Muscles of the FrontThigh

Front Of Thigh

Name the muscles forming boundaries of the femoral triangle

1. Lateral boundary is formed by the medial border of the sartorius.

2. Medial boundary is formed by the medial border of the adductor longus.

3. Base is formed by the inguinal ligament.

4. Apex is formed by the meeting point of the medial borders of the adductor longus and sartorius.

Name the muscles forming the floor of the femoral triangle

The muscles forming the floor of the femoral (from medial to lateral) are

Read And Learn More: Anatomy Notes And Important Question And Answers

1. Medial sloping wall is formed by

1. Adductor longus medially, and
2. Pectineus laterally.

2. Lateral sloping wall is formed by

1. Psoas major medially, and
2. Iliacus laterally.

Name the structures forming the boundaries of the femoral ring

1. Anteriorly: Inguinal ligament,
2. Posteriorly: Pectineus and fascia covering it,
3. Medially: Concave margin of lacunar ligament, and
4. Laterally: Septum separating it from the femoral vein.

Name the cutaneous nerves seen in the roof of the femoral triangle

1. Femoral branch of the genitofemoral nerve:  It supplies the skin over the upper part of the femoral triangle.

2. Branches of the ilioinguinal nerve.

3. Medial cutaneous nerve of thigh it crosses the femoral artery from the lateral to medial.

4. Lateral cutaneous nerve of thigh is seen lateral of femoral triangle.

Name the muscles of the anterior compartment of the thigh

The muscles of the anterior compartment of the thigh are

1. Sartorius,

2. Quadriceps femoris which includes

1. Rectus femoris,
2. Vastus lateralis,
3. Vastus medialis, and
4. Vastus intermedium.

3. Articularis genu.

Superficial Inguinal Lymph Nodes

Superficial Inguinal Lymph Nodes Introduction: The lymph vessels draining all the structures superficial to deep fascia of lower limb drain into superficial inguinal lymph nodes. They accompany the great saphenous vein.

1. Superficial Inguinal Lymph Nodes Arrangement: They are arranged in the form of a “T”.

2. Superficial Inguinal Lymph Nodes Location

1. Along the great saphenous vein is the vertical group of inguinal lymph nodes, and
2. Parallel to an inguinal ligament is the horizontal group of lymph nodes.

3. Afferent and efferent lymphatics

 

4. Superficial Inguinal Lymph Nodes Applied anatomy

The upper group of the superficial inguinal lymph nodes are enlarged due to pathology of the following structures. It may be an infection or malignant growth of one of the following structures.

1. Superolateral part of the uterus,
2. The skin of shaft of penis,
3. Part of the vagina below the hymen, and
4. Part of the anal canal below the pectinate line.
5. Syphilitic lesion of prepuce of penis.

Lateral group lymph nodes of superficial inguinal lymph nodes are enlarged due to pathology of the gluteal region.

Fascia Lata

(Lata—deep and broad)

Fascia Lata Introduction: It is a tough, fibrous, deep fascia which envelops the thigh like a stocking.

1. Fascia Lata Modifications

1. Iliotibial tract, and
2. Saphenous opening.

2. Fascia Lata Gives attachments

1. Proximally is attached to

1. Pubic tubercle,
2. Inguinal ligament,
3. Outer lip of the entire iliac crest (it splits to enclose the tensor fascia lata and gluteus maximus muscles),
4. Dorsal surface of the sacrum,
5. Coccyx,
6. Sacrotuberous ligament, and
7. Ischial tuberosity.

2. Anteromedially attached to

1. Ischiopubic ramus,
2. Anterior margin of pubic symphysis,
3. Pubic crest,
4. Pubic tubercle, and
5. Pectin pubis.

3. Distally attached to the

1. Patella,
2. Inferior margin of the tibial condyles, and
3. Head of the fibula.

3. Fascia Lata Encloses

1. Gluteus maximus
2. Tensor fascia lata.

4. Fascia Lata Functions

1. Protects the deeper structures,
2. Keeps deeper structures in position, and
3. It acts as tight stockings and helps in venous return.

Iliotibial Tract

It is a modified thick fascia of the thigh (fascia lata). It is a 2” wide band.

1. Iliotibial Tract Situation: It is present on the lateral aspect of thigh.

Extends from iliac crest to lateral condyle of tibia.

