The back of the thigh pdf - Lower limb

Basic Anatomy

and passes downward behind the adductor brevis and in

pierces the obturator externus

posterior division

The

the thigh.

rial plexus and supplies the skin on the medial side of

artery. It contributes a variable branch to the subsarto

terminates as a small nerve that supplies the femoral

pectineus. It gives articular branches to the hip joint and

tor brevis, and adductor longus, and occasionally to the

10.30). It gives muscular branches to the gracilis, adduc

the pectineus and adductor longus (Figs. 10.27 and

obturator externus and the adductor brevis and behind

passes downward in front of the

anterior division

The

Branches

anterior and posterior divisions (Fig. 10.27).

obturator foramen (see Fig. 6.12), where it divides into

the lateral wall of the pelvis to reach the upper part of the

cle within the abdomen (see page 222). It runs forward on

and 4) and emerges on the medial border of the psoas mus

The obturator nerve arises from the lumbar plexus (L2, 3,

Compartment of the Thigh

Nerve Supply of the Medial Fascial

vein.

the branches of the artery. It drains into the internal iliac

The obturator vein receives tributaries that correspond to

Obturator Vein

branches and an articular branch to the hip joint.

surface of the obturator membrane. It gives off muscular

eral branches, which pass around the margin of the outer

compartment of the thigh, it divides into medial and lat

tor foramen) (Fig. 10.27). On entering the medial fascial

the obturator canal (i.e., the upper part of the obtura

the pelvis and accompanies the obturator nerve through

465

Obturator Nerve

■

front of the adductor magnus (Fig. 10.27). It terminates

by descending through the opening in the

adduct

tor brevis.

of the adductor magnus, and occasionally to the adduc

branches to the obturator externus, to the adductor part

magnus to supply the knee joint. It gives muscular

group of muscles and permits slow recovery of the muscles

crushed. This operation overcomes the spasm of the adductor

severe cases, the posterior division of the obturator nerve is

the anterior division of the obturator nerve. In addition, in some

form a tenotomy of the adductor longus tendon and to divide

In patients with cerebral palsy who have marked spasticity of

Adductor Muscles and Cerebral Palsy

the adductor group of muscles, it is common practice to per-

supplied by the posterior division of the obturator nerve.

C L I N I C A L N O T E S

The Back of the Thigh

in Figure 10.31 and are described in Table 10.4.

The muscles of the posterior fascial compartment are seen

Sciatic nerve

Nerve supply:

Branches of the profunda femoris artery

Blood supply:

string muscles)

nosus, and a small part of the adductor magnus (ham

Biceps femoris, semitendinosus, semimembra

Muscles:

group of superficial inguinal lymph nodes (Fig. 10.4).

of the thigh drains upward and forward into the vertical

Lymph from the skin and superficial fascia on the back

Lymph Vessels

vein in the popliteal fossa.

lower part of the back of the thigh join the small saphenous

saphenous vein (Fig. 10.19). Superficial veins from the

aspects of the thigh and ultimately drain into the great

Many small veins curve around the medial and lateral

Superficial Veins

(Fig. 10.1).

skin on the back of the thigh and the upper part of the leg

supplies the skin. It gives off numerous branches to the

and in the popliteal fossa it pierces the deep fascia and

muscle (Fig. 10.1). It descends on the back of the thigh,

from beneath the lower border of the gluteus maximus

the sacral plexus, leaves the gluteal region by emerging

a branch of

posterior cutaneous nerve of the thigh,

The

Cutaneous Nerves

Skin

Contents of the Posterior Fascial

Compartment of the Thigh

■

-
-

■

L2 L3 L4

obturator nerve

abdomen

lumbar plexus

pelvis

peritoneum on lateral
wall of pelvis

anterior division

posterior division

adductor
region
of thigh

hip joint

pectineus ?

adductor longus

adductor brevis

gracilis

adductor magnus

(adductor portion)
adductor brevis

knee joint

popliteal artery

femoral artery

subsartorial plexus

with medial cutaneous

nerve of thigh and branch

of saphenous nerve

FIGURE 10.30

Summary of the main branches of the obtura

tor nerve.

466

CHAPTER 10

The Lower Limb

gluteus maximus

ischial spine

sacrotuberous ligament

ischial tuberosity

adductor magnus
(hamstring part)

semimembranosus

semitendinosus

gracilis

tibial nerve

semimembranosus

popliteus

oblique popliteal ligament

common peroneal nerve

biceps femoris
(long head)

gluteus maximus

sciatic nerve

nerve to hamstrings

adductor magnus

quadratus femoris

greater trochanter

gemellus inferior

obturator internus

gemellus superior

piriformis

gluteus minimus

gluteus medius

iliac crest

FIGURE 10.31

Structures in the posterior aspect of the right

thigh.

Muscles of the Posterior Fascial Compartment of the Thigh

T A B L E 1 0 . 4

thigh, it ends by dividing into the tibial and common

of the adductor magnus muscle. In the lower third of the

semimembranosus muscles. It lies on the posterior aspect

riorly by the adjacent margins of the biceps femoris and

midline of the thigh (Fig. 10.31). It is overlapped poste

S1, 2, and 3), leaves the gluteal region as it descends in the

The sciatic nerve, a branch of the sacral plexus (L4 and 5;

Sciatic Nerve

of the Thigh

Nerve Supply of the Posterior Compartment

part of the blood from the compartment.

