clinical anatomy of the lower limb 1 : Flashcards
What type of joint is the hip joint
ball and socket
what type of joint is the knee joint
-hinge joint
-tibia and fibula linked by
interosseous
membrane
what type of joint is the ankle joint
-hinge joint
• tibia, fibula and tarsal bone
Gait cycle
heel strike to heel strike
Gait cycle - phases
-Stance: 60%
• Swing: 40%
what covers the head of the femur
articular cartilage
acetabulum
-partially covered with cartilage
– deepened by fibrocartilage
what are the 3 main ligaments of the joint capsule :
-Ilio -femoral ligament
– pubo-femoral ligament
– ischio-femoral ligament
– ligament of the head of femur
what are the lateral rotators of the gluteal region :
-piriformis • gemellus superior • obturator internus • gemellus inferior • quadratus femoris
what are the extensors of the gluteal region :
-gluteus maximus
what are the abductors and medial rotators of the gluteal region :
-gluteus medius
• gluteus minimus
Motor and sensory innervation of the gluteal region :
branches of sacral plexus
openings of the gluteal region :
greater and lesser sciatic foramen
Blood supply of the gluteal region :
branches of internal iliac
Tensor fasciae
lata function ;
• abducts thigh/ hip joint • stabilizes the knee in extension
Gluteus medius function
abducts and medially rotates the thigh/hip joint
Gluteus minimus fufnction
• abducts and medially rotates the thigh/hip joint
Gluteus maximus
• extends the flexed thigh/hip joint • lateral stabilizer of the hip and knee • abducts and assists in lateral rotation of thigh/ hip joint
gluteal maximus innervaton
inferior gluteal nerve
tensor fasciae ,gluteus med and min innervation
superior gluteal
nerve
what happens during the normal gait
Contraction of the gluteus medius and minimus on the stance leg this prevents tipping to the unsupported side
positive Trendelenburg sign
- The superior gluteal nerved is injured
- waddling gait
Piriformis
nerve to piriformis (S1 & S2) • lateral rotator of the
thigh/hip joint &
abducts flexed
thigh/hip joint
Gemellus inferior
nerve to quadratus femoris • lateral rotator of the thigh/hip joint & abducts flexed thigh/hip joint
Quadratus femoris
nerve to quadratus femoris • lateral rotator of the
thigh/hip joint
Obturator internus
nerve to obturator internus • lateral rotator of the
thigh/hip joint &
abducts flexed
thigh/hip joint
Gemellus superior
nerve to obturator internus • lateral rotator of the thigh/hip joint & abducts flexed thigh/hip joint
blood supply to the hip joint, upper
thigh and gluteal region ?
anastomosis of femoral, inferior gluteal, superior gluteal, and obturator arteries, together with branches from the internal pudendal and femoral arteries
Trochanteric anastomosis:
branches of medial and lateral circumflex arteries • inferior gluteal artery • branch of the superior gluteal
Cruciate anastomosis:
• branches medial and lateral circumflex femoral arteries • branch of 1st perforating branch of profunda femoris artery • branch of inferior gluteal artery
Blood supply to the head of the femur :
-Medial and lateral circumflex
femoral arteries
-Acetabular branch of obturator
artery
Intra-capsular – fracture of the femoral
neck eg subcapital
– damages the retinacular arteries
– compromises blood supply to the
head of femur
– risk of avascular necrosis
Extra-capsular – intertrochanteric
fracture
does not affect blood supply to
the joint
Both intra and extracapsular fractures result
in …..
external rotation of the leg with some
shortening.
acquired coxa vara
decrease in angle
between neck and shaft
Subcutaneous tissue lies beneath the skin.
