Download DEEP FASCIA OF THIGH

DEEP FASCIA OF THIGH
ILIOTIBIAL TRACT AND SAPHENOUS
OPENING
Learning objectives
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Know the arrangement of deep fascia in thigh and how the iliotibial tract
participates in walking and running
Understand the location of saphenous opening and its relations
Clinical application of the topic
Lecture outlines
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Fascia of thigh
Deep fascia of the thigh (fascia lata)
Iliotibial tract
Fascial compartments of the thigh
Anterior compartment of thigh
Medial compartment of thigh
Posterior compartment of thigh
Superficial veins
Saphenous opening
Applied aspect
Fascia of thigh
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The subcutaneous tissue of the hip & thigh is continuous with that of the inferior
abdominal wall and buttock.
At the knee the subcutaneous tissue loses its fat and blends with the deep fascia
Deep fascia: strong & inelastic; it limits outward expansion of the contracting
musculature, the increased pressure “pumps” the blood proximally through the
veins.
Deep fascia of the thigh (fascia lata)
The fascia lata attaches to and is continuous with:
1. inguinal ligament, pubic arch, body of the pubis and pubic tubercle.
2. scarpa’s fascia of the inferior abdominal wall attaches to deep fascia inferior to the
inguinal ligament.
3. Iliac crest (lateral & posterior).
4. Sacrum, coccyx, sacrotuberous ligament, ischial tuberosity postreiorly.
5. Exposed parts of bones at the knee & deep fascia of the leg.
DEEP FASCIA (FASCIA LATA)
(1) Encloses the thigh
(2) Upper end is attached to pelvis and its ligaments
(3) Laterally thickened called ILIOTIBIAL TRACT
(a) Above attached to iliac tubercle
(b) Below to lateral condyle of tibia
(c) Receives insertion of tensor fascia lata and gluteus Maximus
(4) Saphenous opening just below inguinal ligament.
Filled with loose C.T. called cribriform fascia
Transmits saphenous. Vein
ILIOTIBIAL TRACT
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Thickening of the fascia lata that commences at the level of the greater
trochanter,where 3/4th of gluteus maximus and tensor fascia lata are inserted in to
it
Passes vertically downward along the posterolateral aspect of thigh and is
inserted to the lateral condyle of tibia
When knee is straight the tract maintains the knee in extended position
It is particularly in action when the slightly flexed knee is bearing the weight of
the body.thus it is in constant in use during walking and running
In rising from the sitting position gluteus maximus extends the hip and then,as the
knee is extendedby quadriceps, the iliotibial tract operates to assist quadriceps
In leaning forward with the knee slightly flexed it provide the only antigravity
force supporting the knee joint
FASCIAL COMPARTMENTS OF THE THIGH
3 septa from deep fascia to linea aspera
So thigh is divided into 3 compartments
(1) Ant.
(2) Medial
(3) Posterior
Each compartment has its own nerve and blood supply
Anterior compartmentExtensors of the knee
Femoral Nerve
lateral
medial
femur
Medial compartmentAdductors of the knee
Obturator Nerve
Posterior
compartmentFlexors of the
knee
Sciatic Nerve
ANTERIOR COMPARTMENT OF THIGH
MUSCLES
(1) Sartorius
(2) Iliacus
(3) Psoas
(4) Pectineus
(5) Quadriceps femoris
ARTERY; Femoral artery
NERVE: Femoral nerve
MEDIAL COMPARTMENT OF THIGH
MUSCLES
1) Gracilis
2) Adductor longus
3) Add. Brevis
4) Add. Magnus
5) Obturator externus
ARTERY: Profunda A. + Obturator A.
NERVE: Obturator N.
POSTERIOR COMPARTMENT OF THIGH
MUSCLES
1) Biceps femoris
2) Semitendinosus
3) Semimembranosus
4) Small part of Add. Magnus
ARTERY: Profunda A.
NERVE: Sciatic N
SUPERFICIAL VEINS
Great saphenous:
• Formed by the union of the dorsal digital vein of the great toe and the dorsal
venous arch.
• Ascends anterior to the medial malleolus, posterior to the medial condyle of the
femur. It freely communicates with the small saphenous vein.
• Proximally it traverses the saphenous opening in the fascia to enter the femoral
vein.
SAPHENOUS OPENING
• An oval 2 cm long gap in fascia lata infero-lateral to the inguinal ligament,3 cm
below and lateral to the pubic tubercle.
• Medial margin is smooth
• Lateral margin is sharp forming the falciform margin
• Cribiform fascia – a sieve like membrane covering the saphenous opening which
is perforated by great saphenous vein, two small arteries and numerous lymphatic
vessels
APPLIED ASPECT
• Femoral hernia
• Compartment syndrome
• Varicosities in superficial veins of thigh