1. thigh & popliteal fossa
IN 30 QUESTIONS
Kaan Yücel M.D., Ph.D.
28.February.2013 Thursday

2. INTRODUCTION TO THIGH

3. The femoral region (thigh)lies between the gluteal, abdominal, and perineal regions proximally and the knee region distally:
anteriorly separated from the abdominal wall
by the inguinal ligament
posteriorly separated from the gluteal region
by the gluteal fold superficially
by the inferior margins of the gluteus maximus & quadratus femoris on deeper planes

4. Structures enter and leave the top of the thigh by 3 routes:
Posteriorly continuous with the gluteal region
sciatic nerve
Anteriorly abdominal cavity via aperture between inguinal ligament & pelvic bone
Medially thigh & pelvic cavity communicates via obturator canal
Vessels and nerves passing between the thigh
and leg pass through the popliteal fossa posterior to the knee joint.

5. Superficial Fascia of the Thigh Deep Fascia of the Thigh (Fascia Lata)
Attached to the deep fascia below the inguinal ligament.
Deep Fascia of the Thigh (Fascia Lata)
Encloses the thigh like a trouser leg.
Saphenous opening
A gap in the deep fascia in front of the thigh just below the inguinal ligament.
Great saphenous vein via hiatus saphenus drains into femoral vein.
Filled with loose connective tissue called the cribriform fascia.

6. Fascial Compartments of the Thigh
3 fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur.
Anterior compartment of thigh Femoral nerve
muscles extend the leg at the knee joint.
Medial compartment of thigh Obturator nerve
muscles adduct the thigh at the hip joint.
Posterior compartment of thigh Sciatic nerve
muscles extend the thigh at the hip joint & flex the leg at the knee joint.

7. MUSCLES OF THE ANTERIOR
COMPARTMENT
OF THE THIGH
IN 3 QUESTIONS

8. Anterior inferior iliac spine & ilium superior to acetabulum
1. Which muscles are in the anterior part of the thigh?
Sartorius
Quadriceps femoris
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Insertion
base of patella
indirectly via
patellar ligament
to tibial tuberosity
femoral nerve
Origin
Anterior inferior iliac spine & ilium superior to acetabulum
Origin
ASIS & superior part of notch inferior to it
Insertion
Superior part of medial surface of tibia

9. 2…iliopsoas muscle
In addition, the terminal ends of the psoas major and iliacus muscles pass into the upper part of the anterior compartment from sites of origin on the posterior abdominal wall.
Iliacus+psoas major
Ilıopsoas

10. Quadriceps femoris Sartorius
3. Functions of the anterior thigh muscles
Quadriceps femoris
Extends leg at knee joint.
Rectus femoris also steadies hip joint &
helps iliopsoas flex thigh.
Sartorius
Flexes, abducts, and laterally rotates thigh
at hip joint.
Flexes leg at knee joint (medially rotating leg when knee is flexed).
Flexion of thigh at hip joint
Rectus femoris
Sartorius
Extension of leg at knee joint
Quadriceps femoris
Abduction of thigh at hip joint
Sartorius
Lateral rotation of thigh at hip joint
Sartorius

11. MUSCLES OF THE MEDIAL
COMPARTMENT
OF THE THIGH
IN 3 QUESTIONS

12. 1. Which muscles are in the medial part of the thigh?
1.Gracilis
2. Pectineus
3. Adductor longus
4. Adductor brevis
5. Adductor magnus 6.Obturator externus

13. Lateral rotation of thigh
2. Functions of the medial thigh muscles
Lateral rotation of thigh
Adduction of thigh
Flexion of thigh
Extension of thigh
Adductor longus
Adductor brevis
Adductor magnus
Adductor brevis
Adductor magnus
“adductor part”
Adductor magnus
“hamstrings part”
Obturator externus
Gracilis
Adducts thigh; flexes leg; helps rotate leg medially
Pectineus

14. 3. Adductor hiatus
A gap between the aponeurotic distal attachment of the adductor part of the adductor magnus & tendinous distal attachment of the hamstring part.
Transmits femoral artery & vein from the adductor canal in the thigh to the popliteal fossa.
Located lateral and superior to the adductor tubercle of the femur.

15. MUSCLES OF THE POSTERIOR
COMPARTMENT
OF THE THIGH
IN 2 QUESTIONS

16. 1. Which muscles are in the posterior part of the thigh?
Biceps femoris
Short head
Biceps femoris
Long head
Semitendinosus
Semimembranosus

17. 2. Features of hamstring muscles
Proximal attachment to ischial tuberosity
deep to the gluteus maximus.
Distal attachment to the bones of the leg.
Thus act on two joints, producing
hip joint & knee joint.
Innervation by tibial division of the sciatic nerve.

18. ARTERIES OF THE THIGH
IN 3 QUESTIONS

19. 1. Which arteries enter the thigh?
Femoral artery largest & main artery of lower limb
Obturator artery
Inferior gluteal artery
Inferior gluteal artery
Obturator artery
Femoral artery

20. 2. Femoral artery Distal continuation of external iliac artery.
Passes under the inguinal ligament.
Enters the femoral triangle
midpoint of the inguinal ligament
(midway between ASIS & pubic tubercle).
Continues down the thigh in the adductor canal.
Becomes popliteal artery behind the knee.

21. 3. .. branches of the femoral artery
1. Superficial circumflex iliac artery
2. Superficial epigastric artery
3. Superficial external pudendal artery
4. Deep external pudendal artery
5. Profunda femoris artery
Large and important branch
Arises from the lateral side of the femoral artery below the inguinal ligament
6. Descending genicular artery

22. VEINS OF THE THIGH
IN 2 QUESTIONS

23. 1 . Which veins are seen in the thigh?
Superficial & deep veins
Great saphenous vein
Largest superficial vein in the thigh
Originates from a venous arch on the dorsal aspect of the foot.
Ascends along the medial side of the lower limb.
Passes through the saphenous ring.
To connect with the femoral vein in the femoral triangle.

