Vascular / Nerves Of Lower Limb Flashcards
LUMBAR PLEXUS
Formed by?
Situated in?
Main branches?
- is formed by the anterior rami •
-It is situated in the posterior part of the Psoas major. • - Main branches:
• Genitofemoral: to skin of the thigh & cremaster
muscle.
• Obturator: to medial (adductor) group of the thigh
. • Femoral: to anterior group of the thigh.
FEMORAL NERVE -COURSE?
- From dorsal division of ventral rami
- Runs in psoas major muscle
- Below inguinal ligament
- Enter the thigh it is lateral and posterior to femoral artery
- in thigh will give 2 branches ( ant. And post. )
Anterior branch of femoral nerve supplies?
Motor:
Sartorius and pectineus
Sensory:
Skin of anterior and medial thigh
Posterior branch of femoral nerve supply?
Motor:
Quadriceps muscles
Sensory :
Medial aspect of the lower leg = ( saphenous nerve )
FEMORAL NERVE INJURY will cause?
• Motor loss :
Loss of knee extension
• Sensory loss :
On anterior and medial aspect of thigh
Medial side of lower leg
Medial border of foot upto ball of great toe
Sensory loss to medial side of lower leg
Which nerve is injured ?
saphenous nerve
femoral
Obturator nerve
Supplies ?
Gracilis, obturator
externus, adductor brevis,
adductor longus and
adductor magnus.
But hamstring part of the
adductor magnus, which
is innervated by the tibial
nerve.
Damage to obturator nerve. Which adductor muscle will skip the lesion ?
hamstring part of the
adductor magnus, which
is innervated by the tibial
nerve.
numbness and paraesthesia on the medial aspect of the thigh and weakness in adduction of thigh
Damage to which nerve?
Obturator nerve
Patient could present with posture and gait problems due to the loss of adduction.
Damage to which nerve ?
Obturator nerve
management of pain
after lower limb surgery
or for chronic hip pain.
What can we use?
Obturator nerve block
SACRAL PLEXUS
Formed ?
Site?
ventral (anterior)
rami
Site: in front of
piriformis muscle.
Sciatic nerve
Origin?
Course?
- From Sacral Plexus
- Leaves the pelvis through greater
sciatic foramen - below piriformis
- passes in the gluteal region
- posterior compartment of the
thigh. - Divides into tibial & common peroneal (fibular) nerves in the
middle of the back of the thigh.
- Leaves the pelvis through greater
SCIATIC NERVE
Supplies ?
Muscular :
To Hamstrings
Sensory : the skin on the 1. posterior of the thigh 2. Post. gluteal area, 3. entire lower leg (except for its medial aspect= post branch of femoral nerve )
TIBIAL NERVE
Course ?
- From the sciatic nerve
- It travels through the popliteal
fossa - Accompanied with posterior tibial vessels.
- Passes behind the medial malleolus (deep to flexor
retinaculum) - reach the sole of foot where it divides into 2
terminal branches, (Medial & Lateral planter nerves ).
Tibial nerve supplies ?
Muscles of
posterior compartment of leg
& intrinsic muscles of sole
INJURY TO TIBIAL NERVE
Will cause?
Muscles paralyzed:
All muscles of back of leg and sole
=
Damage results in loss
of plantar flexion, loss
of flexion of toes and
weakened inversion
Sensory loss :
Whole of the sole of foot
Damage results in loss
of plantar flexion, loss
of flexion of toes and
weakened inversion
Which nerve is damaged?
INJURY TO TIBIAL NERVE
COMMON PERONEAL (FIBULAR) NERVE
Course?
- As the sciatic nerve
- Leaves popliteal fossa
- turns around the lateral aspect of neck of fibula, (dangerous position).
- Divides into 2 nerve
- Superficial peroneal and Deep peroneal
COMMON PERONEAL (FIBULAR) NERVE Supply?
Superficial peroneal :
to supply the Lateral
compartment of the leg.
Deep peroneal :
to supply the Anterior
compartment of the leg.
INJURY TO COMMON PERONEAL NERVE?