1. Superiorly it has two laminae.

1. Superficial lamina is attached to the tubercle of iliac crest, and
2. Deep lamina is attached to the capsule of hip joint.

2. Inferiorly it is attached to smooth area on the anterior surface of lateral condyle of the tibia.

2. Iliotibial Tract Features: It gives insertion to

1. Greater part of gluteus maximus,
2. Tensor fascia lata.

3. Iliotibial Tract Nerve supply: Superior gluteal nerve.

4. Iliotibial Tract Functions

1. It stabilizes the knee joint both in extension and partial flexion. Hence, it is used constantly during walking and running.
2. It is the main support of knee joint against gravity.
3. It is used as suturing material.

Saphenous Opening

(Saphenous—easily seen)

Saphenous Opening Introduction: It is an oval opening present in the fascia lata.

1. Saphenous Opening Location: 4 cm below and 4 cm lateral to pubic tubercle. The vertical height is 4 cm. It has two margins

1. Upper, lateral and lower, and
2. Medial margin.

1. The lateral margin is superficial and well-defined.

1. It is half-moon shaped, and
2. It is present in front of the femoral sheath. It is also called falciform margin.

2. Saphenous Opening Medial margin is deep and ill-defined due to cribriform fascia.

2. Opening: It is closed by an areolar membrane called cribriform fascia. The fascia is pierced by a number of structures and gives a sieve-like appearance, hence it is called cribriform fascia.

3. The structures passing through the saphenous opening are the following

1. Vein: Great saphenous vein. It receives the following veins before it opens in saphenous openings.

1. Superficial external pudendal vein,
2. Superficial epigastric vein, and
3. Superficial circumflex iliac vein

2. Arteries

1. Superficial external pudendal artery,
2. Superficial epigastric artery, and
3. Deep external pudendal artery—deep branch of femoral artery

3. Lymph vessels: Lymphatics from superficial lymph nodes converge to the saphenous opening. They pass through the cribriform fascia and enter deep inguinal lymph nodes.

4. Comparative anatomy: Saphenous opening is present in fascia lata only in man.

Name the branches of the femoral artery in the femoral triangle

1. Superficial branches

1. Superficial epigastric,
2. Superficial circumflex iliac, and
3. Superficial external pudendal.

2. Deep branches

1. Deep external pudendal artery. It supplies deeper structures in the perineal region

2. Profunda femoris and its branches

1. Medial circumflex femoral artery and its branches
2. Lateral circumflex femoral artery and its branches

3. Muscular branches to muscles of anterior and medial compartment of thigh.

4. The upper two perforating branches of profunda femoris artery arise in the femoral tiangle.

Describe femoral triangle (triangle of Scarpa) under following heads:

1. Femoral Triangle Site,

2. Femoral Triangle Boundaries,

3. Femoral Triangle Roof,

4. Femoral Triangle Floor,

5. Femoral Triangle Contents,

6. Femoral Triangle Relations, and

7. Femoral Triangle Applied anatomy

Introduction: It is subfascial lar depression present in upper part of front of thigh.

1. Femoral Triangle Site

1. It is present in front of the upper 1/3rd of the thigh below the inguinal ligament.
2. In living person, it appears as a lar depression inferior to the inguinal ligament.
3. It is best appreciated when the thigh is flexed, abducted, and laterally rotated.

2. Femoral Triangle Boundaries

1. Laterally: Medial border of sartorius.
2. Medially: Medial border of adductor longus. It can be felt as a distinct ridge when the thigh is adducted against resistance.
3. Base: Inguinal ligament.
4. Apex: It is formed by the meeting point of the medial borders of adductor longus and sartorius. It is directed downward.

3. Femoral Triangle Roof

1. Skin

2. Superficial fascia containing

1. Arteries: Superficial branches of the femoral artery

1. Superficial circumflex iliac,
2. Superficial external pudendal, and
3. Superficial epigastric artery.

2. Veins: Tributaries of the femoral vein

1.   Superficial circumflex iliac,
2. Superficial external pudendal, and
3. Superficial epigastric vein.

3. Nerves

1. The femoral branch of the genitofemoral nerve runs downwards. It is anterior to the femoral artery in the anterior wall of femoral sheath. This nerve supplies an area of skin over the femoral.
2. The lateral cutaneous nerve of the thigh runs near the lateral angle of the femoral.

