Anatomy- Lower Limb – Areas Femoral triangle - a triangular fascial space in the superoanterior third of the thigh - boundaries: o superior: inguinal ligament o medial: adductor longus o lateral: sartorius - floor: o medial pectineus o lateral iliopsoas - roof: fascia lata, cribriform fascia, subcutaneous tissue, skin - contents (medial to lateral): o femoral vein/artery/nerve and their branches o femoral sheath and its contents o deep inguinal LNs - bisected by the femoral artery and vein which leave, and enter the adductor canal at its apex Femoral sheath - funnel-shaped fascial tube that encloses proximal parts of femoral vessels, which lie inferior to inguinal ligament - surrounds the femoral canal but does not enclose the femoral nerve - a diverticulum or inferior prolongation of fasciae lining abdomen (transversalis fascia ant and iliac fascia post) - covered by fascia lata - ends ~4cm inferiorly to inguinal ligament when it becomes continuous with loose c.t. covering femoral vessels - medial wall pierced by the great saphenous vein and lymphatics - purpose: allows femoral vessels to glide in and out, deep to the inguinal ligament, during hip joint movements - compartments: divided by 2 vertical septa into 3 compartments: o lateral: contains femoral artery o intermediate: femoral vein o medial aka the femoral canal 1 Femoral ring - 1cm wide small superior end or mouth of the femoral canal - closed by extraperitoneal fatty tissue - femoral septum, pierced by lymphatics connect inguinal/external iliac LNs - 4 boundaries: o lateral: partition between femoral canal and femoral vein o posterior: superior pubic ramus covered by pectineus muscle and its fascia o medial: lacunar ligament o anterior: medial part of inguinal ligament - a weak area – femoral hernias (protrusion abdominal viscera thru ring into canal) Adductor canal - aka subsartorial or Hunters canal - 15cm long, narrow fascial tunnel in the thigh - deep to middle 1/3 sartorius - provides intermuscular passage thru which femoral vessels pass to reach popliteal fossa - become popliteal vessels - begins 15cm inferior to inguinal ligament where sartorius crosses adductor longus (apex of femoral triangle - ends at adductor hiatus in tendon of adductor magnus - boundaries: o anteriolateral: vastus medialis o posterior: adductor longus and magnus o medial: sartorius - subsartorial plexus of nerves lies on this fascia – in middle 1/3 thigh – supplies overlying skin - contents: o femoral artery and vein o saphenous nerve o nerve to vastus medialis femoral vessels enter canal where sartorius crosses adductor longus, vein lies posterior to artery femoral vessels leave canal through tendinous opening in adductor magnus - adductor hiatus femoral artery enters popliteal fossa, becomes popliteal artery, same for vein profunda femoris A+V don’t enter adductor canal perforating branches of these vessels pierce fibres of adductors to reach post aspect of thigh saphenous nerve (cutaneous branch femoral nerve) accompanies femoral artery thru adductor canal. Enters canal lateral to artery, crosses anteriorly, lies medial at distal end Popliteal Fossa ‘diamond shaped anatomical space behind the knee’ Borders Superomedial - Semimembranosus and semitendinosus Superolateral - Biceps femoris Inferiomedial - Medial head of gastrocnemius Inferolateral - Lateral head of gastrocnemius Roof Fascia lata, strongly reinforced by transverse fibres Pierced by small saphenous vein and posterior femoral cutaneous nerve. Floor (from above down) Popliteal surface of the femur Capsule of the knee joint – reinforced by oblique popliteal ligament. Popliteus muscle – covered by fascia. Contents (medial to lateral) Popliteal artery and branches Branches Muscular branches to the muscles in the popliteal fossa (including 2 large sural arteries) Genicular arteries (5) Middle genicular artery Pierces oblique popliteal ligament to supply cruciates Medial superior genicular artery Deep to semitendinosus, semimembranosus, tendon of adductor magnus – encircles lower end of femur. 2 Lateral superior genicular artery Deep to tendon of biceps femoris – encircles the lower end of the femur. Medial inferior genicular artery Course to the medial head of gastrocnemius – encircles the upper end of the tibia. Lateral inferior genicular artery Runs deep to lateral head of gastroc and crosses tendon of popliteus - encircles upper end of tibia. (Anterior tibial artery) (Posterior tibial artery) Small saphenous vein entering popliteal vein Tibial nerve Branches Muscular branches All muscles that arise in the popliteal fossa and flexor compartment Plantaris Gastrocnemius Soleus Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior. Sural nerve Runs between 2 heads of gastrocnemius Pierces deep fascia half way down the calf to replace the posterior cutaneous nerve of the thigh. Joined by sural communicating nerve Lies close to small saphenous vein. Genicular nerves (3) Accompany the superior and inferior medial genicular arteries to supply medial ligaments and capsule and middle genicular artery to pierce oblique popliteal ligament supplying it and the cruciate ligaments. Common peroneal nerve Branches Sural communicating nerve Pierces the roof of the fossa to join the sural nerve below the bellies of gastrocnemius. Lateral cutaneous nerve of the calf (lateral sural nerve) Pierces the roof of the fossa over the lateral head of gastrocnemius to supply skin over upper part of peroneal and extensor compartments of the leg. Superior and inferior genicular nerves Supply capsule of knee and lateral ligament. Recurrent genicular nerve Arises in the substance of peroneus longus, perforates tibialis anterior and supplies knee joint and superior tibiofibular joint. Popliteal lymph nodes – lie along the popliteal vein Factoids Popliteal artery is deep to popliteal vein which is deep to nerves Skin overlying popliteal fossa supplied by post cut nerve of thigh 3 Posterior to Medial Malleolus Tom Dick And Very Nervous Harry Tibialis posterior tendon Flexor Digitorum Longus tendon Posterior tibial Artery Posterior tibial Vein Tibial Nerve Flexor Hallicus longus tendon 4.