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GNK 483
MUSCULOSKELETAL CONDITIONS
BLOOD AND NERVE SUPPLY TO THE
LOWER LIMB
2012
Arterial Supply
•
Superior gluteal
– Runs through greater sciatic foramen
•
Inferior gluteal
– Runs through gluteal region
•
Obturator
– Runs through obturator foramen to adductor
compartment of thigh & hum head
•
•
Femoral
Popliteal
Femoral Artery
• Main artery
• Origin = external iliac artery
• Course = femoral sheath
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Lateral to femoral vein
Anterior to femoral head
Runs superficially in femoral triangle
Passes through adductor canal
Changes name to popliteal artery at add hiatus
Femoral Artery Branches
• Branches inferior to inguinal ligament
– Superficial circumflex iliac artery
– Superficial epigastric artery
– Superficial external pudendal artery
• Branches in femoral triangle
– Deep external pudendal artery
– Deep femoral artery
– Descending genicular artery
Deep Femoral Artery
• Main artery of thigh
• Arises lateral side of femoral artery
• Leaves femoral triangle betw pectineus & add longus in the
floor of the triangle
• In adductor compartment it runs betw add longus and add
magnus
• Supplies adductors & flexor compartment
• Branches
– Medial circumflex femoral a : clinical importance
• Supplies largest quantity of blood to fem head and neck
– Lateral circumflex femoral a
• Supplies lat side of thigh & fem head
Deep Femoral Artery
• Anastomosis at height of lesser trochanter on
posterior side of thigh
– Medial circumflex femoral
– Lateral circumflex femoral
– Inferior gluteal
– 1st perforator of deep femoral
Popliteal Artery Branches
• Cutaneous
– Posterior surface of leg
• Muscular
– Lower part of thigh muscles
– Calf muscles : sural artery
• Articular
– Medial & lateral superior genicular
– Middle genicular
– Medial & lateral inferior genicular
• Terminal
– Anterior tibial
• Called dorsalis pedis on dorsum of foot
– Posterior tibial
• Divides into medial & lateral plantar aa
• Latter forms plantar arch & anastomosis with dorsalis pedis a
Venous Drainage
• Deep veins
• Superficial veins
• Perforators
Deep Veins
• 2 venae comitantes accompany each artery of the leg
of which popliteal and femoral vv are examples
• Blood flows proximally in these veins with the aid of:
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Valves
Muscular contraction
Pulsation of aa adj to venae comitans
Pressure changes in thorax
Superficial Veins
On dorsum of foot
• Small saphenous
– Post to lateral malleolus
– Middle of calf it runs superficial to calcaneal tendon &
gastroc
– Ascends in relation sural n
– Ends in popliteal vein
• Great saphenous
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Medial side of dorsal arch
Ant to medial malleolus
Ascends in relation to saphenous n
Drains into femoral vein
• Before terminating, great saphenous
receives:
– Superficial epigastric
– External pudendal
– Superficial circumflex iliac
– Anterolateral branch
– Posteromedial branch
• Perforators
– At saphenous opening
– Lower part of thigh Hunters perforating v
– Below knee : Boyd’s perforating v
– Medial aspect of leg
Innervation
Lumbar Plexus
• Femoral n : L2,3,4 (posterior)
– Muscular to ant compartment, pectineus
– Articular to hip & knee
– Cutaneous
• Intermediate ant cutaneous
• Medial ant cutaneous
• saphenous
Lumbar Plexus
• Obturator n : L2,3,4 (anterior)
– Muscular to adductor, gracilis
– Articular to hip & knee
– Cutaneous to medial part of thigh
• Lateral cutaneous nerve to thigh : L2,3
Sacral Plexus
• Sciatic n : L4,5,S1,2,3
– Muscular to hamstrings, add magnus
– Articular to hip & knee
• Tibial n
– Common fibular
• Superficial fibular
– Muscular to peroneus longus & brevis
– Cutaneous to distal 1/3 of leg & dorsum of foot except 1st web space
• Deep fibular
– Muscular to 4 muscles of ant compartment
– Cutaneous to 1st web space
LYMPHATIC SYSTEM
LOWER LIMB