Lower Limb

Dr. Iman Abdel AalDr. Iman Abdel Aal

Lower LimbLower LimbFASCIAL COMPARTMENTS OF THE THIGHFASCIAL COMPARTMENTS OF THE THIGH Three fascial septa Three fascial septa pass from the inner aspect of the deep fascial pass from the inner aspect of the deep fascial

sheath of the thigh to the linea aspera of the femur. By this sheath of the thigh to the linea aspera of the femur. By this means, the thigh is divided into three compartments, each means, the thigh is divided into three compartments, each having muscles, nerves, and arteries. The compartments are having muscles, nerves, and arteries. The compartments are anterior, medial and posterior in position.anterior, medial and posterior in position.

CONTENTS OF THE ANTERIOR FASCIAL CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT OF THE THIGHCOMPARTMENT OF THE THIGH

Muscles: Muscles: Sartorius, iliacus, psoas, pectineus and quadriceps Sartorius, iliacus, psoas, pectineus and quadriceps femoris.femoris.

Blood supply: Blood supply: Femoral artery.Femoral artery. Nerve supply: Nerve supply: Femoral nerve.Femoral nerve.



Front of the ThighFront of the Thigh

SartoriusSartorius The sartorius is a narrow, The sartorius is a narrow,

strap-shaped muscle that covers strap-shaped muscle that covers the femoral artery in the middle the femoral artery in the middle one third of the thigh.one third of the thigh.

Origin: Origin: From the From the anterior anterior superior iliac spine.superior iliac spine.

Insertion: Insertion: The muscle fibers The muscle fibers run downward and medially run downward and medially and are attached to the upper and are attached to the upper part of the part of the medial surface medial surface of the of the shaft of the tibia.shaft of the tibia.



SartoriusSartorius Nerve supply: Nerve supply: Femoral Femoral

nerve.nerve. Action: Action: Flexes, abducts Flexes, abducts

and laterally rotates the and laterally rotates the thigh at the hip joint; thigh at the hip joint; flexes and medially rotates flexes and medially rotates the leg at the knee joint.the leg at the knee joint.


Front of the ThighFront of the ThighIliacusIliacus Origin: Origin: This fan-shaped muscle This fan-shaped muscle

arises from the iliac fossa within the arises from the iliac fossa within the abdomen.abdomen.

Insertion: Insertion: The fibers converge The fibers converge and join the tendon of the psoas and join the tendon of the psoas to to form the iliopsoas muscle.form the iliopsoas muscle.

Nerve supply: Nerve supply: A branch of the A branch of the femoral nerve within the abdomen.femoral nerve within the abdomen.

Action: Action: The iliopsoas flexes the The iliopsoas flexes the thigh on the trunk at the hip joint; thigh on the trunk at the hip joint; or if the thigh is fixed, it flexes the or if the thigh is fixed, it flexes the trunk on the thigh; it also medially trunk on the thigh; it also medially rotates the thigh.rotates the thigh.



PsoasPsoas Origin: Origin: From the roots of the From the roots of the

transverse processes, the sides of transverse processes, the sides of the vertebral bodies and the the vertebral bodies and the intervertebral discs; from the intervertebral discs; from the 1212thth thoracic to the 5th lumbar thoracic to the 5th lumbar vertebrae.vertebrae.

Insertion: Insertion: The fibers run The fibers run downward and laterally and downward and laterally and leave the abdomen to enter the leave the abdomen to enter the thigh by passing behind the thigh by passing behind the inguinal ligament. The iliopsoas inguinal ligament. The iliopsoas tendon is attached to the tendon is attached to the lesser lesser trochanter of the femur.trochanter of the femur.



PsoasPsoas A bursa intervenes between the A bursa intervenes between the

tendon and the hip joint and tendon and the hip joint and may communicate with the may communicate with the joint.joint.

Nerve supply: Nerve supply: Branches Branches from the lumbar plexus.from the lumbar plexus.

Action: Action: The iliopsoas flexes The iliopsoas flexes the thigh on the trunk at the hip the thigh on the trunk at the hip joint; or if the thigh is fixed, it joint; or if the thigh is fixed, it flexes the trunk on the thigh.flexes the trunk on the thigh.



PectineusPectineus Origin: Origin: From the superior From the superior

ramus of the pubis. ramus of the pubis. Insertion:Insertion: The muscle fibers The muscle fibers

pass downward, backward, and pass downward, backward, and laterally and are attached to the laterally and are attached to the upper end of the linea aspera upper end of the linea aspera just just below the lesser trochanter.below the lesser trochanter.

Nerve supply: Nerve supply: Femoral nerve. Femoral nerve. (Occasionally, it receives a branch (Occasionally, it receives a branch from the obturator nerve.)from the obturator nerve.)

Action: Action: Flexes and adducts the Flexes and adducts the thigh at the hip joint.thigh at the hip joint.