3. Deep fascia and structures within it. These include

1. Saphenous opening,
2. Cribriform fascia,
3. Terminal part of the saphenous vein, and
4. Superficial inguinal lymph nodes.

4. Floor: It is muscular and hollow. It is best seen when thigh is flexed. The muscles are grouped as muscles forming medial and lateral sloping wall. They are described from medial to lateral.

1. Medial sloping wall is formed by

1. Adductor longus medially. The medial border forms the boundary of the femoral, hence the whole muscle is included in the floor.
2. Pectineus laterally. It is called key muscle of femoral.

1. Lateral sloping wall is formed by

1. Psoas major medially, and
2. Iliacus laterally. It is covered by fascia iliacus.

5. Femoral Triangle Contents

1. Femoral sheath and its contents (from medial to lateral)

1. Femoral Canal and its Contents, namely

1. Fibrofatty tissue,
2. Cloquet lymph nodes (deep inguinal lymph node, or Rosenmüller lymphnode), and
3. Cloquet lymphatics (afferent and efferent lymphatics of these lymph nodes).

2. Femoral vein and its tributaries

1. Great saphenous vein and its tributaries

1. Superficial epigastric,
2. Superficial circumflex iliac, and
3. Superficial external pudendal.

2. Muscular veins

3. Profunda femoris vein and its tributaries

1. Medial circumflex femoral vein and its tributaries
2. Lateral circumflex femoral vein and its tributaries

3. Femoral artery is central and dominant structure within the femoral and the branches of femoral artery within the femoral are grouped as
1. Superficial branches

1. Superficial epigastric,
2. Superficial circumflex iliac, and
3. Superficial external pudendal.

2. Deep branches are

1. Profunda femoris and its branches,

1. Medial circumflex femoral artery and its branches
2. Lateral circumflex femoral and its branches

2. Muscular branches, and

3. Deep external pudendal supplies muscles of thigh.

4. The upper two perforating branches of profunda femoris artery arise in the femoral triangle.

2. Nerves

1. Femoral nerves and its divisions

1. Anterior division and its branches

1. Muscular branch to Sartorius
2. Medial CUTaneous nerve of thigh, and
3. Intermediate CUTaneous nerve of thigh.

2. Posterior division and its branches

1. Muscular branches to QUADRIceps

1. Rectus femoris,
2. Vastus medialis,
3. Vastus intermedius, and
4. Vastus lateralis.

2. Cutaneous branch—SAPHenous nerve

3. Articular branch to

1. Hip joint, and
2. Knee joint

2. The nerve to the pectineus arises from the femoral nerve just above the inguinal ligament. It passes behind femoral sheath to reach the anterior surface of pectineus.

3. The femoral branch of the genitofemoral nerve occupies the lateral compartment of the femoral sheath. It runs along with the femoral artery. It supplies most of the skin over the femoral .

4. The lateral cutaneous nerve of the thigh crosses the lateral angle of the .It runs on the lateral side of the thigh. It ends by dividing into anterior and posterior branches. These supply the anterolateral aspect of the front of thigh and lateral aspect of the gluteal region respectively.

6. Relations of vessels

1. At the base (from medial to lateral)

1. Femoral Vein,
2. Femoral Artery, and
3. Femoral Nerve.

2. At apex (from anterior to posterior) AVVA

1. Femoral Artery,
2. Femoral Vein,
3. Profunda femoris Vein, and
4. Profunda femoris Artery

7. Femoral Triangle Applied anatomy

Femoral Aartery

Pulsations of femoral artery are felt in femoral . They are felt at the midinguinal point against

1. Head of femur, and
2. Tendon of psoas major.

Stab wound injury at the apex of femoral may be fatal as it cuts all the vessels of lower limb.

Femoral vein

1. Blood can be drawn from the femoral vein by feeling the pulsations of femoral artery and going just medially to it.
2. Femoral vein catheterization is used when rapid access to a large vein is needed.

Saphenous vein

Varicosities of saphenous veins are treated by Trendelenburg’s operation. The tributaries of saphenous vein are tied in the femoral.

