SELF-INSTRUCTIONAL MATERIAL

LOWER LIMB --- ANTEROMEDIAL THIGH

Dr. S. Jimnez-Dietsch
ANTERIOR THIGH MUSCLES
The anterior thigh muscles are in the anterior compartment of the thigh. In general, they are
innervated by the femoral nerve.
The main bulk of the anterior thigh muscles is formed by the quadriceps femoris. It is the
principal extensor of the knee joint.
The four parts of the quadriceps are called:
1.
2.
3.
4.
There is a derivative of the vastus intermedius referred to as the
__________________ muscle. Its function is to pull the articular capsule and
synovial membrane of the knee joint during knee extension so that these joint
elements will not be caught between the patella and femur within the knee joint.
The tendons of the four parts of the quadriceps unite to form the
______________tendon. This tendon continues as the ____________ligament
which attaches to the patella. What is the function of the patella?
The patellar tendon reflex is also called the knee jerk. This myotatic or stretch
reflex tests the integrity of which nerve and which spinal cord segments?
Which is the only portion of the quadriceps that can flex the hip joint besides
extending the knee?

The rest of the anterior thigh muscles are: pectineus, iliopsoas, tensor fascia lata, and
sartorius.
Besides flexing the hip joint, the action of the pectineus is _______________.
The pectineus is usually innervated by the femoral nerve but it may receive a
branch from the _______________nerve.
The iliopsoas is the chief flexor of the hip joint. It is formed by the union of two
muscles:
1.
2.

The fleshy parts of the two muscles that form the iliopsoas lie in the abdomen
but they enter the thigh by passing deep to the _________________ligament
and inserting in the __________________________.

The tensor fascia lata is laterally located in the thigh. Its main action is flexion of
the hip joint. To carry out this function it acts in concert with the _____________
and ________________. By tensing the fascia lata it also supports the femur on
the tibia when standing. Because of its innervation, it is considered a muscle of
the gluteal region. State its innervation.

 The actions of the sartorius produce the once common cross-legged position
used by tailors. What are these actions?
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MEDIAL THIGH MUSCLES
The medial thigh muscles are called the adductor group (ADD) because their main action is to
adduct the hip joint. They consist of 5 muscles innervated by the obturator nerve. Name them.
Which is the most anterior?
The ADD Brevis lies deep to two muscles. Name them.
The largest adductor muscle is the _____________________. It consists of a
hamstring portion which arises from the _________________________and is
innervated by the ______________portion of the sciatic nerve
Which is the only ADD muscle to cross and act at the knee joint as well as the hip
joint? What are its actions?
Which is the most commonly used for muscle grafting (i.e., to replace a
damaged muscle?

FEMORAL TRIANGLE AND FEMORAL SHEATH

The femoral triangle is a fascial space in the anterosuperior third of the thigh.
State its boundaries:
superiorly (base)
medially
laterally
The floor of the femoral triangle is formed by two muscles:
1.
2.
The contents of the femoral triangle is (from lateral to medial mnemonic
NAVEL):
What is the retroinguinal space?

The femoral sheath is a fascial tube that encloses some of the structures contained within the
femoral triangle.
Which structures are contained within the femoral sheath?
Briefly describe the three compartments of the femoral sheath. Which one is
considered the femoral canal? What is the name of the proximal (abdominal)
opening of the femoral canal? What is the relationship between this opening and
the lacunar ligament?

 State the purpose of the femoral sheath.

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FASCIA LATA
This is the deep fascia of the thigh. It is a dense layer of connective tissue that invests the lower
limb like an elastic stocking. There is a gap or hiatus in the fascia lata called the saphenous
opening. This gap is inferior to the medial part of the inguinal ligament.
The medial margin of the saphenous opening is smooth, but its superior, lateral,
and inferior margins form a sharp edge called the _______________.
Which vessel passes through the saphenous opening?
The fascia lata thickens laterally to form the iliotibial tract.
Which two muscles attach to the iliotibial tract?

