Lower Limb I and II Flashcards
Innervation of the lower limb- sources of cutaneous nerves
Lumbar plexus, sacral plexus, posterior rami of lumbar and sacral nerves
Lumbar plexus is formed by and innervates
L1-L4
Anterior and medial thigh
Upper anterior leg; medial leg
The sacral plexus formed by and innervates
Anterior rami of the S1-S4 and contributions from L4 and L5
Lower buttocks
Posterior thigh and leg
Lower anterior leg and foot
Posterior rami of lumbar and sacral nerves innervate
Upper buttocks
Dermatomes of the anterior region:
Dermatomes of the posterior region:
Dermatomes of the coccygeal region:
L1-L5
S1-S2
S3-S5
Tract of the small (lesser, short) saphenous vein
Origin is from the lateral side of the dorsal venous arch of the foot
Ascends from behind lateral malleolus along lateral side of the tendon calcaneus, crosses the latter to the middle of the back of the leg, runs straight upward to pierce the deep fascia in the lower popliteal space
Terminates in popliteal vein between the heads of the gastrocnemius muscle
Tract of the great (long) saphenous vein
Origin is from the dorsal venous arch of the foot
Ascends in front of the medial malleolus, along the medial side of the leg, posterior to the medial condolences of the tibia and femur, along the medial side of the thigh to the saphenous opening
The fascia lata is reinforced laterally by the longitudinal fibers of
The iliotibial tract/band: IT band
The common aponeurotic tendon of the gluteus Maximus and tensor fascia latae muscles
Specialization of the fascia lata that inserts on the iliac tubercle and the medial condolences of the tibia to make the IT band
The arterial blood supply of a joint is derived from
The periarticular anastomosis of blood vessels, which is fed by branches of the arteries passing the joints.
Nerve supply to a joint- hilton’s law
Rich innervation
Supplied by all the nerves which innervate the muscles producing movement at that joint
Nerve supply to a joint represents its major source of self-defense against mechanical insult
Immovable joints:
Structure, description, example
Fibrous- fibrous connections, sutures of skull
Cartilaginous- interposition of cartilaginous plate, epiphyseal cartilages
Slightly movable joints:
Structure, description, and example
Fibrous- ligamentous connection, between tibia and fibula
Cartilaginous- connection by fibrocartilage pad, between pubic bones and intervertebral disc
Freely movable joint:
Structure, description, examples
Movements
Synovial- complex joint bound by joint capsule containing synovial fluid, numerous examples: subdivided by range of movement (knee, hip, ankle)
Can be categorized as a simple or complex articulation
Gliding, angular, circumduction, rotation
Hip joint is made up of:
type and movements
Ball and socket (enarthrosis)
Circumduction of lower limb, lateral rotation and medial rotation.
(Acetabulum and head of the femur)
Ligaments of the hip joint
Acetabular labrum Transverse acetabular Round ligament (ligamentum capitis femoris) Iliofemoral (Y ligament of Bigelow) Pubofemoral Ischiofemoral
The anterior compartment of the thigh:
Function, innervation, blood supply
Flexor of the hip joint and extensor of the knee
Femoral nerve
Femoral artery
Muscles of the anterior thigh: flexors of the hip joint
Pectineus
Sartorius
Psoas major and minor
Illiacus
Pectineus muscle:
Proximal and distal attachments, innervation, main actions
Pubis
Pectineal line of femur (line from lesser trochanter)
Femoral nerve, some obturator nerve
Adducts and flexes thigh
Sartorius muscle:
Proximal and distal attachments, innervation, and main action
ASIS
Medial surface of proximal tibia
Femoral nerve
Flexes, abducts, laterally rotates thigh, flexes knee joint
Psoas major muscle
T12 and lumbar vertebral bodies
Lesser trochanter of femur
Anterior rami of lumbar nerves (L1-L3)
Flexes the thigh
Psoas minor muscle
T12/L1 vertebral bodies
Iliopubic eminence
Anterior rami of lumbar nerves (L1-L2)
