Dr. S. Nishan Silva(MBBS)

Frolich, Human Anatomy, Lower LImb

Surface Anatomy: Anterior Thigh + Leg

PalpatePatellaCondyles of femur

Femoral TriangleSartorius (lateral)Adductor longus

(medial)Inguinal ligament

(superior)Femoral a + v, lymph

nodespg 785

12-3

Surface Anatomy of the Lower Limb

Surface features of the Thigh Sartorius muscle Quadriceps femoris muscle Adductor longus muscle Hamstring muscles Femoral triange

Superficial structuresGreat saphenous vein Drains the medial end of dorsal venous

arch of footPasses upward directly in front of the

medial malleolus.Then ascends on medial side of the leg.Passes behind the knee and curves

forward around the medial side of the thigh.

Passes through the saphenous hiatus in the deep fascia and joins the femoral vein about 4 cm below and lateral to the pubic tubercle.

Superficial structuresTributaries:

Superficial lateral femoral v. Superficial medial femoral v. External pudendal v. Superficial epigastric v. Superficial iliac circumflex v.

Varicose veins

Superficial structures

Superficial fasciaSuperficial arteries:

superficial epigastric a. superficial iliac circumflex a. external pudendal a.

Cutaneous nerves: lateral femoral cutaneous n. anterior and medial cutaneous

branches of femoral n.cutaneous branches of obturator n.

lateral femoral cutaneous n.

anterior and medial cutaneous branches of femoral n.

Cutaneous branches of obturator n.

Superficial structures

Superficial inguinal lymph nodes

Superior group: Lies just distal to the inguinal ligament Receive lymph vessels from anterior

abdominal wall below umbilicus, gluteal region, perineal region, external genital organs

Inferior group: Lies vertical along the terminal great

saphenous v. Receives all superficial lymph vessels

of lower limb, except for those from the posterolateral part of calf

Efferent vessels drain into the deep inguinal ln. or external iliac ln.

Deep fascia of the thigh Fascia lata The deep fascia encloses the thigh like a

trouser leg.Saphenous hiatus

A gap in the deep fasica which lies about 4 cm below and lateral to the pubic tubercle. The falciform margin is the lower lateral border of the opening, which lies anterior to the femoral vessels.

Filled with loose connective tissue called the cribriform fascia

Deep fascia of the thigh Iliotibial tract

laterally the deep fascia forms a thick band, from the iliac tubercle to the lateral condyle of tibial.

The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a group of muscles, the vessels and the nerves.

Lacuna musculorum

Boundaries:Anteriorly: lateral portion

of inguinal ligamentPosterolaterally: ilium Medially: iliopectinal arch

Contents: Iliopsoas femoral n. lateral femoral cutaneous n.

Iliopectinal arch

Femoral n.

Iliopsoas

Lateral femoral cutaneous n.

Lacuna vasorum

Boundaries:Anteriorly: medial portion

of inguinal ligamentPosteriorly: fascia of

pecteineus and pectineal ligament

Medially: lacunar ligamentLaterally: iliopectinal arch

Contents: Femoral sheathFemoral a. and v.Genital branch of

genitofemoral n. Lymphatic vessels

Femoral a.

Femoral v.

Femoral ring

Frolich, Human Anatomy, Lower LImb

Anterior/Posterior compartments

ANTERIOR COMPARTMENT

POSTERIOR COMPARTMENT

MOVEMENT Extension Flexion

MUSCLES Quads

Shin

Hamstrings

Gastrocs

NERVES Femoral n.

(lumbar plexus)

Sciatic n.

(sacral plexus)

Frolich, Human Anatomy, Lower LImb

Frolich, Human Anatomy, Lower LImb

Anterior thigh (femoral n.)

Sartorius (Tailor’s muscle)

Quads (four)Rectus femoris

(crosses hip)3 vastus mm.

