7/27/2019 THIGH dr. borhan.ppt
1/107
LOWER LIMB
7/27/2019 THIGH dr. borhan.ppt
2/107
INTRODUCTION
The primary function of the lower limb is to
- support the weight of the body
- provide a stable foundation in standing,
walking, running (locomotion)
Similar in structure to the upper limbs but
have less freedom of movement
Connected by the pelvic girdle to the trunk
7/27/2019 THIGH dr. borhan.ppt
3/107
ORGANIZATION
Gluteal region
Thigh
Leg
Foot
7/27/2019 THIGH dr. borhan.ppt
4/107
BONES OF THE LOWER LIMB
Pelvic girdle (left & right hip bones)
Femur
Patella
Tibia
Fibula
Tarsal bones
Metatarsal
Phalanges
7/27/2019 THIGH dr. borhan.ppt
5/107
HIP BONE
L. os coxae
Innominate bone
Large irregular bone
Formed by the fusion of 3 bones:
- ilium- pubis
- ischium
7/27/2019 THIGH dr. borhan.ppt
6/107
United at the acetabulum.
Pubis and ischium are separated by
obturator foramen. The 2 hip bones articulated anteriorly at the
pubic symphysis
7/27/2019 THIGH dr. borhan.ppt
7/107
7/27/2019 THIGH dr. borhan.ppt
8/107
7/27/2019 THIGH dr. borhan.ppt
9/107
7/27/2019 THIGH dr. borhan.ppt
10/107
7/27/2019 THIGH dr. borhan.ppt
11/107
7/27/2019 THIGH dr. borhan.ppt
12/107
7/27/2019 THIGH dr. borhan.ppt
13/107
7/27/2019 THIGH dr. borhan.ppt
14/107
ILIUM
Largest part of the hip bone
Upper expanded plate like part
Contributes the superior part of acetabulum
Posterolateral surfacegluteal surface
Long curved superior border
iliac crest
7/27/2019 THIGH dr. borhan.ppt
15/107
ISCHIUM
Posteroinferior part of the hip bone
Forming posteroinferior aspect of acetabulum
Upper, thicker partbody
Lower, thinner partramus
Ischial spine Ischial tuberosity
Lesser sciatic notch
7/27/2019 THIGH dr. borhan.ppt
16/107
PUBIS
Anteromedial part of the hip bone
Anterior part of acetabulum
Divided into body & 2 rami
Articulates with the contralateral pubis at
the symphysis pubis
Pubic crest
Pubic tubercle
7/27/2019 THIGH dr. borhan.ppt
17/107
OBTURATOR FORAMEN
Large oval or triangular aperture
Bounded by the pubis & ischium
Closed by obturator foramen
7/27/2019 THIGH dr. borhan.ppt
18/107
ACETABULUM
Large, cup-shaped cavity or socket on the
lateral aspect of the hip bone.
