Lower Limbs - MSK PDF

MSK, Lower limbs -1 Assistant Prof. Tarek Abdelkader What will be covered in the lectures ❑Anatomical movements ❑Boney skeleton of lower limbs ❑Muscles Gluteal region Thigh Leg & Foot ❑Joints Hip joint Knee joint Ankle joint ❑Blood supply and nerves Anatomical movements...

MSK, Lower limbs -1 Assistant Prof. Tarek Abdelkader What will be covered in the lectures ❑Anatomical movements ❑Boney skeleton of lower limbs ❑Muscles Gluteal region Thigh Leg & Foot ❑Joints Hip joint Knee joint Ankle joint ❑Blood supply and nerves Anatomical movements ✓ Flexion VS Extension Ant or Post movement along the sagittal plane of the human body ✓ Abduction VS Adduction Movement in the coronal plan away from or towards the Medline (limps) ✓ Lateral rotation VS Medial rotation movement of ant surface of thigh away from or towards the Medline (hip joint) ✓ Plantarflexion VS Dorsiflexion movement of ant part of foot away or towards the lower leg (ankle joint) ✓ Eversion VS Inversion turning the bottom of the foot away or towards the midline (subtalar joints) 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 Overall view of the lower limb skeletal system  Greater Sciatic foramen Superior gluteal artery & vein Superior gluteal nerve Piriformis muscle Sciatic nerve Pudendal nerve Inferior gluteal artery and vein Inferior gluteal nerve Medial view Lateral view  Lesser Sciatic foramen Medial view Lateral view Internal pudendal artery & vein Pudendal nerve Obturator internus tendon Nerve to obturator internus  Obturator foramen Obturator artery Obturator vein Obturator nerve Muscles: Psoas major Hip region & Thigh Psoas minor Iliacus Tensor Fascia Latae Pectineus Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Psoas major Lumber vertebra lesser trochanter Lumber plexus Iliolumbar artery Flexes the thigh at (transverse of femur L1-L4 the hip joint process and bodies) Psoas minor Bodies and Pectineal line Spinal nerves L1 Iliolumbar artery Assist in truck intervertebral flexion discs T12-L5 Iliacus Iliac fossa lesser trochanter Femoral nerve Medial circumflex Flexes the thigh at of femur femoral artery the hip joint Tensor Fascia Lata Ant. superior iliac Iliotibial tract Superior gluteal Lateral circumflex Abduction and spin nerve femoral artery & internal rotation of S. gluteal artery thigh Pectineus Superior ramus of (Pectineal line) Femoral N & Medial circumflex Adduction, flexion, pubis (pectineal The line between obturator N femoral artery medial rotation of line) lesser trochanter thigh of femur and linea aspera Gluteal region Gluteus Medius Gluteus Minimus Gluteus maximus Superior gluteal N Piriformis Inferior gluteal N Superior Gemelli Sciatic N Obturator Internus Inferior Gemelli Quadratus Femoris Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Gluteus maximus Posterior surface Iliotibial tract and Inferior gluteal Superior& Inferior Abduction, of the ilium Gluteal tuberosity nerve gluteal artery extension and (gluteal), sacrum (distal to greater lateral rotation of and coccyx trochanter hip Gluteus Medius Posterior surface Lateral surface of Superior gluteal Abduction , flexion of the ilium the greater nerve and medial trochanter rotation of the thigh Gluteus Minimus Posterior surface Anterior side of Superior gluteal Abduction , flexion of the ilium but the greater nerve and medial inferior to gluteus trochanter rotation of the medius thigh Piriformis Anterior surface of Greater trochanter Sacral plexus L5-S2 Lateral rotation, the sacrum of the femur abduction and extension of hip joint Thigh Ant. Femoral triangle compartment Boundaries > inguinal ligament superiorly, adductor longus medially, and sartorius laterally Sartorius Content> Femoral vein Femoral artery Femoral nerve Rectus Femoris Vastus Lateralis Vastus Intermedius Vastus