Organization of the Lower Limb
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1 Organization of the Lower Limb Most illustrations from: Thieme Atlas of Anatomy: Musculoskeletal System. M Schuenke, et al, Anatomy: A Regional Atlas of the Human Body. Carmine Clemente, 4th edition.
2 Limb Development Lower limb develops in an anterolateral position at the level of the L2 to S3 trunk segments Great toe positioned in cephalic direction with the soles of the feet in an ateriomedial direction Knee positioned in a posteriolateral position
3 Limb Rotation Lower Limb Rotation Medial rotation Adduction Extension
4 Segments of the Lower Limb Limb Girdle pelvic girdle (gluteal) Free limb - thigh - leg - foot
5 Joints of the Lower Limb
6 Articulation with Axial Skeleton Sacroiliac jt. Sternoclavicular jt,
7 Sacroiliac Joint Auricular articular surfaces
8 Sacroiliac Joint Anterior sacroiliac ligaments Sacroiliac joint Posterior sacroiliac ligaments
9 Os Coxae Hemipelvis is composed of the ilium, ischium and pubis with articulations centered in acetabulum triradiate articulation Fusion of the 3 bones is complete between 20 and 25 years of age
10 Tri-radiate Articulation
11 Joints of the Free Limb Hip Polyaxial ball and socket joint: Felxion/extension Adduction/abduction Medial/lateral rotation Iliofemoral lig. Pubofemoral lig. Ischiofemoral lig. Ligament of head of femur
12 Joints of the Free Limb Knee Modified hinge joint Tibiofemoral artic. Patelofemoral artic. Femur Tibia Patella
13 Joints of the Free Limb Ankle (talocrural) joint Hinge joint 1 axis of movement: Dorsiflexion/plantarflexion
14 Joints of the Free Limb Foot Interphalangeal joints: Distal Proximal metatarsophalangeal joints Inversion/eversion occurs at subtalar (talocalcaneal) joint
15 Vasculature of the Lower Limb
16 Superficial Veins Great saphenous v. Small saphenous v.
17 Arterial Blood Supply External Iliac a Internal Iliac a Femoral a Popliteal a Superior gluteal a Inferior gluteal a Obturator a Anterior tibial a Posterior tibial aa dorsalis pedis med/lat plantar a
18 Deep Femoral Artery Medial & lateral femoral circumflex arteries
19 Fascial Compartments
20 Fascia of the Lower Limb Gluteal Fascia Fascia Lata Crural Fascia
21 Fascial Compartments of the Thigh anterior compartment Fascial septa divide limb into compartments medial compartment posterior compartment Anterior compartment Fascia Lata Medial (adductor) compartment Posterior compartment
22 Fascial Compartments of the Leg anterior compartment lateral compartment Anterior crural compartment Lateral crural compartment posterior compartment Posterior crural compartment anterior lateral Superficial & deep posterior crural compartments Crural Fascia posterior
23 Lumbosacral Plexus
24 Innervation of the Lower Limb: Lumbosacral Plexus (L1 - S3)
25 Lumbosacral Plexus L1 - S3
26 Gluteal innervation: Superior gluteal n (L4,5, S1): gluteus medius m. gluteus minimus m. tensor fascia lata Inferior gluteal n (L5, S1,2): gluteus maximus m. N to obturator internus (L5, S1, 2): oburator internus superior gemellus Nerve to quadratus femoris (L4,5, S1): inferior gemellus quadratus femorus
27 Compartmental Innervation Of the Free Limb Anterior compartment Medial compartment Posterior compartment Lateral compartment Thigh Leg Foot
28 Anterior (extensor) compartment of the thigh Innervation: femoral nerve anterior anterior
29 Medial (adductor) compartment of the thigh Innervation: obturator nerve* medial medial *Adductor Magnus innervated by both obturator n and tibial division of sciatic n
30 Posterior compartment of the thigh Hamstring mm: arise from ischial tuberosity & are innervated by tibial division of sciatic n. Innervation: Tibial division of sciatic nerve Except short head of biceps femoris: common fibular division of sciatic nerve posterior
31 Posterior compartment of the leg Innervation: tibial n. posterior Superficial posterior crural compartment Deep posterior crural compartment
32 Plantar surface of the foot Innervation: Medial & lateral plantar nerves
33 Innervation of intrinsic muscles of the foot Medial plantar n flexor digitorum brevis flexor hallucis brevis abductor hallucis m 1st lumbrical Lateral plantar n abducator digiti minimi quadratus plantae 2nd, 3rd & 4th lumbricals adductor hallucis Flexor digiti minimi dorsal & plantar interossei
34 Common fibular nerve Nerve supply to the lateral and anterior crural compartments anterior lateral anterior lateral
35 Lateral crural compartment: Superficial fibular nerve Fibularis longus Fibularis brevis lateral
36 Anterior crural compartment: Deep fibular nerve Tibialis anterior m. Extensor hallucis longus m. Extensor digitorum longus m. Fibularis tertius m. anterior
37 Dorsum of the foot: deep fibular nerve Extensor hallucis brevis Extensor digitorum brevis
38 Compartmental Innervation of Free Limb Anterior compartment Medial compartment Posterior compartment Lateral compartment Thigh Femoral n. Obturator n.* Tibial division of sciatic n. * *adductor magnus - obturator n and tibial n *short head of biceps femoris - common fib. division of sciatic n. Leg Deep fibular n. Tibial nerve Superficial fibular n. Foot Deep fibular n. Tibial n. (medial and lateral plantar n.)
39 Dermatomes Key dermatomes* thumb - C6 5th digit of hand - C8 nipples - T4 umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root
40 Key dermatomes* of the Lower Limb umbilicus - T10 hip crease - L1 great toe - L4 5th toe - S1 *area of skin supplied by a dorsal nerve root
41 Cutaneous Nerve Supply to the Lower Limb
42 References Clemente, C Anatomy: A Regional Atlas of the Human Body, 4th edition. Lippincogtt Williams & Wilkins. Rinabesm C,H, Cunningham s Textbook of Anatomy, 11th edition. Oxford University Press. Rosse, C & Gaddum-Rosse, P Hollinshead s Textbook of Anatomy 5th edition. Lippincott-Raven Schuenke, M et al, 2006 Thieme Atlas of Anatomy: Musculoskeletal System. Thieme. Slaby, F., et al Gross Anatomy in the Practice of Medicine. Lea & Febiger.
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this makes sense, however this is lower order thinking and does not solve the lower leg
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