Exam 3 Flashcards
psoas origin
transverse processes of all lumbar vertebrae, sides of vertebral bodies and intervertebral discs from T12 to L5
psoas insertion
fibers run inferiorly and laterally; leave abdomen and enter thigh by passing under inguinal ligament; end in a tendon that inserts into lesser trochanter of femur
psoas innervation
ventral rami of L1 to L3 spinal nerves
psoas actions
flexes thigh at hip joint; if thigh is fixed, it flexes trunk
iliacus origin
iliac fossa
iliacus insertion
fibers converge to insert into lateral side of tendon of psoas major muscle, which ends in lesser trochanter of femur (combined muscles are referred to as iliopsoas)
iliacus innervation
femoral nerve
iliacus actions
flexes thigh at hip joint; if thigh is fixed, it flexes trunk
psoas minor
absent in about 40% of individuals
located entirely within abdomen, anterior to psoas major muscle
psoas minor origin
sides of vertebral bodies of T12 and L1 and intervertebral disc between them
psoas minor insertion
muscle fibers give rise to a long flat tendon which inserts into iliopubic eminence
psoas minor innervation
ventral rami of L1 and L2 spinal nerves
psoas minor action
weak flexor of trunk
quadratus lumborum origin
iliolumbar ligament and posterior part of iliac crest
quadratus lumborum insertion
fibers run superiorly and medially and insert into inferior border of 12th rib and transverse processes of upper 4 lumbar vertebrae
quadratus lumborum innervation
ventral rami of T12 to L3 (or L4) spinal nerves
quadratus lumborum actions
depresses and fixes 12th rib, holding it down against traction exerted by diaphragm in inspiration
lateral flexion of trunk to same side of contracting muscle (unilateral contraction)
may extend lumbar part of vertebral column (bilateral contraction)
iliolumbar ligament
extends from transverse process of L5 to posterior part of iliac crest
diaphragm sternal part
smallest part; fibers originate from posterior surface of xiphoid process
diaphragm costal part
fibers originate from internal surface of lower 6 ribs and their costal cartilages
diaphragm lumbar part
medially, it originates from 2 vertical tendinous columns right and left crura
right crus attaches to vertebral bodies of upper 3 or 4 lumbar vertebrae and intervertebral discs in between
left crus (shorter) attaches to vertebral bodies of upper 2 or 3 lumbar vertebrae and intervertebral discs in between
medial borders of right and left crura are connected by median arcuate ligament (crosses over anterior surface of aorta)
lateral to crura, muscle fibers of lumbar part originate from medial and lateral arcuate ligaments
medial arcuate ligament
thickened, upper margin of fascia that covers anterior surface of psoas major muscle; extends from body of L2 to tip of transverse process of L1
lateral arcuate ligament
thickened, upper margin of fascia that covers anterior surface of quadratus lumborum muscle; extends from tip of transverse process of L1 to 12th rib
diaphragm anterior view
diaphragm curves up into right and left domes
right dome is slightly higher than left due to large size of right lobe of liver
during expiration, right dome reaches upper border of 5th rib (or 4th intercostal space) and left dome reaches lower border of 5th rib
diaphragm lateral view
diaphragm looks like inverted letter “J”
posterior attachment to vertebral column is lower than anterior attachment to sternum
diaphragm main openings
aortic hiatus
located posterior, rather than within diaphragm; bounded by body of T12, right and left crura and median arcuate ligament; transmits aorta (becomes abdominal aorta as it passes through it) and thoracic duct
diaphragm main openings
esophageal hiatus
located anterior and superior to aortic hiatus (level of T10); transmits esophagus, anterior and posterior vagal trunks and esophageal branches of left gastric vessels
diaphragm main openings
caval opening
located anterior, superior and to the right of esophageal hiatus (level of T8), in central tendon; transmits IVC and branches of right phrenic nerve
other structures piercing diaphragm
greater, lesser and least (lowest) splanchnic nerves pierce crura
sympathetic trunk enters abdomen by passing posterior to medial arcuate ligament (least splanchnic nerve may pass posterior to medial arcuate ligament with sympathetic trunk)
sternocostal triangle (hiatus); small gap between sternal and costal origins of diaphragm; transmits superior epigastric vessels
azygos vein may pierce right crus or pass through aortic hiatus; hemiazygos vein pierces left crus
diaphragm actions
most important muscle used in inspiration
