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The front of thigh extends between the hip and knee joints.
The superficial fascia contains:
Great saphenous vein (largest superficial vein).
Cutaneous nerves, superficial vessels, and lymph nodes.
The upper one-third (medially) forms the femoral triangle.
The middle one-third contains the femoral vessels passing through the adductor canal.
Main muscles:
Quadriceps femoris (four-headed muscle) — main extensor of knee.
Iliopsoas — flexor of thigh (upper part).
Adductors — medial side of thigh.
Femoral hernia appears in the upper medial part of the front of thigh
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.Curved upper border of ilium forming the lower margin of waist.
Hands rest on iliac crests in relaxed standing position.
Anterior end of the iliac crest — easily palpable bony point.
Found about 5 cm behind ASIS on outer lip of the iliac crest.
Important reference point for surface anatomy.
Shallow curved line separating front of thigh from anterior abdominal wall.
Corresponds to the inguinal ligament, which runs from ASIS to pubic tubercle.
The downward convexity of the ligament is due to pull by the fascia lata
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.Bony projection at the medial end of the inguinal ligament — palpable landmark.
Pubic symphysis — midline joint between pubic bones.
Pubic crest — ridge between pubic tubercle and symphysis.
Lies about 12.5 cm below the tubercle of iliac crest.
Forms a wide prominence (4–5 cm) at the lateral aspect of the thigh.
Its upper border corresponds roughly to the level of pubic crest.
Midway between ASIS and pubic symphysis.
Lies directly above the femoral artery and head of femur.
Lies slightly lateral to midinguinal point; femoral nerve lies beneath it.
Largest sesamoid bone, located within the quadriceps femoris tendon.
Easily seen and felt in front of knee; movable when knee is extended.
Prominent bump below patella on anterior tibia — attachment for patellar ligament
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.Over the upper medial thigh, the skin is hair-bearing (especially near pubic region).
Clinical note: The upper medial thigh is commonly used for embalming incision, allowing access to femoral artery for fluid injection
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.Composed of two layers:
Superficial fatty layer (Camper’s fascia)
Deep membranous layer (Scarpa’s fascia)
Both continuous with layers of anterior abdominal wall fascia.
The two layers are most distinct near the groin, where cutaneous nerves, vessels, and lymph nodes lie between them.
Holden’s Line:
Firm attachment of the membranous layer to the deep fascia near the inguinal ligament.
Extends horizontally 8 cm from the pubic tubercle.
Prevents downward spread of extravasated urine into the thigh after urethral injury
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.Cutaneous nerves
Cutaneous arteries and veins (including great saphenous vein)
Superficial inguinal lymph nodes
Urethral injury: Urine may extravasate beneath membranous layer of superficial fascia and spread to lower abdominal wall, but not below Holden’s line.
Would you like me to continue next with Cutaneous Nerves of Front of Thigh (next subtopic under Skin and Superficial Fascia) in the same detailed, pointwise style?
Consists of two layers:
Superficial fatty layer (Camper’s fascia)
Deep membranous layer (Scarpa’s fascia)
Both are continuous with the corresponding layers of the anterior abdominal wall.
Layers are most distinct in the groin region, where cutaneous nerves, vessels, and lymph nodes lie between them
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.Firm attachment of the membranous layer to the deep fascia along a horizontal line called Holden’s line.
Begins slightly lateral to the pubic tubercle and extends laterally about 8 cm
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.Prevents downward spread of extravasated urine into thigh after urethral injury
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.Cutaneous nerves
Cutaneous arteries
Great saphenous vein and its tributaries
Superficial inguinal lymph nodes
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.Emerges through the superficial inguinal ring.
Supplies:
Skin at the root of penis (or mons pubis in females).
Anterior one-third of the scrotum or labium majus.
Superomedial part of thigh
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.Pierces the femoral sheath and deep fascia about 2 cm below the midinguinal point.
Supplies most of the skin over the femoral triangle
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.Branch of lumbar plexus.
Emerges behind lateral end of inguinal ligament.
Divides into anterior and posterior branches.
Supplies anterolateral thigh and anterior part of gluteal region
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.Branch of anterior division of femoral nerve.
Pierces deep fascia at the junction of upper and middle thirds of thigh.
