Definition

Inguinal ligament

It is the inverted triangular depression in

the upper 1/3 of the front of the thigh

Boundaries

Base; directed upwards, formed by the

inguinal ligament
Medial border; medial border of
adductor longus muscle
Femoral
Lateral border; medial border of triangle
sartorius muscle
Apex; directed downwards, formed by
meeting of sartorius and adductor Adductor
canal
longus
[N.B.] The apex is continuous below
with the adductor canal.

Medial border of Medial border of

sartorius muscle adductor longus muscle
Floor; formed from medial to lateral by;
● Adductor longus
● Pectineus
● Psoas major
● Iliacus
Psoas major
Iliacus

Adductor longus

Pectineus

[N.B.] Iliacus and psoas major together

form “iliopsoas muscle”.
Roof; formed by;
1) Skin
2) Superficial fascia; containing
a) Veins; upper part of the great saphenous
vein and its tributaries
b) Arteries; the 3 superficial inguinal
branches of the femoral artery
● Superficial circumflex iliac A
● Superficial epigastric A
Lateral
● Superficial external pudendal A cutaneous
Femoral branch
nerve of thigh
of genitofemoral
c) Cutaneous nerves; nerve

● Femoral branch of genitofemoral nerve

● Lateral cutaneous nerve of thigh

d) Superficial inguinal lymph nodes;

● Vertical group; along great saphenous
vein
● Horizontal group; below and parallel
to inguinal ligament
 Horizontal group of superficial Superficial circumflex Superficial Superficial external
inguinal lymph nodes iliac vessels epigastric vessels pudendal vessels

Lateral
cutaneous
nerve of thigh

Vertical group of superficial

inguinal lymph nodes
Great (long)
saphenous vein Femoral branch of Saphenous
Great (long) opening
genitofemoral
saphenous vein
nerve
Roof; (continue)
3) Deep fascia; part of fascia lata, showing the
saphenous opening 3 cm below and lateral
to the pubic tubercle
Fascia lata

Contents Saphenous
opening
Pubic
tubercle
1) Femoral sheath; funnel-shaped fascial sheath
surrounding the upper 3-4 cm of the femoral
vessels
2) One group of lymph nodes; deep inguinal
lymph nodes, along medial side of femoral Lateral cutaneous
nerve of thigh
vein
Femoral
Femoral nerve
sheath
3) Two groups of vessels;
Femoral artery; and all its branches except the Femoral
vein
descending genicular artery
Femoral vein; medial to femoral artery Femoral
artery
4) Three nerves;
Femoral nerve; lateral to femoral artery,
outside the femoral sheath
Femoral branch of genitofemoral nerve
Lateral cutaneous nerve of thigh
Anterior superior
iliac spine
Inguinal ligament

Sartorius muscle

Femoral nerve Pubic tubercle

Symphysis pubis
Femoral artery

Femoral vein Adductor longus

Deep inguinal
lymph nodes
Definition

It is the funnel-shaped sheath formed by Fascia transversalis

downward extension of fascia from the
lower abdomen into the thigh, surrounding
Fascia iliaca
the upper 3-4 cm of the femoral vessels

Formation

Anterior wall; formed by downward

extension of fascia transversalis that lines
the anterior abdominal wall
Posterior wall; formed by downward
extension of fascia iliaca that lines the
posterior abdominal wall
Transversus abdominis muscle
Fascia transversalis
 Fascia transversalis

Extraperitoneal fatty tissue

Parietal peritoneum

Anterior wall of femoral sheath

Cribriform fascia

Lacunar ligament Fascia iliaca

Inguinal ligament
Lateral cutaneous nerve of thigh

Inguinal ligament
Femoral branches of
genitofemoral nerve

Lacunar ligament
 Fascia
transversalis

Fascia iliaca

Beginning of
formation of
femoral sheath
Compartments

The sheath is divided by 2 antero-posterior

septa into 3 compartments:
Lateral compartment; contains the
femoral artery and the femoral branch of
the genitofemoral nerve
Intermediate compartment; contains the
femoral vein
Medial compartment; the shortest
compartment, which forms the “femoral
canal”, which contains;
● Semiliquid fat
● Afferent lymph vessels from the deep
inguinal lymph nodes to external iliac
lymph nodes
● One deep inguinal lymph node called
“lymph node of Cloquet or of
Rosenmuller” (this lymph node
drains glans penis in males or glans
clitoris in females)
What do you think about the importance of the femoral sheath?
Definition

It is the medial and shortest compartment of

the femoral sheath, about 1.5 cm long

Important relations

Anteriorly; medial part of the saphenous

opening and cribriform fascia
Posteriorly; fascia covering pectineus muscle

Pectineus
muscle and its
covering fascia Saphenous
opening
Boundaries

It is conical in shape, having an apex, a base,

anterior wall and posterior wall.
Anterior wall; formed by fascia transversalis
Posterior wall; formed by fascia iliaca
Apex; directed downwards, formed by fusion
of its walls opposite lower end of the
saphenous opening
Base; directed upwards, where it opens into
the abdominal cavity by the “femoral
ring”.

