Download Introduction of the nervous system

The lower limb(1)
山东大学医学院 解剖教研室
李振华
Muscles of lower limb
The muscles of lower limb are divided
into: the muscles of hip, thigh, leg
and foot.
Muscles of hip
 anterior group

Iliopsoas 髂腰肌




iliacus 髂肌
psoas major 腰大肌
Psoas minor 腰小肌
Tensor fasciae latae
阔筋膜张肌

Posterior group







Gluteus maximus 臀大肌
Gluteus medius 臀中肌
Gluteus minimus 臀小肌
Piriformis 梨状肌
Obturator internus 闭孔内肌
Quadratus femoris 股方肌
Obturator externus 闭孔外肌
Muscles of thigh
Anterior group

Sartorius 缝匠肌

Quadricep 股四头肌




Rectus femoris
股直肌
Vastus medialis
股内侧肌
Vastus lateralis
股外侧肌
Vastus intermedius
股中间肌
Medial group
 Pectineus 耻骨肌
 Adductor longus 长收肌
 Adductor brevis 短收肌
 Adductor magnus大收肌
 Gracilis 股薄肌
adduct thigh at hip joint
Posterior group

Biceps femoris
股二头肌

Semitendinosus
半腱肌

Semimembranosus
半膜肌
flex the leg at knee
joint extend the thigh
at hip joint
Muscles of leg
Anterior group

Tibialis anterior 胫骨前肌

Extensor hallucis longus
拇长伸肌


Extensor digitorum
longus 趾长伸肌
Peroneus tertius
第三腓骨肌
Lateral group

Peroneus longus
腓骨长肌

Peroneus brevis
腓骨短肌
plantarflex and evert
the foot
Posterior group

Superficial lager
triceps surae小腿
三头肌

Gastrocnemius
腓肠肌

Soleus 比目鱼肌
Deep layer





Popliteus 腘肌
Flexor digitorum
longus趾长屈肌
Flexor hallucis
longus拇长屈肌
Tibialis posterior
胫骨后肌
Muscles of foot

Muscles on dorsum:
extensor digitorum
brevis

Muscles in sole:
medial, lateral and
intermediate groups
Major muscles of lower limb
Iliopsoas

Origin:





Psoas major: transverse
processes and lateral
surface of bodies of
lumbar vertebrae
Iliacus: iliac fossa
Insertion: lesser
trochanter of femur
Action: flexes thigh on
trunk
Nerve supply: lumbar
plexus
Gluteus maximus

Origin: gluteal surface
of ilium and dorsal
aspect of sacrum

Insertion: gluteal
tuberosity of femur
and iliotibial tract

Action: extends and
laterally rotates thigh
at hip joint; raises
trunk when the lower
limb is fixed

Nerve supply: inferior
gluteal n.
Piriformis

Origin: anterior surface of
sacrum

Insertion: greater
trochanter of femur

Divided the greater sciatic
foramen into suprapiriform
foramen 梨状肌上孔 and
infrapiriform foramen 梨状
肌下孔


Action: rotates thigh
laterally at hip joint
Nerve supply: sacral
plexus
Sartorius




Origin: anterior
superior iliac spine
Insertion: upper
medial surface of tibia
Action: flexes hip and
knee joints; rotates
flexed knee medially
Nerve supply: femoral
n.
Quadriceps femoris
Origin:








Rectus femoris: anterior
inferior iliac spine
Vastus medialis: medial lip
of linea aspera
Vastus lateralis: lateral lip
of linea aspera
Vastus intermedius:
anterior surface of femur
Insertion: tibial tuberosity
via patellar ligament
Action: extends leg at knee
joint; rectus femoris also
flexes thigh at hip joint
Nerve supply: femoral n.
Tibialis anterior




Origin: lateral surface
of tibia
Insertion: medial
cuneiform and base of
1st metatarsal
Action: dorsiflexes and
inverts foot
Nerve supply: deep
peroneal n.
Triceps surae
Origin:






Gastrocnemius: medial and
lateral condyles of femur
Soleus: soleal line of tibia
and upper third of fibula
Insertion: calcaneum via
tendo calcaneus
Action: flexes knee joint
and plantarflexes foot at
ankle joint; steadies leg on
foot during standing
Nerve supply: tibial n.
Tibialis posterior




Origin: posterior
surface of tibia and
ffibula and
interosseous
membrane
Insertion: tuberosity of
navicular, all cuniforms
Action: plantarflexes
and inverts foot
Nerve supply: tibial n.
Arteries of lower limb
Femoral a.




