Anatomy of the lower limb

Transcription

1 Anatomy of the lower limb 1. Bones of the lower limb Pelvis Hip bone/coxal bone Acetabulum o Acetabular margin o Acetabular fossa o Acetabular notch o Lunate surface Ischiopubic ramus Obturator foramen Ilium Body of ilium Ala of ilium/wing of ilium Arcuate line Iliac crest Anterior superior iliac spine Anterior inferior iliac spine Posterior superior iliac spine Posterior inferior iliac spine Iliac fossa Gluteal surface Sacropelvic surface o Auricular surface o Iliac tuberosity Ischium Body Ramus o Ischial tuberosity Ischial spine Greater sciatic notch Lesser sciatic notch Pubis Body Superior pubic ramus o Iliopubic ramus o Pecten pubis/pectineal line 1

2 o Pubic tubercle o Symphysial surface o Obturator crest o Obturator groove o Anterior obturator tubercle o (Posterior obturator tubercle) Inferior pubic ramus Pelvis Greater pelvis Lesser pelvis Linea terminalis Pelvic inlet Pelvic cavity Pelvic outlet Femur Proximal epiphysis Head Fovea for ligament of head Neck Greater trochanter Trochanteric fossa Lesser trochanter Intertrochanteric line Intertrochanteric crest Shaft of femur/diaphysis Linea aspera Gluteal tuberosity Pectineal line Distal epiphysis Medial and lateral condyles Medial epicondyle o Adductor tubercle Lateral epicondyle Medial supracondylar line Lateral supracondylar line Intercondylar fossa Intercondylar line Popliteal surface Patellar surface 2

3 Patella Tibia Base of patella Apex of patella Articular surface Anterior surface Proximal epiphysis Medial and lateral condyle Superior articular surface Intercondylar eminence Anterior and posterior intercondylar area Lateral intercondylar tubercle Medial intercondylar tubercle Fibular articular facet Soleal line Tibial tuberosity Shaft/ Diaphysis Anterior border Medial border Interosseous border Medial surface Lateral surface Posterior surface Distal epiphysis Medial malleolus Articular facet Malleolar groove Inferior articular surface Fibular notch Fibula Proximal epiphysis Head Apex of head Articular facet Neck Shaft/ Diaphysis Interosseous border Anterior border Posterior border Medial surface Lateral surface Posterior surface 3

4 Distal epiphysis Lateral malleolus Articular facet Malleolar fossa Malleolar groove Bones of foot Talus Calcaneus Head Neck Body Trochlea of talus Medial malleolar facet Lateral malleolar facet Navicular articular surface Anterior facet for calcaneus Middle facet for calcaneus Posterior calcaneal articular facet Sulcus tali Lateral process Posterior process Groove for tendon of flexor hallucis longus Calcaneal tuberosity o Medial process; Lateral process Anterior talar articular surface Middle talar articular surface Posterior talar articular surface Calcaneal sulcus Sustentaculum tali Groove for tendon of flexor hallucis longus Groove for tendon of fibularis longus Articular surface for cuboid Os naviculare Tuberosity Medial-, Intermediate-, Lateral cuneiform Cuboid Tuberosity Groove for tendon of fibularis longus Metatarsals ; Phalanges 4

5 2. Joints of lower limb Joints Name Articulating surfaces Type of joint Movements Capsule, ligaments Special components Ligaments to know Sacro-iliac joint Anterior, posterior interosseous sacro-iliac ligaments Pubic symphysis Superior pubic ligament Inferior pubic ligament Ligaments of pelvis Iliolumbar ligament Sacrospinous ligament Sacrotuberous ligament Obturator membrane Inguinal ligament Hip joint Knee joint Ligament of head of femur Transverse acetabular ligament Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Anterior cruciate ligament Posterior cruciate ligament Transverse ligament of knee Tibial collateral ligament Fibular collateral ligament Oblique popliteal ligament Patellar ligament Medial patellar retinaculum Lateral patellar retinaculum 5

6 Tibiofibular joint Anterior ligament of fibular head Posterior ligament of fibular head Syndesmosis tibiofibularis Ankle joint Interosseous membrane Anterior ligament of fibular head Posterior ligament of fibular head Deltoid ligament o Tibionavicular part o Tibiocalcaneal part o Anterior tibiotalar part o Posterior tibiotalar part Lateral ligament o Anterior talofibular ligament o Posterior talofibular ligament o Calcaneofibular ligament Subtalar joint Lateral talocalcaneal ligament Medial talocalcaneal ligament Posterior talocalcaneal ligament Talocalcaneal interosseous ligament Talocalcaneonavicular joint Spring ligament = Plantar calcaneonavicular ligament Talonavicular ligament Bifurcate ligament Calcaneocuboid joint Long plantar ligament Spring ligament = Plantar calcaneonavicular ligament Bifurcate ligament Transverse tarsal joint Bifurcate ligament Tarsometatarsal joint Dorsal tarsometatarsal ligament Plantar tarsometatarsal ligament Interosseous tarsometatarsal ligament Plantar arches 6

