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The Lower Limb Anatomage Table Instructors Guide- Lower Limb Table of Contents Lower Limb 1- The Skeletal System........................................................................................................3 1: Hip Bone...........................................................................................................................................3 2: Hip Joint and Femur..........................................................................................................................4 3: Patella and Knee Joint.......................................................................................................................7 4: Tibia, Fibula, and Ankle Joint...........................................................................................................9 5: Subtalar Joint and Foot....................................................................................................................11 Suggested Clinical Correlates (CC): ..............................................................................................13 Lower Limb 2- The Muscular System....................................................................................................14 1: Gluteal Region and Posterior Thigh................................................................................................14 2: Anterior and Medial Thigh..............................................................................................................15 3: Posterior Compartment of Leg and Sole of Foot............................................................................18 4: Anterior and Lateral Compartments of Leg and Dorsum of Foot...................................................20 Suggested Clinical Correlates (CC): ..............................................................................................22 Lower Limb 3- The Cardiovascular System ..........................................................................................23 1: Arterial Supply to Hip and Thigh....................................................................................................23 2: Arterial Supply to Knee, Leg and Foot...........................................................................................25 3: Venous Return of the Lower Limb..................................................................................................27 Suggested Clinical Correlates (CC): ..............................................................................................29 Appendix..................................................................................................................................................30 Lower Limb 1- The Skeletal System 1: Hip Bone • Describe the three bones comprising the “hip bone” Acetabulum Anterior superior iliac spine Iliac crest Iliac fossa Iliopubic eminence Ilium Ischium Obturator foramen Pubis 1. a. Hip Bone (Anterior) Anterior gluteal line Anterior inferior iliac spine Anterior superior iliac spine Body of ilium External lip of iliac crest Greater sciatic notch Inferior gluteal line Intermediate zone of iliac crest Posterior gluteal line Posterior inferior iliac spine Posterior superior iliac spine Tubercle of iliac crest 1. b. Ilium (Lateral) Body of ischium Ischial ramus Ischial spine Ischial tuberosity Lesser sciatic notch 1. c. Ischium (Lateral) Inferior pubic ramus Obturator crest Obturator groove Pectineal line Pubis Pubic tubercle Superior pubic ramus 1. d. Pubis (Anterior) 2: Hip Joint and Femur • Describe the articulation of the hip joint and discuss the anatomical features of the femur Acetabular notch Acetabulum Fobea capitis Head of femur Ilium Ischium Neck of femur Obturator foramen 2. a. Hip Joint (Anterior) Acetabulum Anterior superior iliac spine Greater trochanter Head of femur Ilium Ischium Lesser trochanter Neck of femur Obturator foramen Pubic symphysis Superior pubic ramus 2. b. Hip X-Ray (Lateral) Greater trochanter Head of femur Intertrochanteric line Lesser trochanter Neck of femur 2. c. Anterior Proximal Femur Gluteal tuberosity Greater trochanter Head of femur Intertrochanteric crest Lateral lip of linea aspera Lesser trochanter Medial lip of linea aspera Neck of femur 2. d. Posterior Proximal Femur Adductor tubercle Lateral epicondyle Medial epicondyle Medial femoral condyle Shaft (body) 2. e. Anterior