THIGH COMPARTMENTS

Dr. NAGAWA EDITH

BscB, MBchB, MScHA
 DEFINITION
• THIGH-Part of the lower limb between the hip
and knee joint.
• The lower limb rotates medially during
development as a result, the original dorsal or
extensor surface becomes anterior then the
ventral or flexor surface becomes posterior.
 Superficial Fascia of the Thigh

• The fatty layer of the superficial fascia on the

anterior abdominal wall extends into the thigh
and continues down over the lower limb
without interruption.
 Contents of superficial fascia
• Fat of the front of the thigh contains;
 Cutaneous nerves,
 Lymphatic vessels and nodes,
 Termination and tributaries of the great
saphenous vein and
 Cutaneous branches of the femoral artery.
 SUPERFICIAL NERVES
• Cutaneous branches of the lumbar plexus-from first
three lumbar nerves,
• Supply fascialata and skin on the front and medial side
of the thigh,
• They include;
 Ilioinguinal nerve
 Femoral branch of the genito-femoral nerve,
 Medial, intermediate and lateral femoral Cutaneous
nerves
 Anterior branch of obturator nerve.
 Superficial arteries and veins
• 4 branches from
femoral artery
• Superficial circumflex
iliac artery
• Superficial epigastric
artery
• Superficial external
pudendal artery
• Deep external pudendal
artery
 great saphenous vein
• drains the medial end of the dorsal venous arch of the
foot.
• passes upward directly in front of the medial malleolus .
• It then ascends in company with the saphenous nerve in
the superficial fascia over the medial side of the leg.
• passes behind the knee and curves forward around the
medial side of the thigh.
• passes through the lower part of the saphenous opening in
the deep fascia and joins the femoral vein about 1.5 in. (4
cm) below and lateral to the pubic tubercle.
 cont
• it possesses numerous valves
• connected to the small saphenous vein by one or two branches
that pass behind the knee.
• Several perforating veins connect the great saphenous vein with
the deep veins along the medial side of the calf .
• At the saphenous opening in the deep fascia, it usually receives
three tributaries which correspond with the arteries in the region:
• superficial circumflex iliac vein, the superficial epigastric
• vein, and the superficial external pudendal vein.
• An additional vein, known as the accessory vein, usually joins the
main vein about the middle of the thigh or higher up at the
saphenous opening.
 Clinical application
Great Saphenous Vein Cutdown
• Exposure of the great saphenous vein
through a skin incision (a“cutdown”) is
usually performed at the ankle. This
site has the disadvantage that phlebitis
is a potential complication.
• Can also be entered at the groin in the
femoral triangle, where phlebitis is
relatively rare; the larger diameter of
the vein at this site permits the use of
large-diameter catheters and the rapid
infusion of large volumes of fluids.
The Great Saphenous Vein in Coronary
Bypass Surgery
• In patients with occlusive coronary
disease caused by atherosclerosis,the
diseased arterial segment can be
bypassed by inserting a graft consisting
of a portion of the great saphenous
vein
• Varicose Veins
• A varicosed vein is one that has a larger
diameter than normal and is elongated and
tortuous.
• commonly occurs in the superficial veins of
the lower limb.
• many causes, including hereditary weakness
of the vein walls and incompetent valves;
elevated intraabdominal pressure as a result
of multiple pregnancies or abdominal tumors;
and thrombophlebitis of the deep veins.
• Pathophysiology- produced by
 incompetence of a valve in a perforating vein
thus every time the patient exercises, high-
pressure venous blood escapes from the
deep veins into the superficial veins and
produces a varicosity, which might be
localized to begin with but becomes more
extensive later
Lymphnodes and vessels
 Superficial Inguinal Lymph Nodes
• lie in the superficial fascia below the inguinal ligament
• can be divided into a horizontal and a vertical group.
• The horizontal group lies just below and parallel to the inguinal ligament.
• The medial members of the group receive superficial lymph vessels
from the anterior abdominal wall below the level of the umbilicus and
from the perineum.
• The lymph vessels from the urethra, the external genitalia of both sexes
(but not the testes), and the lower half of the anal canal are drained by
this route.
• The lateral members of the group receive superficial lymph vessels from
the back below the level of the iliac crests.
• The vertical group lies along the terminal part of the great saphenous
vein and receives most of the superficial lymph vessels of the lower
limb.
• The efferent lymph vessels from the superficial inguinal nodes pass
through the saphenous opening in the deep fascia and join the deep
 Deep Fascia of the Thigh (Fascia Lata)
• encloses the thigh like a trouser leg.
• its upper end is attached to the pelvis and the inguinal
ligament. (superolaterally attached to inguinal ligament,
posteriorly extends from anterior superior iliac spine along
the external lip of the iliac crest splitting to enclose tensor
fascialata and gluteus maximus. Posterior to G. maximus,its
attached to the sacrum and sacrotuberous ligament.
Medially, the attachment extends along the convexity of the
ischial tuberosity and ischiopubic ramus around the medial
side of the limb to the body of the pubic bone.
• The medial part passes deep to the lateral part over
pectineus, posterior to the femoral sheath and is attached to
the pectineal line of the pubic bone.
 cont
• its lateral aspect is thickened to form the iliotibial tract, which is
attached above to the iliac tubercle and below to the lateral
condyle of the tibia(Gerdy’s tubercle)
• The iliotibial tract receives the insertion of the tensor fasciae latae
and the greater part(3/4) of the gluteus maximus muscle.
• The saphenous opening is a gap in the deep fascia in the front of
the thigh just below the inguinal ligament.
• It transmits the great saphenous vein, some small branches of the
femoral artery, and lymph vessels .
• The saphenous opening is situated about 1.5 in. (4 cm) below and
lateral to the pubic tubercle.
• The falciform margin is the lower lateral border of the opening,
which lies anterior to the femoral vessels .
• The saphenous opening is filled with loose connective tissue called
 TENSOR FASCIAE LATAE
• Arises from a 5cm length of the external lip of the
iliac crest between the anterior superior iliac spine
and the tubercle of the crest.
• Thin sheet of muscle at it origin and becomes
thicker at its insertion into the iliotibial tract.
• Innervated by superior gluteal nerve(L4,5 ,S1)
• Action-pulls upon the iliotibial tract,so assisting
gluteus maximus in extending the knee joint.
• Active in helping to stabilize the pelvis during
walking when it assists gluteus medius and minimus
in resisting adduction at the hip
Fascial Compartments of the Thigh
• divided into three
compartments by three
fascial septae that pass
from the inner aspect of
the deep fascia to the
linea aspera; each having
muscles, nerves, and
arteries.
 Anterior or extensor,
 Medial or adductor,
 Posterior or flexor.
 ANTERIOR FASCIAL COMPARTMENT
• Muscles: Sartorius, iliacus,
psoas, pectineus, and
quadriceps femoris

