The Thigh Region
Dr Funmilayo Olopade
Fascia of the lower limbs
• Fascia is a sheet or band of fibrous tissue lying deep
to the skin. It lines, invests, and separates structures
within the body.
• There are three main types of fascia:
• Superficial fascia – blends with the reticular layer
beneath the dermis.
• Deep fascia – envelopes muscles, bones, and
neurovascular structures.
• Visceral fascia – provides membranous investments
that suspend organs within their cavities.
Superficial fascia
• This the layer of tissue that underlies the skin. Made
up of layers of membranes, loosely packed interwoven
collagen and elastic fibers
• It is thicker in the torso and gets thinner in the arms
and legs. Sometimes contains muscle fibers, which
help create certain structures in the body.
Superficial fascia
• Mainly made up of adipose tissue (fat)
and within it travel the superficial veins
and lymphatics, and nerves.
• The thickness and content of superficial
fascia varies by body location, in sexes
and by climate.
Superficial fascia: Functions
• The superficial fascia is made up of a network of
blood arteries, nerves, and lymphatic vessels that
assist in its functions. These include:
• It insulates the body (thermoregulation)
• Stores fat as energy
• Offers cushioning (fat pad) for underlying tissues
• Provides a lubricating layer for skin movement,
Modifications
• With skeletal muscles eg platysma
• With smooth muscles eg subareola muscles of
the nipple, dartos muscle of the scrotum
Deep fascia
• The deep fascia is a thick, fibrous
connective tissue layer, containing
collagen fibres and lies under the
superficial fascia. It protects muscles,
bones, nerves, blood vessels, and
organs. It connects to bones,
tendons, and ligaments, producing a
continuous network of support.
Deep fascia - Functions
• Dense connective tissue contain collagen fibres. This
thick structure offers strength and stability.
• Serves as a structural framework, dividing and
supporting muscles and other tissues. It also conveys
the force generated by muscle contractions and aids in
body posture.
• Deep fascia also forms compartments throughout the
body, which keeps muscles organised and prevents
them from rubbing against one another.
• Deep fascia creates fascial compartments that contain
distinct muscle groups, blood vessels, and nerves
(investing fascia).
• The deep fascia of the lower limb is
very strong and invests the limb like
stockings.
• The deep fascia of the thigh is called
Fascia lata. Thickened laterally to form
Iliotibial tract.
• Crural Fascia – Deep fascia of the leg, a
downward extension of fascia lata
Deep fascia of the thigh (Fascia lata)
• The fascia lata varies in thickness and is
continuous with the deep fascia of the
hip. It is thicker in the proximal and
lateral aspects of the thigh where it
attaches to the gluteus maximus and
tensor fasciae latae muscles. It is also
thick around the knee joint.
• It begins proximally around the iliac
crest and inguinal ligament and ends
distal to the bony prominences of the
tibia.
• There are three modifications of the fascia lata, which
are known as the:
• Iliotibial tract – a thickening on the lateral aspect of the
thigh, tensed by tensor fascia lata
• Intermuscular septae - two intermuscular septa formed
by the fascia lata and these septa form the anterior,
posterior and medial compartments of the thigh.
• Saphenous opening - an ovoid opening 3 cm lateral to
the pubic tubercle, which allows the passage of the long
saphenous vein and lymphatic vessels
Clinical considerations
• Fascia lata grafts – A popular choice for post-
operative grafts to facilitate tissue regeneration and
healing in large wounds
• Also used in reconstructive surgery e.g., heart valve
replacements, sling for Tx of urinary incontinence
• Necrotizing fasciitis is a rare and sometimes fatal soft-
tissue infection that is a medical and surgical
emergency. It is due to inflammation and necrosis at
multiple layers including fascia, muscle, subcutaneous
fat, and subsequent necrosis of overlying skin.
The thigh - Introduction
• The thigh muscles are divided into 3
compartments by intermuscular septa which
pass from the deep fascia (Fascia lata) to the
linea aspera.
