Lower Limb Anatomy

Last updated 20.09.12

 

Index

 

-  Bones

-  Joints

-  Movements & ROM

-  Muscles

-  Fascia

-  Bursae

-  Trigger Points

-  Arterial Supply

-  Venous Drainage

-  Lymphatic Drainage

-  Innervation

-  Cutaneous Innervation

-  Dermatomes

-  Reflexes

-  Regional Anatomy

-  Surface Anatomy

-  Acupuncture

 

 

 

Bones of the Lower Limb

<Lower Limb Anatomy>

 

 

-  Innominate (Pelvis)

-  Femur

-  Tibia

-  Fibula

-  Tarsals

-  Talus

-  Calcaneus

-  Navicular

-  Cuboid

-  Cuneiforms

-  1st Cuneiform

-  2nd Cuneiform

-  3rd Cuneiform

-  Metatarsals

-  Phalanges

-  Proximal

-  Middle

-  Distal

 

 

 

 

Innominate (L. without name) (Os Coxa [L. bone of hip])

 

-      2 bones bilateral, 1 unilaterally

-      Large bone of pelvic girdle

-      Consists of three fused bones

o     Ilium

o     Ischium

o     Pubis

-      Fan shaped with ilium as upper blade, ischium and pubis as the lower blade, acetablum as the center

-      Forms the pelvis with the sacrum and bilateral innominates

-      Differences between sexes

o                                    Male

      Pelvic inlet is heart shaped

o     Female

      Pelvic inlet is oval and broader

      Ischial spines are turned laterally

      Subpubic angle is musch broader

      Greater distance between iliac crests and therefore wider hips

-      Ilium (L. flank)

o     Superior bone of innomiate, superior to ischium and pubis

o     Body

o     Ala (L. wing)

o     Gluteal Lines

      Anterior Gluteal Line

      Posterior Gluteal Line

      Inferior Gluteal Line

o     Iliac Fossa

      Medial aspect of ilium

      Attachment site of ilacus muscle

o     Auricular Facet

o     Arcuate Line

      Links the ?? of the ilium with the pubic cerst???

o     Iliac Crest

         Superior most portion

         Thickened ridge

o         Iliac Tubercule

         Anterioinferior to iliac crest

         Thickened lateral projection of iliac crest

o         Iliac Tuberosity

         Large prominence superior to auricular facet and sacroiliac joint

         Attachment site of interosseous sacroiliac ligament

o         Anterior Superior Iliac Spine (ASIS)

         Attachment site of:

         Sartorius muscle

         Tensor fascia latae muscle

o         Anterior Inferior Iliac Spin (AIIS)

         Attachment site of:

         Rectus femoris muscle

         Iliofemoral ligament

o         Posterior Superior Iliac Spine (PSIS)

o         Greater Sciatic Notch

         Lies between PIIS superiorly and ischial spine inferiorly

         Converted to greater sciatic foramen by sacrospinous ligament inferiorly

o         Posterior Inferior Iliac Spine (PIIS)

-         Acetablum (shaped like a roman vinegar cup)

o         Cup-shaped fossa at area of fusion of ilium, ischium and pubis

o         Pubis anteriorly, ischium posteriorly and ilium superiorly

o         Acetabular Fossa

         Deeper portion of acetablum

         Lodges the ligament for head of femur (ligamentum teres)

o         Lunate Surface (Articular Surface)

         Shaped like a horse shoe

         Articulates with the head of the femur at hip joint

o         Acetabular Notch

         Inferiorly incomplete bony rim

         Covered by transverse acterabular ligament

         Opens superioly into acetabular fossa

-         Ischium

o         Posterioinferior bone of innominate, posterior to pubis and posterioinferior to ilium

o         Ischial Spine

         Forms superior border of lesser sciatic foramen

         Forms inferior border of greaters sciatic foramen

         Attachment site of:

         Sacrospinous ligament

         Superior gamelli muscle at inferiolateral aspect

o         Lesser Sciatic Notch

         Lies between ischial spine and ischial tuberosity

         Smaller than greater sciatic notch of ilium

         Converted into lesser sciatic foramen by sacrospinous ligament superiorly and sacrotuberous ligament inferiorly

o         Ischial Tuberosity

         Forms inferior border of lesser sciatic foramen

         Attachment site of:

         Sacrotuberous ligament

         Inferior gamelli muscle at superiolateral aspect

         Hamstring muscles

o        Long head of biceps femoris muscle

o        Semimembranosus muscle

o        Semitendonosus muscle

         Adductor magnus muscle

         Quadratus femoris muscle on lateral aspect

o         Ischial Ramus

         Projects anteriorly from body

         Joins with pubic ramus at ischiopubic ramus

         Attachment site of:

         Adductor part of adductor magnus muscle at inferior aspect

         Obturator externus muscle on external superior aspect

         Obturator internus muscle on internal superior aspect

-         Obturator Foramen (L. closed)

o         Circular hole in inferiolateral portion of innominate, inferior to acetablum

o         Superior border formed by acetablum

o         Posterior border formed by ischium

o         Anterior border formed by pubis

o         Inferior border formed by ischiopubic ramus

o         Closed by obturator membrane

o         Attachment site of:

         Obturator internus muscle on its anteromedial surface within lesser pelvis

         Obturator externus muscle on its posterolateral surface

-         Ischiopubic Ramus

o         Joins ischium with pubis

o         Creates the inferior border of obturator foramen

-         Pubis (L. groin bone)

o         Anterioinferior bone of innominate, anterior to ischium and anteroinferior to ilum

o         Inferior Pubic Ramus

         Projects inferior and posterior from body of pubis

         Joins with ischial ramus at ischiopubic ramus

         Attachment site of:

         Adductor brevis muscle

         Gracilis muscle

         Hamstring head of adductor magnus muscle

o         Superior Pubic Ramus

         Projects superior and posterior from body of pubis

         Forms part of acetabulum

o         Body of the Pubis

         Attachment site of:

         Adductor longus muscle

         Adductor brevis muscle

         Gracilis muscle

o         Pubic Crest

o         Pecten Pubis (Pectineal Line)

         Attachment site of pectineus muscle

o         Pubic Tubercule

         Attachment site of inguinal ligament

o         Conjoint Ramus

o         Symphysial Surface

         Medial aspect of body of pubis

         Elongated oval facet

         Articulates with interpubic articular disc to form the pubic symphysis with the contralateral pubis

-         Iliopubic Eminence (Pectineal Eminence)

o          

 

 

Femur

 

-      2 bones bilateral, 1 unilaterally

-      Largest and longest bone of body

-      Persons height equals four times the length of the femur

-      Proximal Extremity

o     Head

      Smooth proximal surface

      Forms 2/3rds of a sphere

      Faces medially, superiorly and anteriorly

      Articulates with acetablum at hip joint

      Fovea Capitis Femoris

     Depression inferior to center

     Attachment site of ligamentum teres of femur

     Receives artery to the head of the femur branch of obturator artery

o     Neck

      Connects head to shaft

      Forms angle of about 125o between shaft and head

o     Greater Trochanter

      Large prominence at junction of neck and shaft at superiolateral aspect

      At superiolateral aspect of intertrochanteric crest posteriorly and intertrochanteric line anteriorly

      Attachment site of:

     Gluteus medius muscle

     Gluteus minimis muscle

     Piriformis muscle

     Obturator internus muscle

      Trochanteric Fossa

     Deep groove

     Medial aspect of greater trochanter

     Attachment site of obturator externus muscle

o     Lesser Trochanter

      Large prominence at junction of neck and shaft at inferiomedial aspect

      At inferiomedial aspect of intertrochanteric crest posteriorly and intertrochanteric line anteriorly

