FEMORAL TRIANGLE AND GLUTEAL REGION

salomijale(65)

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Hello everybody,nice to see you all again.we are learning lowerlimb in detail and we learned Lumbosacral plexus and 4 major nerves Common peroneal nerve,Tibial nerve,Femoral nerve and Obturator nerve and their clinical application.so i request you to please go through all my previous posts to gain knowledge about Anatomy.

Now we are going to learn about Femoral Triagnle and Gluteal region

FEMORAL TRIANGLE

It is present in the upper ⅓rd of the anterior aspect of the thigh.

Screenshot_20220814-002255_ibisPaint X.jpg

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Triangle means it has boundaries or sides.so here the boundaries of femoral triangle are -

Base - Inguinal ligament
Laterally- Medial border of sartorius
Medially - Medial border of adductor longus

Even though it is called as triangle,we have to imagine the femoral triangle in 3D manner that it has floor and roof

Floor of Femoral triangle is made up of -

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Iliacus muscle
Psoas major muscle
Pectineus muscle
Adductor longus muscle

Roof of Femoral triangle is made up of -

Fascia lata is a fascia in the thigh that covers the femoral triangle
There is opening in fascia lata that opening is called Saphenous opening this saphenous opening is covered a fascia called cribriform fascia
the saphenous opening has a vein as content called Femoral vein and it drains venous blood from Saphenous vein and Superficial External Pudendal vessels and Superficial epigastric vessels and Superficial circumflex Iliac vessels

So these are the things that are present in roof and floor of the femoral triangle.

Now what are the contents of Femoral triangle(from lateral side to medial) -

1)Femoral nerve
2)Femoral artery
3)Femoral vein
4)Lymph nodes

Image source
These contents are arranged or present in relation to femoral sheath.so what is femoral sheath.now try to understand femoral sheath -

FEMORAL SHEATH

It is a sheath which is formed by the extension of fascia transversalis and extension of fascia iliaca which forms anterior and posterior wall respectively

The femoral nerve is not a content of femoral sheath but it is content of femoral traingle.Femoral sheath is present in femoral traingle and all the contents of femoral triangle pass through the femoral sheath except femoral nerve which passes outside of the femoral sheath.

Femoral sheath has 3 compartments -

Lateral compartment	Intermediate compartment	Medial compartment/Femoral canal
Femoral artery	Femoral vein	Lymph nodes of CLOQUET/ROSENMULLER
Femoral branch of Genitofemoral nerve	-	-

Lymph nodes of cloquet/rosenmuller -
In males,it drains lymph from glans penis
In females,it drains lymph from clitoris

Femoral ring

Femoral ring is base of Femoral canal

Boundaries of Femoral ring are -

Anteriorly - Inguinal ligament
Posteriorly - Pectineal ligament
Medially - Lacunar ligament
Laterally - Femoral vein

Clinical Aspects

Femoral hernia - most commonly seen in females occurs in the femoral canal.

ADDUCTOR CANAL

It is also called Subsartorial canal because it presentbeneath sartorius muscle and Hunter's canal
You can see in the below pic

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Boundaries of Adductor canal are formed by -

Adductor magnus & Adductor longus
Fibrous septum
Vastus medialis
You can see boundaries of Adductor canal below image that i have drawn

The contents or structures that are passing through Adductor canal are -

Femoral vein
Femoral artery
Saphenous nerve
Nerve to vastus medialis

GLUTEAL REGION

The buttocks are called Gluteal region and we have to know what are the muscles present in this region and their nerve supply first so that we can understand the clinical aspects of it later

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Muscle	Nerve supply	Action of the muscle
Gluteus maximus(largest muscle)	Inferior gluteal nerve(L5,S1,S2	Extension at hop joint
Gluteus medius and Gluteus minimus	Superior gluteal nerve(L4,L5,S1)	Abduction at hip joint and stabilizes the pelvis while walking
Gemellus superior	Nerve to obturator internus	Lateral rotation of hip joint
Obturator internus	Nerve to obturator internus	Lateral rotation of hip joint
Gemellus inferior	Nerve to quadratus femoris	Lateral rotation of hip joint
Quadratus femoris	Nerve to quadratus femoris	Lateral rotation of hip joint

Image source

Clinical aspects

Gluteus medius and Gluteus minimus are the two muscles that play key role while walking.
The question is how? So lets understand this- while walking,when we lift one leg then the pelvis on that side tilt to the side of the leg that was lifted due to gravity.but it is not happening in our body why because,the Gluteus medius and Gluteus minimus muscles which are present in the opposite side will contract and pull the pelvis so that the pelvis become stabilized.so this how the these muscles help while walking.

What if these two muscles got paralysed because of injury to the Superior gluetal nerve injury?

In this case,the muscles won't contract and cannot pull pelvis and stabilize it so the pelvis get tilted to the side where leg was raised while walking or the opposite side of muscles paralysed.so the person move his upper part of his body to right side to stabilize the pelvis and to shift the center of gravity.this is called Duchenne's limp.you can understand what i said by observing below image

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Trendelenburg Sign

It is clinical sign and is seen when the patient is asked to stand unassisted on each leg in turn.If pelvic drop occurs on the unsupported leg,then it is said to be positive sign. The Pelvic drop can be recognised by observing the level of the iliac crests on both sides.

We can undertsand this with the example suppose if the left gluteal muscles are weak, then the right side of the pelvis will drop when the patient stands on their left leg and we can understand trendelenberg sign by the below pic

Image source