helps anterior abdominal muscles to increase intra-abdominal pressure assists with evacuation of pelvic contents (micturition, defecation, parturition)
helps in weight-lifting; increased intra-abdominal pressure helps to support vertebral column and prevents flexion (assists extensor back muscles in lifting heavy weights)
thoracoabdominal pump; contraction and descent of diaphragm increases intra-abdominal pressure and decreases intra-thoracic pressure; helps blood in IVC to move up into right atrium and lymph in abdominal lymph vessels to ascend in thoracic duct
hiatal hernia
protrusion of part of stomach into mediastinum through esophageal hiatus of diaphragm
two main types: paraesophageal and sliding
paraesophageal hiatal hernia:
less common; cardial part of stomach remains in abdomen; a pouch of peritoneum containing part of fundus of stomach extends through esophageal hiatus into mediastinum
sliding hiatal hernia
more common; abdominal part of esophagus, cardia and part of fundus of stomach slide superiorly through esophageal hiatus into mediastinum
congenital diaphragmatic hernia
seen in about 1 in 2000 newborns
caused by failure of one or both pleuroperitoneal membranes (folds) to close pericardioperitoneal canals (canals that communicate peritoneal and pleural cavities along posterior body wall); allows abdominal viscera to enter pleural cavity
in 85 to 90% of cases hernia is on left side; parts of intestines, spleen, stomach may enter thoracic cavity; compress heart and lungs (lungs are usually hypoplastic)
large defects are associated with high mortality rate (75%) from pulmonary hypoplasia and dysfunction
lumbar plexus
formed within psoas major muscle by ventral rami of L1, L2, L3 and part of L4 spinal nerves (remaining part of ventral ramus of L4 joins ventral ramus of L5 to form lumbosacral trunk, which contributes to form sacral plexus)
branches of lumbar plexus supply anterior abdominal wall, external genitalia and lower limb
ventral ramus of L1 bifurcates
upper branch divides into iliohypogastric and ilioinguinal nerves; lower branch joins a small branch of ventral ramus of L2 to form genitofemoral nerve
ventral rami of L2, L3 and L4 branch
into anterior and posterior divisions
anterior divisions of L2, L3 and L4 form obturator nerve
posterior divisions of L2, L3 and L4 form femoral nerve
posterior divisions of L2 and L3 form lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve)
branches of lumbar plexus emerge from lateral and medial borders of psoas major muscle and from its anterior surface
from lateral border (in descending order): iliohypogastric, ilioinguinal, lateral femoral cutaneous and femoral nerves
from medial border: obturator nerve
from anterior surface: genitofemoral nerve
lumbar part of sympathetic trunk
consists of 3 to 5 interconnected ganglia
continuous above with thoracic part of sympathetic trunk and below with sacral part of sympathetic trunk
enters abdomen by passing posterior to medial arcuate ligament of diaphragm
runs along medial border of psoas major muscle on bodies of lumbar vertebrae
inferiorly, it passes posterior to common iliac vessels to become continuous with sacral part of sympathetic trunk
lumbar part of sympathetic trunk branches
receives white communicating rami (contain preganglionic sympathetic fibers) from upper 2 lumbar spinal nerves
gives off gray communicating rami (contain postganglionic sympathetic fibers) to all lumbar spinal nerves
lumbar splanchnic nerves (contain preganglionic sympathetic and visceral afferent fibers): originate from lumbar sympathetic trunk and run medially to join aortic or superior hypogastric plexuses
aortic plexus
autonomic plexus formed anterior to abdominal aorta
receives fibers from thoracic (greater, lesser and lowest/least) splanchnic nerves, lumbar splanchnic nerves and vagus nerves
contains prevertebral ganglia (celiac, aortico-renal, superior and inferior mesenteric)
superior hypogastric plexus
downward continuation of aortic plexus, inferior to bifurcation of abdominal aorta
located between right and left common iliac vessels and anterior to body of L5 and sacral promontory
structures at renal hilum (A-P)
renal vein
renal artery
renal pelvis
lymph vessels and autonomic nerves also pass through hilum
kidney anterior anatomical relations
right kidney: liver, 2nd part of duodenum, right colic flexure, coils of small intestine
left kidney: spleen, stomach, pancreas, left colic flexure, coils of small intestine
kidney posterior anatomical relations
