Presentation on theme: "Windsor University School of Medicine"— Presentation transcript:
1Windsor University School of Medicine Gluteal region, thigh & leg The future belongs to those who believe in the beauty of their dreams. Eleanor RooseveltLecture Idara C. Eshiet
2OBJECTIVES 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.
3Bones of lower limb Hip bone ( Ilium, Ischium and pubis) Femur Tibia Fibula
4Areas of transition/Bones & joints of the lower limb.
11Fascia of the thighSuperficial is the continuity of the superficial fascia of anterior abdominal wallDeep fascia thickened laterally to form the illiotibial tactHas a gap called saphenous openingDivided into 3 compartments by 3 intermuscular septa
13Muscle compartments in the thigh In the thigh, there are medial (adductor), anterior (extensor), and posterior (flexor) compartments.
14Anterior Thigh Muscles Anterior thigh muscles are the flexors of the hip and extensors of the knee.
15IliacusAction: Chief flexor of the hip joint. Nerve Supply: Femoral nerve
16Psoas MajorAction: Flexes thigh on trunk Nerve Supply: femoral nerve
17PectineusAction: Flexion & adduction of hip joint Nerve supply: Femoral nerve
18Sartorius Nerve Supply: Femoral nerve Action : 1.Flexion, abduction and Lateral rotation of thigh at hip joint.2. Flexion leg at knee jointNerve Supply: Femoral nerve
19 Tailor's muscleThis 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.
20Quadriceps femoris Four muscles make up this group. They are: rectus femoris,vastus lateralis,vastus medialis,vastus intermedialisAction: extension of kneeRectus femoris also flexes the hip joint as well.Nerve Supply: Femoral nerve
22Medial Compartment of Thigh 1. GracilisAdduction of the the hip joint & flexion of knee joints2. Adductor longusAdduction of the the hip joint.3214
233. Adductor brevisAdduction of the the hip joint.4. Adductor magnus has 2 parts.Ant. Part is an adductorPost. Part is an extensor of the the hip joint5. Obturator externusLateral rotation of hip jointObturator nerve but the post. part of adductor magnus is supplied by tibial nerve which is a branch of the sciatic nerve.
24Adductor magnus & Obturator externus Is innervated by the obturator nerve2. Adductor magnusThe adductor part is innervated by the obturator nerve& the hamstring part is innervated by the tibial division of the sciatic nerve12
25Pectineus, Adductors longus & brevis Is innervated by the femoral nerve2. Adductor longusIs innervated by the obturator nerve3. Adductor brevis132
27Adductor 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.
30Adductor HiatusThe 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.
313. SemimembranosusExtension of hip joint & flexion & medial rotation of knee joint.Nerve Supply: Tibial portion of sciatic nerve
32Posterior Compartment of the Thigh 1. Biceps femorisExtension of the the hip joint & flexion & lateral rotation of the knee joint.Nerve supply:Long head: tibial portion of sciatic nerveShort head: common peroneal portion of sciatic nerve2. SemitendinosusExtension of the the hip joint & flexion & medial rotation of the knee joint.Nerve supply: Tibial portion of sciatic nerve
51Lateral rotation of the thigh@ hip joint nerve Supply: S1 & S2 nerves 4. Piriformis m.Lateral rotation of the hip jointnerve Supply: S1 & S2 nervesImportant landmark of the gluteal region.5. Obturator InternusSame function as piriformisNerve supply: (L5-S1) nerves to obturator internusThe piriformis muscle passes through the greater sciatic foramen. It divides in into a superior and inferior part.
53Muscles of the gluteal region Cont’d. 6. Superior GemellusLateral rotation of the the hip joint(L5-S1) nerves to obturator internus7. Inferior GemellusSame function as superior gamellusNerve to quadratus femoris ( L5, S1)
54Lateral rotation of the thigh @ the hip joint 8. Quadratus FemorisLateral rotation of the the hip joint(L5-S1) nerves to quadratus femoris8
56The 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.
