Download Bone - WordPress.com

Bone
Anterior View:
Posterior View:
Greater Sciatic Foramen
Boundaries
Antlat: greater sciatic notch of ilium
Postmed: sacrotuberous ligament
Inf: sacrospinous ligament and ischial spine
Sup: ant sacroiliac ligament
Contents
Above Piriformis: sup gluteal vessels
sup gluteal nerve
Below Piriformis: inf gluteal and int pudendal vessels
inf gluteal, pudendal, sciatic, post femoral
cutaneous nerves; nerves to obturator internus
and quadratus femoris
Lesser Sciatic Foramen
Boundaries
Front: tuberosity of ischium
Above: spine of ischium and sacrospinous ligmanet
Behind: sacrotuberous ligament
Contents
Tendon of obturator internus
Int pudendal artery and vein
Pudendal nerve
The Hip Joint
Type: multiaxial ball and socket; synovial
Articulating Surfaces: head of femur (2/3 of sphere), acetabulum (accommodates >1/2 femoral surface in
lunate surface)
Acetabular Labrum: increases depth of acetabulum
Capsule: strong; attaches to edge of acetabulum and transverse acetabular ligament; anteriorly attached to
intertrochanteric line and root of greater trochanter, posteriorly attached to neck proximal to greater
trochanter; some reflects back as retinaculum that carries blood vessels to head and neck
Ligaments:
1) Iliofemoral – strong, anterior, AIIS and acetabular rim  intertrochanteric line; prevents overextension
2) Pubofemoral – iliopubic eminence and pubic part of acetabular rim  iliofemoral ligament;
strengthen inf and ant joint; prevents overabduction
3) Ischiofemoral – posterior; ischial acetabular rim  neck of femur; prevents hyperextension
4) Ligament of head of femur – intracapsular; of little importance; acetabular notch  fovea;
contains branch of obturator artery
Anterior aspect strengthen by ligaments, posterior by muscles
Pelvic Ligaments
Sacrotuberous: sacrum and ischial tuberosity
Sacrospinous: sacrum and ischial spine
Inguinal: ASIS and pubic tubercle
Knee Joint
Type: synovial, hinge
Movements: flexion and extension, rotation; knee locks 2Y to MED ROTATION OF FEMUR on tibia;
popliteus unlocks knee by laterally rotating femur
Articulations:
1) Femorotibial (lateral and medial) – femoral and tibial condyles
2) Femoropatellar
Fibular IS NOT involved
Strength: from muscles (esp. vastus medalis) > ligaments
Capsule: attaches to femur (just above condyles), tibial plateau;
has an opening just post to lat tibial condyle for popliteus to pass through where
it is prolonged inflate over popliteus to head of fibula (arcuate popliteal lig); ant
part is formed by quads tendon
Synovial membrane: posteriorly it reflects into intercondylar region covering
cruciates
Continuous with: suprapatellar, popliteus, anserine and gastrocnemius bursae
Artery: genicular anastomosis (from femoral, popliteal, ant and post recurrent
branches of ant tibial recurrent and circumflex fibular arteries). Intra-articular
components supplied by middle genicular branch of popliteal.
