Inferior Extremity Inferior Extremity
Main Function
• Support • Locomotion (propulsion) • Weight Transmission • Gluteal region and Posterior Views • Hip(coxa) • buttock (natis) • Three segments Thigh (proximal) Leg (middle) Foot (distal) • Knee • Anterior(patellar) region • Posterior region (popliteal fossa) • Foot • Upper surface (dorsum) • Sole (Planter) surface Inferior extremity – Bones & joints Hip Girdle • Hip bones Three principal Thigh synovial joints • Femur • Hip joint Knee • Knee joint • Patella (knee cap) • Ankle joint Leg • Tibia • & smaller joints • Fibula of foot Foot •7Tarsals • 5 Metatarsals • 14 Phalages Fe11111r ~~-11te11or \.~1e\"~,. Head I ----FO',,•ea of he-:id Pro:~im-:11 line of ,::aps1Jl-:1r reflection------'-.,. ~ -----~.Jee~. lntertrochanteric line ------··--
E:ody fsh-:1ft) ------
,.Dist-:11 line of i::-:1ps1Jl-:1r ref lee:tion ...... ·
Adductor tubercle
Lateral epicondyle --- '-----Medial epicondyle f----Medial condyle
Lateral condyle Patellar surf ace Fe-11111r I~oste11or \.~1e\\' /Greater troohanter
r ·•.... r\Jed. ------• =----lntertr,:11:+1.:1nteric: c,rest ~ .../ ------: _./ F'rm:irn.:11 line of c.:1psul-:1r reflection_____ •' -----C.:ile.:ir Lesser troc,h.:inter ------Glute.:il tuberosity F'ectine.:il line ~---
Medi-:11 lip of linea asper -:1 ------L.:iter.:ii lip ,:,f line.:1 .:isper -:1
----r·Jutrient for .:imen Body (shaf(I ----
,.Distal line of capsular reflection ... Adductor tubercle
Medial epicondyle ------Lateral epicondyle
Medial condyle --- Lateral condyle
lntercondylar Fossa A.nterior \lie\v Postetior \lie\v of Foot Lateral View – Rt Foot Dorsal \liew (Rt Foot)
7 Tarsals Medial View – Rt Foot 5 Metatarsals 14 Phalanges Lower Limb - Movements Fascia lata- deep fascia of thigh Attachments upper • On front to iliac crest • Inguinal ligament • Pubis , pubic arch , ischial tuberosity • Laterally thickened to form ilio-tibial tract • Sacrum , coccyx , sacro-tuberous lig.- through gluteal fascia Lower • Patella, tibial condyles & head of fibula Modifications of deep fascia
Saphnous opening Iliotibial tract Intermuscular septums
Near ankle joint Retinaculum –Flexor ,Extensor ,Peroneal
Sole Planter aponeurosis Deep transverse metatarsal ligaments Fibrous flexor sheath (toes) Saphnous opening
• Oval aperture in deep fascia of thigh • 3-4 cm below & lateral to pubic tubercle • 3 cm long , 1.5 cm wide • Covered by cribriform fascia • Sharp lateral & inferior margin (falciform) Coxal B011e Lateral \ 7ie\v
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figure Inter-muscular compartments Hamstring) – obturator Nerve femoral Nerve posterior (flexor , (adductor) – Medial Anterior (extensor) – Anterior sciatic (tibial division) • Thigh compartments • • Leg • Anterior (extensor) – deep peroneal • Lateral (peroneal) – superficial peroneal • Posterior (Flexor) (superficial & deep) – sciatic (tibial) superficial epigastric vein saphenous opening pubic tubercle femoral vein femoral artery
superficial external pudenda! vein great saphenous vein -t-----11
accessory vein great saphenous vein
small saphenous vein
perforating vein muscle
superficial fascia
skin
medial malleoius s,aphenous ve.in deep fascia venae ~omitantes dorsal venous arch "venous pump" Popliteal vein umbilicus lymph from lower halt -of anal canal horizontal group of superficial inguinal lymph nodes
vertical group of superficial inguinal lymph nodes
external iliac nodes \ /) s~pe~icia~I • inguinal I nodes 1! saphenous open;ng H' ~
...,._;;;.:.._,, .... __----__.-==------Superficial inguinal l~mph nodes (1Jertical group)
------Superficial l(Jmph •Jessel
Great saphenous 1Jein ------Anterior View Posterior View Lm11bar Plexus Schetna
inguinal ligament
external iliac artery femoral artery profunda artery
- medial femoral lateral femoral circumflex artery circumflex artery femoral artery
~~--:----::::;,~ perforating branches of profunda femoris artery
osterjor tibi&_artery ,- - -
peroneal artery ' anterior tibial artery 11
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dorsal is pedis artery Femoral Sheath
• Funnel shaped extension of fascial lining of abdominal cavity • surrounding upper 4 cms of femoral artery & vein Femoral Sheath
Walls • Ant.wall – fascia transversalis • Post. Wall – fascia iliaca • Lateral wall longer & vertical • Divided in three compartments by two vertical antero-post. septa
0 Femoral canal & ring
• Medial compartment of femoral sheath • Conical in shape , wide above, narrow below • Base or upper end called Femoral Ring • Closed by condensation of extraperitoneal tissue called femoral septum • Wider in females due to wider pelvis & small femoral vessels Femoral canal & ring • Oval shaped Region • 1 inch diameter Dissection - Posterior [Internal] View Boundary • Ant.- inguinal ligament • Post.- pectineus & covering fascia • Laterally- IM septum • Medially- Lacunar ligament Content • Lymph node (cloquet or Rossenmuller) with lymphtics & areolar tissue – drain glans penis in males & clitoris in females moral ring lacunar ligament
Pectineus
Pfotunda femoris artery
adductor longus adductor ma.gnus
Perforating arteries
femora/ vein
IIJ I 11 , ,..,,
Qenicufar artery Bony Attachments ofMuscles ofHip and lbigh Anterior View • Du::::tus fi..1-::1:(I dE'fE'rens ------
------__.-__.--·-· ------______.---· Fi?mor ai :::hE'-:ith -----
Femar:-:ir arterg and velrr