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Dr. Iman Abdel Aal. Lower Limb FASCIAL COMPARTMENTS OF THE THIGH  Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh.

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Presentation on theme: "Dr. Iman Abdel Aal. Lower Limb FASCIAL COMPARTMENTS OF THE THIGH  Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh."— Presentation transcript:

1 Dr. Iman Abdel Aal

2 Lower Limb FASCIAL COMPARTMENTS OF THE THIGH  Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur. By this means, the thigh is divided into three compartments, each having muscles, nerves, and arteries. The compartments are anterior, medial and posterior in position. CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT OF THE THIGH  Muscles: Sartorius, iliacus, psoas, pectineus and quadriceps femoris.  Blood supply: Femoral artery.  Nerve supply: Femoral nerve. Dr. Iman Abdel Aal

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4 Front of the Thigh Sartorius  The sartorius is a narrow, strap-shaped muscle that covers the femoral artery in the middle one third of the thigh.  Origin: From the anterior superior iliac spine.  Insertion: The muscle fibers run downward and medially and are attached to the upper part of the medial surface of the shaft of the tibia. Dr. Iman Abdel Aal

5 Front of the Thigh Sartorius  Nerve supply: Femoral nerve.  Action: Flexes, abducts and laterally rotates the thigh at the hip joint; flexes and medially rotates the leg at the knee joint. Dr. Iman Abdel Aal

6 Front of the Thigh Iliacus  Origin: This fan-shaped muscle arises from the iliac fossa within the abdomen.  Insertion: The fibers converge and join the tendon of the psoas to form the iliopsoas muscle.  Nerve supply: A branch of the femoral nerve within the abdomen.  Action: The iliopsoas flexes the thigh on the trunk at the hip joint; or if the thigh is fixed, it flexes the trunk on the thigh; it also medially rotates the thigh. Dr. Iman Abdel Aal

7 Front of the Thigh Psoas  Origin: From the roots of the transverse processes, the sides of the vertebral bodies and the intervertebral discs; from the 12 th thoracic to the 5th lumbar vertebrae.  Insertion: The fibers run downward and laterally and leave the abdomen to enter the thigh by passing behind the inguinal ligament. The iliopsoas tendon is attached to the lesser trochanter of the femur. Dr. Iman Abdel Aal

8 Front of the Thigh Psoas  A bursa intervenes between the tendon and the hip joint and may communicate with the joint.  Nerve supply: Branches from the lumbar plexus.  Action: The iliopsoas flexes the thigh on the trunk at the hip joint; or if the thigh is fixed, it flexes the trunk on the thigh. Dr. Iman Abdel Aal

9 Front of the Thigh Pectineus  Origin: From the superior ramus of the pubis.  Insertion: The muscle fibers pass downward, backward, and laterally and are attached to the upper end of the linea aspera just below the lesser trochanter.  Nerve supply: Femoral nerve. (Occasionally, it receives a branch from the obturator nerve.)  Action: Flexes and adducts the thigh at the hip joint. Dr. Iman Abdel Aal

10 Front of the Thigh Quadriceps Femoris  The quadriceps femoris muscle consists of 4 parts: 1. The rectus femoris 2. Vastus lateralis. 3. Vastus medialis. 4. Vastus intermedius.  They have a common tendon of insertion into the upper, lateral, and medial borders of the patella and then, via the ligamentum patellae, into the tubercle of the tibia. Dr. Iman Abdel Aal

11 Front of the Thigh Rectus femoris  Origin: A straight head from the anterior inferior iliac spine and a reflected head from the ilium above the acetabulum  Insertion: The two heads unite in front of the hip joint, and the bipennate muscle is inserted into the quadriceps tendon and so into the patella.  Nerve supply: Femoral nerve.  Action: See Action of Quadriceps Femoris Muscle. Dr. Iman Abdel Aal

12 Front of the Thigh Vastus Lateralis  Origin: From the intertrochanteric line, the base of the great trochanter, and the linea aspera of the femur.  Insertion: The fibers pass downward and forward to be inserted into the quadriceps tendon and so into the patella. Some of the tendinous fibers join the capsule of the knee joint and strengthen it.  Nerve supply: Femoral nerve. Dr. Iman Abdel Aal

