Lecture 4: Anterior And Medial Thigh + Femoral Triangle Flashcards
Where does the great saphenous vein begin, travel, and end?
Begins at medial side of dorsal venous arches of the foot
Ascends medially and passes through saphenous opening in deep fascia
Terminates in femoral vein on anterior thigh
The great saphenous vein corresponds to what 3 branches of femoral vein?
External pudendal v.
Superficial circumflex iliac v.
Superficial epigastric v.
What branch of the femoral vein drains the penis and scrotum in males, the vulva and lower vagina in females, and the anal canal?
External pudendal v.
What branch of the femoral vein drains the lateral thigh?
Superficial circumflex iliac v.
What branch of the femoral vein drains the anterior abdominal wall?
Superficial epigastric v.
The superficial inguinal lymph nodes are divided into what 2 groups?
Superior horizontal group
Inferior vertical group
What division of superficial inguinal lymph nodes drains the external pudendal v., superficial circumflex iliac v., and superficial epigastric v.?
Superior horizontal group
[the inferior vertical group drains the remaining superficial tissues of the lower extremity]
What are the 4 cutaneous nerves of the anterior and medial thigh?
Femoral cutaneous nerves (lateral, intermediate, medial)
Ilioinguinal n.
Genitofemoral n. (femoral branch)
Obturator n. (femoral branch)
What stucture is responsible for dividing the thigh into compartments?
Fascia lata (thin, dense CT that also surrounds the thighs)
What 2 muscles make up the anterior compartment of the thigh?
Quadriceps femoris m.
Sartorius m.
What are the 4 muscles that make up the quadriceps femoris m.?
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
3 out of the 4 muscles that make up the quadriceps femoris m. originate on the shaft of the femur, but which one originates on the anterior inferior iliac spine?
What is the significance of this?
Rectus femoris
Since it crosses both hip and knee joints, can perform leg extension AND thigh flexion
What is the insertion for all 4 muscles that make up the quadriceps femoris m.?
Patella
What is the innervation supplying all 4 muscles that make up the quadriceps femoris m.?
Femoral n.
What is the general action of the quadriceps femoris m.?
Leg extension
The quadriceps femoris m. extends the leg via the _________ tendon which inserts on the _______ ________
Patellar; tibial tuberosity
Muscle origin, insertion, innervation, action:
Rectus femoris
Origin: anterior inferior iliac spine
Insertion: patella
Innervation: femoral n.
Action: leg extension and thigh flexion
Muscle origin, insertion, innervation, action:
Vastus lateralis
Origin: shaft of femur
Insertion: patella
Innervation: femoral n.
Function: leg extension
Muscle origin, insertion, innervation, action:
Vastus intermedius
Origin: shaft of femur
Insertion: patella
Innervation: femoral n.
Action: leg extension
Muscle origin, insertion, innervation, action:
Vastus medialis
Origin: shaft of femur
Insertion: patella
Innervation: femoral n.
Action: leg extension
Muscle origin, insertion, innervation, action:
Sartorius
Origin: anterior superior iliac spine
Insertion: medial surface of tibia inferior to tibial tuberosity
Innervation: femoral n.
Action: thigh and leg flexion (crosses hip and knee joints)
How many muscles are in the medial compartment of the thigh?
6
What are the 6 muscles in the medial compartment of the thigh?
Gracilis Pectineus Adductor longus Adductor brevis Adductor magnus Obturator externus
All 6 muscles of the medial compartment of the thigh originate from the ________ aspect of the ox coxae and ________ membrane
Anterior; obturator
All 6 muscles of the medial compartment of the thigh insert on the ____ and _____
Femur; tibia
All 6 muscles of the medial compartment of the thigh are innervated by the obturator nerve except which one?
Pectineus m. (innervated by femoral n.)
[also note that part of the adductor magnus is innervated by tibial n.]
Vascular supply to the 6 muscles of the medial compartment of the thigh come from what 2 arteries?
Obturator a.
Profunda femoris a.
Origin of gracilis
Body and inferior ramus of pubis
Insertion of gracilis
Medial surface of tibia inferior to tibial tuberosity (between insertions of sartorius and semitendinosus)
Only 1/6 muscles in the medial compartment of the thigh crosses two joints, meaning it is able to both ADDUCT the thigh and FLEX the leg. Which muscle does this?
Gracilis
Origin of pectineus
Pecten pubis and superior ramus of pubis
Insertion of pectineus
Pectineal line running from the lesser trochanter toward the linea aspera
Innervation of pectineus
Femoral n.
Innervation of gracilis
Obturator n.
Action of gracilis
Leg flexion
Thigh adduction
Action of pectineus
Medial rotation of hip
Origin of adductor longus
Body and inferior ramus of pubis (same as gracilis)
Insertion of adductor longus
Almost whole length of linea aspera (in line with pectineus)
Innervation of adductor longus
Obturator n.
Origin of adductor brevis
Body and inferior ramus of pubis (same as adductor longus and gracilis)
Insertion of adductor brevis
Inferior part of pectineal line and superior part of linea aspera
Origin of adductor magnus
Ischiopubic ramus and ischial tuberosity
Insertion of adductor magnus
Linea aspera and adductor tubercle
Innervation of adductor magnus
Obturator n.
Tibial n.
[since portion originating from ischial tuberosity has same embryonic tissue as hamstring muscle and this is also innervated by tibial n.]
