the lower limb pelvis, thigh, leg and foot. surface anatomy gluteal region / posterior pelvis iliac...
TRANSCRIPT
![Page 1: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/1.jpg)
The Lower Limb
Pelvis, Thigh, Leg
and Foot
![Page 2: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/2.jpg)
Surface Anatomy Gluteal region / posterior pelvis
Iliac crest
Gluteus maximus Cheeks Natal/gluteal cleft
Vertical midline; “Crack”
Gluteal folds Bottom of cheek; “prominence”
pg 513
![Page 3: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/3.jpg)
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
pg 630
![Page 4: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/4.jpg)
Surface Anatomy Posterior leg
Popliteal fossa Diamond-shape fossa behind knee Boundaries
Biceps femoris (superior-lateral) Semitendinosis and semimembranosis (superior-medial) Gastrocnemius heads (inferior)
Contents Popliteal artery and vein
Calcaneal (Achilles) tendon
pg 632
![Page 5: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/5.jpg)
Surface Anatomy
Anterior leg bones Tibia
Tibial tuberosity Anterior crest Medial surface Medial malleolus
Fibula Lateral malleolus
pg 587
![Page 6: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/6.jpg)
Bones of the Lower Limb Function:
Carry weight of entire erect body Support Locomotion Points for muscular attachments
Components: Thigh
Femur Knee
Patella Leg
Tibia (medial) Fibula (lateral)
Foot Tarsals (7) Metatarsals (5) Phalanges (14)
pg 517
![Page 7: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/7.jpg)
Thigh Femur
Largest, longest, strongest bone in the body!! Receives a lot of stress Courses medially
More in women! Articulates with acetabulum proximally Articulates with tibia and patella distally
pg 557
![Page 8: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/8.jpg)
Knee Patella
Triangular sesamoid bone Protects knee joint Improves leverage of thigh muscles acting across the
knee
pg 584
![Page 9: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/9.jpg)
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
pg 587
![Page 10: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/10.jpg)
Foot Function: Supports the weight of the body Act as a lever to propel the body forward
Parts: Tarsals
Talus = ankle Between tibia and fibula Articulates with both
Calcaneus = heel Attachment for Calcaneal tendon Carries talus
Metatarsals Phalanges
pg 601
![Page 11: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/11.jpg)
Foot
3 arches Medial Lateral Transverse
Has tendons that run inferior to foot bones Help support arches of foot
Longitudinal
pg 614
![Page 12: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/12.jpg)
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
pg 517
![Page 13: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/13.jpg)
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
pg 517
![Page 14: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/14.jpg)
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/Adductor Compartment Adducts thigh Medially rotates thigh
Posterior Compartment Thigh Extends thigh Flexes leg
pg 503
![Page 15: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/15.jpg)
Gluteals Gluteus maximus Origin - Ilium, sacrum and coccyx Insertion - Gluteal tuberosity of femur, iliotibial tract Action - Extends thigh, lateral rotation & abduction Innervation - Inferior gluteal nerve
Gluteus medius & Gluteus minimus Origin – Posterior Ilium Insertion - Greater trochanter of femur Action - Abduction, medial rotation Innervation - Superior gluteal nerve
Lesser Gluteals help stabilize hip to allow fluent bipedal walking
Tensor fasciae latae Origin – iliac crest and ASIS Insertion – iliotibial tract Action - Flex thigh, abduct thigh, medial rotation of thigh Innervation – Superior gluteal nerve
pg 549
![Page 16: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/16.jpg)
Anterior Compartment Thigh Quadriceps femoris
Rectus femoris Origin – anterior inferior iliac spine, margin of
acetabulum Insertion – patella and tibial tuberosity via the patellar
ligament Action – extends knee, flexes thigh
Vastus lateralis Origin-proximal femur, linea aspera
Vastus medialis Origin-proximal femur, linea aspera
Vastus intermedius Origin – anterior and lateral femur Insertion – patella and tibial tuberosity via the patellar
ligament Action – extends knee
All above innervated by the femoral nerve!!!