Quadriceps FemorisQuadriceps Femoris The quadriceps femoris muscle The quadriceps femoris muscle

consists of consists of 4 parts: 4 parts:

1.1. The rectus femorisThe rectus femoris

2.2. Vastus lateralis. Vastus lateralis.

3.3. Vastus medialis.Vastus medialis.

4.4. Vastus intermedius. Vastus intermedius. They have a common tendon of They have a common tendon of

insertion into the upper, lateral, insertion into the upper, lateral, and medial borders of the and medial borders of the patella and then, via the patella and then, via the ligamentum patellaeligamentum patellae, into the , into the tubercle of the tibia.tubercle of the tibia.



Rectus femorisRectus femoris Origin: Origin: A A straight head straight head from from

the anterior inferior iliac spine the anterior inferior iliac spine and a and a reflected head reflected head from the from the ilium above the acetabulum ilium above the acetabulum

Insertion:Insertion: The two heads The two heads unite unite in front of the hip joint, and the in front of the hip joint, and the bipennate muscle is inserted into bipennate muscle is inserted into the the quadriceps tendon and so quadriceps tendon and so into the patella. into the patella.

Nerve supply: Nerve supply: Femoral nerve.Femoral nerve.

Action: Action: See Action of See Action of Quadriceps Femoris Muscle. Quadriceps Femoris Muscle.



Vastus LateralisVastus Lateralis Origin: Origin: From the From the

intertrochanteric line, the base intertrochanteric line, the base of the great trochanter, and the of the great trochanter, and the linea aspera of the femur .linea aspera of the femur .

Insertion:Insertion: The fibers pass The fibers pass downward and forward to be downward and forward to be inserted into inserted into the quadriceps the quadriceps tendon and so into the patella. tendon and so into the patella. Some of the tendinous fibers Some of the tendinous fibers join the capsule of the knee joint join the capsule of the knee joint and and strengthen it.strengthen it.




Vastus MedialisVastus Medialis Origin: Origin: From the From the

intertrochanteric line and the intertrochanteric line and the linea aspera of the femur.linea aspera of the femur.

Insertion:Insertion: The fibers pass The fibers pass downward and forward to be downward and forward to be inserted into the inserted into the quadriceps quadriceps tendon and so into the patella. tendon and so into the patella. Some of the tendinous fibers join Some of the tendinous fibers join the capsule of the knee joint and the capsule of the knee joint and strengthen it. strengthen it. The lowest muscle The lowest muscle fibers are almost fibers are almost horizontal horizontal in in direction.direction.




Vastus IntermediusVastus Intermedius Origin: Origin: From the anterior and From the anterior and

lateral surfaces of the shaft of lateral surfaces of the shaft of the femur.the femur.

Insertion:Insertion: The fibers pass The fibers pass downward and join the downward and join the deep deep aspect of the quadriceps tendon. aspect of the quadriceps tendon. The The articularis genus articularis genus is a small is a small part of the vastus intermedius part of the vastus intermedius that is inserted into the that is inserted into the upper upper part of the part of the synovial membrane synovial membrane of the knee joint. of the knee joint.



Action of Quadriceps Action of Quadriceps Femoris Muscle Femoris Muscle

(Quadriceps Mechanism)(Quadriceps Mechanism) The quadriceps femoris muscle, consisting of the rectus femoris, The quadriceps femoris muscle, consisting of the rectus femoris,

the vastus intermedius, the vastus lateralis and the vastus the vastus intermedius, the vastus lateralis and the vastus medialis, is inserted into the patella and, via the medialis, is inserted into the patella and, via the ligamentum ligamentum patellaepatellae, is attached to the tibial tuberosity. , is attached to the tibial tuberosity.

Together they provide a Together they provide a powerful extensor of the knee joint. powerful extensor of the knee joint. Some of the tendinous fibers of the vastus lateralis and vastus Some of the tendinous fibers of the vastus lateralis and vastus

medialis form bands, or retinacula, that join the capsule of the medialis form bands, or retinacula, that join the capsule of the knee joint and strengthen it. knee joint and strengthen it.

The lowest muscle fibers of the vastus medialis are almost The lowest muscle fibers of the vastus medialis are almost horizontal and horizontal and prevent the patella prevent the patella from being from being pulled laterally pulled laterally during contraction of the quadriceps muscle. The during contraction of the quadriceps muscle. The tone tone of the of the quadriceps muscle quadriceps muscle greatly strengthens greatly strengthens the knee joint.the knee joint.

The rectus femoris muscle also The rectus femoris muscle also flexesflexes the hip joint. the hip joint.


Femoral TriangleFemoral Triangle The femoral triangle is a The femoral triangle is a triangular triangular

depressed depressed area situated in the upper area situated in the upper part of the part of the medial aspect medial aspect of the thigh of the thigh just below the inguinal ligament.just below the inguinal ligament.

