Anterior thigh by- dr. armaan singh

1. Anatomy Of Anterior ThighAnatomy Of Anterior Thigh
By- Dr. Armaan SinghBy- Dr. Armaan Singh

3.  Anterior muscle group:
supplied by femoral nerve
 Sartorius
 Quadriceps: rectus
femoris, vastus medialis,
vastus intermedius and
vastus lateralis
 Pectineus

4.  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

5.  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

6. 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

7.  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

8.  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

9.  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

10.  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

11.  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

12.  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

13.  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

14. 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

15.  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

16.  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

17.  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

18.  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

19.  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

20.  Adductor longus
 Adductor brevis
 Portion of adductor
Magnus
 Gracilis
 Supplied by obturator
Nerve L2,3,4
 Act with lower
abdominals to
stabilise the pelvis

21. lateral medial
inferior

22.  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

23.  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

24.  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

25.  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

26.  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

27.  Inflammation of the tibial
intertendinous bursa
 Must be differentiated
from injury to the lower
attachment of the medial
collateral ligament of the
knee

28.  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

29. Common in soccer
is adductor muscle-
tendon strain.
Be aware of:
• Rectus Femoris
• Sartorius
• Rectus
Abdominus
• Pectineus
• Adductor
Magnus
• Gracilis

30.  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

31.  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)

32.  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

33. 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

34.  Minor
 Origin
 T12 –L1
 Insertion
 Arcuate line
 Iliopubic eminence

35.  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

36.  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

37.  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

38.  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

39.  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

40.  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

41.  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