Femoral canal
and femoral
ring
 Boundaries of the femoral ring:
Inguinal ligament
Femoral ring Anteriorly; inguinal ligament
Femoral vein Posteriorly; pectineal line and pectineal
Femoral artery ligament
Laterally; femoral vein and medial
Lacunar ligament septum of femoral sheath
Medially; crescentic base of the lacunar
ligament

Inguinal ligament

Iliacus muscle Lacunar ligament

Psoas major muscle

Pectineus muscle

The ring is closed by a

condensation of extra-
peritoneal fat called
“femoral septum”.
Pectineal line of Pectineal ligament
superior pubic ramus (lateral extension of
base of lacumar
ligament)
 Femoral
nerve, artery
& vein
Fascia
iliaca

Inguinal
ligament

Femoral canal

Femoral ring

Lacunar ligament

Fascia lata

Deep inguinal lymph node

Femoral sheath

Saphenous opening
Contents of the femoral canal

1) Semiliquid fat
2) Afferent lymph vessels from the deep inguinal lymph nodes to external iliac lymph nodes
3) One deep inguinal lymph node called “lymph node of Cloquet or of Rosenmuller” (this lymph
node drains glans penis in males or glans clitoris in females)

Deep inguinal lymph node

Clinical importance of the femoral canal

1) It provides a dead space that allows distension of the femoral vein during muscular exercise
2) It provides a pathway for the afferent lymph vessels from the lower limb to pelvis and abdomen
3) It may allow the passage of a femoral hernia

Definition of a hernia; it is the protrusion of a

mobile viscus (as loop of intestine) through a
defect in the wall of the cavity in which it is
contained

Definition of femoral hernia; it is the protrusion

of a peritoneal pouch through the femoral ring
and canal into the upper part of the thigh
(femoral triangle)

Frequency; more in females due to their wider

femoral ring (wider pelvis) and smaller femoral
vessels
Formation of femoral hernia; it is formed
by protrusion of a pouch of peritoneum
containing a loop of intestine or an
omentum, through the femoral ring and
canal
Coverings of femoral hernia; from inside outwards;
1) Femoral septum (extraperitoneal tissue)
2) Fascia transversalis (ant wall of femoral sheath)
3) Cribriform fascia (roof of saphenous opening)
4) Superficial fascia and skin

Transversus abdominis muscle

Internal oblique muscle

External oblique aponeurosis

Membranous layer of superficial fascia

Spermatic cord

Cribriform fascia Membranous layer of

superficial fascia
Fascia
transversalis Pectineal ligament
Extraperitoneal fat

Peritoneum Superior
pubic ramus

Pectineus muscle

Fascia lata
Membranous layer of
superficial fascia
Direction of femoral hernia; it takes a U-shaped course as follows:
First; downwards through the femoral ring into the femoral canal
Then; forwards through the saphenous opening, pushing cribriform fascia
Finally; upwards and laterally in the superficial fascia below the inguinal
ligament towards the anterior superior iliac spine
[N.B.] Femoral hernia never moves downwards due to adhesion of the membranous layer of
superficial fascia with fascia lata opposite the lower part of the rim of the saphenous opening

Membranous layer of
superficial fascia of
abdomen

Fascia lata (deep fascia

of the thigh)
Clinically important points about femoral hernia

1) The neck of the femoral hernia lies below and lateral to the pubic tubercle, while that of the
inguinal hernia lies above and medial to the pubic tubercle
2) Manual reduction of the femoral hernia into the abdomen should be performed by pushing it in
the reverse direction of its descent
3) Surgical reduction of the femoral hernia usually requires division of the lacunar ligament, and
this may result in injury of an abnormal obturator artery that crosses the femoral ring and
lacunar ligament in about 30% of people, causing severe hemorrhage

Inferior epigastric
artery

Abnormal obturator
artery

Lacunar ligament
Obturator artery
 Organization of adductors of the thigh

They lie between the medial and posterior

inter-muscular septa of the thigh
They are arranged in 3 layers:
Superficial layer; includes gracilis,
adductor longus and pectineus Pectineus
Middle layer; includes adductor brevis
Deep layer; includes adductor magnus Adductor
longus
Posterior inter-
Adductor
muscular
compartment Gracilis
septum

