1 the lower limb

8/13/2019 1 the Lower Limb

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The Lower Limb

Pelvis, Thigh, Leg and Footdr. Irwan

Bagian anatomi

FK Unsri


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Surface Anatomy


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Surface Anatomy Gluteal region /

posterior pelvis

Iliac crest

Gluteus maximus Cheeks

Natal/gluteal cleft

Vertical midline;

Crack

Gluteal folds

Bottom of cheek;

prominence


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Nelatons line

a line drawn from the anterior

superior lilac spine to the

ischial tuberosity, passing over

or near the top of the greater

trochanter. The trochanter can

be felt superior to this line in a

person which a dislocated hip

or a fractured femoral neck.


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Coxa vara

(abnormally decreased angle ofinclination, it occurs in fractures

of the neck of the femur and

slipping of the femoral

epiphysis )

Coxa valga

(abnormally increasedangle of inclination, in

cases of congenital

dislocation of the hip)

Normal angle

of inclination1250-1300


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Normal alignment Genu varum

(bowleg)

O

Genu valgum

X

1700 >1700


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Surface Anatomy

Anterior thigh and leg

Palpate

Patella

Condyles of femur

Femoral Triangle

Boundaries:

Sartorius (lateral)

Adductor longus (medial) Inguinal ligament (superior)

Contents:

Femoral artery, vein and

nerve, lymph nodes


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Surface Anatomy

Posterior leg Popliteal fossa

Diamond-shape fossabehind knee

Boundaries

Biceps femoris(superior-lateral)

Semitendinosis andsemimembranosis(superior-medial)

Gastrocnemius heads

(inferior) Contents

Popliteal artery and vein

Calcaneal (Achilles)tendon


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Surface Anatomy

Anterior leg bones

Tibia

Tibial tuberosity Anterior crest

Medial surface

Medial malleolus

Fibula Lateral malleolus


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Superficial structuresGreat saphenous vein

Drains the medial end of dorsal venous arch

of foot

Passes upward directly in front of the medial

malleolus.

Then ascends on medial side of the leg. Passes behind the knee and curves forward

around the medial side of the thigh.

Passes through the saphenous hiatus in the

deep fascia and joins the femoral vein about

4 cm below and lateral to the pubic tubercle.


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Superficial structures Tributaries:

Superficial lateral femoral v.

Superficial medial femoral v.

External pudendal v.

Superficial epigastric v.

Superficial iliac circumflex v.


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Superficial epigastric v.

External pudendal v.

Superficial circumflex iliac v.

Great saphenous v.

Superficial lateral femoral v.

Superficial medial femoral v.


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Varicose veins


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Superficial structures

Superficial fascia Superficial arteries:

superficial epigastric a.

superficial iliac circumflex a.

external pudendal a. Cutaneous nerves:

lateral femoral cutaneous n.

anterior and medial cutaneous branches

of femoral n.

cutaneous branches of obturator n.


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lateral femoral cutaneous n.

anterior and medial

cutaneous branches of

femoral n.

Cutaneous branches of

obturator n.


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Superficial structures

Superficial inguinal lymph nodes Superior group:

Lies just distal to the inguinal ligament

Receive lymph vessels from anteriorabdominal wall below umbilicus, glutealregion, perineal region, external genital

organs Inferior group:

Lies vertical along the terminal greatsaphenous v.

Receives all superficial lymph vessels oflower limb, except for those from the

posterolateral part of calf

Efferent vessels drain into the deepinguinal ln. or external iliac ln.


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Deep fascia of the thigh

Fascia lata The deep fascia encloses the thigh like a trouser leg. Saphenous hiatus

A gap in the deep fasica which lies about 4 cm

below and lateral to the pubic tubercle. The

falciform margin is the lower lateral border of

the opening, which lies anterior to the femoralvessels.

Filled with loose connective tissue called the

cribriform fascia


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Deep fascia of the thigh

Iliotibial tract laterally the deep fascia forms a thickband, from the iliac tubercle to the

lateral condyle of tibial.

The fascia lata sends intermuscular

septa to the linea aspera of thefemur. These separate the thigh into

three compartments each of which

contains a group of muscles, the

vessels and the nerves.


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Skeletal

Composition


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Bones of the Lower Limb Function:

Locomotion

Carry weight of entire erect body

Support

Points for muscular attachments

Components: Thigh

Femur

Knee Patella

Leg

Tibia (medial) Fibula (lateral)

Foot Tarsals (7)

Metatarsals (5)

Phalanges (14)


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Thigh

Femur Largest, longest,

strongest bone in thebody!!

Receives a lot ofstress

Courses medially More in women!

