1. 4-2: Hip and Thigh

2. Medial Femoral Compartment Structures

3. Gracilis Gracilis m. Action: • Adduction of thigh • Flexion of leg
Origin:
• Pubis (body and inferior ramus)
Insertion:
• Tibia (proximal medial shaft)
Innervation:
• Obturator nerve
Comment:
• Weak muscle in humans
• Used for muscle transplants

4. Pectineus Pectineus m. Action: • Adduction of thigh • Flexion of thigh
• Medial rotation of thigh
Origin:
• Pubis (body and superior ramus)
Insertion:
• Femur (proximal posterior shaft)
Innervation:
• Femoral nerve
Comment:
• May also receive innervation from obturator nerve

5. Adductor longus Adductor longus m. Action: • Adduction of thigh
Origin:
• Pubis (body and inferior ramus)
Insertion:
• Femur (linea aspera)
Innervation:
• Obturator nerve
Comment:
• Often involved in "pulled groin"

6. Adductor brevis Adductor brevis m. Action: • Adduction of thigh
Origin:
• Pubis (body and inferior ramus)
Insertion:
• Femur (linea aspera)
Innervation:
• Obturator nerve

7. Adductor magnus Adductor magnus m.
Click for animation: Adductor magnus m.
Action:
• Adduction of thigh
• Extension of thigh
Origin:
• Pubis (inferior ramus)
• Ischium (ramus and tuberosity)
Insertion:
• Femur (gluteal tuberosity, linea aspera, and adductor tubercle)
Innervation:
• Obturator and tibial nerves
Comment:
• Comprised of adductor (adductor minimus) and hamstring parts

8. Obturator externus

9. Adductor canal

10. Vasto-adductor membrane

11. Obturator nerve
The obturator nerve, like the femoral nerve, originates from L2 to L4. It descends along the posterior abdominal wall, passes through the pelvic cavity and enters the thigh by passing through the obturator canal
Obturator n.
Location:
• Abdominal wall (posterior)
• Pelvic wall (lateral)
• Thigh (medial)
Contributions:
• Ventral rami of L2-4 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Muscles of medial thigh (adductor group)
General sensation:
Comment:
• Enters thigh via obturator canal of hip bone

12. Obturator artery

13. Anterior Femoral Compartment Structures

14. Lateral femoral cutaneous nerve
Sensory-Parietal peritoneum in iliac fossa; skin over anterolateral thigh
Lateral cutaneous n. of thigh
Location:
• Abdominal wall (posterior)
• Thigh (lateral)
Contributions:
• Ventral rami of L2-3 spinal nerves
Composition:
• Sensory
Sensory:
Comment:
• Enters thigh near anterior superior iliac spine

15. Cutaneous branches of femoral nerve

16. Femoral nerve

17. Femoral nerve branches( Vastus Medialis)
Femoral n. and branches
Location:
• Abdominal wall (posterior)
• Thigh (anterior)
Contributions:
• Ventral rami of L2-4 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Anterior thigh muscles
• Pectineus
• Iliacus
General sensation:
• Skin over anterior and medial thigh, medial leg, and medial margin of foot
Comment:
• Enters thigh posterior to inguinal ligament
• Ends in proximal thigh as numerous named branches

18. Vastus medialis

19. Saphenous n. Saphenous n. Location: • Thigh (medial) • Leg (medial)
• Foot (medial margin)
Contributions:
• Ventral rami of L3-4 spinal nerves
Composition:
• General sensation
General sensation:
• Skin of medial leg
• Skin over medial margin of foot
Comment:
• Branch of femoral nerve

20. Musculature

21. Quadriceps femoris Quadriceps femoris m.
Click for animation: Quadriceps femoris m.
Action:
• Extension of leg
• Flexion of thigh (rectus femoris only)
Origin:
• Vastus lateralis, vastus intermedius, vastus medialis: femur (shaft)
• Rectus femoris: ilium (anterior inferior iliac spine)
Insertion:
• Patella (via a common, quadriceps tendon)
Innervation:
• Femoral nerve
Comment:
• Comprised of four muscles: rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis
• Quadriceps tendon extends from patella to tibial tuberosity as patellar ligament
• Rectus femoris is only muscle of quadriceps group that acts on thigh

