Anterior and Medial Thigh

• Compartments of the Thigh

  Anterior Compartment - Flex Hip; Extend Knee

  Medial Compartment - Adduct Hip

  Posterior Compartment -Extend Hip; Flex Knee

  
• Femur

  
• Anterior Thigh

  Hip Flexors

  •Iliacus

  •Psoas major

  •Pectineus

  •Sartorius

  Knee Extensors

  •Quadriceps

  –Rectus femoris

  –Vastus medialis

  –Vastus lateralis

  –Vastus intermedius

  
• Hip Flexors – Iliopsoas

  •Iliacus

  –Iliac crest, fossa, ala of sacrum, ant. sacroiliac lig. → Psoas tendon, lesser trochanter

  –Femoral nerve (L2, 3)

  –Flex hip

  •Psoas major

  –T12-L5, IV discs, lumbar transverse processes    → Lesser trochanter

  –Anterior rami L1-3

  –Flex hip

  
• Hip Flexors – Pectineus

  •Pectineus

  –Superior ramus of pubis               

    → Pectineal line of femur

  –Femoral nerve (L2, 3) [occassionally br. from obturator]

  –Adduct and flex hip; assist with medial rotation

  
• Iliopsoas and Pectineus

  
• Hip Flexors – Sartorius

  •Sartorius

  –Anterior Superior Iliac Spine

    → Superior part of medial surface Tibia

  –Femoral nerve (L2, 3)

  –Flex, abduct, laterally rotate hip; flex knee

  
• Sartorius

  
• Knee Extensors – Quadriceps

  •Rectus femoris

  –AIIS, ilium above acetabulum

  •Vastus lateralis

  –Gr. Trochanter & Lat. Linea Aspera

  •Vastus medialis

  –Intertrochanteric line & Med. Linea Aspera

  •Vastus intermedius

  –Ant. and Lat. Shaft of femur–

  •→ Quadriceps tendon then tibial tuberosity via Patellar lig.

  •Extend knee (rectus fem. also flexes hip)

  •Femoral nerve (L2,3,4)

  
• Knee Extensors – Quadriceps

  
• Femoral nerve

  •Passes deep to inguinal ligament, medial to ASIS, on tendon of iliopsoas m.

  •Muscular branches: anterior thigh

  •Articular branches: hip and knee

  •Cutaneous branches: anteromedial thigh

  •Saphenous nerve is terminal cutaneous branch – anteromedial knee, leg and foot

  
• Femoral Nerve

  
• Medial Thigh

  Hip Adductors

  •Gracilis

  •Adductor Longus

  •Adductor Brevis

  •Adductor Magnus

  •Obturator Externus
• Medial Thigh

  
• Hip Adductors – Gracilis

  Body and Inf. ramus of Pubis

  →Superior Medial surface Tibia

  Obturator (L2, 3)

  Adducts hip; flexes knee

  
• Hip Adductors – Adductor Longus

  Body of pubis

  → Middle ⅓ Linea aspera

  Obturator (L2,3,4)

  Adducts thigh

  
• Hip Adductors – Adductor Brevis

  Body and Inf. ramus of Pubis  

  →Pectineal Line and proximal Linea Aspera

  Obturator (L2,3,4)

  Adducts thigh (may assist flexion)

  
• Hip Adductors – Adductor Magnus

  Ischiopubic ramus and Ischial tuberosity

  →Linea aspera, Med. Supracondylar line, Adductor tubercle

  Obturator (L2,3,4)

  Hamstring part = tibial division of Sciatic n. (L4)

  Adducts thigh

  Adductor part flexes and hamstring part extends thigh

  
• Obturator Externus

  Margins of obturator foramen & obturator membrane

  →Trochanteric fossa

  Obturator n. (L3,4)

  Laterally rotates thigh

  In the adductor compartment, but is NOT an adductor

  
• Obturator Nerve

  •Anterior divisions L2-4

  •Runs along lateral wall of pelvis to the obturator canal

  •Anterior and Posterior branches (relative to adductor brevis)

  •Muscular branches to medial thigh

  •Anterior branch – cutaneous to middle part of medial thigh

  
• Obturator Nerve

  
• Adductor Canal

  Apex of Femoral Triangle

  • Adductor Hiatus

  Underlies the distal half of sartorius muscle

  Boundaries:

  •Sartorius

  •Vastus medialis

  •Adductor longus

  
• Adductor Canal

  Femoral vessels:

  pass through adductor hiatus to reach popliteal fossa

  Saphenous nerve:

  passes between sartorius and gracilis to supply skin of anteromedial knee, leg and foot

  
• Arterial Supply

  Femoral artery (Continuation of Ext. Iliac a.)

  •Femoral triangle → Adductor canal → Adductor hiatus to become Popliteal a.

  •Anterior and anteromedial thigh

  Profunda femoris → br. of Femoral

  –Deep to Adductor Longus → 3-4 perforating br.s through Adductor Magnus

  –Medial and Lateral Circumflex femoral br.s (usually)
• Arterial Supply

  Obturator artery (from Int. Iliac a.)

  •Through obturator foramen to medial compartment → ant. and post. br.s

  •Anterior branch: muscles of medial compartment

  •Posterior branch: muscles attached to ischial tuberosity
• Cruciate anastomosis:

  Inferior gluteal

  Medial circumflex femoral

  Lateral circumflex femoral

  1st perforating branch

  
• Femoral Vessels