Nerve: femoral, tibial, common fibular, obturator, saphenous
Menisci: wider externally; attached to intercondylar tibia; coronary ligaments extend from menisci to tibial
condyles
1) Medial – C-shaped; broader posteriorly; adheres to surface of TCL therefore less mobile
2) Lateral – nearly circular; smaller; more moveable
Ligaments:
EXTRACAPSULAR
1
2
3
Patellar – distal part of quads tendon; from apex of patella to tibial tuberosity; receives medial and
lateral patellar retinacula from vastus medialis and lateralis
Fibular collateral – cord like; 5cm; extracapsular; strong; lat epicondyle of femur to lat fibular
head; tendon of popliteus passes deep to it, separating it from lat meniscus
Tibial collateral – weaker flat band; intracapsular; med epicondyle of femur to med condyle of
tibia; fibres firmly attached to medial meniscus
INTRA-ARTICULAR
Cruciates WIND on in rotation, and UNWIND on ex rotation; maintain contact of femur with tibia
during flexion
1-Anterior cruciate – weaker; from ANT
INTERCONDYLAR TIBIA  sup, post, lat 
POST LAT CONDYLE OF FEMUR; limits POST
MOVEMENT OF FEMUR ON TIBIA
Tightens on knee extension
2-Posterior cruciate – stronger; from POST
INTERCONYLAR TIBIA  sup, ant, med  ANT
MED CONYLE OF FEMUR; limits ANT
MOVEMENT OF FEMUR ON TIBIA
3-Popliteal tendon
a)oblique: expansion of tendon of
semimembranosus; from med tibial condyle to lat
femoral condyle, blending with joint capsule
b)arcuate: from post fibular head to post knee joint
Factoid: inf fibres of vastus medialis stabilize patella when knee extended; PCL stabilizes knee when knee
flexed
Suprapatellar bursa ascends 5cm+ above patella
There is no active rotation of extended knee
Synovial membrane does not cover back of PCA
Ankle Joint
Medial:
Lateral:
Type: hinge, synovial
Articulating Surfaces: tibia, fibula, trochlea of talus
Capsule: synovial membrane can extends superiorly to IO ligament
Ligaments:
1) Lateral ligament of the ankle:
a. Anterior talofibular ligament: flat, weak band; lat malleolus  neck of talus
b. Posterior talofibular ligament: thick, strong; malleolar fossa  lat tubercle of talus
c. Calcaneofibular ligament: round cord; lat malleolus  lat calcaneus
2) Deltoid ligament: medial malleolus  talus, calcaneus, navicular; stabilizes during eversion
Artery: malleolar branch of fibular, ant and post tibial arteries
Nerve: tibial and deep fibular
Factoid: most stable during dorsiflexion
SubTalar (Talocalcanean) Joint
Type: synovial
Articulating Surfaces: body of talus (concave), sup calcaneus (convex)
clinical subtalar jt also contains talocalcaneal part of talocalcaneonavicular jt
Capsule: weak
Ligaments: med, lat ad post talocalcanean ligament
interosseous talcocalcanean ligament (anterior) – strong, within tarsal sinus
Movement: inversion and eversion
Talocalcaneonavicular Joint
Type: synovial, ball and socket
Articulating Surfaces: head of talus, post navicular, sup surface of plantar calcaneonavicular (spring) lig,
sustentaculum tali, calcaneus
Capsule: blends with interosseous talocalcanean ligament posteriorly
Ligaments: dorsal talonavicular ligament
spring ligament (sustentaculum tali (talar shelf)  postinf navicular bone) – supports talus,
maintains longitudinal arch
Talus
Calcaneus
Calcaneal Tendon
15cm long; continuation of aponeurosis formed halfway down calf; inserts on calcaneal tuberosity; fibres
spiral 90deg (gastrocnemius fibres attach laterally, soleal medially)
Subcutaneous calcaneal bursa
Arches of Foot
Longitudinal
Medial part: higher; calcaneus,
talus (keystone), navicular, 3
cuneiforms, 3 MT’s
Lateral part: flatter; calcaneus,
cuboid, lat 2 MT’s
Support: tibialis anterior,
fibularis longus, flexor hallicus
longus, spring and plantar
ligament, plantar aponeurosis
Transverse
Bones: cuboid, cuneiforms,
bases of MT’s
Support: tibialis anterior and
fibularis longus
Areas
Saphenous Opening
Opening in fascia lata inf to med inguinal ligament; suplatinf margin formed by falciform ligament
(attaches to inguinal ligament); gt saphenous vein passes through suplaterally to enter femoral vein. Post
wall lies ant to pectineus.
