· collateral branch of iliohypogastric n
· derived from L1
· supplies
· root of penis
· anterior 1/3 of scrotum
· small area of thigh beneath medial inguinal ligament
· divides into
· femoral branch - L1
· genital branch - L2
· femoral branch runs down
· on external iliac a
· under inguinal ligament
· into femoral sheath
· pierces anterior wall of sheath
· supplies skin over femoral triangle
· branch of femoral nerve (L2,3)
· pierces deep fascia above sartorius
· supplies medial thigh to knee
· branch of femoral nerve (L2,3)
· pierces upper border of sartorius
· supplies front of thigh to knee
· branch of lumbar plexus (L2,3)
· passes from lateral border of psoas
· lies behind then in iliacus fascia
· passes behind or pierces inguinal ligament
· lies in fibrous tunnel 1 cm medial to ASIS
· enters thigh deep to deep fascia
· pierces fascia 2.5 cm below ASIS
· divides into
· anterior branch (L2)
· posterior branch (L3)
· supplies anterolateral thigh to knee
· L2,3,4
· branches from superficial division supplies medial thigh
· twig from superficial division passes to subsartorial plexus
· supplies area over medial femoral condyle
· network over patella
· formed from terminal twigs of
· medial FCN
· intermediate FCN
· lateral FCN (anterior branch)
· saphenous n (infrapatellar branch)
· branches of femoral artery
· superficial circumflex iliac
· superficial epigastric
· superficial external pudendal
· deep external pudendal
Great saphenous vein
· passes handsbreadth behind medial border of patella
· spirals around medial border of thigh
· pierces cribriform fascia
· 3.5 cm below and medial to pubic tubercle
· joins anteromedial side of femoral vein
· just distal to femoral sheath
· tributaries correspond to branches of femoral a above
· attaches around thigh
· pubic tubercle
· inguinal ligament
· iliac crest
· splits to enclose TFL
· splits to enclose GMax
· sacrum
· sacrotuberous ligament
· ischial tuberosity
· ischiopubic ramus
· pubic bone
· attaches distally to
· patella
· tibial condyles and head of fibula
· encloses muscles
· TFL and Gmax
· converge distally
· area between them filled with fascia lata
· overlapping edges of fascia lata
· deep layer
· lies on pectineus beneath femoral triangle
· prolonged downwards as medial IM septum
· superficial layer
· attached to pubic tubercle and inguinal ligament
· cribriform fascia
· covered by loose fascial covering of opening
· pierced by great saphenous vein and lymphatics
Origin
· external lip of iliac crest
· between ASIS and iliac tubercle
Path
· anterior border edge to edge with sartorius at origin
· muscles diverge for emergence of rectus femoris
Insertion
· iIliotibial tract
Nerve supply
· superior gluteal nerve
· thickening of fascia lata
· starts at greater trochanter
· receives
· tensor fascia lata
· 3/4 of gluteus maximus
· passes down thigh
· crosses and gives off some fibres to lateral femoral condyle
· inserts into Gerdy’s tubercle
· anterior surface of lateral tibial condyle
· when knee straight
· passes in front of axis of flexion
· maintains hyperextension
· when knee flexed
· passes behind axis of flexion
· connects iliotibial tract to lateral lip of linea aspera of femur
· formed by
· inguinal ligament
· medial border of sartorius
· medial border of adductor longus
· floor formed by
· iliacus
· psoas
· pectineus
· adductor brevis (glimpse)
· contents are
· femoral nerve (on iliacus)
· femoral artery (on psoas)
· femoral vein (on pectineus)
Origin
· 1 cm of upper ilium
· immediately below ASIS
Path
· spirals around thigh
· roofs adductor canal
· pierced by
· intermediate FCN
· infrapatellar branch of saphenous n
Insertion
· pes anserinus
Nerve supply
· anterior division of femoral nerve (L2,3,4)
Origin
· hollow of ilium
· anterior sacrotuberous ligaments
Path
· enters thigh beneath lateral inguinal ligament
· iliacus fascia
· covers muscle
· attaches to inguinal ligament
· iliac bursa
· lies between muscle and hollow of iliac fossa
· may communicate with hip joint
Insertion
· greater trochanter
· distal to psoas tendon
Nerve supply
· femoral nerve (L2,3)
· flexes and internally rotates hip
Origin
· T12-L1 to L4-L5 intervertebral discs and adjacent vertebral bodies
· fibrous arches that span concavities of vertebral bodies L1-L4
· transverse processes of L1 to L5
Path
· enters thigh beneath middle of inguinal ligament
· femoral artery lies on it
· iliac bursa between psoas and iliacus
· psoas fascia
· covers muscle
· attaches to inguinal ligament
Nerve supply
· segmentally by L1,2,3
Origin
· pectineal line of pubis
Path
· forms floor of femoral triangle
· femoral vein and canal lie on it
· adductor brevis and anterior division of obturator nerve lie behind it
· covered by deep fold of fascia lata
· continued down as medial IM septum
Insertion
· upper posterior femoral shaft
· vertical line between spiral line and gluteal crest
· below lesser trochanter
· funnel-shaped prolongation of extraperitoneal fascia
· transversalis fascia in front
· psoas fascia behind
· contains femoral vessels
· pierced by femoral branch of genitofemoral nerve
Femoral canal
· space between medial sheath and vein
· provides room for expansion of vein
· contains lymph node of Cloquet
Femoral ring
· abdominal opening of canal
· boundaries
· anteriorly is inguinal ligament
· medially is lacunar ligament
· posteriorly is pectineus
