sheet no .17

Femoral triangle :



**Thigh is the part of the lower limb extending from the hip joint to the knee joint

**Great.S.V-->drains in femoral vien
Small.S.V-->drains in popliteal vien

*iliotibial tract:

O: iliac tubercle-

Ins: lateral condyle of tibia-

it receives the insertion of two muscles-

**All anterior compartment are supplied by femoral nerve
Except:

-Pectineus (usually femoral nerve/occasionally-->obturator nerve)
-Psoas major -->lumbar plexus
**Iliacus/psoas major
(connected by iliopsoas tendon)
-O: iliac fossa(iliacus)/ vertebral column(psoas)
-Ins: lesser trochanter (both)
-AC: prime flexors of hip

**Sartorius:
-O:ASIS(lat.)
-Ins: upper medial surface of tibia(SGS),(sartorius gracellec semi-tendonus)
-Ac: flex hip/flex knee
**rectus femoris:
-Ac: flex hip/extend knee

**Sartorius/rectus femoris-->the only two muscles crossing two joints.

**Vastus lat./ vastus med./ vestus in.m. à cross one joint up only.

**Law of muscles: if a muscle crossing the joint it must perform two different actions on them like rectus femoris (pro: flexion/ dis: extension) but sartorius is an EXCEPTION.

Inguinal ligament

- it is the lower enrolled part of the aponeurosis of the external oblique muscle of the abdomen

-this extends between ASIS and superior pubic ramus at an area called pubic tubercle .
-This will form a line of demarkation(land mark) between Abdomen and thigh.
-It also acts as a bridge which passing below it :( from lateral to medial):
(NAV)
1. Femoral nerve(N)
2. Femoral artery (A)
3-femoral vein(V)
4-ilicus
5-psoas major


Femoral triangle:

▲aspect at anteriomedial aspect of thigh.


1) Borders (boundaries):
- inguinal ligament(Sup.)
- Sartorius(Lat.)
- adductor longus(Med.)

2) Roof :(from superficial to deep)
1.skin
2.Superficial fascia
3. great saphenous vein
4.Saphenous opening
5.Deep fascia of the thigh

3) Floor:( from Med. to lat)

1. Adductor longus
2. Pectineus
3. psoas
4. illiacus

4) Contents: from Lat to Med:

1. femoral nerve and branches
2. femoral art. and branches
3. Femoral vein and tributaries
4. deep inguinal lymph nodes (they drain the deep structures of the lower limb).

Femoral artery

Above external iliac artery**
Below popliteal artery
**within femoral triangle superficial
Behind Sartorius deep

** Aorta gives two branches 1.right common iliac artery
2. left common iliac artery
*each one gives external illiac artery to the lower limbs
internal iliac artery to the pelvis
*femoral artery passing through the femoral triangle
*the main arterial supply of the L.L is femoral artery which is:

1- direct continuation of external illiac artery.
2-start behind the midinguinal point(good clinical mark) then it descend within femoral triangle
there, it is superficial compared to its distal part. (disappear below the sartorius muscle)
3-then it descend down behind sartorius to appear behind knee joint in a space called popliteal fossa there it is called popliteal artery
4- it's terminal end is where it pass through adductor opening to give popliteal artery

Importance:
1-feel the pulse because it is superficial
2-take blood samples
3-give fluids and drugs
4-cardiac catheterization(reach heart from femoral artery)

Branches:
1.profunda femoris artery
- largest branch of the femoral artery
- begins lateral then descend down giving four perforating arteries which will supply the Med. compartment and post. compartment of the thigh.

*4 perforating arteries pass through the 4 openings of the adductor mangus muscle to supply post.C
2. muscular branches: for all the muscles of the anterior compartment
3. articular branches: to the hip and knee joints
Femoral nerve
O: posterior divisions of ventral rami of the L2, L3, L4
(give extensorsàin Ant. C)

>>then leave the abdomen continue to pass below inguinal ligament to reach femoral triangle giving the following branches:
1. muscular branches
2. articular branches: to the hip and knee joints
3. cutaneous branches

*** The longest one of them is called saphenous n. that accompanies the great saphenous vein all through it's pathway.

***Notes:
1)Axilla resembles Femoral triangle
Cubita fossa resembles popliteal fossa
Cephalic.V resembles G.S.V
Basailic.V resembles S.S.V
2)some fibers of vastus lateralis and medialis form what we call retinaculum.
3)quadriceps femoris is inserted into tibial tuberositiy via patellar ligament






I dedicate this sheet to all my friends specially:

Dr.Shahed thaer / Dr.yazan radaideh / Dr. abeer khawatrah/ Dr. yezan 3toom/ Dr.omar radaideh/Dr. sami abdeen /Dr. ahmad abed /Dr. hamzeh saraireh /Dr. farah mshakbeh/Dr. manar jwainat/ najadeh,luma twal ,dina khozouz,omar semreen, ksa,wala2 karadsheh!!
Also:
Dr. abdallah nsoor/Dr. qais radaideh/Dr. khaled mosa/Dr tareq rfoo3 Dr. naser 3'raibeh/Dr abdallah shawabkeh from 2nd year!!

Special thanks to my brother RAMI TAWALBEH for printing this sheet for me!!!!