Supplies anterior surface of thigh between sartorius and midline down to knee
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.Branch of anterior division of femoral nerve.
Has anterior and posterior divisions.
Supplies medial side of lower two-thirds of thigh
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.Longest cutaneous branch of femoral nerve.
Pierces deep fascia on medial side of knee and runs with great saphenous vein.
Supplies skin on medial side of leg and foot up to ball of great toe.
Gives infrapatellar branch to skin over ligamentum patellae
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.Plexus of fine nerves in front of patella, ligamentum patellae, and upper tibia.
Formed by:
Anterior division of lateral cutaneous nerve of thigh
Intermediate cutaneous nerve of thigh
Anterior division of medial cutaneous nerve of thigh
Infrapatellar branch of saphenous nerve
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.Three small arteries arise from the femoral artery just below the inguinal ligament:
Pierces cribriform fascia.
Runs medially in front of spermatic cord.
Supplies external genitalia
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.Pierces cribriform fascia, ascends toward umbilicus.
Supplies lower part of anterior abdominal wall
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.(Next part in continuation, described below)
Runs laterally, parallel to the inguinal ligament, supplying the skin of upper lateral thigh and inguinal region.
Holden’s line acts as a barrier to spread of urine after urethral rupture.
Cutaneous nerves are important for nerve blocks in thigh surgeries and for identifying nerve injury levels.
Superficial arteries are often seen in dissection near the femoral triangle and may be injured during venous cutdown procedures.
Largest and longest superficial vein of the lower limb (saphes = easily seen).
Origin: Medial end of dorsal venous arch of foot.
Course:
Begins on dorsum of foot, passes in front of the medial malleolus.
Ascends along medial side of leg, behind knee, and then forwards in thigh.
At the upper thigh, it pierces the cribriform fascia at the saphenous opening to drain into the femoral vein.
Tributaries before piercing cribriform fascia:
Superficial external pudendal vein
Superficial epigastric vein
Superficial circumflex iliac vein
Numerous unnamed tributaries
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.Clinical Note:
Commonly used for venous cutdown and coronary bypass grafting.
Varicosity of this vein is a frequent cause of visible tortuous veins on the leg.
Variable in number and size, arranged in a T-shaped pattern with:
Upper horizontal group
Lower vertical group
Upper horizontal group subdivided into:
Upper lateral group – drains lateral infraumbilical abdominal wall and gluteal region.
Upper medial group – drains medial infraumbilical wall, external genitalia, urethra, vagina, and anal canal.
Lower vertical group – drains most of the lower limb, along the upper part of great saphenous vein
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.Clinical Note:
Enlarged in lower limb infections, STDs, and carcinoma of vulva or penis.
Definition: Fluid-filled sacs reducing friction between skin and bone at points of pressure.
Function: Provide lubrication and smooth movement; excessive pressure can lead to bursitis
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.Lies in front of lower part of patella and upper part of ligamentum patellae.
Inflammation: Prepatellar bursitis → “Housemaid’s knee” or “Miner’s knee”.
Lies in front of lower part of tibial tuberosity and lower part of ligamentum patellae.
Inflammation: Subcutaneous infrapatellar bursitis → “Clergyman’s knee”.
Suprapatellar bursa and Deep infrapatellar bursa lie deeper beneath quadriceps tendon and ligamentum patellae
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.| Condition | Site of Bursa | Common Name |
|---|---|---|
| Prepatellar bursitis | Front of patella | Housemaid’s knee |
| Subcutaneous infrapatellar bursitis | Over tibial tuberosity |
Clergyman’s knee |
After reflecting the superficial fascia, the deep fascia (fascia lata) becomes visible.
Study its attachments, modifications, and extensions.
The great saphenous vein is traced through the cribriform fascia to the femoral vein via the femoral sheath:
Medial compartment of the sheath → femoral canal (contains lymph node).
Intermediate compartment → femoral vein.
Lateral compartment → femoral artery.
A vertical incision in the deep fascia from the iliac tubercle to the lateral condyle of femur exposes:
Tensor fasciae latae and gluteus maximus attaching to the iliotibial tract.
Quadriceps femoris with its four distinct heads (rectus femoris, vastus medialis, lateralis, and intermedius).
Remove deep fascia from the upper one-third of the front of thigh to display:
Sartorius muscle (obliquely crossing from lateral to medial).
