7 Parts and regions of the lower limb Gluteal region:between iliac crest superiorly and gluteal fold inferiorlyThigh:between hip and kneeKnee:joint between leg and thighLeg:between knee and footAnkleFoot
8 Anterior Region of Thigh Superficial structures:
9 Cutaneous nerves: Femoral branch of jenitofemoral n. ilioinguinal n. Lateral cutaneous n. of thighAnterior cutaneous n. of thighmedial cutaneous n. of thigh
10 Key dermatomes* of the Lower Limb umbilicus - T10hip crease - L1great toe - L45th toe - S1*area of skin supplied by a dorsal nerve root
15 Superficial veins Superficial epigastric v. Superficial circumflex iliac v.Superficial Externalpudendal v.Superficial lateral femoral v.Great saphenous v.
16 Superficial inguinal lymph nodes: Horizontal groupVertical group
17 Superior group: Inferior group: Superficial inguinal lymph nodes Lies just distal to the inguinal ligamentReceive lymph from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organsInferior group:Lies vertical along the terminal great saphenous v.Receives all superficial lymphatics of lower limb, except for those from the posterolateral part of calfEfferent vessels drain into the deep inguinal ln. or external iliac ln.
18 Fascia of the Lower Limb Gluteal Fascia Fascia Lata Crural Fascia
19 Fascial Compartments of the Thigh anterior compartmentFascia Latamedial compartmentposterior compartmentAnterior compartmentMedial (adductor) compartmentPosterior compartment
20 Deep fascia – fascia lata Iliotibial tractSaphenous hiatusfalciform margincribriform fascia
21 Muscles of Hip and Thigh Gluteals (posterior pelvis)Extend thighRotate thighAbducts thighAnterior Compartment ThighFlexes thigh at hipExtends leg at kneeMedial/Adductor CompartmentAdducts thighMedially rotates thighPosterior Compartment ThighExtends thighFlexes leg
22 Anterior Compartment muscles of Thigh Tensor fascia lataO: iliac crest, A.S.I.S.I: iliotibial tractA: Flex thigh, abduct thigh, medial rotation of thighN. : Superior Gluteal n.
23 Sartorius-O – ASIS-I – superior part of medial surface of tibia-A – flexes, abducts, and external rotates thigh-N. Femoral n.
24 Iliopsoas-O – sides of T12-L5 vertebrae, iliac crest & fossa-I – lesser trochanter of femur, pectineal line-A – flexing the thigh-N- Femoral n.
27 Vastus lateralis-O – greater trochanter and lateral lip of linea aspera of femurVastus medialis-O – intertrochanteric line and medial lip of linea aspera of femurVastus intermedius-O – anterior and lateral surfaces of body of femur*Same for all 3-I – base of patellaA – helps flex thigh
28 Femoral triangleThis triangle is bounded by: superiorly; the inguinal ligament (base)laterally; the medial border of sartoriusMedially; the medial border of adductor longusInferiorly; the apex of the triangle is continuous with adductor canal.The anterior wall is fascia lataThe posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to lateral side.
29 Contents of the femoral triangle 1. The femoral artery and its branches,the profunda femoris artery,The lateral and medial circumflex arteries,The deep external pudendal.2. The femoral vein and its tributaries.3. Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein.4. The femoral nerve.5. The femoral canal.
30 Adductor canalExtends from apex of femoral triangle to adductor hiatusBounded by : laterally;vastus medialisposteriorly; adductors longus and magmus,anteriorly ;adductor lamina and sartoriusContents – saphenous nerve, femoral a., femoral v., lymphatic vessels, and loose connective tissue
31 The adductor hiatus is a gap in the distal attachment of adductor magnus to the femur, which permits the femoral vessels to pass from the adductor canal downward into the popliteal space.
32 Femoral sheathThe femoral sheath is a funnel- shaped sheath , derived from transversalis fascia anteriorly and iliac fascia posteriorly. It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.
33 The femoral sheath is divided into three compartments by two fibrous septa. The femoral artery occupies the lateral compartment of the sheath. The femoral vein lies the middle compartment. The medial compartment is small, called the femoral canal.
