ﺍﳌﻌﻬﺪ ﺍﻟﻄﺒﻲ ﺍﻟﺘﻘﻨﻲ / ﺑﻐﺪﺍﺩ

ﻗﺴﻢ ﺍﻟﺘﺄﻫﻴﻞ ﺍﻟﻄﺒﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻄﺒﻴﻌﻲ

ﻓﺮﻉ ﺻﻨﺎﻋﺔ ﺍﻻﻃﺮﺍﻑ ﻭﺍﳌﺴﺎﻧﺪ

General introduction of Anatomy

2013 – 2014 Dr. ASHRAF Ali AL-ZUBAIDI

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 1

GENERAL INTRODUCTION

Anatomy: is the science of body structures and the relationships among Structures. At first the anatomy was studied by dissection, the carful cutting apart of body structures to study their relationships, Nowadays, many imaging of anatomical (ﺗﻘﺪم) to the advancement (ﺗﺴﺎھﻢ) techniques also contribute knowledge. The Anatomy is including many of fields, which is: It is the study of different : (اﻟﻔﺤﺺ اﻟﻌﯿﻨﻲ ) Macroscopic examination 1- structures , which make up the human body . It is the study of : (اﻟﻔﺤﺺ اﻟﻤﺠﮭﺮي ) Microscopic examination 2- seen (اﻟﻜﺎﺋﻦ اﻟﺤﻲ ) microscopic different structures of an organism only by use of a microscope . It is the study of different structures as : (اﻻﺟﮭﺰة اﻟﺠﺴﻤﯿﺔ) Systemic 3- : It comprises of the followings . (ﻛﻜﯿﺎﻧﺎت ﻓﺮدﯾﺔ) individual entities .The bony system \ ( ﻋﻠﻢ اﻟﻌﻈﺎم ) Osteology • . The articular system or joint \(ﻋﻠﻢ اﻟﻤﻔﺎﺻﻞ ) Syndesmology • . The muscular system \ (ﻋﻠﻢ الﻋﻀﻼت )Myology • , Comprising the heart , blood vessels \ (ﻋﻠﻢ اﻻوﻋﯿﺔ ) Angiology • ( اﻟﻌﻘﺪ اﻟﻠﻤﻔﺎوﯾﺔ)lymph nodes & (اﻻوﻋﯿﺔ اﻟﻠﻤﻔﺎوﯾﺔ) lymph vessels .The nervous system \(ﻋﻠﻢ اﻟﺠﮭﺎز اﻟﻌﺼﺒﻲ) Neurology • , ( اﻟﻨﻈﺎم اﻟﺤﺸﻮي ) The visceral system \ (ﻋﻠﻢ اﻻﺣﺸﺎء) Splanchnology • , (ﻧﻈﺎم اﻧﺒﻮﺑﻲ – ھﻀﻤﻲ ) comprising two tubular system – digestive . (اﻟﺠﮭﺎز اﻟﺘﻨﺎﺳﻠﻲ) and genital (اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ) urinary tract The study of form and marking of those :(اﻟﺘﺸﺮﯾﺢ اﻟﺴﻄﺤﻲ) Surface 4- structures by examination through skin. .It is the study of development before birth :(ﻋﻠﻢ اﻻﺟﻨﺔ) Embryology 5-

GLOSSARY OF ANATOMIC TERMINOLOGY

description of location (ﯾﺴﻤﺢ) Reference position of body permitting and movements:

1- Term of Anatomical position: • Head ………. Facing forward • Arms ………. Parallel to the trunk ( straight at the sides ) • Forearms and Hands …….Positioned so the palms face forward • Legs ……… straight • Feet ……….Parallel to each other

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 2

2- Term of Anatomical directions:

Direction means Anterior Toward the front ( located near the front of body ) Posterior Toward the back ( locations nearer the back ) Superior Toward the head ( meaning a higher position ) Inferior Away from the head ( meaning below ) Medial Toward the midline of the body Lateral Away from the midline of the body Proximal Toward the body ( means nearest the origin of a structure ) Distal Away from the body ( farthest from the origin a structure ) Superficial Towards surface of body Deep Inward from body surface

3- Term of Anatomical planes:

Plane Means Median plane Plane which divides the body into equal right and left portions Coronal plane Any plane which divides the body into anterior and posterior portions Transverse plane Any plane which divides the body into superior and inferior

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 3

4- Term of Anatomical movements :

No The movements means in a median plane (اﻟﺠﺰء)the segment (ﯾﺜﻨﻲ) Flexion Bending Flexor Any muscle which bends the segment in a median plane Bending the wrist so the palmar surface of the hand moves Palmar flexion toward the forearm 1 Plantar flexion Bending the ankle so the sole of the foot moves downward Bending the so the dorsal surface of the hand moves toward the Dorsi flexion forearm , bending the ankle so the dorsum of the foot moves upward Extension Straightening the segment in a median plane 2 Hyperextension Extending the segment beyond anatomic position

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 4

Moving the segment away from the body in a Coronal Abduction plane 3 Drawing the segment toward the body in a Coronal Adduction plane

Turning the segment inward along its long axis in a Median rotation transverse plane 4 Turning the segment outward along its long axis in a Lateral rotation transverse plan

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 5

Pronation of the Internal rotation of forearm so the palm faces more 5 backward (اﻟﻜﺐ ) forearm Depressing the first and second metatarsals and Pronation of the forefoot elevating the fourth and fifth metatarsals Pronation ( eversion )of the Turning the medial border of the foot downward so

entire foot the sole faces outward Supination of the external rotation of forearm so the palm faces more 6 forward (اﻟﺒﺴﻂ) forearm Elevating the first and second metatarsals and Supination of the forefoot depressing the fourth and fifth metatarsals Supination ( inversion )of Turning the medial border of the foot upward so the

the entire foot sole faces inward

Circular movement combining flexion , abduction , extension 7 Circumduction and adduction

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

ﻣﻌﻬﺪ ﺍﻟﻄﺐ ﺍﻟﺘﻘﻨﻲ / ﺑﻐﺪﺍﺩ ﻗﺴﻢ ﺍﻟﺘﺄﻫﻴﻞ ﺍﻟﻄﺒﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻄﺒﻴﻌﻲ ﻓﺮﻉ ﺻﻨﺎﻋﺔ ﺍﻻﻃﺮﺍﻑ ﻭﺍﳌﺴﺎﻧﺪ

Bones of the Lower Extremity

2013 - 2014 Dr. ASHRAF Ali AL-ZUBAIDI

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Bones of the Lower Extremity

Introduction in Skeleton system

The human skeleton consists of 206 named bones, most of which are paired on the right and left sides of the body. Bones are grouped in two principal and 126 bones of the (اﻟﮭﯿﻜﻞ اﻟﻤﺤﻮري) division the 80 bones of axial skeleton . (اﻟﮭﯿﻜﻞ اﻟﻤﺤﯿﻄﻲ)appendicular skeleton

Figure 1: Shows the axial and appendicular skeleton

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Classification of bone

According to shape According to regions According to According to structure ossification

Axial Appendicular Membrane Cartilage Membrane & bone bone cartilage bone Skull bone, Upper limb, vertebrae, rib, lower limb Bones of Bones of sternum Clavicle bone vault of skull vertebral column, limbs

Long Flat Short Irregular Sesamoid Accessory Pneumatic

Hummers Skull Carpal Vertebrae Patella Sutural Maxilla , femur bones, & tarsal bones sternum

Macroscopically Macroscopically

Compact Spongy Lamellar Fibrous Dentine Cement Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Bones of the Lower Extremity

A- Pelvic girdle : (Figure 1) Figure 2) they) (ﻋﻈﺎم اﻟﻮرك) The pelvic girdle consists of the two Hip bones (اﻻرﺗﻔﺎق اﻟﻌﺎﻧﻲ) united to each other interiorly at a joint called the Pubic symphsis .(اﻟﻤﻔﺼﻞ اﻟﺤﺮﻗﻔﻲ اﻟﻌﺠﺰي) and they unite posteriorly with Sacrum at Sacroiliac joint The function of the Pelvic is: - Provide a strong a stable support for the Vertebral column. - Connecting between the bones of Lower limbs and the Axial skeleton.

