Kaan Yücel M.D., Ph.D.
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Transcript of Kaan Yücel M.D., Ph.D.
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Kaan Ycel M.D., Ph.D.07.May.2014 Wednesday thigh&popliteal fossa1
The femoral region (thigh)lies between the gluteal, abdominal, and perineal regions proximally and the knee region distally:
anteriorly separated from the abdominal wall by the inguinal ligament
posteriorly separated from the gluteal region by the gluteal fold superficially
by the inferior margins of the gluteus maximus & quadratus femoris on deeper planes
Structures enter and leave the top of the thigh by 3 routes: Posteriorly continuous with the gluteal region sciatic nerve
Anteriorly abdominal cavity via aperture between inguinal ligament & pelvic bone
Medially thigh & pelvic cavity communicates via obturator canal
Vessels and nerves passing between the thigh and leg pass through the popliteal fossa posterior to the knee joint.
Superficial Fascia of the ThighAttached to the deep fascia below the inguinal ligament.Deep Fascia of the Thigh (Fascia Lata)Encloses the thigh like a trouser leg.Saphenous opening A gap in the deep fascia in front of the thigh just below the inguinal ligament.
Great saphenous vein via hiatus saphenus drains into femoral vein. Filled with loose connective tissue called the cribriform fascia.
3 fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur.
Fascial Compartments of the ThighAnterior compartment of thigh Femoral nervemuscles extend the leg at the knee joint. Medial compartment of thigh Obturator nervemuscles adduct the thigh at the hip joint.Posterior compartment of thigh Sciatic nervemuscles extend the thigh at the hip joint & flex the leg at the knee joint.
Linea aspera1. Which muscles are in the anterior part of the thigh?
Sartorius
Origin ASIS & superior part of notch inferior to itInsertion Superior part of medial surface of tibiafemoral nerve1. Which muscles are in the anterior part of the thigh?
Quadriceps femorisRectus femoris Vastus lateralisVastus medialisVastus intermedius Insertion base of patella indirectly via patellar ligament to tibial tuberosity
femoral nerveOriginStraight headAnterior inferior iliac spineReflected head Ilium just superior to the acetabulum
1. Which muscles are in the anterior part of the thigh?
Quadriceps femorisRectus femoris Vastus lateralisVastus medialisVastus intermedius Insertion base of patella indirectly via patellar ligament to tibial tuberosity
femoral nerve
Greater trochanter Lateral lip of linea aspera
Intertrochanteric line Medial lip of linea asperaAnterior and lateral surfaces of shaft of femur1. Which muscles are in the anterior part of the thigh?
Quadriceps femorisRectus femoris Vastus lateralisVastus medialisVastus intermedius Insertion base of patella indirectly via patellar ligament to tibial tuberosity
femoral nerve
1. Which muscles are in the anterior part of the thigh?
Quadriceps femorisRectus femoris Vastus lateralisVastus medialisVastus intermedius Insertion base of patella indirectly via patellar ligament to tibial tuberosity
femoral nerve
Patellar ligament functionally continuation of quadriceps femoris tendon attached above to apex and margins of patella below to the tibial tuberosity.
Prepatellar bursasubcutaneous anterior to patella.
Deep and subcutaneous infrapatellar bursae
deep and subcutaneous sides of the patellar ligament, respectively.
Articularis genuspulls the synovial membrane superiorly during extension of the leg.prevents compression of the folds of the membrane between the femur and the patella2iliopsoas muscle
In addition, the terminal ends of the psoas major and iliacus muscles pass into the upper part of the anterior compartment from sites of origin on the posterior abdominal wall.
Iliacus+psoas majorIlopsoas
Chief flexor of the thigh
2. The most powerful of the hip flexors with the longest range.
3. Can also contribute to lateral rotation of the thigh.
4. Is also a postural muscle, active during standing in maintaining normal lumbar lordosis and resisting hyperextension of the hip joint.
