Lower Limb Anatomy PDF

Anatomy of Lower Limb Limb skeleton Joints & Ligaments Muscles AVN Unit objectives: Know the skeleton – bones and bone features Pelvic bones, femur, tibia, fibula, tarsals, metatarsals, phalanges Be able to identify the muscles and know the muscle facts (origin, insertion, actions...

Anatomy of Lower Limb Limb skeleton Joints & Ligaments Muscles AVN Unit objectives: Know the skeleton – bones and bone features Pelvic bones, femur, tibia, fibula, tarsals, metatarsals, phalanges Be able to identify the muscles and know the muscle facts (origin, insertion, actions and innervation) Know the arteries and veins of lower limb Trunk Skeleton: Review axial skeleton vertebrae, ribs & sternum appendicular skeleton Pelvis = bones that connect vertebral column to lower limb  L4 L5 Review Medial view Lateral view auricular surface Review Pelvic ligaments Greater sciatic foramen Sacrospinous obturator ligament foramen Sacrotuberous ligament lateral view Lesser sciatic foramen Review Pelvic ligaments Which view? Posterior Anterior sacroiliac sacroiliac ligament ligament Inguinal ligament Sacrotuberous Sacrospinous ligament ligament Review Male or female? Which view Pelvic bone Lower Limb Skeleton Femur Fibula Tibia Tarsals Metatarsals Phalanges posterior view of femur  greater trochanter neck head of femur lesser trochanter gluteal tuberosity  posterior view linea aspera Adductor tubercle medial epicondyle lateral epicondyle medial condyle lateral condyle lateral condyle medial condyle tibial tuberosity head of fibula interosseous membrane anterior view lateral malleolus medial malleolus Tarsals, metatarsals and phalanges phalanges cuneiforms medial intermediate metatarsals lateral M I L cuboid navicular talus calcaneus  Knee joint (Tibiofemoral joint) anterior posterior thigh femur femur leg tibia tibia fibula fibula  lateral femoral meniscus condyles Shock absorbers medial meniscus tibia lateral medial anterior view flexed posterior anterior femoral posterior cruciate condyles cruciate ligament ligament lateral medial meniscus meniscus tibia medial lateral collateral collateral ligament ligament anterior view flexed  Functions of collateral and cruciate ligaments? femoral condyles ACL- prevents tibia moving * too much anteriorly * Lateral-fibular Medial- tibial tibia PCL- prevents tibia moving too much posterioly https://youtu.be/CmoYxVx0kyM  medial view extended flexed Lower Limb muscles  LIMB MUSCLES develop from somites composed of hypaxial muscles innervated by ventral rami of spinal nerves  Joints of the lower limb Hip joint (Coxal joint) – ball & socket; flexion, extension, aDduction, aBduction, medial & lateral otations Knee joint (tibiofemoral joint) – hinge; flexion & extension Ankle joint (talocrural joint; tibia, fibula & talus) – hinge; dorsiflexion & plantar flexion Intertarsal joint (Subtalar joint; talus & calcaneus) – plane; eversion & inversion Hip (Ball & Socket joint) Actions Flexion & Extension Adduction & ABduction, Medial rotation & Lateral rotation  Knee (Hinge joint) Actions Flexion and Extension Muscle crosses the hip Muscle crosses the hip posteriorly anteriorly Flex the thigh Extend the thigh Cross the knee Cross the knee posteriorly anteriorly Flex the leg Extend the leg Muscle crosses the hip superiorly Muscle crosses the hip lateral to medial ABduct the thigh ADduct the thigh Medially rotate Laterally rotate the thigh the thigh When a muscle crosses the hip joint obliquely or transversely, i.e., other than in the sagittal plane, then there will likely be rotation of the thigh. Hip and Thigh muscles iliopsoas group (2) commonalities insert on lesser trochanter flex the thigh (hip joint) psoas major m. iliacus m. quadriceps group (5) anterior view commonalities nsert on tibial tuberosity (4) EXTEND the knee (4) femoral n.  quadriceps femoris (4/5) rectus femoris m vastus lateralis m vastus medialis m vastus intermedius m  Sartorius Cross the knee