Deep inguinal lymph nodes in femoral are enlarged in the

1. Infection of the skin of
2. Abdomen below umbilicus.
3. Gluteal region
4. Leg, sole and external genitalia.
5. Malignancy of fundus of uterus.

Stab wounds at the apex of femoral may be fatal as it cuts all vessels of lower limb.

Pus may appear in the femoral behind the femoral sheath. It may travel to

1. The back of thigh along the perforating branches of the profunda femoris artery.
2. The adductor canal and even to the popliteal fossa along the femoral vessels.

Femoral hernia: The femoral ring is a weak area in the anterior abdominal wall. It is of the size of the little finger. The femoral ring is the usual site of a femoral hernia. It is a protrusion of abdominal viscera (often a loop of small intestine) through the femoral ring into the femoral canal. A femoral hernia appears as a mass, often tender, in the femoral, inferolateral to the pubic tubercle.

Direction of course of femoral hernia: As the herniasac enlarges, it passes through the saphenous opening, and then turns upwards. Here it may pass along the course of

1. Superficial circumflex iliac vessels, or
2. Superficial epigastric vessels.

Note: Depending upon the pathway, it may be

1. Above the inguinal ligament, if it chooses the pathway along superficial epigastric vessels.
2. Below the inguinal ligament, if it chooses the pathway along superficial circumflex iliac vessels.

Name the fascia forming the femoral sheath

1. Anterior wall: Transversalis fascia.

2. Posterior wall: Fascia iliaca.

3. Lateral and medial wall: Fusion of fascia transversalis and fascia iliaca.

Enumerate the contents of the femoral sheath

Contents of the femoral sheath (from medial to lateral) are described as the contents of each compartment.

1. Medial compartment is the femoral canal. Femoral Canal and its Contents are

1. Fibrofatty tissue,
2. Cloquet lymph node (deep inguinal lymph node, or Rosenmüller lymph node),and
3. Cloquet lymphatics (afferent and efferent lymphatics of these lymph nodes).

2. Intermediate compartment is venous compartment. It contains femoral vein and its tributary—great saphenous vein.

3. Lateral compartment is arterial compartment. It contains

1. Femoral artery, and
2. Femoral branch of genitofemoral nerve in anterior wall.

Femoral sheath

Femoral sheath Introduction: It is the fascia covering femoral vessels in front of thigh region.

1. Femoral sheath Gross

1. Length: 4 cm.

2. Shape: Conical (funnel).

1. Lateral wall is vertical.
2. Medial wall is obliquely directed downwards and laterally.

2. Femoral sheath Formation

1. Anterior wall: Fascia transversalis.
2. Posterior wall: Fascia iliaca.
3. Lateral and medial wall: Fusion of fascia transversalis and fascia iliacus.
4. Below it blends with tunica adventitia of blood vessels.

3. Communications

1. Superiorly opens into the abdomen.
2. Inferiorly merges with tunica adventitia of femoral vessels.

4. Contents of the femoral sheath (from medial to lateral) are described as the contents of each compartment.

1. Medial compartment: Femoral Canal Contains FCC

1. Fibrofatty tissue
2. Cloquet lymph nodes
3. Cloquet lymphatics

2. Intermediate compartment—venous compartment:

1. Femoral vein and its
2. Tributary—great saphenous vein

3. Lateral compartment—arterial compartment

1. Femoral artery, and
2. Femoral branch of genitofemoral nerve.

5. Structures piercing the various walls

1. Anterior wall is pierced by

1. Superficial epigastric artery,
2. Superficial circumflex iliac artery, and
3. Superficial external pudendal artery.
4. Deep external pudendal artery—deep branch of femoral artery.

2. Lateral wall: Femoral branch of genitofemoral nerve

3. Medial wall

1. Lymph vessels, and
2. Great saphenous vein.

6. Femoral sheath Relations

1. Anterior

1. Skin,
2. Superficial fascia,
3. Fascia lata (deep fascia), and
4. Inguinal ligament.

2. Posterior

1. Nerve to pectineus,
2. Muscles deep to nerve to pectineus (from lateral to medial), Psoas major, and Pectineus.
3. Structure deep to above muscles—capsule of hip joint.