Figure 1:

Anterior view showing pelvic girdle

Figure 2: Lateral view showing portion of hip

bone

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Figure 3:

Lateral and medial view showing portion of hip bone

The Pelvic girdle consists of three fused components:

1- Ilium: The Ilium is the largest of the three components of the Hip bone, it divided body which enters into the formation (ﺳﻔﻠﻲ) and inferior (ﻋﻠﻮي) into a superior :and the Ilium consists ,(اﻟﺤﻖ) of the acetabulum . (ﻋﺮف اﻟﺤﺮﻗﻔﺔ)  Iliac crest . (اﻟﺨﻂ اﻻﻟﻮي اﻻﻣﺎﻣﻲ)  Anterior gluteal line (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻟﺨﻠﻔﯿﺔ اﻟﻌﻠﻮﯾﺔ)  Posterior superior iliac spine (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻟﺨﻠﻔﯿﺔ اﻟﺴﻔﻠﯿﺔ)  Posterior inferior iliac spine (اﻟﺤﻔﺮة اﻟﺤﺮﻗﻔﯿﺔ)  Iliac fossa (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻻﻣﺎﻣﯿﺔ اﻟﻌﻠﻮﯾﺔ)  Anterior superior iliac spine (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻻﻣﺎﻣﯿﺔ اﻟﺴﻔﻠﯿﺔ)  Anterior inferior iliac spine 2- Pubis: part of the Hip bone. It (ﺳﻔﻠﻲ) and inferior (اﻣﺎﻣﻲ) The pubis is the anterior and they (ﻓﺮع اﻟﻌﻈﻢ) ramus (ﺳﻔﻠﻲ) and inferior (ﻋﻠﻮي) consists of superior

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

of Pubic symphsis. And the Pubis (ﺗﺸﻜﯿﻞ) to the formation (ﺗﺴﮭﻢ) contributes consists: (ﻣﻤﺸﻂ اﻟﻌﺎﻧﺔ)  Pectin of Pubis (ﻋﺮف اﻟﻌﺎﻧﺔ)  Pubic crest (ﺣﺪﯾﺒﺔ اﻟﻌﺎﻧﺔ)  Pubic tubercle 3- Ischium: portion of the Hip bone. It is (ﺧﻠﻔﻲ) posterior ,(ﺳﻔﻠﻲ) The Ischium is the inferior ramus. And the (ﺳﻔﻠﻲ) body and inferior (ﻋﻠﻮي) of a superior (ﯾﺘﺄﻟﻒ) composed Ischium consists: (ﺷﻮﻛﺔ اﻟﻮرك)  Ischial spine (اﺣﺪوﺑﺔ اﻟﻮرك)  Ischial tuberosity (Figure 4) : (ﻋﻈﻢ اﻟﻔﺨﺬ ) B- Femur bone The Femur is the longest, heaviest and strongest bone in the body. Its (with the Hip bone (in acetabulum (ﯾﺮﺗﺒﻂ ﺑﻤﻔﺼﻞ) end articulates (اﻟﺪاﻧﻲ) proximal end articulates with the Tibia and Patella. The Femur (اﻟﻘﺎﺻﻲ) and in distal consists:

 The proximal end of the Femur: (رأس ﻋﻈﻢ اﻟﻔﺨﺬ)  Head of Femur (ﻋﻨﻖ ﻋﻈﻢ اﻟﻔﺨﺬ)  Neck of Femur (اﻟﻤﺪور اﻟﻜﺒﯿﺮ)  Greater trochanter (اﻟﻤﺪور اﻟﺼﻐﯿﺮ)  Lesser trochanter (اﻟﺨﻂ ﺑﯿﻦ اﻟﻤﺪورﯾﻦ)  Inter trochanter line (اﻟﻌﺮف ﺑﯿﻦ اﻟﻤﺪورﯾﻦ)  Inter trochanter crest

 Body of femur.  Linea Aspera (posterior view)

 The distal end of the Femur is components:  In anterior view: (اﻟﻠﻘﯿﻤﺔ اﻟﻮﺣﺸﯿﺔ) 1-Lateral epicondyle (اﻟﻠﻘﯿﻤﺔ اﻻﻧﺴﯿﺔ) Medial epicondyle 2-  In posterior view: (اﻟﻠﻘﻤﺔ اﻟﻮﺣﺸﯿﺔ) Lateral condyle 1- (اﻟﻠﻘﻤﺔ اﻻﻧﺴﯿﺔ) Medial condyle 2- (اﻟﺤﻔﺮة ﺑﯿﻦ اﻟﻠﻘﻤﺘﯿﻦ) 3-inter condylar fossa

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Figure 4:

Anterior and posterior view showing Femur bone

Figure 5:

Anterior view showing Patella

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

(Figure 5) : (ﻋﻈﻢ اﻟﺮﺿﻔﺔ ) C- Patella bone bone located anterior to the knee (ﻣﺜﻠﺚ اﻟﺸﻜﻞ) The Patella is a small, triangular joint. It is a sesamoid bone that develops in the tendon of the :it is consists ,(اﻟﻌﻀﻠﺔ اﻟﺮﺑﺎﻋﯿﺔ اﻟﻔﺨﺬﯾﺔ) Quadriceps femoris muscle (ﻗﻤﺔ)  Apex  Body (ﻗﺎﻋﺪة)  Base (Figure 6) : (ﻋﻈﻢ اﻟﻈﻨﺒﻮب ) D- Tibia bone

.of the leg (ﯾﺘﺤﻤﻞ اﻟﻮزن) The Tibia bone is the larger medial weight bearing The Tibia articulates at its proximal end with the Femur and Fibula, and at its distal end with the Fibula and talus bone. The Tibia bone consists:

 The proximal end of the Tibia: (اﻟﻠﻘﻤﺔ اﻟﻮﺣﺸﯿﺔ)  Lateral condyle (اﻟﻠﻘﻤﺔ اﻻﻧﺴﯿﺔ)  Medial condyle (اﺣﺪوﺑﺔ ﻋﻈﻢ اﻟﻈﻨﺒﻮب)  Tibia tuberosity

 Body of Tibia. (اﻟﺤﺎﻓﺔ اﻻﻣﺎﻣﯿﺔ)  Anterior border

 The distal end of the Tibia: (اﻟﻜﻌﺐ اﻻﻧﺴﻲ)  Medial malleolus

(Figure 6) : (ﻋﻈﻢ اﻟﺸﻈﯿﺔ ) E- Fibula bone The Fibula bone is the parallel and lateral to the Tibia but it is smaller than Tibia. The Fibula is articulates in the proximal end with the lateral condyle of Tibia and in the distal end articulates with Talus bone of Ankle. The Fibula bone consists:

 The proximal end of the Fibula: (رأس ﻋﻈﻢ اﻟﺸﻈﯿﺔ)  Head of Fibula

 Body of Fibula.