Articulates with the head of femur to formthe hip joint
Acetabular notch
Acetabular fossa
Lunate surface
7/27/2019 THIGH dr. borhan.ppt
19/107
ANATOMICAL POSITION
Anterior superior iliac spine &
anterosuperior aspect of the pubis lie in the
same vertical plane
7/27/2019 THIGH dr. borhan.ppt
20/107
HIP INJURIES
Hip fractures are common in serious
vehicular accidents
7/27/2019 THIGH dr. borhan.ppt
21/107
7/27/2019 THIGH dr. borhan.ppt
22/107
7/27/2019 THIGH dr. borhan.ppt
23/107
7/27/2019 THIGH dr. borhan.ppt
24/107
FEMUR
Longest & heaviest bone in the body
Transmits body weight from the hip bone to
the tibia
Long bone
Consists of a body (shaft) & 2 ends
Superior end consists of head, neck, 2
trochanters
7/27/2019 THIGH dr. borhan.ppt
25/107
7/27/2019 THIGH dr. borhan.ppt
26/107
7/27/2019 THIGH dr. borhan.ppt
27/107
Head of femur projects superomedially &
slightly anteriorly
Attached to the body by the neck
Neck-body angle126
Less in females
Neckallows for greater mobility
But imposes considerable strain
7/27/2019 THIGH dr. borhan.ppt
28/107
Greater & lesser trochanterslarge
eminences situated at the junction of the
neck & shaft Intertrochanteric line
Intertrochanteric crest
7/27/2019 THIGH dr. borhan.ppt
29/107
Body of femur slightly bowed anteriorly
Smoothly rounded
Posteriorlylinea aspera
Has medial & lateral lips
Lateral lips gluteal tuberosity
Medial lip spiral line
Medial & lateral supracondylar lines
7/27/2019 THIGH dr. borhan.ppt
30/107
Condyleslateral & medial condyles
Separated posteriorly by intercondylar
notch
Above the condyles, epicondyles
7/27/2019 THIGH dr. borhan.ppt
31/107
Angle of inclination varies
Angle - coxa vara (# neck of femur)
- abduction limited Angle - coxa valga (congenital dislocation of
hip joint)
- adduction limited
Fracture neck of femur
- elderly
- osteoporosis (trivial trauma)
7/27/2019 THIGH dr. borhan.ppt
32/107
BLOOD SUPPLY OF FEMUR
Medial femoral circumflex artery
7/27/2019 THIGH dr. borhan.ppt
33/107
7/27/2019 THIGH dr. borhan.ppt
34/107
7/27/2019 THIGH dr. borhan.ppt
35/107
7/27/2019 THIGH dr. borhan.ppt
36/107
7/27/2019 THIGH dr. borhan.ppt
37/107
THIGH
SKIN
Cutaneous nerves
1. Lateral cutaneous nerve of the thigh2. Femoral branch of genitofemoral nerve
3. Ilioinguinal nerve
4. Medial cutaneous nerve of the thigh5. Intermediate cutaneous nerve of the thigh
6. Obturator nerve (anterior division)
7/27/2019 THIGH dr. borhan.ppt
38/107
7/27/2019 THIGH dr. borhan.ppt
39/107
7/27/2019 THIGH dr. borhan.ppt
40/107
7/27/2019 THIGH dr. borhan.ppt
41/107
7/27/2019 THIGH dr. borhan.ppt
42/107
7/27/2019 THIGH dr. borhan.ppt
43/107
7/27/2019 THIGH dr. borhan.ppt
44/107
Superficial veins
1. Great saphenous vein
2. Small saphenous vein
3. Perforating veins
Venous pump
Varicose veins
7/27/2019 THIGH dr. borhan.ppt
45/107
7/27/2019 THIGH dr. borhan.ppt
46/107
7/27/2019 THIGH dr. borhan.ppt
47/107
Lymphatic drainage
Inguinal lymph nodes
- superficial inguinal lymph nodes
- deep inguinal lymph nodes
Superficial inguinal lymph nodes
- horizontal group
- vertical group Deep inguinal lymph nodes
7/27/2019 THIGH dr. borhan.ppt
48/107
7/27/2019 THIGH dr. borhan.ppt
49/107
7/27/2019 THIGH dr. borhan.ppt
50/107
7/27/2019 THIGH dr. borhan.ppt
51/107
DEEP FASCIA
Fascia lata
Attached to the iliac crest & inguinal
