Thigh and Popliteal Fossa

Superficial Venous Drainage of Lower Limbs

Great Saphenous Vein - Ascends medial side of leg and thigh, drains into femoral vein

Small Saphenous Vein - Ascends posterior aspect of leg, piercies popliteal fascia to drain into popliteal vein

Lymphatic Drainage of Lower Limb

Superficial Inguinal Nodes - follows tributaries of great and small saphenous vv. (great saph drains here)

Popliteal Nodes - (small saph drains here)

Deep Inguinal Nodes (popliteal nodes drain to deep inguinal nodes)

Cutaneous Innervation of Thigh

Genitofemoral Nerve (L1-L2) : Femoral br and Genital br

Anterior Cutaneous Branches of Femoral n. (L2-L4)

Cutaneous branches of obturator n, (L2-L4)

Lateral Cutaneous Nerve of Thigh (L2-L3)

Posterior Cutaneous n. of Thigh (S1-S3)

Dermatomes of Lower Limb

S1 - Lateral Ankle, Plantar of foot, and last 2 toes // Lateral aspect of the calcaneus (heel)

L5 - From Lateral Anterior Leg to Middle of Ankle down to first 3 toes // Dorsum of foot, over third metatarsal phalangeal joint

L4 - From Medial Anterior Leg to Medial Ankle // Over Medial Malleolus

L3 - From Knee to Thigh going high medially and low laterally // Medial Femoral Condyle of the Knee

L2 - Upper thigh

L1 - Above thigh // Inguinal Ligament Region

S4-S5 - Genitals // Perianal region, next to the opening of the sphincter

S2 - Posterior thigh and leg // Midpint of the popliteal fossa

Lumbosacral Plexus

Anterior Rami of L1-S4, Innervates lower limb, lower abdominal wall, and pelvis and perineum, sympathetic innervation from T10-L2 spinal segments, consists of Lumbar Plexus (L1-L4) anterior and medial thigh, and Sacral Plexus (L4-S4) posterior and lateral thigh, almost all of leg and foot

Anterior Division of Plexus

Supplies flexor compartment of limb (ventral mass muscles)

Posterior Division of Plexus

Extensor Compartment of Limb (dorsal mass muscles)

Femoral Triangle Borders

Base: Inguinal Ligament

Medial: Adductor Longus

Lateral: Sartorius

Apex: Intersection of sartorius and adductor longus

Arteries of Anterior and Medial Thigh

Deep Femoral

Medial and Lateral Circumflex Femoral

Perforating Branches

Obturator A. (Legg-Calve Perthes Disease)

Veins of Anterior/Medial Thigh

Femoral Vein

Tributaries: Lateral and Medial Circumflex Femoral vv. , Deep Femoral Vein, Great Saphenous Vein

Femoral N

L2-L4

Obturator N

L2-L4

Posterior Thigh is innervated by the Tibial Division of Sciatic n. for all except

Short head of biceps femoris which is common fib division of sciatic

Tibial N.

L4-S3

Arterial supply of Posterior thigh

Perforating Branches of Deep Femoral A.

Inferior Gluteal A. Supplies Superior Hamstrings

Muscular Branches from Popliteal A.

Boundaries of Popliteal Fossa

Biceps Femoris

Semimembranosus

Lateral and Medial Heads of Gastrocnemius

Hilton’s Law

Nerves supplying a joint also supply muscles moving joint and skin covering insertion of muscles

O’Loughlin’s Law

If a muscle crosses a joint, it must move that joint

Medial Collateral Ligament (MCL)

Prevents hyperABduction of leg at knee

Adheres to Medial Meniscus

Extra-articular, extra-synovial

Extends from medial epicondyle of femur to medial condyle and superomedial shaft of tibia

Injury: forced abduction of leg at knee “clipping”

Lateral Collateral Ligament (LCL)

Prevents hyperadduction of leg at knee

Extra-articular, extra-synovial

Does NOT attach to lateral meniscus

Extends from lateral epicondyle of femur to head of fibula

Anterior Cruciate Ligament (ACL)

Prevents posterior displacement of femur on tibia and hyperextension of knee joint

Intra-articular, but extra-synovial

Poor blood supply

Extends from anterior tibia to posterior portion of lateral femoral condyle

Injury: Anterior Drawer Sign and Lachman Test

Posterior Cruciate Ligament (PCL)

Prevents anterior displacement of femur on tibia and knee hyperflexion

poor blood supply

taught on flexion

Intra-articular, but extrasynovial

Extends from posterior portion of tibia to anterior portion of medial femoral condyle

The Unhappy Triad

Lateral blow to the knee

Leg forcibly abducted

laterally rotated

Injury to Medial Collateral Ligament, Medial Meniscus, Anterior Cruciate Ligament (ACL)

Knee Joint Bursae

Prepatellar Bursa: Between skin and anterior patella

Superficial Infrapatellar Bursa: Between skin and patellar ligament

What unlocks knee joint

Popliteus

Lumbrosacral Trunk

L4-L5

Lateral Femoral Cutaneous N.

L2,L3

Genitofemoral

L1,L2

Iliohypogastric N and Ilioguinal n

L1