Compartments of the thigh
• The compartments are:
• Anterior or extensor
• Medial or adductor
• Posterior or flexor
• Based on location or action at the knee joint
Compartments of the thigh
Innervation
• In general, the innervation of the
groups of muscles are:
• Anterior group by Femoral Nerve
• Medial group by Obturator nerve
• Posterior group by Tibial portion of
Sciatic nerve
Anterior compartment
• Largest compartment of the thigh
• The muscles of the anterior
compartment of the thigh are a group
of muscles that (mostly) act to extend
the lower limb at the knee joint. Are
also flexors of the hip
• They are collectively innervated by the
femoral nerve (L2-L4), and receive
arterial supply from the femoral
artery.
Iliopsoas
• The iliopsoas is comprised of two separate
muscles; the psoas major and iliacus.
• These muscles arise in the pelvis and pass
under the inguinal ligament into the
anterior compartment of the thigh –
where they form a common tendon.
• Unlike many of the anterior thigh muscles,
the iliopsoas does not perform extension
of the leg at the knee joint, but acts to flex
the hip joint..
Quadriceps femoris
• Four headed muscle made up of
– Rectus femoris (anterior inferior iliac spine, ilium)
– Vastus lateralis (greater trochanter, linea aspera)
– Vastus intermedius (anterior, lateral femur)
– Vastus medialis (intertrochanteric line, linea aspera)
• It forms the main bulk of the anterior thigh, and
is one of the most powerful muscles in the body.
• Common tendon of insertion to knee
(Quadriceps tendon), continues as patella
ligament, inserts in tibial tuberosity
• Sartorius –It is long and thin, running
across the thigh in a inferomedial
direction. From ASIS to the superior,
medial surface of the tibia. Weak hip and
knee flexor. The sartorius is most
superficially placed muscle in thigh
• Pectineus – This is a flat, quadrangular-
shaped muscle, (pectineal line of the
pubis bone, the posterior aspect of the
femur), adducts and flexes hip joint
Medial Thigh Muscles
• Muscles in the medial compartment of
the thigh are collectively known as the hip
adductors/adductor group of muscles.
• They are attached proximally to
anteroinferior part of pelvic bone and
distally to the linea aspera.
• All the medial thigh muscles are
innervated by the obturator nerve, which
arises from the lumbar plexus. Arterial
supply is through the obturator artery.
• Consists of –
• Adductor magnus
• Adductor longus
• Adductor brevis
• Obturator externus
• Gracilis
• Adductor magnus: The largest muscle in the
medial compartment of the thigh. From rami of
pubis and ischium, to the linea aspera. Acts as
adductor and flexor of the thigh.
• Adductor longus: Large, flat muscle, from the
pubis of the pelvis and expands into a fan shape.
Adducts the thigh
• Adductor brevis: a short muscle, lying under the
adductor longus (From the body and inferior
pubic rami to linea aspera). It separates the
anterior and posterior branches of the obturator
nerve and is an important anatomical landmark
within the medial thigh. Adducts the thigh
• Obturator externus: One of the smaller
muscles of the medial thigh located
superiorly within the compartment. Runs
from membrane of the obturator
foramen to greater trochanter. Adductor
and lateral rotator
• Gracilis: The most superficial and medial
of these muscles. Runs from inferior rami
and body of the pubis, to medial surface
of the tibial shaft. It crosses at both the
hip and knee joints. Adducts the thigh
and flexes the leg at the knee.
• The main action of the
adductor muscles is to pull
the thigh medially toward the
median plane. They
constitute a very large mass
and much may be loss with
minimal loss of function
• Adductor canal is an opening
within the adductor magnus
which transmits the femoral
vessels from the thigh to
behind the knee
Posterior thigh muscles
• The muscles in the posterior
compartment of the thigh are
collectively known as the hamstrings.
They collectively act to extend at the hip
and flex at the knee.
• They are innervated by the sciatic nerve
(L4-S3), with arterial supply from the
inferior gluteal artery and perforating
branches of the deep femoral artery.
