university of sulaimani college of pharmacy anatomy ...1).pdf · arteries of the lower limb:...

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University of Sulaimani

College of Pharmacy

Anatomy

Lectures of Lower Limb

Second Stage

2018-2019

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The Lower Limb: Dr.Shakhawan

Bones of the Lower Limb:

Hip Bone:

The hip bone is composed of i l ium, ischium, and pubis. They meet one another

at the acetabulum. The hip bones art iculate with the sacrum at the sacroil iac

joints (Figs. 1 & 2).

The ilium: (Figs. 1 & 2)

This is the upper part of hip bone; it has:

i liac crest.

anterior superior il iac spine & anterior inferior il iac spine, anteriorly.

posterior superior il iac spine & posterior inferior il iac spine ,

posteriorly.

The ischium: (Figs. 1 & 2)

This is L-shaped bone. It has:

Body.

Ischial ramus.

Ischial spine.

ischial tuberosity.

The pubis: (Figs. 1 & 2)

This is the lower part of the hip bone. It has:

Body.

Superior ramus.

Inferior ramus.

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Figure (1): Bones of the pelvis .

Figure (2): The hip bone.

Superior ramus

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Femur: (Fig. 3)

The femur art iculates above with the acetabulum to form the hip joint and

below with the t ibia and the patella to form the knee joint.

The upper end of the femur has a head, a neck , greater trochanter and

lesser trochanter .

The shaft of the femur has a r idge posteriorly, called l inea aspera.

The lower end of the femur has lateral and medial condyles.

Above the condyles are the medial and lateral epicondyles.

Figure (3): The femur (anterior & posterior surfaces).

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Bones of the Leg:

Patella:

The patella is a large sesamoid bone that l ies within the tendon of the

quadriceps femoris muscle in front of the knee joint (Fig. 4).

Figure (4): The patella.

Tibia: (Fig. 5)

Is the large weight -bearing medial bone of the leg .

I t art iculates with the femur above at the knee joint and with the talus

below at the ankle joint.

At the upper end are the lateral and medial condyles.

Below the condyles is the tibial tuberosity.

The lower end forms the medial malleolus .

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Fibula: (Fig. 5)

Is the slender lateral bone of the leg.

I t takes no part in the art iculat ion at the knee joint.

I t has no role in weight bearing, but provides attachment for muscles.

The upper end has a head & a neck.

The lower end forms the lateral malleolus .

Figure (5): The t ibia & f ibula.

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Bones of the Foot:

Tarsal Bones:

The tarsal bones are calcaneum, talus, navicular, cuboid, and three cuneiform

bones (medial, intermediate & lateral cuneiforms) (Fig. 6).

Metatarsal Bones and Phalanges:

There are 5 metatarsal bones.

Each toe has 3 phalanges except the big toe, which has only 2 (Fig. 6).

Figure (6): Bones of the foot.

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Regions of the lower limb: Dr.Shakhawan

The Gluteal Region (Buttock):

Muscles: gluteus maximus, gluteus medius, gluteus minimus, pir iformis,

obturator internus, superior gemellus & inferior gemellus (Figs. 7 & 8).

The gluteus maximus is the largest muscle in the body. The great thickness of

this muscle makes it ideal for intramuscular inject ions.

Figure (7): The gluteal region.

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Figure (8): The gluteal region & posterior aspect of the thigh.

The thigh:

The thigh is divided into 3 compartments: anterior, posterior & medial .

A) Contents of the Anterior Compartment of the Thigh: (Fig. 9)

Muscles: Sartorius, il iacus, psoas, and quadriceps femoris .

Blood supply: Femoral artery.

Nerve supply: Femoral nerve.

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Figure (9): The anterior & medial compartments of the thigh.

B) Contents of the Medial Compartment of the Thigh: (Fig. 9)

Muscles: Adductor longus, adductor brevis, adductor magnus.

Nerve supply: Obturator nerve.

C) Contents of the Posterior Compartment of the Thigh: (Fig. 8)

Muscles: Biceps femoris, semitendinosus, semimembranosus .

Nerve supply: Sciat ic nerve.

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The leg:

The leg is divided into 3 compartments: anterior, posterior & lateral.

A) Contents of the Anterior Compartment of the Leg: (Fig. 10)

Muscles: The t ibialis anterior, extensor digitorum longus & extensor

hallucis longus.

Nerve supply: Deep peroneal nerve.

Figure (10): The front of the leg & the dorsum of the foot.

