Lower Limb
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| 1.Study the markings of each lower limb bone. |
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| Pelvic Girdle (Hip) | The hip is formed by a pair of hip bones (os coxae, or coxal)
Together with the sacrum and the coccyx, these bones form the bony pelvis
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| pelvic girdle(hip) | ilium, ischium, pubis
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| Ilium | is a large flaring bone that forms the superior region of the coxal bone
Articulates with the sacrum (sacroiliac joint)
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| Ilium | Major markings include the iliac crest, four spines: anterior/posterior (superior, inferior) iliac spine, greater sciatic notch, iliac fossa, and the pelvic brim
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| Ischium | The ischium forms the posteroinferior part of the hip bone
The thick body articulates with the ilium, and the thinner ramus articulates with the pubis
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| Ischium | Major markings include the ischial spine, lesser sciatic notch, and the ischial tuberosity
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| Pubis | The pubic bone forms the anterior portion of the hip bone
It articulates with the ischium and the ilium
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| Pubis | Major markings include superior and inferior rami, pubic tubercle, pubic arch, pubic symphysis, and obturator foramen (along with ilium and ischium)
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| acetabulum | is the socket formed where the three part of the hip bone converge
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| The Lower Limb | The three segments of the lower limb are the thigh, leg, and foot
They carry the weight of the erect body, and are subjected to exceptional forces when one jumps or runs
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| The Lower Limb | Femur, Leg= Tibia, fibula
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| Femur | The sole bone of the thigh is the femur, the largest and strongest bone in the body
It articulates proximally with the hip and distally with the tibia and fibula
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| femur | Major markings include the head, fovea capitis, greater and lesser trochanters, gluteal tuberosity, lateral and medial condyles and epicondyles, linea aspera, and the intercondylar fossa
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| Leg | The tibia and fibula form the skeleton of the leg
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| Leg | They are connected to each other by the interosseous membrane
They articulate with the femur proximally and with the ankle bones distally
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| Tibia | Receives the weight of the body from the femur and transmits it to the foot
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| Tibia | Major markings include medial and lateral condyles, intercondylar eminence, the tibial tuberosity, and medial malleolus
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| Fibula | Sticklike bone with slightly expanded ends located laterally to the tibia
Major markings include the head and lateral malleolus
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| Foot | The skeleton of the foot includes the tarsus, metatarsus, and the phalanges (toes)
The foot supports body weight and acts as a lever to propel the body forward in walking and running
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| Tarsus | Composed of seven bones that form the posterior half of the foot
Body weight is carried primarily on the talus and calcaneus
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| Tarsus | Talus articulates with the tibia and fibula superiorly, and the calcaneus inferiorly
Other tarsus bones include the cuboid and navicular, and the medial, intermediate, and lateral cuneiforms
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| Metatarsals | Five (1-5) long bones that articulate with the proximal phalanges
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| Phalanges | The 14 bones of the toes
Each digit has three phalanges except the hallux, which has no middle phalanx
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| 2. Name the 7 tarsal bones | talus, calcaneus, medial cuneiform, middle(intermediate) cuneiform, lateral cuneiform, navicular, cuboid
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| 3. Which bone is a weight-bearing bone in the leg? | Tibia
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| 4. Study the structures and functions of the knee joint | medial collateral ligament,lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, and meniscus
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| Knee joint: | The largest and most complex joint of the body, consisting of 3 joints within a single synovial cavity: an intermediate patellofemoral joint, a lateral tibiofemoral joint, and a medial tibiofemoral joint.
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| Articular capsule Tibial(medial) and fibular(lateral) collateral ligament: | prevent side-to-side movement.
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| Anterior Cruciate ligament | limits the hyperextension of the knee and prevents the anterior sliding of the tibia on the femur.
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| Posterior cruciate ligament | prevents the posterior sliding of the tibia on the femur.
