Lecture 18: Femoral triangle and Antero-Medical Thigh

Question 1

What is the Fascia Lata made of and its purpose.

Answer 1

This is deep fascia: fibrous connective tissue made of collagen 1 fibres running down the vertical axis of lower limb.
Purpose is to cover thigh and separate it into muscular compartments (with the intermuscular septa) and form part of the Iliotibial band

Question 2

Where does the Fascia Lata attach to superiorly and where does it end

Answer 2

It attaches superiorly to the anterior superior illiac spine, inguinal ligament and pubic tubercle. Laterally to the illiac crest and posteriorly to the sacrum, coccyx and ischial tuberosity.
It extends down the thigh and continues with the deep fascia of the leg.

Question 3

What two muscles are enclosed by split layers of Fascia Lata

Answer 3

Fascia Lata splits to enclose the tendons of Tensor fascia lata and Gluteus maximus

Question 4

What is the iliotibial band/tract made of, where does it insert and whats its purpose

Answer 4

It is made from fascia lata blending with the tendon of tensor fascia lata on the lateral side of the thigh which goes to insert into the lateral aspect of the tibia. Its purpose is to stabilise the knee when standing upright

Question 5

What is the Saphenous opening and its contents

Answer 5

This is a hole just inferior to the inguinal ligament in the fascia lata where Saphenous vein passes through to meet the Femoral vein

Question 6

Where does the inguinal ligament attach

Answer 6

The Anterior superior illiac spine (ASIS) and the pubic turbercle

Question 7

Which is lateral and medial : Greater & lesser trochanter and where is the linea aspera in relation to these two structures

Answer 7

Greater trochanter is on lateral, and lesser trochanter on medial, slightly smaller and lower. The Linea Aspera is the posterior ridge between these two trochanters down the back of the femur for muscle attachment

Question 8

What is the origin, insertion, innervation and movement of Tensor Fascia lata

Answer 8

O: ASIS and illiac crest
I: Lateral condyle of tibia
N: Superior Gluteal nerve
Movement: Abduct thigh and stabilise the pelvis during walking

Question 9

What is the origin, insertion, innervation and movement of Pectineus (smaller muscle lying between ant and med compartment)

Answer 9

O: Superior pubic ramus
I: Inferior to lesser trochanter
N: Femoral and Obturator nerve

Movement: adducts and flexes the thigh

Question 10

What two muscles make up Iliopsoas and what is the common insertion

Answer 10

Iliacus and Psoas Major which insert on the lesser trochanter

Question 11

What is the origin of the Iliacus and the Psoas major muscle

Answer 11

Iliacus : iliac fossa and lateral sacrum.

Psoas Major: Lumbar vertebrae: L2-4

Question 12

What is the movement of Iliopsoas - (and component muscles)

Answer 12

Flexes and externally rotates the thigh

Question 13

What is the innervation of Iliacus and Psoas major

Answer 13

Iliacus: Femoral nerve

Psoas major : L2-L3/4 spinal nerve

Question 14

What is the origin, insertion and movement of Sartorius - the snaky muscle

Answer 14

O: ASIS
I: Pes Anserinus

Movement : Flexes, abducts, externally rotates thigh and flexes leg (put in sitting position

Question 15

What muscles make up Quadriceps Femoris

Answer 15

Rectus Femoris, Vastus Lateralis, Intermedius and Medialis

Question 16

What is the common insertion of the muscles in Quadriceps Femoris

Answer 16

Superior Patella quadriceps tendon which is the tibial tuberosity via Patella tendon

Question 17

What is the origin and movement of the Rectus femoris

Answer 17

Origin: AIIS (straight head) and Superior acetabular rim (reflected head)

Movement is to flex the thigh (as it acts on both hip and knee joint) and extend the leg

Question 18

What is the origin for Vastus Lateralis, V intermedius and V medialis

Answer 18

V Lateralis : Greater trochanter and linea aspera

V Intermedius: Superior 2/3 of femoral shaft, lateral intermuscular septum

V Medialis: Intertrochanteric line, medial intermuscular septum

Question 19

What is the common action of the Vastus muscles

Answer 19

To extend the leg /knee

Question 20

What is the common innervation of Quadriceps femoris and Sartorius muscles

Answer 20

Femoral nerve

Question 21

What muscles in the anterior compartment are not/ not only innervated by the femoral nerve

Answer 21

Pectineus (obturator) psoas major (L2-4)

Tensor fascia lata (superior gluteal )

Question 22

What are the medial thigh muscles

Answer 22

Adductor longus, brevis and magnus.

Gracilis and Obturator externus

Question 23

What is the common insertion and movement of Adductor Longus and Adductor brevis

Answer 23

I: Linea aspera

Movement: Adducts and flexes the thigh

Question 24

What are the different origins of Adductor Longus and Adductor brevis

Answer 24

Adductor Longus: Body of pubis

Adductor brevis: Inferior pubic ramus

Question 25

What are the origins of the Adductor and Hamstring part of the Adductor Magnus and the innervation of these two parts

Answer 25

Origin:
Adductor part: inferior pubic ramus

Hamstring part: ischial tuberosity

Nerve:
Adductor part: Obturator nerve

Hamstring part: Sciatic nerve (tibial branch)

Question 26

Where does Adductor magnus insert and where does it leave a gap

Answer 26

Linea aspera, medial supracondylar ridge and adductor tubercle. It leaves a hole just superior to the adductor tubercle called the adductor hiatus

Question 27

What is the adductor tubercle

Answer 27

A medial tubercle on the bottom head of femur

Question 28

What is the movement of Adductor Magnus

Answer 28

Adducts the thigh, and can flex or extend the thigh depending on the fibres

Question 29

What is the origin, insertion and movement of Gracilis

Answer 29

O: Body of pubis
I: Pes Anserinus

Movement: Adducts the thigh, flexes and internally rotates the leg.

