Anatomy Of Anterior ThighAnatomy Of Anterior Thigh

By- Dr. Armaan SinghBy- Dr. Armaan Singh

Anterior muscle group: supplied by femoral nerve

Sartorius Quadriceps: rectus

femoris, vastus medialis, vastus intermedius and vastus lateralis

Pectineus

Medial or adductor group: adductor longus, adductor brevis, adductor portion adductor magnus and gracillis are supplied by the obturator nerve

Posterior group: hamstring, semimembranosus, semitendinosus, biceps femoris, adductor magnus, below femoral hiatus

Supplied by sciatic nerve

Anterior wall formed by transversalis fascia

Posterior by fascia iliaca Three compartments Medial, short, is the femoral canal,

contains lymph gland Opens into abdomen via femoral ring,

site of femoral hernia Middle compartment contains femoral vein Lateral, femoral artery and femoral branch

of genito-femoral nerve Femoral nerve is outside sheath

Rectus femoris Vastus medialis Vastus intermedius Vastus lateralis Forms the anterior portion of the

capsule of the knee joint The largest muscle group in the

body Wastes rapidly if there is an

effusion, particularly the oblique portion of the vastus medialis

Tendinous origin from the upper part of the anterior inferior iliac spine (epiphysis) and the groove above the acetabulum

The most superficial portion of the quadriceps

The most frequently strained The only portion of the

quadriceps that crosses two joints

Flexes hip, extends knee Femoral nerve

Vastus medialis arises from the lower half of the trochanteric line

The spiral line The medial lip of the linea

aspera The oblique (horizontal) fibres

arise from the lower portion of the adductor magnus, helping to stabilise the patella

Separate branch from femoral nerve

Arises from the upper half of the inter-trochanteric line

The root of the greatertrochanter The lateral lip of the gluteal

tuberosity The lateral lip of the linea

aspera The oblique portion of the

muscle arises from the iliotibial band Separate nerve supply Helps to stabilise the patella Lateralis is a common site for

muscle biopsies and for injections

Arises from the upper two thirds of the anterior and lateral aspect of the shaft of the femur

It is the deepest portion of the quadriceps and is a common site (with vastus lateralis) for myositis ossificans, after a direct blow to the thigh

The articularis genu is inserted into the upper part of the suprapatellar bursa

The rectus femoris forms the most superficial lamina of the quadriceps, passes anterior to the patella

To form the anterior part of the patellar ligament

The fibres of the medialis and the lateralis decussate cross in an X-shape and lie in a plane posterior to the rectus femoris

Some of these fibres form the retinacular fibres

Their oblique portions are inserted into the sides of the patella

The vastus intermedius is the most posterior lamina, forms the main part of the patellar ligament

It is the most powerful extensor The patellar ligament is inserted

into the smooth upper portion of the tibial tuberosity

The quadriceps are the extensors of the knee

Only the rectus femoris portion arises above the hip joint, and therefore is also a flexor of the hip

Lower most fibres of vastus medialis

Partly arise from the adductor magnus

Straightens the pull on the quads tendon and patella

Controls patella tracking during flexion/extension of the knee

Fibres atrophy quickly after knee injury (within 24 hours)

10-15 ml of effusion inhibit VMO VMO rehabilitation strength and

timing of contraction

Anatomical anomalies Femoral torsion Genu valgum Increased Q angle High (Alta) patella Tibial torsion Overpronation Q angles

males 140 and females 170

> 200 greater problems

The Q-angle is the angle formed by a line drawn from the anterior superior iliac spine to the centre of the patella

And a line drawn upwards from the attachment of the patellar ligament to the tibial tubercle passing through this point

Functionally, on standing, the normal angle is 10–15°

With the knee at 90°of flexion, an angle of 6°is normal, while greater than 10°is abnormal

Contraction of the quadriceps tends to displace the patella laterally in the femoral groove

The oblique fibres of the vastus medialis and the bony prominence of the lateral femoral condyle resist this

In young athletes, the patellar ligament is stronger than the bone

Which can lead to a traction apophysitis of the tibial tuberosity, Osgood Schlatter disease

Jumpers’ knee is a lesion at the apex of the patella and the ligament

Sartorius arises from anterior superior illiac spine

Forms lateral boundary of femoral triangle Crosses adductor longus at apex Lies anterior to femoral artery Posterior to adductor longus lies the

profunda artery Knife injury at apex can injury both arteries

and the main blood supply to lower limb Sartorius lies on roof of subsartorial canal