Adductor longus (arising medially, directed laterally).
These muscles form the femoral triangle —
Base: inguinal ligament
Lateral boundary: medial border of sartorius
Medial boundary: medial border of adductor longus
Within the femoral triangle, dissect and identify femoral nerve, artery, vein, and accompanying lymphatics
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.Due to incompetent valves in the great saphenous vein or its perforators.
Leads to venous dilation and tortuosity along the medial thigh and leg.
Common in people with prolonged standing (shopkeepers, nurses).
Saphenofemoral incompetence can be tested by Trendelenburg’s test.
Performed anterior to the medial malleolus to access the vein for intravenous infusion.
Must avoid injury to the saphenous nerve, which accompanies it in the lower leg.
Used as graft vessel in coronary artery bypass operations due to its length and superficial accessibility.
The femoral artery pulsation can be felt at the midinguinal point (between ASIS and pubic symphysis).
Used for arterial catheterization or pulse assessment.
Occurs through the femoral canal (medial compartment of femoral sheath).
More common in females due to wider pelvis.
Lies below and lateral to the pubic tubercle (differentiating from inguinal hernia).
Infection of lower limb, perineum, or external genitalia causes enlargement of the superficial inguinal lymph nodes.
Upper horizontal group affected in genital infections; lower vertical group in leg infections.
Prepatellar bursitis → inflammation of bursa anterior to patella (Housemaid’s knee).
Subcutaneous infrapatellar bursitis → over tibial tuberosity (Clergyman’s knee).
Both result from chronic friction or kneeling posture.
Tested by tapping the ligamentum patellae; a normal reflex indicates integrity of L2–L4 (femoral nerve).
Absence suggests femoral nerve lesion or L4 radiculopathy.
Lateral cutaneous nerve of thigh → compressed beneath the inguinal ligament, producing meralgia paraesthetica (tingling and burning over anterolateral thigh).
Saphenous nerve → may be injured in knee surgeries, causing sensory loss along medial leg.
In straddle injury with urethral rupture, urine extravasates into the superficial perineal pouch, but cannot descend into the thigh due to firm attachment of the membranous layer (Scarpa’s fascia) to deep fascia along Holden’s line.
A tough fibrous sheath that encloses the entire thigh like a sleeve.
Continuous with deep fascia of gluteal region above and leg below
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.Superiorly: Along the line separating thigh from pelvis—
Anteriorly: Inguinal ligament
Laterally: Iliac crest
Posteriorly: Gluteal fascia, sacrum, coccyx, sacrotuberous ligament
Medially: Pubis, pubic arch, and ischial tuberosity
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Inferiorly:
Front and sides → attached to bony prominences and capsule of knee joint.
Posteriorly → forms popliteal fascia, continuous with fascia of back of leg
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.Thickened lateral part of fascia lata forming a 5 cm wide band.
Superior attachments: Splits into two laminae—
Superficial lamina → tubercle of iliac crest.
Deep lamina → capsule of hip joint.
Inferior attachment: Anterior surface of lateral condyle of tibia
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.Between laminae —
Tensor fasciae latae
Gluteus maximus (upper three-fourths part)
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Stabilizes knee joint in extension and partial flexion.
Acts as support against gravity during leaning forward or walking
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.Oval gap in fascia lata → about 2.5 cm long, 2 cm broad.
Position: 4 cm below and 4 cm lateral to pubic tubercle.
Margins:
Lateral margin: Sharp and crescentic — falciform margin.
Medial margin: Ill-defined, deeper, formed by fascia over pectineus muscle.
Closed by cribriform fascia (specialized part of superficial fascia).
Structures passing through:
Great saphenous vein
Superficial branches of femoral artery and vein
Lymphatic vessels
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.The fascia lata sends three septa inward to the linea aspera:
Lateral intermuscular septum: Thickest; separates anterior from posterior compartment.
Medial intermuscular septum: Between anterior and medial compartments.
Posterior intermuscular septum: Poorly defined; between medial and posterior compartments
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.After removing superficial fascia, the deep fascia (fascia lata) is seen.
Identify:
Attachments, iliotibial tract, and saphenous opening.
Trace the great saphenous vein through the cribriform fascia into the femoral vein within the femoral sheath:
Medial compartment → femoral canal (with lymph node).
