lower limb Flashcards
Explain the Ant femoral region , Landmarks,
limitis,projaction,
layers ,
—Land marks :
1-Symphysis
2-pubic tubrecle
3-patella
4-Ant.sup. iliac spine
5-greater trochanter of femur
6-Serratus muscle
7-epicondyle of femur
—limits :
1-sup: line connecting Ant.sup iliac with puibc tubercle
2-inf: circular line drawn 6cm above patella
3-medial: line goes from pubic symphysis to medial epicondyle
4-lateral : line goes from sup.ant iliac spine to lateral epicondyle
—projections:
1-inigunal ligament : projected through sup limit
2-femoral Ar: projacted along line drawn from medial of lnigunal ligament to medial epicondyle
3-femoral v: deep from Ar projacted
4-Femoral N: projacted exteranl from Ar
5- Antcountenous N of the thigh : projacted along the line corssponding to suratus ms .
—layers :
1- skin : thick and movable
2-subcoutenous : it contain blood vessels, lymphatic vessels and nods and nerves branches
2.1: superfasical epigastric Ar : runs in subcotenous cellular tissue up to middle of projaction of ingunal ligament
2.2: superfasical external pudendal : goes inwards into the perineal region
2.3 genetofemoral N : located under medial part if ingunal ligament
2.3 lateral cotenous N of the thigh : passes below sup Ant iliac spine and innervate skin of lateral side till the level of patella
2.4 cotenous Br of obtator N : innervate skin of medial surface of femoral by passing betwen gracilis and aduuctor lungus
3-fascia lata : its consist of 3 bounders
3-1 sup : enclosed by ingunial ligament
3-2 inf : investes all muscles of thigh and form iliotibial tract
3-3 post : passes into gluteal fascia .
all these bounders forms isolated capsule for muscles and divide region by 3 intermascular septa ( lateral , medial , post ) wich attached to linea aspera and divide the subfasical space of the thigh into 3 compartment :
1- Ant compartment ( extensor )
2- post compartment ( flexor )
3- medial compartment ( adductor )
——
explain the Ant femoral region , muscular space ,vascular space , femoral triangle,femoral canal , obtator canal , ant femoral groove ,adductor canal
—muscular space ; lateral
-bounded by :
1-Ant : ingunial ligament
2-post : pubic crest
3-medial : iliopectneal Arch
4-lateral : tendinous Arch
-contain :
1-femoral N
2-ilio pasos m
—vascular space : medial
-bounded by :
1- Ant: ingunial ligament
2-post: pubic crest
3-medial : lacunar ligament
4-lateral : iliopectneal arch
-contain :
1- femoral Ar : more lateral
2-femoral V : more medial
3-femoral Br: of genito femoral
—Femoral triangle ( Scarpa )
-bounded by :
1-medial : adductor longus
2-lateral : Saratus ms
3-sup : ingunial ligament
4-inf : cross of these muscles
5- base : pectneal and iliopsaos m.
-Contain :
1-Femoral Ar : direct communication of External iliac Ar , in level of Sphenous hates Ar and covered by falciform margin , and lies outward from femoral V , and then spiltes into 3 superfascial branches
1.1 superfascial epigastric
1.2 superfascial circumflex iliac
1.3 Pudendal external superfascial - deep one as well
2-femoral V : lies medially from the femoral Ar , while the greater sphounes V and same name vines of superfascial Ar drains into it , later then the vein disappears behind the femoral Ar .
3-deep femoral Ar : its the main vascular collateral of the thigh , the same name V goes inwards and give 2 branches > medial and lateral circumflex Ar
4-medial circumflex Ar : goes horizontally behind femoral vessles in the medial border of iliopasos m . and divided into :
4.1- superfascial br : that goes transversally to garcilis
4.2- deep br : that continuation of the Ar runs between pectinous and obtator external , to split into :
> ascending that goes to gluteal region and Anstamosis with gluteal Ar
> descending : thats runs posterilly of External obtator and adductor minimus to anastamosis with branches of obtator and perforating Ar
5-lateral circumlfex femoral ar : its splits into :
5.1- ascending : thats passes betwen rectus femuris and sartoris then goes up and lateral to gluteal region to anstamosis with superior gluteal Ar and takes a part of formation of subtendinous plexus in greater trochanter
5.2-Descending ; runs down between Rectus femuris and vastus intermediates and reach Arterial plexus of the knee joint and form anastamosis with br id popleatal ar .
