Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Medial Side of the Thigh Lecture PPT
BOUNDARIES
? Anteriorly by anterior intermuscular septum
which separates it from the anterior (extensor)
compartment of the thigh.
? Posteriorly by posterior intermuscular septum
(ill-defined) which separates it from posterior
(flexor) compartment of the thigh.
? Muscles of the medial compartment of the thigh
? Pectineus
? Adductor longus
? Gracilis
? Adductor brevis
? Adductor magnus
Anterior (first) layer pectineus, adductor longus, and gracilis
Middle (second) layer adductor brevis
Posterior (third) layer adductor magnus
Origin and insertion of the pectineus and adductor longus
Origin and insertion of the adductor brevis
Origin and insertion of the adductor magnus and gracilis
Muscle
Nerve supply
Actions
Pectineus Femoral nerve and
Adduction of the thigh
obturator nerve (anterior division)
Adductor Obturator nerve (anterior division) Adduction & medial
longus
rotation of thigh
Adductor Obturator nerve (anterior and
Adduction of thigh
brevis
posterior divisions)
Adductor Adductor part obturator nerve
Adduction and medial
magnus
(posterior division)
rotation of thigh
Hamstring part tibial part of
Weak extension of hip
sciatic nerve
joint
Gracilis
Obturator nerve (anterior division) Adduction of thigh
Flexion and medial
rotation of leg
OBTURATOR NERVE
? Chief nerveadductor compartment of the thigh.
? Arises fromlumbar plexus in the abdomen
? Formed by the ventral division of the anterior
primary rami of L2, L3, L4 spinal nerves.
? Enters the thigh by passing through the obturator
canal.
Course
? In the obturator canal the obturator nerve divides
into anterior and posterior divisions.
? Anterior division passes downwards into the thigh
in front of the obturator externus.
? Then it descends behind the pectineus and the
adductor longus, and in front of the adductor brevis.
? Posterior division enters the thigh by piercing the
anterior part of the obturator externus muscle
? Then it descends behind the adductor brevis and in
front of the adductor magnus.
Distribution
? Anterior division
? Pectineus
? Adductor longus
? Adductor brevis
? Gracilis
? Articular twig to the hip joint
? In adductor canal:
a twig to the subsartorial plexus of nerves.
terminates by supplying the femoral artery.
Distribution cont...
? Posterior division
? Obturator externus
? Adductor magnus
? Adductor brevis
? Its terminal part forms an articular branch
called genicular branch, to supply the knee
joint.
ACCESSORY OBTURATOR NERVE
? Arises from the lumbar plexus.
? Formed by the ventral divisions of the anterior
primary rami of L3, L4 spinal nerves
? It crosses the superior ramus of pubis deep to
pectineus, which it supplies.
? An articular twig to the hip joint
? Terminates by communicating with the anterior
division of the obturator nerve
GLUTEAL REGION
? The gluteal region
overlies the back and
side, of the lateral half of
the pelvis.
? Extent
? Superiorly--iliac crest
? Inferiorly--gluteal fold
? Medially--mid-dorsal line
and natal cleft
? Laterally--anterior
superior iliac spine to the
anterior edge of the
greater trochanter
Cutaneous nerves of the gluteal region
Deep fascia of the gluteal region
? Attached above to the iliac crest and behind to
the sacrum
? It splits to enclose the tensor fasciae latae and
gluteus maximus.
? Between tensor fasciae latae and gluteus
maximus is a thick fascial sheet called gluteal
aponeurosis which covers the gluteus medius
? Laterally, the deep fascia is continuous with the
iliotibial tract.
Gluteal ligaments (sacrotuberous and sacrospinous ligaments)
Structures passing through the greater sciatic foramen
? 1.Above the piriformis:
a) Superior gluteal nerve and vessels
? 2.Below the piriformis:
a) Inferior gluteal nerve and vessels.
b) Sciatic nerve (most lateral structure).
c) Posterior cutaneous nerve of the thigh.
d) Nerve to quadratus femoris.
e) Pudendal nerve.
f) Internal pudendal vessels.
g) Nerve to obturator internus
? Structures passing through the lesser sciatic
foramen
a) Tendon of obturator internus.
b) Nerve to obturator internus.
c) Internal pudendal vessels.
d) Pudendal nerve
MUSCLES OF THE GLUTEAL REGION
? Major muscles
(a) Gluteus maximus.
(b) Gluteus medius.
(c) Gluteus minimus.
(d) Tensor fasciae latae.
? Minor muscles
(a) Piriformis
(b) Superior and inferior gemelli.
(c) Obturator internus.
(d) Quadratus femoris.
(e) Obturator externus
Structures under cover of the gluteus maximus
Muscle
Nerve supply
Actions
Gluteus maximus
Inferior gluteal nerve
Chief extensor of the hip joint
(L5; S1, S2)
Assists in getting up from sitting position
Gluteus medius
Superior gluteal nerve
Abductor of the hip joint
(L5; S1)
Prevents the sagging of pelvis on the
unsupported side
Gluteus minimus
Superior gluteal nerve
Abductor of the hip joint
Tensor fasciae latae Superior gluteal nerve
Supports the femur on tibia during
standing position
Piriformis
Ventral rami of S1, S2
Lateral rotator of the thigh at hip joint*
Gemellus superior
Nerve to obturator
*
internus (L5; S1, S2)
Gemellus inferior
Nerve to quadratus
*
femoris (L4; L5, S1)
Obturator internus
Nerve to obturator
*
internus
Quadratus femoris
Nerve to quadratus
*
femoris (L4; L5, S1)
SUPERIOR GLUTEAL ARTERY
? Branch of the posterior division of internal iliac
artery.
? Divides Superficial and Deep branches
? Superficial branchbetween gluteus medius and
maximus, and supplies both of them.
? Deep branchbetween gluteus medius and
minimus
? subdivides into upper and lower branches
? Upper branch-- spinous anastomosis (ASIS)
? Lower branch-- trochanteric anastomosis
INFERIOR GLUTEAL ARTERY
? Branch of anterior division of the internal iliac artery.
? Branches:
i)Muscular branches to the adjacent muscles.
ii)Anastomotic branches to cruciate and trochanteric
anastomoses.
iii)Artery to sciatic nerve
TRENDELENBURG'S SIGN
? The gluteus medius and minimus prevent the
unsupported side of the pelvis from sagging during
walking
? When the gluteus medius and minimus of one side
are paralyzed due to injury of the superior gluteal
nerve.
? The pelvis sags on the healthy side if that foot is off
the ground.
? As a result, the person walks with a lurching gait
Intramuscular injection in gluteal region
This post was last modified on 30 November 2021