Lower Limb Introduction And Front Of Thigh Question And Answers

Lower Limb Introduction

• The lower limb and upper limb are similar in their basic structure.
• However, with the evolutionary process, functions of lower limb has modified into the transmission of body weight and locomotion and became bulkier and stronger with lesser mobility compared to the upper limb.

Lower Limb Related Terms

1. Hip bone: Is made of 3 elements; ilium, pubis, and ischium
2. Hip girdle: Left and right hip bones form the hip girdle which articulates with the sacrum posteriorly at the sacroiliac joint
3. Bony pelvis: Made of 2 hip bones, sacrum, and coccyx
4. Hip joint: Articulation between hipbone and femur
5. Gluteal region: Overlies the side and back of the pelvis including hip and buttocks
6. Hip/coxa: Superolateral part of gluteal region
7. Buttocks/natis: Inferomedial rounded bulge of gluteal region
8. Inguinal region/groin: The junction between the anterior abdominal wall and thigh. Indicated by a groove
9. Ham/peoples: Represent the lower part of back of the thigh and back of knee
10. Calf/sura: Posterior part of the leg
11. Malleoli: Bony prominence formed by the lower end of the tibia and fibula on medial and lateral part of the ankle respectively

The upper surface of the foot/pes is called the dorsum and the lower surface is called the sole or plantar surface.

Front Of Thigh Introduction

• The front of thigh extends from the hip to the knee joint. It corresponds to back of arm.

Front Of Thigh Question And Answers

Question 1. Briefly explain the superficial fascia of the front of thigh.
Answer:

The superficial fascia of the front of thigh

It has 2 layers on the front of thigh near the inguinal region:

1. Superficial fatty layer
2. Deep membranous layer

• These layers are continuous with corresponding layers of the anterior abdominal wall
• In between these two layers following are situated:
  • Cutaneous nerves
  • Cutaneous arteries
  • Termination of saphenous vein and its tributaries
  • Superficial inguinal lymph nodes.

Read And Learn More: Anatomy Question And Answers 

Superficial fascia of the front of thigh Clinical Anatomy

• The membranous layer of superficial fascia is attached in a linear fashion to the deep fascia of the thigh along a horizontal line that extends laterally from the pubic tubercle about 8 cm.
• This attachment helps to prevent the passage of collected urine from anterior abdominal wall to the front of thigh due to injury of the urethra.

Question 2. Explain in detail about deep fascia of the thigh/fascia lata and their modifications.
Answer:

Deep fascia of the thigh

Deep fascia of the thigh is also known as fascia lata. It is strong and envelopes the thigh like a sleeve.

Deep fascia of thigh Attachments

1. Superiorly
   • Anterior part: Attached to the ASIS, inguinal ligaments and pubic tubercle
   • Lateral part: Iliac crest
   • Posterior part: To sacrum, coccyx, sacrotuberous ligament
   • Medially: Pubis, pubic arch, ischial tuberosity.
2. Inferiorly
   • On the front side of knee: Attached to subcutaneous bony prominence and joint capsule
   • On the back of knee: Continuous on the popliteal fascia.
3. Modification of Fascia Lata
   • Fascia lata presents 3 modifications in the thigh.

Iliotibial Tract

• It is the lateral thickened portion of fascia lata with 5 cm width.
• It splits into superficial and deep lamina superiorly.

Iliotibial Tract Attachments

• Superiorly: Superficial lamina attached to the tubercle of the iliac crest. Deep lamina attached to the capsule of hip joint.
• Inferiorly: Smooth area on the anterior surface of the lateral condyle of the tibia.
• It encloses the 3/4th part of the gluteus maximus and tensor fascia lata muscle in between the 2 lamina in the upper part.
• Function: Support knee in extension and partial flexion.

Saphenous Opening

• It is an oval-shaped opening in the fascia lata.
• Location: Th center of the opening lies 4 cm below and 4 cm lateral to pubic tubercle
• Structures passing through are:
  • Great saphenous vein.
  • Superficial epigastric and superficial external pudendal vessel.
  • Few lymph vessels connect superficial and deep inguinal lymph nodes.

Intermuscular Septa: Intermuscular septa divide the thigh into three compartments:

1. Lateral intermuscular septa
2. Medial intermuscular septa
3. Posterior intermuscular septa.

Iliotibial Tract Clinical Anatomy

Fascia lata is attached to the inguinal ligament. In the lying down position, when hip is extended, the anterior abdominal wall is stretched and palpation of abdominal contents becomes difficult due to the pull of the fascia lata. Therefore semi flexed hip position is preferred.

Question 3. Write a note on the femoral triangle explaining its boundaries and contents.
Answer:

Femoral triangle explaining its boundaries and contents

It is a triangular depression on the front of the upper 1/3rd of the thigh below the inguinal ligament.

Femoral Triangle Boundaries

• Lateral: Medial border of sartorius
• Medial: Medial border of adductor longus
• Base: Inguinal ligament
• Apex: Formed by the meeting of medial and lateral boundaries. It is directed downwards
• Floor: From lateral to medial
  • Iliacus
  • Psoas major (tendon)
  • Pectineus
  • Adductor longus muscles lies.
• Roof: Made by skin, superficial fascia, deep fascia
  • Superficial fascia consists of:
    • Branch of the femoral artery and accompanying veins
    • Superficial inguinal lymph nodes
    • Femoral branch of genitofemoral nerve
    • Branches of ilioinguinal nerve
    • Upper part of great saphenous vein.

