MSK Lower Limbs - 1 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 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 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  Piriformis  Superior gluteal nerve muscle  Sciatic nerve  Pudendal nerve  Inferior gluteal artery and vein  Inferior gluteal nerve Medial view Lateral view  Lesser Sciatic foramen Medial Lateral view view  Internal pudendal artery & vein  Pudendal nerve  Obturator internus tendon  Nerve to obturator  Obturator foramen  Obturator artery  Obturator vein  Obturator nerve Muscl Psoas es: major Hip region & Psoas Thigh minor Iliacus Tensor Fascia Latae Pectineus Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Psoas major Lumber lesser Lumber Iliolumbar Flexes the vertebra trochanter of plexus L1- artery thigh at the (transverse femur L4 hip joint process and bodies) Psoas minor Bodies and Pectineal line Spinal nerves Iliolumbar Assist in interverteb L1 artery truck ral discs flexion T12-L5 Iliacus Iliac fossa lesser Femoral nerve Medial Flexes the trochanter of circumflex thigh at the femur femoral artery hip joint Tensor Fascia Ant. superior Iliotibial tract Superior Lateral Abduction and Lata iliac spin gluteal circumflex internal nerve femoral artery rotation of & thigh S. gluteal artery Pectineus Superior (Pectineal line) Femoral N Medial Adduction, ramus of The line & circumflex flexion, medial Gluteal Gluteus region Medius Gluteus Minimus Gluteus maximus Superior gluteal N Pirifor mis Inferior gluteal Superior N Gemelli Sciatic Obturator N Internus Inferior Gemelli Quadratus Femoris Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Gluteus Posterior Iliotibial tract Inferior Superior& Abduction, maximus surface of the and Gluteal gluteal Inferior gluteal extension and ilium tuberosity nerve artery lateral (gluteal), (distal to rotation of hip sacrum and greater coccyx trochanter Gluteus Medius Posterior Lateral Superior Abduction , surface of the surface of the gluteal flexion and ilium greater nerve medial rotation trochanter of the thigh Gluteus Posterior Anterior Superior Abduction , Minimus surface of the side of the gluteal flexion and ilium but greater nerve medial rotation inferior to trochanter of the thigh gluteus medius Piriformis Anterior Greater Sacral plexus Lateral surface of the trochanter of L5-S2 rotation, sacrum the femur abduction and Thigh Femoral triangle Ant. Boundaries > compartm inguinal ligament superiorly, adductor ent longus medially, and sartorius laterally Sartori us Content> Femoral vein Rectus Femoral Femoris artery Femoral Vastus Vastus nerve Lateralis Intermedius Vastus Medialis Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Sartorius Anterior Superior, Femoral N Profunda Flexion superior iliac medial surface femoris abduction, spine of the tibia lateral rotation at hip joint // flexion and medial rotation at knee joint Vastus Lateralis Greater Common Femoral N Lateral Extension of trochanter and quadriceps circumflex leg at knee the lateral part femoris tendon femoral artery joint & flexion of linea aspera in to the tibial at the hip joint tuberosity Vastus Upper part of Lateral (Note that the Intermedius ant and lateral circumflex tendon surface of femoral artery encloses the femur patella within) Vastus Medialis Intertrochante Femoral ric line and artery & medial of the profunda linea aspera femoris artery Thigh Obturator medial Externus compartm ent Adductor Brevis Gracil Adductor is longus Adductor Magnus Muscle Proximal Distal Nerve supply Blood supply Action attachment attachment Adductor Pubis Middle 1/3 of Obturator nerve Deep femoral Strong Longus linea aspera adductor of thigh and medial rotation Adductor Inferior rami of Linea aspera of Obturator nerve Deep femoral Adduct the Magnus the pubis and the femur thigh. The (Adductor the rami of adductor part ) ischium component Adductor Sciatic N also flexes the Ischial tubercle and thigh, with the (Hamstring tuberosity medial hamstring part ) supracondylar portion line of the extending the femur thigh Gracilis Pubis Anterior Obturator N Obturator Adduction of (Inferior medial aspect artery the thigh at rami & of proximal the hip, and body) tibia flexion of the leg at the knee Obturat Lateral Posterior part Obturator nerve Obturator Adduction and or surface of of greater artery lateral Thigh Post. compartm ent Gracil is Adductor Vastus Magnus Lateralis Biceps Semimembran Femoris osus Semitendino sus Musc Proxima Distal Nerve Blood Acti le l attachment supply supply on attachm ent Biceps The long Fibular head Long head Profunda Flexion at the Femoris head > the and lateral innervated by femoris & knee. It also ischial condyle of the tibial Inferior extends the tuberosity of the tibia nerve// short gluteal thigh at the the ischium. head is hip, and The short innervated by laterally head> the the common rotates at the linea fibular nerve hip and knee aspera on Semitendino posterior The The medial Tibial Flexion of the sus surface ischial of the surface nerve leg at the femur tuberosi of the tibia knee joint. Semimembran The ty Medial Tibial Extension of osus ischial condyle of the nerve thigh at the tuberosi tibia hip. ty Medially rotates the thigh at the hip joint and the leg at the 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 Pubofemo ral 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 √Anatomical lectures √Boney skeleton of lower movements limps √Muscles √ Gluteal region √ Thigh  