Chapter 6: The Lower Limb Flashcards
- attached to the axial skeleton via the sacro-iliac joint
- separated from the abdomen, back, and perineum via a continuous line
lower limb
what is the lower limb divided into?
- gluteal
- thigh
- leg
- foot
posterior region of lower limb
gluteal region
extends to the pelvis
anterior thigh
important transitions between regions of lower limb
- femoral triangle
- popliteal fossa
- tarsal tunnel
contains major blood vessels of the lower limb and one of the major nerves (the femoral)
femoral triangle
pass between the thigh and leg through the popliteal fossa
major vessels and nerves
pass between the leg and foot through the tarsal tunnel
Most nerves and vessels and flexor tendons
major function is support of the body with little energy expenditure
lower limb
center of gravity is just anterior to vertebrae SII
standing erect
how is energy expenditure reduced while standing?
Hip and particularly knee joints can “lock” while standing
second function of the lower limb
locomotion
what are the movements at the hips?
- flexion
- extension
- abduction
- adduction
- medial and lateral rotation
- circumduction
is primarily a hinge joint that flexes and extends
the knee
what are the movements at the ankle?
- dorsiflexion
- plantar flexion
what anatomical features work together to maximized efficiency of walking by reducing the amount that the body’s center of gravity moves?
- Pelvic rotation minimizes a drop
- Movement of knees to the midline reduces a lateral shift
- Knee flexion minimizes a rise
- Pelvic tilt minimizes a rise
how much does the body’s center of gravity fluctuate?
only 5 cm in the vertical and lateral planes
bones of the gluteal region
- hip
- femur
joint between hip and femur
large ball and socket joint
- the bone of the thigh, it articulates with the leg at the knee joint
- shares an articular cavity with the patella
femur
the principle articulation of the knee
joint between the femur and tibia
bones of the leg
- tibia
- fibula
large and weight bearing
tibia
lateral and does not take part in the knee joint nor bear any weight
fibula
formed by a recess formed between the tibia and fibula and part of the talus (tarsal bone)
ankle joint
bone of the foot
- tarsals
- metatarsals
- phalanges
occurs at joints between the tarsal bones
inversion and eversion of the foot
how many tarsal bones are there?
7 tarsal bones
what are the 5 metatarsals limited in their movement by?
deep transverse ligaments
how many phalanges in digits II-V?
3
how many phalanges in digit I?
2
arranged in longitudinal and transverse arches
bones of the foot
- held in place by muscles and ligaments
- absorb shock during walking and standing
transverse arches of the foot
consist predominately of extensors, rotators, and abductors of the hip joint
muscles of the gluteal region
- move the thigh on a fixed pelvis
- control movement of the pelvis relative to the limb bearing the bodies weight
muscles of gluteal region
major flexors of the hip?
iliopsoas- psoas major and iliacus
- originate on the posterior abdominal wall
- pass deep to the inguinal ligament and insert onto proximal parts of the femur
major flexors of the hip
iliopsoas- psoas major and iliacus
what are the muscles in the thigh and leg separated into 3 compartments by?
fascia, bone, and ligaments
what are the 3 compartments in the thigh?
- medial (adductors)
- posterior (hamstrings)
- anterior (quadriceps)
act mainly on the hip joint
adductors of the thigh
extend the hip and flex the knee
hamstrings
extend the knee
quadriceps
what are the 3 compartments in the leg?
- lateral (fibular)
- anterior
- posterior
evert the foot
lateral (fibular) compartment of the leg
dorsiflex the foot and extend digits
anterior compartment of the leg
plantarflex the foot and flex digits
posterior compartment of the leg
what are the 4 major entry points into the lower limb from the abdomen, pelvis, and perineum?
- The gap between the inguinal ligament and pelvic bone
- The greater sciatic foramen
- The lesser sciatic foramen
- The obturator canal
Somatic and general sensory innervation of the lower limb
nerves from the lumbar and sacral plexuses
formed by anterior rami from L1 to L3 and most of L4
lumbar plexus
formed by anterior rami from L4 to S5
sacral plexus
- extend into the leg and innervate parts of the skin
- innervate muscles in the lower limb
Nerves from the lumbar and sacral plexuses
- curves around the head of the fibula on its way into the leg
- can be damaged here by impact
common fibular branch of the sciatic nerve
most important superficial veins
the small and great saphenous
runs up the medial side of the leg and thigh and joins the femoral vein
great saphenous vein
runs up the posterior side of the leg and dives deep into the back of the knee to join the popliteal vein
small saphenous vein
the main parts associated with the lower limb
external surfaces of the pelvis
a site for hamstring and an adductor muscle attachment
ischial tuberosity
covered by a bursa, which we sit on
medial part of ischial tuberosity
- where the head of the femur articulates with the pelvis
- large cup shaped
- has a lunate (articular) surface and a non-articular acetabular fossa
acetabulum
marks the inferior region
acetabular notch
what does the proximal femur contain?
