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Anterior and Medial Compartments of the Thigh

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Anterior and Medial Compartments of the Thigh Anterior and Medial compartments of the thigh Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Terms Related to Movements Movement Definition Flexion A movement that decreases the angle between two body parts Extension A movement that increases the angle between two body parts Abduction A movement away from the midline Adduction A movement towards the midline Medial (internal) rotation A rotational movement towards the midline Lateral (external) rotation A rotational movement away from the midline Elevation A movement in a superior direction Depression A movement in an inferior direction Protraction Anterior movement of the jaw Retraction Posterior movement of the jaw Opposition The movement that involves grasping of the thumb and fingers Movement Definition Supination A rotational movement where the forearm and palm are turned outwards Pronation A rotational movement where the forearm and palm are turned inwards Dorsiflexion Movement at the ankle, so that the foot points more superiorly Plantarflexion Movement at the ankle, so that the foot points inferiorly Inversion The movement of the sole towards the median plane – so that the sole faces in a medial direction Eversion The movement of the sole away from the median plane – so that the sole faces in a lateral direction Circumduction A conical movement of a body part. Circumduction is a combination of flexion, extension, adduction and abduction. Plantarflexion of foot The foot points inferiorly Dorsiflexion of foot The foot points more superiorly Inversion of foot The movement of the sole towards the median plane – so that the sole faces in a medial direction Eversion of foot The movement of the sole away from the median plane – so that the sole faces in a lateral direction Superficial veins are those closer to the surface of the body, and have no corresponding arteries. They return blood from skin and subcutaneous structures by anastomosing (inter-connecting) with deep veins Deep veins are deeper in the body and accompany the principle arteries and usually have the same name Superficial veins can be seen under the skin Superficial veins of lower limb Large veins embedded in the subcutaneous (superficial) fascia are: Great (long) saphenous vein Drains the medial end of the dorsal venous arch. Small (short) saphenous vein Drains the lateral end of the dorsal venous arch. At the knee. The great saphenous vein’s surface marking is classically one hand's breadth posterior to the medial border of the patella or just posterior to the medial condyle of the femur. Superficial veins of lower limb Great (long) saphenous vein Passes up the medial side of the leg, knee, and thigh Ascends in company with the Saphenous nerve Passes through the Saphenous opening Joins the femoral vein (in front of medial malleolus) Small (short) saphenous vein Passes up the back of the leg to penetrate the deep fascia and join the popliteal vein in the popliteal fossa Ascends in company with the Sural nerve (behind lateral malleolus) The normal flow of blood in the lower limbs is from skin and subcutaneous tissues to the superficial veins, which drain by perforating veins to the deep veins, which in turn drain into the iliac veins and inferior vena cava Perforating vein Deep vein Superficial vein Fascia lata: Is a strong fibrous sheet that surrounds the whole of the thigh like a tight trouser. Thick on its lateral side to form the iliotibial tract Saphenous opening is an oval opening in the upper part of the fascia lata of the thigh. Its center lies 1.5 inch below and lateral to the pubic tubercle and is about 3 cm long and 1.5 cm wide The saphenous opening is filled with loose connective tissue called the cribriform fascia Iliotibial tract Tensor Is a strong wide fascia band (thickening Gluteus latae of the deep fascia maximus (fascia lata)) on the lateral side of the thigh) attached above to the iliac tubercle and below to the lateral condyle of tibia. Receives the insertion of tensor fascia latae and gluteus maximus muscles Deep fascia of the thigh (fascia lata) Fascia lata is connected to the linea aspera by three intermuscular septa; 1-Medial intermuscular septum 2-Lateral intermuscular septum 3-Posterior intermuscular septum Anterior Fascial Compartments of the Thigh Contents of the Anterior Fascial Compartment of the Thigh 1-Muscles: Sartorius, iliacus, psoas, and quadriceps femoris, pectineus 2-Blood supply: Femoral artery 3-Nerve supply: Femoral nerve Note: Not all the contents of the anterior compartment have the same function. For example illopsoas is the main flexor of the thigh at the hip joint while quadriceps femoris is the main extensor of the leg at the knee joint Origin: Iliac