right kidney: psoas major, quadratus lumborum, transversus abdominis, diaphragm, 12th rib, subcostal, iliohypogastric and ilioinguinal nerves
left kidney: same + 11th rib (left kidney is higher than right)
contents of renal sinus
branches of renal artery tributaries of renal vein minor and major calyces renal pelvis lymph vessels autonomic nerves adipose tissue
ureter
retroperitoneal organ along its entire course
begins in abdomen as a continuation of renal pelvis
descends on psoas major muscle; passes anterior to bifurcation of common iliac artery
descends on lateral wall of pelvis, anterior to internal iliac artery, to level of ischial spine
turns forward to reach base of urinary bladder
ureter constrictions
where renal pelvis joins ureter
at pelvic brim (where it crosses bifurcation of common iliac artery)
where it pierces wall of urinary bladder (narrowest part)
ureter anterior anatomical relations
right ureter: 2nd part of duodenum, right colic and ileocolic vessels, right ovarian/testicular vessels, lower part of mesentery of small intestine
left ureter: left colic vessels, left ovarian/testicular vessels, sigmoid mesocolon
ureter posterior anatomical relations
psoas major, genitofemoral nerve, bifurcation of common iliac artery (same on both sides)
right suprarenal gland
is pyramidal in shape; caps upper pole of right kidney; related anteriorly to right lobe of liver and IVC; related posteriorly to diaphragm
left suprarenal gland
is crescent-shaped; caps upper pole of left kidney and extends along its medial border; related anteriorly to pancreas, lesser sac and stomach; related posteriorly to diaphragm
adrenal gland internal structure
consists of 2 layers with different functions and embryological origin
cortex (outer layer, originates from mesoderm) and medulla (inner layer, originates from ectoderm [neural crest cells]
equivalent to sympathetic ganglia; cells are innervated by preganglionic sympathetic fibers)
hormones secreted by cortex
mineralocorticoids (aldosterone): involved in regulation of electrolyte and water balance
glucocorticoids (cortisol): involved in regulation of carbohydrate, protein and fat metabolism
small amounts of sex hormones
hormones secreted by medulla
catecholamines (epinephrine and norepinephrine)
adrenal arterial supply
superior suprarenal arteries: branches of inferior phrenic artery
middle suprarenal artery: paired visceral branch of abdominal aorta
inferior suprarenal artery: branch of renal artery
adrenal venous drainage
right suprarenal vein drains into IVC
left suprarenal vein drains into left renal vein
common iliac artery
terminal branch of abdominal aorta
originates at level of L4; runs inferiorly and laterally
terminates at level of L5/S1 intervertebral disc by dividing into external and internal iliac arteries
external iliac artery
continuation of common iliac artery; runs along medial border of psoas major muscle
enters thigh by passing under inguinal ligament to become femoral artery
gives 2 branches just before it enters thigh: inferior epigastric and deep circumflex iliac arteries (supply lower part of anterior abdominal wall)
inferior vena cava
formed by union of right and left common iliac veins at the level of L5
ascends on right side of abdominal aorta, anterior to lumbar vertebral column; passes posterior to right lobe of liver (contained in a deep groove); pierces central tendon of diaphragm (at level of T8); drains into right atrium of heart
tributaries closely correspond with branches of abdominal aorta, except unpaired visceral branches (veins that correspond with unpaired visceral branches of abdominal aorta drain into portal system)
IVC visceral tributaries
right and left renal veins
right suprarenal vein (left drains into left renal vein)
right ovarian/testicular vein (left drains into left renal vein)
hepatic veins
IVC parietal tributaries
inferior phrenic veins
4 pairs of lumbar veins
median sacral vein usually terminates in left common iliac vein
pre-aortic lymph nodes
lie anterior to abdominal aorta around origin of its unpaired visceral branches
drain lymph from organs those branches supply with arterial blood
lymph from stomach, small intestine, colon, spleen, pancreas, gallbladder and liver drains into pre-aortic nodes (celiac, superior mesenteric and inferior mesenteric lymph nodes)
efferent vessels from celiac and superior mesenteric nodes form intestinal trunk
para-aortic nodes (lateral aortic or lumbar nodes)
lie on either side of abdominal aorta
receive lymph from abdominal wall, kidneys, suprarenal glands and testes/ovaries
efferent vessels from upper para-aortic nodes form right and left lumbar trunks.
