Lecture 17: Femoral Triangle & Anteromedial thigh Flashcards
in what place do the ilium, ischium, and pubis fuse?
acetabulum
on what side of femur is linea aspera located?
posterior
linea aspera
what is considered thigh and leg?
thigh: hip joint-knee joint
leg: knee and below
common iliac artery
external iliac artery
internal iliac artery
femoral artery
popliteal artery
posterior tibial a
anterior tibial a
fibular a
deep femoral a( also called profunda femoris a)
descending genicular a
descending branch of lateral circumflex femoral a
lateral circumflex femoral a
medial circumflex femoral a
perforating arteries of profunda femoris a
what artery provides most of the blood supply to the thigh and hip?
profunda femoris(deep femoral a)
obturator a
what is fascia lata?
-dense layer of CT
-separates muscles and muscular compartments from one another
-Fascia Lata attaches superiorly to the pubic tubercle, pubis and inguinal ligament. Laterally to the iliac creat and posteriorly to the sacrum, coccyx, and ischial tuberosity.
-extends down the thigh and attaches around the knee and becomes continuous with the fascia of the leg
-Laterally the fascia Lata blends with the tendon of TFL to form iliotibial Band/Tract. The ITB attaches to the lateral aspect of the tibia. (inferiorly)
-Fascia Lata splits to envelop TFL and Gluteus maximus muscles
-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.
what are the 3 thigh muscle compartments?
-anterior, medial, and posterior: formed by Fascia Lata and intermuscular septae
Iliopsoas: attachments, nerve and arterial supply and action
O: formed by proas major and iliacus
I: lesser trochanter via illiopsoas
psoas : attachments, nerve and arterial supply and action
- Originates from transverse processes L2-L4
- Muscle belly travels down post abdo wall through pelvis
- Passes under inguinal ligament
- Joint tendon inserts at the lesser trochanter
- Innervation – L2-L3 +/-L4 spinal nerves
- Function – Flexes and externally rotates thigh
iliacus:
attachments, nerve and arterial supply and action
- Originates from ilium
- Muscle belly travels down through pelvis
- Passes under inguinal ligament
- Joint tendon inserts at the lesser trochanter
- Innervation – Femoral nerve
- Function – Flexes and externally rotates thigh
Pectineus: attachments, nerve and arterial supply and action
Pectineus
* Originates from superior pubic ramus
* Inserts just below lesser trochanter
* Lies between the anterior and medial compartments of the thigh
* Innervation – Femoral nerve (=/- obturator nerve)
* Function –Thigh adduction (and flexion)
tensor fascia lata: : attachments, nerve and arterial supply and action
Tensor fascia lata
* Originates from ASIS
* Inserts into IT band /lateral aspect proximal tibia
* Innervation – superior gluteal nerve
* Function –Thigh ABDuction (and flexion)
* Function – stabilizes knee joint when walking
Sartorius:
attachments, nerve and arterial supply and action
Sartorius
* Originates from ASIS (like TFL)
* Crosses thigh
* Inserts into medial aspect proximal tibia at pes anserinus
* Innervation – femoral nerve
* Function – Pulls leg into sitting position – flexes knee and
externally rotates thigh
* Longest muscle in body
rectus femoris: attachments, nerve and arterial supply and action
Rectus femoris
* Originates from 1. AIIS and 2. superior acetabular rim
* Crosses two joints
* I: tibial tuberosity via Quadriceps tendon and patellar ligament
* Innervation – femoral nerve
* Function – thigh flexion. knee extension
Vasti muscles: attachments, nerve and arterial supply and action
Vasti muscles
* Originates:
Vastus medialis: intertrochanteric line, medial intermuscular septum
Vastus lateralis: greater trochanter, linea aspera
Vastus inermedius: superior 2/3 of femoral shaft, lateral intermuscular septum
* Quadriceps tendon inserts into superior pole patella( Insertion: tibial tuberosity via Quadriceps tendon and patellar ligament)
* Innervation – femoral nerve
* Function – Knee extension
Adductor longus:
attachments, nerve and arterial supply and action
Adductor longus
* Origin - body pubis
* Inserts - linea aspera posteriorly
* Innervation – Obturator nerve
* Function – ADDucts (and flexes thigh)
adductor brevis:
attachments, nerve and arterial supply and action
