Introduction to the Lower Limb - Ohio University

Introduction to the Lower Limb - Ohio University

Organization of the Lower Limb Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006. Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition. Segments of the Lower Limb Limb Girdle pelvic girdle (gluteal)

Free limb - thigh - leg - foot Limb Development Lower limb develops in an

anterolateral position at the level of the L2 to S3 trunk segments Great toe positioned in cephalic direction with the soles of the feet in an ateriomedial direction Knee positioned in a

posteriolateral position Limb Rotation Lower Limb Rotation Medial rotation Adduction

Extension Joints of the Lower Limb Articulation with Axial Skeleton Sacroiliac jt. Sternoclavicular jt,

Os Coxae Hemipelvis is composed of the ilium, ischium and pubis with articulations centered in acetabulum triradiate articulation Fusion of the 3 bones is complete between 20 and 25 years of age Tri-radiate Articulation

Sacroiliac Joint Auricular articular surfaces Sacroiliac Joint Anterior sacroiliac ligaments Sacroiliac joint Posterior sacroiliac

ligaments Joints of the Free Limb Hip Polyaxial ball and socket joint: Felxion/extension Adduction/abduction Medial/lateral rotation Iliofemoral lig. Pubofemoral lig.

Ischiofemoral lig. Joints of the Free Limb Knee Modified hinge joint Tibiofemoral artic. Patelofemor al artic. Femur

Tibia Patella Joints of the Free Limb Ankle (talocrural) joint Hinge joint 1 axis of movement: Dorsiflexion/plantarflexi on Joints of the Free Limb

Foot Interphalangeal joints: Distal Proximal metatarsophalangeal joints Inversion/eversion occurs at subtalar (talocalcaneal) joint Vasculature of the

Lower Limb Superficial Veins Great saphenous v. Small saphenous v. Arterial Blood

Supply External Iliac a Internal Iliac a Femoral a Superior gluteal a Inferior gluteal a Popliteal a Anterior

tibial a Posterior tibial aa dorsalis pedis med/lat plantar a Obturator a

Deep Femoral Artery Medial & lateral femoral circumflex arteries Fascial Compartments Fascia of the Lower Limb Gluteal Fascia Fascia

Fascia Lata Crural Fascial Compartments of the Thigh anterior compartment Fascial septa divide limb into compartments

medial compartment posterior compartment Fascia Lata Medial (adductor) compartment Posterior compartment

Anterior compartment Fascial Compartments of the Leg anterior compartment Anterior crural compartment lateral compartment

Lateral crural compartment posterior compartment Posterior crural compartment anterior lateral

Superficial & deep posterior crural compartments Crural Fascia posterior Lumbosacral Plexus Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)

Lumbosacral Plexus L1 - S3 Gluteal innervation: Superior gluteal n gluteus medius m.

gluteus minimus m. tensor fascia lata Inferior gluteal n (L4,5, S1): (L5, S1,2):

gluteus maximus m. N to obturator internus (L5, S1, 2): oburator internus superior gemellus Nerve to quadratus femoris (L4,5, S1): inferior gemellus quadratus femorus

Compartmental Innervation Of the Free Limb Anterior compartmen t Thigh Leg Foot

Medial compartment Posterior compartme nt Lateral compartmen t Anterior (extensor) compartment of the

thigh Innervation: femoral nerve anterior anterior Medial (adductor) compartment of the thigh Innervation: obturator nerve*

media l media l *Adductor Magnus innervated by both obturator n and tibial division of sciatic n Posterior compartment of the thigh

Hamstring mm: arise from ischial tuberosity & are innervated by tibial division of sciatic n. Innervation: Tibial division of sciatic nerve Except short head of biceps femoris: common fibular division of sciatic nerve

posterior Posterior compartment of the leg Innervation: tibial n. Superficial posterior crural compartment posterior Deep posterior

crural compartment Plantar surface of the foot Innervation: Medial & lateral plantar nerves Innervation of intrinsic muscles of the foot Medial plantar n

flexor digitorum brevis flexor hallucis brevis abductor hallucis m 1st lumbrical Lateral plantar n abducator digiti minimi quadratus plantae 2nd, 3rd & 4th lumbricals adductor hallucis Flexor digiti minimi dorsal & plantar interossei

Common fibular nerve Nerve supply to the lateral and anterior crural compartments anterior lateral anterior lateral Lateral crural

compartment: Superficial fibular nerve Fibularis longus Fibularis brevis lateral Anterior crural compartment: Deep fibular nerve Tibialis anterior m. Extensor hallucis longus m.

Extensor digitorum longus m. Fibularis tertius m. anterior Dorsum of the foot: deep fibular nerve Extensor hallucis brevis Extensor digitorum brevis Compartmental Innervation of Free Limb

Anterior compartme nt Thigh Femoral n. Medial compartme nt

Posterior compartme nt Obturator n.* Tibial division of sciatic n. * *adductor magnus -

*short head of biceps obturator n and tibial n femoris - common fib. division of sciatic n. Leg Deep fibular n.

Tibial nerve Foot Deep fibular n. Tibial n. (medial and lateral plantar n.)

Lateral compartme nt Superficial fibular n. Dermatomes Key dermatomes* thumb - C6

5th digit of hand C8 nipples - T4 umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root Key dermatomes* of the Lower

Limb umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root Cutaneous Nerve Supply to the Lower Limb

References Clemente, C. 1997 Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins. Rinabesm C,H, 1972. Cunninghams Textbook of Anatomy, 11th edition. Oxford University Press. Rosse, C & Gaddum-Rosse, P. 1997. Hollinsheads Textbook of Anatomy 5th edition. LippincottRaven Schuenke, M et al, 2006 Thieme Atlas of Anatomy: Musculoskeletal System. Thieme. Slaby, F., et al. 1994. Gross Anatomy in the Practice of Medicine. Lea & Febiger.

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