Lower Limb Anatomy

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Questions and Answers

Which of the following structures is NOT a part of the coxal bone?

  • Ilium
  • Femur (correct)
  • Pubis
  • Ischium

What is the primary function of the profunda femoris artery?

  • Supplying the knee joint
  • Supplying the anterior compartment of the leg
  • Supplying the hip and thigh (correct)
  • Supplying the foot

Which nerve innervates the muscles of the anterior compartment of the thigh?

  • Sciatic nerve
  • Femoral nerve (correct)
  • Tibial nerve
  • Obturator nerve

The popliteal artery terminates at the ring of the soleus muscle, giving rise to which two major arteries?

<p>Anterior tibial artery and tibio-peroneal trunk (B)</p> Signup and view all the answers

Which of the following muscles is located in the medial compartment of the thigh and primarily acts as an adductor of the hip joint?

<p>Gracilis (B)</p> Signup and view all the answers

Which of the following bony landmarks serves as the insertion point for the iliotibial tract?

<p>Gerdy's tubercle (B)</p> Signup and view all the answers

Which of the following muscles is responsible for both hip abduction and external rotation?

<p>Piriformis (C)</p> Signup and view all the answers

The femoral artery passes through which anatomical landmark as it transitions from the thigh to the popliteal fossa?

<p>Adductor hiatus (A)</p> Signup and view all the answers

Which compartment of the leg does the tibialis anterior muscle belong to, and what is its primary action?

<p>Anterior compartment; dorsiflexion (D)</p> Signup and view all the answers

What is the main arterial supply to the gluteal region, originating as an extrapelvic branch of the internal iliac artery?

<p>Gluteal artery (B)</p> Signup and view all the answers

Which of the following muscles inserts onto the greater trochanter of the femur?

<p>Obturator Internus (C)</p> Signup and view all the answers

The superficial venous network of the lower limb is composed of two main trunks. Which of the following describes the origin and path of the lesser saphenous vein?

<p>Originates lateral border of foot, runs upward to popliteal fossa (B)</p> Signup and view all the answers

What is the primary action of the flexor hallucis longus muscle?

<p>Flexion of the big toe (D)</p> Signup and view all the answers

The sacrum articulates superiorly with which vertebra at the lumbosacral joint?

<p>L5 (C)</p> Signup and view all the answers

Which of the following bony features is located on the posterior border of the coxal bone?

<p>Greater sciatic notch (A)</p> Signup and view all the answers

Which of the following muscles is located in the posterior compartment of the thigh and is responsible for both thigh extension and knee flexion?

<p>Biceps femoris (C)</p> Signup and view all the answers

What is the origin of the rectus femoris muscle?

<p>Anterior inferior iliac spine (A)</p> Signup and view all the answers

Which artery branches directly from the popliteal artery and supplies the anterior compartment of the leg?

<p>Anterior tibial artery (C)</p> Signup and view all the answers

What action is primarily associated with the gluteus medius muscle?

<p>Hip abduction (A)</p> Signup and view all the answers

The femoral triangle is an important anatomical region in the thigh. Which of the following structures forms its medial border?

<p>Sartorius muscle (A)</p> Signup and view all the answers

Flashcards

Coxal Bone

Also known as the hip bone, it is made up of the Pubis, Ischium, and Ilium.

Anterior Superior Iliac Spine (ASIS)

Located on the anterior border of the coxal bone and serves as the attachment for the sartorius and tensor latae muscles.

Arcuate Line

Marks where the ilium separates into upper and lower sections.

Femur Head

The part of the femur that articulates with the acetabulum of the pelvis to form the hip joint.

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Greater Trochanter

Attachment site for gluteus medius & minimus and piriformis muscles.

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Patella

A sesamoid bone (kneecap) in the shape of an inverted triangle. It has 2 faces (anterior and posterior), a superior base, and an inferior apex.

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Proximal End (Tibia)

A large, quadrangular structure with two articular surfaces (Medial & Lateral Glenoid Cavity) that articulate with medial and lateral femoral condyles.

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Fibular neck Distal End

Lateral malleolus; artioculates with lat s of talus and attach for collateral ligament ankle

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Talus (astragalus)

Located on the proximal part of the foot, cube shaped, 3 segments body, head and neck.

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Cuboid

A tarsal bone that cube shaped, in front of calcaneus and 6 surfaces

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Medial Thigh Muscles

Located in the medial compartment of the thigh and innervated by the obturator nerve, it adducts the hip joint.

