Lower Limb Movements PDF

Anatomy of LOWER Limb Movements of Lower Limb By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study LOWER LIMB standing Normal walking Walking...

Anatomy of LOWER Limb Movements of Lower Limb By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study LOWER LIMB standing Normal walking Walking with paralysis Superior Gluteal Nerve Injury Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 2 LOWER LIMB Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 3  Case Study LOWER LIMB Fracture Neck of Fibula Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 4  Objectives: by the end of this lecture the student must understand the following knowledge: LOWER LIMB Mention the Movements of Lower Limb, regarding: 1. Movement 2. Muscle Producing 3. Nerve Supply 4. Effects of Nerve Injury. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 5  Movements of Hip Joint ( Movement of the Thigh ) Movements Muscle Nerve Supply Iliacus muscle: Femoral nerve in abdomen 1. Iliopsoas LOWER LIMB Flexion Psoas major muscle: Anterior rami of L1 to L3. 2. Rectus femoris Femoral nerve 3. Sartorius 1. Gluteus maximus Inferior Gluteal nerve. Extension All are supplied by tibial part of sciatic nerve except short 2. Hamstring muscles head of biceps femoris which is supplied by common peroneal part of sciatic nerve (Biceps femoris has double nerve supply) All are supplied by obturator nerve. All muscles of medial compartment of the Adductor magnus has double nerve supply: Adduction thigh Pubic part: posterior division of obturator nerve Ischial part: tibial nerve of sciatic nerve 1. Gluteus medius 2. Gluteus minimus Superior Gluteal nerve Abduction 3. Tensor fasciae latae. 4. Sartorius Femoral nerve 1. Anterior fibers of the gluteus medius Medial Rotation 2. Gluteus minimus Superior Gluteal nerve 3. Tensor fasciae latae. Lateral Rotation Small lateral rotators of the thigh SEE NEXT Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 6  Movements of Knee Joint ( Movement of the Leg ) Movements Muscle Nerve Supply 1. Gastrocnemius & Plantaris Posterior tibial nerve (Tibial nerve in leg) Long Head: Tibial part of sciatic nerve. LOWER LIMB 2. Biceps femoris Short Head: Common peroneal nerve 3. Semitendinosus Flexion Tibial part of sciatic nerve. 4. Semimembranosus 5. Sartorius Femoral nerve 6. Gracilis Obturator nerve 7. Popliteus Posterior tibial nerve (Tibial nerve in leg) Extension Quadriceps femoris (Which are ????) All are supplied by femoral nerve Popliteus Posterior tibial nerve (Tibial nerve in leg) Sartorius Femoral nerve Medial Rotation Semitendinosus (Unlocking of the knee) Tibial part of sciatic nerve. Semimembranosus Gracilis Obturator nerve Lateral Rotation Long Head: Tibial part of sciatic nerve. Biceps femoris (Locking of the knee) Short Head: Common peroneal nerve Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 7  Movements of Ankle Joint ( Movement of the Foot ) Movements Muscle Nerve Supply 1. Tibialis anterior LOWER LIMB 2. Extensor Digitorum Longus Dorsiflexion (Extension) Anterior Tibial (Deep peroneal) Nerve 3. Extensor Hallucis Longus 4. Peroneus (Fibularis) Tertius 1. Peroneus (Fibularis) Longus Musculocutaneous (Superficial peroneal) Nerve 2. Peroneus (Fibularis) Brevis 3. Gastrocnemius 4. Soleus Plantarflexion (Flexion) 5. Plantaris Posterior Tibial Nerve 6. Tibialis Posterior 7. Flexor Digitorum Longus 8. Flexor Hallucis Longus Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 8  Movements of Subtalar Joint ( Movement of the Foot ) Movements Muscle Nerve Supply 1. Peroneus (Fibularis) Tertius Anterior Tibial (Deep peroneal) Nerve LOWER LIMB Eversion 2. Peroneus (Fibularis) Longus Musculocutaneous (Superficial peroneal) Nerve 3. Peroneus (Fibularis) Brevis 1. Tibialis anterior 2. Extensor Hallucis Longus Anterior Tibial (Deep peroneal) Nerve 3. Extensor Digitorum Longus Inversion 4. Tibialis posterior Posterior Tibial Nerve 5. Flexor Digitorum Longus 6. Flexor Hallucis Longus Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 9  Movements of Metatarsophalangeal Joint s ( Movement of the Toes ) Movements Muscle Nerve Supply LOWER LIMB 1. Extensor Digitorum Longus Dorsiflexion (Extension) Anterior Tibial (Deep peroneal) Nerve 2. Extensor Hallucis Longus 1. Flexor Digitorum Longus Posterior Tibial Nerve Plantarflexion (Flexion) 2. Flexor Hallucis Longus ▪ 1st lumbrical: is supplied by medial plantar nerve 3. Lumbricals