- Head
- Neck
- Fovea
- Greater and lesser trochanter
- Intertrochanteric line
- The shaft
the site for muscle attachment for muscles found in the gluteal region
greater trochanter
the site for iliosoas and iliacs muscle attachment
lesser trochanter
inserts onto the intertrochanteric crest
quadratus femoris muscle
descends from lateral to medial
shaft of femur
triangular in cross section
middle 1/3 of the shaft of femur
formed by the linea aspera and is a major site of muscle attachment in the thigh
posterior margin of femur
- joint between the femur and acetabulum
- is a stable, multi-axial, weight-bearing joint, at the cost of mobility
Ball and socket synovial joint
the head of the femur and lunate surface of acetabulum
The articular surfaces of the hip joint
what are the surfaces of the hip joint covered with? (except fovea)
hyaline cartilage
raised by the acetabular labrum
rim of the acetabulum
crosses the acetabular fossa as the acetabular ligament
acetabular labrum
attaches the fovea to the acetabular fossa
ligament of head of femur
- attaches to the margins of the articular surfaces (of hip joint)
- Forms a tubular covering around the ligament of head of femur
- Covers the neck of the femur before reflecting onto the fibrous membrane
synovial membrane
what are the 3 ligaments that reinforce the fibrous membrane of the hip joint?
- Iliofemoral
- pubofemoral
- ischiofemoral
oriented in a spiral around the joint so that they become taut when the hip is extended
fibers of Iliofemoral, pubofemoral, and ischiofemoral ligaments
- mainly comes from:
- branches of the obturator
- medial and lateral circumflex femoral
- superior and inferior gluteal
- 1st perforating arteries
blood supply to hip joint
- innervated by:
- articular branches from the femoral
- obturator
- superior gluteal nerves
hip joint
what are the 4 ways that structures can pass into the lower limb from the abdomen and pelvis?
- greater sciatic foramen above/below piriformis muscle
- lesser sciatic foramen
- obturator canal
- gap between inguinal ligament and pelvic bone
Nerves that enter the lower limb from the abdomen and pelvis
terminal nerves from the lumbrosacral plexus
what are the major nerves that that enter the lower limb from the abdomen and pelvis?
- femoral
- obturator
- sciatic
- superior and inferior
- gluteal nerves
what are the other nerves that that enter the lower limb from the abdomen and pelvis?
- lateral cutaneous
- obturator internus
- quadratus femoris
- posterior cutaneous
- perforating cutaneous
- branches of ilio-inguinal and genitofemoral nerves
what are the branches of the lumbrosacral plexus?
- ilio-lingual branch
- genitofemoral
- femoral
- obturator
- sciatic
- superior & inferior gluteal
- lateral & posterior cutaneous nerve of thigh
- nerve to quadratus femoris
- nerve to obturator internus
- perforating cutaneous nerve
- SPINAL SEGMENT: L1
- FUNCTION (MOTOR): No motor function in lower limb, but innervates muscles of the abdominal wall
- FUNCTION (sensory/cutaneous): Skin over anteromedial part of upper thigh and adjacent skin of perineum
ilio-lingual branch of lumbrosacral plexus
- SPINAL SEGMENT: L1, L2
- FUNCTION (motor): No motor function in lower limb but genital branch innervates cremaster muscle in the wall of the spermatic cord in men
- FUNCTION (sensory/cutaneous): Femoral branch innervates skin on anterior central part of upper thigh; genital branch innervates skin in anterior perineum (scrotum in men, mons pubis and anterior labia majora in women)
genitofemoral branch of lumbrosacral plexus
- SPINAL SEGMENT: L2-L4
- FUNCTION (motor): All muscles in the anterior compartment of thigh; in the abdomen, also gives rise to many branches that supply iliacus and pectineus
- FUNCTION (sensory/cutaneous): Skin over the anterior thigh, anteromedial knee, medial side of the leg, and the medial side of the foot
femoral branch of lumbrosacral plexus
- SPINAL SEGMENT: L2-L4
- FUNCTION (motor): All muscles in the medial compartment of thigh (except pectineus and part of adductor magnus attached to ischium); also innervates obturator externus
- FUNCTION (sensory/cutaneous): skin over upper medial aspect of thigh
obturator branch of lumbrosacral plexus
- SPINAL SEGMENT: L4-S3
- FUNCTION (motor): All muscles in the posterior compartment of the thigh and part of the adductor magnus attached to ischium; all muscles in the leg and foot
