Femoral region, Anterior

and Medial
compartments of the
thigh
Class: JC1 2012/2013
Course: Neuromuscular module
Code: NM4
Lecturer: Ahmed M. Saliem.
Date: 28th/ September/ 2012.
ahmed@pu-rcsi.edu.my

Learning objectives

Describe the anterior compartment of the thigh

Name the muscles of the anterior compartment of the thigh, and describe their attachments,
innervations and actions
Understand the structure and function of the iliotibial tract
Name the boundaries of the femoral triangle
Describe the contents of the femoral triangle and their relative positions
Understand the structure of the femoral sheath
Describe the anatomy of the femoral canal and ring
Understand how femoral hernias may occur and how these present clinically
Describe the femoral artery, including commencement, course and main branches
Identify the surface marking of the femoral pulse
Describe the femoral nerve, including origin, root values, course and areas of distribution
Identify the muscles of the anterior compartment of the thigh on examination
Describe the medial compartment of the thigh
Name the muscles of the medial compartment of the thigh, and describe their attachments,
innervations and actions
Describe the obturator nerve, including origin, root values, course and areas of distribution
Identify the adductor canal and hiatus and the structures passing through them.

Pelvis

Lower Limb
Pelvis
Ilium
Ischium
Pubis
Femur
Patella
Tibia
Fibula
Tarsals
Metatarsals
Phalanges

Gluteal
region
Thigh
Leg
Foot

Lower limb - function

Weight bearing
support the body weight with minimal
energy expenditure.
Centre of gravity passes posterior to the
hip joints, anterior to the knee and
ankle joints.
Locomotion
Integrated movement of all joints of the
lower limb to move through space.

Inguinal ligament
Connects the ASIS to the
pubic tubercle.
Creates a passageway from
the abdomen into the
anterolateral aspect of the
thigh through which vessels,
muscles and nerves pass.
Anatomical marker that
delineates the upper margin
of the lower limb.

Fascia of the lower limb

Superficial fascia
forms a continuous layer over the whole of the thigh
consists of areolar tissue containing in its meshes
much fat, between which are found the superficial
vessels and nerves.
Deep fascia fascia lata
Thick membrane like covering of the lower limb
Lies deep to the superficial fascia
Attached superiorly to inguinal ligament, iliac crest,
sacrum, coccyx, pubic bone
Inferiorly the fascia lata is continuous with the deep
fascia of the leg.

Fascia lata - saphenous opening

An aperture of the fascia lata on
the anterior aspect of the thigh
Inferior to the medial end of the
inguinal ligament
Allows the great saphenous vein
to pass from the superficial
fascia through the deep fascia to
meet the femoral vein

Muscular compartment of the

thigh
The thigh is divided into separate
compartments by intermuscular septa
Divided into:
Anterior
Anterior (quads)
Medial (adductors)
Posterior (hamstrings)
Medial
Posterior

Anterior compartment of the

thigh
Muscles which flex the hip joint,
extend the knee joint
Contains:
Iliacus
Psoas
Quadriceps

Vastus medialis
Vastus lateralis
Vastus intermedialis
Rectus femoris

Sartorius

lliacus and Psoas

Together called the iliopsoas
Originate from the posterior abdominal
wall
Iliacus: iliac fossa
Psoas: lumbar vertebrae

Common insertion into the lesser

trochanter of the femur
Innervation:
Iliacus: femoral nerve L2,3,4
Psoas: anterior rami of L1,2,3
Action: hip flexion.

Quadriceps
Group of four muscles
Common insertion through the
quadriceps tendon and patella
Most powerful muscle group in the
body
Consists of:

Vastus medialis
Vastus lateralis
Vastus intermedius
Rectus Femoris

Vastus Medialis
Origin:
intertrochanteric line,
medial lip of linea
aspera shaft of femur
Insertion: quadriceps
tendon and medial
patella
Action: extends knee
Nerve supply: Femoral
nerve (L2,3,4)

Vastus Lateralis
Origin:
intertrochanteric line,
later lip of linea aspera
shaft of femur
Insertion: quadriceps
tendon and medial
patella
Action: extends knee
Nerve supply: Femoral
nerve (L2,3,4)

Vastus Intermedius
Origin: anterior and
lateral shaft of femur
Insertion: quadriceps
tendon and lateral
patella
Action: extends knee
Nerve supply: Femoral
Nerve (L2,3,4)

Rectus Femoris
Origin: straight head
from anterior inferior
iliac spine, reflected
head from ilium
Insertion: quadriceps
tendon
Action: flexes hip,
extends knee
Nerve supply: Femoral
nerve (L2,3,4)

Sartorius
Origin: anterior superior
iliac spine
Insertion: anteromedial
aspect of proximal tibia
Action: flexes hip and
knee
Nerve supply: femoral
nerve (L2,3,4)

Medial Compartment of the thigh

Adductor Muscles
Gracilis, Pectineus, Adductor
longus, Adductor Brevis,
Adductor Magnus, Obturator
Externus
Functions:
Pull the thigh medially
Stabilise stance
Kicking with the medial side of the
foot

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery
Gracilis

Gracilis
Origin: body and inferior ramus of
pubis
Insertion: superior medial surface of
tibia
Action: adducts thigh, flexes leg,
Nerve supply: obturator nerve (L2,3,4)

