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Anterior and Medial Compartments of the Thigh Hannah Neill hneill04@qub.ac.ukLearning Outcomes • Identify the sartorius, rectus femoris, vastus medialis, vastus lateralis and vastus intermedius muscles and describe the origin, insertion, innervation and actions of these muscles • Identify the iliopsoas muscle and describe the innervation and principal action of this muscle • Identify the boundaries of and structures within the femoral triangle • Describe the location and contents of the femoral sheath • Identify the adductor longus, adductor brevis, adductor magnus, pectineus and gracilis muscles and describe the innervation and actions of these muscles • Identify and describe the boundaries of the sub-sartorial canal • Name and identify the structures that travel within the sub-sartorial canalCompartments of the Thigh Compartment Muscles Anterior Quadriceps femoris, sartorius, iliopsoas Posterior Biceps femoris, semimembranosus, semitendinosus Medial Adductor brevis, longus & magnus, gracilis, obturator externus, pectineusIdentify the sartorius, rectus femoris, vastus medialis, vastus lateralis and vastus intermedius muscles and describe the origin, insertion, innervation and actions of these muscles Rectus Femoris Sartorius Vastus Medialis Vastus Lateralis Vastus IntermediusMuscles of Anterior Thigh (Knee Extensors) Muscle Origin Insertion Innervation Main Action Quadratus Femoris Rectus Femoris AIIS & ileum (superior to Common tendon Femoral nerve Extend leg at knee acetabulum) (quadriceps (L2-L4) joint tendon) which (rectus femoris Vastus Lateralis Greater trochanter & attaches to base also helps lateral lip of linea aspera of femur of patella iliopsoas with Vastus Medialis Intertrochanteric line & flexion of thigh) medial lip of linea aspera of femur Vastus Intermedius Anterior & lateral surfaces of shaft of femur Sartorius ASIS Superior medial Femoral nerve Flex, abduct & tibia (L2-L4) lateral rotation of hip Flex kneeClinical Context – Testing Femoral Nerve Lower limb motor neurological examination Patient supine, knee flexed. Ask patient to extend knee against resistance (contract quadratus femoris).Identify the iliopsoas muscle and describe the innervation and principal action of this muscleMuscles of Anterior Thigh (Hip Flexors) Muscle Origin Insertion Innervation Main Action Iliopsoas Psoas major Side of T12-L5 Lesser trochanter Anterior rami of Flex the hip vertebrae, IV disc and of femur lumbar nerves transverse process of (L1-L3) all L1-L5 Psoas minor Side of T12-L1 Pectineal line Anterior rami of vertebrae & IV disc lumbar nerves (L1-L2) Iliacus Iliac crest, iliac fossaTendon of psoas Femoral nerve ala of sacrum, major, lesser (L2-L4) anterior sacro-iliac trochanter ligamentsIdentify the boundaries of and structures within the femoral triangle Boundaries: • Roof– fascialata • Floor – pectineus, iliopsoas • Superior – inguinal ligament • Lateral – medial border of sartorius • Medial – medial border of adductor longus “SAIL”Identify the boundaries of and structures within the femoral triangle Contents: • Femoral nerve (L2-L4) • Femoral artery • Femoral vein • Femoral canal (containing lymph nodes) Note: femoral sheath contains the femoral artery, vein and canal. *the femoral nerve is not located in the femoral sheath!Clinical Context – Femoral Pulse Femoral pulse can be palpated at mid inguinal point. Mid-Inguinal Point Midpoint of Inguinal Ligament Midway between pubic Midway between pubic symphysis & ASIS tubercle & ASIS Femoral pulse Deep inguinal ringBoundaries of the femoral canal • Anterior – inguinal ligament • Posterior– pectineal ligament • Medially – lacunar ligament • Laterally – femoral veinClinical Context – Femoral Hernia Bowel pushes into the femoral canal, underneath the inguinal ligament. Presentation: • Elderly woman • Mildly painful lump in groin (inferolateral to pubic tubercle) • Typically nonreducible Complications: • incarceration (cannot be reduced) • Strangulation • Bowel obstruction • Bowel ischaemia (present systemically unwell)Identify the adductor longus, adductor brevis, adductor magnus, pectineus and gracilis muscles and describe the innervation and actions of these muscles Pectineus GracilisMuscles of Medial Thigh (Hip Adductors) Muscles Origin Insertion Innervation Main Action Adductor Longus Body of pubis inferior Middle 1/3 of linea Obturator nerve Adduct thigh to pubic crest aspera of femur (L2-L4) Adductor Brevis Body of inferior ramus Pectineal line and Adducts thigh of pubis proximal part of linea aspera of femur Adductor Magnus: Inferior ramus of Gluteal tuberosity, Adduct & flex thigh Adductor part pubis, ramus of linea aspera, medial ischium supracondylar line Hamstring part Ischial tuberosity Adductor tubercle of Tibial part of sciatic Extend thigh femur nerve (L4) Gracilis Body & inferior ramus Superior medial tibia Obturator nerve Adduct thigh, flex leg of pubis (L2-L4) Pectineus Superior ramus of Pectineal line of femur Femoral nerve (L2 -L4) Adduct, flex & medially pubis rotate thighIdentify and describe the boundaries of the sub-sartorial / adductor canal Apex of femoral triangle (where sartorius and adductor longus meet) à adductor hiatus of adductor magnus Boundaries: • Anteromedial – sartorius • Lateral – vastus medialis • Posterior– adductor longus & adductor magnusName and identify the structures that travel within the sub- sartorial canal Contents: • Femoral artery • Femoral vein • Nerve to vastus medialis • Saphenous nerve (branch of femoral nerve) the canal, they become the popliteal artery and vein.Which of the following structures are not present in the femoral sheath? A. Femoral artery B. Femoral vein C. Femoral nerveWhich of the following structures are not present in the femoral sheath? A. Femoral artery B. Femoral vein C. Femoral nerveA middle aged patient presents to A&E with a lump in the groin region. On examination the lump is present superior and lateral to the pubic tubercle. What is the diagnosis? A. Inguinal hernia B. Femoral hernia C. Umbilical hernia D. Incisional herniaA middle aged patient presents to A&E with a lump in the groin region. On examination the lump is present superior and lateral to the pubic tubercle. What is the diagnosis? A. Inguinal hernia B. Femoral hernia C. Umbilical hernia D. Incisional herniaYou are a 2 year medical student on the wards. A consultant asks you to assess the patients femoral pulse. Where do you palpate? A. Midpoint of inguinal ligament B. Adductor hiatus C. Popliteal fossa D. Mid-inguinal pointYou are a 2 year medical student on the wards. A consultant asks you to assess the patients femoral pulse. Where do you palpate? A. Midpoint of inguinal ligament B. Adductor hiatus C. Popliteal fossa D. Mid-inguinal pointHelpful Videos • FemoralTriangle https://www.youtube.com/watch?v=FmwvD7jd30&list=PLSL- eqKP1SPFljwf_JW319-g46YcjdQfd&index=15 • Femoral sheath & canal: • https://www.youtube.com/watch?v=EnyJ2U46n88&list=PLSL eqKP1SPFljwf_JW319-g46YcjdQfd&index=29Thank you!