2Objectives Know the type and formation of hip joint. Differentiate the stability and mobility between the hip joint and shoulder joint.Identify the muscles that act at the hip joint.Identify the muscles of the thigh in terms of their origin, insertion, nerve supply and actions.Explain the relationships of contents of the femoral triangle to each other & to the surrounding bone and soft tissue landmarks.
3Surface anatomy of the thigh Surface features of the ThighSartorius muscleQuadriceps femoris muscleAdductor longus muscleHamstring musclesFemoral triange
4Anatomy of the thighThigh is divided to 3 groups of muscles called compartments.Anterior compartmentPosterior compartmentMedial compartment
5The thigh is divided into 3 compartments by 3 intermuscular septa (extending from deep fascia into femur)Anterior CompartmentExtensors of knee:Quadriceps femorisFlexors of hip:1. Sartorius2. Pectineus3. psoas major4. IliacusNerve supply:Femoral nerveMedial CompartmentAdductors of hip:1. Adductor longus2. Adductor brevis3. Adductor magnus(adductor part)4. GracilisNerve supply:Obturator nervePosterior CompartmentFlexors of knee & extensors of hip:HamstringsNerve supply:Sciatic nerve
6Medial Compartment of Thigh MUSCLES:Adductor longusAdductor brevisAdductor magnus (Adductor portion)GracilisACTION:ADDUCTION OF HIP JOINTN.B.: Gracilis also flexes knee jointNERVE SUPPLY:OBTURATOR NERVE12214334Adductor magnus(Adductor portion)Adductor magnus(Hamstring portions)
7Origin Insertion Inferior pubic ramus Ischial ramus Body of pubis Adductor partHamstring hiatusAdductor hiatusAdductor magnus(adductor portion)GracilisAdductor longusAdductor brevisInsertionUpper part of medialsurface of tibia(behind sartorius)Posterior border of femur (Linea Aspera)
11Anterior Compartment of Thigh Contains the:Flexor of the hip:SartoriusPectineuspsoas majorIliacusExtensors of knee (Quadriceps femoris):Rectus femorisVastus lateralisVastus medialisVastus intermedius (deep to rectus femoris)Nerve supply: Femoral nerve4321214Vastus Intermedius(deep to rectus femoris)3
12Anterior superior iliac spine Upper part of medial surface of tibia SartoriusORIGINAnterior superior iliac spineACTION(TAILOR’S POSITION)Flexion, abduction & lateral rotation of hip jointFlexion of knee jointSINSERTIONUpper part of medial surface of tibia
13Pectineus ACTION: Flexion & adduction of hip joint ORIGIN: Superior pubic ramusINSERTION:Back of femur (below lesser trochanter)
14Iliacus & Psoas major (Iliopsoas) ORIGIN:Psoas major: T12 & lumbar vertebraeIliacus: Iliac fossaACTION:Flexion of hip jointINSERTION:Lesser trochanter of femurIn less than 50 percent of humans the psoas major is accompanied by the psoas minor. It is located in front of the psoas major muscle.
15Quadriceps Femoris ORIGIN: Rectus femoris: Anterior inferior iliac spineVastus intermedius:Front of shaft of femurVastus medialis:Posterior border of femurVastus lateralis:
16Quadriceps Femoris INSERTION: Into PATELLA (Patella is a sesamoid bone)From patella into TUBEROSITY OF TIBIA through Ligamentum Patellae (Patellar Ligament)ACTION:Extension of knee joint
18Anterior Compartment Innervation: Femoral Nerve: Action: Hip flexion. Knee extension.
19Femoral Triangle: Location & Boundaries It is a deep hollow in the Upper third of front of thigh inferior to the inguinal ligamentBoundariesBase: Inguinal ligamentMedial: Medial border of the adductor longus muscleLateral: Medial border of the sartorius muscleFloor: (from media to lateral)adductor longusPectineusPsoas majorIliacusRoof: Skin, superficial & deep fascia.IliopsoasPectineus
20Femoral Triangle: Contents From lateral to medial:Femoral nerve & its branchesFemora arteryFemoral veinLymphatic vessels and some deep inguinal lymph nodesContentsFemoral nerveFemoral artery & deep (profunda)femoral branchGreat saphenous vein (superficial),draining into femoral veinLymphaticsFemoral sheath
21ADDUCTOR CANAL (Subsartorial/Hunter’s canal) Adductor hiatusDEFINITION: an aponeurotic tunnel for femoral artery & veinSITE: In middle third of front of thigh deep to sartoriusEXTENT: From apex of femoral triangle to adductor hiatusBOUNDARIES:Roof (Anterior): Sartorius (medially) and vastus medialis (laterally)Floor (Posterior): Adductor longus & magnus
22POSTERIOR COMPARTMENT OF THE THIGH CONTENTSMuscles:Hamstring muscles:Biceps femoris.Semitendinosus.Semimembranosus.Ischial part of adductor magnus.Blood supply:Branches of the profunda femoris artery.Nerve supply:Sciatic nerve.
23Biceps Femoris : Origin: The long head from the ischial tuberosity. The short head from the linea aspera .Insertion:Into the head of the fibula.Nerve supply:The long head is supplied by the tibial part of the sciatic;the short head is supplied by the common peroneal part of the sciatic.Action :Flexion of knee.Lateral rotation of flexed leg.Long head: extends hip.
24SEMITENDINOSUS Origin: Ischial tuberosity. Insertion: Upper part of the medial surface of the shaft of the tibia (SGS)..Nerve supply:Tibial portion of the sciatic.Action:Flexes and medially rotates the leg at the knee joint;Extends the thigh at the hip joint.SEMITENDINOSUS
25SEMIMEMBRANOSUS Origin: Ischial tuberosity. Insertion: Posterior surface of the medial condyle of the tibia.It forms the oblique popliteal ligament, which reinforces the capsule on the back of the knee joint.Nerve supply:Tibial portion of the sciatic nerve.Action:Flexes and medially rotates the leg at the knee joint;Extends the thigh at the hip.SEMIMEMBRANOSUS
26ADDUCTOR MAGNUS (HAMSTRING PART) Origin:Ischial ramus and ischial tuberosityInsertion:Adductor tubercle of the medial condyle of the femur.Nerve supply:The tibial portion of the sciatic.Action:Extends the thigh at the hip joint.
27Posterior compartment of the thigh Innervation:Tibial division of sciatic nerveExcept short head of biceps femoris: common fibular division of sciatic nerveposterior
28BLOOD SUPPLYThe four perforating branches of the profunda femoris artery provide a rich blood supply to this compartment.The profunda femoris vein drains the greater part of the blood from the compartment.
29NERVE SUPPLY Sciatic Nerve The sciatic nerve, a branch of the sacral plexus (L4 and 5; S1, 2, and 3), leaves the gluteal region as it descends in the midline of the thigh.It is overlapped posteriorly by the adjacent margins of the biceps femoris and semimembranosus muscles.It lies on the posterior aspect of the adductor magnus.In the lower third of the thigh it ends by dividing into the tibial and common peroneal nerves.