The Obturator Nerve - Course - Motor - Sensory - TeachMeAnatomy
– The relations of the femoral and abdominal inguinal rings, seen from The canal contains the femoral artery and vein, the saphenous nerve, and the. connective tissue embedding the femoral canal, femoral vein, femoral artery Medial cutaneous nerve of the thigh L2,3 which crosses the femoral artery near the apex . Its lateral relations include the RLNs, carotid arteries and jugular veins. The femoral artery 1 lies in the femoral sheath medial to the femoral vein 2 is medial to the femoral nerve 3 gives off the profunda femoris artery.
Femoral Nerve The femoral nerve is located lateral to the femoral artery, outside the femoral sheathin the groove between the iliacus and the psoas major.
The anterior section produces 2 cutaneous branches- intermediate and medial cutaneous nerves of the thigh. The medial cutaneous branch accompanies the lateral side of the artery; at the apex of the triangle it crosses the front of the artery from lateral to medial side.
The posterior section gives rise to cutaneous nerve- the saphenous nerve.
It goes downward along the lateral side of the artery. Lateral Cutaneous Nerve It appears underneath the lateral border of the psoas major above the iliac crestruns downward and laterally across the iliac fossa in front of the iliacus muscle under cover of the iliac fascia.
It enters the thigh by passing below the lateral end of the inguinal ligament. Occasionally it goes through the inguinal ligament. It gives cutaneous innervation to the upper lateral aspect of the thigh.
Deep Inguinal Lymph Nodes The deep inguinal lymph nodes are generally 3 in number and are located medial to the upper part of the femoral vein. The femoral sheath is split into 3 compartments, viz. The lateral compartment includes the femoral artery and the femoral branch of the genitofemoral nerve. The intermediate compartment includes the femoral vein. The medial compartment is small and called the femoral canal.
Clinical Relevance of the Femoral Triangle Femoral Pulse To measure the femoral pulse, the femoral artery can be palpated just inferior to where it crosses the inguinal ligament. The femoral artery crosses exactly midway between the pubis symphysis and anterior superior iliac spine.
In the leg, it accompanies the great saphenous vein and ends on the medial side of the foot. An accessory femoral nerve from the lumbar plexus is not uncommon. The saphenous and other cutaneous nerves form subsartorial beneath the sartorius and patellar plexuses.
The lateral femoral cutaneous nerve, a branch of the femoral nerve or of the lumbar plexus, supplies skin on the anterolateral aspect of the thigh and is liable to compression in the region of the inguinal ligament and produces paresthesia meralgia paresthetica.
The femoral artery, the continuation of the external iliac artery, enters the femoral triangle by passing posterior to the inguinal ligament see fig. It then enters the adductor canal and passes posteriorward to reach the popliteal fossa by traversing a gap the adductor hiatus between the insertions of the adductor magnus muscle and the femur. There it changes its name to popliteal see figs.
The femoral artery can be represented by the upper two thirds of a line from the midinguinal point midpoint between the anterior superior iliac spine and the pubic symphysis to the adductor tubercle of the femur see fig. Its pulsations can be felt at the midpoint of the inguinal ligament when the thigh is flexed, abducted, and rotated laterally.
The femoral artery can be compressed, palpated or cannulated at the midinguinal point. The femoro-popliteal artery supplies the muscles of the calf, and obstruction interferes with their blood supply, producing symptoms on exertion intermittent claudication. Proximally, the femoral artery gives off the superficial epigastric which proceeds toward the umbilicussuperficial circumflex iliac which runs toward the anterior superior iliac spineand superficial and deep external pudendal arteries to the inguinal and pudendal regions.
Lower Limb Anatomy: The Femoral Triangle - Ponder Med
The most important branch of the femoral artery is the deep femoral profunda femoris artery see fig. The deep femoral artery descends along the medial side of the femur, gives origin to about three perforating arteries which supply nearby musclesand ends by passing through the adductor magnus as the last fourth perforating artery. The perforating arteries form an extensive anastomosis, and the first one meets transverse branches of the circumflex and also the inferior gluteal artery collectively termed the cruciate anastomosis.