 The distal end of the Tibia: (اﻟﻜﻌﺐ اﻟﻮﺣﺸﻲ)  Lateral malleolus

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Figure 6:

Anterior and posterior view showing Tibia and Fibula bone

(Figure 7) : (ﻋﻈﺎم اﻟﻘﺪم ) F- Bones of the Foot The Foot bone consists: : (اﻟﺮﺳﻎ)  Tarsus The Tarsus is the proximal region of foot and consists of ( 7 ) tarsal bones and they include:  Posterior part of foot (ﻋﻈﻢ اﻟﻘﻌﺐ) Talus (ﻋﻈﻢ اﻟﻌﻘﺐ)  Calcaneus (ﻋﻈﻢ اﻟﻨﺮد)  Cuboid Anterior part of foot (اﻟﻌﻈﻢ اﻟﺰورﻗﻲ)  Navicular (اﻟﻌﻈﻢ اﻻﺳﻔﯿﻨﻲ اﻻﻧﺴﻲ) ( First cuneiform (medial (اﻟﻌﻈﻢ اﻻﺳﻔﯿﻨﻲ اﻟﻤﺘﻮﺳﻂ) ( Second cuneiform (inter mediate (اﻟﻌﻈﻢ اﻻﺳﻔﯿﻨﻲ اﻟﻮﺣﺸﻲ) ( Third cuneiform (lateral

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

: ( اﻻﻣﺸﺎط)  Metatarsus The Metatarsus is the intermediate regain of the foot and consists of ( 5 ) metatarsal bones numbered from I to V from the medial to lateral , each metatarsal consist :  proximal base  Shaft (body)  distal head

The base of metatarsal is articulate with distal row of Tarsal bones and the distal head articulate with proximal base of Phalanges.

: ( اﻟﺴﻼﻣﯿﺎت)  Phalanges The Phalanges are the distal component of the foot. The are numbered from ( I to V ) beginning with the great (اﺻﺎﺑﻊ اﻟﻘﺪم) Toes toe. Each Phalanges consist (proximal base, Shaft (body), distal head). The big toe has two Phalanges called proximal and distal Phalanges, the other four toes have three Phalanges – proximal, middle and distal.

Figure 7:

Superior and inferior view showing Foot

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

ﻣﻌﮭد اﻟطب اﻟﺗﻘﻧﻲ / ﺑﻐداد

ﻗﺳم اﻟﺗﺄھﯾل اﻟطﺑﻲ واﻟﻌﻼج اﻟطﺑﯾﻌﻲ

ﻓرع ﺻﻧﺎﻋﺔ اﻻطراف واﻟﻣﺳﺎﻧد

The joints of the body

2013 - 2014 Dr. ASHRAF Ali AL-ZUBAIDI

1 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

The joints of the body

Joint: Also called an articulation is a point of contact between two bones, or between bone and cartilage. The joint have two functions:

.(ﺑﺸﻜﻞ اﻣﻦ) They hold the bones together securely 1- . (ﻗﺎﺑﻠﯿﺔ اﻟﺤﺮﻛﺔ)But also give the rigid skeleton mobility 2-

Classify of joints

The joints are classified in two ways – functionally and structurally. The functional classification based on their amount of movement allowed by the joint, on this basis there are:

for example the joints in the (ﻣﻔﺎﺻﻞ ﺛﺎﺑﺘﺔ) (Immovable joints (Synarthroses axial skeleton for example the (ﻣﻔﺎﺻﻞ ﻣﺘﺤﺮﻛﺔ ﻗﻠﯿﻼ) (Slightly movable joints (Amphiarthroses joints in the axial skeleton for example the joints (ﻣﻔﺎﺻﻞ ﻣﺘﺤﺮﻛﺔ ﺑﺤﺮﯾﺔ)(Freely movable joints (Diarthroses in the upper and lower limb

But in the structurally classification there are:

where the bones in this joint are united together: (ﻣﻔﺎﺻﻞ ﻟﯿﻔﯿﺔ)  Fibrous joints by connective tissue fibers , the best examples of this type of joint are the Sutures of skull. where the bone ends in this joint are: (ﻣﻔﺎﺻﻞ ﻏﻀﺮوﻓﯿﺔ)  Cartilaginous joints connected by cartilage , the best examples of this type of joint that are slightly movable are the Pubic symphysis of pelvis . are those in which the articulating bone ends: (ﻣﻔﺎﺻﻞ زﻻﻟﯿﺔ)  Synovial joints by a joint cavity containing synovial fluid, they account (ﺗﻨﻔﺼﻞ) are separated for all joints of limbs. All synovial joints have four components : (ﻏﻀﺮوف ﻣﻔﺼﻠﻲ) A- Articular cartilage (اﻟﻤﺤﻔﻈﺔ اﻟﻠﯿﻔﯿﺔ) B- Fibrous articular capsule (ﺗﺠﻮﯾﻒ اﻟﻤﻔﺼﻞ) C- Joint cavity (اﻻرﺑﻄﺔ اﻟﺪاﻋﻤﺔ) D- Reinforcing ligaments

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

2 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

3 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 :joints (زﻟﯿﻠﻲ) The type of Synovial

: (اﻟﻤﻔﺎﺻﻞ اﻟﻤﺴﻄﺤﺔ) A- Planar joints

 Articulate: The articulating surfaces of bones in a Planar joint are articulate between flat borders of two bones.  Example: Intertarsal joints, Intercarpal joints. .movment (اﻻﻧﺰﻻق)  Movments: Gliding

: (اﻟﻤﻔﺎﺻﻞ اﻟﺒﻜﺮﯾﺔ ) B- Hinge joints

(ﻣﺤﺪب)  Articulate: In this joint the convex (ﻣﻘﻌﺮ) surface of one bone fits the concave surface of another bone.  Example: Knee joint, Elbow joint. movments in one (زاوﯾﺔ)  Movments: Angular diraction like a door that called flexion and extantion.

: (اﻟﻤﻔﺎﺻﻞ اﻟﺒﻜﺮﯾﺔ ) C- Pivot joints

 Articulate: In this joint the rounded surface of one bone articulate with another . (رﺑﺎط) bone by a ligament  Example: The joint between the Head of Radius and Radiual notch and Ulna.  Movments: Rotation movment in the Radioulnar joint, that enable the Palms to turn anteriorly (Pronation) and posteriorly (supination).

: (اﻟﻤﻔﺎﺻﻞ اﻟﻠﻘﻤﯿﺔ) D- Condyloid joints

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

4 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

shaped – (ﺑﯿﻀﻮي) oval (ﻣﺤﺪب)  Articulate: In this joint the convex of (ﻣﻨﺨﻔﺾ) of one bone fits into the oval – shaped depression (ﺑﺮوز) projection another bone.  Example: The joint between the Radius and Scaphoid and Lunte bones ( Carpal bones). ,(ﺗﻘﺮﯾﺐ)  Movments: Flexion, extention, adduction but no , (دوران) circumduction , (ﺗﺒﻌﯿﺪ) abduction axia rotation.

: (اﻟﻤﻔﺎﺻﻞ اﻟﺴﺮﺟﯿﺔ ) E- Saddle joints

 Articulate: In this joint the articulator surface of one bone is Saddle – shaped and the articulator surface of the other bone fits into.  Example: The joint between the Trapezium bone in Carple bones and Metacarpal of Thumb.  Movments: The movments at these joints are the same as in Condyloid joint.

