MSK TBL 15: Thigh & Inguinal Region Functional Anatomy

blood supply of thigh

femoral & obturator arteries

venous drainage of thigh

femoral vein, popliteal vein, small & great saphenous veins

lymphatic vessels of thigh drain to

lumbar lymphatic trunks, which in turn drain into thoracic duct

majority of arterial blood supply of head of femur is thru

medial & lateral circumflex femoral branches of profunda femoris [branch of femoral artery]

• anastomose to form a ring around neck of femur

acetabulum blood supply

acetabular & pubic branches of obturator artery, along w/ contributions from deep branches of superior gluteal artery

linea aspera

diverges

• proximally lateral ridge = gluteal tuberosity

• proximally medial ridge = pectineal line

lateral epicondyle of femur

gives attachment to FCL of knee joint

intercondylar fossa [notch] of femur

• present btwn lateral & medial condyles

• PCL & ACL attach here

medial epicondyle of femur

give attchmnt to TCL of knee

superiorly passes adductor tubercle

anterior compart of thigh

cause extension of knee & assist in flexion of thigh at hip joint

• sartorius

• quadriceps femoris

  • vastus lateralis, intermedius, medialis

  • rectus femoris

recommended site for intramuscular injections in infants & those who are unable to walk

vastus lateralis

avulsion fracture of anterior iliac spine occurs due to forceful contraction of

rectus femoris

[in young athletes]

posterior compartment of thigh

extend thigh at hip joint, flex knee

• semitendinosus

• semimembranosus [most medial]

• biceps femoris long head

• biceps femoris short head

  • extends thigh at hip joint

  • assists in lateral rotation of knee when flexed

  • embryologically develops in flexor compartment of thigh

    • supplied by common fibular branch of sciatic nerve

*rest are tibial branch of sciatic nerve

medial compartment of thigh

adduction of thigh at hip joint; contribute to thigh flexion

• adductor longus

• adductor brevis

• adductor magnus

  • pubofemoral [adductor] portion

    • innervated by obturator nerve

  • ischiocondylar [hamstring'] portion

    • common embryologic origin w/ posterior compartment of thigh

      • innervated by sciatic nerve

• gracilis

*rest are obturator nerve

• pectineus

  • innervated by anterior division of femoral nerve

which muscle of medial compartment is used during reconstructive surgery?

gracilis

[gracioplasty]

femoral triangle

• triangular depression below inguinal ligament

• prominent when thigh flexed, abducted, & laterally rotated

femoral triangle boundaries

• superior [base]: inguinal ligament

• lateral: medial border of sartorius

• medial: medial border of adductor longus

• floor: pectineus, adductor longus, iliopsoas

• roof: skin, superficial fascia, deep fascia

femoral triangle contents in order from medial to lateral

• femoral vein

• femoral artery

• femoral nerve

“VAN”

femoral triangle contents

1. femoral nerve

2. femoral sheath [contains:]

   1. femoral artery & its branches

   2. femoral vein & its branches

   3. femoral canal

femoral sheath

allows passage to femoral vessels btwn abdomen & thigh

femoral artery

best felt at mid-inguinal point [midpt btwn asis & pubic symphysis]

femoral vein

receives blood from great saphenous vein, circumflex veins, etc

femoral canal

space within femoral sheath which allows for expansion of femoral vein

• contain loose areolar connective tissue, lymphatics, deep inguinal lymph nodes, & cloquet’s lymph node

• common site for femoral hernias

clinically, femoral triangle provides…

• palpation of femoral artery pulse

• obtain venous or arterial blood samples

• coronary angioplasty thru femoral artery

• stop perfuse bleeding

• femoral nerve block

  • local anesthetic for analgesia in leg

• inguinal lymphadenectomy

  • surgical management of metastatic inguinal lymphadenopathy

femoral hernia

• caused by protrusion of single internal body organ thru a weakness in the abdominal wall

• occurs just below inguinal ligament [btwn ASIS & pubic tubercle], when abdominal contents pass thru femoral canal

• types

  • reducible or irreducible

  • obstructed

    • when part of intestine involved in hernia becomes twisted or constricted → intestinal obstruction

  • strangulated

    • when constriction of hernia limits blood supply to part of bowel involved in hernia

      • medical emergency

• present as a groin globular lump or bulge

  • may disappear completely in prone position

• often inferolateral to pubic tubercle

  • *inguinal hernia are superomedial to pubic tubercle

adductor canal

AKA subsartorial / Hunter’s Canal

• extend from apex of femoral triangle to adductor hiatus

• allows passage of saphenous nerve, nerve to vastus medialis, & delivers femoral vessels from anterior thigh to posterior thigh, and then the popliteal fossa

site for saphenous nerve block

adductor canal

• this is the treatment for pain due to saphenous nerve compression

inguinal region

area located in lower portion of anterior abdominal wall

• superficial inguinal lymph nodes drain into deep inguinal lymph nodes in this region

  • ultimately drain into external iliac lymph nodes

adductor canal boundaries

• anterior: adductor lamina & sartorius

• lateral: vastus medialis

• posteromedial: adductors longus & magnus

adductor canal contents

• saphenous nerve

• femoral artery & vein

• lymphatic vessels & loose connective tissue

inguinal canal

• located just above inguinal ligament

• openings are

  • deep [interna] inguinal ring

  • superficial [external] inguinal ring

inguinal canal walls

• anterior: aponeurosis of external oblique muscle

  • reinforced laterally by internal oblique

• posterior [floor]: transversalis fascis & deep inguinal ring

• superior [roof]: aponeurosis of external oblique, internal oblique, transverse abdominalis muscles, & transversalis fascia

• inferior: inguinal ligament [from pubic tubercle to ASIS], lacunar ligament, iliopubic tract

deep [internal] inguinal ring

• located superior to midpt. of inguinal ligament & inferior to ASIS

• bounded superolaterally by transversalis fascia & inferomedially by inferior epigastric vessels

• spermatic cord & round ligament of uterus pass thru here

  • spermatic cord contains: testicular artery, artery to vas deferens, cremaster artery, & vas deferens

  • lymphatics, pampiniform plexus of veins, & genital branch of genitofemoral nerve run along spermatic cord

superficial [external] inguinal ring

• opening in external oblique aponeurosis

• located superior to pubic crest & superolateral to pubic tubercle

• ilioinguinal nerve passes thru it

hydrocele

accumulation of serous fluid around a testicle

often caused by fluid collecting in tunica vaginalis [layer wrapped around testicle]

varicocele

abnormal enlargement of pampiniform venous plexus in male scrotum

*revealed by illumination test

inguinal hernia

• protrusion of abdominal cavity contents thru inguinal canal

• bulges in inguinal area

  • more prominent when coughing, straining, or standing

  • disappears on lying down

• pain or discomfort

indirect inguinal hernia

• abdominal contents protrude deep [internal] inguinal ring

• often located superior to inguinal ligament, & extending into scrotum in males

• sac located lateral to inferior epigastric vessels

• common in children & young adults

direct inguinal hernia

• abdominal contents herniate thru weak spot in transversalis fascia of posterior wall of inguinal canal

• hernial sac passes directly thru inguinal [Hesselbach’s] triangle

• sac located medial to inferior epigastric vessels

• usually doesn’t traverse entire inguinal canal

• hernia protrudes directly to abdominal wall bu may exit thru superficial [external] inguinal ring

• more common in middle-aged & elderly males

inguinal [hesselbach’s] triangle

area bounded by lateral edge of rectus abdominus muscle, inguinal ligament, & inferior epigastric vessels