Anatomy of the Femoral Triangle

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Questions and Answers

What forms the lateral boundary of the femoral triangle?

Sartorius muscle (correct)

Adductor longus muscle

Iliopsoas muscle

Pectineus muscle

Which structure is located medial to the femoral vein within the femoral triangle?

Deep inguinal lymph node (correct)

Fascia lata

Femoral artery

Iliopsoas muscle

Which muscle is NOT part of the floor of the femoral triangle?

Adductor longus muscle

Sartorius muscle (correct)

Pectineus muscle

Iliopsoas muscle

What does the term 'NAVEL' refer to in the context of the femoral triangle?

The contents arranged from medial to lateral Signup and view all the answers

Which component of the femoral sheath is occupied by the femoral artery?

Lateral compartment Signup and view all the answers

What are the primary actions performed by the Pectineus muscle?

Flexes, adducts, and medially rotates the thigh Signup and view all the answers

What anatomical feature distinguishes the adductor canal from the femoral triangle?

Passage of specific nerves and vessels Signup and view all the answers

Which nerve innervates the Iliopsoas muscle?

Femoral nerve and accessory obturator nerve Signup and view all the answers

The femoral sheath is approximately how many centimeters below the inguinal ligament?

3-4 cm Signup and view all the answers

Where does the Pectineus muscle attach proximally?

Superior pubic ramus Signup and view all the answers

Which structure is MOST likely to be obscured when viewing the femoral triangle?

Iliopsoas muscle Signup and view all the answers

What is the significance of the iliopsoas muscle's anatomy?

It connects to the vertebral column, pelvic bone, and femur. Signup and view all the answers

The adductor canal primarily serves to connect the femoral vessels to which area?

Popliteal fossa Signup and view all the answers

Which segment of the femoral sheath contains the deep inguinal lymph nodes?

Medial compartment Signup and view all the answers

Which of the following statements about the Adductor Canal is true?

The adductor hiatus is the opening through which the femoral vessels pass. Signup and view all the answers

What is the primary action of the Iliopsoas at the hip joint?

Flexion of the thigh Signup and view all the answers

Which muscle is considered the most medial in the anterior thigh compartment?

Pectineus Signup and view all the answers

In which population is the Psoas Minor typically found?

Approximately 60% of the population, usually unilaterally Signup and view all the answers

What is the primary role of the cribriform fascia in the femoral region?

It allows passage of the great saphenous vein and efferent lymphatic vessels. Signup and view all the answers

Which muscle attaches to the iliotibial tract?

Gluteus maximus Signup and view all the answers

Which structure is NOT part of the contents of the femoral triangle?

Saphenous vein Signup and view all the answers

The strongest intermuscular septum in the thigh is known as what?

Lateral intermuscular septum Signup and view all the answers

Which structure forms the floor of the femoral triangle?

Pectineus Signup and view all the answers

What is a clinical significance of knowing the femoral triangle's anatomy?

Preventing damage to the femoral nerve during hernia repairs. Signup and view all the answers

What is the primary compartment division of the thigh according to the intermuscular septae?

Anterior, medial, and posterior compartments. Signup and view all the answers

Which of the following statements about the femoral triangle is incorrect?

The femoral nerve is enclosed within the femoral sheath. Signup and view all the answers

The most common clinical procedure involving the femoral triangle is?

Femoral tap for arterial blood sampling Signup and view all the answers

What is the primary function of the deep fascia in the lower limbs?

Encircles the limb enhancing blood return during muscle contraction Signup and view all the answers

Which layer of fascia contains cutaneous nerves and superficial veins?

Subcutaneous tissue Signup and view all the answers

Which muscle is located inferior to the gluteus minimus?

Piriformis Signup and view all the answers

Which of the following fascia types characterizes the plantar aspect of the foot?

Plantar aponeurosis and interosseous fasciae Signup and view all the answers

What is the role of intermuscular septae in the lower limb?

They separate muscles with similar functions Signup and view all the answers

Which of the following statements about the gluteal muscles is incorrect?

The tensor fasciae latae is located posteriorly in the gluteal region. Signup and view all the answers

Which of the following muscles is NOT part of the triceps coxae?

Quadratus femoris Signup and view all the answers

What anatomical structure is primarily responsible for dividing the plantar aspect of the foot into compartments?

Plantar aponeurosis Signup and view all the answers

What is the primary action of the sartorius muscle?

Flexion, abduction, and lateral rotation of the thigh Signup and view all the answers

Which of the following correctly identifies the distal attachment of the sartorius muscle?

