Lower Limb: Front and Medial Aspect of Thigh

Surface Anatomy
1. Axis
2.
3.
4.
5.
6.

SKIN
Cutaneous Nerve (FILM-IPO)
1. Femoral branch of the Geneto-femoral (L1-L2)
2. Inguinal Nerve (L1)
3. Lateral cutaneous of the thigh (L2-L3)
4. Medial cutaneous nerve of the thigh (femoral nerve)
5. Intermediate cutaneous nerve of the thigh (femoral nerve)
6. Patellar plexus
7. Obturator nerve

Superficial Veins
1. Great Saphenous Vein/ Long (arise from medial aspect)
a. Drains medial site of dorsal venous arch (of foot) & ends at femoral vein at saphenous opening
b. (3) tributaries:
i. Superficial circumflex iliac vein
ii. Superficial epigastric vein
iii. Superficial external pudendal vein
2. Small Saphenous Vein/ Lesser
a. Popliteal vein – ending
b. From lateral side

Inguinal Lymph Nodes

1. Superficial
a. In the superficial fascia below inguinal ligament
b. Horizontal & vertical groups
c. Drains into deep inguinal lymph nodes
2. Deep
a. Beneath the deep fascia, medial to femoral vein
b. Drains into nodes along external iliac artery into abdomen

Superficial: (2) Layers

1. Membranous layer of superficial fascia of anterior abdomen
a. Extends into thigh; attached to deep fascia (fascia lata), a fingerbreadth below the inguinal ligament
2. Fatty layer of superficial fascia of anterior abdomen
a. Extends into the thigh, & continues downward without interruption

Deep Fascia (Fascia Lata)

1. Iliotibial tract – thickened lateral aspect
a. Attachments
Superior (S) – Iliac Tubercle
Inferior (I) – lateral condyle of tibia
b. Conjoint aponeurosis of gluteus maximus & tensor fascia lata
2. Saphenous Opening
a. Oval opening in the deep fascia below inguinal ligament, 1 ½ inch (4cm) below and lateral to pubic
tubercle
b. Transmits:
i. Great Saphenous Vein
ii. Small branches of femoral artery
iii. Lymph vessels
c. Filled with loose connective tissue called cribriform fascia

(3) Fascia Septa – divides thigh into:

1. Anterior Compartments
2. Medial Compartments
3. Posterior Compartments

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Muscles of the ANTERIOR COMPARTMENT of the thigh  SIPP
1. Sartorius
2. Iliacus
3. Psoas: Major & Minor
4. Pectineus

Muscle Origin Insertion Nerve Action

Sartorius Anterior superior Upper medial Femoral nerve >Abducts &
iliac spine surface of shaft of (L2, L3) flexes thigh
tibia >With lateral
rotation of thigh
Iliacus Iliac fossa of hip With psoas into Femoral nerve
bone lesses trochanter of (L2, L3) Act jointly in:
femur >Flexing thigh at
Psoas Transverse With iliacus into Lumbar plexus hip joint &
process, bodies lesser trochanter of stabilizing this
& IV discs of T12- femur joint
L5 vertebrae
Pectineus Superior ramus >Pectineal line of Femoral nerve >Adducts &
of pubis femur (L2, L3) flexes thigh
>Inferior to lesser >With medial
trochanter rotation of thigh

QUADRICEPS FEMORIS
1. Rectus Femoris
2. Vastus Lateralis
3. Vastus Intermedialis
4. Vastus Medialis

Muscle Origin Insertion Nerve Action

R. Femoris >Straight head:
anterior iliac
spine
>Reflected head:
ilium above
acetabulum
V. Lateralis Upper end of >Quadriceps Femoral nerve >Extends leg at
shaft of femur tendon into patella, (L2, L3, L4) knee joint
V. Anterior & lateral >then via >Flexes thigh at
Intermedialis surfaces of shaft ligamentum hip joint
patellae into
tubercle of tibia
V. Medialis Upper end of
shaft of femur