- FUNCTION (sensory/cutaneous): Ski over lateral side of leg and foot, and over the sole and dorsal surface of foot
sciatic branch of lumbrosacral plexus
- SPINAL SEGMENT: L4-S1
* FUNCTION (motor): Muscles of the gluteal region (gluteus medius, gluteus minimus, tensor fascia latae)
superior gluteal branch of lumbrosacral plexus
- SPINAL SEGMENT: L5-S2
* FUNCTION (motor): Muscle of the gluteal region (gluteus maximus)
inferior gluteal branch of lumbrosacral plexus
- SPINAL SEGMENT: L2, L3
* FUNCTION (sensory/cutaneous): Parietal peritoneum in iliac fossa; skin over anterolateral thigh
lateral cutaneous nerve of thigh of lumbrosacral plexus
- SPINAL SEGMENT: S1-S3
- FUNCTION (sensory/cutaneous): Skin over gluteal fold and upper medial aspect of thigh and adjacent perineum, posterior aspect of thigh and upper posterior leg
posterior cutaneous nerve of thigh of lumbrosacral plexus
- SPINAL SEGMENT: L4-S1
* FUNCTION (motor): Muscles of gluteal region (quadratus femoris and gemellus inferior)
Nerve to quadratus femoris
of lumbrosacral plexus
- SPINAL SEGMENT: L5-S2
* FUNCTION (motor): Muscles of gluteal region (obturator internus and gemellus superior)
nerve to obturator internus of lumbrosacral plexus
- SPINAL SEGMENT: S, S3
* FUNCTION (sensory/cutaneous): Skin over medial aspect of gluteal fold
perforating cutaneous nerve of lumbrosacral plexus
major artery supplying the lower limb
femoral artery
supply most of the thigh and all of the leg and foot
Branches off the femoral artery
arise from the internal iliac artery and supply the gluteal region
superior and inferior gluteal arteries
branches off the internal iliac and supplies the medial compartment of the thigh
obturator artery
form deep and superficial groups
veins draining the lower limb
generally follow the arteries (femoral, superior gluteal, inferior gluteal, and obturator)
deep veins
the major vein of the lower limb
femoral vein
in the subcutaneous connective tissue and ultimately drain into deep veins
superficial veins
arise from a dorsal arch in the foot
great and small saphenous veins (superficial veins)
drain into the deep and superficial inguinal nodes
lymphatics of lower limb
parallel the course of the inguinal ligament
10 superficial nodes
medial to the femoral vein
3 deep inguinal nodes
receive lymph from the superficial vessels
popliteal nodes
an outer layer of deep connective tissue that forms a stocking-like membrane that covers the limb
fascia lata
superiorly, it is attached to the inguinal ligament, iliac crest, sacrum, coccyx, sacrotuberous ligament, pubic bone
fascia lata
a lateral longitudinal thickening of the fascia lata
iliotibial tract (IT band)
a muscle associated with the superior and anterior aspects of the IT band
tensor fasciae latae
has 1 prominent opening, the saphenous opening
fascia lata
passes through the opening to join the femoral vein
great saphenous vein
formed by the inguinal ligament, medial border of the adductor magnus, medial margin of the Sartorius
femoral triangle
formed by the pectineus, adductor longus, and iliopsoas muscles
floor of the femoral triangle
what is the apex of the femoral triangle?
the adductor canal
pass between the abdomen and lower limb under the inguinal ligament and into the femoral triangle
femoral nerve, artery, and vein and lymphatics
pass inferiorly though the adductor canal and become the popliteal artery and vein behind the knee
femoral artery and vein
meet the sciatic and distribute with its branches (behind knee)
femoral artery and vein
are wrapped in the femoral sheath as they descend
femoral artery, vein, and associated lymphatic vessels
-lies posterolateral to the bony pelvis
gluteal region
The gluteal region communicates with the pelvic region through the……
greater sciatic foramen
The gluteal region communicates with the perineum through the….
lesser sciatic foramen
passes from the pelvic cavity into the lower limb through the greater sciatic foramen
sciatic nerve
pass through the greater sciatic foramen into the gluteal region then through the lesser sciatic foramen into the perineum
pudendal nerve and internal pudendal vessels
what are the 2 groups of the gluteal region?
deep and superficial groups
what muscles are part of the deep group of the gluteal region?
-small, lateral rotatores (piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris)
what muscles are part of the superficial group of the gluteal region?
