2 The parts of the lower limb (1) By means of the position The buttock, the thigh, the leg, the foot. (2) Parts The thigh: anterior, medial and posterior regions. Behind the knee: the popliteal fossa. The leg: anterior, lateral and posterior regions. The foot: dorsum and sole of foot.
3 The function The locomotion and weight bearing The function The locomotion and weight bearing To support the weight and to make the erection of the body besides walking and moving The characteristics of the lower limb as compared with the upper limb (1) The thick and large bones (2) The tough and tensile ligaments (3) The thick and bulky muscles (4) The more stabilization of articular movement
4 I．Surface Landmarks 1. The iliac crest (fourth lumber vertebra). 2 I．Surface Landmarks 1. The iliac crest (fourth lumber vertebra). 2. The anterior superior iliac spine 3. The posterior superior iliac spine 4. The pubic tubercle 5. The tuberosity of ischium 6. The greater trochanter of the femur 7. The patella 8. The popliteal fossa 9. The medial and lateral condyles of the femur 10. The medial and lateral condyles of the tibia 11. The head of the fibula 12. The anterior margin of the tibia
5 II. The Main Contents I ) The skin The skin of the anterior surface is thin, specially the dorsum The skin of the posterior surface is thick, specially sole of foot.
6 II ) The superficial fascia The thickness of the superficial fascia vary in the different regions There are the thickest parts of the superficial fascia in the buttocks and the superior part of the posterior region of the thighs The superficial fascia is abundant in the superficial vein, lymphatic vessel , lymph nodes and cutaneous nerves.
7 The great saphenous vein It’s the largest superficial vein of the lower limb and situated in the anterior and medial parts of the lower limb Begins in the medial side of the dorsum of the foot →Runs upward anterior to the medial malleolus → then on the medial surface of the leg, accompanying with the saphenous nerve →then ascends on the posteromedial surface of the knee → runs upwards on the medial surface of the thigh →inclines anteriorly throngh the thigh → on the lateral and inferior to the pubic tubercle enters the femoral vein through the saphenous hiatus.
8 It receives five large tributaries, as follow: (1) The superficial epigastric vein. (2) The superficial iliac. circumflex vein. (3) The external pudendal vein. (4) The superficial medial femoral vein. (5) The superficial lateral femoral vein.
10 2. The small saphenous vein Begins the lateral side of the dorsum of the foot →runs upward posterior to the lateral malleolus → then ascends along the posterior median line of the leg, accompanying with the sural nerve → then passes between the two heads of gastrocnemius to the lower part of the popliteal fossa → finally pierces the popliteal fascia and drains into the popliteal vein It receives a lot of the tributaries and communicates with the great saphenous vein and deep veins of the lower limb.
11 3. The superficial inguinal lymph nodes They are 8-10 in number, lie in the superficial fascia and are arranged in the shape of “T” (1) The upper nodes They are scattered just distal to the inguinal ligament and receive the lymph from the skin and superficial tissue of abdominal wall below the level of the umbilicus, the buttock, the external genital organs, the perineum and the lower part of the anal canal.
13 (2) The lower nodes They are placed along both sides of the upper part of the great saphenous vein and receive the lymph from the superficial structures of the lower limb excluding the lateral part of the foot and the heel The efferents of the superficial inguinal lymph nodes drain into the deep inguinal lymph nodes.
14 4. The cutaneous nerves (1) The anterior and medial regions of the thigh 1）The ilioinguinal nerve 2）The femoral branch of the genitofemoral nerve 3）The lateral femoral cutaneous nerve 4）The anterior cutaneous branchs of femoral nerve The medial and intermediate femoral cutaneous nerves 5）The saphenous nerve
15 (2) The gluteal region, the back of the thigh and the popliteal fossa 1）The subcostal nerve and the lateral cutaneous branch of iliohypogastric nerve 2）The posterior branch of the lateral femoral cutaneous nerve 3）The inferior gluteal cutaneous nerve 4）The superior gluteal cutaneous nerve 5）The middle gluteal cutaneous nerve.
16 (3) The leg and the dorsum of foot ）The medial sural cutaneous nerve 2）The sural nerve 3）The lateral sural cutaneous nerve 4）The communicating branch of peroneal nerve 5）The distal end of the superficial peroneal nerve 6）The lateral and medial cutaneous branches of foot.
17 ) The deep fascia The deep fascia is the compact(dense) and tenacity ) The deep fascia The deep fascia is the compact(dense) and tenacity. 1. In the thigh The deep fascia of the anterior part of thigh is thick and called as the fascia lata The lateral part of the fascia lata is quite thick and strong, and extends from the anterior portion of the iliac crest superiorly to the lateral condyle of the tibia inferiorly, named the iliotibial tract Just inferolateral to the pubic tubercle, there is an oval deficiency in the fascia, known as the saphenous hiatus.
18 IV ) The muscles The muscles of the anterior and lateral regions of the thigh 1) The anterior group The iliopsoas ( the psoas major iliacus) The tensor fasciae latae ) The anterior group of the muscle of thigh The quadriceps femoris (rectus femoris, vastus medialis, lateralis, intermedius) The sartorius 3) The medial group The pectineus, adductor longus, gracilis, adductor brevis, adductor magnus.
