A Practica Manual on Lower Limb
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Transcript of A Practica Manual on Lower Limb
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A PRACTICAL MANUAL ON THE LOWER LIMB
1. SUPERFICIAL VEINS OF THE LOWER LIMB
2. LUMBOSACRAL PLEXUS
3. INNERVATION OF THE LOWER LIMB
4. COMPARTMENTS OF THE LEG
5. EXTRINSIC MUSCLES OF THE FOOT
6. EXTRINSIC MUSCLES OF THE FOOT
7. SPECIAL REGIONS OF LOWER LIMB
8. NERVE LESIONS OF LOWER LIMB
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SUPERFICIAL VEINS OF THE LOWER LIMB
The great saphenous vein begins medially
and reaches the femoral vein by
passing through a weakened part of
fascia lata called the fossa ovalis which has a sharp margin called the falciform margin.
The small saphenous vein begins laterally
and opens up into the popliteal vein.
IDENTIFY THE THE LABELLED
STRUCTURES
E
D
C
B
A
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LUMBOSACRAL PLEXUS
Four nerves that innervate the lower limb: Femoral nerve, Obturator nerve, Superior
gluteal, and Sciatic nerve.
Lumbo-sacral plexus (L1 – S3):Lumbo-sacral plexus (L1 – S3):
Lumbar plexus (4 segments;L1-L4)
Sacral plexus (4 segments; L5-S3)
Lumbosacral trunk joints these plexuses
DESCRIBE THE L-S PLEXUS.NAME 4 NERVES SUPPLYING THELOWER LIMB!
A
B
E
C
D
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Four nerves that innervate the lower limb: Femoral nerve, Obturator
nerve, Superior gluteal, and Sciatic nerve.
Femoral nerve (L234 posterior division) --- Flexors of hip joint
Obturator nerve (L234 anterior division) --- Adductors of hip joint
The Sciatic (n. ischiadicus; great sciatic nerve) L45S123, supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the
leg and foot. It is the largest nerve in the body.
The Superior Gluteal Nerve (n. glutæus superior) L45S1 arises from the dorsal
divisions: innervates the Glutæi medius and minimus, and the Tensor fasciæ latæ.
LUMBOSACRAL PLEXUS
B
D
A
C
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THE FEMORAL NERVEFemoral nerve (L234 posterior division) --- Flexors of hip joint
Iliopsoas, sartorius, quadriceps femoris, supra articularis genu,
and “pectineus”
SensorySensory: femoralis anterior, medial of leg
and foot.D
B
C
A
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MUSCLES OF THE FEMORAL NERVE(FLEXORS OF HIP JOINT)
D
C
G
B
AH
EI
F
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THE OBTURATOR NERVEObturator nerve (L234 anterior
division) --- Adductors of hip joint
Add. Magnus, add longus, add brevis, add minimus, gracilis,
obturator externus.
Sensory:Sensory: medial femoral region.
C
B
A
D
F
E
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The medial compartment of the thigh is called the adductor
compartment because the major action of this group of muscles is
adduction, except for the hamstring portion of the adductor magnus.
Add. Magnus, add longus, add brevis, add minimus, gracilis,
obturator externus.
MUSCLES OF THE OBTURATOR NERVE(ADDUCTORS OF HIP JOINT)
F
A
B
C
E
D
G
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SCIATIC NERVE(FIBULAR & TIBIAL NERVES)
The Sciatic (n. ischiadicus; great sciatic nerve) L45S123, supplies nearly the whole of the skin of the leg, the muscles of
the back of the thigh, and those of the leg and foot. It is the largest nerve in the body.
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THE SCIATIC NERVE
Sensory:Sensory:
Back of thigh,most of leg, and
foot.
F
E
D
C
B
A
H
J
G
I
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MUSCLES OF THE SCIATIC NERVE(EXTENSORS OF HIP JOINT)
The hamstrings are: biceps femoris (long head)
semimembranosus semitendinosus
hamstring part of the “adductor magnus”
Features:Features:
Or. ischial tub.
In. Tibia-fibula
Nv. tibial divisionF
A
BE
C
D
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The tensor fasciae latae is seen from the lateral side of the
gluteal region
The Superior Gluteal Nerve (n. glutæus superior) L45S1 arises from the dorsal
divisions: innervates the Glutæi medius and minimus, and the Tensor
fasciæ latæ.