- large abductors
- large extenders (glutes & tensor fascia lata)
- largest muscle of the gluteal region
- overlies most of the other muscles of the gluteal region
- a powerful extender of the femur at the hip joint
gluteus maximus
- the most anterior of the superficial muscles of the gluteal region
- stabilizes the knee in extension and stabilizes the hip joint by holding the head of the femur in the acetabulum
tensor fasciae latae
ORIGIN: Anterior surface of sacrum between anterior sacral foramina
piriformis muscle
INSERTION: Medial side of superior border of greater trochanter of femur
piriformis muscle
INNERVATION: Branches S1 and S2
piriformis muscle
FUNCTION: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
piriformis muscle
ORIGIN: Anterolateral wall of true pelvis; deep surface of obturator membrane and surrounding bone
Obturator internus muscle
INSERTION: Medial side of greater trochanter of femur
Obturator internus muscle
INNERVATION: Nerve to obturator internus (L5, S1)
- Obturator internus muscle
- Gemellus superior
- Gemellus inferior
FUCNTION: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
Obturator internus muscle
ORIGIN: External surface of ischial spine
Gemellus superior muscle
INSERTION: Along length of superior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
Gemellus superior muscle
FUNCTION: Laterally rotates the extended femur at hip joint; abducts the flexed femur at hip joint
Gemellus superior muscle
ORIGIN: Upper aspect of ischial tuberosity
Gemellus inferior muscle
INSERTION: Along length of inferior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
Gemellus inferior muscle
FUNCTION: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
Gemellus inferior muscle
ORIGIN: Lateral aspect of the ischium just anterior to the ischial tuberosity
Quadratus femoris muscle
INSERTION: Quadrate tubercle on the intertrochanteric crest of the proximal femur
Quadratus femoris muscle
INNERVATION: Nerve to quadratus femoris
Quadratus femoris muscle
FUNCTION: Laterally rotates femur at hip
Quadratus femoris muscle
ORIGIN: External surface of ilium between inferior and anterior gluteal lines
- gluteus minimus
- gluteus medius
INSERTION: Linear facet on the anterolateral aspect of the greater trochanter
gluteus minimus
INNERVATION: Superior gluteal nerve (L4, L5, S1)
- gluteus minimus
- gluteus medius
- tensor fasciae latae
FUNCTION: Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh
- gluteus minimus
- gluteus medius
INSERTION: Elongate facet of the lateral surface of the greater trochanter
gluteus medius
ORIGIN: Fascia covering gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spinae, dorsal surface of lower sacrum, lateral margin of coccyx, external surface of sacrotuberous ligament
gluteus maximus
INSERTION: Posterior aspect of iliotibial tract of fascia lata and gluteal tuberosity of proximal femur
gluteus maximus
INNERVATION: Inferior gluteal nerve (L5, S1, S2)
gluteus maximus
FUNCTION: Powerful extensor of flexed femur at hip joint, lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh
gluteus maximus
ORIGIN: Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the cress
tensor fasciae latae
INSERTION: Iliotibial tract of fascia lata
tensor fasciae latae
FUNCTION: Stabilizes the knee in extension
tensor fasciae latae
how many nerves enter the gluteal region through the greater sciatic foramen?
7 nerves
how many nerves enter the gluteal region by passing through the sacrotuberous ligament?
1 nerve
in the plane between the superficial and deep layers
most nerves of the gluteal region
what arteries enter the gluteal region from the pelvic cavity?
superior and inferior gluteal arteries
arises from the internal iliac and passes though the gluteal region and into the posterior thigh
inferior gluteal artery
arises from the internal iliac artery and splits into superficial and deep branches
superior gluteal artery
anastomose with branches from the femoral artery
superior and inferior gluteal arteries
separate the thigh from the abdomen and gluteal region respectively
inguinal ligament and gluteal fold
what are the routes used by structures to pass into the thigh?
- gluteal region
- anteriorly just deep to the inguinal ligament
- medially through the obturator canal
what parts is the thigh divided into?
anterior, posterior, and medial compartments
what is the bone of the thigh?
femur
where do the largest muscles of the thigh insert?
insert into the proximal ends of the leg bones (tibia and fibula)
has attachment points for the gastrocnemius of the leg
distal end of the femur
- largest sesamoid bone in the body
- formed in the tendon of the quadriceps
patella
points inferiorly and attaches to the patellar ligament
apex of patella
attaches top the quadriceps tendon
base of patella
articulates with the femur and has medial and lateral facets
posterior surface of patella
is expanded in the transverse plain into the medial and lateral condyles
proximal end of the tibia
- articular
- separated by the intercondylar region where the cruciate ligaments attach
superior surfaces of the condyles (of tibia)
- articular surface of the medial and lateral condyles
- articulates with the femur
tibial plateau
- inferior to the tibial plateau
- where the patellar ligament attaches
tibial tuberosity
- does not take part in the knee joint nor is it weight bearing
- consists of a head, neck, and shaft
fibula
has a facet for articulation with the tibia and an impression for the attachment of the biceps femoris
head of fibula
attaches to the head of the fibula
fibular collateral ligament of the knee
is triangular in cross section with 3 surfaces and 3 borders
shaft of fibula
what are the compartments of the muscles of the thigh?
- anterior compartment
- medial compartment
- posterior compartment
what muscles belong to the anterior compartment of the thigh?
- quadriceps
- sartorius
- innervated by the femoral nerve
what muscles belong to the medial compartment of the thigh?
