Download 1 Anatomy- Lower Limb – Areas

Anatomy- Lower Limb – Areas
Femoral triangle
- a triangular fascial space in the superoanterior third of the thigh
- boundaries:
o superior: inguinal ligament
o medial: adductor longus
o lateral: sartorius
- floor:
o medial pectineus
o lateral iliopsoas
- roof: fascia lata, cribriform fascia, subcutaneous tissue, skin
- contents (medial to lateral):
o femoral vein/artery/nerve and their branches
o femoral sheath and its contents
o deep inguinal LNs
- bisected by the femoral artery and vein which leave, and enter the adductor canal at its apex
Femoral sheath
- funnel-shaped fascial tube that encloses proximal parts of femoral vessels, which lie inferior to inguinal ligament
- surrounds the femoral canal but does not enclose the femoral nerve
- a diverticulum or inferior prolongation of fasciae lining abdomen (transversalis fascia ant and iliac fascia post)
- covered by fascia lata
- ends ~4cm inferiorly to inguinal ligament when it becomes continuous with loose c.t. covering femoral vessels
- medial wall pierced by the great saphenous vein and lymphatics
- purpose: allows femoral vessels to glide in and out, deep to the inguinal ligament, during hip joint movements
- compartments: divided by 2 vertical septa into 3 compartments:
o lateral: contains femoral artery
o intermediate: femoral vein
o medial aka the femoral canal
1
Femoral ring
- 1cm wide small superior end or mouth of the femoral canal
- closed by extraperitoneal fatty tissue - femoral septum, pierced by lymphatics connect inguinal/external iliac LNs
- 4 boundaries:
o lateral: partition between femoral canal and femoral vein
o posterior: superior pubic ramus covered by pectineus muscle and its fascia
o medial: lacunar ligament
o anterior: medial part of inguinal ligament
- a weak area – femoral hernias (protrusion abdominal viscera thru ring into canal)
Adductor canal
- aka subsartorial or Hunters canal
- 15cm long, narrow fascial tunnel in the thigh
- deep to middle 1/3 sartorius
- provides intermuscular passage thru which femoral vessels pass to reach popliteal fossa - become popliteal vessels
- begins 15cm inferior to inguinal ligament where sartorius crosses adductor longus (apex of femoral triangle
- ends at adductor hiatus in tendon of adductor magnus
- boundaries:
o anteriolateral: vastus medialis
o posterior: adductor longus and magnus
o medial: sartorius
- subsartorial plexus of nerves lies on this fascia – in middle 1/3 thigh – supplies overlying skin
- contents:
o femoral artery and vein
o saphenous nerve
o nerve to vastus medialis
femoral vessels enter canal where sartorius crosses adductor longus, vein lies posterior to artery
femoral vessels leave canal through tendinous opening in adductor magnus - adductor hiatus
femoral artery enters popliteal fossa, becomes popliteal artery, same for vein
profunda femoris A+V don’t enter adductor canal
perforating branches of these vessels pierce fibres of adductors to reach post aspect of thigh
saphenous nerve (cutaneous branch femoral nerve) accompanies femoral artery thru adductor
canal. Enters canal lateral to artery, crosses anteriorly, lies medial at distal end
Popliteal Fossa
‘diamond shaped anatomical space behind the knee’
Borders
Superomedial - Semimembranosus and semitendinosus
Superolateral - Biceps femoris
Inferiomedial - Medial head of gastrocnemius
Inferolateral - Lateral head of gastrocnemius
Roof
Fascia lata, strongly reinforced by transverse fibres
Pierced by small saphenous vein and posterior femoral cutaneous nerve.
Floor (from above down)
Popliteal surface of the femur
Capsule of the knee joint – reinforced by oblique popliteal ligament.
Popliteus muscle – covered by fascia.
Contents (medial to lateral)
Popliteal artery and branches
Branches
Muscular branches to the muscles in the popliteal fossa (including 2 large sural arteries)
Genicular arteries (5)
Middle genicular artery
Pierces oblique popliteal ligament to supply cruciates
Medial superior genicular artery
Deep to semitendinosus, semimembranosus, tendon of adductor magnus – encircles
lower end of femur.
2
Lateral superior genicular artery
Deep to tendon of biceps femoris – encircles the lower end of the femur.
Medial inferior genicular artery
Course to the medial head of gastrocnemius – encircles the upper end of the tibia.
Lateral inferior genicular artery
Runs deep to lateral head of gastroc and crosses tendon of popliteus - encircles upper
end of tibia.
(Anterior tibial artery)
(Posterior tibial artery)
Small saphenous vein entering popliteal vein
Tibial nerve
Branches
Muscular branches
All muscles that arise in the popliteal fossa and flexor compartment
Plantaris
Gastrocnemius
Soleus
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior.
Sural nerve
Runs between 2 heads of gastrocnemius
Pierces deep fascia half way down the calf to replace the posterior cutaneous nerve of the thigh.
Joined by sural communicating nerve
Lies close to small saphenous vein.
Genicular nerves (3)
Accompany the superior and inferior medial genicular arteries to supply medial ligaments and
capsule and middle genicular artery to pierce oblique popliteal ligament supplying it and the
cruciate ligaments.
Common peroneal nerve
Branches
Sural communicating nerve
Pierces the roof of the fossa to join the sural nerve below the bellies of gastrocnemius.
Lateral cutaneous nerve of the calf (lateral sural nerve)
Pierces the roof of the fossa over the lateral head of gastrocnemius to supply skin over
upper part of peroneal and extensor compartments of the leg.
Superior and inferior genicular nerves
Supply capsule of knee and lateral ligament.
Recurrent genicular nerve
Arises in the substance of peroneus longus, perforates tibialis anterior and supplies knee
joint and superior tibiofibular joint.
Popliteal lymph nodes – lie along the popliteal vein
Factoids
Popliteal artery is deep to popliteal vein which is deep to nerves
Skin overlying popliteal fossa supplied by post cut nerve of thigh
3
Posterior to Medial Malleolus
Tom Dick And Very Nervous Harry
Tibialis posterior tendon
Flexor Digitorum Longus tendon
Posterior tibial Artery
Posterior tibial Vein
Tibial Nerve
Flexor Hallicus longus tendon
4