2. INTRODUCTION
Part of lower limb which
lies between the hip and
knee joints.
Upper limit formed:
Inguinal Ligament.
Lower: knee joint
Single bone in thigh :
Femur
4. INTERMUSCULAR SEPTUM
Extension of deep fascial :
1) Medial Intermuscular Septum: passes from deep fascia to
medial lip of linea aspera.
It separates anterior & medial compartment.
2) Lateral intermuscular septum: passes deep fascia to
lateral lip of linea aspera.
It separates anterior & posterior compartment.
3) Posterior intermuscular septum: passes deep fascia to
medial lip to medial lip linea aspera.
It separates medial & posterior compartment.
7. The anterior compartment of the thigh is
homologous to the posterior compartment of the
arm.
The posterior compartment of the thigh is
homologous to the anterior compartment of the
arm.
8. Surface landmarks
Iliac crest
Anterior superior iliac
spine
Tubercle of the iliac
crest
Fold of groin
Pubic tubercle
Greater trochanter
Mid inguinal point
Patella
Tibial tuberosity
Ligamentum patellae
Adductor tubercle
9.
10.
11.
12. Dissectional Steps:
FRONT OF THIGH
1. Make curved incision from ASIS to pubic
tubercle.
2. Give a curve incision around scrotum
towards upper medial side of leg
3. Extend it vertically down below the
medial condyle of tibia till tibial
tuberosity.
4. Make a horizontal incision below the tibial
tuberosity till lateral side of leg.
Reflect the skin laterally, exposing the
superficial fatty & deeper membranous
layers of superficial fascia.
13. Important structures in Front of thigh:
Cutaneous nerves & superficial veins
Inguinal ligament
Spermatic cord
Saphenous opening
Cribiform fascia
Superficial fascia
Deep fascia/ Fascia lata
Iliotibial tract
Intermuscular septa
Femoral triangle
Adductor canal
14. Superficial fascia
2 layers
These layers are continuous with corresponding layer of anterior abdominal
wall
These 2 layers are most distinct in uppermost part of thigh, near the groin
region , where the cutaneous nerves, vessels and lymphatic nodes lie
between two layers.
Superficial fatty layer
Deep membranous layer
15. Cutaneous nerves :
The skin of front of thigh is supplied by :
• Ilioinguinal nerve (L1)
• Femoral branch of genitofemoral nerve
(L1, L2)
• Lateral cutaneous nerve of thigh(L2,L3)
• Intermediate cutaneous nerve of thigh
(L2,L3)
• Medial cutaneous nerve of thigh (L2, L3)
• Saphenous nerve(L3,L4)
16. Great/Long Saphenous
Vein
Largest & longest superficial vein
Saphes means easily seen
Begins:
Dorsum of foot from medial end of
dorsum venous arch,
Runs upward in front of medial
malleolus along medial side of leg,
behind knee.
In thigh, it inclines forward to reach
saphenous opening where it pierece
cribriform fascia & drains in femoral
vein.
17. Deep Fascia/ Fascia Lata
Tough fibrous sheath envelops the whole of the
thigh like a sleeve.
Features:
Lateral part: thick & form iliotibial tract
Medial part: covers adductor magnus
Around knee: thick & receives expansion from
laterally: biceps femoris
Medially: sartorius
Anteriorly: quadriceps femoris
18.
19. Attachments:
Above:
Laterally: outer lip of iliac crest
Anterior: inguinal ligament, pubic tubercle, pubic crest,
pubic symphysis
Posterior: sacrotuberous ligament, coccyx, sacrum & pubic
arch.
Below : All bony prominences around knee
Condyles of femur & tibia.
Head of fibula
Margin of patella.
Posteriorly : fascial roof of popliteal fossa
Below the knee: deep fascia of leg.
20. SPECIALIZED COMPONENT OF DEEP FASCIA
SAPHENOUS OPENING: oval gap in fascia
lata a little below & lateral to pubic
tubercle
Cribriform fascia: thinner part below
pubic tubercle
Iliotibial tract: thickened lateral part
Intermuscular septa
21. Ilio tibial tract
Condensed deep fascia of thigh or fascia lata on
lateral side forms a 5cm band.