Flexes the thigh
Iliacus muscle
Iliac crest/fossa
Tendon of the psoas major/lesser trochanter
Femoral nerve
Flexes thigh
Muscles of the anterior thigh: extensor of the knee
Quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis, vastis intermedus
Rectus femoris
AIIS
Via quadriceps tendon to base of patella; the patellar tendon attaches the patella to the tibial tuberosity
Femoral nerve
Extends legs/flexes thigh
Vastus lateralis
Greater trochanter and linea aspera of femur
Via quadriceps tendon to base of patella
Femoral nerve
Extends leg
Vastus medialis
Intertochanteric line and linea aspera of femur
Via quadriceps tendon to base of patella
Femoral nerve
Extend leg
Vastus intermedius
Shaft of the femur
Via quadriceps tendon to base of patella
Femoral nerve
Extends the leg
Femoral nerve cutaneous branches
Anterior cutaneous branches
Saphenous nerve
Medial compartment of the thigh:
Function, origin/insertion, innervation, blood supply
Adductor compartment
Origin on bone around the obturator foramen and insert into femur
Obturator nerve
Profounda femoris and obturator arteries
Muscles of the medial compartment of the thigh
Adductor longus and brevis
Adductor Magnus
Gracious
Obturator externus
Adductor longus
Pubic bone
Linea aspera of femur
Obturator nerve
Adducts thigh
Adductor brevis
Pubic bone
Pectineal line and linea aspera of femur
Obturator nerve
Adducts thigh
Adductor magnus
Adductor part
Ischiopubic ramus
Shaft of the femur
Obturator nerve
Adducts and flexes thigh
Adductor Magnus
Hamstring part
Ischial tuberosity
Adductor tubercle of femur
Tibial division of sciatic nerve
Adducts and extends thigh
Gracilis
Pubic bone
Medial condyles of tibia
Obturator nerve (L2,3)
Adducts thigh, flexes leg, rotates leg medially
Obturator externus
Margins of obturator foramen and obturator membrane
Posterior side of femur; on and around greater trochanter of femur
Obturator nerve (L3,4)
Laterally rotates thigh, steadies head of femur in acetabulum
Boundaries of the femoral triangle
Superiorly- inguinal ligament Medially- medial border of the adductor longus muscle Laterally- sartorius muscle *mnemonic So I May Always Love Sally SAIL
Deep fascia of the thigh (fascia lata) has a defect in it called
Saphenous opening- great saphenous vein passes through here and drains into the femoral vein
Contents of the femoral triangle (from lateral to medial)
Femoral nerve and its branches
Femoral sheath and its contents: femoral artery, femoral vein and its proximal tributaries (great saphenous), and deep inguinal lymph nodes and associated lymph vessels in femoral canal
The femoral sheath contains a medial compartment called:
Femoral canal- entrance into the canal is the femoral ring (a rigid structure bound by ligaments and a muscle)
Lymphatics of the lower limb- vessels
Drain entire lower limb, perineum, trunk of body inferior to the transumbilical plane
Superficial- lie in superficial fascia; some follow great saphenous vein, others drain foot and leg and join those associated with the lesser saphenous vein or drain into popliteal nodes
Deep- accompany blood vessels
Lymphatics of the lower limb- nodes
Popliteal nodes- in popliteal fossa
Superficial inguinal- horizontal group (inferior and parallel to inguinal ligament and drains penis, scrotum, labia, perineum, buttock, abdominal wall) and vertical group (along terminal great saphenous vein and drains its associated vessels)
Deep inguinal- deep to the deep fascia along the medial side of femoral vein and receive drainage from deep lymphatics of the lower extremity and from superficial nodes
Adductor canal (subsartorial tunnel/Hunter’s canal)
Middle third of the thigh, extends from the apex of the femoral triangle to the adductor hiatus in the tendon of the adductor Magnus muscle
Provides intermuscular passage for femoral artery and vein, saphenous nerve, and nerve to the vastus medialis muscle. Vessels emerge into popliteal fossa and become popliteal vessels.
