Medial Thigh Compartment 2024 PDF

The medial thigh  Outline Revision The muscles of the medial thigh. The adductor canal & hiatus The neural structures of the region The blood supply and venous drainage of the region. Some common clinical presentations  Aims To study: – The muscles, the...

The medial thigh  Outline Revision The muscles of the medial thigh. The adductor canal & hiatus The neural structures of the region The blood supply and venous drainage of the region. Some common clinical presentations  Aims To study: – The muscles, their origins, course, insertions and actions. – The nerves, their locations and actions. – The blood supply of the region – The veins and their mechanisms of venous return  Contents of the medial compartment Some other stuff Adductor longus as well. Gracilis Profunda femoris artery & vein Adductor magnus  Medial thigh compartment Common properties: – Common action. ADDuction of the thigh, at the hip, thus aiding stability of the hip joint. – Common innervation. Obturator nerve (usually). – Common blood supply. Profunda femoris & obturator – All antagonised by hip ABductors  Muscles Gracilis Anterior Pectineus ADDuctor longus ADDuctor brevis ADDuctor magnus Posterior + / - Obturator externus (Will be dealt within the gluteal region) – (3 ducks peck grass) Muscles  Gracilis Origin – Body of the pubis Insertion – Upper, medial surface of the tibia, just posterior to sartorius. Action – Hip ADDuction, knee flexion, medial Inserts here rotation of the leg. Innervation – Obturator: L2 - L3  Pectineus Origin – Pectineal surface of the superior ramus of pubis. Insertion – Between the lesser trochanter and the linea aspera Action – ADDucts the thigh at the hip. Innervation – Femoral nerve, L2 - L3, (maybe a bit of obturator).  ADDuctor longus Origin – Pubic crest Insertion – Linea aspera, middle 1/3 of the femur. Action – ADDuction of the thigh. Innervation – Obturator, L2 - L4.  ADDuctor brevis Origin – Body & inferior ramus of pubis. Insertion – Linea aspera, upper portion of femur. Action – ADDuction of thigh. Innervation – Obturator, L2 - L4.  ADDuctor magnus Origin – Ischiopubic ramus & ischial tuberosity. Insertion – ADDuctor portion Posterior femur from gluteal tuberosity to medial supra condylar ridge. – Hamstring portion ADDuctor tubercle Action – ADD: ADDucts the thigh. – Ham: Extends thigh at hip Innervation – ADD: Obturator, L3 & L4. – Ham: Sciatic, L4 & L5.  ADDuctor canal & hiatus It is a channel through which pass a number of structures: – Femoral artery & vein – Saphenous nerve – Lymph vessels – Nerves to VM Starts at inferior apex of femoral triangle. Ends at ADDuctor hiatus Borders – Sartorius – ADDuctor longus & magnus – Vastus medialis & intermedius ADDuctor canal & hiatus ADDuctor canal NB: Long Saphenous vein IS NOT in the canal  Nerves Main supply to muscles is the obturator nerve, L2 - L4. These are ventral branches from the lumbar plexus This splits into anterior & posterior divisions (sometimes there is also an accessory obturator). A bit femoral and sciatic involvement in muscle supply.  Nerves 2 Anterior obturator n – Supplies: Gracilis ADDuctor brevis ADDuctor longus (Sometimes pectineus) Posterior obturator n – Supplies ADDuctor part of ADDuctor magnus (Sometimes ADDuctor brevis) Femoral nerve – Supplies Pectineus Sciatic nerve – Supplies Ham part of ADDuctor magnus  Nerves 3 Cutaneous (sensory) nerves – 2 main nerves supply the skin of the medial thigh. Obturator nerve Medial femoral cutaneous – Branch of the femoral nerve – Also, a little bit of ilioinguinal Nerves 4  Nerves 5 Problems associated with nerve lesions in this area: – Pain, parasthesia etc. – Loss of sensation. – Loss of ADDuction of the thigh at hip.  Vascular structures Arterial supply, shared between: – Profunda femoris Medial femoral circumflex Lateral femoral circumflex 4 x perforating arteries – Obturator artery  Vascular structures 2 Profunda femoris – largest branch of femoral artery, arises on lateral side of femoral artery, 3-5 cm below inguinal lig; passes over surface of pectineus & adductor brevis; – passes posteriorly, lying behind femoral artery & vein on medial side of femur, passing behind tendon of adductor longus; – courses to lie directly on adductor magnus, – perforating branches pass between edge of femur and tendinous insertion of add magnus.  Vascular structures 3 Obturator artery – Arises from internal iliac artery. – Accompanies obturator nerve through obturator canal. – Divides into medial and lateral branches which supply muscles and the hip joint. Obturator canal Obturator vessles and nerve  Vascular structures 4 Both profunda femoris and obturator veins receive tributaries that correspond to the equivalent arteries. The PFV drains into the femoral vein The ObV drains into the internal iliac vein  Summary You should now be able to: – Name the muscles of the medial thigh and describe their origins, insertions and actions. – Name the nerves of the medial thigh, identify which nerves supply which muscles and describe which nerves innervate the skin of the medial thigh. – Describe the vascular structures associated with the medial thigh.  Look forward For next week read up about the: – Muscles – Vascular structures – Nerves, of the medial thigh Next week: – lecture with me – the gluteal region;