1. Windsor University School of Medicine
Gluteal region, thigh & leg The future belongs to those who believe in the beauty of their dreams. Eleanor Roosevelt
Lecture Idara C. Eshiet

2. OBJECTIVES Be able to describe the bones of lower limb.
Be able to describe the muscles of the gluteal region, & thigh.
Be able to describe the femoral triangle & popliteal fossa.
Be able to describe the muscles of the leg.

3. Bones of lower limb Hip bone ( Ilium, Ischium and pubis) Femur Tibia
Fibula

4. Areas of transition/Bones & joints of the lower limb.

5. COXAL BONE /Acetabulum

6. Shaft /Proximal end of the femur

7. Femur vs. Tibia & Fibula

8. Proximal ends of tibia & fibula

9. Tibia & Fibula/ posteromedial view of distal ends.

10. Thigh
Fascia
Compartments : anterior, medial, posterior
muscles

11. Fascia of the thigh
Superficial is the continuity of the superficial fascia of anterior abdominal wall
Deep fascia thickened laterally to form the illiotibial tact
Has a gap called saphenous opening
Divided into 3 compartments by 3 intermuscular septa

13. Muscle compartments in the thigh
In the thigh, there are medial (adductor), anterior (extensor), and posterior (flexor) compartments.

14. Anterior Thigh Muscles
Anterior thigh muscles are the flexors of the hip and extensors of the knee.

15. Iliacus
Action: Chief flexor of the hip joint. Nerve Supply: Femoral nerve

16. Psoas Major
Action: Flexes thigh on trunk Nerve Supply: femoral nerve

17. Pectineus
Action: Flexion & adduction of hip joint Nerve supply: Femoral nerve

18. Sartorius Nerve Supply: Femoral nerve Action :
1.Flexion, abduction and Lateral rotation of thigh at hip joint.
2. Flexion leg at knee joint
Nerve Supply: Femoral nerve

19.  Tailor's muscle
This combination of lateral rotation and flexion of the hip and flexion of the knee gave tailors particularly enlarged sartorius muscles.
Looking at the bottom of one's foot, as if checking to see if one had stepped in gum, demonstrates all four actions of sartorius.

20. Quadriceps femoris Four muscles make up this group. They are:
rectus femoris,
vastus lateralis,
vastus medialis,
vastus intermedialis
Action: extension of knee
Rectus femoris also flexes the hip joint as well.
Nerve Supply: Femoral nerve

21. Quadriceps

22. Medial Compartment of Thigh
1. Gracilis
Adduction of the the hip joint & flexion of knee joints
2. Adductor longus
Adduction of the the hip joint. 3 2 1 4

23. 3. Adductor brevis
Adduction of the the hip joint.
4. Adductor magnus has 2 parts.
Ant. Part is an adductor
Post. Part is an extensor of the the hip joint
5. Obturator externus
Lateral rotation of hip joint
Obturator nerve but the post. part of adductor magnus is supplied by tibial nerve which is a branch of the sciatic nerve.

24. Adductor magnus & Obturator externus
Is innervated by the obturator nerve
2. Adductor magnus
The adductor part is innervated by the obturator nerve
& the hamstring part is innervated by the tibial division of the sciatic nerve 1 2

25. Pectineus, Adductors longus & brevis
Is innervated by the femoral nerve
2. Adductor longus
Is innervated by the obturator nerve
3. Adductor brevis 1 3 2

26. Obturator nerve

27. Adductor Canal, subsartorial canal; Hunter canal
Approximately 15 cm.
It extends from the apex of the femoral triangle, where the sartorius crosses over the adductor longus, to the adductor hiatus in the tendon of the adductor magnus.
Contents: Femoral artery and vein, the saphenous nerve, and the nerve to vastus medialis.

30. Adductor Hiatus
The adductor hiatus is an opening or gap between the aponeurotic distal attachment of the adductor part of the adductor magnus and the tendinous distal attachment of the hamstring part.
The adductor hiatus transmits the femoral artery and vein from the adductor canal in the thigh to the popliteal fossa posterior to the knee.

