THE ANATOMY OF THE ANATOMY OF THE LOWER LIMBTHE LOWER LIMB

BYBY

DR. AHMAD KAMIL SHAHWANDR. AHMAD KAMIL SHAHWAN

PH.D. GENERAL SURGERYPH.D. GENERAL SURGERY

THE LOWER LIMB ANATOMYTHE LOWER LIMB ANATOMY

THE BONES OF THE LOWER LIMBTHE BONES OF THE LOWER LIMB: : THE HIP BONETHE HIP BONE: :

It is a large bone ,thick in some places & It is a large bone ,thick in some places & thin in othersthin in others..

It is formed of 3 bones : It is formed of 3 bones : THE ILIUMTHE ILIUM , , THETHE ISCHIUMISCHIUM & & THE PUPISTHE PUPIS which are fused which are fused together before birthtogether before birth..

They also fused at the They also fused at the acetabulumacetabulum. There is . There is a large opening below the acetabulum a large opening below the acetabulum called the called the obturatorobturator foramenforamen

THE HIP BONETHE HIP BONE: : THE ILIUMTHE ILIUM: : is the upper expanded part of the hip is the upper expanded part of the hip bone ;it is the largest part & consists of bone ;it is the largest part & consists of body body & & a large flat wing called the a large flat wing called the ala ala of the iliumof the ilium. .

It has 3 borders ;The upper border called the It has 3 borders ;The upper border called the iliaciliac crestcrest & ant. & post. borders & ant. & post. borders..The iliac crest The iliac crest lies between the ant .sup. Iliac lies between the ant .sup. Iliac spine & the post. Sup. Iliac spine. Its ant. 2/3 is spine & the post. Sup. Iliac spine. Its ant. 2/3 is thick & convex outward & has inner & outer thick & convex outward & has inner & outer lips with an intermediate rough area in between lips with an intermediate rough area in between , while the post. 1/3 is thin & convex inward & , while the post. 1/3 is thin & convex inward & has 2 sloping surfaces separated by bony has 2 sloping surfaces separated by bony ridge.A bony prominence called the ridge.A bony prominence called the tubercle of tubercle of thethe iliac crestiliac crest is on the outer lip 5 cm . behind is on the outer lip 5 cm . behind the ant. Sup. Iliac spinethe ant. Sup. Iliac spine..

THE HIP BONETHE HIP BONE: : The ant. borderThe ant. border begins at the ASIS below begins at the ASIS below which there is a notch then ant. Inf. Iliac which there is a notch then ant. Inf. Iliac spinespine..

The post. BorderThe post. Border begins in the PSIS & begins in the PSIS & below it there is post inf. Iliac spine below it there is post inf. Iliac spine then form the then form the greater sciatic notchgreater sciatic notch then then be continuous with the post. border of be continuous with the post. border of the ischiumthe ischium..

The ilium has 2 surfaces :the The ilium has 2 surfaces :the outer(=gluteal) surface & the inner outer(=gluteal) surface & the inner (=pelvic) surface(=pelvic) surface..

THE HIP BONETHE HIP BONE: : THE ISCHIUMTHE ISCHIUM : forms the lower & the post. part of : forms the lower & the post. part of hip bone &consists of body , tuberosity & one hip bone &consists of body , tuberosity & one ramusramus..

the bodythe body :the :the ant .borderant .border of the body is of the body is continuous below with the upper border of the continuous below with the upper border of the ramus & both form part of the wall of the ramus & both form part of the wall of the obturator foramenobturator foramen..

The The post. borderpost. border of the body is continuous above of the body is continuous above with the post border of the ilium forming the with the post border of the ilium forming the lower part of the lower part of the greater sciatic notchgreater sciatic notch ,then ,then project to form the project to form the ischial spineischial spine. , & then form . , & then form the the lesser sciatic notchlesser sciatic notch before it form the before it form the

ischial tuberosityischial tuberosity. .

THE HIP BONETHE HIP BONE: :

The The ischial ramusischial ramus is continuous in front with is continuous in front with the inf. Ramus of the pubisthe inf. Ramus of the pubis..

The The ischial tuberosityischial tuberosity is a very strong piece of is a very strong piece of bone which project from the inf. pole of the bone which project from the inf. pole of the

body of the ischiumbody of the ischium. .

It divided to 4 partsIt divided to 4 parts: :

11-- part give origin to semimembransus Mpart give origin to semimembransus M..

22--part give origin to semitendenosus & long part give origin to semitendenosus & long head of biceps Mm head of biceps Mm..

33--part give origin to adductor magnus Mpart give origin to adductor magnus M..

44--part which we sit on& does not give origin to part which we sit on& does not give origin to any M any M . .

THE HIP BONETHE HIP BONE: :

THE PUBISTHE PUBIS :forms the lower & ant. Part of :forms the lower & ant. Part of the hip bone& has a body & 2 ramithe hip bone& has a body & 2 rami..

The bodyThe body : is flat triangular part which : is flat triangular part which articulate with its fellow at the articulate with its fellow at the

symphysis pubissymphysis pubis . .

The body has 3 borders : The upper The body has 3 borders : The upper border called the border called the pubic crestpubic crest & it ends & it ends laterlaly by a projection called the laterlaly by a projection called the pubic pubic tubercletubercle..

The lateral border is very sharp & form The lateral border is very sharp & form boundary of obturator foramenboundary of obturator foramen..

THE HIP BONETHE HIP BONE: : The The sup. Ramussup. Ramus is triangular in shape while is triangular in shape while the the inf. Ramusinf. Ramus starts at the symphysis starts at the symphysis pubis & run obliquely downwards & laterally pubis & run obliquely downwards & laterally to join the ischial ramus & form together the to join the ischial ramus & form together the conjointconjoint (ischio-pubic ) (ischio-pubic ) ramusramus..

THE ARTICULATION OF THE HIP BONETHE ARTICULATION OF THE HIP BONE::11 - -above & behind with the sacrum to form above & behind with the sacrum to form

the the sacro-iliac jointsacro-iliac joint . .22 - -below & in front with the other hip bone at below & in front with the other hip bone at

symphysis pubissymphysis pubis..33 - -through the acetabulum with the head of through the acetabulum with the head of

the femur to form the the femur to form the hip jointhip joint..

THE FEMURTHE FEMURIt is the longest & strongest It is the longest & strongest bone in the bodybone in the bodyIt is formed of upper end , shaft It is formed of upper end , shaft (body) & lower end(body) & lower end..