ILIOPSOAS
3. Functions of the anterior thigh muscles
Quadriceps femorisExtends leg at knee joint.Rectus femoris also steadies hip joint &helps iliopsoas flex thigh.Flexion of thigh at hip jointRectus femorisSartorius
3. Functions of the anterior thigh muscles
SartoriusFlexes, abducts, and laterally rotates thigh at hip joint.Flexes leg at knee joint (medially rotating leg when knee is flexed).Flexion of thigh at hip jointRectus femorisSartoriusAbduction of thigh at hip jointSartoriusLateral rotation of thigh at hip jointSartorius
1. Which muscles are in the medial part of the thigh?
1.Gracilis2. Pectineus3. Adductor longus4. Adductor brevis5. Adductor magnus 6.Obturator externus
2. Functions of the medial thigh muscles
Adduction of thighFlexion of thighExtension of thighLateral rotation of thighAdductor longusAdductor brevisAdductor magnusAdductor brevisAdductor magnusadductor part
Adductor magnushamstrings part
Obturator externusGracilisPectineus
Adducts thigh; flexes leg; helps rotate leg medially3. Adductor hiatus
A gap between the aponeurotic distal attachment of the adductor part of the adductor magnus & tendinous distal attachment of the hamstring part.
Transmits femoral artery & vein from the adductor canal in the thigh to the popliteal fossa.
1. Which muscles are in the posterior part of the thigh?
Biceps femorisShort headBiceps femorisLong head
Semitendinosus
Semimembranosus
2. Features of hamstring muscles
Proximal attachment to ischial tuberosity deep to the gluteus maximus.
Distal attachment to the bones of the leg. Thus act on two joints, producing extension @ hip joint & flexion @ knee joint.
Innervation by tibial division of the sciatic nerve.
1. Which arteries enter the thigh?
Femoral artery largest & main artery of lower limbObturator arteryInferior gluteal artery
Femoral arteryObturator artery
Inferior gluteal artery
2. Femoral artery
Distal continuation of external iliac artery.
Passes under the inguinal ligament.
Enters the femoral triangle midpoint of the inguinal ligament (midway between ASIS & pubic tubercle).
Continues down the thigh in the adductor canal.
Becomes popliteal artery behind the knee.
3. .. branches of the femoral artery
1. Superficial circumflex iliac artery 2. Superficial epigastric artery
3. Superficial external pudendal artery
4. Deep external pudendal artery
5. Profunda femoris artery Large and important branch Arises from the lateral side of the femoral artery below the inguinal ligament
6. Descending genicular artery
1 . Which veins are seen in the thigh?
Great saphenous vein Largest superficial vein in the thigh Originates from a venous arch on the dorsal aspect of the foot.
Ascends along the medial side of the lower limb.
Passes through the saphenous ring.
To connect with the femoral vein in the femoral triangle.
Superficial & deep veins
2. Other veins in the thigh
Femoral veinContinuation of the popliteal vein proximal to the adductor hiatus.
Enters the femoral sheath
Ends posterior to the inguinal ligament, becomes external iliac vein
Profunda Femoris Veindrains into the femoral vein.
Obturator Veindrains into the internal iliac vein.
1. Major nerves of the thigh
3 major nerves in the thigh, each associated with one of the 3 compartments:
Femoral nerve anterior compartment of thigh
Obturator nerve medial compartment of thigh
Sciatic nerve posterior compartment of thigh
2. ..femoral nerve (L2-L4)
Largest branch of the lumbar plexus. Enters the thigh lateral to the femoral artery and the femoral sheath, behind the inguinal ligament.
In the femoral triangle lies on the lateral side of the femoral artery
3 obturator nerve
Enters the medial compartment of thigh through the obturator canal.
Supplies most of the adductor muscles and skin on the medial aspect of the thigh.
4 sciatic nerve
Descends in the midline of the thigh.
