Lower Limb Anatomy Lecture Notes PDF - Western Sydney University

INTRODUCTION TO LOWER LIMB James Dunn [email protected] LEARNING OBJECTIVES Appreciate the major functions of the lower limb and how the component structures contribute to that function Appreciate the movement of lower limb joints and their vulnerability to injury Gain familiarity with...

INTRODUCTION TO LOWER LIMB James Dunn [email protected] LEARNING OBJECTIVES Appreciate the major functions of the lower limb and how the component structures contribute to that function Appreciate the movement of lower limb joints and their vulnerability to injury Gain familiarity with structures comprising the lower limb oIdentify and describe the innervation and blood supply of the lower limb oIdentify bones of the lower limb, their features and joints oRecognise the organisation of muscles in the various regions of the lower limb, and describe their functions OVERVIEW Function of the lower limb Movements of the lower limb Bones of the lower limb Muscle compartments Major blood vessels Innervation to muscle compartments Gluteal Thigh Leg Foot Moore’s Clinically Oriented Anatomy, 8th Ed. Regions of the lower limb Gluteal Thigh Leg Foot Gluteal Thigh Leg Foot Moore’s Clinically Oriented Anatomy, 8th Ed. Functions of the lower limb Locomotion Moving the body Maintain centre of gravity S2 level Within the hips Gray’s Anatomy for Students, 3rd Ed. Movements of the lower limb Gray’s Anatomy for Students, 3rd Ed. Movements of the lower limb Gray’s Anatomy for Students, 3rd Ed. The pelvic girdle Consists of the: - Innominate bone (3 bones) - Femur (proximal) Articulation of lower limb to trunk Homologous to shoulder Sacrifices mobility for much greater stability Netter’s Clinical Anatomy 3rd Ed. Landmarks of the innominate bone Netter’s Clinical Anatomy 3rd Ed. Moore’s Clinically Oriented Anatomy, 8th Ed. The femur Long bone Oblique posture Can move on most axis Articulates with: - Innominate bone - Tibia The proximal femur Netter’s Clinical Anatomy 3rd Ed. The hip joint Anterior Posterior Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Netter’s Clinical Anatomy 3rd Ed. The hip joint Articular cartilage Acetabular labrum Greater trochanter Ligament of head of femur Intertrochanteric line Transverse acetabular ligament Lesser trochanter Netter’s Clinical Anatomy 3rd Ed. The distal femur Netter’s Clinical Anatomy 3rd Ed. The proximal tibia Gray’s Anatomy for Students, 3rd Ed. The patella Netter’s Clinical Anatomy 3rd Ed. The patella The knee ACL PCL Lateral condyle Medial condyle Femorotibial joint Femoral condyles articulate with tibial plateaus (2 joints) Fibular (lateral) collateral ligament Lateral meniscus Patellofemoral joint Patella articulates with femoral trochlear groove Medial meniscus Tibial (medial) collateral ligament Transverse ligament Tibial tuberosity Netter’s Clinical Anatomy 3rd Ed. The important ligaments Anterior cruciate ligament Posteromedial aspect of lat. femoral condyle to ant. tibial eminence Posterior cruciate ligament Medial femoral condyle to post. proximal tibia Collateral ligaments Prevent lateral flexion of knee Netter’s Clinical Anatomy 3rd Ed. ACL PCL Injury of the knee ligaments Collateral Ligaments The tibia and fibula Netter’s Clinical Anatomy 3rd Ed. The foot Important bones are talus and calcaneus 7 tarsal bones 5 metatarsals 14 phalanges Netter’s Clinical Anatomy 3rd Ed. The muscles Iliac muscles Gluteal region Superficial group Deep group Thigh Anterior Posterior Medial Leg Anterior Posterior (superficial and deep) Lateral Moore’s Clinically Oriented Anatomy, 8th Ed. Iliac muscles Psoas major Iliacus Insert onto lesser trochanter as iliopsoas