      Attachment site of iliopsoas muscle

o     Intertrochanteric Line

      Runs from greater trochanter to lesser trochanter on anterior aspect

o     Intertrochanteric Crest

      Distinct ridge

      Runs from greater trochanter to lesser trochanter on posterior aspect

      Quadrate Tubercule

     Flattened surface at midpoint of intertrochanteric crest

     Serves as attachement site of quadratus femoris muscle

-      Shaft (Body)

o     Gluteal Tuberosity

      Roughened area

      Inferior to lesser trochanter on posterior aspect

      Attachment site of gluteus maximus muscle

o     Linea Aspera

      Roughened vertical line at posterior aspect

      Lateral Lip

     Attachment site of:

o     Vastus lateralis muscle

      Medial Lip

     Attachment site of:

o     Vastus medialis muscle

o     Pectineal Line (Spiral Line)

      From lesser trochanter to medial lip of linea aspera

      Attachment site of:

     Pectineus muscle

     Adductor brevis muscle

-      Distal Extremity

o     Medial Supracondylar Ridge

o     Adductor Tubercule (Gerdys Tubercule)

      Small prominence at most superior aspect of medial condyle

      Most inferior portion of medial supracondylar ridge

      Attachment site of:

     Hamstring head of adductor magnus muscle

o     Medial Epicondyle

o     Medial Condyle

      Medial collateral ligament (tibial collateral ligament)

o     Lateral Supracondylar Ridge

o     Lateral Condyle

      Lateral collateral ligament (fibular collateral ligament)

o     Lateral Epicondyle

o     Popliteal Surface

o     Intercondylar Notch

o     Patellar Surface

o     Trochlear Groove

o     Articulates with tibia at tibiofemoral joint

 

Patella

 

-         2 bones bilateral, 1 unilaterally

-         Largest sesamoid bone

-         Base

o         Most superior aspect

o         Attachment site of:

         Quadriceps femoris muscle

         Rectus femoris muscle

         Vastus lateralis muscle

         Vastus intermedius muscle

         Vastus medialis muscle

-         Apex

o         Most inferior aspect

-         Located within quadriceps muscle tendon

-         Articulates with femur at trochlear groove

-         Does not articulate with tibia

-         Attaches to tibial tuberosity by patellar ligament inferiorly and quadriceps muscle superiorly

 

 

Tibia

 

-         2 bones bilateral, 1 unilaterally

-         Weight beating bone of leg

-         Proximal Extremity (Head)

o         Articulates with femur at tibiofemoral joint

o         Tibial Tuberosity

         Attachment site of patellar ligament

-         Shaft (Body)

o         Soleal Line

         Attachment site of:

         Soleus muscle

         Popliteus muscle?

o         Vertical Line

-         Distal Extremity (Head)

o         Medial Malleolus

         Attachment site of deltoid ligament

         ? Groove

         Lies lateral to malleolar groove

         Transmits:

o        Flexor hallicus longus muscle

         Malleolar Groove

         Lies medial to ? groove

         Transmits:

o        Tibialis posterior muscle

o        Flexor digitorum longus muscle

 

 

 

Fibula

 

-         2 bones bilateral, 1 unilaterally

-         Non-weight bearing bone of leg

-         Head (Apex)

-         Shaft (Body)

-         Distal Extremity

o         Lateral Malleolus

 

 

 

 

Talus

-         2 bones bilateral, 1 unilaterally

 

Calcaneus

-         2 bones bilateral, 1 unilaterally

-         Tubercules anterior posterior, medila, lateral

-         Sustentaculum Tali

 

Navicular (L. boat shaped)

-         2 bones bilateral, 1 unilaterally

-         Lies between head of talus and cuneiform bones

-         Navicular Tuberosity

 

Cuboid

-         2 bones bilateral, 1 unilaterally

-         Most lateral tarsal

-         Notch

-         Groove

 

Cuneiform

-         6 bones bilateral, 3 unilaterally

-         1st cuneiform lies most medial

-         2nd cuneiform lies between 1st and 3rd

-         3rd cuneiform lies most lateral

-         Articulate with navicular posteriorly and 1st three metatarsals anteriorly

 

1st Cuneiform (Medial Cuneiform)

-         2 bones bilateral, 1 unilaterally

 

2nd Cuneiform (Middle Cuneiform)

-         2 bones bilateral, 1 unilaterally

 

3rd Cuneiform (Lateral Cuneiform)

-         2 bones bilateral, 1 unilaterally

 

Metatarsals

-         2 bones bilateral, 1 unilaterally

 

Phalanges

-         2 bones bilateral, 1 unilaterally

 

Metacarpals

-         5 long bones unilaterally, 10 bones bilateral

-         Extend from tarsals (ankle) to proximal phalanges (digits)

-         Makes up the palm and dorsum of the hand with the tarsals

-         Numbered from lateral side

o         1st metacarpal is the part of the big toe

o         2nd metacarpal is the part of the 2nd toe

o         3rd metacarpal is the part of the 3rd toe

o         4th metacarpal is the part of the 4th toe

o         5th metacarpal is the part of the little toe

-         Base

o         Proximal extremity

o         Articulates with the tarsals

-         Shaft

o         Slightly concave on medial and lateral borders where dorsal interossei muscles attach

-         Head

o         Distal extremity

o         Small tubercule on dorsal surface is attachment of collateral ligaments and joint capsule

o         Articulates with the proximal phalange of the same digit

 

1st Metacarpal

-         Forms base of the thumb within the palm

-         Base articulates with the ? at the 1st tarsometatarsal joint

-         Head articulates with 1st proximal phalange at the 1st metatarsophalangeal joint

-         Medial surface is attachment of

o         df

-         Lateral surface is attachment of

o         df

 

2nd Metacarpal

-         Forms base of the inex finger within the palm

-         Base articulates with the ? at the 2nd tarsometatarsal joint

-         Head articulates with 2nd proximal phalange at the 2nd metatarsophalangeal joint

-         Medial surface is attachment of

o         df

-         Lateral surface is attachment of

o         df

 

3rd Metacarpal

-         Forms base of the middle finger within the palm

-         Base articulates with the ? at the 3rd tarsometatarsal joint

-         Head articulates with 3rd proximal phalange at the 3rd metatarsophalangeal joint

-         Medial surface is attachment of

o         df

-         Lateral surface is attachment of

o         df

 

4th Metacarpal

-         Forms base of the ring finger within the palm

-         Base articulates with the ? and ? at the 4th tarsometatarsal joint

-         Head articulates with 4th proximal phalange at the 4th metatarsophalangeal joint

-         Medial surface is attachment of

o         df

-         Lateral surface is attachment of

o         df

 

5th Metacarpal

-         Forms base of the little finger within the palm

-         Base articulates with the ? at the 5th tarsometatarsal joint

-         Head articulates with 5th proximal phalange at the 5th metatarsophalangeal joint

-         Medial surface is attachment of

o         df

-         Lateral surface is attachment of

o         df

 

 

 

 

Phalanges

 

 