Distal Femur Adductor tubercle Intercondylar fossa Lateral femoral condyle Lateral supracondylar line Linea aspera Medial femoral condyle Medial supracondylar line Shaft (body) 2. f. Posterior Distal Femur 3: Patella and Knee Joint • Describe the bony articulations of the knee • Describe the ligamentous structures of the knee and describe the types of injuries that might damage them Lateral femoral condyle Lateral tibial condyle Medial femoral condyle Medial tibial condyle Patella Patellar surface of femur 3. a. Knee Articulation (Lateral) Apex of patella Base of patella Patella Patellar tendon (ligament) Quadriceps tendon Tibial tuberosity 3. b. Patellar Ligaments (Anterior) Apex of patella Articular surface of patella Base of patella Nonarticular area 3. c. Patella (Posterior) Anterior interconylar area Lateral condyle of tibia Lateral intercondylar tubercle Medial intercondylar tubercle Medial tibial condyle Tibial tuberosity 3. d. Tibial Plateau (Anterior) Lateral condyle of tibia Lateral femoral condyle Lateral meniscus Medial femoral condyle Medial meniscus Medial tibial condyle 3. e. Menisci (Anterior) Anterior cruciate ligament (ACL) Intercondylar fossa Lateal meniscus Lateral condyle of tibia Lateral femoral condyle Medial femoral condyle Medial meniscus Medial tibial condyle Posterior cruciate ligament (PCL) 3. f. Cruciate Ligaments (Coronal Cut- Posterior) 4: Tibia, Fibula, and Ankle Joint • Describe the articulations of the ankle and describe the supporting ligaments Anterior border of fibula Apex of fibula Gerdy's tubercle Head of fibua Lateral surface of tibia Lateral tibial condyle Neck of fibula Superior tibiofibular joint Tibial tuberosity 4. a. Humerus (Anterior) Anterior border of fibula Anterior border of tibia Inbterosseous border of tibia Medial border of tibia Medial crest of fibula Posterior border of fibula Shaft of fibula Shaft of tibia 4. b. Coronoid Fossa (Anterior) Fibular notch of tibia Inferior tibiofibular joint Lateral malleolus Medial malleolus 4. c. Olecranon Fossa (Posterior) Ankle joint Body of talus Head of talus Lateral malleolus Medial malleolus Neck of talus Trochlea of talus 4. d. Humeroulnar Joint (Medial) 5: Subtalar Joint and Foot • Describe the articulations of the subtalar joint • Identify the weight bearing bones of the leg and foot instrumental to stable standing and walking • Describe the various arches of the foot and the bones involved in each arch Anterior talar articular surface Body of talus Calcaneus Head of talus Medial talar articular surface Neck of talus Posterior talar articular surface Subtalar joint Sustentaculum tali 5. a. Proximal Radioulnar Joint (Anterior) Calcaneus Cuboid Intermediate cuneiform Lateral cuneiform Medial cuneiform Navicular Talus 5. b. Interosseous Borders (Axial Slice) Base of 1st-5th metatarsal Head of 1st-5th metatarsal Shaft of 1st-5th metatarsal 5. c. Distal Radioulnar Joint (Anterior) Distal phalanx Middle phalanx Proximal phalanx 5. d. Wrist (Radioulnar) Joint (Anterior) Calcaneus Cuboid Distal phalanx Navicular Proximal phalanx Shaft of 1st metatarsal Talus 5. e. Carpal Bones (Anterior) Suggested Clinical Correlates (CC): Left Acetabular Component of Left Hip Arthroplasty Extends Into Fat and Soft Tissue Without Nerve Impingement Right Acetabular Component of Total Right Hip Arthroplasty Extends Into Right Sciatic Nerve Acting as Source of Nerve Impingement Case 0357 Hip Arthroplasty Interference Screw from Previous Anterior Cruciate Ligament Reconstruction Medial Titanium Screw Plate Osseous Density Formation Remains of Lucency Case 0073 Knee Tibia Fracture Comminuted Mid to Distal Right Fibular Fracture Nondisplaced Right Posterior Talus Fracture Case 0289 Ankle Fracture Lower Limb 2- The Muscular System 1: Gluteal Region and Posterior Thigh • Describe the muscles and their respective sites of attachment of the gluteal region and posterior compartment of thigh • Identify the compartments of the thigh and describe the actions of the muscles within each Gluteus maximus Gluteus medius Ilium Median sacral crest 1. a. Gluteus Maximus and Medius (Posterior) Gluteus maximus Gluteus medius Gluteus minimus Greater trochanter Ilium Neck of femur 1.b. Gluteus Medius and Minimus (Coronal-cut Low-visibility) Acetabulum Gluteus maximus Head of femur Inferior gluteal a. Ischium Piriformis Superior gluteal a. 1. c. Piriformis ( Coronal-cut Low-visibility) Long head of biceps