3. Lateral: Femoral nerve with its branches

4. Medial: Adductor longus

7. Division: It is divided into three compartments by two vertical septa.

1. Medial compartment: It is also called the femoral canal.

1. Fatty connective tissue.
2. Cloquet lymph node which drains Male: Glans penis, Female: Clitoris.
3. Cloquet lymph vessels.

2. Intermediate or venous compartment which contains femoral vein.

3. Lateral or arterial compartment which contains

1. Femoral artery, and
2. Femoral branch of genitofemoral nerve.

8. Function: It allows freedom for the femoral vessels to glide in and out beneath the inguinal ligament during movements of the hip joint.

9. Age changes: It is rudimentary in newborns. It is elongated after 1 year.

10. Femoral sheath Applied anatomy

Femoral canal is a potential weak point through which abdominal contents pass through.

Femoral hernia is a protrusion of abdominal contents through the femoral canal. It is common in females because of wider femoral ring. The femoral ring is wider in female due to

1. Wider pelvis, and
2. Smaller vessels.

Any swelling lateral and below the pubic tubercle is most likely to be femoral hernia.

The direction of the femoral hernia is:

1. Downwards through the femoral canal,
2. Forwards through the saphenous opening,
3. Upwards along with superficial epigastric and superficial circumflex iliac vessels, and
4. Laterally towards anterior superior iliac spine.

The femoral hernia is reduced in the reverse direction as medially, downwards, backwards and upwards. Strangulated hernia resembles an inflamed deep inguinal lymph node.

The pubic branch of inferior epigastric artery is a branch of external iliac artery.It runs to reach pubic symphysis. Normally, it runs lateral to femoral ring which is safe. If it passes medial to femoral ring, the course is said to be abnormal.Surgeons need to keep the abnormal course of the artery in mind while operating on femoral hernia.

Abnormal obturator artery: Obturator artery usually is a branch of the internal iliac artery. It gives a pubic branch which anastomoses with the pubic branch of the inferior epigastric artery. Occasionally, this anastomosis is large and the obturator artery then appears to be a branch of the inferior epigastric. The abnormal artery usually passes lateral to the femoral canal. It is safe in an operation to enlarge the femoral ring. Sometimes, the abnormal obturator artery may lie along the medial margin of the femoral ring, i.e. along the free margin of the lacunar ligament. Such an artery is likely to be cut if an attempt is made to enlarge the femoral ring.

This abnormal rare position is more frequent in males than in females. The incidence is 1:1000.

Femoral Canal

Femoral Canal Introduction: It is a potential weakness present in the smallest medial compartment of the femoral sheath.

1. Femoral Canal Features

1. It is the smallest, shortest and relatively empty compartment.
2. It is the medial or lymphatic compartment of the femoral sheath.

2. Femoral Canal Gross

1. Length: 2 cm
2. Diameter: About 1 cm
3. Shape: Oval. It has a base and an apex.
4. Base is wider and is called the femoral ring. It is the mouth of the femoral canal. It admits the tip of the little finger and is known as the femoral ring.
5. Apex is narrow.

3. Femoral Canal Attachments and relations: The wall is firmly attached

1. Anteriorly to inguinal ligament,

2. Posteriorly to

1. Pectineal ligament and
2. Fascia covering pectineus.

3. Medially to lacunar ligament, and

4. Femoral Canal Laterally to the septum. It separates femoral canal from venous compartment.

4. Femoral Canal Contents: Femoral Canal Contains

Fibrofatty tissue

Cloquet lymph nodes: There are two deep inguinal lymph nodes in relation to inguinal canal.

One at the inguinal ring and another in the inguinal canal.

Cloquet lymphatics

1. Afferent lymphatics are from

1. Superficial inguinal nodes,
2. Popliteal nodes,
3. Glans penis in males
4. Clitoris in females , and
5. Deep lymphatics of the lower limb.

2. Efferent lymphatics to external iliac group of lymph nodes.

5. Femoral Canal Functions

1. It is the route by which the efferent lymph vessels from the deep inguinal nodes pass to the abdomen
2. It provides a ‘dead space’. The space allows expansion of the femoral vein during increased venous return.

6. Femoral Canal Applied anatomy

Femoral Hernia

Femoral Hernia Introduction: It is the protrusion of abdominal contents through the femoral canal.

Gender: It is more common in female because of wider pelvis and narrower vessels.