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Neurovascular Structures and Relationships in the ANTERIOR THIGH
1. FEMORAL TRIANGLE
a. Triangular depression in the medial thigh just below inguinal ligament
b. Boundaries:
i. Superior = inguinal ligament
ii. Medial = adductor longus
iii. Lateral = sartorius
iv. Floor
1. lateral = iliopsoas
2. medial = pectineus
v. Roof
1. skin, subQ, fascia lata, cribiform fascia
c. Contents of femoral triangle  TAVIS
i. Terminal part of femoral nerve & its branches
ii. Femoral Artery & its branches
iii. Femoral Vein & its tributaries
iv. Deep Inguinal lymph node
v. Femoral Sheath
2. FEMORAL SHEATH
a. Downward protrusion of fascia lining abdominal walls
i. Anterior = fascia terminals
ii. Posterior = fascia iliaca
b. Surrounds femoral vessels & lymphatic for about 1 inch below inguinal ligament
c. (3) components:
i. Lateral = femoral artery
ii. Intermediate = femoral vein
iii. Medial = lymph vessels and lymph nodes (of Cloquet)
*found in canal, called femoral canal
3. FEMORAL CANAL
a. Small medial compartment for lymph vessels
b. Characteristics:
i. 1 ½ inch (1.3 cm) long
ii. Upper opening  femoral ring
iii. Closed by extraperitoneal tissue  femoral septum
iv. Potential site of femoral hernia
c. Boundaries:
i. Anterior = inguinal ligament
ii. Distal = superior ramus of pubis
iii. Medial = lacunar ligament
iv. Lateral = femoral vein
4. ADDUCTOR (SUBTORIAL/HUNTER’S) CANAL
a. Intermuscular cleft at medial aspect of middle 3rd of thigh beneath sartorius
b. Begins: above at apex of femoral triangle
Ends: below at opening of adductor magnus
c. Boundaries:
i. Antero-medially = sartorius
ii. Posterior = adductor longus & magnus
iii. Laterally = vastus medialis
d. Contents:
i. *Terminal part of femoral artery
ii. *Femoral vein
iii. *Saphenous nerve
iv. Terminal part of obturator nerve
v. Deep plymphatic vessel
*main
5. FEMORAL ARTERY
a. Pass behind inguinal ligament as a continuation of external iliac artery
b. Main arterial supply to lower extremities
c. Branches:
i. Superficial circumflex iliac artery
ii. Superficial epigastrica
iii. Superficial external pudendal artery
iv. Deep external pudendal artery
v. Profunda femoris artery
vi. Descending genicular artery
6. FEMORAL VEIN
a. Enters thigh through opening in adductor magnus; continuation of popliteal vein
b. Pass behind inguinal ligament to become the external iliac vein
c. Tributaries:
i. Great saphenous vein
ii. Veins that correspond to branches of the femoral artery
*(except the 3 superficial branches coz’ it drains into great saphenous vein)
7. FEMORAL NERVE
a. Largest branches of lumbar plexus L2-L4

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 b. Supplies all the muscle of anterior compartment of the thigh
c. Emerges at lateral border of psoas; pass downward between psoas & iliacus
d. Enters lateral to femoral artery & femoral sheath
*Does not enter the thigh within the femoral sheath

Branches: ANTERIOR DIVISION

1. Cutaneous Supply
a. Medial cutaneous nerve of the thigh
b. Intermediate cutaneous nerve of the thigh
2. Muscular Supply
a. Sartorius
b. Pectineus

Branches: POSTERIOR DIVISION

1. Cutaneous Supply
a. Saphenous nerve
2. Muscular Supply  the Quadriceps Femoris:
a. Rectus femoris = w/c also supply the hip joint
b. Vasti muscle = w/c also supply the knee joint

Muscles of the MEDIAL COMPARTMENT of the thigh  G-LBM-E

1. Gracilis – most superficial in the medial
2. Adductor Longus
3. Adductor Brevis
4. Adductor Magnus
5. Obturator Externus

