Lower Limb 2 - PDF

 THE THIGH  Skin  Superficialfascia  Deep fascia  Muscles  Superficial Fascia The superficial fascia of the anterior abdominal wall extends downward to the front of the thigh. it is formed of 2 layers; superficial fatty layer and deep membranous l...

 THE THIGH  Skin  Superficialfascia  Deep fascia  Muscles  Superficial Fascia The superficial fascia of the anterior abdominal wall extends downward to the front of the thigh. it is formed of 2 layers; superficial fatty layer and deep membranous layer. The fatty layer of the superficial fascia on the anterior abdominal wall extends into the thigh and continues down over the lower limb without interruption. The membranous layer of the superficial fascia of the anterior abdominal wall extends into the thigh and is attached to the deep fascia of the thigh (fascia lata) about a fingerbreadth below the inguinal ligament. The superficial fascia contains : Superficial inguinal vessels, superficial inguinal lymph nodes and great saphenous vein. Definition: Fascia lata is a tough fibrous sheet which encloses the whole of the thigh like a sleeve. Attachment: (A) Superiorly: It is attached anteriorly to the inguinal ligament; laterally to the iliac crest; posteriorly to the sacrum, coccyx and sacrotuberous ligament; and medially to the pubis, pubic arch and ischial tuberosity. (B) Inferiorly: To the front and sides of the knee (femur, tibia, patella and fibula). Thickness: The fascia lata is thickened laterally to form the iliotibial tract (extending from tubercle of iliac crest to lat. condyle of tibia). The deep facia of the thigh represents some important features which are: The intermuscular septa (3, attached to linea aspra). The saphenous opening. The ilio tibial tract.  Intermuscular septa Three intermuscular septa extend from the deep fascia to the linea aspera and divide the thigh into 3 compartments (1) Lateral intermuscular septum: Extends from the lateral lip of the linea aspera to the ilio tibial tract. It separates the anterior from the posterior compartment of the thigh. (2) Medial intermuscular septum: Extends from the medial lip of the linea aspera to the deep facia on the medial side. Separates the anterior from the medial compartment of the thigh. (3) Posterior intermuscular septum: Extends from the medial lip of the linea aspera to the deep facia on the posterior side. Separates the medial from the posterior compartment of the thigh. It is poorly defined. COMPARTMENTS OF THE THIGH 1- Anterior compartment:  muscles: sartorius, iliacus, psoas major and quadriceps femoris.  Blood supply: femoral artery.  Nerve supply: femoral nerve. 2- Medial compartment :  muscles: gracilis, pectineus, adductor longus, adductor brevis,  adductor magnus and obturator externus.  Blood supply: obturator and profunda femoris arteries.  Nerve supply: obturator nerve. 3-Posterior compartment:  muscles: biceps femoris, semitendinosus and semimembranosus (hamstring).  Blood supply: branches from profunda femoris artery.  Nerve supply: sciatic nerve.  Muscles of the front of the thigh Sartorius Rectus femoris Vastus lateralis Vastus medialis Sartorius muscle: Origin: anterior superior iliac spine. Insertion: upper part of medial surface of tibia. Nerve supply: Femoral n. Action: 1- flexion, abduction and lateral rotation of hip. 2- flexion and medial rotation of knee. Iliacus muscle: Origin: iliac fossa. Insertion: join iliopsoas tendon to be inserted in lesser trochanter of femur. Nerve supply: Femoral n. Action: flexion and medial rotation of thigh. ( when the thigh fixed? Flexion of trunk) Psoas major muscle: Origin: transverse processes and bodies of all lumber v., body of last thoracic v. and intervertebral discs. Insertion: iliopsoas tendon. Nerve supply: lumber plexus. Action: flexion of thigh on trunk. ( when the thigh fixed? Flexion of trunk)  PECTINEUS Origin: From the pectineal surface of the superior pubic ramus. Insertion: The muscle fibers pass downward, backward and laterally and attached to the posterior surface of the femur between the lesser trochanter and linea aspera. Nerve supply: Femoral nerve. Action: Flexion and adduction of the hip joint.  QUADRICEPS FEMORIS MUSCLE Parts Rectus femoris Vastus medialis Vastus lateralis Vastus intermedius QUADRICEPS FEMORIS MUSCLE:  The large quadriceps femoris muscle consists of three vastus muscles (vastus medialis, vastus intermedius, and vastus lateralis) and the rectus femoris muscle. which have a common tendon of insertion into the patella.  Origin: 1. Rectus femoris: arises by 2 heads, Straight head from anterior inferior iliac spine and reflected head from outer surface of ilium above the acetabulum. 2. Vastus lateralis: arises from a line extending from Intertrochanteric line, root of greater trochanter, lateral border of gluteal tuberosity and lateral lip of linea aspra. 3. Vastus medialis: arises from a line extending from lower ½ of intertrochanteric line, spiral line, medial lip of linea aspra and medial supracondylar line. 4. Vastus intermedius: arises from the upper 2/3 of the anterior and lateral surfaces of the shaft of the femur. Insertion: All attach first to the patella by the quadriceps femoris tendon and then to the tibia by the patellar ligament (which extends from apex of patella to tibial tuberosity). Lateral and medial patellar ligaments: these are extensions from vastus lateralis and medialis to the capsule of knee joint. Nerve supply: Femoral nerve  Action: 1- The whole muscle: extension of knee and strengthen its capsule(by retinacula). 2- The tone of the quadriceps muscle greatly strengthens the knee joint. 3- Rectus femoris: flexion of hip. Articularis genu muscle: It is a tiny muscle (articularis genus) originates from the femur just inferior to the origin of the vastus intermedius and inserts into the synovial membrane of knee joint suprapatellar bursa associated with the knee joint.This articular muscle, which is often part of the vastus intermedius muscle, pulls the synovial membrane from the knee joint during extension. Articularis genu