Lecture Notes - Anterior & Medial Thigh

The streaming video of the 2004-5 lab overview is available on the web (password protected). The computer presentation used by Dr. Gest in lecture is available on the web (password protected). You can also download the PowerPoint presentation to print or review.

Osteology:

• Ilium
  
  • Anterior superior iliac spine - for inguinal ligament & sartorius m.
    
  • Anterior inferior iliac spine - for rectus femoris m.
    
  • Iliac tubercle - attachment of iliotibial tract
    
• Ischium - tuberosity, ramus, (ischiopubic ramus)
  
• Pubis - inferior pubic ramus, body & pecten
  
• Femur
  • Medial & lateral epicondyles
  • Greater trochanter
  • Lesser trochanter - for iliopsoas m.
  • Pectineal line - posterior femur inferolateral to lesser trochanter
  • Linea aspera - for adductor muscles
  • Adductor tubercle - for hamstring part of adductor magnus
• Patella - largest sesamoid bone
• Tibia
  • Medial malleolus - medial ankle
• Fibula
  • Lateral malleolus - lateral ankle

• Investing Fascia

• Fascia lata - envelopes thigh
  • Iliotibial tract - lateral thickening, attached to lat. tibial condyle
  • Saphenous opening - for greater saphenous v. & other vs.
• Crural fascia - leg fascia
• Popliteal fascia - behind knee
• Dorsal & plantar fascia of foot

• Superficial Veins

• Dorsal venous arch of foot
• Greater saphenous vein - ant. to med. malleolus, post. to med. epicondyle
  • Superficial epigastric vein
  • Saphenous vein cutdown
• Lesser saphenous vein - post. to lateral malleolus; drains to popliteal v.
• Perforating veins - to deep veins
• Varicose veins

• Cutaneous Nerves

• Lateral femoral cutaneous - from lumbar plexus (L2-3)
  • Meralgia paresthetica - nerve compression
• Anterior femoral cutaneous brs. of femoral n.
• Posterior femoral cutaneous - from sacral plexus (S1-3); deep to fascia lata; inferior cluneal brs.; perineal br.
• Femoral branch of genitofemoral nerve - upper anteromedial thigh
• Cutaneous br. of obturator n. - medial thigh inferiorly
• Saphenous - longest cutaneous nerve; from femoral
• Sural cutaneous - medial & lateral - from tibial & common fibular
• Sural - formed mid-calf by union of brs. of med. & lat. sural
  • Sural nerve graft - piece taken to repair nerve injured elsewhere
• Superficial fibular (peroneal) - anterior ankle & dorsum of foot
• Deep fibular (peroneal) - between 1st & 2nd toes
• Superficial inguinal lymph nodes

Muscles:

• Iliopsoas - to lesser trochanter
  
• Anterior thigh:
  • Sartorius - roof of adductor canal; to pes anserinus on med. condyle of tibia
  • Quadriceps femoris - rectus femoris & 3 vasti
    • Rectus femoris - crosses hip & knee
    • Vastus medialis, intermedius, & lateralis
    • Patellar ligament (tendon) & retinacula
• Medial thigh:
  • Pectineus - innervated by femoral n.
    
  • Gracilis - to pes anserinus
    
  • Adductor longus - anterior-most adductor; floor of adductor canal
    
  • Adductor brevis - between longus & magnus
    
  • Adductor magnus
    • Adductor tendon - ischiocondylar part
    • Adductor hiatus
  • (Obturator externus - deep to adductor magnus origin; will see later)

Femoral triangle:

• Boundaries - inguinal lig., sartorius & add. longus
  
• Muscular & vascular lacunae - under ing. lig.
  
• Contents:
  • Femoral nerve brs.
  • Femoral sheath - transversalis fascia
    • Contents - femoral a,v & lymphatics
    • Femoral canal - med. compartment of femoral sheath; contains deep inguinal node(s)
    • Femoral ring - internal opening of femoral canal; may have deep ing. node (node of Cloquet)
    • Femoral hernia

Adductor canal (subsartorial or Hunter's canal):

• At inferior point of femoral triangle
  
• Contents:
  • Femoral vessels
  • Nerve to vastus medialis
  • Saphenous n.
• Vastoadductor membrane - covers vessels in lower part of canal
  
• Adductor hiatus - femoral vessels pass through to become popliteal vessels

Arteries & Veins:

• Femoral (common femoral) - from ing. lig. to adductor hiatus
  • Deep femoral - between add. longus & brevis
    • Medial circumflex femoral - between iliopsoas & pectineus
    • Lateral circumflex femoral - deep to rectus femoris
    • Perforating brs. (4) - supply hamstrings (post. thigh)
  • Descending genicular artery
• Obturator - adductor origins & hip joint

Nerves:

• Femoral - for anterior thigh
  • Nerve to vastus medialis - within adductor canal
  • Saphenous nerve
• Obturator - for medial thigh; ant. & post. divisions surround adductor brevis

Deep inguinal lymph nodes

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