The Thigh Muscles PDF

The Thigh CHAPTER2 IL O's: By the end of the lectures, the student should be able to: Describe the general features and arrangement of the fascia Outline the compartments of the thigh. Describe the origin, insertion, action and nerve supply of the muscles...

The Thigh CHAPTER2 IL O's: By the end of the lectures, the student should be able to: Describe the general features and arrangement of the fascia Outline the compartments of the thigh. Describe the origin, insertion, action and nerve supply of the muscles of the front of the thigh. Outline the boundaries of the femoral triangle and describe its contents. Describe the formation, compartments and contents of the femoral sheath. Describe the femoral hernia. Outline the position, boundaries and contents of the adductor canal. Describe the beginning course, termination , relations and branches (or tributaries) of the femoral, vessels and the related anastomosis. Discuss the superficial veins of the lower limb. Discuss the main clinical importance of the venous return of lower limb. Define the surface anatomy of the femoral artery and points of its pulsation. Describe the site, formation and branches of the lumbar plexus. Describe the course, relations, branches and effect of injury of the femoral nerve. Identify the muscles, vessels and nerves of the front of thigh. Describe the origin, insertion, action and nerve supply of the muscles of the medial compartment of the thigh. Define the origin, course, termination, relations and branches (or tributaries) of the obturator vessels and nerves. THE THIGH Front and Medial Side of Thigh Fasciae of the thigh 1- The superficial fascia: - It is formed of two layers: superficial fatty layer and deep membranous layer. - Both layers are continuous above with the same layers of the superficial fascia of the anterior abdominal wall. - The deep membranous layer is loosely attached to the deep fascia of the thigh (fascia lata) except just below the inguinal ligament, where it shows a linear fusion extending laterally from the pubic tubercle.  The Thigh 2- The deep fascia It is termed fascia lata {lata= broad); it makes a strong inelastic stocking surrounding the whole thigh. It extends from the root of the limb {above) to the bony prominences around the knee (below). The deep fascia shows three main features: 1- It is thickened laterally to form the ilia-tibial tract. 2- Its supero-medial part shows a perforation called the saphenous opening. 3- Three intermuscular septa (medial, lateral and posterior) extend from its deep surface to the linea aspera and the supracondylar ridges of the femur thus dividing the thigh into three functionally different compartments: a. The anterior compartment: contains the extensors of the knee which are supplied by the femoral nerve. b. The medial compartment: contains the adductors of the thigh which are supplied by the obturator nerve. c. The posterior compartment: contains the flexors of the knee which are supplied by the sciatic nerve. The ilio-tibial tract (band): (Fig.28) It is a vertical thickening of the fascia lata, (1-2 inches wider above than below). It is present on the lateral aspect of the thigh. It extends from the tubercle of the iliac crest (above) to the lateral border of patella, the lateral condyle of tibia, the capsule of knee joint and the head of fibula (below). - It receives the insertion of 2 muscles: Tensor fasciae latae: into its anterior border. Superficial 3/4 of gluteus maximus: into its posterior border. Functions of the ilio-tibial tract: -It extends the insertion of gluteus maximus and tensor fasciae latae downwards to reach the knee joint and acts as a splint for it during sstanding.  The Thigh The Saphenous opening: (Fig. 26) It is an oval opening (3 x 1.5 cm) lying in the upper medial part of the deep fascia of the thigh, 3 cm below and lateral to the pubic tubercle. Its upper, lateral and lower margins form the falciform margin. Deep fascia of thigh (fascia lata) Femoral sheath Femoral vein Saphenous opening Falcfform margin Great saphenous vein Fig. (26): Saphenous opening in deep fascia of the thigh. - The roof of the opening is formed by the cribriform fascia (membranous layer of superficial fascia) which is pierced by: Superficial inguinal arteries: superficial epigastric, superficial external pudenda! and superficial circumflex iliac arteries. Great saphenous vein. Lymph vessels from superficial to deep inguinal lymph nodes. I The Thigh 1- Muscles of Front of Thigh (A) Muscles of the iliac region (Fig. 27) hallo femal neue EXCEPT psoas Last 5 & all ( 1-Psoas major ↑ - Origin Origin:: g A From sides of bodies of last thoracic and all lumbar vertebrae and their intervertebral discs. D From all lumbar transverse processes. W Tendineous arches (which bridge over the lumbar arteries). p Insertion: the muscle together with the iliacus they form the iliopsoas - Insertion: tendon which is inserted into the lesser trochanter of femur. - Nerve Nerve supply supply:: Lumbar nerves (L1, 2, 3) in the abdomen. 2- lliacus j Origin Origin:: from the iliac fossa and the adjoining part of the ala of sacrum. I lesser hodaute Insertion : through the tendon of psoas major, into the lesser trochanter - Insertion: of femur and a distance of one inch below the trochanter. - Nerve supply the femoral nerve Nerve supply: (by branches arising within the abdomen). - Action of iliopsoas: 1- Powerful flexion and passive medial rotation of the thigh upon the pelvis. iliac fossa 2- Both psoas muscles: flexion of the vertebral column as in raising the ↑ trunk from the recumbent to the sitting position. * ! 