Morphological plan of the lower limb Flashcards
Comparison with upper limb
Lower limbs closer together
Extensors are anterior
Flexors are posterior
Medial rotation in development
Brings posterior compartment anterior
Skeleton
Pelvis
Femur
Fibula
Tibia
Tarsal bones x7
Metatarsals x5
Phalanges x14
Limb movements
Flexion/ extension
Abduction/ adduction
Lateral/ medial rotation
Pronation/ supination
Circumduction
Joints
Hip joint
Knee joint
Ankle joint
Joints of the foot
Functional compartments
Gluteal
Thigh
- anterior (extensors of knee)
- posterior (flexors of knee)
- medial (adductors of thigh)
Leg
- anterior (extensors of foot_
- posterior (flexors of foot)
- lateral (everters of foot)
Foot
Three gluteal muscles
Gluteus maximus (extensor and lateral rotator)
Gluteus medius (abductor and medial rotator)
Gluteus minimus (abductor and medial rotator)
Gluteus maximus
Origin: ilium
Inserts: gluteal tuberosity, iliotibial tract
Supplied by inferior gluteal nerve
Gluteus medius and minimus
Origin: ilium
Inserts: greater trochanter
Supplied by superior gluteal nerve
Small muscles of the gluteal region
Equivalent to rotator cuff
- stabilise hip
- lateral rotation of extended thigh
Origin: sacrum (piriformis) and ischium/ ischiopubic ramus
Inserts: greater trochanter
Supplied by branches from sacral plexus
Anterior compartment of thigh
Quadriceps
- extend knee
- rectus femoris- also flexion of hip
Origin: anteiror inferior iliac spine and femur
Insert: tibial tuberosity
Supplied by femoral nerve
Parts of quadriceps
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Posterior compartment of thigh
Hamstrings
- flex knee
- extend hip
- medial rotation
- lateral rotation
Origin: ischial tuberosity
Inserts: tibia, fibula
Supplied by sciatic nerve
Medial compartment of thigh
Pectineus Adductor longus Adductor brevis Gracilis Adductor magnus
Origin: pubis and ischium
Inserts: linea aspera
Adduction, medial rotation
Supplied by obturator nerve
Movements of the thigh
Flexion
Abduction
Extension
Adduction
Flexion of the thigh
Rectus femoris
Sartorius
Iliopsoas
Extension of the thigh
Gluteus maximus
Hamstrings
Hamstring part of adductor magnus
Abduction of the thigh
Gluteus medius
Gluteus minimus
Adduction of the thigh
Adductor longus
Adductor brevis
Adductor part of adductor magnus
Pectineus
Gracilis
Nerve supply
Lumbar plexus
- anterior rami L1 to L4
Sacral plexus
- anterior rami L4 to L5 (via lumbrosacral trunk)
- anterior rami S1 to S4
Femoral nerve L2 to L4
Obturator nerve L2 to L4
Sciatic nerve L4 to S3
Femoral nerve
From lumbar plexus
Motor: anterior compartment of thigh
Sensory: skin over anterior thigh, knee, medial side of leg and foot
Obturator nerve
From lumbar plexus
Motor: medial compartment of thigh (except pectineus and hamstring part of adductor magnus)
Sensory: skin over medial thigh
Sciatic nerve
From sacral plexus
Motor: posterior compartment of thigh, and leg and foot
Sensory: skin over leg and foot (except medial side)
Blood supply
External iliac artery -> (through inguinal ligament) Femoral artery -> (through adductor hiatus) Politeal artery -> Anterior and posterior tibial arteries
Popliteal artery
Divides in leg as anterior/ posterior tibial arteries
Venous drainage
Deep veins follow arteries
Two major superficial veins
- great or long saphenous vein
- small or short saphenous vein
Varicose veins
Damage to valves in perforating veins leads to pooling of blood in superficial veins
Great saphenous vein
Longest vein in the body
Drains medial side of arch
Medial side of limb
Drains into femoral vein in femoral triangle
Short saphenous vein
Drains lateral side of arch
Pierces deep popliteal fascia
Drains into popliteal vein
Lymphatic drainage
Follow general pattern of superficial and deep veins
Superficial inguinal nodes
- drain skin and superficial fascia of lower limb
Deep inguinal nodes
- beside femoral vein
Produna femoris artery
Branch of femoral artery
Large branch to posterior thigh
Femoral triangle
Lateral- medial
- femoral nerve
- femoral artery
- femoral vein
- lymphatics
Femoral nerve does not sit in the femoral sheath
