Transcript Regional anatomy of the lower limb

Dr. Banafshe Esmaeilzade, M.S., Ph.D.
Deptartment of Anatomy
Bushehr Univ. of Medical Sciences
Organization of the Lower Limb
Limb Development
Limb Rotation
Regional anatomy of
the lower limb
Parts and regions of the lower
limb
• Gluteal region:between
iliac crest superiorly and
gluteal fold inferiorly
• Thigh:between hip and
knee
• Knee:joint between leg
and thigh
• Leg:between knee and
foot
• Ankle
• Foot
Anterior Region of Thigh
Superficial structures:
Cutaneous nerves:
Femoral branch of jenitofemoral
n.
Lateral cutaneous n. of thigh
Anterior cutaneous n. of thigh
medial cutaneous n. of thigh
ilioinguinal n.
Key dermatomes* of
the Lower Limb
 umbilicus - T10
 hip crease - L1
 great toe - L4
 5th toe - S1
*area of skin supplied by a
dorsal nerve root
Cutaneous Nerve
Innervation
of the Lower Limb
Superficial arteries:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.
Superficial veins
Superficial epigastric v.
Superficial circumflex iliac v.
Superficial External
pudendal v.
Superficial lateral femoral v.
Great saphenous v.
Superficial inguinal
lymph nodes:
Horizontal group
Vertical group
Superficial inguinal lymph
nodes
Superior group:
Lies just distal to the inguinal
ligament
Receive lymph from anterior
abdominal wall below
umbilicus, gluteal region,
perineal region, external
genital organs
Inferior group:
Lies vertical along the terminal
great saphenous v.
Receives all superficial
lymphatics of lower limb,
except for those from the
posterolateral part of calf
Efferent vessels drain into the
deep inguinal ln. or external
iliac ln.
Fascia of the Lower Limb
Gluteal Fascia
Fascia Lata
Crural Fascia
Fascial Compartments of the Thigh
anterior compartment
Fascia Lata
medial compartment
posterior compartment
Anterior compartment
Medial (adductor) compartment
Posterior compartment
Deep fascia – fascia lata
Iliotibial tract
Saphenous hiatus
falciform margin
cribriform fascia
Muscles of Hip and Thigh
• Gluteals (posterior pelvis)
– Extend thigh
– Rotate thigh
– Abducts thigh
• Anterior Compartment Thigh
– Flexes thigh at hip
– Extends leg at knee
• Medial/Adductor Compartment
– Adducts thigh
– Medially rotates thigh
• Posterior Compartment Thigh
– Extends thigh
– Flexes leg
Anterior Compartment muscles
of Thigh
• Tensor fascia lata
– O: iliac crest, A.S.I.S.
– I: iliotibial tract
– A: Flex thigh, abduct
thigh, medial rotation
of thigh
– N. : Superior Gluteal
n.
• Sartorius
-O – ASIS
-I – superior part of
medial surface of
tibia
-A – flexes, abducts,
and external
rotates thigh
-N. Femoral n.
• Iliopsoas
-O – sides of T12-L5
vertebrae, iliac crest
& fossa
-I – lesser trochanter
of femur, pectineal
line
-A – flexing the thigh
-N- Femoral n.
• Quadriceps Femoris
1) Vastus lateralis
2) Vastus medialis
3) Vastus intermedias
4) Rectus femoris
– O: femur,
– I: patellar ligament
– A: Knee extension
_ N: Femoral n.
pg 299
Rectus femoris
– O: A.I.I.S., margin
acetabulum
– I: patellar ligament
– A: Knee extension,
flexes thigh
• Vastus lateralis
-O – greater trochanter and
lateral lip of linea aspera
of femur
• Vastus medialis
-O – intertrochanteric line
and medial lip of linea
aspera of femur
• Vastus intermedius
-O – anterior and lateral
surfaces of body of femur
*Same for all 3
-I – base of patella
A – helps flex thigh
Femoral triangle
This triangle is bounded by:
superiorly; the inguinal
ligament (base)
laterally; the medial border of
sartorius
Medially; the medial border of
adductor longus
Inferiorly; the apex of the
triangle is continuous with
adductor canal.
The anterior wall is fascia lata
The posterior wall consists of
adductor longus, pectineus
and iliopsoas , from medial to
lateral side.
Contents of the
femoral triangle
1. The femoral artery and its
branches,the profunda femoris
artery,The lateral and medial
circumflex arteries,The deep
external pudendal.
2. The femoral vein and its
tributaries.
3. Three or four deep inguinal
lymph nodes lie along the
medial side of the femoral vein.
4. The femoral nerve.
5. The femoral canal.
Adductor canal
Extends from apex of femoral
triangle to adductor hiatus
Bounded by : laterally;vastus
medialis
posteriorly; adductors longus
and magmus,
anteriorly ;adductor lamina
and sartorius
Contents – saphenous nerve,
femoral a., femoral v.,
lymphatic vessels, and
loose connective tissue
The adductor hiatus is a
gap in the distal
attachment of adductor
magnus to the femur,
which permits the femoral
vessels to pass from the
adductor canal downward
into the popliteal space.
Femoral sheath
The femoral sheath is a funnelshaped sheath , derived from
transversalis fascia anteriorly
and iliac fascia posteriorly. It
surroumds the femoral
vessels and lymphatic about
2.5cm belower the inguinal
ligamemt. Its lower end
disappears at the lower
margin of the saphenous
opening where the sheath
fuses with the adventitia of
the vessels.
