Medial Compartment of Thigh & Adductor Canal PDF

Medial compartment of thigh & adductor canal Dr Sapna Shevade, Asst Professor www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Describe the origin ,insertion, nerve supply and action of muscles of the medial comp...

Medial compartment of thigh & adductor canal Dr Sapna Shevade, Asst Professor www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Describe the origin ,insertion, nerve supply and action of muscles of the medial compartment of the thigh Describe the boundaries of the adductor canal List the contents of adductor canal Muscles of the adductor compartment Obturator externus Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis  Adductor Muscles Origin Obturator foramen Ischiopubic ramus Pectineal line of hip Ischial tuberosity 1. Adductor longus 2. Adductor brevis 6. Obturator externus 3. Adductor part of magnus 4. Gracilis Sciatic part of adductor magnus 5. Pectineus  All muscles are inserted into linea aspra except sciatic part of adductor magnus which is inserted into adductor tubercle of femur obturator externus into trochanteric fossa and gracilis medial to tibial tuberosity. Pectineus insertion on pectinate line of femur Nerve supply All the muscles are supplied by obturator nerve 2 mucles have double nerve supply ✓Pectineus : femoral nerve ✓Adductor magnus (sciatic part) :sciatic nerve Action ✓ All adductors : adduct the hip joint (thigh) ✓ All adductors : medially rotate the hip joint except obturator externus. ✓ Adductor magnus (sciatic part): has extra action which is extension of hip (thigh) ✓ Obturator externus : has extraction which is lateral rotation of the hip joint) Adductor magnus Hamstring part : posterior compartment of thigh Adductor part : medial compartment of thigh Adductor hiatus : opening in the distal attachment of the muscle Femoral artery & femoral vein pass through it to go posteriorly into the popliteal fossa Adductor canal (subsartorialcanal, Hunters canal) Intermuscular space in the middle third of the thigh Its is 15cm long Starts at the apex of the femoral triangle Ends at the lower end of adductor magnus (adductor hiatus) Boundaries : Anteriorly: sartorius. Posteriorly: adductor longus and magnus Laterally: vastus medialis Contents : from lateral to medial ( the femoral vein, femoral artery and the saphenous nerve  Contents : from lateral to medial ( the femoral vein, femoral artery and the saphenous nerve ✓Femoral vein & artery pass through adductor hiatus to the popliteal fossa ✓Saphenous nerve passes between sartorius & gracillis and becomes superficial to supply the skin of anteromedial aspect of knee,leg & foot. Does not pass through adductor hiatus References Netter’s Clinical Anatomy,4th Edition-2019,John T Hanson, Chapter 6,Page 291-366,ISBN 978-0-323-53188-7 https://www-clinicalkey-com.gmulibrary.com/#!/content/book/3- s2.0-B9780323531887000068 https://usmle-rx.scholarrx.com/rx-bricks/brick/CP_MUS0055 Back of thigh & popliteal fossa Dr Sapna S Objectives Describe the origin, insertion, action and nerve supply of the hamstring muscles. Describe, the boundaries and contents of the popliteal fossa. Hamstring muscles Semimembranosus Semitendinosus Biceps femoris Hamstring part of adductor magnus Semitendinosus Origin : ischial tuberosity Insertion: medial surface of upper tibia medial to tibial tuberosity Nerve supply :Sciatic nerve Action Flexes leg at knee joint. Extends thigh at hip joint. Medially rotates the leg  Semimembranosus Origin: ischial tuberosity Insertion: Groove on medial & posterior surface of medial tibial condyle Nerve supply: Sciatic Nerve Action Extends thigh at hip joint Flexes leg at knee joint. Medially rotates the leg M Biceps femoris Origin : Long head: ischial tuberosity. Short head: lateral lip of linea aspera. Insertion : head of fibula Nerve supply: Sciatic nerve Action: Extends thigh at hip joint. Flexes leg at knee joint. Laterally rotates the thigh and leg. Adductor magnus Origin : ischial tuberosity Insertion : linea aspera and adductor tubercle of femur Nerve supply : Sciatic nerve Action Adduction at the hip joint Medial rotation at the hip joint Flexion at the knee joint  Popliteal fossa Diamond-shaped space behind the knee joint Boundaries Upper part of the space Medially : the lower ends of the semitendinosus and semimembranosus muscles. Laterally : the lower end of the biceps femoris muscle.  Lower part of the space Medially: the medial head of the gastrocnemius muscle. Laterally: the plantaris muscle and the lateral head of the gastrocnemius muscle.  Floor Capsule of the knee joint. Back of lower femur. Back of upper tibia. Popliteus muscle.  Roof Skin. Superficial fascia which contains Small saphenous vein. Posterior cutaneous nerve of the thigh. Deep fascia which is continuous above with the fascia lata of the thigh.  Contents Popliteal artery Is the continuation of the femoral artery in the anterior compartment of thigh. It begins as the femoral artery passes through the adductor hiatus in the adductor magnus muscle. The popliteal artery appears behind the knee in the popliteal fossa on the upper medial side under the margin of the semimembranosus muscle..  Contents Popliteal artery It continues to enter the posterior compartment of leg where it ends in the leg by dividing into the anterior and posterior tibial arteries. The popliteal artery is the deepest structure in the popliteal fossa.  