thoracic duct
right and left lumbar trunks and intestinal trunk join to form thoracic duct
sacral plexus
formed by lumbosacral trunk (ventral ramus of L5 spinal nerve + part of ventral ramus of L4 spinal nerve), ventral rami of S1, S2 and S3 spinal nerves and part of ventral ramus of S4 spinal nerve (remainder of ventral ramus of S4 joins coccygeal plexus)
sacral plexus lies against posterior pelvic wall, anterior to piriformis muscle
ventral rami branch into anterior and posterior divisions branches of sacral plexus contain fibers from anterior and/or posterior divisions of specific ventral rami
branches of sacral plexus supply muscles and part of skin of gluteal region, muscles and skin of posterior thigh, muscles and skin of entire leg and foot (except skin over medial aspect of leg and medial border of foot) and muscles and skin of perineum
sciatic nerve
largest nerve in body; composite nerve consisting of common fibular (peroneal) nerve (formed by fibers from posterior divisions of L4, L5, S1 and S2 ventral rami) and tibial nerve (formed by fibers from anterior divisions of L4, L5, S1, S2 and S3 ventral rami)
superior gluteal nerve
formed by fibers from posterior divisions of L4, L5 and S1 ventral rami
inferior gluteal nerve
formed by fibers from posterior divisions of L5, S1 and S2 ventral rami
nerve to piriformis
formed by fibers from posterior divisions of S1 and S2 ventral rami
nerve to quadratus femoris
formed by fibers from anterior divisions of L4, L5 and S1 ventral rami
nerve to obturator internus
formed by fibers from anterior divisions of L5, S1 and S2 ventral rami
posterior cutaneous nerve of thigh (posterior femoral cutaneous nerve)
formed by fibers from anterior divisions of S2 and S3 ventral rami and from posterior divisions of S1and S2 ventral rami
pudendal nerve
formed by fibers from anterior divisions of S2, S3, and S4 ventral rami
pelvic splanchnic nerves
originate from ventral rami of S2, S3 and S4 spinal nerves; contain preganglionic parasympathetic fibers; join inferior hypogastric plexus
boundaries of gluteal region
superior: iliac crest
inferior: gluteal fold (skin fold that separates gluteal region from posterior thigh)
medial: natal (intergluteal) cleft; cleft between right and left buttocks
lateral: line connecting ASIS to greater trochanter
superior clunial nerves
dorsal rami of L1-L3 spinal nerves; supply skin of superior part of gluteal region
medial clunial nerves
dorsal rami of S1-S3 spinal nerves; supply skin of medial part of gluteal region
inferior clunial nerves
branches of posterior cutaneous nerve of thigh; curve around inferior border of gluteus maximus to supply skin of inferior part of gluteal region
lateral cutaneous branch of iliohypogastric nerve
supplies skin of superolateral part of gluteal region
lateral cutaneous nerve of thigh
supplies skin of inferolateral part of gluteal region
gluteus maximus origin
outer (gluteal) surface of ilium (behind posterior gluteal line), posterior surfaces of sacrum and coccyx, sacrotuberous ligament
gluteus maximus insertion
fibers run inferiorly and laterally; most fibers insert into iliotibial tract; deeper and lower fibers insert into gluteal tuberosity of femur
gluteus maximus innervation
inferior gluteal nerve
gluteus maximus action
extension of thigh at hip joint (important in rising from sitting position and in climbing stairs), lateral rotation of thigh at hip joint, provides stability to extended knee (via iliotibial tract)
gluteus medius
fan-shaped muscle; inferior part covered by gluteus maximus; superior part covered by gluteal aponeurosis
gluteus minimus
fan-shaped muscle; lies deep to gluteus medius
gluteus medius origin
outer (gluteal) surface of ilium (between anterior and posterior gluteal lines)
gluteus medius insertion
fibers pass inferiorly and laterally to attach to lateral surface of greater trochanter of femur
gluteus minimus origin
outer (gluteal) surface of ilium (between anterior and inferior gluteal lines)
gluteus minimus insertion
fibers pass inferiorly and laterally to attach to anterior surface of greater trochanter of femur
gluteus medius/minimus innervation
superior gluteal nerve
gluteus medius/minimus actions
abduction and medial rotation of thigh at hip joint
during walking, when foot of opposite side is taken off the ground and thrust forward, gluteus medius and minimus steady pelvis on supporting lower limb (prevent pelvis from tilting downward on unsupported side)
paralysis of gluteus medius and minimus; when patient stands on lower limb on the side of paralysis, pelvis sinks on opposite, unsupported side (positive Trendelenburg’s sign)
tensor fasciae latae origin
outer edge of iliac crest between ASIS and tubercle of iliac crest
tensor fasciae latae insertion
fibers run inferiorly and slightly posteriorly; insert into iliotibial tract
tensor fasciae latae innervation
superior gluteal nerve
tensor fasciae latae actions
helps with flexion, abduction and medial rotation of thigh at hip joint
provides stability to extended knee (via iliotibial tract)
piriformis origin
within pelvis, from anterior surface of sacrum, lateral to anterior sacral foramina (S2-S4 sacral segments)
piriformis insertion
it passes laterally and inferiorly; exits pelvis via greater sciatic foramen; inserts into upper border of greater trochanter