: (اﻟﻤﻔﺎﺻﻞ اﻟﺒﻜﺮﯾﺔ ) F- Ball and socket joints

 Articulate: Consists of ball-like surface of one bone fitting into a cup-like depression of anther bone.  Example: Hip joint, Shoulder joint. (اﻟﻘﺎﺑﻠﯿﺔ)  Movments: At this joints are capable of different kinds of movment.

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014

اﻟﻣﻌﮭد اﻟطﺑﻲ اﻟﺗﻘﻧﻲ / ﺑﻐداد ﻗﺳم اﻟﺗﺄھﯾل اﻟطﺑﻲ واﻟﻌﻼج اﻟطﺑﯾﻌﻲ ﻓرع ﺻﻧﺎﻋﺔ اﻻطراف واﻟﻣﺳﺎﻧد

The general joints of the lower limb the body

2014 - 2013 Dr. ASHRAF Ali AL-ZUBAIDI

1 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 The General joints of the lower limb

Hip joint:

 Definition: Its ball and socket joint formed by the head of the Femur and the acetabulum of the hip bone.

 Anatomical components:

very dense :(اﻟﻤﺤﻔﻈﺔ اﻟﻤﻔﺼﻠﯿﺔ) Articular capsule 1- and strong capsule that extends from (ﻛﺜﯿﻔﺔ ﺟﺪا) of the acetabulum to the neck of (ﺣﺎﻓﺔ) the rim the femur.

It’s a :(اﻟﺮﺑﺎط اﻟﺤﺮﻗﻔﻲ اﻟﻔﺨﺬي) Ilio-femoral ligament 2- ligament extend from the anterior inferior iliac spine of the hip bone to the intertrochanteric line of the femur

It’s a :(اﻟﺮﺑﺎط اﻟﻌﺎﻧﻲ اﻟﻔﺨﺬي) Pubo-femoral ligament 3- ligament extends from the pubic part of the rim of the acetabulum to the neck of the femur.

It’s a : (اﻟﺮﺑﺎط اﻟﻮرﻛﻲ اﻟﻔﺨﺬي) Ischio-femoral ligament 4- ligament extend from the ischial pubic part of the rim of the acetabulum to the neck of the femur.

it's a : (رﺑﺎط رأس اﻟﻔﺨﺬ)Ligament of the head of femur 5- that extends from the (رﺑﺎط ﻣﺜﻠﺜﻲ) triangular band fossa of the acetabulum to the head of the femur.

fibro-cartilage : (اﻟﺮﺑﺎط اﻟﺤﻘﻲ) Acetabular labrum 6- to the margin of the (ﺗﺮﺑﻂ) rim attached (رﺑﺎط ﻟﯿﻔﻲ) the (زﯾﺎدة) that enhances(ﺣﺎﻓﺔ اﻟﺤﻖ) acetabulum depth of the acetabulum.

(اﻟﺮﺑﺎط اﻟﺤﻘﻲ Transverse ligament of the acetabulum 7- strong ligament , it supports part of : اﻟﻤﺴﺘﻌﺮض) the acetabular labrum and is connected with the ligament of the head of the femur and the articular capsule.  Movements: Flexion, extension, abduction, adduction, circumduction, medial rotation, and lateral rotation of thigh.

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 2 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Knee joint:

 Definition: It’s the largest and most complex joint of the body; it's consisting of three joints within a single synovial cavity:

A- An intermediate patella-femoral joint. B- A lateral tibia-femoral joint. C- A medial tibia-femoral joint.  Anatomical components:

independent :(اﻟﻤﺤﻔﻈﺔ اﻟﻤﻔﺼﻠﯿﺔ) Articular capsule 1- capsule unites the bones, and there are a ligament surrounding the joint consists mostly (اﻟﻐﻤﺪ) sheath of muscle tendons.

(اﻟﻘﯿﺪ اﻟﺮﺿﻔﻲ Medial & lateral patellar retinaculam 2- tendons of the (ﻣﻨﺪﻣﺠﺔ) fused : اﻻﻧﺴﻲ واﻟﻮﺣﺸﻲ) that (اﻟﻌﻀﻠﺔ اﻟﺮﺑﺎﻋﯿﺔ اﻟﻔﺨﺬﯾﺔ) quadriceps femoris strengthen the anterior surface of the joint.

continuation :(اﻟﺮﺑﺎط اﻟﺮﺿﻔﻲ) Patellar ligament 3- of the common tendon of the quadriceps (اﻻﺳﺘﻤﺮار) femoris muscle that extends from the patella to the tibial tuberosity.

(اﻟﺮﺑﺎط اﻟﻤﺄﺑﻀﻲ Oblique popliteal ligament pos 4- flat ligament extends from the :اﻟﻤﺎﺋﻞ) intercondylar fossa of the femur to the head of tibia.

: (اﻟﺮﺑﺎط اﻟﻘﻮﺳﻲ اﻟﻤﺄﺑﻀﻲ) Arcuate popliteal ligament 5- extends from the lateral condyle of the femur to the head of fibula.

flat : (اﻟﺮﺑﺎط اﻟﺠﺎﻧﺒﻲ اﻟﻈﻨﺒﻮﺑﻲ) Tibial collateral ligament 6- ligament on the medial surface of the joint that extends from the medial condyle of the femur to the medial condyle of tibia.

: (اﻟﺮﺑﺎط اﻟﺠﺎﻧﺒﻲ اﻟﺸﻈﻮي) Fibular collateral ligament 7- rounded ligament on the lateral surface of the joint that extends from the lateral condyle of the femur to the head of fibula.

: (اﻻرﺑﻄﺔ اﻟﺪاﺧﻠﯿﺔ ﻟﻠﻤﺤﻔﻈﺔ) Interacapsular ligament 8- ligaments within the capsule that connect the tibia and femur:

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 3 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 : (اﻟﺮﺑﺎط اﻟﻤﺘﺼﺎﻟﺐ اﻻﻣﺎﻣﻲ) Anterior cruciate ligament extends posteriorly and laterally from the anterior part of head of tibia to the posterior medial surface of the lateral condyle of the femur.

: (اﻟﺮﺑﺎط اﻟﻤﺘﺼﺎﻟﺐ اﻟﺨﻠﻔﻲ) Posterior cruciate ligament extends anteriorly and medially from the posterior part of head of tibia to the anterior medial surface of the medial condyle of the femur.

two: (اﻻﻗﺮاص اﻟﺘﻤﻔﺼﻠﯿﺔ) Articular discs 9- fibrocartilage discs between the tibia and femoral condyles :

 Medial meniscus: semicircular piece of fibrocartilage(C-shaped).  Lateral meniscus: nearly circular piece of fibrocartilage(an incomplete 0-shaped).  Movements: Flexion, extension, medial rotation, and lateral rotation of leg. Ankle joint:

 Definition: The ankle joint is between :

1- Distal end of tibia and its medial malleolus and talus. 2- And between lateral malleolus of fibula and talus.  Anatomical components:

. (اﻟﺮﺑﺎط اﻟﻀﻨﺒﻮﺑﻲ اﻟﻌﻘﺒﻲ)Talocalcaneal ligament 1-

. (اﻟﺮﺑﻂ اﻟﺪاﻟﻲ اﻻﻧﺴﻲ)Deltoid ligament 2-

. (اﻟﺮﺑﺎط اﻟﻈﻨﺒﻮﺑﻲ اﻟﺸﻈﻮي اﻻﻣﺎﻣﻲ)Anterior talofibular ligament 3-

. (اﻟﺮﺑﺎط اﻟﻈﻨﺒﻮﺑﻲ اﻟﺸﻈﻮي اﻟﺨﻠﻔﻲ)Posterior talofibular ligament 4-

. (اﻟﺮﺑﺎط اﻟﻌﻘﺒﻲ اﻟﺸﻈﻮي)Calcaneofibilar ligament 5-

. (اﻟﺮﺑﺎط اﻟﻈﻨﺒﻮﺑﻲ اﻟﺰورﻗﻲ) Talonavicular ligament 6-  Movements: dorsiflexion an plantar flexion of foot

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Institute of Medical Technology / Baghdad Department of Medical Rehabilitation and Physical Therapy Branch of Manufacturing Prosthesis and Orthotic

Muscles of the Lower limb

Introduction, General location, Origen, insertion, action

2013 - 2014 Dr. ASHRAF Ali AL-ZUBAIDI

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 1

The muscular system Its system provides for movement of the body and its parts, maintains posture generates heat, and stabilizes joints. The muscle tissue has many functions: 1- Producing body movements (total body movements). .(stabilize joints (اﻻﻧﻘﺒﺎض) body positions (skeletal muscle contractions (اﺳﺘﻘﺮار) Stabilizing 2- contractions of ring-like bands of smooth (اﻟﺜﺎﺑﺖ) organ volume (sustained (ﺗﻨﻈﻢ) Regulating 3- muscles of Bladder may prevent outflow of contents of a hollow organ). within the body (cardiac muscle contractions pump blood through (ﻣﻮاد) Moving substances 4- .( (اﻻوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ)the body’s blood vessels 5- Producing heat (as muscle tissue contracts). and they are differ ,(ﺧﺼﺎﺋﺺ)There are three Types of muscle tissue that share some properties from one another in their microscopic anatomy, location and control by nervous and endocrine :(اﻟﻐﺪد اﻟﺼﻤﺎء)systems 1- Cardiac muscle tissue (only the heart contains) which forms most of the heart wall. Cardiac .(ﻻارادﯾﺔ) but its action is involuntary (ﻋﻀﻠﺔ ﻣﺨﻄﻄﺔ) muscle is also striated 2- Smooth muscle tissue: is located in the walls of hollow internal structures, such as blood vessels and most organs in the abdominoplvic. It is also found in the skin, attached to hair The action .(ﻋﻀﻠﺔ ﻣﻠﺴﺎء) Under a microscope, this tissue looks non-striated . (ﺟﺮﯾﺐ اﻟﺸﻌﺮ)follicles .(ﻻارادﯾﺔ) of smooth muscle is usually involuntary 3- Skeletal muscle tissue: is so-named because the function of most skeletal muscles is to move bones of the skeleton, its termed striated because alternating light and dark bands are visible when the tissue is examined under a microscopic, and this tissue works primarily in a . (ارادﯾﺔ اﻻﺳﻠﻮب)voluntary manner

Skeletal muscle (voluntary muscle) The human body contains more than 650 individual muscles anchored to the skeleton, which provide pulling power so that you can move around. These muscles constitute about 40% of your total body weight. The muscle's points of attachment to bones or other muscles are designated as origin or insertion. The point of origin is the point of attachment to the bone to which the muscle is anchored. The point of insertion is the point of attachment to the bone the muscle moves. Generally, the muscles are attached by tough fibrous structures called tendons. These attachments bridge one or more joints and the result of muscle contraction is movement of these joints. The body is moved primarily by muscle groups, not by individual muscles. These groups of muscles power all actions ranging from the threading of a needle to the lifting of heavy weights.

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 2

Muscles of the Lower limb (General location, origin, insertion, action) The muscles that move the Femur (Thigh) A- Anterior femoral muscles:

:(Figure 1) (اﻟﻌﻀﻠﺔ اﻟﺨﯿﺎطﯿﺔ)  Sartorius muscle (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻟﻌﻠﻮﯾﺔ اﻻﻣﺎﻣﯿﺔ) Origin: Anterior superior Iliac spine - - Insertion: Proximal part of medial surface of body of Tibia thigh at Hip (ﺗﻘﺮﯾﺐ) adducts (دوران وﺣﺸﻲ) Action: Flexes laterally rotates - joint, flexes leg at Knee joint

Its consists: Figure 1 : (اﻟﻌﻀﻠﺔ اﻟﺮﺑﺎﻋﯿﺔ اﻟﻔﺨﺬﯾﺔ)  Quadriceps femoris muscle :(Figure 2) (اﻟﻌﻀﻠﺔ اﻟﻤﺴﺘﻘﯿﻤﺔ اﻟﻔﺨﺬﯾﺔ)  Rectus femoris

Figure 2 (اﻟﺸﻮﻛﺔ اﻟﺤﺮﻗﻔﯿﺔ اﻟﺴﻔﻠﻰ اﻻﻣﺎﻣﯿﺔ) Origin: Anterior inferior Iliac spine -

(ﻗﺎﻋﺪة اﻟﺮﺿﻔﺔ) Insertion: Patella base - - Action: Flexes Hip joint, extend Knee joint :(Figure 2) (اﻟﻌﻀﻠﺔ اﻟﻤﺘﺴﻌﺔ اﻻﻧﺴﯿﺔ)  Vastus medialis medial lip of line ,(اﻟﺨﻂ ﺑﯿﻦ اﻟﻤﺪورﯾﻦ) Origin: Intertrochanteric line - (اﻟﺸﻔﺔ اﻻﻧﺴﯿﺔ ﻟﻠﺨﻂ اﻟﺨﺸﻦ) aspera common tendon of Quadriceps) (ﻗﺎﻋﺪة اﻟﺮﺿﻔﺔ) Insertion: Patella base - femoris muscle), anterior border of Tibia - Action: extend leg at Knee joint :(Figure 2) (اﻟﻌﻀﻠﺔ اﻟﻤﺘﺴﻌﺔ اﻟﻮﺣﺸﯿﺔ)  Vastus lateralis (اﻟﺴﻔﻠﯿﺔ) anterior and inferior ,(اﻟﺨﻂ ﺑﯿﻦ اﻟﻤﺪورﯾﻦ) Origin: Intertrochanteric line - (اﻟﻤﺪور اﻟﻜﺒﯿﺮ) border of Greater trochnter common tendon of Quadriceps femoris) (ﻗﺎﻋﺪة اﻟﺮﺿﻔﺔ) Insertion: Patella base - muscle), anterior border of Tibia - Action: extend leg at Knee joint Figure 3): Figure 3) (اﻟﻌﻀﻠﺔ اﻟﻤﺘﺴﻌﺔ اﻟﻤﺘﻮﺳﻄﺔ)  Vastus inter-medius

of the body of the Femur (ﺳﻄﺢ) Origin: Anterior and lateral surfaces - common tendon of Quadriceps) (ﻗﺎﻋﺪة اﻟﺮﺿﻔﺔ) Insertion: Patella base - femoris muscle) , anterior border of Tibia - Action: extend leg at Knee joint

