Download Anterior and Medial Thigh

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Anterior and Medial Thigh
I.
Cutaneous structures
A. vessels - arteries here are relatively short
1. superficial epigastric artery and vein
a. supplies the lower abdominal wall
b. the artery is a branch of the femoral artery
c. the vein empties into the greater saphenous vein
2. superficial circumflex iliac artery and vein
a. supplies the upper lateral aspect of the thigh
b. the artery is a branch of the femoral artery
c. the vein empties into the greater saphenous vein
3. superficial and deep external pudendal arteries and veins
a. supply the integument (skin, hair) of the genitalia
b. the artery is a branch of the femoral artery
c. the vein empties into the greater saphenous vein
4. greater saphenous vein
a. begins and passes anterior to the medial malleolus of the tibia and up the
medial side of the lower leg
b. it then passes posterior to the medial tibial condyle at the knee
c. then ascends the medial thigh to pass into the saphenous opening (hiatus)
and empties into the femoral vein
d. it receives many tributaries along its course
B. cutaneous nerves
1. dermatome charts differ and spinal cord segments overlap in their distribution
a. L1 is over the inguinal ligament
b. L4 is over the patella
2. peripheral cutaneous nerves
a. lateral femoral cutaneous nerve
(1) enters the thigh by passing deep to the lateral end of the inguinal
ligament, over the sartorius muscle, then pierces fascia lata
(2) it supplies the anterolateral surface of the thigh down to the knee
(3) it is a branch of the lumbar plexus; posterior division (L2 & L3)
b. anterior femoral cutaneous nerve
(1) branches of the femoral nerve to the anterior and medial thigh (L2 & L3)
(2) it may has intermediate and medial branches
C. lymph drainage
1. tends to follow venous drainage
2. superficial inguinal nodes drain into the deep inguinal nodes, the into the
external iliac nodes
3. the skin and superficial fascia from the lower abdomen, gluteal region, and
external genitalia send lymph to the superficial inguinal nodes.
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II.
Deep structures
A. deep fascia of the thigh - fascia lata
1. attached above to the pubic bone, inguinal ligament, iliac crest, back of sacrum,
sacrotuberous ligament, ischial tuberosity, and ischiopubic ramus
B. femoral triangle and its contents
1. boundaries
a. above - inguinal ligament
b. lateral - medial border of the sartorius muscle
c. medial - medial border of the adductor longus muscle (some use lateral)
2. roof of the triangle is the fascia lata and the floor is the iliopsoas and pectineus
covered by their fascias
3. contents
a. femoral nerve and its terminal branches
b. femoral artery and vein and their major branches
c. deep inguinal lymph nodes
d. femoral sheath
4. femoral sheath is a downward extension of the transversalis fascia of the
abdomen covering the upper portions of the femoral vessels
a. attached above to the inguinal ligament, lacunar ligament, and the fascias of
iliopsoas and pectineus muscles
b. from lateral to medial there are three compartments
(1) femoral artery
(2) femoral vein
(3) femoral canal containing a lymph node and lymph vessels
(a) femoral hernias pass through the femoral canal and appear as a
swelling at the saphenous hiatus
c. the femoral nerve is not in the femoral sheath
d. the sheath is not attached to the femoral vessels above, but it does fuse to them
about 3 - 4 cm below the inguinal ligament
III.
Anterior osteofascial compartment
A. bounded by the fascia lata and the medial and lateral intermuscular septa and
extending from the pelvis above to the tibia below
B. all muscles are supplied by branches of the femoral nerve (L2, 3 & 4)and vessels
1. muscles
a. sartorius muscle
(1) arises from the anterior superior iliac spine
(2) inserts below to the medial tibial condyle as part of the pes anserinus
(made of its and the tendons of the gracilis and semitendinous muscles)
(3) flexes the thigh and rotates it laterally; flexes the leg
b. quadraceps femoris muscle
(1) arises by four heads
(2) all four heads converge or insert on the patella, then
(a) insertion is through the patellar ligament onto the tibial tuberosity
and retinacula to the tibial condyles
(b) the patella is a sesamoid bone
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(3) rectus femoris muscle #1
(a) arises by a straight head from the anterior inferior iliac spine and a
reflected head from just above the acetabulum
(b) it crosses the hip joint and helps to flex it
(4) vastus lateralis muscle #2
(a) arises from the upper end of the femur, the lateral lip of the linea
aspera, and the lateral intermuscular septum
(5) vastus intermedius muscle #3
(a) arises from almost the entire circumference of the femur except the
linea aspera
(6) vastus medialis muscle #4
(a) arises from the medial lip of the linea aspera and the medial
intermuscular septum
(b) the most inferior fibers extend to a lower level than those of the
vastus lateralis muscle and are more horizontal
(7) quadraceps femoris muscles are the primary extensor of leg at the knee
C. adductor (subsartorial) canal begins at the apex of the femoral triangle and ends
where the femoral vessels enter the hiatus in the adductor magnus muscle
1. contents
a. femoral vessels
b. saphenous nerve
c. nerve to the vastus medialis muscle
D. the artery of the anterior compartment is the femoral artery
1. in the femoral triangle, it gives off some small and large named arteries and
some muscular branches
2. small named arteries are found in the superficial fascia and go to the skin
a. superficial epigastric artery - goes to the umbilicus
b. superficial circumflex iliac artery - goes toward the gluteal region
c. superficial and deep external pudendal artery - goes toward the external
genital region
3. large arteries
a. lateral femoral circumflex artery - usually a branch of the deep femoral
artery, but may be a branch from the femoral artery. Has three branches.
