Download Saphenous nerve

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) Pelvic girdle
ii) Thigh
iii) Leg
iv) Foot
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pelvis
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Hip bone
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femur
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Movement at hip joint
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Thigh
• Superficial fascia of the lower Limb
• Fatty & Membranous layers
• Superficial nerves, superficial vessel, &
superficial inguinal lymph nodes are
present b/w these two layers.
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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 Trat
Saphenous Opening
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Saphenous Opening
supe fascial Veins:
Great Saphenous Vein
Small Saphenous Vein
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An opening or a gape 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.
Superficial veins
great and small saphenous veins and
their tributaries
• Great saphenous vein
It is the longest and thickest •
walled superficial vein in the
body. It begins at the junction of
the medial end of the dorsal
venous arch and the medial
dorsal vein of the great toe runs
upwards and backwards anterior
to the medial malleolus
accompanied by the saphenous
nerve in the
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Superficial inguinal lymph nodes :divided
into two groups
1-horizontal group lies just below and
parallel to the inguinal lig.
2-vertical group lies along the terminal
part of great saphenous vein
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Inguinal ligament
It is the infolded lower border of
the aponeurosis of the external oblique
muscle of the abdomen. It extends
from the pubic tubercle medially to the
anterior superior iliac spine laterally
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The anterior compartment of the
thigh
muscles of the anterior •
compartment of the thigh are
sartorius, the
quadriceps femoris
which include ( rectus femoris, vastus
lateralis, vastus medialis, and vatus
intermedialis muscles) all are
supplied by the femoral nerve
•
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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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Femoral Triangle
A triangular depressed
area situated in the
upper part of the
frontof the thigh just
below the inguinal
ligament
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Bounderies of FT
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•
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Superiorly(base): the inguinal ligament.
Medially: the medial border of the
adductor longus muscle.
Laterally: medial border of the sartorious
muscle.
Inferiorly (apex): is formed as Sartorius
crosses over the lower part of adductor
longus m. continuous with the adductor
canal.
•
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Contents of the triangle
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•
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1-Femoral sheath
It is an extension of the transveralis
fascia of the abdominal cavity which
surrounds the upper 2-3 cm of the
femoral vessels below the inguinal
ligament. The sheath is divided into 3
compartments, the femoral artery occupy
the lateral part of the sheath while the
vein is intermediate, medial to the
femoral vein is the tubular femoral canal,
through which femoral hernia may pass.
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• 2-Femoral artery and its
branches
• 3- Femoral vein and its
tributeries
• 4- Femoral nerve and its
branches
• 5- Femoral branch of
genitofemoral n.
• 6-lateral cutaneous n. of thigh
• 7-deep group of inguinal lymph
node
•
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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
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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
Femoral artery
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Femoral nerve (L2,3,4)
•
arise from the lumber plexus in the
abdomen descend in groove between psoas and
iliacus muscles and give branch to iliacs . it
enters the thigh posterior to the inguinal
ligament and lateral to the femoral sheath. 2cm
below the inguinal ligament it ends by dividing
into anterior and posterior branches .
The anterior division gives:
a-Cutaneous nerves includes the anterior
cutaneous nerve of the thigh.
b-muscular branches to the sartoris and through
which it gives genicular branch to the hip joint.
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•
•
•
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The posterior division gives:
a- Saphenous nerve (L3 L4). It is the longest
branch of the the medial side of the foot.
b- Muscular branches to the quadriceps femoris
muscle (rectus femoris,
vastus
lateralis, medialis and intermedius(.
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The medial side (adductor) of the thigh
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•
•
•
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Includes the adductor muscles
which arise from the external
surfaces of the pubic rami and the
ramus of the ischium. they concerned
with adduction at the hip joint, the
muscles are:
pectineus, adductor longus,
adductorbrevis, adductor magnus,
gracilis
The nerve supply of these muscles is
the obturator nerve (L2, 3, 4).except
the hamstring portion of adductor
magnus from sciatic N. and pectineus
m. receive nerve supply from both
femoral and obturator N.
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Adductor M.
Insertion
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Origin
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The obturator nerve
: arises from the lumbar plexus in the
•
abdomen it descends medial to the psoas
m. at the lateral wall of the pelvis here it
join the obturator vessels and enters the
obturator canal where it divides into
:anterior and posterior branches
•
Anterior branch: descends in the thigh
between adductor longus and adductor
brevis muscles it sends branches to the
these two muscles and gracilis m it also
supply the hip joint.
Posterior branch: pierces the
•
obturator externus m. and descends
between adductor brevis and magnus
muscles. Supply these 3 muscles and ends
as an articular branch through adductor
magnus to the back of the knee joint
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OBT. N
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Obturator artery:
It is a branch of Internal iliac
artery,passes through obturator
canal,divides into anterior and
posterior brancheswhich form a
circle andanastomoses with
medial circumflex femoral artery.
Supplies the neighbouring
muscles and hip joint.