Superior part of the medial surface of the tibia Signup and view all the answers

Which head of the quadriceps femoris muscle is known as the 'kicking muscle' and crosses both the hip and knee joints?

Rectus femoris Signup and view all the answers

What is the role of the patellar ligament in the knee joint?

Encloses the patella and provides stability Signup and view all the answers

Which muscle is most directly responsible for knee extension?

Rectus femoris Signup and view all the answers

What is the primary nerve responsible for innervating the sartorius muscle?

Femoral nerve Signup and view all the answers

Which of the following statements about the vasti muscles is incorrect?

They originate from the anterior inferior iliac spine. Signup and view all the answers

What structure is formed by the convergence of the quadriceps femoris muscle heads?

Quadriceps tendon Signup and view all the answers

Which muscle is the largest and heaviest in the body?

Gluteus Maximus Signup and view all the answers

What is the primary action of the Gluteus Medius?

Abduction and medial rotation of the thigh Signup and view all the answers

Which nerve innervates the Gluteus Minimus?

Superior Gluteal nerve Signup and view all the answers

Which of the following muscles functions as a lateral rotator of the thigh?

Quadratus Femoris Signup and view all the answers

What role do the gluteus medius and minimus play when standing on one leg?

They keep the pelvis level on the supported side Signup and view all the answers

Where does the Gluteus Minimus attach distally?

Anterior surface of the greater trochanter of the femur Signup and view all the answers

Which of the following muscles is part of the deep layer of gluteal muscles?

Piriformis Signup and view all the answers

What is the purpose of gluteal bursae?

To separate muscles from adjacent structures and reduce friction Signup and view all the answers

Which of the following is NOT a function of the lower limbs?

To facilitate respiration Signup and view all the answers

Which region of the lower limbs contains the majority of the femur?

Femoral Region Signup and view all the answers

The term 'crus' refers specifically to which part of the lower limb?

The leg between the knee and ankle Signup and view all the answers

What anatomical features distinguish the knee region?

Prominences of the distal femur and proximal tibia Signup and view all the answers

Which of the following best describes the popliteal fossa?

A fat-filled hollow transmitting neurovascular structures Signup and view all the answers

Which anatomical landmarks define the boundary of the femoral region?

The inguinal region and the knee region Signup and view all the answers

Which statement about the ankle joint is correct?

It includes the medial and lateral malleoli Signup and view all the answers

The anatomical region known as the 'foot' consists of which of the following?

The tarsus, metatarsus, and phalanges Signup and view all the answers

What anatomical structure is located anterior to the distal end of the femur in the knee region?

The patella Signup and view all the answers

What is the primary action of the adductor longus muscle?

Adducts the thigh Signup and view all the answers

Which of the following is a characteristic feature of the gluteal region?

It extends laterally to the posterior margin of the greater trochanter Signup and view all the answers

Which muscle is NOT found in the pes anserinus?

Vastus medialis Signup and view all the answers

What distinguishes the adductor brevis muscle's position concerning the obturator nerve?

It is located between the anterior and posterior divisions of the obturator nerve Signup and view all the answers

Which statement correctly describes the function of obturator externus?

Laterally rotates the thigh Signup and view all the answers

What is a key factor that contributes to the stability of the hip joint?

More than half of the femoral head fits within the acetabulum Signup and view all the answers

Where is the distal attachment of the adductor longus muscle located?

Middle third of the linea aspera of femur Signup and view all the answers

What is the common distal attachment for the adductor longus, adductor brevis, and adductor minimus muscles?

Linea aspera of the femur Signup and view all the answers

Which of the following is true regarding the injection technique in the superolateral quadrant of the buttock?

It is a safe method for administering intramuscular injections. Signup and view all the answers

Which extrinsic ligament of the hip joint prevents excessive abduction?

Pubofemoral ligament Signup and view all the answers

What anatomical feature positions the adductor brevis in relation to the adductor longus?

It can be visualized only when the adductor longus is removed Signup and view all the answers

Which of the following muscles is primarily responsible for the goosefoot-like arrangement at the tibia's distal surface?

Gracilis Signup and view all the answers

What structure is located approximately 4 cm inferolaterally from the pubic tubercle?

Saphenous opening/hiatus Signup and view all the answers

What is a consequence of damage to the retinacular arteries supplied to the hip joint?

Avascular necrosis of the femoral head Signup and view all the answers

Which statement about the ischiofemoral ligament is correct?

It is the weakest of the major ligaments surrounding the hip joint. Signup and view all the answers

What technique involves using fingers to ensure a safe injection site in the hip region?