31. 3. Semimembranosus
Extension of hip joint & flexion & medial rotation of knee joint.
Nerve Supply: Tibial portion of sciatic nerve

32. Posterior Compartment of the Thigh
1. Biceps femoris
Extension of the the hip joint & flexion & lateral rotation of the knee joint.
Nerve supply:
Long head: tibial portion of sciatic nerve
Short head: common peroneal portion of sciatic nerve
2. Semitendinosus
Extension of the the hip joint & flexion & medial rotation of the knee joint.
Nerve supply: Tibial portion of sciatic nerve

34. Movements of Hip joint Flexion Extension Abduction Adduction
Circumduction
Medial rotation
Lateral rotation

35. Movements of Hip joints

36. Muscles responsible for movements of Hip joints.
Flexion : iliopsoas, rectus femoris
Extension: Hamstrings, gluteus maximus
Abductor: Gluteus medius & minimus
Adduction: Gracilis &
3 Adductors

39. Muscles responsible for movements of Hip joints Cont’d.
Medial rotation: gluteus medius & minimus
Lateral rotation:
obturator internus & externus,
piriformis,
superior & inferior gemelli,
quadratus femoris

40. Muscles responsible for movements of Knee Joints.
Flexion: Hamstrings
Extension: Quadriceps
Medial rotation: Semitendinosus & Semimembranosus.
Lateral rotation : Biceps femoris.

42. Muscles of the gluteal region

43. Muscles of the gluteal region
1. Gluteus maximus
Extension of the the hip joint, lateral rotation, steadies the thigh, assists in rising from a sitting position
Inferior gluteal nerve 3 1

44. 44

45. Assists gluteus maximus in extending the knee joint
2. Tensor fasciae latae
Assists gluteus maximus in extending the knee joint
Superior gluteal nerve
Tenses the fascia lata and iliotibial tract

46. 3. Gluteus medius & minimus
Abduction and medial rotation of the thigh; tilts pelvis when walking to permit opp. Leg to clear the ground.
Superior gluteal nerve

47. Positive Trendelenburg's sign
If right gluteus medius and minimus muscles are paralyzed, the unsupported left side of the pelvis falls (sags) instead of rising; normally, the pelvis rises.

51. Lateral rotation of the thigh@ hip joint nerve Supply: S1 & S2 nerves
4. Piriformis m.
Lateral rotation of the hip joint
nerve Supply: S1 & S2 nerves
Important landmark of the gluteal region.
5. Obturator Internus
Same function as piriformis
Nerve supply: (L5-S1) nerves to obturator internus
The piriformis muscle passes through the greater sciatic foramen. It divides in into a superior and inferior part.

53. Muscles of the gluteal region Cont’d.
6. Superior Gemellus
Lateral rotation of the the hip joint
(L5-S1) nerves to obturator internus
7. Inferior Gemellus
Same function as superior gamellus
Nerve to quadratus femoris ( L5, S1)

54. Lateral rotation of the thigh @ the hip joint
8. Quadratus Femoris
Lateral rotation of the the hip joint
(L5-S1) nerves to quadratus femoris 8

55. Femoral triangle & Popliteal fossa
Femoral triangle boundaries, floor, & contents
Popliteal fossa boundaries, floor, & contents

56. The femoral triangle is bounded
Superiorly :Inguinal ligament that forms the base of the femoral triangle.
Medially :Adductor longus.
Laterally :Sartorius.
Apex is where the lateral border of the sartorius crosses the medial border of the adductor longus.
Roof :Fascia lata, subcutaneous tissue, and skin.
Floor :Iliopsoas laterally and the pectineus medially.

57. Femoral Triangle Inguinal ligament Iliopsoas Sartorius Adductor longus
Pectineus
Sartorius
Adductor longus
Adductor
longus

58. Femoral Triangle Contents : (lat. to med.) Femoral nerve
Femoral artery
Femoral vein
Deep inguinal lymph nodes

60. Boundaries of Popliteal fossa
Superolateral : biceps femoris
Superomedial: semimembranosus & semitendinosus
Inferolateral: lateral head of gastrocnemius
Inferomedial: medial head of gastrocnemius

62. Contents of the popliteal fossa
1. Termination of the small saphenous vein.
2. Popliteal arteries and veins.
3. Tibial and common fibular nerves.
4. Posterior cutaneous nerve of thigh
5. Popliteal lymph nodes and lymphatic vessels