Continuation of the external iliac a.
Begins midpoint of inguinal ligament
Principal branch
deep femeral a.股深动脉: arises from
the posterolateral surface of the
femoral artery about 5 cm below the
inguinal ligament.
Distributed to all three muscle
compartments by medial and lateral
femoral circumflex旋股内、外侧动脉
and four perforating arteries 穿动脉
of deep femoral a.
Popliteal a.


Continuation of femoral a.
at adductor hiatus
Divided into anterior and
posterior tibial arteries at
lower border of poplitus
Posterior tibial a.



Passes downwars deep to
gastrocnemius and soleus
Passes behind medial
mallealus by dividing into
medial and lateral plantar
arteries
Branches: peroneal a.,
medial and lateral plantar a,
Anterior tibial a.


Descends on anterior
surface of interosseous
membrane
In front of ankle joint
becomes dorsal a. of foot
Dorsal a. of foot


Passes forward between
tendons of extensor longus
and extensor digitorum
longus to the proximal
End of first intermetatarsal
space
Obturator a.



Branch of internal iliac
a.
Passes through the
obturator foramen and
enters medial
compartment of thigh
supplies obturator
externus, pectineus,
adductors of thigh, and
gracilis
Veins of lower limb
Deep veins: anterior and posterior tibial v. →
popliteal v.→ femoral v. → external iliac v.
 Great saphenous v. 大隐静脉




Begins the medial end of dorsal venous arch of
food
Passes anterior to the medial malleolus and
ascends on the medial side of the leg, then
passes behind the knee and curves forward
around the medial side of the thigh
Inclines anteriorly through the thigh to enter the
femoral vein through the saphenous opening
which lies about 3~4 cm below and lateral to
the pubic tubercle
Tributaries:
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Superficial medial femoral v.
Superficial lateral femoral v.
External pudendal v.
Superficial epigastric v.
Superficial iliac circumflex v.
Superficial epigastric v.
Superficial circumflex iliac v.
External pudendal v.
Superficial medial femoral v.
Superficial lateral femoral v.
Great saphenous v.
Small saphenous v.

Arises from the lateral part
of the dorsal venous arch
of foot

Ascends behind lateral
malleolus and then passes
upward to the midline of
the clft

Pierces the deep fascia
and enters the popliteal v.

It drains the lateral side of
the foot and ankle and the
back of the leg.
Lymph nodes and vessels of lower
limb
Popliteal ln.



Embedded in the fatty
connective tissue of
popliteal fossa
Receive superficial
lymphatic vessels from
posterolateral part of calf,
and from deep lymphatic
vessels accompanying
anterior and posterior tibial
a.
Efferents pass to the deep
inguinal ln.
Superficial inguinal lymph
nodes
Superior group:

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
Lies just distal to the
inguinal ligament
Receive lymph from
anterior abdominal wall
below umbilicus, gluteal
region, perineal region,
external genital organs
Inferior group:




Lies vertical along the
terminal great saphenous v.
Receives all superficial
lymphatics of lower limb,
except for those from the
posterolateral part of calf
Efferent vessels drain into
the deep inguinal ln. or
external iliac ln.
Deep inguinal lymph
nodes

Lie medial to the
femoral v.

Receive deep
lymphatics of lower
limb, perineal region,
and efferent
lymphatics from the
superficial inguinal ln.