The femoral sheath is divided into three compartments
by two fibrous septa. The femoral artery occupies
the lateral compartment of the sheath. The femoral
vein lies the middle compartment. The medial
compartment is small, called the femoral canal.
The femoral
canal
It is about 1.3cm long , and its
upper opening is called the
femoral ring .
The boundaries of the femoral
ring are:, anteriorly; the
inguinal ligamentthe
medially; lacunar ligament;
, posteriorly; the pecten of pubis
laterally; the femoral vein,
superiorly; covered by femoral
septum.
The canal contains a little loose
fatty tissue, a small lymph
node, and some lymph
vessels.
Femoral hernia
A femoral hernia is common in women than in men
(possibly due to a wider pelvis and femoral canal ). If a
loop of intestine is forced into the femoral ring, it expands
to form a swelling in the upper part of the thigh.
Lacuna
musculorum
Bounded by: anteriorly;
lateral portion of
inguinal ligament,
posterolaterally; ilium
Medially; iliopectinal
arch
Contents: iliopsoas m,
femoral n. and lateral
femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Femoral n.
Iliopectinal arch
Lacuna vasorum
Femoral a.
Femoral v.
Femoral ring
Bounded by:
anteriorly,medial
portion of inguinal
ligament
posteromedially,
pectineal ligament
medially,lacunar
ligament ,
Posterolaterally,
iliopectinal arch
Contents:
femoral sheath,
femoral a. and v.,
genital branch of
genitofemoral n.
and lymphatic
vessels, femoral
ring
Arteries of lower limb
Femoral a.
This is the main artery of
the lower limb and is
directly continuous with
the external iliac artery
of the abdomen behind
the inguinal ligament at
the mid- inguinal point. It
becomes the popliteal
artery by passing
through the adductor
tendinous opening.
Femoral a.
Principal branch:
1. Deep femeral a.: arises from
the posterolateral surface of the
femoral artery about 4 cm below
the inguinal ligament.
2. Descending genicular a.
3. Deep external pudendal a.
4. Superficial branches:
– superficial epigastric a.
– superficial iliac circumflex a.
– external pudendal a.
Profunda femoris
Lateral circumflex artery
It arises from the profunda near its
origin and runs laterally among the
branches of the femoral nerve and
then deep to rectus femoris. Here it
divides into ascending, transverse,
and descending branches.
Medial circumflex artery
arises either from the profunda near
its origin or occasionally direct from
the femoral artery.
Four perforating arteries
Medial circumflex a.
Profunda femoral a.
Latral circumflex a.
Saphenous n.
Femoral nerve
It arises from the lumbar
plexus in the abdomen,
and enters the thigh
posterior to the inguinal
ligament and lateral to
the femoral artery. It
ends by dividing into a
number of branches 2cm
below the inguinal
ligament.
Muscular branche to:
pectineus, sartorius,
quadriceps femoris
Cutaneous nerve
branches:
(1) Anterior cutaneous
nerves of the thigh
(medial and lateral).
(2) Saphenous nerve
is the longest branch
of the femoral nerve.
It accompanies the
femoral vessels in the
adductor canal, then
accompanies the
great saphenous vein
to the medial side of
the leg and food.
Femoral vein
This is the direct
continuation of the
popliteal vein. It begins
at the adductor
tendinous opening and
accompanies the
femoral artery to the
inguinal ligament
behind which it
becomes the external
iliac vein.
The femoral vein contains
several valves.
Cutaneous
Medial compartment
Medial compartment muscles
•
•
•
•
•
Adductor longus
Adductor brevis
Adductor magnus
Pectineus
Gracilis
• Pectineus
-O - Superior ramus
of pubis
-I - Pectineal line of
femur
-A – adducts and
flexes thigh
N: Femoral,
obturator
• Adductor Brevis
– O - Inferior Pubic Ramus
– I - Pectineal Line and Linea
Aspera
– A - adducts, flexes, and
medially rotates femur
• Gracillis
– O - pubic Symphysis and
inferior pubic ramus
– I - medial surface of the tibia
– A - adducts thigh, flexes
medially and medially rotates
thigh, flexes leg
– Innervation: Obturator
nerve
• Adductor Longus
– O - med portion of the
superior pubic ramus
– I - linea aspera of femur
– A - adducts, flexes, and
medially rotates the
femur
– Innervation: Obturator
nerve
• Adductor Magnus
– O - ischiopubic ramus and
ischial tuberosity
– I - linea aspera of the femur;
the ischiocondylar part inserts
on the adductor tubercle of the
femur
– A - adducts, flexes, and
medially rotates the femur;
extends the femur
– Innervation: post div of
Obturator nerve and tibial n.
Nerve and artery
• Obturator n.
• Accessory obturator n.
• Obturator a.
• Medial circumflex a.
arises either from the profunda near
its origin or occasionally direct from
the femoral artery.
Obturator Nerve
Nerve of Medial Fascial Compartment of the Thigh
The anterior
division passes
downward in
front of the
obturator
externus.
The posterior division
pierces the obturator
externus and passes
downward behind the
adductor brevis and in
front of the adductor
magnus
Lumbar Plexus
• Femoral nerve
– Cutaneous branches
• Thigh, leg, foot (e.g. saphenous nerve)
– Motor branches
• Anterior thigh muscles (e.g. quadriceps,
sartorius, iliopsoas)
• Obturator nerve
– Sensory
• Skin medial thigh; hip, knee joints
– Motor
• Adductor muscles
• Lateral femoral cutaneous
– Sensory
• Skin lateral thigh
• Genitofemoral
– Sensory
• Skin scrotum, labia major, anterior thigh
– Motor
• Cremaster muscle