Lower Limb Anatomy PDF

Lower Limb Professor: Dr. Tina Chiarelli University of Central Florida College of Medicine  Palpable Landmarks of the Lower Limb https://doctorlib.info/medical/anatomy/26.html Peason: Figure 8-7a Bones of the pelvic girdle....

Lower Limb Professor: Dr. Tina Chiarelli University of Central Florida College of Medicine  Palpable Landmarks of the Lower Limb https://doctorlib.info/medical/anatomy/26.html Peason: Figure 8-7a Bones of the pelvic girdle. Base of sacrum Iliac crest Sacroiliac joint Iliac fossa Anterior superior iliac spine Sacral Ilium promontory Coxal bone (os coxae Anterior Sacrum inferior iliac or hip bone) spine Pubis Coccyx Pelvic brim Acetabulum Pubic tubercle Ischium Pubic crest Pubic symphysis Pelvic girdle Pubic arch Pearson: Figure 8-7b Bones of the pelvic girdle. Tubercle of the iliac crest Anterior gluteal line Ilium Ala Posterior gluteal line Iliac crest Anterior superior iliac spine Posterior superior Inferior iliac spine gluteal line Anterior inferior Posterior inferior iliac spine iliac spine Acetabulum Greater sciatic notch Ischial body Ischial spine Pubic body Lesser sciatic notch Pubis Ischium Ischial Inferior pubic ramus Ilium tuberosity Ischium Ischial ramus Pubis Lateral view, right hip bone Pearson: Figure 8-7c Bones of the pelvic girdle. Ilium Iliac fossa Iliac crest Anterior superior Posterior iliac spine superior iliac spine Posterior inferior Anterior inferior iliac spine iliac spine Body of Auricular Arcuate the ilium surface line Superior pubic Greater sciatic notch ramus Ischial spine Pubic tubercle Obturator foramen Ischium Symphyseal surface Ischial ramus Inferior pubic ramus Medial view, right hip bone The Hip https://doctorlib.info/medical/anatomy/26.html Ligaments of the Hip Joint Iliofemoral Ishiofemoral Pubofemoral Capsular Labrum Transverse acetabular Ligament of head of femur/Ligamentum teres https://doctorlib.info/medical/anatomy/26.html Ligaments of the Hip Joint https://doctorlib.info/medical/anatomy/26.html Ligaments of the Hip Joint https://doctorlib.info/medical/anatomy/26.html  Arteries to the Pelvis Internal iliac artery and Branches Aorta Common iliac artery Internal iliac artery External iliac artery Anterior view Pearson: Figure 20.14a Arterial supply to the pelvis. Figure 20.23a, b, and c Veins of the right lower limb and pelvis. Common iliac vein Internal iliac vein External iliac vein Inguinal ligament Femoral vein Great saphenous vein (superficial) ** Great saphenous Great saphenous vein vein Popliteal vein Popliteal vein Small Anterior saphenous tibial vein vein Fibular vein Fibular vein Small Small saphenous saphenous vein (superficial) Anterior vein (superficial) tibial vein Posterior Dorsalis tibial vein pedis vein Plantar Dorsal veins venous arch Deep plantar arch Dorsal Digital veins metatarsal veins Superficial veins of leg, Posterior view of leg posterior view Anterior view https://doctorlib.info/medical/anatomy/26.html Figure 14.12 The lumbar plexus. Kidney L3 vertebra Ureter Lateral femoral cutaneous nerve Iliohypogastric Psoas major Ilioinguinal External iliac nerve artery Femoral nerve Urinary bladder Lateral Femoral artery femoral cutaneous Nerves of the lumbar plexus, anterior view Obturator Ventral Anterior Ventral rami rami: femoral Anterior division cutaneous Posterior L1 division Saphenous L2 Iliohypogastric Ilioinguinal Genitofemoral L3 Lateral femoral cutaneous L4 Obturator Femoral L5 Lumbosacral trunk Ventral rami and major branches of the Distribution of the major nerves from the lumbar plexus lumbar plexus to the lower limb Figure 14.14 The sacral plexus. Gluteus maximus Piriformis Common fibular nerve Tibial nerve Superior gluteal Inferior gluteal Sciatic nerve nerve Pudendal nerve Dissection of the gluteal region, Sciatic posterior view Posterior Ventral rami femoral Ventral Anterior division rami: cutaneous Posterior nerve L4 division Common Superior fibular gluteal L5 Tibial Lumbosacral trunk Sural (cut) Inferior gluteal S1 Deep fibular Common fibular S2 Superficial Tibial fibular S3 Posterior