Forming a triangular area with the index and middle finger Signup and view all the answers

In relation to the femoral triangle, which component is most closely associated with the deep inguinal lymph nodes?

Femoral sheath Signup and view all the answers

Which of the following statements accurately describes the hip joint capsule?

It is reinforced by strong extracapsular ligaments. Signup and view all the answers

What is a significant aspect of the acetabulum concerning the stability of the hip joint?

It is enhanced by the acetabular labrum, deepening the socket. Signup and view all the answers

Which action is primarily performed by the piriformis muscle?

Abduction and lateral rotation of the thigh Signup and view all the answers

Which component is NOT part of the triceps coxae?

Gluteus medius Signup and view all the answers

What is the primary nerve supply to the inferior gemellus?

Nerve to quadratus femoris Signup and view all the answers

What occurs during a positive Trendelenburg test?

The pelvis on the unsupported side drops Signup and view all the answers

Which statement about the obturator internus is inaccurate?

It acts in abduction and medial rotation of the thigh Signup and view all the answers

Where does the quadratus femoris muscle attach proximally?

Lateral border of the ischial tuberosity Signup and view all the answers

Which of the following actions is associated with the gluteus medius muscle?

Medial rotation and abduction of the thigh Signup and view all the answers

What muscle primarily causes lateral rotation of the thigh?

Gluteus maximus Signup and view all the answers

Which of the following muscles is NOT a lateral rotator of the thigh?

Gluteus medius Signup and view all the answers

Which nerve supplies the piriformis muscle?

Nerve to piriformis Signup and view all the answers

What distinguishes the action of the gemelli muscles?

Abduction and lateral rotation of the thigh Signup and view all the answers

During which gait compensation does the patient lean away from the unsupported side?

Waddling gait Signup and view all the answers

What anatomical feature differentiates the roles of the superior and inferior gemelli?

Their innervation sources Signup and view all the answers

Study Notes

Femoral Triangle

Located in the upper third of the anterior thigh
Bounded superiorly by the inguinal ligament, laterally by the sartorius muscle, and medially by the adductor longus muscle
Floor formed by the pectineus muscle medially and the iliopsoas muscle laterally
Contains the femoral nerve, femoral artery, and femoral vein (lateral to medial)
The femoral vein is medial to the deep inguinal lymph node
The femoral vessels and deep inguinal lymph nodes are enclosed by the femoral sheath
The femoral sheath is a continuation of the transversalis and iliopsoas fascia from the abdomen

Femoral Sheath

Continuation of the transversalis fascia
Located approximately 3 to 4 cm below the inguinal ligament
Encloses only the femoral vessels and deep inguinal lymph nodes, not the femoral nerve.
Divided into three compartments:
- Lateral (contains femoral artery)
- Middle/Intermediate (contains femoral vein)
- Medial (contains the femoral canal and deep inguinal nodes)

Mnemonic for Femoral Triangle Contents

NAVEL (from lateral to medial)
- (Femoral) Nerve
- (Femoral) Artery
- (Femoral) Vein
- Empty Space
- Lymph Nodes

Adductor Canal

Also known as the Subsartorial or Hunter canal
Located in the middle third of the anterior thigh
Allows passage of the femoral vessels, saphenous nerve, and nerve to vastus medialis
Extends from the bisection of the adductor longus muscles and sartorius to the entrance of the femoral vessels into the adductor hiatus
Boundaries:
- Lateral: Vastus Medialis muscle
- Anteromedially: Sartorius
- Posteriorly: Adductor magnus and Adductor longus

Falciform Margin

Inferolateral presenting margin
Enclosed by the cribriform fascia

Cribriform Fascia

Derivative of the membranous layer of the superficial fascia
Allows passage of the great saphenous vein and its tributaries, as well as efferent lymphatic vessels

Intermuscular Septae

Invaginations in the thigh sent by the deep fascia
Divide the thigh into:
- Anterior compartment
- Medial compartment
- Posterior compartment

Iliotibial Tract

Lateral, longitudinal thickening of the fascia lata
Extends from the iliac tubercle to the lateral condyle of the tibia
Receives attachments of the tensor fascia latae and the gluteus maximus muscles

Boundaries of Femoral Triangle

Feature	Structure
Superior	Inguinal ligament
Medial	Adductor longus
Lateral	Sartorius
Floor	Medially: Pectineus; Laterally: Iliopsoas

Roof of Femoral Triangle

Contents (lateral to medial):
- Femoral nerve
- Femoral sheath:
  - Femoral artery (lateral compartment)
  - Femoral vein (middle/intermediate compartment)
  - Deep inguinal lymph nodes (medial to the femoral vein)

Clinical Significance of the Femoral Triangle

Understanding its contents is important for procedures like femoral hernia repair, nerve block, blood extraction, and vascular catheterization.
The area can be accessed for lymph node sampling to assess the spread of cancer.

