Ibk Femoral Triangle Pbl

7/31/2019 Ibk Femoral Triangle Pbl

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GROUP 5DEPARTMENT OF

PHYSIOTHERAPY, COLLEGEOF MEDICINE,UNIVERSITY OFLAGOS.


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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


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QUESTIONS

DESCRIBE THE ANATOMY OF THE FEMORALTRIANGLE.

HOW WOULD YOU LOCATE THE FEMORAL VEIN? WHAT IS THE CONSEQUENCE OF A DAMAGE TO THE

FEMORAL NERVE?

WHAT IS THE FEMORAL CANAL AND ITSANATOMICAL IMPORTANCE?

WHAT IS THE ANATOMICAL SIGNIFICANCE OF THEFEMORAL RING?

WHAT IS THE SIGNIFICANCE OF THE FEMORALTRIANGLE IN POST-MORTEM EXAMINATION?


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DESCRIBE THE ANATOMY OF FEMORAL TRIANGLE

It is the triangular depression on front of upper one-third of thighbelow inguinal ligament.BORDERS:Superiorly: the inguinal ligamentLaterally: satoriusMedially: medial border of the adductor longus muscleApex: meeting point of lateral and medial boundaries( continuous

with the adductor canal)ROOF:Formed by :

(A) Skin(B) 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


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

FLOOR:Medially: Adductor longus and Pectineus

Laterally: Iliacus and Psoas major

CONTENTS:

(a) Femoral artery

(b)

Femoral vein

(c) Femoral sheath

(d) Nerves

(e) Deep inguinal lymph nodes


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(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


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(2) FEMORAL VEIN AND ITS TRIBUTARIES:

Base: medial to artery

Apex: posteromedial to arteryTributaries: Great saphenous vein and circumflex


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(3)FEMORAL SHEATH:a prolongation downward, behind the inguinal

ligament, of the fascia which line the abdomen, thetransversalis fascia being continued down in front of thefemoral vessels and the iliac fascia behind them.


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FEMORAL NERVE:

- Arises from the lumbar plexus, its formed by the ventralrami of L2,L3 and L4.

- Descends within the groove between the psoas majorand Iliacus muscles

- Lateral to the femoral artery as it enters the thigh


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-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.


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SAPHENOUS NERVE:-Sensation of the skin of patella and median side of the leg and foot

- Injury: loss of sensation


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Deep inguinal lymph nodes:-located medial to the femoral vein and under the

cribriform fascia. There are approximately 3 to 5 deepnodes. 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.


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SUMMARY:


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HOW WOULD YOU LOCATE THEFEMORAL VEIN?

The femoral vein is not usually palpable but its positioncan be located inferior to the inguinal ligament byfeeling the pulsations of the femoral artery which is

immediately lateral to the vein. In thin people, thefemoral vein may be close to the surface and may bemistaken for the great saphenous vein. It is important toknow that the femoral vein has no tributaries at thislevel except for the great saphenous vein that joins itapproximately 3cm inferior to the inguinal ligament

from femoral vein. We have branches of greatsaphenous vein, external pudendal vein and superficialepigastric vein.


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CONSEQUENCE OF DAMAGED

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

-WHAT IS FEMORAL NERVE DAMAGE?Femoral nerve dysfunction is the loss of movement and sensation in the leg. This damage is clinicallytermed as Mononeuropathy which also means local damage to a nerve. Many times the damage is to thecomplete 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 structureslike tumors, abscesses can cause femoral nerve damage. Entrapment of the nerve result in damage tothe 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 involvethe whole body, can affect the function of femoral nerve. In mononeuritis multiplex, dysfunction offemoral nerve due to systemic disorder can be noticed.

As the femoral nerve passes through muscles, femoral nerve entrapment due to pressure on the nerve isquite common.
http://www.innovateus.net/health/how-many-muscles-does-human-body-havehttp://www.innovateus.net/health/how-many-muscles-does-human-body-havehttp://www.innovateus.net/health/what-function-myenteric-plexushttp://www.innovateus.net/health/what-function-myenteric-plexushttp://www.innovateus.net/health/what-function-myenteric-plexushttp://www.innovateus.net/health/how-many-muscles-does-human-body-have


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>Breaking of bones in the pelvic area can cause damage to the femoralnerve. Internal bleeding (bleeding in the abdominal area), use of tight orheavy waist belts can compress the femoral nerve or its branches.

>Insertion of catheter in the groin or lying in a position with the thighs andlegs stretched apart (as is many times required for certain surgical ordiagnostic procedures) can cause damage to femoral nerve.

>Diseases like diabetes can lead to damaged femoral nerve due toperipheral neuropathy.

CONSEQUENCES:

Weakened knee or leg :muscle weakness within the leg can makeit difficult for a patient to stand or walk normally making it difficult towalk 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
http://www.buzzle.com/articles/peripheral-neuropathy/http://www.buzzle.com/articles/peripheral-neuropathy/http://www.buzzle.com/articles/peripheral-neuropathy/http://www.buzzle.com/articles/peripheral-neuropathy/


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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.


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ANATOMICAL SIGNIFICANCEOF FEMORAL CANAL.

Definition : The femoral canal is the passageway through

which femoral structures exit from theabdomen into the upper thigh.

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

Boundaries Anteriorly: inguinal ligament

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

muscle


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Compartments and contents

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

The medial compartment is the femoral ring. contains some lymphatic vessels and a lymph

gland imbedded in a small amount of areolartissue The lateral compartment contains the following

structures from medial to lateral::-1. femoral vein2. femoral artery3. genitofemoral nerve

4. femoral nerveThe femoral artery and vein are enclosed by thefemoral sheath, an extension of the transversalisfascia.


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Applied anatomy

The abdominal opening of the femoral canalis the femoral ring.

A femoral hernia occurs through the femoralcanal.

In 30% an aberrant or anomalous obturatorartery (a branch from the inferior epigastric

artery) crosses the lacunar ligament and maybe injured during operations of the femoralhernia


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FEMORAL RING:

-The femoral ring is the base of the femoral canal. Itis directed upward and is oval in form, its longdiameter being directed transversely and measuringabout 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 lacunarligament. laterally by the fibrous septum on the medial side

of the femoral vein.
http://en.wikipedia.org/wiki/Femoral_canalhttp://en.wikipedia.org/wiki/Anteriorhttp://en.wikipedia.org/wiki/Inguinal_ligamenthttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Pectineushttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Lacunar_ligamenthttp://en.wikipedia.org/wiki/Lacunar_ligamenthttp://en.wikipedia.org/wiki/Lacunar_ligamenthttp://en.wikipedia.org/wiki/Femoral_veinhttp://en.wikipedia.org/wiki/Femoral_veinhttp://en.wikipedia.org/wiki/Femoral_veinhttp://en.wikipedia.org/wiki/Lacunar_ligamenthttp://en.wikipedia.org/wiki/Lacunar_ligamenthttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Pectineal_fasciahttp://en.wikipedia.org/wiki/Pectineushttp://en.wikipedia.org/wiki/Posterior_(anatomy)http://en.wikipedia.org/wiki/Inguinal_ligamenthttp://en.wikipedia.org/wiki/Anteriorhttp://en.wikipedia.org/wiki/Femoral_canal


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ANATOMICAL SIGNIFICANCEOF FEMORAL RING:

It is the main site for femoral hernia.


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WHAT IS THE SIGNIFICANCE OF THE FEMORAL TRIANGLEIN POST-MORTEM EXAMINATION?

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