A PRACTICAL MANUAL ON THE LOWER LIMB

1. SUPERFICIAL VEINS OF THE LOWER LIMB

2. LUMBOSACRAL PLEXUS

3. INNERVATION OF THE LOWER LIMB

4. COMPARTMENTS OF THE LEG

5. EXTRINSIC MUSCLES OF THE FOOT

6. EXTRINSIC MUSCLES OF THE FOOT

7. SPECIAL REGIONS OF LOWER LIMB

8. NERVE LESIONS OF LOWER LIMB

SUPERFICIAL VEINS OF THE LOWER LIMB

The great saphenous vein begins medially

and reaches the femoral vein by

passing through a weakened part of

fascia lata called the fossa ovalis which has a sharp margin called the falciform margin.

The small saphenous vein begins laterally

and opens up into the popliteal vein.

IDENTIFY THE THE LABELLED

STRUCTURES

E

D

C

B

A

LUMBOSACRAL PLEXUS

Four nerves that innervate the lower limb: Femoral nerve, Obturator nerve, Superior

gluteal, and Sciatic nerve.

Lumbo-sacral plexus (L1 – S3):Lumbo-sacral plexus (L1 – S3):

Lumbar plexus (4 segments;L1-L4)

Sacral plexus (4 segments; L5-S3)

Lumbosacral trunk joints these plexuses

DESCRIBE THE L-S PLEXUS.NAME 4 NERVES SUPPLYING THELOWER LIMB!

A

B

E

C

D

Four nerves that innervate the lower limb: Femoral nerve, Obturator

nerve, Superior gluteal, and Sciatic nerve.

Femoral nerve (L234 posterior division) --- Flexors of hip joint

Obturator nerve (L234 anterior division) --- Adductors of hip joint

The Sciatic (n. ischiadicus; great sciatic nerve) L45S123, supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the

leg and foot. It is the largest nerve in the body.

The Superior Gluteal Nerve (n. glutæus superior) L45S1 arises from the dorsal

divisions: innervates the Glutæi medius and minimus, and the Tensor fasciæ latæ.

LUMBOSACRAL PLEXUS

B

D

A

C

THE FEMORAL NERVEFemoral nerve (L234 posterior division) --- Flexors of hip joint

Iliopsoas, sartorius, quadriceps femoris, supra articularis genu,

and “pectineus”

SensorySensory: femoralis anterior, medial of leg

and foot.D

B

C

A

MUSCLES OF THE FEMORAL NERVE(FLEXORS OF HIP JOINT)

D

C

G

B

AH

EI

F

THE OBTURATOR NERVEObturator nerve (L234 anterior

division) --- Adductors of hip joint

Add. Magnus, add longus, add brevis, add minimus, gracilis,

obturator externus.

Sensory:Sensory: medial femoral region.

C

B

A

D

F

E

The medial compartment of the thigh is called the adductor

compartment because the major action of this group of muscles is

adduction, except for the hamstring portion of the adductor magnus.

Add. Magnus, add longus, add brevis, add minimus, gracilis,

obturator externus.

MUSCLES OF THE OBTURATOR NERVE(ADDUCTORS OF HIP JOINT)

F

A

B

C

E

D

G

SCIATIC NERVE(FIBULAR & TIBIAL NERVES)

The Sciatic (n. ischiadicus; great sciatic nerve) L45S123, supplies nearly the whole of the skin of the leg, the muscles of

the back of the thigh, and those of the leg and foot. It is the largest nerve in the body.

THE SCIATIC NERVE

Sensory:Sensory:

Back of thigh,most of leg, and

foot.

F

E

D

C

B

A

H

J

G

I

MUSCLES OF THE SCIATIC NERVE(EXTENSORS OF HIP JOINT)

The hamstrings are: biceps femoris (long head)

semimembranosus semitendinosus

hamstring part of the “adductor magnus”

Features:Features:

Or. ischial tub.

In. Tibia-fibula

Nv. tibial divisionF

A

BE

C

D

The tensor fasciae latae is seen from the lateral side of the

gluteal region

The Superior Gluteal Nerve (n. glutæus superior) L45S1 arises from the dorsal

divisions: innervates the Glutæi medius and minimus, and the Tensor

fasciæ latæ.