Posterior thigh Muscles
• Three of the four muscles in the posterior
thigh are collectively called the hamstring
muscles.
• Hamstring muscles have following features:
– Origin is ischial tuberosity
– Insert into the leg bones
– Span and act on 2 joints
– Innervated by the tibial part of sciatic
They extend the hip joint and flex the
knee joint
• The muscles include:
– Semitendinosus
– Semimembranosus
– Long head of biceps femoris
The short head of biceps femoris is not
one of the hamstrings (originates from linea
aspera) but is in the posterior thigh.
• Biceps femoris: has two heads (long head and
short head) and is the most lateral of the
muscles in the posterior thigh. Inserts into
fibula. Flexes the knee, extends the thigh at the
hip, and laterally rotates at the hip and knee
• Semitendinosus: a largely tendinous muscle
situated on the medial aspect of the posterior
thigh. Inserts into medial tibia. Flexion of the leg
at the knee joint. Extension of thigh at the hip.
• Semimembranosus: flat and broad muscle,
located deep to the semitendinosus. Inserts into
the medial tibial condyle. Flexion of the leg at
the knee joint. Extension of thigh at the hip.
Femoral triangle
• The femoral triangle is a wedge-
shaped sub-fascial depression
located within the superomedial
aspect of the anterior thigh. It is
inferior to the inguinal ligament.
• It acts as a conduit for structures
entering and leaving the anterior
thigh.
Borders
• It is bounded:
– Superiorly by inguinal ligament
– Medially by lat. border of Add. Longus
– Laterally by the satorius
• The apex is where the lateral border
of satorius crosses the medial border
of Adductor longus. Base ing. Lig.
• Floor is iliopsoas & pectineus Ms
• Roof is fascia lata, subcutaneous
fascia and skin.
Femoral triangle - Contents
• The femoral triangle serves as a
passageway for the neurovascular
bundle from the pelvis to the lower
limbs
• From lateral to medial:
– Femoral nerve and its branches
– Femoral artery and its branches
– Femoral vein and its tributaries
– Deep inguinal lymph nodes in femoral
canal
The femoral vessels are enclosed
Clinical significance
• Palpation of femoral artery pulse
• Cannulation of the femoral vein
• Cardiac catheterization
• Femoral hernia
Adductor (Hunter’s) Canal
• The Hunter's canal (subsartorial, adductor
canal) is an intermuscular tunnel in the middle
third of the thigh (15cm long), extending from
the apex of the femoral triangle to the
opening in the adductor magnus, the adductor
hiatus.
• The adductor canal serves as a passageway for
structures moving between the anterior thigh
and posterior leg.
Borders
• The adductor canal is bordered by muscular
structures:
• Anteromedial – Sartorius.
• Lateral – Vastus medialis.
• Posterior – Adductor longus and adductor
magnus.
Contents
• Adductor canal transmits the femoral artery,
femoral vein (posterior to the artery) and the
saphenous nerve – the largest cutaneous branch of
the femoral nerve. Some authors include the nerve
to vastus medialis (before it enters the muscle) as a
content of the adductor canal.
• As the femoral artery and vein exit the canal, they
are called the popliteal artery and vein
respectively.
Clinical significance
• The adductor canal block: local anaesthetic is
administered in the adductor canal to block the
saphenous nerve in isolation, or together with the
nerve to the vastus medialis. This can be used to
provide sensory anaesthesia for procedures involving
the distal thigh and femur, knee and lower leg on the
medial side.
• Adductor canal compression syndrome: entrapment
of the neurovascular bundle within the adductor canal.
A rare condition, it is usually caused by hypertrophy of
adjacent muscles such as vastus medialis. It is most
common in young physically active male
Gluteal Region
Gluteal region
• This is the prominent area posterior to the
pelvis which acts as a transitional zone
between the trunk and lower limb
• The gluteal region is an anatomical area
located posteriorly to the pelvic girdle, at the
proximal end of the femur. The muscles in this
region move the lower limb at the hip joint.
