Chapter 8

Medial side of Thigh

Textbook of
Human Anatomy
Volume 3: Lower Limb
Author: Dr Yogesh Sontakke,
JIPMER, Pondicherry
©CBS Publishers & Distributors Pvt Ltd, New Delhi
 As per:
Competency based Undergraduate curriculum
AN15.1
• Describe and demonstrate origin, course, relations, branches (or tributaries), and
termination of important nerves and vessels of medial side of thigh
AN15.2
• Describe and demonstrate major muscles with their attachment nerve supply
and actions

Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate, 2018. Vol. 1; pg 1-
80.
2
Human Anatomy/Yogesh Sontakke
 INTRODUCTION
• Medial compartment of thigh – called adductor compartment

• Well developed in humans and especially in lower limb

• Note: Coracobrachialis represents medial compartment in arm

Boundaries of adductor compartment

• Bounded as follows:

• Anteriorly: Anterior intermuscular septum

• Posteriorly: Ill-defined posterior muscular compartments of thigh on
medial side
Contents of adductor compartment
Muscles
• Intrinsic
• Pectineus
• Gracilis
• Adductor longus
• Adductor brevis
• Adductor magnus
• Extrinsic:
• Obturator externus (functionally
related to muscles of gluteal region)
Contents of adductor compartment
Nerves
• Obturator nerve
• Accessory obturator nerve
Arteries
• Obturator artery
• Medial circumflex femoral artery
 MUSCLES OF ADDUCTOR COMPARTMENT
• Arranged in three layers as follows
• Anterior layer
• Pectineus
• Gracilis
• Adductor longus
• Middle layer
• Adductor brevis
• Posterior layer
• Adductor magnus
 Pectineus
• Flat, quadrangular muscle (pectun = comb
in Latin)
• Forms part of floor of femoral triangle
Origin
• Pectineus originates from following
structures
• Pecten pubis (pectineal line of pubis bone)
• Upper half of pectineal surface of pubis
bone
• Fascia covering pectineus (pectineal
fascia)
 Pectineus
Insertion
 Pectineal line of femur extends
from lesser trochanter to upper
part of linea aspera
 Pectineus
Innervation
• Dual nerve supply
• Anterior fibers – supplied by femoral
nerve
• Posterior fibers – supplied by
anterior division of obturator nerve
Actions
• Flexion and adduction of thigh
 Some interesting facts
• Pectineus and adductor longus lie in same coronal plane

• Developmentally, pectineus – composite muscle derived from two

different sources.

• Has dual nerve supply (femoral and obturator nerves)

• Accessory obturator nerve (present in 30% people),if present,

supplies pectineus muscle
 Gracilis
• Most superficial, long slender muscle of medial
compartment of thigh
• (Gracialis = slender in Latin)
Origin
• Originates from
• Medial margin of lower half of body of pubis
• Ischiopubic ramus
Direction of fibers
• Run vertically downward
• Upper part of muscle – wide and lower part
tappers to form rounded tendon
 Gracilis
Insertion
• Inserts on upper part of medial surface of
tibia in between sartorius and gracilis
Innervation
• Anterior division of obturator nerve
Actions
• Adduction of thigh
• Flexion and medial rotation of leg
 Clinical integration
Muscle transplantation
• Gracilis – commonly used for muscle transplantation and
reconstructive surgery
• Flap utilized consists of as
• Gracilis muscle
• Artery – branch of medial circumflex femoral artery
• Nerve – branch of anterior division of obturator nerve
• Gracilis – also called custodian of virginity
 Adductor longus
• Triangular muscle
• Forms medial part of floor of femoral
triangle Adductor longus and pectineus
lie in same plane
Origin
• Originates as rounded tendon from
front of body of pubis in angle between
pubic crest and symphysis pubis
 Adductor longus
Direction of fibers
• Runs downward, laterally and slightly
backward to reach linea aspera
Insertion
• Inserts in middle third of shaft of femur, on
linea aspera between vastus medialis and
adductor brevis and magnus
Innervation
• Anterior division of obturator nerve
Actions
• Strong adductor and flexor of thigh
 Some interesting facts
Rider’s bone
 Sesamoid bone develops in rounded tendon of adductor
longus
 Some authors term calcified tendon as rider’s bone