-         14 long bones unilaterally, 24 bilateral

-         Extend from metatarsalls inferiorly to distal extent of upper limb

-         Makes up the digits of the hand

-         Numbered from lateral side

o         1st phalanges are of the big toe

o         2nd phalanges are of the 2nd toe

o         3rd phalanges are of the 3rd toe

o         4th phalanges are of the 4th toe

o         5th phalanges are of the little toe

-         Classified from proximal to distal

o         Proximal phalanges are most proximal

o         Middle phalanges lie between proximal and distal phalanges (except in the 1st digit [big toe])

o         Distal phalanges are most distal

-         Base

o         Proximal extremity

o         Articulate proximally

-         Shaft

o         Slightly concave on medial and lateral borders

-         Head

o         Distal extremity

o         Articulate distally

 

Proximal Phalanges

-         5 long bones unilaterally, 10 bilateral

-         Extend from metatarsals distally to middle phallanges (distal phalanx of 1st digit [big toe])

-         Numbered from lateral to medial

o         1st proximal phalanx of big toe

o         2nd proximal phalanx of 2nd toe

o         3rd proximal phalanx of 3rd toe

o         4th proximal phalanx of 4th toes

o         5th proximal phalanx of little toe

-         Base

o         Proximal extremity

o         Articulate proximally with tarsals at tarsometatarsal joints

-         Shaft

o         Slightly concave on medial and lateral borders

-         Head

o         Distal extremity

o         Articulate distally with middle phalanges (distal phalanx of 1st digit [big toe])

 

1st Proximal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Base

o         Attachment site of:

         ? on its medial surface

         ? on its anterior surface

         ? on its lateral surface

o         Articulates with 1st metatarsal at the 1st metatarsophalangeal joint

-         Head

o         Articulates with 1st distal phalanx at 1st interphallangeal joint

 

2nd Proximal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Base:

o         Articulates with 2nd metatarsal at the 2nd metatarsophalangeal joint

-         Head

o         Articulates with 2nd middle phalanx at the 2nd proximal interphalangeal joint

 

3rd Proximal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Base:

o         Articulates with 3rd metatarsal at the 2nd metatarsophalangeal joint

-         Head

o         Articulates with 3rd middle phalanx at the 2nd proximal interphalangeal joint

 

4th Proximal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Base:

o         Articulates with 4th metatarsal at the 2nd metatarsophalangeal joint

-         Head

o         Articulates with 4th middle phalanx at the 2nd proximal interphalangeal joint

 

5th Proximal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Base:

o         Articulates with 5th metatarsal at the 2nd metatarsophalangeal joint

-         Head

o         Articulates with 5th middle phalanx at the 2nd proximal interphalangeal joint

 

Middle Phalanges

-         4 long bones unilaterally, 8 bilateral

-         Extend from proximal phalanges distally to distal phalanges (except for 1st digit [big toe])

-         Numbered from lateral to medial

o         2nd middle phalanx of 2nd toe

o         3rd middle phalanx of 3rd toe

o         4th middle phalanx of 4th toe

o         5th middle phalanx of little toe

-         Base

o         Proximal extremity

o         Articulate proximally with proximal phalanges at proximal interphalangeal joints

-         Shaft

o         Slightly concave on medial and lateral borders

-         Head

o         Distal extremity

o         Articulate distally with the distal phalanges

 

2nd Middle Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with:

o         2nd distal phalanx distally

o         2nd proximal phalanx proximally

 

3rd Middle Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with:

o         3rd distal phalanx distally

o         3rd proximal phalanx proximally

 

4th Middle Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with:

o         4th distal phalanx distally

o         4th proximal phalanx proximally

 

5th Middle Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with:

o         5th distal phalanx distally

o         5th proximal phalanx proximally

 

 

 

 

Distal Phallanges

 

 

-         5 long bones unilaterally, 10 bilateral

-         Extend from middle phalanges (proximal phalanx of 1st digit [big toe]) distally to tip of the toes

-         Numbered from lateral to medial

o         1st distal phalanx of big toe

o         2nd distal phalanx of 2nd toe

o         3rd distal phalanx of 3rd toe

o         4th distal phalanx of 4th toe

o         5th distal phalanx of little toe

-         Base

o         Proximal extremity

o         Articulate proximally with middle phalanges (proximal phalanx of 1st digit [big toe]) at distal interphalangeal joints (interphalangeal joint of 1st digit [big toe])

-         Shaft

o         Slightly concave on medial and lateral borders

-         Head

o         Distal extremity

 

1st Distal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with 1st proximal phalanx proximally

-         Base:

o         Attachment site of:

         ? anteriorly

         ? posteriorly

 

2nd Distal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with 2nd middle phalanx proximally

-         Base:

o         Attachment site of:

         ? anteriorly

         ? posteriorly

 

3rd Distal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with 3rd middle phalanx proximally

-         Base:

o         Attachment site of:

         ? anteriorly

         ? posteriorly

 

4th Distal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with 4th middle phalanx proximally

-         Base:

o         Attachment site of:

         ? anteriorly

         ? posteriorly

 

5th Distal Phalanx

-         1 long bone unilaterally, 2 bilateral

-         Articulates with 5th middle phalanx proximally

-         Base:

o         Attachment site of:

         ? anteriorly

         ? posteriorly

 

 

 

Joints of the Lower Limb

<Lower Limb Anatomy>

 

 

-  Sacroiliac Joint

-  Pubic Symphysis

-  Hip Joint (Coxal)

-  Knee Joint

-  Proximal Tibiofibular Joint

-  Middle Tibiofibular Joint

-  Distal Tibiofibular Joint

-  Ankle Joint (Talocrural Joint)

-  Intertarsal Joints

-  Midtarsal Joints

-  Subtalar Joint

-  Talocalcaneonavicular Joint

-  Tarsometatarsal Joint

-  Metatarsophalangeal Joint

-  Proximal Interphalangeal Joint

-  Distal Interphalangeal Joint

 

 

 

 

Sacroiliac Joint

Class: Synovial

Subclass: Plane

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Anterior sacroiliac ligmament

-      Posterior sacroiliac ligament

-      Interosseous sacroiliac ligament

 

Pubic Symphysis

Class: Cartilaginous

Subclass: Symphysial

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Superior pubic ligament

-      Inferior pubic ligament (Arcuate ligament)

-      Articular disc

-      Inguinal Ligament

o        Not actually part of pubic symphysis

o        Considered in Regional Anatomy of the Lower Limb

 

Hip Joint (Coxal)

Class: Synovial

Subclass: Ball and socket

Bony Contact: head of the femur with acetabulum of innominate

Movement::

-      Abduction

o        gluteus maximus

o        gluteus medius

o        gluteus minimus

-      Adduction:

o        pectineus

o        adductor brevis

o        adductor longus

o        adductor magnus

-      Extension

o        Hamstrings

         long head of biceps femoris

         semitendonosus

         semimembranosus

o        gluteus maximus

o        adductor magnus

-      Flexion

o        iliopsoas

o        rectus femoris

o        sartorius

o        gracilis

o        pectineus

o        adductor brevis

o        adductor longus

-      Lateral Rotation

o        gluteus maximus

o        piriformis

o        obturator externus

o        obturator internus

o        superior gamellus

o        inferior gamellus

o        long and short heads of biceps femoris

-      Medial Rotation

o        semitendonosus

o        semimembranosus

o         

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Iliofemoral Ligament (Y ligament)

o        Anterior portion of joint capsule

o        Shaped like an upside down Y

o        Long axis attaches to AIIS

-      Ischiofemoral Ligament

o        Posterior portion of joint capsule

o        Spiral shaped passing superiolaterally

-      Pubofemoral Ligament

o        Passes deep to lower limb of iliofemoral ligament

-      Acetabular Labrum (L. lip)

o        Transverse Acetabular Ligament

         Bridges acetabular notch

         Foramen deep to ligament allows passage of teres ligament? and vessels to femoral head

o        Transverse Acetabular Ligament

-      Teres Ligament

 

Proximal Tibiofibular Joint

Class: Synovial

Subclass: Plane/gliding

Bony Contact: Head of fibular with fibular facet of tibia

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Load is placed on this joint during dorsiflexion as the fibula is forced superiorly

-      Anterior Tibiofibular Ligament

-      Posterior Tibiofibular Ligament

 

Middle Tibiofibular Joint

Class: Fibrous

Subclass: ????