Thigh flexion Psoas major Iliacus Netter’s Clinical Anatomy 3rd Ed. Gluteal region - superficial Gluteus medius Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia latae Thigh extension Gluteus minimus Gluteus maximus Moore’s Clinically Oriented Anatomy, 8th Ed. Netter’s Clinical Anatomy 3rd Ed. Gluteal region - deep Piriformis Sup. & Inf. Gemellus Obturator internus Quadratus femoris Common attachment at greater trochanter Lateral thigh rotation Piriformis Sup. gemellus Obturator internus Gluteus medius Gluteus minimus Gluteus maximus Inf. gemellus Quadratus femoris Netter’s Clinical Anatomy 3rd Ed. Anterior thigh 5 muscles Sartorius* Rectus femoris Vastus group Rectus and vastus attach to patella – quadriceps tendon Knee Extension Sartorius Netter’s Clinical Anatomy 3rd Ed. Anterior thigh – the quads Rectus femoris Only quad to cross the hip Vastus medialis and lateralis easily visible Vastus intermedius sits behind rectus femoris Vastus muscles start on the posterior femur (linea aspera) Vastus lateralis Rectus femoris Vastus medialis Netter’s Clinical Anatomy 3rd Ed. Posterior thigh Hamstrings Common origin at the ischial tuberosity Biceps attach laterally Semi’s attach medially Knee flexion Help thigh extension too Semimembranosus Biceps femoris long head Semitendinosus Biceps femoris short head Netter’s Clinical Anatomy 3rd Ed. Medial thigh Adduct the thigh at the hip joint Adductor brevis, longus and magnus Pectineus Gracilis Obturator externus is actually a rotator Iliopsoas Obturator externus Adductor brevis Pectineus Vastus intermedius Vastus lateralis Adductor longus (cut) Adductor magnus Gracilis Vastus medialis Netter’s Clinical Anatomy 3rd Ed. Vastus lateralis Anterior leg Vastus medialis Patella Tibialis anterior Either named after function or location Dorsiflexion and toe extension Extensor digitorum longus Extensor hallucis longus Fibularis tertius tendon Netter’s Clinical Anatomy 3rd Ed. Lateral leg Fibularis longus 2 muscles Named either fibularis or peroneus (interchangeable) Foot eversion Fibularis brevis Tibialis anterior Extensor digitorum longus Netter’s Clinical Anatomy 3rd Ed. The posterior compartment Superficial layer Gastrocnemius Soleus Plantaris Deep layer Popliteus Flexor hallucis longus Flexor digitorum longus Tibialis posterior Netter’s Clinical Anatomy 3rd Ed. The lumbar plexus Femoral nerve - L2-4 posterior division - Anterior thigh Obturator nerve - L2-4 anterior division - Medial thigh Netter’s Clinical Anatomy 3rd Ed. Femoral nerve Travels with the femoral artery and vein Can be seen in cadavers at the femoral triangle Innervates anterior thigh Netter’s Clinical Anatomy 3rd Ed. The lumbosacral plexus L4-S3 contribute to the sciatic nerve Posterior (L4-S2) becomes common peroneal (fibular) Anterior(L4-S3) becomes tibial nerve Netter’s Clinical Anatomy 3rd Ed. Sciatic nerve Travels posteriorly down the lower limb Supplies the posterior thigh directly Will bifurcate above the knee and give off branches which innervate leg Netter’s Clinical Anatomy 3rd Ed. Tibial and fibular nerves Sciatic nerve Tibial nerve Deep fibular nerve Common fibular nerve Superficial fibular nerve Netter’s Clinical Anatomy 3rd Ed. Blood supply to the leg Aorta Common Iliac Internal Iliac Superior gluteal artery Obturator artery Inferior gluteal artery External Iliac Femoral Gray’s Anatomy for Students, 3rd Ed. Blood supply to the leg Femoral artery at femoral triangle Passes through adductor hiatus Popliteal artery in the popliteal fossa Netter’s Clinical Anatomy 3rd Ed. Blood supply to the leg Netter’s Clinical Anatomy 3rd Ed. Venous return of the leg Netter’s Clinical Anatomy 3rd Ed. Gray’s Anatomy for Students