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| medial (tibial) collateral ligament | prevent side to side sliding
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| Tibial collateral ligament. | Broad, flat ligament on the medial
surface of the joint that extends from the medial condyle
of the femur to the medial condyle of the tibia
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| Tibial collateral ligament. | Tendons of the sartorius, gracilis, and semitendinosus muscles, all of which strengthen the medial aspect of the joint, cross the ligament.
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| The tibial collateral ligament | is firmly attached to the medial meniscus.
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| lateral(fibular)collateral ligament | prevent side to side sliding
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| Fibular collateral ligament. | This strong, rounded ligament
on the lateral surface of the joint extends from the lateral
condyle of the femur to the lateral side of the head of the
fibula
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| Fibular collateral ligament. | It strengthens the lateral aspect
of the joint.
is covered by
the tendon of the biceps femoris muscle, and the tendon of
the popliteal muscle is deep to it.
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| Anterior cruciate ligament (ACL).(close to patella) | grips on the anterior part of tibia and posterior side of femur prevent sliding anterior sliding prevents hyperextension
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| Anterior cruciate ligament (ACL). | extends
posteriorly and laterally from a point anterior to the intercondylar
area of the tibia to the posterior part of the medial
surface of the lateral condyle of the femur
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| Anterior cruciate ligament (ACL). | limits hyperextension of the knee (which normally
does not occur at this joint) and prevents the anterior
sliding of the tibia on the femur
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| Anterior cruciate ligament (ACL). | This ligament is stretched
or torn in about 70 percent of all serious knee injuries
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| Posterior cruciate ligament (PCL) (by the intercondylar fossa behind posterior) | grips the posterior side tibia and anterior part of femur to prevent posterior sliding of the tibia
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| Posterior cruciate ligament (PCL) | extends
anteriorly and medially from a depression on the posterior
intercondylar area of the tibia and lateral meniscus to the
anterior part of the lateral surface of the medial condyle of the femur
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| Posterior cruciate ligament (PCL) | prevents the posterior
sliding of the tibia (and anterior sliding of the femur)
when the knee is flexed, a very important function when you walk down stairs or a steep incline.
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| Articular discs (menisci). | Two fibrocartilage discs between
the tibial and femoral condyles help compensate for the
irregular shapes of the bones and circulate synovial fluid.
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| Medial meniscus. | The anterior end of this semicircular,
C-shaped piece of fibrocartilage is attached to the anterior
intercondylar fossa of the tibia, in front of the ACL.
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| Medial meniscus. | Its posterior end is attached to the posterior intercondylar
fossa of the tibia between the attachments of
the posterior cruciate ligament and lateral meniscus
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| Lateral meniscus. | This nearly circular piece of fibrocartilage
approaches an incomplete O in shape
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| Lateral meniscus. | Its anterior end is attached anteriorly to the intercondylar eminence of the tibia, and laterally and posteriorly
to the ACL.
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| Lateral meniscus. | Its posterior end is attached posteriorly
to the intercondylar eminence of the tibia, and anteriorly to the posterior end of the medial meniscus.
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| Lateral meniscus. | The anterior
surfaces of the medial and lateral menisci are connected
to each other by the transverse ligament of the knee and to the margins of the head of the tibia by the coronary ligaments
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| 5. What is the “unhappy triad”? | The most common type of knee injury in football usually involves three structures, which sometimes refer as the “unhappy triad”.
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| 5. What is the “unhappy triad”? | 1. rupture of tibial(medial) collateral ligament, associated with tearing of anterior cruciate ligament (ACL), and 3. medial meniscus.
