Femoral Triangle, Adductor canal, vessels and nervrs of the anterior and medial thigh

Question 1

Describe the boundaries of the femoral triangle

Answer 1

Superior: Inguinal Ligament

Medial: Lateral border of adductor longus

Lateral: Medial border of sartorius

Roof: Fascia Lata (deep fascia)

Floor: Pectineus, iliopsoas

Question 2

What are the general contents of the femoral triangle?

Answer 2

Lateral to medial - NAVL

1. Femoral NERVE as it divides into its cutaneous and motor branches
2. Femoral ARTERY with its branches
3. Femoral VEIN
4. LYMPHATICS

Question 3

In the femoral triangle, describe the contents of the femoral sheath. What is this sheath an extension of? What is NOT in the sheath?

Answer 3

Contains: The femoral artery and vein

Extension of: Transversalis fascia from the abdomen

DOES NOT CONTAIN: The femoral nerve

Question 4

Medial to the femoral vein a third partitioned area forms the femoral canal. What can be located in this canal? What clinical correlation is relevent to the femoral canal?

Answer 4

A deep inguinal lymph node can be located here.

Fat, of a portion of a viscus (gut) can protrude from within the abdomen through the entrance of this canal, the “femoral ring”, creating a femoral hernia

Question 5

Describe the adductor canal’s boundaries

AKA: Subsartorial canal, Hunter’s canal

Answer 5

Anteromedially: Sartorius - forms roof over canal - and vastoadductor membrane

Anterolaterally: vastus medialis

Posteriorly: adductor longus superiorly, adductor magnus inferiorly

Question 6

What are the contencts of the adductor canal?

Answer 6

Femoral Artery

Femoral Vein

Motor Nerve to the vastus medialis (from femoral nerve)

Saphenous nerve (from femoral nerve)

Question 7

Describe the adductor canal

Answer 7

Connects the compartment of the femoral triangle with the popliteal fossa.

Begins at the apex of the femoral triangle and passes inferiorly until it reaches and opening in the adductor magnus tendon (adductor hiatus) which communicates with the popliteal fossa.

Question 8

What happens to the nerves that enter the adductor canal?

Answer 8

They DO NOT exit the adductor hiatus. The nerve to vastus medialis pierces that muscle in the canal, and the saphenous nerve pierces the medial wall of the adductor canal to become cutaneous.

Question 9

What route does the descending genicular artery take after branching off the femoral artery in the adductor canal?

Answer 9

Accompanies the saphenous nerve through the medial wall of the canal. (vastoadductor membrane)

Question 10

Describe the course and relationships of the femoral artery

Answer 10

1. Continuation of the external iliac artery inferior to the inguinal ligament.
2. Superiorly in the thigh lies within the femoral triangle
3. Inferiorly in the thigh lies within the adductor canal.
4. As the femoral artery exits the adductor hiatus it becomes the popliteal artery.

Question 11

What branches does the femoral artery give off?

Answer 11

1. Superficial circumflex iliac a.
2. superficial epigastric a.
3. superficial external pudendal a.
4. deep external pudendal a.
5. Deep (profunda) femoral a.
6. Descending genicular a.

** 1-4 to be studied later **

Question 12

What three branches does the deep femoral a. give off?

Answer 12

1. Lateral femoral circumflex a.
2. medial femoral circumflex a.
3. perforating arteries (1-4)

Question 13

Describe the three branches of the lateral femoral circumflex a.

Answer 13

1. Ascending - ascends deep to the tensor fascia lata muscle
2. Transverse - winds around the femur within the substance of the vastus lateralis muscle to anastomose posteriorly with branches of the medial femoral circumflex a., inferior gluteal a., and the first perforating a. (cruciate anastomosis)
3. Descending - descends on the surface of the vastus lateralis and participates with other ateries in the genicular anastamosis

Question 14

Describe the medial femoral circumflex a.

Answer 14

Arises medially from the deep femoral and dives between the psoas and pectineus muscles. It supplies the adductor muscles medially and gives a branch to the acetabulum and ultimately to the head of the femur. posteriorly it supplies the deep lateral rotators of the thigh and ends by participating in the cruciate anastomosis.

Question 15

Describe the descending genicular a.

Answer 15

Arises from the femoral artery just before it passes through the adductor hiatus and divides into:

1. articular branch, which penetrates the substance of the vastus medialis muscle and participates in forming the genicular anastamosis.
2. Saphenous branch, which pierces the vastoadductor memrane with the saphenous n. and with it will istribute to subcutanoues areas of the upper medial portion of the leg

Question 16

Describe the obturator a.

Answer 16

1. Branch of the internal iliac artery
2. passes from the pelvic cavity to the thigh via the obturator canal
3. remains deep to the obturator externus muscle
4. Branches into:
   
   1. Anterior
   2. Posterior
   3. Acetabular - provides branches to the acetabulum and an artery to the head of the femur via the ligamentum teres femoris

Question 17

Describe the course of the femoral nerve

Answer 17

1. originates within the lumbar plexus from ventral rami of spinal nerves L2,3,4
2. Exits the pelvis by passing deep to the inguinal ligament in the groove between the iliacus and psoas major muscles
3. passes through the femoral triangle lateral to the femoral vessels
4. While in the femoral triangle, provides intermediate and medial femoral cutaneous and motor branches to the pectineus, sartorius, rectus femoris, vastus muscles and articularis genu.

Question 18

Describe the saphenous nerve.

Cord level?

Answer 18

Terminal branch of the femoral nerve, along with the saphenous branch of the descending genicular artery, pierces the vastoadductor membrane and descends medially with the greater saphenous v. to provide cutanous sensation to the medial portion of the leg and foot, and the posterior portion of the dorsum of the foot.

(L4)

Question 19

Describe the course of the obturator nerve

Answer 19

1. Originates within the lumbar plexus from ventral rami of spinal nerves L2,3,4
2. Exits the pelvis by passing through the obturator canal, and opening in the obturator membrane
3. As it enters the thigh, it divides into two branches as it meets the adductor brevis
   
   1. Anterior division
   2. Posterior division

Question 20

Describe the anterior division of the obturator nerve

Answer 20

Lies on the surface of the adductor brevis muscle deep to the adductor longus. Innervates the adductor brevis muscle deep to the adductor longus, innervates the adductor longus and brevis, gracilis and sometimes pectineus. Also sends a cutaneous branch to the medial surface of the thigh and a branch to the hip joint.

Question 21

Describe the posterior division of the obturator nerve

Answer 21

Lies on the surface of the adductor magnus, deep to the adductor brevis. It innervates the obturator externus muscle, a portion of the adductor magnus muscle, and sends an articular branch to the knee joint.