6- Femoral N : comes from muscular space and lies outwards of vessels in femoral triangle and splits into :
6.1- superfascial br : that goes to the skin
6.2- deep br : thats innervate qudeacips and pectinous
6.3- then accompanied together to make Siphons N
— Femoral Canal : its formed in case of Hernia bulging through femoral ring , the canal situated between superfascial and deeplamina of fasicalata , it has 2 openings :
1-deep opening ( femoral ) : projected upon medial 3 of inguinal ligament
> the harnia comes from abdominal cavity and gets into the canal through femoral ring and lies in most medial part of vascular spaces and has 4 border :
1-Ant: ingunial ligament
2-post : pecteneal ligament
3-medial : laconar ligament
4-lateral : femoral vein
2-superfascial opening ( sphenous ) projected 1-2 cm downward of its enclosed by cribriform fascia and it has 3 border :
1-Ant: superfascial lamina of fascia lata
2-Post : deeplamina of fascia lata
3-lateral : femoral vein
—Obtator canal : is a groove in inf surface of pubic bone , borded inf by obtator membrane and its muscle , and it has 2 formans :
1-external foramen : is projected 1-2 cm downward, covered by Pectnous of ingunal ligament
2-deep foramen : is projected into Retropubic cellular space and contains:
> obtutor N and Ar , ar anastmosis with medial circumflex femoral , ingunial Ar
> Nerves : Ant.Post branches innervate adductor and garcilis and skin of medial surface of the thigh
—Ant femoral groove: is located in middle 3rd of thigh between addoctor and quadriceps , Covered by proper fascia and sartoris m and femoral V , Ar downward , and there is 3 profrating branches Arise :
1-in level of lesser trochanter
2-proximal border if addoctor longus
3-direct contention of deep femoral Ar.
—Adductor canal ( Hunter ) : its continuation of Ant femoral groove at borderlines of middle and lower 3rd and lies under fascia lata
-walls :
1-Ant : sartorius m . and intermascular septum , vasto adductorium
2-medial : adductor magnus
3-lateral : vastus medialis
-openings :
1-sup opening : femoral Ar , V and sephnous N
2-inf opening : femoral Ar , V runs to polital fossa
3-Ant opening : saphenous N and descending genculate Ar , V
-connections :
1-proximal : connected with femoral triangle
2-Distal : connected with popliteal Fossa
explain the gluteal region , landmarks , limit’s, projections , layers ,NVB
—Landmarks :
1-iliac crest
2-Ant.sup.iliac spine
3-Post.sup.iliac spine
4-intergluteal cleft
5-gluteal fold
6-ischial tubristy
7-greater trochanter
8-sacram and coccyx
—limits:
1-Sup : iliac crest
2-inf : gluteal fold
3-lateral : vertical line drawn from sup ant iliac spine to greater trochanter
4-medial : spinous process if sacrum and coccyx
—projections:
1-Sciatic N : A point projacted in middle distance between ischium tubresity and greater trochanter
2-Sup.glutealnurovascular: projacted in borderline between upper and middle third’s in lateral limits
3-inf.glutealnurovascular : projected outwards and inwards of middle line drawn from same spine to ischium tuberosity
—Layers :
1-skin : thick and slightly movable
2-subcotenouns : its cellular fatty tissue
3-properfasica : attaches to iliac crest and sacrum superiorly and medially and passes into fsica lata inferiorly and anteriorly
4-muscles: located in 3 layers :
4.1- 1st layer : gluteus maximus
4.2- 2nd layer : gluteus medius ,piriformis , gemellus sup , internal obtator , quadratus
4.3- 3rd layer : gluteus minmus , extrenal obtatur ms.
