Dr. Banafshe Esmaeilzade, M.S., Ph.D.Deptartment of Anatomy

Bushehr Univ. of Medical Sciences

,Dr. Banafshe EsmaeilzadeM.S., Ph.D.Deptartment of Anatomy

Bushehr Univ. of Medical Sciences

Organization of the Lower Limb

Limb Development

Limb Rotation

Regional anatomy of the lower limb

Parts and regions of the lower limb

• Gluteal region:between iliac crest superiorly and gluteal fold inferiorly

• Thigh:between hip and knee

• Knee:joint between leg and thigh

• Leg:between knee and foot

• Ankle• Foot

Anterior Region of Thigh

Superficial structures:

Lateral cutaneous n. of thigh

Anterior cutaneous n. of thigh

Cutaneous nerves:

medial cutaneous n. of thigh

Femoral branch of jenitofemoral n.

ilioinguinal n.

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

Cutaneous Nerve

Innervation of the Lower

Limb

Superficial arteries:

superficial epigastric a .superficial iliac circumflex a .

external pudendal a.

Superficial epigastric v.

Superficial External pudendal v.

Superficial circumflex iliac v.

Great saphenous v.Superficial lateral femoral v.

Superficial veins

Superficial inguinal lymph nodes:

Horizontal group

Vertical group

Superficial inguinal lymph nodes

Superior group: Lies just distal to the inguinal ligamentReceive lymph from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs

Inferior group: Lies vertical along the terminal great saphenous v.

Receives all superficial lymphatics of lower limb, except for those from the posterolateral part of calf

Efferent vessels drain into the deep inguinal ln. or external iliac ln.

Gluteal Fascia Fascia Lata Crural Fascia

Fascia of the Lower Limb

Fascia Lata

Fascial Compartments of the Thigh

Anterior compartment

Medial (adductor) compartment

Posterior compartment

anterior compartment

posterior compartment

medial compartment

Deep fascia – fascia lata Iliotibial tract Saphenous hiatus

falciform margin cribriform fascia

Muscles of Hip and Thigh• Gluteals (posterior pelvis)

– Extend thigh– Rotate thigh– Abducts thigh

• Anterior Compartment Thigh– Flexes thigh at hip– Extends leg at knee

• Medial/Adductor Compartment– Adducts thigh– Medially rotates thigh

• Posterior Compartment Thigh– Extends thigh– Flexes leg

Anterior Compartment muscles of Thigh

• Tensor fascia lata– O: iliac crest, A.S.I.S.– I: iliotibial tract– A: Flex thigh, abduct

thigh, medial rotation of thigh

– N. : Superior Gluteal n.

• Sartorius-O – ASIS-I – superior part of

medial surface of tibia

-A – flexes, abducts, and external rotates thigh

-N. Femoral n.

• Iliopsoas

-O – sides of T12-L5 vertebrae, iliac crest & fossa

-I – lesser trochanter of femur, pectineal line

-A – flexing the thigh

-N- Femoral n.Femoral n.

• Quadriceps Femoris

1) Vastus lateralis2) Vastus medialis3) Vastus intermedias4) Rectus femoris

– O: femur, – I: patellar ligament– A: Knee extension_ N: Femoral n.

pg 299

Rectus femoris– O: A.I.I.S., margin

acetabulum– I: patellar ligament– A: Knee extension,

flexes thigh

• Vastus lateralis-O – greater trochanter and

lateral lip of linea aspera of femur

• Vastus medialis-O – intertrochanteric line and

medial lip of linea aspera of femur

• Vastus intermedius-O – anterior and lateral

surfaces of body of femur

*Same for all 3-I – base of patella A – helps flex thigh

Femoral triangleThis triangle is bounded by: superiorly; the inguinal ligament (base)

laterally; the medial border of sartoriusMedially; the medial border of adductor longusInferiorly; the apex of the triangle is continuous with adductor canal.

The anterior wall is fascia lataThe posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to

lateral side .

Contents of the femoral triangle

1 .The femoral artery and its branches,the profunda femoris artery,The lateral and medial circumflex arteries,The deep external pudendal.

2 .The femoral vein and its tributaries.

3 .Three or four deep inguinal lymph nodes lie along the

medial side of the femoral vein .4 .The femoral nerve.5 .The femoral canal.

Adductor canal

Extends from apex of femoral triangle to adductor hiatus

Bounded by : laterally;vastus medialis

posteriorly; adductors longus and magmus,

anteriorly ;adductor lamina and sartorius

Contents – saphenous nerve, femoral a., femoral v., lymphatic vessels, and loose connective tissue

The adductor hiatus is a gap in the distal attachment of adductor magnus to the femur, which permits the femoral vessels to pass from the adductor canal downward into the popliteal space.

Femoral sheath The femoral sheath is a funnel- shaped sheath , derived from transversalis fascia anteriorly and iliac fascia posteriorly. It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of

the vessels .