THE UPPER ENDTHE UPPER END :consists of :consists of the head , the neck ,the the head , the neck ,the greater trochanter & the greater trochanter & the

lesser trochanterlesser trochanter. . THE HEAD: THE HEAD: is less than 2/3 of is less than 2/3 of sphere & faces upwards sphere & faces upwards forwards & medially. In life it forwards & medially. In life it is covered by a cartilage is covered by a cartilage except with central except with central depression called the depression called the foveafovea where the legamentum teres where the legamentum teres is attachedis attached..

THE FEMURTHE FEMURTHE NECKTHE NECK : is 5 cm long & connect the head : is 5 cm long & connect the head with the shaft .It forms an angle (110-120) with the shaft .It forms an angle (110-120) with the axis of the shaft . This angle is with the axis of the shaft . This angle is smaller ( i.e. more acute ) in the female (who smaller ( i.e. more acute ) in the female (who has wide pelvis ) than in male .This angle is has wide pelvis ) than in male .This angle is normally 160 in childrennormally 160 in children..

THE GREATER TROCHANTERTHE GREATER TROCHANTER: is a large : is a large quadrangular piece of bone lies at the quadrangular piece of bone lies at the lateral & upper part of the junction between lateral & upper part of the junction between the neck & the shaft. In its medial surface the neck & the shaft. In its medial surface there is deep depression called the there is deep depression called the

trochantrictrochantric fossafossa. .

THE FEMURTHE FEMURTHE LESSER TROCHANTERTHE LESSER TROCHANTER: is a small : is a small pyramidal projectionpyramidal projection..

The intertrochanteric lineThe intertrochanteric line : connects the : connects the greater & lesser trochanters in front & greater & lesser trochanters in front & continues below the lesser troch. as continues below the lesser troch. as the the spiralspiral lineline on the upper part of the on the upper part of the

shaftshaft. . The intertrochanteric crestThe intertrochanteric crest : is a rough : is a rough

ridge joins the 2 troch. behindridge joins the 2 troch. behind . .In the middle of the crest there is a bony In the middle of the crest there is a bony prominence called the prominence called the quadratequadrate tubercletubercle..

Blood Supply Of The Head of Blood Supply Of The Head of The FemurThe Femur

11-- Blood ascending upwards from the Blood ascending upwards from the shaft along the cancellous bone shaft along the cancellous bone..

22-- Blood from the Vv. In the capsule of Blood from the Vv. In the capsule of the hip joint the hip joint..

33 - - Blood from the artery in the Blood from the artery in the ligamentum teres ligamentum teres . .

THE SHAFT OF THE FEMURTHE SHAFT OF THE FEMURIt is cylindrical in shape & be flattened It is cylindrical in shape & be flattened posteriorly & downward. It is very slightly posteriorly & downward. It is very slightly

curved( convex) anteriorlycurved( convex) anteriorly. . Along the middle of the shaft posteriorly Along the middle of the shaft posteriorly there is rough ridge called there is rough ridge called linea asperalinea aspera with 2 lips (lat. & med.)with 2 lips (lat. & med.)..

The The lateral lip of linea asperalateral lip of linea aspera superiorly join superiorly join the gluteal tuberosity which extends the gluteal tuberosity which extends upward to the base of greater trochupward to the base of greater troch..

The The medial lip of linea asperamedial lip of linea aspera passes above passes above to form the spiral line & ends in the to form the spiral line & ends in the intertroch. Lineintertroch. Line..

THE SHAFT OF THE FEMURTHE SHAFT OF THE FEMURThe pactineal lineThe pactineal line arises from the lesser arises from the lesser troch. & runs down parallel to the medial troch. & runs down parallel to the medial lip of linea asperalip of linea aspera..

In the lower 1/3 of the shaft the lat. & med. In the lower 1/3 of the shaft the lat. & med. Lips diverge from each other & continue Lips diverge from each other & continue down as the down as the lateral & medial lateral & medial supracondylarsupracondylar lineslines to the back of the lat. to the back of the lat. & med. Condyles respectively. leaving & med. Condyles respectively. leaving between them a flat triangular area called between them a flat triangular area called poplitealpopliteal surfacesurface .The med. Supracondylar .The med. Supracondylar line ends below in the line ends below in the adductor tubercleadductor tubercle..

THE LOWER END OF THE THE LOWER END OF THE FEMURFEMUR

It consists of 2 It consists of 2 condylescondyles (med. & lat.) & 2 (med. & lat.) & 2 epicondylesepicondyles( med. & lat.)( med. & lat.). .

The condyles are large bony masses (the The condyles are large bony masses (the lat. Is larger) .Posteriorly the 2 cond. are lat. Is larger) .Posteriorly the 2 cond. are separated from each other by a wide deep separated from each other by a wide deep intercondylar fossa while anteriorly the 2 intercondylar fossa while anteriorly the 2 cond. fused to form the cond. fused to form the articulararticular (patellar) surface(patellar) surface..

The most prominent parts of cond. is the The most prominent parts of cond. is the epicondylesepicondyles where between them where between them posteriorly is the posteriorly is the popliteal surfacepopliteal surface..

The joints of the femurThe joints of the femur

11-- The head articulate with the The head articulate with the acetabulum to form acetabulum to form the hip jointthe hip joint..

22-- The 2 femoral condyles articulate with The 2 femoral condyles articulate with the 2 tibial condyles in the 2 tibial condyles in the knee jointthe knee joint. .

33 - -The ant. surface of the lower end The ant. surface of the lower end articulates with the upper 2/3 of the articulates with the upper 2/3 of the post. surface of the patellapost. surface of the patella..

THE PATELLATHE PATELLA The patella(=the knee cap) : It is a flat & The patella(=the knee cap) : It is a flat &

the largest sesamoid bone in the body the largest sesamoid bone in the body located in the tendon of quadriceps located in the tendon of quadriceps femoris M. in front of the lower end of the femoris M. in front of the lower end of the

femurfemur. .

It is triangular in shape with a base (upper It is triangular in shape with a base (upper border ) & an apex (rounded lower tip )& 2 border ) & an apex (rounded lower tip )& 2 borders (medial & lateral) & 2 surfaces borders (medial & lateral) & 2 surfaces (ant. & post.)(ant. & post.)..

THE PATELLATHE PATELLA The lower 1/3 of the post. surface is rough The lower 1/3 of the post. surface is rough

while its upper 2/3 is smooth & is called the while its upper 2/3 is smooth & is called the articulararticular surfacesurface as it articulates with the as it articulates with the

patellar surface of the femurpatellar surface of the femur. .

The vastus medialis & vastus lateralis Mm The vastus medialis & vastus lateralis Mm are attached to the medial & lateral borders are attached to the medial & lateral borders of the patella respectively while the vastus of the patella respectively while the vastus intermedius & the rectus femoris are intermedius & the rectus femoris are attached to its upper border ( the base )attached to its upper border ( the base )..