Intermediate compartment → femoral vein.
Lateral compartment → femoral artery.
Make a vertical incision in fascia lata from iliac tubercle to lateral condyle of femur.
Expose tensor fasciae latae, gluteus maximus, and iliotibial tract.
Remove fascia lata from upper one-third of thigh to expose sartorius (crossing obliquely) and adductor longus (forming femoral triangle).
Identify femoral nerve, artery, and vein in the triangle
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.Occurs through femoral canal (medial compartment of femoral sheath).
Appears below and lateral to pubic tubercle.
Common in females; may strangulate.
Incompetent valves in the great saphenous vein cause varicosities.
Related to weakness in fascia lata at the saphenous opening.
Due to friction between IT tract and lateral femoral condyle during repeated knee flexion-extension.
Common in runners and cyclists.
Fascia lata grafts are used for reconstructive surgeries (e.g., dura repair, ptosis correction).
Clinical testing site lies under the fascia lata; reflex loss indicates femoral nerve or L3–L4 lesion.
A triangular depression on the front of the upper one-third of thigh, just below the inguinal ligament
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.Base (Superior):
Inguinal ligament
Apex (Inferior):
Point where sartorius (lateral boundary) and adductor longus (medial boundary) meet.
Continuous below with adductor canal
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.Lateral Boundary:
Medial border of sartorius
Medial Boundary:
Medial border of adductor longus
Roof:
Skin
Superficial fascia (contains superficial inguinal lymph nodes, femoral branch of genitofemoral nerve, ilioinguinal branches, superficial vessels, upper part of great saphenous vein)
Deep fascia (including cribriform fascia over saphenous opening)
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.Floor:
Medially: Pectineus and adductor longus
Laterally: Psoas major and iliacus
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.Femoral Artery and Branches
Extends from midinguinal point to apex of triangle.
Branches (6 total):
Superficial: Superficial epigastric, superficial circumflex iliac, superficial external pudendal.
Deep: Profunda femoris, lateral and medial circumflex femoral arteries
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.Femoral Vein and Tributaries
Lies medial to artery at base, posteromedial at apex.
Receives great saphenous vein, circumflex veins, and veins corresponding to arterial branches
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.Femoral Sheath
Encloses upper 3–4 cm of femoral vessels.
Divided into three compartments:
Lateral: Femoral artery + femoral branch of genitofemoral nerve
Intermediate: Femoral vein
Medial: Femoral canal
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.Nerves
Femoral nerve (lateral to artery, outside sheath)
Nerve to pectineus (passes behind sheath to pectineus)
Femoral branch of genitofemoral nerve (within sheath, lateral compartment)
Lateral cutaneous nerve of thigh (crosses lateral angle)
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.Deep Inguinal Lymph Nodes
Medial to upper part of femoral vein.
Drain glans penis or clitoris, deep lower limb lymphatics, and superficial inguinal nodes
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.Funnel-shaped fascial sleeve enclosing the upper 3–4 cm of femoral vessels.
Formation:
Anterior wall → from fascia transversalis.
Posterior wall → from fascia iliaca.
Inferiorly: Merges with connective tissue around femoral vessels
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.Asymmetrical shape:
Lateral wall → vertical
Medial wall → oblique (directed downward and laterally)
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.Compartments:
Lateral (arterial) → Femoral artery + femoral branch of genitofemoral nerve
Intermediate (venous) → Femoral vein
Medial (lymphatic) → Femoral canal
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.Medial compartment of femoral sheath.
Shape: Conical; wide above, narrow below.
Length: ~1.5 cm; Width at base: ~1.5 cm.
Upper end: Femoral ring — the entrance into canal
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.Anterior: Inguinal ligament
Posterior: Pectineus + fascia over it
Medial: Lacunar ligament
Lateral: Femoral vein
Areolar tissue
Fat
Deep inguinal lymph node (of Cloquet/Rosenmüller)
Lymphatic vessels connecting superficial and deep systems
Protrusion of abdominal contents through femoral ring into femoral canal.
Appears below and lateral to pubic tubercle (distinguishes it from inguinal hernia).
Common in females due to wider pelvis and smaller femoral ring.
Complication: May become strangulated.