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adductor canal
•
An intermuscular cleft situated on
the medial aspect of the middle 3rd
of the thigh
• Contents of
• adductor canal
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•
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•
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Femoral artery & vein
Saphenous nerve
Nerve to vastus med
Obturator nerve
Profunda femoris
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Clinical Notes
Femoral artery & vein
Catherization
Varicose veins
Veinous cut down
Saphenous vein in coronary
bypass surgery
Femoral hernia
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gluteal region
Extends from the iliac •
crest above to the
.gluteal fold below
The superficial fascia is •
thick dense and fatty,
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The greater &lesser sciatic foramen:
Sacrotuberous ligament ,Sacrospinous
ligament
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Structures which enter the gluteal region from
the pelvis
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which include
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1-Superior gluteal vessels and nerves.
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2-the piriformis muscle
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3-.inferior gluteal vessels and nerves
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4-sciatic nerve,
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5-the posterior cutanous of the thigh
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6-pudendal nerve
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7—nerve to quadrates femoris
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The lesser sciatic foramen:, transmits structures
between the gluteal region and the perineum
these include; the internal pudendal vessels,
pudendal nerve and nerve to obturator
.internus muscle
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Muscles of the gluteal region
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Superficial abductors and extenders
– A group of large muscles that
abduct and extend the femur. It
includes the gluteus maximus,
gluteus medius, gluteus minimus
and tensor fascia lata.
Deep lateral rotators – A group of •
smaller muscles, that mainly act
to laterally rotate the femur. It
includes the quadratus femoris,
piriformis, gemellus superior,
gemellus inferior and obturator
internus and obturator externus .
:
Glut. region
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Greater S.F transmit : 1. piriformis 2. sup. Gluteal n. and vessels. 3.infer. Glut. N. and vessels .
4sciatic
n. 5. post. Cut. N of thigh. 6. pudendal n. 7. nerve to quadratus femoris m.
lesser s. f. transmit
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pdendal n., internal pudendal art. And nerve to obtur. Intern . M
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Artery of gluteal region
Superior gluteal arteryI •
nferior gluteal artery •
Gluteal nerve
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Deep lateral rotators
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The back of the thigh
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The muscles of the back of the thigh •
are the hamstring muscles which are
extensors of the hip joint and flexors
of the knee joint, all arise from the
ischial tuberosity except the short
head of the biceps m. and all are
.inserted in the bones of the leg
• These muscles include: biceps
femoris, semitendinosus and
semimembranosus. All supplied by
the sciatic nerve.
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• Action hamstring muscles are
extensors of the hip joint and
flexors of the knee joint. In
addition both semiten.and
semimem.act as medial rotaters
of leg when knee joint
semiflexed.biceps femoris act as
lateral rotater of leg when knee
joint semiflexed
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Sciatic nerve
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•
•
•
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(L4 L5 S1 S2 S3): it is the thickest nerve in the body arise from the lumbo sacral plexus, pass
inferior to the piriformis m through the greater sciatic foramen, deep to the gluteus maximus
m. in the upper part of its course it descends over
1ischial wall of the acetabulum.
2Obturator internus m. and the 2 gemelli ms.
3 -Quadratus femoris m.
It leaves the buttock by passing deep to the long head of the biceps femoris, it supply the
hamstring ms from the tibial side of the nerve except the short head of biceps muscle receive
its nerve supply from the common peroneal side, it also gives articular branch to the hip
joint. the sciatic nerve then descends on the posterior surface of the adductor magnus m. at
the lower third of the thigh it divided into medial branch (tibial nerve) and lateral branch
(common peroneal nerve).
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The popliteal fossa
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Contents of the fossa
These include:
1- The popliteal vessels.
2- Branches of the sciatic nerve
the tibial and common peroneal
nerves.
• 3- Popliteal lymph nodes.
• 4- Posterior cutaneous nerve of
the thigh.
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HIP JOINT
•
it is a synovial joint of ball and socket
type, the joint formed between the
head of the femur and the
acetabulum, the articular surface of
which is horseshoe shaped and is
deficient inferiorly at the acetabular
notch. The cavity of the acetabulum
is deepened by the presence of a
fibrocartilaginous rim called the
acetabular labrum, the labrum is
connected across the acetabular
notch by the transverse acetabular
ligament. The strength and stability
of the joint depend on :
• 1depth of the acetabulum which
increased by the labrum acetabulae.
The strong ligaments and m
2- •
Ligaments of the joint
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1iliofemoral ligament is a strong
ligament lie in the front of the joint. it
is inverted Y shaped.
• 2Pubofemoral ligament it is
triangular ligament lie in the lower
anterior part of the capsule.
• 3Ischiofemoral ligament it is
spiral in shape lie posteriorly.
• 4The transverse acetabular
ligament it converts the notch into a
tunnel through which the blood
vessels and nerves enter the joint.
• 5-Ligaments of the head of the
femur it is flat attached to the pit on
the head of the femur and by its base
to the transverse acetabular
ligament.
•
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