Femoral Triangle, Adductor Canal, Gluteal Region (lecture) Flashcards
Femoral Triangle
A triangle Depression in the superior/anterior thigh
Many large neurovascular structures pass through and can be accessed easily
Boundaries of the Femoral Triangle
Mnemonics: SAIL (Sartorius, Adductor longus, and Inguinal ligament)
Superiorly: Inguinal Ligament
Medically: Medial border of the adductor longus
Laterallly by the sartorius
Apex: medial border of the sartorius crosses the lateral border of the adductor longus muscle
Contents of Femoral Triangle
From Lateral to Medial
- Femoral nerve and its branches
- Femoral sheath and its contents
Femoral artery
Femoral vein and its proximal tributaries (Great saphenous vein)
Deep inguinal lymph nodes and associated lymph vessels in the femoral canal
Fascia Lata defect: Saphenous Opening
Great saphenous vein passes through the saphenous opening to drain into the femoral vein
Femoral Canal
Medial compartment of the femoral sheath
Entrance: femoral ring (rigid structure bounded by ligaments and a muscle)
Femoral hernias
Femoral ring is the usual originating site
Passes through the ring, into the femoral canal and ultimately pass through the saphenous opening
In the Femoral Triangle
Lymphatic vessels
Superficial
Lie in superficial fascia; some follow the great saphenous vein and others drain foot and leg and join those associated with smaller sphaneous vein or drain into the popliteal nodes
Lymphatic vessels:
Deep
Accompany the blood vessels
Popliteal lymph nodes
In the popliteal fossa
Superficial inguinal lymph nodes
Horizontal Group
Inferior and parallel to the inguinal ligament and drain penis, scrotum, labia, perineum, buttock , abdominal wall;
Superficial inguinal lymph nodes:
Vertical group
Lies along the terminal part of the great saphenous vein and receives drainage from vessels associated with the great saphenous vein
Deep Inguinal Lymph Nodes
Deep to the deep fascia along the medial side of the femoral vein and receive drainage from deep lymphatics of the lower extremity and superficial nodes
Adductor Canal (subsartorial canal, Hunter Canal)
15 cm in the middle third of thigh
Extends from the apex of femoral triangle to the adductor hiatus in the tendon of the adductor magnus muscle
Provides intermuscular passageway for the femoral artery and vein, saphenous nerve, and nerve to the vastus medialis muscle
Enables femoral vessels to emerge in the popliteal fossa and be renamed the popliteal vessels
Boundaries of the Adductor Canal
Vastus medialis anteriorly and laterally
Adductors longus and magnus posteriorly
Sartorius medially. It overlies the canal, forming its roof
Medial and Lateral Circumflex femoral Arteries
Principle blood supply to the head of the femur
Medial is the main
Retinacular (Nutrient) arteries
Arising mainly from the medial circumflex femoral artery and pass along the femoral neck beneath the capsule
Artery of the ligament of the head of the femur
Branch of the obturator artery that provides variable (0-20%) of the blood supply to the head of the femur in the adult
Gluteal Region
The intergluteal cleft separates the buttocks
Gluteal folds (sulcus) marks the lower limit of the butt and upper limit of the thigh
Level of iliac crests: superior border
Innervation of the skin of the gluteal region
Just be familiar that the clunial nerves supply this region
Ligaments of the Gluteal Region
Sacrospinous ligament: from sacrum to ischial spine
Sacrotuberous ligament: sacrum to ischial tuberosity.
