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The femoral artery is the main arterial supply of the front of the thigh.
The femoral vein is the direct continuation of the popliteal vein and becomes the external iliac vein above the inguinal ligament.
The femoral nerve (L2–L4) is the largest branch of the lumbar plexus and the main motor supply to the anterior compartment.
The iliopsoas is the chief flexor of the thigh.
The quadriceps femoris is the chief extensor of the knee.
The sartorius is the longest muscle in the body and acts across both the hip and knee joints.
The rectus femoris is the only part of quadriceps that flexes the thigh and extends the knee.
The femoral triangle serves as an important landmark for palpation, pulse, and vascular procedures.
The adductor canal (Hunter’s canal) transmits the femoral artery, vein, and saphenous nerve from the femoral triangle to the popliteal fossa.
The vastus medialis prevents lateral displacement of the patella during knee extension.
The psoas major acts as a guide for locating the lumbar plexus during dissections.
The patellar reflex assesses integrity of L3–L4 spinal segments.
The femoral ring is a potential site for femoral hernia, more common in females.
Holden’s line limits spread of urine into the thigh in urethral injuries.
A 45-year-old woman presents with a pulsatile swelling in the upper medial thigh and complains of pain radiating down the limb.
Questions to Consider:
What is the likely diagnosis?
→ Femoral artery aneurysm.
Which structure might be compressing nearby nerves?
→ The femoral nerve, resulting in anterior thigh pain and weakness of knee extension.
How can this be differentiated from a femoral hernia?
→
Femoral artery aneurysm: Pulsatile and has an audible bruit; lies below and lateral to pubic tubercle.
Femoral hernia: Non-pulsatile, reducible swelling that may show cough impulse.
What is the management implication?
→ Requires surgical repair or endovascular intervention, with care to avoid injury to the femoral vein and nerve.
Clinical Presentation:
A middle-aged man reports a pulsatile swelling in the upper thigh, tender on pressure. There is a bruit on auscultation and distal pulses are diminished.
Anatomical Basis:
The aneurysm occurs in the femoral triangle, where the artery lies superficially beneath the skin and fascia.
The femoral vein lies medial, and femoral nerve lateral — both may be compressed, causing venous congestion or anterior thigh pain.
Key Diagnostic Sign:
Swelling lies below the inguinal ligament and lateral to pubic tubercle, distinguishing it from inguinal hernia.
Clinical Presentation:
A swelling appears below and lateral to pubic tubercle, more common in women, becomes prominent on coughing or straining.
Anatomical Basis:
Herniation occurs through the femoral ring, the upper opening of the femoral canal.
Boundaries of femoral ring:
Anterior: Inguinal ligament
Posterior: Pectineus and fascia
Medial: Lacunar ligament
Lateral: Femoral vein
Complication: Strangulation due to rigid boundaries; can compress the femoral vein, leading to leg edema.
Clinical Context:
Used when peripheral veins are collapsed (e.g., shock).
Anatomical Point:
Femoral vein lies medial to femoral artery just below the inguinal ligament.
The needle is inserted 1.5 cm medial to femoral pulse, directed upward.
Incorrect placement risks puncturing the femoral artery or femoral canal lymph nodes.
Clinical Presentation:
Patient with tuberculosis of lumbar vertebrae presents with a fluctuant swelling in the femoral triangle and pain on hip flexion.
Anatomical Basis:
Infection spreads along the psoas sheath into the femoral triangle beneath fascia lata.
The psoas major inserts into the lesser trochanter, and contraction during walking aggravates pain.
May be mistaken for enlarged lymph node or hernia.
Clinical Presentation:
Patient keeps the hip flexed and externally rotated; attempts at extension cause severe pain. Seen in tuberculous hip arthritis or retroperitoneal inflammation.
Anatomical Basis:
Iliopsoas acts as a strong hip flexor.
Inflammation of the muscle or surrounding fascia triggers reflex contraction.
Passive hip extension stretches the inflamed tendon, producing pain.
Clinical Presentation:
Following pelvic surgery or deep wound in groin, patient presents with loss of knee extension, absent patellar reflex, and sensory loss over anterior and medial thigh.
Anatomical Basis:
Femoral nerve (L2–L4) supplies quadriceps femoris, the main extensor of the knee.
Damage causes paralysis of quadriceps → leg buckles during walking.
Saphenous nerve branch explains sensory loss over medial leg.
Clinical Presentation:
Burning pain, tingling, or numbness over anterolateral thigh without motor weakness.
Anatomical Basis:
Caused by compression of lateral cutaneous nerve of thigh (L2–L3) under inguinal ligament near ASIS.
Common in obesity, tight belts, pregnancy, or prolonged sitting.
Pain worsens with hip extension, relieved by flexion.
Clinical Presentation:
Tortuous, dilated veins on the medial side of thigh and leg, with heaviness and swelling.
Anatomical Basis:
Due to incompetence of valves in the great saphenous vein or perforators connecting to deep veins.
Blood reflux causes venous congestion.
Located along the course of femoral triangle and adductor canal.
Special Test:
Trendelenburg’s Test determines the site of valvular incompetence.
Clinical Presentation:
Loss of knee jerk reflex when patellar ligament is tapped.
Anatomical Basis:
Reflex arc involves L3–L4 segments of spinal cord through femoral nerve to quadriceps.
Absence indicates lesion of femoral nerve or L3–L4 root.
Clinical Presentation:
Runner complains of pain on the lateral side of knee after prolonged activity.
Anatomical Basis:
Due to friction between the iliotibial tract and lateral femoral condyle during repetitive flexion and extension.
Common overuse injury in athletes; relieved by stretching IT band and strengthening hip abductors.
Clinical Presentation:
Child with history of improper intramuscular injection develops restricted knee flexion.
Anatomical Basis:
Injection fibrosis leads to shortening of vastus intermedius or rectus femoris.
Knee cannot flex beyond 30–40°, palpable taut band in front of thigh.
Clinical Insight:
The iliotibial tract and quadriceps play key roles in maintaining the upright posture by stabilizing knee extension.
Weakness causes buckling of the knee during walking or standing.
Clinical Context:
Used in lower-limb surgeries to provide anesthesia to saphenous nerve and branches of femoral nerve to knee.
Anatomical Basis:
Local anesthetic injected between vastus medialis and adductor longus/magnus in the canal.
Provides analgesia for knee and medial leg without affecting motor function of quadriceps.
Clinical Presentation:
Painful swelling over front of patella or below patellar ligament.
Anatomical Basis:
Prepatellar bursitis (Housemaid’s knee): due to kneeling on hard surfaces.
Infrapatellar bursitis (Clergyman’s knee): deeper inflammation below patellar ligament.
Involves bursae of the front of thigh continuous with knee structures.
Clinical Presentation:
Following thigh injury, patient complains of severe pain, swelling, and reduced distal pulse.
Anatomical Basis:
Tight fascia lata forms an unyielding boundary around thigh muscles.
Hemorrhage or edema within the anterior compartment compresses vessels and nerves.
Untreated, leads to ischemic necrosis and permanent muscle damage.
Clinical Presentation:
Difficulty in climbing stairs or getting up from sitting position.
Anatomical Basis:
Caused by paralysis of iliopsoas (L1–L3) or injury to femoral nerve.
Seen in diabetes, psoas abscess, or after abdominal surgery.
Applications:
Site for femoral artery ligation in popliteal aneurysm.
Cardiac catheterization or angiography access route.
Femoral vein puncture for central venous pressure monitoring.
Femoral nerve block for lower limb surgeries.
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