pg 563
![Page 17: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/17.jpg)
Anterior Compartment Thigh
Sartorius Origin - anterior superior iliac spine Insertion – medial tibia Action - flex, abduct, lat rotate thigh; weak knee flexor
Iliopsoas Origin - Ilia, sacrum, lumbar vertebrae Insertion – lesser trochanter of femur Action – flexor of thigh Innervation – femoral nerve
pg 551
![Page 18: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/18.jpg)
Adductors Adductor longus Adductor brevis Adductor magnus
Origin – inferior pelvis Insertion – linea aspera of femur Action – adducts and medial rotates Innervation – Obturator nerve
Pectineus Origin – pectineal line of pubis Insertion – lesser trochanter of femur Action – adducts, medial rotates Innervation – femoral, sometimes obturator
Gracilis Origin – pubis (near symphysis) Insertion – medial tibia Action – adducts thigh, flex, medial, rotates leg Innervation – Obturator nerve
pg 566, 565
![Page 19: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/19.jpg)
Posterior Compartment - Hamstring Biceps femoris (2 heads)
Origin – ischial tuberosity (long head) and linea aspera (short head)
Insertion - lateral tibia, head fibula Action - thigh extension, knee flexion, 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!!!pg 568
![Page 20: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/20.jpg)
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
![Page 21: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/21.jpg)
Anterior Compartment Tibialis anterior
Origin - tibia Insertion - tarsals Action - dorsiflexion, foot inversion
Extensor digitorum longus Origin – tibia and fibula Insertion - phalanges Action – toe extension
Extensor hallucis longus Origin – fibula, interosseous membrane Insertion – big toe Action - extend big toe, dorsiflex foot
All innervated by deep fibular nervepg 597
![Page 22: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/22.jpg)
Lateral Compartment Fibularis (peroneus) longus
Origin – lateral fibula Insertion – 5th metatarsal, tarsal Action - plantarflex, evert foot
Fibularis (peroneus) brevis Origin – distal fibula Insertion - proximal fifth metatarsal Action – same as above!!
All innervated by the superficial fibular nervepg 595
![Page 23: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/23.jpg)
Superficial Posterior Compartment Triceps surae
Gastrocnemius (2 heads) Origin - medial and lateral condyles of femur Insertion - posterior calcaneus via Achilles tendon
Soleus Origin – tibia and fibula Insertion – same as above
Action of both – plantarflex foot
Plantaris Origin – posterior femur Insertion – same as above! Action – plantarflex foot, week knee flexion
All innervated by the tibial nerve
pg 590
![Page 24: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/24.jpg)
Deep Posterior Compartment Popliteus
Origin - lateral condyle femur and lateral meniscus Insertion – proximal tibia Action – flex and medially rotate leg
Flexor digitorum longus Origin - tibia Insertion - distal phalanges of toe 2-5 Action – plantarflex and invert foot, flex toe
Flexor hallucis longus Origin - fibula Insertion - distal phalanx of hallux Action - plantarflex and invert foot, flex toe
Tibialis posterior Origin – tibia, fibula, and interosseous membrane Insertion - tarsals and metatarsals Action - plantarflex and invert foot
All innervated by the tibial nerve
pg 591
![Page 25: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/25.jpg)
Muscles of the Foot
Dorsum of Foot Extensor digitorum brevis O: calcaneus, I: prox phalanx of hallux Action: extend MT-P joint Innervation = Deep Peroneal (Fibular) n.
Plantar Surface of Foot (= sole): 4 layers O: Tarsals and/or Metatarsals, I: Phalanges Action: Flex, Ext, ABduct, ADduct Innervation: Medial + Lateral Plantar n. (from Tibial n.)
![Page 26: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/26.jpg)
Plexuses of the Lower Limb
“Lumbosacral plexus” Lumbar Plexus
Arises from L1-L4 Lies within the psoas major muscle
Sacral Plexus Arises from spinal nerve L4-S4 Lies caudal to the lumbar plexus
pg 522
![Page 27: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/27.jpg)
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
pg 464
![Page 28: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/28.jpg)
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, tensor fasciae latae
pg 464
![Page 29: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/29.jpg)
Sacral Plexus
Inferior gluteal nerve Motor
Gluteus maximus
Posterior femoral cutaneous nerve Sensory
Inferior buttocks, posterior thigh, popliteal fossa
Pudendal nerve Sensory
External genitalia, anus
Motor Muscles of perineum
pg 464
![Page 30: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/30.jpg)
Arteries
Common iliac (from aorta) branches into: Internal iliac
Supplies pelvic organs
External iliac Supplies lower limb
pg 300
![Page 31: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/31.jpg)
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, male reproductive glands
pg 541
![Page 32: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/32.jpg)
Arteries External iliac becomes…….
Femoral Once passes the inguinal ligament Lower limb Branches into Deep femoral
Adductors, hamstrings, quadriceps Branches into Medial/lateral femoral circumflex
Head and neck of femur Femoral becomes……
Popliteal (continuation of femoral) Branches into:
Geniculars Knee
Splits into: Anterior Tibial
Anterior leg muscles, further branches to feet Posterior Tibial
Flexor muscles, plantar arch, branches to toespg 570
![Page 33: The Lower Limb Pelvis, Thigh, Leg and Foot. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft](https://reader031.vdocument.in/reader031/viewer/2022020921/56649cc25503460f94989d94/html5/thumbnails/33.jpg)
Veins Deep Veins: Mostly share names of arteries
Ultimately empty into Inferior Vena Cava 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)
pg 542