Lecture 45 - Thigh Flashcards
Lower limb is specialized for
locomotion and weight bearing
4 parts of lower limb:
Gluteal region
Thigh
Leg
Foot
femur facts
• Femur is directed inferomedially
• Longest and heaviest bone
• about ¼ of a persons height
• Consist of a proximal and a distal epiphysis, a neck and a shaft
• Proximal epiphysis
Head - projects superomedially and slightly anteriorly
• Articulates with the acetabulum
• Head connected to the shaft through the neck at about 126 degree angle - angle of inclination
•Angle widest at birth (140 degrees) and diminishes with age (narrowest in old age - 110 degrees).
• Angle less in females than males because females have wider hips
•Other features:
Greater and lesser trochanters
Intertrochanteric line anteriorly
intertrochanteric crest posteriorly
linea aspera
Medial and lateral epicondyles
Medial and lateral condyles
Intercondylar fossa
Popliteal surface
superficial fascia of thigh
• Lies deep to the skin
• Continuous with the abdominal fascia
• In the thigh contains considerable amount of fat
-Nerves in this area: Subcostal (T12); Iliohypogastric (L1); ilioinguinal (L1); genitofemoral (L1-L2); lateralfemoral cutaneous (L2-L3); femoral (L2-L4); Lumbosacral trunk (L4-L5); Obturator (L2-L4); Accessory Obturator (L3-L4)
Subcostal levels
(T12);
Iliohypogastric levels
(L1);
ilioinguinal levels
(L1);
genitofemoral levels
-(L1-L2);
lateralfemoral cutaneous levels
(L2-L3);
femoral levels
(L2-L4);
Lumbosacral trunk levels
(L4-L5);
Obturator levels
(L2-L4);
Accessory Obturator levels
(L3-L4)
Genital branches of the genitofemoral and ilioinguinal nerves supply?
-cutaneous nerves
• emerge from the superficial ring to supply the proximal medial thigh
• Most of the branches go to the genital region
Femoral branch of genitofemoral
-cutaneous nerves
• Supplies the skin over the femoral triangle (proximal part of the anterior thigh)
Medial cutaneous branch of femoral
-cutaneous nerves
• Supplies the skin of the medial thigh
Intermediate cutaneous branch of femoral
-cutaneous nerves
• Supplies the skin of the distal anterior thigh
Lateral femoral cutaneous nerve
-cutaneous nerves
L2-L3
• Enters the thigh medial to ASIS
• Supplies the lateral thigh, lateral to the intermediate cutaneous branch of the femoral nerve
Posterior femoral cutaneous nerve
-cutaneous nerves
-S1-S3
• Supplies the posterior thigh and popliteal region
• Originates from the sacral plexus
• Courses inferiorly into the thigh from the gluteal region
Superficial vessels are where?
Lie in the superficial fascia, immediately below the skin
Superficial epigastric a
- from proximal part of femoral a
- Proceeds superiorly to provide the skin over the lower abdominal wall
Superficial circumflex iliac a
- from proximal part of femoral a
- Proceeds laterally inferior to the inguinal ligament
- Parallels the course of the deep circumflex iliac a
Superficial external pudendal a
-from proximal part of femoral a
Deep external pudendal a
-from proximal part of femoral a
Great saphenous v
- Begins in the foot and ascends to its termination at the proximal part of the thigh
- Located in the superficial fascia
- Has valves; more numerous in the leg
- Enters the thigh by passing posterior to the medial condyle of the femur
- Traverses the saphenous opening in the fascia lata to empty into the femoral vein
- Receives numerous tributaries in the thigh and the leg
Deep fascia (Fascia lata) function and what is it?