The circumflex arteries supply the head and neck of the femur through branches that enter near the trochanters and traverse the neck to reach the head of the femur. Therefore, fractures of the neck can compromise the circulation of the head of the femur resulting in "avascular necrosis" if the artery of the head of the femur is not adequate.
Distally, the femoral artery gives origin to the descending genicular artery, which supplies the knee joint. The femoral vein, which may be double below, accompanies the artery and finally lies medial to it in the femoral triangle.
It receives the great saphenous vein and becomes the external iliac vein. Popliteal fossa The popliteal fossa figs.
Its upper boundaries are the biceps laterally, and the semitendinosus and semimembranosus medially. Its lower boundaries are the lateral and medial heads of the gastrocnemius. The fascial roof is stretched on extension. The floor is formed, from superior to inferior, by the popliteal surface of the femur, the oblique popliteal ligament an expansion of the semimembranosus tendonand fascia overlying the popliteus muscle.
The popliteal fossa contains the common fibular and tibial nerves, popliteal vessels, small saphenous vein, lymph nodes, bursae, and fat. The common fibular nerve. The common fibular nerve L4 to S2 fig. It follows closely the medial edge of the biceps femoris tendon fig.
The common fibular nerve winds around the neck of the fibula, where it can be felt and where it is liable to injury. Under cover of the peroneus longus muscle, it divides into the superficial and deep peroneal nerves see fig. The common peroneal nerve, while still a part of the sciatic nerve, supplies the short head of the biceps femoris muscle. In the popliteal fossa, it gives branches to the knee joint and to skin lateral sural cutaneous nerve and a communication to the medial sural cutaneous nerve.
It sometimes supplies the fibularis longus, tibialis anterior, and extensor digitorum longus muscles. Injury to the common fibular nerve results in loss of eversion and of dorsiflexion of the foot foot-drop and in a sensory loss on the lateral side of the leg and on the dorsum of the foot.
The tibial nerve L4 to S3 fig. It exits the fossa by passing deep to the gastrocnemius, where it lies on the popliteus muscle. At the lower border of the popliteus muscle, it passes deep to the fibrous arch of the soleus. The tibial nerve, while still a part of the sciatic nerve, supplies the semitendinosus, semimembranosus, long head of the biceps, and adductor magnus muscles. In the popliteal fossa, it gives branches to the knee joint and to the gastrocnemius, soleus, plantaris, popliteus, and tibialis posterior muscles.
The branch to the popliteus provides the interosseous nerve of the leg. The tibial nerve gives rise to the medial sural cutaneous nerve, which descends superficially between the heads of the gastrocnemius and usually joins a communication from the common peroneal nerve to form the sural nerve. The sural nerve, which usually arises from both tibial and common peroneal components, lies on the calcaneal tendon, accompanies the small saphenous vein posterior to the lateral malleolus, and supplies the skin of the posterior leg and the lateral part of the foot, including the heel and at least the lateral side of the little toe.
Sensation from the sole of the foot is important in posture and locomotion, and damage to the tibial nerve results in a significant sensory loss on the sole and on the plantar aspects of the toes.
A simple scheme fig. Table shows the segmental innervation of the muscles of the lower limb. Hip joint The hip joint is a ball-and-socket articulation between the acetabulum of the hip bone and the head of the femur see figs.
The angle between the head and neck of the femur and the shaft may be abnormally diminished coxa vara or increased coxa valga. More than half of the head of the femur is within the acetabulum, which is deepened by the fibrous or fibrocartilaginous acetabular labrum and completed on its inferior aspect by the transverse ligament that bridges the acetabular notch figs.
The fibrous joint capsule is attached to the margin of the acetabulum and to the intertrochanteric line of the femur fig. The capsule is thickened anteriorly, to form the V-shaped iliofemoral ligament, and also inferiorly pubofemoral ligament and posteriorly ischiofemoral ligament, which encircles the neck of the femur as the zona orbicularis.