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Load is placed on this joint during dorsiflexion as the fibula is forced superiorly

 

 

Distal Tibiofibular Joint

Class: Fibrous

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation: deep peroneal nerve, tibial nerve

Referred Pain:

-      Minimal movement occurs here, 1-2mm during dorsiflexion

-      Load is placed on this joint during dorsiflexion as the fibula is forced superiorly

-      Anterior Tibiofibular Ligament

-      Posterior Tibiofibular Ligament

-      Inferior Transverse Ligaments

-      Interosseous ligaments

 

Ankle Joint (Talocrural Joint)

Class: Synovial

Subclass: H hinge

Bony Contact:

Movement: Dorsiflexion, plantar flexion, does not allow inversion or eversion

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      Lateral Ligament

o        Shaped like a capital T

o        Composed of three ligaments

         Anterior Talofibular Ligament

         Passes from anterior aspect of distal extremity of fibula anteromedially to anterior surface of talus (anterior tubercule?)

         Forms right side of T but passes partly laterally

         Posterior Talofibular Ligament

         Passes from posterior aspect of distal extremity of fibula medially posteiror surface of talus (posterior/lateral tubercule?)

         Forms left side of T but passes more laterally than it does posteriorly

         Calcaneoficular Ligament

         Forms vertical portion of T but passes postereoinferiorly

o        Thinner and weaker in comparison to medial ligament

-      Medial Ligament (Deltoid Ligament)

o        Composed of three ligaments

         ? Ligament

         ?

         ? Ligament

         ?

         ? Ligament

         ?

-      Interosseos?

 

 

Subtalar Joint

Class: Synovial?

Subclass: Saddle?

Bony Contact: inferior facet? of talus with superior facet? of calcaneous

Movement: eversion?, inversion?

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Talocalcaneonavicular Joint

Class: Synovial

Subclass: Ball and socket

Bony Contact: Head of talus with sustentaculum tali and anterior facet of calcaneous and posterior facet? of navicular

Movement: inversion?, eversion?

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Midtarsal Joint

Class:

Subclass:

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Tarsometatarsal Joint

Class: Synovial

Subclass: Plane?

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Metatarsophalangeal Joint

Class: Synovial

Subclass: Condyloid

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Proximal Interphalangeal Joint

Class: Synovial

Subclass: Hinge

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

-      joint

 

Distal Interphalangeal Joint

Class: Synovial

Subclass: Hinge

Bony Contact:

Movement:

ROM:

Stability:

Vasculature:

Innervation:

Referred Pain:

joint

 

 

 

 

Movements & ROM of the Lower Limb

<Lower Limb Anatomy>

 

 

-  Descriptions

-  Flexion

-  Extension

-  Abduction

-  Adduction

-  Circumduction

-  External (Lateral) Rotation

-  Internal (Medial) Rotation

-  Pronation

-  Supination

-  Closed packed position

-  Neutral position

-  Capsular pattern

 

 

Pectoral Girdle

Movements of the Scapula

 

Elevation

Description:

Muscles: trapezius (upper), levator scapulae

 

Depression

Description:

Muscles: trapezius (lower), serratus anterior, pectoralis minor

 

Protrusion/Abduction

Description:

Muscles: serratus anterior

 

Retraction/Adduction

Description:

Muscles: trapezius, rhomboid major, rhomboid minor

 

Inferior Rotation

Description:

Muscles: rhomboid major, rhomboid minor, levator scapulae

 

Superior Rotation

Description:

Muscles: serratus anterior, trapezius

 

Movements of the Clavicle

 

Elevation

Description:

Muscles: trapezius (upper)

 

Depression

Description:

Muscles: subclavius

 

Movements of the Shoulder Joint

Joint Class:

Joint Subcalss:

 

Adduction

Description:

Muscles: pectoralis major, latissimus dorsi, deltoid (posterior head)

 

Abduction

Description:

Muscles: deltoid, supraspinatus

 

Flexion

Description:

Muscles: pectoralis major (clavicular head), deltoid (anterior head), coracobrachialis, biceps brachii

ROM: 0-180o

End Feel:

-         Glenohumeral: abrupt and firm (ligamentous)

o         Coracoacromial arch

-         Shoulder Complex: abrupt and firm (ligamentous)

 

Extension

Description:

Muscles: latissimus dorsi, deltoid (posterior head), triceps brachii

ROM: 0-60o

End Feel:

-      Glenohumeral: abrupt and firm (ligamentous)

-      Shoulder Complex: abrupt and firm (ligamentous)

 

Medial Rotation (Internal Rotation)

Description:

Muscles: subscapularis, pectoralis major, deltoid (anterior head), latissimus dorsi, teres major

ROM: 0-180o

End Feel:

-      Glenohumeral: abrupt and firm (ligamentous)

-      Shoulder Complex: abrupt and firm (ligamentous)

 

Lateral Rotation (External Rotation)

Description:

Muscles: infraspinatus, teres minor, deltoid (posterior head)

ROM: 0-90o

End Feel:

-      Glenohumeral: abrupt and firm (ligamentous)

-      Shoulder Complex: abrupt and firm (ligamentous)

 

Circumduction

 

Scapulohumeral Rhythm

 

Movements of the Elbow Joint

Joint Class:

Joint Subcalss:

 

Flexion

Description:

Muscles:

ROM:

End Feel:

 

Extension

Description:

Muscles:

ROM:

End Feel:

 

Movements of the Proximal Radioulnar Joint

Joint Class:

Joint Subcalss:

 

Pronation

Description:

Muscles:

ROM:

End Feel:

 

Supination

Description:

Muscles:

ROM:

End Feel:

Movements of the Middle Radioulnar Joint

Joint Class:

Joint Subcalss:

 

Proximal Displacement of Radius

Description:

Muscles:

ROM:

End Feel:

 

Movements of the Distal Radioulnar Joint

Joint Class:

Joint Subcalss:

 

Pronation

Description:

Muscles:

ROM:

End Feel:

 

Supination

Description:

Muscles:

ROM:

End Feel:

Movements of the Radiocarpal and Midcarpal Joints

Joint Class:

Joint Subcalss:

 

Adduction

Description:

Muscles:

ROM:

End Feel:

 

Abduction

Description:

Muscles:

ROM:

End Feel:

 

Flexion

Description:

Muscles:

ROM:

End Feel:

 

Extension

Description:

Muscles:

ROM:

End Feel:

 

Movements of the Metacarpophallangeal Joints

Joint Class:

Joint Subcalss:

 

Adduction

Description:

Muscles:

ROM:

End Feel:

 

Abduction

Description:

Muscles:

ROM:

End Feel:

 

Flexion

Description:

Muscles:

ROM:

End Feel:

 

Extension

Description:

Muscles:

ROM:

End Feel:

 

Movements of the Interphallangeal Joints

Joint Class:

Joint Subcalss:

 

Flexion

Description:

Muscles:

ROM:

End Feel:

 

Extension

Description:

Muscles:

ROM:

End Feel:

 

 

 

 

Fingers

Movements

Axial (median) plane of the hand: passes through the centre of the 3rd digit (middle finger).