63. Floor This is formed by: popliteal surface of the femur,
capsule of knee joint &
popliteus muscle

64. LEG Fascia Muscles of anterior compartment
Muscles of lateral compartment
Muscles of posterior compartment (superficial & deep layers)
Main muscles responsible for ankle joint movements

65. Fascia of the Leg Deep fascia (crural fascia) .
Leg divided into 3 fascia compartments (anterior, posterior, lateral) by 3 intermuscular septa.
In the region of the ankle the fascia forms retinacula :
Superior & inferior extensor retinacula
Flexor retinaculum
Fibular retinaculum

66. Cross-section through the left leg (post. View)
Muscles of the anterior compartment of leg dorsiflex the ankles, extend the toes, & invert the foot.
(deep fibular nerve).
Muscles in the posterior compartment plantarflex the ankle, flex the toe, & invert the foot.
(tibial nerve).
Muscles in the lateral compartment evert the foot.
(superficial fibular nerve).

69. Muscles of anterior compartment
1. Tibialis anterior
Dorsiflexion & inversion of the foot at the ankle.
2. Extensor digitorum longus
Extension of lateral 4 digits & dorsiflexion of the ankle 1 2

70. N. supply: Deep fibular nerve
3. Extensor hallucis longus
Action: Extension of big toe & dorsiflexion of the ankle
Deep fibular nerve from common fibular nerve
4. Fibularis Tertius
Action :Dorsiflexion and eversion of foot
N. supply: Deep fibular nerve

71. Extensor Hallucis longus

73. Muscles of lateral compartment
1. Fibularis longus
Eversion & plantar flexion of foot.
2. Fibularis brevis
Superficial fibular nerve from common fibular nerve 1 2

74. Injury to common fibular nerve
Footdrop and loss of eversion
May cause sensory loss over lateral leg and dorsum of foot
Causes
Direct trauma as nerve passes superficially around neck of fibula

75. Foot drop
Foot drop, sometimes called drop foot, is a general term for difficulty lifting the front part of the foot.
The loss of dorsiflexion of the ankle causes footdrop.

76. Posterior compartment of leg
Muscles in the posterior (flexor) compartment of leg are organized into two groups; superficial and deep.
Nerve supply: Tibial nerve

77. Muscles of the Posterior Compartment of the Leg
Superficial group of muscles
1.Gastrocnemius
2.Soleus
3.Plantaris
Deep group of muscles
1.Popliteus
2.Tibialis posterior
3.Flexor digitorum longus
4.Flexor hallucis longus
Muscles mainly plantarflex, invert the foot and flex the toes.

78. Superficial Group
1. Gastrocnemius Action: Plantar flexion of the foot the ankle), knee flexion Nerve Supply: Tibial nerve 2. Soleus Action: Plantarflexion of the foot

79. 3. Plantaris:
Action: plantarflexion of the foot
Nerve Supply: Tibial nerve

80. Gastrocnemius has two heads; a medial and a lateral head
Gastrocnemius has two heads; a medial and a lateral head. The two heads of the Gastrocnemius muscle and the Soleus muscle are together called the Triceps Surae. Gastrocnemius and plantaris cross knee joint and thus also flex knee . All three contribute to calcaneal tendon

81. Gastrocnemius and plantaris

83. Muscles of posterior compartment (deep layer)
2. Popliteus
Flexion of knee joint
3. Flexor digitorum longus
Flexion of DIP of lateral 4 digits
Tibial nerve 2 5 3 4

85. Plantarflexion & inversion of foot Nerve Supply: tibial nerve
4. Flexor hallucis longus
Flexion of big toe
5. Tibialis posterior
Plantarflexion & inversion of foot
Nerve Supply: tibial nerve

87. Muscles responsible for ankle joint movements (fig.B)
Dorsiflexion :
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Plantarflexion :
Triceps surae
Tibialis posterior
Flexor digitorium longus
Flexor hallucis longus

88. Movements of knee & ankle

89. Surface Anatomy1.

90. Surface Anatomy2.

91. Surface Anatomy3.

92. POWER REVIEW1.
1. What are the 4 regions of the lower limb, and which bones are found in each region?
Hip: ilium, Ischium, & pubis
Thigh: Femur & patella
Leg: Tibia & fibula
Foot: Tarsal bones, metatarsal bones, & phalanges.
2. Name the 7 tarsal bones
Talus, Calcaneus, Cuboid bone, Navicular bone, Cuneiform bones (3)