Boundaries of the adductor canal
Vastus medialis anteriorly and laterally
Adductors longus and Magnus posteriorly
Sartorius medially- overlies the canal, forming its roof
Blood supply to the hip joint
Medial and lateral circumflex femoral arteries- main to head of femur
Retinacular (nutrient) arteries arise from medial circumflex pass along femoral neck beneath capsule
Artery of the ligament of head of femur- branch of obturator artery that provides 0-20% of blood supply to head of femur in adults
Innervation to the skin of gluteal region
Superior clunial nerves (posterior rami, L1-3)
Iliohypogastric nerve
Medial clunial nerves (posterior rami, S1-S3)
Inferior clunial nerves (from posterior femoral nerves)
Ligaments of the gluteal region
Sacrospinous ligament
Sacrotuberous ligament
Create the greater and lesser sciatic foramen
Muscles that insert onto the iliotibial tract
Gluteus Maximus and tensor fasciae latae
Muscles of the gluteal region- superficial group
Actions, attachments, blood and nerve supply
Abduction and extension of thigh
External surface of ilium
IT tract/gluteal tuberosity (Maximus) or greater trochanter (med, min)
Inferior and superior gluteal vessels and nerves
Gluteus Maximus, minimus, medius, and tensor fascia latae
Gluteus Maximus
Ilium and sacrum and sacrotuberous ligament
IT tract and proximal femur
Inferior gluteal nerve
Extends thigh and assists in lateral rotation
Raises trunk from bent forward position
Extends hip in step up*
Gluteus medius
Lateral surface of ilium
Greater trochanter of femur
Superior gluteal nerve
Abduct and medially rotates thigh
Gluteus minimus
Lateral surface of ilium
Greater trochanter of femur
Superior gluteal nerve
Adducts and medially rotates thigh
Tensor fascia latae
ASIS IT tract Superior gluteal nerve Abducts and medially rotates thigh Helps extend knee joint by tensing fascia on lateral side of thigh
Muscles of the gluteal region- deep group
Action, attachments, names
Small lateral rotators and stabilizers of hip joint
Attach from sacrum and ischium to greater trochanter and adjacent to it
Piriformis
Obturator interns
Superior and inferior gemeli
Quadratic femoris
Piriformis muscle
Anterior surface of the sacrum
Greater trochanter
Nerve to the piriformis
Laterally rotates thigh
Obturator internus
Obturator foramen and membrane
Greater trochanter
Nerve to obturator internus
Laterally rotates thigh
Superior and inferior gemeli
Superior- ischial spine, greater trochanter, nerve to obturator internus, laterally rotates thigh
Inferior- ischial tuberosity, greater trochanter, nerve to quadratic femoris, laterally rotates thigh
Quadratus femoris
Ischial tuberosity
Intertrochanteric crest of femur
Nerve to the quadratus femoris
Laterally rotates thigh
Structures passing above and below the piriformis muscle
Above- superior gluteal vessels and nerve
Below- inferior gluteal vessels and nerve, sciatic nerve, posterior femoral cutaneous nerve, superior gemellus muscle, tendon of the obturator internus muscle, inferior gemellus muscle, quadratus femoris muscle.
Blood supply to the gluteal region
Superior gluteal artery- largest branch of internal iliac artery, enters gluteal region through greater sciatic foramen superior to piriformis muscle, under gluteus Maximus to supply buttocks
Inferior gluteal artery- another branch of internal iliac artery, enters the gluteal region through greater sciatic foramen inferior to piriformis muscle and descends on medial side of sciatic nerve, supples buttocks and back of thigh.
Nerve supply to the superficial gluteal region
Superior gluteal nerve (L4-S1) passes through the greater sciatic foramen immediately superior to piriformis muscle, passes between medius and minimus to supply them and the tensor fascia latae muscles
Inferior gluteal nerve (L5-S2) traverses the greater sciatic foramen just inferior to the piriformis muscle and supplies the gluteus maximus
Sciatic nerve- segments and tract
A common sheath that encases two nerves
L4-S3 segments of the sacral plexus
Emerges from greater sciatic foramen inferior to the piriformis muscle
Travels in the posterior compartment of the thigh and posterior to the adductor Magnus muscle
Divides into tibial nerve and common fibular nerve
