Organization of the Lower Limb Flashcards
lower limb joint?
acetabulum
-less mobility, more stability
capsule of hip joint?
limits extension and abduction
does little to inhibit flexion
what allows for actions of climbing and running?
modified hinge at knee and flexion at hip
fibula role?
little to add stability and strength
-mainly for muscle attachments
ankle allows?
hinge joint to jump and run coupled with muscles strong enough to elevate the entire body mass
multiple joints in feet allow?
spring needed for cushioned landing and for negotiating uneven surfaces
tela subcutanea
superficial fascia of lower limb
two layers of superficial fascia ?
fatty and membranous layer
whats between fatty and membranous layer?
inguinal lymph nodes
subQ blood vessels and nerves
deep fascia of lower limb?
stocking like investment
attachments of deep fascia?
above to most of the inferior aspect of bony pelvis and attached to bony prominences at knee and ankle
fascia lata
continuity of deep fascia
- most superior portion of deep fascia
- surrounds thigh and portion of gluteal region
gluteal aponeurosis
thickened portion of fascial lata
-extends inferiorly from posterior portion of iliac crest and forms an incomplete intermuscular septa between gluteus maximus and medius
what muscles is gluteal aponeurosis between?
gluteus maximus
gluteus medius
intramuscular septa
lateral and medial when part of fascia lata
inward projections of fascia lata which extend to femur and delineate muscular compartments
iliotibial tract
lateral thickening of fascia lata
-serves as tendon for tensor facia lata and gluteus maximus
attaches inferiorly to tibia, head of fibula and blends with capsule of knee joint
saphenous vein opening
circular opening in superior anteromedial portion of the fascia lata below the inguinal ligament
-transmits the great saphenous vein
falciform margin
sickle shaped and part of saphenous vein opening
underlain with fascia cribrosa
crural fascia
extension of fascia lata below knee
intermuscular septa
anterior and posterior (when part of crural fascia)
-attach as inward extensions of crural fascia to fibula
-delineate anterior and lateral crural compartments
transverse
- attaches between tibia and fibula posteriorly
- delineate superior and deep posterior compartments
retinacula
thickening of crural fascia at ankle which prevents tendons from bowstringing
- superior and inferior extensor retinacula (anterior)
- superior and inferior fibular retinacula (lateral)
- flexor retinacula - posteromedial
fascia of dorsum of foot?
continous with extensor retinacula
plantar fascia
continuation of fascia of dorsum of foot onto the sole
thickened central portion - plantar aponeurosis
plantar aponeurosis
thickened central portion of plantar fascia
anterior femoral compartment
quads and sartorious
-flex thigh and/or extend leg
artery and nerve in anterior femoral compartment?
femoral artery and nerve
femoral triangle
transitional space between abdominopelvic region and the lower limb
bounded by inguinal ligament, sartorious, adductor longus muscles, and covered by fascia lata
contents of femoral triangle?
femoral vein, artery, nerve, and deep inguinal lymph nodes
medial femoral compartment?
muscles within this compartment flex, adduct, and rotate the thigh
branches of obturator artery and nerve distribute within this compartment
adductor canal
canal connecting femoral triangle with popliteal fossa
-bounded by adductor musculature, vastus medialis, and sartorious
contents of adductor canal?
femoral artery and vein, saphenous vein and nerve to vastus medialis
gluteal compartment
subdivided into superficial and deep compartments
superficial compartment of gluteal?
muscles which mimic deltoid
-abduct, flex, and medially rotates, extends and laterally rotates the thigh
deep compartment of gluteal?
muscles that abduct and laterally rotate thigh
innervation of gluteal compartment?
branches of superior and inferior gluteal arterie and nerves
sciatic nerve
passes between these compartments to gain posterior thigh
posterior femoral compartment
muscles are hamstrings
-flex leg and extend thigh
-branches of deep femoral artery and vein
sciatic nerve traverses entire length of this compartment and provides innervation to all musculature
popliteal fossa
area posterior of knee
transitional zone and pathway for structures passing from thigh into leg
bounds of popliteal fossa
semimembranosus semitendinosus biceps femoris gastrocnemius covered by fascia lata
contents of popliteal fossa
popliteal artery and branches
popliteal vein and tributaries
bifurcation of sciatic nerve into common fibular and tibial branches
posterior crural compartment
superficial and deep compartments
superficial - gastrocnemius, soleus, plantaris
-flex leg and plantar flex foot
deep - muscles that plantar flex and invert foot
innervation of posterior crural compartment?