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 3

:(ﻋﻀﻼت اﻟﻨﺎﺣﯿﺔ اﻟﺤﺮﻗﻔﯿﺔ)  muscles of the Iliac region :(Figure 4) (اﻟﻌﻀﻠﺔ اﻟﺤﺮﻗﻔﯿﺔ)  Iliacuc muscle (اﻟﻔﺮة اﻟﺤﺮﻗﻔﯿﺔ) Origin: Iliac fossa - (اﻟﻤﺪور اﻟﺼﻐﯿﺮ) Insertion: lesser trochanter - of thigh at Hip joint (دوران وﺣﺸﻲ) Action: Flexes laterally rotates - :(Figure 4) (اﻟﻌﻀﻠﺔ اﻟﻘﻄﻨﯿﺔ)  psoas major muscle th st th - Origin: Lateral surfaces of 12 Thoracic and 1 to 4 Lumbar vertebrae Figure 4 (اﻟﻤﺪور اﻟﺼﻐﯿﺮ) Insertion: lesser trochanter -

of thigh at Hip joint (دوران وﺣﺸﻲ) Action: Flexes laterally rotates -

B- Medial femoral muscles:

:(اﻟﻌﻀﻠﺔ اﻟﻤﺸﻄﯿﺔ)  Pectineus muscle (ﻣﻤﺸﻂ اﻟﻌﺎﻧﺔ / اﻟﺤﺎﻓﺔ اﻟﻌﻠﯿﺎ ﻟﺠﺴﻢ اﻟﻌﺎﻧﺔ) Origin: Pectin pubis - (اﻟﺨﻂ اﻟﻤﺸﻄﻲ / ﺗﺤﺖ اﻟﻤﺪور اﻟﺼﻐﯿﺮ) Insertion: Pectineal line - - Action: Flexes and rotates the thigh laterally at the Hip joint Figure 5): Figure 5) (اﻟﻌﻀﻠﺔ اﻟﻤﻘﺮﺑﺔ اﻟﻄﻮﯾﻠﺔ)  Adductor longus muscle - Origin: Anterior pubis (pubic crest and Symphysis pubis) medial lip (اﻟﺨﻂ اﻟﺨﺸﻦ) of linea aspera (اﻟﺜﻠﺚ اﻟﻮﺳﻂ) Insertion: Middle third - - Action: Adducts and flexes the thigh, and laterally rotate the hip joint :(Figure 5) (اﻟﻌﻀﻠﺔ اﻟﻤﻘﺮﺑﺔ اﻟﻘﺼﯿﺮة)  Adductor brevis muscle of pubis (اﻟﻔﺮع اﻟﺴﻔﻠﻲ) Origin: Inferior Ramus - medial lip (اﻟﺨﻂ اﻟﺨﺸﻦ) of linea aspera (اﻟﺜﻠﺚ اﻟﻘﺮﯾﺐ) Insertion: Proximal third - - Action: Adducts and flexes the thigh, and laterally rotate the thigh :(Figure 6) (اﻟﻌﻀﻠﺔ اﻟﻤﻘﺮﺑﺔ اﻟﻜﺒﯿﺮة)  Adductor magnus muscle Figure 5 - Origin: Inferior Ramus of Pubis and Ischium

- Insertion: Linea aspera of Femur and medial Condyle of Femur - Action: Extend, adducts and laterally rotates thigh at the Hip joint :(Figure 7) (اﻟﻌﻀﻠﺔ اﻟﻨﺎﺣﻠﺔ)  Cracilis muscle - Origin: Pubic symphysis and pubic crest - Insertion: Proximal part of medial surface of body of Tibia - Action: adducts and medially rotates thigh at the Hip joint and flexes leg at Knee joint

Figure 6

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 4

C- Muscles of Cluteal region :

Figure 8): Figure 7) (اﻟﻌﻀﻠﺔ اﻻﻟﻮﯾﺔ اﻟﻌﻈﻤﻰ)  Gluteus maximus muscle and Scram and (اﻟﺨﻂ اﻻﻟﻮي اﻟﺨﻠﻔﻲ ﻟﻠﺤﺮﻗﻔﺔ) Origin: Posterior Gluteal line of Ilium - coccyx. medial lip (اﻟﺨﻂ اﻟﺨﺸﻦ) Insertion: Gluteal Proximal third of linea aspera - - Action: Extend, adducts the thigh medially lateral rotation at the Hip joint :(Figure 9) (اﻟﻌﻀﻠﺔ اﻻﻟﻮﯾﺔ اﻟﻮﺳﻄﻰ)  Gluteus medius muscle Figure 8 (اﻟﺴﻄﺢ اﻟﺨﺎرﺟﻲ ﻟﻠﺤﺮﻗﻔﺔ) Origin: Outer surface of Ilium - - Insertion: Greater trochanter of Femur the thigh and medially rotation at the Hip joint (ﺗﺒﻌﯿﺪ) Action: Flexes, Abducts - :(Figure 9) (اﻟﻌﻀﻠﺔ اﻻﻟﻮﯾﺔ اﻟﺼﻐﯿﺮة)  Gluteus minimus muscle (اﻟﺴﻄﺢ اﻟﺨﺎرﺟﻲ ﻟﻠﺤﺮﻗﻔﺔ) Origin: Outer surface of Ilium - - Insertion: Greater trochanter of Femur the thigh medially rotation at the Hip joint (ﺗﺒﻌﯿﺪ) Action: Flexes, Abducts - :(Figure 10) (اﻟﻌﻀﻠﺔ اﻟﻜﻤﺜﺮﯾﺔ)  Piriformis muscle (اﻟﺠﮭﺔ اﻻﻣﺎﻣﯿﺔ ﻟﻠﻌﺠﺰ) Origin: Anterior surface of Sacrum - - Insertion: Superior border of Greater trochanter of Femur Figure 9 the thigh at the Hip joint (ﺗﺒﻌﯿﺪ) Action: Laterally rotates and Abducts - :(اﻟﻌﻀﻠﺔ اﻟﺘﻮأﻣﯿﺔاﻟﻌﻠﯿﺎ)  Superior gemellus muscle (ﺷﻮﻛﺔ اﻟﻮرك) Origin: Ischial spine - - Insertion: Superior border of Greater trochanter of Femur the thigh at the Hip joint (ﺗﺒﻌﯿﺪ) Action: Laterally rotates and abducts - Figure 9 : (اﻟﻌﻀﻠﺔ اﻟﺘﻮأﻣﯿﺔ اﻟﺴﻔﻠﻰ)  Inferior gemellus muscle in body of Ischial (اﺣﺪوﺑﺔ اﻟﻮرك) Origin: Ischial tuberosity - - Insertion: Greater trochanter of Femur the thigh at the Hip joint Figure 10 (ﺗﺒﻌﯿﺪ) Action: Laterally rotates and abducts -

Figure 11 D- Posterior femoral Muscles : :(Figure 11) (اﻟﻌﻀﻠﺔ ذات اﻟﺮأﺳﯿﻦ اﻟﻔﺨﺬﯾﺔ)  Biceps femoris muscle - Origin: Long head – Ischial tuberosity, short head lateral lip of linea aspera of Femur - Insertion: Head of Fibula and leteral Condyle of Tibia - Action: Flexes leg at Knee joint and extends thigh at Hip joint