Medialis Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Sartorius Anterior superior Superior, medial Femoral N Profunda femoris Flexion abduction, iliac spine surface of the tibia lateral rotation at hip joint // flexion and medial rotation at knee joint Vastus Lateralis Greater trochanter Common Femoral N Lateral circumflex Extension of leg at and the lateral quadriceps femoris femoral artery knee joint & part of linea tendon in to the flexion at the hip aspera tibial tuberosity joint Vastus Intermedius Upper part of ant (Note that the Lateral circumflex and lateral surface tendon encloses femoral artery of femur the patella within) Vastus Medialis Intertrochanteric Femoral artery & line and medial of profunda femoris the linea aspera artery Rectus Femoris Anterior inferior Lateral circumflex iliac spine & just femoral artery superior to the acetabulum Thigh medial Obturator Externus compartment Adductor Brevis Gracilis Adductor longus Adductor Magnus Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Adductor Longus Pubis Middle 1/3 of linea Obturator nerve Deep femoral Strong adductor of aspera thigh and medial rotation Adductor Magnus Inferior rami of the Linea aspera of the Obturator nerve Deep femoral Adduct the thigh. (Adductor part ) pubis and the rami femur The adductor of ischium component also flexes the thigh, (Hamstring part ) Ischial tuberosity Adductor tubercle Sciatic N with the hamstring and medial portion extending supracondylar line the thigh of the femur Gracilis Pubis Anterior medial Obturator N Obturator artery Adduction of the (Inferior rami & aspect of proximal thigh at the hip, body) tibia and flexion of the leg at the knee Obturator Lateral surface of Posterior part of Obturator nerve Obturator artery Adduction and Externus obturator greater trochanter lateral rotation of membrane and the thigh. the ischiopubic ramus Thigh Post. compartment Gracilis Adductor Magnus Vastus Lateralis Biceps Femoris Semimembranosus Semitendinosus Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Biceps Femoris The long head > Fibular head and Long head Profunda femoris Flexion at the the ischial lateral condyle of innervated by the & Inferior gluteal knee. It also tuberosity of the the tibia tibial nerve// extends the thigh ischium. short head is at the hip, and The short head> innervated by the laterally rotates at the linea common fibular the hip and knee aspera on nerve posterior surface of the femur Semitendinosus The ischial The medial surface Tibial nerve Flexion of the leg tuberosity of the tibia at the knee joint. Extension of thigh Semimembranosus The ischial Medial condyle of Tibial nerve at the hip. tuberosity the tibia Medially rotates the thigh at the hip joint and the leg at the knee joint Attachments Attachments Movements at the hip joint Movements at the hip joint Movements at the hip joint Surface anatomy Surface anatomy The hip joint The hip joint Iliofemoral ligament Pubofemoral Anteroposterior view Anteroposterior view Femoral head fracture  Atlas of Clinical Gross Anatomy 2nd Ed Functional Anatomy Musculoskeletal Anatomy, Kinesiology, and Palpation for Manual Therapists Fundamentals of Anatomy & Physiology-Pearson Human Anatomy Atlas – Visible Body Thank you  MSK, Lower limbs -2 Assistant Prof. Tarek Abdelkader What will be covered in the lectures ❑Anatomical movements √ ❑Boney skeleton of lower limps √ ❑Muscles √ Gluteal region √ Thigh √ Leg & Foot ❑Joints Hip joint √ Knee joint Ankle joint ❑Blood supply and nerves Leg Ant. compartment Tibialis Anterior Fibularis Longus Extensor Digitorum Longus Gastrocnemius Fibularis Tertius Extensor Hallucis Longus Extensor Retinaculum Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Tibialis Anterior Lateral surface of Medial cuneiform Deep fibular nerve Anterior tibial Dorsiflexion and the tibia & lateral