Ends by dividing into the tibial and common peroneal nerves.
Innervates all muscles in the posterior compartment of thigh and then its branches continue into the leg and foot.
5 cutaneous nerves of the thigh
Lateral cutaneous nerve of the thighbranch of the lumbar plexus (L2& 3)
Medial cutaneous nerve of the thighbranch of the femoral nerve
Intermediate cutaneous nerve of the thighbranch of the femoral nerve
Posterior cutaneous nerve of the thighbranch of the sacral plexus
1. Femoral triangle
Superiorly inguinal ligament Medially lateral border of adductor longusLaterally sartoriusContents; from lateral to medialFemoral nerve Femoral sheath Femoral artery Femoral vein Deep inguinal lymph nodes2. Femoral sheath
A funnel-shaped fascial tube Passes deep to the inguinal ligament
Encloses proximal parts of the femoral vessels and creates the femoral canal medial to them.
Formed by an inferior prolongation of transversalis & iliopsoas fascia
Subdivided into three smaller compartmentsLateral compartment for the femoral artery.Intermediate compartment for the femoral vein.Medial compartment constitutes the femoral canal3. femoral canal
Smallest of the 3 compartments of the femoral sheath
Lies between the medial edge of the femoral sheath and the femoral vein.
4. femoral ring
Boundaries Laterally vertical septum between femoral canal & femoral vein.Posteriorly superior ramus of the pubis covered by the pectineus muscle and its fascia.Medially lacunar ligament Anteriorly medial part of the inguinal ligament.
Upper opening of the femoral canal formed by the small opening at its abdominal end.
5. femoral hernia
Femoral sheath blends with the tunica adventitia of blood vessels.
a potentially weak area in the abdomenThe part of the femoral sheath that forms the medially located femoral canal is not.
femoral herniaA protrusion of peritoneum forced down the femoral canal, pushing the femoral septum before it
6. ..adductor canal
Intermuscular cleft in the middle 1/3 of the thigh beneath the sartorius muscle
Extends from the apex of the femoral triangle to the adductor hiatus
6. ..adductor canal
Containsterminal part of the femoral arteryfemoral vein (lies behind the artery)deep lymph vesselssaphenous nervenerve to the vastus medialisterminal part of the obturator nerve
BoundariesAnteriorly and laterally vastus medialisPosteriorly adductors longus & magnus Medially sartorius, roof of the canal
1. Where is popliteal fossa located?
An area of transition between the thigh and leg
Major route by which structures pass from one region to the other.
Formed between muscles in the posterior compartments of thigh and leg.
2. What are the boundaries of the popliteal fossa?
Superolaterally Biceps femoris
Superomedially Semimembranosus
Inferolaterally and inferomedially Gastrocnemius
Posteriorly Skin & popliteal fascia (roof)
3. What are the contents of the popliteal fossa?
Termination of the small saphenous vein
Popliteal arteries and veins and their branches and tributaries
Tibial and common fibular nerves
Posterior cutaneous nerve of thigh
Popliteal lymph nodes and lymphatic vessels
4. Nerves in the popliteal fossa
The sciatic nerve usually ends at the superior angle of the popliteal fossa by dividing into tibial nerve& common fibular nerve
4. Nerves in the popliteal fossa
tibial nerve descends vertically through the popliteal fossa exits deep to plantaris muscle to enter posterior compartment of leg.
common fibular nerve exits by following the medial border of the biceps femoris tendon over the lower lateral margin of the popliteal fossacontinues to the lateral side of the leg where it swings around the neck of the fibula and enters lateral compartment of leg
5. Popliteal artery/vein
Continuation of the femoral artery
Begins as the femoral artery passes through the adductor hiatus.
Ends lateral to the midline of the leg by dividing into anterior & posterior tibial arteries.
Popliteal vein is superficial to and travels with the popliteal artery. (formation by ant. & post. tibial veins), becomes femoral vein.