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OBJECTIVESDescribe the anatomy of femoral triangle &
adductor canal regarding:
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site, boundaries and contents.
Femoral sheath
Femoral canal
Femoral hernia -applied
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SARTORIUS
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ORIGIN
Anterior superior iliac
spine
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INSERTION
S
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Upper part of medialS
surface of tibia
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ACTION
(TAILOR'S POSITION)
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Flexion, abduction &lateral rotation of hip joint
Flexion of knee joint
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PECTINEUS
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ORIGIN:Superior pubic
ramus
INSERTION:
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PP
Back of femur
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(below lessertrochanter)
ACTION:
Flexion &
adduction of hip
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jointILIOPSOAS: ILIACUS & PSOAS MAJOR
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I PM
I P
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M
INSERTION:
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ACTION:Lesser trochanter of femur
Flexion of hip joint
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Femoral triangle
Contents
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? Femoral n.? Femoral sheath
? Femoral a. and its branches
? Femoral vein and its tributaries.
? Femoral canal
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? Deep inguinal lymph nodes? Fatty tissue
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Femoral triangle
Femoral sheath
? A funnel- shaped sheath
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? Derived from transversalisfascia anteriorly and iliac fascia
posteriorly
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? It surrounds the femoral vesselsand lymphatic about 2.5cm
below the inguinal ligament.
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Femoral sheathFemoral sheath
Divided into three
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compartments by two
fibrous septa
? Lateral compartment:
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femoral a.
? Middle compartment:
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femoral v.? Medial compartment:
femoral canal
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The femoral canal
? About 1.3cm long , and its upper
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opening is called the femoral ring
? Content: a little loose fatty tissue, a
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small lymph node of CLOQUET andsome lymph vessels.
? The boundaries of the femoral ring
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? Anteriorly: the inguinal ligament? Medially: the lacunar ligament
? Posteriorly: the pecten of pubis
? Laterally: the femoral vein
? Superior: covered by femoral
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septum
Femoral hernia
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? If a loop of intestine is forced into thefemoral ring, it expands to form a
swelling in the upper part of the thigh.
Such a condition is known as a femoral
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hernia .? A femoral hernia is more common in
women than in men (possibly because
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their wider pelvis and femoral canal ).Femoral Triangle
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Arrangement of Nerve, Artery,Vein
From medial to lateral
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Femoral Vein
V
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Femoral Ar
A tery
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Femoral Ner
N ve
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Profunda femoris
? Arises from the posterolateral surface of
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the femoral artery about 5 cm below theinguinal ligament.
? Branches:
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? Lateral circumflex artery.? Medial circumflex artery.
? Perforating arteries
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Profunda femoris AMedial circumflex a.
Lateral circumflex a.
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perforating arteries
Femoral vein
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? Begins at the adductor
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tendinous opening? Continues as external iliac
vein deep to inguinal ligament
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? Contains several valves
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Femoral nerve
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? Arises from the lumbar plexus in the
abdomen, and enters the thigh posterior to
the inguinal ligament and lateral to the
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femoral artery.? It ends by dividing into a number of
branches 2 cm below the inguinal ligament.
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? Muscular branches to: pectineus, sartorius,
quadriceps femoris
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Femoral nerve
? Cutaneous branches:
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? Anterior cutaneous nerves ofthe thigh
? Saphenous nerve is the
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longest branch of the femoral
nerve. It accompanies the
femoral vessels in the adductor
canal, then accompanies the
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great saphenous vein to themedial side of the leg and food.
Femoral n.
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Femoral a.Femoral v.
Saphenous nerve
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The deep inguinal lymph nodes
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? Lie medial to the femoral v.
? Receive deep lymphatics of
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lower limb, perineal region,and efferent lymphatics from
the superficial inguinal ln.
? Drain into the external iliac
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ln.
Applied/Clinical Anatomy
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? -stab wound at the apex of the femoral triangle may
cut all the large vessels of the lower limb , injury to
femoral vessels results in fatal hemorrhage.
