1 the lower limb
TRANSCRIPT
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The Lower Limb
Pelvis, Thigh, Leg and Footdr. Irwan
Bagian anatomi
FK Unsri
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Surface Anatomy
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Surface Anatomy Gluteal region /
posterior pelvis
Iliac crest
Gluteus maximus Cheeks
Natal/gluteal cleft
Vertical midline;
Crack
Gluteal folds
Bottom of cheek;
prominence
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Nelatons line
a line drawn from the anterior
superior lilac spine to the
ischial tuberosity, passing over
or near the top of the greater
trochanter. The trochanter can
be felt superior to this line in a
person which a dislocated hip
or a fractured femoral neck.
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Coxa vara
(abnormally decreased angle ofinclination, it occurs in fractures
of the neck of the femur and
slipping of the femoral
epiphysis )
Coxa valga
(abnormally increasedangle of inclination, in
cases of congenital
dislocation of the hip)
Normal angle
of inclination1250-1300
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Normal alignment Genu varum
(bowleg)
O
Genu valgum
X
1700 >1700
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Surface Anatomy
Anterior thigh and leg
Palpate
Patella
Condyles of femur
Femoral Triangle
Boundaries:
Sartorius (lateral)
Adductor longus (medial) Inguinal ligament (superior)
Contents:
Femoral artery, vein and
nerve, lymph nodes
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Surface Anatomy
Posterior leg Popliteal fossa
Diamond-shape fossabehind knee
Boundaries
Biceps femoris(superior-lateral)
Semitendinosis andsemimembranosis(superior-medial)
Gastrocnemius heads
(inferior) Contents
Popliteal artery and vein
Calcaneal (Achilles)tendon
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Surface Anatomy
Anterior leg bones
Tibia
Tibial tuberosity Anterior crest
Medial surface
Medial malleolus
Fibula Lateral malleolus
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Superficial structuresGreat saphenous vein
Drains the medial end of dorsal venous arch
of foot
Passes upward directly in front of the medial
malleolus.
Then ascends on medial side of the leg. Passes behind the knee and curves forward
around the medial side of the thigh.
Passes through the saphenous hiatus in the
deep fascia and joins the femoral vein about
4 cm below and lateral to the pubic tubercle.
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Superficial structures Tributaries:
Superficial lateral femoral v.
Superficial medial femoral v.
External pudendal v.
Superficial epigastric v.
Superficial iliac circumflex v.
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Superficial epigastric v.
External pudendal v.
Superficial circumflex iliac v.
Great saphenous v.
Superficial lateral femoral v.
Superficial medial femoral v.
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Varicose veins
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Superficial structures
Superficial fascia Superficial arteries:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a. Cutaneous nerves:
lateral femoral cutaneous n.
anterior and medial cutaneous branches
of femoral n.
cutaneous branches of obturator n.
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lateral femoral cutaneous n.
anterior and medial
cutaneous branches of
femoral n.
Cutaneous branches of
obturator n.
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Superficial structures
Superficial inguinal lymph nodes Superior group:
Lies just distal to the inguinal ligament
Receive lymph vessels from anteriorabdominal wall below umbilicus, glutealregion, perineal region, external genital
organs Inferior group:
Lies vertical along the terminal greatsaphenous v.
Receives all superficial lymph vessels oflower limb, except for those from the
posterolateral part of calf
Efferent vessels drain into the deepinguinal ln. or external iliac ln.
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Deep fascia of the thigh
Fascia lata The deep fascia encloses the thigh like a trouser leg. Saphenous hiatus
A gap in the deep fasica which lies about 4 cm
below and lateral to the pubic tubercle. The
falciform margin is the lower lateral border of
the opening, which lies anterior to the femoralvessels.
Filled with loose connective tissue called the
cribriform fascia
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Deep fascia of the thigh
Iliotibial tract laterally the deep fascia forms a thickband, from the iliac tubercle to the
lateral condyle of tibial.
The fascia lata sends intermuscular
septa to the linea aspera of thefemur. These separate the thigh into
three compartments each of which
contains a group of muscles, the
vessels and the nerves.
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Skeletal
Composition
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Bones of the Lower Limb Function:
Locomotion
Carry weight of entire erect body
Support
Points for muscular attachments
Components: Thigh
Femur
Knee Patella
Leg
Tibia (medial) Fibula (lateral)
Foot Tarsals (7)
Metatarsals (5)
Phalanges (14)
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Thigh
Femur Largest, longest,
strongest bone in thebody!!