Origin of obturator externus
External surface of obturator membrane and surrounding margins of pubis and ischium
Insertion of obturator externus
Trochanteric fossa (passes posterior to neck of femur)
Action of obturator externus
Lateral rotation of the thigh
Holds head of femur in acetabulum
Muscle origin, insertion, action, and innervation:
Gracilis
Origin: body and inferior ramus of pubis
Insertion: medial surface of tibia inferior to tibial tuberosity (between insertions of sartorius and semitendinosus)
Action: flexion of leg and adduction of thigh
Innervation: obturator n.
Muscle origin, insertion, and innervation:
Pectineus
Origin: pecten pubis and superior ramus of pubis
Insertion: pectineal line running from the lesser trochanter toward the linea aspera
Innervation: femoral n.
Muscle origin, insertion, and innervation:
Adductor longus
Origin: body and inferior ramus of pubis
Insertion: almost whole length of linea aspera (in line with pectineus)
Innervation: obturator n.
Muscle origin, insertion, and innervation:
Adductor brevis
Origin: body and inferior ramus of pubis
Insertion: inferior part of pectineal line and superior part of linea aspera
Innervation: obturator n.
Muscle origin, insertion, and innervation:
Adductor magnus
Origin: ischiopubic ramus and ischial tuberosity
Insertion: linea aspera and adductor tubercle
Innervation: obturator n. and tibial n.
Muscle origin, insertion, and innervation:
Obturator externus
Origin: external surface of obturator membrane and surrounding margins of pubis and ischium
Insertion: trochanteric fossa (passes posterior to neck of femur)
Actions: lateral rotation of thigh, holds head of femur in acetabulum
Most fibers of the fascia lata are oriented horizontally, but which part has vertically oriented fibers?
Iliotibial tract (IT band)
The IT tract/band begins as an _________ of gluteus maximus and tensor fascia lata
Aponeurosis
There are 1-3 lymph nodes located medial to the femoral vein (either within the femoral canal or just inferior to it); what do these drain?
Drain lymph FROM deep structures of lower extremities, penile urethra, glans penis, and glans clitoris INTO external iliac nodes (adjacent to external iliac artery)
What makes up the boundaries of the femoral triangle?
Inguinal ligament
Medial border of sartorius
Lateral border of adductor longus
What 2 muscles make up the “floor” of the femoral triangle?
Pectineus m.
Iliopsoas m.
What two muscles come together to form the iliopsoas m.?
Iliacus
Psoas major
Other than the structures that make up the boundaries of the femoral triangle, what are its contents?
Femoral a. and all of its branches Femoral v. and all of its tributaries Femoral n. Lymphatics Femoral sheath
What is the femoral sheath?
Extraperitoneal areolar tissue that surrounds external iliac vessels in abdomen and extends into the anterior thigh, where it surrounds femoral vessels and some lymphatic vessels deep to the fascia lata
What are the 3 compartments of the femoral sheath and what do they contain?
Lateral - contains femoral a.
Middle - contains femoral v.
Medial (aka femoral canal) - contains some LNs and lymph vessels
Which compartment of the femoral sheath is continuous with the abdominal cavity via the femoral ring?
Medial compartment aka femoral canal
What is a potential pathology associated with the femoral canal?
Femoral hernia = abdominal viscera like small intestine protrudes through the femoral ring (superior opening of femoral canal)
3x more common in females due to differences in osteology of os coxae
The apex of the femoral triangle leads to a narrow, triangular-shaped intermuscular tunnel roughly 6 inches long. What are the 4 muscles that make up the 3 “walls” of this tunnel?
Vastus medialis (lateral wall) Adductor longus and adductor magnus (medial wall) Sartorius (roof)
Other than the walls that make up the apex of the femoral triangle, what are the contents of the intermuscular tunnel?
Femoral a. and veins
Saphenous a.
Saphenous n.
Nerve to vastus medialis
The femoral artery is continuous with what other artery after passing through the adductor hiatus at the inferior limit of the adductor canal?
Popliteal artery
The saphenous artery and nerve become cutaneous as they pass between which 2 muscles to the medial side of the knee?
Gracilis
Sartorius
The femoral a. is a continuation of what artery?
External iliac a.
The femoral artery enters the thigh beneath the ________ ligament, midway between the _______ ______ _____ and ______ _____
Inguinal
Anterior superior iliac spine
Pubic tubercle
What are the 4 named branches of the femoral artery?
External pudendal a.
Superficial circumflex iliac a.
Superficial epigastric a.
Profunda femoris a.
Which branch of the femoral artery supplies the lateral thigh?
Superior circumflex iliac a.
Which branch of the femoral a. supplies the anterior abdominal wall inferior to the umbilicus?
Superficial epigastric a.
Which branch of the femoral a. supplies the penis and scrotum in males, the vulva and lower vagina in females, and the lower half of the anal canal?
External pudendal a.
What are the branches of the profunda femoris (which is itself a branch of the femoral a.)?
2 circumflex branches (lateral and medial)
4 perforating arteries
The profunda femoris a., a branch of the femoral a., has 2 circumflex branches (lateral and medial), and 4 perforating arteries.
What do the 2 circumflex branches supply?
Hip joint and gluteal region
The profunda femoris a., a branch of the femoral a., has 2 circumflex branches (lateral and medial), and 4 perforating arteries.
What do the 4 perforating arteries supply?
Posterior and medial compartments of the thigh