Muscles paralyzed :
Anterior and lateral muscles of leg
=
Deformity = foot drop
Sensory loss:
- Anterior and lateral side of leg
- Dorsum of foot and digits
- Medial side of big toe
INJURY TO COMMON PERONEAL NERVE
Which condition?
foot drop
Damage to the Superficial peroneal Nerve
- result in a loss of eversion.
- loss of sensation over:
dorsum of the foot and the anterolateral aspect of the
lower leg could also result.
Damage to Deep peroneal nerve
?
paralysis of the muscles in the anterior compartment of the leg, and so a patient loses the ability to dorsiflex the foot.
pain along the sensory
distribution of the sciatic nerve. ?
SCIATICA
Pain is felt at • . Posterior aspect of thigh • Posterior and lateral sides of leg • Lateral part of foot
Which condition?
SCIATICA
Causes of sciatica ?
Causes • Prolapse of intervertebral disc • Intra pelvic tumor • Inflammation of sciatic nerve
Branches of internal iliac artery
?
1- Superior gluteal artery
- Leaves the pelvis through greater sciatic foramen above piriformis
- Accompanies sup. gluteal nerve supplies the gluteal muscles
2-Inferior gluteal artery
- Leaves the pelvis through greater sciatic foramen
below piriformis. - Accompanies Inf. gluteal nerve and supplies mainly
gluteus maximus. - Gives an artery to sciatic nerve.
3- Obturator artery
Enters the medial compartment of thigh through the obturator canal Accompanies obturator N. and supplies adductor muscles.
supplies adductor muscles.
Which artery?
Obturator artery
Gives an artery to sciatic nerve. ?
Inferior gluteal artery
supplies mainly
gluteus maximus.
Which artery ?
Inferior gluteal artery
supplies the
gluteal muscles.
Which artery ?
Superior gluteal artery
External iliac artery give ?
- Femoral artery
- Popliteal artety
- Divides into anterior & posterior tibial arteries
- Anterior tibial artery gives :
- A recurrent branch
- Muscular branches.
- anterior medial malleolar artery and an anterior lateral malleolar artery
=
Dorsalis pedis artery Branches : - Medial tarsal artery - Lateral tarsal artery - Arcuate artery (gives dorsal metatarsal and digital branches) - First dorsal metatarsal artery
Posterior tibial artery - Circumflex fibular artery - Peroneal (fibular) artery =
Medial plantar artery:
Lateral plantar artery
(Forms deep plantar arch with dorsalis pedis artery )
It is a continuation of external iliac artery after passing under the inguinal ligament at the midinguinal point.
Which artery ?
Femoral Artery
Femoral Artery
Course ? Termination ?
- It passes vertically through the femoral triangle and then continues down in the adductor canal
- leaves the canal by passing through the adductor hiatus in the adductor magnus muscle and becomes the popliteal artery behind the knee.
Branches of the Femoral Artery ?
I. Four small branches:
- Superficial epigastric a.
- Superficial circumflex iliac a.
- Superficial external pudendal a.
- Deep external pudendal a.
II. Deep artery of the thigh (profunda femoris):
lateral and medial circumflex
femoral branches
three perforating
branches.
It is the major source of blood supply to
the thigh.
Which artety ?
Deep artery of the thigh (profunda femoris):
Deep artery of the thigh (profunda femoris):
Course ?
passes under the adductor longus
Muscle, eventually penetrating through
the adductor magnus to connect with
branches of the popliteal artery behind
the knee
Trochanteric anastomosis
Site ?
Arteries ?
Function?
Site : near the trochanteric fossa Contributing arteries: 1. Ascending branch of the medial circumflex femoral A. 2. Ascending branch of the lateral circumflex femoral A. 3. Branches from the superior gluteal A. 4. Branches from the inferior gluteal A. Function: Main supply of the neck of the femur Anastomosis between the internal and external iliac arteries
Cruciate anastomosis Site ? Arteries ? Function?
Site : back of the thigh Contributing arteries: 1. Transverse branch of the medial circumflex femoral A. 2. Transverse branch of the lateral circumflex femoral A. 3. Descending branch from the inferior gluteal A. 4. Ascending branch of the first perforating A. Function: Anastomosis between the internal and external iliac arteries
Continuation of femoral artery at the adductor hiatus
?
Which artery ?
