Anterior Thigh & Osteology PDF

The Lower Limb MBChB 1 BSP 1 29/09/2024 13:26 Dr. KimbugweG 1 Lower limb Supports body weight For locomotion Maintains balance Divided into 6 regions Gluteal Leg Femoral Ankle Knee Fo...

The Lower Limb MBChB 1 BSP 1 29/09/2024 13:26 Dr. KimbugweG 1 Lower limb Supports body weight For locomotion Maintains balance Divided into 6 regions Gluteal Leg Femoral Ankle Knee Foot 29/09/2024 13:26 Dr. KimbugweG 2  Gluteal region Thigh Knee Calf Leg Ankle Foot Sole 29/09/2024 13:26 Dr. KimbugweG 3 Movements 29/09/2024 13:26 Dr. KimbugweG 4 Movements 29/09/2024 13:26 Dr. KimbugweG 5 Osteology Lower limb bones include: Pelvic girdle Femur Tibia/fibula Tarsals Phalanges 29/09/2024 13:26 Dr. KimbugweG 6 Pelvic girdle Composed of the sacrum & both hip bones The hip bone is composed of: Ilium Ischium Pubis 29/09/2024 13:26 Dr. KimbugweG 7 29/09/2024 13:26 Dr. KimbugweG 8  Hip bone 3 bones joined by hyaline cartilage at birth Y-shaped triradiate cartilage at puberty Begin to fuse at 15-17 years Complete fusion at 20-25 years 29/09/2024 13:26 Dr. KimbugweG 9 Ilium Provides main attachment for muscles Outer aspect Gluteal lines separate the 3 muscles 29/09/2024 13:26 Dr. KimbugweG 10 Ilium Auricular surface articulates with the sacrum Inner aspect 29/09/2024 13:26 Dr. KimbugweG 11 Ischium & Pubis Outer aspect Ischium is postero-inferior 29/09/2024 13:26 Dr. KimbugweG 12 Ischium & Pubis Inner aspect Obturator foramen Closed by obturator membrane Pubis is anteromedial Has an obturator canal Obturator nerve & vessels pass thru the canal 29/09/2024 13:26 Dr. KimbugweG 13 Acetabulum Cup shaped cavity on the lateral hip bone Articulates with the head of the femur to form the hip joint Inferior margin is incomplete forming an Acetabular notch Fossa is covered by articular cartilage 29/09/2024 13:26 Dr. KimbugweG 14 Femur The longest & heaviest bone in the bone ¼ of a person’s height Has a shaft, proximal & distal end Proximal end: Head Neck 2 trochanters 29/09/2024 13:26 Dr. KimbugweG 15 Femur Shaft Provides most muscle attachment Affected by loss of calcium like in rickets 29/09/2024 13:26 Dr. KimbugweG 16 Correlates Fractures of the hip bone (pelvic fractures) Coxa Vara & coxa Vulga Changes in the angle of inclination Femoral fractures Common at the neck (narrowest & weakest) 29/09/2024 13:26 Dr. KimbugweG 17 Fascial compartments of the thigh Superficial fascia Is deep to the skin The Thigh Contains: Fat Superficial vessels Cutaneous nerves Superficial lymphatics & nodes 29/09/2024 13:26 Dr. KimbugweG 18 Fascial compartments of the thigh Deep fascia of thigh Also called fascia Lata Surrounds all thigh muscles An elastic stocking Separates groups of muscles 29/09/2024 13:26 Dr. KimbugweG 19  Thigh muscle compartments 29/09/2024 13:26 Dr. KimbugweG 20 Attachments Inguinal ligament, pubic arch, tubercle & body. Iliac crest Sacrum, coccyx & ischiopubic ramus Deep fascia of the leg & bones Thickened into an iliotibial tract laterally Extends from iliac tubercle to the anterolateral (Gerdy) tubercle of the tibia An aponeurosis of tensor fasciae latae & gluteus maximus muscles 29/09/2024 13:26 Dr. KimbugweG 21 29/09/2024 13:26 Dr. KimbugweG 22 Fascia Lata Saphenous opening (fossa ovalis) A gap in the fascia inferior to the medial inguinal ligament 4cm inferolateral to the pubic tubercle Filled by cribriform fascia Efferent lymphatic vessels from superficial inguinal nodes Great saphenous vein & its tributaries These pass through the opening 29/09/2024 13:26 Dr. KimbugweG 23 29/09/2024 13:26 Dr. KimbugweG 24 Forms 3 septa Fascia Lata Lateral intermuscular septum Medial intermuscular septum Posterior intermuscular septum Separates thigh muscles into 3 groups Anterior Medial Posterior Septa attach to the linea aspera of the femur 29/09/2024 13:26 Dr. KimbugweG 25 Anterior compartment Muscles are all innervated by the femoral nerve Extend the knee joint & flex the hip Medial compartment Muscles adduct the thigh Innervated by the obturator & femoral nerves Posterior compartment Muscles extend the hip & flex the knee Innervated by the sciatic nerve 29/09/2024 13:26 Dr. KimbugweG 26 Anterior Thigh Muscles Sartorius Quadriceps femoris Psoas major Iliacus Pectineus Each is innervated by the femoral nerve Flex the hip & extend the knee 29/09/2024 13:26 Dr. KimbugweG 27 Pectineus Origin: superior ramus of pubis Insertion: pectineal line of femur Action Adducts & flexes the thigh Medial rotation of the thigh Nerve: femoral +/- obturator 29/09/2024 13:26 Dr. KimbugweG 28 Sartorius Tailors muscle Origin: Anterior superior iliac spine Insertion: Medial surface of the tibia Action Abducts thigh at hip joint Laterally rotates the thigh Flexes the hip & knee joints Making a “cross-leg” position