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LOWER LIMB
GLUTEAL REGION
Iliotibial TRACT originates from medial side(iliac crest) and inserts in lateral condyle of tibia. 2 muscles give insertion in iliotibial tract,GLUTEUS MAX and TENSOR FASCIA LATA.(medial to lateral) Cutaneous nerve supply to gluteal region: Upper lateral:L1,T12(iliohypogastric,thoracic) Upper medial:L1,L2,L3,S1,S2,S3 Lower lateral:L2,L3(lat cut and of thigh) Lower medial:S1,S2,S3(pos cut and of thigh) Muscles in this region abducts extends and laterally rotates the femur relative to pelvic bone. Superficial group:tensor fascia lata(stabilize the knee joint),gluteus max,med.min FUNCTION as abductor and extends hip. Deep group:piriformis,obturator internus,gamellus superior,inferior,quadratus femoris FUNCTION as lateral rotator of femur at hip joint. Gamellus SUPERIOR is innervated by OBTURATOR INTERNUS and gamellus inferior is innervated by Nerve. to QUADRATUS FEMORIS. QUADRATUS FEMORIS is the most inferior muscle of the deep group muscles of the region. GLUTEUS MED+MIN abducts the lower limb at hip joint and reduces the pelvic drop over the opposite swing limb during walking by securing the position of pelvis on the stance limb.
7 nerves enter the gluteal region from pelvis through greater sciatic foramen and 1 directly from sacrotuberous ligament(perforating cut. N) Sup gluteal N=> gluteus max+min+tensor fascia lata (only this 1 passes from above the piriformis) Inf gluteal N=> GLUTEUS MAX SCIATIC Nerve.=> to all muscles of post compartment which flexes knee and all muscles that work on foot and ankle joint.
THIGH
Anterior Is separated from the abdomen by INGUINAL LIGAMENT(anterior SUP iliac supine to pubic tubercle ) Anterior Compartment is known as extensors Posterior compartments is known as flexors Medial compartments is known as adductors EXTENSOR GROUP IS MORE POWERFUL THAN FLEXOR COMPARTMENT. LATERAL ROTATOR IS MORE POWERFUL THAN MEDIAL ROTATOR
There are two main places where all the lymph of lower limb drains.1st is inguinal
lymph nodes(femoral canal) 2nd is popliteal lymph nodes(in popliteal fossa). Inguinal lymph nodes are of primary importance. Inguinal lymph nodes are divided in 2 types. Superficial and deep. Superficial is in superficial fascia and joins the deep group by efferent lymph vessels by passing through saphenous opening. Superficial group is divided in 2 types.horizontal (2 medial,lateral 3),vertical(5) Horizontal receives from the perineum and level of umbilicus,but vertical group receives most drainage of LOWER LIMB. Popliteal lymph nodes are 6 in number ,they receive drainage from lateral side of LEG and FOOT,knee joint+anterior.post tibial artery.And they are accompanied by Small saphenous vein in popliteal fossa.
Gracilis is the most superficial muscle of the MED.COMPARTMENT of thigh. Insertion of pes anseri anteromedial to tibial condyle:gracilis is sandwiched b/w sartorius front and semitendinosis behind. Pectineus is below the inguinal ligament and makes the floor of med. Half of the femoral triangle. ADD.longus forms the proximal posterior wall of the add.canal and ADD.magnus forms the distal wall of add.canal and is the largest and deepest muscle in the medial compartment.
