‫بسم الّٰله الرحمن الرحيم‬

Anatomy Final Review Series

Part 3-Lower Limb

Batch 20
The Gluteal Region
☆ sensory innervation
Upper lateral quadrant of the buttock supplied by > L1 + T12
lower lateral quadrant of the buttock supplied by > lateral cutaneous nerve of thigh " L2 L3 "
Upper medial quadrant of the buttock supplied by > posterior rami of L1 _L3 + S1 _ S3
lower medial quadrant of the buttock supplied by > posterior cutaneous nerve of thigh "S2, S3 "
The deep fascia of the thigh " fascia lata " thickenning on lateral side of thigh forming > iliotibial tract
ttach above to tubercle of iliac crest & below to lateral condyle of the tibia , receive insertion for Tensor
ascia lata & greater superfacial part of gluteus maximus
Greater sciatic foramen provide exit from pelvis to gluteal region, structures which exit through it
superior gluteal nerve & vessel above piriforimis
piriformis
sciatic nerve
inferior gluteal nerve & vessl
posterior cutaneous nerve of thigh
nerve to " obturator internus + quadratus femoris "
pudendal nerve & internal pudendal vessel
lesser sciatic foramen provide communication between gluteal region & perineum
tructures pass through the foramen is
Tendon of obturator internus
nerve to obturator internus
● Intramuscular injection in gluteal region should be given in Upper lateral
quadrant of buttock to avoid injury to sciatic nerve
● Gluteus medius + minimus + tensor fascia latae all supplied by superior
gluteal nerve " L4 _ S1 "
● Sciatic nerve is largest nerve in the body " L4 __ S3 " , The posterior
cutaneous nerve of thigh lie posterior to it
● Superior gluteal artery is branch from posterior division of internal iliac
artery , while inferior is from anterior division
● Arteries which share in Trochanteric anstomosis are > superior & inferior
gluteal arteries + medial & lateral femoral cirucumflex arteries
● Arteries which share in Curciate anastomosis anstomosis are > inferior
gluteal artery + medial & lateral femoral cirucumflex arteries + first perforating
artery branch from profunda femoral artery
● The gluteus medius & minimus > on standing on one limb they contract
supporting the pelvis preventing it's tilt to unsupported side , So in injury of
superior gluteal nerve for example in left side , when this patient stand on his
left foot the pelvis will be tilt to right side " positive trendelenburg sign "
• ● lateral rotator of thigh are > piriformis + obturator internus & externus +
Gemellus superior & inferior + quadratus femoris
Thigh :-
3 muscle compartment
- Anterior compartment innervated by femoral nerve
- medial compartment innervated by obturator nerve
- posterior compartment innervated by tibial portion of sciatic nerve.
* but short head of biceps femoris innervated by common peroneal portion of
sciatic .

Muscle has dual innervation:-

Adductor Magnus " obturatior & sciatic"
Pectineus muscle " femoral & obturator"

Muscle which act in two joints :-

Sartorius muscle cause flexion in hip joint and flex knee joint ,abduction and latera
rotation
#femoral_triangle 🔽
Boundaries:-
Superiorly : inguinal ligament
Medially: adductor longus
Laterally: sartorius muscle

Floor : pectineus , iliopsous , adductor longus.

Roof : fascia lata and cripriform fascia and skin over it which innervated by femoral
branch of genitofemoral nerve.

Content : femoral vessels and nerve + femoral branch of genitofemoral nerve ,

lymphatic.

Femoral ring boundaries :

Anteriorly : inguinal ligament
Posteriorly: pectineal ligament
Laterally: femoral vein
Femoral canal lie medial to femoral vein in femoral sheath. " the sheath
s prolongation of iliac & transversalis fascia "
The sheath contain ( femoral vessels and femoral branch of
genitofemoral nerve ) femoral nerve is out the sheath
This canal is a potential weak area and site for femoral hernia " lie
ateral and inferior to pubic tubercle " more common in women.

#saphenous opening :-
Content :- ( great saphenous vein ' small branch of femoral artery,
ymph vessels)
#adductor or subsartorial canal :-
Begin at apex of femoral triangle
Lie between adductor Magnus and longus / vastus medialis.
Covered by sartorius muscle .
Content :-
Hip joint supply and anastomosis:-
Artery of ligementum teres femoris is branch from obturator artery .

Anastomosis around hip is from

Medial and lateral circumflex femoral
Superior and inferior gluteal.

Head of femur is supplied by

Obturator artery in children
Medial femoral circumflex artery in adult.

Clinical correlation:-
Fracture of neck of femur result in ischemic necrosis

Coxa valga :- increase in angle between axis of neck and shaft.

