Unit 10

Anterior and Medial Thigh(Cadaver Supine)

Learn the Three Compartments in the Thigh, Actions and

Nerve Supply

Plate 505Preview

Anterior CompartmentFemoral Nerve

Extension of Knee

Posterior CompartmentSciatic Nerve

Extension of Thigh and Flexion of Knee

Medial Compartment

Obturator NerveAdduction of Thigh

Thigh: Cross Section

F

Lateral Intermuscular

Septum

Medial Intermuscular

Septum

Fascia Lata and Iliotibial

Tract

Posterior Intermuscula

r Septum

P

A M

Right thigh from feet looking up

Plate 498A

Femoral NerveL2-4

ObturatorNerve L2-4

T12

L1

L2

L3

L4

Anterior DivisionPosterior Division

This is the Lumbar

Plexus formed by ventral

rami of L1 - 1/2 of L4

L5

Preview

Plate 498B

Genitofemoral L1,2

Femoral L2-4

Obturator L2-4

Subcostal T12

Iliohypogastric &

IlioinguinalL1

Lat. Femoral Cutaneous

L2,3

Lumbosacral trunks

(1/2 L4-L5)

L1L2

L3L4

L5

These are SOMATIC NERVES!

Pubic tubercle

Anterior Superior Iliac

Spine Inguinal Ligament

Aponeurosis of External Oblique

MuscleObturator Foramen

Palpate or LocateAnterior Superior Iliac Spine

Pubic TubercleInguinal LigamentObturator Foramen

Plate 248Bony Framework

Anterior Inferior Iliac Spine

Inguinal Ligame

nt

ASIS

Pubic Tubercle

Plate 249Inguinal Ligament

External Oblique Muscle

Aponeurosis

Plate 513A

Palpate/LocatePatella

Tibial Tuberosity

Tibial Tuberosity

Medial

Feel the Patella, a sesamoid

bone in the tendon of

the Quadriceps

Muscle

Bones

Quads

P

Plate 544

Preserve the Great

Saphenous Vein

Used in coronary by-pass surgery

Great Saphenous Vein

Great Saphenous Vein

Dorsal Venous Arch

Superficial Veins

“Saphenous Cut-down”

for emergency transfusions;

GS Vein is ALWAYS present in front of medial malleolus

Medial Malleolus

Superficial Veins

Page 584 Moore

These veins can become

“varicose”

Due to incompetent valves

of perforating veins that connect

deep veins with

superficial veins

Blood flow changes direction:

from deep to superficial

Page 583, Moore

Calf Muscular

Pump: return of blood to

heart against gravity

Superficial Veins

Direction of blood flow normally

Anterior Compartment

Femoral Nerve(Extensor

Compartment)

Plate 544

Greater Saphenous Vein

Saphenous Opening in Fascia Lata

Clean and IdentifyFascia LataSaphenous

Opening

The Greater Saphenous Vein terminates in the Femoral Vein here

Plate 494

Locate Iliotibial Tract Tensor Fasciae

Latae

What is the TFL’s

innervation?

Anterior Thigh

Muscles in the Anterior Compartment

Identify, transect,

and reflectSartorius

Plate 492A

The Sartorius is the “tailor’s”

muscle – flexes, abducts, laterally rotates

thigh and flexes leg

Anterior Thigh

Using both muscles

brings you into a cross-

legged sitting

position

Sartorius

ASIS

Medial

AP radiograph of pelvis: prior healed

avulsion fraction of ASIS

Identify the “Quads” or Quadriceps

Femoris4 Heads:Vastus

LateralisVastus MedialisRectus Femoris

Vastus Intermedius

Plate 492A

Vastus Lateralis

Vastus Medialis

Rectus Femoris

Anterior Thigh

Transect the Rectus Femoris

Medial

Plate 492B

After transecting

Rectus Femoris -

identify the Vastus

Intermedius

Note: the origin of the Vasti muscles is from the shaft of the femur but

the Rectus Femoris

originates from the AIIS

Vastus Intermedius

Anterior Thigh

Origin of Rectus

Femoris can be avulsed

during forceful kicking

AIIS

Medial

All 4 heads of the quads insert into the tibial tuberosity via

the Patellar Ligament

Action: Extension of leg at knee

joint

Plate 507A

Read about Osgood-Schlatter disease, Moore,

page 568 inflammation of tibial tuberosity

with chronic pain

Anterior Thigh

Tibial Tuberosity

Patellar Ligament

Quadriceps

Tendon

P

Medial

Patellar Tendon Reflex or knee jerk – tests L2-4 spinal cord segments

and the femoral nerve; page 597 Moore

Plate 543BAnterior Thigh

Reflex Hammer

Femoral Triangle and Contents

Identify boundaries of the Femoral

Triangle

Anterior Thigh

Identify Femoral Nerve

Emerges below Inguinal Ligament

Plate 538A

Femoral NerveL2-4

Lumbar Plexus

Anterior Thigh

Obturator Nerve

Plate 546C

Identify Femoral Artery Femoral Vein

Note the vessels are encased in

the Femoral Sheath

The nerve is not!