Innervation: Femoral nerve The longest muscle in the body 29/09/2024 13:26 Dr. KimbugweG 29 Quadriceps Femoris 4 headed femoral muscle origins Rectus femoris: from ASIS & ilium Vastus lateralis: from greater trochanter & lateral lip of linea aspera of femur Vastus medialis: from intertrochanteric line & medial lip of linea aspera of femur Vastus intermedius: from anterolateral shaft of femur 29/09/2024 13:26 Dr. KimbugweG 30 Quadriceps Femoris Insertion All 4 parts of quadriceps form the quadriceps tendon This inserts into the patella & from here to the tubercle of the tibia Patella is thus a sesamoid bone in the tendon of quadriceps femoris Action Extends leg at knee joint Flexes thigh & steadies hip joint 29/09/2024 13:26 Dr. KimbugweG 31 Iliopsoas Psoas Minor Origin: Sides of T12-L5 & IV discs Insertion: Pectineal line & iliopectineal eminence Psoas Major Origin: Sides & IV discs of T12-L5 & transverse processes of all lumbar vertebrae Insertion: Lesser trochanter of femur 29/09/2024 13:26 Dr. KimbugweG 32 Iliopsoas Iliacus Origin: Iliac crest & fossa, ala of sacrum Insertion: Lesser trochanter of femur Action Flexes, abducts & laterally rotates the thigh at hip joint Flexes leg at knee joint 29/09/2024 13:26 Dr. KimbugweG 33 Femoral triangle Is a fascial space in the superioanterior 1/3 of the thigh Boundaries Medially: Lateral border of the adductor longus muscle Laterally: Medial border of the sartorius muscle Superiorly: Inguinal ligament 29/09/2024 13:26 Dr. KimbugweG 34 29/09/2024 13:26 Dr. KimbugweG 35 Femoral triangle Floor Laterally Iliopsoas Medially Pectineus Roof Fascia Lata Cribriform fascia Subcutaneous tissue Skin Saphenous opening is located in the upper part of the triangle 29/09/2024 13:26 Dr. KimbugweG 36  Femoral triangle Contents From lateral to medial Femoral nerve & its branches Femoral sheath containing: Femoral artery & branches Femoral vein & tributaries Deep inguinal lymph nodes & vessels 29/09/2024 13:26 Dr. KimbugweG 37 Femoral sheath Formed by transversalis fascia & psoas fascia fusion below the inguinal ligament Encloses: Femoral artery Femoral vein Femoral canal Femoral nerve lies outside the sheath on its lateral aspect 29/09/2024 13:26 Dr. KimbugweG 38 Compartments within the femoral sheath. Proximal end (abdominal opening) of the femoral canal is the femoral ring. 29/09/2024 13:26 Dr. KimbugweG 39 Femoral canal Occupies the medial compartment of the triangle Opens into the abdominal cavity superiorly at the femoral ring Contains deep inguinal lymph nodes (gland of Cloquet) A site for herniation of a gut loop causing a femoral hernia 29/09/2024 13:26 Dr. KimbugweG 40 29/09/2024 13:26 Dr. KimbugweG 41 Nerves of anterior compartment Femoral nerve Formed from the lumbar plexus L2, L3 & L4 29/09/2024 13:26 Dr. KimbugweG 42 Nerves of anterior compartment Femoral nerve 29/09/2024 13:30 Dr. KimbugweG 43 Nerves of anterior compartment Femoral nerve Branches Muscular branches Anterior femoral cutaneous branches Lateral femoral cutaneous branches Saphenous nerve branch 29/09/2024 13:26 Dr. KimbugweG 44  Note muscular branches of femoral nerve 29/09/2024 13:26 Dr. KimbugweG 45  Note course of lateral cutaneous nerve and territory of skin it is responsible for 29/09/2024 13:26 Dr. KimbugweG 46 Saphenous nerve Travels with great saphenous vein Continues anterior to medial malleolus at the ankle joint which it innervates 29/09/2024 13:26 Dr. KimbugweG 47 29/09/2024 13:26 Dr. KimbugweG 48 Femoral artery A continuation of external iliac artery Begins at the mid inguinal ligament Branches Profunda: the chief thigh artery gives 3-4 perforating aa Circumflex humoral: supply head & neck of femur esp the medial circumflex a 29/09/2024 13:26 Dr. KimbugweG 49 Femoral vein A continuation of the popliteal vein Receives tributaries that follow the arteries Also receives the great saphenous vein Becomes external iliac vein at the inguinal ligament 29/09/2024 13:26 Dr. KimbugweG 50 Adductor canal Also Hunter or Subsartorial canal 15cm passageway in the middle thigh Extends from apex of the femoral triangle To adductor hiatus in the tendon of adductor magnus A passage for Femoral artery Femoral vein Saphenous nerve Nerve to vastus medialis 29/09/2024 13:26 Dr. KimbugweG 51 Adductor canal Boundaries Anteriorly & laterally: Vastus medialis Posteriorly: adductors longus & magnus Medially: sartorious 29/09/2024 13:26 Dr. KimbugweG 52 Correlates Compartment syndromes & Fasciotomy Femoral cutaneous nerve compression by a tight underwear just below the inguinal ligt results in paraesthesia Psoas abscess & its extension into the thigh Patellar fractures Patellar tendon reflexes Femoral tap & cannulation Femoral artery cannulation Femoral hernias 29/09/2024 13:26 Dr. KimbugweG 53