Drain into the external
iliac ln.
Nerves of lower limb


Femoral n.: supplies
anterior thigh muscles
(quadriceps, sartorius and
pectineus), hip and knee
joint, and skin on
anteromedial side of thigh,
saphenous nerve is
distributed to skin of medial
side of leg and foot
Obturator n.: enters thigh
through obturator foramen;
supplies medial group of
muscles of thigh, obturator
externus, and skin of medial
side of thigh
Branches of sacral plexus



Superior gluteal n.
leaves pelvis through
suprapiriform foramen and
passes between gluteus
medius and minimus to
supplies these muscles and
tensor fasciae latae
Inferior gluteal n.
leaves pelvis through
infrapiriform foramen，and
supplies gluteus maximus
Posterior femoral cutaneous:
leaves pelvis through
infrapiniform foramen,runs
deep to gluteus maximus, and
emerges from ite inferior
border to supply skin of buttock
and then surface skin over
posterior of thigh and calf
Sciatic n. 坐骨神经


Leaves pelvis through infrapiriform
foramen to enter gluteal region, runs
inferiorly laterally deep to gluteus
maximus, passing midway between
the greater trochanter of femur and
ischial tuberosity to back of thigh, lying
deep to long head of biceps femoris,
normally divided into tibial and
common peroneal nerves just above
popliteal fossa
Innervates semitendinosus,
semimembranosus and biceps femoris
and has articular branches to hip and
knee joints



Common peroneal n. 腓总神经
passes over posterior aspect of
head of fibula and then winds
around neck of fibula, deep to
peroneus longus, where it divides
into deep and superficial peroneal
nerves
Deep peroneal n. 腓深神经
descends on interosseous
membrane and enters dorsum of
foot; supplies anterior muscles of
leg, and skin of first interdigital cleft
Superficial peroneal n. 腓浅神经
supplies peroneus longus and
brevis and skin on anterior surface
of leg and dorsum of foot
Tibial n. 胫神经
 Runs inferiorly with
posterior tibial vessels and
terminates beneath flexor
retinaculum by dividing into
medial and lateral plantar
nerves
 Supplies posterior muscles
of leg and knee joint
Regional anatomy of the
lower limb
山东大学医学院 解剖教研室
李振华
Parts and regions of the lower limb

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Gluteal region－between iliac
crest superiorly and gluteal
fold inferiorly
Thigh－between hip and knee
knee－joint between leg and
thigh
Leg－between knee and foot
Ankle
Foot
Surface anatomy




Gluteal region and thigh－anterior superior and inferior
iliac spines，tubercle of iliac crest，ischial tuberosity，
greater trochanter, pubic tubercle, pubic crest, superior
border of pubic symphysis
Knee－patella ligament, tuberosity of tibia, medial and
lateral condyles and epicondyles, tendon of biceps
femoris, tendons of semitendinosus and
semimembranosus, head of fibula
Leg－anterior border of tibia, neck of fibula
Ankle and foot－medial and lateral malleolus, calcaneal
tuberosity, tuberosity of navicular bone, and tuberosity of
fifth metatarsal bone
Anterior and Medial Region of Thigh
Superficial structures－superficial fascia

Superficial arteries:




Superficial veins－great saphenous v.,

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
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superficial epigastric v.
superficial iliac circumflex v.
external pudendal v.
superficial medial femoral v.
superficial lateral femoral v.
Superficial inguinal lymph nodes:



superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.
superior group
inferior group
Cutaneous nerves:


lateral femoral cutaneous n.
anterior and medial cutaneous branches of femoral n.

Deep fascia – fascia lata 阔筋膜


Iliotibial tract 髂胫束
Saphenous hiatus 隐静脉裂孔


falciform margin 镰状缘
cribriform fascia 筛筋膜
Lacuna musculorum
肌腔隙


Bounded by lateral
portion of inguinal
ligament anteriorly, ilium
posterolaterally,
iliopectinal arch medially
Contents: iliopsoas,
femoral n. and lateral
femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Femoral n.
Iliopectinal arch
Lacuna vasorum 血管腔隙

Femoral a.
Femoral v.
Femoral ring


Bounded by medial portion
of inguinal ligament
anteriorly, pectineal
ligament posteromedially,
lacunar ligament medially,
and iliopectinal arch
posterolaterally
Contents:
femoral sheath, femoral a.
and v., genital branch of
genitofemoral n. and
lymphatic vessels, femoral
ring
Femoral triangle



This triangle is bounded by:
the inguinal ligament (base)
superiorly; the medial
border of sartorius laterally;
the medial border of
adductor longus medially.
Inferiorly, the apex of the
triangle is continuous with
adductor canal.
The anterior wall is fascia
lata
The posterior wall consists
of adductor longus,
pectineus and iliopsoas ,
from medial to lateral side.
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.
Femoral sheath

The femoral sheath is a a funnelshaped 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.