22. Rectus femoris Rectus femoris m. Action: • Extension of leg
• Flexion of thigh
Origin:
• Anterior inferior iliac spine
• Groove superior to acetabulum
Insertion:
• Patella
Innervation:
• Femoral
Comment:
• Only muscle of quadriceps group that acts on thigh
• Rectus femoris extends leg as part of quadriceps muscle group

23. Vastus lateralis Vastus lateralis m. Action: • Extension of leg
Origin:
• Femur (lateral side of greater trochanter and linea aspera)
Insertion:
• Patella (via a common quadriceps tendon)
Innervation:
• Femoral nerve
Comment:
• Quadriceps tendon extends from patella to tibial tuberosity as patellar ligament
• Quadriceps femoris muscle comprised of 4 muscles: rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis

24. Vastus intermedius Vastus intermedius m. Action: • Extension of leg
Origin:
• Femur (anterolateral surface of shaft)
Insertion:
• Patella (via a common quadriceps tendon)
Innervation:
• Femoral nerve
Comment:
• Quadriceps tendon extends from patella to tibial tuberosity as patellar ligament
• Quadriceps femoris muscle comprised of 4 muscles: rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis

25. Vastus medialis Vastus medialis m. Action: • Extension of leg Origin:
• Femur (medial side of intertrochanteric line and linea aspera)
Insertion:
• Patella (via a common quadriceps tendon)
Innervation:
• Femoral nerve
Comment:
• Quadriceps tendon extends from patella to tibial tuberosity as patellar ligament
• Quadriceps femoris muscle comprised of 4 muscles: rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis

26. Sartorius Sartorius m. Click for animation: Sartorius m. Action:
• Flexion of thigh
• Lateral rotation of thigh
• Abduction of thigh
• Flexion of leg
Origin:
• Ilium (anterior superior iliac spine)
Insertion:
• Tibia (proximal medial shaft)
Innervation:
• Femoral nerve
Comment:
• Longest muscle in body
• Important in assuming "scissor-legged" or "cross-legged" position

27. Illiopsoas Iliopsoas m. Action: • Flexion of thigh Origin:
• Iliacus part: ilium (iliac fossa)
• Psoas part: body of T12 and all lumbar vertebrae (bodies, transverse processes, and associated intervertebral discs)
Insertion:
• Femur (lesser trochanter)
Innervation:
• Iliacus part: femoral nerve
• Psoas part: ventral rami of L2-3 spinal nerves
Comment:
• Iliopsoas formed by union of iliacus and psoas muscles
• Most powerful flexor of thigh; also active during trunk flexion, especially against resistance (e.g., during sit-ups)
• Iliopsoas has minor role as a lateral rotator of thigh

28. Great saphenous vein

29. Saphenous hiatus
Facia hiatus for greater saphenous vein

30. Inguinal Lymph Nodes

31. Fascia Lata & Illiotibial band
longitudinal fibrous reinforcement of the fascia lata. The action of the ITB and its associated muscles is to flex, abduct, and medially rotate the hip. In addition, the ITB contributes to lateral knee stabilization. During knee extension the ITB moves anterior, while knee flexion moves the ITB posterior. It is attached to the anterolateral iliac tubercle portion of the external lip of the iliac crest and to the lateral condyle of the tibia

32. Femoral Triangle

33. Femoral Sheath
In the femoral triangle, the femoral artery and vein and the associated lymphatic vessels are surrounded by a funnel-shaped sleeve of fascia (the femoral sheath). The sheath is continuous superiorly with the transversalis fascia and iliac fascia of the abdomen and merges inferiorly with connective tissue associated with the vessels

34. Femoral Canal

35. Femoral Vein Femoral v. Drainage: • Abdominal wall (anterior inferior)
• External genitalia
• Thigh muscles
• Femur
• Hip and knee joints
Tributaries:
• Popliteal (at adductor hiatus)
• Great saphenous
• Superficial epigastric
• External pudendal
• Superficial circumflex iliac
• Deep vein of thigh (profunda femoris v.)
Course:
• Ascends in anterior and medial thigh
• Extends from adductor hiatus to inguinal ligament
Termination:
• External iliac
Comment:
• Major vein of lower limb
• Superficial in proximal thigh

