Tibial & Fibular Sides of the Leg
Tibial - Medial
Fibular - Lateral
Peroneal
Fibular (synonym)
Which of the extensor/flexor groups is anterior and which is posterior (Legs)
Extensor - Anterior
Flexors - Posterior
Ilium
Pubis
Ischium
Inguinal Ligament
Inguinal Ligament Attachments
Anterior Superior Iliac Spine to Pubic Tubercle
Acetabulum
Socket of Pelvis
Anterior Superior Iliac Spine and Anterior Inferior Iliac Spine
Iliac Crest
Ischial Tuberosity
Greater & Lesser Trochanters of the Femur
Intertrochanteric Crest
(Posterior)
Intertrochanteric Line
(Anterior)
Linea Aspera
(Posterior)
Adductor Tubercle
Which bone articulates at the distal end of the femur
Tibia
Patella
Femural Condyles
(Posterior)
Tibial Tuberosity
Medial and Lateral Malleolus
Medial is formed by tibia, lateral by fibula
Bony protrusions on either side of your foot
What are tarsal bones
Bones at the base of the foot equivalent to the carpal bones of the hand
How many tarsal bones are there
7
What are the Tarsal Bones
Talus Calcaneus Navicular Bone Cuboid Bone Lateral/Intermediate/Medial Cuneiform
**TALUS COVERS NAVICULAR, NAVICULAR COVERS CUNEIFORM
Fascia Lata
Deep fascia of the thigh, very strong and thickened laterally
Discuss the fascia of the lower limb
Forms a stocking around the leg
Site of muscle attachment
Thickened Laterally
Divides the anterior, medial and posterior compartment by attatching to the linea aspera
Gluteus Maximus
Gluteus Medius
What muscle is deep to gluteus medius
Gluteus minimus
Piriformis
Role of the hamstrings
Extensors of Hips and Flexors of the Knee
Muscles making up the hamstrings
Biceps Femoris
Semimembranosus
Semitendinosus
Semitendinosus has long tendon, semimembrunosus has long membranous region
Where do the hamstrings originate
Ischeal Tuberosity
Where do the hamstrings insert
Fibula (biceps) or Tibia
Common site of hamstring injuries
Ischial tuberosity associated with tearing of the proximal attachment
Role of muscles at the anterior thigh
Flexors of hip & extensors of knee
**Most muscles do one or the other
Heads making up the Quadriceps
Rectus Femorus
Vastus Lateralis
Vastus Intermedius
Vastud Medialis
Which of part of this muscle is the rectus femorus
Where is the vastus intermedius located in this diagram
Posterior to the rectus femorus (not visible)
Innervation of Quadriceps Femoris Muscle
Femoral Nerve (L2-L4)
Functions of quadriceps
Flexion of the hip (only rectus femorus)
Extension of knee (all heads)
How do the quadriceps muscles work together to extend the knee
They come together at the knee where they unite at the quadricpes tendon
Within it is the patella
This carries on to form the patella ligament and attaches at the tibial tuberosity
Sesamoid Bone
Bone embedded within a tendon (e.g. patella)
Iliacus
Psoas Major
Iliopsoas and its parts
Iliacus
Psoas Major
Function of iliopsoas
Flexon & external rotation of thigh at hip
Flexion of trunk at hip
Lateral flexion of trunk (psoas major only)
Sartorius
Forms lateral boundary of femoral triangle
Name these Hip Adductors
Where does the adductor magnus lay relative to the rest of the hip adductors
Posterior/Deep
Which hip adductor is the weakest
Gracilis - often used in transplantation
Groin Strain
The pulling/tearing of one of the proximal attachments of a hip adductor/flexor
Plantar vs Dorsal aspect of foot
Plantar is side on the floor (heel, arch, ball, etc)
Dorsal is the side with your toenails
Plantarflexion
Role of calf muscles
Plantarflexion
Action of muscles in lateral compartment of lower leg
Eversion
Groups of Calf Muscles and their roles
Superficial Group - All plantarflex ankle
Deep Group - Most Planterflex ankle/flex toes
**Superficial generates most force
Superficial Calf Muscles
Gastrocnemius medial and lateral Heads
Soleus (just deep to it)
Discuss the insertion of the superficial calf muscles
These muscles come together to form the calcaneal tendon (achilles tendon) and attaches over onto calcaneus (tarsal bone forming the heel)
Triceps Surae
Another name for Superficial Calf Muscles (since it is made of 3 heads)
Important for venous return since it is constantly active
Which group of muscles produce produce 93% of planterflexion force
Triceps Surae
Which calf muscles of the deep calf muscles plantarflex the ankle
Flexor Digitorum Longus
Flexor Hallucis Longus
Which calf muscle inverts the foot
Tibialis Posterior (TP)
- *ALSO SOMEWHAT ASSISTS IN PLANTARFLEXION
- *DEEPEST MUSCLE OF POSTERIOR LEG
Role of popliteus (calf muscle)
Major stabiliser of knee
What are the everter muscles of the foot
Fibularis Longus & Brevis
**In lateral compartment of lower leg
Relation of fibularis longus & brevis with lateral malleolus
Tendons pass posterior to the lateral malleolus and attaches at lateral aspect of foot
Relation between fibularis brevis and longus
Fibularis longus is superficial to brevis
Fibularis Tertius
Secondary eversion muscle in anterior compartment
Not a main everter
Relation between tendons of fibularis longus and tibialis posterior
The fibularis longus tendon comes across the dorsal aspect of the foot and passes over the tibialis poster tendon to keep it in place
Muscles in the anterior compartment of the lower leg
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallucis Longus
Nerve Roots of Lumbar and Sacral Plexus
Lumbar L1-4
Sacral L4-S4
Terminal Branches of the Lumbosacral Plexus
Femoral Nerve Obturator Nerve Superior Gluteal Nerve Inferior Gluteal Nerve Sciatic Nerve
