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 Limb Development Lower limb develops in an anterolateral position at the level of the L2 to S3 trunk segments ID: 467856
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Slide1
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.Slide2
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 positionSlide3
Limb Rotation
Lower Limb Rotation
Medial rotation
Adduction
Extension Slide4
Segments of the Lower Limb
Limb Girdlepelvic girdle (gluteal)
Free limb
thigh
leg
footSlide5
Joints of the Lower LimbSlide6
Articulation with Axial Skeleton
Sternoclavicular jt,
Sacroiliac jt.Slide7
Sacroiliac Joint
Auricular articular surfacesSlide8
Sacroiliac Joint
Sacroiliac joint
Anterior sacroiliac ligaments
Posterior sacroiliac ligamentsSlide9
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 ageSlide10
Tri-radiate ArticulationSlide11
Joints of the Free Limb
Hip Polyaxial ball and socket joint:Felxion/extension
Adduction/abduction
Medial/lateral rotation
Iliofemoral lig.
Pubofemoral lig.
Ischiofemoral lig.
Ligament of head of femurSlide12
Joints of the Free Limb
KneeModified hinge joint
Femur
Tibia
Patella
Tibiofemoral artic.
Patelofemoral artic.Slide13
Joints of the Free Limb
Ankle (talocrural) joint
Hinge joint
1 axis of movement:
Dorsiflexion/plantarflexionSlide14
Joints of the Free Limb
Foot
Inversion/eversion occurs at subtalar (talocalcaneal) joint
Interphalangeal joints:
Distal
Proximal
metatarsophalangeal joints Slide15
Vasculature
of the Lower LimbSlide16
Superficial Veins
Great saphenous v.
Small saphenous v.Slide17
Arterial Blood Supply
External Iliac a Femoral a
Popliteal a
Anterior Posterior
tibial a tibial aa
dorsalis med/lat
pedis plantar a
Internal Iliac a
Superior gluteal a
Inferior gluteal a
Obturator aSlide18
Deep Femoral Artery
Medial & lateral femoral circumflex arteriesSlide19
Fascial CompartmentsSlide20
Gluteal Fascia Fascia Lata Crural Fascia
Fascia of the Lower LimbSlide21
Fascia Lata
Fascial Compartments of the Thigh
Anterior compartment
Medial (adductor) compartment
Posterior compartment
anterior compartment
posterior compartment
medial compartment
Fascial septa divide limb into compartmentsSlide22
Crural Fascia
Fascial Compartments of the Leg
Anterior crural compartment
Lateral crural compartment
Posterior crural compartment
Superficial & deep
posterior crural compartments
anterior
lateral
posterior
anterior compartment
lateral compartment
posterior compartmentSlide23
Lumbosacral PlexusSlide24
Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)Slide25
Lumbosacral Plexus
L1 - S3Slide26
Gluteal innervation:
Superior gluteal n (L4,5, S1): gluteus medius m. gluteus minimus m. tensor fascia lata
Inferior gluteal n
(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 gemellusquadratus femorusSlide27
Anterior compartment
Medial compartment
Posterior compartment
Lateral compartment
Thigh
Leg
Foot
Compartmental Innervation
Of the Free LimbSlide28
Anterior (extensor) compartment of the thigh
Innervation:
femoral nerve
anterior
anteriorSlide29
Medial (adductor) compartment of the thigh
Innervation:
obturator nerve*
medial
*Adductor Magnus innervated by both obturator n and tibial division of sciatic n
medialSlide30
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
posteriorSlide31
Posterior compartment of the leg
Innervation: tibial n.
Superficial posterior crural compartment
Deep posterior crural compartment
posteriorSlide32
Plantar surface of the foot
Innervation:
Medial & lateral plantar nervesSlide33
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 interosseiSlide34
Common fibular nerve
Nerve supply to the lateral and anterior crural compartments
anterior
lateral
anterior
lateralSlide35
Lateral crural compartment:
Superficial fibular nerveFibularis longusFibularis brevis
lateralSlide36
Anterior crural compartment:
Deep fibular nerveTibialis anterior m.Extensor hallucis longus m.Extensor digitorum longus m.Fibularis tertius m.
anteriorSlide37
Dorsum of the foot:
deep fibular nerve
Extensor hallucis brevis
Extensor digitorum brevisSlide38
Anterior compartment
Medial compartment
Posterior compartment
Lateral compartment
Thigh
Leg
Foot
Compartmental Innervation
of Free Limb
Femoral n.
Obturator n.
*
*
adductor magnus - obturator n and tibial n
Tibial division of sciatic n.
*
*
short head of biceps femoris - common fib. division of sciatic n.
Deep fibular n.
Tibial nerve
Superficial fibular n.
Deep fibular n.
Tibial n.
(medial and lateral plantar n.)Slide39
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
DermatomesSlide40
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
rootSlide41
Cutaneous Nerve Supply
to the Lower LimbSlide42
References
Clemente, C. 1997 Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins.Rinabesm C,H, 1972. Cunningham’s Textbook of Anatomy, 11th edition. Oxford University Press.Rosse, C & Gaddum-Rosse, P. 1997. Hollinshead’
s Textbook of Anatomy 5th edition. Lippincott-Raven
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.