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Femoral Artery

It follows external iliac artery under inguinal ligament and runs downard medial posteriorly joining crural arch and medial femoral condyle. It has 5 Collateral branches

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Profunda Femoris Artery

Main collateral artery which supplies hip & thigh, its terminal branches are: Anterior & Posterior Circumflex Arteries, Quadriceps artery, and Perorating arteries.

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Deep Venous network

It is a satellite vein of arteries. There are normally 2 satellite veins per artery except for popliteal and femoral

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Gluteus Maximus

Origin: External surface Ilium and Sacrum; Insertion: medial part of linea aspera; Action: hip extension; Nerve: Inferior gluteal nerve

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Tensor fascia Latae

Origin: Anterior Superior Iliac Spine; Insertion: Tibia Gerdy's Tubercle; Action: knee extension; Nerve: Inferior gluteal nerve

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Gluteus Medius

Origin:External iliac fossa; Insertion: Greater Trochanter Tuberosity; Action: Hip ABDUCTION; Nerve: Superior Gluteal Nerve

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Obturator internist

Action: external rotation; Nerve: obturator nerve

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Biceps Femoris

Has 2 origins - Short head which originates from linea aspera of femur, and long head originating from ischial tuberosity. Action: Extension thigh and knee flexion; Nerve: sciatic nerve

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Tibialis Anterior

Origin: lateral surface tibia; Insertion: medial 1st cuneiform, 1st metatarsal; Action: foot dorsal flexion and internal rotation; Nerve: anterior tibial nerve

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Study Notes

  • The anatomy of the lower limbs is outlined in the following notes.

Pelvic Girdle

  • The coxal bone (hip bone) consists of the pubis, ischium, and ilium.
  • The coxal bone is flat and irregularly shaped with two surfaces, four borders, and four angles.
  • The two coxal bones are connected anteriorly by the pubic symphysis and posteriorly by the sacroiliac joint.
  • The sacrum articulates superiorly with vertebra L5 at the lumbosacral joint.
  • The pelvic bones articulate posteriorly with the sacrum at the sacro-iliac joints and anteriorly with each other at the pubic symphysis.

Coxal Bone Borders

  • Anterior border: ASIS (anterior superior iliac spine) is the origin for the sartorius and tensor latae muscles, AIIS (anterior inferior iliac spine) is the origin for the rectus femoris, pectineal surface for pectineus muscle, pectineal crest, and pubic spine for rectus abdominis and pyramidalis muscle.
  • Superior border: iliac crest serve as the origin for the external and internal obliques, as well as the transversus abdominis muscle.
  • Posterior border: includes the greater sciatic notch, sciatic spine, and ischial tuberosity.
  • Inferior border: medially, it is the origin of the levator ani and transversus perinei muscles; laterally, it is the origin of the adductor longus, brevis, and magnus muscles.

Ilium

  • Anteriorely, the arcuate line separates the upper and lower parts of the ilium.
  • The superior margin forms the iliac crest, which is a site for muscle attachment and terminates as the anterior or posterior iliac spine.
  • The anterior inferior iliac spine (AIIS) is the attachment site for the rectus femoris muscle and iliofemoral ligament.
  • The iliac tubercle is prominent and posterior.
  • The posterior inferior iliac spine (PIIS) forms the superior margin of the greater sciatic notch.
  • The hip joint is formed by the articular socket of the pelvic bone (acetabulum) and the head of the femur.

Thigh Bone (Femur)

  • The femur is a long bone with two extremities and a diaphysis (shaft).
  • It exhibits anterior convexity and posterior concavity.
  • The diaphysis is prismatic, having three faces and three borders.
  • The gluteal tuberosity serves as the attachment for the gluteus maximus.
  • The posterior border, known as the linea aspera, has three parts: middle, upper, and lower.

Proximal End of Femur

  • Features include the femur head with fovea capitis and the femur neck.
  • The intertrochanteric line separates the trochanters.
  • The greater (lateral) trochanter serves as an attachment site for the gluteus medius, gluteus minimus, and piriformis muscles.
  • The lesser (medial) trochanter serves as the attachment for the iliopsoas muscle.

Distal End of Femur

  • Features include the lateral and medial condyles, femoral trochlea, intercondylar notch, and popliteal fossa (posterior knee joint).

Patella

  • The patella is a sesamoid bone, or kneecap, with an inverted triangular shape, featuring a superior base and an inferior apex.
  • It has two surfaces: anterior and posterior.
  • The anterior surface is convex and rough.
  • The posterior surface is divided into a superior smooth surface and an inferior non-articular surface.
  • The base serves as the attachment site for the quadriceps tendon.
  • The apex is for the patellar ligament.