Articulates withacetabulum proximally

Articulates with tibia

and patella distally


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Knee

Patella

Triangular sesamoid

bone

Protects knee joint Improves leverage of

thigh muscles acting

across the knee

Contained withinpatellar ligament


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Leg

Tibia

Receives the weight of body

from femur and transmits to foot

Second to femur in size and

weight

Articulates with fibula proximally

and distally

Interosseous membrane

Fibula Does NOT bear weight

Muscle attachment

Not part of knee joint

Stabilize ankle joint


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Foot Function: Supports the weight of the

body

Act as a lever to propel thebody forward

Parts: Tarsals

Talus = ankle

Between tibia and fibula

Articulates with both

Calcaneus = heel

Attachment for Calcanealtendon

Carries talus

Navicular

Cuboid

Medial, lateral andintermediate cuneiforms

Metatarsals

Phalanges


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Foot

3 arches Medial

Lateral

Transverse Has tendons that run

inferior to foot bones

Help support archesof foot

Function Recoil after stepping

Longitudinal


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Joints of Lower Limb

Hip (femur + acetabulum) Ball + socket

Multiaxial

Synovial

Knee (femur + tibia) Hinge (modified)

Biaxial

Synovial

Contains menisci, bursa, many

ligaments

Knee (femur + patella)

Plane

Gliding of patella

Synovial


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Joints of Lower Limb

Proximal Tibia + Fibula

Plane, Gliding

Synovial

Distal Tibia + Fibula

Slight give (synarthrosis) Fibrous (syndesmosis)

Ankle (Tibia/Fibula + Talus)

Hinge, Uniaxial

Synovial

Intertarsal & Tarsal-metatarsal Plane, synovial

Metatarsal-phalanges

Condyloid, synovial

Interphalangeal

Hinge, uniaxial


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Muscles


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Muscles of Hip and Thigh Gluteals

Posterior pelvis Extend thigh

Rotate thigh

Abducts thigh

Anterior Compartment Thigh Flexes thigh at hip

Extends leg at knee

Medial/AdductorCompartment

Adducts thigh Medially rotates thigh

Posterior CompartmentThigh Extends thigh

Flexes leg


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Gluteals

Gluteus maximus Origin - Ilium, sacrum and coccyx

Insertion - Gluteal tuberosity of femur,iliotibial tract

Action - Extends thigh, some lateralrotation and abduction

Innervation - Inferior gluteal nerve

Gluteus medius

Gluteus minimus Origin - Ilium

Insertion - Greater trochanter of femur

Action - Abduction, medial rotation

Innervation - Superior gluteal nerve

Lesser Gluteals help stabilize hipto allow fluent bipedal walking


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Posterior Pelvis

Tensor fasciae latae

Originiliac crest and

anterior inferior iliac spine

Insertioniliotibial tractAction - Flex thigh, abduct

thigh, medial rotation of

thigh

InnervationSuperiorgluteal nerve


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Anterior Compartment Thigh Quadriceps femoris

Rectus femoris

Originanterior inferior iliacspine, margin of acetabulum

Insertionpatella and tibialtuberosity via the patellarligament

Actionextends knee, flexesthigh

Vastus lateralis Vastus medialis

Vastus intermedius

Origin - femur

Insertionpatella and tibialtuberosity via the patellar

ligament Actionextends knee

Sartorius

Origin - anterior superior iliacspine

Insertionmedial tibia

Action - flex, abduct, lat rotatethigh; weak knee flexorAll above innervated by the femoral nerve!!!


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Anterior Compartment Thigh

Iliopsoas

Origin - Ilia, sacrum,

lumbar vertebrae

Insertionlessertrochanter

Actionflexor of thigh

Innervationfemoral

nerve


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Adductors Adductor longus

Adductor brevis Adductor magnus

Origininferior pelvis

Insertion - femur

Actionadductsand medial rotates

InnervationObturator nerve

Pectineus Origin - pubis

Insertionlesser trochanter

Actionadducts, medial rotates

Innervationfemoral, sometimesobturator

Gracilis Origin - pubis

Insertionmedial tibia

Actionadductsthigh, flex, medial,rotates leg

InnervationObturator nerve


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Posterior Compartment - Hamstring Biceps femoris (2 heads)

Originischial tuberosity, distalfemur

Insertion - lateral tibia, head

fibula

Action - thigh extension, kneeflexion, lateral rotation

Semitendinosus

Semimembranosus

Origin - ischial tuberosity

Insertion - medial tibia

Action - thigh extension, knee

flexion, medial rotation

Sciatic nerve innervates all of the above muscles!!!


