Lecture Notes - Anterior & Medial Thigh

Superficial Structures of the Lower Limb

• Osteology
  • Ilium
    • Iliac tubercle - attachment of iliotibial tract
    • Post. sup. iliac spine - dimple at S2
  • Femur - largest long bone
    • Medial & lateral epicondyles
  • Tibia
    • Medial malleolus - medial ankle
  • Fibula
    • Lateral malleolus - lateral ankle
• Investing Fascia
  • Fascia lata - envelopes thigh
    • Iliotibial tract - lateral thickening, attached to lat. tibial condyle
    • Saphenous opening - for greater saphenous v. & other vs.
  • Crural fascia - leg fascia
  • Popliteal fascia - behind knee
  • Dorsal & plantar fascia of foot
• Superficial Veins
  • Dorsal venous arch of foot
  • Greater saphenous vein - ant. to med. malleolus, post. to med. epicondyle
    • Superficial epigastric vein
    • Saphenous vein cutdown
  • Lesser saphenous vein - post. to lateral malleolus; drains to popliteal v.
  • Perforating veins - to deep veins
  • Varicose veins
• Cutaneous Nerves
  • Lateral femoral cutaneous - from lumbar plexus (L2-3)
    • Meralgia paresthetica - nerve compression
  • Anterior femoral cutaneous brs. of femoral n.
  • Posterior femoral cutaneous - from sacral plexus (S1-3); deep to fascia lata; inferior cluneal brs.; perineal br.
  • Femoral branch of genitofemoral nerve - upper anteromedial thigh
  • Cutaneous br. of obturator n. - medial thigh inferiorly
  • Saphenous - longest cutaneous nerve; from femoral
  • Sural cutaneous - medial & lateral - from tibial & common fibular
  • Sural - formed mid-calf by union of brs. of med. & lat. sural
    • Sural nerve graft - piece taken to repair nerve injured elsewhere
  • Superficial fibular (peroneal) - anterior ankle & dorsum of foot
  • Deep fibular (peroneal) - between 1st & 2nd toes
• Superficial inguinal lymph nodes
• Deep inguinal lymph nodes

Osteology:

• Ilium
  
  • Anterior superior iliac spine - for inguinal ligament & sartorius m.
    
  • Anterior inferior iliac spine - for rectus femoris m.
    
  • Iliac tubercle - attachment of iliotibial tract
    
• Ischium - tuberosity, ramus, (ischiopubic ramus)
  
• Pubis - inferior pubic ramus, body & pecten
  
• Femur
  • Medial & lateral epicondyles
  • Lesser trochanter - for iliopsoas m.
  • Pectineal line - posterior femur inferolateral to lesser trochanter
  • Linea aspera - for adductor muscles
  • Adductor tubercle - for hamstring part of adductor magnus
• Patella - largest sesamoid bone
• Tibia
  • Medial malleolus - medial ankle
• Fibula
  • Lateral malleolus - lateral ankle

Muscles:

• Iliopsoas - to lesser trochanter
  
• Anterior thigh:
  • Sartorius - roof of adductor canal; to pes anserinus on med. condyle of tibia
  • Quadriceps femoris - rectus femoris & 3 vasti
    • Rectus femoris - crosses hip & knee
    • Vastus medialis, intermedius, & lateralis
    • Patellar ligament (tendon) & retinacula
• Medial thigh:
  • Pectineus - innervated by femoral n.
    
  • Gracilis - to pes anserinus
    
  • Adductor longus - anterior-most adductor; floor of adductor canal
    
  • Adductor brevis - between longus & magnus
    
  • Adductor magnus
    • Adductor tendon - ischiocondylar part
    • Adductor hiatus
  • (Obturator externus - deep to adductor magnus origin; will see later)

Femoral triangle:

• Boundaries - inguinal lig., sartorius & add. longus
  
• Muscular & vascular lacunae - under ing. lig.
  
• Contents:
  • Femoral nerve brs.
  • Femoral sheath - transversalis fascia
    • Contents - femoral a,v & lymphatics
    • Femoral canal - med. compartment of femoral sheath; contains deep inguinal node(s)
    • Femoral ring - internal opening of femoral canal; may have deep ing. node (node of Cloquet)
    • Femoral hernia

Adductor canal (subsartorial or Hunter's canal):

• At inferior point of femoral triangle
  
• Contents:
  • Femoral vessels
  • Nerve to vastus medialis
  • Saphenous n.
• Vastoadductor membrane - covers vessels in lower part of canal
  
• Adductor hiatus - femoral vessels pass through to become popliteal vessels

Arteries & Veins:

• Femoral (common femoral) - from ing. lig. to adductor hiatus
  • Deep femoral - between add. longus & brevis
    • Medial circumflex femoral - between iliopsoas & pectineus
    • Lateral circumflex femoral - deep to rectus femoris
    • Perforating brs. (4) - supply hamstrings (post. thigh)
  • Descending genicular artery
• Obturator - adductor origins & hip joint

Nerves:

• Femoral - for anterior thigh
  • Nerve to vastus medialis - within adductor canal
  • Saphenous nerve
• Obturator - for medial thigh; ant. & post. divisions surround adductor brevis