Transcript Femoral nerve.

Dr. Iman Abdel Aal
Lower Limb
FASCIAL COMPARTMENTS OF THE THIGH
 Three fascial septa pass from the inner aspect of the deep
fascial sheath of the thigh to the linea aspera of the femur.
By this means, the thigh is divided into three
compartments, each having muscles, nerves, and arteries.
The compartments are anterior, medial and posterior in
position.
CONTENTS OF THE ANTERIOR FASCIAL
COMPARTMENT OF THE THIGH



Muscles: Sartorius, iliacus, psoas, pectineus and
quadriceps femoris.
Blood supply: Femoral artery.
Nerve supply: Femoral nerve.
Dr. Iman Abdel Aal
Dr. Iman Abdel Aal
Front of the Thigh
Sartorius

The sartorius is a narrow,
strap-shaped muscle that covers
the femoral artery in the middle
one third of the thigh.

Origin: From the anterior
superior iliac spine.

Insertion: The muscle fibers
run downward and medially
and are attached to the upper
part of the medial surface of the
shaft of the tibia.
Dr. Iman Abdel Aal
Front of the Thigh
Sartorius


Nerve supply: Femoral
nerve.
Action: Flexes, abducts
and laterally rotates the
thigh at the hip joint;
flexes and medially rotates
the leg at the knee joint.
Dr. Iman Abdel Aal
Front of the Thigh
Iliacus

Origin: This fan-shaped
muscle arises from the iliac
fossa within the abdomen.

Insertion: The fibers converge
and join the tendon of the psoas
to form the iliopsoas muscle.

Nerve supply: A branch of
the femoral nerve within the
abdomen.

Action: The iliopsoas flexes
the thigh on the trunk at the hip
joint; or if the thigh is fixed, it
flexes the trunk on the thigh; it
also medially rotates the thigh.
Dr. Iman Abdel Aal
Front of the Thigh
Psoas

Origin: From the roots of the
transverse processes, the sides
of the vertebral bodies and the
intervertebral discs; from the
12th thoracic to the 5th lumbar
vertebrae.

Insertion: The fibers run
downward and laterally and
leave the abdomen to enter the
thigh by passing behind the
inguinal ligament. The iliopsoas
tendon is attached to the lesser
trochanter of the femur.
Dr. Iman Abdel Aal
Front of the Thigh
Psoas

A bursa intervenes between the
tendon and the hip joint and
may communicate with the
joint.

Nerve supply: Branches from
the lumbar plexus.

Action: The iliopsoas flexes
the thigh on the trunk at the hip
joint; or if the thigh is fixed, it
flexes the trunk on the thigh.
Dr. Iman Abdel Aal
Front of the Thigh
Pectineus

Origin: From the superior
ramus of the pubis.

Insertion: The muscle fibers
pass downward, backward, and
laterally and are attached to the
upper end of the linea aspera
just below the lesser trochanter.

Nerve supply: Femoral
nerve. (Occasionally, it receives
a branch from the obturator
nerve.)

Action: Flexes and adducts the
thigh at the hip joint.
Dr. Iman Abdel Aal
Front of the Thigh
Quadriceps Femoris

1.
2.
3.
4.

The quadriceps femoris muscle
consists of 4 parts:
The rectus femoris
Vastus lateralis.
Vastus medialis.
Vastus intermedius.
They have a common tendon of
insertion into the upper, lateral,
and medial borders of the
patella and then, via the
ligamentum patellae, into the
tubercle of the tibia.
Dr. Iman Abdel Aal
Front of the Thigh
Rectus femoris

Origin: A straight head from
the anterior inferior iliac spine
and a reflected head from the
ilium above the acetabulum

Insertion: The two heads
unite in front of the hip joint,
and the bipennate muscle is
inserted into the quadriceps
tendon and so into the patella.

Nerve supply: Femoral
nerve.

Action: See Action of
Quadriceps Femoris Muscle.
Dr. Iman Abdel Aal
Front of the Thigh
Vastus Lateralis

Origin: From the
intertrochanteric line, the base
of the great trochanter, and the
linea aspera of the femur .

Insertion: The fibers pass
downward and forward to be
inserted into the quadriceps
tendon and so into the patella.
Some of the tendinous fibers
join the capsule of the knee joint
and strengthen it.

Nerve supply: Femoral
nerve.
Dr. Iman Abdel Aal
Front of the Thigh
Vastus Medialis

Origin: From the
intertrochanteric line and the
linea aspera of the femur.

Insertion: The fibers pass
downward and forward to be
inserted into the quadriceps
tendon and so into the patella.
Some of the tendinous fibers
join the capsule of the knee joint
and strengthen it. The lowest
muscle fibers are almost
horizontal in direction.