24. 2. Other veins in the thigh
Femoral vein
Continuation of the popliteal vein proximal to the adductor hiatus.
Enters the femoral sheath
Ends posterior to the inguinal ligament, becomes external iliac vein
Profunda Femoris Vein
drains into the femoral vein.
Obturator Vein
drains into the internal iliac vein.

25. NERVES OF THE THIGH
IN 6 QUESTIONS

26. 1. Major nerves of the thigh
3 major nerves in the thigh, each associated with one of the 3 compartments:
Femoral nerve
anterior compartment of thigh
Obturator nerve
medial compartment of thigh
Sciatic nerve
posterior compartment of thigh

27. 2. ..femoral nerve (L2-L4) Largest branch of the lumbar plexus.
Enters the thigh lateral to the femoral artery and the femoral sheath, behind the inguinal ligament.
In the femoral triangle lies on the lateral side of the femoral artery

28. 3… obturator nerve
Enters the medial compartment of thigh through the obturator canal.
Supplies most of the adductor muscles and skin on the medial aspect of the thigh.

29. 4… sciatic nerve Descends in the midline of the thigh.
Ends by dividing into the tibial and common peroneal nerves.
Innervates all muscles in the posterior compartment of thigh and then its branches continue into the leg and foot.

30. 5… cutaneous nerves of the thigh
Lateral cutaneous nerve of the thigh
branch of the lumbar plexus (L2& 3)
Medial cutaneous nerve of the thigh
branch of the femoral nerve
Intermediate cutaneous nerve of the thigh
Posterior cutaneous nerve of the thigh
branch of the sacral plexus

31. Neurovascular Structures and Relationships
in Anteromedial Thigh
IN 6 QUESTIONS

32. 1. Femoral triangle Superiorly inguinal ligament
Medially lateral border of adductor longus
Laterally sartorius
Contents; from lateral to medial
Femoral nerve
Femoral sheath
Femoral artery
Femoral vein
Deep inguinal lymph nodes

33. 2. Femoral sheath A funnel-shaped fascial tube
Passes deep to the inguinal ligament
Encloses proximal parts of the femoral vessels and creates the femoral canal medial to them.
Formed by an inferior prolongation of transversalis & iliopsoas fascia
Subdivided into three smaller compartments
Lateral compartment
for the femoral artery.
Intermediate compartment
for the femoral vein.
Medial compartment
constitutes the femoral canal

34. 3. femoral canal Smallest of the 3 compartments of the femoral sheath
Lies between the medial edge of the femoral sheath and the femoral vein.

35. 4. femoral ring
Upper opening of the femoral canal formed by the small opening at its abdominal end.
Boundaries
Laterally vertical septum between femoral canal & femoral vein.
Posteriorly superior ramus of the pubis covered by the pectineus muscle and its fascia.
Medially lacunar ligament Anteriorly medial part of the inguinal ligament.

36. 5. femoral hernia
Femoral sheath blends with the tunica adventitia of blood vessels.
a potentially weak area in the abdomen
The part of the femoral sheath that forms the medially located femoral canal is not.
femoral hernia
A protrusion of peritoneum forced down the femoral canal, pushing the femoral septum before it

37. 6. ..adductor canal
Intermuscular cleft in the middle 1/3 of the thigh beneath the sartorius muscle
Extends from the apex of the femoral triangle to the adductor hiatus

38. 6. ..adductor canal Contains terminal part of the femoral artery
femoral vein (lies behind the artery)
deep lymph vessels
saphenous nerve
nerve to the vastus medialis
terminal part of the obturator nerve
Boundaries
Anteriorly and laterally vastus medialis
Posteriorly adductors longus & magnus
Medially sartorius, roof of the canal

39. PoplIteal fossa
IN 5 QUESTIONS

40. 1. Where is popliteal fossa located?
An area of transition between the thigh and leg
Major route by which structures pass from one region to the other.
Formed between muscles in the posterior compartments of thigh and leg.

41. 2. What are the boundaries of the popliteal fossa?
Superolaterally
Biceps femoris
Superomedially
Semimembranosus
Inferolaterally and inferomedially
Gastrocnemius
Posteriorly
Skin & popliteal fascia (roof)

42. 3. What are the contents of the popliteal fossa?
Termination of the small saphenous vein
Popliteal arteries and veins and their branches and tributaries
Tibial and common fibular nerves
Posterior cutaneous nerve of thigh
Popliteal lymph nodes and lymphatic vessels

43. 4. Nerves in the popliteal fossa
The sciatic nerve usually ends at the superior angle of the popliteal fossa by dividing into
tibial nerve
&
common fibular nerve

44. 4. Nerves in the popliteal fossa
tibial nerve ,medial and larger terminal branch of the sciatic nerve, descends vertically through the popliteal fossa and exits deep to the margin of plantaris muscle to enter the posterior compartment of leg.
common fibular nerve , lateral, smaller terminal branch of the sciatic nerve, exits by following the medial border of the biceps femoris tendon over the lower lateral margin of the popliteal fossa, and continues to the lateral side of the leg where it swings around the neck of the fibula and enters the lateral compartment of leg

45. 5. Popliteal artery/vein
Continuation of the femoral artery
Begins as the femoral artery passes through the adductor hiatus.
Ends lateral to the midline of the leg by dividing into anterior & posterior tibial arteries.
Popliteal vein is superficial to and travels with the popliteal artery. (formation by ant. & post. tibial veins), becomes femoral vein.