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| 6. Study the origin, insertion, and action of each muscle listed in the tables. |
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| What muscles insert on the lesser trochanter of the femur? | Psoas major, iliacus
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| What muscles insert on the greater trochanter of the femur? | gluteus medius, piriformis
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| Name 6 muscles attach to (origin or insertion) the linea aspera of the femur? | gluteus maximus, adductor longus, adductor magnus, vastus lateralis, vastus medialis, biceps femoris
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| Move the femur | Ilipsoas: psoas major, iliacus;
gluteus maximus
gluteus medius
tensor fasciae latae
piriformis
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| Psoas major | O: lumbar vertebrae
I: lesser trochanter of femur
A:Flex thigh, laterally rotate thigh
N:femoral nerve (lumbar spinal nerves L2-L3)
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| Iliacus | O:Iliac fossa
I: Lesser trochanter of femur
A: Flex thigh, laterally rotate thigh
N: femoral nerve
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| Gluteus maximus | O: Iliac crest, sacrum, coccyx
I: Iliotibial tract & linea aspera (gluteal tuberosity
A:Extends thigh, laterally rotates thigh
primary fxn extension of hip
N:Inferior gluteal
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| Gluteus medius | O: Ilium
I: Greater trochanter of femur
A:Abducts thigh, medially rotates thigh
Only one medial rotation
N: Superior gluteal
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| Tensor fasciae latae | O: Iliac crest
I: Tibia by way of iliotibial tract
A:
N:Superior gluteal
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| Piriformis | O: Anterior sacrum
I: Greater trochanter of femur
A: Abducts thigh, laterally rotates thigh
N: sacral spinal nerves , S1-S2, mainly S1
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| Medial (adductor) compartment of the thigh | adductor longus (anterior to gracilis)
gracilis (long, middle ruler muscle)
adductor magnus (posterior to gracilis, magnus= large big huge muscle)
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| Gracilis | O: Inferior ramus of
pubic
I:Medial of tibia
A: Adducts and flexes
thigh
N: Obturator Nerve
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| Adductor longus | O: Pubic symphysis
I: Linea aspera
A: Adducts and flexes
thigh
N:Obturator Nerve
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| Adductor magnus | O: Inferior ramus of
pubic & ischium
I: Linea aspera
A:Adducts and flexes
thigh
N: Obturator Nerve, Sciatic nerve
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| ANTERIOR (EXTENSOR) COMPARTMENT OF THE THIGH | Quadriceps femoris & sartorius
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| Quadriceps femoris | Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
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| Rectus femoris | O: Ant. Inf. iliac
spine
I: Patella via quadriceps
tendon and then tibial
tuberosity via patellar
ligament
A:All four heads
extends leg at knee
Joint; (rectus femoris
Alone also flexes
Thigh)
N: Femoral Nerve
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| Vastus lateralis | O: Greater trochanter & linea aspera (posterior of femur)
I: Patella via quadriceps
tendon and then tibial
tuberosity via patellar
ligament
A: All four heads
extends leg at knee
Joint; (rectus femoris
Alone also flexes
Thigh)
N:Fe
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| Vastus medialis | O: linea aspera
I: Patella via quadriceps
tendon and then tibial
tuberosity via patellar
ligament
A: All four heads
extends leg at knee
Joint; (rectus femoris
Alone also flexes
Thigh)
N: Femoral Nerve
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| Vastus intermedius | O: Ant. femur (shaft)
I: Patella via quadriceps
tendon and then tibial
tuberosity via patellar
ligament
A: All four heads
extends leg at knee
Joint; (rectus femoris
Alone also flexes
Thigh)
N: Femoral Nerve
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| sartorius (oblique anterior side of thigh) | O: Ant. sup. iliac
spine (cross ur hip)
I:Medial surface of tibia
A: Flexes leg at knee.