Adduction: movement of the digits towards the axial plane of the hand

Abduction: movement of the digits away from the axial plane of the hand

Non Standard Digits

3rd Digit (Middle Finger): as it lies in the axial plane of the hand it may be abducted either medially or laterally and adduction returns it to the axial plane.

1st Digit (Thumb): as its neutral resting position is approximately at right angles to the other digits abduction moves the thumb anteriorly and adduction returns it posteriorly to the 2nd digit (index finger).

 

Range of Motion

 

 

 

 

Muscles of the Lower Limb

<Lower Limb Anatomy>

 

 

-  Muscles of the Gluteal Region

-  Gluteal Muscles

-Tensor Fascia Latae

-Gluteus Maximus

-Gluteus Medius

-Gluteus Minimis

-  Outward Rotators

-Piriformis

-Obturator Internus

-Gamellus Superior

-Gamellus Inferior

-Obturator Externus

-Quadratus Femoris

-  Muscles of the Thigh

-  Anterior Compartment

-Sartorius

-Rectus Femoris

-Vastus Lateralis

-Vastus Intermedius

-Vastus Medialis

-  Medial Compartment

-Pectineus

-Adductor Longus

-Adductor Brevis

-Adductor Magnus

-Gracilis

-  Posterior Compartment

-Biceps Femoris

-Semitendonosus

-Semimembranosus

-  Muscles of the Leg

-  Anterior Compartment

-Tibialis Anterior

-Extensor Hallucis Longus

-Entensor Digitorum Longus

-Peroneus Tertius

-  Lateral Compartment

-Peroneus Longus

-Peroneus Brevis

-  Posterior Compartment

-Gastrocnemius

-Soleus

-Plantaris

-Popliteus

-Flexor Digitorum Longus

-Flexor Hallicus Longus

-Tibialis Posterior

-  Muscles of the Foot (Intrinsic)

-  Plantar

-Flexor Digitorum Brevis

-Quadratus Plantae

-  Dorsal

-Extensor Digitorum Brevis

-Hallucis Muscles

-Flexor Hallucis Brevis

-Abductor Hallucis

-Adductor Hallucis

-Digiti Minimi Muscles

-Flexor Digiti Minimi

-Abductor Digiti Minimi

-Lumbricals

-Plantar Interossei

-Dorsal Interossei

 

 

 

 

 

Muscles of the Gluteal Region

 

Gluteal Muscles

Origin: Innominate (plus sacrum for gluteus maximus)

Insertion:

-      Femur

o        Gluteus maximus to gluteal tuberosity

o        Gluteus medius and gluteus minimus to greater trochanter of femur

-      Iliotibial tract

o        Gluteus maximus

o        Tensor fascia latae

Action:

Innervation:

Blood Supply:

-      Gluteus maximus, gluteus medius and gluteus minimus create the anterior posterior and inferior gluteal lines on the lateral surface of the illium of innominate

 

Gluteus Maximus

 

Attachments

Proximal Attachment (Origin): posteriolateral surface of ala of ilum, posterior surface of sacrum and coccyx and sacrotuberous ligament, aponeurosis of erector spinae muscles, fascia overlying gluteus medius muscle

 

Distal Attachment (Insertion): gluteal tuberosity of femur between attachments of vastus lateralis muscle and adductor magnus muscle, lateral condyle of tibia via the iliotibial tract

 

Action:

-      extension and lateral rotation of thigh by all fibers

-      abduction of thigh by most superior fibers

-      steadies thigh

 

Myotactic Unit/Agonists:

-      longissimus muscles, iliocostalis muscles, hamstrings for trunk extension

-      piriformis muscle for lateral rotation of thigh

 

Antagonists:

-      iliopsoas muscle, rectus femoris muscle (hip flexors) for trunk extension

-      hip adductors for abduction and lateral rotation of thigh

 

Innervation: Inferior gluteal nerve (L5, S1, S2)

 

Blood Supply:

 

Acupoints: BL31-BL36, BL54, GB30

 

Trigger Points

Location

-      Trigger Point 1: lateral to sacral attachment, inferior to PSIS, lateral to 2nd sacral foramen

-      Trigger Point 2: immediately superior to ischial tuberosity, most common

-      Trigger Point 3: most medial fibers, lateral to coccygeal attachment, medial to ischial tuberosity

 

Activation:

 

Perpetuation:

Walking up hill especially with bent forward posture

Freestyle swimming

-      Trigger Point 1:

-      Trigger Point 2

o        changing posture from sitting to standing may compress this point as it moves across the ischial tuberosity

-      Trigger Point 3:

 

Symptoms:

-      Trigger Point 2: restless and uncomfortable in sitting position

-      Trigger Point 3: restless and uncomfortable in sitting position and coccygodynia

 

Restrictions

-        hip flexion

-         

 

Referred Pain:

-      Trigger Point 1:

-      Trigger Point 2:

-      Trigger Point 3:

 

Forms the prominence of the buttock

Trochanteric bursa separates the tendon of gluteus maximus muscle from the greater trochanter of the femur

Ischial bursa separates the tendon of gluteus maximus muscle from the ischial tuberosity of the innominate

Gluteus maximus and vastus lateralis muscles are separated by a bursa

Covers the ischial tuberosity when standing or walking but lies superior to it when sitting

 

Gluteus Medius

Origin: Lateral surface of ilium between anterior and posterior gluteal lines

Insertion: Lateral surface of greater trochanter of femur

Action: Abduction and medial rotation of thigh, stedies pelvis

Innervation: Superior gluteal nerve (L5, S1)

Blood Supply:

Acupoints:

-      Mos

 

Gluteus Minimis

Origin: Lateral surface of ilium between anterior and inferior gluteal lines

Insertion: Anterior surface of greater trochanter of femur

Action: Abduction and medial rotation of thigh, stedies pelvis

Innervation: Superior gluteal nerve (L5, S1)

Blood Supply:

Acupoints:

-      Mos

 

Tensor Fascia Latae (TFL)

Origin: ASIS, anterior portion of external lip iliac crest

Insertion: lateral condyle of tibia via iliotibial tract

Action: abduction, medial rotation, flexion of thigh, help maintain knee extension, steadies trunk on thigh

Innervation: superior gluteal nerve (L4, L5)

Blood Supply:

Acupoints:

-      Mos

 

Muscles of the Gluteal Region

 

Outward Rotators

 

Piriformis

Origin: Anterior surface of sacrum and sacrotuberous ligament

Insertion: Superior border of greater trochanter of femur

Action: Lateral rotation of extended thigh, abduction of flexed thigh, steadies femoral head within acetabulum

Innervation: Branches of S1, S2

Blood Supply:

Acupoints: GB30

-      Superficial and superior to sciatic nerve

 

Obturator Internus

Origin: Internal/pelvic surface of obturator foramen and obturator membrane and surrounding bones (ischiopubic ramus, superior pubic ramus, inferior portion of acetabulum, body of ischium)

Insertion: Medial surface of greater trochanter of femur

Action: Lateral rotation of extended thigh, abduction of flexed thigh, steadies femoral head within acetabulum

Innervation: Nerve to obturator internus (L5, S1)

Blood Supply:

Acupoints:

-      Reinforced by superior and inferior gamelli

 