Factors precipitating femoral hernia

1. Increased intra-abdominal pressure,
2. Chronic cough,
3. Constipation,
4. Multiparous woman ,
5. Tumours in the abdomen, and
6. Old age.

Femoral Hernia Diagnosis: A swelling 4 cm below and lateral to pubic tubercle that increases on increased intra-abdominal pressure goes in favour of femoral hernia.

As the hernia passes down through the narrow femoral ring, it is in a position of considerable danger. The sharp crescentic edge of the lacunar ligament may interfere with its blood supply.

Herniorrhaphy: In repair of the strangulated femoral hernia, position of accessory obturator artery should be kept in mind.

The direction of the femoral hernia is

1. Downwards through the femoral canal,
2. Forwards through saphenous opening,
3. Upwards along with superficial epigastric and superficial circumflex iliac vessels, and
4. Laterally towards anterior superior iliac spine.

The femoral hernia is reduced in reverse direction as medially, downwards, backwards and upwards.

Describe the femoral artery under the following heads

1. Femoral Artery Origin,

2. Femoral Artery Extent,

3. Femoral Artery Course,

4. Femoral Artery Relations,

5. Femoral Artery Branches, and

6. Femoral Artery Applied anatomy.

1. Femoral Artery Origin: Femoral artery is the continuation of the external iliac artery distal to inguinal ligament.

2. Femoral Artery Extent: It extends from mid-inguinal point to the apex of adductor canal.

3. Femoral Artery Course: It passes downward and medially. The upper ½ part is in the femoral and the lower ½ is in the adductor canal. At the apex of the adductor canal, it pierces adductor magnus and continues as popliteal artery.

4. Femoral Artery Relations

1. At the base of femoral

1. Medially—femoral Vein inside the femoral sheath
2. Laterally—femoral nerve outside the femoral sheath and
3. Anteriorly in the femoral sheath—femoral branch of genitofemoral nerve.

2. At the apex of the femoral, relations from anterior to posterior are AVVA

1. Femoral Artery,
2. Femoral Vein,
3. Profunda femoris Vein, and
4. Profunda femoris Artery.

3. Posterior relations from above downward are

1. Psoas major,
2. Pectineus, and
3. Adductor longus.

5. Femoral Artery Branches

1. Superficial

1. Superficial epigastric artery,
2. Superficial circumflex iliac artery, and
3. Superficial external pudendal artery.

2. Deep

1. Profunda femoris: It is the largest deep branch of femoral artery. It is equal to the size of femoral artery. It arises 4 cm below the inguinal ligament. It originates from posterolateral aspect of femoral artery. It spirals deep to femoral artery and passes downwards deep to adductor longus. It soon disappears through the gap between the pectineus and adductor longus. It gives following branches.

1. Lateral circumflex femoral artery. It gives

1. Ascending branch: It takes part in spinous anastomosis.
2. Descending branch: It takes part in anastomosis around knee joint.
3. Transverse branch: It takes part in cruciate anastomosis.

2. Medial circumflex femoral artery. It gives

1. Ascending branch: It takes part in trochanteric anastomosis. It is chief artery of head and neck of femur.
2. Transverse branch: It takes part in cruciate anastomosis.

3. Perforating: There are four perforating arteries. They perforate adductor magnus. One of the perforating arteries gives a large nutrient branch to the femur.

2. Deep external pudendal artery supplies blood to the scrotum in male and labium majus in female

3. Muscular branches to all the deep muscles of thigh.

4. Descending genicular artery: It gives the following branches

1. Saphenous artery, and
2. Muscular artery

3. Termination: It continues as popliteal artery through an opening present in the adductor magnus.

6. Femoral Artery Applied anatomy

The pulsations of femoral artery can be felt just below the inguinal ligament over the head of femur, i.e. midway between the anterior superior iliac spine (ASIS) and pubic symphysis. It may be easily demonstrated using ultrasound.

1. Position of femoral vein can be localized as it lies just medial to the femoral artery.

2. Femoral artery can be compressed against the head of femur to control haemorrhage.

3. The circulation of the limb is not affected in case of the blockage of the femoral artery.

4. In case of the blockage proximal part of the femoral artery, the circulation is maintained through cruciate and trochanteric anastomoses.