Leg Skeleton

  • Composed of the tibia and fibula.

Tibia

  • The Tibia is the medial and larger bone of the leg.
  • It has a diaphysis and 2 extremities
  • The diaphysis is triangular with 3 surfaces (medial, lateral, posterior) and 3 borders.

Proximal End of Tibia

  • The proximal end is large and quadrangular
  • It features two articular surfaces: the medial and lateral glenoid cavities which articulate with the lateral and medial femoral condyles.
  • The intercondylar eminence is present.
  • There are three tuberosities: medial tibial, lateral tibial, and anterior tibial.

Distal End of Tibia

  • The distal end is cuboid with 6 faces.
  • The superior face attaches to the diaphysis.
  • The inferior face articulates with the superior surface of the talus.
  • Grooves for tendons are present on the anterior and posterior faces.
  • The lateral face articulates with the distal fibula.
  • The medial face extends downward to form the medial malleolus, which articulates with the medial surface of the talus.

Fibula

  • The fibula is the lateral and thinner bone of the leg.
  • Has a diaphysis and 2 extremities
  • The diaphysis is triangular with 3 faces (medial, lateral, posterior) and 3 borders.
  • Proximal end includes the fibular head and styloid process.
  • The medial face has an articular surface.
  • The fibular neck connects to the distal end: the lateral malleolus articulates with the lateral side of the talus and provides attachment for the collateral ligament of the ankle.

Skeleton of Foot

  • The skeleton of the foot has 26 bones, divided into the tarsus, metatarsus, and phalanges.

Tarsus

  • The Tarsus has 7 bones divided into 2 parts

Proximal Part of Tarsus

  • Talus (astragalus): cube-shaped with three segments: head, neck, body; articulates superiorly with the distal end of the tibia, inferiorly with the calcaneus, anteriorly with the navicular, laterally with the fibula, and medially with the lateral surface of the talus.
  • Calcaneus: the largest bone of the tarsus, cube-shaped with 6 surfaces.

Distal Part of Tarsus

  • Cuboid: cube-shaped, located in front of the calcaneus; articulates anteriorly with the 4th and 5th metatarsals and medially with the 3rd cuneiform.
  • Navicular: boat-shaped, medial, articulates posteriorly with the head of the talus and anteriorly with the 3 cuneiform bones.
  • Cuneiform bones: named 1-3 from medial to lateral; articulate anteriorly with the first four metatarsals, posteriorly with the navicular, and laterally with the cuboid.

Metatarsus

  • The Metatarsus has 5 bones named 1-5 from medial to lateral, each having a shaft, proximal end, and distal end.

Phalanges

  • The first toe (hallux) has two phalanges (proximal, distal).
  • The other four toes each have three phalanges: proximal, middle, and distal.
  • Each phalanx has a shaft, proximal end (base), and distal end (head).

Muscles

  • Sciatic nerve supplies the muscles of the lower limb.
  • Nerves of the medial compartment: obturator nerve
  • Nerves of the anterior compartment: femoral nerve
  • Nerves of the posterior compartment: sciatic nerve
  • Medial thigh muscles are adductors of the hip joint.
  • Anterior thigh muscles are flexors of the hip joint and extensors of the knee joint.
  • Posterior thigh muscles are extensors of the hip joint and flexors of the knee joint.

Six Thigh Muscles of the Medial Compartment

  • Gracilis
  • Pectineus
  • Adductor longus
  • Adductor brevis
  • Adductor magnus
  • Obturator externus

Five Thigh Muscles of the Anterior Compartment

  • Sartorius
  • 4 quadriceps muscles;
  • Rectus femoris
  • Vastus medialis,
  • Vastus lateralis
  • Vastus intermedius

Three Thigh Muscles of the Posterior Compartment

  • Biceps femoris
  • Semimembranosus
  • Semitendinous muscles

Four Gluteal Muscles (Posterior Side Hip Bone)

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Tensor fasciae latae

Nine Inner Hip Muscles (Anterior Side of Pelvis)

  • Iliacus
  • Psoas major
  • Psoas minor
  • Obturator externus
  • Obturator internus
  • Superior gemelli
  • Inferior gemelli
  • Piriformis
  • Quadratus femoris

Arteries of Lower Limb

  • Thigh & Gluteal Region arteries consist of extrapelvic branches of the Internal iliac artery, Gluteal artery, Sciatic artery,Internal Pudendal artery