femoral cutaneous S4 Plantar branches Pudendal S5 Sciatic Co1 Ventral rami and major branches of the Distribution of the major nerves from sacral plexus, anterior view the sacral plexus to the lower limb, posterior view Figure 14.13 Innervation of the Lower Limb (1 of 2) Figure 14.13 Innervation of the Lower Limb (2 of 2) https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html  Pathologies of the Hip and Thigh Angle of Inclination Biochemically favorable position for walking Abnormal angles increase stress on hip joint and impact gait https://www.physio-pedia.com/Femur Pathologies of the Hip and Thigh Vitamin D/Calcium deficiency Rickets - children Osteomalacia - adults https://en.wikipedia.org/wiki/Rickets  Pathologies of the Hip and Thigh Hip fracture due to osteoporosis in elderly; the fracture causes the person to fall https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=8 5&ContentID=P08957 https://www.pinterest.com/pin/522699100497422748/  Classific Description Notes ation 1 Nondisplaced 2A 2 part, involves Seen in osteoporotic patellofemoral patients articular surface 2B Comminuted, Seen in osteoporotic involves patients patellofemoral articular surface 3A Medial condyle, Involves extending into the patellofemoral intercondylar notch articular surface, but not the femorotibial articular surface 3B Lateral condyle, Involves extending into the patellofemoral intercondylar notch articular surface, but not the femorotibial articular surface 3C Both condyles, Involves extending into the patellofemoral intercondylar notch articular surface, but not the femorotibial https://faculty.washington.edu/jeff8rob/trauma-radiology-reference-resource/11- articular surface lower-extremity/seinsheimer-classification-of-femoral-condylar-fractures/ 4A Medial condyle, extending to the femorotibial articular surface 4B Lateral condyle, extending to the femorotibial articular What is unique about this patient?  Pathologies of the Hip and Thigh Congenital dislocation of the hip: Common birth defect, more in female infants. Either the acetabulum fails to form completely, or the ligaments of the hip joint are loose. Treatment: splint or diaper, or harness of straps to hold femur in its proper position https://www.eugenepeds.com/medical-illustrations/hip-dysplasia/attachment/medical-illustration-hip-dysplasia/ Arteries of the Hip https://doctorlib.info/medical/anatomy/26.html  Anterior Compartment Muscles of the Thigh Primarily extensors of the leg at the knee Sartorius and rectus femoris secondarily flex the thigh at the hip All innervate by the femoral nerve Blood supplied by the femoral artery https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html Medial Compartment Muscles of the Thigh Primarily adductors of the thigh at the hip Most can secondarily flex and/or rotate the thigh Most are innervated by the obturator nerve Blood supplied by the obturator and deep femoral arteries https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html Hunter’s (adductor, subsartorial) Canal Borders: Anterior – Sartorius Lateral – Vastus medialis Posterior – Adductors longus and magnus Contents: Femoral artery and vein Branches of femoral nerve Clinical Significance: Administration of sensory anesthesia for procedures to the distal thigh, femur, knee, and leg on the medial side Sartorius and femoral artery landmarks to locate the saphenous nerve https://en.wikipedia.org/wiki/Adductor_canal  Posterior Muscles of the Thigh Gluteal Region Major extensor of the thigh Medial and lateral rotation, and abduction Gluteus medius is a common IM injection site in the adlt Medial View Lateral View https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html Posterior Muscles of the Thigh Hamstrings Biceps femoris, Semitendinosus, Semimembranosus, and Adductor magnus All innervated by tibial branch of sciatic nerve Characteristics Originate from ischial tuberosity Innervated by tibial nerve Flexors (strong) of the knee joint Extensors (weak) of hip joint Insert around bones of the knee joint https://doctorlib.info/medical/anatomy/26.html