anterior thigh by- dr. armaan singh
TRANSCRIPT
Anatomy Of Anterior ThighAnatomy Of Anterior Thigh
By- Dr. Armaan SinghBy- Dr. Armaan Singh
Anterior muscle group: supplied by femoral nerve
Sartorius Quadriceps: rectus
femoris, vastus medialis, vastus intermedius and vastus lateralis
Pectineus
Medial or adductor group: adductor longus, adductor brevis, adductor portion adductor magnus and gracillis are supplied by the obturator nerve
Posterior group: hamstring, semimembranosus, semitendinosus, biceps femoris, adductor magnus, below femoral hiatus
Supplied by sciatic nerve
Anterior wall formed by transversalis fascia
Posterior by fascia iliaca Three compartments Medial, short, is the femoral canal,
contains lymph gland Opens into abdomen via femoral ring,
site of femoral hernia Middle compartment contains femoral vein Lateral, femoral artery and femoral branch
of genito-femoral nerve Femoral nerve is outside sheath
Rectus femoris Vastus medialis Vastus intermedius Vastus lateralis Forms the anterior portion of the
capsule of the knee joint The largest muscle group in the
body Wastes rapidly if there is an
effusion, particularly the oblique portion of the vastus medialis
Tendinous origin from the upper part of the anterior inferior iliac spine (epiphysis) and the groove above the acetabulum
The most superficial portion of the quadriceps
The most frequently strained The only portion of the
quadriceps that crosses two joints
Flexes hip, extends knee Femoral nerve
Vastus medialis arises from the lower half of the trochanteric line
The spiral line The medial lip of the linea
aspera The oblique (horizontal) fibres
arise from the lower portion of the adductor magnus, helping to stabilise the patella
Separate branch from femoral nerve
Arises from the upper half of the inter-trochanteric line
The root of the greatertrochanter The lateral lip of the gluteal
tuberosity The lateral lip of the linea
aspera The oblique portion of the
muscle arises from the iliotibial band Separate nerve supply Helps to stabilise the patella Lateralis is a common site for
muscle biopsies and for injections
Arises from the upper two thirds of the anterior and lateral aspect of the shaft of the femur
It is the deepest portion of the quadriceps and is a common site (with vastus lateralis) for myositis ossificans, after a direct blow to the thigh
The articularis genu is inserted into the upper part of the suprapatellar bursa
The rectus femoris forms the most superficial lamina of the quadriceps, passes anterior to the patella
To form the anterior part of the patellar ligament
The fibres of the medialis and the lateralis decussate cross in an X-shape and lie in a plane posterior to the rectus femoris
Some of these fibres form the retinacular fibres
Their oblique portions are inserted into the sides of the patella
The vastus intermedius is the most posterior lamina, forms the main part of the patellar ligament
It is the most powerful extensor The patellar ligament is inserted
into the smooth upper portion of the tibial tuberosity
The quadriceps are the extensors of the knee
Only the rectus femoris portion arises above the hip joint, and therefore is also a flexor of the hip
Lower most fibres of vastus medialis
Partly arise from the adductor magnus
Straightens the pull on the quads tendon and patella
Controls patella tracking during flexion/extension of the knee
Fibres atrophy quickly after knee injury (within 24 hours)
10-15 ml of effusion inhibit VMO VMO rehabilitation strength and
timing of contraction
Anatomical anomalies Femoral torsion Genu valgum Increased Q angle High (Alta) patella Tibial torsion Overpronation Q angles
males 140 and females 170
> 200 greater problems
The Q-angle is the angle formed by a line drawn from the anterior superior iliac spine to the centre of the patella
And a line drawn upwards from the attachment of the patellar ligament to the tibial tubercle passing through this point
Functionally, on standing, the normal angle is 10–15°
With the knee at 90°of flexion, an angle of 6°is normal, while greater than 10°is abnormal
Contraction of the quadriceps tends to displace the patella laterally in the femoral groove
The oblique fibres of the vastus medialis and the bony prominence of the lateral femoral condyle resist this
In young athletes, the patellar ligament is stronger than the bone
Which can lead to a traction apophysitis of the tibial tuberosity, Osgood Schlatter disease
Jumpers’ knee is a lesion at the apex of the patella and the ligament
Sartorius arises from anterior superior illiac spine
Forms lateral boundary of femoral triangle Crosses adductor longus at apex Lies anterior to femoral artery Posterior to adductor longus lies the
profunda artery Knife injury at apex can injury both arteries
and the main blood supply to lower limb Sartorius lies on roof of subsartorial canal
which contains femoral artery
Inserted into upper third of medial surface of tibia
Anterior to gracillis and semitendinosus, as part of the pes anserinum
Separated by tibial intertendinous bursa
Supplied by femoral nerve
Adductor longus Adductor brevis Portion of adductor
Magnus Gracilis Supplied by obturator
Nerve L2,3,4 Act with lower
abdominals to stabilise the pelvis
lateral medial
inferior
Tendinous origin, pubic body, has a variable shape
Inserted into medial lip of linea aspera
Most frequently torn at proximal musculo-tendinous junction, which varies