Pectineus Muscle

Feature	Description
Proximal Attachment	Superior pubic ramus
Distal Attachment	Pectineal line of the femur
Nerve	Femoral nerve (L2, L3) and Accessory Obturator Nerves
Action	Flexes, adducts, and medially rotates the thigh

Iliopsoas Muscle

Chief flexor of the thigh at the hip joint
Arises from the posterior abdominal wall and attaches to the lesser trochanter of the femur
The only muscle with attachments to the vertebral column, pelvic bone, and femur
Combination of iliacus and psoas major
The abdominal cavity needs to be opened to see its origin

Table 11. OINA of the Iliopsoas Muscle

Muscle	Psoas Major	Psoas Minor	Iliacus
Proximal attachment	T12-L5 vertebrae and discs	T12-L1 vertebrae	Iliac crest, iliac fossa, sacrum, anterior sacro-iliac ligaments
Distal attachment	Lesser trochanter of the femur	Pectineal line	Lesser trochanter of the femur
Nerve	L1-L4 ventral rami	L1-L2 ventral rami	Femoral nerve (L2-L4)
Action	Flexes thigh at hip joint, laterally flexes vertebral column	Weakly flexes vertebral column	Flexes thigh at hip joint

Pectineus Muscle

Innervated by the femoral nerve (anterior part) and accessory obturator nerve (posterior part)
Considered transitional between the anterior and middle compartments of the thigh
Most medial muscle of the anterior thigh compartment
Adducts, flexes, and medially/internally rotates the thigh (FADIR)

Superficial Fascia

Subcutaneous tissue consisting of loose connective tissue, fat, cutaneous nerves, superficial veins, lymphatic vessels, and lymph nodes

Deep Fascia

Dense connective tissue that encircles the limb like a stocking
Improves blood return during muscle contraction
Types:
- Gluteal fascia (gluteal region)
- Fascia Lata (thigh)
- Crural fascia (leg)
- Dorsal fascia (foot)
- Plantar fascia (foot)
- Thickens to form aponeuroses and retinacula

Muscles of the Gluteal Region

Superficial Layer:
- Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Tensor Fasciae Latae
Deep Layer:
- Piriformis, Obturator Internus, Gemellus Superior, Gemellus Inferior, Quadratus Femoris

Gluteus Medius

Feature	Description
Proximal Attachment	External surface of the ilium between anterior and posterior gluteal lines
Distal Attachment	Lateral surface of the greater trochanter of the femur
Nerve	Superior Gluteal nerve (L5 and S1)
Action	Abduction and medial rotation of the thigh

Gluteus Minimus

Feature	Description
Proximal Attachment	External surface of the ilium between anterior and inferior gluteal lines
Distal Attachment	Anterior surface of the greater trochanter of the femur
Nerve	Superior Gluteal nerve (L4 and S1)
Action	Abduction and medial rotation of the thigh

Gluteus Maximus

Most superficial gluteal muscle
Largest and heaviest muscle in the body
Innervated by the inferior gluteal nerve
Covers other gluteal muscles except for the anterosuperior third of the gluteus medius
Gluteal bursae: membranous sacs that reduce friction between the gluteus maximus and adjacent structures

Tensor Fasciae Latae

Located on the anterolateral aspect of the thigh
Runs from the iliac crest to the lateral border of the patella

Sartorius Muscle

Longest muscle in the body
Runs obliquely from the anterior superior iliac spine to the upper section of the medial surface of the tibia
Crosses both the hip and knee joints
Proximal Attachment: Anterior superior iliac spine
Distal Attachment: Superior part of the medial surface of the tibia
Nerve: Femoral nerve (L2, L3)
Action:
- Flexion, abduction, and lateral rotation of the thigh at the hip joint
- Flexes leg at knee joint (medial rotating leg when knee is flexed)

Quadriceps Femoris Muscle

Chief extensor of the leg
Consists of four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius
Rectus Femoris: Crosses both the hip and knee joints, acting as a kicker muscle
3 Vasti Muscles: Act as primary knee extensors

Adductor Canal

Opening in the aponeurotic distal attachment of the adductor magnus
The femoral vessels change their name to popliteal vessels once they pass through the adductor hiatus

