Download MBBS Anatomy PPT 89 Introduction Interior Extremity Notes

gibbons

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humans

gorillas

bonobos

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chimps

orangutans

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orangutans

bonobos

chimps

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gorillas

gibbons

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humans

Campbell and Loy, Humankind Emerging, 8th ed, p. 138f

Is Bipedalism is bad for your health?

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Pulled muscles, slipped discs & rheumatism

Varicose veins

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Calluses/flat feet

Haemorrhoids !!!!
Bipedal Locomotion

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Why bipedalism?

Apes

The ability to assume a fairly

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erect posture produced

important changes

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Chimpanzee

The Primates, Time-Life (1974) p. 71

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Bipedalism

Bipedalism is related to tool

use

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Bipedalism

Bipedalism also makes hunting

more energy efficient

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Bipedalism

Seed and nut gathering

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and

Feeding from bushes

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Bipedalism

Bipedalism and vision

(visual surveillance)

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Bipedalism

body temperature

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Organization of the Lower Limb

Segments of the Lower Limb

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? Limb Girdle

? pelvic girdle (gluteal)

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? Free limb

- thigh

- leg

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- foot
Parts and regions of the lower limb

? Gluteal region:between iliac

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crest superiorly and gluteal
fold inferiorly

? Thigh:between hip and knee

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? Knee:joint between leg and

thigh

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? Leg:between knee and foot

? Ankle

? Foot

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Composition of Lower Limb

? Skeleton (homologous with upper limb)
? Muscles--anterior, posterior compartments

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? Nerves--sciatic, femoral, Obturator
? Surface anatomy


Bones of the Lower Limb

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? Function:

? Locomotion
? Carry weight of entire erect body

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? Support
? Points for muscular attachments

? Components:

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? Thigh

? Femur

? Knee

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? Patella

? Leg

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? Tibia (medial)
? Fibula (lateral)

? Foot

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? Tarsals (7)
? Metatarsals (5)
? Phalanges (14)

Thigh

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? Femur

? Largest, longest,

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strongest bone in the
body!!

? Receives a lot of stress
? Courses medially

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? Articulates with

acetabulum proximally

? Articulates with tibia and

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patella distally


Knee

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? Patella

? Triangular sesamoid

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bone

? Protects knee joint

? Improves leverage of

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thigh muscles acting
across the knee

? Contained within

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patellar ligament

Leg

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? Tibia

? Receives the weight of body from

femur and transmits to foot

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? Second to femur in size and weight
? Articulates with fibula proximally

and distally

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? Interosseous membrane

? Fibula

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? 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

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body

? Act as a lever to propel the

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body forward

? Parts:

? Tarsals

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? Talus = ankle

? Calcaneus = heel
? Navicular

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? Cuboid
? Medial, lateral and

intermediate cuneiforms

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? Metatarsals
? Phalanges

Fascia of the Lower Limb

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Gluteal Fascia Fascia Lata

Crural Fascia

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Fascial Compartments of the Thigh

anterior compartment

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Fascia Lata

medial compartment

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posterior compartment

Anterior compartment

Medial (adductor) compartment

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Posterior compartment

Deep fascia ? fascia lata

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Iliotibial tract

Saphenous hiatus

falciform margin

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cribriform fascia
Anterior/Posterior compartments

ANTERIOR

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POSTERIOR

COMPARTMENT COMPARTMENT

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MOVEMENT

Extension

Flexion

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MUSCLES

Quads

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Hamstrings

Shin

Gastrocs

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NERVES

Femoral n.

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Sciatic n.

(lumbar plexus)

(sacral plexus)

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Muscles of Hip and Thigh

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? Gluteals

? Posterior pelvis
? Extend thigh

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? Rotate thigh
? Abducts thigh

? Anterior Compartment Thigh

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? Flexes thigh at hip
? Extends leg at knee

? Medial/Adductor Compartment

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? Adducts thigh
? Medially rotates thigh

? Posterior Compartment Thigh

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? Extends thigh
? Flexes leg

Gluteals

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? Gluteus maximus

? Action - Extends thigh, some lateral rotation

and abduction

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? Gluteus medius
? Gluteus minimus

? Action - Abduction, medial rotation

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? Lesser Gluteals help stabilize hip to

allow fluent bipedal walking

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Posterior Pelvis

? Tensor fasciae latae

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? Action - Flex thigh, abduct

thigh, medial rotation of thigh

Anterior Compartment Thigh

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? Quadriceps femoris

? Rectus femoris
? Vastus lateralis

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? Vastus medialis
? Vastus intermedius

? Action ? extends knee

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? Sartorius

All above innervated by the femoral nerve!!!

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Anterior Compartment Thigh

? Iliopsoas

?

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Medial compartment (obturator n.)