5-infragluteal space :
5.1- Ant: fascia and 2 layer
5.2- Post: deeplamina of proper fascia of gletus maxi
5.3- sup: enclosed As result of attachment of properfascia to iliac crest
5,4-medial : enclosed to attachment properfascia to sacrum and coccyx
—NVB :All arteries and nerves in this region comes out from pelvic cavity through greater sciatic foramen that form 2 foramens :
1-SupraPiriform foramen : bounded by greater sciatic notch , piriform ms ,
-contain : Sup gluteal Ar,V,N
1.1-Supgluteal Ar: branches off from post trunk of internal of internal iliac Ar in lesser Plevis and supply Piriform ,gluteal,gluteal Max,med,mini with blood
1.2-Supgluteal V : form olexus covers the Ar
1.3 supGluteal N : lies downward and outwards from vessles and innervate same muscles
2-infraPiriform foramen : bounded by greater sciatic notch ,Sacrospinous ligament, and has 3 bundles
2.1- 1st bundle : Sciatic N , Ar : its the largest N in human body and located laterally in lower margin of glutes max , located more superfascially , while the Post Cutaneous N of femur passes medially from it .
2.2 - 2nd bundle : infgluteal Ar.V.N : Ar is surrounded by same name V and N.
2.3- 3rd bundle : internal pedundal Ar,V,N : they passes medially , lies between Sacro-spin ligament and ischial bone , then pass through pudendal canal ( Alcock ) , nerves passes more downward and medially
-this canal formed by obtatur internal and its fascial with ischial bone
explain Ant region of Knee , landmarks, limits, layers
—landmarks:
1-patella
2-tendon of Qudriceps
3-tibial Tuberosity
4-head of fibula
—limits:
1-Sup : Circular line drawn 6cm above patella
2-inf : circular line drawn in level of tibial tuberosity
3-medial , lateral : 2 vertical like drawn through condaylers of femurs .
—Layers :
1-skin : is thick and movable
2-Subcotenous : Branches of vessels and nerves pass through it , then there is different synovial bursa > knee joint
3-under the fascia : patellar vascular network, more deeper , there is rich Arterial Network > that important for collateral blood circulating At damage of blood flow through femoral or popliteal Ar
explain Post region of Knee , landmarks , limits, projection , popleatial fossa, layers , NVB
—landmark’s:
1-epicondlyes of femurs
2-longtudinal toras
3-musculo-tendinous borders of rhomb
—limits : Same as anterior region
—projections :
1-Tibial N, and popleatial vessels : projacted along a vertical line going from sup angle of popliteal fossa through its middle
2-common Fabular N : projected along the same vertical line further along the medial margin of tendon of biceps femurs downward to external surface of neck of fabula
3-knee joint space : projected a little inf of transverse coutenous fold
—Popleatial fossa : Rhomboid shape
-borders :
1-laterally : biceps femurs
2-medially : semitendouns , semimembrenois
3-inf: Gastrocnemius
—layers :
1-skin :thin and movable
2-Subcotenous : branches from Post femoral cutenous N. reach the articular like at the limits with ant region / saphnous N . splits medially in middle of this region and there superfascial popliteal lymphnodes
3-Popleatial fascia :its continuation of Fasica lata , its thick like aponeurosis duo to it pulsation Can’t be felt at this region
___NVB:
1-tibial N : right under the popliteal fascia , in this spot it gives muscular Br and medial sural cutneous N, then it goes together with saphenous first in groove. between heads of gastrocnemius ms. and in leg it exits into Subcutenous tissue through splitting of properfascua and fuses with lateral sural cutenous N. into Sural N.
2-Common Fabiular N : located lateral from tibial N , which join to medial margin of biceps femurs and gives odd lateral cutenous sural br in the popliteal fossa .
3-Popliteal V : lies more medially and deeper of tibial N .
