Lab Manual - Anterior & Medial Thigh

Assignments:

  1. Complete the learning module entitled Movements of the Lower Limb.
  2. Read the Lab Manual and Dissector Answers, view the Lab Video, and review the Prelab Images.
  3. Read Woodburne & Burkel: 586-588, 590-607

Objectives:

Upon completion of this session, the student will be able to:

  1. Define the femoral triangle and adductor canal, their contents and the spatial relationships of the structures passing through them.
  2. Identify the femoral and obturator arteries and veins and their branches. Give their areas of distribution.
  3. Identify the muscles of the anterior and medial thigh, including their nerve and vascular supply. Describe their role in locomotion.
  4. Predict what nerve or nerves are involved and the probable level of the injury, given a loss of function and/or cutaneous sensation involving the anterior and medial thigh regions.

Summary of Dissection Procedure:

  1. Review the bony landmarks.
  2. Dissect the femoral triangle, noting its boundaries and contents.
  3. Define the adductor canal, open it and identify its contents.
  4. Clean and identify the blood vessels of the anterior and medial thigh.
  5. Clean and identify the components of the quadriceps femoris muscle.
  6. Clean and identify the muscles and nerves of the medial femoral compartment.

Procedure:

1. Review the bony landmarks. (Play movie; View images: N 248, 359, 383, 486A, 486B, 489, 507, 511, 513)

On the pelvis, identify the pubic symphysis, pubic crest, pubic tubercle, pubic pecten, anterior superior iliac spine, anterior inferior iliac spine, iliac crest and tubercle of ilium, ischiopubic ramus, ramus of ischium and inferior pubic ramus. On the femur identify the lesser trochanter, the pectineal line, the linea aspera, the medial and lateral epicondyles and the adductor tubercle. In the leg identify the patella, tibia, and fibula, tibial condyles, tuberosity of the tibia, medial malleolus, and the lateral malleolus.

Knee joint

2. Dissect the femoral triangle, noting its boundaries and contents. (Play movie; View images: N 262, 492, 496, 500A, 500B, 505, 544, 546)

Return to the anterior thigh. Palpate the borders of the femoral triangle. Expose the sartorius muscle throughout its length and note its insertion via the pes anserinus (along with which other two muscles? ). Remove the fascia lata from the femoral triangle and identify the adductor longus, pectineus and iliopsoas muscles. These muscles will be completely dissected later. Within the triangle, identify the femoral nerve, artery and vein, and note their relationships to one another from lateral to medial. Observe the termination of the greater saphenous vein. Observe the femoral sheath and its compartments. Identify the femoral canal. Do you see deep inguinal lymph nodes within the canal? Note how the canal and sheath pass deep to the inguinal ligament into the thigh. Define the vascular and muscular lacunae deep to the inguinal ligament. What is a femoral hernia?

Remove the fascia lata over the anterior muscles of the thigh and palpate the lateral intermuscular septum, noting its relation to the iliotibial tract.

3. Define the adductor canal, open it and identify its contents. (Play movie; View images: N 493, 500, 502, 512, 538)

Define the adductor canal. Elevate and reflect the sartorius muscle by dividing it at its midpoint. Remove the fascia forming the roof of the canal. This will include a dense band of aponeurotic fibers, the vastoadductor membrane, spanning from the adductor magnus to the vastus medialis. Trace the femoral artery and vein through the canal to the adductor hiatus. Identify the nerve to the vastus medialis. Source?

CT of adductor canal

4. Clean and identify the blood vessels of the anterior and medial thigh. (Play movie; View images: N 500, 501, 502, 504, 512, 544)

Locate the femoral artery passing under the inguinal ligament. Define its surface projection. Note relations as it enters the thigh. Locate remnants of the superficial epigastric, superficial external pudendal and superficial circumflex iliac arteries. Trace the femoral artery throughout the thigh, reviewing its course in the femoral triangle and adductor canal. Define the deep femoral artery, muscular branches and note the descending genicular artery. Trace the latter between the vastus medialis and the adductor magnus tendon.

Trace the femoral vein and note its relationship to the femoral artery at the inguinal ligament. Note the junction of the greater saphenous vein and the point of junction of the deep femoral vein. How does the relation of the femoral vein to the femoral artery change throughout the thigh? What are their relations in the popliteal fossa? Remove the vein where necessary to expose the arteries.

Return to the femoral triangle; define and trace the deep femoral artery. What is its relation to the insertions of the adductor muscles? Trace the medial femoral circumflex artery, its course between the iliopsoas tendon and the pectineus muscles, its distribution to the adductor muscles and its termination deep to the quadratus femoris.

Trace the lateral femoral circumflex artery; note its three branches and define the position and area supplied by each. Are there variations in origin? What are the relations to the rectus femoris muscle and to the femoral nerve?

Locate the perforating branches of the deep femoral artery. Their distribution in the hamstring muscles and vastus lateralis will be seen later. How many do you find? How do you distinguish a perforating artery?

5. Clean and identify the components of the quadriceps femoris muscle. (Play movie; View images: N 500, 501, 507)

Define the quadriceps femoris muscle group. Examine the rectus femoris muscle and its straight and reflected heads of origin; it will be necessary to remove the origin of tensor fasciae latae and the anterior fibers of the gluteus medius and minimus to see the reflected head. Identify the vastus medialis, vastus intermedius and vastus lateralis muscles. Trace the four heads, noting their manner of insertion via the patella, patellar ligament and patellar retinacula. What is the function of the patella? Trace the branches of the femoral nerve to the sartorius and all heads of the quadriceps femoris.

Coronal section of the thigh
Coronal section of the thigh
Coronal section of the thigh

6. Clean and identify the muscles and nerves of the medial femoral compartment. (Play movie; View images: N 490, 491, 492, 493, 497, 498, 500, 501, 539)

The medial muscles of the thigh consist of the adductor muscles, supplied primarily by branches of the obturator nerve. Dissect the gracilis muscle, noting its combined insertion with the sartorius and semitendinosus (pes anserinus). Locate the branch of the obturator nerve to the gracilis. Dissect the adductor longus and pectineus muscles as a single sheet of muscle. Reflect them from their origins by using the obturator nerve to gracilis to separate this layer from the underlying adductor brevis and adductor magnus. Define the adductor longus and pectineus by their different origins. Completely expose the anterior division of the obturator nerve. What muscles does it supply? What supplies pectineus? What artery accompanies the nerve?

On the anterior surface of the adductor magnus locate the posterior division of the obturator nerve. Trace it toward the obturator canal. This will assist in separating the adductor brevis from the adductor magnus muscles. Dissect adductor brevis and reflect it from its origin. Complete tracing the posterior division of the obturator nerve. Dissect the adductor magnus, noting its two basic parts, the adductor tendon and the manner of formation of the adductor hiatus.

Cross section of the thigh
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