The posterior capsule is arranged so that the lateral one third to one half of the posterior neck of the femur is extracapsular see fig. Capsular fibers attached to the femur tend to be reflected along the neck as retinacula that carry vessels to the head of the femur. The ligament of the head formerly known as the ligamentum teres extends from the acetabular notch and transverse ligament to a pit on the head of the femur see fig.
The hip joint may be approached surgically from the anterior, posterior, or lateral sides, but it is surrounded by powerful muscles. The iliopsoas, pectineus, and femoral vessels are anterior relations. The hip joint may be tapped by a needle inserted anteriorly halfway between the mid inguinal point and the greater trochanter or laterally superior to the greater trochanter. The hip joint is supplied by branches of the femoral, sciatic, and obturator nerves, which also supply the knee joint.
Hip disease is an important cause of pain referred to the knee. The movements of the thigh at the hip joint are flexion and extension, abduction and adduction, and rotation and circumduction. The movements of the trunk at the hip joint are equally important, as when one lifts the trunk from the supine position.
Flexion of the thigh is usually combined with flexion of the vertebral column, the chief flexor being the iliopsoas muscle. The joint capsule becomes taut during hip extension, with the iliofemoral ligament restricting this motion.
The chief extensor muscles are the hamstrings, with assistance of the gluteus maximus muscle. The abductors are the glutei medius and minimus, and the main adductors are the adductor longus, brevis, and magnus. In rotation of the hip joint, the axis extends from the head of the femur to the medial condyle of the femur not the long axis of the femur.
The lateral rotators at the hip are the short muscles of the gluteal region. The chief medial rotators are the tensor fasciae latae and the glutei medius and minimus. Knee joint The knee joint is a condylar articulation between the condyles of the femur, those of the tibia, and the patella figs.
The articular surfaces are large, complicated, and incongruent. The angle between the vertical axes of the femur and tibia is exaggerated in knock-knee genu valgumwhereas the knees appear more separated in bowlegs genu varum. The knee joint capsule, thin and partly deficient, is attached to the margins of the condyles of the femur, to the patella and patellar ligament, and to the condyles of the tibia. The capsule is strengthened by retinacula derived from the vasti and by an expansion oblique popliteal ligament from the semimembranosus tendon.
A strong extracapsular ligament is present on each side fig. The fibular collateral ligament extends from the lateral epicondyle of the femur to the head of the fibula, and its stabilizing function is aided by the biceps and popliteus tendons. The tibial collateral ligament extends from the medial epicondyle of the femur to the medial surface of the tibia, and it is attached to the medial meniscus. The intra-articular ligaments are the cruciate ligaments and the menisci fig.
The anterior and posterior cruciate ligaments limit, respectively, anterior and posterior slippage of the tibia on the femur. These ligaments are named for their tibial attachments, and they extend, respectively, anterior and posterior to the intercondylar eminence, from the proximity of the intercondylar fossa of the femur to the tibia fig. The ligaments cross each other; hence the name cruciate. You can "represent the ligaments by your lower limbs while standing, i. Rotate your trunk to right and left" Mainland.
The lateral and medial menisci are fibrocartilagenous crescents that lie on the superior surface of the tibia.
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They act as cushions or shock absorbers and facilitate lubrication. Each meniscus is wedge-shaped in section, being thick externally and having a thin, free internal border. The following structures are contained within the femoral triangle from lateral to medial: Lateral cutaneous nerve of thigh - It crosses the lateral angle of the triangle, runs on the lateral side of the thigh and ends by dividing into anterior and posterior branches.
The anterior branch supplies the anterolateral aspect of the thigh while the lateral branche supplies the lateral aspect of the gluteal region. In the thigh, the nerve lies in a groove between iliacus muscle and psoas major muscles, outside the femoral sheath, and lateral to the femoral artery. It passes behind the femoral sheath to reach the anterior surface of the pectineus muscle.
Its contents are shown below from lateral to medial: Femoral branch of the genitofemoral nerve - occupies the lateral compartment of the femoral sheath along with femoral artery. It supplies the skin over the femoral triangle.
It receives drainage from great saphenous veincircumflex veins, and veins corresponding to the branches of the femoral artery here.