of foot ▪ Remaining lumbricals by lateral plantar nerve Adduction (PAD) Plantar Interossei. Lateral plantar nerve Abduction (DAB) Dorsal Interossei of foot Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 10  Movements of Inter - phalangeal Joint s ( Movement of the Phalanges ) LOWER LIMB Movements Muscle Nerve Supply 1. Extensor Digitorum Longus Dorsiflexion (Extension) Anterior Tibial (Deep peroneal) Nerve 2. Extensor Hallucis Longus 1. Flexor Digitorum Longus Posterior Tibial Nerve Plantarflexion (Flexion) 2. Flexor Hallucis Longus ▪ 1st lumbrical: is supplied by medial plantar nerve 3. Lumbricals of foot ▪ Remaining lumbricals by lateral plantar nerve Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 11 Clinical Correlation  Injury of Superior Gluteal Nerve https://www.youtube.com/watch?v=R4dI4nrsVd8 LOWER LIMB 1. Intramuscular injection in gluteal region. Commonest Cause 2. Greater trochanter fracture. 3. Posterior hip joint dislocation. Commonest site Supero-medial quadrant of the gluteal region. Deformity Limp (Waddling Gait) (Gluteal Gait) (Lurching Gait). 1. Gluteus medius. Muscles paralyzed 2. Gluteus minimus. 3. Tensor fascia latae. 1) Abduction of thigh. Motor loss 2) Medial rotation of thigh. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 13 LOWER LIMB Supero-medial Supero-lateral Quadrant Quadrant Infro-medial Infro-lateral Quadrant Quadrant Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 14  Trendelenburg’s sign LOWER LIMB ▪ occurs in people with weak or paralyzed abductor muscles (gluteus medius and gluteus minimus) of the hip. ▪ The sign is demonstrated by asking the patient to stand on one limb. ▪ When the patient stands on the affected limb (injured side), the pelvis severely drops over the swing limb (healthy side) (contralateral side). ▪ Positive signs are typically found in patients with damage to the superior gluteal nerve. ▪ The patient compensates for the pelvic drop by lurching the trunk to the affected side (injured side) to maintain the level of the pelvis throughout the gait cycle. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 15  Injury of Sciatic Nerve 1) Lumbar disc prolapse (herniation). LOWER LIMB Commonest 2) Piriformis Syndrome: spasm in piriformis e.g.: ice skaters, cyclists, and rock climbers Cause 3) Stab wound in the gluteal region or posterior compartment of thigh. Commonest Any part of its course. site 1. Hamstring muscles. Muscles 2. All leg muscles. paralyzed 3. All foot muscles. 1. Extension of hip (Gluteus maximus is still functioning especially if the injury is away from inferior gluteal nerve). Motor loss 2. Flexion of knee (sartorius & Gracilis are still functioning). 3. Dorsiflexion, plantarflexion, inversion & eversion of foot. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 16  Injury of Common Peroneal Nerve LOWER LIMB Commonest Cause Fracture neck of fibula. Commonest site At lateral aspect of knee joint. ▪ Foot drop (plantarflexed and inverted) ▪ This has the effect of making the limb Deformity “too long” ▪ Associated with stepping gait. Muscles Anterior and lateral compartments of leg. paralyzed Motor loss Dorsiflexion & eversion. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 17  Case Scenario (Staff Question) https://www.youtube.com/watch?v=7Ft1bUTzxkM A 45-year-old male presents to the clinic with difficulty lifting the front part of his foot after lifting a LOWER LIMB heavy object, causing him to trip frequently. He reports that this started after he experienced a sharp pain in his lower back that radiated down his leg. On examination, he has a high-stepping gait and cannot dorsiflex his foot. Sensation is reduced over the dorsum of the foot and the lateral aspect of the lower leg. What is the most common cause of foot drop in this patient? A. Herniated lumbar disc B. Hip fracture C. Knee dislocation D. Ankle sprain Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 18 LOWER LIMB Reference ISBN: 978-0-7020-5131-9 ISBN: 978-07817-7525-0 ISBN: 978-1-60913-446-4 Copyright© 2015, 2010, 2005 by Copyright© 2010, by Lippincott Copyright© 2012, by Lippincott Churchill Livingstone, an imprint of Williams & Wilkins, a Wolters Williams & Wilkins, a Wolters Elsevier Inc. Kluwer business. Kluwer business. Chapter 6. Chapter 5. Chapter 10. Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 19 LOWER LIMB Movements of Lower Limb By Dr. Hassan Rezk October 19, 2024 20