13 Front of the Thigh Vastus Medialis  Origin: From the intertrochanteric line and the linea aspera of the femur.  Insertion: The fibers pass downward and forward to be inserted into the quadriceps tendon and so into the patella. Some of the tendinous fibers join the capsule of the knee joint and strengthen it. The lowest muscle fibers are almost horizontal in direction.  Nerve supply: Femoral nerve. Dr. Iman Abdel Aal

14 Front of the Thigh Vastus Intermedius  Origin: From the anterior and lateral surfaces of the shaft of the femur.  Insertion: The fibers pass downward and join the deep aspect of the quadriceps tendon. The articularis genus is a small part of the vastus intermedius that is inserted into the upper part of the synovial membrane of the knee joint.  Nerve supply: Femoral nerve. Dr. Iman Abdel Aal

15 Action of Quadriceps Femoris Muscle (Quadriceps Mechanism)  The quadriceps femoris muscle, consisting of the rectus femoris, the vastus intermedius, the vastus lateralis and the vastus medialis, is inserted into the patella and, via the ligamentum patellae, is attached to the tibial tuberosity.  Together they provide a powerful extensor of the knee joint.  Some of the tendinous fibers of the vastus lateralis and vastus medialis form bands, or retinacula, that join the capsule of the knee joint and strengthen it.  The lowest muscle fibers of the vastus medialis are almost horizontal and prevent the patella from being pulled laterally during contraction of the quadriceps muscle. The tone of the quadriceps muscle greatly strengthens the knee joint.  The rectus femoris muscle also flexes the hip joint. Dr. Iman Abdel Aal

16 Femoral Triangle  The femoral triangle is a triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligament.  It is bounded superiorly by the inguinal ligament, laterally by the sartorius, and medially by the medial border of the adductor longus muscle.  Its floor is gutter shaped and formed from lateral to medial by the iliopsoas, the pectineus and the adductor longus. Dr. Iman Abdel Aal

17 Femoral Triangle  Its roof is formed by the skin and fasciae of the thigh.  The femoral triangle contains: A. The terminal part of the femoral nerve and its branches. B. The femoral sheath. C. The femoral artery and its branches. D. The femoral vein and its tributaries. E. The deep inguinal lymph nodes. Dr. Iman Abdel Aal

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19 Femoral Shealth

20 Femoral Sheath  The femoral sheath is a downward protrusion into the thigh of the fascial envelope lining the abdominal walls.  Its anterior wall is continuous above with the fascia transversalis, and its posterior wall with the fascia iliaca.  The sheath surrounds the femoral vessels and lymphatics for about 1 in. (2.5 cm) below the inguinal ligament.  The femoral artery, as it enters the thigh beneath the inguinal ligament, occupies the lateral compartment of the sheath. Dr. Iman Abdel Aal

21 Femoral Sheath  The femoral vein, as it leaves the thigh, lies on its medial side and is separated from it by a fibrous septum and occupies the intermediate compartment.  The lymph vessels, as they leave the thigh, are separated from the vein by a fibrous septum and occupy the most medial compartment.  The femoral canal is the term used to name the small medial compartment for the lymph vessels. It is about 0.5 in. (1.3cm) long, and its upper opening is referred to as the femoral ring. Dr. Iman Abdel Aal

22 Femoral Sheath  The femoral septum, which is a condensation of extraperitoneal tissue, closes the ring.  The femoral canal contains : a) Fatty connective tissue. b) All the efferent lymph vessels from the deep inguinal lymph nodes. c) One of the deep inguinal lymph nodes.  The femoral sheath is adherent to the walls of the blood vessels and inferiorly blends with the tunica adventitia of these vessels. Dr. Iman Abdel Aal

23 Femoral Sheath  The part of the femoral sheath that forms the medially located femoral canal is not adherent to the walls of the small lymph vessels; it is this site that forms a poten tially weak area in the abdomen.  A protrusion of peritoneum could be forced down the femoral canal, pushing the femoral septum before it.  Such a condition is known as a femoral hernia. Dr. Iman Abdel Aal

24 Femoral Sheath  The upper end of the canal, or femoral ring, has the following important relations:  Anteriorly: the inguinal ligament.  Posteriorly: the superior ramus of the pubis.  Medially: the lacunar ligament.  Laterally: the femoral vein.  The lower end of the canal is normally closed by the adherence of its medial wall to the tunica adventitia of the femoral vein. It lies close to the saphenous opening in the deep fascia of the thigh. Dr. Iman Abdel Aal

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