• Intergluteal (natal) cleft is the groove
which separates the buttocks from
each other.
• The gluteal muscles form the bulk of
the region
• Gluteal fold demarcates the inferior
boundary of the buttock and the
superior boundary of the thigh
• The muscles of the gluteal region can be broadly
divided into two groups:
• Superficial abductors and extenders – group of large
muscles that abduct and extend the femur. Includes
the gluteus maximus, gluteus medius, gluteus
minimus and tensor fascia lata.
• Deep lateral rotators – group of smaller muscles that
mainly act to laterally rotate the femur. Includes the
quadratus femoris, piriformis, gemellus superior,
gemellus inferior and obturator internus.
The Superficial Muscles
• They mainly act to abduct and extend the lower
limb at the hip joint.
• Gluteus Maximus: The largest and most superficial
of the gluteal muscles, producing the shape of the
buttocks. (From the gluteal (posterior) surface of
the ilium, sacrum and coccyx, slopes at a 45° and
inserts onto the iliotibial tract and gluteal
tuberosity of the femur. It is the main extensor of
the thigh, and assists with lateral rotation. Inferior
gluteal nerve.
Gluteus Medius
• This muscle is fan-shaped and lies between to the
gluteus maximus and the minimus. It is similar in
shape and function to the gluteus minimus. (From
the gluteal surface of the ilium and inserts into the
lateral surface of the greater trochanter).
• Actions: Abduction and medial rotation of the lower
limb. It stabilises the pelvis during locomotion,
preventing ‘dropping’ of the pelvis on the
contralateral side.
• Innervation: Superior gluteal nerve
Gluteus minimus
• This is the deepest and smallest of the superficial
gluteal muscles. It is similar in shape and function
to the gluteus medius. (From the ilium and
converges to form a tendon, inserting to the
greater trochanter).
• Actions: Abduction and medial rotation of the
lower limb. It stabilises the pelvis during
locomotion, preventing ‘dropping’ of the pelvis on
the contralateral side.
• Innervation: Superior gluteal nerve.
Tensor fasciae lata
• Tensor fasciae lata is a small superficial muscle
which functions to tighten the fascia lata, and
so abducts and medially rotates the lower limb.
(From the anterior iliac crest, attaching to the
ASIS, it inserts into the iliotibial tract, which
attaches to the lateral condyle of the tibia.
• Actions: Assists the gluteus medius and
minimus in abduction and medial rotation of
the lower limb. It also plays a supportive role in
the gait cycle.
• Innervation: Superior gluteal nerve.
Deep gluteal muscles
• The deep gluteal muscles are a set of smaller
muscles, located underneath the gluteus
minimus. The general action of these muscles
is to laterally rotate the lower limb. They also
stabilise the hip joint by ‘pulling’ the femoral
head into the acetabulum of the pelvis.
• Piriformis: A key landmark in the gluteal region. It is the
most superior of the deep muscles. It divides the greater
sciatic foramen into superior and inferior segments,
giving gluteal nerves and vessels their names. Lateral
rotation and abduction.
• Innervation: Nerve to piriformis.
• Obturator Internus: Forms the lateral walls of the pelvic
cavity. (From the pubis and ischium at the obturator
foramen, through the lesser sciatic foramen, to greater
trochanter of femur. Lateral rotation and abduction.
• Innervation: Nerve to obturator internus.
• The Gemelli – Superior and Inferior: Are two narrow and
triangular muscles, separated by the obturator internus
tendon. Sometimes considered as one muscle with Obt. int
– the triceps coxae.
• The superior gemellus muscle originates from the ischial
spine, the inferior from the ischial tuberosity. They both
attach to the greater trochanter of the femur. Lateral
rotation and abduction.
• Innervation: The superior gemellus muscle by the nerve to
obturator internus, the inferior gemellus by the nerve to
quadratus femoris.
• Quadratus femoris: A flat, square-shaped muscle, the most
inferior of the deep gluteal muscles, located below the
gemelli and obturator internus. (From the lateral aspect of
the ischial tuberosity, attaches to the quadrate tuberosity
on the intertrochanteric crest). Lateral rotation.