 Particularly occurs in horse riders due to friction of tendon

with horse back
 Adductor brevis
• Triangular muscle – located in between
adductor longus and adductor magnus
• To visualize adductor brevis muscle, cut
adductor longus muscle near origin and
reflect it laterally
Origin
• Originates from
• Anterior surface of body of pubis and
• Outer surface of inferior ramus of pubis,
between gracilis and obturator externus
 Adductor brevis
Direction of fibers
• Pass downward, backward, and laterally and
expands to reach linea aspera
Insertion
• Inserts in line extending from lesser
tronchanter to linea aspera
• Extends on upper part of linea aspera
Innervation
• Anterior or posterior division of obturator
nerve
Action
• Adduction of thigh
 Adductor magnus
 Large triangular muscle situated
on medial side of thigh
 Lies posterior to pectineus,
adductor longus, and adductor
brevis muscles
 Hybrid or composite muscle
having dual nerve supply
 Adductor magnus
Origin
 Has two parts: adductor part and
hamstring part
Adductor part
 Originates from outer surface
ischiopubic ramus
Hamstring part
 Originates from inferolateral
part of ischial tuberosity
 Adductor magnus
Direction of fibers
 Originating from pubic ramus are
nearly horizontal
 Originating from ischial ramus
run obliquely downward,
backward, and laterally
 Originating from ischial tuberosity
descend vertically downward
 Adductor magnus
Insertion
 Adductor part inserts on medial margin of gluteal tuberosity, linea aspera, and
medial supracondylar ridge.
 Hamstring part inserts on adductor tubercle of medial condyle of femur
Innervation
 Adductor part – supplied by posterior division of obturator nerve
 Hamstring part – supplied by tibial part of sciatic nerve
Actions
 Adductor part: Adduction and medial rotation of thigh at hip joint
 Hamstring part: Extension of thigh
 Some interesting facts
• Pectineus and adductor magnus – hybrid muscles as they
have dual nerve supply
Adductor hiatus
• Large lowest osseoaponeurotic gap between adductor
magnus and shaft of femur
• Gives passage to femoral vessels from adductor canal to
popliteal fossa
• Upper four osseoaponeurotic openings give passage to
perforating branches of profunda femoris artery
 Some interesting facts
Adductor minimus
• Small and flat muscle constitutes part of adductor magnus
• Fibers arising from pubic ramus and inserts on medial of
gluteal tuberosity
Clinical testing of adductors
• Adductor of thigh – usually tested as group by adduction of
thigh against resistance
• Position of patient: Supine position with extended knee
 OBTURATOR NERVE
• Main nerve of adductor compartment of thigh

• Formation
• Branch of lumbar plexus
• Formed by ventral divisions of anterior primary
rami of L2, L3 and L4 spinal nerves
Root value
• L2, L3, L4
 OBTURATOR NERVE
Course
• In pelvic cavity
• Proximal (upper) part of nerve lies in abdominal and
pelvic cavity
• Emerges out through medial border of psoas major
muscle and passes downward behind common iliac
arteries
• In thigh
• Enters thigh through obturator foramen
• While passing through obturator foramen (canal),
divides into anterior and posterior divisions
 OBTURATOR NERVE
Course
• In thigh
• Anterior division passes downward in front of
obturator externus
• Further, descend behind pectineus and adductor
longus in front of adductor magnus
• Posterior division passes through substance of
obturator externus muscle
• Footnote
• Abdominal aorta → common iliac artery → external
and internal iliac arteries
 OBTURATOR NERVE
Branches (distribution)
• Anterior division
• It supplies
• Adductor longus
• Gracilis
• Pectineus
• Adductor brevis (may be supplied
by posterior division)
• Hip joint
• Branch to subsartorial plexus in
adductor canal to supply femoral
artery
 OBTURATOR NERVE
Branches (distribution)
• Posterior division
• Pierces obturator externus muscle
and supplies
• Obturator externus
• Adductor magnus
• Adductor brevis (if not supplied by
anterior division)
• Genicular branch for popliteal
vessels, cruciate ligaments, and
capsule of knee joint
 Some interesting facts
 Obturator nerve emerges out from medial border of psoas major muscle
 Anterior division of obturator nerve lies deep to adductor longus and pectineus,
whereas posterior division lies behind adductor brevis
 Genicular branch – continuation of posterior division of obturator nerve
 Enters in popliteal fossa and supplies popliteal vessels
 Then pierces lateral popliteal ligament to enter knee joint
 Occasionally pectineus – supplied by anterior division of obturator nerve and
also by femoral nerve
 Pectineus has dual nerve supply
 Clinical integration
Surgical division of obturator nerve
• Spastic paraplegia causing adductor muscle spasm, surgical
division of obturator nerve may be useful to relieve
symptoms
Referred pain of hip to knee
• As obturator nerve supplies both hip and knee joints, may
cause referred pain to knee joint
 Accessory obturator nerve
• Present in 30% individuals
• Formation: Branch of lumbar plexus
• Formed by divisions of ventral
primary rami of L3 and L4 spinal
nerves
• Root value: L3, L4
Course
• Emerges out of medial border of
psoas major muscle on posterior
abdominal wall
 Accessory obturator nerve
Course
• Descends downward and crosses
superior ramus of pubis anterior to
enter thigh
Branches (distribution)
• Supplies
• Pectineus
• Hip joint
• Gives communicating branch of
anterior division of obturator nerve
 OBTURATOR ARTERY
• Supplies adductor muscles along with
profunda femoris artery
Beginning
• Branch of anterior division of internal
iliac artery
Course and branches
• Runs downward along with obturator
nerve in pelvic cavity
• Enters thigh through obturator canal
and divides into anterior and posterior
branches
 OBTURATOR ARTERY
Course and branches
• Anterior branch
• Runs in outer surface of obturator
membrane
• Supplies adjacent muscles and
anastomoses with medial circumflex
femoral artery
• Posterior branch
• Supplies muscles attached with ischial
tuberosity
• Gives acetabular branch passes through
acetabular notch to supply acetabular pad
of fat and head of femur
Thank you…