1. Muscles of thigh D.Rania Gabr D.Sama. D.Elsherbiny

2. Objectives Know the type and formation of hip joint. Differentiate the stability and mobility between the hip joint and shoulder joint. Identify the muscles that act at the hip joint. Identify the muscles of the thigh in terms of their origin, insertion, nerve supply and actions. Explain the relationships of contents of the femoral triangle to each other & to the surrounding bone and soft tissue landmarks.

3. Anterior compartment (Quadriceps femoris muscle) (Extensor group) Femoral nerve Femur Posterior compartment (Hamstring muscles) (Flexor group) Sciatic nerve Medial compartment (Adductor muscles) Obturator nerve Deep fascia Compartments of the thigh

4.  MUSCLES: 1.Adductor longus 2.Adductor brevis 3.Adductor magnus (Adductor part) 4.Gracilis  ACTION: adduction of hip joint N.B.: Gracilis also flexes knee joint  NERVE SUPPLY: obturator nerve Adductor magnus (Adductor portion) Medial Compartment of Thigh 1 2 3 4 Adductor magnus (Hamstring portions) 1 2 3 4

5. Adductor group Pectineus Adductor longus Gracilis Adductor brevis Adductor magnus

6. Medial Compartment

7. Insertion  Posterior border of femur (Linea Aspera)  Upper part of medial surface of tibia (behind sartorius) Adductor longus Adductor brevis Adductor magnus (adductor portion) Gracilis Origin  Body of pubis  Inferior pubic ramus  Ischial ramus Adductor hiatus Hamstring hiatus Adductor part

8. Medial Compartment Blood Supply: Obturator artery: Branch of internal iliac artery.

9. Anterior Compartment of Thigh Vastus Intermedius (deep to rectus femoris) 1 2 3 1 4 2 3 4  Flexor of the hip: 1.Sartorius 2.Pectineus 3.Psoas major 4.Iliacus  Extensors of knee (Quadriceps femoris): 1.Rectus femoris 2.Vastus lateralis 3.Vastus medialis 4.Vastus intermedius Femoral nerve  Nerve supply: Femoral nerve

10. Sartorius Origin Insertion Action (TAILOR’S POSITION)  Flexion, abduction & lateral rotation of hip joint  Flexion of knee joint

11. Pectineus : ACTION:  Flexion & adduction of hip joint Pectineal surface Pectineal line

12. Ilio-psoas Action: Flexion & medial rotaion of hip joint Lesser trochanter P I

13. Quadriceps Femoris 1.Rectus femoris 2.Vastus medialis 3.Vastus lateralis 4.Vastus intermedius

14. Origin of Rectus femoris Straight head Reflected head

15. Vastus medialis Vastus lateralis Vastus intermedius Articularis genu Origin of vasti

16. Ligamentum patellae Patella Insertion ACTION:  Extension of knee joint  Rectus femoris (flexion of hip)

17. Femoral Triangle Def: It is a deep hollow in the Upper third of front of thigh inferior to the inguinal ligament Boundaries  Base: Inguinal ligament  Medial: Medial border of the adductor longus muscle  Lateral: Medial border of the sartorius muscle  Floor: (from media to lateral) adductor longus Pectineus Psoas major Iliacus Roof: Skin, superficial & deep fascia. Pectineus Iliopsoas

18. Sartorius Adductor longus Inguinal ligament Floor of femoral triangle Pectineus Psoas major Iliacus

19. Contents of femoral triangle Femoral a. + its br. + sympathetic plexus Femoral v. + its tribut. Femoral n. +its br. Femoral sheath Lat. cut. n. of the thigh Femoral br. of genito- femoral n. Deep inguinal L.N.

20. Femoral sheath Fascia transversalis Fascia iliaca Femoral ring Femoral canal Lacunar lig. Inguinal lig. Femoral septum

21. Femoral hernia

22. Anterior Compartment Blood Supply: Femoral Artery:

23. :  DEFINITION: an aponeurotic tunnel for femoral artery & vein :  SITE: In middle third of front of thigh deep to sartorius :  EXTENT: From apex of femoral triangle to adductor hiatus :  BOUNDARIES:  Roof (Anterior): Sartorius (medially) and vastus medialis (laterally)  Floor (Posterior): Adductor longus & magnus ADDUCTOR CANAL (Subsartorial/Hunter’s canal) Adductor hiatus

24. Sub-sartorial canal (adductor canal)

25. Subsartorial canal Middle 1/3 Fibrous roof FR VM s s Add s VM Add

26. Femoral vein Femoral artery Saphenous nerve Nerve to Vastus medialis Descending genicular artery medial lateral Fibrous roof Vastus medialis Contents of adductor canal

27. Posterior Compartment Of The Thigh Hamstring muscles: 1.Biceps femoris. 2.Semitendinosus. 3.Semimembranosus. 4.Ischial part of adductor magnus. Action: 1.Extend hip 2.Flex knee Blood supply: profunda femoris artery. Nerve supply: Sciatic nerve.

28. Semi-membranosus Soleal line Oblique popliteal ligament Ischieal tuberosity Medial condyle of tibia Action: 1.Extend hip 2.Flexion and medial rotation of the knee

29. SGS Semi-tendinosus Upper medial surface of tibia Ischieal tuberosity Action: 1.Extend hip 2.Flexion and medial rotation of the knee

30. Biceps femoris Ischeal tubersoity Styloid process of fibula Action: 1.Extend hip 2.Flexion and lateral rotation of the knee

31. B ST SMSM Long head Short head

32. Hamstring muscles

33. Adductor Magnus (Hamstring Part) Nerve supply: The tibial portion of the sciatic. Action: Extension of the hip joint.

34. BLOOD SUPPLY The four perforating branches of the profunda femoris artery.

35. NERVE SUPPLY Sciatic Nerve Origin: L4 and 5; S1, 2, 3. Course; descends between biceps femoris, semimembranosus muscles (posteriorly) and adductor magnus anteriorly. Termination: In the lower third of the thigh it ends by dividing into the tibial and common peroneal nerves.

37. Psoas Major Tensor Fascia Latae Rectus Femoris Adductor Longus Sartorius Vastus Medialis Iliacus Vastus Lateralis Vastus Intermedius DEEP TO RECTUS FEMORIS

38. Surface anatomy of the thigh Surface features of the Thigh – Sartorius muscle – Quadriceps femoris muscle – Adductor longus muscle – Hamstring muscles – Femoral triangle

39. Q: Muscles which produce: 1.Flexion hip and knee……….. 2.Extension hip and flexion knee…… 3.Flexion hip and extension knee…..