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 5

Figure 12): Figure 12) (اﻟﻌﻀﻠﺔ اﻟﻨﺼﻒ وﺗﺮﯾﺔ)  Semitendinosus muscle

- Origin: Ischial tuberosity - Insertion: Proximal part of medial surface of body of Tibia - Action: Flexes leg at Knee joint and extends thigh at Hip joint :(Figure 12) (اﻟﻌﻀﻠﺔ اﻟﻨﺼﻒ ﻏﺸﺎﺋﯿﺔ)  Semimembranosus muscle - Origin: Ischial tuberosity - Insertion: Medial condyle of Tibia - Action: Flexes leg at Knee joint and extends thigh at Hip joint

The muscles that move the Leg & Foot Figure 13 A- Anterior Leg muscles :

:(Figure 13) (اﻟﻌﻀﻠﺔ الظﻨﺒﻮﺑﯿﺔ اﻻﻣﺎﻣﯿﺔ)  Tibialis anterior muscle - Origin: Lateral condyle and body of Tibia - Insertion: Base of 1st Metatarsal bone and 1st Cuneiform. foot at (اﻧﻘﻼب ﻟﻠﺪاﺧﻞ) Action: Dorsiflexes foot at Ankle joint and inverts - intertarsal joint. :(Figure 13) (اﻟﻌﻀﻠﺔ الﺷﻈﻮﯾﺔ اﻟﺜﺎﻟﺜﺔ)  Peroneus tertuius muscle - Origin: Medial surface of Fibula. - Insertion: Base of 5th Metatarsal bone. foot (اﻧﻘﻼب ﻟﻠﺨﺎرج) Action: Dorsiflexes foot at Ankle joint, abduct and eversion - at intertarsal joint. :(Figure 14) (اﻟﻌﻀﻠﺔ ﺑﺎﺳﻄﺔ اﻻﺑﮭﺎم اﻟﻄﻮﯾﻠﺔ)  Extensor hallucis longus muscle Figure 14 - Origin: Medial surface of Fibula.

- Insertion: Distal phalanx of great toe. - Action: Dorsiflexes foot at Ankle joint and extends proximal Phalanx of great toe. :(Figure 14) (اﻟﻌﻀﻠﺔ ﺑﺎﺳﻄﺔ اﻻﺻﺎﺑﻊ اﻟﻄﻮﯾﻠﺔ)  Extensor digitorum longus muscle - Origin: Lateral condyle and body of Tibia. - Insertion: Middle and distal phalanges of toes 2-5. - Action: Dorsiflexes foot at Ankle joint and extends distal and middle Phalanx of toes 2-5.

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B- Posterior Leg muscles :

:(Figure 15) (اﻟﻌﻀﻠﺔ ﺛﻼﺛﯿﺔ اﻟﺮؤوس اﻟﺴﺎﻗﯿﺔ)  Triceps surae muscle Figure 15

:(Figure 15) (الﻋﻀﻠﺔ اﻟﺴﺎﻗﯿﺔ)  Gastrocnemius muscle - Origin: Lateral & medial epicondyle of Femur. - Insertion: Calcaneus bone (Achilles tendon). - Action: Plantar flexes foot at Ankle joint and flexes Leg at Knee joint. :(Figure 15) (الﻋﻀﻠﺔ اﻟﻨﻌﻠﯿﺔ)  Soleus muscle - Origin: Head of Fibula and medial border of Tibia. - Insertion: Calcaneus bone (Achilles tendon). Figure 16 - Action: Plantar flexes foot at Ankle joint. :(Deep m.) (Figure 15)(الﻋﻀﻠﺔ اﻻﺧﻤﺼﯿﺔ)  Plantaris muscle - Origin: Superior border of lateral epicondyle of Femur. - Insertion: Calcaneus bone (Achilles tendon). - Action: Plantar flexes foot at Ankle joint and flexes Leg at Knee joint. :(Deep m.)(Figure 16) (اﻟﻌﻀﻠﺔ اﻟﻤﺄﺑﻀﯿﺔ)  Popliteus muscle - Origin: Lateral epicondyle of Femur. - Insertion: Posterior proximal surface of Tibia. - Action: Flexes Leg at Knee joint and medially rotates Leg. Figure 17): Figure 17)(اﻟﻌﻀﻠﺔ اﻟﻈﻨﺒﻮﺑﯿﺔ اﻟﺨﻠﻔﯿﺔ)  Tibialis posterior muscle

- Origin: Posterior surface of body of Tibia. - Insertion: (2,3,4 Metatarsal), (Navicular),(1,2,3 Cuneiforms) and (Cuboid). (اﻧﻘﻼب ﻟﻠﺪاﺧﻞ) Action: Plantar flexes foot at Ankle joint, adducts and inversion - foot at intertarsal joint. :(Figure 18) (اﻟﻌﻀﻠﺔ ﻣﺜﻨﯿﺔ اﻻﺑﮭﺎم اﻟﻄﻮﯾﻠﺔ)  Flexor hallucis longus muscle - Origin: Posterior surface of body of Fibula. - Insertion: Distal phalanx of great toe. - Action: Plantar flexes foot at Ankle joint and flexes distal Phalanx of great toe. :(Figure 18) (اﻟﻌﻀﻠﺔ ﻣﺜﻨﯿﺔ اﻻﺻﺎﺑﻊ اﻟﻄﻮﯾﻠﺔ)  Flexor digitorum longus muscle - Origin: Posterior surface of body of Tibia. - Insertion: Distal phalanges of toes 2-5.

- Action: Plantar flexes foot at Ankle joint and flexes distal, middle and Figure 18 proximal Phalanges of toes 2-5.

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C- Lateral Leg muscles :

:(Figure 19) (اﻟﻌﻀﻠﺔ اﻟﺸﻈﻮﯾﺔ اﻟﻄﻮﯾﻠﺔ)  Peroneus longus muscle - Origin: Head and body of Fibula. - Insertion: 1st Metatarsal and 1st Cuneiform. .the Foot (اﻧﻘﻼب ﻟﻠﺨﺎرج) Action: Plantar flexes foot at Ankle joint and eversion -

:(Figure 19) (اﻟﻌﻀﻠﺔ اﻟﺸﻈﻮﯾﺔ اﻟﻘﺼﯿﺮة)  Peroneus brevis muscle - Origin: Body of Fibula. Figure 19 - Insertion: Base of 5th Metatarsal.. .the Foot (اﻧﻘﻼب ﻟﻠﺨﺎرج) Action: Plantar flexes foot at Ankle joint and eversion - Figure 20

Dr. ASHRAF Ali AL-ZUBAIDI 2013-2014 ﻣﻌﮭﺪ اﻟﻄﺐ اﻟﺘﻘﻨﻲ / ﺑﻐﺪاد ﻗﺴﻢ اﻟﺘﺄھﯿﻞ اﻟﻄﺒﻲ واﻟﻌﻼج اﻟﻄﺒﯿﻌﻲ ﻓﺮع ﺻﻨﺎﻋﺔ اﻻطﺮاف واﻟﻤﺴﺎﻧﺪ

