LOWER LIMB
Lower Limb:- Lower limb : 1-Hip 2-Buttoch } gluteal region 3-Thigh 4-Leg. 5-Foot 6-Toe Hip bone:- 3 parts fused together at acetabulum. **ilium : - larger - upper part - crest.**ischium : - posterior inferior. - body rest in sitting position . **pubis : - anterior part - felt in lower part of anterior abdominal wall. - public symphysis
Thigh:- - from hip to knee. - bones is femur. - hip joint. - knee joint. - at back of knee is popliteal fossa . Leg(crus):- - from knee to ankle J. - back of leg called culf (sura). - bones is tibia fibula .
Foot:- - dorsum. - sole (planter surface) - tarsal bon . - ankle joint. - metatarsal bones 5 in number. - toes (digit ) 1 st toe- big toe ( hallux).
Front of thigh:- Correspond to back of arm. -Superficial fascia:- 2 layer : - superficial fatty layer. - deep membranous layer. ** has firm attach ment along line (holden's line) Start from pubic tubercle along pubic arch, & Laterally about 8cm .
Contents of superficial fascia: 1- cutanous nerves (7). 2-small cutanous arteries (3). 3-great saphenous vein. 4-superficial inguined L.N. 5-prepattelar and subcutaneous bursa.
Cutanous nerves:- Derived from lumbar plexus:- 1- ilio- inguinal nerve (L1). 2- femoral branch of genitor femral n. (L1,2) 2cm below inguinal ligament . 3- lateral cutancous nerve of thigh( L2,3). 4- intermediate cutancous nerve of thigh (L2,3). 5- medial cutancous nerve of thigh (L2,3). 6- saphenous nerve (L3,4). 7-cutanous branch of anterior division of abturator nerve (L2,3).
Patellar plexus :- - Ant. division of lat. cut. n. of thigh. - Intermediate cut. n. of femoral n. - Ant. division of medial cutan. n. - Infrapattellar branch . of saph. n.
Great (long) saphenous vein:- - Largest ,longest, superficial vein in lower limb. - easily seen. - dorsum of foot ,medial end of dorsal venous arch. - pierced cribriform fascia drain to femoral vein. - contain 10-15 valves. - connected to deep vein by perforating v. which contain valves.
Superficial inguinal L.N. T- shaped : - lower vertical group. - upper lateral group. - upper medial group. Efferent to ---- deep L.N. ** Painful enlargement of superficial inguinal L.N. drains:- - buttoch , ant. abd. Wall, perineum, external gentalia, vagina , anus.
Cutanous arteries :- - superficial circumflex iliac artery . - superficial epigastril artery . - superficial external pudendal artery. - deep external pudendal artery.
Deep fascia of thigh(facia lata). Enclose thigh as sleeve. *attachment : superiorly:- - inguinal ligament. - iliac crest. - sacrum , coccyx. - sacrotuberous ligament . - medially to pubic arch, ischial tuberosity . *attachment inferiorly:- - capsule of knee J. - continues below with fascial of back of leg. thickness:- - idiotibial tnact : - gluteus maximus - tensor fascia lata.
Modification:- 1- saphenous opening (fossa ovalis). - 4 cm below and lateral to pubic tubercle. - falciform margin of saphenous opening 2- cribriform fascia. 3- ilia tibial tract. ** fascia lata is attached to inguinal ligament extended thigh pull downward abd. Wall and make it tense.
Deep extension of fascia lata .:- 3 intermuscular septa divided thigh into 3 compartment . * single the thigh is capable of performing 4 principle types of movement :- 1- adductors (obturator n.) 2- abductors (superior glut. nerve) 3- extensor (anterior femoral muscular ). femoral n. 4- flexor ( posterior femoral muscular), (sciatic nerve).
Femoral triangle:- * femoral lies directly below the inguinal ligament:- Boundaries:- Lat --- med. Border of sartorius m. Med. --- med. Border adductor longus Base . --- linguinal ligament . Floor. --- formed from lateral to medial : ilius , pesctineus , adductor longus m. (part of adductor , magnus). Roof. --- skin, superficial fascia (cribriform fascia ) contain:- - lymph node , vessels,great saph. vein. - femoral branch of G.F.N. - branch of ilioinguinal nerve. - superficial branch of femoral vessels.