Nerve supply: Femoral
nerve.
Dr. Iman Abdel Aal
Front of the Thigh
Vastus Intermedius

Origin: From the anterior and
lateral surfaces of the shaft of
the femur.

Insertion: The fibers pass
downward and join the deep
aspect of the quadriceps tendon.
The articularis genus is a small
part of the vastus intermedius
that is inserted into the upper
part of the synovial membrane
of the knee joint.

Nerve supply: Femoral
nerve.
Dr. Iman Abdel Aal
Action of Quadriceps Femoris
Muscle (Quadriceps Mechanism)

The quadriceps femoris muscle, consisting of the rectus femoris,
the vastus intermedius, the vastus lateralis and the vastus
medialis, is inserted into the patella and, via the ligamentum
patellae, is attached to the tibial tuberosity.

Together they provide a powerful extensor of the knee joint.
Some of the tendinous fibers of the vastus lateralis and vastus
medialis form bands, or retinacula, that join the capsule of the
knee joint and strengthen it.
The lowest muscle fibers of the vastus medialis are almost
horizontal and prevent the patella from being pulled laterally
during contraction of the quadriceps muscle. The tone of the
quadriceps muscle greatly strengthens the knee joint.
The rectus femoris muscle also flexes the hip joint.
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Dr. Iman Abdel Aal
Femoral Triangle
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The femoral triangle is a triangular
depressed area situated in the
upper part of the medial aspect of
the thigh just below the inguinal
ligament.
It is bounded superiorly by the
inguinal ligament, laterally by the
sartorius, and medially by the
medial border of the adductor
longus muscle.
Its floor is gutter shaped and
formed from lateral to medial by
the iliopsoas, the pectineus and the
adductor longus.
Dr. Iman Abdel Aal
Femoral Triangle


A.
B.
C.
D.
E.
Its roof is formed by the skin and
fasciae of the thigh.
The femoral triangle contains:
The terminal part of the femoral
nerve and its branches.
The femoral sheath.
The femoral artery and its
branches.
The femoral vein and its
tributaries.
The deep inguinal lymph nodes.
Dr. Iman Abdel Aal
Dr. Iman Abdel Aal
Femoral
Shealth
Dr. Iman Abdel Aal
Femoral Sheath
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The femoral sheath is a downward
protrusion into the thigh of the fascial
envelope lining the abdominal walls.
Its anterior wall is continuous above
with the fascia transversalis, and its
posterior wall with the fascia iliaca.
The sheath surrounds the femoral
vessels and lymphatics for about 1 in.
(2.5 cm) below the inguinal ligament.
The femoral artery, as it enters the
thigh beneath the inguinal ligament,
occupies the lateral compartment of the
sheath.
Dr. Iman Abdel Aal
Femoral Sheath
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The femoral vein, as it leaves the thigh,
lies on its medial side and is separated
from it by a fibrous septum and
occupies the intermediate
compartment.
The lymph vessels, as they leave the
thigh, are separated from the vein by a
fibrous septum and occupy the most
medial compartment.
The femoral canal is the term used to
name the small medial compartment
for the lymph vessels. It is about 0.5 in.
(1.3cm) long, and its upper opening is
referred to as the femoral ring.
Dr. Iman Abdel Aal
Femoral Sheath
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a)
b)
c)
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The femoral septum, which is a
condensation of extraperitoneal tissue,
closes the ring.
The femoral canal contains :
Fatty connective tissue.
All the efferent lymph vessels from the
deep inguinal lymph nodes.
One of the deep inguinal lymph nodes.
The femoral sheath is adherent to the
walls of the blood vessels and inferiorly
blends with the tunica adventitia of
these vessels.
Dr. Iman Abdel Aal
Femoral Sheath
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The part of the femoral sheath that
forms the medially located femoral
canal is not adherent to the walls of the
small lymph vessels; it is this site that
forms a potentially weak area in the
abdomen.
A protrusion of peritoneum could be
forced down the femoral canal, pushing
the femoral septum before it.
Such a condition is known as a
femoral hernia.
Dr. Iman Abdel Aal
Femoral Sheath
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The upper end of the canal, or femoral
ring, has the following important
relations:
Anteriorly: the inguinal ligament.
Posteriorly: the superior ramus of the
pubis.
Medially: the lacunar ligament.
Laterally: the femoral vein.
The lower end of the canal is normally
closed by the adherence of its medial
wall to the tunica adventitia of the
femoral vein. It lies close to the
saphenous opening in the deep fascia of
the thigh.
Dr. Iman Abdel Aal
Dr. Iman Abdel Aal
Dr. Iman Abdel Aal