The patellar ligament is attached to the The patellar ligament is attached to the apex. These attachments made it stable apex. These attachments made it stable &rarely dislocated&rarely dislocated..

THE BONES OF THE LEGTHE BONES OF THE LEGThey are THE TIBIA & THE FIBULAThey are THE TIBIA & THE FIBULA

THETHE TIBIATIBIA: It is the large , weight : It is the large , weight bearing ,medial bone of the leg .It articulates bearing ,medial bone of the leg .It articulates with the condyles of the femur & the head of with the condyles of the femur & the head of the fibula above & with the talus & distal part the fibula above & with the talus & distal part of the fibula below. It consist of expanded of the fibula below. It consist of expanded

upper end , shaft & smaller lower endupper end , shaft & smaller lower end. . The upper end of the tibiaThe upper end of the tibia :There are :There are lateral &lateral & medial condylesmedial condyles of the tibia which articulate of the tibia which articulate with the lat. & med. Condyles of the femur . with the lat. & med. Condyles of the femur . The lat. & med. The lat. & med. MenesciMenesci intervening . intervening . Between the 2 condyles is the Between the 2 condyles is the intercondylarintercondylar eminanceeminance..

THE TIBIATHE TIBIA

On the lateral On the lateral aspect of the aspect of the lateral lateral condyle ;there condyle ;there is circular is circular articular facet articular facet for the head of for the head of

the fibulathe fibula. .

The shaft of the tibiaThe shaft of the tibia is triangular in cross is triangular in cross section with 3 borders &3 surfaces ;Its section with 3 borders &3 surfaces ;Its ant.ant. & & med. bordersmed. borders with with medial surfacemedial surface between them are subcutaneous ; the between them are subcutaneous ; the ant. border is prominent & form the ant. border is prominent & form the shinshin of the legof the leg . At the junction of the ant. . At the junction of the ant. border & the upper end is the border & the upper end is the tibialtibial tuberositytuberosity which receives the attachment which receives the attachment of ligamentum patellae . The med. border of ligamentum patellae . The med. border becomes rounded below where it becomes rounded below where it becomes continuous with the becomes continuous with the medialmedial

malleolusmalleolus . .

THE TIBIATHE TIBIA

THE TIBIATHE TIBIAThe The lateral(=interosseous) borderlateral(=interosseous) border gives gives

attachment to interosseous membraneattachment to interosseous membrane. .

The upper post. Surface shows an oblique line The upper post. Surface shows an oblique line called the called the soleal linesoleal line for the attachment of for the attachment of soleus M .Below it there is soleus M .Below it there is vertical linevertical line which which

extend to the interosseous borderextend to the interosseous border . .

The lower endThe lower end of the tibia is slightly expanded of the tibia is slightly expanded & on the inf. surface shows saddle shape & on the inf. surface shows saddle shape articular surface for articulation with talus, the articular surface for articulation with talus, the lower end is prolonged down ward & medially lower end is prolonged down ward & medially to form the to form the medial malleolusmedial malleolus..

THE TIBIATHE TIBIAThe lateral surface of medial malleolus articulate The lateral surface of medial malleolus articulate

also with the talusalso with the talus, , On the lat. Surface of the lower end there is a On the lat. Surface of the lower end there is a wide rough depression for articulation with the wide rough depression for articulation with the

fibulafibula. . THE JOINTS OF THE TIBIATHE JOINTS OF THE TIBIA::

11 - -the upper endthe upper end: : 1-11-1--the upper surface of the tibial condyles with the upper surface of the tibial condyles with

the femoral condyles in the femoral condyles in the knee jointthe knee joint..1-21-2--the fibular facet articulate with the flat circular the fibular facet articulate with the flat circular

facet on the fibula in the facet on the fibula in the sup. tibio-fibular sup. tibio-fibular joint joint. (synovial joint.). (synovial joint.) . .

THE TIBIATHE TIBIA22 - -the lower endthe lower end: :

2-12-1 - -the inf. surface of its lower end & the the inf. surface of its lower end & the smooth lateral surface of med. smooth lateral surface of med. malleolus articulate with the talus in malleolus articulate with the talus in the the ankle jointankle joint..

2-22-2 - -the fibular notch articulate with the the fibular notch articulate with the lower end of the fibula in the lower end of the fibula in the inf. tibio- inf. tibio- fibular fibular jointjoint.(a fibrous jt.).(a fibrous jt.),,

THE FIBULATHE FIBULAIt is a very thin, long bone on the lateral side of the It is a very thin, long bone on the lateral side of the tibia .It takes no part in the articualion in the knee tibia .It takes no part in the articualion in the knee joint ; but below it forms the lat. Malleolus of the joint ; but below it forms the lat. Malleolus of the ankle jointankle joint..

It takes no part in transmission of body weight, but it It takes no part in transmission of body weight, but it provides attachments for Mmprovides attachments for Mm..

It consists of upper end (head ), neck , shaft & lower It consists of upper end (head ), neck , shaft & lower endend..

The upper end of the fibulaThe upper end of the fibula::

11 - -The headThe head :It is the bulky upper end has :It is the bulky upper end has aposterolateral projection called the styloid aposterolateral projection called the styloid

process in which the biceps tendon is insertedprocess in which the biceps tendon is inserted. .

THE FIBULATHE FIBULAThe upper part of its medial surface has a circular flat The upper part of its medial surface has a circular flat articular process to articulate with the fibular facet on the articular process to articulate with the fibular facet on the

lateral condyle of the tibialateral condyle of the tibia. .

22 - -The neckThe neck :the constricted upper part :the constricted upper part. .

The shaftThe shaft :Its long twisted bone covered all with Mm. except :Its long twisted bone covered all with Mm. except triangular area above the lat. malleolus which is triangular area above the lat. malleolus which is subcutaneous .It has 3 surfaces & 3 borders .subcutaneous .It has 3 surfaces & 3 borders .

The lower end of the fibulaThe lower end of the fibula :is called the lateral malleolus , :is called the lateral malleolus , Its flattened from side to side & more pointed & longer Its flattened from side to side & more pointed & longer than the medial malleolus. Its lateral surface is than the medial malleolus. Its lateral surface is subcutaneous & its medial smooth surface for subcutaneous & its medial smooth surface for articulation with the lateral surface of the talus .while its articulation with the lateral surface of the talus .while its posterior surface has a shallow groove for the tendons of posterior surface has a shallow groove for the tendons of peroneus longus & brevis .peroneus longus & brevis .

THE FIBULATHE FIBULAThe fibula has 3 functionsThe fibula has 3 functions: :

11 - -gives origin to Mm. of the leggives origin to Mm. of the leg. .

22 - -form part of the ankle jointform part of the ankle joint. .