93. POWER REVIEW2. 3. what is the largest and most posterior tarsal bone?
The calcaneus
4. what structure inserts into the posterior surface of the calcaneus?
The tendon calcaneus (Achilles tendon)
5.the calcaneus articulates with which 2 tarsal bones?
The talus & the cuboid bone

94. POWER REVIEW3. 6. The talus articulates with which 2 tarsal bones?
The calcaneus & the navicular bone
7. The navicular bone articulates with which 5 tarsal bones?
The talus, the cuboid bone, and the 3 cuneiform bones.
8. which movements occur around the intertarsal joints?
Inversion & eversion of the hindfoot

95. POWER REVIEW4. 9. which muscle is the major flexor at the hip joint?
Iliopsoas.
10. name the external rotators of the hip
Piriformis, Gemellus superior, Obturator internus
Gemellus inferior, Obturator externus, Quadratus femoris
11. Name the 5 ligaments that are associated with the hip joint.
Iliofemoral ligament, ischiofemoral ligament, pubofemoral ligament
Transverse acetabular ligament, ligament capitis femoris

96. POWER REVIEW5.
12. list the 4 muscles of the posterior thigh compartment.
Semimembranous m., semitendinous m.,
biceps femoris m. (long & short head), adductor magnus m. (hamstring part)
13.what are the “hamstring” muscles?
The semimembranous m., the tendinosus m.,
the long head of the biceps femoris m., and the adductor magnus m. (hamstring part)

97. POWER REVIEW 6.
14. which of the medial thigh muscles contributes to the action of the hamstrings?
The adductor magnus muscle has 2 portions with separate insertions & innervations, 1 of which contributes to the action of the hamstrings (flex the leg).
15. list the 6 muscles of the medial thigh compartment.
Pectineus m., adductor longus m.,
Adductor magnus m., (adductor part), Adductor brevis m., Gracilis m., Obturator externus m.

98. POWER REVIEW 7.
16. list the 3 muscles of the anterior compartment of the thigh.
Iliopsoas m., Sartorius m., Quadriceps femoris m.
17. which 4 muscles contribute to the quadriceps femoris muscles?
Rectus femoris m., Vastus lateralis m.,
Vastus medialis m., Vastus intermedius m.,

99. Review Questions.1
1. Which of the following muscles is located in the posterior aspect of the thigh?
2. All of the following muscles are lateral rotators of the thigh EXCEPT
3. The deep fascia of the thigh is known as which of the following?
4. The medial and lateral malleoli articulate with which of the following bones?
5. Which of the following muscles is the strongest flexor of the hip joint?

100. Review Questions.2
6. The strongest dorsiflexor of the foot is which of the following muscles?
7. All of the following muscles are lateral rotators of the hip joint EXCEPT
8. Which of the following groups of muscles produce dorsiflexion of the ankle?
9. Which of the following muscles is a flexor of the knee joint?
10. All of the following muscles are located in the deep muscle group of the posterior compartment EXCEPT

101. Review Questions.3
11. Which of the following muscles is the strongest dorsiflexor and invertor of the foot?
12. Muscles that evert the foot include which of the following muscles?
13. Which of the following muscles dorsiflex the ankle?
14. All of the following statements concerning the popliteal fossa are correct EXCEPT
15. Which of the following muscles is located in the posterior aspect of the thigh?

102. Review Questions.4
16. All of the following muscles are lateral rotators of the thigh EXCEPT
17. All of the following statements concerning the gluteus medius and minimus are correct EXCEPT
18. All of the following statements concerning the gluteus maximus are correct EXCEPT
19. All of the following statements concerning the femoral triangle are correct EXCEPT
20. All of the following statements concerning the adductor magnus are correct EXCEPT
21. Which of the following statements concerning the gracilis muscle is correct?

103. T. S. Eliot
No one can become really educated without having pursued some study in which he took no interest--for it is a part of education to learn to interest ourselves in subjects for which we have no aptitude.
………………..references………………………….
Dr. Bolgova PPt.
Gray’s Anatomy for students, 2nd edition