Muscle Origin Insertion Nerve Action

Gracilis >Inferior ramus of >Upper part of >Adduct thigh at
pubis shaft of tibia on hip joint
>Ramus of medial surface >Flexes leg at
ischium >Posterior surface knee joint
of shaft of femur
(linea aspera)
Adductor >Body of pubis, >Posterior surface Obturator nerve
Longus medial to pubic of shaft of femur (L2, L3)
tubercle (linea aspera)
Adductor >Inferior ramus of >Posterior surface
Brevis pubis of shaft of femur >Adduct thigh
(linea aspera) >Lateral rotation

Adductor >Inferior ramus of >Posterior surface >Adductor

Magnus pubis of shaft of femur portion:
>Ramus of >Adductor tubercle Obturator nerve
ischium, ischial of femur >Hamstring part:
tuberosity Sciatic nerve
Obturator >Outer surface of
Externus obturator >Medial surface of >Obturator nerve >Laterally rotates
membrane & greater trochanter thigh at hip joint
pubic & ischial
rami

Neurovascular Structures in the MEDIAL thigh

1. Profunda femoris artery
a. Large artery that arises from lateral side of femoral artery in the femoral triangle, 1 ½ inch below the
inguinal ligament
b. Descends between adductor longus and brevis
c. Branches:
i. Medial
ii.
iii.
2. Profunda femoris vein
a. Receives tributaries that correspond to branches of the artery
b. Drains into the femoral vein
3. Obturator artery
a. Branches of internal iliac artery
b. Branches:
i. Muscular
ii. Articular (to hip joint)
4. Obturator vein
a. Tributaries correspond to branches of the artery
b. Drains into internal iliac vein

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 5. Obturator nerve
a. From lumbar plexus (L2-L4)
b. Emerges on medial border of psoas
c. Branches (ANTERIOR DIVISION):
i. Muscular
1. gracilis
2. adductor brevis
3. adductor longus
4. pectineus
ii. Articular (Hip Joint)
1. Muscular
a. Obturator externus
b. Adductor magnus (adductor part)
c. Adductor brevis
2. Articular
a. Knee joint

KNEE JOINT
- Largest & most complicated joint in the body
- Consists of:
o Sliding joint = patella & femur
o Hinge/ ginglymus = patella & tibia
- Note: *fibula is not directly involved in the knee joint (only for ankle joint)

LIGAMENTS
1. EXTRACAPSULAR LIGAMENTS
a. Ligamentum Patellae:
i. Proximal Attachment = apex of patellae
ii. Distal Attachment = tibial tuberosities
*continuation of tendon of quadriceps femoris
b. Oblique Popliteal Ligament
i. Derived from semimembranous muscle
ii. Strengthens posterior aspect of joint
c. Medial collateral ligament
i. Proximal = medial condyle of femur
ii. Distal = medial surface of tibial shaft
*firmly attached to edge of medial meniscus
d. Lateral collateral ligament
i. Proximal = lateral condyle of femur
ii. Distal = head of fibula
2. INTRACAPSULAR LIGAMENTS
a. Cruciate ligaments
i. (2) ligaments that cross each other within the joint cavity:
1. named anterior & posterior based on tibial attachment
ii. main bond between femur & tibia
1. ANTERIOR CRUCIATE
a. From anterior intercondylar area of tibia to lateral femoral condyle
b. *prevents posterior displacement of femur on tibia
2. POSTERIOR CRUCIATE
a. From posterior intercondylar area of tibia to medial femoral condyle
b. *prevents anterior displacement of femur on tibia
b. Menisci (Medial & Lateral)
C-shaped fibro cartilage that:
i. Deepen articular surfaces of tibial condyles
ii. Serve as cushions between the 2 bones
*Medial meniscus is relatively immobile (attached to medial ligament)

MOVEMENTS OF KNEE
- movements of the knee joint & the muscles that produce the movement:
1. Flexion
i. Biceps femoris
ii. Semitendinosus
iii. Semimembranous assisted by gracilis
iv. Sartorius & popliteus
2. Extension
i. Quadriceps femoris
3. Medial Rotation
i. Sartorius
ii. Gracilis
iii. Semitendinosus
4. Lateral rotation
i. Biceps femoris

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NERVE SUPPLY of the KNEE JOINT  FOCT
1. Femoral nerve
2. Obturator nerve
3. Common peroneal nerve
4. Tibial nerve

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