CBIO Lower Limb

Lower Limb major functions

support

locomotion (move from one place to another)

major regions of lower limb

Gluteal

thigh

leg

foot

gluteal region

region of attachment of lower limb to trunk

muscles that move and stabilize entire limb

thigh region

“femoral”

from hip joint to knee

Leg region

posterior = sural

from knee to ankle

foot region

pedis or pedal

hip movements

extension/flexion

abduction/adduction

knee movement

flexion/extension

ankle movement

dorsiflexion(ankle up)/plantarflexion(ankle down)

pelvis movement

abduction of pelvis on fixed femur

transitional areas of lower limb

femoral triangle

popliteal fossa

tarsal tunnel

femoral triangle boundaries

inguinal ligament (superior)

sartorius muscle (lateral)

adductor longus muscle (medial)

contents of femoral triangle

VAN

femoral vein

femoral artery

femoral nerve

popliteal fossa boundaries

semitendinsosus/semimembranosis muscle

biceps femoris

medial/lateral heads of gastrocnemius muscle

anterior compartment of thigh

extensors of knee

posterior compartment of thigh

extensors of hip and flexors of knee

medial compartment of thigh

adductors of hip

anterior compartment of leg

dorsiflexion of foot, extensors of digits

posterior compartment of leg

plantar flexion of foot, flexion of digits

lateral compartment of leg

eversion of foot

innervation of leg arises from nerves of

lumbar and sacral plexuses

lumbar plexus

femoral nerve

obturator nerve

femoral nerve

most muscles of anterior thigh

obturator nerve

most muscles of medial thigh

sacral plexus

sciatic nerve

tibial nerve

common fibular

tibial nerve

most muscles of posterior thigh and leg

common fibular nerve

muscles of anterior and lateral leg

compartment syndrome

swollen muscles compress vessels and nerves in the same compartment

where is compartment syndrome most commonly seen

upper and lower extremities

causes of compartment syndrome

injury-related

exercise related

acute compartment syndrome

most common type

only lasts for a limited time

develops quickly over a few hours to a few days

usually caused from an injury such as broken arm/leg

caused by bleeding fluid retention and increased inflammation

chronic compartment syndrome

can last up to several weeks

caused from on going vigorous exercise the body can’t adjust to which leads to exceptional compartment syndrome

exceptional compartment syndrome

a form of chronic compartment syndrome

most common in parts of the body that are stressed most during heavy physical activities such as shins, knees, glutes, and thighs

the body become overly exhorted and can’t repair tissue well enough to prevent increased inflammation and pressure

abdominal compartment syndrome

rare but serious type that’s typically caused by severe injury, surgery, or illness that rapidly increases swelling

car accidents, trauma, infections, internal bleeding from the abdomen and pelvic fractures are common triggers

can be life threatening if left untreated because it cuts off blood flow from the abdominal organs: liver, kidney, and bowels

requires hospitalization

major joints

hip join

knee joint

ankle joint

hip joint

pelvic bone

femur

knee joint

femur

patella

tibia

ankle joint

tibia

fibula

talus

bones of foot

tarsals

metatarsals

phalanges

big toe is called

hallux

gluteal region: bony pelvis

os coxae

obturator foramen

sacroiliac joint

os coxae

ilium (iliac crest and anterior superior iliac spine)

ischium (ischial tuberosity)

pubis (pubic symphysis)

acetabulum

cup-shaped fusion of ilium, ischium, and pubis

socket for femoral head

socket for femoral head contents

lunate surface

acetabular fossa

acetabular fossa

origin of ligament of head of femur

proximal femur

head

neck

greater trochanter

lesser trochanter

head of femur contains

fovea capitis

hip joint

multiaxial

ball and socket

hip: gluteal region

gluteus maximus

gluteus medius and minimus

piriformis and quadratus femoris

gluteus maximus

extension of hip

gluteus maximus innervation

inferior gluteal nerve

gluteus medius and minimus

abductors

gluteus medius and minimus innervation

superior gluteal nerve

piriformis and quadratus femoris

lateral rotators

hip flexors

iliopsoas

iliopsoas

iliacus

posts major

piriformis syndrome

irritation/inflammation of piriformis and/or obturator interns

gluteal gait

aka trendelenberg’s gait or a positive trendelenburg sign

hip drops to same side as leg lifts during walking

abductor insufficiency usually caused by traumatic hip injury to superior gluteal nerve

