Transcript File
GNK 483 MUSCULOSKELETAL CONDITIONS BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012 Arterial Supply • Superior gluteal – Runs through greater sciatic foramen • Inferior gluteal – Runs through gluteal region • Obturator – Runs through obturator foramen to adductor compartment of thigh & hum head • • Femoral Popliteal Femoral Artery • Main artery • Origin = external iliac artery • Course = femoral sheath – – – – – Lateral to femoral vein Anterior to femoral head Runs superficially in femoral triangle Passes through adductor canal Changes name to popliteal artery at add hiatus Femoral Artery Branches • Branches inferior to inguinal ligament – Superficial circumflex iliac artery – Superficial epigastric artery – Superficial external pudendal artery • Branches in femoral triangle – Deep external pudendal artery – Deep femoral artery – Descending genicular artery Deep Femoral Artery • Main artery of thigh • Arises lateral side of femoral artery • Leaves femoral triangle betw pectineus & add longus in the floor of the triangle • In adductor compartment it runs betw add longus and add magnus • Supplies adductors & flexor compartment • Branches – Medial circumflex femoral a : clinical importance • Supplies largest quantity of blood to fem head and neck – Lateral circumflex femoral a • Supplies lat side of thigh & fem head Deep Femoral Artery • Anastomosis at height of lesser trochanter on posterior side of thigh – Medial circumflex femoral – Lateral circumflex femoral – Inferior gluteal – 1st perforator of deep femoral Popliteal Artery Branches • Cutaneous – Posterior surface of leg • Muscular – Lower part of thigh muscles – Calf muscles : sural artery • Articular – Medial & lateral superior genicular – Middle genicular – Medial & lateral inferior genicular • Terminal – Anterior tibial • Called dorsalis pedis on dorsum of foot – Posterior tibial • Divides into medial & lateral plantar aa • Latter forms plantar arch & anastomosis with dorsalis pedis a Venous Drainage • Deep veins • Superficial veins • Perforators Deep Veins • 2 venae comitantes accompany each artery of the leg of which popliteal and femoral vv are examples • Blood flows proximally in these veins with the aid of: – – – – Valves Muscular contraction Pulsation of aa adj to venae comitans Pressure changes in thorax Superficial Veins On dorsum of foot • Small saphenous – Post to lateral malleolus – Middle of calf it runs superficial to calcaneal tendon & gastroc – Ascends in relation sural n – Ends in popliteal vein • Great saphenous – – – – Medial side of dorsal arch Ant to medial malleolus Ascends in relation to saphenous n Drains into femoral vein • Before terminating, great saphenous receives: – Superficial epigastric – External pudendal – Superficial circumflex iliac – Anterolateral branch – Posteromedial branch • Perforators – At saphenous opening – Lower part of thigh Hunters perforating v – Below knee : Boyd’s perforating v – Medial aspect of leg Innervation Lumbar Plexus • Femoral n : L2,3,4 (posterior) – Muscular to ant compartment, pectineus – Articular to hip & knee – Cutaneous • Intermediate ant cutaneous • Medial ant cutaneous • saphenous Lumbar Plexus • Obturator n : L2,3,4 (anterior) – Muscular to adductor, gracilis – Articular to hip & knee – Cutaneous to medial part of thigh • Lateral cutaneous nerve to thigh : L2,3 Sacral Plexus • Sciatic n : L4,5,S1,2,3 – Muscular to hamstrings, add magnus – Articular to hip & knee • Tibial n – Common fibular • Superficial fibular – Muscular to peroneus longus & brevis – Cutaneous to distal 1/3 of leg & dorsum of foot except 1st web space • Deep fibular – Muscular to 4 muscles of ant compartment – Cutaneous to 1st web space LYMPHATIC SYSTEM LOWER LIMB