Motor Nerves of Lower limb

2014 - 2013 Dr. ASHRAF ALI AL-ZUBAIDY

DR.ASHRAF ALI AL-ZUBAIDY2013-2014

Motor Nerves of Lower limb

The motor Nerves of Lower limb consists of

:(اﻟﻈﻔﯿﺮة اﻟﻘﻄﻨﯿﺔ)  Lumbar plexus (of spinal (L1 – L4 (ﺟﺬر اﻟﻌﺼﺐ اﻟﺤﺮﻛﻲ اﻻﻣﺎﻣﻲ) It’s the anterior ventral (اﻟﻈﻔﯿﺮة اﻟﻌﻀﺪﯾﺔ) from the lumbar plexus. It differs from the brachial plexus On . (اﺧﺘﻼط ﻣﻌﻘﺪ ﻟﻼﻟﯿﺎف)in that there is no intricate intermingling of Fibers of first four lumbar vertebrae, the lumbar plexus (ﻋﻠﻰ ﺟﺎﻧﺒﻲ) either side posterior to the , (ﺗﻌﺒﺮﺧﺎرﺟﯿﺎ ﺑﺼﻮرة ﻏﯿﺮ ﻣﺒﺎﺷﺮة) passes obliquely outward muscle and interior to the quadrates (اﻟﻌﻀﻠﺔ اﻟﻘﻄﻨﯿﺔ اﻟﻜﺒﺮى) psoas major . (اﻟﻌﻀﻠﺔ اﻟﺮﺑﺎﻋﯿﺔ اﻟﺆوس اﻟﻘﻄﻨﯿﺔ)lumborum muscle The lumber plexus supplies the anterolateral abdominal wall, external genitals, and part of the lower limbs. And its consist of 6 Nerves that it : Nerve Origin Distribution (اﻟﺘﻮزﯾﻊ) (اﻟﻤﻨﺸﻲء) (اﻟﻌﺼﺐ) Iliohypogastric Supplies Muscles of anterior lateral nerve (L1) (ﺟﺪار اﻟﺒﻄﻦ) abdominal wall (اﻟﻌﺼﺐ اﻟﺤﺮﻗﻔﻲ اﻟﺨﺜﻠﻲ) Ilioinguinal nerve Supplies Muscles of anterior lateral (L1) abdominal wall (اﻟﻌﺼﺐ اﻟﺤﺮﻗﻔﻲ اﻻرﺑﻲ) Genitofermoral Supplies Skin over middle anterior nerve (L1- L2) surface of thigh (اﻟﻌﺼﺐ اﻟﺘﻨﺎﺳﻠﻲ اﻟﻔﺨﺬي) Lateral femoral Supplies Shin over lateral , anterior (واﺟﮭﺔ) cutaneous nerve (L2- L3) and posterior aspects of Thigh (اﻟﻌﺼﺐ اﻟﺠﻠﺪي اﻟﻔﺨﺬي اﻟﺠﺎﻧﺒﻲ) Femoral nerve Supplies anterior thigh muscles , (L2 - L4) Hip and knee joint (اﻟﻌﺼﺐ اﻟﻔﺨﺬي) Adductor muscles of Obturator nerve Thigh(Adductor (L2 – L4) longus,brevis,magnus and (اﻟﻌﺼﺐ اﻟﺴﺪادي) pectineus)

DR.ASHRAF ALI AL-ZUBAIDY2012-2013 DR.ASHRAF ALI AL-ZUBAIDY2013-2014

FIGURE 1 :

The Lumbar plexus

:(اﻟﻈﻔﯿﺮة اﻟﻌﺠﺰﯾﺔ)  Sacral plexus The anterior ventral of spinal ( L4 – L5 ) and ( S1 – S4 ) from the anterior to the Sacrum. The sacral plexus (واﻗﻌﺔ) Sacral plexus .its situated supplies the Buttocks and Lower limb. The largest nerve in the body is the Sciatic nerve that arises from the Sacral plexus, the Sacral plexus consist of 11 Nerves that it :

Nerve Origin Distribution (اﻟﺘﻮزﯾﻊ) (اﻟﻤﻨﺸﻲء) (اﻟﻌﺼﺐ) Actually two nerve ( Tibial and into(ﺗﻨﻘﺴﻢ) common peroneal , its splits its two divisions , usually at the knee. (ﯾﻨﺤﺪر)As Sciatic nerve descends Sciatic nerve (L4 – S3) through the thigh, it sends branches (اﻟﻌﺼﺐ اﻟﻮرﻛﻲ) to Hamstring muscle and(ﻓﺮوع ﺟﺎﻧﺒﯿﺔ) adductor magnus

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Supplies Gastrocnemius, Soleus , Popliteus , Tibialis posterior , Flexor A-Tibial nerve digitorum longus and Flexor hallucis : longus muscles and its divides into (اﻟﻌﺼﺐ اﻟﻘﺼﺒﻲ)  Medial plantar  Lateral plantar (L4 – S3)  Medial plantar Abductor hallucis , Flexor digitorum nerve brevis an Flexor hallucis brevis .muscles (اﻟﻌﺼﺐ اﻻﺧﻤﺼﻲ اﻟﻤﺘﻮﺳﻂ)  Lateral plantar Remaining muscles of foot that not nerve su8pplied by Medial planter nerve (اﻟﻌﺼﺐ اﻻﺧﻤﺼﻲ اﻟﻮﺣﺸﻲ)

Divides into B-Common fibular  Superficial fibular nerve  Deep fibular nerve (اﻟﻌﺼﺐ اﻟﺸﻈﻮي اﻟﻤﺸﺘﺮك)

 Superficial (L4- S2) Supplies peroneus longus an Peroneus fibular nerve brevis muscles (اﻟﻌﺼﺐ اﻟﺸﻈﻮي اﻟﺴﻄﺤﻲ )  Deep fibular Supplies Tibials anterior , extensor nerve hallucis longus , preoneus tertius and extensor digitorum longus muscles (اﻟﻌﺼﺐ اﻟﺸﻈﻮي اﻟﻌﻤﯿﻖ)

Superior gluteal (L4 – L5 Gluteus minimus and Gluteus medius nerve and S1) muscles (اﻟﻌﺼﺐ اﻻﻟﯿﻮي اﻟﻌﻠﻮي) Inferior gluteal nerve ( L5 - S1) Gluteus maximus muscle (اﻟﻌﺼﺐ اﻻﻟﯿﻮي اﻟﺴﻔﻠﻲ) Nerve of piriformis (S1 – S2) Piriformis muscle (اﻟﻌﺼﺐ اﻟﻜﻤﺜﺮي) Nerve of Quadratus femoris (L4 – L5 Quadratus femoris and inferior and inferior and S1) gemellus gemellus (اﻟﺘﻮأﻣﯿﺔ اﻟﺴﻔﻠﻰ)

DR.ASHRAF ALI AL-ZUBAIDY2012-2013 DR.ASHRAF ALI AL-ZUBAIDY2013-2014

Nerve of Obturator internus Obturator internus and superior ( L5 – S2 ) (اﻟﻌﺼﺐ اﻟﺴﺎدي اﻟﺪاﺧﻠﻲ) gemellus and superior gemellus Perforating Skin over inferior medial aspect of cutaneous nerve ) ( S2 – S3 ) Buttock اﻟﻌﺼﺐ اﻟﺠﻠﺪي اﻟﺜﺎﻗﺐ) Posterior femoral Skin over anal region , inferior lateral cutaneous nerve ( S1 – S3 ) aspect of Buttock, superior posterior (اﻟﻌﺼﺐ اﻟﺠﻠﺪي اﻟﻔﺨﺬي aspect of Thigh اﻟﺨﻠﻔﻲ) Pudendal nerve Muscles of Perineum ( S2 – S4 ) ( ﻋﻀﻼت اﺳﻔﻞ اﻟﺤﻮض) (اﻟﻌﺼﺐ اﻟﻔﺮﺟﻲ)

FIGURE 2 :

The Sacral plexus

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Figure 3 : The motor Nerves of Lower limb

DR.ASHRAF ALI AL-ZUBAIDY2012-2013