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? -femoral artery is quite superficial in the femoral
triangle thus can be easily exposed for ligation.
catheters are passed upwards till the heart for certain
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minor operations.? -femoral vein is commonly used fir intravenous
infusions in infants.
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Clinical Relevance of the FemoralTriangle
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? Femoral Pulse
? Just inferior to where the femoral artery crosses the
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inguinal ligament, it can be palpated to measure thefemoral pulse.
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? The femoral artery crosses exactly midway betweenthe pubis symphysis and anterior superior iliac spine.
The presence of a femoral pulse means that blood is
reaching the lower extremity.
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Access to the Femoral Artery
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? Within the femoral triangle, the femoral artery
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is located superficially, and thus easy toaccess. This makes it suitable for a range of
clinical procedures.
? One such procedure is coronary angiography.
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? Here, the femoral artery is catheterized with a
long, thin tube. This tube is navigated up the
external iliac artery, common iliac artery,
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aorta, and into the coronary vessels.Cardiac catheterization
? (also called heart catheterization) is a diagnostic and occasionally
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therapeutic procedure that allows a comprehensive examination of
the heart and surrounding blood vessels.
? It enables the physician to take angiograms
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? record blood flow,
? calculate cardiac output and vascular resistance
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? perform an endomyocardial biopsy, and evaluate the heart'selectrical activity.
? Cardiac catheterization is performed by inserting one or more
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catheters (thin flexible tubes) through a peripheral blood vessel in
the arm (antecubital artery or vein) or leg (femoral artery or vein)
under x-ray guidance.
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Coronary artery balloon angioplasty
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? A radioactive dye is thenejected into the coronary
vessels,
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andany
wall
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thickening or blockages can
be
visualized
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via
x-ray
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imaging.? The femoral artery can also
be catheterised to draw
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blood for arterial bloodgases.
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FEMORAL VENOUS CATHETERIZATION? Indications
? Emergency
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venousaccess
during cardiopulmonary resuscitation
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(CPR), in that it provides a rapid andreliable route for the administration of
drugs to the central circulation of the
patient in cardiac arrest
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? In hypotensive trauma patients? Urgent or emergency hemodialysis
access
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? Hemoperfusion access in patients withsevere drug overdose
? Central venous pressure monitoring
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EMBALMING
FEMORAL SHEATH
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? The femoral artery, vein
and canal are contained
within a fascial
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compartment ? knownas the femoral sheath.
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THE FEMORAL CANAL
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? The femoral canal is an anatomical
compartment, located in the anterior thigh. It
is the smallest and most medial part of
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the femoral sheath.? It is approximately 1.3cm long.
FEMORAL CANAL - BOUNDARIES
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? The femoral canal is located in the anterior
thigh, within the femoral triangle. It can be
thought of as a rectangular shaped
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compartment.? It has four borders and an opening:
? Medial border ? Lacunar ligament.
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? Lateral border ? Femoral vein.
? Anterior border ? Inguinal ligament.
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? Posterior border ? Pectineal ligament,superior rami of the pubi and the pectineus
muscle
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Borders of the femoral canal
? The opening to the femoral canal is located at its
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superior border, known as the femoral ring. The
femoral ring is closed by a connective tissue layer ?
the femoral septum.
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? This septum is pierced by the lymphatic vessels
exiting the canal.
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CONTENTS
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? The femoral canal contains:? Lymphatic vessels ? draining the deep
inguinal lymph nodes.
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? Deep lymph node ? the lacunar node.
? Empty space.
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? Loose connective tissue.? The empty space allows distension of the
adjacent femoral vein, so it can cope with
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increased venous return, or increased intra-abdominal pressure..
Clinical Relevance: Femoral Hernia
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? The femoral canal is of particular clinical importance,
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as it a common site of bowel herniation.? A hernia is defined as `where an internal part of the
body pushes through a weakness in the muscle or
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surrounding tissue wall`.? In a femoral hernia, part of the small intestine
protrudes through the femoral ring.
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FEMORAL HERNIA
? It presents as a lump
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situated inferolaterally to
the pubic tubercle.