33 - -the lower end form a pulley for the tendons of the lower end form a pulley for the tendons of peroneal mmperoneal mm..

The Mm. attached to the fibulaThe Mm. attached to the fibula::

One M.,One M.,biceps,biceps, inserted in the head of the fibula inserted in the head of the fibula..

Three mm. arise from the medial surfaceThree mm. arise from the medial surface: :

11 - -Extensor digitorum longus :from the upperExtensor digitorum longus :from the upper.¾ .¾

22 - -Peroneus tertius :from the lowerPeroneus tertius :from the lower. ¼ . ¼

33 - -extensor hallucis longus :from the middleextensor hallucis longus :from the middle.½ .½

THE FIBULATHE FIBULATwo Mm. arise from the lateral (peroneal) surfaceTwo Mm. arise from the lateral (peroneal) surface::

11--peroneus longus :from the upper 2/3peroneus longus :from the upper 2/3. . 22--Peroneus brevis : from the lower 2/3Peroneus brevis : from the lower 2/3. .

Three Mm. arise from the post. (flexor )surfaceThree Mm. arise from the post. (flexor )surface: : 11 - -Soleus :from the back of the head & upper 1/3Soleus :from the back of the head & upper 1/3

22--Tibialis post. M. from the medial side of post. Tibialis post. M. from the medial side of post. surface surface . .

33 - -Flexor hallucis longus: from the lat. side of Flexor hallucis longus: from the lat. side of post. Surface post. Surface . .

THE FOOTTHE FOOTThe foot consists ofThe foot consists of: :

11 - -the tarsal bones (7)the tarsal bones (7). . 22 - -the metatarsal bones (5)the metatarsal bones (5). .

33 - -the toes =digits(5)the toes =digits(5)..TheTarsal bonesTheTarsal bones: :

* *the Calcaneusthe Calcaneus : is the largest ,the longest & the : is the largest ,the longest & the most posterior most posterior . .

**the Talusthe Talus : lies on the top of the calcaneus : lies on the top of the calcaneus. . **the Navicularthe Navicular :lies between the talus & the 3 :lies between the talus & the 3

cuneiform bonescuneiform bones. . **the 3the 3 Cuneiform bones Cuneiform bones ( medial , intermediate & ( medial , intermediate &

lateral ) lies between the navicular bone & the lateral ) lies between the navicular bone & the medial 3 metatarslsmedial 3 metatarsls..

**the the cuboidcuboid lies between the calcaneus & the lateral lies between the calcaneus & the lateral 2 metatarsals2 metatarsals..

THE FOOTTHE FOOTThe metatarsalsThe metatarsals: they are 5 bones , one for each : they are 5 bones , one for each digit .each consists of base , shaft & head . The digit .each consists of base , shaft & head . The medial 3 articulate with the 3 cuneiform bones medial 3 articulate with the 3 cuneiform bones

& the lateral 2 with the cuboid bone& the lateral 2 with the cuboid bone. .

The toesThe toes :each toe has 3 phalanges except the :each toe has 3 phalanges except the big toe has 2.Each phalanx consists of big toe has 2.Each phalanx consists of

base ,shaft & headbase ,shaft & head. .

THE ARCHES OF THE FOOTTHE ARCHES OF THE FOOTThe bones of the foot are arranged to form 2 The bones of the foot are arranged to form 2 longitudinal arches( medial & lateral) & one longitudinal arches( medial & lateral) & one transverse arch. These are bony parts transverse arch. These are bony parts which do not come in contact with ground which do not come in contact with ground when the weight of the body is born on the when the weight of the body is born on the

foot during standingfoot during standing. . The medial longitudinal archThe medial longitudinal arch form from form from calcaneus ,talus ,navicular ,3 cuneiforms & calcaneus ,talus ,navicular ,3 cuneiforms &

medial 3 metatarsals. Its apex is the talusmedial 3 metatarsals. Its apex is the talus. . Its concerned with support of the weight of Its concerned with support of the weight of the body during standingthe body during standing..

THE ARCHES OF THE FOOTTHE ARCHES OF THE FOOTThe lateral longitudinal archThe lateral longitudinal arch form from form from calcaneus ,cuboid,& lateral 2 metatarsals. Its calcaneus ,cuboid,& lateral 2 metatarsals. Its lower than the medial arch. Its concerned with lower than the medial arch. Its concerned with elastic propulsion during walking or runningelastic propulsion during walking or running

The transverse archThe transverse arch at the bases of metatarsals at the bases of metatarsals bonebone..In the flat foot ,there is falling of the archesIn the flat foot ,there is falling of the arches. . The factors maintain the archesThe factors maintain the arches: :

11 - -the shape of the bonesthe shape of the bones..22 - -the ligaments of the foot & the planter the ligaments of the foot & the planter

aponeurosis aponeurosis..33 - -the action of certain Mmthe action of certain Mm..

THE RETINACULI OF THE LEG & FOOTTHE RETINACULI OF THE LEG & FOOT There are 5 retinaculiThere are 5 retinaculi: :

11 - -The superior extensor retThe superior extensor ret.: lies immediately .: lies immediately above the ankle joint above the ankle joint..

22 - -The inferior extensor ret.The inferior extensor ret. :like Y-shape below :like Y-shape below the sup. Ext. ret the sup. Ext. ret . .

33 - -The superior peroneal retThe superior peroneal ret.: lies over the .: lies over the peroneus longus & brevis tendons on the peroneus longus & brevis tendons on the

back of the lat. Malleolus back of the lat. Malleolus:.:.

44 - -The inferior peroneal retThe inferior peroneal ret.: lies on the peroneal .: lies on the peroneal tendons on the lat. Surface of the calcaneus tendons on the lat. Surface of the calcaneus. .

55 - -The flexor ret.:The flexor ret.: between the calcaneus & the between the calcaneus & the medial malleolus medial malleolus..

THE MUSCLES OF THE FOOTTHE MUSCLES OF THE FOOTThere are 4 layers of Mm. & tendons in the There are 4 layers of Mm. & tendons in the

sole separated by layers of facsia in which sole separated by layers of facsia in which the planter vessels & nerves lie the planter vessels & nerves lie..

THE ARTERIES OF THE LOWER LIMBTHE ARTERIES OF THE LOWER LIMBThe femoral arteryThe femoral artery: :

Its is the direct continuation of the Its is the direct continuation of the external iliac iliac A. , It enters the thigh by passing behind the A. , It enters the thigh by passing behind the mid-inguinal point ( midway between the ASIS & mid-inguinal point ( midway between the ASIS & the pubic tubercle). After running vertically the pubic tubercle). After running vertically downward , it enters the femoral triangle then in downward , it enters the femoral triangle then in the adductor canal then pierce the adductor the adductor canal then pierce the adductor magnus M to enter to the popliteal fossa to be magnus M to enter to the popliteal fossa to be the popliteal Athe popliteal A..

