What is the structure and function of the fascia of the hip and thigh? How are the different types of fascia related to clinical conditions? Explore the details in this comprehensive article.

Fascia of the Hip and Thigh: Anatomy

Fascia is a band of connective tissue located beneath the skin, which encloses and separates muscles. There are two main types of fascia: superficial and deep. The superficial fascia is attached to the dermis and aids in movement of the skin. The deep fascia is denser than its superficial counterpart and forms intermuscular septa, which are involved in the formation of muscular compartments.

Superficial Fascia

The superficial fascia of the hip and thigh is continuous with the fascia of the lower back posteriorly and the fascia of the abdominal region anteriorly. This fascia consists of loose areolar and adipose tissue. In the inguinal region, this fascia splits into two layers to enclose the long saphenous vein and superficial inguinal lymph nodes. The superficial fascia is referred to as the cribriform fascia, as it is perforated by the long saphenous vein, lymphatic vessels and by superficial branches of the femoral vein.

Deep Fascia

The deep fascia of the hip is thin over the gluteus maximus muscle but thickens over the anterior two-thirds of the gluteus medius muscle to form a strong aponeurosis. This aponeurosis is attached to the lateral aspect of the iliac crest and splits into two parts to enclose the tensor fascia latae and gluteus maximus muscles. The deep fascia is attached anteriorly to the inguinal ligament and the superior ramus of the pubis. Posteriorly it is attached to the sacrum and coccyx bones. Medially, it is attached to the inferior pubic ramus and to the lower aspect of the sacrotuberous ligament as well as to the ramus and tuberosity of the ischium.

Fascia Lata

The fascia lata, the deep fascia of the thigh, varies in thickness and is continuous with the deep fascia of the hip. It is thicker in the proximal and lateral aspects of the thigh where it attaches to the gluteus maximus and tensor fasciae latae muscles. It is also thick around the knee joint. Over the adductor muscles and posterior aspect of the thigh, the fascia lata is thinner.

Iliotibial Tract

On the lateral aspect of the thigh, the fascia lata thickens to form the iliotibial tract. Superiorly, the iliotibial tract splits into a superficial and a deep layer. The superficial layer is attached to the iliac crest and descends lateral to the tensor fasciae latae muscle. The deep layer is medial to this muscle and blends with the capsule of the hip joint. Distally, the iliotibial tract blends with the aponeurosis of the vastus lateralis muscle before it attaches to Gerdy’s tubercle, which is located on the anterolateral surface of the lateral tibial condyle.

Intermuscular Septa

There are two intermuscular septa formed by the fascia lata and these septa form the anterior, posterior and medial compartments of the thigh. These septa are referred to as the medial and lateral septum. The medial septum is thinner and weaker than the lateral one. It lies between the vastus medialis anteriorly and the adductor and pectineus muscles posteriorly. The lateral septum descends from the gluteus maximus muscle to the lateral condyle of the femur and lies between the vastus lateralis and the short head of the biceps femoris muscle. Both of these septa are attached to the linea aspera of the femur.

Saphenous Opening

In the deep fascia, there is an opening 3 cm lateral to the pubic tubercle, which allows the passage of the long saphenous vein. This aperture, referred to as the saphenous opening, is covered by the superficial fascia and is located inferomedial to the superficial stratum of the fascia lata. It is located lateral to the deep stratum and its superior, inferior and lateral borders are formed by the arched falciform margin.

Iliac Fascia

The iliac fascia covers the iliacus muscle and forms the floor of the femoral sheath. It is attached superiorly to the iliac crest and inferiorly to the inguinal ligament. The iliac fascia continues inferiorly to form the posterior wall of the femoral sheath.

The fascia of the hip and thigh plays a crucial role in the movement and function of the lower limb. Understanding the anatomy and variations of these fasciae is important for both clinicians and researchers, as they can be involved in various pathological conditions such as iliotibial band friction syndrome, eosinophilic fasciitis, and complications related to femoral vein cannulation.