Femoral Triangle Flashcards
Describe the flow of the arteries from the thigh down to foot
Aorta divides anterior at L4 into right and left common iliac arteries
The common iliac arteries divide anterior to the SI (sacroilliac) joint into internal and external iliac arteries.
- Internal iliac artery supplies
pelvic organs and also give off branches that supply the hip region via anastomotic vessels - External iliac artery becomes the femoral artery once it passes under the inguinal ligament.
Femoral artery gives off profundal femoris branch at level of neck of femur
Profunda femoris a. branches:
* Medial circumflex femoral a.
* Lateral circumflex femoral a.
* Profunda femoris a with Perforating arteries
Lateral circumflex femoral a.
Branch:
* Descending branch of
Lateral circumflex femoral a.
The femoral artery enters the popliteal fossa behind the knee to become the Popliteal artery.
After the Popliteal artery exits the fossa inferiorly, it trifurcates into three:
1. the Anterior Tibial artery, Which becomes the dorsalis pedis artery
2. Posterior Tibial artery
3. Peroneal/fibular artery
what is the area of deficency on fascia
Anteriorly the Fascia Lata has a deficiency inferior to the inguinal ligament, the Saphenous Opening, where the Saphenous Vein passes through to meet the Femoral Vein
Lecture Slide
Attachment sites for Fascia Lata (Superior, lateral, posterior)
Superiorly fascia lata attaches to the pubic tubercle, pubis and inguinal ligament
laterally to the iliac crest
posteriorly to the sacrum, coccyx and ischial tuberosity
Where does fascia lata extend to, attaches to
It extends down the thigh and attaches around the knee and becomes continuous with the fascia in the leg (part of lower limb below the knee)
3 muscle compartments are formed by
Fascia Lata and intermuscular septae
What intermuscular septae is the strongest
Lateral intermuscular septae
Compartments of THIGH
3 Compartments
Anterior
Medial
Posterior
Label Diagram
Iliotibial band (Part of fascia lata, just a thickening of it)
- blends in with?
-Envelops what muscles
-Attaches to?
-Role?
Laterally the Fascia Lata blends with the tendon of Tensor Facia Lata muscle to form the iliotibial band (or iliotibial tract)
Fascia Lata splits to envelop TFL and Gluteus maximus muscles
ITB attaches to the lateral aspect of the tibia
Role in knee stability when knee is straight
Anterior compartment of thigh
(Describe the ones NOT inverated by femoral NERVE)
Origin
Insertion
Action
Nerve Supply
Pectineus
Origin:
Superior pubic ramus
Insertion:
Inferior to lesser trochanter
Action:
Adducts and flexes thigh
Nerve Supply:
Femoral and Obtrucator
Iliopsoas
Origin:
Formed by Psoas major and iliacus
Insertion:
Lesser trochanter via iliopsoas tendon
Iliacus:
Origin:
Iliac fossa, lateral sacrum
Insertion:
Lesser trochanter
Action:
Flexes and externally rotates thigh
Nerve Supply:
Femoral
Psoas Major
Origin:
Lumbar vertebrae
Insertion:
Lesser trochanter
Action:
Flexes and externally rotates thigh
Nerve Supply:
L2 and L3
Tensor Fascia Lata
Origin:
ASIS, illac crest
Insertion:
Lateral condyle of tibia
Action:
Abducts thigh, dynamic stabiliser
Nerve Supply:
Superior Gluteal
Anterior compartment of thigh
(Describe the ones THAT ARE inverated by femoral NERVE)
Origin
Insertion
Action
Nerve Supply
Sartorius
Origin:
ASIS
Insertion:
Superior part of medial tib
Action:
Flexes, abducts, externally rotates thigh, flex leg
Nerve Supply:
Femoral
Quadriceps femoris:
Origin:
Consists of rectus femoris and vasti
Insertion:
Tib tuberosity via patella tendon
Rectus Femoris:
Origin:
Straight head: AIIS
Reflected head: Superior acetabular rim
Insertion:
Superior patella
Action:
Flex thigh, extend leg
Nerve Supply:
Femoral
Vastus Lateralis
Origin:
Greater Trochanter, linea aspera
Insertion:
Superior Patella
Action:
Extend leg
Nerve Supply:
Femoral
Vastus Intermedius
Origin:
Superior 2/3 femoral shaft, lateral intermuscular septum
Insertion:
Superior patella
Action:
Extend leg
Nerve Supply:
Femoral
Vastus medialis
Origin:
Intertrochanteric line, medial intermuscular septum
Insertion:
Superior Patella
Action:
Extend leg
Nerve Supply:
Femoral
Medial compartment of thigh- Adductors
Origin
Insertion
Action
Nerve
Adductor longis
Origin
Body of pubis
Insertion
Linea Aspera
Action
Adducts, flexes thigh
Nerve
Obtrucator
Adductor brevis
Origin
Inferior pubic ramus
Insertion
Linea aspera
Action
Adducts, flexes thigh
Nerve
Obtrucator
Adductor Magnus
Origin
Tibial tuberosity
Insertion
Linea aspera, adductor tubercle
Action
Adducts thigh, flex and extend thigh
Nerve
Sciatic (Tibial)
Gracilis
Origin
Body of pubis
Insertion
Superior part of medial tibia
Action
Adducts thigh, flex and internally rotates leg
Nerve
Obtrurator
What forms the pes anserinus
-clinical importance
Formed by tendons of sartorius, gracilis, and semitendinosus
Clinically important as tendons are used for repair of anterior cruciate ligament tears in the knee.