MUSCLES OF THE SUPERIOR GLUTEAL NERVE(ABDUCTORS OF HIP JOINT)
F
E
D
C
B
A
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THE TIBIAL NERVE
The superficial part of the leg is made up of three muscles:
1. gastrocnemius
2. plantaris 3. soleus
The deepest layer of muscles includes
the:
1. tibialis posterior
2. flexor digitorum longus
3. flexor hallucis longus
4. popliteus
The nervesare the:
1. medial plantar
2. lateral plantar
D
C
B
A
G
E
F
H
I
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MUSCLES OF THE TIBIAL NERVE
The superficial part of the leg is made up of three muscles:
Gastrocnemius, plantaris, soleus.
The deepest layer of muscles includes the:
tibialis posterior, flexor digitorum longus, flexor hallucis longus.
E
D
C
B
A
G
H
F
The posterior compartment of the
leg is usually subdivided into
superficial and deep parts.
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THE FIBULAR NERVE(PERONEAL NERVE)
The Deep Peroneal Nerve
supplies muscular branches to the
Tibialis anterior, Extensor digitorum
longus, Peronæus
tertius, and Extensor hallucis prop ius, and the
skin between the first and second toe.
The Superficial Peroneal Nerve
(n. peronæus superficialis) supplies the
Peronei longus and brevis and the skin over the greater part of the
dorsum of the foot.
E
F
G
D
A
C
B
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MUSCLES OF THE FIBULAR NERVE(ANTERIOR & LATERAL COMPARTMENTS)
The anterior compartment contains
muscles that are basically extensors of the ankle
and toes. They include: tibialis anterior, extensor
digitorum longus, extensor hallucis longus
G
HCB
A
DE
F
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MUSCLES OF THE FIBULAR NERVE(ANTERIOR & LATERAL COMPARTMENTS)
The SUPERFICIAL peroneal nerve branches
from the common peroneal nerve near the neck of the fibula and passes between the peroneus longus and
brevis muscles, at which point they supply the
muscles. The DEEP branch then continues onto the dorsum of the foot to supply the skin
there.
HF G
B
A D
E
C
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EXTRINSIC MUSCLES OF THE FOOT
dorsum of foot (intrinsic):extensor digitorum brevis
extensor hallucis brevis
Extrinsic muscles originate outside the foot
ED
C
B
A
F G IH
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INTRINSIC MUSCLES OF THE FOOT
sole of foot1st layer abductor hallucis flexor digitorum brevis abductor digiti minimi
2nd layer accessory flexor (quadratus plantae) lumbricals tendons of flexor digitorum longus tendon of flexor hallucis longus
3rd layer flexor hallucis brevis adductor hallucis
oblique head transverse head
flexor digiti minimi brevis
D
F
EC
AB
I
JH
G
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INTRINSIC MUSCLES OF THE FOOT
4th layer interossei
4 dorsal interossei 3 plantar interossei
tendon of peroneus longus
tendon of tibialis posterior
dorsum of foot:extensor digitorum brevis
extensor hallucis brevis
DC
BA
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MMOVEMENTS OF OVEMENTS OF THE FOOTTHE FOOT
1. 1. PROPULSIONPROPULSION::
-FLEXION AND EXTENSION OF THE ANKLE AND TOES
2. 2. ADAPTATIONADAPTATION::
- INVERSION & EVERSION
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SPECIAL REGIONS OF LOWER LIMB
The muscles of the gluteal region are responsible for extension, abduction, lateral rotation and slight medial rotation of the hip
joint.
1. superior gluteal 2. inferior gluteal 3. sciatic 4. posterior femoral
cutaneous 5. pudendal
For im injectionGLUTEAL REGION
E
D
C
B
A
I
G
F
J
KH
L
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LYMPH DRAINAGE OF THE LOWER LIMB
Superficial inguinal lymph nodes are arranged into three anatomical groups - medial, lateral and lower. They drain from the lower abdominal wall, perineum (including vulva and vagina), anal canal, scrotal skin, penis and the entire lower limb. They do not drain the testes which instead, drain to the upper para-
aortic nodes within the abdomen.
Drainage is to the external iliac
nodes.
E
D
C
BA
F
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FEMORAL TRIANGLE
The sheath contains the following items, from lateral to medial:
1. femoral artery 2. femoral vein 3. femoral canal (usually containing a lymph
node). The femoral canal is also the site of a
femoral hernia.
The femoral nerve is not considered to be in the sheath.
GB
A
E
F
D
C
H
I
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NERVE LESIONS OF LOWER LIMB
Femoral nerve lesion Common fibular nerve lesion
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THANK YOU
• In the way of righteousness there is life, along that path is immortality. (Pr 12:28)
• I walk in the way of righteousness, along the paths of justice, (Pr 8:20)
• The path of the righteous is like the first gleam of dawn, shining ever brighter till the full light of day. (Pr 4:18)