LL 2: Anterior and Medial Thigh
What is the adductor canal?
(aka Hunters, sub sartorial canal) transmits the: - femoral artery and branches - femoral vein and branches - saphenous nerve - N to vastus medialis serves as a gateway for the femoral vessels to the popliteal fossa (aka vessels go from anterior to posterior compartments. NOT NERVES THOUGH!)
What are the risks of femoral hernia? What layers are the intestines covered with?
- can be strangulated by the pectineal lig, lacunar lig., or the saphenous opening - loops of intestines are covered by (superficial to deep): skin, superficial fascia, femoral sheath, visceral peritoneum
Why would you use the femoral triangle for access?
- femoral nerve block - angiography - cannulation of femoral vein
What are the muscles of the medial thigh?
1. obturator ext. 2. pectineus 3. adductor longus 4. adductor brevis 5. adductor magnus 6. adductor minimus (posterior) 7. gracilis
What are the proximal attachments of rectus femoris and what are it's action, innervation, and blood supply?
AIIS and acetabulum extension of knee femoral artery and nerve (L2-L4)
What are the attachments, actions, innervation, and blood supply to sartorius?
ASIS to anteromedial side of tibia Flexes hip and extension of knee Femoral artery and nerve (L2-L4)
What is the function of muscles within the anterior thigh compartment?
Extension of the knee/leg (number 1!!!) Flexion of the hip/thigh (secondary, only 2 muscles)
What is the route of the femoral nerve? What is the cutaneous inn.?
Fem = L2-4
Where does the obturator artery originate?
In pelvis from internal iliac artery
What are the branches off the deep femoral artery?
Lateral circumflex femoral medial circumflex femoral perforationg arteries 1-3 muscular
What order will the structures in the femoral triangle be found in?
Nerve, Artery, Vein, Empty Space, Lympathics (NAVEL) from lateral to medial
What are the perforators?
Perforators perforate the muscles, to connect the superficial arteries to the deep arteries where they drain.
What muscles compose the quadriceps?
Quadreceps femoris muscle: has 4 heads Medial: vasctus medialis Lateral: vastus lateralis Central: rectus femoris Deep to rectus femoris: vastus intermedius
What are the borders of the femoral triangle? What forms the floor and roof?
Superior border: Inguinal ligament Lateral border: Sartorius Medial border: Adductor longus Floor: Pectineus and iliopsoas muscles covered by the iliopectineal fascia Roof: Fascia lata with the saphenous hiatus
What are the borders of the femoral triangle? What forms the floor and what forms the roof?
Superior border: Inguinal ligament Lateral border: Sartorius Medial border: Adductor longus Floor: Pectineus and iliopsoas muscles covered by the iliopectineal fascia Roof: Fascia lata with the saphenous hiatus
What is the function of the medial thigh muscles?
adduction of the hip/thigh, also some medial rotation
What is the action of medial thigh muscles?
adduction of the thigh/hip
What muscles does the deep femoral artery run between?
adductor longus and magnus
What may result from damage to the ascending branch of the medial circumflex femoral artery?
avascular necrosis of the femoral head/neck
Where is the inguinal ligament found?
between ASIS and pubic tubercle
Where will the muscles of the quadriceps converge?
converge on one tendon in the knee (quadriceps femoris tendon) and attach to tibial tuberosity through patellar tendon
What structures are enclosed in the femoral sheath?
femoral artery, vein, and lymphatic vessels and nodes in CT "lacuna lymphatica" (femoral ring)
What is the innervation to the anterior thigh muscles?
femoral nerve (L2-4) and anterior rami from lumbar plexus (L1-L4)
How can an inguinal and femoral hernia be differentiated?
femoral under the inguinal ligament, inguinal often up higher
How is the popliteal artery formed?
formed by femoral artery as it goes through adductor canal and enters popliteal fossa
How is the femoral artery formed?
formed when external iliac artery passes inguinal ligament
How does the great saphenous vein form?
