Robert Wise

Thigh, hip + gluteal region anatomy

Teams of two1 minute to answer8 questionsAim is to apply some knowledge, some are

hard but remember these aren’t exam questions.

Marks are written in brackets e.g. (2)Add up at the end

Pub Quiz Style

Whilst watching surgery, the surgeon asks you to describe the EXTERNAL ligaments that contribute to stability of the hip joint (1)

How do these help keep you upright? (1)

Question 1

Three ligaments reinforce the external surface of the fibrous membrane and stabilize the joint: the iliofemoral, pubofemoral, and ischiofemoral ligaments. (1)

These get tighter in extension to assist you in keeping upright (1)

Question 1 answer

You are asked perform a Cardiac examination on a patient. You know from their notes that they underwent a CABG procedure in Jan 2015, using the great saphenous vein.

Where on them do you look to check the vein’s scar? (2)

Question 2

The great saphenous ascends up the medial side of the leg, knee, and thigh to connect with the femoral vein just inferior to the inguinal ligament. (1)

It is one of the important superficial veins in the leg, located in the subcutaneous tissue. (1)

Question 2 answer

An F1 doctor needs take an arterial blood gasses sample from an ill patient, the radial arteries are inaccessible. They ask you to describe how to locate the femoral artery on the anterior thigh? (2)

Question 3

I would locate the femoral triangle in the proximal anterior thigh, this is bordered by the Inguinal Ligament, Sartorius and ADductor longus. (1)

The Femoral artery enters at the midinguinal point ±1.5 cm, I would palpate here for the pulse. (1)

Question 3 answer

In GP you see a patient with a right Psoas Muscle abscess causing compression of the femoral nerve.

What reflex may be weakened, and which nerve root does this correspond to? (1)

What motor loss may the patient complain of? (1)

Describe the sensory loss of this patient? (1)

Question 4

The femoral nerve originates from L2-L4 spinal cord segments, we’d expect to see compromise in their patella tendon reflex (L3-4), this is a Lower Motor Neuron sign. (1)

They may have weak knee extension (1)

Numbness along the anterior of the thigh (and anteromedial side of the calf) (1)

Question 4 answer

ObturatorFemoralSciatic & Post . Cut. N. ThighSuperficial & Deep Fibular

Damage to a nerve in the gluteal region can cause a Trendelenburg sign. You see someone in UHCW ahead of you, they are walking with a lateral lean to the LEFT.

Describe WHICH nerve had been damaged and its course. (2)

Question 5

The superior gluteal nerve supplies Gluteus Medius & Minimus. This patient is leaning to the LEFT, and they are leaning towards the weakened side to compensate. So we predict it is the Left Superior Gluteal Nerve. (1)

The superior gluteal nerve originates in the sacral plexus (L4-L5). It leaves the pelvis through the greater sciatic foramen above the piriformis. (1)

Question 5 Answer

On a ward round you see a patient who has intermittent leg claudication. The surgeon tells you they have chronic leg ischemia secondary to athermanous change.

The femoral artery originates from which artery, and passes though which hole, to continue as the Popliteal Artery? (1)

Which leg compartment does the femoral artery sit in? (1)

Which branch supplies the deep tissue of that compartment, and does it leave the thigh? (1)

Question 6

The Femoral artery originates from the external iliac artery becomes the popliteal artery as it passes through an opening in adductor magnus called the adductor hiatus. (1)

The femoral artery sits in the Anterior Compartment. (1)

A deep branch called profunda femoris artery, but this does not leave the thigh. (1)

Question 6 answers

You come across an elderly lady in a shopping center. The security guard tell you she fell. Her leg looks shortened and externally rotated. You apply basic first aid, check ABCDE, and supporting the leg with clothing while the ambulance arrives.

What are the lateral rotator muscles of the hip? (1)

What nerve runs posterior the hip joint? (1)What does this nerve supply? (1)

Question 7

Piriformis, gemelli, Quadratus femoris and Obturator internus.

Sciatic nerve (L4-S3)

Supplies posterior compartment of thigh and the leg & foot

Question 7 Answer

Later in the week, you visit the same elderly lady who was admitted to your ward at Warwick hospital. She has severe ecchymosis (bruising) on the posterior thigh, they have had to cut the fascia to release the pressure.

What are the muscles of the posterior thigh compartment? (1)

Question 8

Question 8 Answer

1. Semimembranosus (medially)

2. Semitendinosus (medially)

3. Biceps femoris (laterally)

Bonus Question

Name these four important nerves that exit the lumbar plexus

Bonus Question