2 OBJECTIVES OF THIS LECTURE 1.Boundaries of femoral triangle.2.Contents of femoral triangle.3.Femoral vessels, surface marking of femoral artery, branches of femoral artery.4.Inguinal group of lymph nodes.5.Muscles of anterior compartment of thigh – origin/insertion/nerve supply/actions.6.Dermatomes of thigh.7.Superficial veins of thigh – great saphenous/small saphenous veins & varicose veins.
3 BOUNDARIES OF FEMORAL TRIANGLE SUPERIORLYSUPERIORLYLATERALLY
4 LAND MARKSAnterior superior iliac spine, iliac crest, pubic symphysis, pubic tubercle.Inguinal ligament, femoral artery pulsation can be felt at ½ “ below mid inguinal point.Patella, condyles of femur, ligamentum patellae, tibial tuberosity, condyles of tibia, and styloid process of fibula, head & neck of fibula.Palpation of common peroneal nerve at the neck of fibula, popleteal artery pulsation at the popleteal fossa.
5 THE FEMORAL TRIANGLEThe femoral triangle is the name given to an area of the anterior aspect of the thigh formed as different muscles and the ligament crossed each other producing an inverted triangular area .The lateral border is formed by the sartorius, the medial border is formed by the adductor longus, the inguinal ligament forms the superior border, and the apex of the triangle is formed by crossing of the sartorius over the adductor longus.The roof is formed by the fascia lata, cribriform fascia, and the skin.The floor of the triangle is formed, from medial to lateral, by the adductor longus, adductor brevis, pectineus, and iliopsoas.The contents are the femoral vessels and nerve.
10 FEMORAL VESSELSFemoral artery is the continuation of the external iliac artery beyond the mid inguinal point. It supplies all the structures in the thigh region.Femoral vein lies medial to the femoral artery, both are enclosed in the femoral sheath, which is the continuation of tranversalis fascia and psoas fascia below the inguinal ligament.Surface marking of femoral artery:- Take a mid point of inguinal ligament, another lower point at the medial condyle of femur, the position of limb is flexion at hip joint, abduction and lateral rotation, line is drawn connecting the two points, upper 2/3 indicates surface marking of femoral artery.
13 PROFUNDA FEMORIS It is the main artery of the thigh region. It arises from the femoral artery.It gives lateral circumflex femoral, medial circumflex femoral and perforating branches.The perforating branches takes part in the anastomosis around the shaft of femur, and inter trochanteric anastomosis.
15 INGUINAL GROUP OF LYMPH NODES Superficial group of lymph nodes lies in the superficial fascia parallel to the inguinal ligament.Deep inguinal group of lymph nodes lies in the femoral canal.Inguinal group of lymph nodes drain the whole lower limb, groin region, and from anterior abdominal wall below the umbilicus.
17 ANTERIOR COMPARTMENT OF THIGH It is extensor compartment of thigh.Femoral nerve is the nerve of anterior compartment of thigh.Fascia lata is the deep fascia of the thigh.It is attached superiorly to the iliac crest, anterior superior iliac spine, inguinal ligament, pubic tubercle and pubic symphysis.
18 ILIOTIBIAL TRACT &TENSOR FASCIA LATAE Iliotibial tract is the thickening of the fascia lata at the lateral aspect of thigh.It encloses a muscle, tensor fascia latae.Gluteus maximus gets inserted into it.
19 DERMATOMES OF THE THIGH Ilioinguinal nerve.Genitofemoral nerve.Anterior cutaneous nerve of thigh.Lateral cutaneous nerve of thigh.
20 POSTERIOR ASPECT OF THIGH DERMATOMES Medial cutaneous nerve of the thigh.Posterior cutaneous nerve of thigh.Lateral cutaneous nerve of thigh.
22 THE SAPHENOUS VEINSThe long /great saphenous vein is the largest vein in the body.It arises from the dorsal venous arch of the foot, ascends upwards in the superficial fascia of leg, and medial aspect of thigh, pierces the cribriform fascia and ends in the femoral vein.It is connected to the deep veins at various places by perforators.The blood flows from superficial to deep veins, they have lots of valves, that checks unidirectional flow of blood.
23 The short saphenous vein/small saphenous vein It also arises from the dorsal venous arch of the foot, on the lateral aspect of the arch.It runs in the superficial fascia of posterior part of leg and ends in the popliteal vein.It is also connected with deep vein by the perforators.Incompetence of these perforators and valves leads to stasis of blood, forming the varicose veins.
29 SARTORIUS O-Anterior superior iliac spine. I- medial surface of upper end of shaft of tibia, pes anserinus.N.A.-femoral nerve.A.- flexion at hip joint and flexion at knee joint.
30 RECTUS FEMORISIt has two heads, straight head arises from anterior inferior iliac spine.The reflected head arises from area just above acetabulum.Inserted in to patella.N.S.- femoral nerveA.- flexion at hip & extension at knee.
31 VASTUS LATERALIS/INTERMEDIUS/ MEDIALIS All three vasti + rectus femoris together forms quadriceps femoris.All three vasti arise from shaft of femur.Get inserted in to tibial tuberosity after enclosing patella, the largest sessamoid bone.All are innervated by branches from femoral nerve.Action of quadriceps femoris is extension at knee joint.
33 PECTINEUS/ILIOPSOASPectineus is a muscle of medial compartment of thigh. It forms the floor of the femoral triangle.Ilio-psoas is a muscle from the posterior abdominal wall, passes below inguinal ligament forms floor of femoral triangle.Iliopsoas get inserted on to the lesser trochanter of femur, it brings flexion of hip joint.
35 SUB-SARTORIAL CANALThe femoral artery exits the femoral triangle by running to the apex of the triangle and entering the sub-sartorial canal / Hunter’s canal/ Adductor’s canal.Later the femoral artery enters the popleteal fossa by passing through the adductor magnus hiatus.