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FASCIAL SKELETON
Deep fascia of the lower limb
Is well defined and forms a tough circumferential stockinglikestructure that contains the musculature.
Septa pass from the deep surface of the facial sheath to thebone within, confining the functional muscle groups withinosteofascial compartments
TOUGH FASCIA
Gives additional areas of attachment to the muscles andensures that they work to maxima effect
Thickening in the ensheating layer act as as additional
tendons example iliotibial tract Thickenings from fibrous retinacula where tendons cross
joints
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LOCATING THE SCIATIC NERVE
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Vertical line highest point of the iliac crest
Horizontal linemidway between the iliac crest
and ischial tuberosity
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FEMORAL TRIANGLE
- Depression formed in the anterior thigh Medial margin of adductor longus muscle
- Tendon can be palpated as a cord like structure that
attaches to bone immediately inferior to the pubictubercle
Medial margin of sartorius muscle
- Originates from the anterior superior iliac spine and
attach to the medial aspect of the tibia Inguinal ligament
- Originates from the anterior superior iliac spine andattach to the pubic tubercle
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Structures around the knee
Patella - prominent palpable feature at the knee
- the quadriceps femoris tendon attaches superiorly to it and the
patellar ligament connects the inferior surface of the patella to thetibial tuberosity
- DEEP TENDON REFLEX ( a tap on the patellar ligament tests reflex
activity mainly at spinal cord levels L3 and L4
Head of the fibula palpable protuberance on the lateral surface of the knee
inferior to the lateral condyle of the tibia. It can also be located following thetendon of the biceps femoris inferiorly.
Common fibular nervepasses around the lateral surface of the neck of the
fibula just inferior to the head and can often be felt as a cord-like structure in
this position.
Iliotibial tractflat tendinous structure, which attaches to the lateral tibial
condyle, is most prominent when the knee is fully extended. The anterior
edge of the tract raises a sharp vertical fold of skin posterior to the lateral
edge of the patella.
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POPLITEAL FOSSA
Diamond shaped depression formed between thehamstring and gastrocnemius muscle posterior to the knee
Border
Inferior border medial and lateral head of the
gastrocnemius muscle
Superior border
lateral biceps femoris muscle
medial (semimebranosus andsemitendinosus muscles)
*tendons of these muscles are palpable and often visible
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Contents (PPTC)
- Popliteal artery (deepest, upper medial side)
popliteal vein, tibial nerve and common
fibular nerve, posterior cutaneous nerve of
the thigh
* Small saphenous vein
penetrates deep part of the posteriorfascia in the upper leg and joins the popliteal vein
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TARSAL TUNNEL
- Medial side of the foot in the groove between the medialmalleolus and the heel (calcaneal tuberosity) and by theoverlying flexor retinaculum.
- Structures passes to the tarsal tunnel
from anteromedial to posterolateral (Tom Dick And AVery Nervous Harry)
Tibialis posterior, Flexor digitorum longus, posterior tibialartery and associated veins, tibial nerve flexorhallucis longus
*tendons pass in compartments formed by the septa of the
flexor retinaculum* The tibial artery is palpable just posteroinferior to the medialmalleolus on the anterior face of the visible groove betweenthe heel and the medial malleolus.
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Tibialis anterior tendonmedial side of the ankle anterior to the medial maleolus
Calcaneal tendon largest tendon entering the foot and is prominent on the posterior
aspect of the foot as it descends from the leg to the heel. A tap with a tendon hammer
of tendon. Test reflex activity of spinal cord levels S1 and S2.
Fibularis longus and fibularis brevis raise a linear fold of skin during eversion,
descends from the lower leg to the posterior edge of the lateral malleolus.
Fibularis brevis lateral surface of the foot descending obliquely to the base of
Metatarsal V. Fibularis tertius, extensor digitorum longus and extensor hallucis longusare visible on
the dorsal aspect of the foot from lateral to medial.
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MAJOR SUPERFICIAL VEINS
Begins as a dorsal venous arch in the foot
Medial arch curves superior and anteriorly as greatsaphenous vein then passes through an aperture in thefascia lata (saphenous ring) to join with the femoralvein in the femoral triangle. -internal iliac vein
Lateral arch passes through the posterior to the lateralmalleolus as the small saphenous vein passes throughthe deep fascia in the upper one third of the leg and
connects with the popliteal vein At the area of theadductor hiatus and then in the popliteal fossa.
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PLANTAR ARTERIAL ARCH
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lesser sciatic foramen
-obturator
Internal
Maximus iliotibial tract
- gluteal tuberosity