Download MBBS 1st Year Anatomy Lower Limb Notes

LOWER Limb

Gluteal Region: OR Buttock

Bounded

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• Superially ? By iliac crest
• Inferiorly ? By fold of buttock

The Region is largely made up of gluteal Muscles and thick layer of Superficial fascia.

? Bones of The Gluteal Region:

Hip Bone

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• Ilium, Ischium, pubis form
• The hip Bone. They meet one another at the acetabulum

Femur

• Articulates above With Acetabulum ? form The hip joint
• Articulates below With tibia and patella ? form the knee joint

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Fractures of neck of femur are Common and Cause Avascular Necrosis of the head of femur ? resulting in Severe

• Excruciating pain in hip and Gluteal Region
• Unable to Walk

of femur And Cup-Shaped acetabulum of hip Bone

Articular Surfaces are Covered with Hyalin Cartilage.

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• Type Synovial Ball-and-Socket Joint
• Movements Has a Wide Range of movements
  • Flexion
  • Extension Mainly By Gluteus Maximus
  • Abduction
  • Adduction

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  • Lateral Rotation
  • Medial Rotation
  • Circumduction

• Anastomosis Around Hip Joint

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Trochanteric Anastomosis

• Provides Main Blood Supply to head of the femur.
• Arteries pass along the femoral Neck beneath the Capsule
• Arteries take part in Anastomosis
  • Superior gluteal, Inferior gluteal Artery
  • Medial femoral Circumflex Artery, Lateral femoral Circumflex Artery

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Cruciate Anastomosis

• Situated at the level of lesser trochanter of femur
• Together With trochanteric Anastomosis provides a connection b/w Internal Iliac and femoral Arteries
• Arteries take part
  • Inferior gluteal Artery

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  • Medial femoral Circumflex Artery
  • Lateral femoral Circumflex Artery
  • 1st perforating Artery Branch of profunda Artery

Femoral Neck fractures Interfere with and Completely Interrupt The Blood Supply From Root of Femoral Neck to femoral Head. Avascular Necrosis of femur head.

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Superior Gluteal, Inferior Gluteal Artery Branches of Internal Iliac Artery

Most of the blood Supply to femur head arising mostly from Medial femoral Circumflex Artery.

• Sacrotuberous Ligament

Connects the back of Sacrum to the Ischial Tuberosity

• Sacrospinous Ligament

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Connects the back of Sacrum to the spine of Ischium

The function of these Ligaments is to Stabilize The Sacrum, prevent its rotation at Sacroiliac Joint by Weight of Vertebral Column.

? Foramina of the Gluteal Region:

• Greater Sciatic foramen
  • formed by the Greater Sciatic Notch of hip bone And Sacrotuberous, Sacrospinous Ligaments
  • Provides Exit from pelvis into Gluteal region

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  • Structures exit the foramen
    • Piriformis
    • Sciatic Nerve
    • Posterior Cutaneous Nerve of thigh
    • Superior and Inferior gluteal Nerves
    • Nerves to Obturator Internus and Quadratus femoris

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    • Pudendal Nerve / Supplies Structures in The Perineum

perior and Inferior Gluteal Arteries,

Lesser Sciatic Foramen

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• formed by the lesser Siatic notch of hip bone And Sacrotuberous, Sacrospinous Ligaments
• Provides an Entrance into perineum from gluteal Region
• Structures pass Through Foramen
  • Tendon of Obturator Internus M
  • Nerve to Obturator Internus
  • Pudendal Nerve

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  • Internal pudendal Artery and Vein

? Muscles of Gluteal Region:

• Gluteus Maximus
  • Main Extensor and laterally Rotater of hip Joint
  • Extend's Knee Joint

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  • Help in Climbing up of Stairs in Standing from sitting position
  • Nerve Supply ? Inferior gluteal Nerve /L
    • When Injured
    • Weakened Hip Extension
    • Difficulty rising from a sitting

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is ideal for I/M injection.

Uppes Outer Quadran of the buttock, To avoid injury to underlying Sciatic Nerve

Sciatic Nerve

• Branch of Sacral plexus/ L4, L5, S1, S2, S3.

