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Adductor magnus and pectineus are hybrid muscles, each having a dual nerve supply.
Adductor magnus is supplied by both obturator nerve (adductor part) and tibial part of sciatic nerve (hamstring part).
Pectineus receives dual supply from femoral and obturator nerves.
Femoral and obturator nerves supply both the hip and knee joints, which explains referred pain between these joints.
The obturator nerve lies along the medial border of psoas major, crosses the ala of sacrum, enters the pelvis, and exits via the obturator foramen to reach the medial thigh.
The obturator artery (branch of internal iliac) and medial circumflex femoral artery (branch of profunda femoris) are the chief vessels in this compartment.
The adductor hiatus is an opening in adductor magnus through which the femoral vessels pass from the thigh to the popliteal fossa.
Gracilis is the most superficial and the only two-joint muscle in the medial compartment.
Obturator externus is a lateral rotator of the thigh despite being located in the adductor region.
Adductor longus gives rise to the term “rider’s strain” due to overstretching during horse riding or athletic activity.
Volume 2, BD Chaurasia’s Human …
Case:
A 50-year-old woman with right knee osteoarthritis develops pain in her right hip after several months of physiotherapy.
Questions:
Why did she develop hip pain along with knee pain?
What is the common nerve supply to both joints?
What is the root value of this nerve?
Answer:
The hip pain is referred pain from the knee joint because both are supplied by the obturator nerve.
The obturator nerve supplies the hip and knee joints, so irritation in one joint can produce pain in the other.
The root value of the obturator nerve is L2, L3, L4 (ventral divisions of ventral primary rami).
Similarly, the femoral nerve also contributes to both joints (L2, L3, L4 dorsal divisions).
Case:
A woman undergoing hysterectomy develops loss of adduction of the thigh and numbness over the medial aspect of the thigh.
Explanation:
The obturator nerve runs close to the lateral pelvic wall and can be injured during pelvic operations, especially when ligating the uterine artery.
Effects:
Weakness or paralysis of adductor muscles (adductor longus, brevis, magnus, gracilis).
Sensory loss along the medial thigh.
Difficulty crossing the legs due to loss of adduction.
Case:
A woman with ovarian inflammation experiences pain radiating to the medial side of the thigh.
Explanation:
Pain is referred via the obturator nerve, which supplies both the medial thigh skin and pelvic peritoneum.
Irritation of the obturator nerve within the pelvis results in medial thigh pain, even though the primary pathology is pelvic.
Case:
A horse rider complains of pain near the pubic symphysis after an abrupt abduction of the thigh.
Explanation:
The adductor longus origin (near pubic body) is overstretched or torn — known as Rider’s Strain.
Common in horse riders, sprinters, and footballers.
May result in local tenderness and hematoma near the pubic crest.
Case:
During repair of a femoral hernia, a surgeon accidentally cuts a large vessel near the pubic ramus, causing heavy bleeding.
Explanation:
The vessel injured is an aberrant obturator artery arising from the inferior epigastric artery — this connection is called “corona mortis” (circle of death).
Injury to this vessel may cause fatal hemorrhage unless promptly ligated.
Case:
An athlete presents with deep groin pain radiating to the medial thigh and weakness of thigh adduction.
Explanation:
Due to entrapment of the obturator nerve as it passes through the obturator canal.
Common in runners or individuals with repetitive hip movements.
Diagnosed by adduction weakness and electromyography (EMG) changes in adductor muscles.
Case:
Following a fracture neck of femur, a patient develops pain and stiffness in hip joint.
Explanation:
The medial circumflex femoral artery supplies the head and neck of the femur through retinacular arteries.
These vessels can be torn in fracture or dislocation → avascular necrosis (AVN).
In children, the foveolar branch of obturator artery also contributes to the head’s blood supply.
Case:
A plastic surgeon uses the gracilis muscle for reconstructing the anal sphincter in a patient with incontinence.
Explanation:
The gracilis has a long, slender shape, predictable neurovascular pedicle, and insignificant loss of function when removed.
Hence, it is often used in reconstructive and microsurgical transplants (e.g., facial reanimation, anal sphincteroplasty).
Case:
After a pubic ramus fracture, the patient complains of pain and weakness in thigh adduction.
Explanation:
The obturator nerve lies close to the superior pubic ramus, so pelvic fractures can compress or stretch it.
Leads to weakness of adductors and pain radiating to the medial thigh.
Case:
A patient with a femoral nerve lesion complains of difficulty in flexing and adducting the hip.
Explanation:
The pectineus (a hybrid muscle) is supplied mainly by the femoral nerve, and partly by the obturator nerve.
Damage to femoral nerve weakens both flexion and adduction at the hip joint.
Case:
A patient with chronic knee arthritis develops pain in the hip though hip imaging is normal.
Explanation:
Pain is referred via obturator and femoral nerves, both of which supply hip and knee joints.
Shared segmental innervation (L2–L4) explains cross-referral of pain.
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