Muscles of the Lower Muscles of the Lower LimbLimb

Dr. Emad I ShaqouraDr. Emad I Shaqoura

IUG Faculty of MedicineIUG Faculty of Medicine

Thigh: anterior & medial Thigh: anterior & medial aspects:aspects:

Cutaneous Nerves:Cutaneous Nerves: The lateral cutaneous The lateral cutaneous nerve of the thigh, a branch of the lumbar nerve of the thigh, a branch of the lumbar plexus (L2 and 3), enters the thigh behind plexus (L2 and 3), enters the thigh behind the lateral end of the inguinal ligamentthe lateral end of the inguinal ligament

Femoral branch of the genitofemoral nerveFemoral branch of the genitofemoral nerve Ilioinguinal nerve Ilioinguinal nerve Medial cutaneous nerve of the thigh Medial cutaneous nerve of the thigh Intermediate cutaneous nerve of the thigh Intermediate cutaneous nerve of the thigh

Superficial VeinsSuperficial Veins The The great saphenous veingreat saphenous vein:: ascends in ascends in

the medial side in company with the the medial side in company with the saphenous nerve and passes behind the saphenous nerve and passes behind the knee and curves forward around the medial knee and curves forward around the medial side of the thigh. It passes through the side of the thigh. It passes through the lower part of the saphenous opening in the lower part of the saphenous opening in the deep fascia and joins the femoral vein deep fascia and joins the femoral vein about 1.5 in. (4 cm) below and lateral to about 1.5 in. (4 cm) below and lateral to the pubic tuberclethe pubic tubercle

It receives three tributaries:It receives three tributaries: the superficial the superficial circumflex iliac vein, the superficial circumflex iliac vein, the superficial epigastric vein, and the superficial external epigastric vein, and the superficial external pudendal vein pudendal vein

Superficial VeinsSuperficial Veins

Small saphenous vein:Small saphenous vein: arises from the arises from the lateral part of the dorsal venous arch of lateral part of the dorsal venous arch of the foot (Fig. 10-19). It ascends behind the foot (Fig. 10-19). It ascends behind the lateral malleolus in company with the the lateral malleolus in company with the sural nerve. It runs up the middle of the sural nerve. It runs up the middle of the back of the leg. The vein pierces the back of the leg. The vein pierces the deep fascia and passes between the two deep fascia and passes between the two heads of the gastrocnemius muscle in heads of the gastrocnemius muscle in the lower part of the popliteal fossa. It the lower part of the popliteal fossa. It ends in the popliteal vein.ends in the popliteal vein.

Inguinal Lymph Nodes Inguinal Lymph Nodes

Superficial Inguinal Lymph Nodes:Superficial Inguinal Lymph Nodes: The superficial nodes lie in the The superficial nodes lie in the

superficial fascia below the inguinal superficial fascia below the inguinal ligament and can be divided into a ligament and can be divided into a horizontal and a vertical group horizontal and a vertical group

Deep Inguinal Lymph Nodes:Deep Inguinal Lymph Nodes: The The deep nodes are located beneath deep nodes are located beneath the deep fascia and lie along the the deep fascia and lie along the medial side of the femoral vein medial side of the femoral vein

Superficial & Deep Fascia Superficial & Deep Fascia of the Thigh:of the Thigh: Superficial FasciaSuperficial Fascia of the Thigh :of the Thigh : fatty layer of the fatty layer of the

superficial fascia.superficial fascia. Deep Fascia of the Thigh (Fascia Lata):Deep Fascia of the Thigh (Fascia Lata): encloses encloses

the thigh like a trouser leg and at its upper end is the thigh like a trouser leg and at its upper end is attached to the pelvis and the inguinal ligament. On attached to the pelvis and the inguinal ligament. On its lateral aspect, it is thickened to form the its lateral aspect, it is thickened to form the iliotibial iliotibial tracttract , which is attached above to the iliac tubercle , which is attached above to the iliac tubercle and below to the lateral condyle of the tibia.and below to the lateral condyle of the tibia.

saphenous openingsaphenous opening is a gap in the deep fascia in is a gap in the deep fascia in the front of the thigh just below the inguinal ligament. the front of the thigh just below the inguinal ligament. It transmits the great saphenous vein, some small It transmits the great saphenous vein, some small branches of the femoral artery, and lymph vessels. branches of the femoral artery, and lymph vessels. saphenous opening is a gap in the deep fascia in the saphenous opening is a gap in the deep fascia in the front of the thigh just below the inguinal ligament. It front of the thigh just below the inguinal ligament. It transmits the great saphenous vein, some small transmits the great saphenous vein, some small branches of the femoral artery, and lymph vessels branches of the femoral artery, and lymph vessels

Fascial Compartments of Fascial Compartments of the Thigh: the Thigh: Three fascial septa pass from the inner Three fascial septa pass from the inner

aspect of the deep fascial sheath of aspect of the deep fascial sheath of the thigh to the linea aspera of the the thigh to the linea aspera of the femur: The compartments are femur: The compartments are anterioranterior, , medialmedial, and , and posteriorposterior in position. in position.