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• Largest Nerve In The Body
• Consist of Tibial and Common peroneal Nerves bound together Wd fascia
• Usually gives no branches in the gluteal Region

• Gluteus Medius, Gluteus Minimus
• Abducts Thigh at Hip Joint

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• Tilts pelvis when Walking to Permit opposite leg to clear ground/ Stabilizers of pelvis during Walk
• Medial Rotator's of Thigh at hip Joint
• Nerve Supply Superior Gluteal Nerve L5, S1
  • When Injured / damaged
  • Paralysis of Gluteus medius, Minimus
  • Presentation Waddling Gait "Trendelenburg's Sign" / Gait

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  • Weakness of /in Abduction of Hip
  • Patient Cannot Keep pelvis level when Standing on one leg.

Great and Small Saphenous v

Deep Vein's

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• Anterior and posterior Tibial Vein
• Popliteal Vein
• femoral Vein

Perforating Veins

Communicating Vessels That run Superficial and deep Veins. They possess valve That are arranged to prevent the flow of From deep to superficial Veins / Varicose Ve

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• Superficial Veins
• Perforating Vein's
• Deep Vein's

Femoral Vein

Popliteal Vein

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• Small Saphenous Behind lateral Malleolus
• Post. Tibial Vein <<
• Ant. Tibial Vein
• Peroneal Vein <
• Perforator

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• Lateral Margi- nal Vein

Anterior Superior Iliac Spine

? Inguinal Ligament

? Pubic Tubercle

? Saphenous opening Fascia

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>Opening in Adduct

? perforator above k

> Perforater below

A 3 perforators aF

? Posterior Arch v

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Great Saphe in front of Medi

? Medial Marg

Dorsal Metat

Dorsal digital

? Dorsal Venous Arch

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has a larger diameter

Commonly occurs in The Superficial Veins of lower limb. Varicosed Veins have many 'Causes Including

• Hereditary Weakness of Vein Walls
• Incompetent Valves of perforating Vein
• Elevated Intra abdominal pressure DIT Multiple pregnancies, Abdominal tumors.

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• Thrombophlebitis of deep Veins

Arterial Supply Of Lower Limb

• Femoral Artery
  • Origin Continuation of External iliac Artery at Mid-Inguinal Point
  • Location Anterior Compartment of Thigh
  • Termination At Adductor Hiatus in Adductor Magnus Muscle

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  • Branches Superficial
    • Superficial Circumflex Artery
    • Superficial epigastric Artery
    • Superficial external pudendal
  • Deep
    • Profunda femoris / large Artery

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    • Deep external pudendal Artery

5: 15 a large deep femoral Arte

• Medial femoral Circumflex Artery ? Supply
  • Head of femur and

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  • Gives off Musculor branches in Medi Compartment of Thigh
• Lateral femoral Circumflex Axtery >
• Perforating Arteries (four) ? Supplies Posterior Compartment of Thigh

• Popliteal Artery
  • Origin Continuation of femoral Artery at Adducitor hiatus in Adductor Magnus Muscle

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  • Location Popliteal fossa
  • Termination At the level of lower Border of popliteus Muscle by dividing into Anterior and Posterior Tibial Arteries
  • Supplies Knee Joint

• Anterior Tibial Artery
  • Smaller Terminal Branch of popliteal Artery

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  • Location ? Ant. Compartment of leg/ Courses with deep peroneal Nerve in Ant. Compartmen of leg
  • Termination terminated as

pedis Artery ? pulse on

hallucis longus Tendon; libed to note quality of blood Supply to foot.

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• Posterior Tibial Artery
  • Larger Terminal Branch of popliteal Artery
  • Location Courses with tibial Nerve in posterior Compartment of leg. Passes Post. to Medial Malleade
  • Termination Terminated by dividing into Medial and lateral plantar Arteries
  • Branches Fibular Artery ? Supply lateral Compartment of leg
    • Plantar Arterial Arch
    • Medial plantar Artery

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    • Lateral plantar Artery

? Great Saphenous Vein used for Coronary Artery Bypass Surgery.