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery

Pectineus
Origin: pectineal line and adjacent bone
of pelvis
Insertion: base of lesser trochanter to
linea aspera on posterior surface of
proximal femur
Action: adducts and flexes thigh
Innervation: Femoral Nerve L2,3,4

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery

Obturator externus
Origin: margins of obturator membrane
and surrounding bone
Insertion: trochanteric fossa
Action: laterally rotates thigh, stabilises
head of femur the acetabulum
Innervation: obturator Nerve L2,3,4

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery

Adductor Longus
Origin: body of pubis
Insertion: middle third of linea aspera
Action: adducts thigh
Innervation: obturator nerve (anterior
division) L2,3,4

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery

Adductor Brevis
Origin: body and inferior ramus of pubis
Insertion: upper one third of linea aspera
of shaft of femur
Action: adducts thigh
Innervation: obturator nerve L2,3,4

Obturator Externus
Pectineus
Adductor Brevis

Adductor Longus

Adductor Magnus
Adductor Hiatus
for Femoral Artery

Adductor Magnus

Femoral triangle

Femoral triangle

A triangular shaped depression of the upper

thigh. Its apex is directed downward, and the
sides are formed by:
Laterally: the medial margin of the Sartorius
Medially: the lateral margin of the Adductor
longus
Superiorly: the inguinal ligament.

The floor of the space is formed from its

lateral to its medial side by the Iliopsoas and
the Pectineus
Its contents from lateral to medial:

Femoral nerve
Femoral artery
Femoral vein
Lymphatics

Femoral Sheath

Lateral
Medial
Nerve, Artery, Vein

Femoral Sheath
In the femoral triangle, the femoral
artery, vein and associated
lymphatics are surrounded by a
sheath of fascia
Each contained in a separate
compartment
The most medial hold the
lymphatics the femoral canal
The femoral nerve is NOT
contained within the sheath

Inguinal lymph nodes

Most lymphatic vessels in the lower limb drain
into superficial and deep inguinal lymph nodes
Superficial nodes:
Lie in the superficial fascia
Parallel to the course of the inguinal ligament
Medially they extend along the terminal part of the
great saphenous vein
Receive lymph from the gluteal region, lower
abdominal wall, perineum, and superficial regions
of the lower limb.

Inguinal lymph nodes

Deep nodes:
Medial to the femoral
vein
Receive lymph from deep
lymphatics associated
with femoral vessels
Interconnect with
superficial nodes and
drain into the external
iliac nodes

1, 2, 3 Superficial nodes
4 Deep nodes

Adductor canal

Adductor canal
An aponeurotic tunnel in the middle third of the thigh
Extending from the apex of the femoral triangle to the
opening in the Adductor magnus.
It is bounded, in front and laterally, by the Vastus
medialis; behind by the Adductors longus and
magnus.
The canal contains the femoral artery and vein, the
saphenous nerve, and the nerve to the Vastus
medialis.

Great Saphenous vein

Lies in the subcutaneous connective tissue
originates from the dorsal venous arch in the
foot
Medial continuation becomes the great
saphenous vein, passing medially up the limb to
connect to the femoral vein in the femoral
triangle
Lateral continuation becomes the small
saphenous vein, ascending up the posterior
aspect of the leg to connect with the popliteal
vein behind the knee

Varicose Veins

Femoral Nerve
Originates from the
lumbar plexus (L2L4).
Enters the femoral
triangle by passing
under the inguinal
ligament

Divides into anterior and posterior divisions

which supply muscles of the anterior
compartment of the thigh

Femoral Artery
Major artery supplying the
lower limb
Continuation of the external
iliac artery of the abdomen
Begins as the external iliac
passes under the inguinal
ligament to enter the lower limb
Branches supply most of the
thigh and all of the leg and foot

Femoral Artery
Passes inferiorly and medially in
the adductor canal, ending as it
passes through the adductor
hiatus in the adductor magnus
muscle to become the popliteal
artery
Pulse can be palpated just
inferior to the inguinal ligament
halfway between the ASIS and
the pubic symphysis

Femoral Artery - Branches

Deep artery of the thigh (profunda
femoris) major source of blood supply
to the thigh
gives lateral circumflex femoral
and Medial circumflex femoral
and Perforating arteries.

Femoral Vein
The major deep vein draining the lower
limb
Becomes the External Iliac vein when it
passes under the inguinal ligament to
enter the abdomen
Follows the course of the Femoral Artery

Pelvic Girdle

Posterior Superior
Iliac Spine (PSIS)

Greater Sciatic Notch

Ischial Spine
Ischial Tuberosity
Lesser Sciatic Notch

Obturator Canal
Connects the abdominopelvic region with the
medial compartment of the thigh
Obturator foramen almost completely closed
by obturator membrane
Deficiency in obturator membrane results in
obturator canal
Structures passing through:
Obturator nerve and vessels

References
Clinically oriented anatomy by regions 8 th
edition: Richard S. Snell.
Essential clinical anatomy 4th edition: Keith
L. Moore.
Clinically Oriented Anatomy 6th edition:
Keith L. Moore.
Clinical anatomy 2nd edition: Stanley
Monkhouse.

The End
Thank you