Transcript Lower Limb - Larry Frolich

Lower Limb








What is a limb?
Skeleton
Joints
Pelvis or limb girdle
Hip/Hip Muscles
Lumber and sacral
plexus—getting spinal
nerves out onto limb
Muscles—anterior
and posterior
compartments
Surface anatomy
Frolich, Human Anatomy, Lower LImb




Skeleton
(homologous
upper limb)
Muscles--ante
posterior
compartments
Nerves--sciati
femoral
Surface anato
What is a limb?

Ventral somatic outgrowth of
outer tube





Bones (made of bony tissue,
cartilage, and other tissues)
Joints
Muscles
Nerves (with motor neurons to
muscles, sensory neurons to
skin, proprioceptors)
No viscera--all innervation is
somatic (motor or sensory)
from ventral ramus of spinal
nerve (except autonomics to
blood vessels)
Frolich, Human Anatomy, Lower LImb
Upper Limb
Lower





Frolich, Human Anatomy, Lower LImb
Pelvis
Scapula
Humerus
Femur
Radius,
Tibia,
fibula
ulna
Carpals
Tarsals
Digits
 Metatarsals
Metacarpals
 Phalanges
Upper Limb





Frolich, Human Anatomy, Lower LImb
Scapula
Humerus
Radius, ulna
Carpals
Digits
 Metacarpals
 Phalanges
Frolich, Human Anatomy, Lower LImb
Tibia/fibula
Tibia--big toe side
 Fibula--little toe side
(no pronation/supination)

Frolich, Human Anatomy, Lower LImb
Ankle


Talus--forms ankle
joint
Calcaneus--forms
heel
Frolich, Human Anatomy, Lower LImb
Foot

Function:



Support weight
Act as lever when walking
Tarsals

Talus = ankle
• Between tibia + fibula
• Articulates w/both

Calcaneus = heel
• Attachment for Calcaneal
tendon
• Carries talus

Metatarsals


Phalanges

Frolich, Human Anatomy, Lower LImb
Homologous to metacarpals
Smaller, less nimble
Joints of Lower Limb

Hip (femur +
acetabulum)




Knee (femur + patella)




Plane
Gliding of patella
Synovial
Knee (femur + tibia)


Frolich, Human Anatomy, Lower LImb
Ball + socket
Multiaxial
Synovial
Hinge
Biaxial
Joints of Lower Limb

Proximal Tibia + Fibula




Distal Tibia + Fibula





pg 218
Slight “give”
Fibrous
Ankle (Tibia/Fibula + Talus)

Frolich, Human Anatomy, Lower LImb
Plane
Gliding
Synovial
Hinge
Uniaxial
Synovial
Lower Limb Movements

Hip



Bending on posterior
side is flexion (except
hip)
Bending on anterior
sided is extension
(except hip)



Knee



Dorsiflexion/plantarflexion
Inversion/eversion
Toes

Frolich, Human Anatomy, Lower LImb
Flexion/extension
Ankle


Flexion/extension
Abduction/adduction
Lateral/medial rotation
Flexion/extension
Pelvic tilt and a reverse lumbar curve
(or how we got to be upright)

Bowl concept
pelvis spills forward
 Hernia
 “beer belly”
 In human minor pelvis is
behind (posterior) to guts
and abdominal cavity


Compare human pelvic
position with quadruped
(cat for instance)
Frolich, Human Anatomy, Lower LImb
Human pelvis still
has quadruped
orientation
Frolich, Human Anatomy, Lower LImb
Bony structure of the pelvis
MAIN STRUCTURES
 Hip bone (innominate,
os coxae)--fusion of






Ilium (“hips”)
Ischium (“rear”)
Pubis (anterior midline)
Sacrum and coccyx
Acetabulum
Femur--head, neck,
greater trochanter
Frolich, Human Anatomy, Lower LImb
HOLES
 False and true pelvis
(major, minor pelvis)
 Pelvic inlet, pelvic outlet
 Sacrotuberous ligament
 Sacrospinous ligament
 Greater, lesser sciatic
foramen
 Obturator foramen
Frolich, Human Anatomy, Lower LImb
Female






Cavity is broad, shallow

Pelvic inlet oval + outlet round 
Bones are lighter, thinner

Pubic angle larger

Coccyx more flexible, straighter 
Ischial tuberosities shorter, more 
everted
Frolich, Human Anatomy, Lower LImb
Male
Cavity is narrow, deep
Smaller inlet + outlet
Bones heavier, thicker
Pubic angle more acute
Coccyx less flexible, more curved
Ischial tuberosities longer, face
more medially
Posterior and
lateral hip

Gluts (gluteal nn.)



