2. Lower limb

4. QUADRICEPS FEMORIS RECTUS FEMORIS : Quadriceps tendon in to petella
Origin : Straight Head:
A.I.I.S
Reflected Head:
Ilium (Above Acetabulum)
Insertion :
Quadriceps tendon in to petella
Via lig.patellae in to tibial tubercle
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint
Flexion of thigh at hip joint

5. VASTUS LATERALIS petella via Lig.patellae in to tubercle of tibia
Origin : Upper end & shaft of femur
Insertion : Quadriceps tendon in to
petella via Lig.patellae in to
tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint

6. VASTUS MEDIALIS petella Via Lig.patellae in to tubercle of tibia
Origin : Upper end & shaft of femur
Insertion : Quadriceps tendon in to
petella Via Lig.patellae in to
tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee &
Stabilizes Patella

7. VASTUS INTERMEDIUS of shaft of femur petella Via Lig.patellae
Origin : Anterior & lateral surface
of shaft of femur
Insertion : Quadriceps tendon in to
petella Via Lig.patellae
in to tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint

8. VASTUS INTERMEDIUS of shaft of femur petella Via Lig.patellae
Origin : Anterior & lateral surface
of shaft of femur
Insertion : Quadriceps tendon in to
petella Via Lig.patellae
in to tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint

9. SARTORIUS shaft of tibia N. supply: Femoral nerve
Origin : A.S.I.S.
Insertion : Upper medial surface of
shaft of tibia
N. supply: Femoral nerve
Action :1.Flexion, abduction and
Lateral rotation of thigh at hip joint.
2. Flexion leg at knee joint

10. ILIACUS lesser trochanter of femur N. supply: Femoral nerve
Origin : Iliac fossa of hip bone
Insertion : Along with psoas into
lesser trochanter of femur
N. supply: Femoral nerve
Action :Flexes thigh on trunk
Eg.: Sitting up from lying down

11. PSOAS I.V.D.’S of T12 & L 1-L5 vertebrae trochanter of femur
Origin : Trasnverse process, bodies &
I.V.D.’S of T12 & L 1-L5 vertebrae
Insertion : Along with Iliacus into lesser
trochanter of femur
N. supply: Lumbar plexus
Action : Flexes thigh on trunk
Eg.: Sitting up from lying down
T12
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12. PECTINEUS Upper end of linea aspera of shaft of femur
Origin : Superior ramus of Pubis
Insertion :
Upper end of linea aspera of
shaft of femur
N. supply: Femoral nerve
Action :Flexion, adduction ofthigh
at hip joint

13. Femoral Triangle
The femoral triangle, a subfascial space, is a triangular landmark useful in dissection and in understanding relationships in the groin.
In living people it appears as a triangular depression inferior to the inguinal ligament when the thigh is flexed, abducted, and laterally rotated.

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

16. The femoral triangle is bounded
Superiorly by the inguinal ligament (the thickened inferior margin of the external oblique aponeurosis) that forms the base of the femoral triangle.
Medially by the adductor longus.
Laterally by the sartorius.
Apex is where the lateral border of the sartorius crosses the medial border of the adductor longus.
Roof of the femoral triangle is formed by the fascia lata, subcutaneous tissue, and skin.
Floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus medially.

19. The contents of the femoral triangle, from lateral to medial
Femoral nerve and its (terminal) branches.
Femoral sheath and its contents:
Femoral artery and several of its branches.
Femoral vein and its proximal tributaries (e.g., the great saphenous and deep femoral veins).
Deep inguinal lymph nodes and associated lymphatic vessels.
NAVL(Lateral to medial)

21. Femoral Sheath
The femoral sheath is a funnel-shaped fascial tube of varying length (usually 3 to“4 cm) that passes deep to the inguinal ligament.
The sheath is formed by an inferior prolongation of transversalis and iliopsoas fascia from the abdomen/greater pelvis.
The femoral sheath is subdivided internally into three compartments.
1. Lateral compartment for the femoral artery.
2. Intermediate compartment for the femoral vein.
3. Medial compartment, which constitutes the femoral canal

23. Femoral canal
The femoral canal is the smallest of the three compartments.
It is short (approximately 1.25 cm).
The base of the femoral canal, formed by the small (approximately 1 cm wide) proximal opening at its abdominal end, is the oval femoral ring.

24. Femoral Hernia
Femoral Hernias are much more common in women, but can occur in men. 
A weakness in the lower groin allows an intestinal sac to drop into the femoral canal.