ligament
Laterallythickened to form iliotibial tract
Saphenous openinggap in the deep fascia,
just below the inguinal ligament
7/27/2019 THIGH dr. borhan.ppt
52/107
FASCIAL COMPARTMENTS
3 intermuscular septa
- lateral intermuscular septum
- medial intermuscular septum- posterior intermuscular septum
Compartments of the thigh
- anterior- medial
- posterior
7/27/2019 THIGH dr. borhan.ppt
53/107
ANTERIOR COMPARTMENT
Muscles
- sartorius
- quadriceps femoris- iliacus
- psoas
- pectineus Blood supplyfemoral artery
Nerve supplyfemoral nerve
7/27/2019 THIGH dr. borhan.ppt
54/107
SARTORIUS
Tailors muscle
Origin: ASIS (anterior superior iliac spine)
Insertion: upper part of medial surface oftibia
Nerve supply: femoral nerve
Action: flexes, abducts, laterally rotates thethigh at the hip joint; flexes & mediallyrotates the leg at the knee joint
7/27/2019 THIGH dr. borhan.ppt
55/107
7/27/2019 THIGH dr. borhan.ppt
56/107
7/27/2019 THIGH dr. borhan.ppt
57/107
7/27/2019 THIGH dr. borhan.ppt
58/107
7/27/2019 THIGH dr. borhan.ppt
59/107
ILIACUS
Origin: iliac fossa
Insertion: join the tendon of psoas to form
iliopsoas
Nerve supply: femoral
Action: flexes the thigh/flexes the trunk
7/27/2019 THIGH dr. borhan.ppt
60/107
7/27/2019 THIGH dr. borhan.ppt
61/107
PSOAS MAJOR
Long fusiform muscle that arises in the
abdomen & descends into the thigh
Origin: lumbar vertebrae
Insertion: lesser trochanter of the femur
Nerve supply: branches from lumbar plexus
Action: flexes the thigh on the trunk/flexes
the trunk on the thigh
7/27/2019 THIGH dr. borhan.ppt
62/107
7/27/2019 THIGH dr. borhan.ppt
63/107
PECTINEUS
Origin: superior ramus of pubis
Insertion: upper end of linea aspera just
below the lesser trochanter Nerve supply: femoral nerve (+ obturator
nerve)
Action: flexes & adducts thigh at the hipjoint
7/27/2019 THIGH dr. borhan.ppt
64/107
7/27/2019 THIGH dr. borhan.ppt
65/107
QUADRICEPS FEMORIS
4 parts:
- rectus femoris
- vastus lateralis
- vastus intermedius
- vastus medialis
7/27/2019 THIGH dr. borhan.ppt
66/107
7/27/2019 THIGH dr. borhan.ppt
67/107
7/27/2019 THIGH dr. borhan.ppt
68/107
7/27/2019 THIGH dr. borhan.ppt
69/107
Action
- inserted into the patella & via theligamentum patellae into the tibial
tuberosity.
- powerful extensor of the knee joint- lowest fibers of v. medialis are horizontal
& prevent lateral displacement of patella
- the tone of quadriceps greatly strengthensthe knee joint
7/27/2019 THIGH dr. borhan.ppt
70/107
FEMORAL ARTERY
Enters the thigh behind the inguinalligament
Continuation of external iliac artery Midway between the anterior superior iliac
spine & symphysis pubis
Main arterial supply of the lower limb
Ends at the adductor hiatus
Continues as popliteal artery
7/27/2019 THIGH dr. borhan.ppt
71/107
7/27/2019 THIGH dr. borhan.ppt
72/107
7/27/2019 THIGH dr. borhan.ppt
73/107
7/27/2019 THIGH dr. borhan.ppt
74/107
Branches
- superficial circumflex iliac artery
- superficial epigastric artery
- superficial external pudendal artery
- deep external pudendal artery
- profunda femoris artery
7/27/2019 THIGH dr. borhan.ppt
75/107
FEMORAL VEIN
Tributaries
- great saphenous vein
FEMORAL VEIN
7/27/2019 THIGH dr. borhan.ppt
76/107
FEMORAL VEIN
CATHETERIZATION
Rapid access to a large vein
7/27/2019 THIGH dr. borhan.ppt
