Lecture-5

Dr. A. Bose
Professor
Department of Anatomy
Adductor group of muscles
 These group of muscles are present on medial side of
thigh supplied by obturator nerve
 Are concerned with adduction of hip joint
 Disposed in 3 layers
 Anterior layer consists of pectineus & Adductor longus
 Middle layer consists of adductor brevis
 Posterior layer consists adductor magnus
 All pass from hip bone to back of femur
 Medial to these is gracilis muscle- the long slender &
graceful muscle
Adductor group of
muscles
Adductor group of muscles
 The muscles on the medial side of the thigh
(pectineus, adductor longus, brevis, magnus, and
gracilis) are mostly adductors of the thigh, and are
innervated by the obturator nerve

 The three named adductors are used in all

movements in which the thighs are pressed
together.

 The adductor magnus, however, consists of an

adductor part antero-superiorly and an hamstring
extensor part medially.
Adductor group of muscles
 The adductor longus is the medial boundary of the
femoral triangle. Ossification may occur in its tendon
due to repeated trauma ("rider's bone").
 The adductor brevis is sandwiched between the
anterior and posterior branches of the obturator nerve.
 The lower end of the adductor magnus allows the
passage of the femoral vessels into the popliteal fossa,
forming the adductor hiatus.
Muscles of medial side of thigh
Adductor group of muscles
 Adductor longus-Arises by a narrow tendon
 Important relations
 Helps to form the floor of femoral triangle, lateral
border is related to pectineus
 Its lower part forms posterior wall of adductor canal
 Related to the contents of adductor canal
 Its uppermost part is related to spermatic cord
 Deep to it-adductor brevis
- a small part of adductor magnus
Adductor group of muscles
 Adductor longus-
 Muscle strains of the adductor longus may occur
in horseback riders and produce pain
 Happen because the riders adduct their thighs to keep
from falling from the animal.
 In riders, the rounded tendon of adductor longus often
gets calcified which is often referred to as rider’s bone
Adductor group of muscles
 Adductor brevis
 Important relations
 Arises from pubis inferior to adductor longus
 It lies deep to pectineus & adductor longus
 It lies superficial to adductor magnus
 It lies between anterior & posterior divisions of
obturator nerve
 Profunda femoris vessels & anterior divisions of
obturator nerve lie superficial to it
Adductor group of muscles
 Adductor magnus
 Relations
 Near the insertion there are a series of apertures for
passage of blood vessels
 Largest & lowest is for femoral blood vessels
 Muscle forms a partition separating structures in
anterior & medial compartment of thigh from those in
posterior compartment
 Femoral & profunda femoris vessels, pecdtineus,
adductor longus & brevis are anterior to it
 Sciatic nerve & hamstrings are posterior to it
The obturator nerve
 The obturator nerve (L[2],3,4,[5]) arises from the
lumbar plexus in abdomen
 In the substance of the psoas major muscle.
 It emerges at the medial margin of the psoas and
 Accompanies the obturator vessels to the obturator
groove,
 In obturator groove, it divides into anterior and
posterior branches.
 These pass through the obturator foramen to reach the
thigh
 In thigh they are separated by the adductor brevis.
The obturator nerve
 The obturator nerve (L2 to 4) emerges from the medial
side of the psoas and enters the thigh through the
obturator foramen.
 It supplies the adductor muscles and gracilis,
 the skin of the medial side of the thigh, and
 the hip and knee joints.
 The accessory obturator nerve (L3, 4), when present,
enters the thigh deep to the pectineus, which it
supplies.
The obturator nerve
The obturator
nerve