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Muscles of the Leg

Anterior Compartment Dorsiflex ankle, invert foot, extend toes

Innervation: Deep fibular nerve

Lateral Compartment Plantarflex, evert foot

Innervation: Superficial Fibular nerve

Posterior Compartment Superficial and deep layers

Plantarflex foot, flex toes

Innervation: Tibial nerve


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Anterior Compartment Tibialis anterior

Origin - tibia

Insertion - tarsals

Action - dorsiflexion, foot inversion

Extensor digitorum longus

Origintibia and fibula

Insertion - phalanges

Actiontoe extension

Extensor hallucis longus

Originfibula, interosseousmembrane

Insertionbig toe

Action - extend big toe, dorsiflex

foot

All innervated by deep fibular nerve


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Lateral Compartment Fibularis (peroneus) longus

Originlateral fibula

Insertion5thmetatarsal,

tarsal

Action - plantarflex, evert

foot

Fibularis (peroneus) brevis

Origindistal fibula Insertion - proximal fifth

metatarsal

Actionsame as above!!

All innervated by the superficial fibular nerve


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Superficial Posterior Compartment Triceps surae

Gastrocnemius (2 heads)

Origin - medial and lateral condyles of

femur

Insertion - posterior calcaneus via

Achilles tendon

Soleus

Origintibia and fibula

Insertionsame as above

Action of bothplantarflex foot

Plantaris (variable) Originposterior femur

Insertionsame as above!

Actionplantarflex foot, week knee

flexionAll innervated by the tibial nerve


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Deep Posterior Compartment

Popliteus Origin - lateral condyle femur

and lateral meniscus

Insertionproximal tibia

Actionflex and medially rotate leg

Flexor digitorum longus Origin - tibia

Insertion - distal phalanges of toe 2-5

Actionplantarflex and invert foot, flex toe

Flexor hallucis longus Origin - fibula

Insertion - distal phalanx of hallux

Action - plantarflex and invert foot, flex toe Tibialis posterior

Origintibia, fibula, and interosseousmembrane

Insertion - tarsals and metatarsals

Action - plantarflex and invert foot

All innervated by the tibial nerve


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Innervation


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Plexuses of the Lower Limb

Lumbosacral plexus Lumbar Plexus

Arises from L1-L4

Lies within the psoas major

muscle

Mostly anterior structures

Sacral Plexus

Arises from spinal nerve

L4-S4

Lies caudal to the lumbarplexus

Mostly posterior structures


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Lumbar Plexus

Femoral nerve Cutaneous branches

Thigh, leg, foot (e.g. saphenous nerve)

Motor branches Anterior thigh muscles (e.g. quadriceps,

sartorius, iliopsoas)

Obturator nerve Sensory

Skin medial thigh; hip, knee joints

Motor Adductor muscles

Lateral femoral cutaneous Sensory

Skin lateral thigh

Genitofemoral Sensory

Skin scrotum, labia major, anterior thigh

Motor Cremaster muscle


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Sacral Plexus Sciatic

Motor: Hamstring

Branches into: Tibial nerve

Cutaneous

Posterior leg and sole of foot

Motor Posterior leg, foot

Common fibular (peroneal) nerve Cutaneous

Anterior and lateral leg, dorsum foot

Motor

Lateral compartment, tibialis anterior,toe extensors

Superior gluteal nerve Motor

Gluteus medius and minimus, tensorfasciae latae


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Sacral Plexus (continued)

Inferior gluteal nerve Motor

Gluteus maximus

Posterior femoral

cutaneous nerve Sensory

Inferior buttocks, posteriorthigh, popliteal fossa

Pudendal nerve Sensory

External genitalia, anus

Motor Muscles of perineum


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Vasculature


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Arteries

Common iliac (from

aorta) branches into:

Internal iliac Supplies pelvic organs

External iliac

Supplies lower limb


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Arteries

Internal iliac branches into: Cranial and Caudal Gluteals

(Superior and Inferior) Gluteals

Internal Pudendal Perineum, external genitalia

Obturator

Adductor muscles Other branches supply rectum,

bladder, uterus, vagina, malereproductive glands

A t i


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Arteries

External iliac becomes. Femoral

Once passes the inguinal ligament

Lower limb

Branches into Deep femoral Adductors, hamstrings, quadriceps

Branches intoMedial/lateral femoralcircumflex

Head and neck of femur

Femoral becomes Popliteal(continuation of femoral)

Branches into:

Geniculars Knee

Splits into: Anterior Tibial

Anterior leg muscles, further branches tofeet

Posterior Tibial

Flexor muscles, plantar arch, branches to


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Veins Deep Veins: Mostly share names ofarteries

Ultimately empty into Inferior VenaCava

Plantar

Tibial

Fibular

Popliteal Femoral

External/internal iliac

Common iliac

Superficial Veins

Dorsal venous arch (foot)

Great saphenous (empties into femoral)

Small saphenous (empties into

popliteal)

1 the lower limb

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