Anterior and Medial Aspect of the Thigh PDF

Anterior and Medial Aspect of the Thigh ProfDrMTiryakioglu Fascia of the thigh superficial fascia contains considerable amount of fat and superficial vessels  Fascia of Thigh Deep Fascia/Fascia lata Strong, dense, broad layer between tubercle o...

Anterior and Medial Aspect of the Thigh ProfDrMTiryakioglu Fascia of the thigh superficial fascia contains considerable amount of fat and superficial vessels  Fascia of Thigh Deep Fascia/Fascia lata Strong, dense, broad layer between tubercle of the iliac crest and tibia Tensor fascia lata and gluteus maximus attach to the iliotibial tract Tensor fascia lata pulls on the iliotibial tract The iliotibial tract is where the fascia lata is extremely strong between the tubercle of the iliac crest and the tibia giving attachments for the two muscles Fascia Lata Saphenous Opening A gap or deficiency in the fascia lata, just inferior to the inguinal ligament is known as the saphenous opening (fossa ovalis) The sickle-shaped margin of the saphenous opening is called “falciform margin” Sieve like “Cribriform fascia” covers the saphenous opening Cutaneous Innervation of Thigh Ilioinguinal n Femoral branch of genitofemoral n Subcostal n Obturator n Anterior cutaneous branch of femoral n and its medial brs Lat femoral cutaneus n  Femoral Triangle Superomedial part of the thigh contains the femoral vessels, the femoral nerve, and inguinal lymph nodes Boundaries: Sup : inguinal lig. Medial : medial border of the adductor longus muscle Lateral : medial border of the sartorius muscle Floor : medial part: adductor longus and pectineus muscle, lateral part: iliopsoas muscle Roof : skin and fascia u the femoral pulsations can be easily palpated 2-3 cm inferior to the midpoint of the inguinal lig.  Femoral Triangle 1) Femoral vein 2) Femoral artery: Superficial epigastric a. Superficial iliac circumflex a. Superficial and deep external pudendal aa. Deep femoral a. Medial circumflex femoral a. Lateral circumflex femoral a. 3) Femoral nerve 4) Saphenous nerve 5) Superficial and deep inguinal lymph nodes Femoral Triangle  Femoral Sheath Funnel-shaped fascial tube (transversalis fascia anteriorly, iliac fascia posteriorly) Covered by the fascia latae Contains femoral vessels-femoral canal Ends 4 cm inferior to the inguinal lig. Medial wall of the femoral sheath is pierced by the great saphenous vein and lymph. vessels It is subdivided by two vertical septa A lateral comp. for the femoral artery An intermed. comp. for the femoral vein A medial comp. called the femoral canal Femoral Canal short, conical canal contains a few lymph vessels, nodes, loose connective tissue, and fat extends distally and ends about 4 cm inf to the inguinal lig u The small abdominal opening of the femoral canal Boundaries: Lat: femoral vein Femoral Ring Post: pectineus muscle Med: the lacunar lig, conjoint tendon Ant: the ing. lig and spermatic cord Femoral hernia: a protrusion of abdominal viscera through the the femoral ring into the femoral canal Anterior Thigh Muscles  Iliopsoas muscle Consists of psoas major and iliacus muscles Psoas major m O: Transverse processes of vertebral bodies and intervertebral discs of T12-L5 I: Lesser trochanter of femur via iliopsoas tendon N: Femoral n F: Acts conjointly with the iliacus muscle- flexion of the thigh Iliacus muscle O: Iliac crest, iliac fossa, ala of sacrum I: Lesser trochanter F: Flexes the thigh assisting psoas major N: Femoral n M. psoas minor O: T12-L1 intervertebral discs I: Pecten pubis, iliopubic eminence, and lateral side of iliac fascia F: Minimally flexes trunk N: L1 Tensor fascia lata muscle O: Anterior superior iliac spine I: Iliotibial tract F: Abducts and flexes thigh and helps to keep the knee extended in erect posture N: Superior gluteal n Sartorius muscle longest and most superficial muscle covers the femoral artery O: anterior superior iliac spine I: superior part of the medial surface of tibia N: femoral nerve F: flexes thigh and leg, abducts the thigh and rotates it laterally Quadriceps femoris m. Rectus femoris Vastus medialis Vastus lateralis Vastus intermedius  Quadriceps femoris m. O: rectus femoris; anterior inferior iliac spine and groove sup to acetabulum; 3 vasti arise from the body of femur I: attach to the base of patella and the tibial tuberosity-with a common tendon that continues inferiorly as the patellar ligament F: extends leg at the knee joint N: Femoral n Medial Thigh Muscles Medial Aspect of the Thigh Gracilis Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis Long strap-like muscle Most superficial of the adductor group Crosses the knee joint O: body and inferior ramus of pubis I: superior part of medial surface of tibia F: adducts thigh and flexes leg N: obturator n Pectineus Small muscle on the floor of the femoral triangle O: pectineal line of pubis I: pectineal line of femur F: adducts and flexes thigh N: femoralis and obturator Adductor Longus anterior part of adductor group muscles O: anterior surface of body of pubis I: middle third of linea aspera of femur F: adducts and flexes the thigh N: obturator n Adductor Brevis O: body and inferior ramus of pubis I: pectineal line and proximal part of linea aspera of femur F: adducts thigh N: obturator n Adductor Magnus Largest of the adductors O: inferior ramus of pubis, ramus of ischium and ischial tuberosity I: gluteal tuberosity, linea aspera, medial supracondylar line, and adductor tubercle of femur F: adducts and extends thigh N: ant. part: obturator n post. part: tibial nerve Adductor Canal (Subsartorial Canal OR Hunter’s Canal) A narrow fascial tunnel by an intermuscular cleft deep to the sartorius muscle middle third of the medial part of thigh contains femoral vessels pass to reach the popliteal fossa end point-the adductor hiatus; the tendinous opening of the adductor magnus muscle Contents The femoral vessels----vein lying posterior to the artery. Femoral artery-vein leaves the adductor canal through the adductor hiatus becoming popliteal artery-vein Saphenous nerve does not across the adductor canal; it pierces deep fascia (vasto-adductor intermuscular membrane) on the medial side of the knee, passes down with saphenous vein Arteries of the Thigh Femoral artery Superficial epigastric artery Superficial circumflex iliac artery External pudendal arteries (sf&deep) Deep femoral artery (largest branch; chief artery of the femur) Descending genicular artery Deep femoral artery arises from the lateral side of the femoral artery within the femoral triangle about 4 cm inferior to the inguinal lig. Branches: Medial circumflex femoral artery Lateral circumflex femoral artery Perforating aa Nutrient arteries for femur u Medial circumflex femoral artery is important for the arterial supply of head and neck of femur Veins of the Thigh Superficial veins: Great saphenous vein Begins at the medial end of the dorsal venous arch of the foot Passes anterior to the medial malleolus Obliquely crosses tibia to the medial aspect of the knee Runs superolaterally to the anterior midline of the thigh Drains into the femoral vein at the saphenous opening Deep veins: Femoral vein Great saphenous vein Femoral n (L2,L3,L4) Descends posterolaterally through the pelvis to the midpoint of the inguinal lig. Passes lateral to the femoral vessels *outside the femoral sheath Cutaneous branches: Lateral femoral cutaneous n Anterior cutaneous branches of femoral n Saphenous nerve