Cross the knee anteriorly posteriorly Extend the leg Flex the leg “the tailor’s muscle” Gluteal group (4) Gluteus maximus Gluteus medius Gluteus minimus Tensor fasciae latae commonalities ORIGIN from ilium aBduction of hip (3/4) extension of hip superior & inferior gluteal nn  posterior view O gluteus O medius gluteus minimus O I I gluteus I maximus  gluteus gluteus gluteus maximus medius minimus m. m m Superiorly Superiorly Posteriorly Anteriorly & Obliquely & Posteriorly & Obliquely? Obliquely ACTIONS? lateral view of right hip  O Iliac crest & Ant.Sup.Iliac Spine lateral view tensor fasciae latae m I iliotibial tract Superiorly Anteriorly ACTIONS? Gluteal region  adductor group (5) Pectineus ADductor longus, brevis, magnus Gracilis commonalities origin from pubis & ischium insert on linea aspera adduction of hip obturator n anterior view - superficial adduct pectineus m adductor longus m gracilis m  adducto adductor r brevis m magnus m  Pectineus Adductor longus Adductor brevis  Pectineus Adductor longus Adductor brevis Lateral to medial Anteriorly Action? Action? Obliquely Action? anterior view lateral view gracilis m What joint is crossed? Where/how is the joint crossed?  Gracilis Anteriorly Lateral to medial Action? Action? lateral view anterior view Gracilis Action? medial view adducto r magnus m adductor hiatus  Adductor magnus Lateral to medial Action? Posteriorly Action? anterior view lateral view  Adductor magnus adductor   plus hamstring Anterior view Posterior view P AB M AL anterior posterior anterior  Hamstring group Lateral hamstring biceps femoris m Medial hamstrings semimembranosus m semitendinosus m posterior view  hamstring group (3) commonalities rigin from ischial tuberosity Flex the knee & Extend the hip tibial n. posterior view  Lateral hamstring iceps femoris m What joints are crossed? Hip & Knee Where/how are the joints crossed? ** Hip Knee Posteriorly Posteriorly Action? Action? Medial hamstrings semimembranosus m semitendinosus m What joints are crossed? Hip & Knee Where/how are the joints crossed? Hip Knee Posteriorly Posteriorly Action? Action? Thigh muscles- compartments anterior medial posterior Quadriceps Anterior thigh Adductors Medial thigh Hamstrings Posterior thigh Lower Limb- Leg muscles and neurovasculature 3 compartments of the leg: posterior, anterior & lateral dorsiflexors plantarflexors  Superficial Layer posterior compartment (3) commonalities innervated by tibial nerve insert onto posterior calcaneus via Achilles tendon plantarflex foot (ankle) plantarflexion  superficial layer (3) of POSTERIOR compartment gastrocnemius m plantaris m soleus m Where/how are the joints crossed? What does the action have to be?  Deep Layer posterior compartment (3) commonalities innervated by tibial nerve tendons pass posterior to medial malleolus plantarflex foot (ankle) flex toes (2) Tibialis posterior Flexor digitorum longus Flexor hallucis longus medial malleolus  tibialis tibialis  posterior  posterior flexor flexor digitorum  flexor digitorum  longus  hallucis longus  flexor longus hallucis longus Hallux   Any digit flexion by Tibialis posterior? Flex toes 2 to 5 Flexor digitorum longus Flexor hallucis longus Flex the hallux  Flexor digitorum longus, flexor hallucis longus, tibialis posterior medial view inversion subtalar joint medially medial malleolus Plantarflexion medial malleolus Tibialis posterior m Flexor Digitorum longus m Flexor Hallucis longus m medial view Muscles of the POSTERIOR compartment toe flexors knee flexors D, H G, P plantarflexion of foot inversion of foot T, D, H, T, D, H G, S, P  Lateral compartment: FIBULARIS GROUP (2) commonalities originate from lateral surface of fibula pass posterior to the lateral malleolus plantarflex foot (ankle) evert foot (ankle) innervated by superficial fibular nerve  fibularis longus fibularis brevis fibularis longus tendon plantar view anterior view lateral view  fibularis longus and fibularis brevis