Supeior Gamellus

Origin: Ischial spine

Insertion: Medial surface of greater trochanter of femur with tendon of obturator internus

Action: Lateral rotation of extended thigh, abduction of flexed thigh, steadies femoral head within acetabulum

Innervation: Branch of nerve to obturator internus (L5, S1)

Blood Supply:

Acupoints:

-      Reinforces obturator internus

 

Inferior Gamellus

Origin: Ischial tuberosity

Insertion: Medial surface of greater trochanter of femur with tendon of obturator internus

Action: Lateral rotation of extended thigh, abduction of flexed thigh, steadies femoral head within acetabulum

Innervation: Branch of nerve to quadratus femoris (L5, S1)

Blood Supply:

Acupoints:

-      Reinforces obturator internus

 

Obturator Externus

Origin: External surface of obturator foramen and obturator membrane and surrounding bones (ischiopubic ramus, superior pubic ramus, inferior portion of acetabulum, body of ischium)

Insertion: trochanteric fossa of femur

Action: lateral rotation, steadies femoral head within acetabulum

Innervation: obturator nerve (L3, L4)

Blood Supply:

Acupoints:

-      Mos

 

Quadratus Femoris

Origin: lateral border of ischial tuberosity

Insertion: quadrate tubercule on intertrochanteric crest and inferior to it

Action: lateral rotation of thigh, steadies femoral head within acetabulum

Innervation: nerve to quadratus femoris (L5, S1)

Blood Supply:

Acupoints:

-      Mos

 

Muscles of the Thigh

 

Anterior Compartment

 

Sartorius

Origin: ASIS, superior portion of notch inferior to ASIS of ilium

Insertion: superior surface of medial aspect of tibia

Action: flexion, abduction and lateral rotation of thigh

Innervation: femoral nerve (L2, L3)

Blood Supply:

 

Quadriceps Femoris

Composed of 4 muscles

Origin:

Insertion: base of patella

Action: extension of leg at knee

Innervation: posterior division of femoral nerve (L2, L3, L4)

Blood Supply:

 

Rectus Femoris

Origin: AIIS and groove on ilium superior to acetabulum

Insertion: base of patella

Action: extension of leg at knee, steadies hip joint, assists hip flexion

Innervation: posterior division of femoral nerve (L2, L3, L4)

Blood Supply:

 

Vastus Lateralis

Origin: greater trochanter and lateral lip of linea aspera of femur

Insertion: base of patella

Action: extension of leg at knee

Innervation: posterior division of femoral nerve (L2, L3, L4)

Blood Supply:

 

Vastus Intermedius

Origin: anterior and lateral surfaces of shaft of femur

Insertion: base of patella

Action: extension of leg at knee

Innervation: posterior division of femoral nerve (L2, L3, L4)

Blood Supply:

 

Vastus Medialis

Origin: intertrochanteric line and medial ip of linea aspera of femur

Insertion: base of patella

Action: extension of leg at knee

Innervation: posterior division of femoral nerve (L2, L3, L4)

Blood Supply:

 

Muscles of the Thigh

 

Medial Compartment

Action: adduction of thigh

 

Pectineus

Origin: pectin pubis

Insertion: pectineal line of femur

Action: adduction, flexion of thigh

Innervation: femoral nerve (L2, L3)

Blood Supply:

-      Mos

 

Adductor Longus

Origin: body of pubis inferior to pubic crest

Insertion: middle third of linea aspera of femur

Action: adduction of thigh

Innervation: anterior branch of obturator nerve (L2, L3, L4)

Blood Supply:

-      Mos

 

Adductor Brevis

Origin: body and inferior ramus of pubis

Insertion: pectineal line and proximal portion of linea aspera of femur

Action: adduction, may assist flexion of thigh

Innervation: obturator nerve (L2, L3, L4)

Blood Supply:

-      Mos

 

Adductor Magnus

-      Divided into two heads:

o        Adductor head

o        Hamstring head

Origin: inferior ramus of pubis

-      Adductor head: ishial ramus

-      Hamstring head: ischial tuberosity

Insertion: gluteal tuberosity

-      Adductor head: linea aspera of femur

-      Hamstring head: medial supracondylar ridge, adductor tubercule of femur

Action: adduction of thigh

-      Adductor head: flexion of thigh

-      Hamstring head: extension of thigh

Innervation:

-      Adductor head: obturator nerve (L2, L3, L4)

-      Hamstring head: tibial portion of sciatic nerve (L4)

Blood Supply:

-      Adductor canal

 

Gracilis

Origin: body and inferior ramus of pubis

Insertion: superior portion of medial aspect of tibia

Action: adduction of thigh, flexion and medial rotation of leg

Innervation: obturator nerve (L2, L3)

Blood Supply:

-      Mos

 

Muscles of the Thigh

 

Posterior Compartment

Origin: ischial tuberosity

Action: extension of thigh, flexion and medial rotation of leg

Innervation: sciatic nerve (L5, S1, S2)

Blood Supply:

-      Mos

 

Semimembranosus

Origin: ischial tuberosity

Insertion: medial surface of superior aspect of tibia

Action: extension of thigh, flexion and medial rotation of leg

Innervation: tibial division of sciatic nerve (L5, S1, S2)

Blood Supply:

Acupoints:

-      Mos

 

Semitendonous

Origin: ischial tuberosity

Insertion: posterior part of medial condyle of tibia

Action: extension of thigh, flexion and medial rotation of leg

Innervation: tibial division of sciatic nerve (L5, S1, S2)

Blood Supply:

Acupoints:

-      Mos

 

Biceps Femoris

-      Divided into two heads:

o        Long head

o        Short head

Origin:

-      Long Head: ischial tuberosity

-      Short Head: lateral lip of linea aspera and lateral supracondylar ridge

Insertion: lateral side of head of fibula

Action: flexion and lateral rotation of thigh

-      Long Head: extension of thigh

Innervation:

-      Long Head: tibial division of sciatic nerve (L5, S1, S2)

-      Short Head: common peroneal nerve of sciatic nerve (L5, S1, S2)

Blood Supply:

Acupoints:

-      Tendon at insertion on fibula is split by fibular collateral ligament

 

Muscles of the Leg

 

Anterior Compartment

 

Tibialis Anterior

Origin: lateral condyle and superior half of lateral aspect of tibia

Insertion: medial and inferior aspects of medial cuneiform, base 1st metatarsal

Action: dorsifelxion of ankle, inversion of foot

Innervation: deep fibular nerve (L4, L5)

Blood Supply:

Acupoints:

 

Extensor Hallucis Longus

Origin: middle portion of anterior surface of fibula and interosseous membrane

Insertion: dorsal aspect of base of 1st distal phallanx

Action: extension of 1st toe, dorsiflexion of ankle

Innervation: deep fibular nerve (L5, S1)

Blood Supply:

Acupoints:

 

Entensor Digitorum Longus

Origin: lateral condyle of tibia, superior three quarters of anterior aspect of fibula and interosseous membrane

Insertion: middle and distal phalanges of 2nd to 5th toes

Action: extension of 2nd to 5th toes, dorsiflexion of ankle

Innervation: deep fibular nerve (L5, S1)

Blood Supply:

Acupoints:

 

Fibularis Tertius (Peroneus Tertius)

Origin: inferior third of anterior aspect of fibula and interosseous membrane

Insertion: dorsal aspect of 5th metatarsal

Action: dorsiflexion of ankle, eversion of foot

Innervation: deep fibular nerve (L5, S1)

Blood Supply:

Acupoints:

 

