerve are:

Back 50

-quadriceps femoris
-sartorius
-pectineus
-iliacus

Front 51

The anterior cutaneous branch that supplies the anterior thigh is a branch of ____

Back 51

-femoral nerve

Front 52

The saphenous nerve is a (motor/sensory) nerve and it supplies:

Back 52

-sensory
-medial knee, leg, foot

Front 53

Femoral injury in the abdomen can cause paralysis to: (muscles/actions)

Back 53

-iliopsoas - weakness of flexing thigh
-quadriceps femoris - knee extension/knee jerk reflex

Front 54

Stab wound in the upper thigh, in the femoral triangle, will cause a loss of: (muscle/action)
This will also cause loss of sensation on what part of the leg?

Back 54

-quadriceps femoris - knee extension/knee jerk reflex
**Will affect iliopsoas**
-anterior thigh (femoral nerve) and medial leg, ankle, foot (saphenous nerve)

Front 55

The posterior branch of the obturator nerve supplies:

Back 55

-obturator externus
-adductor brevis
-adductor magnus

Front 56

The anterior branch of the obturator nerve supplies:

Back 56

-adductor longus
-gracilis
-adductor brevis
-pectines (sometimes)

Front 57

The obturator nerve also carries sensory information from the:

Back 57

-medial thigh

Front 58

The obturator nerve arises from the anterior divisions of what spinal nerves?

Back 58

-L2, 3, 4

Front 59

What may cause a paresis (weakness) or paralysis of the adductor muscles of the thigh? Ex. Soccer kicks or crossing leg becomes difficult.

Back 59

-pelvic tumor or pregnant uterus affecting the obturator nerve

Front 60

Meralgia paresthetica may be caused by entrapment of:

Back 60

lateral femoral cutaneous nerve

Front 61

What structures pass through the obturator canal?

Back 61

-obturator nerve
-obturator vessels

Front 62

What structures pass between the inguinal ligament and the pelvic bone?

Back 62

Muscles:
-psoas major
-iliacus
-pectinius

Vessels:
-femoral artery
-femoral vein
-lymphatics

Nerves:
-femoral branch of genitofemoral nerve
-lateral cutaneous nerve of thigh

Front 63

What are the boarders of the popliteal fossa?

Back 63

-Biceps femoris
-Semimembranosus
-Semitendinosus
-Lateral/medial heads of gastrocnemius

Front 64

Name the main structures that can be found in the popliteal fossa:

Back 64

-poplitleal artery
-poplitleal vein
-tibial and common fibular branch of the sciatic nerve

Front 65

The popliteal artery is a continuation of the _____ and divides into:

Back 65

-femoral artery (at adductor hiatus)
-anterior and posterior tibial arteries

Front 66

The superior part of the popliteal artery lies against _____ which can cause vascular complications if fractured.

Back 66

posterior surface of femur

Front 67

The ____ gives of 5 genicular (knee) branches that help provide collateral circulation around the joint (genicular anastomoses)

These branches are:

Back 67

-popliteal artery

-Lateral superior genicular a.
-Superior medial genicular a.
-Lateral inferior genicular a.
-Inferior medial genicular a.
-Middle genicular a.

Front 68

What are the superior anastomoses of the femoral/popliteal artery?
What are the inferior?

Back 68

-Descending branch of lateral femoral circumflex artery
-Descending genicular artery from femoral artery

Front 69

Two articulations of the knee joint are between:

Back 69

-patella and femur
-femur and tibia

**fibula does not participate

Front 70

The superior portion of the tibia, where the femur articulates is called the:

Back 70

tibial plateau

Front 71

The synovial cavity is partly subdivided into superior and inferior compartments by:

Back 71

-medial and lateral menisci

Front 72

What structures stabilize the knee joint in the:
anterior:
lateral:
medial:
posterior:

Back 72

Anterior:
-quadriceps femoris tendon
-patella ligament

Lateral:
-lateral patellar retinacula
-fibular collateral ligament

Medial:
-medial patellar retinacula
-tibial collateral ligament

Posterior:
-oblique popliteal ligament
-arcuate popliteal ligament

Front 73

What structure, that extends from the medial epicondyle of the femur to the medial condyle of the tibia, is often torn with the medial meniscus?

Back 73

Tibial (medial) collateral ligament (MCL)

Front 74

What separates the fibular (lateral) collateral ligament from the lateral meniscus?

Back 74

popliteal tendon

Front 75

What structure passes from the lateral epicondyle of the femur to the head of the fibula?
What splits around this ligament?

Back 75

-fibular (lateral) collateral ligament

-tendon of biceps femoris

Front 76

What are the two intracapsular ligaments of the knee joint?
Where do these attach?

Back 76

-Anterior cruciate ligament (ACL) - anterior intercondylar area of tibia to lateral femoral condyle

-Posterior cruciate ligament (PCL) - posterior intercondylar area of tibia to medial femoral condyle

Front 77

Rupture of the ACL (3rd degree sprain) shows what sign?

Back 77

-anterior drawer sign - tibia can be pulled anteriorly on a fixed femur

*ACL prevent posterior displacement of femur and hyperextension of knee

Front 78

Rupture of the PCL (3rd degree sparin) shows what sign?

Back 78

-posterior drawer sign - tibia can be pushed posteriorly on a fixed femur

*PCL prevents anterior displacement of femur on tibia

Front 79

The (anterior drawer test/Lachman test) is more sensitive for ACL damage

Back 79

Lachman

Front 80

Describe how to do anterior drawer test
Posterior drawer test?

Back 80

Hip flexed 45 degree
Knee flexed 90 degrees
Both hand behind knee
Sitting on dorsum of foot
Both hands grasp proximal tibia and slide it forward

Posterior is the same, except tibia is directed posteriorly

**hamstring can cause false negative for test - wait for it to relax**

Front 81

Describe how to do the Lachman test

Back 81

-patient supine and hip flexed 20-30 degrees
-on hand just above patella
-other hand tries to dislodge the patella forward

Front 82

A blown knee may damage what 3 parts of the knee as an "unhappy triad"

Back 82

-tibial (medial) collateral ligament (MCL)
-medial meniscus
-anterior cruciate ligament (ACL)

Front 83

An anterior dislocation will rupture what structures?

Back 83

-both cruciate ligaments (ACL/PCL)

Front 84

A complete dislocation will rupture what structures?

Back 84

-medial collateral ligament
-medial meniscus
-both cruciate ligaments (ACL/PCL)
-posterior capsule

Front 85

Name the four bursae associated with the quadriceps femoris tendon

Back 85

-suprapatellar bursa - may mask joint effusion (water in knee) or spread infection of knee

-prepatellar bursa, superficial and deep infrapatellar bursae - all may be irritated by friction

Front 86

Housemaids knee is also called:

Back 86

prepatellar bursitis

Front 87

If a posterior bursae that communicates with the knee swells with joint effusion, it may form ______, which can interfere with joint movement. If the cyst ruptures, acute pain and swelling may resemble _____

Back 87

-Baker's (popliteal) cyst
-deep vein thrombosis

Front 88

If the medial tibiofemoral angle is too large, it is called:
If medial tibiofemoral angle is too small, it is called:

Back 88

-genu valgum - "knock knees" (lateral compression)
-genu varum - "bow legs" (medial compression)

Front 89

What are some predisposing factors that increase the chance of patellar dislocations?

Back 89

-shallow patellar groove
-abnormal patella
-laterally displaced quadriceps femoris insertion