Contains:
- loose connective tissue
- fat
- cutaneous nerves
- superficial veins
- lymphatic vessels and lymph nodes
fascia lata
thickened deep fascia in thigh and gluteal
region, attached along a line that defines the upper
margin of the lower limb and is continuous with the
fascia of the leg inferiorly
iliotibial tract
-longitudinal band along the lateral
margin of the limb from the anterolateral tubercle of
the iliac crest to the lateral condyle of the tibia
fascia cruris
– fascia in the leg
Thigh Compartments- Anterior compartment
• Femoral nerve
• Flexors of thigh
• Extensors of the
knee
Thigh Compartments-Posterior compartment
Sciatic nerve
• Extend the thigh
• Flex the knee
Thigh Compartments-Medial compartment
• Obturator nerve • Adductors of thigh • Except hamstring part of adductor magnus • Part of pectineus
lower limb -Posterior compartment muscles
semitendinosus
• semimembranosus
• biceps femoris (dual innervation
lower limb -Posterior compartment sensory innervation :
posterior femoral cutaneous nerve(S1-S3)
lower limb -Posterior compartment openings :
adductor hiatus
lower limb -Posterior compartment blood supply :
perforating branches of deep femoral artery
semimembranosus
origin: ischial tuberosity • sciatic nerve (tibial part) • function: • flexes the leg/knee joint • extends the thigh/hip joint
biceps femoris
origin: long head (LH): ischial tuberosity • origin: short head (SH): femur • sciatic nerve: LH (tibial part), SH (common fibular part) • function: • LH - flexes the leg/knee joint. extends the thigh/ hip joint • SH - flexes the leg/knee join
Sciatic nerve
• Combination of two nerves -common fibular -tibia -exits the pelvis below the piriformis • Separates proximal to the popliteal fossa
Anterior compartment-MUSCLES
-iliopsoas
• sartorius
• quadriceps femoris
Lower limb-Anterior compartment-OPENINGS(CANAL)
Femoral canal, subsartorial (adductor/Hunter’s) canal
Lower limb -Anterior compartment-BLOOD SUPPLY
Femoral artery and its branches
rectus
femoris
quadriceps femoris tendon, patella ligament • femoral nerve • flexes the thigh/ hip joint, extends the leg/knee joint
vastus intermedius
vastus lateralis
vastus medialis
quadriceps femoris tendon, patella ligament • femoral nerve • extends the leg/knee joint
ilio-psoas
anterior rami L1-3/ femoral
nerve
• flexes the thigh/hip joint
sartorius
- femoral nerve
- flexes the thigh/hip joint
- flexes the leg/knee joint
lower limb-Medial compartment:MUSCLES
- pectineus (dual innervation)
- gracilis
- adductors
- obturator externus
lower limb-Medial compartment:MOTOR & SENSORY INNERVATION:
obturator and tibial nerves
lower limb-Medial compartment:BLOOD SUPPLY
obturator artery
adductor
longus
obturator nerve
• adducts and medially
rotates the thigh/hip
joint
adductor brevis
• obturator nerve
• adducts and medially
/hip join
adductor
magnus
• adductor part: • obturator nerve • hamstring part: • sciatic (tibial) nerve • adducts and medially /hip joint
pectineus
• femoral and obturator nerve
• adducts and flexes thigh/hip
joint
g
gracilis
• obturator nerve
• adducts thigh and flexes leg/
knee joint
obturator
externus
• obturator nerve
• lateral rotation of
the thigh/hip joint
lateral circumflex femoral artery:
passes deep to sartorius and rectus femoris
• ascending branch
• descending branch
• transverse branch
• medial circumflex femoral artery
- one branch ascends to the trochanteric fossa
* one passes laterally to participate in the cruciate anastomosis
• perforating arteries
• penetrate adductor magnus and supply posterior compartment
• ascending and descending branches that interconnect forming
a longitudinal channel
Femoral Sheath
inferior extension of the
transversalis fascia and the
iliopsoas fascia from the abdomen.
femoral canal
contains
lymph nodes.
▪ Femoral ring
pening of this canal superiorly is potentially a weak point in the lower abdomen and is the site for femoral hernias
Femoral triangle Borders:
• superior: inguinal ligament (forms the base) • medial: medial border of the adductor longus • lateral: medial border of the sartorius • roof: fascia lata • floor: pectineus, iliopsoas and the adductor longus
Adductor canal
fascial tunnel in the middle third of
the thigh
