The Lower Limb - Fisiokinesiterapia extremity.pdfPlexuses of the Lower Limb “Lumbosacral plexus”...
Transcript of The Lower Limb - Fisiokinesiterapia extremity.pdfPlexuses of the Lower Limb “Lumbosacral plexus”...
The Lower Limb
Pelvis, Thigh, Legand Foot
Surface Anatomy
Surface AnatomyGluteal region / posterior pelvis
Iliac crestGluteus maximus
Cheeks
Natal/gluteal cleft Vertical midline; “Crack”
Gluteal folds Bottom of cheek; “prominence”
Surface Anatomy
Anterior thigh and legPalpate
PatellaCondyles of femur
Femoral TriangleBoundaries:
Sartorius (lateral)Adductor longus (medial)Inguinal ligament (superior)
Contents:Femoral artery, vein and nerve, lymph nodes
Surface AnatomyPosterior leg
Popliteal fossaDiamond-shape fossabehind kneeBoundaries
Biceps femoris(superior-lateral)Semitendinosis and semimembranosis(superior-medial)Gastrocnemius heads (inferior)
ContentsPopliteal artery and vein
Calcaneal (Achilles) tendon
Surface Anatomy
Anterior leg bonesTibia
Tibial tuberosityAnterior crestMedial surfaceMedial malleolus
FibulaLateral malleolus
Skeletal Composition
Bones of the Lower LimbFunction:
LocomotionCarry weight of entire erect bodySupportPoints for muscular attachments
Components:Thigh
FemurKnee
PatellaLeg
Tibia (medial)Fibula (lateral)
FootTarsals (7)Metatarsals (5)Phalanges (14)
Thigh
FemurLargest, longest, strongest bone in the body!!Receives a lot of stressCourses medially
More in women!Articulates with acetabulum proximallyArticulates with tibia and patella distally
KneePatella
Triangular sesamoidboneProtects knee jointImproves leverage of thigh muscles acting across the kneeContained within patellar ligament
LegTibia
Receives the weight of body from femur and transmits to footSecond to femur in size and weightArticulates with fibula proximally and distally
Interosseous membrane
FibulaDoes NOT bear weightMuscle attachmentNot part of knee jointStabilize ankle joint
Foot Function:Supports the weight of the bodyAct as a lever to propel the body forward
Parts:Tarsals
Talus = ankleBetween tibia and fibulaArticulates with both
Calcaneus = heelAttachment for CalcanealtendonCarries talus
NavicularCuboidMedial, lateral and intermediate cuneiforms
MetatarsalsPhalanges
Foot
3 archesMedialLateralTransverse
Has tendons that run inferior to foot bones
Help support arches of foot
FunctionRecoil after stepping
Longitudinal
Joints of Lower Limb
Hip (femur + acetabulum)Ball + socketMultiaxialSynovial
Knee (femur + tibia)Hinge (modified)BiaxialSynovialContains menisci, bursa, many ligaments
Knee (femur + patella)Plane Gliding of patellaSynovial
Joints of Lower Limb
Proximal Tibia + FibulaPlane, GlidingSynovial
Distal Tibia + FibulaSlight “give” (synarthrosis)Fibrous (syndesmosis)
Ankle (Tibia/Fibula + Talus)Hinge, UniaxialSynovial
Intertarsal & Tarsal-metatarsalPlane, synovial
Metatarsal-phalangesCondyloid, synovial
InterphalangealHinge, uniaxial
Muscles
Muscles of Hip and ThighGluteals
Posterior pelvisExtend thighRotate thighAbducts thigh
Anterior Compartment ThighFlexes thigh at hipExtends leg at knee
Medial/Adductor Compartment
Adducts thighMedially rotates thigh
Posterior Compartment Thigh
Extends thighFlexes leg
GlutealsGluteus maximus
Origin - Ilium, sacrum and coccyxInsertion - Gluteal tuberosity of femur, iliotibial tractAction - Extends thigh, some lateral rotation and abductionInnervation - Inferior gluteal nerve
Gluteus mediusGluteus minimus
Origin - Ilium Insertion - Greater trochanter of femur Action - Abduction, medial rotationInnervation - Superior gluteal nerve
Lesser Gluteals help stabilize hip to allow fluent bipedal walking
Posterior PelvisTensor fasciae latae
Origin – iliac crest and anterior inferior iliac spineInsertion – iliotibial tractAction - Flex thigh, abduct thigh, medial rotation of thighInnervation – Superior gluteal nerve
Anterior Compartment ThighQuadriceps femoris
Rectus femorisOrigin – anterior inferior iliac spine, margin of acetabulumInsertion – patella and tibialtuberosity via the patellar ligament Action – extends knee, flexes thigh
Vastus lateralisVastus medialisVastus intermedius
Origin - femurInsertion – patella and tibialtuberosity via the patellar ligamentAction – extends knee
SartoriusOrigin - anterior superior iliac spineInsertion – medial tibiaAction - flex, abduct, lat rotate thigh; weak knee flexorAll above innervated by the femoral nerve!!!