Popliteal artery
is the deepest structure in popliteal fossa
?
Popliteal artery
Popliteal artery
Course/ termination ?
It is the deepest structure in popliteal fossa
it passes under the tendinous arch of the
soleus muscle to enter the deep region of
the posterior compartment of the leg.
Termination:
Divides into anterior & posterior tibial arteries at Lower border of popliteus muscle
Popliteal artery
Branches ?
Branches: Two sural branches to muscles of the
superficial group of the back of the leg 5 genicular branches to knee joint
Originate from the popliteal A and passes into the anterior compartment of the leg through an aperture in the interosseous membrane.
?
Anterior tibial artery
Anterior tibial artery
Course?
It descends on the interosseous membrane.
In the distal leg, It leaves the leg by passing deep
to extensor retinaculum and continues onto the
dorsal aspect of the foot as the dorsalis pedis A.
Anterior tibial artery
Branches ?
Branches
1. A recurrent branch , which connects with the
anastomotic network of vessels around the knee joint.
2. Muscular branches.
3. An anterior medial malleolar artery and an
anterior lateral malleolar artery , which share in ankle anastomosis.
Posterior tibial artery
Course? Termination?
Descends in posterior compartment of the leg. -Passes deep to flexor retinaculum.
Midway between medial malleolus and calcaneus as it will divide into medial & lateral plantar arteries
Posterior tibial artery
Branches ?
Branches: • Circumflex fibular artery: Winds around neck of fibula • Peroneal (fibular) artery: Supplies both posterior and lateral compartments of the leg.
Continuation of ant. tibial artery midway between 2 malleoli ?
Dorsalis pedis artery
Dorsalis pedis artery
Course? Termination?
Course: • Runs on dorsum of foot • Enters sole of foot through between the
two heads of the first interosseous muscle
as deep planter artery. Termination: Joins the deep plantar arch in sole of foot
Dorsalis pedis artery branches ?
Medial tarsal artery • Lateral tarsal artery • Arcuate artery (gives dorsal metatarsal and
digital branches) • First dorsal metatarsal artery
Medial plantar artery
Origin ? Course? Btranches ?
Origin: Posterior tibial artery Course and branches: • Gives a deep branch • Runs the 1 st layer of the sole • joins the digital branch of the deep planter arch,
which supplies the medial side of the big toe
Lateral plantar artery
Origin? Course? Branches?
Origin: Posterior tibial artery Course and branches: • Runs between muscles of 1 st and 2nd layers of sole • Forms deep plantar arch with dorsalis pedis artery • Gives plantar metatarsal and digital branches
They generally follow the arteries
(femoral, superior gluteal, inferior gluteal,
and obturator).
Type of vein/
The deep veins
great saphenous vein and
the small saphenous vein.
• They are in the subcutaneous connective
tissue.
Type of vein ?
The superficial veins
connect the superficial and deep veins
Type of vein ?
perforating veins
Union of the anterior & posterior tibial veins
?
Popliteal vein
Popliteal vein
Course? Termination? Tributaries ?
Course: One of the popliteal fossa contents Termination: Continues as the femoral vein at adductor hiatus Tributaries: Small (short)saphenous vein
Continuation of popliteal vein at the
adductor hiatus
?
Femoral vein
Femoral vein
Course / termination tributaries ?
Course:
In the adductor canal, it lies posterolateral
to the femoral artery.
In the femoral triangle, It lies medial to
the femoral artery in the femoral triangle. Termination:
Continues as external iliac vein behind the
inguinal ligament
Tributaries:
- Great saphenous vein
- Profunda femoris vein
Begins from medial end of the dorsal venous arch on the dorsum of the foot. ?
Great saphenous vein
Great saphenous vein
Course? Termination?
Course:
Ascends in front of medial malleolus in close relation with saphenous nerve. Then posteromedial to knee Then along the anteromedial part of the thigh to pierce the cribriform fascia
Termination: In femoral vein
Begins from lateral end of the dorsal venous arch on the dorsum of the foot
Small saphenous vein
Small saphenous vein
Course ? Termination ?
Course: • Ascends behind lateral malleolus. • Then in the midline on gastronemous. Termination: In popliteal vein