• The iliac Crest useful Landmark in determining The proper location for a spinal tap.

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atic Drainage of lower limb &

Lymphatics

• Superficial runs along Superficial Veins
• Deep suns along Deep vein's

Cysterni Chyli

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Lymph Nodes Left lumbar trunk

?

Left Lumbar Nodes Left Sub

?

Common Iliac lymph Nodes

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?

External Iliac lymph Nodes

* lymphatics of Glans/Penis Drains into Deep Deep Inguinal Lymph Node

Supexficial Inguinal Lymph Node

• Superficial Horizontal

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• Vertical

Poplis Lymph No

Receive Super Lymph vessels

Receive Superficial Receive Superficial

?

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Lymph Vessel's From

lymph vessels from late

• Anterior Abd wall
• Bullock Side o
• below the level of

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• Thigh and le
• Umbilicus
• Medial side of leg. Kr

Next Page

?

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• Dorsal Foot

• Perineum
• Urethra
• External genitalia of Bath Sex / except testes and Glans penis

External Geniitalia

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• Skin of penis
• Scratum
• Lower 3rd of Vagina
• Anal canal below pectinate line / Distal 1/3rd of anal Canal
• Back below the level of Iliac crests (lateral Nodes of Horizontal Group)

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*Testes lymphatics Drains into Para Aortic Lymph Nodes.

lexus:

Divisi

Posterior Division

Iliohypogastric Nerve

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Ilio Inguinal Nerve

Genitofemoral Nerve (4,2)?

Lateral femoral Cutaneou's Nerve of Thigh/22,63

?

L

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L2 Ventr

L? of

Ls

Ly

?

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Spir

>

Root's

?Lumbo Sacral trunk

Obturator Nerve /L

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Femoral Nerve/22123124

Located Behind lateral end of Inguinal ligament

• Supply Skin of lateral aspect of Thigh
• Clinical Importance

Compressed during pregnancy dit Change in posture features ? Numbness, Paresis, tingling Sensation on lateral aspect of thigh

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• Total 31 Spinal Nerr

C1 Spinal Nerve Pure Motor, Laspinal Nerve >

and Remaining 29 Spimo Nerves are Mixed Ner

?

Sen

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ich of lumbar plexus (L2,3,4)

Enter's the Thigh Lateral to femoral Artery and femoral Sheath, behind Inguinal lig

• Supplies All The Muscles of Anterior Compartment of thigh

Note That femoral Nerve does not enter the Thigh Within the femoral Sheath.

• Primary Action's Extend knee

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Muscles Of Ant. Compartment Of Thigh:

IlioPsoas Muscle

Main Flexor of thigh at hip Joint

• Sartorius Muscle

.

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• Pectineus Muscle

• Quadriceps Femoris
  • All Muscles Innervat by Femoral Nerve

All Muscles are Fle of Thigh at Hip Joi

4 Muscles

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• Rectus femoris
• Vastus Medialis
• Intermedius
• Lateral

Nerve Injury

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• Weakened hip Flexion
• Weakened Knee Extension
• Sensory loss on anterior thigh, Media foot

Obturator Nerve &

Branch of Lumbar plexus (L2,3,4) Ante Division

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• Supplies Muscles of Medial Compartment Thigh
• Primary Actions Adduct Thigh, M Roitate thigh

Muscles of Medial Compartiment Of Thighs

.

• Gracilis

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• Adductor Longus
• Adductor Brevis
• Adductor Magnus
  • All Muscles Innervaited Obturactor Nerve Except Hamstring portion of Add Magnus (Sciatic Nerve)

Adductor portion

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Hamstring portion

• Obturator Externus
  • All Muscles are Adduct of thigh at Hip Joint Except amstring portion/Extend

Injury

• Sensory loss on Medial thigh

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Femoral Triangle &

A depression below the fold of the Groin in the upper part of thigh

Boundaries:

• Base Inguinal ligament
• Lateral Border Sartorius Muscle

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• Medial Border Adductor Longus Muscle
• Apex Downward & Medially
• Roof ? Skin, Superficial and Deep fascia
• Floor Muscle's (Medial to Lateral) Adductor Longus. Pectineus Iliopsoas

Contents:

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• Femoral Nerve
• Femoral Artery
• Femoral Vein, Femoral Canal
• Horizontal Group of Superficial Inguinal lymph Nodes
• Great Saphenous Vein Joins The femoral Vein

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Femoral Sheath?