femoris Semimembranosus Semitendinosus Short head of biceps femoris 1. d. Hamstings (Posterior) 2: Anterior and Medial Thigh • Identify the muscles of the anterior and medial compartment of the thigh • Describe the sites of muscle attachement and the associated actions of the individual muscles of the anterior and medial compartments of the thigh 2. a. Thigh Compartments (Axial Cut- Superior) Adductor longus Adductor magnus Anterior compartment of thigh Femur Gracilis Long head of biceps femoris Medial compartment of thigh Posterior compartment of thigh Rectus femoris Sartorius Semimembranosus Semitendinosus Vastus intermedialis Vastus lateralis Vastus medialis Anterior superior iliac spine (ASIS) Iliotibial tract (IT band) Quadriceps tendon Rectus femoris Sartorius Tensor fascia latae Vastus lateralis Vastus medialis 2. b. Anterior Compartment of Thigh (Anterior) Anterior inferior iliac spine (ASIIS) Patella Quadriceps tendon Vastus intermedialis Vastus lateralis Vastus medialis 2. c. Vastus Intermedius (Coronal-cut Low-visibility) Patella Patellar tendon Quadriceps tendon Tibial tuberosity 2. d. Quadriceps Tendon (Anterior) Adductor longus Anterior superior iliac spine (ASIS) Femoral a. Femoral v. Great saphenous v. Iliopsoas Inguinal ligament Lymph node Pectineus Pubic tubercle Sartorius 2. e. Femoral Triangle (Anterior) Adductor longus Adductor magnus Gracilis Pectineus Sartorius 2. f. Medial Compartment of Thigh (Anteromedial) 3: Posterior Compartment of Leg and Sole of Foot • Describe the contents of the posterior compartment of the leg and review the actions of the muscles within this compartment • Describe the sites of muscles attachment for the muscles extending from the posterior leg to the sole of the foot Lateral head of gastrocnemius Long head of biceps femoris Medial head of gastrocnemius Semimembranosus Semitendinosus 3. a. Popliteal Fossa (Posterior) Head of fibula Lateral head of gastrocnemius Medial head of gastrocnmeius Politeal v. Popliteal a. Popliteus 3. b. Popliteus (Coronal-cut Low-visibility) Calcaneal tendon Calcaneus Gastrocnemius Lateral head of gastrocnemius Medal head of gastrocnmeius Soleus 3. c. Posterior Compartment of Leg (Superficial) Calcaneal tendon Calcaneus Flexor digitorum longus tendon Flexor hallucis longus tendon Medial malleolus Tibialis posterior tendon 3. d. Posterior Compartment of the Leg (Deep) Abductor hallucis Flexor digitorum brevis tendon Flexor hallucis longus tendon Lateral head of flexor hallucis brevis LumbricalsFlexor digitorum longus tendon Medial head of flexor hallucis brevis Quadratus plantae 3. e. Sole of Foot (Inferior) 4: Anterior and Lateral Compartments of Leg and Dorsum of Foot • Describe the contents of the anterior and lateral compartments of the leg and review the actions of the muscles within these compartments • Describe the sites of muscles attachment for the muscles extending from the anterior and lateral leg to the dorsum of the foot Extensor digitorum longus tendon Extensor hallucis longus tendon Fibularis tertius Head of fibula Lateral malleolus Tibailis anterior Tibialis anterior tendon 4. a. Compartments of Leg (Axial-cut Inferior) Anterior compartment of leg Fibula Lateral compartment of leg Posterior compartment of leg (Deep) Posterior compartment of leg (Superficial) Tibia 4. b. Anterior Compartment of Leg (Anterior) Fibularis brevis Fibularis brevis tendon Fibularis longus Fibularis longus tendon Head of fibula Lateral malleolus 4. c. Lateral Compartment of Leg (Lateral) Exensor digitorum longus tendon Extensor digitorum brevis Extensor hallucis brevis Extensor hallucis brevis tendon Extensor hallucis longus tendon Fibularis brevis tendon Fibularis longus tendon Fibularis tertius Lateral malleolus Tibialis anterior tendon 4. d. Dorsum of Foot (Superior) Suggested Clinical Correlates (CC): Mass Located Between Semimembranosus and Biceps Femoris Case 0083 Knee Sarcoma Total knee arthroplasty Amputation stump Case 0184 Knee Replacement & Amputation Lower Limb 3- The Cardiovascular System 1: Arterial Supply to Hip and Thigh • Describe the course of arteries as they course through the gluteal region and thigh • Identify the landmarks for the name changes of the vessels from the hip to the thigh External iliac a. Femoral a. 1. a. Femoral Arteries (Anterior) Common iliac a. External iliac a. Femoral a. Inferior gluteal a. Internal iliac a. Superior gluteal a. 1. b. Gluteal