The upper 10 cm of femoral A. is superficial & The upper 10 cm of femoral A. is superficial & may easily injured or punctured by a needle. may easily injured or punctured by a needle. The femoral vein is medial to it while the The femoral vein is medial to it while the femoral nerve is lateral to it ( VAN)femoral nerve is lateral to it ( VAN)..

The femoral arteryThe femoral arteryThe branches of femoral AThe branches of femoral A:.:.

11 - -Superficial branchesSuperficial branches: :

1-11-1 - -superficial epigastric Asuperficial epigastric A..

1-21-2 - -superficial circumflex iliac Asuperficial circumflex iliac A..

1-31-3 - -superficial external pudendal Asuperficial external pudendal A..

22 - -Deep branchesDeep branches: :

2-12-1 - -deep external pudednal Adeep external pudednal A . .

2-22-2 - -the profunda femoris Athe profunda femoris A..

The femoral arteryThe femoral artery

The profunda femoris A.: is the largest branch The profunda femoris A.: is the largest branch , arise from the upper part of fem. A. to pass , arise from the upper part of fem. A. to pass behind it to end as the 4behind it to end as the 4thth perforating Aa. It perforating Aa. It gives ofgives of::

11 - -lateral circumflex femoral Alateral circumflex femoral A..

22 - -medial circumflex femoral Amedial circumflex femoral A..

33 - -four perforating Aafour perforating Aa..

THE POPLITEAL ARTERYTHE POPLITEAL ARTERYIt begins at the opening in the adductor magnus It begins at the opening in the adductor magnus as the continuation of the femoral A. & ends at as the continuation of the femoral A. & ends at the lower border of the popliteus M. by dividing the lower border of the popliteus M. by dividing into ant. & post. Tibial arteries. It is the deepest into ant. & post. Tibial arteries. It is the deepest str. of the popl. Fossa. It lies on( from above –str. of the popl. Fossa. It lies on( from above –downward) :the popliteal surface of the femur , downward) :the popliteal surface of the femur , then the back of the capsule of the knee joint , then the back of the capsule of the knee joint , then the fascia over the popliteus Mm.It gives of then the fascia over the popliteus Mm.It gives of muscular & articular branches to form rich muscular & articular branches to form rich anastamosis around the knee jointanastamosis around the knee joint..

THE ANTERIOR TIBIAL ARTERYTHE ANTERIOR TIBIAL ARTERYIt begins at the lower border of the popliteus It begins at the lower border of the popliteus M. in the posterior comp. as the smaller M. in the posterior comp. as the smaller terminal branch of the popl. A. & after terminal branch of the popl. A. & after running downwards in the ant. compt. of the running downwards in the ant. compt. of the leg to ends in front of the ankle joint by leg to ends in front of the ankle joint by becoming the becoming the dorsalis pedisdorsalis pedis AA. It gives off. It gives off

11 - -ant.& post. Recurrent br. to anastamose ant.& post. Recurrent br. to anastamose around the knee joint around the knee joint. .

22 - -ant.medial malleolar & ant. Lateral malleolar ant.medial malleolar & ant. Lateral malleolar br. to anastamose around the ankle joint br. to anastamose around the ankle joint 3- muscular br. to M. of ant. compt of the 3- muscular br. to M. of ant. compt of the

leg leg . .

THE DORSALIS PEDIS ARTERYTHE DORSALIS PEDIS ARTERY

It begins in front of the ankle joint as a It begins in front of the ankle joint as a continuation of ant. tibial A. runs forward continuation of ant. tibial A. runs forward on the dorsum of the foot to pass in the on the dorsum of the foot to pass in the 11stst intermetatarsal space then reach the intermetatarsal space then reach the sole of the foot to anastamose with the sole of the foot to anastamose with the end of the planter archend of the planter arch..

It passes on the talus ,navicular & It passes on the talus ,navicular & intermediate cuneiform bone & pass intermediate cuneiform bone & pass behind the inf. Ext. retbehind the inf. Ext. ret..

THE POSTERIOR TIBIAL ARTERYTHE POSTERIOR TIBIAL ARTERYIt begins at the lower border of the It begins at the lower border of the

popliteus M.as the larger terminal branch popliteus M.as the larger terminal branch of the popliteal A.& after running of the popliteal A.& after running downward in the post. cmpt. It ends by downward in the post. cmpt. It ends by dividing to dividing to medial &medial & lateral planter Aalateral planter Aa..

It is deep in the upper part of the leg It is deep in the upper part of the leg while superficial in the lower part to be while superficial in the lower part to be palpated midway between the medial palpated midway between the medial malleolus & medial tubercle of the malleolus & medial tubercle of the calcaneum , there it divided to med. & calcaneum , there it divided to med. & lat.planter Aa. which form the main blood lat.planter Aa. which form the main blood supply of the footsupply of the foot..

THE POSTERIOR TIBIAL ARTERYTHE POSTERIOR TIBIAL ARTERYThe peroneal A.:The peroneal A.: is a big branch arise just is a big branch arise just below the origin of the post. tibial A. below the origin of the post. tibial A. passing downward & lateraly towards the passing downward & lateraly towards the fibula then vertically with the medial border fibula then vertically with the medial border of the fibula.in the lower part to end behind of the fibula.in the lower part to end behind the inf.tibio-fibular joint& share in the the inf.tibio-fibular joint& share in the

anastamosis around the lat. Malloelusanastamosis around the lat. Malloelus . .

It gives of a It gives of a perforating brperforating br. which pierce the . which pierce the interosseus membrane & share in the same interosseus membrane & share in the same anastamosisanastamosis..

The lateral planter AThe lateral planter A.. : :It begins under cover of It begins under cover of

flexor retinaculum . flexor retinaculum . Passing toward the Passing toward the

base of 5base of 5thth metatarsal metatarsal then pass medially then pass medially across the foot to across the foot to

form the planter arch form the planter arch with the dorsalis pedis with the dorsalis pedis A. It gives off planter A. It gives off planter digital Aa. & planter digital Aa. & planter

metatarsal Aametatarsal Aa..The medial planter A.:The medial planter A.: is is a small branch arise a small branch arise under the flex. Ret. & under the flex. Ret. &

supply the big toesupply the big toe..

THE LUMBAR PLEXUSTHE LUMBAR PLEXUSIt is formed in the Psoas major M. in front of the lower lumbar transverse processes by the anterior primary rami of the upper 4 lumbar nerves.( L1,L2, L3, L4). It gives 4 small & 2 big

nerves: 1 -the small branches:

1-1 -ilio-hypogastric N (L1). 1-2 -ilio-inguinal N.(L1).