MUSCLES OF THE SUPERIOR GLUTEAL NERVE(ABDUCTORS OF HIP JOINT)

F

E

D

C

B

A

THE TIBIAL NERVE

The superficial part of the leg is made up of three muscles:

1. gastrocnemius

2. plantaris 3. soleus

The deepest layer of muscles includes

the:

1. tibialis posterior

2. flexor digitorum longus

3. flexor hallucis longus

4. popliteus

The nervesare the:

1. medial plantar

2. lateral plantar

D

C

B

A

G

E

F

H

I

MUSCLES OF THE TIBIAL NERVE

The superficial part of the leg is made up of three muscles:

Gastrocnemius, plantaris, soleus.

The deepest layer of muscles includes the:

tibialis posterior, flexor digitorum longus, flexor hallucis longus.

E

D

C

B

A

G

H

F

The posterior compartment of the

leg is usually subdivided into

superficial and deep parts.

THE FIBULAR NERVE(PERONEAL NERVE)

The Deep Peroneal Nerve

supplies muscular branches to the

Tibialis anterior, Extensor digitorum

longus, Peronæus

tertius, and Extensor hallucis prop ius, and the

skin between the first and second toe.

The Superficial Peroneal Nerve

(n. peronæus superficialis) supplies the

Peronei longus and brevis and the skin over the greater part of the

dorsum of the foot.

E

F

G

D

A

C

B

MUSCLES OF THE FIBULAR NERVE(ANTERIOR & LATERAL COMPARTMENTS)

The anterior compartment contains

muscles that are basically extensors of the ankle

and toes. They include: tibialis anterior, extensor

digitorum longus, extensor hallucis longus

G

HCB

A

DE

F

MUSCLES OF THE FIBULAR NERVE(ANTERIOR & LATERAL COMPARTMENTS)

The SUPERFICIAL peroneal nerve branches

from the common peroneal nerve near the neck of the fibula and passes between the peroneus longus and

brevis muscles, at which point they supply the

muscles. The DEEP branch then continues onto the dorsum of the foot to supply the skin

there.

HF G

B

A D

E

C

EXTRINSIC MUSCLES OF THE FOOT

dorsum of foot (intrinsic):extensor digitorum brevis

extensor hallucis brevis

Extrinsic muscles originate outside the foot

ED

C

B

A

F G IH

INTRINSIC MUSCLES OF THE FOOT

sole of foot1st layer abductor hallucis flexor digitorum brevis abductor digiti minimi

2nd layer accessory flexor (quadratus plantae) lumbricals tendons of flexor digitorum longus tendon of flexor hallucis longus

3rd layer flexor hallucis brevis adductor hallucis

oblique head transverse head

flexor digiti minimi brevis

D

F

EC

AB

I

JH

G

INTRINSIC MUSCLES OF THE FOOT

4th layer interossei

4 dorsal interossei 3 plantar interossei

tendon of peroneus longus

tendon of tibialis posterior

dorsum of foot:extensor digitorum brevis

extensor hallucis brevis

DC

BA

MMOVEMENTS OF OVEMENTS OF THE FOOTTHE FOOT

1. 1. PROPULSIONPROPULSION::

-FLEXION AND EXTENSION OF THE ANKLE AND TOES

2. 2. ADAPTATIONADAPTATION::

- INVERSION & EVERSION

SPECIAL REGIONS OF LOWER LIMB

The muscles of the gluteal region are responsible for extension, abduction, lateral rotation and slight medial rotation of the hip

joint.

1. superior gluteal 2. inferior gluteal 3. sciatic 4. posterior femoral

cutaneous 5. pudendal

For im injectionGLUTEAL REGION

E

D

C

B

A

I

G

F

J

KH

L

LYMPH DRAINAGE OF THE LOWER LIMB

Superficial inguinal lymph nodes are arranged into three anatomical groups - medial, lateral and lower. They drain from the lower abdominal wall, perineum (including vulva and vagina), anal canal, scrotal skin, penis and the entire lower limb. They do not drain the testes which instead, drain to the upper para-

aortic nodes within the abdomen.

Drainage is to the external iliac

nodes.

E

D

C

BA

F

FEMORAL TRIANGLE

The sheath contains the following items, from lateral to medial:

1. femoral artery 2. femoral vein 3. femoral canal (usually containing a lymph

node). The femoral canal is also the site of a

femoral hernia.

The femoral nerve is not considered to be in the sheath.

GB

A

E

F

D

C

H

I

NERVE LESIONS OF LOWER LIMB

Femoral nerve lesion Common fibular nerve lesion

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