62Contents 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 thigh5. Popliteal lymph nodes and lymphatic vessels
63Floor This is formed by: popliteal surface of the femur, capsule of knee joint &popliteus muscle
64LEG Fascia Muscles of anterior compartment Muscles of lateral compartmentMuscles of posterior compartment (superficial & deep layers)Main muscles responsible for ankle joint movements
65Fascia 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 retinaculaFlexor retinaculumFibular retinaculum
66Cross-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).
69Muscles of anterior compartment 1. Tibialis anteriorDorsiflexion & inversion of the foot at the ankle.2. Extensor digitorum longusExtension of lateral 4 digits & dorsiflexion of the ankle12
70N. supply: Deep fibular nerve 3. Extensor hallucis longusAction: Extension of big toe & dorsiflexion of the ankleDeep fibular nerve from common fibular nerve4. Fibularis TertiusAction :Dorsiflexion and eversion of footN. supply: Deep fibular nerve
73Muscles of lateral compartment 1. Fibularis longusEversion & plantar flexion of foot.2. Fibularis brevisSuperficial fibular nerve from common fibular nerve12
74Injury to common fibular nerve Footdrop and loss of eversionMay cause sensory loss over lateral leg and dorsum of footCausesDirect trauma as nerve passes superficially around neck of fibula
75Foot dropFoot 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.
76Posterior compartment of leg Muscles in the posterior (flexor) compartment of leg are organized into two groups; superficial and deep.Nerve supply: Tibial nerve
77Muscles of the Posterior Compartment of the Leg Superficial group of muscles1.Gastrocnemius2.Soleus3.PlantarisDeep group of muscles1.Popliteus2.Tibialis posterior3.Flexor digitorum longus4.Flexor hallucis longusMuscles mainly plantarflex, invert the foot and flex the toes.
78Superficial Group1. Gastrocnemius Action: Plantar flexion of the foot the ankle), knee flexion Nerve Supply: Tibial nerve 2. Soleus Action: Plantarflexion of the foot
793. Plantaris:Action: plantarflexion of the footNerve Supply: Tibial nerve
80Gastrocnemius 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
92POWER REVIEW1.1. What are the 4 regions of the lower limb, and which bones are found in each region?Hip: ilium, Ischium, & pubisThigh: Femur & patellaLeg: Tibia & fibulaFoot: Tarsal bones, metatarsal bones, & phalanges.2. Name the 7 tarsal bonesTalus, Calcaneus, Cuboid bone, Navicular bone, Cuneiform bones (3)
93POWER REVIEW2. 3. what is the largest and most posterior tarsal bone? The calcaneus4. 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
94POWER REVIEW3. 6. The talus articulates with which 2 tarsal bones? The calcaneus & the navicular bone7. 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
95POWER REVIEW4. 9. which muscle is the major flexor at the hip joint? Iliopsoas.10. name the external rotators of the hipPiriformis, Gemellus superior, Obturator internusGemellus inferior, Obturator externus, Quadratus femoris11. Name the 5 ligaments that are associated with the hip joint.Iliofemoral ligament, ischiofemoral ligament, pubofemoral ligamentTransverse acetabular ligament, ligament capitis femoris
96POWER 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)
97POWER 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.
98POWER 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.,
99Review Questions.11. 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 EXCEPT3. 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?
100Review Questions.26. 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 EXCEPT8. 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
101Review Questions.311. 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 EXCEPT15. Which of the following muscles is located in the posterior aspect of the thigh?
102Review Questions.416. All of the following muscles are lateral rotators of the thigh EXCEPT17. All of the following statements concerning the gluteus medius and minimus are correct EXCEPT18. All of the following statements concerning the gluteus maximus are correct EXCEPT19. All of the following statements concerning the femoral triangle are correct EXCEPT20. All of the following statements concerning the adductor magnus are correct EXCEPT21. Which of the following statements concerning the gracilis muscle is correct?
103T. S. EliotNo 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