Receives a lot ofstress
Courses medially More in women!
Articulates withacetabulum proximally
Articulates with tibia
and patella distally
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Knee
Patella
Triangular sesamoid
bone
Protects knee joint Improves leverage of
thigh muscles acting
across the knee
Contained withinpatellar ligament
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Leg
Tibia
Receives the weight of body
from femur and transmits to foot
Second to femur in size and
weight
Articulates with fibula proximally
and distally
Interosseous membrane
Fibula Does NOT bear weight
Muscle attachment
Not part of knee joint
Stabilize ankle joint
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Foot Function: Supports the weight of the
body
Act as a lever to propel thebody forward
Parts: Tarsals
Talus = ankle
Between tibia and fibula
Articulates with both
Calcaneus = heel
Attachment for Calcanealtendon
Carries talus
Navicular
Cuboid
Medial, lateral andintermediate cuneiforms
Metatarsals
Phalanges
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Foot
3 arches Medial
Lateral
Transverse Has tendons that run
inferior to foot bones
Help support archesof foot
Function Recoil after stepping
Longitudinal
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Joints of Lower Limb
Hip (femur + acetabulum) Ball + socket
Multiaxial
Synovial
Knee (femur + tibia) Hinge (modified)
Biaxial
Synovial
Contains menisci, bursa, many
ligaments
Knee (femur + patella)
Plane
Gliding of patella
Synovial
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Joints of Lower Limb
Proximal Tibia + Fibula
Plane, Gliding
Synovial
Distal Tibia + Fibula
Slight give (synarthrosis) Fibrous (syndesmosis)
Ankle (Tibia/Fibula + Talus)
Hinge, Uniaxial
Synovial
Intertarsal & Tarsal-metatarsal Plane, synovial
Metatarsal-phalanges
Condyloid, synovial
Interphalangeal
Hinge, uniaxial
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Muscles
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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/AdductorCompartment
Adducts thigh Medially rotates thigh
Posterior CompartmentThigh Extends thigh
Flexes leg
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Gluteals
Gluteus maximus Origin - Ilium, sacrum and coccyx
Insertion - Gluteal tuberosity of femur,iliotibial tract
Action - Extends thigh, some lateralrotation and abduction
Innervation - Inferior gluteal nerve
Gluteus medius
Gluteus minimus Origin - Ilium
Insertion - Greater trochanter of femur
Action - Abduction, medial rotation
Innervation - Superior gluteal nerve
Lesser Gluteals help stabilize hipto allow fluent bipedal walking
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Posterior Pelvis
Tensor fasciae latae
Originiliac crest and
anterior inferior iliac spine
Insertioniliotibial tractAction - Flex thigh, abduct
thigh, medial rotation of
thigh
InnervationSuperiorgluteal nerve
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Anterior Compartment Thigh Quadriceps femoris
Rectus femoris
Originanterior inferior iliacspine, margin of acetabulum
Insertionpatella and tibialtuberosity via the patellarligament
Actionextends knee, flexesthigh
Vastus lateralis Vastus medialis
Vastus intermedius
Origin - femur
Insertionpatella and tibialtuberosity via the patellar
ligament Actionextends knee
Sartorius
Origin - anterior superior iliacspine
Insertionmedial tibia
Action - flex, abduct, lat rotatethigh; weak knee flexorAll above innervated by the femoral nerve!!!
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Anterior Compartment Thigh
Iliopsoas
Origin - Ilia, sacrum,
lumbar vertebrae
Insertionlessertrochanter
Actionflexor of thigh
Innervationfemoral
nerve
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Adductors Adductor longus
Adductor brevis Adductor magnus
Origininferior pelvis
Insertion - femur
Actionadductsand medial rotates
InnervationObturator nerve
Pectineus Origin - pubis
Insertionlesser trochanter
Actionadducts, medial rotates
Innervationfemoral, sometimesobturator
Gracilis Origin - pubis
Insertionmedial tibia
Actionadductsthigh, flex, medial,rotates leg
InnervationObturator nerve
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Posterior Compartment - Hamstring Biceps femoris (2 heads)
Originischial tuberosity, distalfemur
Insertion - lateral tibia, head
fibula
Action - thigh extension, kneeflexion, lateral rotation
Semitendinosus
Semimembranosus
Origin - ischial tuberosity
Insertion - medial tibia
Action - thigh extension, knee
flexion, medial rotation
Sciatic nerve innervates all of the above muscles!!!