- Prevents bulging of muscles
- A dense layer of connective tissue between the muscles of the thigh and the superficial fascia
- It is very strong along the anterior and lateral parts of the thigh
Iliotibial tract (band) is made from what?
thickening of the deep fascia (Fascia lata)
Fascia lata attachments
SUPERIORLY: • Inguinal ligament • Parts of the hip bone (Pubic bone, iliac crest, Ischial tuberosity) • Sacrum and coccyx • Scarpa’s fascia and the sacrotuberous ligament
INFERIORLY: knee joint it is continuous with the crural fascia
what divides the thigh into compartments?
Deep fascia (Facia lata) -lateral, medial, posterior intermuscular septa -all attach commn point at the linea aspera (ant medial post compartments)
Anterior compartment muscles
- Flexors of the hip and extensors of the knee
- Nerve of the compartment=Femoral Nerve
1. Sartorius m
2. rectus femoris m
3. vastus lateralis m
4. vastus medialis m
5. vastus intermedius m
6. articularis genu m
7. psoas major m
8. iliacus m
9. tensor fascia latae m
Sartorius m
- Anterior compartment muscle
- ASIS –> medial side of tibia
- Supplied by femoral n
- crosses hip and knee joints (actions on those joint)
rectus femoris m
- Anterior compartment muscle
- Quadriceps femoris
- Anterior inferior iliac spine - tendon attaches to patella and patellar ligament goes from patella to tibial tuberosity
- Supplied by femoral n
vastus lateralis m
- Anterior compartment muscle
- Quadriceps femoris
- linea aspera - tendon attaches to patella and patellar ligament goes from patella to tibial tuberosity
- Supplied by femoral n
vastus intermedius m
- Anterior compartment muscle
- Quadriceps femoris
- body of femur - tendon attaches to patella and patellar ligament goes from patella to tibial tuberosity
- Supplied by femoral n
articularis genu m
- Anterior compartment muscle
- Anterior part of the femur – synovial membrane of knee
- not much function with this guy –> pulls up on synovial membrane so it doesnt get caught up in knee actions
- Supplied by femoral n
psoas major m
- Anterior compartment muscle
- iliopsoas
- Lumbar vertebrae – Lesser trochanter of femur
- Supplied by femoral n
liacus m
- Anterior compartment muscle
- iliopsoas
- Iliac crest and fossa – Leser trochanter of femur
- Supplied by femoral n
tensor fascia latae m
-Anterior compartment muscle
-Anterior superior iliac spine – iliotibial
tract
-Supplied by femoral n
vastus medialis m
- Anterior compartment muscle
- Quadriceps femoris
- linea aspera - tendon attaches to patella and patellar ligament goes from patella to tibial tuberosity
- Supplied by femoral n
Medial Compartment muscles
- Adductor group
- Nerve of the compartment=Obturator nerve
1. pectineus m
2. adductor longus m
3. adductor brevis m
4. adductor magnus m (adductor parts & hamstring part)
5. gracilis m
6. obturator externus m
obturator externus m
- Medial Compartment muscle
- Margins of obturator foramen and obturator membrane – Trochanteric fossa of femur
- innervated by obturator n
gracilis m
- Medial Compartment muscle
- inferior ramus of pubis – superior part of medial surface of tibia
- innervated by obturator n
adductor magnus m
- Medial Compartment muscle
1. Adductor part: - Ischiopubic ramus – linea aspera
- supplied by obturator nerve
2. Hamstring part: - Ischial tuberosity – adductor tubercle of femur
- supplied by Tibial nerve
adductor brevis m
- Medial Compartment muscle
- inferior ramus of pubic bone – linea aspera
- innervated by obturator n
adductor longus m
- Medial Compartment muscle
- body of pubic bone – linea aspera
- innervated by obturator n
pectineus m
- Medial Compartment muscle
- Superior ramus of pubis – pectineal line of femur
- *-Innervated by femoral and obturator nerves**
Posterior compartment muscles
- Hamstring muscles (except the short head of biceps femoris)
- Act on two joints – extend hip and flex knee
- Originate from Ischial Tuberosity