? Adductor muscles

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? Gracilis

? Adductor

? Magnus

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? Longus
? brevis


Posterior Compartment - Hamstring

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? Biceps femoris (2 heads)

? Action - thigh extension, knee

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flexion, lateral rotation

? Semitendinosus

? Semimembranosus

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? Action - thigh extension, knee

flexion, medial rotation

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Sciatic nerve innervates all of the above muscles!!!

Muscles of the Leg

? Anterior Compartment

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? Dorsiflex ankle, invert foot,

extend toes

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? Innervation: Deep fibular

nerve

? Lateral Compartment

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? Plantarflex, evert foot
? Innervation: Superficial

Fibular nerve

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? Posterior Compartment

? Superficial and deep layers
? Plantarflex foot, flex toes

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? Innervation: Tibial nerve


Anterior Compartment

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? Tibialis anterior

? Action - dorsiflexion, foot inversion

? Extensor digitorum longus

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? Action ? toe extension

? Extensor hallucis longus

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? Action - extend big toe, dorsiflex foot

All innervated by deep fibular nerve

Lateral Compartment

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? Fibularis (peroneus) longus

? Action - plantarflex, evert foot

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? Fibularis (peroneus) brevis

? Action ? same as above!!

All innervated by the superficial fibular nerve

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Superficial Posterior Compartment

? Triceps surae

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? Gastrocnemius (2 heads)

? Origin - medial and lateral condyles of femur

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? Insertion - posterior calcaneus via Achilles

tendon

? Soleus

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? Origin ? tibia and fibula

? Insertion ? same as above

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? Action of both ? plantarflex foot

? Plantaris (variable)

? Origin ? posterior femur

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? Insertion ? same as above!
? Action ? plantarflex foot, week knee flexion

All innervated by the tibial nerve

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Deep Posterior Compartment

?

Popliteus

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? Origin - lateral condyle femur

and lateral meniscus

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? Insertion ? proximal tibia
? Action ? flex and medially rotate leg

?

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Flexor digitorum longus

? Origin - tibia
? Insertion - distal phalanges of toe 2-5
? Action ? plantarflex and invert foot, flex toe

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?

Flexor hallucis longus

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? Origin - fibula
? Insertion - distal phalanx of hallux
? Action - plantarflex and invert foot, flex toe

?

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Tibialis posterior

? Origin ? tibia, fibula, and interosseous

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membrane

? Insertion - tarsals and metatarsals
? Action - plantarflex and invert foot

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All innervated by the tibial nerve

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Leg movements by compartment (in

leg all nare branches of sciatic)

Intrinsics of foot

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Frolich, Human Anatomy,
Lower LImb

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Innervation

Plexuses of the Lower Limb

? "Lumbosacral plexus"

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? Lumbar Plexus

? Arises from L1-L4
? Lies within the psoas major

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muscle

? Mostly anterior structures

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? Sacral Plexus

? Arises from spinal nerve L4-S4
? Lies caudal to the lumbar

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plexus

? Mostly posterior structures

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Lumbar Plexus

?

Femoral nerve

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? Cutaneous branches

? Thigh, leg, foot (e.g. saphenous nerve)

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? Motor branches

? Anterior thigh muscles (e.g. quadriceps, sartorius,

iliopsoas)

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?

Obturator nerve

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? Sensory

? Skin medial thigh; hip, knee joints

? Motor

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? Adductor muscles

?

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Lateral femoral cutaneous

? Sensory

? Skin lateral thigh

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?

Genitofemoral

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? Sensory

? Skin scrotum, labia major, anterior thigh

? Motor

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? Cremaster muscle

Sacral Plexus

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? Sciatic

? Motor:

? Hamstring

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? Branches into:

? Tibial nerve

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? Cutaneous

? Posterior leg and sole of foot

? Motor

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? Posterior leg, foot

? Common fibular (peroneal) nerve

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? Cutaneous

? Anterior and lateral leg, dorsum foot

? Motor

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? Lateral compartment, tibialis anterior, toe

extensors

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? Superior gluteal nerve

? Motor

? Gluteus medius and minimus, tensor fasciae

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latae


Sacral Plexus (continued)

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? Inferior gluteal nerve

? Motor

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? Gluteus maximus

? Posterior femoral cutaneous

nerve

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? Sensory

? Inferior buttocks, posterior

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thigh, popliteal fossa

? Pudendal nerve

? Sensory

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? External genitalia, anus

? Motor

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? Muscles of perineum

Vasculature

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Arteries

? Common iliac (from aorta)

branches into:

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? Internal iliac

? Supplies pelvic organs

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? External iliac

? Supplies lower limb

Arteries

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? Internal iliac branches into:

? Cranial and Caudal Gluteals

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(Superior and Inferior)

? Gluteals

? Internal Pudendal

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? Perineum, external genitalia

? Obturator

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? Adductor muscles

? Other branches supply rectum,

bladder, uterus, vagina, male

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reproductive glands


Arteries

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? External iliac becomes.......