(vast--big)

Musculature

AnteriorRectus FemorisVastus LateralisVastus IntermediusVastus Medialis

Musculature

AnteriorPosterior

SemimembranosusSemitendinosusBiceps femorisPopliteus

Musculature

Lateral restrainers of kneeTensor Fascia LataIliotibial Band

Frolich, Human Anatomy, Lower LImb

Posterior Thigh

Gluts (gluteal nn.)Maximus—extensor of thighMedius--pelvic tilt

Lateral rotators (spinal nn.)Piriformis syndrome

Hamstrings (sciatic n.)Biceps femorisSemimembranousSemitendinous

Frolich, Human Anatomy, Lower LImb

Medial compartment (obturator n.)

Adductor musclesGracilisAdductor

Magnus Longus brevis

Femoral triangle A triangular depressed area situated in

the upper part of the medial aspect of the thigh just below the inguinal ligament

Boundaries Superiorly (base) : the inguinal ligament Laterally: medial border of sartorius Medially: medial border of adductor

longus Apex: continuous with adductor canalAnterior wall: fascia lataPosterior wall: consists of iliopsoas,

pectineus and adductor longus from lateral to medial side

Femoral triangle

Contents Femoral n.Femoral sheathFemoral a. and its branches Femoral vein and its tributaries.Femoral canalDeep inguinal lymph nodesFatty tissue

Femoral triangle

Femoral sheath A funnel- shaped sheath Derived from transversalis fascia

anteriorly and iliac fascia posteriorly

It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt.

Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.

Femoral sheath

Femoral sheath Divided into three compartments by two fibrous

septa

Lateral compartment: femoral a. Middle compartment: femoral v.Medial compartment: femoral canal

The femoral canal About 1.3cm long , and its upper

opening is called the femoral ring Contains: a little loose fatty tissue,

a small lymph node, and some lymph vessels.

The boundaries of the femoral ring Anteriorly: the inguinal ligament Medially: the lacunar ligament Posteriorly: the pecten of pubis Laterally: the femoral vein Superior: covered by femoral

septum

Femoral hernia If a loop of intestine is forced

into the femoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral hernia .

A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).

Femoral artery

Femoral a. Continuation of the external iliac a. Begins midpoint of inguinal ligamentEnds at the adductor tendinous

opening by entering the popliteal fossa as the popliteal artery

Principal branch － deep femeral a. arises from the posterolateral surface of the

femoral artery about 5 cm below the inguinal ligament.

Medial femoral circumflex lateral femoral circumflex Four perforating arteries

Profunda femoris

Arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.

Branches: Lateral circumflex artery. Medial circumflex artery.Perforating arteries

deep femeral a.

Lateral circumflex a. Medial circumflex a.

perforating arteries

Femoral vein Begins at the adductor tendinous

opening Continues as external iliac vein

deep to inguinal ligament Contains several valves

The deep inguinal lymph nodes

Lie medial to the femoral v.Receive deep lymphatics of

lower limb, perineal region, and efferent lymphatics from the superficial inguinal ln.

Drain into the external iliac ln.

Femoral nerve Arises from the lumbar plexus in

the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery.

It ends by dividing into a number of branches 2 cm below the inguinal ligament.

Muscular branche to: pectineus, sartorius, quadriceps femoris

Femoral nerve

Cutaneous branches: Anterior cutaneous

nerves of the thigh Saphenous nerve is the

longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.

Femoral n.

Femoral a.

Femoral v.

Saphenous nerve

Adductor canal An intermuscular cleft situated on the medial

aspect of the middle third of the thigh beneath the sartorius.

Extends from apex of femoral triangle to adductor tendinous opening

Boundies Anterior wall: adductor lamina and

sartorius Lateral wall : vastus medialis Posteomedial wall: adductors longus and

magmus Contents

Saphenous n. Femoral a. and femoral v. lymphatic vessels and loose connective

tissue

Blood vessels and nerve of medial side of thigh Obturator a.

Arises from internal iliac artery in the lesser pelvis

passes through the obturator canal where it divides into anterior and posterior branches.

Obturator n. Arises from the lumbar plexus in

the abdomen. Enters the thigh through the

obturator canal where it divides into anterior and posterior branches.

Supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh

Obturator n.

Strains-hamstring

Strains- groin

AP LAT

FRACTURED LT. FEMUR