Femoral Triangle Mnemonics

• Femoral triangle: Boundaries ‘So I May Always Love Sally’:
• Superiorly: Inguinal ligament
• Medially: Adductor longus
• Laterally: Sartorius

Femoral Triangle Contents

• Femoral artery and its branches
• Femoral vein and its branches
• Femoral nerve
• Deep inguinal lymph nodes
• The lateral cutaneous nerve of thigh
• Femoral branch of genitofemoral nerve
• Fibrofatty tissue.

Femoral Triangle Mnemonic Femoral triangle: Arrangement of contents

NAVEL

• From lateral hip towards medial navel:
• Nerve (directly behind sheath)
• Artery (within sheath)
• Vein (within sheath)
• Empty space (between vein and lymph)
• Lymphatics (with deep inguinal node).

Question 4. Write a note on the femoral sheath explaining about its boundaries and contents.
Answer:

Femoral sheath

• It is a funnel-shaped sleeve of fascia enclosing the upper 3 to 4 cm of femoral vessels.

Femoral Sheath Boundaries:

• Base
  • Directed upwards
• Apex
  • Directed downwards merging with the connective tissue of femoral vessels
• Anterior wall
  • Formed by fascia transversalis
• Posterior wall
  • Formed by fascia iliaca
• Lateral wall
  • Vertical
• Medial wall
  • Oblique, directed downward, and laterally

The sheath is divided into 3 compartments by septa:

• Lateral/arterial compartment: Contains of:
  • Femoral artery
  • Femoral branch of genitofemoral nerve
• Intermediate/venous compartment: Contains of:
  • Femoral vein
• Medial/lymphatic compartment or femoral canal: Contains:
  • Lymph node of cloquet or rosenmuller
  • Fibrofatty tissue.

Question 5. Write a short note on femoral canal.
Answer:

Femoral Canal

• It is the medial compartment of femoral sheath.
• Conical shape, wide above at base and narrow below about 1.5 cm long and 1.5 cm wide at the base.
• Base is called Femoral ring.
• The boundary of femoral ring is important:
  • Anterior: Inguinal ligament
  • Medial: Sharp edge of lacunar ligament
  • Posterior: Pecten pubis
  • Lateral: Femoral vein.
• Usually, a fatty areolar tissue called the femoral septum closes the femoral ring.

Femoral Canal Clinical Anatomy

• The femoral ring is a weak zone in the groin region.
• When conditions which increase abdominal pressure (for example, pregnancy) or conditions which weaken the femoral ring furthermore (for example, old age), intra-abdominal contents especially loop of the bowel can herniated through it and is known as femoral hernia.
• Femoral hernia is more common in females due to a larger femoral ring as a result of wider pelvis.

Question 6. Enumerate the muscles of front of thigh.
Answer:

Front Of Thigh Intrinsic muscles

• Sartorius
• Quadriceps femoris: 4 muscles
  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedius
  • articularis genu

Front Of Thigh Extrinsic muscles

• Iliacus
• Psoas major
• Pectineus
• Adductor longus
• Tensor fascia lata

Question 7. List all the four muscles belonging to quadriceps femoris with their origin, insertion, nerve supply, and actions.
Answer:

Rest of Muscles of Anterior Compartment of Thigh

Quadriceps Femoris Clinical Anatomy

The anterolateral region of thigh is used for giving intramuscular injections in infants and children and for self-injection in adults since it is the safest.

Question 8. Write a note on adductor or hunters or sub sartorial canal explaining about its extent, boundaries, and contents.
Answer:

Adductor

It is an intramuscular tunnel situated medial 1/3rd of thigh.

Adductor or Hunters or Subsartorial Canal Extend

• Above: Apex of the femoral triangle
• Below: Tendinous opening in the adductor magnus

Adductor or Hunters or Subsartorial Canal Shape

• Triangular on cross-section.

Adductor or Hunters or Subsartorial Canal Boundaries

• Anterolateral wall:
  • Vastus medialis
• Posterior/flor:
  • Adductor longus
  • Adductor Magnus below
• Medial/roof:
  • Strong fibrous membrane
  • Sartorius muscle.

Adductor or Hunters or Subsartorial Canal Contents

• Femoral artery
• Femoral vein
• Saphenous nerve
• Nerve to vastus medialis
• Anterior and posterior division of obturator nerve
• Descending genicular artery.

Adductor or Hunters or Subsartorial Canal Clinical Anatomy

The femoral artery is exposed and ligated in the adductor canal during the surgery for popliteal artery aneurysm known as hunter’s operation.

Front Of Thigh Multiple Choice Questions

Question 1. The Profunda femoris artery leaves the femoral triangle through:

1. Apex
2. Behind the sartorius
3. Between psoas major and pectineus
4. Between pectineus and adductor longus

Answer: 4. Between pectineus and adductor longus

Question 2. Femoral branch of the genitofemoral nerve is located in:

1. Femoral canal
2. Inguinal canal
3. Middle compartment of femoral sheath
4. Lateral compartment of femoral sheath

Answer: 4. Lateral compartment of femoral sheath

Question 3. When the s1 root is irritated, patient experiences pain in which of the following?

1. Medial aspect of thigh
2. Gluteal region
3. Popliteal fossa
4. Lateral side of foot

Answer: 4. Lateral side of foot

Question 4. Which of these pairs does not shares common nerve supply?

1. Soleus and popliteus
2. Gluteus medius and tensor fasciae latae
3. Quadratus femoris and superior gemellus
4. Obturator externus and adductor brevis

Answer: 3. Quadratus femoris and superior gemellus

Question 5. The femoral hernia is manually reduced by pushing the hernia sequentially in the following directions:

1. Upwards, backwards and medially
2. Forwards upwards and laterally
3. Backwards, downwards and medially
4. Downwards, backwards and upwards

Answer: 4. Downwards, backwards and upwards