(1) ascending branch - passes above the greater trochanter of the femur to
enter the gluteal region
(2) transverse branch - passes below and lateral to the greater trochanter
(3) descending branch - accompanies the nerve to the vastus lateralis into
the muscle, supplying it and descending to the knee
b. medial femoral circumflex artery - usually a branch of the deep femoral
artery but may be a branch from the femoral artery.
(1) it always passes between the iliopsoas and pectineus muscles
(a) ascending branch - appears in the gluteal region above the quadratus
femoris muscle
(b) transverse branch - appears in back of the thigh between the
quadratus femoris and adductor magnus muscles
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E. the nerve of the anterior compartment is the femoral nerve (L2, 3, 4)
1. in the femoral triangle, the nerve divides into many branches
a. nerve to the pectineus muscle - passes behind the femoral vessels
b. nerve to the vastus lateralis muscle - accompanies the descending branch of
the lateral femoral circumflex artery
c. nerve to the sartorius muscle - usually multiple and some may continue as
anterior femoral cutaneous nerves
d. nerve to the rectus femoris muscle
e. nerve to the vastus intermedius muscle
f. nerve to the vastus medialis muscle - travels with the saphenous nerve in
in the adductor canal some distance before entering the muscle
g. saphenous nerve - a sensory nerve to the medial side of the leg and foot
(1) it gives off the infrapatellar branch which pierces the sartorius muscle
(2) in the superficial fascia it accompanies the greater saphenous vein
2. the hip and knee joints are supplied by the femoral nerve via muscular branches
IV.
Medial osteofascial compartment
A. bounded by the fascia lata, medial and posterior intermuscular septa
B. begins above from the pubis and ischium and ends at the linea aspera or its upper
and lower extensions
C. it is also called the adductor compartment
D. deep femoral artery and obturator nerve (L2, 3, 4) are major the suppliers of this
compartment
E. muscles
1. pectineus muscle
a. arises from the upper surface of the superior ramus of the pubic bone
b. inserts on the pectineal line below the lesser trochanter of the femur
c. flexes the hip joint and medially rotates and adducts the thigh
d. innervation - mostly by a branch of the femoral nerve or if present, the
accessory obturator nerve
2. adductor longus muscle
a. arises from the pubis
b. inserts on the middle third of the linea aspera
c. adducts and medially rotates the thigh
d. innervation – anterior branch of the obturator nerve
3. adductor brevis muscle
a. lies in a plane posterior to the previous two muscles and anterior to the
adductor magnus muscle
b. arises from the inferior pubic ramus
c. inserts on the linea aspera, proximal to the adductor longus muscle insertion
d. adducts and medially rotates the thigh
e. innervation – anterior or posterior branch of the obturator nerve
4. adductor magnus muscle
a. arises from the ischiopubic ramus back to the ischial tuberosity adjacent to the
origin of the hamstring muscles
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b. inserts along the entire back of the shaft of the femur down to the adductor
tubercle that is on the medial supracondylar line
c. the adductor magnus is divided into two parts
(1) the upper fibers are horizontal - from pubic ramus
(a) adducts, medially rotates and assists in flexing the thigh
(b) innervated by posterior division of the obturator nerve (L3 & 4)
(2) the lower fibers become more vertical - from ischial ramus
(a) derived from flexor hamstring muscles
(b) adducts, laterally rotates ,and extends the thigh
(c) innervated by tibial division of the sciatic nerve
5. obturator externus muscle
a. it covers the outer surface of the anterior wall of the pelvis
b. arises from the pubic rami, ischial ramus, and 2/3 of obturator membrane
c. it passes beneath the hip joint capsule
d. inserts in the trochanteric fossa of the femur
e. it is a lateral rotator of the thigh
6. gracilis muscle
a. arises from the margin of the pubis and inferior pubic ramus
b. inserts with the sartorius muscle below the medial tibial condyle as part of the
pes anserinus
c. adducts the thigh and assists in flexion of the leg at the knee
d. innervation – anterior branch of the obturator nerve
F. the adductor or medial compartment receives blood from several sources
1. obturator artery - supplies the areas adjacent to the origins of the muscles
2. femoral, medial femoral circumflex, and deep femoral arteries all contribute
to the compartment
3. deep femoral artery - runs deep to the adductor longus muscle and sends three or
four perforating branches and muscular branches
G. obturator nerve - supplies all medial compartment muscles
1. the major supply to the pectineus muscle is the femoral nerve or accessory
obturator nerve (if present)
2. the adductor magnus muscle frequently receives axons from the sciatic nerve
3. the obturator nerve has anterior and posterior branches
a. anterior branch
(1) lies on the surface of the adductor brevis
(2) it supplies the adductor longus, adductor brevis, and gracilis muscles
b. posterior branch
(1) lies on the posterior surface of the adductor brevis muscle
(2) it supplies the obturator externus and adductor magnus (upper portion)
muscles: supplies the adductor brevis muscle if anterior branch doesn't
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