Medial inter-
muscular Adductor
septum brevis

Adductor
magnus
 Gracilis Muscle

It is the most medial muscle of the thigh

Origin; from the anterior surface of body of
pubis close to symphysis pubis, and from the
adjoining part of the inferior pubic ramus
Insertion; into the upper part of medial surface Origin of
of tibia, between insertions of sartorius and gracilis from
semitendinosus (pes anserinus) outer surface of
body of pubis
and inferior
Nerve supply; from the anterior division of the
pubic ramus
obturator nerve
Gracilis
Action;
1) Adduction of thigh (hip joint)
2) Flexion and medial rotation of leg (knee
joint)
3) Together with sartorius & semitendinosus,
it helps to steady the pelvis on the femur
and tibia (guy robes)
Insertion of
sartorius Insertion
of gracilis
Insertion of
semitendinosus
 Pectineus Muscle

Pectineus
Origin; from the pectineal line and
pectineal surface of the superior pubic
ramus
Insertion; into the upper part of the
pectineal line of femur (the line Origin of
extending from the lesser trochanter to pectineus from
pectineal line of
the linea aspera) the superior
pubic ramus
Nerve supply; from the main trunk of the
femoral nerve, and occasionally
receives and additional branch from
the anterior division of the obturator
nerve or from the accessory obturator Insertion of
nerve if present pectineus
into
Action; pectineal
line of femur
1) Adduction of thigh (hip joint)
2) Flexion of thigh (hip joint)
 Pubic tubercle

Adductor Longus Muscle

Origin; by a rounded tendon from the

outer surface of body of pubis,
below the pubic tubercle
Insertion; into the linea aspera of
femur (in the middle 1/3 of back of
femur) Origin of
adductor longus
Nerve supply; from the anterior from outer
surface of body
division of the obturator nerve of pubis, below
pubic tubercle
Action; adduction and medial rotation
of thigh (hip joint)

Insertion of
Rider’s or cavalry bone; bone adductor Adductor
longus into
deposition within the upper part of linea aspera
longus
adductor longus muscle due to
repeated injury in horseback riders
caused by pressure against the
saddle (a form of traumatic myositis
ossificans)
 Outline of
adductor longus
muscle
Important relations of adductor longus muscle;
Superficial circumflex
1) It forms the medial boundary and shares in the iliac artery Superficial
floor of the femoral triangle epigastric artery
2) It shares in the formation of the floor of the Femoral Superficial external
artery
adductor canal pudendal artery
Medial
3) It separates the femoral artery in front of it circumflex Profunda
from the profunda femoris artery behind it femoral artery femoris
artery

Ascending branch
of lateral
circmflex femoral
artery
Transverse branch of lateral
circmflex femoral artery
Descending branch
of lateral circmflex
femoral artery
Adductor
longus

Perforating branches Femoral

Adductor
of profunda femoris artery
longus
artery
 Adductor Brevis Muscle

Origin; from the outer surface of body

of pubis and inferior pubic ramus,
just lateral to origin of gracilis
Insertion; into the lower part of
pectineal line of femur, and upper
part of linea aspera Origin of Adductor
adductor brevis brevis
Nerve supply; from the anterior and from outer
surface of body
posterior divisions of the obturator of pubis, below
nerve origin of
adductor longus
Action; adduction and medial rotation
of thigh (hip joint) Insertion of
adductor
brevis into
[N.B.] Adductor brevis muscle linea aspera
separates the anterior and posterior Adductor
divisions of the obturator nerve. brevis
 Adductor Anterior and
brevis muscle posterior branches
of obturator nerve
 Adductor Magnus Muscle

It has double origin, double insertion, double nerve supply and double action.
Origin;
Pubic (adductor) part; from outer surface of the ischio-pubic ramus
Ischial (hamstring) part; from lateral part of the lower triangular area of the ischial tuberosity

Origin of ischial part of

adductor magnus from
lateral part of the lower
triangular area of the
Origin of pubic part ischial tuberosity
of adductor magnus
from outer surface of
the ischio-pubic
ramus
Insertion;
Pubic (adductor) part; inserts into
medial margin of gluteal tuberosity,
medial lip of linea aspera, and
medial supra-condylar line
Ischial (hamstring) part; its fibers Insertion of
adductor magnus
descend vertically to insert into into medial lip of
adductor tubercle of femur gluteal tuberosity

Adductor
Nerve supply; Insertion of
brevis
adductor magnus
Pubic (adductor) part; from posterior into medial lip of
linea aspera
division of obturator nerve Pubic part of
Ischial (hamstring) part; from tibial adductor
part of sciatic nerve magnus

