Download MBBS Medial Side of the Thigh Lecture PPT

BOUNDARIES

? Anteriorly by anterior intermuscular septum

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which separates it from the anterior (extensor)

compartment of the thigh.

? Posteriorly by posterior intermuscular septum

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(ill-defined) which separates it from posterior

(flexor) compartment of the thigh.

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? Muscles of the medial compartment of the thigh
? Pectineus
? Adductor longus

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? Gracilis
? Adductor brevis
? Adductor magnus

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Anterior (first) layer pectineus, adductor longus, and gracilis


Middle (second) layer adductor brevis

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Posterior (third) layer adductor magnus


Origin and insertion of the pectineus and adductor longus

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Origin and insertion of the adductor brevis

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Origin and insertion of the adductor magnus and gracilis
Muscle

Nerve supply

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Actions

Pectineus Femoral nerve and

Adduction of the thigh

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obturator nerve (anterior division)

Adductor Obturator nerve (anterior division) Adduction & medial

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longus

rotation of thigh

Adductor Obturator nerve (anterior and

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Adduction of thigh

brevis

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posterior divisions)

Adductor Adductor part obturator nerve

Adduction and medial

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magnus

(posterior division)

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rotation of thigh

Hamstring part tibial part of

Weak extension of hip

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sciatic nerve

joint

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Gracilis

Obturator nerve (anterior division) Adduction of thigh

Flexion and medial

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rotation of leg
OBTURATOR NERVE

? Chief nerveadductor compartment of the thigh.

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? Arises fromlumbar plexus in the abdomen
? Formed by the ventral division of the anterior

primary rami of L2, L3, L4 spinal nerves.

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? Enters the thigh by passing through the obturator

canal.
Course

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? In the obturator canal the obturator nerve divides

into anterior and posterior divisions.

? Anterior division passes downwards into the thigh

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in front of the obturator externus.

? Then it descends behind the pectineus and the

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adductor longus, and in front of the adductor brevis.

? Posterior division enters the thigh by piercing the

anterior part of the obturator externus muscle

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? Then it descends behind the adductor brevis and in

front of the adductor magnus.

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Distribution

? Anterior division
? Pectineus
? Adductor longus

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? Adductor brevis
? Gracilis
? Articular twig to the hip joint
? In adductor canal:
a twig to the subsartorial plexus of nerves.

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terminates by supplying the femoral artery.

Distribution cont...

? Posterior division

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? Obturator externus
? Adductor magnus
? Adductor brevis
? Its terminal part forms an articular branch

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called genicular branch, to supply the knee

joint.
ACCESSORY OBTURATOR NERVE

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? Arises from the lumbar plexus.
? Formed by the ventral divisions of the anterior

primary rami of L3, L4 spinal nerves

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? It crosses the superior ramus of pubis deep to

pectineus, which it supplies.

? An articular twig to the hip joint

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? Terminates by communicating with the anterior

division of the obturator nerve

GLUTEAL REGION

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? The gluteal region

overlies the back and

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side, of the lateral half of

the pelvis.

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? Extent
? Superiorly--iliac crest
? Inferiorly--gluteal fold
? Medially--mid-dorsal line

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and natal cleft

? Laterally--anterior

superior iliac spine to the

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anterior edge of the

greater trochanter

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Cutaneous nerves of the gluteal region
Deep fascia of the gluteal region

? Attached above to the iliac crest and behind to

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the sacrum

? It splits to enclose the tensor fasciae latae and

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gluteus maximus.

? Between tensor fasciae latae and gluteus

maximus is a thick fascial sheet called gluteal

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aponeurosis which covers the gluteus medius

? Laterally, the deep fascia is continuous with the

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iliotibial tract.



Gluteal ligaments (sacrotuberous and sacrospinous ligaments)

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Structures passing through the greater sciatic foramen

? 1.Above the piriformis:

a) Superior gluteal nerve and vessels

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? 2.Below the piriformis:

a) Inferior gluteal nerve and vessels.

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b) Sciatic nerve (most lateral structure).

c) Posterior cutaneous nerve of the thigh.

d) Nerve to quadratus femoris.

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e) Pudendal nerve.

f) Internal pudendal vessels.

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g) Nerve to obturator internus

? Structures passing through the lesser sciatic

foramen

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a) Tendon of obturator internus.
b) Nerve to obturator internus.
c) Internal pudendal vessels.
d) Pudendal nerve

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MUSCLES OF THE GLUTEAL REGION

? Major muscles
(a) Gluteus maximus.

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(b) Gluteus medius.
(c) Gluteus minimus.
(d) Tensor fasciae latae.

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? Minor muscles
(a) Piriformis
(b) Superior and inferior gemelli.
(c) Obturator internus.
(d) Quadratus femoris.

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(e) Obturator externus



Structures under cover of the gluteus maximus

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Muscle

Nerve supply

Actions

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Gluteus maximus

Inferior gluteal nerve

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Chief extensor of the hip joint

(L5; S1, S2)

Assists in getting up from sitting position

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Gluteus medius

Superior gluteal nerve

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Abductor of the hip joint

(L5; S1)

Prevents the sagging of pelvis on the

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unsupported side

Gluteus minimus

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Superior gluteal nerve

Abductor of the hip joint

Tensor fasciae latae Superior gluteal nerve

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Supports the femur on tibia during

standing position

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Piriformis

Ventral rami of S1, S2

Lateral rotator of the thigh at hip joint*

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Gemellus superior

Nerve to obturator

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*

internus (L5; S1, S2)

Gemellus inferior

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Nerve to quadratus

*

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femoris (L4; L5, S1)

Obturator internus

Nerve to obturator

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*

internus

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Quadratus femoris

Nerve to quadratus

*

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femoris (L4; L5, S1)
SUPERIOR GLUTEAL ARTERY

? Branch of the posterior division of internal iliac

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artery.

? Divides Superficial and Deep branches
? Superficial branchbetween gluteus medius and

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maximus, and supplies both of them.

? Deep branchbetween gluteus medius and

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minimus

? subdivides into upper and lower branches
? Upper branch-- spinous anastomosis (ASIS)
? Lower branch-- trochanteric anastomosis

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INFERIOR GLUTEAL ARTERY

? Branch of anterior division of the internal iliac artery.
? Branches:

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i)Muscular branches to the adjacent muscles.
ii)Anastomotic branches to cruciate and trochanteric

anastomoses.

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iii)Artery to sciatic nerve
TRENDELENBURG'S SIGN

? The gluteus medius and minimus prevent the

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unsupported side of the pelvis from sagging during

walking

? When the gluteus medius and minimus of one side

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are paralyzed due to injury of the superior gluteal

nerve.

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? The pelvis sags on the healthy side if that foot is off

the ground.

? As a result, the person walks with a lurching gait

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Intramuscular injection in gluteal region