Femoral Artery

  • Origin: Follows external iliac artery under inguinal ligament
  • Scarpa Femoral Triangle Region
  • Path: runs downward medial posteriorly joining crural arch and medial femoral condyle Artery has 5 Collateral branches
    • Superficial circumflex iliac artery
    • SuperficiaL epigastric artery
    • SUperficial external pudendal artery
    • Deep external pudendal artery
    • Profunda femoris artery

Profunda Femoris Artery

  • The profunda femoris artery supplies main collateral artery to the hip & thigh its terminal branches

    • Anterior & Posterior Circumflex Arteries
    • Quadriceps artery
    • Perforating arteries
  • Termination: femoral artery is continued by popliteal artery

Popliteal Artery

  • Origin: follows femoral at third adductor ring
  • Path: vertical, axis of popliteal fossa
  • 7 Collateral branches
    • 5 articular arteries of knee
    • 2 gastrocnemius muscles
  • Termination: end at ring of soleus muscle and gives rise to anterior tibial artery & tibioperoneal trunk
  • Popliteal artery runs along popliteal fossa and connect with popliteal nerve and internal popliteal sciatic nerve located behind it

Leg Arteries

  • Anterior Tibial artery:
    • Arises from popliteal artery
    • Passes over interosseous membrane to anterior compartments
    • Continues as pedal artery
    • It gives rise to:
      • Recurrent branches (tibial and peroneal)
      • Muscles branches for muscles anterior compartment

Tibio-Peroneal Trunk

  • The Tibio-peroneal trunk:
    • Arises from bifurcation popliteal artery
    • Descends vertically into posterior compartment of leg
    • Terminates bifurcation into posterior tibial artery and peroneal artery
  • Peroneal artery supplies fibula and peroneal muscles
  • Posterior Tibial artery supplies posterior compartment of leg gives rise to internal and external plantar arteries
  • Sciatic nerve branches into deep Fibular Nerve and Tibial nerves innervate the leg and foot

Foot Arteries

  • Pedal artery innervates dorsum foot
  • Runs on dorsal surface and terminates indorsal interosseous artery
  • Internal and external plantar arteries innervate sole of foot
  • Internal plantar artery is internal bifurcation branch of posterior tibial artery on medial border foot
  • External plantar artery is external bifurcation branch of posterior tibial artery on lateralborder foot

Venous Drainage

  • The superficial venous network has two main trunks:
    • Greater Saphenous vein: originates anterior to medial malleolus runs inside leg and knee and ascends to saphenofemoral junction
    • Lesser Saphenous vein: originates lateral border of foot runs upward to popliteal fossa joining popliteal vein
  • The deep venous network consists of satellite veins of arteries, with 2 satellite veins per artery except for popliteal and femoral.
  • Lymphatics: Lyphatic vessels lead to inguinal and retrocrural lymph does & inguinal nodes occupy femoral Scarpa triangle & receive from external genitalia and abdominal wall

Thigh Region

  • The thigh region has 3 muscular compartments: anterior, medial, and posterior.

Anterior Region of Thigh

  • Sartorius muscle
  • Quadriceps muscles
    • Rectus Femoris
    • Vastus medialis
    • Vastus Lateralis
    • Vastus Intermedius

Gluteal Region

  • The gluteal region has 2 layers: a superficial and a deep layer.
  • Superficial Layer:
    • Gluteus maximus muscle
    • Tensor fascia latae muscle
    • Iliotibial tract
  • Deep Layer:
    • Gluteus medius muscle
    • Gluteus minimus
    • Piriformis
    • Pelvic muscles

Pelvic Muscles

  • Superior Gemellus Muscle
  • Obturator internist
  • Inferior Gemellus Muscle
  • Obturator externus
  • Quadratus Femoris

Limits of the Femoral Triangle

  • The limits of the femoral triangle have;
    • Inguinal Ligament superiorly
    • Adductor Longus laterally
    • Sartorius Muscle medially

