Anterior and medial thigh

Fascia

• is a strong connective tissue that

  strengthens and divides the muscles into functional groups

The functional groups of the thigh

1. Anterior compartment: flex the thigh at the knee, extend the leg at the knee and has femoral nerve innervation

2. Medial compartment: adductors of the thigh at the hip joint, obturator nerve innervation

3. Posterior compartment: extend the thigh at the hip joint, flex the leg at the knee and sciatic nerve innervation

Iliotibial band

• Band of Maissiat - fibrous structure connecting ilium and tibia

• Unique to man

• Origin - iliac crest / iliac tubercle

• Vertical component of the fascia lata of the thigh

Femur

• largest and strongest bone of the body

• makes a quarter of one’s height

• articulates proximally with the acetabulum and distally with the tibia and fibula

Labels of the femur

Patella

• Sesamoid bone in quadriceps tendon

• Acts as pulley for the forces of anterior thigh muscles acting on the tibia

Uniarthrodial and Biarthrodial muscles

• are one joint and two joint muscles

Muscles in anterior compartment of thigh

• Uniarthrodial: Iliacus and psoas (iliopsoas), quadriceps femoris (vastus lateralis, vastus medialis oblique, vastus intermedius)

• Biarthrodial: sartorius, quadriceps femoris (rectus femoris), tensor

  fascia lata

Muscles in medial compartment of thigh

• Uniarthrodial: adductor magnus, adductor longus, adductor brevis,

  pectineus

• Biarthrodial: gracilis

Muscles in the posterior compartment of thigh

• Uniarthrodial: biceps femoris (short head

• Biarthrodial: biceps femoris (long head), semitendinosus

Anterior muscles of the thigh

• Iliopsoas

• Sartorius

• Quadriceps Femoris

Muscles that move the thigh

Iliopsoas (iliacus and psoas major):

• Flexes thigh at hip

• Arises lumbar vertebrae & ilium

• Inserts on femur

Iliopsoas

• Action: Flexion of the hip, anterior hip tilt

• Origin: Psoas: Bodies and transverse processes T12 – L5 and intervertebral discs.

  Iliacus: Iliac fossa

• Insertion: Lesser trochanter

• Innervation:

  Psoas: L1,L2,L3

  Iliacus: Femoral nerve (L2,3,4)

Sartorius

• Action: Flexion. Adduction &

  external rotation of thigh.

  Knee flexion

• Origin: Anterior superior iliac spine

  (ASIS)

• Insertion: Medial tibia inferior and

  medial to tibial tuberosity

• Innervation: Femoral nerve

  (Longest muscle in the body)

Quadriceps Femoris

Consists of four heads that form the flesh of the front and sides of the thigh:

• Rectus femoris

• Vastus lateralis

• Vastus medialis

• Vastus intermedius

all three vastus heads originate from the femur and the rectus head from the iliac spine

all four heads have a common insertion tendon which inserts into the patella then to the tibia via the patellar tendon

Rectus Femoris

• Action: Flexion of hip, extension of knee(kicking)

• Origin: Straight head: Inferior iliac spine

  Reflected head: superior to acetabulum

• Insertion: patella

• Innervation: Femoral nerve

Vastus lateralis (VL)

• Action: Knee extension

• Origin: Lateral intertrochanteric

  line, greater trochanter, gluteal

  tuberosity, linea aspera

• Insertion: patella

• Innervation: Femoral nerve

Vastus lateralis (VL)

• Origin: Intertrochanteric line, greater

  trochanter, gluteal tuberosity, linea aspera

Vastus medialis obliqe (VMO)

• Action: Knee extension

• Origin: Medial intertrochanteric

  line, linea aspera, medial

  supracondylar line

• Insertion: patella

• Innervation: Femoral nerve

Vastus intermedius

• Action:  Knee extension

• Origin:  Upper anterior and lateral femur

• Insertion:  patella

• Innervation: Femoral nerve

Tensor Fascia Lata

• Action:  Hip abduction

• Origin:  Anterior iliac crest, ASIS, deep surface of fascia lata

• Insertion:  ITB junction of upper and middle thirds

• Innervation: Gluteal nerve (L5/S1)

Medial muscles of the thigh

• Gracilis

• Pectineus

• Adductor longus

• Adductor brevis

• Adductor magnus

Gracilis

• Action:  Adducts, medially (internally) rotates thigh, and flexes the knee

• Origin: Body of pubis, ischiopubic (inferior) ramus

• Insertion:  Medial proximal shaft of tibia

• Innervation:   Obturator nerve (L2,3,4

Pectineus (is proximal to the surface)

• Action:  Adducts, medially rotates, and flexes the thigh.