• Blood supply: Femoral

artery and vein

Innervation: Femoral nerve

Muscle Origin Insertion innervation Action
Sartorius Anterior superior Upper Femoral Draws the lower limb into the
iliac medial Nerve L2, 3 sitting tailor’s position (thigh
spine surface of flexed, laterally rotated and
shaft of tibia abducted, knee flexed)

Iliacus Iliac fossa of hip With psoas Femoral Flexes thigh on

bone into nerve trunk; if thigh is
lesser L2, 3 fixed, it flexes the
trochanter trunk on the thigh
of femur as in sitting up
from lying down
Psoas Transverse With iliacus Lumbar Flexes thigh on
processes, into plexus trunk; if thigh is
bodies, and lesser L1, 2, 3 fixed, it flexes the
intervertebral trochanter trunk on thigh as
discs of the 12th of femur in sitting up from
thoracic and five lying down
lumbar
vertebrae
Pectineus Superior ramus Upper end Femoral Flexes and adducts
of pubis of linea nerve thigh at hip joint
aspera of L2, 3
shaft of
femur
Rectus Straight head: Quadriceps Femoral Extension of leg at
femoris anterior tendon nerve knee joint; flexes
inferior iliac spine into patella, L2, 3, 4 thigh at hip joint
Reflected head: then
ilium via
above ligamentum
acetabulum patellae into
tubercle of
tibia