It is bounded It is bounded superiorly superiorly by the by the inguinal ligament, inguinal ligament, laterallylaterally by the by the sartorius, and sartorius, and mediallymedially by the by the medial border of the adductor medial border of the adductor longus muscle. longus muscle.

ItsIts floor floor is gutter shaped and formed is gutter shaped and formed from lateral to medial by the from lateral to medial by the iliopsoas, the pectineus and the iliopsoas, the pectineus and the adductor longus. adductor longus.


Femoral TriangleFemoral Triangle Its Its roof roof is formed by the skin and is formed by the skin and

fasciae of the thigh.fasciae of the thigh. The The femoral triangle femoral triangle contains:contains:

A.A. The terminal part of the femoral The terminal part of the femoral nerve and its branches.nerve and its branches.

B.B. The femoral sheath. The femoral sheath.

C.C. The femoral artery and its The femoral artery and its branches. branches.

D.D. The femoral vein and its The femoral vein and its tributaries.tributaries.

E.E. The deep inguinal lymph nodes.The deep inguinal lymph nodes.




Femoral

Shealth

Femoral SheathFemoral Sheath The The femoral sheath femoral sheath is a downward is a downward

protrusion into the thigh of the protrusion into the thigh of the fascial fascial envelopeenvelope lining the abdominal walls. lining the abdominal walls.

Its Its anterior wall anterior wall is continuous above is continuous above with the fascia transversalis, and its with the fascia transversalis, and its posterior wall posterior wall with the fascia iliaca. with the fascia iliaca.

The The sheath surrounds sheath surrounds the femoral the femoral vessels and lymphatics for about 1 in. vessels and lymphatics for about 1 in. (2.5 cm) below the inguinal ligament. (2.5 cm) below the inguinal ligament.

The The femoral artery, femoral artery, as it enters the as it enters the thigh beneath the inguinal ligament, thigh beneath the inguinal ligament, occupies the occupies the lateral compartment lateral compartment of the of the sheath. sheath.


Femoral SheathFemoral Sheath The The femoral vein, femoral vein, as it leaves the thigh, as it leaves the thigh,

lies on its medial side and is separated lies on its medial side and is separated from it by a fibrous septum and from it by a fibrous septum and occupies the occupies the intermediate compartment. intermediate compartment.

The The lymph vessels, lymph vessels, as they leave the as they leave the thigh, are separated from the vein by a thigh, are separated from the vein by a fibrous septum and occupy the most fibrous septum and occupy the most medial compartment. medial compartment.

The The femoral canal femoral canal is the term used to is the term used to name the small medial compartment for name the small medial compartment for the lymph vessels. It is about 0.5 in. the lymph vessels. It is about 0.5 in. (1.3cm) long, and its upper opening is (1.3cm) long, and its upper opening is referred to as the referred to as the femoral ring. femoral ring.


Femoral SheathFemoral Sheath The The femoral septum, femoral septum, which is a which is a

condensation of extraperitoneal tissue, condensation of extraperitoneal tissue, closes the ring. closes the ring.

The The femoral canal femoral canal contains :contains :

a)a) Fatty connective tissue. Fatty connective tissue.

b)b) All the efferent lymph vessels from the All the efferent lymph vessels from the deep inguinal lymph nodes.deep inguinal lymph nodes.

c)c) One of the deep inguinal lymph nodes.One of the deep inguinal lymph nodes. The The femoral sheath femoral sheath is adherent to the is adherent to the

walls of the blood vessels and inferiorly walls of the blood vessels and inferiorly blends with the tunica adventitia of blends with the tunica adventitia of these vessels. these vessels.


Femoral SheathFemoral Sheath The part of the The part of the femoral sheath femoral sheath that that

forms the medially located femoral forms the medially located femoral canal is not adherent to the walls of the canal is not adherent to the walls of the small lymph vessels; it is this site that small lymph vessels; it is this site that forms a potenforms a potentially tially weak area in the weak area in the abdomen. abdomen.

A A protrusion of peritoneum protrusion of peritoneum could be could be forced down the femoral canal, pushing forced down the femoral canal, pushing the the femoral septum femoral septum before it. before it.

Such a condition is known as a Such a condition is known as a

femoral hernia.femoral hernia.


Femoral SheathFemoral Sheath The upper end of the canal, or femoral The upper end of the canal, or femoral

ring, has the following important ring, has the following important relations:relations:

Anteriorly: Anteriorly: the inguinal ligament. the inguinal ligament. Posteriorly: Posteriorly: the superior ramus of the the superior ramus of the

pubis.pubis. Medially: Medially: the lacunar ligament.the lacunar ligament. Laterally: Laterally: the femoral vein.the femoral vein. The lower end of the canal is normally The lower end of the canal is normally

closed by the adherence of its closed by the adherence of its medial wall medial wall to the to the tunica adventitia tunica adventitia of the femoral of the femoral vein. It lies close to the saphenous opening vein. It lies close to the saphenous opening in the deep fascia of the thigh.in the deep fascia of the thigh.




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Lower Limb

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