Thigh, Knee and Leg




Thigh


Front of the right upper thigh (female)


Part of the fascia lata (deep fascia of the thigh, 14) has been removed to display the femoral vessels and nerve and the adjacent muscles. The femoral nerve (21), artery (20), vein (18) and canal (17) lie in that order from lateral to medial beneath the inguinal ligament (19). The great saphenous vein (12) passes through the saphenous opening (16) in the fascia lata to enter the femoral vein (18); a number of smaller veins enter the great saphenous just before it joins the femoral.





Inguinal and femoral regions, in the female







Palpation of femoral pulse















  • Various superficial veins ( 5, 13, 15, 25 ) run into the great saphenous vein ( 12 ); this helps to distinguish the great saphenous from the femoral vein ( 18 ), which superficially at this level receives only the great saphenous itself. See p. 70 for further details of the great saphenous vein.



  • Although arising at the front of the thigh, the profunda femoris artery is the main supply to muscles on the back of the thigh as well as those on the front.



  • The adductor canal, which is triangular in cross section, is bounded in front by sartorius, laterally by vastus medialis, and behind by adductor longus (above) and adductor magnus (below). The contents of the adductor canal are the femoral artery and vein, the saphenous nerve and the nerve to vastus medialis.



  • The femoral pulse can be felt midway between the anterior superior iliac spine and the midline pubic symphysis (the midinguinal point or femoral point).






  • 1

    Anterior superior iliac spine


  • 2

    External oblique aponeurosis


  • 3

    Cut edge of rectus sheath


  • 4

    Rectus abdominis


  • 5

    Superficial epigastric vein


  • 6

    Superficial inguinal ring


  • 7

    Round ligament of uterus


  • 8

    Mons pubis


  • 9

    Gracilis


  • 10

    Adductor longus


  • 11

    Pectineus


  • 12

    Great saphenous vein


  • 13

    Superficial external pudendal vessels


  • 14

    Fascia lata


  • 15

    Accessory saphenous vein


  • 16

    Lower edge of saphenous opening


  • 17

    Position of femoral canal


  • 18

    Femoral vein


  • 19

    Inguinal ligament


  • 20

    Femoral artery


  • 21

    Femoral nerve




  • 24

    Sartorius


  • 25

    Superficial circumflex iliac vessels


  • 26

    Fascia lata overlying tensor fasciae latae



Front of the right upper thigh (male)


In this deeper dissection the removal of part of sartorius (3) displays the profunda femoris artery (24). The femoral artery (9) passes in front of adductor longus (18); the profunda (24) passes behind it. Separation of the adjacent borders of pectineus (13) and adductor longus (18) allows the anterior division of the obturator nerve (15) to be seen in front of adductor brevis (17). The medial circumflex femoral artery (12) disappears backward between pectineus (13) and the tendon of psoas (hidden behind the uppermost part of the femoral artery (upper 9). The lateral circumflex femoral artery (11, which often arises directly from the femoral artery, as here, and not from the profunda) courses laterally and supplies adjacent muscles. Branches of the femoral nerve (8) include the saphenous nerve (25), which will run as far as the medial side of the foot.





Femoral vessels and nerve, in the male






  • 1

    Tensor fasciae latae


  • 2

    Lateral femoral cutaneous nerve


  • 3

    Sartorius


  • 4

    Iliacus


  • 5

    Superficial circumflex iliac artery (double)


  • 6

    Inguinal ligament


  • 7

    Superficial epigastric artery


  • 8

    Femoral nerve


  • 9

    Femoral artery


  • 10

    Femoral vein


  • 11

    Lateral circumflex femoral artery


  • 12

    Medial circumflex femoral artery


  • 13

    Pectineus


  • 14

    Superficial external pudendal artery


  • 15

    Anterior branch of obturator nerve


  • 16

    Spermatic cord


  • 17

    Adductor brevis


  • 18

    Adductor longus


  • 19

    Gracilis


  • 20

    Vastus medialis


  • 21

    Vastus intermedius


  • 22

    Rectus femoris


  • 23

    Nerve to vastus medialis


  • 24

    Profunda femoris artery


  • 25

    Saphenous nerve


  • 26

    Nerve to rectus femoris










Lower right thigh, medial side


The lower part of sartorius (3) has been displaced medially to open up the lower part of the adductor canal and expose the femoral artery (4) passing through the opening in adductor magnus (6) to enter the popliteal fossa behind the knee and become the popliteal artery.





From the front and medial side






  • 1

    Gracilis


  • 2

    Adductor magnus


  • 3

    Sartorius


  • 4

    Femoral artery


  • 5

    Saphenous nerve


  • 6

    Opening in adductor magnus


  • 7

    Vastus medialis and nerve


  • 8

    Rectus femoris


  • 9

    Iliotibial tract


  • 10

    Quadriceps tendon


  • 11

    Patella


  • 12

    Medial patellar retinaculum


  • 13

    Lowest (horizontal) fibres of vastus medialis


  • 14

    Saphenous branch of descending genicular artery








Axial section through lower right thigh


The section is viewed as when looking upward from knee to hip. The three vastus muscles (1, 3, 5) envelop the femur (2) at the front and sides, and rectus femoris (4) at this level is narrow and is becoming tendinous. The femoral vessels (20) are between vastus medialis (1) and adductor magnus (12), approaching the adductor magnus opening (13), and the profunda femoris vessels (11) lie close to the back of the femur (2). The sciatic nerve (10) is deeply placed between biceps (8, 9) laterally and semimembranosus (14) and semitendinosus (15) medially.





Axial section at the level of the opening in adductor magnus






  • 1

    Vastus medialis


  • 2

    Femur


  • 3

    Vastus intermedius


  • 4

    Rectus femoris


  • 5

    Vastus lateralis


  • 6

    Iliotibial tract


  • 7

    Lateral intermuscular septum


  • 8

    Short head of biceps


  • 9

    Long head of biceps


  • 10

    Sciatic nerve


  • 11

    Profunda femoris vessels


  • 12

    Adductor magnus


  • 13

    Opening in adductor magnus


  • 14

    Semimembranosus


  • 15

    Semitendinosus


  • 16

    Gracilis


  • 17

    Sartorius


  • 18

    Great saphenous vein


  • 19

    Saphenous nerve


  • 20

    Femoral vessels














  • The muscles commonly called the hamstrings span both the hip and knee joints: they arise from the ischial tuberosity and run to the upper end of the tibia and fibula, and consist of semitendinosus, semimembranosus, and the long head of biceps. The short head of biceps is not a hamstring, since although it joins the long head it arises from the back of the femur and hence does not span the hip joint. Semitendinosus is named from the long tendon at its lower end. Semimembranosus is named from the broad tendinous origin at its upper end.


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Aug 10, 2019 | Posted by in ORTHOPEDIC | Comments Off on Thigh, Knee and Leg
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