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Organization of the Lower Limb Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006. Anatomy: A Regional Atlas.

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Presentation on theme: "Organization of the Lower Limb Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, 2006. Anatomy: A Regional Atlas."— Presentation transcript:

1 Organization of the Lower Limb Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition.

2 Limb Development Lower limb develops in an anterolateral position at the level of the L2 to S3 trunk segments Great toe positioned in cephalic direction with the soles of the feet in an ateriomedial direction Knee positioned in a posteriolateral position

3 Limb Rotation Lower Limb Rotation Medial rotation Adduction Extension

4 Segments of the Lower Limb Limb Girdle –pelvic girdle (gluteal) Free limb - thigh - leg - foot

5 Joints of the Lower Limb

6 Articulation with Axial Skeleton Sternoclavicular jt, Sacroiliac jt.

7 Sacroiliac Joint Auricular articular surfaces

8 Sacroiliac Joint Sacroiliac joint Anterior sacroiliac ligaments Posterior sacroiliac ligaments

9 Os Coxae Hemipelvis is composed of the ilium, ischium and pubis with articulations centered in acetabulum – triradiate articulation Fusion of the 3 bones is complete between 20 and 25 years of age

10 Tri-radiate Articulation

11 Joints of the Free Limb Hip Polyaxial ball and socket joint: Felxion/extension Adduction/abduction Medial/lateral rotation Iliofemoral lig. Pubofemoral lig. Ischiofemoral lig. Ligament of head of femur

12 Joints of the Free Limb Knee Modified hinge joint Femur Tibia Patella Tibiofemoral artic. Patelofemoral artic.

13 Joints of the Free Limb Ankle (talocrural) joint Hinge joint 1 axis of movement: Dorsiflexion/plantarflexion

14 Joints of the Free Limb Foot Inversion/eversion occurs at subtalar (talocalcaneal) joint Interphalangeal joints: Distal Proximal metatarsophalangeal joints

15 Vasculature of the Lower Limb

16 Superficial Veins Great saphenous v. Small saphenous v.

17 Arterial Blood Supply External Iliac a Femoral a Popliteal a Anterior Posterior tibial a tibial aa dorsalis med/lat pedis plantar a Internal Iliac a Superior gluteal a Inferior gluteal a Obturator a

18 Deep Femoral Artery Medial & lateral femoral circumflex arteries

19 Fascial Compartments

20 Gluteal Fascia Fascia Lata Crural Fascia Fascia of the Lower Limb

21 Fascia Lata Fascial Compartments of the Thigh Anterior compartment Medial (adductor) compartment Posterior compartment anterior compartment posterior compartment medial compartment Fascial septa divide limb into compartments

22 Crural Fascia Fascial Compartments of the Leg Anterior crural compartment Lateral crural compartment Posterior crural compartment Superficial & deep posterior crural compartments anterior lateral posterior anterior compartment lateral compartment posterior compartment

23 Lumbosacral Plexus

24 Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)

25 Lumbosacral Plexus L1 - S3

26 Gluteal innervation: Superior gluteal n (L4,5, S1) : gluteus medius m. gluteus minimus m. tensor fascia lata Inferior gluteal n (L5, S1,2) : gluteus maximus m. N to obturator internus (L5, S1, 2) : oburator internus superior gemellus Nerve to quadratus femoris (L4,5, S1) : inferior gemellus quadratus femorus

27 Anterior compartment Medial compartment Posterior compartment Lateral compartment Thigh Leg Foot Compartmental Innervation Of the Free Limb

28 Anterior (extensor) compartment of the thigh Innervation: femoral nerve anterior

29 Medial (adductor) compartment of the thigh Innervation: obturator nerve* medial *Adductor Magnus innervated by both obturator n and tibial division of sciatic n medial

30 Posterior compartment of the thigh Hamstring mm: arise from ischial tuberosity & are innervated by tibial division of sciatic n. Innervation: Tibial division of sciatic nerve Except short head of biceps femoris: common fibular division of sciatic nerve posterior

31 Posterior compartment of the leg Innervation: tibial n. Superficial posterior crural compartment Deep posterior crural compartment posterior

32 Plantar surface of the foot Innervation: Medial & lateral plantar nerves

33 Innervation of intrinsic muscles of the foot Medial plantar n flexor digitorum brevis flexor hallucis brevis abductor hallucis m 1st lumbrical Lateral plantar n abducator digiti minimi quadratus plantae 2nd, 3rd & 4th lumbricals adductor hallucis Flexor digiti minimi dorsal & plantar interossei

34 Common fibular nerve Nerve supply to the lateral and anterior crural compartments anterior lateral anterior lateral

35 Lateral crural compartment: Superficial fibular nerve Fibularis longus Fibularis brevis lateral

36 Anterior crural compartment: Deep fibular nerve Tibialis anterior m. Extensor hallucis longus m. Extensor digitorum longus m. Fibularis tertius m. anterior

37 Dorsum of the foot: deep fibular nerve Extensor hallucis brevis Extensor digitorum brevis

38 Anterior compartment Medial compartment Posterior compartment Lateral compartment Thigh Leg Foot Compartmental Innervation of Free Limb Femoral n. Obturator n. * * adductor magnus - obturator n and tibial n Tibial division of sciatic n. * * short head of biceps femoris - common fib. division of sciatic n. Deep fibular n.Tibial nerve Superficial fibular n. Deep fibular n.Tibial n. (medial and lateral plantar n.)

39 Key dermatomes* thumb - C6 5th digit of hand - C8 nipples - T4 umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root Dermatomes

40 Key dermatomes* of the Lower Limb umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root

41 Cutaneous Nerve Supply to the Lower Limb

42 References Clemente, C Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins. Rinabesm C,H, Cunninghams Textbook of Anatomy, 11th edition. Oxford University Press. Rosse, C & Gaddum-Rosse, P Hollinsheads Textbook of Anatomy 5th edition. Lippincott-Raven Schuenke, M et al, 2006 Thieme Atlas of Anatomy: Musculoskeletal System. Thieme. Slaby, F., et al Gross Anatomy in the Practice of Medicine. Lea & Febiger.


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