Muscles of the Leg

 

Lateral Compartment

 

Peroneus Longus

Origin: head and superior two thirds of lateral aspect of fibula

Insertion: base of 1st metatarsal and medial cuneiform

Action: eversion of foot, weak plantarflexion of ankle

Innervation: superficial fibular nerve (L5, S1, S2)

Blood Supply:

Acupoints:

 

Peroneus Brevis

Origin: inferior two thirds of lateral aspect of fibula

Insertion: dorsal aspect of tuberosity of 5th metatarsal

Action: eversion of foot, weak plantarflexion of ankle

Innervation: superficial fibular nerve (L5, S1, S2)

Blood Supply:

Acupoints:

 

Muscles of the Leg

 

Posterior Compartment

 

Gastrocnemius

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Soleus

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Plantaris

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Popliteus

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Flexor Digitorum Longus

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Flexor Hallicus Longus

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Tibialis Posterior

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Muscles of the Foot (Intrinsic)

 

Plantar

 

Flexor Digitorum Brevis

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Quadratus Plantae

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Muscles of the Foot (Intrinsic)

 

Dorsal

 

Extensor Digitorum Brevis

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Muscles of the Foot (Intrinsic)

 

Hallucis Muscles

 

Flexor Hallucis Brevis

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Abductor Hallucis

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Adductor Hallucis

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Muscles of the Foot (Intrinsic)

 

Digiti Minimi Muscles

 

Flexor Digiti Minimi

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Abductor Digiti Minimi

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Muscles of the Foot (Intrinsic)

 

Short Muscles of the Foot

 

Lumbricals

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Plantar Interossei

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

Dorsal Interossei

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Acupoints:

 

 

 

 

Fascia of the Lower Limb

<Lower Limb Anatomy>

 

 

 

 

 

 

Bursae of the Lower Limb

<Lower Limb Anatomy>

 

 

Bursae – Knee

 

The knee joint has 8 bursae as most of the surrounding tendons run parallel to the bones and pull across the joint. Four of these bursae communicate with the synovial cavity of the knee:

(1)    Suprapatellar bursa

(2)    Popliteus bursa

(3)    Gastrocnemius bursa

(4)    Semimembranosus bursa (potentially)

Whilst the remaining bursa are independent of the synovial cavity

(5)    Anserine bursa

(6)    Subcuteneous prepatellar bursa

(7)    Subcuteneous infrapatellar bursa

(8)    Deep infrapatellar bursa

 

Suprapatellar Bursa (Quadriceps Bursa)

Extension of the synovial cavity passing superiorly between the femur and the tendon of the quadriceps femoris muscle. Extends several centimeters superior to the base of the patella. Held in position by a component of the vastus intermedius muscle (articularis genus muscle).

 

Popliteus Bursa

Extension of lateral part of the synovial cavity inferior to the lateral menicus lying between the tendon of the popliteus muscle and the lateral condyle of the tibia. Occassionally continuous with the synovial cavity of the proximal tibiofibular joint as a result of perofration of the partition between the popliteus bursa and its joint cavity.

 

Anserine Bursa

Consists of several diverticula and lies between the tendons of the sartorius muscle, gracilis muscle and semitendonsus muscle at the pes anserinus from the proximal part of the medial surface of the tibia and from the tibial collateral ligament.

 

Gastrocnemius Bursa

Extension of the synovial cavity lies deep to the proximal attachment of the tendon of the medial head of the gastrocnemius muscle.

 

Semimembranosus Bursa

Lies between the medial head of the gastrocnemius muscle and the distal attachment of the semimembranosus muscle. It is frequently a prolongation of the gastrocnemius bursa and may therefore be in communication with the synovial cavity.

 

Subcutaneous Prepatellar Bursa

Lies between the skin and the anterior surface of the patella.

 

Subcutaneous Infrapatellar Bursa

Lies between the skin and the tibial tuberosity.

 

Deep Infrapatellar Bursa

Lies between the patellar ligament and the anterior surface of the tibia superior to the tibial tuberosity. Separated from the knee joint by the infrapatellar fat pad.

 

 

 

Trigger Points of the Lower Limb

<Lower Limb Anatomy>

 

 

 

 

Arterial Supply of the Lower Limb

<Lower Limb Anatomy>

 

 

Common Iliac artery

-  is the bifurcation of the abdominal aorta at the level of the body of L4

-  Bifurcates within the pelvis to form the internal iliac artery and external iliac artery

-  Internal Iliac artery

o     Superior Gluteal artery

     Passes through greater sciatic foramen superior to piriformis muscle

o     Inferior Gluteal artery

     Passes through greater sciatic foramen inferior to piriformis muscle

o     Obturator artery

     Continuation of the internal iIiac artery through the obturator foramen of the innominate

-  External Illiac artery

o     Femoral artery

     Deep to the inguinal ligament

     Lateral to femoral nerve medial to femoral vein within the femoral triangle

     Profunda Femoris artery

      Major branch of the femoral artery in the thigh

      Supplies most of the muscles of the thigh:

o      

      Gives rise to:

o     Lateral Femoral Circumflex artery

     Surrounds the femur to communicate with the medial femoral circumflex artery

     Supplies the femur

o     Medial Femoral Circumflex artery

     Surrounds the femur to communicate with the lateral femoral circumflex artery

     Supplies the femur

o     Continues down the thigh deep to sartorius muscle in the subsartorial canal and passes posteriorly through the adductor canal (adductor magnus muscle) to the popliteal fossa as the

     Popliteal artery in the centre of the popliteal fossa deep to the popliteal vein and then passes inferiorly superior to the popliteus muscle before it bifurcates

      Anterior Tibial artery penetrates the interosseos membrane (tibia and fibula) and runs inferiorly until it crosses the dorsal surface of the foot as the

o     Dorsalis Pedis artery which passes deep to flexor digitorum longus muscle and flexor digitorum brevis muscle and forms the

                                                                                   Arcuate artery which traverses laterally across the dorsal aspect of the foot

     Dorsal Metatarsal arteries

     Dorsal Digital arteries

o     The Dorsalis Pedis artery then passes inferiorly to the plantar aspect of the foot between the metatarsals of the 1st and 2nd digits (toes) to join the plantar arch

      Posterior Tibial artery is the posterior continuation of the femoral artery and continues down the posterior aspect of the lower leg giving off the

o        Peroneal artery

      The posterior tibial artery then forms the

o     Medial Plantar artery

  joins the lateral plantar artery to form the Plantar Arch

o     Lateral Plantar artery

  joins the medial plantar artery to form the Plantar Arch

 

 

 

Venous Drainage of the Lower Limb

<Lower Limb Anatomy>

 

Brachial vein

Cephalic vein

Median Cubital vein

Right Brachiocephalic vein

n      Supreme Intercostal vein

Left Brachiocephalic vein

 

Subclavian vein is accompanied anteriorly by the subclavian artery as they pass between the anterior scalene muslce and middle scalene muscle superior to the clavicle

 

 

Lymphatic Drainage of the Lower Limb

<Lower Limb Anatomy>

 

 

 

 

Innervation of the Lower Limb

<Lower Limb Anatomy>

                                                 

 

Saccral Plexus

lumbosacral trunk, sciatic nerve (tibial nerve [sural nerve], common peroneal nerve [sural nerve, deep peroneal nerve, superficial peroneal nerve]), superior gluteal nerve, inferior gluteal nerve, posterior femoral cutaneous nerve, pudendal