Vastus Upper part of As above Femoral Extension of leg at

lateralis the nerve knee joint
intertrochanteric L2, 3, 4
line, greater
tronchanter,
lateral lip of the
linea aspera &
lateral
intermuscular
septum.
Vastus Lower part of As above Femoral Extension of leg
medialis intertrochanteric nerve at knee joint;
line & medial lip L2, 3, 4 stabilizes patella
of linear aspera
& from tendon of
adductor magnus
below the hiatus
for the femoral
vessels.

Vastus Anterior and Femoral Extension of leg

intermedius lateral nerve at knee joint;
surfaces of the L2, 3, 4 articularis genus
upper 2/3 of the retracts synovial
shaft of femur. membrane
 Action of Quadriceps Femoris Muscle
(Quadriceps Mechanism)

• The quadriceps femoris muscle is inserted into the patella and, via
the ligamentum patellae, is attached to the tibial tuberosity .
• Together, they provide a powerful extensor of the knee joint.
• Some of the tendinous fibers of the vastus lateralis and vastus
medialis form bands, or retinacula, which join the capsule of the
knee joint and strengthen it.
• The lowest muscle fibers of the vastus medialis are almost horizontal
and prevent the patella from being pulled laterally during contraction
of the quadriceps muscle.
• The tone of the quadriceps muscle greatly strengthens the knee joint.
• The rectus femoris muscle also flexes the hip joint.
THE FEMORAL TRIANGLE
 Femoral triangle
• boundaries
• Laterally- medial border of Sartorius
• Medially – medial border of adductor longus
• superiorly– inguinal ligament
• Floor –gutter shapped , formed by
iliacus,psoas, pectineus and adductor longus
- Roof- skin & Fasciae of thigh
 contents
• Femoral sheath
• Femoral vein and its tributaries
• Femoral artery and its braches
• Terminal part of Femoral nerve and its
branches
• Deep inguinal lymph nodes
 Femoral Sheath
• downward protrusion into the thigh of the fascia lining the
abdominal walls .
• Its anterior wall is continuous above with the fascia
transversalis and its posterior wall with the fascia iliaca.
• it surrounds the femoral vessels and lymphatics for about 1 in.
(2.5 cm) below the inguinal ligament and its adherent to the
walls of the blood vessels except on the medial aspect where
it forms the femoral canal.
• inferiorly blends with the tunica adventitia of these vessels
• Divide into 3 compartments by a fibrous septum;
• the lateral compartment – contains femoral artery as it
enters the thigh
• the intermediate compartment- femoral vein, as it leaves
the thigh,
• medial compartment- The lymph vessels, as they leave the
 The femoral canal
• small space on medial side of the femoral vein.
• It is about 0.5 in. (1.3 cm) long,
• It contains
• Fatty connective tissue,
• all the efferent lymph vessels from the deep inguinal lymph nodes,
and one deep inguinal lymph node of cloquet.
• Its widest at its abdominal end, where its opening(femoral ring) has
four boundaries
 Anteriorly-medial part of inguinal ligament,
 Medially- cresenteric edge of the lacunar ligament
 Posteriorly- pectineal ligament
 Laterally –femoral vein
• It’s a potentially weak area in the abdomen for possible herniation of
abdominal contents (femoral hernia)
• lower end of the canal is normally closed by the adherence of its
 Femoral hernia
• more common in women than in men
• neck of the sac always lies below and lateral
to the pubic tubercle
• differential diagnosis
 inguinal hernia
 Inguinal lymphadenitis
 saphenous varix
 aneurysm of the femoral artery
BLOOD SUPPLY
 Femoral Artery