Femoral Triangle
Boundaries
Superior: inguinal ligament (inf margin of ex oblique aponeurosis)
Medial: med border of adductor longus
Lateral: med border of sartorius
Floor: iliopsoas (lateral), pectineus (medial), adductor longus
Roof: fascia lata and cribiform fascia, sub cut tissue, skin
Contents
Femoral nerve
Femoral sheath: femoral artery, vein and inguinal lymph
Lat cutaneous nerve, femoral branch of genitofemoral nerve
Ileopectineal arch splits area post to inguinal ligament into 2
Femoral sheath: formed by transversalis and iliopsoas fascia; 3 compartments
1) Lateral - artery
2) Intermediate - vein
3) Medial = femoral canal; allows femoral vein to expand; femoral ring = base; can contain lymph
node of Cloquet
Factoid - femoral branch of genitofemoral nerve lies within femoral sheath but pierces it anteriorly to
supply skin overlying femoral triangle
- mid-inguinal point is half way between ASIS and pubic symphysis
- femoral pulse is 2-3cm inf to midpoint of inguinal ligament
- femoral nerve is midway between ASIS and pubic tubercle
- long saphenous vein joins femoral vein within triangle
Adductor Canal
Course: From apex of femoral triangle to
adductor hiatus
Contents: femoral artery and vein,
saphenous nerve, nerve to vastus medialis
NOT FEMORAL NERVE
Boundaries:
ant and lat – vastus medialis
floor – adductor longus and magnus
medial – adductor longus and magnus,
sartorius
roof – fascia, sartorius
Popliteal Fossa
Boundaries
Upper: semimembranosus
biceps femoris
Lower: gastrocnemius
plantaris
Floor: popliteus (inf), capsule (mid),
femur (sup)
Roof: skin and Popliteal fascia
Deeply, sup boundary by med and lat
supracondylar lines
Contents
Small saphenous vein entering popliteal vein
Popliteal artery and vein
Tibial and common fibular nerve
- tibial is largest, most superficial
Post cut nerve of thigh
Lymph nodes and vessels
Factoids
Popliteal artery is deep to popliteal vein
which is deep to nerves
Skin overlying popliteal fossa supplied by
post cut nerve of thigh
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
Muscles
Muscles Inserting Onto Greater Trochanter
Gluteus medius and minimus (maximus goes
to iliotibial tract)
Gemellus superior and inferior
Obturator internus and externus
Piriformis
Quadratus femoris
Gluteal Region
Gluteus Maximus
Course: post gluteal line, post sacrum and coccyx, sacrotuberous ligament  iliotibial tract, gluteal
tuberosity of femur
Action: extends and laterally rotates thigh
Nerve: inf gluteal
Artery: sup and inf gluteal
Gluteus Medius
Course: ext ilium between post and ant gluteal lines  greater trochanter of femur
Action: abduct and medially rotates thigh
Nerve: sup gluteal
Artery: sup gluteal
Gluteus Minimus
Course: ext ilium between ant and inf gluteal lines  greater trochanter of femur
Action: abducts and medially rotates thigh
Nerve: sup gluteal
Artery: sup gluteal
Piriformis
Course: ant sacrum  upper greater trochanter of femur
Action: laterally rotates and abducts thigh
Nerve: S1 – 2
Artery:
Factoid: passes through greater sciatic foramen
Superior Gemellus
Course: ischial spine  obturator internus tendon
Action: laterally rotates femur
Nerve: nerve to obturator internus
Artery: inferior gluteal
Inferior Gemellus
Course: ischial tuberosity  obturator internus tendon
Action: laterally rotates femur
Nerve: nerve to quadratus femoris
Artery: inferior gluteal
Obturator Internus
Course: internal obturator membrane and margin of obturator foramen med greater trochanter above
trochanteric fossa
Action: laterally rotates and abducts thigh
Nerve: nerve to obturator internus
Artery: obturator