26. Femoral Nerve
Cutaneous nerve: saphenous nerve and medial and intermediate cutaneous nerve of thigh.
Motor nerves: Quadriceps femoris muscles (rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis muscles) and the sartorius muscle

27. Femoral Nerve

28. Femoral Artery Branches
1.Superficial circumflex iliac artery
2.Superficial epigastric artery
3.Superficial external pudendal artery
4.Deep external pudendal artery
5.Deep artery of thigh OR Profunda femoris artery
6.Medial circumflex femoral
7.Lateral circumflex femoral

30. Femoral Vein
The femoral vein is the continuation of the popliteal vein proximal to the adductor hiatus.
Tributaries
The tributaries of the femoral vein are the great saphenous vein and veins that correspond to the branches of the femoral artery.
The superficial circumflex iliac vein, the superficial epigastric vein, and the external pudendal veins drain into the great saphenous vein.

31. Femoral vein and artery cathetarization

32. 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.

34. Medial compartment of thigh
Muscles: Gracilis, adductor longus, adductor brevis, adductor magnus, and obturator externus.
Blood supply: Profunda femoris artery and obturator artery.
Nerve supply: Obturator nerve

36. GRACILIS ramus of Ischium part of shaft of tibia
Origin : Inferior ramus of Pubis &
ramus of Ischium
Insertion :Medial aspect of upper
part of shaft of tibia
N. supply: Obturator nerve
Action : Adduction of thigh at hip joint
Flexion of Leg at Knee joint

37. ADDUCTOR LONGUS to pubic tubercle shaft of femur
Origin : Body of Pubis, medial
to pubic tubercle
Insertion : Posterior surface of
shaft of femur
N. supply: Obturator nerve
Action : Adduction of thigh at
hip joint
Assists Lateral rotation

38. ADDUCTOR BREVIS shaft of femur N. supply: Obturator nerve hip joint
Origin : Inferior ramus of pibis
Insertion : Posterior surface of
shaft of femur
N. supply: Obturator nerve
Action : Adduction of thigh at
hip joint
Assists Lateral rotation

39. ADDUCTOR MAGNUS Ramus of ischium Ischial tuberosity shaft of femur
Origin : Inferior ramus of pubis
Ramus of ischium
Ischial tuberosity
(HAMSTRING PORTION)
Insertion :Posterior surface of
shaft of femur
Adductor tubercle of femur
N. supply: Obturator + Sciatic
nerves
Action : Adduction of thigh at hip
Assists Lateral rotation &
Extension of thigh at hip joint

40. 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.

41. OBTURATOR EXTERNUS Obturator membrane Pubic & Ischial rami
Origin : Outer surface of
Obturator membrane
Pubic & Ischial rami
Insertion :Medial surface of
greater trochanter
N. supply: Obturator nerve
Action : Lateral rotation of thigh at
hip joint

42. Obturator nerve
As the obturator nerve enters the thigh, it divides into two branches, an anterior branch and a posterior branch, which are separated by the adductor brevis muscle:
Anterior branch: adductor longus, gracilis, and adductor brevis muscles, and often contributes to the supply of the pectineus muscle, and cutaneous branches innervate the skin on the medial side of the thigh.
Posterior branch: obturator externus and adductor brevis muscles and the part of adductor magnus that attaches to the linea aspera

43. Obturator nerve

44. Obturator nerve

45. Deep artery of thigh (Profunda femoris artery)
Branches :lateral and medial circumflex femoral branches and four perforating branches.
Lateral circumflex femoral artery: 3 branches
1. Ascending branch
2. Descending branch
3. Transverse branch
Medial femoral circumflex artery: It takes part in the formation of the cruciate anastomosis.

47. Obturator Artery
The obturator artery is a branch of the internal iliac artery.
It gives off muscular branches and an articular branch to the hip joint.

48. THE POSTERIOR THIGH MUSCLES

49. There are four muscles in the posterior aspect of the thigh
These are;
The harmstrings:
Semitendinosus
Semimembranosus
Long head of biceps femoris
2. Short head of biceps femoris
All except the short head of biceps femoris cross both the hip and knee joints

51. THE HAMSTRINGS They have common features These are;
Supplied by the tibial division of the sciatic nerve
Act on two joints- knee and hip, producing extension at the hip and flexion at the knee
Prox. Attach is to the ischial tuberosity, deep to G. maximus

52. Muscles of the posterior compartment of thigh. Posterior view.

54. The two actions of the hamstrings cannot be performed maximally at the same time
When the thighs and the legs are fixed, the hamstrings help extend the trunk at the knee joint
They are the hip extensors involved in walking on flat ground, when the G. max demonstrate minimal activity.
Here contraction is eccentric