ligament)+internal iliac artery(passes from greater sciatic foramen and supplies to gluteal region) External iliac ARTERYobturator artery(in pelvic region)+femoral artery Obturator artery(medial comp of thigh)ant,post(anastomosis in hip joint) Femoral arterysmall,large Small branch of F.Asuperficial circumflex(ANTERIOR COMP OF THIGH),external pudendal (SKIN OF SCROTUM AND LABIUM MAJORA) Large branch of F.ADeep femoral (behind add.longus,b/w add.magnus and magnus,goes posterior to thigh and supply there)lateral circumflex F.A+medial circumflex F.A(CRUCIATE ANASTOMOSIS) INTERNAL iliac ARTERYsup.GLUTEAL Nerve.+inf.GLUTEAL Nerve. Arterial supply to leg Femoral artery is named as popliteal artery in POPLITEAL FOSSA. Popliteal artery(in lower border of popliteal fossa)anterior tibial+post tibial artery and also gives genicular branches to knee joint. Anterior TIBIAL ARTERY pierce the intermuscular septa and enters in the anterior compartment of leg. On passing below EXTENSOR RETINACULA it enters foot called as DORSALIS PEDIS ARTERY. DPA gives 3 branches,lateral tarsal artery+arcuate artery and 1st dorsal metatarsal artery. And joins with the lateral planter artery on 1st metatarsal and completes plantar dorsal arch. Posterior TIBIAL ARTERY passes beneath the flexor retinaculum and gives 2 branches, lateral planter artery+medial planter artery. Medial is smaller than lateral planter artery. On the level of 5th metatarsal lateral planter artery curves medially and joins the DPA and completes the planter arch.
LUMBER PLEXUS
L1ilioinguinal+iliohypogastric
L1+L2Genitofemoral L2+L3Lateral cutaneous nerve L2+L3+L4femoral(post)+obturator(ant) L4+L5+S1Superior gluteal nerve S1+S2+S3posterior cut.N.of thigh S2+S3+S4pudendal Nerve. L5+S1+S2inf. Gluteal Nerve. L4+L5+S1+S2+S3sciatic Nerve.common peroneal(L4+L5+S1+S2),tibial Nerve.(L4+L5+S1+S2+S3)
Sciatic Nerve. supplies semitendinosis+semimembranosus+bicep femoris+post part of ADD.magnus Obturator Nerve. (med to psoas muscle on lat side & enters to supplies medial compartment of thigh by add canal) ,obt.externus+adductors+magnus(anterior Part) Saphenous Nerve. passes along with F.A but does not pass from add.hiatus but passes from medial side of knee b/w sartorius and gracilis.(branch of F.N)
IMPORTANT ANASTOMOSIS
Cruciate ANASTOMOSIS,in hip joint at the level of LESSER TROCHANTER of FEMUR.it si in b/w: inf gluteal artery+med femoral circumflex+lat femoral circumflex+1st perforating artery(branch of profunda which is cutaneous branch of F.A) it is to make connection b/w F.A & INTERNAL iliac ARTERY Trochanteric anastomosis,main blood supply to FEMORAL HEAD,it si b/w following: sup.gluteal+inf.gluteal+lat.circumflex+med.circumflex arteries,IT IS AT THE LEVEL OF GREATER TROCHANTER. Anastomosis around knee joint is b/w the followings: 5 genicular branches of P.A+descending branch of F.A+descending branch of lateral circumflex of F.A+2 recurrent artery of A.T.A+circumflex fibular of P.T.A
IMPORTANT RELATIONS
Femoral sheath covers the femoral vessels and lymph.and itself lies in depression called FEMORAL TRIANGLE. Most medial is femoral canal(lymph sac),It is covered by femoral ring,femoral septum closes the ring. Lateral to it is FEMORAL VEIN.(intermediate comp) Lateral to F.V is FEMORAL ARTERY(lateral comp) MOST LATERAL of FEMORAL TRIANGLE not the femoral sheath is FEMORAL Nerve. Popliteus is important muscle of UNLOCKING but not the LOCKING of knee joint. Popliteus muscle gives origin on medial condyle of tibia and insertion on lateral condyle of femur.