? Femoral

? Once passes the inguinal ligament

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? Lower limb
? Branches into Deep femoral

? Adductors, hamstrings, quadriceps
? Branches into Medial/lateral femoral circumflex

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? Head and neck of femur

? Femoral becomes......

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? Popliteal (continuation of femoral)

? Branches into:

? Geniculars

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? Knee

? Splits into:

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? Anterior Tibial

? Anterior leg muscles, further branches to feet

? Posterior Tibial

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? Flexor muscles, plantar arch, branches to toes

Veins

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? Deep Veins: Mostly share names of

arteries

? Ultimately empty into Inferior Vena Cava

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? Plantar

? Tibial

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? Fibular

? Popliteal

? Femoral

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? External/internal iliac

? Common iliac

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? Superficial Veins

? Dorsal venous arch (foot)
? Great saphenous (empties into femoral)
? Small saphenous (empties into popliteal)

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SURFACE ANATOMY

All of the following structures

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are palpable in the inguinal
region:
Symphysis pubis.
Body of pubis.
Pubic tubercle.

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Anterior Superior Iliac
Spine.


The inguinal ligament extends

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between:

pubic tubercle and

ASIS.

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In the mid-inguinal point you can
feel the pulsations of the femoral
artery.
The femoral vein lies on the

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medial side of the artery.
While the femoral nerve lies lateral
to the artery.

54

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? Midinguinal point:

? It is a point on the inguinal

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ligament midway between the
symphysis pubis and the ASIS.

? The femoral artery is an important

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site for vascular access as a large
number of arteriographic
procedures are undertaken
through its percutaneous
puncture, (coronary angiography).

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55


Anterior Compartment of Thigh

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Superficial structures

Cutaneous nerves:

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Femoral branch of jenitofemoral
n.

ilioinguinal n.

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Lateral cutaneous n. of thigh

Anterior cutaneous n. of thigh

medial cutaneous n. of thigh

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Key dermatomes* of
the Lower Limb

umbilicus - T10

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hip crease - L1

great toe - L4

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5th toe - S1

*area of skin supplied by a
dorsal nerve root

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Cutaneous Nerve

Innervation

of the Lower Limb

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Superficial arteries:

superficial epigastric

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a.
superficial iliac
circumflex a.
external pudendal a.

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Superficial veins

Superficial epigastric v.

Superficial circumflex iliac v.

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Superficial External

pudendal v.

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Superficial lateral femoral v.

Great saphenous v.

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Superficial inguinal

lymph nodes:

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Horizontal group

Vertical group

Superficial inguinal

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lymph nodes

Superior group:

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Lies just distal to the

inguinal ligament

Receive lymph from

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anterior abdominal wall
below umbilicus, gluteal
region, perineal region,
external genital organs

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Superficial inguinal lymph nodes

Inferior group:

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Lies vertical along the

terminal great
saphenous v.

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Receives all superficial

lymphatics of lower limb,
except for those from

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the posterolateral part
of calf

Efferent vessels drain into

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the deep inguinal ln. or
external iliac ln.

THE FEMORAL TRIANGLE

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SIGNIFICANCE

? The femoral triangle is a hollow in

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the anterior thigh region.

? Many large neurovascular structures

pass through this area, and can be

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accessed relatively easily.

? Thus, it is an area of both anatomical

and clinical importance.

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Surface anatomy of the femoral

triangle

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BOUNDARIES

? Superior border ? Formed by

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the inguinal ligament.

? Lateral border ? Formed by

the medial border of the

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sartorius muscle.

? Medial border ? Formed by

the

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medial

border

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of

the adductor longus muscle.
The rest of this muscle forms
part of the floor of the

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triangle.

THE FEMORAL TRIANGLE

? It also has a floor and a

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roof:

? Anteriorly, the roof of the

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femoral triangle is formed
by the fascia lata.

? Posteriorly, the base of the

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femoral triangle is formed
by the pectineus, iliopsoas
and adductor longus
muscles.

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Inguinal Ligament

? The inguinal ligament

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acts as a flexor
retinaculum, supporting
the contents of the
femoral triangle during
flexion at the hip

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The contents of the femoral triangle

? Contents
? The femoral triangle

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contains some of the
major neurovascular
structures of the lower
limb. Its contents (lateral

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to medial) are:

? Femoral nerve ?

Innervates the anterior

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compartment of the
thigh, and provides
sensory branches for the
leg and foot.

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The contents of the femoral triangle

? Femoral artery ?

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Responsible for the
majority of the arterial
supply to the lower limb.

? Femoral vein ? The great

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saphenous vein drains
into the femoral vein
within the triangle.

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? Femoral canal ? A

structure which contains
deep lymph nodes and
vessels

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