• enters the thigh from behind the inguinal

ligament(at the mid inguinal point), as a
continuation of the external iliac artery.
• is the main arterial supply to the lower limb.
• It descends almost vertically toward the
adductor tubercle of the femur and ends at
the opening in the adductor magnus muscle
by entering the popliteal space as the
popliteal artery
 Relations
• Anteriorly: In the upper part of its course, it is
superficial and is covered by skin and fascia. In
the lower part of its course, it passes behind
the sartorius muscle.
• Posteriorly: The artery lies on the psoas
major, which separates it from the hip joint
capsule, the pectineus, and the adductor
longus. The femoral vein intervenes between
the artery and the adductor longus.
• Medially: It is related to the femoral vein in
the upper part of its course .
 Branches
• The superficial circumflex iliac artery i- runs up
to the region of the anterior superior iliac spine .
• The superficial epigastric artery -crosses the
inguinal ligament and runs to the region of the
umbilicus.
• The superficial external pudendal artery- runs
medially to supply the skin of the scrotum (or
labium majus).
• The deep external pudendal artery – runs
medially and supplies the skin of the scrotum (or
labium majus).
• The profunda femoris artery
 The profunda femoris artery
• - large and important branch of the femoral artery (chief
artery of the thigh)
• Arises from the lateral side of the femoral artery about 1.5
in. (4 cm) below the inguinal ligament
• It passes medially behind the femoral vessels and enters
the medial fascial compartment
• It ends by becoming the fourth perforating artery.
• At its origin, it gives off the medial and lateral femoral
circumflex arteries, and during its course it gives off three
perforating arteries .
• The descending genicular artery is a small branch that
arises from the femoral artery near its termination
It assists in supplying the knee joint.
VENOUS DRAINAGE
 Femoral vein
• Enters the thigh by passing through the opening in
the adductor magnus as a continuation of the
popliteal vein.
• It ascends through the thigh, lying at first on the
lateral side of the artery, then posterior to it, and
finally on its medial side .
• It leaves the thigh in the intermediate
compartment of the femoral sheath and passes
behind the inguinal ligament to become the
external iliac vein.
 Tributaries
• great saphenous vein and veins that
correspond to the branches of the femoral
artery.
• The superficial circumflex iliac vein, the
superficial epigastric vein, and the external
pudendal veins drain into the great saphenous
vein.
 Deep Inguinal Lymph Nodes
• located beneath the deep
fascia
• lie along the medial side of
the femoral vein;
• receive all the lymph from the
superficial inguinal nodes.
• Also receive lymph from the
deep structures of the lower
limb through the popliteal
nodes.
• the efferent vessels from
these nodes enter the
abdomen by passing through
the femoral canal to lymph
nodes along the external iliac
 NERVE SUPPLY- FEMORAL NERVE
• the largest branch of the lumbar
plexus (L2, 3, and 4).
• It emerges from the lateral border of
the psoas muscle within the
abdomen.
• passes downward in the interval
between the psoas and iliacus lying
behind the fascia iliaca .
• enters the thigh lateral to the
femoral artery and the femoral
sheath, behind the inguinal
ligament , about 1.5 in. (4 cm) below
the inguinal ligament,.
• it terminates by dividing into anterior
and posterior divisions.
• supplies all the muscles of the
anterior compartment of the thigh.
 Branches

