Medial compartment of the thigh

Contents

  • Muscle
    • gracillis
    • adductors longus
    • adductor brevis
    • adductor magnus
    • obturator externus
  • Nerve
    • obturator nerve
  • Vessels
    • produnda femoris & obturator artery
  • Action of all adductors
    • Less important in prime movement of adduction than in synergic activities associated with posture & gait

Muscles

Gracilis

  • most superficial muscle
  • Origin
    • Edge of inferior pubic ramus & adjoining ischial ramus
  • Insertion
    • Upper part of medial surface of shaft of tibia just behind sartorius
  • Nerve Supply
    • Anterior division of obturator nerve

Adductor longus

  • most superficial of 3 adductors
  • upper border lies between the femoral & profunda femoris vessels
  • Origin
    • Circular area on body of pubis, in angle of pubic crest & symphysis
    • Tendon is sometimes ossified (rider’s bone)
  • Insertion
    • Via apneurotic flat tendon into middle third of linea aspera of femur
  • Nerve Supply
    • Anterior division of obturator nerve

Adductor brevis

  • Anterior division of obturator nerve passes downwards on its anterior surface & posterior division passes behind it
  • Origin
    • Body & inferior ramus of pubis, deep to pectineus & adductor longus
  • Insertion
    • Upper part of linea aspera immediately behind insertion of pectineus & adductor longus
  • Nerve Supply
    • Anterior division of obturator nerve

Adductor magnus

  • Composite muscle formed by fusion of adductor & hamstring muscle masses, each with their own nerve supply
  • Medial circumflex femoral artery passes between upper border of adductor magnus & lower border of quadratus femoris to reach the cruciate anastomosis
  • Near the top of the medial supracondylar line, there is a gap in the muscle attachment through which the femoral vessels pass, changing to the popliteal vessels
  • Along the linea aspera attachment there are 4 small openings, the lowest for the end of the profunda femoris vessels & the others for their perforating branches
  • Origin & Insertion
    • Hamstring
    • Ischial tuberosity attaching to adductor tubercle of femur & medial supracondylar line
  • Adductor
    • Ischial tuberosity & ischiopubic ramus inserting progressively higher along the medial supracondylar line, the linea aspera, up to gluteal tuberosity
  • Nerve Supply
    • Hamstring
      • Tibial part of sciatic nerve
    • Adductor
      • Posterior division of obturator (L2,3)

Obturator externus

  • Origin
    • Obturator membrane & anterior bony margin of obturator foramen
    • muscle passes laterally & posteriorly beneath neck of femur where it narrows into a tendon that spirals in contact with the back of the femoral neck
  • Insertion
    • Medial surface of greater trochanter into a deep pit, the trochanteric fossa
  • Nerve Supply
    • Posterior division of obturator nerve
  • Action
    • With other short muscles around hip, stabilizes & supports the proximal part of limb
    • Lateral rotator of femur

Nerves

Obturator nerve:

  • Origin
    • Anterior branches of L2-4, via lumbar plexus
  • Path
    • Through psoas major, exiting medial border, deep / posterior to common iliac artery then lateral to the internal iliac artery, superior and anterior / superficial to obturator vessels, to obturator foramen.
    • Through upper part of obturator foramen into obturator canal at which point it divides into anterior and posterior divisions which are separated by obturator externus and adductor brevis.
  • Supply
    • Adductor muscles / medial compartment: obturator externus, gracilis, adductors longus, brevis and magnus. Variably supplies the pectineus.

Vessels

Obturator artery:

  • Origin
    • Branch from the anterior division of internal iliac artery
  • Path
    • From internal iliac artery, anteriorly and inferiorly, to the superior part of the obturator foramen, then through the obturator canal, then divides into anterior and posterior branches.
    • Within the pelvis lies posterior to the ureter, on posterior and lateral walls.
  • Supply
    • Anterior branch: obturator externus, pectineus, adductors, gracilis, and anastomoses with posterior branch of obturator artery and medial femoral circumflex artery
    • Posterior branch: twig to muscles of ischial tuberosity (adductor magnus, biceps femoris, semimembranosus, semitendinosus), twig to artery of ligamentum teres via articular branch, and anastomoses with inferior gluteal artery and anterior branch of obturator artery

References

Author Contributions

Sean Griffiths, WH Resident, 2020