Gluteal Tuberosity
A rough, bumpy ridge of bone coursing inferiorly from the intertrochanteric crest to the superior end of the linea aspera
Serves as attachment site for the gluteus Maximus muscle
Intertrochanteric Crest
smooth, thick ridge of bone that forms the posterior junction of the femoral neck and shaft; runs obliquely from the greater trochanter to the lesser trochanter. Near the center of the crest is a small tubercle for the attachment of the quadratic Femoris muscle
Iliotibial band (IT band)
Longitudinal fibrous reinforcement of fascia lata
Attaches from iliac tubercle to lateral condyle of tibia
Gluteus maximus and tensor fasciae latae muscles insert into the IT band
IT band syndrome
Common cause of lateral knee pain
Results from excessive friction between the IT band and lateral femoral epicondyle
Muscles of the Gluteal Region
They all point roughly in the direction of, and connect outright with, the greater trochanter (except gluteus maximus)
Organized into a superficial and deep group
Superficial Gluteal Group
Actions: abduction and extension of the thigh
Prox: the external surface of the ilium
Distal: IT band/ Gluteal tuberosity (Maximus) or greater trochanter (mediums and minimus)
Blood and nerve supply: inferior and superior gluteal vessels and nerves
Gluteus Maximus
Sup Gluteal muscle
Prox: ilium and sacrum and sacrotuberous ligament
Distal: IT band and proximal femur
Innervation: inferior gluteal nerve
Actions: extends the thigh and assists in lateral rotations
Gluteus Medius
Sup gluteal muscle
Prox: lateral surface of the ilium
Distal: greater trochanter of the femur
Innervation: Superior Gluteal nerve
Action: abduct and medially rotate the thigh
Gluteus Minimus
Sup gluteal muscle
Prox: lateral surface of the ilium
Distal: Greater trochanter of the femur
Innervation: superior gluteal nerve
Action: abduction and medially rotate the thigh
Tensor Fasciae Latae
Sup Gluteal Muscle
Prox: ASIS
Distal: IT band
innervation: superior gluteal nerve
Action: abduct and medially rotate the thigh
Deep Gluteal Group of Muscles
Are small lateral rotators and stabilizers of the hip joint
Attach from the sacrum and ischium to the greater trochanter or adjacent to it
Piriformis (deep gluteal muscle)
Prox: anterior surface of the sacrum
Distal: greater trochanter
Innervation: nerve to piriformis
Action: laterally rotates the thigh
Obturator Internus (Deep gluteal muscle)
Prox: obturator foramen and obturator membrane
Distal: greater trochanter
Innervation: Nerve to obturator internus
Action: laterally rotates the thigh
Superior and inferior gemelli (deep Gluteal muscle)
Superior Prox: ischial spine. Inferior prox: ischial tuberosity
Distal: greater trochanter
Innervation: Sup: nerve to the obturator internus
Inf: nerve to the quadratus femoris
Action: Laterally rotates the thigh
Quadratus femoris (deep gluteal muscle)
Prox: Ischial Tuberosity
Distal: Intertrochanteric crest of femur
Nerve to the quadratus femoris
Action: laterally rotates the thigh
Structures passing above the Piriformis Muscle
Vessels: superior gluteal vessels
Nerves: Superior Gluteal nerve
Structures passing below the piriformis muscle
Vessels: inferior gluteal vessels
Internal pudendal vessels
Nerves: inferior Gluteal nerve, sciatic nerve, posterior femoral cutaneous nerve, nerve to quadratus femoris, nerve to obturator internus, pudendal nerve
Other: superior gemellus, tendon of the obturator internus, inferior gemellus, and quadratus femoris
Superior Gluteal Artery
Largest branch of internal iliac artery
Enters gluteal region through the greater sciatic foramen superior to piriformis muscle
Under gluteus maximus: divides into branches that supply buttocks
Inferior Gluteal Artery
Another branch of internal iliac artery, enters gluteal region through the greater sciatic foramen inferior to the piriformis muscle and descends on the medial side of the sciatic nerve
Supplies muscles of buttocks and back of thigh
Superior Gluteal Nerve (L4,5, S1)
Passes through the greater sciatic foramen immediately superior to the pisiformis. Passes btwn gluteus medius and minimus and supplies both muscles as well as tensor fasciae latae
Inferior Gluteal Nerve (L5, S1,2)
Traverses the greater sciatic foramen just inferior to the pisiformis muscle and supplies the gluteus maximus
Sciatic Nerve
Largest nerve in the human body
L4,5,S1,2,3 segments of sacral plexus
emerges from the greater sciatic foramen inferior to piriformis muscle
Travels in the posterior compartment of the thigh posterior to the adductor magnus muscle
Contains tibial division and common fibular division
Will divide into tibial nerve (posterior compartment of leg and plantar foot) and common fibular nerve (nerve of anterior and lateral compartments of the leg)
Piriformis Syndrome
TIghtness or spasm causes the muscle to compress and irritate the sciatic nerve. Brings lower back and buttock pain that is sometimes severe
May be confused with sciatica
Positive Trendenlenburg’s Sign
Stability of the hip joint when a person stands on one leg with the foot of the opposite leg raised above the ground depends on the gluteus medius and minimus muscles being functionally normal. If the hip abductors are weak or paralyzed, then the pelvis will sink downwards on the opposite, unsupported side