Intragluteal Injections

Safe areas:
- Superolateral quadrant of the buttock
- Superior to the line extending from the PSIS and to the superior border of the greater trochanter
- Anterolateral part of the thigh
- Triangular area between the index finger directed to the ASIS and middle finger spread posteriorly until the iliac tubercle

Hip Joint

Ball and socket joint allowing movement in three axes (Circumduction)
Articular surfaces: Head of the femur (Ball) and Acetabulum of the hip bone (Socket)
Stable joint due to:
- Deep acetabulum
- Strong extracapsular ligaments
- Thickened joint capsule
Supplied by the Medial and Lateral femoral circumflex arteries

Extracapsular Ligaments of the Hip Joint

Iliofemoral:
- Strongest ligament in the body
- Reinforces the hip joint anterosuperiorly
Pubofemoral:
- Reinforces the hip joint inferomedially
- Prevents over abduction
Ischiofemoral:
- Reinforces the hip joint posteriorly
- Prevents hyperextension
Weakest ligament: Ischiofemoral

Fascia of the Femoral Region

The Saphenous Opening (Fossa Ovalis) is an opening in the fascia lata located 4 cm inferolaterally from the pubic tubercle.
Damage to arteries in this region can lead to avascular necrosis of the femoral head, especially in cases of ephemeral neck fracture.

Medial Thigh Muscles

The medial thigh muscles include the adductor longus, adductor brevis, adductor minimus, gracilis, and obturator externus.
These muscles are supplied by the obturator nerve.
They function in adduction and medial/internal rotation of the thigh, except for the obturator externus which laterally rotates the thigh.

Adductor Longus

The adductor longus is a horseback-riding muscle, meaning it contracts actively during horseback riding.
It attaches proximally to the body of the pubis inferior to the pubic crest and distally to the middle third of the linea aspera of the femur.

Adductor Brevis

The adductor brevis is located between the anterior and posterior divisions of the obturator nerve.
It attaches proximally to the upper anterior part of the adductor magnus.
It is supplied by the obturator nerve, like other muscles of the medial thigh compartment.

Piriformis Muscle

The piriformis muscle attaches proximally to the anterior surface of the 2nd to 4th sacral segments and the superior margin of the greater sciatic notch, and distally to the sacrotuberous ligament, superior border of the greater trochanter of femur, and branches of the anterior rami of S1 and S2.
It functions in abduction and lateral rotation of the thigh.

Triceps Coxae

The triceps coxae is a group of muscles occupying the gap between the piriformis and quadratus femoris muscles.
All gluteal muscles are lateral rotators of the thigh, except for the gluteus medius, gluteus minimus, and tensor fasciae latae.
It consists of the obturator internus, superior gemellus, and inferior gemellus.

Superior/Inferior Gemellus

The superior gemellus attaches proximally to the ischial spine and the inferior gemellus attaches to the ischial tuberosity.
Both muscles attach distally to the medial surface of the greater trochanter (trochanteric fossa) of the femur.
The superior gemellus is supplied by the nerve to the obturator internus, and the inferior gemellus is supplied by the nerve to the quadratus femoris.
Both muscles function in abduction and lateral rotation of the thigh.

Obturator Internus

The obturator internus attaches proximally to the pelvic surface of ilium and ischium, and the obturator membrane, and distally to the medial surface of the greater trochanter (trochanteric fossa) of the femur.
It is supplied by the nerve to obturator internus (L5-S2).
It functions in abduction and lateral rotation of the thigh.

Quadratus Femoris

The quadratus femoris attaches proximally to the lateral border of the ischial tuberosity, and distally to the quadrate tubercle on the intertrochanteric crest of the femur and the area inferior to it.
It is supplied by the nerve to the quadratus femoris.
It functions in abduction and lateral rotation of the thigh.

Trendelenburg Test

The Trendelenburg Test is used to assess hip dysfunction by observing pelvic movement during single-leg stance.
A positive Trendelenburg Test indicates weakness, non-functionality, or paralysis of the gluteus medius and minimus on the supported side, typically due to a lesion involving the superior gluteal nerve, fracture of the greater trochanter, or dislocation of the hip joint.
A negative test shows stability with the pelvis remaining level during single-leg stance.
Gait compensations in cases of hip injury or weakness include a waddling gait, steppage gait, and swing-out gait.

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Description

This quiz delves into the anatomical structures and relationships within the femoral triangle. It covers aspects such as the boundaries, contents, and the significance of related muscles. Perfect for students studying anatomy or preparing for medical examinations.