N

Anterior Thigh

Inguinal Ligament

A

V

Femoral sheath

ASIS

Pubic Tubercle

External Iliac Vessels

Note Femoral Canal

Spell NAVEL

There are 3 compartments formed by the Femoral Sheath

1

2

3

Anterior Thigh

N

AV

E L

Lateral

Intermediate

Medial1

Moore page 601

Note Femoral Hernia in Femoral Canal

More common

in females Lateral to pubic tubercle

Anterior Thigh

Moore page 606

Remove the Femoral

Sheath and follow the Femoral

Vessels into the Adductor

Canal and through the

Adductor Hiatus

Note the Saphenous Nerve

Plate 500BAnterior Thigh

Femoral Nerve,

Artery and Vein

Adductor Canal

Saphenous Nerve

Adductor Hiatus

One is the Pectineus

muscle which is variably

supplied by the Femoral Nerve and

the Obturator

NerveA flexor and adductor of

thigh

Plate 492A

There are two muscles that form the floor of the

Femoral Triangle

Anterior Thigh

Pectineus

Medial

The other is the

Iliopsoas

Inserts on lesser

trochanter

The strongest flexor of hip joint

Plate 496Anterior Thigh

Iliacus

Psoas

Iliopsoas

Identify branches of

Femoral ArteryDeep Femoral

Perforating Branches

Deep Femoral

Plate 512Anterior Thigh

Femoral Artery

Medial

Perforating

branches

Lateral Circumflex

Femoral Medial Circumflex

Femoral

Plate 512Anterior Thigh

Deep Femoral Artery

The deep femoral artery has two other significant branches

Lateral Circumflex FemoralMedial Circumflex Femoral

These are critical for blood supply to head of femur especially medial circumflex femoral

artery

Moore, page 680

Deep

Retinacular branches are most important

Summary

Anterior Compartment Nerve Supply: Femoral Nerve

Blood Supply: Branches of Femoral Artery

Action of Muscles: Extension of Leg at Knee and Flexion of

Thigh at the Hip

Medial Thigh

Obturator Nerve(Adductor

Compartment)

Gracilis

Adductor Longus

Divide and reflect Adductor Longus

Plate 492B Medial Thigh

Expose and Identify muscles

of the adductor/medial

compartmentGracilis

Adductor LongusAdductor Brevis

Adductor Magnus

P

Adductor Brevis

Plate 500 Medial Thigh

Identify Adductor Brevis

P

Divided Adductor Longus

AL

Gracilis

Sartorius

Medial

Plate 500 Medial Thigh

Identify Anterior and

Posterior branches of the Obturator Nerve

Obturator Nerve

Medial

Adductor Brevis

IdentifyAdductor Magnus

This muscle receives branches from two nerves:

Tibial and Obturator

“groin pulls” = strain

Plate 493 Medial Thigh

Adductor Magnus

Foramina for Perforating branches

Adductor Hiatus

“Hamstring part”

Adductor Magnus

Gracilis

Adductor Longus

Adductor Brevis

Note origins of the

adductor muscles;

they mostly insert on the back of the

femur

Pectineus

Plate 491Attachments

Linea Aspera

Posterior

The adductor muscles adduct the thigh at the

hip joint

Plate 485

Inguinal Ligament

Sartorius

Vastus Lateralis

Rectus Femoris

Vastus Medial

is Gastrocnemius

Greater Saphenou

s Vein

Surface Anatomy

Patella Ligament

Summary of Medial Compartment

Nerve Supply: Obturator Nerve

Blood Supply: Obturator Artery

Action of Muscles: Adduction of thigh at hip joint

Hip Joint

Plate 488 Hip Joint

Ilium

Pubis

Ischium

Greater Trochanter

LesserTrochanter

IC

A

Head

Neck

Femur

Obturator Foramen

IT

X-Ray Hip JointLeft Side

Stable articulation between the head of the femur and

acetabulum

Iliofemoral (Y)

ligament

Pubofemoral ligament

Plate 487A Hip Joint

Hip JointBall and SocketStrong CapsuleReinforced by

ligaments:

IliofemoralPubofemoralIschiofemoral

Posteriorly, note

Ischiofemoral ligament

Sciatic nerve is in danger in a

posterior dislocation

Plate 487B Hip Joint

Note head of femur and acetabulum Ligamentum of

the Head: can be an

important blood supply to head of

femur-branch of Obturator

artery

Plate 487C

HA

Hip Joint

Obturator Artery

Ligament of the Head

Femoral Fracture: fractures of femoral neck in elderly people are problematic because of

disruption of blood flow to the head of the femur (most important is medial circumflex femoral artery - often torn when neck is fractured).

Avascular septic necrosis may occur.

Limb is laterally rotated and shorter

Moore, page 682

Retinacular arteries are in danger of disruption

with a neck fracture

Plate 512 Hip Joint

Lateral Circumflex

Femoral Medial Circumflex

Femoral

Deep Femoral Artery

Retinacular branches

Hip dislocation can be congenital or acquired

(uncommon except in traumatic injuries). Posterior dislocations

are most common.

Hip Joint

Moore,Page 683

Limb is medially

rotated and shorter

Hip Joint

Laboratory/Quiz

The dissectors for Unit 11 should remove the skin

from the anterior leg and dorsum of foot before

Wednesday’s dissection

Finish removing skin from anterior and lateral leg to dorsum of

foot