1. Hip region, movement patterns, fascia and bony landmarks

Lower Extremity: Movement Patterns, Fascia, and Bony Landmarks

• Lower Extremity Movement: Covers hip, knee, and ankle movement patterns, including actions like abduction, adduction, extension, and flexion. Also includes descriptions of hip rotation (lateral and medial). Ankle movements include dorsiflexion and plantar flexion, as well as eversion and inversion.

LE Lecture Unit Objectives

• Muscle Knowledge: Students should demonstrate understanding of muscle attachments, actions, and innervation.
• Soft Tissue & Joints: Identify blood supply to soft tissues and joints.
• Impairments: Identify functional limitations associated with lower extremity peripheral nerve lesions.
• Joints & Freedom of Movement: Classify joints according to shape (number of articular surfaces) and degrees of freedom.
• Pathology Understanding: Demonstrate understanding of discussed pathologies within the context of the unit's lecture material.

Fascia of the Lower Limb

• Superficial Fascia: Lies deep to the skin. Composed of loose connective tissue, containing fat, cutaneous nerves, superficial veins, and lymphatics. Continuous with the fascia of the inferior, anterolateral abdominal wall, and buttocks.
• Deep Fascia ("Fascia Lata"): Dense connective tissue layer between the subcutaneous tissue and muscles in the thigh. Non-elastic. Encircles the limb like a stocking, preventing muscle bulging during contraction for greater efficiency. Continuous with the deep fascia of the leg (crural fascia).

Bony Landmarks – Internal View

• Ilium: includes ASIS, AIIS, PSIS, PIIS, Iliac crest, Wing of ilium: iliac foss, Greater sciatic notch, Ischial spine, Lesser sciatic notch, Body of ischium, Ischial tuberosity, Obturator foramen, Arcuate line, and Pectineal line.

Bony Landmarks – External View

• Iliac Crest: ASIS, AIIS, PSIS, PIIS.
• Ilium: Wing of ilium: gluteal surface
• Gluteal Lines: ant, post, inf
• Greater Sciatic Notch: Ischial Spine, Lesser Sciatic Notch, Body of Ischium, Ischial Tuberosity, Obturator Foramen, Acetabulum.

Pelvis Bone Identification

• Pelvic Bones: Ilium, Ischium, Pubis, Sacrum, Coccyx.
• Joints: Sacroiliac joints, pubic symphysis.

Sacrum/Coccyx Landmarks

• Ala of the Sacrum: A wing-like structure of the sacrum
• Body of SV1: Lateral view.
• Auricular Surface: Part of the sacrum that articulates with the ilium.
• Sacral Promontory: Forward-facing projection at the top of the sacrum.
• Sacral Foramina: Passages in the sacrum for nerves and blood vessels.
• Cornu of the Sacrum: Posterior view (only).
• Transverse Process: part of the Coccyx.
• Tip of Coccyx Projection at the bottom of the coccyx.

Pelvic Brim

• The superior margin of the pelvic brim is formed by the superior pubic symphysis, pecten pubis (pectineal line), arcuate line of the ilium, the anterior border of the ala of the sacrum, and the sacral promontory.

Pelvic Apertures

• Superior Pelvic Aperture (Pelvic Inlet): formed by the pelvic brim, separating the true and false pelves
• Inferior Pelvic Aperture (Pelvic Outlet): bounded posteriorly by the sacrum and coccyx, anteriorly by the pubic symphysis, laterally by the ischial tuberosities. It is closed by the pelvic diaphragm.

Pelvis Major

• "False Pelvis," superior to the pelvic brim.
• Found in the abdominal cavity.
• Bounded by the iliac fossae, abdominal wall, and L5 and S1 vertebrae.

Pelvis Minor

• "True Pelvis," inferior to the superior pelvic aperture
• Contains pelvic viscera
• Bounded posteriorly by the sacrum and coccyx, and anteriorly by the pubic symphysis.
• Laterally by the ilium and ischium.

Male vs. Female Pelvis

• Male: Thicker, heavier, more prominent markings, round obturator foramen, larger acetabulum, heart-shaped superior pelvic aperture, smaller inferior pelvic aperture, narrow pelvis major, and deep pelvis minor.
• Female: Thinner, less prominent markings, oval obturator foramen, smaller acetabulum, oval or round superior pelvic aperture, larger inferior pelvic aperture, shallow pelvis major, wide and shallow pelvis minor.

Obturator Foramen

• Formed by bodies and rami of the pubis and ischium.
• Nearly closed by an obturator membrane.
• Obturator nerves, arteries, and veins pass through this foramen, exiting into the obturator canal.

Greater Sciatic Foramen

• Formed anteriorly and superiorly by the greater sciatic notch, and inferiorly by the sacrospinous ligament and posteriorly by the sacrotuberous ligament.
• Acts as exit for pelvis vessels and nerves.

Lesser Sciatic Foramen

• Formed by the lesser sciatic notch (anterioly), the ischial spine and sacrospinous ligaments, and posteriorly (from the lesser sciatic notch) by the sacrotuberous ligament.
• Transmits the obturator internus tendon, and associated nerves and blood vessels.

Sacrococcygeal Joint

• Cartilaginous joint
• Articulates between the apex of the sacrum and the base of the coccyx.
• Contains sacrococcygeal ligaments (anterior, posterior, and lateral)
• Fibrocartilaginous intervertebral disc.

Pubic Symphysis

• Cartilaginous joint between superior rami of the pubic bones.
• Has a fibrocartilage interpubic disc.
• Strengthened by fibers of rectus abdominis and external oblique muscles.