Obturator Externus
Course: external obturator membrane and sup and inf pubic rami  trochanteric fossa of femur
Action: laterally rotates thigh
Nerve: obturator
Artery: obturator
Quadratus Femoris
Course: lat ischial tuberosity  quadrate line of femur below intertrochanteric crest
Action: laterally rotates thigh
Nerve: nerve to quadratus femoris
Artery: inf gluteal
Posterior Thigh
Semimembranosus
Course: upper lateral ischial tuberosity  med condyle of tibia
Action: Extends thigh, flexes knee
Nerve: tibial
Artery: deep femoral
Semitendinosus
Course: lower, med ischial tuberosity (common tendon with biceps femoris)  med tibia (via pes
anserinus)
Action: extends thigh, flexes knee
Nerve: tibial
Artery: deep femoral
Factoid: pes anserinus is common insertion for gracilis, sartorius and semitendinosus
Bicep femoris
Long head: ischial tuberosity  head of fibula and lat condyle of tibia
Short head: lat lip of linea aspera  head of fibula and lat condyle of tibia
Action: extends thigh, flexes knee
Nerve: long head – tibial nerve
short head – common fibular nerve
Artery: deep femoral
Medial Thigh
Adductor Magnus
Course: ischiopubic ramus and ischial tuberosity  linea aspera and adductor tubercle of femur
Action: adducts, flexes and medially rotates thigh
ischiocondylar part: extends thigh
Nerve: post division of obturator nerve
ischiocondylar part: tibial nerve
Artery: obturator, deep femoral, medial femoral circumflex
Gracilis
Course: pubic symphysis and inf pubic ramus  med tibia (via pes anserinus)
Action: adducts, flexes and medially rotates thigh, flexes knee
Nerve: ant division of obturator nerve
Artery: obturator
Adductor Brevis
Course: inf pubic ramus  pectineal line and linea aspera
Action: adducts, flexes and medially rotates thigh
Nerve: ant division of obturator nerve
Artery: obturator, deep femoral
Adductor Longus
Course: med sup pubic ramus  lower 2/3 linea aspera of femur
Action: adducts, flexes and medially rotates thigh
Nerve: ant division of obturator nerve
Artery: obturator, deep femoral
Anterior Compartment of Thigh
Iliacus
Course: iliac fossa and crest, ala of sacrum  lesser trochanter of femur
Action: flexes thigh
Nerve: femoral
Artery: iliolumbar
Factoid: inserts with psoas major via iliopsoas tendon
Iliopsoas
Course: iliac fossa, bodies and transverse processes of lumbar vertebrae  lesser trochanter of femur
Action: flexes thigh, flexes lumbar
Nerve: L2-4, femoral
Artery: iliolumbar
Pectineus
Course: pectin of pubis  pectineal line of femur
Action: adducts, flexes, and medially rotates thigh
Nerve: femoral and ant division of obturator – DUAL NERVE SUPPLY
Artery: med femoral circumflex
Sartorius
Course: ant sup iliac spine  med tibia (pes anserinus)
Action: flexes, abducts and laterally rotates thigh, flexes knee
Nerve: femoral
Artery: lat femoral circumflex, saphenous
Quadriceps Femoris
1) Rectus Femoris
a. Straight head: ant inf iliac spine  patellar ligament (patella and tibial tuberosity)
b. Reflected head: sup rim of acetabulum  patellar ligament
2) Vastus Intermedius: ant lat femur  patella
3) Vastus Lateralis: lat IM septum, lat linea aspera and gluteal tuberosity  patella and med patellar
retinaculum
4) Vastus Medialis: med IM septum, med linea aspera  patella and med patellar retinaculum
Action: extends knee (all), flexes thigh (rectus femoris)
Nerve: femoral
Artery: lat circumflex femoral (all), perforating branches of deep femoral (vastus medialis)
Anterior Compartment Leg
Tibialis Anterior
Course: lat tibial condyle and upper lat tibia  med medial cuneiform and 1st MT
Action: dorsiflexes and inverts foot