eversion lateral view subtalar joint laterally Where/how is the joint crossed? What does the action have to be? Plantarflexion eversion inversion lateral medial malleolus Plantar flexion  Anterior compartment ANTERIOR TIBIAL GROUP (4) commonalities Insertion tendons located on dorsal foot (do not pass behind either malleolus) dorsiflex foot (ankle) extend the toes (2) innervated by deep fibular nerve  extensor tibialis digitorum  anterior TA * longus extensor hallucis  longus EDL *  fibularis EHL * tertius FT *     Extensor Tibialis anterior Retinaculum Fibularis tertius EHL EDL  Where/how are the joints crossed? What does the action have to be? extensor extensor digitorum hallucis longus longus Extend toes  Where/how is joint crossed? What does the action have to be? Dorsiflexion fibularis tibialis tertius anterior extensor extensor digitorum hallucis longus longus Tibialis anterior inversion medial view subtalar joint medially Fibularis tertius lateral view eversion subtalar joint laterally  Anterior Compartment Muscle Actions extension of toes EDL dorsiflexion EHL eversion inversion TA EDL FT TA EHL FT  Preview of Lower Lumbar Neurovasculature nternal iliac a Superior gluteal a Inferior gluteal a Obturator a External iliac a Femoral a Deep femoral a Popliteal a Anterior tibial a Dorsalis pedis a Superior gluteal n Posterior tibial a Inferior gluteal n Fibular a Obturator n Femoral n Sciatic n – Tibial n, Common fibular n, Superficial & Deep fibular n Lower limb- Blood supply and drainage  Abdominal aorta Common iliac artery Internal iliac artery External iliac artery  Superior gluteal artery P emerges superior to piriformis m Inferior gluteal artery emerges inferior to piriformis m both are branches of internal iliac artery External iliac artery deep femoral artery femoral artery Adductor hiatus Femoral triangle popliteal fossa (posterior knee) popliteal artery popliteal vein popliteal artery arterial supply to leg and foot posterior tibial fibular artery artery deep to deep to soleus flexor hallucis longus anterior tibial artery deep to tibialis anterior m Dorsalis pedis artery Sites of palpation for lower limb pulses Femoral Popliteal pulse pulse Dorsalis pedis Posterior tibial pulse pulse Deep venous drainage of the lower limb Deep veins have the same pattern and naming as the arteries Superficial venous drainage of the lower limb great small saphenous v saphenous v lateral foot medial foot  drains deep into popliteal vein ascends on posterior calf small saphenous v begins on lateral foot  drains deep into femoral vein just distal to inguinal ligament used in coronary bypass surgery great saphenous v. ascends along medial leg & medial thigh begins on medial foot Superficial veins drain into deep veins Varicose vein  Lower limb Motor nerves All lower limb muscle is hypaxial. Therefore, somatic motor innervation of lower limb muscle is by ventral rami. Nerves of the lumbosacral plexus: inferior and superior gluteal nerves obturator nerve femoral nerve sciatic nerve tibial nerve common fibular nerve Deep fibular nerve Superficial fibular nerve  Superior gluteal n. p Inferior gluteal n. sciatic nerve  obturator n. look for it deep to the adductor longus muscle Obturator a/v are in the same place femoral nerve  sciatic nerve deep to gluteus maximus m & hamstring muscles tibial common fibular divides in popliteal fossa  tibial nerve deep to gastrocnemius and soleus mm superficial to tibialis posterior m tibial nerve popliteal fossa common fibular nerve  Common clinical problems of the somatic nerve supply to the lower limb Sciatica – a symptom Causes of sciatica: Disc herniation Lumbar spinal stenosis “Piriformis Syndrome”  Common clinical problems of the somatic nerve supply to the lower limb Injury to common fibular nerve “foot drop” Why is plantarflexion not affected?  Common clinical problems of the somatic nerve supply to the lower limb Injury to tibial nerve Tarsal tunnel syndrome