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GROUP 5

DEPARTMENT OF PHYSIOTHERAPY, COLLEGE OF MEDICINE,UNIVERSITY OF LAGOS.

Ogunsusi Olawumi F. 100704032 Olugbode Omowonuola N. 110704761 Olademo Folasade C. 100704034 Ojo Motunrayo L. 110704750 Ojo Olushola V. 110704751 Oguntoye Ibukunoluwapo E. 100704033 Oke Rafiat A. 110704753 Olambiwonnu Halimah B. 110704756 Ogunwoolu Enioluwa R. 110704749

QUESTIONS

DESCRIBE THE ANATOMY OF THE FEMORAL TRIANGLE. HOW WOULD YOU LOCATE THE FEMORAL VEIN? WHAT IS THE CONSEQUENCE OF A DAMAGE TO THE FEMORAL NERVE? WHAT IS THE FEMORAL CANAL AND ITS ANATOMICAL IMPORTANCE? WHAT IS THE ANATOMICAL SIGNIFICANCE OF THE FEMORAL RING? WHAT IS THE SIGNIFICANCE OF THE FEMORAL TRIANGLE IN POST-MORTEM EXAMINATION?

DESCRIBE THE ANATOMY OF FEMORAL TRIANGLE


It is the triangular depression on front of upper one-third of thigh below inguinal ligament. BORDERS: Superiorly: the inguinal ligament Laterally: satorius Medially: medial border of the adductor longus muscle Apex: meeting point of lateral and medial boundaries( continuous with the adductor canal) ROOF: Formed by : Skin Superficial fascia containing: (1)Superficial inguinal lymph nodes (2)Femoral branch of genitofemoral nerve (3)Branches of ilioinguinal nerves (4)Branches of femoral artery (5)Tributaries of femoral vein (6)Upper part of great saphenous vein

(A) (B)

(C)Deep fascia with saphenous opening and cribriform fascia.

FLOOR:
Medially: Adductor longus and Pectineus Laterally: Iliacus and Psoas major

CONTENTS:
(a) (b)

Femoral artery Femoral vein

(c)
(d) (e)

Femoral sheath
Nerves Deep inguinal lymph nodes

(1) FEMORAL ARTERY AND ITS BRANCHES: Extends from base to apex 3 superficial branches: -Superficial external pudendal -Superficial epigastric -Superficial circumflex iliac 3 deep branches: -profunda femoris- medial + lateral circumflex -Deep external pudendal -Muscular branches

(2) FEMORAL VEIN AND ITS TRIBUTARIES: Base: medial to artery Apex: posteromedial to artery Tributaries: Great saphenous vein and circumflex

(3)FEMORAL SHEATH:
a prolongation downward, behind the inguinal ligament, of the fascia which line the abdomen, the transversalis fascia being continued down in front of the femoral vessels and the iliac fascia behind them.

FEMORAL NERVE: - Arises from the lumbar plexus, its formed by the ventral
rami of L2,L3 and L4. - Descends within the groove between the psoas major and Iliacus muscles - Lateral to the femoral artery as it enters the thigh

-The femoral nerve supplies the frontal area of thigh. - Two branches: (a) Anterior cutaneous nerve (b) Saphenous nerve

ANTERIOR CUTANEOUS NERVE:


-Sensation of the skin of the anterior and median aspect of the thigh - injury: loss of sensation.

SAPHENOUS

NERVE: -Sensation of the skin of patella and median side of the leg and foot - Injury: loss of sensation

Deep inguinal lymph nodes:


-located medial to the femoral vein and under the cribriform fascia. There are approximately 3 to 5 deep nodes. The superior-most node is located under the inguinal ligament and is called Cloquet's node. -The deep inguinal lymph nodes drain superiorly to the external iliac lymph nodes, then to the pelvic lymph nodes and on to the Para-aortic lymph nodes.

SUMMARY:

HOW WOULD YOU LOCATE THE FEMORAL VEIN?


The femoral vein is not usually palpable but its position can be located inferior to the inguinal ligament by feeling the pulsations of the femoral artery which is immediately lateral to the vein. In thin people, the femoral vein may be close to the surface and may be mistaken for the great saphenous vein. It is important to know that the femoral vein has no tributaries at this level except for the great saphenous vein that joins it approximately 3cm inferior to the inguinal ligament from femoral vein. We have branches of great saphenous vein, external pudendal vein and superficial epigastric vein.