Nerve: deep fibular
Artery: ant tibial
Factoid: ant tibial artery lies lateral to this
Extensor Digitorum Longus
Course: lat condyle of tibia, ant fibula, lat IO membrane  extensor expansions lat 4 toes
Action: extends MTP, PIP and DIPJ lat 4 toes
Nerve: deep fibular
Artery: ant tibial
Factoid: ant tibial artery lies medial to this
Extensor Hallicus Longus
Course: med ½ ant fibula and IO membrane  base DP GT
Action: extends MTP and IPJ GT
Nerve: deep fibular
Artery: ant tibial
Fibularis Tertius
Course: distal ant fibula  dorsum shaft 5th MT
Action: everts foot
Nerve: deep fibular
Artery: ant tibial
Lateral Compartment Leg
Boundaries:
Lat surface fibula
Ant and post IM septa
Deep fascia leg
Superior fibular retinaculum
Fibularis Brevis
Course: lower 1/3 lat fibula 
tuberosity base 5th MT
Action: plantar flexes and everts
foot
Nerve: sup fibular
Artery: fibular
Fibularis Longus
Course: upper 2/3 lat surface
fibula  past groove on ant-inf
aspect of cuboid  deep to
intrinsic muscles of foot  med
cuneiform and base 1st MT
Action: plantar flexes and everts
foot
Nerve: superficial fibular
Artery: fibular
Tendons are posterior to lat
malleous, through sup fibular
retinaculum (from lat malleolus to
calcaneus)
Posterior Compartment Leg
SUPERFICIAL
Gastrocnemius
Medial head: above medial femoral
condyle  dorsum of calcaneus via
calcaneal tendon
Lateral head: above lateral femoral
condyle  dorsum of calcaneus via
calcaneal tendon
Action: flexes knee, plantar flexes foot
Nerve: tibial
Artery: sural, post tibial
Soleus
Course: post head and upper shaft fibula,
soleal line tibia  calcaneus via
Achille’s tendon
Action: plantar flexion
Nerve: tibial
Artery: post tibial
Plantaris
Course: above lat femoral condyle 
calcaneus medial to calcaneal tendon
Action: flex knee, plantar flexion
Nerve: tibial
Artery: popliteal
DEEP
Flexor Hallicus Longus
Course: lower 2/3 post fibula  base DP
GT
Action: flexes MTP and PIPJ GT, plantar
flexes foot
Nerve: tibial
Artery: fibular, tibial
Factoid: important in ‘push off’
Flexor Digitorum Longus
Course: mid ½ post tibia  bases DP
digits
Action: flexes MTP, PIP and DIPJ, plantar
flexes foot
Nerve: tibial
Artery: tibial
Tibialis Posterior
Course: IO membrane, postmed fibula,
postlat tibia  tuberosity of navicular and
med cuneiform, MT’s
Action: plantar flexes and inverts foot
Nerve: tibial
Artery: fibular, tibial
Popliteus
Course: lat condyle femur  post tibia
above soleal line
Action: flexes knee, med rotate femur
Nerve: tibial
Artery: popliteal
Factoid: unlocks knee to initiate flexion of
knee; lies immediately deep to popliteal
art; may attach to lat meniscus
Muscles of the Foot
1ST LAYER
1. Abductor Hallicus
Course: med tuberosity of calcaneus, flexor retinaculum, plantar
aponeurosis  med base PP gt toe
Action: abducts GT, flexes MTPJ
Nerve: medial plantar
Artery: med plantar
2. Flexor Digitorum Brevis
Course: med tuberosity of calcaneus, plantar aponeurosis, IM septum
 base MP 2-5
Action: flexes MTP and PIPJ 2-5
Nerve: med plantar
Artery: med and lat plantar
Factoid: splits to allow passage of flexor digitorum longus
3. Abductor digiti minimi
Course: med and lat tuberosity of calcaneus, plantar aponeurosis, IM
septum  lat base PP 5th digit
Action: abducts LT, flexes MTPJ
Nerve: lat plantar nerve
Artery: lat plantar
2ND LAYER
1. Quadratus Plantae
Course: med plantar surface of calcaneus  postlat
tendon of flexor digitorum longus
Action: flexes lat 4 digits
Nerve: lat plantar
2. Lumbricals
Course: tendons of FDL  med expansion
Action: flex PIP, extend MIP and DIP
Nerve: med plantar (med 1), lat plantar (lat 3)
