The Lower Limb. Anatomy RHS 241 Lecture 2 Dr. Einas Al-Eisa
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1 The Lower Limb Anatomy RHS 241 Lecture 2 Dr. Einas Al-Eisa
2 The bony pelvis Protective osseofibrous ring for the pelvic viscera Transfer of forces to: acetabulum & head of femur (when standing) ischial tuberosities (when sitting) Large surface area for the attachment of muscles
3 The bony pelvis Orientation When in the anatomical position: the ASIS and pubic symphysis lie within the same vertical line
4 Articulations Anteriorly: Pubic symphysis Posteriorly: sacroiliac joints
5 What are the primary functions of the sacroiliac joints when in the anatomical position?
6 Innominate bone Ilium Ischium Pubis
7 Where (i.e., in which region approximately) does fusion of the three components of an innominate bone occur to form a single bone as seen in adults?
8 Pelvis: lateral view
9 Ilium Iliac crest Anterior superior iliac spine (ASIS) Anterior inferior iliac spine Posterior superior iliac spine (PSIS) Auricular surface (articular surface of SIJ) Supracristal line: joins the highest points of the iliac crests (to locate the position the spinous process of L4)
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11 Pubis Body Pubic crest (superior margin of the body) Pubic tubercles (prominent lateral eminence of pubic crest) Superior & inferior rami (project laterally from the body)
12 Ischium Ischial tuberosity Greater sciatic notch (superior to the iliac spine) Lesser sciatic notch (inferior to the iliac spine)
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14 Pelvis: medial view
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17 Femur Long bone: Shaft (diaphysis) Enlarged proximal & distal ends (epiphysis) Angle of obliquity: in the anatomical position, the distal ends are closer to midline than proximal ends (more in females)
18 Long Bones
19 Femur- proximal end Head: articulates with acetabulum (hip J) Pit (fovea of head): attachment of a ligament Neck: directed laterally, downward, & posteriorly (common site of fractures)
20 Right femur
21 Femur- proximal end Greater trochanter: attachment of muscles Lesser trochanter: attachment of muscles Intertrochanteric line: anterior at the junction of the neck & shaft Intertrochanteric crest: prominent; posterior at the junction of the neck & shaft
22 Femur- shaft Linea aspera: posterior (roughened by the attachment of thigh muscles) Popliteal surface: posterior Supraconylar lines: medially & laterally
23 Right femur
24 Femur- distal end Why is the distal end of femur enlarged? Medial & lateral condyles: articulate with the tibia (knee joint) Intercondylar notch (fossa): posterior Patellar surface: anterior (articulates with the patella to for the femoropatellar joint)
25 Hip joint Synovial Ball & socket (multiaxial) Articular sufaces: Head of femur Lunate surface of acetabulum (U-shaped) Acetabular labrum: complete ring of fibrocartilage
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27 What function is served by the acetabular labrum?
28 Ligaments Capsular ligaments of the hip are strong and taut (particularly in the extended position) The joint is most vulnerable to dislocation when in flexion and external rotation (e.g., sitting in a car)
29 Ligaments Iliofemoral: anterior two bands of fibers (medial & lateral) known clinically as the Y ligament of Bigelow ASIS to intertrochanteric line prevent overextension of hip
30 Ligaments Pubofemoral: anterior & inferior extends laterally from the pubic bone to the intertrochanteric line prevent over-abduction
31 Hip Joint: Anterior View
32 Ligaments Ischiofemoral: posterior from the ischium, arches forward over the neck of the femur attaches anteriorly to the intertrochanteric line prevent hyperextension of hip
33 Hip Joint: Posterior View
34 Ligaments Transverse ligament of the acetabulum: inferior bridges the ends (horns) of the lunate articular surface
35 Ligaments Ligament of the head of femur: Carries a blood vessel to the femoral head Attached to the pit (fovea) of the femur
36
37 Gluteal region Sciatic nerve enters the gluteal region near the midpoint of a line joining the PSIS & ischial tuberosity Common site for intramuscular injections: upper lateral quadrant (to avoid damage to the sciatic nerve)
38
39 Sacral Plexus
40 Routes for neurovascular structures from the pelvis to gluteal region & thigh = osseofibrous spaces or holes through which nerves and blood vessels enter and leave the thigh from the pelvis
41 Routes for neurovascular structures Inguinal route: formed by the inguinal ligament and the innominate bone (anterior) Obturator route: the opening or canal within the obturator membrane Gluteal route: osseofibrous ring formed by the greater sciatic notch and accessory ligaments of the SIJc
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43
44 Muscles of the gluteal region Gluteus maximus: inferior gluteal nerve extension & lateral rotation Gluteus medius: superior gluteal nerve abduction Gluteus minimus: superior gluteal nerve
45 Gluteal Region & Posterior thigh
46 Muscles of the gluteal region Gluteus medius & minimus: chief abductors (on a free limb) During walking, they contract on the weightbearing side to prevent the pelvis on the nonweight-bearing side from dropping Trendlenburg gait?
47 When standing on booth feet and shifting your weight from one limb to the other, on which side are the gluteus medius & minimus contracting?
48 Short lateral rotators of the thigh Piriformis (anterior surface of sacrum to greater trochanter) Obturator internus (to greater trochanter) Obturator externus (to greater trochanter) The gemelli muscles (superior & inferior) Quadratus femoris (ischial tuberosity to intertrochanteric crest)
49 Gluteal Region
50 Gluteal Region: Deep
51 Short lateral rotators of the thigh Common function: assist lateral rotation of the femur Oriented like the fascicles of the gluteus maximus Most of those muscles lie posterior to the neck of the femur
52 What is the strongest lateral rotator of the thigh?
53 Structure of spinal nerves
54
55
56 Spinal nerves
57 Sacral Plexus
58 Spinal cord & Nerve roots Dermatome = the area of skin supplied by a single nerve root Myotome = group of muscles supplied by a single nerve root Sclerotome = an area of bone or fascia supplied by a single nerve root
59 Neurological testing Dermatome: may exhibit sensory changes for light touch and pin prick Myotome: assessed by performing isometric resisted tests held for 3-5 seconds (L1-L2: hip flexion, L3: knee extension, L4: ankle dorsiflexion & inversion, L5: extension of big toe, S1-S2: plantar flexion & knee flexion, S3-S4: muscles of the pelvic floor & bladder)
60 Neurological testing Reflexes: The qudriceps reflex L3 The achilles tendon reflex S1
61 Referred Pain Pain felt in a part of the body that is usually far from the tissue that have caused it. May be due to misinterpretation by the brain as to the source of the painful stimulus. Indicates that one of the structures innervated by a nerve root is causing signs & symptoms in other tissues supplied by that same nerve root.
62 Radiating (radicular) Pain = Pain felt in a dermatome, myotome, or sclerotome because of direct involvement of a spinal nerve root.
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