- adductor muscles
- most of which are innervated by the obturator nerve
what muscles belong to the posterior compartment of the thigh?
hamstrings innervated by the sciatic nerve
act on the hip and knee joint
Muscles of the anterior compartment of the thigh
- act on the hip and are powerful flexors of the thigh at the hip joint
- contribute to lateral rotation
psoas major and iliacus
why are the psoas major and iliacus known as the iliopsoas?
psoas major and iliacus originate as separate muscles but insert in a common tendon on the lesser trochanter
act on the hip and the knee
sartorius and rectus femoris
act on the knee
vastus muscles
mainly extend the leg at the knee but also help stabilize the patellar
quadriceps
a small muscle that pulls the suprapatellar bursa away from the knee joint during extension
articular genus
a 3-pronged combined tendon of the sartorius, gracilis, semitendinosus muscles
pes anserinus (goose foot)
ORIGIN: Posterior abdominal wall (lumbar and thoracic vertebrae and tendinous arches
Psoas major
INSERTION: Lesser trochanter of femur
- Psoas major
- iliacus
INNERVATION: Anterior rami (L1, L2, L3)
Psoas major
FUNCTION: Flexes thigh at hip joint
- Psoas major
- iliacus
ORIGIN: Posterior abdominal wall (iliac fossa)
iliacus
INNERVATION: Femoral nerve (L2, L3)
- iliacus
- Vastus medialis
- Vastus intermedius
- Vastus lateralis
- Rectus femoris
- Sartorius
ORIGIN: Femur- medial part of intertrochanteric line, pectineal line, medial lip of the linea aspera, medial supra condylar line
vastus medialis
INSERTION: Quadriceps femoris tendon and medial border of patella
vastus medialis
FUNCTION: Extends leg at knee
- vastus medialis
- Vastus intermedius
- Vastus lateralis
ORIGIN: Femur- upper 2/3 of anterior and lateral surfaces
Vastus intermedius
INSERTION: Quadriceps femoris tendon, lateral margin of patella, and lateral condyle of tibia
Vastus intermedius
ORIGIN: Femur- lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity, lateral lip of linea aspera
Vastus lateralis
INSERTION: Quadriceps femoris tendon and lateral margin of patella
Vastus lateralis
ORIGIN: Straight head originates from anterior iliac spine; reflected head from ilium just superior to acetabulum
Rectus femoris
INSERTION: Quadriceps femoris tendon
Rectus femoris
FUNCTION: Flexes thigh at hip joint and extends leg at knee joint
Rectus femoris
ORIGIN: Anterior superior iliac spine
sartorius
INSERTION: Medial surface of tibia inferomedial to tibial tuberosity
sartorius
FUNCTION: Flexes thigh at hip, flexes leg at knee
sartorius
- these muscles mainly adduct the thigh at the hip joint
- Some muscles in this group medially rotate the thigh at the hip
muscles in medial compartment of the thigh
- lateral rotator of the thigh at the hip
- inserts on the posterior side of the femur and thus externally rotates the thigh
obturator externus
more anterior than other muscles in the medial compartment of the thigh
pectineus and the adductor longus
the next deepest muscle in the medial compartment after the pectineus and the adductor longus
adductor brevis
- the largest and is more posterior than the other muscles in medial compartment of thigh
- made of the adductor and hamstring parts
- has perforations for the branches of the deep artery of the thigh
adductor magnus
- separates the adductor and hamstring parts
- allows the femoral artery and associated veins to pass between the adductor canal and the popliteal fossa
adductor hiatus
ORIGIN: A line on the external surface of the body of the pubis, the inferior pubic ramus, and ramus of ischium
gracilis muscle
INSERTION: Medial surface of proximal shaft of tibia
gracilis muscle
INNERVATION: Obturator nerve (L2, L3)
- gracilis muscle
- adductor brevis
FUNCTION: Adducts thigh at hip joint and flexes leg at knee joint
gracilis muscle
ORIGIN: Pectineal line (pectin pubis) and adjacent bone of pelvis
Pectineus muscle
INSERTION: Oblique line extending from base of lesser trochanter to linea aspera on posterior surface of proximal femur
Pectineus muscle
INNERVATION: Femoral nerve (L2, L3)
Pectineus muscle
FUNCTION: Adducts and flexes thigh at hip joint
Pectineus muscle
ORIGIN: External surface of body of pubis
Adductor longus muscle
INSERTION: Linea aspera on middle 1/3 of shaft of femur
Adductor longus muscle
INNERVATION: Obturator nerve (L2, L3, L4)
Adductor longus muscle
FUNCTION: Adducts and medially rotates thigh at hip joint
- Adductor longus muscle
- Adductor brevis
- Adductor magnus
ORIGIN: External surface of body of pubis and inferior pubic ramus
adductor brevis muscle
INSERTION: Posterior surface of proximal femur and upper 1/3 of linea aspera
adductor brevis muscle
ORIGIN: Adductor part- ischiopubic ramus; Hamstring part- ischial tuberosity
Adductor magnus muscle