Or may tear at teno-periosteal junction
Site of junction varies, medial or lateral, may be longer in some
Anterior division obturator nerve
Origin lower portion of body of pubis
Inferior pubic ramus Inserted into lower half of
the pectineal line Upper half of the linea
aspera Deep to adductor longus Separates two divisions
of obturator nerve Anterior division supplies
it
Triangular area of ischial tuberosity Ramus of ischium and inferior
ramus of pubis Inserted into medial lip of gluteal
tuberosity Lateral lip of linea aspera Medial supracondylar line Adductor tubercle Hiatus for popliteal vessels Origin of oblique fibres of vastus medialis Post division obturator nerve Sciatic nerve below hiatus for femoral
vessels
Gracilis is the weakest, most medial and superficial of the adductors
Gracilis is the only one that crosses the knee joint
It arises from a thin aponeurosis, lower half of the body and the inferior ramus of the pubis and part of the ramus of the ischium. It is strap like above
It ends in a rounded tendon, inserted into the upper portion of the medial surface of the tibia between the sartorius and the semitendinosus
Gracilis is separated from sartorius and the semitendinosus by the tibial intertendinous bursa (pes anserinum)
Gracilis is usually supplied by the anterior division of the obturator nerve, L2, 3, 4
It adducts the hip and flexes and medially rotates the leg
Inflammation of the tibial intertendinous bursa
Must be differentiated from injury to the lower attachment of the medial collateral ligament of the knee
The adductors adduct the femur and help to stabilise and counteract the rotation of the pelvis, particularly during the double support
When the anterior limb is flexed and the posterior limb is extended
Carlsoo, 1972
Common in soccer is adductor muscle-tendon strain. Be aware of:
• Rectus Femoris• Sartorius• Rectus
Abdominus• Pectineus• Adductor
Magnus• Gracilis
If the hip is flexed, the adductors rotate the hip medially
When the hip is extended the adductors can laterally rotate
They can also flex the extended hip and extend the flexed hip
At the beginning of the swing phase of walking they work synergistically with the iliopsoas
At the end of the swing phase, they work with the hamstrings, which contract to prevent further hip flexion
The pectineus muscle is a short flat muscle, which forms part of the floor of the femoral triangle
It arises from the anterior aspect of the superior ramus of the pubic bone and the fascia covering it
It is inserted into the upper half of a line drawn from the lesser trochanter to the linea aspera and lies posterior to the femoral sheat
It is supplied by a branch from the femoral nerve or the accessory obturator (L2, 3)
The pectineus is mainly a flexor of the thigh and a weak adductor
There may occasionally be some fusion between the adductor longus and brevis or with the pectineus
Doubling of the origin of the adductor longus or brevis may also take place
Origin Intervertebral discs, adjoining
bodies of T12-L5 vertebrae Medial half, anterior aspect of
five lumbar transverse processes
Fibrous arches on the sides of the bodies of the four upper four lumbar vertebrae, over four lumbar arteries
Inserted into the lesser trochanter of femur
Nerve L2,3,4
Minor Origin T12 –L1 Insertion Arcuate line Iliopubic eminence
The psoas is covered by fascia which is attached medially to the lumbar vertebrae
To the fibrous arches Medially along the brim of the
pelvis to the arcuate and pectineal lines
Laterally, the fascia is attached to the transverse processes of the lumbar vertebrae
Medial Arcuate Ligament is a thickening of fascia over the Psoas
Flexes the hip when acting from above
Lumbar plexus is formed inside the substance of psoas
A strain of the psoas muscle may be the cause of chronic groin pain, and you must take care not to mistake it for an adductor strain
Psoas bursa, between psoas and capsule of hip joint, may communicate with the synovial membrane of the joint
Psoas abscess will present in the groin
The iliacus Origin: iliac fossa and iliac crest Inserted into the lateral aspect of the psoas
and into the femur below the lesser trochanter Nerve L2,3 The iliopsoas is an active postural or stabilising
muscle of the hip which helps to prevent hyperextension of the hip while standing
Acting from above, the iliopsoas flexes the hip and may be either a medial or a lateral rotator; acting from below, psoas flexes spine
In walking, the iliopsoas is used to start swinging the leg forwards
On level ground the leg moves forwards like a pendulum to complete the swing
Stronger contraction of the iliopsoas is required when running or walking up a hill
When climbing stairs, the iliopsoas lifts the leg and places the foot on the stair above
When preparing to stand from sitting, the iliopsoas pulls the trunk forwards as the femur is fixed
The trunk leans forwards and, before standing upright, the centre of gravity of the trunk moves over the feet
In sitting up from lying, the iliopsoas pulls on the pelvis and the lower vertebrae in order to pull the trunk up
Tyldesley & Grieve, 1989
Running with the legs lifted high, helps to develop the iliopsoas
The iliopsoas is also used in the downbeat of freestyle swimming
The iliopsoas is the main muscle involved in straight leg sit-ups
These, however, should never be done as they put stress on the lumbar vertebrae and do nothing for the abdominal muscles