5. In case of the blockage of the arteries of the distal part of the thigh, the circulation is maintained through perforating branches of profunda femoris artery and its anastomosis with the branches of the popliteal artery.

6. Severe narrowing of arteries of the lower limb, with an inadequate collateral circulation, can lead to pain in muscles. The pain appears on walking and disappears with rest. The pain appears as the person takes a few steps. It is called intermittent claudication (claudication, limping).

Name the branches of femoral nerve

1. Muscular branches

1. In pelvis. To

1. Iliacus
2. Pectineus

2. In thigh

1. Sartorius

2. Quadriceps femoris

1. Rectus femoris
2. Vastus medialis
3. Vastus lateralis
4. Vastus intermedius

2. Cutaneous branches

1. Saphenous nerve
2. Medial CUTaneous nerve of thigh
3. Intermediate CUTaneous nerve of thigh

3. Articular branches to hip and knee joint

Describe the femoral nerve under the following heads

1. Femoral Nerve Root value,

2. Femoral Nerve Branches,

3. Femoral Nerve Course and relations, and

4. Femoral Nerve Applied anatomy.

 

1. Femoral Nerve Root value: It is formed by dorsal division of ventral rami of.

2. Femoral Nerve Branches

1. From the trunk

1. Branch to iliacus,
2. Branch to pectineus, and
3. Vascular branches to the femoral artery.

2. From the divisions

1. Anterior division (superficial branches)

It has one muscular and two cutaneous branches.

Muscular: SARTorius.

CUTaneous

1. Medial CUTaneous nerve of thigh. It carries sensations of the skin of the medial side of thigh.
2. Intermediate CUTaneous nerve of thigh. It carries sensations of the skin of front of thigh and takes part in the patellar plexus.

2. Posterior division. It gives the following branches

1. Muscular branches to QUADRIceps femoris

1. Rectus femoris,
2. Vastus medialis,
3. Vastus intermedius, and
4. Vastus lateralis.

2. Cutaneous branch is the SAPHenous nerve. It supplies skin over

1. Upper part of leg, and
2. Medial part of leg
3. Medial part of sole of foot.

3. Articular branch to Joints.

1. Hip joint, and
2. Knee joint.

4. Femoral Nerve Vascular: To the femoral artery and its branches.

3. Course and relations

1. In the pelvis: The nerve is formed in the substance of psoas major. It runs on the lateral border of psoas major between psoas major and iliacus.

2. In the thigh: It enters thigh by passing deep to inguinal ligament.

1. It lies on the lateral side of the femoral artery and outside the femoral sheath.
2. The nerve runs 2.5 cm below the inguinal ligament. It breaks like a “cauda equina” into numerous motor and sensory twigs.
3. The two divisions of the femoral nerve pass anterior and posterior to the lateral circumflex femoral artery.

3. Relations

1. Anterior: Skin, superficial fascia and deep fascia.
2. Posterior and medial: Psoas major.
3. Posterior and lateral: Iliacus.

4. Femoral Nerve Applied anatomy

Disease of the hip joint may be referred to the knee joint.

Femoral nerve

1. Neuroma of the femoral nerve or its branches is one of the differential diagnoses of lump in femoral
2. Accumulation of pus or blood in the psoas sheath may compress the femoral nerve.
3. Injury to femoral nerve causes paralysis of quadriceps femoris and affects extension of knee joint.

Femoral nerve neuropathy: The main trunk of the femoral nerve may be compressed by

1. Entrapment of femoral nerve
2. Compression by retroperitoneal tumour.
3. Manifestations
4. Wasting and weakness of quadriceps which results in
5. Difficulty in walking.
6. A localized neuropathy of the femoral nerve may occur in diabetes mellitus.
7. Following are the characteristic clinical features
8. Wasting and weakness of quadriceps leading to considerable difficulty in walking.
9. Pain and paraesthesia on the anterior and medial aspects of the thigh. It extends along the medial aspect of the leg and foot.
10. The femoral nerve block can be easily achieved in the femoral . The anaesthetic solution is injected one-finger breadth lateral to the point of femoral pulse. It is just below the mid-inguinal point.
11. Injury to nerve results in atrophy of extensor muscles of thigh. It presents as weakness in extension of knee joint. There is loss of knee jerk.
12. Effect of femoral nerve injury in gunshot wounds results in
13. Motor loss: Inability to extend the knee. It is due to paralysis of the quadriceps femoris muscle.
14. Sensory loss medial aspect of the thigh, leg and medial border of the foot as far as the ball of the big toe. It is due to the involvement of
15. Intermediate and lateral cutaneous nerves of the thigh, and
16. Saphenous nerve.
17. The saphenous nerve may be entrapped at the site where it pierces the roof of the adductor canal. This will cause pain and paraesthesia along the medial side of the knee and leg.