Lateral rotators (spinal nn.)

Frolich, Human Anatomy, Lower LImb
Maximus—extensor of thigh
Medius--pelvic tilt (relative to
insertion with foot planted)
Piriformis syndrome
Anterior Hip

Iliopsoas
iliacus
 psoas


Quadratus
lumborum
Frolich, Human Anatomy, Lower LImb
Lumbar and
sacral plexus
Mr. Bill is happy—so
easy
 Lumbar plexus forms
femoral n.—anterior
 Sacral plexus forms
sciatic n.--posterior

Femoral n.
Sciatic n.
Frolich, Human Anatomy, Lower LImb

With leg out to
side like
quadruped,
lumbar-anterior,
sacral-posterior
makes sense

Lumbar plexus
(femoral nerve)
Frolich, Human Anatomy, Lower LImb
Sacral plexus
(sciatic nerve)
Dermatomes show twisting of
leg during development
Dorsal becomes anterior:
thus “dorsiflexion” and
extension in anterior
compartment (unlike upper
limb)
Ventral becomes posterior:
thus flexion is in posterior
compartment (unlike upper
limb)
Frolich, Human Anatomy, Lower LImb
Anterior/Posterior compartments
ANTERIOR
POSTERIOR
COMPARTMENT COMPARTMENT
MOVEMENT
Extension
Flexion
MUSCLES
Quads
Shin
Hamstrings
Gastrocs
NERVES
Femoral n.
(lumbar plexus)
Sciatic n.
(sacral plexus)
Frolich, Human Anatomy, Lower LImb
Thigh movements by
compartment
Frolich, Human Anatomy, Lower LImb
Anterior thigh (femoral n.)


Sartorius (Tailor’s
muscle)
Quads (four)


Rectus femoris
(crosses hip)
3 vastus mm.
(vast--big)
Frolich, Human Anatomy, Lower LImb
Posterior thigh (sciatic n.)

Hamstrings
Biceps femoris
 Semimembranous
 Semitendinous

Frolich, Human Anatomy, Lower LImb
Medial thigh (obturator n.)

Adductor muscles


Gracilis
Adductor
• Magnus
• Longus
• brevis
Frolich, Human Anatomy, Lower LImb
Leg movements by
compartment (in leg all nn are branches of sciatic)
Frolich, Human Anatomy, Lower LImb
Anterior Leg (deep fibular n.)

Extensors (dorsiflexors)




Fibularis (peroneus)
longus
Extensor digitorum
longus
Extensor hallicus longus
Tibialis anteriorus
Frolich, Human Anatomy, Lower LImb
Lateral Leg (superficial fibular n.)

Frolich, Human Anatomy, Lower LImb
Fibularis
brevis/longus
Posterior Leg (tibial n.)

Flexors
(plantarflexors)



Frolich, Human Anatomy, Lower LImb
Gastrocs and
soleus
Flexor digitorum
longus
Flexor hallucus
longus
Human gait
Humans only large
mammal marathoners,
ultra-runners
 Prehistoric cultures
hunted by exhausting
large prey
 Bipedalism very efficient
energetically
 Gastroc-Achilles spring
 One other large mammal
more efficient—also
bipedal
Frolich, Human Anatomy, Lower LImb

Intrinsics of foot
Frolich, Human Anatomy, Lower LImb
pg 792
Surface Anatomy:
Anterior Thigh + Leg

Palpate



Femoral Triangle




pg 785
Frolich, Human Anatomy, Lower LImb
Patella
Condyles of femur
Sartorius (lateral)
Adductor longus (medial)
Inguinal ligament
(superior)
Femoral a + v, lymph
nodes
Surface Anatomy: Posterior Leg

Popliteal fossa


Boundaries




pg 793
Frolich, Human Anatomy, Lower LImb
Biceps femoris (sup-lat)
Semitendinosis +
semimembranosis (supmed)
Gastrocnemius heads (inf)
Contents


Diamond-shape fossa
behind knee
Popliteal a + v
Calcaneal (Achilles)
tendon
Blood
supply to
lower limb

Internal Iliac




Cranial + Caudal Gluteals= gluteals
Internal Pudendal = perineum, external
genitalia
Obturator = adductor muscles
External Iliac

Femoral = lower limb
• Deep femoral = adductors, hamstrings,
quadriceps

Popliteal (continuation of femoral)
• Geniculars = knee
• Anterior Tibial = ant. leg muscles, further
branches to feet
• Posterior Tibial = flexor muscles, plantar
arch, branches to toes
Frolich, Human Anatomy, Lower LImb