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GNK 483 MUSCULOSKELETAL CONDITIONS. BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012. Arterial Supply. Superior gluteal Runs through greater sciatic foramen Inferior gluteal Runs through gluteal region Obturator Runs through obturator foramen to adductor compartment of thigh & hum head
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GNK 483 MUSCULOSKELETAL CONDITIONS BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012
Arterial Supply • Superior gluteal • Runs through greater sciatic foramen • Inferior gluteal • Runs through gluteal region • Obturator • Runs through obturator foramen to adductor compartment of thigh & hum head • Femoral • Popliteal
Femoral Artery • Main artery • Origin = external iliac artery • Course = femoral sheath • Lateral to femoral vein • Anterior to femoral head • Runs superficially in femoral triangle • Passes through adductor canal • Changes name to popliteal artery at add hiatus
Femoral Artery Branches • Branches inferior to inguinal ligament • Superficial circumflex iliac artery • Superficial epigastric artery • Superficial external pudendal artery • Branches in femoral triangle • Deep external pudendal artery • Deep femoral artery • Descending genicular artery
Deep Femoral Artery • Main artery of thigh • Arises lateral side of femoral artery • Leaves femoral triangle betw pectineus & add longus in the floor of the triangle • In adductor compartment it runs betw add longus and add magnus • Supplies adductors & flexor compartment • Branches • Medial circumflex femoral a : clinical importance • Supplies largest quantity of blood to fem head and neck • Lateral circumflex femoral a • Supplies lat side of thigh & fem head
Deep Femoral Artery • Anastomosis at height of lesser trochanter on posterior side of thigh • Medial circumflex femoral • Lateral circumflex femoral • Inferior gluteal • 1st perforator of deep femoral
Popliteal Artery Branches • Cutaneous • Posterior surface of leg • Muscular • Lower part of thigh muscles • Calf muscles : sural artery • Articular • Medial & lateral superior genicular • Middle genicular • Medial & lateral inferior genicular • Terminal • Anterior tibial • Called dorsalis pedis on dorsum of foot • Posterior tibial • Divides into medial & lateral plantar aa • Latter forms plantar arch & anastomosis with dorsalis pedis a
Venous Drainage • Deep veins • Superficial veins • Perforators
Deep Veins • 2 venae comitantes accompany each artery of the leg of which popliteal and femoral vv are examples • Blood flows proximally in these veins with the aid of: • Valves • Muscular contraction • Pulsation of aa adj to venae comitans • Pressure changes in thorax
Superficial VeinsOn dorsum of foot • Small saphenous • Post to lateral malleolus • Middle of calf it runs superficial to calcaneal tendon & gastroc • Ascends in relation sural n • Ends in popliteal vein • Great saphenous • Medial side of dorsal arch • Ant to medial malleolus • Ascends in relation to saphenous n • Drains into femoral vein
Before terminating, great saphenous receives: • Superficial epigastric • External pudendal • Superficial circumflex iliac • Anterolateral branch • Posteromedial branch • Perforators • At saphenous opening • Lower part of thigh Hunters perforating v • Below knee : Boyd’s perforating v • Medial aspect of leg
Lumbar Plexus • Femoral n : L2,3,4 (posterior) • Muscular to ant compartment, pectineus • Articular to hip & knee • Cutaneous • Intermediate ant cutaneous • Medial ant cutaneous • saphenous
Lumbar Plexus • Obturator n : L2,3,4 (anterior) • Muscular to adductor, gracilis • Articular to hip & knee • Cutaneous to medial part of thigh • Lateral cutaneous nerve to thigh : L2,3
Sacral Plexus • Sciatic n : L4,5,S1,2,3 • Muscular to hamstrings, add magnus • Articular to hip & knee • Tibial n • Common fibular • Superficial fibular • Muscular to peroneus longus & brevis • Cutaneous to distal 1/3 of leg & dorsum of foot except 1st web space • Deep fibular • Muscular to 4 muscles of ant compartment • Cutaneous to 1st web space
LYMPHATIC SYSTEM LOWER LIMB