-FEMORAL NERVE:

CONSEQUENCE OF DAMAGED FEMORAL NERVE:

The femoral nerve is part of the lumbar plexus. It originates from the lumbar region and supplies to the muscles of the anterior thigh and skin region. It contains both sensory and motor nerve fibers. The motor nerve fibers supply the muscles of extension which allows the leg to straighten at the knees while the sensory nerve fibers receives input from the front of the thigh and lower leg, allowing the brain to detect pain and pressure.

-WHAT IS FEMORAL NERVE DAMAGE?

Femoral nerve dysfunction is the loss of movement and sensation in the leg. This damage is clinically termed as Mononeuropathy which also means local damage to a nerve. Many times the damage is to the complete body - systemic disorder.

-FEMORAL NERVE DAMAGE: CAUSES


Direct injury or trauma to the leg can damage the nerve. Excessive or prolonged pressure on the nerve can lead to its dysfunction. Femoral nerve entrapment or compression of the nerve by surrounding parts of the body or by structures like tumors, abscesses can cause femoral nerve damage. Entrapment of the nerve result in damage to the myelin sheath. If femoral nerve is suppressed due to pressure, it may not get sufficient oxygen. Insufficient blood supply (ischemia) to femoral nerve can result in several health complications. Systemic disorders which involve the whole body, can affect the function of femoral nerve. In mononeuritis multiplex, dysfunction of femoral nerve due to systemic disorder can be noticed. As the femoral nerve passes through muscles, femoral nerve entrapment due to pressure on the nerve is quite common.

>Breaking of bones in the pelvic area can cause damage to the femoral nerve. Internal bleeding (bleeding in the abdominal area), use of tight or heavy waist belts can compress the femoral nerve or its branches. >Insertion of catheter in the groin or lying in a position with the thighs and legs stretched apart (as is many times required for certain surgical or diagnostic procedures) can cause damage to femoral nerve. >Diseases like diabetes can lead to damaged femoral nerve due to peripheral neuropathy.

CONSEQUENCES:

Weakened knee or leg :muscle weakness within the leg can make it difficult for a patient to stand or walk normally making it difficult to walk down a flight of stairs Tingling or burning sensation in the knee, thigh or leg Complete numbness in the thigh, knee or leg Buckling of the knee

Femoral nerve pain


Problem straightening the knee Problem bending the leg

Difficulty in bending the knee


Low knee reflex or absence of knee reflex Smaller than normal quadriceps muscles on the front of the thigh

Difficulty going up and down the stairs, especially down the stairs.

ANATOMICAL SIGNIFICANCE OF FEMORAL CANAL.


Definition : The femoral canal is the passageway through which femoral structures exit from the abdomen into the upper thigh.

It is conical In shape and measures about 1.25 cm. in length.

Boundaries Anteriorly: inguinal ligament Medially: pubic bone and lacunar ligament Laterally: iliopsoas muscle Posteriorly: pubic ramus and pectineus muscle

Compartments and contents


Femoral canal : divided into two compartments by the medial border of the femoral vein.

1. 2. 3. 4.

The medial compartment is the femoral ring. contains some lymphatic vessels and a lymph gland imbedded in a small amount of areolar tissue The lateral compartment contains the following structures from medial to lateral::femoral vein femoral artery genitofemoral nerve femoral nerve The femoral artery and vein are enclosed by the femoral sheath, an extension of the transversalis fascia.

Applied anatomy

The abdominal opening of the femoral canal is the femoral ring. A femoral hernia occurs through the femoral canal. In 30% an aberrant or anomalous obturator artery (a branch from the inferior epigastric artery) crosses the lacunar ligament and may be injured during operations of the femoral hernia

FEMORAL RING:
-The femoral ring is the base of the femoral canal. It is directed upward and is oval in form, its long diameter being directed transversely and measuring about 1.25 cm. BOUNDARIES: The femoral ring is bounded as follows: anteriorly by the inguinal ligament. posteriorly by the pectineus covered by the pectineal fascia. medially by the crescentic base of the lacunar ligament. laterally by the fibrous septum on the medial side of the femoral vein.

ANATOMICAL SIGNIFICANCE OF FEMORAL RING:


It

is the main site for femoral hernia.

WHAT IS THE SIGNIFICANCE OF THE FEMORAL TRIANGLE IN POST-MORTEM EXAMINATION?