3- One psoas only: lateral flexion of vertebral column. A - femoral nerve & Lesser hochauten  The Thigh (B) Muscles of anterior compartment of thigh Extensor muscles of the thigh (Fig. 28) 1- Sartorius ant. sup. iliac spine D The longest muscle in the body having parallel fibers (strap muscle). Origin : lower part of the anterior superior iliac spine Origin: Insertion: into the upper part of the medial surface of the shaft of tibia Insertion: (superficial and in front of insertion of gracifis and semitendinosus muscles) (S.G.S). Nerve supply: femoral nerve. Action: (Tailor's leg position). 1- Flexion, abduction and lateral rotation of the thigh at the hip joint. 2- Flexion and medial rotation of the leg at the knee joint. 3- Steady the pelvis on the femur (together with the guy rope muscles: graci lis and semitendinosus ). & upper surface med. sheft libia  The Thigh 2- Quadriceps femoris (Fig. 29-a) This muscle has 4 heads (hence the name quadriceps). (I) Rectus femoris: - Origin: arises by 2 heads (straight and reflected): Straight head: from the anterior inferior iliac spine. Reflected head: from a depression just above the acetabulum, (II) Vastus lateralis: - Origin: it has a linear origin from: rechs Upper part of intertrochanteric line. -Semoris Root of greater trochanter. Lateral lip of gluteal tuberosity. Lateral lip of linea aspera (upper Yz). (Ill) Vastus medialis: In analis ermedieei vase - - Origin: it has a linear origin from : Lower part of intertrochanteric line Spiral line Medial lip of linea aspera. Medial supracondylar line (upper Yz). (IV) Vastus intermedius: *Origin: from the upper 2/3 of the anterior and lateral surfaces of the femur.  The Thigh 55 : N.B.: A small slender muscle called the articularis genus (considered as the deep lower fibers of vastus intermedius muscle) arises from the lower part of the front of femur and is inserted into the upper part of the synovial membrane of the knee joint. Insertion of the quadriceps femoris muscle: (Fig. 29-b) The tendons of the 4 muscles unite to form a single strong tendon which is inserted into: a- Base of patella. b- Tuberosity of tibia through ligamentum patellae. Nerve supply: femoral nerve The branch to vastus intermedius supplies also the articularis genus muscle. - Action: 1- Powerful extension of the knee joint. 2- Flexion of the hip joint through the rectus femoris. 3- The lower fibers of the vastus medialis help to stabilize the patella against the lateral pull induced by the ilia-tibial tract. 4- The articularis genus pulls the synovial membrane of the knee joint upwards during extension of the leg.  The Thigh 2- Muscles of the Medial Compartment of Thigh Adductor muscles of the thigh (Fig. 30) lower part of -body of publis hollo obhurator except # neuve 1- Gracilis pecineur !! The most medial muscle of the thigh Origin : arises from the lower part of the body ,of the pubis and the pubic Origin: arch near middle line. Insertion : into the upper part of the medial surface of the shaft of tibia Insertion: between the insertions of sartorius and semitendinosus. Nerve supply: obturator nerve (anterior division). Action: 1- Adduction of the thigh. D 2- Flexion and medial rotation of the leg. 3- Steady the pelvis on the femur. 15 Layer peclineus : , addudor longus N.B.: und leyer adductor breves " : - The other adductors are arranged in 3 layers: sic layer addenchor : magne I - The first layer: pectineus and adductor longus. a - The second layer: adductor brevis. - The third layer: adductor magnus. med. Surface shaft of Libia I 2- Pectineus Origin : from the pectineal line and pectineal surface of superior pubic Origin: ramus. Insertion : in the upper Yz of a line extending from the lesser Insertion: trochanter to the linea aspera (pectineal line of femur). line peclineal Nerve supply: femoral nerve (sometimes receives an additional branch from the XprbäneAction: obturator nerve). Adduction of the thigh. - Flexion of the hip joint. · I perline line of fermar  The Thigh 59 oder surface of luberce pubis BELOW pubic & 3- Adductor longus Origin Origin:: by a rounded tendon from the outer surface of the body of the pubis below the pubic tubercle. Insertion : in the middle 2/4 of linea aspera of femur. Insertion: Nerve supply: obturator nerve (anterior division). Action: Adduction of the thigh. - #idelse Ye Linea no per 4- Adductor brevis Origin Origin:: from the front of the body of the pubis and inferior pubic ramus between the origins of the obturator extern us and gracilis muscles. Insertioni Insertion: in the lower 1/2 of the pectineal line of femur and the upper part of linea aspera. - Nerve supply: obturator nerve (L 2,3,4). Action: adduction of thigh I N.B.: The anterior division of obturator nerve lies anterior to the adductor brevis muscle and its posterior division lies posterior to the same muscle. lover be pecined I s- Adductor magnus I upper of linea aspera It has double origin, insertion, nerve supply and action. - Origin Origin:: Pubic (adductor) part: from the outer surface of pubic arch. lschial (hamstring) part: from the lateral part of the lower tri- i angular area of the ischial tuberosity. ↑ outer surface of pubia arch Insertion:  The Thigh Insertion: Pubic part: the fibers spread to be inserted into the medial margin of gluteal tuberosity, the medial lip of linea aspera and the medial supracondylar line. lschial part: the fibers descend vertically to be inserted into the adductor tubercle. There is a gap (adductor hiatus) in the attachment of this muscle to the medial supracondylar line which allows the femoral vessels to pass from the adductor canal downwards into the popliteal fossa. - Nerve supply: Pubic (adductor) part: obturator nerve (posterior division). lschial (hamstring) part: sciatic nerve (tibial part). -Action: Pubic part: adduction - lschial part: extension of the hip joint (like hamstring muscles). ·