tibial nerve and posterior tibial artery distribute
lateral crural compartment?
contains muscles which plantar flex and evert foot
-branches of superficial fibular nerve and fibular artery distribute here
anterior crural compartment and dorsum of foot
muscles that dorsi flex and invert foot, extend toes and assist in eversion of foot
deep fibular nerve and anterior tibial artery distribute here
plantar foot
4 compartments
- medial
- lateral
- central
- interosseous
hallux
great toe
digiti minimi
small toe
posterior tibial artery
bifurcates to lateral and medial plantar artery
-distributes to plantar foot compartments
tibial nerve
bifurcates and forms lateral and medial plantar nerves
share innervation of plantar foot compartments
lower limb artery?
femoral
exits abdominopelvic cavity deep to inguinal ligament to enter femoral triangle
femoral artery in triangle?
major branches to hip joint, anterior and posterior thigh
course of femoral artery?
through triangle
- enters adductor canal to gain posterior of lower limb (popliteal fossa)
- becomes popliteal artery when escapes adductor canal, and provides branches to knee joint
-upon exiting the popliteal fossa, bifurcates to form anterior and posterior popliteal arteries
posterior tibial artery
circulation to posterior and lateral compartments
-via fibular artery
also to plantar surface of foot
major anastomoses of lower limb?
hip, knee, ankle, foot
deep veins in lower limb?
named for arteries with which they travel
distal veins?
doubled, located lateral and medial to artery with which they travel
superficial veins?
great saphenous vein
lesser saphenous vein
greater saphenous vein
begins on medial side of dorsum of foot (dorsal venous arch)
ascends medially along leg and thigh
- anterior to medial malleolus at ankle
- posterior to medial condyle of femur
parallels course of saphenous nerve in leg
receives superficial venous drainage from upper thigh and lower abdomen prior to joining femoral vein
empties into femoral vein
-after passing through the saphenous vein opening of fascia lata
lesser saphenous vein
begins on lateral side of dorsum of foot (dorsal venouns arch)
ascends laterally behind lateral malleolus and along midline of calf parrallening sural nerve
pierces crural fascia to join popliteal vein
superficial veins?
contain valves
- due to increased black flow - venous congestion
- can form varicosities (tortuous, incompetent veins)
used in coronary bypass surgeries**
popliteal nodes
lymph nodes in popliteal fossa
superficial inguinal nodes
located inferior to inguinal ligament, within superficial fascial layer
assume shape of a T
- horizontal portion located parallel and inferior to inguinal ligament
- vertical portion located over saphenous vein opening
deep inguinal nodes
located deep to fascia lata within femoral triangle, medial to femoral vein
iliac nodes
external, internal, and common
located along paths of those vessels
lymph drainage?
superficial - lymphatic channels that parallel course of superficial veins
-from subQ areas of of entire lower limb, deep inguinal nodes, gluteal region, and perineum
deep - lymphatic channels parallel to deep vessels
-deep inguinal lymph nodes receive lymph from muscles, tendons, joint capsules of entire lower limb
motor innervation of lower limb?
spinal cord segments (L2-4)
-via femoral and obturator nerves and L4-S3 from sacral plexus via sciatic nerve and its branches
femoral nerve
L 2,3,4
- enters femoral triangle deep to inguinal ligament
- provides motor and sensory branches while in triangle
- innervates anterior femoral musculature and skin of anterior thigh, medial leg, and medial foot
obturator nerve
L 2,3,4
- enters thigh via obturator canal
- provides motor innevation to adductor muscles of thigh and cutaneous to medial surface of thigh
sciatic nerve
L 4,5 S 1,2,3
exits pelvis via greater sciatic foramen
- courses through posterior thigh to bifurcate
- in popliteal fossa into tibial and common fibular nerve
innervates all posterior thigh, leg, and plantar musculature as well as specific cutaneous areas of corresponding regions
sensory innervation of lower limb?
cutaneous innervation from branches of lumbar and sacral plexus and dorsal rami of spinal nerves L1-3 and S1-3
sacral plexus?
ventral rami of L1-S2
dermatomes of lower limb?
involved spinal cord levels L1-S2
-spiral around limb from lateral to medial in barber pole fashion
L4 dermatome located anterior to greater trochanter, overlays the patella, medial malleolus and great toe
S1,2 descends middle and posterior thigh and leg
S1 overlays lateral malleolus
S2 located on medial plantar surface of heel
L4 and S1 cross dorsum and plantar surface of foot from medial to lateral