Formed by downward Extension of fascia Karination Anteriorly and iliac lascia posteriorly in Ant. aspect of upper th

into 3 compartments With help of

Compar

Lateral Compartment<

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Medial Comp

D? femoral C

femoral Nerm

L? femoral Shee

outside of femoral Sheath

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-7 femoral Vein

? femoral Artery

uscle

Femoral Canal:

scia

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?

Medial Compartment of femoral She in femoral triangle

Contents:

Pad of fat Deep Inguinal lymph Nodes/Rosenm

Clinical Importance:

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femoral hernia may Descend de Through this Canal into anterior of upper Thigh

Adductor Canal / SubSartorial/ Hun

Tater Muscular Cleft Situated Beneal The Sartorius Muscle, in The Middle : of the thigh immediately distal to Ape femoral triangle

• Bounded Laterally by Vastus Medialis I Posteriorly by Adductor longus ar

Musde

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Netver.colivides

Superficial and Deep perineal

Sciatic Nerve 1

• Often damaged following posterior hip dislocation
• Complete Sciatic Nerve lesion Results in Sensory and Motor defictis in The Posterior Compartment of thigh and all functions below The Knee

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• Features of Sciatic Nerve Injury ?
  • Weakened Extension of thigh
  • Loss of flexion of Knee
  • Sensory loss on the post. Thigh and leg (except Medial Side and foot
  • Loss of All functions below the knee

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Tibial Nerve

• Larger terminal Branch of Sciatic Nerve (Ly,LS, 51, 52, 53) Anterior Division
• Supplies Muscles of post. Compartment of thi All Muscle's of post. Compartment of le Planitar Muscles of foot, *Sole Skin
• Primary Actions Flex Knee
  • Extend Thigh
  • Help in Walking

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  • Plantar flex foot (31-2)
  • on tip of toe.
  • Digit's
  • Inversion*

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akness in Knee flexion

• Weakened Inversion
• Sensory loss of log (except Medial) and plantar foot

Common Peroneal Nerve:

• Smaller Terminal Branch of. Sciatic I (Ly, L5, S1, S2) Posterior Division

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• Supply Short head of Biceps fema
• Primary Action ? Flex knee
• Crosses Lateral aspect of knee at The * Neck of fibula Where it is In most frequently damaged Nerve of The laver limb
• 2 terminal Branches arises lateral Side of Neck of fibula

? Superficial Peroneal Nerve:

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• Supply All Muscles of lateral Compartment of leg
  • Skin Overlying Dorsum
  • Primary Action ? Eversion of

? Deep Peroneal Nerve :

Supply

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• All Muscles of Anter Compartment of leg whic in Walking on Heel
• kin of space b/W 2nd digitis

• Inversion

• Common Peroneal Nerve Injury / Neck of fibula produces a Combination of defictis of lesion of Deep and Superficial Nerves...

Features of

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deep Peroneal

• Loss of Dorsiflexion / Foot Drop
• Loss of extension of digitis
• Neave Injury
• Weakened In Version

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• Sensory loss limited to Skin of 1st Web Space b/w great toe and 2nd toes.

Features of

Superficial

• Loss of Eversion of foot
• peroneal Nerve

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• Sensory loss on lateral Surface of lay and dorsum of foot
• Injury

Sensory Innervation of Lower Leg and Foot &

• Superficial Peroneal Nerve: > Dorsum of foot, Medial Side of big toe, Adjacent Sides of 2nd, 3rd, 4th and 5th toes
• Deep peroneal Nerve : 1st Dorsal Web Spa.

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• Lateral and Medial Plantar Branches of tibial Ner Sole of foot
• Sural Nerve / Combination of both peroneal and tibia branches post. leg and Lateral Side of to
• Saphenous Nerve Fedial ley and Medial foot

The body

Articula

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Above are The Rounded

Blow are the Condyles of tibia and Their Cartilaginous Menisci.