36. Femoral Artery

37. Gluteal aponeurosis

38. Gluteus maximus Gluteus maximus m.
Click for animation: Gluteus maximus m.
Action:
• Extension of thigh
• Lateral rotation of thigh
• Abduction of thigh
Origin:
• Ilium (ala)
• Sacrum
• Coccyx
Insertion:
• Iliotibial tract
• Femur (gluteal tuberosity)
Innervation:
• Inferior gluteal nerve
Comment:
• Important for powerful extension of femur (running, climbing stairs, rising from seated position)
• Not important in walking

39. Sacrotuberous ligament

40. Sacrospinous ligament

41. Gluteus medius Gluteus medius m.
Click for animation: Gluteus medius m.
Action:
• Abduction of thigh (non weight-bearing)
• Lowers pelvis on weight-bearing side
Origin:
• Ilium (ala)
Insertion:
• Femur (greater trochanter)
Innervation:
• Superior gluteal nerve
Comment:
• Lowering ("tilting" downward) pelvis on weight-bearing side allows non weight-bearing limb to swing forward during walking
• Acts with gluteus minimus

42. Gluteus minimus Gluteus minimus m. Action:
• Abduction of thigh (non weight-bearing)
• Lowers pelvis on weight-bearing side
Origin:
• Ilium (ala)
Insertion:
• Femur (greater trochanter)
Innervation:
• Superior gluteal nerve
Comment:
• Lowering ("tilting" downward) pelvis on weight-bearing side allows non weight-bearing limb to swing forward during walking
• Acts with gluteus medius

43. Piriformis Piriformis m. Action: • Lateral rotation of thigh Origin:
• Sacrum (anterior surface)
Insertion:
• Femur (greater trochanter)
Innervation:
• Ventral rami of L5-S2 spinal nerves
Comment:
• Exits pelvis through greater sciatic foramen

44. Superior gemellus and Inferior Gemellus
Superior and inferior gemellus mm.
Action:
• Lateral rotation of thigh
Origin:
• Superior gemellus: ischium (spine)
• Inferior gemellus: ischium (tuberosity)
Insertion:
• Femur (greater trochanter)
Innervation:
• Ventral rami of L5-S1 spinal nerve

45. Obturator internus Obturator internus m. Action:
• Lateral rotation of thigh
Origin:
• Pubis
• Ischium
• Obturator membrane (pelvic surface)
Insertion:
• Femur (greater trochanter)
Innervation:
• Ventral rami of L5-S1 spinal nerves
Comment:
• Tendon exits pelvis through lesser sciatic foramen

46. Quadratus femoris Quadratus femoris m. Action:
• Lateral rotation of thigh
Origin:
• Ischium (tuberosity)
Insertion:
• Femur (intertrochanteric crest)
Innervation:
• Ventral rami of L5-S1 spinal nerves

47. Tensor fasciae latae Tensor fasciae latae m. Action:
• Flexion of femur
• Abduction of femur
• Medial rotation of femur
• Stabilizes knee in full extension
Origin:
• Ilium (crest and anterior superior iliac spine)
Insertion:
• Iliotibial tract
Innervation:
• Superior gluteal nerve

48. Superior gluteal artery and Nerve

49. Posterior femoral cutaneous nerve
Posterior cutaneous n. of thigh and branches
Location:
• Hip (posterior)
• Thigh (posterior)
• Leg (proximal posterior)
• Perineum
Contributions:
• Ventral rami of S1-3 spinal nerves
Composition:
• General sensation
General sensation:
• Lower gluteal region
• Skin around anus and posterior scrotum/labia majora
• Knee (posterior)
Comment:
• Exits pelvis via greater sciatic foramen
• Parallels sciatic nerve in hip and proximal thigh
• Supplies more skin with sensory innervation that any other nerve