Flexes, abducts,
laterally rotates thigh
N:Femoral Nerve
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| POSTERIOR (FLEXOR) COMPARTMENT OF THE THIGH | hamstrings: biceps femoris (lateral), semitendinosus (medial superficial), semimembranosus (medial deep)
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| biceps femoris (lateral) | O: Long head: ischial
tuberosity; short
head: linea aspera
I: Head of fibula
A: All three: flexes leg
And extends thigh
N: Sciatic nerve
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| semitendinosus (medial superficial) | O:Ischial tuberosity
I:Medial surface &
condyle of tibia
A:All three: flexes leg
And extends thigh;
both insert tibia extension of the hip & flexion of knee
N:Sciatic nerve
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| semimembranosus (medial deep) | O:Ischial tuberosity
I:Medial surface &
condyle of tibia
A:All three: flexes leg
And extends thigh;
both insert tibia extension of the hip & flexion of knee
N:Sciatic nerve
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| Move foot & toes |
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| ANTERIOR COMPARTMENT OF THE LEG | tibialis anterior, extensor hallucis longus, extensor digitorum longus
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| tibialis anterior | O: Lateral condyle &
body of tibia
I: 1st (medial)cuneiform &
1st metatarsal
A:Dorsiflexes foot
inverts foot
(no toes)
N:Deep fibular (peroneal) nerve
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| Extensor hallucis longus | O:
I:
A: Dorsiflexes foot &
Extends great toe
(big toe)
N:Deep fibular (peroneal) nerve
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| Extensor digitorum Longus | O:
I:
A: Dorsiflexes foot &
Extends toes
( 4 toes)
N: Deep fibular (peroneal) nerve
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| LATERAL (FIBULAR) COMPARTMENT OF THE LEG | peroneus (fibularis) longus, peroneus ( fibularis) brevis
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| peroneus (fibularis) longus | O: Head & body of
fibula, lateral
condyle of tibia
I: 1st metatarsal
& 1st cuneiform
A: Both muscles plantar
flex foot & evert
foot
primary fxn evertion
N:Superficial fibular nerve
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| peroneus ( fibularis) brevis | O:
I:
A: Both muscles plantar
flex foot & evert
foot
N: Superficial fibular nerve
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| SUPERFICIAL POSTERIOR COMPARTMENT OF THE LEG | gastrocnemius, soleus
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| gastrocnemius | O: Lateral and medial
condyles of femur
I: Calcaneus by way of
calcaneal (Achilles)
tendon (both muscles)
A: Plantar flexes foot ( weight bearing muscle)
N: Tibial nerve
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| soleus | O: head of fibula &
medial border of
tibia
(leg bone)
I: Calcaneus by way of
calcaneal (Achilles)
tendon (both muscles)
A: Plantar flexes foot
N:Tibial nerve
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| DEEP POSTERIOR COMPARTMENT OF THE LEG | tibialis posterior ( middle, small, narrow),
flexor digitorum longus (medial all 4 toes, cross over),
flexor hallucis longus ( lateral, big toe, but large)
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| Tibialis posterior | O:
I:
A: Plantar flexes foot
& inverts foot
N: Tibial nerve
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| Flexor digitorum longus | O:
I:
A: Plantar flexes foot
& flexes toes
N: Tibial nerve
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| Flexor hallucis longus | O:
I:
A:Plantar flexes foot
& flexes great toe
N:Tibial nerve
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| 7. Study the lumbar plexus and sacral plexus: |
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| Lumbar plexus: | femoral nerve, obturator nerve
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| Lumbar plexus | - Anterior rami of spinal nerves L1-L4.
- Supplies the anterolateral abdominal wall, external genitals, and part of the lower extremity.
The major nerves are the femoral and the obturator
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| Femoral nerve | - Deep to inguinal ligament, lateral to femoral artery.
- Supplies flexors of thigh, extensors of leg; skin on front and medial thigh, medial leg and foot.
- Injury: inability to extend the leg and loss of sensation in the skin over anteromedial thigh
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| Obturator nerve | - Through obturator foramen.
- Supplies adductor muscles of leg, skin over medial thigh.
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| Sacral Plexus | sciatic nerve: the tibial and the common fibular (peroneal) nerves
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| Sacral Plexus | Arises from L4-S4 and serves the buttock, lower limb, pelvic structures, and the perineum
The major nerve is the sciatic, the longest and thickest nerve of the body
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| Sacral Plexus | The sciatic is actually composed of two nerves: the tibial and the common fibular (peroneal) nerves
- Supplies the buttock, perineum, and lower extremities.