piriformis innervation
nerve to piriformis (supplies piriformis inside pelvis, does not enter gluteal region)
piriformis action
lateral rotation of thigh at hip joint, steadies femoral head in acetabulum
obturator internus origin
pelvic (internal) surface of obturator membrane and bony margins of obturator foramen
obturator internus insertion
muscle tapers posteriorly to a narrow belly and tendon; enters gluteal region via lesser sciatic foramen; joined by superior and inferior gemelli in gluteal region; together they insert into medial surface of greater trochanter
obturator internus innervation
nerve to obturator internus
obturator internus action
lateral rotation of thigh at hip joint, steadies femoral head in acetabulum
superior gemellus
Origin: posterior surface of ischial spine
Insertion: with tendon of obturator internus into medial aspect of greater trochanter
Innervation : nerve to obturator internus
Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum
inferior gemellus
Origin: upper part of ischial tuberosity
Insertion: with tendon of obturator internus into medial aspect of greater trochanter
Innervation: nerve to quadratus femoris
Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum
quadratus femoris
Origin: upper part of lateral border of ischial tuberosity
Insertion: fibers pass laterally; insert into quadrate tubercle (on intertrochanteric crest of femur) and area inferior to it
Innervation: nerve to quadratus femoris
Action: lateral rotation of thigh at hip joint, steadies femoral head in acetabulum
posterior cutaneous nerve of thigh
branch of sacral plexus (anterior divisions of ventral rami of S2 and S3 spinal nerves and posterior divisions of ventral rami of S1 and S2 spinal nerves) leaves pelvis through greater sciatic foramen, inferior to piriformis
descends deep to gluteus maximus, just medial to sciatic nerve as it leaves gluteal region, passes superficial to long head of biceps femoris continues on back of thigh superficial to hamstring muscles and deep to fascia lata
posterior cutaneous nerve of thigh branches:
inferior clunial nerves: curve around inferior border of gluteus maximus supply skin of inferior part of gluteal region
perineal branches: supply skin of superomedial thigh and adjacent perineum
cutaneous branches to back of thigh and upper leg
superior gluteal nerve
branch of sacral plexus (posterior divisions of ventral rami of L4-S1 spinal nerves) leaves pelvis through greater sciatic foramen, superior to piriformis, with superior gluteal vessels
runs forward between gluteus medius and gluteus minimus
superior gluteal nerve branches:
muscular branches to gluteus medius, gluteus minimus and tensor fasciae latae
articular branch to hip joint
inferior gluteal nerve
branch of sacral plexus (posterior divisions of ventral rami of L5-S2 spinal nerves)
leaves pelvis through greater sciatic foramen, inferior to piriformis, with inferior gluteal vessels
supplies gluteus maximus
pudendal nerve
branch of sacral plexus (anterior divisions of ventral rami of S2-S4 spinal nerves)
leaves pelvis through greater sciatic foramen, inferior to piriformis, with internal pudendal vessels (most medial structure inferior to piriformis); curves around posterior aspect of ischial spine; passes through lesser sciatic foramen to enter perineum
nerve to obturator internus
branch of sacral plexus (anterior divisions of ventral rami of L5-S2 spinal nerves)
leaves pelvis through greater sciatic foramen, inferior to piriformis and just lateral to pudendal nerve and internal pudendal vessels; gives a branch to superior gemellus; passes through lesser sciatic foramen; supplies obturator internus
nerve to quadratus femoris
branch of sacral plexus (anterior divisions of ventral rami of L4-S1 spinal nerves)
leaves pelvis through greater sciatic foramen, inferior to piriformis descends deep (anterior) to obturator internus and gemelli supplies quadratus femoris, inferior gemellus and hip joint
superior and inferior gluteal arteries
branches of internal iliac artery (originate within pelvis)
leave pelvic cavity and enter gluteal region via greater sciatic foramen with corresponding nerves
divide into branches distributed throughout gluteal region
internal pudendal artery
branch of internal iliac artery (originates within pelvis)
accompanies pudendal nerve through gluteal region and into perineum
has no important branches in gluteal region
veins of gluteal region
superior and inferior gluteal and internal pudendal veins; accompany arteries of same name; drain into internal iliac vein
sciatic foramen structures
piriformis muscle sciatic nerve posterior cutaneous nerve of thigh superior and inferior gluteal nerves nerve to obturator internus nerve to quadratus femoris pudendal nerve superior and inferior gluteal vessels internal pudendal vessels
lesser sciatic foramen
obturator internus muscle
nerve to obturator internus
pudendal nerve
internal pudendal vessels
cutaneous innervation anterior thigh L-M
lateral cutaneous branch of subcostal nerve
femoral branch of genitofemoral nerve
ilioinguinal nerve
lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve): supplies skin along lateral aspect of thigh
anterior cutaneous nerves of thigh (anterior femoral cutaneous nerves): branches of femoral nerve supply skin of anterior and medial aspects of thigh