• The anterior division

• Gives off two cutaneous and two muscular branches.
• The cutaneous branches are the medial cutaneous nerve
of the thigh and the intermediate cutaneous nerves that
supply the skin of the medial and anterior surfaces of the
thigh, respectively
• The muscular branches supply the sartorius and the
pectineus.
 The posterior division gives off one cutaneous branch,
the saphenous nerve, and muscular branches to the
quadriceps muscle.
 The saphenous nerve
 runs downward and medially and crosses the femoral artery
from its lateral to its medial side .
 It emerges on the medial side of the knee between the
tendons of sartorius and gracilis .
 It then runs down the medial side of the leg in company with
the great saphenous vein.
 It passes in front of the medial malleolus and along the medial
border of the foot, where it terminates in the region of the ball
of the big toe.
 The muscular branch of the rectus femoris also supplies the
hip joint; the branches to the three vasti muscles also supply
the knee joint.
 Femoral nerve injury
• The main trunk of the femoral nerve is not subject to an
entrapment neuropathy, but it may be compressed by
retroperitoneal tumours or retroperitoneal h in patients
on anticoagulants or with a bleeding diathesis.
• A localized lesion of the femoral nerve may occur in
diabetes mellitus (one of the forms of diabetic
amyotrophy).
• Presents with wasting and weakness of quadriceps
femoris, which results in considerable difficulty in walking
and a tendency for the leg to collapse.
• Pain and paraesthesia may occur on the anterior and
medial aspect of the thigh, extending down the medial
aspect of the leg in the distribution of the saphenous
 Femoral nerve injury
• Dancers may stretch the
nerve by prolonged
hyperextension of the
hip
• Compress the nerve
under the inguinal
ligament
• Nerve may also be
compressed due to a
haematoma following a
partial tear of the iliacus
O’Brien, 1997
 ADDUCTOR CANAL
• Also-subsartorial or hunter’s canal
• Intermascular cleft, medial aspect of thigh from apex
of femoral triangle to below opening in adductor
magnus
• Anteromedial wall-sartorius muscle and fascia
• Posterior wall-adductor longus and magnus
• Lateral wall –Vastus medialis
• Terminal part of femoral artery, vein , deep lymh
vessels, saphenous nerve, nerve to vastus medialis,
terminal part of obturator nerve
Blood Supply to the Femoral Head and Neck

• . In the young, the epiphysis of the head is supplied by a small

branch of the obturator artery, which passes to the head along
the ligament of the femoral head.
• The upper part of the neck of the femur receives a profuse
blood supply from the medial femoral circumflex artery.
• These branches pierce the capsule and ascend the neck deep
to the synovial membrane.
• As long as the epiphyseal cartilage remains, no communication
occurs between the two sources of blood.
• In the adult, after the epiphyseal cartilage disappears, an
anastomosis between the two sources of blood supply is
established.
 Clinical significance
• Fractures of the femoral
neck interfere with or
completely interrupt
the blood supply from
the root of the femoral
neck to the femoral
head with resultant
avascular necrosis.
 The Neck of the Femur and Coxa Valga and Coxa Vara

• The neck of the femur is inclined at an angle with the

shaft; the angle is about 160° in the young child and
about 125° in the adult.
• An increase in this angle (coxa valga), occurs, for
example, in cases of congenital dislocation of the hip.
• In this condition, adduction of the hip joint is limited.
• A decrease in this angle (coxa vara), occurs in fractures
• of the femoral neck and in slipping of the femoral
epiphysis.
• In this condition, abduction of the hip joint is limited.
 cont

• Avascular necrosis of the head is a common

complication.
• If the fragments are not impacted, considerable
displacement occurs.
• The strong muscles of the thigh including the rectus
femoris, the adductor muscles, and the hamstring
muscles, pull the distal fragment upward, so that the
leg is shortened.
• The gluteus maximus, the piriformis, the obturator
internus, the gemelli,and the quadratus femoris rotate
the distal fragment laterally, as seen by the toes
pointing laterally.
 Fractures of the Femur
• Femoral neck fractures-
common and are of two
• types, subcapital and
trochanteric.
• Subcapital fracture
• occurs in the elderly and is
usually produced by a minor
trip or stumble.
• particularly common in women
after menopause due to
thinning of the cortical and
trabecular bone caused
estrogen deficiency
 Trochanteric fractures
• commonly occur in the young and middle
aged as a result of direct trauma.
• The fracture line is extracapsular,and both
fragments have a profuse blood supply.
• If the bone fragments are not impacted, the
pull of the strong muscles will produce
shortening and lateral rotation of the leg.
 Fractures of the shaft of the femur

• usually occur in young and healthy persons.

• In fractures of the upper third of the shaft of the femur,
the proximal fragment is flexed by the iliopsoas;
abducted by the gluteus medius and minimus; and
laterally rotated by the gluteus maximus, the piriformis,
the obturator internus, the gemelli, and the quadratus
femoris .
• The lower fragment is adducted by the adductor
muscles, pulled upward by the hamstrings and
quadriceps, and laterally rotated by the adductors and
the weight of the foot
 ASANTE SANA
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