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Lower Limb I

Lower Limb I. Regions. Gluteal region (buttocks) R egion between trunk and free lower limb Femoral region (thigh region) Region between hip and knee Knee region Posterior area of knee: popliteal fossa Leg region Between knees and ankle Ankle region Foot region

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Lower Limb I

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  1. Lower Limb I

  2. Regions • Gluteal region (buttocks) • Region between trunk and free lower limb • Femoral region (thigh region) • Region between hip and knee • Knee region • Posterior area of knee: popliteal fossa • Leg region • Between knees and ankle • Ankle region • Foot region • Tarsus,metatarsus, phalanges

  3. Note • Thigh Flexes anteriorly

  4. Note • Knee flexes posteriorly

  5. Osteology - Femur • Largest bone in the body • Superior end: Head, neck, greater and lesser trochanters • Shaft • Linea aspera • Medial and lateral femoral condyles • Patella

  6. Osteology - Femur Head Neck • Most common site for femur fracture, especially with age w/ osteoporosis

  7. Osteology - Femur Greater Trochanter Lesser Trochanter • Fractures usually from direct trauma

  8. Osteology - Femur Shaft Linea Aspera– where abductors of the thigh attaches • Fractures usually from direct trauma

  9. Osteology - Femur Medial femoral condyle Lateral femoral condyle - Articulates with the menisci (cartilage) and tibial condyles to form knee joints

  10. Osteology – Femur Medial epicondyle Lateral epicondyle

  11. Osteology - Femur Patella articulation surface Patella – free floating (sesamoid) bone

  12. Osteology – Tibia & Fibula Tibia (shin bone) – weight bearing, articulates with femur proximally and talus distally Fibula – site of muscle attachment, does take part in ankle joint but not knee joint • Tibial fractures usually at narrowest part of shaft • Also most common site for compound fractures • Fibular fractures often associated with fracture-dislocations of ankle joint which at combined with tibial fractures

  13. Osteology – Tibial condyles Lateral condyle Medial condyle

  14. Osteology – Tibia Tibial tuberosity – site of quadriceps femoris attachment via patellar ligament Medial malleolus

  15. Osteology – Tibia & Fibula Interosseous membrane – where fibula attaches to tibia Lateral malleolus – not weight bearing, site for muscle attachment

  16. Superficial Anatomy Deep fascia

  17. Deep fascia Fascia lata– holds thigh in place and compresses to pump venous blood out of lower limb. Helps muscle work in unison when walking/running Iliotibial tract – point of insertion of muscles found in hip onto lateral aspect of knee & leg

  18. Superficial fascia, nerves, and veins

  19. Great saphenous vein • Drains blood from medial aspect of foot, leg, and thigh • Its large size makes it a popular site for IVs Popular for coronary bypass b/c Readily accessible Sufficient distance between tributaries so that usable lengths can be harvested Walls contains more muscular and elastic fibers than other superficial veins • Can become varicose, valves are incompetent due to dilation • Deep venous thrombosis swelling, warmth, and erythema

  20. Great saphenous vein Saphenous opening – opening in fascia latawhere great saphenous vein empties into the femoral vein

  21. Small Saphenous Vein

  22. Superficial nerves Lateral cutaneous nerve of the thigh (L2, L3) Posterior cutaneous nerve of the thigh (S1-S3) – largest cutaneous nerve in the body

  23. Thigh Compartments Anterior Medial Posterior

  24. Fascia compartments of are closed spaces & are rigid • Inc. volume  Inc. intracompartmental pressure  compartment syndrome • Relieved with fasciotomy

  25. Thigh Compartments Anterior Compartment Rules: Most muscles innervated/supplied by femoral nerve & artery Most are flexors of hip and extensor of knee

  26. Quadriceps Femoris • Innervation: femoral (L2, L3, L4) • Supply: femoral artery • 4 heads at origin  unites at quadriceps tendon patellar ligament  tibial tuberosity via the patella • Rectus femoris • Vastuslateralis • Vastusmedialis • Vastusintermedius • Patellar reflex – leg extends in response to sudden stretching of patellar ligament Quadriceps tendon