3. Flexor Digitorum Longus
Course: mid ½ post tibia  bases DP digits
Action: flexes MTP, PIP and DIPJ, plantar flexes foot
Nerve: tibial
Artery: tibial
4. Flexor Hallicus Longus
Course: lower 2/3 post fibula  base DP GT
Action: flexes MTP and PIPJ GT, plantar flexes foot
Nerve: tibial
Artery: fibular, tibial
Factoid: important in ‘push off’
3RD LAYER
1. Flexor Hallicus Brevis
Course: cuboid, lat cuneiform, med 1st MT  med
PP GT, lat PP GT
Action: flexes MTPJ GT
Nerve: med plantar
Artery: med plantar
Factoid: tendons of insertion contain sesamoid bone
2. Adductor Hallicus
Oblique head: bases of MT 2-4  lat side base PP
GT
Transverse head: heads of MT 3-5  lat side base
PP GT
Action: adducts GT
Nerve: lat plantar (deep branch)
Artery: plantar arterial arch
Factoid: plantar arterial arch passes sup to oblique
head of adductor hallucis
3. Flexor Digiti Minimi Brevis
Course: base 5th MT  lat base PP LT
Action: flexes MTPJ LT
Nerve: lat plantar
Artery: lat plantar
4TH LAYER
Dorsal Interosseous (4)
Course: shafts MT  base PP
Action: abduct 2-4; flex MTPJ and extend IPJ
Nerve: lat plantar (deep branch)
Artery: dorsal metatarsal
Plantar Interossei (3)
Course: bases and med sides MT  med bases of P
Action: adducts digits, flex MTPJ
Nerve: lat plantar
Extensor Digitorum Brevis
Course: suplat calcaneus  extensor expansion toes
1-4
Action: extends toes 1-4
Nerve: deep fibular
Artery: dorsalis pedis
Extensor Hallicus Brevis
Course: suplat calcaneus  dorsum of base PP GT
Action: extends GT
Nerve: deep fibular
Artery: dorsalis pedis
MUSCLE ATTACHMENTS
ARTERIES
Blood Supply to Hip
Trochanteric anastomosis (gter trochanter): descending sup gluteal
inf gluteal
ascending branches of med and lat circumflex femoral
Cruciate anastomosis (lesser trochanter): descending branch of inf gluteal
ascending branch of 1st perforating artery
transverse branches of med and lat circumflex femoral
Femoral Artery
Continuation of ex iliac beginning at femoral triangle 
descends on iliopsoas, pectineus and adductor longus 
enters adductor canal (vein lies post to artery, saphenous
nerve ant to artery)  pass through adductor hiatus 
becomes popliteal artery
Factoid: bisects femoral triangle
Profunda Femoris
Arises from lat side of fem art within fem triangle, 4cm inf to inguinal ligament  runs lat to fem art 
passes posterior leaving fem triangle between pectineus and adductor longus  descends post to adductor
longus
Branches: perforating branches – perforate adductor magnus to post and lat compartments of thigh
circumflex femoral – med branch – passes between iliopsoas and pectineus; supplies blood to head
and neck of femur
lat branch – passes deep to sartorius and rectus femoris
Popliteal Artery
Popliteal
Begins when femoral artery passes
through adductor hiatus of adductor
magnus Passes inferolaterally
through fossa  Divides at inf border
of popliteus  ant and post tibial
arteries
Starts medial to tibial nerve, ends
lateral to it. Popliteal vein lies between
the two
Gives off sural arteries to supply
gastrocnemius
Branches form genicular anastomosis
1) Inf lat genicular
2) Inf med genicular
3) Sup lat genicular
4) Sup med genicular
5) Mid genicular
Also contribute to
anastomosis:
Descending genicular branch
of femoral art
Descending branch of lat
femoral circumflex art
Ant tibial recurrent branch of
ant tibial art
Anterior Tibial Artery
Begins at inf border of popliteus  passes anteriorly
through IO membrane  descends on ant surface of IO
membrane between EHL and TA with deep fibular nerve
 changes name to dorsalis pedis
Give off ant and post tibial recurrent arteries at knee;