Lumbar plexus in
relation to the
muscular layers of
the abdominal wall
The obturator nerve
 The anterior branch, which lies posterior to the
pectineus and adductor longus, supplies these two
(not always the pectineus) as well as the gracilis,
adductor brevis, and skin on the medial side of the
thigh.
 The posterior branch pierces and supplies the
obturator externus, and gives twigs to the adductor
magnus (and sometimes brevis).
 An accessory obturator nerve (L3,4 or L2,3), when
present, communicates with the anterior branch of the
obturator and supplies the pectineus.
 The obturator nerve
Nerve Source Branches Motor Sensory Notes
obturator lumbar anterior muscles of the skin of the obturator
n. plexus and medial thigh: lower n. passes
(ventral posterior adductor medial through the
primary brs. longus m., thigh obturator
rami of adductor brevis canal
spinal m. and
nerves L2- adductor
L4) magnus m.,
gracilis m.,
obturator
externus m.
The obturator artery
 The obturator artery , a branch of the internal iliac
artery in lesser pelvis
 Accompanies obturator nerve
 sends anterior and posterior branches around the
margin of the obturator foramen,
 These form an arterial circle on obturator membrane
deep to obturator externus.
 The posterior branch gives off an acetabular branch,
which passes through the acetabular notch and is an
important vascular source for the head of the femur
 The obturator artery
Artery Source Branches Supply to Notes
Obturator internal iliac pubic br., medial anterior and posterior
a., anterior acetabular thigh and brs. pass on the
division br., anterior hip anterior and posterior
br., sides of the adductor
posterior br. brevis m.; aberrant
obturator a. arises
from the inferior
epigastric a. in 30%
of cases
The obturator externus
 Origin- 1- ramus of ischium
-2- ramus of pubis
-3- obturator membrane(medial 2/3rd )
 The muscle ends in a tendon that runs upwards &
laterally behind neck of femur to reach gluteal region
 Insertion- into the trochanteric fossa of femur
 Nerve supply- by a branch from obturator nerve (L3-
L4)
 Action- Flex & lateral rotate thigh, but its main action
is to act as an extensile ligament of hip joint
Quick revision
 Q-What are the main compartments of the thigh?
 Ans- The compartments of the thigh are the anterior,
for the quadriceps (femoral nerve); the medial, for the
adductors (obturator nerve); and the posterior, for the
hamstrings (sciatic nerve)..
 Q- What is the clinical importance of the femoral
canal?
 Ans- The femoral ring and canal are the site of femoral
hernia. The neck of a femoral hernia is found
immediately inferolateral to the pubic tubercle.
Quick revision
 Q-What is the iliotibial tract?
 Ans- The iliotibial tract is an important thickening of
the fascia lata laterally. It extends from the iliac crest to
the lateral condyle of the tibia, it receives the
insertions of the gluteus maximus and tensor fasciae
latae, and it stabilizes the knee. The combination of
tensor, tract, and gluteus maximus may be thought of
as the deltoid of the thigh, i.e., comparable to the
anterior, middle, and posterior fibers, respectively, in
the upper limb
Quick revision
 Q- What are the chief contents of (a) the femoral
triangle and (b) the adductor canal?
 Ans- The femoral triangle contains the femoral nerve
and vessels; the adductor canal contains the femoral
vessels and saphenous nerve. John Hunter, who
proposed ligature of an artery well proximal to an
aneurysm, ligated the femoral artery in the adductor
(Hunter's) canal in 1785.
 Q- On which structures does one kneel?
 Ans- One kneels chiefly on the tuberosity of the tibia
(separated from the skin by the subcutaneous
infrapatellar bursa) and the ligamentum patellae.
Quick revision
 Q- What is the chief action of the quadriceps?
 Ans- All four parts of the quadriceps extend the knee.
The muscle is involved in many movements, e.g.,
rising from a chair and walking. In quadriceps
paralysis, a patient can stand erect, because the body
weight tends to hyperextend the knee. Walking,
however, is then performed in short steps that avoid
extending the hip and flexing the knee, and such a
patient may press the knee posteriorward with the
hand.
Quick revision
 Q- Where is the reflex center for the knee jerk?
 Ans- The center for the knee jerk is chiefly in the L3-4
segment of the spinal cord. The quadriceps is
innervated by L2 to 4.
 Q- How far distally does the cutaneous territory of the
saphenous nerve extend?
 Ans- The saphenous nerve, which may be regarded as
the termination of the femoral nerve (L2 to 4),
generally supplies skin as far as the medial side of the
foot.
Quick revision
 Q- Which is the most important branch of the femoral
artery?
 Ans- The deep femoral artery is the most important
branch of the femoral artery. Sudden occlusion of the
femoral artery above the origin of the deep femoral
almost always causes gangrene; blockage below the
deep femoral origin seldom does so.
 Q- To which features is the pubic tubercle a guide?
 Ans- The pubic tubercle is a guide to the superficial
inguinal ring, femoral ring, and saphenous opening.
Quick revision
 Q- What is the innervation of the hip and knee joints?
 Ans- Both hip and knee joints are supplied ultimately
by branches of the femoral, sciatic, and obturator
nerves. Hip disease is an important cause of pain
referred to the knee.
 Q- Which bursae communicate with the cavity of the
knee joint?
 Ans- Usually the suprapatellar pouch and bursae
related to the popliteus, gastrocnemius, and
semimembranosus communicate with the cavity of the
knee joint.
Quick revision
 Q- Where are frequent sites for varicose veins?
 Ans- The return of venous blood from the lower limbs
to the heart requires a pump (the muscles) and non-
return valves. Loss of valvular competence (varicose
veins) is not uncommon in the great and small
saphenous veins. A similar phenomenon may occur at
other sites, e.g., the spermatic cord (varicocele),
esophagus (varices), and anal canal (hemorrhoids)
Quick revision
 Q- What is the clinical importance of thoraco-
epigastric venous connections?
 Ans- Superficial veins at the sides of the abdomen
become noticeably enlarged in obstruction of the
inferior vena cava. Blood from the lower limbs
(femoral veins) by-passes the inferior vena cava and
travels by way of the abdominal and thoracic walls to
tributaries of the axillary veins and thence to the
superior vena cava.
Quick revision
 1- What is clergy man’s knee?
 2- What is house maid’s knee?
 3-On what does the body weight rest in the sitting
position?
 4-Compare the acetabulum with the glenoid cavity of
the scapula.
 5-