 

n       Lumbar PlexusFormed within the paoas major muscle from ventral rami of L1 to L4 (L1, L2, L3, L4). Occassionally contributed to by the subcostal nerve (T12). All lumbar ventral rami receive gray rami communicantes (sympathetic). L1 and L2 contribute white rami communicantes (sympathetic)

n      Obturator Nerve (L2, L3, L4) descends through psoas major muscle and departs from its medial border at the edge of the pelvis, pierces the psoas fascia, crosses the sacroiliac joint, passes lateral to the internal iliac artery, internal iliac vein, ureter and then enters the pelvis minor. Exits the pelvis through the obturator foramen (ischium and pubis) and enters the thigh it supples the adductor muscles of the thigh: adductor longus muscle, adductor brevis muscle, adductor part of adductor magnus muscle, gracilis muscle, obturator externus muscle)

n      Femoral nerve

n      Saphenous Nerve descends through the femoral triangle lateral to the femoral sheath, accompanies the femoral artery in the adductor canal and passes superficial as it passes between sartorius muscle and gracilis muscle, passes anterioinferiorly to supply the skin and fascia of the medial aspects of the knee, leg and foot

 

Passes posteriolaterally through pelvis to the midpoint of the inguinal ligament, lies lateral to the femoral artery as it passes through the femoral triangle. Supplies anterior thigh muscles. Supplies articular branches to hip and knee. Supplies anteromedial side of lower limb

 

femoral nerve (anterior femoral cutaneous nerve, saphenous nerve), obturator nerve, lateral femoral cutaneous nerve, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve

 

inferior gluteal nerve (L5, S1, S2)

supplies gluteus maximus from deep surface

exits pelvis through greater sciatic foramen between piriformis muscle and sacrospinous ligament accompanied by inferior gluteal artery and inferior gluteal vein

passess between gluteus medius muscle and gluteus maximus muscle

 

 

Common Peroneal Nerve

-  Branch of sciatic nerve

-  Passes anteriorly inferior to head of fibula

-  Lateral Cutaneous Nerve of Calf

-  Superficial Peroneal Nerve

-  Deep Peroneal Nerve

 

 

 

 

Regional Anatomy of the Lower Limb

<Lower Limb Anatomy>

 

 

Lesser Sciatic Foramen

-      Posterior aspect of pelvis between the inferior aspect of the sacrum and ischium of innominate

-      Formed by the lesser sciatic notch of the ischium, sacrotuberous ligament and sacrospinous ligament

-      Contents

o        Obturator internus muscle

o        Pudendal nerve

-      Passageway for structures from/to the perineum

 

Obturator (L. closed) Canal

-      Located

-      Passes anteriosuperiorly across obturator membrane

-      Transmits

o        Obturator nerve

o        Obturator artery

o        Obturator vein

-      Obturator membrane

 

Greater Sciatic Foramen

-      Formed by the greater sciatic notch of the ilium, sacrotuberous ligament and sacrospinous ligament

-      Lies superior and is larger than the lesser sciatic foramen

-      Contents: piriformis muscle, internal pudendal artery, inferior gluteal artery, superior gluteal artery, sciatic nerve

-      Passageway for structures from/to the pelvis

 

Inguinal Ligament

-      Passes from ASIS of ilium to pubic crest of pubis

-      Formed from the aponeurosis of the three flat muscles of the anterior abdominal wall:

o        External oblique muscle

o        Internal oblique muscle

o        Transverse abdominis muscle

-      Inguinal Canal

 

Inguinal Canal

Formed from the aponeurosis of the three flat muscles of the anterior abdominal wall (external oblique muscle, internal oblique muscle and transverse abdominis muscle). Allows passage of:

-        spermatic cord (male)

-        round ligament (female)

-        ilioinguinal nerve

-        genital branch of genitofemoral nerve

deep inguinal ring, superficial inguinal ring

 

 

Inguinal Triangle (Hesselbachs Triangle)

Borders

-        semilunaris of rectus sheath (rectus abdominus muscle)

-        Inferior epigastric artery

-        Inguinal ligament

Common site for direct inguinal hernias

 

Femoral Triangle

Contains many important structures: the femoral nerve, saphenous nerve, femoral artery, femoral vein, femoral lymph nodes and inguinal lymph nodes

Roof: cribriform fascia

Floor: illiacus muscle, pectineus muscle, adductor longus muscle

Medial Wall: adductor longus muscle

Lateral Wall: sartorius muscle

Superior Wall: inguinal ligament

Inferior Wall (apex): junction of medial borders of sartorius muscle and adductor longus muscle

 

Femoral Sheath

Encloses the proximal parts of the femoral vessels (femoral artery and femoral vein) inferior to the inguinal ligament. Composed of the transversalis fascia anteriorly and the iliac fascia posteriorly. Ends about 4cm (in adult) distal to the inguinal ligament and is continuous with the adventitia of the femoral vessels (femoral artery and femoral vein). Medial wall is pierced by the great saphenous vein and lymphatic vessels. The sheath allows the femoral vessels (femoral artery and femoral vein) to glide in and out deep to the inguinal ligament.

Contains 3 compartments:

(1)    Lateral Compartment which contains the femoral artery

(2)    Intermediate Compartment which contains the femoral vein

(3)    Medial Compartment which is also called the femoral canal

 

Femoral Canal

The medial compartment of the femoral sheath. Lies between the medial edge of the femoral sheath and the femoral vein. Allows expansion of the femoral vein during increased venous return. Conical shape with proximal end its widest portion called the femoral ring and the distal end at the proximal part of the saphenous opening.

Contains:

-      Lymph vessels

-      Deep inguinal lymph nodes

-      Loose connective tissue

-      Adipose tissue

 

Femoral Ring

Superior opening of femoral canal. Closed by extraperitoneal adipose tissue called the femoral septum which is pierced by lymph vessels.

Lateral Border: partition between the femoral ring and the femoral vein

Medial Border: lacunar ligament and lacunar tendon

Anterior Border: inguinal ligament

Posterior Border: superior ramus of pubis and pectineus muscle

 

Popliteal Fossa

 

Pelvis (L. basin)

-        2 innominates and sacrum

-        Forms a complete circle of bone

 

Pelvic Inlet

Posterior Wall: sacral prominatory and ala of saccrum

Lateral Wall: ilac crest, ASIS, AIIS, pubic crest

Antererior Wall: pubic symphysis

 

True Pelvis or Greater Pelvis

Cavity inferior to Pelvic Inlet

 

False Pelvis or Lesser Pelvis

Cavity supeiro to Pelvic Inlet

 

Pelvic Girdle

2 innominates

 

Adductor Canal (Subsartorial Canal, Hunters Canal)

-      Narrow fascial tunnel

-      Approximately 15cm long in an average adult

-      Lies deep to middle third of sartorius muscle where it crosses superficial to adductor magnus muscle

-      Intermuscular passage for femoral vessles (femoral vein, femoral artery) to reach poplital fossa

-      Terminates inferiorly at the adductor hiatus in the tendon between the adductor and hamstring heads of adductor magnus muscle

-      Lateral border: vastus medialis muscle

-      Postereomedial border: adductor longus muscle, adductor magnus muscle

-      Anterior border: sartorius muscle

-      Ceiling: sartorius muscle, subsartorial fascia

-      Contents:

o        Femoral artery anterior to femoral vein

o        Femoral vein posterior to femoral artery

o        Saphenous nerve lateral to femoral artery superiorly

o        Nerve to vastus medialis (branch of femoral nerve)

 

Pes Anserine Tendons