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Thigh

Thigh. Dr. S. Nishan Silva (MBBS). Surface Anatomy: Anterior Thigh + Leg. Palpate Patella Condyles of femur Femoral Triangle Sartorius (lateral) Adductor longus (medial) Inguinal ligament (superior) Femoral a + v, lymph nodes. pg 785. Surface Anatomy of the Lower Limb.

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Thigh

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  1. Thigh Dr. S. Nishan Silva (MBBS)

  2. Surface Anatomy: Anterior Thigh + Leg • Palpate • Patella • Condyles of femur • Femoral Triangle • Sartorius (lateral) • Adductor longus (medial) • Inguinal ligament (superior) • Femoral a + v, lymph nodes pg 785

  3. Surface Anatomy of the Lower Limb • Surface features of the Thigh • Sartorius muscle • Quadriceps femoris muscle • Adductor longus muscle • Hamstring muscles • Femoral triange

  4. Superficial structures Great saphenous vein • Drains the medial end of dorsal venous arch of foot • Passes 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.

  5. Superficial structures • Tributaries: • Superficial lateral femoral v. • Superficial medial femoral v. • External pudendal v. • Superficial epigastric v. • Superficial iliac circumflex v.

  6. Varicose veins

  7. Superficial structures Superficial fascia • Superficial 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.

  8. lateral femoral cutaneous n. anterior and medial cutaneous branches of femoral n. Cutaneous branches of obturator n.

  9. 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.

  10. 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

  11. Deep fascia of the thigh • Iliotibial tractlaterally 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.

  12. Lacuna musculorum • Boundaries: • Anteriorly: lateral portion of inguinal ligament • Posterolaterally: ilium • Medially: iliopectinal arch • Contents: • Iliopsoas • femoral n. • lateral femoral cutaneous n. Lateral femoral cutaneous n. Iliopsoas Iliopectinal arch Femoral n.

  13. Femoral a. Femoral v. Femoral ring Lacuna vasorum • Boundaries: • Anteriorly: medial portion of inguinal ligament • Posteriorly: fascia of pecteineus and pectineal ligament • Medially: lacunar ligament • Laterally: iliopectinal arch • Contents: • Femoral sheath • Femoral a. and v. • Genital branch of genitofemoral n. • Lymphatic vessels

  14. Anterior/Posterior compartments

  15. BONY ANATOMY OF THE FEMUR

  16. BONY ANATOMY OF THE FEMUR

  17. Thigh movements by compartment

  18. Anterior thigh (femoral n.) • Sartorius (Tailor’s muscle) • Quads (four) • Rectus femoris (crosses hip) • 3 vastus mm. (vast--big)

  19. Musculature • Anterior • Rectus Femoris • Vastus Lateralis • Vastus Intermedius • Vastus Medialis

  20. Musculature • Anterior • Posterior • Semimembranosus • Semitendinosus • Biceps femoris • Popliteus

  21. Musculature • Lateral restrainers of knee • Tensor Fascia Lata • Iliotibial Band

  22. Posterior Thigh • Gluts (gluteal nn.) • Maximus—extensor of thigh • Medius--pelvic tilt • Lateral rotators (spinal nn.) • Piriformis syndrome • Hamstrings (sciatic n.) • Biceps femoris • Semimembranous • Semitendinous

  23. Medial compartment (obturator n.) • Adductor muscles • Gracilis • Adductor • Magnus • Longus • brevis

  24. 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 canal • Anterior wall:fascia lata • Posterior wall:consists of iliopsoas, pectineus and adductor longus from lateral to medial side

  25. Femoral triangle Contents • Femoral n. • Femoral sheath • Femoral a. and its branches • Femoral vein and its tributaries. • Femoral canal • Deep inguinal lymph nodes • Fatty tissue

  26. 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.

  27. Femoral sheath Femoral sheath Divided into three compartments by two fibrous septa • Lateral compartment: femoral a. • Middle compartment: femoral v. • Medial compartment: femoral canal

  28. 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

  29. 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 ).

  30. Femoral artery Femoral a. • Continuation of the external iliac a. • Begins midpoint of inguinal ligament • Ends 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

  31. Profundafemoris • 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

  32. deep femeral a. Medial circumflex a. • Lateral circumflex a. • perforating arteries

  33. Femoral vein • Begins at the adductor tendinous opening • Continues as external iliac vein deep to inguinal ligament • Contains several valves

  34. 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.

  35. 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

  36. 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.

  37. Femoral n. Femoral a. Femoral v. Saphenous nerve

  38. 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

  39. 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

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