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Medial compartment of thigh
- 1. Medial compartment of thigh Dr Rajiv Ranjan RIMS, RanchiD rR ajiv R anjan
- 3. Medial compartment • The contents of the medial compartment of the thigh • • Muscles: these comprise the hip adductors: gracilis, pectineus, adductor longus, adductor brevis, adductor magnus & Obturator externus • • Arteries: profunda femoris (artery to the adductors) as well as its medial circumflex femoral and perforating branches and the obturator artery. • Veins: profunda femoris and obturator veins. • Nerves: the anterior and posterior divisions of the obturator nerve D rR ajiv R anjan
- 4. Medial compartment of the thigh D rR ajiv R anjan
- 5. Medial compartment of the thigh (Dissected view) D rR ajiv R anjan
- 6. PECTINEUS • Origin : Pecten pubis • Insertion : along a line from the lesser trochanter to the linea aspera • Innervated : dual innervation • femoral nerve, L2 and 3, and • accessory obturator nerve, L3 • Actions - adducts the thigh and flexes it on the pelvis D rR ajiv R anjan
- 7. Pectineus • Actions - Adducts the thigh and flexes it on the pelvis D rR ajiv R anjan
- 8. GRACILIS (l. slender) • Origin : inferior pubic ramus, and the adjoining part of the ischial ramus • Insert – pes anserinus • Innervation : obturator nerve, L2,3D rR ajiv R anjan
- 9. Action Adductor of the thigh Flexes the leg and rotates it medially D rR ajiv R anjan
- 10. ADDUCTOR LONGUS • Arises by a narrow tendon (ossified Rider’s bone) from body of pubis betn crest and symphysis • Inserts by an aponeurosis into the linea aspera in the middle third of the femur • Lies betn Femoral and Profunda Femoris vessels • Innervation - anterior division of the Obturator Nerve, L2, 3 and 4 D rR ajiv R anjan
- 11. Action Adductor & medial rotators of the thigh D rR ajiv R anjan
- 12. ADDUCTOR BREVIS • Arises from body and inferior ramus of the pubis • Insert along a line from the lesser trochanter to the linea aspera • Relations- Anteriorly anterior branch of the obturator nerve Posteriorly posterior branch of the obturator nerve • Innervation- obturator nerve, L2 and 3 D rR ajiv R anjan
- 13. Action • Adduct and flex the femur at the hip D rR ajiv R anjan
- 14. ADDUCTOR MAGNUS • Origin • Adductor part inferior pubis ramus & conjoined ischial ramus • Hamstring part inferolateral aspect of the ischial tuberosity • short, horizontal fibres from the pubic ramus are inserted into the medial margin of the gluteal tuberosity of the femur • The fibres from the ischial ramus insert via a broad aponeurosis into the linea aspera and the proximal part of the medial supracondylar line • fibres from the ischial tuberosity, is a thick mass which descends almost vertically to its attachment to the adductor tubercle on the medial condyle of the femur M. D rR ajiv R anjan
- 15. Cont….. • The long, linear attachment of the muscle is interrupted by a series of osseo- aponeurotic openings, bridged by tendinous arches attached to the bone. • The upper four are small and transmit the perforating branches and the termination of the profunda femoris artery. • The lowest is large and allows the femoral vessels to cross to the popliteal fossa. • Innervation - doubly innervated by the obturator nerve and the tibial division of the sciatic nerve (L2, 3 and 4) D rR ajiv R anjan
- 16. ADDUCTOR MAGNUS Action Adductor & medial rotators of the thigh D rR ajiv R anjan
- 17. Obturator Externus • Arises from whole of obturator membrane and from ant. Bony margin of obturator foramen • Inserted on the medial surface of greater trochanter into a deep pit ( trochanteric fossa) • Innervation – post. div. of obturator N L3,4 • Action stabilizer and Lat. Rotator of thighD rR ajiv R anjan
- 18. Obturator artery • Emerge from obturator foramen with the nerve and divide into ant. and post. branches • They anastomose with each other and with medial circumflex art. • From the post br. Articular twig to hip joint arises which runs in the lig. of head femur and supply the fovea. D rR ajiv R anjan
- 19. Obturator nerve • arises from the ventral branches of the L2-4 • Near the foramen it divides into anterior and posterior branches, separated at first by part of obturator externus and lower down by adductor brevis • Anterior branch – • Near the obturator foramen the anterior branch supplies the hip joint • Behind pectineus it supplies adductor longus, gracilis, usually adductor brevis and often pectineus • At the lower border of adductor longus it forms subsartorial plexus D rR ajiv R anjan
- 21. Obturator nerve • Posterior branch – • pierces obturator externus anteriorly, supplies it and passes behind adductor brevis to the front of adductor magnus, dividing into branches to this • usually sends an articular filament to the knee joint D rR ajiv R anjan
- 22. TROCHANTERIC ANASTOMOSIS lies near the trochanteric fossa of femur It is an anastomosis between ascending branch of medial circumflex femoral A ascending branch of lateral circumflex femoral A descending branch of superior gluteal A descending branch inferior gluteal A 1st perforating artery may also contribute D rR ajiv R anjan
- 23. TROCHANTERIC ANASTOMOSIS • Creating an extracapsular 'arterial ring of the femoral neck' • Branches from this ring, the retinacular vessels, pierce the capsule and ascend along the femoral neck to give the main blood supply to the head of the femur D rR ajiv R anjan
- 24. CRUCIATE ANASTOMOSIS Lies @ the level of lesser trochanter It is an anastomosis betn transverse br. of medial circumflex femoral A transverse br. of lateral circumflex femoral A descending br. of inferior gluteal A ascending br. of first perforating A D rR ajiv R anjan
- 25. Route for collateral circulation D rR ajiv R anjan