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.
The femoral canal



It is about 1.3cm long , and its
upper opening is called the
femoral ring .
The boundaries of the femoral
ring are: the inguinal ligament,
anteriorly; the lacunar ligament腔
隙韧带 medially; the pecten of
pubis, posteriorly; the femoral
vein, laterally. covered by femoral
septum股环隔 superiorly.
The canal contains a little loose
fatty tissue, a small lymph node,
and some lymph vessels.
Femoral hernia
A 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.
Femoral nerve


It 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 2 cm
below the inguinal ligament.
Muscular branche to:
pectineus, sartorius,
quadriceps femoris
Cutaneous 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.

Femoral artery

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.
Profunda femoris


which arises from the posterolateral surface
of the femoral artery about 5 cm below the
inguinal ligament.
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 artery
arises either from the profunda near its origin
or occasionally direct from the femoral artery.
Femoral vein


This 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.
The deep inguinal lymph nodes

Three or four deep inguinal
lymph nodes lie along the
medial side of the femoral
vein. Afferent lymph vessels
reach them from the
superficial inguinal and
popliteal lymph nodes and
from the deep structures of
the limb. Efferent lymph
vessels pass from the deep
inguinal nodes along the
femoral vessels to the
external iliac nodes on the
external iliac vessels in the
abdomen.
Adductor canal



Extends from apex of femoral
triangle to adductor hiatus
Bounded by vastus medialis
laterally, adductors longus and
magmus posteriorly, and
adductor lamina and sartorius
anteriorly
Contents – saphenous nerve,
femoral a., femoral v., lymphatic
vessels, and loose connective
tissue
Blood vessels and nerve of medial side of
thigh

Obturator a. :
arises from internal iliac artery in
the lesser pelvis, passes through
the obturator canal where it
divides into anterior and posterior
branches.

Obturator n.:
arises from the lumbar plexus in
the abdomen. It enters the thigh
through the obturator canal where
it divides into anterior and
posterior branches. The anterior
branch descends anterior to the
adductor brevis. The posterior
branch descends between
adductors brevis and magnus
supplying both.
Front of the leg and dorsum of the
Superficial
veins
foot



The dorsal venous arch lies on the distal
parts of the bodies of the metatarsals. It
drains the dorsum of the foot and toes.
The small saphenous vein runs
posteriorly, passing first inferior and then
posterior to the lateral malleolus. It
ascends to the popliteal fossa in the back
of the leg.
The great saphenous vein passes
posterioriy on the medial side of the foot. It
ascends anterior to the medial malleolus,
then obliquely across the distal third of the
medial surface of the tibia.
Cutaneous nerves
 The upper two-thirds of the front of
the leg is supllied by the saphenous
nerve (L3,4) medially, and the
lateral cutaneous nerve of the calf
laterally.
 The lower third is supplied by the
superficial peroneal and saphenous
nerves.
 The dorsum of the foot is mainly
supplied by the medial and
intermediate cutaneous branches of
the superficial peroneal nerve.
However, the lateral margin is
supplied by the sural nerve and the
medial margin by the saphenous
nerve proximally and the superficial
peroneal distally.
 The first interdigital cleft and the
skin immediately proximal to it are
supplied by the deep peroneal
nerve.
Deep fascia


