Video: Neurovasculature of the hip and thigh

Hello, everyone! This is Joao from Kenhub, and welcome to another anatomy tutorial where I'm going to be covering the neurovasculature of the hip and thigh.

So on this tutorial, what we’re going to be doing is describing or looking at your hip and thigh, like you see here on this image. We’re looking at them from an anterior view on this particular image, and we’re going to be describing the different arteries, veins, and nerves or the main arteries, veins, and nerves that you find on your hip and thigh.

And before we do so, I would like to start off, then, with the first one on the list, the arteries that are now seen here, isolated on the image on the right side. And before we talk about them in a little bit more detail, I would like to, then, list the structures.

Now, in terms of arteries, we’re going to be talking about the lateral and medial femoral circumflex arteries, the descending genicular artery, the femoral and deep femoral arteries, and the inferior and superior gluteal arteries.

We’re going to start off with the main artery of the hip and thigh, specifically the thigh—this one that you see, highlighted in green. And keep in mind that we are looking at the anterior view of the hip, and also you notice here the thigh bone or the femur. And notice, then, this structure here, highlighted in green, which is the artery that we’re going to be describing now: the femoral artery.

The femoral artery is the biggest and most important artery of the leg. It is the continuation of another one known as the external iliac artery which, in turn, is a continuation of an important structure or important artery in your body, the most important one, known as the aorta.

Now, also important to add here about the femoral artery is that it will become the femoral artery once it crosses this ligament that you see partially here, the inguinal ligament, and then it becomes the femoral artery, as you see here, highlighted in green.

Now, as I mentioned just now, when it exits the pelvis through the vascular lacuna, it runs down to or towards the popliteal fossa, as you can see here, the artery just running down into the popliteal fossa. And from there, we’re going to start calling it the popliteal artery. During its course, the femoral artery gives off several branches which we will be talking about some of them here on this tutorial.

Let’s start with the first one that you see, now highlighted in green. And now you have a broader view of the femoral artery here. Remember, that we just talked about it before. We’re still looking at it from an anterior view. You also see here the inguinal ligament. And then, once it crosses the inguinal ligament towards the thigh, then it becomes the femoral artery.

But now you’re seeing here this highlighted image, this… or this highlighted structure which shows the branch, one of the branches of the femoral artery, and this one is known as the deep femoral artery. And this one branches off proximally and runs deeper in the thigh than the femoral artery, hence the name: deep femoral artery. And it runs caudally also close to the femur between the pectineus muscle and the adductor longus muscle. The deep femoral artery gives off two arteries or two important arteries that we’re going to be talking about, two other branches known as the medial and lateral circumflex arteries.

Now, we’re going to be covering those branches that come out of the deep femoral artery that are now seen here, highlighted in green. On the image on the left side, we’re seeing the highlight of the medial femoral circumflex artery, while on the right side, we see the lateral femoral circumflex artery. And the reason why we call them medial versus lateral is, if you look at this image here where you can see both, the medial is highlighted, as you can clearly notice here, while the lateral is not highlighted but you see it here. But just for purposes of distinguishing them from medial to lateral, you notice here that the medial femoral circumflex artery is, then, branching off of the deep femoral artery and taking a medial route, as you can see here, towards the midline of your body. While the lateral one is, then, branching off towards the size of your body. That’s why we call it, then, the lateral femoral circumflex artery.

And the circumflex arteries leave the deep femoral artery and runs spirally on the medial or lateral sides around the femur in order to supply the head and neck of this bone with arterial blood. And at the back of the femur, they form what is known as collateral arteries which ensure a continuous and also safe circulation of blood in your body, in this part of your body in case one of these structures, then, gets injured. So the more branches you have, the safer it is for the blood to circulate in case one of these structures gets or suffers some sort of injury or trauma.

We’re moving a bit further down now to, then, highlight this structure, this blood vessel that you see now on the screen. This one is coming out of the femoral artery as you can clearly see here. And you notice here the anterior view of your knees. So I’ve got a bit of more location. And this structure is, then, called the descending genicular artery. And this artery leaves the femoral artery at the distal part of the thigh and splits up into the saphenous and an articular branch supplying the region of the knee joint.

We’re going to return far back up, and now we’re looking at the posterior view of the thigh and hip as well, and more specifically here, we see clearly the bony pelvis. And now, we’re highlighting two arteries here that are known, on the left side, as the superior gluteal artery. And on the other side, a bit further down, then we find the inferior gluteal artery. And these are the two arteries, two last arteries we want to cover here. And then what you need to know is that they are branches of the internal iliac artery supplying the gluteal region with oxygenated blood.

Let’s zoom in here the inferior gluteal artery, so we can talk a little bit more this structure. Now, this inferior gluteal artery, as you can clearly see here from this image, is exiting the greater sciatic foramen and then running below this muscle which is known as the piriformis muscle. It leaves the pelvis and goes until the subcutaneous tissue of the dorsal thigh. And the inferior gluteal artery supplies the piriformis muscle and also the quadratus femoris muscle. And in addition, this inferior gluteal artery will be, then, supplying the skin of the gluteal and upper thigh regions.