55. Length varies but it’s a matter of conditioning
TEST;
Flex the leg against resistance
The muscles especially the tendons on each side of the popliteal fossa should be prominent as you bend the knee

57. SEMITENDINOSUS Its a semitendinous muscle as the name implies
Has a fusiform belly
About 2/3rd of its distance down the thigh, it becomes tendinous
Distal attachment is in the medial surface of superior part of tibia
It forms part of the pes anserinus

58. SEMIMEMBRANOSUS
Has a flattened membraneous proximal attachment to the ischial tuberosity
Tendon forms around the middle of the thigh
Tendon descend to the posterior part of the tibial condyle and divides into 3 parts;
1.Blends with the popliteal fossa
2. Attach directly to the posterior aspect of the tibial condyle
3. A reflected part that reinforces the intercondylar part of the joint capsule of the KJ as the oblique popliteal ligament

59. BICEPS FEMORIS Has two prox. attachment LONG AND SHORT HEAD
In the inferior part of the thigh, long head becomes tendinous and joined by short head
The round common tendon attaches to the head of fibular and
The long head crosses and provide protection for the sciatic nerve
The lateral branch of the SN continue the relationship- runs with the biceps femoris

60. The short head is attached proximally to the lateral lip of the inferior 1/3rd of the linea aspera
Also to the supracondylar ridge of the femur

61. N/S The hamstring muscle is supplied by the tibial branch of the SN
The biceps femoris is innervated by the fibular branch
Thus since each nerve have different nerve supply a wound in the posterior thigh with nerve injury may paralyzed one head and not the other

62. B/S From the internal iliac artery through perforating branches
These branches enter the posterior compartment by perforating aponeurotic portion of the adductor magnus attachment and medial intermuscular septum,

63. CLINICAL
A person with paralyzed harmstrings tend to fall forward cos the G. max cannot maintain the necessary muscle tone to stand straight
Harmstring strains are common in individuals who run and kick hard. They are two times as common as quadriceps strains
HURDLER’S INJURY;
Avulsion of the ischial tuberosity. May result from forceful flexion of the hip with knee extended [e.g. in kicking football]

64. Popliteal Fossa

65. Popliteal fossa
The popliteal fossa is a diamond-shaped space behind the knee joint formed between muscles in the posterior compartments of the thigh and leg.

66. POPLITEAL FOSSA Boundaries Laterally :Biceps femoris above,
and Plantaris and lateral head of
Gastrocnemius below.
Medially : Semitendinous & Semimembranosus above,
and by the medial head of
Floor is formed by the popliteal surface of the femur, upper end of the tibia, oblique popliteal lig.
and the fascia covering the Popliteus;
Roof is formed by the fascia lata.

67. Contents: Tibial nerve and common peroneal nerve
Popliteal vein & Termination of the small saphenous vein
Popliteal artery
Popliteal lymph nodes
Post. Cutaneous branches.

71. popliteal artery Branches 1.superior lateral 2.superior medial
3.Middle
4.inferior lateral
5.inferior medial genicular

72. Popliteal Vein Tributaries
1.Veins that correspond to branches given off by the popliteal artery
2. Small saphenous vein, which perforates the deep fascia and passes between the two heads of the gastrocnemius muscle to end in the popliteal vein

73. Nerves in the Popliteal Fossa
The sciatic nerve usually ends at the superior angle of the popliteal fossa by dividing into the tibial and common fibular nerves.
Cutaneous: Sural nerve and sural communicating branch

75. LOWER LIMB
LEG

76. LEG
The leg is that part of the lower limb between the knee joint and ankle joint .
The leg is divided into anterior (extensor), posterior (flexor), and lateral (fibular) compartments .

77. Leg movements by compartment

78. Anterior Compartment Muscles : 1.Tibialis anterior
2.Extensor hallucis longus
3.Extensor digitorum longus
4.Fibularis tertius
ACTION:Dorsiflex the foot at the ankle joint, extend the toes, and invert the foot
Blood supply: Anterior tibial artery
Nerve supply: Deep peroneal nerve

79. Anterior Leg (deep fibular n.)
Fibularis (peroneus) longus
Extensor digitorum longus
Extensor hallicus longus
Tibialis anterior

80. Tibialis anterior
Origin: Lateral surface of tibia and adjacent interosseous membrane
Insertion: Medial cuneiform and base of first metatarsal bone
Nerve Supply:Deep peroneal nerve
Action:Dorsiflexion of foot at ankle joint; inversion of foot