Anterior Compartment Thigh
IliopsoasOrigin - Ilia, sacrum, lumbar vertebraeInsertion – lesser trochanterAction – flexor of thighInnervation – femoral nerve
AdductorsAdductor longusAdductor brevisAdductor magnus
Origin – inferior pelvisInsertion - femurAction – adducts and medial rotatesInnervation – Obturator nerve
PectineusOrigin - pubisInsertion – lesser trochanterAction – adducts, medial rotatesInnervation – femoral, sometimes obturator
GracilisOrigin - pubisInsertion – medial tibiaAction – adducts thigh, flex, medial, rotates legInnervation – Obturator nerve
Posterior Compartment - HamstringBiceps femoris (2 heads)
Origin – ischial tuberosity, distal femurInsertion - lateral tibia, head fibulaAction - thigh extension, knee flexion, lateral rotation
SemitendinosusSemimembranosus
Origin - ischial tuberosityInsertion - medial tibiaAction - thigh extension, knee flexion, medial rotation
Sciatic nerve innervates all of the above muscles!!!
Muscles of the Leg
Anterior CompartmentDorsiflex ankle, invert foot, extend toesInnervation: Deep fibular nerve
Lateral CompartmentPlantarflex, evert footInnervation: Superficial Fibular nerve
Posterior Compartment Superficial and deep layersPlantarflex foot, flex toesInnervation: Tibial nerve
Anterior CompartmentTibialis anterior
Origin - tibiaInsertion - tarsalsAction - dorsiflexion, foot inversion
Extensor digitorum longusOrigin – tibia and fibulaInsertion - phalangesAction – toe extension
Extensor hallucis longusOrigin – fibula, interosseousmembraneInsertion – big toeAction - extend big toe, dorsiflexfoot
All innervated by deep fibular nerve
Lateral CompartmentFibularis (peroneus) longus
Origin – lateral fibulaInsertion – 5th metatarsal, tarsalAction - plantarflex, evertfoot
Fibularis (peroneus) brevisOrigin – distal fibulaInsertion - proximal fifth metatarsalAction – same as above!!
All innervated by the superficial fibular nerve
Superficial Posterior CompartmentTriceps surae
Gastrocnemius (2 heads)Origin - medial and lateral condyles of femurInsertion - posterior calcaneus via Achilles tendon
SoleusOrigin – tibia and fibulaInsertion – same as above
Action of both – plantarflex foot
Plantaris (variable)Origin – posterior femurInsertion – same as above!Action – plantarflex foot, week knee flexionAll innervated by the tibial nerve
Deep Posterior CompartmentPopliteus
Origin - lateral condyle femur and lateral meniscusInsertion – proximal tibiaAction – flex and medially rotate leg
Flexor digitorum longusOrigin - tibiaInsertion - distal phalanges of toe 2-5 Action – plantarflex and invert foot, flex toe
Flexor hallucis longusOrigin - fibulaInsertion - distal phalanx of halluxAction - plantarflex and invert foot, flex toe
Tibialis posteriorOrigin – tibia, fibula, and interosseousmembraneInsertion - tarsals and metatarsalsAction - plantarflex and invert foot
All innervated by the tibial nerve
Innervation
Plexuses of the Lower Limb“Lumbosacral plexus”Lumbar Plexus
Arises from L1-L4Lies within the psoas major muscleMostly anterior structures
Sacral PlexusArises from spinal nerve L4-S4Lies caudal to the lumbar plexusMostly posterior structures
Lumbar PlexusFemoral nerve
Cutaneous branchesThigh, leg, foot (e.g. saphenous nerve)
Motor branchesAnterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas)
Obturator nerveSensory
Skin medial thigh; hip, knee jointsMotor
Adductor musclesLateral femoral cutaneous
SensorySkin lateral thigh
GenitofemoralSensory
Skin scrotum, labia major, anterior thighMotor
Cremaster muscle
Sacral PlexusSciatic
Motor:Hamstring
Branches into:Tibial nerve
CutaneousPosterior leg and sole of foot
MotorPosterior leg, foot
Common fibular (peroneal) nerveCutaneous
Anterior and lateral leg, dorsum footMotor
Lateral compartment, tibialis anterior, toe extensors
Superior gluteal nerveMotor
Gluteus medius and minimus, tensor fasciae latae
Sacral Plexus (continued)
Inferior gluteal nerveMotor
Gluteus maximus
Posterior femoral cutaneous nerve
SensoryInferior buttocks, posterior thigh, popliteal fossa
Pudendal nerveSensory
External genitalia, anusMotor
Muscles of perineum
Vasculature
Arteries
Common iliac (from aorta) branches into:
Internal iliacSupplies pelvic organs
External iliacSupplies lower limb
Arteries
Internal iliac branches into:Cranial and Caudal Gluteals
(Superior and Inferior)Gluteals
Internal PudendalPerineum, external genitalia
ObturatorAdductor muscles
Other branches supply rectum, bladder, uterus, vagina, male reproductive glands
ArteriesExternal iliac becomes…….
FemoralOnce passes the inguinal ligamentLower limbBranches into Deep femoral
Adductors, hamstrings, quadricepsBranches into Medial/lateral femoral circumflex
Head and neck of femur
Femoral becomes……Popliteal (continuation of femoral)
Branches into:Geniculars
KneeSplits into:
Anterior TibialAnterior leg muscles, further branches to feet
Posterior TibialFlexor muscles, plantar arch, branches to toes
Veins Deep Veins: Mostly share names of arteries
Ultimately empty into Inferior Vena Cava
PlantarTibialFibularPoplitealFemoralExternal/internal iliacCommon iliac
Superficial Veins Dorsal venous arch (foot)Great saphenous (empties into femoral)Small saphenous (empties into popliteal)