50. Sciatic nerve Sciatic n. Location: • Hip (posterior)
• Thigh (posterior)
Contributions:
• Ventral rami of L4-S3 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Posterior thigh muscles
• Hamstring part of adductor magnus
• All leg muscles
• All foot muscles
General sensation:
• Skin of lateral leg
• Skin of dorsum and sole of foot
• Skin over lateral margin of foot
Branches:
• Tibial
• Common fibular
Comment:
• Tibial and common fibular nerves in common connective tissue sheath form sciatic nerve
• Largest nerve of body
• Herniated intervertebral disks in lower lumbar region may produce symptoms (numbness, tingling, muscle weakness) along distribution of sciatic nerve ("sciatica")

51. Long Head Biceps femoris
Long head of biceps femoris m.
Action:
• Flexion of leg
• Extension of thigh
Origin:
• Ischium (tuberosity)
Insertion:
• Fibula (head)
Innervation:
• Tibial nerve
Comment:
• One of hamstring muscles (semitendinosus, semimembranosus, and long head of biceps femurs)
• Tendon unites with that of biceps femoris, short head
• Common tendon pierced by fibular collateral ligament

52. Short Head of Biceps femoris
Short head of biceps femoris m.
Action:
• Flexion of leg
Origin:
• Femur (linea aspera)
Insertion:
• Fibula (head)
Innervation:
• Common fibular nerve
Comment:
• Tendon unites with that of long head of biceps femoris
• Common tendon pierced by fibular collateral ligament

53. Semitendinosus Semitendinosus m. Click for animation: Hamstring mm.
Action:
• Flexion of leg
• Extension of thigh
Origin:
• Ischium (tuberosity)
Insertion:
• Tibia (proximal medial shaft)
Innervation:
• Tibial nerve
Comment:
• One of hamstring muscles (semitendinosus, semimembranosus, and long head of biceps femurs)

54. Semimembranosus Semimembranosus m. Click for animation: Hamstring mm.
Action:
• Flexion of leg
• Extension of thigh
Origin:
• Ischium (tuberosity)
Insertion:
• Tibia (medial condyle)
Innervation:
• Tibial nerve
Comment:
• One of hamstring muscles (semitendinosus, semimembranosus, and long head of biceps femurs)

55. Sciatic Nerve Sciatic n. and branches Location: • Hip (posterior)
• Thigh (posterior)
Contributions:
• Ventral rami of L4-S3 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Posterior thigh muscles
• Hamstring part of adductor magnus
• All leg muscles
• All foot muscles
General sensation:
• Skin of lateral leg
• Skin of dorsum and sole of foot
• Skin over lateral margin of foot
Branches:
• Tibial
• Common fibular
Comment:
• Tibial and common fibular nerves in common connective tissue sheath form sciatic nerve
• Largest nerve of body
• Herniated intervertebral disks in lower lumbar region may produce symptoms (numbness, tingling, and muscle weakness) along distribution of sciatic nerve ("sciatica")

56. Common fibular nerve Common fibular n. Location: • Gluteal region
• Thigh (posterior)
• Leg (lateral proximal)
Contributions:
• Ventral rami of L4-S2 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Anterior leg muscles
• Lateral leg muscles
• Dorsum of foot muscles
General sensation:
• Skin over lateral proximal and anterior distal leg
Branches:
• Superficial fibular
• Deep fibular
Comment:
• In connective tissue sheath with tibial nerve as sciatic nerve to mid-thigh
• Subcutaneous position on neck of fibula makes it vulnerable in trauma to lateral knee region

57. Tibial nerve Tibial n. and branches Location:
• Thigh (distal posterior)
• Leg (posterior)
• Ankle (medial)
• Foot (sole)
Contributions:
• Ventral rami of L4-S3 spinal nerves
Composition:
• Motor
• General sensation
Motor:
• Adductor magnum
• Hamstring muscles of posterior thigh
• Muscles of posterior leg
• Intrinsic foot muscles (sole)
General sensation:
• Leg (lateral proximal)
• Leg (posterior distal one-third)
Comment:
• Bound together with common fibular nerve to form sciatic nerve
• Separates from common fibular nerve in posterior distal thigh
• Divides at medial ankle into medial and lateral plantar nerves

58. Perforating branches of deep femoral a.