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Transcript
ANATOMY OF LOWER LIMB
DR. SIDRA HASAN
1
Introduction
Lower limb is designed to
support the body, its weight
& it is mainly responsible
for gait
Organization of the Lower
Limb
Lower limb has four parts
i) Hip (gluteal region)
ii) Thigh
iii) Knee
iv) Leg
v) Ankle
vi) Foot
2
Superficial fascia of the
lower Limb
Fatty & Membranous layers
Superficial nerves, superficial
vessel, & superficial inguinal
lymph nodes are present b/w these
two layers.
Nerves:
Lat. Cut. N of thigh
Med. Cut. N of thigh
Intermed. Cut. N of thigh
Femoral br. of Genitofemoral n
Ilioinguinal n
Branch from obturator n
Patellar plexus
Veins:
Great Saphenous Vein
Small Saphenous Vein
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Superficial Inguinal Lymph Nodes
Horizontal Group
Vertical Group
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Deep fascia of the lower limb
Fascia Lata (deep fascia of the thigh)
Crural Fascia (deep fascia of the leg)
Iliotibial Tract
Saphenous Opening
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Saphenous Opening
An opening or a
gap in the deep
fascia in the front
of the thigh 4cm
inferolateral to the
pubic tubercle.
The saphenous
opening is covered
by loose CT called
CRIBRIFORM
fascia.
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Fascial Compartments of the Thigh
Three fascial septa pass from the inner aspect of the deep
fascial sheath of the thigh to the linea aspera of the femur.
Making Anterior posterior & Medial compartments. Having
muscles, nerves & arteries.
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Muscles of the Anterior Fascial
Compartments of the Thigh
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Muscles of the Anterior Fascial
Compartments of the Thigh
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Muscles of the Anterior Fascial
Compartments of the Thigh
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Muscles of the Anterior Fascial
Compartments of the Thigh
Quadriceps Femoris
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Muscles of the Anterior Fascial
Compartments of the Thigh
Quadriceps Femoris
Femoral Triangle
A triangular
depressed area
situated in the upper
part of the medial
aspect of the thigh
just below the
inguinal ligament
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BUNDARIES OF FEMORAL TRIANGLE
•
•
•
•
•
•
•
Medially by adductor longus
Laterally by medial Border of sartorius
Base by inguinal ligament
Apex : by meeting of medial & lateral border
Roof:
1)Skin ,
2)Superfacial fasia ( containing sup.inginal lymph nodes,
femoral branch of genitofemoral N. ,Ilioinguinal N. Branches,
superficial branches of femoral arteries n veins &upper part of
great saphanous vein
• 3) Deep fascia with saphanous opening and cribriform fascia
• Floor : medially by adductor longus and pectineus and
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laterally by psoas major and iliacus
CONTENTS OF TRIANGLE
•
•
•
•
•
•
•
•
•
FEMORAL ARTERY &Its branches ( 6 branches)
FEMORAL VEIN & its tributraies
FEMORAL SHEATH encloses upper 4cm of femoral vessels.
NERVES
1) FEMORAL Nerve
2) Nerve to pectineus
3) Femoral branch of genitofemoral nerve
4) Lateral cutaneous nerve of thigh
5) Deep inguinal lymph nodes
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Blood Supply of the Anterior Fascial
Compartments of the Thigh
Femoral Artery
main artery of lower limb
Origin
Continuation of Ext. Iliac artery below
the inguinal ligament. Enters the
thigh midway between the ant. Sup.
Iliac spine & pubic Symphysis
Termination
Ends at the opening in the adductor
magnus muscle by entering the
popliteal fossa as popliteal artery
Branches
Superficial:
Sup. Ext. Pudendal
Sup. Epigastric
Sup circumflex iliac Lat. Cir femoral
Med. Cir. Femoral
Deep:
4 perforating a
Profunda femoris
Deep Ext. pudendal
Descending genicular
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19
Femoral Nerve
Largest branch of lumbar
plexus
20
Femoral Sheath
Inferior prolongation of transversalis &
iliopsoas fascia
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The femoral
sheath does not
enclose the
femoral nerve
24
The adductor (subsartorial) canal
An intermuscular cleft
situated on the medial
aspect of the middle 3rd
of the thigh
Contents of
adductor canal
Femoral artery & vein
Deep lymph vessels
Saphenous nerve
Nerve to vastus med
Obturator nerve
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Boundaries of adductor canal
ANTERIOR WALL : Vastus medialis
POSTERIOR WALL or floor : Adductor longus above
&adductor magnus below
MEDIAL WALL OR roof :strong fibrous membrane joining
ant. &post. Walls.. Its overlapped by sartorious.
>SUBSARTORIAL PLEXUS:
LIES ON FIBROUS ROOF
Formed by branches from med. Cut.nerve of thigh,the
saphanous nerve and ant. Div. of obturator nerve.
It supplies the overlying fascia lata &the neibouring skin.
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POPLITEAL FOSSA
• POPLITEAL FOSSA is a diamond shaped depression
lying behind the knee joint.. The lower part of femur &
upper part of tibia.
• BOUNDARIES OF FOSSA
• SUPEROLATERAL : BICEPS FEMORIS
• SUPEROMEDIAL : SEMITENDINOSIS supplemented
by the gracilis,the sartorious, the adductor magnus
• INFEROLATERAL :LAT. Head of gastrocnemius
• INFEROMEDIAL : MED. Head of gastrocnemius
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• ROOF : Formed by deep fascia (popliteal fascia)
• The superfascial fascia over roof contains
1) Short saohanous vein
2)Three cutaneous nerves . Terminal part of post.
Cutaneous nerve of thigh.peroneal (sural)
communicating nerve
FLOOR:
1) POPLITEAL Surface of femur
2)capsule of knee joint &oblique popliteal ligament
3)strong popliteal fascia covering popliteus muscle
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Contents
•
•
•
•
•
•
•
•
Popliteal artery n its branches
Popliteal vein & its tributries
TIBIAL nerve n its branches
Common peroneal n branches
Post. Cutaneous n of thigh
Genicular branch of obturator nerve
Popliteal lymph nodes
fat
34
Clinical Notes
Femoral artery & vein
Catherization
Varicose veins
Veinous cut down
Saphenous vein in coronary
bypass surgery
Femoral hernia
35
36
Interosseous membrane
• Binds tibia & fibula together &provide
attachments for neighbouring muscles.
• SUPERIOR EXTENSOR RETINACULUM
• ATTACHMENTS:
• MEDIALLY: Lower part of ant. Border of tibia
• LATERALLY:Lower part of ant. Border of fibula
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