Inguinal Ligament

Original Editor - Khloud Shreif

Top Contributors - Khloud Shreif

Description[edit | edit source]

Inguinal triangle.png

The inguinal ligament or Poupart's ligament formed from the aponeurosis of the lower border of external obliquis muscle. It has 2 surfaces concave and convex, the convex surface toward the thigh attached to the deep fascia that pulling the ligament downward. It is a site for attachment of internal obliquis muscle at the lateral 2/3 and transversus abdominis at the lateral 1/3. It extends from the pubic tubercle medially to ASIS laterally and forming the superior border of the femoral triangle.

The midpoint between the ASIS and symphysis pubis called midinguinal point, an important surgical landmark, behind the external iliac artery continues as the femoral artery. The inguinal ligament has three extensions; lacunar, pectineal, and reflected part.

Attachments[edit | edit source]

  • Lacunar and cooper ligament
    Lacunar/ Gimbernat's ligament, extends down from the medial border of the inguinal ligament, reflected backward and laterally to insert in pectineal line and also named as the pectineal part, it is triangular in shape attached to pubic tubercle by its apex while the base is free and directed laterally. Attached to the inguinal ligament at the anterior margin or upper border, and to the pectineal line from the posterior margin/or lower border.
  • Pectineal/ cooper’s ligament, it is an extension from the lacunar ligament extending from the lacunar ligament and attaches to the pectineal line run on the superior ramus of the pubic bone forming the posterior border of the femoral ring[1].
  • Reflected part of the ligament, thin band extend from the medial end of the inguinal ligament to the linea alba.

Function[edit | edit source]

Forming the floor for the inguinal canal, and protecting structures passing between the pelvis and thigh. The following structures pass behind the inguinal ligament ;

  1. Psoas major, iliacus, and pectineus
  2. Femoral nerve, artery, and vein at the midinguinal point.
  3. Lateral cutaneous nerve of thigh
  4. Lymphatics
  5. Deep cirumflex artery

Clinical relevance[edit | edit source]

The inguinal ligament is considered as a landmark to distinguish clinically between the groin hernia in which the bulge is above the ligament, and femoral hernia the bulge is below the ligament[2].

Inguinal distribution, groin injury, or sport's man groin[3]: weakness of the inguinal ligament attachments maybe exist.

Assessment[edit | edit source]

From the patient supine position the hip in abduction, externally rotated and knee flexed, the structures related to the pubic tubercle examined by careful palpation from adductor tendon medially, then pectineus, lacunar ligament, inguinal ligament, conjoined tendon, and rectus sheath attachment (pubic clock), through the posterior inguinal canal, and during the assessment, the tenderness may extend along the inguinal ligament.

[4]

Treatment[edit | edit source]

Treatment of inguinal disruption varying from:

NSAID , corticosteroid injection into the origin of adductor longus.

Physiotherapy management involving the release of the inguinal ligament (according to the structure of the ligament we can treat it as a tendon).

Surgical intervention, laparoscopic TAPP repair with inguinal ligament tenotomy[5].

[6]

Resources[edit | edit source]

Ken Hub

Musculoskeletal Key

References[edit | edit source]

  1. Steinke H, Wiersbicki D, Völker A, Pieroh P, Kulow C, Wolf B, Osterhoff G. The fascial connections of the pectineal ligament. Clinical Anatomy. 2019 Oct;32(7):961-9.
  2. Sugumar K, Gupta M. Anatomy, Abdomen, and Pelvis, Inguinal (Crural, Pouparts) Ligament.
  3. Rennie WJ, Lloyd DM. Sportsman's groin: the inguinal ligament and the Lloyd technique. Journal of the Belgian Society of Radiology. 2017;101(Suppl 2).
  4. Watchful hands. How to find the inguinal ligament (surface anatomy). Available from: http://www.youtube.com/watch?v=OONg2NjwwBI[last accessed 21/7/2021]
  5. Clelland AD, Varsou O. A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management. Surgical and Radiologic Anatomy. 2019 Mar;41(3):265-74.
  6. OMMinutes. Inguinal Counterstrain. Available from: http://www.youtube.com/watch?v=yedkQL8[last accessed 21/7/2021]