Content:- 1- femoral v. 2- femoral a. 3- femoral nerve.
** Femoral canal a widest at its abdominal end called femoral ring which has 4 boundaries:- Ant. --- medial part of inguinal ligament Medially --- cresent edge of lucanar ligament Posteriorly --- pectinal line of horizant ramus of pubic bone which cover by expansion from conjoint tendon that fused with periostium and is called pectineal ligament . Laterally --- femoral vein. ** anterior wall of femoral sheath is pierced by femoral branch of gen to femoral nerve.Femoral artery:- * continuation of external iliac a. behind midway of inguinal ligament called femoral point . * it passes through an opening in adductor maguns to become popliteal a. * the first 3-4cm of vessels with femoral vein enclosed in femral sheath . Relation :-
Anteriorly: - skin in femoral triangle. - superficial fascia - superficial inguinal circumflex iliac v. - femoral branch of G.F.N. - medial cutan n. of thigh Posteriorly: - tendon of psoaas major , pectin adductor longus. - capsule of hip joint . - nerve to pectineus. ** Lateral to a. Is femoral nerve ** Medial to a. Is femoral vein in upper end of femoral triangle and posterior to artery in lower end.
In adductor canal:- The artery lies deeper covered with skin , superficial fascia , deep fascia , sartorius , and fibrous roof of canal. The saphenous nerve at first lateral then infront of artery and then medial and behind the artery. ** The artery is related to adductor longus above and to adduct magnus below.
Branches of femoral a.:- 1- superficial epigastric artery. 2- superficial circumflex iliac artery. 3- superficial external pudandal artery. 4- deep external pudendal artery . 5- muscular branches. 6- profuda femoral artery. - largest branch of femoral a. From lateral side , about 2.5 cm below inguinal ligament . - end by piercing adductor magnus to anastomosis with muscles branch of popliteal a.
- terminal part of profunals is called 4th perforating a.
Branches of profunda femoris a.: a. lateral circumflex femoral a. b. medial circumflex femoral a. c. perforating arteries. 7- descending genicular artery.
Femoral vein:- - enter lower angle of femoral triangle it lies posterior to artery , and come to lies on medial side of artery to lower limb of femoral sheath. - it receive tributary corresponding to prefunda femoral a. - great saphenous vein join its medial side. - pass under inguinal ligament and run as external iliac vein. - it has values just above the junction with profunda and great saphenous vein.
Femoral nerve:- - nerve of extensor compartment of thigh - formed by primary rami of lumbar nerve (L2,3,4) - passing deep to inguinal ligament at lateral angle of femoral sheath which separate it from femoral artery. - branches between lateral circumflex artery it divided:- 1- superficial division:- 1- cutanous branch : - inter medial cutanous n. of the thigh - medial cutanous n. of thigh 2- muscular branch: - sartorius m. - pectinous m. 2- deep division:- 1- one cutanous (saphenous n.) 2- muscular branches. - n. to rectus femoris. - n. to vastus medialis . - n. to vastus lateralis , intermedial .
Femoris muscles:- - it is extensor of knee joint. - inserted into tubersity of tibia. - sesamoid bone in the tendon called patella (knee cup). - tendon above patella called the quadriceps tendon , below patella called ligament patella. - it is biggest muscles in the body . - Rectus femoris: - reflection head. - straight hesd. - Vastus latendis. - Vastus intermedias . - Vastus medialis.
Quadriceps tendon:- - it is trilaminar. - 3 lamina fused together by interchanges of fibers. passes across patella into ligament patella and retinacula . this ligament connected lower part of patella with tuberosity tibia. ** Nerve supply of quadriceps femoris by posterior division of femoral nerve.
Sartorius muscles:- - longest m. In the body. - originated from ant. superior iliac spin and inserted with gracilis semi tendinous to upper part of medial surface of tibia. - from lateral boundries of femoral triangle . - in middle of thigh it form roof of what we called adductor canal ( subsartorial) . - nerve supply by femoral n. Articularis geuns muscle:- - small muscle from vastus medialis. - its nerve supply is femoral n.