The deep fascia of the leg is
very strong.
Superior extensor retinaculum
伸肌上支持带

Inferior extensor retinaculum
伸肌下支持带
Deep peroneal nerve




It arises from the common peroneal nerve
between the neck of the fibula and the
peroneus longus muscle
It descends in the anterior compartment of
the leg with the anterior tibial vessels.
It supplies all the muscles of the anterior
compartment of the leg and extensor
digitorum brevis.
If the nerve is destroyed, dorsiflexion of the
ankle and extension of the
metatarsophalangeal joints is lost, and
inversion is weakened the condition known
as ‘drop foot’.
Anterior tibial artery
 It from the popliteai artery at the lower
border of popliteus. It passes
forwards above the interosseous
membrane, and turns downwards on
the anterior surface of that membrane
with the deep peroneal nerve.
 It becomes the dorsalis pedis artery,
midway between the malleoli.
The anterior tibial veins are closely
applied to the artery.
Dorsalis pedis artery
 It begins on the anterior surface of
the ankle joint and runs with the
deep peroneal nerve
 it divides into the arcuate artery and
the first dorsal metatarsal artery at
the proximal end of the first
intermetatarsal space.
 On the dorsum of the foot it lies on
the tarsal bones and is readily
palpated against them between the
tendons of extensor hallucis longus
and extensor digitorum longus.
Dissetion
Superficial epigastric v.
Superficial circumflex iliac v.
Lateral cutaneous n. of thigh
External pudendal v.
Anterior cutaneous n. of thigh
Superficial lateral femoral v.
Superficial medial femoral v.
Great saphenous v.
Femoral n.
Femoral a.
Femoral v.
Medial circumflex a.
Profunda femoral a.
Latral circumflex a.
Saphenous n.
Obturator n.
Deep peroneal n.
Superficial peroneal n.
Anterior tibial a.
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Dorsal a. of foot
The gluteal region
and back of thigh and leg
山东大学医学院 解剖教研室
李振华
Cutaneous nerves
Superior cluneal n.
Medial cluneal n.
Inferior cluneal n.
suprapiriform foramen
infrapiriform foramen
Structures passing
suprapiriform foramen

Superior gluteal n., a., v. from
lateral to medial side
Structures passing
infrapiriform foramen

Sciatic n., posterior femoral
cutaneous n., inferior gluteal
n., a.,v., internal pudendal
v.,
a., and pudendal n. from lateral
to medial side
Pudendal nerve, internal pudendal artery
 These structures enter the gluteal region through the infrapiriform
foramen.
 They then curve forwards to enter the perineum through the
lesser sciatic foramen.
★Sciatic nerve


Course: It arises from the sacral plexus and
passes through infrapiriform foramen into the
gluteal region, deep to gluteus maximus,
passing midway between the greater trochanter
of femur and ischial tuberosity to back of thigh,
the nerve lies deep to the long head of biceps
on the posterior surface of adductor magnus.
The sciatic nerve usually ends half-way down
the back of the thigh by dividing into the
common peroneal and tibial nerves.
Distribution: semitendinosus,
semimembranosus and biceps femoris and has
articular branches to hip and knee joints
Relationship of sciatic n. to the piriformis
Boundaries of the popliteal fossa 腘窝




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Diamond-shaped
Upper lateral boundary:
Biceps femoris
Upper medial boundary:
semimembranosus and
semitendinosus
Two lower boundaries are
the heads of gastrocnemius
Posterior wall: deep fascia
Anterior wall: popliteal
surface of the femur, the
posterior capsule of the
knee joint, and the fascia
covering poplitells
Contents of the popliteal fossa
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Tibial and common
peroneal nerves and
their branches
Popliteal vein and its
tributaries
Popliteal artery and
its branches
Popliteal lympn nodes
Fatty tissue
Popliteal artery
It begins at the adductor
tendinous opening in. Here
it is continuous with the
femoral artery. It ends at
the lower border of the
popliteus muscle where it
divides into anterior and
posterior tibial arteries.
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Branches:
1. Superior, inferior, and
middle genicular arteries
2. Muscular branches
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Popliteal vein
 This is formed by the junction of the anterior
and posterior tibial veins near the lower
border of the popliteus muscle.
Popliteal lymph nodes
 There may be one or two nodes just under
the deep fascia, close to the popliteal fossa
vessels.
 They drain the deep tissues of the leg and
foot and the knee joint. They also receive
superficial lymph vessels from the lateral
side of the foot, the heel, and the back of the
calf. These drain along the line of the small
saphenous vein.
The back of the leg
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Find the small saphenous
vein
Find the Sural nerve and
Peroneal communicating
nerve
Find out
 Gastrocnemius
 Soleus
 Plantaris
 Tibial nerve
 Popliteal artery and
branches (Peroneal artery )
 Popliteus
 Flexor hallucis longus
 Flexor digitorum longus
 Tibialis posterior
Malleolar canal
Formed by midial surface
of calcaneus, flexor
retinaculum and medial
malleolus
Structures passing
Malleolar canal
 Tibialis posterior
 Flexor digitirum longus
 Posterior tibial a. v. and n.
 Flexor hallucis longus
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