Insertion of
Action; adductor magnus
into medial
Pubic (adductor) part; adduction and supracondylar
line
medial rotation of the thigh (hip Ischial part of
adductor
joint) magnus
Ischial (hamstring) part; extension of
the thigh (hip joint)
 Important relations of adductor
magnus muscle

1) There is a gap between the insertions

of the pubic and ischial parts of the
muscle, called “adductor hiatus”,
which allows passage of femoral
vessels into the popliteal fossa to
become popliteal vessels Sciatic
nerve

2) It forms the floor of the adductor canal

3) Its insertion close to the linea aspera is
Perforating
perforated by the perforating branches branches of
of profunda femoris artery profunda
femoris
artery

Femoral artery
becoming
Adductor popliteal artery
canal at adductor
hiatus
Adductor
magnus
It is the nerve of the medial (adductor) compartment of
the thigh
Origin: it arises in the abdomen from the posterior
divisions of the ventral primary rami of L2, 3 and 4 of
the lumbar plexus
Course and relations:
A) In the pelvis;
• It appears at the medial margin of psoas major muscle
• It descends on the ala of sacrum, then on the sidewall
of the pelvis, accompanying the obturator vessels

Psoas major
muscle

Obturator
nerve
Obturator
artery
B) In the thigh;
• It leaves the pelvis by passing
through the obturator canal to reach
the medial compartment of the thigh
• It ends soon by dividing into anterior
and posterior divisions; Articular
Anterior division; passes in front of branch to hip
joint Adductor
obturator externus, then descends longus M
between adductor longus and Obturator (cut)
adductor brevis externus M
Anterior
Posterior division; passes through Adductor division of
obturator externus, then descends brevis M obturator nerve
between adductor adductor brevis
and adductor magnus Adductor
Gracilis M
longus M (cut)

Posterior Adductor
division of magnus M
obturator nerve
Branches:
A) Branches of the anterior division;
• Articular branch; to hip joint
• Muscular branches; to adductor
longus, adductor brevis and gracilis
(may give a branch to pectineus)
• Cutaneous branch; to a small area of
skin of the medial side of the thigh
above the knee
• Communicating branch; to the sub-
sartorial plexus
B) Branches of the posterior division;
• Articular branch; to knee joint
(passes through the adductor hiatus
to supply the posterior aspect of
capsule of knee joint)
• Muscular branches; to obturator
externus, adductor brevis and pubic
part of adductor magnus
 Accessory Obturator Nerve
• It is found in 30% of people
• It may arise from the
anterior divisions of L2
and L3 or L3 and L4
ventral rami
• It appears at the medial
margin of psoas major, and
descends behind the
obturator nerve
• It crosses over the superior
pubic ramus, where it
gives an articular branch to
hip joint, then passes deep
to pectineus and ends by
supplying it
Accessory
obturator
nerve
Obturator
nerve
 [Subsartorial or Hunter’s canal]

Anterior compartment

Medial compartment

Posterior compartment
Definition

It is the intermuscular tunnel that lies on the medial aspect of the middle 1/3 of the thigh, under
cover of sartorius muscle (connecting femoral triangle above with the popliteal fossa below).

Beginning and termination

● It begins above at the apex of the

femoral triangle.
● It ends below at the adductor hiatus by
opening into the popliteal fossa.

Apex of femoral
triangle

Adductor hiatus
 Boundaries

The canal is triangular in cross section, having 3 walls:

1) Anteromedial wall (roof); formed by sartorius
muscle, resting on a sheet of deep fascia extending
between vastus medialis and adductor magnus
2) Anterolateral wall; formed by vastus medialis
3) Posterior wall (floor); formed by adductor longus
(above) and adductor magnus (below)

Adductor
longus M. Vastus lateralis
M.
Adductor Vastus
magnus M. intermedius M.

Rectus femoris
M.
Sartorius M.

Vastus medialis
M.
Contents

1) Femoral artery; it enters the canal through the

apex of femoral triangle, and leaves it through the
adductor hiatus where it becomes the popliteal
artery (it gives off the descending genicular artery
near the lower end of the canal)
2) Femoral vein
3) Saphenous nerve; it crosses the artery from lateral
to medial, and pierces the roof of the canal near its
lower end to reach the medial side of knee
4) Nerve to vastus medialis
5) Articular branch of the posterior division of the
obturator nerve; leaves the canal through the
adductor hiatus to reach posterior aspect of knee
Adductor hiatus; it is the gap between the pubic
and ischial parts of adductor magnus, allowing
communication of the front of the thigh with
the back of the knee joint, and at which the
femoral vessels become the popliteal vessels