Principle of relative positioning of structures in the human body
The Femoral Arteries and Veins The common femoral artery is a direct artery is medial to the femoral nerve, and the femoral vein is medial to the femoral artery. The vein runs the length of the leg in relationship with the saphenous nerve. The femoral nerve is the largest branch of the lumbar plexus and is the major PhD, ECS, FAPTA, in Orthopaedic Physical Therapy Secrets (Third Edition), . and is enclosed with the femoral artery and vein within the femoral sheath. sonogram of the inguinal region showing the femoral nerve and its relations. Nerves are tougher than most other structures, followed by arteries, veins, and lymphatic . The femoral nerve supplies the muscles of the lateral territory.
The plexus emerges from the cervical portion of the vertebral column and the great artery arises almost directly from the heart. The plexus would thus be predicted to lie above, behind, and then lateral to the artery, as observed. The three cords of the plexus are disposed around the second part of the axillary artery the part behind the pectoralis as their names suggest, serving their targets; the plexus has the more direct position relative to the artery.
Given that the elbow joint is always flexed in the embryo, the median nerve takes the shortest route, crossing superficial to the brachial artery in the arm and to the ulnar artery in the forearm.
Most of the nerves and blood vessels are arranged laterally to medially, respectively, and the larger the nerve, the more lateral it lies. As all the nerves emanate from the midline of the body, more lateral means more direct to the gluteal region.
The pudendal nerve and the internal pudendal artery and vein are arranged medially to laterally, respectively[ 1 ], because their targets are medial to the foramen. In the triangle, the femoral artery runs along a boundary line that separates two independent motor-nerve territories. The femoral nerve supplies the muscles of the lateral territory[ 1 ].
It enters the triangle slightly lateral to the artery, while the femoral vein lies medial to the artery, and the deep lymph vessels lie mainly medial to the vein[ 1 ].
In this case, the nerve and artery both take their own most direct route, following the vein and lymphatic vessels, respectively. The great nerve stem pursues a straight course down the back of the limb, while the great blood vessel stem descends at the front of the limb, runs laterally and dorsally, and enters the popliteal fossa from the medial side. The vessels are therefore initially medial to the nerve, which enters the fossa from the upper angle of the fossa.
The artery takes the more direct route lying before the vein at the apex of the femoral triangle, and medially and ventrally to the vein at the popliteal fossa. The great blood vessel stem then curves laterally, pulled by the anterior tibial peroneal blood vessels, before resuming its course medially. The nerve, however, continues on a straight course. Because the knee joint is always flexed in the embryo, the nerve takes the shortest route, passing superficial to the great venous stem.
These nerves and arteries adjust their positions, with the arteries passing superficial to the nerves[ 1 ], such that the nerves take the shortest route into the sole of the foot.
Each posterior intercostal artery is accompanied by a vein and a nerve, above and below the artery, respectively. The nerve adopts the most direct route to their targets, the intercostal muscles, followed by the artery, and then the vein. Supplementary explanations 1 Lymph vessels are more slender than their accompanying great blood vessels or nerves. When lymph vessels travel together with these great structures such as in the femoral trianglemost will follow the same principles and adopt a less direct route than the great veins, whilst being as direct as possible.
Autonomic nerves often run along the arteries and form a plexus around them, otherwise they could be ruptured by even slight shaking. These nerve fibers thus travel with their arteries on the same direct route.
Femoral vein - Wikipedia
Tendons are stronger than nerves or vessels, and the tendon of the extensor hallucis longus is positioned in front of them at the bend of the ankle. It then divides into the tibial nerve innervating the flexors of the knee, extensors of the ankle, flexors of the toes and skin over the posterior surface of the leg.Femoral Triangle - Everything You Need To Know - Dr. Nabil Ebraheim
The other half of this division is the common peroneal nerve supplying innervation to the short head of the biceps femoris, fibularis, tibialis anterior, extensors of the toes, the skin over the anterior surface of the leg and dorsal surface of the foot.
The posterior femoral cutaneous nerve supplies sensation to the skin of the perineum and posterior surface of the thigh. The superior gluteal nerve supplies motor function to the abductors of the hip while the inferior gluteal nerve innervates the gluteus maximus. The femoral nerve supplies innervation sensation and motor to the anterior thigh. The obturator nerve sensitizes to the medial thigh and motor function to the adductors. Muscles The hip flexors are composed of the iliacus, psoas, sartorius, and pectineus.
The iliacus and the psoas are both flexors of the thigh in relation to the torso and receive blood supply from the lumbar branch of the iliopsoas of the internal iliac artery. The pectineus is also unique as it adducts the thigh and flexes the hip, is usually innervated by the femoral nerve but is sometimes innervated by the obturator nerve. Its blood supply is from the medial circumflex femoral branch of the femoral and obturator artery.
The four muscles in the extensor group are the vastus lateralis, vastus intermedius, vastus medialis, and rectus femoris. All 4 function to extend the knee but the rectus femoris is also an accessory flexor of the hip. The next group of muscles located laterally on the thigh is the hip abductors.
This group of muscles is composed of the gluteus minimus, medius, and maximus and the tensor fascia lata. All of the gluteal muscles function as abductors of the thigh. The gluteus maximus also extends the hip, assists in lateral rotation of the thigh and is innervated by the inferior gluteal nerve L5, S1, S2. This muscle belly is supplied by the superior and inferior gluteal arteries and the first perforating branch of the profundal femoris artery.
With the gluteus medius, the anterior fibers rotate the hip medially, and the posterior fibers rotate the hip laterally. The superior gluteal nerve L4, L5, S1 is the innervating nerve, and the superior gluteal artery is the blood supply. The gluteus minimus has the same innervation and blood supply as the medius but with the additional function of medially rotating the hip.
The tensor fascia lata differs in that its main function is stabilization of the hip and knee joints. Innervation is by the superior gluteal nerve L4, L5, S1 and blood supply is by the superior gluteal and lateral femoral circumflex artery.
It is also necessary to appreciate clinically that this is a case where the nerve is more lateral than the vein. In most other cases the nerve relative to its associated artery and vein would be the deepest or more medial followed by the artery and then the vein. But in this case it is the opposite. This must be remembered when venous or arterial samples are required from the femoral vessels.
The basins are separated by the fascia lata. For patients with palpable nodal disease, removal of the superficial and deep basins are recommended. In a patient with a positive sentinel lymph node biopsy, generally only the superficial nodes are removed, unless Cloquet's node the most superior of the deep nodes is clinically positive.
Borders of the femoral triangle of the Visible Human Male. Contents of the femoral triangle of the Visible Human Male.