7 3. Muscles of the lower limb Origin, insertion, function, innervation Muscles of the pelvis Iliopsoas Piriformis Obturator internus Gluteus maximus Gluteus medius Gluteus minimus Tensor fasciae latae Gemelli sup. et inf. Obturator externus Quadratus femoris Fascia lata, iliotibial tract Extensors of thigh Quadriceps femoris o Rectus femoris o Vastus medialis o Vastus lateralis o Vastus intermedius Sartorius Flexors of thigh Semitendinosus Semimembranosus Biceps femoris Adductors of thigh Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis Extensors of leg Tibialis anterior Extensor hallucis longus Extensor digitorum longus 7

8 Flexors of leg Triceps surae (mm. gastrocnemii, m. soleus, m. plantaris), tendo calcanei Popliteus Flexor digitorum longus Flexor hallucis longus Tibialis posterior Fibular muscles of leg Fibularis (Peroneus) longus Fibularis (Peroneus) brevis Muscles of back of foot Extensor hallucis brevis Extensor digitorum brevis Muscles of the sole Plantar aponeurosis Medial plantar eminence Abductor hallucis Flexor hallucis brevis Adductor hallucis Lateral plantar eminence Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi Intermedial plantar eminence Flexor digitorum brevis Lumbricals Quadratus plantae Planter interossei Dorsal interossei 8

9 4. Blood supply of lower limb Internal iliac a. o Superior gluteal a. o Inferior gluteal a. o Internal pudendal a. o Obturator a. - acetabular branch External iliac a. o Inferior epigastric a. o Deep circumflex iliac a. Femoral a. o Deep artery of thigh Medial circumflex femoral a. Lateral circumflex femoral a. Perforating aa. o Descending genicular a. Popliteal a. o Superior lateral genicular a. o Superior medial genicular a. o Middle genicular a. o Sural aa. o Inferior lateral genicular a. o Inferior medial genicular a. Anterior tibial a. o Anterior tibial recurrent a. o Anterior lateral malleolar a. o Anterior medial malleolar a. Dorsalis pedis a./dorsal a. of foot o Later tarsal a. o Medial tarsal aa. o Arcuate a. o Dorsal metatarsal aa. o Dorsal digital aa. o Deep plantar a. Posterior tibial a. o Circumflex fibular branch o Fibular a. o Medial malleolar branches o Calcaneal branches Medial plantar a. o Deep branch o Superficial branch 9

10 Lateral plantar a. o Deep plantar arch o Plantar metatarsal aa. o Common plantar digital aa. o Plantar digital arteries proper External iliac v. Femoral v. Popliteal v. Great saphenous v. Small saphenous v. Dorsal venous arch of foot Theoretical question Lymph drainage of lower limb Pulse points on lower limb Anastomoses of deep superficial veins of lower limb. 10

11 5. Nerves of lower limb Lumbar plexus Iliohypogastric n. Ilio-inguinal n. Genitofemoral n. Lateral cutaneous nerve of thigh Femoral n. o Muscular branches o Anterior femoral cutaneous n. o Saphenous n. Obturator n. o Anterior br. o Posterior br. Lumbosacral trunk Sacral plexus Superior gluteal n. Inferior gluteal n. Posterior cutaneous n. of thigh Sciatic n. o Tibial n. Med. sural cutaneous n. sural n. lateral dorsal cutaneous nerve of foot Medial calcaneal branches Medial plantar n. Common plantar digital nerves Proper plantar digital nerves Lateral plantar n. Deep br. Superficial br. Common plantar digital nerves Proper plantar digital nerves o Fibular n. Lateral sural cutaneous n. Superficial fibular n. Medial dorsal cutaneous nerve of foot Intemediate dorsal cutaneous nerve of foot Deep fibular n. Pudendal n. 11

12 Theoretical questions Skin innervation of lower limb Parts of lower limb innervated by branches of the lumbar plexus. Topography Suprapiriform hiatus - contents Infrapiriform hiatus - contents Subinguinal hiatus Femoral canal Adductor canal Popliteal fossa Obturator canal Medial malleolar region Lateral malleolar region Femoral trigone 12