1-3 -Genito-femoral N. (L1&L2). 1-4 -Lateral coetaneous N .of the thigh(L2&L3)

2-The main branches: 2-1-Femoral N.(L2,L3,L4) dorsal divisions.

2-2-Obturator N .(L2,L3,L4) ventral divisions

THE LUMBAR PLEXUSTHE LUMBAR PLEXUSThe genito-femoral N. emerge from the The genito-femoral N. emerge from the ant. surface of the Psoas M , the ant. surface of the Psoas M , the obturator N. from its medial side, while obturator N. from its medial side, while the ilio-hypogastric,ilio-inguinal , the ilio-hypogastric,ilio-inguinal , lat.cut. N. of the thigh & femoral N . lat.cut. N. of the thigh & femoral N . emerge from its lateral borderemerge from its lateral border..

The obturator NThe obturator N. is the N. of the medial . is the N. of the medial (adductor) compt. of the thigh. It (adductor) compt. of the thigh. It supplies the adductor Mm, gracilis & supplies the adductor Mm, gracilis & obturator externus Mm.,both hip & knee obturator externus Mm.,both hip & knee joints & skin over the medial aspect of joints & skin over the medial aspect of the thighthe thigh..

The femoral NThe femoral N:.:.It is the N. of ant. (extensor) comp. of the thighIt is the N. of ant. (extensor) comp. of the thigh..

It enters the thigh behind the inguinal lig. lateral to It enters the thigh behind the inguinal lig. lateral to femoral A. to enter the femoral trianglefemoral A. to enter the femoral triangle..

Before it enters the thigh , it supplies the iliacus M. Before it enters the thigh , it supplies the iliacus M. then after it enters the thigh it supplies the then after it enters the thigh it supplies the

pectineus M. then it divided topectineus M. then it divided to: : 11 - -ant. Groupant. Group : which gives : which gives: :

1-11-1 - -intermediate cut. N. of the thighintermediate cut. N. of the thigh. . 1-21-2--medial cut. N. of the thighmedial cut. N. of the thigh. .

1-31-3--branch to sartoriusbranch to sartorius. . 22 - -post. Grouppost. Group : which gives : which gives: :

2-12-1--saphenous Nsaphenous N..2-22-2 - -branches to quadriceps femoris Mbranches to quadriceps femoris M. .

2-32-3 - -articular br. to knee jointarticular br. to knee joint. .

The saphenous NThe saphenous N: : It runs on the lat. side of the femoral A. till it It runs on the lat. side of the femoral A. till it enters the adductor canal where it crosses enters the adductor canal where it crosses in front of the femoral A. from lateral to in front of the femoral A. from lateral to medial. It gives an infra-patellar br. to join medial. It gives an infra-patellar br. to join the patellar plexus then supply the medial the patellar plexus then supply the medial side of the leg then supplies the medial side side of the leg then supplies the medial side of the footof the foot..

THE SACRAL PLUXESTHE SACRAL PLUXES: : It is formed by the lumbo-sacral trunk (L4,L5) & It is formed by the lumbo-sacral trunk (L4,L5) & the anterior primary rami of S1 , S2 , S3 , S4the anterior primary rami of S1 , S2 , S3 , S4. .

THE BRANCHES. OF SACRAL PLUXESTHE BRANCHES. OF SACRAL PLUXES

11 - -From the post. surfaceFrom the post. surface: :

1-11-1 - -The sup. gluteal N ( L4 ,L5 ,S1)The sup. gluteal N ( L4 ,L5 ,S1)

1-21-2 - -The inf. gluteal N( L5 ,S1 ,S2)The inf. gluteal N( L5 ,S1 ,S2)

22 - -From the ant. SurfaceFrom the ant. Surface: :

2-12-1--The N .to quadratus femoris (L4,L5,S1 )The N .to quadratus femoris (L4,L5,S1 )

2-22-2--The N. to oburator internus (L5 ,S1 ,S2 )The N. to oburator internus (L5 ,S1 ,S2 )

33 - -The cutaneous NnThe cutaneous Nn:.:.

3-13-1 - -The perforating cutaneous N. (S2 & S3 )The perforating cutaneous N. (S2 & S3 )

3-23-2 - -The post. cutaneous N. of the thigh (S1, The post. cutaneous N. of the thigh (S1, S2 , S3 ) S2 , S3 )

44 - -from the roots of the plexusfrom the roots of the plexus: : 4-14-1 - -Branches to piriformis ( S1 , S2 )Branches to piriformis ( S1 , S2 )

4-24-2 -- --The pelvic splanchnic(parasympathetic) The pelvic splanchnic(parasympathetic) Nn.(S2 ,S 3, S4)Nn.(S2 ,S 3, S4)

55 - -The two terminal branchesThe two terminal branches: :

5-15-1--the sciatic N. (L4,L5,S1,S2,S3 )the sciatic N. (L4,L5,S1,S2,S3 )

5-25-2--The pudendal N.(S1,S2,S3,S4 )The pudendal N.(S1,S2,S3,S4 )

THE SCIATIC NERVE (L4,5+S1,2,3THE SCIATIC NERVE (L4,5+S1,2,3))It is the largest N. in the body .It arise from the sacral It is the largest N. in the body .It arise from the sacral plexus in the pelvis as flat & broad N. then be plexus in the pelvis as flat & broad N. then be rounded as it traced downward & ends in the rounded as it traced downward & ends in the middle of the thigh by dividing tomiddle of the thigh by dividing to::

11 - -tibialtibial (=medial popliteal )from ventral divisions of (=medial popliteal )from ventral divisions of L4,5 & S1,2,3 L4,5 & S1,2,3..

22 - -common peronealcommon peroneal(=lateral popliteal) N. from the (=lateral popliteal) N. from the dorsal divisions of L4,5 & S1,2 dorsal divisions of L4,5 & S1,2..

The sciatic N. leaves the pelvis through greater The sciatic N. leaves the pelvis through greater sciatic foramen below the piriformis M. to reach sciatic foramen below the piriformis M. to reach the gluteal region under cover of the gluteus the gluteal region under cover of the gluteus maximus M. then downward in the back of the maximus M. then downward in the back of the thigh where supply the thigh where supply the biceps ,semitendenosus ,semimembrenesus & biceps ,semitendenosus ,semimembrenesus & adductor magnus Mmadductor magnus Mm..