Adductor brevis
* Origin – inferior pubic ramus
* Inserts - linea aspera behind adductor longus
* Innervation – Obturator nerve
* Function – ADDucts (and flexes thigh)
adductor magnus:
attachments, nerve and arterial supply and action
Adductor magnus
* Very large muscle
* 2 parts
* Origin 1 Adductor part inferior pubic ramus . Innervation – Obturator nerve
- Origin 2 Hamstring part Ischial tuberosity. Innervation – sciatic (tibial n)
- Inserts - linea aspera, adductor tubercle, supracondylar ridge
- Function – ADDucts (and flexes and extends thigh)
Gracilis:
attachments, nerve and arterial supply and action
Gracilis
* Origin - body pubis
* Inserts – Superior part of medial tibia (pes anserinus)
* Innervation – Obturator nerve
* Function – ADDucts (and internally rotates leg)
Pes anserinus
Formed by tendons of sartorius, gracilis, (and
semitendinosus)
- Clinically important as tendons are used for
repair of anterior cruciate tears in the knee. - Muscles are important but not main movers
of hip and knee
Femoral nerve: path, muscles
- Originate from L2, L3, L4. Formed within Psoas major.
- Pass along posterior abdominal wall and through pelvis. Enter thigh under the inguinal ligament. Passes under the midpoint of the inguinal lig.
- the most lateral structure of the femoral triangle.
- Almost immediately splits into
multiple muscular branches to
anterior thigh muscles. Innervates the anterior compartment of the thigh.( flexors of the hip and extensors of the knee) - Also innervates skin on anterior
aspect of thigh via anterior cutaneous nerve of thigh - And medial leg and foot via saphenous nerve (runs with saphenous vein)
- Supplies hip joint (in part)
Obturator nerve: path, muscles
- Originate from L2, L3, L4
- 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
superficial veins in the leg
- Small saphenous: posterior leg
- Great saphenous vein: runs medially up the leg. It joins femoral vein via defect in fascia lata in femoral triangle.
femoral triangle: borders, contents
- The femoral triangle is a fascial space at the superior aspect of the 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 and the roof is Fascia Lata, subcutaneous tissue and skin
- The contents of the femoral triangle from lateral to medial are the Femoral Nerve, Femoral Sheath, Femoral Artery, Femoral Vein, lymphatic vessels
femoral sheath:
- 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 subcompartment of the sheath) the proximal end of which is called the
Femoral Ring. Allows expansion of the femoral vein.
adductor canal: location, structure, function, contents
- Also known as the Subsartorial Canal as it occurs
deep to the middle third of Sartorius - It provides a passage for the femoral vessels 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 and
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
- The adductor canal block is an interfascial plane
block performed in the thigh. - It anesthetizes multiple distal branches of the femoral nerve including the saphenous nerve and
branches of the mixed sensory and motor nerves to the quadricep (vastus medialis), as well as
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 the femoral artery?
- The Femoral Artery is often used for arterial samples when unable
to collect peripheral samples (e.g. when peripherally shut down in
shock). - 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: cannulation of femoral vein
- The Femoral Vein can be used for central access as it is relatively
easy to find and access. - 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
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.
The Femoral Nerve is easily found lateral
to the Femoral Artery in the Femoral
Triangle.
Pass needle through the 2 layers of fascia
to infiltrate around the nerve
Clinical applications
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). - Femoral hernias are 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
ASIS
AIIS
muscles of the anterior thigh compartment
pectineus
iliopsoas( iliacus, psoas major)
tensor fascia lata
sartorius
quadriceps femoris( rectus femoris, vastus medialis, vastus intermedius, vastus lateralis)
medial compartment thigh muscles
adductor longus
adductor brevis
adductor magnus
gracilis
obturator externus
