ANTERIOR & MEDIAL COMPARTMENTS of the THIGH M1 Gross and Developmental Anatomy 8:00 AM, October 28,

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  • ANTERIOR & MEDIAL COMPARTMENTS

    of the THIGH

    M1 - Anatomy

    M1 Gross and Developmental Anatomy 8:00 AM, October 28, 2008 Dr. Milton M. Sholley

    Professor of Anatomy and Neurobiology 2

    Compartmentalization of the Thigh

    Syllabus page 179

    3

    Pelvis Formed by two coxal (hip) bones and the sacrum

    Hip bone Hip boneSacrum

    Pubic symphysis

    Sacroiliac jointSacroiliac joint

    Adapted from: Grant’s Atlas, 12th ed. Fig. 4.22, p. 311

    Sacral promontory

    4

    Ilium

    Ischium Pubis

    Coxal (hip) bone A fusion of three bones in the adult

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.31B, p. 397

    5

    Coxal (hip) bone Lateral view

    Iliac crest

    Anterior superior iliac spine

    Anterior inferior iliac spine

    Acetabulum (hip joint socket)

    Pubic tubercle

    Ischial tuberosity

    Ischial spine

    Lesser sciatic notch

    Greater sciatic notch

    Posterior superior iliac spine

    Posterior inferior iliac spine

    Obturator foramen

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.31A, p. 397

    6

    Coxal (hip) bone Medial view

    Anterior superior iliac spine

    Ischial spine

    Symphyseal surface of pubis

    Pectineal line Arcuate line

    Adapted from: Grant’s Atlas, 12th ed. Fig. 4.23A, p. 312

  • 7Grant’s Atlas, 12th ed. Fig. 4.24A, p. 313

    Grant’s Atlas, 12th ed. Fig. 4.23C, p. 312

    Sacrum and Coccyx

    Anterior view Lateral view

    8Grant’s Atlas, 12th ed. Fig. 4.23A, p. 312

    Grant’s Atlas, 12th ed. Fig. 4.23C, p. 312

    Grant’s Atlas, 12th ed. Fig. 4.26A, p. 316

    Coxal bone Medial view

    Sacrum (and coccyx) Lateral view

    9 Anterior view Posterior view

    Grant’s Atlas, 12th ed. Fig. 5.22A, p. 380

    Grant’s Atlas, 12th ed. Fig. 5.22C, p. 381

    Anterior superior iliac spine

    Greater trochanter Greater trochanter

    Gluteal tuberosity

    Ischial tuberosity

    Lesser trochanter

    Intertrochanteric crest

    Intertrochanteric line

    Linea aspera Pectineal line

    Patella

    Tibial tuberosity

    Pectineal line

    10

    AP Radiograph of Pelvis

    Adapted from: Grant’s Atlas, 12th ed. Fig. 4.22A&B, p. 311

    11APPelvis(Hip)-21.jpg

    Radiologic Anatomy

    12

    Hip Joint Capsule (frontal section)

    Fibrous capsule

    Synovial capsule

    Fibrous capsule

    Synovial capsule

    Grant’s Atlas, 12th ed. Fig. 5.32B, p. 398

    Synovial cavity

    Ligament of the head of the femur

  • 13 Anterior view

    Angle between neck and shaft of femur ~126o = Normal angle in adult

    Weight transfer across this angle produces great stress in the neck of the femur. This stress is resisted by the natural support provided by the orientation of the bony trabeculae within the femoral neck. Degeneration of bone in these trabeculae, as can occur from osteoporosis, may cause hip fracture due to failure of the femoral neck to support the body weight.

    14Grant’s Atlas, 12th ed. Fig. 5.34 A, p. 400

    Blood Supply to Neck and Head of Femur

    1. Medial femoral circumflex artery 2. Lateral femoral circumflex artery 3. Artery of the ligament of the head

    of the femur12

    1 2

    3

    Adapted from: Hollinshead’s Text, 5th ed. Fig.17-17, p. 328

    Ascending branches

    15Anterior view

    Iliofemoral ligament (Y-ligament of Bigelow)

    Tightens during hip extension and thus limits hip extension

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.29A, p. 394

    16Posterior view

    Ischiofemoral ligament

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.29C, p. 395

    Tightens during hip extension and thus limits hip extension

    17

    Compartmentalization of the Thigh

    Syllabus page 179 18

    Compartmental Innervations and

    Actions of Contained Muscles

    Syllabus page 184

  • 19

    IV. Anterior compartment of the thigh (Contains muscles innervated by the femoral nerve--see muscle chart on syllabus page 189)