Muscles of the gluteal region
• Are organized into 2 layers:
Superficial and Deep
• The superficial layer consists of:
– Gluteal maximus-extensor, lat rot
– Gluteal medius
– Gluteal minimus
They are extensors, abductors and rotators of
the thigh
• Deep layer consists of
smaller muscles:
– piriformis
– obturator internus
– superior and inferior gemelli
– quadratus femoris.
• Are lateral rotators and
stabilizers of the hip joint.
Piriformis - Landmark of gluteal region
• The piriformis is an important anatomical landmark in the
gluteal region. It travels through the greater sciatic foramen,
it divides the gluteal region into an inferior and superior
part. This division determines the name of the vessels and
nerves that supply the area. The superior gluteal nerve and
vessels emerge into the gluteal region superiorly to the
piriformis (and vice versa for the inferior gluteal nerve).
• The piriformis can be used to locate the sciatic nerve (a
major peripheral nerve of the lower limb). The sciatic nerve
enters the gluteal region directly inferior to the piriformis,
and is visible as a flat band, approximately 2cm wide.
Popliteal fossa
• The popliteal fossa is a fat-filled diamond
shaped area located on the posterior aspect
of the knee. It is the main path by which
vessels and nerves pass between the thigh
and the leg.
Boundaries
• It is diamond shaped with four borders, which are formed
by the muscles in the posterior compartment of the leg
and thigh. These include:
• Superolateral by biceps femoris
• Superomedial by semimembranosus and semitendinosus
• Inferomedial by the medial head of the gastrocnemius
• Inferolateral by Lateral head of gastrocnemius and
plantaris
• The floor is the popliteal surface of the femur.
• The roof is the popliteal fascia, a continuation of fascia
lata, and the overlying skin
Contents of popliteal fossa
• Popliteal arteries and vein and their branches
• Tibial and common fibular nerves (superficial)
• Posterior cutaneous nerve
• Termination of saphenous vein
• Popliteal lymph nodes
Clinical significance
• Intragluteal injections
• Trendelenburg sign – superior gluteal
nerve
• Hamstring injuries: strains, tears,
avulsion of ischial tuberosity
• Popliteal pulse
• Femoral fracture and popliteal
haemorrhage
Leg Region
The Leg
• This is the portion between the knee and the
ankle. Superficial to deep structures:
Compartments of the leg
• Anterior compartment
• Lateral compartment (Superficial)
• Posterior compartment
• Deep posterior compartment
Anterior compartment
• Anterior compartment contains the muscles
that dorsiflex the ankle and extend the toes:
• Tibialis anterior- dorsiflexion, foot inversion
• Extensor hallucis longus- extend the great
toe, dorsiflex ankle
• Extensor digitorum longus- extension of toes,
dorsiflexion of ankle
• Fibularis tertius (peroneus tertius)- forefoot
eversion, weak ankle dorsiflexion
• Nerve supply: Deep peroneal nerve
Lateral compartment
Muscles: Peroneus Longus-
Peroneus Brevis
Actions: Forefoot eversion and ankle
plantar flexion
Nerve: Superficial peroneal/fibular
nerve
Superficial posterior compartment
• Contains the plantar flexor muscles:
• Gastrocnemius - 2 heads
• Soleus
• Plantaris
• Gastro and Soleus form Achilles tendon
• Action – Plantar flexes foot; flexes leg
• Nerve: Tibial nerve
Deep Posterior Compartment
• Muscles:
• Popliteus- flex and medially rotate leg
• Flexor digitorum longus - plantarflex and
invert foot, flex toe
• Flexor hallucis longus - plantarflex and invert
foot, flex toe
• Tibialis posterior - plantarflex and invert foot
• Nerve: Tibial nerve
Clinical significance
• Achilles Problems: tendonitis, rupture
• Compartment Syndrome: pressure increases
within a non-extensible space within the limb.
Any Questions??
