LOWER LIMB

INTRODUCTION
The primary function of the lower limb is to - support the weight of the body - provide a stable foundation in standing, walking, running (locomotion) Similar in structure to the upper limbs but have less freedom of movement Connected by the pelvic girdle to the trunk

ORGANIZATION
Gluteal region Thigh Leg Foot

BONES OF THE LOWER LIMB

Pelvic girdle (left & right hip bones) Femur Patella Tibia Fibula Tarsal bones Metatarsal Phalanges

HIP BONE
L. os coxae Innominate bone Large irregular bone Formed by the fusion of 3 bones: - ilium - pubis - ischium

 United at the acetabulum. Pubis and ischium are separated by obturator foramen. The 2 hip bones articulated anteriorly at the pubic symphysis

ILIUM
Largest part of the hip bone Upper expanded plate like part Contributes the superior part of acetabulum Posterolateral surface gluteal surface Long curved superior border iliac crest

ISCHIUM
Posteroinferior part of the hip bone Forming posteroinferior aspect of acetabulum Upper, thicker part body Lower, thinner part ramus Ischial spine Ischial tuberosity Lesser sciatic notch

PUBIS
Anteromedial part of the hip bone Anterior part of acetabulum Divided into body & 2 rami Articulates with the contralateral pubis at the symphysis pubis Pubic crest Pubic tubercle

OBTURATOR FORAMEN
Large oval or triangular aperture Bounded by the pubis & ischium Closed by obturator foramen

ACETABULUM
Large, cup-shaped cavity or socket on the lateral aspect of the hip bone. Articulates with the head of femur to form the hip joint Acetabular notch Acetabular fossa Lunate surface

ANATOMICAL POSITION
Anterior superior iliac spine & anterosuperior aspect of the pubis lie in the same vertical plane

HIP INJURIES
Hip fractures are common in serious vehicular accidents

FEMUR
Longest & heaviest bone in the body Transmits body weight from the hip bone to the tibia Long bone Consists of a body (shaft) & 2 ends Superior end consists of head, neck, 2 trochanters

 Head of femur projects superomedially & slightly anteriorly Attached to the body by the neck Neck-body angle 126 Less in females Neck allows for greater mobility But imposes considerable strain

 Greater & lesser trochanters large eminences situated at the junction of the neck & shaft Intertrochanteric line Intertrochanteric crest

Body of femur slightly bowed anteriorly Smoothly rounded Posteriorly linea aspera Has medial & lateral lips Lateral lips gluteal tuberosity Medial lip spiral line Medial & lateral supracondylar lines

 Condyles lateral & medial condyles Separated posteriorly by intercondylar notch Above the condyles, epicondyles

 Angle of inclination varies Angle - coxa vara (# neck of femur) - abduction limited Angle - coxa valga (congenital dislocation of hip joint) - adduction limited Fracture neck of femur - elderly - osteoporosis (trivial trauma)

BLOOD SUPPLY OF FEMUR

Medial femoral circumflex artery

THIGH
1. 2. 3. 4. 5. 6.

SKIN Cutaneous nerves Lateral cutaneous nerve of the thigh Femoral branch of genitofemoral nerve Ilioinguinal nerve Medial cutaneous nerve of the thigh Intermediate cutaneous nerve of the thigh Obturator nerve (anterior division)

 1. 2. 3.

Superficial veins Great saphenous vein Small saphenous vein Perforating veins Venous pump Varicose veins

 Lymphatic drainage Inguinal lymph nodes - superficial inguinal lymph nodes - deep inguinal lymph nodes Superficial inguinal lymph nodes - horizontal group - vertical group Deep inguinal lymph nodes

DEEP FASCIA
Fascia lata Attached to the iliac crest & inguinal ligament Laterally thickened to form iliotibial tract Saphenous opening gap in the deep fascia, just below the inguinal ligament

FASCIAL COMPARTMENTS
3 intermuscular septa - lateral intermuscular septum - medial intermuscular septum - posterior intermuscular septum Compartments of the thigh - anterior - medial - posterior

ANTERIOR COMPARTMENT
Muscles - sartorius - quadriceps femoris - iliacus - psoas - pectineus Blood supply femoral artery Nerve supply femoral nerve

