Adductor region of thigh

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1. ADDUCTOR REGION By- Dr. Vibhash Kumar Vaidya Department of Anatomy

2. Adductor Compartment It is well developed Its counterpart in the arm has undergone degeneration during the course of evolution Represented only by a weak coracobrachialis muscle of the flexor compartment of the arm

3. Boundaries Anteriorly - Medial intermuscular septum which separates it from the anterior (extensor) compartment of the thigh Posteriorly - ill-defined posterior intermuscular septum which separates it from posterior (flexor) compartment of the thigh The posterior intermuscular septum is ill-defined and incomplete due to the presence of a composite muscle, the adductor magnus , consisting of two components—adductor and flexor (hamstring) belonging to adductor and flexor compartments of the thigh, respectively

4. Contents Muscles: Adductor longus , adductor brevis , adductor magnus , gracilis , pectineus , and obturator externus . Nerve: Obturator nerve. Arteries: Profunda femoris artery and obturator artery.

5. Muscles The muscles of the medial compartment of the thigh are arranged into three layers. From superficial to deep these are Anterior (first) layer consists of pectineus , adductor longus , and gracilis . Middle (second) layer consists of adductor brevis . Posterior (third) layer consists of adductor magnus .

6. Obturator Nerve Chief nerve of the adductor compartment of the thigh Arises from the lumbar plexus in the abdomen It is formed by the ventral division of the anterior primary rami of L2, L3, L4 spinal nerves It enters the thigh by passing through the obturator canal

7. Course and Distribution While passing through the obturator canal the obturator nerve divides into anterior and posterior divisions Anterior division- passes downwards into the thigh in front of the obturator externus Then descends behind the pectineus and the adductor longus , and in front of the adductor brevis The anterior division supplies the following muscles : Pectineus Adductor longus Gracilis Adductor brevis The anterior division also gives an articular twig to the hip joint Distal to the adductor longus , it enters the adductor canal where it provides a twig to the subsartorial plexus of nerves and terminates by supplying the femoral artery in the adductor canal

8. Posterior division- enters the thigh by piercing the anterior part of the obturator externus muscle which it supplies It then descends behind the adductor brevis and in front of the adductor magnus The posterior division supplies the following muscles : Obturator externus Adductor magnus Adductor brevis Its terminal part forms an articular branch called genicular branch Which pierces the adductor magnus or passes through hiatus for femoral vessels to reach the popliteal fossa Where it runs along the popliteal vessels and pierces the oblique popliteal ligament to supply the knee joint Course and Distribution

9. Clinical Anatomy Adductor spasm of the thigh : Spasm of the adductors of the thigh in spastic paraplegia may be relieved by surgical division of the obturator nerve. Referred pain : In diseases of the knee joint, the pain may be referred to the hip joint along the obturator nerve (L2, L3, and L4) because it supplies both these joints.

10. Profunda Femoris Artery Largest branch of the femoral artery The chief source of blood supply to the muscles of all the three compartments of the thigh It arises from the lateral side of the femoral artery in the femoral triangle about 4 cm below the inguinal ligament behind the femoral vessels, giving off medial and lateral circumflex arteries It then passes posteriorly between pectineus and adductor longus then descends close to femur successively between adductor longus and adductor brevis , between adductor longus and adductor magnus Here it gives off first three perforating arteries Its terminal part pierces the adductor magnus as the fourth perforating artery to reach the back of the leg

11. Branches Muscular branches Medial circumflex femoral artery Lateral circumflex femoral artery Four perforating arteries.

12. Obturator Artery It arises from the anterior division of internal iliac artery in the pelvis It enters the adductor compartment of the thigh through the obturator canal Just outside the obturator canal It divides into medial and lateral branches The lateral branch gives off an acetabular twig Which enters the acetabulum through a gap between acetabular notch and transverse acetabular ligament Where it supplies acetabular fat and gives off a slender artery to the femoral head along the ligament of the head of femur.