Leg & Foot √ Hip joint Joints  Knee joint  Ankle joint Blood supply and nerves Leg Ant. compartment Tibialis Anterior Fibularis Longus Extensor Digitorum Longus Gastrocne mius Fibularis Extensor Hallucis Tertius Longus Extensor Retinaculum Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Tibialis Anterior Lateral Medial Deep fibular Anterior Dorsiflexion surface of the cuneiform and nerve tibial and tibia & lateral the base of 1st artery inversion of foot tibial condyle metatarsal Extensor Upper tibia and The tendon Extends digits travels 2-5 Digitorum fibula, to the dorsal and dorsiflexion Longus 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 Middle shaft of The base of the Extension of big Hallucis the  Gastrocne mius Fibularis Soleu Longus s Tibialis Anterior Extensor Digitorum Flexor Digitorum Longus Longus Leg medial and Fibularis lateral Tibialis Brevis view Posterior Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Fibularis Longus Head of the Medial Superficial Fibular artery Plantarflexion fibula and the cuneiform and fibular and eversion lateral tibial base of 1st (peroneal) of foot condyle metatarsal nerve Fibularis Brevis distal two- The tendon Superficial Fibular artery Plantarflexion thirds of the then fibular and eversion surface of attaches to a (peroneal) of foot fibular shaft tuberosity on nerve 5th metatarsal  Planta Gastrocne ris mius Leg Post. Compartment superficial Short muscles saphenous vein Sural Soleu nerve s Achilles tendon (Tendocalca neus) Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Gastrocnemius Lateral & Fuse with Tibial nerve Sural artery Plantarflexes medial heads soleus muscle and post at the ankle attach to the to from the tibial joint, and lateral and calcaneal because it medial tendon and crosses the femoral inserts into knee, it is a condyles calcaneus bone flexor there respectively Plantaris Lateral Calcaneal Tibial nerve Sural artery It supracondylar tendon and plantarflexes line of the inserts into at the ankle femur calcaneus joint bone Soleus Soleal line of Calcaneal Tibial nerve Sural artery and Plantarflexes the tibia and tendon and post tibial the foot at proximal inserts into the ankle fibular area calcaneus joint bone  Poplite us Tibialis posterior Flexor Digitorum Flexor Hallucis Longus Longus Leg Post. Compartment deep muscles Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Popliteus Lateral condyle Just superior to Tibial nerve Sural artery Laterally rotates of the femur & soleal line on the femur on lateral the the meniscus tibia tibia Tibialis Posterior Interosseous Navicular Post. Tibial Inverts and artery membrane tuberosity, plantarflexes the between the adjacent tarsal foot, maintains tibia the and fibula, and bones and the medial arch of the posterior bases of the foot surfaces of the two metatarsals bones Flexor Medial surface Divides into 4 Post. Tibial Flexes the Digitorum of artery lateral Longus the tibia parts attaching four toes into the bases of Popliteal fossa  Flexor digitorum Flexor hallucis longus longus Lumbricals of the foot Abductor hallucis Abductor digiti Plantar minimi aponeurosis Flexor digitorum brevis Sole of the foot superficial Muscle Proxima Distal Nerve supply Blood supply Action l attachment attachm ent Abductor Calcaneus Proximal Medial or medial or Abducts the big hallucis tuberosity phalanx of 1st lateral lateral toe & toe plantar nerve plantar artery plantar aponeurosis Abductor Calcaneus Proximal Abducts & flexes digiti tuberosity phalanx of 5th the small toe minimi & toe plantar aponeurosis Flexor digitorum Medial tubercle Medial and Flexes 2nd to 5th of lateral brevis plantar sides of middle toes. calcaneus phalanges and 2nd to 5th toes plantar aponeuro sis Lumbricals Arise form Proximal Flex the  Flexor hallucis Sole of the longus foot deep Flexor hallucis brevis Lumbricals of the foot Flexor digitorum Abductor longus hallucis Quadratus plantae Movements at the knee joint Biceps femoris Surface anatomy Surface anatomy Surface anatomy  Knee joint Cruciate Ligaments Menis ci Tibial collateral ligament Patellar ligament Fibular collateral ligament Ankle joint Medial Ligament Lateral Ligament Movements at the ankle joint Gastrocnemius Tibialis anterior Soleu extensor hallucis s longus Planta extensor digitorum ris longus Tibialis posterior Flexor hallucis longus Flexor digitorum longus Movements at the subtalar joint Tibialis anterior, Fibularis Longus Tibialis Fibularis posterior brevis Flexor hallucis Fibularis longus tertius Arches of metatarsal bases, the the foot 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 Common Aorta Iliac artery Internal Iliac External artery Iliac artery Femoral Obturator artery artery Profun da femori s Circumflex artery femoral artery Profunda Circumflex femoris femoral artery artery Femo ral arter y  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  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 Femo ral vein  Nerves of the lower limb Hip region & Gluteal Thigh region Inferior & superior gluteal Femoral nerves nerve Pudendal nerve Saphenous Sciatic nerve nerve Obturator nerve Popliteal Leg fossa Tibial nerve Tibial nerve Deep fibular nerve Common fibular Superficial fibular nerve nerve Sural nerve Nerves of the lower limb Femoral nerve Saphenous Obturator nerve nerve Inferior gluteal Superior gluteal nerve 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  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