organization of the lower limb
DESCRIPTION
Organization of the Lower Limb. Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006. Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition. Limb Development. - PowerPoint PPT PresentationTRANSCRIPT
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Organization of the Lower Limb
Most illustrations from:Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006.
Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition.
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Limb Development
• Lower limb develops in an anterolateral position at the level of the L2 to S3 trunk segments
• Great toe positioned in cephalic direction with the soles of the feet in an ateriomedial direction
• Knee positioned in a posteriolateral position
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Limb Rotation
Lower Limb Rotation
• Medial rotation• Adduction• Extension
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Segments of the Lower Limb
• Limb Girdle– pelvic girdle (gluteal)
• Free limb- thigh - leg- foot
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Joints of the Lower Limb
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Articulation with Axial Skeleton
Sternoclavicular jt,
Sacroiliac jt.
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Sacroiliac Joint
Auricular articular surfaces
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Sacroiliac Joint
Sacroiliac joint
Anterior sacroiliac ligaments
Posterior sacroiliac ligaments
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Os Coxae• Hemipelvis is composed of the ilium,
ischium and pubis with articulations centered in acetabulum – triradiate articulation
• Fusion of the 3 bones is complete between 20 and 25 years of age
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Tri-radiate Articulation
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Joints of the Free LimbHip
Polyaxial ball and socket joint:• Felxion/extension• Adduction/abduction• Medial/lateral rotation
Iliofemoral lig.Pubofemoral lig.Ischiofemoral lig.
Ligament of head of femur
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Joints of the Free LimbKneeModified hinge joint
FemurTibiaPatella
Tibiofemoral artic.
Patelofemoral artic.
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Joints of the Free LimbAnkle (talocrural) joint
Hinge joint1 axis of movement: Dorsiflexion/plantarflexion
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Joints of the Free LimbFoot
Inversion/eversion occurs at subtalar (talocalcaneal) joint
Interphalangeal joints: Distal Proximal
metatarsophalangeal joints
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Vasculature of the
Lower Limb
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Superficial Veins
Great saphenous v. Small saphenous
v.
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Arterial Blood Supply
External Iliac a
Femoral a
Popliteal a
Anterior Posteriortibial a tibial aa
dorsalis med/latpedis plantar a
Internal Iliac a
Superior gluteal a Inferior gluteal a
Obturator a
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Deep Femoral Artery
Medial & lateral femoral circumflex arteries
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Fascial Compartments
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Gluteal Fascia Fascia Lata Crural Fascia
Fascia of the Lower Limb
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Fascia Lata
Fascial Compartments of the Thigh
Anterior compartment
Medial (adductor) compartment
Posterior compartment
anterior compartment
posterior compartment
medial compartment
Fascial septa divide limb into compartments
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Crural Fascia
Fascial Compartments of the Leg
Anterior crural compartment
Lateral crural compartment
Posterior crural compartment
Superficial & deepposterior crural compartments
anterior
lateral
posterior
anterior compartment
lateral compartment
posterior compartment
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Lumbosacral Plexus
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Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)
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Lumbosacral PlexusL1 - S3
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Gluteal innervation:Superior gluteal n (L4,5, S1):• gluteus medius m.• gluteus minimus m.• tensor fascia lataInferior gluteal n (L5, S1,2):• gluteus maximus m.N to obturator internus (L5, S1, 2):• oburator internus• superior gemellusNerve to quadratus femoris (L4,5, S1):• inferior gemellus• quadratus femorus
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Anterior compartmen
t
Medial compartment
Posterior compartme
nt
Lateral compartmen
t
Thigh
Leg
Foot
Compartmental Innervation Of the Free Limb
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Anterior (extensor) compartment of the thigh
Innervation: femoral nerve
anterior
anterior
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Medial (adductor) compartment of the thighInnervation:
obturator nerve*
medial
*Adductor Magnus innervated by both obturator n and tibial division of sciatic n
medial
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Posterior compartment of the thighHamstring mm: arise from ischial tuberosity & are innervated by tibial division of sciatic n.Innervation:• Tibial division of sciatic
nerve Except short head of
biceps femoris: common fibular division of sciatic nerve
posterior
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Posterior compartment of the leg Innervation: tibial n.
Superficial posterior crural compartment Deep posterior
crural compartment
posterior
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Plantar surface of the foot
Innervation:Medial & lateral plantar nerves
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Innervation of intrinsic muscles of the foot
Medial plantar n•flexor digitorum brevis
•flexor hallucis brevis
•abductor hallucis m•1st lumbrical
Lateral plantar n •abducator digiti minimi •quadratus plantae
•2nd, 3rd & 4th lumbricals •adductor hallucis •Flexor digiti minimi •dorsal & plantar
interossei
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Common fibular nerveNerve supply to the lateral and anterior crural compartments
anterior
lateral
anterior
lateral
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Lateral crural compartment:Superficial fibular nerveFibularis longusFibularis brevis
lateral
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Anterior crural compartment:Deep fibular nerve• Tibialis anterior m.• Extensor hallucis longus m.• Extensor digitorum longus m.• Fibularis tertius m.
anterior
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Dorsum of the foot: deep fibular nerve• Extensor hallucis brevis• Extensor digitorum brevis
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Anterior compartme
nt
Medial compartme
nt
Posterior compartme
nt
Lateral compartme
nt
Thigh
Leg
Foot
Compartmental Innervation of Free Limb
Femoral n. Obturator n.**adductor magnus - obturator n and tibial n
Tibial division of sciatic n. **short head of biceps
femoris - common fib. division of sciatic n.
Deep fibular n.
Tibial nerve Superficial fibular n.
Deep fibular n.
Tibial n. (medial and
lateral plantar n.)
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Key dermatomes* thumb - C6 5th digit of hand -
C8 nipples - T4 umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1
*area of skin supplied by a dorsal nerve root
Dermatomes
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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
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Cutaneous Nerve Supply to the Lower Limb
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References
Clemente, C. 1997 Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins.Rinabesm C,H, 1972. Cunningham’s Textbook of Anatomy, 11th edition. Oxford University Press.Rosse, C & Gaddum-Rosse, P. 1997. Hollinshead’s Textbook of Anatomy 5th edition. Lippincott-RavenSchuenke, M et al, 2006 Thieme Atlas of Anatomy: Musculoskeletal System. Thieme.Slaby, F., et al. 1994. Gross Anatomy in the Practice of Medicine. Lea & Febiger.