 Good day everybody. Dr. Sanjay Sanyal, Professor, Department Chair. This is going to be a demonstration of the adductor region of the thigh. So this is a supine cannibal, this is the right side. I'm narrating from the right side, the camera person is on the left side. This muscle that we see in front of us, this muscle which I'm tracing with my instrument here, this is the adductor brevis, the medial most muscle of the adductor group. It takes origin from the superior pubic remus and it gets inserted into the upper part of the linea aspera. This is part of the floor of the femoral triangle. Just after the adductor brevis we have this muscle here, this one. This is the adductor longus. It takes origin from the crest of the pubic bone and it continues down and it gets inserted onto the middle one third of the linea aspera. This forms a middle boundary of the femoral triangle. And when I lift this up we can see yet another bigger muscle underneath this one here. And when I retract it we can see the part of the muscle here also. And we can see the muscle continuing further down here also. So this whole thing that we see here, this is the largest of the adductor muscles, this is the adductor magnus. This has got two components, adductor component and hamstring component. The adductor component takes origin from the ischic pubic remus and it gets inserted in a fan shaped fashion to almost the entire length of the linea aspera and that is where my finger has disappeared. It's on the posterior aspect of the femur. There is a hamstring component which takes origin from the ischial tuberosity behind which we cannot see in this dissection. And the tendon runs down almost vertically and that tendon is called the adductor tendon. But that is the hamstring component and that gets inserted onto the adductor tubercle. This is my finger is tracing on the adductor tendon. This vertical portion that we see here, this is the adductor tendon which is coming from the ischial tuberosity and it comes vertically down and gets inserted onto tubercle on the medial corner of the femur and that is known as adductor tubercle. This is the portion which is forming the medial boundary of the adductor hiatus which I shall show you a little later. And if we were to tap this tendon here as I'm doing right now, then it can produce the adductor reflex. So this is the hamstring component of the adductor magnus. So that brings me to the enough supply of the adductor muscles. The adductor muscles are all supplied by the obtrator nerve. This is the neurovascular bundle coming from the obtrator canal in the obtrator foramen from the pelvis. This contains the obtrator nerve and the obtrator artery. It is coming between the adductor longus and the adductor magnus and it supplies the adductor muscles. To trace it further, we can see these are the branches of the obtrator nerve which are supplying the adductor longus, adductor magnus, adductor bivis and it is also supplying this muscle which I have not mentioned yet. This is the gracilis muscle. The gracilis muscle is also a muscle of the adductor compartment. It takes origin from the pubic bone and it continues vertically down as a graceful tendon and it gets inserted into the pest and serenus which I shall mention subsequently. This gracilis muscle does not have much of an inductor function. However, it is used in clinical practice for repairing an incontinent anal sphincter. The hamstring component of the adductor longus is supplied by the tibial division of shitegner. The obtrator nerve also supplies partly muscle which is in the flow of the femoral triangle and that is the pectinus muscle. As the term implies, the combined action of all these adductors is adduction of the thigh. There is yet another muscle called the obtrator internus which is not visible. That is responsible for adduction of the thigh and as well as lateral rotation of the thigh. People who ride horses for many years, they can develop heterotopic ossification at the tendon of origin of the adductor longus because of constant adduction of the leg and that heterotopic ossification is referred to as writer's bones which can be felt as a hard structure in front of the pubic bone that is called the writer's bone. So these are the muscles of the adductor component at the neurovascular structures. Now I shall show you the course of the profunda femoris artery and how it is related to the adductor vaginas. To do that, let's put the femoral vessels in place. So this is the femoral vein and this is the femoral artery because this is highly thrombosed and as a hardest cement, it got cracked. And if you were to trace it, we notice that they are giving this branch here. This is the profunda femoris artery. The profunda femoris artery and the profunda femoris vein, they run deep. That's why they're called profunda femoris and these profunda femoris vessels, they run then deep in relation to the insertion of the adductor vaginas to the linea aspera. And as they're running down, they give these vessels that we can see here. This is one vessel. This is a vessel which perforates through the insertion of the adductor vaginas and goes to the posterior aspect