INSERTION: Posterior surface of proximal femur and upper 1/3 of linea aspera; adductor tubercle and supracondylar line
Adductor magnus muscle
INNERVATION: Obturator nerve (L2, L3); Sciatic nerve (tibial division) (L2, L3, L4)
Adductor magnus muscle
ORIGIN: External surface of obturator membrane and adjacent bone
obturator externus muscle
INSERTION: trochanteric fossa
obturator externus muscle
INNERVATION: Obturator nerve (posterior division (L3, L4)
obturator externus muscle
FUNCTION: Laterally rotates thigh at hip joint
obturator externus muscle
cross both the hip and knee joints
all muscles in the posterior compartment of the thigh EXCEPT biceps femoris
- they flex the knee joint and extend the hip joint
- rotators at both joints
muscles in the posterior compartment of the thigh (hamstrings)
ORIGIN: Long head- inferomedial part of upper area of ischial tuberosity; short head- lateral lip of linea aspera
Biceps femoris
INSERTION: head of fibula
Biceps femoris
INNERVATION: Sciatic (L5, S1, S2
- Biceps femoris
- Semitendinosus
- Semimembranosus
FUNCTION: Flexes leg at knee joint; extends and laterally rotates thigh at hip joint and laterally rotates leg at knee joint
Biceps femoris
ORIGIN: Inferomedial part of upper area of the ischial tuberosity
Semitendinosus
INSERTION: Medial surface of proximal tibia
Semitendinosus
FUNCTION: Flexes leg at knee joint and extends thigh at hip joint; medially rotates thigh at hip joint and leg at knee joint
- Semitendinosus
- Semimembranosus
ORIGIN: Superolateral impression on the ischial tuberosity
Semimembranosus
INSERTION: Groove and adjacent bone on medial and posterior surface of medial tibial condyle
Semimembranosus
- the 3 arteries that enter the thigh
- contribute to an anastomotic network around the hip-joint
- femoral
- obturator
- inferior gluteal arteries
the largest and supplies most of the lower limb
femoral artery
the 4 small branches that originate off the femoral artery?
- superficial epigastric
- superficial circumflex iliac
- superficial external pudendal
- deep pudendal arteries
branch off the deep artery in the thigh and penetrate into the posterior compartment
perforating arteries
- arises off the internal iliac artery in the pelvic cavity
- branches into the anterior and posterior branches that form a ring around the margin of the obturator membrane
obturator artery
superficial and passes through the saphenous ring
great saphenous vein
what are the 3 major nerves associated with the thigh?
- femoral nerve
- obturator nerve
- sciatic nerve
-originates from the lumbar plexus (L2-L4) and enters the femoral triangle by passing deep to the inguinal ligament and innervates the anterior compartment
femoral nerve
Before entering the lower limb it supplies the iliacus and pectineus muscles
femoral nerve
After passing into the lower limb it divides into posterior and anterior branches
femoral nerve
what are the additional branches of the femoral nerve?
- anterior cutaneous branches
- numerous motor nerves
- one long cutaneous nerve (the saphenous)
- originates from the lumbar plexus (L2-L4) and descends in the psoas muscle
- innervates most of the adductors and skin of the medial compartment
obturator nerve
- passes into the medial compartment by passing through the obturator canal
- Upon entering the lower limb it divides into the anterior and posterior branches
obturator nerve
-a branch off the lumbrosacral plexus (L4-S3) that descends into the posterior compartment from the gluteal region
sciatic nerve
- Its branches continue into the lower limb and foot
- Proximal to the knee it divides into the tibial and common fibular nerve
sciatic nerve
supplies all muscles in the posterior compartment of the thigh and leg (except short head of biceps femoris) and all intrinsic muscles of the sole of the foot and parts of the skin
tibial nerve
innervates the short head of biceps femoris, all muscles in the anterior lateral compartments of the leg, muscles in the foot, and parts of the skin
common fibular nerve
- the largest synovial joint in the body
- consists of the articulation between the femur and tibia (weight-bearing) and between the patella and femur
knee joint
allows the pull of the quadriceps muscles to be directed over the knee onto the tibia without tendon wear
patella
accommodate changes in shape of the articular surfaces during movement
2 menisci
- It is reinforced by 2 collateral and 2 cruciate ligaments
- a hinge joint that can also lock
knee
surfaces of the articular bones that contribute to the knee are covered in…….
hyaline
what are the major surfaces of the knee?
the 2 femoral condyles and the adjacent surfaces of the superior aspect of the tibial condyles
The areas of the femoral condyles that articulate with the tibia in extension are….
flat
the areas that articulate with the tibia during flexion are….