Popliteal vein It is formed by union of the venae commutants of the anterior and posterior tibial arteries at the lower border of the popliteus. The popliteal vein is superficial to the popliteal artery. It exits the popliteal fossa superiorly to become the femoral vein by passing through the adductor hiatus.  Nerves Tibial and common fibular nerves The tibial and common fibular nerves originate in the upper part of the popliteal fossa as the two major branches of the sciatic nerve. They enter the region from above under the margin of the biceps femoris muscle. They are the most superficial of the structures in the popliteal fossa. Popliteal lymph nodes References John Hansen. “Netter's Clinical Anatomy”,5th edition 2023. Chapter 6, 289-364 https://www-clinicalkey-com.gmulibrary.com/#!/content/book/3-s2.0- B9780323826624000060?scrollTo=%23hl0001992 Knee joint Synovial joint Modified hinge joint It is the site of articulation between the lower end of femur , the upper end of tibia and patella. The fibula is not involved in the knee joint Articular surface 2 femoro -tibial articulations (lateral and medial) between the lateral & the medial femoral and tibial condyles (weight bearing). One intermediate femoro-patellar articulation between the patella and the femur (allows the pull of the quadriceps femoris muscle to be directed anteriorly over the knee). Fibrous capsule Superiorly : Femoral condyles anteriorly. Femoral condyles & inter-condylar fossa of femur posteriorly Inferiorly : The articular margin of tibia, except where the tendon of the popliteus & ligamentum patellae crosses the bone.  Laterally: The articular capsule is deficient, to allow the tendon of popliteus to get out of the joint Anteriorly: The articular capsule is deficient because of the passage of ligamentum patellae.  Fibrous capsule is reinforced by muscles Anteriorly:By retinacula of vasti. Posteriorly:Biceps femoris laterally &semimembranosus and semi- tendinosus medially  Synovial membrane It lines the capsule It attaches to peripheral margins of patella and Edges of menisci. It separates cruciate ligaments from joint cavity they intra –capsular, extra-synovial.  Articular cartilages Hyaline cartilage covering the femoral condyles. Menisci: Semilunar plates of fibro-cartilage on the articular surface of the tibia. Stabilize joint & Shock absorber. Ends (horns) firmly attached to inter- condylar area of tibia. External margins attached to the synovial membrane.  Ligaments: Extrinsic Ligaments: Tibial collateral ligament: It is strong flat band. It extends from the medial epicondyle of femur to the medial surface of medial condyle of tibia. Its the deeper fibers are firmly attached to the medial meniscus. Fibular collateral ligament: It extends from the lateral epicondyle of the femur to the lateral surface of head of the fibula. It is separated from the lateral meniscus with the tendon of the popliteus muscle  Oblique popliteal ligament Is an expansion of the tendon of the semimembranosus that strengthen the fibrous capsule posteriorly. Arcuate popliteal ligament It extends from the posterior aspect head of the fibula over the popliteus to the posterior surface of the capsule of knee joint. The ligamentum patellae It is attached above to the lower border of the patella and below to the tuberosity of the tibia.  Intrinsic Ligaments: Anterior cruciate ligament: It extends from the anterior part of the inter-condylar area of the tibia>> extends superiorly, posteriorly and laterally >> to attach to posterior part of medial surface of lateral condyle of femur.  With the knee joint extended, it prevents the posterior displacement of the femur on the tibia. With the knee joint flexed, it prevents the anterior displacement of tibia.  Posterior cruciate ligament It extends from the posterior part of the inter -condylar area of the tibia >> extends superiorly, anteriorly and medially >> to attach to anterior part of the lateral surface of medial condyle of femur.  With the knee joint extended, it prevents the anterior displacement of the femur on the tibia. With the knee joint flexed, it prevents posterior displacement of the tibia  Anterior menisco -femoral ligament It arises from the posterior horn of the lateral meniscus to the medial condyle of the femur. It passes superiorly and medially in front of the posterior cruciate ligament  Posterior menisco -femoral ligament It attaches to the posterior horn of the lateral meniscus to the medial condyle of the femur. It crosses superiorly and medially behind the posterior cruciate ligament. Transverse ligament of knee joint: It joins the anterior edges of the 2 mensci Movements Flexion: The biceps femoris, semitendinosus, and semimembranosus muscles, assisted by the gracilis, sartorius, gastrocnemius, plantaris and popliteus muscles. Extension: Quadriceps assisted by tensor fascia lata Locking unlocking mechanism (inevitable rotation) : When standing, the knee joint is 'locked' into position, thereby reducing the amount of muscle work needed to maintain the standing position. It is done by medial rotation of the femur on the tibia at the end of extension (quadriceps femoris). Then to start flexion, the knee has to be unlocked through lateral rotation of femur on tibia (popliteus). Another feature that keeps the knee extended when standing is that the body's center of gravity is positioned anterior to the knee joint (due front convexity of the femur).  Blood supply : Nerve supply: The knee joint is innervated by branches from the obturator, femoral, tibial, and common fibular nerves.