anterior branch of obturator nerve: supplies small area of skin on medial aspect of thigh
posterior thigh innervation
posterior cutaneous nerve of thigh (posterior femoral cutaneous nerve)
great saphenous vein
originates from medial end of dorsal venous arch of foot ascends anterior to medial malleolus and along medial aspect of leg (with saphenous nerve) passes posteromedial to knee joint (approximately a hand’s breath posterior to medial border of patella) runs superiorly along medial aspect of thigh in upper thigh passes through saphenous opening (opening in fascia lata) drains into femoral vein
connected to deep veins via several perforating veins along its course blood flows from superficial to deep veins through these perforating veins (valves prevent flow in opposite direction) if valves become incompetent, perforating veins leak blood during muscular contraction superficial veins become dilated and varicose
small saphenous vein
originates from lateral end of dorsal venous arch of foot passes inferior and then posterior to lateral malleolus in lower ⅓ of leg, it lies just lateral to calcaneal (Achilles) tendon as it ascends in leg, it inclines slightly medially to reach midline of calf pierces crural fascia (dep fascia of leg) in middle or upper ⅓ of leg drains into popliteal vein
along its course in foot and leg it is accompanied by sural nerve
connected to deep veins of leg via perforating veins also communicates with great saphenous vein
superficial inguinal lymph nodes
lie in superficial fascia
efferent vessels from superficial inguinal lymph nodes pass through saphenous opening; drain into deep inguinal lymph nodes
superficial inguinal lymph nodes horizontal group
lies just below and parallel to inguinal ligament; receives superficial lymph vessels from anterior abdominal wall (below umbilicus), perineum and gluteal region
superficial inguinal lymph nodes vertical group
lies along terminal part of great saphenous vein; receives all superficial lymph vessels of lower limb (except those from lateral foot and lateral leg; accompany small saphenous vein and drain into popliteal lymph nodes)
deep fascia of thigh
encloses thigh like a stocking
thickened along lateral aspect to form iliotibial tract
deep fascia saphenous opening:
gap in fascia lata in superomedial part of anterior aspect of thigh
transmits great saphenous vein, small superficial branches of femoral vessels and efferent lymph vessels from superficial inguinal lymph nodes
inferior inguinal muscular space
located lateral to interlacunar ligament; contains psoas major and iliacus muscles, femoral nerve and lateral cutaneous nerve of thigh
inferior inguinal vascular space
located medial to interlacunar ligament; contains femoral artery and vein, lymphatics and femoral branch of genitofemoral nerve
muscles of anterior compartment
sartorius
pectineus
quadriceps femoris
iliopsoas
sartorius origin
ASIS
sartorius insertion
fibers run inferiorly and medially
insert into upper part of medial surface of shaft of tibia (part of pes anserinus together with gracilis and semitendinosus)
sartorius innervation
femoral nerve
sartorius actions
flexion, abduction and lateral rotation of thigh at hip joint
flexion and medial rotation of leg at knee joint
pectineus origin
pectineal line (pecten pubis) of superior ramus of pubis
pectineus insertion
fibers pass inferiorly and laterally; attach to posterior aspect of femur between lesser trochanter and upper end of linea aspera (pectineal line of femur)
pectineus innervation
femoral nerve (occasionally, it also receives some innervation from obturator nerve)
pectineus action
flexion and adduction of thigh at hip joint
quadriceps femoris
rectus femoris
vastus medialis
vastus intermedius
vastus lateralis
rectus femoris origin
straight head: AIIS; reflected head; ilium, immediately above acetabulum
rectus femoris is the only head of quadriceps femoris that originates from hip bone
vastus lateralis origin
upper part of intertrochanteric line, base of greater trochanter, lateral border of gluteal tuberosity and linea aspera
vastus medialis origin
lower part of intertrochanteric line, spiral line and linea aspera
vastus intermedius origin
anterior and lateral surfaces of shaft of femur
quadriceps femoris insertion
4 muscles pass distally and form quadriceps femoris tendon that encloses patella; distal to patella, patellar ligament is functionally the continuation of quadriceps femoris tendon; extends from lower part of patella to tibial tuberosity
quadriceps femoris innervation
femoral nerve
quadriceps femoris action
extension of leg at knee joint (4 heads)
rectus femoris: flexion of thigh at hip joint
iliopsoas insertion
lesser trochanter of femur
iliopsoas innervation
ventral rami L1-L3
femoral nerve
iliopsoas action
flexion of thigh at hip joint
acting from below (femur fixed): flexion of trunk
muscles of medial compartment
gracilis adductor longus adductor brevis adductor magnus obturator externus
gracilis origin
body and inferior ramus of pubis
gracilis insertion
fibers run vertically down; insert into upper part of medial surface of shaft of tibia; only muscle of medial compartment that crosses knee joint (part of pes anserinus together with sartorius and semitendinosus)
gracilis innervation
obturator nerve
gracilis action
adduction of thigh at hip joint