Arteries (Lateral) Common iliac a. External iliac a. Femoral a. Internal iliac a. Obturator a. Superficial circumflex iliac a. Superficial epigastric a. 1. c. Obturator Artery (Anterior) Deep femoral a. Femoral a. Perforating a. 1. d. Deep Femoral Artery (Posterior) Ascending branch Deep femoral a. Descending branch Femoral a. Lateal circumflex femoral a. Medial circumflex femoral a. Perforating a. 1. e. Hip Collateral Circualtion (Anterior) Adductor magnus Femoral a. (in adductor canal) Femoral a. (in adductor hiatus) Femur Patella Popliteal a. Popliteal fossa Sartorius 1. f. Adductor Hiatus (Sagittal-cut Medial) 2: Arterial Supply to Knee, Leg and Foot • Describe the course of arteries as they course through the knee, leg, and foot and discuss possible sites of constriction or damage • Identify the landmarks for the name changes of the vessels of the knee, leg, and foot Anterior tibial a. Femoral a. (in adductor hiatus) Fibular a. Popliteal a. Posterior tibial a. 2. a. Popliteal Artery (Posterior) Anterior tibial a. Fibular a. Popliteal a. Posterior tibial a. 2. b. Tibial Arteries (Lateral) Ankle Anterior tibial a. Distal tibia Dorsal artery of foot Talus 2. c. Dorsal Artery of Foot (Anterior) Lateral plantar a. Medial plantar a. Posteiror tibial a. 2. d. Plantar Arteries (Inferior) 3: Venous Return of the Lower Limb • Discuss the patterns and distribution of the veins of the lower limb and identify the major points of drainage both at the knee and the hip Abdominal aorta Common iliac a. External iliac a. Inferior vena cava (IVC) Internal iliac a. 3. a. Common Iliac Vessels (Coronal-cut Anterior) Femoral a. Femoral v. Great saphenous v. 3. b. Venae Commitantes (Anterior) Great saphenous v. Popliteal a. Popliteal v. Small saphenous v. 3. c. Small Saphenous Vein (Posterior) Suggested Clinical Correlates (CC): Varicose Veins Venous Phase Runoff Case 0250 Leg Runoff Venous Phase Bursitis in Right Calcaneous and Talus Bone Severe Calcification in Right Distal Popliteal Case 0248 Leg Runoff Venous Phase Appendix Lower Limb 1-The Skeletal System Library Case: 0367 Goal(s): Identify, describe structures, and discuss clinical correlates of (1) hip joint, (2) knee joint, (3) ankle joint, and (4) standing and walking. Annotated Anatomy: 1: Hip Bone Acetabulum, Anterior gluteal line, Anterior inferior iliac spine, Anterior superior iliac spine, Body of ilium, Body of ischium, External lip of iliac crest, Greater sciatic notch, Iliac crest, Iliac fossa, Iliopubic eminence, Ilium, Inferior gluteal line, Inferior pubic ramus, Intermediate zone of iliac crest, Ischial ramus, Ischial spine, Ischial tuberosity, Ischium, Lesser sciatic notch, Obturator crest, Obturator foramen, Obturator groove, Pectineal line, Posterior gluteal line, Posterior inferior iliac spine, Posterior superior iliac spine, Pubic tubercle, Pubis, Superior pubic ramus, Tubercle of iliac crest 2: Hip Joint and Femur Acetabular notch, Acetabulum, Adductor tubercle, Anterior superior iliac spine, Fovea capitis, Gluteal tuberosity, Greater trochanter, Head of femur, Ilium, Intercondylar fossa, Intertrochanteric crest Intertrochanteric line, Ischium, Lateral epicondyle, Lateral femoral condyle, Lateral lip of linea aspera, Lateral supracondylar line, Lesser trochanter, Linea aspera, Medial epicondyle, Medial femoral condyle, Medial lip of linea aspera, Medial supracondylar line, Neck of femur, Obturator foramen, Pubic symphysis, Shaft (body), Superior pubic ramus 3: Patella and Knee Joint Anterior cruciate ligament (ACL), Anterior interconylar area, Apex of patella, Articular surface of patella, Base of patella, Intercondylar fossa, Lateal meniscus, Lateral condyle of tibia, Lateral femoral condyle, Lateral intercondylar tubercle, Lateral meniscus, Lateral tibial condyle, Medial femoral condyle, Medial intercondylar tubercle, Medial meniscus, Medial tibial condyle, Nonarticular area, Patella, Patellar surface of femur, Patellar tendon (ligament), Posterior cruciate ligament (PCL), Quadriceps tendon, Tibial tuberosity 4: Tibia, Fibula, and Ankle Joint Anterior compartment of leg, Exensor digitorum longus tendon, Extensor digitorum brevis, Extensor digitorum longus tendon, Extensor hallucis brevis, Extensor hallucis brevis tendon, Extensor hallucis longus tendon, Fibula, Fibularis brevis, Fibularis brevis tendon, Fibularis longus, Fibularis longus tendon, Fibularis tertius, Head of fibula, Lateral compartment