Contents of the Anterior Fascial Contents of the Anterior Fascial Compartment of the Thigh:Compartment of the Thigh:

Muscles: Sartorius, iliacus, psoas, Muscles: Sartorius, iliacus, psoas, pectineus, and quadriceps femorispectineus, and quadriceps femoris

Blood supply: Femoral arteryBlood supply: Femoral artery Nerve supply: Femoral nerveNerve supply: Femoral nerve

Femoral TriangleFemoral Triangle

It is a triangular depressed area situated in the upper It is a triangular depressed area situated in the upper part of the medial aspect of the thigh just below the part of the medial aspect of the thigh just below the inguinal ligament. inguinal ligament. Its boundaries are as follows:Its boundaries are as follows:

Superiorly:Superiorly: The inguinal ligament. The inguinal ligament. Laterally:Laterally: The sartorius muscle. The sartorius muscle. Medially:Medially: The adductor longus muscle. The adductor longus muscle. Its floorIts floor is gutter shaped and formed from lateral to is gutter shaped and formed from lateral to

medial by the iliopsoas, the pectineus, and the medial by the iliopsoas, the pectineus, and the adductor longus. Its roof is formed by the skin and adductor longus. Its roof is formed by the skin and fasciae of the thigh.fasciae of the thigh.

The femoral triangle containsThe femoral triangle contains the terminal part of the the terminal part of the femoral nerve and its branches, the femoral sheath, femoral nerve and its branches, the femoral sheath, the femoral artery and its branches, the femoral vein the femoral artery and its branches, the femoral vein and its tributaries, and the deep inguinal lymph nodes.and its tributaries, and the deep inguinal lymph nodes.

Adductor (sub-sartorial) Adductor (sub-sartorial) CanalCanal It is an intermuscular cleft situated on the medial It is an intermuscular cleft situated on the medial

aspect of the middle third of the thigh beneath the aspect of the middle third of the thigh beneath the sartorius muscle. It commences above at the apex of sartorius muscle. It commences above at the apex of the femoral triangle and ends below at the opening in the femoral triangle and ends below at the opening in the adductor magnus. the adductor magnus.

The antero-medial wallThe antero-medial wall is formed by the sartorius is formed by the sartorius muscle and fascia.muscle and fascia.

The posterior wallThe posterior wall is formed by the adductor longus and is formed by the adductor longus and magnus.magnus.

The lateral wallThe lateral wall is formed by the vastus medialis. is formed by the vastus medialis. The adductor canal containsThe adductor canal contains the terminal part of the the terminal part of the

femoral artery, the femoral vein, the deep lymph femoral artery, the femoral vein, the deep lymph vessels, the saphenous nerve, the nerve to the vastus vessels, the saphenous nerve, the nerve to the vastus medialis, and the terminal part of the obturator nerve.medialis, and the terminal part of the obturator nerve.

Muscles of the Gluteal Muscles of the Gluteal Region:Region:

Foramina of the Gluteal Foramina of the Gluteal RegionRegion

Greater Sciatic ForamenGreater Sciatic Foramen:: is formed by the greater sciatic is formed by the greater sciatic notch of the hip bone and the sacrotuberous and sacrospinous notch of the hip bone and the sacrotuberous and sacrospinous ligaments. It provides an exit from the pelvis into the gluteal ligaments. It provides an exit from the pelvis into the gluteal region.region.

The following structures exit the foramen:The following structures exit the foramen: Piriformis, Sciatic Piriformis, Sciatic nerve, Posterior cutaneous nerve of the thigh, Superior and nerve, Posterior cutaneous nerve of the thigh, Superior and inferior gluteal nerves, Nerves to the obturator internus and inferior gluteal nerves, Nerves to the obturator internus and quadratus femoris, Pudendal nerve, Superior and inferior gluteal quadratus femoris, Pudendal nerve, Superior and inferior gluteal arteries and veins, Internal pudendal artery and vein.arteries and veins, Internal pudendal artery and vein.