· laterally is femoral vein
· enters at midinguinal point
· lies on psoas major tendon
· separates it from capsule of hip joint
· passes beheath sartorius into adductor canal
Profunda femoris
· arises from lateral side of femoral a
· spirals backwards deep to adductor longus
· separates femoral and profunda femoris arteries
Branches of profunda femoris
Medial circumflex femoral artery
· arises from medial side of profunda
· occasionally from femoral a
· passes posterior between pectineus and psoas
· as closely to femur as mucles allow
· runs above adductor brevis
· meets continuous borders of adductor magnus and quadratus femoris
· divides on quadratus femoris into
1. ascending branch
· passes along upper border of quadratus femoris
· follows obturator externus to trochanteric anastomosis
2. transverse branch
· passes back between quadratus femoris and adductor magnus
· forms limb of cruciate anastomosis
Lateral circumflex femoral artery
· arises from lateral side of profunda
· occasionally from femoral a
· passes laterally
· as closely to femur as muscles allow
· passes between branches of femoral n
· divides them into superficial and deep branches
· exits femoral triangle behind sartorius
· lies deep to rectus femoris
· divides into
1. ascending branch
· runs up on vastus lateralis
· under sartorius and TFL
· gives branch to trochanteric anastomosis
· passes to anastomosis on ASIS
2. transverse branch
· passes across vastus lateralis
· forms limb of cruciate anastomosis
3. descending branch
· passes downwards in groove between vastus lateralis and intermedius
Perforating branches
· four in number
· pass immediately posteriorly wrt. adductor brevis
· above (1)
· through (2)
· below (1)
· pass through adductor magnus
· perforate lateral intermuscular septum
· end in vastus lateralis
· enters lower angle of femoral triangle posterior to artery
· comes to lie on medial side
· receives
· tributary corresponding to profunda femoris
· great saphenous vein just distal to femoral sheath on anteromedial side
· passes under inguinal ligament
· becomes external iliac vein
· nerve of extensor compartment
· formed from posterior divisions of anterior rami of L2,3,4
· obturator n formed from anterior divisions of same nerve
· lies between psoas and iliacus in iliac fossa
· supplies iliacus
· passes deep to inguinal ligament at lateral edge of femoral sheath
· breaks up into branches
· divided into superficial and deep by lateral circumflex femoral a
· superficial - 2 cutaneous (FCN) and 2 muscular (proximal)
· deep - 4 muscular (quads) and saphenous
Superficial branches (from anterior division)
1. intermediate FCN
2. medial FCN
3. branch to sartorius
4. branch to pectineus
Deep branches (from posterior division)
1. nerve to rectus femoris
· usually double
· gives branch to hip joint
2. nerve to vastus medialis
· largest branch
· passes on lateral side of femoral artery
· enters adductor canal
· branch sinks into vastus medialis
· continues in canal to knee joint
3. nerve to vastus lateralis
· descends with descending branch of LCFA
· in groove between vastus lateralis and intermedius
4. nerve to vastus intermedius
· passes backwards to enter muscle
5. saphenous nerve
· enters adductor canal
· passes across femoral a to its medial side
· leaves canal by passing beneath posterior border of sartorius
Rectus femoris
· straight head
· upper 1/2 of AIIS
· reflected head
· shallow concavity above acetabulum
Vastus lateralis
· upper 1/2 of intertrochanteric line
· vastus ridge
· lateral lip of linea aspera
· upper 2/3 of lateral supracondylar line
· lateral intermuscular septum
Vastus intermedius
· greater trochanter
· anterior and lateral surface of upper 2/3 of femur
Vastus medialis
· spiral line
· medial lip of linea aspera
· tendon of adductor magnus below femoral hiatus
Rectus femoris
· forms anterior lamina of quadriceps tendon
Vastus lateralis
· forms intermediate lamina of quadriceps tendon
Vastus intermedius
· forms deep lamina of quadriceps tendon
Vastus medialis
· inserts into
· aponeurosis of vastus intermedius
· tendon of rectus femoris
· medial border of patella
Origin
· distal to vastus intermedius on shaft of femur
Path
· thin ribbon of muscle
Insertion
· upper convexity of suprapatellar bursa
· syn. subsartorial, Hunter’s canal
· starts at inferior apex of femoral canal
· floor is groove between
· laterally - vastus medialis
· medially - adductor longus above and adductor magnus below
· roof is sartorius and underlying fascia
· contains
· femoral artery and vein
· saphenous nerve
· nerve to vastus medialis (upper part)
· vein spirals around artery
· medial in femoral triangle
· posterior in canal
· lateral at adductor hiatus
· artery lies between nerve and vein
· vessels leave by passing through hiatus between hamstring and adductor parts of adductor magnus
· below this canal contains
· saphenous n
· descending genicular a (anastomotica magna)
· saphenous n gives off infrapatellar branch
· pierces sartorius
· saphenous n exits canal
· behind posterior border of sartorius
· in front of gracilis
· descending genicular a becomes
· saphenous a that accompanies saphenous n
· muscular a that sinks into vastus medialis
· in fascial roof
· receives branches from
· intermediate FCN
· saphenous n
· anterior branch of obturator n
· supplies
· overlying fascia lata
· skin above medial knee