of leg, Lateral malleolus, Posterior compartment of leg (Deep), Posterior compartment of leg (Superficial), Tibia, Tibailis anterior, Tibialis anterior tendon 5: Subtalar Joint and Foot Anterior talar articular surface, Base of 1st-5th metatarsal, Body of talus, Calcaneus, Cuboid, Distal phalanx, Head of 1st-5th metatarsal, Head of talus, Intermediate cuneiform, Lateral cuneiform, Medial cuneiform, Medial talar articular surface, Middle phalanx, Navicular, Neck of talus, Posterior talar articular surface, Proximal phalanx, Shaft of 1st-5th metatarsal, Subtalar joint, Sustentaculum tali, Talus Lower Limb 2- The Muscular System Library Case: 0362 Goal(s): Identify, describe structures, attachments, functions and discuss clinical correlates of (1) the gluteal region, (2) anterior compartment of thigh, (3) medial compartment of thigh, (4) posterior compartment of thigh, (5) adductor canal, and (6) sole of foot. Annotated Anatomy: 1: Gluteal Region and Posterior Thigh Acetabulum, Gluteus maximus, Gluteus medius, Gluteus minimus, Greater trochanter, Head of femur, Ilium, Inferior gluteal a., Ischium, Long head of biceps femoris, Median sacral crest, Neck of femur, Piriformis, Semimembranosus, Semitendinosus, Short head of biceps femoris, Superior gluteal a. 2: Anterior and Medial Thigh Adductor longus, Adductor magnus, Anterior compartment of thigh, Anterior inferior iliac spine (ASIIS), Anterior superior iliac spine (ASIS), Femoral a., Femoral v., Femur, Gracilis, Great saphenous v., Iliopsoas, Iliotibial tract (IT band), Inguinal ligament, Long head of biceps femoris, Lymph node, Medial compartment of thigh, Patella, Patellar tendon, Pectineus, Posterior compartment of thigh, Pubic tubercle, Quadriceps tendon, Rectus femoris, Sartorius, Semimembranosus, Semitendinosus, Tensor fascia latae, Tibial tuberosity, Vastus intermedialis, Vastus lateralis, Vastus medialis 3: Posterior Compartment of Leg and Sole of Foot Abductor hallucis, Calcaneal tendon, Calcaneus, Flexor digitorum brevis tendon, Flexor hallucis longus tendon, Gastrocnemius, Head of fibula, Lateral head of flexor hallucis brevis, Lateral head of gastrocnemius, Long head of biceps femoris, LumbricalsFlexor digitorum longus tendon, Medal head of gastrocnmeius, Medial head of flexor hallucis brevis, Medial head of gastrocnemius, Medial malleolus, Politeal v., Popliteal a., Popliteus, Quadratus plantae, Semimembranosus, Semitendinosus, Soleus, Tibialis posterior tendon Anterior compartment of leg, Exensor digitorum 4: Anterior and Lateral Compartments of Leg and Dorsum longus tendon, Extensor digitorum brevis, Extensor digitorum longus tendon, Extensor hallucis brevis, of Foot Extensor hallucis brevis tendon, Extensor hallucis longus tendon, Extensor hallucis longus tendon, Fibula, Fibularis brevis, Fibularis brevis tendon, Fibularis brevis tendon, Fibularis longus, Fibularis longus tendon, Fibularis longus tendon, Fibularis tertius, Fibularis tertius, Head of fibula, Head of fibula, Lateral compartment of leg, Lateral malleolus, Posterior compartment of leg (Deep), Posterior compartment of leg (Superficial), Tibailis anterior, Tibia, Tibialis anterior tendon Lower Limb 3- The Cardiovascular System Library Case: 0362 (Topic 1-2), 0296 (Topic 3) Goal(s): Identify, describe structures, and discuss clinical correlates of the (1) popliteal fossa, (2) arterial supply of lower limb, and (3) venous drainage of lower limb. Annotated Anatomy: 1: Arterial Supply to Hip and Thigh Adductor magnus, Ascending branch, Common iliac a., Deep femoral a., Descending branch, External iliac a., Femoral a., Femoral a. (in adductor canal), Femoral a. (in adductor hiatus), Femur, Inferior gluteal a., Internal iliac a., Internal iliac a., Lateal circumflex femoral a., Medial circumflex femoral a., Obturator a., Patella, Perforating a., Popliteal a., Popliteal fossa, Sartorius, Superficial circumflex iliac a., Superficial epigastric a., Superior gluteal a. 2: Arterial Supply to Knee, Leg and Ankle, Anterior tibial a., Anterior tibial a., Distal tibia, Dorsal artery of foot, Femoral a. (in adductor Foot hiatus), Fibular a., Lateral plantar a., Medial plantar a., Popliteal a., Posteiror tibial a., Talus 3: Venous Return of the Lower Limb Abdominal aorta, Common iliac a., External iliac a., Femoral a., Femoral v., Great saphenous v., Inferior vena cava (IVC), Internal iliac a.
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