Lesser Sciatic ForamenLesser Sciatic Foramen:: is formed by the lesser sciatic notch is formed by the lesser sciatic notch of the hip bone and the sacrotuberous and sacrospinous of the hip bone and the sacrotuberous and sacrospinous ligaments. It provides an entrance into the perineum from the ligaments. It provides an entrance into the perineum from the gluteal region. Its presence enables nerves and blood vessels gluteal region. Its presence enables nerves and blood vessels that have left the pelvis through the greater sciatic foramen that have left the pelvis through the greater sciatic foramen above the pelvic floor to enter the perineum below the pelvic above the pelvic floor to enter the perineum below the pelvic floor.floor.

The following structures pass through the foramen:The following structures pass through the foramen: Tendon of Tendon of obturator internus muscle,Nerve to obturator internus,Pudendal obturator internus muscle,Nerve to obturator internus,Pudendal nerve,Internal pudendal artery and veinnerve,Internal pudendal artery and vein

Popliteal FossaPopliteal Fossa

The popliteal fossa is a diamond-shaped intermuscular space The popliteal fossa is a diamond-shaped intermuscular space situated at the back of the knee. It contains the popliteal situated at the back of the knee. It contains the popliteal vessels, the small saphenous vein, the common peroneal and vessels, the small saphenous vein, the common peroneal and tibial nerves, the posterior cutaneous nerve of the thigh, the tibial nerves, the posterior cutaneous nerve of the thigh, the genicular branch of the obturator nerve, connective tissue, genicular branch of the obturator nerve, connective tissue, and lymph nodes.and lymph nodes.

Boundaries:Boundaries: Laterally:Laterally: The biceps femoris above and the lateral head of The biceps femoris above and the lateral head of

the gastrocnemius and plantaris below.the gastrocnemius and plantaris below. Medially:Medially: The semimembranosus and semitendinosus above The semimembranosus and semitendinosus above

and the medial head of the gastrocnemius below.and the medial head of the gastrocnemius below. The anterior wall or floorThe anterior wall or floor is formed by the popliteal surface of is formed by the popliteal surface of

the femur, the posterior ligament of the knee joint, and the the femur, the posterior ligament of the knee joint, and the popliteus muscle.popliteus muscle.

The roofThe roof is formed by skin, superficial fascia, and the deep is formed by skin, superficial fascia, and the deep fascia of the thigh.fascia of the thigh.

Lateral Compartment of Lateral Compartment of the leg:the leg:

Posterior compartment Posterior compartment of leg: of leg: Muscles in the posterior (flexor) compartment of leg are organized Muscles in the posterior (flexor) compartment of leg are organized

into two groups, superficial and deep, separated by a layer of deep into two groups, superficial and deep, separated by a layer of deep fascia. Generally, the muscles mainly plantarflex and invert the foot fascia. Generally, the muscles mainly plantarflex and invert the foot and flex the toes. All are innervated by the tibial nerve. and flex the toes. All are innervated by the tibial nerve.

The superficial groupThe superficial group comprises three muscles-gastrocnemius, comprises three muscles-gastrocnemius, plantaris, and soleus -all of which insert onto the heel (calcaneus) of plantaris, and soleus -all of which insert onto the heel (calcaneus) of the foot and plantarflex the foot at the ankle joint. They propel the the foot and plantarflex the foot at the ankle joint. They propel the body forward off the planted foot during walking and can elevate the body forward off the planted foot during walking and can elevate the body upwards onto the toes when standing. body upwards onto the toes when standing.

Two of the muscles (gastrocnemius and plantaris) originate on the Two of the muscles (gastrocnemius and plantaris) originate on the distal end of the femur so can also flex the knee.distal end of the femur so can also flex the knee.

The The gastrocnemiusgastrocnemius muscle is the most superficial of the muscles in muscle is the most superficial of the muscles in the posterior compartment and is one of the largest muscles in the the posterior compartment and is one of the largest muscles in the leg. It originates by two heads, one lateral and one medial: leg. It originates by two heads, one lateral and one medial:

the the medial headmedial head is attached to the posterior aspect of the distal is attached to the posterior aspect of the distal femur just behind the adductor tubercle and above the articular femur just behind the adductor tubercle and above the articular surface of the medial condyle; surface of the medial condyle;

the the lateral headlateral head originates from a facet on the upper lateral originates from a facet on the upper lateral surface of the lateral femoral condyle where it joins the lateral surface of the lateral femoral condyle where it joins the lateral supracondylar line. supracondylar line.