    A. Iliopsoas muscle complex

    B. Quadriceps femoris muscle

    C. Sartorius muscle

    D. Pectineus muscle

    A

    C D

    B

    B

    B

    (Syllabus location--page 184)

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.20A, p. 375

    20

    21 22

    23

    From: Hollinshead’s Text, 5th ed. Fig.18-18 C&D, p. 364

    24

    Borders of the Femoral Triangle

    Inguinal ligament

    Adductor longus m.

    Sartorius m.

    Syllabus page 185

  • 25Grant’s Atlas, 12th ed. Fig. 5.17A, p. 372

    Grant’s Atlas, 12th ed. Fig. 5.18C, p. 373

    26

    L M

    Adapted from: Grant’s Atlas, 10th ed. Fig. 5.12B, p. 314

    Lateral Medial

    Anterior

    Femoral N A V EL

    Head of femur Syllabus page 185

    27Grant’s Atlas, 12th ed. Fig. 5.16A, p. 371

    28

    Lateral Medial

    Anterior

    Head of femur

    Femoral sheath encloses: 1. Femoral artery 2. Femoral vein 3. Femoral canal

    (i.e. empty space with lymphatics or EL)

    Adapted from: Grant’s Atlas, 10th ed. Fig. 5.12B, p. 314

    29Syllabus page 200 30Grant’s Atlas, 12 th ed.

    Fig. 5.18C, p. 373 Grant’s Atlas, 12th ed. Fig. 5.18A, p. 373

  • 31 From: Hollinshead’s Text, 5th ed. Fig.18-18 E&F, p. 364

    32

    Superficial veins and Superficial inguinal lymph nodes are located within the fat-containing superficial fascia, which lies

    between the skin and the Fascia lata (deep fascia).

    Grant’s Atlas, 12th ed. Fig. 5.15A, p. 370

    Grant’s Atlas, 12th ed. Fig. 5.15C, p. 370

    33

    Superficial Inguinal Lymph Nodes

    Grant’s Atlas, 12th ed. Fig. 5.13A, p. 367

    34

    Superficial Inguinal Lymph Nodes

    Grant’s Atlas, 12th ed. Fig. 5.13A, p. 367

    35

    Radiologic Anatomy Pelvic Lymphangiogram

    Pelvic Lymphangiogram-61l.jpg

    Superficial Inguinal Lymph Nodes

    Superficial Inguinal Lymph Nodes

    36

    Greater Saphenous Vein

    Medial malleolus

    Lesser Saphenous Vein

    Lateral malleolus

  • 37Grant’s Atlas, 12th ed. p. 378

    Medial Compartment Muscles (See muscle chart on syllabus

    page 190 and Grant’s Atlas page 378 for labels.)

    38

    Adductor hiatus - An opening between the two insertions of the adductor magnus muscle that allows passage of the femoral artery and vein from the anterior compartment into the popliteal fossa.

    Medial femoral circumflex artery - Passes posteriorly in the fascial plane between the iliopsoas and pectineus muscles.

    39

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.21A, p. 379

    Pes anserinus

    Combined tendons of:

    Medial view

    Sartorius

    Gracilis

    Semitendinosus

    40

    Adapted from: Grant’s Atlas, 12th ed. Fig. 5.21B, p. 379

    Muscular Tripod One muscle from each compartment provides support on the medial side of the knee. The three combined tendons of insertion form the pes anserinus.

    Anterior view

    S=Sartorius G=Gracilis T=Semitendinosus

    41

    Lumbar plexus in situ

    Lateral femoral cutaneous nerve

    Obturator nerve

    Femoral nerve

    Entrapment neuropathy here causes

    Meralgia parastetica

    42

  • Lumbar Plexus

    Subcostal nerve

    Lateral femoral cutaneous nerve (L2, 3)

    Femoral nerve (L2-4)

    Ventral rami

    Iliohypogastric nerve (T12, L1)

    Genitofemoral nerve (L1, 2)

    T12

    L1

    L2

    L3

    L4

    Ilioinguinal nerve (L1)

    Obturator nerve (L2-4) Anterior divisions Posterior divisions

    Syllabus page 188