? more common in women
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due to
? their wider bony pelvis
? Narrower blood vessels
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FEMORAL HERNIA
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? The borders of the femoral canalare tough, and not particularly
extendible.
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? This can compress the hernia,
interfering with its blood supply.
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A hernia with a compromisedblood supply is known as
a strangulated hernia
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Femoral Canal
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? During open femoral hernia repair lacunar ligament may
have to be incised ? this puts an accessory obturator artery
at risk
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? 50% of people have an accessory or abnormal obturator
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artery? Accessary Obturator Artery:
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? Deep inferior epigastric gives a pubic branch to the
periosteum of superior pubic ramus ? this anastamoses
with the pubic braches of obturator artery
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? If obturator artery absent ? then this anastamosis is
patent
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Cross-section of the thigh, showing
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the borders of the adductor canal.
Note: the adductor magnus is not visible in this
illustration
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CONTENTS
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? The adductor canal serves as a passageway fromstructures moving between the anterior thigh and
posterior leg.
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? It contains the femoral artery, femoral vein, nerve to
the vastus medialis and the saphenous nerve (the
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largest cutaneous branch of the femoral nerve).? As the femoral artery and vein exit the canal, they
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become the popliteal artery and vein respectively.
Clinical Relevance ? Adductor Canal
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Block
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? In the adductor canal block, local anaesthetic isadministered in the adductor canal to block
the saphenous nerve in isolation, or together
with the nerve to the vastus medialis.
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? The block can be used to provide sensory
anaesthesia for procedures involving the distal
thigh and femur, knee and lower leg on the
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medial side.? The sartorius and femoral artery are used as
anatomical landmarks to locate the saphenous
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nerve.Adductor Canal Compression
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Syndrome? Adductor
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canal
compression
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syndromedescribes entrapment of the neurovascular
bundle within the adductor canal.
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? caused by hypertrophy of adjacent muscles suchas vastus medialis.
? It is most common in young males, who may
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present with claudication symptoms due to
femoral artery occlusion (more common) or
neurological symptoms due to entrapment of the
saphenous nerve.
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Adductor canal
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? An intermuscular cleft situated on the medial aspect of
the middle third of the thigh beneath the sartorius.
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? Extends from apex of femoral triangle to adductortendinous opening
? Boundies
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? Anterior wall: adductor lamina and sartorius
? Lateral wall : vastus medialis
? Posteomedial wall: adductors longus and magmus
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? Contents? Saphenous n.
? Femoral a. and femoral v.
? lymphatic vessels and loose connective tissue
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Femoral triangle / RELATIONS
Deep contents
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?Femoral a. & v.surrounded by
femoral sheath
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?Profunda
femoris a. ?
principal artery
of thigh
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?Lat and med.
femoral
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circumflex aa.?Deep external
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pudendal a.?Femoral n.
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?A few deeper
lymph nodes --
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Anterior view
Femoral triangle / RELATIONS
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Anterior view
Blood vessels and nerve of medial side of thigh
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? Obturator a.? Arises from internal iliac artery in the
lesser pelvis
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? passes through the obturator canal where
it divides into anterior and posterior
branches.
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? Obturator n.
? Arises from the lumbar plexus in the
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abdomen.? Enters the thigh through the obturator
canal where it divides into anterior and
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posterior branches.? Supplies medial group of muscles of thigh,
obturator externus, and skin of medial
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side of thighTest
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QuestionAnswer
? What is the midinguinal
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? ? way between PS and ASIS
point?
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? Name the structure for
? Femoral artery
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which the midinguinal pointis a landmark?
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Test
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Question
Answer
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? What is the Midpoint of? ? way between PT and ASIS
Inguinal Ligament?
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? Name the structure for
? Deep inguinal ring
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which the midinguinal point
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Test
Question
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Answer? What are the
? Anterior ? medial part of inguinal
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borders of the
ligament
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Femoral Ring?? Lateral ? femoral vein
? Posterior ? pectineal ligament and
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pectaneus
? Medial ? crescentic edge of
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lacunar ligament