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| Superior gluteal nerve | gluteus minimus and medius; tensor fasciae latae
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| Inferior gluteal nerve | gluteus maximus
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| Sciatic nerve | hamstring muscles & adductor magnus
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| Tibial nerve | flexor muscles in the posterior compartment of leg
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| Common peroneal (fibular) nerve | lateral (superficial peroneal) and anterior compartments (deep peroneal) of leg
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| Common peroneal (fibular) nerve | injury: footdrop
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| Sciatica | a type of neuritis characterized by severe pain along the path of the sciatic nerve and its branches. Inflammation and infection; most common cause: herniated disc
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| 8. What spinal nerves make up each plexus? | Lumbar Plexus (L1-L4)
Sacral Plexus (L4-S4)
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| 9. What are the main nerves coming out from the lumbar plexus? | Femoral Nerve
Obturator Nerve
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| 9. from sacral plexus? | Superior gluteal
Inferior gluteal
Sciatic nerve
Tibial nerve
Common fibular nerve
Superficial fibular nerve
Deep fibular nerve
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| 10. What area or muscles are innervated by femoral nerve? | Flexors of hip (iliacus, psoas major)
Extensor of knee (quadriceps femoris= rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) + sartorius
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| 10. by obturator nerve? | Adductors of hip (adductor longus, adductor magnus, gracilis
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| 10. by superior gluteal nerve? | Gluteus medius, tensor fasciae latae
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| 10. by inferior gluteal nerve? | Gluteus maximus
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| 11. What are the two nerves make up the sciatic nerve? | the tibial and the common fibular (peroneal) nerves
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| 12. What area or muscles are innervated by the sciatic nerve? | - Supplies the buttock, perineum, and lower extremities;
Hamstrings (biceps femoris, semitendinosus, semimembranosus)
Adductor magnus
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| 12. by the tibial nerve? | Posterior leg muscles (5): gastrocnemius, soleus, tibialis posterior, flexor digitorum longus, flexor hallucis longus
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| 12. deep fibular nerve? | Anterior leg muscles (3) = tibialis anterior, Extensor hallucis longus
, Extensor digitorum Longus
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| 12. by superficial fibular nerve? | Lateral leg muscles (2): fibularis longus, fiburalis brevis
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| 13. What nerve injury would cause a condition called footdrop? | Common fibular nerve
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| 14. What muscle is innervated by both obturator and sciatic nerve? | adductor magnus
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| 15. What muscles are commonly used as an intramuscular injection site? | Intramuscular (IM) injection sites:
Gluteus medius, vastus lateralis, and deltoid
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| 16. What muscles and structure form the femoral triangle? | Femoral triangle:
Boundaries: Superior-medial: inguinal ligament
Lateral: sartorius
Inferior-medial: adductor longus
Floor: iliopsoas
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| 16. What are the contents of the triangle? | Contents (medial – lateral): VAN (femoral vein, artery, nerve), deep inguinal lymph nodes, and entrance of great saphenous vein
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| 17.What muscles form the boundary of the popliteal fossa? | Popliteal fossa: (diamond-shaped space)
Boundaries:
superior (medial: semitendinosus, semimembranosus; lateral: biceps femoris)
Inferior: gastrocnemius (medial & lateral head)
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| 17. What are the contents of the fossa? | Contents: popliteal artery and vein; bifurcation of sciatic nerve into tibial and common fibular nerve; entrance of small saphenous vein
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| 18. Study the great saphenous vein. | -The longest vein in the body
-Medial side of lower limb; empties into femoral vein at femoral triangle.
-Subject to becoming varicose with formation of clots.
-Is used in coronary bypass surgery.
-Are often used for prolonged IV.
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| great saphenous vein | medial ankle= medial malleolus
pass anterior to the medial malleolus of the tibia and then superiorly along the medial
aspect of the leg and thigh just deep to the skin
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| Small (short) saphenous vein: | - Lateral side, empties into popliteal veins in the popliteal fossa.
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| Superficial veins: | Great saphenous vein & Small (short) saphenous vein
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