flexion and medial rotation of leg at knee joint
adductor longus origin
body of pubis
adductor longus insertion
fibers diverge as they pass inferiorly and laterally insert into middle ⅓ of linea aspera
adductor longus innervation
obturator nerve
adductor longus action
adduction and flexion of thigh at hip joint
adductor brevis origin
body and inferior ramus of pubis
adductor brevis insertion
fibers diverge as they pass inferiorly and laterally; insert into posterior surface of femur, just lateral to pectineal line, and proximal part of linea aspera
adductor brevis innervation
obturator nerve
adductor brevis action
adduction and flexion of thigh at hip joint
adductor magnus origin
inferior ramus of pubis, ramus of ischium and ischial tuberosity
adductor magnus insertion
medial border of gluteal tuberosity, linea aspera, medial supracondylar line and adductor tubercle of femur
adductor magnus
adductor part
consists of fibers that originate from inferior ramus of pubis and ramus of ischium and insert into medial border of gluteal tuberosity, linea aspera and medial supracondylar line of femur
adductor magnus
hamstring part
most medial part of muscle consists of fibers vertically oriented that extend from ischial tuberosity to adductor tubercle of femur
adductor magnus innervation
adductor part: obturator nerve
hamstring part: tibial division of sciatic nerve
adductor magnus action
adductor part: adduction of thigh at hip joint
hamstring part: extension of thigh at hip joint
adductor hiatus
gap in lower part of adductor magnus that communicates adductor canal with popliteal fossa
as femoral vessels pass through adductor hiatus, they become popliteal vessels
obturator externus
Origin: outer surface of obturator membrane and bony margins of obturator foramen
Insertion: fibers converge and pass inferior and then posterior to hip joint insert into trochanteric fossa on medial surface of greater trochanter
Nerve supply: obturator nerve
Action: lateral rotation of thigh at hip joint
femoral triangle
triangular, depressed area in upper part of anterior thigh
femoral triangle is continuous inferiorly with adductor (subsartorial) canal
femoral triangle boundaries
superior: inguinal ligament
lateral: medial border of sartorius
medial: medial border of adductor longus (some authors consider lateral border of adductor longus as medial boundary)
floor (from lateral to medial): iliopsoas, pectineus and adductor longus muscles
roof: overlying fascia lata
adductor canal
subsartorial, hunter’s
intermuscular space located on medial aspect of middle ⅓ of thigh
begins superiorly at apex of femoral triangle and ends inferiorly at adductor hiatus
triangular in cross-section
adductor canal walls
medial wall: sartorius
anterior wall: vastus medialis
posterior wall: adductor longus and adductor magnus
adductor canal contents
femoral artery and vein
saphenous nerve
nerve to vastus medialis (both are branches of femoral nerve)
genicular branch of posterior division of obturator nerve
femoral triangle contents
lateral cutaneous nerve of thigh femoral nerve and artery and their branches femoral vein and its tributaries femoral branch of genitofemoral nerve deep inguinal lymph nodes adipose tissue
femoral artery
main arterial supply to lower limb
begins at the level of inguinal ligament, as a continuation of external iliac artery
ends at adductor hiatus: after adductor hiatus, it enters popliteal fossa and becomes popliteal artery
descends first through femoral triangle and then through adductor canal
in upper part of femoral triangle, it lies between femoral nerve (lateral to artery) and femoral vein (medial to artery)
in lower part of its course, it lies anterior to femoral vein
femoral artery branches
its initial segment gives off small branches that contribute to supply inferior part of anterior abdominal wall and external genitalia (superficial epigastric, superficial circumflex iliac and superficial and deep external pudendal arteries)
muscular branches (supply muscles of anterior and medial compartments of thigh)
profunda femoris (deep femoral) artery
descending genicular artery: small branch that originates from femoral artery close to adductor hiatus contributes to arterial anastomosis around knee joint
profunda femoris (deep femoral) artery
largest and most important branch of femoral artery
chief source of blood supply to thigh muscles
originates from femoral artery in upper part of femoral triangle
as it descends, it passes posterior to femoral artery
leaves femoral triangle by passing between pectineus and adductor longus, then it descends posterior to adductor longus and anterior to adductor brevis and magnus (adductor longus separates profunda femoris artery from femoral artery)
terminates as 4th perforating artery
profunda femoris (deep femoral) artery branches
medial and lateral circumflex femoral arteries
perforating arteries
muscular branches (supply neighboring muscles)
medial and lateral circumflex femoral arteries
arise from profunda femoris near its origin, in femoral triangle (may originate directly from femoral artery)
circumflex femoral arteries pass around upper part of shaft of femur, give off branches to muscles of anterior and medial compartment of thigh, femur, hip joint and knee joint
perforating arteries
