Transcript Surface anatomy of lower limb

The Foot
•Bones
•Joint
•Muscles
•Artery & Nerves
Superficial veins
Great saphenous vein
Small saphenous vein
Arteries
Ant. Tibial
Dorsalis pedis artery
Ant. Tibial
Post. Tibial
• Medial plantar
• Crosses over the two
tendons long flexor
• Lateral plantar
• Deep to flexor digitorum brevis
Nerves
Fibular n.
Common plantar digital n.
Medial plantar n.
• Flexor digitorum brevis
• Flexor hallucis brevis
• Abductor hallucis
Lateral plantar n.
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Flexor accessories
Abductor digiti minimi
Interosseous muscles (deep brunch)
Adductor hallucis (deep brunch)
Flexor digiti minimi brevis (sup. brunch)
Surface anatomy of lower limb
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Ankle and foot
medial and lateral malleolus
Tarsal tunnel
Tendons
Dorsalis pedis a.
Plantar arch
Normal Knee – Anterior, Extended
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Surface Anatomy - Anterior, Extended
Patella
Indented
Hollow
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Normal Knee – Anterior, Flexed
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Surface Anatomy - Anterior, Flexed
Patella
Tibial
Tuberosity
Head
Of
Fibula
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Palpation – Anterior*
Patella:
Lateral and Medial Patellar Facets
Superior
And
Inferior
Patellar Facets
Medial Fat
Pat
Lateral Fat Pad
Patellar Tendon**
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Surface Anatomy - Medial
Tibial
Tuberosity
Joint
Line
Patella
Medial
Femoral
Condyle
Medial
Tibial
Condyle
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Palpation - Medial
Medial Collateral Ligament (MCL)*
Pes anserine
bursa**
Medial joint
line
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Surface Anatomy – Lateral
Quadriceps
Patella
Tibial
Tuberosity
Head
Of
Fibula
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Common fibular nerve
Injury to the common peroneal nerve
• The common fibular nerve may be
severed during fracture of the fibula
neck.
• Results in paralysis of all muscles in
the anterior and lateral compartments
of the leg.
• The loss of eversion of the foot and
dorsiflexion of the ankle causes footdrop.
• Foot-drop: the foot drops and the toes
drag of the floor when walking.
Popliteal fossa
PNS Throughout Life
• Dermatome – an area of skin
• Innervated by cutaneous branches of a single spinal nerve
• Embryonic muscles migrate to new locations
• Some skin dermatomes become displaced
• Muscles and skin always retain their original nerve supply
Posterior
Anterior
Map of
Dermatomes
Innervation of the Skin: Dermatomes
• Upper limb – skin is supplied by nerves of the brachial
plexus
• Lower limb:
Lumbar nerves – anterior surface
Sacral nerves – posterior surface
Elsie (L.3 ) is trying to rescue her clumsy man Slim (SI) from a septic tank (SciaTIC nerve), using a rope and a balloon. He has
some GLUe (nerves to GLUteus muscles) on his leg. She is pregnant· is FEMale (FEMoral nerve) and has an OBstetric
condition (OBturator nerve).
lumbar disc herniation
lumbar disc herniation
Disc Level
Root
Comp.
Weakness
Reflex
Involvement
Sensory Loss
Pain Distribution
L3-L4
L4
quadriceps,
tibialis anterior
knee jerk
medial knee and shin
anterior thigh
L4-L5
L5
extension of big
toe
no significant
big toe
back of thigh, lateral calf
S1
gastrocnemius
(ankle plantar
flexion)
Achilles
lateral foot and heel
back of thigh and calf
L5-S1
Lower limb dermatomes
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L1 Dermatome:
over trochanter and groin
L2 Dermatome:
front of thigh to knee
L3 Dermatome:
upper buttock, anterior thigh and knee, medial lower leg
L4 Dermatome:
lateral Buttock, lateral thigh, medial leg, dorsum of foot, big toe
L5 Dermatome:
Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot,
medial half of sole, first, second, and third toes
S1 Dermatome:
Buttock, thigh, and posterior leg
S2 Dermatome:
Buttock, thigh, and posterior leg
S3 Dermatome:
Groin, medial thigh to knee
S4 Dermatome:
Perineum, genitals, lower sacrum