rounded
is where the patellar articulates with the femur
V-shaped trench on the anterior side of the femoral condyle
- 2 found in the knee joint
- are attached to facets in the intertubercular region of the tibial plateau
C-shaped fibrocartilaginous menisci
attached to the joint capsule whereas the lateral meniscus is not and is therefore more mobile
medial meniscus
- are attached via the transverse ligament of the knee
- improve congruency between femoral and tibial condyles where articulating femoral surfaces change from curved to flat in flexion and extension
menisci
attaches to the margins of the articular surfaces and the inferior and superior margins of the menisci
synovial membrane
outside the articular cavity
2 cruciate ligaments
provide low-friction surfaces for movement of the knee joint
subpopliteal recess and the suprapatellar bursa
- extensive and encloses the articular cavity and intercondylar region
- strengthened by the IT band and oblique popliteal ligament
fibrous membrane of the knee joint
continuous with the fibrous membrane
tibial collateral
separated from the fibrous membrane
fibular collateral
major ligaments of the knee
- patellar
- tibial (medial) collateral
- fibular (lateral) collateral
- cruciate ligaments
attached to the deeper fibrous membrane
tibial (medial) collateral
is separated from the fibrous membrane by a bursa
fibular (lateral) collateral
prevents anterior displacement of tibia on fixed femur
anterior cruciate
prevents posterior displacement of tibia on fixed femur
posterior cruciate
-knee joint is locked into place, reducing the work needed
standing postition
provide a stable platform for extension of knee joint
flat portions of the femoral condyle that articulate with the tibia during extension
tightens all associated ligaments
Medial rotation of the femur
maintains knee extension
A center of gravity in a plane anterior to the knee
unlocks the knee by initiating lateral rotation
popliteus muscle
mainly through the genicular branches of the femoral, popliteal, lateral circumflex femoral, circumflex fibular, and recurrent branches from anterior tibial
Vascular supply of the knee joint
form an anastomotic network around the joint
vascular supply of knee joint
what is the knee innervated by?
- obturator
- femoral
- tibial
- common fibular nerves (sciatic)
- is synovial and allows little movement
- reinforced by anterior and posterior ligaments
small proximal tibiofibular joint
articulates with the tibia on the underside of the lateral condyle
fibula
- the major route between the thigh and leg
- is a diamond shaped fossa formed by muscles
- contains: tibial and common fibular nerves and popliteal artery and vein
popliteal fossa
formed by superficial fascia and skin
roof of popliteal fossa
penetrates the roof of popliteal fossa to join the popliteal vein
small saphenous
penetrates the roof before descending with the small saphenous
posterior cutaneous nerve of the thigh
the part of the lower limb between the knee and the ankl
the leg
how do structures pass into the leg from the thigh?
popliteal fossa
how do structures pass into the foot from the leg?
tarsal tunnel
separate the anterior and posterior compartments of the leg
- tibia
- fibula
- interosseous membrane
separate the lateral compartment from the anterior and posterior compartments of the leg
fibula and anterior and posterior intermuscular septa
is triangular in cross section
shaft of tibia
is rectangular with a bony protuberance, the medial malleolus
distal end of tibia
triangular in cross section and, except for the ends, is enclosed in muscle
fibular
forms the lateral malleolus
distal end of fibula
- is a tough fibrous sheet of connective tissue
- connects the tibia and fibula
- provides increased surface area for muscle attachment
interosseous membrane
allow blood vessels to pass through the membrane
the 2 apertures of interosseous membrane
separated into superficial and deep groups
Muscles of the posterior compartment of the leg
contains the gastrocnemius, plantaris, and soleus
superficial group of muscles of posterior compartment of leg
- insert into the calcaneal tendon
- as a unit propel the body forward off the planted foot
gastrocnemius, plantaris, and soleus
ORIGIN: Medial head- posterior surface of distal femur just superior to medial condyle; lateral head- upper posterolateral surface of lateral femoral condyle
gastrocnemius muscle
INSERTION: Via calcaneal tendon, to posterior surface of calcaneus
- gastrocnemius muscle
- plantaris
- soleus
INNERVATION: Tibial nerve (S1, S2)
- gastrocnemius muscle
- plantaris
- soleus
FUNCTION: Plantarflexes foot and flexes knee
gastrocnemius muscle
- plantaris
- soleus
ORIGIN: Inferior part of lateral supracondylar line of femur and oblique popliteal ligament of knee
plantaris
ORIGIN: Soleal line and medial border of tibia; posterior aspect of fibular head and adjacent surfaces of neck proximal shaft; tendinous arch between tibial and fibular attachments
soleus
what are the 4 muscles in the deep group of the posterior compartment of the leg?