THE SCIATIC NERVE (L4,5+S1,2,3THE SCIATIC NERVE (L4,5+S1,2,3

THE TIBIAL (MEDIAL THE TIBIAL (MEDIAL POPLITEAL) N.(L4,5+S1,2,3)POPLITEAL) N.(L4,5+S1,2,3)

It begins in the middle of the thigh as the largest It begins in the middle of the thigh as the largest terminal br. of sciatic N ,descend in the popliteal terminal br. of sciatic N ,descend in the popliteal fossa to ends in the lower border of popliteus M by fossa to ends in the lower border of popliteus M by becoming the becoming the post. tibial Npost. tibial N. which descends to the . which descends to the back of the legback of the leg..

It lies superficial to popliteal Vv.& gives offIt lies superficial to popliteal Vv.& gives off::

11--the cutaneous br. the cutaneous br. Sural NSural N..

22 - -the muscular br. to gastrocnemius , the muscular br. to gastrocnemius , soleus ,popliteus & plantaris Mmsoleus ,popliteus & plantaris Mm..

33 - -the articular br. to the knee jointthe articular br. to the knee joint..

The sural N. descend over The sural N. descend over the the back of the calf the the back of the calf then joinded with the then joinded with the sural communicatin br. sural communicatin br. Of lat. Popliteal N. to go Of lat. Popliteal N. to go behind & below the behind & below the lateral malleolus( with the lateral malleolus( with the short saphenous vein) short saphenous vein) then along the lateral then along the lateral border of the foot to end border of the foot to end by suppling the lateral by suppling the lateral side of the little toeside of the little toe..

The posterior tibial nThe posterior tibial n..It begins at the lower border of popliteus M as It begins at the lower border of popliteus M as a continuation of tibial (medial popliteal) N.& a continuation of tibial (medial popliteal) N.& pass downward to ends under the flexor pass downward to ends under the flexor retinaculum by dividing to medial & lateral retinaculum by dividing to medial & lateral planter Nn. It suppliesplanter Nn. It supplies::

11 - -muscular br. to soleus , tibialis post. muscular br. to soleus , tibialis post. ,flexor digitorum longus & flexor ,flexor digitorum longus & flexor

hallucis longus hallucis longus , ,

22 - -medial calcaneal br. to the skin of the medial calcaneal br. to the skin of the heel& medial side of the sole of the foot heel& medial side of the sole of the foot

33 - -articular br. to ankle jointarticular br. to ankle joint. .

The medial planter NThe medial planter N.: It arise under the flexor .: It arise under the flexor retinaculum as the larger terminal br. of retinaculum as the larger terminal br. of post. Tibial N. to ends at the bases of post. Tibial N. to ends at the bases of metatarsal bones by dividing to 3 planter metatarsal bones by dividing to 3 planter digital Nndigital Nn..

It supplies the flexor digitorum brevis , flexor It supplies the flexor digitorum brevis , flexor hallucis brevis , abductor hallucis & 1hallucis brevis , abductor hallucis & 1stst lumbrical Mm., also supplies the skin on the lumbrical Mm., also supplies the skin on the medial part of the sole & the medial 3 ½ toes medial part of the sole & the medial 3 ½ toes

by the planter digital Nnby the planter digital Nn . .The lateral planter NThe lateral planter N : It arise under the flexor : It arise under the flexor retinaculum as the smaller terminal br. of retinaculum as the smaller terminal br. of post. Tibial N. to ends at the base of 5post. Tibial N. to ends at the base of 5thth metatarsal where supplies the skin of the metatarsal where supplies the skin of the lateral 1 ½ toes & some small Mmlateral 1 ½ toes & some small Mm..

The common peroneal (lateral The common peroneal (lateral popliteal) N. L4,L5,S1,S2popliteal) N. L4,L5,S1,S2

The smaller terminal br. of sciatic N .,begins The smaller terminal br. of sciatic N .,begins in the middle of the thigh then runs in the middle of the thigh then runs downward & laterally in the popliteal fossa downward & laterally in the popliteal fossa to ends on the lateral aspect of the neck of to ends on the lateral aspect of the neck of the fibula by dividing to the fibula by dividing to deep peroneal (ant. deep peroneal (ant. tibial) & the superficial peroneal ( musculo-tibial) & the superficial peroneal ( musculo-cutaneous) Nn.cutaneous) Nn. It gives the lateral It gives the lateral cutaneous N. of the calf & the sural cutaneous N. of the calf & the sural communicating br.& articular br. to the knee communicating br.& articular br. to the knee joint.( i.e. no muscular br.)joint.( i.e. no muscular br.)..

The anterior tibial N.(deep peroneal) NThe anterior tibial N.(deep peroneal) N..

It begins on the lateral side of the neck of It begins on the lateral side of the neck of the fibula as the deep terminal br. of lat. the fibula as the deep terminal br. of lat. Popliteal N. It runs downward in the Popliteal N. It runs downward in the ant.comp. of the leg & passes in front ant.comp. of the leg & passes in front of the ankle joint under the inf. ext. of the ankle joint under the inf. ext. retinaculum into the dorsum of the foot retinaculum into the dorsum of the foot & ends by supplying the intertarsal & & ends by supplying the intertarsal & tarsometatarsal joints.It supplies all the tarsometatarsal joints.It supplies all the Mm in the ant. comp. of the leg &small Mm in the ant. comp. of the leg &small area of skin in the cleft between the 1area of skin in the cleft between the 1stst

& 2& 2ndnd toes.& the ankle joint toes.& the ankle joint. .

The musculo-cutaneous(the superficial The musculo-cutaneous(the superficial peroneal ) Nperoneal ) N..It begins on the lateral side of the neck of the It begins on the lateral side of the neck of the fibula as the superficial terminal br. of lat. fibula as the superficial terminal br. of lat. Popliteal N. It runs downward in the lat. Popliteal N. It runs downward in the lat. comp. of the leg & ends in the lower part of comp. of the leg & ends in the lower part of the leg by dividing to med. & lat. br. on the the leg by dividing to med. & lat. br. on the dorsum of the foot. It supplies the Mm of lat. dorsum of the foot. It supplies the Mm of lat. comp. of the leg & the skin of the lower 2/3comp. of the leg & the skin of the lower 2/3rdrd of the lateral aspect of the leg & the skin of of the lateral aspect of the leg & the skin of dorsum of the foot& the toes except the cleft dorsum of the foot& the toes except the cleft between the 1between the 1stst & 2 & 2ndnd toes(ant.tibial N.) &lat. toes(ant.tibial N.) &lat. Side of little toe (sural N.)Side of little toe (sural N.)..

Segmental cutaneous supply of the lower limbSegmental cutaneous supply of the lower limb

The skin of the lower limb is The skin of the lower limb is supplied by L1,2,3,4,5&S1,2,3. supplied by L1,2,3,4,5&S1,2,3. as fallowsas fallows::L1,2,3 :front ,med. & latL1,2,3 :front ,med. & lat..

of the thighof the thigh. . L4 :antero-medial aspect of the L4 :antero-medial aspect of the legleg..