Artery can be palpated at midinguinal point — access for angiography or catheterization.
Enlargement of deep or superficial inguinal nodes in infections of lower limb or genitalia.
Femoral pulse → halfway between ASIS and pubic symphysis.
Pressure here controls bleeding from lower limb injuries.
Femoral sheath and canal are key landmarks in hernia repair and vascular surgeries of groin.
These sections complete the Femoral Triangle with its Boundaries, Contents, Femoral Sheath, Femoral Canal, and Clinical Anatomy for both practical dissection and exam theory.
Continuation of the external iliac artery beyond the inguinal ligament, beginning at the midinguinal point.
Lies in the femoral triangle, just lateral to the femoral vein and medial to the femoral nerve.
Passes downward through the femoral triangle, then enters the adductor canal.
Terminates at the adductor hiatus, where it continues as the popliteal artery.
Anteriorly: Skin, fasciae, superficial branches, and femoral branch of genitofemoral nerve.
Posteriorly: Psoas major, pectineus, adductor longus, and adductor magnus.
Medially: Femoral vein.
Laterally: Femoral nerve and its branches.
Superficial Branches
Superficial external pudendal artery – to skin of scrotum/labia and lower abdominal wall.
Superficial epigastric artery – to lower part of anterior abdominal wall.
Superficial circumflex iliac artery – to skin and fascia along iliac crest.
Deep Branches
Profunda femoris artery – chief artery of the thigh.
Deep external pudendal artery – to external genitalia.
Muscular branches – to sartorius, quadriceps, and adductors.
Arises from the lateral side of the femoral artery, about 4 cm below the inguinal ligament.
Descends posterior to the femoral vessels, passing between adductor muscles.
Gives off:
Medial circumflex femoral artery – to head and neck of femur and adductors.
Lateral circumflex femoral artery – divides into ascending, transverse, and descending branches.
Perforating arteries (4 in total) – pierce adductor magnus to supply the posterior thigh.
Pulse: Felt at the midinguinal point, midway between ASIS and pubic symphysis.
Compression: Can be pressed against the femoral head to control bleeding.
Catheterization: Common access site for diagnostic and interventional cardiac procedures.
Aneurysm: Appears as a pulsatile swelling in the upper thigh.
Occlusion: Causes feeble or absent femoral pulse; may indicate coarctation or thrombosis.
Continuation of the popliteal vein at the lower end of the adductor canal.
Ends by becoming the external iliac vein behind the inguinal ligament.
Lies medial to the artery in upper thigh, posterior to it at the apex of femoral triangle, and lateral at the lower end.
Great saphenous vein.
Veins accompanying profunda femoris, deep external pudendal, and muscular branches.
Lateral and medial circumflex femoral veins.
Descending genicular vein.
Used for intravenous infusion in infants and in adults with collapsed peripheral veins.
Injury may occur during venous puncture at the femoral triangle.
Arises from posterior divisions of L2, L3, and L4 spinal nerves of the lumbar plexus.
It is the largest branch of the lumbar plexus.
Enters the thigh behind the inguinal ligament, lateral to the femoral artery.
Lies in the groove between psoas major and iliacus.
Divides into anterior and posterior divisions about 2.5 cm below the inguinal ligament.
The lateral circumflex femoral artery passes between these two divisions.
From the trunk: To iliacus and pectineus.
From anterior division: To sartorius.
From posterior division: To rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, and articularis genu.
Nerve to vastus medialis carries proprioceptive fibers for the knee joint.
From anterior division: Intermediate and medial cutaneous nerves of thigh.
From posterior division: Saphenous nerve (continues to leg and foot).
Hip joint: From nerve to rectus femoris.
Knee joint: From nerves to vasti muscles.
Follows Hilton’s Law – a nerve supplying a muscle also supplies the joint the muscle acts upon.
Small branches to the femoral artery and its branches.
Injury:
Causes paralysis of quadriceps femoris → loss of knee extension.
Patellar reflex is absent.
Sensory loss over anterior and medial thigh and medial leg (via saphenous nerve).
Femoral nerve block:
Performed for surgeries on the knee joint or anterior thigh to achieve regional anesthesia.
