third week lectures

7/28/2019 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



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S ,2,3,4Pudendal nerve


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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third week lectures

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