Attachments :
Above: at the junction of upper 1/3rd &lower 2/3rd of
thigh, it splits into two layers
Superficial layer attached to anterior 5cm of outer lip
of iliac crest.
Deep layer blend with fibrous capsule of hip joint.
Below: attached to oval facet on anterior surface of
lateral condyle of tibia.
22.
23. IMPORTANCE
2 muscle are inserted:
1) 3/4th part of Gluteus maximus
2) Tensor fascia latae
Stabilizes the knee both in
extension & partial flexion
It is used constantly during
walking & running
Tract is main support of knee
against gravity.
24. FEMORAL TRIANGLE
It is a triangular depression
on front of upper 1/3rd of
thigh immediately below
the inguinal ring.
The apex of triangle is
directed downward formed
by point where medial &
lateral boundaries cross.
The apex is continuous
below with adductor canal.
29. FEMORAL SHEATH
Funnel shaped sleeve of fascia enclosing the
upper 3-4cm of femoral vessels.
Sheath formed by
downward extension 2 layer of fascia of abdomen.
Inferiorly sheath merges with connective tissue
around femoral vessels.
Asymmetrical : lateral wall vertical
medial wall oblique
Anterior
(Fascia transversalis)
Posterior
(fascia iliaca)
30. Compartment of sheath
Sheath divided into 3
compartments by
septa
Lateral/arterial:
contains F.A &
femoral branch of
genitofemoral nerve
Intermediate/ venous
Medial/ lymphatics:
smallest of all &
known as femoral
canal.
31. FEMORAL CANAL
Medial compartment of femoral sheath
Conical in shape, being wide above or at base and
narrow below.
1.5cm long, 1.5cm wide at base.
Base or upper end is called femoral ring.
Boundaries of femoral ring:
anterior: inguinal ligament
Posterior: pectineus & its covering fascia
Medially: lacunar ligament
Laterally: septum separating from femoral vein.
Contains: lymph node Rosenmuller, lymphatics &
small amount areolar tissue.
32. Adductor canal
also called the subsartorial canal or
Hunter’s canal.
The adductor canal is an
intermuscular space situated on the
medial side of the middle one-third
of the thigh
The canal extends from the apex of
the femoral triangle, above; to the
tendinous opening in the adductor
magnus, below
The canal is triangular on cross-
section
15cm in length.
34. CONTENTS:
From lateral to medial:
Nerve to vastus medialis
Saphenous nerve
Femoral vein
Femoral artery
Posterior division of obturator nerve
35. Muscle of front of thigh
Anterior muscle Medial muscle
1. Iliacus
2. Psoas major
3. Tensor fascia lata
4. Sartorius
5. Quadriceps femoris
• Rectus femoris
• Vastus medialis
• Vastus intermedius
• Vastus lateralis
6. Articular genu
1. Gracilis
2. Pectineus
3. Adductor longus
4. Adductor brevis
5. Adductor part of Adductor
magnus
36.
37.
38.
39. Iliacus
Origin:
Iliac fossa
Inner lip of iliac crest
Iliolumbar ligament
Lateral part of upper surface of
sacrum.
Insertion:
Lesser trochanter of femur
Nerve supply: Femoral nerve
Action: flexion of thigh
40. Psoas major
Origin:
Anterior surface of transverse process
lumbar vertebrae
There are 5 slips:
highest b/w T12& L1;
Lowest b/w L4& L5
Insertion:
Lesser trochanter of femur
Nerve : branches of ventral rami of spinal
nerves L1, L2& L3
Action:
Flexion of thigh
Flexion of lumbar part vertebral column
41.
42. Tensor fasciae latae
Origin
Anterior part of outer lip of iliac crest
Outer aspect of anterior superior iliac
spine
Insertion:
Upper end of Iliotibial tract
Nerve : superior gluteal nerve(L4,L5,S1)
Action:
Helps in maintain erect posture by
stabilizing pelvis on head of femur, &
femur on tibia
Extension of leg
43. Sartorius
Origin
Anterior superior iliac spine
Small area below spine
Insertion:
Upper end of tibia on a vertical
line on upper part of medial
surface.