Name the nerves forming the sub sartorial plexus

Subsartorial plexus is formed by

1. Posterior branch of the medial femoral cutaneous nerve,
2. Anterior division of obturator nerve, and
3. Saphenous nerve.

Attachments to patella

1. Vastus medialis,
2. Vastus intermedius,
3. Vastus lateralis,
4. Rectus femoris, and
5. Ligamentum patellae.

 

Describe adductor canal OR subsartorial canal OR Hunter’s canal under following heads:

1. Adductor Canal Gross anatomy,

2. Adductor Canal Boundaries,

3. Adductor Canal Contents, and

4. Adductor Canal Applied anatomy.

1. Adductor Canal Gross anatomy: It is a musculoaponeurotic passage or tunnel present in the middle 1/3rd of thigh

A. Length: 6” or 15 cm.

1. Extent: It extends from the apex of the femoral to 5 osseo-aponeurotic openings of the adductor magnus, i.e. it begins 4” below the inguinal ligament and ends 4” above the adductor tubercle.
2. Location: It is situated on the middle 1/3rd of the medial side of the thigh.
3. Shape: It is lar in cross-section.

2. Adductor CanalBoundaries

1. Anterolateral wall is formed by vastus medialis.

2. Roof or medial wall is formed by

1. Strong fascia that extends across vastus medialis to adductor longus in the upper part and vastus medialis to adductor magnus in the lower part.

2. Sartorius’s muscle.

3. Subsartorial plexus which is formed by

1. Posterior branch of medial femoral cutaneous nerve.
2. The anterior division of obturator nerve.
3. Saphenous nerve

This plexus supplies Fascia lata, and Skin on the medial side of knee.

3. Floor: In the upper part, it is formed by the adductor longus muscle and in the lower part, it is formed by the adductor magnus muscle.

4. Apex is formed by meeting point of vastus medialis and adductor muscle on linea aspera of femur.

5. Function: It provides the passage for femoral vessels.

3. Adductor Canal Contents

1. Contents coursing through upper end to lower end.

1. Femoral artery: It lies anterior to the femoral vein in upper part and medial to the vein in the lower part.
2. Femoral vein, and
3. Saphenous nerve—longest cutaneous nerve of the body.

2. Other contents

1. Descending genicular artery (branch of femoral artery) and its branches into

1. Superficial branch saphenous artery: It crosses the femoral artery anteriorly from the lateral to the medial side.
2. Deep branch muscular artery which enters vastus medialis and joins the arterial anastomosis around the knee.

2. Anterior and posterior divisions of obturator nerve.

3. Nerve to vastus medialis: It lies lateral to the femoral artery.

4. Deep lymph vessels.

5. Vascular branch of the anterior division of the obturator nerve.

6. Genicular branch of the posterior division of obturator nerve.

The 3rd perforator which lies in the middle of the thigh is known as the Hunterian perforator. It connects the great saphenous vein to the femoral vein in the adductor canal or Hunter’s canal.

4. Adductor Canal Applied anatomy

Adductor canal is the site of ligation of femoral artery.

A tourniquet is applied against the linea aspera in adductor canal. It is to arrest bleeding of popliteal vessels in the following situations:

1. In rupture of an aneurysm of popliteal artery,
2. For the treatment of an aneurysm of the popliteal artery.
3. Below knee amputation surgery.

The surgical approach to the femoral artery in the adductor canal.

1. The incision is taken on the medial aspect of the lower thigh.
2. Sartorius is retracted medially.
3. Fascial roof of the canal is divided.

The saphenous nerve may be entrapped at the site where it pierces the roof of the adductor canal. This will cause pain and paraesthesia along the medial side of the knee and leg.