Introduction to the Lower Limb
Transcript of Introduction to the Lower Limb
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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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Segments of the Lower Limb
• Limb Girdle – pelvic girdle (gluteal)
• Free limb
- thigh
- leg
- foot
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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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Joints of the Lower Limb
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Articulation with Axial Skeleton
Sternoclavicular jt,
Sacroiliac jt.
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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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Sacroiliac Joint
Auricular articular
surfaces
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Sacroiliac Joint
Sacroiliac joint
Anterior sacroiliac ligaments
Posterior sacroiliac ligaments
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Joints of the Free Limb
Hip Polyaxial ball and socket joint: •Felxion/extension •Adduction/abduction •Medial/lateral rotation
Iliofemoral lig.
Pubofemoral lig.
Ischiofemoral lig.
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Joints of the Free Limb
Knee Modified hinge joint
Femur
Tibia
Patella
Tibiofemoral
artic.
Patelofemoral
artic.
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Joints of the Free Limb Ankle (talocrural) joint
Hinge joint
1 axis of movement: Dorsiflexion/plantarflexion
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Joints of the Free Limb Foot
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 Posterior
tibial a tibial aa
dorsalis med/lat
pedis 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 & deep
posterior 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 Plexus
L1 - S3
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Gluteal innervation:
Superior gluteal n (L4,5, S1):
• gluteus medius m.
• gluteus minimus m.
• tensor fascia lata
Inferior gluteal n (L5, S1,2):
•gluteus maximus m.
N to obturator internus
(L5, S1, 2):
•oburator internus
•superior gemellus
Nerve to quadratus femoris
(L4,5, S1):
•inferior gemellus
•quadratus femorus
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Anterior
compartment
Medial
compartment
Posterior
compartment
Lateral
compartment
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 thigh
Innervation:
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 thigh Hamstring 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 nerve
Nerve supply to the lateral and
anterior crural compartments
anterior
lateral
anterior
lateral
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Lateral crural compartment:
Superficial fibular nerve
Fibularis longus
Fibularis 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
compartment
Medial
compartment
Posterior
compartment
Lateral
compartment
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-Raven
Schuenke, 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.