(Fig. 10.27). The profunda femoris vein drains the greater

artery provide a rich blood supply to this compartment

The four perforating branches of the profunda femoris

of the Thigh

Blood Supply of the Posterior Compartment

oblique popliteal ligament.

on the back of the knee joint; the expansion is called the

sion upward and laterally, which reinforces the capsule

The semimembranosus insertion sends a fibrous expan

nerve.

sciatic nerve and the adductor part from the obturator

receives its nerve supply from the tibial portion of the

The hamstring part of the adductor magnus muscle

and the short head from the common peroneal portion.

the sciatic nerve, the long head from the tibial portion,

The biceps femoris muscle receives its nerve supply from

Note the following:

Tibial portion of

Muscle

Origin

Insertion

Nerve Supply

Nerve Root

Action

Biceps femoris

Long head: ischial

tuberosity

Head of fibula

Long head: tibial

portion of

sciatic nerve

L5; S1, 2

Flexes and laterally rotates leg

at knee joint; long head also

extends thigh at hip joint

Short head: linea

aspera, lateral

supracondylar

ridge of shaft of

femur

Short head:

common

peroneal portion

of sciatic nerve

Semitendinosus

Ischial tuberosity

Upper part

of medial

surface of

shaft of tibia

sciatic nerve

L5; S1, 2

Flexes and medially rotates leg

at knee joint; extends thigh at

hip joint

Semimembranosus

Ischial tuberosity

Medial condyle

of tibia

sciatic nerve

L5; S1, 2

Flexes and medially rotates leg

at knee joint; extends thigh at

hip joint

Adductor magnus

(hamstring

portion)

Ischial tuberosity

Adductor

tubercle of

femur

sciatic nerve

L2, 3, 4

Extends thigh at hip joint

The predominant nerve root supply is indicated by boldface type.

■

Basic Anatomy

467

peroneal nerves (Figs. 10.29 and 10.31). Occasionally, the

The synovial membrane lines the capsule and is

membrane (Fig. 10.18).

notch. It lies within the joint and is ensheathed by synovial

the transverse ligament and the margins of the acetabular

on the head of the femur (fovea capitis) and by its base to

angular (Fig. 10.18). It is attached by its apex to the pit

is flat and tri

ligament of the head of the femur

The

through which the blood vessels and nerves enter the joint.

10.18). The ligament converts the notch into a tunnel

acetabular labrum as it bridges the acetabular notch (Fig.

is formed by the

transverse acetabular ligament

The

limits extension.

and are attached to the greater trochanter. This ligament

margin (Fig. 10.32). The fibers pass upward and laterally

attached to the body of the ischium near the acetabular

is spiral shaped and is

ischiofemoral ligament

The

extension and abduction.

part of the intertrochanteric line. This ligament limits

of the pubis, and the apex is attached below to the lower

The base of the ligament is attached to the superior ramus

is triangular (Fig. 10.32).

pubofemoral ligament

The

extension during standing.

teric line of the femur. This strong ligament prevents over

attached to the upper and lower parts of the intertrochan

inferior iliac spine above; below, the two limbs of the Y are

ligament (Fig. 10.32). Its base is attached to the anterior

is a strong, inverted Y-shaped

iliofemoral ligament

The

These blood vessels supply the head and neck of the femur.

retinacula.

reflected upward along the neck as bands called

front, some of its fibers, accompanied by blood vessels, are

behind. At its attachment to the intertrochanteric line in

halfway along the posterior aspect of the neck of the bone

to the intertrochanteric line of the femur in front and

ular labrum medially (Fig. 10.18). Laterally, it is attached

The capsule encloses the joint and is attached to the acetab

The hip joint is a synovial ball-and-socket joint.

Type

The articular surfaces are covered with hyaline cartilage.

(Fig. 10.18).

transverse acetabular ligament

notch and is here called the

The labrum bridges across the acetabular

tabular labrum.

ace

by the presence of a fibrocartilaginous rim called the

The cavity of the acetabulum is deepened

acetabular notch.

lum is horseshoe shaped and is deficient inferiorly at the

hip bone (Fig. 10.18). The articular surface of the acetabu

head of the femur and the cup-shaped acetabulum of the

The hip joint is the articulation between the hemispherical

run medially to supply the muscles (Figs. 10.29 and 10.31).

arise from the tibial component of the sciatic nerve and

hamstring part of the adductor magnus. These branches

ris, the semitendinosus, the semimembranosus, and the

to the long head of the biceps femo

Muscular branches

course is described on page 479.

fossa on the lateral side of the tibial nerve. Its further

sciatic nerve (Figs. 10.29 and 10.31), enters the popliteal

a terminal branch of the

common peroneal nerve,

The

Its further course is described on page 479.

(Figs. 10.17, 10.29, and 10.31), enters the popliteal fossa.

a terminal branch of the sciatic nerve

tibial nerve,

The

Branches

even inside the pelvis.

level—in the upper part of the thigh, the gluteal region, or

sciatic nerve divides into its two terminal parts at a higher

■

Hip Joint

Articulation

Capsule

Ligaments

-
-

Synovial Membrane

attached to

the articular surfaces (Fig. 10.18).

the margins of

the joint capsule. It ensheathes the ligament of the head of

It covers the portion of the neck of the femur that lies within

anterior inferior
iliac spine

opening for bursa

superior ramus of pubis

pubofemoral
ligament

intertrochanteric
line

iliofemoral ligament

capsule

ischium

iliofemoral ligament

ischiofemoral
ligament

intertrochanteric
crest

area of loose attachment
of capsule

FIGURE 10.32

Anterior aspect (A) and posterior aspect (B) of the right hip joint.