Question 30

What is the origin, insertion and movement of Obturator externus

Answer 30

O: Obturator foramen and membrane
I: Posterior intertrochanteric fossa

Movement: Externally rotate the thigh

Question 31

What is the Pes Anserinus (Gooses foot) and what is its clinical relevance

Answer 31

It is the superior part of the medial Tibia where 3 muscles attach: Sartorius, Gracilis and Semitendinosus . These tendons can be used to reconstruct a torn Anterior crucial ligament of the knee

Question 32

What nerve innervates the muscles of medial compartment of thigh - the parts that do the adduction movement

Answer 32

Obturator nerve

Question 33

From which 3 vertebrae do the nerves of the leg : Femoral and Obturator come from and what plexus is this

Answer 33

Anterior rami of L2-4. The nerves come from the lumbar plexus

Question 34

Describe the path of the obturator nerve/ where I can find it and its cutaneous innervation

Answer 34

Obturator nerve comes out of the lumbar plexus and then goes in through the pelvis out of the obturator foramen and can be found sitting on top of adductor magnus.

Its cutaneous innervation is the lower medial 2/3 of the thigh

Question 35

Describe the path of the Femoral nerve, its muscular and cutraneous innervation

Answer 35

Formed within Psoas major and passes under midpoint of inguinal ligament to be the most lateral structure in femoral triangle (in front of iliopsoas).
Muscular innervation to flexors of hip and extensors of knee in anterior compartment.
Cutaneous is the anterior cutaneous nerve of the thigh which has terminal branch = Saphenous Nerve which supplies medial 1/3 of leg.

Question 36

Describe the main arterial supply to the thigh

Answer 36

This is from the femoral artery which becomes so when the external iliac artery crosses under the inguinal ligament. Its first branch to the lateral side is the profunda femoris on the medial aspect of the femur. It has the med + lat circumflex arteries which supply the hip joint and the 3 branches of perforating arteries which go around the shaft of femur

Question 37

What are the borders of the femoral triangle, roof and floor- the fascial space at the superior aspect of the thigh.

Answer 37

Superior border by inguinal ligament, medial border by Adductor longus and lateral border by Sartorius.

Floor is the iliopsoas and pectineus and the roof is fascia lata, subcutaneous tissue and skin

Question 38

What are the contents of the femoral triangle lateral to medial

Answer 38

Femoral nerve, Femoral sheath, Femoral artery, Femoral vein and lymphatic vessels

Question 39

Describe the femoral sheath: boundaries and contents

Answer 39

Extension of the fascia from the posterior abdominal wall which starts at the inguinal ligament and extends inferiorly, contains the Femoral artery, vein and lymphatics- not nerve.

Question 40

What is the femoral canal and femoral ring

Answer 40

The medial subcompartment of the femoral sheath which has space allowing for femoral vein expansion containing fat and lymphatics. Proximal end of the canal is the femoral ring

Question 41

What is the medial, posterior and lateral borders of the adductor canal,inlet and outlet

Answer 41

Inlet is apex of femoral triangle.
Medial border is Sartorius. Lateral border is Vastus medialus and Posterior border is Adductors longus and Magnus. The outlet is Adductor hiatus in Adductor magnus muscle.

Question 42

What is purpose of the adductor canal

Answer 42

Purpose : Allows contents to go down the thigh and exit at the back of the knee into popliteal fossa to become popliteal vessels.

Question 43

What is the contents of adductor canal

Answer 43

femoral artery and vein, the nerve to vastus medialis and Saphenous nerve

Question 44

What is the clinical application of Femoral pulse

Answer 44

Femoral artery is used for arterial samples when unable to collect periphery samples.
Also used to insert contrast into the aorta and coronary arteries

Question 45

What is the clinical application of Cannulation of femoral vein

Answer 45

A long catheter can be inserted into Femoral vein as it passes through femoral triangle to take measurements for the right side of the heart

Question 46

What is the clinical application of Femoral Nerve block

Answer 46

Nerve block for pain relief following hip or femoral fractures is placed here

Question 47

What is the clinical application of Femoral hernia

Answer 47

More common in women vs men, this happens when some intestine can get stuck in the femoral ring - weak area of lower abdominal wall which can be at risk of strangulation if it extends beyond the femoral canal through saphenous opening

Question 48

What is the veinous return from the leg

Answer 48

From the inferior vena cava there are common illiac veins which branch into internal and external illiac veins. The external illiac vein becomes the femoral vein which give two branches, the Great Saphenous vein which comes through the Saphenous opening and runs mainly medially as the most superficial structure and the small saphenous vein which stays under the fascia lata.