of the thigh. This is another vessel. Like that, there will be four such vessels and they are referred to as perforating arteries. So these perforating arteries, they come from the profunda femoris artery, they pierce through the insertion of the adductor vaginas and they go to the posterior aspect of the thigh and they are the ones we supply the posterior aspect of the thigh. And the main profunda femoris terminates in the fourth perforating artery and it runs in relation to the anterior surface of the adductor vaginas close to its insertion. So that is the relationship between the profunda femoris, the perforating arteries and the adductor vaginas. Now let's trace the adductor canal. For that, I have replaced back the sartorius here on top of the adductor longus. The adductor canal starts where the apex of the femoral triangle starts and it goes and ends at the adductor hiatus. Therefore to see that, I have reflected the sartorius and this is the location of the adductor canal. So what do we see in the adductor canal? First of all, we see this structure here. This is the syphilis nerve. The syphilis nerve was highly brittle, so therefore it got inadvertently torn but we have salvaged it here. This is the syphilis nerve. It's coming from the femoral nerve here. This is the longest cutaneous branch of the femoral nerve and the only branch which goes outside the thigh and this runs in the adductor canal. And we can see it very clearly here along its full length. This syphilis nerve, after it passes through the adductor canal, it comes out through the adductor canal. It goes under the sartorius and then it comes to the leg and it accompanies the long syphilis nerve and it goes all the way, supplies the medial surface of the leg and little bit of the medial surface of the foot. So this is the syphilis nerve. That's one content. The next content is this. This is the femoral artery and behind that, the third content is the femoral vein and the fourth content is this nerve here. This is the nerve to the vastus medialis, which is this muscle here. So these are the contents of the adductor canal. The red canal is bounded by the sartorius medially. Under that, there was a sub-sartorean fascia which has been removed. Laterally, it is bounded by the atastus medialis and posteriorly, it is bounded by the adductor longus and behind that by the adductor magnus. I shall trace my finger along the femoral vessels and as I trace my finger, we can see that it is disappearing in one place here. This is the adductor hiatus and my finger has now gone into the pocridial fossa. If you look at my finger, you'll find that medial to my finger is this tendon here, which I had mentioned earlier. This is the adductor tendon, which is the hamstring component of the adductor magnus, coming from the ischial tuberosity. Lateral to my finger is the rest of the adductor magnus, which is the adductor component of the adductor magnus. Therefore, the adductor hiatus is an opening between the hamstring and the adductor component of the adductor magnus through which the femoral artery and the femoral vein passes and it goes to the pocridial fossa and there it becomes known as the pocridial artery and the pocridial vein. So, that is about the adductor hiatus, which is the termination of the adductor canal. Before I conclude, I need to show you something more, which I had mentioned before. I have put three muscles together below the knee and we can see a structure here when I lift these three tendons up. This structure that we can see here, this is referred to as the pes anserinas. The word pes anserinas in Latin literally means the foot of a goose and if you look very carefully, it somehow resembles the foot of a goose. This is pes anserinas is composed of the combined insertion of three muscles, one each from each of the compartments of the thigh. The first is this muscle here. This is the sartorius which was running like this and we can see it. I have separated it out here and brought it in front. So, this is the sartorius. This is from the anterior compartment. The next muscle, this is the grace which I had mentioned is the muscle of the medial compartment and this tender, this is the semi tendonosis, which is the muscle of the posterior compartment. These three muscles together constitute the pes anserinas insertion on the upper medial aspect of the tibia and under the pes anserinas, there is a bursa which is referred to as the ancerine bursa and if you were to look under the pes anserinas, we can see a tough ligament here which has been represented by my instrument. This is the tibial collateral ligament. So, there is a pes anserinas ancerine bursa between these two and there can be a bursa under the tibial collateral ligament between the ligament and the medial surface of the tibia. So, these are the structure that we can see in relation to the adductor compartment that I wanted to mention to you with their respective clinical correlations and the functional aspects. Thank you very much for watching Dr. Sanyal Sanyal. David, who is a camera person, if you have any questions or comments, please put them in the comment section below. Have a nice day.