Nerve: Femoral nerve (L2,L3)
Action:
Flexion of leg
Flexion of thig
Lateral rotation of thigh
45. Rectus femoris
Origin:
Tendinous origin from hip bone
by 2 heads
Straight head: from ant.inferior
iliac crest
Reflected head: from ilium just
above acetabulum
Insertion: upper border of patella
47. Vastus intermedius
Origin:
Shaft of femur from
anterior& lateral
surface.
Insertion:
Deep to rectus femoris
i.e. upper boder of
patella
48. Vastus lateralis
Origin:
Upper end of trochanteric line
Anterior border of greater trochanter
Lower boder of greater trochanter
Lateral margin of gluteal tuberosity
Lateral lip linea aspera
Insertion:
Lateral border of patella
49. Insertion of quadriceps femoris:
All 4 parts inserted into
patella
Patella transmit pull
Ligamentum patellae
tibial tuberosity.
50. Nerve supply: Femoral nerve (L2,L3,L4)
Actions of quadriceps femoris:
Muscle strengthens the lower extremity at
knee.
Vastus medialis prevents lateral
displacement of patella.
51. Articular Genu
Origin:
Anterior surface of lower part of
shaft of femur below origin of
vastus intermedius
Insertion:
Synovial membrane of knee joint.
Action:
Pull the synovial membrane of
knee joint during its extension.
Nerve: femoral nerve
53. FEMORAL VEIN
Begins as upward
continuation Popliteal vein
at lower end of adductor
canal & ends by becoming
continues with external iliac
behind inguinal ligament.
Tributaries it receives:
Great saphenous vein
Veins accompanying deep
branches of femoral artery
i.e. profunda, deep external
pudenal & muscular,
56. Dissection Steps
Identify adductor longus which forma medial
boundary of femoral triangle.
Cut this muscle 3cm below its origin &reflect
distal part laterally.
Lateral to adductor longus is pectineus muscle.cut
to its origin & reflect laterally.
Deeper to these, Adductor brevis & divide close to
its origin.
Deepest muscle comprise the adductor magnus.
Lyling vertically along medial side is Gracilis.
57.
58. Gracilis
Origin
Medial margin of lower half of body
of pubis
Inf ramus pubis
Adjoining part of ramus of ischium.
Insertion:
Upper part medial surface of tibia
Nerve: obturator nerve(l2,l3)
Action
Flexion of leg
Medial rotation & adduction thigh.
59. PECTINEUS
Origin:
Superior ramus pubis
Insertion:
Posterior aspect on femur
on a line passing from
lesser trochanter to linea
aspera
Nerve:
Femoral & obturator
Action:
Adduction& flexion thigh
60. ADDUCTOR LONGUS
Origin:
Front of body of pevis
Insertion:
Posterior aspect of middle 1/3rd of
shaft of femur into linea aspera
b/w insertion of vastus medialis &
adductor brevis and magnus.
Nerve:
Ant. Division of Obturator nerve.
Action:
Adduction & flexion thigh.
61. ADDUCTOR BREVIS
Origin:
Lower part of body of pubis
Inferior ramus pubis.
Insertion:
Line extending from lesser
trochanter to linea aspera
Upper part linea aspera
Nerve: obturator nerve
Action: adduction & flexion
thigh.
62. Adductor magnus
Adductor part: Hamstring part:
Origin: ramus of ischium
Lower part inferior
ramus pubis
Origin: Inferior & lateral
part of ischial tuberosity
Insertion: medial margin
of gluteal tuberosity
• Linea aspera
• Medial condylar ridge
Insertion: adductor
tubercle on medial
condyle of femur
Nerve: obturator nerve Nerve: sciatic nerve
85. Medial compartment muscle
(superficial to deep)
Superficial layer
Lateral to medial
1.Pectineus
2.Adductor longus
3.Gracilis
Intermediate layer
• Adductor brevis
Deep layer
Adductor magnus
86.
87.
88.
89.
90.
91.
92.
93.
94.