SARTORIUS
Tailors muscle Origin: ASIS (anterior superior iliac spine) Insertion: upper part of medial surface of tibia Nerve supply: femoral nerve Action: flexes, abducts, laterally rotates the thigh at the hip joint; flexes & medially rotates the leg at the knee joint

ILIACUS
Origin: iliac fossa Insertion: join the tendon of psoas to form iliopsoas Nerve supply: femoral Action: flexes the thigh/flexes the trunk

PSOAS MAJOR
Long fusiform muscle that arises in the abdomen & descends into the thigh Origin: lumbar vertebrae Insertion: lesser trochanter of the femur Nerve supply: branches from lumbar plexus Action: flexes the thigh on the trunk/flexes the trunk on the thigh

PECTINEUS
Origin: superior ramus of pubis Insertion: upper end of linea aspera just below the lesser trochanter Nerve supply: femoral nerve (+ obturator nerve) Action: flexes & adducts thigh at the hip joint

QUADRICEPS FEMORIS
4 parts: - rectus femoris - vastus lateralis - vastus intermedius - vastus medialis

 Action - inserted into the patella & via the ligamentum patellae into the tibial tuberosity. - powerful extensor of the knee joint - lowest fibers of v. medialis are horizontal & prevent lateral displacement of patella - the tone of quadriceps greatly strengthens the knee joint

FEMORAL ARTERY
Enters the thigh behind the inguinal ligament Continuation of external iliac artery Midway between the anterior superior iliac spine & symphysis pubis Main arterial supply of the lower limb Ends at the adductor hiatus Continues as popliteal artery

 Branches - superficial circumflex iliac artery - superficial epigastric artery - superficial external pudendal artery - deep external pudendal artery - profunda femoris artery

FEMORAL VEIN
Tributaries - great saphenous vein

FEMORAL VEIN CATHETERIZATION

Rapid access to a large vein

FEMORAL NERVE
Largest branch of the lumbar plexus L2, 3, 4 Lateral to the femoral artery Supplies all muscles of the anterior compartment

MEDIAL COMPARTMENT
Muscles: - gracilis - adductor longus - adductor brevis - adductor magnus - obturator externus Blood supply: profunda femoris & obturator arteries Nerve supply: obturator nerve

GRACILIS
Origin: outer surface inferior ramus of pubis Insertion: upper part of the medial side of tibia Nerve supply: obturator Action: adducts the thigh, flexes the leg

ADDUCTOR LONGUS
Origin: body of pubis Insertion: linea aspera Nerve supply: obturator nerve Action: adducts the thigh & assists in lateral rotation

ADDUCTOR BREVIS
Origin: inferior ramus of pubis Insertion: linea aspera Nerve supply: obturator nerve Action: adducts the thigh & assists in lateral rotation

ADDUCTOR MAGNUS
Adductor & hamstring portions Origin: inferior ramus of pubis, ramus of ischium, ischial tuberosity Insertion: linea aspera, adductor tubercle Nerve supply: obturator nerve Action: adducts the thigh & assists in lateral rotation; extends the thigh

OBTURATOR EXTERNUS
Origin: outer surface of obturator membrane & pubic & ischial rami Insertion: medial surface of greater trochanter Nerve supply: obturator nerve Action: laterally rotates the thigh

POSTERIOR COMPARTMENT
Contents Muscles: - biceps femoris - semitendinosus - semimembranosus - adductor magnus (hamstring part) Blood supply: profunda femoris artery Nerve supply: sciatic nerve

BICEPS FEMORIS
Origin: long head ischial tuberosity short head linea aspera Insertion: head of fibula Nerve supply: tibial n. & common peronael n. Action: flexes & laterally rotates the leg; extends the hip joint

SEMITENDINOSUS
Origin: ischial tuberosity Insertion: upper part of the medial surface of the tibia Nerve supply: tibial part of sciatic Action: flexes & medially rotates the leg; extends the hip joint

SEMIMEMBRANOSUS
Origin: ischial tuberosity Insertion: posteromedial surface of the medial condyle of tibia Nerve supply: tibial part of sciatic nerve Action: flexes & medially rotates the leg; extends the hip joint