malleolar arteries over med and lat malleoli
Accompanied by ant tibial vein
Posterior Tibial Artery
Begins at distal border of popliteus as popliteal artery
passes deep to tendinous arch of soleus and gives off
fibular artery  accompanied by tibial nerve  runs
post to medial malleolus  runs between tendons of
FHL and FDL  divides into med and lat plantar
arteries
Gives off tibial nutrient artery
Accompanied by deep tibial vein
Fibular Artery
Arises from post tibial artery inf to distal border of
popliteus and tendinous arch of soleus  descends to
med side of fibula within FHL
Branches: nutrient artery of fibula
perforating branch – pierves IO membrane
lat calcaneal branch  heel
lat malleolar branch
Dorsalis Pedis Artery
Continuation of ant tibial artery. Travels deep to
extensor hallicus longus in ankle  lies lat to tendon of
EHL  ends when divides to form 1st dorsal metatarsal
and deep plantar artery
Joins lat plantar artery to form plantar arch
VEINS
Femoral Vein
Ascends through adductor canal,
passing from postlat to fem art to
posterior  femoral canal  becomes
ex iliac vein. Receives greater
saphenous vein in femoral triangle
Popliteal Vein
Begins at distal border of popliteus as
post tibial and ant tibial veins meet 
peroneal vein drains into it
Lies in sheath with popliteal artery,
passing from med to lat side of artery
Becomes femoral vein as passes
through adductor hiatus
Small saphenous vein drains in in
popliteal fossa
Med and lat plantar veins form post
tibial and fibular veins POST TO
MED AND LAT MALLEOLI
Great Saphenous Vein
Formed by union of dorsal vein of gt toe and
dorsal venous arch  ascends ANTERIOR
TO MEDIAL MALLEOLUS  POST TO
MEDIAL CONDYLE OF FEMUR  passes
through saphenous opening in fascia lata 
enters femoral vein in femoral triangle
Accompanied by saphenous nerve
Small Saphenous Vein
Formed by union of dorsal vein of lt toe and
dorsal venous arch ascends POST TO LAT
MALLEOLUS  along lateral border of
calcaneal tendon  penetrates deep fascia 
between 2 heads of gastrocnemius ascends 
enters popliteal vein
Accompanied by sural nerve
NERVES
Clunial Nerve
Superior, middle and inferior clunial nerve – supply skin over iliac crest
Superior Gluteal Nerve
Course: runs between gluteus medius and minimus with deep branch of sup gluteal artery
Supplies: gluteus medius and tensor of fascia lata
Lesion: loss of abduction at hip
Inferior Gluteal Nerve
Course: runs through greater sciatic foramen (inf to Piriformis, deep to gluteus maximus and sup to sciatic
nerve) with inf gluteal vessels
Supplies: gluteus maximus
Lesion: loss of extension of hip
Sciatic Nerve
Course: formed at inf border of Piriformis; most lateral
structure coming through greater sciatic foramen  runs
inflat under gluteus maximus midway between greater
trochanter and ischial tuberosity  rests on ischium 
passes post to obturator internus, quadratus femoris and
adductor magnus  travels in thigh deep to biceps femoris
Accompanied by post femoral cutaneous nerve and inf
gluteal artery
Branches: tibial and common fibular nerve
Supplies: post thigh muscles, all muscles of leg and foot,
most skin of leg and foot
Lesion: loss of all motor except adduction and flexion of
thigh and extension of knee
loss of sensation lower leg and foot
Surface marking: midpoint between ischial tuberosity and
gter trochanter  apex of popliteal fossa
Pudendal Nerve
Most medial structure to exit greater sciatic foramen inf to Piriformis  enters perineum through lesser
sciatic foramen
Femoral Nerve
Splits into superficial (R) and deep
(L) groups