  27. Quadriceps Femoris: rectus femoris • Origin: Anterior inferior iliac spine & ilium (just superior to the acetabulum) • Crosses two joints • Hip & knee joints • Action: flex hip and extend knee (ex. kicking a ball)

  28. Quadriceps Femoris:Vastuslateralis • Origin: Femur • Extend knee (only)

  29. Quadriceps Femoris:Vastusmedialis • Origin: Femur • Extend knee (only)

  30. Quadriceps Femoris:Vastusintermedius • Deep to rectus femoris • Origin: Femur • Extend knee (only)

  31. Quadriceps Femoris:Vastusintermedius • Deep to rectus femoris • Origin: Femur • Extend knee (only)

  32. Patellar ligament • 4 heads of Quadriceps femoris quadriceps tendon  patellar ligament  tibial tuberosity via patella • Tapping patellar ligament  patella reflex • Tests femoral nerve and L2-L4 spinal cord segments

  33. Sartorius • Strap-like muscle that runs obliquely across thigh • ASIS  medial part of proximal tibia • Action: flexes, abducts, and laterally rotates the hip as well as flexes the knee (exception from anterior compartment) • think hacky sack

  34. Iliopsoas • Fusiform muscle from psoas major and iliacus • Chief flexor of thigh & standing • Attachment: vertebral column, pelvis, and femur • Innveration: • Anterior rami L1,L2: psoas major • Femoral nerve: iliacus

  35. Pectineus • Small muscle that runs from superior pubic ramus  femur (just distal to lesser trochanter) • Innervation: usually femoral, sometimes obturator • Action: adducts and flexes the thigh • Can potentially be placed in either anterior or medial compartment

  36. Tensor fasciae latae • Like pectinus, lies at border of two compartments (shares aspects of both) • Originates from iliac crest & ASIS  iliotibial tract • Innervation: superior gluteal nerve (exception from anterior compartment) • Action: controversial, think military “stand at attention” – keep knees extended • But also helps flex & adduct thigh

  37. Thigh Compartments Medial compartment Rules: Most crosses hip joint and adduct the thigh at the hip All except “hamstrings part” are innervated by obturator nerve (L2-L4)

  38. Adductors – all originates pubis  lineaaspera Adductor longus Adductor brevis

  39. Adductors – all originates pubis  lineaaspera Adductor magnus • In addition to pubis  lineaaspera • The “hamstring” part of adductor magnus originates from the ischial tuberosity  adductor tubercle of femur • Innervation: Obturator • Hamstring part innervated by tibial part of sciatic nerve (exception) • Action: adduct the thigh • Hamstrings part extend the thigh

  40. NOTE • Hamstring part of the adductor magnusextends thigh • Not innervated by obturator nerve

  41. Gracilis • Long strap-like muscle • pubis  medial tibia • Only muscle to cross knee joint + hip joint • Action: primarily adductor of thigh… • flex leg at knee • rotate leg medial when knee is flexed

  42. Obturatorexternus • “appreciate” this muscle – very deep, we won’t see in lab • Found on surface of membrane that covers the obturator foramen  femur in gluteal region • Action: lateral rotation of thigh (exception)

  43. Clinical Correlates • “Groin pull” – strain, stretching, and some tearing to proximal attachment of thigh muscles in anterior and/or medial compartment • Runner’s knee (chondromalaciapatallae) – soreness around or deep to patella results from quadriceps imbalance

  44. The femoral triangle

  45. The femoral triangle • Triangular region bounded • superiorly by inguinal ligament • Laterally by sartorious • Medially by adductor longus • Floor by iliopsoas & pectineus • NAVEL (lateral  medial) • Nerve, artery, vein, empty space [femoral canal] and lymphatics • Empty space (femoral canal) – weak spot in abdominal wall  femoral hernia • Lymphatics too small to be seen in gross anatomy Empty space (femoral canal) Sartorius

  46. The femoral triangle • Triangular region bounded • superiorly by inguinal ligament • Pubic tubercle  ASIS Sartorius

  47. The femoral triangle • Triangular region bounded • Laterally by sartorious Sartorius

  48. The femoral triangle • Triangular region bounded • Medially by adductor longus Sartorius

  49. The femoral triangle • Triangular region bounded • Floor by iliopsoas & pectineus

  50. Nerves

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