and the base of 1st artery inversion of foot tibial condyle metatarsal Extensor Upper tibia and The tendon travels Extends digits 2-5 Digitorum Longus fibula, to the dorsal and dorsiflexion of interosseous surface of the foot. foot membrane The tendon splits into four, each attach to the bases of distal phalanges of toes 2-5 Extensor Hallucis Middle shaft of the The base of the Extension of big Longus fibula and distal phalanx of toe & dorsiflexion interosseous the great toe and inversion of membrane foot Fibularis Tertius Ant. surface of the attaches to the Dorsiflexion and fibula & base of metatarsal eversion of foot tibiofibular V ligament  Gastrocnemius Fibularis Longus Soleus Tibialis Anterior Extensor Digitorum Longus Flexor Digitorum Longus Leg medial and lateral Fibularis Brevis view Tibialis Posterior Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Fibularis Longus Head of the fibula Medial cuneiform Superficial fibular Fibular artery Plantarflexion and and the lateral and base of 1st (peroneal) nerve eversion of foot tibial condyle metatarsal Fibularis Brevis distal two-thirds of The tendon then Superficial fibular Fibular artery Plantarflexion and the surface of attaches to a (peroneal) nerve eversion of foot fibular shaft tuberosity on 5th metatarsal  Plantaris Gastrocnemius Leg Post. Compartment superficial muscles Short saphenous vein Sural nerve Soleus Achilles tendon (Tendocalcaneus) Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Gastrocnemius Lateral & medial Fuse with soleus Tibial nerve Sural artery and Plantarflexes at heads attach to muscle to from the post tibial the ankle joint, the lateral and calcaneal tendon and because it medial femoral and inserts into crosses the knee, condyles calcaneus bone it is a flexor there respectively Plantaris Lateral Calcaneal tendon Tibial nerve Sural artery It plantarflexes at supracondylar line and inserts into the ankle joint of the femur calcaneus bone Soleus Soleal line of the Calcaneal tendon Tibial nerve Sural artery and Plantarflexes the tibia and proximal and inserts into post tibial foot at the ankle fibular area calcaneus bone joint  Popliteus Tibialis posterior Flexor Digitorum Longus Flexor Hallucis Longus Leg Post. Compartment deep muscles Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Popliteus Lateral condyle of Just superior to Tibial nerve Sural artery Laterally rotates the femur & lateral soleal line on the the femur on the meniscus tibia tibia Tibialis Posterior Interosseous Navicular Post. Tibial artery Inverts and membrane tuberosity, plantarflexes the between the tibia adjacent tarsal foot, maintains the and fibula, and bones and the medial arch of the posterior surfaces bases of the foot of the two bones metatarsals Flexor Digitorum Medial surface of Divides into 4 Post. Tibial artery Flexes the lateral Longus the tibia parts attaching four toes into the bases of the distal phalanges of 2nd to 5th toes Flexor Hallucis Posterior surface Base of the distal Post. Tibial artery Flexes the great Longus of the fibula phalanx of the & fibular artery toe great toe Popliteal fossa  Flexor digitorum longus Flexor hallucis longus Lumbricals of the foot Abductor hallucis Abductor digiti minimi Plantar aponeurosis Flexor digitorum brevis Sole of the foot superficial Muscle Proximal Distal attachment Nerve supply Blood supply Action attachment Abductor hallucis Calcaneus Proximal phalanx Medial or lateral medial or lateral Abducts the big toe tuberosity & of 1st toe plantar nerve plantar artery plantar aponeurosis Abductor digiti Calcaneus Proximal phalanx Abducts & flexes the minimi tuberosity & of 5th toe small toe plantar aponeurosis Flexor digitorum Medial tubercle of Medial and lateral Flexes 2nd to 5th brevis plantar calcaneus sides of middle toes. and plantar phalanges 2nd to