Introduction Lower limb is designed to support the body, its weight & it is mainly responsible for gait Organization of the Lower Limb Lower limb has four parts Thigh Leg Ankle Foot Superficial fascia of the lower Limb Fatty & Membranous layers Superficial nerves, superficial vessel, & superficial inguinal lymph nodes are present b/w these two layers.
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pelvis
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Hip bone
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femur
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Movement at hip joint
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Deep fascia of the lower limb
Fascia Lata (deep fascia of the thigh) Crural Fascia (deep fascia of the leg) Iliotibial Trat Saphenous Opening
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Saphenous Opening
supe fascial Veins: Great Saphenous Vein Small Saphenous VeinAn opening or a gape in the deep fascia in the front of the thigh 4cm inferolateral to the pubic tubercle. The saphenous opening is covered by loose CT called CRIBRIFORM fascia.
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Fascial Compartments of the Thigh
Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur. Making Anterior posterior & Medial compartments. Having muscles, nerves & arteries.Dr. Vohra
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*Muscles of the Anterior Fascial Compartments of the Thigh
*Muscles of the Anterior Fascial Compartments of the Thigh Quadriceps Femoris
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Blood Supply of the Anterior Fascial Compartments of the Thigh Femoral Artery main artery of lower limb
Origin Continuation of Ext. Iliac artery below the inguinal ligament. Enters the thigh midway between the ant. Sup. Iliac spine & pubic Symphysis Termination Ends at the opening in the adductor magnus muscle by entering the popliteal fossa as popliteal artery
Branches Superficial: Sup. Ext. Pudendal Sup. Epigastric Sup circumflex iliac Deep: Profunda femoris Deep Ext. pudendal Descending genicular
Lat. Cir femoral Med. Cir. Femoral 4 perforating a
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Femoral artery
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Femoral nerve (L2,3,4)
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Femoral Triangle
A triangular depressed area situated in the upper part of the frontof the thigh just below the inguinal ligament
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Contents of the triangle
1-Femoral sheath It is an extension of the transveralis fascia of the abdominal cavity which surrounds the upper 2-3 cm of the femoral vessels below the inguinal ligament. The sheath is divided into 3 compartments, the femoral artery occupy the lateral part of the sheath while the vein is intermediate, medial to the femoral vein is the tubular femoral canal, through which femoral hernia may pass.Dr. Vohra
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*The medial side (adductor) of the thigh
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*Adductor M.
InsertionOrigin
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The obturator nerve
: arises from the lumbar plexus in the abdomen it descends medial to the psoas m. at the lateral wall of the pelvis here it join the obturator vessels and enters the obturator canal where it divides into anterior and posterior branches: Anterior branch: descends in the thigh between adductor longus and adductor brevis muscles it sends branches to the these two muscles and gracilis m it also supply the hip joint. Posterior branch: pierces the obturator externus m. and descends between adductor brevis and magnus muscles. Supply these 3 muscles and ends as an articular branch through adductor magnus to the back of the knee jointDr. Vohra
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OBT. N
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Obturator artery:
It is a branch of Internal iliac artery,passes through obturator canal,divides into anterior and posterior brancheswhich form a circle andanastomoses with medial circumflex femoral artery. Supplies the neighbouring muscles and hip joint.
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*adductor canal
Dr. Vohra* An intermuscular cleft situated on the medial aspect of the middle 3rd of the thigh Contents of adductor canal Femoral artery & vein Saphenous nerve Nerve to vastus med Obturator nerve Profunda femoris
Femoral artery & vein Catherization Varicose veins Veinous cut down Saphenous vein in coronary bypass surgery Femoral hernia
Clinical Notes
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gluteal region
Extends from the iliac crest above to the gluteal fold below. The superficial fascia is thick dense and fatty,Dr. Vohra
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The greater &lesser sciatic foramen:
Sacrotuberous ligament ,Sacrospinous ligament
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Structures which enter the gluteal region from the pelvis
which include1-Superior gluteal vessels and nerves. 2-the piriformis muscle3-.inferior gluteal vessels and nerves 4-sciatic nerve, 5-the posterior cutanous of the thigh 6-pudendal nerve7—nerve to quadrates femoris The lesser sciatic foramen:, transmits structures between the gluteal region and the perineum these include; the internal pudendal vessels, pudendal nerve and nerve to obturator internus muscle. Dr. Vohra*
Muscles of the gluteal region :
Superficial abductors and extenders – A group of large muscles that abduct and extend the femur. It includes the gluteus maximus, gluteus medius, gluteus minimus and tensor fascia lata.Deep lateral rotators – A group of smaller muscles, that mainly act to laterally rotate the femur. It includes the quadratus femoris, piriformis, gemellus superior, gemellus inferior and obturator internus and obturator externus .Glut. region
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*Greater S.F transmit : 1. piriformis 2. sup. Gluteal n. and vessels. 3.infer. Glut. N. and vessels . 4sciatic n. 5. post. Cut. N of thigh. 6. pudendal n. 7. nerve to quadratus femoris m. lesser s. f. transmit pdendal n., internal pudendal art. And nerve to obtur. Intern . M . .
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Artery of gluteal region
Superior gluteal arteryI nferior gluteal arteryGluteal nerve
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Deep lateral rotators
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The back of the thigh
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Action hamstring muscles are extensors of the hip joint and flexors of the knee joint. In addition both semiten.and semimem.act as medial rotaters of leg when knee joint semiflexed.biceps femoris act as lateral rotater of leg when knee joint semiflexed
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Sciatic nerve
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*The popliteal fossa
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HIP JOINT
it is a synovial joint of ball and socket type, the joint formed between the head of the femur and the acetabulum, the articular surface of which is horseshoe shaped and is deficient inferiorly at the acetabular notch. The cavity of the acetabulum is deepened by the presence of a fibrocartilaginous rim called the acetabular labrum, the labrum is connected across the acetabular notch by the transverse acetabular ligament. The strength and stability of the joint depend on : 1- depth of the acetabulum which increased by the labrum acetabulae. 2- The strong ligaments and mLigaments of the joint
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