- politeus
- flexor hallicus longus
- flexor digitorum longus
- tibialis posterior
- the smallest muscle of deep group
- it unlocks the knee joint at the initiation of flexion
popliteus
ORIGIN: lateral femoral condyle
popliteus
INSERTION: posterior surface of proximal tibia
popliteus
INNERVATION: Tibial nerve (L4 to S1)
popliteus
FUCNTION: Stabilizes knee joint (resists lateral rotation of tibia on femur). Unlocks knee joint (laterally rotates femur on fixed tibia)
popliteus
ORIGIN: Posterior surface of fibula and adjacent interosseous membrane
Flexor hallicus longus
INNERVATION: Plantar surface of distal phalanx of great toe
Flexor hallicus longus
INNERVATION: Tibial nerve (S2, S3)
- Flexor hallicus longus
- Flexor digitorum longus
FUNCTION: flexes great toe
Flexor hallicus longus
ORIGIN: Medial side of posterior surface of the tibia
Flexor digitorum longus
INSERTION: Plantar surfaces of bases of distal phalanges of the lateral 4 toes
Flexor digitorum longus
FUNCTION: flexes 4 lateral toes
Flexor digitorum longus
ORIGIN: Posterior surface of interosseous membrane and adjacent regions of tibia and fibula
tibialis posterior
INSERTION: Mainly to tuberosity of navicular and adjacent region of medial compartment
tibialis posterior
INNERVATION: Tibial nerve (L4, L5)
tibialis posterior
FUNCTION: Inversion and plantarflexion of foot; support of medial arch of foot during walking
tibialis posterior
- major blood supply to the leg
- divides into the anterior and posterior tibial arteries
popliteal artery
branch off the popliteal artery to supply the gastrocnemius, soleus, and plantaris muscles
2 large sural arteries
passes through the superior aperture of the interosseous membrane to supply the anterior compartment
anterior tibial artery
supplies the posterior compartment and has 2 major branches (circumflex fibular and fibular arteries)
posterior tibial artery
passes through the inferior aperture to anastomose with the anterior tibial artery
perforating branch
- is the major nerve of the posterior compartment of leg
- passes into the foot via the tarsal tunnel where supplies most of the intrinsic muscles and skin
tibial nerve (a branch of the sciatic)
gives rise to the branches that supply all the muscles and 2 cutaneous branches (sural and medial calcaneal nerves)
tibial nerve in the leg
- the 2 muscles in the lateral compartment of the leg
- evert the foot
- innervated by the superficial fibular nerve (branch of the common fibular)
fibularis longus and brevis
ORIGIN: Upper lateral surface of fibula, head of fibula, and occasionally the lateral tibial condyle
fibularis longus
INSERTION: Undersurface of lateral sides of distal end of medial cuneiform and base of metatarsal I
fibularis longus
INNERVATION: Superficial fibular nerve (L5, S1, S2)
- fibularis longus
- fibularis brevis
FUNCTION: Eversion and plantarflexion of foot; supports arches of foot
fibularis longus
ORIGIN: Lower 2/3 of lateral surface of shaft of fibula
fibularis brevis
INSERTION: Lateral tubercle at base of metatarsal V
fibularis brevis
FUNCTION: Eversion of foot
fibularis brevis
do any major arteries pass vertically through the lateral compartment?
no
mostly supplied by the branches of the fibular artery from the posterior compartment
lateral compartment of the leg
nerve associated with the lateral compartment
superficial fibular nerve which is a branch of the common fibular
gives off 2 cutaneous branches (sural communicating and lateral sural nerves) before continuing around into the lateral compartment
common fibular nerve
splits into the superficial and deep fibular nerves
common fibular nerve
- the 4 muscles in the anterior compartment of the leg
- they dorsiflex the foot at the ankle joint, extend the toes, and invert the foot
- are innervated by the fibular nerve
- tibialis anterior
- extensor hallicus longus
- extensor digitorum longus
- fibularis tertius
ORIGIN: Lateral surface of tibia and adjacent interosseous membrane
tibialis anterior
INSERTION: Medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of metatarsal I
tibialis anterior
INNERVATION: Deep fibular nerve (L4, L5)
tibialis anterior
FUNCTION: Dorsiflexion of foot at ankle joint; inversion of foot; dynamic support of medial arch of foot
tibialis anterior
ORIGIN: Middle ½ of medial surface of fibula and adjacent surface of interosseous membrane
Extensor hallicus longus
INSERTION: Dorsal surface of base of distal phalanx of great toe
Extensor hallicus longus
INNERVATION: Deep fibular nerve (L4, S1)
- Extensor hallicus longus
- Extensor digitorum longus
- fibularis tertius
FUNCTION: Extension of great toe and dorsiflexion of foot
Extensor hallicus longus
ORIGIN: Proximal ½ of medial surface of fibula and related surface of lateral tibial condyle
Extensor digitorum longus
INSERTION: Via dorsal digital expansions into base of distal and middle phalanges of lateral 4 toes
Extensor digitorum longus
FUNCTION: Extension of lateral 4 toes and dorsiflexion of foot
Extensor digitorum longus
ORIGIN: Distal part of medial surface of fibula
fibularis tertius
INSERTION: Dorsomedial surface of base of metatarsal V
fibularis tertius
FUNCTION: Dorsiflexion and eversion of foot
fibularis tertius
- artery associated with the anterior compartment of leg
- enters the anterior compartment through the superior interosseous aperture
anterior tibial artery
gives off the recurrent branch that supplies the knee
anterior tibial artery (proximally)
gives off the anterior medial malleolar and anterior lateral malleolar arteries before passing into the foot
anterior tibial artery (distally)
innervates the all muscles in the anterior compartment and continues down to innervate muscles of the foot
deep fibular nerve