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Muscles of the Leg
Anterior Compartment Dorsiflex ankle, invert foot, extend toes
Innervation: Deep fibular nerve
Lateral Compartment Plantarflex, evert foot
Innervation: Superficial Fibular nerve
Posterior Compartment Superficial and deep layers
Plantarflex foot, flex toes
Innervation: Tibial nerve
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Anterior Compartment Tibialis anterior
Origin - tibia
Insertion - tarsals
Action - dorsiflexion, foot inversion
Extensor digitorum longus
Origintibia and fibula
Insertion - phalanges
Actiontoe extension
Extensor hallucis longus
Originfibula, interosseousmembrane
Insertionbig toe
Action - extend big toe, dorsiflex
foot
All innervated by deep fibular nerve
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Lateral Compartment Fibularis (peroneus) longus
Originlateral fibula
Insertion5thmetatarsal,
tarsal
Action - plantarflex, evert
foot
Fibularis (peroneus) brevis
Origindistal fibula Insertion - proximal fifth
metatarsal
Actionsame as above!!
All innervated by the superficial fibular nerve
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Superficial Posterior Compartment Triceps surae
Gastrocnemius (2 heads)
Origin - medial and lateral condyles of
femur
Insertion - posterior calcaneus via
Achilles tendon
Soleus
Origintibia and fibula
Insertionsame as above
Action of bothplantarflex foot
Plantaris (variable) Originposterior femur
Insertionsame as above!
Actionplantarflex foot, week knee
flexionAll innervated by the tibial nerve
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Deep Posterior Compartment
Popliteus Origin - lateral condyle femur
and lateral meniscus
Insertionproximal tibia
Actionflex and medially rotate leg
Flexor digitorum longus Origin - tibia
Insertion - distal phalanges of toe 2-5
Actionplantarflex and invert foot, flex toe
Flexor hallucis longus Origin - fibula
Insertion - distal phalanx of hallux
Action - plantarflex and invert foot, flex toe Tibialis posterior
Origintibia, fibula, and interosseousmembrane
Insertion - tarsals and metatarsals
Action - plantarflex and invert foot
All innervated by the tibial nerve
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Innervation
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Plexuses of the Lower Limb
Lumbosacral plexus Lumbar Plexus
Arises from L1-L4
Lies within the psoas major
muscle
Mostly anterior structures
Sacral Plexus
Arises from spinal nerve
L4-S4
Lies caudal to the lumbarplexus
Mostly posterior structures
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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
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Sacral Plexus Sciatic
Motor: Hamstring
Branches into: Tibial nerve
Cutaneous
Posterior leg and sole of foot
Motor Posterior leg, foot
Common fibular (peroneal) nerve Cutaneous
Anterior and lateral leg, dorsum foot
Motor
Lateral compartment, tibialis anterior,toe extensors
Superior gluteal nerve Motor
Gluteus medius and minimus, tensorfasciae latae
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Sacral Plexus (continued)
Inferior gluteal nerve Motor
Gluteus maximus
Posterior femoral
cutaneous nerve Sensory
Inferior buttocks, posteriorthigh, popliteal fossa
Pudendal nerve Sensory
External genitalia, anus
Motor Muscles of perineum
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Vasculature
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Arteries
Common iliac (from
aorta) branches into:
Internal iliac Supplies pelvic organs
External iliac
Supplies lower limb
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Arteries
Internal iliac branches into: Cranial and Caudal Gluteals
(Superior and Inferior) Gluteals
Internal Pudendal Perineum, external genitalia
Obturator
Adductor muscles Other branches supply rectum,
bladder, uterus, vagina, malereproductive glands
A t i
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Arteries
External iliac becomes. Femoral
Once passes the inguinal ligament
Lower limb
Branches into Deep femoral Adductors, hamstrings, quadriceps
Branches intoMedial/lateral femoralcircumflex
Head and neck of femur
Femoral becomes Popliteal(continuation of femoral)
Branches into:
Geniculars Knee
Splits into: Anterior Tibial
Anterior leg muscles, further branches tofeet
Posterior Tibial
Flexor muscles, plantar arch, branches to
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Veins Deep Veins: Mostly share names ofarteries
Ultimately empty into Inferior VenaCava
Plantar
Tibial
Fibular
Popliteal Femoral
External/internal iliac
Common iliac
Superficial Veins
Dorsal venous arch (foot)
Great saphenous (empties into femoral)
Small saphenous (empties into
popliteal)