Sup: 2 muscular, 2 cutaneous
Deep: 2 muscular, 2 cutaneous
Course: descends through psoas major  down between psoas major and iliacus  deep to inguinal
ligament midpoint  splits into ant and post divisions  through femoral triangle where separated from
femoral artery by portion of psoas major
Anterior division: anterior cutaneous branch (intermediate and medial cutaneous)
muscular branches – to pectineus and sartorius
Posterior division: saphenous – accompanies femoral artery and vein in adductor canal  becomes
superficial by passing between sartorius and gracilis  skin and fascia on
antmed knee, leg and foot
muscular branches – to quads
articular branches – to knee and hip
Factoid: largest branch of lumbar plexus)
comes from POSTERIOR divisions of anterior rami
Obturator Nerve
From ventral divisions of L2-4  descends through
psoas major  pierces psoas fascia, crosses
sacroiliac joint, passes lat to in iliac vessels and
ureter  leaves pelvis through obturator foramen 
divides into ant and post branches which are
separated by obturator externus then adductor brevis
Supplies: obturator externus, pectineus, adductor
longus, adductor brevis, gracilis, adductor magnus,
and med thigh
Tibial Nerve
Formed at bifurcation of sciatic nerve at top of popliteal
fossa where it lies medial to vessels  passes between 2
heads of gastrocnemius deep to tendinous arch of soleus
with post tibial vessels  descends in post compartment
of leg deep to soleus on tibialis posterior  lies between
tendons of FHL and FDL POSTERIOR TO MEDIAL
MALLEOLUS  terminates as med and lat plantar
nerves
Gives branches in fossa – gastrocnemius, soleus,
plantaris, popliteus. Also supplies tibialis posterior,
FDL, FHL
Med plantar – supplies AbH, FDB, 1st lumbrical, medial
sole of foot and med 3.5 toes
Lat plantar – supplies quadratus plantae, FDM, AdH,
IO, AbDM and 3 lumbricals, lat sole and lat 1.5 toes
Med sural cutaneous (joined by sural communicating
branch from fibular  sural nerve)  skin of inf leg and
lat foot
Lesion: loss of flexion of toes and inversion of foot; loss
of sensation sole of foot
Common Fibular Nerve
From dorsal branches L4+5, S1+2  begins at top of
popliteal fossa  Follows med border of biceps femoris
in lat popliteal fossa  Passes superficial to lat head of
gastrocnemius  passes between soleus and fibularis
longus  Winds around post neck of fibula runs deep
to fibularis longus  Divides into superficial and deep
fibular nerve
Lesion: loss of extension toes and foot; loss of sensation
lat lower leg and upper foot
Before division: articular branch to knee
lat sural cutaneous – postlat calf
Superficial Fibular Nerve
Begins between fibularis longus and fibula  runs between
fibular muscles and EDL  pierces deep fascia to become
superficial at lower 1/3 leg  divides into medial and
intermediate dorsal cutaneous nerve
Supplies: fibularis longus and brevis; skin of distal ant leg and
dorsum of foot
Action: everts foot
Deep Fibular Nerve
Arises between fibularis longus and neck of fibula 
accompanies ant tibial artery between tibialis anterior and EDL
 pierces ant crural intermuscular septum and EDL  runs
deep to EDL  descends ant to IO membrane with ant tibial
artery between TA and EHL  divides into lateral and medial
terminal branch at ankle
Supplies: skin of 1st webspace, tibialis anterior, EDL, fibularis
tertius, EHL, ankle
Action: dorsiflexion, extension toes
Sural Nerve
Formed by medial sural cutaneous and peroneal anastomotic
branches  passes down with small saphenous vein, near lat
margin of tendocalcaneus, behind lat malleolus. Becomes lat
dorsal cutaneous nerve