Popliteal fossa:contains:-
1-popliteal vessels
2-small saphenous vein
3-common peroneal and tibial nerve
4-lymph node
5-posterior cutenous nerve of the thigh
6-genicular branch of obturator nerve.
Floor froms by poplitues muscle ,obliuqe ligament of the knee ,popliteal surface of the
femur .
Most deep structure in the fossa is popliteal artery,and popliteal vein superficial to it .
Most lateral structure is common peroneal nerve
Leg:
Muscles of lateral part of the leg innervated by superficail proneal nerve"pernous longus
and brevis "
Muscles of anterior part of the leg innervated by deep proneal nerve .
Posterior part innervated by tibial nerve
Gasterocnemus flex the knee and planterflex the foot .
Tendocancleus made by common tendon of gastrocenmus and solieus .
kle Region
structures that pass anterior to extensor reticulum from medial to lateral
saphenous nerve & great saohenous vein in front of medial malleolus
superficial peroneal nerve
_
structures that pass below the extensor reticulum from medial to lateral " Tom Has Very Nice Doges and Pigs "
Tibilais anterior tendon
Extensor hallucis longus tendon
Anterior tibial artery & accompany vena comitantes
Deep peroneal nerve
Extensor Digitorum longus
peroneus tertius
___
structures that pass behind the medial malleolus beneath the flexor reticulum from medial to lateral " Tom Does Very Nice Hats "
Tibilais posterior tendon
flexor digitorum longud
posterior tibial artery & accompany vena comitantes
Tibial nerve
Flexor hallucis longus
____
Structures that pass behind the lateral malleolus Superficial to the superior peroneal retinculum from
The sural nerve
Small saphenous vein
____
Structures that pass behind the lateral malleolus beneath the superior peroneal retinculum from
The Foot
● Tendon lie medial to sustenculum tali > flexor digitorum longus
tendon , Tendon lie below sustenculum tali > Flexor hallcius longus
, Tendon lie above sustenculum tali > tibilais posterior
● The Flexor digitorum longus tendon provide insertion for Quadratus
plantae muscle & origin for lumbrical muscles
● All internisic muscles of sole of foot are supplied by lateral planter
nerve except
_ Abductor hallucis
_ Flexor digitorum brevis
_ flexor hallucis brevis
_ fisrt lumbrical
> they are supplied by medial plantar nerve
● The Deep peroneal nerve supply the skin between the big & 2nd toes
● lateral margin of the foot is supplied by sural nerve & skin on medial
☆ The Arches of the foot
● Medial longitudinal arch formed by > calcaneum , talus , navicular ,
three cuneiform & 1st three metatarsal bones
_ The key stone in maintaining support to medial arch > talus
_ important ligament for its support > planter calcanonavicular ligamen
" spring ligament"
_ Tendons which supports it > flexor halucis longus + both tendons of
tibilais
● lateral longitudinal arch formed by > calcaneum , cuboid, 4th & 5th
metatarsal bones
_The key stone in maintaining support to lateral arch > cuboid
_ ligaments which give it's support > long & short planter ligament
_ Tendons which supports it > both pernous longus sepcially & brevis
● Transverse arch formed by > boase of all.metatarsal bones + cuboid ,
three cuneiform it's supported by > adductor halluscis + tendon of
ood vessels:-

emoral artery :
a continuation of external iliac artery distal to inguinal ligament.
n through femoral triangle and adductor canal.

Note
e midpoint of the inguinal ligament:-
alfway between the anterior superior iliac spine and pubic tubercle, is the landmark for the (femoral nerve).

he mid-inguinal point:- halfway between the anterior superior iliac spine and the pubic symphysis, is the landmark for (the
moral artery).

popliteal artery
continuation of femoral artery at adductor hiatus run through popliteal fossa.
the lower border of popliteus muscle it divide into anterior and posterior tibial

s vulnerable to injury from femur fracture and knee dislocation

give 5 genicular arteries.

Anterior tibial continuous as dorsalis pedis artery anterior to ankle joint.

pulsation can be palpated on the dorsum of foot between ( tendons of extensor hallucis longus & extensor digitorum
ngus)
Veins
* Superficial and deep
The deep veins follow the arteries
Deep veins of leg to politeal veins to femoral vein

The Superficial veins are :

* great saphenous vein begins ( medial end ) of dorsal venous arch pass
through saphenous opening to join femoral vein.
It pass infront of the medial malleolus and accompany the saphenous
nerve.
It is used for coronary artery bypass₩

*short saphenous vein

Begin at the (lateral end) of dorsal venous arch .
Hip joint :
Ball and socket synovial joint .
Ligament :
İliofemoral>resist hyperextension&lateral rotation.
İschofemoral>limits extension and medial rotation
Pubofemoral>limits extension and abduction

Proximal tabiofibular joint :-

Plane type synovial joint

Distal tabiofibular joint:-

Fibrous joint
 e knee joints
ype : is modified hinge joint " it's allow limited rotation "
rticular surfaces : between medial femoral condyle with medial tibial condyle
eral femral condyle with lateral tibial condyle
ttaler surface of femur with pattalla
The fibrous capusle of joint deficient anteriorly being replaced by tendon of quadriceps + patella +
ttaler ligament
xtra capsular ligament >
patllar ligament
medial collateral ligament " attach to medial meniscus "
ateral collateral ligament " separated from lateral
eniscus by popltius muscle "
medial & lateral collateral ligament prvent side to side movement of tibia on femur )
oblique popliteal ligament " tendoius expansion of semimembranousus "
ntracapusular structures
2 meniscus >
Anterior curuciate ligament " prevent anterior displacement of tibia "
posterior curciate ligament " prevent posterior displacement of tibia "
endon of popltius
2 meniscuofemral ligament
Ankle joint:-
ype = hinge synovial joint.
Allow planterflexion and dorsiflexion .

t is between tibia and fibula + talus bone.

his joint reinforced ...

Medially by ' medial ( deltoid ) ligament

t prevent over eversion of foot and maintain medial longitudinal
rch .