Lower Limb
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Transcript of Lower Limb
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The Lower Limb
Pelvis, Thigh, Leg
and Foot
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Surface Anatomy
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Surface Anatomy Gluteal region /
posterior pelvis Iliac crest Gluteus maximus
Cheeks
Natal/gluteal cleft Vertical midline;
“Crack”
Gluteal folds Bottom of cheek;
“prominence”
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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
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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
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Surface Anatomy
Anterior leg bones Tibia
Tibial tuberosity Anterior crest Medial surface Medial malleolus
Fibula Lateral malleolus
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Skeletal Composition
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Bones of the Lower Limb Function:
Locomotion Carry weight of entire erect body Support Points for muscular attachments
Components: Thigh
Femur Knee
Patella Leg
Tibia (medial) Fibula (lateral)
Foot Tarsals (7) Metatarsals (5) Phalanges (14)
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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
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Knee Patella
Triangular sesamoid bone
Protects knee joint Improves leverage of
thigh muscles acting across the knee
Contained within patellar ligament
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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
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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
Navicular Cuboid Medial, lateral and
intermediate cuneiforms Metatarsals Phalanges
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Foot
3 arches Medial Lateral Transverse
Has tendons that run inferior to foot bones
Help support arches of foot
Function Recoil after stepping
Longitudinal
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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
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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
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Muscles
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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
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Gluteals Gluteus maximus
Origin - Ilium, sacrum and coccyx Insertion - Gluteal tuberosity of femur,
iliotibial tract Action - Extends thigh, some lateral
rotation and abduction Innervation - Inferior gluteal nerve
Gluteus medius Gluteus minimus
Origin - Ilium Insertion - Greater trochanter of femur Action - Abduction, medial rotation Innervation - Superior gluteal nerve
Lesser Gluteals help stabilize hip to allow fluent bipedal walking
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Posterior Pelvis Tensor fasciae latae
Origin – iliac crest and anterior inferior iliac spine
Insertion – iliotibial tract Action - Flex thigh, abduct
thigh, medial rotation of thigh
Innervation – Superior gluteal nerve
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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 Vastus medialis Vastus intermedius
Origin - femur Insertion – patella and tibial
tuberosity via the patellar ligament Action – extends knee
Sartorius Origin - anterior superior iliac spine Insertion – medial tibia Action - flex, abduct, lat rotate
thigh; weak knee flexor
All above innervated by the femoral nerve!!!
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Anterior Compartment Thigh
Iliopsoas Origin - Ilia, sacrum,
lumbar vertebrae Insertion – lesser
trochanter Action – flexor of thigh Innervation – femoral
nerve
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Adductors Adductor longus Adductor brevis Adductor magnus
Origin – inferior pelvis Insertion - femur Action – adducts and medial rotates Innervation – Obturator nerve
Pectineus Origin - pubis Insertion – lesser trochanter Action – adducts, medial rotates Innervation – femoral, sometimes
obturator Gracilis
Origin - pubis Insertion – medial tibia Action – adducts thigh, flex, medial,
rotates leg Innervation – Obturator nerve
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Posterior Compartment - Hamstring Biceps femoris (2 heads)
Origin – ischial tuberosity, distal femur
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!!!
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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
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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 nerve
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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 nerve
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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 (variable) Origin – posterior femur Insertion – same as above! Action – plantarflex foot, week knee
flexionAll innervated by the tibial nerve
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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
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Innervation
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Plexuses of the Lower Limb “Lumbosacral plexus” Lumbar Plexus
Arises from L1-L4 Lies within the psoas major
muscle Mostly anterior structures
Sacral Plexus Arises from spinal nerve
L4-S4 Lies caudal to the lumbar
plexus Mostly posterior structures
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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
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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
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Sacral Plexus (continued)
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
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Vasculature
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Arteries
Common iliac (from aorta) branches into: Internal iliac
Supplies pelvic organs
External iliac Supplies lower limb
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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
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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 toes
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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)