13 Anterior Medial Thigh

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					                           D’YOUVILLE COLLEGE
                  BIOLOGY 339/639 GROSS HUMAN ANATOMY
                                LECTURE #13
                    ANTERIOR & MEDIAL THIGH (chapter 5)

1.    Special Features (figs. 5 – 13A & B, 5 – 14A & 5 – 15A):
      • superficial inguinal lymph nodes
      • fascia lata wraps thigh like a stocking, laterally thickened as iliotibial tract
      • great saphenous vein traverses saphenous opening (in fascia lata) to reach
femoral v.

        Femoral Triangle (figs. 5 – 25, 5 – 26 & 5 – 27):
           • sartorius m. (laterally)
           • adductor longus m. (medially)
           • inguinal ligament (superiorly, base of triangle)
           • pectineus & iliopsoas mm. (floor)
           • fascia lata (roof)
        • contains femoral nerve, artery & vein + deep inguinal lymph nodes (navl -
lateral to medial)
        • contains femoral sheath (figs. 5 – 26 & 5 – 28), a fascial tube enclosing the
artery & vein (not the nerve) + femoral canal (space occupied by lymph nodes &
vulnerable to femoral hernias)

       Adductor Canal (figs. 5 – 27B & 5 – 30):
       • fascial tunnel covered by sartorius
          - conveys femoral vessels from femoral triangle to hiatus of adductor
       magnus, where they leave anterior thigh to enter popliteal fossa
          - also carries 2 branches of femoral n. (n. to vastus medialis, saphenous n.)

2.     Skeletal Relationships:
       a. Os Coxa (Hip Bone) (fig. 5 – 6):
           Anterior Superior Iliac Spine (ASIS): attachment for sartorius and tensor
fasciae latae mm. & superior end of inguinal ligament
           Anterior Inferior Iliac Spine (AIIS): attachment for rectus femoris m.
           Pubic Tubercle: inferior attachment for inguinal ligament
           Pecten Pubis: ridge on superior ramus of pubis, pectineus m. attaches
           Obturator Foramen: conveys obturator vessels and nerve from pelvic cavity
to medial thigh
           Pubic Arch: formed by two inferior rami + symphysis pubis; attachments
for several adductor mm.

       b. Femur (Thigh Bone) (fig. 5 – 7):
          Greater trochanter: attachment for vastus lateralis m. & lateral rotators
          Lesser Trochanter: attachment for iliopsoas m.
          Linea Aspera: vertical, roughened line on midposterior shaft; attachment for
(medial to lateral): vastus medialis, pectineus & adductor longus, adductor brevis,
adductor magnus, gluteus maximus, biceps femoris (short head) & vastus lateralis
          Adductor Tubercle: immediately superior to medial epicondyle; attachment
for adductor magnus

3.     Muscles (figs. 5 – 21, 5 – 23, tables 5 – 3 & 5 – 4):
       a. Iliopsoas: fused psoas major & iliacus mm. (discussed with post. abd. wall)

       b. Sartorius:
          attachments: origin from ASIS; insertion at medial proximal tibial shaft
          innervation: femoral n.
          actions: flexion of leg at knee; flexion, abduction, lateral rotation of thigh

        c. Tensor Fasciae Latae (figs. 5 – 34J, 5 – 47 & table 5 –6):
           attachments: origin from ASIS and adjacent iliac crest; insertion at iliotibial
tract (which attaches to lateral condyle of tibia)
           innervation: superior gluteal n.
           actions: abduction, medial rotation, & flexion of thigh; stabilizes extended
knee; stabilizes trunk on hip

      Quadriceps femoris group:
         innervation: femoral n.
         actions: flexion of thigh at hip (rectus femoris only); extension of leg at knee
      d. Rectus Femoris:
         attachments: origin from AIIS; insertion at tibial tuberosity via common
tendon (quadriceps tendon) with sesamoid bone (patella) embedded in it;
continuation beyond patella is patellar ligament

       e. Vastus Lateralis:
          attachments: origin from greater trochanter & lateral lip of linea aspera;
insertion at tibial tuberosity via quadriceps tendon & patellar ligament

      f. Vastus Medialis:
         attachments: origin from medial lip of linea aspera; insertion at tibial
tuberosity via quadriceps tendon & patellar ligament

        g. Vastus Intermedius:
           attachments: origin from anterolateral surface of femoral shaft; insertion at
tibial tuberosity via quadriceps tendon & patellar ligament

       Deep medial muscle:
       h. Obturator Externus:
           attachments: origin from border of obturator foramen & membrane;
insertion at trochanteric fossa of femur
           innervation: obturator n.
           actions: lateral rotation of thigh; stabilizes hip joint
       Adductor group:
           innervation: obturator n., (except pectineus which is femoral n.)
       i. Pectineus:
           attachments: origin from pecten pubis; insertion at pectineal line of femur
(top of linea aspera)
           actions: flexion of femur at hip; adduction of thigh

      j. Gracilis:
          attachments: origin from body & inferior ramus of pubis; insertion at
superior medial surface of tibia, below sartorius
          actions: adduction of thigh, flexion of leg at knee

       k. Adductor Longus:
          attachments: origin: body of pubis; insertion: middle third of linea aspera
          actions: adduction of thigh, flexion of thigh at hip

       l. Adductor Brevis:
          attachments: origin from body of pubis; insertion at superior one third of
linea aspera
          actions: adduction of thigh

       m. Adductor Magnus:
          attachments: origin from inferior ramus of pubis + ramus & tuberosity of
ischium; insertion at linea aspera & adductor tubercle of femur
          actions: adduction of thigh, flexion of thigh at hip (adductor part) extension
of thigh at hip (hamstring part - innervated by tibial division of sciatic)

4.      Nerves (figs. 2 – 97, 5 – 16 & table 5 – 1):
        a. Femoral n.: from lumbar plexus (L2 - L4), supplies mm. of anterior thigh
(quadriceps group) + pectineus & iliacus portion of iliopsoas; cutaneous branches to
anterior & medial thigh, medial leg (via saphenous n.)
        b. Obturator n.: (L2 - L4) passes through obturator foramen from lumbar
plexus ; supplies adductor mm. & obturator externus; small sensory branch to medial
        c. Lateral Femoral Cutaneous n.: (L2 & L3) from lumbar plexus, sensory to
lateral skin of thigh

5.     Vessels of Anterior & Medial Thigh (figs. 5 – 15A, 5 – 29 & table 5 – 5):

        a. Femoral a.: continuation of external iliac a., below inguinal ligament
           • passes through femoral triangle to adductor canal, continues through
adductor hiatus to become popliteal a.
           • supplies anterior and medial thigh mm.; produces profunda femoris a.
        b. Deep Femoral a. (Profunda Femoris a.): arises posteriorly from femoral a. (in
femoral triangle)
           • supplies deep anterior mm. & mm. of posterior thigh via perforating
arteries; produces lateral & medial circumflex femoral aa. (to hip and knee joints)
        c. Obturator a.: branch of internal iliac, passing through obturator foramen to
medial thigh; supplies adductor mm. and obturator externus; branch to hip joint
        d. Great Saphenous v.: superficial drainage from medial foot (dorsal venous
arch); ascends in superficial fascia of medial leg & thigh to empty into femoral v.


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