Transcript 18-Medial side of thigh.ppt

Prof. Saeed Abuel Makarem
CUTANEOUS INNERVATION
UPPER PART:
 Ilioinguinal
nerve
 MIDDLE PART:
 Anterior division
of obturator
nerve
 LOWER PART:
 Posterior branch
of medial
cutaneous nerve
of thigh
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Prof. Saeed Abuel Makarem
CONTENTS
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Prof. Saeed Abuel Makarem
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MUSCLES:
Adductor longus
Adductor brevis
Adductor magnus
(pubic or
adductor part)
Gracilis
Obturator
externus
NERVE:
Obturator
VESSELS:
Obturator &
Profunda femoris
ADDUCTORS OF HIP JOINT
ORIGINS
Adductor longus:
body of pubis (below
pubic tubercle)
 Adductor brevis:
 Body of pubis +
inferior pubic ramus
 Gracilis:
 Inferior pubic ramus
& ischial ramus.
 Adductor magnus:
Inferior pubic ramus
+ ischial ramus.
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Prof. Saeed Abuel Makarem
ADDUCTORS OF HIP JOINT
INSERTION
 Adductors
Longus
 Brevis
 Magnus): Into the
linea aspera
 Gracilis:
 Upper part of
medial surface of
tibia (behind
sartorius), (SGS)
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Prof. Saeed Abuel Makarem
ADDUCTORS OF HIP JOINT
NERVE SUPPLY
ALL ADDUCTORS
ARE SUPPLIED
BY Anterior division
of the obturator
nerve
 EXCEPT
 Pubic part of
ADDUCTOR
MAGNUS By the
posterior division of
the obturator nerve.
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Prof. Saeed Abuel Makarem
OBTURATOR EXTERNUS
Origin:
 Outer margin of
obturator foramen &
outer surface of
obturator membrane
 Insertion:
 Trochanteric fossa
 Nerve supply:
 Posterior division of
obturator nerve
 Action:
 Lateral rotation of
hip joint
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Prof. Saeed Abuel Makarem
OBTURATOR NERVE
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Prof. Saeed Abuel Makarem
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Origin:
Branch of lumbar plexus,
From anterior division of
ventral rami of L2,3,4
Course & relations:
It passes medial to psoas
major
It descends behind common
iliac & lateral to internal
iliac vessels
It passes through obturator
canal, above obturator
vessels, to reach the thigh
In the thigh, it divides into
anterior (between adductor
longus & brevis) and
posterior (between adductor
brevis & magnus) divisions.
OBTURATOR NERVE
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Prof. Saeed Abuel Makarem
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Branches:
From anterior division:
Muscular to:
adductor longus,
adductor brevis &
gracilis
Articular to: hip joint
Cutaneous to: middle part of
thigh
From posterior division:
Muscular to:
adductor portion of
adductor magnus,
obturator externus
Articular to: knee joint
OBTURATOR ARTERY
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Prof. Saeed Abuel Makarem
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Origin: branch of
anterior division of
internal iliac artery.
Course & relations:
It passes through the
obturator canal.
In the thigh, it divides
into medial & lateral
branches running along
the outer surface of
obturator membrane,
deep to obturator
externus.
Branches:
Muscular to: adductors &
obturator externus.
Articular to: hip joint.
ADDUCTOR (SUBSARTORIAL) CANAL
Prof. Saeed Abuel Makarem
ADDUCTOR (HUNTER’S) CANAL
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Prof. Saeed Abuel Makarem
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Structure:
an intermuscular tunnel
Site:
in middle third of thigh
Extension:
Upper end:
Apex of the femoral triangle
Lower end:
Opening of the adductor
magnus
Boundaries:
Antero-lateral wall:
vastus medialis
Posterior wall (floor): adductor
longus & magnus
Antero-medial wall (roof):
fascia stretching from anterolateral to posterior wall. The
roof is covered by sartorius.
ADDUCTOR (SUBSARTORIAL) CANAL
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Prof. Saeed Abuel Makarem
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Contents:
Femoral artery:
crosses the whole canal
& gives a branch
(descending genicular) to
the knee joint
Femoral vein:
crosses the whole canal,
at first postero-lateral
then posterior to the
artery (from below
upward).
Saphenous nerve: crosses
in front of the artery
then pierces the fibrous
roof near the lower end
of the canal.
Nerve to vastus medialis:
descends lateral to the
artery & leaves the canal
at its middle, to supply
vastus medialis.