Anatomy Of AnterioMedial Thigh

Objectives

– Know the muscles that comprise the quadriceps, femoris
– Understand Iliopsoas, pectineus, sartorius, graciis, and the three adductor muscles, longus, brevis and Magmus
– Understand the Femoral triangle and its relationship to the muscles and arteries involved
– Identify the major branches of the artery ( profunda, perforating arteries, medial and lateral circumflex.
– Understand the great saphanous vein and its subdivisions
– Describe femoral hernia and understand its clinical significance

Anatomical boundaries of the Thigh

  • It extends superiorly from the inguinal ligament.
  • And inferiorly to the knee, thus transverse 2 joints.
  • One is a Ball socket joint ( the Hip joint ).
    The other is a Hinge joint ( the knee).
  • Muscles that lie superior transverse anteriorly to the joint and insert into the lesser trochanter.
  • 2 muscles fit the description described above ( illopsoas, and iliacus ) and are flexors of the hip.
  • Quadracept femoris consists of 4 easy to remember Muscles, They are responsible for extending the leg and thus they insert just inferiorly to the patella.

Cutaneous Innervations of the AnterioMedial Thigh

1) Femoral branch of the Genital femoral ( L1,L2).
2) Cutaneous Lateral Femoral ( L2,L3).
3) Cutaneous branches of the Femoral Nerve (L2,L3,L4).
4) Ilioinguinal (L1).

Inguinal Lymph Drainage

  • Associated with the cribs form ( superficial fascia, which is a continuation of scarpas fascia)
  • Remember lympnodes drain from Superficial to Deep.

2 Important Groups of Superficial Lymphnodes

Horizontal chain ( lies just bellow the inguinal ligament)
Drains
1) Abdominal wall (lower part)
2) External Genitalia (not the testis and ovaries )
3) Gluts , and Buttocks

Vertical Chain ( Lies along the femoral Vein)

Drains the lower limbs that are involved with the Great saphonous and Femoral Vein only ( So the dorsi Laterl part of the foot and the heel do not drain into the vertical lymphnodes) ( They are involved with the popletial vein and the small saphnous vein and drain intothe popliteal nodes).

Important Muscles of The AnteriorThigh

  1. Illiopsoas- Insert at the lesser Trochanter flexion of the hip
  2. Illiacus-Inserts at the lesser Trochanter flexion of the hip
  3. Pectinius- Extends from the pectineal Line and inserts into the lesser trochanter
  4. Sartorious- Extends from the ASIS to the medial aspect of the Tibia (contributes to the Pes- anisaris).
  5. Quadraceps Femoris- Extension of the Leg
    a. Rectus Femoris
    b. Vastus Intermedius
    c. Vastus Lateralis
    d. Vastus MedialisFemoral Nerve innervates all the anterior thigh muscles, it terminates as the saphanous nerve which leaves the adductor canal,

Medial thigh Muscles

Adductor and Medial Thigh rotators

1) Pectinius– Femoral Nerve (Innervations)
2) Adductor Brevis– (Oburator posterior branch sometimes)
3) Adductor Longus– (Oburator Anterior branch)
4) Adductor Magnus– (Oburoator posteriorbranch and Tibial)
5) Gracilis– (Oburator ( Oburator Anterior Branch)

Note : The oberator nerve enters the lower limb via the obterator foramen, and is L2,3,4 off the
lumbar plexus and all Medial Thigh Muscles are innervated by the Obturator Nerve.

Femoral Triangle

Boundries

  1. Superiorly it is bound by the Inguinal Ligament
  2. Laterally it is bounded by the sertorius muscle
  3. Medially by adductor longus
  4. The Roof of the Triangle is Fasia Lata
  5. The floor consists of 2 things
    a. Illiopsoas and its fascia laterally
    b. Pectinius and its fascia medially

Femoral Sheath

An extension of the transversalis fascia
And it forms a ring called the femoral ring,
Medial border is Lacunar ligament
Site of the Femoral Hernia
Contains femoral Artery, Vein and Lymphatics but not the Nerve!!!

Contents of the Femoral Triangle (NAVEL):
1) Femoral Nerve
2) Femoral Artery
3) Femoral Vein
4) Empty space
5) Lymph nodes

Superficial Branches of the Femoral Artery( supply the Fascia, skin, and muscle):

– Superficial Epigastric
– Superficial External Pudendal
– Superficial Iliac circumflex

Deep Branches of the Femoral Artery ( supplies the muscles, Genitalia:

  • Deep external Pudendal
  • Profunda Femoris
    a. Medial Femoral Circumflex
    b. Lateral Femoral Circumflex
    c. Perforating Arteries- 4 of them and all relate to the adductor magnus, hamstrings, and medial musculature
  • Decending genicular goes to the medial leg and knee joint

Adductor Canal

Boundries – Medially Sertorius
Laterally – Vastus Mediallis
Posterior – Adductor Longus and Magnus

Contents of the Adductor canal subsartorial Canal:

1) Femoral Artery
2) Femoral Vein
3) Saphanous nerve
4) Nerve to vastus Medialis

Atrrial Supply is via:
a. prefunda femoris
b. medial circumflex
c. oborator artery

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