Baraa Ayed حسام أبو عوض. Ahmad Salman. 1 P a g e

Transcription

1 4 Baraa Ayed حسام أبو عوض Ahmad Salman 1 P a g e

2 Today we are going to cover these concepts: Iliotibial tract Anterior compartment of the thigh and the hip Medial compartment of the thigh Femoral triangle Iliotibial tract It is a thickeneddeep fascia at the lateral side of the thigh (the entire deep fascia of the thigh is called Fascia Lata ). Origin: Iliac tubercle Insertion: Lateral condyle of the tibia ) بثبتهم ع بعض) Function: Fixation of the femurand the knee Two muscles insert here: Tensor Fascia Lata and Gluteus Maximus The thigh We divide the thigh into 3 compartments; Anterior (front), medial and posterior. The function of the muscles in the front is extension The function of those found posteriorly is Flexion Exception: muscles coming from the trunk/vertebral column to the lower limb The Muscles of the anterior compartment: Iliopsoas Pectineus Quadriceps femoris Sartorius - All are supplied by femoral artery and - All are supplied by femoral nerve except the psoas major that is not supplied by femoral nerve - Iliopsoas:consist of two muscles; iliacus and psoas major Iliacus:origin from the iliac fossa Psoas: origin from the transverse-processes,bodies and intervertebral disks of the 12 th thoracic vertebra and the five lumbar vertebrae Both inserted on the lesser trochanter (so given a combined name). Action: Main flexors of the thigh at the trunk (hip joint) (you can fix the insertion and flex your trunk on the thigh via these muscles). Nerve supply: iliacus by femoral nerve psoas by lumbar plexus (L1-L3) 2 P a g e Clinical application:if the patient has an inflammed appendix ( الزايدة (التهاب and you flex their thigh in the direction of their abdomen ( رجليه ع بطنه (ثنيت pain will arise (psoas major hits the appendix) this may be indicator for appendicitis - Quadriceps femoris:has four heads

3 3 P a g e Rectus femoris Vastus medialis( medial to the rectus femoris) Vastus lateralis ( lateral to the rectus femoris) Vastus intermedius ( posterior to the rectus femoris) - Rectus femoris: Origin: straight head from the anterior inferior iliac spine and the reflected head from the ilium above the acetabulum - Vastus intermedius: Origin: anterior and lateral surfaces of shaft of femur - Vastus medialis and lateralis: Origin: from the upper end of the shaft of the femur ( medial and lateral) - All are inserted in the patella then (via ligamentum patellae) in the tibial tuberosity. - Action: extension of the knee joint. But the rectus femoris crosses two joints, so it does an additional action which is flexion of the hip joint. - Note: the lowest tendon of vastus medialis is called vastus medialis oblique. When the friction at the patellofemoral joint increases due to excessive running, this will result in Runner's syndrome and the solution is strengthening VMO and some clinicians say that the entire quadriceps muscle should be strengthened. Sartorius: Origin anterior superior iliac spine Insertion SGS (sartorius, gracilis and semi-tendinosis) area (upper medialsurface of shaft of the tibia) Action Abducts, laterally rotates and flexes the hip joint medially rotates and flexes the knee joint Pectineus: Origin Pectineal surface Insertion upper end of linea aspera Action Flexion and adduction of the thigh (some classify it as an adductor with the medial compartment muscles) Medial compartment of the thigh: Adductor longus, brevis, magnus andgracilis (also obturator externus, but the doctor prefers to mention it with the lateral rotators of the thigh) All are supplied by obturator nerve Main action is adduction of the thigh (gracilis also flexes the knee and may cause some lateral rotation to the leg). Blood supply: by profundafemoris artery and obturator artery All take an origin from pubic arch ( the union of the inferior pubic ramus and the ischial ramus)except adductor longus from the body of pubis All are inserted in thelinea aspera EXCEPT gracilis SGS area

4 Obturator externus : takes origin from the outer surface of obturator membrane, pubis and the ischial ramus and it s inserted at the medial surface of greater trochanter and it s supplied by the obturator nerve and its main action is lateral rotation of the thigh at the hip joint. Femoral triangle Superior border: Inguinal ligament Lateral border: Sartorius Medial border: adductor longus The floor : pectineus muscle, adductor longus and iliopsoas The roof: - Skin - superficial fascia which contains: A-superficial inguinal lymph nodes B-femoral branch of the genitofemoral nerve C-branches of ilioinguinal nerve D-superficial branches of the femoral artery and corresponding veins E-terminal part of the great saphenous vein - deep fascia containing the Saphenous opening Contents of femoral triangle: 1-Terminal part of the femoral nerve and its branches. 2-The femoral sheath!!! 3-The femoral artery and its branches. 4-The femoral vein and its tributaries. 5-Deep inguinal lymph nodes 6-femoral branch of genitofemoral nerve 7-lateral cutaneous nerve of the thigh Femoral sheath: It is covered by a fascia, anteriorly called fascia transversalis and posteriorly called fascia iliacus, )ماشيين مع بعض ( nerve Contain: femoral artery (lateral) and femoral branch of genitofemoral femoral vein( intermediate) and in the medial side there is a space called femoral canal The borders of femoral canal: Anterior: inguinal ligament Posterior: pectineal ligament Medially: lacunar ligament Laterally: femoral vein And it contains lymph nodes. Femoral canal moves upwards and enters the abdomen via an opening called the femoral ring (on the abdomen), so hernia may occur (muscles weakened intestines exit via this opening) and it 4 P a g e

5 may even reach to the saphenous opening and exit through it. Importance of the canal: if the venous return of the lower limb is high then the vein will still find some space to expand in. There is another ring called the superficial inguinal ring near the pubic tubercle. Hernia may occur here too (inguinal hernia). Differentiating between femoral and inguinal hernia is done via the pubic tubercle (femoral hernia is lateral to the tuberclewhile the inguinal one is medial to it). To determine pubic tubercle s position: adduct your thigh and then you will see the tendon of the adductor longus which is attached to the pubic body, from there determine the pubic tubercle and see the position of the hernia. 5 P a g e