Contents of the Femoral Triangle

  • Femoral nerve, artery, vein
  • Iliac
  • Superior circumflex artery
  • Superficial epigastric artery
  • Superficial external pudendal artery
  • Deep External Pudendal artery
Muscle Origin Insertion Action Nerve
Gluteus Maximus External surface Ilium Sacrum Medial part of linea aspera Hip extension Inferior gluteal.
Tensor fascia Latae Anterior Superior Iliac Spine Tibia Gerdy's Tubercle Knee extension Inferior gluteal.
Gluteus Medius External iliac fossa Greater Trochanter Tuberosity Hip ABDUCTION Superior Gluteal.
Gluteus Minimus External iliac fossa Greater trochanter Hip Abduction Superior Gluteal.
Piriformis Anterior surface sacrum Greater trochanter Hip abduction external rotation Sacral nerve plexus
Superior Gemellus Sciatic spine Greater trochanter External rotation hip Sacral nerve
Inferior Gemellus Ischial tuberosity Greater trochanter External rotation hip Sacral nerve
Obturator internist Around foramen ovale Greater Trochanter External rotation Obturator nerve
Obturator externus Around obturator foramen Greater trochanter External rotation Obturator nerve
Quadratus Femoris Ischial tuberosity Anterior intertrochanteric line femur External rotation Inferior gluteal artery
Sartorius Anterior Superior Iliac Spine Medial Tibial condyle Knee extension hip flexion Femoral nerve
Rectus Femoris Anterior Superior Iliac Spine Anterior tuberosity Tibia Knee extension Femoral nerve
Vastus Medialis N/A Tibiali anterior tuberosity Knee Extension femoral nerve
Vastus Intermedius Anterior lateral aspect of femur Anterior tuberosity tibia knee extension Femoral nerve
Gracilis Pubis Medial tibial condyle Knee extension bending hip Obturator nerve
Psoas Iliacus Lumbar vertebral column and Iliac Lesser trochanter tuberosity External rotation Lumbar nerve
Pectinus Pectineal line pubis Linea aspera of Femur Adduction external hip rotation Femoral nerve
Adductor Longus Pubis Linea aspera Femur Hip Adduction Obturator nerve
Adductor Brevis Pubis Linea aspera Femur Adduction flexion internal rotation Obturator nerve
Adductor Magnus Pubis and Ischium Postermedial Fernoral Face Hip Adduction Flexion and Internal rotation Obturator Nerve
Biceps Femoris Short head: Linea Aspera of Femur, Long head: Ischial Tuberosity Styloid Fibula head Extension thigh and knee flexion Sciatic Nerve
Semitendinosus Ischial Tuberosity Proximal end Tibia Thigh Extension and Knee Flexion Tibial Sciatic Nerve
Semimembranosus Ischial Tuberosity Medial condyle Tibia Thigh Extension and Knee Flexion Tibial Sciatic Nerve
Tibialis Anterior lateral surface of Tibia Medial 1st cuneiform 1st metatarsal Dorsal Flextion and Internal rotation Anterior Tibial Nerve
(Extensor Hallucis Longus) Fibula and Interosseous membrane Base distal phalanx big toe P3 extension (P2) Anterior Tibial Nerve
Extensor Digitorum Longus Fibular Tibial Condyle Distal and Medial planges digits 2-5 toe flexion Anterior Tibial Nerve
Peroneus Longus Lateral Fibula Diaphysis Base 1st Metacarpal Bone Foot Abduction and external Rotation Superifical Peroneal Nerve
Peroneus Brevis Lateral Fibula Diaphysis Base of 5th Metatarsal Bone Foot Abduction and External Rotation Superifical Peroneal Nerve
Gastrocnemius Medial Medial Femoral Condyle Achilles Calcaneal tendon posterior tuberosity of calcaneus Plantar Flexion foot Posterior Tibial nerve
Gastrocnemius Lateral Lateral Femoral Condyle Achilles Calcaneal tendon posterior tuberosity of calcaneus Plantar Flexion foot Posterior Tibial nerve
Soleus Tibial Fibula Superior side Achilles Calcaneal tendon posterior tuberosity of calcaneus Plantar Flexion foot Posterior Tibial nerve
Plantarus External Femoral condyle Calcaneus Plantar flexion foot Posterior Tibial Nerve
Flexor digitorum Longus Posterior Tibia Base P3 of last 4 metatarsal bones toe flexion Posterior Tibial nerve
Flexor Hallucis Longus Posterior Tibia base P2 big toe flexion P2on1 Posterior Tibial nerve
Tibialis Posterior Tibia fibula interosseous membrane Navicular Bone foot Foot Abduction internal External Rotation Posterior Tibial nerve

Foot Muscles

  • Middle Compartment:
    • Middle plantar fascia
    • Digitorum brevis muscle
    • Flexor digitorum muscle accessories
    • Terminals tendons of flexor digitorum longus last four toes
    • Four lumbrical muscles
  • Medial Compartment:
    • Muscles of big toe
      • Abductor hallucis
      • Halucis brevis
      • adductor hallucis
  • Lateral Compartment:
    • Muscles of 5th toe
      • Abductor digiti minimi
      • Flexor digiti minimi

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