Pulsation of P.A can be felt when knee is flexed.(and that of posterior tibial in normal posture and that of DPA in little dorsiflexed) TIBIAL CONDYLES=TIBIAL PLATES Condyles of tibia are convex shape menisci provides it convexity. Medial menisci is lunate shape and lat.menisci is fully rounded. Thickened knee joint capsule on posterior Side prevents HYPEREXTENSION of knee joint Plantaris is a vestigial muscle. Flexor accessories=quadratus plantae (in foot) Fibrous septum&deep fascia separates the leg in compartments there are 3 fibrous septum: Transverse intermuscular septum=beneath soleus Posterior crural septa=in front of soleus Anterior crural septa Hamstring muscles= semitendinosis+semimembranosus+ bicep femoris (&part of add.magnus),they are POWERFUL flexors of leg+extensors of hip. Graciles and sartorius are weak flexor of leg. Popliteus is a minor flexors cause medial rotation of tibia (unlocking) Dorsiflexors=tibialis anterior+long extensors of foot(EDL+EHL) Planterflexors=gastrocnemius+soleus+plantaris Inversion=tibialis anterior +tibialis post Eversion= peroneus longus+peroneus brevis+peroneus tertius (foot planter-ed)LOCKING: *Extension of musclesfemur rotates medially(ligaments are taut menisci compress) (foot planter-ed)UNLOCKING: *Flexion of muscles(ligaments &menisci relaxes)tibia rotates laterally (foot off the ground)LOCKING: *Extension of musclesTibia rotates laterally(ligaments taut,menisci compress)
(foot off the ground)LOCKING: *Flexion of muscles(ligaments &menisci relaxes)femur rotates medially ANKLE JOINT: Active dorsiflexion can be of 10 degree Active Planterflexion can b of 20 degree, In passive movements thus can b doubled
Maintenance of arches depends on the following things: Shape of the bones Ligaments Muscle tone But the last one is not important as much because when you are standing for long periods your ligaments are getting affected and causing your arches to disappear Small muscles peroneus longus and tibialis anterior play no role in normal static control. Femoral Hernia: Lymph nodes lie in the most medial compartment of femoral sheath called femoral canal,the wall of femoral sheath is strictly bound to vessels of femoral sheath but not strictly bound to lymph vessels,so there presents a potential weak area,a protrusion of any anatomical structure can lead to bulging of this area all this condition is named femoral hernia, Why femoral nerve is outside the femoral sheath????? femoral sheath is formed by fascia iliaca posteriorly and fascia transversalis anteriorly, Retroinguinal space is divided into two compartments by iliopsoas fascia,,,muscular and vascular,nerve descends in muscular compartment,,as fascia transversalis doesn't extend into muscular part of retroinguinal space and so femoral nerve is not inside femoral sheath.. it lies behind the fascia iliaca Gateways to gluteal regions: Lesser sciatic foramen: It is for reentry of structures left from greater sciatic foramen and exit fo structure of perineum IN PTI I:INTERNAL PUDENDAL ARTERY N:NERVE TO OBTURATOR INTERNUS P:PUDENDAL NERVE T:TENDON TO OBTURATOR INTERNUS MUSCLE I:INTERNAL PUDENDAL VEIN Gateways to gluteal regions: Greater sciatic foramina which is further separated by piriformis in upper and lower part... Structures passing from greater sciatic foramen: PSP IN SSP G P:PIRIFORMIS S:SCIATIC NERVE P:POST CUTANEOUS NERVE OF THIGH
I:INTERNAL PUDENDAL ARTERY and VEIN N:NERVE TO OBTURATOR and QUADRATUS FEMORIS S:SUP and INF GLUTEAL NERVES S:SUP and INF GLUTEAL ARTERIES and VEINS P:PUDENDAL NERVES G:GAMELLUS Remember the significance of piriformis and dividing this foramen in upper and lower is just to Separate sup and infer gluteal nerves and vessels 2ND HEART OF THE BODY IS IN LEG ,VENOUS PLEXUS IN SOLEUS Gastrocnemius helps you to win long jumps but soleus is slow in action Eversion and inversion is at midtarsal & transverse tarsal joint (talocalcaneonavicular & calcaneocuboid) but not at ankle joint.
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