Nerves in Sciatic Nerve
Common Fibular Nerve
Tibial Nerve
What does the Femoral Nerve Innervate
Most of the anterior compartment (quads) of the thigh
What does the Obturator Nerve Innervate
Most of the medial compartment of thigh (Adductors)
What do the Gluteal Nerves Innervate
Some muscles of the gluteal region
What does the Sciatic Nerve Innervate
Posterior compartment of thigh
What does the Common Fibular Nerve Innervate
Superficial Branch - Lateral compartment of leg
Deep - Anterior compartment of leg
What does the Tibial Nerve Innervate
Posterior Compartment of Leg
Why is the piriformis an important anatomical landmark
The Sciatic Nerve comes out below it
The inferior gluteal neurovascular bundle (VAN) passes below it and innervates the gluteus maximus
The superior VAN passes above it and innervates gluteus minimus and medius
Popliteal Fossa
Diamond Shaped space behind the knee
Contents of the popliteal fossa
Sciatic Nerve splitting out of sheath releasing tibial nerve into fossa
Sural Nerve (cutaneous)
**Common fibular nerve goes laterally
What forms the sural nerve
A branch coming off the tibial and a branch coming off the common fibular
Role of the Sural Nerve
Cutaneous Nerve for the lateral aspects of the leg and foot
Femoral Triangle Boundaries
Superior - Inguinal Ligament
Medial - Adductor Longus
Lateral - Sartorius
Floor - Pectineus
**APEX WHERE AL & S MUSCLES MEET
Contents of Femoral Triangle
Femoral VAN (Medial to Lateral)
(Vein including Branches)
Lymphatic Drainage*
Bondaries of Popliteal Fossa
Biceps Femoris
Semimembranosus
Semitendinous Tendon
Lateral & Medial Heads of Gastrocnemius
Contents of Popliteal Fossa
Popliteal Vein
Popliteal Artery & Branches
Termination of Small Saphenous Vein
Nerves
Lymphatic Vessels & Nodes
Discuss the path of the femoral nerve
From the femoral triangle, it innervates the various muscles around it
After this it carries on through the adductor canal as a sensory nerve (Saphenous Nerve) where it carries onto the medial aspect of the leg and provides the cutaneous innervation
Discuss the path of the Tibial Nerve
It goes in the popliteal fossa then carries on in the posterior region of the leg region’s deep compartment
Discuss the path of the Common Fibular Nerve
Comes off the sciatic, goes laterally and winds around the head of the fibula (it is exposed and at risk during injury)
It branches into a superficial branch that goes in the lateral department and a deep branch that goes in the anterior compartment
Common trauma to nerves - Femoral Nerve
Anterior Thigh Trauma
Common trauma to nerves - Superior Gluteal Nerve
Hip Surgery
Common trauma to nerves - Sciatic Nerve
Posterior Hip Dislocation
Common trauma to nerves - Common Fibular Nerve
Trauma/Fracture at neck of fibula
Origins of Femoral Artery
Abdominal Aorta Bifurcates into Common Iliac
Branches into External and Internal Iliac arteries
Once the External Iliac goes under inguinal ligament it becomes the Femoral Artery which carries on down the thigh
Main branch of femoral artery and its importance
Profunda Femoris Artery
This artery is important because it forms several branches that form important anatamoses at the hip
**Look at Post View
What is the adductor hiatus
An opening in the Adductor Magnus muscle
Path of the Femoral Artery
It goes down the thigh and goes through the adductor hiatus
It then goes posteriorly and becomes the popliteal artery
Discuss the path of the Popliteal Artery till the end(s)
Popliteal Artery branches into the Anterior and Posterior Tibial Arteries
The Anterior goes down the anterior compartment of the leg to become the dorsal artery of the foot
The Posterior goes around the medial malleolus through to the foot
Where can the Femoral Pulse be palpated
Midway across the Inguinal Ligament
Where can the Popliteal Pulse be palpated
Deep in the popliteal fossa between the tendons
Where can the Posterior Tibial Pulse be palpated
Posterior to the Medial Malleolus
Where can the Dorsalis Pedis Pulse be palpated
Lateral to the Extensor Hallucis Longus Tendon
Clinical Relevance of Femoral Triangle
Used to locate the Femoral Artery for Canulation
Superficiality Relations of Great Saphenous Vein
Superficial to Fascia Lata
Where does the Great Saphenous Vein join the Femoral Vein
In the Femoral Triangle (I think) through the Saphenous opening
Lymphatic Drainage of Lower Limb
Lower limb drains directly or indirectly into the inguinal lymph nodes
Femoral Sheath, Canal and Ring
Structure that surrounds the Artery, Vein and Lymphatic Vessel (Each in own compartment)
Femoral Nerve is outside of it
Femoral Canal is where the lymphatic vessel is (Medial Compartment)
Femoral Ring is the top end of that canal
Clinical Relevance of Femoral Sheath/Canal
At risk of part of the digestive system entering the femoral ring if it’s weak; the abdominal contents may then come out of the inferior aspect and go through the saphenous opening
This creates a Femoral Hernia due to tissue strangulation
Venous Drainage of Lower Limb
Small Saphenous Vein drains into the Popliteal Vein in the Popliteal Fossa
This then drains into the Femoral Vein
Perforating veins allow blood from superficial vein to drain into deeper veins
Circulatory Problems most likely to affect the lower limb
Arterial Insufficiency
Venous Insufficiency
(Lymph)oedema
Which Bones form the Pelvis
Ischium
Ilium
Pubis
Sacram