- Nerve of compartment - Tibial nerve
1. biceps femoris m (long and short head)
2. semitendinosus m
3. semimembranosus m
biceps femoris m
- Posterior compartment muscle
1. Long head: - Ischial tuberosity – Fibular head
- Innervated by tibial nerve
2. Short head: - Linea aspera – Fibular head
- nnervated by the common peroneal nerve
semitendinosus m
- Posterior compartment muscle
- Ischial tuberosity – Medial surface of upper tibia
semimembranosus m
- Posterior compartment muscle
- Ischial tuberosity – medial tibial condyle
Femoral Triangle boundaries:
- Superior - inguinal ligament
- Medial - medial border of adductor longs
- Lateral - medial border of sartorial
- Base – inguinal ligament
- Apex - where the sartorius crosses the adductor longs
- Roof - fascia lata
- Floor - iliopsoas and pectineus muscles
Femoral Triangle contents
- femoral artery and branches
- femoral vein and branches
- femoral nerve and branches
- lymphatic vessels and nodes
- Femoral sheath -Funnel-shaped fascial tube; 3 compartments: Lateral; Intermediate; Medial – femoral canal
Adductor canal (Subsartorial, Hunter’s canal)
- About 15 cm long
* Extend from the apex of the femoral triangle to the adductor hiatus in the adductor magnus muscle
Adductor canal -boundaries and contents:
a. Boundaries
• Anteromedial - sartorius
• Lateral - vastus medialis
• Posterior - adductor longus and magnus
b. Contents
• femoral artery (lateral side) and vein (medial side)
• Saphenous nerve (femoral branch - sensory)
• Nerve to vastus medialis (branch of femoral - motor)
Femoral nerve
- (L2, L3, L4)
- The largest branch of the lumbar plexus
- Travels deep to the inguinal ligament to enter the femoral triangle
- Unlike the femoral artery and vein it is not enclosed by the femoral sheath
- Lies lateral to the femoral artery
- Breaks up into sensory and motor branches while still in the triangle
femoral Sensory branches
- Medial femoral cutaneous nerve
- Intermediate femoral cutaneous nerve
- Saphenous nerve: Travels through the adductor canal; It leaves the canal at its lower end to innervate the skin of the leg and foot
femoral Motor branches to muscles:
- Sartorius
- Quadriceps femoris
- Articularis genu
- Pectineus - This muscle also gets a branch from the obturator nerve
Obturator nerve
- Divides into an anterior and a posterior division in the obturator foramen
1. Anterior division - Located between adductor longus and brevis
- Supplies adductor longus, gracilis, adductor brevis and part of pectineus
2. Posterior division - Located between adductor brevis and magnus
- Supplies obturator externus, adductor brevis and adductor magnus
Femoral a
- Continuation of the external iliac artery
- Enters the thigh by passing below the inguinal ligament, lateral to the femoral vein
- gives of the profunda (or deep) femoral a (largest branch)–> branches into lateral and medial femoral circumlfex= these anastamose
- goes through adductor canal
- last branch before crossing the knee is the descending genicular (genicular=knee)
- goes through adductor hiatus and ends up behind the knee joint
nerve that sometimes passes through the piriformis muscle:
common peroneal?
the plexeses are all from the
ventral rami
sartorius, gracilis, and semitendinosus form the:
s insirinus???? SP!! – looks like a birds foot or something weird like that
transversalis fascia of abdomen forms sheeth around
- femoral artery and vein and femoral canal (sometimes has lymphatics)
- NOT THE NERVE
adductor brevis muscle has what nerve passing anteriorly and posteriorly?
the obturator nerve splits to pass ant and posteriorly
profunda femoral a branches
- later and medial femoral circumflex–> anastamose together
- ascending descending (ends in the knee joint) and transverse branches
- 4 perforating branches = supply BACK of the thing
what artery supplies the back of the thigh?
-4 perforating branches = supply BACK of the thing