The femoral sheath is divided into three compartments by two fibrous septa. The femoral artery occupies the lateral compartment of the sheath. The femoral vein lies the middle compartment. The medial

compartment is small, called the femoral canal .

The femoral canal

It is about 1.3cm long , and its upper opening is called the

femoral ring . The boundaries of the femoral ring are:, anteriorly; the inguinal ligamentthe

medially; lacunar ligament; ,posteriorly; the pecten of pubis

laterally; the femoral vein, superiorly; covered by femoral

septum .The canal contains a little loose fatty tissue, a small lymph node, and some lymph vessels.

Femoral hernia A femoral hernia is common in women than in men (possibly

due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands to form a swelling in

the upper part of the thigh .

Lacuna musculorum

Bounded by: anteriorly; lateral portion of inguinal ligament,

posterolaterally; iliumMedially; iliopectinal

arch Contents: iliopsoas m,

femoral n. and lateral femoral cutaneous n.

Iliopectinal arch

Femoral n.Iliopsoas

Lateral femoral cutaneous n.

Lacuna vasorum Bounded by: anteriorly,medial portion of inguinal ligament posteromedially, pectineal ligament medially,lacunar

ligament, Posterolaterally,iliopectinal arch

Contents :femoral sheath, femoral a. and v., genital branch of genitofemoral n. and lymphatic vessels, femoral ring

Femoral a.

Femoral v.

Femoral ring

Femoral a.

This is the main artery of the lower limb and is directly continuous with the external iliac artery of the abdomen behind the inguinal ligament at the mid- inguinal point. It becomes the popliteal artery by passing through the adductor tendinous opening.

Arteries of lower limb

Femoral a.Principal branch: 1. Deep femeral a.: arises from the posterolateral surface of the femoral artery about 4 cm below the inguinal

ligament .2. Descending genicular a.

3. Deep external pudendal a.

4. Superficial branches:– superficial epigastric a. – superficial iliac circumflex a. – external pudendal a.

Profunda femoris

Lateral circumflex artery It arises from the profunda near its

origin and runs laterally among the branches of the femoral nerve and then deep to rectus femoris. Here it divides into ascending, transverse,

and descending branches .Medial circumflex artery

arises either from the profunda near its origin or occasionally direct from

the femoral artery.

Four perforating arteries

Profunda femoral a.

Latral circumflex a.

Medial circumflex a.

Saphenous n.

Femoral nerve

It arises from the lumbar plexus in the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2cm below the inguinal

ligament .Muscular branche to: pectineus, sartorius, quadriceps femoris

Cutaneous nerve branches:

(1 )Anterior cutaneous nerves of the thigh

(medial and lateral) .(2) Saphenous nerve

is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.

Femoral veinThis is the direct continuation of the popliteal vein. It begins at the adductor tendinous opening and accompanies the femoral artery to the inguinal ligament behind which it becomes the

external iliac vein .The femoral vein contains several valves.

Cutaneous

Medial compartment

Medial compartment muscles

• Adductor longus• Adductor brevis• Adductor magnus• Pectineus• Gracilis

• Pectineus

-O - Superior ramus of pubis

-I - Pectineal line of femur

-A – adducts and flexes thigh

N: Femoral, obturator

• Adductor Brevis– O - Inferior Pubic Ramus– I - Pectineal Line and Linea

Aspera– A - adducts, flexes, and

medially rotates femur

• Gracillis– O - pubic Symphysis and

inferior pubic ramus– I - medial surface of the tibia– A - adducts thigh, flexes

medially and medially rotates thigh, flexes leg

– Innervation: Obturator nerve

• Adductor Longus– O - med portion of the

superior pubic ramus– I - linea aspera of femur– A - adducts, flexes, and

medially rotates the femur

– Innervation: Obturator nerve

• Adductor Magnus– O - ischiopubic ramus and

ischial tuberosity– I - linea aspera of the femur;

the ischiocondylar part inserts on the adductor tubercle of the femur

– A - adducts, flexes, and medially rotates the femur; extends the femur

– Innervation: post div of Obturator nerve and tibial n.

Nerve and artery

• Obturator n.

• Accessory obturator n.

• Obturator a.

• Medial circumflex a.

arises either from the profunda near its origin or occasionally direct from the femoral artery.

Obturator NerveNerve of Medial Fascial Compartment of the Thigh

The posterior division pierces the obturator externus and passes downward behind the adductor brevis and in front of the adductor magnus

The anterior division passes downward in front of the obturator externus.

Lumbar Plexus• Femoral nerve

– Cutaneous branches• Thigh, leg, foot (e.g. saphenous nerve)

– Motor branches• Anterior thigh muscles (e.g. quadriceps,

sartorius, iliopsoas)• Obturator nerve

– Sensory• Skin medial thigh; hip, knee joints

– Motor• Adductor muscles

• Lateral femoral cutaneous– Sensory

• Skin lateral thigh• Genitofemoral

– Sensory• Skin scrotum, labia major, anterior thigh

– Motor• Cremaster muscle