from femoral vein, pierces femoral sheath
What will attach to the tubercle on the medial side of the distal femur?
hamstring portion of adductor magnus (called adductor tubercle)
How would you differentiate between a femoral hernia and a psoas abscess?
hernias are usually medial psoas absess is usually lateral they appear v. similarly do a CBC and look for infection (abscess would be infection, hernia isn't)
What is the femoral triangle?
important transitional area, the femoral shell forms a major vascular portal into the thigh
What is the lacunar ligament and what is the clinical significance?
inferior fibers of the inguinal ligament that attaches it to pubic bone lateral edge is sharp and can cause strangulation of bowel perferating through femoral canal, can lead to death of that portion of the bowel
What are the borders of the femoral triangle?
inguinal ligament, sartorius, adductor longus
What are the internal and external openings of the femoral canal?
internal: lacuna lymphatica (femoral ring) External: hiatus saphenus
What is the function and innervation of the obturator externus muscle?
lateral (external) rotation innervated by obturator nerve
Where will anterior hip muscles attach distally?
lesser trochanter of femur
What artery supplies the head and neck of the femur?
medial circumflex artery
What part of the subinguinal hiatus will the femoral canal be found in?
most medio-lateral border of the subinguinal hiatus
What is the cutaneous inn. of the obturator n.?
note = ovarian cancer, stuff growing in pelvis disrupt the obturator nerve L2-4
What are the two main arteries within the ant/med thigh?
obturator and femoral arteries
What innervates the medial compartment?
obturator nerve
What is the innervation to muscles in the medial thigh?
obturator nerve (L2-L4)
What structures transverse the obturator canal?
obturator nerve and vessels
Describe the saphenous hiatus
opening on the fascia lata covered by connective tissue fascia perforated by lymph vessels (cribriform fascia)
What are the exceptions to obturator inn. the medial compartment?
pectineus = femoral n. hamstring part of adductor Magnus = sciatic n.
What do the perforating arteries from deep femoral artery supply?
perforate the adductor magnus and get to the flexor compartment of the thigh. Give the nutrient arteries of the femoral shaft.
What is another name for the deep femoral artery?
profunda femoris artery
What is a femoral hernia?
protrusion of adipose/gut loops through *the femoral ring and into the femoral canal* appears as a mass in the femoral triangle more common in females (note: can also emerge through the saphenous opening and ascend superficial to the inguinal lig.)
What are the anterior hip muscles and what are their actions?
psoas major and iliacus: join to form iliopsoas muscle under inguinal ligament function: main flexors of the hip
What are the attachments of the medial thigh muscles?
pubic bone to posteromedial aspect of femur (linea aspera) gracilis most medial and part of pes anserinus
How may the patella become dislocated?
quadriceps will pull laterally on the patella causing it to dislocate (more common in women due to the angle of the leg)
Where do femoral hernias occur?
through the femoral canal: will enter femoral triangle more common in females
What is the femoral sheath derived from?
transversals and iliac fascia encloses 3 spaces: lateral: femoral art. intermediate: femoral v. medial: femoral canal
What is the first part of the quadriceps to atrophy in knee joint disease?
vastus medialis also the last to recover; when it is weak may result in improper tracking of the patella = patellofemoral syndrome or patellar dislocation
What is the subinguinal hiatus?
where stuff travels under the inguinal lig. ex. femoral sheath travels here
What are the borders fo the femoral canal?
•Anterior: fascia lata • Posterior: Fascia pectinea • Lateral: Vena femoral•Anterior: fascia lata • Posterior: Fascia pectinea • Lateral: Vena femoralisis
What vessels will pass through the saphenous hiatus?
•Great saphenous vein •External pudendal a./v. •Superficial epigastric a./v. •Superficial circumflex iliac a./v. think GuESS
What are the branches off the femoral artery?
•Superficial circumflex iliac artery •Superficial external pudendal •Deep external pudendal artery •Deep (profunda) femoral artery •Descending genicular artery •Muscular