Download - Third Week Lectures
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Skin ( cutaneous innervation)
LigamentsMuscles
Nerves & blood vesseles
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Cutaneous nerve supply
1- Upper lateral area: iliohypogastric andsubcostal nerves.
2- Lower lateral area: lateral cut. Nerve ofthigh.
3- Upper medial area: upper three lumber(L1,2,3)and upper three sacral nerves(S1,2,3).
4- Lower medial area: posterior cut. Nerveof thigh.
Area of intramuscular injection.
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Greater and lesser sciatic foramina and their
contents
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Muscles of gluteal region
1- Gluteus maximus.
2- Gluteus medius.
3- Gluteus minimus.4- Tensor fasciae lata.
5- Piriformis.
6- Quadratus femoris.7- Obturator internus and 2 gemelli.
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Tensor fascia lata
Gluteus maximus
Ilio tibial tract
Gluteus maximus and
iliotibial tract
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Gluteus maximus
Origin: outer surface of ilium
behind post. Gluteal line, back of
sacrum and coccyx, back of
sacrotuberous ligaments.
Insertion: iliotibial tract and
gluteal tuberosity.
Nerve supply: inferior gluteal n.
Action: 1-extension & lat. rotation
of hip joint.
2- Maintains knee joint
extended.
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Tensor fasciae lata
Origin: outer lip of iliac crest.
Insertion: iliotibial tract.
Nerve supply: superior gluteal
nerve.
Action: Maintains knee joint
extended.
Tensor fascia
lata
Gluteus
maximus
Ilio tibial
tract
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Structures under cover of gluteus maximusMuscles
Bones
Nerves
Vesseles
Joints
Brsae
ligaments
Gluteus minimus
Gluteus medius
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Gluteus medius
Origin: outer surface of iliumbetween post. And middle gluteal
lines.
Insertion: lat. Surface of greater
trochanter.
Nerve supply: superior gluteal n.
Action: 1- abduction of hip joint.2- support the pelvis.
3- medial rotation of thigh.
Gluteus mininus
Origin: outer surface of iliumbetween middle and inferiorgluteal lines.
Insertion: ant. Surface of greater
trochanter.
Nerve supply: superior gluteal n.
Action: 1- abduction of hip joint.2- support the pelvis.
3- medial rotation of thigh.
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Gluteus minimus
Gluteus medius
Gluteus minimus
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Gluteus minimusGluteus medius
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Piriformis
Opturator internusand 2 gemelli
Small muscles of the gluteal region
Quadratus femoris
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Piriformis
Origin: Inner suface of middlethree pieces of sacrum.
Insertion: upper border of
greater trochanter.
Nerve supply: sacral plexus.
Action: lateral rotation ofthigh.
Quadratus femoris
Origin: lat. Margin of ischialtuberosity.
Insertion: Quadrate tubercle.
Nerve supply: nerve toquadratus femoris.
Action: lateral rotation ofthigh.
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Obturator internus
Origin: Inner suface of obturatormembrane, margin ofobturator foramen.
Insertion: medial surface ofgreater trochanter.
Nerve supply: nerve to obturatorinternus.
Action: lateral rotation of thigh.
Superior and inferiorgemelli
Origin: lower margin of ischialspine and upper margin ofischial tuberosity.
Insertion: tendon of obturatorinternus.
Nerve supply: nerve to obturatorinternus and nerve quadratus
femoris.
Action: lateral rotation of thigh.
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Iliotibial tract:Attachment:(A) Superiorly: It spilits into two laminae to receive the insertion of the tensor fasciae lata
anteriorly and 3/4 of the gluteus maximus posteriorly. (NB: The superficial lamina is attached to
the tubercle of the iliac crest and the deep lamina to the capsule of the hip).
(B) Inferiorly: Is attached to the anterior surface of the lateral condyle of the tibia.
Muscles attached to it:
Tensor fasiae latae.
Gluteus maximus.
Function: It fixes the hip over the femur and the femur over the tibia. This leads to
stabilization of the knee in extension and partial flexion and is therefore allows itscontinous use in walking and running.
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Nerves of the gluteal region
Sciatic nerve
Post. Cut. N. of the thigh
Nerves of the gluteal region
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S ,2,3,4Pudendal nerve
Nerves of the gluteal region
Superior gluteal
L 4,5 ,S 1
Inf. gluteal gluteal
L 5 ,S 1,2
n. to quadratus
femoris L 4,5 ,S 1
n. to obturator
internus L 5 ,S 1,2
Posterior cut. N.
of the thigh
S 1,2,3
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1- Sciatic nerveArise from sacral plexus L4,5.
S1,2,3.4.
Course:
Termination:
Branches: 1- Articular
2- Muscular.