95. Back of thigh & popliteal fossa
Region on post aspect of thigh
that extends from lower border
of gluteus maximum to upper
limit of popliteal fossa, vessels
& nerves of back of thigh
Continues down from gluteal
region
In lower 1/3rd thigh
Quadrilateral depression
Popliteal fossa
96. Content back of thigh
MUSCLES:
HAMSTRING : Semitendinsous
semimembranosus
long head Biceps femoris
Short head of Biceps femoris
Hamstring part of Adductor Magnus
Nerves:
Sciatic nerve
Posterior cutaneous nerve of thigh
The tibial nerve runs downwards
superficial to popliteal vein
Vessels
Popliteal artery
Popliteal vein
97. Dissection steps
A transverse incision on
back of thigh at
junction of upper2/3rd
& lower1/3rd.
A transverse incision on
back of leg at junction
of upper 1/4th & lower
3/4th
A vertical incision
joining the mid points
of two transverse
incisions.
100. Muscles of back of thigh:
Upper part of thigh:
From medial to lateral(superficial)
Semitendinosus
Long head of biceps femoris
In deep layer
Semimembranosus
hamstring part of Adductor
magnus
Lower part of thigh
Gastrocnemius: medial& lateral
Plantaris (lateral side)
101. Common origin of hamstring muscle:
ischial tuberosity.
Insertion:
Semitendinosus: upper part
medial surface tibia
Semimembranosus: medial
condyl tibia
Long head of biceps femoris:
both heads in common tendon
attached to head of fibula.
103. Nerve supply of hamstring:
Tibial part of sciatic
nerve(L4,5,S1,2,3)
ACTION
FLEXION OF LEG AT KNEE JOINT
Medial rotator of legin semiflxed knee.
104. Biceps femoris
Origin:
Short head: linea aspera of
femur
Long head: ischial tuberosity
Insertion:
Head of fibula
Nerve innervation:
Long head: tibial part of sciatic
nerve
Short head: peroneal part of
sciatic nerve
105. Adductor magnus
Hybrid muscle bcz double nerve
supply.
Origin:
Hamstring part: ischial tuberosity
larteral part
Adductor part : ramus of ischium
& inf. Ramus pubis.
Insertion:
Adductor part: gluteal tuberosity&
linea aspera
Hamstring part: adductor tubercle
of femur
106.
107. Sciatic nerve relation
In gluteal region : enters through greater sciatic
foramen below piriformis.
In thigh: enters in back of thigh at lower border of
gluteus maximus.
It runs vertically downwards till popliteal fossa at
junction of upper 2/3rd & lower1/3rd of thigh
where it terminates into tibial & common
perinoeal
Relations:
Superficial: cross by long head biceps femoris
Deep: adductor magnus
Medial semimembranosus & semitendinosus.
Lateral: biceps femoris
108.
109. Arteries of back
Terminal branches
profunda femoris
Deep branch
femoral artery
111. Popliteal fossa
Popliteal in latin Hamstring
of knee.
Shallow diamond shaped
depression felt best at back
of knee joint, when knee is
semi flexed.
Correspond to cubital fossa
of fore arm.
112. Shape: diamond / rhomboid shape
Importance:
Provides passage for main vessels & nerves
from thigh to leg.
Boundaries:
Above:
medial: semitendinosus & semimembranosus
lateral: biceps femoris
Below:
medial: medial head gastrocnemius
lateral: lateral head of gastrocnemius &
plantaris
113. Roof:
skin & subcutaneous tissue
superficial fascia: contains
1. short saphenous vein
2. three cutaneous nerve:
post cut. Nerve thigh
post. Division of medial cut. Nerve thigh
sural communicating branches
Deep fascia or popliteal fascia.
Floor:
1. Popliteal surface of femur
2. Capsule of knee joint
3. Strong popliteal fascia.
114. CONTENTS
1. The popliteal artery and its branches
2. The popliteal vein and its tributaries
3. The tibial nerve and its branches
4. The common peroneal nerve and its
branches
5. The posterior cutaneous nerve of the
thigh
6. The genicular branch of the obturator
nerve
7. The popliteal lymph nodes
8. Fat: Surrounds and supports all the
above structures
119. Popliteal vein
Begins at lower border of
popliteus
Union of Ant. &Post. Tibial
vein
It receives:
Small saphenous vein
Corresponding to popliteal
artery