which contains femoral artery

Inserted into upper third of medial surface of tibia

Anterior to gracillis and semitendinosus, as part of the pes anserinum

Separated by tibial intertendinous bursa

Supplied by femoral nerve

Adductor longus Adductor brevis Portion of adductor

Magnus Gracilis Supplied by obturator

Nerve L2,3,4 Act with lower

abdominals to stabilise the pelvis

lateral medial

inferior

Tendinous origin, pubic body, has a variable shape

Inserted into medial lip of linea aspera

Most frequently torn at proximal musculo-tendinous junction, which varies

Or may tear at teno-periosteal junction

Site of junction varies, medial or lateral, may be longer in some

Anterior division obturator nerve

Origin lower portion of body of pubis

Inferior pubic ramus Inserted into lower half of

the pectineal line Upper half of the linea

aspera Deep to adductor longus Separates two divisions

of obturator nerve Anterior division supplies

it

Triangular area of ischial tuberosity Ramus of ischium and inferior

ramus of pubis Inserted into medial lip of gluteal

tuberosity Lateral lip of linea aspera Medial supracondylar line Adductor tubercle Hiatus for popliteal vessels Origin of oblique fibres of vastus medialis Post division obturator nerve Sciatic nerve below hiatus for femoral

vessels

Gracilis is the weakest, most medial and superficial of the adductors

Gracilis is the only one that crosses the knee joint

It arises from a thin aponeurosis, lower half of the body and the inferior ramus of the pubis and part of the ramus of the ischium. It is strap like above

It ends in a rounded tendon, inserted into the upper portion of the medial surface of the tibia between the sartorius and the semitendinosus

Gracilis is separated from sartorius and the semitendinosus by the tibial intertendinous bursa (pes anserinum)

Gracilis is usually supplied by the anterior division of the obturator nerve, L2, 3, 4

It adducts the hip and flexes and medially rotates the leg

Inflammation of the tibial intertendinous bursa

Must be differentiated from injury to the lower attachment of the medial collateral ligament of the knee

The adductors adduct the femur and help to stabilise and counteract the rotation of the pelvis, particularly during the double support

When the anterior limb is flexed and the posterior limb is extended

Carlsoo, 1972

Common in soccer is adductor muscle-tendon strain. Be aware of:

• Rectus Femoris• Sartorius• Rectus

Abdominus• Pectineus• Adductor

Magnus• Gracilis

If the hip is flexed, the adductors rotate the hip medially

When the hip is extended the adductors can laterally rotate

They can also flex the extended hip and extend the flexed hip

At the beginning of the swing phase of walking they work synergistically with the iliopsoas

At the end of the swing phase, they work with the hamstrings, which contract to prevent further hip flexion

The pectineus muscle is a short flat muscle, which forms part of the floor of the femoral triangle

It arises from the anterior aspect of the superior ramus of the pubic bone and the fascia covering it

It is inserted into the upper half of a line drawn from the lesser trochanter to the linea aspera and lies posterior to the femoral sheat

It is supplied by a branch from the femoral nerve or the accessory obturator (L2, 3)

The pectineus is mainly a flexor of the thigh and a weak adductor

There may occasionally be some fusion between the adductor longus and brevis or with the pectineus

Doubling of the origin of the adductor longus or brevis may also take place

Origin Intervertebral discs, adjoining

bodies of T12-L5 vertebrae Medial half, anterior aspect of

five lumbar transverse processes

Fibrous arches on the sides of the bodies of the four upper four lumbar vertebrae, over four lumbar arteries

Inserted into the lesser trochanter of femur

Nerve L2,3,4

Minor Origin T12 –L1 Insertion Arcuate line Iliopubic eminence

The psoas is covered by fascia which is attached medially to the lumbar vertebrae

To the fibrous arches Medially along the brim of the

pelvis to the arcuate and pectineal lines

Laterally, the fascia is attached to the transverse processes of the lumbar vertebrae

Medial Arcuate Ligament is a thickening of fascia over the Psoas

Flexes the hip when acting from above

Lumbar plexus is formed inside the substance of psoas

A strain of the psoas muscle may be the cause of chronic groin pain, and you must take care not to mistake it for an adductor strain

Psoas bursa, between psoas and capsule of hip joint, may communicate with the synovial membrane of the joint

Psoas abscess will present in the groin

The iliacus Origin: iliac fossa and iliac crest Inserted into the lateral aspect of the psoas

and into the femur below the lesser trochanter Nerve L2,3 The iliopsoas is an active postural or stabilising

muscle of the hip which helps to prevent hyperextension of the hip while standing

Acting from above, the iliopsoas flexes the hip and may be either a medial or a lateral rotator; acting from below, psoas flexes spine

In walking, the iliopsoas is used to start swinging the leg forwards

On level ground the leg moves forwards like a pendulum to complete the swing

Stronger contraction of the iliopsoas is required when running or walking up a hill

When climbing stairs, the iliopsoas lifts the leg and places the foot on the stair above

When preparing to stand from sitting, the iliopsoas pulls the trunk forwards as the femur is fixed

The trunk leans forwards and, before standing upright, the centre of gravity of the trunk moves over the feet

In sitting up from lying, the iliopsoas pulls on the pelvis and the lower vertebrae in order to pull the trunk up

Tyldesley & Grieve, 1989

Running with the legs lifted high, helps to develop the iliopsoas

The iliopsoas is also used in the downbeat of freestyle swimming

The iliopsoas is the main muscle involved in straight leg sit-ups

These, however, should never be done as they put stress on the lumbar vertebrae and do nothing for the abdominal muscles