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B) Contents of the Lateral Compartment of the Leg: (Fig. 10)

Muscles: Peroneus longus and peroneus brevis

Nerve supply: Superf icial peroneal nerve.

C) Contents of the Posterior Compartment of the Leg: (Figs. 11 & 12)

Muscles: Gastrocnemius, plantaris, soleus, f lexor digitorum longus, f lexor

hallucis longus, and t ibialis posterior

Nerve supply: Tibial nerve.

The gastrocnemius, plantaris & soleus muscles have a common tendon called

Tendoachilis (Fig. 11).

Figure (11): The back of the leg.

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Figure (12): The posterior compartment of the leg the showing deep structures.

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The Sole of the Foot: (Figs. 13 & 14)

Muscles of the sole of the foot are described in four layers:

First layer: Abductor hallucis, f lexor digitorum brevis, abductor digit i

minimi

Second layer: Quadratus plantae, lumbricals.

Third layer: Flexor hallucis brevis, adductor hallucis, f lexor digit i minimi

brevis

Fourth layer: Interossei.

Figure (13): The sole of the foot.

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Figure (14): The sole of the foot showing the deeper structures.

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Arteries of the Lower Limb: Dr.Shakhawan

Femoral Artery: (Figs. 9 & 15)

The femoral artery is the main arterial supply to the lower l imb. It enters the

thigh by passing under the inguinal l igament, as a continuation of the external

i l iac artery. It ends by becoming the popliteal artery.

Popliteal Artery:

The popliteal artery is the continuation of the femoral artery. It ends by dividing

into anterior and posterior t ibial arteries (Figs. 11, 12 & 15).

Anterior Tibial Artery:

The anterior t ibial artery is the smaller of the terminal branches of the popliteal

artery (Fig. 12 & 15). It passes into the anterior compartment of the leg (Figs. 10

& 15).

Posterior Tibial Artery:

The posterior t ibial artery is the larger of the terminal branches of the popliteal

artery (Fig. 12 & 15). I t passes behind the medial malleolus and terminates by

dividing into medial and lateral plantar arteries.

Veins of the Lower Limb:

A) Superficial Veins:

1. Great saphenous vein: has numerous valves (Figs. 10 & 16).

2. Small saphenous vein: (Fig. 16).

B) Deep Veins:

Popliteal vein and femoral vein (Figs. 9 & 16) .

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Figure (15): Arteries of the upper l imb.

Figure (16): Veins of the lower l imb.

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Femoral Nerve:

The femoral nerve enters the thigh under the inguinal l igament (Fig. 9) . It

supplies the muscles of the anterior compartment of the thigh.

Sciatic Nerve:

The sciat ic is the largest nerve in the body. I t descends in the midline of the

thigh & ends in the lower third of the thigh by dividing into the t ibial and common

peroneal nerves (Fig. 8). The common peroneal nerve divides into superf icial

and deep peroneal nerves.

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Joints of the Lower Limb: Dr.Shakhawan

Hip Joint: (Fig. 17)

The hip joint is formed by art iculat ion between head of the femur and

acetabulum of the hip bone.

Ligaments:

1. I liofemoral l igament.

2. Pubofemoral l igament.

3. Ischiofemoral ligament .

Movements:

The hip joint has a wide range of movement. There is f lexion, extension,

abduction, adduction, lateral rotat ion & medial rotat ion.

Figure (17): The hip joint (A) anterior aspect, (B) posterior aspect.

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Knee Joint: (Fig. 18)

This is the largest and most complicated joint in the body. Art iculat ion is

between the condyles of the femur above & the condyles of the t ibia below . In

front, the art iculat ion is between the lower end of the femur and the patella.

Ligaments:

1) Ligamentum patellae.

2) Lateral collateral ligament .

3) Medial collateral ligament .

4) Anterior Cruciate Ligament.

5) Posterior Cruciate Ligament.

Menisci:

These are C-shaped sheets of f ibrocart i lage that are attached to the condyles of

femur & t ibia. They act as cushions or shock absorber to reduce load.

Movements:

The knee joint has f lexion, extension, medial rotat ion & lateral rotat ion.

Figure (18): The knee joint.

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Ankle Joint: (Fig. 19)

The ankle joint is formed by art iculat ion between the lower end of t ibia & f ibula

and the talus.

Ligaments:

1) Medial ligament.

2) Lateral ligament.

Movements:

Dorsif lexion and plantar f lexion are possible.

Figure (19): The ankle joint (A) medial aspect, (B) lateral aspect.