hip injection site

gluteal region quadrants

upper lateral quadrant of hip

avoids sciatic nerve and arterial branches

deep fascia

“stocking” of the leg

deep fascia names

fascia lata

iliotibial tract

tensor fascia latte muscle

fascia lata

deep fascia is thickest around thigh and gluteal region

iliotibial tract

fascia lata is bundled into a long ligament like band from iliac crest to lateral condyle of tibia just below knee

tensor fascia latte muscle

inserts into the IT tract

arteries of lower limb

major artery of lower limb = femoral artery

femoral artery

continuation of external iliac artery from common iliac artery

all blood supply to hip, pelvis, and lower limb from CIA

deep vein

femoral vein

femoral vein

external iliac vein then common iliac being before merging to become IVC

superficial veins

great saphenous vein

small saphenous vein

great saphenous vein

longest vein in body

dorsal venous arch of foot

ascends medially to merge with femoral vein just inferior to inguinal ligament

small saphenous vein

ascends laterally from dorsal venous arch, penetrates deep fascia behind knee and merges with popliteal vein

Thigh distal femur

linea aspera

adductor tubercle

medial/lateral epicondyles

articular surfaces (patellar surface and medial/lateral condyles)

intercondylar fossa

muscles of anterior compartment of thigh

extensors of leg at knee

femoral nerve

muscles of posterior compartment of thigh

extend thigh at hip and flex leg at knee

sciatic nerve (tibial nerve except short head of biceps)

muscles of medial compartment of thigh

adduct thigh at hip

obturator nerve

thigh anterior compartment contains

iliac and psoas major

quadriceps femoris

sartorius

iliac and posts major insert where

lesser trochanter and are major flexors of thigh at hip joint

iliacus, quadriceps femoris, and sartorius are innverated by

femoral nerve

quadriceps

vastus muscles

rectus femoris

vastus muscles

lateralis, intermedius, and medialis

vastus muscles originate

along a line roughly between greater and lesser trochanter

vastus muscles insert

into patella via the quadriceps tendon which continues as the patellar ligament to the tibial tuberosity

rectus femoris

originates on hip (anterior inferior iliac spine and superior acetabulum)

extension of leg at knee and flexes thigh at hip

sartorius

flexes thigh and flexes leg in a crossing motion

sartorius inserts on

medial tibia with gracilis and semitendinosus in an arrangement called the “goose foot” (pes anserinus)

medial compartment of thigh

gracilis

pectineus

adductors longus, brevis, and magnus

muscles of medial compartment of thigh do what

adduct the thigh

(adductors longus, brevis, and magnus also medially rotate)

muscles of medial compartment of thigh are innervated by

obturator nerve

adductor longus

more anterior and superficial of the three

adductor brevis

posterior/deep to longus

adductor magnus

largest/deepest of the three

femoral artery

continues posteriorly through adductor hiatus to emerge as popliteal artery

deep artery of thigh

perforating arteries supply posterior compartment muscles

posterior compartment of thigh

lateral: biceps femoris

medial: semitendinosus and semimembranosus

posterior compartment of thigh muscles do what

all flex leg at knee

all except short head of biceps femoris extend thigh at hip

innervation of posterior compartment of thigh muscles

tibial nerve except short head of biceps femoris

the knee

the largest synovial (fluid containing) joint in the skeleton

articulations of the knee

femur-tibia (weight bearing)

femur-patella (reduces tendon wear)

locking mechanism of knee

when flexed: condyles are on their rounded surface with tibia

when extended: condyles are on their flatter, inferior surface

Menisci

lateral and medial

crescent shaped fibrocartilage