aponeurosis 5th toes Lumbricals Arise form the Proximal phalanx Flex the tendons of flexor of 2nd to 4th toes metatarsophalangeal digitorum longus joint  Flexor hallucis longus Sole of the foot deep Flexor hallucis brevis Lumbricals of the foot Flexor digitorum longus Abductor hallucis Quadratus plantae Movements at the knee joint Biceps femoris Surface anatomy Surface anatomy Surface anatomy  Knee joint Cruciate Ligaments Menisci Tibial collateral ligament Patellar ligament Fibular collateral ligament Ankle joint Medial Ligament Lateral Ligament Movements at the ankle joint Gastrocnemius Tibialis anterior Soleus extensor hallucis longus Plantaris extensor digitorum Tibialis posterior longus Flexor hallucis longus Flexor digitorum longus Fibularis longus Fibularis brevis. Movements at the subtalar joint Tibialis anterior, Fibularis Longus Tibialis posterior Fibularis brevis Flexor hallucis longus Fibularis tertius Arches of the foot metatarsal bases, the cuboid and the three cuneiform bones calcaneus, talus, navicular, three cuneiforms and first three metatarsal bones calcaneus, cuboid and 4th and 5th metatarsal bones  Arterial blood supply Common iliac artery Internal iliac > Gluteal arteries & Obturator artery External iliac > Femoral artery Femoral artery Profunda femoris Circumflex femoral artery (branches from profunda femoris artery) popliteal artery (continuation of the femoral artery after it passes through the adductor hiatus to the back of the knee ) Anterior tibial artery (continues in the foot as Dorsalis pedis) Posterior tibial artery Fibular (peroneal) artery (branch from posterior tibial artery) Genicular branches Arterial blood supply Descending Aorta Common Iliac artery Internal Iliac artery External Iliac artery Femoral artery Obturator artery Profunda femoris artery Circumflex femoral artery Profunda femoris Circumflex femoral artery artery Femoral artery  Popliteal artery Anterior tibial artery Posterior tibial artery Fibular artery Dorsalis pedis artery  Venous drainage Superficial veins: only 2 main veins 1. Small saphenous vein (formed by both; the dorsal venous arch of the foot and dorsal vein of the big toe) 2. Great saphenous vein (formed by both; the dorsal venous arch of the foot and dorsal vein of the big toe) Deep veins Dorsal and planter veins of the foot Anterior, posterior tibial and fibular veins in the leg which will give popliteal at the back of knee joint (popliteal fossa) Femoral vein, profunda femoris and circumflex femoral vein (all will drain into the external iliac vein) Superior & Inferior gluteal veins will drain the gluteal region and empty in the internal iliac vein  Popliteal vein Anterior tibial vein Fibular vein Posterior tibial vein Venous drainage Great saphenous vein Small saphenous vein Dorsal venous arch Great saphenous vein Profunda femoris vein Femoral vein  Nerves of the lower limb Hip region & Thigh Gluteal region Inferior & superior gluteal nerves Femoral nerve Pudendal nerve Saphenous nerve Sciatic nerve Obturator nerve Popliteal fossa Leg Tibial nerve Tibial nerve Deep fibular nerve Common fibular nerve Superficial fibular nerve Sural nerve Nerves of the lower limb Femoral nerve Saphenous nerve Obturator nerve Inferior gluteal nerve Superior gluteal nerve Pudendal nerve Sciatic nerve  Sciatic nerve Tibial nerve Common fibular nerve Deep fibular nerve Superficial fibular nerve Saphenous nerve  Tibial nerve Superficial fibular nerve Sural nerve  Dorsalis pedis Vein Dorsalis pedis artery Dorsal venous arch Lateral view CT scan – sagittal view  Anteroposterior view Lateral view Lateral view  Atlas of Clinical Gross Anatomy 2nd Ed Functional Anatomy Musculoskeletal Anatomy, Kinesiology, and Palpation for Manual Therapists Fundamentals of Anatomy & Physiology-Pearson Human Anatomy Atlas – Visible Body Thank you