https://doctorlib.info/medical/anatomy/26.html Posterior Femoral Region Division of sciatic nerve Common fibular and tibial nerves Perforating vessels (artery and vein) Anterior - Femoral Triangle Borders: Sartorius laterally; Adductor longus medially; and the Ilioinguinal ligament superiorly. Floor: iliopsoas, pectineus, and adductor longus Contents: Lateral femoral cutaneous nerve Femoral nerve Structures inside the femoral sheath Contents within the Femoral Sheath: Femoral artery Genitofemoral nerve Femoral vein Lymph nodes and areolar tissue (femoral canal) Rosenmuller node (drain the glans penis and clitoris) Femoral hernia: painful, more in female, below and lateral to pubic tubercle https://web.duke.edu/anatomy/Lab14/Lab14.html Femoral Hernia http://www.laparoscopyhospital.com/femoral-hernia.html&docid Pearson: Figure 8-10a The tibia and fibula of the right leg. Intercondylar eminence Lateral condyle Medial Head condyle Superior tibiofibular Tibial joint tuberosity Fibula sometimes used for bone grafting Mid-shaft fractures of Interosseous membrane Lateral condyle tibia + fibula are common distal Anterior border Tibial tuberosity fractures in Skiers Fibula Tibia Anterior view, proximal tibia Inferior tibiofibular joint Medial malleolus Lateral malleolus Inferior articular surface Anterior view Pearson: Figure 8-10b The tibia and fibula of the right leg. Articular surface of medial condyle Articular surface of lateral condyle Medial condyle Head of fibula Interosseous Lateral membrane condyle Fibular articular facet Line for Tibia Fibula soleus muscle Posterior view, proximal tibia Fibular notch Medial malleolus Lateral malleolus Inferior articular surface Posterior view https://doctorlib.info/medical/anatomy/27.html  Patella Sesamoid bone Embedded in the tendon that secures the quadriceps muscles Protects the knee anteriorly Improves leverage of the thigh muscles across the knee https://doctorlib.info/medical/anatomy/27.html https://doctorlib.info/medical/anatomy/27.html https://doctorlib.info/medical/anatomy/27.html https://doctorlib.info/medical/anatomy/27.html https://doctorlib.info/medical/anatomy/27.html Popliteal Fossa Diamond Shape Inferiorly Gastrocnemius Superiorly Semitendinosus and semimembranosus (medial) Biceps femoris (lateral) Floor is composed of: Popliteal surface of femur, knee joint and upper tibia, oblique popliteal ligament, and popliteal muscle with its covering fascia Content of Popliteal Fossa: Popliteal artery Popliteal vein Tibial nerve Common peroneal nerve https://boneandspine.com/popliteal-fossa-anatomy/ Genicular arteries and veins  Arteries of the Leg Lateral and medial superior genicular arteries Lateral and medial inferior genicular arteries Medial (middle) genicular artery (piercing the oblique popliteal ligament to reach inside the knee joint) Anterior tibial artery Posterior tibial artery Fibular artery Dorsalis pedis artery https://web.duke.edu/anatomy/Lab14/Lab14.html Muscles of the Leg https://doctorlib.info/medical/anatomy/26.html  Posterior Compartment Leg Muscles https://doctorlib.info/medical/anatomy/26.html Can be divided up as superficial or deep flexors of the foot at the ankle and flexors of the toes All innervated by the tibial nerve Blood supplied by the posterior tibial artery https://doctorlib.info/medical/anatomy/26.html Anterior Compartment Muscles Extensors of the foot at the ankle and extensors of the toes Innervated by the deep fibular nerve Blood supplied by the anterior tibial artery https://doctorlib.info/medical/anatomy/26.html Lateral Compartment Muscles of the Leg Eversion of the foot, with weak plantarflexion of the ankle Innervated by the superficial fibular nerve Blood supplied by the fibular artery https://doctorlib.info/medical/anatomy/26.html  Inflammation of the muscle, tendon, and bone tissue along the distal two thirds of the tibial shaft. Primary cause is due to repetitive pulling of the tibialis posterior tendon usually during running. Quickly increasing workout intensity, improper footwear, or improper movement (excessive pronation)  Exertional Compartment Syndrome Unlike shin splints, the pain felt during exercise subsides after the activity causing it is stopped. In addition, there is no pain caused during palpation. Treatment is to significantly modify or cease causative activity; surgery via fascial release Compartment Syndrome: Trauma and Disease  Common iliac artery Arteries of the Leg Internal iliac artery Superior gluteal artery When the Anterior tibial artery passes beneath External iliac artery the superior extensor retinaculum, it is called **Femoral artery dorsal artery of the foot or Dorsalis Pedis Deep artery of thigh Lateral circumflex artery femoral artery Together, the lateral tarsal and dorsalis pedis Descending branch make the arcuate artery giving rise to the Medial circumflex femoral artery metatarsal and dorsal digital arteries Obturator artery Dorsalis pedis gives a deep branch to join the Adductor hiatus plantar arch **Popliteal artery Genicular artery Anterior tibial artery Posterior tibial artery Fibular artery Dorsalis pedis artery Arcuate artery Dorsal metatarsal arteries Arteries of the Leg Posterior tibial artery in the plantar region gives the medial and lateral plantar arteries Lateral plantar artery makes most part of the Popliteal artery** plantar arch which give rise to plantar metatarsal arteries and proper plantar digital arteries Anterior tibial artery The dorsal and plantar arches are connected via perforating branches. Posterior tibial Fibular artery artery Pulsation of Dorsalis pedis artery may be lost in some peripheral vascular diseases such as Lateral plantar Burger’s disease or also in diabetes mellitus artery Dorsalis pedis artery (from top of foot) Medial plantar Occlusion of blood vessels lead to gangrene and artery Plantar arch even auto-amputation of the first toe Posterior view of leg Pearson: Figure 20.15b Arteries of the right pelvis and lower limb. Figure 20.23a, b, and c Veins of the right lower limb and pelvis. Common iliac vein Internal iliac vein External iliac vein Inguinal ligament Femoral vein Great saphenous vein (superficial) ** Great saphenous Great saphenous vein vein Popliteal vein Popliteal vein Small Anterior saphenous tibial vein vein Fibular vein Fibular vein Small Small saphenous saphenous vein (superficial) Anterior vein (superficial) tibial vein Posterior Dorsalis tibial vein pedis vein Plantar Dorsal veins venous arch Deep plantar arch Dorsal Digital veins metatarsal veins Superficial veins of leg, Posterior view of leg posterior view Anterior view Pearson: Figure 8-11a Bones of the right foot. Phalanges Distal Middle Proximal I II III Medial Metatarsals cuneiform IV V Intermediate cuneiform Lateral cuneiform Navicular Cuboid Tarsals Talus Trochlea of talus Calcaneus Superior view Pearson: Figure 8-11b Bones of the right foot. Talus Medial Intermediate malleolar cuneiform Navicular facet First metatarsal Medial Calcaneus cuneiform Calcaneal Medial view tuberosity Pearson: Figure 8-11c Bones of the right foot. Lateral Navicular Intermediate cuneiform malleolar facet Lateral cuneiform Talus Calcaneus Cuboid Fifth metatarsal Lateral view Metatarsal stress fractures: As a result of repetitive stress on foot. 2nd and 3rd metatarsals are mostly affected Treatment: rest and wearing stiff or well cushioned shoes Joints of the Ankle and Foot https://doctorlib.info/medical/anatomy/28.html Ligaments of the Ankle and Foot https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://www.floridaortho.com/specialties/foot-ankle-lower-leg/ankle-fractures-broken-ankle/ https://radiologyassistant.nl/musculoskeletal/ankle/weber-and-lauge-hansen- classification Tendon Sheaths and Retinacula of the Ankle Synovial sheaths provide protection and lubrication for muscle tendons passing from the leg to the foot Flexor retinaculum: plantarflexor tendons Extensor retinaculum: dorsiflexor tendons Fibular retinaculum: Fibularis tendons of the lateral compartment https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html https://doctorlib.info/medical/anatomy/28.html