Label the nerves of lower limb
MUST know
Femoral, obtrucator, sciatic nerves MINIMUM
Lecture Slide
Where does Femoral nerve and Obturator nerve originate from
L2, L3, L4 od spinal nerve roots
Describe flow of femoral nerve
- How does it innervate skin on anterior aspect AND medial leg and foot
Pass along posterior abdominal wall
and through pelvis. Enter thigh under
inguinal ligament
* Almost immediately splits into multiple muscular branches to anterior thigh muscles
Also innervates skin on anterior aspect of thigh via anterior cutaneous nerve of thigh
* And medial leg and foot via saphenous nerve
Supplies hip joint
Obturator Nerve
- Flow
-supplies what
- Pass along posterior abdominal wall and
around the pelvis to enter thigh under
through the obturator foramen. - Supplies muscular branches to medial
compartment muscles thigh muscles - Also innervates small area of skin on medial
thigh via cutaneous branch
What are the superifical veins
- Small saphenous posterior leg
- Great saphenous vein (runs medially up leg from foot). Joins femoral vein vua defect in fascia lata
Femoral Triangle
-where is it
-borders (superior, medial, lateral, floor and roof)
-contents of triangle
The femoral triangle is a fascial space at the
superior aspect of thigh
The space is bounded
superiorly by the Inguinal Ligament
medially by Adductor Longus
laterally by Sartorius.
The floor of the triangle is Iliopsoas and Pectineus
roof is Fascia Lata, subcutaneous tissue and skin
The contents (LATERAL TO MEDIAL)
Femoral nerve, femoral sheath, Femoral artery, femoral vein, lymphatic vessels
Mnemonic NAVL
Femoral Nerve
- formed with?
-passes under?
-supply what compartment/ become what later on
Formed within Psoas Major from L2-L4.
Passes under the midpoint of the inguinal ligament to be the most lateral structure in the femoral triangle
muscular branches supply the anterior compartment (Flexors of hip and extensors of knee) and terminal branches become the saphenous nerve and descends medially as a cutaneous nerve
Femoral Sheath:
- starts where
- Contains what
- Femoral ring?
- Starts at inguinal ligament and extends inferiorly.
- Contains Femoral Artery, Vein and lymphatics. Does NOT contain the Femoral Nerve
The medial part of the sheath contains the Femoral Canal (really a sub-compartment of the sheath) the proximal end of which is called the Femoral Ring. Allows expansion of the femoral vein.
Adductor Canal:
-where is it
-purpose
-Borders
-Inlet and outlet
-Contents
occurs deep to the middle third of Sartorius
It provides a passage for the femoral A&V&N to pass through the thigh to reach the popliteal fossa and become the popliteal vessels
The canal is bounded
medially by Sartorius
posteriorly by Adductors Longus and Magnus laterally by Vastus Medialis.
The inlet to the canal is the apex of the femoral triangle and the outlet is the adductor hiatus in the Adductor Magnus muscle.
The contents include the Femoral artery and vein, the and the nerve to vastus medialis and Saphenous nerve (cutaneous branch of femoral N)
Adductor canal block
-where is it
-What distal branches of the femoral nerve does it anesthetise?
-purpose
is an interfascial plane block performed in the thigh.
It anesthetizes multiple distal branches of the femoral nerve including the
- saphenous nerve
-branches of the mixed sensory and motor nerves to the quadricep (vastus medialis),
-branches of the obturator nerve.
It is used for anaesthesia and/or analgesia for surgery of the knee, medial lower leg and ankle.
CLinical Applications of Femoral artery
The Femoral Artery is often used for arterial samples when unable to collect peripheral samples
It is also used for cardiac and other angiography procedures when a catheter is passed up the Femoral Artery to the aorta and coronary arteries and contrast injected
Clinical Applications of Cannulation of Femoral Vein
A long catheter can be inserted into the Femoral Vein as it passes through the Femoral Triangle and blood samples or pressure measurements from the right side of the heart can then be taken (via the External Iliac Vein, Common Iliac Vein and IVC)
Clinical applications of Femoral Nerve block
Following hip or femoral fractures it is
often desirable to place a nerve block for
pain relief rather than use large amounts
of oral or intravenous analgesics.
Pass needle through the 2 layers of fascia to infiltrate around the nerve
Clinical Application: Femoral Hernia
The femoral ring is a weak area in the lower abdominal wall and as such is a site for hernia (usually a loop of small intestine).
More common in women than men
If the hernia extends beyond the femoral canal through the Saphenous opening and into the thigh then it may be at risk of strangulation
