unit 10 anterior and medial thigh (cadaver supine)
TRANSCRIPT
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Unit 10
Anterior and Medial Thigh(Cadaver Supine)
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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
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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
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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!
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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
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Inguinal Ligame
nt
ASIS
Pubic Tubercle
Plate 249Inguinal Ligament
External Oblique Muscle
Aponeurosis
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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
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Plate 544
Preserve the Great
Saphenous Vein
Used in coronary by-pass surgery
Great Saphenous Vein
Great Saphenous Vein
Dorsal Venous Arch
Superficial Veins
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“Saphenous Cut-down”
for emergency transfusions;
GS Vein is ALWAYS present in front of medial malleolus
Medial Malleolus
Superficial Veins
Page 584 Moore
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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
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Anterior Compartment
Femoral Nerve(Extensor
Compartment)
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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
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Plate 494
Locate Iliotibial Tract Tensor Fasciae
Latae
What is the TFL’s
innervation?
Anterior Thigh
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Muscles in the Anterior Compartment
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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
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AP radiograph of pelvis: prior healed
avulsion fraction of ASIS
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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
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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
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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
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Patellar Tendon Reflex or knee jerk – tests L2-4 spinal cord segments
and the femoral nerve; page 597 Moore
Plate 543BAnterior Thigh
Reflex Hammer
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Femoral Triangle and Contents
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Identify boundaries of the Femoral
Triangle
Anterior Thigh
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Identify Femoral Nerve
Emerges below Inguinal Ligament
Plate 538A
Femoral NerveL2-4
Lumbar Plexus
Anterior Thigh
Obturator Nerve
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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
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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
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Note Femoral Hernia in Femoral Canal
More common
in females Lateral to pubic tubercle
Anterior Thigh
Moore page 606
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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
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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
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The other is the
Iliopsoas
Inserts on lesser
trochanter
The strongest flexor of hip joint
Plate 496Anterior Thigh
Iliacus
Psoas
Iliopsoas
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Identify branches of
Femoral ArteryDeep Femoral
Perforating Branches
Deep Femoral
Plate 512Anterior Thigh
Femoral Artery
Medial
Perforating
branches
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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
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Moore, page 680
Deep
Retinacular branches are most important
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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
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Medial Thigh
Obturator Nerve(Adductor
Compartment)
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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
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Adductor Brevis
Plate 500 Medial Thigh
Identify Adductor Brevis
P
Divided Adductor Longus
AL
Gracilis
Sartorius
Medial
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Plate 500 Medial Thigh
Identify Anterior and
Posterior branches of the Obturator Nerve
Obturator Nerve
Medial
Adductor Brevis
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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”
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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
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Plate 485
Inguinal Ligament
Sartorius
Vastus Lateralis
Rectus Femoris
Vastus Medial
is Gastrocnemius
Greater Saphenou
s Vein
Surface Anatomy
Patella Ligament
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Summary of Medial Compartment
Nerve Supply: Obturator Nerve
Blood Supply: Obturator Artery
Action of Muscles: Adduction of thigh at hip joint
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Hip Joint
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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
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Iliofemoral (Y)
ligament
Pubofemoral ligament
Plate 487A Hip Joint
Hip JointBall and SocketStrong CapsuleReinforced by
ligaments:
IliofemoralPubofemoralIschiofemoral
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Posteriorly, note
Ischiofemoral ligament
Sciatic nerve is in danger in a
posterior dislocation
Plate 487B Hip Joint
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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
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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
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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
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Hip dislocation can be congenital or acquired
(uncommon except in traumatic injuries). Posterior dislocations
are most common.
Hip Joint
Moore,Page 683
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Limb is medially
rotated and shorter
Hip Joint
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Laboratory/Quiz
The dissectors for Unit 11 should remove the skin
from the anterior leg and dorsum of foot before
Wednesday’s dissection
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Finish removing skin from anterior and lateral leg to dorsum of
foot