Palsy:
Results in difficulty climbing stairs or rising from sitting position due to weak quadriceps.
| Structure | Key Features | Clinical Relevance |
|---|---|---|
| Femoral artery | Continuation of external iliac artery through femoral triangle | Pulse, catheterization, aneurysm |
| Femoral vein | Upward continuation of popliteal vein | IV access in infants, circulation collapse |
| Femoral nerve | L2–L4; divides into anterior and posterior divisions | Injury → loss of knee extension, sensory loss |
Sartorius
Longest muscle in the body.
Origin: Anterior superior iliac spine (ASIS).
Insertion: Upper part of medial surface of tibia.
Nerve supply: Femoral nerve.
Action: Flexes thigh and leg, abducts and laterally rotates thigh.
Quadriceps Femoris
Large extensor muscle with four heads:
Rectus femoris: From AIIS; flexes thigh and extends leg.
Vastus lateralis: From greater trochanter and linea aspera; extends leg.
Vastus medialis: From intertrochanteric line and linea aspera; extends leg and prevents lateral patellar displacement.
Vastus intermedius: From anterior femoral shaft; extends leg.
Nerve supply: Femoral nerve.
Insertion: Common tendon into the base of patella; via ligamentum patellae to tibial tuberosity.
Articularis Genu
Small flat muscle deep to vastus intermedius.
Action: Pulls synovial membrane of knee joint upward during extension to prevent pinching.
Origin: Anterior surfaces and lower borders of transverse processes of lumbar vertebrae (T12–L5).
Insertion: Joins tendon of iliacus to insert on lesser trochanter of femur.
Nerve supply: Ventral rami of L1–L3.
Action: Flexes thigh at hip joint; assists in flexion of trunk.
Origin: Upper two-thirds of iliac fossa, inner lip of iliac crest, and ventral sacroiliac ligaments.
Insertion: Lateral part of anterior surface of lesser trochanter (with psoas).
Nerve supply: Femoral nerve.
Action: Chief flexor of thigh; stabilizes hip joint during walking and standing.
Psoas Abscess
Tubercular infection of lumbar vertebrae may spread along the psoas sheath into the femoral triangle, presenting as a swelling that mimics an enlarged lymph node.
Flexion of thigh causes pain.
Patellar Reflex (Knee Jerk)
Reflex contraction of quadriceps when ligamentum patellae is tapped.
Tests L3–L4 spinal segments and integrity of femoral nerve.
Intramuscular Injection Site
Vastus lateralis is a safe and preferred muscle for IM injections in infants and adults.
Quadriceps Paralysis
Injury to femoral nerve results in loss of knee extension and absent patellar reflex.
Intermuscular passage on the medial side of the middle one-third of thigh.
Also called Hunter’s canal after John Hunter, who performed femoral artery ligation here for popliteal aneurysm
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.Superior limit: Apex of femoral triangle.
Inferior limit: Tendinous opening in adductor magnus.
Triangular in cross-section.
Anterolateral wall: Vastus medialis.
Posteromedial wall (floor): Adductor longus (above) and adductor magnus (below).
Medial wall (roof): Strong fibrous membrane joining the other two walls; covered by sartorius muscle.
Femoral artery
Gives muscular branches and descending genicular artery (divides into superficial and deep branches).
Continues as popliteal artery through adductor hiatus.
Femoral vein – lies posterior in upper part, lateral in lower part.
Saphenous nerve – crosses artery from lateral to medial, exits through roof.
Nerve to vastus medialis – lateral to artery, enters muscle.
Branches of obturator nerve:
Anterior division → joins subsartorial plexus and supplies femoral artery.
Posterior division → accompanies femoral vessels to the knee joint.
Lies on the fibrous roof under sartorius.
Formed by branches of:
Medial cutaneous nerve of thigh
Saphenous nerve
Anterior division of obturator nerve
Supplies skin and fascia over medial thigh
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.Reflect sartorius laterally to expose the fibrous roof.
Identify:
Femoral artery and its descending genicular branch.
Femoral vein and its position relative to artery.
Saphenous nerve crossing artery from lateral to medial.
Nerve to vastus medialis entering muscle laterally.
The canal opens distally into the popliteal fossa through the adductor hiatus.
This completes the section on the Muscles of the Front of Thigh, Iliopsoas Complex, and Adductor Canal with its Dissection and Clinical Correlations — ideal for both dissection hall and exam revision.
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