19 3. The muscles of the leg, the dorsum of foot 1) The ｍ 3. The muscles of the leg, the dorsum of foot 1) The ｍ.of anterior group of the leg From the medial to the lateral: tibialis anterior; extensor hallucis longus; extensor digitorum longus. The muscles of lateral group of the leg peroneus longus; peroneus brevis.
20 4) The muscules of the dorsum of foot extensor digitorum brevis, extensor hallucis brevis.
21 V) The regional structures 1 V) The regional structures The lacuna musculorum and lacuna vasorum They are the gap and situated between the inguinal ligament and hip bone. This gap is divided into the Lacuna musculorum laterally and lacuna vasorum medially by the iliopectineal arch. They are the passages from the abdomen to the thigh.
22 1) lacuna musculorum The boundary: anterior----- the inguinal lig 1) lacuna musculorum The boundary: anterior----- the inguinal lig. posteriolateral－ the ilium medial －－－－ the iliopectineal arch The contents: the lateral femoral cutaneous nerve, the iliopsoas, the femoral nerve.
23 2) Lacuna vasorum The boundaries: anterior——the inguinal lig 2) Lacuna vasorum The boundaries: anterior——the inguinal lig. p—— the pectineal lig. Lateral:the iliopectineal arch, medial :the lacunar The contents the femoral artery the femoral vein the femoral canal the lymphatic vessels
24 2. The femoral triangle 1）The position The superomedial part of the thigh 2）The formation The superior boundary: the inguinal lig. The lateral boundary: the medial border of sartorius The medial boundary: the medial border of adductor longus The floor: the iliopsoas, pectineus, adductor longus The roof: the skin, superficial fascia and deep fascia The apex: directed downwards and communicates with the adductor canal
25 The contents From the lateral to the medial The femoral nerve The femoral sheath: from the lateral to the medial femoral artery; femoral vein; femoral canal; deep inguinal lymph nodes
26 The femoral nerve It arises from lumber plexus, descends behind the iliac fascia and the surface of the iliacus, and enters the femoral triangle posterior to the inguinal ligament and lateral to the femoral sheath through the lacuna musculorum. The main branch is short and ends by dividing into a number of branches 2cm below the inguinal ligament. Its muscular branches supply the quadriceps femoris, sartorius and pectineus. Its cutaneous branches are intermediate, medial femoral cutaneous nerves and the saphenous nerve. Its articular branches pass to the hip and knee joints.
27 femoral sheath It is a funnel shaped fascial tube which encloses the femoral artery, the femoral vein and the femoral canal formed by the prolongation of the fascia lining the abdomen (transverse fascia anteriorly and iliac fascia posteriorly) It ends 4cm inferior to the inguinal ligament and is fused with the adventitia of the femoral vessels. The sheath is subdivided by two partitions into three compartments. The lateral compartment contains the femoral artery; the intermediate one contains the femoral vein; the medial compartment forms the femoral canal.
28 ★ The femoral artery It is main trunk of the lower limb ★ The femoral artery It is main trunk of the lower limb. It is continuous with the external iliac artery at the mid-inguinal point, then passes down the femoral triangle and enters the femoral canal. It becomes the popliteal artery by passing through the adductor tendinous opening into the popliteal fossa In addition to three small superficial arteries, the main branch of the femoral artery is the deep femoral artery which arises from the posterolateral surface of femoral artery 2-5cm below the inguinal ligament and gives off the lateral femoral circumflex artery, medial femoral circumflex artery and 3-4 branches of the perforating artery.
29 ★ The femoral vein It is medial to the femoral artery and receives the tributaries accompanying the branches of the femoral artery.
30 ★ The femoral canal and deep inguinal lymph nodes It is a infundibuliform (funnelform) clearance(space) about 1-1.5cm long and the medial compartment of the femoral sheath It is the place of the susceptibility to the femoral hernia.
32 ● The formation of the femoral canal: Upper end(femoral ring) laterally: the femoral vein medially: lacuna lig. and conjoined tendon anteriorly: inguinal lig posteriorly: pectineal lig. Lower end blindness, directing the saphenous hiatus Wall of the canal Anterior wall is the fascia lata Posterior wall is the pectineus fascia Lateral wall is the femoral vein
33 ● The contents of the femoral canal: to 2 deep inguinal lymph nodes and the lymphatic vessels; loose areolar tissue and fat.
34 3. The adductor canal (of Hunter) (1) Position It is a deep furrow on the medial side of the middle of the thigh about 15cm in length. (2) Formation Anteriorly: the sartorius and the adductor lamina; Laterally: the vastus medialis; Posteriorly: the adductor longus and magnus; Superior opening: connecting the femoral triangle; Inferior opening: connecting the popliteal fossa.
35 (3)The contents of The adductor canal from the anterior to posterior The saphenous nerve; The femoral artery; The femoral vein.
36 6. The malleolar canal Position: It is the medial side of the ankle joint Formation: It is formed by the flexor retinaculum (which bridges across the interval between the calcaneus and the medial malleolus) together with the calcaneus.
37 The contents of the mallelar canal: From the anterior to the posterior The tendon and tendinous sheath of the tibialis posterior; The tendon and tendinous sheath of the flexor digitorum longus; The posterior tibial artery and vein and the tibial nerve; The tendon and tendinous sheath of the flexor hallucis longus.