77/107
FEMORAL NERVE
Largest branch of the lumbar plexus
L2, 3, 4
Lateral to the femoral artery
Supplies all muscles of the anterior
compartment
7/27/2019 THIGH dr. borhan.ppt
78/107
7/27/2019 THIGH dr. borhan.ppt
79/107
7/27/2019 THIGH dr. borhan.ppt
80/107
7/27/2019 THIGH dr. borhan.ppt
81/107
MEDIAL COMPARTMENT
Muscles:
- gracilis
- adductor longus
- adductor brevis
- adductor magnus
- obturator externus
Blood supply: profunda femoris & obturator arteries
Nerve supply: obturator nerve
7/27/2019 THIGH dr. borhan.ppt
82/107
GRACILIS
Origin: outer surface inferior ramus of pubis
Insertion: upper part of the medial side of
tibia Nerve supply: obturator
Action: adducts the thigh, flexes the leg
7/27/2019 THIGH dr. borhan.ppt
83/107
7/27/2019 THIGH dr. borhan.ppt
84/107
ADDUCTOR LONGUS
Origin: body of pubis
Insertion: linea aspera
Nerve supply: obturator nerve
Action: adducts the thigh & assists in lateral
rotation
7/27/2019 THIGH dr. borhan.ppt
85/107
7/27/2019 THIGH dr. borhan.ppt
86/107
ADDUCTOR BREVIS
Origin: inferior ramus of pubis
Insertion: linea aspera
Nerve supply: obturator nerve
Action: adducts the thigh & assists in lateral
rotation
7/27/2019 THIGH dr. borhan.ppt
87/107
ADDUCTOR MAGNUS
Adductor & hamstring portions
Origin: inferior ramus of pubis, ramus of
ischium, ischial tuberosity Insertion: linea aspera, adductor tubercle
Nerve supply: obturator nerve
Action: adducts the thigh & assists in lateral
rotation; extends the thigh
7/27/2019 THIGH dr. borhan.ppt
88/107
7/27/2019 THIGH dr. borhan.ppt
89/107
7/27/2019 THIGH dr. borhan.ppt
90/107
OBTURATOR EXTERNUS
Origin: outer surface of obturator membrane
& pubic & ischial rami
Insertion: medial surface of greatertrochanter
Nerve supply: obturator nerve
Action: laterally rotates the thigh
7/27/2019 THIGH dr. borhan.ppt
91/107
7/27/2019 THIGH dr. borhan.ppt
92/107
7/27/2019 THIGH dr. borhan.ppt
93/107
POSTERIOR COMPARTMENT
7/27/2019 THIGH dr. borhan.ppt
94/107
POSTERIOR COMPARTMENT
Contents
Muscles:
- biceps femoris
- semitendinosus
- semimembranosus
- adductor magnus (hamstring part) Blood supply: profunda femoris artery
Nerve supply: sciatic nerve
7/27/2019 THIGH dr. borhan.ppt
95/107
BICEPS FEMORIS
Origin: long headischial tuberosity
short headlinea aspera
Insertion: head of fibula
Nerve supply: tibial n. & common peronael n.
Action: flexes & laterally rotates the leg;
extends the hip joint
7/27/2019 THIGH dr. borhan.ppt
96/107
7/27/2019 THIGH dr. borhan.ppt
97/107
7/27/2019 THIGH dr. borhan.ppt
98/107
SEMITENDINOSUS
Origin: ischial tuberosity
Insertion: upper part of the medial surface
of the tibia Nerve supply: tibial part of sciatic
Action: flexes & medially rotates the leg;
extends the hip joint
7/27/2019 THIGH dr. borhan.ppt
99/107
SEMIMEMBRANOSUS
Origin: ischial tuberosity
Insertion: posteromedial surface of the
medial condyle of tibia Nerve supply: tibial part of sciatic nerve
Action: flexes & medially rotates the leg;
extends the hip joint
7/27/2019 THIGH dr. borhan.ppt
100/107
7/27/2019 THIGH dr. borhan.ppt
101/107
7/27/2019 THIGH dr. borhan.ppt
102/107
7/27/2019 THIGH dr. borhan.ppt
103/107
7/27/2019 THIGH dr. borhan.ppt
104/107
7/27/2019 THIGH dr. borhan.ppt
105/107
7/27/2019 THIGH dr. borhan.ppt
106/107
7/27/2019 THIGH dr. borhan.ppt
107/107