L5 :ant. aspect of the leg & L5 :ant. aspect of the leg & med.side of the footmed.side of the footS1 :lat. Side of the foot&latS1 :lat. Side of the foot&lat..side of the legside of the leg..

S2 :post. Surface of the legS2 :post. Surface of the leg & & the thighthe thigh..

S3 :lower&med. Part ofS3 :lower&med. Part of gluteal regiongluteal region. .

The veins of the lower limbThe veins of the lower limb::The veins of the lower limb divided to superficial & The veins of the lower limb divided to superficial & deep veins according to the deep fasciadeep veins according to the deep fascia..

The superficial veinsThe superficial veins : which divided to great (long) : which divided to great (long) saphenous vein & small (short ) saphenous veinsaphenous vein & small (short ) saphenous vein..

The great saphenous veinThe great saphenous vein :It begins at the medial :It begins at the medial end of the dorsal venous plexus on the dorsum of end of the dorsal venous plexus on the dorsum of the foot & ascends immediately in front of the the foot & ascends immediately in front of the medial malleolus where the saphenous N. lies in medial malleolus where the saphenous N. lies in front of the vein. Then the vein ascend on the front of the vein. Then the vein ascend on the medial side of the leg then the post. parts of the medial side of the leg then the post. parts of the medial condyles of the tibia & the femur to the medial condyles of the tibia & the femur to the groin where it pierces the deep fascia at the groin where it pierces the deep fascia at the saphenous opening to enter the femoral veinsaphenous opening to enter the femoral vein..

The upper part of great saph. V. receives The upper part of great saph. V. receives superficial veins from the thigh , external superficial veins from the thigh , external genetalia & ant. Abdominal wallgenetalia & ant. Abdominal wallThe great saph. Vein contain many valves The great saph. Vein contain many valves below the knee & 2 valves just before below the knee & 2 valves just before

entering the femoral veinentering the femoral vein . . The small saphenous veinThe small saphenous vein :It begins behind :It begins behind the lat. malleolus & drains the lat. side of the lat. malleolus & drains the lat. side of the venous plexus on the dorsum of the the venous plexus on the dorsum of the foot .It ascends over the back of the calf to foot .It ascends over the back of the calf to the popliteal fossa where it perforates the the popliteal fossa where it perforates the deep fascia & ends in the popliteal veindeep fascia & ends in the popliteal vein..

The deep veins of the lower limbThe deep veins of the lower limb::The venae comitantes of the The venae comitantes of the ant. & post. tibial ant. & post. tibial Aa.Aa. unite together at the lower border of unite together at the lower border of popliteus M. to form the popliteus M. to form the popliteal veinpopliteal vein which which after ascending in the popliteal fossa ,it after ascending in the popliteal fossa ,it receives the small saph. vein ,then enters the receives the small saph. vein ,then enters the opening in the adductor magnus M. to form opening in the adductor magnus M. to form the femoral veinthe femoral vein..

The femoral veinThe femoral vein : It begins at the opening in the : It begins at the opening in the adductor magnus M. as a continuation of adductor magnus M. as a continuation of popliteal vein then pass in the adductor canal popliteal vein then pass in the adductor canal the femoral triangle & ends behind the the femoral triangle & ends behind the inguinal ligament to become the external iliac inguinal ligament to become the external iliac vein. It is behind the femoral A. in the apex of vein. It is behind the femoral A. in the apex of femoral triangle to be medial to it in the base femoral triangle to be medial to it in the base of the triangleof the triangle..

The femoral vein The femoral vein receivereceive: :

11 - -deep external deep external pudendal veinpudendal vein. .

22 - -profunda femoris profunda femoris veinvein. .

33 - -medial & lateral medial & lateral circumflex femoral circumflex femoral

veinsveins . .

44 - -great saphenous great saphenous veinvein. .

55 - -muscular veinsmuscular veins. .

The femoral triangleThe femoral triangleIt is found in the upper1/3It is found in the upper1/3rdrd of the of the front of the thighfront of the thigh..

From aboveFrom above: the inguinal lig: the inguinal lig . .

laterallylaterally :medial border of sartorius :medial border of sartorius MM..

MediallyMedially :medial border of adductor :medial border of adductor longus Mlongus M . .

The roofThe roof :skin , superficial fascia & :skin , superficial fascia & deep fasciadeep fascia . .

The floorThe floor : 4 Mm.( from med. to : 4 Mm.( from med. to lat.):adductor longus , pectineus, lat.):adductor longus , pectineus,

psoas major & iliacuspsoas major & iliacus . .

The femoral triangle contentsThe femoral triangle contents::11 - -The femoral artery & its branchesThe femoral artery & its branches..

22 - -The femoral vein& its tributariesThe femoral vein& its tributaries..

33 - -The femoral sheath( & the femoral The femoral sheath( & the femoral canal ) canal )..

44 - -The femoral nerve & its branchesThe femoral nerve & its branches. .

55 - -The deep inguinal lymph nodes(3-4) The deep inguinal lymph nodes(3-4) along the medial side of femoral vein along the medial side of femoral vein. .

66 - -The femoral br. of genito-femoral NThe femoral br. of genito-femoral N..

77 - -The lat. cut N. of the thighThe lat. cut N. of the thigh..

The femoral sheath & the femoral canalThe femoral sheath & the femoral canalThe femoral A. & V. enter the femoral triangle from The femoral A. & V. enter the femoral triangle from behind the inguinal lig. within a sheath of fascia called behind the inguinal lig. within a sheath of fascia called the femoral sheaththe femoral sheath which descends from the lower which descends from the lower abdomen to surround the upper part of the femoral Vvabdomen to surround the upper part of the femoral Vv..

The femoral sheath is funnel- shape ,4 cm long. It The femoral sheath is funnel- shape ,4 cm long. It divided todivided to: :

11 - -lateral comp.lateral comp. contains femoral A contains femoral A..22 - -Intermediate comp.Intermediate comp. contains the femoral vein contains the femoral vein..

33 - -medial comp.:medial comp.: a small vertically placed gap called the a small vertically placed gap called the femoral canalfemoral canal contains a lymph node & loose areolar contains a lymph node & loose areolar tissue.It opens in the abdomenal cavity by an opening tissue.It opens in the abdomenal cavity by an opening called called The femoral ringThe femoral ring whish is normally closed by whish is normally closed by condensation of extra-peritoneal tissue called the condensation of extra-peritoneal tissue called the femoral septumfemoral septum. The canal is closed below by the . The canal is closed below by the blending of its wallblending of its wall..