there are usually 4 (4th perforating artery is the terminal branch of profunda femoris artery
perforating arteries pierce adductor brevis and/or adductor magnus (close to their femoral insertion) reach posterior compartment of thigh
provide chief blood supply to posterior compartment muscles
trochanteric anastomosis:
located near trochanteric fossa of femur; established between branches of superior gluteal, inferior gluteal, medial circumflex femoral and lateral circumflex femoral arteries
cruciate anastomosis
located at the level of lesser trochanter; established between branches of inferior gluteal, medial circumflex femoral, lateral circumflex femoral and 1st perforating arteries
trochanteric AND cruciate anastomoses
provide connections between branches of internal iliac and femoral arteries; become important if there is an occlusion of femoral artery proximal to origin of profunda femoris artery
femoral vein
begins at adductor hiatus, as a continuation of popliteal vein
ascends through adductor canal and femoral triangle, first posterior and then medial to femoral artery
terminates at the level of inguinal ligament, where it becomes continuous with external iliac vein
tributaries: great saphenous vein + veins that accompany branches of femoral artery (share same name)
obturator artery
usually originates in pelvis from anterior division (trunk) of internal iliac artery
runs anteriorly on lateral pelvic wall with obturator nerve and vein leaves pelvis and enters medial compartment of thigh via obturator canal (upper part of obturator foramen)
divides into anterior and posterior branches pass around margins of obturator foramen
gives branches to muscles in medial compartment of thigh and to hip joint
obturator vein
receives tributaries that correspond to branches of obturator artery
drains into internal iliac vein
deep inguinal lymph nodes
lie along medial side of upper part of femoral vein
receive lymph from superficial inguinal lymph nodes
also receive lymph from all deep tissues of lower extremity
deep structures located above knee drain directly into deep inguinal lymph nodes
deep structures from knee down drain first into popliteal lymph nodes; efferent vessels from popliteal lymph nodes accompany femoral vessels and drain into deep inguinal lymph nodes
efferent vessels from deep inguinal lymph nodes drain into external iliac lymph nodes
femoral sheath
fascia that lines abdominal walls (endoabdominal fascia) extends into upper thigh to form femoral sheath
femoral sheath surrounds femoral vessels and lymphatics for about 1 inch inferior to inguinal ligament (does not surround femoral nerve); blends inferiorly with adventitia of femoral vessels
femoral sheath lateral compartment
contains femoral artery
femoral sheath intermediate compartment
contains femoral vein
femoral sheath medial compartment
it is known as femoral canal
contains lymph vessels and usually one of the deep inguinal lymph nodes
upper end of femoral canal is known as femoral ring
femoral canal is the site of femoral hernias (protrusion of abdominal contents through femoral canal into upper thigh)
femoral nerve
largest branch of lumbar plexus (posterior divisions of ventral rami of L2-L4 spinal nerves)
emerges from lateral border of psoas major within abdomen descends in interval between psoas major and iliacus
enters thigh by passing inferior to inguinal ligament in muscular space (lacuna)
in femoral triangle, it is located lateral to femoral artery, outside femoral sheath
terminates by dividing into multiple branches about 4 cm inferior to inguinal ligament
femoral nerve branches
muscular branches to iliacus, sartorius, pectineus and 4 heads of quadriceps femoris
anterior cutaneous nerves of thigh (anterior femoral cutaneous nerves): supply skin of anterior surface and part of medial surface of thigh
articular branches to hip and knee joints
saphenous nerve
saphenous nerve
longest branch of femoral nerve
runs inferiorly and medially, first in femoral triangle and then in adductor canal (passes anterior to femoral vessels in adductor canal)
becomes superficial on medial side of knee between tendons of sartorius and gracilis; descends along medial side of leg with great saphenous vein; passes anterior to medial malleolus; runs along medial border of foot, usually as far as 1st metatarsophalangeal joint (ball of great toe)
supplies skin of medial aspect of leg and along medial border of foot to ball of great toe
obturator nerve
branch of lumbar plexus (anterior divisions of ventral rami of L2-L4 spinal nerves)
emerges from medial border of psoas major; runs anteriorly on lateral wall of pelvis with obturator artery and vein; leaves pelvis and enters medial compartment of thigh via obturator canal (upper part of obturator foramen)
within obturator canal, it divides into anterior and posterior branches (divisions)
obturator nerve anterior branch
descends posterior to adductor longus and anterior to adductor brevis
supplies adductor longus, adductor brevis and gracilis (occasionally pectineus), hip joint and a small cutaneous area on medial aspect of thigh
obturator nerve posterior branch
pierces obturator externus; descends posterior to adductor brevis and anterior to adductor magnus; supplies obturator externus and adductor part of adductor magnus (occasionally adductor brevis) and knee joint