Now, it is time for us to then pay a little bit more attention to the superior gluteal artery, if you remember correctly from the previous slides. And this one runs dorsally and goes through the greater sciatic foramen where it splits into a superficial and deep branch. The superior gluteal artery will be supplying several structures including your gluteal muscles, the three gluteal muscles that you have on each side of your hip, or gluteal, or buttocks region. It will also be supplying the piriformis muscle, the tensor fasciae latae muscle, and also the surrounding skin.

And since we covered the main arteries that we find on the hip and thigh, we’re ready to move on and talk about the main vein that we find on the hip and thigh. So this is what we’re going to be covering here on this tutorial. We’re going to have some words on the femoral vein. And the femoral vein is... like the femoral artery, as you can now see here highlighted in green, the femoral vein is the largest and most prominent vein of the leg. It drains blood from the lower leg back towards the pelvis where it, then, follows a path towards your heart carrying deoxygenated blood.

The following veins will be draining blood into the femoral vein: the popliteal vein, the deep femoral vein, and the great saphenous vein—all of these veins that will be covered on separate tutorials when we go into more detail on the different veins of the thigh and lower leg.

Important to add here that the femoral vein drains blood into the external iliac and, thus, is the most important venous connection between your lower leg and the pelvis.

And like I mentioned, this was just an overview of the femoral vein which is the main vein that you find on the hip and thigh, but we’re going to discuss it later on on a different tutorial in more detail.

But we’re now ready to move on the different nerves that we find on the hip and thigh regions. And I'm going to list them right now for you. The first ones are the inferior middle and superior cluneal nerves. We’re going to also be seeing the lateral and posterior femoral cutaneous nerves. We’re going to talk about the femoral nerve. And also others on the list will include the saphenous nerve and the inferior and superior gluteal nerves. And not to forget, the sciatic nerve will also be mentioned on this tutorial.

And we’re going to start off with these, the first ones on the list that we saw previously. Now, we have three images here, three highlights, and three nerves that we’re going to briefly mention. And all of these innervate areas of the buttocks skin, corresponding to, then, their names.

Now, the first one on the far left are known as the inferior cluneal nerves. On the middle image, we’re going to be looking at the medial cluneal nerves. And then, on this one, we see the superior cluneal nerves.

Now, the superior cluneal nerves are branches or dorsal branches of L1 to L3. The middle cluneal nerves are dorsal branches of S1 to S3. And the inferior cluneal nerves from posterior femoral cutaneous nerve. So just a brief mentioning of where these nerves come from.

We are now ready to move on to the next one on that list, now seen here highlighted. This is the lateral femoral cutaneous nerve. And the lateral femoral cutaneous nerve is also called or also known as the lateral cutaneous nerve of the thigh. And it is a nerve of the lumbar plexus. It innervates the skin on the lateral part of your thigh.

The next one that we’re going to be highlighting and showing you here—and notice that I just turned around to then show the posterior view of the hip and thigh to show you this highlighted nerve—which is known as the posterior femoral cutaneous nerve. And this nerve is also called or also known as the posterior cutaneous nerve of the thigh. It provides innervation to several structures including the skin of the posterior surface of the thigh and leg as well as the skin of the perineum.

We’re now turning again to an anterior view to show you this highlighted nerve, which is known as the femoral nerve. The femoral nerve is the largest branch of the lumbar plexus. Now, this important nerve will be, then, innervating several structures in your body. A lot of muscles which include, then, the iliacus, the sartorius, the rectus femoris, the vastus medialis, vastus lateralis, the vastus intermedius, and the pectineus muscle.

We’re now moving on to the next one that you see here, highlighted in green. This is known as the saphenous nerve. And as you can clearly see here, this is the largest branch of the femoral nerve that we just talked about. So this is the femoral nerve, and you can clearly see that the saphenous nerve is then a branch of the femoral nerve.

The saphenous nerve will be innervating the skin of the front and medial sides of the leg.

We’re now moving on to, now, the back again to show you this highlighted nerve. This is known as the inferior gluteal nerve. The inferior gluteal nerve is a nerve that will be innervating the gluteus maximus. It is responsible for the movement of the gluteus maximus in activities requiring the hip to extend the thigh such as climbing stairs.

If you have an inferior gluteal nerve, you should have, then, this one that we’re going to be seeing now and highlighting, still from a dorsal view of the hip and thigh. Now, we’re looking at the superior gluteal nerve. And the superior gluteal nerve originates at the sacral plexus. And this nerve will be innervating a few muscles as well, including the gluteus medius, gluteus minimus, and the tensor fasciae latae.

Ready to move on to a next nerve that we see also from a posterior view, highlighted in green, this is the sciatic nerve. And the sciatic nerve is the longest and widest single nerve in the human body going from the top of the leg to the foot on the posterior aspect. Begins in the lower back and runs through the buttock and down the lower limb. The sciatic nerve is such a long nerve that will be innervating a few structures along its course. Now, it’s going to be supplying nearly the entire skin of the leg, the muscles of the posterior or the posterior thigh muscles, and also the muscles of the leg and foot—so a lot of structures that will be, then, innervated by this long, running sciatic nerve.