• Origin:  Superior ramus of pubis

• Insertion:  Femur (pectineal line).

• Innervation:   Obturator / Femoral nerve

Adductor longus

• Action:  Adducts the thigh.

• Origin: Body of pubis

• Insertion: Linea aspera (middle third)

• Innervation:   Obturator nerve

Adductor brevis

• Action:  Adducts the thigh and weak hip flexor

• Origin: Body of pubis , inferior pubic ramus

• Insertion: Posterior surface of proximal femur and linea aspera (upper third)

• Innervation:   Obturator nerve

Adductor magnus

• Action: Adducts  thigh (adductor part)

     Extends thigh (hamstring part)

• Origin: Adductor part: ischial ramus (inferior ramus)

    Hamstring part: ischial tuberosity

• Insertion: Adductor part: post. surface of proximal  femur and linea aspera, medial supracondylar line

    Hamstring part: adductor tubercle

• Innervation: Adductor part: obturator nerve

    Hamstring part: sciatic (tibial division)

Femoral triangle

• Base: inguinal ligament

• Medial border: adductor longus

• Lateral border: sartorius

• Floor: iliopsoas, pectineus, adductor longus

• Apex: continual with adductor canal that descends medially and through the adductor hiatus

Major structures of femoral triangle

• From lateral to medial:

  Femoral nerve, femoral artery, Femoral vein, lymphatic vessels

Femoral sheath

• subdivided in three

  compartments containing (from

  lateral to medial): femoral artery,

  femoral vein and lymphatics (femoral

  canal)

Femoral sheath

• contains fat, lymph vessels and a deep inguinal lymph

  node

Femoral ring

• upper end of femoral canal. It is potentially a weak point in the lower abdomen and is the site of

  femoral hernias

Saphenous opening/ring

• An opening in the fascia lata, in upper medial thigh, for passage of the great saphenous vein, lymph vessels and small arteries

Adductor canal (subsartorial canal)

• Canal between the muscles of lower medial thigh

• Boundaries: Anteriorly - vastus medialis posteriorly - adductor longus and magnus,

  medially (and the roof) - sartorius

• Contents: femoral vessels, saphenous n. and n. to vastus medialis

Innervation of the lower limb

• The lower limb’s nervous

  control is through both the

  lumbar and sacral plex

Femoral Nerve

• The femoral nerve supplies motor innervation to the anterior thigh muscles:

  • Quadriceps femoris (knee extensor)

  • Sartorius (hip flexor)

  • Iliacus (hip flexor)

  Sensory information is perceived from :

  • Anterior and medial thigh

  • Medial leg (continuation as saphenous nerve – pierces fascia 10cm above the knee

Obturator Nerve

• The obturator nerve supplies motor innervation to the medial thigh muscles:

  • Adductors

  • Gracilis

  • Pectineus

  • Obturator externus

  Sensory information is perceived from :

  • Superiomedial thigh

External iliac artery

• The external iliac artery is renamed the femoral artery when it passes through the inguinal ligament

• This area can be landmarked by creating a line from the iliac crest to the pubic symphysis

Femoral artery

• The deep femoral artery (profunda

  femoris) supplies blood to the hip

  joint and many thigh muscles.

  The femoral artery itself passes

  through the adductor magnus muscle

  (adductor hiatus) and travels down

  the back of the leg to become the

  popliteal artery

Veins

• The popliteal vein curves around

  the front of the top of the knee on

  the anterior side of the thigh,

  becoming the femoral vein.

  The femoral vein meets up with the

  great saphenous vein (superficial &

  medial), forming the external iliac

  vein.