In front is the articulation b/W/ lower end of femur and The patella

Articular Surfaces of femur, Tibia, palella a Covered With Hyaline Cartidage.

Type: foi

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Joint BIW Femur and Tibia Synovia Joint of Hinge Variety.

Joint B/W patella and Jemur Syne Joint of plane gliding Variety

Knee Joint is a Weight- Bearing Joint and Stability of joint depends on Musdes (Quad femoris and hamstring Muscles) That cros The joint. The Strength of Knee Joint depe on The Strength of the ligament's tha bind femur to Tibia.

Ligaments:

Extracap sular

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• Lateral / Fibular Collateral Cordlike and is attached above to lat Condyle of femur and blow to head o fibula Portantos Medial displacemer of tibia under the femur

is allached above To

below to Medial Surface of shoft of Tibia Firmly attached to Edge of The Medial Meniscus Both Collateral ligament's are taut Wd Knee exten-

• Ligamentum Patellal
• Oblique popliteal ligament

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Iatracapsular

• Anterior Cruciate ligament / ACL : ACL is attached to Anterior Intercondylar area of Tibia and passes upward, word and laterally to be attached to the posterior part of the Medial Surface of lateral femoral Condyle

Sion

ACL prevents posterior displacement of femun on Tibia

With the knee Joint Flexed ACL prevents The Tibia from being pulled Anteriorly.

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• ACL Resists Hyperextension.
• Posterior Cruciate ligament / PCL : PCL is attached to posterior Intercondylar area of Tibia and passes upward, forward and Medially to be attached to the Anterior. Past of lateral Surface of Medial femoral Condyle

* PCL prevents Anterior displacement of femur on the tibia

With The Knee Joint Flexed PCL prevents the tibig from being pulled posteriorly

Shaped Sheets of fibrocartilage.

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hier

(femur and Tinia)

> Serve as Shock Absorbers.

CUS

ten

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Four ligaments

ton

Medial Collateral

lateral Collateral

ACL

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PCL

.

are Conomonly Injured in the knee.

• Most frequently Injured Ligament in the body ACL
• Most frequently Torn Ligament at The Kn > Tibial / Medial Collateral 15 Commonly seen following latere trauma to The knee

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Movements of Knee Joint :

• Flexion
• Extension.
• Medial Rotation
• Lateral Rotation

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Comman Knee Injuries:

3 Most Commonly Injured Structures at The Knee ar

• Tibial (Medial) Collateral
• Medial Meniscus
• ACL

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Saphenous Nerve: Branch of femoral Nerve

• Location Medial aspect of Knee J
• Sensory Innervation Medial leg and Medial
• Injury Injection in Knee Joint

Largest Sesameld bene (bone that develops.

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Tibia:

Within the tendon of Quadriceps femoris Muscle in front of the Knee Joint)

Large Weight bearing Medial bone of Theleg

Fibula:

Slender Lateral Bone of the leg

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Bones of the foot:

Tarsal Bones:

Calcaneum

• Largest bone of foot
• forms prominence of heel

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* Talus ? Only articulates With the tibia and fibula at Ankle Joint.

3 Cunliform Small - Wedged Shaped

Navicular

Cuboid

Medial, Intermediate, lateral.

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Metatarsal Bones:

• 1st three attached Nd 3 Cuneiform Bones
• 4in, 5th attached Wd Cuboid

Palangess

Each toe ha Except Big toe

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kle

Articulations

B/W lower end of tibia, the two malleoli, and the body of the talus

Articular Surfaces are Covered with Hyaline Cartilages.

Type:

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Synovial Hinge Joint

Movements:

• Dorsiflexion. > toes pointing upw
• Plantar flexion toes pointing down

The movements of Inversion, Eversion tam Place at the Tarsal Joints and Not at I Ankle Joint

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Anterior talofibular / Lateral (Collateral) lig of Ankle is frequently Damaged.

Foot Proper

Six layers in foot proper

4 layers are Muscular

2 layers are Neurovascular

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Muscular

1

2

3

5

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Neurovascular

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