Lecture 18: Femoral triangle and Antero-Medical Thigh Flashcards
What is the Fascia Lata made of and its purpose.
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
Where does the Fascia Lata attach to superiorly and where does it end
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.
What two muscles are enclosed by split layers of Fascia Lata
Fascia Lata splits to enclose the tendons of Tensor fascia lata and Gluteus maximus
What is the iliotibial band/tract made of, where does it insert and whats its purpose
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
What is the Saphenous opening and its contents
This is a hole just inferior to the inguinal ligament in the fascia lata where Saphenous vein passes through to meet the Femoral vein
Where does the inguinal ligament attach
The Anterior superior illiac spine (ASIS) and the pubic turbercle
Which is lateral and medial : Greater & lesser trochanter and where is the linea aspera in relation to these two structures
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
What is the origin, insertion, innervation and movement of Tensor Fascia lata
O: ASIS and illiac crest
I: Lateral condyle of tibia
N: Superior Gluteal nerve
Movement: Abduct thigh and stabilise the pelvis during walking
What is the origin, insertion, innervation and movement of Pectineus (smaller muscle lying between ant and med compartment)
O: Superior pubic ramus
I: Inferior to lesser trochanter
N: Femoral and Obturator nerve
Movement: adducts and flexes the thigh
What two muscles make up Iliopsoas and what is the common insertion
Iliacus and Psoas Major which insert on the lesser trochanter
What is the origin of the Iliacus and the Psoas major muscle
Iliacus : iliac fossa and lateral sacrum.
Psoas Major: Lumbar vertebrae: L2-4
What is the movement of Iliopsoas - (and component muscles)
Flexes and externally rotates the thigh
What is the innervation of Iliacus and Psoas major
Iliacus: Femoral nerve
Psoas major : L2-L3/4 spinal nerve
What is the origin, insertion and movement of Sartorius - the snaky muscle
O: ASIS
I: Pes Anserinus
Movement : Flexes, abducts, externally rotates thigh and flexes leg (put in sitting position
What muscles make up Quadriceps Femoris
Rectus Femoris, Vastus Lateralis, Intermedius and Medialis
What is the common insertion of the muscles in Quadriceps Femoris
Superior Patella quadriceps tendon which is the tibial tuberosity via Patella tendon
What is the origin and movement of the Rectus femoris
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
What is the origin for Vastus Lateralis, V intermedius and V medialis
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
What is the common action of the Vastus muscles
To extend the leg /knee
What is the common innervation of Quadriceps femoris and Sartorius muscles
Femoral nerve
What muscles in the anterior compartment are not/ not only innervated by the femoral nerve
Pectineus (obturator) psoas major (L2-4)
Tensor fascia lata (superior gluteal )
What are the medial thigh muscles
Adductor longus, brevis and magnus.
Gracilis and Obturator externus
What is the common insertion and movement of Adductor Longus and Adductor brevis
I: Linea aspera
Movement: Adducts and flexes the thigh
What are the different origins of Adductor Longus and Adductor brevis
Adductor Longus: Body of pubis
Adductor brevis: Inferior pubic ramus
What are the origins of the Adductor and Hamstring part of the Adductor Magnus and the innervation of these two parts
Origin:
Adductor part: inferior pubic ramus
Hamstring part: ischial tuberosity
Nerve:
Adductor part: Obturator nerve
Hamstring part: Sciatic nerve (tibial branch)
Where does Adductor magnus insert and where does it leave a gap
Linea aspera, medial supracondylar ridge and adductor tubercle. It leaves a hole just superior to the adductor tubercle called the adductor hiatus
What is the adductor tubercle
A medial tubercle on the bottom head of femur
What is the movement of Adductor Magnus
Adducts the thigh, and can flex or extend the thigh depending on the fibres
What is the origin, insertion and movement of Gracilis
O: Body of pubis
I: Pes Anserinus
Movement: Adducts the thigh, flexes and internally rotates the leg.
What is the origin, insertion and movement of Obturator externus
O: Obturator foramen and membrane
I: Posterior intertrochanteric fossa
Movement: Externally rotate the thigh
What is the Pes Anserinus (Gooses foot) and what is its clinical relevance
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
What nerve innervates the muscles of medial compartment of thigh - the parts that do the adduction movement
Obturator nerve
From which 3 vertebrae do the nerves of the leg : Femoral and Obturator come from and what plexus is this
Anterior rami of L2-4. The nerves come from the lumbar plexus
Describe the path of the obturator nerve/ where I can find it and its cutaneous innervation
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
Describe the path of the Femoral nerve, its muscular and cutraneous innervation
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.
Describe the main arterial supply to the thigh
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
What are the borders of the femoral triangle, roof and floor- the fascial space at the superior aspect of the thigh.
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
What are the contents of the femoral triangle lateral to medial
Femoral nerve, Femoral sheath, Femoral artery, Femoral vein and lymphatic vessels
Describe the femoral sheath: boundaries and contents
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.
What is the femoral canal and femoral ring
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
What is the medial, posterior and lateral borders of the adductor canal,inlet and outlet
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.
What is purpose of the adductor canal
Purpose : Allows contents to go down the thigh and exit at the back of the knee into popliteal fossa to become popliteal vessels.
What is the contents of adductor canal
femoral artery and vein, the nerve to vastus medialis and Saphenous nerve
What is the clinical application of Femoral pulse
Femoral artery is used for arterial samples when unable to collect periphery samples.
Also used to insert contrast into the aorta and coronary arteries
What is the clinical application of Cannulation of femoral vein
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
What is the clinical application of Femoral Nerve block
Nerve block for pain relief following hip or femoral fractures is placed here
What is the clinical application of Femoral hernia
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
What is the veinous return from the leg
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.