VESSELS AND NERVES

The femoral nerve is the largest branch of the lumbar plexus.
The femoral nerve enters the femoral triangle ______________(medial / lateral)
to the femoral vessels.
The terminal branch of the femoral nerve is a cutaneous branch called the
________________nerve and this branch supplies the skin on the
____________aspect of the knee, leg, and foot.
The femoral artery is the chief artery to the lower limb.
The femoral artery is the continuation of which artery?
The largest branch of the femoral artery is known as:___________________.
It arises in the femoral triangle and is the chief artery to the thigh. It lies
______________________(anterior / posterior) to the femoral artery and vein
on the medial side of the femur. What are its main branches?
There are two circumflex femoral arteries that encircle the proximal end of the femur.
Name them.
They branch from which arterial stem?
Which one supplies most of the blood to the head and neck of the femur?
The femoral vein is the continuation of the popliteal vein.
The femoral vein enters the femoral sheath __________________(medial /
lateral) to the femoral artery and ___________________(medial / lateral) to the
femoral canal.
At the inguinal ligament, the femoral vein becomes the
_________________vein.
In the inferior part of the femoral triangle, the femoral vein receives two major

tributaries: the deep vein of the thigh and the great saphenous vein. Which of
these two veins is formed by the union of three or four perforating veins?
The obturator artery is usually a branch of the internal iliac artery.
It can also originate from which vessel?
Does it passes through the obturator foramen?
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ADDUCTOR CANAL (ADD canal of Hunter)

The adductor canal is a fascial tunnel in the thigh. It is also called the subsartorial canal
because it is located deep to the sartorius muscle.
The ADD canal provides a passage through which the femoral vessels pass to
reach the popliteal fossa and become ______________________vessels.
The ADD canal begins at the apex of the femoral triangle where the sartorius
crosses over the following muscle:_______________________.
The ADD canal ends at the following opening:______________________. This
opening or hiatus is located in the tendon of the following muscle:
____________.
The contents of the ADD canal are:
1.
2.
3.
CLINICAL CORRELATIONS
Refer to your textbook and make sure you read the following clinical considerations:
1. femoral hernias
2. left cardiac angiography
3. right cardiac angiography
4. groin pull
5. transplantation of gracilis
6. femoral pulse and cannulation of femoral artery

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ADDITIONAL INFORMATION
Regarding the anterior thigh muscles..
The psoas major and iliacus are usually referred to as the iliopsoas muscle because
of their common insertion (lesser trochanter of femur) and action (hip flexion). The
iliopsoas is a powerful hip flexor. If the thigh is fixed (e.g., supine position), it flexes the
trunk on the thigh (e.g., sit-ups).
Very Important Clinical Note:
During sit-ups, the iliopsoas increases the lumbar lordotic curve because it pulls forward
the lumbar curvature. Therefore, if abdominals are not strong enough to carry out the
lumbar flexion during sit-ups, the pull of the iliopsoas can lead to microtrauma and back
problems. Patients with back injuries and weak abdominals should never perform
sit-ups to rise from the supine position (they should turn on the side and push-up
with arms).

Regarding the femoral hernias

The femoral ring is a weak area in the lower abdominal wall that is the site of femoral
hernias.Thus when intra-abdominal pressure rises very high (as may occur when a
chronically constipated person attempts o defecate) abdominal contents may be forced
through the femoral ring into the femoral canal. The hernial sac (femoral hernia) forms
a swelling inferior to the inguinal ligament (very important to know: this swelling is
inferolateral to that caused by an inguinal hernia).
In a nutshell:
A femoral hernia is a protrusion of fat, peritoneum, and usually a loop of
intestine through the femoral ring into the femoral canal. Initially, the
hernia is small and contained within the femoral canal, but it can enlarge
by passing through the saphenous opening into the thigh, inferior to the
inguinal ligament.
Femoral hernias are rare in males, they are more frequent in women (3:1) because the
femoral ring is larger in women than in men and their femoral vessels are smaller.
Because of the ligamentous boundaries, there is a high potential for strangulation and
necrosis of the herniated loop of bowel of intestines in a femoral hernia.