81. Extensor digitorum longus
Origin: Anterior surface of shaft of fibula
Insertion: Extensor expansion of lateral four toes
Nerve Supply: Deep peroneal nerve
Action: Extension of lateral four toes and dorsiflexion of foot

82. Extensor hallucis longus
Origin: Anterior surface of shaft of fibula
Insertion: Base of distal phalanx of great toe
Nerve Supply: Deep peroneal nerve
Action: Extension of great toe and dorsiflexion of foot

83. Fibularis tertius Origin: Anterior surface of shaft of fibula
Insertion: Base of fifth metatarsal bone
Nerve Supply: Deep peroneal nerve
Action: Dorsiflexion and eversion of foot

84. Arteries Anterior tibial artery:
In the distal leg, it lies between the tendons of the tibialis anterior and extensor hallucis longus muscles.

85. Nerves Deep fibular nerve:
This nerve originates in the lateral compartment of leg as one of the two divisions of the common fibular nerve.

87. Posterior compartment of leg
Muscles in the posterior (flexor) compartment of leg are organized into two groups, superficial and deep.
Blood supply: Posterior tibial artery.
Nerve supply: Tibial nerve

88. 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 and invert the foot and flex the toes.

89. Gastrocnemius Origin: Lateral head from lateral condyle of femur
Medial head from above medial condyle
Insertion:Via tendo calcaneus into posterior surface of calcaneum
Innervation:Tibial nerve
Function:Plantarflexes foot and flexes knee

90. Plantaris Origin: Lateral supracondylar ridge of femur
Insertion: Posterior surface of calcaneum
Innervation: Tibial nerve
Function: Plantarflexes foot and flexes knee

91. Soleus Origin:Shafts of tibia and fibula
Insertion:Posterior surface of calcaneum
Innervation:Tibial nerve
Function:Plantarflexes the foot

93. Popliteus Origin:Lateral surface of lateral condyle of femur
Insertion:Posterior surface of shaft of tibia above soleal line
Innervation:Tibial nerve
Function: Flexes leg at knee joint; unlocks knee joint by lateral rotation of femur on tibia and slackens ligaments of joint

94. Flexor digitorum longus
Origin: Posterior surface of shaft of tibia
Insertion: Bases of distal phalanges of lateral four toes
Innervation: Tibial nerve
Function: Flexes distal phalanges of lateral four toes; plantar flexes foot at ankle joint

95. Flexor hallucis longus
Origin: Posterior surface of shaft of fibula
Insertion: Base of distal phalanx of big toe
Innervation: Tibial nerve
Function:Flexes distal phalanx of big toe; plantar flexes foot at ankle joint

96. Tibialis posterior
Origin:Posterior surface of shafts of tibia and fibula and interosseous membrane
Insertion:Tuberosity of navicular bone
Innervation: Tibial nerve
Function: Inversion and plantarflexion of foot

98. Posterior Compartment
Nerve supply:
Tibial nerve:
Supplies all muscles in posterior compartment.
Divides into medial and lateral plantar nerves inferior and posterior to medial malleolus.
Gives off medial sural cutaneous nerve.
Joins with communicating branch of common peroneal (fibular) nerve to form:
Sural nerve:
Cutaneous.

100. Posterior Compartment
Blood supply:
Posterior tibial artery:
Largest branch of popliteal artery.
Divides into medial and lateral plantar arteries deep to origin of abductor hallucis muscle.
Peroneal artery:
Most important branch of posterior tibial artery.
Supplies lateral compartment and popliteus muscles.
Supplies other muscles in posterior compartment.

101. Arteries in the posterior compartment of leg.

102. Lateral compartment of leg
Muscles: Peroneus longus and peroneus brevis
Blood supply: Branches from the peroneal artery
Nerve supply: Superficial peroneal nerve

103. Peroneus longus Origin:Lateral surface of shaft of fibula
Insertion:Base of first metatarsal and the medial cuneiform
Innervation:Superficial peroneal nerve
Function:Plantar flexes foot at ankle joint; everts foot

105. Peroneus brevis Origin:Lateral surface of shaft of fibula
Insertion:Base of fifth metatarsal bone
Innervation:Superficial peroneal nerve
Function:Plantar flexes foot at ankle joint; everts foot

106. Lateral Compartment Nerve supply:
Superficial peroneal (fibular) nerve:
Deep to peroneus longus.
Inserts on lateral tuberosity.
Blood supply:
No major arteries in lateral compartment.
Muscular branches arise from the peroneal artery:
Branch of posterior tibial.