fossa Iliacus Insertion: with psoas into lesser trochanter Nerve supply: Femoral nerve Action: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on the thigh as in sitting up from lying down Lesser trochanter Psoas Origin: Transverse processes, bodies, and intervertebral discs of the 12th thoracic and lumbar vertebrae Insertion: With iliacus into lesser trochanter Nerve supply: Lumbar plexus Action: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on the thigh as in sitting up from lying down Iliopsoas Quadriceps femoris Rectus femoris Origin: Straight head: anterior inferior iliac spine (AIIS) Reflected head: ilium above acetabulum Insertion: Quadriceps tendon into patella, then via ligamentum patellae into tibial tuberosity Nerve supply: Femoral nerve Action: Extension of leg at knee joint; flexes thigh at hip joint Vastus lateralis Vastus= Great or Wide Origin: Shaft of femur Insertion: Quadriceps tendon into patella, then via ligamentum patellae into tibial tuberosity Nerve supply: Femoral nerve Action: Extension of leg at knee joint Vastus medialis Origin: Shaft of femur Insertion: Quadriceps tendon into patella, then via ligamentum patellae into tibial tuberosity Nerve supply: Femoral nerve Action: Extension of leg at knee joint; stabilizes patella Vastus intermedius Origin: Shaft of femur Insertion: Quadriceps tendon into patella, then via ligamentum patellae into tibial tuberosity Nerve supply: Femoral nerve Action: Extension of leg at knee joint; articularis genu retracts synovial membrane Sartorius Origin: Anterior superior iliac spine (ASIS) Insertion: Upper medial surface of shaft of tibia (SGS) Nerve supply: Femoral nerve Action: Flexes, abducts, laterally rotates thigh at hip joint; flexes and medially Sartor = Tailor rotates leg at knee joint Helps rotate the leg to the cross-legged position This name was chosen in reference to the cross-legged position in which tailors once sat The upper medial surface of shaft of tibia The combined tendons of insertion are termed is called SGS area for pes anserinus the attachments of 3 (goose foot) muscles: Sartorius Gracilis Semitendinosus Pectineus Origin: Pectineal line of pubis Insertion: Pectineal line of femur Nerve supply: Femoral nerve Action: Flexes and adducts thigh at hip joint Psoas Femoral nerve Is the largest branch of the lumbar plexus (L2, 3, and 4). It emerges from the lateral border of the psoas muscle Leaves the abdomen by passing through the gap behind the inguinal ligament Enters the thigh lateral to the femoral artery and the femoral sheath Innervates all muscles in the anterior compartment of the thigh Innervates skin over the anterior and medial aspects of the thigh, the medial aspect of the knee, leg and the foot (as far as the ball of the big toe) Femoral vein Femoral artery Note that the femoral nerve does not enter the thigh within the femoral sheath Cutaneous branches 1- Medial cutaneous nerve of the thigh 2- Intermediate cutaneous nerve of the thigh 3- Saphenous nerve Muscular branches L2 Iliacus Pectineus Sartorius L3 Quadriceps femoris L4 Articular branches Hip joint Knee joint Femoral nerve L2 L3 L4 Iliacus Inguinal ligament Pectineus Sartorius Quadriceps femoris Femoral branch of genitofemoral nerve Ilio-inguinal nerve Lateral cutaneous nerve of the thigh Obturator nerve Femoral nerve (Intermediate and medial cutaneous nerves of thigh) Lateral Medial THE SAPHENOUS NERVE Femoral Runs downward and nerve medially. It emerges between the tendons of sartorius and gracilis It then runs down in Femoral nerve company with the great (Intermediate and Saphenous saphenous vein. medial cutaneous nerve nerves of thigh) It passes in front of the medial malleolus Femoral nerve (Saphenous nerve) Supplies the medial side of the knee, leg and foot as far as the ball of the big toe Saphenous nerve The saphenous nerve accompanies the femoral artery through the adductor canal, but does not pass through the adductor hiatus with the femoral artery. Rather, the saphenous nerve penetrates the deep fascia and appears between the sartorius and gracilis muscles on the medial side of the knee, and continues down the medial side of the leg to the foot, and supplies skin on the medial side of the knee, leg, and foot. Medial Fascial Compartment of the Thigh Can you think of a bone that can be suitable to provide an origin for an adductor muscle of the hip joint? The Pubic bone Would you be able to think of a bone that can be a good insertion FOR the adductor muscles ? The femur Medial fascial compartment of the Thigh Contents of the Medial Fascial Compartment of the Thigh 1- Muscles: Pectineus, Adductor Longus, Adductor Brevis, Adductor Magnus, Gracilis Obturator externus 2-Nerve supply: Obturator nerve 3-Blood supply: Profunda femoris artery and obturator artery In the practical session Remember that the
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