3- Terminal (commonperoneal and tibial)
The sciatic nerve gives no branches
in gluteal region.
1- Post. Cut. Nerve of
thigh(S1,2,3)Course and relations:
Branches: 1- cutaneous
2- gluteal
3- perineal
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3- Superior glutealnerve(L4,5.S1) Course and branches:
Effect of injury:
4- Inferior glutealnerve(L5.S1,2)
Course and branches:
Effect of injury:
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5- Nerve to
obturator
internus(L5.S1,2) Course and branches:
6- Nerve to
quadratus
femoris(L4,5.S1) Course and branches:
n. to
quadratus
femoris L
4,5 ,S 1
n. toobturator
internus L 5
,S 1,2
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7- Pudendal nerve(S2,3,4)Course and relations
S ,2,3,4
Pudendal nerve
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Arteries of the gluteal region
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1- Superior gluteal artery:
From post. Division of internal iliac
artery.
Supply the gluteal region.
2- Inferior gluteal artery:
From ant. Division of internal iliacartery.
Supply the gluteal region and sciatic
nerve.
Arteries of the gluteal region
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3- Internal pudendal artery
From ant. Division of internal
iliac artery.
Course: arise from greater sciatic
foramen below piriformis, passes
across ischial spine to enter lesser
sciatic notch.
Supply the perineum.
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Cut. Innervation
Contents:o Muscleso Nerves
o vesseles
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Cut. Innervation
1- Medial cut. Nerve
Of thigh.
2- Post. Cut. Nerve
Of thigh
3- Lat. Cut. NerveOf thigh.
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Muscles:
1- Biceps femoris:
Long head lower medial part of upperquadrangular area of ischial tuberosity.
Short head lower part of linea aspra &
lat. Supracondylar line.
The 2 heads unite and inserted into upper end
of fibula (styloid process).The muscle supplied by sciatic nerve (the long
head by tibial & the short head by common
peroneal).
The 2 heads flexion of knee and lat.
Rotation.
The long head extention of hip .
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2- Semitendinosus:
Originated from lower medial part of upper
quadrangular area of ischial tuberosity ( in
common with long head of biceps femoris).Inserted into upper part of medial surface
of tibia (SGS).
Supplied by tibial nerve.
Extension of hip and flexion and medial
rotation of knee.3- Semimembranosus:
Originated from upper lat. Part of upper
quadrangular area of ischial tuberosity.
Inserted into a groove on the back of
medial condyle of tibia and back of capsuleof knee joint.
Supplied by tibial nerve.
Extension of hip and flexion and medial
rotation of knee.
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Guy-Robe Muscles
stabilize the bony pelvis.
3 muscles3 different groups
3 different origins,
3 different nerve supply
3 different actions
One insertion.
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The popliteal fossa is a diamond-shapedintermuscular space situated at the back of the knee.
The fossa is most prominent when the knee joint is
flexed. It contains the popliteal vessels, the small
saphenous vein, the common peroneal and tibial
nerves, the posterior cutaneous nerve of the thigh,
the genicular branch of the obturator nerve,
connective tissue, and lymph nodes.
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Boundaries and roof
Fl
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Floor
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Contents
(1) Popliteal artery and its branches.
(2) Popliteal vein and its tributaries.
(3) Tibial nerve and its branches.
(4) Common peroneal nerve and its branches.
(5) Posterior cutaneous nerve of the thigh.(6) Genicular branch of obturator nerve.
(7) Popliteal lymph nodes.
(8) Small saphenous vein.
(9) Fat.
Arrangement of the contents
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Popliteal a.
Origin :
Termination:
Course and relations:
Branches:
1- Muscular.
2- Five genicular
branches to knee
joint.
Popliteal a.
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The small saphenous vein
arises from the lateral part of
the dorsal venous arch of the
foot . It ascends behind thelateral malleolus in company
with the sural nerve. It follows
the lateral border of the
tendo calcaneus and then
runs up the middle of the
back of the leg. The veinpierces the deep fascia and
passes between the two
heads of the gastrocnemius
muscle in the lower part of
the popliteal fossa, it ends in
the popliteal vein . The smallsaphenous vein has numerous
valves along its course.
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Tibial nerve
Medial popliteal n.L 4,5, S 1,2,3 Tibial
1 Cut.(sural)
3 Genicular
muscular
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P li l l h d
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Popliteal lymph nodes Near the termination of the small saphenous vein deep to the
deep fascia.
Afferents:
(1) The territory of the small saphenous vein (lateral side of the
foot and leg).
(2) Deep parts of the leg running along the anterior and
posterior tibial vessels.
(3) Knee joint.
Efferents: Run along the popliteal and femoral vessels to
terminate into the deep inguinal lymph nodes
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