34 The femoral canalIt is about 1.3cm long , and its upper opening is called the femoral ring .The boundaries of the femoral ring are:, anteriorly; the inguinal ligamentthemedially; lacunar ligament;, posteriorly; the pecten of pubis laterally; the femoral vein, superiorly; covered by femoral septum.The canal contains a little loose fatty tissue, a small lymph node, and some lymph vessels.
35 Femoral herniaA femoral hernia is common in women than in men (possibly due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh.
36 Lacuna musculorumBounded by: anteriorly; lateral portion of inguinal ligament,posterolaterally; iliumMedially; iliopectinal archContents: iliopsoas m, femoral n. and lateral femoral cutaneous n.Lateral femoral cutaneous n.IliopsoasFemoral n.Iliopectinal arch
37 Lacuna vasorumBounded by: anteriorly,medial portion of inguinal ligament posteromedially, pectineal ligament medially,lacunar ligament ,Posterolaterally,iliopectinal arch Contents:femoral sheath, femoral a. and v., genital branch of genitofemoral n. and lymphatic vessels, femoral ringFemoral a.Femoral v.Femoral ring
38 Arteries of lower limb Femoral a. This is the main artery of the lower limb and is directly continuous with the external iliac artery of the abdomen behind the inguinal ligament at the mid- inguinal point. It becomes the popliteal artery by passing through the adductor tendinous opening.
39 2. Descending genicular a. 3. Deep external pudendal a. Femoral a.Principal branch: Deep femeral a.: arises from the posterolateral surface of the femoral artery about 4 cm below the inguinal ligament.2. Descending genicular a.3. Deep external pudendal a.4. Superficial branches:superficial epigastric a.superficial iliac circumflex a.external pudendal a.
40 Profunda femoris Four perforating arteries Lateral circumflex artery It arises from the profunda near its origin and runs laterally among the branches of the femoral nerve and then deep to rectus femoris. Here it divides into ascending, transverse, and descending branches.Medial circumflex arteryarises either from the profunda near its origin or occasionally direct fromthe femoral artery.Four perforating arteries
41 Medial circumflex a.Profunda femoral a.Latral circumflex a.Saphenous n.
42 Femoral nerveIt arises from the lumbar plexus in the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2cm below the inguinal ligament.Muscular branche to: pectineus, sartorius, quadriceps femoris
43 Cutaneous nerve branches: (1) Anterior cutaneous nerves of the thigh (medial and lateral).(2) Saphenous nerve is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.
44 Femoral veinThis is the direct continuation of the popliteal vein. It begins at the adductor tendinous opening and accompanies the femoral artery to the inguinal ligament behind which it becomes the external iliac vein.The femoral vein contains several valves.
49 Pectineus-O - Superior ramus of pubis-I - Pectineal line of femur-A – adducts and flexes thighN: Femoral, obturator
50 Innervation: Obturator nerve Adductor BrevisO - Inferior Pubic RamusI - Pectineal Line and Linea AsperaA - adducts, flexes, and medially rotates femurGracillisO - pubic Symphysis and inferior pubic ramusI - medial surface of the tibiaA - adducts thigh, flexes medially and medially rotates thigh, flexes legInnervation: Obturator nerve
51 Adductor Longus O - med portion of the superior pubic ramus I - linea aspera of femurA - adducts, flexes, and medially rotates the femurInnervation: Obturator nerve
52 Adductor MagnusO - ischiopubic ramus and ischial tuberosityI - linea aspera of the femur; the ischiocondylar part inserts on the adductor tubercle of the femurA - adducts, flexes, and medially rotates the femur; extends the femurInnervation: post div of Obturator nerve and tibial n.
53 Nerve and artery Obturator n. Accessory obturator n. Obturator a. Medial circumflex a.arises either from the profunda near its origin or occasionally direct from the femoral artery.
54 Nerve of Medial Fascial Compartment of the Thigh Obturator NerveNerve of Medial Fascial Compartment of the ThighThe posterior division pierces the obturator externus and passes downward behind the adductor brevis and in front of the adductor magnusThe anterior division passes downward in front of the obturator externus.