4-popleatial Ar: lies more medially and deeper , mostly, both Ar and V embedded in tight Fascial sheath runs into the popliteal fossa at the superior limit of this region from adductor canal
5-Geniculate Muscular Br: Its , Suplat,Supmed,infralat,inframed,middle in the popleatial fossa
explain the Ant region of the Leg , landmarks,limits,projections,layers , Ant compartment ms , lateral compartment ms , NVB
—landmarks:
1-medial and lateral Malleoli
2-head of fabula
3-condyles of tibia
4-tibia tiberosty
5-Ant.medial border of tibia
—limits:
1-Sup: horizontal line drown in level of tibial tubersoty
2-inf:horizontal line drawn through the bas of malleoli
3-medially: vertical line drawn through medial border of tibia
4-laterally: vertical line drawn in groove between fibularia and soleas M .
—projections :
1-Ant tibial Ar , deep fabiular N : line projected middle distance between tibial tubrosity and head of fibula to middle of distance between malleoli
—layers :
1-skin : thin and movable
2-subcutaneous:has a common structure, except in region of tibial tuberosty almost not present
2.1-Superfascial fibular N : passes in subcutaneous cellular tissue at border line of middle and lower third of leg , by antlaterla border of leg
2.2- Greater saphenous V. : runs Antromedially accompanied with lateral Cutenous sural N
3-Properfascia : its similar to aponeurosis and covers Extensor ms. and fibular ms of leg , this fascia consist of 2 intermascular septum :
1-Ant intermascular septum : which attached to Ant margin of fibular and divided muscles of leg into Ant and lateral compartments
2-Post intermascular septum : attached to post margin of fibula and divided ms of leg into post and lateral compartments
—Ant compartment conatin :
1-Tibialis Anterior ma
2-extensor hallucis ms
3-extensor tertus ms
4-Anterior tibial Ar,V
5-deep fibular N .
—Lateral Compartment Contain :
1-Fibularis longus ms
2-Fibularis brevis ms
3-Superfasical fibular N
—NVB :
1-lateral Compartment:
-bounded by :
1. Ant : Antimtermascular septum
2. post intermascular septum
3. medial : fibula
4. lateral Proper fascia
-Contain :
1-Superfascial Fibular N : exited between portions of fibularis longus and goes down along the Antintermascular septum till the lower 3rd of leg when it places the fascia and goes to subcutaneous
2-Superior musculo fibular canal: located also between portions of fibularia longus , in level of lateral condyle of tibia and head if fibula , through it the Common fibular N . enters which splits into superfascial and deep fibular N .
2- Ant compartment:
-bounded by :
2.1-lateral: extensor digitorm longus
2.2-medially : Ant surface of tibia
2.3 in the middle of lateral and medial : hallucis longus
-Contain:
1-Deep fibular N : passes from lateral compartment into Ant one by perforating Antintermascular septum in the upper 3rd
2-Ant.Tibial Ar : it passes in Ant compartment through opening in internal membrane situated at medial margin of fibula , and gives anastamosis with : descending gemiculate Ar , inf,medial gemiculate Ar , then it gives off Antmedial and Antlateral malleolar Ars
explain the Post region of leg , landmarks, limits, projections, layers , superfascial posterior Compartment ms, deep posterior compartment ms , NVB
—landmarks:
1-head of fibula
2-tibial condyle
3-Achilles tendon
4-lateral and medial malleoli
5-eminence of gastrocnemius ms.
—limits: same as Ant region
—projections :
1-tibial Nerovascular bundle : projected along the line drawn from middle of popleatial fossa to middle distance between medial malleoli and Achilles tendon
—layers :
1-skin: thin and easily taken in fold , innervated by saphenous N.
2- Subcutaneous:
2.1-lesser saphenous V: goes around lateral malleolis then runs upward and medially like the greater one and then unites with deep veins through profotating vines , in middle of leg it precise the proper fascia and lies under its lamina in pirgoff canal then runs into popliteal V. and its accompanied with medial cutenous sural N , while from lateral side the lateral cutenous sural N branching from common tibial N . in the distal part of the leg both together forms Sural N . which is innervate skin in area of lateral malleoli
2.2- Saphenous N : branch out of femoral N, and splits into branches in narrow area of skin in Postmedial surface of leg along the rest of post region of skin is innervated by branches from tibial and fibular N
3- proper fascia : its forms the Post Compartment
—NVB :
